Usefulness of aqueous and vitreous humor analysis in infectious uveitis

Santos, Helen Nazareth Veloso dos; Ferracioli-Oda, Eduardo; Barbosa, Thaisa Silveira; Otani, Camila Sayuri Vicentini; Tanaka, Tatiana; Silva, Luciane de Carvalho Sarahyba da; Lopes, Guilherme de Oliveira; Doi, Andre; Hirata, Carlos Eduardo; Yamamoto, Jiro

doi:10.6061/clinics/2020/e1498

Cited by 12 publications

(16 citation statements)

References 38 publications

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“…PCR has proven to be an asset to the diagnosis of infectious uveitides, however only a few centers have since published their practice patterns with PCR [ 20 – 25 ]. De Santos et al recently published a similar study, although of a smaller number of cases ( n = 28), which showed a change in treatment of around 50% of cases due to the results of PCR.…”

Section: Discussionmentioning

confidence: 99%

“…De Santos et al recently published a similar study, although of a smaller number of cases ( n = 28), which showed a change in treatment of around 50% of cases due to the results of PCR. This study is most representative of our “Unknown” cases subset as they evaluated PCR in situations where the clinical course was atypical or aggressive with an imminent threat to vision [ 20 ]. In contrast, two other studies analyzed clinical subsets where the utility of PCR was more confirmatory in nature [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…When used together, these two types of PCR can help to identify and confirm a causative infectious agent [ 19 ]. PCR is now widely accepted as a useful adjunct to help diagnose cases of infectious uveitis; however, few centers have since published their experience with PCR and its effect on management in the literature [ 20 – 25 ]. The present study was undertaken to report the experience of PCR testing in various clinical scenarios at a large tertiary care center in New York City.…”

Section: Introductionmentioning

confidence: 99%

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The impact of polymerase chain reaction (PCR) on diagnosis and management of infectious uveitis at a tertiary care facility

Fallon

Narayan

Lin

et al. 2022

J Ophthal Inflamm Infect

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Background Polymerase Chain Reaction (PCR) is a well-accepted adjunct in the management of infectious uveitis. In turn, few reports in the literature have evaluated how PCR then impacts patient care. This study aims to evaluate the impact of PCR sampling on diagnosis and treatment of infectious uveitidies at a large tertiary care facility. Main body This is a retrospective, observational study of patients with aqueous and vitreous PCR samples obtained from 2014 to 2019. The study was undertaken at a single institution. At least one follow up visit following results of PCR testing was required for inclusion. If a patient had multiple PCR samples taken, only the first sample was included. The patients were divided into three categories based on pre-sampling diagnosis. A chi-square test was used to analyze the data. 108 cases were available for analysis. PCR did not change diagnosis or management in any of the cases where pre-sampling diagnosis carried a high clinical suspicion for negative PCR. Overall, the results of PCR testing had a more significant impact on diagnosis in those cases where pre-sampling diagnosis was unknown versus those where it was confirmatory in nature, thus presumed to be related to an infectious entity tested by PCR (74% vs. 29%, p = 0.00006). The rate of treatment change based on PCR was similar between those cases where there was a high clinical suspicion for positive PCR and those where pre-sampling diagnosis was unknown (32% vs. 33%, p = 0.95). Further analyzing specimens separately depending on source of sample, this pattern persisted for aqueous samples, with PCR showing a more significant impact on diagnosis in those cases where the diagnosis was unknown versus those where sampling was confirmatory (86% vs. 31%, p = 0.00004). The rate of change in treatment between the two groups was similar (35% vs. 31%, p = 0.79). Vitreous samples followed a similar pattern with a higher rate of diagnosis change for those cases where pre-sampling diagnosis was unknown and a similar rate in treatment change between the two groups, however this did not reach statistical signifigance (44% vs. 25%, p = 0.28; 27% vs. 33%, p = 0.74). Conclusion There is no well-defined algorithm as to when to employ PCR testing in uveitis. As expected, in our experience, it has the largest impact on diagnosis when the diagnosis is unknown, however even when confirmatory in nature, it continues to impact patient management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of polymerase chain reaction (PCR) on diagnosis and management of infectious uveitis at a tertiary care facility

Fallon

Narayan

Lin

et al. 2022

J Ophthal Inflamm Infect

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“…The paucibacillary in nature and preferential localization of MTb in retinal pigment epithelium previously described by Rao et al (Rao et al, 2006) could influence the positivity rate depending on site-specific samples obtained for PCR as described in quantitative analysis (Sharma et al, 2010). In the daily setting, obtaining vitreous samples is an uneasy task, and aqueous samples are often considered a sample of choice even in posterior uveitis (Figueira et al, 2017;Santos et al, 2020). Besides the potential influence of site-specific samples, Bhagya et al (Sudheer et al, 2018) found more positive results from patients with acute uveitis.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of polymerase chain reaction for ocular tuberculosis diagnosis in relation to antitubercular therapy response: a meta-analysis

Nora

Putera

Khalisha

et al. 2021

International Journal of Infectious Diseases

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“…Extractions of aqueous humors are less invasive and associated with fewer complications than extractions of vitreous material, and aqueous humor examinations can provide satisfactory information for many questions [16,199,337,347,351]. Aqueous humors are also often informative for the diagnosis of posterior uveitis and allow for etiological diagnoses [19,337,347,[351][352][353][354][355][356].…”

Section: Examination Of Intraocular Specimens In Horses Suffering Fro...mentioning

confidence: 99%

Infectious Uveitis in Horses and New Insights in Its Leptospiral Biofilm-Related Pathogenesis

2022

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Uveitis is a sight-threatening eye disease in equids known worldwide that leads to considerable pain and suffering. By far the most common type of uveitis in Germany and neighboring countries is classical equine recurrent uveitis (ERU), which is caused by chronic intraocular leptospiral infection and is the main cause of infectious uveitis in horses. Other infectious causes are extremely rare and are usually clinically distinguishable from ERU. ERU can be treated very effectively by vitreous cavity lavage (vitrectomy). For proper indications of this demanding surgery, it is necessary to differentiate ERU from other types of uveitis in which vitrectomy is not helpful. This can be conducted on the basis of anamnesis in combination with ophthalmologic findings and by aqueous humor examination. During vitrectomy, vitreous material is obtained. These vitreous samples have historically been used for numerous etiologic studies. In this way, a chronic intraocular leptospiral infection has been shown to be the cause of typical ERU and, among other findings, ERU has also been recognized as a biofilm infection, providing new insights into the pathogenesis of ERU and explaining some thus far unexplainable phenomena of ERU. ERU may not only have transmissible aspects to some types of uveitis in humans, but may also serve as a model for a spontaneously occurring biofilm infection. Vitreous material obtained during therapeutically indicated vitrectomy can be used for further studies on in vivo biofilm formation, biofilm composition and possible therapeutic approaches.

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Usefulness of aqueous and vitreous humor analysis in infectious uveitis

Cited by 12 publications

References 38 publications

The impact of polymerase chain reaction (PCR) on diagnosis and management of infectious uveitis at a tertiary care facility

The impact of polymerase chain reaction (PCR) on diagnosis and management of infectious uveitis at a tertiary care facility

The diagnostic value of polymerase chain reaction for ocular tuberculosis diagnosis in relation to antitubercular therapy response: a meta-analysis

Infectious Uveitis in Horses and New Insights in Its Leptospiral Biofilm-Related Pathogenesis

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