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Human monkeypox is a zoonosis caused by an orthopoxvirus and the clinical presentation resembles that of smallpox and chickenpox. The disease may start with a prodrome that includes lymphadenopathy, headache, fatigue, and fever, followed by a vesiculo-pustular rash. Ocular manifestations such as conjunctivitis and edema are present in approximately 20% of affected people, with a greater incidence among unvaccinated patients. Corneal involvement has also been reported and can result in corneal scarring and severe forms of keratitis. The natural course of the disease is most often benign and self-limiting, however, in some individuals, especially immunocompromised patients, there is a risk of complications such as bronchopneumonia, encephalitis, and vision loss. Herein, we present a case of a patient with monkeypox which caused conjunctival vesicles and anterior uveitis.
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Mpox , Uveíte Anterior , Animais , Humanos , Monkeypox virus , Zoonoses , Uveíte Anterior/diagnóstico , OlhoRESUMO
PURPOSE: To describe the prevalence, incidence, and sociodemographic characteristics of uveitis in Colombia based on the National Health Registry of Colombia, the Integrated Social Protection Information System database (SISPRO). METHODS: We performed a cross-sectional study using SISPRO. Along with the International Classification of Diseases, we were able to identify cases of general uveitis (GU), anterior (AU), and posterior uveitis (PU) from 2015 to 2019. For 2020, we used a statistical model for spatial data to predict the prevalence/incidence of the diseases and compared it to the data retrieved in SISPRO. RESULTS: The average prevalence of GU was 14.66 cases per 100,000 inhabitants, while the average incidence rate of GU during the same period was 13.61 cases per 100,000 inhabitants per year. In 2020, there was a noticeable decrease in the incidence and prevalence of GU. Similar trends were observed when analyzing the incidence and prevalence of AU and PU separately. Females accounted for most reported cases, and there was a notable shift towards older age groups (over 50 years) for uveitis occurrence in males and females. Regions such as Bogotá, Antioquia, Valle del Cauca, and the Andean region had higher numbers of cases and a more significant disease burden. CONCLUSIONS: Our study represents Colombia's first population-based characterization of GU, AU, and PU epidemiology. Our results highlight the importance of understanding disease patterns according to sociodemographic factors intrinsic to distinct geographic locations to design better preventive, diagnostic, and treatment approaches in the Colombian population.
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INTRODUCTION: Bilateral acute iris transillumination (BAIT) is a clinical condition characterized by acute bilateral loss of iris pigment epithelium and iris transillumination. Because of the similar presentation, it is commonly confused with anterior uveitis, making it an important differential diagnosis for this condition. CASE DESCRIPTION: We report the case of a 60-year-old male patient who presented all the characteristics of BAIT after undergoing systemic treatment with moxifloxacin and that had the intraocular pressure (IOP) successfully controlled with selective laser trabeculoplasty (SLT). CONCLUSION: SLT might be an effective therapeutic option and should be considered for the control of IOP in BAIT.
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BACKGROUND: This study aimed to report a case of bilateral anterior non-granulomatous chronic non-infectious uveitis associated with isolated nail psoriasis without articular involvement. CASE PRESENTATION: A 55-year-old man with a history of open-angle glaucoma was referred to our uveitis and ocular immunology center with intraocular inflammation concordant with chronic non-infectious bilateral anterior non-granulomatous uveitis. At presentation, he had moderate inflammation in the anterior chamber bilaterally and lesions characteristic of nail psoriasis. Nail psoriasis was later confirmed by nail ultrasonography performed by a radiologist who specialized in psoriasis. Appropriate clinical and paraclinical assessments were conducted, ruling out all other possible causes of uveitis. The patient required dual systemic immunomodulatory therapy with methotrexate and adalimumab, topical anti-inflammatory drugs (steroidal and non-steroidal), and anti-glaucoma therapy to achieve satisfactory inflammatory and ocular pressure control. DISCUSSION AND CONCLUSIONS: This is the first report of non-infectious uveitis associated with nail compromise in a patient without other manifestations of psoriasis. Despite reports on the relationship between psoriatic disease and uveitis, there is insufficient information on clinical phenotypes associated with uveitis that could lead to later diagnosis and treatment of associated intraocular inflammation. Clinicians should be aware of all subtypes of psoriasis that increases a risk of developing uveitis in these patients.
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Glaucoma de Ângulo Aberto , Psoríase , Uveíte Anterior , Uveíte , Adalimumab/uso terapêutico , Glaucoma de Ângulo Aberto/complicações , Humanos , Inflamação/tratamento farmacológico , Masculino , Metotrexato , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Uveíte/complicações , Uveíte/etiologia , Uveíte Anterior/diagnóstico , Uveíte Anterior/etiologiaRESUMO
PURPOSE: To present a national guideline for ophthalmologic care and surveillance of juvenile idiopathic arthritis-associated uveitis (JIA-uveitis). METHODS: Review article based on medical literature and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology/Brazilian Council of Ophthalmology and the Brazilian Society of Pediatrics/Brazilian Society of Rheumatology. Studies with a high level of evidence were selected by searching the PubMed/Medline database. The final document was approved by the experts. RESULTS: The main recommendations are that children/adolescents with JIA should undergo screening according to their risk factors. Ophthalmological checkups should also consider ocular inflammation and therapy. Topical glucocorticoids should be the first line of therapy, with systemic glucocorticoids acting as bridge treatments in severe uveitis. Methotrexate should be the first-line systemic therapy and anti-tumor necrosis factor (anti-TNF alpha) the second for uncontrolled uveitis. CONCLUSIONS: This evidence-based guideline for JIA-uveitis will be useful for both ophthalmology and rheumatology practice.
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Artrite Juvenil , Uveíte , Adolescente , Criança , Humanos , Artrite Juvenil/complicações , Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Inibidores do Fator de Necrose Tumoral , Brasil/epidemiologia , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Uveíte/etiologia , Glucocorticoides/uso terapêutico , Fator de Necrose Tumoral alfa , Prática Clínica Baseada em EvidênciasRESUMO
Purpose: To report a case of a drug-induced anterior uveitis secondary to the use ofintracameral moxifloxacin.Case report: A 64-year-old Colombian male patient presented with severe ocular pain and photophobia in his left eye 15 days after cataract surgery. In the ophthalmology and glaucoma specialist evaluation, pigment dispersion in the anterior chamber and camerular angle, severe anterior segment inflammation, and elevated intraocular pressure were observed. Poor response to treatment for a suspected viral origin and exclusion of other possible etiologies, led to the conclusion of intracameral moxifloxacin induced anterior uveitis.Conclusion and importance: We present the second published case worldwide about anterior uveitis secondary to intracameral moxifloxacin, which may rarely cause hypertensive uveitis that may be confused with viral uveitis. This provides evidence on the importance of postoperative follow-up by the surgeon for an early referral and treatment of these cases.
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Câmara Anterior/efeitos dos fármacos , Antibacterianos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Moxifloxacina/efeitos adversos , Uveíte Anterior/induzido quimicamente , Extração de Catarata , Diagnóstico Diferencial , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Endoftalmite/prevenção & controle , Síndrome de Exfoliação/induzido quimicamente , Síndrome de Exfoliação/diagnóstico , Dor Ocular/induzido quimicamente , Dor Ocular/diagnóstico , Gonioscopia , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/induzido quimicamente , Hipertensão Ocular/diagnóstico , Fotofobia/induzido quimicamente , Fotofobia/diagnóstico , Uveíte Anterior/diagnósticoRESUMO
PURPOSE: To describe clinical features of patients with diabetes mellitus-associated uveitis (DMAU). METHODS: Retrospective analysis of clinical records of patients with uveitis and diabetes mellitus (DM) presented in an uveitis referral centre in Chile. Demographic data, comorbidities, complete ophthalmic examination, and treatments were analyzed. RESULTS: We found 72 patients with uveitis and DM: 16 with DMAU and poorly regulated DM (22%), 15 with DMAU and well-controlled DM (21%), and 41 with uveitis due to established other causes than DM (57%). Patients with DMAU in poorly regulated diabetes, presented inflammation of 3-4+ cells in 33%, a fibrinous reaction in 28%, hypopyon in 17% and posterior synechiae in 83%, compared with 5%, 0%, 0%, and 50% in the group with well-controlled DM, respectively (p < 0.05). Most DMAU patients responded well to topical or periocular steroids. CONCLUSION: Patients with DMAU with poorly regulated DM present a more severe inflammation compared with patients with DMAU with well-controlled DM.
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Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Uveíte Anterior/etiologia , Acuidade Visual , Chile/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Prognóstico , Estudos Retrospectivos , Uveíte Anterior/epidemiologiaRESUMO
This study aimed to investigate the predictive factors for uveitis recurrence (UR) risk in Behcet's disease (BD) patients. BD patients (n=164) with a history of uveitis were recruited, and demographic data, clinical features, and laboratory tests were recorded. Uveitis was defined as anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis referring to the "International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease". In total, there were 70 UR patients and 94 non-UR patients. Compared to non-UR patients, UR patients appeared to be older and presented with increased uveitis occurrence rate and times within 3 months, oral ulcers occurrence rate, as well as higher concentrations of triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), and serum amyloid A (SAA). Multivariate logistic model disclosed that uveitis occurrence times within 3 months, oral ulcers, TG, LDL, and SAA independently predicted higher risk of UR. Furthermore, receiver operating characteristic curve analysis showed that the combination of uveitis occurrence times within 3 months, oral ulcers, TG, LDL, and SAA exhibited a high predictive value for UR risk with an area under the curve of 0.983 (95%CI: 0.969−0.998). In conclusion, uveitis occurrence times within 3 months, oral ulcers, TG, LDL, and SAA might be potential predictive factors for UR risk in BD patients, which can help in prevention and management of the disease.
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Humanos , Masculino , Feminino , Adulto , Uveíte/etiologia , Síndrome de Behçet/complicações , Recidiva , Uveíte/tratamento farmacológico , Síndrome de Behçet/tratamento farmacológico , Fatores de Risco , Curva ROCRESUMO
Purpose: To describe two cases of anterior and intermediate uveitis following yellow fever vaccination with fractional dose. Methods: Case report. Results: Case 1: A 35 year-old healthy woman presented with unilateral anterior uveitis 10 days after the yellow fever vaccination. Testing excluded infectious and rheumatic diseases and the episode was fully recovered after a short course of topical treatment. Case 2: A 21 year-old previously healthy woman presented with blurred vision in the left eye (OS) 14 days after the yellow fever vaccination. The ophthalmic examination of the OS revealed intermediated uveitis. Testing excluded infectious and neurological diseases. After six weeks of treatment with oral prednisone, the ocular inflammation had resolved. Conclusion: Physicians should be aware of the possibility of eye inflammation following the yellow fever vaccination.
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Retina/diagnóstico por imagem , Uveíte Anterior/etiologia , Uveíte Intermediária/etiologia , Vacinação/efeitos adversos , Vacina contra Febre Amarela/efeitos adversos , Administração Oral , Adulto , Dexametasona/administração & dosagem , Feminino , Angiofluoresceinografia , Fundo de Olho , Glucocorticoides/administração & dosagem , Humanos , Prednisona/administração & dosagem , Uveíte Anterior/diagnóstico , Uveíte Intermediária/diagnóstico , Acuidade Visual , Febre Amarela/prevenção & controle , Vírus da Febre Amarela/imunologia , Adulto JovemRESUMO
PURPOSE: To describe the clinical characteristics, diagnosis, and treatment of VIAU in immunocompromised patients. METHODS: A critical review of literature was performed. RESULTS: Diagnosis and treatment of VIAU in immunocompromised patients may be a challenge due to atypical clinical-courses, severe presentations, and more frequent recurrences. A conclusive diagnosis can be made by aqueous-humour PCR-analysis. Visual prognosis depends on early diagnosis and prompt treatment. Frequent ocular examinations are recommended in HIV patients with CD-4-counts below 100 in order to rule out opportunistic ocular coinfections. It is essential to bear in mind the potential side-effects of therapeutic interventions and consider the possibility of Immune Recovery Uveitis (IRU) in eyes with treated viral retinitis after the initiation of HAART. CONCLUSIONS: Early diagnosis and treatment of VIAU in immunocompromised patients can be achieved with high suspicion, recognizing clinical features, and obtaining specimens for molecular diagnostic testing in order to avoid usually severe ocular morbidity.
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Humor Aquoso/virologia , Infecções Oculares Virais , Imunidade Inata , Hospedeiro Imunocomprometido , Uveíte Anterior , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/imunologia , Infecções Oculares Virais/virologia , Humanos , Uveíte Anterior/diagnóstico , Uveíte Anterior/imunologia , Uveíte Anterior/virologiaRESUMO
Resumo Objetivo: A uveíte anterior aguda é a principal manifestação extra-articular na espondiloartrite. O objetivo deste estudo foi analisar se a presença da uveíte se associa com diferentes manifestações clínicas, laboratoriais, radiológicas e a terapêutica nos pacientes com espondiloartrite. Métodos: Estudo observacional retrospectivo realizado com 153 pacientes portadores de espondiloartrite atendidos no período de 1997 a 2017 na Grande Florianópolis, Brasil. Foram analisados dados demográficos, laboratoriais, clínicos e do tratamento de pacientes com espondiloartrite em relação a presença ou não de uveíte. Resultados: A uveíte foi encontrada em 26,8% dos pacientes. A presença de complicações foi rara, ocorrendo catarata em somente quatro pacientes e glaucoma em dois deles. Foi observada uma tendência a maior frequência de uveíte anterior aguda no sexo masculino (p=0,06), nos pacientes com história familiar (p=0,19) e HLA-B27 positivos (p=0,14). Pacientes com espondiloartrite e uveíte mais frequentemente usavam anti-TNF (p=0,04) e apresentavam sacroiliite em exames de imagem (p=0,02). Não observou-se associação entre a uveíte e o acometimento cardiovascular (p=0,44), cutâneo (p=0,13) ou gastrointestinal (p=0,10). Conclusão: A uveíte que ocorre em pacientes com espondiloartrite é comum, tem predomínio no sexo masculino e é mais frequente em pacientes com HLA-B27 positivo. O uso de imunobiológicos como o anti-TNF é frequente nos pacientes com uveíte.
Abstract Objective: Acute anterior uveitis (AAU) is the most common extra-articular manifestation of spondyloarthritis. The aim of this study is to analyze if the presence of uveitis is associated with a diferent clinical manifestation, laboratorial, radiological and therapetiuc among spondyloarthritis patients. Methods: This was a observational retrospective study with 153 patients with spondyloarthritis attended in the period from 1997 to 2017 in Florianopolis, Brazil. It was analyzed demografical, laboratorial, clinical and therapeutic data in spondyloarthritis patients with or without uveitis. Results: 26,8% of the patients with spondyloarthritis presented uveitis. The presence of complications was rare, with cataract occurring in only four patients and glaucoma in two of them. A higher frequency of acute anterior uveitis in males (p = 0.06) was observed in patients with a family history (p = 0.19) and HLA-B27 positive (p = 0.14). Patients with spondyloarthritis and uveitis more frequently used anti-TNF (p = 0.04) and presented sacroiliitis on imaging tests (p = 0.02). There was no association between uveitis and cardiovascular (p = 0.44), cutaneous (p = 0.13) or gastrointestinal involvement (p = 0.10). Conclusion: Uveitis in patients with spondylarthritis is common, predominantly in males, and more frequently in HLA-B27 positive patients. The use of immunobiological agents such as anti-TNF is common in patients with uveitis.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Uveíte/etiologia , Uveíte/epidemiologia , Espondilartrite/complicações , Espondilite Anquilosante , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Raios X , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Antígeno HLA-B27/sangue , Anti-Inflamatórios não Esteroides/uso terapêutico , Metotrexato/uso terapêutico , Estudos Retrospectivos , Antirreumáticos/uso terapêutico , Espondilartrite/diagnóstico , Espondilartrite/tratamento farmacológico , Sacroileíte/diagnóstico por imagem , Estudo Observacional , Leflunomida/uso terapêutico , Inibidores do Fator de Necrose Tumoral/uso terapêuticoRESUMO
Chikungunya virus (CHIKV) is an RNA virus transmitted by Aedes mosquitoes. The clinical manifestations include fever, arthralgia, rash, and other atypical clinical findings including ocular lesions. We report the case of a 57-year-old man with meningoencephalitis and anterior uveitis due to CHIKV. The patient had developed bilateral anterior uveitis with iris atrophy and a cotton wool spot on the left eye, and his serum, urine, saliva, and cerebrospinal fluid were positive for CHIKV by RT-PCR. The spectrum of the ophthalmologic manifestations and its pathophysiology in cases of CHIKV infections needs to be better understood. Additional studies examining the ocular lesions caused by CHIKV could improve the therapeutic goals of reducing the morbidity and sequels.
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Febre de Chikungunya/complicações , Encefalite Viral/etiologia , Infecções Oculares Virais/etiologia , Uveíte Anterior/etiologia , Doença Aguda , Aedes/virologia , Animais , Humor Aquoso/virologia , Febre de Chikungunya/transmissão , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Encefalite Viral/diagnóstico , Encefalite Viral/virologia , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/virologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA Viral/análise , Tomografia de Coerência Óptica , Uveíte Anterior/diagnóstico , Uveíte Anterior/virologiaRESUMO
PURPOSE: To describe the visual prognosis and remission rate of chronic anterior uveitis in pediatric patients. METHODS: A retrospective case series of children with chronic anterior uveitis treated in the University of Buenos Aires. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Uveitis remission was defined according to SUN criteria. RESULTS: There were 35 pediatric patients (61 eyes), mean age of uveitis onset was 7.69 ± 3 years, 60% were females and 74% had bilateral disease, median follow-up was 60 months (range: 12-192 months). JIA was more frequent in females (80.95 vs 21.43; p<0.0001) and oligoarthritis was the most common form. Remission rate was higher in males (HR = 4.99; 95% CI = 1.16-21.51; p = 0.031). More than 40 eyes remained with the same BCVA at 1 year of follow-up. CONCLUSIONS: Although remission was not common and only occurred after long-term follow-up, visual prognosis was good Received 30 August 2015; revised 6 March 2016; accepted 14 March 2016; published online 18 May 2016.
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Uveíte Anterior/diagnóstico , Acuidade Visual/fisiologia , Adolescente , Artrite Juvenil/diagnóstico , Criança , Pré-Escolar , Doença Crônica , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Antígeno HLA-B27/imunologia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/fisiopatologiaRESUMO
La inflamación de los contenidos intraoculares o uveítis afectará a alrededor de un tercio de los pacientes con espondiloartropatías, especialmente a aquéllos con espondilitis anquilosante. La uveítis típica será unilateral, aguda y autolimitada, afectando los componentes de la úvea anterior: iris y cuerpo ciliar. Pese a ser muy sintomáticas se asocian a bajo riesgo de pérdida visual permanente. Su tratamiento es tópico, en base a corticoides y midriáticos. La terapia inmunosupresora y con menor frecuencia los biológicos, están reservados para los infrecuentes casos crónicos. Es posible reducir la frecuencia e intensidad de las recidivas con metotrexato o sulfasalazina, pero la evidencia que sostiene esta indicación es pobre.
The inflammatory disease affecting the intraocular contents we know as uveitis will affect around one every three patients with spondyloarthropaties, in particular those presenting ankylosing spondylitis. The typical uveitis attack will be unilateral, acute and self-limited, affecting the components of the anterior uvea; this is iris and ciliary body. Despite being very symptomatic, their associated risk of permanent vision loss is low. Treatment is based on topical therapy with corticosteroids and mydriatic eye drops. Systemic immunosuppressive therapy and rarely biologic agents are reserved for the infrequent chronic cases. The use of methotrexate and sulfadiazine could possibly reduce the frequency and intensity of uveitis recurrencies, but evidence supporting this practice is poor.
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Humanos , Espondiloartropatias/complicações , Uveíte Anterior/etiologia , Uveíte Anterior/terapia , Corticosteroides/uso terapêutico , Espondilite Anquilosante/complicações , Prednisolona/uso terapêuticoRESUMO
Objetivo: reportar el caso de un paciente con uveítis anterior por cuerpo extraño intraocular en iris de ojo derecho. Diseño del estudio: reporte de caso. Descripción del caso: paciente de 69 años de edad, con antecedente de catarata hace 6 años por trauma ocular en ojo derecho. Consultó por trauma ocular derecho de 4 días de evolución. En la valoración inicial debido a la gran inflamación ocular y edema corneal no se logró la visualización de un cuerpo extraño intraocular en iris derecho, que posterior al tratamiento antiinflamatorio se hizo evidente. Se realizó extracción quirúrgica combinado con facoemulsificación e inserción de lente intraocular a pesar de existir mayor riesgo inflamatorio secundario. Discusión: la presencia de cuerpos extraños intraoculares secundarios a trauma ocular tienen mayor incidencia en adultos jóvenes de sexo masculino; para un correcto enfoque es necesario la realización de un diagnóstico temprano, apoyados con imágenes diagnósticas, con el fin de evitar secuelas. La cirugía de catarata con implante de lente intraocular en casos de trauma penetrante, generalmente se realiza una vez haya concluido el proceso inflamatorio; en este caso se asumió el riesgo de retirar la catarata con implantación de lente intraocular, aprovechando un adecuado control inflamatorio, logrando un buen resultado final.
Objective: to report a case of a patient with anterior uveitis by an intraocular foreign body in the iris of the right eye. Study Design: case report. Case Description: It's a 69 years old patient, with a history of cataract from six years that were the result of an ocular trauma in the right eye. He consulted for right ocular trauma with 4 days of duration. In the initial assessment due to the large ocular inflammation and corneal edema viewing an intraocular foreign body in the right iris was not achieved, that became apparent after post-infl ammatory treatment. Surgical removal of the foreign body combined with phacoemulsification and intraocular lens insertion despite the existence of secondary inflammatory greater risk was performed. Discussion: the presence of secondary intraocular foreign bodies after ocular trauma have a higher incidence in young adult males; it is necessary to suspect the diagnosis and perform the proper diagnostic tests, to avoid any sequelae. Cataract surgery with intraocular lens implantation in cases of penetrating trauma, is usually performed after accomplishing the inflammatory process; in this case the risk of cataract removal with insertion of intraocular lens is assumed, taking a proper infl ammatory control, achieving a good outcome.
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Corpos Estranhos no Olho/terapia , Endoftalmite/terapia , Traumatismos Oculares/terapia , Uveíte Anterior/terapiaRESUMO
PURPOSE: Since few reports had been published on the prevalence of toxocariasis in ankylosing spondylitis (AS) patients with acute non-granulomatous anterior uveitis (ANGAU), the aim of this work was to determine the presence of antibodies against Toxocara canis in AS patients with ANGAU. METHODS: Thirty-six patients (14 female and 22 male) with AS were enrolled in the study. The history of ANGAU was accepted only if diagnosed by an ophthalmologist. The detection of IgG antibodies to T. canis was determined by enzyme-linked immunosorbent assay. In addition, antibodies to Ascaris lumbricoides were also tested to verify non-specific reactions. RESULTS: The prevalence of ANGAU in the AS patients was 58% (21 / 36), and 38% (8 / 21) of the patients with ANGAU were positive for antibodies to Toxocara, while 7% (1 / 15) of AS patients without ANGAU were positive for T. canis (p = 0.038, two tails; mid-p exact). No antibodies were detected to A. lumbricoides antigens in the serum samples of patients with AS. CONCLUSIONS: These data suggest that the seroprevalence of antibodies to T. canis is high in Mexican patients with AS-associated uveitis, suggesting a chronic asymptomatic toxocariosis, which could be associated with the pathogenesis of ANGAU; however, further larger-scale studies are needed to confirm this observation.
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Anticorpos Anti-Idiotípicos/isolamento & purificação , Infecções Oculares Parasitárias/imunologia , Imunoglobulina G/imunologia , Espondilite Anquilosante/complicações , Toxocara canis/imunologia , Toxocaríase/imunologia , Uveíte Anterior/imunologia , Doença Aguda , Adulto , Idoso , Animais , Ensaio de Imunoadsorção Enzimática , Infecções Oculares Parasitárias/complicações , Infecções Oculares Parasitárias/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Espondilite Anquilosante/imunologia , Espondilite Anquilosante/parasitologia , Toxocara canis/isolamento & purificação , Toxocaríase/complicações , Toxocaríase/parasitologia , Uveíte Anterior/complicações , Uveíte Anterior/parasitologia , Adulto JovemRESUMO
O presente trabalho propõe uma revisão de epidemiologia, patogênese, quadro clínico, diagnóstico e tratamento da espondilite anquilosante e sua associação com alteração ocular com a devida condução da doença e suas manifestações. Os autores utilizaram em sua pesquisa os bancos de dados PubMed (MEDLINE), LILACS e Biblioteca do Centro de Estudos de Oftalmologia. A espondilite anquilosante é uma doença inflamatória crônica que acomete preferencialmente o esqueleto axial, podendo evoluir com rigidez e limitação funcional progressiva. Seu início costuma ocorrer por volta da segunda à terceira década de vida, preferencialmente em indivíduos do gênero masculino, caucasianos e HLA-B27-positivos. Sua etiologia e patogênese não são completamente elucidadas, e seu diagnóstico costuma ser tardio. O controle clínico e o tratamento são frequentemente satisfatórios.A uveíte anterior aguda é a manifestação extra-articular mais comum, ocorrendo em cerca de 20%-30% dos pacientes com espondilite anquilosante. Aproximadamente metade dos casos de uveíte anterior aguda está associada à presença do antígeno HLA-B27, podendo ser a primeira manifestação de uma doença reumatológica não diagnosticada, geralmente com boa resposta terapêutica e bom prognóstico. Concluímos que, para melhor avaliação e tratamento dos pacientes com uveíte, é importante maior integração entre oftalmologistas e reumatologistas.
The present article reviews the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of ankylosing spondylitis and its association with ocular changes. The authors used the PubMed (MEDLINE), LILACS, and Ophthalmology Library databases. Ankylosing spondylitis is a chronic inflammatory disease that usually affects the axial skeleton and can progress to stiffness and progressive functional limitation. Ankylosing spondylitis usually begins around the second to third decade of life, preferentially in HLA-B27-positive white males. Its etiology and pathogenesis are not completely understood, and its diagnosis is diffi cult. Clinical control and treatment are frequently satisfactory. Acute anterior uveíte is the most common extra-articular manifestation, occurring in 20%-30% of the patients with ankylosing spondylitis. Approximately half of the acute anterior uveíte cases are associated with the presence of the HLA-B27 antigen. It can be the first manifestation of an undiagnosed rheumatic disease, usually having a good prognosis and appropriate response to treatment. In conclusion, for better assessment and treatment of patients with uveitis, ophthalmologists and rheumatologists should work together.
Assuntos
Humanos , Espondilite Anquilosante/complicações , Uveíte/etiologia , /imunologia , Prognóstico , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/etiologia , Espondilite Anquilosante/imunologia , Espondilite Anquilosante/terapia , Uveíte/diagnóstico , Uveíte/imunologia , Uveíte/terapiaRESUMO
The authors describe one case of anterior uveitis after treatment of age-related macular degeneration with both antiangiogenic drugs: ranibizumab and bevacizumab. The case is described as a complication of ranibizumab and bevacizumab due to an inflammatory process. Several reasons are suggested to explain this possibility, and the authors conclude that the main cause remains unknown.
RESUMO
Objetivo: Comparar la eficacia y seguridad de las suspensiones oftálmicas de acetato de prednisolona al 1% y de rimexolona al 1%, en el tratamiento de la uveítis anterior aguda (UAA) en pacientes HLA B27+. Material y métodos: Se seleccionaron al azar 68 pacientes con UAA HLA -B27+ para tratamiento con acetato de prednisolona al 1% o rimexolona al 1%. En todos los pacientes la inflamación en cámara anterior era leve a moderada. La presión intraocular (PIO) y el grado de inflamación fueron evaluados semanalmentre durante seis semanas. Fue un estudio clínico prospectivo, aleatorio y doble ciego. Resultados: Al cuantificar las células en cámara anterior no se encontraron diferencias estadísticamente significativas entre uno y otro grupos. En el grupo de rimexolona el flare disminuyó desde la primera semana. En los grupos la presión intraocular se elevó con respecto a la basal desde la primera semana, la variación fue más significativa en el grupo de rimexolona. La PIO final fue menor en el grupo de rimexolona, siendo esta diferencia estadísticamente significativa . Conclusión: Para el tratamiento de la UAA HLA -B27+, leve a moderada, la rimexolona al 1% y la prednisolona al 1% tiene una eficiencia similar. En este estudio las variaciones de presión intraocular en los dos grupos no fueron clínicamente significativas.
Purpose: To compare the efficacy and safety of prednisolone acetate 1 % vs. rimexolone 1 % ophthalmic suspension in the treatment of acute anterior uveitis (AAU) in HLA-B27+ patients. Methods: Sixty-eight AAU HLA-B27+ patients were randomly selected for treatment with prednisolone acetate 1% or Rimexolone 1%. All patients showed mild to moderate anterior chamber inflammation. This was a prospective, randomized, double blind, clinical trial. Results: There was no statistically significant difference between both groups when anterior chamber cells were measured. In the rimexolone group, flare diminished since the first week. In both groups the intraocular pressure (IOP) raised since the first week; the increase washighly significant in the rimexolone group. Final intraocular pressure was higher in the prednisolone group. Conclusion: Rimexolone 1 % is as effective as prednisolone acetate 1% in the treatment of mild to moderate AAU HLA B27+. IOP increased in both groups, but this variation was not clinically significant.