ABSTRACT
PURPOSE: To identify the clinical characteristics that may predict the diagnosis of Rubella virus (RV) or Cytomegalovirus (CMV) among cases of chronic treatment resistant or steroid dependent unilateral anterior uveitis (AU). METHODS: Thirty-three consecutive patients with a diagnosis of CMV and 32 patients with RV chronic AU were enrolled. The respective frequency of certain demographic and clinical characteristics was compared between the two groups. RESULTS: The presence of abnormal vessels in the anterior chamber angle (75% and 6.1%, respectively, p < .001), vitritis (68.8%-12.1%, p < .001), iris heterochromia (40.6%-15.2%, p = .022) and iris nodules (21.9%-3%, p = .027) were more common among RV AU. Conversely, intraocular pressure greater than 26 mmHg was more commonly encountered in CMV associated AU (63.6%-15.6%, respectively, p < .001) and large keratic precipitates were detected only in CMV-associated AU. CONCLUSIONS: RV- and CMV-induced chronic AU differ significantly in the prevalence of specific clinical characteristics.
ABSTRACT
PURPOSE: Relapsing ocular inflammation occurs in about 70% of patients with Behçet's disease (BD) and can lead to permanent loss of vision. Neovascularization of the optic disc (NVD) or elsewhere in the retina (NVE) is a relatively uncommon but severe complication that lacks standardized treatment. METHODS: We report on the therapeutic use of anti-TNF monoclonal antibodies for BD-associated NVD and NVE in one pediatric patient (subcutaneous adalimumab) and one young man (intravenous infliximab). Also, we review the previously published experience on biologic therapeutic options, namely anti-TNF agents and interferon-alpha in a total of three and eight patients, respectively. RESULTS: A fast-onset therapeutic effect was observed in both patients leading to complete regression of neovascularizations. CONCLUSIONS: Both options may lead to regression of neovascularization, thus preventing loss of vision, but comparative studies need to determine the optimal treatment for this sight-threatening complication of BD.
Subject(s)
Adalimumab/therapeutic use , Antirheumatic Agents/therapeutic use , Behcet Syndrome/drug therapy , Infliximab/therapeutic use , Retinal Neovascularization/drug therapy , Uveitis/drug therapy , Administration, Oral , Azathioprine/therapeutic use , Behcet Syndrome/complications , Child , Glucocorticoids/therapeutic use , Humans , Male , Prednisone/therapeutic use , Retinal Neovascularization/etiology , Uveitis/complications , Visual Acuity/physiology , Young AdultABSTRACT
BACKGROUND: To evaluate the correlation of fundus autofluorescence (FAF) with indocyanine green angiography (ICGA) in patients with various posterior uveitis disorders. METHODS: Interventional case series including 23 eyes of 15 patients with diagnosis of a specific type of retinochoroiditis, such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous-like choroiditis, multifocal choroiditis (MFC), Harada disease, and syphilitic retinochoroiditis. Also, some cases with undefined retinochoroiditis were included. FAF and ICGA were performed and correlated at baseline and during follow-up after treatment. RESULTS: In ICGA, early hypofluorescence was found to be the hallmark of acute choroidal inflammation, resolving in later stages and remaining in the late phase in areas with retinal pigment epithelium (RPE) damage. Poorly defined hyperautofluorescent areas correlated with acute choroidal lesions. Hypoautofluorescent delineation suggested the initiation of RPE healing processes, correlating well with the late phase of ICGA and delineating the RPE damage. Early hyperautofluorescence with late hypofluorescence in ICGA indicated the presence of primary RPE involvement. CONCLUSION: FAF contributes to the interpretation of RPE disease and may be a useful tool for the follow-up of progressive inflammatory disorders. Comparative evaluation of FAF and ICGA allows a characterization of the sequence of inflammatory events and the level of tissue affected.
Subject(s)
Uveitis, Posterior/diagnosis , Uveitis, Posterior/pathology , Angiography/methods , Choroid/pathology , Choroiditis/diagnosis , Choroiditis/pathology , Coloring Agents , Fluorescein Angiography/methods , Humans , Indocyanine Green , Inflammation/diagnosis , Inflammation/pathology , Optical Imaging/methods , Retinal Pigment Epithelium/pathologyABSTRACT
PURPOSE: To report a case of bilateral recurrent posterior uveitis caused by human herpes virus-6 (HHV-6) in a human immunodeficiency virus-positive individual. METHODS: Comprehensive ophthalmic examination, including imaging with optical coherence tomography, fluorescein and indocyanine green angiography, and adequate laboratory tests were performed. A human immunodeficiency virus-positive patient without any AIDS defining condition, with a history of recurrent bilateral posterior uveitis referred to us with the diagnosis of retinal detachment. RESULTS: Vitreous polymerase chain reaction detected an aberrant band for herpes viruses, which proved to be human herpes virus-6 by repeated polymerase chain reactions. Serum antibodies titer was positive for human herpes virus-6. The patient responded well to antiviral therapy with valacyclovir. CONCLUSION: This is the first case of human herpes virus-6-related bilateral posterior uveitis in a human immunodeficiency virus-positive individual without clinical manifestations of AIDS.
