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Uludag Kirimli G, Hassan M, Onghanseng N, Or C, Yasar C, Park S, Akhavanrezayat A, Mobasserian A, Yavari N, Bazojoo V, Khojasteh H, Ghoraba H, Karaca I, Trong Tuong Than N, Zaidi M, Nguyen QD. Ocular manifestations and clinical outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU). Eye (Lond) 2024; 38:349-356. [PMID: 37626158 PMCID: PMC10810898 DOI: 10.1038/s41433-023-02695-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE To describe the various ocular clinical features and visual outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU). METHODS The medical records of 13 patients (26 eyes) diagnosed with TINU were reviewed. RESULTS Twenty-six (26) eyes of 13 patients with TINU were reviewed in this study. The median age at onset of uveitis was 14 (range, 9-45). Eight (61.5%) subjects were female. The median follow-up of patients was 30 months (range, 6-89 months). Posterior segment findings were seen in 18 eyes of 9 patients (69.2%). The most common posterior findings were optic nerve head inflammation (16 eyes, 88.8%) and retinal vasculitis (13 eyes, 72.2%). Other posterior findings included vitritis (8 eyes, 44.4%), macular edema (6 eyes, 33.3%), snowball (4 eyes, 22.2%), and chorioretinal lesions (2 eye, 11.1%). Eight patients had fluorescein angiography (FA) data available and most eyes had retinal capillary leakage (13 eyes, 81.2%) followed by optic disc staining/leakage (12 eyes, 75%). Twelve (12) patients (92.3%) were treated with immunomodulatory treatment (IMT) and/or biologics. Five patients (%38.4) required biologics to control intraocular inflammation. CONCLUSION Posterior segment involvement may be common in patients with TINU syndrome. FA provides significant information for detecting posterior segment involvement and disease activity in TINU. The majority of patients required systemic treatment in order to control intraocular inflammation and prevent relapses.
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Affiliation(s)
- Gunay Uludag Kirimli
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Hassan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Neil Onghanseng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Chris Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sungwho Park
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Vahid Bazojoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hassan Khojasteh
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Ngoc Trong Tuong Than
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Moosa Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
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Or C, Lajevardi S, Ghoraba H, Park JH, Onghanseng N, Halim MS, Hasanreisoglu M, Hassan M, Uludag G, Akhavanrezayat A, Nguyen QD. Posterior Segment Ocular Findings in HLA-B27 Positive Patients with Uveitis: A Retrospective Analysis. Clin Ophthalmol 2023; 17:1271-1276. [PMID: 37152636 PMCID: PMC10162386 DOI: 10.2147/opth.s408728] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose To describe the prevalence and characteristics of posterior segment manifestations in patients with HLA-B27-associated uveitis using wide field imaging. Methods Medical records of patients diagnosed with HLA-B27-associated uveitis from a tertiary uveitis clinic were reviewed. Posterior segment involvements including but not limited to peripheral vasculitis, optic disc inflammation, and macula edema documented based on medical records and various imaging modalities including wide field fluorescein angiography and optical coherence tomography, were noted. Demographic characteristics, accompanied with systemic diseases as well as duration and chronicity of uveitis, were also evaluated. Patients with significant systemic and ocular comorbidities were excluded. Statistical analyses including chi-squared tests and paired t-tests were employed. Results Of the 44 patients with HLA-B27 associated uveitis, 22 patients (50%) were noted to demonstrate posterior segment involvement. Disc leakage and peripheral vasculitis were the most common findings of posterior involvement. Those with anterior chamber inflammation were found to have a significantly increased risk of posterior involvement. Those with posterior involvement were also noted to have a statistically significant decreased visual acuity. No significant association was found between documented duration of disease and posterior segment involvement. Conclusion The prevalence of posterior segment involvement in HLA-B27 associated uveitis is higher compared to previous reports when evaluated with wide angle imaging modalities. Careful examination of the posterior segment is required in patients with HLA-B27 associated uveitis.
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Affiliation(s)
- Chris Or
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Jung Hyun Park
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Neil Onghanseng
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
- Department of Ophthalmology, Makati Medical Center, Manila, Philippines
| | | | - Murat Hasanreisoglu
- Department of Ophthalmology, Koç University, School of Medicine, Istanbul, Turkey
| | - Muhammad Hassan
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Gunay Uludag
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | | | - Quan Dong Nguyen
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
- Correspondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute at Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA, Tel +1 650 725 7245, Email
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Ishihara R, Khan Y, Halim MS, Akhavanrezayat A, Onghanseng N, Levin MH, Nguyen QD. Acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis. Am J Ophthalmol Case Rep 2022; 29:101760. [PMID: 36561880 PMCID: PMC9763352 DOI: 10.1016/j.ajoc.2022.101760] [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: 06/02/2022] [Revised: 11/05/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To report the clinical and anatomical features of an unusual case of acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis. Observations A 39-year-old patient, who was a known case of chronic headache with nonspecific visual symptoms for nine years, developed scotomas in her right eye. She was initially diagnosed with AIBSES which had been stable, but later worsened with symptoms of subsequent blind spot enlargement and photopsia on the left eye a year later. Increase in the size of the blind spot over the left eye and stability of the blind spot enlargement over the right eye was documented on Humphrey visual field (HVF) testing. Due to the rapid onset and severity of symptoms, an inflammatory etiology was entertained and this prompted referral to our clinic. At initial presentation, fluorescein angiogram (FA) revealed moderate diffuse vasculitis and disc leakage in the left eye, which existed alongside the enlarged blind spot. Corticosteroid treatment was suggested and initiated. The patient was found to have a reduction in the size of her blind spot and a decrease in severity of retinal vasculitis a month later. Unfortunately, the patient was then lost to follow up and had stopped steroid treatment of her own accord. After nine months without treatment, the patient's blind spot increased to a larger size than her initial presentation, as documented on HVF, with recurrence of vasculitis in the left eye. Conclusion and Importance This is an unusual case of AIBSES which presented with vasculitis and rapid progression and has responded to steroids. Though monocular AIBSES has been shown to later affect the contralateral eye, concurrent vasculitis with AIBSES has not previously been reported. Furthermore, the response to treatment with reduction in blind spot enlargement is unusual for AIBSES. These findings stress the need for regular monitoring in cases of AIBSES.
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Affiliation(s)
- Rhys Ishihara
- University of Texas Medical Branch, Department of Ophthalmology and Visual Sciences, Galveston, TX, USA
| | - Youan Khan
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA,Ocular Imaging Research and Reading Center (OIRRC), Sunnyvale, CA, USA
| | | | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Marc Harris Levin
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA,Corresponding author. Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, 94303, USA.
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Halim MS, Hasanreisoglu M, Onghanseng N, Tran ANT, Hassan M, Yilmaz M, Segawa A, Gurelik G, Afridi R, Ormaechea MS, Uludag G, Kesim C, Nguyen NV, Bae JH, Park JH, Do DV, Ibrahim MA, Sepah YJ, Nguyen QD. Correlation of Clinical Aqueous Flare Grading to Semi-Automated Flare Measurements Using Laser Flare Photometry. Ocul Immunol Inflamm 2022; 30:1906-1912. [PMID: 35081012 PMCID: PMC10863987 DOI: 10.1080/09273948.2021.1971723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare laser flare photometry (LFP) measurements of aqueous flare with Standardization of Uveitis Nomenclature (SUN) and modified SUN grading. METHODS In this prospective study with multicenter design, uveitis patients were classified according to SUN and modified SUN grading scales. LFP was performed with Kowa FM-700 flaremeter. Mean LFP values were compared with SUN and MSUN scores. RESULTS The study included 475 LFP measurements, of which 216, 48, 150, 31, 28 and 2 had 0, 0.5+, 1+, 1.5+, 2+ and 3+ flare, respectively. LFP values were significantly different between each two consecutive steps for both clinical gradings (all P < .05). Cut-off values for modified SUN grading steps were defined as 5.7, 9.7, 15.7 and 43.2 for 0/0.5+, 0.5+/ 1+, 1+/1.5+ and 1.5/2+ borders of clinical flare, respectively. CONCLUSIONS LFP proves to be an objective measurement in analyzing aqueous flare comparable to both SUN and MSUN clinical grading systems.
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Affiliation(s)
- Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Murat Hasanreisoglu
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkey
- KUTTAM, Koç University Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Mervenur Yilmaz
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Asadu Segawa
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Gokhan Gurelik
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Maria Soledad Ormaechea
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Cem Kesim
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkey
| | - Nam V Nguyen
- Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Jeong Hun Bae
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Jung Huynh Park
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Mohamed A Ibrahim
- Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Pham AT, Onghanseng N, Halim MS, Ormaechea MS, Hassan M, Akhavanrezayat A, Uludag G, Tran ANT, Razeen MM, Sredar N, Dubra A, Nguyen QD. Reflectance adaptive optics findings in a patient with Vogt-Koyanagi-Harada disease. Am J Ophthalmol Case Rep 2022; 27:101660. [PMID: 35880207 PMCID: PMC9307596 DOI: 10.1016/j.ajoc.2022.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/25/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To describe the reflectance adaptive optics scanning laser ophthalmoscopy (AOSLO) findings in different stages of Vogt-Koyanagi-Harada (VKH) disease and correlate them to visual gain post treatment. Confocal (cAOSLO) and non-confocal split-detector AOSLO (sdAOSLO) were used to assess longitudinally the status of the photoreceptors in a patient with VKH managed on corticosteroid and immunomodulatory therapy. Observation A 32-year-old Japanese American female presented with a 2-week history of blurred vision in both eyes (OU) and worsening headache previously diagnosed as a case of VKH and treated with high dose oral prednisone. At the time of presentation, though vision was improving, and frank serous retinal detachments were absent, spectral domain optical coherence tomography (SD-OCT) showed presence of residual subretinal fluid with disruption of the photoreceptor inner segments and outer segments (IS/OS) involving OU. The photoreceptor mosaic at the foveal center appeared very sparse with large areas devoid of visible photoreceptors on cAOSLO, in agreement with the SD-OCT data. sdAOSLO imaging over the same location shows a higher number of contiguous photoreceptors. After imaging, the patient was started on mycophenolate mofetil as steroid-sparing long-term therapy. Three months later, visual acuity improved to 20/20 OU, and SD-OCT showed almost complete resolution of subretinal fluid with significant improvement of the IS/OS SD-OCT signal, OU. cAOSLO imaging revealed a contiguous photoreceptor mosaic without gaps and of normal appearance. Conclusions and Importance VKH patients may demonstrate transient photoreceptor abnormalities on SD-OCT and cAOSLO imaging. sdAOSLO imaging revealed intact photoreceptor segments in areas that appeared as voids on cAOSLO, which later showed structural recovery on SD-OCT and cAOSLO. Therefore, sdAOSLO may predict potential for improvement in patients wherein there appears to be photoreceptor loss in cAOSLO and/or SD-OCT.
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Halim MS, Onghanseng N, Park JH, yilmaz M, Segawa A, Ertop M, Hassan M, Tran AN, Aktas Z, Ozdek S, Gurelik G, Do DV, Sepah YJ, Nguyen QD, Hasanreisoglu M. Effect of Fundus Fluorescein Angiography on Semiautomated Aqueous Flare Measurements. Ocul Immunol Inflamm 2022; 30:424-427. [PMID: 32966150 PMCID: PMC10863992 DOI: 10.1080/09273948.2020.1799036] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effects of fluorescein fundus angiography (FFA) on semiautomated aqueous flare measurements. METHODS Laser flare photometer (LFP) measurements was performed at baseline, 30 min, and 4 h after the intravenous administration of sodium fluorescein dye. FFA was performed immediately after the baseline LFP measurement. LFP values at 30 min and 4 h after FFA were compared to baseline values. Mean change in LFP measurements at 30 min and 4 hafter baseline was compared between FFA arm and controls. RESULTS The mean flare measurement in the FFA and control arm dropped 6% (p value = 0.002) and 9% (p value = 0.04), respectively. Mean change in LFP measurement at 30 min and 4 h after baseline was not significant between FFA arm and controls. CONCLUSIONS Administration of fluorescein dye does not increase LFP values. The decrease in the LFP measurement following FFA may be attributed to dilation drops.
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Affiliation(s)
- Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Neil Onghanseng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Jung Hyun Park
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Mervenur yilmaz
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Asadu Segawa
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Mestan Ertop
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Muhammad Hassan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anh Nt Tran
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Zeynep Aktas
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Sengul Ozdek
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Gokhan Gurelik
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Diana V. Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Yasir J. Sepah
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Murat Hasanreisoglu
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkey
- Research Center for Translational Medicine, Koç University, Istanbul, Turkey
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Park JG, Halim MS, Uludag G, Onghanseng N, Sredar N, Sepah YJ, Nguyen QD. Distinct Patterns of Choroidal Lesions in Punctate Inner Choroidopathy and Multifocal Choroiditis Determined by Heatmap Analysis. Ocul Immunol Inflamm 2022; 30:276-281. [PMID: 34228580 PMCID: PMC10889846 DOI: 10.1080/09273948.2021.1939391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A heatmap analysis of choroidal lesions in patients with punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) with or without uveitis was performed to determine if there were any distinguishing features among these uveitic entities. METHODS Retrospective review of medical records was conducted at the Byers Eye Institute, Stanford. Fundus photographs were masked and placed on a standardized template. Lesions were identified and heatmaps were generated in a standardized fashion. RESULTS 30 eyes were identified with PIC or MFC. Heatmap analysis revealed three distinct patterns of fundus lesions: posterior, peripheral, and combined. All patients with PIC had the posterior pattern. Patients with MFC had the peripheral or combined pattern, and all patients with MFC with uveitis had the combined pattern. CONCLUSION Three patterns of fundus lesions were identified in patients with PIC and MFC. PIC and MFC may represent two separate disease entities with distinct phenotypes of choroidal lesions.
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Affiliation(s)
- Jong G Park
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Gunay Uludag
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Nripun Sredar
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
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Abstract
BACKGROUND Posterior blepharitis is common and causes ocular surface and lid damage as well as discomfort. It affects 37% to 47% of all ophthalmology patients; its incidence increasing with age. It is a multifactorial disease associated with multiple other pathologies, such as rosacea, meibomianitis, and infections. Treatment usually focuses on reliefing the symptoms by using artificial tears, lid scrubs, and warm compresses. The condition may be notoriously difficult to manage adequately once it becomes chronic. One such management approach for chronic blepharitis is the use of oral antibiotics for both their antibacterial as well as anti-inflammatory properties. There are currently no guidelines regarding the use of oral antibiotics, including antibiotic type, dosage, and treatment duration, for the treatment of chronic blepharitis. OBJECTIVES To assess the benefits and harms of oral antibiotic use for people with chronic blepharitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2020, Issue 8); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 29 August 2020. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing oral antibiotics with placebo in adult participants with chronic blepharitis (including staphylococcal, seborrhoeic, or Meibomian Gland Dysfunction (MGD)). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and graded the certainty of the body of evidence for six outcomes using the GRADE classification. MAIN RESULTS We included two studies with 220 participants (numbers of eyes unclear). One parallel-group RCT comparing oral doxycycline (40 mg once a day) with placebo enrolled 70 participants with blepharitis and facial rosacea in the USA. Follow-up duration was three months. One three-arm RCT conducted in South Korea investigated the effect of high-dose (200 mg twice a day) and low-dose (20 mg twice a day) doxycycline versus placebo after one month of study medication. It enrolled 50 participants with chronic MGD in each study arm (i.e. 150 participants enrolled in total). The two studies did not evaluate the same outcome measurements, which precluded any meta-analysis. The evidence for the effect of oral antibiotics on subjective improvement in symptoms was very uncertain. One study suggested that there was little to no effect of oral doxycycline on subjective symptoms based on the Ocular Surface Disease Index (OSDI) scores ranging from 0 to 100 (higher score indicates worse condition) (mean difference (MD) 3.55, 95% confidence interval (CI) -4.61 to 11.71; n = 70) and bulbar conjunctival hyperemia ranging from 0 (clear) to 4 (severe) (MD -0.01, 95% CI -0.38 to 0.36; n = 70) at 12 weeks. The three-arm RCT showed that oral doxycycline may slightly improve number of symptoms (MD -0.56, 95% CI -0.95 to -0.17; n = 93 (high-dose doxycycline versus placebo); MD -0.48, 95% CI -0.86 to -0.10; n = 93 (low-dose doxycycline versus placebo)) and proportion of participants with symptom improvement (risk ratio (RR) 6.13, 95% CI 2.61 to 14.42; n = 93 (high-dose doxycycline versus placebo); RR 6.54, 95% CI 2.79 to 15.30; n = 93 (low-dose doxycycline versus placebo)) at one month, but the evidence is very uncertain. We judged the certainty of evidence for subjective symptoms as very low. One study evaluated aqueous tear production by Schirmer's test (mm/5 min) (higher score indicates better condition) and tear film stability by measuring tear film break-up time (TBUT) in seconds (higher score indicates better condition) at one month. We found very low certainty evidence that oral doxycycline may improve these clinical signs. The estimated MD in Schirmer's test score after one month of treatment was 4.09 mm (95% CI 2.38 to 5.80; n = 93) in the high-dose doxycycline group versus the placebo group and 3.76 mm (95% CI 1.85 to 5.67; n = 93) in the low-dose doxycycline group versus the placebo group. The estimated MD in TBUT after one month was 1.58 seconds (95% CI 0.57 to 2.59; n = 93) when comparing the high-dose doxycycline group with the placebo group, and 1.70 seconds (95% CI 0.96 to 2.44; n = 93) when comparing the low-dose doxycycline group with the placebo group. Although there was a noted improvement in these scores, their clinical importance remains uncertain. One study suggested that oral doxycycline may increase the incidence of serious side effects: 18 (39%) participants in the high-dose doxycycline group, 8 (17%) in the low-dose doxycycline group, and 3 (6%) out of 47 participants in the placebo group experienced serious side effects (RR 6.13, 95% CI 1.94 to 19.41; n = 93 (high-dose doxycycline versus placebo); RR 2.72, 95% CI 0.77 to 9.64; n = 93 (low-dose doxycycline versus placebo)). Additionally, one study reported that one case of migraine headache and five cases of headache were observed in the oral doxycycline group, and one case of non-Hodgkin's lymphoma was observed in the placebo group. We judged the certainty of evidence for adverse events as very low. AUTHORS' CONCLUSIONS There was insufficient evidence to draw any meaningful conclusions on the use of oral antibiotics for chronic blepharitis. Very low certainty evidence suggests that oral antibiotics may improve clinical signs, but may cause more adverse events. The evidence for the effect of oral antibiotics on subjective symptoms is very uncertain. Further trials are needed to provide high quality evidence on the use of oral antibiotics in the treatment of chronic blepharitis.
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Affiliation(s)
- Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Sueko M Ng
- Department of Ophthalmology, School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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9
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Uludag G, Onghanseng N, Tran ANT, Hassan M, Halim MS, Sepah YJ, Do DV, Nguyen QD. Current concepts in the diagnosis and management of antiphospholipid syndrome and ocular manifestations. J Ophthalmic Inflamm Infect 2021; 11:11. [PMID: 33834305 PMCID: PMC8032459 DOI: 10.1186/s12348-021-00240-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/24/2020] [Accepted: 03/02/2021] [Indexed: 12/18/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder associated with obstetrical complications, thrombotic complications involving both arteries and veins, and non-thrombotic manifestations affecting multiple other systems presenting in various clinical forms. Diagnosis requires the presence of antiphospholipid antibodies. The exact pathogenesis of APS is not fully known. However, it has recently been shown that activation of different types of cells by antiphospholipid antibodies plays an important role in thrombosis formation. Ocular involvement is one of the important clinical manifestations of APS and can vary in presentations. Therefore, as an ophthalmologist, it is crucial to be familiar with the ocular findings of APS to prevent further complications that can develop. Furthermore, the ongoing identification of new and specific factors contributing to the pathogenesis of APS may provide new therapeutic options in the management of the disease in the future.
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Affiliation(s)
- Gunay Uludag
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA
| | - Neil Onghanseng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA
| | - Anh N T Tran
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA
| | - Muhammad Hassan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.,Ocular Imaging Research and Reading Center, Sunnyvale, CA, USA
| | - Yasir J Sepah
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.,Ocular Imaging Research and Reading Center, Sunnyvale, CA, USA
| | - Diana V Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.
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10
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Sadiq MA, Halim MS, Hassan MM, Onghanseng N, Karaca I, Agarwal A, Afridi R, Sepah YJ, Do DV, Nguyen QD. Retraction Note to: Pharmacological agents in development for diabetic macular edema. Int J Retina Vitreous 2020; 6:65. [PMID: 33372631 PMCID: PMC7720503 DOI: 10.1186/s40942-020-00271-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mohammad Ali Sadiq
- Department of Ophthalmology, University of Louisville, Louisville, KY, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA.,Ocular Imaging Researchs and Reading Center (OIRRC), Sunnyvale, CA, USA
| | - Muha Mmad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA
| | - Irmak Karaca
- Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey
| | - Aniruddha Agarwal
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA.,Ocular Imaging Researchs and Reading Center (OIRRC), Sunnyvale, CA, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA.
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11
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Halim MS, Onghanseng N, Hassan M, Besalti Z, Ng SM, Nguyen QD. Oral antibiotics for chronic blepharitis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013697] [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: 11/10/2022]
Affiliation(s)
| | - Neil Onghanseng
- Byers Eye Institute; Stanford University; Palo Alto California USA
| | - Muhammad Hassan
- Byers Eye Institute; Stanford University; Palo Alto California USA
| | - Zelal Besalti
- Byers Eye Institute; Stanford University; Palo Alto California USA
| | - Sueko M Ng
- Department of Ophthalmology, School of Medicine; University of Colorado; Aurora CO USA
| | - Quan Dong Nguyen
- Byers Eye Institute; Stanford University; Palo Alto California USA
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12
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Sadiq MA, Halim MS, Hassan M, Onghanseng N, Karaca I, Agarwal A, Afridi R, Sepah YJ, Do DV, Nguyen QD. RETRACTED ARTICLE: Pharmacological agents in development for diabetic macular edema. Int J Retina Vitreous 2020; 6:29. [DOI: 10.1186/s40942-020-00234-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 01/10/2023] Open
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13
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Hassan M, Karkhur S, Bae JH, Halim MS, Ormaechea MS, Onghanseng N, Nguyen NV, Afridi R, Sepah YJ, Do DV, Nguyen QD. New therapies in development for the management of non-infectious uveitis: A review. Clin Exp Ophthalmol 2020; 47:396-417. [PMID: 30938012 DOI: 10.1111/ceo.13511] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 11/12/2018] [Revised: 03/16/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
Uveitis is a spectrum of inflammatory disorders characterized by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with high-dose corticosteroids is associated with side effects and cannot be maintained long term. Therefore, steroid-sparing agents are needed to decrease the burden of steroid therapy. Currently, the therapeutic approach for non-infectious uveitis (NIU) consists of a step-ladder strategy with the first-line option being corticosteroids in various formulations followed by the use of first-, second- and third-line agents in cases with suboptimal steroid response. Unfortunately, the agents currently at our disposal have limitations such as having a narrow therapeutic window along with their own individual potential side-effect profiles. Therefore, research has been targeted to identify newer drugs as well as new uses for older drugs that target specific pathways in the inflammatory response. Such efforts are made in order to provide targeted and safer therapy with reduced side effects and greater efficacy. Several specially designed molecular antibodies are currently in various phases of investigations that can potentially halt the inflammation in patients with NIU. In the review, we have provided a comprehensive overview of the current and upcoming therapeutic options for patients with NIU.
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Affiliation(s)
- Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Samendra Karkhur
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Jeong H Bae
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Maria S Ormaechea
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Nam V Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Quan D Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California
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14
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Ormaechea MS, Hassan M, Onghanseng N, Park JH, Mahajan S, Al-Kirwi KY, Uludag G, Halim MS, Schlaen A, Sepah YJ, Do DV, Nguyen QD. Safety of systemic therapy for noninfectious uveitis. Expert Opin Drug Saf 2019; 18:1219-1235. [PMID: 31801415 DOI: 10.1080/14740338.2019.1692810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/08/2023]
Abstract
Introduction: The treatment strategies for noninfectious uveitis (NIU) aim to achieve disease remission, prevention of recurrences, and preserving vision, while minimizing the side effects associated with the therapies used.Areas covered: The index review aims to provide a detailed overview of the adverse events and safety parameters associated with the systemic therapies for the management of the NIU.Expert opinion: Despite being the cornerstone of management of acute cases of NIU, long-term corticosteroid use is associated with multi-system side effects, requiring the use of steroid-sparing agents. Adalimumab was recently approved by the FDA for the management of NIU based on the results of VISUAL studies. Similarly, newer drugs targeting various aspects of the inflammatory cascade are being developed. However, until we completely understand the molecular pathways of the inflammatory diseases, the therapeutic profile of these newer agents needs to be broad enough to suppress inflammatory cascade and narrow enough to spare normal cellular processes. Another strategy that has shown some potential in decreasing the systemic side effects is to provide local drug delivery. Therefore, the future of management of NIU is very bright with many novel therapeutic agents and strategies of drug delivery on the horizon.
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Affiliation(s)
- Maria Soledad Ormaechea
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina.,Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jung Hyun Park
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Khalid Yusuf Al-Kirwi
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Department of Ophthalmology, Imamein Khadhimein Medical City University Hospital, Baghdad, Iraq
| | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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