Uvea & Inflammatory Diseases

11–20 of 24 articles Page 2 of 3

All Cornea 36 Cataract 17 Glaucoma 14 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 16

9 min read

Seasonal Hyperacute Panuveitis (SHAPU)

Introduction: Seasonal Hyperacute Panuveitis (SHAPU) is a mysterious eye disease with grave prognosis, reported only from Nepal. Though it was reported for the first time in 1975,1-3 no definite etiopathogenesis has been established to date. It occurs as an outbreak in certain regions of Nepal in a cyclical pattern during the autumn season and peaks during the winter season (August–December) only in odd years. Thus, after the first outbreak of 1975, the next outbreaks occurred in 1977,1979, 1981, and so on and the last outbreak was reported in 2019. SHAPU predominately occurs among children4 and the youngest reported case is a 38- day-male baby.5 No gender predilection has been identified in SHAPU.4 All cases are mainly immunocompetent with no prior history of systemic or ocular illness/trauma.4, 6 SHAPU is very devastating and generally leads to the loss of sight within a week, followed by cosmetic disfigurement due to phthisis bulbi, which can have a significant emotional impact on t

Dr. Ranju Kharel (Sitaula)
20 min read

Uveitic Macular Edema

Introduction: Macular edema is defined as swelling of the layers of neurosensory retina within the macula. Cystoid macular edema (CME) is a subtype of macular edema characterized by extracellular accumulation of fluid within the outer plexiform layer of the retina in the form of intraretinal cyst. It is known as one of the complications, that develops consequent to a final common pathway in diverse diseases affecting the blood-retinal barrier. CME is a major cause of visual loss in uveitis. The overall reported prevalence of visual impairment associated with uveitic CME is 33–42 % and is influenced by the age, location, severity, and duration of retinal edema. [1,2] In young age, the retinal tissue shows resistance to development of CME, but advanced age is independently associated with early development of CME, regardless of the duration of uveitis. In contrast, the most frequent causes of visual loss in pediatric uveitis are retinal scars and glaucoma. [3] Panuveitis and intermediate

Dr. Amit H Palkar · Dr. Parthopratim Dutta Majumder
9 min read

How do we treat inflammatory CNVM ?

Inflammatory choroidal neovascular membranes (CNVM) cause an acute and significant visual loss 1,2. Mostly affecting eyes with posterior or panuveitis, the chronic recurrent nature of inflammation further worsens the visual prognosis in these eyes, such as serpiginous like choroiditis, punctuate inner choroidopathy (PIC), multifocal choroiditis, Vogt-Koyanagi-Harada (VKH) disease, presumed ocular histoplasmosis syndrome, toxoplasma retinochoroiditis, etc,.3,4 . The angiogenic stimulus in inflammatory CNVM is driven by local inflammation and/or a degenerative breach in retinal pigment epithelium (RPE)-Bruch’s membrane complex4. An active intraocular inflammation induces the release of several inflammatory mediators including cytokines, chemokines, vascular endothelial growth factor (VEGF) and complement activation, which in turn promote retinal and choroidal neovascularization. Majority of inflammatory CNVM are classic (on fundus fluorescein angiography), and type 2 on spectral domain o

Dr. Krinjeela Bazgain · Dr. Nitin Kumar · +1 other
25 min read

An Approach to a Case of Retinitis

Inflammation of retinal tissue causes characteristic fundus findings depending on whether it is full-thickness or partial-thickness or outer or inner retinal involvement. Figure 1A: A case of epidemic retinitis: Bright yellow superficial fluffy lesion superiorly to the disc obscuring retinal vessels passing through it is typical of inner or full-thickness retinitis. 1B: A case of progressive outer retinal necrosis: Yellowish lesions with clear retinal overlying vasculature suggests outer retinitis. Full-thickness or inner retinal involvement produces bright yellow fluffy lesions with indistinct borders. (Figure 1A) Retinal vasculature passing through these lesions appears obscured. At times, such lesions can mimic cotton-wool spots and may produce moderate to severe vitritis. Outer retinal inflammatory lesions appear dull orange or yellow with indistinct borders, retinal vessels may remain clear over the lesions (Figure 1B) and vitritis could be mild-moderate. Differentiating retinitis

Dr. Ankush Kawali · Dr. Sanjay Srinivasan · +1 other
12 min read

Ocular Tuberculosis

Ocular involvement in TB has been recognized for a long time and was first described in 17111. The spectrum of tuberculosis (TB)-related uveitis is wide. Its diagnosis still remains a challenge due to the lack of uniformity in the diagnostic criteria along with difficulties encountered in confirming the diagnosis by the laboratory methods available. It is a major concern in countries endemic for TB, and intraocular TB is being increasingly reported from various regions2-4. The true prevalence of intraocular TB is not known in India. While it has been reported to be 0.39% in South India, it is much higher (9.86%) in North India1,5. Varying rates of its prevalence have been reported from the world over (0.5% in the U.S.A., 6.31% in Italy, 6.9% in Japan, and 10.5% in Saudi Arabia). The largest series of patients with presumed intraocular TB and their outcome has been recently reported from our center6. Pathogenesis Uveitis due to latent TB has been reported since long. However, their exac

Dr. Reema Bansal · Prof. Vishali Gupta · +1 other
18 min read

Ocular Syphilis

Introduction: Syphilis is considered as a great mimicker due to its varied protean manifestations. It was first recognized in Europe in the late 15th century.[1] There have been several hypotheses regarding the origin and spread of syphilis and it is believed that the disease was brought back from the New World by the crew of Christopher Columbus, some of whom likely had syphilis on returning to Spain. Since the advent of Penicillin in the mid-20th century, the incidence of syphilis has reduced however it still represents a larger global problem [2] and an estimated 12 million new cases of syphilis are added every year worldwide and more than 90% are from developing countries.[3] The risk is particularly higher in men who have sex with men (MSM) and socially marginalized groups and those with HIV Co-infection.[4] The 2015 statistics from The Center for disease control and prevention (CDC) reported a 7.5 per 100,000 population of primary and secondary syphilis. (4). There has been a rec

Dr. Mudit Tyagi · Dr. Subhakar Reddy
4 min read

Ten Pearls for Managing a Case of Tubercular Uveitis

Pattern recognition is critical in the diagnosis and treatment of any form of uveitis. Here are 10 pearls that will make it easier to recognize patterns of presentation and resolution in tubercular uveitis. The general approach to diagnosis: We are all aware of the role of identifying clinical signs of TB in the eye and that of ancillary tests for systemic TB (immunological and radiological). However, we tend to ignore the last part – the exclusion of non-TB entities. These include various infectious and non-infectious conditions that can match a given clinical sign of ocular TB. Tubercular retinal vasculitis – 1: TB retinal vasculitis typically causes a periphlebitis, though rarely arterioles can also be affected. The most common clue for a tubercular etiology is the presence of active or healed retinitis lesions underlying the blood vessels (subvascular lesions). These are intraretinal granuloma and are highly predictive of tubercular etiology in TB-endemic countries (Kaza et al., 20

Dr. Soumyava Basu
20 min read

Ocular Sarcoidosis: A Review for the Postgraduates

Introduction: Sarcoidosis is a chronic multisystemic granulomatous disorder caused by an exaggerated cellular immune response to a variety of self or non-self-antigens in a genetically predisposed individual resulting in non-caseating granulomas. Ocular involvement occurs in 25-60% of systemic sarcoidosis at some point of time1. In this article, we look at the emerging literature on epidemiology, pathogenesis, clinical profile, and management in ocular sarcoidosis. Epidemiology: Sarcoidosis has an overall incidence of 6-10 per 100,000. Although sarcoidosis occurs worldwide, it is predominant in certain ethnic and racial groups like the Afro-Caribbean, Scandinavian, and Irish populations2-4. Highest incidence of ocular sarcoidosis is in the 20-40-year age group. Some studies show two peaks of incidence for ocular sarcoidosis the first at ages 20-30 and the second at ages 50-605. There is also a higher incidence of ocular involvement in women4. The reported incidence of ocular sarcoidosi

Dr. Vinaya Kumar Konana · Dr. Kalpana Babu
19 min read

Cytomegalovirus Retinitis Simplified

Introduction: Cytomegalovirus (CMV) retinitis is an opportunistic viral posterior uveitis that occurs mostly in severely immunocompromised Acquired Immunodeficiency Syndrome (AIDS) patients or, rarely, in those on immunosuppressive therapy after organ transplantation, or who are on systemic corticosteroids.1 More than 75% of AIDS patients with CD4+ counts less than 50 cells/?L have CMV retinitis. It is the most common ocular opportunistic infection in AIDS patients and accounts for 75-85% of all CMV end-organ disease.2 Before the introduction of Highly Active Antiretroviral Treatment (HAART), 30% of patients with Human Immunodeficiency Virus (HIV) developed CMV retinitis during their lifetime, but with the advent of HAART, there is a 75% reduction in the number of new cases of CMV retinitis.3 Rarely, CMV retinitis may occur in non-HIV patients having some degree of immune dysfunction, such as advanced age, diabetes mellitus, corticosteroid, and non-cytotoxic immunosuppressive drug usag

Dr. Swapnil Parchand · Dr. Anil Gangwe
36 min read

Viral Uveitis: Ready reckoner for the Postgraduates

Viral ocular infections can cause sight-threatening diseases in humans either as an isolated ocular infection or as a part of systemic illness. Although many viruses may naturally be harbored in human beings, the common ones causing ocular infections include herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV). They may remain dormant for several years with periodic asymptomatic virus shedding in immunocompetent individuals. However, in situations where the immunity is reduced due to age or, comorbidities, the symptomatic disease can occur. Ocular damage is caused by the direct cellular damage by the virus itself or the inflammatory response to the infection. Virus-specific T lymphocytes as well as humoral immunity with specific antibodies help to control the acute infection. Here we look at anterior and posterior viral uveitis in two separate sections and the common causative viruses. Viral Anterior Uveitis ( VAU) Introduction Anterior uveitis (AU) is th

Dr. Vinita Rao · Dr. Gazal Patnaik