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Hernanz I, Moll-Udina A, Garcia-Tirado A, Garcia-Fernandez M, Gutierrez-Ezquerro R, Garcia-Arumi C, Llorenç V, Cuadros C, Fonollosa A, Sainz-de-la-Maza M, Adán A. The retinal bacillary layer detachment: Clinical features and outcomes in posterior uveitis. J Fr Ophtalmol 2023; 46:916-920. [PMID: 37210295 DOI: 10.1016/j.jfo.2022.12.031] [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] [Received: 11/09/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 05/22/2023]
Abstract
PURPOSE To describe the clinical characteristics, presentation and response to treatment in posterior uveitis patients with bacillary layer detachment (BLD) seen on optical coherence tomography (OCT). MATERIALS AND METHODS Retrospective review of patients with posterior uveitis and SD-OCT scans consistent with BLD. Data collected included demographics, uveitic etiology, treatment and duration of follow-up. Outcome measures included macular volume, central subfoveal thickness and visual acuity. RESULTS Sixteen patients (20 eyes) were included. Twelve were female (75%). The mean age was 43.68 ± 14.7 years. The most frequent etiology of the uveitis was Vogt-Koyanagi-Harada (VKH) disease (n=10), followed by sympathetic ophthalmia (n=2). BLD was bilateral in four patients. Eight patients were treated with intravenous methylprednisolone boluses. Immunosuppressive therapies were required in 8 patients. The mean follow-up was 70 months (range: 2.0-216.0). CONCLUSION BLD was observed in a series of posterior uveitis cases of various etiologies, showing functional and structural resolution with treatment in most cases.
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Affiliation(s)
- I Hernanz
- Department of ophthalmology, Fundación Jiménez Diaz Hospital, Avenue Reyes Católicos 2, 28003 Madrid, Spain.
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Garcia-Tirado
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | | | - C Garcia-Arumi
- Departmentofophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - C Cuadros
- Department of ophthalmology, Oviedo University Hospital, Oviedo, Spain
| | - A Fonollosa
- Department of ophthalmology, Cruces University Hospital, Bilbao, Spain
| | - M Sainz-de-la-Maza
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Hernanz I, Arconada C, López Corral A, Sánchez-Pernaute O, Carreño E. Recurrent Anterior Non-necrotizing Scleritis as an Adverse Event of ChAdOx1 nCoV-19 (Vaxzevria) Vaccine. Ocul Immunol Inflamm 2022; 30:1247-1249. [PMID: 35394853 DOI: 10.1080/09273948.2022.2044058] [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: 10/18/2022]
Abstract
PURPOSE To describe a case of anterior scleritis related to SARS-CoV-2 vaccine. SARS-CoV-2 vaccines appear safe; however vaccination has triggered thromboembolic events in predisposed patients. METHODS A retrospective case report of anterior scleritis in a woman following administration of both ChAdOx1nCoV-19 vaccine doses was studied by complete ophthalmologic examination and complementary tests. RESULTS The patient has overcome SARS-CoV-2 infection a year prior. Ancillary tests including autoimmune and infectious diseases were negative. The chronology between ChAdOx1nCoV-19 vaccine and the sequential episodes of scleritis may have a cause-and-effect relationship. CONCLUSION Ophthalmologists may be aware of scleritis as an ocular manifestation following ChAdOx1nCoV-19 vaccine, in otherwise healthy patients.
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Affiliation(s)
- I Hernanz
- Department of Ophthalmology, Hospital Infanta Elena, Madrid, Spain.,Department of Ophthalmology, Hospital Jiménez Diaz, Madrid, Spain
| | - C Arconada
- Department of Ophthalmology, Hospital Infanta Elena, Madrid, Spain.,Department of Ophthalmology, Hospital Jiménez Diaz, Madrid, Spain
| | - A López Corral
- Department of Ophthalmology, Hospital Infanta Elena, Madrid, Spain.,Department of Ophthalmology, Hospital Jiménez Diaz, Madrid, Spain
| | - O Sánchez-Pernaute
- Department of Ophthalmology, Hospital Infanta Elena, Madrid, Spain.,Department of Ophthalmology, Hospital Jiménez Diaz, Madrid, Spain
| | - E Carreño
- Department of Ophthalmology, Hospital Infanta Elena, Madrid, Spain.,Department of Ophthalmology, Hospital Jiménez Diaz, Madrid, Spain
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Hernanz I, Larque AB, Quintana LF, Espigol-Frigole G, Espinosa G, Adan A, Sainz-de-la-Maza M. Scleritis and sclerokeratitis associated with IgA vasculitis: A case series. Am J Ophthalmol Case Rep 2021; 22:101100. [PMID: 33997470 PMCID: PMC8093897 DOI: 10.1016/j.ajoc.2021.101100] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 10/30/2022] Open
Abstract
Purpose To describe a case series of scleritis associated with IgA vasculitis (IgAV) at a tertiary referral center. Observations Three men with scleritis associated with IgAV were identified: one with anterior scleritis alone, one with anterior scleritis and peripheral ulcerative keratitis (sclerokeratitis), and one with anterior and posterior scleritis. Visual acuity was preserved except from the patient who developed posterior scleritis. Ocular pain was the main symptom at presentation. All patients had a previous history of palpable purpura, but only one was aware of his underlying IgAV. Laboratory results revealed microhematuria and proteinuria with normal urinary β2 microglobulin levels and negative serum ANCAs. Skin or kidney biopsy demonstrated leukocytoclastic vasculitis or glomerulonephritis with dominant IgA immune deposits. Conclusions and Importance Although uncommon, IgAV should be included in the differential diagnosis of anterior scleritis alone or associated with peripheral ulcerative keratitis or posterior scleritis, even in systemically asymptomatic patients. Urinalysis should not be underestimated in assessment of scleritis to detect early stages of glomerular disease. Scleritis may be the first manifestation whose study may lead to the diagnosis of IgAV. Multidisciplinary approach is necessary to prevent irreversible organ damage such as renal failure.
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Affiliation(s)
- I Hernanz
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A B Larque
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L F Quintana
- Department of Nephrology and Renal Transplantation, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - G Espigol-Frigole
- Department of Autoimmune Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - G Espinosa
- Department of Autoimmune Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - A Adan
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - M Sainz-de-la-Maza
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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4
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Hernanz I, Miguel Escuder L, Chamorro L, Moll-Udina A, Espinosa G, Sainz de la Maza M, Llorenç V, Adán A. Tuberculosis-Related Uveitis in Patients under Anti-TNF-alpha Therapy: A Case Series. Ocul Immunol Inflamm 2020; 30:839-844. [PMID: 33216652 DOI: 10.1080/09273948.2020.1834588] [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: 10/23/2022]
Abstract
Tumor necrosis factor inhibitors (anti-TNF) have emerged as an effective treatment in noninfectious uveitis (NIU). Anti-TNF may increase the predisposition to infectious disease as tuberculosis (TB). TB-related uveitis in the context of an uveitogenic concurrent systemic immune-mediated disease under anti-TNF treatment remain a diagnostic challenge, deserving special focus on this rare context. Retrospective chart review of patients on anti-TNF drugs for systemic immune-mediated diseases that developed a multicentric microbiologically confirmed active TB with concurrent intraocular involvement.Three patients were recorded. Screening for TB before starting anti-TNF resulted negative in two patients. The other patient had received anti-tuberculous treatment in the past. All showed a microbiologically confirmed extraocular TB after unexpected atypical reactivation of the uveitis shifting to chronic granulomatous pattern.Specialists should be aware of TB reactivation, even with previous negative screening, when ocular uveitis signs and activity do not match with the expected pattern in a patient on anti-TNF drugs.
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Affiliation(s)
- I Hernanz
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - L Miguel Escuder
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - L Chamorro
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - A Moll-Udina
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - G Espinosa
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - M Sainz de la Maza
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - V Llorenç
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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5
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Hernanz I, Moll-Udina A, Dotti-Boada M, Carrión MT, Llorenç V, Adán A. Non-pharmacological complications associated with Intravitreal dexamethasone implant injection. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:471-477. [PMID: 32654825 DOI: 10.1016/j.oftal.2020.06.005] [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] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Intravitreal dexamethasone implant (IID) is an effective and safe treatment for macular oedema as described in the literature. Ocular hypertension and cataracts are the most frequent complications. The indications of IID in the last few years have led to the retrospective reporting of rare complications, with potential visual impact related to the injection procedure. METHODS A case series is presented of fifteen patients treated with IID for macular oedema who developed non-pharmacological complications related to the injection procedure or the implant itself, including, among others anterior chamber migration, intracrystalline injection, endophthalmitis, or segmentation. Differentiation was made between true complications and those that did not lead to any ocular damage. Epidemiological and baseline data were collected along with the treatment and outcome in each case. An analysis was made of multimodal imaging available. RESULTS The incidence of complications was 0.65% in this series Anterior chamber migration was the most frequent complication (n=4), followed by intracrystalline injection, and endophthalmitis (n=2). The times between the injection and complications were variable. Visual impairment was the most common symptom (n=6). However, despite the complications found, IID was an effective treatment in most of the reported cases. CONCLUSIONS Clinicians should be aware of these rare non-pharmacological complications so that they may be prevented and detected early, avoiding irreversible ocular damage.
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Affiliation(s)
- I Hernanz
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España.
| | - A Moll-Udina
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M Dotti-Boada
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M T Carrión
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - V Llorenç
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - A Adán
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
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Abstract
PURPOSE To report five cases of ocular Toxocariasis (OT) in which ultrawide-field (UWF) imaging was helpful in diagnosis and assessment. OT is an underdiagnosed condition triggered by the ocular invasion of Toxocara larvae. Typical features are peripheral granuloma or endophthalmitis.Methods: A retrospective case series of 10 outpatients were studied by complete ophthalmologic examination and complementary tests. UWF retinal imaging, fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SDOCT) were retrospectively analyzed. Five patients with suspected OT were included.Results: UWF imaging and FAF was able to detect all retinal lesions in a single rapid capture. Two patients showed positive serology for Toxocara. An image suggesting the larva in the vitreous cavity was shown in one patient. Antihelmintic 15 treatment along with steroids was prescribed in two patients.Conclusion: UWF imaging and SDOCT provide a more efficient approach and follow-up in OT, raising final standards of care.
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Affiliation(s)
- I Hernanz
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Belles V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Civera A Adan
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Abstract
A 75-year-old patient presented with a superior vena cava syndrome (SVCS) lasting 3 years. A prostatic carcinoma was found and a supraclavicular lymph node biopsy specimen disclosed metastasis of the prostatic carcinoma. Antiandrogen and luteinizing hormone-releasing hormone analogue therapy produced a marked improvement. Prostatic carcinoma, although a very rare cause, must be considered in the diagnosis of cases of SVCS with a protracted course, since it is a treatable disease.
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Affiliation(s)
- C Montalbán
- Department of Internal Medicine, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
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