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Uveitis
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
De-Kuang Hwang, Yih-Shiou Hwang
More than 60 diseases are associated with or directly cause the inflammation of uveal tissue.13 These etiologies can be categorized into three groups: infectious, noninfectious, and idiopathic. Infectious uveitis refers to intraocular inflammation caused mainly by pathogens, which can be identified intraocularly. Pathogens, including viruses, bacteria, parasites, and mycobacteria, may directly infect intraocular tissues or trigger host immune responses, leading to various degrees of uveal inflammation. Noninfectious uveitis results from the immune-mediated inflammation associated with systemic or intraocular rheumatological diseases. Systemic rheumatological disorders such as seronegative spondyloarthropathy, Behçet’s disease, sarcoidosis, Vogt–Koyanagi–Harada (VKH) disease, juvenile idiopathic arthritis, and multiple sclerosis have been reported to be strongly associated with uveitis. In several situations, the autoimmune or autoinflammatory response can occur with specific presentations that are all restricted to the eyes, such as multifocal choroiditis, birdshot chorioretinopathy, serpiginous choroiditis, and sympathetic ophthalmia (Table 16.1). Exogenous stimulation such as trauma to the eyeball, intraocular surgical procedures, and medications may also induce uveitis. Uveitis cases in which the exact etiologies cannot be identified on the basis of recent knowledge are categorized under “idiopathic uveitis” or “uveitis with unidentified etiology.” Idiopathic uveitis is more commonly noninfectious, but could occasionally be infectious with unidentifiable pathogens.
Posterior uveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
Birdshot is a type of lead shot used to kill birds in which the gun discharges multiple small pellets over a wide area which increases the chances of hitting a relatively small moving target such as a bird in flight. This is opposed to buckshot in which larger animals such as deer are hit with a concentrated force of lead which is designed to cause maximum damage in one place as a scattered shot such as birdshot would likely merely annoy a deer which would then run off. It is actually vitally important to understand this before appreciating birdshot chorioretinopathy as the fundus in this condition has bilateral widely distributed lesions that are equally sized and scattered in such a way that it is easy to imagine that they have been shot from a gun. They are almost entirely post-equatorial and spread out more thinly further from the optic disc. They are less obvious than the lesions mentioned in this category thus far as they are cream coloured, not pigmented and around a quarter of a disc diameter in size (Figure 5.9). The view is quite distinctive although the cream colour may be closely related to the natural colour of the fundus and the contrast between the two can make them difficult to see. In this case the green filter on the slit lamp can be very useful to enhance visualisation of the dots.
Retina
Published in Fiona Rowe, Visual Fields via the Visual Pathway, 2016
Visual field defects are located according to the position on the retina of the pathological infective lesions (Figure 5.15). A variety of visual field patterns may be seen in inflammatory disorders. In cases of birdshot chorioretinopathy, the most common visual field patterns were multiple foci and arcuate defects. Perimetry provided objective monitoring of disease activity (Gordon et al. 2007).
Bilateral Panuveitis with Occlusive Vasculitis following Coronavirus Disease 2019 Vaccination
Published in Ocular Immunology and Inflammation, 2023
Mélanie Hébert, Simon Couture, Isabelle Schmit
Other etiologies of retinal vasculitis have been for the most part excluded in this case.30 These include intraocular infections such as herpes simplex virus, herpes zoster virus, syphilis, toxoplasmosis, tuberculosis, or cytomegalovirus, which were identified in about 15% of patients with retinal vasculitis in one series.16 Other diagnoses such Behçet’s disease and sarcoidosis are much less likely in the absence of other systemic findings and negative testing. The presentation also does not suggest birdshot chorioretinopathy. It is important to consider that most cases of retinal vasculitis remain idiopathic or associated with idiopathic uveitis or pars planitis in nearly 43% of cases.31 This could also be the case here, returning to the hypothesis that it happened after vaccination simply coincidentally.
Acquired Vitelliform-Like Lesion in Uveitis: A case-series
Published in Ocular Immunology and Inflammation, 2022
Arash Maleki, Sydney Look-Why, Soheila Asgari, Ambika Manhapra, Sebastian Gomez, C. Stephen Foster
There were 12 patients and 21 eyes in the AVLL group. Confirmed sarcoidosis, diagnosed though a lung biopsy, was observed in one out of twelve patients. Birdshot chorioretinopathy (3 patients), anterior uveitis (1 patient), intermediate uveitis (2 patients), idiopathic panuveitis (3 patients), syphilitic panuveitis (1 patient), and multifocal choroiditis (1 patient) were the other diagnoses in the remaining patients. Prior to the first visit with us, systemic corticosteroid or immunomodulatory therapies had been employed in six patients. Some of these patients had received both. Visual symptoms included decreased vision in seven patients (58.3%), floaters in four patients (33.3%), photopsia and photophobia each in three patients (25%), redness and pressure pain in two patients (16.7%) and color vision defect in one patient (8.33%). The average of LogMAR vision was 0.51 ± 0.34 (20/60) (range: 0.1–1.2). Active anterior chamber inflammation and vitreous inflammation was present in eight (66.7%) and six (50%) patients, respectively. ICGA had been done in 9 patients and 18 eyes, which showed patches of active choroiditis (44.5%) with no abnormalities in the sub-foveal area. Three patients had done full-field ERG. One patient had an abnormal 30-Hz flicker ERG.
Retinal Microvascular Alterations in Patients with Quiescent Posterior and Panuveitis Using Optical Coherence Tomography Angiography
Published in Ocular Immunology and Inflammation, 2022
Aniruddha Agarwal, Sushil Bhatt, Shreya Keshari, Roel J. Erckens, Tos T. J. M. Berendschot, C. A. B. Webers, Rupesh Agrawal, Reema Bansal, Vishali Gupta
A reduction in retinal and choroidal thickness in patients with healed/quiescent disease has been previously demonstrated by other authors. Karampelas et al.17 showed a reduction in choroidal thickness among patients with idiopathic panuveitis compared to healthy control subjects. The authors also measured Haller’s layer thickness values and found them to be reduced as well.17 Similar reduction in outer retinal layer thicknesses has been observed in patients with healed long-standing birdshot chorioretinopathy by Symes et al.18 Bittencourt et al. evaluated eyes with myopia, noninfectious uveitis, and healthy controls for choroidal thickness values. They observed thinner choroid in patients with uveitis compared to both healthy controls and myopic patients.19 Thus, our study agrees with previously reported literature in this regard.