Topic

#Uvea and Intraocular Inflammation

22 articles
  1. Articles 1 Apr 2021 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
  2. Articles 1 Apr 2021 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
  3. Articles 1 Apr 2021 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
  4. Articles 1 Apr 2021 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
  5. Articles 1 Apr 2021 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
  6. Articles 1 Apr 2021 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
  7. Articles 1 Apr 2021 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
  8. Articles 1 Apr 2021 13 min read

    A Beginner's Guide to Ultrasound Biomicroscopy

    Introduction: Anterior segment ocular imaging has gone through various inventions starting from the ultrasound in the 20th century to the recent AS- OCT.1 Ultrasound bio-microscopy, one of the ocular imaging devices is a high-resolution technique, which allows in vivo assessment of the structures of the anterior segment of the eye where cross-sectional images of ocular structures are obtained at microscopic resolution. 2The higher frequency of UBM ranging between 35 and 50 MHz, gives a depth of about 4 mm and an axial and lateral resolution of approximately 25 and 50 microns, respectively. 3 Being a non-invasive technique, efficient regardless of the clarity of the optical media and due to its portability can be performed both in adults and children with no complications.4 The internal acoustic characteristics of UBM, accompanied by the very fine backscatter speckle patterns, permit clear differentiation of ocular tissue at various levels.5 UBM imaging has been very useful in understan

    Dr. Sowkath Ali · Dr. Eunice Goh · +1 other
  9. Articles 1 Apr 2021 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
  10. Articles 1 Apr 2021 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

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