RESUMO
PURPOSE: The aim of this study was to describe the epidemiological profile of uveitis cases treated at University Hospital Clementino Fraga Filho and to identify the presentation pattern of intraocular inflammation on the basis of clinical, anatomical, etiological, and demographic criteria. METHODS: A retrospective study was conducted using data from the medical records of 408 patients with active disease who attended the ophthalmology service between March and October 2018. Age, sex, visual acuity at the time of diagnosis, anatomical and etiological diagnoses, the clinical aspect, and the main symptoms reported during anamnesis were described. RESULTS: Of the 408 patients in the study, 52% were male and 48% were female. The patients' mean age was 42 years, and most (84%) were between 19 and 64 years old. Anterior uveitis was observed in 37.75% of the patients; posterior uveitis, in 49.75%; panuveitis, in 4.66%; and intermediate uveitis, in 3.43%. Only 18 patients (4.41%) presented with scleritis. Of the 390 patients with anatomical classifications, 76% had known etiologies, with the most prevalent diagnoses being toxoplasmosis (35.4%), followed by juvenile idiopathic arthritis (6.4%), ankylosing spondylitis (5.9%), and syphilis (4.9%). Infectious uveitis corresponded to 49.7% of the patients, while 26.6% of the cases were of noninfectious origin. Anterior uveitis had the highest number of cases classified as idiopathic (49.4%). In the cases of posterior uveitis, the etiology was established 94% of the time. The most frequent symptoms were ocular pain (71.8%) and blurring vision (56.8%). CONCLUSIONS: The present study confirmed the historical importance of infectious uveitis in our population, especially ocular toxoplasmosis. Uveitis appears to have no predilection for sex but mainly affects young people of working age, thus generating social and economic consequences. Despite the evolution of diagnostic methods, idiopathic uveitis remains one of the major etiologies. Epidemiological studies point to different presentation patterns of uveitis in different populations, but these may reflect the distinct characteristics of each institution.
Assuntos
Uveíte Anterior , Uveíte Posterior , Uveíte , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Hospitais Universitários , Humanos , Masculino , Estudos Retrospectivos , Uveíte/epidemiologia , Uveíte/etiologia , Uveíte Anterior/complicações , Uveíte Posterior/complicações , Transtornos da Visão/etiologiaRESUMO
RESUMEN La retinitis necrotizante aguda, es una necrosis retinal de todas las capas de la retina. Se caracteriza por necrosis fibrinoides de la pared de los vasos y oclusión vascular. Se presentó un caso de una paciente de 42 años de edad, con pérdida brusca de la visión del ojo derecho, con una semana de evolución. Al examen oftalmológico se observó haze vítreo 2+, edema sucio del disco óptico, con borramiento de todos sus bordes. Presencia de exudación blanca-amarillenta retiniana extensa, en toda la periferia y área ecuatorial asociada a hemorragias intraretinianas. Se realizó además del examen fundoscòpico toma de muestra de humor acuoso para reacción en cadena de la polimerasa y angiografía fluoresceínica. Los signos fundoscópicos de la paciente, así como las anomalías detectadas en la angiografía fluoresceínica sugirieron el diagnóstico clínico de síndrome de necrosis retinal aguda. Se confirmó el diagnóstico etiológico viral, semanas después por el resultado de polimerasa. Se practicó la terapéutica médica y fotocoagulación laser focal retiniano correspondiente, asociado a cirugía del desprendimiento de retina mixto mediante vitrectomía pars plana y se logró la re aplicación de la retina.
ABSTRACT The acute necrotizing retinitis is a retinal necrosis of all the retinal layers. It is characterized by fibrinoid necrosis of the vases' wall and vascular occlusion. The case presented is the case of a female patient aged 42 years, who suffers sudden loss of the left eye vision, with a week of evolution. At the ophthalmologic examination it was observed a 2+ vitreous haze, dirty edema of the optic disk, with effacement of all of its margins. There it was an extended white-yellowish retinal exudation in the entire periphery and the equatorial area, associated to intra-retinal hemorrhages. Besides the funduscopic examination, it was taken a sample of the aqueous humor for a polymerase chain reaction (PCR) and fluorescein angiography. The patient's funduscopic signs, and also the anomalies detected in the fluorescein angiography suggested the clinical diagnosis of acute retinal necrosis syndrome. After several weeks, the viral etiologic diagnosis was confirmed by polymerase chain reaction. It was practiced the correspondent medical therapeutics and focal retinal laser coagulation associated to mixt retinal detachment through pars plana vitrectomy; the retina reapplication was achieved.
Assuntos
Humanos , Feminino , Adulto , Descolamento Retiniano/cirurgia , Síndrome de Necrose Retiniana Aguda/complicações , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/etiologia , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Uveíte Anterior/complicações , Vitrectomia/métodos , Descolamento Retiniano/diagnóstico , Aciclovir/uso terapêutico , Ceratite Herpética/tratamento farmacológicoRESUMO
Alrededor de un tercio de los afectados por espondiloartropatías hará uveítis. Casi siempre serán uveítis anteriores, agudas, unilaterales y autolimitadas, que alter-narán entre uno y otro ojo. El tratamiento de elección es el corticoide tópico du-rante la crisis, que habitualmente resolverá en un plazo no mayor a doce semanas. Hay varias estrategias para reducir la frecuencia e intensidad de las crisis, las que han sido evaluadas en pequeños estudios en sujetos con tres o más episodios anuales. Han sido beneficiosos el metotrexato, sulfasalazina y antiinflamatorios no esteroidales (AI-NEs), estos últimos en dosis de dos veces por día, no así los AINEs en toma única diaria. Los agentes biológicos anti factor de necrosis tumoral (anti-TNF por su sigla en in-glés), excepto el etanercept, se asocian a muy altos índices de prevención de recidivas en estudios observacionales, pero los estudios comparativos sólo se han hecho para uveítis no-anteriores.
About one third of all subjects affected by spondiloarthropaties will suffer from uve-itis. These will happen to be acute, anterior, unilateral and self-limited uveitis attacks, alternating between one and other eye. First choice treatment consists of topical cor-ticosteroid during the episode that will usually resolve in no more than twelve weeks. There are several useful strategies to reduce the frequency and intensity of the uveitis at-tacks. These have been studied in small trials with reduced number of subjects suffering from three or more episodes per year. They have shown a beneficial effect for methotrex-ate, sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs), these last when prescribed twice a day, without proven benefit from taking single daily doses of NSAIDs. Anti-tumor necrosis factor (anti-TNF) biologic agents, except for etanercept, are asso-ciated to a huge reduction in the frequency of uveitis attacks in observational studies, but comparative trials available have addressed non-anterior uveitis exclusively.
Assuntos
Humanos , Uveíte Anterior/complicações , Uveíte Anterior/tratamento farmacológico , Espondiloartropatias/complicações , Artrite Psoriásica/terapia , Uveíte Anterior/epidemiologia , Antirreumáticos/uso terapêuticoRESUMO
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.
Assuntos
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
BACKGROUND: Uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result. METHODS: Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. Polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma. RESULTS: Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management. CONCLUSION: Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication.
Assuntos
Ceratite Herpética/complicações , Uveíte Anterior/virologia , Aciclovir/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Idoso , Antivirais/uso terapêutico , Humor Aquoso/virologia , Atrofia , Catarata/complicações , Extração de Catarata , Doença Crônica , Glaucoma/etiologia , Glaucoma/cirurgia , Humanos , Iris/patologia , Ceratite Dendrítica/complicações , Ceratite Herpética/diagnóstico , Ceratite Herpética/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Simplexvirus/isolamento & purificação , Trifluridina , Uveíte Anterior/complicações , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológicoRESUMO
BACKGROUND: Uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result. METHODS: Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. Polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma. RESULTS: Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management. CONCLUSION: Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication
Assuntos
Masculino , Adolescente , Pessoa de Meia-Idade , Humanos , Ceratite Herpética/complicações , Uveíte Anterior/virologia , Atrofia , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Extração de Catarata , Doença Crônica , Catarata/complicações , Ceratite Dendrítica/complicações , Ceratite Herpética/diagnóstico , Ceratite Herpética/tratamento farmacológico , Corticosteroides/uso terapêutico , Glaucoma/etiologia , Glaucoma/cirurgia , Humor Aquoso/virologia , Iris/patologia , Simplexvirus/isolamento & purificação , Trifluridina , Uveíte Anterior/complicações , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológicoRESUMO
Objetivo: Determinar a incidência e a etiologia dos casos de uveítes em Curitiba-PR. Métodos: Foram estudados 68 casos de uveítes em Curitiba, PR, atendidos no ambulatório de oftalmologia no período de janeiro a abril de 1998 procurando estabelecer o diagnóstico a partir de ampla investigaçäol clínica e laboratorial. Resultados: Em nosso estudo, contatamos que a uveíte posterior foi a mais encontrada (49 por cento), seguindo-se a panuveíte (29 por cento) e, com menor freqüência, a uveíte anterior (22 por cento). A etiologia mais freqüente para as uveítes posteriores foi a toxoplasmose, responsável por 88 por cento dos casos. Entre as panuveítes, novamente a toxoplasmose prevaleceu, com 85 por cento e, dentro das uveítes anteriores, a principal causa foi a espondilite anquilosante com 20 por cento. Conclusäo: Em Curitiba, há um predomínio de uveítes posteriores e panuveítes, sendo a causa mais comum a toxoplasmose. No entanto, enfatiza-se que existem outras causas importantes de uveítes que devem ser lembradas pelo oftalmologista na investigaçäo clínica.
Assuntos
Humanos , Masculino , Feminino , Toxoplasmose/complicações , Uveíte Anterior/complicações , Uveíte Posterior/complicações , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/etiologiaRESUMO
INTRODUCTION: An association between polymorphism of the HLA linked LMP2 locus and the development of acute anterior uveitis (AAU) has previously been described in B27 positive white subjects with ankylosing spondylitis (AS). This study evaluated LMP2 alleles in two HLA-B27 positive Mexican populations of patients with spondyloarthropathy known to have a different clinical spectrum of disease from white people. PATIENTS AND METHODS: The study populations consisted of 90 AS patients from Guadalajara with predominantly adult onset disease and 80 AS patients from Mexico City with predominantly juvenile onset disease. LMP2-CfoI amplified fragment length polymorphisms were determined after polymerase chain reaction amplification and digestion with CfoI restriction enzyme. RESULTS: There was an increased LMP2A allelic frequency in patients who had had AAU in both Guadalajara (31.8%) and Mexico City (33.3%) when compared with non-AAU patients (15.2% and 17.7% of Guadalajara and Mexico City populations, respectively). The odds ratio relating LMP2A allelic frequency and AAU for the combined population, stratified by age at onset of disease, was 2.51 (p = 0.01). LMP2 alleles did not influence the age at onset of disease or the development of peripheral arthritis. CONCLUSIONS: These data support the view that polymorphism at the LMP2 locus is associated with the development of AAU in B27 positive subjects with AS. The requirement for both the less common LMP2 allele and HLA-B27 is consistent with the low prevalence of AAU in Mexican patients with spondyloarthritis.
Assuntos
Antígeno HLA-B27 , Polimorfismo Genético , Espondilite Anquilosante/genética , Uveíte Anterior/genética , Proteínas da Matriz Viral/genética , Doença Aguda , Adolescente , Adulto , Idade de Início , Criança , Suscetibilidade a Doenças , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Razão de Chances , Espondilite Anquilosante/complicações , Espondilite Anquilosante/etnologia , Espondilite Anquilosante/imunologia , Uveíte Anterior/complicações , Uveíte Anterior/imunologiaRESUMO
We report a case of acute tubulointerstitial nephritis and uveitis (TINU syndrome) in a 47-year-old woman who also was found to have antineutrophil cytoplasmic antibody. The patient developed severe acute renal failure that improved after a high dose (1 mg/kg/d) of corticosteroid therapy. The diagnosis of the disorder is discussed, as well as the finding of antineutrophil cytoplasmic antibody.
Assuntos
Autoanticorpos/imunologia , Nefrite Intersticial/imunologia , Uveíte Anterior/imunologia , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/etiologia , Anticorpos Anticitoplasma de Neutrófilos , Biomarcadores/análise , Feminino , Glucocorticoides/uso terapêutico , Humanos , Túbulos Renais/patologia , Pessoa de Meia-Idade , Nefrite Intersticial/complicações , Nefrite Intersticial/tratamento farmacológico , Nefrite Intersticial/patologia , Prednisona/uso terapêutico , Síndrome , Uveíte Anterior/complicações , Uveíte Anterior/tratamento farmacológicoRESUMO
Os autores relatam um caso de toxoplasmose ganglionar associada com uveíte anterior granulomatosa sem lesäo retiniana e tentam, neste estudo, explicar a fisiopatologia deste achado. É a primeira publicaçäo sobrea presença cancomitante de toxoplasmose ganglionar com iridocicle granulomatosa sem retinocoroidite em paciente imunocompatente.