Search

To compare clinical profile and visual outcomes of occlusive versus non-occlusive retinal vasculitis (RV). A retrospective comparative study 284 patients were enrolled, including 124 patients with occlusive RV (ORV) and 160 patients with non-occlusive RV (NORV). Patients with ORV were older (p ≤ 10–3), predominantly male (p ≤10-3), with less bilateral involvement (31.5% vs 53,4%; p ≤ 10−3). Infectious RV was more frequently diagnosed in the ORV group than in the NORV group (48.8% vs 32.9%, p =.006). Behçet disease and ocular tuberculosis were the leading causes of ORV. Idiopathic RV, Behçet disease, and sarcoidosis were the most common causes of NORV. Independent predictive factors of poor visual outcome were worse baseline visual acuity in both groups (p =.006 and p ≤ 10–3, respectively), and retinal hemorrhages (p =.048) and optic atrophy (p =.040) in the ORV group. Occlusive and non-occlusive RV have distinctive clinical and etiological profile. [ABSTRACT FROM AUTHOR]

Introduction: Retinal vasculitis (RV) is a sight-threatening intraocular inflammatory condition involving retinal blood vessels. Discrimination between infectious and noninfectious etiologies is mandatory to appropriate management and favorable outcome. Areas covered: A comprehensive literature review between January 1986 and January 2019 was conducted in PubMed database. Pathophysiology, clinical and imaging features, differential diagnosis, treatment, and prognosis of RV were reviewed. Expert opinion: In any patient with RV, a tailored diagnostic approach is recommended. A masquerade syndrome should always be excluded first, and then an infectious cause must be ruled out before corticosteroid or immunosuppressive therapy can be considered. Clinician also should be aware of sight-threatening complications that may affect visual prognosis. [ABSTRACT FROM AUTHOR]

A 33-year-old patient was diagnosed with acute Vogt-Koyanagi-Harada (VKH) disease and was prescribed prednisolone (1 mg/kg/day) and azathioprine (2.5 mg/kg/day). She mistakenly took an excessively high dose (4 mg/kg/day) of prednisolone for 14 days. The erroneous dose of corticosteroids was progressively corrected. Several weeks after initial presentation, the patient developed a polymerase chain reaction-proven bilateral cytomegalovirus retinitis, with extensive occlusive arteritis in the right eye. Systemic immunosuppressive therapy was temporarily discontinued and viral retinitis was successfully managed with systemic and intravitreal ganciclovir. Corticosteroids were reintroduced to control recurrent VKH disease. Final visual acuity was 20/1000 in the right eye and 20/50 in the left eye. [ABSTRACT FROM AUTHOR]

We report a case of a 52-year-old woman presented with atypical central serous chorioretinopathy (CSCR) that had been misdiagnosed as posterior uveitis and treated with systemic corticosteroids and immunosuppressive therapy, with subsequent severe chorioretinal damage. Diagnosis was straightened through multimodal imaging. Anatomical improvement was achieved after discontinuation of corticosteroids and intravitreal injection of bevacizumab. However, visual acuity remained severely impaired in one eye. Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment. Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management. [ABSTRACT FROM AUTHOR]

Vogt-Koyanagi-Harada (VKH) disease is usually defined as a bilateral chronic granulomatous panuveitis that may be associated with CNS, auditory and integumentary manifestations. An autoimmune reaction against melanocyte antigens in genetically predisposed patients without history of ocular trauma is presumed to cause the disease. Features of ocular and extraocular involvement vary according to disease phase, and the condition can present with disease features limited to intraocular inflammation without associated systemic manifestations. Exudative retinal detachment is the most specific feature to acute VKH disease. Ancillary tests (mainly fluorescein angiography) may help in establishing the definitive diagnosis. On the other hand, sunset glow fundus is typical to chronic VKH disease. Complications are more likely to occur in the chronic recurrent phase. The mainstay of treatment for acute VKH relies on prompt systemic corticosteroid therapy initiated as a high dose and then tapered gradually. The duration of corticosteroid therapy is recommended to be at least 6 months. Other immunosuppressants may be given as second-line or, in selected cases, as first-line therapy. Early diagnosis with rapid initiation of corticosteroids reduces recurrence and thus improves visual prognosis. [ABSTRACT FROM AUTHOR]

Any patient with a diagnosis of central serous chorioretinopathy (CSCR) should be questioned to determine any recent corticosteroid use, as the poor visual outcome may be due to unrecognized corticosteroid use. Atypical forms of CSCR may be misdiagnosed as an inflammatory serous retinal detachment, mainly Vogt-Koyanagi-Harada disease. CSCR that develops in association with preexisting uveitis could be a challenging diagnosis as it might be misinterpreted as a worsening of the primary inflammatory condition. Failure to differentiate CSCR from retinal or choroidal inflammatory diseases may result in inappropriate use of corticosteroids, leading to exacerbation of the condition and permanent visual loss. Discontinuation of corticosteroids should be the first step in the treatment of CSCR associated with corticosteroid therapy, and the use of immunosuppressive or immunomodulatory drugs may be required to control systemic or ocular inflammatory disease. The prognosis is usually favorable, but persistent visual loss may occur. [ABSTRACT FROM AUTHOR]