ABSTRACT
A 41-year-old woman with AIDS presented with progressive nasal visual field loss in her right eye. Ophthalmic examination revealed widespread retinal opacification with hemorrhage consistent with progressive outer retinal necrosis, which was confirmed by polymerase chain reaction for varicella zoster virus DNA. The patient was treated with intravenous and intravitreal foscarnet and ganciclovir with improvement clinically. Optical coherence tomography (OCT) and fundus autofluorescence imaging revealed progressive changes indicative of widespread retinal pigment epithelial (RPE) and outer retinal dysfunction. OCT showed progressive changes in macular architecture, including neurosensory elevation, cystoid macular edema, and severe outer retinal necrosis, at initial examination and 1 week and 1 month of follow-up. Fundus autofluorescence revealed stippled hyperfluorescence within extensive zones of hypofluorescence, which progressed during follow-up. OCT and fundus autofluorescence was useful in the characterization of the RPE and retinal anatomy in this patient with progressive outer retinal necrosis.
ABSTRACT
OBJECTIVE: To characterize the fundus autofluorescence (FAF) findings in patients with white dot syndromes (WDSs). METHODS: Patients with WDSs underwent ophthalmic examination, fundus photography, fluorescein angiography, and FAF imaging. Patients were categorized as having no, minimal, or predominant foveal hypoautofluorescence. The severity of visual impairment was then correlated with the degree of foveal hypoautofluorescence. RESULTS: Fifty-five eyes of 28 patients with WDSs were evaluated. Visual acuities ranged from 20/12.5 to hand motions. Diagnoses included serpiginous choroidopathy (5 patients), birdshot retinochoroidopathy (10), multifocal choroiditis (8), relentless placoid chorioretinitis (1), presumed tuberculosis-associated serpiginouslike choroidopathy (1), acute posterior multifocal placoid pigment epitheliopathy (1), and acute zonal occult outer retinopathy (2). In active serpiginous choroidopathy, notable hyperautofluorescence in active disease distinguished it from the variegated FAF features of tuberculosis-associated serpiginouslike choroidopathy. The percentage of patients with visual acuity impairment of less than 20/40 differed among eyes with no, minimal, and predominant foveal hypoautofluorescence (P < .001). Patients with predominant foveal hypoautofluorescence demonstrated worse visual acuity than those with minimal or no foveal hypoautofluorescence (both P < .001). CONCLUSIONS: Fundus autofluorescence imaging is useful in the evaluation of the WDS. Visual acuity impairment is correlated with foveal hypoautofluorescence. Further studies are needed to evaluate the precise role of FAF imaging in the WDSs.
Subject(s)
Chorioretinitis/diagnosis , Fluorescein Angiography , Fundus Oculi , Retinal Pigment Epithelium/pathology , Uveitis, Posterior/diagnosis , Vision Disorders/diagnosis , Adult , Aged , Female , Humans , Male , Middle Aged , Photography , Syndrome , Visual Acuity/physiologySubject(s)
Hearing Loss, Sensorineural/diagnosis , Nervous System Diseases/diagnosis , Sarcoidosis/diagnosis , Uveitis, Anterior/diagnosis , Vestibular Diseases/diagnosis , Adolescent , Audiometry, Pure-Tone , Glucocorticoids/therapeutic use , Hearing Loss, Sensorineural/drug therapy , Humans , Magnetic Resonance Imaging , Male , Nervous System Diseases/drug therapy , Sarcoidosis/drug therapy , Tomography, X-Ray Computed , Uveitis, Anterior/drug therapy , Vestibular Diseases/drug therapyABSTRACT
OBJECTIVE: To evaluate CD4(+)Foxp3(+) (forkhead box P3) T-regulatory cell populations in patients with uveitis and to determine if T-regulatory cell populations are associated with disease features. METHODS: Patients with uveitis were evaluated for CD4(+)Foxp3(+) T-regulatory cells by flow cytometry. Systemic and ocular diagnoses, disease activity, and the presence of cystoid macular edema were reviewed. Percentages of CD4(+)Foxp3(+) lymphocytes were compared for patients with inactive vs active disease, systemic vs ocular diagnoses, and the presence or absence of cystoid macular edema. Real-time polymerase chain reaction testing was performed on 2 patients with extremely low CD4(+)Foxp3(+) cell populations to assess Foxp3 mRNA. RESULTS: A total of 20 patients with intermediate uveitis, posterior uveitis, and panuveitis were evaluated. The mean age was 40.6 years and the mean visual acuity was 20/57. Percentages of CD4(+)Foxp3(+) cells were lower in patients with active compared with inactive uveitis (P< .05). No differences in T-regulatory cells were observed between the other subgroups. Two patients with recalcitrant uveitis who demonstrated less than 1% CD4(+)Foxp3(+) lymphocytes showed extremely low or absent Foxp3 mRNA. CONCLUSION: T-regulatory cells are reduced in patients with active compared with inactive disease. Severe depletion of CD4(+)Foxp3(+) T cells and Foxp3 mRNA in 2 patients with severe uveitis suggests that loss of the T-regulatory cells of uveitis may be a salient feature in certain patients.
