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A Rare Presentation: Bilateral Necrotizing Scleritis in Primary Sjögren's Syndrome. 罕见的病例:原发性斯约格伦综合征的双侧坏死性巩膜炎。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-01-01 Epub Date: 2024-05-06 DOI: 10.1080/09273948.2024.2347573
Shishir Narain, Richa Pyare, P D Rath

Purpose: We report a rare and challenging case of bilateral necrotizing scleritis in primary Sjögren's syndrome (pSS).

Methods: Retrospective case report.

Results: A 72-year-old diabetic, hypertensive female patient presented with sudden onset of painful red left eye and was noted to have a corneal ulcer with severe thinning. She was managed with topical fortified antibiotics and tissue glue and bandage contact lens. During subsequent follow-ups, she developed necrotizing scleral melts in both eyes. On investigations, antinuclear antibodies were positive in a dilution of 1:160 with 2+ speckled pattern, with antinuclear antibody line immunoassay showing anti SS-A/ Ro52 positive. In view of rapidly developing scleral thinning and impending perforation, she was started on intravenous methylprednisolone 1 g/day for 3 days, along with steroid-sparing immunomodulatory therapy (mycophenolate mofetil 500 mg twice a day). She showed a rapid response to therapy and is currently stable on tapering oral steroids and mycophenolate mofetil.

Conclusion: This case underscores the unique presentation of pSS, characterized by bilateral necrotizing scleritis. The favorable outcome was attained through prompt immunosuppressive intervention and a collaborative, multidisciplinary approach. Further, this case report addresses a gap in the existing literature concerning pSS-related scleritis. It also emphasizes the crucial role of a rheumatologist in the comprehensive management of this condition.

目的:我们报告了一例罕见且具有挑战性的原发性斯约格伦综合征(pSS)双侧坏死性巩膜炎病例:方法:回顾性病例报告:一名 72 岁的糖尿病、高血压女性患者突然出现左眼红肿疼痛,并发现角膜溃疡,角膜严重变薄。她接受了局部强化抗生素、组织胶和绷带接触镜治疗。在随后的随访中,她的双眼都出现了坏死性巩膜融化。经检查,抗核抗体在 1:160 稀释度时呈阳性,有 2+ 斑点,抗核抗体线免疫测定显示抗 SS-A/ Ro52 阳性。鉴于巩膜迅速变薄,穿孔迫在眉睫,她开始接受甲基强的松龙静脉注射,每天 1 克,连续 3 天,同时接受类固醇稀释免疫调节疗法(霉酚酸酯 500 毫克,每天两次)。她对治疗的反应很快,目前在逐渐减少口服类固醇和霉酚酸酯治疗后病情稳定:本病例强调了以双侧坏死性巩膜炎为特征的 pSS 的独特表现。通过及时的免疫抑制干预和多学科协作治疗,患者获得了良好的治疗效果。此外,本病例报告填补了现有文献中有关 pSS 相关性硬膜炎的空白。它还强调了风湿免疫科医生在这种疾病的综合治疗中的关键作用。
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引用次数: 0
Ocular Tuberculosis Diagnosis Through Biomarkers: Clinical Relevance of Serum C1q and Whole Blood Interferon Gene Signature Score. 通过生物标志物诊断眼结核:血清 C1q 和全血干扰素基因签名评分的临床意义。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-01-01 Epub Date: 2024-06-24 DOI: 10.1080/09273948.2024.2368670
Rina La Distia Nora, Ikhwanuliman Putera, Benjamin Schrijver, Gurmeet Singh, Marleen Bakker, Mei Riasanti, Lukman Edwar, Made Susiyanti, Yulia Aziza, Josianne C E M Ten Berge, Saskia M Rombach, P Martin van Hagen, Ratna Sitompul, Willem A Dik

Purpose: To assess the clinical relevance of pathophysiology-based biomarkers, specifically serum C1q and whole blood interferon gene signature score (IGSS), in ocular tuberculosis (OTB) diagnosis by conducting an integrative analysis of clinical presentations and treatment response.

Methods: This retrospective cohort study analysed data from 70 patients with suspected OTB at a tertiary care uveitis practice in Indonesia. Serum C1q levels and whole blood IGSS were quantified. Patients were categorized into four quadrants based on their biomarker profiles: quadrant 1 (high C1q & low IGSS), quadrant 2 (high C1q & high IGSS), quadrant 3 (low C1q & high IGSS), and quadrant 4 (low C1q & low IGSS). Characteristics of clinical presentations, work-up results, and treatment outcomes were explored according to the predefined quadrants.

Results: We identified that the majority of OTB patients diagnosed with concurrent active pulmonary TB were in quadrant 1, 2, or 3 (20/23, 87.0%). Twenty-seven patients (27/47, 57.4%) with clinically undifferentiated uveitis were in quadrant 4 (p < 0.001). Among patients in quadrants 1, 2, and 3, completion of a full course of antitubercular treatment (ATT) was associated with a lower number of patients showing persistence or recurrence of ocular inflammation compared to those who were not fully treated with ATT (14.3% vs 85.7%, p = 0.001).

Conclusions: Based on the analysis of clinical features and treatment outcomes, patients with elevated levels of either or both serum C1q and whole blood IGSS may reflect active TB disease in the eye, necessitating full ATT management.

目的:通过对临床表现和治疗反应进行综合分析,评估基于病理生理学的生物标志物(尤其是血清C1q和全血干扰素基因特征评分(IGSS))在眼结核(OTB)诊断中的临床相关性:这项回顾性队列研究分析了印度尼西亚一家三级眼色素膜炎诊所的 70 名疑似 OTB 患者的数据。对血清 C1q 水平和全血 IGSS 进行了量化。根据患者的生物标志物特征将其分为四个象限:第1象限(高C1q和低IGSS)、第2象限(高C1q和高IGSS)、第3象限(低C1q和高IGSS)和第4象限(低C1q和低IGSS)。根据预先确定的象限探讨了临床表现、检查结果和治疗效果的特征:我们发现,大多数确诊并发活动性肺结核的 OTB 患者属于第 1、2 或 3 象限(20/23,87.0%)。临床未分化葡萄膜炎的 27 例患者(27/47,57.4%)位于第 4 象限(P = 0.001):根据对临床特征和治疗结果的分析,血清 C1q 和全血 IGSS 水平升高或同时升高的患者可能反映出眼部存在活动性结核病,需要进行全面的 ATT 治疗。
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引用次数: 0
Perinuclear Antineutrophil Cytoplasmic Antibody-Associated Ocular Manifestations: Case Series and Literature Review. 核周抗中性粒细胞胞浆抗体相关眼部表现:病例系列和文献综述。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-01-01 Epub Date: 2024-05-06 DOI: 10.1080/09273948.2024.2346820
Yi Wen Lim, On Heong Liew

Purpose: To investigate the diversity of ocular manifestations in patients with positive perinuclear antineutrophil cytoplasmic antibody (p-ANCA).

Methods: The clinical records of five patients exhibiting ocular manifestations and testing positive for serum MPO-ANCA were retrospectively reviewed.

Results: Three out of five patients were female. The youngest patient was aged 26, whereas the eldest was 83 years old. 80% (n = 4) of them had purely anterior segment involvement, with the commonest manifestation being peripheral ulcerative keratitis and scleritis. Only one patient had posterior segment involvement, specifically posterior ischemic optic neuropathy. Two patients demonstrated unilateral involvement. There was only one patient diagnosed with systemic involvement, presenting as mixed nephrotic and nephritic syndrome, who required a course of intravenous methylprednisolone during the active stage. Three patients required second-line immunosuppressants throughout the course due to frequent relapse.

Conclusion: Anterior segment ocular manifestations are not uncommon and can be the initial presentation of p-ANCA-associated vasculitis (AAV). Therefore, its evaluation should be considered in establishing the diagnosis of AAV, a life-threatening disease.

目的:研究核周抗中性粒细胞胞浆抗体(p-ANCA)阳性患者眼部表现的多样性:方法:回顾性审查五名有眼部表现且血清 MPO-ANCA 检测呈阳性的患者的临床病历:结果:五名患者中有三名女性。最小的患者 26 岁,最大的患者 83 岁。其中 80% 的患者(4 人)仅受累于前段,最常见的表现是周边溃疡性角膜炎和巩膜炎。只有一名患者后段受累,特别是后部缺血性视神经病变。两名患者表现为单侧受累。只有一名患者被诊断为全身受累,表现为混合性肾病和肾炎综合征,在活动期需要静脉注射甲基强的松龙。三名患者在整个病程中因频繁复发而需要二线免疫抑制剂:结论:前节眼部表现并不少见,可能是 p-ANCA 相关性血管炎(AAV)的最初表现。因此,在确诊危及生命的 AAV 时应考虑对其进行评估。
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引用次数: 0
Subretinal Fibrosis Developing 10 Years After First Presentation with Chronic Ocular Sarcoidosis in a Child. 一名儿童首次患上慢性眼肉样瘤病 10 年后出现视网膜下纤维化。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-01-01 Epub Date: 2024-06-12 DOI: 10.1080/09273948.2024.2363481
Neofytos Mavris, Tarek Jaouni, Radgonde Amer

Purpose: To provide a comprehensive overview of the diagnostic and therapeutic journey of a pediatric patient with persistent sarcoid-associated panuveitis over a 10-year period, who ultimately developed bilateral macular subretinal fibrosis and visual loss.

Methods: Retrospective case report.

Results: The patient was diagnosed with sarcoidosis after undergoing a transbronchial biopsy. She was followed up because of granulomatous panuveitis, multifocal choroiditis, and papillitis bilaterally. She maintained a stable condition, and visual acuity was 0.3 RE and 0.5 LE. Immunomodulatory therapy included prednisone, methotrexate, and adalimumab. The patient was lost to follow-up for 20 months because of the COVID-19 pandemic. She was represented with active uveitis and was not responding to TNF-ɑ inhibitors (adalimumab and infliximab). Ultimately, the patient's intraocular inflammation was successfully controlled by using intravitreal steroids (Triamcinolone and Fluocinolone acetonide implant). However, the visual outcome was guarded because of bilateral subretinal fibrosis.

Conclusion: 10% of patients with sarcoidosis-associated uveitis risk blindness in one eye. The index case progressed to sight-robbing bilateral subretinal fibrosis, a rare complication of ocular sarcoidosis despite a combination of conventional and biologic anti-inflammatory therapies. There is a pressing need to develop new treatment agents for refractory non-infectious uveitis.

目的:全面概述一名患有持续性肉样瘤相关泛葡萄膜炎的儿科患者的诊断和治疗历程,该患者在10年时间里最终发展为双侧黄斑视网膜下纤维化和视力丧失:方法:回顾性病例报告:结果:患者在接受经支气管活检后被诊断为肉样瘤病。由于出现肉芽肿性泛葡萄膜炎、多灶性脉络膜炎和双侧乳头炎,她接受了随访。她的病情保持稳定,视力为 0.3 RE 和 0.5 LE。免疫调节治疗包括泼尼松、甲氨蝶呤和阿达木单抗。由于 COVID-19 大流行,患者失去了 20 个月的随访。她被诊断为活动性葡萄膜炎,对 TNF-ɑ 抑制剂(阿达木单抗和英夫利昔单抗)无效。最终,患者通过使用玻璃体内类固醇(曲安奈德和氟西酮醋酸酯植入剂)成功控制了眼内炎症。结论:10%的肉样瘤病相关葡萄膜炎患者有单眼失明的风险。结论:10%的肉样瘤病相关葡萄膜炎患者有单眼失明的风险,该病例的病情恶化为双侧视网膜下纤维化,这是一种罕见的眼部肉样瘤病并发症,尽管已采用常规和生物抗炎疗法。目前迫切需要开发治疗难治性非感染性葡萄膜炎的新药。
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引用次数: 0
Norepinephrine Attenuates Benzalkonium Chloride-Induced Dry Eye Disease by Regulating the PINK1/Parkin Mitophagy Pathway. 去甲肾上腺素通过调节PINK1/Parkin线粒体自噬途径减轻苯扎氯铵诱导的干眼病。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-27 DOI: 10.1080/09273948.2024.2447816
Han Zhao, Wushuang Wang, Yun Yang, Changming Feng, Tong Lin, Lan Gong

Background: Increased reactive oxygen species (ROS) are involved in the pathological process of dry eye disease. Our previous results suggested that norepinephrine (NE) has a protective effect on dry eye.

Purpose: This study explored the potential therapeutic role and underlying mechanisms of NE in benzalkonium chloride (BAC)-induced dry eye disease.

Methods: BAC-pretreated human corneal epithelial cells (HCEpiC) were cultured with various concentrations of NE. A BAC-induced dry eye mice model was established to explore the role of NE. Alterations in mice corneal tissues, ROS levels, mitochondrial function, and mitophagy levels were analyzed.

Results: In vitro, our results revealed that BAC-exposed HCEpiC led to mitochondrial malfunction, which involved excessive ROS production, decreased mitochondrial membrane potential (MMP), and promoted mitochondrial fragmentation through increased DRP1 and fission protein 1 (Fis1) expression and reduced mitofusin 2 (Mfn2) expression. Moreover, topical BAC application induced excessive mitophagy. These effects were reversed by NE. Additionally, the increased expression of LC3B, SQSTM1/p62, PINK1, and Parkin, which control mitophagy, in BAC-exposed HCEpiC was suppressed by NE. In BAC-induced C57BL/6J mice, NE resulted in lower fluorescein staining scores, decreased TUNEL-positive cells, and decreased mitochondrial fragmentation.

Conclusions: In conclusion, our findings showed that NE therapy prevented HCEpiC following BAC application by regulating mitochondrial quality control, which is controlled by PINK1/Parkin-dependent mitophagy. Our research suggests a potential targeted treatment for dry eye disease.

背景:活性氧(ROS)的增加参与了干眼病的病理过程。我们之前的研究结果表明,去甲肾上腺素(NE)对干眼症有保护作用。目的:探讨NE在苯扎氯铵(benzalkonium chloride, BAC)诱发的干眼病中的潜在治疗作用及其机制。方法:用不同浓度的NE培养bac预处理的人角膜上皮细胞(HCEpiC)。建立bac诱导小鼠干眼模型,探讨NE的作用。分析小鼠角膜组织、ROS水平、线粒体功能和线粒体自噬水平的变化。结果:在体外,我们的研究结果显示,bac暴露的HCEpiC导致线粒体功能障碍,包括过量的ROS产生,降低线粒体膜电位(MMP),并通过增加DRP1和裂变蛋白1 (Fis1)表达和降低mitofusin 2 (Mfn2)表达促进线粒体断裂。此外,局部应用BAC诱导了过度的线粒体自噬。这些影响被NE逆转了。此外,在bac暴露的HCEpiC中,控制有丝分裂的LC3B、SQSTM1/p62、PINK1和Parkin的表达增加被NE抑制。在bac诱导的C57BL/6J小鼠中,NE导致荧光素染色评分降低,tunel阳性细胞减少,线粒体断裂减少。结论:总之,我们的研究结果表明,NE治疗通过调节线粒体质量控制来预防BAC后的HCEpiC,线粒体质量控制由PINK1/帕金森依赖性线粒体自噬控制。我们的研究为干眼症提供了一种潜在的靶向治疗方法。
{"title":"Norepinephrine Attenuates Benzalkonium Chloride-Induced Dry Eye Disease by Regulating the PINK1/Parkin Mitophagy Pathway.","authors":"Han Zhao, Wushuang Wang, Yun Yang, Changming Feng, Tong Lin, Lan Gong","doi":"10.1080/09273948.2024.2447816","DOIUrl":"https://doi.org/10.1080/09273948.2024.2447816","url":null,"abstract":"<p><strong>Background: </strong>Increased reactive oxygen species (ROS) are involved in the pathological process of dry eye disease. Our previous results suggested that norepinephrine (NE) has a protective effect on dry eye.</p><p><strong>Purpose: </strong>This study explored the potential therapeutic role and underlying mechanisms of NE in benzalkonium chloride (BAC)-induced dry eye disease.</p><p><strong>Methods: </strong>BAC-pretreated human corneal epithelial cells (HCEpiC) were cultured with various concentrations of NE. A BAC-induced dry eye mice model was established to explore the role of NE. Alterations in mice corneal tissues, ROS levels, mitochondrial function, and mitophagy levels were analyzed.</p><p><strong>Results: </strong>In vitro, our results revealed that BAC-exposed HCEpiC led to mitochondrial malfunction, which involved excessive ROS production, decreased mitochondrial membrane potential (MMP), and promoted mitochondrial fragmentation through increased DRP1 and fission protein 1 (Fis1) expression and reduced mitofusin 2 (Mfn2) expression. Moreover, topical BAC application induced excessive mitophagy. These effects were reversed by NE. Additionally, the increased expression of LC3B, SQSTM1/p62, PINK1, and Parkin, which control mitophagy, in BAC-exposed HCEpiC was suppressed by NE. In BAC-induced C57BL/6J mice, NE resulted in lower fluorescein staining scores, decreased TUNEL-positive cells, and decreased mitochondrial fragmentation.</p><p><strong>Conclusions: </strong>In conclusion, our findings showed that NE therapy prevented HCEpiC following BAC application by regulating mitochondrial quality control, which is controlled by PINK1/Parkin-dependent mitophagy. Our research suggests a potential targeted treatment for dry eye disease.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":" ","pages":"1-15"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sequential Macular Hole Formation as a Rare Complication of Rickettsia Post Fever Retinitis. 继发性黄斑裂孔形成是立克次体发热后视网膜炎的罕见并发症。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-26 DOI: 10.1080/09273948.2024.2446408
Sai Bhakti Mishra, Gaurang Sehgal, Naresh Kumar Yadav, Ankush Kawali, Padmamalini Mahendradas

Purpose: We describe a rare complication of macular hole formation in rickettsia post-fever retinitis.

Patients and methods: Retrospective observational case report of a patient who presented with post-fever retinitis and cystoid macular edema that later progressed to a macular hole. Clinical record and multimodal imaging including fundus photography, fundus fluorescein angiography (FFA), and spectral domain optical coherence tomography (SD-OCT) were analyzed.

Results: Initial examination revealed multifocal retinitis lesions with vitritis associated with disc and macular edema, consistent with a diagnosis of post-fever retinitis. During the course of her treatment, she developed a full-thickness macular hole, complicating the management and requiring surgical intervention.

Conclusion: Continued monitoring and management are essential to address potential sequelae and ensure minimised long-term ocular morbidity in affected patients. Further reports are needed to precise and characterize this clinical relationship and its management.

目的:我们描述一个罕见的并发症,黄斑孔形成立克次体发烧后视网膜炎。患者和方法:回顾性观察病例报告,患者表现为发热后视网膜炎和黄斑囊样水肿,后来发展为黄斑孔。对临床记录和眼底摄影、眼底荧光素血管造影(FFA)和光谱域光学相干断层扫描(SD-OCT)等多模态成像进行分析。结果:初步检查显示多灶性视网膜炎病变伴玻璃体炎伴椎间盘和黄斑水肿,符合发热后视网膜炎的诊断。在她的治疗过程中,她出现了一个全层黄斑孔,使治疗复杂化,需要手术干预。结论:持续的监测和管理对于解决潜在的后遗症和确保最小化受影响患者的长期眼部发病率至关重要。需要进一步的报告来精确和描述这种临床关系及其管理。
{"title":"Sequential Macular Hole Formation as a Rare Complication of Rickettsia Post Fever Retinitis.","authors":"Sai Bhakti Mishra, Gaurang Sehgal, Naresh Kumar Yadav, Ankush Kawali, Padmamalini Mahendradas","doi":"10.1080/09273948.2024.2446408","DOIUrl":"https://doi.org/10.1080/09273948.2024.2446408","url":null,"abstract":"<p><strong>Purpose: </strong>We describe a rare complication of macular hole formation in rickettsia post-fever retinitis.</p><p><strong>Patients and methods: </strong>Retrospective observational case report of a patient who presented with post-fever retinitis and cystoid macular edema that later progressed to a macular hole. Clinical record and multimodal imaging including fundus photography, fundus fluorescein angiography (FFA), and spectral domain optical coherence tomography (SD-OCT) were analyzed.</p><p><strong>Results: </strong>Initial examination revealed multifocal retinitis lesions with vitritis associated with disc and macular edema, consistent with a diagnosis of post-fever retinitis. During the course of her treatment, she developed a full-thickness macular hole, complicating the management and requiring surgical intervention.</p><p><strong>Conclusion: </strong>Continued monitoring and management are essential to address potential sequelae and ensure minimised long-term ocular morbidity in affected patients. Further reports are needed to precise and characterize this clinical relationship and its management.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":" ","pages":"1-4"},"PeriodicalIF":2.6,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Unusual Case of Exudative Retinal Detachment in a 6-Year-Old Child with Acute Retinal Necrosis. 6岁儿童急性视网膜坏死罕见渗出性视网膜脱离1例。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-21 DOI: 10.1080/09273948.2024.2444512
Rakshita Deepak Kene, Saloni Desai, Chetan Rao, Parthopratim Dutta Majumder

Purpose: To report a case of exudative retinal detachment (ERD) in a child with Acute retinal necrosis (ARN).

Method: Retrospective Chart Review.

Result: A six-year-old boy presented with anterior uveitis with hypopyon and exudative retinal detachment with peripheral confluent patches of retinitis in the left eye. Examination of the right eye was unremarkable. B scan ultrasonography of the left eye revealed moderate vitreous echoes along with a membrane in the inferior quadrant persisting on low gains indicating localised inferior retinal detachment with the presence of shifting fluid. Fundus examination under general anaesthesia failed to locate any break in the retina. Polymerase chain reaction from the aqueous aspirate was positive for Herpes Simplex Virus (HSV)-I. The child was treated with intravenous acyclovir three times a day, intravitreal injection of ganciclovir and subsequently started on oral steroids (0.5 mg/kg/day). While continuing antiviral treatment, dose of corticosteroid was gradually increased to 1 mg/kg/day. Intravenous injection of acyclovir for 28 days and six intravitreal injections with corticosteroid led to complete resolution of ERD. Six months after initial presentation, the patient underwent lens aspiration with intraocular lens (IOL) implantation under general anaesthesia, under antiviral coverage. Following surgery, his BCVA in the left eye improved to 6/12.

Conclusion: ERD is a rare complication of ARN, typically associated with HSV infection. Meticulous monitoring and combined systemic and local antiviral therapy, complemented by judicious corticosteroid use, are essential for managing such cases effectively.

目的:报告一例渗出性视网膜脱离(ERD)患儿急性视网膜坏死(ARN)。方法:回顾性图表复习。结果:1例6岁男童以左眼前葡萄膜炎伴低网膜及渗出性视网膜脱离合并周围性视网膜炎。右眼检查无明显异常。左眼B超显示中度玻璃体回声,伴下象限膜持续低增益,提示局部下视网膜脱离伴移位液。全麻下眼底检查未发现视网膜有任何破裂。从水吸出的聚合酶链反应阳性的单纯疱疹病毒(HSV)- 1。患儿接受每日3次静脉注射阿昔洛韦,玻璃体内注射更昔洛韦,随后开始口服类固醇(0.5 mg/kg/天)。在继续抗病毒治疗的同时,皮质类固醇的剂量逐渐增加到1mg /kg/天。静脉注射阿昔洛韦28天,玻璃体内注射皮质类固醇6次,导致ERD完全消退。初次就诊6个月后,患者在全身麻醉和抗病毒药物覆盖下接受晶状体吸出和人工晶状体植入术。手术后,他的左眼BCVA改善到6/12。结论:ERD是一种罕见的ARN并发症,通常与HSV感染有关。严密的监测和综合的全身和局部抗病毒治疗,辅以明智的皮质类固醇使用,对于有效管理此类病例至关重要。
{"title":"An Unusual Case of Exudative Retinal Detachment in a 6-Year-Old Child with Acute Retinal Necrosis.","authors":"Rakshita Deepak Kene, Saloni Desai, Chetan Rao, Parthopratim Dutta Majumder","doi":"10.1080/09273948.2024.2444512","DOIUrl":"https://doi.org/10.1080/09273948.2024.2444512","url":null,"abstract":"<p><strong>Purpose: </strong>To report a case of exudative retinal detachment (ERD) in a child with Acute retinal necrosis (ARN).</p><p><strong>Method: </strong>Retrospective Chart Review.</p><p><strong>Result: </strong>A six-year-old boy presented with anterior uveitis with hypopyon and exudative retinal detachment with peripheral confluent patches of retinitis in the left eye. Examination of the right eye was unremarkable. B scan ultrasonography of the left eye revealed moderate vitreous echoes along with a membrane in the inferior quadrant persisting on low gains indicating localised inferior retinal detachment with the presence of shifting fluid. Fundus examination under general anaesthesia failed to locate any break in the retina. Polymerase chain reaction from the aqueous aspirate was positive for Herpes Simplex Virus (HSV)-I. The child was treated with intravenous acyclovir three times a day, intravitreal injection of ganciclovir and subsequently started on oral steroids (0.5 mg/kg/day). While continuing antiviral treatment, dose of corticosteroid was gradually increased to 1 mg/kg/day. Intravenous injection of acyclovir for 28 days and six intravitreal injections with corticosteroid led to complete resolution of ERD. Six months after initial presentation, the patient underwent lens aspiration with intraocular lens (IOL) implantation under general anaesthesia, under antiviral coverage. Following surgery, his BCVA in the left eye improved to 6/12.</p><p><strong>Conclusion: </strong>ERD is a rare complication of ARN, typically associated with HSV infection. Meticulous monitoring and combined systemic and local antiviral therapy, complemented by judicious corticosteroid use, are essential for managing such cases effectively.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":" ","pages":"1-4"},"PeriodicalIF":2.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of Herpes Zoster Ophthalmicus with Optic Neuritis and Cavernous Sinus Involvement: A Case Report. 带状疱疹伴视神经炎及海绵状窦受累的治疗1例。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1080/09273948.2024.2443672
Jack E Feist, Nathan Lambert-Cheatham, Melis Kabaalioglu Guner

Purpose: To report a treatment approach of a rare presentation of herpes zoster ophthalmicus (HZO) with optic neuropathy and oculomotor nerve palsy.

Methods: Report of one case.

Results: Multiple lesions involving the optic nerve and cavernous sinus were demonstrated on magnetic resonance imaging in a patient with a characteristic herpes zoster rash in the V1 dermatomal distribution. Following treatment with systemic ganciclovir and intravenous corticosteroids, the patient experienced dramatic improvement in visual acuity, from hand motion to 20/25.

Conclusion: This report demonstrates a rare case of HZO optic neuropathy with cavernous sinus involvement that was successfully treated with an unconventional medication regimen.

目的:报告一罕见的带状疱疹伴视神经病变和动眼神经麻痹的治疗方法。方法:报告1例病例。结果:磁共振成像显示,视神经和海绵状窦的多发性病变,在V1皮肤分布的特征性带状疱疹皮疹患者。在接受全身更昔洛韦和静脉注射皮质类固醇治疗后,患者的视力显著改善,从手部运动到20/25。结论:本报告报告了一例罕见的HZO视神经病变伴海绵窦受累的病例,并成功地采用了非常规的药物治疗方案。
{"title":"Management of Herpes Zoster Ophthalmicus with Optic Neuritis and Cavernous Sinus Involvement: A Case Report.","authors":"Jack E Feist, Nathan Lambert-Cheatham, Melis Kabaalioglu Guner","doi":"10.1080/09273948.2024.2443672","DOIUrl":"https://doi.org/10.1080/09273948.2024.2443672","url":null,"abstract":"<p><strong>Purpose: </strong>To report a treatment approach of a rare presentation of herpes zoster ophthalmicus (HZO) with optic neuropathy and oculomotor nerve palsy.</p><p><strong>Methods: </strong>Report of one case.</p><p><strong>Results: </strong>Multiple lesions involving the optic nerve and cavernous sinus were demonstrated on magnetic resonance imaging in a patient with a characteristic herpes zoster rash in the V1 dermatomal distribution. Following treatment with systemic ganciclovir and intravenous corticosteroids, the patient experienced dramatic improvement in visual acuity, from hand motion to 20/25.</p><p><strong>Conclusion: </strong>This report demonstrates a rare case of HZO optic neuropathy with cavernous sinus involvement that was successfully treated with an unconventional medication regimen.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":" ","pages":"1-4"},"PeriodicalIF":2.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pattern of Uveitis in Northern Vietnam. 越南北部葡萄膜炎的类型。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-16 DOI: 10.1080/09273948.2024.2436633
Hoa Dung Do, Van Trong Pham, Tung Quoc Mai, Son Viet Le, Bahram Bodaghi, Thi Hong Nhung Le, Thi Kim Yen Dao, Hanh Hong Tran

Purpose: To characterize the spectrum of uveitis in patients visiting three tertiary hospitals in Hanoi, Vietnam.

Methods: This study collected prospective and multicenter data from patients diagnosed with uveitis at three tertiary hospitals in Hanoi City, Vietnam, between January 2022 and January 2024. Data on age, sex, clinical and laboratory findings, and etiology were collected.

Results: Of 410 patients included, 54.6% were women. The mean age of patients was 39.9 years. Most cases were unilateral and chronic. Anterior uveitis was the most common case (40%), followed by panuveitis (30%), posterior uveitis (26.1%), and intermediate uveitis (3.9%). Undifferentiated uveitis, accounting for 32%, was the most prevalent form across all anatomical groups. The leading etiologies for anterior uveitis included Posner-Schlossman syndrome (18.5%), cytomegalovirus (CMV)-induced uveitis (11%), and Herpes simplex virus-induced uveitis (8.5%). For posterior uveitis, the primary causes were Vogt-Koyanagi-Harada (VKH) syndrome (17.8%), toxocariasis (10.3%), and toxoplasmosis (6.5%). The identified causes of panuveitis included VKH syndrome (24.4%), Behcet's disease (15.4%), and CMV-induced panuveitis (5.7%). We observed six cases of uveitis associated with Haemophilus influenzae (1.5%) without any concomitant systemic symptoms. In our patient population, the most common complication was cataract (11.2%), followed by uveitic macular edema (11%).

Conclusions: Various uveitis patterns were observed among Vietnamese patients, with non-infectious uveitis being predominant.

目的:分析越南河内三所三级医院患者葡萄膜炎的特征。方法:本研究收集了2022年1月至2024年1月期间在越南河内市三家三级医院诊断为葡萄膜炎的患者的前瞻性和多中心数据。收集了年龄、性别、临床和实验室结果以及病因的数据。结果:纳入的410例患者中,女性占54.6%。患者平均年龄39.9岁。大多数病例为单侧慢性。最常见的是前葡萄膜炎(40%),其次是全葡萄膜炎(30%)、后葡萄膜炎(26.1%)和中葡萄膜炎(3.9%)。未分化葡萄膜炎占32%,是所有解剖类群中最常见的形式。前葡萄膜炎的主要病因包括Posner-Schlossman综合征(18.5%)、巨细胞病毒(CMV)引起的葡萄膜炎(11%)和单纯疱疹病毒引起的葡萄膜炎(8.5%)。后葡萄膜炎的主要病因为Vogt-Koyanagi-Harada (VKH)综合征(17.8%)、弓形虫病(10.3%)和弓形虫病(6.5%)。确定的全葡萄膜炎病因包括VKH综合征(24.4%)、白塞病(15.4%)和巨细胞病毒引起的全葡萄膜炎(5.7%)。我们观察到6例葡萄膜炎与流感嗜血杆菌相关(1.5%),没有任何伴随的全身症状。在我们的患者群体中,最常见的并发症是白内障(11.2%),其次是葡萄膜性黄斑水肿(11%)。结论:越南患者存在多种类型的葡萄膜炎,以非感染性葡萄膜炎为主。
{"title":"Pattern of Uveitis in Northern Vietnam.","authors":"Hoa Dung Do, Van Trong Pham, Tung Quoc Mai, Son Viet Le, Bahram Bodaghi, Thi Hong Nhung Le, Thi Kim Yen Dao, Hanh Hong Tran","doi":"10.1080/09273948.2024.2436633","DOIUrl":"10.1080/09273948.2024.2436633","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the spectrum of uveitis in patients visiting three tertiary hospitals in Hanoi, Vietnam.</p><p><strong>Methods: </strong>This study collected prospective and multicenter data from patients diagnosed with uveitis at three tertiary hospitals in Hanoi City, Vietnam, between January 2022 and January 2024. Data on age, sex, clinical and laboratory findings, and etiology were collected.</p><p><strong>Results: </strong>Of 410 patients included, 54.6% were women. The mean age of patients was 39.9 years. Most cases were unilateral and chronic. Anterior uveitis was the most common case (40%), followed by panuveitis (30%), posterior uveitis (26.1%), and intermediate uveitis (3.9%). Undifferentiated uveitis, accounting for 32%, was the most prevalent form across all anatomical groups. The leading etiologies for anterior uveitis included Posner-Schlossman syndrome (18.5%), cytomegalovirus (CMV)-induced uveitis (11%), and Herpes simplex virus-induced uveitis (8.5%). For posterior uveitis, the primary causes were Vogt-Koyanagi-Harada (VKH) syndrome (17.8%), toxocariasis (10.3%), and toxoplasmosis (6.5%). The identified causes of panuveitis included VKH syndrome (24.4%), Behcet's disease (15.4%), and CMV-induced panuveitis (5.7%). We observed six cases of uveitis associated with <i>Haemophilus influenzae</i> (1.5%) without any concomitant systemic symptoms. In our patient population, the most common complication was cataract (11.2%), followed by uveitic macular edema (11%).</p><p><strong>Conclusions: </strong>Various uveitis patterns were observed among Vietnamese patients, with non-infectious uveitis being predominant.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":" ","pages":"1-12"},"PeriodicalIF":2.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pattern of Uveitis in a Tertiary Care Eye Hospital Setting in Pakistan: A Comprehensive Analysis. 在巴基斯坦三级护理眼科医院设置葡萄膜炎的模式:综合分析。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-12 DOI: 10.1080/09273948.2024.2439903
Uzma Naz, Saliha Naz, Fawad Rizvi, Zeeshan Kamil

Purpose: To determine the patterns of uveitis evident in patients presenting at the Uveitis Department of a tertiary care eye hospital located in Karachi, Pakistan.

Study design: Prospective cross-sectional study.

Location and duration of study: This study was conducted at Layton Rahmatullah Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital-Korangi, Karachi, Pakistan from August 2020 to July 2023.

Methodology: This prospective study was conducted at the Uveitis Department of LRBT Tertiary Teaching Eye Hospital, Karachi, Pakistan, from August 2020 to July 2023, following ethical review board approval. Patients underwent detailed history-taking, clinical examination by a uveitis specialist. Informed written consent was obtained. Demographic data were recorded, excluding post-opendophthalmitis cases. Laboratory tests and ocular investigations were performed when necessary.

Result: In this study, 5791 patients were analysed, with a predominance of females (55.4%) and a mean age of 38.22 ± 13.06 years. Bilateral eye involvement was found in 60.4% of cases, and the most common uveitis types were anterior (35.1%) and pan-uveitis (28.9%). Non-infectious uveitis (72.14%) was more prevalent, with idiopathic uveitis being the most common cause (33.2%). Significant associations were found between anatomical locations of uveitis and various clinical characteristics (age, gender, eye involvement and infection status). For instance, anterior uveitis was more commonly associated with unilateral eye involvement, while bilateral eye involvement was more frequent in cases of pan-uveitis and posterior uveitis. Additionally, infectious aetiology was more prevalent in pan-uveitis and posterior uveitis (p < 0.001).

Conclusion: The primary aim of this study was to determine the patterns of uveitis cases observed at a tertiary eye care hospital in Karachi, Pakistan. The predominant aetiology identified was idiopathic uveitis. Nevertheless, it is essential to recognize that the determined prevalence may be subject to the inherent limitations of this study, notably pertaining to financial barriers and limited availability of diagnostic modalities.

目的:确定在巴基斯坦卡拉奇一家三级眼科医院葡萄膜炎科就诊的患者中葡萄膜炎的明显模式。研究设计:前瞻性横断面研究。研究地点和时间:本研究于2020年8月至2023年7月在巴基斯坦卡拉奇的Layton Rahmatullah慈善信托基金(LRBT)第三教学眼科医院- korangi进行。方法:这项前瞻性研究是在伦理审查委员会批准后,于2020年8月至2023年7月在巴基斯坦卡拉奇LRBT三级教学眼科医院葡萄膜炎科进行的。患者接受了葡萄膜炎专家详细的病史记录和临床检查。获得知情的书面同意。统计数据被记录下来,不包括开放性眼炎病例。必要时进行实验室检查和眼部检查。结果:本组共分析5791例患者,以女性为主(55.4%),平均年龄38.22±13.06岁。60.4%的病例累及双侧眼睛,最常见的葡萄膜炎类型为前膜炎(35.1%)和泛葡萄膜炎(28.9%)。非感染性葡萄膜炎(72.14%)更为普遍,特发性葡萄膜炎是最常见的原因(33.2%)。发现葡萄膜炎的解剖位置与各种临床特征(年龄、性别、眼部受累和感染状况)之间存在显著关联。例如,前葡萄膜炎更常与单侧眼睛受累有关,而双侧眼睛受累在泛葡萄膜炎和后葡萄膜炎的情况下更为常见。此外,感染性病因在泛葡萄膜炎和后葡萄膜炎中更为普遍(p结论:本研究的主要目的是确定在巴基斯坦卡拉奇一家三级眼科医院观察到的葡萄膜炎病例的模式。主要病因为特发性葡萄膜炎。然而,必须认识到,确定的患病率可能受到本研究的固有局限性,特别是与财政障碍和诊断方式的有限可用性有关。
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Ocular Immunology and Inflammation
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