MULTIMODAL IMAGING IN HELLP-RELATED CHORIORETINOPATHY

Purpose:To illustrate with multimodal imaging a case of HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) complicated by bilateral multifocal serous retinal detachments, subretinal exudation, and papilledema.Methods:Case report. Fundus photography, spectral domain optical coherence tomography (SD-OCT), fluorescein angiography, and indocyanine green angiography were performed at presentation and the day after. We also present the SD-OCT follow-up at 8 days, 1 year, and 4 years.Results:A 25-year-old 5-month-pregnant Guinean woman complained about decreased visual acuity in the right eye. Eye fundus and multimodal imaging were abnormal in both eyes. Spectral domain optical coherence tomography showed the presence of multifocal serous retinal detachments, subretinal deposits, and intraretinal cysts. Indocyanin green angiography revealed an irregular choroidal perfusion and localized choroidal ischemia. Spectral domain optical coherence tomography also provided assessment of retinal changes during the long-term follow-up, showing tissue damage in the outer retina.Conclusion:Serous retinal detachments during pregnancy can be the leading sign of HELLP syndrome - a potentially life-threatening condition. Spectral domain optical coherence tomography is a noninvasive and useful tool for its diagnosis and follow-up. ICG is important to confirm the choroidal ischemia and choroidal vascular abnormalities, underlying conditions leading to main sign of HELLP syndrome in the eye.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Single Dexamethasone Intravitreal Implant in the Treatment of Noninfectious Uveitis

Purpose: To investigate the effect of a single intravitreal dexamethasone implant (IVT-DI; Ozurdex; Allergan, Inc.) on visual acuity, macular thickness, and intraocular pressure (IOP) in active noninfectious uveitis. Methods: Medical records of patients with noninfectious active uveitis treated by IVT-DIs were retrospectively reviewed. Uveitis etiologies, treatment indications, best corrected visual acuity (BCVA), central retinal thickness measured by ocular coherence tomography, IOP, and systemic, local, and topical treatments were collected. Parameters were analyzed before the injection of the implant, after 1.5 ± 0.8 months and 4.4 ± 0.9 months for the BCVA, after 2 ± 1.3 months and 4.6 ± 1.3 months for the ocular coherence tomography, and after 1.3 ± 0.7 months and 4.4 ± 1 months for the IOP. Results: We included 14 patients (20 eyes, 20 implant injections) with cystoid macular edema (78%), vasculitis (7%), choroiditis (7%), and vasculitis associated with choroiditis (7%). Before the injection, mean visual acuity was 0.4 ± 0.5 logMAR (logarithm of the minimum angle of resolution) that improved to 0.3 ± 0.5 logMAR (P = 0.0002) after 1.5 ± 0.8 months and to 0.3 ± 0.5 logMAR (P = 0.005) after 4.4 ± 0.9 months. A statistically significant decrease of macular thickness was observed both at 2 ± 1.3 months and at 4.6 ± 1.3 months after IVT-DI. Mean IOP was 16 ± 5 mmHg before injections, 18 ± 6 mmHg (P = 0.13) at 1.3 ± 0.7 months, and 15 ± 4 mmHg (P = 0.65) at 4.4 ± 1 months. By Kaplan-Meier analysis, we found that after 3.3 months, 17% of the eyes still present a BCVA amelioration ≥0.3 logMAR. Conclusions: In our patients with active noninfectious uveitis, injection of a first single dexamethasone implant was found to improve visual acuity and decrease macular thickness without significant increase of IOP, although the effect seems limited in time.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Clinical Utility of 18F-FDG PET/CT in the Work-up of Children with Uveitis

Purpose: To evaluate 18F-fluorodeoxyglucose Positron Emission Tomography/ultra low dose Computed Tomography (18F-FDG PET/ ULD CT) in the work-up of pediatric uveitis. Methods: Retrospective study of 12 children followed for uveitis who underwent whole body 18F-FDG PET/ULD CT between 2011 and 2019. Results: The average age of the patients was 11 years. A total of 100% of patients presented with bilateral uveitis, 50% had panuveitis and 92% had various choroidal involvement. Relevant information for diagnosis was provided in four patients. 5/12 had an abnormal 18F-FDG uptake. Of these, three patients had pathognomonic images of active granulomatous diseases. Three patients underwent PET CT-guided biopsies of which two were positive for sarcoidosis. Conclusion: 18F-FDG PET/CT provided important information for final diagnosis in approximately 30% (4/12) of pediatric patients with bilateral uveitis. Whole body FDG PET/ULD CT can contribute to the final diagnosis thanks to pathognomonic image of active granulomatous disease and/or by indicating metabolically active site of biopsy that would not be visualized in thorax CT.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers

Purpose: To evaluate diagnostic methods and clinical signs of CMV anterior uveitis (AU), a rarely described entity in Europe. Methods: We included patients with clinical characteristics of CMV AU and positive PCR and/or Goldmann-Witmer coefficient (GWc) for CMV. Results: We report 21 patients with unilateral uveitis (100%) and signs of Posner-Schlossman syndrome (PSS) (n = 20, 95.2%), Fuchs uveitis syndrome (FUS) (n = 1, 4.7%), and endotheliitis (n = 4, 19,04%). PCR was positive in 15/21 (71.4%) and GWc in 8/9 patients (88.9%) in aqueous for CMV. GWc was the only positive test in 6/9 patients (66,6%). When PCR alone was performed (without GWc) in the first tap, repeated aqueous taps were needed, twice in five cases and thrice in one case. Conclusion: Combining PCR and GWc were very helpful to confirm the clinical diagnosis of CMV AU. In case of very high clinical suspicion and negative results, repeated tap seems to be recommended

P2Y₂^-/- TL proliferate less and secrete less cytokines in response to in vitro IRBP restimulation.

<p>Twelve days after s.c. immunization with IRBP 1–20 peptide, P2Y₂^+/+ and P2Y₂^-/- mice were sacrificed and their spleen and draining lymph nodes collected and dissociated. (A) Splenic TL were semi-purified by passage on nylon wool fiber columns and pooled with LN cells before being in vitro restimulated in medium alone (CTRL) or supplemented with IRBP 1–20 peptide. TL proliferation was tested after 72h by (³H)- incorporation. Data are from a representative experiment of 10 with 4 mice per group. (B) Cytokine secretion was quantified, by specific ELISA, in culture supernatants after 48h of IRBP restimulation. Data are from a representative experiment of 5 or 6 or 3 respectively, with 4 mice per group. ns: not significant; **<i>p</i> < 0,01; ***<i>p</i> < 0,001.</p

P2Y₂^-/- reduced TL proliferation in response to in vitro IRBP restimulation is linked to a defect in P2Y₂^-/- APC activation capacities.

<p>Twelve days after s.c. immunization with IRBP 1–20 peptide, P2Y₂^+/+ and P2Y₂^-/- mice were sacrificed and their spleen and draining lymph nodes collected and dissociated. (A) Splenic TL were semi-purified by passage on nylon wool fiber columns and pooled with LN cells before being in vitro restimulated in medium alone (CTRL) or supplemented with Dynabeads Mouse T-activator CD3/CD28. TL proliferation was tested after 72h by (³H)-thymidine incorporation. Data are from a representative experiment of 6 with 4 mice per group. ns: not significant (B) Spleens from P2Y₂^+/+ and P2Y₂^-/- IRBP-immunized were independently processed and analyzed by qPCR for β-Actin, CD3 and Foxp3 mRNA expression. Data are from 5 different mice in each group and are expressed as relative expression of Foxp3 versus CD3. ns: not significant (C) CD4+ TL were isolated from LN of P2Y₂^+/+ and P2Y₂^-/- mice by magnetic separation and co-cultured with total irradiated (30 Gy) splenocytes (APC) in autologous and cross-culture conditions, in presence of IRBP 1–20 peptide. TL proliferation was tested after 72h by (³H)-thymidine incorporation. Data, expressed in cpm, are from a representative experiment of 3 with 4 mice per group. ns: not significant; **<i>p</i> < 0,01; ***<i>p</i> < 0,001.</p

No difference in cell number or in cell phenotype between P2Y₂^+/+ and P2Y₂^-/- IRBP-immunized mice.

<p>Twelve days after s.c. immunization with IRBP 1–20 peptide emulsified in CFA and combined with an i.p. injection of PTX, P2Y₂^+/+ and P2Y₂^-/- mice were sacrificed and their spleen and draining lymph nodes collected and dissociated. (A) Total cell number count of mixture of splenic T lymphocytes semi-purified by passage on nylon wool fiber columns and LN cells. Mean +/- SEM. (B) Spleens and LN were independently characterized by flow cytometry for cellular phenotype by using FITC- or PE- anti-mouse antibodies directed against CD3, CD11b, CD11c and MHCII surface molecules. TL: CD3+; DC: CD11c+/CD11b+ or MHCII+; APC tot: DC + CD11c-/CD11b+ or MHCII+. Mean +/- SEM. Data are from at least 10 different mice in each group.</p

P2Y2R deficiency attenuates experimental autoimmune uveitis development.

We aimed to study the role of the nucleotide receptor P2Y2R in the development of experimental autoimmune uveitis (EAU). EAU was induced in P2Y2+/+ and P2Y2-/- mice by immunization with IRBP peptide or by adoptive transfer of in vitro restimulated semi-purified IRBP-specific enriched T lymphocytes from spleens and lymph nodes isolated from native C57Bl/6 or P2Y2+/+ and P2Y2-/- immunized mice. Clinical and histological scores were used to grade disease severity. Splenocytes and lymph node cell phenotypes were analyzed using flow cytometry. Semi-purified lymphocytes and MACS-purified CD4+ T lymphocytes from P2Y2+/+ and P2Y2-/- immunized mice were tested for proliferation and cytokine secretion. Our data show that clinical and histological scores were significantly decreased in IRBP-immunized P2Y2-/- mice as in P2Y2-/- mice adoptively transfered with enriched T lymphocytes from C57Bl/6 IRBP-immunized mice. In parallel, naïve C57Bl/6 mice adoptively transferred with T lymphocytes from P2Y2-/- IRBP-immunized mice also showed significantly less disease. No differences in term of spleen and lymph node cell recruitment or phenotype appeared between P2Y2-/- and P2Y2+/+ immunized mice. However, once restimulated in vitro with IRBP, P2Y2-/- T cells proliferate less and secrete less cytokines than the P2Y2+/+ one. We further found that antigen-presenting cells of P2Y2-/- immunized mice were responsible for this proliferation defect. Together our data show that P2Y2-/- mice are less susceptible to mount an autoimmune response against IRBP. Those results are in accordance with the danger model, which makes a link between autoreactive lymphocyte activation, cell migration and the release of danger signals such as extracellular nucleotides