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Choroidal neovascularization secondary to tubulointerstitial nephritis and uveitis syndrome (TINU) in an adult patient.

Heymann HB, Colon D, Gill MK - J Ophthalmic Inflamm Infect (2015)

Bottom Line: Clinical examination and investigations show the development of CNV in the left eye.The patient was treated with ranibizumab (Genentech, San Francisco, CA) intravitreal injections with improvement in symptoms and clinical findings.The CNV associated with TINU is responsive to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 440, Chicago, IL, 60611, USA.

ABSTRACT

Background: Inflammation is a well-known risk factor for the development of choroidal neovascularization (CNV), yet not all causes of intraocular inflammation have been documented to cause CNV. Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare cause of intraocular inflammation mostly in pediatric patients and only seldom has been associated with development of CNV.

Findings: A 34-year-old pregnant female with a past history of bilateral ocular inflammation secondary to TINU presents 1 year after diagnosis with vision loss in the left eye. Clinical examination and investigations show the development of CNV in the left eye. The patient was treated with ranibizumab (Genentech, San Francisco, CA) intravitreal injections with improvement in symptoms and clinical findings.

Conclusions: We report the first case of CNV secondary to TINU in an adult patient. The CNV associated with TINU is responsive to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.

No MeSH data available.


Related in: MedlinePlus

a Color fundus photo of left eye shows pinpoint hemorrhage overlying the fovea. b Fluorescein angiography of left eye demonstrates late phase parafoveal leakage consistent with neovascularization
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Fig1: a Color fundus photo of left eye shows pinpoint hemorrhage overlying the fovea. b Fluorescein angiography of left eye demonstrates late phase parafoveal leakage consistent with neovascularization

Mentions: On her presentation to the retina service, the patient’s best corrected visual acuity was found to be 20/500 in her left eye. The anterior segment examination was significant for pigment on the anterior capsule of the lenses bilaterally consistent with prior inflammation. There was no active intraocular inflammation in either eye. Her dilated fundus exam of the left eye was significant for central thickening of the macula with pinpoint parafoveal hemorrhage (Fig. 1a). Spectral-domain optical coherence tomography (SD-OCT) imaging showed distortion of foveal contour and a break in Bruch’s membrane with disruption of overlying photoreceptors consistent with choroidal neovascularization (Fig. 2a). Fluorescein angiography was deferred as the patient was pregnant. To support further the diagnosis of TINU, the patient was tested for HLA-DRB1*0102 and the result was positive for subtype DR1,8; DQ 4,5. The patient was offered intraocular anti-vascular endothelial growth factor (anti-VEGF) therapy or intraocular steroids; however, following discussion of the risks, benefits, and alternatives, the patient declined any treatment until after delivery.Fig. 1


Choroidal neovascularization secondary to tubulointerstitial nephritis and uveitis syndrome (TINU) in an adult patient.

Heymann HB, Colon D, Gill MK - J Ophthalmic Inflamm Infect (2015)

a Color fundus photo of left eye shows pinpoint hemorrhage overlying the fovea. b Fluorescein angiography of left eye demonstrates late phase parafoveal leakage consistent with neovascularization
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596145&req=5

Fig1: a Color fundus photo of left eye shows pinpoint hemorrhage overlying the fovea. b Fluorescein angiography of left eye demonstrates late phase parafoveal leakage consistent with neovascularization
Mentions: On her presentation to the retina service, the patient’s best corrected visual acuity was found to be 20/500 in her left eye. The anterior segment examination was significant for pigment on the anterior capsule of the lenses bilaterally consistent with prior inflammation. There was no active intraocular inflammation in either eye. Her dilated fundus exam of the left eye was significant for central thickening of the macula with pinpoint parafoveal hemorrhage (Fig. 1a). Spectral-domain optical coherence tomography (SD-OCT) imaging showed distortion of foveal contour and a break in Bruch’s membrane with disruption of overlying photoreceptors consistent with choroidal neovascularization (Fig. 2a). Fluorescein angiography was deferred as the patient was pregnant. To support further the diagnosis of TINU, the patient was tested for HLA-DRB1*0102 and the result was positive for subtype DR1,8; DQ 4,5. The patient was offered intraocular anti-vascular endothelial growth factor (anti-VEGF) therapy or intraocular steroids; however, following discussion of the risks, benefits, and alternatives, the patient declined any treatment until after delivery.Fig. 1

Bottom Line: Clinical examination and investigations show the development of CNV in the left eye.The patient was treated with ranibizumab (Genentech, San Francisco, CA) intravitreal injections with improvement in symptoms and clinical findings.The CNV associated with TINU is responsive to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 440, Chicago, IL, 60611, USA.

ABSTRACT

Background: Inflammation is a well-known risk factor for the development of choroidal neovascularization (CNV), yet not all causes of intraocular inflammation have been documented to cause CNV. Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare cause of intraocular inflammation mostly in pediatric patients and only seldom has been associated with development of CNV.

Findings: A 34-year-old pregnant female with a past history of bilateral ocular inflammation secondary to TINU presents 1 year after diagnosis with vision loss in the left eye. Clinical examination and investigations show the development of CNV in the left eye. The patient was treated with ranibizumab (Genentech, San Francisco, CA) intravitreal injections with improvement in symptoms and clinical findings.

Conclusions: We report the first case of CNV secondary to TINU in an adult patient. The CNV associated with TINU is responsive to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.

No MeSH data available.


Related in: MedlinePlus