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Biomedical subjects

Aniki Rothova

Publications and source records attributed to Aniki Rothova.

At least 19 recordsLinked to original sources
PubMed2006

Anterior uveitis: a manifestation of graft-versus-host disease.

PURPOSE: To describe the occurrence of anterior uveitis along with systemic manifestations of chronic graft-versus-host disease (GVHD) after nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) in 3 patients with hematologic malignancies. DESIGN: Retrospective small case series. PARTICIPANTS: Three patients who underwent HSCT and 4 age- and gender-matched controls for cytokine analysis in ocular fluid. METHODS: Interventional study of patients who underwent HSCT. Screening for evidence of infectious causes and immunological analysis of ocular fluid samples. MAIN OUTCOME MEASURES: Clinical features of uveitis and results of aqueous analysis. RESULTS: Anterior uveitis developed during an exacerbation of chronic GVHD in 3 patients after allogeneic HSCT for hematologic malignancies. Patients exhibited no abnormalities on extensive uveitis screening, and in addition, serologic and wide-ranging aqueous analysis showed no evidence of recent infections. We observed signs of inflammation in the ocular fluid in 2 of 3 patients by the determination of different cytokines. No other explanation for uveitis was found except the exacerbation of GVHD. Treatment, both systemic and topical, directed to chronic GVHD induced remission of uveitis in all patients along with amelioration of other signs of GVHD. CONCLUSIONS: Anterior uveitis occurred in the wake of the acute exacerbation of chronic GVHD after HSCT and may represent an ocular manifestation of chronic GVHD.

Adult↗
PubMed2006

Rubella virus is associated with fuchs heterochromic iridocyclitis.

PURPOSE: To determine whether rubella virus (RV) is involved in the pathogenesis of Fuchs heterochromic iridocyclitis (FHI). DESIGN: Retrospective patient-controlled study. METHODS: Intraocular immunoglobulin G production against RV, herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii was determined in the aqueous humor of 14 patients with FHI, 13 control subjects with herpetic uveitis anterior, and 19 control subjects with ocular toxoplasmosis by calculation of the Goldmann-Witmer coefficient (GWC). RESULTS: All patients and control subjects were seropositive for RV. Intraocular antibody production (GWC >3) against RV was found in 13 of 14 patients (93%) with FHI. Intraocular antibody production against HSV, VZV, or T gondii was not detected. None of the control subjects with herpetic uveitis anterior or with toxoplasma chorioretinitis had a positive GWC for rubella virus (P < .0001, Fisher exact test). CONCLUSION: Rubella virus, but not HSV, VZV, or T gondii, is associated with FHI.

Adult↗
PubMed2006

Research criteria for the diagnosis of birdshot chorioretinopathy: results of an international consensus conference.

PURPOSE: To present and evaluate research criteria for the diagnosis of birdshot chorioretinopathy. DESIGN: Consensus statement. METHODS: Investigators who attended an international conference on birdshot chorioretinopathy drafted diagnostic criteria, which were refined after comment by conference attendees. Sensitivity and specificity of the criteria were evaluated by review of 82 previously diagnosed cases and evaluation of 80 consecutive patients with other forms of uveitis. RESULTS: Criteria, including presence of "birdshot lesions" and mild intraocular inflammation in both eyes, are based on clinical findings in the absence of systemic disease; HLA-A29 is supportive of diagnosis, but not required. Diagnostic criteria were found to be 100% specific and 97.5% sensitive. Positive predictive value was 100%; negative predictive value was 97.6%. CONCLUSIONS: Standardized criteria for the diagnosis of birdshot chorioretinopathy will facilitate clinical research and the comparison of results from studies performed at different institutions by ensuring a homogeneous population of study patients.

Biomedical Research↗
PubMed2006

Rapid progression of diabetic retinopathy in eyes with posterior uveitis.

PURPOSE: To report on two patients who developed rapid progression of asymmetric diabetic retinopathy (DRP) in eyes affected by posterior uveitis in contrast to their fellow eyes not affected by uveitis. DESIGN: Observational case report. METHODS: Two patients with diabetes mellitus (DM) and unilateral uveitis underwent repeated ophthalmologic examinations and fluorescein angiography. RESULTS: Two patients with DM and unilateral posterior uveitis developed proliferative DRP in eyes with previous uveitis within 3 months after the uveitis subsided. In contrast, the retinal findings of nonuveitic eyes remained unchanged on follow-up of several years. CONCLUSIONS: Since the pathogenesis of intraocular inflammation and diabetic retinopathy acts through similar biochemical mediators and pathways, it is feasible that posterior uveitis accelerates the progression of diabetic retinopathy. Our results support this hypothesis and point out a risk for rapid retinopathy development in eyes affected with posterior uveitis.

Adult↗
PubMed2006

Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis.

PURPOSE: To determine the relative contribution of the analysis of intraocular antibody production and the polymerase chain reaction (PCR) in aqueous humor (AH) to the diagnosis of infectious uveitis. DESIGN: Retrospective case-control study. METHODS: Paired AH and serum samples from 230 patients suspected of infectious uveitis were examined for intraocular antibody production against herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii by calculating the Goldmann-Witmer coefficient (GWC). In addition, AH samples were investigated by real-time PCR to determine the presence of microbial DNA. RESULTS: Positive results were obtained in 54 cases (23%): 13 HSV (24%), 16 VZV (30%), and 25 T gondii (46%). Of these, 23 (43%) were positive for both GWC and PCR, 26 (48%) only for GWC, and 5 (9%) only for PCR. With PCR as the sole diagnostic approach, a correct diagnosis of the infectious etiology would have been missed in 34% of cases for the herpes viruses and in 64% for T gondii. Analysis of the relationship between a positive laboratory diagnosis and the time of sampling after onset of ocular disease demonstrated that intraocular antibody production was found throughout the course of the diseases. Viral DNA was more readily detected early in infection. In contrast, T gondii nucleic acid was not detected until 3 weeks after onset of ocular disease. CONCLUSIONS: Analysis of intraocular antibody production contributed considerably to the etiological diagnosis of infectious uveitis, most notably of ocular toxoplasmosis early after onset of disease. Therefore, both PCR and GWC determination might be performed for comprehensive diagnosis of intraocular infections.

Animals↗
PubMed2006

Long-term follow-up of intermediate uveitis in children.

PURPOSE: To analyze the clinical manifestations, remissions, and visual prognosis of intermediate uveitis in children, and to identify the risk factors for poor visual outcome. DESIGN: Retrospective cohort study. METHODS: Institutional study of 32 consecutive patients examined at a tertiary referral center with intermediate uveitis and the onset of ocular disease before the age of 16 years. Numerous variables were assessed, including age and gender distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features and complications, therapeutic strategies and their outcomes, remission and final visual acuity, and characteristics associated with poor visual outcome. RESULTS: Bilateral involvement was observed in 94% of the patients. Remission was observed in seven out of 15 patients (47%) with completed follow-up of five years. For our 32 subjects, we found a mean time to remission of 6.4 years (SE 0.7, CI 5.1 to 7.7). Visual outcome was favorable as only three patients developed unilateral acuity of less than 0.1 after five-year follow-up, and no additional blind eyes manifested. No associated systemic diseases were established. Optic disk edema was the most frequent complication observed (71%). Cystoid macular edema (CME) was observed in 44% of the patients and was the most common cause of visual loss. CONCLUSIONS: Intermediate uveitis of childhood might exhibit a self-limiting course after several years. Visual loss was limited despite the high rate of severe ocular complications.

Adolescent↗
PubMed2006

A randomized, masked, cross-over trial of lisinopril for inflammatory macular edema.

PURPOSE: To analyze the effect of angiotensin-converting enzyme (ACE) inhibitor lisinopril on inflammatory cystoid macular edema and visual acuity. DESIGN: Randomized, double-blind, placebo-controlled cross-over trial. METHODS: setting: Outpatient clinic of the Department of Ophthalmology at the University Medical Center of Utrecht. patients: Forty patients with inflammatory cystoid macular edema were included. intervention: Each patient received lisinopril (10 mg daily) or placebo for three months. After two months of a lisinopril/placebo free wash-out period, the groups received the reverse study medication for three months. Fluorescein angiography was performed to evaluate the retina. main outcome measures: Cystoid macular edema, best-corrected visual acuity and contrast sensitivity. RESULTS: Lisinopril had no effect on cystoid macular edema, visual acuity, papillary leakage, retinal vasculitis, and choroidal leakage. In a subgroup analysis, we observed a decrease in blood pressure (lisinopril, 14 of 36 patients; placebo, 5 of 36 patients; P = .02) and a decrease in morning urinary albumin excretion (lisinopril, 23 of 35 patients; placebo 10 of 34 patients, P = .003) was observed. CONCLUSIONS: Although lisinopril had no effect on inflammatory cystoid macular edema and visual acuity, we found a positive effect on the vascular system.

Adult↗
PubMed2006

Distinct cytokine and chemokine profiles in the aqueous of patients with uveitis and cystoid macular edema.

PURPOSE: To investigate the global cytokine and chemokine expression pattern in the aqueous humor of uveitis patients and relate them to clinical features. DESIGN: Cross-sectional study. METHODS: In 31 aqueous humor samples from uveitis patients, the concentration of mediators was measured by a multiplex immunoassay. Eleven control samples were included. RESULTS: Uveitis samples had higher levels of interleukin-6, interleukin-8, soluble intercellular adhesion molecule, soluble vascular cell adhesion molecule (sVCAM), and interferon-inducible protein-10 (IP-10) than nonuveitis controls. Active uveitis samples had higher levels of interleukin-6, interleukin-10, interferon-gamma, sVCAM, regulated on activation, normal T cell expressed and secreted (RANTES), and IP-10 than quiescent uveitis samples. Infectious uveitis was associated with higher levels of interleukin-10 than noninfectious uveitis (P < .03 for all subgroups). No significant differences were found between cystoid macular edema (CME) and non-CME samples. CONCLUSIONS: Elevated levels of specific mediators were found in active and in infectious uveitis, but not in CME. Mediator profiles might lead to a better understanding of the pathogenesis of uveitis.

Adult↗
PubMed2006

Ocular hypertension and secondary glaucoma in children with uveitis.

PURPOSE: To identify the risk factors for ocular hypertension and secondary glaucoma in children with uveitis. DESIGN: Retrospective observational case series of 147 patient records. PARTICIPANTS: Two hundred fifty-six eyes of 147 children with uveitis diagnosed before the age of 16 years. METHODS: Data were obtained from the medical records of children with uveitis evaluated at our institute from 1990 through 2004. MAIN OUTCOME MEASURES: Localization and course of uveitis (acute or chronic), underlying systemic disease, onset of ocular hypertension, onset of secondary glaucoma, treatment with steroids, antinuclear antibodies (ANAs), lens extractions, number of blind eyes at onset and during follow-up, and the duration of follow-up. RESULTS: Elevated intraocular pressure developed in 35% of children with pediatric uveitis regardless of the form or type of uveitis during a follow-up of 5 years. Secondary glaucoma, however, developed more frequently in juvenile idiopathic arthritis-associated uveitis (38%) compared with other forms of uveitis (11%) and more frequently in children with uveitis who were ANA positive (42%) than in those who were ANA negative (6%). Elevated intraocular pressure occurred in two thirds of all children within the first 2 years after the diagnosis of uveitis. Except for patients with juvenile idiopathic arthritis-associated uveitis, periocular steroid injections represented an additional risk factor for secondary glaucoma, but this risk was limited to the early phase of the disease process. CONCLUSIONS: In children with uveitis in this series, juvenile idiopathic arthritis-associated uveitis and ANA-positive uveitis without evidence of arthritis are the most important risk factors for developing secondary glaucoma.

Acute Disease↗
PubMed2006

Impact of macular edema on visual acuity in uveitis.

OBJECTIVE: To investigate the impact of cystoid macular edema (CME) on visual acuity in patients with uveitis. DESIGN: Cross-sectional study. PARTICIPANTS: The data from 529 patients (842 eyes) with uveitis were analyzed. MAIN OUTCOME MEASURES: We recorded gender and age of the patients, anatomic site and diagnosis of uveitis, associations with systemic diseases, onset and duration of uveitis, presence of CME, best-corrected visual acuity, and the causes of decrease in visual acuity. RESULTS: Cystoid macular edema was noted in 175 (33%) of all uveitis patients, of whom 77 (44%) had visual acuity of 20/60 or less in at least 1 eye. The mean visual acuity for eyes with CME was significantly worse than for eyes without CME (0.25 vs. 0.4; P = 0.003). Of all uveitis patients, 185 (35%) had visual acuity of 20/60 or less in at least 1 eye, which was caused by CME in 77 (42%) patients. Poor visual acuity in patients with CME was associated with the advanced age of the patients, chronic inflammation, and various specific uveitis entities. The development of visually impaired or blind eyes in patients with panuveitis and intermediate uveitis was caused in most cases by CME (59% and 85%, respectively). CONCLUSIONS: Cystoid macular edema was a major cause of visual loss in patients with uveitis. The unsatisfactory visual acuity in patients with uveitis underlines the need for improved management of this complication.

Adolescent↗
PubMed2006

The pros and cons of intravitreal triamcinolone injections for uveitis and inflammatory cystoid macular edema.

Intravitreal triamcinolone acetonide (IVTA) injections are gaining in popularity and are regularly administered nowadays for various ocular diseases. This paper presents a literature review on the use, efficacy, and complications of IVTA application in non-infectious uveitis and inflammatory cystoid macular edema (CME). In addition, we describe the experiences of our own institute. IVTA applications brought about a quick improvement in vision in the majority of cases. Drawbacks included the temporary duration of the effect with the need for repeated injections which re-exposed patients to the risk of complications. The risk of bacterial endophthalmitis was 0.5% and was further influenced by the specific IVTA preparation. Based on the literature review, we chose ready-for-use IVTA injections prepared by our pharmacy department, in which 90% of the toxic additives were removed and the dispensed dose of triamcinolone acetonide was validated to diminish the risk of endophthalmitis. Elevated intraocular pressure (IOP) was seen in 30-43% of the eyes and cataract developed in 29% of the eyes of patients, who were usually of advanced age. In conclusion, the rapid effect of IVTA might be of value in severe presentations of non-infectious uveitis and CME and might shorten the time interval needed for the improvement.

Glucocorticoids↗
PubMed2005

The effect of non-steroidal anti-inflammatory drugs on inflammatory cystoid macular edema.

PURPOSE: To assess the role of systemic non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of inflammatory cystoid macular edema (iCME). DESIGN: Pilot study. METHODS: We included 66 patients with iCME and treated them with naproxen (2 x 250 mg daily; n = 28) or rofecoxib (1 x 25 mg daily; n = 38). After 4 months of therapy, visual acuity and inflammation activity were measured. We evaluated the grade of CME, retinal vasculitis, and papillary leakage with fluorescein angiography. RESULTS: No clear effect of NSAIDs on iCME, visual acuity, and intraocular inflammation was observed. A beneficial effect was noted in less than 8% of the affected eyes. The drop-out rate after 4 months of treatment was 52%, because of adverse effects or inefficacy of the treatment. Improvement of visual acuity was slightly better in patients who were treated with naproxen compared with rofecoxib (P < or = .05). CONCLUSION: Systemic NSAIDs have a limited role (if any) in the treatment of iCME.

Adolescent↗
PubMed2004

Endothelial cell activation and hypercoagulability in ocular Behçet's disease.

PURPOSE: To investigate the presence of a hypercoagulable state and vascular endothelial dysfunction in patients with ocular Behçet's disease and relate the results to the activity of ocular and systemic involvement. DESIGN: Cross-sectional laboratory and clinical study. METHODS: Prospective study of blood samples of 24 patients diagnosed with ocular Behçet's disease, which were analyzed for factor VIII, factor XI, von Willebrand factor antigen and ristocetin (vWF ag and risto), antithrombin III (ATIII), protein C and S, fibrinogen and activated protein C (APC) resistance. The results were compared with 40 healthy controls and analyzed for association with ocular and systemic clinical features. RESULTS: The mean values of factor VIII, factor XI, vWF ag, vWF risto, ATIII, and fibrinogen were significantly raised compared to healthy population (for all: P <.001). Most striking were factor VIII activity levels above 130% in 79% (19 of 24) of our patients. 67% (16 of 24) had levels of factor VIII above 150%, which correlates with a fivefold increase in risk of thrombosis. Other prothrombogenic factors were negative in all but 2 patients (1 protein C deficiency, 1 factor V Leiden mutation). Endothelial cell activation, measured by vWF activity, revealed elevated levels in 42% (10/24). Complete/incomplete Behçet's disease patients with present or previous macular edema had significantly higher FVIII levels than complete/incomplete Behçet's disease patients who had never shown any signs of macular edema (P =.04). Further correlations between the laboratory results and clinical symptoms were not found. CONCLUSIONS: We found a generalized hypercoagulable state with endothelial cell activation in ocular Behçet's disease, irrespectively of current ocular disease activity.

Activated Protein C Resistance↗
PubMed2004

Trace microalbuminuria in inflammatory cystoid macular edema.

PURPOSE: To assess the role of cardiovascular morbidity, its risk factors, and microalbuminuria in the development of inflammatory cystoid macular edema (CME). DESIGN: A matched case-control study. METHODS: study population: We included 24 consecutive patients with uveitis and CME. Twenty four uveitis patients without CME, matched for age and duration of uveitis served as controls. intervention and observation procedures: Patients and controls were interviewed for the presence of cardiovascular risk factors and cardiovascular morbidity. All medications were registered. Morning urinary albumin concentration was measured, as well as blood pressure, C-reactive protein, and creatinine in blood. Patients suffering from diabetes mellitus were excluded from this study. main outcome measures: The presence of cardiovascular morbidity and its risk factors and microalbuminuria in uveitis patients with and without CME. RESULTS: We found a positive association between trace- and/or microalbuminuria and inflammatory CME (P = .001; odds ratio 13.0, 95% CI 2.5 to 68.1 and P = .015; odds ratio 5.9, 95% CI 1.6 to 22.6), but no relation between CME and cardiovascular morbidity or its risk factors. No additional association between trace- and/or any microalbuminuria and general characteristics of patients, specific factors related to general disease as a cause of ocular inflammation, location of uveitis, duration of uveitis, and medication was found. CONCLUSIONS: The presence of trace- and/or microalbuminuria in inflammatory CME might indicate the presence of early systemic vascular disease and carry the risk of developing CME. This finding brings new insight into the pathogenesis of CME and could open up new avenues for the treatment of CME.

Adolescent↗
PubMed2004

Birdshot chorioretinopathy: long-term manifestations and visual prognosis.

PURPOSE: To ascertain the clinical features and long-term visual prognosis of birdshot chorioretinopathy (BCR), and to identify patients at risk of visual loss. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Fifty-five consecutive patients with HLA-A29-positive BCR who were identified in ophthalmology departments of the University Medical Center of Utrecht and The Eye Hospital Rotterdam, of whom 37 were observed for at least 5 years. INTERVENTION: A review of the medical and photographic and/or angiographic records of 55 patients with HLA-A29-positive BCR. MAIN OUTCOME MEASURES: Numerous variables were compared, including age and gender distribution, onset and course of BCR, ocular manifestations, therapeutic strategies and their outcomes, complications, systemic diseases, visual acuity (VA), and features associated with poor visual outcome. RESULTS: Loss of VA was gradual; the number of affected eyes with VA less than 20/200 increased from 9 of 108 (8%) at onset to 22 of 73 (30%) at 5 years and 19 of 49 (39%) at 10 years of follow-up. The cause of compromised VA was predominantly macular edema and macular atrophy (42 of 55 [76% of cases]). We found strong associations between the VA at onset and visual outcome after 5 and 10 years (P = 0.005 and P = 0.006, respectively). Mean VA at the 5-year follow-up was significantly lower if macular leakage was observed on angiography (P<0.001). No differences in annual loss of VA were observed between patients treated by standard therapeutic modalities and untreated patients. CONCLUSION: The visual prognosis of BCR in a spectrum of uveitis is poor, and the recommended therapeutic regimens have had no effect on long-term visual prognosis. New treatment strategies are needed for this blinding disorder.

Adult↗
PubMed2003

Rhegmatogenous retinal detachment and uveitis.

PURPOSE: To evaluate the frequency, high-risk factors, and visual prognosis of rhegmatogenous retinal detachment (RRD) in patients with uveitis. DESIGN: Retrospective case-control study. PARTICIPANTS: We included 1387 consecutive patients with uveitis who consulted our uveitis clinic from January 1990 through December 1997 of whom 43 patients (46 eyes) with RRD were identified. The retinal detachment (RD) controls were 212 consecutive patients with RRD (221 eyes, first occurrence of RD, not associated with uveitis) who were admitted for surgery in the period from April 1999 to April 2000. The uveitis control group consisted of 150 age-matched patients (210 eyes) selected from the entire uveitis series. INTERVENTION: Retrospective analysis of clinical data. MAIN OUTCOME MEASURES: The presence of RRD and eventual risk factors for RRD, such as myopia, retinal lattice degeneration, prior intraocular surgery, anatomic location of uveitis, its specific diagnosis, and clinical manifestations. Furthermore, the surgical and nonsurgical outcomes of RRD, as well as the results of various treatment regimens, were analyzed. RESULTS: RRD was identified in 3.1% of the patients with uveitis. RRD was most frequently associated with panuveitis (6.6%). RRD was associated more frequently with infectious (7.6%) than noninfectious uveitis (2.1%). At the onset of RRD, uveitis was active in most (46%) affected eyes. Proliferative vitreoretinopathy was present in 30% of the uveitic RRD eyes at presentation in contrast to 12% of the RRD control eyes. In uveitic RRD, the retina was reattached in 59% of eyes with a single operation; the final anatomic reattachment rate was 88%. Finally, a visual acuity of less than 20/200 was present in 71% of the uveitic RRD eyes, 10% of which had no light perception. CONCLUSIONS: We discovered a high prevalence of RRD in patients with active panuveitis and infectious uveitis and document that uveitis in itself is a risk factor for the development of RRD. The visual prognosis of RRD in uveitis was poor because of the uveitis itself and the frequent development of proliferative vitreoretinopathy.

Adolescent↗
PubMed2003

Polymerase chain reaction detection of Neisseria meningitidis in the intraocular fluid of a patient with endogenous endophthalmitis but without associated meningitis.

PURPOSE: To report a patient with Neisseria meningitidis endophthalmitis without associated meningitis with full visual recovery, with early detection of the microorganism using polymerase chain reaction (PCR) analysis. DESIGN: Retrospective, observational case report. PARTICIPANTS: One patient with endogenous endophthalmitis. METHODS: Polymerase chain reaction analysis and culture of the intraocular fluid sample. Polymerase chain reaction analysis was performed with a universal (16S rRNA) primer set to detect bacterial DNA, and subsequently a specific probe was used to detect Neisseria species DNA. RESULTS: The 16S rRNA primers detected bacterial DNA, the specific probe detected Neisseria species DNA, and culture was positive for Neisseria meningitidis serotype C. CONCLUSIONS: A universal bacterial PCR can be very helpful for the diagnosis of endogenous bacterial endophthalmitis at an early stage of the disease.

Adolescent↗