Original article
Clinical course of HTLV-1 infection associated intermediate uveitis
Evolución clínica de la uveítis intermedia asociada a infección por el virus linfotrópico de células T humano tipo 1 (HTLV-1)
a Departamento de Úvea, Oftálmica Clínica de la Visión, Lima, Peru
b Unidad de Investigación Clínica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
c Departamento de Oftalmología, Hospital Nacional Guillermo Almenara Yrigoyen, Lima, Peru
d Unidad de Oftalmología Basada en Evidencias (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
e Departamento de Retina, Oftálmica Clínica de la Visión, Lima, Peru
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"apellidos" => "Arana-Kaik" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Departamento de Úvea, Oftálmica Clínica de la Visión, Lima, Peru" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Investigación Clínica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Nacional Guillermo Almenara Yrigoyen, Lima, Peru" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Oftalmología Basada en Evidencias (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Retina, Oftálmica Clínica de la Visión, Lima, Peru" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución clínica de la uveítis intermedia asociada a infección por el virus linfotrópico de células T humano tipo 1 (HTLV-1)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1263 "Ancho" => 1508 "Tamanyo" => 70671 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of initial and final visual acuity (VA) per eye.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Human T-cell lymphotropic virus type 1 (HTLV-1) uveitis was described by Nakao in 1989 in patients with tropical spastic paraparesis<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and later, in isolation, by Mochizuki.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> It is characterised by intermediate uveitis with vitreous opacity and retinal vasculitis. Diagnosis is based on seropositivity for HTLV-1 virus, but can also be arrived at by polymerase chain reaction in aqueous humour and peripheral blood samples, as well as exclusion of other known causes of uveitis,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> without association with known human leukocyte antigens.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Treatment is with local corticosteroids, avoiding systemic immunosuppression.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">HTLV-1 uveitis occurs most frequently in endemic regions such as Japan, central and equatorial Africa, Oceania and South America.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6–8</span></a> In Europe, HTLV-1 infection is uncommon and, in Spain, it occurs exceptionally in Spanish patients with blood transfusions, and more frequently in those who have resided in endemic areas or migrants from Latin America and Africa.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a> In Latin America, it occurs more frequently in Amerindian populations in Argentina, Colombia, Paraguay, Chile, Bolivia and Peru (Quechua and Aymara ethnicity), in Afro-American populations in Brazil, French Guyana, Suriname, Colombia and Peru, in Japanese migrants in Bolivia, Brazil and Peru, and in the general population in Brazil, Colombia and Peru.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,13,14</span></a> In Peru, HTLV-1 seroprevalence in the general population is around 2%, being higher in at-risk populations, such as sex workers.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In a series of uveitis cases conducted in Lima (Peru), Siverio and Campos reported that intermediate uveitis associated with HTLV-1 infection accounted for 29.4% of all cases of intermediate uveitis, being the second most frequent after idiopathic intermediate uveitis. In patients over 50 years of age this entity accounted for 45.5% of intermediate uveitis cases (personal communication).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The aim of the present study is to describe the characteristics associated with the presentation, treatment and follow-up of HTLV-1-associated intermediate uveitis in patients seen at a clinic in Lima.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective, descriptive and longitudinal study was conducted that included patients with a diagnosis of intermediate uveitis associated with HTLV-1 infection, seen and diagnosed consecutively in a private ophthalmology referral clinic (Oftálmica Clínica de la Visión, Lima, Peru) by an ophthalmologist specialising in uveitis (C. Siverio) from 2012 to 2018. Intermediate uveitis was defined as uveitis in which the presence of inflammatory cells is observed mainly in the vitreous humour (intermediate uveitis proper, according to the SUN classification<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>) or in the vitreous humour and anterior chamber equally (intermediate and anterior uveitis, according to the SUN classification) without inflammatory lesions in the choroids or retina. A case of intermediate uveitis associated with HTLV-1 infection was defined as a case with positive ELISA serology for HTLV 1 and 2 and negative for treponemal (FTA-Abs), non-treponemal (VDRL or RPR) tests, without suspicion of tuberculosis (normal chest X-ray or negative PPD) and without symptoms suggestive of demyelinating neurological disease (therefore no brain MRI was requested). The degree of cellularity in the anterior chamber and the course of the disease was determined using the SUN criteria<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and the degree of opacity in the vitreous cavity according to the scheme described by Foster et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To investigate the presence of cystoid macular edema, posterior pole optical coherence tomography was performed in 9 patients with fundus examination suspected of having this condition. Retinal angiofluoresceinography was used in only one patient. Eyes diagnosed with HTLV-1-associated intermediate uveitis were treated with periocular injections of depot corticosteroids (40 mg/ml triamcinolone acetate or methylprednisolone acetate), which were repeated at intervals of no less than 4 weeks until significant improvement in the patient's symptoms and inflammatory signs was evident. Prednisolone acetate drops and oral prednisone were also administered as warranted by the inflammatory condition.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Episodes of <span class="elsevierStyleItalic">acute</span> uveitis were classified as <span class="elsevierStyleItalic">acute</span> if inflammatory cells were present in the intraocular cavity for less than 3 months, <span class="elsevierStyleItalic">recurrent</span> if they recurred 3 months or more after the previous episode, and <span class="elsevierStyleItalic">chronic</span> if inflammatory cells were present for more than 3 months. In some chronic cases, attempts were made to reduce recurrences by using low doses of oral prednisone (5-7.5 mg/day) for prolonged periods (more than 3 months).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The medical records system of the clinic was accessed and data were obtained on the epidemiological, clinical, therapeutic and follow-up characteristics of patients with a diagnosis of uveitis evaluated between 2012 and 2018. Qualitative variables were expressed as proportions and percentages, and quantitative variables as averages, means and standard deviation. Microsoft Excel 2019 ® and SPSS v. 25.0 ® were used for data processing and analysis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Out of 389 patients with uveitis evaluated in the study period, 74 exhibited intermediate uveitis, of which 18 (28 eyes) had a diagnosis of intermediate uveitis associated with HTLV-1 infection. The mean age of these patients at presentation was 57.3 years (range: 38-76). Of the total, 14 patients (77.8%) were aged 50 or older. The sex distribution was: 12 females (66.6%) and 6 males (33.3%). The average follow-up time was 1280 days (range: 0-4105).</p><p id="par0045" class="elsevierStylePara elsevierViewall">At presentation, 12 patients (66.6%) had involvement in only one eye and 6 patients (33.3%) in both eyes. The most frequent symptoms were blurred or decreased vision in 22 eyes (78.6%) and floaters in 16 eyes (57.1%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Initial best corrected visual acuity (BCVA) was between 20/20 and hand movement, being 20/40 or better in 15 eyes (53.6%) and 20/70 or better in 23 eyes (82.1%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Mean baseline intraocular pressure was 14.95 mmHg; in 2 eyes it was 22 mmHg while 5 eyes had a history of uveitis associated with ocular hypertension prior to the current presentation. Clinical examination of the anterior segment revealed retrokeratotic precipitates in 14 eyes (50%), with spiculated precipitates being more frequent: 5 eyes (17.9%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Cells in the aqueous humour were found in 17 eyes (60.7%), in which the most frequent degree of cellularity was 0.5+ to 1+: 11 eyes (39.3%). The degree of vitreous opacity was mild (1-2 + ) in 22 eyes (78.5%). Fundus examination revealed the presence of retinal vasculitis in 5 eyes (17.9%). Other clinical signs were found at presentation, including epiretinal infiltrates in 7 eyes (25%). No <span class="elsevierStyleItalic">pars plana</span> exudates, retinal hemorrhages or hemovitreous hemorrhages were found in any eye.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Patients affected in both eyes increased from 6 (33%) at presentation to 10 (55.5%) at the end of follow-up. The course of the disease was chronic in 17 eyes (60.7%), recurrent in 5 eyes (17.9%) and acute in 4 eyes (14.3%). In 2 eyes the follow-up time was less than 3 months, so the course of the disease could not be established.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The most frequent treatment for acute conditions with greater symptomatology or inflammatory signs was periocular injection of triamcinolone or methylprednisolone (40 mg/1 cc), which was applied at some point during follow-up in 15 eyes (53.6%). The number of applications ranged from 1 to 7 applications per eye, with a minimum time of 4 weeks between multiple applications. Prednisolone acetate 1% drops were used in 16 eyes (60.7%). Oral prednisone was administered in some cases to control the acute condition at a dose of 1 mg/kg per day for a short time and, in other cases, to prevent recurrences at doses of 7.5 mg/kg per day or less for a long time. Prednisolone acetate 1% drops were also used in 16 eyes (60.7%).</p><p id="par0060" class="elsevierStylePara elsevierViewall">The following complications occurred: epimacular membrane in 14 eyes (50%), cataract in 6 eyes (21.4%) and glaucoma in 2 eyes (7.1%). No eyes were found with cystoid macular edema. Surgeries performed during the follow-up time were cataract in 3 eyes (10.7%) and glaucoma in 2 eyes (7.2%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">At the end of follow-up, only 2 eyes lost one line of vision, 2 maintained initial visual acuity (VA) and the other 24 (85.7%) improved to varying degrees (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The final VA was 20/40 or better in 24 eyes (85.7%) and 20/70 or better in 27 eyes (96.4%). The causes of a final VA of 20/50 or worse were: vitreous opacity in 2 eyes, epimacular membrane in one eye and keratoconus (not related to uveitis) in one eye.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">In the present study, intermediate uveitis associated with HTLV-1 infection was observed to occur predominantly in the second half of life, with an average patient age of 57.3 years. In other case series, the average age was 42.8 years (Nakao et al.),<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> 47 years (Rathsam-Pinheiro)<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and 49.5 years.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> This contrasts with the younger age of presentation reported for other types of intermediate uveitis, such as <span class="elsevierStyleItalic">pars planitis</span>, which is more common in children and adolescents.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Female patients predominated over male patients, at a ratio of approximately 2:1, similar to that shown in other series.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23–25</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the clinical picture at presentation, we observed that this disease produced a mild to moderate decrease in VA (82% of eyes with vision of 20/70 or better), similar to that reported in other series.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,25,26</span></a> Similarly, we found that the degree of cellular infiltration in both the vitreous and anterior chamber was mild to moderate. No exudates were seen in the <span class="elsevierStyleItalic">pars plana</span>, unlike those seen in cases of <span class="elsevierStyleItalic">pars planitis</span>. Some eyes showed small, spiculated retrokeratic precipitates, similar to those seen in Fuchs’ heterochromic iridocyclitis. This finding, to our knowledge, has not been described in other series. At the end of the study, more than half of the patients had involvement in both eyes. Other authors report a higher proportion of patients with unilateral uveitis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,27</span></a> The course of uveitis was recurrent or chronic in 78.6% of eyes.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In terms of treatment, the most symptomatic cases were treated with periocular injections of depot corticosteroids (triamcinolone or methylprednisolone), as this is the most effective treatment with the least adverse effects. However, in several cases multiple injections were necessary to control inflammation. In some, low-dose oral prednisone was used in an attempt to reduce the number of recurrences; however, we cannot conclude from the present study that this measure had an effect. There are no studies demonstrating the effectiveness and safety of immunosuppressive therapy in patients with uveitis associated with systemic HTLV-1 infection. Biological treatments such as adalimumab, a tumour necrosis factor monoclonal antibody -α, one of the most widely used medicament for treating inflammatory diseases, could increase the viral load and put the patient at risk of developing systemic manifestations, such as adult T-cell leukaemia/lymphoma or HTLV-1-associated myelopathy. However, an <span class="elsevierStyleItalic">in vitro</span> study has been conducted with this drug for the topical treatment of HTLV-1-associated uveitis with apparently beneficial results.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Complications were mild, the most frequent being epimacular membrane; however, this was clinically significant in only one eye. No other complications were found, such as cystoid macular edema or vitreous hemorrhage, which are common in other intermediate uveitis such as <span class="elsevierStyleItalic">pars planitis</span>. In the present study, 85.7% of eyes improved one or more lines of vision at the end of follow-up, which is better than reported in other studies: Nakao<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> (63.5%) and Kase<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> (71.4%). At the end of follow-up, most patients had good VA.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The limitations of the present study are due to its retrospective nature. Diagnosis was based on a compatible clinical picture and serological tests, but not on molecular tests for virus detection in intraocular fluids. However, the proportion of HTLV-1 seropositivity in patients with intermediate uveitis in Peru (29.4%) compared to the general population (2%) suggests a very strong causal association.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Intermediate uveitis associated with HTLV-1 infection occurred mainly in patients in the second half of life, with a recurrent or chronic course and with a good visual prognosis.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">Self-financed by the authors.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1740878" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1535377" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1740877" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1535378" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-01-13" "fechaAceptado" => "2021-05-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1535377" "palabras" => array:3 [ 0 => "HTLV-I Infections" 1 => "Intermediate uveitis" 2 => "Infectious uveitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1535378" "palabras" => array:3 [ 0 => "Infección por HTLV-1" 1 => "Uveítis intermedia" 2 => "Uveítis infecciosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical features at presentation, delivered treatment and follow-up of a case series of human T-cell lymphotropic virus type 1 (HTLV-1) associated intermediate uveitis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective, descriptive and longitudinal study of patients with HTLV-1 associated intermediate uveitis treated at a reference ophthalmology facility in Lima, Peru, during the years 2012 to 2018.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 18 patients (28 eyes) were included, the average age at presentation was 57.3 years, 66.6% were women, and the average follow-up time was 1,280 days. The most frequent symptoms were blurred or diminished vision (78.6%) and floaters (57.1%). Best corrected visual acuity was 20/40 or better in 53.6%. The mean initial intraocular pressure was 14.95 mmHg. Keratic precipitates were observed in 50% of eyes, 17.9% were of the stellate type. The most frequent treatment was periocular corticosteroid injections (53.6%). Complications such as epimacular membrane (50%), cataract (21.4%) and glaucoma (7.1%) occurred. At the end of follow-up, only 2 eyes lost one line of vision; the final best corrected visual acuity was 20/40 or better in 85.7%, and 20/70 or better in 96.4%. Patients with both eyes affected increased from 33% at presentation to 55.5%. The course of the disease was chronic in 60.7%.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">HTLV-1 associated intermediate uveitis mainly occurred in patients in the second half of life, developing a chronic course and with good visual prognosis.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Describir las características asociadas a la presentación, tratamiento y seguimiento de una serie de casos de uveítis intermedia asociada al virus linfotrópico de células T humano de tipo 1 (HTLV-1).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo, descriptivo y longitudinal. Se incluyó a pacientes con uveítis intermedia asociada a infección por HTLV-1 atendidos en una clínica oftalmológica de referencia de Lima (Perú), durante 2012-2018.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluyó a 18 pacientes (28 ojos). La edad promedio a la presentación fue de 57,3 años; el 66,6% fueron mujeres. El tiempo de seguimiento promedio fue de 1.280 días. Los síntomas más frecuentes fueron visión borrosa o disminuida (78,6%) y visión de cuerpos flotantes (57,1%). La agudeza visual mejor corregida fue de 20/40 o mejor en el 53,6%. La presión intraocular inicial promedio fue de 14,95 mmHg. Se observaron precipitados retroqueráticos en el 50% de ojos, siendo el tipo más frecuente el espiculado (17,9% de los ojos). El tratamiento más frecuente fue la inyección periocular de corticoides (en el 53,6% de los ojos). Se presentaron complicaciones como membrana epimacular (50%), catarata (21,4%) y glaucoma (7,1%). Al final del seguimiento, solo 2 ojos perdieron una línea de visión; la agudeza visual mejor corregida final fue de 20/40 o mejor en el 85,7%, y de 20/70 o mejor en el 96,4%. Los pacientes afectados en ambos ojos aumentaron de 33% a la presentación a 55,5%. El curso de la enfermedad fue crónico en el 60,7%.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La uveítis intermedia asociada a infección por HTLV-1 se presentó principalmente en la segunda mitad de la vida, con curso crónico y buen pronóstico visual.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Siverio-Llosa C, Silva-Ocas I, Gálvez-Olórtegui T, Arana-Kaik G. Evolución clínica de la uveítis intermedia asociada a infección por el virus linfotrópico de células T humano tipo 1 (HTLV-1). Arch Soc Esp Oftalmol. 2022;97:386–390.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1263 "Ancho" => 1508 "Tamanyo" => 70671 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of initial and final visual acuity (VA) per eye.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms and signs \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blurred or impaired vision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (78,6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Floating vision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (57,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Redness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (14,3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Photophobia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (14,3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (10,7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Photopsies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epiretinal infiltrates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chorioretinal scars \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (14,3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Snowballs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cellular precipitates on posterior hyaloid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diffuse atrophy of the iris \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild eye redness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Corneal edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple subretinal infiltrates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3,6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Symptoms and signs at first assessment.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">BCVA: best corrected visual acuity; HM: hand movement.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BCVA \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/20-20/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/30-20/40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/50-20/70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/100-20/150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/200-20/400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Best corrected visual acuity at first assessment.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of precipitates \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small spiculated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cells in endothelium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Large \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Types of retrokeratotic precipitates during the first assessment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninfectious anterior uveitis in patients infected with human T-lymphotropic virus type I" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. 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