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Posterior Uveitis (posterior + uveitis)
Selected Abstracts1263: Symptoms and signs of posterior uveitisACTA OPHTHALMOLOGICA, Issue 2010M KHAIRALLAH Purpose Posterior uveitis (PU) is an important anatomic form of uveitis in which the primary site of inflammation is the choroid or retina, with or without subsequent vitreous involvement. Methods Review of symptoms and signs of PU. Results The onset of PU can be sudden or less frequently insidious. Most common ocular symptoms include blurred vision, loss of vision, and floaters. Some patients with PU may have no symptoms, especially if inflammatory process is asymmetric. PU is usually associated with vitritis that can vary from mild to severe. Vitritis should be graded according to standardized grading systems. Other vitreous changes may include vitreous strands, vitreous hemorrhage, vitreous traction, and posterior vitreous detachment. Retinal and/or choroidal inflammation can be focal, multifocal, or more diffuse. It is important to distinguish between active and inactive chorioretinal disease. Retinal vasculitis can occur in the setting of several PU entities. It can involve retinal veins or arteries. It appears as focal, multifocal, or diffuse vascular cuffing or sheathing. Other retinal vasculitic changes include retinal hemorrhages, retinal vascular occlusion, retinal/optic disc neovascularization, and aneurysms. Maculopathy is common patients with PU. It may result from direct inflammatory infiltration, macular edema, serous retinal detachment, retinal ischemia, epiretinal membrane, or macular hole. Optic nerve involvement that can occur in association with PU include optic disc hyperemia/edema, optic neuritis, neuroretinitis, optic disc exudate, and optic disc granuloma. Conclusion Clinical examination is a key step in the diagnostic approach to PU. Clinician should be aware of the array of ocular symptoms of signs and their importance in orienting the differential diagnosis. [source] 1362: Infectious posterior uveitisACTA OPHTHALMOLOGICA, Issue 2010N MARKOMICHELAKIS Several infectious agents (parasites, bacteria, fungi, and viruses) can invade the eye and lead to ocular inflammation. Infectious causes should always be considered and ruled out in all patients with posterior uveitis. Toxoplasma gondii is by far the most common cause of infectious posterior uveitis in all ages, while Toxocara canis infects typically children. Onchocerciasis and other parasitic diseases may also cause posterior uveitis, more commonly in developing countries. Nowadays, old bacterial diseases, tuberculosis and syphilis, emerged as common causes of posterior uveitis. Bartonella henselae and Borrelia burgdorferi are other bacteria that can also cause posterior uveitis. Fungal posterior uveitis usually occurs in immunosuppressed patients or in intravenous drug users. Herpes viruses (HSV, VZV, CMV) are also associated with infectious retinitis, in immunocompromised as well as immunocompetent patients, with quite destructive clinical course. Recently, more viruses (such as West Nile virus, Rift valley fever, dengue fever, and chikungunya) have been recognized as etiologic factors of posterior infectious uveitis. A rapid and accurate diagnosis is of high importance for the successful treatment and visual outcome of infectious uveitis. Techniques and methods, such PCR and detection of specific antibodies in the intraocular fluids (Goldmann-Witmer coefficient), play a key role towards the detection of the pathogen of posterior infectious uveitis. [source] 4151: Epidemiology of uveitis in the Middle East and North AfricaACTA OPHTHALMOLOGICA, Issue 2010M KHAIRALLAH Purpose Numerous studies have examined the pattern of uveitis around the world. Most of them are from western countries, including the USA and countries in Europe, and Eastern Asia. The aim of this presentation is to review the epidemiological characteristics of uveitis in the the Middle East and North Africa. Methods The epidemiologic data on uveitis available from the Middle East and North Africa were reviewed. Results Several recent studies addressed the pattern of uveitis in different countries, including Iran, Saudi Arabia, Turkey, and Tunisia. Uveitis was most often seen in adults with a peak age at presentation in the third and fourth decades. There was no dramatic difference in gender distribution. Anterior uveitis was the most common anatomic form of uveitis, but a high rate of posterior uveitis and panuveitis was reported. A definitive or presumed specific diagnosis could be established for 57-87% of patients. The most common infectious entities were herpetic anterior uveitis, toxoplasmosis, and tuberculosis (Saudi Arabia). The most common identifiable non-infectious entities included Behçet's disease and Vogt-Koyanagi-Harada disease. Conclusion Herpetic infection, toxoplasmosis, and tuberculosis are the most common infectious causes of uveitis in the Middle East and North Africa. Behçet's diease and Vogt-Koyanagi-Harada disease are the most common non-infectious uveitic entities.HLA-B27 acute anterior uveitis, ocular sarcoidosis, and juvenile idiopathic arthritis associated uveitis are less common than in western countries. [source] Gene therapy for posterior uveitisACTA OPHTHALMOLOGICA, Issue 2009AD DICK Purpose To investigate the role of gene therapy incorporating release of immunomodulatory cytokines in animal models of intraocular inflammation Methods By inoculating with either AAV or lente viruses incorporating genes for IL-1RA or IL-10 into either the anterior chamber or subretinally we onserved the ability to suppress either endotoxin induced uveitis (EIU) or experimental autoimmiune uveoretinitis (EAU). Results Anterior chamber inoculation with lente-IL-10 or IL-1RA successfully suppresses inflammation and protein exudation into the eye during the course of EIU. Subretinal injection of AAV-IL-10 suppresses EAU. The extent of local macrophage activation is also suppressed as there is marked reduction in nitrotyrosine expression within the retina. Conclusion Gene therapy with immunomodulatory cytokines offers a potential to suppress active inflammatory processes within the retina. Mechanisms will be discussed in the talk in relation to macrophage activation and restoring myeloid cell (microgolial) homeostasis within the retina. [source] Progress in the appraisal and management of inflammatory CNVsACTA OPHTHALMOLOGICA, Issue 2009P NERI Purpose To review the current Literature and to describe the experience of a tertiary referral centre on the progress in the appraisal and the management of inflammatory choroidal neovascularization (CNV). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results CNV is a potentially severe sequela of posterior uveitis. The role of chronic inflammation has been described in experimental uveitis. For such reasons, even when biomicroscopy and fluorangiography (FA) cannot detect abnormalities, Indocyanine Green Angiography (ICGA) can show choridal anomalies. ICGA greatly improved the appraisal of the choroidal involvement, by providing reliable data for the diagnosis and for the management of inflammatory CNV. The new spectral domain optical coherence tomography (OCT) equipments can provide further informations that can be useful for a correct clinical assessment. The out-come of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. Steroids, both local and systemic, are the first line therapy for non-infectious choroidal inflammation, although their long-term use can lead to unpleasant sequala, such as glaucoma and cataract. Immunesuppressive agents, lasers photocoagulation, photodynamic treatment, surgical removal and anti-Vascular Endothelial Growth Fact (VEGF) are other options. Conclusion CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant informations about the choroidal status. Several therapeutic options have been considered, but no guidelines are available at the moment. [source] The present role of corticosteroids in uveitisACTA OPHTHALMOLOGICA, Issue 2009M KHAIRALLAH Corticosteroids are the most widely used anti-inflammatory and immunosuppressant drugs in ophthalmology in general, and remain the mainstay of therapy for patients with uveitis. An infectious etiology for intraocular inflammation should be adequately excluded or appropriately covered with anti-infectious therapy before administration of corticosteroid therapy. Topical corticosteroids alone are usually effective in the management of anterior uveitis and have little activity against intermediate or posterior uveitis. Ocular adverse effects of topical steroid therapy mainly include ocular hypertension and cataract. The use of periocular steroid injections (subconjunctival, anterior or posterior subtenon, orbital floor) are important modalities in the management of anterior uveitis refractory to topical treatment and intermediate or posterior uveitis, particularly unilateral cases. Systemic corticosteroids remain the initial drug of choice for most patients with severe bilateral intermediate or posterior uveitis. Therapy is initiated with 1.0 to 2.0 mg/Kg of oral prednisone or prednisolone as a single morning dose, followed by a slow taper. Use of intravenous pulse steroid therapy is an important option in acute, severe, bilateral posterior segment inflammation. In several cases, the level of systemic steroid required to control the inflammation is too high and unacceptable. Immunosuppressive drugs as steroid-sparing agents are indicated is such cases. Intravitreal injection of triamcinolone acetonide and slow-release intraocular devices are therapeutic options that can be used in selected uveitis cases refractory to conventional therapy and biologic agents. [source] Therapeutic efficacy of intravitreal bevacizumab on posterior uveitis complicated by neovascularizationACTA OPHTHALMOLOGICA, Issue 3 2009Shree Kurup Abstract. Purpose:, To evaluate the therapeutic effect of intravitreal bevacizumab in patients with uveitis-associated choroidal/retinal neovascularization. Methods:, Two female patients (40 years, 15 years) with posterior uveitis, (one presumed ocular sarcoidosis, one lupus) were evaluated for neovascularization of the posterior segment. Both patients were given a single dose of 1.25 mg intravitreal bevacizumab. Results:, Significant anatomical and functional recovery was evident in both patients within a few weeks. Conclusion:, In selected uveitic patients, bevacizumab may be an option for managing neovascularization. [source] Antimicrobial treatment of presumed ocular tuberculosisACTA OPHTHALMOLOGICA, Issue 2007S KOUPRIANOFF Purpose: Uveitis secondary to a tuberculosis is rarely reported, even in a tertiary a care center. The prevalence of tuberculosis is low in Western Europe and its microbiological identification is difficult. However, anti tuberculosis treatment may be useful when the diagnosis of tuberculosis is presumed. Methods: The clinical records of patients with suspected tuberculosis uveitis referred to the Ophthalmology Department of the Grenoble University, between January 2005 and January 2007 were retrospectively analyzed. Patients were included in this series if they received a specific antituberculosis treatment. Results: This series included 10 patients (3M/7F, mean age 54.1). The clinical features of ocular inflammation were: bilateral panuveitis, episcleritis, bilateral posterior uveitis, and pars planitis. Tuberculin skin test, chest computerized tomography, BK sputum, and internal medicine consultation were performed for all patients. The diagnosis of presumed tuberculosis was based upon: history, thoracic imaging, and tuberculin skin test. None had extra-ocular symptoms. Sputum cultures were negative, 2 adenopathy biopsies confirmed the diagnosis. Nine patients received specific antituberculosis therapy, without systemic steroid therapy. All of them improved; no relapse occurred after 1 to 2 years after the end of therapy. In one case, tuberculosis specific therapy allowed to taper the systemic steroid therapy. Conclusions: The diagnosis of uveitis associated with tuberculosis is difficult since it depends on a spectrum of indirect signs. Bacteriological identification is rarely obtained. In presumed ocular tuberculosis, antituberculosis therapy may be useful to control intraocular inflammation, with or without steroid therapy. [source] Efficacy of periocular corticosteroid injections in the management of posterior uveitisCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2005Wico W Lai MD FACS No abstract is available for this article. [source] | ||||||||||