DIS - Posterior Uveitis II - Week 4 Flashcards by B H

What is cytomegalovirus also known as?

Human herpesvirus type 5

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Is cytomegalovirus widespread among adults, children, or rare in humans? Explain why.

Affects most of the adult population
Post infection, it remains latent in the host
-possible reactivation

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What percentage of adults are seropositive to cytomegalovirus? What about people with HIV?

Normal - 50%
HIV - 95-100%

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What kind of syptoms are associated with systemic cytomegalovirus (2)?

Mononucleosis-like symptoms or none
-asymptomatic

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Is cytomegalovirus retinitis common or rare? In wha four populations is it particularly more common?

Uncommon/rare in normals
Prospers with immunodeficiency:
-HIV
-elderly
-leukaemia
-immunosuppression via steroid, chemotherapy, etc

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When did cytomegalovirus come into prominence?

With the rise of HIV/AIDS

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When does cytomegalovirus retinitis tend to occur relative to HIV? What is the prognosis like from the first sign of infection (for life, not visual prognosis)?

Relatively late occurence
Short average time to death from the first sign of CMV infection

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What cells does HIV target?

CD4+

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What is the most common intraocular infection in HIV/AIDS?

CMV retinitis

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What type of vision loss does untreated cytomegalovirus retinitis result in and when?

Progressive visual loss creeping
-when CD4+ count drops to 50-100 cells/uL

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What eventually results from cytomegalovirus retinitis (2)?

Eventual blindness from full thickness retinal necrosis and retinal detachment

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In what percentage of patients is cytomegalovirus retinitis bilateral? In what percentage is the macula involved?

Bilateral in 10-20%
Macular involvement in 50%

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Describe what full thickness retinitis/retinal necrosis appears like (including colour). What is it often adjacent to? What else would you expect to see and what can its appearance be likened to?

Multiple yellow/white geographic lesions
Often adjacent to vessels
Vascilitis often present
Looks like ketchup on cottage cheese

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Is vitritis seen with cytomegalovirus retinitis? Explain.

Yes, mild vitritis

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What is the management for cytomegalovirus retinitis?

IV Gancyclovir

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List three other general AIDS-related retinal disorders, aside from CMV.

HIV retinopathy
Candidiasis
Other causes of posterior uveitis
-syphilis, TB, candida, pneumocystitis, etc

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List four other viral AIDS-related retinal disorders.

Acute retinal necrosis
-necrotising retinitis
HSV1 (younger)
HSV2 and VSV (older)
Progressive outer retinal necrosis

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What is the interaction between progressive outer retinal necrosis and VZV?

Aggressive reaction

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What is kaposi’s sarcoma aused by and in what condition is it usually seen?

Human herpes virus type 8

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How is syphilis generally transmitted?

Sexually transmitted infection (STI/STD)

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What causes syphilis? What shape is it?

Trepenoma pallidum
-spirochaete

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Briefly describe primary (1), secondary (1), and tertiary (3) syphilis.

Primary - initial STD
Secondary - rash and systemic symptoms
Tertiary
-neurosyphilis
-cardiovascular
-gummatous (granulomas)

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Can syphilis be contracted from blood transfusion or open skin lesions?

Yes, occasionally

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What effect has improved HIV survivability had on syphilis prevalence?

Increased prevalence of syphilis

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What kind of keratitis occurs with congenital syphilis?

Interstitial keratitis

What kind of uveitis can occur with syphilis and at what stage?

Anterior or posterior, at any stage

Is anterior uveitis from syphilis often granulomatous or non-granulomatous?

Often non-granulomatous

List the four types of postrior uveitis that may be seen with syphilis.

Chorioretinitis -disseminated -posterior placoid Retinitis Retinal vasculitis

Describe the appearance of disseminated chorioretinitis. What classic appearance does it have when congenital? Is vitritis present?

Multiple yellow/grey lesions -vitritis often present Classic salt/pepper appearance when congenital

Describe the appearance of posterior placoid chorioretinitis. Where is it generally found? Is vitritis present?

Around the disc -yellow/grey lesions with pale centres -vitritis often present

Describe retinal vasculitis and what it often resembles.

Isolated retinal vessel inflammation -mild leakage to extreme -often resembles BVO

What is responsible for tuberculosis?

Mycobacterium tuberculosis

In what patients and countries is ocular TB often seen?

HIV patients Endemic countries

What is a typical feature of posterior segment TB? List 5 additional things you may see.

Choroidal granuloma -granulomatous Also: Vasculitis Keratitis Scleritis Anterior uveitis Retinitis

What can hypersensitivity to TB organisms result in (2)?

Occlusion of vessels, leading to ischaemia

What is sympathetic ophthalmia and what does it generally follow? What can occur in the fellow eye and why?

Bilateral granulomatous uveitis Follows penetrating trauma Trauma to the first eye also excites inflammation in the fellow eye

After what surgery is sympathetic ophthalmia most common? Comment in rarity after cataract surgery, malignant melanoma, and cyclo-cryotherapy.

Vitrectomy - most common antecedent event Rarely occurs in the others

Are rates of sympathetic ophthalmia increasing or decreasing?

Increasing

What is the typical onset for sympathetic ophthalmia post-exciting and what is the range?

Typically 3 months -days to decades

List 3 anterior features of sympathetic ophthalmia.

Mild anterior uveitis -granulomatous Mutton fat keratic precipitates

List 4 posterior features of sympathetic ophthalmia.

Vitritis -moderate to severe Posterior uveitis -multiple peripheral yellow/white lesions papillitis Circumpapillary choroidal lesions

What is the treatment for sympathetic ophthalmia (2)?

Systemic steroids -high dose, tapered over 3/12 Immunosuppression -cyclosporin

Define white dot syndrome.

Distinct inflammatory disorders of uncertain aetiology

Describe the lesions in white dot syndrome, including colour, size, and position.

Some are yellow rather than white Often larger than dots More superficial dots tend to be white and probably represent retinitis

List 5 examples of diseases that can be considered white dot syndrome.

Acute multifocal posterior pigment placoid epitheliopathy -AMPPPE Multiple evansecent white dot syndrome -MEWDS Birdshot retino-choroidopathy Acute retinal pigment epitheliitis Punctate inner choroidopathy

What will you often see with acute multifocal posterior pigment placoid epitheliopathy and what is it thought to be secondary to?

Choroidal vasculitis secondary to RPE dysfunction

What may you see in acute multifocal posterior pigment placoid epitheliopathy with recent viral illness?

Hypersensitivity-induced occlusive vasculitis of choroidal lobules

What appearance do lesions have in acute multifocal posterior pigment placoid epitheliopathy? Include colour, position, and layer.

Multiple large plaque-like lesions -cream-coloured -initially at the posterior pole -RPE level

What kind of vision loss (VA and VF) is present with acute multifocal posterior pigment placoid epitheliopathy? What will patients often initially experience?

VA - 6/12 to 6/120 Central/paracentral scotoma Sudden onset of blurred vision or photopsia -possible flashing lights up to a few weeks before

What age does acute multifocal posterior pigment placoid epitheliopathy tend to occur?

<30

What event does acute multifocal posterior pigment placoid epitheliopathy tend to follow?

Viral illness

Is acute multifocal posterior pigment placoid epitheliopathy usually uni- or bilateral?

Bilateral

True or false Anterior uveitis and vitritis may be seen with acute multifocal posterior pigment placoid epitheliopathy

True

Describe the typical angiography pattern for acute multifocal posterior pigment placoid epitheliopathy (2).

Initial dark hypo-fluorescence late slow hyperfluorescence

What eventually happens with acute multifocal posterior pigment placoid epitheliopathy?

Slow spontaneous recovery

What age and gender does multiple evanescent white dot syndrome tend to occur?

Young women

Is multiple evanescent white dot syndrome usually uni- or bilateral?

Unilateral

Describe the lesions in multiple evanescent white dot syndrome including size, colour, layer, and position (2). Are cells present in the vitreous?

multiple small discrete white lesions in deep layers (RPE) Found at the posterior pole -perifoveal but not foveal Cells in the vitreous

Describe what vision loss is opften like with multiple evanescent white dot syndrome. Is RAPD present?

Sudden drop in VA (up to 6/60) Possible RAPD

Is multiple evanescent white dot syndrome self-limiting or does it require urgent treatment?

Self-limiting ~2 months

What is the visual outcome following multiple evanescent white dot syndrome expected to be?

6/6 to 6/12

Describe the appearance of birdshot retinochoroidopathy.

Scattered lesions like shotgun scatter

Is birdshot retinochoroidopathy typically uni- or bilateral? Is it inflammatory? Is it chronic or acute?

Bilateral chronic inflammatory disease

Is birdshot retinochoroidopathy common or uncommon?

Uncommon

What age does birdshot retinochoroidopathy typically occur? What race and gender?

6th to 7th decade -white -female

List four symptoms of birdshot retinochoroidopathy. Is pain often present?

Blurred vision Dsturbed colour vision Night vision difficulty Floaters No pain

Is vitritis present with birdshot retinochoroidopathy?

Yes (diffuse)

True or false Snowbanking is present with birdshot retinochoroidopathy.

False

What is VA like with birdshot retinochoroidopathy?

6/12 to 6/18

Describe the lesions seen in birdshot retinochoroidopathy including shape, colour, size, and position (2).

Round ovoid subretinal lesions Cream coloured Small Numerous -macula and midperiphery -mostly macula

Would you see vasculitis with birdshot retinochoroidopathy?

Yes, significant

What would you expect to see on fluorescein angiography with birdshot retinochoroidopathy?

Hyperfluorescence/leakage

What percentage of patients will recover from birdshot retinochoroidopathy? What about the rest (and why this outcome for them)?

20% will recover The rest have exacerbations or poor VA due to CMO or atrophic scars

What is the treatment for birdshot retinochoroidopathy (2)?

Steroids/cyclosporins

What visual changes occur with acute retinal pigment epitheliitis (2)?

Acute VA drop and/or metamorphopsia

What age does acute retinal pigment epitheliitis tend to occur?

Young

What do you expect to see with acute retinal pigment epitheliitis (2)?

Subtle RPE changes -deep grey/dark spots with a yellow halo clustered around the posterior pole Central serous retinopathy

True or false EOG is normal with acute retinal pigment epitheliitis What does this indicate?

False, it is abnormal -indicates widespread RPE upset

What kind of aetiology is acute retinal pigment epitheliitis thought to have?

Viral

What is puncate inner choroidopathy part of (2)? What is the diagnosis for this condition?

Part of multifocal choroiditis and panuveitis Dx ocular histoplasmosis

In what age, gender, and ametropic status does puncate inner choroidopathy tend to occur?

Young myopic females

What is vision (VA and VF) often like with puncate inner choroidopathy?

Blurred vision Light flashes Paracentral scotoma

Is intraocular inflammation present with puncate inner choroidopathy?

Describe the lesions of puncate inner choroidopathy, including deepness, elevation, colour, number, and position.

Multiple, deep, yellow punched out appearance

Do lesions of puncate inner choroidopathy resolve?

Yes, after a few weeks -atrophic/pigmented

What risk do lesions of puncate inner choroidopathy present?

CNV

What is the prognosis of puncate inner choroidopathy like?

Good, if the macula is unaffected

Describe serpiginous choroidopathy, mentioning whether it is uni- or bilateral, acute or progressive.

Idiopathic bilateral progressive inflammation

What is the onset of serpiginous choroidopathy?

4th to 6th decade

What is vision like with serpiginous choroidopathy (2)?

Blurred vision ± metamorphopsia

What are lesions like with serpiginous choroidopathy? Include colour, borders, shape, and where they spread to.

Yellow-white subretinal infiltrates Spreads outwards to the macula

Is vitritis and anterior uveitis present with serpiginous choroidopathy?

Yes

Do remisison/reactivation cycles occur with serpiginous choroidopathy?

Yes

What is the treatment of serpiginous choroidopathy (3)?

Steroids Cyclosporin Azathyoprine

What is ophthalmomyiasis caused by? Is it common or rare?

Intraocular larval infestation -rodent fly -rare

Is ophthalmomyiasis anterior or posterior?

Can be either

How does ophthalmomyiasis appear on funduscopy?

Tracks in the sub-retinal space -can still be moving

What is the treatment option for ophthalmomyasis if the causative agent is alive (1) or dead (1)?

Alive - laser PC Dead - removal via vitrectomy

List four causes of visual loss with active inflammation in posterior uveitis.

Vitritis CMO Disc oedema Obliterative retinal vasculitis

List five causes of visual loss with non-inflammatory causes in posterior uveitis.

Cataract Vitreous debris Chronic macular problem Glaucoma Optic atrophy

List 5 examples of chronic macular problems that can lead to visual loss in posterior uveitis with non-inflammatory causes.

Persistent/chronic CMO RPE disturbance ERM SRNVM Macular hole (full/partial)

What is usually the treatment for posterior uveitis (5)? What about systemic treatment (5)?

Systemic/oral steroids unless -condition is selflimiting or minimally sight threatening -steroids aggravating condition/contraindicated -specific drug used -causative agent/organism is known Systemic -treat autoimmune aspect of uveitis -antimetabolites -cyclophosphamides -cyclosporin -tacrolimin

What three conditions would you consider if you see multiple white lesions on funduscopy with no inflammation?

POHS PIC Dystrophies

What three conditions would you consider if you see multiple white lesions on funduscopy with minimal inflammation?

AMPPPE MEWS RPE epitheliitis

What eight conditions would you consider if you see multiple white lesions on funduscopy with lots of inflammation?

Multifocal choroiditis including -sympathetic ophthalmia -birdshot -sarcoid -behcets -VKH -infections -post-op/trauma

DIS - Posterior Uveitis II - Week 4 Flashcards

(105 cards)