ocular manifestations

眼部表现
  • 文章类型: Editorial
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  • 文章类型: Journal Article
    背景:本研究旨在探讨ANCA相关性血管炎(AAV)的眼部表现,专注于肉芽肿性多血管炎(GPA),嗜酸性肉芽肿性多血管炎(EGPA),和显微镜下多血管炎(MPA),并检查与实验室参数和其他全身表现的关联。
    方法:这项回顾性研究回顾了2016年1月至2023年11月两个主要中国医疗中心的533例AAV患者的数据。包括诊断在内的数据,疾病的颅骨表现,眼部并发症,并对实验室参数进行了分析。单变量和多变量逻辑回归分析评估了疾病表现之间的关联。还利用机器学习模型来预测AAV患者中视网膜/眼睛受累的风险。
    结果:在533例患者中(210GPA,217MPA,99EGPA,和7个未分类的AAV),其中20.64%出现眼部并发症,GPA分布为36.67%,MPA为7.37%,和18.18%在EGPA。最常见的眼部表现包括巩膜炎和眶后肿块/泪囊炎,在GPA患者中尤其普遍。在9.09%的EGPA病例中观察到视网膜受累。机器学习模型得出嗜酸性粒细胞百分比(EOS%),高敏C反应蛋白(hsCRP),CD4+T细胞/CD8+T细胞比值(T4/T8)可以预测视网膜受累。此外,白细胞,EOS%,APTT,IgA,hsCRP,PR3-ANCA,T4/T8可以预测眼部受累。
    结论:眼部表现是所有形式的AAV的普遍并发症。通过机器学习开发的预测模型为早期干预和量身定制的患者护理提供了有前途的工具。这就需要多学科的方法,整合风湿病学和眼科专业知识,以获得最佳患者预后。
    BACKGROUND: This study aimed to explore ocular manifestations in ANCA-associated vasculitis (AAV), focusing on granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), and microscopic polyangiitis (MPA) and to examine the associations with laboratory parameters and other systemic manifestations.
    METHODS: This retrospective study reviewed data from 533 AAV patients across two major Chinese medical centers from January 2016 to November 2023. Data including diagnosis, cranial manifestations of disease, ocular complications, and laboratory parameters were analyzed. Univariate and multivariable logistic regression analyses assessed associations across disease manifestations. Machine learning models were also utilized to predict the risk of retinal/eye involvement in AAV patients.
    RESULTS: Among 533 patients (210 GPA, 217 MPA, 99 EGPA, and 7 unclassified AAV), ocular complications were observed in 20.64% of them, with a distribution of 36.67% in GPA, 7.37% in MPA, and 18.18% in EGPA. The most common ocular manifestations included scleritis and retro-orbital mass/dacryocystitis, which were notably prevalent in GPA patients. Retinal involvement was observed in 9.09% of EGPA cases. The machine learning models yielded that eosinophil percentage (EOS%), high-sensitivity C-reactive protein (hsCRP), and CD4 + T cell/CD8 + T cell ratio (T4/T8) can predict retinal involvement. Furthermore, the white blood cell, EOS%, APTT, IgA, hsCRP, PR3-ANCA, and T4/T8 can predict eye involvement.
    CONCLUSIONS: Ocular manifestations are a prevalent complication across all forms of AAV. Predictive models developed through machine learning offer promising tools for early intervention and tailored patient care. This necessitates a multidisciplinary approach, integrating rheumatology and ophthalmology expertise for optimal patient outcomes.
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  • 文章类型: Case Reports
    后巩膜炎是一种罕见的炎症性眼部疾病,影响巩膜的后段,在女性中更为普遍。其临床表现,通常是非特异性的,包括眼痛,头痛,和视力丧失。由于缺乏对视力构成潜在威胁的特定症状,误诊很常见。病因通常与风湿病有关,如类风湿性关节炎(RA),系统性红斑狼疮(SLE),和抗中性粒细胞胞浆抗体(ANCA)相关血管炎。后巩膜炎提出了诊断挑战,模仿许多其他眼部疾病,因此有必要进行全面的临床眼科检查。实验室研究,包括炎症标志物和风湿性疾病标志物,可以识别潜在的全身性疾病。成像,包括B超和磁共振成像(MRI),有助于准确诊断。治疗包括非甾体抗炎药(NSAID),以及用于轻度疾病的局部皮质类固醇和用于严重疾病的全身性皮质类固醇。对于难治性病例,生物治疗变得越来越重要。涉及眼科和风湿病的多学科方法对于这种潜在的视力威胁疾病的管理至关重要。该病例报告重点介绍了一名46岁的女性,有RA相关的后巩膜炎病史。
    Posterior scleritis is a rare inflammatory eye condition affecting the posterior segments of the sclera and is more prevalent in females. Its clinical presentation, often nonspecific, includes ocular pain, headache, and vision loss. Misdiagnosis is common due to a lack of specific symptoms posing a potential threat to vision. The etiology is often tied to rheumatic diseases, such as rheumatoid arthritis (RA), systemic erythematous lupus (SLE), and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. Posterior scleritis poses diagnostic challenges, mimicking many other ocular conditions, hence necessitating a thorough clinical eye exam. Laboratory studies, including inflammatory markers and markers of rheumatic diseases, may identify underlying systemic diseases. Imaging, including B-scan ultrasound and magnetic resonance imaging (MRI), aids in accurate diagnosis. Treatment involves non-steroidal anti-inflammatory drugs (NSAID), as well as topical corticosteroids for mild disease and systemic corticosteroids for severe disease. Biologic therapy has become increasingly significant for refractory cases. A multidisciplinary approach involving ophthalmology and rheumatology is crucial in the management of this potential sight-threatening disease. This case report highlights a 46-year-old woman with a history of RA-associated posterior scleritis.
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  • 文章类型: Case Reports
    登革热(DF),由登革热病毒(DENV)引起并通过伊蚊传播,因其系统性表现而广为人知,它的眼部受累最近引起了人们的注意。我们介绍了一例41岁的台湾女性,该女性在与DENV-1相关的DF诊断后发展为急性黄斑神经视网膜病变(AMN),强调需要意识到这种并发症。病人,有完全消退的视神经炎(ON)和合并症的病史,在DF发作后第10天出现视力模糊。眼科检查显示黄斑水肿,椭球带(EZ)入渗,和脉络膜包膜受累。尽管用皮质类固醇进行脉冲治疗,视觉障碍持续存在,突出了管理眼部并发症的挑战。DF的眼部表现包括出血,炎症,血管并发症。DF相关AMN,一个罕见的演讲,在诊断和治疗反应评估中提出了挑战。虽然大多数患者自发康复,有些人面临持续性视力障碍,尤其是AMN。我们的案例强调了认识到DF中眼部并发症的重要性,需要采用多学科方法进行最佳管理和进一步研究,以描绘治疗策略和结果。
    Dengue fever (DF), which is caused by the dengue virus (DENV) and transmitted through Aedes mosquitoes, is well recognized for its systemic manifestations, with its ocular involvement gaining recent attention. We present a case of a 41-year-old Taiwanese female who developed acute macular neuroretinopathy (AMN) following a DF diagnosis related to DENV-1, emphasizing the need for awareness of this complication. The patient, with a history of completely resolved optic neuritis (ON) and comorbidities, experienced blurred vision on day 10 after the onset of DF. The ophthalmic examination revealed macular edema, ellipsoid zone (EZ) infiltration, and choriocapillaris involvement. Despite pulse therapy with corticosteroids, visual disturbances persisted, highlighting the challenge of managing ocular complications. Ocular manifestations in DF include hemorrhages, inflammation, and vascular complications. DF-associated AMN, a rare presentation, poses challenges in diagnosis and treatment response evaluation. While most patients recover spontaneously, some face persistent visual impairment, especially with AMN. Our case emphasizes the importance of recognizing ocular complications in DF, necessitating a multidisciplinary approach for optimal management and further research to delineate treatment strategies and outcomes.
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  • 文章类型: Journal Article
    由SARS-CoV-2引起的COVID-19通常表现为发烧和呼吸急促等症状,但也会影响其他器官。越来越多的证据表明潜在的眼部并发症。在这篇文章中,我们旨在系统回顾COVID-19的眼部表现。
    我们进行了系统评价,以探讨COVID-19的眼部表现。我们搜索了包括PubMed在内的在线数据库,Embase,Scopus,和WebofScience至2023年9月4日。经过两个阶段的筛选过程并应用纳入/排除标准,符合条件的文章被推进到数据提取阶段.PRISMA检查表和纽卡斯尔-渥太华量表(NOS)用于质量和偏倚风险评估。
    我们从42篇文章中选择并提取了数据。大多数研究都是横断面的(n=33),在土耳其进行的次数最多(n=10)。最常见的眼部表现是结膜炎,在24篇文章中报道,其次是畏光,燃烧,化疗,瘙痒,和眼部疼痛。大多数研究报告从这些表现中完全恢复;然而,一项研究提到两名患者的视力丧失。
    一般来说,COVID-19的眼部表现似乎可以自发或通过支持治疗解决。对于更严重的病例,医疗和手术都被采用了,结果表明,完全复苏是可以实现的。
    UNASSIGNED: COVID-19 caused by SARS-CoV-2, commonly presents with symptoms such as fever and shortness of breath but can also affect other organs. There is growing evidence pointing to potential eye complications. In this article, we aim to systematically review the ocular manifestations of COVID-19.
    UNASSIGNED: We conducted a systematic review to explore the ocular manifestations of COVID-19. We searched online databases including PubMed, Embase, Scopus, and Web of Science up to September 4, 2023. After a two-stage screening process and applying inclusion/exclusion criteria, eligible articles were advanced to the data extraction phase. The PRISMA checklist and Newcastle-Ottawa Scale (NOS) were used for quality and bias risk assessments.
    UNASSIGNED: We selected and extracted data from 42 articles. Most of the studies were cross-sectional (n = 33), with the highest number conducted in Turkey (n = 10). The most frequent ocular manifestation was conjunctivitis, reported in 24 articles, followed by photophobia, burning, chemosis, itching, and ocular pain. Most studies reported complete recovery from these manifestations; however, one study mentioned visual loss in two patients.
    UNASSIGNED: In general, ocular manifestations of COVID-19 appear to resolve either spontaneously or with supportive treatments. For more severe cases, both medical treatment and surgery have been employed, with the outcomes suggesting that complete recoveries are attainable.
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  • 文章类型: Journal Article
    简介:头颈癌(HNCs)带来了巨大的全球健康负担,尤其是在印度,口腔癌,特别是影响舌头,是普遍的。全球跨国公司的很大一部分(57.5%)集中在亚洲,印度贡献30%。尽管取得了进步,由于HNC的侵袭性和转移潜力,挑战依然存在。本研究旨在探讨HNC与眼部表现之间的联系。方法:在班加罗尔医学院和研究所进行了一项横断面研究,涉及47例确诊为HNC和眼部不适的患者。临床评估包括视力,前段和后段检查,必要时进行专门调查。结果:观察到各种恶性肿瘤,患有SCC上颌骨和色素性干皮病,各占病例的10.63%。眼部检查揭示了视力挑战,眼前段发现像肿块,外斜视,色素性病变,和各种眼底异常。眼前段发现包括肿块,通常伴有突出或相对传入瞳孔缺损(RAPD)。此外,外斜视,色素性病变,并观察到其他条件。眼底检查揭示了一系列发现,包括媒体混浊(10.63%),缺乏观点(17.02%),和浅盘(6.38%)。治疗计划多种多样,包括切除活检(42.55%),exenterationprocedures,丝裂霉素-C的应用,以及化疗和放疗的转诊。结论:本研究强调了诊断为HNC的患者的眼科评估和调查的意义。强调早期发现和干预的价值。缩写:HNC=头颈部癌,OCT=光学相干断层扫描,WNL=在正常范围内,SCC=鳞状细胞癌,MRI=磁共振成像,CT=计算机断层扫描,RAPD=相对传入瞳孔缺损,XP=色素性干皮病。
    Introduction: Head and neck cancers (HNCs) present a significant global health burden, especially in India, where oral cavity cancers, notably affecting the tongue, are prevalent. A substantial portion of global HNCs (57.5%) is concentrated in Asia, India contributing with 30%. Despite advancements, challenges persist due to HNCs\' invasive nature and metastatic potential. This study aims to explore the link between HNCs and ocular manifestations. Methods: A cross-sectional study was conducted at Bangalore Medical College and Research Institute involving 47 patients with diagnosed HNCs and ocular complaints. Clinical evaluations encompassed visual acuity, anterior and posterior segment examinations, and specialized investigations when necessary. Results: A diverse range of malignancies were observed, with SCC maxilla and xeroderma pigmentosa, each accounting for 10.63% of cases. Ocular examinations unveiled visual acuity challenges, anterior segment findings like masses, exotropia, pigmented lesions, and varied fundus abnormalities. The anterior segment findings encompassed masses often accompanied by protrusion or relative afferent pupillary defect (RAPD). Additionally, exotropia, pigmented lesions, and other conditions were observed. Fundus examination revealed a spectrum of findings, including media haziness (10.63%), lack of view (17.02%), and pale discs (6.38%). Treatment plans were diverse, including excision biopsies (42.55%), exenteration procedures, Mitomycin-C applications, and referrals for chemotherapy and radiotherapy. Conclusion: The present study underscores the significance of ophthalmological assessment and investigations in patients with diagnosed HNCs, emphasizing the value of early detection and intervention. Abbreviations: HNC = Head and Neck Cancer, OCT = Optical Coherence Tomography, WNL = Within Normal Limits, SCC = Squamous Cell Carcinoma, MRI = Magnetic Resonance Imaging, CT = Computed Tomography, RAPD = Relative Afferent Pupillary Defect, XP = Xeroderma Pigmentosa.
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  • 文章类型: Journal Article
    自2008年在日本引入联合抗逆转录病毒疗法(cART)以来,人类免疫缺陷病毒(HIV)患者的眼部表现谱发生了变化。这项研究,2012年1月至2023年8月在东京医学和牙科大学医院进行,旨在了解cART时代HIV患者眼部表现的流行病学和临床特征。在218名被诊断为艾滋病毒的患者中,23例(10.55%)出现眼部表现,均为男性,32-73岁。最常见的眼部并发症是葡萄膜炎(60.67%)。值得注意的是,与早期的日本研究相比,cART时代葡萄膜炎的患病率激增。我们的数据还表明葡萄膜炎和艾滋病毒之间存在潜在的直接联系,特别是在尚未接受cART的患者中。然而,巨细胞病毒视网膜炎,我们研究中另一种常见的眼部疾病,似乎与开始cART的患者有更强的相关性。眼部状况与CD4+T细胞计数均无显著相关性。重要的是,我们观察到的眼部表现患病率(10.55%)低于以前的研究,强调cART和国家医疗保健支持的潜在影响。这些发现为在cART可用性期间日本HIV患者眼部表现的演变提供了独特的见解。
    Since the introduction of combination antiretroviral therapy (cART) in Japan in 2008, the spectrum of ocular manifestations in patients with human immunodeficiency virus (HIV) has changed. This study, conducted at Tokyo Medical and Dental University Hospital between January 2012 and August 2023, aimed to understand the epidemiology and clinical features of ocular manifestations in patients with HIV during the cART era. Of the 218 patients diagnosed with HIV, 23 (10.55%) exhibited ocular manifestations; all were male, aged 32-73. The most prevalent ocular complication was uveitis (60.67%). Notably, the prevalence of uveitis in this cART era has surged compared to earlier Japanese studies. Our data also suggest a potential direct link between uveitis and HIV, particularly in patients who have not yet undergone cART. However, cytomegalovirus retinitis, another prevalent ocular disease in our study, appeared more strongly associated with patients who commenced cART. Neither ocular condition was significantly correlated with CD4+ T-cell count. Importantly, our observed ocular manifestation prevalence (10.55%) was lower than that in previous studies, emphasizing the potential influence of cART and national healthcare support. These findings provide unique insights into the evolution of ocular manifestations in patients with HIV in Japan amidst cART availability.
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  • 文章类型: Journal Article
    本病例系列和叙述性文献综述的目的是强调多模式成像在脊髓小脑共济失调7型患者眼科检查中的重要性,并提供最相关的成像技术的总结。该病例系列包括3名SCA7患者。文献综述揭示了21篇有关SCA7眼部表现的出版物,并总结了最相关的方面。分析不同影像学技术在SCA7患者随访中的作用,包括色觉测试,角膜内皮地形图,彩色眼底照相(CFP)和自发荧光,近红外反射成像,谱域光学相干层析成像(SDOCT),视野检查,和电生理测试。SDOCT提供随时间的疾病进展的快速和非侵入性成像评估。包括NIR成像在内的其他检查可以提供有关感光体改变和RPE细微破坏的进一步信息,这在早期阶段与CFP并不明显。电生理测试提供有关视锥细胞和视杆营养不良状态的基本结果,这对指导未来的基因疗法可能至关重要。在SCA7患者的诊断和管理中,多模态成像是全面眼科检查的重要补充。
    The aim of this case series and narrative literature review is to highlight the importance of multimodal imaging in the ophthalmological examination of patients with spinocerebellar ataxia type 7 and provide a summary of the most relevant imaging techniques. Three patients with SCA7 were included in this case series. A literature review revealed twenty-one publications regarding ocular manifestations of SCA7, and the most relevant aspects are summarized. The role of different imaging techniques in the follow-up of SCA7 patients is analyzed, including color vision testing, corneal endothelial topography, color fundus photography (CFP) and autofluorescence, near infrared reflectance imaging, spectral domain optical coherence tomography (SDOCT), visual field examination, and electrophysiological tests. SDOCT provides a rapid and non-invasive imaging evaluation of disease progression over time. Additional examination including NIR imaging can provide further information on photoreceptor alteration and subtle disruption of the RPE, which are not evident with CFP at an early stage. Electrophysiological tests provide essential results on the state of cone and rod dystrophy, which could be paramount in guiding future genetic therapies. Multimodal imaging is a valuable addition to comprehensive ophthalmological examination in the diagnosis and management of patients with SCA7.
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  • 文章类型: Journal Article
    风湿病与生活质量的显著下降有关,这不仅与潜在疾病的进展有关,而且与共存疾病的发展有关。该组疾病中可能的并发症之一是眼部受累。视力受损与生活质量的显著下降密切相关,也可能加剧与身体功能相关的问题。因此,在治疗基础疾病时可能会导致严重的并发症。此外,从临床的角度来看,同样重要的是要注意,眼部疾病可能先于炎症性关节和脊柱疾病的发生,以及系统性结缔组织疾病的器官受累。因此,注意眼部症状有助于早期诊断,从而改善患者预后。由于上述原因,在常规风湿病治疗中应仔细考虑眼部疾病。
    Rheumatic diseases are associated with a significant decline in quality of life, which is not only related to the progression of the underlying disease but also to the development of coexisting conditions. One of the possible complications in this group of diseases is ocular involvement. Impaired vision is strongly associated with a significant decline in quality of life and can also exacerbate problems related to physical functioning. Consequently, it can lead to serious complications in the treatment of the underlying disease. Additionally, from a clinical point of view, it is also important to note that ocular diseases may precede the occurrence of inflammatory joint and spinal diseases, as well as organ involvement in systemic connective tissue disorders. Therefore, paying attention to ocular symptoms can help in early diagnosis and thus improve patient prognosis. For the aforementioned reasons, ocular diseases should be carefully considered in routine rheumatologic practice.
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  • 文章类型: Journal Article
    COVID-19的眼部异常患病率根据不同的报告而有所不同。然而,目前关于眼分泌物中存在该病毒及其与结膜炎的关联的现有证据尚不明确.
    为了揭示COVID-19患者的眼部特征,并结合临床数据进行描述,炎症标志物,和呼吸支持疗法。
    通过问卷式访谈对494名COV19患者的眼部症状进行评估和记录,和眼科检查.数据包括年龄,性别,疾病严重程度,收集鼻咽拭子结果。回顾了实验室测试值。COVID-19感染患者分为严重病例和轻度病例。
    眼部特征的患病率为(2.83%)。最常见的特征是结膜充血,顿唇,和瘙痒的异物感。有眼部表现的CPAP支持治疗的患者瘙痒率较高,异物感率较低。在炎症标志物的水平上没有发现差异。同时,使用呼吸辅助治疗的患者显示白细胞值较高,血小板计数,红细胞沉降率,C反应蛋白,铁蛋白,和乳酸脱氢酶.
    COVID-19的眼部受累以及疾病通过眼部组织和分泌物传播的可能性,已经在一些报告中登记了,患病率为2-32%。涉及外部和内部眼部。
    COVID-19患者的眼部特征并不少见。
    UNASSIGNED: The prevalence of ocular abnormalities of COVID-19 is different according to different reports. However, currently available evidence on the presence of this virus in ocular secretions and its association with conjunctivitis is not well established.
    UNASSIGNED: To reveal the ocular features among COVID-19 patients and to describe them with the findings of clinical data, inflammatory markers, and respiratory support therapy.
    UNASSIGNED: Ocular symptoms were evaluated and recorded in 494 COV19 patients through questionnaire-style interviews, and an ophthalmologic examination. Data including age, sex, disease severity, and nasopharyngeal swab results were collected. Laboratory test values were reviewed. Patients with COVID-19 infections were classified into severe cases and mild cases.
    UNASSIGNED: The prevalence of ocular features was (2.83%). The most common features were conjunctival hyperaemia, epiphora, and foreign body sensation with itching. Patients with ocular manifestations on CPAP support therapy had higher rates of itching, lower rates of foreign body sensation. No differences were found in the levels of inflammatory marker. Meanwhile, patients used respiratory-aid therapy revealed higher values of white blood cells, platelet counts, erythrocyte sedimentation rate, C-reactive protein, ferritin, and lactate dehydrogenase.
    UNASSIGNED: Ocular involvement in COVID-19 and possibility of disease transmission through ocular tissues and secretions, has been registered in some reports, with a prevalence of 2-32%. The external and internal ocular parts are involved.
    UNASSIGNED: Ocular features are not infrequent in COVID-19 patients.
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