Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Diabetic retinopathy (DR) is a leading cause of vision-loss globally. Of an estimated 285 million people with diabetes mellitus worldwide, approximately one third have signs of DR and of these, a further one third of DR is vision-threatening DR, including diabetic macular edema (DME). The identification of established modifiable risk factors for DR such as hyperglycemia and hypertension has provided the basis for risk factor control in preventing onset and progression of DR. Additional research investigating novel risk factors has improved our understanding of multiple biological pathways involved in the pathogenesis of DR and DME, especially those involved in inflammation and oxidative stress. Variations in DR prevalence between populations have also sparked interest in genetic studies to identify loci associated with disease susceptibility. In this review, major trends in the prevalence, incidence, progression and regression of DR and DME are explored, and gaps in literature identified. Established and novel risk factors are also extensively reviewed with a focus on landmark studies and updates from the recent literature.

/pdf/epidemiology-of-diabetic-retinopathy-diabetic-macular-edema-16vzgjcxp4.pdf

Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss

https://serval.unil.ch/resource/serval:BIB_3A01220E0FF1.P001/REF.pdf

Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis.

Section 1: Basic Principles Introduction * The Uvea: Anatomy, Histology and Embryology * Definition, Classification, Etiology and Epidemiology * General Principles and Philosophy Section 2: Principles of Diagnosis and Therapy Diagnosis of Uveitis * Imaging Studies for Uveitis * Treatment of Uveitis-Overview * Corticosteroids * Mydriatic and Cycloplegic Agents * Nonsteroidal Anti-inflammatory Drugs * Immunosuppressive Chemotherapy * Diagnostic Surgery * Therapeutic Vitreoretinal Surgery * Clinical Trials and Evidence-based Medicine in the Medical Management of Uveitis Section 3: The Uveitis Syndromes- Infectious Syphilis * Borreliosis * Bartonella * Tuberculosis * Leptospirosis * Brucellosis * Ocular Whipple's Disease * Rickettsial Diseases * Ocular Leprosy * Herpes viruses * Emergent Viral Infections * Rift Valley Fever * Measles * Rubella * Presumed Ocular Histoplasmosis Syndrome * Candidiasis * Coccidioidomycosis * Cryptococcosis * Sporotrichosis * Toxoplasmosis * Other Vector-Borne Parasitic Infections * Free-living Amebas and Amebiasis * Giardia Lamblia * Trypanosomiasis * Pneumocystosis * Ocular Toxocariasis * Ascariasis * Onchocerciasis * Loiasis * Cysticercosis * Diffuse Unilateral Subacute Neuroretinitis * Schistosomiasis * Ophthalmomyiasis * Ophthalmia Nodosa * Human Immunodeficiency Virus Associated Uveitis Section 4: The Uveitis Syndromes- Masquerade Syndromes Masquerade Syndromes: Malignancies * Masquerade Syndromes: Endophthalmitis * Nonmalignant, Noninfectious Masquerade Syndromes Section 5: The Uveitis Syndromes- Autoimmune Seronegative Spondyloarthropathies * Systemic Lupus Erythematosus * Scleroderma * Giant Cell Arteritis * Adamantiades-Behcet's Disease * Polyarteritis Nodosa * Granulomatosis with Polyangitis (Wegener) (GPA) * Polychondritis * Fuchs' Heterochromic Iridocyclitis * Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria * Sarcoidosis * Tubulointerstitial Nephritis and Uveitis Syndrome * Birdshot Retinochoroidopathy * Sympathetic Ophthalmia * Vogt-Koyanagi-Harada Disease * Multifocal Choroiditis and Panuveitis * Multiple Evanescent White Dot Syndrome * Acute Posterior Multifocal Placoid Pigment Epitheliopathy * Acute Retinal Pigment Epitheliitis * Serpiginous Choroiditis * Subretinal Fibrosis and Uveitis Syndrome * Punctate Inner Choroiditis:Diagnosis and Management * Acute Zonal Occult Outer Retinopathy * Lens-Induced Uveitis * Retinal Vasculitis * Intermediate Uveitis Section 6: Other Medication-Induced Uveitis * Pediatric Uveitis * Pregnancy and Uveitis * Traumatic Uveitis

Diagnosis and treatment of uveitis

Neuro-Behcet’s disease (NBD) is one of the more serious manifestations of Behcet’s disease (BD), which is a relapsing inflammatory multisystem disease with an interesting epidemiology. Though NBD is relatively uncommon, being potentially treatable, neurologists need to consider it in the differential diagnosis of inflammatory, infective, or demyelinating CNS disorders. Evidence-based information on key issues of NBD diagnosis and management is scarce, and planning for such studies is challenging. We therefore initiated this project to develop expert consensus recommendations that might be helpful to neurologists and other clinicians, created through an extensive literature review and wide consultations with an international advisory panel, followed by a Delphi exercise. We agreed on consensus criteria for the diagnosis of NBD with two levels of certainty in addition to recommendations on when to consider NBD in a neurological patient, and on the use of various paraclinical tests. The management recommendations included treatment of the parenchymal NBD and cerebral venous thrombosis, the use of disease modifying therapies, prognostic factors, outcome measures, and headache in BD. Future studies are needed to validate the proposed criteria and provide evidence-based treatments.

/pdf/diagnosis-and-management-of-neuro-behcet-s-disease-4503mu3gsy.pdf

Diagnosis and management of Neuro-Behcet's disease: international consensus recommendations.

Purpose: To estimate prevalence and number of people visually impaired or blind due to cataract.

Methods: Based on the Global Burden of Diseases Study 2010 and ongoing literature research, we examined how many people were affected by moderate to severe vision impairment (MSVI; presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60) due to cataract.

Results: In 2010, of overall 32.4 million blind and 191 million vision impaired, 10.8 million people were blind and 35.1 million were visually impaired due to cataract. Cataract caused worldwide 33.4% of all blindness in 2010, and 18.4% of all MSVI. These figures were lower in the high-income regions ( 40%) in South and Southeast Asia and Oceania. From 1990 to 2010, the number of blind or visually impaired due to cataract decreased by 11.4% and by 20.2%, respectively; the age-standardized global prevalence of cataract-related blindness and MSVI reduced by 46% and 50%, respectively, and the worldwide crude prevalence of cataract-related blindness and MSVI reduced by 32% and 39%, respectively. The percentage of global blindness and MSVI caused by cataract decreased from 38.6% to 33.4%, and from 25.6% to 18.4%, respectively. This decrease took place in almost all world regions, except East Sub-Saharan Africa.

Conclusions: In 2010, one in three blind people was blind due to cataract, and one of six visually impaired people was visually impaired due to cataract. Despite major improvements in terms of reduction of prevalence, cataract remains a major public health problem.

/pdf/number-of-people-blind-or-visually-impaired-by-cataract-11oki36zva.pdf

Number of people blind or visually impaired by cataract worldwide and in world regions, 1990 to 2010

Behcet disease (BD) is a multisystem inflammatory disorder that is an important cause of morbidity worldwide. BD is most common along the ancient "Silk Road" route in the Far East and Mediterranean basin. The eye is the most commonly involved organ in BD patients.The prototypical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Less commonly, BD may present in the form of conjunctivitis, conjunctival ulcers, keratitis, episcleritis, scleritis, and extraocular muscle paralysis. Uveitis in BD carries significant implications for the patient, because it is a chronic recurrent disease characterized by explosive attacks of severe inflammation that may cause significant, cumulative damage to the intraocular structures. This review summarizes the epidemiology of systemic and ocular clinical features of BD with particular focus on risk factors, clinical characteristics, complications, and prognosis of BD-associated uveitis.

Epidemiology of Behçet Disease

Purpose: To describe optical coherence tomography angiography (OCTA) findings in eyes with Behcet uveitis (BU) and to compare these findings with those of fluorescein angiography (FA). 

Methods: Prospective, comparative, cross-sectional study. Patients presenting with clinically active BU involving the posterior segment were evaluated using FA, spectral domain optical coherence tomography (SD-OCT), and OCTA. Optical coherence tomography angiograms were reviewed and analyzed. Foveal avascular zone areas and vessel densities were also reported. 

Results: Twenty-five patients (44 eyes) were included. Perifoveal microvascular changes were more frequently observed on OCTA than on FA (95.5 vs 59.1%; P < 0.001). Disruption of the perifoveal capillary arcade, areas of retinal capillary nonperfusion/hypoperfusion, and perifoveal capillary abnormalities, including rarefied, dilated, or shunting vessels were observed more frequently using OCTA than FA (40.9 vs 25%; P = 0.039, 86.4 vs 34.1%; P < 0.001, and 84.1 vs 36.4%; P < 0.001, respectively). Areas of retinal capillary nonperfusion/hypoperfusion were more frequently observed in the deep than in the superficial capillary plexus (81.8 vs 63.6%; P = 0.039). Capillary abnormalities and disorganization of the normal architecture of the capillary network were more frequent in the deep than in the superficial capillary plexus (P < 0.001). Foveal avascular zone area was not significantly larger in eyes with BU than in control group in both the superficial and the deep capillary plexuses (0.4 vs 0.34 mm; P = 0.23 and 0.72 vs 0.53 mm; P = 0.053, respectively). Capillary vessel density was significantly lower in eyes with BU than in control group in the deep capillary plexus (13.7 vs 17.2 mm 21; P = 0.004). 

Conclusion: OCTA allows better visualization and characterization of perifoveal microvascular changes than FA in eyes with active BU. The deep capillary plexus seemed to be more severely involved than the superficial capillary plexus.

Optical coherence tomography angiography in patients with behçet uveitis.

Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.

/pdf/infectious-optic-neuropathies-a-clinical-update-3m7dckjret.pdf

Infectious optic neuropathies: a clinical update.

Emergent and resurgent arthropod vector-borne diseases are major causes of systemic morbidity and death and expanding worldwide. Among them, viral and bacterial agents including West Nile virus, Dengue fever, Chikungunya, Rift Valley fever, and rickettsioses have been recently associated with an array of ocular manifestations. These include anterior uveitis, retinitis, chorioretinitis, retinal vasculitis and optic nerve involvement. Proper clinical diagnosis of any of these infectious diseases is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by the detection of a specific antibody in serum. Ocular involvement associated with emergent infections usually has a self-limited course, but it can result in persistent visual impairment. There is currently no proven specific treatment for arboviral diseases, and therapy is mostly supportive. Vaccination for humans against these viruses is still in the research phase. Doxycycline is the treatment of choice for rickettsial diseases. Prevention, including public measures to reduce the number of mosquitoes and personal protection, remains the mainstay for arthropod vector disease control. Influenza A (H1N1) virus was responsible for a pandemic human influenza in 2009, and was recently associated with various posterior segment changes.

/pdf/new-infectious-etiologies-for-posterior-uveitis-4n7psp31md.pdf

Rim Kahloun

Papers

Number of people blind or visually impaired by cataract worldwide and in world regions, 1990 to 2010

Epidemiology of Behçet Disease

Optical coherence tomography angiography in patients with behçet uveitis.

Infectious optic neuropathies: a clinical update.

New Infectious Etiologies for Posterior Uveitis