Publications by authors named "Debra A Goldstein"

141 Publications

Use of Short-wave Blue Fundus Autofluorescence to Detect and Monitor Acute Regional Outer Retinopathy in Punctate Inner Choroidopathy.

Ocul Immunol Inflamm 2021 Feb 5:1-7. Epub 2021 Feb 5.

Department of Ophthalmology, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA.

: To describe the utility of fundus autofluorescence (FAF) for detection and monitoring of acute regional outer retinopathy in punctate inner choroidopathy (PIC). : Multimodal imaging case series. : Patients with PIC and acute regional hyperautofluorescence were identified. Multimodal imaging, treatment, and clinical course were reviewed. : Six eyes of five patients were included (5 women, mean age 39 years, range 28-69). All endorsed new symptoms. Short-wave blue FAF revealed regional hyperautofluorescence in the symptomatic eye, corresponding to ellipsoid zone (EZ) loss on optical coherence tomography (OCT). All patients were treated with local or systemic corticosteroids or immunosuppression, with resolution of symptoms and acute imaging abnormalities. : Symptomatic acute regional outer retinopathy in PIC, manifesting as hyperautofluorescence and EZ loss, is easily identifiable using widefield FAF imaging. Treatment resulted in resolution of symptoms and imaging findings in our cohort, and should be considered in this patient population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1849736DOI Listing
February 2021

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 447 Patients with Tubercular Intermediate Uveitis and Panuveitis.

Ocul Immunol Inflamm 2020 Nov 17:1-11. Epub 2020 Nov 17.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India.

Tubercular intermediate uveitis (TIU) and panuveitis (TBP) are difficult to manage because of limitations in diagnostic tools and lack of evidence-based treatment guidelines. The Collaborative Ocular Tuberculosis Study (COTS) analyzed treatment regimens and therapeutic outcomes in patients with TIU and TBP. Multicentre retrospective analysis. A total of 138 TIU and 309 TBP patients were included. A total of 382 subjects received antitubercular therapy (ATT) (n = 382/447; 85.4%) and 382 received corticosteroids (n = 382/447; 85.4%). Treatment failure was observed in 78 individuals (n = 78/447; 17.4%), occurring less frequently in patients receiving ATT (n = 66/382; 17.2%) compared to those who did not (n = 12/65; 18.5%). The study did not show any statistically significant therapeutic effect of ATT in patients with TIU and TBP. Taking into account the limitations of the retrospective, non-randomized study design, resultant reliance on reported data records, and unequal size of the samples, the current study cannot provide conclusive evidence on the therapeutic benefit of ATT in TIU and TBP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1808226DOI Listing
November 2020

The diverse multi-modal imaging findings of recurrent primary vitreoretinal lymphoma.

Am J Ophthalmol Case Rep 2020 Dec 25;20:100936. Epub 2020 Sep 25.

Uveitis Service, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.

We present a case of a 44-year-old man with biopsy-proven primary vitreoretinal lymphoma (PVRL), who developed multiple ocular recurrences over the course of six years. Recurrences were imaged with color fundus photography, fundus autofluorescence, and optical coherence tomography. This case demonstrates a single patient with a myriad of imaging findings of PVRL as well as response to a variety of therapeutic interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajoc.2020.100936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595882PMC
December 2020

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Descriptive Review of Tubercular Uveitis in Paediatric Population.

Ocul Immunol Inflamm 2020 Aug 17:1-7. Epub 2020 Aug 17.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India.

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 (). 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1781197DOI Listing
August 2020

Birdshot chorioretinopathy presenting in a teenager.

Am J Ophthalmol Case Rep 2020 Sep 3;19:100807. Epub 2020 Jul 3.

Uveitis Service, Northwestern University, Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA.

Purpose: To describe clinical features of the youngest patient with well-documented HLA-A29-positive birdshot chorioretinopathy (BCR).

Observations: A 17-year-old female presented with poor night vision and floaters. Examination revealed bilateral vitritis, retinal vasculitis, and numerous cream-colored ovoid lesions in the fundus. Fluorescein angiography revealed bilateral optic disc leakage, large vessel leakage and diffuse capillary ferning. There were hundreds of small hypocyanescent spots evenly distributed in the posterior pole of both eyes on indocyanine green angiography. Workup was positive for HLA-A29.2. Systemic immunosuppression with adalimumab 40mg/0.4mL was initiated every two weeks and escalated to weekly dosing. The patient's early age of disease onset prompted evaluation of her parents. The mother's exam was normal and she was HLA-A29 negative. Examination of the father revealed peripapillary choroidal lesions as well as hypocyanescent spots on ICG. HLA-typing revealed the presence of HLA-A29.2.

Conclusions And Importance: BCR rarely occurs in the pediatric population. We present the youngest patient with well-documented BCR in the literature to highlight that this disease deserves consideration even in young patients. Interestingly, choroidal lesions were also found in an asymptomatic parent with HLA-A29.2 positivity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajoc.2020.100807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365988PMC
September 2020

Visual Morbidity in Ocular Tuberculosis - Collaborative Ocular Tuberculosis Study (COTS)-1: Report #6.

Ocul Immunol Inflamm 2020 Jun 30:1-9. Epub 2020 Jun 30.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India.

Objective: Aim of the study was to examine extent, natural history, and clinical features associated with visual impairment (VI) in patients diagnosed with ocular tuberculosis (OTB) by the Collaborative Ocular Tuberculosis Study (COTS)-1.

Methods: Multi-center retrospective cohort study. Main outcomes were VI.

Results: A total of 302 patients were included in the study, including 175 patients whose data related to BCVA were available throughout the 2 years of follow up. Mean BCVA grossly improved at 12, 18, and 24 months of follow-up ( < .001). Mean BCVA was worse at 12-18th month follow-up for patients treated with ATT versus patients who were not treated with ATT, but patients treated with ATT had a statistically significant improvement in BCVA at the 24-month endpoint.

Conclusions: OTB is associated with significant visual morbidity, future well-designed prospective studies are warranted to establish the causal association between OTB and visual loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1774905DOI Listing
June 2020

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 165 Patients with Tubercular Anterior Uveitis.

Ocul Immunol Inflamm 2020 Jun 30:1-10. Epub 2020 Jun 30.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1761400DOI Listing
June 2020

Twenty-four Month Outcomes in the Collaborative Ocular Tuberculosis Study (COTS)-1: Defining the "Cure" in Ocular Tuberculosis.

Ocul Immunol Inflamm 2020 Jun 26:1-9. Epub 2020 Jun 26.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India.

Purpose: To report the clinical findings, anatomical features, and treatment outcomes in subjects with ocular tuberculosis (OTB) at 24 months in the Collaborative Ocular Tuberculosis Study (COTS)-1.

Methods: Of the 945 subjects included in COTS-1, those who completed a 24-month follow-up after completion of treatment were included. The main outcome measure was a number of patients with treatment failure (TF).

Results: 228 subjects (120 males; mean age of 42.82 ± 14.73 years) were included. Most common phenotype of uveitis was posterior ( = 81; 35.53%), and panuveitis ( = 76; 33.33%). Fifty-two patients (22.81%) had TF. On univariable analysis, odds of high TF was observed with bilaterality (OR: 3.46, = .003), vitreous haze (OR: 2.14, = .018), and use of immunosuppressive therapies (OR: 5.45, = .003). However, only bilaterality was significant in the multiple regression model (OR: 2.84; = .02).

Conclusions: Majority of subjects (>75%) achieved cure in the COTS-1 at 24-month follow-up. The concept of "cure" may be a valuable clinical endpoint in trials for OTB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1761401DOI Listing
June 2020

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of regression following intravitreal dexamethasone (Ozurdex) implant.

Retin Cases Brief Rep 2020 Jun 5. Epub 2020 Jun 5.

Feinberg School of Medicine, Northwestern University, Department of Ophthalmology, Chicago, IL.

Purpose: To report the use of dexamethasone (Ozurdex, Allergan Inc.) intravitreal implant in the management of acute zonal occult outer retinopathy (AZOOR).

Methods: Observational case report RESULTS:: A 63-year-old woman presented with a 10-year history of progressing bilateral, though asymmetric, visual impairment and scotomata with clinical and imaging findings compatible with AZOOR. The right eye had recently progressed rapidly until macular involvement occurred with loss of visual acuity. Under our observation progression toward the fovea in the left eye occurred, Ozurdex intravitreal implant treatment was offered and administered. Autofluorescence imaging documented resolution of the hyperautofluorescent borders and slight regression of the involved retina. An injection was repeated every 6 months for 3 injections, and after a follow-up period of 20 months after the first and 8 months after the last injection, no further signs of progression were observed in her left eye.

Conclusion: Dexamethasone implant effectively achieved regression of active disease in a patient with longstanding, progressive AZOOR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICB.0000000000001009DOI Listing
June 2020

Tubulointerstitial Nephritis and Uveitis Syndrome: Characterization of Clinical Features.

Ocul Immunol Inflamm 2020 May 28:1-6. Epub 2020 May 28.

Department of Ophthalmology, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA.

Purpose: To describe clinical manifestations of patients with tubulointerstitial nephritis and uveitis syndrome (TINU) with a focus on posterior segment findings.

Methods: Retrospective chart review.

Results: 17 patients were diagnosed with TINU. Ten (59%) were female. Average age at presentation was 19 years (range 7-49). Urine β2-microglobulin was elevated in all tested patients. Six patients (35%) had isolated anterior uveitis. Eleven (65%) had posterior segment findings. Three (18%) had multifocal choroidal lesions, seven (41%) had disc edema, four (24%) had macular edema, three (18%) had choroidal neovascular membranes, two (12%) had retinal vasculitis, one (6%) had disc neovascularization and vitreous hemorrhage, one (6%) had bilateral posterior scleritis. Eleven (65%) required systemic steroid therapy, seven (41%) required immunomodulatory therapy.

Conclusions: TINU occurs in all age groups. Posterior segment manifestations are common. Most patients required systemic steroid therapy, with a significant number requiring long-term systemic immunomodulation. Careful fundus examination is required on all patients with TINU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1736311DOI Listing
May 2020

Success of Weekly Adalimumab in Refractory Ocular Inflammatory Disease.

Ophthalmology 2020 10 17;127(10):1431-1433. Epub 2020 Apr 17.

Uveitis Service, Northwestern University, Feinberg School of Medicine, Department of Ophthalmology, Chicago, Illinois. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ophtha.2020.04.009DOI Listing
October 2020

The Collaborative Ocular Tuberculosis Study (COTS) Consensus (CON) Group Meeting Proceedings.

Authors:
Rupesh Agrawal Ilaria Testi Sarakshi Mahajan Yew Sen Yuen Aniruddha Agarwal Andres Rousselot Dhananjay Raje Dinesh Visva Gunasekeran Onn Min Kon Talin Barisani-Asenbauer John H Kempen Amod Gupta Douglas A Jabs Justine R Smith Bahram Bodaghi Manfred Zierhut Marc DeSmet Peter Mc Cluskey Mamta Agarwal Manisha Agarwal Kanika Aggarwal Mukesh Agrawal Hassan Al-Dhibi Sofia Androudi Fatma Asyari Manohar Babu Balasundaram Kalpana Babu Murthy Edoardo Baglivo Alay Banker Reema Bansal Soumyava Basu Digamber Behera Jyotirmay Biswas Ester Carreño Laure Caspers Soon Phaik Chee Romi Chhabra Luca Cimino Luz Elena Concha Del Rio Emmett T Cunningham Andrè Luiz Land Curi Dipankar Das Ekaterina Denisova Alastair K Denniston Marie-Hélène Errera Alejandro Fonollosa Amala George Debra A Goldstein Yan Guex Crosier Avinash Gurbaxani Alessandro Invernizzi Hazlita M Isa Shah Md Islam Nicholas Jones Deeksha Katoch Moncef Khairallah Amit Khosla Michal Kramer Amitabh Kumar Atul Kumar Rina La Distia Nora Richard Lee Careen Lowder Saurabh Luthra Padmamalini Mahendradas Dorine Makhoul Shahana Mazumdar Salil Mehta Elisabetta Miserocchi Manabu Mochizuki Oli S Mohamed Cristina Muccioli Marion R Munk Somasheila Murthy Shishir Narain Heloisa Nascimento Piergiorgio Neri Myhanh Nguyen Annabelle A Okada Pinar Ozdal Alan Palestine Francesco Pichi S R Rathinam Ariel Schlaen Shobha Sehgal H Nida Sen Aman Sharma Kusum Sharma Samir S Shoughy Nirbhai Singh Ramandeep Singh Masoud Soheilian Sudharshan Sridharan Jennifer E Thorne Christoph Tappeiner Stephen Teoh Maria Sofia Tognon Ilknur Tugal-Tutkun Mudit Tyagi Harvey Uy Daniel Vitor Vasconcelos Santos Natasa Vidovic Valentincic Mark Westcott Ryoji Yanai Bety Yanez Alvarez Rahman Zahedur Quan Dong Nguyen Carlos Pavesio Vishali Gupta

Ocul Immunol Inflamm 2020 Apr 6:1-11. Epub 2020 Apr 6.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1716025DOI Listing
April 2020

Tubercular Uveitis: Nuggets from Collaborative Ocular Tuberculosis Study (COTS)-1.

Ocul Immunol Inflamm 2019 Nov 25:1-9. Epub 2019 Nov 25.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Tuberculosis (TB) is a major infection that can affect the eye as first and sole presentation without features of systemic disease. Controversy exists regarding diagnosis and management of tubercular uveitis (TBU), further compounded by regional variations in disease expression. Collaborative Ocular Tuberculosis Study (COTS)-1 aims to address knowledge deficits through collaboration amongst uveitis specialists across the globe by sharing the data of patients with TBU presented at participating centers from January 2004 to December 2014. Data collection was facilitated by a novel method of real-time encrypted web-based data entry allowing regular updates as new data and recommendations become available. Information on clinical features, investigation findings, management, and treatment outcomes were reviewed to get an idea about real world scenario. The current review aims to focus on methodology and briefing of published reports from COTS group in COTS-1 study to highlight key messages from this large data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2019.1646774DOI Listing
November 2019

Novel imaging modalities in patients with uveitis.

Can J Ophthalmol 2020 02 9;55(1):20-29. Epub 2019 Aug 9.

Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address:

Imaging is one of the key elements in the diagnosis and management of ocular diseases. This is particularly true of retinal conditions. In this review we discuss novel imaging modalities such as optical coherence tomography angiography (OCTA), choroidal optical coherence tomography (OCT), anterior chamber OCT, as well as widefield imaging modalities and fundus autofluorescence. We describe the advantages and shortcomings of these imaging modalities in comparison to the more traditional ones, as well as some common pitfalls. We also provide examples of how these newer imaging methods can aid clinicians in their decision making, and provide novel insights into disease pathogenesis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2019.06.005DOI Listing
February 2020

The Utility of Lyme Testing in the Workup of Ocular Inflammation.

Ocul Immunol Inflamm 2021 Jan 2;29(1):149-153. Epub 2019 Oct 2.

Department of Ophthalmology, Northwestern University, Chicago, IL, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2019.1657904DOI Listing
January 2021

OCT Angiography Imaging in Serpiginous Choroidopathy.

Ophthalmol Retina 2018 04 19;2(4):351-359. Epub 2017 Oct 19.

Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address:

Purpose: To report OCTA findings in 3 cases, 2 active and 1 inactive, of serpiginous choroidopathy (SC) and describe OCTA changes in response to treatment.

Design: Retrospective case series.

Participants: We studied 6 eyes of 3 patients with SC.

Methods: Retrospective case series of 3 patients with SC undergoing multimodal imaging, including OCTA. In 1 treated eye, both pre- and posttreatment images were compared.

Main Outcome Measures: Description of OCTA findings in patients with SC.

Results: In the active phase, OCTA images show an apparent absence of the choriocapillaris with variable outer retinal and retinal pigment epithelial thickening. After treatment, OCTA of previously active lesions demonstrates a partial reappearance of the choriocapillaris, especially at lesion margins. In inactive SC, the choriocapillaris, along with the retinal pigment epithelium and outer retina, is notably absent.

Conclusions: Optical coherence tomography angiography suggests absence of choriocapillaris in both active and inactive phases of SC with partial reestablishment following treatment. Although the exact pathogenesis of SC is not elucidated by these findings, OCTA images allow us to better evaluate choroidal involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oret.2017.07.023DOI Listing
April 2018

Uveitis in Patients Treated with CTLA-4 and PD-1 Checkpoint Blockade Inhibition.

Ocul Immunol Inflamm 2020 1;28(2):217-227. Epub 2019 Mar 1.

Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.

: To investigate the link between treatment with CTLA-4 and PD-1 checkpoint blockade inhibitors and the development of noninfectious uveitis.: A survey was distributed to uveitis specialists to identify patients who developed uveitis while receiving either PD-1 inhibitors pembrolizumab and nivolumab; PD-L1 inhibitors atezolizumab, avelumab, and durvalumab; or the CTLA-4 inhibitor ipilimumab.: Fifteen patients from seven institutions were identified. The most common cancer diagnosis (13/15) was malignant melanoma. Fourteen patients had a new uveitis diagnosis following checkpoint blockade administration (six anterior uveitis, six panuveitis, one posterior uveitis, one anterior/intermediate combined); one patient developed optic neuritis. Uveitis was diagnosed within 6 months after drug initiation for 11/12 patients (median 63 days). Corticosteroid treatment was effective for most patients, although two patients had permanent loss of vision.: Patients on checkpoint inhibitor therapy should be educated to seek care if they develop ocular symptoms, and prompt referral to specialists should be incorporated into oncology protocols.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2019.1577978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832811PMC
January 2021

Partial Scleral Rupture Presenting 4 Years After Laser in Situ Keratomileusis.

Cornea 2019 Apr;38(4):498-501

Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL.

Purpose: To report a case of partial scleral rupture after laser in situ keratomileusis (LASIK) surgery.

Methods: This is a retrospective case report describing a late complication of LASIK surgery.

Results: A 32-year-old white woman with a history of LASIK surgery performed with a mechanical microkeratome 4 years previously presented for evaluation of partial bilateral scleral ruptures. An arcuate filtering bleb along the contour of the cornea was found on the right eye with associated hypotony and corneal astigmatism. There were no signs or symptoms of prior inflammation, and rheumatologic workup was negative. Imaging revealed scleral microbreaks in the absence of adjacent thinning.

Conclusions: The pattern and location of thinning without findings consistent with inflammatory disease suggest that the partial bilateral scleral rupture was because of mechanical damage at the time of LASIK, possibly compounded by the hormonal changes of pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0000000000001850DOI Listing
April 2019

Moving From Syndromic Description to Etiologic Diagnosis for Uveitis.

JAMA Ophthalmol 2019 04;137(4):438-439

Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2018.6202DOI Listing
April 2019

Vertical Hyperreflective Lesions on Optical Coherence Tomography in Vitreoretinal Lymphoma.

JAMA Ophthalmol 2019 02;137(2):194-198

Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois.

Importance: Vitreoretinal lymphoma is a diagnostic challenge and the pathophysiology is still unclear.

Objective: To describe an imaging finding seen on optical coherence tomography (OCT) of patients with vitreoretinal lymphoma.

Design, Setting, And Participants: This case series study was a retrospective medical record review of patients who received a diagnosis of vitreoretinal lymphoma at the Department of Ophthalmology at Northwestern University between July 2014 and January 2016.

Main Outcomes And Measures: Optical coherence tomography findings in vitreoretinal lymphoma.

Results: We identified 7 patients (4 women [57.1%]; mean [range] age, 62.4 [45-75] years; 12 eyes) with intraocular lymphoma involving the retina (5 patients [71.4%] with primary vitreoretinal or central nervous system lymphoma with ocular involvement, 1 patient [14.3%] with testicular lymphoma with secondary central nervous system lymphoma and vitreoretinal lymphoma, and 1 patient [14.3%] with secondary vitreoretinal lymphoma). We identified vertical hyperreflective lesions that showed moderate or high reflectivity and affected all layers of the neuroretina in 5 patients (7 of 12 eyes [58.3%]). These often preceded the development of subretinal pigment epithelial deposits and were often localized around second-order and third-order retinal vessels. In most cases, they resolved with minimal or no scarring after the initiation of chemotherapy.

Conclusions And Relevance: Vertical hyperreflective lesions are a common physical finding on OCT in eyes with vitreoretinal lymphoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2018.5835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439833PMC
February 2019

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Description of the Spectrum of Choroidal Involvement in 245 Patients with Tubercular Uveitis.

Ocul Immunol Inflamm 2018 Aug 29:1-11. Epub 2018 Aug 29.

e Advanced Eye Centre, Department of Ophthalmology , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India.

Purpose: To contribute a global description of the spectrum of choroidal involvement in tubercular uveitis (TBU).

Methods: Retrospective cohort study of TBU patients with choroidal involvement from 25 centers between January 2004 and December 2014. Medical records of patients with a minimum follow-up of 1 year were reviewed.

Results: 245 patients were included. The phenotypic variations included serpiginous-like choroiditis (SLC) (46%), tuberculoma (13.5%), multifocal choroiditis (MFC) (9.4%), ampiginous choroiditis (9%), among others. 219 patients were treated with anti-tubercular therapy (ATT) (n = 219/245, 89.38%), 229 patients with steroids (n = 229/245, 93.47%) and 28 patients with immunosuppressive agents (n = 28/245, 11.42%). Treatment failure was noted in 38 patients (n = 38/245, 15.5%). Patients with SLC and ampiginous choroiditis appeared to have superior outcomes on survival analysis (p = 0.06).

Conclusion: This study provides a comprehensive description of choroidal involvement in TBU. Patients with SLC and ampiginous choroiditis may have better clinical outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2018.1489061DOI Listing
August 2018

The Influence of Race and Sex on the Side Effect Profile of Methotrexate in the Treatment of Uveitis.

Ocul Immunol Inflamm 2019 13;27(7):1160-1164. Epub 2018 Aug 13.

Ophthalmology, Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA.

: To detect any correlation between race and sex and the side effects of methotrexate in uveitis treatment. : Retrospective review of patients seen at Northwestern Memorial Hospital between August 2012 and September 2014 with a history of MTX treatment for uveitis. Demographic, treatment, and side-effect data were collected for each patient. : Ninety-seven patients were included (25 males, 72 females). Twenty-eight patients reported African American race, 60 reported Caucasian race, and the remaining 9 reported Asian, Hispanic, or Arabic ethnicity. Males experienced more gastrointestinal upset than females (24% versus 13.8%). Caucasians had more gastrointestinal complaints (20% versus 8%) while African Americans developed more hair loss (14% versus 6.6%), although the numbers were too small to detect a statistical difference. : While our sample was small, these findings suggest racial and gender disparities in the side effects experienced by patients treated with methotrexate. This information may be useful to clinicians counseling patients on risk profile.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2018.1498905DOI Listing
April 2020

Tuberculous Uveitis Presenting with a Bullous Exudative Retinal Detachment: A Case Report and Systematic Literature Review.

Ocul Immunol Inflamm 2019 3;27(6):998-1009. Epub 2018 Jul 3.

Department of Ophthalmology, Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA.

: To describe tuberculous uveitis (TU) presenting as a bullous retinal detachment (RD) and to perform a comprehensive literature review on TU with similar features. : Observational case report and systematic literature review. : An 84-year-old woman presented with bilateral granulomatous uveitis and bullous RD in the left eye. The interferon gamma release assay was strongly positive, but all other tests were unremarkable. The patient was diagnosed with TU and started on anti-tubercular therapy (ATT) and systemic steroids with excellent treatment response. Twenty-six articles (32 cases) reported TU with exudative RD. Choroidal tuberculoma was the most common clinical manifestation, followed by optic disc edema and retinal exudate. Systemic steroids with ATT improved vision in more patients (78.6%) than ATT alone (50.0%) or oral steroids followed by ATT (50.0%). : Atypical presentations of TU make diagnosis and treatment difficult. A high level of suspicion for TU is needed to minimize ocular morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2018.1485958DOI Listing
February 2020

Relapse of Juvenile Idiopathic Arthritis-Associated Uveitis after Discontinuation of Immunomodulatory Therapy.

Ocul Immunol Inflamm 2019 16;27(4):686-692. Epub 2018 Feb 16.

d Department of Ophthalmology , University of Illinois at Chicago , Chicago , Illinois , USA.

: To assess treatment outcomes in juvenile idiopathic arthritis (JIA)-associated uveitis and relapse rates upon discontinuation of immunomodulatory therapy (IMT). : Medical records of patients with JIA-associated uveitis seen at the University of Illinois at Chicago and the F.I. Proctor Foundation uveitis clinics from September 14, 1988 to January 5, 2011 were reviewed. The main outcome was time to relapse after attempting to discontinue IMT.: Of 66 patients with JIA-associated uveitis, 51 (77%) received IMT as either sole or combination therapy. Of a total of 51, 41 (80%) patients achieved corticosteroid-sparing control. Attempts were made to discontinue treatment in 19/51 (37%) patients. Of a total of 19 patients, 13 (68%) attempting to discontinue IMT relapsed, with a median time to relapse of 288 days from the time of attempted taper/discontinuation (IQR: 108-338).: Corticosteroid-sparing control of inflammation was achieved in the majority of patients; however, attempts to stop IMT were often unsuccessful. Close follow-up of patients after discontinuation of therapy is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2018.1424341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365220PMC
December 2019

The Collaborative Ocular Tuberculosis Study (COTS)-1 Report 3: Polymerase Chain Reaction in the Diagnosis and Management of Tubercular Uveitis: Global Trends.

Ocul Immunol Inflamm 2019 20;27(3):465-473. Epub 2017 Dec 20.

a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India.

: To analyze the role of polymerase chain reaction (PCR) of ocular fluids in management of tubercular (TB) anterior, intermediate, posterior, and panuveitis. In Collaborative Ocular Tuberculosis Study (COTS)-1 (25 centers,  = 962), patients with TB-related uveitis were included. 59 patients undergoing PCR of intraocular fluids (18 females; 53 Asian Indians) were included. 59 (6.13%) of COTS-1 underwent PCR analysis. PCR was positive for Mycobacterium TB in 33 patients (23 males; all Asian Indians). 26 patients were PCR negative (18 males). Eight patients with negative PCR had systemic TB. Anti-TB therapy was given in 18 negative and 31 PCR cases. At 1-year follow-up, five patients with positive PCR (15.15%) and three with negative PCR (11.54%) had persistence/worsening of inflammation. : Data from COTS-1 suggest that PCR is not commonly done for diagnosing intraocular TB and positive/negative results may not influence management or treatment outcomes in the real world scenario.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2017.1406529DOI Listing
December 2019

Fundus Autofluorescence Findings in Eyes With Birdshot Chorioretinitis.

Invest Ophthalmol Vis Sci 2017 08;58(10):4015-4025

Ocular Inflammatory Disease Center, UCLA Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.

Purpose: The purpose of this study was to describe fundus autofluorescence (FAF) findings in eyes with birdshot chorioretinitis (BSCR) and to compare findings to demographic, medical, and clinical characteristics.

Methods: In this multicenter, prospective, cross-sectional study, 172 eyes (86 patients) with BSCR were investigated. Participants underwent a standardized evaluation including collection of demographic data, ophthalmic and treatment history, and ophthalmologic examination. Using a standardized protocol, hypo- and hyperautofluorescence in macular and extramacular regions and specific patterns of abnormal FAF could be scored for 167 eyes. Images were scored by two independent, masked graders. Measures of visual function included best-corrected visual acuity (BCVA), contrast sensitivity (CS), color vision, and Humphrey visual field mean deviation (HVF-MD).

Results: Any abnormal FAF finding was observed in 132 eyes (79.0%); macular abnormalities were observed in 84 eyes (49.1%). The most common findings were peripapillary confluent hypoautofluorescence (122 eyes [73.1%]); extramacular granular hypoautofluorescence (100 eyes [59.9%]); and macular granular hypoautofluorescence (67 eyes [40.1%]). Confluent hypoautofluorescence was related to longer median disease duration (8.7 years) than granular hypoautofluorescence (7.9 years) or hyperautofluorescence (5.6 years). Macular confluent hypoautofluorescence was associated with BCVA ≤20/25 (odds ratio [OR] = 7.83, P = 0.007), BCVA ≤20/50 (OR = 4.94, P = 0.002), and abnormal CS (OR = 4.56, P = 0.009). Presence of macular or extramacular hypoautofluorescence was related to HVF-MD ≤-3 dB (OR = 2.43, P = 0.01 and OR = 2.89, P = 0.003, respectively).

Conclusions: In this large cohort, various FAF abnormalities were found, indicating that disorders of the retinal pigment epithelium are features of BSCR. Abnormal FAF is a marker of visual dysfunction in the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1167/iovs.17-21897DOI Listing
August 2017

Multiple Sclerosis-Associated Uveitis.

Ocul Immunol Inflamm 2017 06;25(3):299-301

g Centre for Ophthalmology , University Tuebingen, Schleichstrasse , Tuebingen , Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2017.1334469DOI Listing
June 2017

Anterior Segment Optical Coherence Tomography Angiography for Identification of Iris Vasculature and Staging of Iris Neovascularization: A Pilot Study.

Curr Eye Res 2017 08 25;42(8):1136-1142. Epub 2017 Apr 25.

a Department of Ophthalmology, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA.

Purpose/Aim of the study: To assess the ability of optical coherence tomographic angiography (OCTA) to visualize the normal iris vasculature as well as neovascularization of the iris (NVI).

Materials And Methods: Study participants with healthy eyes, patients at risk of NVI development and patients with active or regressed NVI were consecutively included in this cross-sectional observational study. Imaging was performed using a commercially available OCTA system (RTVue- XR Avanti, Optovue Inc., Fremont, CA, USA). Abnormal iris vessels were graded on OCTA according to a modified clinical staging system and compared to slitlamp and gonioscopic findings.

Results: Fifty eyes of 26 study participants (16 healthy eyes, 19 eyes at risk, 15 eyes with different stages of NVI) were imaged using OCTA. In 11 out of 16 healthy eyes (69%) with light or moderately dark iris pigmentation, we observed physiological, radially aligned iris vasculature on OCTA imaging, which could not be visualized in five eyes (31%) with darkly pigmented irides. One eye in the "eyes at risk" group was diagnosed with NVI based on OCTA, which was not observed clinically. Fifteen eyes with clinically active or regressed NVI were imaged. Different stages of NVI could be differentiated by OCTA, corresponding well to an established clinical grading system. Four eyes showed regressed NVI by OCTA, not seen clinically, and were graded as a newly defined stage 4.

Conclusions: This pilot clinical study showed that OCTA for imaging of the iris vasculature in health and disease is highly dependent on iris pigmentation. Fine, clinically invisible iris vessels can be visualized by OCTA in the very early stages as well as in the regressed stage of NVI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02713683.2017.1293113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753407PMC
August 2017

Visualization of Photoreceptors in Birdshot Chorioretinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy: A Pilot Study.

Ocul Immunol Inflamm 2017 Oct 31;25(5):610-620. Epub 2017 Mar 31.

b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA.

Purpose: Adaptive optics scanning laser ophthalmoscopy (AOSLO) allows en face visualization of specific layers of the retina. This pilot study evaluated the ability of AOSLO to visualize photoreceptor integrity in patients with birdshot chorioretinopathy (BCR).

Method: A total of 16 consecutive patients with HLA-A29+ BCR were imaged using the prototype Apaeros retinal imaging system. Images of high quality were aligned with infrared reflectance photos and correlated with spectral domain optical coherence tomography (SD-OCT).

Results: Images of four eyes of three patients were of sufficient quality to allow posterior pole montage and point-to-point correlation with SD-OCT. Areas of photoreceptor disruption on SD-OCT were seen as patchy areas of loss on AOSLO, whereas areas of intact interdigitation zone and inner segment/outer segment junction correlated with normal appearing photoreceptors on AOSLO.

Conclusions: Using AOSLO, we found one instance of subclinical photoreceptor disruption not seen on SD-OCT. Ultimately, there are unique challenges associated with imaging BCR patients using AOSLO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2017.1298819DOI Listing
October 2017