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Abd El Latif E, Abdelhalim AS, Montasser AS, Said MH, Shikhoun Ahmed M, Abdel Kader Fouly Galal M, Ibrahim W, Samy Abd Elaziz M, Fathi Abuelkheir A, Elbarbary H, Elsayed AMA, Lotfy A, Elmorsy OA, Gab-Alla AA, Hatata RM, Abousamra AAH, Farouk MM, Elbakary MA, Awara AM, Amer I, Elzawahry WMAE, Kandil HW, Barrada OA, Bakr Elessawy K, Zayed MA, El Hennawi H, Tawfik MA. Pattern of Intermediate Uveitis in an Egyptian Cohort. Ocul Immunol Inflamm 2019; 28:524-531. [PMID: 31642742 DOI: 10.1080/09273948.2019.1668429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the clinical experience with intermediate uveitis at six Egyptian tertiary eye centers.Methods: A multicenter retrospective chart review of all patients with intermediate uveitis seen at six ocular inflammation referral clinics in Egypt between January 2010 and January 2017.Results: The study included a total of 781 patients with intermediate uveitis. The study cohort comprised of 282 male and 499 female patients. In over half of our cohort (58.77%), no specific cause could be confirmed. The remaining patients had sarcoidosis (16.26%), tuberculosis (14.85%), multiple sclerosis (9.09%), and TINU (1.02%). By the end of our study, 62% of the affected eyes had a BCVA better than 20/40Conclusion: More than 40% of our patients with intermediate uveitis had sarcoidosis, tuberculosis, multiple sclerosis, or TINU as the underlying etiology. Owing to their potential morbidity, these diseases need to be considered in Egyptian patients presenting with intermediate uveitis.
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Affiliation(s)
- Eiman Abd El Latif
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Mohamed Hassan Said
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Walid Ibrahim
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Amr Fathi Abuelkheir
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hossameldeen Elbarbary
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Ayman Lotfy
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Osama A Elmorsy
- Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amr A Gab-Alla
- Department of Ophthalmology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ragai Magdy Hatata
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | | | - Molham A Elbakary
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Mahmoud Awara
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ibrahim Amer
- Department of Ophthalmology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | | | - Hazem W Kandil
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar A Barrada
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Kareem Bakr Elessawy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Zayed
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hazem El Hennawi
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Tawfik
- Department of Ophthalmology, Memorial Institute for Ophthalmic Research, Cairo, Egypt
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Stavrou P, Baltatzis S, Letko E, Samson CM, Christen W, Foster CS. Pars plana vitrectomy in patients with intermediate uveitis. Ocul Immunol Inflamm 2001; 9:141-51. [PMID: 11815883 DOI: 10.1076/ocii.9.3.141.3965] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the effect of pars plana vitrectomy in patients with intermediate uveitis. METHODS Retrospective analysis of the clinical course and visual outcome following pars plana vitrectomy in patients with intermediate uveitis. RESULTS Thirty-two patients (43 eyes) were included in the study. Pars plana vitrectomy was combined with cataract surgery in 22 of 43 eyes. The intermediate uveitis was associated with sarcoidosis in 16 eyes and multiple sclerosis in five eyes, and was idiopathic in 22 eyes. The mean (+/-SD) follow-up was 45.6 (+/-38) months (range: 6-146 months). In 19 of 43 eyes (44.1%), there was improvement in the course of uveitis, allowing the discontinuation of immunosuppressive treatment in seven patients. Cystoid macular edema resolved in 12 of 37 eyes (32.4%). Forty of 43 eyes achieved a better or retained their initial visual acuity. The remaining three eyes deteriorated by two or more lines in the Snellen chart due to the progression of cataract, chronic cystoid macular edema, and glaucomatous optic atrophy, respectively. CONCLUSIONS The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the course of uveitis and the associated complications of cystoid macular edema, thereby reducing the need for long-term immunosuppression. Pars plana vitrectomy combined with simultaneous cataract surgery can improve the visual outcome in these patients.
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Affiliation(s)
- P Stavrou
- Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Martin T, Weber M, Schmitt C, Weber JC, Tongio MM, Flament J, Sahel J, Pasquali JL. Association of intermediate uveitis with HLA-A28: definition of a new systemic syndrome? Graefes Arch Clin Exp Ophthalmol 1995; 233:269-74. [PMID: 7622075 DOI: 10.1007/bf00177648] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Endogenous posterior uveitis (PU) can be associated with systemic diseases, and certain forms have strong association with HLA antigens. Much less is known regarding intermediate uveitis (IU). The purpose of this study was to determine whether IU is associated with the HLA system and whether it can be associated with systemic symptoms. METHODS In 179 consecutive patients consulting for uveitis, a detailed history was obtained and a physical examination performed. HLA typing for 71 HLA-A, B, DR and DQ antigens, laboratory tests, and radiography of the chest, sinuses, and sacroiliac joints were systematically performed. RESULTS Thirty-two patients (18%) had IU; 51 (28.5%) had PU and constituted our internal control group. Nine of the patients with IU (28%) had the HLA-A28 antigen, compared with 8.1% of a healthy control population and 8.6% of the patients with PU (P < 0.001). An associated disease was found in four patients with IU (12.5%) (none was HLA-A28) and in 45% of the patients with PU (P < 0.01). Some 67% of HLA-A28 patients with IU had arthralgias affecting the knee(s), compared with 17% of non-HLA-A28 patients and 18% of patients with PU (P < 0.05 and P < 0.01 respectively); 55% had gonalgias and hypocomplementemia compared with 9% and 2% respectively (P < 0.01 and P < 0.001). CONCLUSIONS IU is significantly associated with HLA-A28; patients having this antigen may represent a subset of the disease characterized by an increased prevalence of arthralgias and hypocomplementemia.
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Affiliation(s)
- T Martin
- Unité d'Immunologie Clinique, Hôpital Civil Hôpitaux, Universitaries, Strasbourg, France
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Ortega-Larrocea G, Arellanes-Garcia L. Pars planitis: epidemiology and clinical outcome in a large community hospital in Mexico City. Int Ophthalmol 1995; 19:117-20. [PMID: 8586494 DOI: 10.1007/bf00133182] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Medical records of 51 patients with a diagnosis of pars planitis (97 eyes) were reviewed. Based upon the severity of vitreous inflammation, in 34 eyes (35%) the condition was classified as mild, in 38 (39%) as moderate, and in 25 eyes (26%) as severe. Vascular sheathing was present in 51 eyes (53%), snowballs in 42 (43%), snowbanks in 29 (30%), cataract in 19 (20%), cystoid macular edema in 26 (27%), retinal detachment in 4 (4%) and glaucoma in 3 (3%) eyes. Treatment consisted of prednisone and periocular injections of deposteroids or immunosuppressive agents; 13 patients required surgery for retinal repair, glaucoma, vitreous opacities or cataract. After treatment the visual acuity improved in 58% of the eyes, did not change in 33%, and worsened in 9%.
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Affiliation(s)
- G Ortega-Larrocea
- Department of Uveitis, Asociación para evitar la ceguera en México, Luis Sanchez Bulnes Hospital, Mexico City, Mexico
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Abstract
PURPOSE The authors analyzed the incidence of cataract development and the visual outcome of cataract surgery performed on patients with sarcoidosis-associated uveitis who were treated at the Immunology Service at the Massachusetts Eye and Ear Infirmary during a 17-year period. METHODS The records of 102 patients with sarcoidosis-associated uveitis who were treated with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, or with systemic immunosuppressive chemotherapy were reviewed. Cataract surgery was performed on those eyes in which cataract developed, resulting in decreased visual acuity of 20/100 or less. The incidence of cataract development and visual results of cataract extraction and intraocular lens implantation were analyzed. RESULTS In this cohort of 102 patients, visually significant cataracts that warranted surgery developed in 10 (16 eyes). In addition, four patients (5 eyes) had a visually significant cataract at the time of first evaluation. A total of 14 patients (21 eyes) underwent cataract surgery. Posterior chamber lens implantation accompanied cataract surgery in 19 (90.5%) of 21 eyes. The average final visual acuity of the 21 eyes after cataract surgery was 20/51, and 61% of the eyes achieved a stable visual acuity of 20/40 or better. The major causes of the decreased visual acuity in patients who had less than 20/40 visual acuity were sequelae of chronic posterior uveitis, cystoid macular edema, epiretinal membrane, and glaucomatous optic nerve damage. CONCLUSION Posterior chamber lens implantation and cataract surgery in patients with sarcoidosis-associated uveitis can be well tolerated when absolute control of the inflammation is achieved. Pre-existing retinal pathology and glaucoma as a result of uncontrolled inflammation resulting in permanent ocular structural damage were found to be the most important factors for determining the postoperative final visual acuity.
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Affiliation(s)
- Y A Akova
- Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston 02114
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