Acute zonal occult outer retinopathy in a patient with graft-versus-host disease

Cheung, Marsha C.; Nune, George; Hwang, David G.; Sutter, Erich E.; Duncan, Jacque L.

doi:10.1016/j.ajo.2004.06.042

Cited by 15 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 1 ] Autoimmune and inflammatory hypotheses were proposed by Jampol and Becker [ 13 , 14 ]. Other possible mechanisms includes fungal infiltration, [ 15 , 16 ] polycythemia vera, [ 17 ] toxic retinopathy, [ 14 , 18 , 19 ] and anti-retinal antibody [ 20 , 21 ]. Heckenlively and Ferreyra [ 22 ] reviewed retinal disorders evoked by autoantibodies and established a clinical term of autoimmune retinopathy (AIR).…”

Section: Discussionmentioning

confidence: 99%

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

2017

View full text Add to dashboard Cite

BackgroundAZOOR was first described by Gass in 1993 as a syndrome with rapid loss of one or more extensive zones of the outer retinal segments. It is characterized by photopsia, minimal funduscopic changes, and electroretinographic abnormalities. The efficacy of systemic steroids in treating AZOOR has been previously described and advocated by the concept of autoimmune retinopathy. However, the use of intravitreal of sustained-released steroid had not been mentioned to date.Case presentationA 34-year-old man had sudden onset of central scotoma and photopsia in the left eye. His visual acuity continued deteriorating. The visual field defect demonstrated bilateral enlarged blind spots and altitudinal defects. Fluorescein angiography (FA) showed nonspecific retinal inflammation, and an electroretinogram (ERG) illustrated decreased amplitude of the b wave in both eyes. Optical coherence tomography (OCT) examinations revealed parafoveal loss of the photoreceptor inner/outer segment (IS/OS) junction. Therefore, acute zonal occult outer retinopathy (AZOOR) was diagnosed. Although his vision did not improve under the initial treatment of systemic corticosteroid and calcium channel blocker, remarkable improvement was noticed after the intravitreal injection(IVI) of Ozurdex, consistent with the recovered IS/OS junction disruption.ConclusionsWe herein report a typical case of AZOOR, suggesting that the intravitreal injection of steroid may benefit in certain patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

2017

View full text Add to dashboard Cite

show abstract

“…3 -5 The pathogenesis of the disease was uncertain, but Gass 6 speculated that a virus, entering the retina through the peripapillary area, was the best explanation for the progressive abnormalities in the fundus. Further considerations included his viral hypothesis, 7 an immune-mediated process or toxic retinopathy, [8][9][10] or fungal infections. 11,12 Numerous therapies, including immunosuppressive agents, anti-inflammatory drugs, and antiviral therapy, used singularly and in combination have shown no proven evidence of benefit.…”

mentioning

confidence: 99%

“…11,12 Numerous therapies, including immunosuppressive agents, anti-inflammatory drugs, and antiviral therapy, used singularly and in combination have shown no proven evidence of benefit. 4,7,8,[12][13][14] Since the original report by Gass, 1 the described spectrum of changes in the fundus in numerous studies [3][4][5][15][16][17][18] has varied from a normal appearance to a severely damaged retina. Nonspecific chorioretinal signs of inflammation and the unknown etiology of the condition have led to difficulties in distinguishing AZOOR from other entities such as optic neuropathies, paraneoplastic diseases, autoimmune retinopathies, toxic degenerations, and infectious diseases, including diffuse unilateral subacute neuroretinitis, lymphoma, and a myriad of hereditary chorioretinal diseases (eg, retinitis pigmentosa).…”

mentioning

confidence: 99%

Acute Zonal Occult Outer Retinopathy

et al. 2014

View full text Add to dashboard Cite

IMPORTANCE We describe the multimodal imaging in a group of patients showing a distinct clinical entity that best represents acute zonal occult outer retinopathy (AZOOR). OBJECTIVE To propose a classification of AZOOR based on clinical fundus and multimodal imaging. DESIGN, SETTING AND PARTICIPANTS A retrospective review of patients diagnosed as having AZOOR at 2 centers. After reviewing more than 400 cases diagnosed or referred to us as AZOOR or AZOOR complex, we assembled 30 cases that fit our current definition; (48 eyes) with a median age at diagnosis of 47 years (age range, 17-86 years) and a mean follow-up period of 39 months. Twenty patients were female. Eighteen patients had initially been seen with bilateral lesions, mostly asymmetric (4 cases were symmetric). Most patients had no remarkable medical or ocular history. The median visual acuity at the time of presentation was 20/25 (range, 20/20 to 20/400). MAIN OUTCOMES AND MEASURES Multimodal imaging, including fundus photography, fluorescein and indocyanine green angiography, fundus autofluorescence imaging, and corresponding eye-tracked spectral-domain coherence tomography imaging. RESULTS Each patient was initially seen with visual symptoms of photopsia and scotoma, and most had a detectable lesion in the fundus evident clinically or detected on multimodal imaging. The clinical appearance of the AZOOR lesions varied depending on their duration and location, but some features were characteristic, including a demarcating line of the progression at the level of the outer retina and a trizonal pattern of sequential involvement of the outer retina, retinal pigment epithelium, and choroid, as well as frequent zonal progression. Advanced cases of AZOOR demonstrated disruption of the inner and outer retina and severe damage or loss of the retinal pigment epithelium and the choroid. CONCLUSIONS AND RELEVANCE A specific definition of AZOOR based on multimodal imaging is proposed to help physicians distinguish it from other diseases of the posterior fundus, including white spot syndromes and autoimmune, hereditary, paraneoplastic, toxic, and other inflammatory retinopathies.

show abstract

“…Scleritis had been reported as the initial manifestation of cGVHD, but this is not common (Kim et al , 2002). Rarely, retinal pathology can be seen after HSCT, including central serous retinopathy, retinal pigmented epitheliopathy and retinal microvasculopathy; some authors have questioned whether these manifestations are due to GVHD or are side effects of immunosuppressive therapy (Fawzi and Cunningham, 2001; Strouthidis et al , 2003; Cheung et al , 2004; Kawase et al , 2005). Vitritis has also been reported as a manifestation of ocular GVHD, but this is exceedingly rare (Sheidow et al , 2004).…”

Section: Ocular Diseasementioning

confidence: 99%

Mucosal graft‐vs‐host disease

Lew

Smith

2007

Oral Diseases

View full text Add to dashboard Cite

Graft‐vs‐host disease (GVHD) is a serious complication of hematopoietic stem cell transplantation (HSCT). Indications for HSCT have greatly expanded, and more patients are undergoing HSCT today than ever before. In addition, the options for immunosuppressive therapy for both prevention and treatment of GVHD have also expanded. These changes have in turn altered the landscape of this disease. We have reviewed the current literature on this subject and presented an update on this disease with a particular emphasis on mucosal manifestations.

show abstract

Acute zonal occult outer retinopathy in a patient with graft-versus-host disease

Cited by 15 publications

References 5 publications

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

Acute Zonal Occult Outer Retinopathy

Mucosal graft‐vs‐host disease

Contact Info

Product

Resources

About