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PubMed2006

Primary treatment of acute retinal necrosis with oral antiviral therapy.

PURPOSE: To explore the possibility of oral antiviral therapy in lieu of intravenous acyclovir for treating acute retinal necrosis (ARN), a necrotizing retinopathy caused by herpes simplex virus type 1 or 2 or by varicella zoster virus. DESIGN: Retrospective, interventional, small case series. PARTICIPANTS: Four patients (6 eyes). METHODS: Patients were treated with oral antiviral therapy. Medications included valacyclovir (1 g 3 times daily), oral famciclovir (500 mg 3 times daily), and topical and oral corticosteroids. MAIN OUTCOME MEASURES: Improvement of symptoms, including photophobia, blurred vision, ocular discomfort, and floaters; increase in visual acuity; and resolution of vitreitis, retinitis, and retinal vasculitis, where present. RESULTS: Symptoms and visual acuity improved within 2 weeks to 1 month in 3 of 4 patients (75%) treated with oral antiviral medication. One patient required surgical treatment for asymptomatic retinal detachment after 3 weeks of treatment; retinal detachment in the fellow eye was repaired 2 months later. Duration of antiviral therapy ranged from 5 weeks to 3 months. CONCLUSIONS: For 4 patients with relatively indolent cases of ARN, oral antiviral therapy alone was effective in eliminating signs and symptoms of the disease. In particular, oral valacyclovir and famciclovir appeared to be effective, although further study is necessary to determine whether these drugs are as effective as intravenous acyclovir for initial treatment of ARN.

2-Aminopurine↗
PubMed1980

Birdshot retinochoroidopathy.

Four patients, two men and two women ranging in age from 40 to 70 years, had birdshot retinochoroidopathy. The special features of this entity are diffuse posterior choroidopathy with associated vitritis and retinal vasculitis. Decreased central vision is caused by cystoid macular edema. In the early course of this disease, the cystoid macular edema may be responsive to corticosteroids. The diffuse choroidopathy is associated with abnormal retinal pigment epithelium and sensory retinal function on electrophysiologic testing. No previously described choroidal or retinal pigment epithelium diseases appear to resemble this entity.

Adult↗
PubMed2006

Therapy insight: The recognition and treatment of retinal manifestations of systemic vasculitis.

A variety of retinal signs can occur in patients who have systemic vasculitides, or who experience complications of these diseases or their treatment. Although treatment of these retinal manifestations is usually the treatment of the systemic disease, specific treatment is occasionally indicated to preserve vision. The more prevalent of the systemic vasculitides are giant cell arteritis, polyarteritis nodosa, Wegener's granulomatosis, Churg-Strauss syndrome, relapsing polychondritis and systemic lupus erythematosus. Less frequently occurring vasculitides include Takayasu's arteritis, Goodpasture's disease, microscopic polyangiitis and Henoch-Schönlein purpura, as well as vasculitis secondary to scleroderma and rheumatoid arthritis. This article describes the pathogenesis, clinical features and treatment of retinal manifestations of systemic vasculitides.

Clinical Trials as Topic↗
PubMed2005

Visual aspects of Behçet's disease.

Behçet's disease is a systemic vasculitis characterized by recurrent oral and genital ulcers and ocular inflammation. The disease may also involve the joints, skin, central nervous system, the lungs, and gastrointestinal tract. Ocular manifestations include anterior uveitis, posterior uveitis, macular edema, retinal vasculitis, conjunctival ulcers, optic neuropathy, papilledema, secondary glaucoma, cataract, and neovascularization of iris or retina. The cause of Behçet's disease is unknown but autoimmune and genetic factors are considered important in its pathogenesis. Promising new imaging techniques and treatments are available to provide better management for patients. This review focuses on recent data on visual aspects, pathogenesis, and the treatment of Behçet's disease.

Behcet Syndrome↗
PubMed2006

Visual aspects of Behçet's disease.

Behçet's disease is a systemic vasculitis characterized by recurrent oral and genital ulcers and ocular inflammation. The disease may also involve the joints, skin, central nervous system, the lungs, and gastrointestinal tract. Ocular manifestations include anterior uveitis, posterior uveitis, macular edema, retinal vasculitis, conjunctival ulcers, optic neuropathy, papilledema, secondary glaucoma, cataract, and neovascularization of iris or retina. The cause of Behçet's disease is unknown, but autoimmune and genetic factors are considered important in its pathogenesis. Promising new imaging techniques and treatments are available to provide better management for patients. This review focuses on recent data on visual aspects, pathogenesis, and the treatment of Behçet's disease.

Journal Article↗
PubMed2000

Progressive outer retinal necrosis caused by herpes simplex virus type 1 in a patient with acquired immunodeficiency syndrome.

OBJECTIVE/BACKGROUND: To identify the etiologic agent of rapidly progressive outer retinal necrosis (PORN) in a 32-year-old man with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from cytomegalovirus (CMV). Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis, diagnosed clinically as PORN. Death occurred after failure of multiple organs. DESIGN: Case report. METHODS: Both globes were taken at autopsy, fixed in formalin, and examined histopathologically and immunohistochemically to identify causative agents in the retinal lesions. MAIN OUTCOME MEASURE: Immunohistochemistry. RESULTS: All layers of the retina were severely damaged and contained focal calcification. Cytomegalic inclusion bodies were found in cells in the damaged retina of the right eye. Immunohistochemical studies for herpesviruses revealed the presence of CMV antigens in the right retina at the posterior pole and herpes simplex virus type 1 (HSV-1)-specific antigen in the periphery of both retinas. No varicella-zoster virus (VZV) antigen was detected in either retina. CONCLUSIONS: PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, HSV-1 can be an etiologic agent.

AIDS-Related Opportunistic Infections↗
PubMed1991

The role of antineutrophil cytoplasm antibodies, anticardiolipin antibodies, von Willebrand factor antigen, and fibronectin for the diagnosis of systemic vasculitis.

Autoantibodies directed against cytoplasmic components of neutrophil granulocytes and monocytes (c-ANCA) are a disease specific marker for Wegner's granulomatosis (WG). Autoantibodies against cardiolipin (aCl) are specific for a subgroup of autoimmune disorders, which can also be associated with systemic vasculitis. Fibronectin (Fn) and von Willebrand factor antigen (vWfAg) are produced by blood vessel endothelial cells in response to injury. We tested sera of 61 patients with various types of systemic vasculitides, sera of 13 patients with retinal vasculitis, and sera of 199 patients with rheumatic diseases for c-ANCA, aCl, Fn, and vWfAg. c-ANCA was positive in 14/17 patients with WG, and 2/4 with polyarteritis nodosa (PAN). No serum from healthy donors or patients with other vasculitic or rheumatic diseases was positive for c-ANCA. Moreover, we found aCl, Fn, and vWfAg significantly elevated in almost all patients with vasculitic syndromes. Therefore, we consider c-ANCA a marker, specific for the diagnosis of WG or PAN, whereas aCl, Fn, and vWfAg are nonspecific but sensitive markers of vascular damage.

Adult↗
PubMed2003

[Brivudine as an alternative systemic therapy to aciclovir and ganciclovir in acute retinal necrosis syndrome due to varicella-zoster virus].

BACKGROUND: Two cases of acute retinal necrosis (ARN-) syndrome caused by an infection with varicella zoster virus (VZV) are demonstrated. VZV-DNA was detected in vitreous biopsies by polymerase-chain-reaction (PCR). The course of retinal necrosis was decisively improved by changing antiviral therapy from aciclovir and/or ganciclovir to brivudine. MATERIAL AND METHODS: Patient 1: 51 years, male, initial visual acuity 20/40; patient 2: 17 years, female, initial visual acuity 20/30. Both patients were immunocompetent and presented with an unilateral acute retinal necrosis syndrome with peripheral chorioretinitis, retinal vasculitis, vitreous inflammation and optic disc swelling, which resulted in progressive visual loss in a few days. RESULTS: In both patients VZV-DNA was detected in vitreous biopsies with PCR. A regression of intraocular inflammation and necrotic retinal foci was only observed after changing the initial systemic therapy from aciclovir (Zovirax) intravenously 1500 mg/day) and/or ganciclovir (Cymeven) intravenously 250 mg/day) to brivudine (Zostex) per os 500 mg/day). Vitreoretinal surgery was necessary in both patients because of rhegmatogenous retinal detachment. Visual acuity stabilised in patient 1 to 20/200 and in patient 2 to 20/25 during a follow-up of 16 or 32 months, respectively. CONCLUSION: Brivudine represents an alternative therapy, if standard treatment with aciclovir and/or ganciclovir failed in cases of ARN-syndrome due to presumed drug-resistant varicella zoster virus-subtypes. Complete remission and preservation of a satisfactory function can be achieved.

Acyclovir↗
PubMed1993

[Useful examinations and therapies in immunologic diseases].

Screening by immune disease is useful for one part in the various ocular inflammatory processes, uveitis, vasculitis, (epi)scleritis and myositis, for the other in collagen diseases with possible eye complications. The various forms of uveitis can be related either to rheumatic disease, to some HLA antigen, to a microbiological agent, sometimes to sarcoidosis. Retinal vasculitis remains almost always of unknown origin, while scleritis and myositis are often related to rheumatic disease, eventually to Wegener's granulomatosis. On the other side, in collagen disease (SLE, polymyositis, sclerodermia a.s.o.) the eye can participate either with fundus, scleral or orbital changes. Concerning therapy, steroids and immunosuppressive cytostatic drugs are the most useful; since most cases remain with unknown etiology, they cannot take benefit from specific therapy, except for instance the retinochoroiditis due to toxoplasmosis.

Autoimmune Diseases↗
PubMed1997

Early experience with intravenous immunoglobulin treatment in Wegener's granulomatosis with ocular involvement.

BACKGROUND: Pooled intravenous gammaglobulin (IVIg) was reported to be effective in the treatment of Wegener's granulomatosis (WG). No reports have been made on the effects of this new treatment on ocular manifestations of WG. METHOD: IVIg treatment was given to two patients suffering from WG with ocular involvement after several other treatment regimes had failed. RESULTS: Although the systemic disease was under control, the ocular symptoms of both patients worsened during and after IVIg treatment. In one case an adverse effect consisting of retinal vasculitis was noted on two occasions. CONCLUSION: Although beneficial effects of IVIg treatment on WG have been previously described, the two cases with ocular involvement presented here did not reveal any positive response. Paradoxical and unpredictable reactions cannot be ruled out. Thus, patients treated with IVIg should be closely surveyed by an ophthalmologist.

Adult↗
PubMed1993

Anticardiolipin antibodies in Adamantiades-Behçet's disease.

Moderately raised levels of circulating anticardiolipin antibodies were found in 14 of 30 patients with active Adamantiades-Behçet's disease (46.7%) who were not receiving treatment. Three patients showed the IgG isotype, nine the IgM isotype, and two had both IgG and IgM isotypes. Statistical analysis, to determine possible correlations between anticardiolipin antibodies and clinical features, and meta-analysis of the data available, were performed. A positive correlation between erythema nodosum and histologically confirmed cutaneous vasculitis and the presence of circulating anticardiolipin antibodies of the IgM isotype was found (P = 0.017 and 0.018, respectively), whereas the IgG isotype did not correlate with any clinical feature. Evaluation of data on other clinical manifestations showed no correlation, either with the IgG or IgM isotypes. In particular, there was no association of circulating anticardiolipin antibodies with the incidence of thrombosis, systemic vasculitis, retinal involvement or neurological features. These results suggest that anticardiolipin antibodies do not play a major pathogenetic role in Adamantiades-Behçet's disease, but they may serve as an additional marker for a risk of the development of cutaneous vasculitis such as erythema nodosum.

Adolescent↗
PubMed1985

Autoimmune mechanisms in inflammatory eye disease.

This paper summarises the principal immunopathological mechanisms which may underlie ocular inflammation and draws attention to how autoimmune reactions may be regulated by idiotypic networks of the immune system. The study of autoimmunity in inflammatory eye disease is illustrated by our current investigations of retinal vasculitis in man and of experimental autoimmune uveoretinitis in rodents where three lines of evidence indicate that immune complex formation may be a compensatory host response to the development of antiretinal autoimmunity. In discussing immunological implications of these results we suggest that retinal inflammation in antiretinal autoimmunity is limited by a protective anti-idiotypic antibody response and that retinal disease arises when this compensatory response is improperly balanced. The clinical implications of this reasoning include the identification of patients at risk of relapse of ocular disease and the development of therapeutic methods for restoring an imbalanced anti-idiotypic autoimmune response towards normality.

Animals↗
PubMed1982

Bilateral acute retinal necrosis.

Four patients who experienced the sudden onset of anterior uveitis with large keratic precipitates and dense vitreous opacities developed confluent yellow-white swellings and exudates in the peripheral retina and sheathing and obliteration of retinal arteries. After absorption of the exudates, atrophic patches in the peripheral retina and a funnel-shaped retinal detachment with many tears appeared. Angiograms showed retinal edema, fluorescein leakage from the choroid in the affected areas, and perivasculitis of the retinal arteries. Although treatment seemed unable to alter the course of the disease, in one case the retina reattachment after vitrectomy and filling of the vitreous space with silicone oil. Histopathologic studies disclosed extensive atrophy and degeneration of the outer retinal layers and pigment epithelium and occlusion of the retinal vessels. An infection may trigger the uveitis, leading to an autoimmune sensitization against rods and cones that causes severe local immune-complex disease and retinal vasculitis.

Adult↗
PubMed1984

Proliferative lupus retinopathy.

Preretinal neovascularization in response to retinal vascular occlusions developed in two patients receiving treatment for systemic lupus erythematosus. In both patients, the preretinal neovascularization was asymptomatic and was discovered on routine ocular examination. One patient required bilateral peripheral ablative argon-laser therapy for florid preretinal neovascularization. This patient had severe occlusive retinal vasculitis despite serologic evidence of remission of the underlying disease process.

Adolescent↗
PubMed1984

[Fluorescein angiography in the diagnosis of periarteritis nodosa].

Periarteritis Nodosa (P.A.N.) is a systemic connective tissue disease with a variety of manifestations that includes ocular involvement in 20% of cases. The diagnosis of this condition is difficult due to the absence of any specific clinical signs or laboratory findings. However, histologic studies have demonstrated a segmental vasculitis that is often necrotic. Ocular findings frequently include choroidal involvement that is characteristic. Nevertheless, angiographic studies of this disease are extremely rare. The findings in three patients suspected of having P.A.N. are presented. Fluorescein angiography established the diagnosis of P.A.N. in two cases and ruled-out its presence in the third case. In the first case angiography demonstrated a retinal vasculitis with multiple arteriolar and capillary occlusions. There was also ischemic involvement of the choriocapillaris and a mild anterior optic nerve vasculitis. All findings resolved, leaving numerous Elschnig spots. In the second case the angiogram showed acute multifocal ischemia of the choriocapillaris. The ocular examination and fluorescein angiogram in the third case were entirely normal, thereby ruling-out P.A.N. on the basis of insufficient criteria. Acute multifocal choroidal ischemia is present in a variety of rare conditions: Toxemia of pregnancy, Disseminated Intravascular coagulopathy, Moskowitz Disease (T.T.P.), Leukemia and Malignant Hypertension. However, the presence of multifocal choroidal ischemia in the presence of a systemic connective tissue disorder strongly favors the diagnosis of P.A.N. The relative contributions of co-existent Malignant Hypertension and P.A.N. in producing choroidal ischemia are discussed. The spectrum of clinical manifestations and laboratory findings in P.A.N. as well as hypotheses concerning pathogenesis (immune-complex deposition) are described. Among all systemic vasculitis , only P.A.N., and rarely Scleroderma, feature choroidal involvement. This is possibly due to the fact that the degree of vasculitis in P.A.N. is sufficiently severe to cause clinically significant choroidal involvement.

Adult↗
PubMed1997

Bilateral loss of vision and macular ischemia related to Behçet disease.

PURPOSE: To report a 61-year-old man with sudden onset of visual loss in both eyes related to bilateral macular ischemia. METHODS: The patient underwent comprehensive ophthalmic examination including slit-lamp and fundus examination, fluorescein angiography, and visual field testing as well as biologic screening. RESULTS: Bilateral macular ischemia associated with peripheral retinal vasculitis was confirmed by angiography. We diagnosed Behçet disease by association of ocular, oral, and cutaneous involvement according to the criteria of the international study group for Behçet disease. The patient was treated with corticosteroids. CONCLUSION: In Behçet disease, sudden onset of bilateral vision loss may be associated with bilateral retinal vascular disease and macular ischemia. Prompt diagnosis and treatment with systemic corticosteroids may be beneficial.

Behcet Syndrome↗
PubMed1987

The ocular manifestations of Rocky Mountain spotted fever.

To our knowledge, this is the first report of an iris nodule in a case of Rocky Mountain spotted fever (RMSF). The iris nodule may be similar to the "typhus nodule" of the central nervous system reported at autopsy in patients with typhus rickettsial disease. Previous case reports of RMSF have emphasized either anterior uveitis or retinal vasculitis. In the case reported here, both occurred in our patient as a result of RMSF. Also, we review the ophthalmic literature on rickettsial disease.

Adult↗
PubMed1992

Induction of experimental autoimmune uveoretinitis in Lewis rats with purified recombinant human retinal S-antigen fusion protein.

Full-length human retinal cDNA for S antigen (S-ag) and for the alpha subunit of transducin (alpha-Td) were subcloned into a bacterial expression plasmid vector to generate recombinant fusion proteins with glutathione-S-transferase (GST). The recombinant GST-S-ag and rGST-alpha-Td fusion proteins were purified from bacterial extracts by continuous flow preparative gel electrophoresis under denaturing conditions, and were assessed for their ability to induce experimental autoimmune uveoretinitis (EAU). Immunization of Lewis rats with single doses of 10 micrograms-100 micrograms rGST-S-ag in Freund's complete adjuvant supplemented with Bordetella pertussis readily induced clinical signs of EAU. Immunization with GST alone did not induce EAU indicating that disease activity was ascribable to the S-ag residues in the fusion protein. Although the alpha-Td shares limited sequence homology with S-ag, the rGST-alpha-Td fusion protein was also not uveitogenic in Lewis rats. The clinical severity of EAU in Lewis rats sensitized with rGST-S-ag was found to be milder than that induced with native S-ag preparations purified from human retina. However, humoral antibody responses to sensitization with the recombinant S-ag fusion protein were of a higher magnitude than with native S-ag. The availability of recombinant preparations of human S-ag protein will be of value in studying its processing and presentation to T cells derived from patients with autoimmune retinal vasculitis.

Animals↗