Long-term evaluation of dexamethasone intravitreal implant in vitrectomized and non-vitrectomized eyes with macular edema secondary to non-infectious uveitis. - Pelegrín, L.; de la Maza, M. S.; Molins, B.; Ríos, J.; Adán, A. (Eye (London, England), 2015)
PURPOSE: To compare dexamethasone (DEX) intravitreal implant effect in non-vitrectomized (non-PPV) vs vitrectomized (PPV) eyes with macular edema (ME) secondary to non-infectious uveitis. METHODS: Medical records of patients with uveitic ME treated with DEX-intravitreal implant were reviewed. Main outcome measures were changes in central retinal thickness (CRT), best corrected visual acuity (BCVA), intraocular pressure (IOP), vitreous haze and adverse events. Statistical analysis was performed by Longitudinal Linear model using the General Estimating Equation methodology. RESULTS: Forty-two eyes of 32 patients were included. Median follow-up time was 18 months (interquartile range (IQR): 12-24). Median CRT showed its maximum decrease at the first month in non-PPV and PPV eyes without statistically significant differences between both groups (P=NS). Median Snellen BCVA, converted to logarithm (LogMAR), showed its maximum improvement at third month in both groups without statistically significant differences between them (P=NS). Median IOP was higher in non-PPV eyes than in PPV eyes from third (P=0.025) to 12th month (P=0.013). Vitreous haze score improved in both groups since first month and showed no differences (P=0.706). Reinjection was performed in 45.2% of eyes at a median time of 5 months IQR: (5-6). Ocular hypertension (47.6%) was the most common adverse event. CONCLUSIONS: DEX-intravitreal implant for uveitic ME has similar long-term safety profile and good response measured in terms of CRT decrease, BCVA, and vitreous haze improvement in both groups. Non-PPV eyes following DEX-intravitreal implant showed higher IOP increase than PPV eyes, showing the need for close IOP monitoring.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Adolescent; Child; Drug Evaluation; Drug Implants; Intravitreal Injections; Uveitis/complications/*drug therapy; Retina/pathology; Visual Acuity/drug effects; Macular Edema/*drug therapy/etiology; Dexamethasone/*administration & dosage/adverse effects; Glucocorticoids/*administration & dosage/adverse effects; Intraocular Pressure/drug effects; Retreatment; *Vitrectomy

Successful multi-modality approach in management of human leukocyte antigen-B27 associated fulminant panuveitis - rare presentation. - Kumar, Ashok; Ambiya, Vikas; Kapoor, Gaurav; Arora, Amit (Romanian journal of ophthalmology, 2018)
Objective: To report a multimodality approach in the management of human leukocyte antigen B27 (HLA-B27) associated fulminant posterior uveitis, an uncommon presentation, with good visual and anatomical recovery. Methods: A 33-year-old young male presented with HLA-B27 associated severe posterior uveitis, which is a relatively uncommon presentation. The patient had severe vitritis with papillitis, which was sequentially and stepwise managed with oral steroids, pars plana vitrectomy, immunosuppressive agents and sustained release intravitreal steroid implant. Results: The patient had a good recovery of vision with complete resolution of inflammation and without any long-term complication. Conclusion: HLAB27 positivity can be associated with an uncommon presentation of fulminant posterior uveitis that requires a judicious and stepwise multimodality approach in its management, and can have a good visual and anatomical outcome as demonstrated in our case.
Keywords: Humans; Male; Adult; Glucocorticoids/*therapeutic use; Combined Modality Therapy; Immunosuppressive Agents/*therapeutic use; Visual Acuity; Drug Implants; Ozurdex; *Vitrectomy; HLA-B27; HLA-B27 Antigen/*immunology; immunosuppressive agents; Panuveitis/diagnosis/immunology/*therapy; papillitis; pars plana vitrectomy; posterior uveitis; Uveitis, Posterior/diagnosis/immunology/*therapy

Enteric-coated mycophenolate sodium in the treatment of non-infectious intermediate uveitis: results of a prospective, controlled, randomised, open-label, early terminated multicentre trial. - Deuter, Christoph M. E.; Engelmann, Katrin; Heiligenhaus, Arnd; Lanzl, Ines; Mackensen, Friederike; Ness, Thomas; Pleyer, Uwe; Stuebiger, Nicole; Wilhelm, Barbara; Luedtke, Holger; Zierhut, Manfred; Doycheva, Deshka (The British journal of ophthalmology, 2018)
BACKGROUND/AIMS: To evaluate the efficacy, safety and tolerability of enteric-coated mycophenolate sodium (EC-MPS) in combination with low-dose corticosteroids compared with a monotherapy with low-dose corticosteroids in subjects with non-infectious intermediate uveitis (IU). METHODS: Open-label, prospective, controlled, randomised multicentre trial. Patients were randomised in a 1:1 ratio to either the treatment group (prednisolone plus EC-MPS) or control group (prednisolone monotherapy). Patients in the control group who relapsed within 6 months changed to the crossover group (prednisolone plus EC-MPS). Maximum treatment duration was 15 months. The primary endpoint was the time to first relapse in the treatment group and control group. RESULTS: Forty-one patients at eight sites were analysed. Twenty-two patients were allocated to the treatment group, with 19 patients in the control group. A first relapse occurred in 9 patients (40.9%) in the treatment group and 15 patients (78.9%) in the control group (p=0.03). The median time to the first relapse was >15 months for the treatment group and 2.8 months for the control group (p=0.07). The probability of relapse-free survival at month 15 was estimated to be 52.9% in the treatment group and 19.7% in the control group (p=0.01). 15 patients changed to the crossover group. Of these, only four patients developed a second relapse. No safety concerns arose during the trial. Only one patient had to discontinue EC-MPS due to increased liver enzymes. CONCLUSION: EC-MPS can be considered an effective and well-tolerated immunosuppressive drug to prevent relapses in patients with chronic IU. TRIAL REGISTRATION NUMBER: EUDRACT number: 2009-009998-10, Results.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Prospective Studies; Young Adult; Adolescent; Prednisolone/therapeutic use; Anti-Inflammatory Agents/therapeutic use; Immunosuppressive Agents/*therapeutic use; Disease-Free Survival; Visual Acuity; Uveitis, Intermediate/*drug therapy; Mycophenolic Acid/*therapeutic use; *immunosuppressive treatment; *intermediate uveitis; *mycophenolic acid

Treatment with repeat dexamethasone implants results in long-term disease control in eyes with noninfectious uveitis. - Tomkins-Netzer, Oren; Taylor, Simon R. J.; Bar, Asaf; Lula, Albert; Yaganti, Satish; Talat, Lazha; Lightman, Sue (Ophthalmology, 2014)
PURPOSE: To describe the long-term outcome of eyes with uveitis after repeated treatment with dexamethasone implants (Ozurdex; Allergan, Inc., Irvine, CA). DESIGN: Retrospective, observational case series. PARTICIPANTS: Thirty-eight eyes of 27 patients with uveitis that were treated with 61 dexamethasone implants. METHODS: All eyes underwent dexamethasone pellet implantation. Anatomic and functional outcomes, as well as ocular complications, were noted. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze score, and presence of increased intraocular pressure or cataract. RESULTS: Average follow-up was 17.3 ± 1.8 months after the first implant (median, 13.3 months; range, 3-54.5 months; 54.65 eye-years), with 14 eyes (36.9%) receiving a single implant and 24 eyes (63.1%) receiving multiple implantations. After the first implantation, average BCVA improved significantly from 0.47 ± 0.05 logarithm of the minimum angle of resolution (logMAR) units (Snellen equivalent, 20/60) to 0.27 ± 0.07 logMAR (Snellen equivalent, 20/37; P<0.001); CRT decreased by 263 ± 44.22 μm (P = 0.003), although macular edema persisted in 50% of eyes, and the percentage of eyes achieving a vitreous haze score of 0 increased from 58% to 83% (P = 0.03). The median duration of therapeutic effect after the first injection was 6 months (range, 2-42 months), with a similar response achieved after each repeat implantation. The accumulated effect of repeat dexamethasone implants resulted in a continued improvement in BCVA (R(2) = 0.91; P<0.0001), with significant improvement and stabilization of CRT. After repeated implantations, 2 eyes had progression of posterior subcapsular opacities, although neither required surgery. There were 7 instances of increased intraocular pressure of more than 21 mmHg at a rate of 0.13 per eye-year, all of which responded to pharmacologic treatment. CONCLUSIONS: The accumulated effect of repeat dexamethasone pellet implantations improves retinal thickness and resolves ocular inflammation, resulting in restoration of ocular function. Ocular complications were minimal, with no eyes requiring surgery for increased ocular pressure or progression of cataract.
Keywords: Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Tomography, Optical Coherence; Visual Acuity/physiology; Drug Implants; Uveitis/*drug therapy; Cataract/chemically induced; Dexamethasone/*administration & dosage/adverse effects; Glucocorticoids/*administration & dosage/adverse effects; Vitreous Body/drug effects; Intraocular Pressure/drug effects; Retreatment; Macular Edema/drug therapy; Ocular Hypertension/chemically induced; Retina/drug effects/pathology

Viscocanalostomy in patients with glaucoma secondary to uveitis: preliminary report. - Miserocchi, Elisabetta; Carassa, Roberto G.; Bettin, Paolo; Brancato, Rosario (Journal of cataract and refractive surgery, 2004)
PURPOSE: To assess the efficacy of viscocanalostomy in eyes with uncontrolled glaucoma secondary to uveitis. SETTING: Immunology and Uveitis Service, Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milan, Italy. METHODS: All consecutive patients with glaucoma secondary to uveitis and inadequate intraocular pressure (IOP) control (IOP >21 mm Hg) under maximum-tolerated medical therapy had viscocanalostomy. Patients with active uveitis at the time of surgery, peripheral anterior synechias in the upper quadrant, previous ocular surgery, or sight in only 1 eye were excluded. Eleven eyes of 11 patients with a mean age of 52.2 years +/- 19.9 (SD) were operated on. The etiology of the uveitis was recorded. The ocular variables were IOP, best corrected visual acuity, number of antiglaucoma medications, and complications. Success was defined as an IOP between 6 mm Hg and 21 mm Hg (inclusive) without medication (complete success), or with 1 or more antiglaucoma medications and/or goniopuncture (qualified success). The mean follow-up was 45.9 +/- 11.6 months (range 23 to 56 months). RESULTS: Viscocanalostomy significantly reduced IOP from a mean baseline value of 35.1 +/- 7.0 mm Hg (range 23 to 48 mm Hg) to a mean final value of 18.1 +/- 4.9 mm Hg (range 12 to 30 mm Hg) (P<.0001). Complete success was achieved in 6 eyes (54.5%) and qualified success, in 10 eyes (90.9%). The mean number of preoperative and final antiglaucoma medications was 3.4 +/- 0.8 (range 2 to 4) and 0.7 +/- 1.2 (range 0 to 3), respectively (P =.0004). Complications were minor and included transient hyphema and postoperative IOP spike. CONCLUSION: This preliminary study suggests that viscocanalostomy is a safe, effective surgical alternative for treating glaucoma in patients with uveitis.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Follow-Up Studies; Treatment Outcome; Safety; Adolescent; Antihypertensive Agents/therapeutic use; Visual Acuity; Intraocular Pressure; Uveitis/*complications; Filtering Surgery/*methods; Glaucoma/*etiology/*surgery

Revisiting early postoperative follow-up after phacoemulsification. - Ahmed, Iqbal Ike K.; Kranemann, Christoph; Chipman, Mary; Malam, Faiz (Journal of cataract and refractive surgery, 2002)
PURPOSE: To determine whether postoperative evaluation of routine phacoemulsification can be safely and effectively performed on the day of surgery and 4 days postoperatively and evaluate the incidence and management of early intraocular pressure (IOP) elevations 3 to 7 hours postoperatively in patients with or without glaucoma. SETTING: Community-based hospital. METHODS: This retrospective series comprised 465 consecutive patients who had phacoemulsification and intraocular lens implantation. All patients had postoperative follow-up on the day of surgery (3 to 7 hours postoperatively) and at 4 days. Patients were classified into 2 groups: nonglaucoma (NG), 396 patients; and glaucoma (GL), 69 patients. The main outcome measures were the incidence and management of postoperative complications including IOP spikes, wound leaks, uveitis, and endophthalmitis. RESULTS: Three to 7 hours postoperatively, 73 NG (18.4%) and 32 GL (46.4%) patients had IOP elevations greater than 28 mm Hg, a significant change from baseline (P <.0001). Fourteen NG (3.6%) and 13 GL (18.8%) patients had IOP elevations greater than 40 mm Hg (P <.0001). Significant IOP elevations were effectively managed with a paracentesis with or without short-term antiglaucoma medications on the day of surgery, with 75 NG (18.9%) and 39 GL (56.5%) patients requiring IOP intervention. There were no IOP elevations greater than 21 mm Hg on the next day or at 4 days. There were no complications that were missed at the same-day evaluation that may have been identified at the 1-day postoperative visit. CONCLUSIONS: The results indicate that after routine phacoemulsification, patients can be safely and effectively reviewed on the day of surgery and 4 days postoperatively to identify and manage early postoperative IOP spikes. A significant number of patients, particularly those with preexisting glaucoma, had potentially harmful IOP spikes 3 to 7 hours postoperatively.
Keywords: Humans; Time Factors; Follow-Up Studies; Retrospective Studies; Anti-Inflammatory Agents/therapeutic use; Antihypertensive Agents/therapeutic use; Visual Acuity; Intraocular Pressure; *Phacoemulsification; *Lens Implantation, Intraocular; Ocular Hypertension/diagnosis/drug therapy; Postoperative Care/*methods; Postoperative Complications/diagnosis/drug therapy; Steroids; Uveitis, Anterior/diagnosis/drug therapy; Wound Healing

The efficacy of sirolimus in the treatment of patients with refractory uveitis. - Shanmuganathan, V. A.; Casely, E. M.; Raj, D.; Powell, R. J.; Joseph, A.; Amoaku, W. M.; Dua, H. S. (The British journal of ophthalmology, 2005)
AIMS: To determine the efficacy of sirolimus in the treatment of patients with severe non-infectious uveitis. METHODS: Eight patients with severe non-infectious uveitis were recruited to an open study. Inclusion criteria were limited to patients whose disease was not controlled with at least two or more separate steroid sparing immunosuppressants (either because of unacceptable side effects or ineffectiveness of the drug) or who required regular doses of corticosteroids either as high dose systemic or orbital floor injections in order to control their disease. Intraocular inflammation, visual acuity, symptoms, corticosteroid burden, drug toxicity, and side effects were monitored. RESULTS: Sirolimus therapy was effective in five of the eight patients, all of whom had their dose of corticosteroids reduced or discontinued. Treatment in three patients was considered a failure as it caused intolerable side effects and/or failed to control the uveitis. Side effects were common and were typically gastrointestinal or cutaneous in nature. The severity of symptoms was dose dependent in most cases and occurred at trough blood levels above 25 ng/ml. CONCLUSION: Sirolimus is an effective and potent immunosuppressive treatment in the majority of patients with non-infectious uveitis and can reduce the need for long term supplementary corticosteroid therapy. Further studies are required to establish the long term efficacy and safety of sirolimus alone or in combination with other steroid sparing immunosuppressants.
Keywords: Female; Humans; Male; Middle Aged; Adult; Treatment Outcome; Severity of Illness Index; Drug Administration Schedule; Recurrence; Chronic Disease; Prednisolone/administration & dosage; Glucocorticoids/administration & dosage; Visual Acuity/drug effects; Uveitis/*drug therapy/physiopathology; Immunosuppressive Agents/adverse effects/*therapeutic use; Sirolimus/adverse effects/*therapeutic use

Combined orbital floor betamethasone and depot methylprednisolone in uveitis. - Duguid, I. G. M.; Ford, R. L.; Horgan, S. E.; Towler, H. M. A.; Lightman, S. L. (Ocular immunology and inflammation, 2005)
PURPOSE: To evaluate the outcome of orbital floor injection of betamethasone and methylprednisolone in the management of uveitis, with particular reference to its efficacy in avoiding increase in systemic immunosuppressive drugs. METHODS: A sample of all patients attending the Uveitis Service at Moorfields Eye Hospital was carried out over a three-month period. All patients who had received one or more orbital floor injections of betamethasone (4 mg) and methylprednisolone (Depo-Medrone; 40 mg) in the management of their uveitis were identified and the case notes reviewed. RESULTS: A total of 48 patients who had received 75 orbital floor injections were identified during the sample period. Most patients had either panuveitis (n = 24) or pars planitis (n = 14). One-month post-injection visual acuity (VA) had improved by at least one Snellen line after 33/75 injections (44%) and at least two lines after 11/75 (15%), was unchanged after 25 (33%), but had deteriorated in 14 (19%). VA was not recorded after 3/75 injections. The only complications recorded were periorbital haemorrhage (n = 1) and complaints of persistent pain after an injection (n = 1). Symptoms (pain and subjective vision) improved after 36/75 injections (47%), were unchanged after 24 (32%), and were reported as worse after five (7%). Additionally, three patients reported an improvement in symptoms which lasted less than one month. Signs other than VA were improved after 28/75 (37%), were unchanged after 38 (51%), and deteriorated after only one injection. Of the 31 patients given orbital floor injections to avoid systemic therapy, seven (23%) subsequently went on to require it, and the clinical course then improved in 45%. CONCLUSIONS: Combined orbital floor injection of betamethasone and methylprednisolone can result in improved visual acuity, symptoms, and signs of inflammation in uveitis, and may therefore avoid the necessity for increased systemic medication.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Treatment Outcome; Adolescent; Glucocorticoids/*therapeutic use; Child; Child, Preschool; Injections; Visual Acuity; Uveitis/*drug therapy; Delayed-Action Preparations; Betamethasone/*therapeutic use; Methylprednisolone Acetate; Methylprednisolone/*analogs & derivatives/*therapeutic use; Orbit/*drug effects

Efficacy of etanercept in preventing relapse of uveitis controlled by methotrexate. - Foster, C. Stephen; Tufail, Fehma; Waheed, Nadia Khalida; Chu, David; Miserocchi, Elisabetta; Baltatzis, Stefanos; Vredeveld, Cindy M. (Archives of ophthalmology (Chicago, Ill. : 1960), 2003)
OBJECTIVE: To evaluate the efficacy of etanercept vs placebo in preventing relapses of uveitis in patients taking methotrexate with control of uveitis and whose methotrexate dosage was being tapered. METHODS: Patients with chronic or recurrent noninfectious uveitis with inflammation controlled by low-dose methotrexate were randomized to either the drug or placebo group in a double-masked manner, given a methotrexate taper schedule, and followed for 24 weeks. The main outcome measures were control of inflammation, visual acuity, and adverse reactions. Data were analyzed both as an attempt-to-treat analysis and an analysis only of those patients who completed the study. RESULTS: A total of 20 patients were randomized to the drug and placebo groups. Relapse of uveitis occurred in 3 of 10 patients in the treatment group and 5 of 10 patients in the control group. Two patients in the treatment group withdrew prematurely from the study due to adverse effects. There was no significant difference between the treatment and placebo groups with regard to the rate of relapse and the final visual acuity. No patient suffered from any irreversible, long-term morbidity or mortality. CONCLUSION: Etanercept has no significant efficacy over placebo in preventing relapses of uveitis in patients being tapered from methotrexate.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Prospective Studies; Safety; Etanercept; Chronic Disease; Methotrexate/administration & dosage/*therapeutic use; Visual Acuity; Immunosuppressive Agents/administration & dosage/*therapeutic use; Secondary Prevention; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use; Immunoglobulin G/administration & dosage/*therapeutic use; Receptors, Tumor Necrosis Factor/administration & dosage/*therapeutic use; Recombinant Fusion Proteins/therapeutic use; Uveitis/complications/*prevention & control

Serious ocular complications of cosmetic iris implants in 14 eyes. - Hoguet, Ambika; Ritterband, David; Koplin, Richard; Wu, Elaine; Raviv, Tal; Aljian, John; Seedor, John (Journal of cataract and refractive surgery, 2012)
PURPOSE: To report the presentation and subsequent management of a series of patients presenting with cosmetic iris implants. SETTING: New York Eye and Ear Infirmary, New York, New York, USA. DESIGN: Case series. METHODS: In this evaluation of patients with NewColorIris cosmetic iris implants, data collected included patient demographics, visual acuity, intraocular pressure (IOP), endothelial cell count, and slitlamp examination findings at presentation. Medical and surgical interventions and the postoperative course were recorded. RESULTS: Fourteen eyes of 7 patients (ages 22 to 60; 71% men) were identified. Nine eyes (64%) presented with decreased visual acuity, 7 (50%) had elevated IOP, 5 (36%) had corneal edema, and 5 (36%) had anterior uveitis. All 14 eyes had explantation of the iris prosthesis (range 4 to 33 months after placement). The minimum follow-up after implant removal in all eyes was 2 months (range 2 to 28 months). Intraoperative complications included suprachoroidal hemorrhage during explantation in 1 eye. Postoperative complications included corneal edema (8 eyes), cataract (9 eyes), and increased IOP/glaucoma (7 eyes). Secondary surgeries included Descemet-stripping automated endothelial keratoplasty (5 eyes), cataract extraction with intraocular lens placement (7 eyes), trabeculectomy (3 eyes), glaucoma drainage implant placement (3 eyes), and penetrating keratoplasty (1 eye). CONCLUSIONS: The cosmetic iris implants may result in severe ocular morbidity. Complications in our series included uveitis, glaucoma, corneal edema, and decreased visual acuity. Although explantation helped stabilize symptoms, additional medical and surgical intervention to control IOP and corneal decompensation was required in many cases. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Keywords: Female; Humans; Male; Middle Aged; Adult; Young Adult; Visual Acuity/physiology; Intraocular Pressure/physiology; Cell Count; Glaucoma Drainage Implants; Keratoplasty, Penetrating; *Eye Color; *Iris; *Postoperative Complications; Anterior Eye Segment/surgery; Corneal Edema/*etiology/surgery; Corneal Endothelial Cell Loss/pathology; Descemet Stripping Endothelial Keratoplasty; Device Removal; Ocular Hypertension/*etiology/surgery; Prostheses and Implants/*adverse effects; Uveitis, Anterior/*etiology/surgery

Long-term treatment of refractory posterior uveitis with anti-TNFalpha (infliximab). - Benitez-del-Castillo, J. M.; Martinez-de-la-Casa, J. M.; Pato-Cour, E.; Méndez-Fernández, R.; López-Abad, C.; Matilla, M.; Garcia-Sanchez, J. (Eye (London, England), 2005)
PURPOSE: To evaluate the long-term efficacy and safety of infliximab as treatment for noninfectious posterior uveitis. METHODS: An open-label clinical trial including seven patients (12 eyes) with posterior uveitis refractory to conventional treatment regimens with corticosteroids and at least one immunosuppressive agent. Three intravenous doses of 5 mg/kg of infliximab were administered at weeks 0, 2, and 6. Infliximab infusion was repeated in patients undergoing a relapse of uveitis after initial remission. Improvement was defined as amelioration of visual acuity or disappearance of retinal exudates and/or haemorrhages, decreased macular oedema and/or vitreous opacities. All patients were followed up for at least 36 months. RESULTS: Six of the seven patients (five diagnosed with Behçet's disease and one diagnosed with sarcoidosis) showed a significant improvement after the first infliximab dose. Only in one patient diagnosed with chronic idiopathic multifocal choroiditis did the drug have no effect, and this patient was withdrawn from the study. At the end of follow-up, one eye had lost one line of vision and three eyes showed improved vision. All eyes had improved in terms of signs of inflammation. No adverse effects of treatment were observed. CONCLUSION: Infliximab is efficient and safe for the long-term management of refractory posterior uveitis, especially in patients with predominant retinal vasculitis and vitritis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Treatment Outcome; Drug Administration Schedule; Recurrence; Antibodies, Monoclonal/*therapeutic use; Infliximab; Immunosuppressive Agents/*therapeutic use; Tumor Necrosis Factor-alpha/*antagonists & inhibitors; Visual Acuity; Uveitis, Posterior/*drug therapy/physiopathology; Behcet Syndrome/drug therapy/physiopathology

Ahmed valve implantation in glaucoma secondary to chronic uveitis. - Ozdal, P. C.; Vianna, R. N. G.; Deschênes, J. (Eye (London, England), 2006)
PURPOSE: To evaluate the efficacy of Ahmed valve (AV) implantation in patients with uveitic glaucoma. METHODS: In total, 18 patients (19 eyes) with glaucoma secondary to chronic uveitis, who underwent AV implantation were retrospectively reviewed. Visual acuity, intraocular pressure (IOP), and glaucoma medications at the most recent examination prior to surgery, were compared with those of last postoperative examination. The surgical success was defined as IOP less than 21 mmHg and greater than 4 mmHg without loss of light perception and visually devastating complications at the last postoperative examination. Decrease in the number of glaucoma medications was also a criterion for surgical success. RESULTS: The mean follow-up period was 26+/-9.7 months. The mean preoperative and postoperative IOPs were 33.3+/-9.7 (range, 20-57) mmHg and 17.3+/-10.8 (range, 6-40) mmHg respectively (P<0.0001). The mean number of antiglaucoma medications was 3.5+/-0.8 (range, 2-5) preoperatively and 1.4+/-1.3 (range, 0-4) postoperatively (P<0.0001). Valve occlusion (five eyes, 26.3%) was the most commonly observed complication. Surgical success was achieved in 13 eyes (68.4%). The cumulative probability of success was 94.4% at 1 year and 60% at 2 years. Five eyes (26.3%) with IOP greater than 21 mmHg and one (5.3%) with corneal decompensation requiring penetrating keratoplasty were considered as failures. CONCLUSIONS: The implantation of AV is an effective surgical procedure for the management of uveitic glaucoma. The inflammatory background might contribute to the occurrence of valve occlusion, which is the most common complication. Prevention of this complication is an essential factor for improving the surgical outcome.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Drug Administration Schedule; Adolescent; Chronic Disease; Child; Visual Acuity; *Glaucoma Drainage Implants; Intraocular Pressure; Uveitis/*complications; Antihypertensive Agents/administration & dosage; Glaucoma/etiology/physiopathology/*surgery; Prosthesis Failure; Prosthesis Implantation/adverse effects

Intravitreal triamcinolone for persistent cystoid macular oedema in eyes with quiescent uveitis. - Maca, Saskia M.; Abela-Formanek, Claudette; Kiss, Christopher G.; Sacu, Stefan G.; Benesch, Thomas; Barisani-Asenbauer, Talin (Clinical & experimental ophthalmology, 2009)
BACKGROUND: To determine the outcome following injections of triamcinolone acetate (IVTA) in the treatment of persistent cystoid macular oedema (CMO) in quiescent, non-infectious uveitis. METHODS: Retrospective analysis of patients with inactive uveitis requiring/not requiring immunosuppressive therapy who received IVTA because of chronic CMO refractory to previous systemic steroids. Number of IVTA (re-)treatments, distance visual acuity, near visual acuity, mean foveal thickness, intraocular pressure, duration of CMO, type of uveitis and systemic therapy were assessed previous to and 1, 4, 12 weeks following each IVTA treatment. RESULTS: Between March 2003 and May 2006, 24 eyes of 18 patients received between one and three IVTA injections. A resolution of chronic CMO was observed in 7/24 eyes (29.2%, 5 eyes after single injection of IVTA, 1 eye each after two and three injections of IVTA), a significant increase in distance visual acuity in 9/24 eyes (37.5%; 5 eyes with resolution of CMO, 4 eyes despite persistent CMO) and in near visual acuity in 13/24 eyes (54.6%; 6 eyes with resolution of CMO, 7 eyes despite persistent CMO). CONCLUSIONS: IVTA might be considered as a treatment for patients with chronic CMO when persistent despite previous systemic steroid therapy. Even patients without sustained resolution of CMO after IVTA might benefit in terms of transiently increasing visual acuity, but progression of cataract and rise in intraocular pressure limit repeatability.
Keywords: Female; Humans; Male; Middle Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Chronic Disease; Injections; Visual Acuity; Cataract/chemically induced; Vitreous Body; Intraocular Pressure/drug effects; Macular Edema/*drug therapy/etiology/physiopathology; Uveitis/complications/*drug therapy/physiopathology; Glucocorticoids/adverse effects/*therapeutic use; Triamcinolone Acetonide/adverse effects/*therapeutic use

Tomographic assessment of therapeutic response to uveitic macular oedema. - Sivaprasad, Sobha; Ikeji, Felicia; Xing, Wen; Lightman, Sue (Clinical & experimental ophthalmology, 2007)
PURPOSE: To evaluate the therapeutic effects on the different morphological patterns of uveitic macular oedema and central macular thickness using optical coherence tomography (OCT). METHODS: Retrospective observational case series. Fifty consecutive patients with a clinical diagnosis of new or recurrent macular oedema due to uveitis were examined with serial OCTs for 1 year. The correlation between different patterns of macular oedema (diffuse macular oedema, inner cystoid oedema, outer cystoid oedema, oedema involving both inner and outer layers of retina and serous retinal detachment) and change in logMAR visual acuity and the recorded variables including age, gender, systemic disease associated with uveitis, location and duration of uveitis, and duration of macular oedema were examined. Response to treatment was measured as change in logMAR visual acuity and evolution of patterns of macular oedema. RESULTS: Diffuse macular oedema, external cystoid and serous retinal detachment responded well to treatment. Cysts in the inner retinal layers were more resistant to treatment. The cysts in the outer layers disappeared faster than cysts in the inner layers in patients with cysts in both layers at baseline. Multivariate analysis showed that cystoid macular oedema (all types) (P = 0.03) and inner cystoid oedema (P = 0.031) were the variables significantly associated with final visual acuity. CONCLUSION: Assessment of patterns of uveitic macular oedema by OCT gives useful information on the prognosis. Inner retinal cystoid oedema is more resistant to treatment than any other patterns of oedema.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Retrospective Studies; Adolescent; Child; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity; Macula Lutea/pathology; Tomography, Optical Coherence/*methods; Acetazolamide/therapeutic use; Immunologic Factors/therapeutic use; Macular Edema/*diagnosis/*drug therapy/etiology; Uveitis/complications/*diagnosis/*drug therapy

Smoking complicates the course of non-infectious uveitis. - Roesel, Martin; Ruttig, Anne; Schumacher, Claudia; Heinz, Carsten; Heiligenhaus, Arnd (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2011)
BACKGROUND: Data concerning the association of smoking and uveitis are limited. The aim of this study was to evaluate the effect of tobacco smoking on uveitis activity and complications of noninfections uveitis and the need for immunosuppressive therapy. METHODS: We conducted an observational cross-sectional study in 350 patients with noninfectious uveitis. All patients completed a questionnaire concerning smoking habits. Primary outcome measure was uveitis activity in smokers as compared to nonsmokers; secondary outcome measures were need for immunosuppression and uveitis complications. RESULTS: In all 115 patients (32.9%) were smokers. Smokers had an increased risk for active uveitis (OR 1.8; 95% CI, 1.2-2.9; p = 0.007). Smokers with anterior uveitis had anterior chamber cells more often than nonsmokers (p = 0.008) and required significantly more topical steroid eyedrops (p = 0.002). Uveitis developed at a younger age in smokers than in nonsmokers (p = 0.027). The number of smokers who needed any second-line immunosuppression (p = 0.642) and the number of immunosuppressive agents required (p = 0.794) did not differ from that for nonsmokers. The number of pack-years significantly increased the risk of macular edema (p = 0.020) und cataract (p = 0.022). CONCLUSIONS: Smoking is associated with uveitis activity, leading to increased need for steroid eyedrops and increased incidence of cataract and macular edema. The results highlight the need to encourage uveitis patients to stop or at least to reduce their smoking.
Keywords: Female; Humans; Male; Adult; Risk Factors; Surveys and Questionnaires; Cross-Sectional Studies; Immunosuppressive Agents/administration & dosage; Visual Acuity/physiology; Age of Onset; Immunosuppression Therapy; Uveitis/drug therapy/*etiology/physiopathology; Smoking/*adverse effects

Dexamethasone intravitreal implant: an effective adjunctive treatment for recalcitrant noninfectious uveitis. - Miserocchi, E.; Modorati, G.; Pastore, M. R.; Bandello, F. (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2012)
PURPOSE: To describe our experience in treating recalcitrant and severe cases of noninfectious posterior uveitis with the 0.7-mg dexamethasone intravitreal implant as adjunctive anti-inflammatory treatment. PROCEDURES: Retrospective study. Twelve patients (8 females; 4 males; 14 affected eyes, 15 implants) with severe recalcitrant uveitis were treated. Patients had an inadequate control of uveitis despite different immunosuppressants and periocular corticosteroid therapy. Primary outcome measures evaluated were: decrease in uveitis activity, improvement in visual acuity, reduction of macular thickness, and occurrence of adverse events. RESULTS: Uveitis activity decreased in all patients after the implant. The mean follow-up time from injection was 9 months. Best-corrected visual acuity improved from 20/80 to 20/40 at the end of follow-up. The mean retinal thickness improved from 496 to 226 µm. Adverse events encountered were: 3 eyes with intraocular pressure elevation, 1 vitreous hemorrhage and 1 subconjunctival hemorrhage. Three patients reduced the daily systemic corticosteroid dosage after treatment. CONCLUSIONS: The 0.7-mg dexamethasone intravitreal implant appears to be a novel and promising adjunctive treatment for patients with severe posterior noninfectious uveitis recalcitrant to different immunosuppressive agents.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Glucocorticoids/administration & dosage; Visual Acuity; Intravitreal Injections; Dexamethasone/*administration & dosage; Uveitis, Posterior/*drug therapy; Drug Implants/*administration & dosage

Intermediate Uveitis Associated with Tattooing of Eyebrows as a Manifestation of Systemic Sarcoidosis: Report of Two Cases. - Ebrahimiadib, Nazanin; Adelpour, Farid; Ghahari, Mohammadreza; Mehrpour, Mohammad (Ocular immunology and inflammation, 2021)
Permanent make-up tattooing as a cosmetic procedure is gaining popularity especially among women. Although it is considered a relatively safe intervention, the ink used can rarely be a trigger of sarcoidosis. Uveitis can occur as part of this inflammatory process. In this study, we describe two ladies presented with tattoo-associated uveitis as the first manifestations of systemic sarcoidosis. They developed intermediate uveitis shortly after skin inflammation several months after permanent make-up tattooing of eyebrows. Lung involvement, high ACE levels, and negative PPD were present. Skin granuloma formation was diffuse over the area of tattoo in one patient and localized in the other one. This is the first report of uveitis following make-up tattoo.
Keywords: Female; Humans; Middle Aged; Tomography, X-Ray Computed; Fluorescein Angiography; uveitis; Visual Acuity/physiology; Tattooing/*adverse effects; Tattoo; Ophthalmoscopy; Retinal Vasculitis/diagnosis; *Eyebrows; Granuloma, Foreign-Body/diagnosis/*etiology; Peptidyl-Dipeptidase A/blood; Radiography, Thoracic; sarcoidosis; Sarcoidosis, Pulmonary/*diagnosis; Uveitis, Intermediate/diagnosis/*etiology

A randomized trial of tacrolimus versus tacrolimus and prednisone for the maintenance of disease remission in noninfectious uveitis. - Lee, Richard W. J.; Greenwood, Rosemary; Taylor, Hazel; Amer, Radgonde; Biester, Sabine; Heissigerova, Jarka; Forrester, John V.; Dick, Andrew D. (Ophthalmology, 2012)
PURPOSE: To compare tacrolimus monotherapy with tacrolimus and prednisone therapy for the maintenance of disease remission in subjects with noninfectious posterior segment intraocular inflammation (PSII). DESIGN: Randomized, controlled, phase 2b, open-label, dual-center noninferiority trial. PARTICIPANTS: Fifty-eight patients with sight-threatening PSII. METHODS: Patients requiring a second-line systemic immunosuppressive agent to control their PSII were treated with therapeutic doses of oral tacrolimus. Those subjects who subsequently were able to taper their prednisone dose to 10 mg daily without disease reactivation were assigned randomly either to stop prednisone or to continue 7.5 to 10 mg prednisone daily for 9 months. MAIN OUTCOME MEASURES: Change in logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) and rate of patient withdrawal resulting from treatment inefficacy or intolerance. RESULTS: Thirty-five patients successfully tapered their prednisone to 10 mg daily. Of these, 16 were allocated randomly to receive tacrolimus monotherapy and 19 to continue taking prednisone and tacrolimus dual therapy. The difference in the mean change in VA for monotherapy compared with the dual therapy group was less than 1 logMAR letter (logMAR, -0.008; 95% confidence interval, -0.108 to 0.092; P = 0.870). The proportion of patients who tolerated treatment and maintained disease remission for 9 months after randomization also was similar in both groups (monotherapy, 62.5%; dual therapy, 68.4%; P = 0.694). All monotherapy treatment failures were the result of disease reactivation, whereas 50% of dual-therapy failures were the result of drug intolerance. CONCLUSIONS: This study provides preliminary evidence that corticosteroids can be withdrawn in tacrolimus-treated patients who are able to achieve control of PSII with 10 mg prednisone daily, and any advantage of dual therapy in the prevention of disease reactivation was offset by its greater treatment intolerance. These findings support the further evaluation of corticosteroid-free treatment in future phase 3 trials (International Standard Randomised Controlled Trial Number Register identification, ISRCTN46576063). FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: Female; Humans; Male; Adult; Drug Therapy, Combination; Treatment Outcome; Administration, Oral; Remission Induction; Visual Acuity/physiology; Uveitis/*drug therapy/physiopathology; Immunosuppressive Agents/adverse effects/*therapeutic use; Glucocorticoids/adverse effects/*therapeutic use; Maintenance Chemotherapy; Prednisone/adverse effects/*therapeutic use; Tacrolimus/adverse effects/*therapeutic use

SAFETY AND EFFICACY OF INTRAVITREAL DEXAMETHASONE IMPLANTS IN THE MANAGEMENT OF MACULAR EDEMA SECONDARY TO INFECTIOUS UVEITIS. - Fonollosa, Alex; Llorenç, Victor; Artaraz, Joseba; Jimenez, Beatriz; Ruiz-Arruza, Ioana; Agirrebengoa, Koldo; Cordero-Coma, Miguel; Costales-Mier, Felipe; Adan, Alfredo (Retina (Philadelphia, Pa.), 2016)
PURPOSE: To assess the safety and efficacy of intravitreal dexamethasone implants in the treatment of macular edema secondary to infectious uveitis. METHODS: We retrospectively reviewed clinical records from three uveitis referral units in Spain. The main outcome measures were rate of reactivation of infection, improvements in visual acuity and resolution of macular edema, as measured by optical coherence tomography. RESULTS: We included eight eyes from seven patients with a median age of 64 years (30-75). Etiologies of the infections were Herpes simplex virus-type 1, Varicela-Zoster virus, Treponema pallidum, Brucella mellitensis, Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus. Median visual acuity was 20/160 (20/30-20/400) at baseline and 20/70 (20/25-20/200) at the last follow-up visit. Mean macular thickness was 516 μm (115) at baseline and 266.3 μm (40) at the last follow-up visit. Visual acuity improved in 100% of the eyes and none of the eyes showed macular edema at the last follow-up visit. Five patients required reinjections of the implant. Only one patient required antiglaucoma drops for a temporary increase in ocular pressure. There were no cases of reactivation of the infectious ocular disease. Median follow-up time was 18 months. CONCLUSION: In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Tomography, Optical Coherence; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage/adverse effects; Glucocorticoids/*administration & dosage/adverse effects; Macular Edema/diagnostic imaging/*drug therapy/microbiology; Uveitis/diagnostic imaging/*drug therapy/microbiology

Clinical features in tubulointerstitial nephritis and uveitis (TINU) syndrome. - Goda, Chiho; Kotake, Satoshi; Ichiishi, Akira; Namba, Kenichi; Kitaichi, Nobuyoshi; Ohno, Shigeaki (American journal of ophthalmology, 2005)
PURPOSE: To analyze clinical features of the tubulointerstitial nephritis and uveitis (TINU) syndrome in Japan, especially exacerbations or recurrences of uveitis. DESIGN: Retrospective observational study. METHODS: We reviewed the clinical features in 12 patients with TINU syndrome diagnosed by renal biopsy, who were evaluated and treated at the Department of Ophthalmology, Hokkaido University Hospital. Visual acuity was measured using decimal visual acuity. RESULTS: Patient age ranged from 10 to 33 years (mean 21 years), and females accounted for 83% of the cases. Both eyes were affected in 11 patients (92%). All 12 patients initially experienced ocular symptoms, with hyperemia being the chief complaint. We diagnosed patients as having uveitis and conducted blood tests and urinalysis. Urinalysis did show characteristic findings, most notably glucosuria, increased beta2 microglobulin that were > or = 10 times that of normal levels, and increased N-acetylglucosaminidose levels in a high percentage of patients. Recurrent or exacerbating uveitis was seen in six patients (50%). In exacerbated or recurrent uveitis, inflammation was more severe (> or = 3+ cells of the anterior eye segment). The ocular inflammation generally responded well to treatment with oral corticosteroids, and the number of recurrences was lower at corticosteroid doses of > or = prednisolone 40 mg. CONCLUSIONS: Ophthalmologists play an important role in the initial discovery of patients with TINU syndrome. Because inflammation was more severe in exacerbated or recurrent uveitis, in instances where uveitis is refractory to local therapy, oral corticosteroids should be considered as early as possible.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Adolescent; Administration, Oral; Recurrence; Child; Glucocorticoids/therapeutic use; Visual Acuity; Syndrome; Hyperemia/diagnosis; Nephritis, Interstitial/*diagnosis/drug therapy/physiopathology; Uveitis/*diagnosis/drug therapy/physiopathology

Immunosuppressants used in a steroid-sparing strategy for childhood uveitis. - Schatz, Claude Speeg; Uzel, Jean Louis; Leininger, Laurent; Danner, Stéphanie; Terzic, Joëlle; Fischbach, Michel (Journal of pediatric ophthalmology and strabismus, 2007)
PURPOSE: To review, with respect to etiology, the efficacy and complications of different immunosuppressants used in a steroid-sparing strategy for children with uveitis. PATIENTS AND METHODS: Forty children with uveitis were observed during a 5-year period, from 1997 to 2002. After complete ocular and physical assessment, routine and specific laboratory investigations were conducted along with radiologic examination. All cases underwent local therapy. Systemic corticosteroids were necessary in 75% of cases. Pediatric staff determined the need for initial association or sequential relay with immunosuppressants, depending on the severity of the uveitis. A steroid-sparing strategy was developed. RESULTS: The average age was 6.5 years (range, 3 months to 14 years), with a male-to-female ratio of 23 to 17. Uveitis was anterior in 55% of cases, intermediate in 2.5%, posterior in 42.5%, and bilateral in 62.5%. A positive etiology was found in 47.5% of cases, and articular symptoms were present in 25%. Overall, the improvement in visual acuity was 62.2%. Where corticotherapy was associated with azathioprine, a 61% improvement was achieved. Corticosteroid therapy associated with mycophenolate mofetil resulted in a 94% improvement. No complications were present in 42.5% of cases. Ocular complications were present in 57.5% of cases and systemic complications were present in 12.5% of cases, none being directly related to the use of steroids. CONCLUSION: The association of systemic corticotherapy and immunosuppressants in pediatric relapsing or steroid-dependent uveitis allows good recovery of visual acuity, fewer complications, and a minimization of side effects, especially those related to systemic corticosteroids. It requires close collaboration between the ophthalmologist and a fully involved pediatrician.
Keywords: Female; Humans; Male; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Glucocorticoids/*therapeutic use; Child; Child, Preschool; Infant; Immunosuppressive Agents/*therapeutic use; Prevalence; Visual Acuity; Uveitis, Intermediate/*drug therapy/epidemiology; Uveitis, Posterior/*drug therapy/epidemiology; *Practice Guidelines as Topic; Uveitis, Anterior/*drug therapy/epidemiology

Chronic Recurrent Vogt-Koyanagi-Harada Disease and Development of 'Sunset Glow Fundus' Predict Worse Retinal Sensitivity. - Abu El-Asrar, Ahmed M.; Al Mudhaiyan, Tariq; Al Najashi, AlHatoon A.; Hemachandran, Suhail; Hariz, Rajab; Mousa, Ahmed; Al-Muammar, Abdulrahman (Ocular immunology and inflammation, 2017)
PURPOSE: To investigate prognostic factors for retinal sensitivity assessed by microperimetry in patients with Vogt-Koyanagi-Harada (VKH) disease. METHODS: In total, 34 patients with initial-onset acute disease and 19 patients with chronic recurrent disease were retrospectively evaluated. RESULTS: The mean follow-up period was 40.4 ± 40.5 months. Sensitivity was significantly worse in eyes with more severe anterior segment inflammation at presentation, as indicated by the presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, and posterior synechiae. Chronic recurrent presentation, development of complications, and 'sunset glow fundus' were significantly associated with worse sensitivity. Using logistic regression analysis, better sensitivity was significantly associated with initial-onset acute presentation (odds ratio, OR = 6.9; 95% confidence interval, CI = 1.53-9.66). CONCLUSIONS: Chronic recurrent presentation and development of complications and 'sunset glow fundus' are associated with a worse sensitivity outcome.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Follow-Up Studies; Retrospective Studies; Young Adult; Adolescent; Administration, Oral; Recurrence; Chronic Disease; Child; Injections, Intravenous; Visual Field Tests; Fundus Oculi; Visual Acuity/*physiology; Visual Fields/physiology; outcome; Vogt–Koyanagi–Harada disease; Glucocorticoids/administration & dosage/therapeutic use; Immunomodulatory therapy; Methylprednisolone/administration & dosage/therapeutic use; microperimetry; Retina/*physiopathology; Retinal Diseases/*diagnosis/drug therapy/physiopathology; retinal sensitivity; Uveomeningoencephalitic Syndrome/*diagnosis/drug therapy/physiopathology

Initial evaluation of subcutaneous daclizumab treatments for noninfectious uveitis: a multicenter noncomparative interventional case series. - Nussenblatt, Robert B.; Peterson, Jan S.; Foster, C. Stephen; Rao, Narsing A.; See, Robert F.; Letko, Eric; Buggage, Ronald R. (Ophthalmology, 2005)
PURPOSE: To assess the feasibility of a study design that may determine whether subcutaneous administration of the interleukin-2 receptor antibody daclizumab can safely reduce the dependence on standard systemic corticosteroids or other immunosuppressive regimens in patients with sight-threatening, noninfectious intermediate uveitis, posterior uveitis, or panuveitis. DESIGN: Prospective, multicenter, nonrandomized, noncomparative, open-label interventional trial. PARTICIPANTS: Fifteen patients, 5 each at 3 clinical centers, with noninfectious intermediate, posterior, or panuveitis, who require a currently stable immunosuppression regimen of systemic corticosteroids and/or other systemic treatments to control noninfectious intraocular inflammation. METHODS: After enrollment and baseline ophthalmic evaluations, 2 induction treatments were given 2 weeks apart using subcutaneous (SC) daclizumab at 2 mg/kg. Subcutaneous daclizumab maintenance treatments were then continued every 2 weeks at 1 mg/kg for 6 months. The initial immunosuppression load was tapered over 8 to 12 weeks in a staggered fashion beginning with the first induction treatment. Safety evaluations were performed at each treatment visit, with a primary efficacy evaluation at 12 weeks and a repeat efficacy evaluation at 26 weeks. MAIN OUTCOME MEASURES: Best-corrected visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS] method) with a concurrent taper of concomitant systemic immunosuppression medication load (tabulated by use of a weighted scoring system) was assessed; target for success was defined as a 50% or greater reduction in concomitant immunosuppression load by 12 weeks while maintaining visual acuity within 5 ETDRS letters of baseline. Ocular inflammation was assessed at each visit with standardized grading scales. RESULTS: Ten of 15 patients (67%) receiving SC daclizumab treatments every other week successfully achieved the primary efficacy end point of reducing their concomitant immunosuppression load by at least 50% while maintaining their baseline visual acuity at 12 and 26 weeks. Subcutaneous daclizumab injections were well tolerated with no serious adverse events observed during the 6 months of treatments, although 3 patients experienced possibly related, nonserious adverse events. CONCLUSIONS: Subcutaneous daclizumab induction treatments at 2 mg/kg followed by 1 mg/kg maintenance treatments every other week seems safe and, in most cases, may reduce the concomitant immunosuppressive load required to treat noninfectious uveitis for 12 to 26 weeks.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Prospective Studies; Safety; Adolescent; Feasibility Studies; Immunoglobulin G/*administration & dosage/therapeutic use; Antibodies, Monoclonal/*administration & dosage/therapeutic use; Drug Evaluation; Visual Acuity; Injections, Subcutaneous; Uveitis, Posterior/*drug therapy; Antibodies, Monoclonal, Humanized; Panuveitis/*drug therapy; Uveitis, Intermediate/*drug therapy; Daclizumab; Immunosuppressive Agents/*administration & dosage/therapeutic use; Receptors, Interleukin-2/immunology

Orbital floor triamcinolone acetonide injections for the management of active non-infectious uveitis. - Roesel, M.; Gutfleisch, M.; Heinz, C.; Heimes, B.; Zurek-Imhoff, B.; Heiligenhaus, A. (Eye (London, England), 2009)
PURPOSE: To evaluate the effect of orbital floor triamcinolone acetonide (OFTA) injections on inflammation and visual acuity in active non-infectious uveitis. METHODS: Monocentre, retrospective study in 94 eyes (86 patients) with acute non-infectious uveitis receiving a single OFTA (40 mg) injection. Outcome measures were anterior chamber (AC) and vitreous cell counts, laser flare photometry, best-corrected visual acuity (BCVA), and complications over a 6-month follow-up period. RESULTS: The number of patients with >or=1+ cells in AC and vitreous was significantly lower after treatment than at baseline (each, P<0.01 at the follow-up examinations). The anti-inflammatory effect lasted for the 6-month follow-up period. Laser flare photometry values were also significantly lower than the baseline levels at 3 (P<0.01) and 6 (P=0.034) months. BCVA did not differ before and after treatment. Macular oedema was reduced in 27%, unchanged in another 59%, and worse in 14%. Within 6 months, ocular hypertension was observed in up to 8% and progressing cataract was noted in 29%.ConclusionsOFTA injections improved AC and vitreous inflammation, but the effect on visual acuity and macular oedema was limited.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Visual Acuity; Triamcinolone Acetonide/*administration & dosage; Anti-Inflammatory Agents/*administration & dosage; Macular Edema/drug therapy; Uveitis/*drug therapy/pathology; Anterior Chamber/cytology/pathology; Injections/methods; Photometry/methods; Vitreous Body/cytology/pathology

Optical coherence tomography-guided ranibizumab injection for cystoid macular edema in well-controlled uveitis: twelve-month outcomes. - Reddy, Ashvini K.; Cabrera, Mariana; Yeh, Steven; Davis, Janet L.; Albini, Thomas A. (Retina (Philadelphia, Pa.), 2014)
PURPOSE: To determine whether serial ranibizumab injections are effective in the treatment of cystoid macular edema in patients with chronic controlled noninfectious uveitis. METHODS: Five eyes of 5 patients were included in a prospective noncomparative therapeutic trial. They received intravitreal injections of ranibizumab at Day 0 and were followed monthly for 1 year. Injections were repeated monthly if persistent or new cystic edema manifested on optical coherence tomography. The primary outcome measure was the mean change in best-corrected visual acuity from baseline at 12 months. Secondary outcome measures included mean percentage change in central subfield retinal thickness (CST) and incidence of adverse events through Month 24. RESULTS: Thirty-two injections were performed over the study period. At 1 year, the mean increase in acuity was 12.2 Early Treatment for Diabetic Retinopathy Study letters (P = 0.015). There was a statistically significant increase in visual acuity over time (P = 0.002). The CST decreased by 31.4%, 46.0%, 37.6%, and 45.4% relative to baseline at 3, 6, 9, and 12 months, respectively (P = 0.003). One patient experienced recurrence of uveitis with subsequent cataract and glaucoma progression. CONCLUSION: Optical coherence tomography-guided monthly intravitreal ranibizumab injections delivered over the course of 1 year resulted in improved vision and reduced central retinal thickness.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Treatment Outcome; Antibodies, Monoclonal, Humanized/*therapeutic use; Fluorescein Angiography; Intravitreal Injections; Uveitis/complications/*drug therapy; Visual Acuity/drug effects; Macular Edema/*drug therapy/etiology; Angiogenesis Inhibitors/*therapeutic use; Vascular Endothelial Growth Factor A/antagonists & inhibitors; *Tomography, Optical Coherence; Ranibizumab

ACQUIRED VITELLIFORM LESIONS THAT RESPOND TO IMMUNE SUPPRESSION IN A PATIENT WITH SARCOIDOSIS. - Heymann, Hans B.; Jampol, Lee M. (Retinal cases & brief reports, 2020)
PURPOSE: To describe a patient with sarcoid uveitis who developed bilateral vitelliform lesions with subretinal fluid that responded to immune suppression on three occasions. METHODS: Chart review was performed on a single patient to collect all relevant clinical information and diagnostic imaging. RESULTS: A case of sarcoidosis with acquired vitelliform lesions is described. CONCLUSION: Patients with ocular sarcoidosis can rarely develop vitelliform lesions. Our patient responded to systemic immune suppression.
Keywords: Female; Humans; Adult; Biopsy; *Visual Acuity; Immunosuppression Therapy/*adverse effects; Immunosuppressive Agents/*adverse effects/therapeutic use; Sarcoidosis/*complications/diagnosis/therapy; Uveitis/diagnosis/*etiology/immunology

Anterior and Intermediate Uveitis Following Yellow Fever Vaccination with Fractional Dose: Case Reports. - Biancardi, Ana Luiza; Moraes, Haroldo Vieira de Jr (Ocular immunology and inflammation, 2019)
Purpose: To describe two cases of anterior and intermediate uveitis following yellow fever vaccination with fractional dose. Methods: Case report. Results: Case 1: A 35 year-old healthy woman presented with unilateral anterior uveitis 10 days after the yellow fever vaccination. Testing excluded infectious and rheumatic diseases and the episode was fully recovered after a short course of topical treatment. Case 2: A 21 year-old previously healthy woman presented with blurred vision in the left eye (OS) 14 days after the yellow fever vaccination. The ophthalmic examination of the OS revealed intermediated uveitis. Testing excluded infectious and neurological diseases. After six weeks of treatment with oral prednisone, the ocular inflammation had resolved. Conclusion: Physicians should be aware of the possibility of eye inflammation following the yellow fever vaccination.
Keywords: Female; Humans; Adult; Young Adult; Administration, Oral; Prednisone/administration & dosage; Fluorescein Angiography; Glucocorticoids/administration & dosage; uveitis; Fundus Oculi; Visual Acuity; Vaccination/*adverse effects; Dexamethasone/administration & dosage; intermediate uveitis; yellow fever vaccine; Yellow Fever Vaccine/*adverse effects; Uveitis, Intermediate/diagnosis/*etiology; Anterior uveitis; causality; Retina/*diagnostic imaging; Uveitis, Anterior/diagnosis/*etiology; Yellow fever virus/immunology; Yellow Fever/prevention & control

The Effect of Different Dosing Schedules of Intravitreal Sirolimus, a Mammalian Target of Rapamycin (mTOR) Inhibitor, in the Treatment of Non-Infectious Uveitis (An American Ophthalmological Society Thesis). - Nguyen, Quan Dong; Sadiq, Mohammad Ali; Soliman, Mohamed Kamel; Agarwal, Aniruddha; Do, Diana V.; Sepah, Yasir J. (Transactions of the American Ophthalmological Society, 2016)
PURPOSE: To determine if two different doses of intravitreal sirolimus, an mTOR inhibitor, can decrease inflammation and is safe in eyes with non-infectious posterior, intermediate, or panuveitis in the Sirolimus as a Therapeutic Approach UVEitis: Protocol-2 (SAVE-2) Study. METHODS: SAVE-2 is a prospective randomized, phase II, open-label interventional clinical trial conducted at 4 clinical centers in the United States. Eligible subjects were randomized into one of two treatments. Group 1 received 440µg of intravitreal sirolimus in study eyes on days 0, 30, 60, 90, 120, and 150; group 2 received 880µg of intravitreal sirolimus on days 0, 60, and 120. Fellow eyes were also eligible to receive sirolimus (of opposite dose to that of study eye). Primary endpoint of the study was at month 6 (M6). RESULTS: 24 subjects have been randomized in SAVE-2 and are included in the analysis. Vitreous haze decreased by ≥2 steps in 63.6% and 50% of patients in groups 1 and 2, respectively at M6 (p=0.695). Mean change in best-corrected visual acuity for subjects was +3.66 and -2.91 ETDRS letters in group 1 and 2, respectively. Among subjects with macular edema at baseline (n=13), the mean change in foveal thickness was -89.42µm in group 1 and +81.5µm in group 2 at M6. CONCLUSIONS: Both low and high doses of intravitreal sirolimus were found to decrease vitreous haze in eyes with non-infectious uveitis. Low dose (440µg) sirolimus administered monthly may be more efficacious in reducing uveitic macular edema than high dose (880µg) administered every 2 months.
Keywords: Female; Humans; Male; Middle Aged; United States; Prospective Studies; Time Factors; Follow-Up Studies; Treatment Outcome; Dose-Response Relationship, Drug; Drug Administration Schedule; Tomography, Optical Coherence; Immunosuppressive Agents/administration & dosage; Uveitis/diagnosis/*drug therapy; Sirolimus/*administration & dosage; Ophthalmology; Societies, Medical; TOR Serine-Threonine Kinases/*antagonists & inhibitors

Systemic Immunosuppression Is Highly Effective in the Long-term Control of Inflammatory non-infectious Uveitic Choroidal Neovascularization: A Comparative Study. - Neri, P.; Pichi, F.; Pirani, V.; Arapi, I. (Ocular immunology and inflammation, 2021)
Purpose: To compare immediate versus delayed introduction of immunosuppressives for naive noninfectious inflammatory choroidal neovascularization (iCNV).Methods: a retrospective, consecutive, comparative, interventional case series of patients with a diagnosis of inflammatory CNV and a minimum follow of 36 months. Patients were divided into two groups: Group A received Immunosuppressives if needed, while Group B since baseline. Both groups received systemic steroids and intravitreal ranibizumab since baseline. Primary end point was to compare the BCVA outcome till 36-month follow-up.Results: Twenty-nine eyes with iCNV were enrolled. In the long term, best-corrected visual acuity (BCVA) was significantly better in group B. At 3-month follow-up, Group B reduced steroids <10 mg/day significantly (p = .0001, Fisher's Exact Test). At 36 months of follow up, injections given were 2.9 (0.9 SD) in group A and 1.25 (0.4 SD) in group B.Conclusion: early immunosuppressive therapy exerts a positive action on the long-term control of uveitic CNV.
Keywords: Female; Humans; Male; Adult; Follow-Up Studies; Retrospective Studies; Glucocorticoids/*therapeutic use; Immunosuppressive Agents/*therapeutic use; Fluorescein Angiography; Tomography, Optical Coherence; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Uveitis; Intravitreal Injections; Angiogenesis Inhibitors/*therapeutic use; Vascular Endothelial Growth Factor A/antagonists & inhibitors; anti-vascular endothelial growth factor; choroidal neovascularization; Choroidal Neovascularization/diagnosis/*drug therapy/physiopathology; Choroiditis/diagnosis/*drug therapy/physiopathology; immunesuppressive drugs; Ranibizumab/*therapeutic use; steroids

Intravitreal infliximab for the treatment of sight-threatening chronic noninfectious uveitis. - Farvardin, Mohsen; Afarid, Mehrdad; Mehryar, Morsal; Hosseini, Hamid (Retina (Philadelphia, Pa.), 2010)
PURPOSE: Tumor necrosis factor-alpha is known to play an important role in various immune-mediated ocular diseases. Infliximab, a chimeric monoclonal antibody against tumor necrosis factor-alpha, has been used for the treatment of various chronic systemic and ocular inflammatory diseases. The purpose of this study was to evaluate the effect of intravitreal injection of infliximab on the visual acuity and central macular thickness in patients with chronic noninfectious uveitis. METHODS: Ten eyes of 7 patients with chronic persistent noninfectious uveitis who were nonresponsive to conventional previous medications during the previous 3 months were included in this study. The patients received intravitreal injection of 1.5 mg/0.15 mL infliximab. Mean best-corrected visual acuity and mean central macular thickness 1 day before and 4 weeks after the injection were evaluated and compared. RESULTS: Mean logarithm of the minimum angle of resolution before and after injection was 1.37 ± 0.43 and 0.67 ± 0.56, respectively, with statistically significant improvement after injection (P = 0.005). The mean central macular thickness before and after injection was 673.20 ± 338.39 μm and 456.40 ± 317.46 μm, respectively, with a significant decrease in the central macular thickness after the injection (P = 0.005). CONCLUSION: Intravitreal injection of infliximab may improve the visual acuity and decrease the central macular thickness in patients with chronic noninfectious uveitis and significant visual loss and central macular edema.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Follow-Up Studies; Young Adult; Adolescent; Chronic Disease; Child; Infliximab; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Fluorescein Angiography; Tomography, Optical Coherence; Visual Acuity/physiology; Intravitreal Injections; Macula Lutea/pathology; Anti-Inflammatory Agents/administration & dosage/*therapeutic use; Antibodies, Monoclonal/administration & dosage/*therapeutic use; Eye Infections/drug therapy/immunology; Uveitis/*drug therapy/immunology/physiopathology

Multifocal choroiditis with panuveitis in an 8-year-old boy with long-standing idiopathic acute anterior uveitis. - Grixti, Andre; Hagan, Richard; Nayak, Harish; Chandna, Arvind (European journal of ophthalmology, 2016)
PURPOSE: To report successful treatment of a rare case of sight-threatening pediatric multifocal choroiditis with panuveitis (MFCPU) and the use of electrophysiology to confirm return of macular function. METHODS: Case report. RESULTS: An 8-year-old boy with a history of bilateral recurrent non-juvenile idiopathic arthritis acute anterior uveitis (AAU) presented with new-onset blurry vision and floaters in both eyes. Visual acuity had deteriorated to 20/200 right eye and 20/100 left eye. Cells were observed in the anterior chamber and vitreous of both eyes. Ophthalmoscopy showed multiple active small cream-colored chorioretinal lesions and cystoid macular edema (CME) in both eyes in the absence of systemic disease, suggestive of idiopathic MFCPU. Successful rapid visual recovery and resolution of CME confirmed by spectral-domain optical coherence tomography (SD-OCT) was achieved with prompt intensive systemic steroid therapy followed by early introduction of methotrexate. After 9 months, his visual acuities improved to 20/32, and pattern reversal visual evoked potentials and 19 hexagon multifocal electroretinography posttreatment were normal, showing recovery of macular function. CONCLUSIONS: Multifocal choroiditis with panuveitis is rare in children and has not been documented in the presence of previous longstanding recurrent AAU. Onset of floaters in children should alert the clinician to early stages of posterior pole involvement and progression to reduction in vision due to CME requires prompt aggressive steroid therapy monitored by clinical examination, SD-OCT, and electrophysiology, followed by early introduction of immunosuppressive drugs for long-term stability and to avoid steroid-induced adverse effects in children.
Keywords: Humans; Male; Retrospective Studies; Drug Combinations; Infusions, Intravenous; Child; Electroretinography; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Acute Disease; Administration, Topical; Multifocal Choroiditis; Arthritis, Juvenile/*complications/diagnosis/physiopathology; Choroiditis/drug therapy/*etiology/physiopathology; Methylprednisolone; Panuveitis/drug therapy/*etiology/physiopathology; Prednisolone/analogs & derivatives/therapeutic use; Retina/physiopathology; Uveitis, Anterior/*complications/drug therapy/physiopathology

Lensectomy-vitrectomy in chronic uveitis. - Smith, R. E.; Kokoris, N.; Nobe, J. R.; Diddie, K. R.; Cherney, E. F. (Transactions of the American Ophthalmological Society, 1983)
Cataract extraction in patients with chronic uveitis may be hazardous, although recent studies have indicated an improvement in prognosis using lensectomy-vitrectomy techniques in selected cases of uveitic cataracts. The results of lensectomy-vitrectomy in 12 eyes with uveitic cataract are reported. All patients had improvement in vision. No significant "flare-up" of the underlying uveitis occurred. The importance of extensive preoperative evaluation is emphasized. The major cause of decreased acuity postoperatively was persistent cystoid macular edema, a complication of chronic inflammation.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Adolescent; Combined Modality Therapy; Chronic Disease; Child; Visual Acuity; Postoperative Complications/epidemiology; *Vitrectomy; Cataract Extraction/*methods; Adrenal Cortex Hormones/therapeutic use; Cataract/complications; Macular Edema/epidemiology; Premedication; Uveitis/complications/drug therapy/*therapy

Ellipsoid layer restoration after Ozurdex(®) treatment in a patient with acute posterior multifocal placoid pigment epitheliopathy. - Mora-Cantallops, Arnau; Pérez, M. Dolores; Revenga, Marcelino; González-López, Julio Jose (European journal of ophthalmology, 2021)
An atypical case of acute posterior multifocal placoid pigment epitheliopathy with a clear reappearance of the ellipsoid layer of the retina after Ozurdex(®) intravitreal implantation is presented. A 51-year-old woman reported a 3-week history of left eye photopsia. On slit-lamp examination, yellowish placoid lesions were found on her left eye fundus. Ancillary tests were performed. The patient was diagnosed as a left eye acute posterior multifocal placoid pigment epitheliopathy, and observational approach was decided. Later, the condition started to progress in an ampiginous manner and a decrease of visual acuity caused by an increase in number and size of the lesions was observed. As the disease was progressing with the conservative, observational approach, and the macula was menaced, an intravitreal dexamethasone implant was injected in the left eye with a consequent improvement of the visual acuity and lesion stabilization. The ellipsoid layer, unidentifiable inside the placoid lesions in previous optical coherence tomography tests, reappeared after the treatment. Intravitreal dexamethasone implants can be used to stabilize acute posterior multifocal placoid pigment epitheliopathy lesions and help resolve the condition. Spectral domain optical coherence tomography can also be useful for monitoring these lesions, as the ellipsoid layer may reappear upon resolution.
Keywords: Female; Humans; Middle Aged; Adult; uveitis; Visual Acuity/physiology; Tomography, Optical Coherence/methods; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Fluorescein Angiography/methods; Posterior uveitis; choroidal/retinal inflammation; dexamethasone; immunology; ophthalmology; retina; Retina/diagnostic imaging/*drug effects/pathology; uvea; White Dot Syndromes/diagnostic imaging/*drug therapy/physiopathology

Influence of the vitreomacular interface on the efficacy of intravitreal therapy for uveitis-associated cystoid macular oedema. - Munk, Marion R.; Ram, Radha; Rademaker, Alfred; Liu, Dachao; Setlur, Vikram; Chau, Felix; Schmidt-Erfurth, Ursula; Goldstein, Debra A. (Acta ophthalmologica, 2015)
PURPOSE: To evaluate the effect of the vitreomacular interface (VMI) on treatment efficacy of intravitreal therapy in uveitic cystoid macular oedema (CME). METHODS: Retrospective analysis of CME resolution, CME recurrence rate and monthly course of central retinal thickness (CRT), retinal volume (RV) and best corrected visual acuity (BCVA) after intravitreal injection with respect to the VMI configuration on spectral-domain OCT using chi-squared test and repeated measures anova adjusted for confounding covariates epiretinal membrane, administered drug and subretinal fluid. RESULTS: Fifty-nine eyes of 53 patients (mean age: 47.4 ± 16.9 years) were included. VMI status had no effect on complete CME resolution rate (p = 0.16, corrected p-value: 0.32), time until resolution (p = 0.09, corrected p-value: 0.27) or CME relapse rate (p = 0.29, corrected p-value: 0.29). Change over time did not differ among the VMI configuration groups for BVCA (p = 0.82) and RV (p = 0.18), but CRT decrease was greater and faster in the posterior vitreous detachment (PVD) group compared to the posterior vitreous attachment (PVA) and vitreous macular adhesion (VMA) groups (p = 0.04). Also, the percentage of patients experiencing a ≥ 20% CRT thickness decrease after intravitreal injection was greater in the PVD group (83%) compared to the VMA (64%) and the PVA (16%) group (p = 0.027), however, not after correction for multiple testing (corrected p-value: 0.11). CONCLUSION: The VMI configuration seems to be a factor contributing to treatment efficacy in uveitic CME in terms of CRT decrease, although BCVA outcome did not differ according to VMI status.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Glucocorticoids/*therapeutic use; Tomography, Optical Coherence; uveitis; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Dexamethasone/therapeutic use; Angiogenesis Inhibitors/*therapeutic use; *Vitreous Body; Triamcinolone Acetonide/therapeutic use; cystoid macular oedema; Bevacizumab/therapeutic use; Eye Diseases/*physiopathology; intravitreal therapy; macular oedema; optical coherence tomography; posterior vitreous attachment; Retinal Diseases/*physiopathology; Tissue Adhesions/physiopathology; triamcinolone; vitreomacular adhesion; vitreomacular traction

Long-term reduction of laser flare values after trabeculectomy but not after cyclodestructive procedures in uveitis patients. - Heinz, Carsten; Zurek-Imhoff, Beatrix; Koch, Jörg; Rösel, Martin; Heiligenhaus, Arnd (International ophthalmology, 2011)
The aim of this study was to examine long-term changes of laser flare (LF) after trabeculectomy (TE) and transscleral diode cyclophotocoagulation (TDCPC) in patients with uveitic secondary glaucoma. Retrospective, single-center analysis. Overall, 40 TE (mean follow-up 21.1 months) and 68 TDCPC (mean follow-up 21.8 months, P = 0.38) procedures were performed. The intraocular pressure (IOP) level was consistently lower in the TE group at the preoperative visit and at each follow-up visit, while IOP reduction was similar in both groups (P = 0.91). LF decreased from 59.4 photons/ms at baseline to 41.9 photons/ms in the TE group (P = 0.017) and remained unchanged in the TDCPC group (71.2 vs. 70.7 photons/ms, P = 0.84). No significant increase in the number of complications could be observed at the end of the postoperative follow-up, while best-corrected visual acuity drop and cataract formation was higher in the TE group. TE significantly reduced postoperative LF values. Higher LF values did not increase the development of new complications in this study, but an increased occurrence of cataract formation was seen in the TE group.
Keywords: Female; Humans; Male; Adult; Time Factors; Follow-Up Studies; Retrospective Studies; Young Adult; Recovery of Function; Visual Acuity; Intraocular Pressure; Ciliary Body/*surgery; Sclera/*surgery; Glaucoma/complications/*surgery; Uveitis/complications/*surgery; Laser Coagulation/*adverse effects; Cataract/diagnosis/*etiology; Trabeculectomy/*adverse effects/methods

Endogenous uveitis: current concepts of treatment. - Herman, D. C. (Mayo Clinic proceedings, 1990)
The medical treatment of patients with uveitis often necessitates the use of systemically administered drugs, including corticosteroids, cytotoxic agents, and cyclosporine. Because of the potential side effects of these medications, physicians unfamiliar with inflammatory ocular disease may be asked to participate in the care of these patients. The most important criteria on which to base the decisions of when and how to treat patients with uveitis are the site and severity of the inflammation, the degree of visual acuity, and the potential for restoration of vision with treatment. Slit-lamp examination, indirect ophthalmoscopy, and fluorescein angiography are useful for evaluating the loss of vision in patients with endogenous uveitis. The main goal of treatment is to prevent permanent scarring and deterioration of vision as a result of the disease or the drug side effects. Frequent reassessment will help ensure adequate treatment and will minimize adverse drug effects.
Keywords: Humans; Male; Middle Aged; Prognosis; Severity of Illness Index; Combined Modality Therapy; Fluorescein Angiography; Prednisone/therapeutic use; Ophthalmoscopy; Adrenal Cortex Hormones/therapeutic use; Behcet Syndrome/complications; Cytotoxins/therapeutic use; Uveitis/complications/etiology/immunology/surgery/*therapy; Vision Disorders/diagnosis/etiology/prevention & control; Visual Acuity/drug effects/*physiology

Bilateral decompression retinopathy after deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome. - Muñoz-Negrete, Francisco J.; Díez-Álvarez, Laura; Garcia, Carlota Fuente; Rebolleda, Gema (European journal of ophthalmology, 2020)
INTRODUCTION: To report the first case of bilateral ocular decompression retinopathy after uneventful non-perforating deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome. CASE DESCRIPTION: An 8-year-old girl affected by tubulointerstitial nephritis and uveitis syndrome developed ocular hypertension (45 mmHg in the right eye and 42 mmHg in the left eye) associated with recurrent episodes of uveitis and chronic use of steroids despite maximum hypotensive medical treatment. Bilateral non-perforating deep sclerectomy with mitomycin C (0.2 mg/mL, 1 min) was performed under general anesthesia without complications. The first postoperative day, the visual acuity was reduced to 0.6 in the right eye and 0.05 in the left eye and the intraocular pressure was 3 mmHg in both eyes. Fundoscopy revealed bilateral optic nerve swelling and diffuse retinal hemorrhages, some of them with scattered-white centers. About 2 months after surgery, the visual acuity was normal and the fundus examination showed complete resolution. CONCLUSION: The ocular decompression retinopathy is an uncommon complication after non-perforating deep sclerectomy. This is the first case of bilateral ocular decompression retinopathy reported after non-perforating deep sclerectomy in a child with ocular hypertension secondary to recurrent uveitis and chronic use of steroids associated with tubulointerstitial nephritis and uveitis syndrome.
Keywords: Female; Humans; Combined Modality Therapy; Child; Visual Acuity/physiology; Tonometry, Ocular; Intraocular Pressure; Alkylating Agents/*administration & dosage; Mitomycin/*administration & dosage; deep sclerectomy; Nephritis, Interstitial/drug therapy/surgery/*therapy; Ocular decompression retinopathy; ocular hypertension; Papilledema/diagnosis/*etiology/physiopathology; Retinal Hemorrhage/diagnosis/*etiology/physiopathology; Sclerostomy/*adverse effects; tubulointerstitial nephritis and uveitis syndrome; Uveitis/drug therapy/surgery/*therapy; Vision Disorders/diagnosis/*etiology/physiopathology

Periocular triamcinolone acetonide injections for cystoid macular edema complicating noninfectious uveitis. - Leder, Henry A.; Jabs, Douglas A.; Galor, Anat; Dunn, James P.; Thorne, Jennifer E. (American journal of ophthalmology, 2011)
PURPOSE: To describe the effectiveness of periocular corticosteroid injections in the treatment of cystoid macular edema (CME) complicating noninfectious uveitis. DESIGN: Retrospective cohort study. METHODS: A total of 126 patients (156 eyes) were evaluated for presence of CME, visual acuity, intraocular pressure, degree of intraocular inflammation, and the presence of ocular complications. Main outcome measures included resolution of CME and visual acuity at the 1- and 3-month visits, failure of periocular injection therapy, and side effects. RESULTS: Twenty-eight percent of the 156 eyes had anterior uveitis, 22% intermediate uveitis, and 31% panuveitis. Of these eyes, 53% demonstrated clinical resolution of CME at 1 month and 57% at 3 months after a single periocular corticosteroid injection. Forty eyes were treated with >1 periocular injection because the CME persisted 1 month after the first injection (1 additional injection in 21 eyes; 2 additional injections in 14 eyes; >2 additional injections in 5 eyes). For the 21 eyes treated with a second periocular corticosteroid injection, 81% had no CME 1 month after the second injection and 48% had no CME 3 months after the second injection. Twenty-three eyes (15%) failed periocular corticosteroid therapy. Of eyes initially responding to periocular injection, CME recurred in 53% (median time to recurrence = 20.2 weeks). A halving of the visual angle was observed in 52% and 57% at the 1- and 3-month visits after injection, respectively. CONCLUSIONS: Fifty-three percent of eyes treated with a single periocular corticosteroid injection had clinical resolution of CME 1 month after the injection.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Time Factors; Retrospective Studies; Treatment Outcome; Adolescent; Recurrence; Child; Visual Acuity/physiology; Injections, Intraocular; Intraocular Pressure/physiology; Macular Edema/*drug therapy/etiology/physiopathology; Uveitis/complications/*drug therapy/physiopathology; Glucocorticoids/adverse effects/*therapeutic use; Triamcinolone Acetonide/adverse effects/*therapeutic use

Clinical characteristics of virus-related uveitic secondary glaucoma: focus on cytomegalovirus and varicella zoster virus. - Fan, Xintong; Li, Zhizhe; Zhai, Ruyi; Sheng, Qilian; Kong, Xiangmei (BMC ophthalmology, 2022)
BACKGROUND: We aimed to analyze the clinical characteristics of secondary glaucoma related to cytomegalovirus (CMV)- and varicella zoster virus (VZV)-positive uveitis. METHODS: In this retrospective study, we enrolled patients with anterior uveitic secondary glaucoma. All the patients underwent aqueous and serum analyses for viral antibody through enzyme-linked immunosorbent assay. Among the 60 included patients, 22 had CMV-negative Posner-Schlossman syndrome (CMV-negative PSS), 25 had CMV-positive PSS, and 13 had VZV-positive anterior uveitis secondary glaucoma (VZV-AUSG). We evaluated the following main indicators: age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), corneal endothelial cell (CEC) count, ocular morphological changes, and medical treatments. RESULTS: We found that 53.2% (25/47) patients with PSS were CMV-positive. Patients with CMV-positive PSS had a larger cup-to-disc ratio (p = .043), lower CEC density (p = .017), more severe CEC loss (p < .001), and more iris depigmentation (p = .006) than CMV-negative PSS patients. Compared with patients with CMV-positive PSS, those with VZV-AUSG were older (p = .003), presented a higher IOP (p = .015), and had poorer BCVA (p < .001). Patients with CMV-positive PSS and VZV-AUSG all accepted ganciclovir treatment, and those with CMV-positive PSS used fewer antiglaucoma agents simultaneously compared with CMV-negative PSS (p = .005) and VZV-AUSG (p < .001). All three groups had a comparable proportion of patients requiring antiglaucoma surgery. CONCLUSIONS: We observed some distinctive clinical features in CMV-positive PSS compared with CMV-negative PSS. Further, we found that patients with VZV-AUSG presented with a higher IOP and worse visual acuity, and required more antiglaucoma medication than those with CMV-positive PSS.
Keywords: Humans; Retrospective Studies; Uveitic glaucoma; *Cytomegalovirus Infections/complications/drug therapy; *Eye Infections, Viral/complications/diagnosis/drug therapy; *Glaucoma/etiology; Aqueous Humor; Cytomegalovirus; Cytomegalovirus/genetics; DNA, Viral/analysis; Herpesvirus 3, Human; Posner-Schlossman syndrome; Secondary glaucoma; Varicella zoster virus

Outcomes of changing immunosuppressive therapy after treatment failure in patients with noninfectious uveitis. - Joshi, Lavnish; Talat, Lazha; Yaganti, Satish; Sandhu, Sartaj; Taylor, Simon R. J.; Wakefield, Denis; McCluskey, Peter; Lightman, Susan (Ophthalmology, 2014)
PURPOSE: To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia. METHODS: Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained. MAIN OUTCOME MEASURES: For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined. RESULTS: A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients. CONCLUSIONS: Our data suggest that control of inflammation can be achieved after switching or combining ISAs.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Treatment Failure; Retrospective Studies; Treatment Outcome; Young Adult; Methotrexate/therapeutic use; Adolescent; Prednisolone/therapeutic use; Child; Child, Preschool; Immunosuppressive Agents/*therapeutic use; Cohort Studies; Cyclosporine/therapeutic use; Azathioprine/therapeutic use; Visual Acuity/physiology; Uveitis/*drug therapy/physiopathology; Mycophenolic Acid/analogs & derivatives/therapeutic use; *Drug Substitution

Sterile endophthalmitis after intravitreal triamcinolone: a possible association with uveitis. - Taban, Mehryar; Singh, Rishi P.; Chung, Jeffrey Yau-Huei; Lowder, Careen Y.; Perez, Victor L.; Kaiser, Peter K. (American journal of ophthalmology, 2007)
PURPOSE: To report an association between uveitis and sterile endophthalmitis after intravitreal triamcinolone acetonide injection. DESIGN: Retrospective case series. METHODS: A retrospective analysis of all patients receiving intravitreal triamcinolone injection at the Cole Eye Institute from January 2006 through September 2006 was carried out to evaluate for the occurrence of bacterial or sterile endophthalmitis. Indication for treatment, ocular history, best-corrected Snellen visual acuity, and clinical examination findings were recorded from the clinical charts before injection and at last follow-up. RESULTS: A total of 310 eyes received intravitreal triamcinolone injection for various causes, including age-related macular degeneration (AMD), diabetic retinopathy, vascular occlusion, and cystoid macular edema (CME) resulting from uveitis. There were no cases of culture-positive infectious endophthalmitis. There were six cases (1.9%) of sterile endophthalmitis. Of these six cases, four had prior history of uveitis, whereas only 20 of the 310 cases had a prior history of uveitis. All six patients sought treatment within three days of injection, and all recovered rapidly. Presenting visual acuity was either counting fingers or hand movements. Median best-corrected visual acuity before injection was 20/100(+), whereas median final visual acuity was 20/80(-). CONCLUSIONS: Patients with a history of uveitis may be at increased risk of experiencing sterile endophthalmitis resulting from intravitreal triamcinolone injection.
Keywords: Female; Humans; Male; Middle Aged; Aged; Aged, 80 and over; Retrospective Studies; Risk Factors; Injections; Visual Acuity; Triamcinolone Acetonide/*administration & dosage; Glucocorticoids/*administration & dosage; Uveitis/*complications; Vitreous Body; Endophthalmitis/*etiology; Retinal Diseases/drug therapy/etiology

Ophthalmic manifestations in familial Mediterranean fever: a case series of 6 patients. - Yazici, Alper; Ozdal, Pinar; Yuksekkaya, Pinar; Elgin, Ufuk; Teke, Mehmet Yasin; Sari, Esin (European journal of ophthalmology, 2014)
PURPOSE: To describe the ocular involvement of patients with familial Mediterranean fever (FMF) followed in a tertiary referral center. METHODS: The data of 6 patients with FMF were retrospectively reviewed. Detailed ophthalmologic examinations, type of inflammation, course of the disease, number of recurrences, treatment regimens, complications, and comorbid ocular or systemic diseases were noted. RESULTS: The mean age ± SD at diagnosis was 29.3 ± 19.3 (4-53) years. A total of 66.7% of the patients were male and 66.7% of the patients had bilateral disease. The anatomical distribution of the ophthalmic involvement was as follows: posterior uveitis in 2 (33.3%), anterior uveitis in 2 (33.3%), posterior scleritis in 1 (16.7%), and intermediate uveitis in 1 (16.7%) patient. The course was recurrent in 50% of the patients. Final visual acuities were favorable except in the patients with chronic course uveitis. Cystoid macula edema, epiretinal membrane, retinal ischemia, cataract, glaucoma, and band keratopathy were complications noted in the follow-up period. Both cataract and glaucoma patients (50%) needed a surgical intervention. In 33.3% of patients, Behçet disease was present as a concurrent disease. In patients with posterior uveitis and the patient with intermediate uveitis (50%), systemic immunosuppression was required. CONCLUSIONS: There was a male and bilateral involvement predominance. The course of the inflammation was recurrent in half of the patients. Since ocular involvement in FMF is very rare, it should be considered as diagnosis of exclusion.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Young Adult; Adolescent; Prednisolone/therapeutic use; Administration, Oral; Infusions, Intravenous; Child; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Acute Disease; Uveitis, Intermediate/*diagnosis/drug therapy; Methylprednisolone/therapeutic use; Familial Mediterranean Fever/*diagnosis/drug therapy; Scleritis/*diagnosis/drug therapy; Uveitis, Anterior/*diagnosis/drug therapy; Uveitis, Posterior/*diagnosis/drug therapy

Intravitreal Steroid Treatment for Uveitis Associated with Dabrafenib and Trametinib for Metastatic Cutaneous Melanoma. - Woltsche, Nora; Kruger, Michael Andreas; Weger, Martin; Wolf, Ingrid Hildegard; Seidel, Gerald (Ocular immunology and inflammation, 2021)
Purpose: To report a case of bilateral retinal inflammation under long-term therapy with dabrafenib/trametinib for metastatic cutaneous melanoma.Methods: Retrospective chart review.Results: A 59-year-old patient with metastatic cutaneous melanoma diagnosed in 2004 under treatment with dabrafenib/trametinib since 2014 presented to our department with intraretinal hemorrhage and extrafoveal macula edema on the right eye and optic disc swelling on the left eye. The patient did not report visual complaints. After cessation of dabrafenib/trametinib and subconjunctival and intravitreal corticosteroid injections, optic disc swelling on the left eye recovered after 6 months. The macula edema on the right eye was treated with one intravitreal anti-VEGF (vascular endothelial growth factor) injection after encroaching upon the fovea 10 months after initial presentation. The final visual acuity was 20/20 on both eyes.Conclusion: Even after years of treatment with low dose dabrafenib/trametinib, ocular toxicity can develop. Such cases can respond well to intravitreal corticosteroids.
Keywords: Humans; Retrospective Studies; Glucocorticoids/*therapeutic use; Fluorescein Angiography; Visual Acuity/physiology; Uveitis; Intravitreal Injections; Coloring Agents/administration & dosage; Indocyanine Green/administration & dosage; Triamcinolone Acetonide/therapeutic use; Antineoplastic Combined Chemotherapy Protocols/*adverse effects; BRAF inhibitor; Imidazoles/administration & dosage; Macular Edema/chemically induced/drug therapy/physiopathology; MEK inhibitor; melanoma; Melanoma/*drug therapy; ocular toxicity; Oximes/administration & dosage; Papilledema/chemically induced/drug therapy/physiopathology; Pyridones/administration & dosage; Pyrimidinones/administration & dosage; Skin Neoplasms/*drug therapy; Uveitis/chemically induced/*drug therapy/physiopathology

Pars plana vitrectomy, fluocinolone acetonide implantation, and silicone oil infusion for the treatment of chronic, refractory uveitic hypotony. - Dayani, Pouya N.; Chow, Jessica; Stinnett, Sandra S.; Jaffe, Glenn J. (American journal of ophthalmology, 2011)
PURPOSE: To assess the feasibility and outcomes of combining fluocinolone acetonide sustained drug delivery implant insertion, pars plana vitrectomy, and silicone oil infusion to treat patients with chronic, refractory ocular hypotony resulting from uveitis. DESIGN: Retrospective chart review. METHODS: A retrospective, institutional chart review was performed. Outcome measures included visual acuity, intraocular pressure, and adverse events. RESULTS: A total of 13 eyes of 11 patients were studied. All patients were women, had a mean age of 57 years (range, 26 to 73 years), and had a diagnosis of panuveitis. The mean duration of preoperative hypotony was 42 months (range, 11 to 108 months). Patients were followed up on average for 22 months (range, 9 to 46 months) after the combined surgical procedure. The mean preoperative visual acuity was 20/1000 (logarithm of the minimal angle of resolution, 1.7). At the 6- and 12-month visits, the mean visual acuity remained stable at 20/800 (logarithm of the minimal angle of resolution, 1.6; P = .74) and 20/600 (P = .34), respectively. At baseline, the mean intraocular pressure (IOP) was 2.3 mm Hg. The average IOP was 5.9 mm Hg, 5.1 mm Hg, and 5.0 mm Hg at 6, 12, and 24 months after surgery, respectively. The increase in IOP relative to the baseline IOP was statistically significant at 6 and 12 months (P = .027 and P = .004, respectively). The duration of preoperative hypotony inversely correlated with the IOP at 6 months (P = .027). No intraoperative complications were encountered and the procedure was well tolerated. CONCLUSIONS: Fluocinolone acetonide implantation combined with pars plana vitrectomy and silicone oil infusion is feasible and is well tolerated in the management of chronic, refractory ocular hypotony associated with uveitis.
Keywords: Female; Humans; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Combined Modality Therapy; Recurrence; Chronic Disease; Visual Acuity/physiology; Drug Implants; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Tonometry, Ocular; Vitreous Body; Fluocinolone Acetonide/*administration & dosage; *Vitrectomy; Silicone Oils/*administration & dosage; Ocular Hypotension/drug therapy/etiology/surgery/*therapy; Uveitis/complications/drug therapy/surgery/*therapy

Clinical outcomes of intravenous immunoglobulin therapy in refractory uveitis. - Garcia-Geremias, M.; Carreño, E.; Epps, S. J.; Lee, R. W. J.; Dick, A. D. (International ophthalmology, 2015)
Intravenous immunoglobulin (IVIg) therapy has multiple mechanisms of immunomodulatory action. We wished therefore to assess its efficacy in a spectrum of patients with refractory uveitis. Retrospective review of clinical charts was conducted to document response to IVIg treatment in consecutive patients with treatment-refractory uveitis. Main outcome measures were control of intraocular inflammation, visual acuity, progression of the disease, and complications. Four (two male) patients, with a mean age at the beginning of the treatment of 47 years (range: 39-64), were included in the study. Indication for treatment was patients with active non-infectious uveitis refractory to steroids and immunomodulatory therapy. All patients received a course of 0.5 g/kg per day of IVIg for three consecutive days, repeating this course at a mean of 11 week (range: 2-39 weeks) intervals when indicated clinically. The median duration of the IVIg therapy was 7 months (range: 3-14 months). In three patients treatment resulted in stabilisation and prevention of progression of the disease, and additionally in two patients it facilitated a decrease in prednisolone dose. Treatment failed to induce long-term remission in one patient with recurrence of macular oedema. IVIg was well tolerated with neither immediate nor longer-term adverse events observed. In three out of four cases IVIg was an effective adjunctive therapy and well tolerated for the management of treatment-refractory uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Disease Progression; Injections, Intravenous; Visual Acuity; Uveitis/*drug therapy; Immunoglobulins, Intravenous/*administration & dosage; Immunologic Factors/*administration & dosage

Intravenous tocilizumab in idiopathic pediatric uveitis with refractory cystoid macular edema - A case report. - Babu, Kalpana; Sudheer, Bhagya; Rao, Anand P. (Indian journal of ophthalmology, 2019)
A 13-year-old boy with a 4-year history of idiopathic pediatric uveitis and recurrent uveitic macular edema had failed conventional immunomodulatory therapy and presented to us with a vision of 6/24 [right eye (OD)] and 6/9 [left eye (OS)]. Fluorescein angiography showed diffuse vascular leakage along with cystoid macular edema (CME). Intravenous tocilizumab (10 mg/kg body) was given as 14 injections over 12 months. Repeat fluorescein angiography every 3 months showed a dramatic improvement in the vascular leakage and resolution of CME. At 13 months OF follow-up, vision had improved to 6/9p (OD) and 6/6(OS) with no recurrence of inflammation or CME.
Keywords: Humans; Male; Follow-Up Studies; Adolescent; Injections, Intravenous; Fluorescein Angiography; Tomography, Optical Coherence; *tocilizumab; Fundus Oculi; Visual Acuity; Uveitis/complications/diagnosis/*drug therapy; Macula Lutea/*pathology; Antibodies, Monoclonal, Humanized/*administration & dosage; *Biologics; *cystoid macular edema; *idiopathic; *pediatric uveitis; Macular Edema/complications/diagnosis/*drug therapy

Topical difluprednate monotherapy for uveitic macular edema. - Symes, Richard J.; Forooghian, Farzin (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2016)
OBJECTIVE: To describe the use of topical difluprednate for the treatment of uveitic macular edema. DESIGN: Retrospective review of 3 consecutive cases of uveitic macular edema. METHODS: Patients were treated with topical difluprednate monotherapy. RESULTS: All patients experienced complete resolution of uveitic macular edema within 2-4 weeks. We observed a statistically significant improvement in central subfield macular thickness (p = 0.04). There was an overall improvement in visual acuity, but this result was not statistically significant (p = 0.33). CONCLUSIONS: Topical difluprednate can be effective for uveitic macular edema. Further investigation of this therapy in prospective randomized controlled trials is warranted.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Glucocorticoids/*therapeutic use; Tomography, Optical Coherence; Ophthalmic Solutions; Visual Acuity/drug effects; Administration, Topical; Uveitis, Intermediate/diagnosis/*drug therapy/physiopathology; Uveitis, Anterior/diagnosis/*drug therapy/physiopathology; Macular Edema/diagnosis/*drug therapy/physiopathology; Fluprednisolone/*analogs & derivatives/therapeutic use

Syphilitic uveitis in human immunodeficiency virus-infected patients. - Shalaby, I. A.; Dunn, J. P.; Semba, R. D.; Jabs, D. A. (Archives of ophthalmology (Chicago, Ill. : 1960), 1997)
OBJECTIVE: To document the incidence and clinical features of syphilitic uveitis in patients coinfected with human immunodeficiency virus (HIV). DESIGN: Retrospective chart review. SETTINGS: Single tertiary uveitis referral center. PATIENTS: The charts of HIV-infected patients with uveitis and a reactive fluorescent treponemal antibody absorption test seen between November 1983 and June 1995 were reviewed. RESULTS: Syphilis was the most common bacterial cause of uveitis in this group. Thirteen patients (0.6% of the 2085 HIV-positive patients seen in the clinic during the study period) were dually infected. Twelve patients were male. Six patients (46%) had previously been treated for syphilis, 4 with intramuscular penicillin G benzathine only. Four patients (31%) had isolated anterior uveitis, 3 patients (23%) had anterior and intermediate uveitis, and 5 patients (38%) had panuveitis. One patient (8%) presented with optic nerve and retinal atrophy. Eight patients were treated with intravenous penicillin, 3 with intravenous and intramuscular penicillin, and 1 with intravenous ceftriaxone sodium. Of the 12 patients for whom follow-up examinations were available after treatment, ocular inflammation decreased in 11 (92%) and visual acuity improved in 8 (67%). Rapid plasma reagin titers decreased a median of 64-fold compared with pretreatment levels, and all patients with reactive cerebrospinal fluid who underwent pretreatment and posttreatment lumbar punctures normalized following therapy with intravenous antibiotics. CONCLUSIONS: Syphilis is an uncommon cause of uveitis in HIV-infected patients. Anterior uveitis is the most common ocular manifestation, but panuveitis is more common than isolated anterior uveitis. Intravenous penicillin is effective therapy.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Treatment Outcome; Recurrence; Injections, Intravenous; Visual Acuity; Penicillins/therapeutic use; HIV Infections/*complications; Syphilis/*complications/drug therapy; Uveitis/*microbiology/physiopathology

Subretinal fibrosis and uveitis: a spectral domain OCT study of its evolution and the minimal therapeutic effect of the off-label treatment with ranibizumab. - Symeonidis, Chrysanthos; Dastiridou, Anna; Konidaris, Vasilis; Brazitikos, Periklis; Androudi, Sofia (Ocular immunology and inflammation, 2014)
PURPOSE: The subretinal fibrosis and uveitis (SFU) syndrome is a rare multifocal posterior uveitis characterized by progressive subretinal fibrosis and significant visual loss. METHODS: Slit-lamp examination, dilated fundoscopy, fluorescein angiography, Spectral Domain-Optical Coherence Tomography (SD-OCT) and laboratory testing were employed. RESULTS: A 52-year-old male presented with bilateral (best-corrected visual acuity: 2/10) visual loss. Clinical examination revealed bilateral anterior uveitis with posterior synechiae and posterior uveitis. Medical workup revealed no pathologic findings. Treatment included 1 gr intravenous prednisone followed by oral prednisone, immunosuppresive therapy and three ranibizumab injections in the right eye with no improvement. One year later, there was significant subretinal fibrosis. In the second year follow-up, the picture was slightly worse, with persisting bilateral macular edema and fibrosis. CONCLUSIONS: This is the first SFU syndrome report monitored with SD-OCT. This novel imaging modality can localize the lesion level, guide the therapeutic approach and may prove helpful in assessing disease prognosis.
Keywords: Humans; Male; Middle Aged; Dose-Response Relationship, Drug; Fluorescein Angiography; uveitis; Fundus Oculi; Visual Acuity; Retina/*pathology; Tomography, Optical Coherence/*methods; pediatric; Choroiditis; Antibodies, Monoclonal, Humanized/*administration & dosage; Ranibizumab; Uveitis, Posterior/*diagnosis/drug therapy; *Off-Label Use; ranibizumab; spectral domain optical coherence tomography; subretinal fibrosis

Failure of medical therapy despite normal intraocular pressure. - Walland, Mark J.; Carassa, Roberto G.; Goldberg, Ivan; Grehn, Franz; Heuer, Dale K.; Khaw, Peng T.; Thomas, Ravi; Parikh, Rajul (Clinical & experimental ophthalmology, 2006)
The disease glaucoma is now defined by characteristic optic disc and visual field change, without specific reference to the intraocular pressure (IOP). Success of treatment is no longer judged by the mere attainment of IOP less than 21 mmHg. Controversy remains, however, in deciding appropriate management where optic disc and/or visual field damage continues to progress despite a 'normal' IOP having been achieved with medical treatment. A panel of international glaucoma experts has provided management recommendations in four clinical scenarios--open-angle glaucoma, open-angle glaucoma in a myopic contact lens wearer, uveitic glaucoma and open-angle glaucoma in combination with visually significant cataract--where optic nerve and visual field progression has continued despite an IOP less than 21 mmHg on full medical treatment. Surgical intervention with mitomycin trabeculectomy is the most favoured further therapy.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Treatment Failure; Disease Progression; Visual Fields; Intraocular Pressure/*physiology; Antihypertensive Agents/*therapeutic use; Cataract/complications; Contact Lenses; Glaucoma, Open-Angle/*drug therapy/surgery; Myopia/complications; Practice Guidelines as Topic; Trabeculectomy/methods; Uveitis/complications; Vision Disorders/prevention & control

Diltiazem co treatment with cyclosporine for induction of disease remission in sight-threatening non-infectious intraocular inflammation. - Shalaby, Usama (Japanese journal of ophthalmology, 2017)
PURPOSE: To investigate the effects of diltiazem co-treatment with microemulsified cyclosporine-A (CsA) on dosage, blood concentrations of CsA, as well as therapeutic and side effects in patients with sight-threatening non-infectious intraocular inflammation. METHODS: A prospective, randomized, placebo-controlled, open-label trial of 39 patients with sight-threatening non-infectious intraocular inflammation. The change in visual acuity (LogMAR), the grade of inflammatory activity, therapeutic concentration of CsA in the blood and systemic and renal toxicity were determined after comparing two groups, one treated with CsA and diltiazem (treatment group), and the other without diltiazem (control group). RESULTS: Compared with the control group, the concentration of CsA in the blood of the treatment group significantly increased (P < 0.05) requiring a reduction in dosage of CsA (P < 0.05). CONCLUSION: In patients with severe intraocular inflammation treated with CsA and diltiazem, blood concentrations of CsA increased as the dosage decreased. This efficient combination therapy reduced patient's economic burden, at the same time decreasing systemic and renal toxicity which in turn may promote the use of CsA for longer periods.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Prospective Studies; Follow-Up Studies; Dose-Response Relationship, Drug; Remission Induction/methods; Immunosuppressive Agents/administration & dosage; *Uveitis; Uveitis/diagnosis/*drug therapy; *Cyclosporine; *Diltiazem; *Intraocular inflammation; *Renal toxicity; Cyclosporine/*administration & dosage; Diltiazem/*administration & dosage; Vasodilator Agents/administration & dosage

[Therapy of cystoid diffuse macular edema after uveitis and cataract surgery with the carbonic anhydrase inhibitor acetazolamide (Diamox)]. - Schilling, H.; Pauleikhoff, D.; Schrenk, M.; Wessing, A. (Klinische Monatsblatter fur Augenheilkunde, 1993)
BACKGROUND: Observations made by Cox, Bird et al. (1988), who first used acetazolamide (Diamox) for treatment of macular edema of various origin in a higher number of patients, let assume a positive effect of this therapy on fluid accumulation specifically inside the inner retinal layers. Based on these studies 15 patients (20 eyes) with cystoid or cystoid-diffuse macular edema were treated with acetazolamide in a pilot-study. MATERIALS AND METHODS: Eleven patients (fifteen eyes) had postuveitic macular edema, four other patients (five eyes) had cystoid edema following cataract surgery. Patients with additional diseases causing macular edema of retinal vascular origin were excluded. The initial dose was 500 mg daily. In one patient responding to therapy the dose was gradually reduced after three weeks down to a minimum of 125 mg every second day. For evaluation of the therapeutical results fluorescein angiography and visual acuity were taken into account. RESULTS: Eleven patients (fourteen out of twenty eyes) showed a distinct therapeutical effect with decrease of macular edema in repeatedly controlled fluorescein angiography. All these patients had a subjective improvement of vision which correlated with an increase of visual acuity in exactly one half of all patients. Therapy was stopped, when the macular edema had still appeared unchanged in angiography after three weeks or when--in spite of fluid reduction in angiography--no improvement of visual acuity could be obtained in the next two months. The maintenance dose showed large individual variation with a minimum of 125 mg every second day and a maximum of 250 mg per day. Attempts to stop therapy resulted in a early reappearance of the edema of original extension with corresponding deterioration of visual acuity and sensitivity of central visual field. In a few patients even the reduction of the dose below the individual maintenance dose could be demonstrated angiographically. All patients were under continuous internal medical control, permanent side-effects of acetazolamide with the doses used in this study were not seen. CONCLUSIONS: The results show that acetazolamide is a basically effective agent against cystoid macular edema and that a therapeutical trial is justified based on the treatment criteria of this study. The factors limiting the therapeutical effect of acetazolamide cannot yet be evaluated on the basis of the small amount of patients in this pilot-study. Considering the patient data a time factor depending on the period between onset of edema-related symptoms and begin of treatment is likely. In the group of unsuccessfully treated cases we had the patients with the longest period of preexisting edema (more than one year) of the study.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Follow-Up Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Fluorescein Angiography; Uveitis/*drug therapy; Visual Acuity/drug effects; Delayed-Action Preparations; Acetazolamide/*administration & dosage; Macular Edema/diagnosis/*drug therapy

Intravenous pulse methylprednisolone in the treatment of uveitis associated with multiple sclerosis. - Wakefield, D.; Jennings, A.; McCluskey, P. J. (Clinical & experimental ophthalmology, 2000)
PURPOSE: To demonstrate the safety and effectiveness of intravenous methylprednisolone (IVMP) in the treatment of uveitis in association with multiple sclerosis (MS). METHODS: Uveitis is an unusual manifestation of MS that may be severe, chronic and require systemic immunosuppression therapy. High-dose IVMP has previously been shown to be effective in the treatment of inflammatory eye disease and MS. Eight episodes of uveitis in five patients with MS were treated over a 10-year period in an open, uncontrolled trial. Two patients had chronic anterior uveitis, one patient had bilateral panuveitis and two patients had intermediate uveitis. RESULTS: All patients responded to IVMP with evidence of a decrease in intraocular inflammatory activity and improved visual acuity (VA) within 2 weeks of commencing treatment. There were no severe ocular or systemic steroid side effects. CONCLUSIONS: Intravenous methylprednisolone is an effective, well-tolerated form of therapy for uveitis in patients with MS.
Keywords: Female; Humans; Adult; Safety; Injections, Intravenous; Visual Acuity; Glucocorticoids/*administration & dosage; Multiple Sclerosis/*complications; Methylprednisolone/*administration & dosage; Uveitis, Anterior/*drug therapy/etiology; Uveitis, Intermediate/*drug therapy/etiology; Uveitis, Posterior/*drug therapy/etiology

[Posner-Schlossman syndrome]. - Köhler, U. (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1992)
The clinical features of Posner-Schlossman syndrome and the various differential diagnoses are described in a 20-year-old patient. Additional to Posner-Schlossman syndrome this patient showed signs of Axenfeld's anomaly. He also presented symptoms of a status-dysrhaphicus-like state after atrial septal defect and the ability to overstrain the distal finger joints. Posner-Schlossman syndrome, heterochromic cyclitis, anterior-chamber cleavage syndrome and ICE syndrome (iridocorneal-endothelial syndrome: Chandler's, Cogan-Reese syndrome and progressive essential iris atrophy) often produce similar effects at the Descemet membrane, the anterior chamber angle and the iris. Because of the same mesodermal origin of these tissues we suggest that all the diseases mentioned above are merely different clinical expressions of one main disease.
Keywords: Humans; Male; Adult; Combined Modality Therapy; Trabeculectomy; Syndrome; Laser Therapy; Visual Acuity/drug effects/physiology; Glaucoma, Open-Angle/*physiopathology/surgery; Intraocular Pressure/drug effects/*physiology; Iridocyclitis/*physiopathology/surgery; Timolol/administration & dosage; Visual Fields/drug effects/physiology

Subconjunctival sirolimus for the treatment of chronic active anterior uveitis: results of a pilot trial. - Sen, H. Nida; Larson, Theresa A.; Meleth, Annal D.; Smith, Wendy M.; Nussenblatt, Robert B. (American journal of ophthalmology, 2012)
PURPOSE: To evaluate the safety and possible efficacy of subconjunctival sirolimus for the treatment of chronic active anterior uveitis. DESIGN: Prospective, nonrandomized, open-label clinical trial. METHODS: This single-center pilot trial enrolled 5 patients with chronic active anterior uveitis. The study drug was administered as a single subconjunctival injection of 30 μL (1320 μg) sirolimus in the study eye at the baseline visit. Study visits were performed at baseline, at 2 weeks, at 4 weeks, and monthly until 4 months, and included a complete ophthalmic examination, review of systems, adverse event assessment at each visit, physical examination, and ancillary ophthalmic testing at some visits. The primary outcome measure was a 2-step reduction in the anterior chamber inflammation within 4 weeks of injection of the study drug. RESULTS: There were 3 female and 2 male patients; 4 patients had idiopathic anterior uveitis and 1 had psoriatic arthritis-associated anterior uveitis. Three of the 5 patients met the primary outcome criteria by showing at least a 2-step decrease in inflammation within 4 weeks; 2 patients showed a 1-step decrease in inflammation within the same time frame. No recurrence was encountered during a 4-month follow-up. There were no serious adverse events. CONCLUSIONS: Subconjunctival sirolimus appears to be well tolerated in this pilot trial and shows promise as a treatment for active inflammation in patients with chronic anterior uveitis. Larger studies are needed to assess its usefulness in uveitis.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Prospective Studies; Treatment Outcome; Chronic Disease; Visual Acuity/physiology; Injections, Intraocular; Conjunctiva/drug effects; Immunosuppressive Agents/*administration & dosage/adverse effects; Uveitis, Anterior/*drug therapy/physiopathology; Sirolimus/*administration & dosage/adverse effects

The use of low dose methotrexate in children with chronic anterior and intermediate uveitis. - Malik, A. R.; Pavesio, C. (The British journal of ophthalmology, 2005)
AIM: To assess the efficacy of low dose methotrexate (MTX) therapy for children with chronic anterior and intermediate uveitis. METHODS: A retrospective case review of 10 children who received MTX for chronic uveitis at a tertiary referral centre was performed. The following data were recorded for each patient: age, sex, race, duration of uveitis, primary diagnosis, anatomical localisation of uveitis, corticosteroid therapy, dose range of MTX, duration of MTX therapy, and side effects of MTX therapy. Several clinical parameters were evaluated to study the effect of MTX. These included visual acuity, anterior chamber inflammation, and topical and oral corticosteroid requirement. RESULTS: After MTX VA of 6/6 or better was present in 100% right eyes and 80% left eyes (p = 0.055 and p = 0.016, respectively). Anterior chamber inflammation decreased in 60% of children after MTX (p = 0.0168). The requirement of topical steroid decreased from a mean of 5.6 times a day before MTX to 1.5 times a day after MTX (p = 0.005). The dose of oral steroid decreased from a mean of 18 mg per day to 2.85 mg per day (p = 0.012). The most common adverse effect was nausea (20%). No patient required discontinuation of MTX because of side effects. CONCLUSION: MTX is effective and safe for chronic anterior and intermediate uveitis in children. An increase awareness of its efficacy is required among paediatricians and ophthalmologists to prevent sight threatening complication of chronic uveitis and its treatment with long term use of steroids.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Drug Administration Schedule; Adolescent; Administration, Oral; Methotrexate/*administration & dosage/adverse effects; Chronic Disease; Child; Visual Acuity/physiology; Administration, Topical; Immunosuppressive Agents/*administration & dosage/adverse effects; Uveitis, Intermediate/*drug therapy/physiopathology; Uveitis, Anterior/*drug therapy/physiopathology; Adrenal Cortex Hormones/administration & dosage; Nausea/chemically induced

Secondary glaucoma in patients with uveitis. - Merayo-Lloves, J.; Power, W. J.; Rodriguez, A.; Pedroza-Seres, M.; Foster, C. S. (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1999)
PURPOSE: To evaluate the prevalence of secondary glaucoma (SG), clinical forms of uveitis more frequently associated with glaucoma, and describe the treatment and complications encountered in a cohort of patients with glaucoma and uveitis during a 10-year period. METHODS: The hospital records of patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary for a decade were reviewed for cases of SG. RESULTS: One hundred and twenty of the 1,254 patients (9.6%) with uveitis developed SG. SG was more frequent in anterior uveitis (67%) but was also associated with posterior uveitis (13%) and pars planitis (4%). Herpetic keratouveitis (22%), Fuchs' iridocyclitis (19%), juvenile rheumatoid arthritis-associated iridocyclitis (16%), syphilis (14%), and sarcoidosis (12%) were the leading types of uveitis associated with SG. Despite aggressive medical and surgical therapy, SG was associated with progressive visual field loss and optic nerve damage in 39 patients (33%). CONCLUSION: SG is an underappreciated, vision-threatening complication in patients with uveitis. Increased vigilance for emergence of this complicating problem during the care of patients with uveitis is warranted, and medical and surgical treatment for reducing IOP should be especially aggressive in these patients. We hypothesize that earlier, more aggressive treatment of uveitis will reduce the presence of glaucoma as an additional vision-robbing complication of uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Adolescent; Child; Child, Preschool; Longitudinal Studies; Cohort Studies; Visual Fields; Prevalence; Visual Acuity; Carbonic Anhydrase Inhibitors/therapeutic use; Vision Disorders/etiology; Adrenergic Agents/therapeutic use; Glaucoma/complications/drug therapy/epidemiology/*etiology/surgery; Optic Nerve Diseases/etiology; Uveitis/classification/*complications

Long-term outcome of an intravitreal dexamethasone implant for the treatment of noninfectious uveitic macular edema. - Habot-Wilner, Zohar; Sorkin, Nir; Goldenberg, Dafna; Loewenstein, Anat; Goldstein, Michaella (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2014)
PURPOSE: To report the long-term outcome of an intravitreal dexamethasone drug delivery system (DEX-DDS) injection for noninfectious uveitic macular edema. METHODS: This was a retrospective study of 8 eyes (7 patients). RESULTS: The mean follow-up time was 17.3 months. Macular edema resolved in all eyes at 3.9 weeks (range 1-6.9) postinjection. The central point thickness improved from 612 ± 143 to 250 ± 55 µm (p < 0.05). The mean best corrected visual acuity improved by 0.25 logMAR (p < 0.05) at 3.9 weeks (range 1-6.9) postinjection. In 5 eyes, macular edema did not recur after a mean follow-up of 14.5 months. In 3 eyes, macular edema relapsed after 4.7 months (range 3.6-6.3) and resolved again following further injections. Two eyes developed intraocular pressure elevation, which was well controlled with topical treatment. CONCLUSIONS: Intravitreal DEX-DDS injections resulted in resolution of macular edema and visual acuity improvement. Some eyes required repeated injections, but most eyes achieved long-term resolution. No significant complications were noticed.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Tomography, Optical Coherence; Uveitis/diagnosis/*drug therapy/physiopathology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Visual Acuity/drug effects; Vitreous Body/drug effects; Macular Edema/diagnosis/*drug therapy/physiopathology

Long-term results of cataract extraction with intraocular lens implantation in patients with uveitis. - Rahman, I.; Jones, N. P. (Eye (London, England), 2005)
OBJECTIVE: To investigate the long-term visual results after cataract extraction in patients with uveitis, and to demonstrate the long-term viability of intraocular lenses. DESIGN: In all, 61 patients (72 eyes), with update clinical examination, were retrospectively evaluated. Comparison of preoperative, postoperative, and latest visual function including best-corrected Snellen visual acuity, progression of uveitis and its complications, need for postoperative medical or surgical interventions. RESULTS: After a minimum follow-up of 5 years (mean 7 years 7 months), 82% of eyes maintained a visual improvement of two Snellen lines, 74% maintained 6/9 or better, and 14% had 6/18 or worse. The mode acuity was better than 6/6. The prevalence of macular oedema or scarring was 24%, of posterior capsule opacification 96%, and of glaucoma drainage, 15%. CONCLUSIONS: We report the long-term follow-up of cataract extraction and intraocular lens (IOL) implantation performed by a single surgeon on patients with uveitis attending a regional tertiary referral uveitis clinic. Using stringent perioperative and postoperative control of inflammation, patients with uveitis usually maintain high visual acuity over long-term follow-up. The incidence of sight-threatening postoperative complications is low and no ongoing complication has been attributed to IOL implantation.
Keywords: Humans; Middle Aged; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Retrospective Studies; Disease Progression; Adolescent; Anti-Inflammatory Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity; *Cataract Extraction; Phacoemulsification; Uveitis/*complications/drug therapy/physiopathology; *Lens Implantation, Intraocular/adverse effects; Cataract/complications; Preoperative Care/methods

Dexamethasone Intravitreal Implant in the Treatment of Uveitic Macular Edema in the Perioperative Cataract Setting: A Case Series. - Larochelle, Marissa Bucci; Smith, Jesse; Dacey, Mark S. (American journal of ophthalmology, 2016)
PURPOSE: To examine the efficacy of the dexamethasone (DEX) intravitreal implant (Ozurdex; Allergan, Inc, Irvine, California, USA) in the control of uveitic macular edema in the perioperative setting of cataract surgery. DESIGN: Retrospective observational case series. METHODS: setting: Clinical practice. PARTICIPANTS: A total of 17 eyes of 14 patients that received a DEX implant for cystoids macular edema (CME) associated with noninfectious uveitis who underwent subsequent phacoemulsification within 4 months. INTERVENTION: Each patient was treated with a DEX 0.7 mg intravitreal implant and underwent phacoemulsification with intraocular lens placement. MAIN OUTCOME MEASURES: Primary outcome measure was the change in central macular thickness (CMT) measured by optical coherence tomography (OCT), measured preoperatively and postoperatively. RESULTS: Seventeen eyes (14 patients) were included for analysis. There was no statistically significant change from preoperative CMT (mean 302 μm) to postoperative CMT (307 μm) on OCT. In the subset of eyes that underwent phacoemulsification within 4 weeks of the DEX implant (8 eyes), the mean change in CMT was -47.0 μm, compared to +51.1 μm in those that received the DEX implant greater than 4 weeks prior to phacoemulsification (P = .005). CONCLUSIONS: Intravitreal dexamethasone implant was shown to prevent the recurrence or worsening of macular edema in uveitic patients with a history of CME who underwent phacoemulsification. The mean CMT decreased in the subset of eyes that received the DEX implant within 4 weeks prior to cataract surgery.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Recurrence; Tomography, Optical Coherence; Visual Acuity; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Cataract/*complications; *Phacoemulsification; Lens Implantation, Intraocular; Macular Edema/*drug therapy/etiology/physiopathology; Uveitis/*drug therapy/etiology/physiopathology; *Postoperative Complications

Clinical outcome of chronic immunosuppression in patients with non-infectious uveitis. - Menezo, Victor; Lau, Chun; Comer, Marie; Lightman, Susan (Clinical & experimental ophthalmology, 2005)
AIM: To determine the visual outcome and corticosteroid dose requirement in patients with non-infectious uveitis affecting the posterior segment treated with corticosteroids and additional second-line immunosuppression. METHOD: A retrospective, non-comparative case series was carried out. Seventy-two patients (141 eyes) with uncontrolled non-infectious uveitis on systemic prednisolone were treated with at least one second-line immunosuppressive agent in addition to systemic prednisolone and followed for at least 3 months. Visual acuity (VA), clinical disease activity, corticosteroid-sparing effect, disease relapses requiring corticosteroid dose increase,and side-effects from second-line agents were evaluated. RESULTS: At the end of the follow-up period (mean: 55.5 months),70 eyes (49.6%) had VA of 6/9 or better. There was a reduction in the mean maintenance dose of prednisolone required before the introduction of the second-line agent (19 mg/day +/- 2 SE)when compared to the mean maintenance dose of prednisolone at the end of the data collection (9 mg/day +/- 1 SE; P <0.001). There was also a significant reduction in the number of disease relapses requiring an increase in prednisolone dose after starting the second-line agents as compared to the year before (P <0.02). CONCLUSION: In patients with uveitis affecting the posterior segment, the addition of all second-line immunosuppressive therapy was effective in allowing reduction of the dose of systemic prednisolone to 10 mg/day or less, in controlling intraocular inflammation, reducing the number of relapses and in maintaining vision. Because of their side-effects, immunosuppressive treatment should be individualized and monitored closely but its addition is beneficial in the short and longer term.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Retrospective Studies; Treatment Outcome; Adolescent; Visual Acuity; Glucocorticoids/*administration & dosage; Uveitis, Posterior/*drug therapy/physiopathology; Immunosuppressive Agents/*administration & dosage; Prednisolone/*administration & dosage; Immune Tolerance

New observations on vitiligo and ocular disease. - Wagoner, M. D.; Albert, D. M.; Lerner, A. B.; Kirkwood, J.; Forget, B. M.; Nordlund, J. J. (American journal of ophthalmology, 1983)
We examined 223 consecutive patients with vitiligo for ocular disease and 154 consecutive patients with uveitis for vitiligo to better determine the nature of the relationship between vitiligo and ocular disease. Of the 129 patients whose uveitis had an unknown cause, seven (5.4%) had cutaneous depigmentation, poliosis, or early graying of hair. The incidence is 0.5% in the general population (P less than .02). None of the 25 patients whose uveitis had a known cause had vitiligo. Eleven (4.8%) of 223 patients with vitiligo had uveitis at the time of the study or had had it within the previous two years. Of 27 patients in whom vitiligo was associated with cutaneous melanoma, five (18.5%) had had uveitis within the previous two years. In three of these five, the uveitis began within one month of the appearance of cutaneous changes. Evidence of old chorioretinal scars were present in 69 of 223 patients with vitiligo (30.9%) but in only two of 148 control patients (P less than .001). Sixty of 223 patients with vitiligo (26.9%) had evidence of hypopigmentation or atrophy of the retinal pigment epithelium, or both, not related to old chorioretinitis or macular degeneration but only six of 148 controls did (P less than .001).
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Adolescent; Child; Child, Preschool; Visual Acuity; Eye Diseases/*diagnosis/etiology; Psoriasis/diagnosis/drug therapy; PUVA Therapy; Uveitis/diagnosis/etiology; Vitiligo/*diagnosis/drug therapy

Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of 'sunset glow fundus' in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. - Abu El-Asrar, Ahmed M.; Dosari, Mona; Hemachandran, Suhail; Gikandi, Priscilla W.; Al-Muammar, Abdulrahman (Acta ophthalmologica, 2017)
PURPOSE: To evaluate the effectiveness and safety of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS: This prospective study included 38 patients (76 eyes). The main outcome measures were final visual acuity, corticosteroid-sparing effect, progression to chronic recurrent granulomatous uveitis and development of complications, particularly 'sunset glow fundus'. RESULTS: The mean follow-up period was 37.0 ± 29.3 (range 9-120 months). Visual acuity of 20/20 was achieved by 93.4% of the eyes. Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering to 10 mg or less daily was 3.8 ± 1.3 months (range 3-7 months). Twenty-two patients (57.9%) discontinued treatment without relapse of inflammation. The mean time observed off of treatment was 28.1 ± 19.6 months (range 1-60 months). None of the eyes progressed to chronic recurrent granulomatous uveitis. The ocular complications encountered were glaucoma in two eyes (2.6%) and cataract in five eyes (6.6%). None of the eyes developed 'sunset glow fundus', and none of the patients developed any systemic adverse events associated with the treatment. CONCLUSIONS: Use of MMF as first-line therapy combined with systemic corticosteroids in patients with initial-onset acute VKH disease prevents progression to chronic recurrent granulomatous inflammation and development of 'sunset glow fundus'.
Keywords: Female; Humans; Male; Adult; Drug Therapy, Combination; Prospective Studies; Disease Progression; Adolescent; Glucocorticoids/*therapeutic use; Administration, Oral; Recurrence; Child; Injections, Intravenous; Enzyme Inhibitors/therapeutic use; Prednisone/therapeutic use; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Acute Disease; immunomodulatory therapy; mycophenolate mofetil; Mycophenolic Acid/*therapeutic use; Methylprednisolone/therapeutic use; recurrence; Inflammation/prevention & control; ‘sunset glow fundus’; *Fundus Oculi; Uveomeningoencephalitic Syndrome/diagnosis/*drug therapy/physiopathology; Vogt-Koyanagi-Harada disease

Reimplantation of a fluocinolone acetonide sustained drug delivery implant for chronic uveitis. - Jaffe, Glenn J. (American journal of ophthalmology, 2008)
PURPOSE: To determine the effects of a second fluocinolone implant inserted in eyes with uveitis in which recurrent inflammation developed after the original implant was placed. DESIGN: Prospective, interventional trial. METHODS: Study subjects comprised all consecutive patients with noninfectious posterior uveitis who were treated at the Duke Eye Center from March 2004 to July 2007, and followed for at least nine months, in whom a fluocinolone acetonide implant was initially inserted, and in whom the implant was replaced, or a second implant was inserted because of recurrent inflammation. The main outcome measures were inflammation recurrences, use of adjunctive anti-inflammatory therapy, visual acuity, intraocular pressure (IOP), and adverse events. RESULTS: Seventeen eyes of 14 patients were studied. The mean time from original fluocinolone implantation to first uveitis recurrence was 38 months. The time from first inflammation recurrence to the second implantation was eight months. The average follow-up was 17 months. Inflammation developed in only one eye during follow-up, three years after the second fluocinolone implant insertion. Adjunctive steroid use was decreased significantly. The mean snellen visual acuity 12 months after the second implant insertion was 20/78, compared with 20/400 at the time of the original fluocinolone implant placement (P = .04). The average IOP was unchanged after surgery compared with the preoperative IOP. CONCLUSIONS: The fluocinolone implant controls ocular inflammation for an average of three years after initial insertion. After the implant is depleted of drug, inflammation may recur. Placement of a new implant maintains the eye in a quiet state and stabilizes or improves visual acuity for an extended time. Adverse events during insertion of a new implant are uncommon.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Chronic Disease; Drug Implants; Visual Acuity/drug effects; Glucocorticoids/*administration & dosage/adverse effects; Intraocular Pressure/drug effects; Uveitis, Posterior/*drug therapy; Retreatment; *Drug Delivery Systems; Fluocinolone Acetonide/*administration & dosage/adverse effects; Secondary Prevention

Ab Interno Tube Occlusion for Postoperative Hypotony in a Patient With an Ahmed Glaucoma Drainage Device. - Feinstein, Max; Moussa, Kareem; Han, Ying (Journal of glaucoma, 2018)
PURPOSE: To report a case of Ahmed glaucoma valve-induced hypotony that was successfully managed with postoperative intraluminal stenting of the aqueous shunt tube. PATIENT AND METHODS: We describe a 68-year-old man with advanced uveitic glaucoma with an intraocular pressure (IOP) of 25 mm Hg in the left eye. The patient initially responded well to an Ahmed glaucoma valve implant, but at 10 weeks postimplantation, the patient underwent cataract surgery and developed persistent hypotony, choroidal folds, and decreased vision. RESULTS: Before partial occlusion of the aqueous shunt tube, the patient had an IOP of 3 mm Hg and a best-corrected visual acuity (BCVA) of 20/60. Following intraluminal stenting of the aqueous shunt tube with 4-0 polypropylene suture (Prolene; Ethican), IOP rose from 7 to 10 mm Hg, BCVA improved to 20/30, and the choroidal folds resolved; IOP and BCVA remained stable through 1 year of follow-up and no additional surgical or pharmacological interventions were required. CONCLUSIONS: Aqueous shunt-induced hypotony can be successfully managed with intraluminal stenting and should be considered before tubal ligation or shunt removal.
Keywords: Humans; Male; Aged; Treatment Outcome; Visual Acuity; Tonometry, Ocular; Intraocular Pressure; Glaucoma/physiopathology/*surgery; Glaucoma Drainage Implants/*adverse effects; Prosthesis Implantation/adverse effects; *Suture Techniques; Drainage/adverse effects; Ocular Hypotension/*etiology/*surgery; Postoperative Complications/physiopathology/*surgery; Reoperation/methods; Stents/adverse effects

Periocular triamcinolone acetonide injections for control of intraocular inflammation associated with uveitis. - Salek, Sherveen S.; Leder, Henry A.; Butler, Nicholas J.; Gan, Theresa J.; Dunn, James P.; Thorne, Jennifer E. (Ocular immunology and inflammation, 2013)
PURPOSE: To describe the effectiveness of periocular corticosteroid injections for the control of intraocular inflammation associated with noninfectious uveitis. METHODS: A total of 81 patients (109 eyes) who received a periocular injection were evaluated for active inflammation, visual acuity, intraocular pressure, degree of intraocular inflammation, and the presence of ocular complications, including macular edema. RESULTS: Of all eyes, 36% (95%CI: 25%, 45%) demonstrated clinical resolution of inflammation at the 1-month visit after first injection, and 48% (95%CI: 37%, 59%) at 3 months. For multiple injections, 50% (95%CI: 28%, 72%) demonstrated resolution of inflammation at 1 month after the last injection, and 41% (95%CI: 20%, 63%) resolution of inflammation at 3 months after the last injection. Of the 49 eyes that initially responded, the estimated median time to recurrence was 7.6 months. CONCLUSIONS: Approximately half of the treated eyes had resolution of intraocular inflammation at 3 months after corticosteroid injection.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Child; Child, Preschool; Glucocorticoids/administration & dosage; Visual Acuity; Injections, Intraocular; Triamcinolone Acetonide/*administration & dosage; Uveitis/*drug therapy/physiopathology

Sympathetic ophthalmia: Report of a case series and comprehensive review of the literature. - Yang, Jing; Li, Yan; Xie, Ruotian; Li, Xiaorong; Zhang, Xiaomin (European journal of ophthalmology, 2021)
PURPOSE: To evaluate the factors related to sympathetic ophthalmia (SO) in a series of patients in our ophthalmology center and previously published cases. METHODS: A retrospective and noncomparative review was performed on 16 patients with SO attending our ophthalmology center from 2013 to 2019. A total of 87 previously published cases of SO were identified by searching the Medline database from 2009 to 2019. RESULTS: Sixteen patients were included in the analysis, and six cases were induced by transscleral cyclophotocoagulation (TCP). All patients had achieved controlled inflammation at their last follow-up visit. Thirteen patients (81.3%) had improved best-corrected visual acuity (BCVA). A review of the literature revealed 87 previously reported cases of SO. Shared clinical features and treatment outcomes were summarized. CONCLUSION: Ocular therapies, including both penetrating ocular therapy and non-penetrating ocular intervention, have become increasingly prevalent risk factors for SO, and the latent period has increased compared to past reports. Visual prognosis with appropriate medical management is relatively good.
Keywords: Humans; Retrospective Studies; Visual Acuity; *Ophthalmia, Sympathetic/diagnosis/etiology; Ciliary Body; Immunosuppressants; Light Coagulation; ocular therapy; ocular trauma; oral prednisone; sympathetic ophthalmia

Incidence and management of glaucoma in Vogt-Koyanagi-Harada syndrome. - Forster, D. J.; Rao, N. A.; Hill, R. A.; Nguyen, Q. H.; Baerveldt, G. (Ophthalmology, 1993)
BACKGROUND: The Vogt-Koyanagi-Harada syndrome is a bilateral panuveitis associated with neurologic and dermatologic manifestations. METHODS: The authors reviewed the charts of all patients with Vogt-Koyanagi-Harada syndrome seen at their institution over the past decade to determine the incidence of glaucoma, as well as the results of medical and surgical therapy for glaucoma, in this group of patients. FINDINGS: Of 42 patients diagnosed with Vogt-Koyanagi-Harada syndrome, evidence of glaucoma requiring either medical or surgical intervention occurred in 16 patients (38.1%). Of these, nine (56.3%) had open-angle glaucoma and seven (43.7%) had angle-closure secondary to pupillary block. In 5 (31.3%) of the 16 patients, medical therapy alone was sufficient to control intraocular pressure. Eleven patients (68.7%) required surgical intervention, consisting of laser iridotomy, surgical iridectomy, trabeculectomy with or without 5-fluorouracil, and/or Molteno implantation. CONCLUSION: The relative success of each of these procedures in this group of patients is discussed. Glaucoma is a common complication in the Vogt-Koyanagi-Harada syndrome, and one that is often difficult to control.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Treatment Outcome; Incidence; Adolescent; Visual Acuity; Intraocular Pressure; Trabeculectomy; Uveomeningoencephalitic Syndrome/*complications; Laser Therapy; Adrenergic beta-Antagonists/therapeutic use; Glaucoma, Angle-Closure/*etiology/surgery/*therapy; Glaucoma, Open-Angle/*etiology/surgery/*therapy; Iris/surgery; Sympathomimetics/therapeutic use

Artificial iris devices: benefits, limitations, and management of complications. - Koch, Konrad R.; Heindl, Ludwig M.; Cursiefen, Claus; Koch, Hans-Reinhard (Journal of cataract and refractive surgery, 2014)
PURPOSE: To discuss limitations and benefits of a custom-made foldable artificial iris (Artificialiris) in the management of acquired iris defects. SETTING: Hochkreuzklinik Eye Hospital, Bonn, and the Department of Ophthalmology, University of Cologne, Germany. DESIGN: Case series. METHODS: We reviewed the clinical course and surgical management in eyes with sight-compromising complications after phakic anterior chamber implantation of synthetic iris devices between November 2011 and January 2012. RESULTS: Three eyes of 2 patients were reviewed. One patient developed cataract and corneal decompensation after anterior chamber artificial iris implantation in the left eye to treat post-uveitic mydriasis. Further treatment included artificial iris removal, cataract surgery, iridoplasty, and Descemet membrane endothelial keratoplasty (DMEK). By the 6-month follow-up, visual acuity had increased from 20/50 to 20/25. The second patient presented with bilateral secondary glaucoma, cataract, corneal edema, and iris atrophy after implantation of Newiris devices for cosmetic reasons. He consecutively had binocular explantation of the cosmetic devices, cataract surgery, artificial iris implantation, and DMEK in both eyes and Ahmed valve implantation in the right eye. During the 6-month follow-up, the intraocular pressure remained sufficiently adjusted in both eyes. Photophobia was eliminated, and visual acuity improved to 20/32 in the right eye and 20/20 in the left eye. CONCLUSIONS: In patients with major iris defects ineligible for pupilloplasties, the artificial iris allows functionally and esthetically satisfactory anterior segment reconstruction. To prevent secondary complications, the artificial iris should only be implanted in aphakic or pseudophakic eyes and placed in the posterior chamber.
Keywords: Humans; Male; Middle Aged; Treatment Outcome; Visual Acuity/physiology; Intraocular Pressure/physiology; Prosthesis Implantation; Cataract Extraction; *Iris; *Postoperative Complications; Descemet Stripping Endothelial Keratoplasty; Device Removal; Uveitis/complications; *Artificial Organs; Mydriasis/etiology/*surgery; Photophobia/prevention & control

The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt-Koyanagi-Harada disease. - Abu El-Asrar, Ahmed M.; Hemachandran, Suhail; Al-Mezaine, Hani S.; Kangave, Dustan; Al-Muammar, Abdulrahman M. (Acta ophthalmologica, 2012)
PURPOSE: To study the effectiveness of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. The outcomes in this group were compared with those of another group of patients with VKH disease who were treated with corticosteroid monotherapy or with delayed addition of immunomodulatory therapy. METHODS: This prospective study included 19 patients (38 eyes) diagnosed with acute uveitis associated with VKH disease. RESULTS: The mean follow-up period was 27.0 ± 11.1 months (range 16-54 months). Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering prednisone to 10 mg or less daily was 5.1 ± 1.2 months (range 3-7 months). Ten (53%) patients discontinued treatment without relapse of inflammation. The mean time observed of treatment was 17.3 ± 11.9 months (range 3-41.5 months). Visual acuity of 20/20 was achieved by 38% of the eyes in the corticosteroid group and by 74% in the corticosteroid + MMF group (p < 0.001). Recurrent inflammation of ≥3 times was reduced significantly (p = 0.0383) in the corticosteroid + MMF group (3%) as compared to corticosteroid group (18%). Development of all complications was significantly higher in the corticosteroid group (43%) compared with the corticosteroid + MMF group (8%) (p < 0.001). None of the eyes in the corticosteroid + MMF group developed 'sunset glow fundus'. CONCLUSIONS: Addition of MMF as first-line therapy to corticosteroids in patients with acute uveitis associated with VKH disease leads to significant reduction in recurrences of uveitis and development of late complications and significantly improves visual outcome.
Keywords: Female; Humans; Male; Adult; Drug Therapy, Combination; Prospective Studies; Follow-Up Studies; Treatment Outcome; Young Adult; Adolescent; Administration, Oral; Infusions, Intravenous; Child; Immunosuppressive Agents/*therapeutic use; Fluorescein Angiography; Glucocorticoids/administration & dosage/*therapeutic use; Prednisone/administration & dosage/therapeutic use; Visual Acuity/physiology; Acute Disease; Ophthalmoscopy; Secondary Prevention; Methylprednisolone/administration & dosage/therapeutic use; Coloring Agents; Indocyanine Green; Mycophenolic Acid/*analogs & derivatives/therapeutic use; Uveitis, Posterior/diagnosis/*drug therapy/etiology; Uveomeningoencephalitic Syndrome/complications/diagnosis/*drug therapy

Grid laser photocoagulation for macular oedema in uveitis or the Irvine-Gass syndrome. - Lardenoye, C. W.; van Schooneveld, M. J.; Frits Treffers, W.; Rothova, A. (The British journal of ophthalmology, 1998)
AIMS: To determine the effect of modified macular grid photocoagulation in patients with refractory macular oedema due to uveitis or cataract extraction. METHODS: In this study 20 patients with macular oedema underwent modified macular grid laser photocoagulation and were followed by means of standardised examinations (day 0, months 2, 6, and 12) consisting of best corrected visual acuity and fluorescein angiography. RESULTS: The mean visual acuity increased from 0.16 before to 0.3 after laser treatment (p = 0.013), and fluorescein leakage was significantly reduced (p = 0.005). Visual prognosis was influenced by duration of the uveitis, not by sex or age. CONCLUSION: Modified macular grid laser photocoagulation had a beneficial effect on macular oedema caused by uveitis or the Irvine-Gass syndrome. A prospective, randomised study is needed to determine the exact place of modified macular grid photocoagulation in the treatment of patients with inflammatory or postsurgical macular oedema.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Analysis of Variance; Fluorescein Angiography; Cataract Extraction/*adverse effects; Visual Acuity; Uveitis/*complications; Laser Coagulation/*methods; Macular Degeneration/etiology/*surgery

Ahmed valve implantation for uncontrolled pediatric uveitic glaucoma. - Kafkala, Chrysanthi; Hynes, Alla; Choi, John; Topalkara, Aysen; Foster, C. Stephen (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2005)
PURPOSE: We sought to evaluate the safety and efficacy of Ahmed valve implantation for the management of glaucoma associated with chronic uveitis in pediatric patients. METHODS: A retrospective chart review was conducted of 6 pediatric patients (7 eyes) who underwent Ahmed valve implantation because of refractory uveitic glaucoma. Intraocular pressure (IOP) reduction, preoperative and postoperative visual acuities, the number of hypotensive medications required, and complications associated with the operation were evaluated. RESULTS: Mean follow-up was 36.8 months (range, 6-60). At the last visit, all 7 eyes had IOPs between 9 and 18 mm Hg (average, 12.1). IOP reduction averaged 69.6% (P = 0.0005, paired t-test). The number of hypotensive agents was reduced from an average of 3 to an average of 0.71 medicines per eye (P = 0.001). The only complication was hemorrhagic choroidal detachment postoperatively in two eyes; both resolved within one month. CONCLUSIONS: For children with good immunomodulatory control of their inflammation and appropriate follow-up, Ahmed valve implantation can be an effective and safe procedure for treating pediatric uveitic glaucoma.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Adolescent; Child; Immunosuppressive Agents/therapeutic use; Visual Acuity; *Glaucoma Drainage Implants; Intraocular Pressure; Glaucoma/etiology/*surgery; Postoperative Complications; Prosthesis Implantation/methods; Uveitis, Anterior/complications

Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. - Kempen, John H.; Altaweel, Michael M.; Holbrook, Janet T.; Jabs, Douglas A.; Louis, Thomas A.; Sugar, Elizabeth A.; Thorne, Jennifer E. (Ophthalmology, 2011)
OBJECTIVE: To compare the relative effectiveness of systemic corticosteroids plus immunosuppression when indicated (systemic therapy) versus fluocinolone acetonide implant (implant therapy) for noninfectious intermediate, posterior, or panuveitis (uveitis). DESIGN: Randomized controlled parallel superiority trial. PARTICIPANTS: Patients with active or recently active uveitis. METHODS: Participants were randomized (allocation ratio 1:1) to systemic or implant therapy at 23 centers (3 countries). Implant-assigned participants with bilateral uveitis were assigned to have each eye that warranted study treatment implanted. Treatment-outcome associations were analyzed by assigned treatment for all eyes with uveitis. MAIN OUTCOME MEASURES: Masked examiners measured the primary outcome: change in best-corrected visual acuity from baseline. Secondary outcomes included patient-reported quality of life, ophthalmologist-graded uveitis activity, and local and systemic complications of uveitis or therapy. Reading Center graders and glaucoma specialists assessing ocular complications were masked. Participants, ophthalmologists, and coordinators were unmasked. RESULTS: On evaluation of changes from baseline to 24 months among 255 patients randomized to implant and systemic therapy (479 eyes with uveitis), the implant and systemic therapy groups had an improvement in visual acuity of +6.0 and +3.2 letters (P = 0.16, 95% confidence interval on difference in improvement between groups, -1.2 to +6.7 letters, positive values favoring implant), an improvement in vision-related quality of life of +11.4 and +6.8 units (P = 0.043), a change in EuroQol-EQ5D health utility of +0.02 and -0.02 (P = 0.060), and residual active uveitis in 12% and 29% (P=0.001), respectively. Over the 24 month period, implant-assigned eyes had a higher risk of cataract surgery (80%, hazard ratio [HR] = 3.3, P < 0.0001), treatment for elevated intraocular pressure (61%, HR=4.2, P < 0.0001), and glaucoma (17%, HR=4.2, P = 0.0008). Patients assigned to systemic therapy had more prescription-requiring infections than patients assigned to implant therapy (0.60 vs 0.36/person-year, P=0.034), without notable long-term consequences; systemic adverse outcomes otherwise were unusual in both groups, with minimal differences between groups. CONCLUSIONS: In each treatment group, mean visual acuity improved over 24 months, with neither approach superior to a degree detectable with the study's power. Therefore, the specific advantages and disadvantages identified should dictate selection between the alternative treatments in consideration of individual patients' particular circumstances. Systemic therapy with aggressive use of corticosteroid-sparing immunosuppression was well tolerated, suggesting that this approach is reasonably safe for local and systemic inflammatory disorders. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: Female; Humans; Male; Middle Aged; Drug Therapy, Combination; Treatment Outcome; Quality of Life; Visual Acuity/physiology; Drug Implants; Glucocorticoids/*administration & dosage; Visual Fields/physiology; Uveitis, Posterior/diagnosis/*drug therapy/physiopathology; Sickness Impact Profile; Fluocinolone Acetonide/*administration & dosage; Immunosuppressive Agents/*administration & dosage; Panuveitis/diagnosis/*drug therapy/physiopathology; Uveitis, Intermediate/diagnosis/*drug therapy/physiopathology; Macular Edema/drug therapy; Prednisone/*administration & dosage

Intraoperative intravitreal injection of triamcinolone acetonide for cataract extraction in patients with uveitis. - Alkawas, Ayman A.; Hamdy, Alaa M.; Shahien, Ezzat A. (Ocular immunology and inflammation, 2010)
PURPOSE: To evaluate the efficacy of intravitreal triamcinolone injection in controlling postoperative inflammation after cataract extraction in patients with uveitis. METHODS: This retrospective study included 30 eyes with uveitis that had phacoemulsification or extracapsular cataract extraction with intraocular lens implantation. Intravitreal triamcinolone acetonide (4 mg) was injected at the end of surgery. No systemic steroids were given after surgery. RESULTS: Visual acuity improvement of 2 lines or more occurred in 26 eyes (86.7%). Six eyes (20%) had a best-corrected visual acuity of 6/60 or better before surgery, which increased to 22 eyes (73.3%) after surgery. Five eyes (16.7%) had a visual acuity of 6/12 or better after surgery. Intravitreal triamcinolone injection controlled the postoperative inflammation in all eyes for at least 3 months following surgery. CONCLUSION: Intravitreal triamcinolone injection was effective in controlling postoperative inflammation after cataract extraction in patients with uveitis sparing the use of systemic steroids.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Postoperative Complications/*prevention & control; Injections, Intraocular; Triamcinolone Acetonide/*administration & dosage; Glucocorticoids/*administration & dosage; Vitreous Body; Visual Acuity/drug effects; *Cataract Extraction; Postoperative Period; Lens Implantation, Intraocular; Cataract/*complications/physiopathology; Uveitis/*complications/physiopathology; *Intraoperative Care; Inflammation/*etiology/prevention & control

Intravitreal methotrexate in the management of presumed tuberculous serpiginous-like choroiditis. - Julian, Karina; Langner-Wegscheider, Beate-J.; Haas, Anton; De Smet, Marc D. (Retina (Philadelphia, Pa.), 2013)
PURPOSE: To report on the use of intravitreal methotrexate (IVT MTX) as part of treatment of presumed tuberculous serpiginous-like choroiditis progressing despite the use of tuberculostatics. METHODS: Case series of patients suffering from serpiginous-like choroiditis with positive tuberculin skin test who received IVT injections of MTX as part of treatment. Ocular disease was active despite the use of systemic tuberculostatic (isoniazid, rifampicin, pyrazinamide, and ethambutol), and choroidal lesions showed signs of progression. A single injection of IVT MTX (400 μg/0.1 mL) was administered in the eye with macular-threatening features. Change in visual acuity, appearance of the lesion, and staining patterns on angiography were among the main outcome measurements. RESULTS: Three eyes from two patients were included. Both cases presented bilateral involvement with mild vitritis. In all three eyes, choroidal lesions healed within the first month after an IVT MTX injection with visual acuity improvement in two. No adverse reaction was related to the medication or to the procedure. Patients were followed for a mean of 13.5 months after being injected. CONCLUSION: The use of IVT MTX seems effective in the management of the inflammatory component of tuberculous serpiginous-like choroiditis, whereas systemic tuberculostatics are aimed at controlling the infectious one.
Keywords: Female; Humans; Middle Aged; Drug Therapy, Combination; Disease Progression; Methotrexate/adverse effects/*therapeutic use; Immunosuppressive Agents/*therapeutic use; Fluorescein Angiography; Visual Acuity; Intravitreal Injections; Tuberculosis, Ocular/diagnosis/*drug therapy/microbiology; Tuberculin Test; Antitubercular Agents/adverse effects/*therapeutic use; Choroiditis/diagnosis/*drug therapy/microbiology

Long-term survival of Molteno glaucoma drainage devices. - Mills, R. P.; Reynolds, A.; Emond, M. J.; Barlow, W. E.; Leen, M. M. (Ophthalmology, 1996)
PURPOSE: To evaluate the long-term outcome of the Molteno implant drainage device using survival analysis. METHODS: A retrospective chart review was performed on 77 eyes of 71 patients that underwent Molteno implantation for intractable glaucoma unresponsive to conventional management from October 1984 to April 1990 at the University of Washington Eye Center and had at least 6 months of follow-up data. Success was defined as a postoperative intraocular pressure of 22 mmHg or lower with (qualified success) or without (complete success) glaucoma medications and no additional glaucoma surgery, phthisis, or loss of light perception. RESULTS: The median follow-up was 44 months (range, 6-107 months). Indications for Molteno implantation were aphakia/pseudophakia (n=24), neovascular glaucoma (n=20), uveitic glaucoma (n=12), failed trabeculectomy (n=9), traumatic glaucoma (n=8), and congenital glaucoma (n=4). The total success was 57% (23% complete; 34% qualified) at the last follow-up. Kaplan-Meier survival curves demonstrated a continuous and relatively linear attrition of success over at least 5 1/2 postoperative years. The uveitic glaucoma group had the highest success rate of 75%. Eyes with neovascular glaucoma failed significantly more frequently than those with uveitic glaucoma (P<0.01). There was no significant difference in outcome based on sex, race, single versus double plate, anterior chamber versus posterior chamber tube placement, or two-stage versus single-stage surgery. Younger age was associated with a significantly higher failure rate after controlling for glaucoma category (P<0.01). CONCLUSION: The Molteno implant drainage device offers a reasonable long- term outcome in eyes with intractable glaucomas. However, an ongoing rate of failure, not unlike that seen after other filtration surgery, is to be expected.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Survival Analysis; Adolescent; Infant, Newborn; Child; Child, Preschool; Infant; Visual Acuity; Intraocular Pressure; Glaucoma/*surgery; *Molteno Implants/adverse effects; Drainage/*instrumentation

Steroid prophylaxis in eyes with uveitis undergoing phacoemulsification. - Meacock, W. R.; Spalton, D. J.; Bender, L.; Antcliff, R.; Heatley, C.; Stanford, M. R.; Graham, E. M. (The British journal of ophthalmology, 2004)
AIM: To compare the efficacy of two preoperative steroid regimens for cataract surgery in patients with uveitis. METHODS: 40 uveitis patients with cataract underwent phacoemulsification and intraocular lens (IOL) implantation. Preoperatively they were randomised into two groups: group 1 (20 patients) received a single dose of intravenous methylprednisolone (15 mg/kg) half an hour before surgery, and group 2 (20 patients) received a 2 week course of oral prednisolone (0.5 mg/kg) which was tapered postoperatively. Preoperatively patients had aqueous flare and cells measured with the Kowa laser flare meter. On days 1, 7, 28, and 90 aqueous flare and cells were measured, and on days 7 and 90 fluorescein angiography was performed to determine the incidence of cystoid macular oedema (CMO). RESULTS: At all postoperative visits the mean increase in flare was greater for group 1 (intravenous steroid). Patients with posterior synechiae had greater blood-aqueous barrier damage (BAB) postoperatively. There were no statistically significant differences in logMAR visual acuity and incidences of CMO between the two groups at 7 and 90 days. CONCLUSION: A 2 week course of oral prednisolone, tapered postoperatively, produced a better recovery of the BAB than a single dose of intravenous methylprednisolone and is thus the recommended preoperative regimen.
Keywords: Female; Humans; Male; Middle Aged; Treatment Outcome; Administration, Oral; Injections, Intravenous; Visual Acuity/physiology; Uveitis/*drug therapy; Glucocorticoids/*administration & dosage; Preoperative Care; Anti-Inflammatory Agents/*administration & dosage; Macular Edema/etiology; Phacoemulsification/*methods; Prednisolone/*administration & dosage; Methylprednisolone/*administration & dosage; Blood-Aqueous Barrier/*drug effects/physiopathology; Postoperative Complications/etiology

Dexamethasone intravitreal implant in the treatment of persistent uveitic macular edema in the absence of active inflammation. - Cao, Jennifer H.; Mulvahill, Matthew; Zhang, Li; Joondeph, Brian C.; Dacey, Mark S. (Ophthalmology, 2014)
PURPOSE: To examine the observational effectiveness of the dexamethasone (DEX) intravitreal implant (Ozurdex; Allergan, Inc., Irvine, CA) in the treatment of noninfectious uveitic macular edema in patients with otherwise quiescent uveitis. DESIGN: Retrospective chart review. PARTICIPANTS: A total of 27 consecutive patients with persistent macular edema resistant to standard short-term therapy despite quiescent noninfectious intermediate or posterior uveitis. METHODS: Each patient was treated with a DEX 0.7 mg implant. MAIN OUTCOME MEASURES: Primary outcome measure was resolution of macular edema 1 month after injection as measured by decrease in central macular thickness (CMT). Secondary outcome was change in visual acuity 1, 2, and 3 months after injection. RESULTS: A total of 27 eyes of 27 patients were included for analysis. One eye was randomly selected for 6 of these patients who received bilateral DEX implants. There was a statistically significant reduction in mean CMT 1 month after DEX implantation (mean, 278.9 μm; range, 206-352 μm) compared with baseline (mean, 478.7 μm; range, 330-667 μm) (P < 0.0001). There was a statistically significant improvement in visual acuity at 3 months (logarithm of the minimum angle of resolution [logMAR] 0.41; 20/51) compared with baseline (logMAR 0.60; 20/80) (P = 0.0005). There were no major complications after DEX implantation. CONCLUSIONS: The DEX implant resulted in a statistically significant improvement in mean CMT and visual acuity without any serious adverse events.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Young Adult; Adolescent; Child; Visual Acuity; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Uveitis/*complications; Macular Edema/*drug therapy; Anti-Inflammatory Agents/*administration & dosage

Secondary glaucoma in patients with juvenile rheumatoid arthritis-associated iridocyclitis. - Foster, C. S.; Havrlikova, K.; Baltatzis, S.; Christen, W. G.; Merayo-Lloves, J. (Acta ophthalmologica Scandinavica, 2000)
PURPOSE: The prevalence and management of glaucoma were evaluated in patients with juvenile rheumatoid arthritis (JRA)-associated iridocyclitis. METHODS: The records of 69 patients with JRA-associated iridocyclitis were reviewed. RESULTS: Twenty-nine (42%) of these patients had secondary glaucoma or ocular hypertension. Glaucoma was controlled with topical treatment in only 7 of the 41 affected eyes (17%); systemic carbonic anhydrase inhibitor therapy resulted in control of another 8 eyes. Surgery controlled all but one of the remainder. CONCLUSION: Glaucoma is a common complication of JRA-associated iridocyclitis. It results from prolonged, inadequately treated intraocular inflammation and in some instances, from steroid use. Medical and surgical therapy for the glaucoma associated with JRA-uveitis is challenging and incompletely effective. We suspect that a more aggressive approach to the treatment of JRA-associated uveitis, earlier in the course of the disease may reduce this vision robbing contribution to the process.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Adolescent; Child; Child, Preschool; Prevalence; Ophthalmic Solutions; Visual Acuity; Age of Onset; Glaucoma/epidemiology/*etiology/therapy; Carbonic Anhydrase Inhibitors/therapeutic use; Adrenergic beta-Antagonists/therapeutic use; Arthritis, Juvenile/*complications/epidemiology/therapy; Boston/epidemiology; Filtering Surgery; Iridocyclitis/epidemiology/*etiology/therapy; Ocular Hypertension/etiology

[Treatment of ocular inflammatory disease with glucocorticoids and cyclophosphamide pulses]. - Cuchacovich, M.; Verdaguer, J. I.; Gatica, H.; López, J. M.; Verdaguer, J. (Revista medica de Chile, 1995)
The effectiveness, toxicity and prognostic factors influencing responses to cyclophosphamide (CP) iv pulses plus oral glucocorticosteroids (GC) in patients with GC-resistant ocular inflammatory diseases (OID) was evaluated in a cohort of 15 consecutive patients suffering from active, non-infectious OID refractory to oral GC. All patients underwent monthly evaluations with clinical, hematological, hepatic, renal and ophthalmologic tests. These included checking visual acuity and both anterior chamber and posterior segment inflammation. The overall effect evaluated by repeated measurements ANOVA demonstrated that after an average of 5 CP pulses 1-10, the group showed significant improvement regarding of visual acuity and inflammation (p < 0.000001). Amelioration was not sustained over time in patients with granulomatous uveitis. Patients with retinal vasculitis experienced rapid and sustained recovery. By the end of the follow-up period, 53% of the patients had improved, 20% remained stationary and 26% suffered visual acuity deterioration as compared with the baseline. No serious side effects were detected during treatment and follow-up. CONCLUSIONS: A combination of oral GC and iv CP pulses appears to be an effective way to treat patients suffering from noninfectious, non-granulomatous, GC-resistant OID.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Prospective Studies; Follow-Up Studies; Chronic Disease; Analysis of Variance; Uveitis/*drug therapy; Glucocorticoids/*administration & dosage; Prednisone/*administration & dosage; Cyclophosphamide/*administration & dosage; Pulsatile Flow; Retinitis/*drug therapy

Long-term control of cystoid macular oedema in noninfectious uveitis with Mycophenolate Mofetil. - Neri, Piergiorgio; Mariotti, Cesare; Cimino, Luca; Mercanti, Lucia; Giovannini, Alfonso (International ophthalmology, 2009)
PURPOSE: To evaluate the long-term safety and efficacy of Mycophenolate Mofetil (MMF) for the control of cystoid macular oedema (CMO) secondary to noninfectious uveitis (NU). METHODS: The medical records of 19 consecutive patients with inflammatory CMO treated with MMF were retrospectively reviewed. Patient demographics, best corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography (OCT) findings were evaluated. RESULTS: There were eight females and 11 males with a mean age of 32.9 +/- 8.9 years. After a 1-year follow-up, 18/19 patients (31 eyes, 96.9%, P < 0.05) no longer had signs of CMO, as per their FA and OCT findings; the mean central foveal thickness (CFT) was 167.2 +/- 12.8 microm. At the last follow-up, only 3/19 patients, all affected by Behçet panuveitis, had recurrences of CMO. Mean BCVA improved from 0.34 +/- 0.14 SD at baseline to 0.65 +/- 0.2 SD at last follow-up. CONCLUSIONS: MMF was safe and effective in controlling CMO and in reducing the uveitis relapse rate in patients not responding to traditional immunosuppressants. Further case-controlled studies are mandatory to validate those preliminary results.
Keywords: Female; Humans; Male; Adult; Drug Therapy, Combination; Treatment Outcome; Disease Progression; Prednisone/administration & dosage; Anti-Inflammatory Agents/administration & dosage; Immunosuppressive Agents/administration & dosage; Methylprednisolone/administration & dosage; Uveitis/*complications/drug therapy; *Macular Edema/drug therapy/etiology; Mycophenolic Acid/administration & dosage/*analogs & derivatives; Time

Comment on: Rebound inflammation after an intravitreal injection in Vogt-Koyanagi-Harada syndrome. - Jain, Manish (Indian journal of ophthalmology, 2018)
Keywords: Humans; Inflammation; Visual Acuity; *Intravitreal Injections; *Uveomeningoencephalitic Syndrome

Pars-plana vitrectomy in cystoid macular edema associated with intermediate uveitis. - Wiechens, B.; Nölle, B.; Reichelt, J. A. (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2001)
BACKGROUND: Cystoid macular edema (CME) is a common complication in the course of intermediate uveitis. In spite of systemic therapy with steroids or carbonic anhydrase inhibitors, persistence of CME is observed. Pars plana vitrectomy (PPV) is known to influence the course of intermediate uveitis positively. The present study was performed to investigate the role of PPV in the therapy of CME in intermediate uveitis. MATERIALS AND METHODS: Forty-two eyes of 32 patients were re-examined after PPV for CME. In all eyes fluorescein angiography was performed. Average age at the time of surgery was 31.9 years (range 6-64 years). All patients had received systemic corticosteroid and/or immunosuppressive treatment during the course of their disease. In some patients systemic therapy with carbonic anhydrase inhibitors was performed. The mean duration of postoperative follow-up was 20.2 months (range 6-102 months). RESULTS: Preoperative visual acuity (VA) in all eyes was between 1/10 and 0.5. Total regression of CME after surgery was observed in 18 of 42 eyes (42.8%), partial improvement in 7 eyes (16.7%). In 13 of 42 eyes (30.9%) the CME remained unchanged. Twenty-one of 42 eyes (50.0%) experienced a postoperative improvement of VA of 2 lines or more. In 18 of 42 eyes (42.8%) there was no change; in 3 eyes (7.2%) VA was less. In the long-term follow-up the corresponding results were slightly worse (17/17/8 eyes) due to secondary complications. In the majority of patients systemic medical therapy could be reduced or discontinued. CONCLUSION: Pars-plana vitrectomy led to regression of CME in 59% of cases and to subsequent improvement of VA in 50% of eyes with intermediate uveitis. PPV should be considered soon after medical therapy has been shown to be ineffective.
Keywords: Female; Humans; Male; Middle Aged; Adult; Treatment Outcome; Adolescent; Child; Fluorescein Angiography; Fundus Oculi; Visual Acuity; *Vitrectomy; Intraoperative Complications; Postoperative Complications; Macular Edema/etiology/*surgery; Uveitis, Intermediate/*complications

Bilateral effect of unilateral dexamethasone intravitreal implant in a case of noninfectious uveitic macular edema and vitritis. - Habot-Wilner, Zohar; Sorkin, Nir; Goldenberg, Dafna; Goldstein, Michaella (Retinal cases & brief reports, 2015)
PURPOSE: To describe a bilateral therapeutic effect of the 0.7-mg dexamethasone drug delivery system injected in 1 eye of a patient with bilateral, noninfectious uveitic macular edema and vitritis. METHODS: Interventional case report. RESULTS: A 26-year-old woman had vitritis and macular edema in both eyes and received a dexamethasone drug delivery system injection to the right eye. Best-corrected visual acuity, clinical examination, and Heidelberg Spectralis spectral domain optical coherence tomography were performed at baseline and during follow-up visits. Follow-up time was 24 months. Vitritis and macular edema completely resolved in both eyes with bilateral improvement in visual acuity. Treatment effect enabled systemic immunosuppressive treatment to be lowered, and the effect lasted for 24 months. CONCLUSION: Unilateral dexamethasone drug delivery system injection might have a bilateral therapeutic effect in uveitic eyes. This observation may be related to the compromised blood-retina barrier in eyes with uveitis. Further studies are warranted to assess this effect.
Keywords: Female; Humans; Adult; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Visual Acuity; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Macular Edema/complications/diagnosis/*drug therapy; Uveitis, Intermediate/complications/diagnosis/*drug therapy; Vitreous Body/*pathology

Phacoemulsification with intraocular lens implantation in patients with uveitis. - Suresh, P. S.; Jones, N. P. (Eye (London, England), 2001)
PURPOSE: To investigate the safety and efficacy of phacoemulsification with intraocular lens implantation in eyes affected by uveitis. METHODS: A retrospective case series is presented including casenote review and update patient examinations. Patient data were withdrawn from the Uveitis Clinic database. All uveitis patients undergoing phacoemulsification with intraocular lens implantation from August 1995 to November 2000 were included. A pre-operative preparation protocol was used. Operative and post-operative complications, degree of postoperative inflammation, best-corrected and final visual acuity were the main outcome measures. RESULTS: Eighty-six eyes of 75 patients underwent surgery, which in 11 cases was combined with trabeculectomy. Mean follow-up was 24.1 months. Eight eyes (10%) had severe or fibrinous uveitis post-operatively. The mean delay between surgery and return to baseline treatment was 8.6 weeks. Posterior capsule opacification occurred in 42% of eyes and Nd-YAG capsulotomy was required in 21%. Cystoid macular oedema was seen in 2 eyes. Seventy-two per cent of eyes retain a visual acuity of 6/9 or better, and 87% of eyes retain a post-operative improvement of 2 or more lines of Snellen acuity. CONCLUSIONS: With careful patient selection, appropriate pre-operative preparation, diligent surgery and close post-operative supervision, phacoemulsification with intraocular lens implantation is safe and effective in the great majority of eyes with uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage; Visual Acuity; Uveitis/*complications/drug therapy; Administration, Topical; Macular Edema/etiology; Cataract/*etiology; Hyphema/etiology; Laser Therapy/statistics & numerical data; Lenses, Intraocular/*adverse effects; Phacoemulsification/*adverse effects/methods; Trabeculectomy/statistics & numerical data

[Role of Azathioprine in steroid resistant non infectious ocular inflammatory diseases]. - Cuchacovich, Miguel; Pacheco, Patricio; Díaz, Gonzalo; Rojas, Basilio; Stoppel, Juan; Merino, Guillermo; Verdaguer, Juan Ignacio; Verdaguer, Juan; Villarroel, Francisco (Revista medica de Chile, 2007)
BACKGROUND: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. AIM: To evaluate the role of Azathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. PATIENTS AND METHODS: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. RESULTS: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87%). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 %, visual acuity improved. The ocular inflammatory score decreased in 86.5%. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. CONCLUSIONS: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Adolescent; Drug Resistance; Uveitis/*drug therapy; Immunosuppressive Agents/adverse effects/*therapeutic use; Steroids/therapeutic use; Scleritis/drug therapy; Azathioprine/adverse effects/*therapeutic use; Choroid Diseases/drug therapy; Retinal Diseases/drug therapy; Uveomeningoencephalitic Syndrome/drug therapy

Long-term outcome of intravitreal triamcinolone acetonide injection for the treatment of uveitis attacks in Behçet disease. - Park, Un Chul; Park, Jung Hyun; Yu, Hyeong Gon (Ocular immunology and inflammation, 2014)
PURPOSE: To evaluate the long-term efficacy and safety of intravitreal triamcinolone acetonide (IVTA) injection for posterior segment inflammation in Behçet disease (BD) patients. METHODS: The authors reviewed the medical records of BD patients who underwent IVTA injection (4 mg/0.1 mL) for posterior uveitis attack unresponsive to systemic immunosuppression and were followed up for more than 24 months. RESULTS: Forty-nine patients (49 eyes) were included. Mean best-corrected visual acuity improved from 0.89 logMAR units to 0.70, 0.64 at 12, 24 months, respectively. Complete inflammation control was achieved in 87.0% of patients, but 60.0% of them experienced relapse within 12 months. For phakic eyes, cumulative probabilities for cataract surgery were 13.8%, 48.9%, and 60.2% at 12, 24, and 36 months, respectively. Intraocular pressure elevation exceeding 21 mmHg was noted in 40.8%. CONCLUSIONS: In Behçet uveitis attack that is unresponsive or intolerant to systemic medications, IVTA injection is an effective therapeutic option, although ocular complications could limit its efficacy and repeatability.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Fluorescein Angiography; Glucocorticoids/administration & dosage/*therapeutic use; Visual Acuity/physiology; Uveitis, Posterior/diagnosis/*drug therapy; Intravitreal Injections; Intraocular Pressure; Triamcinolone Acetonide/administration & dosage/*therapeutic use; Behcet Syndrome/diagnosis/*drug therapy

Uveitis related to juvenile idiopathic arthritis: familial cases and possible genetic implication in the pathogenesis. - Julián, Karina; Terrada, Céline; Quartier, Pierre; Lehoang, Phuc; Bodaghi, Bahram (Ocular immunology and inflammation, 2010)
PURPOSE: To describe four cases of familial Juvenile Idiopathic Arthritis (JIA) associated uveitis. DESIGN: Retrospective observational case series. METHODS: Clinical data from patients who present familial JIA-associated uveitis are described and possible genetic influence in disease etiology is reviewed. RESULTS: Two sisters, 6- and 7-year-old, developed bilateral anterior uveitis related to oligoarticular JIA. Arthritis in both began by the age of 18 months; uveitis developed simultaneously in one of them and less than one year after arthritis in the other one. Both received topical and systemic treatment to control the ocular disease. Glaucoma occurred in both cases and bilateral cataract in one case. In the other family, a 2-year-old girl developed unilateral uveitis in the context of oligoarticular JIA which was diagnosed by 1-year-old. The disease became soon bilateral and she received topical and systemic immunosuppressive treatment. Her mother suffered from bilateral anterior uveitis associated to oligoarticular inflammatory disease during her infancy, later diagnosed as JIA-associated uveitis. CONCLUSIONS: Familial cases of JIA uveitis, although not very common, support the possible role of genetic influence in the pathogenesis of the disease, with horizontal and vertical inheritance being possible. The evolution of ocular disease is similar to the non-familial cases, except for an earlier age of onset.
Keywords: Female; Humans; Adult; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Anti-Inflammatory Agents/therapeutic use; Chronic Disease; Child; Child, Preschool; Glucocorticoids/therapeutic use; Visual Acuity; Carbonic Anhydrase Inhibitors/therapeutic use; Adrenergic beta-Antagonists/therapeutic use; *Genetic Predisposition to Disease; Anterior Eye Segment/pathology; Arthritis, Juvenile/*complications/genetics; Uveitis, Anterior/drug therapy/*etiology/genetics

Sutureless combined 25-gauge vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation for management of uveitic cataract associated with posterior segment disease. - Soheilian, Masoud; Mirdehghan, Seyed Ali; Peyman, Gholam A. (Retina (Philadelphia, Pa.), 2008)
PURPOSE: To report visual outcomes and complication rates associated with one-stage surgery for the management of uveitic cataract associated with posterior segment disease. METHODS: In this interventional case series, 19 eyes (19 patients) with posterior segment involvement due to chronic uveitis underwent sutureless scleral tunnel incision phacoemulsification combined with total vitrectomy using 25-gauge instruments and posterior chamber intraocular lens (PC-IOL) implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema, and complications of surgery. RESULTS: After a minimum 12-month follow-up, visual acuity was >or=20/100 in 12 eyes (63.2%); 6 eyes (31.6%) had visual acuity of >or=20/40. A decrease in postoperative inflammatory activity of 1 grade was observed in 8 eyes (42.1%). Sixteen eyes had cystoid macular edema before surgery; and 12 eyes had cystoid macular edema after surgery. Early postoperative complications included the following: transient corneal edema, 10 eyes (50.3%); fibrin reaction, 3 eyes (15.8%), and posterior synechiae, 9 eyes (47.3%). Glaucoma was the most common late postoperative complication (3 eyes [18.8%]). Nine eyes (47.4%) needed YAG laser capsulotomy during the first year. CONCLUSION: Sutureless combined 25-gauge total vitrectomy, phacoemulsification, and PC-IOL implantation may be well tolerated with an acceptable complication rate for selected uveitic eyes with significant cataract and coexisting posterior segment disease for restoring useful vision.
Keywords: Female; Humans; Male; Middle Aged; Adult; Adolescent; Chronic Disease; Visual Acuity; Intraoperative Complications; Postoperative Complications; Uveitis/complications/*surgery; Phacoemulsification/*methods; Cataract/complications/*therapy; Laser Coagulation; Lens Implantation, Intraocular/*methods; Microsurgery/*methods; Suture Techniques; Vision Disorders/rehabilitation; Vitrectomy/*methods

Cataract surgery in uveitis. - Roesel, Martin; Heinz, Carsten; Koch, Joerg Michael; Heiligenhaus, Arnd (Ophthalmology, 2008)
Keywords: Humans; Prospective Studies; Administration, Oral; Combined Modality Therapy; Fluorescein Angiography; Tomography, Optical Coherence; Prednisolone/administration & dosage; Glucocorticoids/administration & dosage; Injections; Visual Acuity; Intraocular Pressure; Intraoperative Care; *Phacoemulsification; Cataract/*etiology; *Lens Implantation, Intraocular; Anterior Chamber/pathology; Macular Edema/diagnosis/drug therapy; Triamcinolone Acetonide/administration & dosage; Uveitis/*complications/prevention & control

Tocilizumab for the treatment of birdshot uveitis that failed interferon alpha and anti-tumor necrosis factor-alpha therapy: two cases report and literature review. - Leclercq, Mathilde; Le Besnerais, M.; Langlois, V.; Girszyn, N.; Benhamou, Y.; Ngo, C.; Levesque, H.; Muraine, M.; Gueudry, J. (Clinical rheumatology, 2018)
Biotherapies appear as potential drugs for the treatment of inflammatory noninfectious uveitis. In this report, we show that tocilizumab, an anti-IL-6 agent, greatly improved two patients with birdshot chorioretinopathy refractory to conventional immunosuppressive drugs, interferon α2a, and anti-TNFα agents. After a follow-up of 22 months, patients exhibited an improvement of both visual acuity and macular edema. A corticosteroid-sparing effect was achieved in both cases.
Keywords: Female; Humans; Adult; Treatment Outcome; Anti-Inflammatory Agents/*therapeutic use; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Antibodies, Monoclonal, Humanized/*therapeutic use; Uveitis/*drug therapy; Macular edema; Retreatment; Interferon-alpha/*therapeutic use; Birdshot chorioretinopathy; Birdshot Chorioretinopathy; Chorioretinitis/*drug therapy; Interferon α2a; Tocilizumab

Tocilizumab treatment for refractory uveitis-related cystoid macular edema. - Adán, Alfredo; Mesquida, Marina; Llorenç, Victor; Espinosa, Gerard; Molins, Blanca; Hernández, Maria V.; Pelegrín, Laura (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2013)
BACKGROUND: This retrospective study investigated the efficacy of tocilizumab (TCZ), a fully humanized antibody that binds both to soluble and membrane bound IL-6 receptors, for the treatment of uveitis-related cystoid macular edema (CME) refractory to immunomodulatory therapy. METHODS: Five refractory patients with uveitis-related CME who received TCZ between January and August 2012 were included. All patients received 8 mg/kg TCZ at 4-week intervals. Data regarding patient demographics, use of immunosuppressive drugs, biologic agents or intravitreal therapies prior to TCZ infusions were collected. Main outcome measure was central foveal thickness (CFT) measured by optical coherence tomography at 6 months. Secondary outcome measures were degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria) and visual acuity (logarithm of the minimum angle of resolution [log-MAR]) at month 6. Adverse events (AEs) related to TCZ therapy were also assessed. RESULTS: Eight eyes from five patients (all females) were included. Mean age was 49.4 years (range, 30-68). Mean follow-up was 8.4 months (range, 6-12). Before TCZ, all patients received and failed conventional immunosuppressive therapy and had received at least another biologic agent. Uveitis diagnoses were Birdshot chorioretinopathy (n = 3), juvenile idiopathic arthritis (JIA)-associated uveitis (n = 1), and idiopathic panuveitis (n = 1). Mean evolution of CME was 13.4 years (range, 2-30). Mean baseline CFT (95% confidence interval) was 602 ± 236 μm at baseline, 386 ± 113 μm at month 1 (p = 0.006), 323 ± 103 μm at month 3 (p = 0.026), and 294.5 ± 94.5 μm at month 6 (p = 0.014). Median best-corrected visual acuity (BCVA) improved from 0.66 ± 0.57 at baseline to 0.47 ± 0.62 at month 6 (p = 0.035). After 6 months, an improvement of ≥ 2 lines of BCVA was observed in 50% of eyes (p = 0.028) remained stable in 25% and worsened in none of the patients. Sustained uveitis remission was achieved in all patients. No AEs were reported. CONCLUSIONS: These data suggest that TCZ is effective for treating CME in otherwise treatment-refractory cases of uveitis.
Keywords: Female; Humans; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Infusions, Intravenous; Drug Resistance; Antibodies, Monoclonal, Humanized/*therapeutic use; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Macular Edema/diagnosis/*drug therapy/etiology; Uveitis/complications/diagnosis/*drug therapy; Fovea Centralis/pathology; Receptors, Interleukin-6/immunology

Bilateral nongranulomatous uveitis with infective endocarditis. - Ha, Sang Won; Shin, Jae Pil; Kim, Si Yeol; Park, Dong Ho (Korean journal of ophthalmology : KJO, 2013)
A 32-year-old male who had infective endocarditis complained of photophobia and blurred vision in both eyes. Biomicroscopic examination and fundus examination revealed anterior chamber reaction, vitritis, optic disc swelling, and Roth spots. He was diagnosed with bilateral nongranulomatous uveitis and treated with topical steroid eye drops and posterior sub-Tenon injection of triamcinolone. His visual symptoms were resolved within 1 week, and inflammation resolved within 4 weeks after treatment.
Keywords: Humans; Male; Adult; Fluorescein Angiography; Glucocorticoids/administration & dosage; Fundus Oculi; Visual Acuity; Uveitis; Uveitis/*complications/diagnosis/drug therapy; Intravitreal Injections; Intraocular Pressure; Diagnosis, Differential; Triamcinolone Acetonide/administration & dosage; Echocardiography, Transesophageal; Endocarditis, Bacterial/*complications/diagnosis; Immune system disease; Optic disc

[Cystoid macular edema in uveitis]. - Thurau, S. R. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2005)
Cystoid macular edema (CME) is the most frequent cause of visual deterioration in uveitis patients. Intraocular inflammation disturbs the blood-retina barrier and leads to retinal edema. The basis of successful treatment is the anti-inflammatory and immunosuppressive therapy of uveitis. Restoration of the blood-retina barrier is mediated by corticosteroids and nonsteroidal anti-inflammatory agents. Resorption of extracellular fluid is improved by systemic carboanhydrase inhibitors. Despite aggressive therapy loss of visual acuity is frequent. Therefore, early diagnosis of CME and initiation of treatment, even if visual acuity is not yet impeded, is mandatory.
Keywords: Humans; Prognosis; Time Factors; Clinical Trials as Topic; Fluorescein Angiography; Tomography, Optical Coherence; Visual Acuity; Vitrectomy; Acetazolamide/administration & dosage/therapeutic use; Carbonic Anhydrase Inhibitors/administration & dosage/therapeutic use; Adrenal Cortex Hormones/administration & dosage/therapeutic use; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/therapeutic use; Blood-Retinal Barrier; Macular Edema/diagnosis/*drug therapy/*etiology; Uveitis/*complications/*drug therapy

[Differential treatment of postoperative and uveitis-induced inflammatory cystoid macular edema]. - Guex-Crosier, Y.; Othenin-Girard, P.; Herbort, C. P. (Klinische Monatsblatter fur Augenheilkunde, 1992)
Twenty-five eyes (23 patients) with inflammatory cystoid macular edema (CME) (11 after cataract surgery and 14 eyes (12 patients) with uveitis) were followed in a prospective open study. The aim was to determine the efficiency of a combined treatment of Diamox (acetazolamide), Voltaren Ophtha (diclofenac, a NSAID) and Ultracortenol (prednisolone acetate) and in the case of treatment failure, the usefulness of posterior subtenon's injections of corticosteroids (Kenacort 40 mg (triamcinolone)). Seven eyes (all pseudophakic CMEs) responded successfully to the initial therapy. Their mean visual acuity improved from 0.31 +/- 0.13 to 0.93 +/- 0.08 after 18 +/- 5 days (p less than or equal to 0.001). Of the sixteen of 18 evaluable eyes that were additionally treated with a mean of 3.28 +/- 1.07 three-weekly posterior subtenon's injections, 15 eyes including all uveitis CME responded to treatment. Their mean visual acuity improved from 0.49 +/- 0.20 to 0.96 +/- 0.31 (p less than or equal to 0.001). Two patients were excluded; in 22/23 eyes the sequential treatment was successful with an overall success rate of 95% of cases (improvement of five lines on the Snellen chart or final visual acuity of 0.8 or better). Initial angiographic cystoid macular edema was comparable and significantly improved after therapy in the two treatment groups. No mean intraocular pressure rise was noted after steroid injections. Measurement of anterior chamber inflammation with the laser flare-cell meter (Kowa FC-1000) showed elevated flare in all cases which significantly decreased in both treatment groups and represented a good follow-up parameter for the effect of antiinflammatory treatment and restoration of blood-ocular barrier.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Prospective Studies; Injections; Ophthalmic Solutions; Visual Acuity/drug effects; Uveitis/*complications/drug therapy; Macular Edema/*drug therapy; Acetazolamide/*administration & dosage; Diclofenac/*administration & dosage; Triamcinolone Acetonide/administration & dosage; *Lenses, Intraocular; Postoperative Complications/*drug therapy; Prednisolone/administration & dosage/*analogs & derivatives

Intravitreal bevacizumab (avastin) as a treatment for refractory macular edema in patients with uveitis: a pilot study. - Mackensen, Friederike; Heinz, Carsten; Becker, Matthias D.; Heiligenhaus, Arnd (Retina (Philadelphia, Pa.), 2008)
PURPOSE: : Bevacizumab is a monoclonal antibody to vascular endothelial growth factor (VEGF) which has been successfully used for the treatment of age-related macular degeneration with choroidal neovascularization. As VEGF is involved in the pathomechanisms of inflammation and endothelial dysfunction the authors used bevacizumab as a last resort treatment in patients with persistent uveitic cystoid macular edema (CME). PATIENTS AND METHODS: : Persistent uveitic CME was defined by optical coherence tomography (OCT) measurements >250 mum despite previous treatments. The authors reviewed patients with persistent CME who subsequently had been treated with intravitreous bevacizumab 1.25 or 2.5 mg. Improvement was judged by visual acuity (VA) gain >/=2 lines and thickness reduction in OCT. RESULTS: : Eleven eyes of 10 patients were injected since February 2006. Median follow-up was 70 days. Reduction in central retinal thickness could be seen as early as 2 weeks with a mean foveal thickness reduction of 127.2 mum at 4 weeks. Concurrent improvement in VA was seen in 4 of 10 patients, and was unchanged in the others. Four patients received two injections and five patients received three injections. Except for progression of cataract in one eye no ocular or systemic adverse events were recorded. CONCLUSIONS: : Intravitreal bevacizumab seems to be an effective and safe treatment in the management of refractory inflammatory CME. The effect is transient, and reinjections may be necessary, although the time until reinjection is needed differs individually.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Retrospective Studies; Fluorescein Angiography; Tomography, Optical Coherence; Injections; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Vitreous Body; Retina/pathology; Antibodies, Monoclonal, Humanized; Bevacizumab; Antibodies, Monoclonal/*administration & dosage; Macular Edema/diagnosis/*drug therapy/physiopathology; Angiogenesis Inhibitors/*administration & dosage; Vascular Endothelial Growth Factor A

The Use of Ozurdex (Dexamethasone Intravitreal Implant) During Anterior Segment Surgery in Patients with Chronic Recurrent Uveitis. - Ragam, Ashwinee P.; Kolomeyer, Anton M.; Nayak, Natasha V.; Chu, David S. (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2015)
PURPOSE: To describe the outcomes of concurrent Ozurdex implantation during anterior segment surgery in patients with chronic recurrent uveitis. METHODS: Retrospective chart review. Data recorded from preoperative and 1-, 3-, and 6-month postoperative visits included visual acuity, intraocular pressure (IOP), medications, and clinical examination findings of inflammation. RESULTS: Twelve patients (12 eyes) with chronic, recurrent noninfectious uveitis undergoing cataract extraction (n=9) or intraocular lens (IOL) explantation (n=3) were included. Mean duration of follow-up after Ozurdex implantation was 12.9 months. There was a significant reduction (n=10, P=0.02) in the average number of inflammation recurrences 6 months before surgery compared to 6 months after surgery with Ozurdex in affected eyes. IOP remained stable in the postoperative period. One patient undergoing anterior chamber IOL (ACIOL) explantation experienced migration of Ozurdex into the anterior chamber resulting in corneal edema that resolved after 1 month. CONCLUSIONS: Ozurdex safely and effectively controlled postoperative inflammation in eyes with chronic recurrent uveitis when concurrently implanted during anterior segment surgery in our patients. Caution should be exercised in cases of IOL explantation, as Ozurdex use is now contraindicated in eyes with posterior capsule rupture and ACIOLs.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Recurrence; Chronic Disease; Drug Implants; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Uveitis/drug therapy/physiopathology/surgery/*therapy; Visual Acuity/drug effects; Postoperative Period; Lenses, Intraocular; Lens Implantation, Intraocular/*methods; Anterior Chamber/*surgery; Cataract Extraction/methods; Intravitreal Injections/*methods

How do you know? - Rosenbaum, J. T.; Deodhar, A.; Suhler, E. B.; Smith, J. R. (The British journal of ophthalmology, 2004)
Keywords: Humans; Treatment Outcome; Randomized Controlled Trials as Topic; Uveitis/physiopathology/*therapy; Visual Acuity/physiology; Biological Therapy/methods

Clinical effectiveness of a new oral curcumin formulation in acute non-infectious uveitic macular edema: a 12-month observational study. - Allegri, P.; Rosa, R.; Masala, A.; Rissotto, R.; Rissotto, F.; Crivelli, M. G.; Peri, S. (European review for medical and pharmacological sciences, 2022)
OBJECTIVE: Oral supplementation with curcumin demonstrated a beneficial effect on some ocular diseases, including uveitis and macular edema. This study aimed to evaluate the effectiveness and safety of a curcumin formulation with the hydrophilic carrier (CHC; Diabec®, Alfa Intes, Italy) as an adjuvant to standard steroid treatment in adults suffering from acute non-infectious uveitic macular edema (NIUME). PATIENTS AND METHODS: This was a monocenter prospective observational study carried out between January 2019 and May 2020 on consecutive patients with a new diagnosis of NIUME. Patients were treated with standard therapy or with a CHC add-on to standard treatment. The observation period for each patient was 12 months. The Best Corrected Visual Acuity (BCVA) and the Central Macular Thickness (CMT) were the primary outcomes; Foveal Avascular Zone (FAZ) and intraocular pressure (IOP) were also assessed, along with safety data. RESULTS: A total of 43 eyes of 26 patients were analyzed. CHC-treated eyes showed an improvement in mean BCVA from baseline (0.34 logMar) to T6 (0.20 logMar) and T12 (0.19 logMar; p≤0.05 and p≤0.01, respectively); CMT decreased from a mean of 320 μm (T0) to 278 μm (T6; p≤0.05) and 272 μm (T12; p≤0.01). A significant improvement of mean BCVA in the CHC group at T6 and T12 was reported compared to the control group (p≤0.01). FAZ and IOP showed no statistically significant variations in both groups. No adverse events were recorded. CONCLUSIONS: CHC as an adjuvant treatment improved the anatomical and functional outcomes, without significant side effects in eyes affected by the recent onset of NIUME, compared to the sole standard therapy.
Keywords: Humans; Adult; Treatment Outcome; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; Visual Acuity; Intravitreal Injections; *Macular Edema/drug therapy; *Uveitis/diagnosis/drug therapy; *Curcumin/therapeutic use

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease. - Wroblewski, Keith; Sen, H. Nida; Yeh, Steven; Faia, Lisa; Li, Zhuging; Sran, Pushpa; Gangaputra, Sapna; Vitale, Susan; Sherry, Patti; Nussenblatt, Robert (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2011)
OBJECTIVE: Safety and efficacy of daclizumab during an 11-year period. DESIGN: Structured, retrospective chart review. PARTICIPANTS: Thirty-nine patients. METHODS: Patients with chronic, noninfectious intermediate and/or posterior uveitis. RESULTS: Thirty-nine patients (78 eyes) were treated for a mean of 40.3 months. Visual acuity improved by ≥2 lines in the better eye in 7 patients (18.4%) and worsened by 2 lines in 6 patients (15.8%) with a mean of 2.8 Snellen lines of vision lost per eye. Six eyes with vitreous cell less than grade 2 lost 2 lines of vision and 7 eyes with less than grade 2 vitreous cell improved 2 lines. Mean number of immunosuppressive medications per patient decreased from 1.89 medications/patient to 1.17 medications/patient. The average number of periocular injections per patient was 1.46 (range, 0-9). The mean number of flares was 2.05/patient (range, 0-12), with the rate being 0.62 flares per patient-year. Four patients developed cancer during the course of this study. Mean time to onset of malignancy was 26 months and the mean age in this group was 49 years. CONCLUSIONS: Daclizumab demonstrated efficacy in the reduction of concomitant immunosuppressive medication, stabilization of visual acuity, and the prevention of uveitic flares in most cases. Dermatologic complications were the most frequently observed adverse event in our series. Four patients developed solid tumor malignancies during this 11-year period.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Immunoglobulin G/adverse effects/*therapeutic use; Injections, Intravenous; Visual Acuity/physiology; Injections, Subcutaneous; Antibodies, Monoclonal, Humanized/adverse effects/*therapeutic use; Uveitis, Posterior/*drug therapy/physiopathology; Vitreous Body/pathology; Immunosuppressive Agents/adverse effects/*therapeutic use; Uveitis, Intermediate/*drug therapy/physiopathology; Daclizumab

Dexamethasone Intravitreal Implant (Ozurdex) in Paediatric Patients with Non-infectious Intermediate Uveitis and Related Cystoid Macular Oedema: Evaluation of Macular Morphology and Function with Six-month Follow-up; a Deeper Role of MfERG? - Iarossi, Giancarlo; Coppè, Andrea Maria; Catena, Gino; Petroni, Sergio; Montes, Marco; Buzzonetti, Luca (Ocular immunology and inflammation, 2022)
PURPOSE: To evaluate the efficacy of Ozurdex implant by analyzing macular morphology and function in pediatric uveitis and related cystoid macular edema (CMO). METHODS: Main outcomes were visual acuity, mfERG and photopic ERG response, and central macular thickness. Mean values recorded at each time-point were compared to baseline and correlations between functional and anatomical parameters were evaluated. RESULTS: Resolution of intraocular inflammation and CMO was achieved in all eyes 1 month after implant without procedure or drug-related complications. Mean visual acuity and mfERG amplitude improved showing a statistically significant difference to baseline values for the first 4 months. Mean central macular thickness showed a statistically significant reduction for all follow-up time. Photopic ERG did not vary significantly. Statistically significant correlation was found between trends of visual acuity, central macular thickness, and mfERG responses. CONCLUSION: Correlation found between macular morphology and function confirms the efficacy of Ozurdex in pediatric uveitis.
Keywords: Humans; Follow-Up Studies; Retrospective Studies; Child; Glucocorticoids/therapeutic use; Drug Implants; Intravitreal Injections; Dexamethasone/therapeutic use; *Macular Edema/diagnosis/drug therapy/etiology; *Uveitis, Intermediate/complications/diagnosis/drug therapy; *Uveitis/complications/diagnosis/drug therapy; cystoid macular edema (CMO); dexamethasone intravitreal implant (Ozurdex); macular function; mfERG; Noninfectious intermediate uveitis

Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis. - Lam, Linda A.; Lowder, Careen Y.; Baerveldt, George; Smith, Scott D.; Traboulsi, Elias I. (American journal of ophthalmology, 2003)
PURPOSE: To evaluate outcomes of cataract surgery with posterior chamber intraocular lens (IOL) implantation with or without trabeculectomy in children with juvenile rheumatoid arthritis (JRA)-associated uveitis. DESIGN: Interventional case series. METHOD: Retrospective chart review of five patients aged 12 years or younger with JRA-associated uveitis who underwent cataract surgery with posterior chamber IOL with or without trabeculectomy at the Cleveland Clinic Foundation from December 1995 to October 2001. RESULTS: Four female patients and one male patient ranging from age 7 to 12 years were identified. One patient had bilateral involvement; six eyes were included in the study. Three eyes underwent cataract extraction with posterior chamber IOL, and three underwent combined cataract surgery with posterior chamber IOL and trabeculectomy. Median age at surgery was 8.5 years, with a median follow-up of 43.5 months. Four of five children (five eyes) were on systemic methotrexate immunosuppressive therapy for a median length of 1.25 years before surgery. Two of five patients (three eyes) were also on additional systemic immunosuppressive or anti-inflammatory treatments. All eyes received frequent topical corticosteroid therapy for a median of 2 weeks preoperatively and 8.5 weeks postoperatively. A final postoperative Snellen visual acuity of 20/40 or better was achieved in all children. A median final visual acuity improvement of 7 Snellen lines was observed after cataract surgery. CONCLUSIONS: With adequate long-term preoperative and postoperative control of intraocular inflammation with systemic immunosuppressive therapy in addition to intensive topical corticosteroid treatment, children with JRA-associated uveitis can demonstrate favorable surgical outcomes after cataract surgery with posterior chamber IOL.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Methotrexate/therapeutic use; Anti-Inflammatory Agents/therapeutic use; Child; Immunosuppressive Agents/therapeutic use; Visual Acuity; Trabeculectomy; Administration, Topical; *Phacoemulsification; Cataract/*etiology; Uveitis/drug therapy/*etiology; Arthritis, Juvenile/*complications/drug therapy; *Lens Implantation, Intraocular; Glucocorticoids; Capsulorhexis; Glaucoma/etiology/surgery; Prednisolone/*analogs & derivatives/therapeutic use

Cyclosporin A therapy in refractory non-infectious childhood uveitis. - Kilmartin, D. J.; Forrester, J. V.; Dick, A. D. (The British journal of ophthalmology, 1998)
AIMS: To assess the immunosuppressive efficacy, steroid sparing effect and adverse effects of cyclosporin A (CsA) therapy in refractory non-infectious childhood uveitis. METHODS: A retrospective case series review of the medical records of children on CsA therapy attending a tertiary referral centre for refractory endogenous uveitis was performed. Low dose (< or = 5.0 mg/kg/day) CsA therapy was started either as monotherapy or in combination with other agents. The CsA immunosuppressive efficacy was assessed by visual acuity and binocular indirect ophthalmoscopy (BIO) score outcomes and steroid sparing effect by growth charts and ability to withdraw or maintain a low steroid dose. Possible CsA adverse effects were monitored by routine biochemistry (including serum creatinine) and haematological tests, blood pressure recordings, and symptoms. RESULTS: 14 patients (25 eyes, 10 males, four females) were recruited with steroid failure as the most common CsA indication. Age (mean (SD)) at start of CsA therapy was 8.7 (4.1) years with a duration of CsA therapy of 20.9 (range 3.5-88.3) months at a maintenance CsA dose of 4.0 (1.0) mg/kg/day. From baseline, visual acuity improved or was maintained in 23 (92%) eyes and BIO score improved in 19 (76%) eyes. Height centiles were preserved and the maintenance prednisolone dose was 6.3 (3.3) mg/day, where required, in 10 (71%) patients. Nephrotoxicity was not observed, with transient systemic hypertension developing in one patient. Minor adverse effects were more common but were well tolerated. CONCLUSIONS: Cyclosporin A therapy is effective and safe in the medium term, if closely monitored, in refractory non-infectious childhood uveitis.
Keywords: Female; Humans; Male; Drug Therapy, Combination; Retrospective Studies; Treatment Outcome; Methotrexate/therapeutic use; Adolescent; Prednisolone/therapeutic use; Chronic Disease; Child; Child, Preschool; Cyclosporine/*therapeutic use; Immunosuppressive Agents/*therapeutic use; Azathioprine/therapeutic use; Visual Acuity; Uveitis/*drug therapy; Arthritis, Juvenile/drug therapy

A clinical trial of FK506 in refractory uveitis. - Mochizuki, M.; Masuda, K.; Sakane, T.; Ito, K.; Kogure, M.; Sugino, N.; Usui, M.; Mizushima, Y.; Ohno, S.; Inaba, G. (American journal of ophthalmology, 1993)
We performed a clinical open trial to evaluate the efficacy and the adverse side effects of a single therapy with FK506 in refractory uveitis as a multicenter study in Japan. Fifty-three patients (41 patients with Bechçet's disease, five with Vogt-Koyanagi-Harada disease, four with idiopathic retinal vasculitis, and three with other forms of uveitis) were enrolled in the study. FK506 was given orally for 12 weeks. Treatment with FK506 exhibited therapeutic effects in a dosage-dependent manner: the effectiveness was 38% in patients treated with an initial dosage of 0.05 mg/kg of body weight per day, 60% with 0.10 mg/kg of body weight per day, 83% with 0.15 mg/kg of body weight per day, and 79% with 0.20 mg/kg of body weight per day. Overall efficacy with dosage adjustment when needed was 76.5% at the conclusion of the study at the end of the 12th week. The FK506 therapy induced a variety of adverse side effects, the incidence of which depended on the dosage. The major side effects were renal impairment (28.3%, 15 of 53 patients), neurologic symptoms (20.8%, 11 of 53 patients), gastrointestinal symptoms (18.9%, ten of 53 patients), and hyperglycemia (13.2%, seven of 53 patients). The trough level of FK506 in the whole blood correlated with both the efficacy of the therapy and with the incidence of adverse effects. It is recommended to maintain the trough level between 15 and 25 ng/ml. On the basis of these results, a daily dosage of 0.10 to 0.15 mg/kg of body weight per day was suggested as an appropriate therapeutic dosage for refractory uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Dose-Response Relationship, Drug; Drug Administration Schedule; Administration, Oral; Japan; Visual Acuity; Uveitis/*drug therapy; Tacrolimus/administration & dosage/adverse effects/*therapeutic use

Metastatic melanoma and immunotherapy-related uveitis: an incidence in Northern Ireland. - Dolaghan, Michael J.; Oladipo, Bode; Cooke, Carole A.; McAvoy, Clara E. (Eye (London, England), 2019)
Keywords: Female; Humans; Male; Aged; Incidence; Electroretinography; Tomography, Optical Coherence; Visual Acuity/physiology; Northern Ireland/epidemiology; Retina/physiopathology; Antineoplastic Combined Chemotherapy Protocols/*adverse effects; Antibodies, Monoclonal, Humanized/adverse effects; Antineoplastic Agents, Immunological/*adverse effects; Immunotherapy/*adverse effects; Ipilimumab/adverse effects; Melanoma/*drug therapy/secondary; Nivolumab/adverse effects; Panuveitis/*chemically induced/diagnostic imaging/epidemiology/physiopathology; Uveitis, Anterior/*chemically induced/diagnostic imaging/epidemiology/physiopathology

Medical treatment of macular edema in patients with uveitis. - Rojas, B.; Zafirakis, P.; Christen, W.; Markomichelakis, N. N.; Foster, C. S. (Documenta ophthalmologica. Advances in ophthalmology, 1999)
PURPOSE: To determine the efficacy of medical treatment of cystoid macular edema (CME) in patients with uveitis. METHODS: Retrospective study of 40 patients (57 eyes) with uveitis and CME. Inclusion criteria were presence of CME with minimal and no macular pathology, or vascular disease which could account for CME. Patients who had undergone intraocular surgery or had visual acuity (VA) of > or = 20/40 were excluded. The diagnosis of CME was based on clinical and/or angiographic findings. Three treatment groups were defined: (1) transseptal injection of steroids (n=13 eyes); (2) systemic non steroidal anti-inflammatory drugs (NSAIDs) (n=11 eyes); both 1 and 2 (n=33 eyes). RESULTS: Overall, 79% of eyes improved 3 or more lines of Snellen VA after treatment: 51% improved 4 or more lines. The average number of lines improved was 3.8 for eyes treated with transseptal injections of steroids, 2.9 for eyes treated with NSAIDs, and 4 for eyes treated with both. For all 3 treatment groups between 60-70% of eyes improving 2 or more lines reached best VA only after a minimum of 6 months of follow up. CONCLUSIONS: CME, a vision threatening complication of uveitis, respond fairly well to medical treatment; however, the best VA is achieved after several months. The improvement in VA did not differ markedly among the three treatment groups.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Adolescent; Recurrence; Child; Fluorescein Angiography; Glucocorticoids/administration & dosage/*therapeutic use; Fundus Oculi; Visual Acuity; Macula Lutea/pathology; Vitreous Body/pathology; Drug Administration Routes; Anterior Chamber/pathology; Carbonic Anhydrase Inhibitors/administration & dosage/therapeutic use; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use; Macular Edema/complications/diagnosis/*drug therapy; Uveitis, Anterior/*complications/diagnosis/drug therapy; Uveitis, Intermediate/*complications/diagnosis/drug therapy; Uveitis, Posterior/*complications/diagnosis/drug therapy

Early resolved acute syphilitic posterior placoid chorioretinitis. - Ji, Yong-Sok; Yang, Jee Myung; Park, Sang-Woo (Optometry and vision science : official publication of the American Academy of Optometry, 2015)
PURPOSE: Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare ocular manifestation of syphilis, and its natural course is not well understood. We herein present two unusual cases of ASPPC in which there was almost total resolution of the fundus and optical coherence tomography (OCT) findings during the early presentation before treatment was initiated. CASE REPORTS: Patient 1: A 44-year-old man presented with a 4-day history of decreased visual acuity in his left eye. Dilated fundus examination revealed a yellowish subretinal placoid lesion in the posterior pole, and OCT images showed subretinal fluid and irregular or granular hyperreflectivity of the retinal pigment epithelium. Ten days later, the yellowish placoid lesion had dramatically improved and the OCT findings showed absence of the subretinal fluid and hyperreflective lesion without any treatment. Patient 2: A 35-year-old man presented with a 3-day history of decreased visual acuity in his right eye. Dilated fundus examination showed a yellow submacular placoid lesion, and OCT images showed a small amount of subretinal fluid with disruption of the inner segment/outer segment junction. Four days after presentation, the fundus and OCT findings had markedly resolved without definitive treatment. In both cases, serologic test results confirmed the diagnosis of syphilis, and the patients were referred to the Department of Infectious Disease for systemic antibiotic treatment. After treatment, the patients' visual acuities were improved, but the disruption of the inner segment/outer segment junction on OCT images remained. CONCLUSIONS: In patients with ASPPC, fundus and OCT findings can spontaneously recover during the early clinical course before treatment.
Keywords: Humans; Male; Adult; Infusions, Intravenous; Fluorescein Angiography; Fundus Oculi; Visual Acuity/physiology; Tomography, Optical Coherence/methods; Syphilis Serodiagnosis; Anti-Bacterial Agents/therapeutic use; Chorioretinitis/*diagnosis/drug therapy/microbiology; Eye Infections, Bacterial/*diagnosis/drug therapy/microbiology; Penicillin G/therapeutic use; Syphilis/*diagnosis/drug therapy/microbiology

Prospective optical coherence tomographic evaluation of the efficacy of oral and posterior subtenon corticosteroids in patients with intermediate uveitis. - Venkatesh, Pradeep; Abhas, Zaheer; Garg, Satpal; Vohra, Rajpal (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2007)
PURPOSE: To prospectively evaluate the efficacy of oral corticosteroids and posterior subtenon injection in the treatment of macular edema in patients with intermediate uveitis using optical coherence tomography (OCT). METHODS: Twenty-two patients with intermediate uveitis were treated with posterior subtenon injection when the disease was unilateral (group A, n=11) or with oral steroids when the disease was bilateral (group B, n=11). Changes in macular thickness from baseline was determined using OCT in both groups at day 0, day 3, day 14, 6 weeks and 12 weeks. RESULTS: Statistically significant improvement in Snellen visual acuity in group A was seen at 6 weeks and in group B at 2 weeks. In patients receiving oral corticosteroids, foveal thickness decreased by 63% by day 3. In those treated with posterior subtenon injection, even at day 14 only a 55% reduction of foveal thickness was evident. Spearman's correlation coefficient for visual acuity and foveal thickness was found to be significant. CONCLUSION: OCT confirms a significantly more rapid decrease in macular edema in patients treated with oral corticosteroids. A short course of oral steroids may be useful in enabling earlier visual recovery in patients treated with posterior subtenon injection for unilateral uveitic macular edema.
Keywords: Female; Humans; Male; Adult; Prospective Studies; Treatment Outcome; Administration, Oral; Injections; Macular Edema/diagnosis/*drug therapy/etiology; Triamcinolone Acetonide/*administration & dosage; Glucocorticoids/*administration & dosage; Visual Acuity/drug effects; Administration, Topical; Drug Administration Routes; Connective Tissue; Prednisolone/*administration & dosage; *Tomography, Optical Coherence; Uveitis, Intermediate/complications/diagnosis/*drug therapy; Betamethasone/*administration & dosage

Infliximab for chronic cystoid macular edema associated with uveitis. - Markomichelakis, Nikos N.; Theodossiadis, Panagiotis G.; Pantelia, Eygenia; Papaefthimiou, Semina; Theodossiadis, George P.; Sfikakis, Petros P. (American journal of ophthalmology, 2004)
PURPOSE: To assess the efficacy of the anti-TNF monoclonal antibody infliximab in uveitis patients without clinically evident ocular inflammation and impaired visual acuity because of chronic cystoid macular edema (CME). DESIGN: Prospective, noncomparative, interventional case series. METHODS: Patients with refractory CME (14 eyes, mean duration of 14 months), associated with intermediate uveitis (n = 6), Adamantiades-Behcet disease (n = 2), adult-type vascular pseudotumor (n = 1), and HLAB27+-related uveitis (n = 1) received an intravenous infliximab infusion (5 mg/kg); five patients were retreated after 1 month. RESULTS: Macular thickness, measured by ocular coherence tomography, was reduced from 428 +/- 138 microm to 219 +/- 51 microm at 2 months postbaseline (P = .0001), while visual acuity increased from 0.41 +/- 0.18 to 0.83 +/- 0.17 (P < .00001). Anatomic and functional improvement was sustained at 6 months in all. No ocular or extra-ocular side effects were noted. CONCLUSION: These promising results suggest that TNF may play an important pathogenetic role in chronic CME, thus, a controlled trial is warranted.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Infusions, Intravenous; Chronic Disease; Antibodies, Monoclonal/*therapeutic use; Infliximab; Tomography, Optical Coherence; Visual Acuity; Uveitis/diagnosis/*drug therapy; Macular Edema/diagnosis/*drug therapy; Tumor Necrosis Factor-alpha/therapeutic use

Long-term effect of acetazolamide treatment of patients with uveitic chronic cystoid macular edema is limited by persisting inflammation. - Schilling, Harald; Heiligenhaus, Arnd; Laube, Thomas; Bornfeld, Norbert; Jurklies, Bernhard (Retina (Philadelphia, Pa.), 2005)
PURPOSE: To assess the long-term effect of acetazolamide treatment on patients with cystoid macular edema (CME) in the course of intermediate or posterior chronic uveitis and to define those patients who may particularly benefit from the drug. METHODS: Fifty-two eyes (45 patients) with chronic uveitic CME were treated with acetazolamide at an initial dosage of 500 mg/d. The effect of treatment was assessed by fluorescein angiography, ophthalmoscopy, visual acuity, and Amsler testing. Therapy was withdrawn when CME did not improve at 3 weeks. In cases with CME improvement, the dosage was gradually tapered. RESULTS: The mean follow-up was 3.1 years (minimum, 1.5 years). Two subgroups were identified: group 1, quiescence of uveitis with acetazolamide as the single therapeutic agent (33 eyes); and group 2, chronically active uveitis requiring additional systemic antiinflammatory drugs (19 eyes). In both groups, visual acuity improvement was statistically significant (group 1, P = 0.012; group 2, P = 0.025). In 12 patients with a stable visual acuity gain, the medication dose could be tapered off completely without any recurrent edema shown by fluorescein angiography after a minimum follow-up of 1 year. Sixteen patients required a maintenance dosage, ranging from 125 to 500 mg daily. No major adverse effects of the medication were observed. CONCLUSIONS: During long-term follow-up, low-dose acetazolamide can be a useful therapeutic option for chronic CME in uveitis. The effect was better in patients with quiescence of uveitis than in those with chronically active uveitis. Permanent therapy is not imperative in every case.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Chronic Disease; Child; Fluorescein Angiography; Visual Acuity; Uveitis, Intermediate/diagnosis/*drug therapy; Uveitis, Posterior/diagnosis/*drug therapy; Ophthalmoscopy; Macular Edema/diagnosis/*drug therapy; Acetazolamide/administration & dosage/*therapeutic use; Carbonic Anhydrase Inhibitors/administration & dosage/*therapeutic use

Loss of efficacy during long-term infliximab therapy for sight-threatening childhood uveitis. - Simonini, G.; Zannin, M. E.; Caputo, R.; Falcini, F.; de Martino, M.; Zulian, F.; Cimaz, R. (Rheumatology (Oxford, England), 2008)
OBJECTIVE: To describe efficacy and safety of infliximab in the treatment of childhood chronic uveitis during a long-term follow-up. METHODS: Fifteen patients (median age 12 yrs, range 5-21 yrs) with chronic uveitis were enrolled. Before infliximab treatment, children had presented active uveitis despite treatment with MTX and/or CSA. All were also receiving oral prednisone (1-2 mg/kg/day) for at least 1 month. Infliximab (5 mg/kg) was administered at weeks 0, 2, 6 and then every 6-8 weeks. Later on, in patients enrolled in Florence the administration interval was progressively increased up to 10 weeks if uveitis did not flare, whilst in children from Padua the scheduled infusion rate was maintained every 6 weeks. Absence or recurrence rate of uveitis up to the last visit was recorded. RESULTS: Median follow-up on treatment was 30 months (range 16-38 months), median number of infusions 22 (range 11-30). During the first year, 13/15 children achieved a complete remission over a median period of 10 weeks, but all relapsed thereafter. The probability of a first relapse was correlated to length of treatment, once remission was achieved (P < 0.03). The total number of relapses correlated with the duration of treatment (r(s) = 0.81; P < 0.002) and with the total number of infusions (r(s) = 0.83; P < 0.001). The total number of relapses on treatment at last follow-up was not significantly different between the two centres. CONCLUSIONS: Even if limited to a small group, infliximab appears to be an effective treatment for uveitis in children, but its efficacy seems to wane over time.
Keywords: Female; Humans; Male; Prospective Studies; Follow-Up Studies; Treatment Outcome; Drug Administration Schedule; Adolescent; Recurrence; Remission Induction; Chronic Disease; Child; Child, Preschool; Infant; Infliximab; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Drug Resistance; Antibodies, Monoclonal/*administration & dosage/therapeutic use; Visual Acuity/drug effects; Uveitis/*drug therapy/physiopathology; Anti-Inflammatory Agents/*administration & dosage/therapeutic use

Methylprednisolone pulse therapy in severe anterior uveitis. - Wakefield, D. (Australian and New Zealand journal of ophthalmology, 1985)
Six patients with severe, refractory anterior uveitis (AU) were treated with intermittent, intravenous pulses of methylprednisolone (MP). Five patients had bilateral AU and all had decreased visual acuities. AU was idiopathic in four subjects, one male had ankylosing spondylitis (HLA-B27 +) and one female had juvenile polyarthritis. All patients were initially treated with 1 g of MP intravenously (IV) on alternate days during the first week. Subsequently, patients received weekly injections of MP on a reducing dosage regime to a maintenance dose of 125 mg IV weekly. This therapy produced a rapid resolution of the signs of uveal inflammation and improved visual acuity. Two patients have been maintained on this treatment regime for over 12 months without evidence of disease relapse or serious drug side effect. Pulse MP is effective in the treatment of severe anterior uveitis and may be a useful adjunct in the management of patients with uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Administration Schedule; Adolescent; Methylprednisolone/*therapeutic use; Visual Acuity/drug effects; Intraocular Pressure/drug effects; Uveitis, Anterior/*drug therapy

Cystoid macular edema associated with topical latanoprost in glaucomatous eyes with a normally functioning blood-ocular barrier. - Furuichi, M.; Chiba, T.; Abe, K.; Kogure, S.; Iijima, H.; Tsukahara, S.; Kashiwagi, K. (Journal of glaucoma, 2001)
PURPOSE: To study prospectively using optical coherence tomography (OCT) whether topical latanoprost induces retinal disorders, such as cystoid macular edema, in patients with glaucoma and a normally functioning blood-ocular barrier. METHODS: Sixty-eight eyes of 38 patients with glaucoma and no history of intraocular surgery, uveitis, or laser trabeculoplasty were studied. Before initiation of latanoprost treatment and after 1, 3, and 6 months of treatment, OCT images were taken, and the following tests were performed: visual acuity examination, fundus ophthalmoscopy, intraocular pressure measurement, and fundus color photography. To evaluate retinal thickness in the fovea accurately. OCT scanning was repeated six times, and the smallest value was used as the retinal thickness in the fovea. RESULTS: Latanoprost ophthalmic solution did not influence retinal thickness in the fovea at any investigated time points compared with the time before instillation, and no changes were observed in visual acuity, ophthalmoscopic findings, and fundus photographs. The intraocular pressure was reduced significantly at all investigated time points compared with the time before instillation. CONCLUSIONS: It is unlikely that topical latanoprost induces retinal disorders, such as cystoid macular edema, in glaucomatous eyes with a normally functioning blood-ocular barrier.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Ophthalmic Solutions; Visual Acuity; Glaucoma, Open-Angle/*drug therapy/physiopathology; Ocular Hypertension/drug therapy/physiopathology; Intraocular Pressure/drug effects; Latanoprost; Antihypertensive Agents/*adverse effects; Blood-Retinal Barrier/*physiology; Interferometry; Light; Macular Edema/*chemically induced/diagnosis/physiopathology; Prostaglandins F, Synthetic/*adverse effects; Tomography

Systematic correlation of morphologic alterations and retinal function in eyes with uveitis-associated cystoid macular oedema during development, resolution and relapse. - Munk, Marion R.; Kiss, Christopher G.; Steiner, Irene; Sulzbacher, Florian; Roberts, Phillipp; Kroh, Maria; Montuoro, Alessio; Simader, Christian; Schmidt-Erfurth, Ursula (The British journal of ophthalmology, 2013)
PURPOSE: To evaluate morphological changes due to uveitis-associated cystoid macular oedema (uvCME) and their impact on central retinal sensitivity (CRS) before and after intravitreal triamcinolone-acetonide (IVTA). METHODS: 28 eyes with uvCME were examined with microperimetry and spectral-domain optical-coherence-tomography (SD-OCT) before and after IVTA. Microperimetry-maps were superimposed on SD-OCT and morphological-alterations were correlated point to point with CRS and followed-up for 3 months. The effects of morphological-alterations on CRS over time were evaluated with a linear mixed-model. RESULTS: Mean-CRS increased significantly after IVTA (p=0.009). Proportion of cysts correlated negatively with corresponding CRS (estimate/95% CI -3.8 dB/-6.6 to -0.9, p=0.011). Proportion of diffuse macular-oedema (DifME) had no significant effect on mean-CRS (-0.76 dB/-4.9 to 3.3, p=0.71). The proportion of serous retinal detachment (SRD) had a borderline significant effect on mean-CRS (-9.5 dB/-19.1 to 0.1, p=0.052), however the initial presence of SRD at baseline had no significant negative effect on mean-CRS (-1.3 dB/-4.9 to 2.3, p=0.46). Patients with epiretinal-membrane showed lower mean-CRS than patients without (-3.3 dB/-6.5 to -0.008, p=0.05). The lowest percentage of morphological-alterations was achieved 30 days post IVTA concordant to best visual-acuity (logMAR 0.16 ± 0.26), while best mean-CRS was achieved 90 days post IVTA (16.9 ± 1.8 dB). Fixation-stability showed no significant improvement. CONCLUSIONS: UvCME Morphological-alterations were associated with specific CRS-decreases. DifME showed no significant- and SRD only a borderline effect on mean-CRS, which implicates that their presence should be considered when interpreting SD-OCT and making treatment-decisions.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Anti-Inflammatory Agents/therapeutic use; Recurrence; Visual Field Tests; Visual Acuity/physiology; Tomography, Optical Coherence/methods; Intravitreal Injections; Visual Fields/physiology; Uveitis/*complications/drug therapy; Imaging; *Macular Edema/drug therapy/pathology/physiopathology; Macula; Treatment Medical; Triamcinolone/therapeutic use

Optical Coherence Tomography Anatomic and Temporal Biomarkers in Uveitic Macular Edema. - Ciulla, Thomas A.; Kapik, Barry; Barakat, Mark R.; Khurana, Rahul N.; Nguyen, Quan Dong; Grewal, Dilraj S.; Albini, Thomas; Cunningham, Emmett T. Jr; Goldstein, Debra A. (American journal of ophthalmology, 2022)
PURPOSE: To assess the relationship between best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) features in noninfectious uveitis (NIU)-related macular edema. DESIGN: Clinical cohort study from post hoc analysis of 2 phase 3 clinical trials. METHODS: Correlation and longitudinal treatment analyses were performed. Of 198 patients with NIU, 134 received suprachoroidal CLS-TA (proprietary formulation of a triamcinolone acetonide injectable suspension), and 64 received sham, with 12.9% and 72%, respectively, receiving rescue therapy. RESULTS: At baseline, mean BCVA progressively worsened with each ordinal drop in central subfield ellipsoid zone (EZ) integrity. Eyes with normal baseline EZ experienced greater 24-week change in BCVA versus those with some degree of baseline EZ disruption (11.9 vs 9.4 letters, P = .006). In contrast, eyes with baseline central subfield cystoid spaces and/or subretinal fluid showed more improvement (13.7 or 17.2 letters, respectively) at 24 weeks, versus those without such findings (5.5 [P = .012] or 9.5 letters [P < .001], respectively). Longitudinal modeling for CLS-TA-treated eyes showed that central subfield thickness (CST) reached 90% of maximal improvement by week 3, whereas 90% maximal response in BCVA was not reached until week 9. CLS-TA-treated eyes that showed CST reduction of ≥50 µm at 4 weeks experienced a greater 24-week improvement in BCVA versus those without such an early response (14.6 vs 6.5 letters, P = .006 for difference). CONCLUSIONS: Pretreatment EZ integrity and the presence of central subfield cystoid spaces or subretinal fluid each predict improved therapeutic response to treatment in eyes with NIU. In CLS-TA treated eyes, longitudinal modeling shows CST improvement preceding BCVA improvement.
Keywords: Humans; Follow-Up Studies; Treatment Outcome; Cohort Studies; Visual Acuity; Tomography, Optical Coherence/methods; Intravitreal Injections; *Uveitis/diagnosis/drug therapy; *Macular Edema/diagnostic imaging/drug therapy; Biomarkers; Clinical Trials, Phase III as Topic

Retrospective case review of pediatric patients with uveitis treated with infliximab. - Rajaraman, Ravindran T.; Kimura, Yukiko; Li, Suzanne; Haines, Kathleen; Chu, David S. (Ophthalmology, 2006)
PURPOSE: To assess the response and adverse events associated with infliximab treatment for refractory, noninfectious pediatric uveitis. DESIGN: Retrospective noncomparative case series of pediatric patients with refractory uveitis treated with infliximab. PARTICIPANTS: Six patients were identified. Diagnoses of the participants included idiopathic uveitis (n = 1), juvenile rheumatoid arthritis with uveitis (n = 3), idiopathic retinal vasculitis with uveitis (n = 1), and bilateral pars planitis, with vitreitis and papillitis of the left eye (n = 1). Uveitis developed in the patients (5 female, 1 male) at a mean age of 9.0 years (+/-5.0 years; range, 0.9-14.8 years). All patients had bilateral eye involvement. These patients were refractory to or dependent on topical steroids (n = 4), oral prednisone (n = 3), or both, and were also refractory to the following therapies: methotrexate (n = 6), cyclosporine (n = 3), mycophenolate mofetil (n = 3), etanercept (n = 3), and daclizumab (n = 1). INTERVENTION: All patients initially received infliximab at doses between 5 and 10 mg/kg at 2- to 4-week intervals, and then were maintained at 4- to 8-week intervals at doses of 5 to 18 mg/kg. Mean follow-up time on treatment has been 48.1 weeks (+/-14.9 weeks; range, 32-74 weeks). MAIN OUTCOME MEASURES: Primary outcome measures included the quantitative measurement of the amount of ocular inflammation in different locations within the eye. Patients were monitored for infusion reactions as well as other potential side effects. The children's clinical status, complete blood counts, and liver function panels were monitored by pediatric rheumatologists every 6 weeks. RESULTS: All 6 patients showed reduction in their intraocular inflammation after infliximab therapy was initiated. Furthermore, control of ocular inflammation was achieved while receiving infliximab therapy. Topical and systemic corticosteroids were able to be discontinued in all patients except for 1 patient, who is currently weaning off prednisone. The only adverse reactions seen were the development of vitreous hemorrhage in 1 patient and a case of transient upper respiratory infusion reaction. No patient has had to discontinue treatment. CONCLUSIONS: Infliximab seems to be an effective agent for the treatment of refractory pediatric uveitis without apparent serious toxicity in this series of patients.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Adolescent; Antirheumatic Agents/adverse effects/*therapeutic use; Infusions, Intravenous; Child; Infliximab; Visual Acuity; Uveitis/*drug therapy/etiology; Antibodies, Monoclonal/adverse effects/*therapeutic use; Arthritis, Juvenile/complications/drug therapy

Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. - Antcliff, R. J.; Spalton, D. J.; Stanford, M. R.; Graham, E. M.; ffytche, T. J.; Marshall, J. (Ophthalmology, 2001)
PURPOSE: To investigate the use of intravitreal injection of triamcinolone acetonide (TA) for the treatment of refractory uveitic cystoid macular edema (CME). DESIGN: Prospective, nonrandomized, self-controlled comparative trial. PARTICIPANTS: Six patients with chronic CME resistant to treatment with systemic steroids, orbital floor steroids, and cyclosporine A. Three patients were followed for more than 1 year, and the other three for between 3 and 9 months. INTERVENTION: Injection of 2 mg of TA into the vitreous cavity. TESTING: Optical coherence tomography scanning of the fovea before and after injection and logarithmic minimal angle of resolution visual acuity. MAIN OUTCOME MEASURES: Visual acuity, retinal thickness, cystoid space height, and intraocular pressure. RESULTS: There was complete anatomic resolution of CME in five of the six cases within 1 week after injection. Cystoid spaces began to return between 6 weeks and 3 months after injection. Two patients with longer term follow-up responded to further orbital floor steroid injection and had no CME 1 year later. One patient had raised intraocular pressure develop, requiring a trabeculectomy. Mean improvement in visual acuity after 12 months was 0.27 (range, 0.14-0.42). CONCLUSIONS: Complete anatomic and, to some extent, functional recovery can be induced by intravitreal TA despite long-term refractory inflammatory CME. Optical coherence tomography aids in the management of these cases.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Treatment Outcome; Glucocorticoids/*therapeutic use; Injections; Visual Acuity; Macular Edema/diagnosis/*drug therapy/etiology; Intraocular Pressure; Uveitis/complications/diagnosis/*drug therapy; Triamcinolone Acetonide/*therapeutic use; Vitreous Body/*drug effects; Interferometry; Tomography; *Diagnostic Techniques, Ophthalmological; Sound

Assessment of visual outcome after cataract surgery in patients with uveitis. - Okhravi, N.; Lightman, S. L.; Towler, H. M. (Ophthalmology, 1999)
OBJECTIVE: To assess the outcome of cataract surgery in eyes of patients with uveitis. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: A total of 90 eyes of 76 patients fulfilled the enrollment criteria. INTERVENTION: All patients had their surgery performed using standard cataract extraction techniques. Unless contraindicated, preoperative systemic steroids were administered to all patients with posterior disease, chronic anterior uveitis, with known macular edema, and those in whom outcome of cataract surgery on the fellow eye had been poor. RESULTS: Patients were divided into those with anterior disease (n = 53) and those with posterior disease (n = 37). Overall, 81 (90%) of 90 eyes showed improvement in vision (median +4 Snellen lines). In those with anterior disease, the development of severe uveitis in the first week postsurgery was associated with a greater incidence of macular edema (P = 0.014). The single largest diagnosis in those with posterior disease was that of panuveitis (n = 24). This group showed the poorest visual outcomes in this study. The majority of patients, however, were noted to have visual loss secondary to conditions present before surgery. CONCLUSION: Cataract surgery in eyes with uveitis leads to an improvement of vision in the majority of cases. Severe postoperative uveitis is the most common postoperative complication and is associated with a significant risk of macular edema in those with anterior disease. In the posterior group, poor visual outcome after surgery is most commonly the result of preoperative vision-limiting conditions.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Prospective Studies; Treatment Outcome; Adolescent; *Cataract Extraction; Cataract/*complications; Lens Implantation, Intraocular; Uveitis, Posterior/*complications; Postoperative Complications; Laser Therapy; *Visual Acuity/physiology; Lens Capsule, Crystalline/pathology/surgery; Uveitis, Anterior/*complications

Uveitis-glaucoma-hyphaema (UGH) syndrome treated with local laser iridoplasty. - Walland, Mark J. (Clinical & experimental ophthalmology, 2017)
Keywords: Humans; Male; Middle Aged; Visual Acuity; Syndrome; Uveitis/diagnosis/*surgery; *Argon Plasma Coagulation; *Laser Therapy; Glaucoma/diagnosis/*surgery; Hyphema/diagnosis/*surgery; Iris/*surgery; Pseudophakia/etiology

Ocular complications of laser-assisted eyebrow epilation. - Shulman, S.; Bichler, I. (Eye (London, England), 2009)
PURPOSE: To report a series of patients with ocular complications associated with laser-assisted eyebrow hair removal. PATIENTS AND METHODS: Case reports of three patients with eye pain and photophobia following laser epilation of the eyebrow region. The eye examination included visual acuity, slit-lamp examination, tonometry and fundoscopy. The follow-up period was 3 months. RESULTS: Each patient had conjunctival hyperaemia in one or both eyes and anterior chamber pigmentary cells. One patient presented with posterior synechiae, which did not respond to treatment. CONCLUSIONS: Laser epilation of the eyebrows may result in anterior uveitis as well as irreversible damage to the iris.
Keywords: Female; Humans; Adult; Treatment Outcome; Young Adult; Visual Acuity; Administration, Topical; Ophthalmic Solutions/administration & dosage; Steroids/therapeutic use; *Eyebrows; Eye Diseases/drug therapy/*etiology; Hair Removal/*adverse effects/methods; Laser Therapy/*adverse effects; Mydriatics/administration & dosage; Pupil Disorders/drug therapy/etiology; Uveitis/drug therapy/etiology

Transscleral diode laser cyclophotocoagulation as primary surgical treatment for secondary glaucoma in juvenile idiopathic arthritis: high failure rate after short term follow up. - Heinz, C.; Koch, J. M.; Heiligenhaus, A. (The British journal of ophthalmology, 2006)
AIM: To evaluate the success rates of transscleral diode cyclophotocoagulation (TD-CPC) for secondary glaucoma in patients with juvenile idiopathic arthritis (JIA) as primary surgical treatment. METHODS: Retrospective chart review of 12 paediatric patients with JIA associated uveitis and secondary open angle glaucoma. RESULTS: 21 eyes of the 12 patients had chronic anterior uveitis, 21 eyes had secondary open angle glaucoma, and 19 eyes were treated 41 times with TD-CPC. Patients underwent a mean of 2.15 treatment sessions per eye. Pretreatment intraocular pressure (IOP) was 30.2 (5.5) mm Hg before the first treatment, 30.5 (5.7) mm Hg before the second treatment, and 28.7 (6.3) mm Hg before the third treatment. Reduction of IOP 6 weeks after treatment was highest after the second and third treatments with 9.4 (8.8) and 8.7 (5.8) mm Hg, respectively and 5.2 (10.7) mm Hg after the first treatment. Qualified success (IOP </=21 mm Hg with glaucoma medication) was achieved at the end of follow up in six of 19 eyes (32%, follow up time 10.1 (9.3) months). CONCLUSION: TD-CPC as a primary surgical treatment in JIA patients, is often unsatisfactory in eyes with uveitic glaucoma.
Keywords: Female; Humans; Male; Treatment Failure; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Combined Modality Therapy; Child; Child, Preschool; Visual Acuity; Intraocular Pressure; Laser Coagulation/*methods; Antihypertensive Agents/administration & dosage; Arthritis, Juvenile/*complications; Uveitis, Anterior/complications; Glaucoma, Open-Angle/drug therapy/*etiology/*surgery

Adhesion Molecule Targeted Therapy for Non-Infectious Uveitis. - Chen, Yi-Hsing; Lightman, Sue; Eskandarpour, Malihe; Calder, Virginia L. (International journal of molecular sciences, 2022)
Non-infectious uveitis (NIU) is an inflammatory eye disease initiated via CD4(+) T-cell activation and transmigration, resulting in focal retinal tissue damage and visual acuity disturbance. Cell adhesion molecules (CAMs) are activated during the inflammatory process to facilitate the leukocyte recruitment cascade. Our review focused on CAM-targeted therapies in experimental autoimmune uveitis (EAU) and NIU. We concluded that CAM-based therapies have demonstrated benefits for controlling EAU severity with decreases in immune cell migration, especially via ICAM-1/LFA-1 and VCAM-1/VLA-4 (integrin) pathways. P-selectin and E-selectin are more involved specifically in uveitis related to vasculitis. These therapies have potential clinical applications for the development of a more personalized and specific treatment. Localized therapies are the future direction to avoid serious systemic side effects.
Keywords: Humans; Inflammation; uveitis; non-infectious uveitis; *Cell Adhesion Molecules; *Molecular Targeted Therapy; adhesion molecule; experimental autoimmune uveitis; integrin; intercellular cell adhesion molecule-1 (ICAM-1); lymphocyte function-associated antigen-1 (LFA-1); selectin; Uveitis/metabolism/*therapy; vascular cell adhesion protein 1 (VCAM-1); very late antigen-4 (VLA-4)

[Intravenous corticosteroid megadose treatment in ocular Behçet disease]. - Postelmans, L.; Verougstraete, C.; Libert, J.; Efira, A.; Caspers-Velu, L. (Bulletin de la Societe belge d'ophtalmologie, 1996)
Ocular Behçet's disease is characterized by a very poor visual prognosis. Twelve patients which had a maintenance treatment with immunosuppressors received 30 intravenous i.v. bolus of corticoids for uncontrolled severe retinal vasculitis (macular edema 58% of cases) and papillitis (100% of cases) (1 bolus treatment = 0.5-2 g of i.v. methylprednisolone once a day, for 3 days). In addition, oral immunosuppression was moderately increased in order to prevent further recurrences. Tolerance was good in all cases. Visual acuity (VA) remained stable or improved after one month in 87% of cases following the bolus treatment. In 92%, the VA remained stable or improved for a mean follow-up of 6 years. These good results suggest that intravenous bolus of steroids is a safe and efficient therapy which may prevent further decrease of the visual acuity and may reduce the side effects of the immunosuppressive treatment needed to control severe posterior uveitis in Behçet's disease.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Follow-Up Studies; Treatment Outcome; Anti-Inflammatory Agents/*therapeutic use; Injections, Intravenous; Fluorescein Angiography; Visual Acuity; Methylprednisolone/*therapeutic use; Behcet Syndrome/*complications; Panuveitis/diagnosis/*drug therapy/*etiology

Treatment of pars planitis with cryotherapy. - Okinami, S.; Sunakawa, M.; Arai, I.; Iwaki, M.; Nihira, M.; Ogino, N. (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1991)
Cryotherapy was performed on 28 eyes exhibiting massive exudates (snowbank) over the pars plana and the ora serrata. Twenty-six patients ranging in age from 8 to 52 years were treated and then followed up for a median of 34 months. Eleven eyes needed repeat cryotherapy. After cryotherapy, retinal vasculitis and vitreous opacities decreased in most eyes. Although only 3 of 5 eyes with a snowbank greater than 90 degrees and treated over 1 year from the onset achieved visual acuity of 20/25 or better, all 12 eyes with a snowbank smaller than 60 degrees and treated within 3 months after the onset maintained a visual acuity of 20/25 or better. The prognosis was not different from the 20 eyes that received systemic steroid treatment and the 8 eyes that received no systemic steroids. We recommend cryotherapy as the primary treatment for pars planitis with a snowbank.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Adolescent; Combined Modality Therapy; Child; Ophthalmoscopy; Visual Acuity/drug effects; Reoperation; Adrenal Cortex Hormones/administration & dosage; Postoperative Complications/etiology; *Cryosurgery; Pars Planitis/drug therapy/*surgery

Abatacept: a potential therapy in refractory cases of juvenile idiopathic arthritis-associated uveitis. - Kenawy, Nihal; Cleary, Gavin; Mewar, Devesh; Beare, Nicholas; Chandna, Arvind; Pearce, Ian (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2011)
BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common of all systemic conditions associated with childhood uveitis. Visual impairment has been shown to be as high as 40% of which 10% being blind (6/60 or worse). Due to the lack of well-designed randomized control trials for paediatric uveitis and arthritis there are limited comparative data regarding the efficacy of single or combination treatments. Recently, abatacept was shown to control ocular inflammation in a case of psoriatic arthritis- associated uveitis, seven cases of JIA- associated uveitis and in JIA. We present two cases with JIA-associated uveitis who have responded dramatically to abatacept therapy following unsuccessful therapy with other immunosuppressants. Control of arthritis still represents a challenge with this treatment. METHODS: Prospective review of two patients with refractory JIA- associated uveitis not responding to maximum conventional treatment. Patients were regularly reviewed in the ophthalmology and rheumatology clinics. Assessment of their ocular condition was characterized according to the Standardization of Uveitis Nomenclature (SUN) group. RESULTS: In case 1, ocular inflammation was brought under control after repeated abatacept infusions. Case 2 showed complete resolution of cystoids macular edema CME and improvement of 5 Snellen's lines in best corrected visual acuity. After 9 months, the ocular condition of both patients remains in remission with steroid sparing. Joint disease was brought to clinical remission in case 2, but not in case 1. CONCLUSIONS: Abatacept is a promising alternative treatment in refractory cases of JIA uveitis but may not be as successful in controlling joint disease. Larger series with long term follow up of biological therapies in paediatric uveitis are essential to assess the efficacy and cost effectiveness.
Keywords: Female; Humans; Prospective Studies; Adolescent; Infusions, Intravenous; Immunosuppressive Agents/*therapeutic use; Tomography, Optical Coherence; Visual Acuity/physiology; Macular Edema/drug therapy; Uveitis, Anterior/*drug therapy/physiopathology; Arthritis, Juvenile/*drug therapy/physiopathology; Abatacept; Immunoconjugates/*therapeutic use

Cystoid macular edema associated with latanoprost therapy in a case series of patients with glaucoma and ocular hypertension. - Moroi, S. E.; Gottfredsdottir, M. S.; Schteingart, M. T.; Elner, S. G.; Lee, C. M.; Schertzer, R. M.; Abrams, G. W.; Johnson, M. W. (Ophthalmology, 1999)
OBJECTIVE: To identify coexisting ocular diagnoses in a case series of eyes that developed cystoid macular edema (CME) associated with latanoprost therapy. DESIGN: Retrospective observational case series. PARTICIPANTS: Seven eyes of seven patients who developed CME possibly associated with latanoprost treatment were studied. INTERVENTION: When these patients, all of whom were treated with latanoprost in addition to other glaucoma medications, described blurred vision or eye irritation, ocular examination revealed CME, which was confirmed by fluorescein angiography. Latanoprost was discontinued, and in three cases topical corticosteroids and nonsteroidal anti-inflammatory agents were used to treat the CME. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure were determined before latanoprost use began, during therapy, and after latanoprost use ceased. In these cases, resolution of CME was documented clinically after discontinuing latanoprost. RESULTS: Clinically significant CME developed after 1 to 11 months of latanoprost treatment, with an average decrease of 3 lines in Snellen visual acuity. Intraocular pressure decreased an average of 27.9% during treatment. Cystoid macular edema was confirmed in all cases by fluorescein angiography. In these seven patients, the following coexisting ocular conditions may have placed these eyes at risk for prostaglandin-mediated blood-retinal barrier vascular insufficiency: history of dipivefrin-associated CME, epiretinal membrane, complicated cataract surgery, history of macular edema associated with branch retinal vein occlusion, history of anterior uveitis, and diabetes mellitus. In all cases, the macular edema resolved following discontinuation of latanoprost, in some instances with concomitant use of steroidal and nonsteroidal anti-inflammatory agents. CONCLUSIONS: In this case series of pseudophakic, aphakic, or phakic eyes, the temporal relationships between the use of latanoprost and developing CME, and the resolution of CME following cessation of the drug, suggest an association between latanoprost and CME. In all cases, coexisting ocular conditions associated with an altered blood-retinal barrier were present.
Keywords: Female; Humans; Male; Middle Aged; Aged; Retrospective Studies; Risk Factors; Fluorescein Angiography; Fundus Oculi; Visual Acuity; Intraocular Pressure; Latanoprost; Pseudophakia/complications; Aphakia, Postcataract/complications; Glaucoma, Open-Angle/*complications/drug therapy; Macular Edema/*chemically induced; Ocular Hypertension/*complications/drug therapy; Prostaglandins F, Synthetic/*adverse effects/therapeutic use

[A long-term study of morphological and functional developments after central serous chorioretinitis]. - Fuhrmeister, H. (Klinische Monatsblatter fur Augenheilkunde, 1983)
Of 163 patients suffering from central serous chorioretinopathy, 40 who had been treated by light coagulation and 40 who had been treated conservatively were selected at random. They were examined at intervals averaging 5.7 and 4.6 years respectively after the initial treatment. Central visual acuity, central visual fields and the fundus were examined. The central visual acuity of the light-coagulated patients was normal both after initial treatment as well as at re-examination. In contrast, only one-half of the conservatively treated patients had normal visual acuity following initial treatment. However, after an average of 4.6 years it was normal in 34 cases. Neither quantitatively nor qualitatively was there any significant difference in the functional defects of the central visual fields in the two groups. The incidence of degenerative central retinal changes - above all at the level of the pigment epithelium - was considerably higher in the conservatively treated group than in the light-coagulated one.
Keywords: Humans; Follow-Up Studies; Visual Fields; Visual Acuity; *Light Coagulation; Chorioretinitis/pathology/*surgery/therapy

Successful Treatment with Infliximab for Refractory Uveitis in a Hemodialysis Patient with Behçet's Disease and a Review of the Literature for Infliximab Use in Patients on Hemodialysis. - Kurata, Izumi; Tsuboi, Hiroto; Takahashi, Hidenori; Abe, Saori; Ebe, Hiroshi; Hagiwara, Shinya; Umeda, Naoto; Kondo, Yuya; Ogishima, Hiroshi; Suzuki, Takeshi; Matsumoto, Isao; Hoshi, Sujin; et al. (Internal medicine (Tokyo, Japan), 2015)
A 36-year-old man with a 16-year history of refractory Behçet's disease (BD)-associated uveitis and chronic renal failure requiring hemodialysis suffered from frequent ocular attacks despite treatment with systemic corticosteroids and cyclosporine A. Following infliximab administration, the patient's BD ocular attack score 24 and visual acuity improved. Although he developed mild acute gastroenteritis, he did not experience any other adverse events. In our review of the literature, we identified seven patients on hemodialysis with inflammatory disease successfully treated with infliximab. Infliximab may be effective and safe in cases of BD and other diseases, including in patients under hemodialysis.
Keywords: Humans; Male; Adult; Treatment Outcome; Dose-Response Relationship, Drug; Infliximab/*therapeutic use; Cyclosporine/therapeutic use; Visual Acuity; Glucocorticoids/*administration & dosage; Adrenal Cortex Hormones/*administration & dosage; Uveitis/*drug therapy/immunology; *Renal Dialysis; Behcet Syndrome/*drug therapy/immunology

Vitreous hemorrhage in multiple sclerosis-associated uveitis. - Valentincic, Natasa Vidovic; Kraut, Aleksandra; Rothova, Aniki (Ocular immunology and inflammation, 2007)
PURPOSE: To report on six patients who developed vitreous hemorrhage (VH) in the course of intermediate uveitis (IU) associated with multiple sclerosis (MS). METHODS: Observational case series. RESULTS: Six out of 25 patients (24%) with IU and MS seen at two tertiary centers developed VH. Average age at onset of MS was 26 years and average age at the onset of IU was 25 years. IU developed before the onset of MS in four of the six patients (67%). All patients had IU associated with peripheral phlebitis. The average interval between the onset of IU and the occurrence of VH was five years (range: 0-11 years; VH was the initial sign of uveitis in 2 patients). VH cleared spontaneously in all cases; however, subsequent retinal detachment developed in two eyes. All six patients had ischemic retinal areas and four had subretinal neovascularizations. Optimal visual acuity five years after VH varied from no light perception to full visual acuity. The causes of diminished acuity included optic neuritis, cystoid macular edema (CME), and retinal detachment. CONCLUSION: The possibility of MS-associated uveitis should be considered in patients with IU and VH.
Keywords: Female; Humans; Male; Adult; Follow-Up Studies; Adolescent; Child; Fluorescein Angiography; Glucocorticoids/therapeutic use; Fundus Oculi; Visual Acuity; Uveitis/*complications; Diagnosis, Differential; Multiple Sclerosis/*complications; Laser Coagulation; Vitreous Hemorrhage/diagnosis/*etiology/therapy

Intravitreal Antivascular Endothelial Growth Factor Treatment for Inflammatory Choroidal Neovascularization in Noninfectious Uveitis. - Woronkowicz, Malgorzata; Niederer, Rachael; Lightman, Sue; Tomkins-Netzer, Oren (American journal of ophthalmology, 2022)
PURPOSE: To compare visual outcome and recurrence rates of eyes with noninfectious inflammatory choroidal neovascularization (CNV) treated with or without anti-vascular endothelial growth factor (VEGF) injections and immunosuppression. DESIGN: Retrospective, nonrandomized clinical study. METHODS: Participants: Patients with CNV secondary to noninfectious inflammatory causes who attended uveitis clinics at Moorfields Eye Hospital between January 2000 and April 2016. Data were gathered from the clinical notes of all subjects examined in clinic. MAIN OUTCOME MEASURES: change in best-corrected visual acuity (BCVA), mean time to CNV recurrence, moderate vision loss (≤20/50), and severe vision loss (≤20/200). RESULTS: A total of 166 patients (204 eyes) with noninfectious inflammatory CNV were included in this study with a median follow-up of 6.9 years (interquartile range: 2.9-11.7; 1652 eye-years). The mean BCVA at the time of CNV diagnosis was 0.38 ± 0.05 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent 20/47) in the eyes that received the first-line anti-VEGF treatment and 0.44 ± 0.03 logMAR (Snellen equivalent 20/55) in the eyes on other treatment modalities (P = .39). Eyes treated first with anti-VEGF (n = 55) received the mean of 4.35 ± 0.53 injections and showed a statistically significant improvement in vision at all time points (P < .001) except for a 5-year visit (P = .25). The rest of the eyes demonstrated no significant change in vision throughout follow-up (all P > .05). At the final visit, the mean BCVA was 0.26 ± 0.11 logMAR (Snellen equivalent 20/36) in the former and 0.35 ± 0.06 logMAR (Snellen equivalent 20/44) in the latter. The mean time to CNV recurrence was 186 ± 15.1 months, and the risk was significantly reduced by treatment with oral corticosteroids (adjusted hazard ratio = 0.32, confidence interval: 0.17-0.59, P < .001) or anti-VEGF injections (adjusted hazard ratio = 0.31, confidence interval: 0.18-0.52, P < .001). CONCLUSIONS: Eyes that developed inflammatory CNV were at risk of vision loss. Those receiving early anti-VEGF injections achieved a better visual outcome and had a reduced risk of CNV recurrence. Oral corticosteroids also had an effect that reduces the risk of recurrence in eyes previously treated.
Keywords: Humans; Retrospective Studies; Treatment Outcome; Fluorescein Angiography; Tomography, Optical Coherence; Intravitreal Injections; Bevacizumab/therapeutic use; Vascular Endothelial Growth Factor A; *Uveitis/complications/diagnosis/drug therapy; *Choroidal Neovascularization/diagnosis/drug therapy/etiology; Angiogenesis Inhibitors/therapeutic use; Endothelial Growth Factors/therapeutic use

A randomized, masked, cross-over trial of acetazolamide for cystoid macular edema in patients with uveitis. - Whitcup, S. M.; Csaky, K. G.; Podgor, M. J.; Chew, E. Y.; Perry, C. H.; Nussenblatt, R. B. (Ophthalmology, 1996)
PURPOSE: To study the effect of acetazolamide on cystoid macular edema in patients with uveitis. METHODS: Forty patients with chronic intermediate, posterior, or panuveitis associated cystoid macular edema were randomized into a masked, cross-over trial comparing acetazolamide versus placebo. Patients received an initial 4-week course of either acetazolamide or placebo (course A) followed by a 4-week washout period. They then received a 4-week course of the opposite study medication (course B). Primary endpoints included area of cystoid macular edema measured on late-phase views of fluorescein angiography and visual acuity. RESULTS: Thirty-seven patients completed the trial and were available for analysis; 17 (46%) were randomized to receive acetazolamide and 20 (54%) to receive placebo during course A. Acetazolamide resulted in a 0.5-disc area (25%) decrease in cystoid macular edema over that of placebo (P = 0.01; estimated treatment effect = -0.5 disc areas; 95% confidence interval, -0.9 to -0.1). However, there was no statistically significant effect of acetazolamide on visual acuity (P = 0.61; estimated treatment effect = 0.6 letters; 95% confidence interval, -2 to 3). CONCLUSIONS: A 4-week course of acetazolamide therapy results in a statistically significant but small decrease in cystoid macular edema in patients with chronic uveitis, and does not improve visual acuity. In contrast to previous studies in the literature, acetazolamide may have a more limited clinical benefit in patients with long-standing cystoid macular edema associated with chronic uveitis.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Aged; Adolescent; Cross-Over Studies; Chronic Disease; Fluorescein Angiography; Fundus Oculi; Visual Acuity; Uveitis/*complications; Acetazolamide/adverse effects/*therapeutic use; Carbonic Anhydrase Inhibitors/adverse effects/*therapeutic use; Macular Edema/*drug therapy/etiology/pathology

Uveitis preceding Crohn's disease by 8 years. - Paroli, Maria Pia; Spinucci, Giovanni; Bruscolini, Alice; La Cava, Maurizio; Abicca, Irene (International ophthalmology, 2011)
We report the clinical history of a child affected by Crohn's disease in which uveitis precedes intestinal involvement by years and occurs with the atypical features of anterior chronic inflammation complicated by unilateral optic disc edema, rather than recurrent anterior uveitis with sudden onset which has been more widely reported in inflammatory bowel diseases. The uveitis onset occurred 8 years before symptoms of the primary intestinal disease, while in inflammatory bowel diseases the intestinal inflammation typically precedes ocular symptoms, and ocular inflammation only occasionally precedes inflammatory involvement of the bowel.
Keywords: Humans; Male; Drug Therapy, Combination; Time Factors; Sulfasalazine/therapeutic use; Child; Child, Preschool; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use; Azathioprine/therapeutic use; Visual Acuity/physiology; Vitrectomy; Papilledema/diagnosis; Crohn Disease/*diagnosis/drug therapy; Endoscopy, Gastrointestinal; Microscopy; Uveitis, Anterior/*diagnosis/surgery

Preclinical and clinical study of FK506 in uveitis. - Mochizuki, M.; Ikeda, E.; Shirao, M.; Fujito, S.; Yoshimura, K.; Shimada, N. (Current eye research, 1992)
Efficacy of a new immunosuppressive agent, FK506, in refractory uveitis was studied in 8 patients: 5 with Behcet's disease and 3 with idiopathic retinal vasculitis. The agent was given by oral administration every 12 hours. The previous therapy with systemic corticosteroids or immunosuppressive agents including cyclosporine failed to subside uveitis in these cases. During the observation period of 21.6 +/- 7.8 weeks (mean +/- SD) under FK506 at doses with 0.05, 0.1, 0.15 or 0.2 mg/kg/day, the visual acuity was increased in 44% of treated eyes, unchanged in 44% and decreased in 12%. The inflammatory activity in the ocular fundus was improved in 69% and unchanged in 6% of treated eyes. The effects of FK506 on uveitis by the criteria of improvement of visual acuity and uveitis activity was dose-dependent: 0.05 and 0.1 mg/kg/day were ineffective but 0.15 and 0.2 mg/kg/day were effective in most cases. One patient with Behcet's disease converted from cyclosporine developed moderate renal impairment in 4 weeks under FK506 and the therapy was discontinued in 8 weeks, though the uveitis activity as well as visual acuity was markedly improved. Other 7 cases had no side effect of FK506. Although the number of cases was small and observation period was short, the present clinical data indicate that FK506 is effective to treat refractory uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Administration, Oral; Visual Acuity; Animals; Tacrolimus/administration & dosage/adverse effects/*therapeutic use; Antigens; Arrestin; Autoantigens; Autoimmune Diseases/drug therapy; Behcet Syndrome/drug therapy; Drug Evaluation, Preclinical; Eye Proteins; Injections, Intraperitoneal; Rats; Rats, Inbred Lew; Uveitis/chemically induced/*drug therapy; Vasculitis/drug therapy

Anterior uveitis associated with latanoprost. - Fechtner, R. D.; Khouri, A. S.; Zimmerman, T. J.; Bullock, J.; Feldman, R.; Kulkarni, P.; Michael, A. J.; Realini, T.; Warwar, R. (American journal of ophthalmology, 1998)
PURPOSE: To report the association of anterior uveitis with the use of latanoprost. METHODS: We studied four patients with complicated open-angle glaucoma who had anterior uveitis associated with the use of latanoprost. The uveitis was unilateral and occurred only in the eye receiving latanoprost in three patients. In one patient, latanoprost was used in both eyes, and the uveitis was bilateral. Four of five eyes had a history of prior inflammation and/or prior incisional surgery. All patients were rechallenged with the drug. RESULTS: The uveitis improved after cessation of latanoprost with or without topical corticosteroids. It recurred after rechallenging with latanoprost in all eyes. CONCLUSION: There is a possible association between latanoprost and anterior uveitis. Topical prostaglandin analogs may be relatively contraindicated in patients with a history of uveitis or prior ocular surgery. This association may also be possible in eyes that have not had previous uveitis or incisional surgery.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Glucocorticoids/therapeutic use; Ophthalmic Solutions; Visual Acuity; Intraocular Pressure/drug effects; Administration, Topical; Latanoprost; Prednisolone/analogs & derivatives/therapeutic use; Glaucoma, Open-Angle/drug therapy; Prostaglandins F, Synthetic/administration & dosage/*adverse effects; Uveitis, Anterior/*chemically induced/drug therapy/physiopathology

Pars plana vitrectomy assisted by triamcinolone acetonide for refractory uveitis: a case series study. - Sonoda, K.-H.; Enaida, H.; Ueno, A.; Nakamura, T.; Kawano, Y.-I.; Kubota, T.; Sakamoto, T.; Ishibashi, T. (The British journal of ophthalmology, 2003)
AIM: To examine the outcome of a triamcinolone acetonide (TA) assisted pars plana vitrectomy (PPV) for refractory uveitis. METHODS: Six patients suffering from proliferative vitreoretinopathy (PVR) with refractory uveitis underwent a TA assisted PPV. The patients consisted of one with Vogt-Koyanagi-Harada disease, one with acute retinal necrosis, one with Behçet's disease, and three with sarcoidosis. TA was inoculated into the vitreous cavity to visualise the vitreous. In four of six patients, 4 mg of TA were intentionally left in the vitreous cavity to reduce the degree of postoperative inflammation. RESULTS: The vitreous body was clearly seen using TA during surgery, which greatly helped us to perform a posterior hyaloid resection safely and thoroughly. As we previously observed in other disease, TA allowed us to visualise the transparent vitreous and thus was helpful in removing the vitreous cortex from the retina completely in uveitis. One patient (Behçet's disease, in whom TA was intentionally left) showed an elevated intraocular pressure (IOP) transiently after surgery which was controllable by topical eye drops. The remaining TA diminished day by day and had almost completely disappeared within a month from operation. CONCLUSION: TA improved the visibility of the hyaloid and the safety of the surgical procedures and no serious complications were observed after TA assisted PPV in uveitis. Although the long term effects are still unknown, this method appears to be potentially useful as an improved treatment for PVR associated with refractory uveitis.
Keywords: Female; Humans; Middle Aged; Adult; Follow-Up Studies; Treatment Outcome; Anti-Inflammatory Agents/*therapeutic use; Chemotherapy, Adjuvant; Visual Acuity; Triamcinolone Acetonide/*therapeutic use; Vitrectomy/*methods; Uveitis/complications/drug therapy/*surgery; Vitreoretinopathy, Proliferative/etiology

Treatment of severe refractory uveitis with intravenous cyclophosphamide. - Rosenbaum, J. T. (The Journal of rheumatology, 1994)
OBJECTIVE: We assessed the efficacy of intravenous (iv) cyclophosphamide therapy for patients with uveitis. METHODS: Eleven patients with uveitis were treated with iv cyclophosphamide. Patients were from a tertiary care, referral practice, had failed oral corticosteroid therapy, and had disease that interfered with activities of daily living. RESULTS: Only 5 patients benefitted and the improvement was sustained without additional immunosuppression in only 2 patients, one of whom had only mild eye disease and was receiving cyclophosphamide for a central nervous system vasculitis. Four patients worsened during the therapy. CONCLUSION: Although iv cyclophosphamide may have fewer risks than daily, oral cyclophosphamide, the majority of patients with uveitis do not experience a sustained benefit from this therapeutic approach.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Treatment Outcome; Injections, Intravenous; Visual Acuity/drug effects; Uveitis/*drug therapy/physiopathology; Cyclophosphamide/*therapeutic use

Bevacizumab for choroidal neovascularization related to inflammatory diseases. - Kramer, Michal; Axer-Siegel, Ruth; Jaouni, Tareq; Reich, Ehud; Hemo, Itzhak; Priel, Ethan; Averbukh, Edward; Ehrlich, Rita; Chowers, Itay; Weinberger, Dov; Amer, Radgonde (Retina (Philadelphia, Pa.), 2010)
PURPOSE: The purpose of this study was to report our experience with intravitreal bevacizumab for inflammation-related choroidal neovascularization in two tertiary centers. METHODS: This study was a retrospective analysis of patients with choroidal neovascularization related to inflammatory diseases, treated with intravitreal bevacizumab injections (1.25 mg/0.05 mL). RESULTS: Ten eyes of 10 patients (range, 14-78 years; mean age, 44 years) with underlying uveitis were treated with intravitreal bevacizumab for inflammation-related choroidal neovascularization from 2006 to 2008. Mean follow-up time was 13 +/- 8 months, and the mean number of injections was 2.7 +/- 2. Resolved leakage on fluorescein angiography and resolution of subretinal fluid on optical coherence tomography occurred in all patients, with improvement in visual acuity in 9 of 10 eyes and no change in visual acuity in 1 of 10 eyes. Seven patients received additional treatment based on the underlying condition. Mean macular thickness on optical coherence tomography decreased from 394 +/- 116 microm to 254 +/- 52 microm (P < 0.01). Mean visual acuity improved from 0.87 +/- 0.74 logarithm of the minimum angle of resolution to 0.38 +/- 0.63 (P = 0.005). Seven patients reached a visual acuity of 0.2 logarithm of the minimum angle of resolution (Snellen 6/9) or better. CONCLUSION: Intravitreal bevacizumab is an effective treatment for choroidal neovascularization related to inflammatory diseases when inflammation is controlled.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Injections; Immunosuppressive Agents/administration & dosage; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Vitreous Body; Antibodies, Monoclonal, Humanized; Bevacizumab; Antibodies, Monoclonal/*administration & dosage; Choroidal Neovascularization/diagnosis/*drug therapy/physiopathology; Angiogenesis Inhibitors/*administration & dosage; Vascular Endothelial Growth Factor A/*antagonists & inhibitors

Low-dose cyclosporin A therapy in treating chronic, noninfectious uveitis. - Vitale, A. T.; Rodriguez, A.; Foster, C. S. (Ophthalmology, 1996)
PURPOSE: To describe the authors' approach to the management of patients with recalcitrant, chronic, endogenous uveitis using low-dose Cyclosporin A (CSA) alone or in combination with other immunosuppressive agents with attention to the anti-inflammatory efficacy, visual outcome, and side effects of therapy. METHODS: The authors reviewed the records of 50 patients (92 eyes) with uveitis of various etiologies who had been treated with low-dose CSA (2.5-5.0 mg/kg daily) alone or in combination with prednisone and/or azathioprine (1.5-2.0 mg/kg daily). The median follow-up on low-dose CSA was 16 months (range, 6-64 months). RESULTS: Inflammatory control was achieved in 68 (73.9%) eyes, while persistent inflammatory activity was observed in 14 (15.2%). Thirty-eight (41%) eyes improved two Snellen lines or more, 43 (47.0%) stabilized, and 11 (12.0%) lost two lines or more. The CSA was discontinued because of nephrotoxicity in three patients and in each of two with systemic hypertension and constitutional intolerance to the drug, respectively. Thirteen patients enjoy inflammatory remission with this regimen. CONCLUSION: Low-dose CSA used alone or in combination with other immunosuppressive agents is effective in achieving inflammatory control with a favorable visual outcome and provides a useful steroid-sparing strategy in the management of chronic endogenous uveitis. The CSA-associated toxicity may be reduced by initiating therapy at very low initial doses, with incremental dosage escalation to the desired target range.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Anti-Inflammatory Agents/therapeutic use; Chronic Disease; Prednisone/therapeutic use; Azathioprine/therapeutic use; Ophthalmic Solutions; Visual Acuity; Uveitis/*drug therapy/etiology; Cyclosporine/administration & dosage/adverse effects/*therapeutic use; Immunosuppressive Agents/administration & dosage/adverse effects/*therapeutic use; Kidney/drug effects

Treatment of glaucomatocyclitic crises. - Hung, P. T.; Chang, J. M. (American journal of ophthalmology, 1974)
Keywords: Female; Humans; Male; Middle Aged; Adult; Adolescent; Visual Acuity/drug effects; Acetazolamide/therapeutic use; Vision Disorders/etiology; Iris/surgery; *Intraocular Pressure/drug effects; Epinephrine/therapeutic use; Glaucoma/surgery/*therapy; Periodicity; Uveitis, Anterior/surgery/*therapy

Clinical trial to compare efficacy and side-effects of injection of posterior sub-Tenon triamcinolone versus orbital floor methylprednisolone in the management of posterior uveitis. - Ferrante, Paolo; Ramsey, Andrew; Bunce, Catey; Lightman, Susan (Clinical & experimental ophthalmology, 2004)
AIM: To compare the efficacy and side-effects of posterior sub-Tenon injection of triamcinolone acetonide (Kenalog) with orbital floor injection of methylpredisolone acetate (Depomedrone) in the management of posterior uveitis. METHODS: Non-randomized comparative prospective clinical study. Sixty-four eyes from 60 consecutive patients with non-infectious posterior uveitis requiring treatment were allocated on an alternate 1:1 basis to receive either orbital floor methylprednisolone or sub-Tenon triamcinolone using standard procedures and assessed at 6 and 12 weeks. RESULTS: After five eyes of five patients who had received the same treatment bilaterally were excluded from the statistical analysis, 14 out of 29 eyes treated with orbital floor methylprednisolone and 10 out of the 30 eyes given sub-Tenon triamcinolone improved at 6 weeks. There was no statistically significant difference in the improvement rate between the two groups. However, two patients given triamcinolone had prolonged upper lid ptosis, which required surgery, and another two developed markedly raised intraocular pressure, neither of which occurred in the methylprednisolone-treated group. CONCLUSIONS: Although the two drugs and routes compared were of similar efficacy, lid ptosis occurred in the triamcinolone-treated but not the methylprednisolone group. This should be borne in mind when choosing the preferred route of delivery of periocular corticosteroid in the treatment of posterior uveitis.
Keywords: Humans; Prospective Studies; Treatment Outcome; Safety; Glucocorticoids/administration & dosage/adverse effects/*therapeutic use; Injections; Visual Acuity; Intraocular Pressure/drug effects; Uveitis, Posterior/*drug therapy; Drug Administration Routes; Connective Tissue; Orbit; Triamcinolone Acetonide/administration & dosage/adverse effects/*therapeutic use; Blepharoptosis/chemically induced/surgery; Methylprednisolone/administration & dosage/adverse effects/*therapeutic use

Uveitis in patients with autoimmune hepatitis. - Efe, Cumali; Ozaslan, Ersan; Purnak, Tugrul; Ozbalkan, Zeynep; Altiparmak, Emin (American journal of ophthalmology, 2010)
Keywords: Humans; Drug Therapy, Combination; Chronic Disease; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity; Uveitis/*complications/diagnosis/drug therapy; Macular Edema/etiology; Cataract/etiology; Glaucoma/etiology; Hepatitis, Autoimmune/*complications/diagnosis/drug therapy

Posner-Schlossman syndrome: a case report. - Harrington, J. R. (Journal of the American Optometric Association, 1999)
BACKGROUND: Glaucomatocyclitic Crisis (AKA Posner-Schlossman syndrome) is a syndrome that affects patients between the ages of 20 and 50 years. It is characterized by a mild recurrent anterior uveitis associated with an out-of-proportion intraocular pressure spike in the same eye. The cause is unclear, but many theories exist. Some researchers have tried to connect it with primary open-angle glaucoma. CASE REPORT: A review of the record of a 41-year-old Hispanic woman with Posner-Schlossman syndrome is discussed. She sought treatment on multiple occasions with symptoms of mild pain, photophobia, and a blurry left eye. Examination revealed mild anterior chamber reaction and an intraocular pressure (IOP) spike in the same eye. She was treated with topical anti-inflammatory and pressure-lowering agents. Each individual flare-up was treated successfully, but the patient began to show equivocal signs of primary open-angle glaucoma (PDAG). She is currently treated prophylactically for POAG with a beta-blocker. No etiologic factor was identified in this patient. The differential diagnosis is straight-forward and the treatment is general uveitic therapy--minus cycloplegics--combined with an IOP-lowering drop. CONCLUSION: This is an interesting and relatively rare uveitic condition. The list of differential diagnoses is long, as is the theorized etiologies; however, clinically the condition is relatively quickly identifiable by the presence (and absence) of signs and symptoms.
Keywords: Female; Humans; Adult; Anti-Inflammatory Agents/therapeutic use; Visual Fields; Ophthalmic Solutions; Diagnosis, Differential; Syndrome; Adrenergic beta-Antagonists/therapeutic use; *Intraocular Pressure; Glaucoma, Open-Angle/*diagnosis/physiopathology/prevention & control; Iridocyclitis/*diagnosis/drug therapy

Lensectomy and vitrectomy for complicated cataract secondary to uveitis. - Diamond, J. G.; Kaplan, H. J. (Archives of ophthalmology (Chicago, Ill. : 1960), 1978)
Combined lensectomy-vitrectomy was performed on 13 patients (15 eyes) with complicated cataracts from uveitis. Preoperative visual acuities were 20/200 or less for at least one year. The postoperative follow-up period averaged 10.5 months with visual acuities of 20/25 or better in eight eyes, 20/70 in two eyes, and 20/100 to 20/400 in five eyes. The primary cause of decreased vision postoperatively was cystoid macular edema with frequently associated optic disc edema.
Keywords: Female; Humans; Male; Middle Aged; Adult; Adolescent; Child; Visual Acuity; Intraocular Pressure; Uveitis/*complications; *Cataract Extraction; Postoperative Care; Preoperative Care; Postoperative Complications; Cataract/*etiology/physiopathology; Methods; Vitreous Body/*surgery

Treatment of non-infectious ophthalmic inflammatory diseases with 1.5% dexamethasone γ-cyclodextrin nanoparticle eye drops. - Imamachi, Katsue; Stefánsson, Einar; Ohira, Akihiro; Tanito, Masaki (Acta ophthalmologica, 2019)
Keywords: Female; Humans; Male; Middle Aged; Aged; Tomography, Optical Coherence; Ophthalmic Solutions; Visual Acuity/physiology; Administration, Ophthalmic; Uveitis/diagnostic imaging/*drug therapy/physiopathology; beta-Cyclodextrins/*administration & dosage/chemistry; Dexamethasone/administration & dosage/*analogs & derivatives/chemistry; Eye Infections/drug therapy; Glucocorticoids/*administration & dosage/chemistry; Microscopy, Acoustic; Nanoparticles/administration & dosage/chemistry; Papilledema/diagnostic imaging/*drug therapy/physiopathology; Scleritis/diagnostic imaging/*drug therapy/physiopathology; Vitreous Body/diagnostic imaging/*drug effects/physiopathology

Rifabutin-associated hypopyon uveitis in human immunodeficiency virus-negative immunocompetent individuals. - Bhagat, N.; Read, R. W.; Rao, N. A.; Smith, R. E.; Chong, L. P. (Ophthalmology, 2001)
OBJECTIVE: To report the occurrence of rifabutin-associated hypopyon uveitis in human immunodeficiency virus (HIV)-negative immunocompetent individuals. DESIGN: Retrospective case series. PARTICIPANTS: Three HIV-negative subjects on rifabutin and clarithromycin for Mycobacterium avium complex infections with hypopyon uveitis are described. One subject was iatrogenically immunosuppressed because of a prior lung transplant. Two subjects had no known immunosuppressive conditions. INTERVENTION: Topical and regional steroid therapy. Discontinuation of rifabutin was required in two subjects. MAIN OUTCOME MEASURES: Visual acuity, resolution of hypopyon, anterior uveitis, and vitreitis. RESULTS: All subjects had resolution of hypopyon after therapy, two within 24 hours of beginning topical steroids. Vitreitis resolved with the discontinuation of rifabutin in two subjects. Chronic low-grade anterior uveitis and vitreitis were observed in the remaining subject, whose rifabutin dose was lowered but not discontinued because of active Mycobacterium avium complex osteomyelitis. CONCLUSIONS: Rifabutin-associated uveitis is well described in HIV-positive individuals, but it has been reported only once in an HIV-negative individual. We report two cases of hypopyon uveitis in immunocompetent individuals and one case in an immunosuppressed HIV-negative individual. All three subjects were receiving concurrent rifabutin and clarithromycin. Awareness that this entity can occur in HIV negative and nonimmunosuppressed individuals and that it can mimic infectious endophthalmitis may spare the subject from an invasive workup of systemic infection.
Keywords: Female; Humans; Middle Aged; Adult; Aged; Retrospective Studies; Anti-Inflammatory Agents/therapeutic use; Visual Acuity; Vitreous Body/drug effects; Diagnosis, Differential; Administration, Topical; Glucocorticoids; Uveitis, Anterior/*chemically induced/diagnosis/drug therapy; Prednisolone/*analogs & derivatives/therapeutic use; *HIV Seronegativity; *Immunocompetence; Anti-Bacterial Agents/*adverse effects; Endophthalmitis/diagnosis; Eye Diseases/chemically induced/drug therapy; Mycobacterium avium Complex/isolation & purification; Mycobacterium avium-intracellulare Infection/drug therapy; Osteomyelitis/drug therapy/microbiology; Pneumonia, Bacterial/drug therapy; Rifabutin/*adverse effects; Suppuration/chemically induced/diagnosis/drug therapy

Analysis of a novel protocol of pulsed intravenous cyclophosphamide for recalcitrant or severe ocular inflammatory disease. - Suelves, Ana M.; Arcinue, Cheryl A.; González-Martín, Jesús María; Kruh, Jonathan N.; Foster, C. Stephen (Ophthalmology, 2013)
PURPOSE: To analyze the success rate of pulsed intravenous (IV) cyclophosphamide (CyP) for noninfectious ocular inflammatory disease and to identify risk factors for failure of therapy. DESIGN: Retrospective, interventional, noncomparative cohort study. PARTICIPANTS: One hundred ten eyes of 65 patients. METHODS: Through a computer search of the Massachusetts Eye Research and Surgery Institution's database, we identified patients who were treated with IV CyP between May 2005 and April 2012. We obtained demographic and clinical information through review of the electronic health record of each patient. MAIN OUTCOMES MEASURES: Clinical response, corticosteroid-sparing effect, recurrence rate, calculated "risk factors" for failure, visual acuity, and adverse reactions. RESULTS: Pulsed IV CyP achieved complete remission of inflammation (for ≥ 2 visits) in 54 patients (84.4%). Sustained remission of inflammation occurred in 70% of patients within 3 months, 86.6% of patients within 6 months, and 91.7% within 9 months. The mean time to achieving quiescence was 3.5 months. The success rate in reducing corticosteroid to prednisone ≤ 10 mg/d within 6 months, while maintaining control of ocular inflammation, was 89.7% (95% confidence interval [CI], 81.1-93.5%). The mean duration of clinical remission for those patients who had a positive response to CyP was 32.67 months (95% CI, 25.91-39.43). Relapse of vasculitis was observed in 1 patient (1.5%) after completing the course of therapy. Early initiation of therapy during the course of the disease was correlated with a lesser rate of recurrence (P = 0.028). The most common adverse effects were nausea (29%) and transient lymphopenia (26%). The mean best-corrected visual acuity (BCVA) improved from 0.59 ± 0.66 at baseline to 0.30 ± 0.54 at 6 months of follow-up (P<0.001). The mean follow-up period was 31.61 ± 20.47 months. CONCLUSIONS: Pulsed IV CyP employing our protocol results in an extremely high rate of sustained complete remission in patients with recalcitrant and fulminant, vision-threatening ocular inflammatory disorders, with an excellent safety profile in the hands of physicians trained and skilled in the art of this therapy. It also allows tapering and discontinuing corticosteroids in most patients. Early initiation of therapy may decrease the risk of relapses. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Treatment Failure; Follow-Up Studies; Retrospective Studies; Risk Factors; Young Adult; Adolescent; Clinical Protocols; Infusions, Intravenous; Recurrence; Fluorescein Angiography; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Immunosuppressive Agents/*administration & dosage/adverse effects; Retinal Vasculitis/diagnosis/*drug therapy/physiopathology; Scleritis/diagnosis/*drug therapy/physiopathology; Pulse Therapy, Drug; Cyclophosphamide/*administration & dosage/adverse effects; Pemphigoid, Benign Mucous Membrane/diagnosis/*drug therapy/physiopathology

Late-onset severe diffuse lamellar keratitis associated with uveitis after LASIK in a patient with ankylosing spondylitis. - Díaz-Valle, David; Arriola-Villalobos, Pedro; Sánchez, José M. Benitez-del-Castillo; Santos Bueso, Enrique; de la Casa, José M. Martínez; Sardiña, Ricardo Cuiña (Journal of refractive surgery (Thorofare, N.J. : 1995), 2009)
PURPOSE: To report a case of diffuse lamellar keratitis (DLK) associated with acute anterior uveitis that occurred 3 years after uneventful LASIK in a patient with a history of ankylosing spondylitis and recurrent acute anterior uveitis. METHODS: A 36-year-old man presented with pain and decreased vision in the left eye. Left eye visual acuity was 20/100. He had undergone bilateral LASIK 3 years prior to presentation to treat moderate myopia. RESULTS: Slit-lamp examination revealed aqueous flare and cells, vertical corneal folds, and cell aggregates at the central interface. Flattening and thinning of the cornea were observed with Pentacam (Oculus Optikgeräte GmbH). Diffuse lamellar keratitis stage III was diagnosed and intensive corticosteroid and anticollagenolytic treatment was started with satisfactory results. CONCLUSIONS: Acute anterior uveitis may be a predisposing factor for late-onset DLK after LASIK surgery. Indication of LASIK in patients at high risk of developing recurrent flares of acute anterior uveitis, such as those with spondyloarthropathies, should be carefully considered.
Keywords: Humans; Male; Adult; Risk Factors; Recurrence; Glucocorticoids/therapeutic use; Visual Acuity; Uveitis, Anterior/diagnosis/drug therapy/*etiology; Corneal Topography; Keratitis/diagnosis/drug therapy/*etiology; Keratomileusis, Laser In Situ/*adverse effects; Myopia/complications/surgery; Spondylitis, Ankylosing/*complications

Retinal and choroidal vascular occlusion after posterior sub-tenon triamcinolone injection. - Moshfeghi, Darius M.; Lowder, Careen Y.; Roth, Daniel B.; Kaiser, Peter K. (American journal of ophthalmology, 2002)
PURPOSE: To report a case of retinal and choroidal vascular occlusion occurring as a complication after posterior sub-Tenon triamcinolone injection for treatment of uveitic cystoid macular edema. DESIGN: Interventional case report. METHODS: Retrospective study. A 32-year-old woman with uveitis and cystoid macular edema underwent a right posterior sub-Tenon injection of triamcinolone (40 mg/ml, 1 ml total) through a superotemporal approach after topical anesthesia. After the procedure, the patient experienced severe eye pain, orbital ecchymosis, and globe proptosis consistent with retrobulbar hemorrhage. RESULTS: Dilated fundus examination of the right eye (OD) demonstrated multiple intraretinal hemorrhages with particulate white emboli occluding the retinal and choroidal vessels. Visual acuity was no light perception. Ocular massage and hypotensive therapy was initiated for an intraocular pressure of 50 mm Hg. Canthotomy and cantholysis were performed. A total of 39 months post-incident, her visual acuity improved to 20/100. CONCLUSION: Posterior sub-Tenon triamcinolone injection can rarely result in retinal and choroidal occlusion. Immediate intervention may preserve limited visual acuity.
Keywords: Female; Humans; Adult; Retrospective Studies; Antihypertensive Agents/therapeutic use; Fluorescein Angiography; Injections; Visual Acuity; Intraocular Pressure/drug effects; Glucocorticoids/*adverse effects; Macular Edema/complications/drug therapy; Choroid Diseases/*chemically induced/diagnosis; Choroid/*blood supply/pathology; Fascia; Massage; Ocular Hypertension/*chemically induced/drug therapy; Pain/etiology; Retinal Artery Occlusion/*chemically induced/diagnosis; Retinal Hemorrhage/chemically induced/diagnosis; Triamcinolone/*adverse effects; Uveitis/complications/drug therapy

Treatment of cystoid macular edema secondary to chronic non-infectious intermediate uveitis with an intraocular dexamethasone implant. - Rossetto, Julia Dutra; Nascimento, Heloisa; Fernandes, Delia Diana Paola González; Belfort, Rubens Jr; Muccioli, Cristina (Arquivos brasileiros de oftalmologia, 2015)
PURPOSE: To evaluate the use of a slow-release dexamethasone 0.7-mg intravitreal implant for cystoid macular edema (CME) secondary to intermediate uveitis and refractory to systemic steroids. METHODS: A retrospective study of the best-corrected visual acuity (BCVA), intraocular inflammation, intraocular pressure (IOP), fundus photography, optical coherence tomography (OCT), inflammation, and adverse reactions of five patients (women, mean age of 35 years) with cystoid macular edema treated with a dexamethasone implant. Patients were evaluated in seven visits until the 150th day after the implant. RESULTS: Four patients had bilateral pars planitis and one had bilateral intermediate uveitis associated with juvenile idiopathic arthritis. Six dexamethasone devices were implanted, under topical anesthesia (one each in six eyes, five patients). The mean follow-up time was 5 months. The best-corrected visual acuity improved in all eyes that received an implant, with five having improvements of two or more lines. Optical coherence tomography showed thinning of the macula in all eyes treated, and we saw a correlation between the best-corrected visual acuity and retinal thinning. No serious adverse events occurred and no significant increase in intraocular pressure was observed. CONCLUSIONS: Slow-release dexamethasone intravitreal implants can effectively treat CME secondary to intermediate uveitis and refractory to systemic steroids.
Keywords: Female; Humans; Middle Aged; Adult; Aged; Retrospective Studies; Young Adult; Drug Implants; Visual Acuity/drug effects; Macular Edema/*drug therapy/etiology; Delayed-Action Preparations; Dexamethasone/administration & dosage/*therapeutic use; Anti-Inflammatory Agents/administration & dosage/*therapeutic use; Uveitis, Intermediate/*complications

Repositioning and follow-up of intralenticular dexamethasone implant. - Munteanu, Mihnea; Rosca, Cosmin (Journal of cataract and refractive surgery, 2013)
We report the case of a 54-year-old man who attended our emergency department complaining of severe floaters and decreased vision in his right eye. Seven days earlier, a dexamethasone intravitreal implant (Oxurdex) had been placed for a noninfectious posterior uveitis. Slitlamp examination showed the implant had penetrated the posterior lens capsule and was lodged in the posterior cortex of the lens; a posterior cortical cataract developed subsequently. Removal of the cataract, repositioning of the implant to the posterior segment, and the postoperative course are described. To our knowledge, this is the first report of the repositioning of an intralenticular dexamethasone intravitreal implant.
Keywords: Humans; Male; Middle Aged; Follow-Up Studies; Tomography, Optical Coherence; Visual Acuity; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Ophthalmoscopy; Vitreous Body/drug effects; Reoperation; *Phacoemulsification; Lens Implantation, Intraocular; Cataract/etiology; Drug Implants/*adverse effects; Eye Foreign Bodies/diagnosis/etiology/*surgery; Foreign-Body Migration/diagnosis/etiology/*surgery; Posterior Capsule of the Lens/injuries; Uveitis/drug therapy

[Treatment of refractory glaucomas by transscleral cyclophotocoagulation using semiconductor diode laser. Analysis of 50 patients followed-up over 19 months]. - Hamard, P.; Gayraud, J. M.; Kopel, J.; Valtot, F.; Quesnot, S.; Hamard, H. (Journal francais d'ophtalmologie, 1997)
PURPOSE: To evaluate the effects of transscleral cyclophotocoagulation with the diode laser for refractory glaucoma with respect to intra-ocular pressure, reduction of medical therapy and complications. METHODS: The diode laser system (Iris Medical Instrument, Oculight SLX) was used to treat 50 eyes of 47 patients with therapy resistant glaucoma and a poor prognosis with filtering surgery. All eyes had maximal hypotonic therapy and 40 (82%) patients were using carbonic anhydrase inhibitors. Laser energy was delivered to the eye through a quartz glass fiber optic probe [13 to 20 spots over 270 degrees using 3.5 J (1.75 W x 2.0 sec)]. The mean follow-up was 19.4 +/- 9.1 months (from 12 to 29 months). RESULTS: Intra-ocular pressure significantly decreased from mean baseline 32.4 +/- 9.1 mmHg to 19.7 +/- 8.1 mmHg at the end of the follow-up (p < 0.001). An intra-ocular-pressure below 20 mmHg was obtained in 66% of the eyes. In 13 patients the carbonic anhydrase inhibitors were discontinued. Six of the 8 painful eyes had pain relief. Visual acuity decreased in 17 (34%): cataract progression in 5 eyes, uncontrolled intra-ocular-pressure in 4 eyes, glaucoma progression despite controlled intra-ocular-pressure in 3 eyes, corneal dystrophy in 3 eyes. Chronic uveitis occurred in 5 (10%) eyes. No conjonctival, scleral or direct lens damage was detected. CONCLUSION: Contact transscleral cylophotocoagulation with the diode laser system can be successfully used to reduce intra-ocular-pressure in therapy resistant glaucoma. The incidence of complications is low with no loss of vision related to cyclodestruction.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Adolescent; Chronic Disease; Child; Child, Preschool; Infant; Visual Acuity; Intraocular Pressure; Reoperation; Uveitis/etiology; *Laser Coagulation/adverse effects; Evaluation Studies as Topic; Glaucoma/drug therapy/*surgery

Anterior uveitis as a side effect of topical brimonidine. - Byles, D. B.; Frith, P.; Salmon, J. F. (American journal of ophthalmology, 2000)
PURPOSE: To report anterior uveitis as a late side-effect of topical brimonidine tartrate 0.2% (Alphagan; Allergan Inc., Irvine, California). METHODS: Four patients aged 79 to 91 (mean, 83) years, who developed acute anterior uveitis while using topical brimonidine for chronic glaucoma, were clinically evaluated for causes of uveitis. When the inflammation had completely cleared, topical brimonidine was recommenced in one eye only to determine causality. RESULTS: All four patients developed acute granulomatous anterior uveitis, which resolved rapidly on stopping brimonidine and receiving treatment with topical corticosteroids. The uveitis occurred 11 to 15 (mean, 13.8) months after commencement of brimonidine 0.2% twice daily. None of the patients had a previous history of uveitis, and no other identifiable cause of uveitis was found. In all patients, on rechallenge with brimonidine instilled twice daily to one eye, uveitis recurred within 3 weeks in that eye only. CONCLUSIONS: These findings suggest that brimonidine can cause anterior uveitis as a late side effect. The inflammation settles rapidly on stopping the medication and on using topical corticosteroids and recurs on rechallenge with brimonidine.
Keywords: Female; Humans; Male; Aged; Aged, 80 and over; Recurrence; Visual Acuity; Acute Disease; Intraocular Pressure; Administration, Topical; Ophthalmic Solutions/adverse effects/therapeutic use; Adrenergic alpha-Agonists/*adverse effects/therapeutic use; Anterior Eye Segment/drug effects; Brimonidine Tartrate; Glaucoma/drug therapy; Quinoxalines/*adverse effects/therapeutic use; Uveitis, Anterior/*chemically induced/diagnosis

An exceptional case of full-thickness macular hole closure in a patient with Behçet disease. - Uçar, Didar; Atalay, Eray; Özyazgan, Yilmaz; Özkök, Ahmet; Yıldırım, Yeliz (Ocular immunology and inflammation, 2014)
PURPOSE: To present a case of a full-thickness macular hole closure in a patient with Behcet uveitis. DESIGN: A 23-year-old-male patient with Behcet Disease had clinically inactive uveitis with topical steroids, oral azathiopurine and cyclosporine until he developed a retinal infiltrate in the left eye which evolved into a full-thickness macular hole during the follow-up. METHODS: Strict control of inflammation and subsequent vitrectomy was planned. Meanwhile another attack of panuveitis developed in the left eye and subcutaneous Interferon alfa-2b interferon treatment was initiated. RESULTS: After 2 months, the patient was clinically inactive with complete closure of the macular hole. CONCLUSIONS: Strict control of inflammation may result in closure of the macular hole and avoid the need for vitrectomy.
Keywords: Humans; Male; Drug Therapy, Combination; Young Adult; Administration, Oral; Immunosuppressive Agents/*therapeutic use; Fluorescein Angiography; Tomography, Optical Coherence; Cyclosporine/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Behcet Syndrome/*complications/diagnosis/drug therapy; Administration, Topical; Interferon alpha-2; Recombinant Proteins/therapeutic use; Azathioprine; Interferon-alpha/therapeutic use; Panuveitis/*complications/diagnosis/drug therapy; Remission, Spontaneous; Retinal Perforations/etiology/*physiopathology

Bilateral effect of unilateral ranibizumab in patients with uveitis-related macular edema. - Acharya, Nisha R.; Sittivarakul, Wantanee; Qian, Ying; Hong, Kevin C.; Lee, Salena M. (Retina (Philadelphia, Pa.), 2011)
PURPOSE: To describe an observed therapeutic effect of ranibizumab in untreated contralateral eyes of patients with bilateral uveitis-related cystoid macular edema. METHODS: The authors conducted an open-label, prospective, nonrandomized, interventional study to evaluate the effect of intravitreal ranibizumab injections for the off-label treatment of persistent uveitic cystoid macular edema. Patients were given 3 monthly injections of 0.5 mg intravitreal ranibizumab in the eye with worse vision. Subsequent monthly ranibizumab injections were administered based on macular thickness measurements. Best-spectacle corrected visual acuity measurements and optical coherence tomography scans were performed on both eyes at baseline and at monthly follow-up visits. RESULTS: Three of the seven patients in our nonrandomized consecutive case series presented with controlled uveitis and cystoid macular edema bilaterally. Two of the three patients demonstrated a significant improvement in visual acuity and a reduction in macular edema in both eyes after three monthly injections to the study eye. One patient experienced limited effect bilaterally possibly because of the presence of epiretinal membranes in both eyes. CONCLUSION: The authors observed a beneficial effect of ranibizumab in both eyes of patients who were treated unilaterally for uveitis-related cystoid macular edema. This warrants further investigation of the pharmacokinetics and systemic availability of ranibizumab, particularly in patients with uveitis.
Keywords: Female; Humans; Middle Aged; Aged; Prospective Studies; Treatment Outcome; Young Adult; Tomography, Optical Coherence; Visual Acuity/physiology; Intravitreal Injections; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Off-Label Use; Antibodies, Monoclonal, Humanized/administration & dosage/*therapeutic use; Ranibizumab; Angiogenesis Inhibitors/administration & dosage/*therapeutic use; Functional Laterality

Multistage approach to uveitic cataract management in children. - Fan, Dorothy S. P.; Chan, Carmen K. M.; Cheng, Arthur C. K.; Rao, Srinivas K.; Yu, Christopher B. O.; Lam, Dennis S. C. (Journal of pediatric ophthalmology and strabismus, 2006)
Phototherapeutic keratectomy, cataract extraction and hydrophobic acrylic lens implantation, Nd:YAG laser capsulotomy, glaucoma valve implantation, and intravitreal steroid injections resulted in substantial visual improvement in three eyes of two children with complicated cataract due to severe uveitis. At follow-up of 6 months to 4 years, the children had clear corneas and normal intraocular pressures.
Keywords: Female; Humans; Follow-Up Studies; Recurrence; Child; Child, Preschool; Visual Acuity; Cataract/*complications; Cataract Extraction/*methods; Lens Implantation, Intraocular/*methods; Lasers, Excimer; Photorefractive Keratectomy/*methods; Uveitis, Anterior/*complications/surgery

Combined cyclosporin A-steroid-MTX treatment in endogenous non-infectious uveitis. - Pascalis, L.; Pia, G.; Aresu, G.; Frongia, T.; Barca, L. (Journal of autoimmunity, 1993)
Thirty-two patients with endogenous uveitis resistant to treatment with high doses of cortisone and other immunosuppressive agents were treated with cyclosporin A (at an initial dose of 5 mg/kg/die, subsequently modified according to individual clinical response), fluocortolone and methotrexate. Total and lasting disease remission was obtained in all patients, together with the recovery of normal visual acuity in 20 cases and its significant improvement in the remaining 12. Furthermore, in all patients the total disappearance of all ocular inflammatory activity was observed and maintained for a period of 10.87 +/- 5.31 (6-18) months. No signs of renal or hepatic toxicity were observed in any of the patients. A form of hirsutism appeared in only two cases.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Adolescent; Methotrexate/*therapeutic use; Chronic Disease; Cyclosporine/*therapeutic use; Visual Acuity/drug effects; Autoimmune Diseases/complications; Fluocortolone/*therapeutic use; Uveitis/complications/*drug therapy/etiology

Bilateral rubeosis iridis and rubeotic glaucoma due to peripheral occlusive vasculitis associated with multiple sclerosis. - Turner, S. J.; Dharmasena, A.; Deane, J. (Ocular immunology and inflammation, 2011)
Multiple sclerosis is associated with iridocyclitis, intermediate uveitis, retinal periphlebitis, and optic neuritis. The periphlebitis is known to be rarely sight-threatening as a result of the sequelae of retinal neovascularization. CASE: This is a rare case of bilateral rubeosis iridis and rubeotic glaucoma in the setting of a branch retinal vein occlusion, widespread peripheral periphlebitis, and angiographic peripheral closure associated with "clinically definite" multiple sclerosis. DISCUSSION: The case illustrates the extreme end of the spectrum of peripheral retinal ischemia and neovascularization associated with demyelinating disease, which can present as rubeotic glaucoma. Such patients require a proactive approach to inflammation, neovascularization, and raised intraocular pressure, including systemic immunosuppression, photocoagulation, and augmented trabeculectomy, respectively. As with other causes of peripheral ischemia, a favorable visual outcome can often be achieved using this strategy.
Keywords: Humans; Male; Adult; Treatment Outcome; Prednisolone/therapeutic use; Immunosuppressive Agents/therapeutic use; Visual Acuity/drug effects; Mitomycin/therapeutic use; Acetazolamide/therapeutic use; Multiple Sclerosis/*complications; Light Coagulation; Glaucoma, Neovascular/*etiology/surgery; Iritis/*etiology/surgery; Retinal Neovascularization/*complications/surgery; Retinal Vein Occlusion/*complications/etiology

Endogenous pneumococcal endophthalmitis followed by pneumococcal-induced uveitis. - Nessi, Fabio; Bovey, Etienne H.; Guex-Crosier, Yan (Klinische Monatsblatter fur Augenheilkunde, 2003)
BACKGROUND: We describe the case of a fulminant bilateral endophthalmitis occurring in a patient, who had 9 years earlier a splenectomy for an idiopathic thrombocytopenic purpura. HISTORY AND SIGNS: A 40-year-old woman, back from a trip to Morocco, presented with high fever, rapid decrease in visual acuity and loss of consciousness. Medical examination revealed a pneumococcal meningitis and bilateral endophthalmitis. THERAPY AND OUTCOME: Endophthalmitis was treated with local and intravitreal antibiotics injections (vancomycin and amikacin). Repeated parabulbar betamethasone injections were performed. Intravenous (iv) methylprednisolone pulses were followed by oral steroid therapy while systemic antibiotics were given (ceftriaxone and vancomycin). In spite of this therapy, fundus examination was impossible because the anterior chamber was filled with fibrin. A cataract developed with severe vitritis and we could observe a progressive narrowing of the anterior chamber. The patient underwent a bilateral vitrectomy and lensectomy. The retina had no lesion. No bacteria were found in the vitreous culture. Evolution was characterized by an increased ocular pressure due to anterior synechiae. Visual acuity remained under 1/10. The severe ocular inflammation could be the result of a mixed mechanism including an infectious followed by a severe immune response against bacterial components. CONCLUSIONS: This case report is rare. To our knowledge, only 3 similar cases have been reported in the literature.
Keywords: Female; Humans; Adult; Disease Progression; Combined Modality Therapy; Reoperation; Vitrectomy; Keratoplasty, Penetrating; Anti-Bacterial Agents; Drug Therapy, Combination/therapeutic use; Endophthalmitis/*diagnosis/surgery; Iritis/*diagnosis/surgery; Meningitis, Pneumococcal/*diagnosis/surgery; Opportunistic Infections/*diagnosis/surgery; Pneumococcal Infections/*diagnosis/surgery; Postoperative Complications/diagnosis/surgery; Purpura, Thrombocytopenic/surgery; Splenectomy

Granulomatous uveitis and choroidal detachment in a patient after topical treatment with Bimatoprost: A case report. - Massimo, Lorusso; Micelli Ferrari, Luisa; Nikolopoulou Gisotti, Eleni; Zito, Roberta; MicelliFerrari, Tommaso; Anna, Ferretta; Bordinone, Marco Antonio (European journal of ophthalmology, 2022)
BACKGROUND: Bimatoprost 0.03% is an intraocular pressure (IOP) lowering prostaglandin analog with different adverse side effects such as potential ocular inflammatory effect and ocular hyperemia. CASE PRESENTATION: We report a case of 80-year-old woman diagnosed with bilateral glaucomatous uveitis, and choroidal detachment in the left eye after topical bimatoprost administration. During the patient's hospitalization, Bimatoprost treatment was discontinued and local steroid therapy was administrated. After 1 week we reported a marked improvement of visual acuity, IOP measurement was 12 mmHg in both eyes. Anterior segment examination showed complete resolution of conjunctival and pericheratic hyperemia with significant reduction of endothelial precipitates in both eyes. CONCLUSIONS: In our case, the anterior granulomatous uveitis occurred in both pseudophakic eyes and the choroidal detachment (CD) in the eye that previously had trabeculectomy. Probably the scar tissue of the trabeculectomy allowed a better penetration of the Bimatoprost or a greater sensitivity due to an altered trabecular tissue. This work confirms that the onset physiopathology mechanism of granulomatous uveitis and CD following instillation of Bimatoprost remains uncertain.
Keywords: Female; Humans; Aged, 80 and over; Antihypertensive Agents/therapeutic use; Intraocular Pressure; glaucoma; *Choroidal Effusions; *Glaucoma/chemically induced/drug therapy; *Hyperemia/chemically induced; *Uveitis, Anterior/drug therapy; *Uveitis/chemically induced/diagnosis/drug therapy; Amides/adverse effects; Bimatoprost; Bimatoprost/adverse effects; Cloprostenol/therapeutic use; granulomatous uveitis; prostaglandin; trabecular outflow; uveoscleral outflow

Fuchs' heterochromic uveitis associated with retinal break or dialysis. - Sungur, Gülten; Hazirolan, Dicle; Duman, Sunay; Kasim, Remzi (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2008)
BACKGROUND: Three cases of Fuchs' heterochromic uveitis (FHU) are described, 2 with peripheral retinal breaks and 1 with retinal dialysis. METHODS: Argon laser photocoagulation was applied around the breaks and the dialysis. RESULTS: The retinal breaks and dialysis were successfully photocoagulated. INTERPRETATION: Thorough inspection of the fundus, including the peripheral retina, is important in patients with FHU to exclude a retinal break or a dialysis.
Keywords: Female; Humans; Male; Adult; Adolescent; Visual Acuity; Laser Coagulation; Iridocyclitis/diagnosis/*etiology/surgery; Retinal Perforations/*complications/diagnosis/surgery

Bilateral nongranulomatous anterior uveitis associated with bimatoprost. - Packer, Mark; Fine, I. Howard; Hoffman, Richard S. (Journal of cataract and refractive surgery, 2003)
A 72-year-old man with long-standing bilateral glaucoma became refractory to levobunolol ophthalmic solution therapy after many years. Brimonidine was prescribed, but the patient developed a hypersensitivity several months later that was treated with loteprednol ophthalmic suspension. Bimatoprost was initiated 2 weeks later. Within an hour of the first dose of bimatoprost, the patient reported eye pain and photophobia that remained unresolved the following day. Examination revealed acute bilateral nongranulomatous anterior uveitis that was effectively treated with loteprednol. While observations in human and animal models suggest an association between certain prostaglandin-like agents and intraocular inflammation, this report is one of the first to suggest a link between bimatoprost and intraocular inflammatory reaction.
Keywords: Humans; Male; Aged; Visual Acuity; Intraocular Pressure; Antihypertensive Agents/*adverse effects; Glaucoma/drug therapy; Bimatoprost; Amides; Cloprostenol/analogs & derivatives; Lipids/*adverse effects; Uveitis, Anterior/*chemically induced

Ocular presentation of sarcoidosis in children. - Kataria, S.; Trevathan, G. E.; Holland, J. E.; Kataria, Y. P. (Clinical pediatrics, 1983)
Ocular manifestations of sarcoidosis in children are the second most common occurrence after hilar adenopathy and pulmonary abnormalities. We present the case history of a 14-year-old black boy who presented with redness of the left eye, blurred vision, and decreased visual acuity. He was subsequently diagnosed as having sarcoidosis. All patients with uveitis or ocular findings suggestive of sarcoidosis should have a through medical examination and a chest x-ray. Those suspected of or proven to have sarcoidosis should have a complete ophthalmological examination. Sarcoidosis in children appears to be more frequent than previously estimated.
Keywords: Humans; Male; Drug Therapy, Combination; Follow-Up Studies; Adolescent; Visual Acuity; Granuloma/etiology; Sarcoidosis/*complications; Uveitis/drug therapy/*etiology/pathology

Tuberculosis-related choriocapillaritis (multifocal-serpiginous choroiditis): follow-up and precise monitoring of therapy by indocyanine green angiography. - De Luigi, Giulia; Mantovani, Alessandro; Papadia, Marina; Herbort, Carl P. (International ophthalmology, 2012)
To report the case of a patient initially diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), characterized by relentless evolution despite high-dose steroid therapy. An interferon-gamma release assay (IGRA) indicated a diagnosis of suspected tuberculous choriocapillaritis and the disease responded only to massive inflammation suppressive therapy and antibiotic therapy. Case report. Review of clinical features and investigational procedures. Smoldering relentless evolution and subsequent arrest of progression could be precisely monitored by indocyanine green angiography (ICGA). The patient did not recover after standard anti-tubercolosis (TB) therapy combined with corticosteroid. A fourth antibiotic had to be added in order to stop the progression of the retinal disease. In each case of choriocapillaritis such as APMPPE an infectious cause including TB has to be excluded making IGRA tests unavoidable. As the main structure involved is the choriocapillaris the most precise follow-up or monitoring is obtained with ICGA.
Keywords: Female; Humans; Adult; Drug Therapy, Combination; Follow-Up Studies; Dose-Response Relationship, Drug; Administration, Oral; Fluorescein Angiography/*methods; Fundus Oculi; Visual Acuity; Diagnosis, Differential; Multifocal Choroiditis; Glucocorticoids/administration & dosage/therapeutic use; Coloring Agents; Choroid/*blood supply/pathology; *Indocyanine Green; Antibodies, Bacterial/analysis; Antitubercular Agents/administration & dosage/therapeutic use; Capillaries/*pathology; Choroiditis/diagnosis/drug therapy/*microbiology; Immunosuppressive Agents/administration & dosage/therapeutic use; Mycobacterium tuberculosis/*immunology; Vasculitis/diagnosis/drug therapy/*microbiology

Intravitreal fluocinolone acetonide 0.19 mg (Iluvien®) for the treatment of uveitic macular edema: 2-year follow-up of 20 patients. - Studsgaard, Anne; Clemmensen, Kåre Ørts; Nielsen, Mette Slot (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2022)
PURPOSE: To evaluate intravitreal 0.19 mg fluocinolone acetonide implant (FAi) (Iluvien®) for the treatment of chronic non-infectious uveitis with associated cystoid macular edema (CME). METHODS: A retrospective review of medical reports from a single Danish tertiary centre including 20 patients (20 eyes), treated with 0.19 mg FAi for non-infectious uveitic CME. The primary endpoints were change in best corrected visual acuity (BCVA) and central retinal thickness (CRT). The secondary endpoints were recurrence rate, change in systemic treatment, and intraocular pressure (IOP). RESULTS: Mean follow-up of the 20 eyes was 2.3 ± 1.1 years. BCVA improved at 6 (p = 0.13), 12 (p = 0.05), 18 (p = 0.03), and 24 months and CRT decreased at 6 (p = 0.004), 12 (p = 0.006), 18, and 24 months after 0.19 mg FAi. Within 18 months after implantation, four of 14 patients (28.6%) relapsed. Three of five patients discontinued systemic corticosteroids within 4 months and one patient continued with reduced dose. Five of 10 patients receiving disease-modifying antirheumatic drugs (DMARDs) at time of implantation discontinued within 1 year. No patients started new systemic treatment. Eight eyes were treated with topical IOP-lowering medication at the time of implantation, of these two later underwent trabeculectomy. There were no complications associated with previous glaucoma surgery. CONCLUSION: This long-term follow-up study showed that intravitreal treatment with 0.19 mg FAi should be considered in the treatment of chronic non-infectious uveitic CME in selected patients. This treatment is safe even in selected glaucoma patients and may offer reduction or cessation of local or systemic anti-inflammatory treatment.
Keywords: Humans; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Visual Acuity; Intravitreal Injections; Drug Implants/therapeutic use; Glucocorticoids; Cystoid macular edema; *Macular Edema/diagnosis/drug therapy/etiology; *Uveitis/complications/diagnosis/drug therapy; *Diabetic Retinopathy/complications; *Glaucoma/complications; Fluocinolone acetonide; Fluocinolone Acetonide; Iluvien®; Intravitreal treatment; Non-infectious uveitis

Fluocinolone acetonide sustained drug delivery device to treat severe uveitis. - Jaffe, G. J.; Ben-Nun, J.; Guo, H.; Dunn, J. P.; Ashton, P. (Ophthalmology, 2000)
PURPOSE: Uveitis is often a chronic disease requiring long-term medical therapy. In this report, we describe a pilot safety and efficacy trial of a novel sustained drug delivery system containing fluocinolone acetonide to treat patients with severe uveitis. DESIGN: Prospective, noncomparative, interventional case series PARTICIPANTS: Patients with severe uveitis. METHODS: Sustained drug delivery devices designed to release fluocinolone acetonide for at least 2.5 years were implanted through the pars plana into the vitreous cavity of seven eyes of five patients. All patients had severe uveitis not well controlled with, or intolerant to, repeated periocular corticosteroid injections, systemic corticosteroids, nonsteroidal immunosuppressive agents, or a combination thereof at the time of device implantation. Before device implantation, patients underwent complete evaluation including history, ophthalmologic examination, fluorescein angiography, visual field testing, and electroretinography. After surgery, patients were reexamined at 1 week, 2 weeks, 4 weeks, and at 1- to 3-month intervals. Visual fields, electroretinograms, and fluorescein angiography were repeated at 3- to 6-month intervals. MAIN OUTCOME MEASURES: Preoperative and postoperative visual acuity, ocular inflammation, anti-inflammatory medication use, and intraocular pressure. RESULTS: Patients had a diagnosis of Behçet's syndrome (two eyes), or idiopathic panuveitis (five eyes, including two with necrotizing retinitis, two with progressive chorioretinitis, and one with iridocyclitis and intermediate uveitis). Patients were observed an average of 10 months (range, 5-19 months). All eyes had stabilized or improved visual acuity after device implantation, and four of seven eyes had an improvement of three lines or more. The mean initial visual acuity, measured by Snellen chart, was 20/207, and the mean final visual acuity was 20/57 (P = 0.02). After surgery, at the final visit, no eye had clinically detectable inflammation, and all seven eyes had a marked reduction in systemic, topical, and periocular anti-inflammatory medication use. Four eyes had increased intraocular pressure 6 weeks to 6 months after device implantation. Intraocular pressure has been controlled on topical medications. No patient experienced intraoperative complications. CONCLUSIONS: A fluocinolone acetonide sustained drug delivery device is a promising new therapy for the treatment of severe uveitis. Intraocular pressure must be carefully monitored long after device implantation. Based on these data, a randomized study of a larger group of patients is warranted.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Prospective Studies; Adolescent; Electroretinography; Fluorescein Angiography; Visual Fields; Drug Evaluation; Visual Acuity; Drug Implants; Intraocular Pressure; Uveitis/diagnosis/*drug therapy; Glucocorticoids/*administration & dosage/adverse effects; Delayed-Action Preparations; *Drug Delivery Systems; Fluocinolone Acetonide/*administration & dosage/adverse effects

Short-term outcomes of coaxial microincision cataract surgery for uveitis-associated cataract without postoperative systemic steroid therapy. - Takayama, Kei; Fujii, Sayuri; Ishikawa, Sho; Takeuchi, Masaru (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2014)
PURPOSE: To study the necessity of prophylactic systemic steroid therapy after coaxial microincision cataract surgery (MICS) conducted in aged patients during remission of uveitis. PROCEDURES: A total of 17 consecutive patients who underwent MICS were enrolled in this retrospective study. The median age was 73 years. MICS via a 2.2-mm incision was performed. None of the patients received systemic steroid administration after surgery. The visual acuity, intraocular pressure (IOP) and inflammation scores were recorded. RESULTS: The mean logMAR visual acuity was significantly improved from 0.56 ± 0.58 to 0.10 ± 0.30, and the mean inflammation score was reduced from 0.20 to 0.14. Postoperative complications were recurrence of ocular inflammation in 1 eye and elevation of IOP more than 21 mm Hg in 1 eye, which were resolved by topical steroids and topical antiglaucoma medication. CONCLUSIONS: Prophylactic systemic steroid therapy after MICS may not be necessary in aged uveitis patients without posterior complications before cataract surgery.
Keywords: Female; Humans; Male; Middle Aged; Aged; Aged, 80 and over; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Dose-Response Relationship, Drug; Visual Acuity; Glucocorticoids/*administration & dosage; Cataract Extraction/*methods; Secondary Prevention; Drug Administration Routes; Postoperative Care/*methods; Cataract/diagnosis/*etiology; Minimally Invasive Surgical Procedures/*methods; Uveitis/*complications/diagnosis/prevention & control

Posner-Schlossman syndrome and nonarteritic anterior ischemic optic neuropathy. - Irak, Inci; Katz, Bradley J.; Zabriskie, Norm A.; Zimmerman, Paul L. (Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 2003)
A 41-year-old woman with acute OD pain and decreased visual acuity presented with anterior uveitis, an intraocular pressure of 56 mm Hg, an open angle, ipsilateral nerve fiber bundle visual field defects, and optic nerve edema. With control of intraocular pressure and uveitis, visual acuity improved to 20/25, visual field defects persisted, and optic disc pallor developed. She has remained stable over 23 months of follow-up. This case represents a concurrence of glaucomatocyclitic crisis (Posner-Schlossman syndrome, PSS) and nonarteritic ischemic optic neuropathy (NAION). Although this combination occurs rarely, patients with PSS and other risk factors for NAION, including an optic disc that lacks a physiologic cup, should be protected against NAION by prophylactic treatment with ocular antihypertensive medications.
Keywords: Female; Humans; Adult; Visual Fields; Visual Acuity; Uveitis/*complications; Intraocular Pressure/drug effects; Syndrome; Latanoprost; *Ciliary Body; Glaucoma/*complications; Optic Disk/pathology; Optic Neuropathy, Ischemic/drug therapy/*etiology/pathology/physiopathology; Prostaglandins F, Synthetic/therapeutic use

Open noncontrolled multicenter long-term trial with ciclosporin in endogenous non-infectious uveitis. - Secchi, A. G.; De Rosa, C.; Pivetti-Pezzi, P.; Rossi, A.; De Molfetta, V.; Tognon, S.; Latanza, L.; Catarinelli, G.; Scorrano, R.; Bragliani, G. (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1991)
The efficacy, tolerability and safety of low doses (5-7 mg/kg/day) of oral ciclosporin (CS) for treatment of endogenous uveitis resistant to conventional therapy were studied in an open, noncontrolled, multicenter long-term trial. CS was shown to be effective for patients with posterior or intermediate noninfectious uveitis; it limited the progression of the disease, decreased the number and severity of inflammatory relapses, and improved visual acuity while reducing signs of intraocular inflammation. Moreover, in corticodependent patients, a steroid-sparing effect was also obtained. At low doses and by means of the careful monitoring of safety parameters, the side effects (especially renal function impairment) were well controlled. Efficacy was maintained during long-term treatment.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Dose-Response Relationship, Drug; Creatinine/blood; Long-Term Care; Uveitis/*drug therapy; Visual Acuity/drug effects; Cyclosporine/*administration & dosage/adverse effects

Surgical drainage of chronic serous retinal detachment associated with uveitis. - Galor, Anat; Lowder, Careen Y.; Kaiser, Peter K.; Perez, Victor L.; Sears, Jonathan E. (Retina (Philadelphia, Pa.), 2008)
PURPOSE: To evaluate the anatomic and visual outcomes after surgical management of chronic serous retinal detachments (SRD) associated with uveitis. METHODS: Retrospective, interventional, case study of patients with uveitis with controlled ocular inflammation who underwent drainage of a chronic SRD at the Cole Eye Institute (1998-2006). Data collected included diagnosis, ophthalmic findings, medical management, surgical technique, complications, and anatomic and visual outcomes. RESULTS: Five patients with uveitis were identified who underwent surgical drainage of a SRD. Preoperative medical treatment included prednisone 1 mg/kg with various tapering regimens. The median time on oral corticosteroids preoperatively was 4 months (range 3-6 months). Four patients received further adjuvant treatment. Median time from SRD diagnosis to surgical drainage was 6 months (range 3-15 months). No patient had active intraocular inflammation preoperatively. Retinal reattachment was achieved in all patients after a median follow-up of 55 months (range 1-61 months). Four of five patients experienced improvement in visual acuity after surgical intervention. CONCLUSION: Select patients with uveitis with a SRD whose subretinal fluid fails to resorb after medical therapy and resolution of inflammation can achieve long-term retinal reattachment by surgical management.
Keywords: Female; Humans; Male; Adult; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Adolescent; Chronic Disease; Visual Acuity/physiology; Uveitis/complications/*surgery; *Serum; Drainage/*methods; Exudates and Transudates; Retinal Detachment/complications/*surgery

Uveitic angle closure glaucoma in a patient with inactive cytomegalovirus retinitis and immune recovery uveitis. - Goldberg, Daniel E.; Freeman, William R. (Ophthalmic surgery and lasers, 2002)
We report a case of uveitic acute angle closure glaucoma in a patient with acquired immunodeficiency syndrome (AIDS) associated with inactive cytomegalovirus retinitis and immune recovery vitritis. We conducted a long-term, follow-up examination of a 47-year-old male with AIDS and inactive cytomegalovirus retinitis caused by immune recovery on highly active antiretroviral therapy (HAART). We found vitritis and ultimate development of uveitic glaucoma in the postoperative periods following repair of retinal detachment and extracapsular cataract extraction with intraocular lens implant. An episode of acute angle closure secondary to posterior synechiae and iris bombé subsequently developed, requiring peripheral laser iridotomy. Immune recovery in the setting of inactive cytomegalovirus retinitis can result in intraocular inflammation severe enough to cause angle closure glaucoma and profound ocular morbidity.
Keywords: Humans; Male; Middle Aged; Treatment Outcome; *HIV-1; Visual Acuity; Acute Disease; Intraocular Pressure; Vitreous Body/*pathology; AIDS-Related Opportunistic Infections/complications; Antiretroviral Therapy, Highly Active; Cytomegalovirus Retinitis/*complications; Eye Diseases/*complications; Glaucoma, Angle-Closure/*etiology; Iridectomy/methods; Laser Therapy/methods; Uveitis, Anterior/*etiology

Diode laser-induced uveitis and visual field defect. - Sheikh, Amber; Hodge, William; Coupland, Stuart (Ophthalmic plastic and reconstructive surgery, 2007)
A 38-year-old woman underwent periocular photoepilation of upper eyelids with protective lenses. As a result of the procedure, the patient developed uveitis and a visual field defect. It is recommended that patients who wish to undergo this procedure be informed of its potential side effects.
Keywords: Female; Humans; Adult; Electroretinography; Laser Therapy/*adverse effects; *Visual Fields; Eyelids/surgery; Hair Removal/*methods; Scotoma/*etiology; Uveitis/*etiology

[Intraocular pressure elevation after subtenon injection of triamcinolone acetonide during uveitis]. - Bui Quoc, E.; Bodaghi, B.; Adam, R.; Burtin, T.; Cassoux, N.; Dreifuss, S.; Fardeau, C.; LeHoang, P. (Journal francais d'ophtalmologie, 2002)
INTRODUCTION: New therapeutic concepts in the management of ocular inflammation have led to the development of periocular and intravitreal injections. Such treatment modalities can induce intraocular pressure elevation. PATIENTS AND METHODS: Periocular injections have been given to patients suffering from strictly unilateral or bilateral but asymmetrical and noninfectious posterior uveitis. A history of corticosteroid-induced glaucoma was a contraindication to such treatment. A retrospective review of cases who were given subtenon triamcinolone acetonide injection between May and October 2001 was undertaken to evaluate the efficacy of the treatment and the risk of intraocular pressure elevation. Ocular pressure was measured before and after the injection and the efficacy of the treatment was evaluated by measurements of visual acuity and fluorescein angiography. RESULTS: One or several injections were given to 61 patients. Intraocular pressure rose in 13 patients (21.3%). Medical treatment was unsuccessful in three cases and surgical excision of periocular corticosteroid deposit was required. Therefore, intraocular pressure was controlled with no other medication. Treatment was considered effective in 32 patients (52.45%): improvement of visual acuity (more than two lines) or control of inflammation on fluorescein angiography. DISCUSSION: and conclusions: Periocular subtenon injection of triamcinolone acetonide in posterior noninfectious uveitis is a safe procedure. Intraocular pressure elevation is not frequent and can be controlled through medical treatment or surgical excision of a residual deposit, in which pharmacologically active triamcinolone can be present several months after the injection.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Adolescent; Child; Injections; Uveitis/*drug therapy; Anti-Inflammatory Agents/administration & dosage/*adverse effects; Ocular Hypertension/*chemically induced; Triamcinolone Acetonide/administration & dosage/*adverse effects

Uveitis as a complication of sinusitis. - Glover, G. W.; Maclean, H. (The Journal of laryngology and otology, 1972)
Keywords: Humans; Male; Middle Aged; Radiography; Visual Acuity; Uveitis/drug therapy/*etiology; Ampicillin/therapeutic use; Maxillary Sinus; Sinusitis/*complications/diagnostic imaging/surgery; Therapeutic Irrigation

The effect of a single intravitreal implantation of dexamethasone on the fellow eye in bilateral non-infectious uveitis - case report. - Ciszewska, J.; Brydak-Godowska, J.; Kuźnik-Borkowska, A.; Kęcik, D. (European review for medical and pharmacological sciences, 2016)
OBJECTIVE: To present the influence of dexamethasone intravitreal implant due to macular edema in non-infectious uveitis in the fellow eye. PATIENTS AND METHODS: A 25-year-old patient with a long history of juvenile arthritis with concomitant recurrent bilateral uveitis, complicated with increases of intraocular pressure and macular edema was treated with a single intravitreal dexamethasone implant into the eye with lower visual acuity. RESULTS: During a 36-month follow-up, the patient's bilateral visual acuity improved. The retinal thickness in both maculae decreased. CONCLUSIONS: Treating macular edema in the course of recurrent uveitis accompanying a systemic disease with dexamethasone depot in vitreous may play a beneficial role also in the fellow eye, when affected. This therapeutic effect in the fellow eye may suggest that the medication can penetrate into the circulatory system and reach such other organs as the fellow eye.
Keywords: Humans; Male; Adult; Treatment Outcome; Glucocorticoids/therapeutic use; Drug Implants; Dexamethasone/*administration & dosage; Intraocular Pressure/physiology; Anti-Inflammatory Agents/*administration & dosage; Visual Acuity/drug effects/physiology; Intravitreal Injections/*methods; Macular Edema/complications/diagnosis/drug therapy; Uveitis/*diagnosis/*drug therapy/etiology

Response of human immunodeficiency virus-associated uveitis to zidovudine. - Farrell, P. L.; Heinemann, M. H.; Roberts, C. W.; Polsky, B.; Gold, J. W.; Mamelok, A. (American journal of ophthalmology, 1988)
A patient with human immunodeficiency virus (HIV) type 1 infection developed chronic iridocyclitis and anterior vitritis that were poorly responsive to topical and systemic corticosteroid therapy. Anterior chamber paracentesis was performed and HIV was isolated from culture of aqueous humor. Subsequent treatment with oral zidovudine resulted in resolution of the iridocyclitis and vitritis and full functional recovery of the eye. This case suggests that HIV may be a cause of uveitis responsive to systemic zidovudine therapy.
Keywords: Humans; Male; Adult; Administration, Oral; Visual Acuity; Acquired Immunodeficiency Syndrome/*complications; Thymidine/*analogs & derivatives/therapeutic use; Uveitis/*complications/drug therapy/pathology; Zidovudine

Atypical central lesions in serpiginous choroiditis treated with oral prednisone. - Hoyng, C.; Tilanus, M.; Deutman, A. (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 1998)
PURPOSE: To demonstrate the effect of oral prednisone in the treatment of atypical isolated central lesions in two patients with serpiginous choroiditis. METHODS: Two patients with a history of serpiginous choroiditis in the fellow eye developed an isolated central lesion. One patient showed combined detachment of the retinal pigment epithelium and serous detachment of the retina, while the other showed thickening of the retinal pigment epithelium and shallow detachment of the retina. Both patients were treated with 80 mg/day of oral prednisone. RESULTS: In both patients regression of the lesion and improvement of visual acuity was achieved within several days without the development of a chorioretinal scar. In one patient the lesion recurred after discontinuation of the prednisone. With continuation of a low dose of prednisone for several months definite regression of the lesion and improvement of visual acuity to near-normal values was achieved in both patients. CONCLUSION: In two patients with visual loss due to an atypical central lesion in serpiginous choroiditis, regression of the lesion without the development of a typical chorioretinal scar and subsequent improvement of visual acuity was achieved with the administration of oral prednisone.
Keywords: Humans; Male; Adult; Glucocorticoids/*therapeutic use; Administration, Oral; Prednisone/*therapeutic use; Fluorescein Angiography; Fundus Oculi; Visual Acuity/drug effects; Choroiditis/complications/*drug therapy/pathology; Retinal Detachment/etiology

Neutralizing tumor necrosis factor activity leads to remission in patients with refractory noninfectious posterior uveitis. - Murphy, Conor C.; Greiner, Kathrin; Plskova, Jarka; Duncan, Linda; Frost, Andrew; Isaacs, John D.; Rebello, Peppy; Waldmann, Herman; Hale, Geoff; Forrester, John V.; Dick, Andrew D. (Archives of ophthalmology (Chicago, Ill. : 1960), 2004)
OBJECTIVE: To evaluate the efficacy and safety of tumor necrosis factor (TNF) inhibition with the p55 TNF receptor fusion protein (TNFr-Ig) for severe sight-threatening noninfectious posterior segment intraocular inflammation. METHODS: Seventeen patients with refractory noninfectious posterior segment intraocular inflammation received TNFr-Ig by intravenous infusion in this nonrandomized, open-label, pilot study. The primary outcome measure was logMAR visual acuity. Secondary outcome measures were binocular indirect ophthalmoscopy score, cystoid macular edema, adverse effects, and vision-related (visual core module 1) and health-related (36-Item Short-Form Health Survey) quality of life. RESULTS: Within 1 month of TNFr-Ig therapy, 9 patients (53%) achieved at least a 2-line improvement in visual acuity, 8 (57%) of 14 patients with vitreous haze before treatment achieved an improvement in binocular indirect ophthalmoscopy score to 0, and macular edema resolved in 5 (56%) of 9 affected patients. Twelve (71%) of the patients achieved complete cessation of intraocular inflammation following TNFr-Ig therapy. A reduction in concomitant immunosuppression was possible for 11 patients (65%) following TNFr-Ig therapy. However, all but 1 patient required continuing adjuvant therapy during the response to TNFr-Ig, which had a median duration of 3 months. Adverse effects included mild infusion reactions in 3 patients and transient lymphocytopenia in 2 patients. CONCLUSION: Therapy with TNFr-Ig was safe and effective for treating patients with sight-threatening noninfectious posterior segment intraocular inflammation resistant to conventional immunotherapy, but adjuvant immunosuppression and repeat infusions would be required to maintain long-term remission.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Treatment Outcome; Safety; Quality of Life; Receptors, Tumor Necrosis Factor/*therapeutic use; Infusions, Intravenous; Tumor Necrosis Factor-alpha/*antagonists & inhibitors; Visual Acuity/physiology; Ophthalmoscopy; Uveitis, Posterior/*drug therapy; Immunoglobulin gamma-Chains; Immunoglobulin Heavy Chains/adverse effects/*therapeutic use; Recombinant Fusion Proteins/adverse effects/*therapeutic use

Rituximab as a treatment option for refractory endogenous anterior uveitis. - Tappeiner, C.; Heinz, C.; Specker, C.; Heiligenhaus, A. (Ophthalmic research, 2007)
BACKGROUND: To report on anti-CD20 antibody therapy in a patient with uveitis refractive to immunosuppression therapy. METHODS: Case report with ophthalmoscopic, optical coherence tomography and fluorescein-angiographic findings. RESULTS: A 49-year-old woman was suffering from bilateral, noninfectious chronic anterior uveitis refractive to corticosteroids and immunosuppressive drugs. Bilateral visual acuity was 20/100 due to cataract and cystoid macular edema (CME). After treatment with rituximab, vision and CME improved, and uveitis was stable until the final visit (follow-up at 12 months). CONCLUSION: The case report suggests that rituximab may be helpful for selected patients with chronic anterior uveitis refractive to corticosteroids and immunosuppressive medication.
Keywords: Female; Humans; Middle Aged; Follow-Up Studies; Infusions, Intravenous; Chronic Disease; Fluorescein Angiography; Tomography, Optical Coherence; Fundus Oculi; Ophthalmoscopy; Antibodies, Monoclonal/administration & dosage/*therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antigens, CD20; Immunologic Factors/administration & dosage/*therapeutic use; Rituximab; Uveitis, Anterior/*drug therapy/pathology

Influence of some factors on the sutures of the lens. - Polunin, G. S.; Fyodorov, S.; Ivanov, A. A. (Lens and eye toxicity research, 1990)
A clinical study of the lens transparency conditions was made on 118 patients with regard for an applicable treatment, the use of hyperbaric oxygenation and a type of lesion. It showed, that sutures of the lens were wider in patients with uveitis and in diabetic patients as compared with the control-group patients who had no other pathologies. Glaucomatous patients had very narrow sutures. Initial opacifications of the lens were perceived in patients with uveitis and in diabetic patients as stars oriented along sutures beneath the posterior capsule in the area of the nucleus. Following hyperbaric oxygenation and equally the corticosteroid therapy, there was a decrease in the thickness of the sutures, and the degree of transparency of the lenticular nucleus changed as well mainly in the zone bordering on the posterior cortex strata. The study underlines the importance of examination of the condition of the lens sutures in determining the toxic impact produced by different factors on the lens.
Keywords: Humans; Middle Aged; Adult; Adolescent; Chronic Disease; Visual Acuity; Adrenal Cortex Hormones/therapeutic use; Cataract/*pathology; Densitometry; Diabetic Retinopathy/pathology/therapy; Glaucoma/*pathology/therapy; Hyperbaric Oxygenation; Lens, Crystalline/*pathology; Photography; Retinal Degeneration/pathology/therapy; Timolol/therapeutic use; Uveitis/pathology/therapy

Low-dose intraocular triamcinolone injection for intractable macular oedema and inflammation in patients with uveitis. - Das-Bhaumik, R. G.; Jones, N. P. (Eye (London, England), 2006)
AIMS: To evaluate the efficacy and safety of low-dose (2 mg in 0.05 ml) intraocular triamcinolone injection for patients with uveitis-related cystoid macular oedema and/or intractable intraocular inflammation. PATIENTS AND METHODS: Retrospective clinical case series. RESULTS: Cystoid macular oedema was eliminated in 24/30 eyes (80%). Intractable intraocular inflammation was eliminated in 4/8 eyes (50%). Snellen visual acuity was improved by two lines or more after 14/36 injections (38.9%). Intraocular pressure rose to above 21 mmHg after 8/36 injections (22%). There were no major complications. CONCLUSIONS: Low-dose (2 mg in 0.05 ml) intraocular triamcinolone acetonide injection is safe and effective for the management of refractory uveitic macular oedema. Its usefulness in controlling inflammation alone is questionable.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Adolescent; Chronic Disease; Injections; Visual Acuity/physiology; Triamcinolone Acetonide/*administration & dosage; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Anti-Inflammatory Agents/*administration & dosage

Potential of Pegylated Interferon Alpha-2a in Behçet Uveitis: A Report of Five Cases. - Bielefeld, Philip; Devilliers, Hervé; Deschasse, Clémence; Saadoun, David; Sève, Pascal; Muselier, Aurore; Creuzot-Garcher, Catherine; Besancenot, Jean-François; Bron, Alain Marie (Ocular immunology and inflammation, 2016)
Keywords: Female; Humans; Male; Middle Aged; Adult; Antiviral Agents/*therapeutic use; Visual Acuity/physiology; Injections, Subcutaneous; Interferon-alpha/*therapeutic use; Recombinant Proteins/therapeutic use; Behcet Syndrome/diagnosis/*drug therapy/physiopathology; Polyethylene Glycols/*therapeutic use

Outcome of fluocinolone acetonide implant (Retisert) reimplantation for chronic noninfectious posterior uveitis. - Taban, Mehran; Lowder, Careen Y.; Kaiser, Peter K. (Retina (Philadelphia, Pa.), 2008)
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Kaplan-Meier Estimate; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Recurrence; Chronic Disease; Visual Acuity/drug effects; Uveitis, Posterior/*drug therapy/physiopathology; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Retreatment; Fluocinolone Acetonide/*administration & dosage/adverse effects; Retinal Detachment/etiology/surgery; Cataract Extraction; Drug Implants/adverse effects; Glaucoma/chemically induced/surgery; Retinal Perforations/chemically induced/complications; Vitreous Hemorrhage/chemically induced

[Combination surgery for wet age-related macular degeneration and chronic peripheral uveitis]. - Zapuskalov, I. V.; Krivosheina, O. I.; Khoroshikh, Yu I. (Vestnik oftalmologii, 2016)
AIM: To develop a combination surgery for wet age-related macular degeneration and concurrent chronic peripheral uveitis that would include intravitreal injection of Lucentis and cryocerclage of the peripheral retina. MATERIAL AND METHODS: A total of 75 patients were examined and divided into 2 groups: the main group (37 patients) and the controls (38 patients). Patients from the main group underwent the new combination surgery, while the controls received intravitreal Lucentis alone (peripheral uveitis was managed therapeutically). RESULTS: It has been found that the new combination method provides a significant and stable improvement in visual acuity (by a factor of 10) and a decrease in the area of central scotoma (by a factor of 2.95) in the postoperative period. The period needed for recovery in the central retinal thickness is also 1.6 times shorter. CONCLUSION: The new combination surgery for wet age-related macular degeneration and concurrent chronic peripheral uveitis provides rapid reduction of inflammation in the extreme periphery of the fundus and a 1.5 times faster (as compared to traditional methods) primary restoration of topographic anatomy of the retina in the macular region.
Keywords: Female; Humans; Male; Middle Aged; Aged; Treatment Outcome; Combined Modality Therapy; Chronic Disease; Visual Acuity; Intravitreal Injections; Diagnostic Techniques, Ophthalmological; Ophthalmologic Surgical Procedures/*methods; Angiogenesis Inhibitors/administration & dosage; *Uveitis/complications/diagnosis/therapy; *Wet Macular Degeneration/complications/diagnosis/drug therapy/physiopathology/surgery; Ranibizumab/*administration & dosage; Scotoma/diagnosis/etiology/therapy

Antituberculosis therapy in the treatment of peripheral uveitis. - Psilas, K.; Aspiotis, M.; Petroutsos, G.; Kalogeropoulos, C.; Constantopoulos, S. (Annals of ophthalmology, 1991)
Tuberculous uveitis usually appears as chronic anterior uveitis or disseminated choroiditis. From 1982 to 1989, we conducted a retrospective study of 23 patients with presumed tuberculous uveitis. All patients had a positive tuberculin purified protein derivative skin test. The diagnosis was based on history, positive skin test, and physical examination. We excluded other conditions that could induce uveitis, based on the absence of signs, symptoms, or laboratory results suggesting any other diagnosis. Tuberculous uveitis was also considered in the differential diagnosis when progressive ocular inflammation was resistant to corticosteroid therapy. The patients received the following treatment: (1) isoniazid (300mg/day) and rifampin (600mg/day) for nine to 12 months, (2) ethambutol (1200mg/day) in some cases for two to three months, and (3) corticosteroids orally where indicated. In cases with anterior uveitis, we added local instillation of mydriatics and corticosteroids. There was no regression, nor were there any side effects of antituberculosis therapy in all 23 patients. We noted clinical improvement in 78% of cases. Five patients had other conditions (cataract or retinal detachment) that worsened their vision.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Follow-Up Studies; Retrospective Studies; Administration, Oral; Visual Acuity; Uveitis/diagnosis/*drug therapy; Antitubercular Agents/*therapeutic use; Adrenal Cortex Hormones/therapeutic use; Tuberculosis, Ocular/*drug therapy

Bilateral response following unilateral intravitreal bevacizumab injection in a child with uveitic cystoid macular edema. - Al-Dhibi, Hassan; Khan, Arif O. (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2009)
Untreated cystoid macular edema (CME) is a major cause for visual loss in intermediate and posterior forms of uveitis. Conventional treatments for inflammatory CME include steroids, nonsteroidal antiinflammatory agents, and carbonic anhydrase inhibitors; however, not all patients respond, even after quieting of the uveitis. Intravitreal injection of bevacizumab, a monoclonal antibody to vascular endothelial growth factor, has recently been suggested as a short-term treatment for inflammatory CME in adults. Because unilaterally injected bevacizumab can reach the contralateral eye via the systemic circulation there may be a contralateral clinical effect; however, the few reports that evaluate this in adults are conflicting. The purpose of this report is to document bilateral reduction of uveitic CME following unilateral intravitreal bevacizumab injection in an 8-year-old girl.
Keywords: Female; Humans; Child; Tomography, Optical Coherence; Injections; Visual Acuity; Uveitis, Intermediate/diagnosis/*drug therapy; Intraocular Pressure; Vitreous Body; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Macular Edema/diagnosis/*drug therapy; Antibodies, Monoclonal, Humanized; Bevacizumab; Antibodies, Monoclonal/*administration & dosage; Angiogenesis Inhibitors/*administration & dosage; Functional Laterality

Intravenous daclizumab for recalcitrant ocular inflammatory disease. - Bhat, Pooja; Castañeda-Cervantes, Rene A.; Doctor, Priyanka P.; Foster, C. Stephen (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2009)
BACKGROUND: To evaluate outcomes of patients with recalcitrant ocular inflammation treated with intravenous daclizumab. METHODS: Retrospective case-series. Seventeen patients (33 eyes) with ocular inflammation who had failed several previous systemic immunomodulatory therapies were included in this study. Daclizumab was infused intravenously at a dose of 1 mg per kilogram every 2 weeks. The dose and intervals were adjusted according to control of inflammation off systemic and/or topical corticosteroid therapy. Control of ocular inflammation without corticosteroid therapy was the primary efficacy end point. RESULTS: The mean patient age at the commencement of daclizumab therapy was 34.8(range 8-64 years). Three patients were less than 16 years of age at the initiation of therapy. The duration of drug use was 23.6 +/- 15.7 months (range 8-68 months), and the time to control inflammation was 9.8 +/- 11.3 weeks, which was achieved in 15 patients (88.2%). Flare-up rate was 44 per 100 person-years follow-up. Fifteen of 33 eyes (45%) had an improvement in the visual acuity, 13 eyes (39.3%) had stable acuities, and five eyes (15%) had a worsening of their acuities. Two patients (14%) exhibited worsening of ocular inflammation, and were declared as treatment failures. Side effects associated with daclizumab included nausea, fatigue and muscle aches. CONCLUSION: Daclizumab is effective in controlling inflammation in patients with stubborn non-infectious ocular inflammation. It has a corticosteroid-sparing effect, can be used as long-term therapy in children and adults, and is capable of inducing durable remission.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Infusions, Intravenous; Child; Glucocorticoids/administration & dosage; Visual Acuity/physiology; Uveitis/*drug therapy/physiopathology; Antibodies, Monoclonal, Humanized; Daclizumab; Antibodies, Monoclonal/administration & dosage/adverse effects/*therapeutic use; Immunosuppressive Agents/administration & dosage/adverse effects/*therapeutic use; Immunoglobulin G/administration & dosage/adverse effects/*therapeutic use

Ocular decompression retinopathy after anterior chamber paracentesis for uveitic glaucoma. - Rao, Sunil K.; Greenberg, Paul B.; Macintyre, Ross B. L.; Ducharme, Joseph F. (Retina (Philadelphia, Pa.), 2009)
Keywords: Humans; Male; Young Adult; Fluorescein Angiography; Visual Acuity; Intraocular Pressure; Uveitis/*complications; Glaucoma/etiology/physiopathology/*surgery; *Decompression, Surgical; Anterior Chamber/physiopathology/*surgery; Corneal Edema/etiology/physiopathology/*surgery; Paracentesis/*adverse effects; Retinal Hemorrhage/diagnosis/*etiology

[Therapy of the ocular form of Behçet disease with cyclosporin A]. - Pahlitzsch, T.; Wyrobisch, W.; Kämpe, C.; Wiederholt, M. (Klinische Monatsblatter fur Augenheilkunde, 1990)
Three patients with Behçet's disease and therapy-resistant posterior uveitis have been treated with cyclosporin A (CS-A) for four years. The uveitis has been controlled better, as indicated by the reduced frequency of inflammation, and there was an initial improvement in visual acuity. However, it has not been possible to prevent a slight, gradual loss of visual acuity over the years. Relapses were observed after dose reductions to blood levels below 400-500 ng/ml and following discontinuation of CS-A therapy. Few relapses occurred at higher CS-A concentrations. It was found that both types of relapse could be controlled by increasing the CS-A dose. An at least transitory increase in creatinine levels as a side effect of CS-A was observed in all patients. The authors' results and reports in the literature suggest that CS-A is an effective immunosuppressive therapy in Behçet's disease and is superior to other immunosuppressives used so far.
Keywords: Female; Humans; Male; Adult; Drug Therapy, Combination; Follow-Up Studies; Dose-Response Relationship, Drug; Recurrence; Prednisolone/administration & dosage; Visual Acuity/drug effects; Uveitis, Posterior/*drug therapy; Behcet Syndrome/*drug therapy; Cyclosporins/*administration & dosage

Management of bilateral uveitis secondary to intraocular filariasis. - Pradhan, Zia Sultan; Jacob, Pushpa; Dikshit, Smita (Archives of ophthalmology (Chicago, Ill. : 1960), 2011)
Keywords: Humans; Male; Middle Aged; Drug Therapy, Combination; Combined Modality Therapy; Doxycycline/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Intraocular Pressure; *Phacoemulsification; Lens Implantation, Intraocular; Animals; *Trabeculectomy; Antiprotozoal Agents/*therapeutic use; Eye Infections, Parasitic/parasitology/*therapy; Filariasis/parasitology/*therapy; Postoperative Complications/prevention & control; Uveitis/parasitology/*therapy; Wuchereria bancrofti/*isolation & purification

Glaucomatocyclitic crisis in a child. - Burnstein, Y.; Shelton, K.; Higginbotham, E. J. (American journal of ophthalmology, 1998)
PURPOSE: To report a case of glaucomatocyclitic crisis (Posner-Schlossman syndrome) in a child. METHOD: Case report. A 13-year-old boy presented with decreased vision, photophobia, halos, and pain in the right eye. RESULT: Findings in this child were consistent with a diagnosis of Posner-Schlossman syndrome. CONCLUSION: Glaucomatocyclitic crisis can occur in a child and must be included in the differential diagnosis of uveitis and glaucoma in pediatric patients.
Keywords: Humans; Male; Drug Therapy, Combination; Adolescent; Visual Acuity; Intraocular Pressure; Diagnosis, Differential; Syndrome; Uveitis, Intermediate/*diagnosis/drug therapy; Pain/diagnosis; Prednisolone/analogs & derivatives/therapeutic use; Timolol/therapeutic use; Clonidine/analogs & derivatives/therapeutic use; Corneal Edema/diagnosis; Glaucoma/*diagnosis/drug therapy; Sulfonamides/therapeutic use; Thiophenes/therapeutic use; Vision Disorders/diagnosis

The results of retinal detachment surgery. Analysis of 268 operations with a broad scleral buckle. - Kreiger, A. E.; Hodgkinson, B. J.; Frederick, A. R. Jr; Smith, T. R. (Archives of ophthalmology (Chicago, Ill. : 1960), 1971)
Keywords: Humans; Visual Fields; Fundus Oculi; Visual Acuity; Choroid; Sclera/*surgery; Gonioscopy; Postoperative Complications; Cataract/complications; Uveitis/complications; Iris/surgery; Methods; Retinal Detachment/complications/*surgery; Anesthesia, General; Cryosurgery; Diathermy; Diplopia/complications; Drainage; Eye Diseases/complications; Glaucoma/complications; Hemorrhage/complications; Keratitis/complications; Prostheses and Implants; Retinal Diseases/complications; Silicones; Sutures

Posterior sub-Tenon's injections of corticosteroids in uveitis patients with cystoid macular edema. - Jennings, T.; Rusin, M. M.; Tessler, H. H.; Cunha-Vaz, J. G. (Japanese journal of ophthalmology, 1988)
Cystoid macular edema (CME) is a major cause of visual impairment and is thought to be due to abnormal perifoveal capillary permeability. Posterior sub-Tenon's corticosteroid injections are used to improve the visual acuity in CME, although their mechanism of action is uncertain. In this study, visual acuity, blood retinal barrier (BRB) permeability, and fluorescein angiograms were recorded immediately before and one and four weeks after the administration of steroid injections. Ten patients (12 treated eyes) with CME secondary to uveitis were studied. Visual improvement, defined as an increase in at least two lines of Snellen visual acuity, was seen in half of the treated eyes. In some patients, these improvements were not directly related to changes in the BRB permeability or the amount of macular fluid. Posterior sub-Tenon's corticosteroid injections do not consistently affect blood retinal barrier permeability.
Keywords: Female; Humans; Male; Middle Aged; Adult; Time Factors; Adolescent; Fluorescein Angiography; Injections, Intramuscular; Visual Acuity; Uveitis/complications/*drug therapy; Blood-Retinal Barrier/drug effects; Eye; Macular Edema/*complications; Methylprednisolone/pharmacology/*therapeutic use; Permeability; Retina/metabolism; Triamcinolone/pharmacology/*therapeutic use

Ask the doctor. I'm 64 and have been diagnosed with uveitis in my right eye. What causes it, and what is the best treatment for it? - Robb-Nicholson, Celeste (Harvard women's health watch, 2012)
Keywords: Female; Humans; Middle Aged; Treatment Outcome; Remission Induction; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use; Visual Acuity; Secondary Prevention; *Health Knowledge, Attitudes, Practice; Ophthalmic Solutions/*therapeutic use; Patient Education as Topic; Uveitis/diagnosis/*drug therapy/*prevention & control

IOLs in uveitis patients. - Anderson, W. (Ophthalmology, 1994)
Keywords: Humans; Prognosis; Chronic Disease; Contraindications; Visual Acuity; Uveitis/*surgery; Cataract Extraction; *Lenses, Intraocular; Iridocyclitis/surgery; Pars Planitis/surgery

[The use of tissue plasminogen activator in the post-operative treatment of fibrinoid uveitis]. - Chiseliţă, Dorin; Antohi, Ingrid; Cionca, Daniela; Medvichi, Radu; Cimpoeşu, Diana (Oftalmologia (Bucharest, Romania : 1990), 2006)
PURPOSE: To evaluate the efficacy and safety of tissue plasminogen activator in management of postoperative fibrinous uveitis. MATERIAL AND METHOD: Prospective study, interventional case series including 13 patients who developed fibrinous membrane in anterior chamber; patients were operated for cataract (4 cases), for cataract and glaucoma (7 cases) and for corneoscleral lacerations (2 cases). Initial treatment consisted of corticosteroid administration (topically, subconjunctival +/- systemic) and mydriatic-cycloplegic drugs. Inadequate response imposed intracavitary administration of tissue plasminogen activator (25 microg/ml, 0.2 ml). The main outcomes were: complete resolution of fibrinous membrane, presence of adverse events and visual rehabilitation. RESULTS: Fibrinous membrane resorption starts in the next hours and complete resolution was proved in all cases after a mean time 53.55 +/- 37.65 (24-146) hours. In 12 patients we used only one administration of tissue plasminogen activator, but in one case we repeated it. It was not signaled any adverse event drug related. It was an important increase of visual acuity in all cases. CONCLUSION: Intracavitary administration of tissue plasminogen activator is a safe and efficient alternative in the management of postoperative fibrinous membrane.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Prospective Studies; Algorithms; Visual Acuity; Adrenal Cortex Hormones/therapeutic use; Uveitis/*drug therapy/pathology; *Cataract Extraction/adverse effects; Eye Diseases/surgery; Fibrin/*drug effects; Fibrinolytic Agents/*therapeutic use; Injections, Intralesional; Postoperative Complications/*drug therapy/pathology; Tissue Plasminogen Activator/*therapeutic use

[Uveitis masquerade syndrome in Gaucher disease. Causal treatment by alglucerase substitution therapy]. - Dann, K.; Althaus, C.; Kersten, A.; vom Dahl, S.; Sundmacher, R. (Klinische Monatsblatter fur Augenheilkunde, 1998)
BACKGROUND: Gaucher's disease, a sphingolipidose transmitted by autosomal-recessive inheritance, is caused by a deficiency of the lysosomal enzyme beta-glucocerebrosidase which is responsible for hydrolysation of glucocerebroside to ceramid and glucose. Thus glucocerebroside is accumulated in the reticuloendothelial cells of spleen, liver and bone marrow and pathognomonic Gaucher's cells are formed. CASE REPORT: In May 1997 a 42-year-old female patient presented with left-sided intermediate uveitis of unknown origin and decreasing visual acuity to perception of hand movements and intact projection of light since September 1996. To exclude a systemic disease a thorough medical examination--showing hepatoslpenomegaly, anemia, thrombocytopenia and bone lesions--was initiated and revealed advanced M. Gaucher (Type I) by bone marrow punction. Intravenous therapy with alglucerase was administered promptly. After five months of treatment vitreous opacities resolved almost completely and visual acuity increased to 0.7. CONCLUSIONS: The dramatic improvement occurred under treatment with alglucerase after no response to steroid treatment. Thus intermediate uveitis with severe vitritis can be interpreted as uveitis masquerade syndrome with M. Gaucher. To the best of our knowledge, this is the first case of M. Gaucher presenting initially as intermediate uveitis and showing successful clinical improvement during administration of alglucerase.
Keywords: Female; Humans; Adult; Follow-Up Studies; Infusions, Intravenous; Visual Acuity/drug effects; Uveitis, Intermediate/*diagnosis/drug therapy; Gaucher Disease/*diagnosis/drug therapy; Glucosylceramidase/*administration & dosage

Metipranolol-associated nongranulomatous anterior uveitis. - Patel, N. P.; Patel, K. H.; Moster, M. R.; Spaeth, G. L. (American journal of ophthalmology, 1997)
PURPOSE: To describe the findings in a patient with a nongranulomatous anterior uveitis, presumed to be induced by metipranolol. METHOD: A 69-year-old woman developed bilateral, nongranulomatous, anterior uveitis while undergoing treatment with metipranolol 0.3% for primary open-angle glaucoma. Four months after resolution of the initial episode, the patient was challenged with metipranolol 0.3% in the right eye. RESULT: On reinstituting metipranolol 0.3%, the patient once again developed a unilateral, nongranulomatous, anterior uveitis in the challenged eye. CONCLUSION: Metipranolol 0.3% eyedrops, used to treat primary open-angle glaucoma, appear to cause a nongranulomatous anterior uveitis.
Keywords: Female; Humans; Aged; Recurrence; Ophthalmic Solutions; Visual Acuity; Intraocular Pressure; Glaucoma, Open-Angle/drug therapy; Uveitis, Anterior/*chemically induced; Adrenergic beta-Antagonists/*adverse effects/therapeutic use; Granuloma/chemically induced; Metipranolol/*adverse effects/therapeutic use

Short-term results of a single intravitreal bevacizumab (avastin) injection versus a single intravitreal triamcinolone acetonide (kenacort) injection for the management of refractory noninfectious uveitic cystoid macular edema. - Lasave, Andrés F.; Zeballos, David G.; El-Haig, Wael M.; Díaz-Llopis, Manuel; Salom, David; Arevalo, J. Fernando (Ocular immunology and inflammation, 2009)
PURPOSE: To report the short-term results of a single intravitreal injection of bevacizumab (IVB) versus a single intravitreal injection of triamcinolone acetonide (IVT) to treat refractory noninfectious uveitic cystoid macular edema (CME). METHODS: Twenty-eight consecutive patients (36 eyes) were retrospectively included. Patients received either 2.5 mg of IVB (16 eyes) or 4 mg of IVT (20 eyes). RESULTS: In the IVT group, baseline best-corrected visual acuity (BCVA) was logMAR 1.1 +/- 0.2, and improved to 0.7 +/- 0.3 (p < .001) at 6 months. In the IVB group, baseline BCVA was logMAR of 1.2 +/- 0.4 and improved to 0.8 +/- 0.4 at 6 months (p = .031). At 6 months, central macular thickness (CMT) in the IVT group improved from 454.8 +/- 238.9 microm to 296 +/- 134.4 microm (p < .0001). CONCLUSION: A single IVT injection improves BCVA and reduces CMT more effectively than IVB in refractory noninfectious uveitic CME at 6 months.
Keywords: Female; Humans; Male; Middle Aged; Adult; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Tomography, Optical Coherence; Injections, Intraocular; Triamcinolone Acetonide/*administration & dosage; Vitreous Body; Visual Acuity/drug effects; Anti-Inflammatory Agents/*administration & dosage; Antibodies, Monoclonal, Humanized; Bevacizumab; Antibodies, Monoclonal/*administration & dosage; Macula Lutea/drug effects/pathology; Macular Edema/diagnosis/*drug therapy/etiology/physiopathology; Uveitis/*complications/*drug therapy/physiopathology

Abatacept for refractory juvenile idiopathic arthritis-associated uveitis- a case report. - Angeles-Han, Sheila; Flynn, Thomas; Lehman, Thomas (The Journal of rheumatology, 2008)
Keywords: Female; Humans; Drug Therapy, Combination; Treatment Outcome; Adolescent; Antirheumatic Agents/*therapeutic use; Infusions, Intravenous; Cyclosporine/therapeutic use; Prednisone/therapeutic use; Uveitis/*drug therapy/etiology; Visual Acuity/drug effects/physiology; Abatacept; Immunoconjugates/*therapeutic use; Arthritis, Juvenile/complications/*drug therapy

Subretinal neovascularization with geographic (serpiginous) choroiditis. - Jampol, L. M.; Orth, D.; Daily, M. J.; Rabb, M. F. (American journal of ophthalmology, 1979)
Three patients with geographic choroiditis developed subretinal neovascular membranes associated with subretinal hemorrhage and serous elevation of the retina. Proximity of the membrane to the foveal avascular zone prevented photocoagulation of the neovascular membrane in one patient. Central visual acuity remained 6/60 (20/200) despite systemic corticosteroid therapy. The neovascular membranes in the other two patients were obliterated by argon laser photocoagulation with preservation of central vision. The inflammatory process of geographic choroiditis can disrupt Bruch's membrane, allowing occasional choroidal vascular growth. Concomitant destruction of choroidal vessels may account for rarity of subretinal neovascularization in geographic choroiditis.
Keywords: Female; Humans; Male; Middle Aged; Aged; Visual Acuity; Laser Therapy; Retinal Detachment/etiology; *Neovascularization, Pathologic; *Retinal Vessels; Argon; Choroiditis/*complications/physiopathology; Retinal Hemorrhage/etiology