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Teeuw GJ, Vergouwen DPC, Ramdas WD, Sanchez-Brea L, Andrade De Jesus D, Rothova A, Vingerling JR, Ten Berge JC. Assessment of conjunctival, episcleral and scleral thickness in healthy individuals using anterior segment optical coherence tomography. Acta Ophthalmol 2023. [PMID: 38140822 DOI: 10.1111/aos.16606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To determine the thickness of the conjunctiva, episclera and sclera in healthy individuals using anterior segment optical coherence tomography (AS-OCT). METHODS We prospectively included 107 healthy individuals of different age groups (18-39 years, 40-54 years, 55-69 years and ≥70 years). For each eye, AS-OCT scans of four quadrants (temporal, nasal, superior and inferior) were acquired. The thickness of the conjunctiva, episclera and sclera was measured for each scan. In addition, the axial length of both eyes was measured, and general characteristics, including smoking, allergies and contact lens use, were collected. RESULTS The mean conjunctival thickness was significantly different between the nasal and superior quadrants (87 ± 30 μm vs. 77 ± 16 μm; p < 0.001), as well as the superior and inferior quadrants (77 ± 16 μm vs. 86 ± 19 μm; p = 0.001). The mean episcleral thickness was larger in the superior (174 ± 54 μm) and inferior (141 ± 43 μm) quadrants, compared to the nasal (83 ± 38 μm) and temporal quadrants (90 ± 44 μm). The mean scleral thickness of the inferior quadrant was the largest (596 ± 64 μm), followed by the nasal (567 ± 76 μm), temporal (516 ± 67 μm) and superior (467 ± 52 μm) quadrants (all p < 0.001). The averaged scleral thickness increased 0.96 μm per age year (0.41-1.47 μm, p < 0.001). CONCLUSIONS This study provides an assessment of the thickness of scleral and adjacent superficial layers in healthy individuals determined on AS-OCT, which could enable future research into the use of AS-OCT in diseases affecting the anterior eye wall.
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Affiliation(s)
- G J Teeuw
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W D Ramdas
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Sanchez-Brea
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Andrade De Jesus
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J R Vingerling
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Vergouwen DPC, Ten Berge JC, Boukhrissi S, Rothova A, Schreurs MWJ. Clinical Relevance of Autoantibodies and Inflammatory Parameters in Non-infectious Scleritis. Ocul Immunol Inflamm 2022; 30:1859-1865. [PMID: 34464233 DOI: 10.1080/09273948.2021.1966050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Scleritis is a potentially blinding disorder, with highly unpredictable course and outcome. We analyzed the prevalence and clinical relevance of autoantibodies and inflammatory parameters in non-infectious scleritis. METHODS Retrospective analysis of laboratory findings in all consecutive patients at the department of Ophthalmology of the Erasmus MC with non-infectious scleritis. RESULTS We included 81 patients with non-infectious scleritis. A systemic autoimmune disease was present in 46%. Positive anti-nuclear antibodies were found in 30%, anti-neutrophil cytoplasmic antibodies were positive in 19%, and the presence of rheumatoid factor was shown in 17%. The aforementioned autoantibodies, as well as inflammatory parameters, failed to show prognostic clinical value. In contrast, anti-citrullinated peptide antibodies (ACPA), found in 9% of scleritis patients, were significantly associated with the development of scleral necrosis (P = .01). CONCLUSIONS The presence of ACPA in patients with non-infectious scleritis was associated with the development of scleral necrosis.
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Affiliation(s)
- D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - S Boukhrissi
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M W J Schreurs
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Vergouwen DPC, Ten Berge JC, Naus-Postema NC, Rothova A. Subconjunctival Rituximab Administration for the Treatment of Scleritis. Ocul Immunol Inflamm 2022; 30:1309-1311. [PMID: 35171758 DOI: 10.1080/09273948.2022.2029498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Scleritis is a sight-threatening inflammation, which is commonly accompanied by severe complications. Aggressive systemic immunosuppressive treatment, which is frequently needed, can be associated with serious complications, and might therefore be (temporarily) contraindicated. METHODS We report on the outcomes of three patients with severe, active, non-infectious scleritis, refractory or intolerant to systemic treatment, who received subconjunctival rituximab (RTX) injections. A dose of 2.5 to 7.5 mg was administered after topical anesthesia, and follow-up varied from 8 to 10 months. RESULTS Subconjunctival RTX showed minimal to no effect on subjective symptoms, clinical features and/or ultrasound images. No serious adverse effects occurred. CONCLUSION Further studies are needed to assess the effect of local administration of RTX in scleritis, but our limited observation is not promising.
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Affiliation(s)
- D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - N C Naus-Postema
- Department of Ophthalmology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Vergouwen DPC, Ten Berge JC, Rothova A. Recurrences of Scleritis after Ocular Surgery. Ocul Immunol Inflamm 2021; 30:1029-1030. [PMID: 33545011 DOI: 10.1080/09273948.2020.1855357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- D P C Vergouwen
- Departments of Ophthalmology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J C Ten Berge
- Departments of Ophthalmology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A Rothova
- Departments of Ophthalmology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Vergouwen DPC, Rothova A, Berge JCT, Verdijk RM, van Laar JAM, Vingerling JR, Schreurs MWJ. Current insights in the pathogenesis of scleritis. Exp Eye Res 2020; 197:108078. [PMID: 32504648 DOI: 10.1016/j.exer.2020.108078] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
Scleritis is a sight-threatening inflammation characterized by severe pain and redness of the eye. It can cause blindness by severe complications like scleral and corneal necrosis, keratitis, and uveitis. The pathogenesis of scleritis is largely unknown due to a combination of the rarity of the disease, the little available human tissue-based research material, and the lack of animal models. The immune system is assumed to play a crucial role in the pathogenesis of scleritis. Multiple clues indicate probable antigenic stimuli in scleritis, and the involvement of matrix metalloproteinases in the destruction of scleral tissue. In this article we review the current insights into the pathogenesis of scleritis, and we suggest new hypotheses by implementing knowledge of systemic autoimmune disease pathogenesis. Understanding the pathogenesis of scleritis is crucial to improve the clinical management, as well as to find novel treatment modalities.
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Affiliation(s)
- D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R M Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A M van Laar
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Section Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J R Vingerling
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Abstract
Purpose: To present a rare case of scleritis associated with a prior diagnosis of giant cell arteritis (GCA) that was unresponsive to glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), methotrexate, and azathioprine, but reached and maintained a full remission with tocilizumab.Observations: A 62-year-old Caucasian female presented with scleritis and headache. Four years earlier, the patient was diagnosed with GCA. Treatment with topical and systemic NSAIDs, prednisone and diverse disease-modifying antirheumatic drugsonly had a partial effect on the scleritis whilst the arthralgia and headaches increased. Despite the absence of laboratory evidence of active GCA, tocilizumab was started and the scleritis and headaches disappeared within several days. Prednisone could be fully tapered within 3 months and to date, 12 months after the start of tocilizumab, the patient has maintained a sustained remission.Conclusions: Our patient demonstrates that tocilizumab might represent a therapeutic option for scleritis, and its further evaluation for this severe ocular disease is worthwhile.
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Affiliation(s)
- Huub J Poelman
- Department of Ophthalmogy, Erasmus MC, Rotterdam, The Netherlands
| | - Paul L A Van Daele
- Internal Medicine, Section Allergology & Clinical Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmogy, Erasmus MC, Rotterdam, The Netherlands
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Groen-Hakan F, Van Der Eijk A, Rothova A. The Usefulness of Aqueous Fluid Analysis for Epstein–Barr Virus in Patients with Uveitis. Ocul Immunol Inflamm 2018; 28:126-132. [DOI: 10.1080/09273948.2018.1543709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F. Groen-Hakan
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A.A. Van Der Eijk
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A. Rothova
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
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La Distia Nora R, Sitompul R, Bakker M, Susiyanti M, Edwar L, Sjamsoe S, Singh G, van Hagen MP, Rothova A. Tuberculosis and other causes of uveitis in Indonesia. Eye (Lond) 2018; 32:546-554. [PMID: 29099497 PMCID: PMC5848274 DOI: 10.1038/eye.2017.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/10/2017] [Indexed: 12/18/2022] Open
Abstract
PurposeThe purpose of this study is to assess the causes of uveitis in Indonesia and determine the importance of tuberculosis (TB) as a cause of uveitis.Patients and methodsProspective cohort study examining 146 consecutive new human immunodeficiency virus-negative patients with active uveitis between June 2014 and May 2015. We assessed the anatomic locations and specific causes of uveitis, as well as associations with infectious and non-infectious systemic diseases. We determined the prevalence of positive QuantiFERON Tb Gold test (QFT) results in Indonesian patients with uveitis and calculated the number of patients with active systemic TB.ResultsPosterior and panuveitis were the most common anatomic entities (38% each). Infections represented the most frequent cause of uveitis (33%); the most prevalent were toxoplasmosis (19%) and active systemic TB (8%). The majority of patients were QFT positive (61%). A specific diagnosis could not be established in 45% of the patients. At first presentation to the ophthalmologist, the majority of patients (66%) had a visual acuity of less than finger counting at 3 m and already exhibited various complications of uveitis. When classifying the QFT-positive patients with unexplained uveitis into a TB-related group, the percentage of 'TB-associated' uveitis cases increased from 8-48%. Highly elevated QFT levels were observed in patients with uveitis of unknown cause and no signs of active systemic TB.ConclusionsIn Indonesia, infectious uveitis was the most common type of uveitis and the leading causes consisted of toxoplasmosis and TB. The association observed between highly elevated QFT results and uveitis of otherwise unexplained origins indicates that a link exists between the latent TB infection and the development of uveitis.
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Affiliation(s)
- R La Distia Nora
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
- Department of Clinical Immunology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Sitompul
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - M Bakker
- Department of Pulmonary Diseases, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Susiyanti
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - L Edwar
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - S Sjamsoe
- Faculty of Medicine, Department of Ophthalmology, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - G Singh
- Respirology and Critical Illness Division, Department of Internal Medicine, University of Indonesia and Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - M P van Hagen
- Department of Clinical Immunology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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Affiliation(s)
- Z. Fazil
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J. C. Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A. W. Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A. Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - W. A. Dik
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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de Visser L, de Boer J, Rijkers G, Wiertz K, van den Ham H, de Boer R, van Loon A, Rothova A, de Groot-Mijnes DF. Cytokines and Chemokines Involved in Acute Retinal Necrosis. ACTA ACUST UNITED AC 2017; 58:2139-2151. [DOI: 10.1167/iovs.16-20799] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- L. de Visser
- Department of Ophthalmology, Utrecht University, Utrecht, The Netherlands 2Department of Medical Microbiology, Utrecht University, Utrecht, The Netherlands
| | - J.H. de Boer
- Department of Ophthalmology, Utrecht University, Utrecht, The Netherlands
| | - G.T. Rijkers
- Department of Science, University College Roosevelt, Middelburg, The Netherlands 4Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - K. Wiertz
- Department of Ophthalmology, Utrecht University, Utrecht, The Netherlands
| | - H.J. van den Ham
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - R. de Boer
- Theoretical Biology & Bioinformatics, Utrecht University, Utrecht, The Netherlands
| | - A.M. van Loon
- Department of Medical Microbiology, Utrecht University, Utrecht, The Netherlands
| | - A. Rothova
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - D. F. de Groot-Mijnes
- Department of Ophthalmology, Utrecht University, Utrecht, The Netherlands 2Department of Medical Microbiology, Utrecht University, Utrecht, The Netherlands
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Hermans LE, Oosterheert JJ, Kampschreur LM, Ossewaarde-van Norel J, Dekkers J, Rothova A, de Groot-Mijnes JDF. Molecular and Serological Intraocular Fluid Analysis ofCoxiella burnetii-seropositive Patients with Concurrent Idiopathic Uveitis. Ocul Immunol Inflamm 2014; 24:77-80. [DOI: 10.3109/09273948.2014.925123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | - J. Dekkers
- Department of Virology,
- Department of Ophthalmology,
| | - A. Rothova
- Department of Ophthalmology,
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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Kalinina Ayuso V, ten Cate HAT, van den Does P, Rothova A, de Boer JH. Young age as a risk factor for complicated course and visual outcome in intermediate uveitis in children. Br J Ophthalmol 2010; 95:646-51. [DOI: 10.1136/bjo.2010.184267] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sijssens KM, Los LI, Rothova A, Schellekens PAWJF, van de Does P, Stilma JS, de Boer HJ. Long-term ocular complications in aphakic versus pseudophakic eyes of children with juvenile idiopathic arthritis-associated uveitis. Br J Ophthalmol 2010; 94:1145-9. [DOI: 10.1136/bjo.2009.167379] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Clement DS, Postma G, Rothova A, Grutters JC, Prokop M, de Jong PA. Intraocular sarcoidosis: association of clinical characteristics of uveitis with positive chest high-resolution computed tomography findings. Br J Ophthalmol 2009; 94:219-22. [DOI: 10.1136/bjo.2009.161588] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- J H de Boer
- FC Donders Institute of Ophthalmology, University Medical Center Utrecht, E.03.401, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Visser N, Rothova A, de Groot-Mijnes JDF, de Visser L. Searching for intraocular antibody production against Parvovirus B19, Mumps virus and Measles virus in patients with intermediate and posterior uveitis. Br J Ophthalmol 2009; 93:841-2. [DOI: 10.1136/bjo.2008.150607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vidovic-Valentincic N, Kraut A, Hawlina M, Stunf S, Rothova A. Intermediate uveitis: long-term course and visual outcome. Br J Ophthalmol 2008; 93:477-80. [DOI: 10.1136/bjo.2008.149039] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pathanapitoon K, Kunavisarut P, Ausayakhun S, Sirirungsi W, Rothova A. Uveitis in a tertiary ophthalmology centre in Thailand. Br J Ophthalmol 2008; 92:474-8. [DOI: 10.1136/bjo.2007.132175] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Groot-Mijnes JDF, ten Dam-van Loon NH, Weersink AJL, van Loon AM, Rothova A. [Relationship between rubella virus and Fuchs heterochromic uveitis; 2 patients]. Ned Tijdschr Geneeskd 2007; 151:2631-2634. [PMID: 18161266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Two otherwise healthy men, aged 26 and 29 years, were diagnosed with Fuchs heterochromic uveitis (FHU) on the basis of the presence of iris heterochromia or iris atrophy, stellate corneal precipitates, and/or cataract. Microbiological investigation of aqueous humour demonstrated intraocular antibody production against rubella virus, but not against Toxoplasma gondii, herpes simplex virus or varicella zoster virus. Microbial nucleic acid detection was negative for all pathogens. Some time later, both patients underwent cataract surgery, which improved their vision considerably. FHU is a chronic, generally unilateral iridocyclitis, accompanied by the above-mentioned ophthalmologic manifestations in the absence of systemic disease. Little is known about the pathogenesis ofFHU, but recent publications have provided evidence for the possible involvement of the rubella virus.
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Pathanapitoon K, Suksomboon S, Kunavisarut P, Ausayakhun S, Wattananikorn S, Leetrakool N, Rothova A. HLA-B27-associated acute anterior uveitis in the University Referral Centre in North Thailand: clinical presentation and visual prognosis. Br J Ophthalmol 2006; 90:1448-50. [PMID: 16899524 PMCID: PMC1857526 DOI: 10.1136/bjo.2006.099788] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2006] [Indexed: 01/20/2023]
Abstract
BACKGROUND Acute anterior uveitis (AAU) is the most frequent type of uveitis encountered in the west. Although human leucocyte antigen (HLA)-B27-associated ankylosing spondylitis was reported in South East Asia, it is not known whether HLA-B27-associated ocular disease is prevalent in Thailand. METHODS A prospective study of 100 unrelated blood donors and 121 consecutive patients with AAU was carried out. All people underwent HLA-B27 typing and full ocular examination. Radiological examination of the sacroiliac joints was conducted in patients with low back pain or arthralgias. RESULTS The prevalence of HLA-B27 was 10% among the blood donors in contrast with 44% in the AAU group (p<0.001). The clinical characteristics of HLA-B27-associated AAU were similar to those published throughout the world (unilaterality in 74%, hypopyon in 31%, recurrent AAU in 64%). However, the increased intraocular pressure (IOP) was more common in the HLA-B-27-negative group (p = 0.03) than in their HLA-B27-positive counterparts. At least 15% of the HLA B27-positive group had radiological signs of ankylosing spondylitis. CONCLUSION The prevalence of HLA-B27 in the population without uveitis in Thailand is about 10% and clinical characteristics of HLA-B27-positive AAU are similar to those reported in the west. In contrast with earlier reports, HLA-B27-negative AAU in Thailand was associated with increased IOP and should be further studied.
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Affiliation(s)
- K Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Chiang Mai 50200, Thailand.
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Abstract
PURPOSE To determine ophthalmologic and systemic factors associated with the presence of cystoid macular oedema (CMO) in patients with uveitis. METHODS Retrospective cross-sectional study in which 97 consecutive patients with uveitis filled in an extensive questionnaire for the presence of cardiovascular diseases and its risk factors. An analysis of the ophthalmologic and questionnaire data was conducted. RESULTS CMO was present in 44% (43/97) of patients. Its presence was strongly associated with increasing age (P=0.001) and age at onset of uveitis (P<0.001). For patients older than 50 years, the risk of having CMO was 3.8-fold (95% confidence intervals 1.6-9.0) larger than for younger patients. The most frequent anatomic location of uveitis associated with CMO was panuveitis (49%). Papillary leakage on fluorescein angiography was associated with CMO (P<0.001), independently of other risk factors. After adjustment for age, multivariate logistic regression showed no association between cardiovascular disease and its risk factors and the presence of CMO. CONCLUSIONS Age, independent of duration of uveitis, was a major risk factor for the presence of CMO in uveitis. A positive correlation between CMO and papillary leakage on angiography was noted.
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Affiliation(s)
- B van Kooij
- Department of Ophthalmology, FC Donders Institute of Ophthalmology, University Medical Center, Utrecht, The Netherlands. b.vankooij@ oogh.azu.nl
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de Groot-Mijnes J, van Loon A, Zuurveen S, Martinus R, de Visser L, Weersink A, Rothova A. Identification of new pathogens involved in infectious uveitis. J Clin Virol 2006. [PMCID: PMC7172614 DOI: 10.1016/s1386-6532(06)80732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Probst K, Fijnheer R, Schellekens P, Rothova A. Intraocular and plasma levels of cellular fibronectin in patients with uveitis and diabetes mellitus. Br J Ophthalmol 2004; 88:667-72. [PMID: 15090421 PMCID: PMC1772136 DOI: 10.1136/bjo.2003.026542] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2003] [Indexed: 01/06/2023]
Abstract
AIMS To determine intraocular and plasma levels of cellular fibronectin (cFN) in patients with uveitis or diabetes mellitus (DM) and to assess the association with disease activity, macular oedema, and vascular leakage on fluorescein angiography. In addition, to examine whether cFN is locally produced in the eye. METHODS Intraocular and plasma levels of cFN were determined by ELISA in 39 patients with uveitis (23 active, 16 non-active), in 11 patients with DM (eight with and three without diabetic retinopathy) and in 17 control patients. The influence of diabetic retinopathy, inflammatory activity, vascular leakage, and macular oedema (MO) on intraocular and plasma cFN levels was studied. Local production of cFN was determined by calculating absolute and relative intraocular to plasma ratios. Aqueous and vitreous levels of cFN were compared. RESULTS No differences in plasma cFN levels were found between patients with uveitis, DM, or controls. Intraocular cFN levels were significantly raised in patients with uveitis and DM, specifically in those with active disease (active uveitis and active diabetic retinopathy versus controls: p = 0.001 and 0.002 respectively). Further, intraocular cFN levels were significantly elevated in patients with macular oedema or vascular leakage, irrespectively of whether associated with uveitis or DM (p = 0.001 and 0.002). Intraocular cFN levels were consistently higher in the vitreous than the aqueous. Intraocular production of cFN was documented by elevated absolute and relative intraocular to plasma ratios in nine out of 11 patients tested. CONCLUSIONS Elevated intraocular cFN levels were found in uveitis and DM, especially in those with active processes, intraocular vascular damage, and MO. These results suggest that locally produced cFN levels reflect intraocular vascular damage.
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Affiliation(s)
- K Probst
- FC Donders Institute of Ophthalmology, University Medical Center, Utrecht, Netherlands.
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Abstract
AIMS To investigate the manifestations and severity of uveitis in children and to identify the risk and specific causes of blindness in this population. METHODS Retrospective study of data of 123 consecutive patients examined with active uveitis and the onset of ocular disease before the age of 16 years. Numerous variables were assessed including age and sex distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features and complications, therapeutic strategies and their outcomes, final visual acuity, and characteristics associated with poor visual outcome. RESULTS Systemic disease was observed in 36/123 patients (29%), with juvenile idiopathic arthritis being the most frequent (25/123, 20%). Toxoplasma retinochoroiditis was diagnosed in 12/23 patients with posterior uveitis (52%; 10% of all with uveitis). Severe intraocular inflammation required systemic drugs in 57 (46%) patients. Ocular complications were observed in 93 patients (76%), of which the most common was cataract (43/123, 35%). Intraocular surgery was required in 35 patients (28%; in total 75 procedures). Three patients (2%) became legally blind and an additional 20/121 (17%) had one legally blind eye caused by uveitis. The most frequent causes of blindness were chorioretinal scars in the macular area and glaucoma in contrast with cystoid macular oedema (CMO) in adults. CONCLUSIONS Uveitis in childhood is a potentially blinding disease, in the majority of patients characterised by a chronic course and a high complication rate.
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Affiliation(s)
- J de Boer
- FC Donders Institute of Ophthalmology, University Medical Center, Utrecht, Netherlands.
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Abstract
AIM To report on eight patients with severe idiopathic intermediate uveitis (IU) and granuloma annulare (GA), a self limiting cutaneous condition of unknown aetiology. METHODS Retrospective case series. Clinical ophthalmic and dermatological data were studied and fluorescein angiography and skin biopsies were reviewed. RESULTS All patients with idiopathic IU had similar ocular features (eight with vitritis, seven with retinal vasculitis) and developed complications such as cystoid macular oedema (n=5), cataract (n=4), and glaucoma (n=3). Systemic diseases were not found, but a localised type of GA was observed in all. CONCLUSION Seven out of eight patients with IU and GA developed severe retinal vasculitis. Further studies are needed for a better understanding of this association, a common pathogenesis, and its eventual clinical consequences.
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Affiliation(s)
- B van Kooij
- Department of Ophthalmology, FC Donders Institute, University Hospital Utrecht, The Netherlands.
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Rothova A. Lung adenocarcinoma and malignant uveitis masquerade syndrome: author reply. Ophthalmology 2001. [DOI: 10.1016/s0161-6420(01)00831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
BACKGROUND Incorrect diagnosis of the uveitic masquerade syndromes (UMS) may have severe consequences. In this study, the frequency, clinical manifestations, and informative diagnostic tests for UMS are described. DESIGN Retrospective observational case series. PARTICIPANTS Forty patients with UMS were identified in a cohort of 828 consecutive patients with uveitis. The mean follow-up was 4.5 years. METHODS A review of clinical, laboratory, photographic, and angiographic records was performed. MAIN OUTCOME MEASURES Clinical features, associated systemic diseases, diagnostic procedures and their role in the diagnostic process, and systemic and visual outcomes. RESULTS Nineteen patients had intraocular malignancy (48% of all with UMS; 2.3% of all with uveitis), mainly intraocular lymphoma (n = 13) and leukemia (n = 3). The ophthalmologist was the first to recognize malignant disease in 11 of 19 patients (58%). Of 21 patients with nonmalignant UMS, 10 had an ocular vascular disease and 5 a hereditary ocular disorder. The patients with malignant UMS were older than those with nonmalignant UMS (average age, 50 vs 44 years, P: < 0.05). During follow-up, 9 of 19 patients with malignant UMS died. The most informative diagnostic procedure for malignant UMS was intraocular fluid analysis; for nonmalignant UMS, fluorescein angiography. The cytologic analysis of intraocular fluids yielded the best results for diagnosing intraocular malignancies (7 of 11 patients, 64%); the association of negative cytologic results with the recent administration of systemic corticosteroids was noted. Immunophenotyping of the aqueous confirmed the diagnosis of hematologic malignancy for 3 of 5 patients examined. Panuveitis was the most frequent manifestation of malignant UMS. Intraocular lymphomas presented with isolated vitreitis (n = 6), chorioretinal lesions (n = 5) and iris infiltration (n = 2). Clinical presentation of nonmalignant UMS was diverse but consisted mainly of abnormalities of the retinal vasculature. CONCLUSIONS UMS was diagnosed in 5% of the patients with uveitis at a tertiary center. Despite the variety of underlying disorders and different clinical presentations, a high frequency of malignant and vascular diseases was found. Awareness of the clinical manifestations of UMS and application of the correct diagnostic procedures should promote timely diagnosis and treatment, which are essential not only for visual acuity but also for the life of the patient.
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Affiliation(s)
- A Rothova
- F.C. Donders Institute of Ophthalmology, University Medical Center, Utrecht, The Netherlands.
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Lardenoye CW, Probst K, DeLint PJ, Rothova A. Photoreceptor function in eyes with macular edema. Invest Ophthalmol Vis Sci 2000; 41:4048-53. [PMID: 11053311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
PURPOSE The irreversible loss of visual acuity in macular edema is usually attributed to permanent loss of photoreceptor cells, although there is hardly any information on changes in photoreceptor function in macular edema. The purpose of this study was to assess photoreceptor function in various stages of macular edema and to relate the findings to visual acuity and angiographic changes. METHODS Directional sensitivity (optical Stiles-Crawford effect) and visual pigment density of foveal cones was measured with a custom-built scanning laser ophthalmoscope (SLO) in 19 eyes of 19 patients. Twelve eyes exhibited macular edema: five of inflammatory origin, and seven of diabetic origin. Seven eyes with an intraocular inflammatory disease without clinical or angiographic evidence of edema were also included (four of which had previous macular edema and one of which had shown development of macular edema at the 1-year follow-up). Results of SLO measurements were related to findings using fluorescein angiography and Snellen visual acuity, both assessed at the time of SLO measurement and 6 months thereafter. RESULTS Eyes with macular edema exhibited diminished directional sensitivity of photoreceptor cells in the fovea compared with eyes without (P = 0.02). Visual pigment density of eyes with macular edema was decreased and associated with both initial and follow-up visual function and with the angiographic macular edema grade at follow-up. Abnormal directional sensitivity and pigment density were already present in eyes with slight edematous changes and normal visual acuity. CONCLUSIONS Eyes with inflammatory or diabetic macular edema showed decreased directional sensitivity and visual pigment density in the macular area. These findings may support a role for SLO measurements in detecting retinal damage due to macular edema.
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Affiliation(s)
- C W Lardenoye
- Department of Ophthalmology, F. C. Donders Institute, University Hospital Utrecht, The Netherlands.
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Abstract
AIM To investigate the frequency of HLA-B27 in patients with presumed Bartonella henselae associated uveitis and to describe the clinical characteristics of HLA-B27 positive patients with uveitis and presumed ocular bartonellosis (POB). METHODS The diagnosis of POB was considered in 19 patients with unexplained uveitis (except for the HLA-B27 association) and high positive IgG (titre >/=1:900) and/or IgM (titre >/=1:250) antibodies against B henselae. In addition to B henselae serology and HLA-B27 typing, all patients underwent an extensive standard diagnostic screening procedure for uveitis and in all cases the results were within the normal limits. The control group consisted of 25 consecutive patients with panuveitis and negative B henselae serology. RESULTS HLA-B27 was positive in six of the 19 patients (32%) with POB in contrast to the 4% frequency of HLA-B27 in the control group (p=0.03) and 8% prevalence of HLA-B27 in the Dutch population (p=0.003). At the time of positive Bartonella serological testing five of six HLA-B27 positive patients with POB had severe posterior segment involvement with papillitis, macular oedema, and vitreitis. The duration of intraocular inflammatory activity was more than 6 months in five HLA-B27 positive patients. Although four of the six HLA-B27 positive patients had previous recurrent attacks of acute anterior uveitis, the clinical presentation at the time of positive Bartonella serology differed, as illustrated by the involvement of the posterior segment and chronic course of the ocular disease. CONCLUSIONS The frequency of HLA-B27 in patients with uveitis and serological characteristics of acute infection with B henselae is higher than in the general Dutch population. The findings of this study also suggest a relation between infection with Bartonella species and HLA-B27.
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Affiliation(s)
- F T Kerkhoff
- Department of Ophthalmology, FC Donders Institute, University Hospital, 3508 GA Utrecht, Netherlands.
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Van der Lelij A, Ooijman FM, Kijlstra A, Rothova A. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: a distinct clinical entity among herpetic eye diseases. Ophthalmology 2000; 107:1164-70. [PMID: 10857838 DOI: 10.1016/s0161-6420(00)00115-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To determine the cause and describe the clinical features of unilateral anterior uveitis with sectoral atrophy of the iris in the absence of associated keratitis. DESIGN Retrospective, observational case series. PARTICIPANTS Thirty-one patients with unilateral anterior uveitis with sectoral iris atrophy and without (previous) keratitis. METHODS The patients were selected from our database of 592 patients with anterior uveitis. MAIN OUTCOME MEASURES We reviewed the clinical data on the 31 patients and the results of diagnostic anterior chamber fluid analysis for 24 of the 31 patients. Specifically, production of local antibodies against herpes simplex virus (HSV) and varicella zoster virus (VZV) was determined and the polymerase chain reaction was performed to demonstrate the DNA of HSV, VZV, and cytomegalovirus (CMV) in the aqueous samples. RESULTS Main clinical characteristics of anterior uveitis with iris atrophy included unilateral involvement with a prolonged course and recurrent exacerbations in all cases. Elevated intraocular pressure during intraocular inflammation occurred in 90% of patients (28 of 31). Visual outcome was favorable because 29 of 31 patients (94%) retained a visual acuity of 20/32 or more. The causal agent was identified as HSV in 83% (20 of 24) and VZV in 13% (3 of 24) and was inconclusive in one case. The patients with HSV uveitis were younger than those with VZV uveitis (mean age at onset 34 and 65 years, respectively; P = 0.0056). CONCLUSIONS Unilateral anterior uveitis with sectoral atrophy of the iris without associated (previous) keratitis is a distinct entity among herpetic eye diseases. Recurrent unilateral anterior uveitis with iris atrophy and/or elevated intraocular pressure has most likely been caused by HSV.
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MESH Headings
- Adolescent
- Adult
- Age of Onset
- Aged
- Antibodies, Viral/analysis
- Aqueous Humor/virology
- Atrophy
- Child
- DNA, Viral/analysis
- Eye Infections, Viral/complications
- Eye Infections, Viral/virology
- Female
- Herpes Simplex/complications
- Herpes Simplex/virology
- Herpes Zoster Ophthalmicus/complications
- Herpes Zoster Ophthalmicus/virology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/immunology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Humans
- Intraocular Pressure
- Iris/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Retrospective Studies
- Uveitis, Anterior/diagnosis
- Uveitis, Anterior/etiology
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Affiliation(s)
- A Van der Lelij
- Department of Ophthalmology, University Medical Centre, Utrecht, The Netherlands
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Rothova A. Comment on 'Posterior segment inflammation in HLA-B27+ acute anterior uveitis: clinical characteristics'. Ocul Immunol Inflamm 2000; 8:73-5. [PMID: 10896457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Affiliation(s)
- A Rothova
- Department of Ophthalmology, FC Donders Institute, University Medical Centre, Utrecht, PO Box 85 500, 3508 GA Utrecht, Netherlands
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Abstract
PURPOSE To report on the clinical course and prognosis of retinal breaks and detachment occurring in patients with ocular toxoplasmosis. DESIGN Retrospective cross-sectional observational study. PARTICIPANTS One hundred fifty consecutive patients with ocular toxoplasmosis. INTERVENTION A review of all records of patients with ocular toxoplasmosis who had consulted our department from 1990 through 1997 was performed. MAIN OUTCOME MEASURES The presence of retinal detachment or breaks and possible risk factors, such as age, myopia, the interval between the last recurrence of inflammation and the onset of retinal detachment, severity of vitritis, previous treatment methods, and the location of the retinal abnormalities, were analyzed. RESULTS We found a frequency of 6% (9/150) for retinal detachment and an additional 5% (7/150) for retinal breaks among our patients with ocular toxoplasmosis. Attacks of active ocular toxoplasmosis preceding the retinal detachment or retinal breaks were characterized by severe intraocular inflammation. The frequency of myopia in our patients with retinal detachment or retinal breaks was significantly higher than in patients with ocular toxoplasmosis without retinal detachment or retinal breaks. The functional prognosis for the patients with retinal detachment was poor; legal blindness (visual acuity < or = 20/200) resulting from retinal detachment occurred in five of the nine patients. CONCLUSIONS Careful retinal examination in ocular toxoplasmosis is warranted, especially in patients with myopia and severe intraocular inflammation.
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Affiliation(s)
- L H Bosch-Driessen
- Donders Institute of Ophthalmology, University Hospital Utrecht, The Netherlands
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Abstract
ABSTRACT
We describe the clinical and laboratory features of a 55-year-old human immunodeficiency virus-negative female patient who presented with bilateral intraocular inflammatory disease (neuroretinitis type) and behavioral changes caused by a
Bartonella grahamii
infection. Diagnosis was based on the PCR analysis of DNA extracted from the intraocular fluids. DNA analysis of the PCR product revealed a 100% identity with the 16S rRNA gene sequence of
B. grahamii
. The patient was successfully treated with doxycycline (200 mg/day) and rifampin (600 mg/day) for 4 weeks. This is the first report that demonstrates the presence of a
Bartonella
species in the intraocular fluids of a nonimmunocompromised patient and that indicates that
B. grahamii
is pathogenic for humans.
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Affiliation(s)
- F T Kerkhoff
- Department of Ophthalmology, F. C. Donders Institute, University Hospital, Utrecht, The Netherlands.
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Ongkosuwito JV, Bosch-Driessen EH, Kijlstra A, Rothova A. Serologic evaluation of patients with primary and recurrent ocular toxoplasmosis for evidence of recent infection. Am J Ophthalmol 1999; 128:407-12. [PMID: 10577580 DOI: 10.1016/s0002-9394(99)00266-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify the frequency of recently acquired vs chronic systemic Toxoplasma gondii infections in patients with ocular toxoplasmosis. METHODS Serum samples from 22 patients with primary ocular toxoplasmosis (not from scars) and 42 patients with recurrent ocular toxoplasmosis were tested for the presence of anti-T. gondii IgM, IgG, and IgA antibodies and compared with samples from 24 patients with other causes of uveitis. Intraocular production of anti-T. gondii IgG and IgA, and the presence of T. gondii DNA was determined in patient s and control subjects from whom ocular fluid was available. RESULTS Serologic evidence of recently acquired infection was found for 11 (50%) of 22 patients with primary ocular toxoplasmosis and for one (2%) of 42 with recurrent ocular toxoplasmosis. In the uveitis control group, anti-T. gondii IgM antibodies could be detected in two (8%) of 24 patients, but anti-T. gondii IgA antibodies were not detectable. Patients with primary ocular toxoplasmosis and serologic markers of recently acquired systemic infection were significantly older than those with chronic infection (P = .008). Intraocular production of anti-T. gondii IgG was more frequently noted in patients with recurrent than primary ocular toxoplasmosis (81% vs 41%; P < .001), but intraocular T. gondii DNA was more frequently found in patients with primary ocular toxoplasmosis than in those with recurrent ocular toxoplasmosis (37% vs 4%; P < .01). CONCLUSIONS Primary ocular toxoplasmosis can be seen in either recently acquired or chronic T. gondii infection. Patients with ocular disease and recently acquired infection were older and more likely to have T. gondii DNA in intraocular fluids.
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Affiliation(s)
- J V Ongkosuwito
- Department of Ophthalmology, Academic Medical Center, Netherlands Ophthalmic Research Institute, Amsterdam.
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Abstract
PURPOSE Although recurrences are typical of congenital toxoplasmosis, the long-term ocular manifestations in postnatally acquired toxoplasmosis have never been systematically studied. We report on the ocular manifestations complicating the chronic phase of postnatally acquired toxoplasmosis. METHODS Review of the clinical data of 14 patients who presented with active ocular toxoplasmosis not associated with scars and who had serologic characteristics of recently acquired systemic toxoplasmosis. RESULTS Mean follow-up was 4.6 years. Recurrent ocular disease developed in eight (57%) of 14 cases. The number of patients with recurrences increased with the follow-up time: four (29%) of 14 during the first year of follow-up; eight (57%) of 14 during the second year; and eight of nine during the third follow-up year. No risk factors for the development of recurrences were identified. Satellite lesions developed in five of eight patients with recurrences, whereas lesions not adjacent to old scars, located in areas of previously unaffected retina, developed in three patients. CONCLUSIONS In postnatally acquired toxoplasmosis, frequent recurrences of ocular disease can be seen during the chronic phase of infection.
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Affiliation(s)
- E H Bosch-Driessen
- F.C. Donders Institute of Ophthalmology, University Hospital Utrecht, The Netherlands.
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Abstract
AIM To investigate whether serum levels of soluble intercellular adhesion molecule 1 (sICAM-1) can serve as a marker of the presence of systemic disease in intermediate uveitis. METHODS In a multicentre study sICAM-1 serum levels were measured in 61 patients with idiopathic intermediate uveitis, controls included 56 uveitis patients with a systemic disease (26 sarcoid associated uveitis and 30 HLA-B27 positive acute anterior uveitis), 58 uveitis patients without systemic disease (30 toxoplasma chorioretinitis and 28 Fuchs' hetrochromic cyclitis), and 21 normal controls. The clinical records of the patients with intermediate uveitis were analysed for disease characteristics at the time of blood sampling and for a relation with the development of a systemic disease after a mean follow up of 4.5 years. RESULTS Increased serum levels of sICAM-1 were found in 34 out of 61 patients with intermediate uveitis and were significantly different when compared with toxoplasmosis, Fuchs' cyclitis, and healthy controls (p<0.001). Elevated sICAM-1 levels were also found in 18 out of 26 patients with sarcoid uveitis and in 11 out of 30 patients with HLA-B27 associated anterior uveitis. Raised sICAM-1 levels in the intermediate uveitis group were significantly associated with active ocular disease (p<0.01) and the presence of vitreous exudates (p<0.05). Increased levels of sICAM-1 correlated with interleukin 8 levels (IL-8) (tested in a previous study in the same group of intermediate uveitis patients) in patients with active systemic involvement. Follow up of the patients showed that an established or suspected systemic disease was found more often in the 21 intermediate uveitis patients with increased sICAM-1 and IL-8 levels compared with the other 40 patients with intermediate uveitis (p<0.01). CONCLUSIONS The measurement of both sICAM-1 and IL-8 can be used as a marker for ocular disease activity and for a predisposition of developing an associated systemic disease in intermediate uveitis patients.
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Affiliation(s)
- A M Klok
- Department Ophthalmo-Immunology, Netherlands Ophthalmic Research Institute, Amsterdam
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Abstract
PURPOSE To investigate the immunoglobulin classes associated with the intraocular anti-Toxoplasma gondii antibody response during clinical ocular toxoplasmosis and to determine which immunoglobulin class is most helpful in the diagnosis of this disease. METHODS Paired serum and intraocular fluid samples from 155 patients who had uveitis were tested for intraocular anti-T. gondii IgG, IgA, and IgM antibody production. The presence of T. gondii DNA was determined by polymerase chain reaction. Patients were divided into two groups, based on the initial clinical diagnosis; group 1 included 78 patients with presumed ocular toxoplasmosis, and group 2 included 77 patients with uveitis that was not clinically suspected to be ocular toxoplasmosis. Samples from 27 nonuveitis patients who underwent intraocular surgery were used as control subjects. The final diagnosis was based on the clinical course and interpretation of laboratory tests. RESULTS A final diagnosis of ocular toxoplasmosis was made in 88 of 155 patients (group 1, 68; group 2, 20). Among these patients, 65% had intraocular IgG production, 52% had intraocular IgA production, 37.5% had both IgG and IgA production, 27% had IgG production only, and 15% had IgA production only. Of the 13 patients tested, only one had intraocular IgM production. Intraocular IgA could not be detected in patients who had final diagnoses other than ocular toxoplasmosis or in control subjects. A positive polymerase chain reaction combined with a test that was positive for intraocular IgG production had a sensitivity of 77%, which increased to 91% after the detection of intraocular IgA production was added. CONCLUSIONS Immunoglobulin G is the major class involved in the humoral immune response against the T. gondii parasite, followed by IgA. The determination of IgA production is useful as an additional test in the diagnosis of ocular toxoplasmosis.
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Affiliation(s)
- M J Ronday
- Netherlands Ophthalmic Research Institute, Amsterdam
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Abstract
BACKGROUND The spectrum of diseases caused by Bartonella henselae continues to expand and ocular involvement during this infection is being diagnosed with increasing frequency. METHODS The clinical features and visual prognosis for 13 patients with intraocular inflammatory disease and laboratory evidence of bartonellosis were investigated. There were nine patients with neuroretinitis and four with panuveitis with positive antibody titres against B henselae determined by an enzyme immunoassay (IgG exceeding 1:900 and/or IgM exceeding 1:250). RESULTS Positive IgG levels were found for eight patients and positive IgM levels for five. Despite animal exposure of 10 patients, only two (IgG positive) cases had systemic symptoms consistent with the diagnosis of cat scratch disease. Pathological fluorescein leakage of the optic disc was observed in all affected eyes. At 6 months' follow up, 3/18 (17%) affected eyes had a visual acuity of less than 20/100, owing to optic disc atrophy and cystoid macular oedema. 12 patients (17 eyes) were treated with antibiotics; visual acuity improved two or more Snellen lines for 9/17 (53%) eyes. CONCLUSIONS The possibility of B henselae infection should be considered in patients with neuroretinitis and panuveitis (especially in cases with associated optic nerve involvement) even in the absence of systemic symptoms typical for cat scratch disease.
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Affiliation(s)
- F T Kerkhoff
- Department of Ophthalmology, FC Donders Institute, University Hospital Utrecht, Netherlands
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Abstract
AIMS To investigate the efficacy of azithromycin in patients with ocular toxoplasmosis. METHODS 11 immunocompetent patients with ocular toxoplasmosis were treated with azithromycin (500 mg the first day, followed by 250 mg/day for 5 weeks). Ocular and systemic examinations were performed during active retinitis episodes and all patients were followed for at least 1 year. RESULTS The intraocular inflammation disappeared within 4 weeks in seven patients, including two cases with progressive retinitis despite previous treatment with pyrimethamine, sulphadiazine, and folinic acid. Recurrence of retinitis occurred in three patients (27%) within the first year of follow up. No systemic side effects of azithromycin were encountered. CONCLUSION These results indicate that although azithromycin cannot prevent recurrent disease it may be an effective alternative for patients with ocular toxoplasmosis who cannot tolerate standard therapies.
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Affiliation(s)
- A Rothova
- Department of Ophthalmology, FC Donders Institute, Academic Hospital Utrecht, Netherlands
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Njoo FL, Rothova A, Van Der Lelij A. Progressive outer retinal necrosis in a patient with cutaneous non-Hodgkin's T cell lymphoma (Sézary syndrome). Br J Ophthalmol 1998; 82:1218-9. [PMID: 9924317 PMCID: PMC1722367 DOI: 10.1136/bjo.82.10.1215d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
PURPOSE To determine the role of Bartonella henselae in intraocular inflammatory disease and identify its clinical features. METHODS We retrospectively determined the serum immunoglobulin (Ig)G and IgM antibodies against B. henselae and Bartonella quintana by enzyme immunoassays in stored sera of 138 consecutive newly referred patients with uveitis who, during the acute stage of their ocular disease, underwent a standardized screening protocol to determine the cause of uveitis. RESULTS For the entire series, the frequency of high positive levels of IgG (above 1:900) or IgM (above 1:300) antibody against B. henselae was 6% (8/138) and 3% (4/138), respectively. Except for cross-reactions between B. henselae and B. quintana, we did not find additional evidence for cross-reactions among the various bacteria tested (Coxiella burnetii and Chlamydia pneumoniae). All patients with proven infectious uveitis (n = 21) and those with established uveitic entities (n = 37) had negative B. henselae serology. High positive IgG levels were observed in 9% of patients (5/54) with unknown cause of uveitis, in two subjects with human leukocyte antigen (HLA)-B27 positive uveitis, and in one with sarcoidosis. Five patients with uveitis of unknown origin and highly elevated IgG levels against B. henselae exhibited clinical features characterized by papillitis with surrounding retinal focal lesions or edema. CONCLUSIONS The serologic and clinical data indicate that uveitis in seropositive cases may be caused by B. henselae. We do not recommend including testing for B. henselae in initial screening of patients with uveitis, but consider it worthwhile for those with papillitis and screening results within normal limits.
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Affiliation(s)
- A Rothova
- Department of Ophthalmology, F.C. Donders Institute, Academic Hospital Utrecht, The Netherlands
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Lardenoye CW, van Schooneveld MJ, Frits Treffers W, Rothova A. Grid laser photocoagulation for macular oedema in uveitis or the Irvine-Gass syndrome. Br J Ophthalmol 1998; 82:1013-6. [PMID: 9893590 PMCID: PMC1722763 DOI: 10.1136/bjo.82.9.1013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine the effect of modified macular grid photocoagulation in patients with refractory macular oedema due to uveitis or cataract extraction. METHODS In this study 20 patients with macular oedema underwent modified macular grid laser photocoagulation and were followed by means of standardised examinations (day 0, months 2, 6, and 12) consisting of best corrected visual acuity and fluorescein angiography. RESULTS The mean visual acuity increased from 0.16 before to 0.3 after laser treatment (p = 0.013), and fluorescein leakage was significantly reduced (p = 0.005). Visual prognosis was influenced by duration of the uveitis, not by sex or age. CONCLUSION Modified macular grid laser photocoagulation had a beneficial effect on macular oedema caused by uveitis or the Irvine-Gass syndrome. A prospective, randomised study is needed to determine the exact place of modified macular grid photocoagulation in the treatment of patients with inflammatory or postsurgical macular oedema.
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Affiliation(s)
- C W Lardenoye
- Department of Ophthalmology, FC Donders Institute, University Hospital Utrecht, Netherlands
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Affiliation(s)
- E H Bosch-Driessen
- Donders Institute of Ophthalmology, University Hospital Utrecht, Netherlands
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Klok AM, Luyendijk L, Zaal MJ, Rothova A, Hack CE, Kijlstra A. Elevated serum IL-8 levels are associated with disease activity in idiopathic intermediate uveitis. Br J Ophthalmol 1998; 82:871-4. [PMID: 9828768 PMCID: PMC1722703 DOI: 10.1136/bjo.82.8.871] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To find a laboratory indicator for systemic involvement in intermediate uveitis. METHODS Interleukin 8 (IL-8) and C reactive protein (CRP) serum levels were measured in patients with idiopathic intermediate uveitis (n = 61), uveitis controls (n = 143), and normal controls (n = 29). The records of those with intermediate uveitis were reviewed with the emphasis on disease activity and severity as characterised by the presence of cystoid macular oedema, vitreous exudates or snowbank formation, papillitis, and periphlebitis. RESULTS Increased serum IL-8 (> or = 20 pg/ml) was found in 27 out of 61 patients with intermediate uveitis (p < 0.01), 12 of 27 patients with sarcoid uveitis (p < 0.05), in 19 of 30 patients with HLA-B27 associated acute anterior uveitis (p < 0.05), and in five of 29 healthy controls. Raised IL-8 levels in intermediate uveitis were significantly associated with active disease (p < 0.001) and the presence of vitreous exudates (p < 0.001), papillitis, and periphlebitis (p < 0.01). Elevated CRP levels were found in 12 of the 143 uveitis controls but in none of the intermediate uveitis patients or normal controls. During follow up an associated systemic disease was more frequently noticed in patients with an elevated serum IL-8 at entry into the study. CONCLUSIONS Elevated IL-8 serum levels were found in patients with active intermediate uveitis of unknown origin. An elevated IL-8 level seems to predispose the patient to a later development of associated systemic disease.
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Affiliation(s)
- A M Klok
- Department of Ophthalmo-Immunology, Netherlands Ophthalmic Research Institute, Amsterdam
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Abstract
OBJECTIVE This study aimed to describe the clinical presentation, angiographic findings, and natural history of acquired arterial macroaneurysms diagnosed in 8 of 48 patients with peripheral multifocal chorioretinitis (PMC) (panuveitis with multiple peripheral punched-out chorioretinal lesions). DESIGN A retrospective case-control study. PARTICIPANTS Forty-eight consecutive patients with PMC, consisting of 13 patients with histologically or radiologically proven sarcoidosis, 11 with laboratory evidence of (presumed) sarcoidosis, and 24 with no evidence of systemic disease, participated in the study. INTERVENTION A review of the clinical, photographic, and angiographic records was performed. MAIN OUTCOME MEASURES Arterial macroaneurysms, clinical symptoms, and associations with systemic disease were measured. RESULTS Of 48 patients with PMC, 8 (17%) had arterial macroaneurysms: 3 (38%) of 8 with histologically proven sarcoidosis, 1 (20%) of 5 with radiologically proven sarcoidosis, 2 (18%) of 11 with laboratory evidence of sarcoidosis, and 2 (8%) of 24 patients with no evidence of systemic sarcoidosis. All eight patients were white females older than 60 years of age. Macroaneurysms appeared to be unrelated to the systemic hypertension (5 of 17 compared to 3 of 31; P = 0.11); however, the frequency of cerebrovascular accidents or myocardial infarctions was higher among those with macroaneurysms (5 of 8 vs. 2 of 40; P = 0.0000). Three of the eight patients reported visual complaints related to macroaneurysms; only one patient required laser treatment. Fluorescein angiography showed no evidence of previous vasculitis in the involved area. CONCLUSIONS Arterial macroaneurysms, which occur in elderly female patients with PMC, are associated with severe cardiovascular disease. Whether the macroaneurysms are a complication of an inflammatory vascular process remains speculative.
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Affiliation(s)
- A Rothova
- Department of Ophthalmology, FC Donders Institute, Academic Hospital Utrecht, The Netherlands
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Abstract
OBJECTIVE The purpose of the study is to delineate the clinical features, complications, visual prognosis, and associated systemic diseases of peripheral multifocal chorioretinitis. DESIGN The study design was a retrospective study. PARTICIPANTS Of 828 patients with uveitis, 53 patients (6.4%) fulfilled all 3 of the following criteria: (1) the presence of multiple (>10), small, round, punched-out lesions in the peripheral retina; (2) the absence of central chorioretinal lesions; and (3) an associated intraocular inflammatory reaction. RESULTS The majority of patients were elderly white females with bilateral ocular involvement. The presenting symptoms consisted of vitreitis and/or iritis, papillitis, and numerous retinal punched-out lesions in the periphery. On initial examination, the complications included cystoid macular edema (CME) (48%), glaucoma (25%), and cataracts (19%), resulting in a mean visual acuity of 20/80. After more than 2 years of follow-up, CME was found in 72% and cataract in 62% of the affected eyes. Submacular neovascularization never developed. The final mean visual acuity was 20/60; this was mainly dependent on the presence of CME (eyes with CME; visual acuity was 20/80, eyes without CME; visual acuity was 20/50). In 25% of patients, an association with sarcoidosis was observed (histologic and radiologic diagnoses), and an additional 29% of patients had elevated serum angiotensin-converting enzyme levels. CONCLUSIONS Within the spectrum of multifocal chorioretinitis, the authors have defined a distinct clinical entity of peripheral multifocal chorioretinitis. The recognition of this clinical entity may be valuable because of its specific symptoms, prognosis, and association with sarcoidosis.
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Affiliation(s)
- C W Lardenoye
- Department of Ophthalmology, F.C. Donders Institute, University Hospital Utrecht, The Netherlands
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Abstract
BACKGROUND Differentiation between infectious and non-infectious uveitis is of crucial value for accurate management of patients with uveitis. Tests performed on aqueous humour yield more relevant information than those done in serum. The objective of this study was to evaluate whether the aqueous humour tap for diagnostic purposes is a safe procedure to perform in uveitis patients. METHODS In this retrospective study 361 patients with uveitis, who underwent a diagnostic anterior chamber paracentesis in an outpatient clinic, were investigated. 72 of the 361 patients were examined 30 minutes after the puncture. The site of the paracentesis, the depth of the anterior chamber, and cells in the anterior chamber were examined. All 361 patients were evaluated within 2 weeks after the paracentesis was performed. The final follow up period varied from 6 months to more than 3 years. The clinical data were analysed with the emphasis on the occurrence of cataract and a history of corneal infections or endophthalmitis. RESULTS In this series no serious side effects such as cataract, keratitis, or endophthalmitis were observed. The depth of the anterior chamber of all evaluated patients was restored after 30 minutes. In five out of 72 cases (three AIDS patients with cytomegalovirus retinitis and two patients with anterior uveitis due to herpes simplex virus) a small hyphaema was observed 30 minutes after the paracentesis took place. CONCLUSION Anterior chamber paracentesis appears to be a safe procedure in the hands of an experienced ophthalmologist.
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Affiliation(s)
- A Van der Lelij
- Department of Ophthalmology, F C Donders Institute, University Hospital Utrecht, Netherlands
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