Cases Of Posterior Uveitis Research Articles

The retinal bacillary layer detachment: Clinical features and outcomes in posterior uveitis

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). 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. Sixteen patients (20eyes) were included. Twelve were female (75%). The mean age was 43.68±14.7years. 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 8patients. The mean follow-up was 70months (range: 2.0-216.0). BLD was observed in a series of posterior uveitis cases of various etiologies, showing functional and structural resolution with treatment in most cases.

Practice patterns regarding regional corticosteroid treatment in noninfectious Uveitis: a survey study

BackgroundRegional corticosteroid therapy for noninfectious uveitis is well-established but usage patterns have not been studied extensively. This study aims to assess practice patterns of retina and uveitis specialists regarding their preferences on the use of local corticosteroid therapy.MethodsA 13-question survey was developed regarding the practice patterns of regional corticosteroid use in specific situations and populations. The survey was distributed to both the American Uveitis Society and Macula Society.ResultsResponses from 87 ophthalmologists were analyzed. The two most commonly used drugs were the dexamethasone intravitreal implant (Ozurdex®) and posterior sub-tenon’s triamcinolone (also known as posterior sub-Tenon’s Kenalog, or PSTK). Regional corticosteroids were used more frequently as first-line treatment in more than half of posterior uveitis cases when compared to anterior uveitis (39.1–46.0% vs 10.3%, respectively). Respondents were more willing to use regional corticosteroids in more than half of unilateral uveitis cases than in bilateral cases (54.7% vs 18.6%, respectively). A majority of respondents (67.1%) stated that they would avoid using regional corticosteroids in patients under 8 years old.ConclusionsOur results demonstrate more frequent regional corticosteroid use in posterior segment uveitis, unilateral cases, and avoidance in younger pediatric patients. Overall, the variability in these responses highlights the need for guidelines regarding regional corticosteroid use.

Analysis of the clinical diagnosis and treatment of uveitis.

Uveitis is a not uncommon potentially sight-threatening intraocular inflammatory disorder and a major cause of blindness worldwide. Early diagnosis and effective treatment are very important to reduce complications and protect vision. In a retrospective series, we enrolled 263 (390 eyes) consecutive uveitis patients, comprising 126 males and 137 females. The clinical types of uveitis, treatment efficacy, complications and visual prognosis were evaluated by detailed clinical examination, laboratory tests and treatment observation. There were 101 cases of panuveitis (38.4%), 85 cases of anterior uveitis (32.3%), 75 cases of posterior uveitis (28.5%), and 2 cases of intermediate uveitis (8%). There was a statistically significant difference in (I) visual acuity between the acute and recovery periods (F=13.12, P<0.05); (II) visual acuity between first-time and recurrent patients (F=9.26, P<0.05); (III) visual acuity in the affected and healthy eyes in the total, anterior and posterior uveitis groups (P<0.05); and (IV) the presence of ocular complications. There was also a statistically significant difference in the presence or absence of ocular complications between patients with initial disease and those with a recurrence of disease (F=59.51, P<0.05). In all its varying presentations, uveitis has a great impact on visual acuity. A careful clinical history should be taken and specific laboratory tests should be performed in order to improve the diagnosis and determine the etiology, and practitioners should provide appropriate treatment to avoid ocular complications, which can further damage visual acuity.

Intraocular pressure fluctuation following intravitreal dexamethasone implant and incidence of secondary ocular hypertension: a Zambian perspective.

Introductionto evaluate the effect of dexamethasone biodegradable implant (DEX-I), on intraocular pressure (IOP), to determine the incidence of secondary ocular hypertension (OHT) and to analyze the IOP changes as per the treatment indication in Zambian cohort.Methodsretrospective consecutive case series of patients receiving one DEX-I between January 2016 and September 2018 with a minimum follow-up of four months in a tertiary care centre in Zambia. The IOP was recorded before the injection and at 1st week, 1st, 2nd, 3rd and 4th month after the injection. Ocular hypertension was defined as IOP ≥ 21 mmHg or an increase of ≥ 10 mmHg from baseline.Resultsthe effects of 122 injections given to ninety - nine patients (65 male: 65%; mean age 57.3) were included. The main indications for treatment were diabetic macular edema (DME, 52%), retinal vein occlusion (18%), post-surgical macular edema (18%) and non-infectious posterior uveitis (10%). Mean IOP before the injection was was 14.7mmHg and at 1st week, 1st, 2nd, 3rd and 4th months after the injection it was 14.4 (p=0.08), 16.1 (p=0.01), 17.5 (p<0.001), 15.7 (p=0.006) and 14.9 (p=0.06) mmHg, respectively. The incidence of secondary OHT was 30.32% in this cohort. Peak incidence of OHT was between 1 - 2 months, with majority of cases in DME group (75%) and 43% diabetic eyes followed by 23% non-infectious posterior uveitis cases developing OHT post injection. OHT was well managed with anti-glaucoma medications only.ConclusionDEX-I showed a good pressure tolerance in this cohort. Secondary ocular hypertension developed in one-third of patients receiving injection which was transient and successfully managed with topical anti-glaucoma medications only. Diabetic eyes are more prone to develop ocular hypertension and therefore needs close monitoring following injection.

Serpiginous choroiditis: a complex pharmacotherapeutic approach

Serpiginous choroiditis is a rare recurrent eye disorder which is characterized by formation of irregularly shaped (serpiginous) lesions involving two layers of the eye surface (the retinal pigment epithelium and the choriocapillaris). It is a rare clinical entity which causes less than 5% of posterior uveitis cases (3.9/1, 00,000 person-years). Diagnosing this rare disorder is a challenge in itself followed by its complex pharmacotherapeutic approach which is seen in the following case report. It will aid in bringing to light the various challenges faced in treatment to open a window for early diagnosis and better treatment regimens while keeping in mind the constant motivation and relaxed mind a patient needs to fight such a rare disease.

Advanced Birdshot Chorioretinopathy Presenting as Chronic Cystoid Macular Edema and Vitritis Following Cataract Surgery

Purpose: The purpose of this case report is to present a case of birdshot chorioretinopathy in an elderly woman who presented with postoperative macular edema and vitritis following cataract surgery. Methods: A retrospective case report was compiled of the use of optical coherence tomography, scanning laser ophthalmoscopy, fluorescein angiography, and wide-angle fundus photography to document exam findings. Results: An 81-year old woman presented with steroid-resistant bilateral cystoid macular edema and vitritis following cataract surgery. Clinical testing, including serum HLA-A29, was suggestive of birdshot chorioretinopathy. Pars plana vitrectomy with membrane peeling was performed, and the patient was started on both steroid-sparing immunomodulatory therapy and systemic corticosteroids. Her macular edema improved and her disease progression stabilized. Conclusions: To the best of the authors’ knowledge, this is the oldest patient diagnosed with birdshot chorioretinopathy to be reported in the literature. The unusual initial presentation following cataract extraction highlights the importance of diagnostic vigilance when facing an unusual case of posterior uveitis.

Demographic and Clinical Features of Pediatric Uveitis in Israel

ABSTRACT Purpose: To report the epidemiology, etiology, ocular characteristics, treatment and visual outcome of pediatric uveitis in Israel. Methods: Retrospective study from two tertiary uveitis centers. Results: Included were 107 patients (182 eyes), 55% females. Mean age at diagnosis 8.8 years. Uveitis was predominantly anterior, idiopathic, bilateral, and chronic. Systemic associations were seen in 36% of patients of which the most common disease was juvenile idiopathic arthritis. Infectious uveitis accounted for 37% of posterior uveitis cases of which toxoplasmosis was the most common cause. Anterior segment complications were commonly observed at presentation (41%); the most predominant were posterior synechiae, cataract, and band keratopathy. The most common posterior segment complications were papillitis, epiretinal membrane, and macular atrophy/scar. Ninety-three percent of eyes had visual acuity >20/40 at last follow-up. Conclusion: The pattern of pediatric uveitis in Israel is similar to that in the western world. Visual outcome was good in most eyes.

Infliximab for the treatment of posterior uveitis with retinal neovascularization in Behet disease.

To report a case of posterior uveitis with retinal neovascularization in a patient with Behet disease treated with infliximab. A 50-year-old man with a history of recurrent relapses of ocular inflammation despite immunosuppressive therapy developed retinal neovascularization near the optic disk. The patient was treated with infliximab and followed up for 12 months. Retinal neovascularization regressed 8 months after the first antitumor necrosis factor (TNF) treatment and with six infusions of infliximab. The ocular inflammation resolved almost completely. The result suggests that anti-TNF therapy may be effective in the treatment of retinal neovascularization caused by panuveitis in Behet disease. (Eur J Ophthalmol 2004; 14: #-8).

Pattern of posterior uveitis in a tertiary care government eye hospital in South India

Background: The spectrum of uveitis cases is largely influenced by genetic, geographic, and environmental factors. The causes and types of posterior uveitis cases in patients attending a Tertiary Care Eye Hospital, attached to Government Medical College, in a major South Indian city catering to two important states were studied. Aim: To analyze the pattern of posterior uveitis in a tertiary care government eye hospital. Design: Retrospective noncomparative case series. Materials and Methods: A retrospective analysis of 101 posterior uveitis cases attending the retina/uvea outpatient department of a major government eye hospital, seen between January 2014 and June 2015, was done to know the clinical pattern of the posterior uveitis entities. A comprehensive eye examination with a tailored laboratory investigations approach was used to arrive at a diagnosis. Results: Of the 101 patients, there were 56 (55.5%) males and 45 (44.5%) females, in the age group of 15–65 years. A specific diagnosis could be established in 75% of the patients, including infections in 19 cases (18%), specific ocular disease in 45 cases (44.5%). Idiopathic group comprised 25 cases (24.75%). In the infective group, tuberculosis was more than toxoplasmosis. Vogt-Koyanagi-Harada (VKH) cases, presenting as posterior uveitis, comprised 19 cases (18.8%). Conclusion: Tuberculosis and toxoplasmosis were the common infective causes, and VKH, multifocal choroiditis, and serpiginous choroidopathy were the common noninfective entities.

Pattern of Pediatric Uveitis at a Tertiary Referral Institute in North India

ABSTRACTPurpose: To report the pattern of pediatric uveitis in a tertiary care referral center in North India.Methods: In a retrospective study, records of pediatric uveitis cases presenting at our center between 1996 and 2015 were reviewed for demographic data, anatomic distribution, and diagnosis.Results: Out of 9600 patients with uveitis, 369 children (3.84%; age ≤16 years; males: 54.20%) were included in the study. Anterior uveitis was the commonest presentation (n = 158; 42.81%), followed by posterior uveitis (n = 102; 27.64%). Uveitis was bilateral in 57.18% (n = 211). Infective etiology was seen in 99 children, of which tuberculosis was the commonest cause (n = 55; 14.91%). Among non-infectious etiologies, juvenile idiopathic arthritis (JIA) was the commonest cause (n = 59; 15.99%).Conclusions: While anterior uveitis is the commonest uveitis in children, our cohort reported a high number of posterior uveitis cases compared to previous studies. Tuberculosis and JIA were the commonest causes of pediatric uveitis.

PRESUMED POSTERIOR UVEITIS RELATED TO EHRLICHIA EXPOSURE

To describe a case of posterior uveitis with retinal vasculitis related to Ehrlichia exposure. Single case report of a 68-year-old woman with posterior uveitis, steroid-induced glaucoma, and retinal holes. Ehrlichia titers were elevated 4-fold (1:256; normal <1:64) with an otherwise normal laboratory workup. The patient's cystoid macular edema responded to sub-Tenon's triamcinolone and oral doxycycline. To our knowledge, this is the first case of posterior uveitis associated with Ehrlichia reported in humans.

Clinical characteristics of 1215 cases with uveitis

Objective To analyze the clinical character of uveitis in second hospital of Jilin university. Methods Retrospectively analyze the clinical data of uveitis patients referred to from Second Hospital of Jilin University from September 2009 to September 2014. According to anatomical location, the manifestation of these uveitis patients were divided into anterior uveitis, panuveitis, intermediate uveitis and posterior uveitis. To discuss the possible causes of these patients according to the general information and relevant clinical laboratory examinations results. Results There were 1215 cases in this study, which included 587 male, accounting for 48.31%; and 628 female, accounting for 51.69%. The ratio of male-to-female was 0.93∶1. The range of the age of these patients was from 4 to 91 years old. The mean age of these patients at the onset of these disease was (41.43±14.20) years. Of the 1215 cases, 40 male and 43 female were younger than 20 years. The ratio of male-to-female was 0.93∶1; 412 male and 396 female were between 21 and 50 years old. The ratio of male-to-female was 1.04∶1; 135 male 189 female were older than 50 years. The ratio of male-to-female was 0.71∶1. There were 572 cases of anterior uveitis, accounting for 47.08%; 527 cases of panuveitis, accounting for 43.37%; 52 cases of intermediate uveitis, accounting for 4.28%; 64 cases of posterior uveitis, accounting for 5.27%. 703 cases had etiological diagnosis according to the clinical character and the auxiliary results, accounting for 57.68%. Vogt-koyanagi Haradal (VKH) syndrome, ankylosing spondylitis associated with uveitis and Behcet's disease were the common entity, accounting for 30.44%, 19.77% and 14.22% respectively. Conclusions The mean age of these patients in this study was older, compared to other reports. Female patients were more than male, especially in these patients older than 50 years. VKH syndrome, ankylosing spondylitis associated with uveitis and Behcet's disease were the common entities. Key words: Uveitis/etiology; Uveitis/classification; Disease attributes

Trends in Patterns of Posterior Uveitis and Panuveitis in a Tertiary Institution in Singapore

Purpose: The study aims to analyze the trends of posterior uveitis and panuveitis patients seen by a tertiary eye center in Singapore between 2004 and 2012.Methods: We conducted a retrospective analysis of 363 consecutive new cases of posterior uveitis and panuveitis. The cases were segregated into idiopathic, infectious, or noninfectious.Results: We found statistically significant differences between etiologies and ethnicity (p = 0.014). We noticed a statistically significant downward trend (Spearman's rho (ρ) = −0.812, p = 0.008) for dengue uveitis, and an upward trend for the idiopathic category (Spearman's rho (ρ) = 0.753, p = 0.019).Conclusions: We observed differences between etiologies and ethnicity, pointing toward potential susceptibility variations. There was an upward trend of idiopathic causes, possibly due to better control of systemic and infectious etiologies. The dengue uveitis incidence correlates well with our national statistics. The downward trend of dengue uveitis could be due to the introduction of Singapore's dengue surveillance in 2005, emphasizing the importance of controlling the disease.

A posterior uveitis of sarcoid etiology

In the article, a clinical case of posterior uveitis with peripheral choroiditis of sarcoid etiology is described, where the ophthalmic lesion turned up to be the first sarcoidosis manifestation. A posterior uveitis with its choroidal granulomas in comparison with an anterior uveitis is less frequent but more spectacular for the diagnosis of this disease.

Central serous chorioretinopathy misdiagnosed as posterior uveitis: frequency and consequences

AbstractPurpose Central serous chorioretinopathy (CSC) is one of the differential diagnoses to be kept in mind in case of posterior uveitis. Its diagnosis is of utmost importance as CSC misdiagnosed as posterior uveitis can worsen related to the prescription of corticosteroid therapy. The purpose of this study was to determine the proportion of cases of CSC misdiagnosed as a posterior uveitis.Methods Charts of patients seen in the section of inflammatory eye diseases at the Centre for Opththalmic Specialised Care (COS) in Lausanne, Switzerland seen from 1995 to 2011 were reviewed and referred cases of CSC misdiagnosed as posterior uveitis were studied.Results In a collective of 1268 patients seen from 1995 to 2011 at the COS, 12 patients (0.95%) with CSC were misdiagnosed as posterior uveitis. Erroneous diagnoses were Ocular tuberculosis in 3 cases, Vogt‐Koyanagi‐Harada disease in 2 cases, lupus (LED) in one case and undetermined uveitis in 3 cases. In 3 cases CSC developed following corticosteroid therapy for uveitis (2) or systemic inflammatory disease (1) and was misdiagnosed as worsening of the underlying inflammatory disease. Bad functional outcome was proportional to the diagnostic delay of CSC. The most useful means to diagnose CSC retrospectively was either the original angiography, especially indocyanine green angiography (ICGA), or OCT.Conclusion CSC is not a rare misdiagnosis in posterior uveitis representing a percentage of nearly 1% in a total collective of uveitis cases but reaching a proportion of about 3% when only posterior uveitis cases are considered. Investigative methods such as angiography including ICGA, and OCT are crucial for reaching a diagnosis as quickly as possible to avoid disease worsening corticosteroid therapy.

Imaging in uveitis: techniques and indications

AbstractPurpose To present the array of the main imaging methods used or that should be used in the investigation of uveitis and specify their respective indications.Methods Review of the different imaging modalities as well as laser flare photometry (LFP).Results Imaging work‐up of (posterior) uveitis automatically and routinely always comprised FA and more recently OCT. FA usually does not bring new unknown elements as it gives information on the superficial structures accessible to fundus examination but it allows more precise appraisal of the pathology of these superficial structures such as retinal vasculitis, macular oedema, retinal ischemia, subretinal fluid, retinal neovessels as well as optic disc inflammation. OCT gives morphologic quasi‐histologic details of the retina, especially useful because it is non‐invasive and allows close follow‐up. FAF gives information on inflammation induced changes on the retinal pigment epithelium and photoreceptor outer segments but FAF still needs to be better standardized if possible at all. Mostly, these methods fail to give information on the choroid, at least as often involved as the retina, which can only be explored by ICGA. Unlike FA and OCT, ICGA very often shows occult unknown elements. It is therefore obvious that ICGA should be included in routine imaging work‐up of those cases of posterior uveitis where angiography is deemed necessary and choroiditis cannot be excluded.Conclusion Classical imaging methods and newer modalities together with LFP transformed uveitis monitoring into a precise clinical science, as long as these methods are used which unfortunately is far from being the case.

Uveitis- a rare disease often associated with systemic diseases and infections- a systematic review of 2619 patients

BackgroundUveitis is an autoimmune disease of the eye that refers to any of a number of intraocular inflammatory conditions. Because it is a rare disease, uveitis is often overlooked, and the possible associations between uveitis and extra-ocular disease manifestations are not well known. The aim of this study was to characterize uveitis in a large sample of patients and to evaluate the relationship between uveitis and systemic diseases.MethodsThe present study is a cross-sectional study of a cohort of patients with uveitis. Records from consecutive uveitis patients who were seen by the Uveitis Service in the Department of Ophthalmology at the Medical University of Vienna between 1995 and 2009 were selected from the clinical databases. The cases were classified according to the Standardization of Uveitis Nomenclature Study Group criteria for Uveitis.ResultsData were available for 2619 patients, of whom 59.9% suffered from anterior, 14.8% from intermediate, 18.3% from posterior and 7.0% from panuveitis. 37.2% of all cases showed an association between uveitis and extra-organ diseases; diseases with primarily arthritic manifestations were seen in 10.1% of all cases, non-infectious systemic diseases (i.e., Behçet´s disease, sarcoidosis or multiple sclerosis) in 8.4% and infectious uveitis in 18.7%. 49.4% of subjects suffering from anterior uveitis tested positively for the HLA-B27 antigen. In posterior uveitis cases 29% were caused by ocular toxoplasmosis and 17.7% by multifocal choroiditis.ConclusionOphthalmologists, rheumatologists, infectiologists, neurologists and general practitioners should be familiar with the differential diagnosis of uveitis. A better interdisciplinary approach could help in tailoring of the work-up, earlier diagnosis of co-existing diseases and management of uveitis patients.

Prevalence of uveitis in indigenous populations presenting to remote clinics of central Australia: The Central Australian Ocular Health Study

To report the prevalence of current and previous uveitis within the indigenous population living within Central Australia. Population-based cross-sectional study in Central Australia. One thousand eight hundred and eighty-four subjects who identified themselves as indigenous Australians, presenting to the remote clinics during the 36-month period between July 2005 and June 2008. Clinical assessments for active or previous uveitis were performed. Data were collected using a standardized form. Prevalence of various types of uveitis. Four of 1881 subjects had evidence of previous or current anterior uveitis, giving a prevalence for anterior uveitis of 0.21% (95% confidence interval, 0.01-0.42%). Eleven of 1854 patients had signs of previous posterior uveitis, giving a prevalence for posterior uveitis of 0.59% (95% confidence interval 0.24-0.94%). Nine of the 11 patients with posterior uveitis cases (82%) had presumed toxoplasma retinochoroiditis. There were no cases of intermediate uveitis or panuveitis observed in this study. There were no observed cases consistent with well-recognized clinical uveitic syndromes, such as Behçet's disease or Vogt-Koyanagi-Harada syndrome. A distinct pattern of uveitis appears to be present among indigenous population of remote Central Australia. Posterior uveitis was commoner than anterior uveitis with a predominance of toxoplasma retinochoroiditis. Environmental factors appeared to be more important in this genetically distinct population, with infective causes and ocular trauma being the most common aetiologies of uveitis.

Population-based prevalence of uveitis in Southern India

PurposeTo estimate the prevalence of uveitis in rural Tamil Nadu, India.MethodsCluster sampling identified a population-based sample of 5150 persons ages 40 years and older, representative of three districts in Tamil...

Pattern of uveitis in North East India: A tertiary eye care center study

We conducted an institutional-based retrospective study on 308 uveitic patients and analyzed the pattern of uveitis in Northeastern India. Anterior uveitis was the most common type (47.07%) followed by posterior (29.87%), intermediate (12.98%) and panuveitis (10.06%). Toxoplasmosis (40.21%) had the highest incidence among posterior uveitis cases. Harada's form of Vogt Koyanagi Harada's disease is a frequent occurrence in this subset of the population.