Intravitreal Sirolimus for Noninfectious Uveitis: A Phase III Sirolimus Study Assessing Double-masKed Uveitis TReAtment (SAKURA). - Nguyen, Quan Dong; Merrill, Pauline T.; Clark, W. Lloyd; Banker, Alay S.; Fardeau, Christine; Franco, Pablo; LeHoang, Phuc; Ohno, Shigeaki; Rathinam, Sivakumar R.; Thurau, Stephan; Abraham, Abu; Wilson, Laura; et al. (Ophthalmology, 2016)
PURPOSE: To evaluate the efficacy and safety of intravitreal sirolimus in the treatment of noninfectious uveitis (NIU) of the posterior segment (i.e., posterior, intermediate, or panuveitis). DESIGN: Phase III, randomized, double-masked, active-controlled, 6-month study with intravitreal sirolimus. PARTICIPANTS: Adults with active NIU of the posterior segment (intermediate, posterior, or panuveitis), defined as a vitreous haze (VH) score >1+. Subjects discontinued NIU medications before baseline, except for systemic corticosteroids, which were allowed only for those already receiving them at baseline and were rapidly tapered after baseline per protocol. METHODS: Intravitreal sirolimus assigned 1:1:1 at doses of 44 (active control), 440, or 880 μg, administered on Days 1, 60, and 120. MAIN OUTCOME MEASURES: The primary efficacy outcome was the percentage of subjects with VH 0 response at Month 5 (study eye) without use of rescue therapy. Secondary outcomes at Month 5 were VH 0 or 0.5+ response rate, corticosteroid tapering success rate (i.e., tapering to a prednisone-equivalent dosage of ≤5 mg/day), and changes in best-corrected visual acuity (BCVA). Adverse events during the double-masked treatment period are presented. RESULTS: A total of 347 subjects were randomized. Higher proportions of subjects in the intravitreal sirolimus 440 μg (22.8%; P = 0.025) and 880 μg (16.4%; P = 0.182) groups met the primary end point than in the 44 μg group (10.3%). Likewise, higher proportions of subjects in the 440 μg (52.6%; P = 0.008) and 880 μg (43.1%; P = 0.228) groups achieved a VH score of 0 or 0.5+ than in the 44 μg group (35.0%). Mean BCVA was maintained throughout the study in each dose group, and the majority of subjects receiving corticosteroids at baseline successfully tapered off corticosteroids (44 μg [63.6%], 440 μg [76.9%], and 880 μg [66.7%]). Adverse events in the treatment and active control groups were similar in incidence, and all doses were well tolerated. CONCLUSIONS: Intravitreal sirolimus 440 μg demonstrated a significant improvement in ocular inflammation with preservation of BCVA in subjects with active NIU of the posterior segment.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Adolescent; Tomography, Optical Coherence; Immunosuppressive Agents/administration & dosage; *Visual Acuity; Intravitreal Injections; Uveitis/diagnosis/*drug therapy; Retina/*pathology; Sirolimus/*administration & dosage; Posterior Eye Segment/*pathology

Time Trade-off Utility Values in Noninfectious Uveitis. - Niemeyer, Katherine M.; Gonzales, John A.; Doan, Thuy; Browne, Erica N.; Rao, Maya M.; Acharya, Nisha R. (American journal of ophthalmology, 2019)
PURPOSE: To investigate time trade-off (TTO) utility values in patients with noninfectious uveitis and determine whether patient demographics and clinical characteristics are associated with utility scores. DESIGN: Time trade-off utility analysis. METHODS: Setting: A tertiary care uveitis center in San Francisco, California, USA. PATIENT POPULATION: One hundred and four consecutive adults with noninfectious uveitis, enrolled between November 2016 and February 2017. MAIN OUTCOME MEASURES: TTO utility values, as collected by an interviewer-guided survey. Information regarding general health, ocular symptoms, and religion was also collected and medical record review was conducted to record anatomic location of uveitis, disease activity, visual acuity, and treatments. Multivariable regression analysis with backward selection was used to identify variables associated with TTO values. RESULTS: Median TTO score was 0.975 (interquartile range [IQR]: 0.8-1.0), corresponding to trading a median 1.28 years of remaining life for healthy eyes (IQR: 0-6.29). Regression analysis revealed that worse eye visual acuity, >6 months of oral corticosteroid use, and current antidepressant use were associated with lower TTO scores (P = .008, P = .006, P = .008, respectively), controlling for age and sex. In particular, patients who had been taking oral corticosteroids for more than 6 months, regardless of dose, were 10.5 times more likely to trade 20% or more years of remaining life (TTO ≤0.8) than patients not taking oral corticosteroids (95% confidence interval: 2.3, 48.1; P = .002). CONCLUSIONS: Patients with noninfectious uveitis had measurable, though modest, reductions in quality of life, as assessed by TTO, and these decreases were significantly associated with visual acuity in the worse eye and long-term oral corticosteroid use.
Keywords: Female; Humans; Male; Middle Aged; Adult; Administration, Oral; Health Status; Surveys and Questionnaires; Cross-Sectional Studies; Glucocorticoids/administration & dosage; Visual Acuity/physiology; *Sickness Impact Profile; Antidepressive Agents/administration & dosage; Health Surveys; Quality of Life/*psychology; Tertiary Care Centers; Uveitis/physiopathology/*psychology

RESOLUTION OF NONINFECTIOUS UVEITIC CYSTOID MACULAR EDEMA WITH TOPICAL DIFLUPREDNATE. - Feiler, Daniel L.; Srivastava, Sunil K.; Pichi, Francesco; Bena, James; Lowder, Careen Y. (Retina (Philadelphia, Pa.), 2017)
PURPOSE: To evaluate the short-term safety and efficacy of topical difluprednate (0.05%) for the treatment of noninfectious uveitic cystoid macular edema. METHODS: Twenty-seven patients (35 eyes) undergoing treatment with difluprednate 4 times daily for 3 weeks for noninfectious uveitic cystoid macular edema were reviewed for visual acuity, intraocular pressure, optical coherence tomography, and fluorescein angiography results. A mixed model analysis was fit with each measure as the outcome, visit as the primary predictor, and patient and eye as random effects. RESULTS: Mean central foveal thickness decreased by 117 μm (P < 0.001) at 30 ± 15 days, 124 μm (P < 0.001) at 60 ± 15 days, and 152 μm (P < 0.001) at 180 ± 30 days. Complete resolution of intraretinal fluid was observed in 15 of 34 (44%) eyes at 30 ± 15 days, 11 of 21 (52%) eyes at 60 ± 15 days, and 9 of 12 (75%) eyes at 180 ± 30 days. Improvement in fluorescein leakage was noted in 7 of 8 eyes (88%). Visual acuity improved by a mean of 5 letters (P = 0.001) at 30 ± 15 days, 5.5 letters (P = 0.007) at 60 ± 15 days, and 7 letters (P = 0.032) at 180 ± 30 days. Mean increase in intraocular pressure was 1.48 mmHg at 30 ± 15 days (P = 0.080), 1.92 mmHg at 60 ± 15 days (P = 0.110), and 6.18 mmHg (P = 0.001) at 180 ± 30 days. CONCLUSION: Topical difluprednate is a well-tolerated and effective treatment for noninfectious uveitic cystoid macular edema with decreased central foveal thickness, mild improvement in visual acuity, and elevation of intraocular pressure observed in a few patients.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Fluorescein Angiography; Tomography, Optical Coherence; Outcome Assessment, Health Care/methods; Visual Acuity; Uveitis/*drug therapy; Glucocorticoids/*administration & dosage; Intraocular Pressure; Administration, Topical; Fluprednisolone/administration & dosage/*analogs & derivatives; Macular Edema/*drug therapy; Ophthalmic Solutions/administration & dosage

Multiple Sclerosis-related Uveitis: Does MS Treatment Affect Uveitis Course? - Jouve, Léa; Benrabah, Rabah; Héron, Emmanuel; Bodaghi, Bahram; Le Hoang, Phuc; Touitou, Valérie (Ocular immunology and inflammation, 2017)
PURPOSE: Few data are available regarding the optimal treatment of multiple sclerosis (MS)-related uveitis. The aim of this study was to describe clinical features of MS-associated uveitis and determine how MS treatment affects the course of uveitis. METHODS: Retrospective, multicenter study. Patients were divided into two groups according to the use (group 2) or not (group 1) of immunomodulatory drugs. Characteristics of uveitis and treatment were reviewed. RESULTS: A total of 68 eyes from 36 patients (17 in group 1 and 19 in group 2) were included. All patients were treated with topical and/or systemic steroids for uveitis. Uveitis occurred 1-17 years prior to neurologic symptoms in 78% of patients. Uveitis was more severe in group 2 (p<0.05), with a tendency toward a higher rate of chronic uveitis (p = 0.06). CONCLUSIONS: MS-related uveitis has often a favorable evolution. Patients on interferon-beta have more severe and chronic uveitis. As far as we are concerned, interferon-beta given on the sole indication of uveitis is not recommended. If steroid-sparing agent is required for intraocular inflammation, immunosuppressive drugs should be considered.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Glucocorticoids/*therapeutic use; Immunosuppressive Agents/*therapeutic use; uveitis; Ophthalmic Solutions; Visual Acuity; Uveitis/diagnosis/*drug therapy/physiopathology; Administration, Ophthalmic; Corticosteroids; cystoid macular edema; immunosuppressive drugs; interferon-beta; Multiple Sclerosis/diagnosis/*drug therapy/physiopathology; relapsing-remitting MS

Prevalence and management of elevated intraocular pressure after placement of an intravitreal sustained-release steroid implant. - Bollinger, Kathryn E.; Smith, Scott D. (Current opinion in ophthalmology, 2009)
PURPOSE OF REVIEW: The fluocinolone acetonide intravitreal implant was approved by the United States Food and Drug Administration in April, 2005 for treatment of noninfectious posterior segment uveitis (NIPU). This therapy is effective with respect to prevention of uveitis recurrence. However, corticosteroid-associated increased intraocular pressure frequently occurs in implanted eyes and must be managed appropriately to prevent glaucomatous vision loss. RECENT FINDINGS: Pooled results from three recent prospective randomized trials show that 75% of eyes receiving the fluocinolone acetonide implant required intraocular pressure (IOP) lowering therapy at some point within the 3-year study course. Eyes requiring surgical intervention had a high rate of hypotony but also showed stable postoperative visual acuity. SUMMARY: Fluocinolone acetonide intravitreal implants are an effective therapy for NIPU. However, patients receiving this treatment are at high risk for development of vision-threatening increased IOP. Therefore, we recommend that patients treated with fluocinolone acetonide implants receive frequent IOP monitoring and referral to a glaucoma specialist if pressure control is not achieved.
Keywords: Humans; Clinical Trials as Topic; Prevalence; Drug Implants; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Delayed-Action Preparations; Fluocinolone Acetonide/*administration & dosage/*adverse effects; Glaucoma/chemically induced; Ocular Hypertension/*chemically induced/epidemiology/prevention & control/therapy; Uveitis, Posterior/*drug therapy

Efficacy and Safety of Sarilumab for the Treatment of Posterior Segment Noninfectious Uveitis (SARIL-NIU):: The Phase 2 SATURN Study. - Heissigerová, Jarmila; Callanan, David; de Smet, Marc D.; Srivastava, Sunil K.; Karkanová, Michala; Garcia-Garcia, Olga; Kadayifcilar, Sibel; Ozyazgan, Yilmaz; Vitti, Robert; Erickson, Kristine; Athanikar, Aditya; Chu, Karen; et al. (Ophthalmology, 2019)
PURPOSE: To assess efficacy and safety of sarilumab, a human anti-interleukin-6 receptor antibody, for treatment of posterior segment noninfectious uveitis (NIU). DESIGN: Randomized, double-masked, placebo-controlled, phase 2 study. PARTICIPANTS: Fifty-eight patients (eyes) with noninfectious intermediate, posterior, or panuveitis. METHODS: Eyes received treatment every 2 weeks for 16 weeks with subcutaneous sarilumab 200 mg or placebo. MAIN OUTCOME MEASURES: The primary end point was the proportion of patients with ≥2-step reduction in vitreous haze (VH) on the Miami scale or with a reduction of systemic corticosteroids (prednisolone or equivalent) to a dose of <10 mg/day at week 16. Primary end point was based on VH evaluation by a central reading center. Investigator evaluation of VH was a prespecified, planned secondary analysis. RESULTS: At week 16, proportion of patients taking sarilumab or placebo with ≥2-step reduction in VH or corticosteroid dose <10 mg/day was 46.1% vs. 30.0% (P = 0.2354) based on central reading center assessment of VH and 64.0% vs. 35.0% (P = 0.0372) based on investigator assessment of VH, respectively. In the subgroup of eyes with VH grade ≥2 at baseline, the mean VH reduction from baseline to week 16 was significantly greater with sarilumab vs. placebo regardless of assessment by the central reading center (-2.1 [n = 11] vs. -1.7 [n = 3], respectively; P = 0.0255) or investigator (-2.5 [n = 19] vs. -1.2 [n = 11], respectively; P = 0.0170). The mean best-corrected visual acuity gain from baseline to week 16 was greater with sarilumab vs. placebo in the overall population (8.9 vs. 3.6 letters, respectively; P = 0.0333) and in the subgroup of eyes with central subfield thickness (CST) ≥300 μm at baseline (12.2 [n = 13] vs. 2.1 [n = 7] letters, respectively; P = 0.0517). Corresponding changes in CST were -46.8 vs. +2.6 μm (P = 0.0683) in the overall population and -112.5 [n = 13] vs. -1.8 [n = 6] μm (P = 0.1317) in the subgroup of eyes with CST ≥300 μm at baseline, respectively. The most common ocular adverse events were worsening of uveitis (0 [placebo] and 3 [sarilumab] patients) and retinal infiltrates (1 [placebo] and 2 [sarilumab] patients). CONCLUSIONS: Subcutaneous sarilumab may provide clinical benefits in the management of NIU of the posterior segment, especially in eyes with uveitic macular edema.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Treatment Outcome; Antirheumatic Agents/adverse effects/*therapeutic use; Visual Acuity/physiology; Intravitreal Injections; Macular Edema/diagnosis/drug therapy/physiopathology; Uveitis, Posterior/diagnosis/*drug therapy/physiopathology; Antibodies, Monoclonal, Humanized/adverse effects/*therapeutic use

Vogt-Koyanagi-Harada-like Disease following Yellow Fever Vaccination. - Campos, Wesley R.; Cenachi, Sarah P. F.; Soares, Matheus Schmidt; Gonçalves, Priscila Freitas; Vasconcelos-Santos, Daniel V. (Ocular immunology and inflammation, 2021)
Purpose: To report the manifestation of Vogt-Koyanagi-Harada-like disease (VKH) following yellow fever vaccination.Methods: Case report.Results: A 34-year-old immunocompetent male had tinnitus, headache, and decreased vision after a booster dose of yellow fever vaccine. Visual acuity was 20/100 in the right eye and 20/80 in the left, with serous retinal detachment (SRD) and choroidal thickening identified on clinical examination and multimodal imaging. Lumbar puncture revealed pleocytosis and an increased protein content, but extensive investigations ruled out infectious/neurological diseases. Pulse intravenous methylprednisolone was given, followed by a tapering regimen of high-dose oral prednisone. Azathioprine was started early, 3 weeks after initiation of oral steroids. Intraocular inflammation and SRD rapidly resolved, with visual acuity reaching 20/20 in both eyes, after 3 weeks. No recurrence of intraocular inflammation or sign of depigmentation was so far noticed, at 2 years of follow-up.Conclusion: Yellow fever vaccine may be a possible trigger for VKH.
Keywords: Humans; Male; Adult; Time Factors; Follow-Up Studies; uveitis; *Visual Acuity; Fundus Oculi; Vaccination/*adverse effects; Tomography, Optical Coherence/methods; Fluorescein Angiography/methods; Choroiditis; Immunocompromised Host; Uveomeningoencephalitic Syndrome/diagnosis/*etiology; Vogt–Koyanagi–Harada disease; yellow fever vaccine; Yellow Fever Vaccine/*adverse effects; Yellow fever virus/*immunology; Yellow Fever/*prevention & control

Effects of sub-Tenon's triamcinolone injections in patients with uveitis. - Ferreira, Bianca Gubiani; Marinho, Diane Ruschel; Diligenti, Felipe Teloken (Arquivos brasileiros de oftalmologia, 2018)
PURPOSE: To evaluate the response to sub-Tenon's triamcinolone injection in patients with uveitis. METHODS: We studied 28 eyes with macular edema associated with controlled uveitis. We administered sub-Tenon's injection of triamcinolone and followed the patients for 180 days to analyze the positive effects (improvement of macular edema and visual acuity) and monitor the possible adverse effects. This prospective study was conducted at the Department of Ophthalmology, Hospital de Clínicas de Porto Alegre, Brazil. RESULTS: We observed improvement in macular edema in 86% of patients. The mean central macular thickness at each time point of assessment was 432.22, 298.80, 286.37, 267.49, 253.87, and 253.49 mm at baseline (before sub-Tenon's injection of triamcinolone), 15 days after the procedure, at 30 days, at 60 days, at 90 days, and at 180 days, respectively. The mean reduction in retinal thickness was 30.8%, 33.7%, 38.11%, 41.2%, and 41.35% at 15, 30, 60, 90, and 180 days of follow-up, respectively. Visual acuity also improved in 85.7% of patients, with a mean improvement of 1.36, 1.93, 2.23, 2.26, and 2.30 lines gained on the Early Treatment Diabetic Retinopathy Study chart at 15, 30, 60, 90, and 180 days of follow-up, respectively. No statistically significant increases in intraocular pressure and conjunctival abnormalities were caused by the procedure, and no other adverse effects were observed. Overall, the results of this study were similar to those described in the literature. CONCLUSIONS: Sub-Tenon's injection of triamcinolone provides reduced macular thickness and improvement in visual acuity with no significant adverse effects and is therefore an effective and safe procedure for the treatment of sequelae of uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Treatment Outcome; Young Adult; Visual Acuity; Triamcinolone Acetonide/*administration & dosage; Intravitreal Injections; Uveitis/complications/*drug therapy; Intraocular Pressure; Anti-Inflammatory Agents/*administration & dosage; Macular Edema/etiology

Intravitreal Dexamethasone Implant in the Treatment of Non-infectious Uveitis. - Hasanreisoğlu, Murat; Özdemir, Hüseyin Baran; Özkan, Kaan; Yüksel, Murat; Aktaş, Zeynep; Atalay, Hatice Tuba; Özdek, Şengül; Gürelik, Gökhan (Turkish journal of ophthalmology, 2019)
OBJECTIVES: To evaluate the long-term results of intravitreal dexamethasone implant (DEX) for noninfectious uveitis. MATERIALS AND METHODS: The study included 62 eyes of 44 patients treated with DEX implant due to noninfectious uveitis and followed up for at least a year. Best-corrected visual acuity (BCVA), central foveal thickness, intraocular pressure (IOP), vitreous haze score, indications, immunomodulatory therapy and steroid usage before/after injection, number of injections, and adverse events were analyzed retrospectively. RESULTS: Average follow-up was 20 months (range 12-64 months). The female/male ratio was 29/15. Mean age was 50 years (range 22-75 years). The most frequent uveitis etiologies were idiopathic (25 patients, 40.3%) and Behçet’s uveitis. (17 patients, 27.4%) The most common indication for DEX injection was cystoid macular edema together with resistant vitreous haze (26 eyes, 41.9%). Twenty-two eyes (30%) received more than one DEX injection. Mean BCVA was improved from 0.55 logMAR at baseline to 0.38, 0.32, and 0.35 after 1, 3, and 6 months, respectively (p<0.001 for each). Mean CFT was decreased from 386 μm at baseline to 288, 311, and 302 μm after 1, 3, and 6 months, respectively (p<0.001 for each). Mean IOP did not change significantly during follow-up. Five eyes (8%) received topical anti-glaucoma medication (IOP ≥25 mmHg). Eighteen (46%) of 39 phakic eyes underwent cataract surgery during follow-up. Similar efficacy of the DEX implant was observed in eyes that received multiple injections. Systemic immunomodulatory therapy did not change significantly during follow-up. CONCLUSION: Intravitreal DEX injection does not alter systemic immunomodulatory therapy, but may facilitate the management of noninfectious uveitis by suppressing local intraocular inflammation. Multiple injections yielded comparable visual and anatomical outcomes to single injections. Follow-up for ocular hypertension and cataract formation are important, especially in eyes receiving multiple injections.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; *Visual Acuity; Intravitreal Injections; Dexamethasone/*administration & dosage; Uveitis/diagnosis/*drug therapy; *uveitis; *Dexamethasone implant; *intravitreal injection; *Ozurdex; Drug Contamination; Fovea Centralis/pathology

Post-Streptococcal Uveitis: Case Report. - Medina, Carlos Augusto; Fajardo, Angela; Calderon, Ana; Aracena, Manuel (Ocular immunology and inflammation, 2019)
Background: Post-streptococcal uveitis is a rare ocular disease which is part of other auto-immune conditions associated with post-streptococcal syndrome. It was first mentioned in medical literature in 1991, with only a few cases published at that time. We are presenting the case of a patient with bilateral panuveitis subsequent to bacterial pharyngotonsillitis, with studies which had come back negative for other uveitis etiologies and which had responded very well to established treatment. Clinical Case: A case of post-streptococcal uveitis is presented with a review of current concepts of this rare eye disease.
Keywords: Female; Humans; Middle Aged; Dose-Response Relationship, Drug; Administration, Oral; Prednisone/administration & dosage; Fundus Oculi; Visual Acuity; Uveitis, Anterior/diagnosis/drug therapy/*etiology; Fluorescein Angiography/methods; Panuveitis; Panuveitis/diagnosis/*etiology; post-streptococcal syndrome; post-streptococcal uveitis; Streptococcal Infections/*complications/diagnosis; Syndrome; Tonsillitis/*complications/diagnosis

Morphologic and functional evaluations during development, resolution, and relapse of uveitis-associated cystoid macular edema. - Munk, Marion R.; Bolz, Matthias; Huf, Wolfgang; Sulzbacher, Florian; Roberts, Philipp; Simader, Christian; Rückert, René; Kiss, Christopher G. (Retina (Philadelphia, Pa.), 2013)
OBJECTIVES: To describe progression and resolution of uveitis-associated cystoid macular edema (uvCME) using spectral-domain optical coherence tomography and find predictive factors for successful intravitreal triamcinolone acetonide (IVTA) therapy. METHODS: Twenty-nine eyes with treatment-naive uvCME were examined before and at 5 scheduled visits within 3 months after intravitreal triamcinolone acetonide administration. Distribution, resolution, relapse, and development of uvCME were evaluated using spectral-domain optical coherence tomography to describe morphology, progression, and relapse according to a standardized reading protocol. Applying repeated measures analysis of variance, morphologic findings were evaluated as predictive factors of the treatment outcome. RESULTS: At baseline, 89.3% presented with focal CME; 65.6% had outer nuclear/Henley's layer and inner nuclear layer cysts. Following intravitreal triamcinolone acetonide administration, cysts of outer nuclear/Henley's layer diminished before those of inner nuclear layer (P = 0.0004). Small-pointed subretinal detachment (SRD) resolution synchronized with inner nuclear layer cyst extinction, whereas dome-shaped SRD resolution lagged behind (P = 0.014). Relapses of CME appeared in 71.4% of eyes with parafoveal inner nuclear layer cysts. Cysts of outer nuclear/Henley's layer were present in an additional 28.6%. None of the eyes developed SRD during CME relapse. The main effect variables "SRD" and "absence of epiretinal membrane" were associated with greater best-corrected visual acuity improvement (P = 0.05 and P = 0.047), whereas the side effect variables "CME duration", "age," and "uveitis location" had no additional effect on best-corrected visual acuity. Baseline SRD predicted a relapse-free clinical course within the observational period (P = 0.025). CONCLUSION: Different morphologic patterns in uvCME may represent different stages in uvCME progression, and initial morphologic appearance can be linked to the clinical prognosis after the treatment.
Keywords: Female; Humans; Male; Middle Aged; Prospective Studies; Treatment Outcome; Disease Progression; Glucocorticoids/*therapeutic use; Recurrence; Tomography, Optical Coherence; Visual Acuity/physiology; Intravitreal Injections; Epiretinal Membrane/*diagnosis; Macular Edema/*diagnosis/drug therapy/physiopathology; Retinal Detachment/*diagnosis; Triamcinolone Acetonide/*therapeutic use; Uveitis, Anterior/*diagnosis/drug therapy/physiopathology

Efficacy and Safety of High-Energy Selective Laser Trabeculoplasty for Steroid-Induced Glaucoma in Patients with Quiescent Uveitis. - Xiao, Junyan; Zhao, Chan; Liang, Anyi; Zhang, Meifen; Cheng, Gangwei (Ocular immunology and inflammation, 2021)
Purpose: To assess the efficacy and safety of high-energy selective laser trabeculoplasty (SLT) for steroid-induced glaucoma in patients with quiescent uveitis.Methods: A retrospective study of steroid-induced glaucoma in quiescent uveitic patients who underwent SLT at our center from December 2014 to November 2017 and had been followed up for at least 1 year. Intraocular pressure (IOP) and IOP-lowering medications were recorded at baseline, and at 1 week, 1 month, 3 months, 6 months and 12 months after SLT. Treatment success was defined as IOP ≤18 mmHg and a ≥ 20% reduction in IOP without additional glaucoma surgery.Results: Twenty eyes from 19 patients were included. At the 12-month visit, mean IOP and mean number of IOP-lowering medications were significantly reduced as compared to baseline with an overall success rate of 65.0%.Conclusions: High-energy SLT appeared to be an effective and safe procedure for steroid-induced glaucoma with quiescent uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Adolescent; Child; Visual Acuity/physiology; Uveitis; Uveitis/*drug therapy; Intraocular Pressure/physiology; Tonometry, Ocular; Glaucoma, Open-Angle/chemically induced/physiopathology/*surgery; Glucocorticoids/*adverse effects; high-energy; intraocular pressure; Laser Therapy/*methods; Lasers, Solid-State/therapeutic use; selective laser trabeculoplasty; steroid-induced glaucoma; Trabeculectomy/*methods

Dexamethasone implants in paediatric patients with noninfectious intermediate or posterior uveitis: first prospective exploratory case series. - Winterhalter, Sibylle; Behrens, Uwe Diedrich; Salchow, Daniel; Joussen, Antonia M.; Pleyer, Uwe (BMC ophthalmology, 2017)
BACKGROUND: To evaluate the efficacy and safety of dexamethasone (DEX) implants in paediatric patients with noninfectious intermediate or posterior uveitis. METHODS: Prospective single center exploratory case series. Children and adolescents, 6 to 17 years old, with a vitreous haze score of ≥1.5+ or cystoid macular edema (CME) of >300 μm were enrolled. Vitreous haze score at month 2 was chosen as primary endpoint. Best corrected visual acuity (BCVA), central retinal thickness (CRT) and concomitant medication at month 6 were defined as secondary endpoints. Intraocular pressure (IOP) and cataract formation were determined as safety endpoints. RESULTS: Three out of 6 eligible patients participated in the case series. At month 2, vitreous haze was reduced from a score of 1.5+ to 0.5+ and 0 and BCVA improved by ≥3 lines, ≥4 lines and ≥2 lines of Early Treatment of Diabetic Retinopathy (ETDRS)-letters, respectively. Visual acuity gain was accompanied by a CRT reduction of -186 μm and -83 μm in the first and third patient, in whom CME was the indication for DEX implantation. A reduction of concomitant medication was achieved in 1 patient. IOP increase was seen in all 3 patients, but could be treated sufficiently with primarily IOP lowering medications and without need for glaucoma surgery. Cataract progression did not occur. CONCLUSIONS: DEX implants led to an improvement in all endpoints, especially BCVA. This study confirms that IOP rises may also occur in the paediatric population and should be monitored and treated appropriately. TRIAL REGISTRATION: European Union Drug Regulating Authorities Clinical Trials (EudraCT)- nr: 2013-000541-39.
Keywords: Female; Humans; Male; Prospective Studies; Adolescent; Child; Visual Acuity/physiology; Uveitis; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; *Drug Implants; Macular edema; Dexamethasone implant; Vitreous Body/pathology; Glaucoma; Anti-Inflammatory Agents/*administration & dosage; Cataract; Delayed-Action Preparations/therapeutic use; Paediatric patients; Uveitis, Intermediate/*drug therapy/pathology/physiopathology; Uveitis, Posterior/*drug therapy/pathology/physiopathology; Vitreous haze

Incidence and Management of Glaucoma in Vogt Koyanagi Harada Disease. - Pandey, Amit; Balekudaru, Shantha; Venkatramani, Devendra V.; George, Amala E.; Lingam, Vijaya; Biswas, Jyotirmay (Journal of glaucoma, 2016)
PURPOSE: To analyse the prevalence, incidence, and risk factors of glaucoma in Vogt Koyanagi Harada (VKH) disease and study the changes in visual acuity and intraocular pressure (IOP) with treatment. MATERIALS AND METHODS: Retrospective chart analysis of 448 eyes of 224 patients of Indian origin diagnosed with VKH disease from January 1990 to December 2013, who had a minimum follow-up of 3 months was performed. RESULTS: Seventy-one eyes (15.8%) developed sustained elevation in IOP. The prevalence of glaucoma at presentation was 15.8% and the cumulative incidence of glaucoma was 11.7%. The mechanisms of glaucoma were open-angle glaucoma in 46 eyes, (64.8%), angle closure in 21 eyes (29.6%), and of combined mechanisms in the remainder (4 eyes, 5.6%). Acute angle-closure crisis developed in 9 eyes (12.6%). Uveal effusion (odds ratio 9.47; confidence interval, 4.08-20.03) and increased number of recurrences (odds ratio 1.31; confidence interval, 1.13-1.53) were found to be significant risk factors for the development of glaucoma. Successful control of IOP was achieved in 64% at 12 months using medical/ laser treatment for glaucoma and was 50 % at 12 months following surgical management. CONCLUSIONS: Glaucoma is a frequent complication of uveitis in VKH disease. Presence of uveal effusion and increased number of recurrences of inflammation are significant risk factors.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Risk Factors; Incidence; Antihypertensive Agents/therapeutic use; Recurrence; Prevalence; Odds Ratio; Visual Acuity; Intraocular Pressure; Trabeculectomy; Carbonic Anhydrase Inhibitors/therapeutic use; Glaucoma/*epidemiology/*etiology/therapy; Iridectomy; Uveitis/etiology; Uveomeningoencephalitic Syndrome/*complications

Clinical review: Update on treatment of inflammatory macular edema. - Ossewaarde-van Norel, Annette; Rothova, Aniki (Ocular immunology and inflammation, 2011)
The aim of this review is to summarize the recent developments in the treatment of inflammatory macular edema (ME). Inflammatory ME represents a major cause of visual loss in uveitis and its adequate management is crucial for the maintenance of useful vision in patients with uveitis. Recent studies favor early treatment of inflammatory ME, even in patients with full visual acuity. After recapitulating the standard treatment modalities for inflammatory ME the authors address novel corticosteroid implants. They review the literature on the efficacy of anti-VEGF agents for inflammatory ME and point out their beneficial, but transient effects. Further, they present recent data on the value of systemic biologics in uveitic ME and evaluate the effectiveness of vitrectomy. Finally, they propose an algorithm for the treatment of inflammatory ME and point out that the individual risk-benefit ratio, especially with systemic immunosuppressive therapy, should always be considered.
Keywords: Humans; Anti-Inflammatory Agents/therapeutic use; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Algorithms; Immunosuppressive Agents/therapeutic use; Intravitreal Injections; Adrenal Cortex Hormones/*therapeutic use; Visual Acuity/drug effects; Drug Implants/therapeutic use; Acetazolamide/therapeutic use; Interferons/therapeutic use; Macular Edema/*drug therapy/surgery; Somatostatin/analogs & derivatives; Uveitis/drug therapy/surgery; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Vitrectomy

[Glaucoma and uveitis. Causes of and treatment options for increased intraocular pressure in cases of inflammatory ophthalmology]. - Dietlein, T. S. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2003)
Uveitic secondary glaucoma poses one of the most difficult problems for differential diagnostics and therapeutics in the field of clinical glaucomatology. The prevalence of glaucoma among uveitis patients ranges between 5 and 20% with great fluctuations depending on the underlying disease, duration of the disease, and the patient's age. Based on slit-lamp examination, uveitis can be classified as granulomatous and non-granulomatous. The effects of uveitic glaucoma on the quality of life and central visual acuity are particularly serious during childhood. Surgical reduction of eye pressure in cases of uveitic secondary glaucoma should only be performed if medical treatment of the underlying disease or ocular inflammation does not lower the eye pressure level and if in the presence of glaucomatous damage to the optic nerve the level of intraocular pressure is so high that a drastic decrease in pressure that cannot be achieved by medication becomes necessary.
Keywords: Humans; Risk Assessment; Intraocular Pressure; Eye Diseases/complications/diagnosis/therapy; Glaucoma/*diagnosis/etiology/*therapy; Inflammation/complications/diagnosis/therapy; Ocular Hypertension/diagnosis/etiology/therapy; Uveitis/complications/*diagnosis/*therapy

RESPONSE OF INFLAMMATORY CYSTOID MACULAR EDEMA TO TREATMENT USING ORAL ACETAZOLAMIDE. - Pepple, Kathryn L.; Nguyen, Macklin H.; Pakzad-Vaezi, Kaivon; Williamson, Kathleen; Odell, Naomi; Lee, Cecilia; Leveque, Thellea K.; Van Gelder, Russell N. (Retina (Philadelphia, Pa.), 2019)
PURPOSE: To determine the treatment effect of oral acetazolamide on refractory inflammatory macular edema. METHODS: A retrospective review of identified patients with uveitic or pseudophakic macular edema treated using acetazolamide between 2007 and 2014. Visual acuity and central macular subfield thickness was determined at baseline and at first follow-up. Baseline optical coherence tomography features were analyzed as predictors of acetazolamide response. RESULTS: Sixteen patients (19 eyes) of 61 screened met all criteria. Mean age was 57.9 years (19.7-81.1). The most common diagnosis was idiopathic uveitis (n = 6, 31.6%). Mean uveitis duration was 4.4 years (0.2-27.5). Average central macular subfield thickness decreased significantly (from 471.8 ± 110.6 μm to 358.3 ± 50.4 μm) (P < 0.0001). Average visual acuity (logarithm of the minimum angle of resolution) improved significantly from 20/54 (0.43 ± 0.25) to 20/37 (0.27 ± 0.16) (P = 0.003). Pretreatment optical coherence tomographies demonstrated intraretinal fluid (n = 19, 100%), subretinal fluid (n = 8, 42.1%), epiretinal membrane (n = 13, 68.3%), and vitreomacular traction (n = 1, 5.2%). No optical coherence tomography characteristic was predictive of a response to therapy. CONCLUSION: There is a significant benefit to vision and central macular subfield thickness after acetazolamide treatment in patients with inflammatory macular edema. In patients with refractory inflammatory macular edema, treatment using acetazolamide can provide anatomical and visual benefit without corticosteroid-related adverse effects.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Administration, Oral; Fluorescein Angiography; Tomography, Optical Coherence; *Visual Acuity; Fundus Oculi; Acetazolamide/*administration & dosage; Carbonic Anhydrase Inhibitors/administration & dosage; Macula Lutea/*pathology; Macular Edema/diagnosis/*drug therapy

Efficacy and safety of intravenous secukinumab in noninfectious uveitis requiring steroid-sparing immunosuppressive therapy. - Letko, Erik; Yeh, Steven; Foster, C. Stephen; Pleyer, Uwe; Brigell, Mitchell; Grosskreutz, Cynthia L. (Ophthalmology, 2015)
PURPOSE: Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, exhibited promising activity in a proof-of-concept study when administered in intravenous (IV) doses to patients with active, chronic, noninfectious uveitis. This study compared the efficacy and safety of different IV and subcutaneous (SC) doses of secukinumab in patients with noninfectious uveitis. DESIGN: Multicenter, randomized, double-masked, dose-ranging, phase 2 clinical trial. PARTICIPANTS: Thirty-seven patients with active noninfectious intermediate uveitis, posterior uveitis, or panuveitis who required corticosteroid-sparing immunosuppressive therapy. METHODS: Patients were randomized to secukinumab 300 mg SC every 2 weeks for 4 doses, secukinumab 10 mg/kg IV every 2 weeks for 4 doses, or secukinumab 30 mg/kg IV every 4 weeks for 2 doses. Intravenous or SC saline was administered to maintain masking. Efficacy was assessed on day 57 (2-4 weeks after last dose). MAIN OUTCOME MEASURES: Percentage of patients with treatment response, defined as (1) at least a 2-grade reduction in vitreous haze score or trace or absent vitreous haze in the study eye without an increase in corticosteroid dose and without uveitis worsening or (2) reduction in corticosteroid dosages to prespecified levels without uveitis worsening. Percentage of patients with remission, defined as anterior chamber cell and vitreous haze scores of 0 or 0.5+ in both eyes without corticosteroid therapy or uveitis worsening. RESULTS: Secukinumab 30 mg/kg IV and 10 mg/kg IV, compared with the 300 mg SC dose, produced higher responder rates (72.7% and 61.5% vs. 33.3%, respectively) and remission rates (27.3% and 38.5% vs. 16.7%, respectively). Statistical and clinical superiority for the 30 mg/kg IV dose compared with the 300 mg SC dose was established in a Bayesian probability model. Other measures, including time to response onset, change in visual acuity, and change in vitreous haze score, showed numeric trends favoring IV dosing. Secukinumab, administered in IV or SC formulations, appeared safe and was well tolerated. CONCLUSIONS: Intravenous secukinumab was effective and well tolerated in noninfectious uveitis requiring systemic corticosteroid-sparing immunosuppressive therapy. Greater activity with IV dosing suggests that patients may not receive sufficient drug with SC administration. High-dose IV secukinumab may be necessary to deliver secukinumab in therapeutic concentrations.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Aged; Treatment Outcome; Young Adult; Adolescent; Chronic Disease; Injections, Intravenous; Visual Acuity/physiology; Injections, Subcutaneous; Glucocorticoids/*administration & dosage; Uveitis/diagnosis/*drug therapy; Vitreous Body/pathology; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal/*administration & dosage/adverse effects/pharmacokinetics; Eye Diseases/diagnosis; Immunosuppressive Agents/*administration & dosage; Interleukin-17/*antagonists & inhibitors

Inflammatory Relapses after Immunosuppressive Drug Discontinuation in Uveitis Patients: A Survival Analysis. - Gómez-Gómez, Alejandro; García-González, Javier; Peiteado, Diana; Borrego-Sanz, Lara; Arriola-Villalobos, Pedro; Esteban-Ortega, Mar; Martín-López, María; Ventura-Hidalgo, María; Perez-Blazquez, Eugenio; Pato, Esperanza; Díaz-Valle, David; Muñoz-Fernández, Santiago; et al. (Ocular immunology and inflammation, 2021)
Purpose: To estimate the incidence rate (IR) and identify risk factors associated to inflammatory relapse after immunosuppressive drug (ISD) discontinuation in noninfectious uveitis patients.Methods: Multicenter longitudinal retrospective study, including patients from four uveitis clinics followed-up until December 2018. Hazard ratios for different variables were estimated using multivariable Cox models.Results: 32 patients (34 episodes of ISD discontinuation) were analyzed (median and maximum follow-up time: 2.4 and 19.2 years, respectively). Fourteen patients presented at least one relapse: anterior (8 patients), intermediate (5) and posterior (8). IR (95% confidence interval) of the first relapse was 14.3 (8.6-23.8) episodes per 100 patient-years (median survival time: 4.8 years). Early use of ISDs, panuveitis, and higher oral corticosteroid dosage at discontinuation were associated with higher hazards of relapse in multivariable analysis.Conclusions: Relapse is a frequent and early event after ISD discontinuation. Identifying relapse risk factors could support the physician's decision regarding ISD discontinuation.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Risk Factors; Treatment Outcome; Young Adult; Incidence; Survival Analysis; Recurrence; Immunosuppressive Agents/*therapeutic use; uveitis; Visual Acuity; Uveitis/diagnosis/*drug therapy; *Withholding Treatment; immunosuppressive drug; Inflammation/diagnosis/*epidemiology; inflammatory relapse; oral corticosteroids; Spain/epidemiology

Comparison of Modified Posterior Sub-Tenon's vs. Trans-Septal Triamcinolone Injection for Non-infectious Uveitis. - McKay, K. Matthew; Borkar, Durga S.; Sevgi, Duriye Damla; Susarla, Gayatri; Papaliodis, George N.; Sobrin, Lucia (Ocular immunology and inflammation, 2021)
Purpose: To compare the safety and efficacy of trans-septal vs. modified posterior sub-Tenon's (PST) corticosteroid injections for noninfectious uveitis.Methods: Retrospective comparison of periocular triamcinolone injection by modified PST (n = 36) vs. traditional trans-septal (n = 79) techniques. Safety and efficacy outcomes were analyzed with regression models.Results: There was no significant difference in visual acuity improvement between the groups at 6 months. There were higher rates of vitritis resolution in the modified PST group but this was not statistically significant (85.7% vs 62.9%, p = .07). Intraocular pressure (IOP) elevation rate trended higher with the modified PST injection (21.9% vs 9.0%, p = .06), with no instances of glaucoma surgery in either group. Two modified PST injection patients with refractory IOP rises had IOP normalization after corticosteroid depot removal. One year cataract surgery rates were similar.Conclusion: Modified PST injection offers clinical efficacy but with possibly higher IOP response rate which could be managed with corticosteroid removal.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Glucocorticoids/*therapeutic use; uveitis; Visual Acuity/physiology; Intraocular Pressure/physiology; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Triamcinolone Acetonide/*therapeutic use; *Injections, Intraocular; Periocular steroid injection; steroid intraocular pressure response; Tenon Capsule/*drug effects; uveitic cystoid macular edema; vitritis

Efficacy and safety of latanoprost in eyes with uveitic glaucoma. - Markomichelakis, Nikos N.; Kostakou, Agori; Halkiadakis, Ioannis; Chalkidou, Sonia; Papakonstantinou, Dimitrios; Georgopoulos, Gerasimos (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2009)
BACKGROUND: To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis. METHODS: Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment. RESULTS: Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p = 0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p = 0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 +/- 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 +/-0.7 for these patients (p = 0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 +/- 8.4 mmHg to 18.6 +/- 5.3 mmHg (p < 0.001) in the latanoprost group and from 28.2 +/-8.1 mmHg to 22.6 +/-10.1 mmHg (p < 0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema. CONCLUSION: Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma.
Keywords: Female; Humans; Male; Adult; Follow-Up Studies; Treatment Outcome; Drug Combinations; Recurrence; Visual Acuity; Tonometry, Ocular; Gonioscopy; Antihypertensive Agents/adverse effects/*therapeutic use; Glaucoma/*drug therapy/etiology; Intraocular Pressure/*drug effects; Latanoprost; Ocular Hypertension/drug therapy/etiology; Prostaglandins F, Synthetic/adverse effects/*therapeutic use; Sulfonamides/adverse effects/therapeutic use; Thiophenes/adverse effects/therapeutic use; Timolol/adverse effects/therapeutic use; Uveitis, Anterior/complications/*drug therapy; Uveitis, Intermediate/complications/*drug therapy

The Influence of Phacoemulsification on Intraocular Pressure Control and Trabeculectomy Survival in Uveitic Glaucoma. - Almobarak, Faisal A.; Alharbi, Ali H.; Morales, Jose; Aljadaan, Ibrahim (Journal of glaucoma, 2017)
OBJECTIVES: To evaluate the influence of phacoemulsification on intraocular pressure (IOP) control and survival of mitomycin C (MMC)-enhanced trabeculectomy in uveitic glaucoma (UG). MATERIALS AND METHODS: Retrospective case-control study included 54 eyes from 40 patients with UG who underwent MMC-enhanced trabeculectomy as an initial procedure to treat glaucoma at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 2002 and 2014. Eyes were divided into 2 groups: the first group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second group included eyes that did not have cataract surgery. The main outcome measures were changes in the IOP, the number of antiglaucoma medications, IOP control, and trabeculectomy survival. RESULTS: There were no differences in the overall trabeculectomy survival of eyes that underwent cataract surgery and those that did not (P=0.681, log-rank) nor the final IOP [15.54 mm Hg (±6.3) in the study group and 13.34 mm Hg (±5.6) in the control group, P=0.247]. However, more antiglaucoma medications were needed to control the IOP after cataract surgery at the last follow-up [1.59 medications (±1.4) in the study group and 0.50 medications (±0.7) in the control group; P=0.009]. CONCLUSIONS: UG eyes that underwent phacoemulsification following MMC-enhanced trabeculectomy required more medications to control the IOP than those that did not undergo cataract surgery and therefore less IOP control. Such changes in IOP control did not affect the overall trabeculectomy survival rate.
Keywords: Female; Humans; Male; Middle Aged; Adult; Case-Control Studies; Retrospective Studies; Treatment Outcome; Visual Acuity; Intraocular Pressure/*physiology; Tonometry, Ocular; *Phacoemulsification; Alkylating Agents/administration & dosage; Antihypertensive Agents/administration & dosage; Cataract/*etiology; Glaucoma, Open-Angle/physiopathology/*surgery; Lens Implantation, Intraocular; Mitomycin/administration & dosage; Trabecular Meshwork/drug effects; Trabeculectomy/*adverse effects; Uveitis/physiopathology/*surgery

Retinal vessel oxygen saturation is affected in uveitis associated with Vogt-Koyanagi-Harada disease. - Abu El-Asrar, Ahmed M.; AlBloushi, Abdulrahman F.; Gikandi, Priscilla W.; Hardarson, Sveinn Hákon; Stefánsson, Einar (The British journal of ophthalmology, 2019)
AIMS: To discover whether retinal vessel oxygen metabolism is affected in uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS: 41 patients with VKH disease (82 eyes) and 12 healthy subjects (24 eyes) matched in age and gender were prospectively evaluated. Retinal oxygen saturation and vessel calibre were measured with a non-invasive spectrophotometric retinal oximeter (Oxymap T1). RESULTS: In healthy controls, mean arteriolar oxygen saturation (%) was 93.8±5.9 and venular saturation was 60.1±5.8. In acute VKH uveitic phase associated with exudative retinal detachment (n=12), arteriolar and venular oxygen saturation values were 104.7±7.8 and 67.9±7.7, respectively, and both are significantly higher than the healthy group (p<0.001; p=0.001, respectively). In patients with VKH disease who recovered after immunosuppressive therapy and restored normal anatomy without 'sunset glow fundus' (n=13), oximetry values were 96.4±9.6 and 61.6±7.5, respectively, similar to healthy controls. In patients with 'sunset glow fundus' and chorioretinal atrophy (n=16), saturation levels were 88.6±7.8 and 50.0±13.1, respectively, significantly lower than healthy controls (p=0.02; p=0.003, respectively). These patients also had significantly smaller diameter of retinal arterioles and venules compared with controls (p=0.035; p=0.001, respectively). CONCLUSIONS: Retinal oxygen metabolism is altered in uveitis associated with VKH disease. Oxygen saturation profile is abnormal in acute uveitic phase of the disease and returns to normal in those who recover with normal fundus appearance, but not in eyes that suffer permanent anatomical damage with 'sunset glow fundus' and chorioretinal atrophy. Retinal oximetry may be of value in evaluating vascular and metabolic aspects of posterior uveitis.
Keywords: Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Prospective Studies; Young Adult; Adolescent; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; Fundus Oculi; Visual Acuity; Ophthalmoscopy; *uveitis; *retinal oxymetry; *retinal vessel oxygen saturation; *vogt-koyanagi-harada disease; Antibiotics, Antineoplastic/therapeutic use; Coloring Agents/administration & dosage; Indocyanine Green/administration & dosage; Mycophenolic Acid/therapeutic use; Oximetry; Oxygen/*blood; Retinal Vessels/*physiology; Uveitis/diagnosis/drug therapy/*physiopathology; Uveomeningoencephalitic Syndrome/diagnosis/drug therapy/*physiopathology

Clinical features and visual outcome of intermediate uveitis in children. - Jain, Rajni; Ferrante, Paulo; Reddy, Gopi T.; Lightman, Susan (Clinical & experimental ophthalmology, 2005)
PURPOSE: To determine the presentation, course, treatment and outcome of idiopathic intermediate uveitis in children. METHODS: The records of all patients under the age of 16 presenting with idiopathic intermediate uveitis under the care of one consultant (SL) between 1990 and 2001 were reviewed. The case notes were analysed with respect to presenting symptoms, associated conditions, ocular signs, change in visual acuity, treatment and complications. All patients with systemic disease were specifically excluded from the study. RESULTS: Twenty-six patients (45 eyes) were identified with intermediate uveitis from 114 cases of childhood uveitis seen. The mean age at presentation was 10 years (range 7-13 years) and the average follow-up time was 3 years (range 0-7 years). All patients had varying degrees of vitritis, 28 eyes had snowbanks and 5 had cystoid macular oedema at presentation. Six patients required no treatment, five received topical treatment only, five were managed with orbital floor steroids alone and a further two were managed with orbital floor steroids and oral prednisolone. Systemic steroids were required in eight patients, four of whom also required cyclosporin. Six of these children had successful disease control and maintained a visual acuity of 6/9 in at least one affected eye. CONCLUSION: Idiopathic intermediate uveitis is a relatively uncommon condition in children but can have severe effects on vision. With careful management, vision can be preserved in at least one eye. This study describes the course of the disease in a relatively large series. The variation in disease severity prompts the use of individually tailored immunosuppressive regimens.
Keywords: Female; Humans; Male; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Child; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/*physiology; Age Distribution; Uveitis, Intermediate/*diagnosis/drug therapy

Nd:YAG Laser Posterior Capsulotomy in Adult Patients with Uveitis. - Kolli, Hema; Evers, Charlotte; Murray, Philip I. (Ocular immunology and inflammation, 2021)
Purpose: To study the complication rate of Nd:YAG laser posterior capsulotomy in patients with uveitis.Method: Retrospective case note analysis of pseudophakic uveitis patients having undergone Nd:YAG laser posterior capsulotomy between January 2016 and December 2018. Complications documented included uveitis flare, raised intraocular pressure, intraocular lens damage/displacement, cystoid macular edema, and retinal detachment.Results: There were 39 eyes of 38 patients (20M, 18F; age 27-89 years). Mean interval between cataract surgery and laser was 55 months (range 8-286 months). Mean laser energy was 79 mJ (range 33-207 mJ). At 3 months 62% of eyes achieved a 2-5 Snellen line improvement that was maintained at 12 months. Vision was unchanged in 21% of eyes due to preexisting pathology, with no eyes having worse vision. No post-laser complications were documented.Conclusions: Nd:YAG laser posterior capsulotomy is a safe procedure in uveitis patients, resulting in a good improvement in vision.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Visual Acuity/physiology; Uveitis; Tonometry, Ocular; complications; Intraocular Pressure; Uveitis/*complications; Laser Therapy/*methods; Lens Implantation, Intraocular; Lasers, Solid-State/*therapeutic use; Nd:YAG laser; Phacoemulsification; posterior capsulotomy; Posterior Capsulotomy/*methods; pseudophakia; Pseudophakia/complications

Safety and Efficacy of Intravitreal Dexamethasone Implant for Refractory Uveitic Macular Edema in Adults and Children. - Ratra, Dhanashree; Barh, Atanu; Banerjee, Manideepa; Ratra, Vineet; Biswas, Jyotirmay (Ocular immunology and inflammation, 2018)
PURPOSE: To assess safety and efficacy of intravitreal dexamethasone (DEX) implant in refractory uveitic macular edema (ME). METHODS: We retrospectively analyzed medical records of patients with nonresponsive ME secondary to chronic, noninfectious intermediate or posterior uveitis, treated with intravitreal DEX implants. RESULTS: A total of 42 eyes of 34 patients (aged 6-67 years) received 56 implants. Mean follow-up was 19.2 ± 2.2 months after DEX implant. The mean visual acuity (0.48 ± 0.06 logMAR to 0.34 ± 0.1 logMAR) and mean central retinal thickness (472.2 ± 35 to 274.7 ± 60.6 µm) improved considerably before and after DEX implant. A total of 11 eyes needed repeat implants after a prolonged time to recurrence (12.6-20.9 months). A total of 10 eyes needed no additional treatment. Oral steroids could be stopped in 40% patients. Intraocular pressure increased in seven and cataract progressed in six eyes. CONCLUSION: Intravitreal DEX implant is safe and effective adjunct therapy. It reduces dependence on systemic steroids, immunosuppressives and provides long-term effects.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Child; uveitis; Drug Implants; Intravitreal Injections; Intraocular Pressure; Retina/pathology; Visual Acuity/drug effects; Dexamethasone/*administration & dosage/adverse effects; Glucocorticoids/*administration & dosage/adverse effects; Dexamethasone; intravitreal injection; macular edema; Macular Edema/*drug therapy/etiology/physiopathology; Retreatment; sustained release implant; Uveitis/complications/*drug therapy/physiopathology

Injectable Fluocinolone Acetonide Long-Acting Implant for Noninfectious Intermediate Uveitis, Posterior Uveitis, and Panuveitis: Two-Year Results. - Jaffe, Glenn J.; Lin, Phoebe; Keenan, Robert T.; Ashton, Paul; Skalak, Cindy; Stinnett, Sandra S. (Ophthalmology, 2016)
PURPOSE: To determine the effect of an injectable fluocinolone acetonide implant (FAi) in eyes with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. DESIGN: Noncomparative, interventional, dose-randomized, dose-masked, prospective, individual, investigator-sponsored investigational new drug study. PARTICIPANTS: Eleven eyes of 11 participants with a history of recurrent noninfectious intermediate uveitis, posterior, or panuveitis. METHODS: Participants were randomized to receive either a low- or a high-dose FAi. Eyes were observed on day 0 (day the implant was injected) and then at regular intervals through 2 years. MAIN OUTCOME MEASURES: Ocular inflammation, visual acuity, anti-inflammatory medication use, and safety parameters before and after FAi implantation. RESULTS: All participants were followed up for 2 years. At baseline, mean study eye visual acuity was 0.56 logarithm of the minimum angle of resolution (logMAR; standard deviation [SD], 0.43 logMAR). These values improved significantly to +0.25 logMAR (SD, 0.14 logMAR) and +0.17 logMAR (SD, 0.14 logMAR) at 12 and 24 months after implantation, respectively (P = 0.041 and P = 0.016, respectively). The average number of inflammation recurrences in the 12 months before implantation was 1.54 episodes per eye. None of the study eyes experienced a recurrence during the follow-up period. Of the 6 participants who continued receiving systemic medication after implantation, the dosage was reduced in 4 participants. Five of 11 eyes received an average of 1.6 posterior sub-Tenon triamcinolone acetonide (PSTA) injections in the 12 months preceding implantation. None required a PSTA injection after FAi implantation. The most common adverse event was intraocular pressure (IOP) rise. At baseline, 1 study eye (9%) required pressure-lowering drops; 2 additional study eyes (18%) required them during the follow-up period. Filtering procedures were performed in 2 of these eyes (18.1%). No FAi explantations were required, nor were any participants lost to follow-up during the investigation. CONCLUSIONS: It is feasible to place a long-acting FAi in an outpatient setting, without prolonged adverse events attributed to the implant injection procedure. The FAi effectively controlled intraocular inflammation in all eyes in the study, and at the last follow-up, all implanted eyes demonstrated an improvement in visual acuity. Elevated IOP that occurred in 18% of FAi-implanted eyes was managed by standard means. The FAi implant is a promising approach for patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis who do not respond to, or are intolerant to, conventional therapy.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Young Adult; Visual Acuity; Drug Implants; Glucocorticoids/*administration & dosage; Intraocular Pressure; Fluocinolone Acetonide/*administration & dosage; Uveitis, Posterior/*drug therapy; Anti-Inflammatory Agents/*administration & dosage; Delayed-Action Preparations/*therapeutic use; Panuveitis/*drug therapy; Uveitis, Intermediate/*drug therapy

Anti-Tumor Necrosis Factor Treatment in the Management of Pediatric Noninfectious Uveitis: Infliximab Versus Adalimumab. - Ucan Gunduz, Gamze; Yalcinbayir, Ozgur; Cekic, Sukru; Yildiz, Meral; Kilic, Sara S. (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2021)
Purpose: Management of uveitis displays a particular challenge in childhood. This study aims to compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in pediatric noninfectious uveitis that were refractory to conventional immunosuppresives. Methods: This retrospective single-center study included 33 patients who were treated with anti-tumor necrosis factor (TNF) agents (16 with IFX and 17 with ADA). Patients had diverse etiologies, including juvenile idiopathic arthritis, idiopathic uveitis, and Behçet's disease. Demographic characteristics, systemic diagnosis, findings of the ophthalmological examination, control of ocular inflammation, response to treatment, and the rate of clinical remission were studied. Results: Fourteen (87.5%) patients receiving IFX and 10 (58.8%) patients receiving ADA achieved response to treatment during the follow-up (P = 0.118). The agents were discontinued with complete clinical remission in 6 (37.5%) patients receiving IFX and in 2 (11.8%) patients receiving ADA (P = 0.118). Baseline visual acuities and parameters of inflammation improved significantly in both groups after anti-TNF therapy. Conclusion: Both IFX and ADA are safe and effective for pediatric noninfectious uveitis.
Keywords: Female; Humans; Male; Case-Control Studies; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Safety; Adolescent; Remission Induction; Inflammation/drug therapy; Child; Child, Preschool; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Cross-Sectional Studies; Uveitis/diagnosis/*drug therapy/etiology; Visual Acuity/drug effects; *uveitis; *adalimumab; *infliximab; *noninfectious; *pediatric; Adalimumab/administration & dosage/*adverse effects/therapeutic use; Eye Diseases/pathology; Infliximab/administration & dosage/*adverse effects/therapeutic use; Noncommunicable Diseases/*drug therapy; Tumor Necrosis Factor Inhibitors/administration & dosage/*adverse effects/therapeutic use

Outcome of Treating Pediatric Uveitis With Dexamethasone Implants. - Tomkins-Netzer, Oren; Talat, Lazha; Seguin-Greenstein, Sophie; Bar, Asaf; Lightman, Sue (American journal of ophthalmology, 2016)
PURPOSE: To describe the outcome in children of eyes with uveitis following repeated treatment with dexamethasone (Ozurdex) implants. DESIGN: Retrospective, interventional study. METHODS: Twenty-two eyes of 16 pediatric patients with uveitis were treated with 35 dexamethasone implants at a tertiary referral center. Following implantations, anatomic and functional outcomes, as well as ocular complications, were noted. Main outcome measures included best-corrected visual acuity, central retinal thickness, number and dosage of systemic immunosuppression drugs, vitreous haze score, and presence of raised intraocular pressure or cataract. RESULTS: Following the first implantation, average best-corrected visual acuity improved significantly from 0.55 ± 0.08 logMAR to 0.37 ± 0.08 logMAR (P = .024), central retinal thickness decreased by 219 ± 55 μm (P = .01), and the percentage of eyes achieving a vitreous haze score of 0 increased from 41% to 88% (P = .006). The median time to relapse following the first injection was 9 months, with a similar response achieved after each repeat implantation. Children previously requiring systemic immunosuppression at the time of the first implantation were able to stop or significantly reduce the dose and number of drugs. In total there were 4 instances of cataract progression that were not visually significant and did not require surgical treatment and 6 cases of raised IOP, 5 of which were treated pharmacologically with no surgical intervention required and 1 that required revision of a previous filtration surgery. There were no cases of implant migration into the anterior chamber, endophthalmitis, or retinal detachment. CONCLUSIONS: The use of dexamethasone implants in children results in improved retinal thickness and reduction in ocular inflammation, which can improve vision for several months. Repeat implantations result in continued control of the inflammation, allowing for reduction of systemic immunosuppression with few ocular complications.
Keywords: Female; Humans; Male; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Child; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Visual Acuity/drug effects; Uveitis, Posterior/diagnosis/*drug therapy/physiopathology; Retreatment; Panuveitis/diagnosis/*drug therapy/physiopathology; Uveitis, Intermediate/diagnosis/*drug therapy/physiopathology

A randomized clinical trial comparing methotrexate and mycophenolate mofetil for noninfectious uveitis. - Rathinam, Sivakumar R.; Babu, Manohar; Thundikandy, Radhika; Kanakath, Anuradha; Nardone, Natalie; Esterberg, Elizabeth; Lee, Salena M.; Enanoria, Wayne T. A.; Porco, Travis C.; Browne, Erica N.; Weinrib, Rachel; Acharya, Nisha R. (Ophthalmology, 2014)
OBJECTIVE: To compare the relative effectiveness of methotrexate and mycophenolate mofetil for noninfectious intermediate uveitis, posterior uveitis, or panuveitis. DESIGN: Multicenter, block-randomized, observer-masked clinical trial. PARTICIPANTS: Eighty patients with noninfectious intermediate, posterior, or panuveitis requiring corticosteroid-sparing therapy at Aravind Eye Hospitals in Madurai and Coimbatore, India. INTERVENTION: Patients were randomized to receive 25 mg weekly oral methotrexate or 1 g twice daily oral mycophenolate mofetil and were monitored monthly for 6 months. Oral prednisone and topical corticosteroids were tapered. MAIN OUTCOME MEASURES: Masked examiners assessed the primary outcome of treatment success, defined by achieving the following at 5 and 6 months: (1) ≤0.5+ anterior chamber cells, ≤0.5+ vitreous cells, ≤0.5+ vitreous haze and no active retinal/choroidal lesions in both eyes, (2) ≤10 mg of prednisone and ≤2 drops of prednisolone acetate 1% a day, and (3) no declaration of treatment failure because of intolerability or safety. Additional outcomes included time to sustained corticosteroid-sparing control of inflammation, change in best spectacle-corrected visual acuity, resolution of macular edema, adverse events, subgroup analysis by anatomic location, and medication adherence. RESULTS: Forty-one patients were randomized to methotrexate and 39 to mycophenolate mofetil. A total of 67 patients (35 methotrexate, 32 mycophenolate mofetil) contributed to the primary outcome. Sixty-nine percent of patients achieved treatment success with methotrexate and 47% with mycophenolate mofetil (P = 0.09). Treatment failure from adverse events or tolerability was not different by treatment arm (P = 0.99). There were no differences between treatment groups in time to corticosteroid-sparing control of inflammation (P = 0.44), change in best spectacle-corrected visual acuity (P = 0.68), or resolution of macular edema (P = 0.31). CONCLUSIONS: There was no statistically significant difference in corticosteroid-sparing control of inflammation between patients receiving methotrexate or mycophenolate mofetil. However, there was a 22% difference in treatment success favoring methotrexate.
Keywords: Female; Humans; Male; Middle Aged; Adult; Young Adult; Methotrexate/adverse effects/*therapeutic use; Administration, Oral; Visual Acuity; Uveitis/*drug therapy; Immunosuppressive Agents/adverse effects/*therapeutic use; Macular Edema/drug therapy; Mycophenolic Acid/adverse effects/*analogs & derivatives/therapeutic use

Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia. - Shantha, Jessica G.; Crozier, Ian; Hayek, Brent R.; Bruce, Beau B.; Gargu, Catherine; Brown, Jerry; Fankhauser, John; Yeh, Steven (Ophthalmology, 2017)
PURPOSE: To describe the ocular findings, visual impairment, and association of structural complications of uveitis with visual impairment in a cohort of survivors of Ebola virus disease (EVD) in Monrovia, Liberia. DESIGN: Retrospective, uncontrolled, cross-sectional study. PARTICIPANTS: Survivors of EVD who were evaluated in an ophthalmology clinic at Eternal Love Winning Africa (ELWA) Hospital in Monrovia, Liberia. METHODS: A cohort of EVD survivors who underwent baseline ophthalmic evaluation at ELWA Hospital were retrospectively reviewed for demographic information, length of Ebola treatment unit (ETU) stay, visual acuity (VA), and ophthalmic examination findings. For patients with uveitis, disease activity (active vs. inactive) and grade of inflammation were recorded according to Standardization of Uveitis Nomenclature criteria. The level of VA impairment was categorized according to World Health Organization classification for VA impairment as follows: normal/mild, VA 20/70 or better; moderate, VA 20/70-20/200; severe, VA 20/200-20/400; blindness, VA <20/400. Visual acuity, length of ETU stay, and structural complications were compared between EVD survivors with and without uveitis. Structural complications associated with moderate VA impairment or poorer were analyzed. MAIN OUTCOME MEASURES: Frequency of ocular complications including uveitis and optic neuropathy in EVD survivors, level of VA impairment in EVD survivors with uveitis, and structural complications associated with VA impairment in EVD survivors. RESULTS: A total of 96 survivors of EVD were examined. A total of 21 patients developed an EVD-associated uveitis, and 3 patients developed an EVD-associated optic neuropathy. Visual acuity was blind (VA >20/400) in 38.5% of eyes with uveitis. Anatomic subtypes of uveitis included anterior, posterior, and panuveitis in 2, 13, and 6 patients, respectively. Examination findings associated with at least moderate visual impairment by World Health Organization criteria (VA <20/70) included keratic precipitates (P < 0.002), posterior synechiae (P < 0.002), vitritis (P < 0.005), and chorioretinal scars (P < 0.02). CONCLUSIONS: Survivors of EVD are at risk for uveitis, which may lead to secondary structural complications, visual impairment, and blindness. Eye care resources should be mobilized for EVD survivors in West Africa because of the frequency of this spectrum of disease complication and its potential for severe VA impairment and blindness.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Length of Stay; Retrospective Studies; Risk Factors; Young Adult; Adolescent; Child; Cross-Sectional Studies; Visual Acuity; Cataract/epidemiology/etiology; Hemorrhagic Fever, Ebola/*complications; Liberia/epidemiology; Uveitis/epidemiology/*etiology; Vision Disorders/epidemiology/*etiology/pathology

Adalimumab for Treatment of Noninfectious Uveitis: Immunogenicity and Clinical Relevance of Measuring Serum Drug Levels and Antidrug Antibodies. - Cordero-Coma, Miguel; Calleja-Antolín, Sara; Garzo-García, Irene; Nuñez-Garnés, Ana M.; Álvarez-Castro, Carolina; Franco-Benito, Manuel; Ruiz de Morales, Jose G. (Ophthalmology, 2016)
PURPOSE: To evaluate the rate of immunogenicity induced by adalimumab and its relationship with drug serum levels and clinical responses in patients with noninfectious uveitis. DESIGN: Prospective observational study. PARTICIPANTS: Consecutive patients from 1 referral center who initiated treatment with adalimumab for active noninfectious uveitis resistant to conventional therapy. METHODS: All patients received 40 mg adalimumab every other week. Patients were evaluated clinically and immunologically before and after 4, 8, and 24 weeks of treatment. MAIN OUTCOME MEASURES: Clinical evaluation included assessment of changes in visual acuity, degree of inflammation in the anterior chamber and vitreous cavity, central macular thickness, and retinal angiographic leakage. Immunologic evaluation included assessment of serum trough adalimumab and antibodies against adalimumab (AAA) levels and class II HLA typing. RESULTS: Twenty-five patients were enrolled. Overall, 18 of 25 patients (72%) showed a favorable clinical response to adalimumab therapy. Eleven patients (44%) achieved a complete response and 7 (28%) achieved a partial response. However, 7 of 25 patients (28%) were considered nonresponders. Median trough adalimumab serum levels were higher in responders than in nonresponders (P < 0.001). We observed AAA positivity (AAA+) at least 1 time point in 8 of 25 patients (32%), including 4 with transitory AAA and 4 with permanent AAA. In all patients with permanent AAA+, trough adalimumab levels became undetectable (P < 0.001). However, in patients who demonstrated transitory AAA+, no correlation was observed between AAA titers and adalimumab trough levels (P = 0.2).Concomitant immunosuppression did not show any protective effect on adalimumab immunogenicity in our cohort. An association between the presence of AAA+ and a worse uveitis outcome was observed only in patients with permanent AAA+, which correlated with undetectable adalimumab trough levels (P = 0.014). CONCLUSIONS: Treatment of noninfectious uveitis with adalimumab is associated with high rates of favorable clinical response. Overall, adalimumab trough levels were higher in responder patients. Development of permanent AAA was associated with undetectable trough adalimumab levels and worse uveitis outcome. Immunogenicity was more common in patients in whom uveitis was associated with a systemic disease and was not influenced by concomitant immunosuppressors.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Treatment Outcome; Adolescent; Remission Induction; Child; Child, Preschool; Enzyme-Linked Immunosorbent Assay; Antibodies, Anti-Idiotypic/*blood; Visual Acuity; Adalimumab/immunology/*therapeutic use; Anti-Inflammatory Agents/immunology/pharmacokinetics/*therapeutic use; Antibody Formation/immunology; Histocompatibility Testing; Uveitis/*blood/*drug therapy

Infliximab for uveitis of Behçet's syndrome: a trend for earlier initiation. - Guzelant, Gul; Ucar, Didar; Esatoglu, Sinem Nihal; Hatemi, Gulen; Ozyazgan, Yilmaz; Yurdakul, Sebahattin; Seyahi, Emire; Yazici, Hasan; Hamuryudan, Vedat (Clinical and experimental rheumatology, 2017)
OBJECTIVES: The prognosis of uveitis in Behçet's syndrome (BS) has improved over decades. Whether this is related to the use of more aggressive management strategies is not known. METHODS: This is a retrospective study of BS patients who received infliximab (IFX) for refractory eye disease between 2003-2015. The patients were divided into two groups according to the date of onset of in IFX treatment as before and after 2013. We compared the two groups in terms of disease characteristics at the onset of IFX treatment and response to treatment. RESULTS: There were 43 patients in the old and 14 patients in the new group. The duration of uveitis and previous immunosuppressive treatment before the initiation of IFX were significantly shorter in the new group compared to the old group (p=0.043 and p=0.028, respectively). The baseline visual acuity (VA) at the initiation of IFX was better in the new group, but this was only significant for the left eye. Treatment with IFX was effective in both groups in preserving VA and this was more pronounced in the new group. Attack frequency under IFX was significantly lower in the new group (p<0.001). CONCLUSIONS: IFX seems to be initiated earlier and also in less severe cases during the course of BS uveitis than before. Despite the few numbers of patients and relatively short duration of follow-up, our results give a hint that this change has improved the outcome.
Keywords: Female; Humans; Male; Adult; Time Factors; Retrospective Studies; Treatment Outcome; Severity of Illness Index; Drug Administration Schedule; Visual Acuity/drug effects; Anti-Inflammatory Agents/*administration & dosage/adverse effects; *Time-to-Treatment; Behcet Syndrome/complications/diagnosis/*drug therapy/immunology; Infliximab/*administration & dosage/adverse effects; Uveitis/diagnosis/*drug therapy/immunology

COMBINED VITRECTOMY WITH INTRAVITREAL DEXAMETHASONE IMPLANT FOR REFRACTORY MACULAR EDEMA SECONDARY TO DIABETIC RETINOPATHY, RETINAL VEIN OCCLUSION, AND NONINFECTIOUS POSTERIOR UVEITIS. - Pang, John Paul; Son, Gisung; Yoon, Young Hee; Kim, June-Gone; Lee, Joo Yong (Retina (Philadelphia, Pa.), 2020)
PURPOSE: To compare the efficacy of intraoperative intravitreal dexamethasone implant for macular edema secondary to diabetic retinopathy (DME), retinal vein occlusion (RVO), and noninfectious posterior uveitis. METHODS: A retrospective review of 62 patients (29 men and 33 women; mean age 51.19 ± 14.41 years; 65 eyes) was performed. Best-corrected visual acuity (in logarithm of the minimal angle of resolution), central foveal thickness, intraocular pressure, and postoperative edema-free period were postoperatively assessed up to 1 year. The preoperative and postoperative numbers of other intravitreal injections needed were compared. RESULTS: Best-corrected visual acuity gradually improved in the DME group (from 0.87 to 0.51) but failed to improve from Month 3 onward in the RVO and uveitis groups. Central foveal thickness decreased in all groups, especially in the DME group (from 550.93 to 338.10 μm). Edema-free period was longest in the DME group (19.34 ± 15.12 months), followed by the uveitis (12.91 ± 7.85 months) and RVO (8.50 ± 8.76 months) groups. Subjects in the uveitis group used more intraocular pressure-lowering agents (1.00 ± 1.27) than those in the DME (0.13 ± 0.49) and RVO (0.36 ± 0.79) groups. Increased intraocular pressure events were most frequent in postoperative Week 1, especially in the uveitis group. CONCLUSION: Vitrectomy combined with intravitreal dexamethasone implant for DME, RVO, and noninfectious posterior uveitis had a favorable clinical outcome.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Combined Modality Therapy; Tomography, Optical Coherence; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; *Vitrectomy; Diabetic Retinopathy/*complications; Macular Edema/diagnostic imaging/etiology/physiopathology/*therapy; Retinal Vein Occlusion/*complications; Uveitis, Posterior/*complications

Outcomes of Vogt-Koyanagi-Harada Disease: A Subanalysis From a Randomized Clinical Trial of Antimetabolite Therapies. - Shen, Elizabeth; Rathinam, Sivakumar R.; Babu, Manohar; Kanakath, Anuradha; Thundikandy, Radhika; Lee, Salena M.; Browne, Erica N.; Porco, Travis C.; Acharya, Nisha R. (American journal of ophthalmology, 2016)
PURPOSE: To report outcomes of Vogt-Koyanagi-Harada (VKH) disease from a clinical trial of antimetabolite therapies. DESIGN: Subanalysis from an observer-masked randomized clinical trial for noninfectious intermediate, posterior, and panuveitis. METHODS: setting: Clinical practice at Aravind Eye Hospitals, India. PATIENT POPULATION: Forty-three of 80 patients enrolled (54%) diagnosed with VKH. INTERVENTION: Patients were randomized to either 25 mg oral methotrexate weekly or 1 g mycophenolate mofetil twice daily, with a corticosteroid taper. MAIN OUTCOME MEASURES: Primary outcome was corticosteroid-sparing control of inflammation at 5 and 6 months. Secondary outcomes included visual acuity, central subfield thickness, and adverse events. Patients were categorized as acute (diagnosis ≤3 months prior to enrollment) or chronic (diagnosis >3 months prior to enrollment). RESULTS: Twenty-seven patients were randomized to methotrexate and 16 to mycophenolate mofetil; 30 had acute VKH. The odds of achieving corticosteroid-sparing control of inflammation with methotrexate were 2.5 times (95% CI: 0.6, 9.8; P = .20) the odds with mycophenolate mofetil, a difference that was not statistically significant. The average improvement in visual acuity was 12.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. On average, visual acuity for patients with acute VKH improved by 14 more ETDRS letters than those with chronic VKH (P < .001), but there was no difference in corticosteroid-sparing control of inflammation (P = .99). All 26 eyes with a serous retinal detachment at baseline resolved, and 88% achieved corticosteroid-sparing control of inflammation. CONCLUSIONS: The majority of patients treated with antimetabolites and corticosteroids were able to achieve corticosteroid-sparing control of inflammation by 6 months. Although patients with acute VKH gained more visual improvement than those with chronic VKH, this did not correspond with a higher rate of controlled inflammation.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Administration Schedule; Methotrexate/administration & dosage/*therapeutic use; Visual Acuity; Immunosuppressive Agents/administration & dosage/*therapeutic use; Enzyme Inhibitors/administration & dosage/*therapeutic use; Mycophenolic Acid/administration & dosage/*therapeutic use; Panuveitis/*drug therapy/etiology/physiopathology; Uveomeningoencephalitic Syndrome/*drug therapy

Intravitreal injection therapy in the treatment of noninfectious uveitis. - Modorati, Giulio; Miserocchi, Elisabetta (Developments in ophthalmology, 2012)
Uveitis is responsible for 5-20% of legal blindness in the United States and in Europe. In noninfectious uveitis, the most frequent uveitic complication that endangers sight is cystoid macular edema. Clinical characteristics, inflammation grading and visual acuity determine the choice of the correct therapy for each patient. We can utilize drugs either alone or in combination using different dosages and routes of administration. Intravitreal injection directly into the vitreous cavity leads to rapid therapeutic drug concentration in the retinal tissue and reduces systemic side effects. Intravitreally injected triamcinolone acetonide is the most powerful drug for the treatment of cystoid macular edema related to intraocular inflammation, but it also causes the most frequent and serious side effects. Due to the numerous side effects associated with the use of corticosteroids, there is a need to identify other anti-inflammatory agents with a better safety profile. Recent studies have demonstrated that intravitreal immunosuppressant injections of methotrexate or anti-VEGF agents may lead to fewer intraocular side effects, but also have a lower therapeutic activity for the reduction of macular edema. At present, intraocular anti-TNF-α drugs do not show promising results. As regards nonsteroidal anti-inflammatory drugs, further data are necessary to fully understand their efficacy and potential side effects.
Keywords: Humans; Intravitreal Injections; Animals; Anti-Inflammatory Agents/*administration & dosage/pharmacokinetics; Immunosuppressive Agents/*administration & dosage/pharmacokinetics; Macular Degeneration/etiology/prevention & control; Macular Edema/etiology/prevention & control; Uveitis/complications/*drug therapy/metabolism

Development of a dexamethasone intravitreal implant for the treatment of noninfectious posterior segment uveitis. - Whitcup, Scott M.; Robinson, Michael R. (Annals of the New York Academy of Sciences, 2015)
Uveitis is a group of ocular inflammatory disorders that can lead to severe vision loss. Despite advances in anti-inflammatory therapy, many patients are resistant to or intolerant of existing treatments. A biodegradable, sustained-release implant, dexamethasone intravitreal implant 0.7 mg (Ozurdex), has been developed to deliver dexamethasone to target tissues in the posterior segment of the eye, minimizing systemic drug exposure and limiting side effects. The implant releases dexamethasone over a period of up to 6 months as the poly(D,L-lactide-co-glycolide) polymer matrix of the implant is metabolized to carbon dioxide and water. The implant is placed in the vitreous of the eye with a single-use applicator in a sutureless, office-based procedure. Treatment with a single dexamethasone intravitreal implant in patients with noninfectious intermediate or posterior uveitis has been shown to produce significant improvements in intraocular inflammation and best-corrected visual acuity with treatment benefit sustained for 6 months. Dexamethasone intravitreal implant has also been shown to reduce central retinal thickness and improve best-corrected visual acuity in patients with macular edema of various etiologies. The implant has been approved for treatment of noninfectious uveitis involving the posterior segment, diabetic macular edema, and macular edema associated with branch and central retinal vein occlusion.
Keywords: Humans; Treatment Outcome; Uveitis/*drug therapy; Visual Acuity/drug effects; intravitreal injection; *Drug Delivery Systems; corticosteroids; Dexamethasone/pharmacology/*therapeutic use; drug delivery system; inflammation; Lactic Acid/chemistry; poly(d,l-lactide-co-glycolide); Polyglycolic Acid/chemistry; Polylactic Acid-Polyglycolic Acid Copolymer; visual acuity

Earlier use of systemic immunosuppression is associated with fewer ophthalmic surgeries in paediatric non-infectious uveitis. - Cheung, Crystal Sin Yi; Mireskandari, Kamiar; Ali, Asim; Silverman, Earl; Tehrani, Nasrin (The British journal of ophthalmology, 2020)
BACKGROUND/AIMS: There is a paucity of large trials investigating the effect of management strategies for paediatric non-infectious uveitis on complications requiring surgery. The purpose of our study is to investigate whether earlier initiation of systemic immunosuppression in paediatric non-infectious uveitis is associated with fewer ophthalmic surgeries. METHODS: A retrospective review was conducted on 48 children with non-infectious uveitis assessed in 1998-2013. Patients were divided into uveitis diagnosed before December 2008 (group 1) and after January 2009 (group 2). Duration from uveitis onset to methotrexate initiation (U-MTX) and biological addition (U-Biologic) were reviewed. Follow-up visits with topical corticosteroids >3 times daily and active uveitis (≥1+ cells) during 3.5 years were documented. The main outcome measure was the need for ≥1 ophthalmic surgery at 3.5 years. RESULTS: In group 1, 69.5% of patients required ≥1 ophthalmic surgery at 3.5 years versus 26.9% in group 2 (p=0.005). U-MTX was 28.9±11.8 weeks and 14.2±10.0 weeks for groups 1 and 2 (p=0.028). U-Biologic was 134.6±46.0 weeks and 82.3±43.3 weeks for groups 1 and 2 (p=0.0016). Corticosteroid use >3 times daily was 85.9±52.7 weeks and 14.6±11.1 weeks for groups 1 and 2. Multivariate regression showed methotrexate initiation within 6 months of uveitis onset lowered the likelihood of needing ophthalmic surgery at 3.5 years (OR=6.2, 95% CI 1.2 to 33.4; p=0.033). Univariate regression demonstrated biological addition within 18 months of uveitis onset reduced the likelihood of requiring ophthalmic surgery (OR 12.57, 95% CI 1.28 to 123.48; p=0.030). CONCLUSION: Earlier control of uveitis by addition of immunosuppressive therapy reduced the need for ophthalmic surgery.
Keywords: Female; Humans; Male; Time Factors; Retrospective Studies; Antirheumatic Agents/therapeutic use; Methotrexate/*therapeutic use; Administration, Oral; Child; Child, Preschool; *inflammation; Immunosuppressive Agents/*therapeutic use; Infliximab/therapeutic use; Glucocorticoids/administration & dosage; Visual Acuity/physiology; Injections, Subcutaneous; Adalimumab/therapeutic use; *glaucoma; *immunology; *lens and zonules; *treatment surgery; Arthritis, Juvenile/drug therapy/physiopathology; Eye Infections, Bacterial/drug therapy/microbiology; Immunosuppression Therapy; Ophthalmologic Surgical Procedures/*statistics & numerical data; Uveitis, Anterior/*drug therapy/microbiology/physiopathology

Combined Ahmed Glaucoma Valve Placement, Intravitreal Fluocinolone Acetonide Implantation and Cataract Extraction for Chronic Uveitis. - Chang, Ingrid T.; Gupta, Divakar; Slabaugh, Mark A.; Vemulakonda, Gurunadh A.; Chen, Philip P. (Journal of glaucoma, 2016)
PURPOSE: To report the outcomes of combined Ahmed glaucoma valve (AGV) placement, intravitreal fluocinolone acetonide implant, and cataract extraction procedure in the treatment of chronic noninfectious uveitis. PATIENTS AND METHODS: Retrospective case series of patients with chronic noninfectious uveitis who underwent AGV placement, intravitreal fluocinolone acetonide implantation, and cataract extraction in a single surgical session performed at 1 institution from January 2009 to November 2014. Outcome measures included intraocular pressure (IOP) and glaucoma medication use. Secondary outcome measures included visual acuity, systemic anti-inflammatory medications, number of uveitis flares, and complications. RESULTS: Fifteen eyes of 10 patients were studied, with a mean age of 40.3±15.7 and mean follow-up duration of 26 months (range, 13 to 39 mo). Before surgery, the IOP was 18.5±7.3 mm Hg and patients were using 1.5±1.5 topical glaucoma medications. At the 12-month follow-up, IOP was 12.8±3.2 mm Hg (P=0.01) and patients were using 0.5±0.8 (P=0.03) topical glaucoma medications. At 36 months of follow-up, late, nonsustained hypotony had occurred in 3 eyes (20%), and 1 eye (6%) had received a second AGV for IOP control. Before treatment, patients had 2.7±1.5 uveitis flares in the year before surgery while on an average of 2.1±0.6 systemic anti-inflammatory medications, which decreased to an average of 0.1±0.3 (P<0.01) flares the year after surgery while on an average of 0.4±1.1 (P<0.01) systemic medications. CONCLUSION: Combined AGV, intravitreal fluocinolone acetonide implant, and cataract extraction is effective in controlling IOP and reducing the number of glaucoma medications at 12 months after treatment in patients with chronic uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Chronic Disease; Glucocorticoids/administration & dosage; Visual Acuity; Drug Implants; Intravitreal Injections; *Glaucoma Drainage Implants; Tonometry, Ocular; Intraocular Pressure; Cataract/*complications; Fluocinolone Acetonide/*administration & dosage; Cataract Extraction/*methods; Filtering Surgery/*methods; Glaucoma/complications/*surgery; Uveitis/complications/*drug therapy/surgery

Outcome of Intravitreal Dexamethasone Implant Use in Uveitic Eyes Undergoing Pars Plana Vitrectomy Surgery. - Kirkland, Kyle A.; Uwaydat, Sami H.; Siddiqui, Mohammad Z.; Chancellor, John R.; Soliman, Mohamed K.; Kurup, Shree; Sallam, Ahmed B. (Ocular immunology and inflammation, 2021)
Purpose: To report the outcomes in eyes with noninfectious uveitis receiving dexamethasone implant at the time of pars plana vitrectomy (PPV).Methods: Retrospective analysis of visual acuity (VA), intraocular pressure (IOP), vitreous haze score (VHS), and central subfield thickness (CST) at baseline and follow-up visits.Results: Fourteen eyes received dexamethasone implant at the time of PPV. The CST was improved from 469 ± 182 µm at baseline to 320 ± 60 at 6 months (p = .0112) and 295 ± 46 at 12 months (p = .0728). Vitritis only recurred in 2 eyes at 6 months (18.2%) and 1 eye at 12 months (14.3%). The probability of VA improvement of ≥0.3 logMAR was 57% at 6 months and 66% at 12 months. Therapy for IOP rise was initiated in 6 eyes (42.9%).Conclusions: Local delivery of dexamethasone implant with PPV is a feasible method to counteract postoperative inflammation and macular thickening.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Tomography, Optical Coherence; uveitis; Visual Acuity/physiology; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; *Drug Implants; Phacoemulsification; *Vitrectomy; Dexamethasone Implant; Diabetic Retinopathy/surgery; Epiretinal Membrane/surgery; Panuveitis/diagnostic imaging/*drug therapy/physiopathology; PPV; Retinal Vein Occlusion/surgery; vitrectomy

Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients. - Rachmiel, Rony; Trope, Graham E.; Buys, Yvonne M.; Flanagan, John G.; Chipman, Mary L. (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2008)
BACKGROUND: The poor long-term success rate of repeat trabeculectomies in refractory uveitic glaucoma (UG) patients has led to the use of glaucoma drainage devices (GDDs). However, the success and complication rates of GDDs in UG patients utilizing a control group with standard demographic data, design, and surgical technique have never been evaluated. METHODS: Fifteen patients (15 eyes) with chronic uveitis and 53 patients (53 eyes) with uncontrolled open-angle glaucoma (OAG) who underwent Ahmed glaucoma valve (AGV) implantation were included in a retrospective, comparative, case-controlled study. Postoperative intraocular pressure (IOP), number of antiglaucoma medications, visual acuity, and complications were compared. RESULTS: There was a significant difference between the UG versus the OAG group with respect to age only (59.3 years vs 68.4 years, p = 0.006). Regression analysis of the postoperative IOP controlled for age and glaucoma type, and preoperative IOP revealed significantly lower IOP in the UG group at 1 month (p = 0.04; 95% confidence interval [CI] -5.9 to 0.15) and 2 months (p = 0.008; 95% CI -6.0 to 0.97). No significant differences were found at 3, 6, 12, 24, and 30 months. The cumulative success rates at 3 to 30 months for the UG and OAG groups were 80% to 66.6% versus 84.9% to 57% (p = 0.713), respectively. The only complication between the 2 groups that was significantly different was tube removal, which occurred more often in the UG group (p = 0.018). INTERPRETATION: AGV implantation is an effective and safe procedure in the management of UG, similar to primary OAG.
Keywords: Female; Humans; Male; Middle Aged; Aged; Case-Control Studies; Treatment Outcome; Chronic Disease; Visual Acuity; *Glaucoma Drainage Implants; Intraocular Pressure; Antihypertensive Agents/administration & dosage; *Prosthesis Implantation; Glaucoma, Open-Angle/complications/*surgery; Intraoperative Complications; Postoperative Complications; Uveitis/complications/*surgery

Tocilizumab in Uveitic Macular Edema Refractory to Previous Immunomodulatory Treatment. - Deuter, Christoph M. E.; Zierhut, Manfred; Igney-Oertel, Annette; Xenitidis, Theodoros; Feidt, Alexandra; Sobolewska, Bianka; Stuebiger, Nicole; Doycheva, Deshka (Ocular immunology and inflammation, 2017)
PURPOSE: To analyze the efficacy of tocilizumab in uveitic macular edema (ME) resistant to various immunomodulatory drugs. METHODS: Patients received tocilizumab every 4 weeks intravenously. Central foveal thickness (CFT) was assessed by optical coherence tomography (OCT). RESULTS: Five patients (8 eyes) who were ineffectively pretreated with systemic prednisolone, at least one immunosuppressive drug, and at least one biologic drug for uveitic macular edema were included in the study. At 3 months, a response of ME (≥25% reduction in CFT) was observed in 6 eyes (75.0%) of 5 patients. During follow-up, complete resolution of ME was achieved in 5 eyes (62.5%) of 4 patients. Improvement of BCVA was observed in 3 eyes of 3 patients, and stabilization in 3 eyes of 3 patients. Tocilizumab was well tolerated, and no severe side effects occurred. CONCLUSIONS: Treatment with tocilizumab can be considered in chronic uveitic macular edema even if previous immunomodulatory therapy has failed.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Infusions, Intravenous; Antibodies, Monoclonal, Humanized/*therapeutic use; Fluorescein Angiography; Tomography, Optical Coherence; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; uveitis; Visual Acuity/physiology; therapy; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; macular edema; immunomodulatory drug; tocilizumab

Outcome of viscodilation and tensioning of Schlemm's canal for uveitic glaucoma. - Kalin-Hajdu, Evan; Hammamji, Karim; Gagné, Sébastien; Harasymowycz, Paul (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2014)
OBJECTIVE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of Schlemm's canal (canaloplasty) in the treatment of uveitic glaucoma (UG). DESIGN: Pilot, retrospective, noncomparative case series. PARTICIPANTS: Nineteen uveitic eyes of 15 patients with UG. METHODS: The main outcome measure was surgical success. Secondary outcome measures included intraocular pressure, usage of ocular hypotensive medication, visual acuity, and sight-threatening complications. Patients were included when UG could not be controlled despite maximum tolerated medical therapy. Exclusion criteria were peripheral anterior synechiae and previous glaucoma surgery. RESULTS: Mean follow-up time from canaloplasty was 2.6 ± 1.1 years. Mean intraocular pressure decreased from 30.4 ± 8.4 mm Hg preoperatively to 13.8 ± 5.0 mm Hg at last follow-up (p < 0.001). The mean number of ocular hypotensive medications decreased from 3.7 ± 0.8 preoperatively to 0.4 ± 1.0 at last follow-up (p < 0.001). At last follow-up, the complete success, qualified success, and failure rates were 73.7%, 10.5%, and 15.8%, respectively. No canaloplasty-related permanent sight-reducing complications occurred. Preoperative best corrected visual acuity decreased more than 1 Snellen line in 1 eye due to exacerbation of uveitis 18 months postoperatively. CONCLUSIONS: Canaloplasty appears to be a relatively safe and effective initial surgical intervention in UG.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Intraocular Pressure/physiology; Tonometry, Ocular; Glaucoma/physiopathology/*surgery; Lasers, Solid-State/therapeutic use; Uveitis/physiopathology/*surgery; Phacoemulsification; Filtering Surgery/*methods; Anterior Eye Segment/*surgery; Laser Therapy; Surgical Flaps; Viscosupplements/administration & dosage

The influence of mitomycin C concentration on the outcome of trabeculectomy in uveitic glaucoma. - Almobarak, Faisal A.; Alharbi, Ali H.; Morales, Jose; Aljadaan, Ibrahim (International ophthalmology, 2018)
PURPOSE: To evaluate the influence of mitomycin C (MMC) concentration on the outcome of trabeculectomy in uveitic glaucoma. METHODS: Retrospective comparative study included 50 patients who underwent MMC-enhanced trabeculectomy for uncontrolled uveitic glaucoma. Patients were divided into two groups based on the concentration of MMC used during trabeculectomy (high [0.04%] or low [0.02%]). The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the need for further glaucoma surgeries, and trabeculectomy success. RESULTS: There were no differences in the IOP nor antiglaucoma medications. The success rates were 76.0 and 68.0%, while the failure rates were 24.0 and 32.0% in the 0.02 and 0.04% MMC groups, respectively. CONCLUSION: Trabeculectomy augmented with low (0.02%) MMC concentration seems to have comparable outcomes in uveitic glaucoma compared with high (0.04%) concentration.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Antihypertensive Agents/therapeutic use; Visual Acuity/physiology; Uveitis; Intraocular Pressure/physiology; Tonometry, Ocular; Trabeculectomy; Glaucoma; Glaucoma, Open-Angle/physiopathology/*surgery; Uveitis/physiopathology/*surgery; *Trabeculectomy; Alkylating Agents/*administration & dosage; Conjunctiva/drug effects; Mitomycin C; Mitomycin/*administration & dosage; Outcome; Tenon Capsule/drug effects

The effect of patient compliance on remission rates in pediatric noninfectious uveitis. - Ashkenazy, Noy; Saboo, Ujwala S.; Robertson, Zachary M.; Cao, Jennifer (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2019)
PURPOSE: To identify barriers to compliance in pediatric noninfectious uveitis, and to examine its association with achieving steroid-free remission. METHODS: A retrospective analysis was performed on pediatric patients with noninfectious uveitis on immunomodulatory therapy treated at the University of Texas Southwestern Medical School and Children's Medical Center (Dallas, TX) between September 2015 and March 2017. Compliance barriers were identified and rates of achieving steroid-free remission were calculated. RESULTS: A total of 57 patients with noninfectious uveitis requiring immunosuppressive therapy met inclusion criteria. Thirty-three (58%) of patients were compliant. Notable barriers to compliance included regimens requiring >3 medications, patient/parent negligence, transportation issues, family strife, and presence of an associated systemic autoimmune disease (P < 0.050). At a median follow-up of 24 months, a total of 28 (49%) achieved steroid-free remission. The presence of 3 or more compliance barriers was associated with decreased remission rates (P < 0.050). Poor compliance was associated with decreased rates of steroid-free remission (21% vs 79% [P = 0.002]). CONCLUSIONS: Noncompliant patients with noninfectious pediatric uveitis requiring immunomodulatory therapy were found to have a lower rate of achieving steroid-free remission compared to patients who exhibited full compliance.
Keywords: Female; Humans; Male; Retrospective Studies; Child; Immunosuppressive Agents/*therapeutic use; *Visual Acuity; Uveitis/*drug therapy; *Patient Compliance; Remission Induction/*methods

Response of Postoperative and Chronic Uveitic Cystoid Macular Edema to a Dexamethasone-Based Intravitreal Implant (Ozurdex). - Garweg, Justus G.; Baglivo, Edoardo; Freiberg, Florentina J.; Pfau, Maximilian; Pfister, Isabel B.; Michels, Stephan; Zandi, Souska (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2016)
PURPOSE: To survey the clinical responses to treatment of chronic postoperative and uveitic cystoid macular edema (CME) with a dexamethasone-based intravitreal implant (Ozurdex(®)). METHODS: This retrospective, interventional case series reports on patients with chronic CME after uncomplicated vitrectomy for epiretinal gliosis or phacoemulsification (group 1: 12 eyes) or secondary to noninfectious endogenous uveitis (group 2: 36 eyes). Central retinal thickness (CRT), best-corrected visual acuity (BCVA, logMAR), and intraocular pressure (IOP) throughout follow-up were gleaned from the medical records. RESULTS: In group 1, CRT decreased, compared with baseline, from 519 ± 43 to 297 ± 23 and 356 ± 49 μm by the 1- and 3-month visit (P = 0.02) and to 429 ± 57 μm before reimplantation. In group 2, CRT decreased from 460 ± 31 to 300 ± 21 and 312 ± 26 μm by the 1- and 3-month follow-up, respectively (P = 0.001), and to 373 ± 32 μm before reimplantation. Complete resolution of CME was achieved in 67% and 94% (groups 1 and 2, respectively) by 1 month and in 42% and 80% by 3 months after injection. In group 1, BCVA improved from 0.46 ± 0.08 to 0.27 ± 0.09 and 0.20 ± 0.06 (P = 0.01) by the 1- and 3-month follow-up, respectively, and to 0.32 ± 0.08 before reimplantation. In group 2, BCVA improved from 0.47 ± 0.06 to 0.34 ± 0.09, 0.26 ± 0.07, and 0.29 ± 0.08 (P < 0.05) at 1 and 3 months of follow-up and before reimplantation, respectively. A significant IOP increase was not observed in either group. Mean time to reimplantation of Ozurdex was 6.4 ± 5.7 and 6.6 ± 3.4 months for postoperative and uveitic CME, respectively. CONCLUSION: Ozurdex seems to achieve a sustained effect over up to 6 months in postsurgical and uveitic CME.
Keywords: Humans; Middle Aged; Aged; Kaplan-Meier Estimate; Retrospective Studies; Chronic Disease; Cohort Studies; Intravitreal Injections; Intraocular Pressure/drug effects; Dexamethasone/administration & dosage/*therapeutic use; Drug Implants/administration & dosage/*therapeutic use; Macular Edema/*drug therapy/*surgery; Uveitis/*drug therapy/*surgery

Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial. - Jiang, Lu; Wan, Wenjuan; Xun, Yan; Xiong, Liang; Wu, Binge; Xiang, Yongguo; Li, Zhouyu; Zhu, Lu; Ji, Yan; Yang, Peizeng; Hu, Ke (BMC ophthalmology, 2020)
BACKGROUND: To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of cataract caused by uveitis. METHODS: This was a prospective, single-masked, randomised, controlled clinical trial. One hundred and six patients with uveitis-associated cataract underwent phacoemulsification with perfusion fluid temperature at 4 °C (treatment group) or 24 °C (control group). Anterior chamber inflammation grade, corneal endothelial cell count, corneal thickness, macular fovea thickness, and intraocular pressure (IOP) were observed on the 1st day and 7th day after operation. RESULTS: The aqueous flare score was 0.83 ± 0.76 in the 4 °C group, which was lower than that in the 24 °C group (1.51 ± 1.02, p = 0.006) on the first day after operation. The aqueous cells score was lower in the 4 °C group (0.17 ± 0.38) than that in the 24 °C group (0.62 ± 0.94, p = 0.025). The mean corneal thickness of incision in the 4 °C group (907.66 ± 85.37 μm) was thinner than that in the 24 °C group (963.75 ± 103.81 μm, p = 0.005). Corneal endothelial cells density, macular fovea thickness, or percentage of transiently increased IOP showed no difference between the two groups (p > 0.05). There was no significant difference in all the main outcome parameters between the two groups on the 7th day after operation (p > 0.05). CONCLUSIONS: Hypothermic perfusion in the phacoemulsification of uveitis-associated cataract is safe, and it can effectively inhibit anterior chamber inflammation and reduce the incisional corneal edema in the early postoperative stage. TRIAL REGISTRATION: The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/, Registration Number: ChiCTR1800016145).
Keywords: Female; Humans; Male; Adult; Prospective Studies; Follow-Up Studies; Treatment Outcome; Single-Blind Method; Visual Acuity; Uveitis; Intraocular Pressure/physiology; Uveitis/*complications/diagnosis; Postoperative Period; Cataract; Cataract/*etiology; Phacoemulsification; Hypothermia; Hypothermia, Induced/*methods; Perfusion/*methods; Phacoemulsification/*methods; Postoperative inflammation

Uveitis following dengue fever. - Gupta, A.; Srinivasan, R.; Setia, S.; Soundravally, R.; Pandian, D. G. (Eye (London, England), 2009)
OBJECTIVE: To report the occurrence of uveitis in patients with prior history of dengue fever. METHODS: A case series of patients with uveitis, presenting with ocular symptoms 3-5 months after contracting dengue fever during the dengue epidemic without any other attributable cause for uveitis. The dengue fever had subsided without any complication. None of the patients had any ocular complication during the acute dengue infection. They were treated on the lines of uveitis with local steroids, cycloplegic, and ocular hypotensive medications, when required, and oral steroid in case of posterior segment involvement. Patients' follow-up varied from 3-5 months. RESULTS: Six patients with serological evidence of prior dengue fever had presented with uveitis not attributable to any other disease. Seven eyes of six patients were affected. Anterior uveitis without any evidence of posterior segment involvement was present in six eyes of five patients whereas one patient had severe vitritis also. The most common symptom was progressive decrease in vision and only three out of seven eyes had evidence of ciliary congestion. All patients promptly responded to the treatment and visual acuity returned to 6/9 or better in five eyes, while 6/24 and 6/18 in other two eyes due to the presence of cataract. None of these patients had recurrence during the follow-up period. CONCLUSION: Uveitis in dengue infection is rare and ophthalmologists should be aware of these delayed ophthalmic complications. The prognosis of post-dengue uveitis is good.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Anti-Inflammatory Agents/therapeutic use; Visual Acuity; Ciliary Arteries; Dengue/*complications; Steroids/therapeutic use; Uveitis/drug therapy/*etiology

In vivo analysis of choroidal vascularity index changes in eyes with Fuchs uveitis syndrome. - Ozcelik-Kose, Alev; Balci, Sevcan; Turan-Vural, Ece (Photodiagnosis and photodynamic therapy, 2021)
BACKGROUND: This study aimed to investigate changes in the choroidal vascularity index (CVI) in eyes with Fuchs uveitis syndrome (FUS) and determine the effect of heterochromia on choroidal vascularity using binarisation of enhanced-depth imaging (EDI)-optical coherence tomography (OCT) images. METHODS: The study included the affected eyes (FEs) and unaffected fellow eyes (NFEs) of 24 patients with unilateral FUS and the eyes of 30 healthy controls (HCs). The subfoveal total choroidal area (TCA) and the luminal area (LA) were determined by binarised EDI-OCT images using Image J software (National Institutes of Health, Bethesda, MD). The CVI value was calculated by dividing the LA value by the TCA value. RESULTS: The CVI values were significantly lower in FEs (58.8 ± 3.7 %) compared to NFEs (62.3 ± 3.9 %, p = 0.002) and HCs (61.1 ± 3.7 %, p = 0.008). The mean LA was significantly narrower in FEs than in NFEs (p = 0.047) and HCs (p = 0.001). Additionally, the mean CVI values were significantly lower in eyes with heterochromia compared to those without heterochromia (p = 0.024) in the affected eyes of patients with FUS. CONCLUSION: This study shows that there are significant quantitative structural changes, especially in the luminal part of the subfoveal choroid, in eyes with FUS. The choroid seems to be more affected in the presence of heterochromia. These findings might support posterior involvement and the chronicity of the disease.
Keywords: Humans; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; *Uveitis; *Photochemotherapy/methods; Binarisation; Choroid/diagnostic imaging; Choroidal inflammation; Choroidal vascularity index; EDI-OCT; Fuchs uveitis syndrome; Photosensitizing Agents

Diagnostic Challenges in Inflammatory Choroidal Neovascular Membranes. - Bansal, Reema; Bansal, Pooja; Gupta, Amod; Gupta, Vishali; Dogra, Mangat R.; Singh, Ramandeep; Katoch, Deeksha (Ocular immunology and inflammation, 2017)
PURPOSE: To describe the clinical presentations of inflammatory choroidal neovascular membranes (CNVMs) and factors leading to their delayed diagnosis. METHODS: Retrospective analysis of chart records and digital images of 60 patients (73 eyes) with inflammatory CNVM (January 1998 to December 2013) to obtain demographic and clinical details, particularly the time of the first documentation of inflammatory CNVM by the uveitis specialist, time of its actual appearance on digital images, and the earliest clinical indicators of a CNVM. RESULTS: In total, 14 (19.2%) eyes had a delayed diagnosis of inflammatory CNVMs, of which five developed significant visual loss. The earliest clinical indicators of CNVM that were overlooked initially due to their subtle appearance, included a tiny subretinal hemorrhage (five eyes), peripapillary halo/fluid/scar (eight eyes), and a subfoveal scar (one eye). The causes of uveitis in these eyes included Vogt-Koyanagi-Harada disease (five eyes, 35.7%), tubercular uveitis (five eyes, 35.7%), idiopathic (three eyes, 21.4%), and sympathetic ophthalmia (one eye, 7.1%). Presence of significant background fundus scarring, sunset glow fundus, visually significant cataract, poorly dilating pupil, media haze due to vitritis, cystoid macular edema, and multiple chorioretinal scars in these eyes probably predisposed to delayed detection of an underlying CNVM. CONCLUSIONS: A high index of suspicion and comparison of serial fundus photographs to identify the earliest clues of inflammatory CNVMs are important to prevent diagnostic delays and poorer outcomes.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Young Adult; Adolescent; Child; Fluorescein Angiography; uveitis; Visual Acuity; Uveitis/*diagnosis; inflammation; Bevacizumab; choroidal neovascular membrane; Choroidal Neovascularization/*diagnosis; Delayed Diagnosis; diagnosis; Inflammation/*diagnosis

Local therapy for cancer therapy-associated uveitis: a case series and review of the literature. - Venkat, Arthi Ganesh; Arepalli, Sruthi; Sharma, Sumit; Karthik, Naveen; Lowder, Careen; Ehlers, Justis P.; Singh, Arun; Goshe, Jeffrey; Srivastava, Sunil (The British journal of ophthalmology, 2020)
BACKGROUND/AIMS: Immunotherapy and targeted therapy for metastatic cancer may cause immune-related adverse events (irAEs) such as uveitis. If irAEs are severe or require systemic steroids, cancer therapy is often held or discontinued. Local steroid therapy for cancer therapy-associated uveitis allows the continuation of cancer therapy. This series demonstrates successful management of cancer therapy-associated uveitis with local therapy based on uveitis subtype. METHODS: This is an Institutional Review Board-approved retrospective case series of patients with uveitis secondary to immunotherapy or targeted therapy managed with local treatment, and focused literature review. RESULTS: Five patients (median age: 54, range 31 to 75) were included. Time to uveitis onset following cancer therapy initiation was 3 to 12 months. All patients received checkpoint inhibitor therapy; one patient additionally received targeted therapy. Two patients presented with anterior uveitis, two with panuveitis and one with posterior uveitis. Four of five patients demonstrated evidence of posterior segment inflammation on multimodal imaging. Anterior uveitis was successfully treated with topical prednisolone acetate 1% (PA 1%) alone, and posterior segment involvement recalcitrant to topical PA 1% was treated successfully with topical difluprednate, intravitreal triamcinolone acetonide or a combination. Patients with isolated anterior uveitis did not require maintenance topical therapy; those with posterior and panuveitis required chronic low-dose topical therapy. CONCLUSION: Based on our series as well as the existing literature demonstrating the use of local therapy for irAEs, we propose an approach to local therapy for cancer therapy-associated uveitis starting with topical steroids and initiating injectable steroids in cases of recalcitrant panuveitis or posterior uveitis. Subclinical inflammation on posterior segment imaging responds robustly to difluprednate or intravitreal steroid therapy, and patients with posterior segment involvement may require more aggressive management and long-term maintenance.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Tomography, Optical Coherence; *Visual Acuity; Drug Implants; Intravitreal Injections; Uveitis/diagnosis/*drug therapy/etiology; Immunosuppressive Agents/*administration & dosage; *Drugs; *Inflammation; Neoplasms/*complications

Intraocular methotrexate in the treatment of uveitis and uveitic cystoid macular edema. - Taylor, Simon R. J.; Habot-Wilner, Zohar; Pacheco, Patricio; Lightman, Sue L. (Ophthalmology, 2009)
OBJECTIVE: A pilot study to evaluate the use of intravitreal methotrexate (MTX) for the treatment of uveitis and uveitic cystoid macular edema (CME). DESIGN: Prospective, consecutive, interventional case series. PARTICIPANTS: Fifteen eyes of 15 patients with a unilateral exacerbation of noninfectious intermediate, posterior uveitis, or panuveitis and/or CME such that visual acuity (VA) was 20/40 or worse, together with a history of increased intraocular pressure (IOP) in response to corticosteroid administration. INTERVENTION: Intravitreal injection of 400 microg in 0.1 ml MTX. MAIN OUTCOME MEASURES: The primary outcome measure was VA (using the Early Treatment Diabetic Retinopathy Study chart). Other outcome measures included ocular inflammation scores, time to relapse, levels of systemic corticosteroid and immunosuppressive therapy, and ocular coherence tomography. Potential complications of intravitreal MTX injection, including cataract progression, vitreous hemorrhage, retinal detachment, and corneal epitheliopathy, were assessed. RESULTS: VA improved at all time points and was statistically significant at the 3- and 6-month follow-up examinations. The mean visual improvement was 4 lines at 3 months and 4.5 lines at 6 months, with no statistical difference between the best VA obtained after MTX injection and after previous corticosteroid treatment, including intravitreal triamcinolone acetate injection. Five patients relapsed after a median of 4 months; a similar improvement was seen after re-injection. Ocular inflammation scores improved at all time points, and systemic immunosuppressive medication was reduced in 3 of 7 patients taking this at the start of the trial. CONCLUSIONS: In patients with uveitis and uveitic CME, intravitreal MTX can improve VA and reduce CME and, in some patients, allows the reduction of immunosuppressive therapy. Relapse occurs at a median of 4 months in some patients, but reinjection has similar efficacy.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Prospective Studies; Follow-Up Studies; Treatment Outcome; Methotrexate/adverse effects/*therapeutic use; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Injections; Visual Acuity/physiology; Intraocular Pressure/physiology; Vitreous Body; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Immunosuppressive Agents/adverse effects/*therapeutic use

[Cataract surgery in children with non-infectious uveitis: Review of current practices in France]. - Costet, C.; Andrèbe, C.; Paya, C.; Pillet, P.; Richer, O.; Rougier, M. B.; Korobelnik, J. F.; Coste, V. (Journal francais d'ophtalmologie, 2019)
PURPOSE: To evaluate the medical-surgical management of cataract surgery in children with chronic uveitis in various French pediatric ophthalmology centers. MATERIALS AND METHODS: Two-part study: first, a descriptive observational segment on the evaluation of French practices. A questionnaire was sent to the various pediatric ophthalmologists in France. A second retrospective chart review, including children with non-infectious chronic uveitis who had cataract surgery in the pediatric ophthalmology department of Bordeaux University Hospital from 2008 to 2017. RESULTS: Twenty-one ophthalmologists responded to the questionnaire. Only 23.8% systematically initiated immunosuppressive drugs (aside from corticosteroids) before surgery. A total of 88.2% prescribed oral corticosteroid treatment preoperatively. Eleven surgeons administered intravenous corticosteroid boluses during the surgery, and primary lens implantation is the most common method used in 95.2%. A total of 76.2% initiated oral steroid therapy after surgery. Postoperatively, all surgeons started local therapy with high-dose corticosteroids. At one year, 100% achieved improvement of visual acuity greater than or equal to 2 lines. On our service, 10 eyes (7 children) underwent cataract surgery. Seven were treated with systemic immunosuppressive drugs (aside from corticosteroids) and 80% of cases received oral corticosteroid therapy a few days before surgery. An intravenous corticosteroid bolus was administered preoperatively in 8 cases, and primary lens implantation was performed in 100% of cases. Postoperatively, 5 children received oral corticosteroid treatment. All were treated with local high dose steroids. At one year, the mean best-corrected visual acuity was 0.18 LogMar (0-0.7, SD: 0.25). CONCLUSION: When performed with an aggressive anti-inflammatory protocol, cataract surgery leads to a good visual outcome in selected children with chronic uveitis.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Adolescent; Combined Modality Therapy; France/epidemiology; Chronic Disease; Child; Child, Preschool; Surveys and Questionnaires; Uveitis/complications/drug therapy/epidemiology/*surgery; Corticosteroids; Lens Implantation, Intraocular; *Cataract Extraction/adverse effects/statistics & numerical data; Adrenal Cortex Hormones/therapeutic use; Cataract surgery; Cataract/complications/epidemiology/*therapy; Chirurgie de la cataracte; Corticothérapie; Hospitals, Pediatric; Implants intraoculaires; Intraocular lenses; Pediatric uveitis; Postoperative Complications/epidemiology/etiology; Practice Patterns, Physicians'/*statistics & numerical data; Traitements; Treatments; Uvéites pédiatriques

Association Between Long-Lasting Intravitreous Fluocinolone Acetonide Implant vs Systemic Anti-inflammatory Therapy and Visual Acuity at 7 Years Among Patients With Intermediate, Posterior, or Panuveitis. - Kempen, John H.; Altaweel, Michael M.; Holbrook, Janet T.; Sugar, Elizabeth A.; Thorne, Jennifer E.; Jabs, Douglas A. (JAMA, 2017)
IMPORTANCE: A randomized clinical trial comparing fluocinolone acetonide implant vs systemic corticosteroids and immunosuppression for treatment of severe noninfectious intermediate, posterior, and panuveitides did not result in a significant difference in visual acuity at 2 and 4.5 years; longer-term outcomes are not known. OBJECTIVE: To compare the association between intravitreous fluocinolone acetonide implant vs systemic therapy and long-term visual and other outcomes in patients with uveitis. DESIGN, SETTING, AND PARTICIPANTS: Nonprespecified 7-year observational follow-up of the Multicenter Uveitis Steroid Treatment (MUST) randomized clinical trial comparing the alternative treatments. Follow-up was conducted in tertiary uveitis subspecialty practices in the United States (21), the United Kingdom (1), and Australia (1). Of 255 patients 13 years or older with intermediate, posterior, or panuveitis (active within ≤60 days) enrolled in the MUST trial between December 6, 2005, and December 9, 2008, 215 consented to ongoing follow-up through at least 7 years postrandomization (last visit, February 10, 2016). INTERVENTIONS: Participants had been randomized to receive a surgically placed intravitreous fluocinolone acetonide implant or systemic corticosteroids supplemented by immunosuppression. When both eyes required treatment, both eyes were treated. MAIN OUTCOMES AND MEASURES: Primary outcome was change from baseline in best-corrected visual acuity in uveitic eyes (5 letters = 1 visual acuity chart line; potential range of change in letters read, -121 to +101; minimal clinically important difference, 7 letters), analyzed by treatment assignment accounting for nonindependence of eyes when patients had 2 uveitic eyes. Secondary outcomes included potential systemic toxicities of corticosteroid and immunosuppressive therapy and death. RESULTS: Seven-year data were obtained for 161 uveitic eyes (70% of 90 patients assigned to implant) and 167 uveitic eyes (71% of 90 patients assigned to systemic therapy) (77% female; median age at enrollment, 48 [interquartile range, 36-56] years). Change in mean visual acuity from baseline (implant, 61.7; systemic therapy, 65.0) through 7 years (implant, 55.8; systemic therapy, 66.2) favored systemic therapy by 7.2 (95% CI, 2.1-12) letters. Among protocol-specified, prospectively collected systemic adverse outcomes, the cumulative 7-year incidence in the implant and systemic therapy groups, respectively, was less than 10%, with the exceptions of hyperlipidemia (6.1% vs 11.2%), hypertension (9.8% vs 18.4%), osteopenia (41.5% vs 43.1%), fractures (11.3% vs 18.6%), hospitalization (47.6% vs 42.3%), and antibiotic-treated infection (57.4% vs 72.3%). CONCLUSIONS AND RELEVANCE: In 7-year extended follow-up of a randomized trial of patients with severe intermediate, posterior, or panuveitis, those randomized to receive systemic therapy had better visual acuity than those randomized to receive intravitreous fluocinolone acetonide implants. Study interpretation is limited by loss to follow-up. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00132691.
Keywords: Female; Humans; Male; Middle Aged; Adult; United States; Time Factors; Follow-Up Studies; Treatment Outcome; Quality of Life; Australia; United Kingdom; Drug Implants; Intravitreal Injections; Uveitis/*drug therapy; Visual Acuity/*drug effects; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Fluocinolone Acetonide/*administration & dosage/adverse effects; Immunosuppression Therapy/adverse effects; Panuveitis/drug therapy

Cataract surgery in patients with uveitis. - Rojas, B.; Foster, C. S. (Current opinion in ophthalmology, 1996)
Until recently, cataract surgery in a patient with uveitis was regarded as a hazardous procedure that yielded unpredictable and often disappointing results. With an increasing number of ophthalmologists recognizing the consequences of chronic low-grade inflammation and therefore treating uveitis patients more aggressively, with a better selection of cases for surgery, and with better surgical techniques, more patients with a history of uveitis who need cataract surgery enjoy a successful outcome than ever before. Careful management and control of inflammation preoperatively and after surgery is critical to success. An in-the-bag posterior chamber lens implant can be part of the surgical plan in selected cases. The aims of the authors in this article are to emphasize the ideas of, intolerance to inflammation, a limited tolerance for steroids to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision, and strict criteria for selection and management of those patients with uveitis who need cataract surgery.
Keywords: Humans; Treatment Outcome; Visual Acuity; Postoperative Care; Preoperative Care; Cataract Extraction/*methods; Cataract/*complications/physiopathology; Lenses, Intraocular; Uveitis/*complications/physiopathology

Vogt-Koyanagi-Harada Disease Associated with Hepatitis B Vaccination. - Sood, Arjun B.; O'Keefe, Ghazala; Bui, Diem; Jain, Nieraj (Ocular immunology and inflammation, 2019)
Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease associated with hepatitis B vaccination. Methods: Case report. Results: A 43-year-old Caucasian male presented with a three-week history of blurry vision, pain, photophobia, and redness in both eyes. Three days prior to the onset of symptoms, he had received the hepatitis B virus vaccine. Clinical evaluation revealed multifocal placoid lesions in the posterior pole, choroidal thickening, and serous macular detachment. Targeted laboratory investigations were negative for infectious or autoimmune markers. After treatment with oral corticosteroids, the patient had resolution of symptoms with near-total recovery of visual function. The patient later reported systemic findings of hearing loss, tinnitus, and integumentary changes. A diagnosis of VKH disease was made and inflammation was managed with oral corticosteroids followed by methotrexate for long-term disease control. Conclusions: VKH disease is an inflammatory condition primarily affecting the choroid, retinal pigment epithelium, and outer retina. The underlying etiology is unclear, but it can be associated with a viral prodrome suggesting an infectious trigger in a genetically susceptible individual. Our case suggests that hepatitis B vaccination may trigger a similar inflammatory response.
Keywords: Humans; Male; Adult; Fluorescein Angiography; Tomography, Optical Coherence; uveitis; *Visual Acuity; Fundus Oculi; Vaccination/*adverse effects; Uveomeningoencephalitic Syndrome/diagnosis/*etiology; Hepatitis B Vaccines/*adverse effects; Hepatitis B virus/immunology; Hepatitis B/prevention & control; Imaging; immunomodulators; vaccine; Vogt–Koyanagi–Harada

[Intravitreal implants: drug carriers and carriers of hope?]. - Winterhalter, S.; Ruokonen, P.; van der Velden, K. H.; Pleyer, U.; Joussen, A. M. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2011)
Immunosuppressive agents are used for the therapy of noninfectious uveitis if intraocular quiescence and freedom from recurrences are not achievable with oral steroids at a low dosage. Partially, severe side effects are tolerated to preserve visual acuity even if the disease is limited to the eyes. Because of this a therapy would be desirable which is highly effective, limited to the eyes and with few side effects. For this fluocinolone acetonide and dexamethasone drug delivery systems were developed. Dexamethasone implants were already approved for the therapy of retinal vein occlusions and are used successfully. Diabetic macular edema would be another possible indication for dexamethasone implants.
Keywords: Humans; Chronic Disease; Drug Resistance; Randomized Controlled Trials as Topic; Drug Implants; Visual Acuity/drug effects; Dexamethasone/*administration & dosage/adverse effects; Fluocinolone Acetonide/*administration & dosage/adverse effects; Adrenal Cortex Hormones/administration & dosage/adverse effects; Diabetic Retinopathy/*drug therapy/immunology; Drug Carriers; Immunosuppressive Agents/*administration & dosage/adverse effects; Macular Edema/*drug therapy/immunology; Retinal Vein Occlusion/*drug therapy/immunology; Secondary Prevention; Uveitis, Intermediate/*drug therapy/immunology; Uveitis, Posterior/*drug therapy/immunology; Vitreous Body/*drug effects

Novel Dexamethasone Sodium Phosphate Treatment (DSP-Visulex) for Noninfectious Anterior Uveitis: A Randomized Phase I/II Clinical Trial. - Papangkorn, Kongnara; Truett, Kim R.; Vitale, Albert T.; Jhaveri, Chirag; Scales, David K.; Foster, C. Stephen; Montieth, Alyssa; Higuchi, John W.; Brar, Balbir; Higuchi, William I. (Current eye research, 2019)
PURPOSE: Frequent steroid drops represent a challenge in patient compliance. This study evaluated the safety and efficacy of 5 minute topical dexamethasone sodium phosphate-Visulex (DSP-Visulex) treatment regimen (two applications on the first week then weekly after) compared to daily prednisolone acetate 1% (PA) for noninfectious anterior uveitis. MATERIALS AND METHODS: Forty-four patients were randomized to 8% DSP-Visulex with placebo eye drops (8% group, n = 14), 15% DSP-Visulex with placebo eye drops (15% group, n = 15), or Vehicle-Visulex with PA eye drops (PA group, n = 15). Patients received daily eye drops and Visulex treatments on days 1, 3, 8, and 15 with an optional treatment on day 22. Efficacy measures were change in anterior chamber cell (ACC) count from baseline and proportion of patients with zero ACC count at days 8, 15, and 29. Safety measures were adverse events (AEs), visual acuity, ocular symptoms, and intraocular pressure (IOP). RESULTS: ACC resolution over time was similar among the three groups. The percentage of patients with clear ACC was 18%, 22%, and 15% on day 8; 27%, 56%, and 54% on day 15; and 90%, 88%, and 77% on day 29 for the 8%, 15%, and PA groups, respectively. The numbers of reported AEs were 10, 36, and 12 for the 8%, 15%, and PA groups, respectively. Ten patients among all groups experienced treatment-related AEs, which included headache, eye pain, corneal abrasion, conjunctival/corneal staining, conjunctivitis, visual acuity reduction, and keratitis all of which were resolved during the timeframe of patients' participation in the study. IOP elevation was noted in the PA group throughout the study, whereas IOP elevation in the DSP-Visulex groups was observed at day 3 but not thereafter. CONCLUSIONS: The efficacy of the DSP-Visulex applications was comparable to the daily PA drops in the treatment of noninfectious anterior uveitis. Both 8% and 15% DSP-Visulex treatments were safe and well tolerated.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Glucocorticoids/administration & dosage; *Visual Acuity; Ophthalmic Solutions; Intraocular Pressure/physiology; Slit Lamp Microscopy; *uveitis; Administration, Topical; *clinical trial; *dexamethasone; *Ocular drug delivery; *safety and efficacy; Anterior Chamber/*pathology; Cell Count; Dexamethasone/administration & dosage/*analogs & derivatives; Uveitis, Anterior/diagnosis/*drug therapy/physiopathology

Uveoretinal Adverse Effects Presented during Systemic Anticancer Chemotherapy: a 10-Year Single Center Experience. - Cho, Ah Ran; Yoon, Young Hee; Kim, June Gone; Kim, Yoon Jeon; Lee, Joo Yong (Journal of Korean medical science, 2018)
BACKGROUND: The present study describes our 10-year experience with uveoretinal adverse events that manifest because of chemotherapy. METHODS: A retrospective chart review was performed for all patients who presented to the ophthalmologic department while undergoing systemic chemotherapy between July 2005 and June 2015. RESULTS: A total of 55 patients (mean age, 51.2 years, 38 women [69.1%]) suspected of having uveoretinal disease owing to the use of chemotherapeutic agents alone were enrolled. Breast cancer was the predominant disease (36.4%); noninfectious anterior uveitis (21.8%) was the most common condition. Bilateral involvement was observed in 16 patients (29.1%). Although cisplatin (21.8%) was the most commonly used drug, daunorubicin, cytarabine, tamoxifen, toremifene, and imatinib were also frequently used. The median duration until ophthalmologic diagnosis was 208.5 days (range, 19-5,945 days). The proportion of patients with final visual acuity (VA) < 20/40 Snellen VA (0.5 decimal VA) was 32.7%. However, no relationship was observed between final VA < 20/40 and age, sex, therapeutic agents, and metastasis. CONCLUSION: Uveoretinal complications were mostly mild to moderate and exhibited a favorable response to conservative therapy. A considerable number of patients exhibited significant irreversible loss of vision after cessation of the causative chemotherapeutic agent. Ophthalmological monitoring is required during chemotherapy.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Young Adult; Antineoplastic Agents/*adverse effects/therapeutic use; Visual Acuity; Uveitis; Cancer Chemotherapy Agents; Chemotherapy; Corneal Diseases/diagnosis/etiology; Drug Toxicity; Neoplasms/drug therapy/pathology; Targeted Molecular Therapy; Uveitis/diagnosis/*etiology

Associations among visual acuity and vision- and health-related quality of life among patients in the multicenter uveitis steroid treatment trial. - Frick, Kevin D.; Drye, Lea T.; Kempen, John H.; Dunn, James P.; Holland, Gary N.; Latkany, Paul; Rao, Narsing A.; Sen, H. Nida; Sugar, Elizabeth A.; Thorne, Jennifer E.; Wang, Robert C.; Holbrook, Janet T. (Investigative ophthalmology & visual science, 2012)
PURPOSE: To evaluate the associations between visual acuity and self-reported visual function; visual acuity and health-related quality of life (QoL) metrics; a summary measure of self-reported visual function and health-related QoL; and individual domains of self-reported visual function and health-related QoL in patients with uveitis. METHODS: Best-corrected visual acuity, vision-related functioning as assessed by the NEI VFQ-25, and health-related QoL as assessed by the SF-36 and EuroQoL EQ-5D questionnaires were obtained at enrollment in a clinical trial of uveitis treatments. Multivariate regression and Spearman correlations were used to evaluate associations between visual acuity, vision-related function, and health-related QoL. RESULTS: Among the 255 patients, median visual acuity in the better-seeing eyes was 20/25, the vision-related function score indicated impairment (median, 60), and health-related QoL scores were within the normal population range. Better visual acuity was predictive of higher visual function scores (P ≤ 0.001), a higher SF-36 physical component score, and a higher EQ-5D health utility score (P < 0.001). The vision-specific function score was predictive of all general health-related QoL (P < 0.001). The correlations between visual function score and general quality of life measures were moderate (ρ = 0.29-0.52). CONCLUSIONS: The vision-related function score correlated positively with visual acuity and moderately positively with general QoL measures. Cost-utility analyses relying on changes in generic healthy utility measures will be more likely to detect changes when there are clinically meaningful changes in vision-related function, rather than when there are only changes in visual acuity. (ClinicalTrials.gov number, NCT00132691.).
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Treatment Outcome; Administration, Oral; *Quality of Life; Surveys and Questionnaires; *Visual Acuity; Drug Implants; Fluocinolone Acetonide/administration & dosage/*analogs & derivatives; Glucocorticoids/*administration & dosage; Uveitis/*drug therapy/physiopathology; Health Surveys; Immunosuppressive Agents/*administration & dosage; *Health Status

INFLIXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS INTERMEDIATE UVEITIS RESISTANT TO CONVENTIONAL IMMUNOMODULATORY THERAPY. - Maleki, Arash; Sahawneh, Haitham F.; Ma, Lina; Meese, Halea; He, Yuchen; Foster, C. Stephen (Retina (Philadelphia, Pa.), 2017)
PURPOSE: To examine the efficacy and safety of infliximab therapy in the treatment for noninfectious intermediate uveitis resistant to conventional immunomodulatory therapy. METHODS: Forty-four eyes of 23 patients with resistant noninfectious intermediate uveitis who were treated with infliximab infusions for a minimum period of 3 months were included. Demographic data, clinical data, and fluorescein angiography and optical coherence tomography findings were collected from the Massachusetts Eye Research and Surgery Institution database between August 2005 and February 2014. Clinical response, improvement in ancillary test findings, and major side effects were evaluated. RESULTS: Nineteen patients (82.6%) achieved remission. The mean duration of treatment to induce remission was 3.99 ± 3.06 months (range, 2-14.7). Cystoid macular edema was the only complication observed during the course of the treatment in 1 eye (2.27%). One patient (4.3%) developed major side effects. None of the patients developed central or peripheral demyelinating neuropathies or multiple sclerosis. At 6 months after remission, logarithm of the minimum angle of resolution visual acuity (P = 0.006) and central macular thickness (P = 0.03) showed significant improvement in patients who achieved remission. CONCLUSION: A significant number of patients achieved remission on infliximab therapy. The incidence of major side effects in our cohort was low.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Young Adult; Adolescent; Remission Induction; Child; Infliximab/*therapeutic use; Tomography, Optical Coherence; Immunotherapy/*methods; Visual Acuity/physiology; Uveitis, Intermediate/*drug therapy/pathology/physiopathology; Macular Edema/pathology

Intravitreal and orbital floor triamcinolone acetonide injections in noninfectious uveitis: a comparative study. - Roesel, Martin; Gutfleisch, Matthias; Heinz, Carsten; Heimes, Britta; Zurek-Imhoff, Beatrix; Heiligenhaus, Arnd (Ophthalmic research, 2009)
PURPOSE: To compare the effect of orbital floor (OFTA) or intravitreal (IVTA) administration of triamcinolone acetonide on visual acuity and chronic cystoid macular edema (CME) in patients with uveitis. METHODS: Retrospective study of patients suffering from chronic noninfectious uveitis in whom CME (n = 97) did not respond to systemic corticosteroids and/or immunosuppression combined with acetazolamide. Patients received a single injection of either IVTA (n = 48, group 1) or OFTA (n = 49, group 2). Best-corrected visual acuity, macular edema (fluorescein angiography), uveitis activity, ocular hypertension, and cataract formation were analyzed over the course of 1 year. RESULTS: Improvement in visual acuity (> or = 2 lines, LogMAR) was noted in 50% (IVTA) and 34% (OFTA) after 3 months (p = 0.23), and in 18% (IVTA) and 20% (OFTA) after 12 months. CME improved in 100% (IVTA) and 76% (OFTA) of the eyes within the first month postoperatively (p = 0.36). Macular edema was reduced in 100% (group 1) and 20% (group 2) after 3 months (p < 0.01). At 1 year, cataract progression was noted in 68% (IVTA) and 27% (OFTA) (p < 0.01). Increased intraocular pressure (>21 mm Hg) was detected in 21% (IVTA) and 0% (OFTA) at 4 weeks (p < 0.01) after injection. CONCLUSION: Uveitic CME and visual acuity not responding to systemic immunosuppression and acetazolamide may improve after an IVTA and OFTA injection. The effect is mostly transient. While the IVTA injections were more effective for improving CME, ocular hypertension and cataracts developed more often.
Keywords: Female; Humans; Male; Middle Aged; Retrospective Studies; Chronic Disease; Fluorescein Angiography; Injections; Uveitis/complications/*drug therapy; Cataract/chemically induced; Visual Acuity/drug effects; Glucocorticoids/*administration & dosage/adverse effects; Intraocular Pressure/drug effects; *Orbit; *Vitreous Body; Drug Administration Routes; Macular Edema/drug therapy/etiology; Triamcinolone Acetonide/*administration & dosage/adverse effects

Long-term treatment with rituximab in severe juvenile idiopathic arthritis-associated uveitis. - Miserocchi, Elisabetta; Modorati, Giulio; Berchicci, Luigi; Pontikaki, Irene; Meroni, Pierluigi; Gerloni, Valeria (The British journal of ophthalmology, 2016)
BACKGROUND/AIMS: To evaluate retrospectively the long-term efficacy of rituximab in patients with severe juvenile idiopathic arthritis (JIA)-associated uveitis. METHODS: Eight patients (15 eyes) with severe and longstanding JIA uveitis, who had an inadequate response in controlling uveitis to one or more biologic agents including tumour necrosis factor blockers and abatacept, received rituximab therapy. Rituximab was given at a dose of 1000 mg per infusion on days 1 and 15 and then every 6 months. Clinical responses to treatment, including decrease in uveitis activity, visual acuity changes, reduction of concomitant local and systemic corticosteroid and/or immunosuppressants, and occurrence of adverse events, were assessed. RESULTS: Eight patients with a mean±SD age of 22.8±5.5 years were treated. The mean ocular disease duration was 17.7 years; the mean±SD follow-up time on rituximab was 44.75±4.9 months; and the mean number of rituximab infusions received was 8.75 (range 6-12). All patients achieved complete control of uveitis, but in two patients rituximab was discontinued due to inefficacy in treating arthritis. The decrease in uveitis activity was evident 4-5 months after the first infusion. Systemic corticosteroids and immunosuppressants used in association with rituximab were discontinued in five patients at the end of follow-up. None of the patients experienced visual worsening during the follow-up. No drug-related complications were encountered. CONCLUSIONS: Rituximab may be a promising effective treatment option for refractory uveitis associated with JIA leading to long-term quiescence of uveitis, particularly for patients who have not previously responded to other biologic therapies.
Keywords: Female; Humans; Male; Adult; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Severity of Illness Index; Dose-Response Relationship, Drug; Adolescent; Infusions, Intravenous; Visual Acuity/*physiology; Immunologic Factors/administration & dosage; Uveitis/diagnosis/*drug therapy/etiology; *Drugs; *Inflammation; *Child health (paediatrics); *Immunology; Arthritis, Juvenile/*complications/diagnosis/drug therapy; Rituximab/*administration & dosage

Primary (Month-6) Outcomes of the STOP-Uveitis Study: Evaluating the Safety, Tolerability, and Efficacy of Tocilizumab in Patients With Noninfectious Uveitis. - Sepah, Yasir Jamal; Sadiq, Mohammad Ali; Chu, David S.; Dacey, Mark; Gallemore, Ron; Dayani, Pouya; Hanout, Mostafa; Hassan, Muhammad; Afridi, Rubbia; Agarwal, Aniruddha; Halim, Muhammad Sohail; Do, Diana V.; et al. (American journal of ophthalmology, 2017)
PURPOSE: To report the primary endpoint analyses of the safety and efficacy of 2 different doses of intravenous (IV) infusions of tocilizumab (TCZ), an IL-6 inhibitor, in eyes with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. DESIGN: Randomized, controlled, multicenter clinical trial. METHODS: STOP-Uveitis is a randomized, open-label safety, efficacy, and bioactivity clinical trial conducted at 5 clinical centers across the United States. The study evaluated the role of TCZ in patients with noninfectious uveitis (NIU). Thirty-seven patients with NIU were randomized into one of 2 treatment groups in a ratio of 1:1. Group 1 received IV infusions of 4 mg/kg TCZ and group 2 received IV infusions of 8 mg/kg TCZ. Infusions were given every 4 weeks in both groups until month 6 (primary endpoint). Primary outcome measure was incidence and severity of systemic and ocular adverse events through month 6. Secondary outcome measures included mean change in visual acuity (VA), vitreous haze (VH), and central macular thickness (CMT) at month 6. RESULTS: A total of 37 patients were randomized in the study. At month 6, 43.5% of patients who had the potential for a 2-step decrease in VH demonstrated a 2-step decrease (40% in Group 1 and 46.1% in Group 2). Mean change in CMT was -83.88 ± 136.1 μm at month 6 (-131.5 ± 41.56 μm in Group 1 and -38.92 ± 13.7 μm in Group 2). Mean change in VA was +8.22 ± 11.83 ETDRS letters at month 6 (10.9 ± 14.6 in Group 1 and 5.5 ± 7.8 in Group 2). Repeated infusions of TCZ were well tolerated. CONCLUSIONS: Repeated IV administrations of TCZ are well tolerated. TCZ (both 4 and 8 mg/kg) is effective in improving VA and reducing VH and CMT in eyes with noninfectious intermediate uveitis, posterior uveitis, and panuveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Time Factors; Follow-Up Studies; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Single-Blind Method; Adolescent; Infusions, Intravenous; Fluorescein Angiography; *Visual Acuity; Fundus Oculi; Uveitis/diagnosis/*drug therapy/physiopathology; Tomography, Optical Coherence/methods; Vitreous Body/pathology; *Drug Tolerance; Antibodies, Monoclonal, Humanized/*administration & dosage

Incidence and clinical features of recurrent Vogt-Koyanagi-Harada disease in Japanese individuals. - Iwahashi, Chiharu; Okuno, Kensuke; Hashida, Noriyasu; Nakai, Kei; Ohguro, Nobuyuki; Nishida, Kohji (Japanese journal of ophthalmology, 2015)
PURPOSE: Our aim was to determine the recurrence rate of inflammation in Vogt-Koyanagi-Harada (VKH) disease and to describe its clinical features. METHODS: We retrospectively evaluated patients diagnosed as having VKH disease with exudative retinal detachment at the Osaka University Hospital or the Japanese Community Healthcare Organization, Osaka Hospital, between 1998 and 2012. All patients received high-dose corticosteroid therapy as the initial treatment and were followed for at least 6 months. Demographic data, including age, sex, visual acuity (VA) levels at initial presentation and at 1 year after initial therapy, treatment received, and recurrent episodes were reviewed. RESULTS: Fifty-five consecutive patients with VKH disease were identified (36 women; mean age 38.6 ± 10.4 years). Fourteen patients (25.5 %) had recurrent inflammation, which manifested as posterior uveitis in eight and as anterior uveitis in six of the patients. Recurrent posterior segment inflammation was more likely to develop in patients whose VA at initial presentation was poor (P = 0.039) and in whom orally administered corticosteroid was tapered rapidly (to 30 mg within 3 weeks or less, to 20 mg within 2 months or less, and to 10 mg within 3 months or less) (P = 0.006, P = 0.066, and P = 0.041, respectively). CONCLUSIONS: About 25 % of patients with VKH disease had recurrent inflammation. Poor initial VA and rapid tapering of the corticosteroid were associated with posterior recurrence.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Young Adult; Incidence; Administration, Oral; Recurrence; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Asians/ethnology; Japan/epidemiology; Retinal Detachment/diagnosis/drug therapy/ethnology; Uveitis, Anterior/diagnosis/drug therapy/ethnology; Uveitis, Posterior/diagnosis/drug therapy/ethnology; Uveomeningoencephalitic Syndrome/*diagnosis/drug therapy/*ethnology

Interferon-alpha2a and Systemic Corticosteroid in Monotherapy in Chronic Uveitis: Results of the Randomized Controlled BIRDFERON Study. - Fardeau, Christine; Simon, Anne; Rodde, Benoît; Viscogliosi, Fabiana; Labalette, Pierre; Looten, Vincent; Tézenas du Montcel, Sophie; LeHoang, Phuc (American journal of ophthalmology, 2017)
PURPOSE: Macular edema is the leading cause of vision loss in bilateral chronic noninfectious posterior uveitis, and is currently being treated using corticosteroids, immunosuppressive agents, and biotherapies. The aim of this trial was to assess and compare the efficacy and safety of corticosteroids and interferon-α (IFN-α) in adults with such conditions. DESIGN: Randomized controlled trial. METHODS: Subjects: Adult patients with bilateral posterior autoimmune noninfectious and nontumoral uveitis complicated by macular edema in at least 1 eye. INTERVENTION: Patients received either subcutaneous IFN-α2a, systemic corticosteroids, or no treatment for 4 months. The efficacy and safety were assessed for up to 4 months. MAIN OUTCOME MEASURES: The main endpoint was the change of the central foveal thickness (CFT) obtained by optical coherence tomography. RESULTS: Forty-eight patients were included. In intention-to-treat analysis, the median CFT change showed no significant difference. However, the per-protocol analysis showed a significant difference between groups for both eyes (OD and OS), and for the worse and better eyes. Statistically significant difference was found between the control and corticosteroid groups for the OD (P = .0285), and between the control and IFN-α groups for the OD (P = .0424) and worse eye (P = .0354). Serious adverse events occurred in 2 patients in the IFN group, in 1 patient in the corticosteroid group, and in 2 patients in the control group and were completely resolved after switch. CONCLUSIONS: IFN-α and systemic corticosteroids, compared with no treatment, were associated with significant anatomic and visual improvement shown in the per-protocol study.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Time Factors; Follow-Up Studies; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Chronic Disease; Tomography, Optical Coherence; Visual Acuity; Injections, Subcutaneous; Macular Edema/diagnosis/*drug therapy/etiology; Glucocorticoids/*administration & dosage; Interferon-alpha/*administration & dosage; Recombinant Proteins/administration & dosage; Immunologic Factors/administration & dosage; Fovea Centralis/pathology; Interferon alpha-2; Uveitis, Posterior/complications/diagnosis/*drug therapy

Anti-tumour necrosis factor biological therapies for the treatment of uveitic macular oedema (UMO) for non-infectious uveitis. - Barry, Robert J.; Tallouzi, Mohammad O.; Bucknall, Nick; Mathers, Jonathan M.; Murray, Philip I.; Calvert, Melanie J.; Moore, David J.; Denniston, Alastair K. (The Cochrane database of systematic reviews, 2018)
BACKGROUND: Non-infectious uveitis describes a heterogenous group of ocular disorders characterised by intraocular inflammation in the absence of infection. Uveitis is a leading cause of visual loss, most commonly due to uveitic macular oedema (UMO). Treatment is aimed at reducing disease activity by suppression of the intraocular inflammatory response. In the case of macular oedema, the aim is to restore macular architecture as quickly as possible, in order to prevent irreversible photoreceptor damage in this area. Acute exacerbations are typically managed with corticosteroids, which may be administered topically, locally or systemically. Whilst these are often rapidly effective in achieving disease control, long-term use is associated with significant local and systemic side effects, and 'steroid sparing agents' are typically used to achieve prolonged control in severe or recalcitrant disease. Anti-tumour necrosis factor (TNF) drugs block a critical cytokine in the inflammatory signalling process, and have emerged as effective steroid-sparing immunomodulatory agents in a wide range of non-ocular conditions. There is mechanistic data to suggest that they may provide a more targeted approach to disease control in UMO than other agents, but to date, these agents have predominantly been used 'off label' as the majority are not licensed for ocular use. This review aims to summarise the available literature reporting the use of anti-TNF therapy in UMO, thus developing the evidence-base on which to make future treatment decisions and develop clinical guidelines in this area. OBJECTIVES: To assess the efficacy of anti-TNF therapy in treatment of UMO. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Ovid Embase; LILACS; Web of Science Conference Proceedings Citation Index- Science (CPCI-S); System for Information on Grey Literature in Europe (OpenGrey); the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 29 March 2018. SELECTION CRITERIA: We planned to include all relevant randomised controlled trials assessing the use of anti-TNF agents in treatment of UMO. No limits were applied to participant age, gender or ethnicity. The primary comparisons of this review were: anti-TNF versus no treatment or placebo; anti-TNF versus another pharmacological agent; comparison of different anti-TNF drugs; comparison of different doses and routes of administration of the same anti-TNF drug. The primary outcome measure that we assessed for this review was best-corrected visual acuity (BCVA) in the treated eye. Secondary outcome measures were anatomical macular change, clinical estimation of vitreous haze and health-related quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts retrieved through the database searches. We retrieved full-text reports of studies categorised as 'unsure' or 'include' after we had reviewed the abstracts. Two review authors independently reviewed each full-text report for eligibility. We resolved discrepancies through discussion. MAIN RESULTS: We identified no completed or ongoing trial that was eligible for this Cochrane Review. AUTHORS' CONCLUSIONS: Our review did not identify any evidence from randomised controlled trials for or against the role of anti-TNF agents in the management of UMO. Although there are a number of high-quality randomised controlled trials that demonstrate the efficacy of anti-TNF agents in preventing recurrence of inflammation in uveitis, the reported study outcomes do not include changes in UMO. As a result, there were insufficient data to conclude whether there was a significant treatment effect specifically for UMO. Future trials should be designed to include quantitative measures of UMO as primary study outcomes, for example by reporting the presence or absence of UMO, or by measuring central macular thickness for study participants. Furthermore, whilst UMO is an important complication of uveitis, we acknowledge that uveitis is associated with many significant structural and functional complications. It is not possible to determine treatment efficacy based on a single outcome measure. We recommend that future reviews of therapeutic interventions in uveitis should use composite measures of treatment response comprising a range of potential complications of disease.
Keywords: Humans; Tumor Necrosis Factor-alpha/*antagonists & inhibitors; Uveitis/*complications; Macular Edema/*drug therapy/etiology; Off-Label Use

Single Dexamethasone Intravitreal Implant in the Treatment of Noninfectious Uveitis. - Frère, Ariane; Caspers, Laure; Makhoul, Dorine; Judice, Lia; Postelmans, Laurence; Janssens, Xavier; Lefebvre, Pierre; Mélot, Christian; Willermain, François (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2017)
PURPOSE: To investigate the effect of a single intravitreal dexamethasone implant (IVT-DI; Ozurdex; Allergan, Inc.) on visual acuity, macular thickness, and intraocular pressure (IOP) in active noninfectious uveitis. METHODS: Medical records of patients with noninfectious active uveitis treated by IVT-DIs were retrospectively reviewed. Uveitis etiologies, treatment indications, best corrected visual acuity (BCVA), central retinal thickness measured by ocular coherence tomography, IOP, and systemic, local, and topical treatments were collected. Parameters were analyzed before the injection of the implant, after 1.5 ± 0.8 months and 4.4 ± 0.9 months for the BCVA, after 2 ± 1.3 months and 4.6 ± 1.3 months for the ocular coherence tomography, and after 1.3 ± 0.7 months and 4.4 ± 1 months for the IOP. RESULTS: We included 14 patients (20 eyes, 20 implant injections) with cystoid macular edema (78%), vasculitis (7%), choroiditis (7%), and vasculitis associated with choroiditis (7%). Before the injection, mean visual acuity was 0.4 ± 0.5 logMAR (logarithm of the minimum angle of resolution) that improved to 0.3 ± 0.5 logMAR (P = 0.0002) after 1.5 ± 0.8 months and to 0.3 ± 0.5 logMAR (P = 0.005) after 4.4 ± 0.9 months. A statistically significant decrease of macular thickness was observed both at 2 ± 1.3 months and at 4.6 ± 1.3 months after IVT-DI. Mean IOP was 16 ± 5 mmHg before injections, 18 ± 6 mmHg (P = 0.13) at 1.3 ± 0.7 months, and 15 ± 4 mmHg (P = 0.65) at 4.4 ± 1 months. By Kaplan-Meier analysis, we found that after 3.3 months, 17% of the eyes still present a BCVA amelioration ≥0.3 logMAR. CONCLUSIONS: In our patients with active noninfectious uveitis, injection of a first single dexamethasone implant was found to improve visual acuity and decrease macular thickness without significant increase of IOP, although the effect seems limited in time.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Intravitreal Injections; Uveitis/*drug therapy; *uveitis; *noninfectious; *dexamethasone; *intravitreal implant; Dexamethasone/*administration & dosage/*therapeutic use

Current evidence of anti-tumor necrosis factor α treatment efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach of individual drugs. - Simonini, Gabriele; Druce, Katie; Cimaz, Rolando; Macfarlane, Gary J.; Jones, Gareth T. (Arthritis care & research, 2014)
OBJECTIVE: To summarize evidence regarding the effectiveness of anti-tumor necrosis factor α (anti-TNFα) treatments in childhood autoimmune chronic uveitis (ACU), refractory to previous disease-modifying antirheumatic drugs (DMARDs). METHODS: A systematic search between January 2000 and October 2012 was conducted using EMBase, Ovid Medline, Evidence-Based Medicine (EBM) Reviews: American College of Physicians Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of anti-TNFα therapy, in children ages ≤16 years, as the first treatment with a biologic agent for ACU, refractory to topical and/or systemic steroid therapy and at least 1 DMARD, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the Standardization of Uveitis Nomenclature Working Group criteria. We determined a combined estimate of the proportion of children responding to anti-TNFα treatment, including etanercept (ETA), infliximab (INF), or adalimumab (ADA). RESULTS: We initially identified 989 articles, of which 148 were potentially eligible. In total, 22 retrospective chart reviews and 1 randomized clinical trial were deemed eligible, thus including 229 children (ADA: n = 31, ETA: n = 54, and INF: n = 144). On pooled analysis of observational studies, the proportion of responding children was 87% (95% confidence interval [95% CI] 75-98%) for ADA, 72% (95% CI 64-79%) for INF, and 33% (95% CI 19-47%) for ETA. There was no difference in the proportion of responders between ADA and INF (χ(2) = 3.06, P = 0.08), although both showed superior efficacy compared with ETA (ADA versus ETA: χ(2) = 20.9, P < 0.001 and INF versus ETA: χ(2) = 20.9, P < 0.001). CONCLUSION: Although randomized controlled trials are needed, the available evidence suggests that INF and ADA provide proven similar benefits in the treatment of childhood ACU, and they are both superior to ETA.
Keywords: Humans; Treatment Failure; Retrospective Studies; Remission Induction; Chronic Disease; Child; Tumor Necrosis Factor-alpha/*antagonists & inhibitors; Uveitis/*drug therapy; Visual Acuity/drug effects; Antirheumatic Agents/pharmacology/*therapeutic use

Corticosteroid-Related Adverse Events Systematically Increase with Corticosteroid Dose in Noninfectious Intermediate, Posterior, or Panuveitis: Post Hoc Analyses from the VISUAL-1 and VISUAL-2 Trials. - Suhler, Eric B.; Thorne, Jennifer E.; Mittal, Manish; Betts, Keith A.; Tari, Samir; Camez, Anne; Bao, Yanjun; Joshi, Avani (Ophthalmology, 2017)
PURPOSE: Chronic use of corticosteroids for the treatment of uveitis has been linked with drug-associated toxicity and adverse events (AEs). This study examines the association between corticosteroid dosage and incidence rates of corticosteroid-related AEs. DESIGN: A post hoc analysis of the VISUAL-1 and VISUAL-2 placebo-controlled clinical trials. PARTICIPANTS: The clinical trials consisted of adults with active (VISUAL-1) and inactive (VISUAL-2) noninfectious intermediate, posterior, and panuveitis. Patients were randomized to receive adalimumab or placebo and underwent a protocol-defined mandatory taper to discontinue their oral corticosteroids. METHODS: Adverse event data were collected at each visit and included an assessment of the corticosteroid relationship by the investigator. A longitudinal Poisson regression model was estimated controlling for time-dependent corticosteroid dose, age, sex, prior oral corticosteroid dose, prior topical corticosteroid use, and concomitant immunosuppressive drug use. Only patients randomized to placebo were considered. MAIN OUTCOME MEASURES: The primary outcome measure was the frequency of AEs. RESULTS: The incidence rates of corticosteroid-related AEs among placebo patients during the prednisone treatment period in VISUAL-1 was statistically higher than after discontinuation (454.2 per 100 patient-years [PY] vs. 36.1 per 100 PY, incident rate ratio = 12.6, P < 0.001). Incidence rate ratios among VISUAL-2 patients were similarly high (317.5 per 100 PY vs. 41.1 per 100 PY, incident rate ratio = 7.7, P < 0.001). Based on the Poisson multivariate longitudinal Generalized Estimating Equation (GEE) model, each 10 mg increase in prednisone dose is associated with a 1.5- and 2.6-fold increase (P < 0.001 and P < 0.001) in the rate of corticosteroid-related AEs in VISUAL-1 and VISUAL-2, respectively. This implies in turn that a patient with active uveitis taking 60 mg/day of prednisone will experience, on average, an additional 10.1 (95% confidence interval (CI), 6.3-14.5; P < 0.001) corticosteroid-related AEs per year compared with a patient taking 10 mg/day, whereas a patient with inactive uveitis taking 35 mg/day of prednisone will experience, on average, an additional 23.5 (95% CI, 7.6-52.7; P = 0.05) corticosteroid-related AEs per year compared with a patient taking 10 mg/day. CONCLUSIONS: Evidence from VISUAL-1 and VISUAL-2 suggests that the incidence rates of corticosteroid-related AEs increase systematically with corticosteroid dose.
Keywords: Double-Blind Method; Female; Humans; Male; Adult; Incidence; Drug Combinations; Administration, Oral; Visual Acuity; Uveitis, Posterior/*drug therapy; Panuveitis/*drug therapy; Uveitis, Intermediate/*drug therapy; Adalimumab/administration & dosage/adverse effects; Anti-Inflammatory Agents/administration & dosage/*adverse effects; Drug-Related Side Effects and Adverse Reactions/epidemiology/*etiology; Glucocorticoids/administration & dosage/*adverse effects; Prednisone/administration & dosage/adverse effects

Vision-related functioning outcomes of dexamethasone intravitreal implant in noninfectious intermediate or posterior uveitis. - Lightman, Susan; Belfort, Rubens Jr; Naik, Rupali K.; Lowder, Careen; Foster, C. Stephen; Rentz, Anne M.; Cui, Harry; Whitcup, Scott M.; Kowalski, Jonathan W.; Revicki, Dennis A. (Investigative ophthalmology & visual science, 2013)
PURPOSE: To evaluate the effect of a single treatment with dexamethasone intravitreal implant (DEX implant) on patient-reported visual functioning in patients with noninfectious intermediate or posterior uveitis. METHODS: Patient eyes with noninfectious intermediate or posterior uveitis were randomized to a single treatment with DEX implant 0.70 mg (n=77), DEX implant 0.35 mg (n=76), or a sham procedure (n=76) and followed for 26 weeks. Vision-related functioning was measured using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) assessed at baseline and at weeks 8, 16, and 26 or early exit. Analysis of covariance and mixed model analysis of covariance were used to compare vision-related functioning between the DEX implant 0.70 and 0.35 mg groups and the sham group. RESULTS: By 8 weeks, the DEX implant 0.70 mg group demonstrated significant improvements in NEI VFQ-25 subscales near vision (P=0.031), distance vision (P=0.023), peripheral vision (P=0.045), vision-specific social functioning (P=0.019), and the NEI VFQ-25 composite score (P=0.007) compared with sham. After 26 weeks, the DEX implant 0.70 mg group reported significant improvements in NEI VFQ-25 subscales distance vision (P=0.003), vision-specific role difficulties (P=0.038), vision-specific dependency (P=0.017), vision-specific social functioning (P=0.009), vision-specific mental health (P=0.036), and the composite score (P=0.001) compared with sham. CONCLUSIONS: In patients with noninfectious intermediate or posterior uveitis receiving a single treatment of DEX implant 0.70 mg, significant and clinically meaningful improvements in patient-reported visual functioning were observed as early as week 8 and were maintained over 26 weeks. (ClinicalTrials.gov number, NCT00333814.).
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Young Adult; Adolescent; Analysis of Variance; Surveys and Questionnaires; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Uveitis, Posterior/*drug therapy/physiopathology; Anti-Inflammatory Agents/*administration & dosage; dexamethasone intravitreal implant; quality of life; treatment outcomes

Effect of Adalimumab on Visual Functioning in Patients With Noninfectious Intermediate Uveitis, Posterior Uveitis, and Panuveitis in the VISUAL-1 and VISUAL-2 Trials. - Sheppard, John; Joshi, Avani; Betts, Keith A.; Hudgens, Stacie; Tari, Samir; Chen, Naijun; Skup, Martha; Dick, Andrew D. (JAMA ophthalmology, 2017)
IMPORTANCE: Adalimumab was recently approved for the treatment of noninfectious intermediate uveitis, posterior uveitis, and panuveitis. OBJECTIVE: To assess the effect of adalimumab on the visual functioning and quality of life in patients with corticosteroid-dependent noninfectious intermediate uveitis, posterior uveitis, and panuveitis. DESIGN: A post hoc analysis of clinical trials of adults with active (VISUAL-1) and inactive (VISUAL-2) noninfectious intermediate uveitis, posterior uveitis, and panuveitis was conducted in the United States, Canada, Europe, Israel, Australia, Latin America, and Japan. A total of 217 patients (110 adalimumab, 107 placebo) in VISUAL-1 and 226 patients (115 adalimumab, 111 placebo) in VISUAL-2 were studied using intent-to-treat analyses. The clinical trials were conducted between August 10, 2010, and May 14, 2015. INTERVENTIONS: In VISUAL-1 and VISUAL-2, patients were randomized to receive adalimumab, 80-mg, subcutaneous loading dose followed by 40 mg every other week or placebo for 80 weeks. All patients underwent prednisone tapering, with patients in VISUAL-1 receiving an initial prednisone burst. MAIN OUTCOMES AND MEASURES: The 25-item National Eye Institute Vision Function Questionnaire (NEI VFQ-25) composite score questionnaire assessed the impact of visual impairment from the patient's perspective; scores on the questionnaire range from 0 to 100, with higher scores indicating better vision-related quality of life. The change in NEI VFQ-25 from best state achieved prior to week 6 (VISUAL-1) and from baseline state (VISUAL-2) to the final or early termination visit was determined in each group and statistically compared using analysis of variance. The temporal effects of adalimumab and placebo on NEI VFQ-25 were investigated using a longitudinal model. RESULTS: Of the 217 patients in VISUAL-1, 124 (57.1%) were women; the mean (SD) age was 42.7 (14.9) years. Of the 226 patients in VISUAL-2, 138 (61.1%) were women; the mean (SD) age was 42.5 (13.4). In VISUAL-1, the change from final score to best score in NEI VFQ-25 was -1.30 for adalimumab and -5.50 for placebo-a difference of 4.20 (95% CI, 1.04 to 7.36; P = .01) associated with adalimumab compared with placebo. In VISUAL-2, the change from baseline NEI VFQ-25 was 3.36 for adalimumab and 1.24 for placebo-a difference of 2.12 (95% CI, -0.81 to 5.04; P = .16). In both trials, the longitudinal models showed a significant difference in NEI VFQ-25 between adalimumab and placebo of 3.07 (95% CI, 2.09 to 4.06; P < .001) and 4.66 (95% CI, 0.05 to 9.26; P = .048) in the VISUAL-1 (74.15 vs 71.08) and VISUAL-2 (82.39 vs 77.73) trials, respectively. CONCLUSIONS AND RELEVANCE: This post hoc analysis suggests that adalimumab is associated with statistically significant and clinically meaningful improvements in patient-reported visual functioning for patients with noninfectious intermediate uveitis, posterior uveitis, and panuveitis. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT01138657 (VISUAL-1) and NCT01124838 (VISUAL-2).
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Dose-Response Relationship, Drug; Anti-Inflammatory Agents/administration & dosage; Adalimumab/*administration & dosage; Injections, Subcutaneous; Visual Acuity/*drug effects; Uveitis, Posterior/*drug therapy/physiopathology; *Health Status; Panuveitis/*drug therapy/physiopathology; Uveitis, Intermediate/*drug therapy/physiopathology

Precision Medicine: Personalized Proteomics for the Diagnosis and Treatment of Idiopathic Inflammatory Disease. - Velez, Gabriel; Roybal, C. Nathaniel; Colgan, Diana; Tsang, Stephen H.; Bassuk, Alexander G.; Mahajan, Vinit B. (JAMA ophthalmology, 2016)
IMPORTANCE: To better characterize posterior uveitis, vitreous samples from 15 patients were subjected to antibody arrays, and the expression levels of 200 human cytokines were evaluated. Expression was analyzed by 1-way analysis of variance (significance at P < .01), unsupervised cluster algorithm, and pathway analysis. OBSERVATIONS: Unbiased clustering of patients, based on their cytokine expression profile, suggested that particular protein networks and molecular pathways are altered in various forms of uveitis. Expression of interleukin 23 (IL-23), IL-1 receptor I (IL-1RI), IL-17R, tissue inhibitors of metalloproteinase 1 and 2 (TIMP-1 and TIMP-2), insulinlike growth factor-binding protein 2 (IGFBP-2), nerve growth factor (b-NGF), platelet-derived growth factor receptor β polypeptide (PDGFRb), bone morphogenic protein 4 (BMP-4), and stem cell factor (SCF) constituted a common cytokine signature in the vitreous of patients with uveitis. In 1 patient with progressive, idiopathic visual loss, this last-line analysis implicated retinal autoimmunity, a diagnosis that was validated when her serum sample was found to contain antibodies to S-arrestin, a retinal protein and potent cause of autoimmune retinal degeneration. CONCLUSIONS AND RELEVANCE: The analysis identifies a common cytokine signature for posterior uveitis and guides the diagnosis of a patient with idiopathic uveitis. Personalized treatment reversed the visual loss, illustrating how proteomic tools may individualize therapy.
Keywords: Humans; Male; Middle Aged; Adult; Case-Control Studies; Follow-Up Studies; Treatment Outcome; Severity of Illness Index; Analysis of Variance; Risk Assessment; Uveitis/diagnosis/*drug therapy; Visual Acuity/drug effects; Immunosuppressive Agents/*administration & dosage; Adrenal Cortex Hormones/*administration & dosage; Cytokines/*metabolism; Precision Medicine/*methods; Proteomics/*methods; Reference Values

Tocilizumab Employment in the Treatment of Resistant Juvenile Idiopathic Arthritis Associated Uveitis. - Maleki, Arash; Manhapra, Ambika; Asgari, Soheila; Chang, Peter Y.; Foster, C. Stephen; Anesi, Stephen D. (Ocular immunology and inflammation, 2021)
AIM: To determine the efficacy and safety of intravenous tocilizumab in refractory juvenile idiopathic arthritis associated uveitis. PATIENTS AND METHODS: This was a retrospective observational case series. Patients with refractory juvenile idiopathic arthritis associated uveitis, who had received tocilizumab were included in this study. RESULTS: 8 patients (14 eyes) were included in this study. The average age of the patients at the first visit was 16.8 ± 11.2 years (7-40). The average duration of follow-up period after starting treatment was 28.6 ± 24.6 months (9-70). Intravenous tocilizumab infusions induced and maintained remission in 5 patients (8 eyes). Vasculitis was resolved within 8 months in all but one patient. The presence of papillitis before starting treatment was directly correlated with visual acuity improvement. No side effects were observed. CONCLUSION: Intravenous tocilizumab infusion can be an effective and safe method of treatment to induce and maintain remission in resistant juvenile idiopathic arthritis associated uveitis.
Keywords: Humans; Infusions, Intravenous; *Visual Acuity; immunomodulatory therapy; tocilizumab; Antibodies, Monoclonal, Humanized/*administration & dosage; Arthritis, Juvenile/*complications/drug therapy; Biologic response modifiers; juvenile idiopathic arthritis; Uveitis/*drug therapy/etiology

Success with single-agent immunosuppression for multifocal choroidopathies. - Goldberg, Naomi R.; Lyu, Theodore; Moshier, Erin; Godbold, James; Jabs, Douglas A. (American journal of ophthalmology, 2014)
PURPOSE: To evaluate the success of single-agent immunosuppression for patients with the posterior uveitides, birdshot chorioretinitis, multifocal choroiditis with panuveitis, and punctate inner choroiditis. DESIGN: Retrospective case series. METHODS: setting: Tertiary care uveitis practices. population: Patients initiated on immunomodulatory therapy. intervention: Patients were treated with prednisone 1 mg/kg and mycophenolate 2 g daily. Prednisone was tapered after 1 month. Immunosuppression was escalated to mycophenolate 3 g daily, with addition of a second agent, as needed, to achieve treatment success. outcome measure: Treatment success, defined as no disease activity with prednisone dose ≤10 mg daily, at 6, 12, and 24 months. RESULTS: Twenty-seven patients were followed. Mean presentation and 2-year follow-up acuities were 20/41 and 20/42, respectively. For birdshot chorioretinitis, mean (±standard deviation) quantitative Goldmann visual field scores improved from 761 ± 69 degrees (IV/4 isopter) and 496 ± 115 degrees (I/4 isopter) at presentation to 784 ± 57 degrees and 564 ± 125 degrees, respectively. Prednisone was successfully tapered in 95% of patients; mean prednisone doses at 1 and 2 years were 5.3 ± 4.1 and 5.7 ± 4.8 mg/day, respectively. At 2 years, prednisone was discontinued in 11% of patients. Treatment success was achieved in 74% of patients on 1 immunosuppressant, and in an additional 21% of patients on 2 agents, for an overall 95% success rate at 2 years. CONCLUSIONS: Posterior uveitides can be treated with 1 agent in most patients, but the data suggest a need to escalate therapy to higher mycophenolate doses, and in one fifth of cases to add a second agent to maintain disease suppression with acceptably low prednisone doses.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Adolescent; Glucocorticoids/*therapeutic use; Immunosuppressive Agents/*therapeutic use; Prednisone/*therapeutic use; Electroretinography; Azathioprine/therapeutic use; Visual Acuity/physiology; Visual Fields/physiology; Panuveitis/*drug therapy/physiopathology; Chorioretinitis/*drug therapy/physiopathology; Choroiditis/drug therapy/physiopathology; Multifocal Choroiditis; Mycophenolic Acid/analogs & derivatives/therapeutic use; Tacrolimus/therapeutic use

A Rare Presentation of Cyclitis Induced Myopia. - Ijaz, Umar; Habib, Asad; Rathore, Hassan Sajjad (Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2018)
Unilateral cyclitis leading to myopia is a rare and clinical relevant entity. In clinical settings, pseudomyopia is generally encountered in the form of accommodative spasm, which is always bilateral. Cyclitis due to inflammation, on the other hand, can cause pseudomyopia unilaterally and it is a very rare presentation. A young male with acute anterior uveitis, presented with acute episode of unilateral myopia. When patient was examined on first visit, there were no cells in anterior chamber; so he was started on cycloplegic eye drops, but his condition didn't improve. Examination on subsequent visit revealed cellular reaction in anterior chamber and narrowing of anterior chamber angles on anterior segment optical coherence tomography (OCT). Treatment for uveitis was started and patient's visual acuity and refractive error improved. Pseudomyopia is a known complication of several drugs and certain medical conditions. The possible mechanism is supraciliary exudation causing relaxation of zonular fibers and increased convexity of the crystalline lens. Myopia in the setting of a mild cellular reaction can easily be missed and has not been reported yet to the best of authors' literature search.
Keywords: Humans; Male; Adult; Tomography, Optical Coherence; Visual Acuity/physiology; Anterior Chamber/*pathology; Muscle Spasticity/drug therapy/*etiology; Mydriatics/therapeutic use; Myopia/*etiology; Refractive Errors; Therapeutics; Uveitis/*diagnosis/drug therapy

Efficacy and safety of deep sclerectomy in uveitic glaucoma. - Al Obeidan, Saleh A.; Osman, Essam A.; Al-Muammar, Abdulrahman M.; Abu El-Asrar, Ahmed M. (International ophthalmology, 2009)
PURPOSE: To evaluate the safety and efficacy of deep sclerectomy with implant and mitomycin C in uveitic glaucoma. Design Prospective, noncomparative case study. PATIENTS AND METHODS: Nine patients (13 eyes) with uncontrolled uveitic glaucoma underwent deep sclerectomy with implant from 2002 to 2006. All patients had their uveitis controlled before and after surgery with anti-inflammatory therapy. Main outcome measures Control of intraocular pressure. A secondary outcome measure was the number of antiglaucoma medications required to achieve the desired intraocular pressure. Visual acuity and complication associated with the surgery were monitored. RESULTS: Mean follow-up was 21 months (range 12-54 months). Intraocular pressure (IOP) was reduced from a mean preoperative value of 28.7 mmHg to a mean postoperative value of 13.85 mmHg (Wilcoxon signed rank test P = 0.005). At the most recent visit, complete success was obtained in 84.6%, qualified success was obtained in 7.7%, and complete failure in 7.7%. Mean number of antiglaucoma medications was reduced from 3.07 to 0.2 (Wilcoxon signed rank test P = 0.001). Neodymium:YAG goniopuncture was performed in two eyes. Postoperative complications included transient hypotony with maculopathy in one eye, shallow choroidal effusions in two eyes, and progression of cataract in four eyes. CONCLUSION: Deep sclerectomy with implant in uveitic glaucoma appeared to be effective in controlling the IOP at short-term follow-up with no serious postoperative side-effects.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Treatment Outcome; Young Adult; Adolescent; Child; Uveitis/*complications; Postoperative Care; Postoperative Period; Intraocular Pressure/drug effects; Mitomycin/administration & dosage; Postoperative Complications; Drug Delivery Systems/instrumentation; Glaucoma Drainage Implants; Glaucoma/drug therapy/*etiology/physiopathology/*surgery; Sclerostomy/*adverse effects/*methods; Surgical Sponges

Multicenter study of intravitreal dexamethasone implant in noninfectious uveitis: indications, outcomes, and reinjection frequency. - Zarranz-Ventura, Javier; Carreño, Ester; Johnston, Robert L.; Mohammed, Quresh; Ross, Adam H.; Barker, Carl; Fonollosa, Alex; Artaraz, Joseba; Pelegrin, Laura; Adan, Alfredo; Lee, Richard W.; Dick, Andrew D.; et al. (American journal of ophthalmology, 2014)
PURPOSE: To identify clinical outcomes and treatment patterns of intravitreal dexamethasone implant (Ozurdex; Allergan, Inc) in noninfectious uveitis in the clinical setting. DESIGN: Multicenter retrospective cohort study. METHODS: Eighty-two eyes (63 patients) receiving 142 implant injections over 35 months were included. Treatment indication, uveitis diagnosis, visual acuity, intraocular pressure, vitreous haze score, central retinal thickness by optical coherence tomography, phakic status, number of injections, time to reinjection, systemic treatments, and complications data were collected. Time to visual acuity and vitreous haze score improvement as per the Standardization of Uveitis Nomenclature guidelines were also determined. RESULTS: The probability of visual acuity improvement (≥0.3 logarithm of the minimal angle of resolution units improvement) was 39% at 1 month, 49% at 3 months, 52% at 6 months, and 58% at 12 months. Eyes with baseline vitritis (vitreous haze score ≥+0.5, n = 45) had a probability of vitreous haze score improvement (2-step decrease or change from +0.5 to 0) at 2 weeks of 41%, at 1 month 63%, at 3 months 73%, at 6 months 79%, and at 12 months 88%. In eyes that completed 12-month follow-up (n = 54), 40.7% underwent 2 injections (mean time to second injection of 6.6 ± 1.9 months) and 11.2% required ≥3 injections (mean time to third injection of 11 ± 1.5 months). CONCLUSIONS: Dexamethasone implant use in uveitis provides favorable visual acuity and vitreous haze score outcomes but requires repeated injections, an important consideration when choosing intraocular treatment as a route to controlling uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Cohort Studies; Drug Implants; Intravitreal Injections; Uveitis/diagnosis/*drug therapy; Retina/pathology; Visual Acuity/drug effects; Dexamethasone/*administration & dosage/adverse effects; Glucocorticoids/*administration & dosage/adverse effects; Vitreous Body/drug effects; Intraocular Pressure/drug effects; Retreatment

The Manchester Uveitis Clinic: The first 3000 patients, 2: Uveitis Manifestations, Complications, Medical and Surgical Management. - Jones, N. P. (Ocular immunology and inflammation, 2015)
PURPOSE: To demonstrate the manifestations and complications of uveitis, and their medical and surgical management, in a very large group of patients attending the Manchester Uveitis Clinic (MUC), a specialist uveitis clinic in the Northwest of England, UK. METHODS: Retrospective retrieval of data on a computerized database incorporating all new referrals to MUC from 1991 to 2013. RESULTS: A total of 3000 new patients with uveitis were seen during a 22-year period, of which 25.2% had a single acute episode, 13.6% had acute recurrent uveitis, 20.2% had chronic fluctuating uveitis, and 41.0% had chronic unremitting uveitis. The commonest complications were cataract (35% of patients), macular edema (20.5%), and glaucoma (19.5%). Oral steroids were required in 36% of patients, oral immunosuppression in 16%, and biologic treatment in 2%. Major intraocular surgery was required in 28%. CONCLUSIONS: Oral steroid usage is not an independent risk factor for cataract formation in patients with uveitis. Oral immunosuppression usage has increased 4-fold during this study period.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Follow-Up Studies; Retrospective Studies; Incidence; uveitis; Immunosuppression Therapy/*methods; Visual Acuity; complications; glaucoma; Cataract; macular edema; Glaucoma/epidemiology/*etiology; immunosuppression; Macular Edema/epidemiology/*etiology; Ophthalmologic Surgical Procedures/*methods; United Kingdom/epidemiology; Uveitis/complications/*epidemiology/therapy

Levofloxacin and Tobramycin for Severe Bacterial Keratouveitis. - Accorinti, Massimo; Colao, Lorena; Gilardi, Marta; Cecere, Michela; Salotti, Alessandra; Pesci, Francesca Romana (Ocular immunology and inflammation, 2016)
PURPOSE: To report on clinical features and outcome of severe bacterial keratouveitis. METHODS: Twenty patients with severe bacterial keratouveitis treated with topical tobramycin and levofloxacin and oral levofloxacin were included. Main outcome measures were ulcers location, bacterial isolates, risk factors, visual prognosis. RESULTS: Centrally located ulcer/abscess was present in 65% of patients. Contact lens (CL) wear was the most common risk factor (70%). Bacterial isolates were observed in 58% of patients, none resistant to tobramycin and levofloxacin. Pseudomonas aeruginosa was found in 47% of positive cases and in 64% of CL wearers. After therapy, the mean visual acuity improved significantly (p < 0.0001), particularly in contact lens wearers (p = 0.04) and in patients younger than 60 years old (p < 0.001). CONCLUSIONS: Pseudomonas aeruginosa is the most frequent cause of bacterial keratouveitis and CL wear the most common risk factor. Topical tobramycin and levofloxacin and oral levofloxacin are effective in the treatment of bacterial keratouveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Risk Factors; Young Adult; Adolescent; Anti-Bacterial Agents/*therapeutic use; Ophthalmic Solutions; Visual Acuity; Administration, Topical; Antibiotic therapy; Bacteria/isolation & purification; bacterial keratitis; contact lens; Contact Lenses/adverse effects; Corneal Ulcer/*drug therapy/microbiology; intraocular inflammation; Levofloxacin/*therapeutic use; Pseudomonas aeruginosa; Tobramycin/*therapeutic use; Uveitis, Anterior/*drug therapy/microbiology

Mycophenolate mofetil as an immunomodulator in refractory noninfectious uveitis. - Rodriguez, Ever Ernesto Caso; Sakata, Viviane Mayumi; Cavalcanti, Daniel Cesar Torres Melo; Zaghetto, Juliana Marques; Olivalves, Edilberto; Hirata, Carlos Eduardo; Yamamoto, Joyce Hisae (Arquivos brasileiros de oftalmologia, 2016)
PURPOSE: To evaluate the efficacy and tolerance of mycophenolate mofetil (MMF) for the treatment of noninfectious uveitis using the methods advocated by the Standardization of Uveitis Nomenclature (SUN) Working Group and to compare this with other studies of immunosuppression in ocular inflammation. METHODS: Retrospective case series. Patients with noninfectious uveitis, followed at a tertiary Uveitis Service in São Paulo, Brazil, from 2007 to 2014 and receiving oral MMF for a minimum of 6 months, were retrospectively reviewed. After reaching an optimal dose of MMF, patients were evaluated after 6 (T6), 12 (T12), and 24 months (T24). The optimal dose varied for each patient (medium 2.2 g/day, range 1.0-3.0 g/day). The main outcome measures were: 1) success on achieving complete control of inflammation in both eyes and/or oral prednisone dosage reduction to ≤10 mg per day, and 2) the length of time required to reduce oral prednisone to ≤10 mg/day, partial control of ocular inflammation, and side effects. RESULTS: In a cohort of 16 patients with refractory noninfectious uveitis, 67% reached the ideal prednisone dose after 1 year of MMF treatment and 83% after 2 years of MMF treatment. Complete or partial inflammation control was achieved in 43.7% at T12. Two patients (14%) had disease remission after 4.7 years of MMF treatment. Adverse effects were gastrointestinal disturbances, infection, insomnia, and liver function abnormalities at a rate of 0.03 patient-year each. CONCLUSIONS: This small retrospective case series is consistent with the literature concerning the high efficacy and moderate tolerability of MMF in noninfectious uveitis. Observation of patients should be continued for at least 1 year to clearly determine MMF efficacy.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Administration, Oral; Recurrence; Visual Acuity; Uveitis/*drug therapy; Immunosuppressive Agents/administration & dosage/*therapeutic use; Mycophenolic Acid/administration & dosage/*therapeutic use

[Analysis of the life quality of infectious and non-infectious patients with uveitis using the NEI-VFQ-25 questionnaire]. - Mello, Paula Resende Aquino de Assis Pereira; Roma, Adriano de Carvalho; Moraes Júnior, Haroldo Vieira (Arquivos brasileiros de oftalmologia, 2008)
PURPOSE: To evaluate the life quality of patients with infectious and non-infectious uveitis evaluated at the uveitis service of the Hospital Universitário Clementino Fraga Filho-UFRJ, using the NEI-VFQ-25 questionnaire in order to clarify the importance of uveitis diagnosis and treatment as well as its consequences to visual and social functions of the patients. METHODS: Prospective study of 30 patients with uveitis, who were divided into two groups according to the etiology, infectious and non-infectious, with the NEI-VFQ-25 form that evaluates the life quality regarding general and visual health which was applied twice to each patient. RESULTS: The main cause of infectious uveitis was toxoplasmosis, and of the non-infectious was Vogt-Koyanagi-Harada syndrome. Concerning quality of life, general health is better in the infectious uveitis group, but ocular health is regular in both groups. Although visual deficit does not cause great disturbances and social restrictions, both groups show important emotional alteration, but in the non-infectious group this alteration causes a higher dependence level regarding daily activities. CONCLUSION: The greater social dependence as well as that regarding performance of daily activities in the uveitis group of non-infectious cause is explained by the chronic and relapsing mode of these affections, which turns life quality lower if compared to the other group.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Young Adult; Adolescent; Health Status; *Quality of Life; Visual Acuity/physiology; *Surveys and Questionnaires; Activities of Daily Living/psychology; Dependency, Psychological; Pain/diagnosis; Uveitis/etiology/physiopathology/*psychology

Combination of Intravenous Methotrexate and Methylprednisolone Therapy in the Treatment of Severe Ocular Inflammatory Diseases. - Maleki, Arash; Ueberroth, Jordan A.; Walsh, Marisa; Foster, Frances; Chang, Peter Y.; Anesi, Stephen D.; Foster, Charles Stephen (Ocular immunology and inflammation, 2021)
Purpose: To evaluate the efficacy of intravenous methotrexate and methylprednisolone in severe, sight-threatening ocular inflammatory conditions.Methods: This was a retrospective observational case series. Patients who had received intravenous methotrexate for ocular inflammation with at least 24 months of follow-up were included in the study.Results: Ten patients (20 eyes) were included in this study. Mean age of the patients was 47.2 ± 17.7 (range:19-74). At 1-month follow-up visit, nine patients showed improvement and one patient failed treatment. At 12-month follow-up visit, all patients were in remission. Two patients were only on intravenous methotrexate infusions. At twenty-four-month follow-up visit, only one patient, in remission, was on intravenous methotrexate therapy. Leukopenia was the only adverse effect observed.Conclusion: Intravenous methotrexate and methylprednisolone infusions can be an effective method of treatment in patients with severe, sight-threatening ocular inflammatory conditions.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Young Adult; Glucocorticoids/*therapeutic use; Methotrexate/*therapeutic use; Infusions, Intravenous; Immunosuppressive Agents/*therapeutic use; uveitis; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Methylprednisolone/*therapeutic use; Intravenous methotrexate; methylprednisolone; ocular inflammation; retinal vasculitis; Retinal Vasculitis/diagnosis/*drug therapy/physiopathology; scleritis; Scleritis/diagnosis/*drug therapy/physiopathology

Simvastatin as an Adjunct to Conventional Therapy of Non-infectious Uveitis: A Randomized, Open-Label Pilot Study. - Shirinsky, Ivan V.; Biryukova, Anastasia A.; Shirinsky, Valery S. (Current eye research, 2017)
PURPOSE: Statins have been shown to reduce ocular inflammation in animal models of uveitis and to prevent development of uveitis in observational studies. There have been no experimental human studies evaluating statins' efficacy and safety in uveitis. In this study, we aimed to investigate efficacy and safety of simvastatin in patients with uveitis. METHODS: For this single-center, open-label, randomized study, we enrolled patients with acute non-infectious uveitis. The patients were randomized to receive 40 mg simvastatin per day for 2 months in addition to conventional treatment or conventional treatment alone. The studied outcomes were the rate of steroid-sparing control of ocular inflammation, measures of ocular inflammation, intraocular pressure, and visual acuity. RESULTS: Fifty patients were enrolled in the study. Twenty-five patients were randomly assigned to receive simvastatin with conventional treatment and 25 to conventional treatment alone. Simvastatin was associated with significantly higher rates of steroid-sparing ocular inflammation control, decrease in anterior chamber inflammation, and improvement in visual acuity. The treatment was well tolerated, no serious adverse effects were observed. CONCLUSIONS: Our findings suggest that statins may have therapeutic potential in uveitis. These results need to be confirmed in double-blind, randomized, controlled studies.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Treatment Outcome; Glucocorticoids/*therapeutic use; Chemotherapy, Adjuvant; Visual Acuity; Uveitis/diagnosis/*drug therapy; *Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase; *non-infectious uveitis; *randomized study; *statins; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use; Simvastatin/*therapeutic use

Diagnosis and treatment of tuberculous uveitis in a low endemic setting. - Vos, A. G.; Wassenberg, M. W. M.; de Hoog, J.; Oosterheert, J. J. (International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2013)
OBJECTIVE: To determine factors associated with the diagnosis of tuberculous uveitis and the response to anti-tuberculous treatment (ATT). METHODS: A retrospective case study was performed at the University Medical Centre Utrecht between October 2007 and December 2009. Patients with possible tuberculous uveitis (TBU) were selected from all patients with an unexplained uveitis. Demographics, ethnicity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tuberculin skin test (TST), QuantiFERON (QFT) test, and ocular findings were evaluated. An interdisciplinary panel discussed if there was a presumed TBU and decided to start treatment. When there was a decrease in intraocular cell count and/or improvement in visual acuity after ATT, the confirmation of presumed TBU was made. RESULTS: Of 585 patients with unexplained uveitis, 66 (11.3%) fulfilled the definition of possible TBU. Ten (15.4%) patients were regarded as having presumed TBU and received ATT. All of them had latent tuberculosis (LTB). The ocular situation improved in seven patients (70%). A history of TB contact, abnormalities on chest radiology, and extraocular manifestations of TB were associated with a good response to ATT in the case of presumed tuberculous uveitis. CONCLUSIONS: Tuberculous uveitis remains difficult to diagnose. No clearly correlating factors that predicted the response to ATT, including ocular parameters, could be identified.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Risk Factors; Treatment Outcome; Uveitis; Antitubercular Agents/therapeutic use; Latent tuberculosis; Tuberculosis; Tuberculosis, Ocular/*diagnosis/*drug therapy; Uveitis/*diagnosis/*drug therapy

Intraoperative intravitreal triamcinolone acetonide injection for prevention of postoperative inflammation and complications after phacoemulsification in patients with uveitic cataract. - Ren, Yan; Du, Shufang; Zheng, Dongping; Shi, Yanyun; Pan, Luping; Yan, Hua (BMC ophthalmology, 2021)
BACKGROUND: We aimed to evaluate the efficacy and safety of phacoemulsification with intravitreal 3 mg triamcinolone acetonide injection in preventing postoperative inflammation and complications in patients with non-infectious anterior uveitis and panuveitis complicated cataract. METHOD: In this retrospective cohort study, 140 uveitic cataract patients who received phacoemulsification and intraocular lens implantation in Shanxi Eye hospital from January 2018 to January 2020 were reviewed. The IVTA group (51 eyes of 41 patients) received intravitreal injection of 3 mg triamcinolone acetonide (TA) at the end of surgery, and the control group (51 eyes of 41 patients) without injection matched by propensity score matching were enrolled. Outcome measures were best corrected visual acuity (BCVA), anterior chamber inflammation, intraocular pressure, corneal endothelial cell density, central macular thickness and complications within 3 months follow-up. RESULTS: The degree of postoperative anterior chamber inflammation in the IVTA group was lighter than that in the control group (P < 0.05). The postoperative logMAR BCVA of anterior uveitis was better and improved more quickly in the IVTA group(P < 0.05). Postoperative time of using corticosteroids was shorter in the IVTA group as compared to the control group (P < 0.05). The central macular thickness at postoperative month 1 was statistically significantly lower in the IVTA group (P < 0.05). There were no statistically significant differences between the two groups in postoperative corneal endothelial cell density and intraocular pressure (P > 0.05). Two of 51 eyes (3.9%) in the IVTA group and 8 of 51 eyes (15.7%) in the control group had recurrence of uveitis; 6 of 45 eyes (13.3%) in the control group developed cystoid macular edema but none in the IVTA group; 11 of 51 eyes (21.6%) in the IVTA group and 22 of 51 eyes (43.1%) in the control group developed posterior synechiae postoperatively. CONCLUSIONS: Intraoperative Intravitreal injection of 3 mg TA is an effective and safe adjunctive therapy for preventing postoperative inflammation and complications to promote early recovery for anterior uveitis or panuveitis complicated cataract patients following phacoemulsification. TRIAL REGISTRATION: This retrospective cohort study was in accordance with the tenets of the Helsinki Declaration and was approved by the Shanxi Eye Hospital Ethics Committee. Written informed consent was obtained from all participants for their clinical records to be used in this study.
Keywords: Humans; Retrospective Studies; Inflammation; Glucocorticoids/therapeutic use; Visual Acuity; Intravitreal Injections; Vitreous Body; *Phacoemulsification; Phacoemulsification; *Cataract; *Uveitis/complications/drug therapy/prevention & control; Intravitreal injection; Triamcinolone acetonide; Triamcinolone Acetonide/therapeutic use; Uveitic cataract

[Intravitreal triamcinolone acetonide for the treatment of intraocular edematous and neovascular diseases]. - Jonas, J. B.; Kreissig, I.; Kamppeter, B.; Degenring, R. F. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2004)
BACKGROUND: Within the last 2 years, intravitreal application of triamcinolone acetonide has exponentially increased as a treatment option for various intraocular neovascular and edematous proliferative disorders. METHODS AND RESULTS: The best response to intravitreal triamcinolone acetonide injection in terms of gain in visual acuity was obtained for eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of noninfectious uveitis including sympathetic ophthalmia. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful for exudative age-related macular degeneration, alone or in combination with photodynamic therapy. In eyes with chronic, therapy-resistant, ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy, such as secondary ocular hypertension in about 40% of the eyes injected, cataractogenesis, postoperative infectious and noninfectious endophthalmitis, and pseudo-endophthalmitis will be covered in another article. Intravitreal triamcinolone injection can be combined with other intraocular surgeries including cataract surgery. Cataract surgery performed some months after the injection did not show a markedly elevated rate of complications. If vision increases after the intravitreal triamcinolone injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone ranges between 2 and 9 months, probably depending on the dosage used. CONCLUSIONS: Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular oedematous and neovascular disorders. One has to take into account the side effects and the lack of long-term follow-up observations.
Keywords: Humans; Aged; Time Factors; Combined Modality Therapy; Injections; Visual Acuity; Uveitis/*drug therapy; Intraocular Pressure; Vitreous Body; Glucocorticoids/*administration & dosage/adverse effects; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Macular Edema/drug therapy; Triamcinolone Acetonide/*administration & dosage/adverse effects; Angiogenesis Inhibitors/*administration & dosage/adverse effects; Diabetic Retinopathy/drug therapy; Iris Diseases/*drug therapy; Macular Degeneration/*drug therapy; Ocular Hypotension; Ophthalmia, Sympathetic/*drug therapy; Papilledema/drug therapy; Photochemotherapy; Retinal Diseases/*drug therapy; Retinal Neovascularization/drug therapy; Retinal Vein Occlusion/drug therapy

Adalimumab in Juvenile Idiopathic Arthritis-Associated Uveitis: 5-Year Follow-up of the Bristol Participants of the SYCAMORE Trial. - Horton, Sarah; Jones, Ashley P.; Guly, Catherine M.; Hardwick, Ben; Beresford, Michael W.; Lee, Richard W.; Dick, Andrew D.; Ramanan, Athimalaipet V. (American journal of ophthalmology, 2019)
PURPOSE: To determine longer-term outcomes of participants enrolled from a single center in the SYCAMORE trial, a randomized placebo-controlled trial of adalimumab vs placebo in children with juvenile idiopathic arthritis-associated uveitis (JIA-U) uncontrolled on methotrexate. DESIGN: Retrospective interventional case series. METHODS: Medical records of all 28 SYCAMORE participants recruited at the Bristol Eye Hospital were reviewed at approximately 3-monthly intervals up to 5 years from the trial randomization date. Uveitis activity, treatment course, visual outcomes, ocular complications, and adverse events were recorded. Data are presented using summary statistics. RESULTS: Following withdrawal of the investigational medicinal product (IMP), 25 of the 28 participants were started on adalimumab for active JIA-U. Of the 12 participants in the active treatment arm of the SYCAMORE study, 11 (92%) were restarted on adalimumab after withdrawal of the IMP for active JIA-U (median time to flare 188 days [range 42-413 days). Two participants stopped adalimumab for uncontrolled JIA-U. One participant had a reduction in vision to 0.3 owing to cataract. Mean visual acuity for the remaining 27 participants was -0.04 (right eye) and -0.05 (left eye). CONCLUSIONS: Drug-induced remission of JIA-U did not persist when adalimumab was withdrawn after 1-2 years of treatment. Adalimumab was well tolerated and visual acuity outcomes were excellent.
Keywords: Female; Humans; Male; Drug Therapy, Combination; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Dose-Response Relationship, Drug; Child; Methotrexate/administration & dosage; Antirheumatic Agents/administration & dosage; *Visual Acuity; Adalimumab/*administration & dosage; Arthritis, Juvenile/*complications/drug therapy; Uveitis/*drug therapy/etiology/physiopathology

Subfoveal serous retinal detachment in patients with uveitic macular edema. - Ossewaarde-van Norel, Jeannette; Berg, Elize M.; Sijssens, Karen M.; Rothova, Aniki (Archives of ophthalmology (Chicago, Ill. : 1960), 2011)
OBJECTIVE: To assess the clinical characteristics and effect on visual acuity (VA) of a subfoveal serous retinal detachment (SRD) associated with macular edema (ME) in patients with uveitis. METHODS: Clinical and optical coherence tomograph characteristics were retrospectively assessed in 37 patients with uveitic ME with a subfoveal SRD (case individuals) and 61 patients with uveitic ME without a subfoveal SRD (control individuals), matched for uveitis location, sex, and age. Scans of the case and control individuals took place between September 19, 2003, and July 21, 2008. RESULTS: Patients with a subfoveal SRD had a shorter history of uveitis (P = .03) and ME (P = .03) and a lower VA (P = .003). Mean total retinal thickness (TRT) in cases exceeded that of controls (449 vs 326 μm; P < .001). The median subfoveal SRD duration was 2 months, and 29 of 36 SRDs (81%) had disappeared at the 3-month follow-up examination. The improvement in VA and the decrease in TRT after 3 months were better in the subfoveal SRD group than in the control group (P = .001 for VA and P = .001 for TRT), resulting in similar VA and TRT after 3 months. CONCLUSIONS: A subfoveal SRD was associated with lower VA and developed typically in the early stages of uveitis and ME. The subfoveal SRD and VA reacted favorably to treatment with periocular and systemic steroids and/or oral acetazolamide.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Case-Control Studies; Follow-Up Studies; Retrospective Studies; Young Adult; Adolescent; Child; Tomography, Optical Coherence; Immunosuppressive Agents/therapeutic use; Visual Acuity/physiology; Acetazolamide/therapeutic use; Fovea Centralis; Macular Edema/*complications/drug therapy/physiopathology; Retinal Detachment/*complications/drug therapy/physiopathology; Uveitis/*complications/drug therapy/physiopathology

Outcomes of phacoemulsification in patients with uveitis at a tertiary center in São Paulo, Brazil: a review of cases from 2007 to 2012. - Cerqueira, Patrícia M. G.; Silva, Felipe T. B. Gaspar C. da; Carricondo, Pedro Carlos; Olivalves, Edilberto; Hirata, Carlos Eduardo; Yamamoto, Joyce Hisae (Arquivos brasileiros de oftalmologia, 2017)
PURPOSE: To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. METHODS: Consecutive patients with uveitis and cataracts who had phacoemulsification and acrylic IOL implantation during 2007-2012 were evaluated for visual outcomes, etiology, and complications. Inflammation was controlled for at least 3 months before surgery, and oral prednisone (0.5 mg/kg/day) was administered to patients with non-infectious uveitis. RESULTS: This study investigated 45 eyes in 38 patients with a mean age of 52 ± 12.5 years. The most common etiologies among non-infectious causes (n=32; 73.3%) were Vogt-Koyanagi-Harada disease (n=9), Fuchs heterochromic iridocyclitis (n=4), and sympathetic ophthalmia (n=3). Four cases were idiopathic. Among infectious cases (n=13; 28.9%), the most common causes were toxoplasmosis (n=6) and presumed ocular tuberculosis (n=4). An acrylic IOL was implanted in-the-bag in all cases. After 1-year follow-up, an improvement in visual acuity of two or more lines was observed in 38 eyes (84.4%), and 28 eyes (62.2%) achieved a postoperative visual acuity of ≥0.5. Posterior capsule opacification was observed in 10 eyes (22.2%). Persistent postoperative inflammation (of >6 months) was observed in seven eyes (15.5%) and recurrence occurred in four eyes (8.8%). IOL was explanted in one eye. Intraocular hypertension was observed in six eyes (13.3%). CONCLUSIONS: Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataracts and uveitis. Good preoperative and postoperative control of inflammation plays an important role in achieving favorable visual outcomes. Furthermore, the final visual outcome depends on the posterior segment status.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Brazil; Retrospective Studies; Treatment Outcome; Young Adult; Visual Acuity; Preoperative Care; Postoperative Complications; Cataract Extraction/adverse effects/*statistics & numerical data; Inflammation/etiology; Lens Implantation, Intraocular/adverse effects/*statistics & numerical data; Phacoemulsification/adverse effects/*statistics & numerical data; Tertiary Care Centers/statistics & numerical data; Uveitis/*surgery

Combined fluocinolone acetonide intravitreal insertion and glaucoma drainage device placement for chronic uveitis and glaucoma. - Malone, Paula E.; Herndon, Leon W.; Muir, Kelly W.; Jaffe, Glenn J. (American journal of ophthalmology, 2010)
PURPOSE: To determine whether a fluocinolone acetonide sustained-release intravitreal drug delivery system can be implanted safely at the same time that a glaucoma drainage device is placed for eyes with uveitis and elevated intraocular pressure (IOP) receiving maximum tolerated IOP-lowering therapy. DESIGN: Retrospective, observational case series. METHODS: Subjects had chronic noninfectious intermediate or posterior uveitis and elevated IOP while receiving maximum tolerated medical therapy. Fluocinolone acetonide implantation and glaucoma tube shunt placement were performed in a single surgical session. The main outcome measures were inflammatory recurrences, visual acuity (VA), use of adjunctive anti-inflammatory therapy, IOP, and adverse events. RESULTS: Seven eyes of 5 patients were studied. The average number of recurrences 12 months before implantation was 3 episodes per eye; of the 3 eyes followed up for more than 30 months, none had an inflammatory recurrence within 30 months after implantation. The mean Snellen visual acuity 12 months after the combined surgery was 20/114, compared with 20/400 at baseline. Adjunctive steroid use decreased. Average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg 12 months after the combined surgery (P = .019). CONCLUSIONS: The favorable results observed in all eyes suggest that fluocinolone acetonide implantation can be safely combined with glaucoma tube shunt placement in a single surgical session in eyes with uveitis and elevated IOP receiving maximum tolerated IOP-lowering therapy. Uveitis recurrences decreased, visual acuity improved, and IOP decreased. There were no adverse events during insertion of the fluocinolone acetonide implant and placement of the glaucoma tube shunt.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Combined Modality Therapy; Feasibility Studies; Recurrence; Chronic Disease; Visual Acuity/physiology; Drug Implants; *Glaucoma Drainage Implants; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Vitreous Body; Glaucoma/etiology/*surgery; Fluocinolone Acetonide/*administration & dosage; Uveitis, Intermediate/complications/*drug therapy; Uveitis, Posterior/complications/*drug therapy

Necrotizing nocardial scleritis after combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation: a case report and review of the literature. - Ramos-Esteban, Jerome Charles; Servat, Juan Javier; Silva, Renata Siqueira da; Ambrósio, Renato Jr; Tauber, Shachar; Bia, Frank (Arquivos brasileiros de oftalmologia, 2007)
We report the history and clinical presentation of an 88-year-old female with Fuchs dystrophy who developed an acute anterior necrotizing scleritis in her left eye 23 months after an uncomplicated combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation which progressed to slceral perforation with uveal prolapses. The patient underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis. Surgical specimens of the area of scleral perforation were sent for histology and microbiologic studies. Analysis of surgical specimens revealed the presence of culture-proven Nocardia asteroides as a causative agent for the patient's scleral perforation. Results of her systemic autoimmune work-up were not conclusive. Successful treatment with tectonic scleral reinforcement with donor corneal tissue and preserved pericardium, oral and topical trimethoprim-sulfamethoxazole and topical amikacin salvaged the globe and increased vision. The patient's final best-corrected visual acuity sixteen months after her last operation remains 20/70. Prompt surgical intervention with submission of appropriate specimens for pathological diagnosis and microbiology, along with consultation with rheumatologic and infectious disease specialists, are mandatory to minimize visual loss in cases of suspected infectious necrotizing scleritis.
Keywords: Female; Humans; Aged, 80 and over; Drug Therapy, Combination; Anti-Bacterial Agents/administration & dosage/therapeutic use; Ophthalmic Solutions; Visual Acuity; *Nocardia asteroides/isolation & purification; *Nocardia Infections/microbiology/pathology; Abscess/microbiology/pathology/therapy; Anterior Chamber/microbiology; Eye Infections, Bacterial/*microbiology/pathology/therapy; Fuchs' Endothelial Dystrophy/complications; Keratoplasty, Penetrating/adverse effects; Lens Implantation, Intraocular/adverse effects; Necrosis; Phacoemulsification/adverse effects; Scleritis/*microbiology/pathology/therapy; Uveitis, Anterior/microbiology/therapy

[A cost-effectiveness study of dexamethasone implants in macular edema]. - Lozano López, V.; Serrano García, M.; Mantolán Sarmiento, C.; Pareja Ríos, A.; Losada Castillo, M. J.; Cordovés Dorta, L.; Quijada Fumero, E.; Virgós Aller, T.; Bullejos Molina, M. (Archivos de la Sociedad Espanola de Oftalmologia, 2015)
OBJECTIVE: To analyze the cost-effectiveness and benefits of a dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA.) in its clinically relevant applications. MATERIAL AND METHODS: A total of 88 eyes of 86 patients with macular edema of > 300 μm measured by optical coherence tomography (Cirrus Zeiss, Dublin, CA, USA) were included in this two-year retrospective study, with a minimum of 6 months follow-up. The patients were divide into 3 groups: group 1 with macular edema in retinal vein occlusion, group 2 with non-infectious posterior uveitis, and group 3 with diabetic macular edema. The treatment was off-label but supported by the literature. Before implantation, and on days 1, 30, 60, 90 and 180, corrected visual acuity (Snellen), central retinal thickness, intraocular pressure and biomicroscopy were evaluated. The cost-benefit analysis was tabulated by line of visual acuity gained, comparing the main therapeutic alternatives and assessment of the safety profile of the dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA). RESULTS: The results of this study did not differ from the published studies, in terms of visual acuity improvement in 63.3% of cases, and with central macular thickness improvement in 97% of cases. There were relapses, which occurred after 120 days on average, and the need for retreatment was 40.9%. Increased intraocular pressure >23 mm Hg was among the side effects in 29.54%, and was controlled with topical treatment, except in 1.13% requiring surgical treatment. The development of cataract was 44.7%, and 10.6% required surgery. Treatment results showed less frequent use of Ozurdex® than other treatments for disease control, being a cost saving option. DISCUSSION: Cost-effectiveness analyses are clinically relevant when applying treatment strategies in patients with macular edema. Dexamethasone intravitreal implant appears to be a safe and efficient therapy.
Keywords: Female; Humans; Male; Middle Aged; Aged; Retrospective Studies; Treatment Outcome; Recurrence; Tomography, Optical Coherence; Cost-Benefit Analysis; Visual Acuity; Drug Implants; Cataract/chemically induced; Vitreous Body; Macular edema; Vitrectomy; Off-Label Use; Diabetic Retinopathy/drug therapy; Angiogenesis Inhibitors/economics/therapeutic use; Anti-Inflammatory Agents/administration & dosage/*economics/therapeutic use; Antibodies, Monoclonal/economics/therapeutic use; Cost; Coste; Dexamethasone/administration & dosage/*economics/therapeutic use; Diabetic retinopathy; Edema macular; Efficiency; Eficiencia; Macular Edema/drug therapy/*economics/surgery; Non-infectious posterior uveitis; Oclusión venosa retiniana; Ozurdex(®); Retinal vein occlusion; Retinal Vein Occlusion/complications/drug therapy; Retinopatía diabética; Triamcinolone Acetonide/economics/therapeutic use; Uveítis posterior no infecciosa; Uveitis, Posterior/complications/drug therapy

Ozurdex for refractory macular edema secondary to diabetes, vein occlusion, uveitis and pseudophakia. - Teja, Salina; Sawatzky, Lauren; Wiens, Theresa; Maberley, David; Ma, Patrick (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2019)
OBJECTIVE: To analyze the functional and morphological effects of the intravitreal dexamethasone implant (Ozurdex, Allergan) on patients with macular edema secondary to retinal vein occlusion (RVO), diabetic retinopathy (DME), posterior noninfectious uveitis (NIU), or pseudophakic Irvine-Gass syndrome (IGS). METHODS: 144 charts were retrospectively reviewed; 100 eyes met inclusion criteria for analysis: at least one intravitreal dexamethasone implant injection, refractory to antivascular endothelial growth factor, and had ≥6 months of follow-up postinsertion. The primary outcome was the efficacy of the dexamethasone implant in reducing macular edema as measured by reduction in central retinal thickness (CRT). Secondary outcomes included visual acuity (VA), duration of treatment efficacy (measured by time to next treatment), and safety. The Wilcoxon signed-rank test was used to compare values from baseline, and Kaplan-Meier survival curves were used to analyze time to retreatment. RESULTS: There were 28 patients with RVO, 30 with DME, 24 with posterior NIU, and 18 with IGS. VA improved from baseline to month 6 in all groups, but was not statistically significant. CRT improved in all 4 groups, and was statistically significant for DME (p = 0.008) and NIU (p = 0.05). At 3 months, 34 patients (41.5%) required retreatment; by month 6, 46 patients (56.1%) required retreatment. There was a large variation between the groups in number of patients requiring intraocular pressure (IOP)-lowering medications. Two patients needed IOP-lowering surgery. One patient developed endophthalmitis. CONCLUSION: The use of intravitreal dexamethasone implants in patients with refractory retinal diseases is well tolerated and results in consistently improved anatomic outcomes, but the positive anatomic outcomes are not necessarily correlated to improvements in visual function. Patients who are treated earlier in the disease process will had better outcomes. This patient population were refractory to treatment and, therefore, have less-predictable functional outcomes.
Keywords: Female; Humans; Male; Aged; Retrospective Studies; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Macular Edema/diagnosis/*drug therapy/etiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Uveitis/*complications/diagnosis; Macula Lutea/*pathology; Diabetic Retinopathy/*complications/diagnosis/drug therapy; Pseudophakia/*complications/diagnosis; Retinal Vein Occlusion

Combined Ahmed valve and phacoemulsification with intraocular lens implantation under infliximab in refractory uveitic glaucoma. - Parihar, Jitendra K. S.; Kaushik, Jaya; Jain, Vaibhav K.; Trehan, Hemant S.; Mishra, Avinash; Baranwal, Vinod K. (European journal of ophthalmology, 2018)
PURPOSE: To evaluate the outcome of combined Ahmed glaucoma valve (AGV) and phacoemulsification with posterior chamber intraocular lens implantation under infliximab in refractory uveitic glaucoma (UG). METHODS: In this prospective interventional case series, 26 eyes of 26 patients with refractory UG underwent surgery under intravenous infliximab. The success rate was defined as intraocular pressure (IOP) 5 to 21 mm Hg with or without antiglaucoma medications (AGM), without additional glaucoma surgical intervention. RESULTS: The mean IOP (37.8 ± 11.86 to 12.2 ± 2.8 mm Hg; p<0.0001) and mean number of AGM (3.4 ± 1.2 to 0.4 ± 0.1; p<0.001) were significantly reduced after surgery at 2 years. Kaplan-Meier survival analysis showed a cumulative probability of success for IOP control of 92% at 2 years of follow-up. CONCLUSIONS: Combined AGV and phacoemulsification is an effective treatment for controlling refractory UG with complicated cataract under infliximab.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Treatment Outcome; Infusions, Intravenous; Infliximab; Antirheumatic Agents/*administration & dosage; Infliximab/*administration & dosage; Visual Acuity/physiology; Uveitis; *Glaucoma Drainage Implants; Intraocular Pressure/physiology; Prosthesis Implantation; Tonometry, Ocular; Behçet disease; Glaucoma/etiology/*surgery; Phacoemulsification/*methods; *Lens Implantation, Intraocular; Ahmed glaucoma valve; Postuveitic cataract and glaucoma; Uveitic glaucoma; Uveitis, Anterior/complications/*surgery

Outcomes of cataract surgery in eyes with previous herpes zoster ophthalmicus. - He, Yan; de Melo Franco, Rafael; Kron-Gray, Michelle M.; Musch, David C.; Soong, H. Kaz (Journal of cataract and refractive surgery, 2015)
PURPOSE: To report the outcomes of cataract surgery in eyes with previous herpes zoster ophthalmicus (HZO). SETTING: Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA. DESIGN: Retrospective case series. METHODS: Eyes with a history of HZO that had phacoemulsification and intraocular lens implantation were reviewed. The information analyzed included the ophthalmologic history, visual acuity, preoperative and postoperative adjunct treatments, and complications. Analysis of the mean corrected distance visual acuity (CDVA) at 1 month, 1 year, and the last follow-up was performed. RESULTS: Twenty-four eyes were evaluated. The mean CDVA improved from 20/112 (0.75 logMAR ± 0.63 [SD]) preoperatively to 20/53 (0.42 ± 0.56 logMAR) 1 month postoperatively (P = .007) and 20/44 (0.34 ± 0.55 logMAR) at 1 year (P = .052) but decreased to 20/71 (0.55 ± 0.72 logMAR) by last follow-up (P = .605 versus preoperative CDVA). Eleven patients (45.8%) had recurrent keratouveitis after the first episode, 5 before cataract surgery and 6 after cataract surgery. Three had penetrating keratoplasty for worsening corneal opacification. Two patients had tractional retinal detachment from chronic uveitis and required vitrectomy and retinal repair. CONCLUSIONS: Visual recovery after cataract surgery in HZO might be compromised by chronic factors such as ocular surface disease and keratouveitis. Despite long quiescent waiting periods before surgery and aggressive preoperative and postoperative maintenance therapy, visual improvement might be hindered by the inherent pathology associated with HZO. Nevertheless, with careful patient selection, reasonable visual improvement can be achieved. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Visual Acuity/physiology; *Phacoemulsification; Intraoperative Complications; Postoperative Complications; *Lens Implantation, Intraocular; Cataract/complications/physiopathology; Herpes Zoster Ophthalmicus/*complications/physiopathology/surgery; Keratoplasty, Penetrating; Patient Outcome Assessment; Retinal Detachment/etiology/surgery; Uveitis/complications/surgery

Treatment of Non-infectious Uveitic Macular Edema with the Intravitreal Dexamethasone Implant. - Nobre-Cardoso, João; Champion, Emmanuelle; Darugar, Adil; Fel, Audrey; Lehoang, Phuc; Bodaghi, Bahram (Ocular immunology and inflammation, 2017)
PURPOSE: To describe the clinical outcome of phakic eyes with macular edema (ME) due to non-infectious uveitis treated with a dexamethasone intravitreal implant. METHODS: A retrospective analysis of 41 eyes treated with a total of 58 dexamethasone intravitreal implants was conducted. Best corrected visual acuity (BCVA), central retinal thickness (CRT) and complications data were collected. RESULTS: One month after the first implant, even as CRT improved significantly in most eyes (p<0.001), 31.7% showed no improvement in BCVA. At 6 months post-implantation, CRT and BCVA had deteriorated in up to 70% of patients. Thirteen eyes were re-implanted, with a similar effect to that of the first implant. Ocular hypertension developed in 36.2% of eyes, and three eyes had cataract surgery, all in eyes with repeated implants. CONCLUSIONS: The dexamethasone intravitreal implant can be safely used to treat ME due to non-infectious uveitis, but with a limited and short effect on BCVA.
Keywords: Female; Humans; Male; Middle Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; uveitis; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Retina/pathology; Vitreous Body/drug effects; macular edema; Macular Edema/*drug therapy/etiology/physiopathology; Retreatment; Uveitis/complications/*drug therapy/physiopathology; visual acuity; Postoperative Complications; dexamethasone intravitreal implant; Central retinal thickness

Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients. - Díaz-Llopis, Manuel; Salom, David; Garcia-de-Vicuña, Carmen; Cordero-Coma, Miguel; Ortega, Gabriela; Ortego, Norberto; Suarez-de-Figueroa, Marta; Rio-Pardo, Maria J.; Fernandez-Cid, Carlos; Fonollosa, Alex; Blanco, Ricardo; Garcia-Aparicio, Angel M.; et al. (Ophthalmology, 2012)
OBJECTIVE: To evaluate adalimumab therapy in refractory uveitis. DESIGN: Prospective case series. PARTICIPANTS: A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated. INTERVENTION: Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6). MAIN OUTCOME MEASURES: Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography). RESULTS: There were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behçet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) μ at baseline versus 240 (36) μ at the 6-month visit (P < 0.001). Visual acuity improved by -0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (-15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up. CONCLUSIONS: Adalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.
Keywords: Female; Humans; Male; Adult; Prospective Studies; Treatment Outcome; Adolescent; Child; Child, Preschool; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Drug Resistance; Methotrexate/administration & dosage; Adalimumab; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Visual Acuity/physiology; Injections, Subcutaneous; Macula Lutea/pathology; Off-Label Use; Uveitis/*drug therapy/etiology/physiopathology; Anti-Inflammatory Agents/administration & dosage/*therapeutic use; Antibodies, Monoclonal, Humanized/administration & dosage/*therapeutic use; Cyclosporine/administration & dosage

High-dose intravenous corticosteroids for ocular inflammatory diseases. - Charkoudian, Leon D.; Ying, Gui-shuang; Pujari, Siddharth S.; Gangaputra, Sapna; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Kempen, John H. (Ocular immunology and inflammation, 2012)
PURPOSE: To evaluate the effectiveness and risk of complications of high-dose intravenous pulsed corticosteroids for noninfectious ocular inflammatory diseases. METHODS: Retrospective cohort study in which 104 eyes of 70 patients who received high-dose intravenous corticosteroids for treatment of active ocular inflammation were identified from five centers. The main outcome measures were control of inflammation and occurrence of ocular or systemic complications within 1 month after treatment. RESULTS: Within ≤1 month of starting treatment, 57% of eyes achieved complete control of inflammation (95% confidence interval (CI): 33-83%), improving to 82% when near-complete control was included (95% CI: 61-96%). Most eyes (85%; 95% CI: 70-95%) gained clinically significant improvement in anterior chamber inflammation. One patient developed a colon perforation during treatment. No other major complications were recorded. CONCLUSIONS: Treatment of ocular inflammation with high-dose intravenous corticosteroids resulted in substantial clinical improvement for most cases within 1 month. Complications of therapy were infrequent.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Infusions, Intravenous; Child; Cohort Studies; Uveitis/*drug therapy; Visual Acuity/drug effects; Adrenal Cortex Hormones/*administration & dosage/adverse effects; Scleritis/drug therapy

Secukinumab in the treatment of noninfectious uveitis: results of three randomized, controlled clinical trials. - Dick, Andrew D.; Tugal-Tutkun, Ilknur; Foster, Stephen; Zierhut, Manfred; Melissa Liew, S. H.; Bezlyak, Vladimir; Androudi, Sofia (Ophthalmology, 2013)
PURPOSE: To determine the efficacy and safety of different doses of secukinumab, a fully human monoclonal antibody for targeted interleukin-17A blockade, in patients with noninfectious uveitis. DESIGN: Three multicenter, randomized, double-masked, placebo-controlled, dose-ranging phase III studies: SHIELD, INSURE, and ENDURE. PARTICIPANTS: A total of 118 patients with Behçet's uveitis (SHIELD study); 31 patients with active, noninfectious, non-Behçet's uveitis (INSURE study); and 125 patients with quiescent, noninfectious, non-Behçet's uveitis (ENDURE study) were enrolled. METHODS: After an initial subcutaneous (s.c.) loading phase in each treatment arm, patients received s.c. maintenance therapy with secukinumab 300 mg every 2 weeks (q2w), secukinumab 300 mg monthly (q4w), or placebo in the SHIELD study; secukinumab 300 mg q2w, secukinumab 300 mg q4w, secukinumab 150 mg q4w, or placebo in the INSURE study; or secukinumab 300 mg q2w, secukinumab 300 mg q4w, secukinumab 150 mg q4w, or placebo in the ENDURE study. MAIN OUTCOME MEASURES: Reduction of uveitis recurrence or vitreous haze score during withdrawal of concomitant immunosuppressive medication (ISM). Other end points included best-corrected visual acuity, ISM use (expressed as a standardized ISM score), and safety outcomes. RESULTS: After completion or early termination of each trial, there were no statistically significant differences in uveitis recurrence between the secukinumab treatment groups and placebo groups in any study. Secukinumab was associated with a significant reduction in mean total post-baseline ISM score (P = 0.019; 300 mg q4w vs. placebo) in the SHIELD study. Likewise, secukinumab was associated with a greater median reduction in ISM score versus placebo in the INSURE study, although no statistical analysis of the difference was conducted because of the small sample size. Overall, there was no loss in visual acuity reported in any treatment group during follow-up in all 3 studies. According to descriptive safety statistics, the frequencies of ocular and nonocular adverse events seemed to be slightly higher among secukinumab groups versus placebo across the 3 studies. CONCLUSIONS: The primary efficacy end points of the 3 studies were not met. The secondary efficacy data from these studies suggest a beneficial effect of secukinumab in reducing the use of concomitant ISM.
Keywords: Double-Blind Method; Humans; Prospective Studies; Follow-Up Studies; Treatment Outcome; Dose-Response Relationship, Drug; Visual Acuity; Injections, Subcutaneous; Uveitis/diagnosis/*drug therapy; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal/*administration & dosage

Epiretinal membranes in uveitic macular edema: effect on vision and response to therapy. - Lehpamer, Brian; Moshier, Erin; Pahk, Patricia; Goldberg, Naomi; Ackert, Jessica; Godbold, James; Jabs, Douglas A. (American journal of ophthalmology, 2014)
PURPOSE: To evaluate the effects of epiretinal membranes on the response of uveitic macular edema to therapy and on visual acuity outcomes. DESIGN: Retrospective case series. METHODS: One hundred four eyes of 77 patients with uveitic macular edema were identified at a tertiary care center. Epiretinal membranes were diagnosed when identified by 2 investigators' grading of spectral-domain optical coherence tomography and scored for the presence or absence of surface wrinkling. Outcomes included best-corrected visual acuity, central subfield thickness, and rates of macular edema improvement (>20% reduction in central subfield thickness) and resolution (reduction of central subfield thickness to <315 μm) at 3 and 6 months follow-up. RESULTS: Seventy-two eyes of 59 patients had an epiretinal membrane on presentation. Eyes without epiretinal membranes and with epiretinal membranes without surface wrinkling were not significantly different at presentation or at 3 and 6 months follow-up. Conversely, eyes with an epiretinal membrane with retinal surface wrinkling had a greater proportion of eyes with 20/200 or worse visual acuity at presentation, and had worse mean acuities at 3 months (20/94 vs 20/35 for eyes without an epiretinal membrane, P = .002) and at 6 months follow-up (20/110 vs 20/36 for eyes without an epiretinal membrane, P = .02). At 6 months of follow-up the mean central subfield thicknesses were: eyes without an epiretinal membrane, 338 ± 23 μm; and eyes with an epiretinal membrane and surface wrinkling, 405 ± 22 μm (P = .05). CONCLUSIONS: In eyes with epiretinal membranes and retinal surface wrinkling, uveitic macular edema had a poorer visual acuity response to medical therapy and thicker maculae at 6 months.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Administration, Oral; Tomography, Optical Coherence; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Intravitreal Injections; Visual Acuity/*physiology; Uveitis/diagnosis/drug therapy/*physiopathology; Epiretinal Membrane/diagnosis/*physiopathology; Macular Edema/diagnosis/drug therapy/*physiopathology; Vision Disorders/diagnosis/drug therapy/*physiopathology

Efficacy and potential complications of difluprednate use for pediatric uveitis. - Slabaugh, Mark A.; Herlihy, Erin; Ongchin, Sharel; van Gelder, Russell N. (American journal of ophthalmology, 2012)
PURPOSE: To evaluate the clinical effect of topical difluprednate in pediatric patients for treatment of noninfectious uveitis. DESIGN: Retrospective, observational case series. METHODS: Twenty-six eyes of 14 pediatric patients with noninfectious uveitis who were treated with topical difluprednate were evaluated. Anterior and posterior cell grade, visual acuity, intraocular pressure (IOP), and cystoid macular edema (CME) were recorded at each visit. Main outcome measures were changes in anterior segment cell, CME, visual acuity, and IOP and development of a visually significant cataract. RESULTS: A significant (≥ 2-grade decrease or decrease to 0 in anterior segment cell) reduction in anterior segment inflammation was observed during treatment with topical difluprednate in 88% of eyes (22/25) when used as an adjuvant to systemic immunomodulatory therapy. In addition, improvement in CME associated with uveitis was seen in response to topical therapy with difluprednate in 78% of eyes with CME (7/9). A significant IOP response (IOP increase of ≥ 10 mm Hg from baseline and IOP ≥ 24 mm Hg) was seen in 50% of eyes (13/26) and in 50% of patients (7/14); 3 eyes of 2 patients required glaucoma surgery. Cataract formation or progression was observed in 39% of eyes (10/26) and in 43% of patients (6/14); 5 eyes of 3 patients required cataract surgery. CONCLUSIONS: Difluprednate is an effective agent for both control of anterior segment inflammation and reduction of CME in pediatric patients with uveitis when used as an adjuvant to systemic immunomodulatory therapy. A high rate of steroid-induced IOP elevation and cataract formation is seen in this population. Close monitoring of pediatric patients receiving difluprednate is recommended.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Adolescent; Child; Cataract/chemically induced; Visual Acuity/drug effects; Glucocorticoids/*administration & dosage/adverse effects; Uveitis/*drug therapy/physiopathology; Intraocular Pressure/drug effects; Administration, Topical; Aqueous Humor/cytology; Fluprednisolone/administration & dosage/adverse effects/*analogs & derivatives; Macular Edema/physiopathology; Ocular Hypertension/chemically induced; Ophthalmic Solutions/adverse effects/therapeutic use

Evaluation of dexamethasone phosphate delivered by ocular iontophoresis for treating noninfectious anterior uveitis. - Cohen, Amy E.; Assang, Carol; Patane, Michael A.; From, Stephen; Korenfeld, Michael (Ophthalmology, 2012)
PURPOSE: Determine safe, effective, iontophoretic dose(s) of EGP-437 (dexamethasone phosphate formulated for iontophoresis) in patients with noninfectious anterior uveitis; evaluate systemic drug exposures. DESIGN: Prospective, phase I/II, multicenter, double-masked, parallel group, randomized clinical trial. PARTICIPANTS: Forty outpatients with anterior uveitis. METHODS: Forty of 42 randomized patients received an iontophoresis treatment in 1 qualifying eye and completed the study. Patients were randomized into 1 of 4 iontophoresis dose groups (1.6, 4.8, 10.0, or 14.0 mA-min), treated with EGP-437 via the EyeGate II Delivery System (EGDS), and followed until day 28. MAIN OUTCOME MEASURES: The main outcome measures were anterior chamber cell (ACC) scores at days 14 and 28; time to ACC score of zero; proportion of patients with an ACC score reduction from baseline of ≥ 0.5 at day 28; mean change from baseline in ACC score at day 28; and the systemic exposures of dexamethasone and dexamethasone phosphate after EGP-437 treatment with the EGDS. RESULTS: After a single EGP-437 treatment, 19 of 40 patients (48%) achieved an ACC score of zero at day 14. By day 28, 24 of 40 patients (60%) achieved an ACC score of zero. A Kaplan-Meier analysis demonstrated that the 1.6 mA-min dose was the most effective and revealed an inverse dose response; median days to an ACC score of zero were 11.5 days in the 1.6 mA-min group versus 31 days in the 14.0 mA-min group. Twenty-six patients (65%) had an ACC score reduction from baseline of ≥ 0.5 at day 28. The mean change in ACC score from baseline to day 28 was -2.14 with a median of -2.00. Throughout the study, the mean intraocular pressure remained within normal range and mean best-corrected visual acuity at 4 meters remained relatively stable. Most adverse events were mild; no serious adverse events were reported. Pharmacokinetics results showed low short-term systemic exposure to dexamethasone after iontophoresis; no nonocular systemic corticosteroid-mediated effects were observed. CONCLUSIONS: Approximately two thirds of the patients reached an ACC score of zero within 28 days, after only receiving 1 iontophoresis treatment. The lower doses seemed to be the most effective, and treatments were well-tolerated. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Follow-Up Studies; Treatment Outcome; Young Adult; Glucocorticoids/*administration & dosage; Drug Delivery Systems; Dexamethasone/administration & dosage/*analogs & derivatives; *Iontophoresis; Uveitis, Anterior/*drug therapy/physiopathology

Varicella zoster virus-associated Chorioretinitis: a case report. - Kim, Joo Yeon; Lee, Ji Hwan; Lee, Christopher Seungkyu; Lee, Sung Chul (BMC ophthalmology, 2018)
BACKGROUND: Chorioretinitis is an unusual form of varicella zoster virus (VZV)-associated uveitis, and no report has described VZV-associated chorioretinitis using serial optical coherence tomography (OCT) images obtained during the course of resolution. CASE PRESENTATION: A 61-year-old woman presented with acute, unilateral vision loss in her right eye. Her visual acuity was count fingers in the right eye and 16/20 in the left eye, and she exhibited skin vesicles on her right forehead. Slit lamp biomicroscopy, funduscopy, OCT, and intraocular fluid analysis were performed. The right eye exhibited multiple inflammatory lesions at the posterior pole, macular edema, and disc swelling on the fundus examination. OCT revealed predominant involvement of the choroid and the retinal pigment epithelium (RPE). Intraocular fluid analysis showed positivity for VZV. The patient was admitted and treated with intravenous acyclovir. Additional oral prednisolone was used to reduce the inflammatory reaction. After 2 weeks of treatment with acyclovir, the lesion resolved, with undulation of the RPE. Her final visual acuity was 20/20. CONCLUSIONS: VZV-associated posterior uveitis may present as multifocal chorioretinitis. Intraocular fluid analysis is important to detect an infectious origin.
Keywords: Female; Humans; Middle Aged; Prednisolone/therapeutic use; Administration, Oral; Combined Modality Therapy; Antiviral Agents/therapeutic use; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; Uveitis; Acyclovir/therapeutic use; Chorioretinitis; Chorioretinitis/diagnosis/drug therapy/*virology; Eye Infections, Viral/diagnosis/drug therapy/*virology; Herpesvirus 3; Herpesvirus 3, Human/*isolation & purification; Human; Uveitis, Posterior/diagnosis/drug therapy/*virology; Varicella Zoster Virus Infection/diagnosis/drug therapy/*virology

Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoid choroiditis. - Bansal, Reema; Gupta, Amod; Gupta, Vishali; Dogra, Mangat R.; Sharma, Aman; Bambery, Pradeep (Ophthalmology, 2012)
PURPOSE: To describe the clinical features, course, and outcome in tubercular serpiginous-like choroiditis. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 105 patients (141 eyes) between May 2002 and July 2010. METHODS: Patients had the following inclusion criteria: (1) complete clinical records and digital fundus images at baseline and follow-up visits, (2) positive tuberculin skin test or QuantiFERON-TB Gold (Cellestis International Pty Ltd. Chadstone, Victoria, Australia) test result, (3) active serpiginous-like choroiditis in at least 1 eye, (4) all known causes of infectious (except tuberculosis) and noninfectious uveitis ruled out, and (5) a minimum of 9 months of follow-up from initiation of treatment that included antitubercular therapy (ATT) with oral corticosteroids (93 patients) or corticosteroids alone (12 patients). MAIN OUTCOME MEASURES: Clinical characteristics and evolution of choroiditis lesions from the acute to healed stage, recurrence, visual outcome, and complications. RESULTS: Mean age was 33 ± 9.3 years (range, 12-54 years; 75 male and 30 female patients). Serpiginous-like choroiditis was bilateral (at least 1 eye active) in 66 patients (62.9%). Of 171 affected eyes, 141 (82.45%) had active lesions at presentation. Of 141 eyes, 115 (81.56%) showed vitreous inflammation. Lesions were multifocal in 133 eyes (94.3%), were noncontiguous to optic disc in 122 eyes (86.52%), and involved the macula in 125 eyes (88.65%). Of patients receiving ATT, all showed resolution of lesions and 9 (9.7%) developed recurrences (median follow-up, 21 months). In addition, 12 patients (12.9%) showed continued progression over a median 3.5 weeks after initiation of therapy. Of 12 patients treated with corticosteroids alone, none showed progression but 9 (75%) developed recurrence (median, 26.5 months). Final visual acuity of ≥ 6/12 was achieved in 108 eyes (76.60%) versus 72 eyes (51.06%) before treatment. Fovea was spared in 95 of 125 eyes (76%) with macular involvement. Five eyes (3.5%) developed choroidal neovascular membrane. CONCLUSIONS: Tubercular serpiginous-like choroiditis presented as multifocal serpiginoid choroiditis affecting predominantly young to middle-aged men. It was frequently bilateral with vitreous inflammation and characterized by multifocal lesions that were noncontiguous to the optic disc and showed serpiginoid spread. Antitubercular therapy significantly reduced recurrences. Lesions responded to combined antitubercular and steroid therapy, usually spared fovea, and had a good final visual acuity.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Child; Cohort Studies; Fluorescein Angiography; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Antitubercular Agents/therapeutic use; Choroiditis/*diagnosis/drug therapy/physiopathology; Tuberculin Test; Tuberculosis, Ocular/*diagnosis/drug therapy/physiopathology

Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients. - Adán, Alfredo; Pelegrín, Laura; Rey, Amanda; Llorenç, Victor; Mesquida, Marina; Molins, Blanca; Ríos, José; Keller, Johannes (Retina (Philadelphia, Pa.), 2013)
PURPOSE: To evaluate the safety and efficacy of Ozurdex (dexamethasone intravitreal implant) 0.7 mg in the treatment of uveitic macular edema in vitrectomized eyes. METHODS: Data from 13 patients (17 eyes) with persistent uveitic cystoid macular edema and a history of pars plana vitrectomy in the study eyes that were treated with intravitreal injection of 0.7-mg dexamethasone implant were reviewed retrospectively. Main outcome measures were changes in central retinal thickness measured by optical coherence tomography and changes in best-corrected visual acuity. RESULTS: The median age of patients was 61 years (range, 19-81 years). The median duration of uveitic macular edema was 12 months (range, 2-72 months). The mean baseline central retinal thickness (95% confidence interval) was 461.6 μm (403.8-519.4), decreased to 277.2 μm (244.6-309.8) at 4 weeks (P < 0.01), remained low at 349.9 μm (281.8-418.0) at 3 months (P = 0.01), and then reached 394.1 μm (328.3-459.8) at 6 months (P = 0.14). After 3 months, there was a median improvement of 2 lines of best-corrected visual acuity, with 52.9% of eyes gaining 2 lines or more (P < 0.01). At 6 months, there were 5 eyes that maintained the 2 lines gain and none had lost >1 line from baseline (P = 0.03). In 8 eyes (47.1%), reinjection of the implant was performed at a mean of 6.5 months. Ocular hypertension (47.1%), hypotony (11.8%), anterior chamber displacement of the implant (5.9%), and glaucoma, which required filtration surgery (5.9%), were the most common adverse events. Mean follow-up was 9.6 months (range, 6-17 months). CONCLUSION: In this small case series of eyes with limited follow-up, treatment with dexamethasone intravitreal implant injection for uveitic macular edema in vitrectomized eyes was associated with favorable visual outcomes and had an acceptable safety profile.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Young Adult; Visual Acuity; Drug Implants; Intravitreal Injections; Intraocular Pressure; Dexamethasone/*administration & dosage/adverse effects; Anti-Inflammatory Agents/*administration & dosage/adverse effects; *Vitrectomy; Macular Edema/*drug therapy/etiology/surgery; Uveitis/*complications/surgery

Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: a prospective study. - Kotaniemi, K.; Kautiainen, H.; Karma, A.; Aho, K. (Ophthalmology, 2001)
OBJECTIVE: To examine the occurrence and characteristics of uveitis in patients with recently diagnosed juvenile chronic arthritis (JCA). DESIGN: A prospective observational case series. PARTICIPANTS/METHODS: The study covered the new cases detected with JCA (426 children), all of whom were referred to an ophthalmologic consultation during 1989 to 1996 at the Pediatric Department of the Rheumatism Foundation Hospital, Heinola, Finland. MAIN OUTCOME MEASURES: The children with JCA were followed by ophthalmologic and pediatric examinations two to four times a year. The type and course of arthritis and presentation and characteristics of uveitis were examined prospectively. RESULTS: Uveitis was detected in 104 of 426 children (24%). Two thirds of all patients and the same proportion of those with uveitis were girls. Proportionally, uveitis was found to be as common among children with oligoarthritis (27%) as among those with seronegative polyarthritis (25%). Antinuclear antibodies (ANA) were detected significantly more frequently in patients with uveitis (66%) than among those without uveitis (37%) (P < 0.001). The uveitis was asymptomatic in 99 cases; only 5 children had episodes of acute anterior symptomatic uveitis. Uveitis was found before or within 3 months from the onset of recent arthritis in 51 of 104 children (49%) and later on in 53 of 104 children (51%). The mean age at diagnosis of uveitis was 5.9 years (range, 1.1-17.7; median, 4.9 years). The mean period from the diagnosis of JCA to the diagnosis of uveitis was 1.1 years (range, -2.4-6.5; median, 0.3 years). The mean age at diagnosis of JCA was 4.8 years (range, 0.6-15; median, 3.2 years) among those with uveitis and 7.3 years (range, 0.9-16; median, 6.7 years) among those who did not have it (P < 0.001). Uveitis was ongoing in 63 children at the end of the follow-up period. The mean follow-up time was 4.5 years (range, 0-9.7) for all children and 5.6 years (range, 1.3-9.6) for those with uveitis. In most instances, the visual prognosis was good. In 25 of 104 patients (24%) one or more complications of uveitis were found, but in only three children did the visual acuity decrease to 20/60 or less, and none became blind. All the other patients had visual acuity > or = 20/40. CONCLUSIONS: In this patient group, uveitis in JCA frequently appeared very early after the onset of arthritis. The uveitis was significantly more common in patients with an early onset of arthritis combined with ANA positivity. The proportion of children with uveitis was as large in those with polyarthritis as in those with oligoarthritis, with no predilection to girls.
Keywords: Female; Humans; Male; Prospective Studies; Adolescent; Anti-Inflammatory Agents/therapeutic use; Child; Child, Preschool; Infant; Antibodies, Antinuclear/analysis; Immunosuppressive Agents/therapeutic use; Visual Acuity; Age of Onset; Administration, Topical; Arthritis, Juvenile/*complications/diagnosis/drug therapy; Glucocorticoids; Uveitis/diagnosis/drug therapy/*etiology

Mycophenolate Mofetil for the Treatment of Multiple Sclerosis-associated Uveitis. - Hedayatfar, Alireza; Falavarjani, Khalil Ghasemi; Soheilian, Masoud; Elmi Sadr, Navid; Modarres, Mehdi; Parvaresh, Mohammad Mehdi; Naseripour, Masood; Rohani, Mohammad; Almasi, Mostafa; Chee, Soon-Phaik (Ocular immunology and inflammation, 2017)
PURPOSE: To report the efficacy of mycophenolate mofetil (MMF) as adjunctive therapy for the treatment of multiple sclerosis (MS)-associated uveitis. METHODS: In this retrospective, interventional case series, patients with MS-associated uveitis who were treated by MMF as an adjunct therapy to systemic corticosteroid were studied. Patients' demographics, clinical course, response to treatment, and complications were assessed. RESULTS: A total of 30 eyes of 15 patients with a mean age of 34.5 ± 8.3 years were studied. In three patients (20%), onset of uveitis preceded the diagnosis of MS. The course of MS was relapsing-remitting in 11 patients (73.3%) and secondary progressive in four patients (26.7%). At 1 year after institution of MMF, all the patients were on oral prednisolone ≤ 7.5 mg/day, all eyes were quiet without macular edema, and 53.3% of eyes gained visual improvement. Supplemental periocular and intraocular injections were needed during the first 6 months after starting MMF therapy. The systemic adverse effects were transient and minor in severity. CONCLUSIONS: MMF had beneficial effects on vision and intraocular inflammation with an acceptable safety profile.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Prednisolone/therapeutic use; Enzyme Inhibitors/*therapeutic use; Chemotherapy, Adjuvant; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; uveitis; Visual Acuity/physiology; Uveitis/*drug therapy/physiopathology; Multiple sclerosis; Multiple Sclerosis/*drug therapy/physiopathology; mycophenolate mofetil; Mycophenolic Acid/*therapeutic use

Intravitreal and posterior subtenon triamcinolone acetonide in idiopathic bilateral uveitic macular oedema. - Choudhry, Surbhit; Ghosh, Sudipta (Clinical & experimental ophthalmology, 2007)
PURPOSE: To study the efficacy of intravitreal triamcinolone acetonide (IVTA) versus posterior subtenon triamcinolone acetonide (PSTA) in bilateral macular oedema secondary to idiopathic intermediate uveitis. METHODS: In a prospective, interventional case series, 10 patients (20 eyes) with bilateral uveitic macular oedema were included. Patients underwent fundus fluorescein angiography, record of visual acuity and intraocular pressure (IOP). Patients received IVTA 4 mg/0.1 mL in one eye and PSTA 20 mg/0.5 mL in the fellow eye at an interval of > or =4 weeks. The outcome measures were record of IOP, best corrected visual acuity and angiographic resolution of cystoid macular oedema at 3 and 6 months. RESULTS: The mean pre-intervention IOP at baseline between the IVTA and the PSTA group was comparable. At 1 week, the mean IOP recorded was greater in the eyes that received IVTA than those that received PSTA (P < 0.001). However, at 1- and 3-month follow up, the mean IOP between the two groups was similar. Best corrected visual acuity of > or =6/12 achieved at 3 and 6 months in the IVTA and PSTA group was comparable (77.8% vs. 44.4% [P = 0.14] and 88.9% vs. 77.8% [P = 0.53]). There was also no significant difference in angiographic resolution of cystoid macular oedema at 3 (P = 0.32) and 6 months (P = 0.53) between the two groups. Recurrence of macular oedema was seen in one and two eyes that received IVTA and PSTA, respectively, at 6 months. CONCLUSION: Triamcinolone acetonide injection, whether administered intravitreally or via posterior subtenon route, is an effective treatment option in achieving complete anatomic and functional improvement in cases treated for macular oedema secondary to idiopathic intermediate uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Follow-Up Studies; Treatment Outcome; Fluorescein Angiography; Tomography, Optical Coherence; Injections; Visual Acuity; Triamcinolone Acetonide/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure; Vitreous Body; Macular Edema/*drug therapy/etiology; Uveitis, Intermediate/complications/*drug therapy; Connective Tissue

Dexamethasone intravitreal implant (Ozurdex®) for pediatric uveitis. - Sella, Ruti; Oray, Merih; Friling, Ronit; Umar, Lewaa; Tugal-Tutkun, Ilknur; Kramer, Michal (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2015)
PURPOSE: The purpose of this study was to investigate the safety and effectiveness of an intravitreally injected dexamethasone-containing implant (Ozurdex(®)) in the treatment of uveitis in children. METHODS: The study group included ten patients (14 eyes) aged 6.5-15 years (mean age 12 years) with intermediate or posterior uveitis who were treated with the Ozurdex implant at two tertiary medical centers between 2009 and 2014, following an insufficient response to standard uveitis therapy. All were followed for at least 6 months (mean 12.2 ± 4.9 months). Clinical data before and after treatment were collected retrospectively from the medical files. Outcome measures were best corrected visual acuity, vitreous haze, and macular thickness. Ocular complications were documented. RESULTS: Visual acuity improved in 12 eyes (86 %) and intraocular inflammation decreased in 13 eyes (93 %) from 1 week to 3 months after the first injection. Macular edema decreased in all eyes from 1 month to 3 months after the first injection. Five patients underwent repeated injections because of an increase in macular thickness at 3-6 month follow-up. Complications included cataract progression in one patient after one injection and cataract formation in two patients after two injections, and an elevation in intraocular pressure in two patients who responded well to topical treatment. CONCLUSIONS: Both single and repeated injections of a dexamethasone-containing implant are safe and effective for the treatment of noninfectious intermediate and posterior uveitis in children. The duration of the beneficial effect may be limited. More data are required to establish the safety profile of the implant in the pediatric age group.
Keywords: Female; Humans; Male; Retrospective Studies; Adolescent; Child; Inflammation; Tomography, Optical Coherence; Visual Acuity/physiology; Uveitis; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; *Drug Implants; Dexamethasone implant; Uveitis, Posterior/*drug therapy/physiopathology; Ozurdex; Macular Edema/drug therapy; Pediatric uveitis; Uveitis, Intermediate/*drug therapy/physiopathology

LONG-TERM OUTCOMES OF RITUXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS POSTERIOR UVEITIS REFRACTORY TO CONVENTIONAL IMMUNOSUPPRESSIVE THERAPY. - Lasave, Andres F.; You, Caiyun; Ma, Lina; Abusamra, Khawla; Lamba, Neerav; Valdes Navarro, Manuel; Meese, Halea; Foster, C. Stephen (Retina (Philadelphia, Pa.), 2018)
PURPOSE: To assess long-term effectiveness of rituximab therapy for refractory noninfectious uveitis affecting the posterior segment. METHODS: Retrospective case series. Patients diagnosed with recalcitrant noninfectious posterior uveitis who were treated with rituximab intravenous infusions between 2010 and 2015 were included. Patients underwent best-corrected visual acuity testing and fluorescein angiography evidence of disk or vascular staining at 6, 12, 18, and 24 months. Patients had at least 24 months of follow-up. RESULTS: Eleven patients (21 eyes) with refractory posterior uveitis treated with intravenous rituximab were included. Nine (81.8%) patients were female. Mean follow-up was 29.3 ± 7.8 months. rituximab was administered as complementary therapy because of previous inefficacy of other therapies in 7 (63.7%) patients, and it was the only treatment in four (36.3%) patients who did not tolerate other drugs. Inflammation signs by fluorescein angiography were controlled in nine (81.8%) patients at the end of follow-up. Baseline best-corrected visual acuity was 20/80 (logarithm of the minimal angle of resolution 0.6 ± 0.4), and final best-corrected visual acuity was 20/40 (0.3 ± 0.5) (P = 0.005). No significant side effects were reported. CONCLUSION: Rituximab therapy was associated with stability and remission of recalcitrant noninfectious posterior uveitis in patients who did not tolerate or did not respond to other therapies.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Injections, Intravenous; Antirheumatic Agents/administration & dosage; Fluorescein Angiography; Tomography, Optical Coherence; *Visual Acuity; Immunosuppression Therapy/*methods; Fundus Oculi; Uveitis, Posterior/diagnosis/*drug therapy; Rituximab/*administration & dosage; Drug Resistance/*drug effects; Immunosuppressive Agents/*pharmacology; Optic Disk/*pathology

Juvenile arthritis-associated uveitis: visual outcomes and prognosis. - Chen, Celia S.; Roberton, Don; Hammerton, Michael E. (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2004)
BACKGROUND: The current issues in the management of uveitis associated with juvenile arthritis revolve mainly around the treatment of mild disease and how to treat patients with more severe disease. The aims of this study were to determine the incidence of uveitis in a cohort of patients with juvenile arthritis as well as the nature of treatment and the risk factors for visual loss. METHODS: Review of the charts of 71 patients with juvenile arthritis, as defined by the American Academy of Rheumatology, seen between 1992 and 2001 at a combined rheumatology and ophthalmology clinic. Information collected included the patient's sex, age at diagnosis of arthritis and uveitis, and date of diagnosis of arthritis and uveitis. The rheumatologic diagnosis, results of serologic testing, and details of systemic and topical treatments were also recorded. RESULTS: There were 47 girls and 24 boys ranging in age from 16 months to 13 years. The median age at diagnosis of juvenile arthritis was 4 years and 1 month. Twenty-seven patients (38%) had uveitis. The median age at uveitis onset was 5.9 years, with an average interval of 18 months from the diagnosis of arthritis; 11 patients had uveitis at the time of arthritis diagnosis. There was a positive relation between anti-nuclear antibody positivity and the development of uveitis (p < 0.05). Thirteen (48%) of the 27 patients with uveitis had mild anterior segment inflammation, with fewer than 25 cells in the anterior chamber. This group had spontaneous resolution of uveitis without topical therapy. All the patients without uveitis had a final visual acuity of 6/9 or better. Five of the patients with uveitis had a final visual acuity of 6/36 or worse. Cataract was the most common complication affecting visual outcome. Cataract extraction initially improved the visual acuity, but posterior segment complications and glaucoma compromised the final visual outcome. INTERPRETATION: We found an incidence of uveitis of 38% with long-term follow-up of patients with juvenile arthritis; the uveitis was diagnosed an average of 18 months after the arthritis. Almost half of the patients with uveitis had minor anterior segment inflammation. These patients did not receive topical treatment and had good visual outcomes. Patients with uveitis at the time of diagnosis of arthritis tended to have a worse visual prognosis and experienced persistent uveitis despite treatment. In this series, cataract extraction was beneficial in improving visual acuity immediately postoperatively, but posterior segment changes and glaucoma may compromise final visual outcomes.
Keywords: Female; Humans; Male; Prognosis; Drug Therapy, Combination; Follow-Up Studies; Risk Factors; Incidence; Adolescent; Child; Child, Preschool; Infant; Glucocorticoids/therapeutic use; Visual Acuity/*physiology; Antibodies, Antinuclear/blood; Arthritis, Juvenile/diagnosis/drug therapy/*epidemiology; Cataract Extraction; HLA-B27 Antigen/blood; Rheumatoid Factor/blood; Uveitis/diagnosis/drug therapy/*epidemiology

Quality-of-Life Outcomes From a Randomized Clinical Trial Comparing Antimetabolites for Intermediate, Posterior, and Panuveitis. - Niemeyer, Katherine M.; Gonzales, John A.; Rathinam, Sivakumar R.; Babu, Manohar; Thundikandy, Radhika; Kanakath, Anuradha; Porco, Travis C.; Browne, Erica N.; Rao, Maya M.; Acharya, Nisha R. (American journal of ophthalmology, 2017)
PURPOSE: To evaluate the changes in quality of life in noninfectious uveitis patients treated with 2 of the most commonly prescribed antimetabolite treatments. DESIGN: Secondary analysis of a multicenter, block-randomized clinical trial. METHODS: Eighty patients at Aravind Eye Hospitals in Madurai and Coimbatore, India, with noninfectious intermediate, posterior, or panuveitis were randomized to receive oral methotrexate, 25 mg weekly, or oral mycophenolate mofetil, 1 g twice daily, and were followed up monthly for 6 months. Best-corrected visual acuity, Indian Vision Function Questionnaire (IND-VFQ), and Medical Outcomes Study 36-item Short Form Survey (SF-36) were obtained at enrollment and at 6 months (or prior, in the event of early treatment failure). RESULTS: IND-VFQ scores, on average, increased by 9.2 points from trial enrollment to 6 months (95% confidence interval [CI]: 4.9, 13.5, P = .0001). Although the SF-36 physical component summary score did not significantly differ over the course of the trial, the mental component summary score decreased by 2.3 points (95% CI: -4.4, -0.1, P = .04) and the vitality subscale decreased by 3.5 points (95% CI: -5.6, -1.4, P = .001). Quality-of-life scores did not differ between treatment arms. Linear regression modeling showed a 3.2-point improvement in IND-VFQ score for every 5-letter improvement in visual acuity (95% CI: 1.9, 4.3; P < .001). CONCLUSIONS: Although uveitis treatment was associated with increased vision and vision-related quality of life, patient-reported physical health did not change after 6 months of treatment, and mental health decreased. Despite improved visual outcomes, uveitis patients receiving systemic immunosuppressive therapy may experience a deterioration in mental health-related quality of life.
Keywords: Female; Humans; Male; Adult; Follow-Up Studies; Treatment Outcome; Dose-Response Relationship, Drug; Administration, Oral; *Quality of Life; *Visual Acuity; *Health Status; *Surveys and Questionnaires; Antimetabolites/*administration & dosage; Panuveitis/*drug therapy/psychology; Uveitis, Posterior/*drug therapy/psychology

[Efficacy of a Dexamethasone Implant for the Treatment of Refractory Cystoid Macular Oedema in Non-Infectious Uveitis]. - Breitbach, M.; Rack, D.; Dietzel, M.; Heinz, C.; Heiligenhaus, A. (Klinische Monatsblatter fur Augenheilkunde, 2016)
PURPOSE: To evaluate the efficacy of an intravitreal dexamethasone implant (Ozurdex®) in patients with cystoid macular oedema (CME) suffering from non-infectious uveitis. METHODS: Monocentric, retrospective, single-arm analysis in 49 patients (59 implanted eyes) with inactive uveitis, in whom CME had been unresponsive to corticosteroids and/or immunosuppressants and systemic acetazolamide, and who received a dexamethasone implant. Patients were followed up at 6, 12 and 24 weeks after unilateral (n = 39)/bilateral (n = 10) implantation. The primary outcome measure was central foveal thickness (CFT), as measured by Spectralis optical coherence tomography (OCT); secondary outcome measures were improvement in best-corrected visual acuity (BCVA), laser flare photometry and safety measures, including intraocular pressure (IOP) and cataract progression. RESULTS: At 6, 12 and 24 weeks, mean CFT was reduced (≥ 20 %) in 68, 44 and 45 % and BCVA improved (≥ 2 lines) in 47, 40 and 26 %, respectively, as compared to baseline. At 6, 12 and 24 weeks, significant flare reduction was observed in 70, 41, and 42 %, respectively. Cumulative cataract progression was observed in 12, 18 and 31 % at 6, 12 and 24 weeks, respectively. IOP ≥ 22 mmHg was noted in 5 % at baseline and in 21, 3, and 0 % at 6, 12 and 24 weeks, respectively. CONCLUSIONS: In uveitis patients with CME refractory to systemic anti-inflammatory drugs, the dexamethasone implant improves CME transiently. However, IOP increase and cataract progression are common side effects.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Young Adult; Chronic Disease; Anti-Inflammatory Agents/administration & dosage; Macular Edema/diagnosis/*drug therapy/etiology; Intravitreal Injections; Dexamethasone/*administration & dosage; Visual Acuity/drug effects; Uveitis/complications/diagnosis/*drug therapy; Drug Implants/*administration & dosage; Vision Disorders/diagnosis/etiology/*prevention & control

Systemic Steroid Sparing Effect of Intravitreal Dexamethasone Implant in Chronic Noninfectious Uveitic Macular Edema. - Fabiani, Claudia; Vitale, Antonio; Emmi, Giacomo; Lopalco, Giuseppe; Vannozzi, Lorenzo; Bacherini, Daniela; Guerriero, Silvana; Favale, Rosa Anna; Fusco, Fiorella; Franceschini, Rossella; Frediani, Bruno; Iannone, Florenzo; et al. (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2017)
PURPOSE: To evaluate the effectiveness and the systemic corticosteroid sparing effect of a single intravitreal dexamethasone (DEX) implant in patients with chronic noninfectious uveitic macular edema (UME). METHODS: Data from 22 eyes treated with DEX implant for UME related to systemic or ocular-confined noninfectious diseases were retrospectively analyzed. RESULTS: The mean systemic prednisone (or equivalent) dosage significantly decreased at 3- and 6-month follow-up evaluations compared to baseline (P = 0.002 and P = 0.01, respectively). Compared to baseline, central macular thickness values significantly decreased at 1-, 3-, and 6-month evaluations after the implantation (P < 0.0001). The mean best corrected visual acuity (BCVA) value gradually improved at 1-, 3-, and 6-month visits compared to baseline (P = 0.009, P = 0.0004, and P = 0.0001, respectively). At fluorescein angiography, active retinal vasculitis was identified in 11 (50%) eyes at baseline, 3 (13.6%) eyes at 1- and 3-month follow-up, and in 2 (9.1%) eyes at the last visit. Regarding side effects, 3/22 (13.6%) eyes presented a newly recognized intraocular hypertension at 1-month follow-up; however, intraocular pressure reverted to normal values within the 6-month follow-up in all cases. CONCLUSIONS: Treatment with intravitreal DEX implant in noninfectious uveitis allowed a significant corticosteroid sparing effect, a significant improvement in BCVA, and a prompt resolution of UME and vasculitis. No safety issues were observed.
Keywords: Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Chronic Disease; Prednisone/administration & dosage; Fluorescein Angiography; Tomography, Optical Coherence; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Visual Acuity/drug effects; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Intraocular Pressure/drug effects; *macular edema; *uveitis; *dexamethasone; *intravitreal implant; *steroid sparing effect

Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results. - Tomkins-Netzer, Oren; Lightman, Susan; Drye, Lea; Kempen, John; Holland, Gary N.; Rao, Narsing A.; Stawell, Richard J.; Vitale, Albert; Jabs, Douglas A. (Ophthalmology, 2015)
PURPOSE: To evaluate the 2-year outcomes of uveitic macular edema. DESIGN: Longitudinal follow-up of a randomized cohort. PARTICIPANTS: At baseline, 148 eyes of 117 patients enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial had macular edema, and 134 eyes of 108 patients completed 2-year follow-up. METHODS: Patients enrolled in the study were randomized to either systemic immunosuppression or intravitreal fluocinolone acetonide implant therapy. Macular edema was defined as thickening of the retina (center point thickness≥240 μm) on time-domain optical coherence tomography (OCT) of macula. MAIN OUTCOME MEASURES: Improvement in macular edema (≥20% reduction in central point thickness on OCT), resolution of macular edema (normalization of thickness on OCT), and best-corrected visual acuity (BCVA). RESULTS: Between randomization and 2-years' follow-up, 62% and 25% of eyes in the systemic and implant groups, respectively, received at least 1 supplemental regional corticosteroid injection. By 2-years' follow-up, macular edema improved in 71% of eyes and resolved in 60%. There were no differences between treatment groups in the proportion of eyes with macular edema improving (systemic therapy vs. implant, 65% vs. 77%; P=0.20) and resolving (52% vs. 68%; P=0.28), but eyes randomized to implant had more improvement in macular thickness (median decrease of 180 vs. 109 μm in the systemic therapy group; P=0.04). Eyes with baseline fluorescein angiographic leakage were more likely to improve than those without (76% vs. 58%; P=0.03). Overall, there was a mean 5-letter (1 line) improvement in BCVA at 2 years. Mean changes in BCVA from baseline at 2 years by macular edema response status were: resolution, +10 letters; improvement without resolution, +10 letters (P=0.92); little to no change, 6 letters (P=0.19); and worsening, -16 letters (worsening acuity; P=0.0003). CONCLUSIONS: About two thirds of eyes with uveitic macular edema were observed to experience improvement in the edema and visual acuity with implant or systemic treatment. Fluocinolone acetonide implant therapy was associated with a greater quantitative improvement in thickness. Fluorescein angiography leakage was associated with a greater likelihood of improvement in macular edema.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Follow-Up Studies; Treatment Outcome; Administration, Oral; Fluorescein Angiography; Tomography, Optical Coherence; Macular Edema/diagnosis/*drug therapy/etiology; Drug Implants; Intravitreal Injections; Glucocorticoids/*administration & dosage; Visual Acuity/drug effects; Uveitis/complications/diagnosis/*drug therapy; Fluocinolone Acetonide/*administration & dosage; Prednisolone/*administration & dosage

Use of adalimumab in refractory non-infectious childhood chronic uveitis: efficacy in ocular disease--a case cohort interventional study. - Sen, Ethan S.; Sharma, Srilakshmi; Hinchcliffe, Annie; Dick, Andrew D.; Ramanan, Athimalaipet V. (Rheumatology (Oxford, England), 2012)
OBJECTIVE: To assess the use of adalimumab in the treatment of refractory non-infectious childhood chronic uveitis. METHODS: A case cohort interventional study was performed on patients with uveitis, who were treated with adalimumab after failure of treatment with a combination of corticosteroids and another immunosuppressant drug. Main outcome measures were (i) stability of vision, (ii) stability of inflammation and (iii) reduction of immunosuppressive load. Adverse events and reasons for stopping adalimumab were noted. RESULTS: Seventeen patients from a single regional centre were included in the study. Nine patients had previously received an anti-TNF agent, and because of inefficacy, all were changed to adalimumab. At 12 months, fewer patients had visual acuity worse than LogMAR 0.4 (18% vs 32% at baseline). Using standardized uveitis nomenclature criteria, at 3 months, 50% of the patients eyes (n = 32) had improved, 16% had stable inflammation and 3% had worsened, whereas 31% were maintained with no anterior chamber cells. Six patients required courses of oral steroids for uveitis. Seven patients received intra- or periocular injections of steroids. Adalimumab treatment was interrupted in one patient because of varicella zoster infection. It was stopped in three patients. Seven (41%) patients reported injection site reactions. CONCLUSION: In this group of children with refractory uveitis, use of adalimumab was associated with improvement in visual acuity and improving or stable ocular inflammation. However, it did not completely obviate the need for systemic or periocular steroid treatment. Prospective randomized controlled trials are required to help determine which subset of patients may benefit from adalimumab and the duration of treatment.
Keywords: Female; Humans; Male; Case-Control Studies; Prospective Studies; Treatment Outcome; Chronic Disease; Child; Adalimumab; Visual Acuity/physiology; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Uveitis/complications/*drug therapy/physiopathology; Administration, Cutaneous; Antibodies, Monoclonal, Humanized/*administration & dosage/adverse effects; Arthritis, Rheumatoid/complications; Vision Disorders/*drug therapy/physiopathology

Effect of an Injectable Fluocinolone Acetonide Insert on Recurrence Rates in Chronic Noninfectious Uveitis Affecting the Posterior Segment: Twelve-Month Results. - Jaffe, Glenn J.; Foster, C. Stephen; Pavesio, Carlos E.; Paggiarino, Dario A.; Riedel, Gerard E. (Ophthalmology, 2019)
PURPOSE: To assess the safety and efficacy of an intravitreal fluocinolone acetonide (FA) insert to manage inflammation associated with chronic noninfectious posterior uveitis. DESIGN: Multicenter, randomized, prospective, doubled-masked, sham-controlled, 3-year phase 3 clinical trial. PARTICIPANTS: One hundred twenty-nine participants with recurrent noninfectious posterior uveitis were assigned randomly to FA insert (n = 87) or sham injection (n = 42). The more severely affected eye in participants with bilateral disease was designated as the study eye. METHODS: The insert (FA, 0.18 mg) was injected into the vitreous cavity; sham injection mimicked the insert delivery procedure. Ophthalmic examinations, OCT, and ocular tolerability and discomfort assessments were conducted; study visits were on days 7 and 28 and months 2, 3, 6, 9, and 12. Uveitis recurrence was treated as needed. The 6-month recurrence rate was the primary outcome measure. RESULTS: The 6-month (28% and 91%) and 12-month (38% and 98%) uveitis recurrence rates were significantly lower (P < 0.001) with FA insert vs. sham, respectively. Fewer recurrences per study eye (mean, 0.7 vs. 2.5), lower incidence of 15-letter or more decrease in best-corrected visual acuity (14% vs. 31%), and reduced systemic (19% vs. 40%) and local (7% vs. 62%) uveitis adjunctive treatments were observed with FA insert vs. sham, respectively. The FA insert group showed higher rates of cataract. Intraocular pressure-lowering treatment use was similar between groups. No deaths, treatment-related study discontinuations, or unanticipated safety signals were observed through 12 months. CONCLUSIONS: Chronic noninfectious posterior uveitis was managed successfully in this study population; FA insert eyes experienced fewer uveitis recurrence episodes, required fewer adjunctive treatments, and demonstrated less visual acuity loss compared with sham eyes. The FA insert treatment group showed higher rates of cataract; delivery by injection was not associated with an increase in ocular adverse events or any other safety measures not typically associated with local steroid use, suggesting the procedure is appropriate for an office setting.
Keywords: Double-Blind Method; Humans; Prospective Studies; Time Factors; Treatment Outcome; Recurrence; Chronic Disease; Tomography, Optical Coherence; Visual Acuity/physiology; Intravitreal Injections; Glucocorticoids/*administration & dosage; *Drug Implants; Fluocinolone Acetonide/*administration & dosage; Uveitis, Posterior/*diagnosis/*drug therapy/microbiology

Treatment of inflammatory macular edema with humanized anti-CD11a antibody therapy. - Faia, Lisa J.; Sen, H. Nida; Li, Zhuqing; Yeh, Steven; Wroblewski, Keith J.; Nussenblatt, Robert B. (Investigative ophthalmology & visual science, 2011)
PURPOSE: To evaluate the safety and efficacy of treating macular edema, secondary to noninfectious uveitis, with a humanized anti-CD11a antibody. METHODS: Six patients received weekly subcutaneous treatments for 16 weeks according to this open-label, prospective, noncomparative phase I/II trial. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were compared to baseline. Adverse events were recorded and assessed. Blood was sampled to assess the levels of CD56(bright) regulatory NK cells before initiation and after termination of the study. RESULTS: No serious adverse events were reported by the patients. Patients' ages ranged from 22 to 82 years. Mean BCVA improvements were 6.7 ± 6.9 ETDRS letters in the worse eye and 1.7 ± 5.2 letters in the better eye. Mean CMT reductions were 128 ± 105 μm in the worse eye and 57 ± 68 μm in the better eye. Anti-CD11a antibody treatments resulted in an increase in the CD56(bright) regulatory NK cell population in the peripheral blood of the patients. CONCLUSIONS: Anti-CD11a treatment improved visual function, reduced macular thickness, and increased the level of CD56(bright) regulatory NK cells in patients with uveitic macular edema refractory to other immunosuppressive medications. Targeting CD11a may be beneficial in treating other causes of macular edema.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Aged, 80 and over; Prospective Studies; Young Adult; Tomography, Optical Coherence; Flow Cytometry; Visual Acuity/physiology; Injections, Subcutaneous; Macula Lutea/pathology; Antibodies, Monoclonal, Humanized; Uveitis/diagnosis/*drug therapy/immunology; Antibodies, Monoclonal/adverse effects/*therapeutic use; CD11a Antigen/*immunology; CD56 Antigen/metabolism; Killer Cells, Natural/immunology; Macular Edema/diagnosis/*drug therapy/immunology

Structural and functional outcomes after treatment of uveitic macular oedema: an optical coherence tomography and multifocal electroretinogram study. - Georgiadou, Evi; Moschos, Marilita M.; Margetis, Ioannis; Chalkiadakis, John; Markomichelakis, Nikos N. (Clinical & experimental optometry, 2012)
BACKGROUND:   The aim was to evaluate the correlation between the anatomical and functional outcomes before and after treatment of uveitic macular oedema. METHODS:   Thirty-three eyes of 33 patients with uveitic macular oedema were included in the present study. Visual acuity (VA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were measured before and after treatment of the macular oedema. Correlation analyses between VA, OCT and mfERG parameters were performed. RESULTS:   The VA and mfERG measurements showed statistically significant improvement after treatment of the macular oedema (p < 0.01) and OCT-measured central foveal thickness decreased significantly from 434 ± 135 µm before treatment to 267 ± 92 µm after treatment (p < 0.001). Correlation analyses showed that uveitic central foveal thickness before treatment was correlated with mfERG N1 response amplitude of area 1 (Spearman's r = -0.62, p < 0.001). VA (logMAR) after treatment had a negative correlation with the mfERG N1 response amplitude of area 1 (Spearman's r = -0.56, p = 0.001). Also, there was no correlation between the final VA and pre-treatment OCT and mfERG measurements. CONCLUSION:   This study deals with cystoid macular oedema associated with recurrent uveitis. In cystoid macular oedema, the value of mfERG before treatment is related to the central foveal thickness and VA. In contrast, after treatment the decrease of macular thickness is not always followed by an improvement of mfERG and VA. This supports the view that in uveitic macular oedema, the decrease in macular thickness after treatment may not be used as a predictor of improvement of macular function.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Prospective Studies; Follow-Up Studies; Treatment Outcome; Reproducibility of Results; Visual Acuity; Uveitis/*complications/diagnosis/drug therapy; Glucocorticoids/*administration & dosage; Tomography, Optical Coherence/*methods; Diagnosis, Differential; Immunosuppressive Agents/*administration & dosage; Drug Administration Routes; Electroretinography/*methods; Fovea Centralis/*pathology/physiopathology; Macular Edema/*diagnosis/drug therapy/etiology

Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis. - Roesel, Martin; Heinz, Carsten; Koch, Joerg Michael; Heiligenhaus, Arnd (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2010)
PURPOSE: To compare orbital floor triamcinolone acetonide and oral prednisolone in cataract surgery in patients with chronic non-infectious uveitis with regard to visual outcome, postoperative inflammation and macular edema. METHODS: Monocentric prospective randomized clinical trial with 40 eyes included. Patients underwent phacoemulsification with intraocular acrylic foldable lens (IOL) implantation. Patients were randomized either to intraoperative orbital floor triamcinolone acetonide (TA) (1 ml = 40 mg) (group 1, n = 20), or to 4-week postoperative oral prednisolone (group 2, n = 20). Laser flare photometry (LFM), cells in the anterior chamber (AC), best-corrected visual acuity (BCVA), IOL cell deposits, cystoid macular edema (CME) by means of fluorescein angiography, and central foveal thickness (OCT), posterior capsule opacification (PCO), and intraocular pressure (IOP) were analysed during a 6-months period. RESULTS: Mean BCVA postoperatively improved (p < 0.01) from logMAR 0.74 and 0.86 to 0.23 and 0.35 in groups 1 and 2 respectively.The number of AC cells, LFM and IOL cell deposits did not differ. Macular edema stayed unchanged in most cases in both groups, and mean foveal thickness (OCT) initially increased postoperatively, but after 6 months it nearly returned to baseline thickness. Differences between the groups were not significant. Up to 12% in group 1 and 28% of group 2 developed IOP elevation over 21 mmHg. CONCLUSIONS: A single intraoperative orbital floor injection of triamcinolone acetonide is as effective on postoperative inflammation, macular edema, and visual outcome as a 4-week course of postoperative oral prednisolone in cataract surgery with IOL implantation in uveitis patients.
Keywords: Female; Humans; Male; Middle Aged; Prospective Studies; Administration, Oral; Fluorescein Angiography; Injections; Triamcinolone Acetonide/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Visual Acuity/*physiology; Intraoperative Care; *Phacoemulsification; Uveitis/complications/*drug therapy/physiopathology; Postoperative Complications; *Lens Implantation, Intraocular; Prednisolone/*administration & dosage; Anterior Chamber/pathology; Cataract/complications/physiopathology/therapy; Orbit; Photometry

Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis. - Pichi, Francesco; Nucci, Paolo; Baynes, Kimberly; Lowder, Careen Y.; Srivastava, Sunil K. (International ophthalmology, 2017)
The purpose of this study is to review the results of treatment of juvenile idiopathic arthritis-related uveitis with the use of intravitreal dexamethasone implant. Sixteen eyes with Juvenile idiopathic arthritis (JIA)-associated uveitis received intravitreal dexamethasone implant to treat recalcitrant anterior segment inflammation (43.7 %), chronic macular edema (6.2 %), or a combination of both (50 %). One month after injection, mean visual acuity had improvement to 39.6 ± 11 ETDRS letters (p < 0.001). Mean AC cells measure at 1 month was 0.79 and 0.75 at 3 months. One month after injection, there was a significant reduction of central retinal thickness (CRT) to 342.4 ± 79.3 µm (p < 0.01). One month after the second implant, 11 eyes (91.6 %) achieved improved activity of the anterior uveitis, and mean best-corrected visual acuity improved to 44.6 ± 8.1 ETDRS letters (p < 0.01). At 1 month after the second injection, 4/5 eyes had resolution of macular edema with CRT of 250.4 ± 13.7 µm (p < 0.01). Of the 16 eyes, 12 eyes received a second injection at mean of 7.5 ± 3.1 months after the first treatment, and 5 eyes received a third Ozurdex injection on average 7 ± 4.6 months after the second injection. Of the 16 eyes, five eyes were pseudophakic prior to injection. Of the remaining 11 eyes, 8 (73 %) developed worsening posterior subcapsular cataract at a mean of 7.3 ± 1.2 months after the first injection. After the first injection, only one eye required topical antiglaucoma therapy with maximum pressure of 25 mmHg. In patients with recalcitrant JIA-associated active uveitis, injection of sustained-release dexamethasone can achieve control of anterior inflammation and resolution of macular edema.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Young Adult; Adolescent; Child; Tomography, Optical Coherence; Visual Acuity; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Delayed-Action Preparations; Macular Edema/drug therapy; Uveitis/*drug therapy/etiology; Arthritis, Juvenile/*complications; Cystoid macular edema; Dexamethasone intravitreal implant; Juvenile idiopathic arthritis-associated uveitis

Topical dexamethasone-cyclodextrin nanoparticle eye drops for non-infectious Uveitic macular oedema and vitritis - a pilot study. - Shulman, Shiri; Jóhannesson, Gauti; Stefánsson, Einar; Loewenstein, Anat; Rosenblatt, Amir; Habot-Wilner, Zohar (Acta ophthalmologica, 2015)
PURPOSE: To evaluate the safety and efficacy of 1.5% dexamethasone nanoparticle (DexNP) drops in eyes with non-infectious uveitic macular oedema and vitritis. METHODS: In a prospective pilot study, DexNP drops were administered four times a day for 4 weeks followed by drops tapering over a period of another 4 weeks. Follow-up time was 12 weeks. RESULTS: Five eyes with macular oedema and three eyes with vitritis were included in the study. Best corrected visual acuity (BCVA) significantly improved from a median of 0.2 logMAR to a median of 0.15 logMAR at 4 weeks' time (p < 0.05). Median BCVA was 0.175 logMAR and 0.2 logMAR, at week 8 and 12, respectively (p > 0.05). Macular oedema significantly improved at all time-points as compared to baseline (p < 0.05) and resolved in all eyes during follow-up. One eye had macular oedema relapse at week 12. Vitritis improved in all eyes and resolved completely in two eyes. One eye had intraocular pressure (IOP) elevation which was well controlled with topical antihypertensive treatment, and one eye had cataract progression. CONCLUSION: This short pilot study demonstrates favourable effect of 1.5% DexNP eye drops on eyes with non-infectious uveitic macular oedema and vitritis. Further comparative long-term studies are warranted to assess this effect.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Aged; Prospective Studies; Follow-Up Studies; Ophthalmic Solutions; Uveitis/*drug therapy; Retina/pathology; Visual Acuity/drug effects; intermediate uveitis; non-infectious uveitis; Administration, Topical; Macular Edema/*drug therapy; vitritis; Vitreous Body/*drug effects; 1.5% dexamethasone nanoparticle eye drops; beta-Cyclodextrins/*administration & dosage/adverse effects/chemistry; dexamethasone-cyclodextrin nanoparticle eye drops; Dexamethasone/administration & dosage/adverse effects/*analogs & derivatives/chemistry; Eye Diseases/*drug therapy; Glucocorticoids/*administration & dosage/adverse effects/chemistry; Nanoparticles/chemistry; uveitic macular oedema

Mycophenolate mofetil in the treatment of uveitis in children. - Doycheva, D.; Deuter, C.; Stuebiger, N.; Biester, S.; Zierhut, M. (The British journal of ophthalmology, 2007)
BACKGROUND: Mycophenolate mofetil (MMF) is a new immunosuppressive agent that effectively controls the intraocular inflammation in adults. PURPOSE: To assess the efficacy of MMF in uveitis in children and to analyse the possible side effects. PARTICIPANTS AND METHODS: A retrospective analysis was carried out on 17 children (32 eyes) with intraocular inflammation treated with MMF and followed up at the University Eye Hospital Tuebingen, Tuebingen, Germany, between 2000 and 2005. All children had chronic non-infectious uveitis and received MMF for at least 6 months. All patients were given steroids or other immunosuppressive agents before initiating treatment with MMF. RESULTS: 17 children (10 boys and 7 girls) with a mean age of 8 (range 2-13) years at the onset of uveitis were examined. The average duration of follow-up after initiation of MMF was 3 (range 2-5) years. A steroid-sparing effect was achieved in 88% of the patients. The oral prednisolone was successfully discontinued in 41% children and reduced to a daily dose of < or =5 mg in 47% of the children. 24% of the patients remained relapse-free during the treatment, but a reduction in the relapse rate was observed in all other patients except one. Visual acuity was increased or maintained in 13 children (76%). Mild side effects (headache, rash, gastrointestinal discomfort) occurred in 7 patients (41%) and were the cause of discontinuation of MMF in 1 patient. CONCLUSION: The results of our study are encouraging and suggest that MMF is an effective agent also in the treatment for uveitis in children, with marked steroid-sparing potential and an acceptable side effect profile.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Drug Administration Schedule; Adolescent; Recurrence; Chronic Disease; Child; Child, Preschool; Anti-Inflammatory Agents/administration & dosage; Prednisolone/administration & dosage; Glucocorticoids/administration & dosage; Age of Onset; Visual Acuity/drug effects; Uveitis/*drug therapy/physiopathology; Immunosuppressive Agents/adverse effects/*therapeutic use; Mycophenolic Acid/adverse effects/*analogs & derivatives/therapeutic use

Comparison of infliximab versus ciclosporin during the initial 6-month treatment period in Behçet disease. - Yamada, Yukiko; Sugita, Sunao; Tanaka, Hiroyuki; Kamoi, Koju; Kawaguchi, Tatsushi; Mochizuki, Manabu (The British journal of ophthalmology, 2010)
AIM: To compare the efficacy and safety of infliximab versus ciclosporin A (CsA) in refractory uveoretinitis in Behçet disease. METHODS: In this retrospective clinical chart review of patients with Behçet disease who were treated with CsA or infliximab, we collected information on the number of uveitis attacks, visual acuity and adverse side effects that occurred during the 6 months prior to and after the initiation of CsA (n=20) or infliximab (n=17). RESULTS: The number of acute episodes of uveitis during the 6 months before and after initiation of CsA were 3.3+/-2.4 and 1.2+/-1.2, and those of infliximab were 3.1+/-2.7 and 0.4+/-1.0, respectively (p<0.005). The number of episodes after infliximab administration was significantly lower than that seen for CsA (p<0.05). During the 6-month treatment period, there were no significant differences noted in the improvement of the visual acuity between the two therapies. After CsA administration, neurological symptoms and renal toxicity were seen in one patient each, while after the infliximab administration, an infusion reaction and leucopenia were seen in one patient each. CONCLUSION: During the initial 6 months of treatment, infliximab proved to be more effective in reducing acute episodes of uveitis in Behçet disease.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Infliximab; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Drug Evaluation; Acute Disease; Visual Acuity/drug effects; Immunosuppressive Agents/adverse effects/*therapeutic use; Secondary Prevention; Antibodies, Monoclonal/adverse effects/*therapeutic use; Behcet Syndrome/*drug therapy; Cyclosporine/adverse effects/*therapeutic use; Uveitis/physiopathology/*prevention & control

Intravitreal Adalimumab in Active Noninfectious Uveitis: A Pilot Study. - Hamam, Rola N.; Barikian, Anita W.; Antonios, Rafic S.; Abdulaal, Marwan R.; Alameddine, Ramzi M.; El Mollayess, Georges; Mansour, Ahmad M. (Ocular immunology and inflammation, 2016)
PURPOSE: To evaluate the short-term efficacy of intravitreal adalimumab (IVA) for the treatment of eyes with active noninfectious uveitis. METHODS: Consecutive eyes with active noninfectious uveitis were injected with IVA at 0, 2, then every 4 weeks for total of 26 weeks. RESULTS: Six out of 7 patients (12 of 13 eyes) completed 26 weeks of treatment. One patient (1 eye) failed treatment. Seven out of 12 eyes had improvement of ≥2 ETDRS lines. Three out of three eyes had resolution of anterior chamber cells. And 9 of 10 eyes with vitreous haze had zero haze at 26 weeks. Five out of 8 eyes with macular edema had complete resolution. Median fluorescein angiography score improved from 14 to 4 on last follow-up. CONCLUSIONS: IVA was effective in controlling the inflammation, decreasing the macular edema, and improving the best corrected visual acuity in the majority of eyes in this series.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Prospective Studies; Treatment Outcome; Young Adult; Anti-Inflammatory Agents/*therapeutic use; Adalimumab; Tumor Necrosis Factor-alpha/*antagonists & inhibitors; Fluorescein Angiography; Tomography, Optical Coherence; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Intravitreal Injections; Vitreous Body/drug effects; Anterior Chamber/pathology; Adalimumab/*therapeutic use; Eye Infections/drug therapy/physiopathology; intravitreal adalimumab; Macular Edema/diagnostic imaging/drug therapy/physiopathology; noninfectious uveitis; uveitis treatment

Periocular corticosteroid injections in uveitis: effects and complications. - Sen, H. Nida; Vitale, Susan; Gangaputra, Sapna S.; Nussenblatt, Robert B.; Liesegang, Teresa L.; Levy-Clarke, Grace A.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Kempen, John H. (Ophthalmology, 2014)
PURPOSE: To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. DESIGN: Multicenter, retrospective cohort study. PARTICIPANTS: A total of 914 patients (1192 eyes) who had received ≥ 1 periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. METHODS: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. MAIN OUTCOME MEASURES: Control of inflammation, improvement of visual acuity (VA) to ≥ 20/40, improvement of VA loss attributed to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery. RESULTS: Among 914 patients (1192 eyes) who received ≥ 1 periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤ 6 months, 72.7% (95% CI, 69.1-76.3) of the eyes achieved complete control of inflammation and 49.7% (95% CI, 45.5-54.1) showed an improvement in VA from <20/40 to ≥ 20/40. Among the subset with VA <20/40 attributed to ME, 33.1% (95% CI, 25.2-42.7) improved to ≥ 20/40. By 12 months, the cumulative incidence of ≥ 1 visits with an intraocular pressure of ≥ 24 mmHg and ≥ 30 mmHg was 34.0% (95% CI, 24.8-45.4) and 15.0% (95% CI, 11.8-19.1) respectively; glaucoma surgery was performed in 2.4% of eyes (95% CI, 1.4-3.9). Within 12 months, among phakic eyes initially ≥ 20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2% (95% CI, 15.9-25.6); cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes (95% CI, 11.1-17.2). CONCLUSIONS: Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, VA improved in one half of the patients at some point within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Adolescent; Infant, Newborn; Child; Child, Preschool; Infant; Injections, Intraocular; Uveitis/*drug therapy/physiopathology; Glucocorticoids/adverse effects/*therapeutic use; Triamcinolone Acetonide/adverse effects/*therapeutic use; Visual Acuity/drug effects/physiology

Hypotensive effect of juxtascleral administration of anecortave acetate in different types of glaucoma. - Prata, Tiago Santos; Tavares, Ivan Maynart; Mello, Paulo Augusto; Tamura, Caroline; Lima, Verônica Castro; Belfort, Rubens (Journal of glaucoma, 2010)
PURPOSE: To evaluate the intraocular pressure (IOP)-lowering effect of anecortave acetate, delivered by anterior juxtascleral depot injection, in eyes with various forms of glaucoma. METHODS: A prospective, interventional case series was carried out. Twenty-eight uncontrolled glaucoma patients received a single injection of anecortave acetate (24 to 30 mg) in 1 selected eye under topical anesthesia. Postinjection assessments were scheduled at week 1 and months 1, 2, and 3. RESULTS: Mean ± SD age of patients was 58.2 ± 18.6 years. Twelve patients had open-angle glaucoma and 16 had angle-closure glaucoma. Uveitic/steroid-induced glaucoma was the most frequent diagnosis (11 patients, 39.2%). Mean baseline IOP was 30.7 ± 9.3 mm Hg. Mean IOP at week 1 and months 1, 2, and 3 were 21.3 ± 6.1, 19.8 ± 6.3, 20.9 ± 7.3, and 21.7 ± 6.8 mm Hg, respectively. Significant mean IOP reductions were observed at week 1 and months 1, 2, and 3 (29.3%, 33.8%, 30.1%, and 27.2%, respectively; P<0.001). CONCLUSION: A single administration of anecortave acetate by anterior juxtascleral depot injection seems to result in a significant IOP reduction (compared with baseline) for at least 3 months in eyes with different types of glaucoma. No injection-related or drug-related serious adverse events were observed. Additional studies are required to better determine the efficacy, safety, and mechanism of action of this alternative treatment.
Keywords: Female; Humans; Male; Middle Aged; Aged; Prospective Studies; Injections; Visual Acuity; Glucocorticoids/*administration & dosage; Tonometry, Ocular; Glaucoma, Open-Angle/*drug therapy/physiopathology; Delayed-Action Preparations; Intraocular Pressure/*drug effects; Anterior Eye Segment; Glaucoma, Angle-Closure/*drug therapy/physiopathology; Pregnadienediols/*administration & dosage; Sclera

Uveitis following intravitreal bevacizumab: a non-infectious cluster. - Kay, Christine N.; Tarantola, Ryan M.; Gehrs, Karen M.; Folk, James C.; Mahajan, Vinit B.; Boldt, H. Culver; Syed, Nasreen A.; Russell, Stephen R. (Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye, 2011)
BACKGROUND AND OBJECTIVE: In this retrospective case series, the authors report seven cases of bevacizumab-related uveitis that occurred within a 4-month period. PATIENTS AND METHODS: Seven eyes of six patients developed non-infectious uveitis following bevacizumab intravitreal injections in a cohort of 978 consecutive bevacizumab injections. RESULTS: The mean age of patients was 74.6 years (range: 26 to 92). All patients developed symptom onset within 1 day of injection. Shared signs and symptoms included corneal edema, anterior chamber and vitreous cell, conjunctival injection, ocular pain, and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. All seven eyes had been previously injected with bevacizumab, with a mean number of antecedent injections of 6.1 (range: 3 to 12). CONCLUSION: A cluster of sterile bevacizumab-related uveitic reactions was described in this case series. Acute onset of symptoms, absence of hypopyon, a predominant anterior segment reaction, and prompt improvement on topical steroid therapy are useful clinical features distinguishing this uveitic syndrome from infectious endophthalmitis.
Keywords: Humans; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Immunosuppressive Agents/administration & dosage; Visual Acuity/physiology; Intravitreal Injections; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Antibodies, Monoclonal, Humanized; Bevacizumab; Angiogenesis Inhibitors/*adverse effects; Antibodies, Monoclonal/*adverse effects; Uveitis, Anterior/*chemically induced/diagnosis/drug therapy

Management of uveitic glaucoma with Ahmed glaucoma valve implantation. - Da Mata, A.; Burk, S. E.; Netland, P. A.; Baltatzis, S.; Christen, W.; Foster, C. S. (Ophthalmology, 1999)
OBJECTIVE: To evaluate the safety and efficacy of Ahmed glaucoma valve implantation for the management of glaucoma associated with chronic uveitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Nineteen patients (21 eyes) with chronic uveitis underwent Ahmed glaucoma valve implantation for uncontrolled glaucoma between 1995 and 1998. INTERVENTION: All patients had their uveitis controlled before surgery via immunomodulatory therapy. Ahmed glaucoma valve implantation was performed. Immunosuppression was continued in the early postoperative period for strict control of inflammation. MAIN OUTCOME MEASURES: Control of intraocular pressure (IOP). A secondary outcome measure was the number of antiglaucoma medications required to achieve the desired IOP. Visual acuity and complications associated with the surgery were monitored. RESULTS: The postoperative follow-up averaged 24.5 months. At the most recent visit, all 21 eyes had IOPs between 5 and 18 mmHg. The average pressure reduction after Ahmed glaucoma valve implantation was 23.7 mmHg. The average number of antiglaucoma medicines required to achieve the desired IOP was reduced from 3.5 before surgery to 0.6 after surgery. No eye lost even a single line of Snellen acuity at the most recent postoperative visit. Two eyes developed hypotony in the course of follow-up. One resolved without specific intervention, and the other eye required two autologous blood injections and tube ligature to correct the hypotony. One eye underwent Ahmed glaucoma valve replacement for abrupt valve failure. Two eyes underwent penetrating keratoplasty for reasons believed to be unrelated to the glaucoma surgery. Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 94% at 1 year. CONCLUSIONS: Ahmed glaucoma valve implantation can be an effective and safe method in the management of uveitic glaucoma. The authors hypothesize that control of the patients' uveitis, through preoperative and long-term postoperative immunomodulatory therapy, may have contributed to the success rate reported herein.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Aged, 80 and over; Retrospective Studies; Adolescent; Chronic Disease; Child; Immunosuppressive Agents/therapeutic use; Visual Acuity; *Glaucoma Drainage Implants; Prosthesis Implantation; Intraocular Pressure; Trabeculectomy; Glaucoma/etiology/*surgery; Postoperative Complications; Uveitis, Anterior/*complications/drug therapy

Immune keratitis: An unusual primary presentation of neuro-Behçet's disease. - Jinagal, Jitender; Agarwal, Aniruddha; Negi, Avinash; Gupta, Gaurav; Sharma, Vikas; Gupta, Parul Chawla; Ram, Jagat (European journal of ophthalmology, 2019)
A 19-year-old Nepalese male presented with complaints of bilateral ocular discomfort, photophobia, watering, and redness for 1 week. Visual acuity was 6/12 and 6/60 in the right and left eye, respectively. On biomicroscopic examination, presence of peripheral stromal infiltrates with conjunctival follicles was noted; infiltrates progressed to involve central cornea with further decrease in vision over next few days. After ruling out infectious keratitis, detailed systemic examination and laboratory investigations were diagnostic of neuro-Behçet's disease. Patient responded to systemic steroidal and immunosuppressive therapy characterized by corneal healing and visual acuity improvement to 6/6 and 6/9. Although rare, but neuro-Behçet's disease can primarily present as bilateral immune keratitis and every case of bilateral keratitis needs early systemic evaluation after ruling out infective etiologies.
Keywords: Humans; Male; Drug Therapy, Combination; Young Adult; Infusions, Intravenous; Cyclosporine/therapeutic use; Cyclophosphamide/therapeutic use; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Behçet disease; Slit Lamp Microscopy; Behcet Syndrome/*diagnosis/drug therapy; bilateral keratitis; immune keratitis; Keratitis/*diagnosis/drug therapy; Lubricant Eye Drops/administration & dosage; Methylprednisolone/therapeutic use; neuro-Behçet; peripheral keratitis

Intravitreal ketorolac for chronic uveitis and macular edema: a pilot study. - Kim, Stephen J.; Doherty, Terrence J.; Cherney, Edward F. (Archives of ophthalmology (Chicago, Ill. : 1960), 2012)
OBJECTIVE: To investigate the adverse ocular effects of intravitreal ketorolac (4 mg) in patients with chronic uveitis and complications of chronic inflammation (macular edema). METHODS: We conducted a prospective phase 1 clinical trial involving 10 eyes of 10 adult patients with chronic inflammation and/or macular edema for whom previous treatment failed or who could not tolerate corticosteroids because of adverse ocular effects. Baseline (day 0) electroretinography, fluorescein angiogram, spectral domain optical coherence tomography (OCT), Goldmann visual field, and complete ophthalmic examination were performed, and then a single intravitreal injection of ketorolac (4 mg) was administered. Another ophthalmic examination with OCT was performed on day 3. Ophthalmic examination with fluorescein angiogram and OCT was repeated on days 7 and 30, and ophthalmic examination with fluorescein angiogram, OCT, electroretinography, and Goldmann visual field was performed on day 90. The study took place from March 1, 2010, through February 28, 2011. RESULTS: On the basis of ophthalmic examination findings, visual field, and electroretinography testing, there were no observed adverse ocular effects of intravitreal ketorolac. In 2 of 2 eyes with active intraocular inflammation, there was early resolution of inflammation, and in 4 of 8 eyes with macular edema, there appeared to be transient reduction in OCT thickness and/or fluorescein angiogram leakage. CONCLUSION: A single intravitreal injection of ketorolac (4 mg) appeared to be well tolerated. CLINICAL RELEVANCE: Intravitreal ketorolac requires further clinical trials to determine whether it is an effective means to treat posterior segment inflammation as a safer alternative to corticosteroids in patients at increased risk of cataract formation and increased intraocular pressure.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Aged; Aged, 80 and over; Prospective Studies; Treatment Outcome; Chronic Disease; Visual Fields/drug effects; Electroretinography; Fluorescein Angiography; Tomography, Optical Coherence; Visual Field Tests; Uveitis/diagnosis/*drug therapy/physiopathology; Intravitreal Injections; Visual Acuity/drug effects; Intraocular Pressure/drug effects; Cyclooxygenase Inhibitors/*administration & dosage/adverse effects; Ketorolac Tromethamine/*administration & dosage/adverse effects; Macular Edema/diagnosis/*drug therapy/physiopathology; Retina/physiology

EFFICACY AND SAFETY OF DEXAMETHASONE INTRAVITREAL IMPLANT FOR PERSISTENT UVEITIC CYSTOID MACULAR EDEMA. - Khurana, Rahul N.; Porco, Travis C. (Retina (Philadelphia, Pa.), 2015)
PURPOSE: To investigate dexamethasone intravitreal implant (DEX Implant 0.7 mg, Ozurdex; Allergan, Inc, Irvine, CA) as a treatment for persistent cystoid macular edema (CME) secondary to uveitis. METHODS: Treatment and outcomes data were collected retrospectively for 18 eyes from 13 consecutive patients treated with the DEX Implant for persistent, noninfectious uveitic CME. Outcome measures included the cumulative incidence of resolution of CME, visual acuity, central retinal thickness (measured by spectral domain optical coherence tomography), and vitreous haze score. RESULTS: After a single DEX Implant, there was no detectable CME in 89% and 72% of eyes at 1 month and 3 months, respectively. The median time to recurrence of CME (±standard error) was 201 ± 62 days. The percentage of eyes with no recurrence of CME was 35% at 6 months and 30% at 12 months. At 3 months, there was a significant improvement from baseline in mean visual acuity (+2.1 lines, P < 0.01). Eyes with an epiretinal membrane at baseline had shorter time to recurrence of CME and smaller improvements in visual acuity and central retinal thickness than eyes without an epiretinal membrane. At least 1 episode of intraocular pressure >25 mmHg occurred within the first 3 months in 11% (2 of 18) of eyes; all effectively managed with topical hypotensive medications. CONCLUSION: A single DEX Implant produced sustained improvements in both visual acuity and retinal thickness in the majority of eyes with persistent uveitic CME. Uveitic CME did gradually recur in most eyes; however, close posttreatment monitoring is recommended.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Recurrence; Tomography, Optical Coherence; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage/adverse effects; Glucocorticoids/*administration & dosage/adverse effects; Intraocular Pressure/drug effects; Macular Edema/*drug therapy/etiology/physiopathology; Uveitis/complications/*drug therapy/physiopathology; Visual Acuity/drug effects/physiology; Retina/drug effects/pathology

Uveitis in patients with autoimmune hepatitis. - Lim, Lyndell L.; Scarborough, John D.; Thorne, Jennifer E.; Graham, Elizabeth; Kempen, John H.; Mackensen, Friederike; Nguyen, Quan Dong; Prabriputaloong, Tisha; Read, Russell W.; Suhler, Eric B.; Schwartz, Jonathan M.; Smith, Justine R. (American journal of ophthalmology, 2009)
PURPOSE: To report seven cases of uveitis occurring in patients with autoimmune hepatitis (AIH), raising the possibility that uveitis may be an extrahepatic feature of AIH. DESIGN: Multicenter, retrospective, observational case series of patients with AIH and uveitis. METHODS: One index case was identified at Oregon Health & Science University. Further cases were identified by a web-based survey of members of the American Uveitis Society, the International Uveitis Study Group, the Proctor Foundation mailing list server, and the First SUN International Workshop. Respondents were asked to provide clinical information about uveitis phenotype, AIH features, and treatment. RESULTS: Clinical information was obtained for seven individuals (four females and three males; age range, seven to 67 years) who suffered from AIH and uveitis. Average duration of follow-up was 5.5 years. All patients had chronic, persistent bilateral uveitis that was anterior (n = 3), intermediate (n = 1), or pan (n = 3) in location. Every patient had complications arising from his or her uveitis, including cataract (n = 5), glaucoma (n = 3), cystoid macular edema (n = 3), and posterior synechiae (n = 3). Final visual acuities ranged from 20/16 to hand movements. To treat the uveitis and/or AIH, the majority of patients required oral prednisone and all seven patients were treated with systemic immunosuppression. CONCLUSION: Despite the small size of this study, our findings suggest an association between AIH and uveitis. The uveitis is chronic, bilateral, and associated with sight-threatening complications, necessitating systemic immunosuppression in some individuals.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Adolescent; Chronic Disease; Child; 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

Complications of presumed ocular tuberculosis. - Hamade, Issam H.; Tabbara, Khalid F. (Acta ophthalmologica, 2010)
PURPOSE: To determine the effect of steroid treatment on visual outcome and ocular complications in patients with presumed ocular tuberculosis. METHODS: Retrospective review of patients with presumptive ocular tuberculosis. The clinical diagnosis was made based on ocular findings, positive purified protein derivative (PPD) testing of more than 15 mm induration, exclusion of other causes of uveitis and positive ocular response to anti-tuberculous therapy (ATT) within 4 weeks. Group 1 included patients who had received oral prednisone or subtenon injection of triamcinolone acetonide prior to ATT. Group 2 included patients who did not receive corticosteroid therapy prior to administration of ATT. RESULTS:   Among 500 consecutive new cases of uveitis encountered in 1997-2007 there were 49 (10%) patients with presumed ocular tuberculosis. These comprised 28 (57%) male and 21 (43%) female patients with a mean age of 45 years (range 12-76 years). Four (20%) patients in group 1 had initial visual acuity of 20/40 or better, in comparison to eight (28%) patients in group 2. At 1-year follow-up, six (30%) patients in group 1 had a visual acuity of 20/40 or better compared with 20 (69%) patients in group 2 (p = 0.007). Of 20 eyes (26%) in group 1 that had visual acuity of < 20/50 at 1-year follow up, 14 (70%) eyes developed severe chorioretinal lesion (p = 0.019). CONCLUSION: Early administration of corticosteroids without anti-tuberculous therapy in presumed ocular tuberculosis may lead to poor visual outcome compared with patients who did not receive corticosteroids prior to presentation. Furthermore, the severity of chorioretinitis lesion in the group of patients given corticosteroid prior to ATT may account for the poor visual outcome.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Young Adult; Adolescent; Administration, Oral; Child; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Antitubercular Agents/therapeutic use; Chorioretinitis/drug therapy/*etiology/physiopathology; Tuberculosis, Ocular/*complications/drug therapy/physiopathology; Uveitis/drug therapy/*etiology/physiopathology

Vogt-Koyanagi-Harada disease in Hispanic patients. - Sukavatcharin, Somsiri; Tsai, Julie H.; Rao, Narsing A. (International ophthalmology, 2007)
PURPOSE: To describe the clinical features of Vogt-Koyanagi-Harada disease (VKH) in Hispanic patients. METHODS: Retrospective review of the records of 48 Hispanic patients diagnosed with VKH. The patients were divided into two groups: patients in the early phase of VKH (n = 11) were those who presented within 1 month after the onset of symptoms; patients in the late or chronic VKH phase (n = 37) were those who presented 6 months after onset of symptoms. Demographic data, clinical features, complications and initial and final visual acuity for each patient were recorded. RESULTS: All 11 patients in early phase VKH presented with bilateral uveitis (100%). Meningismus was noted in six cases and auditory disturbances in three. Ocular findings for these 11 patients included exudative retinal detachment in ten patients (91%) and marked optic disc edema in one patient. In the late phase VKH, ocular findings included sunset glow fundus in 26 patients (70%), peripheral nummular scars in 27 (73%), and retinal pigment epithelium hyperplasia in seven (19%). Extraocular manifestations noted in this group of patients included vitiligo in four, poliosis in six, and alopecia in five; auditory disturbances were found in four patients. The visual acuity improved in 60-70% of the patients after treatment with corticosteroids alone or in combination with immunosuppressive agents. CONCLUSION: Hispanic patients with VKH often present without extraocular changes during early phase of the disease. However, once the disease evolves into the chronic phase, integumentary system involvement may become apparent in some patients.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Adolescent; Child; Fluorescein Angiography; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity; Age Distribution; *Hispanic or Latino; Sex Distribution; Uveomeningoencephalitic Syndrome/diagnosis/drug therapy/*ethnology

Risk factors associated with intraocular pressure increase in patients with uveitis treated with the fluocinolone acetonide implant. - Parekh, Anjali; Srivastava, Sunil; Bena, James; Albini, Thomas; Nguyen, Quan Dong; Goldstein, Debra A. (JAMA ophthalmology, 2015)
IMPORTANCE: Elevated intraocular pressure (IOP) is a well-known adverse event associated with the fluocinolone acetonide implant (FAI), but no data are available regarding factors associated with increased risk of IOP elevation in patients treated with the FAI. OBJECTIVE: To report risk factors that may predispose patients to elevated IOP after treatment with the FAI. DESIGN, SETTING, AND PARTICIPANTS: Data from 3 multicenter, 3-year, prospective, randomized, phase 2b/3 clinical trials evaluating the safety and efficacy of the FAI were pooled and analyzed. Patients had no underlying glaucoma and at least one eye with a history of recurrent noninfectious uveitis affecting the posterior segment. Patients were treated with 1 or more of the following: systemic therapy (corticosteroids or other immunosuppressive drugs) for at least 3 months before enrollment, 2 or more sub-Tenon capsule corticosteroid injections for uveitis management during the 6 months before enrollment, or systemic corticosteroid or sub-Tenon capsule corticosteroid injection therapy required for at least 2 separate recurrences within 6 months before enrollment. MAIN OUTCOMES AND MEASURES: Factors evaluated as risk factors for IOP elevation included age, sex, lens status, uveitis severity at enrollment, and location of uveitis. RESULTS: Data analyses were based on 641 eyes. A total of 351 eyes did not receive the FAI, whereas 290 eyes had the 0.59-mg FAI placed. An increase in IOP of 10 mm Hg or elevation to 30 mm Hg was seen in 60 untreated eyes (17.1%) and 188 treated eyes (65.1%) (hazard ratio, 5.80; 95% CI, 4.28-7.70; P < .001). A total of 8 untreated eyes (2.3%) required surgical intervention for elevated IOP compared with 93 treated eyes (32.1%) (hazard ratio, 16.48; 95% CI, 8.24-32.96; P < .001). In patients with the FAI, younger age, male sex, and phakic lens status were associated with higher risk of IOP elevation and the need for glaucoma surgery (P = .003, P < .001, and P < .001, respectively). CONCLUSIONS AND RELEVANCE: Patients receiving the FAI are at higher risk of developing an IOP increase of 10 mm Hg or an absolute IOP of 30 mm Hg when compared with patients without the FAI. Patients who are male, younger, and phakic are at an even higher risk for elevated IOP and possibly glaucoma surgery.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Prospective Studies; Risk Factors; Adolescent; Child; Visual Acuity; Injections, Intraocular; Drug Implants; Uveitis/*drug therapy; Tonometry, Ocular; Intraocular Pressure/*drug effects; Tenon Capsule/drug effects; Glucocorticoids/administration & dosage/*adverse effects; Fluocinolone Acetonide/administration & dosage/*adverse effects; Ocular Hypertension/*chemically induced/diagnosis

Efficacy and tolerability of interferon alpha treatment in patients with chronic cystoid macular oedema due to non-infectious uveitis. - Deuter, C. M. E.; Kötter, I.; Günaydin, I.; Stübiger, N.; Doycheva, D. G.; Zierhut, M. (The British journal of ophthalmology, 2009)
AIM: To assess the efficacy and tolerability of interferon (IFN) alpha in chronic cystoid macular oedema (CMO) due to non-infectious uveitis. METHODS: Retrospective analysis of an interventional case series. IFN alpha-2a was administered at an initial dose of 3 or 6 million IU per day subcutaneously and tapered afterwards to the lowest possible dose to maintain the absence of CMO. Treatment efficacy was assessed by optical coherence tomography. RESULTS: Twenty-four patients with chronic CMO (median duration 36.0 months) due to non-infectious anterior (n = 2), intermediate (n = 18) or posterior (n = 4) uveitis have been analysed. Ineffective pretreatment included systemic corticosteroids (all patients), acetazolamide (22 patients) and at least one immunosuppressive drug (18 patients). IFN therapy was shown to be effective (= complete resolution of CMO within 3 months, able to taper IFN) in 15 patients (62.5%), partly effective (= incomplete resolution of CMO, unable to taper IFN) in six patients (25.0%) and not effective (= no response or recurrence of CMO) in three patients (12.5%). IFN treatment was generally well tolerated. Common side effects including flu-like symptoms, fatigue or increased liver enzymes were dose-dependent and led to discontinuation of IFN in only one patient. CONCLUSION: The data demonstrate IFN alpha to be an effective and well-tolerated therapy for chronic refractory uveitic CMO.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Antiviral Agents/*therapeutic use; Treatment Outcome; Drug Administration Schedule; Chronic Disease; Tomography, Optical Coherence; Visual Acuity/physiology; Uveitis/*complications; Macular Edema/*drug therapy; Interferon-alpha/*therapeutic use

Clinical Characteristics of Primary Vitreoretinal Lymphoma in an Indian Population. - Mahajan, Sarakshi; Nijhawan, Raje; Rajwanshi, Aravind; Karkhur, Samendra; Mulkutar, Samyak; Dogra, Mohit; Lal, Vivek; Gupta, Vishali; Gupta, Amod (Ocular immunology and inflammation, 2017)
PURPOSE: Primary vitreoretinal lymphomas (PVRL) pose a major diagnostic challenge, especially in the countries with a high prevalence of infectious variety of uveitis. The present study aims to report the clinical characteristics and diagnostic difficulties in patients with PVRL in an Indian Population. METHODS: Retrospective chart reviews of 12 patients with a diagnosis of PVRL. RESULTS: The study included 6 men and 6 women, with a mean age of 55.66 ± 8.76 years. All had bilateral disease. The clinical signs included anterior uveitis (12 eyes; 50.0%); vitritis (18 eyes; 75%); vitreous clumps (16 eyes; 66.6%); subretinal deposits (11 eyes; 45.8%); retinal vasculitis (6 eyes; 25%); and optic disc swelling (2 eyes; 8.3%). The most commonly mistaken diagnosis was intraocular tuberculosis. The intraocular lesions responded to multiple intravitreal methotrexate injections. CONCLUSIONS: PVRL in India was likely to be mistaken for an infectious variety of uveitis. A high index of suspicion and thorough clinical examination is necessary to make the diagnosis.
Keywords: Female; Humans; Male; Middle Aged; Retrospective Studies; Methotrexate/therapeutic use; India; Fluorescein Angiography; Immunosuppressive Agents/therapeutic use; uveitis; Visual Acuity/physiology; Intravitreal Injections; Vitrectomy; Eye Neoplasms/*diagnosis/drug therapy; Intraocular Lymphoma/*diagnosis/drug therapy; intravitreal methotrexate; Papilledema/diagnosis; primary CNS lymphoma; Primary vitreoretinal lymphoma; Retinal Neoplasms/*diagnosis/drug therapy; Retinal Vasculitis/diagnosis; subretinal deposits; Uveitis, Anterior/diagnosis; Vitreous Body/drug effects/*pathology

Intravitreal diclofenac for treatment of refractory uveitis-associated cystoid macular oedema: A before and after clinical study. - Kianersi, Farzan; Rezaeian-Ramsheh, Abdolreza; Pourazizi, Mohsen; Kianersi, Hamidreza (Acta ophthalmologica, 2018)
BACKGROUND: Cystoid macular oedema (CME) is one of the important complications of uveitis leading to irreversible blindness. Currently, there is no gold standard treatment for this condition. The aim of this study was to investigate the effects of single intravitreal diclofenac (IVD) injection on short-term outcome of refractory uveitis-associated CME. METHODS: This was a prospective clinical study on 16 consecutive patients (16 eyes) with refractory uveitis-associated CME. Intravitreal injection of 500 μg/0.1 ml of diclofenac sodium was given to the patients. The clinical outcomes considered were best-corrected visual acuity (BCVA) change and central macular thickness (CMT) changes in the pre- and postinjection periods. Follow-up examinations were performed at 1 and 4 weeks after the injection. RESULTS: Age of the patients varied from 18 to 59 years (mean ± SD: 39.5 ± 13.2 years). Ten patients (62.5%) were females. Statistically significant differences were found in the decrease of mean BCVA (logMAR) (p = 0.043) and mean CMT (p = 0.003) during the study period. There was no significant difference in the intraocular pressure (IOP) increase at the end of the study (p = 0.94). CONCLUSION: Intravitreal diclofenac (IVD) may be a promising treatment for refractory uveitis-associated CME. Further clinical trials with a larger sample size should be conducted to confirm these findings and compare them with other treatments.
Keywords: Humans; Middle Aged; Adult; Prospective Studies; Time Factors; Follow-Up Studies; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Adolescent; Fluorescein Angiography; Tomography, Optical Coherence; uveitis; *Visual Acuity; Fundus Oculi; Macular Edema/diagnosis/*drug therapy/etiology; Uveitis/*complications/diagnosis/drug therapy; Intravitreal Injections; Macula Lutea/*pathology; Cyclooxygenase Inhibitors/administration & dosage; cystoid macular oedema; diclofenac; Diclofenac/*administration & dosage

SUPRACHOROIDAL INJECTION OF TRIAMCINOLONE ACETONIDE, CLS-TA, FOR MACULAR EDEMA DUE TO NONINFECTIOUS UVEITIS: A Randomized, Phase 2 Study (DOGWOOD). - Yeh, Steven; Kurup, Shree K.; Wang, Robert C.; Foster, C. Stephen; Noronha, Glenn; Nguyen, Quan Dong; Do, Diana V. (Retina (Philadelphia, Pa.), 2019)
PURPOSE: Evaluate a single suprachoroidal injection of a proprietary triamcinolone acetonide suspension, CLS-TA, in subjects with macular edema due to noninfectious uveitis. METHODS: Randomized, controlled, masked Phase 2 study. Safety and efficacy of a single suprachoroidal injection of CLS-TA (4.0 and 0.8 mg in a 4:1 ratio) were assessed at 1 and 2 months after injection. The primary efficacy endpoint was change in central subfield thickness from baseline to Month 2, assessed by spectral domain optical coherence tomography. RESULTS: Twenty-two adults were enrolled. The primary endpoint was met in subjects who received suprachoroidal injection of CLS-TA 4.0 mg, mean central subfield thickness significantly decreased from baseline by 135 µm and 164 µm at Month 1 (P = 0.0056) and Month 2 (P = 0.0017), respectively. At Month 2, 69% of subjects who received 4.0 mg experienced ≥20% reduction in central subfield thickness, and 65% had improvement of best-corrected visual acuity of ≥5 Early Treatment Diabetic Retinopathy Study letters, with a mean improvement of 9.2 letters (P = 0.0004). Safety analyses supported acceptable safety/tolerability, with no corticosteroid-related increases in intraocular pressure. CONCLUSION: A single suprachoroidal injection of CLS-TA (4.0 mg; 0.1 mL) in subjects with macular edema due to noninfectious uveitis was well-tolerated, significantly reduced central subfield thickness from baseline at 2 months, and significantly improved visual acuity.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Glucocorticoids/administration & dosage; Injections; Visual Acuity; Choroid; Macular Edema/diagnosis/*drug therapy/etiology; Triamcinolone Acetonide/*administration & dosage; Uveitis/*complications/diagnosis/drug therapy; Tomography, Optical Coherence/*methods

Oral corticosteroid exposure and increased risk of related complications in patients with noninfectious intermediate, posterior, or panuveitis: Real-world data analysis. - Chirikov, Viktor V.; Shah, Ruchit; Kwon, Youngmin; Patel, Dipen (Ophthalmic epidemiology, 2019)
PURPOSE: This study causally examined the dose-response relationship between oral corticosteroids (OCS) exposure and long-term complications among noninfectious uveitis adult patients in the United States. METHODS: The study design was longitudinal, retrospective cohort using Truven Health MarketScan claims database years 2000-2015. The index date was the first day after diagnosis on which OCS≥ 5 mg prednisone equivalent was administered. The period following the index date was parsed into quarters for tracking OCS-related complications; follow-up time was censored when patients switched off of OCS monotherapy. Each quarter of follow-up was divided into 4 groups based on the mean cumulative daily OCS dose (< 7.5 mg; 7.5 to < 30 mg; 30 to < 60 mg; and ≥ 60 mg) and covariate balancing propensity scoring was used to balance groups on baseline characteristics in the first quarter post-index. Marginal structural models (MSMs) were employed to account for time-varying endogeneity between temporal changes in mean cumulative OCS dose and the risk of complications. Patients with systemic autoimmune conditions at baseline were excluded. RESULTS: The study sample included 3966 patients with a median follow-up of 2 years. Compared to those receiving < 7.5 mg, patients with higher mean cumulative OCS dose had 10%, 16%, and 28% higher risk, respectively, of any OCS-related complication in any given quarter. CONCLUSIONS: A moderate dose-response relationship was found between the long-term use of OCS monotherapy and the risk of developing complications in noninfectious intermediate, posterior, or panuveitis patients. Future research should examine optimal approaches to achieve inflammation control while minimizing OCS exposure.
Keywords: Female; Humans; Male; Middle Aged; Time Factors; Follow-Up Studies; Retrospective Studies; Risk Factors; Dose-Response Relationship, Drug; Administration, Oral; *Visual Acuity; *Uveitis; United States/epidemiology; *administrative claims; *immunosuppression; *marginal structural model; Data Analysis; Drug-Related Side Effects and Adverse Reactions/*epidemiology; Glucocorticoids/administration & dosage/adverse effects; Panuveitis/*drug therapy/epidemiology; Prednisone/administration & dosage/*adverse effects; Propensity Score; Uveitis, Intermediate/*drug therapy/epidemiology; Uveitis, Posterior/*drug therapy/epidemiology

Infliximab to treat chronic noninfectious uveitis in children: retrospective case series with long-term follow-up. - Ardoin, Stacy P.; Kredich, Deborah; Rabinovich, Egla; Schanberg, Laura E.; Jaffe, Glenn J. (American journal of ophthalmology, 2007)
PURPOSE: To assess a response to infliximab therapy in childhood uveitis. DESIGN: Retrospective case series. METHODS: We reviewed the course of 16 children with noninfectious uveitis treated with infliximab at an academic medical center. Outcome measures included incidence of uveitis recurrences, proportion of patients achieving zero or two-step decline in ocular inflammation, visual acuity, and proportion discontinuing topical glucocorticoids at zero, three, six, nine, and 12 months of therapy. RESULTS: Of sixteen children (29 affected eyes) with median age 11 years, six had associated extraocular inflammatory conditions. Fifteen of 16 were treated with concomitant methotrexate. Median follow-up was 26 months and median maintenance infliximab dose was 8.2 mg/kg. The median interval between infliximab infusions was 5.6 weeks. At one year, 64% achieved zero ocular inflammation, and 79% had zero inflammation or a two-step decline in inflammation. Topical glucocorticoids were discontinued in 69%, and 58% remained free of uveitis recurrence at one year. Visual acuity remained stable. Infliximab was discontinued in two children, one because of inefficacy and the other because of parental concern about potential side effects. No adverse events occurred. CONCLUSIONS: Sixteen children with chronic, noninfectious uveitis tolerated chronic methotrexate and infliximab therapy. Visual acuity remained stable, control of ocular inflammation improved, and reliance on topical glucocorticoids decreased. High infliximab doses and frequent dosing intervals were necessary to control uveitis.
Keywords: Female; Humans; Male; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Methotrexate/therapeutic use; Adolescent; Recurrence; Anti-Inflammatory Agents/*therapeutic use; Chronic Disease; Child; Child, Preschool; Antibodies, Monoclonal/*therapeutic use; Infliximab; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Visual Acuity; Uveitis/*drug therapy

The role of methotrexate in resolving ocular inflammation after specific therapy for presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis. - Sahin, Ozlem; Ziaei, Alireza (Retina (Philadelphia, Pa.), 2014)
PURPOSE: This study was designed to investigate whether the antiinflammatory and antiproliferative activity of oral and intravitreal methotrexate (MTX) suppresses intraocular inflammation in patients with presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis. METHODS: Interventional prospective study including three cases with presumed latent syphilitic uveitis treated with intravenous penicillin and oral MTX, and two cases with presumed tuberculosis-related uveitis treated with standard antituberculosis therapy and intravitreal MTX injections. Treatment efficacy of all cases was assessed by best-corrected visual acuity, fundus fluorescein angiography, and optical coherence tomography. RESULTS: Four eyes of 3 patients with presumed latent syphilitic uveitis had improved best-corrected visual acuity, suppression of intraocular inflammation, and resolution of cystoid macular edema in 6 months with oral MTX therapy. No recurrence of intraocular inflammation was observed in 6 months to 18 months of follow-up period after cessation of MTX. Two eyes of two patients with presumed tuberculosis-related uveitis showed improved best-corrected visual acuity, suppression of intraocular inflammation, and resolution of cystoid macular edema after intravitreal injections of MTX. No recurrence of intraocular inflammation was observed in 6 months to 8 months of follow-up period after cessation of antituberculous therapy. CONCLUSION: For the first time in the treatment of presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis, we believe that MTX might have an adjunctive role to suppress intraocular inflammation, reduce uveitic macular edema, and prevent the recurrences of the diseases.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged, 80 and over; Drug Therapy, Combination; Prospective Studies; Administration, Oral; Methotrexate/administration & dosage/*therapeutic use; Fluorescein Angiography; Tomography, Optical Coherence; Visual Acuity/physiology; Intravitreal Injections; Interferon-gamma Release Tests; Tuberculosis, Ocular/diagnosis/*drug therapy/microbiology; Syphilis Serodiagnosis; Immunosuppressive Agents/administration & dosage/*therapeutic use; Anti-Bacterial Agents/therapeutic use; Eye Infections, Bacterial/diagnosis/drug therapy/microbiology; Penicillins/therapeutic use; Syphilis, Latent/diagnosis/*drug therapy/microbiology; Uveitis/diagnosis/microbiology/*prevention & control

Twenty-Four Months Follow-Up of Intravitreal Bevacizumab Injection Versus Intravitreal Triamcinolone Acetonide Injection for the Management of Persistent Non-Infectious Uveitic Cystoid Macular Edema. - Lasave, Andrés F.; Schlaen, Ariel; Zeballos, David G.; Díaz-Llopis, Manuel; Couto, Cristóbal; El-Haig, Wael M.; Arevalo, J. Fernando (Ocular immunology and inflammation, 2019)
PURPOSE: To report the efficacy of intravitreal bevacizumab (IVB) injection versus intravitreal triamcinolone acetonide (IVT) for persistent non-infectious uveitic cystoid macular edema (CME). METHODS: Interventional retrospective comparative case series evaluated 37 consecutive patients (44 eyes) with completely controlled uveitis and recalcitrant CME. Patients received repeated injections of 1.25 mg of IVB or 4 mg of IVT. RESULTS: Best-corrected visual acuity (BCVA) at baseline and 24 months was logMAR 1 and 0.8 respectively, in the IVB group (p = 0.002) and; logMAR of 1.1 and 0.6, in the IVT group (p = 0.001). Central macular thickness at baseline and 24 months was 399.2 µm and 333.7 µm (p < 0.0009), respectively, for the IVB group and; 464.4 µm and 316.5 µm in the IVT group (p = 0.044). Postoperatively, IOP increased in the IVT group. CONCLUSIONS: Repeated injections with IVT improve BCVA as effectively as repeated injections with IVB in the long-term management of persistent uveitic CME.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; *Visual Acuity; Macular Edema/diagnosis/*drug therapy/etiology; Triamcinolone Acetonide/*administration & dosage; Uveitis/*complications/diagnosis/drug therapy; Intravitreal Injections; Macula Lutea/pathology; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Bevacizumab; Angiogenesis Inhibitors/administration & dosage; Bevacizumab/*administration & dosage; Intravitreal Injection; Triamcinolone Acetonide; Uveitic Cystoid Macular Edema

Long-term outcomes and prognostic factors for trabeculectomy with mitomycin C in eyes with uveitic glaucoma: a retrospective cohort study. - Iwao, Keiichiro; Inatani, Masaru; Seto, Takahiko; Takihara, Yuji; Ogata-Iwao, Minako; Okinami, Satoshi; Tanihara, Hidenobu (Journal of glaucoma, 2014)
PURPOSE: To elucidate the long-term outcomes and prognostic factors for trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG). METHODS: A retrospective, consecutive, comparative cohort study was conducted with 204 patients who underwent trabeculectomy with MMC between 1999 and 2008 at 2 Japanese clinical centers. The study group included 101 eyes with UG and 103 eyes with primary open-angle glaucoma (POAG). Surgical failure was defined as intraocular pressure levels of ≥21 mm Hg or an additional glaucoma surgery. Kaplan-Meier survival curves for surgical failure were compared between UG and POAG eyes, and prognostic factors for surgical failure of trabeculectomy in UG eyes were analyzed by the Cox proportional hazards model. Secondary outcome measures included comparisons of the frequency of additional cataract surgery and other surgical complications after trabeculectomy between UG and POAG eyes. RESULTS: The mean follow-up periods (±SD) were 34.7±37.9 and 37.7±34.7 months (median, 24.0 and 27.4 mo) for UG and POAG, respectively. The subtypes of uveitis were granulomatous uveitis (n=20) including sarcoidosis (n=12), Vogt-Koyanagi-Harada disease (n=5) and varicella zoster virus uveitis (n=3), Behçet disease (n=10), Posner-Schlossman syndrome (n=5), and other types of UG (n=12). Fifty-four eyes were diagnosed with idiopathic UG. The 3-year probabilities of success after trabeculectomy were 71.3% and 89.7% for UG and POAG, respectively (P=0.0171). A multivariable model showed that UG eyes with previous cataract surgery [relative risk (RR)=2.957, P=0.0344)] and granulomatous uveitis (RR=3.805, P=0.0106) were associated with surgical failure. UG eyes experienced more frequent cataract surgeries after trabeculectomy than POAG eyes: the 3-year probabilities of additional cataract surgery of 62.6% and 10.7% for UG and POAG, respectively (P<0.0001). There was no significant difference in the frequency of surgical complications such as bleb leakage, hypotensive maculopathy, severe anterior-chamber hemorrhage, and infectious endophthalmitis. CONCLUSIONS: Trabeculectomy with MMC was less effective in maintaining intraocular pressure reduction in UG eyes than in POAG eyes. The prognostic factors for surgical failure of trabeculectomy in UG eyes were previous cataract surgery and granulomatous uveitis. In addition, UG eyes after trabeculectomy more frequently required additional cataract surgery.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Treatment Failure; Follow-Up Studies; Retrospective Studies; Risk Factors; Combined Modality Therapy; Visual Acuity/physiology; Tonometry, Ocular; Intraocular Pressure; Postoperative Complications; *Trabeculectomy; Alkylating Agents/*administration & dosage; Mitomycin/*administration & dosage; Cataract Extraction; Glaucoma, Open-Angle/diagnosis/*surgery; Trabecular Meshwork/drug effects/*surgery; Uveitis/diagnosis/*surgery

Uveitis in Behçet disease: an analysis of 880 patients. - Tugal-Tutkun, Ilknur; Onal, Sumru; Altan-Yaycioglu, Rana; Huseyin Altunbas, Hasan; Urgancioglu, Meri (American journal of ophthalmology, 2004)
PURPOSE: We aimed to describe the demographic and clinical features, ocular manifestations, complications, visual prognosis, and treatment in a large population of Turkish patients with Behçet uveitis. We also aimed to compare visual prognosis between male and female sex and between patients who presented before and after 1990. DESIGN: Observational case series. METHODS: A retrospective study of 880 consecutive patients (1,567 eyes) with Behçet uveitis seen at the Uveitis Service, Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, from 1980 to 1998. All patients met the classification criteria of the International Study Group for Behçet's Disease. Information on the patient's sex, age at onset of uveitis, ocular features, ocular complications, visual acuity, and systemic treatment was collected. RESULTS: Five hundred ninety-nine patients (68%) were male and 281 (32%) were female. The mean age at onset of uveitis was 28.5 years in male and 30 years in female patients. Ocular involvement was bilateral in 78.1% and unilateral in 21.9% of the patients. Panuveitis was the most common form in both sexes. Fundus lesions as well as sight-threatening complications were more common in males. At the beginning of the follow-up, potential visual acuity was 0.1 or less in 30.9% of eyes in males and 24.2% of eyes in females. Kaplan-Meier survival analysis estimated the risks of losing useful vision (>0.1) at 5 and 10 years for males and females as 21% vs 10% and 30% vs 17%, respectively. Male patients who presented in the 1990s had a significantly lower risk of losing vision compared with male patients who presented in the 1980s. CONCLUSION: Behçet uveitis starts frequently around the end of the third decade and has a male predominance. The disease is more severe and the risk of losing useful vision is higher in males than in females. However, this risk has been significantly reduced in the 1990s.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Risk Factors; Adolescent; Combined Modality Therapy; Child; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity; Age Distribution; Sex Distribution; Behcet Syndrome/*complications/diagnosis/epidemiology/therapy; Ophthalmologic Surgical Procedures; Turkey/epidemiology; Uveitis/*complications/diagnosis/epidemiology/therapy; Vision Disorders/etiology

The multicenter uveitis steroid treatment trial: rationale, design, and baseline characteristics. - Kempen, John H.; Altaweel, Michael M.; Holbrook, Janet T.; Jabs, Douglas A.; Sugar, Elizabeth A. (American journal of ophthalmology, 2010)
PURPOSE: To describe the design and methods of the Multicenter Uveitis Steroid Treatment (MUST) trial and the baseline characteristics of enrolled patients. DESIGN: Baseline data from a 1:1 randomized, parallel treatment design clinical trial at 23 clinical centers comparing systemic corticosteroid therapy (and immunosuppression when indicated) with fluocinolone acetonide implant placement. METHODS: Eligible patients had active or recently active noninfectious intermediate uveitis, posterior uveitis, or panuveitis. The study design had 90% power (2-sided type I error rate, 0.05) to detect a 7.5-letter (1.5-line) difference between groups in the mean visual acuity change between baseline and 2 years. Secondary outcomes include ocular and systemic complications of therapy and quality of life. Baseline characteristics include demographic and clinical characteristics, quality of life, and reading center gradings of lens and fundus photographs, optical coherence tomography images, and fluorescein angiograms. RESULTS: Over 3 years, 255 patients were enrolled (481 eyes with uveitis). At baseline, 50% of eyes with uveitis had best-corrected visual acuity worse than 20/40 (16% worse than 20/200). Lens opacities (39% of gradeable phakic eyes), macular edema (36%), and epiretinal membrane (48%) were common. Mean health utility was 74.1. CONCLUSIONS: The MUST trial will compare fluocinolone acetonide implant versus systemic therapy for management of intermediate uveitis, posterior uveitis, and panuveitis. Patients with intermediate uveitis, posterior uveitis, or panuveitis enrolled in the trial had a high burden of reduced visual acuity, cataract, macular edema, and epiretinal membrane; overall quality of life was lower than expected based on visual acuity.
Keywords: Female; Humans; Male; Middle Aged; Adult; Treatment Outcome; Quality of Life; Administration, Oral; *Research Design; Fluorescein Angiography; Tomography, Optical Coherence; Immunosuppressive Agents/administration & dosage; Visual Acuity/physiology; Drug Implants; Uveitis/*drug therapy; Glucocorticoids/*administration & dosage; Sickness Impact Profile; Fluocinolone Acetonide/*administration & dosage

Fyodorov-Zuev keratoprosthesis implantation: long-term results in patients with multiple failed corneal grafts. - Ghaffariyeh, Alireza; Honarpisheh, Nazafarin; Karkhaneh, Akbar; Abudi, Reza; Moroz, Zinaida Ivanovna; Peyman, Alireza; Faramarzi, Abolhasan; Abasov, Fuad (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2011)
BACKGROUND: The long term results of the Fyodorov-Zuev keratoprosthesis are presented for ten patients with repeated graft failures. METHODS: The study took place at Dr Khodadoust Eye Hospital. The Fyodorov-Zuev keratoprosthesis was implanted in ten patients with repeated graft failures, including seven patients with old trachoma, two patients with chemical injury, and a patient with thermal injury. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. RESULTS: Preoperative best-uncorrected visual acuity (BUVA) ranged from counting fingers to light perception (median: light perception). The keratoprosthesis dramatically improved vision in most patients. Patients retained BUVA of 20/200-20/50 in 50%, 20/60-20/100 in 30%, 20/200 in 10% and 20/400 in 10%. Overall, 90% had 1 year postoperative vision of 20/200 or better. 70% of cases had BUVA of 20/200 or better at the last follow-up (average 52 months). Of ten keratoprosthesis implanted, three have been removed, and as a result, retention rate was 70% during average follow-up of 52 months .The most common postoperative complications were retroprosthetic membrane formation (40%), uveitis (20%), glaucoma (20%), tissue overgrowth (20%), early leakage (20%), late leakage (20%), aseptic necrosis (20%), retinal detachment (10%), endophthalmitis (10%), and granulation tissue growth (10%). CONCLUSIONS: Fyodorov-Zuev keratoprosthesis is an effective means of managing repeated corneal graft failure.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Treatment Failure; Treatment Outcome; Recurrence; Visual Acuity/physiology; Visual Fields/physiology; Corneal Diseases/*surgery; Reoperation; *Prosthesis Implantation; Postoperative Complications; *Corneal Transplantation; *Prostheses and Implants; Graft Rejection/etiology/*surgery

Choroiditis in a patient with multiple sclerosis. - Correnti, Anthony J.; Huang, John J. (Ocular immunology and inflammation, 2008)
PURPOSE: To describe choroiditis in multiple sclerosis (MS). DESIGN: Case report. METHODS: Clinical findings, fluorescein angiography, optical coherence tomography, and treatment are presented. A 50-year-old man with MS presented with vitritis and multiple choroidal lesions in the fovea and periphery in both eyes. Fluorescein angiography (FA) revealed early hyperfluorescence and late leakage of the lesions. Optical coherence tomography showed subretinal fluid in the right eye. One month post-treatment, visual acuity returned to the baseline with complete resolution of subretinal fluid and decreased leakage on FA. CONCLUSIONS: Choroiditis might be related to MS, but may also be a chance occurrence.
Keywords: Humans; Male; Middle Aged; Follow-Up Studies; Drug Administration Schedule; Administration, Oral; Prednisolone/administration & dosage; Fundus Oculi; Visual Acuity/drug effects; *Fluorescein Angiography; *Tomography, Optical Coherence; Choroiditis/*complications/*diagnosis/drug therapy/physiopathology; Multiple Sclerosis/*complications; Mycophenolic Acid/administration & dosage/analogs & derivatives

PROSPECTIVE EVALUATION OF A SUSTAINED-RELEASE DEXAMETHASONE INTRAVITREAL IMPLANT FOR CYSTOID MACULAR EDEMA IN QUIESCENT UVEITIS. - Khurana, Rahul N.; Bansal, Alok S.; Chang, Louis K.; Palmer, James D.; Wu, Chengqing; Wieland, Mark R. (Retina (Philadelphia, Pa.), 2017)
PURPOSE: To investigate dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc) in the treatment of uveitic cystoid macular edema that had persisted in the absence of intraocular inflammation. METHODS: In this prospective interventional case series, 10 patients with uveitic cystoid macular edema and quiescent uveitis were treated with dexamethasone intravitreal implant at baseline and evaluated monthly for one year. Patients were retreated whenever cystoid macular edema recurred. The primary outcome measure was best-corrected visual acuity (BCVA) at day 90. RESULTS: At day 90, mean improvement from baseline BCVA was 14.4 letters (P = 0.0003), 70% of patients had a ≥10 letter BCVA improvement, 50% of patients had a ≥15 letter BCVA improvement, and the mean decrease from baseline central subfield retinal thickness was 140 μm (P = 0.008). Improvements were maintained through day 360 with retreatment as needed. At day 360, mean improvement in BCVA was 16.5 letters (P = 0.006) and the mean decrease in central subfield retinal thickness was 158 μm (P = 0.002). One patient experienced intraocular pressure >25 mmHg (managed with topical medication). Two phakic patients (2/8; 25%) had worsening of lens opacity requiring cataract extraction. CONCLUSION: Dexamethasone intravitreal implant may be an effective treatment for patients with persistent cystoid macular edema in quiescent uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Visual Acuity; Drug Implants; Intravitreal Injections; Uveitis/*drug therapy; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Macular Edema/*drug therapy; Delayed-Action Preparations

Clinical Experience of Interferon Alfa-2a Treatment for Refractory Uveitis in Behçet's Disease. - Park, Ji-Youn; Chung, Yoo-Ri; Lee, Kihwang; Song, Ji Hun; Lee, Eun-So (Yonsei medical journal, 2015)
Behçet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behçet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behçet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients.
Keywords: Female; Humans; Male; Adult; Treatment Outcome; Recurrence; Remission Induction; Chronic Disease; Cyclosporine/therapeutic use; Immunosuppressive Agents/administration & dosage; uveitis; Visual Acuity; Uveitis/diagnosis/*drug therapy/etiology; Interferon alpha-2; Interferon-alpha/*therapeutic use; Behcet Syndrome/complications/diagnosis/*drug therapy; Behçet's disease; interferon alfa-2a; Recombinant Proteins/therapeutic use; Turkey

Multicenter study of infliximab for refractory uveoretinitis in Behçet disease. - Okada, Annabelle A.; Goto, Hiroshi; Ohno, Shigeaki; Mochizuki, Manabu (Archives of ophthalmology (Chicago, Ill. : 1960), 2012)
OBJECTIVE: To describe the effects of infliximab on refractory uveoretinitis in patients with Behçet disease during the first year of treatment. METHODS: Data were collected prospectively at 8 tertiary uveitis centers. Safety was analyzed in 63 patients. Efficacy was analyzed in 50 patients, after exclusion of those who had received infliximab for various reasons before the study. RESULTS: Eighty-nine percent (56 of 63) of the patients were male, with 70% (44 of 63) of the patients aged 25 to 44 years. The safety analysis demonstrated that 34 episodes of adverse effects occurred in 46% (29 of 63) of patients during 1 year, including 3 episodes of infusion reactions. No adverse effects were deemed serious. The efficacy analysis at 1 year showed that uveoretinitis had improved in 69% (33 of 48), had improved somewhat in 23% (11 of 48), was unchanged in 8% (4 of 48), and had worsened in no patients. The mean number of ocular attacks per 6-month period decreased from 2.66 at baseline to 0.44 during months 1 through 6 of infliximab therapy and to 0.79 during months 7 through 12. Forty-four percent (21 of 48) of patients had no ocular attacks during the 1-year period. Efficacy was best for patients with uveoretinitis duration of less than 5 years. The mean best-corrected visual acuity improved logarithm of the minimum angle of resolution from 0.736 at the first infliximab infusion to 0.616 at the end of 1 year (P = .01). CONCLUSIONS: Infliximab treatment for Behçet disease uveoretinitis was well tolerated, with nonserious adverse effects occurring in about half of the patients. At the end of 1 year, uveoretinitis had improved or improved somewhat in 92% (44 of 48) of patients, accompanied by improvement in the mean visual acuity.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Treatment Outcome; Young Adult; Adolescent; Infusions, Intravenous; Recurrence; Infliximab; Visual Acuity/physiology; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Uveitis/*drug therapy/etiology; Antibodies, Monoclonal/*administration & dosage/adverse effects; Behcet Syndrome/complications/*drug therapy; Retinitis/*drug therapy/etiology

Efficacy and safety of intravitreal bevacizumab compared with intravitreal and posterior sub-tenon triamcinolone acetonide for treatment of uveitic cystoid macular edema. - Bae, Jeong Hun; Lee, Christopher Seungkyu; Lee, Sung Chul (Retina (Philadelphia, Pa.), 2011)
PURPOSE: To demonstrate the effect of bevacizumab compared with triamcinolone acetonide for the treatment of persistent cystoid macular edema in noninfectious uveitis. METHODS: The medical records of 31 eyes of 31 patients with uveitic cystoid macular edema that had persisted despite conventional treatment were reviewed. Ten eyes received 1.25 mg of intravitreal bevacizumab (IVB), 11 eyes received 4 mg of intravitreal triamcinolone acetonide (IVTA), and 10 eyes received 40 mg of posterior sub-Tenon triamcinolone acetonide (PSTA). Changes in visual acuity with a logarithmic minimal angle of resolution and central foveal thickness measured with optical coherence tomography were analyzed. RESULTS: The mean follow-up was 22.3 weeks. The best improvement in visual acuity and reduction in central foveal thickness was achieved at 4 weeks in all groups but worsened with time until 12 weeks (visual acuity improved from baseline by 0.19, 0.27, and 0.16 and central foveal thickness decreased from baseline by 167.4 mm, 327.6 mm, and 166.4 mm with IVB,IVTA, and PSTA, respectively; P , 0.001). The results with IVTA were better than those with IVB or PSTA, although the difference did not reach statistical significance. Intravitreal bevacizumab provided a significantly better effect in visual acuity gain in Behcet uveitis than in non-Behcet uveitis (P = 0.045). Kaplan–Meier survival analysis showed that the median period of effect were 16 weeks with IVB, 30 weeks with IVTA, and 12 weeks with PSTA.An increase in intraocular pressure (.5 mmHg greater than baseline) was observed in 1 eye(10%) with IVB, 5 eyes (45.5%) with IVTA, and 4 eyes (40%) with PSTA. CONCLUSION: Intravitreal bevacizumab was a well-tolerated and effective supplementary therapy for persistent uveitic cystoid macular edema, especially in Behcet uveitis and for patients with the risk of an increase in intraocular pressure. However, reinjection may be required because of the limited potency and duration of the positive effects of IVB.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Tomography, Optical Coherence; Injections, Intraocular; Vitreous Body; Visual Acuity/drug effects; Glucocorticoids/*administration & dosage/adverse effects; Intraocular Pressure/drug effects; Antibodies, Monoclonal, Humanized; Bevacizumab; Triamcinolone Acetonide/*administration & dosage/adverse effects; Antibodies, Monoclonal/*administration & dosage/adverse effects; Behcet Syndrome/complications; Fovea Centralis/drug effects/pathology; Macular Edema/*complications/*drug therapy/pathology; Tenon Capsule; Uveitis/*complications/etiology

Long-term effects of tocilizumab therapy for refractory uveitis-related macular edema. - Mesquida, Marina; Molins, Blanca; Llorenç, Victor; Sainz de la Maza, Maite; Adán, Alfredo (Ophthalmology, 2014)
OBJECTIVE: To report the long-term efficacy and safety of the interleukin-6 receptor antagonist tocilizumab for refractory uveitis-related macular edema (ME). DESIGN: Retrospective cohort study. PARTICIPANTS: Eyes with uveitis seen at a single tertiary referral center for which ME was the principal cause of reduced visual acuity. METHODS: Data were obtained by standardized chart review. MAIN OUTCOME MEASURES: Central foveal thickness (CFT) measured by optical coherence tomography, degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), and visual acuity (logarithm of the minimum angle of resolution [logMAR]) were recorded during tocilizumab therapy at months 1, 3, 6, and 12. RESULTS: Eleven eyes from 7 patients (all women) were included. Mean age was 43.4 years. Mean duration of ME was 14.2 years. Mean follow-up with tocilizumab therapy was 15.2 months (range, 12-18 months). Before tocilizumab therapy, conventional immunosuppressive therapy and 1 or more biologic agents failed in all patients. Uveitis diagnoses were birdshot chorioretinopathy (n = 3), juvenile idiopathic arthritis-associated uveitis (n = 3), and idiopathic panuveitis (n = 1). Mean CFT was 550 ± 226 μm at baseline, 389 ± 112 μm at month 1 (P = 0.007), 317 ± 88 μm at month 3 (P = 0.01), 292 ± 79 μm at month 6 (P = 0.006), and 274 ± 56 μm at month 12 of follow-up (P = 0.002). Mean logMAR best-corrected visual acuity improved from 0.67 ± 0.53 at baseline to 0.4 ± 0.56 at month 12 (P = 0.008). Tocilizumab therapy was withdrawn in 2 patients because of sustained remission at month 12. In both patients, ME relapsed 3 months after tocilizumab withdrawal. Reinitiation of tocilizumab therapy led to good uveitis control and ME resolution. Tocilizumab generally was well tolerated and no serious adverse events were reported. CONCLUSIONS: In this study, tocilizumab was effective in the treatment of refractory inflammatory ME. No serious adverse events were observed.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Young Adult; Anti-Inflammatory Agents/*therapeutic use; Injections, Intravenous; Antibodies, Monoclonal, Humanized/*therapeutic use; Tomography, Optical Coherence; Visual Acuity/physiology; Uveitis/complications/*drug therapy; Fovea Centralis/pathology; Macular Edema/*drug therapy/etiology/physiopathology

Treatment of noninfectious intermediate and posterior uveitis with the humanized anti-Tac mAb: a phase I/II clinical trial. - Nussenblatt, R. B.; Fortin, E.; Schiffman, R.; Rizzo, L.; Smith, J.; Van Veldhuisen, P.; Sran, P.; Yaffe, A.; Goldman, C. K.; Waldmann, T. A.; Whitcup, S. M. (Proceedings of the National Academy of Sciences of the United States of America, 1999)
To evaluate the safety and potential therapeutic activity of humanized anti-IL-2 receptor mAb (Daclizumab) therapy in the treatment of patients with severe, sight-threatening, intermediate and posterior noninfectious uveitis, a nonrandomized, open-label, pilot study was performed. Patients with uveitis were treated with a minimum of 20 mg of prednisone, cyclosporine, antimetabolites, or any combination of these agents were eligible. Patients were weaned off their systemic immunosuppressive agents according to a standardized schedule, while ultimately receiving Daclizumab infusions every 4 weeks. Anti-IL-2 receptor antibody therapy, given intravenously with intervals of up to 4 weeks in lieu of standard immunosuppressive therapy, appeared to prevent the expression of severe sight-threatening intraocular inflammatory disease in 8 of 10 patients treated over a 12-month period, with noted improvements in visual acuity. One patient met a primary endpoint with a loss of vision of 10 letters or more from baseline in one eye and another patient discontinued therapy because of evidence of increased ocular inflammation. All patients were able to tolerate the study medications without the need for dose reduction. We report effective long-term use of anti-IL-2 therapy for an autoimmune indication. These initial findings would suggest that anti-IL-2 receptor therapy may be an effective therapeutic approach for uveitis and, by implication, other disorders with a predominant Th1 profile.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Drug Therapy, Combination; Treatment Outcome; Infusions, Intravenous; Prednisone/administration & dosage; Antibodies, Monoclonal, Humanized; Immunosuppressive Agents/*administration & dosage; Cyclosporine/administration & dosage; Antibodies, Monoclonal/*administration & dosage; Daclizumab; Immunoglobulin G/*administration & dosage; Immunotherapy; Th1 Cells/immunology; Uveitis/*drug therapy/immunology

Visual outcomes of pars plana vitrectomy with epiretinal membrane peel in patients with uveitis. - Tanawade, Rajeev G.; Tsierkezou, Loukia; Bindra, Mandeep S.; Patton, Niall A.; Jones, Nicholas P. (Retina (Philadelphia, Pa.), 2015)
PURPOSE: To report the outcomes of pars plana vitrectomy with epiretinal membrane (ERM) peel, with or without internal limiting membrane peel, in patients with uveitis. METHODS: Retrospective interventional case series of patients undergoing pars plana vitrectomy with ERM peel between January 2005 and March 2012. Sixteen consecutive patients (16 eyes) were identified, with a minimum postoperative follow-up of 6 months. Visual acuity, anatomical outcomes, perioperative control of inflammation, and complications were assessed. RESULTS: The mean age at surgery was 47.3 years (range, 14-68 years), with a mean duration of ERM at surgery of 21.3 months (3-84 months). At 6 months, visual acuity improved in 31.25% of eyes, stabilized in 31.25%, and was worse in 37.5%. The causes of reduced visual acuity postoperatively included severe preexisting macular pathology and unoperated cataract. CONCLUSION: Pars plana vitrectomy with ERM peel in eyes with uveitis may improve or stabilize visual acuity, especially in eyes with macular traction, but in the absence of traction, outcomes are variable and unpredictable. Prevention of ERM formation by aggressive control of inflammation is important.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Young Adult; Adolescent; Prednisolone/therapeutic use; Tomography, Optical Coherence; Azathioprine/therapeutic use; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/*physiology; *Vitrectomy; Mycophenolic Acid/analogs & derivatives/therapeutic use; Endotamponade; Epiretinal Membrane/complications/physiopathology/*surgery; Uveitis/etiology/physiopathology/*surgery

Mycophenolate sodium for immunosuppressive treatment in uveitis. - Deuter, Christoph M. E.; Doycheva, Deshka; Stuebiger, Nicole; Zierhut, Manfred (Ocular immunology and inflammation, 2009)
PURPOSE: To assess the efficacy and tolerability of mycophenolate sodium (MPS) in patients with uveitis. METHODS: Retrospective analysis including uveitis patients treated with MPS (Myfortic) for at least 3 months duration. MPS was administered in a dose of 720 mg twice daily. RESULTS: We analyzed 35 patients (65 affected eyes) with anterior (n = 5), intermediate (n = 23), posterior (n = 6), and panuveitis (n = 1). Previous treatment consisted of systemic corticosteroids in all patients and at least one immunomodulating agent in 15 patients. Mean duration of MPS therapy was calculated as 9.6 months (3-31 months). MPS was able to control intraocular inflammation without relapse in 30 patients (85.7%). Stabilization or improvement of visual acuity was achieved in 60 eyes (92.3%). Tolerability of MPS was good or moderate in 34 patients (97.1%). CONCLUSIONS: MPS was demonstrated as an effective and well-tolerated immunosuppressive drug for different forms of uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Treatment Failure; Retrospective Studies; Treatment Outcome; Young Adult; Drug Administration Schedule; Adolescent; Visual Acuity/drug effects; Uveitis/*drug therapy/physiopathology; Retreatment; Adrenal Cortex Hormones/therapeutic use; Immunosuppressive Agents/*administration & dosage/adverse effects; Immunologic Factors/therapeutic use; Mycophenolic Acid/*administration & dosage/adverse effects

Trabeculectomy with antiproliferative agents in uveitic glaucoma. - Ceballos, Elizenda M.; Beck, Allen D.; Lynn, Michael J. (Journal of glaucoma, 2002)
PURPOSE: To evaluate the outcome of trabeculectomy with antiproliferative agents in patients with uveitic glaucoma METHODS: A retrospective chart review of 44 eyes of 44 patients with uveitic glaucoma who underwent trabeculectomy with mitomycin C or 5-fluorouracil. The authors defined complete success as an intraocular pressure of 21 mm Hg or lower without pressure-lowering medications, qualified success as an intraocular pressure of 21 mm Hg or lower with medications, and failure as an intraocular pressure of more than 21 mm Hg with medications, loss of light perception, or the need for reoperation. RESULTS: The cumulative probability of complete or qualified success was 78% at 1 year and 62% at 2 years. At 2 years, success rates were 39% in males and 71% in females (P = 0.02), 74% in white patients and 55% in black patients (P = 0.58), and 45% in patients with idiopathic uveitis and 74% in patients with sarcoid uveitis (P = 0.17). Sixteen of 31 (51.6%) phakic patients developed new cataracts or had progression of existing cataracts and required cataract extraction. Four of 16 eyes (25%) lost intraocular pressure control and needed repeat trabeculectomy after undergoing cataract surgery. CONCLUSIONS: Patients with uveitic glaucoma can have good outcomes after trabeculectomy with antiproliferative agents. Male gender was the only statistically significant risk factor for trabeculectomy failure. Cataract management in the presence of a filtering bleb poses a treatment dilemma between improvement of visual acuity and loss of intraocular pressure control.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Adolescent; Combined Modality Therapy; Child; Child, Preschool; Visual Acuity; Intraocular Pressure; Trabeculectomy/*methods; Antibiotics, Antineoplastic/therapeutic use; Antimetabolites, Antineoplastic/therapeutic use; Blacks; Fluorouracil/*therapeutic use; Glaucoma/ethnology/etiology/*therapy; Mitomycin/*therapeutic use; Uveitis/complications/ethnology/*therapy; Whites

Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two-centre, prospective, randomized trial. - Mora, Paolo; Gonzales, Stefania; Ghirardini, Stella; Rubino, Pierangela; Orsoni, Jelka G.; Gandolfi, Stefano A.; Majo, Francois; Guex-Crosier, Yan (Acta ophthalmologica, 2016)
PURPOSE: To compare the postoperative risk of inflammatory relapse in two groups of uveitic patients who underwent cataract surgery: one group had perioperative topical steroids alone and the other used topical and oral steroids. METHODS: Prospective, randomized, unmasked, duocentric clinical trial conducted at the University of Parma (Italy), and the Jules Gonin Eye Hospital of Lausanne (Switzerland). Patients with a history of non-infectious uveitis requiring cataract surgery in 2009-2013 were assigned to two groups of perioperative prophylaxis: (A) intensive topical steroids alone; (B) the same topical regimen combined with oral steroids. Uveitis relapse over a period of 6 months was assessed. RESULTS: In total, 52 eyes in 50 patients were randomized: 28 eyes were assigned to group A (topical) and 24 eyes to group B (topical + oral). Mean relapse-free survival time was 131 ± 11 days in group A and 150 ± 13 days in group B. This difference was not statistically significant (p = 0.42). At the end of follow-up, the groups were also comparable in terms of significant improvement in visual acuity (p < 0.01), mean central macular thickness (CMT) and IOP variation. CONCLUSIONS: Absolute and long-lasting control of ocular, and possibly systemic, inflammation predisposes uveitis patients to satisfactory results after cataract extraction and intraocular lens implantation. Despite a lower rate of recurrences following oral steroid supplementation, the efficacy of an intensive perioperative topical steroid regimen alone in preventing postoperative uveitis relapse was statistically comparable. Secondary outcomes were also comparable between the two groups. Transient IOP elevation should be expected until treatment discontinuation.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Prospective Studies; Follow-Up Studies; Administration, Oral; Recurrence; uveitis; Ophthalmic Solutions; Visual Acuity/physiology; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Retina/pathology; Administration, Topical; *Phacoemulsification; *Lens Implantation, Intraocular; cataract surgery; Perioperative Care; prophylaxis; recurrence; Uveitis/*prevention & control

Treating uveitis-associated hypotony with pars plana vitrectomy and silicone oil injection. - Kapur, Rashmi; Birnbaum, Andrea D.; Goldstein, Debra A.; Tessler, Howard H.; Shapiro, Michael J.; Ulanski, Lawrence J.; Blair, Michael P. (Retina (Philadelphia, Pa.), 2010)
PURPOSE: The purpose of this study was to determine the effect on intraocular pressure (IOP) and visual acuity of treating uveitis-related hypotony in patients with vitrectomy and intravitreal silicone oil injection. METHODS: Patients who underwent pars plana vitrectomy and silicone oil injection for uveitis-associated hypotony treatment were identified retrospectively. The primary outcome was maintaining an IOP of > or =5 mmHg. Visual acuity improvement was defined as an increase in > or =2 lines of acuity. RESULTS: Twelve eyes of 10 patients were identified. Median preoperative IOP was 2 mmHg (range: 0-7 mmHg). Two of 12 eyes had an IOP of > or =5 mmHg at presentation. The number of eyes with an IOP of > or =5 mmHg was 7 of 12 eyes (58%) at 1 month, 4 of 12 eyes (33%) at 3 months, 6 of 12 eyes (50%) at 6 months, and 3 of 9 eyes (33%) at 1 year. Five of 12 eyes (42%) were reinjected between 1 and 3 times with silicone oil for recurring hypotony. Median presenting Snellen visual acuity was counting fingers (range: 20/125 to light perception). Seven of 9 eyes (78%) maintained their preoperative vision at 1 year. CONCLUSION: Intraocular pressure elevated modestly in most patients in this series. However, results were often transient, and some eyes required repeated silicone oil injections. Although silicone oil is reasonable to consider for the treatment and maintenance of IOP in patients with ocular hypotony secondary to uveitis, better treatments are needed.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Adolescent; Combined Modality Therapy; Recurrence; Child; Injections; Visual Acuity/physiology; Intraocular Pressure/physiology; Retreatment; *Vitrectomy; Ocular Hypotension/etiology/physiopathology/*therapy; Silicone Oils/*administration & dosage; Uveitis/complications/physiopathology/*therapy

Role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis. - Bansal, Reema; Gupta, Amod; Gupta, Vishali; Dogra, Mangat Ram; Bambery, Pradeep; Arora, Sunil Kumar (American journal of ophthalmology, 2008)
PURPOSE: To assess the role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis (TB). DESIGN: Retrospective, interventional case series. METHODS: A total of 360 patients from uveitis clinic with following inclusion criteria were studied: 1) complete clinical records of visual acuity, slit-lamp biomicroscopic examination, intraocular pressure, complications if any, and treatment records at the baseline and at all follow-up visits; 2) a documented positive tuberculin skin test (10 mm of induration or more) at 48 to 72 hours; 3) evidence of active uveitis, i.e., cellular reaction in the anterior chamber with or without keratic precipitates, and/or active vitreous inflammation, retinal vasculitis, choroiditis, or neuroretinitis; 4) all known causes of infectious uveitis except TB and known noninfectious uveitic syndromes ruled out; and 5) a minimum one year of follow-up from the initiation of treatment. Of these, 216 patients (Group A) received four-drug anti-tubercular therapy and corticosteroids, and 144 patients (Group B) received corticosteroids alone. The main outcome measure was recurrence of inflammation after minimum six months of initiating treatment in each group. RESULTS: Recurrences reduced significantly (P < .001) in Group A (15.74%) as compared to Group B (46.53%) over a median follow-up of 24 and 31 months, respectively. The patients treated with anti-tubercular therapy with corticosteroids had decreased risk of developing recurrence of uveitis by approximately two-thirds as compared to those treated with corticosteroids alone. CONCLUSION: Addition of anti-tubercular therapy to corticosteroids in uveitis patients with latent/manifest TB led to significant reduction in recurrences of uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Kaplan-Meier Estimate; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Proportional Hazards Models; Adrenal Cortex Hormones/*therapeutic use; Antitubercular Agents/*therapeutic use; Secondary Prevention; Tuberculosis, Ocular/*drug therapy/*physiopathology; Uveitis/*microbiology

Subretinal neovascular membranes complicating uveitis: frequency, treatments, and visual outcome. - Perentes, Yannis; Van Tran, T.; Sickenberg, Michel; Herbort, Carl P. (Ocular immunology and inflammation, 2005)
PURPOSE: Retrospective evaluation in a uveitic population of subretinal neovascular membranes (SRNMs), their occurrence, visual impact, and outcome in differently treated subgroups of patients. METHODS: Medical records of patients were reviewed and cases with SRNM (n = 12) identified. Intraocular inflammation was classified according to vitreous examination records as high (2+ cells), low (1/2+ to 1+ cells), or inactive (0 cells). Visual outcome was considered to be +VA (same or gain of one or more Snellen lines) or -VA (loss of Snellen lines). In nine cases, treatment consisted of the oral administration of high doses of corticosteroids (CST) for one month, tapered down in favorable situations (+VA or SRNM angiographic regression) or maintained at half the dose in unfavorable situations (-VA or SRNM angiographic progression) while additional laser therapies, including photodynamic therapy (PDT), transpupillary thermotherapy (TTT), or argon laser therapy (CLT)), were performed in some of the cases. The above treatment scheme was not applied in three cases (pre-PDT period; undiagnosed underlying uveitis treated without CST). RESULTS: Twelve out of 648 patients (1.9%) with uveitis developed SRNM. The mean visual impact was 4.5 Snellen lines and mean follow-up time was 19.5 months. Two patients with high intraocular inflammation had a favorable visual outcome with CST alone. Eight patients with low intraocular inflammation had a favorable visual outcome with CST alone in three cases, with additional laser therapy in four cases (PDT in 3 cases and TTT in 1 case), and exclusively with PDT in one case (undiagnosed uveitis). Two patients with no intraocular inflammation had unfavorable visual outcome with CST alone (no PDT/TTT available). CONCLUSION: SRNMs occurred as a rare complication of uveitis. Their visual outcome was relatively favorable. Although high doses of CST seem to be the first step in the management of SRNMs, alternative laser treatments should be considered early, especially in cases of absence or low intraocular inflammation.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Incidence; Disease Progression; Adolescent; Glucocorticoids/*therapeutic use; Fluorescein Angiography; Fundus Oculi; Uveitis/*complications/diagnosis; Retina/pathology; Laser Coagulation/*methods; *Visual Acuity/physiology; Hyperthermia, Induced/*methods; Photochemotherapy/*methods; Retinal Neovascularization/epidemiology/*etiology/therapy; Switzerland/epidemiology

Intravitreal triamcinolone for macular oedema: efficacy in relation to aetiology. - Sørensen, Torben Lykke; Haamann, Per; Villumsen, Jørgen; Larsen, Michael (Acta ophthalmologica Scandinavica, 2005)
PURPOSE: To evaluate the efficacy and safety of intravitreal triamcinolone in patients with macular oedema of varying aetiology. METHODS: Two milligrams of intravitreal triamcinolone acetonide was injected into 34 eyes with persistent macular oedema (17 eyes with macula oedema secondary to posterior uveitis, 13 eyes with diabetic retinopathy, and four with pseudophakic macular oedema). Best corrected visual acuity was determined and transfoveal optical coherence tomography performed after 1 week, 1 month, 3 months and 6 months. RESULTS: Treatment improved visual acuity and subjective visual quality, and reduced foveal thickness in eyes with posterior uveitis and eyes with macular oedema secondary to diabetic retinopathy. Eyes treated for pseudophakic cystoid macular oedema demonstrated no improvement. A total of 32% of patients experienced a significant post-injection increase in intraocular pressure. Endophthalmitis, rhegmatogenous retinal detachment and cataract were absent. CONCLUSION: Intravitreal triamcinolone appears to induce marked a improvement in macular oedema secondary to non-infectious uveitis and diabetic retinopathy.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Safety; Tomography, Optical Coherence; Glucocorticoids/administration & dosage/*therapeutic use; Injections; Visual Acuity; Intraocular Pressure; Vitreous Body; Macular Edema/*drug therapy/etiology; Diabetic Retinopathy/*complications; Uveitis, Posterior/*complications; Pseudophakia/*complications; Triamcinolone Acetonide/administration & dosage/*therapeutic use

Tuberculin skin testing in uveitis patients and treatment of presumed intraocular tuberculosis in Japan. - Morimura, Yoshihiro; Okada, Annabelle A.; Kawahara, Sumie; Miyamoto, Yuko; Kawai, Shin; Hirakata, Akito; Hida, Tetsuo (Ophthalmology, 2002)
PURPOSE: To evaluate the results of tuberculin skin testing in Japanese patients with intraocular inflammation and to assess the outcome of treatment for presumed intraocular tuberculosis in selected patients. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: One hundred twenty-six patients, newly referred to the Ocular Inflammation Service at the Kyorin Eye Center from April 1998 to August 2000, underwent systemic evaluation for the diagnosis and/or treatment of uveitis. METHODS: Tuberculin skin testing with purified protein derivative was performed as part of the systemic evaluation. The diagnosis of presumed intraocular tuberculosis was made when findings were consistent with possible intraocular tuberculosis, the tuberculin skin test was positive (induration more than 10 mm), and no other cause of uveitis was suggested by symptoms, signs, or ancillary testing. Using these criteria, 10 patients were given a diagnosis of presumed intraocular tuberculosis and treated with antituberculosis therapy consisting of isoniazid, with or without rifampicin. Some of these patients also received a tapered course of oral corticosteroids after the initiation of antituberculosis treatment. None of the patients had any signs or symptoms of acquired immunodeficiency syndrome. MAIN OUTCOME MEASURES: Visual acuity and ophthalmologic examination to assess degree of intraocular inflammation. RESULTS: Twenty-six of the 126 patients (20.6%) had a positive tuberculin skin test result. Ten of these 26 patients (38.5%) were treated for a diagnosis of presumed intraocular tuberculosis. Nine patients had no evidence of pulmonary tuberculosis, and one patient had presumed tuberculous hilar lymphadenitis. The predominant clinical finding was choroidal or optic disc nodule in three patients, retinal vasculitis in three patients, and choroiditis in four patients. Nine patients exhibited decreased intraocular inflammation with treatment. CONCLUSIONS: Roughly one fifth of the uveitis patients who underwent systemic evaluation had a positive tuberculin skin test result, and 9 of 10 selected skin test-positive patients with clinical findings consistent with intraocular tuberculosis had a favorable response to antituberculosis therapy. These results suggest that intraocular tuberculosis continues to be a major diagnostic consideration for uveitis patients in Japan.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Prospective Studies; Fluorescein Angiography; Glucocorticoids/therapeutic use; Fundus Oculi; Visual Acuity; Isoniazid/therapeutic use; Rifampin/therapeutic use; Japan/epidemiology; Antitubercular Agents/therapeutic use; Tuberculin Test/*methods; Tuberculosis, Ocular/*diagnosis/*drug therapy/etiology; Uveitis/*diagnosis/*drug therapy/epidemiology

Long-term effects of intravitreal infliximab for treatment of sight-threatening chronic noninfectious uveitis. - Farvardin, Mohsen; Afarid, Mehrdad; Shahrzad, Sahab (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2012)
PURPOSE: This study aimed to evaluate the safety and long-term effects of infliximab on chronic noninfectious uveitis with measuring best corrected visual acuity (BCVA) and central macular thickness (CMT). METHOD: Ten eyes of 7 patients were included in this prospective case series. All the patients had noninfectious anterior and posterior uveitis that was unresponsive to conventional treatments for 3 months. About 1.5 mg of infliximab in 0.15 cc was injected intravitreally and the patients were followed for 6 months. BCVA was measured by Snellen chart and grading of vitritis was measured according to binocular indirect ophthalmoscope score before injection, 4 weeks, 3 months, and 6 months after the injection. CMT was measured 1 day before injection and compared with the same factors 4 weeks and 6 months after the injection. RESULTS: Mean of LogMAR before injection was 1.37±0.43 that changed to 0.67±0.55 and 1.38±0.36 one month and 6 months after the injection, respectively. Mean CMT before injection was 673.2±338.39 that changed to 456.4±317.46 and 659.3±342.48, 4 weeks and 6 months after the injection, respectively. Mean vitreous haziness grade before injection, 4 weeks, 3 months, and 6 months after the injection was 2.7, 0.95, 2.3, and 2.6, respectively. CONCLUSIONS: Intravitreal Infliximab may be used in treatment of noninfectious uveitis. It probably improves the vision and decreases the macular edema but its effect is temporary and repeated injections may be needed to achieve the best therapeutic goal.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Time Factors; Follow-Up Studies; Treatment Outcome; Young Adult; Adolescent; Child; Infliximab; Intravitreal Injections; Ophthalmoscopy; Visual Acuity/drug effects; Macular Edema/*drug therapy; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/adverse effects/*therapeutic use; Antibodies, Monoclonal/administration & dosage/adverse effects/*therapeutic use; Uveitis/*drug therapy/pathology

Intraocular methotrexate can induce extended remission in some patients in noninfectious uveitis. - Taylor, Simon R. J.; Banker, Alay; Schlaen, Ariel; Couto, Cristobal; Matthe, Egbert; Joshi, Lavnish; Menezo, Victor; Nguyen, Ethan; Tomkins-Netzer, Oren; Bar, Asaf; Morarji, Jiten; McCluskey, Peter; et al. (Retina (Philadelphia, Pa.), 2013)
PURPOSE: To assess the outcomes of the intravitreal administration of methotrexate in uveitis. METHODS: Multicenter, retrospective interventional case series of patients with noninfectious uveitis. Thirty-eight eyes of 30 patients were enrolled, including a total of 54 intravitreal injections of methotrexate at a dose of 400 µg in 0.1 mL. The primary outcome measure was visual acuity. Secondary outcome measures included control of intraocular inflammation and cystoid macular edema, time to relapse, development of adverse events, and levels of systemic corticosteroid and immunosuppressive therapy. RESULTS: Methotrexate proved effective in controlling intraocular inflammation and improving vision in 30 of 38 eyes (79%). The side effect profile was good, with no reported serious ocular adverse events and only one patient having an intraocular pressure of >21 mmHg. Of the 30 eyes that responded to treatment, 8 relapsed, but 22 (73%) entered an extended period of remission, with the Kaplan-Meier estimate of median time to relapse for the whole group being 17 months. The eight eyes that relapsed were reinjected and all responded to treatment. One eye relapsed at 3 months, but 7 eyes again entered extended remission. Of the 14 patients on systemic therapy at the start of the study, 8 (57%) were able to significantly reduce this following intravitreal methotrexate injection. CONCLUSION: In patients with uveitis and uveitic cystoid macular edema, intravitreal MTX can effectively improve visual acuity and reduce cystoid macular edema and, in some patients, allows the reduction of immunosuppressive therapy. Some patients relapse at 3 to 4 months, but a large proportion (73%) enter an extended period of remission of up to 18 months. This larger study extends the results obtained from previous smaller studies suggesting the viability of intravitreal methotrexate as a treatment option in uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Methotrexate/*therapeutic use; Immunosuppressive Agents/*therapeutic use; Intravitreal Injections; Visual Acuity/drug effects; Uveitis/*drug therapy/physiopathology; Macular Edema/drug therapy/physiopathology

Safety and efficacy of infliximab therapy in active behcet's uveitis: an open-label trial. - Al-Rayes, H.; Al-Swailem, R.; Al-Balawi, M.; Al-Dohayan, N.; Al-Zaidi, S.; Tariq, M. (Rheumatology international, 2008)
In this open-label trial, ten male patients with active Behcet's uveitis were enrolled. Initially, two infliximab infusions (5 mg/kg) were given at weeks 0 and 2. The patients continued to receive conventional therapy on recurrence of severe uveitis (RSU) attack. The patients with further attack were regularly given infliximab infusions every 8 weeks. In cases of further RSU attacks, the infusion interval was reduced to 6 weeks. The total follow-up period was 3 years. The patients were monitored for RSU, visual acuity and adverse effects. Reduction in the doses of prednisolone was also monitored. After receiving two infliximab infusions at weeks 0 and 2, three patients remained attack-free and seven patients had another RSU attack between 8th and 47th week. These patients were regularly given infliximab at 8-week intervals. Five out of seven patients remained attack-free. In two patients who had further attack, infusion frequency was increased to 6 weeks. There was a remarkable improvement in visual acuity with no significant adverse reaction except mild respiratory tract infection (two patients), headache (one patient) and mild infusion reaction (one patient). Infliximab is a safe and effective drug for the management of Behcet's uveitis. Selection of optimal dose and frequency of infusion required standardization for individual patient.
Keywords: Humans; Male; Adult; Treatment Outcome; Drug Administration Schedule; Recurrence; Anti-Inflammatory Agents/*therapeutic use; Antibodies, Monoclonal/*therapeutic use; Infliximab; Diagnostic Techniques, Ophthalmological; Uveitis, Anterior/*drug therapy/physiopathology; Visual Acuity/drug effects/physiology; Behcet Syndrome/*drug therapy/physiopathology

Efficacy of Ozurdex implant in treatment of noninfectious intermediate uveitis. - Palla, Swetha; Biswas, Jyotirmay; Nagesha, Chokkahalli K. (Indian journal of ophthalmology, 2015)
AIMS: To report our experiences using Ozurdex, a biodegradable implant, containing 0.7 mg of dexamethasone in the treatment of noninfectious intermediate uveitis. SETTINGS AND DESIGN: Retrospective study design. METHODS: We conducted a retrospective study of medical records of patients with noninfectious intermediate uveitis having either cystoid macular edema (CME) or vitritis who were not responsive to standard treatment and subsequently received Ozurdex implant from March 2011 to April 2013. The outcomes measured were best-corrected visual acuity, central retinal thickness (CRT), and vitreous haze score. STATISTICAL ANALYSIS USED: Paired t-test was used to test the significance of difference between quantitative variables. A P < 0.05 is taken to denote significant relationship. RESULTS: Twenty eyes of 15 patients with mean age of 39.8 years who received Ozurdex implant were included in the study. The mean baseline visual acuity improved from 0. 666 logarithm of the minimum angle of resolution (logMAR) units to 0.479 logMAR units at 6 weeks after the implant. The mean CRT improved from 536.1 to 361.4 microns at 6 weeks postimplant both parameters were statistically significant. The ocular inflammation was controlled in almost all the patients. Cataract and raised intraocular pressure were documented complications. CONCLUSION: Ozurdex implant is a promising treatment option and efficient in controlling the inflammation and CME in cases of noninfectious intermediate uveitis not responding to standard treatment.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Adolescent; Child; Tomography, Optical Coherence; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Eye Diseases/diagnosis/drug therapy/physiopathology; Macular Edema/diagnosis/drug therapy/physiopathology; Uveitis, Intermediate/diagnosis/*drug therapy/physiopathology; Vitreous Body/drug effects/physiopathology

Outcome of intravitreal triamcinolone in uveitis. - Kok, Howesen; Lau, Chun; Maycock, Nicholas; McCluskey, Peter; Lightman, Susan (Ophthalmology, 2005)
PURPOSE: To report the short-term outcome of intravitreal triamcinolone acetate (TA) in the treatment of uveitic cystoid macular edema (CME). DESIGN: Retrospective noncomparative (nonrandomized, uncontrolled) interventional case series. PARTICIPANTS: Sixty-five eyes of 54 patients with uveitis-related CME inadequately responsive to treatment combinations of oral corticosteroid, periocular orbital floor corticosteroid injections, and second-line immunosuppressive agents. INTERVENTION: Intravitreal injection of 4 mg/0.1 ml of TA. MAIN OUTCOME MEASURES: Visual acuity (VA), intraocular pressure (IOP), levels of inflammation, and immunosuppressive therapy were assessed. Other potential complications, including cataract progression, vitreous hemorrhage, endophthalmitis, and retinal detachment (RD), were looked for. RESULTS: The mean follow-up was 8.0 months (range, 3-51), and the mean improvement of VA after intravitreal TA was 0.26 (from 0.65 to 0.39 logarithm of the minimum angle of resolution; Snellen, 6/24-6/12, approximately). This occurred at a mean of 4 weeks (range, 1-30). The improvement in VA was more significant if the duration of CME before intravitreal TA was < or =12 months (P = 0.006) and if patients were < or =60 years old (P = 0.005). Patients with the worst vision before treatment also improved the least. The most important side effect was raised IOP (mean rise, 10.3 mmHg), with 28 eyes (43.1%) experiencing an IOP rise of >10 mmHg. Patients younger than 40 years were more likely to experience this IOP rise than those older than 40. Thirty-three eyes (51%) were treated with antiglaucoma medications, with a mean duration of treatment of 17.4+/-13.3 weeks, and no patient required trabeculectomy or lost vision. The dosage of oral corticosteroids and/or second-line immunosuppressive medication was reduced or stopped altogether in 18 of 33 eyes (54.5%) during the study period. There were no cases of injection-related vitreous hemorrhage, endophthalmitis, or RD. CONCLUSIONS: In patients with uveitic CME, intravitreal TA can effectively reduce CME and improve VA and, in some eyes, allows the cessation and/or reduction of immunosuppressive therapy. The period of effectivity varies in different patients and, in some eyes, is limited. Treatment was associated in 43.1% with a rise in IOP, which was transient and treatable medically.
Keywords: Humans; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Glucocorticoids/administration & dosage/adverse effects/*therapeutic use; Adolescent; Chronic Disease; Prednisolone/administration & dosage; Injections; Vitreous Body; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Visual Acuity/drug effects/physiology; Cataract/physiopathology; Intraocular Pressure/drug effects/physiology; Triamcinolone Acetonide/administration & dosage/adverse effects/*therapeutic use; Vitreous Hemorrhage/physiopathology

Comparison of Surgical Outcome After Ahmed Valve Implantation for Patients With and Without Fluocinolone Intravitreal Implant (Retisert). - Hennein, Lauren; Hou, Jing; Stewart, Jay M.; Lowry, Eugene A.; Jiang, Zhengxuan; Enanoria, Wayne T. A.; Han, Ying (Journal of glaucoma, 2016)
PURPOSE: To determine whether long-term, slow-release exposure to corticosteroids with Retisert promotes better surgical outcomes after Ahmed valve implantation. PATIENTS: This comparative retrospective cohort study included 17 study eyes (10 patients) with uncontrolled uveitis requiring Retisert and Ahmed implantation, and 55 control eyes (51 patients) with other types of medically uncontrolled glaucoma that only received Ahmed. MATERIALS AND METHODS: Main outcome measures were intraocular pressure (IOP), glaucoma eye drops per day, best-corrected visual acuity, early complications, and late complications at 1, 3, 6, and 12 months. Linear mixed effects models were used to model IOP, glaucoma drops per day, and visual acuity at 1 year after surgery. RESULTS: At 1 year, the study eyes had a mean IOP of 12.24, which was lower than that for control eyes at 15.17 (P=0.04). At 1 year, the average number of glaucoma eye drops used per day for study eyes was 1.4, which was lower than that for control eyes at 2.3 (P=0.03). At 1 year, there were no statistically significant differences in change in visual acuity, early complications, and late complications between study and control eyes. CONCLUSIONS: Patients who received a Retisert implantation had lower IOP and used fewer glaucoma eye drops compared with control eyes at 1-year post-Ahmed valve surgery. This study suggests that long-term, slow-release corticosteroid medication from Retisert (fluocinolone acetonide) may improve the surgical outcome for patients with an Ahmed valve implantation and/or Retisert helps control uveitis in patients with uveitic glaucoma receiving Ahmed valves.
Keywords: Female; Humans; Male; Middle Aged; Adult; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Visual Acuity; Drug Implants; Fluocinolone Acetonide/administration & dosage/*analogs & derivatives; Intravitreal Injections; Intraocular Pressure/*physiology; Glaucoma Drainage Implants/*adverse effects; Glaucoma/*surgery; Postoperative Complications/etiology/*prevention & control; Uveitis/etiology/*prevention & control

Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis-Related Uveitic Glaucoma: A Retrospective Analysis. - Leinonen, Sanna; Kotaniemi, Kaisu; Kivelä, Tero; Majander, Anna (JAMA ophthalmology, 2015)
IMPORTANCE: The majority of patients with juvenile idiopathic arthritis-related uveitic glaucoma require surgery to control intraocular pressure. Trabeculectomy with mitomycin C (MMC) is a major treatment option, although both chronic inflammation and young age increase risk of filtration failure. Factors that potentially protect from filtration failure are important to identify. OBJECTIVE: To evaluate the potential effect of treatment with tumor necrosis factor (TNF) inhibitor on the success of an MMC-augmented trabeculectomy for patients with juvenile idiopathic arthritis-related uveitic glaucoma. DESIGN, SETTING, AND PARTICIPANTS: In a retrospective observational study with a median follow-up of 7.9 years at the Department of Ophthalmology, Helsinki University Hospital, in Helsinki, Finland, 29 eyes of 29 consecutive patients (3.1-20.4 years of age) underwent an MMC-augmented primary trabeculectomy during the period from April 1996 to January 2014. Fifteen patients were treated with systemic TNF inhibitors at the time of their trabeculectomy to control their uveitis, arthritis, or both. No changes were made to the antirheumatic therapy preoperatively. MAIN OUTCOMES AND MEASURES: Successful trabeculectomies, determined by Kaplan-Meier analysis, in which patients have intraocular pressure of 21 mm Hg or lower without antiglaucomatous medications or further glaucoma procedures. RESULTS: The success rate of trabeculectomy for patients who were treated with TNF inhibitors was 73% (95% CI, 44%-89%) at 1, 5, and 10 years after surgery, whereas the success rates of trabeculectomy for patients who were not treated with TNF inhibitors were 57%, 16%, and 0% at 1, 5, and 10 years after surgery, respectively (P = .01). The trabeculectomies of patients who were treated with TNF inhibitors were successful for a median of 3.2 years (95% CI, 0.3-9.9 years), whereas the trabeculectomies of patients who were not treated with TNF inhibitors were successful for a median of 1.2 years (95% CI, 0.6-3.6 years) (P = .14). Nine eyes of 9 patients had previously undergone cyclodestruction, intraocular surgery, or both (ie, prior ocular surgery). The effect of TNF was observed especially in the eyes of patients who had not undergone prior ocular surgery (at 5 years: 83% success rate for patients who had not undergone prior ocular surgery vs 19% success rate for patients who had). A difference in the overall success rate between patients who had and patients who had not had prior surgery was not identified. CONCLUSIONS AND RELEVANCE: Our retrospective data suggest that better control of intraocular pressure was achieved in the eyes of patients with juvenile idiopathic arthritis-related uveitis glaucoma who were treated with TNF inhibitors at the time of their MMC-augmented primary trabeculectomy. The retrospective design of the present study suggests that our data can be used for the planning of future studies but not for making treatment decisions.
Keywords: Female; Humans; Male; Retrospective Studies; Young Adult; Antirheumatic Agents/therapeutic use; Adolescent; Combined Modality Therapy; Anti-Inflammatory Agents/therapeutic use; Child; Child, Preschool; Visual Acuity/physiology; Intraocular Pressure/physiology; Tonometry, Ocular; Uveitis/*drug therapy/physiopathology; *Trabeculectomy; Alkylating Agents/*administration & dosage; Mitomycin/*administration & dosage; *Tumor Necrosis Factor Inhibitors; Arthritis, Juvenile/*drug therapy/physiopathology; Glaucoma, Open-Angle/drug therapy/physiopathology/surgery/*therapy

Scleral thinning after transcleral diode laser cycloablation. - Morales, Jose; Al-Shahwan, Sami; Al-Dawoud, Ahmed; Vila-Coro, Antonio Aguirre; Kumarasamy, Manjula (Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye, 2007)
BACKGROUND AND OBJECTIVE: To highlight the occurrence of scleral thinning after transcleral diode laser cycloablation therapy. PATIENTS AND METHODS: A retrospective chart review was done of consecutive patients from the glaucoma and pediatric ophthalmology clinics of a tertiary eye care center in whom the presence of scleral thinning was noted after transcleral diode laser cycloablation therapy. RESULTS: Eleven eyes of 9 patients with various types of glaucoma (traumatic, congenital, juvenile, steroid induced, uveitic, and secondary angle closure) were found to have scleral thinning after undergoing transcleral diode laser cycloablation therapy for refractory glaucoma. Seven patients had undergone only 1 session before new scleral thinning was noted. Two patients had bilateral transcleral diode laser cycloablation therapy and subsequent bilateral thinning. CONCLUSIONS: Scleral thinning may occur after diode laser cycloablation therapy even with only 1 treatment session and intact sclera, and young patients may be more susceptible to thinning.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Adolescent; Visual Acuity; Intraocular Pressure; Ciliary Body/*surgery; Glaucoma/*surgery; Laser Coagulation/*adverse effects; Sclera/*pathology; Scleral Diseases/*etiology

Clinical course of patients with Behçet's uveitis following discontinuation of infliximab therapy. - Kawaguchi, Tatsushi; Kawazoe, Yuko; Kamoi, Koju; Miyanaga, Masaru; Takase, Hiroshi; Sugita, Sunao; Mochizuki, Manabu (Japanese journal of ophthalmology, 2014)
PURPOSE: To investigate the clinical course of Behçet's uveitis patients following discontinuation of infliximab therapy. METHODS: This retrospective chart review study examined Behçet's disease patients who received infliximab treatment between 2000 and 2012. Medical records of patients whose infliximab treatment was discontinued were reviewed, with special focus on the frequency of uveitis attacks in the period before initiation, during treatment and after cessation of the infliximab therapy. Mean visual acuities were evaluated for each treatment period. RESULTS: Out of the 43 patients treated with infliximab at our uveitis clinic, ten were discontinued due to adverse events or inefficiency. Data for seven patients followed for more than 12 months before initiation and after cessation of infliximab were analyzed. Frequency of acute uveitis attacks was 7.43 per 12 months before initiation of infliximab, 2.86 during treatment and 0.57 after cessation. A statistically higher frequency of uveitis attacks was observed before initiation of infliximab compared to during (p < 0.05) and after cessation of treatment (p < 0.05). There was no statistical significance observed between the period during treatment and after cessation (p = 0.29). The mean logMAR was 0.79 at baseline, 0.68 during treatment, and 0.88 at 12 months after cessation. These differences were not statistically significant. CONCLUSIONS: A satisfactory clinical course with well-controlled ocular inflammation was found after discontinuation of infliximab therapy in Behçet's uveitis patients. These results suggest that a safe, pre-planned discontinuation of infliximab therapy can be performed in patients with Behçet's uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Infliximab; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage; Visual Acuity/physiology; *Withholding Treatment; Antibodies, Monoclonal/*administration & dosage; Behcet Syndrome/drug therapy/*physiopathology; Uveitis, Anterior/drug therapy/*physiopathology

Iluvien Implantation for Uveitis and Uveitic Macular Edema. - Reddy, Ashvini K.; Burkholder, Bryn M.; Khan, Irfan R.; Thorne, Jennifer E. (Ocular immunology and inflammation, 2018)
Keywords: Humans; Male; Adult; Tomography, Optical Coherence; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Vitreous Body/drug effects; Fluocinolone Acetonide/*administration & dosage; Macular Edema/diagnosis/*drug therapy/physiopathology

Intravitreal dexamethasone implant as an option for anti-inflammatory therapy of tuberculosis uveitis. - Hasanreisoglu, Murat; Gulpinar Ikiz, Gokcen; Aktas, Zeynep; Ozdek, Sengul (International ophthalmology, 2019)
INTRODUCTION: Tuberculosis-associated uveitis remains a diagnostic and therapeutic challenge. After diagnosis of tuberculosis and initiation of anti-tuberculosis therapy for tuberculosis uveitis, the clinical responses are favorable. However, at 4-6 weeks of the therapy, there commonly occurs paradoxical deterioration due to an increase in inflammation which is often accompanied by cystoid macular edema. Thus, adjuvant administration of anti-inflammatory regimen should be considered. For this purpose, systemic and periocular steroids, systemic and intravitreal immunosuppressive agents have been tested. Nevertheless, there is no report in the literature about intravitreal dexamethasone slow-release implants for the treatment of this inflammatory condition. METHODS: Case presentation. RESULTS: We presented a tuberculosis uveitis case whose ocular inflammation is partially modified by systemic and periocular steroid injections and then well controlled by the intravitreal dexamethasone implant. CONCLUSION: Intravitreal dexamethasone implant injection seems to be a safe and potent option for the treatment of macular edema secondary to tuberculosis uveitis.
Keywords: Female; Humans; Adult; Drug Therapy, Combination; Follow-Up Studies; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Visual Acuity; Uveitis; Drug Implants; Dexamethasone/*administration & dosage; Uveitis/diagnosis/*drug therapy; Infectious; Antitubercular Agents/*therapeutic use; Dexamethasone implant; Tuberculosis; Eye Infections, Bacterial/diagnosis/*drug therapy; Granuloma; Intravitreal; Jarisch–Herxheimer reaction; Posterior uveitis; Tuberculosis, Ocular/diagnosis/*drug therapy

A comparison between the fluocinolone acetonide (Retisert) and dexamethasone (Ozurdex) intravitreal implants in uveitis. - Arcinue, Cheryl A.; Cerón, Olga M.; Foster, C. Stephen (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2013)
PURPOSE: To evaluate the efficacy and safety of the fluocinolone acetonide (Retisert) implant compared with the dexamethasone (Ozurdex) implant in patients with noninfectious uveitis. DESIGN: Comparative case series. STUDY PARTICIPANTS: Twenty-seven eyes received either the fluocinolone acetonide (FA) (n=16) or dexamethasone (n=11) implant. METHODS: Chart review of patients at the Massachusetts Eye Research and Surgery Institution (MERSI) was done and patients were selected and matched according to age, sex, and type of uveitis. Eyes that received either the FA or dexamethasone implant, with follow-up ranging from 6 months to 2 years, were included. MAIN OUTCOME MEASURE: The recurrence rate of uveitis after implantation. RESULTS: There were no significant differences in the baseline demographic characteristics. The majority of cases were idiopathic panuveitis, with 36.4% and 31.3% of eyes in the Ozurdex and Retisert groups, respectively. Recurrence rates of uveitis were 1.7 and 0.5 per 100 person-months in the Retisert and Ozurdex groups, respectively, with Retisert-implanted eyes 3.16 times more at risk of recurrence; however, this difference was not statistically significant (P=0.41). No significant differences were seen in terms of improvement in inflammatory score and best-corrected visual acuity (BCVA). The median survival time for a second implant was 13 and 28 months for the Ozurdex and Retisert groups, respectively (P=0.0028). Eyes with the Ozurdex were 5 times more likely to receive a second implant (P=0.02). No eyes in the Ozurdex group needed additional glaucoma medications, surgery, or laser compared to 44% of eyes in the Retisert group. Eyes with the Retisert implant had a statistically higher rate of having more glaucoma medications, surgery, or laser (P=0.02). In the Ozurdex group, 50% of phakic eyes at baseline had cataract progression and subsequent surgery compared with 100% of Retisert phakic eyes. Eyes with the Retisert implant are 4.7 times more at risk of cataract progression (P=0.04). CONCLUSIONS: The dexamethasone (Ozurdex) implant seems comparable to the fluocinolone acetonide (Retisert) implant in preventing recurrence of noninfectious uveitis and in improving inflammation and BCVA. However, there were higher rates of cataract progression and need for glaucoma medications, laser, and surgery with the Retisert implant.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Disease Progression; Drug Implants; Intravitreal Injections; Anti-Inflammatory Agents/administration & dosage/adverse effects/*therapeutic use; Dexamethasone/administration & dosage/adverse effects/*therapeutic use; Visual Acuity/drug effects; Secondary Prevention; Uveitis/*drug therapy/pathology; Cataract/pathology; Fluocinolone Acetonide/administration & dosage/adverse effects/*therapeutic use; Glucocorticoids/administration & dosage/adverse effects/therapeutic use

Iris metastasis as the initial presentation of metastatic esophageal cancer diagnosed by fine needle aspiration biopsy: A case report. - Ozawa, Hiroko; Usui, Yoshihiko; Takano, Yoji; Horiuchi, Naoki; Kuribayashi, Tohru; Kurihara, Toshihide; Smith, Lois E. H.; Tsubota, Kazuo; Tomita, Yohei (Medicine, 2021)
RATIONALE: Metastasis of neoplasms to the eye is quite uncommon. In this case report, we describe a patient where primary esophageal cancer was diagnosed by fine needle aspiration biopsy (FNAB) of an iris tumor. PATIENT CONCERNS: A 70-year-old male complained of redness and discomfort in the right eye. DIAGNOSIS AND INTERVENTIONS: The patient's right eye was diagnosed as idiopathic uveitis, and a topical steroid was administered. As vitreous opacities were observed even after topical therapy, oral prednisolone was administered. On slit-lamp examination of the right eye, an iris mass with neovascularization was seen in the anterior chamber. A metastatic tumor was suspected, and FNAB was performed. Histology revealed squamous cell carcinoma. Systemic workup revealed esophageal cancer with several metastases. Best-corrected visual acuity decreased to 20/400, and intraocular pressure was 40 mmHg in the right eye. Two iris tumors with neovascularization were present extending into the anterior chamber with posterior iris synechiae and 360 degree peripheral anterior synechiae. Intraocular pressure in the right eye was medically managed with hypotensive eye drops and oral acetazolamide. Iris metastases were treated with 40 Gray of radiation therapy and concurrent chemotherapy. OUTCOMES: The tumor regressed, but intraocular pressure was refractory to treatment because of 360 degree goniosynechial closure. The right eye lost light perception six months after treatment commenced, and the patient died 9 months after the onset of therapy due to multiple systemic metastases. LESSONS: This is a rare case of masquerade syndrome without systemic symptoms in which FNAB of an iris tumor led to a diagnosis of metastatic esophageal squamous cell carcinoma. Although the patient lost his sight due to uncontrollable ocular hypertension, systemic chemotherapy, and radiation therapy were initially effective in the treatment of the metastatic iris tumor. As the prognosis of patients with metastatic iris tumors is poor, it is important for ophthalmologists to consider such diagnoses and conduct systemic investigations when necessary.
Keywords: Humans; Male; Aged; Administration, Oral; Visual Acuity; Intraocular Pressure/drug effects; Anterior Chamber/pathology; Acetazolamide/administration & dosage/therapeutic use; Biopsy, Fine-Needle/*methods; Carbonic Anhydrase Inhibitors/administration & dosage/therapeutic use; Carcinoma, Squamous Cell/diagnosis; Chemoradiotherapy/methods; Esophageal Neoplasms/*pathology; Fatal Outcome; Iris Neoplasms/diagnosis/*secondary/therapy; Iris/*pathology; Neoplasm Metastasis/pathology; Neovascularization, Pathologic/pathology; Ocular Hypertension/*drug therapy

Comparison of intravitreal injection of bevacizumab and triamcinolone acetonide in the treatment of uveitic macular edema. - Rahimi, Mansour; Shahrzad, Seyed Sahabaldin; Banifatemi, Mohammad (Iranian journal of immunology : IJI, 2012)
BACKGROUND: Cystoid Macular Edema (CME) is one of the most common and sight threatening complications of uveitis. Intravitreal injection of corticosteroids and Anti-VEGF are two routine options for treatment. OBJECTIVE: To compare the effects of intravitreal injections of Bevacizumab and Triamcinolone Acetonide for the treatment of persistent macular edema in non-infectious uveitis. METHODS: In a randomized clinical trial, sixty eyes of 55 patients were enrolled in the study. Patients were divided into two groups with randomized digits table. 29 eyes received 4 mg of intravitreal triamcinolone acetonide, and 31 eyes received 1.25 mg of intravitreal bevacizumab. Two main outcome measures were changes in visual acuity, measured with logarithm of minimal angle of resolution, and central macular thickness, measured with optical coherence tomography. RESULTS: The mean follow-up was 25.3 weeks. The best visual acuities were achieved 6 months after injection in both groups. Improvement in visual acuity at 6 months was achieved in 28/29 (96%) of eyes in Triamcinolone group and in 26/31 (83%) eyes in Bevacizumab group (p=0.196). None of the eyes showed worsening of visual acuity after 6 months. Mean of central macular thickness in the pre-injection time for intravitreal triamcinolone acetonide (IVTA) group was 295.62 μ, and 309.87 μ in intravitreal bevacizumab (IVB) group, which were decreased after six months to 199.27 μ and 221.06 μ, respectively (p<0.001). CONCLUSION: This study shows that IVT and IVB are both effective in improving vision in uveitic CME. Although effects of triamcinolone on Central Macular Thickness (CMT) are more apparent, this superiority is not seen on Best Corrected Visual Acuity (BCVA).
Keywords: Female; Humans; Male; Adult; Treatment Outcome; Young Adult; Adolescent; Immunotherapy/*methods; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Bevacizumab; Macular Edema/*drug therapy/immunology; Triamcinolone Acetonide/*administration & dosage/adverse effects; Angiogenesis Inhibitors/*administration & dosage/adverse effects; Antibodies, Monoclonal, Humanized/*administration & dosage/adverse effects; Uveitis/*drug therapy/immunology; Vascular Endothelial Growth Factor A/immunology; Vision, Ocular/drug effects

Multimodal Imaging of Post-Infectious Unilateral Outer Retinopathy and Choroiditis. - Kodati, Shilpa; Gangaputra, Sapna; Sen, H. Nida (Ocular immunology and inflammation, 2019)
Purpose: To describe with multimodal imaging a case of post-infectious unilateral outer retinopathy with choroiditis. Methods: Retrospective chart review of a case of a 67-year old male who presented following the onset of viral symptoms with an acute onset outer retinopathy, small vessel leakage on fluorescein angiography, and choroidal involvement evident on indocyanine green angiography and near infrared fundus autofluorescence (NIR-AF). Work up for infectious and autoimmune etiologies was negative. Results: Treatment with IV methylprednisolone followed by high dose oral prednisone resulted in improvement in visual acuity, outer retinal reconstitution and resolution of the choroidal changes. Conclusions: Despite this presentation sharing features with both acute zonal occult outer retinopathy (AZOOR) and multifocal choroiditis (MFC), the case is highly atypical of both entities.
Keywords: Humans; Male; Aged; Retrospective Studies; Infusions, Intravenous; Glucocorticoids/therapeutic use; Visual Acuity; Multimodal Imaging; Choroiditis; Coloring Agents/administration & dosage; Indocyanine Green/administration & dosage; retinal vasculitis; Methylprednisolone/therapeutic use; *Fluorescein Angiography; *Tomography, Optical Coherence; Capillary Permeability; Eye Infections, Viral/diagnosis/drug therapy/virology; multi-modal imaging; Multifocal Choroiditis/*diagnosis/drug therapy/virology; outer retinopathy; post-infectious; Scotoma/*diagnosis/drug therapy/virology; White Dot Syndromes/*diagnosis/drug therapy/virology

Comparison between intravitreal and orbital floor triamcinolone acetonide after phacoemulsification in patients with endogenous uveitis. - Roesel, Martin; Tappeiner, Christoph; Heinz, Carsten; Koch, Joerg M.; Heiligenhaus, Arnd (American journal of ophthalmology, 2009)
PURPOSE: To compare the effect of intravitreal and orbital floor triamcinolone acetonide (TA) on macular edema, visual outcome, and course of postoperative inflammation after cataract surgery in uveitis patients. DESIGN: Prospective, randomized clinical trial. METHODS: Monocenter study (40 patients) with chronic endogenous uveitis who underwent phacoemulsification with intraocular lens implantation with either 4 mg intravitreal TA (n = 20) or 40 mg orbital floor TA (n = 20). The primary outcome was influence on cystoid macular edema (CME). Secondary outcome measures were best-corrected visual acuity (BCVA), anterior chamber cell grade, laser flare photometry, giant cell deposition, posterior capsule opacification (PCO), and intraocular pressure. RESULTS: Mean central foveal thickness decreased in the intravitreal TA group and increased in the orbital floor TA group (P < .001 at one and three months). CME improved in 50% of patients after intravitreal TA, whereas it was unchanged after orbital floor TA (difference between the groups at three months, P = .049). Mean BCVA (logarithm of the minimal angle of resolution) improved postoperatively (P < .001) from 0.76 and 0.74 to 0.22 and 0.23 in the intravitreal TA and orbital floor TA group, respectively. Anterior chamber cell count at one month was lower in the intravitreal TA than in the orbital floor TA group (P = .02). Laser flare photometry values and giant cell numbers were slightly higher after orbital floor TA than after intravitreal TA. The groups did not differ with respect to PCO rate and ocular hypertension. CONCLUSIONS: The CME improvement and anti-inflammatory effect after intravitreal TA was better than after orbital floor TA injection in cataract surgery in uveitis patients.
Keywords: Female; Humans; Male; Middle Aged; Prospective Studies; Chronic Disease; Injections; Visual Acuity/physiology; Triamcinolone Acetonide/*administration & dosage; Vitreous Body; Postoperative Care; Anti-Inflammatory Agents/*administration & dosage; *Phacoemulsification; Macular Edema/*drug therapy/etiology/physiopathology; Uveitis/complications/*drug therapy/physiopathology; Drug Administration Routes; *Lens Implantation, Intraocular; Orbit; Pseudophakia/physiopathology

Infliximab therapy for the treatment of refractory ocular inflammatory disease. - Sobrin, Lucia; Kim, Eva C.; Christen, William; Papadaki, Thekla; Letko, Erik; Foster, C. Stephen (Archives of ophthalmology (Chicago, Ill. : 1960), 2007)
OBJECTIVE: To report the outcomes of infliximab therapy in the treatment of ocular inflammatory disease refractory to traditional immunomodulatory therapy (IMT). METHODS: We retrospectively reviewed the medical records of 27 patients. All patients had noninfectious ocular inflammatory disease refractory to traditional IMT and received 5 mg/kg of infliximab at 2-week to 8-week intervals. Main outcome measures were clinical response, reduction in concomitant IMT, and adverse effects. Cumulative incidences of inflammation control and vision change were calculated using life-table methods. RESULTS: Twenty-one patients experienced sustained improvement in inflammation with their initial course of infliximab therapy. Cumulative incidence of inflammation resolution at 12 months was greater than 90%. Sixteen patients were able to decrease the dose of their concomitant IMT medication or stop all other IMT. Four patients were able to discontinue all other IMT while receiving infliximab therapy. Three patients with scleritis were eventually able to remain inflammation-free while not taking any medication. At 12 months, 56% and 65% of left and right eyes, respectively, showed visual acuity improvement by 2 or more Snellen lines. Only 1 patient developed an adverse event requiring therapy discontinuation. CONCLUSIONS: We found a high rate of ocular inflammation control with infliximab therapy. The incidence of adverse effects in this study was low.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Time Factors; Retrospective Studies; Incidence; Adolescent; Infusions, Intravenous; Anti-Inflammatory Agents/*therapeutic use; Child; Antibodies, Monoclonal/*therapeutic use; Infliximab; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Drug Resistance; Uveitis/*drug therapy; Inflammation/prevention & control; Life Tables; Retinal Vasculitis/*drug therapy; Scleritis/*drug therapy

Dexamethasone intravitreal implant (Ozurdex) for the treatment of pediatric uveitis. - Bratton, Monica L.; He, Yu-Guang; Weakley, David R. (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2014)
PURPOSE: To report our experience using Ozurdex (Allergan, Irvine, CA), a biodegradable intravitreal implant containing of 0.7 mg of dexamethasone approved for use in adults with noninfectious uveitis in adults, in the treatment of pediatric uveitis. METHODS: The medical records of consecutive patients with noninfectious posterior uveitis who were unresponsive to standard treatment and subsequently received the Ozurdex implant from March 2011 to March 2013 were retrospectively reviewed. RESULTS: A total of 14 eyes of 11 patients (mean age, 10.1 years; range 4-12) received 22 Ozurdex implants during the study period. Of the 11 patients, 7 had idiopathic intermediate or posterior uveitis, 1 had sympathetic ophthalmia, 2 had juvenile idiopathic arthritis, and 1 had sarcoidosis. All patients were uncontrolled with standard treatment, including topical or sub-Tenon's or systemic corticosteriods and/or immune-modulation. Visual acuity improved after Ozurdex implant in 5 of 8 patients (63%). Intraocular inflammation was controlled or improved after 17 of 22 of implants (12 eyes [77%]). The frequency of topical corticosteroids was decreased and/or discontinued after 18 of 22 implants (12 eyes [82%]). Complications included implant migration into the anterior chamber (4 aphakic eyes), increased intraocular pressure (5 eyes), and progression of a preexisting cataract (1 eye). The uveitis reoccurred in 57% of eyes at 4.3 months (2-7 months) after injection. CONCLUSIONS: The Ozurdex implant in combination with systemic immunomodulatory therapy resulted in improved visual acuity, control of intraocular inflammation, and a decrease in corticosteroid use. In the majority of eyes the uveitis reoccurred around 4 months after injection. The adverse events in our study are similar to those identified in adult studies.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Child; Child, Preschool; Drug Implants; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Uveitis/*drug therapy/physiopathology; Administration, Topical; Vitreous Body/*drug effects; *Absorbable Implants; Immunomodulation

Evaluation of the effect of acetazolamide on cystoid macular oedema in patients with Behcet's disease. - Lashay, A. R.; Rahimi, A.; Chams, H.; Davatchi, F.; Shahram, F.; Hatmi, Z. N.; Khalkhali, H.; Beigi, B. (Eye (London, England), 2003)
AIM: To study the effect of acetazolamide on cystoid macular oedema (CMO) in patients with Behcet's disease. PATIENTS AND METHODS: A total of 67 eyes of 35 Behcet's patients with chronic, but well-controlled uveitis, and CMO were randomised into a double-masked, crossover trial comparing the effect of acetazolamide vs placebo. The patients received an initial 4-week course of either 250 mg acetazolamide twice daily (b.i.d.) or placebo, followed by a 4-week washout period. They then received a 4-week course of the reverse study medication. An improvement in visual acuity and fundus fluorescein angiographic findings was assessed. RESULTS: In total, 29 patients (55 eyes) completed the trial and were available for analysis. Of the 29, 16 men and 13 were women. The age range was 13-50 years (mean 33.6 years). Patients on acetazolamide showed a slightly better improvement of angiographic signs (at least by one grade improvement) over that of placebo (12 vs five eyes). They also had less deterioration of angiographic signs over that of placebo (three vs seven eyes). However, these findings were not statistically significant (P=0.99). Acetazolamide had no statistically significant effect (P=0.53) on the improvement of visual acuity of patients over that of placebo (13 vs eight eyes), nor on the deterioration of visual acuity (three vs 11 eyes). CONCLUSION: Despite seemingly favourable results, the 4-week course of acetazolamide (250 mg b.i.d.) has no statistically significant effect on the improvement of the visual acuity and the fluorescein angiographic findings in Behcet's patients with CMO.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Adult; Adolescent; Cross-Over Studies; Fluorescein Angiography; Visual Acuity/drug effects; Carbonic Anhydrase Inhibitors/*therapeutic use; Macular Edema/*drug therapy/etiology/physiopathology; Acetazolamide/*therapeutic use; Behcet Syndrome/*complications; Diuretics/*therapeutic use; Uveitis, Posterior/complications

Tuberculous uveitis, a resurgent and underdiagnosed disease. - Cimino, Luca; Herbort, Carl P.; Aldigeri, Raffaella; Salvarani, Carlo; Boiardi, Luigi (International ophthalmology, 2009)
BACKGROUND: Over the last decade ocular involvement due to tuberculosis has re-emerged. In non-endemic areas the low frequency of active tuberculosis is at the origin of an underestimation of the disease. The purpose of this study is to report a group of patients with presumed tuberculous uveitis and to analyse the pre-diagnostic course, the diagnostic delay and the evolution of ocular inflammation after diagnosis and anti-tuberculous treatment. METHODS: Criteria for presumed tuberculous uveitis included the presence of a hyperpositive tuberculin skin test with compatible uveitis and the exclusion of other possible etiologies. RESULTS: Thirty-five patients fulfilled the diagnostic criteria for presumed tuberculous uveitis and were included in the study. The diagnosis was performed at presentation in only seven patients, while the correct diagnosis was delayed in the other 30 patients. The mean diagnostic delay was 5.7 +/- 4 years. Anti-tuberculous therapy was given for a minimum of 6 to a maximum of 24 months. Post-diagnostic mean follow-up was 30.4 +/- 13.4 months. Anti-tuberculous therapy resulted in a highly significant increase in visual acuity, from 0.53 to 0.78 (P < 0.001), a highly significant decrease of recurrences, from 100 to 10% (P < 0.001), with only three recurrences observed during the follow-up, and a highly significant decrease in intra-ocular pressure, from 18.3 to 13.7 (P < 0.001). CONCLUSIONS: Our study tends to confirm the existence of tuberculous uveitis and supports the validity of the proposed diagnostic criteria. Recognition of the correct diagnosis and specific therapy, even with substantial delay, avoids recurrences, improves visual acuity and intra-ocular inflammation and decreases intra-ocular pressure.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Time Factors; Follow-Up Studies; Treatment Outcome; Young Adult; Drug Administration Schedule; Reproducibility of Results; Visual Acuity/drug effects; Intraocular Pressure/drug effects; Secondary Prevention; Tuberculosis, Ocular/*diagnosis/drug therapy/physiopathology; Antitubercular Agents/administration & dosage; Tuberculin Test/standards; Uveitis/*diagnosis/*microbiology/physiopathology

Intravitreal adalimumab for refractory uveitis-related macular edema. - Androudi, Sofia; Tsironi, Evangelia; Kalogeropoulos, Christos; Theodoridou, Athina; Brazitikos, Periklis (Ophthalmology, 2010)
OBJECTIVE: To evaluate the safety and efficacy of intravitreal adalimumab injections on refractory cystoid macular edema (CME) secondary to noninfectious uveitis. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Eight consecutive patients with controlled uveitis and chronic, refractory CME who had failed steroid treatment. INTERVENTION: Intravitreal adalimumab injections were given monthly for 3 months. MAIN OUTCOME MEASURES: Mean change in central retinal thickness (CRT) on optical coherence tomography (OCT); secondary objective was the mean change in best-corrected visual acuity (BCVA). RESULTS: Five of the eight patients completed the 6-month follow-up. For all 5 patients, the changes in BCVA from baseline to 3 months were not statistically significant (P=0.070). Similarly, the change in BCVA from baseline to 6 months was not statistically significant (P=1.0). The mean CRT at baseline was 692 microm. The changes from baseline to 3 months were not statistically significant (P=0.466); the changes from baseline to 6 months were also not statistically significant (P=0.808). We did not observe any ocular or systemic adverse effects. CONCLUSIONS: Intravitreal adalimumab showed no efficacy in improving BCVA or reducing CRT in patients with chronic uveitic macular edema.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Follow-Up Studies; Young Adult; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Adalimumab; Tomography, Optical Coherence; Injections; Uveitis/complications/*drug therapy; Vitreous Body; Visual Acuity/drug effects; Macular Edema/*drug therapy/etiology; Anti-Inflammatory Agents/*administration & dosage; Antibodies, Monoclonal, Humanized; Retreatment; Antibodies, Monoclonal/*administration & dosage; Retina/drug effects

Evaluation of the effect on outcomes of the route of administration of corticosteroids in acute Vogt-Koyanagi-Harada disease. - Read, Russell W.; Yu, Fei; Accorinti, Massimo; Bodaghi, Bahram; Chee, Soon-Phaik; Fardeau, Christine; Goto, Hiroshi; Holland, Gary N.; Kawashima, Hidetoshi; Kojima, Eri; Lehoang, Phuc; Lemaitre, Claire; et al. (American journal of ophthalmology, 2006)
PURPOSE: To compare the effect on outcomes of the route of administration of corticosteroids in acute Vogt-Koyanagi-Harada disease. DESIGN: Retrospective comparative interventional case series. SETTINGS: Nine international uveitis specialty clinics. STUDY POPULATION: Forty-eight patients presenting over a three-year period to a study center with acute Vogt-Koyanagi-Harada disease. INTERVENTION: Initial treatment with corticosteroid either orally (Oral only group) or intravenously followed by an oral taper (IV+Oral group). MAIN OUTCOME MEASURES: Change in visual acuity with treatment; development of ocular complications, including visually significant cataract, choroidal neovascularization, subretinal fibrosis, fundus pigment migration, nummular hypopigmented lesions, and diffuse fundus depigmentation; use of immunosuppressive therapy. RESULTS: The Oral only group comprised 15 patients (31%) and the IV+Oral group 33 patients (69%). Median follow-up was 15 months. There was no difference in duration of follow-up between groups (P = .234). There was no difference in the change in visual acuity between groups, adjusting for initial visual acuity (P = .402). There were no differences in the rates of development of visually significant cataract, fundus pigmentary changes, or in the rate of use of subsequent immunosuppressive therapy between treatment groups. No patients developed choroidal neovascularization or subretinal fibrosis over the study period. CONCLUSIONS: Route of administration of corticosteroid had no detectable effect on change in visual acuity nor on the development of visually significant complications over the study period. Prospective trials are necessary to address speed of resolution and definitively answer outcome questions.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Adolescent; Administration, Oral; Child; Injections, Intravenous; Prednisone/administration & dosage; Methylprednisolone/administration & dosage; Visual Acuity/physiology; Acute Disease; Glucocorticoids/*administration & dosage; Uveomeningoencephalitic Syndrome/*drug therapy/physiopathology

Treating chronic noninfectious posterior segment uveitis: the impact of cumulative damage. Proceedings of an expert panel roundtable discussion. - Nguyen, Quan Dong; Callanan, David; Dugel, Pravin; Godfrey, David G.; Goldstein, Debra A.; Wilensky, Jacob T. (Retina (Philadelphia, Pa.), 2006)
Chronic noninfectious posterior segment uveitis refers to inflammation of the retina, choroid, vitreous, or optic nerve, and may result in permanent vision loss. The inflammation can be constant, or characterized by periodic exacerbations on an underlying baseline of inflammation. Recent studies indicate that this vision loss often results from cumulative damage over multiple recurrences of inflammation, rather than from a single initiating event. Most forms of local therapy provide only transient suppression of inflammation, and the use of systemic agents may be limited by serious side effects. The course of uveitis may, therefore, be marked by recurrent episodes of inflammation, each contributing to progressive and permanent loss of visual acuity. The goal of uveitis treatment should not only be to suppress inflammation when it recurs but also to attain complete remission of inflammation, and thus prevent complications such as cystoid macular edema (CME) and permanent cumulative damage. The RETISERT intravitreal implant offers sustained local control of inflammation without the systemic side effects that limit standard immunosuppressive and oral corticosteroid therapies. The recommendation of the expert panel was that RETISERT is a useful addition to the armamentarium for the treatment of chronic noninfectious posterior segment uveitis and may help to prevent cumulative damage from repeated occurrences of inflammation, especially when vision can be improved rather than only stabilized.
Keywords: Humans; Injections; Visual Acuity; Drug Implants; Vitreous Body; Uveitis, Posterior/*drug therapy; Anti-Inflammatory Agents/administration & dosage/*therapeutic use; Fluocinolone Acetonide/administration & dosage/*therapeutic use

Intravitreal bevacizumab in refractory uveitic macular edema: one-year follow-up. - Cervantes-Castañeda, Rene A.; Giuliari, Gian Paolo; Gallagher, Michael J.; Yilmaz, Taygan; MacDonell, Rebecca E.; Quinones, Karina; Foster, Charles S. (European journal of ophthalmology, 2009)
PURPOSE: Uveitis is a major cause of ocular morbidity in developed countries. It has been demonstrated that macular edema is a significant cause of decreased visual acuity and macular edema in these patients. In this article, we evaluate the long-term outcome of intravitreal bevacizumab in the treatment of refractory uveitic macular edema. METHODS: In this retrospective, noncomparative, interventional case series, uveitic patients with macular edema who were refractory to conventional therapy and who were treated with intravitreal bevacizumab were identified and assessed. Best-corrected visual acuity and optical coherence tomography central macular thickness measurements were collected and analyzed with correlative statistical analysis, including the use of Student paired t-test, Kaplan-Meier, and linear regression analysis. RESULTS: Twenty-nine eyes of 27 patients with diverse uveitic etiologies were analyzed and followed up at 1 year. Thirteen patients received a single intravitreal bevacizumab injection. Six patients required a second intravitreal bevacizumab injection, while 10 patients received combination therapy of intravitreal bevacizumab and triamcinolone acetonide. Baseline mean logMAR visual acuity was -0.59. At 1 year, the mean logMAR visual acuity was -0.42-/+ 0.36 (p=0.0045). Baseline mean central macular thickness was 383.66 microm. At 1 year, the mean thickness was 294.32-/+110.87 (p=0.0007). CONCLUSIONS: Intravitreal bevacizumab is a useful and therapeutically beneficial agent in the treatment of refractory uveitic macular edema. Some patients will require adjunctive intravitreal bevacizumab injections or the use of combination therapy with intravitreal triamcinolone acetonide.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Antibodies, Monoclonal/*therapeutic use; Tomography, Optical Coherence; Injections; Glucocorticoids/therapeutic use; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Vitreous Body; Angiogenesis Inhibitors/*therapeutic use; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Antibodies, Monoclonal, Humanized; Bevacizumab; Triamcinolone Acetonide/therapeutic use; Macular Edema/diagnosis/*drug therapy/physiopathology

A Rare Case of Infectious Multifocal Serpiginoid Choroiditis. - Mitrašević, Miloš; Jovanović, Svetlana; Radotić, Filip; Pešić, Snežana; Jovanović, Zorica (Acta clinica Croatica, 2016)
Multifocal serpiginoid choroiditis is an infectious variety of serpiginous choroiditis. The disease is characterized by infectious etiology and overlapping clinical features in an intermediary form of acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. In a 33-year-old patient, bilateral multiple placoid partially confluent chorioretinal lesions were diagnosed after a febrile flu-like episode. On the right eye, there was a progressive decrease in visual acuity. Later, the lesions had a prolonged progressive devastating clinical course and widespread distribution of placoid lesions, and took the form of serpiginoid choroiditis. We conducted extensive laboratory work-up and ancillary investigation for granulomatous diseases such as tuberculosis and sarcoidosis, and the results were not consistent with these entities. Systemic medical work-up revealed a history of exposure to the human immunodeficiency virus, herpes simplex virus 1, varicella zoster virus and cytomegalovirus. The titer of Mycoplasma pneumoniae IgM antibodies was positive. After serological analysis positive for Mycoplasma pneumoniae, systemic antibiotic therapy and anti-inflammatory doses of corticosteroids were administered. Improvement of visual acuity after the introduction of causal antibiotic therapy in combination with anti-inflammatory therapy confirmed our suspicion that Mycoplasma pneumoniae was the etiologic cause of multifocal serpiginoid choroiditis.
Keywords: Humans; Male; Adult; Drug Therapy, Combination; Fluorescein Angiography; Visual Acuity; Diagnosis, Differential; Multifocal Choroiditis; *Acute posterior multifocal placoid pigment epitheliopathy; *Mycoplasma pneumoniae; *Serpiginoid choroiditis; *Serpiginous choroiditis; Anti-Infective Agents/administration & dosage/therapeutic use; Anti-Inflammatory Agents/administration & dosage/therapeutic use; Choroiditis/*diagnosis/diagnostic imaging/drug therapy; Mycoplasma Infections/*diagnosis/diagnostic imaging/drug therapy; Mycoplasma pneumoniae/*isolation & purification

Pars plana vitrectomy versus immunomodulatory therapy for intermediate uveitis: a prospective, randomized pilot study. - Quinones, Karina; Choi, John Y.; Yilmaz, Taygan; Kafkala, Chrysanthi; Letko, Erik; Foster, C. Stephen (Ocular immunology and inflammation, 2010)
PURPOSE: Comparison of pars plana vitrectomy (PPV) with immunomodulatory therapy (IMT) for patients with intermediate uveitis (IU). METHODS: A prospective, randomized pilot study was performed on patients with recalcitrant IU associated with degradation of visual acuity (VA) despite standard treatment. Outcome measures (VA, intraocular pressure, anterior chamber and vitreous cellular infiltrate) were collected. RESULTS: Sixteen patients (18 eyes) were randomized to the PPV IMT group. Nine of 11 eyes (82%) treated with PPV showed resolution of inflammation at follow-up, at 5.93 years. Four of 7 eyes (57%) given IMT had persistent inflammation requiring subsequent PPV. PPV patients showed greater improvement in Snellen line, IOP, and vitreous cell reduction. Three PPV patients had cystoid macular edema (CME) initially; all resolved postoperatively. CME improved in 2 of 3 eyes using IMT. CONCLUSIONS: A higher percentage of patients treated with PPV had improvement of uveitis compared to those given IMT. A multicentered clinical trial is needed to confirm and statistically validate these conclusions.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Time Factors; Follow-Up Studies; Treatment Outcome; Young Adult; Adolescent; Immunologic Factors/*therapeutic use; Child; Visual Acuity; Intraocular Pressure; Vitreous Body/pathology; Retreatment; Anterior Chamber/pathology; Eye Diseases/complications/pathology; Macular Edema/complications/drug therapy; Uveitis, Intermediate/complications/pathology/physiopathology/*therapy; Vitrectomy/adverse effects/*methods

Trabeculectomy with mitomycin-C in uveitic glaucoma associated with Behçet disease. - Yalvac, Ilgaz Sagdic; Sungur, Gulten; Turhan, Ece; Eksioglu, Umit; Duman, Sunay (Journal of glaucoma, 2004)
PURPOSE: To determine the effect of intraoperative application of Mitomycin-C (MMC) with trabeculectomy in uveitic glaucoma associated with Behçet disease. MATERIALS AND METHODS: Twenty-six eyes of 26 patients with uveitic glaucoma associated with Behçet disease who underwent trabeculectomy with MMC between 1996 and 2001 were reviewed in this retrospective, noncomparative study. Trabeculectomy + MMC in concentration of 0.4 mg/mL for 3 minutes was performed to all patients. Main outcome measures were control of IOP, the number of antiglaucoma medications required to achieve the desired IOP, visual acuity and complications. The surgical success was defined as IOP less than 22 mm Hg and greater than 5 mm Hg without additional further glaucoma surgery or loss of light perception. RESULTS: The cumulative probability of success was 83.3% at 1 year, 76.2% at 2 years, 70% at 3 years, 66.7% at 4 years and 62.5% at 5 years after surgery. The mean follow-up was 40.0+/-18.0 months. At last follow-up 23% of the patients required no antiglaucoma medications. Best-corrected visual acuity improved or remained within two lines of preoperative visual acuity in 19 eyes (73.1%). Glaucomatous (1 eye 3.8%) and nonglaucomatous optic atrophy (3 eyes 11.5%) was the most frequent reason for visual decrease (total 4 eyes 15.2%). The most common complications were cataract formation in 6 eyes (23.1%), bleb leakage in 4 eyes (15.3%) and choroidal effusion in 3 eyes (11.5%). Phthisis bulbi was found in one (3.8%) patient. CONCLUSION: Trabeculectomy and intraoperative application of MMC appears to provide long term safety and effectiveness in uveitic glaucoma associated with Behçet disease.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Adolescent; Chemotherapy, Adjuvant; Visual Acuity; Intraocular Pressure; Uveitis/*complications; Reoperation; Glaucoma/drug therapy/*etiology/physiopathology/*surgery; Life Tables; Behcet Syndrome/*complications; *Trabeculectomy/adverse effects; Mitomycin/adverse effects/*therapeutic use

Cataract surgery under systemic infliximab therapy in patients with refractory uveitis associated with Behcet disease. - Alfawaz, Abdullah; Alrashidi, Sultan; Kalantan, Hatem; Al-Mezaine, Hani; Abu, Ahmed M. (Annals of Saudi medicine, 2014)
BACKGROUND AND OBJECTIVES: This study is to evaluate the outcome of cataract surgery in patients with refractory uveitis associated with Behçet disease (BD) treated with infliximab. DESIGN AND SETTINGS: A retrospective study in a university-based tertiary referral center in the period between July 2003 and November 2011. METHODS: This is a retrospective study of patients with refractory uveitis associated with BD who underwent phacoemulsification cataract surgery under systemic infliximab therapy between July 2003 and November 2011 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. RESULTS: Six patients (9 eyes), 5 of which were male and 1 female, were identified in this study. The mean (SD) age and follow-up period were 26.2 (6.6) years (range, 16-36 years) and 51.6 (28.8) months (range, 12.84 months), respectively. All the patients underwent phacoemulsification with intraocular lens implantation. Postoperatively, visual acuity improved in all eyes and was 20/40 or better in 7 eyes (77.8%). In the immediate postoperative period, anterior chamber inflammation ranged from 2+ to 3+ cells. None of the patients developed inflammation relapse postoperatively. The most common postoperative complication was posterior capsular opacification in 5 eyes (55%), 4 of which were managed with neodymium:yttrium-aluminum garnet laser capsulotomy. Three eyes had glaucoma, 2 of which underwent successful glaucoma surgery and one was managed with topical antiglaucoma medications. CONCLUSION: In patients with refractory uveitis associated with BD who are treated with infliximab, cataract surgery is safe and has a good prognosis.
Keywords: Female; Humans; Male; Adult; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Antibodies, Monoclonal/*therapeutic use; Infliximab; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use; Visual Acuity; Lasers, Solid-State/therapeutic use; Uveitis/*drug therapy/etiology; Behcet Syndrome/complications/*drug therapy; *Lens Implantation, Intraocular/adverse effects; *Phacoemulsification/adverse effects; Capsule Opacification/etiology; Glaucoma/complications/surgery

Efficacy of Methylprednisolone Pulse Followed by Oral Prednisone in Birdshot Chorioretinopathy. - Hafidi, Meriem; Loria, Olivier; Kodjikian, Laurent; Denis, Philippe; Ferrand, Muriel R.; Broussolle, Christiane; Sève, Pascal (Ocular immunology and inflammation, 2017)
PURPOSE: To report the outcomes of initial methylprednisolone pulse then oral prednisone in the treatment of birdshot chorioretinopathy (BSCR). METHODS: We retrospectively reviewed medical records of 21 BSCR patients, treated with initial methylprednisolone, prednisone, or immunosuppressive therapy. Main outcome measures were changes in visual acuity, intraocular inflammation, concomitant immunosuppressive drug or intravitreal steroid, and adverse events. RESULTS: In total, 14 patients were initially treated with methylprednisolone; four patients with prednisone; and three with immunosuppressive drug. Intraocular inflammation was controlled in 10 of 14 patients (71%) at 1 year, with a mean dose of 6.2 mg/day prednisone. Patients treated initially by methylprednisolone had improved visual acuity at 1 year, but it was not significantly different from patients treated initially by prednisone. CONCLUSIONS: Corticosteroid therapy, including initial methylprednisolone pulse then prednisone, was effective in stabilizing vision and decreasing inflammation in most patients with BSCR.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Drug Combinations; Administration, Oral; Prednisone/*therapeutic use; uveitis; Visual Acuity/physiology; Glucocorticoids/*administration & dosage; Chorioretinitis/diagnosis/*drug therapy/physiopathology; methylprednisolone; Birdshot chorioretinopathy; Birdshot Chorioretinopathy; Methylprednisolone/*administration & dosage; prednisone; pulse; Pulse Therapy, Drug

Biologic response modifier therapy for psoriatic ocular inflammatory disease. - Huynh, Nancy; Cervantes-Castaneda, Rene A.; Bhat, Pooja; Gallagher, Michael J.; Foster, C. Stephen (Ocular immunology and inflammation, 2008)
PURPOSE: To evaluate the efficacy and safety of biologic response modifiers (BRMs) in the treatment of patients with psoriatic ocular inflammatory disease. METHODS: The records of 8 patients diagnosed with psoriatic ocular inflammatory disease who received adalimumab or infliximab were reviewed. Main outcome measures were control of intraocular inflammation, visual acuities, and adverse effects of therapy. RESULTS: The mean patient age was 53 +/- 15 years. Three patients had psoriatic panuveitis, 3 had psoriatic scleritis, and 2 patients had psoriatic anterior uveitis. The ocular inflammatory disease was bilateral in 7 patients. Four patients received adalimumab, and 4 received infliximab. Average time of therapy was 6.1 +/- 4.7 months. Six patients were treated concurrently with methotrexate. With respect to visual acuity, 2 patients demonstrated improvement, 2 patients demonstrated deterioration, and 4 patients remained stable. Seven patients achieved remission of their ocular inflammation. CONCLUSIONS: BMRs can be a useful adjunctive therapy for psoriatic ocular inflammatory disease.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Treatment Outcome; Drug Administration Schedule; Methotrexate/therapeutic use; Remission Induction; Infliximab; Adalimumab; Anti-Inflammatory Agents/administration & dosage/adverse effects/*therapeutic use; Visual Acuity/drug effects; Antibodies, Monoclonal, Humanized; Uveitis/*drug therapy/etiology/physiopathology; Antibodies, Monoclonal/administration & dosage/adverse effects/*therapeutic use; Biological Therapy/adverse effects; Psoriasis/*complications; Scleritis/*drug therapy/etiology/physiopathology

Safety and efficacy of intravitreal triamcinolone acetonide for uveitic macular edema. - Androudi, Sofia; Letko, Erik; Meniconi, Margherita; Papadaki, Thekla; Ahmed, Muna; Foster, C. Stephen (Ocular immunology and inflammation, 2005)
BACKGROUND: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (TA) for treating macular edema secondary to non-infectious uveitis. METHODS: Retrospective review of sixteen patients (20 eyes) with chronic cystoid macular edema (CME) as a consequence of controlled intermediate uveitis, posterior uveitis, or panuveitis who received at least one intravitreal injection of TA. Main outcome measures were visual acuity (VA), intraocular pressure (IOP), formation or progression of an existing cataract, and CME resolution during the follow-up period. RESULTS: At last follow-up, VA showed improvement (compared to baseline) in 11 eyes (55%), deterioration in three eyes (15%), remained completely unchanged in one eye (5%), and showed improvement initially but returned to baseline levels in five eyes (25%). At last follow-up, CME had relapsed or was still present in 10 of the eyes (50%). The remaining eyes showed complete resolution of the CME, without evidence of recurrence during the follow-up time. Mean VA at last follow-up showed statistically significant improvement (p = 0.02) in nonvitrectomized eyes (mean baseline VA: 1.14 +/- 0.58; mean final VA: 0.96 +/- 0.66) compared to the almost unaltered mean visual acuity for vitrectomized eyes (mean baseline VA: 0.76 +/- 0.41; mean final VA: 0.71 +/- 0.48)(p = 0.40, paired samples t-test). Elevation of IOP was transient in all cases and responded well to topical medications, except for one patient who required placement of an Ahmed valve. Preexisting cataract progressed in three of the 15 phakic eyes (20%). One patient developed a retinal detachment and required additional surgery to reattach it. Patients were followed for a mean of 34 weeks (median: 32 weeks; range: 19-56 weeks). CONCLUSIONS: Intravitreal TA may play a role in the treatment of uveitis-related CME. Further controlled studies are necessary to test this hypothesis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Safety; Injections; Visual Acuity; Triamcinolone Acetonide/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure; Vitreous Body; Uveitis/*complications/drug therapy/physiopathology; Macular Edema/*drug therapy/*etiology/physiopathology

Short-term safety and efficacy of intravitreal triamcinolone acetonide for uveitic macular edema in children. - Sallam, Ahmed; Comer, Richard M.; Chang, John H.; Grigg, John R.; Andrews, Richard; McCluskey, Peter J.; Lightman, Susan (Archives of ophthalmology (Chicago, Ill. : 1960), 2008)
OBJECTIVES: To evaluate the short-term safety and efficacy of intravitreal (IV) triamcinolone acetonide (TA) for treating pediatric cystoid macular edema (CME) secondary to noninfectious uveitis. METHODS: A retrospective noncomparative interventional case series. The medical records of 15 consecutive children (16 eyes) with uveitic CME treated with IVTA (2 or 4 mg) were reviewed. Data collected included details of uveitis, CME, visual acuity, intraocular pressure, and cataract development. The median follow-up time was 16 months (range, 9-36 months). RESULTS: Resolution of CME was achieved in all of the treated eyes. The median time taken for CME to resolve was 3 weeks (range, 1-24 weeks). The mean improvement of visual acuity after IVTA was 0.6 logarithm of the minimum angle of resolution. Following initial response to IVTA, CME relapsed in 5 eyes (31%) after a median time of 7 months (range, 3-13 months). The most common adverse effect was increased intraocular pressure, with an increase of more than 15 mm Hg in 5 eyes (31%). Steroid-induced cataract was observed in 6 of 11 phakic eyes (55%). CONCLUSIONS: We found that IVTA is efficacious in the treatment of uveitic CME in children and results in CME resolution and visual acuity improvement. As in adults, treatment in children may be associated with elevated intraocular pressure and cataract.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Adolescent; Recurrence; Child; Child, Preschool; Injections; Visual Acuity; Uveitis/complications/*drug therapy; Intraocular Pressure; Vitreous Body; Macular Edema/*drug therapy/etiology; Glucocorticoids/adverse effects/*therapeutic use; Triamcinolone Acetonide/adverse effects/*therapeutic use

Intravitreal Dexamethasone Implant for the Treatment of Macular Edema in Chronic Non-infectious Uveitis. - Tsang, Adrian C.; Virgili, Gianni; Abtahi, Maryam; Gottlieb, Chloe C. (Ocular immunology and inflammation, 2017)
PURPOSE: To report observations on the single and repeat use of the dexamethasone (DEX) intravitreal implant (Ozurdex; Allergan, Inc, Irvine, CA) for the treatment of macular edema in patients with non-infectious posterior segment uveitis. METHODS: A chart review of 15 consecutive patients (25 eyes) was conducted. The primary outcome measure of the first and subsequent implants was central retinal thickness (CRT) on spectral-domain optical coherence tomography (sdOCT). Secondary outcomes were best-corrected visual acuity (BCVA), time to repeat implant, and adverse events. Multilevel mixed-effects linear regression was used to determine the effect of the DEX implant compared with baseline. The Kaplan-Meier estimator was used to examine survival from relapse. RESULTS: A total of 35 implants on 25 eyes of 15 patients were included in the analysis. Of these, 91.4% (32 of 35 eyes) had a reduction in CRT and 80% (20 of 25 eyes) had improved BCVA. After the first DEX implant, CRT decreased from 590 µm (SE: 28 µm) at baseline to 370 µm (SE: 31 µm) at 3 months (p < 0.001). The logMAR VA was 0.614 (SE: 0.089) at baseline and improved to 0.35 (SE: 0.10, p = 0.002), reaching a statistically significant difference at 3 months. A repeat implant led to VA improvement of -0.184 logMAR (SE: 0.171 logMAR) and CRT reduction of -291 µm (SE: 74 µm). There was no significant difference in effect between the first repeat implant and the initial implant. Kaplan-Meier estimates of treatment success were 72% between 3 and 6 months. CONCLUSIONS: The DEX implant is an effective adjunct treatment to systemic corticosteroid or immunomodulatory therapy. Additional research is required to determine the efficacy of DEX implant as monotherapy for controlling chronic uveitic macular edema.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Recurrence; Chronic Disease; Tomography, Optical Coherence; uveitis; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Retina/pathology; Uveitis, Posterior/*drug therapy/physiopathology; Macular Edema/*drug therapy/physiopathology; Dexamethasone; macular edema; Retreatment

[Effect of intravitreal and orbital floor triamcinolone acetonide injection on intraocular inflammation in patients with active non-infectious uveitis]. - Roesel, M.; Gutfleisch, M.; Heinz, C.; Heimes, B.; Zurek-Imhoff, B.; Heiligenhaus, A. (Klinische Monatsblatter fur Augenheilkunde, 2009)
BACKGROUND: Currently, triamcinolone acetonide (TA) is frequently used to treat inflammation in non-infectious uveitis. The aim of this study was to compare the effect of TA on intraocular inflammation after a single intravitreal or orbital floor injection of the drug in patients with non-infectious uveitis. PATIENTS AND METHODS: This was a monocentre, retrospective study in 114 eyes (103 patients). Twenty eyes were treated with intravitreal and 94 eyes with orbital floor TA. The main outcome measure was cells in the anterior chamber and anterior vitreous. Secondary outcome measures included protein accumulation in the aqueous humor (according to laser-flare photometry), best-corrected visual acuity, and complications. Follow-up evaluations were performed at 1, 3, and 6 months after TA injection. RESULTS: After either intravitreal or orbital floor TA injection, the intraocular inflammation in the anterior chamber and vitreous decreased (p < 0.001, for both administration forms, and at all follow-up time points). Laser-flare values decreased in both groups. One month after injection, the visual acuity in the intravitreally treated patients was increased (p < 0.01), whereas the poor visual acuity persisted in the orbital floor group. The effect on macular oedema after intravitreal TA was better than in the orbital floor group (p < 0.01). Progression and increased cataract incidence were detected in 50 % after intravitreal and in 29 % after orbital floor TA. CONCLUSIONS: After both intravitreal and orbital floor TA injection, the intraocular inflammation decreased. The effect of intravitreal TA on macular oedema and visual acuity was better than that of orbital floor TA, but intraocular pressure elevation and progressive cataract were more often observed in this group.
Keywords: Female; Humans; Male; Middle Aged; Adult; Treatment Outcome; Anti-Inflammatory Agents/administration & dosage; Prevalence; Injections; Triamcinolone Acetonide/*administration & dosage; Vitreous Body; Uveitis/*drug therapy/*epidemiology

Definition of Uveitis Refractory to Treatment: A Systematic Review in the Absence of a Consensus. - Valenzuela, Rodrigo A.; Flores, Iván; Pujol, Myriam; Llanos, Carolina; Carreño, Ester; Rada, Gabriel; Herbort, Carl P. Jr; Cuitino, Loreto; Urzua, Cristhian A. (Ocular immunology and inflammation, 2022)
PURPOSE: To evaluate the different definition of refractoriness in uveitis in the literature. METHODS: We systematically searched the literature in order to identify definitions of refractory noninfectious uveitis in adult patients. A search strategy in the databases of MEDLINE and Scopus was used to find articles published between January 2005 and October 2018. RESULTS: Definitions of corticosteroids-refractoriness were related to two main concepts: persistence of inflammation despite the use of corticosteroid and recurrences above a dosage threshold. In terms of immunomodulatory therapy and biologic agents, we observed a great variety of definitions: persistence of inflammation, number of attacks, side effects or complications, symptoms, and best-corrected visual acuity. CONCLUSIONS: The results of this systematic review demonstrate the current lack of consensus on the definition for refractory uveitis, regardless of the treatment being used and revealed a new terminology based on a comprehensive and operational definition for each specific category of refractoriness.
Keywords: Humans; Adult; Treatment Outcome; Inflammation/drug therapy; Adrenal Cortex Hormones/therapeutic use; uveitis treatment; Immunomodulation; *Uveitis/diagnosis/drug therapy; biologics; consensus; Consensus; definition; glucocorticoids; immunomodulatory; intractable; refractory; Resistant