Diagnosis and management of infectious uveitis discussed at EURETINA

Importance of early diagnosis and robust therapeutic management of infectious uveitis discussed at wide-ranging symposium

Dermot McGrath

Posted: Tuesday, September 12, 2017

Stefan Seregard and Carlos Pavesio chaired an EURETINA Update on Uveitis Infections

The importance of early diagnosis and robust therapeutic management to avoid vision-threatening complications of infectious uveitis were among the key issues highlighted in a wide-ranging symposium on uveitis infections at the 17th EURETINA Congress in Barcelona.

Addressing the issue of diagnostic tools for infectious uveitis, Bahram Bodaghi MD said these cases are particularly challenging for the treating physician.

“There is an underestimated prevalence of infectious uveitis with a very large spectrum of potential agents involved. Late diagnosis may lead to serious vision loss and morbidity,” he said.

He added that new serologic and molecular procedures will allow better characterisation of clinical features associated with different geno-species in the near future, paving the way to more targeted therapies.

In cases of necrotising herpetic retinitis, Nicholas Jones MD reminded the audience of the importance of thorough investigation before settling on a diagnosis.

“Remember that it is not confirmed anterior uveitis until the posterior segment has been examined and has been found to be normal,” he said.

Dr Jones noted that acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) comprise a spectrum of potentially devastating, rapidly progressive viral retinopathies.

The consequences of a late or wrong diagnosis may lead to circumferential retinitis, complex detachment, optic neuropathy, blindness and bilateral involvement.

The growing global problem of ocular tuberculosis (TB) was highlighted by Professor Carlos Pavesio, who said that its prevalence has increased in recent years due to globalisation, population movements and AIDS. The picture is further complicated by the emergence of multidrug resistant strains of TB.

He warned that the ocular form of the disease may present without any systemic manifestations and is thus particularly challenging to diagnose for the ophthalmologist.

The good news is that patients frequently show a dramatic response to current therapies with no subsequent recurrences, he said.

Far less positive outcomes, however, can be expected in cases of endogenous endophthalmitis, an uncommon intraocular infection with potentially devastating visual consequences, emphasised Professor Miles Stanford in his presentation.

The infection, caused by the haematogenous spread of organisms to the eye, is responsible for roughly 2-to-6% of all endophthalmitis cases, said Prof. Stanford.

Prompt diagnosis and treatment are essential to obtain the best visual outcomes. The underlying infection should also be investigated and managed, although it remains unidentified in many cases.

Turning to ocular toxoplasmosis, Laurent Kodjikian MD noted that this is the most frequent form of posterior uveitis in the world, accounting for between 20 and 60% of cases. The prognosis is worst in immunocompromised and elderly patients with possible multifocal and extensive lesions, he said.

Blurred vision is the main complaint of ocular toxoplasmic patients and can be diagnosed by detection of antibodies or parasite DNA.

“It is still unclear whether an effective curative treatment exists and ocular toxoplasmosis typically needs therapy with several combinations of drugs to eliminate the parasite and accompanying inflammation,” concluded Dr Kodjikian.

Rounding off the symposium, Moncef Khairallah MD discussed the challenge of emerging infectious diseases transmitted by mosquitoes, ticks and other anthropods. These diseases include Rickettsial disease, West Nile Virus, Dengue Fever, Chikungunya, Zika Virus and Ebola Virus.

“Early diagnosis of these diseases can be achieved based on the association of typical ocular findings with a history of high fever and other systemic symptoms allied to specific epidemiological data,” he said.

Such early diagnosis is essential for appropriate management to minimise the risk of systemic and ocular morbidity, he concluded.