Ординатура / Офтальмология / Английские материалы / Essentials in Ophthalmology Uveitis and Immunological Disorders_Pleyer, Forrester_2004
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ESSENTIALS IN OPHTHALMOLOGY: Uveitis and Immunological Disorders.
U. Pleyer · B. Mondino (Eds.)
ESSENTIALS IN OPHTHALMOLOGY |
Glaucoma |
G. K. Krieglstein · R. N. Weinreb |
Cataract and Refractive Surgery |
Series Editors |
|
|
Uveitis and Immunological Disorders |
|
Vitreo-retinal Surgery |
|
Medical Retina |
|
Oculoplastics and Orbit |
|
Paediatric Ophthalmology, |
|
Neuro-ophthalmology, Genetics |
|
Cornea and External Eye Disease |
Editors Uwe Pleyer
Bartly Mondino
Uveitis and
Immunological
Disorders
With 73 Figures, Mostly in Colour,
and 26 Tables
123
Series Editors |
Volume Editors |
Günther K. Krieglstein, MD |
Uwe Pleyer, MD |
Professor and Chairman |
Professor of Ophthalmology |
Department of Ophthalmology |
Augenklinik Charité |
University of Cologne |
Campus Virchow Klinikum |
Joseph-Stelzmann-Straße 9 |
Augustenburger Platz 1 |
50931 Cologne |
13353 Berlin |
Germany |
Germany |
Robert N. Weinreb, MD |
Bartly Mondino, MD |
Professor and Director |
Professor of Ophthalmology |
Hamilton Glaucoma Center |
Jules Stein Eye Institute |
Department of Ophthalmology – 0946 |
100 Stein Plaza #2–142 |
University of California at San Diego |
Los Angeles, CA 90095-7000 |
9500 Gilman Drive |
USA |
La Jolla, CA 92093-0946 |
|
USA |
|
ISBN 3-540-20045-2 |
ISSN 1612-3212 |
Springer Verlag Berlin Heidelberg New York |
|
Library of Congress Control Number: 2004106762
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© Springer-Verlag Berlin Heidelberg 2005
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Foreword
Essentials in Ophthalmology is a new review series covering all of ophthalmology categorized in eight subspecialties. It will be published quarterly; thus each subspecialty will be reviewed biannually.
Given the multiplicity of medical publications already available, why is a new series needed? Consider that the half-life of medical knowledge is estimated to be around 5 years. Moreover, it can be as long as 8 years between the description of a medical innovation in a peer-reviewed scientific journal and publication in a medical textbook.A series that narrows this time span between journal and textbook would provide a more rapid and efficient transfer of medical knowledge into clinical practice, and enhance care of our patients.
For the series, each subspecialty volume comprises 10–20 chapters selected by two distinguished editors and written by internationally renowned specialists. The selection of these contributions is based more on recent and note-
worthy advances in the subspecialty than on systematic completeness. Each article is structured in a standardized format and length, with citations for additional reading and an appropriate number of illustrations to enhance important points. Since every subspecialty volume is issued in a recurring sequence during the 2-year cycle, the reader has the opportunity to focus on the progress in a particular subspecialty or to be updated on the whole field. The clinical relevance of all material presented will be well established, so application to clinical practice can be made with confidence.
This new series will earn space on the bookshelves of those ophthalmologists who seek to maintain the timeliness and relevance of their clinical practice.
G. K. Krieglstein
R. N. Weinreb
Series Editors
Preface
Essentials in Ophthalmology is a publication series that includes eight volumes covering the following topics: Glaucoma, Cataract and Refractive Surgery, Uveitis and Immunological Disorders,Vitreo-Retinal Surgery, Medical Retina, Ocular Plastics and Orbit, Neuro-Ophthal- mology, Paediatric Ophthalmology, and Cornea and External Eye Disease. A volume on each topic will be published every 2 years with one being published each quarter. Every 2 years, each volume will be repeated in a new and updated version with different topics.
Each volume is designed to bridge the gap between primary research literature and daily practice. Although current and practical information is stressed in each volume, the latest in research information and directions is also highlighted. The series is designed to be user friendly with numerous tables and illustrations. The target audience includes ophthalmologists and optometrists in practice and training as well as libraries.
The third volume in this series is entitled
Uveitis and Immunological Disorders. Our knowledge and understanding of these diseases has increased exponentially over the past decade, especially in the areas of immunopathogenesis and immunogenetics. This volume will provide the practitioner with practical information on how to diagnose and treat these difficult and, in some cases, blinding disorders. In addition,
there are important discussions of mechanisms underlying these conditions that incorporate the most recent, up-to-date research material available. A “Summary for the Clinician” as well as “Core Messages” enhance the value of the chapters. These aids will help the reader to focus on the important messages in each chapter.
The scope of chapters ranges from diseases that are relatively common and usually require only topical therapy such as ocular allergy and dry eye to diseases that may result in blindness without systemic therapy such as ocular cicatricial pemphigoid, scleritis and some forms of uveitis. Two of the chapters, “Immune Mechanisms in Uveitis” and “Uveitis and Genetics”, provide the reader with the latest laboratory research in these areas.
This volume has information of interest to a wide range of ophthalmic subspecialists. For example, the anterior segment subspecialist will find an interest in subjects such as ocular allergy,dry eye,cicatricial pemphigoid,corneal transplantation, scleritis and herpes viruses. Retina and uveitis specialists will have a special interest in the chapters dealing with uveitis and its mechanisms and therapy, including medical and surgical. Lastly, the chapter covering uveitis in children provides important and useful information for paediatric ophthalmologists.
Uwe Pleyer
Bartly Mondino
Contents
Chapter 1 |
|
Chapter 3 |
|
||
Targets in Ocular Allergy |
|
Ocular Cicatricial Pemphigoid |
|
||
Alessandra Micera, Sergio Bonini, |
|
Ahmed Muna, C. Stephen Foster |
|
||
Alessandro Lambiase, Roberto Sgrulletta, |
|
|
|
||
Stefano Bonini |
|
3.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
25 |
|
|
|
|
3.2 |
Pathophysiology . . . . . . . . . . . . . . . . . |
26 |
1.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
1 |
3.3 |
Epidemiology . . . . . . . . . . . . . . . . . . . |
26 |
1.2 |
Chronic Allergic Eye Diseases . . . . . . |
2 |
3.4 |
Clinical History . . . . . . . . . . . . . . . . . . |
26 |
1.3 |
Effector Cells and Cytokine Release. |
2 |
3.5 |
Clinical Signs . . . . . . . . . . . . . . . . . . . . |
26 |
1.4 |
Chemokines |
|
3.6 |
Staging . . . . . . . . . . . . . . . . . . . . . . . . . |
27 |
|
and Adhesion Molecules . . . . . . . . . . |
3 |
3.7 |
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . |
28 |
1.5 |
Neuropeptide |
|
3.7.1 |
Laboratory Tests . . . . . . . . . . . . . . . . . |
28 |
|
and Growth Factor Involvement . . . . |
4 |
3.7.2 |
Conjunctival Biopsy . . . . . . . . . . . . . . |
28 |
1.6 |
Tissue Remodelling |
|
3.7.3 |
Histology . . . . . . . . . . . . . . . . . . . . . . . |
29 |
|
and the Contribution of Fibroblasts |
5 |
3.8 |
Treatment . . . . . . . . . . . . . . . . . . . . . . |
29 |
1.7 |
Metabolism of Extracellular Matrix . |
6 |
3.8.1 |
Medical . . . . . . . . . . . . . . . . . . . . . . . . . |
29 |
1.8 |
Conclusions . . . . . . . . . . . . . . . . . . . . . |
7 |
3.8.2 |
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . |
31 |
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
8 |
3.9 |
Collaborative Care . . . . . . . . . . . . . . . |
33 |
|
|
|
|
3.10 |
Prognosis . . . . . . . . . . . . . . . . . . . . . . . |
33 |
|
|
|
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
34 |
|
Chapter 2
Dry Eye: Inflammation
of the Lacrimal Functional Unit
Stephen C. Pflugfelder, Michael E. Stern
2.1 Introduction . . . . . . . . . . . . . . . . . . . . 11
2.1.1 Basics . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.1.2 Lacrimal Functional Unit . . . . . . . . . 12
2.2Specific Pathologies
of the Lacrimal Functional Unit . . . . 14
2.2.1Dysfunction of the Afferent System . 14
2.2.2Dysfunction of the Efferent System . 15
2.2.3 Glandular Dysfunction . . . . . . . . . . . |
15 |
2.3Lacrimal Keratoconjunctivitis
Inflammation . . . . . . . . . . . . . . . . . . . 16
2.3.1 Corneal Epithelial Disease . . . . . . . . 17
2.3.2 Conjunctival Epithelial Disease . . . . 17
2.3.3 Inflammation . . . . . . . . . . . . . . . . . . . 18
2.4 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . 19
2.5 Therapies . . . . . . . . . . . . . . . . . . . . . . . 21
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Chapter 4
Immunomodulation
for Corneal Transplantation
Douglas J. Coster, Keryn A. Williams
4.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
35 |
4.2Why Has Corneal Transplantation Fallen Behind Solid Organ
Grafting? . . . . . . . . . . . . . . . . . . . . . . . 36
4.3Immunomodulation
for Corneal Transplantation . . . . . . . 36
4.4Actuarial Survival Data
|
on Corneal Transplantation . . . . . . . |
37 |
4.5 |
Options for Immunomodulation . . . |
38 |
4.6 |
Corneal Privilege . . . . . . . . . . . . . . . . |
38 |
4.7Mechanisms
of Corneal Allograft Rejection . . . . . 39
XContents
4.8 |
The Afferent Limb: |
|
Chapter 6 |
|
|
|
Sensitization to Corneal Alloantigens |
39 |
Clinical Aspects of MALT |
|
|
4.9 |
The Efferent Limb: |
|
Erich Knop, Nadja Knop, Uwe Pleyer |
|
|
|
Histological Correlates . . . . . . . . . . . |
40 |
|
|
|
4.10 |
Current Approaches |
|
6.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
67 |
|
to Immunomodulation |
|
6.2 |
Structure and Function of MALT . . . |
68 |
|
for Corneal Transplantation . . . . . . . |
41 |
6.2.1 |
Structure of MALT . . . . . . . . . . . . . . . |
68 |
4.10.1 |
Anti-inflammatory Measures . . . . . . |
41 |
6.2.2 |
Eye-Associated Lymphoid Tissue |
|
4.10.2 |
Atraumatic Microsurgical Technique |
41 |
|
(EALT) . . . . . . . . . . . . . . . . . . . . . . . . . |
71 |
4.10.3 |
Topical Corticosteroids . . . . . . . . . . . |
41 |
6.2.3 |
Basic Functions of MALT . . . . . . . . . |
74 |
4.10.4 HLA Matching for Class I |
|
6.3 |
Dry Eye Disease . . . . . . . . . . . . . . . . . |
76 |
|
|
and Class II Antigens . . . . . . . . . . . . . |
41 |
6.3.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
75 |
4.10.5 Systemic Immunosuppression . . . . . |
42 |
6.3.2 |
Epidemiology, Definition |
|
|
4.10.6 Systemic Corticosteroids . . . . . . . . . . |
42 |
|
and Characteristics of Dry Eye . . . . . |
76 |
|
4.10.7 Antiproliferative Agents . . . . . . . . . . |
43 |
6.3.3 |
Novel Therapeutic Approaches |
|
|
4.10.8 Calcineurin Blockers . . . . . . . . . . . . . |
43 |
|
to Dry Eye Disease . . . . . . . . . . . . . . . |
80 |
|
4.10.9 Combination Therapy . . . . . . . . . . . . |
44 |
6.4 |
Ocular Allergy . . . . . . . . . . . . . . . . . . . |
81 |
|
4.10.10Side Effects of Systemic |
|
6.4.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
81 |
|
|
Immunosuppression . . . . . . . . . . . . . |
44 |
6.4.2 |
Epidemiology, Definition |
|
4.11 |
Novel Approaches |
|
|
and Characteristics |
|
|
to Immunomodulation . . . . . . . . . . . |
45 |
|
of Allergic Eye Disease . . . . . . . . . . . |
81 |
4.11.1 |
Monoclonal Antibody Fragments . . |
45 |
6.4.3 |
Course and Therapy Options |
|
4.11.2 |
Gene Therapy . . . . . . . . . . . . . . . . . . . |
45 |
|
in Allergic Ocular Disease . . . . . . . . . |
84 |
4.12 |
Conclusion . . . . . . . . . . . . . . . . . . . . . . |
46 |
6.5 |
Keratoplasty . . . . . . . . . . . . . . . . . . . . . |
84 |
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
46 |
6.5.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
84 |
|
|
|
|
6.5.2 |
Immunological Characteristics |
|
|
|
|
|
of Keratoplasty . . . . . . . . . . . . . . . . . . |
85 |
Chapter 5 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
87 |
||
Scleritis |
|
|
|
|
|
Alisa Kim, Sean Dumars, Samir Shah, |
|
|
|
|
|
Bartly Mondino |
|
Chapter 7 |
|
||
|
|
|
Immunogenetics |
|
|
5.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
52 |
of Ocular Inflammatory Disease |
|
|
5.1.1 |
Classification . . . . . . . . . . . . . . . . . . . . |
52 |
Ralph D. Levinson |
|
|
5.1.2 |
Anatomy . . . . . . . . . . . . . . . . . . . . . . . |
55 |
|
|
|
5.1.3 |
Pathogenesis . . . . . . . . . . . . . . . . . . . . |
55 |
7.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
91 |
5.1.4 |
Histopathology . . . . . . . . . . . . . . . . . . |
56 |
7.2 |
Human Leukocyte Antigens . . . . . . . |
93 |
5.2 |
Clinical Presentation . . . . . . . . . . . . . |
57 |
7.2.1 |
HLA Nomenclature . . . . . . . . . . . . . . |
94 |
5.2.1 |
History: Ocular Symptoms . . . . . . . . |
57 |
7.2.2 |
Class I HLA . . . . . . . . . . . . . . . . . . . . . |
94 |
5.2.2 |
Physical Examination: |
|
7.2.3 |
Class II HLA . . . . . . . . . . . . . . . . . . . . |
95 |
|
Ocular Signs . . . . . . . . . . . . . . . . . . . . |
58 |
7.2.4 |
HLA Haplotypes |
|
5.2.3 |
Associated Ocular Manifestations . . |
60 |
|
and Linkage Disequilibrium . . . . . . . |
95 |
5.2.4 |
Systemic Diseases: |
|
7.2.5 |
HLA and Disease Pathogenesis . . . . |
95 |
|
Clinical Evaluation . . . . . . . . . . . . . . . |
61 |
7.3 |
HLA Associations |
|
5.3 |
Diagnostic Tools . . . . . . . . . . . . . . . . . |
62 |
|
with Ocular Inflammatory Disease . |
96 |
5.4 |
Medical Management . . . . . . . . . . . . . |
63 |
7.3.1 |
Class I HLA Associations |
|
5.5 |
Surgical Management . . . . . . . . . . . . |
64 |
|
with Ocular Inflammatory Disease . |
96 |
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
65 |
7.3.2 |
Class II HLA Associations |
|
|
|
|
|
|
with Ocular Inflammatory Disease . |
98 |
|
|
|
|
|
Contents |
XI |
|
|
|
|
|
|
|
7.3.3 |
HLA Associations |
|
9.9 |
Prognostic Factors for Uveitis. . . |
. . . 131 |
|
|
with Ocular Infections . . . . . . . . . . . . |
100 |
9.9.1 |
Gender . . . . . . . . . . . . . . . . . . . . . . |
. . . 132 |
|
7.3.4 |
HLA Associations |
|
9.9.2 |
Type of Arthritis . . . . . . . . . . . . . . |
. . . 132 |
|
|
with External Ocular Inflammation. 100 |
9.9.3 |
Onset of Arthritis . . . . . . . . . . . . . |
. . . 132 |
|
|
7.3.5 |
HLA Associations |
|
9.9.4 |
Severity of Uveitis at Onset . . . . . |
. . . 132 |
|
|
with Extraocular Disease . . . . . . . . . . |
100 |
9.10 |
Correlation of Uveitis |
|
|
7.4 |
Non-HLA Genes Associated |
|
|
and Arthritis Activity . . . . . . . . . . |
. . . 133 |
|
|
with Ocular Inflammatory Disease . |
101 |
9.11 |
Treatment of Uveitis in JCA. . . . . |
. . . 133 |
|
7.5 |
Other Ocular Diseases . . . . . . . . . . . . |
102 |
9.11.1 |
Topical Steroid Treatment . . . . . . |
. . . 133 |
|
7.6 |
Conclusion . . . . . . . . . . . . . . . . . . . . . . |
102 |
9.11.2 |
Nonsteroidal Anti-inflammatory |
|
|
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
102 |
|
Drugs (NSAID) . . . . . . . . . . . . . . . |
. . . 134 |
|
|
|
|
|
9.11.3 |
Systemic Immunomodulatory |
|
|
|
|
|
|
Agents . . . . . . . . . . . . . . . . . . . . . . . |
. . . 134 |
|
Chapter 8 |
|
9.12 |
Recommendations |
|
|
|
Immune Mechanisms in Uveitis |
|
|
for Ocular Screening in JCA . . . . |
. . . 136 |
|
|
Ling Chen, Lynn K. Gordon |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . 136 |
|
||
8.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
109 |
|
|
|
|
8.2 |
Animal Uveitis Models . . . . . . . . . . . |
110 |
Chapter 10 |
|
|
|
8.2.1 |
Experimental Autoimmune |
|
Herpes Viruses in Ocular Inflammation |
|
||
|
Uveitis (EAU). . . . . . . . . . . . . . . . . . . . |
110 |
Bahram Bodaghi, Phuc LeHoang |
|
|
|
8.2.2 |
Endotoxin-Induced Uveitis (EIU) . . |
116 |
|
|
|
|
8.2.3 |
Experimental Melanin-Protein- |
|
10.1 |
Introduction . . . . . . . . . . . . . . . . . |
. . . 141 |
|
|
Induced Uveitis (EMIU) . . . . . . . . . . |
116 |
10.2 |
Fundamental Virology . . . . . . . . . |
. . . 143 |
|
8.2.4 |
Experimental Autoimmune Pigment |
|
10.3 |
Epidemiology . . . . . . . . . . . . . . . . |
. . . 143 |
|
|
Epithelial Membrane Protein- |
|
10.4 |
Pathophysiology . . . . . . . . . . . . . . |
. . . 144 |
|
|
Induced Uveitis (EAPU). . . . . . . . . . . |
117 |
10.4.1 |
Experimental Viral Uveitis . . . . . |
. . . 144 |
|
8.3 |
Immune Mechanisms |
|
10.4.2 |
Experimental Models |
|
|
|
in Human Uveitis . . . . . . . . . . . . . . . . |
117 |
|
to Study Viral Retinitis . . . . . . . . |
. . . 145 |
|
8.3.1 |
HLA-Associated Human Uveitis . . . |
117 |
10.5 |
Clinical Features . . . . . . . . . . . . . . |
. . . 145 |
|
8.3.2 |
Behçet’s Disease . . . . . . . . . . . . . . . . . |
119 |
10.5.1 |
Anterior Uveitis . . . . . . . . . . . . . . |
. . . 145 |
|
8.3.3 |
Vogt-Koyanagi-Harada Syndrome . . |
120 |
10.5.2 |
Viral Retinopathies . . . . . . . . . . . |
. . . 147 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
121 |
10.5.3 |
Differential Diagnosis . . . . . . . . . |
. . . 149 |
|
|
|
|
|
10.5.4 |
Putative Viral-Associated Uveitis |
. . . 150 |
|
|
|
|
10.6 |
Diagnosis . . . . . . . . . . . . . . . . . . . . |
. . . 150 |
|
Chapter 9 |
|
10.6.1 |
Obtention of Ocular Fluids . . . . . |
. . . 151 |
|
|
The Tip of the Iceberg: Current Knowledge |
|
10.6.2 |
Herpes Viruses . . . . . . . . . . . . . . . |
. . . 151 |
|
|
of Uveitis in Juvenile Arthritis |
|
10.6.3 Search for Antiviral Antibodies . |
. . . 152 |
|
||
Uwe Pleyer, Claudia Sengler, |
|
10.7 |
Treatment . . . . . . . . . . . . . . . . . . . |
. . . 153 |
|
|
Natasa Orlic, Rolf Keitzer |
|
10.7.1 |
Anterior Uveitis . . . . . . . . . . . . . . |
. . . 153 |
|
|
|
|
|
10.7.2 |
Viral Retinopathies . . . . . . . . . . . |
. . . 154 |
|
9.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
125 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . 157 |
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|
9.2 |
Classification of Arthritis . . . . . . . . . |
126 |
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|
|
9.3 |
Epidemiology . . . . . . . . . . . . . . . . . . . |
126 |
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|
|
9.4 |
Pathogenesis . . . . . . . . . . . . . . . . . . . . |
127 |
Chapter 11 |
|
|
|
9.5 |
Risk Factors for the Development |
|
Cytomegalovirus and the Eye |
|
|
|
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of Uveitis in JRA . . . . . . . . . . . . . . . . . |
128 |
Marc D. de Smet |
|
|
|
9.6 |
Clinical Features of Uveitis in JCA . . |
128 |
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9.7 |
Complications of Uveitis in JCA . . . . |
129 |
11.1 |
Introduction . . . . . . . . . . . . . . . . . |
. . . 161 |
|
9.7.1 |
Macula Edema . . . . . . . . . . . . . . . . . . |
130 |
11.2 |
Populations at Risk . . . . . . . . . . . |
. . . 161 |
|
9.8 |
Differential Diagnosis . . . . . . . . . . . . |
130 |
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XII Contents
11.2.1 |
HIV Associated |
|
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Immunosuppression . . . . . . . . . . . . . |
161 |
11.2.2 |
Immunosuppression |
|
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in Non-HIV Settings. . . . . . . . . . . . . . |
162 |
11.3 |
Appearance and Course . . . . . . . . . . . |
163 |
11.3.1 |
Manifestation Prior |
|
|
to Initial Treatment . . . . . . . . . . . . . . |
163 |
11.3.2 |
Manifestations Under Therapy . . . . . |
164 |
11.3.3 |
Differential Diagnosis . . . . . . . . . . . . |
165 |
11.3.4 |
Investigations . . . . . . . . . . . . . . . . . . . |
166 |
11.4 |
Therapeutic Agents . . . . . . . . . . . . . . |
166 |
11.4.1 |
Ganciclovir. . . . . . . . . . . . . . . . . . . . . . |
166 |
11.4.2 |
Valganciclovir . . . . . . . . . . . . . . . . . . . |
167 |
11.4.3 |
Foscarnet . . . . . . . . . . . . . . . . . . . . . . . |
167 |
11.4.4 |
Other Agents . . . . . . . . . . . . . . . . . . . . |
167 |
11.5Screening and Treatment
Algorithms . . . . . . . . . . . . . . . . . . . . . 167
11.5.1 CMV in HIV Infected Patients . . . . . 168
11.5.2 CMV in Other Immunosuppressive
States . . . . . . . . . . . . . . . . . . . . . . . . . . 168
11.6 Management of Complications . . . . . 168
11.6.1 Immune Recovery . . . . . . . . . . . . . . . 168
11.6.2 Retinal Detachment . . . . . . . . . . . . . . 168
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Chapter 12
Behçet’s Disease
Manfred Zierhut, Nicole Stübiger,
Christoph Deuter, Ina Kötter
12.1 |
Introduction . . . . . . . . . . . . . . . . . . . . |
173 |
12.2 |
Definition and Epidemiology of BD |
174 |
12.2.1 |
Definition . . . . . . . . . . . . . . . . . . . . . . . |
174 |
12.2.2 |
History . . . . . . . . . . . . . . . . . . . . . . . . . |
174 |
12.2.3 |
Epidemiology . . . . . . . . . . . . . . . . . . . |
174 |
12.3 |
Genetics of BD . . . . . . . . . . . . . . . . . . |
178 |
12.4 |
Immunology . . . . . . . . . . . . . . . . . . . . |
182 |
12.4.1 |
T Cells . . . . . . . . . . . . . . . . . . . . . . . . . |
182 |
12.4.2 |
NK Cells . . . . . . . . . . . . . . . . . . . . . . . . |
183 |
12.4.3 |
Neutrophils . . . . . . . . . . . . . . . . . . . . . |
183 |
12.4.4 |
Endothelial Dysfunction . . . . . . . . . . |
183 |
12.4.5 |
Coagulation and Fibrinolytic |
|
|
Pathway Abnormalities . . . . . . . . . . . |
184 |
12.5General (Extraocular)
Manifestations of BD . . . . . . . . . . . . . 184
12.5.1 Oral Aphthous Ulcerations . . . . . . . . 184
12.5.2 Genital Ulcerations . . . . . . . . . . . . . . . 185
12.5.3 Skin Lesions . . . . . . . . . . . . . . . . . . . . . 185
12.5.4 Pathergy Phenomenon . . . . . . . . . . . 185
12.5.5 Skeletal System . . . . . . . . . . . . . . . . . . 185 12.5.6 Gastrointestinal Manifestations . . . . 186 12.5.7 Neurological Manifestations . . . . . . . 186 12.5.8 Vascular Manifestations . . . . . . . . . . . 186 12.5.9 Rare Manifestations . . . . . . . . . . . . . . 187 12.5.10Life Expectancy . . . . . . . . . . . . . . . . . . 187 12.6 Ocular Involvement . . . . . . . . . . . . . . 187 12.6.1 Anterior Segment Changes . . . . . . . . 188 12.6.2 Posterior Segment Changes . . . . . . . 188 12.6.3 Complications . . . . . . . . . . . . . . . . . . . 189 12.6.4 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . 190 12.7 Therapy . . . . . . . . . . . . . . . . . . . . . . . . 190 12.7.1 Local Treatment . . . . . . . . . . . . . . . . . 191 12.7.2 Systemic Treatment. . . . . . . . . . . . . . . 191 12.7.3 Surgical Treatment . . . . . . . . . . . . . . . 194 12.7.4 Practical Treatment
Recommendations . . . . . . . . . . . . . . . 194 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Chapter 13
Choroiditis:
General Considerations and Classification
Carl P. Herbort
13.1 Introduction . . . . . . . . . . . . . . . . . . . . 202
13.2Indocyanine Green Angiography
(ICGA) . . . . . . . . . . . . . . . . . . . . . . . . . 202 13.2.1 Physicochemical Properties
of Indocyanine Green (ICG) . . . . . . . 202
13.2.2Standard ICG Angiographic Protocol for Inflammatory
Diseases . . . . . . . . . . . . . . . . . . . . . . . . 204 13.2.3 Principles for the Interpretation
of ICGA [9, 10] . . . . . . . . . . . . . . . . . . . 204
13.2.4Differences Between Fluorescein and Indocyanine Green
Angiography . . . . . . . . . . . . . . . . . . . . 205
13.2.5 Clinico-pathologic-angiographic
Correlations . . . . . . . . . . . . . . . . . . . . 205
13.2.6 Relevance of ICGA in Ocular
Inflammatory Diseases . . . . . . . . . . . 205
13.3The Concepts of Inflammatory
Choriocapillaropathy
and Stromal Choroiditis [12] . . . . . . . 206
13.3.1 Primary Inflammatory
Choriocapillaropathy (PICCP) . . . . . 206
13.3.2 Stromal Choroiditis . . . . . . . . . . . . . . 207
13.3.3 Secondary Inflammatory
Choriocapillaropathy . . . . . . . . . . . . . 207
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207