ABSTRACT
AIMS: To describe demographic and clinical characteristics as well as etiologies and visual outcomes of patients with scleritis. METHODS: This is a descriptive, observational and retrospective study. We reviewed the electronic health records of patients with diagnosis of scleritis, who presented at the Institute of Ophthalmology Conde de Valenciana from January 2009 to December 2019. RESULTS: The cohort consisted of 162 patients with mean follow-up of 33.7 months. Mean age of scleritis presentation was 53.8 years. The most common type of scleritis was anterior nodular in 67 patients (41.3%). Most cases were idiopathic (52.4%). Visual outcomes were worse in anterior necrotizing scleritis. The most used drugs were oral NSAIDs and corticosteroids. CONCLUSION: The visual outcome in most patients is favorable, however it depends on scleritis type and etiology, with worse prognosis in anterior necrotizing scleritis forms and associated with autoimmune or systemic diseases.
Subject(s)
Scleritis , Humans , Middle Aged , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Glucocorticoids/therapeutic use , Mexico/epidemiology , Observational Studies as Topic , Retrospective Studies , Scleritis/diagnosis , Scleritis/drug therapy , Scleritis/epidemiology , Treatment OutcomeABSTRACT
PURPOSE: To determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease. METHODS: This retrospective, longitudinal observational study analyzed the demographic data, disease stage, glaucoma development, intraocular pressure, best-corrected visual acuity, lens status, optic nerve, gonioscopy, management, and visual outcomes of VKH disease. Clinical features were used to categorize the stage of VKH disease. VKH eyes were divided into two groups, with or without glaucoma, undergoing further analysis, including statistical analysis. RESULTS: 305 eyes of 155 patients with VKH disease with a median follow-up of 22 months were included. Secondary glaucoma developed in 67 (22%) eyes, most of which (64.2%) had chronic recurrent VKH at presentation. Angle-closure was present in 55 (82.1%) of glaucoma eyes. Peripheral anterior and posterior synechiae were present in 58 (86.6%) and 51 (76.1%) eyes, respectively. Pupillary block and posterior synechiae resulted in iris bombé in 17 (25.4%) eyes with glaucoma. At the last visit, visual acuity was worse in eyes with glaucoma (p < 0.001). CONCLUSION: We found that angle-closure disease is a significant cause of secondary glaucoma in VKH. Eyes with glaucoma were more likely to present in the chronic recurrent stage of the disease.
Subject(s)
Glaucoma, Angle-Closure , Glaucoma , Uveomeningoencephalitic Syndrome , Humans , Uveomeningoencephalitic Syndrome/complications , Uveomeningoencephalitic Syndrome/diagnosis , Uveomeningoencephalitic Syndrome/epidemiology , Glaucoma, Angle-Closure/diagnosis , Glaucoma, Angle-Closure/epidemiology , Glaucoma, Angle-Closure/etiology , Retrospective Studies , Prevalence , Glaucoma/etiologyABSTRACT
BACKGROUND: The purpose of this study was to evaluate the characteristics and outcomes of cataract surgery with/without vitrectomy in patients with pars planitis who received immunosuppressive therapy. METHODS: This was a retrospective case series, single-center study. Twenty-two patients with pars planitis who received immunosuppressive therapy were included, with a median age at presentation of 9.5 years, having had cataract surgery. The following data was collected: age at presentation and at cataract surgery, time of follow-up, best-corrected visual acuity (BCVA) before the surgery and at 1 week, 1 and 6 months after the procedure, immunosuppressive therapy, complications and causes for failed visual improvement. The variables associated with an improvement in visual acuity were evaluated. RESULTS: All patients had phacoemulsification with intraocular lens implantation. The most common immunosuppressive therapy used for the patients was methotrexate in nine patients (40.9%). The BCVA improved from a median of 20/400 to 20/100 after 6 months of follow-up (p = 0.0005); 14 patients (63.6%) improved two lines of vision or more. No significant risk factors were found for the association with improvement in visual acuity after the surgery. No improvement in visual acuity was attributed to posterior segment manifestations or amblyopia; the most common complication was posterior capsule opacification in 11 eyes (50%). The median follow-up after the surgery was 32 months. CONCLUSION: Phacoemulsification was the procedure for all the patients. Visual acuity improved in patients with pars planitis treated with immunosuppressive drugs who underwent cataract surgery, except for the patients with posterior segment complications or amblyopia.
Subject(s)
Cataract/complications , Immunosuppression Therapy/methods , Immunosuppressive Agents/therapeutic use , Pars Planitis/complications , Phacoemulsification/methods , Visual Acuity , Vitrectomy/methods , Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Lens Implantation, Intraocular/methods , Male , Pars Planitis/diagnosis , Pars Planitis/therapy , Retrospective Studies , Treatment Outcome , Young AdultSubject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ethnology , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/genetics , Genetic Predisposition to Disease , Polymorphism, Genetic , Protein Tyrosine Phosphatase, Non-Receptor Type 22/genetics , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/metabolism , Gene Frequency , Humans , Mexico/epidemiology , Polymerase Chain Reaction , Protein Tyrosine Phosphatase, Non-Receptor Type 22/metabolism , Risk ManagementABSTRACT
AIM: To report the main features of sympathetic ophthalmia in a referral ophthalmology center. METHODS: Retrospective clinical study. We reviewed clinical records of patients with diagnosis of sympathetic ophthalmia attending the Uveitis Department from 2007 to 2013. Patients were selected by clinical criteria. Descriptive statistics were used to assess variables. RESULTS: Twenty patients were included for analysis, 13 males and 7 females. Mean follow up was 1 year. The median age of presentation was 50 years. Fifty percent had history of ocular trauma and 50% had history of intraocular surgery, of which 40% underwent phacoemulsification. The time between injury and onset of symptoms ranged from 1 to 456 months. Most common ocular manifestations were mutton fat keratic precipitates and anterior chamber inflammation. All patients received oral prednisone as single or combined therapy. Sixty percent of the sympathizing eyes improved two or more lines of vision and 20% lost two or more lines of vision. CONCLUSION: This report from a single center adds to the body of literature of sympathetic ophthalmia occurring in a specific population. Our data found a high proportion of patients with sympathetic ophthalmia after phacoemulsification.
ABSTRACT
The Vogt-Koyanagi-Harada syndrome is a disease with dermatological, neurologic and auditory findings, associated with a bilateral granulomatous panuveitis. We present the case of a 42-year-old woman who started with ophthalmic manifestations, and in a late follow-up she developed the characteristic dermatological findings.
Subject(s)
Uveomeningoencephalitic Syndrome/pathology , Adult , Female , Humans , Panuveitis/pathology , Retinal Detachment/pathology , Vitiligo/pathologyABSTRACT
AIM: To evaluate the clinical course of the patients with pars planitis that received immunosuppressive drugs. METHODS: We retrospectively analysed the data of 10â years from 374 patients with pars planitis in a large reference centre in Mexico City and included 49 patients (92 eyes). RESULTS: Median age at presentation was 8â years. 35 patients (71.4%) were male and 43 patients (87.7%) had bilateral disease. Diverse immunosuppressive medications were used, mainly methotrexate (69.4%) and azathioprine (63.3%) with 18 patients requiring more than one drug. The main indications for starting immunosuppressive therapy were lack of response to initial treatment and advance disease at presentation. The results showed good response with steroid reduction (69.3% of patients), visual acuity improvement (51% of patients) and inflammatory disease reduction (59.1% of patients). In 25 patients (51%), steroids were started previous to immunosuppressors and in 24 (49%) at the same time without significant difference in clinical improvement (p=0.210) or visual outcome (p=0.498). Thirteen patients (26.5%) presented mild adverse effects. The median of the final visual acuity was 20/40. The median follow-up time was 44â months (range 13-115â months). CONCLUSIONS: Immunosuppressive therapy allows an adequate control of inflammatory disease in pars planitis, with clinical and visual improvement and steroid dose reduction.
Subject(s)
Immunosuppressive Agents/therapeutic use , Pars Planitis/drug therapy , Adolescent , Adult , Azathioprine/adverse effects , Azathioprine/therapeutic use , Child , Child, Preschool , Cyclophosphamide/adverse effects , Cyclophosphamide/therapeutic use , Cyclosporine/adverse effects , Cyclosporine/therapeutic use , Female , Humans , Immunosuppressive Agents/adverse effects , Male , Methotrexate/adverse effects , Methotrexate/therapeutic use , Mexico , Middle Aged , Pars Planitis/diagnosis , Referral and Consultation , Retrospective Studies , Visual AcuityABSTRACT
AIM: To evaluate the frequency, phenotype and the potential function of CD57+ T cell subsets in patients with pars planitis. METHODS: CD4+CD57+ and CD8+CD57+ T cells were quantitated in peripheral blood from 15 patients with pars planitis and 15 healthy controls. To evaluate the phenotype and potential function of CD57+ T cell subsets CCR7, CD27, CD28, CD45RA, CD45RO, intracellular IFN-gamma, IL-4, perforin and granzyme-A expression were assessed by flow cytometry. RESULTS: CD57+ T cells subsets were increased in patients with pars planitis (p = 0.002). The majority of CD4+CD57+ T cells were CCR7-CD27-CD28-CD45RO+, while the most CD8+CD57+ T cells were CCR7-CD27-CD28-CD45RA+. The number of cells positive for intracellular IFN-gamma and IL-4 was higher in the CD57+ T cell populations. A greater number of CD8+CD57+ T cells than CD8+CD57- T cells were positive to perforin (p = 0.006) and granzyme-A (p = 0.01). CONCLUSIONS: CD57+ T cells had a phenotype associated with peripheral memory (CCR7-CD27-CD28-). Cytokine production by CD57+ T cells suggests that these cells may play a role in helper cell regulation. High expression of intracellular proteins involved in cytotoxicity suggests that CD8+CD57+ T cells may play an effector role. Taken together, this study proposes that CD57+ T cells function as memory-effector T cell subsets during pars planitis pathogenesis.
Subject(s)
CD57 Antigens/immunology , Pars Planitis/immunology , T-Lymphocytes/immunology , Adolescent , CD28 Antigens/immunology , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Child , Female , Granzymes/immunology , Humans , Immunologic Memory/immunology , Immunophenotyping/methods , Interferon-gamma/immunology , Interleukin-4/immunology , Leukocyte Common Antigens/immunology , Male , Membrane Glycoproteins/immunology , Perforin , Pore Forming Cytotoxic Proteins/immunology , Receptors, CCR7 , Receptors, Chemokine/immunology , Tumor Necrosis Factor Receptor Superfamily, Member 7/immunologyABSTRACT
Objetivo. Informar las manifestaciones oftalmológicas en pacientes con granulomatosis de Wegener (GW). Método. Se revisó la base de datos del Instituto de Oftalmología Conde de Valenciana. Se recolectó la exploración oftalmológica completa, los exámenes de laboratorio y de gabinete, el tratamiento y la evolución. Resultados. Se incluyeron 11 pacientes con GW (18 ojos). Siete pacientes masculinos y 4 femeninos con edad promedio de 43.7 años (28-55). Tres habían tenido diagnóstico previo de GW y los 8 restantes se diagnosticaron en nuestro departamento. Siete presentaron cuadros bilaterales y 4 unilaterales. Las formas de presentación clínica fueron escleritis necrosante con queratitis ulcerativa periférica (QUP) (7/18), escleritis difusa (3/18), escleritis nodular (1/18), uveítis anterior no granulomatosa (1/18), neuropatía óptica isquémica (1/18), neuropatía óptica retrobulbar (1/18), desprendimiento de retina seroso (2/18) y dacriocistitis (2/18). De los 18 ojos, la capacidad visual final fue mejor o igual a 20/40 en 13, 20/400 en 3, cuenta dedos a 30cm o no-percepción de luz en 1. Actualmente 7 pacientes se encuentran en fase inactiva. Conclusiones. Las manifestaciones oftalmológicas más frecuentes en pacientes con GW fueron: escleritis necrosante y QUP. En la mayoría, la GW se diagnosticó después de las manifestaciones oftalmológicas, sin embargo, todos presentaron síntomas sistémicos u oftalmológicos previos.
OBJECTIVE: Report the ophthalmologic manifestations among patients with Wegener 's Granulomatosis (WG). METHOD: We reviewed the database of the Instituto de Oftalmologia Fundación Conde de Valenciana in order to collect information regarding complete ophthalmic examination, laboratory and cabinet tests, treatment, and disease progression. RESULTS: We included 11 patients with WG (18 eyes). Seven men and four women, mean age 43.7 years (range = 28-55). Three patients had a prior diagnosis of WG and the remaining eight patients were diagnosed by our study team. Seven subjects developed a bilateral affection and four had unilateral involvement. The clinical presentation was necrotizing scleritis with peripheral ulcerative keratitis (PUK) (7/18), diffuse scleritis (3/18), nodular scleritis (1/18), non-granulomatous uveitis (1/18), optic ischemic neuropathy (1/18), retrobulbar neuritis (1/18), serous retinal detachment (2/18), and dacryocystitis (2/18). Final visual acuity was better or equal to 20/40 (13/18), 20/400 (3/18), finger-counting or no-perception of light in 1/18. Currently, seven patients are symptom free. CONCLUSIONS: The most frequent ophthalmic manifestations among our patients with WG were: necrotizing scleritis and PUK. In most cases, WG was diagnosed after ophthalmic manifestations; however, all patients displayed prior systemic or ocular symptoms.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Granulomatosis with Polyangiitis/complications , Inflammation/etiology , Eye Diseases/etiology , Antibodies, Antineutrophil Cytoplasmic/blood , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/drug therapy , Immunosuppressive Agents/therapeutic use , Inflammation/diagnosis , Inflammation/drug therapy , Eye Diseases/diagnosis , Eye Diseases/drug therapy , Treatment OutcomeABSTRACT
OBJECTIVE: Report the ophthalmologic manifestations among patients with Wegener 's Granulomatosis (WG). METHOD: We reviewed the database of the Instituto de Oftalmologia Fundación Conde de Valenciana in order to collect information regarding complete ophthalmic examination, laboratory and cabinet tests, treatment, and disease progression. RESULTS: We included 11 patients with WG (18 eyes). Seven men and four women, mean age 43.7 years (range = 28-55). Three patients had a prior diagnosis of WG and the remaining eight patients were diagnosed by our study team. Seven subjects developed a bilateral affection and four had unilateral involvement. The clinical presentation was necrotizing scleritis with peripheral ulcerative keratitis (PUK) (7/18), diffuse scleritis (3/18), nodular scleritis (1/18), non-granulomatous uveitis (1/18), optic ischemic neuropathy (1/18), retrobulbar neuritis (1/18), serous retinal detachment (2/18), and dacryocystitis (2/18). Final visual acuity was better or equal to 20/40 (13/18), 20/400 (3/18), finger-counting or no-perception of light in 1/18. Currently, seven patients are symptom free. CONCLUSIONS: The most frequent ophthalmic manifestations among our patients with WG were: necrotizing scleritis and PUK. In most cases, WG was diagnosed after ophthalmic manifestations; however, all patients displayed prior systemic or ocular symptoms.
Subject(s)
Eye Diseases/etiology , Granulomatosis with Polyangiitis/complications , Inflammation/etiology , Adult , Antibodies, Antineutrophil Cytoplasmic/blood , Eye Diseases/diagnosis , Eye Diseases/drug therapy , Female , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Inflammation/diagnosis , Inflammation/drug therapy , Male , Middle Aged , Treatment OutcomeABSTRACT
The eye has multiple mechanisms of immune regulation implicated in the maintenance of ocular immune privilege. However, sometimes diseases or disorders appear and can cause clinical manifestations of intraocular inflammation; usually those diseases are collectively named "uveitis". Despite the uveitis is the main cause of eye morbidity and lost of visual function, the vast majority of the immune mechanisms involved in its generation remains unknown. In this article, the authors reviews the process of immune regulation inside the eye, the immunological mechanisms of damage implicated in the generation of uveitis, as well as the clinical aspects associated with the immune pathogenesis; in the last part of this paper we present the most recent trends in ocular research related to immunological damage in uveitis.
Subject(s)
Uveitis/immunology , Autoantigens/immunology , Autoimmune Diseases/immunology , Autoimmune Diseases/pathology , Behcet Syndrome/complications , Eye Proteins/immunology , Genetic Predisposition to Disease , HLA Antigens/genetics , HLA Antigens/immunology , Humans , Immune Tolerance , Killer Cells, Natural/immunology , Models, Immunological , Neutrophils/immunology , Research , T-Lymphocytes, Cytotoxic/immunology , Uveitis/classification , Uveitis/pathology , Uveomeningoencephalitic Syndrome/immunology , Uveomeningoencephalitic Syndrome/pathologyABSTRACT
El objetivo del presente trabajo fue analizar y actualizar los datos de distribución de la micosis sistémica histoplasmosis, en el estado de Morelos. Con base en los estudios inmunoepidemiológicos, las actividades ocupacionales de la población rural expuesta a riesgo de infección y los resultados preliminares de epidemiología molecular, que han aportado hallazgos sobre el polimorfismo genético y la dispersión del agente etiológico en la naturaleza, se reunieron datos que permitirán proponer criterios de prevalencia de la enfermedad y trazar un mapa epidemiológico de Morelos.
