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Wang J, Fan W, Liu B, Pu N, Wu H, Xue R, Li S, Song Z, Tao Y. Encapsulated cell technology: Delivering cytokines to treat posterior ocular diseases. Pharmacol Res 2024; 203:107159. [PMID: 38554790 DOI: 10.1016/j.phrs.2024.107159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Encapsulated cell technology (ECT) is a targeted delivery method that uses the genetically engineered cells in semipermeable polymer capsules to deliver cytokines. Thus far, ECT has been extensively utilized in pharmacologic research, and shows enormous potentials in the treatment of posterior segment diseases. Due to the biological barriers within the eyeball, it is difficult to attain effective therapeutic concentration in the posterior segment through topical administration of drug molecules. Encouragingly, therapeutic cytokines provided by ECT can cross these biological barriers and achieve sustained release at the desired location. The encapsulation system uses permeable materials that allow growth factors and cytokines to diffuse efficiently into retinal tissue. Moreover, the ECT based treatment can be terminated timely when we need to retrieve the implant, which makes the therapy reversible and provides a safer alternative for intraocular gene therapy. Meanwhile, we also place special emphasis on optimizing encapsulation materials and enhancing preservation techniques to achieve the stable release of growth factors and cytokines in the eyeball. This technology holds great promise for the treatment of patients with dry AMD, RP, glaucoma and MacTel. These findings would enrich our understandings of ECT and promote its future applications in treatment of degenerative retinopathy. This review comprises articles evaluating the exactness of artificial intelligence-based formulas published from 2000 to March 2024. The papers were identified by a literature search of various databases (PubMed/MEDLINE, Google Scholar, Cochrane Library and Web of Science).
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Affiliation(s)
- Jiale Wang
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Wenhui Fan
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Bo Liu
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Ning Pu
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Hao Wu
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Rongyue Xue
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Siyu Li
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Zongming Song
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; Eye Research institute, Henan Academy of Medical Sciences, China.
| | - Ye Tao
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China; Eye Research institute, Henan Academy of Medical Sciences, China.
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Ambiya V, Shankar S, Kumar A, Srujana D. Toxoplasma Retinochoroiditis Following Intravitreal Dexamethasone Implant Injection for Diabetic Macular Edema: A Rare Complication. Ocul Immunol Inflamm 2023:1-3. [PMID: 37071819 DOI: 10.1080/09273948.2023.2195933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE To report a case of ocular toxoplasmosis as a rare complication of intravitreal dexamethasone implant in a case of diabetic macular edema. METHODS A 56 years old male, a known case of Proliferative Diabetic Retinopathy, received intravitreal dexamethasone implant for diabetic macular edema in left eye. He developed toxoplasma retinochoroiditis involving the macula with further diminution of vision in his left eye 3 weeks after the injection. His serum titres were positive for Toxoplasma IgG (161 IU/ml). He was treated with oral Sulfamethoxazole 800 mg + Trimethoprim 160 mg 12 hourly for 4 weeks. RESULTS The visual acuity in left eye improved with resolution of retinochoroiditis after the course of antibiotic therapy. CONCLUSION It is imperative to follow-up closely after intravitreal steroid implantation, to look for the possible rare complication of infectious retinitis/retinochoroiditis, as timely antimicrobial treatment can lead to a good visual outcome.
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Affiliation(s)
- Vikas Ambiya
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Sandeep Shankar
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Ashok Kumar
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Dubbaka Srujana
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
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Helal RS, Abu Sbeit R, Al-Baker ZM. Unusual pattern of herpetic optic neuropathy: a case report and literature review of the pathophysiology of herpetic uveitis. J Ophthalmic Inflamm Infect 2023; 13:12. [PMID: 36943518 PMCID: PMC10030693 DOI: 10.1186/s12348-023-00335-4] [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: 10/10/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
Herpetic uveitis is a relatively common type of intraocular inflammation with a broad spectrum of manifestations ranging from mild anterior uveitis to rapidly progressing vision threatening necrotizing retinitis. Posterior herpetic uveitis presents with different clinical patterns within a spectrum depending presumably on the immune status of the patient. Systemic steroid use for viral uveitis without prior antiviral coverage is inappropriate and can lead to dramatic sequelae. Here, we report an unusual case of herpetic optic neuropathy in the contra lateral eye of a patient with acute retinal necrosis after improper use of oral steroids.
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Affiliation(s)
| | - Rami Abu Sbeit
- Ophthalmology Department, Hamad Medical Corporation, Doha, Qatar
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Aksu-Ceylan N, Cebeci Z, Altinkurt E, Kir N, Oray M, Tugal-Tutkun I. Interferon Alpha-2a for the Treatment of Cystoid Macular Edema Secondary to Acute Retinal Necrosis. Ocul Immunol Inflamm 2022; 30:1788-1797. [PMID: 34348058 DOI: 10.1080/09273948.2021.1957121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To report the results of interferon (IFN) α-2a treatment in patients with cystoid macular edema (CME) secondary to acute retinal necrosis (ARN). METHODS We reviewed the records of seven patients (eight eyes) who received IFNα-2a for post-ARN CME. The initial dose of IFNα-2a was 3 MIU/day and it could be tapered down to 3 MIU twice a week. Efficacy was assessed by central macular thickness (CMT) on spectral-domain optical coherence tomography and visual acuity. RESULTS Age range of seven patients (four men, three women) was 36-74 years. Mean CMT decreased from 477.9 ± 167.5 μm to 367.3 ± 120.5 μm at first week, and vision improved up to five lines in five eyes. CME relapsed after cessation of IFNα-2a in all and improved following reinstitution of treatment. Treatment was discontinued in one patient because of depression. Three patients electively discontinued treatment due to poor tolerability or lack of functional improvement. CONCLUSION IFNα-2a is an effective therapeutic option for post-ARN CME, though side effects such as fatigue, elevated liver enzymes, neutropenia, and depression may limit tolerability. Lower initial doses may be a better tolerated.
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Affiliation(s)
- Nihan Aksu-Ceylan
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Zafer Cebeci
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Emre Altinkurt
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Nur Kir
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Merih Oray
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
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Cunningham ET, Moorthy RS, Witkin AJ, Zierhut M. Occlusive Retinal Vasculitis Following Intravitreal Drug Delivery. Ocul Immunol Inflamm 2022; 30:1501-1504. [PMID: 33847216 DOI: 10.1080/09273948.2021.1882243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Indianapolis, Indiana, USA
- The Department of Ophthalmology, Indiana University Medical Center, Indianapolis, Indiana, USA
- St. Vincent Hospital and Health Services, Indianapolis, Indiana, USA
| | - Andre J Witkin
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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Cai Y, Yang Y, Zhong X. A Case Report of Intravitreal Dexamethasone Implant with Exudative Retinal Detachment for Ocular Toxocariasis Treatment. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:133-137. [PMID: 35500895 PMCID: PMC9058278 DOI: 10.3347/kjp.2022.60.2.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022]
Abstract
Toxocariasis is one of the most common geohelminth infections in several parts of the world. We describe a rare case of ocular toxocariasis with secondary exudative retinal detachment treated with albendazole and an intravitreal dexamethasone implant. A 13-year-old boy with counting finger vision was diagnosed with retinal vasculitis and exudative retinal detachment in his right eye. Fundoscopic examination revealed retinal hemorrhage, retinal vasculitis, and exudative retinal detachment. Serological test using serum and intraocular aqueous humor were positive for anti-Toxocara specific IgG antibodies. He received repeated doses of intravitreal dexamethasone implants combined with oral albendazole. A sequential follow-up optical coherence tomography revealed that the retina was successfully reattached. His visual acuity subsequently improved to 20/400.
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Karkhur S, Soni D. Clinical spectrum, disease course and management outcome of post-fever retinitis cases: experience from a tertiary eye institute in central India. Int Ophthalmol 2022; 42:2697-2709. [PMID: 35391586 PMCID: PMC8989109 DOI: 10.1007/s10792-022-02258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
Purpose To report a series of five cases with retinitis following episodes of febrile illness, its evaluation, management and outcome. Method Retrospective, consecutive case series of five patients presenting with acute retinitis, following a febrile illness. Results The retinal lesions had a sudden onset with rapid evolution, preceded by a febrile episode within one month of presentation, in all cases. Extensive serology and PCR testing were non-contributory toward identifying the etiology and guiding therapy. Systemic corticosteroid therapy was effective in hastening the resolution of lesions. Conclusion Post-fever retinitis appears to be a distinct clinical form of acute hemorrhagic non-necrotizing retinitis without a uniformly identifiable cause, and some evidence pointing toward a para-infectious etiology secondary to flu-like illnesses. With an unusual morphological presentation and annual seasonal patterns in the endemic areas, it is important to differentiate this entity, from other forms of infectious retinitis, before initiating corticosteroid therapy.
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Affiliation(s)
- Samendra Karkhur
- Retina & Uveitis Service, Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS) Bhopal, AIIMS Road, Saket Nagar, Bhopal, Madhya Pradesh, 462 020, India.
| | - Deepak Soni
- Retina & Uveitis Service, Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS) Bhopal, AIIMS Road, Saket Nagar, Bhopal, Madhya Pradesh, 462 020, India
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Ng CC, McDonald HR, Johnson RN, Cunningham ET. Optic disc edema with peripapillary serous retinal detachment as the presenting sign of necrotizing herpetic retinitis. Am J Ophthalmol Case Rep 2022; 25:101423. [PMID: 35198831 PMCID: PMC8850683 DOI: 10.1016/j.ajoc.2022.101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/30/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To describe an atypical case of necrotizing herpetic retinitis (NHR) that presented initially with mild anterior uveitis, optic disc swelling, and peripapillary serous retinal detachment (SRD). Observations A 48-year-old Asian Indian man presented with blurred central vision and pain in his left eye. Examination revealed mild anterior chamber inflammation, optic disc swelling, and a peripapillary SRD in the affected eye. Multimodal imaging, including widefield fluorescein angiography, showed optic disc leakage and confirmed the presence of a peripapillary SRD, but was otherwise unremarkable with no evidence of retinitis. The patient was diagnosed with presumed Vogt-Koyanagi-Harada disease and was treated with systemic corticosteroids. While there was objective visual improvement initially, the patient subsequently noted peripheral vision loss and was found to have peripheral necrotizing retinitis and occlusive retinal vasculitis in affected eye. Polymerase chain reaction-based testing of aqueous humor detected varicella zoster virus DNA, confirming the diagnosis of NHR. Conclusion and importance Optic disc edema and peripapillary SRD may precede the development of overt retinitis in some patients with NHR.
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Affiliation(s)
- Caleb C Ng
- West Coast Retina Medical Group, San Francisco, CA, USA.,The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - H Richard McDonald
- West Coast Retina Medical Group, San Francisco, CA, USA.,The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Robert N Johnson
- West Coast Retina Medical Group, San Francisco, CA, USA.,The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Emmett T Cunningham
- West Coast Retina Medical Group, San Francisco, CA, USA.,The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.,The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
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Samanta R, Puthalath AS, Sood G, Singh R, Dogra M. Macular dual retinitis with Herpes simplex and Cytomegalovirus following periocular corticosteroid in a patient of Pemphigus Vulgaris. Eur J Ophthalmol 2021; 33:11206721211052847. [PMID: 34632829 DOI: 10.1177/11206721211052847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) retinitis may occur in non-HIV individuals following systemic immunosuppressive treatment or periocular corticosteroid administration. However, simultaneous multiple viral retinitis is rare in HIV-negative individuals. We report a case of dual viral retinitis in a non-HIV female on systemic immunosuppressive for pemphigus vulgaris who was administered a periocular corticosteroid injection. METHOD A 32-year-old female on double immunosuppressive therapy (prednisolone and cyclophosphamide) for pemphigus vulgaris, presented with gradual painless diminution of vision in the right eye for one month. She was initially diagnosed to have possible autoimmune neuroretinitis by the referring ophthalmologist and received a single injection of posterior subtenon triamcinolone acetonide for the same. Her vision however deteriorated further and she received an intravitreal ganciclovir injection with a revised diagnosis of CMV retinitis. Due to suboptimal response she was referred to us. Aqueous Polymerase chain reaction (PCR) revealed dual positivity for CMV and Herpes simplex virus. She was successfully managed with intravitreal ganciclovir injections, systemic acyclovir and tapering of systemic immunosuppressive drugs. RESULT The retinitis lesions resolved gradually leaving behind a pale optic disc and foveal atrophy at 12 weeks follow-up. CONCLUSION Infective etiology must be ruled out in immunosuppressed patients before considering periocular corticosteroids. Dual viral involvement, although rare, may cause fulminant retinitis in predisposed individuals. High index of suspicion and PCR from ocular fluids should be performed at the earliest in patients with atypical or poorly responding retinitis lesions.
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Affiliation(s)
- Ramanuj Samanta
- Department of Ophthalmology, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Athul S Puthalath
- Department of Ophthalmology, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Gitanjli Sood
- Department of Ophthalmology, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Ramandeep Singh
- Advanced Eye Centre, Department of Ophthalmology, 29751Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Mohit Dogra
- Advanced Eye Centre, Department of Ophthalmology, 29751Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Case Report: Acute Retinal Necrosis after Intravitreal Ranibizumab for Exudative Macular Degeneration. Optom Vis Sci 2021; 98:206-211. [PMID: 33633018 DOI: 10.1097/opx.0000000000001649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Acute retinal necrosis (ARN) may occur after intravitreal ranibizumab (IVR) treatment for patients with exudative age-related macular degeneration (AMD). Awareness of this unusual but devastating complication after IVR is needed. Early identification may help provide timely antiviral treatment and prevent irreversible visual loss. PURPOSE This study aimed to report a case of ARN after IVR in a patient with exudative AMD. CASE REPORT A 67-year-old male patient complained of blurred vision in his left eye for 1 month. The patient was diagnosed with exudative AMD after detailed ophthalmic clinical evaluations. He received IVR once in his left eye. Three days after IVR, he developed varicella-zoster virus-associated ARN, which was treated with systemic and intravitreal antiviral therapy. Because of progressive inflammation, the patient underwent 25G pars plana vitrectomy with silicone oil tamponade. Seven months later, the patient was administered intravitreal aflibercept once in his left eye. Three months after intravitreal aflibercept, he underwent removal of silicone oil, and retinal detachment occurred 2 weeks after the surgery because of low IOP, and the patient eventually discontinued treatment. CONCLUSIONS This study reports the first case of varicella-zoster virus-associated ARN after IVR. Early ARN may be very difficult to distinguish from intraocular inflammation after IVR. Therefore, early detection of viral DNA in the intraocular fluid using polymerase chain reaction is recommended. Immediate antiviral treatment may be beneficial to prevent severe visual loss.
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Zemba M, Rogoz RE, Zaharia AC, Dimirache AE, Dumitrescu OM, Dărăbuş DM. Challenges in HIV-Negative Cytomegalovirus Retinitis - case report. Rom J Ophthalmol 2021; 65:247-254. [PMID: 35036645 PMCID: PMC8697781 DOI: 10.22336/rjo.2021.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 20-year-old girl with severe combined seronegative immunodeficiency who developed a bilateral decrease in visual acuity due to retinal necrosis. After further investigations, increased serological viral levels of Cytomegalovirus (CMV) were detected and confirmed the diagnosis of CMV retinitis in both eyes. After three weeks of systemic therapy with oral valganciclovir, her condition improved, with the best corrected visual acuity of the most affected eye changing from finger counting at presentation to 6/ 12. Although financial matters determined her to discontinue the antiviral treatment after three months, her ophthalmological status remained stable, and she resumed therapy after four weeks of pause. At the four months follow-up, despite an unchanged visual function, her general condition deteriorated. In the absence of appropriate treatment for her immunodeficiency both the patient's ophthalmological and systemic prognosis were poor.
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Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Farmacy Bucharest, Romania
| | - Roxana-Elena Rogoz
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Alexandra Cătălina Zaharia
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Andreea Elena Dimirache
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Diana-Maria Dărăbuş
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
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Sadik MT, Aksu Ceylan N, Cebeci Z, Kir N, Oray M, Tugal-Tutkun I. Patterns of cytomegalovirus retinitis at a tertiary referral center in Turkey. Int Ophthalmol 2021; 41:2981-2992. [PMID: 33885967 DOI: 10.1007/s10792-021-01857-3] [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: 02/14/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze predisposing conditions in Turkish patients with CMV retinitis and to compare HIV-positive and HIV-negative patients. METHODS We reviewed medical charts and ocular images of 41 patients with CMV retinitis diagnosed between 1996 and 2019. RESULTS Eleven patients (27%) had HIV infection and 30 were immunocompromised from diverse causes. Initial visual acuity, type, zone, and extent of CMV retinitis, and response to anti-CMV treatment were not significantly different between the two groups. Vitreous haze and panretinal occlusive vasculopathy were the presenting features only in non-HIV patients, seen in 34% and 16% of eyes, respectively. Although not statistically significant, recurrent CMV retinitis was more common in non-HIV patients (17.4% vs. 4.3%/eye-year) and immune recovery uveitis was more common in HIV patients (43% vs. 26%/eye-year). Visual outcomes were similar. Final visual acuity of 1 logMAR or worse was significantly associated with the recurrence of CMV retinitis (odds ratio 9.67; p = 0.01) and also with the occurrence of immune recovery uveitis (odds ratio 4.31; p = 0.058). CONCLUSIONS Diverse immunocompromising conditions are more commonly associated with CMV retinitis than HIV infection in Turkish patients. Intraocular inflammation was more commonly associated with active retinitis in non-HIV patients and immune recovery uveitis was more common in HIV patients.
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Affiliation(s)
- Muhammed Talha Sadik
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Nihan Aksu Ceylan
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Zafer Cebeci
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Nur Kir
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Merih Oray
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey.
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Wu CY, Knight D, Freeman W. White Macula After Pars Plana Vitrectomy in a 71-Year-Old Woman. JAMA Ophthalmol 2021; 139:478-479. [PMID: 33538786 DOI: 10.1001/jamaophthalmol.2020.4616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chris Y Wu
- Shiley Eye Institute, University of California at San Diego, La Jolla
| | - Darren Knight
- Shiley Eye Institute, University of California at San Diego, La Jolla
| | - William Freeman
- Shiley Eye Institute, University of California at San Diego, La Jolla
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14
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Ong AP, Sims JL, Niederer RL. Infectious Uveitis after Local Steroid and/or Methotrexate Injections at A Tertiary Referral Center in New Zealand: A Case Series. Ocul Immunol Inflamm 2021; 30:1176-1180. [PMID: 33792480 DOI: 10.1080/09273948.2020.1860230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim: Infectious uveitis is one of the most visually devastating causes of uveitis worldwide and accounts for 19.6% of all cases of uveitis in New Zealand. With the burgeoning use of intravitreal injections, there has been a commensurate increase in the number of injection-related complications and reports of infectious uveitis following their administration in recent years. We present a case series of four patients with infectious uveitis after local injections.Method: We retrospectively reviewed the data of four patients (mean age, 67.25 ± 7.58 years) who presented to the department of ophthalmology at Auckland District Health Board with infectious uveitis which occurred or worsened after local triamcinolone acetonide (TA) and/or methotrexate (MTX) injections.Results: Three patients received local TA and one patient received intravitreal MTX. All patients were immunosuppressed prior to treatment. Two patients had toxoplasma chorioretinitis which worsened with local TA and one patient developed cytomegalovirus (CMV) retinitis after intravitreal TA. The last patient had syphilis retinopathy which worsened with intravitreal MTX. There were atypical presentations, as demonstrated by a case of presumed birdshot chorioretinopathy flare which tested positive for toxoplasma chorioretinitis with polymerase chain reaction (PCR).Conclusion: Uveitis due to infectious etiologies needs to be carefully excluded prior to the use of local steroid and/or methotrexate injections. Disease presentations may be atypical in the presence of marked immunosuppression following local therapy. Polymerase chain reaction (PCR) can play an important role in the diagnosis in this setting.
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Affiliation(s)
- Aaron Pc Ong
- Department of Ophthalmology, Southern District Health Board, Dunedin, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
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Cytomegalovirus retinitis following dexamethasone intravitreal implant. Am J Ophthalmol Case Rep 2021; 22:101055. [PMID: 33732951 PMCID: PMC7944023 DOI: 10.1016/j.ajoc.2021.101055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/07/2020] [Accepted: 02/21/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To describe a case of Cytomegalovirus (CMV) Retinitis in an immunocompetent patient following Dexamethasone Intravitreal Implant (DII). Observations Retrospective chart review of a single patient. An 80-year-old immunocompetent male presented with floaters in his left eye 10 weeks after his DII. He was noted to have a visual acuity of 20/1200 in his left eye and a panuveitis with CMV retinitis. The patient underwent a vitreous biopsy and given immediate intravitreal foscarnet and an ongoing management regimen of oral valganciclovir for two months. His vision improved to 20/200 and his CMV retinitis resolved. Conclusion and Importance DII can trigger CMV retinitis in immunocompetent patients.
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16
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Chandler LC, Yusuf IH, McClements ME, Barnard AR, MacLaren RE, Xue K. Immunomodulatory Effects of Hydroxychloroquine and Chloroquine in Viral Infections and Their Potential Application in Retinal Gene Therapy. Int J Mol Sci 2020; 21:E4972. [PMID: 32674481 PMCID: PMC7404262 DOI: 10.3390/ijms21144972] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/25/2022] Open
Abstract
Effective treatment of retinal diseases with adeno-associated virus (AAV)-mediated gene therapy is highly dependent on the proportion of successfully transduced cells. However, due to inflammatory reactions at high vector doses, adjunctive treatment may be necessary to enhance the therapeutic outcome. Hydroxychloroquine and chloroquine are anti-malarial drugs that have been successfully used in the treatment of autoimmune diseases. Evidence suggests that at high concentrations, hydroxychloroquine and chloroquine can impact viral infection and replication by increasing endosomal and lysosomal pH. This effect has led to investigations into the potential benefits of these drugs in the treatment of viral infections, including human immunodeficiency virus and severe acute respiratory syndrome coronavirus-2. However, at lower concentrations, hydroxychloroquine and chloroquine appear to exert immunomodulatory effects by inhibiting nucleic acid sensors, including toll-like receptor 9 and cyclic GMP-AMP synthase. This dose-dependent effect on their mechanism of action supports observations of increased viral infections associated with lower drug doses. In this review, we explore the immunomodulatory activity of hydroxychloroquine and chloroquine, their impact on viral infections, and their potential to improve the efficacy and safety of retinal gene therapy by reducing AAV-induced immune responses. The safety and practicalities of delivering hydroxychloroquine into the retina will also be discussed.
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Affiliation(s)
- Laurel C. Chandler
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK; (I.H.Y.); (M.E.M.); (A.R.B.); (R.E.M.)
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Imran H. Yusuf
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK; (I.H.Y.); (M.E.M.); (A.R.B.); (R.E.M.)
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Michelle E. McClements
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK; (I.H.Y.); (M.E.M.); (A.R.B.); (R.E.M.)
| | - Alun R. Barnard
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK; (I.H.Y.); (M.E.M.); (A.R.B.); (R.E.M.)
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Robert E. MacLaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK; (I.H.Y.); (M.E.M.); (A.R.B.); (R.E.M.)
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Kanmin Xue
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK; (I.H.Y.); (M.E.M.); (A.R.B.); (R.E.M.)
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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17
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Zhang ZY, Liu XY, Jiang T. Acute retinal necrosis following dexamethasone intravitreal implant (Ozurdex®) administration in an immunocompetent adult with a history of HSV encephalitis: a case report. BMC Ophthalmol 2020; 20:247. [PMID: 32571253 PMCID: PMC7310153 DOI: 10.1186/s12886-020-01514-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background Dexamethasone intravitreal implants (0.7 mg) (Ozurdex®, Allergan Inc., Madison, NJ) are FDA approved for managing macular oedema (ME) of retinal vein occlusion (RVO). The major complications associated with intravitreal Ozurdex® implant include increased intraocular pressure and cataract progression. In regard to the occurrence of retinal complications, we report an unusual intravitreal Ozurdex® implantation-related acute retinal necrosis (ARN). Case presentation A 45-year-old immunocompetent woman with a history of encephalitis presented with photophobia, redness, floaters, and rapidly decreased vision in her left eye. Three and six months ago, she received two doses of intravitreal Ozurdex® implant for ME of RVO. Clinical evaluation, including slit-lamp biomicroscopy, retinal photography, and fluorescein angiography, revealed anterior chamber cells, granulomatous keratic precipitates, cells in the vitreous, optic disc oedema, occlusive retinal vasculitis, scattered retinal haemorrhages, one quadrant of peripheral white areas with retinal necrosis, optic disc and vessels fluorescein staining, and retinal nonperfusion zones. All the above clinical manifestations showed an ARN. Herpes simplex virus was detected in the aqueous and vitreous humour by quantitative polymerase chain reaction testing. Intravenous acyclovir 500 mg tid for 7 days followed by oral valcyclovir was immediately performed for ARN. At 4 months, the patient’s condition improved without retinal detachment, and the best-corrected visual acuity remained stable at 0.3. Conclusions ARN might represent a risk of Ozurdex® administration.
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Affiliation(s)
- Zhi-Yong Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, People's Republic of China. .,Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
| | - Xiu-Yun Liu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, People's Republic of China.,Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Tao Jiang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, People's Republic of China.,Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
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18
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Pleyer U, Gross U, Schlüter D, Wilking H, Seeber F. Toxoplasmosis in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:435-444. [PMID: 31423982 DOI: 10.3238/arztebl.2019.0435] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND With approximately 30% of the world population infected, Toxoplasma gondii is one of the most widespread pathogenic parasites in both humans and animals and a major problem for health economics in many countries. METHODS This review is based on the findings of individual studies, meta-analyses, and Cochrane Reviews retrieved by a selective literature survey of the Medline and Google Scholar databases. RESULTS Current data indicate a high rate of Toxoplasma gondii infection in Germany, ranging from 20% to 77% depending on age (95% confidence interval for 18- to 29-year-olds [17.0; 23.1]; for 70- to 79-year-olds [72.7; 80.5]). Male sex, caring for a cat, and a body mass index of 30 or more are independent risk factors for seroconversion. Postnatally acquired (food-related) infec- tion is predominant, but maternal-to-fetal transmission still plays an important role. While most infections are asymptomatic, congenital toxoplasmosis and reactivated Toxoplasma encephalitis in immunosuppressed persons (transplant recipients and others) are sources of considerable morbidity. Toxoplasma gondii infection of the retina is the most common cause of infectious uveitis in Germany. The diagnosis and treatment of this type of parasitic infection are particular to the specific organs involved in the individual patient. CONCLUSION Desirable steps for the near future include development of an effective treatment for the cystic stage and identifica- tion of biomarkers to assess the risk of reactivation and predict the disease course.
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Affiliation(s)
- Uwe Pleyer
- Department of Ophthalmology, Charité Campus Virchow, University Faculty of Medicine, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Institute of Medical Microbiology and German Reference Laboratory for Toxoplasma Infection, Faculty of Medicine University of Göttingen; Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH); Unit 35: Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin; Unit 16: Mycotic and parasitic agents and mycobacteria, Robert Koch Institute, Berlin
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19
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Scoles D, Ammar MJ, Carroll RM, Orlin SE, Addis V, Maguire AM. Cytomegalovirus retinitis in an immunocompetent host after complicated cataract surgery. Am J Ophthalmol Case Rep 2020; 18:100702. [PMID: 32309678 PMCID: PMC7154989 DOI: 10.1016/j.ajoc.2020.100702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/02/2020] [Accepted: 04/05/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To report a case of an immunocompetent patient who developed cytomegalovirus (CMV) retinitis after complicated cataract surgery resulting in aphakia. Observations A 67-year-old man with type 2 diabetes developed retinitis six months after cataract surgery that resulted in aphakia. Anterior chamber DNA testing was positive for CMV. Comprehensive systemic work-up revealed no immune insufficiency. The retinitis was successfully treated with intravitreal foscarnet and extended oral valgancyclovir treatment, however, he subsequently developed rhegmatogenous retinal detachment. Conclusion and importance CMV retinitis may occur in immunocompetent patients in the setting of aphakia and prolonged topical steroid use.
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Affiliation(s)
- Drew Scoles
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael J Ammar
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert M Carroll
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Stephen E Orlin
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Victoria Addis
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Albert M Maguire
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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20
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Traitement des uvéites intermédiaires, postérieures et panuvéites non infectieuses. J Fr Ophtalmol 2020; 43:341-361. [DOI: 10.1016/j.jfo.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 01/01/2023]
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21
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Fung AT, Tran T, Lim LL, Samarawickrama C, Arnold J, Gillies M, Catt C, Mitchell L, Symons A, Buttery R, Cottee L, Tumuluri K, Beaumont P. Local delivery of corticosteroids in clinical ophthalmology: A review. Clin Exp Ophthalmol 2020; 48:366-401. [PMID: 31860766 PMCID: PMC7187156 DOI: 10.1111/ceo.13702] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/21/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino-vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer-term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the types of periocular steroid delivery, their clinical applications in ophthalmology and their side effects.
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Affiliation(s)
- Adrian T. Fung
- Westmead Clinical SchoolDiscipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Department of Ophthalmology, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
| | - Tuan Tran
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
| | - Lyndell L. Lim
- Royal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia
- Centre for Eye Research AustraliaMelbourneVictoriaAustralia
- University of MelbourneMelbourneVictoriaAustralia
| | - Chameen Samarawickrama
- Westmead Clinical SchoolDiscipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Liverpool Clinical School, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Mark Gillies
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
| | - Caroline Catt
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Children's Hospital WestmeadWestmeadNew South WalesAustralia
| | | | | | | | - Lisa Cottee
- Eye Doctors Mona ValeSydneyNew South WalesAustralia
| | - Krishna Tumuluri
- Westmead Clinical SchoolDiscipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Department of Ophthalmology, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
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22
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Bajgai P, Sharma A, Singh R. Disseminated Tubercular Granulomas Associated with the Use of Azathioprine. Ocul Immunol Inflamm 2020; 29:906-910. [PMID: 31940236 DOI: 10.1080/09273948.2019.1704021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe a case of multiple disseminated choroidal tuberculomas in a patient of early-phase Vogt-Koyanagi- Harada (VKH) disease being treated with Azathioprine.Methods: A retrospective chart review.Results: A 55-year-old female, a diagnosed case of VKH disease, was being treated with oral steroids and Azathioprine. During one of her follow-up visit, she was detected with multiple subretinal granulomas with surrounding fluid in both eyes. Fundus fluorescein angiography (FFA), Indocyanine green angiography (ICGA) and Optical Coherence Tomography (OCT) favored the presence of choroidal granulomas and Positron emission Tomography (PET) scan revealed lesions in spleen as well. She was started on anti-tubercular therapy along with oral steroids. She responded very well to treatment and her choroidal granulomas resolved in follow-up.Conclusion: Disseminated tubercular granulomas can rarely occur with the use of oral Azathioprine and poses caution for its use in cases requiring long-term immunosuppressants.
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Affiliation(s)
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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23
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Khairallah M, Khochtali S, Mahjoub A, Dridi T, Ksiaa I, Abroug N. Cytomegalovirus retinitis following corticosteroid overdose for Vogt-Koyanagi-Harada disease. Indian J Ophthalmol 2020; 68:2012-2014. [PMID: 32823462 PMCID: PMC7690477 DOI: 10.4103/ijo.ijo_628_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 33-year-old patient was diagnosed with acute Vogt-Koyanagi-Harada (VKH) disease and was prescribed prednisolone (1 mg/kg/day) and azathioprine (2.5 mg/kg/day). She mistakenly took an excessively high dose (4 mg/kg/day) of prednisolone for 14 days. The erroneous dose of corticosteroids was progressively corrected. Several weeks after initial presentation, the patient developed a polymerase chain reaction-proven bilateral cytomegalovirus retinitis, with extensive occlusive arteritis in the right eye. Systemic immunosuppressive therapy was temporarily discontinued and viral retinitis was successfully managed with systemic and intravitreal ganciclovir. Corticosteroids were reintroduced to control recurrent VKH disease. Final visual acuity was 20/1000 in the right eye and 20/50 in the left eye.
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24
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Chawan-Saad J, Wu M, Wu A, Wu L. Corticosteroids for Diabetic Macular Edema. Taiwan J Ophthalmol 2019; 9:233-242. [PMID: 31942428 PMCID: PMC6947754 DOI: 10.4103/tjo.tjo_68_19] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
Diabetic macular edema (DME) is a chronic condition with a multifactorial pathogenesis. Vascular endothelial growth factor (VEGF) and several inflammatory mediators are upregulated in eyes with DME. VEGF inhibitors and corticosteroids have all been used successfully in the management of DME. Currently available corticosteroids include triamcinolone acetonide (TA), the dexamethasone (DEX) intravitreal implant, and the fluocinolone acetonide (FA) intravitreal implant. The response to treatment can vary substantially with each treatment modality. Some cases of DME are VEGF driven, and in others, inflammation plays a key role. Chronicity appears to favor corticosteroid treatment. There are no clear guidelines to guide switching from an anti-VEGF to a corticosteroid. Combination therapy of an anti-VEGF drug and a corticosteroid does not appear to provide additional benefit over monotherapy with either drug. The main advantage of corticosteroids over VEGF inhibitors is their longer duration of action. Vitrectomy does not affect the pharmacokinetics of the corticosteroid implants. Common adverse events of corticosteroids include cataract formation, cataract progression, and ocular hypertension. TA may cause a sterile endophthalmitis and pseudoendophthalmitis. Migration of the intravitreal DEX and FA implants into the anterior chamber can be problematic. Because of their less favorable safety profile, corticosteroids are generally used as a second-line treatment for DME. Advantages of using an intravitreal corticosteroid implant include the reduction of treatment burden and predictable pharmacokinetics even in vitrectomized eyes. Pseudophakic eyes, previously vitrectomized eyes and eyes with long-standing DME, particularly of patients who have difficulty in maintaining a monthly appointment, may benefit from primary treatment with a corticosteroid intravitreal implant.
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Affiliation(s)
- Jorge Chawan-Saad
- Ophthalmology Department, Mexico Hospital, Costa Rican Social Security, San Jose, Costa Rica, USA
| | - Max Wu
- College of Enginnering, Cornell University, Ithaca, NY, USA.,Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica, USA
| | - Andres Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica, USA
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica, USA.,Illinois Eye and Ear Infirmary, University of Illinois, Chicago, IL, USA
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25
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Garweg JG. [Pharmacological treatment strategies and surgical options for uveitis]. Ophthalmologe 2019; 116:942-950. [PMID: 30796601 DOI: 10.1007/s00347-019-0870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Modern treatment of uveitis aims at a complete control of inflammatory activity, preservation of visual function and the prevention of secondary organ damage as a consequence of the underlying inflammatory disease and its treatment. OBJECTIVE This article gives an update about the strategies of pharmacological and surgical options for uveitis. MATERIAL AND METHODS The outcomes reported here are based on a PubMed search using the terms <"uveitis" AND "therapy"> and <"uveitis" AND "surgery" OR "surgical treatment">. All prospective studies and case series with more than 20 cases as well as review articles from the last 5 years along with cited cross-references were evaluated. RESULTS Local and systemic corticosteroids form the foundation of treatment after exclusion of an infectious etiology. If uveitis activity is not controlled within 6 weeks or if the daily corticosteroid dosage is unacceptably high, a treatment escalation using immunomodulatory drugs is required. If a complete control of inflammatory activity is not achieved, in a third phase treatment is supplemented by antibody-based treatment or cytokines, so-called biologics, with the aim of complete long-term freedom from disease without local or systemic steroid treatment. This target is achieved in 65-80% and guarantees long-term functional stability and anatomical integrity. Early treatment escalation in cases of persisting or recurrent activity as a rule prevents new secondary organ damage. Surgical options are utilized for diagnostic purposes, the administration of intravitreal drugs and for treatment of secondary complications. CONCLUSION Just like the majority of immunological diseases, uveitis is a chronic disease requiring long-term and possibly lifelong treatment and remission (absence of inflammation without treatment) is achieved in only <20%. Surgical interventions can be performed with a good prognosis, if the optic nerve head and macula are not involved. They have a substantially lower complication rate when freedom from symptoms exists preoperatively for at least 3 months.
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Affiliation(s)
- Justus G Garweg
- Berner Augenklinik am Lindenhofspital, Affiliation: Klinik und Poliklinik für Augenheilkunde, Inselspital, Universität Bern, Bremgartenstr 119, 3012, Bern, Schweiz. .,Swiss Eye Institute, Rotkreuz, Schweiz.
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26
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Takayama K, Kaburaki T, Takeuchi M. Development of Acute Retinal Necrosis in a Patient with Ocular Sarcoidosis: A Case Report. Ocul Immunol Inflamm 2019; 27:1067-1070. [PMID: 31414927 DOI: 10.1080/09273948.2019.1635168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To report a case of acute retinal necrosis (ARN) caused by varicella-zoster virus (VZV) in an elderly patient with ocular sarcoidosis after oral corticosteroid indication. Methods: Retrospective case report. Results: A 75-year-old male with a past history of ocular sarcoidosis came with blurred left vision. Ocular findings in the left eye were consistent with ocular sarcoidosis, while no inflammation in the right eye. On day 14, intraocular inflammation in the left eye resolved by topical corticosteroid, but inflammatory cells were found in the right eye. Suspecting recurrence of ocular sarcoidosis, systemic corticosteroid was initiated. On day 21, inflammation worsened, and the presence of extended yellowish white peripheral retinal lesion in the right eye suggested ARN. Polymerase chain reaction (PCR) testing using ocular fluid detected 3.0 × 107 copies/ml of VZV DNA. Conclusions: In the case of poor response to immunosuppressive therapy in elderly uveitis, infection including ARN should be considered. Immediate PCR testing for pathogen screening is required.
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Affiliation(s)
- Kei Takayama
- Department of Ophthalmology, National Defense Medical College , Tokorozawa , Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Tokyo University Graduate School of Medicine , Tokyo , Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College , Tokorozawa , Japan
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27
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CYTOMEGALOVIRUS RETINITIS AFTER AN INTRAVITREAL DEXAMETHASONE IMPLANT IN AN IMMUNOCOMPETENT PATIENT. Retin Cases Brief Rep 2019; 15:670-672. [PMID: 31339873 DOI: 10.1097/icb.0000000000000904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To present the case of a 71-year-old woman who developed cytomegalovirus retinitis after the administration of an intravitreal dexamethasone implant in an immunocompetent patient. METHODS Retrospective case report. PATIENTS Single patient with a diagnosis of cytomegalovirus retinitis associated with the intravitreal dexamethasone implant. RESULTS The patient developed cytomegalovirus retinitis three months after an intravitreal injection of a dexamethasone implant for macular edema. The patient had no history of poor immune function and was not taking immunosuppressive medications. CONCLUSION Cytomegalovirus retinitis has been associated with local steroid therapy. This has been described in both immunocompromised and immunocompetent patients. The intravitreal dexamethasone implant may cause local immunosuppression and result in cytomegalovirus retinitis in immunocompetent patients.
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28
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Urbančič M, Gardašević Topčić I. Dexamethasone implant in the management of diabetic macular edema from clinician's perspective. Clin Ophthalmol 2019; 13:829-840. [PMID: 31190726 PMCID: PMC6526171 DOI: 10.2147/opth.s206769] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
The aim of this article is to provide an overview of characteristics and principles of use of dexamethasone implant in patients with diabetic macular edema (DME). The condensed information about patient selection, dosing, and postinjection management is provided to make the clinician’s decisions easier in real-life practice. DME is a common complication of diabetes and the leading cause of visual loss in the working-age population. Inflammation plays an important role in the pathogenesis of DME. The breakdown of the blood–retinal barrier involves the expression of inflammatory cytokines and growth factors, including vascular endothelial growth factor (VEGF). Steroids have proved to be effective in the treatment of DME by blocking the production of VEGF and other inflammatory cytokines, by inhibiting leukostasis, and by enhancing the barrier function of vascular endothelial cell tight junctions. Dexamethasone intravitreal implant has demonstrated efficacy in the treatment of DME resistant to anti-VEGF therapy and in vitrectomized eyes. Data from clinical trials suggest that dexamethasone implant can be considered as first-line treatment in pseudophakic eyes. Dexamethasone implant is also the first-line therapy in patients not suited for anti-VEGF therapy, pregnant women, and patients unable to return for frequent monitoring. It has been shown that the maximum effect of dexamethasone implant on visual gain and retinal thickness occurs approximately 2 months after injection. Various treatment regimens are used in real-life situations, and reported reinjection intervals were usually <6 months. The number of retreatments needed decreased over time. Treatment algorithms should be personalized. Postinjection management and follow-up should consider potential adverse events such as intraocular pressure elevation and cataract.
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Affiliation(s)
- Mojca Urbančič
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Wu XN, Lightman S, Tomkins‐Netzer O. Viral retinitis: diagnosis and management in the era of biologic immunosuppression: A review. Clin Exp Ophthalmol 2019; 47:381-395. [DOI: 10.1111/ceo.13500] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/08/2019] [Accepted: 02/18/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Xia Ni Wu
- Ophthalmology, Moorfields Eye Hospital London UK
- Faculty of Brain Sciences, Institute of Ophthalmology London UK
| | - Sue Lightman
- Ophthalmology, Moorfields Eye Hospital London UK
- Faculty of Brain Sciences, Institute of Ophthalmology London UK
| | - Oren Tomkins‐Netzer
- Ophthalmology, Moorfields Eye Hospital London UK
- Faculty of Brain Sciences, Institute of Ophthalmology London UK
- Department of OphthalmologyBnai Zion Medical Centre Haifa Israel
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Jeong A, Park DG, Sagong M. Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.9.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Areum Jeong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong-Geun Park
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Shapira Y, Mimouni M, Vishnevskia-Dai V. Cytomegalovirus retinitis in HIV-negative patients - associated conditions, clinical presentation, diagnostic methods and treatment strategy. Acta Ophthalmol 2018; 96:e761-e767. [PMID: 29068151 DOI: 10.1111/aos.13553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/30/2017] [Indexed: 02/04/2023]
Abstract
In recent years, numerous reports have tied cytomegalovirus retinitis (CMVR) with multiple systemic conditions in the absence of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). These range from reports in apparently healthy individuals, through conditions rendering limited immune dysfunction such as advanced age and diabetes mellitus, and finally severe immune dysfunction such as in haematological and rheumatological conditions. Reports are also emerging, suggesting that induced local ocular immunosuppression is a risk factor for CMVR. We herein present a comprehensive collection of the accumulated findings regarding CMVR in non-HIV patients. We summarize the spectrum of underlying morbidity that has been associated with CMVR, its clinical presentation, diagnostic methods and treatment choice in the attempt to suggest the optimal treatment strategy in this complicated and diverse patient population which is still currently lacking a consensus.
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Affiliation(s)
- Yinon Shapira
- Department of Ophthalmology; Rambam Health Care Campus; Haifa Israel
| | - Michael Mimouni
- Department of Ophthalmology; Rambam Health Care Campus; Haifa Israel
| | - Vicktoria Vishnevskia-Dai
- Ocular Oncology and Autoimmune Center; The Goldschleger Eye Institute; Sheba Medical Center; Tel Aviv University; Tel Aviv-Yafo Israel
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ACUTE RETINAL NECROSIS AFTER ADMINISTRATION OF ADALIMUMAB, A SYSTEMIC ANTITUMOR NECROSIS FACTOR ANTIBODY. Retin Cases Brief Rep 2018; 12:307-309. [PMID: 27997458 DOI: 10.1097/icb.0000000000000499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of acute retinal necrosis in a patient on anti-tumor necrosis factor α immunosuppressive therapy. METHODS Case report. RESULTS A 47-year-old man with psoriasis presented with blurred vision and floaters in the left eye 4 days after receiving his fourth dose of adalimumab, a tumor necrosis factor α antagonist. He was diagnosed with acute retinal necrosis and was treated with intravenous acyclovir as well as prophylactic laser barricade. Seven years later, he is 20/20 with no history of a retinal detachment. CONCLUSION Physicians prescribing tumor necrosis factor α antagonist immunosuppressive therapy should be aware of the potential of developing acute retinal necrosis.
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Dogra M, Rohilla V, Dogra M, Singh R. Macular cytomegalovirus retinitis following dexamethasone intravitreal implant combined with phacoemulsification. Indian J Ophthalmol 2018; 66:1361-1363. [PMID: 30127173 PMCID: PMC6113845 DOI: 10.4103/ijo.ijo_171_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old diabetic patient, who had undergone a renal transplant 2 years earlier, presented with sudden decrease in vision in his left eye (LE). He had undergone phacoemulsification combined with intravitreal dexamethasone implant injection in his LE 2 months earlier, for coexistent cataract and diabetic macular edema. Examination revealed necrotizing retinitis with hemorrhages in the macula. A diagnosis of cytomegalovirus retinitis was made, which was confirmed on vitreous polymerase chain reaction. Intravitreal and systemic ganciclovir led to the resolution of retinitis and improvement of visual acuity over a follow-up of 9 months.
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Affiliation(s)
- Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikash Rohilla
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sato T, Kitamura R, Kaburaki T, Takeuchi M. Retinitis associated with double infection of Epstein-Barr virus and varicella-zoster virus: A case report. Medicine (Baltimore) 2018; 97:e11663. [PMID: 30075555 PMCID: PMC6081094 DOI: 10.1097/md.0000000000011663] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Chronic uveitis with immunosuppressive agents could develop chronic herpetic retinitis with varicella-zoster virus (VZV) or herpes simplex virus (HSV). Ocular Epstein-Barr virus (EBV) infection develops uveitis and vitritis, but the clinical feature of EBV retinitis is not typical as a viral retinitis. EBV retinitis is rare, and only a few cases of EBV retinitis have been reported. Herein, we describe a case of retinitis with EBV and VZV which were the primary viruses verified by multiplex polymerase chain reaction (PCR). PATIENT CONCERNS A 75-year-old woman suffered from sudden visual loss in the left eye. She had been diagnosed with rheumatoid arthritis. At presentation, visual acuity (VA) was 20/400 in the left eye. Slit lamp examination disclosed fine white keratic precipitates with infiltrating cells and dense vitreous opacities in the anterior segment and vitreous. Fundus photographs showed multifocal chorioretinal scars in macula and peripheral retina, and granular lesions surrounding arcade vessels. DIAGNOSES Ocular toxoplasmosis was primarily suspected. INTERVENTIONS However, serological test showed negative of toxoplasmosis. Therefore, a diagnostic and therapeutic vitrectomy was performed. Vitreous fluid sample was used for multiplex PCR for detection of human herpesvirus (HHV) -1 to -8, toxoplasmosis and toxocariasis. OUTCOMES Multiplex PCR detected 5.8 × 10 copies/mL of EBV-deoxyribonucleic acid (DNA), and 3.6 × 10 copies/mL of VZV-DNA in the sample. Therefore, we could diagnose the unidentified panuveitis a retinitis associated with double infection of EBV and VZV. At 85 days after the vitrectomy, VA of the left eye recovered to be 20/16. LESSONS Elderly patients under immunosuppression may be susceptible to develop retinitis associated with infection of multiple HHVs, and multiplex PCR is an excellent tool to diagnose an unidentified panuveitis resembling this case.
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Affiliation(s)
- Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Saitama
| | - Riki Kitamura
- Department of Ophthalmology, National Defense Medical College, Saitama
| | | | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama
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Ahmed A, Sudharshan S, Gopal S, Majumder PD, Biswas J. Toxoplasma retinitis following intravitreal injection of triamcinolone acetonide: A case report and review of literature. Indian J Ophthalmol 2018; 66:1205-1208. [PMID: 30038184 PMCID: PMC6080440 DOI: 10.4103/ijo.ijo_142_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to report a case of atypical toxoplasma retinochoroiditis following intravitreal triamcinolone acetonide (IVTA) injection and to review the literature pertaining to toxoplasma retinochoroiditis following intravitreal injection of corticosteroid. Clinical data were collected from a 64-year-old male who developed toxoplasma retinitis 2 months after IVTA. A review of the literature was conducted to identify additional reports on similar cases. A 64-year-old male, known diabetic with nonproliferative diabetic retinopathy in both the eyes and optic atrophy in the left eye, presented with atypical retinitis inferior to the disc following IVTA. Real-time polymerase chain reaction and serology confirmed the toxoplasma etiology, and the patient was started on anti-toxoplasma therapy along with oral corticosteroid leading to regression of the lesion by 3 months. A high index of suspicion and proper microbiological diagnosis with appropriate antimicrobial therapy can aid in the management of toxoplasma retinochoroiditis following intravitreal injection of corticosteroid.
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Affiliation(s)
- Arshee Ahmed
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Sriram Gopal
- Athreya Retinal Centre, Trichy, Tamil Nadu, India
| | | | - Jyotirmay Biswas
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Zafeiropoulos P, Tamboura P, Dimou M, Christodoulou E, Stefaniotou M. Cytomegalovirus retinitis, in a diabetic immunocompetent patient, after intravitreal ranibizumab injection. Eur J Ophthalmol 2018; 29:NP10-NP12. [PMID: 29747535 DOI: 10.1177/1120672118772525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We here report a case of cytomegalovirus retinitis in a diabetic patient that occurred after intravitreal ranibizumab injection. A 75-year-old woman was treated with intravitreal ranibizumab injections for diabetic macular edema. During this period, a retinitis occurred in her left eye along with increased IgG and later IgM cytomegalovirus antibody titers. Ocular and intravenous ganciclovir was administered. Cytomegalovirus retinitis subsided post treatment with residual areas of retinal atrophy. Ophthalmologists should be aware of the incidence of cytomegalovirus retinitis, in diabetic patients, after ranibizumab injection.
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Affiliation(s)
| | | | - Maria Dimou
- 2 General Hospital of Ptolemaida, Ptolemaida, Greece
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Abstract
Purpose of review To review the epidemiology, diagnosis, and management of cytomegalovirus retinitis (CMVR) in the post-combined antiretroviral era (cART) era. Recent findings Although cART has dramatically reduced CMVR incidence and morbidity in the HIV population, CMVR continues to cause significant vision loss in both HIV and non-HIV patients, especially amongst patients without immune reconstitution. Advances in imaging including ultra-widefield fundus and autofluorescence imaging, optical coherence tomography, and adaptive optics may reflect CMVR activity; however, the diagnosis remains a clinical one. There have been minimal advances in therapy, with several agents no longer available due to market concerns. Summary Despite reduced incidence and morbidity in the post-cART HIV population, CMVR continues to cause vision loss amongst HIV and non-HIV patients. Diagnosis remains primarily clinical, and therapy centers upon immune reconstitution along with systemic and/or intravitreal antivirals. Further studies are necessary to determine whether advanced imaging can influence management, and whether novel antiviral agents or adoptive immune transfer have a role in treatment of drug-resistance CMVR.
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Gupta MP, Patel S, Orlin A, Marlow E, Chee RI, Nadelmann J, Chan R, D'Amico DJ, Kiss S. SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN MACULA-INVOLVING CYTOMEGALOVIRUS RETINITIS. Retina 2018; 38:1000-1010. [PMID: 28376042 PMCID: PMC5943072 DOI: 10.1097/iae.0000000000001644] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the microstructural features of cytomegalovirus (CMV) retinitis by spectral domain optical coherence tomography (OCT). METHODS Subjects were patients with macula-involving CMV retinitis with OCT imaging. The leading edge of retinitis in the macula was identified based on fundus imaging, and OCT findings were longitudinally evaluated in three areas: within the area of active retinitis, at the leading edge of retinitis, and just beyond the leading edge of retinitis. RESULTS Optical coherence tomography imaging of macular CMV retinitis identified vitreous cells in 10 eyes (100%), posterior vitreous detachment in four eyes (40%), broad-based vitreomacular traction in one eye (10%), epiretinal membrane in eight eyes (80%), and lamellar hole-associated epiretinal proliferation associated with an atrophic hole in one eye (10%). Retinal architectural disruption, disruption of inner retinal layers, disruption of the external limiting membrane, and ellipsoid zone abnormalities were noted within the area of retinitis in all eyes and decreased in frequency and severity at and beyond the leading edge of retinitis, although all 10 eyes (100%) exhibited one of these abnormalities, especially outer retinal microabnormalities, beyond the leading edge of retinitis. CONCLUSION Microstructural abnormalities were frequently noted on OCT of CMV retinitis, including within the retina beyond the leading edge of retinitis identified by corresponding fundus imaging. Outer retinal abnormalities were noted more frequently than inner retinal abnormalities beyond the leading edge of retinitis. These findings provide insight into the effects of CMV retinitis on retinal microstructure and potentially on vision and highlight the potential utility of OCT for monitoring microprogression of macula-involving CMV retinitis.
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Affiliation(s)
- Mrinali P. Gupta
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Sarju Patel
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Anton Orlin
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Elizabeth Marlow
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Ru-Ik Chee
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | | | - R.V.Paul Chan
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
- Department of Ophthalmology, Illinois Eye & Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Donald J. D'Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Szilard Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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Lee JH, Agarwal A, Mahendradas P, Lee CS, Gupta V, Pavesio CE, Agrawal R. Viral posterior uveitis. Surv Ophthalmol 2017; 62:404-445. [PMID: 28012878 PMCID: PMC5654632 DOI: 10.1016/j.survophthal.2016.12.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 12/28/2022]
Abstract
The causes of posterior uveitis can be divided into infectious, autoimmune, or masquerade syndromes. Viral infections, a significant cause of sight-threatening ocular diseases in the posterior segment, include human herpesviruses, measles, rubella, and arboviruses such as dengue, West Nile, and chikungunya virus. Viral posterior uveitis may occur as an isolated ocular disease in congenital or acquired infections or as part of a systemic viral illness. Many viruses remain latent in the infected host with a risk of reactivation that depends on various factors, including virulence and host immunity, age, and comorbidities. Although some viral illnesses are self-limiting and have a good visual prognosis, others, such as cytomegalovirus retinitis or acute retinal necrosis, may result in serious complications and profound vision loss. Since some of these infections may respond well to antiviral therapy, it is important to work up all cases of posterior uveitis to rule out an infectious etiology. We review the clinical features, diagnostic tools, treatment regimens, and long-term outcomes for each of these viral posterior uveitides.
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Affiliation(s)
- Joanne H Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aniruddha Agarwal
- Department of Vitreoretina and Uveitis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Cecilia S Lee
- Department of Uveitis, University of Washington, Seattle, Washington, USA
| | - Vishali Gupta
- Department of Vitreoretina and Uveitis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Carlos E Pavesio
- Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom; Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
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Port AD, Orlin A, Kiss S, Patel S, D'Amico DJ, Gupta MP. Cytomegalovirus Retinitis: A Review. J Ocul Pharmacol Ther 2017; 33:224-234. [DOI: 10.1089/jop.2016.0140] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alexander D. Port
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Anton Orlin
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Szilard Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Sarju Patel
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Donald J. D'Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Mrinali P. Gupta
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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SAFETY AND EFFICACY OF INTRAVITREAL DEXAMETHASONE IMPLANTS IN THE MANAGEMENT OF MACULAR EDEMA SECONDARY TO INFECTIOUS UVEITIS. Retina 2017; 36:1778-85. [PMID: 27183031 DOI: 10.1097/iae.0000000000001001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the safety and efficacy of intravitreal dexamethasone implants in the treatment of macular edema secondary to infectious uveitis. METHODS We retrospectively reviewed clinical records from three uveitis referral units in Spain. The main outcome measures were rate of reactivation of infection, improvements in visual acuity and resolution of macular edema, as measured by optical coherence tomography. RESULTS We included eight eyes from seven patients with a median age of 64 years (30-75). Etiologies of the infections were Herpes simplex virus-type 1, Varicela-Zoster virus, Treponema pallidum, Brucella mellitensis, Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus. Median visual acuity was 20/160 (20/30-20/400) at baseline and 20/70 (20/25-20/200) at the last follow-up visit. Mean macular thickness was 516 μm (115) at baseline and 266.3 μm (40) at the last follow-up visit. Visual acuity improved in 100% of the eyes and none of the eyes showed macular edema at the last follow-up visit. Five patients required reinjections of the implant. Only one patient required antiglaucoma drops for a temporary increase in ocular pressure. There were no cases of reactivation of the infectious ocular disease. Median follow-up time was 18 months. CONCLUSION In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.
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Majumder PD, Biswas J, Ambreen A, Amin R, Pannu ZR, Bedda AM. Intravitreal dexamethasone implant for the treatment of cystoid macular oedema associated with acute retinal necrosis. J Ophthalmic Inflamm Infect 2016; 6:49. [PMID: 28012104 PMCID: PMC5182243 DOI: 10.1186/s12348-016-0116-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Acute retinal necrosis is a rare but devastating ocular condition. We report two cases of acute retinal necrosis in immunocompetent patients, complicated by cystoid macular oedema and treated with intravitreal dexamethasone (OZURDEX®) implant. Results Two patients diagnosed with acute retinal necrosis were treated with intravenous acyclovir. Both of them developed cystoid macular oedema following resolution of viral retinitis. Ocular condition of the first patient was further complicated by central serous chorioretinopathy. Under unavoidable circumstances, cystoid macular oedema in both the patients was treated with intravitreal dexamethasone implant with great caution. Resolution of cystoid macular oedema without recurrence of viral retinitis was noted in the long-term follow-up. Conclusions Findings of the case report should be interpreted cautiously, and extreme caution should be exercised prior deciding the management with a corticosteroid implant in patients with viral retinitis. However, intravitreal dexamethasone implant can be a useful option in selected patients with cystoid macular oedema in acute retinal necrosis.
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Affiliation(s)
- Parthopratim Dutta Majumder
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600 006, Tamil Nadu, India
| | - Jyotirmay Biswas
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600 006, Tamil Nadu, India.
| | - Asra Ambreen
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600 006, Tamil Nadu, India
| | - Rowayda Amin
- Ophthalmology department, Faculty of Medicine, Alexandria University, 42 Memphis street, Camp Caesar, Apt #5, Alexandria, Egypt
| | | | - Ahmed Magdy Bedda
- Ophthalmology department, Faculty of Medicine, Alexandria University, 42 Memphis street, Camp Caesar, Apt #5, Alexandria, Egypt
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Thrane AS, Hove M, Kjersem B, Krohn J. Acute retinal necrosis and ocular neovascularization caused by cytomegalovirus following intravitreal dexamethasone implant (Ozurdex ® ) in an immunocompetent patient. Acta Ophthalmol 2016; 94:e813-e814. [PMID: 27274005 DOI: 10.1111/aos.13131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Morten Hove
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
| | - Bård Kjersem
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
| | - Jørgen Krohn
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
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Downes KM, Tarasewicz D, Weisberg LJ, Cunningham ET. Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients-case report and comprehensive review of the literature. J Ophthalmic Inflamm Infect 2016; 6:3. [PMID: 26809342 PMCID: PMC4726639 DOI: 10.1186/s12348-016-0070-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/04/2016] [Indexed: 12/21/2022] Open
Abstract
We describe a 65-year-old Thai woman who developed cytomegalovirus retinitis (CMVR) in the setting of Good syndrome-a rare, acquired partial immune deficiency caused by thymoma. The patient subsequently developed vitritis with cystoid macular edema (CME) similar to immune recovery uveitis (IRU) despite control of the retinitis with antiviral agents. A comprehensive review of the literature through December, 2014, identified an additional 279 eyes of 208 patients with CMVR in the absence of human immunodeficiency virus (HIV) infection. Including our newly reported case, 9 of the 208 patients (4.3 %) had Good syndrome. Twenty-one of the 208 patients (10.1 %) had CMVR related to intraocular or periocular corticosteroid administration. The remaining 178 patients (85.6 %) acquired CMVR from other causes. Within the subset of patients who did not have Good syndrome or did not acquire CMVR followed by intraocular or periocular corticosteroid administration, there were many other factors contributing to a decline in immune function. The most common included age over 60 years (33.1 %), an underlying malignancy (28.7 %), a systemic autoimmune disorder requiring systemic immunosuppression (19.1 %), organ (15.2 %) or bone marrow (16.3 %) transplantation requiring systemic immunosuppression, and diabetes mellitus (6.1 %). Only 4.5 % of the patients had no identifiable contributor to a decline in immune function. While the clinical features of CMVR are generally similar in HIV-negative and HIV-positive patients, the rates of moderate to severe intraocular inflammation and of occlusive retinal vasculitis appear to be higher in HIV-negative patients.
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Affiliation(s)
- Kenneth M Downes
- The Department of Ophthalmology, California Pacific Medical Center, 2340 Clay Street 5th, San Francisco, CA, 94115, USA.
| | - Dariusz Tarasewicz
- The Department of Ophthalmology, Kaiser Permanente Medical Center, South San Francisco, CA, USA
| | - Laurie J Weisberg
- The Department of Hematology/Oncology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
| | - Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, 2340 Clay Street 5th, San Francisco, CA, 94115, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
- West Coast Retina Medical Group, San Francisco, CA, USA
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Olson DJ, Parhiz AT, Wirthlin RS. Reactivation of Latent Toxoplasmosis Following Dexamethasone Implant Injection. Ophthalmic Surg Lasers Imaging Retina 2016; 47:1050-1052. [DOI: 10.3928/23258160-20161031-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/16/2016] [Indexed: 11/20/2022]
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Iu LP, Fan MC, Lau JK, Chan TS, Kwong YL, Wong IY. Long-term Follow-up of Cytomegalovirus Retinitis in Non-HIV Immunocompromised Patients: Clinical Features and Visual Prognosis. Am J Ophthalmol 2016; 165:145-53. [PMID: 27005706 DOI: 10.1016/j.ajo.2016.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate clinical features and long-term visual outcome of cytomegalovirus (CMV) retinitis in patients without human immunodeficiency virus (HIV) infection, and to determine factors that predict visual outcome. DESIGN Retrospective cohort study. METHODS Consecutive patients with CMV retinitis without HIV infection were reviewed. Main outcome measures included clinical features, proportion of eyes with 6-month and final visual acuity (VA) <20/70 and <20/400, and odds ratios of factors associated with poor visual outcome. RESULTS A total of 20 eyes from 13 patients were included with a median follow-up time of 17 months. All had at least 6 months of follow-up except 1 patient who died from sepsis at 1 month. At presentation, 50% of eyes had VA <20/70 and 25% had VA <20/400. Zone 1 involvement occurred in 55% and vitreous haze ≥grade 2+ occurred in 25%. Recurrence occurred in 33.3% at a mean time of 6.4 ± 3.3 weeks after discontinuation of anti-CMV therapy. The retinal detachment rate was 21.7% per eye-year and mortality rate was 11.7% per person-year. At final visit, 60% had VA <20/70 and 35% had VA <20/400. Macular involvement was significantly associated with poor final VA <20/400 (odds ratio = 25.00, P = .016). CONCLUSIONS CMV retinitis without HIV infection was often aggressive at presentation. Significant intraocular inflammation was not uncommon. The long-term visual outcome was poor, especially in those with macular involvement.
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Kheir V, Vaudaux J, Guex-Crosier Y. Review of the latest systemic treatments for chronic non-infectious uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1153425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Clemson CM, Yost J, Taylor AW. The Role of Alpha-MSH as a Modulator of Ocular Immunobiology Exemplifies Mechanistic Differences between Melanocortins and Steroids. Ocul Immunol Inflamm 2016; 25:179-189. [PMID: 26807874 PMCID: PMC5769144 DOI: 10.3109/09273948.2015.1092560] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Melanocortins are a highly conserved family of peptides and receptors that includes multiple proopiomelanocortin-derived peptides and five defined melanocortin receptors. The melanocortins have an important role in maintaining immune homeostasis and in suppressing inflammation. Within the healthy eye, the melanocortins have a central role in preventing inflammation and maintaining immune privilege. A central mediator of the anti-inflammatory activity is the non-steroidogenic melanocortin peptide alpha-melanocyte stimulating hormone. In this review we summarize the major findings of melanocortin regulation of ocular immunobiology with particular interest in the ability of melanocortin to induce immune tolerance and cytoprotection. The melanocortins have therapeutic potential because their mechanisms of action in regulating immunity are distinctly different from the actions of steroids.
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Affiliation(s)
- Christine M Clemson
- a Autoimmune and Rare Diseases , Mallinckrodt Pharmaceuticals , Hayward , CA , USA
| | - John Yost
- a Autoimmune and Rare Diseases , Mallinckrodt Pharmaceuticals , Hayward , CA , USA
| | - Andrew W Taylor
- b Department of Ophthalmology , Boston University School of Medicine , Boston , MA , USA
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