Amaurosis fugax with elevated acute phase proteins

Case report of a 66-year-old woman with episodes of amaurosis fugax and hemicranic headache with otherwise normal ophthalmologic and neurological examinations and normal imaging. While ESR was in the normal range for patient's age, acute phase proteins (C-reactive protein and fibrinogen) were elevated. Giant cell arteritis was proved by temporal artery biopsy. Giant cell arteritis should be considered as an important differential diagnosis of amaurosis fugax even in patients with normal ESR. Acute phase protein testing can give relevant diagnostic information.Fallbericht einer 66-jährigen Patientin mit Amaurosis-fugax-Episoden und Halbseitenkopfschmerz, aber ansonsten regelrechten ophthalmologischen und neurologischen Befunden und unauffälliger Bildgebung. Im Gegensatz zur normalen Blutsenkungsgeschwindigkeit waren die Akutphasenproteine (C-reaktives Protein und Fibrinogen) erhöht. Die vermutete Riesenzellarteritis konnte durch eine Temporalarterien-Biopsie histologisch gesichert werden. Die Riesenzellarteritis sollte als wichtige Differentialdiagnose bei unklarer Amaurosis fugax auch bei normaler Blutsenkung in Betracht gezogen werden; Akutphasenproteine (C-reaktives Protein, Fibrinogen) können diagnostisch hilfreich sein.Ce travail présente le cas d'une patiente âgée de 66 ans avec des épisodes d'amaurosis fugax et des hémicrânies mais un status neurologique et ophtalmologique sans particularités et des examens d'imageries diagnostiques normaux. Contrairement à la vitesse de sédimentation qui était normale, les protéines de la phase aiguë (protéine C réactive et fibrinogène) étaient élevées. La suspicion d'artérite à cellules géantes a été confirmée histologiquement par une biopsie de l'artère temporale. L'artérite temporale doit faire partie du diagnostic différentiel en présence d'amaurosis fugax même si la vitesse de sédimentation reste normale; la mesure des protéines de la phase aiguë (protéine C réactive, fibrinogène) peut être utile au diagnostic

Current ophthalmology practice patterns for syphilitic uveitis

Abstract BACKGROUND: Syphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns. METHODS: 103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis. RESULTS: Members managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10-14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis. CONCLUSION: This comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis

Current practice in the management of ocular toxoplasmosis

Background Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. Methods 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy. Results For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%. Conclusion Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists