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Dynamic Changes of Fundus and Predictors of Visual Prognosis in New-Onset Vogt-Koyanagi-Harada Disease. 新发 Vogt-Koyanagi-Harada 病的眼底动态变化和视觉预后的预测因素。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-06-25 DOI: 10.1080/09273948.2024.2369940
Suo Guo, Rong Hu, Meiwen Wang, Lan Xia, Peizeng Yang

Purpose: To characterize the dynamic changes of fundus in Vogt-Koyanagi-Harada (VKH) disease through enhanced spectral-domain optical coherence tomography (EDI-OCT) and explore the predictors of visual prognosis.

Methods: In this retrospective cohort study, a total of 2152 VKH patients referred to our uveitis center from January 2013 to April 2022 were screened; 151 new-onset VKH patients (299 eyes) and 82 healthy controls (164 eyes) were included. The manifestations of fundus at baseline, 1 month, 3 months, and 12 months after treatment were analysed and their relevance to visual prognosis were evaluated.

Results: After retinal detachment (RD) (97.3%) and optic disc swelling (100%) presented at baseline, retinal reattachment (81.6%) and the granular hyperreflective depositions at the retinal pigment epithelium (RPE) (61.5%) were observed at month 1. The RPE and ellipsoid zone rearrangement accompanying interdigitation zone attenuation (57.9%) was noted finally. Choroidal thickness of patients was higher than that in the controls at baseline and month 1 (both P < 0.001). Best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) (P < 0.001; OR, 4.01), subretinal fibrinoid exudate (P < 0.001; OR, 3.9) and RPE folds (p = 0.001; OR, 2.39) at baseline, and the RD at month 1 (P < 0.001; OR, 3.42) were associated with visual prognosis.

Conclusions: New-onset VKH patients after treatment exhibited dynamic changes in the fundus especially the outer retina during a 12-month period. The BCVA, subretinal fibrinoid exudate, and RPE folds at baseline, and RD at month May 1, serve as predictors of visual prognosis.

目的:通过增强光谱域光学相干断层扫描(EDI-OCT)描述Vogt-Koyanagi-Harada(VKH)病眼底的动态变化,并探讨视觉预后的预测因素:在这项回顾性队列研究中,共筛选了2013年1月至2022年4月期间转诊至我院葡萄膜炎中心的2152名VKH患者,其中包括151名新发VKH患者(299眼)和82名健康对照者(164眼)。对基线、治疗后1个月、3个月和12个月的眼底表现进行分析,并评估其与视力预后的相关性:结果:基线时出现视网膜脱离(97.3%)和视盘肿胀(100%),1 个月后观察到视网膜再粘连(81.6%)和视网膜色素上皮(RPE)颗粒状高反射沉积(61.5%)。在基线和第 1 个月时,患者的脉络膜厚度高于对照组(P 均<0.001)。基线时的最佳矫正视力(BCVA)(最小分辨角对数[logMAR])(P < 0.001;OR,4.01)、视网膜下纤维素渗出(P < 0.001;OR,3.9)和RPE皱褶(P = 0.001;OR,2.39)以及第1个月时的RD(P < 0.001;OR,3.42)与视力预后相关:结论:新发 VKH 患者在接受治疗后的 12 个月内,眼底尤其是外层视网膜会发生动态变化。基线时的BCVA、视网膜下纤维素渗出和RPE皱褶以及5月1日时的RD可预测视力预后。
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引用次数: 0
Periorbital Tuberculosis: A Rare Case of Extrapulmonary Tuberculosis. 眶周结核病:肺外结核的罕见病例。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-09-25 DOI: 10.1080/09273948.2024.2407460
Aylin Var, Yusuf Uysal, Mehmet Kuruş, Yağmur Seda Yeşiltaş, Uğur Bozlar, Şeref Özkara, Ali Albay

Purpose: Orbital/periorbital tuberculosis (TB) is an uncommon manifestation of extrapulmonary TB, presenting diagnostic challenges due to its varied clinical features that can mimic other diseases. This report aims to present a rare case of periorbital TB in a young man.

Methods: Case report.

Results: A 36-year-old man presented with painless left periorbital swelling and discharge following facial trauma. Despite initial treatment with antibiotics elsewhere, symptoms persisted. Imaging revealed a periorbital abscess with adjacent bone involvement. Microbiologic studies demonstrated Mycobacterium tuberculosis complex growth, confirming TB. There was no evidence of systemic TB. The patient received anti-tuberculosis therapy. At the 8-month follow-up, he remained symptom-free.

Conclusion: Orbital/periorbital TB, although rare, should be taken into consideration in regions with high TB prevalence when dealing with chronic, non-resolving periorbital lesions. Advanced imaging and molecular diagnostics play crucial roles in confirming the diagnosis, especially given the low sensitivity of traditional culture methods for extrapulmonary TB.

目的:眼眶/眶周结核病(TB)是肺外结核病的一种不常见表现,由于其临床特征多样,可与其他疾病混淆,因此给诊断带来了挑战。本报告旨在介绍一例罕见的年轻男性眶周结核病例:方法:病例报告:一名 36 岁的男子在面部外伤后出现左侧眶周无痛性肿胀和分泌物。尽管最初在其他地方使用了抗生素治疗,但症状依然存在。影像学检查发现眶周脓肿并累及邻近骨骼。微生物学检查显示有结核分枝杆菌复合体生长,证实为肺结核。没有全身结核病的证据。患者接受了抗结核治疗。随访8个月,患者仍无症状:眼眶/眶周结核病虽然罕见,但在结核病高发地区,在处理慢性、无缓解的眶周病变时应加以考虑。先进的成像和分子诊断技术在确诊中起着至关重要的作用,尤其是考虑到传统培养方法对肺外结核病的敏感性较低。
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引用次数: 0
Acinetobacter baumannii Endogenous Endophthalmitis Presenting with Iris Nodules. 伴有虹膜结节的鲍曼不动杆菌内源性眼内炎
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-10-04 DOI: 10.1080/09273948.2024.2412215
Kalpana Babu, S Chandana, Aniruddha Tirumalai, Krishna R Murthy

Aim: We report a unique finding of iris nodules in a woman with endogenous endophthalmitis due to Acinetobacter baumannii with no history of ocular surgery or trauma and good visual outcome.

Materials & methods: Retrospective case report.

Results: A 39-year-old woman with a history of type 2 diabetes mellitus presented with a decrease in vision in the right eye of 1-month duration. On examination, her BCVA was CF2m (OD) and 6/6 (OS). Right eye examination showed medium-to-large-sized keratic precipitates, iris nodules, and vitritis. PCR on the aqueous showed faint positivity for Propionibacterium acne and was negative to panfungal genome. Despite two intravitreal injections of vancomycin (1 mg/0.1 ml) and intravenous cefazolin 1 g bd for 5 days, there was progression to hypopyon. Vitrectomy with lensectomy was done. The vitreous culture grew Acinetobacter baumannii. She was given multiple intravitreal ceftazidime (2.25 mg/0.1 ml) with dexamethasone (0.4 mg/0.1 ml) injections. She was also put on tab bactrim DS twice a day for 3 months along with tab doxycycline 100 mg twice a day for 3 months by the infectious disease specialist. As the inflammation improved, the iris nodules were the last to resolve completely in 6 weeks. At 15-month follow-up, her eye was quiet, and vision was 6/9 (OD) with aphakic correction.

Conclusion: We report a rare finding of iris nodules in a patient with culture proven Acinetobacter baumannii endogenous endophthalmitis.

目的:我们报告了一例独特的虹膜结节病例,该患者因鲍曼不动杆菌引起内源性眼内炎,无眼部手术或外伤史,视力恢复良好:回顾性病例报告:一名39岁的女性患者,有2型糖尿病史,右眼视力下降持续了1个月。经检查,她的 BCVA 为 CF2m(OD)和 6/6(OS)。右眼检查显示有中到大型角膜沉淀、虹膜结节和玻璃体炎。水样 PCR 显示痤疮丙酸杆菌微弱阳性,泛真菌基因组阴性。尽管连续 5 天在玻璃体内注射了两次万古霉素(1 毫克/0.1 毫升)并静脉注射了 1 克头孢唑啉,但病情仍发展为黄疽。患者接受了玻璃体切除术。玻璃体培养出鲍曼不动杆菌。医生给她进行了多次玻璃体内头孢他啶(2.25 毫克/0.1 毫升)和地塞米松(0.4 毫克/0.1 毫升)注射。传染病专家还让她服用巴曲溴铵,每天两次,持续 3 个月,同时服用多西环素 100 毫克,每天两次,持续 3 个月。随着炎症的改善,虹膜结节在 6 周内最后完全消退。在 15 个月的随访中,她的眼睛恢复平静,视力为 6/9 (OD),无晶体眼矫正:我们报告了一名经培养证实患有鲍曼不动杆菌内源性眼内炎的患者出现虹膜结节的罕见病例。
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引用次数: 0
Posterior Scleritis Associated with Late-Onset Takayasu Arteritis: A Case Report. 晚发高安动脉炎伴发后巩膜炎:病例报告。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-10-10 DOI: 10.1080/09273948.2024.2413894
Yann Bertolani, Tetiana Goncharova, Eric Kirkegaard-Biosca, Julia Angrill-Valls, Natalia Anglada-Masferrer, Liliana Gutuleac, Laura Distefano, Miguel Ángel Zapata

Purpose: To describe a rare case of posterior scleritis associated with late-onset Takayasu arteritis.

Methods: A case report of a 75-year-old female presenting with posterior scleritis, eventually diagnosed with late-onset Takayasu arteritis was described. Several medical evaluation visits were conducted, including ophthalmological and rheumatological follow-up. Multiple diagnostic tests were carried out, and the cornerstones of the treatment were corticosteroids and the IL-6 inhibitor tocilizumab.

Results: The patient was admitted to our hospital's emergency room with right unilateral eyelid edema, chemosis and red eye. She had previously experienced two episodes that were misdiagnosed as preseptal cellulitis. The presence of choroidal folds and the T sign on the ultrasound exam were highly suggestive of posterior scleritis. Later, the patient was diagnosed with Takayasu arteritis, a type of large vessel vasculitis. Treatment with steroids was started, which was later switched to IL-6 inhibitors to achieve better control of the systemic disease.

Conclusion: Posterior scleritis is often misdiagnosed, necessitating high clinical suspicion. Multimodal diagnosis is important to establish an accurate diagnosis. Up to 34% of cases may be associated with a systemic disease. This is the first case described in the literature of posterior scleritis associated with late-onset Takayasu arteritis.

目的:描述一例罕见的后巩膜炎伴有晚发型高安动脉炎的病例:报告了一例 75 岁女性后巩膜炎病例,该病例最终被诊断为晚发性高安动脉炎。对患者进行了多次医疗评估,包括眼科和风湿科随访。进行了多项诊断检查,治疗的基础是皮质类固醇激素和 IL-6 抑制剂托西珠单抗:患者因右单侧眼睑水肿、化脓和红眼病被送入我院急诊室。此前,她曾有过两次眼睑水肿,但被误诊为眼睑前蜂窝组织炎。超声波检查发现脉络膜皱褶和 T 征,高度提示后巩膜炎。后来,患者被诊断为高安动脉炎,这是一种大血管炎。患者开始接受类固醇治疗,后来改用IL-6抑制剂,以更好地控制全身疾病:结论:后巩膜炎经常被误诊,临床上需要高度怀疑。多模式诊断对于确定准确诊断非常重要。多达 34% 的病例可能伴有全身性疾病。这是文献中描述的第一例后巩膜炎伴有晚发高安动脉炎的病例。
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引用次数: 0
Unusual and Atypical Ocular Infections. 异常和非典型眼部感染。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-31 DOI: 10.1080/09273948.2025.2458997
Derrick P Smit, Ilknur Tugal-Tutkun, Jennifer E Thorne
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引用次数: 0
Intermediate Uveitis with Cystoid Macular Edema as Presentation of Retained Caterpillar Hair in the Vitreous Cavity. 中间葡萄膜炎伴有囊样黄斑水肿,表现为玻璃体腔内毛虫毛发残留。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-05-07 DOI: 10.1080/09273948.2024.2345282
Nitin Kumar Menia, Sabia Handa, Ashish Markan, Umang Thakur, Aniruddha Agarwal, Vishali Gupta

Purpose: To report an unusual case of retained caterpillar hair in the vitreous cavity presenting as recurrent Intermediate Uveitis with cystoid macular edema.

Method: Case Report.

Results: A 40-year-old male presented to our uveitis clinic with recurrent episodes of redness and diminution of vision in his left eye for 3 years. He was diagnosed and treated elsewhere as a case of recurrent intermediate uveitis and was referred to our center for a second opinion to initiate immunosuppressive therapy. A detailed history revealed that a caterpillar had fallen into his left eye 3 years back, followed by severe irritation, pain, and redness. He received topical antibiotics and corticosteroids, and retained caterpillar hair was removed from the ocular surface. During the last 3 years, the patient had multiple episodes of inflammation despite being treated with oral and topical corticosteroids. At the current visit, a meticulous clinical examination at our centre revealed multiple, migrated, retained caterpillar hair in the vitreous cavity. The patient was diagnosed with Ophthalmia Nodosa (Type V) and managed with surgical intervention (vitreous surgery). The case highlights an unusual presentation of ON and the role of pars plana vitrectomy in its successful management.

Conclusion: We highlight a rare and unusual presentation of ophthalmia nodosa and its successful management.

目的:报告一例玻璃体腔内毛毛虫毛发滞留,表现为复发性中度葡萄膜炎伴囊样黄斑水肿的罕见病例:方法:病例报告:一名 40 岁男性因左眼反复发红、视力下降 3 年到我院葡萄膜炎门诊就诊。他在其他地方被诊断为复发性中度葡萄膜炎并接受了治疗,后被转诊至本中心接受免疫抑制治疗。详细的病史显示,3 年前,一只毛毛虫掉进了他的左眼,随后出现了严重的刺激、疼痛和发红。他接受了局部抗生素和皮质类固醇治疗,并清除了眼球表面残留的毛虫毛发。在过去的 3 年中,尽管患者接受了口服和局部皮质类固醇治疗,但炎症仍多次发作。本次就诊时,本中心对其进行了细致的临床检查,发现玻璃体腔内有多根移位的毛虫毛发。患者被诊断为结节性眼炎(V 型),并接受了手术治疗(玻璃体手术)。本病例强调了结节眼的不寻常表现以及玻璃体旁切除术在成功治疗结节眼中的作用:我们重点介绍了结节性眼炎的一种罕见和不寻常的表现形式及其成功治疗。
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引用次数: 0
Ocular Leptospirosis: Report of a Challenging Diagnosis. 眼部钩端螺旋体病:一个棘手诊断的报告
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-06-26 DOI: 10.1080/09273948.2024.2367651
Guilherme Macedo Souza, Heloisa Nascimento, Rubens Belfort

Purpose: To report a challenging case of serologically confirmed posterior uveitis due to leptospirosis.

Methods: Review of medical records.

Results: Thirteen-year-old boy presented focal necrotizing retinochoroiditis after flood exposure. Laboratory work-up confirmed leptospirosis infection and proper antibiotic treatment was done. The patient evolved well. but during late follow-up he developed nummular keratitis.

Conclusion: Leptospirosis is a possible etiology of necrotizing posterior uveitis. The use of antimicrobial therapy is controversial but was used in this case, in association with corticosteroids, leading to resolution of retinal inflammation. Despite treatment, the patient developed late corneal opacities, which did not lead to visual impairment.

目的:报告一例经血清学确诊的钩端螺旋体病引起的后葡萄膜炎病例:方法:回顾病历:13岁的男孩在洪水暴露后出现局灶性坏死性视网膜脉络膜炎。实验室检查证实患者感染了钩端螺旋体病,并进行了适当的抗生素治疗。但在后期随访期间,他又患上了麻木性角膜炎:结论:钩端螺旋体病可能是坏死性后葡萄膜炎的病因之一。结论:钩端螺旋体病可能是导致坏死性后葡萄膜炎的病因,抗菌治疗的使用存在争议,但在本病例中,抗菌治疗与皮质类固醇联合使用,导致视网膜炎症消退。尽管进行了治疗,但患者还是出现了晚期角膜翳,但并未导致视力受损。
{"title":"Ocular Leptospirosis: Report of a Challenging Diagnosis.","authors":"Guilherme Macedo Souza, Heloisa Nascimento, Rubens Belfort","doi":"10.1080/09273948.2024.2367651","DOIUrl":"10.1080/09273948.2024.2367651","url":null,"abstract":"<p><strong>Purpose: </strong>To report a challenging case of serologically confirmed posterior uveitis due to leptospirosis.</p><p><strong>Methods: </strong>Review of medical records.</p><p><strong>Results: </strong>Thirteen-year-old boy presented focal necrotizing retinochoroiditis after flood exposure. Laboratory work-up confirmed leptospirosis infection and proper antibiotic treatment was done. The patient evolved well. but during late follow-up he developed nummular keratitis.</p><p><strong>Conclusion: </strong>Leptospirosis is a possible etiology of necrotizing posterior uveitis. The use of antimicrobial therapy is controversial but was used in this case, in association with corticosteroids, leading to resolution of retinal inflammation. Despite treatment, the patient developed late corneal opacities, which did not lead to visual impairment.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":" ","pages":"214-217"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451082","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
Ocular Involvement in Patients with Brucellosis: A Single-Center Prospective Study. 布鲁氏菌病患者的眼部受累:单中心前瞻性研究
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-06-25 DOI: 10.1080/09273948.2024.2369655
Murat Aydin, Ahmet Duhan Özbay, Nurten Nur Aydin

Purpose: The aim of this study was to evaluate the prevalence, type and treatment outcomes of ocular involvement in patients with brucellosis.

Methods: This prospective, single-center study enrolled patients admitted to the infectious disease outpatient clinic with diagnosed brucellosis between July 15, 2022 and July 15, 2023. Diagnosis was based on clinical symptoms and a standard Brucella tube agglutination test (≥1/160) or a positive blood culture. Ophthalmologic examinations were performed at baseline and in the first month of treatment. Third and sixth month follow-up examinations were also performed for patients with ocular findings.

Results: Ocular involvement occurred in 60 (24.8%) of 242 patients. Conjunctivitis was the most common ocular involvement and was observed in 39 patients (16.1%). Uveitis was the second most common ocular involvement in 14 patients (5.8%). Scleritis was the least common ocular involvement and was observed in only one patient. Patients with ocular involvement were older (p = 0.027) and had higher rates of weight loss and spondylodiscitis (p = 0.044 and 0.001, respectively). Among laboratory parameters, erythrocyte sedimentation rate and lactate dehydrogenase levels were significantly higher in patients with ocular involvement (p = 0.001 and 0.036, respectively). There were no significant differences in other demographic, clinical, and laboratory characteristics between patients with and without ocular involvement. In 56 (93.3%) patients, the ocular findings improved during the follow-up examination.

Conclusion: Brucellosis, a systemic infection, can manifest with ocular involvement. Early detection and treatment through ophthalmological examination are crucial in managing brucellosis.

目的:本研究旨在评估布鲁氏菌病患者眼部受累的患病率、类型和治疗效果:这项前瞻性单中心研究招募了2022年7月15日至2023年7月15日期间感染性疾病门诊确诊的布鲁氏菌病患者。诊断依据是临床症状和标准布鲁氏菌试管凝集试验(≥1/160)或血液培养阳性。在基线期和治疗的第一个月进行眼科检查。对有眼部检查结果的患者还进行了第三和第六个月的随访检查:结果:242 例患者中有 60 例(24.8%)出现眼部病变。结膜炎是最常见的眼部病变,有 39 名患者(16.1%)出现结膜炎。葡萄膜炎是第二种最常见的眼部病变,有 14 名患者(5.8%)患此病。巩膜炎是最不常见的眼部病变,仅有一名患者发病。眼部受累的患者年龄较大(p = 0.027),体重减轻和脊柱盘炎的发病率较高(p = 0.044 和 0.001)。在实验室指标中,眼部受累患者的红细胞沉降率和乳酸脱氢酶水平明显更高(p = 0.001 和 0.036)。有眼部受累和没有眼部受累的患者在其他人口统计学、临床和实验室特征方面没有明显差异。56例(93.3%)患者的眼部症状在随访检查中有所改善:结论:布鲁氏杆菌病是一种全身性感染,可表现为眼部受累。结论:布鲁氏杆菌病是一种全身性感染,可表现为眼部受累,通过眼科检查及早发现和治疗是控制布鲁氏杆菌病的关键。
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引用次数: 0
Asymptomatic Ophthalmomyiasis Interna Posterior with Central Pigment Accumulation in the Inner Retina. 无症状眼球后膜内炎伴内视网膜中央色素积聚。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-07-12 DOI: 10.1080/09273948.2024.2374433
Vishal Jadhav, Jyoti Goyal, Suman Sahu, Anup Kelgaonkar, Soumyava Basu, Avinash Pathengay

Purpose: To report a case of ophthalmomyiasis interna posterior which was asymptomatic and had pigment clumps in the inner retina at the macula.

Methods: Single-centre, observational, retrospective case report.

Results: A routine refractive error check-up for an asymptomatic 52-year-old Asian Indian woman, who had relied on glasses for 8 years, unfolded a captivating narrative within her retina. This coloured fundus photo unveils mid-peripheral retinal disease with multiple outer retinal atrophic tracts, circumlinear patterns, and intricately intertwined RPE atrophic tracts. These were hyper-autofluorescent on blue autofluorescence. The inferonasal periphery had two-disc diameters of pigmented retinal-choroidal atrophic scar. The macula revealed a collection of black intraretinal pigments in parafoveal areas. The distinct clinical presentation, marked by multiple tracts and unilateral manifestation without disc pallor, hinted at the intriguing possibility of self-resolved "Ophthalmomyiasis interna posterior."

Conclusion: The course of disease in ophthalmomyiasis interna posterior can be self-limiting and asymptomatic. The presence of inner retinal pigments at foveal and parafoveal areas, possibly due to pigment migration from the peripheral outer retinal tracts, is a rare presentation.

目的:报告一例无症状、黄斑内侧视网膜上有色素团块的后眼肌间皮瘤病例:单中心、观察性、回顾性病例报告:一位 52 岁的亚裔印度妇女无症状,佩戴眼镜已有 8 年之久,在一次例行屈光不正检查中,她的视网膜内出现了一个迷人的故事。这张彩色眼底照片揭示了视网膜中周的病变,其中有多个视网膜外层萎缩道、环状纹和错综复杂的 RPE 萎缩道。这些病变在蓝色自发荧光下呈高自发荧光。视网膜下周有两盘直径的色素性视网膜-脉络膜萎缩瘢痕。黄斑区旁有黑色视网膜内色素聚集。其独特的临床表现以多发和单侧表现为特征,且无视盘苍白,这暗示了自我解决的 "Ophthalmomyiasis interna posterior "的耐人寻味的可能性:后间质性眼肌症的病程可以是自限性和无症状的。在眼窝和眼窝旁区域出现视网膜内色素,可能是由于外周视网膜外层色素迁移所致,这是一种罕见的表现。
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引用次数: 0
Ocular Syphilis - Clinical Features and Outcome in HIV Positive and HIV Negative Patients from a Tertiary Eye Center from India - A Comparative Study. 眼梅毒--来自印度一家三级眼科中心的 HIV 阳性和 HIV 阴性患者的临床特征和结果--一项比较研究。
IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-02-01 Epub Date: 2024-08-15 DOI: 10.1080/09273948.2024.2382347
Arshee S Ahmed, Nair Nivedita, Sridharan Sudharshan, Anitha Manoharan, Appakkudal R Anand, Poongulali Selvamuthu, Jyotirmay Biswas

Purpose: To study and compare the clinical characteristics and outcome of ocular syphilis between HIV positive and HIV negative patients.

Methods: Retrospective hospital-based case series from a tertiary eye care hospital in India. Patients with uveitis and positive syphilis serology were included. Demographics, clinical features, investigations, imaging and treatment modalities were noted.

Results: Hundred and five (105) eyes of 66 patients were analyzed. Males were predominantly affected (n = 57/66, 86.4%). Secondary syphilis was the most common stage of presentation (n = 48/66, 72.7%). Two groups were identified: HIV positive (HIVP) patients (n = 39/66, 59%) and HIV negative (HIVN) patients (n = 27/66, 41%). 12/39 (30.8%) patients were newly diagnosed with HIV at the time of ocular presentation. Panuveitis was the most common presenting feature in both groups (n = 66/105 eyes, 62.8%). Diffuse necrotizing retinitis was more common in HIV patients (HIVP - 15 Vs HIVN - 5 eyes). Ocular co-infections were more common in HIV patients, ocular tuberculosis, the commonest in both groups. Intravenous penicillin and titrated dose of systemic steroids were the mainstay of treatment. Improvement in mean logMAR was noted from 1.415 to 0.828 with p-value < 0.001. At final follow-up, 71.8% patients showed visual improvement. Complete resolution of ocular inflammation was noted in 95.5% patients.

Conclusion: Ocular syphilis poses a diagnostic challenge considering the varied presentations and clinical course both in immunocompromised and immunocompetent groups. Clinical presentations are not always classical. High index of suspicion with supportive laboratory investigations and with characteristic OCT features helps diagnosis. All uveitis patients, especially with those suspected with infectious etiology, need to be tested for syphilis serology to prevent vision loss in this resurgent disease.

目的:研究和比较 HIV 阳性和阴性患者眼梅毒的临床特征和结果:方法:印度一家三级眼科医院的回顾性医院病例系列。纳入葡萄膜炎和梅毒血清学阳性患者。结果:共发现105例葡萄膜炎患者:结果:对66名患者的105只眼睛进行了分析。男性患者占多数(57/66,86.4%)。继发性梅毒是最常见的发病阶段(n = 48/66,72.7%)。患者分为两组:HIV阳性(HIVP)患者(n = 39/66,59%)和HIV阴性(HIVN)患者(n = 27/66,41%)。12/39(30.8%)名患者在出现眼部症状时是新诊断出的艾滋病病毒感染者。泛发性葡萄膜炎是两组患者最常见的发病特征(n = 66/105,62.8%)。弥漫性坏死性视网膜炎在艾滋病患者中更为常见(HIVP-15 眼,HIVN-5 眼)。眼部合并感染在艾滋病病毒感染者中更为常见,眼部结核病在两组患者中最为常见。静脉注射青霉素和滴定剂量的全身类固醇是治疗的主要方法。平均对数值从 1.415 降至 0.828,P 值为 结论:考虑到眼梅毒在免疫力低下和免疫力正常人群中的不同表现和临床过程,眼梅毒给诊断带来了挑战。临床表现并不总是典型的。高度怀疑并辅以实验室检查和特征性 OCT 特征有助于诊断。所有葡萄膜炎患者,尤其是疑似感染性病因的患者,都需要进行梅毒血清学检测,以防止这种死灰复燃的疾病造成视力丧失。
{"title":"Ocular Syphilis - Clinical Features and Outcome in HIV Positive and HIV Negative Patients from a Tertiary Eye Center from India - A Comparative Study.","authors":"Arshee S Ahmed, Nair Nivedita, Sridharan Sudharshan, Anitha Manoharan, Appakkudal R Anand, Poongulali Selvamuthu, Jyotirmay Biswas","doi":"10.1080/09273948.2024.2382347","DOIUrl":"10.1080/09273948.2024.2382347","url":null,"abstract":"<p><strong>Purpose: </strong>To study and compare the clinical characteristics and outcome of ocular syphilis between HIV positive and HIV negative patients.</p><p><strong>Methods: </strong>Retrospective hospital-based case series from a tertiary eye care hospital in India. Patients with uveitis and positive syphilis serology were included. Demographics, clinical features, investigations, imaging and treatment modalities were noted.</p><p><strong>Results: </strong>Hundred and five (105) eyes of 66 patients were analyzed. Males were predominantly affected (<i>n</i> = 57/66, 86.4%). Secondary syphilis was the most common stage of presentation (<i>n</i> = 48/66, 72.7%). Two groups were identified: HIV positive (HIVP) patients (<i>n</i> = 39/66, 59%) and HIV negative (HIVN) patients (<i>n</i> = 27/66, 41%). 12/39 (30.8%) patients were newly diagnosed with HIV at the time of ocular presentation. Panuveitis was the most common presenting feature in both groups (<i>n</i> = 66/105 eyes, 62.8%). Diffuse necrotizing retinitis was more common in HIV patients (HIVP - 15 Vs HIVN - 5 eyes). Ocular co-infections were more common in HIV patients, ocular tuberculosis, the commonest in both groups. Intravenous penicillin and titrated dose of systemic steroids were the mainstay of treatment. Improvement in mean logMAR was noted from 1.415 to 0.828 with <i>p</i>-value < 0.001. At final follow-up, 71.8% patients showed visual improvement. Complete resolution of ocular inflammation was noted in 95.5% patients.</p><p><strong>Conclusion: </strong>Ocular syphilis poses a diagnostic challenge considering the varied presentations and clinical course both in immunocompromised and immunocompetent groups. Clinical presentations are not always classical. High index of suspicion with supportive laboratory investigations and with characteristic OCT features helps diagnosis. All uveitis patients, especially with those suspected with infectious etiology, need to be tested for syphilis serology to prevent vision loss in this resurgent disease.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":" ","pages":"235-242"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982885","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}
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Ocular Immunology and Inflammation
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