Drug-induced uveitis: A review

Agarwal, Manisha; Majumder, Parthopratim Dutta; Babu, Kalpana; Konana, Vinaya Kumar; Goyal, Mallika; Touhami, Sara; Stanescu-Segall, Dinu; Bodaghi, Bahram

doi:10.4103/ijo.ijo_816_20

Cited by 55 publications

(39 citation statements)

References 91 publications

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“…Commonly proposed mechanisms have included both molecular mimicry and antigen-specific cell and antibody-mediated hypersensitivity reactions. [12][13][14]…”

Section: Discussionmentioning

confidence: 99%

Association of Ocular Adverse Events With Inactivated COVID-19 Vaccination in Patients in Abu Dhabi

et al. 2021

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s of March 2021, the COVID-19 pandemic has caused 35 million infections and more than 1 million deaths worldwide, leading to the urgent demand for a vaccine. 1 To date, 2 inactivated vaccine candidates have been reported to protect against SARS-CoV-2. The inactivated COVID-19 vaccine by Sinopharm's China National Biotec Group is mixed with aluminum-based adjuvant and has been found tolerable and immunogenic in healthy people with 2 doses administered 21 days apart. 2 As of March 2021, the United Arab Emirates Ministry of Health and Prevention announced that the United Arab Emirates had crossed 2 million doses of the Sinopharm inactivated vaccine (20% of the population). We hereby present a case series of ocular adverse events presenting at Cleveland Clinic Abu Dhabi in the United Arab Emirates after receiving the Sinopharm COVID-19 vaccine. MethodsRetrospective consecutive case series, adherent to the reporting guidelines, 3 of patients presenting at the retina and uveitis service from September 2020 to January 2021 were performed in accordance with the ethical standards of the Declaration of Helsinki. 4 The institutional review board of Cleveland Clinic Abu Dhabi waived the need for approval of a case series of fewer than 10 patients. Written informed consent was obtained from all enrolled individuals.The main inclusion criterion was the development of ocular symptoms within 15 days from the first dose of the COVID-19 vaccine. Each patient underwent Snellen best-corrected visual acuity (BCVA) that was then converted to logMAR and IMPORTANCE As vaccinations against COVID-19 continue, potential ocular adverse events should be reported in detail to increase awareness among the medical community, although typically, a causal relationship cannot be established definitively.OBJECTIVE To describe ocular adverse events that occur soon after receiving an inactivated COVID-19 vaccination (Sinopharm). DESIGN, SETTING, AND PARTICIPANTSThis case series took place from September 2020 to January 2021 at Cleveland Clinic Abu Dhabi, a tertiary referral center. Patients who reported ocular adverse events and presented within 15 days from the first of 2 doses of an inactivated COVID-19 vaccine were analyzed. MAIN OUTCOMES AND MEASURESEach patient underwent Snellen best-corrected visual acuity that was then converted to logMAR, applanation tonometry, and biomicroscopic examination with indirect ophthalmoscopy. Color fundus photography was obtained with a conventional 9-field fundus photography camera or with a widefield fundus photography system. Optical coherence tomography and optical coherence tomographic angiography images were obtained. Sex, race, age, and clinical data were self-reported.RESULTS Nine eyes of 7 patients (3 male individuals) presenting with ocular complaints following COVID-19 vaccine were included in the study. The mean (SD) age was 41.4 (9.3) years (range, 30-55 years); the mean best-corrected visual acuity was 0.23 logMAR (range, 0-1 logMAR; approximate Snellen equivalent, 20/32). The mean time of ocular adv...

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“…Commonly proposed mechanisms have included both molecular mimicry and antigen-specific cell and antibody-mediated hypersensitivity reactions. [12][13][14]…”

Section: Discussionmentioning

confidence: 99%

Association of Ocular Adverse Events With Inactivated COVID-19 Vaccination in Patients in Abu Dhabi

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Theoretical pathophysiology of COVID-19 inactivation-related ocular inflammation is unknown. Respectively molecular mimicry and antigen-specific cellular and antibodymediated immune system disorders have been suggested as possibilities (17)(18)(19). The discovery of COVID-19 viral RNA in the retina is significant.…”

Section: Discussionmentioning

confidence: 99%

Retinal hemorrhage of late post COVID-19 and post vaccine related pathogenic mechanisms: A new challenge for ophthalmologist in COVID era

Amin

Nahin

Dola

et al. 2022

Preprint

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“…Drug-induced uveitis can occur via two distinct processes: the direct and the indirect mechanisms. 26 The direct mechanism involves direct interaction of the drug with intraocular tissues leading to inflammation. The indirect mechanisms include immune cell induction and rupturing of microvasculature, resulting in disruption of the blood ocular barrier.…”

Section: Discussionmentioning

confidence: 99%

“…The indirect mechanisms include immune cell induction and rupturing of microvasculature, resulting in disruption of the blood ocular barrier. 26 Several drugs including MEK inhibitors and tumor necrosis factor-α inhibitors have been implicated in the induction of uveitis. 27 Other drugs reported to induce uveitis include metipranolol, sulfonamides, bisphosphonates, cidofovir, triamcinolone acetonide.…”

Section: Discussionmentioning

confidence: 99%

Unilateral acute anterior uveitis with macular edema following the use of sildenafil citrate in a patient with HLA-B27 positivity

Regenold

Ghoraba

Akhavanrezayat

et al. 2021

American Journal of Ophthalmology Case Reports

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Purpose To present a case of acute anterior uveitis with macular edema associated with sildenafil citrate use in an HLA-B27 positive patient. Observations A 54-year-old Caucasian male presented at an ophthalmology tertiary center with complaint of pinkish discoloration, irritation, and photophobia in the left eye (OS). He noted that these symptoms appeared one day after using sildenafil for the first time to treat his erectile dysfunction. The patient had no significant ocular history besides refractive surgery in both eyes (OU) and his medical history was insignificant. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and 20/25 in OS. Slit-lamp-examination (SLE) demonstrated trace cells and 1+ flare in the anterior chamber (AC) in OS and was nonrevealing in AC in OD. Spectral domain optical coherence tomography (SD-OCT) showed parafoveal subretinal hyperreflective deposits in OU. The patient was diagnosed with acute anterior uveitis (AAU) in the left eye and was placed on topical prednisolone acetate. At 2-week follow-up, the patient reported that his eye symptoms had improved since starting topical steroids but worsened again two days after he had used sildenafil for a second time. In OS, best-corrected visual acuity (BCVA) worsened to 20/40, and SLE revealed 1+ cells and 1+ flare in AC. SD-OCT revealed cystoid macular edema only in OS. Fluorescein angiography showed mild staining around the optic disc and significant macular leakage in OS and minimal macular leakage in OD. Uveitis evaluations revealed that the patient was human leukocyte antigen-27 (HLA-B27) positive. The patient was asked to remain off sildenafil and continue topical prednisolone acetate. At 3-month follow-up, BCVA improved to 20/20 in OS with no evidence of active inflammation. Conclusions and importance Sildenafil citrate use might be associated with new onset of intraocular inflammation in predisposed patients. Further studies are necessary to establish this relationship.

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Drug-induced uveitis: A review

Cited by 55 publications

References 91 publications

Association of Ocular Adverse Events With Inactivated COVID-19 Vaccination in Patients in Abu Dhabi

Association of Ocular Adverse Events With Inactivated COVID-19 Vaccination in Patients in Abu Dhabi

Retinal hemorrhage of late post COVID-19 and post vaccine related pathogenic mechanisms: A new challenge for ophthalmologist in COVID era

Unilateral acute anterior uveitis with macular edema following the use of sildenafil citrate in a patient with HLA-B27 positivity

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