Purpose: To examine disease profile of tubercular uveitis (TBU) in Paediatric population.
Methods: Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis ...Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed.
Results: Mean age of disease presentation was 12.8 (range 4-18 years), with predominance of males (n = 14/20; 70.0%) and Asian ethnicity (n = 25/29; 86.2%). Posterior uveitis (n = 14/28; 50%) was the most frequent uveitis phenotype, with choroidal involvement occurring in 64.7% (n = 11/17). Incidence of optic disc edema and macular edema was higher in children (n = 8/18; 44.4% and n = 5/18; 27.8%, respectively) than in adults (n = 160/942; 16.9% and n = 135/942; 14.3%, respectively). Comparison of optic disc edema between subgroups showed a significant difference (P =.006). All patients received oral corticosteroids, most of them with antitubercular therapy. Treatment failure developed in 4.8% (n = 1/21).
Conclusions: Children have a more severe inflammatory response to the disease, and an intensive anti-inflammatory therapeutic regimen is required to achieve a positive treatment outcome.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Purpose: The Collaborative Ocular Tuberculosis Study (COTS) Group sought to address the diagnostic uncertainty through retrospective cohort analysis of treatment regimens and therapeutic outcomes for ...patients with tubercular Anterior Uveitis (TAU) across international centers.
Methods: Multicentre retrospective analysis of patients diagnosed with TAU between January 2004 to December 2014 that had a minimum follow-up of 1 year.
Results: One hundred and sixty-five patients were included. One hundred and seven subjects received antitubercular therapy (ATT) (n = 107/165; 64.9%) with all the patients receiving topical steroid therapy. Treatment failure was noted in 17 patients (n = 17/165; 10.3%), more frequently described in patients that received ATT (n = 13/107, 12.2%), than those that did not receive ATT (n = 4/58, 6.9%).
Conclusion: In this retrospective study, addition of ATT did not have any statistically significant impact on outcome in patients with TAU.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract only
Anti‐vascular endothelial growth factor (VEGF) agents, such as bevacizumab, ranibizumab, and aflibercept, are widely used in the treatment of various retinal diseases. Recently, ...brolucizumab, a novel anti‐VEGF agent, has been introduced in the market for the treatment of neovascular age‐related macular degeneration. However, the use of some anti‐VEGF agents has been associated with an increased risk of intraocular inflammation.
In particular, brolucizumab has been reported to be associated with a higher incidence of intraocular inflammation compared to other anti‐VEGF agents. The inflammation can manifest as anterior uveitis, vitritis, or even occlusive retinal vasculitis, and lead to severe and permanent visual loss in some cases. Although the exact mechanism of this phenomenon is not fully understood, it is believed to be related to the immune response triggered by the injection of foreign proteins into the eye.
The clinical presentation of intraocular inflammation can range from mild symptoms, such as ocular discomfort and blurry vision, to severe visual loss. Prompt and appropriate management of intraocular inflammation is crucial to preserve vision in patients receiving anti‐VEGF agents. Early detection of inflammation and prompt initiation of anti‐inflammatory treatment can prevent further damage to the eye.
In cases of mild to moderate inflammation, close monitoring and topical or systemic anti‐inflammatory medication may be sufficient to control the inflammation and prevent visual deterioration. Cessation of the causative anti‐VEGF treatment may be necessary to prevent further exacerbation of the inflammation. In such cases, the patient may need to be switched to an alternative treatment option for their underlying condition.
Overall, clinicians should maintain a high level of vigilance for the development of intraocular inflammation in patients receiving anti‐VEGF therapy. Close monitoring, early detection, and appropriate management of inflammation can help preserve vision and minimize the potential complications associated with these agents.
Abstract only
Uveitis is a potentially sight‐threatening condition characterized by inflammation of the uvea. Accurate diagnosis of uveitis is crucial for appropriate management and preservation of ...vision. The diagnosis of uveitis can be challenging due to the overlapping clinical features with other ocular diseases. In this context, imaging techniques such as fluorescein angiography (FA) and indocyanine green angiography (ICGA) have become indispensable tools in the differential diagnosis of uveitis.
FA is a widely used imaging modality in the diagnosis and management of uveitis. It involves the intravenous injection of fluorescein dye, which highlights the blood vessels of the retina and choroid. FA can reveal the presence of leakage, staining, and non‐perfusion areas in the retinal and choroidal vasculature, which are indicative of the inflammatory process in uveitis. Moreover, FA can detect complications such as occlusive vasculitis or choroidal neovascularization. FA can also be used to monitor the response to treatment and detect complications of uveitis such as cystoid macular oedema.
ICGA is another imaging modality that complements FA in the diagnosis of uveitis. ICGA involves the intravenous injection of indocyanine green dye, which better highlights the choroidal vasculature. ICGA can identify areas of choroidal hypoperfusion, which are often seen in posterior uveitis such as Vogt‐Koyanagi‐Harada disease or Birdshot retinochoroiditis. ICGA can also delineate areas of choroidal neovascularization. Furthermore, ICGA can help differentiate between active and inactive uveitis, which is crucial in determining the appropriate course of treatment.
In addition to their diagnostic value, FA and ICGA can provide valuable information on the pathogenesis of uveitis. FA and ICGA can reveal the presence of subclinical inflammation in asymptomatic patients, which can guide the early initiation of treatment and prevent irreversible damage to the retina and choroid. Additionally, FA and ICGA can identify the location and extent of inflammation in uveitis, which can help in the selection of appropriate treatment modalities such as corticosteroids, immunomodulators and biologic agents.
In conclusion, FA and ICGA are invaluable tools in the differential diagnosis and management of uveitis. These imaging modalities can provide vital information on the presence, location and extent of inflammation in uveitis, which can guide the selection of appropriate treatment modalities and prevent irreversible visual loss.
Aging enhances frequency of chronic diseases like cardiovascular diseases or periodontitis. Here we reproduced an age-dependent model of the periodontium, a fully physiological approach to ...periodontal conditions, to evaluate the impact of dietary fat type on gingival tissue of young (6 months old) and old (24 months old) rats.
Animals were fed life-long on diets based on monounsaturated fatty acids (MUFA) as virgin olive oil, n-6 polyunsaturated fatty acids (n-6PUFA), as sunflower oil, or n-3PUFA, as fish oil. Age-related alveolar bone loss was higher in n-6PUFA fed rats, probably as a consequence of the ablation of the cell capacity to adapt to aging. Gene expression analysis suggests that MUFA or n-3PUFA allowed mitochondria to maintain an adequate turnover through induction of biogenesis, autophagy and the antioxidant systems, and avoiding mitochondrial electron transport system alterations.
The main finding is that the enhanced alveolar bone loss associated to age may be targeted by an appropriate dietary treatment. The mechanisms involved in this phenomenon are related with an ablation of the cell capacity to adapt to aging. Thus, MUFA or n-3PUFA might allow mitochondrial maintaining turnover through biogenesis or autophagy. They might also be able to induce the corresponding antioxidant systems to counteract age-related oxidative stress, and do not inhibit mitochondrial electron transport chain. From the nutritional and clinical point of view, it is noteworthy that the potential treatments to attenuate alveolar bone loss (a feature of periodontal disease) associated to age could be similar to some of the proposed for the prevention and treatment of cardiovascular diseases, a group of pathologies recently associated with age-related periodontitis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
To describe the epidemiology, indications and surgical results of pars plana vitrectomy (PPV) in patients over 85 years of age.
Methods
A retrospective cohort study was performed including ...all consecutive patients aged 85 years or older who underwent PPV between September 2018 and March 2022 in a single hospital in Madrid, Spain. Data on diagnosis, comorbidities, surgical indication, surgical details, surgical complications and surgical outcomes were collected from medical records.
Results
A total of 124 eyes of 119 patients (56 males, 47.1%) underwent PPV. Median age was 87 years (range 85–96). The most common surgical indications were complications of cataract surgery in 34 patients (28.6%), macular epiretinal membrane in 32 (26.9%), and rhegmatogenous retinal detachment (RRD) in 12 (10.1%). Mean preoperative best corrected visual acuity (BCVA) was 13.33 ± 42.34 ETDRS letters and improved to 40.05 ± 41.04 letters at 3 months (
p
< 0.001). BCVA had improved in 68.82% of patients at 3 months. Patients with chronic kidney disease (CKD;
p
< 0.001), RRD (
p
= 0.003), ocular trauma (
p
= 0.001) and age-related macular degeneration (AMD;
p
= 0.002) showed worse BCVA at 3 months from surgery. Patients with better preoperative BCVA (
p
< 0.001), and those who underwent 25G PPV (
p
= 0.041) showed better visual outcomes.
Conclusions
PPV is an effective technique for improving visual acuity in patients aged 85 years and older with vitreoretinal diseases. Visual outcomes were better when patients had a better preoperative visual acuity and underwent 25G PPV. Patients with a previous diagnosis of AMD or CKD, and those undergoing surgery for ocular trauma or RRD had worse visual outcomes.
An adequate pancreatic structure is necessary for optimal organ function. Structural changes are critical in the development of age-related pancreatic disorders. In this context, it has been reported ...that different pancreatic compartments from rats were affected according to the fat composition consumed. Since there is a close relationship between mitochondria, oxidative stress and aging, an experimental approach has been developed to gain more insight into this process in the pancreas. A low dosage of coenzyme Q was administered life-long in rats in order to try to prevent pancreatic aging-related alterations associated to some dietary fat sources. According to that, three groups of rats were fed normocaloric diets containing Coenzyme Q (CoQ) for two years, where virgin olive, sunflower, or fish oil was included as unique fat source. Pancreatic samples for microscopy and blood samples were collected at the moment of euthanasia. The main finding is that CoQ supplementation gives different results according to fat used in diet. When sunflower oil was the main fat in the diet, CoQ supplementation seems to improve endocrine pancreas structure and in particular β-cell mass resembling positive effects of virgin olive oil. Conversely, CoQ intake does not seem to improve the structural alterations of exocrine compartment previously observed in fish oil fed rats. Therefore CoQ may improve pancreatic alterations associated to the chronic intake of some dietary fat sources.
To compare the degree of satisfaction of patients and observers about scars secondary to skin incisions in oculoplastic surgery performed with cold blade versus Colorado microcautery needle.
A ...cross-sectional noninferiority comparative study was performed. Eighty patients undergoing surgery for blepharoptosis repair, lateral tarsal strip, or dacryocystorhinostomy with cold blade or Colorado needle between January 2011 and July 2011 were included. Groups were paired by sex and surgery type. Scars were assessed between January 2012 and July 2012 using 2 validated scales (Patient and Observer Scar Assessment Scale POSAS and Vancouver Scar Scale VSS) by the patient and 2 trained observers. Sample size was predetermined, and 38 patients were needed in each group to detect differences of at least 8 points in the POSAS with 90% power.
Patients operated with Colorado needle were 7.3 years older than those operated with cold blade (p = 0.007). No statistically significant differences between both techniques were observed either in the individual items or in the composite scores, correcting for age (POSAS, p = 0.518; VSS, p = 0.367). Multiple linear regression analysis showed that patients undergoing dacryocystorhinostomy had significantly lower scores in OSAS (p= 0.034) and VSS (p = 0.034), independent of the other variables in the model. No association between the surgical instrument and the final score was observed for any of the analyzed scales.
Esthetic results of periocular scars secondary to skin incisions performed with cold blade or Colorado needle are clinically similar in Spanish patients. Esthetic result of dacryocystorhinostomy scars showed lower scores in OSAS and VSS.
Purpose
To describe the epidemiology and clinical characteristics of psoriatic arthritis (PsA) related uveitis in Madrid, Spain.
Methods
A case series nested in a retrospective single-center cohort ...of 494 patients with PsA was performed. Patients older than 18 years old whit a clinical diagnosis PsA-related uveitis who attended the Ramon y Cajal University Hospital in Madrid, Spain, between 1st January 2017 and 31st December 2019 were included in the study. Epidemiological and clinical data were retrieved from the electronic medical records.
Results
Thirteen cases of psoriatic arthritis-related uveitis (6 men and 7 women) were included. PsA-related uveitis showed an incidence of 0.05 cases per 100,000 persons/year (CI95 0.00–0.35), and a prevalence of 2.19 cases per 100,000 persons (CI95 1.24–3.79). The prevalence of active uveitis in the cohort of PsA patients was 2.6%. The first episode of uveitis (mean age of 48.15 ± 15.41 years) was anterior and unilateral in 92.31% of the cases. Most of the patients had a recurrent course (69.2%) with 0.92 flare-ups per patient/year (CI95 0.85–0.96). The uveitis preceded the diagnosis of psoriatic arthritis in 62.5% of the patients. In patients with PsA-related uveitis, HLA-B27 was present in 23.1%, HLA-Cw6 in 7.7%.
Conclusions
Uveitis is a PsA manifestation that affects roughly 1 in 37 PsA patients, and that may precede the articular symptoms. It generally presents as a unilateral acute anterior uveitis and has a recurrent course. The most frequent observed complications are elevated intraocular pressure and cataracts.
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