Treatment of Uveitis and Outcomes of Glaucoma Drainage Implant Surgery: A Meta-Analysis. - Chaku M; Bajwa A; Lee JK; Netland PA (Ocular immunology and inflammation, 2019)
Purpose: We performed a meta-analysis to evaluate the effect of uveitis treatment on glaucoma drainage implant surgical outcomes. Methods: We included 16 articles in the meta-analysis. Two groups were defined based on medical therapy of uveitis: Group 1: poorly controlled uveitis, and Group 2: well-controlled uveitis including use of immunomodulatory medications. Results: The two groups were similar in comparisons of follow-up time, age, gender, and etiology of uveitis. Meta-analysis demonstrated significantly greater success in Group 2 (95.1%) compared to Group 1 (81.6%) at 1 year after glaucoma drainage implant surgery (P = .001). The final success was significantly greater (P 0.014) in group 2 compared with group 1 (86.1% and 74.3%, respectively). Conclusion: Surgical success was significantly higher in uveitic glaucoma patients treated with more intensive immunosuppressive therapy before and after glaucoma drainage implant surgery. The level of control of uveitis perioperatively appears to influence glaucoma drainage implant surgery outcomes.

[A clinical evaluation of uveitis-associated secondary glaucoma]. - Takahashi T; Ohtani S; Miyata K; Miyata N; Sirato S; Mochizuki M (Nippon Ganka Gakkai zasshi, 2002)
PURPOSE: To investigate the clinical features of secondary glaucoma associated with uveitis. SUBJECTS AND METHODS: The subjects of the study were 1,604 eyes of 1,099 patients with uveitis at Miyata Eye Hospital, Miyakonojo, Miyazaki, between October 1974 and January 2000. The intraocular pressure (IOP) and clinical data were analyzed retrospectively. Secondary glaucoma was defined as being an IOP higher than 21 mmHg and needing treatment with medication to control the high IOP. RESULTS: Secondary glaucoma was found in 293 eyes (18.3%) of 217 patients (19.7%) among the uveitis patients. The clinical entity with the highest frequency of secondary glaucoma was Posner-Schlossman syndrome in 100%, followed by sarcoidosis in 34.1%, herpetic anterior uveitis in 30.4%, Behçet's disease in 20.8%, HLA-B 27 related acute anterior uveitis in 20.0%, Vogt-Koyanagi-Harada' disease in 16.4%, and HTLV-1 uveitis in 16.2%. Among the 293 eyes with secondary glaucoma, the majority (72%) had active anterior uveitis at the time of high IOP. Only 7.5% of secondary glaucoma eyes had peripheral anterior synechia wider than 180 degrees of trabecular meshwork. Steroid glaucoma was found only in 8.9% of the secondary glaucoma eyes. Surgical therapy mainly with trabeculectomy with anti-metabolites was performed in 38 eyes and the postsurgical IOP was controlled to 20 mmHg or lower in 36 eyes. Despite the medical and surgical therapy for secondary glaucoma, defect of the visual field was found in 38% of the secondary glaucoma eyes. CONCLUSIONS: The frequency of secondary glaucoma in 1,604 eyes with uveitis was 18.3%, and the frequency of secondary glaucoma differed depending upon the clinical entity of uveitis. The evaluation and the management of IOP are very important in treatment patients with uveitis, in addition to the management of intraocular inflammation.

Risk of elevated intraocular pressure and glaucoma in patients with uveitis: results of the multicenter uveitis steroid treatment trial. - Friedman DS; Holbrook JT; Ansari H; Alexander J; Burke A; Reed SB; Katz J; Thorne JE; Lightman SL; Kempen JH; MUST Research Group (Ophthalmology, 2013)
OBJECTIVE: To report the 2-year incidence of raised intraocular pressure (IOP) and glaucomatous optic nerve damage in patients with uveitis randomized to either fluocinolone acetonide (FA) implants or systemic therapy. Secondarily, we sought to explore patient and eye characteristics associated with IOP elevation or nerve damage. DESIGN: A randomized, partially masked trial in which patients were randomized to either FA implants or systemic therapy. PARTICIPANTS: Patients aged ≥ 13 years with noninfectious intermediate, posterior, or panuveitis active within the prior 60 days for which systemic corticosteroids were indicated were eligible. METHODS: Visual fields were obtained at baseline and every 12 months using the Humphrey 24-2 Swedish interactive threshold algorithm (SITA) fast protocol. Stereoscopic optic nerve photos were taken at baseline and at 3-, 6-, 12-, and 24-month follow-up visits. Masked examiners measured IOP at every study visit. MAIN OUTCOME MEASURES: Glaucoma was diagnosed based on an increase in optic nerve cup-to-disc ratio with visual field worsening or increased cup-to-disc ratio alone, for cases where visual field change was not evaluable, because of missing data or severe visual field loss at baseline. RESULTS: Most patients were treated as assigned; among those evaluated for glaucoma, 97% and 10% of patients assigned to implant and systemic treatment, respectively, received implants. More patients (65%) assigned to implants experienced an IOP elevation of ≥ 10 mmHg versus 24% assigned to systemic treatment (P<0.001). Similarly, 69% of patients assigned to the implant required IOP-lowering therapy versus 26% in the systemic group (P<0.001). Glaucomatous optic nerve damage developed in 23% versus 6% (P<0.001) of implant and systemic patients, respectively. In addition to treatment assignment, black race, use of IOP-lowering medications, and uveitis activity at baseline were associated with incident glaucoma (P<0.05). CONCLUSIONS: Implant-assigned eyes had about a 4-fold risk of developing IOP elevation of ≥ 10 mmHg and incident glaucomatous optic neuropathy over the first 2 years compared with those assigned to systemic therapy. Central visual acuity was unaffected. Aggressive IOP monitoring with early treatment (often including early filtration surgery) is needed to avoid glaucoma when vision-threatening inflammation requires implant therapy. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Morphologic assessment for glaucoma in the Multicenter Uveitis Steroid Treatment (MUST) trial. - Gangaputra SS; Altaweel MM; Peng Q; Friedman DS; Rao PK; Foster CS; Kim RY; Reed SB; Srivastava SK; Wong IG; Kempen JH; MUST Trial Research Group (Ocular immunology and inflammation, 2011)
PURPOSE: To compare Reading Center (RC) cup-to-disc ratio (CDR) assessment from stereoscopic photographs with clinician estimation in a uveitis clinical trial. METHODS: Clinical estimation of CDR was performed by ophthalmologists via dilated biomicroscopy. Photographic evaluation was performed at an independent RC by masked, certified evaluators. Quality control was performed by repeat grading of 77 randomly selected images. RESULTS: Among 479 eyes with uveitis, 353 eyes had clinical and photographic grades for CDR. Agreement between clinical and RC grading was fair, with exact agreement of 29%. Agreement within 0.1 and 0.2 CDR was 70 and 93%, respectively (weighted κ = .34). Intergrader reproducibility at the RC was better (weighted κ = .59, ICC 0.74). CONCLUSION: Morphologic assessment of cup to disc ratio is an important outcome and safety measure for determining glaucomatous damage in clinical trials. Masked RC measurements are more likely to be accurate than biomicroscopic grading in identifying meaningful anatomical change associated with glaucoma.

Efficacy of glaucoma drainage devices in uveitic glaucoma and a meta-analysis of the literature. - Ramdas WD; Pals J; Rothova A; Wolfs RCW (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2019)
PURPOSE: To assess the efficacy of glaucoma drainage devices (GDD) in uveitic glaucoma and non-uveitic glaucoma, and to perform a meta-analysis of previously published results to compare with our data. METHODS: Retrospective case-control study, in which all eyes that underwent GDD surgery were included from 2015 onwards. Cases were defined as patients with uveitic glaucoma. Patients with non-uveitic glaucoma served as controls. To compare our results, a review of the literature was performed using PubMed database. RESULTS: A total of 99 eyes were included (38 with uveitic glaucoma). The preoperative IOP was 25.9 ± 7.7 mmHg and 27.9 ± 9.6 mmHg for patients with and without uveitis (p = 0.277). No significant differences were found between patients with and without uveitis in the final IOP or reduction in IOP (44.9% vs. 42.8%, respectively). Within the first year after surgery, 13.2% of cases developed macular edema (vs. 6.6%; p = 0.267) and 15.8% a transient hypotony (vs. 8.2%; p = 0.242). A meta-analysis of 24 studies showed a postoperative weighted mean difference of - 17.8 mmHg and 2.2 lower number of IOP-lowering medications in uveitic glaucoma (compared to - 13.2 mmHg and 3.5 in the current study, respectively). CONCLUSION: GDD surgery in patients with uveitis has a similar effect on IOP as in patients without uveitis. The risks of developing macular edema and hypotony were slightly higher in patients with uveitis, but the results were not statistically significant. These findings are in line with previous reports, though data on the efficacy of GDD surgery and macular edema in uveitic glaucoma is scarce.

Brimonidine-associated uveitis - a descriptive case series. - Hopf S; Mercieca K; Pfeiffer N; Prokosch-Willing V (BMC ophthalmology, 2020)
BACKGROUND: Anterior uveitis secondary to topical brimonidine administration is rare and not well-defined. In glaucoma patients using brimonidine, one must consider this phenomenon to avoid mis-diagnosis and over-treatment with topical steroids which in turn may increase intraocular pressure (IOP). This is the largest case series including the longest patient follow-up in the current literature. METHODS: Sixteen patients (26 eyes) with consultant diagnosed brimonidine-associated anterior uveitis in a tertiary referral glaucoma clinic presenting between 2015 and 2019 were included in this retrospective case series. Clinical records were taken for descriptive analysis. Main outcome measures were the key clinical features, and disease course (therapy, IOP control, patient outcome). RESULTS: Key features were conjunctival ciliary injection and mutton fat keratic precipitation in all eyes. The findings were bilateral in 10 patients. Time between initiation of brimonidine treatment and presentation was 1 week to 49 months. Glaucoma sub-types were mostly pseudo-exfoliative and primary open angle glaucoma. Brimonidine treatment was stopped immediately. Additionally, topical corticosteroids were prescribed in 18 eyes and tapered down during the following 4 weeks. Thirteen eyes did not need surgical or laser treatment (median follow-up time 15 months). No patient showed recurrence of inflammation after cessation of brimonidine. CONCLUSIONS: This type of anterior uveitis is an uncommon but important manifestation which should always be considered in glaucoma patients on brimonidine treatment. Although treatable at its root cause, problems may persist, especially with respect to IOP control. The latter may necessitate glaucoma surgery after the resolved episode of the uveitis.
Keywords: Glaucoma; Anterior uveitis; Brimonidine; Brimonidine-associated uveitis; Drug-induced uveitis

Uveitis and cystoid macular oedema secondary to topical prostaglandin analogue use in ocular hypertension and open angle glaucoma. - Hu J; Vu JT; Hong B; Gottlieb C (The British journal of ophthalmology, 2020)
BACKGROUND: Of the side effects of prostaglandin analogues (PGAs), uveitis and cystoid macular oedema (CME) have significant potential for vision loss based on postmarket reports. Caution has been advised due to concerns of macular oedema and uveitis. In this report, we researched and summarised the original data suggesting these effects and determined their incidence. METHODS: Preferred Reporting Items for Systematic review and Meta-Analyses guidelines were followed. Studies evaluating topical PGAs in patients with ocular hypertension or open angle glaucoma were included. MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, LILACS and ClinicalTrials.gov were searched between 1946 and 2019. Experimental studies, animal studies and randomised studies with other intraocular pressure-lowering eye drops were excluded. RESULTS: 214 studies (28 232 patients) met the inclusion criteria. Using prospective data, the incidence of uveitis and CME among PGA users were 62/28 232 (0.22%) and 25/28 232 (0.09%), respectively. A higher frequency of both uveitis and CME were found among latanoprost users compared with bimatoprost. There were 21 case studies reporting CME including 48 eyes in 43 patients. 47 of 48 eyes (97.9%) had previous incisional ocular surgery. 8 eyes were re-challenged, of which 7 (87.5%) recurred. 7 case studies reported uveitis in 15 eyes of 10 patients. 7 of 15 eyes (46.7%) were either pseudophakic or aphakic. 6 eyes were re-challenged, and all 6 (100%) recurred. CONCLUSIONS: Cases of uveitis or CME revealed a confounding effect of ocular surgery, aphakia or subluxed intraocular lens. PGAs may be used in non-surgical patients without concern of causing CME or uveitis. The incidences of PGA-associated CME and uveitis are rare with limited prospective studies on the cause-effect relationship.
Keywords: glaucoma; inflammation; macula; pharmacology

[Incidence of endogenous uveitis at Kyushu University Hospital]. - Koike I; Sonoda KH; Ariyama A; Sata I; Kifuku K; Miyazaki M; Kawano Y; Ishibashi T (Nippon Ganka Gakkai zasshi, 2004)
PURPOSE: We performed a clinical statistical study on recent patients with endogenous uveitis at the clinic of the Department of Ophthalmology, Kyushu University Hospital. SUBJECTS: We studied 616 patients with endogenous uveitis who first visited the clinic of the Department of Ophthalmology, Kyushu University Hospital, between January 1996 and December 2001. RESULTS AND CONCLUSION: The most frequent clinical entity was sarcoidosis (8.6%), followed by Behçet's disease (8.4%), Vogt-Koyanagi-Harada syndrome (6.5%), human T-lymphotropic virus type I (HTLV-1) uveitis (3.9%), and toxoplasmosis (2.6%). Unclassified uveitis comprised 58.1% in our study. Next we classified the subjects into four age groups; adolescent (0-19 years old), young (20-39 years old), middle-aged (40-59 years old), and elderly (60-years old). We also classified the disease into four groups: uveitis pan, anterior, intermediate, and posterior uveitis, according to the site of inflammation. The most frequent clinical entity was Behçet's disease in the young group, and sarcoidosis in the elderly group. The frequency of unclassified uveitis was high in the adolescent and the elderly groups. As to the anatomic diagnosis of uveitis, panuveitis was most frequent, followed by anterior, posterior, and intermediate uveitis. Finally we investigated the frequency of secondary glaucoma. The frequency in all 616 patients was 19.7%. Secondary glaucoma was more frequent in male patients and more frequent in the middle-aged and the elderly groups.

Juvenile idiopathic arthritis-associated uveitis. - Sen ES; Ramanan AV (Best practice & research. Clinical rheumatology, 2017)
Juvenile idiopathic arthritis (JIA) is the commonest rheumatic disease in children and JIA-associated uveitis its most frequent extra-articular manifestation. The uveitis is potentially sight-threatening and thus carries a considerable risk of morbidity with associated reduction in quality of life. The commonest form of uveitis seen in association with JIA is chronic anterior uveitis, which is almost always asymptomatic in the initial stages. Therefore, screening for JIA-associated uveitis in at-risk patients is essential. The aim of early detection and treatment is to minimise intraocular inflammation and to avoid complications that lead to visual loss, which can result from both disease activity and medications. The sight-threatening complications of JIA-associated uveitis include cataracts, glaucoma, band keratopathy, and macular oedema. There is increasing evidence for the early introduction of systemic immunosuppressive therapies to reduce topical and systemic use of glucocorticoids. A recently published randomised controlled trial of adalimumab in JIA-associated uveitis now provides convincing evidence for the use of this biologic in patients who fail to respond adequately to methotrexate. Tocilizumab and abatacept are being investigated as alternatives in children inadequately treated with anti-tumour necrosis factor drugs.

Heparin-surface-modified intraocular lens implantation in patients with glaucoma, diabetes, or uveitis. - Lin CL; Wang AG; Chou JC; Shieh G; Liu JH (Journal of cataract and refractive surgery, 1994)
We investigated the clinical outcome in two groups of patients who had an extracapsular cataract extraction and implantation of a heparin-surface-modified intraocular lens (HSM IOL) (Group 1) or a conventional poly(methyl methacrylate) (PMMA) lens (Group 2). Nineteen patients in Group 1 had bilateral cataract extraction with implantation of an HSM IOL in one eye and a conventional lens in the fellow eye. All patients had glaucoma, diabetes, or uveitis. Over the long term, there was no statistically significant difference between groups in visual acuity, corneal edema, anterior chamber reaction, and amount of posterior synechia formation and IOL deposits. Yet short-term clinical evaluation revealed significantly less reaction in eyes with the HSM IOL than in those with the PMMA lens. In patients with both lens types implanted, early postoperative anterior chamber reaction was less and IOL deposits fewer in the eye with the HSM IOL.

Cytomegalovirus Anterior Uveitis Following Topical Cyclosporine A. - Siak J; Chee SP (Ocular immunology and inflammation, 2018)
Cytomegalovirus (CMV) anterior uveitis and endotheliitis occurs among immunocompetent individuals and may manifest as Posner-Schlossman syndrome or Fuchs uveitis syndrome. The condition may first present following ophthalmic surgery, the use of a fluocinolone-sustained steroid drug delivery implant, or the use of topical prostaglandin analogues for the treatment of glaucoma. We report the first case of a non-human immunodeficiency virus-infected individual who presented with CMV anterior uveitis after the use of topical cyclosporine A 0.05% ophthalmic emulsion for the treatment of symptomatic dry eyes.

Juvenile idiopathic arthritis-associated uveitis: a nationwide population-based study in Taiwan. - Yu HH; Chen PC; Wang LC; Lee JH; Lin YT; Yang YH; Lin CP; Chiang BL (PloS one, 2013)
OBJECTIVE: The incidence and prevalence of juvenile idiopathic arthritis (JIA) vary widely across the world but data in East Asia is lacking. Uveitis is a serious cause of morbidity in JIA. This study aimed to analyze the incidence and prevalence of JIA, and the characteristics of JIA-associated uveitis in Taiwan. METHODS: A population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. Each patient was individually tracked from 1999 to 2009 to identify the diagnosis of JIA and uveitis using the International Classification of Diseases diagnostic codes. Multivariate logistic regression was used to determine the risk factors and complications of uveitis in patients with JIA. RESULTS: The study cohort had 2636 cases of JIA and included juvenile rheumatoid arthritis (57.7%), enthesitis-related arthritis (ERA) (39.2%), and psoriatic arthritis (3.1%). The average annual incidence of JIA and JIA-associated uveitis were 4.93 (range, 3.93-6.23) and 0.25 (range, 0.12-0.37) cases per 100,000 population, respectively. The average period prevalence of JIA was 33.8 cases per 100,000 population. Uveitis occurred in 4.7% of patients with JIA, while JIA-associated uveitis was complicated by cataract (11.2%) and glaucoma (24.8%). Enthesitis-related arthritis was significantly associated with uveitis (OR: 3.47; 95% CI: 2.24-5.37) (p<0.0001). Uveitis diagnosed before JIA was the most significant risk factor for complications of glaucoma or cataract (OR: 3.54; 95% CI: 1.44-8.72) (p = 0.006). CONCLUSIONS: The incidence of JIA is low but that of JIA-associated uveitis is increasing. Higher percentage of males in patients with ERA and the strong association between ERA and uveitis are unique for children with JIA in Taiwan. Uveitis diagnosed before arthritis is an important risk factor for complications. Continuous ophthalmologic follow-up is needed for children with JIA or uveitis of unknown etiology.

[Uveitis and juvenile idiopathic arthritis]. - García-Consuegra Molina J; Tapia Moreno R; Abelairas Gómez J; Peralta Calvo J; Merino Muñoz R (Anales espanoles de pediatria, 2001)
OBJECTIVE: Anterior uveitis is one of the most important extra-articular manifestations of juvenile idiopathic arthritis (JIA). The objective was to analyze the frequency of uveitis in patients with JIA and to describe its clinical and evolutive characteristics. PATIENTS AND METHOD: Among the 234 children diagnosed with JIA in our hospital, those presenting uveitis were studied. RESULTS: Seventeen children, 16 girls and 1 boy, presented uveitis in 28 eyes, representing a prevalence of 7.3%. Among patients with pauci- or oligo-articular forms of the disease, the percentage increased to 13.3%; polyarticular forms accounted for 10%. Only one of the 12 patients with psoriatic arthritis developed uveitis. Mean age at diagnosis of the ocular condition was 4.5 years and the interval between diagnosis of arthritis to detection of uveitis was 661.5 months. In two patients uveitis was diagnosed before arthritis. Thirty-seven episodes of uveitic activity were identified, of which 27 were asymptomatic. Fifty-three percent of the affected eyes developed complications (posterior synechias in 43%, cataracts in 25%, in-band keratopathy in 18% and glaucoma in 7%). Surgery was required in six eyes. A marked loss of vision occurred in four eyes, despite ophthalmologic treatment. Conclusions Anterior uveitis is a cause of morbidity in JIA. Periodic ophthalmologic explorations are essential for early diagnosis and treatment.

Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis. - Weiss AH; Wallace CA; Sherry DD (The Journal of pediatrics, 1998)
We used low-dose methotrexate to treat seven children with juvenile rheumatoid arthritis-associated uveitis complicated by cataract and glaucoma or resistant to topical corticosteroid. The use of methotrexate decreased the severity of uveitis in six of seven patients and allowed for the discontinuation or reduction of corticosteroid drops.

Unilateral recalcitrant glaucoma associated with cytomegalovirus in an immunocompromised child with Wiskott-Aldrich syndrome. - Kaushik S; Singh R; Gupta A; Singh S; Suri D; Sarpal N; Pandav SS (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2013)
We report a case of anterior uveitis and unilateral recalcitrant glaucoma in an immunocompromised 6-year-old boy diagnosed with Wiskott-Aldrich syndrome who presented with elevated intraocular pressure (IOP), mild anterior uveitis, and unilateral acute glaucoma. Polymerase chain reaction from the aqueous was positive for cytomegalovirus (CMV). After initially responding to ganciclovir, the IOP rose again. With worsening optic nerve status, the patient underwent glaucoma filtration surgery with mitomycin C, and a postoperative regimen for CMV retinitis was initiated.

Quality of Life and Risks Associated with Systemic Anti-inflammatory Therapy versus Fluocinolone Acetonide Intraocular Implant for Intermediate Uveitis, Posterior Uveitis, or Panuveitis: Fifty-four-Month Results of the Multicenter Uveitis Steroid Treatment Trial and Follow-up Study. - Multicenter Uveitis Steroid Treatment (MUST) Trial Follow-up Study Research Group (Ophthalmology, 2015)
PURPOSE: To evaluate the risks and quality-of-life (QoL) outcomes of fluocinolone acetonide implant versus systemic therapy with corticosteroid and immunosuppression when indicated for intermediate uveitis, posterior uveitis, and panuveitis. DESIGN: Additional follow-up of a randomized trial cohort. PARTICIPANTS: Two hundred fifty-five patients with intermediate uveitis, posterior uveitis, or panuveitis, randomized to implant or systemic therapy. METHODS: Randomized subjects with intermediate uveitis, posterior uveitis, or panuveitis (479 eyes) were followed up over 54 months, with 79.2% completing the 54-month visit. MAIN OUTCOME MEASURES: Local and systemic potential complications of the therapies and self-reported health utility and vision-related and generic health-related QoL were studied prospectively. RESULTS: Among initially phakic eyes, cataract and cataract surgery occurred significantly more often in the implant group (hazard ratio [HR], 3.0; P = 0.0001; and HR, 3.8; P < 0.0001, respectively). In the implant group, most cataract surgery occurred within the first 2 years. Intraocular pressure elevation measures occurred more frequently in the implant group (HR range, 3.7-5.6; all P < 0.0001), and glaucoma (assessed annually) also occurred more frequently (26.3% vs. 10.2% by 48 months; HR, 3.0; P = 0.0002). In contrast, potential complications of systemic therapy, including measures of hypertension, hyperlipidemia, diabetes, bone disease, and hematologic and serum chemistry indicators of immunosuppression toxicity, did not differ between groups through 54 months. Indices of QoL initially favored implant therapy by a modest margin. However, all summary measures of health utility and vision-related or generic health-related QoL were minimally and nonsignificantly different by 54 months, with the exception of the 36-item Short-Form Health Survey physical component summary score, which favored implant by a small margin at 54 months (3.17 on a scale of 100; P = 0.01, not adjusted for multiple comparisons). Mean QoL results were favorable in both groups. CONCLUSIONS: These results suggest that fluocinolone acetonide implant therapy is associated with a clinically important increased risk of glaucoma and cataract with respect to systemic therapy, suggesting that careful monitoring and early intervention to prevent glaucoma is warranted with implant therapy. Systemic therapy subjects avoided a significant excess of toxicities of systemic corticosteroid and immunosuppressive therapies in the trial. Self-reported QoL measures initially favored implant therapy, but over time the measures converged, with generally favorable QoL in both groups.

Uveitis (acute anterior). - Islam N; Pavesio C (Clinical evidence, 2010)
INTRODUCTION: Anterior uveitis is rare, with an annual incidence of 12/100,000 population, although it is more common in Finland (annual incidence of 23/100,000), probably because of genetic factors, such as high frequency of HLA-B27 in the population. It is often self-limiting, but can, in some cases, lead to complications such as posterior synechiae, cataract, glaucoma, and chronic uveitis. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of anti-inflammatory eye drops on acute anterior uveitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found six systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids, mydriatics, and non-steroidal anti-inflammatory drug eye drops.

Phacoemulsification with intraocular lens implantation in patients with uveitis. - Ram J; Gupta A; Kumar S; Kaushik S; Gupta N; Severia S (Journal of cataract and refractive surgery, 2010)
PURPOSE: To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. SETTING: Tertiary care center, Chandigarh, India. METHODS: Consecutive patients with uveitis and visually significant cataract were retrospectively studied for outcomes after phacoemulsification and implantation of a poly(methyl methacrylate) (PMMA) or a hydrophobic acrylic IOL. RESULTS: The study comprised 108 eyes of 81 patients (50 women, 31 men) with a mean age of 42.3 years +/- 13.98 (SD) (range 18 to 75 years) and a mean follow-up of 21.95 months (range 12 to 66 months). Etiology of uveitis was presumed tuberculosis (n = 24), Vogt-Koyanagi-Harada syndrome (n = 9), Behçet disease (n = 8), sarcoidosis (n = 5), ankylosing spondylitis (n = 4), serpiginous choroiditis (n = 2), and idiopathic (n = 29). The mean corrected distance visual acuity (CDVA) was 1.08 +/- 0.85 logMAR preoperatively and 0.42 +/- 0.78 D logMAR postoperatively; the improvement was statistically significant (P<.001, paired t test); Seventy-seven eyes (71.30%) achieved a CDVA between 0.00 logMAR and 0.30 logMAR (20/20 to 20/40 Snellen). Posterior capsule opacification (PCO) requiring neodymium:YAG capsulotomy occurred in 31 eyes (28.70%); posterior synechias in 27 eyes (25.00%); cystoid macular edema (CME) in 23 eyes (21.30%); recurrent uveitis in 6 eyes (5.55%); and epiretinal membrane formation, glaucoma, and iris bombe in 5 eyes (4.63%) each. CONCLUSIONS: Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataract and uveitis. The main complications affecting visual outcomes were macular involvement, CME, PCO, and glaucoma. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Uveitis (acute anterior). - Islam N; Pavesio C (BMJ clinical evidence, 2007)
INTRODUCTION: Anterior uveitis is rare, with an annual incidence of 12/100,000 population, although it is more common in Finland (annual incidence of 23/100,000), probably because of genetic factors, such as high frequency of HLA-B27 in the population. It is often self-limiting, but can, in some cases, lead to complications such as posterior synechiae, cataract, glaucoma, and chronic uveitis. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of anti-inflammatory eye drops on acute anterior uveitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found six systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids, mydriatics, and non-steroidal anti-inflammatory drug eye drops.

Uveitis Associated with Juvenile Idiopathic Arthritis, our Observations. - Cosickic A; Halilbasic M; Selimovic A; Avdagic H (Medical archives (Sarajevo, Bosnia and Herzegovina), 2017)
INTRODUCTION: Uveitis as extra-articular manifestation of juvenile idiopathic arthritis (JIA) is present in 20% of children with the persistent form, in 30% with the extended oligoarticular form, while it is present in psoriatic and polyarticular rheumatoid factor (RF) negative arthritis in 10% and 14%, respectively. AIM: The aim of the study was to evaluate the frequency of uveitis and its complications in children with JIA. MATERIAL AND METHODS: A retrospective study was conducted with an analysis of the medical records of children with JIA who were treated for the last 5 years. The analysis included the following: the child's age and sex, age at onset of arthritis, of uveitis, complications, RF values and antinuclear antibodies (ANA). RESULTS: The study included 97 children with JIA: in 14 (14.4%) uveitis was observed; the most common form of JIA was the oligoarticular extended form (6/14), oligoarticular persistent form was observed in 5 children, while 3 children with uveitis had polyarticular RF negative JIA. The age of arthritis onset was lower in children with uveitis (4.7 vs 8.2 years); ANA positivity was more common in children with JIA and uveitis (64% vs 41%). Uveitis was the first manifestation of the disease for 2 children; 28.6% of children had clinically asymptomatic uveitis, while 42.4% of children developed uveitis within 4 years from the JIA onset. 8/14 children developed uveitis complications: 3 cases of synechia, 2 band keratopathy, 2 cataracta, 1 glaucoma. CONCLUSION: Uveitis as significantly present manifestation of JIA requires to timely recognize, treat, monitor children in order to prevent complications.

Neovascular glaucoma in a Nigerian African population. - Ashaye AO; Adeoti CO (East African medical journal, 2006)
OBJECTIVE: To determine the ocular and systemic factors associated with neovascular glaucoma (NVG) in an African population. DESIGN: Hospital based cross sectional study. SETTING: Eye clinic, Department of Ophthalmology, University College Hospital, Ibadan, Nigeria. SUBJECTS: Sixty one consecutive patients with clinical diagnosis of NVG seen between January 1995 and December 1999 had a complete ocular evaluation. RESULTS: Among the 61 subjects studied with an identifiable aetiological factor presumably causing neovascular glaucoma, 82% had associated posterior segment diseases producing ischaemia. These were retinal venous obstruction (78.7%), retinal arterial occlusion (1.6%). Those with no identifiable vaso-occlusive disease had couching (11.5%), aphakia with vitreous loss (3.3%) and chronic uveitis (1.6%). Systemic arterial hypertension was present in 62.3% while diabetes mellitus was present in only 8.3% of the subjects studied. Chronic uveitis and penetrating eye injury were infrequently diagnosed. Chronic open angle glaucoma was present in the other eye of 37.7% of subjects. Neovascular glaucoma was unilateral in 95.1% of subjects. 84.4% of affected eyes were blind on presentation. Males outnumbered females among subjects with NVG above 40 years, while females outnumbered males in the subjects below 40 years of age. Eyes of that were couched constitute a significant proportion of subjects with neovascular glaucoma. CONCLUSION: Medical conditions such as systemic hypertension, diabetes and ocular conditions like retinal vein, retinal artery occlusion, couching and glaucoma were associated with NVG. Most of these ocular and systemic associations should be identified early and treated to prevent neovascular glaucoma in the other eye of the subject.

Extracapsular cataract surgery with and without intraocular lens implantation in Fuchs' Heterochromic Uveitis. - Jones NP (Eye (London, England), 1990)
The results of extracapsular cataract extraction, with or without posterior chamber intraocular lens (IOL) implantation, in Fuchs Heterochromic Uveitis, are reported. Twenty-nine patients underwent 30 operations. Twenty-two patients (73%) obtained a visual acuity of 6/12 or better. Post-operative uveitis or glaucoma were encountered in 13 eyes, including 11 of 20 eyes with IOL implantation (55%), and two of ten eyes without IOL implantation (20%). IOL implantation is a significant additional factor in cataract surgery in patients with FHU. Preoperative risk factors include severe iris atrophy, secondary glaucoma, and severe abnormalities of iris vasculature. IOL implantation is not recommended in these eyes. The routine postoperative use of anti-glaucoma medication is recommended. Long-term postoperative follow-up is important.

Uveitis secondary to leishmaniasis immune reconstitution syndrome in a HIV-positive patient. - Davies O; Allen F; Gruener AM; Simons R; Graham EM; Larbalestier N (International journal of STD & AIDS, 2016)
We describe the case of a HIV-positive patient treated for visceral leishmaniasis who developed uveitis as part of a leishmaniasis immune reconstitution syndrome. Visceral leishmaniasis is increasingly found in HIV-positive adults. Its ophthalmic manifestations can range from relatively minor to complicated anterior uveitis, leading to secondary glaucoma and loss of vision. Clinicians caring for people living with HIV should be alert to the complications of leishmaniasis that can occur before and during treatment.

Ocular uveitis as the initial presentation of syphilis. - Hong MC; Sheu SJ; Wu TT; Chuang CT (Journal of the Chinese Medical Association : JCMA, 2007)
BACKGROUND: To document the characteristics of syphilitic patients who present with ocular uveitis clinically and are diagnosed by an ophthalmologist first. METHODS: Retrospective chart review of uveitis patients in the department of ophthalmology between 1992 and 2004 was done. We included only those patients with positive serologic tests, active ocular uveitis, and record of detailed examination. RESULTS: There were 8 syphilitic patients (14 eyes) who presented with ocular syphilis clinically and who were diagnosed by an ophthalmologist first. The ocular diagnosis included panuveitis (11 eyes, 78.6%), anterior uveitis (2 eyes, 14.3%), and posterior uveitis (1 eye, 7.1%). Two patients (25%) had unilateral eye involvement, and 6 patients (75%) had involvement in bilateral eyes. One patient (2 eyes) with panuveitis also had bilateral exudative retinal detachment and chronic angle closure glaucoma. All 8 patients were negative for human immunodeficiency virus. Dark field examination of aqueous humor in 2 cases revealed Treponema pallidum, which was confirmed by immunofluorescent test. Treatment included systemic penicillin in 7 patients and oral tetracycline in 1 patient (due to penicillin allergy). Visual function and uveitis improved after treatment in all patients. CONCLUSION: Syphilis can be presented initially as ocular uveitis without obvious systemic manifestation. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis. If treated early enough, the response is good, even if the patient is allergic to penicillin. Awareness of the multiple manifestations of ocular syphilis is the key to early detection of the disease.

Visual prognosis in children with chronic anterior uveitis and arthritis. - Cabral DA; Petty RE; Malleson PN; Ensworth S; McCormick AQ; Shroeder ML (The Journal of rheumatology, 1994)
OBJECTIVE: To determine the visual and ocular prognosis for children with uveitis and chronic arthritis and in patients with uveitis with juvenile rheumatoid arthritis (JRA) or juvenile psoriatic arthritis (JPsA) and to evaluate risk factors associated with ocular complications. METHODS: We studied 49 children with chronic arthritis having greater than 2 years ophthalmological followup from onset of uveitis. Visual acuity and ocular complications (band keratopathy, synechiae, cataracts, glaucoma, or phthisis bulbi) were documented. For the 45 patients with JRA/JPsA, the antinuclear antibody and HLA status, time and mode of onset, and the course of uveitis, were evaluated as risk factors for developing complications. RESULTS: Mean followup was 9.4 years from diagnosis of uveitis (82 affected eyes). Ocular complications developed in 27 eyes (33%). Visual impairment (corrected acuity 20/50 or worse), occurring only in the presence of complicated uveitis, was present in 12 eyes (15%). Of 45 patients with JRA/JPsA, over 95% developed uveitis within 5 years of onset of arthritis. Those with complicated uveitis (n = 13, mean followup 8.6 years) and uncomplicated uveitis (n = 32, mean followup 10 years) were compared: factors significantly associated with complicated uveitis were (1) a chronic course of uveitis (2) JPsA (3) diagnosis of uveitis prior to, or at the time of arthritis onset (4) symptomatic onset. CONCLUSION: The risk of developing uveitis 5 years after the onset of JRA/JPsA is small. Although ocular complications were common (33%) among patients with uveitis, normal vision was maintained or correctable for over half of them. Those with uveitis and risk factors for developing ocular complications may need close ophthalmological scrutiny.

Efficacy and safety of latanoprost in eyes with uveitic glaucoma. - Markomichelakis NN; Kostakou A; Halkiadakis I; Chalkidou S; Papakonstantinou D; Georgopoulos G (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.

Uveitis and Juvenile Psoriatic Arthritis or Psoriasis. - Salek SS; Pradeep A; Guly C; Ramanan AV; Rosenbaum JT (American journal of ophthalmology, 2018)
PURPOSE: To describe the phenotype of the uveitis that accompanies juvenile psoriatic arthritis or psoriasis. DESIGN: Observational case series. METHODS: Setting: Two university-based referral clinics: 1 in England, 1 in the United States. STUDY POPULATION: Five children with uveitis and psoriatic arthritis and 1 with uveitis and psoriasis Observational Procedure: Retrospective chart review. MAIN OUTCOME MEASURES: Demographics of subjects such as age and sex; description of ocular and joint disease; surgical and other complications; medical treatment. RESULTS: Five of the 6 children in this series had the onset of disease at or before age 6 (P = .0008 compared to expected age of onset for psoriatic arthritis in childhood). All children in this series had an inadequate response to topical corticosteroids. Most of the children were treated with systemic corticosteroids for many months, yet all of them went on to require methotrexate. Therapy with systemic methotrexate did not suffice, as all the patients also required some form of biologic therapy. Five of 6 had surgeries such as vitrectomy, cataract extraction, or a procedure for glaucoma control. CONCLUSIONS: The observations suggest that the uveitis that accompanies juvenile psoriatic arthritis might be a distinct disease that is particularly severe when its onset affects children aged 6 years or younger.

Intraocular lens implantation in patients with juvenile idiopathic arthritis-associated uveitis. - Kotaniemi K; Penttila H (Ophthalmic research, 2006)
OBJECTIVE: To evaluate the development of cataract and the results of cataract surgery with intraocular lens (IOL) implantation in patients with chronic uveitis associated with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: A hospital-based retrospective case series consisted of 25 patients with JIA-associated uveitis. The mean age of the patients was 5.8 years at the onset of arthritis and 6.8 years at the onset of uveitis. During the 15-year study period cataract surgery with implantation of an IOL was performed in 36 eyes. In 17 eyes phacoemulsification and initial posterior capsulectomy with anterior core vitrectomy were performed. The treatment of JIA and uveitis was carefully adjusted with systemic immunosuppressive drugs and topical corticosteroids perioperatively. The mean postoperative follow-up period was 3.3 years. RESULTS: The first signs of cataract were observed 2.3 years (mean) after the diagnosis of uveitis and the cataract operation of the first eye was performed 4.5 years (mean) after the diagnosis of uveitis. After IOL surgery the visual result was good (> or = 0.5) in 64%, moderate (0.3 to < 0.5) in 11% and impaired (< 0.3) in 25% of eyes. Secondary cataract developed in 16 eyes but in none of the eyes with initial posterior capsulectomy and core vitrectomy. Secondary glaucoma developed in 18 eyes, retinal detachment in 2, cystoid macular edema in 16 and band keratopathy in 12 eyes. CONCLUSION: Cataract is an early complication of JIA-associated uveitis. Under strict control of uveitis, IOL implantation is an important alternative in visual rehabilitation for this type of patient.

Aqueous tap and rapid diagnosis of cytomegalovirus anterior uveitis: the Reggio Emilia experience. - De Simone L; Belloni L; Aldigeri R; Zerbini A; Mastrofilippo V; Sangiovanni A; Parmeggiani M; Fontana L; Cimino L (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2019)
PURPOSE: The diagnosis of cytomegalovirus (CMV) anterior uveitis in immunocompetent patients requires confirmation by polymerase chain reaction (PCR) analysis and/or intraocular antibody index (AI) assay. In this study, we analyzed the different contributions of PCR and AI to CMV diagnosis by performing one single aqueous tap. METHODS: A retrospective chart review was conducted of HIV-negative patients attending the Ocular Immunology Unit of Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy, from March 2015 to April 2018 with a diagnosis of hypertensive anterior granulomatous uveitis compatible with suspected CMV etiology. Diagnosis was confirmed by real-time PCR (RT-PCR) and intraocular antibody production against CMV on aqueous humor samples. Clinical features were compared to antibody titer and diagnostic delay. RESULTS: Twenty-three patients with suspected CMV uveitis (13 males, 10 females, mean age 48 ± 16 years) were included in the analysis. AI was positive in 20/23 (87%) samples, and PCR tested positive in 9/23 (39%). By combining both tests, the sensitivity was 100%. Median diagnostic delay was 29 months (IQR 9-107). Diagnostic delay and antibody titer were significantly associated with glaucoma (r = 0.714, p < 0.0001; r = 0.476, p = 0.02, respectively). CONCLUSIONS: Our data suggest that to improve the diagnostic accuracy of CMV anterior uveitis, PCR and AI are both useful and complimentary. In our series, AI was the most sensitive diagnostic tool. One single aqueous tap is sufficient to achieve 100% sensitivity in CMV diagnosis. Early diagnosis is necessary to prevent the development of glaucoma.

Phacoemulsification and posterior chamber intraocular lens implantation in uveitis. - Kang YH; Lee JH (Korean journal of ophthalmology : KJO, 1997)
We reviewed the results of posterior chamber intraocular lens (PCL) implantation following scleral tunnel incision and phacoemulsification (PE) in 28 eyes with uveitis. Best-corrected visual acuity (BCVA) improved in 89% of eyes and the final BCVA was 20/40 or better in 64% of eyes. Intraoperative complication was a posterior capsular break (3 eyes). Postoperative complications were microcorneal edema (4 eyes), anterior chamber hyphema (3 eyes), posterior capsular opacity (3 eyes), fibrinous pupillary membrane (2 eyes), iris posterior synechia (2 eyes), neovascular glaucoma (1 eye), and retinal detachment (1 eye). In two eyes of three aftercataracts, visual improvement was achieved by Nd: YAG capsulotomy. A well-planned PE and PCL implantation through scleral tunnel in uveitis was not much more dangerous than expected.

Comparative analysis of the eye function and complications after removal of complicated cataract due to uveitis and senile cataract. - Jurowski P; Goś R; Kaszuba-Bartkowiak K; Zeman-Miecznik A (Klinika oczna, 2005)
PURPOSE: retrospective, comparative analysis of the effectiveness of the results among patients who underwent removal of complicated cataract due to uveitis and senile cataract. MATERIAL AND METHODS: Patients with cataract enrolled in this study were divided into two groups. Group 1 comprised 30 eyes with complicated cataract due to uveitis. The main causes of uveitis were: rheumatoid arthritis in 8 eyes, ankylosing spondylitis in 7, Reiter syndrome in 3, psoriatic arthritis in 3, systemic sarcoidosis in 2, post-traumatic uveitis in 1. In 6 patients (6 eyes) the etiology of uveitis was unknown. Group 2 comprised 30 eyes with senile cataract. In 5 patients in each group there were coexisting glaucoma. In both groups phacoemulsification or phacoaspiration and foldable three piece IOL implantation were performed. The follow-up period was 12 months. Best corrected visual acuity and intra and postoperative complications were taken into consideration. RESULTS: There were no differences in gender and cataract hardness between the two groups. Significantly younger patients were in group 1 p< 0.01. Mean preop./ postop. visual acuity was better in group 2 as compared with group 1: 0.4/ 0.8 and 0.2/ 0.5, respectively, p < 0.01. In both groups however, the preoperative visual acuity was significantly lowest in patients with coexisting glaucoma: group 1, 0.1 p < 0.01 and in group 2: 0.25 p < 0.001. Significantly more frequent intraoperative complications were observed in group 1 as compared with group 2 e.g., corneal burn 10% and 6.6%, local sphincter damage 10% and 0%, zonular rupture 10% and 3.3% respectively. Similarly, in the late postoperative period more frequent complications were observed in group 1 than in group 2 e.g.: secondary cataract 50% and 13.3%, IOL decentration 40% and 6.6%, capsule contraction 80% and 10%, glaucoma 10% and 3.3% respectively. Recurrence of uveitis was observed in 30% of eyes in group 1. CONCLUSIONS: Although the modern microsurgical technology and IOL implantation have led to more effective treatment of senile cataract, the surgery of complicated cataract due to uveitis is still not free from complications. Future surgical strategy of complicated cataract owing to uveitis has to comprise the most adequate qualification criteria e.g. choice of the optimal period for surgery and the most convenient surgical technique as well as the most effective perioperative anti-inflammatory treatment.

Adverse events after intravitreal triamcinolone in patients with and without uveitis. - Galor A; Margolis R; Brasil OM; Perez VL; Kaiser PK; Sears JE; Lowder CY; Smith SD (Ophthalmology, 2007)
PURPOSE: To evaluate the rates of adverse ocular events after intravitreal triamcinolone acetonide (IVTA) injection in patients with and without uveitis. DESIGN: Retrospective observational case series. PARTICIPANTS: Two hundred twenty-two eyes of 173 patients were included in the study: 45 eyes of 31 patients with macular edema (ME) due to uveitis and 177 eyes of 142 patients with ME secondary to other etiologies. METHODS: Retrospective review of patients who received IVTA at the Cole Eye Institute for ME attributable to various causes between the years 2001 and 2005. Data review of clinical records included patient demographics, etiology of ME, and adverse outcomes after injection. Rates of adverse outcomes in patients with and without uveitis were compared. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) elevation and posterior subcapsular cataract (PSC) progression. RESULTS: Uveitis patients were significantly younger, more likely to be female, and more likely to have had prior posterior sub-Tenon's capsule steroid injection and/or glaucoma therapy than their nonuveitis counterparts. In a multivariate analysis adjusting for the differences in these factors, the presence of uveitis was the strongest risk factor for an adverse IOP event (odds ratio, 2.5; 95% confidence interval [CI], 1.0-6.1; P = 0.05). The odds of having a documented increase in PSC after IVTA injection were 5.6 times greater in uveitis eyes (P = 0.007; 95% CI, 1.6-19.6). CONCLUSIONS: Intraocular pressure elevation and PSC progression occurred with greater frequency in uveitis patients receiving IVTA. Patients with uveitis treated with IVTA should be counseled about these risks and monitored closely.

Long-term results of cataract extraction with intraocular lens implantation in patients with uveitis. - Rahman I; Jones NP (Eye (London, England), 2005)
OBJECTIVE: To investigate the long-term visual results after cataract extraction in patients with uveitis, and to demonstrate the long-term viability of intraocular lenses. DESIGN: In all, 61 patients (72 eyes), with update clinical examination, were retrospectively evaluated. Comparison of preoperative, postoperative, and latest visual function including best-corrected Snellen visual acuity, progression of uveitis and its complications, need for postoperative medical or surgical interventions. RESULTS: After a minimum follow-up of 5 years (mean 7 years 7 months), 82% of eyes maintained a visual improvement of two Snellen lines, 74% maintained 6/9 or better, and 14% had 6/18 or worse. The mode acuity was better than 6/6. The prevalence of macular oedema or scarring was 24%, of posterior capsule opacification 96%, and of glaucoma drainage, 15%. CONCLUSIONS: We report the long-term follow-up of cataract extraction and intraocular lens (IOL) implantation performed by a single surgeon on patients with uveitis attending a regional tertiary referral uveitis clinic. Using stringent perioperative and postoperative control of inflammation, patients with uveitis usually maintain high visual acuity over long-term follow-up. The incidence of sight-threatening postoperative complications is low and no ongoing complication has been attributed to IOL implantation.

Cataract extraction and intraocular lens implantation in children with uveitis. - Lundvall A; Zetterström C (The British journal of ophthalmology, 2000)
AIM: To evaluate the long term results of cataract surgery with intraocular lens implantation (IOL) in children with uveitis. METHODS: The study included 10 eyes in seven children (age 3.5-10 years, mean 6.5 years). The cataract surgery included capsulorhexis of the anterior and the posterior capsule, anterior vitrectomy in some eyes, and implantation of a heparin surface modified (HSM) poly(methyl methacrylate) (PMMA) IOL into the capsular bag. RESULTS: Follow up periods ranged from 1 to 5 years. Best corrected visual acuity after surgery reached 20/50-20/20 in all but two eyes. Opacities or membranes requiring reoperation developed in seven eyes. Glaucoma developed in three eyes after the cataract operation. CONCLUSION: These results suggest that implantation of a HSM PMMA IOL is an alternative to correct aphakia also in children with uveitis.

[Epidemiology of uveitis in juvenile idiopathic arthritis from a national paediatric rheumatologic and ophthalmologic database]. - Heiligenhaus A; Niewerth M; Mingels A; Ganser G; Thon A; Pleyer U; Greiner K; Minden K (Klinische Monatsblatter fur Augenheilkunde, 2005)
BACKGROUND: Uveitis is a frequent and potentially vision-threatening manifestation of juvenile idiopathic arthritis (JIA). There are only a few population-based studies providing data on the frequency and severity of uveitis. METHODS: Documentation of patients with JIA was collected in a national database. An analysis of the paediatric rheumatologic and ophthalmologic data collected from all patients that were included in 2002 was performed. RESULTS: Uveitis was documented in 12 % of a total of 3271 JIA patients: extended oligoarthritis (25 %), persistent oligoarthritis (16 %), seronegative polyarthritis (4 %), seropositive polyarthritis (2 %), psoriatic arthritis (10 %), enthesitis-related arthritis (ERA) (7 %), systemic arthritis (1 %), other arthritis forms (11 %). Ophthalmologic data were available from 115 uveitis patients (28 %). Mean age at onset of uveitis was 5.2 (SD 3.2) years. JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs. 7.0 years), and were more often girls (74 vs. 63 %) or ANA-positive (86 vs. 42 %) than the patients without uveitis. Uveitis complications were present in 45 % at initial presentation of uveitis. After a mean duration of 5.6 years, complications were noted in 56 %, and included band keratopathy (29 %), posterior synechiae (27 %), cataract (26 %), glaucoma (8 %), and macula oedema (6 %). Final visual acuity was less than 20/50 in 31 % and less than 20/200 in 12 % of eyes. In patients with uveitis, immunosuppressive or immunomodulatory drugs were used significantly more often than in patients without uveitis (75 % vs. 43 %). CONCLUSIONS: The nationwide data documents the spectrum of uveitis in patients with JIA, the complications and the therapy for uveitis. The high rate of uveitis complications at the time of diagnosis points out the need for early ophthalmologic screening and therapy, and for a close collaboration between ophthalmologist and paediatric rheumatologist.

A Rare Patient With Orbital Apex Syndrome, Anterior Uveitis, and Necrotizing Scleritis Due to Herpes Zoster Ophthalmicus. - Aydin E; Balikoglu-Yilmaz M; Imre SS; Koc F; Kazanci L; Ozturk AT (The Journal of craniofacial surgery, 2016)
The purpose of this study was to describe a patient of orbital apex syndrome, anterior uveitis, secondary glaucoma, corneal dellen, and necrotizing scleritis following an attack of herpes zoster ophthalmicus, and the placement of a pericardial patch graft. A 64-year-old male patient with blepharoptosis of his right eye and multiple vesicles on the forehead, nose and cheeks, limitation on all gazes, blepharoptosis, and exophthalmia was eventually diagnosed with ophthalmic zona with orbital apex syndrome. After the treatment with systemic antiviral and steroid, there was complete recovery of the unilateral vesicular eruption, ophthalmoplegia, and ptosis at the third month follow-up. However, anterior uveitis, necrotizing scleritis, secondary glaucoma, and corneal dellen developed during follow-up. At the ninth month, pericardial patch graft (Tutoplast) was placed due to progression of the scleral thinning. Graft vascularization was completed. Careful and long-term follow-up of patients with ophthalmic zona is required for possible ophthalmic complications of varicella zoster virus infections. A pericardial patch graft might be placed due to the development of necrotizing scleritis.

Molteno implants as a treatment for refractory glaucoma in black patients. - Freedman J; Rubin B (Archives of ophthalmology (Chicago, Ill. : 1960), 1991)
Eighty-two black patients with refractory glaucoma were treated with a single-plate Molteno implant inserted in a single-stage procedure. A successful outcome (intraocular pressure less than or equal to 21 mm Hg with or without adjunctive medical therapy) was achieved in 72% of the patients with a mean follow-up of 30 months. Success was achieved in 23 (73%) of the 31 patients with open angle glaucoma, 20 (83%) of the 24 patients with either aphakic or pseudophakic glaucoma, 12 (67%) of the 18 patients with neovascular glaucoma, four (80%) of the five patients with uveitic glaucoma, and two (50%) of the four patients with congenital glaucoma. All but four patients required additional medical therapy. Visual acuities remained the same or improved in 21 (68%) of the 31 patients with open angle glaucoma, 11 (61%) of the 18 with neovascular glaucoma, 19 (79%) of the 24 patients with aphakic/pseudophakic glaucoma, three (75%) of the four patients with congenital glaucoma, and four (80%) of the five patients with uveitic glaucoma. Complications included hyphema (18%), "kissing" choroidal effusion (6%), blocked tube (8%), flat anterior chamber (12%), cataracts (5%), Tenon's cyst (encapsulated bleb) (17%), uveitis (7%), phthisis bulbi (5%), and erosion of the silicone tube (1%).

Characteristics of Cytomegalovirus Uveitis in Immunocompetent Patients. - Woo JH; Lim WK; Ho SL; Teoh SC (Ocular immunology and inflammation, 2015)
PURPOSE: To present the clinical characteristics of patients with anterior uveitis who had evidence of cytomegalovirus (CMV) infection on polymerase chain reaction PCR-based assays for viral DNA in aqueous samples. METHODS: This was a retrospective observational case series of 16 patients with CMV infection on qualitative polymerase chain reaction PCR-based assays for viral DNA in aqueous samples. Case records of 16 patients were reviewed and relevant clinical information was collected using a standardized data sheet. RESULTS: There were 10 male and 6 female patients, with 16 eyes included. The median age at the first attack was 52 years (range 27-77 years). Thirteen patients (81.3%) presented with an initial BCVA of 20/40 or better. Eleven eyes (68.8%) had anterior chamber inflammation of 1+ cells or less. Eight eyes (50.0%) had concomitant sectoral iris atrophy, while 2 eyes were noted to have heterochromic irides. Eleven patients (68.8%) presented with an elevated intraocular pressure. Seven patients (43.8%) had clinical features that led to a presumptive diagnosis of Posner-Schlossman syndrome, while 3 patients (18.8%) were initially diagnosed with Fuchs heterochromic iridocyclitis. Six patients were initially treated for uveitic glaucoma or anterior uveitis of unknown cause. CONCLUSIONS: There is a spectrum of clinical manifestations of CMV anterior uveitis. A high index of suspicion of a possible viral etiology, especially CMV, and subsequent accurate identification of the virus involved are fundamental to the overall therapeutic approach.

Intraocular pressure outcome of patients with fluocinolone acetonide intravitreal implant for noninfectious uveitis. - Bollinger K; Kim J; Lowder CY; Kaiser PK; Smith SD (Ophthalmology, 2011)
PURPOSE: To evaluate the intraocular pressure (IOP) outcomes of patients with noninfectious posterior uveitis treated with a fluocinolone acetonide (FA) intravitreal implant over an 8-year period. DESIGN: Retrospective clinical case series. PARTICIPANTS: Forty-seven eyes of 35 patients. METHODS: Retrospective review of medical records of all patients receiving FA implants between June 2001 and March 2009 was performed. Data were pooled to record visual acuity (VA) and to characterize the incidence and outcome of glaucoma surgical intervention. MAIN OUTCOME MEASURES: Incidence of glaucoma surgery and IOP before and after glaucoma surgical intervention. Visual acuity before and after FA implant placement. RESULTS: Nineteen of 42 eyes (45%) receiving FA implants over the course of the study period required glaucoma surgical intervention. Success of IOP-lowering surgery was achieved in 94%, 94%, and 92% of eyes at 6, 12, and 24 months postoperatively. No patient lost more than 1 line of VA. There was an average 2-line gain of acuity at 3 years after FA implant placement for those patients who underwent IOP-lowering surgery. CONCLUSIONS: Patients receiving FA implants have a significant risk of increased IOP that frequently necessitates glaucoma surgery. Glaucoma surgery, when necessary, offers an effective method to decrease IOP. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Cataract surgery in patients with sarcoidosis-associated uveitis. - Akova YA; Foster CS (Ophthalmology, 1994)
PURPOSE: The authors analyzed the incidence of cataract development and the visual outcome of cataract surgery performed on patients with sarcoidosis-associated uveitis who were treated at the Immunology Service at the Massachusetts Eye and Ear Infirmary during a 17-year period. METHODS: The records of 102 patients with sarcoidosis-associated uveitis who were treated with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, or with systemic immunosuppressive chemotherapy were reviewed. Cataract surgery was performed on those eyes in which cataract developed, resulting in decreased visual acuity of 20/100 or less. The incidence of cataract development and visual results of cataract extraction and intraocular lens implantation were analyzed. RESULTS: In this cohort of 102 patients, visually significant cataracts that warranted surgery developed in 10 (16 eyes). In addition, four patients (5 eyes) had a visually significant cataract at the time of first evaluation. A total of 14 patients (21 eyes) underwent cataract surgery. Posterior chamber lens implantation accompanied cataract surgery in 19 (90.5%) of 21 eyes. The average final visual acuity of the 21 eyes after cataract surgery was 20/51, and 61% of the eyes achieved a stable visual acuity of 20/40 or better. The major causes of the decreased visual acuity in patients who had less than 20/40 visual acuity were sequelae of chronic posterior uveitis, cystoid macular edema, epiretinal membrane, and glaucomatous optic nerve damage. CONCLUSION: Posterior chamber lens implantation and cataract surgery in patients with sarcoidosis-associated uveitis can be well tolerated when absolute control of the inflammation is achieved. Pre-existing retinal pathology and glaucoma as a result of uncontrolled inflammation resulting in permanent ocular structural damage were found to be the most important factors for determining the postoperative final visual acuity.

Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results. - Callanan DG; Jaffe GJ; Martin DF; Pearson PA; Comstock TL (Archives of ophthalmology (Chicago, Ill. : 1960), 2008)
OBJECTIVES: To evaluate the safety and efficacy of 0.59-mg and 2.1-mg fluocinolone acetonide (FA) intravitreous implants in noninfectious posterior uveitis. DESIGN: A 3-year, multicenter, randomized, historically controlled trial of the 0.59-mg FA intravitreous implant in 110 patients and the 2.1-mg FA intravitreous implant in 168 patients. MAIN OUTCOME MEASURES: Recurrence rate, vision, and complications. RESULTS: Uveitis recurrence was reduced in implanted eyes from 62% (during the 1-year preimplantation period) to 4%, 10%, and 20% during the 1-, 2-, and 3-year postimplantation periods, respectively, for the 0.59-mg dose group (P < .01) and from 58% to 7%, 17%, and 41%, respectively, for the 2.1-mg dose group (P < .01). More implanted eyes than nonimplanted eyes had improved visual acuity (P < .01). Implanted eyes had higher incidences of intraocular pressure elevation (> or = 10 mm Hg) than nonimplanted eyes (P < .01), and glaucoma surgery was required in 40% of implanted eyes vs 2% of nonimplanted eyes (P < .01). Cataracts were extracted in 93% of phakic implanted eyes vs 20% of phakic nonimplanted eyes (P < .01). CONCLUSIONS: The FA implant significantly reduced uveitis recurrence and improved or stabilized visual acuity in subjects with noninfectious posterior uveitis. Most subjects required cataract extraction, and a significant proportion required intraocular pressure-lowering surgery. APPLICATION TO CLINICAL PRACTICE: The FA implant provides an alternative therapy for prolonged control of inflammation in noninfectious posterior uveitis. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00407082.

Postoperative outcomes after implantation of intraocular lenses in eyes with cataract and uveitis. - Mandić Z; Petric I; Bencić G; Vatavuk Z; Bojić L (Collegium antropologicum, 2005)
Despite advances in surgical technique and implant materials, cataract surgery in patients with uveitis is still a challenging procedure. We retrospectively evaluated postoperative outcomes of cataract surgery in 35 eyes of 29 patients with uveitis. Phacoemulsification with posterior chamber intraocular lens implantation was performed in all eyes. Postoperative evaluations were performed at day 2, and then at 7 days, 1, 3, and 6 months respectively. There were 16 males, and 13 females, aged 31 to 68 years. Follow-up ranged from 4 to 35 months. At final follow-up 33 eyes (94%) had an improvement in visual acuity compared with preoperative levels (p < 0,05). Giant cells were observed in the intraocular lens optic in 7 eyes (20%). Posterior capsule opacification occurred in 10 eyes (29%). Clinical cystoid macular edema was observed in 4 eyes, and 2 eyes required trabeculectomy with mitomycin C due to secondary glaucoma. Cataract surgery in patients with uveitis leads to successful visual results after correct surgical timing, and adequate anti-inflammatory therapy. There were no significant differences in the degree of inflammation after implantation of various types of intraocular lenses.

Clinical Characteristics of Uveitis in Patients with Psoriasis in Korea: A Retrospective Multicenter Case Series. - Lee Y; Oh BL; Yu HG; Youn SW; Woo SJ (Korean journal of ophthalmology : KJO, 2021)
PURPOSE: To describe the clinical characteristics and treatment outcomes of uveitis in patients with psoriasis in Korea. METHODS: The medical records of 20 patients (27 eyes) with psoriatic uveitis in two tertiary hospitals were retrospectively reviewed. We analyzed data about patient demographics, uveitis types, laterality, onset of disease, human leukocyte antigen (HLA) types, intraocular pressure, visual acuity, comorbidities, and medical treatments and outcomes for uveitis and psoriasis. RESULTS: The cohort comprised 11 males and nine females (age of onset, 50.1 ± 13.2 years) and the mean follow-up period was 3.9 ± 4.0 years. Types of uveitis included anterior (85%), intermediate (10%), and panuveitis (5%). A total of 13 (65%) cases presented with unilateral involvement and 12 out of 18 patients (66.7%) were positive for HLA-B27. The average intraocular pressure of affected eyes was 11.6 ± 3.6 at the first visit and 13.8 ± 3.6 mmHg at the final visit. The average logarithm of the minimum angle of resolution visual acuity of affected eyes at the initial examination was 0.16 ± 0.52 and 0.27 ± 0.71 at the last examination. Most common comorbidity (13 patients, 65%) was psoriatic arthritis (PsA). All cases underwent topical corticosteroid treatment; however, 11 (55%) required systemic corticosteroid and immunosuppressants for the treatment of uveitis. Notable deterioration in visual outcome was found in two cases (10%) due to severe intraocular inflammation and its complications (uveitic glaucoma and bullous keratopathy). Recurrent uveitis was observed in 57.9% of patients. Patients with PsA tended to have higher positive rate of HLA-B27 (83.3%). However, there was no significant correlation between visual prognosis and location of psoriatic uveitis, presence of PsA, and HLA-B27 positivity. CONCLUSIONS: Psoriatic uveitis in Koreans usually presents with anterior uveitis with unilateral involvement. PsA was the most common comorbidity. In majority of patients, visual outcomes are satisfactory with appropriate topical or systemic immunosuppressive treatment.

[Incidence of uveitis in the northern Kyushu region of Japan --comparison between the periods of 1996-2001 and 2003-2008]. - Hikita S; Sonoda KH; Hijioka K; Fujimoto T; Ito T; Ishibashi T (Nippon Ganka Gakkai zasshi, 2012)
PURPOSE: To report the clinical statistical analysis of patients with uveitis in the northern Kyushu region of Japan. SUBJECTS AND METHODS: This retrospective study involved 735 new patients with uveitis who visited the Kyushu university hospital from January 2003 to December 2008. The subjects were classified into four groups; adolescent (0-19 years), young (20-39 years), middle-aged (40-59 years) and old (60 years or older) and were compared with the results of our previous studies. RESULT: This study comprised 343 men and 392 women. The age averaged 47.2 years. Definitive diagnosis was made in 385 cases (52.4%). The most frequent clinical entity was sarcoidosis (9.8%), followed by Vogt-Koyanagi-Harada disease (7.9%), Behçet's disease (7.6%), acute anterior uveitis associated with human leukocyte antigen (HLA)-B27 (4.5%), herpetic iridocyclitis (3.1%), human T-lymphotropic virus type I associated uveitis (HU) (2.7%), and intraocular lymphoma (2.3%). The proportion of unclassified uveitis was large among females in general, and among adolescents in the four groups. The incidence of secondary glaucoma in the whole group of 735 patients with uveitis was 22.2%. Among the patients with ocular hypertension, the proportion of steroid responders was large in the adolescent group. CONCLUSION: Compared with our previous report, this study shows increasing frequency of sarcoidosis and decreasing frequency of Behçet's disease except in the young group. HU showed a decreasing incidence.

Methotrexate for uveitis associated with juvenile idiopathic arthritis: value and requirement for additional anti-inflammatory medication. - Heiligenhaus A; Mingels A; Heinz C; Ganser G (European journal of ophthalmology, 2007)
PURPOSE: To study the value of methotrexate (MTX) and the requirement for additional anti-inflammatory drugs for the treatment of severe chronic iridocyclitis associated with juvenile idiopathic arthritis (JIA). METHODS: Institutional study of 35 consecutive patients with JIA started on MTX as the single systemic immunosuppressive drug for the treatment of associated iridocyclitis. The clinical epidemiologic data, course of visual acuity (VA), development of complications, and the need for additional anti-inflammatory drugs were analyzed. RESULTS: Mean follow-up with MTX treatment was 27.6 months. Uveitic complications were present in 31 patients before MTX treatment. With MTX, quiescence of uveitis was obtained with (n=21) or without (n=4) additional topical steroids. Additional systemic immunosuppressive drugs were required in another 7 patients: cyclosporine A (n=4), azathioprine (n=1), infliximab (n=1), or etanercept (n=1). Three patients had active uveitis at the end of the follow-up period. During MTX therapy, uveitis first developed in the unaffected fellow eyes in 2 patients, and secondary glaucoma or ocular hypertension occurred in 7 patients. The VA deteriorated in 6, improved in 13, and was stable in the remaining eyes. CONCLUSIONS: The data suggest that MTX is very effective in controlling inflammation of uveitis in patients with JIA. However, additional topical steroids or systemic immunosuppressive drugs are often required.

Cytomegalovirus-related uncontrolled glaucoma in an immunocompetent patient: a case report and systematic review. - Xi L; Zhang L; Fei W (BMC ophthalmology, 2018)
BACKGROUND: Cytomegalovirus can cause ocular anterior uveitis with ocular hypertension. Basis on the therapy, ocular pressure usually can be controlled. We report a case of a man who had unilateral cytomegalovirus anterior uveitis with refractory glaucoma during the process of treatment. CASE PRESENTATION: A 57-year-old man who was diagnosed Posner-Schlossman syndrome and was admitted for repeatly attacks of raised IOP in left eye for 4 months. We found the cytomegalovirus -DNA was high (1800 copies/ml) in his aqueous. After systemic used of antiviral drug accompany with topical used of anti-inflammation, anti-glaucoma agents and genciclovir gel, the ocular pressure was dropped to normal. While the pressure elevated again in a month after stopping systemic antiviral treatment. Furthermore, the second test showed cytomegalovirus in aqueous humor decreased to 526 copies/ml. Intravenous drugs to antiviral, anti-inflammatory and anti-glaucoma were applied, but the ocular pressure was still high. In the progression of glaucomatous damage in the eye, glaucoma surgery was operated with no cytomegalovirus was detected. At last, the postoperative ocular pressure has been controlled. CONCLUSIONS: CMV infection is not rare. Patients have unilateral mild anterior inflammation with relapsed attacks of elevated intraocular pressure should be considered for CMV infection. We found that concurrent use of systemic and topical ganciclovir in a short period could reduce ocular CMV significantly, while ocular hypertension recurred. The antiviral treatment should be individualized. Glaucoma surgery could be offered to protect CEC loss and glaucomatous damage.
Keywords: Glaucoma; Anterior uveitis; Cytomegalovirus; Immunocompetent; Posner–Schlossman syndrome (PSS)

Long-term outcomes and prognostic factors for trabeculectomy with mitomycin C in eyes with uveitic glaucoma: a retrospective cohort study. - Iwao K; Inatani M; Seto T; Takihara Y; Ogata-Iwao M; Okinami S; Tanihara H (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.

Clinical features of human T-lymphotropic virus type 1 uveitis: a long-term follow-up. - Takahashi T; Takase H; Urano T; Sugita S; Miyata K; Miyata N; Mochizuki M (Ocular immunology and inflammation, 2000)
To investigate the clinical manifestations of human T-lymphotropic virus type-1 uveitis (HU), 112 HU patients who were followed up periodically for more than one year were retrospectively analyzed with respect to their ophthalmological and systemic complications. The gender ratio (female/male ratio) of the HU patients was 2.0 and the initial complications were foggy vision in 34.5%, ocular floaters in 33.3%, and blurred vision in 15.5%. As for the ocular symptoms, the majority (78.6%) of patients were classified as intermediate uveitis with vitreous inflammation. Recurrence of uveitis episodes was seen in one half of the patients (51.8%); 12 patients had more than six uveitis episodes. The interval of uveitis episodes varied from two weeks to 10 years. Nearly one half of the patients (43.8%) had ocular complications: e.g., cataract in 22 patients, persistent vitreous opacities in 17 patients, and glaucoma in 16 patients. Although the visual prognosis was essentially good, 11 patients had poor visual prognosis (<0.1). The causes of poor vision in these patients were cataract, cystoid macular edema, epiretinal membrane, and optic nerve atrophy. Of the 112 HU patients, two developed HTLV-I-associated myelopathy (TSP/HAM) after the onset of HU, while none developed adult T-cell leukemia. Sixteen HU patients had a previous history of Graves' disease and a past history of methimazole therapy, while Graves' disease was found in another HU patient only after HU onset and methimazole was not administered before the onset of HU. The present data of long-term follow-up indicate that (1) HU causes various ocular complications and its visual prognosis can be poor, (2) TSP/HAM can be induced even after the onset of HU, and (3) methimazole is not a risk factor of HU after Graves' disease.

Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. - Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group; Kempen JH; Altaweel MM; Holbrook JT; Jabs DA; Louis TA; Sugar EA; Thorne JE (Ophthalmology, 2011)
OBJECTIVE: To compare the relative effectiveness of systemic corticosteroids plus immunosuppression when indicated (systemic therapy) versus fluocinolone acetonide implant (implant therapy) for noninfectious intermediate, posterior, or panuveitis (uveitis). DESIGN: Randomized controlled parallel superiority trial. PARTICIPANTS: Patients with active or recently active uveitis. METHODS: Participants were randomized (allocation ratio 1:1) to systemic or implant therapy at 23 centers (3 countries). Implant-assigned participants with bilateral uveitis were assigned to have each eye that warranted study treatment implanted. Treatment-outcome associations were analyzed by assigned treatment for all eyes with uveitis. MAIN OUTCOME MEASURES: Masked examiners measured the primary outcome: change in best-corrected visual acuity from baseline. Secondary outcomes included patient-reported quality of life, ophthalmologist-graded uveitis activity, and local and systemic complications of uveitis or therapy. Reading Center graders and glaucoma specialists assessing ocular complications were masked. Participants, ophthalmologists, and coordinators were unmasked. RESULTS: On evaluation of changes from baseline to 24 months among 255 patients randomized to implant and systemic therapy (479 eyes with uveitis), the implant and systemic therapy groups had an improvement in visual acuity of +6.0 and +3.2 letters (P = 0.16, 95% confidence interval on difference in improvement between groups, -1.2 to +6.7 letters, positive values favoring implant), an improvement in vision-related quality of life of +11.4 and +6.8 units (P = 0.043), a change in EuroQol-EQ5D health utility of +0.02 and -0.02 (P = 0.060), and residual active uveitis in 12% and 29% (P=0.001), respectively. Over the 24 month period, implant-assigned eyes had a higher risk of cataract surgery (80%, hazard ratio [HR] = 3.3, P < 0.0001), treatment for elevated intraocular pressure (61%, HR=4.2, P < 0.0001), and glaucoma (17%, HR=4.2, P = 0.0008). Patients assigned to systemic therapy had more prescription-requiring infections than patients assigned to implant therapy (0.60 vs 0.36/person-year, P=0.034), without notable long-term consequences; systemic adverse outcomes otherwise were unusual in both groups, with minimal differences between groups. CONCLUSIONS: In each treatment group, mean visual acuity improved over 24 months, with neither approach superior to a degree detectable with the study's power. Therefore, the specific advantages and disadvantages identified should dictate selection between the alternative treatments in consideration of individual patients' particular circumstances. Systemic therapy with aggressive use of corticosteroid-sparing immunosuppression was well tolerated, suggesting that this approach is reasonably safe for local and systemic inflammatory disorders. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Combined fluocinolone acetonide intraocular delivery system insertion, phacoemulsification, and intraocular lens implantation for severe uveitis. - Chieh JJ; Carlson AN; Jaffe GJ (American journal of ophthalmology, 2008)
PURPOSE: To determine whether a three-year fluocinolone acetonide sustained drug delivery system can be implanted safely at the same time that phacoemulsification and intraocular lens (IOL) implantation are performed for a visually significant cataract in eyes with uveitis. DESIGN: Retrospective, single-center case series. METHODS: All consecutive patients treated from April 1998 through September 2006 at an academic clinical practice with intermediate uveitis, posterior uveitis, or panuveitis requiring immunosuppressive therapy, periocular corticosteroid injections, or both. Phacoemulsification, IOL implantation, and fluocinolone acetonide implant insertion were performed during a single surgical session. The main outcome measures were preoperative and postoperative ocular inflammation, visual acuity (VA), intraoperative complications, anti-inflammatory medication use, IOP, and postoperative adverse events. RESULTS: Twenty-four eyes of 21 patients were studied. Mean follow-up duration was 27 months (range, six to 60 months). No patients had intraoperative complications. The mean Snellen VA at baseline was 20/316, which improved significantly to 20/75 at 12 months. The average number of recurrences in the 12 months before implantation was 2.2 episodes per eye. Only one eye experienced a recurrence at seven months after implantation. Topical corticosteroids, posterior sub-Tenon capsule injections, and systemic anti-inflammatory medications were reduced significantly at 12 months. Average IOP was unchanged after surgery compared with preoperative IOP; 15% underwent glaucoma filtering surgery. CONCLUSIONS: A fluocinolone acetonide implant insertion can be combined safely with phacoemulsification plus IOL implantation during the same surgical session in eyes with uveitis. VA generally was improved, uveitis recurrences decreased, and the need for immunosuppression decreased. The most common side effect was increased IOP.

Incidence and Outcome of Uveitic Glaucoma in Eyes With Intermediate, Posterior, or Panuveitis Followed up to 10 Years After Randomization to Fluocinolone Acetonide Implant or Systemic Therapy. - Kempen JH; Van Natta ML; Friedman DS; Altaweel MM; Ansari H; Dunn JP; Elner SG; Holbrook JT; Lim LL; Sugar EA; Jabs DA; Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study Research Group (American journal of ophthalmology, 2020)
PURPOSE: To evaluate long-term risk and outcomes of glaucoma in eyes with intermediate, posterior, and panuveitis managed with systemic or fluocinolone acetonide (0.59 mg, "implant") therapy. DESIGN: Prospective Follow-up of the Multicenter Uveitis Steroid Treatment (MUST) Clinical Trial Cohort. METHODS: Patients with intermediate, posterior, or panuveitis randomized to implant or systemic therapy (corticosteroid plus immunosuppression in >90%) were followed prospectively for glaucoma incidence and outcome. RESULTS: Among 405 uveitic at-risk eyes of 232 patients (median follow-up = 6.9 years), 40% (79/196) of eyes assigned and treated with implant and 8% (17/209) of eyes assigned and treated with systemic therapy (censoring eyes receiving an implant on implantation) developed glaucoma (hazard ratio [HR] = 5.9, 95% confidence interval [CI] 3.2, 10.8; P < .001). Adjustment for intraocular pressure (IOP) elevation during follow-up only partially mitigated the association of implant treatment with glaucoma incidence: HR = 3.1 (95% CI 1.6, 6.0); P = .001. Among 112 eyes of 83 patients developing glaucoma, the 5-year cumulative incidence following diagnosis of sustained (2 or more consecutive visits) worsening of mean deviation by ≥6 dB was 20% (95% CI 12%, 33%); 5-year cumulative incidence of sustained worsening of cup-to-disc ratio by ≥0.2 was 26% (95% CI 17%, 39%). CONCLUSIONS: The implant has substantially higher risk of glaucoma than systemic therapy, a difference not entirely explained by posttreatment IOP elevation. Management of IOP elevation was effective in preventing worsening of glaucoma for the large majority of cases, but even under expert clinical management, some glaucoma worsened. Uveitis cases should be monitored carefully for IOP elevation and glaucoma indefinitely.

Update on biologic therapies for juvenile idiopathic arthritis-associated uveitis. - Thomas J; Kuthyar S; Shantha JG; Angeles-Han ST; Yeh S (Annals of eye science, 2021)
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and juvenile idiopathic associated uveitis (JIA-U) is the most frequently noted extra-articular manifestation. JIA-U can present asymptomatically and lead to ocular complications, so regular screening and monitoring are needed to prevent potentially sight-threatening sequelae. Topical glucocorticoids such as prednisolone acetate are usually the first line of treatment for anterior uveitis associated with JIA-U, but long-term use may be associated with cataract, ocular hypertension and glaucoma. Disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate allow tapering of the corticosteroids to prevent long-term complications. Biologic therapies have been increasingly used as targeted therapies for JIA-U, particularly monoclonal antibodies targeting the proinflammatory cytokine TNF-α such as adalimumab and infliximab. One recent, multicenter, prospective, randomized clinical trial provided evidence of the efficacy of adalimumab with methotrexate for JIA-U compared to methotrexate alone. Another clinical trial studying the interleukin-6 inhibitor tocilizumab for JIA-U showed promise in tapering topical corticosteroids. Additionally, JAK inhibitors are emerging biologic therapies for JIA-U in patients refractory to TNF-α inhibitors, with a clinical trial assessing the efficacy of baricitinib for JIA-U underway. While clinical trials on these novel biologics are limited, further investigation of these agents may provide additional therapeutic options for JIA-U.

Retisert: is the new advance in treatment of uveitis a good one? - Mohammad DA; Sweet BV; Elner SG (The Annals of pharmacotherapy, 2007)
OBJECTIVE: To review the use of corticosteroids for the treatment of uveitis, with a focus on the pharmacology, efficacy, and safety of a newer delivery device, Retisert. DATA SOURCES: A PubMed/MEDLINE search from 1950 through February 2007 was conducted, and manufacturer-provided data were reviewed. STUDY SELECTION AND DATA EXTRACTION: Animal studies and Phase II and III clinical trials evaluating the safety and efficacy of Retisert for the treatment of uveitis were considered. The data were extracted from PubMed/MEDLINE using the search terms fluocinolone acetonide, corticosteroids, intravitreal implant, uveitis, ocular steroids, and Retisert. DATA SYNTHESIS: The findings of the clinical studies showed, with use of Retisert, a reduction in the recurrence of uveitis, improvement in visual acuity, and a decreased need for adjunctive therapy with corticosteroids and immunosuppressant agents. There are currently no studies directly comparing Retisert with other treatment options. The most commonly reported adverse events (ADEs) in clinical trials included cataracts, increased intraocular pressure, post-procedural complications associated with implant insertion, and ocular pain. Other ocular ADEs included decreased visual acuity, glaucoma, blurred vision, an abnormal sensation in the eye, eye irritation, and a change in tearing. These ADEs are similar to those seen with chronic corticosteroid therapy delivered by other ocular routes. CONCLUSIONS: Retisert implants have been shown to deliver sufficient drug for a longer period of time compared with the traditional steroid delivery methods. Promising efficacy results show a significant reduction in recurrence rate and improvement in visual acuity for approximately 3 years after implant. However, the drug carries the risks associated with the implant procedure and with chronic exposure of the eye to steroids. Until more data on the long-term safety are known, Retisert should be reserved for patients who are no longer tolerant of or responsive to more traditional treatment modalities.

Uveitic angle closure glaucoma in a patient with inactive cytomegalovirus retinitis and immune recovery uveitis. - Goldberg DE; Freeman WR (Ophthalmic surgery and lasers, 2002)
We report a case of uveitic acute angle closure glaucoma in a patient with acquired immunodeficiency syndrome (AIDS) associated with inactive cytomegalovirus retinitis and immune recovery vitritis. We conducted a long-term, follow-up examination of a 47-year-old male with AIDS and inactive cytomegalovirus retinitis caused by immune recovery on highly active antiretroviral therapy (HAART). We found vitritis and ultimate development of uveitic glaucoma in the postoperative periods following repair of retinal detachment and extracapsular cataract extraction with intraocular lens implant. An episode of acute angle closure secondary to posterior synechiae and iris bombé subsequently developed, requiring peripheral laser iridotomy. Immune recovery in the setting of inactive cytomegalovirus retinitis can result in intraocular inflammation severe enough to cause angle closure glaucoma and profound ocular morbidity.

Iridial pigmentation induced by latanoprost ophthalmic solution in Japanese glaucoma patients. - Chiba T; Kashiwagi K; Kogure S; Abe K; Shibuya T; Furuichi M; Iijima H; Tsukahara S (Journal of glaucoma, 2001)
PURPOSE: To investigate the incidence of iridial pigmentation induced by latanoprost ophthalmic solution in Japanese glaucoma patients by a prospective and observer-masked study. PATIENTS AND METHODS: Sixty-nine eyes of 69 glaucoma patients were included. Patients who had undergone intraocular surgery, laser trabeculoplasty, and laser iridotomy within 12 months before enrollment, and patients with history of uveitis and any changes in antiglaucoma drugs within 6 months before enrollment were excluded. Iridial photographs were taken by one examiner under the same conditions at 1, 3, and 6 months after the initiation of latanoprost treatment. Three glaucoma specialists, masked of patient information, independently assessed the iridial pigmentation. Cases with iridial pigmentation diagnosed by three specialists were categorized as showing a definite increase in iridial pigmentation. RESULTS: A definite increase in iridial pigmentation occurred in 3.5%, 9.7%, and 35.0% of eyes within 1, 3, and 6 months of treatment, respectively. Age, gender, or concomitantly used eyedrops did not significantly influence the incidence of iridial pigmentation within 6 months of instillation. A reduction of intraocular pressure by latanoprost did not differ significantly between patients with and without iridial pigmentation. CONCLUSION: The incidence of iridial pigmentation by latanoprost ophthalmic solution in Japanese patients was higher than previously reported values in pigmented races.

Causes of reduced visual acuity on long-term follow-up after cataract extraction in patients with uveitis and juvenile rheumatoid arthritis. - Fox GM; Flynn HW; Davis JL; Culbertson W (American journal of ophthalmology, 1992)
We reviewed the long-term follow-up on a consecutive series of 16 eyes from ten patients with juvenile rheumatoid arthritis-associated cataracts that were removed by using pars plana lensectomy and vitrectomy. All patients had prominent cataracts, chronic uveitis, posterior synechiae, and vitreitis preoperatively, and had at least 12 months of follow-up postoperatively. The median length of follow-up was 51 months (range, 12 months to ten years). In the early postoperative period, a visual acuity of 20/70 or better was obtained in 13 of 16 eyes (81%). With longer follow-up, the final visual acuity was 20/70 or better in only nine of 16 eyes (56%). The primary categories of delayed visual loss in these cases were glaucoma and macular disease (chronic cystoid macular edema, macular hole, hypotony maculopathy, and recurrent macular pucker). Despite these limitations in maintaining good visual acuity, a pars plana lensectomy and vitrectomy approach is effective for cataracts in these patients with uveitis.

Effect of Adalimumab for the Treatment of Uveitis in Juvenile Idiopathic Arthritis - Assistance Publique - Hôpitaux de Paris (clinicaltrials.gov, 2011)
20% of patients with juvenile idiopathic arthritis (JIA) develop usually bilateral, chronic anterior uveitis, dependent on steroid eye drops and sometimes systemic steroid therapy, with a risk of complications such as cataract, band keratopathy and glaucoma, usually responsible for loss of vision. No maintenance treatment has been demonstrated to be effective. Methotrexate (MTX), the maintenance treatment most commonly used in JIA, could have a beneficial effect, but this effect is not sufficient to stop progression of uveitis in most patients. Our preliminary experience and that of other teams based on small series of patients is in favour of the efficacy of anti‐Tumour Necrosis Factor alpha (TNFalpha) monoclonal antibodies (Ab) in JIA‐associated uveitis. An international multicentre randomized trial of a humanized monoclonal antibody, adalimumab, in JIA has demonstrated its efficacy on joint lesions and its good safety as monotherapy or in combination with methotrexate. However, children with active uveitis were excluded from this trial. The investigators propose a French multicentre, randomized, double‐blind, placebo‐controlled trial to evaluate the efficacy of adalimumab in JIA‐associated uveitis in patients over the age of 4 years. These patients must have active uveitis (Laser flare‐cell meter score of at least 30 photons/ms) despite topical steroid therapy, with intolerance or failure to at least 3 months of MTX therapy. The dose of adalimumab will be 40 mg eow for children age 13 and over and for children younger than 13 adalimumab 24 mg per m2 BSA (up to a maximum total body dose of 40 mg). The activity of uveitis will be evaluated by laser flare photometry, a recently validated technique for follow‐up of the efficacy of treatments of anterior uveitis. Seven hospital ophthalmology departments in France are equipped with laser flare photometry and have a sufficient experience to participate in this trial (Paris‐Pitie‐Salpetriere, Paris‐Cochin, Nantes, Lille, Grenoble, Bordeaux and Lyon). Several teams of paediatric rheumatologists and hospital rheumatologists working with these ophthalmology departments will also be able to include patients. The primary endpoint is an at least 30% reduction of ocular inflammation after 2 months of treatment, quantified by laser flare photometry, considering the more severely affected eye in the case of bilateral uveitis. Based on the hypothesis of a response rate of at least 50% with adalimumab versus a maximum of 10% with placebo, comparison of two groups of 19 patients would be sufficient to conclude on a significant difference for a two‐sided alpha risk of p=0.05 and a power of 80%. The investigators therefore plan to include 40 patients with randomization to two equal groups, one receiving 4 subcutaneous injections of adalimumab and the other receiving 4 injections of placebo on D0, D14, D28, and D42 with assessment of the primary endpoint at M2. The planned duration of inclusion is 2 years with a total duration of the trial of 3 years. From visit M2 onwards, all patients will be treated by adalimumab injections every 2 weeks and will be followed for 1 year of treatment. Clinical, laboratory and ophthalmological evaluation including laser flare photometry and conventional slit lamp examination will be performed at each visit (pre‐inclusion, D0, D14, M1, M2, M3, M4, M5, M6, M9 and M12). Deterioration of ocular inflammation during the first 2 months will justify decoding for the patient concerned who will be considered to be a treatment failure. A study will be conducted in parallel: gene expression profile studies on whole blood by a team experienced in the study of JIA and other inflammatory diseases (Dr Pascual, Dallas, USA).

Supraciliary Micro-stent Implantation for Open-Angle Glaucoma Failing Topical Therapy: 1-Year Results of a Multicenter Study. - García-Feijoo J; Rau M; Grisanti S; Grisanti S; Höh H; Erb C; Guguchkova P; Ahmed I; Grabner G; Reitsamer H; Shaarawy T; Ianchulev T (American journal of ophthalmology, 2015)
PURPOSE: To evaluate the safety and efficacy of a supraciliary micro-stent (CyPass Micro-Stent; Transcend Medical, Menlo Park, California, USA) for surgical treatment of glaucoma in patients refractory to topical medications. DESIGN: Multicenter, single-arm interventional study. METHODS: Patients with open-angle glaucoma (Shaffer Grade 3 and 4) and uncontrolled medicated intraocular pressure (IOP) >21 mm Hg at baseline and candidates for conventional glaucoma surgery were enrolled. Glaucoma medications were discontinued at surgery and resumed at investigator discretion. CyPass Micro-Stent implantation was completed in all patients using a standard clear corneal approach. Adverse events, postoperative IOP changes, and need for IOP-lowering medications during the first 12 postoperative months (12M) were monitored. RESULTS: Sixty-five eyes were enrolled, and 55 were available at 12M, accounting for loss to follow-up and early termination. Baseline IOP was 24.5 ± 2.8 mm Hg, and the mean number of medications recorded was 2.2 ± 1.1. There were no serious intraoperative events or major adverse events (eg, retinal or choroidal detachment, persistent uveitis, persistent hyphema, hypotony maculopathy). The most common adverse events included IOP increases >30 mm Hg beyond 1 month (11%, 7/65), transient hyphema (6%, 4/65), and cataract progression (12%, 5/41 phakic eyes). Mean IOP was 16.4 ± 5.5 mm Hg at 12 months-a 34.7% reduction (P < .0001). Mean medication usage also decreased from baseline to a mean of 1.4 ± 1.3 medications at 12M (P = .002). In eyes originally indicated for conventional glaucoma surgery, no secondary surgery was performed in 83% (53/64). CONCLUSION: Supraciliary stenting with the CyPass Micro-Stent effectively lowers IOP as a surgical treatment for glaucoma, precluding the need for more invasive glaucoma surgery in >80% of patients at 1 year, thereby reducing postoperative glaucoma surgical complications.

A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). - Ramanan AV; Dick AD; Benton D; Compeyrot-Lacassagne S; Dawoud D; Hardwick B; Hickey H; Hughes D; Jones A; Woo P; Edelsten C; Beresford MW; et al. (Trials, 2014)
BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk of inflammation of the uvea in the eye (uveitis). Overall, 20% to 25% of paediatric uveitis is associated with JIA. Major risk factors for development of uveitis in JIA are oligoarticular pattern of arthritis, an age at onset of arthritis of less than seven years of age, and antinuclear antibody positivity. In the initial stages of mild to moderate inflammation the uveitis is asymptomatic. This has led to current practice of screening all children with JIA for uveitis. Approximately 12% to 38% of patients with JIA develop uveitis in seven years following onset of arthritis. In 30% to 50% of children with JIA-associated uveitis structural complications are present at diagnosis. Furthermore about 50% to 75% of those with severe uveitis will eventually develop visual impairment secondary to ocular complications such as cataract and glaucoma. Defining the severity of inflammation and structural complications in uveitis patients is now possible following Standardised Uveitis Nomenclature (SUN) guidelines, and modified to incorporate the consensus of end point and outcome criteria into the design of randomised trials. Despite current screening and therapeutic options (pre-biologics) 10% to 15% of children with JIA-associated uveitis may develop bilateral visual impairment and certified legally blind. To date, there remains no controlled trial evidence of benefits of biologic therapy. METHODS/DESIGN: This study will randomise 154 patients aged 2 to 18 years with active JIA-associated uveitis (despite methotrexate (MTX) treatment for at least 12 weeks). All participants will be treated for 18 months, with follow up of 3 years from randomisation (continuing on MTX throughout). All participants will receive a stable dose of MTX and in addition either adalimumab (20 mg/0.8 ml for patients<30 kg or 40 mg/0.8 ml for patients weighing 30 kg or more, subcutaneous (s/c) injection every 2 weeks based on body weight), or placebo (0.8 ml as appropriate according to body weight) s/c injection every 2 weeks. DISCUSSION: This is the first randomised controlled trial that will assess the clinical effectiveness, safety and cost effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis. TRIAL REGISTRATION: ISRCTN10065623.

Anti-Interleukin-6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to Anti-Tumor Necrosis Factor Therapy: a Multicenter Study of Twenty-Five Patients - Calvo-Rio, V; Santos-Gomez, M; Calvo, I; Gonzalez-Fernandez, MI; Lopez-Montesinos, B; Mesquida, M; Adan, A; Hernandez, MV; Maiz, O; Atanes, A; et al. (2017)
Objective: To assess the efficacy of tocilizumab (TCZ) for the treatment of juvenile idiopathic arthritis (JIA)‐associated uveitis. Methods: We conducted a multicenter study of patients with JIA‐associated uveitis that was refractory to conventional immunosuppressive drugs and anti‐tumor necrosis factor (anti‐TNF) agents. Results: We assessed 25 patients (21 female; 47 affected eyes) with a mean +/‐ SD age of 18.5 +/‐ 8.3 years. Uveitis was bilateral in 22 patients. Cystoid macular edema was present in 9 patients. Ocular sequelae found at initiation of TCZ included cataracts (n = 13), glaucoma (n = 7), synechiae (n = 10), band keratopathy (n = 12), maculopathy (n = 9), and amblyopia (n = 5). Before TCZ, patients had received corticosteroids, conventional immunosuppressive drugs, and biologic agents (median 2 [range 1‐5]), including adalimumab (n = 24), etanercept (n = 8), infliximab (n = 7), abatacept (n = 6), rituximab (n = 2), anakinra (n = 1), and golimumab (n = 1). Patients received 8 mg/kg TCZ intravenously every 4 weeks in most cases. TCZ yielded rapid and maintained improvement in all ocular parameters. After 6 months of therapy, 79.2% of patients showed improvement in anterior chamber cell numbers, and 88.2% showed improvement after 1 year. Central macular thickness measured by optical coherence tomography in patients with cystoid macular edema decreased from a mean +/‐ SD of 401.7 +/‐ 86.8 mum to 259.1 +/‐ 39.5 mum after 6 months of TCZ (P = 0.012). The best‐corrected visual acuity increased from 0.56 +/‐ 0.35 to 0.64 +/‐ 0.32 (P < 0.01). After a median follow‐up of 12 months, visual improvement persisted, and complete remission of uveitis was observed in 19 of 25 patients. Significant reduction in the prednisone dosage was also achieved. The main adverse effects were severe autoimmune thrombocytopenia in 1 patient, pneumonia and then autoimmune anemia and thrombocytopenia in 1 patient, and viral conjunctivitis and bullous impetigo in 1 patient. Conclusion: TCZ appears to be a useful therapy for severe refractory JIA‐associated uveitis. Copyright © 2016, American College of Rheumatology

Immune recovery uveitis in HIV patients with cytomegalovirus retinitis in the era of HAART therapy-a 5-year study from Singapore. - Yeo TH; Yeo TK; Wong EP; Agrawal R; Teoh SC (Journal of ophthalmic inflammation and infection, 2016)
BACKGROUND: The aim of this study is to analyse the clinical features of HIV patients with cytomegalovirus retinitis (CMVR) developing immune recovery uveitis (IRU) while on highly active antiretroviral therapy (HAART) and to identify the risk factors, visual outcomes and complications of IRU. RESULTS: Majority (n = 26, 86.7 %) of patients were male, with 76.7 % (n = 23) of patients having bilateral disease. Twenty-seven eyes (50.9 %) had both anterior uveitis and vitritis. The median CD4 at IRU was 210 cells/μL (IQR 140-279), with 86.7 % having CD4 >100 cells/μL. The median duration from initiation of HAART to IRU was significantly different between those <50 years old (median 763 days, IQR 174-1872 days) and those ≥50 years old (median 161 days, IQR 84.5-278 days). Fourteen eyes (26.4 %) had loss of one or more Snellen lines visual acuity at 6 months while the rest maintained or improved vision. Complications developed in 21 eyes, with cataract (66.7 %), glaucoma and ocular hypertension (33.3 %) being the most common. The risk of complications was associated with the absolute difference in CD4 counts at IRU and at HAART commencement (p = 0.041). Age was also negatively associated with the duration from HAART to IRU (p = 0.005, Spearman's rho coefficient = -0.503). CONCLUSIONS: It is common to have both anterior uveitis and vitritis in IRU. There was a positive association between the increase in CD4 from HIV to IRU diagnoses and the risk of developing complications. Younger patients appeared to develop IRU later than older patients after HAART, suggesting that long-term follow-ups are essential for these patients.

A double masked randomised 4-week, placebo-controlled study in the USA, Thailand and Taiwan to compare the efficacy of oral valganciclovir and topical 2% ganciclovir in the treatment of cytomegalovirus anterior uveitis: study protocol. - Takhar JS; Joye AS; Somkijrungroj T; Laovirojjanakul W; Lin CP; Lietman TM; Porco TC; Keenan JD; Gebreegziabher EA; Seitzman GD; Rose-Nussbaumer J; Doan TA; et al. (BMJ open, 2019)
INTRODUCTION: Cytomegalovirus (CMV) anterior uveitis is a recognised cause of anterior uveitis in immunocompetent patients and is preventable cause of vision loss. Ocular sequelae include corneal endothelial damage which can cause corneal oedema and failure, as well as glaucoma. Recurrences of inflammation are common and therefore patients are often exposed to long-term therapy. Oral therapy is available in the form of valganciclovir, although with the caveat of systemic side effects such as bone marrow suppression and renal failure necessitating regular interval laboratory monitoring. Recent reports have demonstrated that topical 2% ganciclovir solution may offer promising treatment outcomes in patients with CMV anterior uveitis with superior safety, cost-effectiveness and convenience profiles. An investigation into the relative equipoise of these therapies is warranted for these reasons. METHODS AND ANALYSIS: The Systemic and Topical Control of Cytomegalovirus Anterior uveitis: Treatment Outcomes (STACCATO) trial is designed as a multicentre, block randomised by site, double-masked, placebo-controlled trial comparing the efficacy of oral valganciclovir, 2% topical ganciclovir and placebo in treating PCR-proven CMV anterior uveitis. Participant clinical evaluation will occur at three study time points by a masked study ophthalmologist over a 28-day period to assess resolution of ocular inflammation (secondary outcome). A control group will provide additional information about the possible impact that the infected host's immune response may play in controlling local viral replication. The primary analysis is an analysis of covariance (three arms) correcting for baseline to compare quantitative CMV viral load in the anterior chamber (AC) aqueous fluid before and 7 days after treatment. ETHICS AND DISSEMINATION: The University of California San Francisco Committee on Human Research and the Khon Kaen University Institutional Review Board have given ethical approval. The results of this trial will be presented at local and international meetings and submitted for peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER: NCT03576898.

Phacoemulsification in patients with Fuchs' heterochromic uveitis. - Ram J; Kaushik S; Brar GS; Gupta A; Gupta A (Journal of cataract and refractive surgery, 2002)
PURPOSE: To evaluate the results of phacoemulsification with capsular bag fixation of a poly(methyl methacrylate) (PMMA), acrylic, or silicone intraocular lens (IOL) in patients with complicated cataract resulting from Fuchs' heterochromic uveitis (FHU). SETTING: Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: This study evaluated 20 eyes of 19 patients with FHU and cataract who had uneventful phacoemulsification with endocapsular implantation of an IOL and completed a 1-year follow-up. RESULTS: Preoperatively, loss of the iris collarette and fine keratic precipitates were seen in all 20 eyes, iris heterochromia in 16, iris atrophy in 12, and iris nodules in 2. Fourteen eyes had mild or negligible preoperative anterior chamber inflammation. No eye had increased intraocular pressure. An acrylic IOL was implanted in 10 eyes, a silicone IOL in 4, and a PMMA IOL in 6. There were no significant differences in outcomes among the 3 IOL groups. Three patients had intraoperative hyphema that resolved spontaneously. Postoperatively, 16 eyes had mild anterior chamber reaction. Four patients had significant anterior chamber inflammation necessitating the use of frequent topical steroids. No case had secondary glaucoma or posterior synechias. The best corrected visual acuity was 6/5 in 6 eyes, 6/6 in 11, and 6/9 in 3. CONCLUSIONS: Uneventful phacoemulsification with endocapsular IOL implantation visually rehabilitated patients with FHU. All 3 IOLs yielded similar results except for increased early postoperative inflammation and late dense anterior capsule opacification in the silicone group. Further studies comparing the outcome of different IOL materials are required to determine their effectiveness in patients with FHU.

Efficacy of selective laser trabeculoplasty in primary angle-closure glaucoma: a randomized clinical trial. - Narayanaswamy A; Leung CK; Istiantoro DV; Perera SA; Ho CL; Nongpiur ME; Baskaran M; Htoon HM; Wong TT; Goh D; Su DH; Belkin M; et al. (JAMA ophthalmology, 2015)
IMPORTANCE: Selective laser trabeculoplasty (SLT) should be explored as a therapeutic option in eyes with angle closure. OBJECTIVE: To assess the intraocular pressure (IOP)-lowering efficacy of SLT in eyes with primary angle closure (PAC) and PAC glaucoma (PACG). DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial at tertiary eye care institutions of 100 patients diagnosed as having PAC or PAC glaucoma in which the angles had opened at least 180° (visible posterior trabecular meshwork on gonioscopy) after laser iridotomy. Recruitment and baseline were completed from June 2009 to April 2012 and 6-month follow-up was completed from December 2009 to November 2012. INTERVENTIONS: Eligible patients with a baseline IOP greater than 21 mm Hg were randomized to either SLT or prostaglandin analog (PGA; travoprost, 0.004%). The SLT was repeated if the IOP reduction was less than 20.0% from baseline at the 1- or 3-month follow-up visit. MAIN OUTCOMES AND MEASURES: The primary outcome measure was the change in IOP from baseline to the final follow-up visit (at 6 months). The frequency of additional postoperative treatments and complications were secondary outcomes. RESULTS: Fifty patients (96 eyes) were randomized to SLT and 50 patients (99 eyes) to PGA medical therapy. At 6 months, 49 patients in the SLT group and 47 in the PGA group completed follow-up. Analysis was based on intent to treat. At 6 months, IOP decreased by 4.0 mm Hg (95% CI, 3.2-4.8) in the SLT group (P < .001) and by 4.2 mm Hg (95% CI, 3.5-4.9) in the PGA group (P < .001). There were no differences between the SLT and PGA groups in the absolute mean reduction of IOP (4.0 vs 4.2 mm Hg, respectively; P = .78) or in the percentage of reduction in IOP (16.9% vs 18.5%, respectively; P = .52). Complete success (IOP ≤21 mm Hg without medications) was achieved in 60.0% eyes of the SLT group, compared with 84.0% of eyes in the PGA group (P = .008). No patients required glaucoma surgery. Additional medications were required in 22.0% of patients in the SLT group compared with 8.0% in the PGA group (P = .05). One patient in the SLT group (2.0%) had a transient posttreatment IOP spike greater than 5 mm Hg. The mean endothelial cell count showed a significant decrease from baseline in the SLT arm (4.8% decrease; P = .001). No other events such as persistent uveitis or increase in peripheral anterior synechiae were noted in eyes that underwent SLT. Two patients in the PGA group exited owing to drug-related complications (1 patient with uveitis and 1 with allergic conjunctivitis). CONCLUSIONS AND RELEVANCE: Eyes with PAC or PACG respond to SLT in the short term, but the overall long-term therapeutic effectiveness needs further evaluation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01004900.

Efficacy, safety, and survival rates of IOP-lowering effect of phacoemulsification alone or combined with canaloplasty in glaucoma patients. - Arthur SN; Cantor LB; WuDunn D; Pattar GR; Catoira-Boyle Y; Morgan LS; Hoop JS (Journal of glaucoma, 2014)
PURPOSE: To evaluate efficacy and survival rates of intraocular pressure (IOP)-lowering effect obtained with phacoemulsification (phaco) alone or in combination with canaloplasty (PCP) in patients with open-angle glaucoma (OAG). METHODS: Retrospective chart review of consecutive cases at the Department of Ophthalmology, Indiana University. Visual acuity (VA), IOP, number of medications (Meds), failures, and survival rates of IOP-lowering effect were analyzed. Inclusion criteria were: patients older than 18 years with OAG and cataract. Exclusion criteria were: no light perception vision, prior glaucoma surgery, chronic uveitis, angle-closure glaucoma, and advanced-stage or end-stage OAG. Failure criteria were: IOP>21 mm Hg or <20% reduction, IOP<6 mm Hg, further glaucoma surgeries, and loss of light perception vision. RESULTS: Thirty-seven patients underwent phaco and 32 patients had PCP. Follow-up was 21.8±10.1 versus 18.8±9.6 months for phaco and PCP, respectively (P=0.21). Age (y) (74.7±9.8 vs. 76.1±8.3, P=0.54), sex (P=81), and laser status (P=0.75) were similar between the groups. Preoperatively, mean±SD logMAR VA (0.5±0.7 vs. 0.5±0.5, P=0.77), IOP (16.2±4.6 vs. 18.2±5.1, P=0.13), and Meds (1.4±1.1 vs. 1.3±0.7, P=0.75) were similar for phaco and PCP, respectively. At 24-month phaco (n=17) and PCP (n=11), respectively, mean±SD were: logMAR VA 0.2±0.2 versus 0.4±0.7, P=0.29; IOP 14.1±4.0 versus 12.9±3.8, P=0.43; and Meds 1.5±1.2 versus 0.3±0.5, P=0.005. Rates of successful IOP lowering without medications for phaco versus PCP at 12 months were 34% versus 75%, respectively (P=0.003). CONCLUSIONS: A combination of canaloplasty with phaco results in a decreased number of glaucoma medications and increased survival rate of IOP-lowering effect compared with phaco alone.

Zur Epidemiologie des felinen Glaukoms - M Lüscher; M Hässig; S A Pot; B M Spiess (Kleintierpraxis, 2013)
Objective: The aim of this retrospective study was to investigate the epidemiology and the risk factors of feline glaucoma presented between 1990 and 2011. Methods: Detailed information was obtained from case records. Glaucoma was classified as congenital, primary, or secondary. Data was evaluated for breed, gender, age at presentation, intraocular pressure, character of glaucoma, as well as etiology of secondary glaucoma. Results: A total of 124 cats with glaucoma were diagnosed between 1990 and 2011, 114 of which had secondary glaucoma 5 primary, and 2 congenital glaucomas. Three end-stage glaucomas could not be classified. The mean age at diagnosis was 9.7 ± 3.1 years, with a range between 30 days and 24 years. In ten different breeds the overall female:male ratio in all 124 cases was 1:1,8 (44 female and 80 male cats). The most common risk factors for development of secondary glaucoma were anterior uveitis (58.3%), intraocular neoplasia (17,1%), and lens luxation (7%). In 45 cats with secondary glaucoma the cause for uveitis was recorded: idiopathic (35.7%), Toxoplasma gondii (31.3%), trauma (22.2%), corona virus infection (8.9%), and feline leukemia virus infection (1.9%). Seventeen of the 20 cats with intraocular neoplasia had iris melanoma, and one each had a ciliary body adenoma/adenocarcinoma, lymphoma and metastatic neoplasia from a distant site. Conclusion: Most glaucomas were unilateral and secondary to other eye conditions. Nine risk factors for secondary glaucoma were identified, with anterior uveitis, intraocular neoplasia and lens luxation being the most prevalent. This is in agreement with similar earlier studies. POAG appears to be the most common form of primary glaucoma in cats.

Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four-week results of a multicenter randomized clinical study. - Jaffe GJ; Martin D; Callanan D; Pearson PA; Levy B; Comstock T; Fluocinolone Acetonide Uveitis Study Group (Ophthalmology, 2006)
PURPOSE: To report the interim 34-week safety and efficacy results of a 3-year study to evaluate an investigational intravitreal fluocinolone acetonide (FA) implant in patients with noninfectious posterior uveitis. DESIGN: Prospective, dose-masked, dose-randomized, historically controlled, multicenter trial in patients with unilateral or bilateral disease. PARTICIPANTS: A total of 278 patients with recurrent noninfectious posterior uveitis were randomized to receive a 0.59-mg (n = 110) or 2.1-mg (n = 168) implant. In patients with bilateral disease, the more severely affected eye received the implant. METHODS: The implant was inserted surgically into the vitreous cavity through a pars plana incision. Follow-up visits were scheduled on day 2, week 1, and then every 4 to 6 weeks through 34 weeks after implantation. Systemic, periocular, and topical therapies were reduced as allowed by the clinical response. MAIN OUTCOME MEASURES: The primary efficacy outcome was a comparison of the recurrence rate in the implanted eye from the 34 weeks before implantation to the 34 weeks after implantation. Visual acuity (VA), need for adjunctive therapy, and safety also were assessed. RESULTS: Combining both doses, the FA implant reduced the rate of recurrences from 51.4% in the 34 weeks preceding implantation to 6.1% postimplantation (P<0.0001) in the study eyes. Comparatively, there was a significant increase in the recurrence rate in the fellow nonimplanted eyes from 20.3% preimplantation to 42.0% postimplantation (P<0.0001). Visual acuity was stabilized or improved in 87% of implanted eyes and generally was associated with reductions in the area of macular hyperfluorescence. The percentage of eyes that required systemic medications, periocular injections, and topical corticosteroids decreased from 52.9%, 63.0%, and 35.7%, respectively, preimplantation to 12.1%, 2.2%, and 16.5% postimplantation (P< or =0.0001 in all cases). At week 34, 51.1% of implanted eyes required ocular antihypertensive drops, and 5.8% underwent glaucoma filtering surgery. Lens opacity scores increased by > or =2 grades in 19.8% of phakic implanted eyes, and 9.9% required cataract surgery. There were no statistically significant differences in any of the parameters studied for the 0.59-mg implant, compared with the 2.1-mg implant. CONCLUSIONS: The FA implant significantly reduced uveitis recurrences, improved VA, and decreased the need for adjunctive therapy in the studied patient population. The most common side effects included increased intraocular pressure and cataract progression.

Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center. - Prete M; Guerriero S; Dammacco R; Fatone MC; Vacca A; Dammacco F; Racanelli V (Journal of ophthalmic inflammation and infection, 2014)
BACKGROUND: The aim of this study was to identify the main features of a cohort of Caucasian patients with idiopathic (I) and systemic disease-associated (SDA) autoimmune uveitis (AU) who were followed up at a single tertiary reference center. The study consisted of a retrospective analysis of the demographic, clinical, and laboratory features and the response to treatment of 104 patients with AU evaluated between 2004 and 2013, with a median follow-up of 4.8 years. The primary outcome measure was the response to systemic treatment after 24 months of therapy. The data are expressed as the range, percentage, or mean ± standard error. Categorical variables were assessed by Fisher's exact test. RESULTS: The mean age at diagnosis was 40.1 ± 17.8 years for men and 44.1 ± 15.3 years for women. There was a slight female predominance. Of the 104 patients, 72.1% had I-AU and 27.9% SDA-AU. The most frequent associations were with ankylosing spondyloarthritis, autoimmune thyroiditis, inflammatory bowel diseases, and Behcet's disease. Symptoms at presentation consisted of eye redness and pain (28.8%), decreased visual acuity (25.9%), and floaters (18.3%). Complications included cataracts (24%), retinal neovascularization (16.3%), chorio-retinal scars (10.6%), cystoid macular edema (8.6%), glaucoma/ocular hypertension (7.7%), epiretinal membranes (4.8%), and retinal detachment (3.8%). The prevalence of autoantibodies, mostly antinuclear antibodies, was comparable between the I-AU and SDA-AU groups. Fisher's exact test showed a direct correlation between patients with class I HLA B27, Cw8, B5 (51, 52), B51, or Cw2 and the presence of AU, whereas among patients with class II HLA, only DQ1 was a predisposing factor for AU. The therapeutic spectrum included corticosteroids and immunosuppressive agents, given either alone or in various combinations according to the severity of AU and the extent of the clinical response. Among the immunosuppressive drugs, azathioprine was preferentially used for anterior uveitis, and cyclosporine-A for intermediate and posterior uveitis. An assessment of the patients after 24 months of therapy showed a complete remission in 43.3% and a significant clinical improvement in 26.9%. CONCLUSIONS: At our tertiary reference center, the prevalence in Caucasian patients of I-AU was approximately 2.5-fold higher than that of SDA-AU. Our findings point to the need for a patient-tailored therapeutic approach according to the anatomic site and the severity of AU. Therapy should be prolonged, over a period of months and even up to 1-2 years, in order to achieve stable control of the disease and to prevent severe complications. The outcome of SDA-AU is also influenced by treatment of the underlying systemic disease. Additional controlled trials are needed to assess the efficacy and the long-term safety of both the prescribed therapeutic agents and their combinations.

Postoperative complications of intraocular lens implantation in patients with Fuchs' heterochromic cyclitis. - Ram J; Jain S; Pandav SS; Gupta A; Mangat GS (Journal of cataract and refractive surgery, 1995)
We studied 29 eyes of 24 patients with Fuchs' heterochromic cyclitis who had extracapsular cataract extraction and posterior chamber intraocular lens implantation. Follow-up ranged from one to four years (mean two years). Intraoperative complications included mild hyphema (n = 4). Early postoperative complications included uveitis (n = 9), glaucoma (n = 7), pigment deposits on the lens surface (n = 8), vitreous opacities (n = 8), and cystoid macular edema (n = 1). Late postoperative complications included posterior capsule opacification (n = 6), recurrent uveitis (n = 4), and persistent glaucoma (n = 3). Best corrected visual acuity of 20/40 or better was achieved in 24 eyes (82.8%).

Ab interno trabecular bypass surgery with Trabectome for open-angle glaucoma. - Hu K; Shah A; Virgili G; Bunce C; Gazzard G (The Cochrane database of systematic reviews, 2021)
BACKGROUND: Glaucoma is the leading cause of irreversible blindness. Minimally invasive surgical techniques, such as ab interno trabecular bypass surgery, have been introduced to prevent glaucoma from progressing.   OBJECTIVES: In light of the potential benefits for people with open-angle glaucoma and the widespread uptake of the technique, it is important to critically evaluate the evidence for whether treatment with ab interno trabecular bypass surgery with Trabectome is both efficacious and safe. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2020, Issue 7); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 17 July 2020. SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) of ab interno trabecular bypass surgery with Trabectome compared to other surgical treatments (other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment, or medical treatment. We also included trials in which these devices were combined with phacoemulsification compared to phacoemulsification in combination with other glaucoma surgery or alone. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. Our primary outcome was proportion of participants who were medication-free (not using eye drops). Secondary outcomes included mean change in intraocular pressure (IOP), proportion of participants who required further glaucoma surgery, mean change in quality of life, proportion of participants who achieved an IOP of 21 mmHg or less, 17 mmHg or less, or 14 mmHg or less and rate of visual field progression. Adverse effects were the proportion of participants experiencing intra- and postoperative complications. All outcomes were measured in the short term (6 to 18 months), medium term (18 to 36 months), and long term (36 months or longer). MAIN RESULTS: In this update, we included one RCT which had previously been identified as an ongoing study in our 2016 publication. This trial was a single-centre, single-surgeon RCT set in Canada with 19 participants. Participants were adults who had open-angle glaucoma, open angles, and had inadequately controlled IOP that required surgical intervention. The study was terminated before the intended sample size was reached 'due to slow recruitment and increasing lack of clinical equipoise over time'. This reduced the power of the study to detect clinically important effects. We assessed the trial as being at high risk of attrition, reporting, and other potential sources of biases. The risks of performance and detection bias are unclear. The intervention group of 10 people had Trabectome ab interno trabeculotomy combined with cataract extraction (phaco-AIT) and the comparator group of 9 people had trabeculectomy with mitomycin C combined with cataract extraction (phaco-Trab), one of whom was lost to follow-up. Seven of 10 participants in the phaco-AIT group and 4 of 8 in the phaco-Trab group were medication-free (not using drops) at 12 months (odds ratio (OR) 2.33, 95% confidence interval (CI) 0.34 to 16.2; very low-certainty evidence). At 12 months, the mean change in IOP was worse for phaco-AIT than for phaco-Trab, but this evidence was very uncertain (mean difference (MD) 3.70 mmHg, 95% CI -1.44 to 8.84; very low-certainty evidence) in the phaco-AIT group, as was the difference in the mean number of IOP-lowering drops taken per day (MD -0.41, 95% CI -1.22 to 0.40; very low-certainty evidence). Only one participant in the phaco-AIT group required further glaucoma surgery. The study protocol declared that quality of life and visual field progression were measured, but they were not reported All 8 participants with complete data in the phaco-Trab group and 8 of 10 in the phaco-AIT had at least one early or late postoperative complication (e.g. day 1 IOP spike, hypotony, choroidal effusion, bleb leak or encapsulation, uveitis, or peripheral anterior synechiae). The evidence was very low-certainty due to high risk of bias for several domains for this study and for large imprecision of all estimates. We also identified one ongoing study, identified from the International Clinical Trials Registry Platform (ICTRP): a multicentre, open, RCT comparing Trabectome to ab interno trabeculectomy using microhook. The study investigators plan to recruit 120 adults between 20 and 90 years of age. The primary outcome is duration of treatment success. Secondary outcomes include postoperative IOP, number of anti-glaucoma medications, and adverse events. AUTHORS' CONCLUSIONS: There is currently no high-quality evidence for the outcomes of ab interno trabecular bypass surgery with Trabectome for open-angle glaucoma. Properly designed RCTs are needed to assess the long-term efficacy and safety of this technique.

Extracapsular cataract surgery with and without intraocular lens implantation in Fuchs heterochromic cyclitis. - O'Neill D; Murray PI; Patel BC; Hamilton AM (Ophthalmology, 1995)
PURPOSE: To compare the surgical and postoperative complications and visual outcome of extracapsular cataract extraction (ECCE) with and without intraocular lens (IOL) implant in Fuchs heterochromic cyclitis. METHODS: The records of 77 patients with Fuchs heterochromic cyclitis who had undergone ECCE were reviewed. Of a total of 77 eyes, a posterior chamber IOL (PC IOL) was implanted in 43 eyes, whereas 34 eyes did not receive an implant. RESULTS: In the pseudophakic group, 40 (93%) eyes achieved 20/40 or better. This level also was achieved in 29 (85%) eyes not receiving an implant. Intraoperative anterior chamber hemorrhage was documented in 18 eyes but there was no correlation with preoperative gonioscopic findings. A temporary or permanent elevation of intraocular pressure was noted in five of eight eyes that had marked anterior chamber hemorrhage. Severe postoperative uveitis occurred in ten eyes and was more common in patients with glaucoma who had PC IOL implantation, but this did not adversely affect the visual outcome. Of 40 eyes with PC IOL implant, severe postoperative uveitis developed in 7. In six of these seven eyes, the implant was a three-piece lens with polypropylene haptics. Severe postoperative uveitis developed in 6 of 16 eyes with preoperative glaucoma. Five of these six eyes had a PC IOL implant. Of the 34 aphakic patients, 10 (29%) were intolerant of contact lens correction. There was no difference in the incidence of postoperative uveitis, cystoid macular edema, and development of glaucoma between the two groups. CONCLUSION: Implantation of PC IOLs in ECCE in patients with Fuchs heterochromic cyclitis appears to a safe procedure, but careful postoperative follow-up of intraocular pressure, particularly in patients with intraoperative hemorrhage or postoperative uveitis, is indicated.

Cataract. - Allen D (Clinical evidence, 2011)
INTRODUCTION: Cataract accounts for over 47% of blindness worldwide, causing blindness in about 17.3 million people in 1990. Surgery for cataract in people with glaucoma may affect glaucoma control. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of surgery for age-related cataract without other ocular comorbidity? What are the effects of treatment for age-related cataract in people with glaucoma? What are the effects of surgical treatments for age-related cataract in people with diabetic retinopathy? What are the effects of surgical treatments for age-related cataract in people with chronic uveitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 20 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: for people with cataract without other ocular co-morbidity: cataract surgery alone, cataract surgery with non-concomitant glaucoma surgery, concomitant cataract and glaucoma surgery, intracapsular extraction, manual (large or small) incision extracapsular extraction, and phaco extracapsular extraction; for people with cataract with co-morbid diabetic retinopathy: cataract surgery alone, and adding diabetic retinopathy treatment to cataract surgery; for people with cataract and co-morbid chronic uveitis: cataract surgery, and medical control of uveitis at the time of cataract surgery.

Cataract management in juvenile idiopathic arthritis: simultaneous versus secondary intraocular lens implantation. - Magli A; Forte R; Rombetto L; Alessio M (Ocular immunology and inflammation, 2014)
PURPOSE: To compare primary versus secondary intraocular lens (IOL) implantation after cataract removal in patients with juvenile idiopathic arthritis (JIA). METHODS: Retrospective interventional study. Data were obtained for 40 children (40 eyes) with JIA-associated uveitis operated on for cataract before the age of 16 years between January 1998 and January 2005. RESULTS: Twenty-one patients underwent primary IOL implantation at a mean age of 13.1 ± 2.6 (9-16) years. Mean follow-up was 48.2 ± 5.4 (35-64) months. Nineteen patients underwent cataract removal at a mean age 12.3 ± 2.0 (9-16) years and secondary IOL implantation 13.6 ± 0.3 (11-16) months later. Mean follow-up was 47.2 ± 6.5 (32-64) months. BCVA difference between the two groups was significant at 24-month visit only (p = 0.001). Incidence of secondary glaucoma was significantly lower in the group that underwent secondary IOL implantation (p = 0.01). CONCLUSION: Secondary IOL implantation after cataract removal in children with JIA-related uveitis provided a significantly lower incidence of secondary glaucoma.

A 5-year, randomized, open-label safety study of latanoprost and usual care in patients with open-angle glaucoma or ocular hypertension. - Goldberg I; Li XY; Selaru P; Paggiarino D (European journal of ophthalmology, 2008)
PURPOSE: To investigate the incidence of latanoprost-related adverse events of the cornea, iris, and retina and the occurrence of hyperpigmentation. METHODS: An open-label safety surveillance study was conducted in 14 countries. Patients on intraocular pressure (IOP)-reducing therapy other than latanoprost were eligible if they required a change in therapy. Patients were randomly assigned (2:1) to latanoprost administered once daily or to usual care (any other commercially available medication). Patients were examined at baseline and every 6 months for 5 years. RESULTS: In all, 5854 patients were included (latanoprost, 3936; usual care, 1918). Of those initially randomized to latanoprost, 2707 (68.8%) completed the study, and 4638 (79.2%) patients received at least one dose of latanoprost. Five-year risks were < or = 3.17% for new occurrences of corneal erosions, iritis/uveitis, or macular edema in both randomization groups. Serious adverse drug reactions were reported in 17/3936 (0.43%) latanoprost and 9/1918 (0.47%) usual care patients. In all, 87.6% of patients ever treated with latanoprost had no increased iris pigmentation; no serious adverse drug reactions were reported in patients with increased iris pigmentation. CONCLUSIONS: This 5-year study suggests that latanoprost as prescribed in 14 countries is a safe long-term treatment for patients with glaucoma and ocular hypertension.

Relative afferent pupillary defects in primary open-angle glaucoma--five years' experience. - Page CJ; Merritt JC; Evans B (Journal of the National Medical Association, 1985)
Afferent pupillary defects may accompany asymmetric primary open-angle glaucoma, though the exact incidence has not been reported. Charts were reviewed on 89 patients attending the Glaucoma/Uveitis Clinic at the North Carolina Memorial Hospital in Chapel Hill, North Carolina over a five-year period. All patients had primary open-angle glaucoma diagnosed by: (1) increased ocular tensions (22 mmHg) in the presence of open-anterior-chamber angles and (2) optic-nerve cupping and atrophy compatible with (3) pressure-dependent, visual-field loss. No subjects with secondary glaucomas, primary-angle-closure glaucoma, or ocular hypertension are included.The presence of the relative afferent pupillary defect was noted in 21 of 89 patients (23 percent). Sixteen of 70 black patients had relative afferent pupillary defect in the more severely affected eye, while five of 19 white patients demonstrated afferent pupils. Other demographic characteristics of this population are described. Two typical primary-open-angle glaucoma patients are discussed to demonstrate comparable changes within the optic nerves and Goldmann visual fields. The presence of the relative afferent pupillary defect best correlates with asymmetric, visual-field loss in the more severely affected eye.

Two-year double-masked comparison of bimatoprost with timolol in patients with glaucoma or ocular hypertension. - Cohen JS; Gross RL; Cheetham JK; VanDenburgh AM; Bernstein P; Whitcup SM (Survey of ophthalmology, 2004)
The object of this study was to compare the long term efficacy and safety of bimatoprost with timolol in patients with glaucoma or ocular hypertension. In a 12-month extension of two identically designed 1-year, multicenter, randomized, double-masked clinical trials, patients were treated topically with bimatoprost 0.03% QD (n=167), bimatoprost 0.03% BID (n=131), or timolol 0.5% BID (n=81). Main outcome measures were IOP at 8 am and 10 am and safety parameters. Bimatoprost QD provided significantly greater mean reduction from baseline IOP than did timolol at both measurements at each study visit (P< or =.001). At 10 am (peak timolol effect) at month 24, the mean reduction from baseline IOP was 7.8 mm Hg with bimatoprost QD and 4.6 mm Hg with timolol (P<.001). Patients treated with bimatoprost QD also sustained significantly lower mean IOP than timolol-treated patients at every follow-up visit throughout the 2-year study period (P< or =.006). At 10 am at month 24, a significantly greater proportion of bimatoprost QD than timolol patients achieved target pressures of < or =13-18 mm Hg (P< or =.010). Bimatoprost sustained an excellent safety profile during the second year of treatment. Most adverse events were mild, and there were no reports of increased iris pigmentation, uveitis, or CME. The incidence of hyperemia was significantly higher with bimatoprost QD (13.8%) than with timolol (2.5%) (P=.006). Mean reduction from baseline IOP with bimatoprost BID was not significantly different from that with timolol at month 24 at 10 am (P=.474). We conclude that bimatoprost QD provides superior IOP lowering to timolol, and is safe and well tolerated over 24 months of treatment.

Therapeutic targets of renin-angiotensin system in ocular disorders. - Choudhary R; Kapoor MS; Singh A; Bodakhe SH (Journal of current ophthalmology, 2017)
PURPOSE: To review current literature on the renin-angiotensin system (RAS)-mediated pathogenic mechanisms and therapeutic targets in ocular diseases. METHODS: A comprehensive literature survey was performed on PubMed, Scopus, and Google Scholar databases published from 1977 to 2016. The search terms were a RAS, angiotensin, angiotensin receptor, prorenin, pro (renin) receptor, angiotensin converting enzyme inhibitor, angiotensin receptor blocker associated with ocular disorders like cataract, glaucoma, diabetic retinopathy (DR), macular degeneration, and uveitis. Articles were reviewed on the basis of the association between ocular disorders and RAS and relevant articles were discussed. RESULTS: The literature revealed that the individual RAS components including renin, angiotensins, angiotensin converting enzymes, and RAS receptors have been expressed in the specific ocular tissues like retina, choroid, and ciliary body. The activation of both circulatory and local RAS potentiate the various inflammatory and angiogenic signaling molecules, including vascular endothelial growth factor (VEGF), extracellular signal-regulated kinase, and advanced glycation end products (AGE) in the ocular tissues and leads to several blinding disorders like DR, glaucoma, and macular degeneration. The classical and newer RAS inhibitors have illustrated protective effects on blinding disorders, including DR, glaucoma, macular degeneration, uveitis, and cataract. CONCLUSIONS: The RAS components are present in the extrarenal tissues including ocular tissue and have an imperative role in the ocular pathophysiology. The clinical studies are needed to show the role of therapeutic modalities targeting RAS in the treatment of different ocular disorders.

Trabeculotomy in a Behçet's Disease Patient One Week after Infliximab Administration. - Koike A; Handa T; Zako M (Case reports in ophthalmology, 2012)
PURPOSE: To describe a patient with Behçet's disease and anterior uveitis, which was not cured by local and systemic corticosteroid treatments, who underwent trabeculotomy one week after infliximab administration. METHODS: The patient received preoperative antibiotic therapy followed by trabeculotomy one week after infliximab administration. We observed ocular findings before and after surgery. RESULTS: Anterior uveitis improved after infliximab administration. The elevated intraocular pressure improved after surgery and there were no intraoperative complications. Neither ocular inflammatory attacks nor infectious complications were found in the operated eye of the patient during follow-up. CONCLUSION: Trabeculotomy one week after administration of infliximab appears to be safe and effective in treating secondary glaucoma associated with Behçet's disease.

A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma. - Nagar M; Ogunyomade A; O'Brart DP; Howes F; Marshall J (The British journal of ophthalmology, 2005)
AIM: To compare 90 degrees , 180 degrees , and 360 degrees selective laser trabeculoplasty (SLT, 532 nm Nd:YAG laser) with latanoprost 0.005% for the control of intraocular pressure (IOP) in ocular hypertension (OHT) and open angle glaucoma (OAG). METHODS: A prospective, randomised clinical trial in the Department of Ophthalmology, St Thomas's Hospital, London, and Clayton Eye Centre, Wakefield, West Yorkshire. 167 patients (167 eyes) with either OHT or OAG were randomised to receive 90 degrees , 180 degrees , and 360 degrees SLT or latanoprost 0.005% at night and were evaluated at 1 hour, 1 day, 1 week and 1, 3, 6, and 12 months. RESULTS: The mean follow up was 10.3 months (range 1--12 months). Early, transient, complications such as postoperative ocular pain, uveitis, and 1 hour IOP spike occurred in a number of eyes after SLT, with pain being reported more frequently after 360 degrees than 90 degrees treatments (p>0.001). Success rates defined in terms of both a 20% or more and a 30% or more IOP reduction from baseline measurements with no additional antiglaucomatous interventions were better with latanoprost than 90 degrees (p<0.001) and 180 degrees SLT (p<0.02) treatments. Differences in success rates between latanoprost and 360 degrees SLT did not reach statistical significance (p<0.5). Success rates were greater with 180 degrees and 360 degrees compared to 90 degrees SLT (p<0.05). With 360 degrees SLT, 82% of eyes achieved a >20% IOP reduction and 59% a >30% reduction from baseline. Although success rates were better with 360 degrees than 180 degrees SLT treatments, differences did not reach statistical significance. There were no differences with regard to age, sex, race, pretreatment IOP, OHT versus OAG, laser power settings, and total laser energy delivered between eyes which responded, in terms of a >20% and a >30% IOP reduction, and those that did not respond with 180 degrees and 360 degrees SLT treatments. CONCLUSIONS: Success rates were higher with latanoprost 0.005% at night than with 90 degrees and 180 degrees SLT treatments. 90 degrees SLT is generally not effective. 360 degrees SLT appears to be an effective treatment with approximately 60% of eyes achieving an IOP reduction of 30% or more. Transient anterior uveitis with associated ocular discomfort is not unusual in the first few days after SLT. Late complications causing ocular morbidity after SLT were not encountered.

Management of nucleus loss into the vitreous: long term follow up in 63 patients. - Romero-Aroca P; Fernández-Ballart J; Méndez-Marín I; Salvat-Serra M; Baget-Bernaldiz M; Buil-Calvo JA (Clinical ophthalmology (Auckland, N.Z.), 2007)
BACKGROUND: The aim of present study is to determine the long-term results of patients who undergo pars plana vitrectomy after retained nucleus into the vitreous. SETTING: Service of Ophthalmology, Hospital Universitari St Joan, Reus (Barcelona), Spain. METHODS: Retrospective, noncomparative, consecutive case series. Medical records were reviewed of all patients who underwent pars plana vitrectomy for retained nucleus into the vitreous after complicated cataract surgery, over a 9-year period between August 1, 1997 and July 31, 2005. RESULT: The incidence of retained lens fragments was 0.57% (63 patients), the postoperative visual acuity was higher than 20/40 in 59.60% and fell to 48.93% by the end of the study, and was related to the presence of CME and retinal detachment. The CME appeared in 31.91% of the patients and was related to preoperative uveitis an corneal edema. In the group of patients on whom the vitrectomy was performed at the time of cataract complication, visual acuity was higher than 20/40 in 77.77%, and no one developed secondary glaucoma or uveitis. CONCLUSION: Being retrospective, our study was not result conclusive. Despite the initial good results of these patients after PPV surgery, follow-up should be accurate and over a long period of time in order to minimize postoperative complications such as retinal detachment, retinal breaks, secondary glaucoma and CME.

Efficacy and safety of vitrectomy for congenital cataract surgery: a systematic review and meta-analysis based on randomized and controlled trials. - Cao K; Wang J; Zhang J; Yusufu M; Jin S; Hou S; Zhu G; Wang B; Xiong Y; Li J; Li X; Chai L; et al. (Acta ophthalmologica, 2019)
PURPOSE: To explore the effectiveness and safety of vitrectomy for congenital cataract surgery. METHODS: We searched PubMed, Science Direct, The Cochrane Library, China National Knowledge Infrastructure and the Wanfang Database. Two researchers extracted data and assessed paper quality independently. Posterior capsule opacification (PCO) or visual axis opacification (VAO), reoperation rate, visual acuity, intraocular lenses (IOL) deposit, synechias, uveitis, secondary glaucoma, low-contrast sensitivity and IOL decentration were compared. RESULTS: We included 11 randomized controlled trials (RCTs) with 634 congenital cataract eyes. Cases of posterior capsule opacification in vitrectomy group were significantly less than that of control group, with risk ratio (RR) of 0.15 [95% confidence interval (CI): 0.09, 0.26], and there was no heterogeneity (I2  = 0%, p = 0.94). Reoperation rate in vitrectomy group was lower than that of control group either (RR = 0.40, 95%CI: 0.17, 0.94), and there was no heterogeneity (I2  = 0%, p = 0.85). Best-corrected visual acuity (BCVA) measured in LogMAR unit of vitrectomy group was smaller, with a mean difference (MD) of -0.17 (95%CI: -0.28, -0.05), and I2 was only 22%, indicating of a small heterogeneity. No statistical difference was found between two groups on IOL deposit (RR = 1.23, 95%CI: 0.70, 2.17), and the heterogeneity was small (I2  = 16%, p = 0.31). No statistical difference was found between two groups on synechias (RR = 1.08, 95%CI: 0.60, 1.94), with a quite small heterogeneity (I2  = 3%, p = 0.38). No statistical difference was found between two groups on uveitis (RR = 0.55, 95%CI: 0.15, 2.01), and there was no heterogeneity (I2  = 0%, p = 0.94). There was no statistical difference on IOP either, with a MD of 0.25 (95%CI: -1.56, 2.07), and there was no heterogeneity (I2  = 0%). Egger's test showed that there was no publication bias for all assessed outcomes. Low-contrast sensitivity was better in the vitrectomy group. And no evidence indicated vitrectomy could lead to a higher risk on secondary glaucoma or IOL decentration. CONCLUSION: Vitrectomy helps lower the PCO risk and reoperation risk after congenital cataract surgery, and also, vitrectomy helps patients gain a better BCVA and achieve a better low-contrast sensitivity, with no trade-off on IOP control, IOL deposit, synechias, uveitis and secondary glaucoma. We recommend performing vitrectomy during congenital cataract surgery.

Management of retained intravitreal lens fragments after phacoemulsification surgery. - Yang CS; Lee FL; Hsu WM; Liu JH (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift für Augenheilkunde, 2002)
PURPOSE: To evaluate the clinical features of eyes with retained intravitreal lens fragments after phacoemulsification surgery and to assess the guidelines of management and the visual outcome after vitrectomy. METHODS: Twenty-five consecutive patients referred to our institute for retained intravitreal lens fragments after phacoemulsification cataract surgery were evaluated retrospectively over a 7-year period. RESULTS: The clinical features of retained lens fragments included deceased visual acuity of 6/60 or worse (68%), uveitis (60%), glaucoma (48%), corneal edema (44%) and retinal detachment in 2 patients (8%). There were 24 patients who underwent pars plana vitrectomy; 1 patient was managed with medical therapy. After vitrectomy, 17 eyes (71%) showed visual improvement, and final visual acuity was 6/12 or better in 13 eyes (54%). The causes of poor final visual outcome of 6/60 or worse included retinal detachment and cystoid macular edema. The time interval between vitrectomy and phacoemulsification was within 4 weeks in 17 patients (71%), ranging from on the same day to 97 days. There was only a trend of better visual outcome in early vitrectomy patients (within 1 week). There was no statistical difference between the initial intraocular lens status and final visual acuity. CONCLUSION: Vitectomy with removal of retained intravitreal lens fragments is beneficial for patients with persistent uveitis and glaucoma after phacoemulsification. In the majority of patients, visual improvement was achieved after vitrectomy. However, poor visual outcome may occur secondary to retinal detachment and cystoid macular edema.

Clinical Spectrum of HLA-B27-associated Ocular Inflammation. - Pathanapitoon K; Dodds EM; Cunningham ET; Rothova A (Ocular immunology and inflammation, 2017)
Human leukocyte antigen (HLA)-B27-associated anterior uveitis (AU) is the most commonly diagnosed form of AU and represents the largest entity of non-infectious uveitis around the world. The most typical ocular manifestation associated with HLA-B27 consists of unilateral AU of acute onset. The HLA-B27-associated acute AU represents a distinct clinical entity occurring typically in young adults between the ages of 20 and 40 years. HLA-B27-associated acute AU is typically unilateral and lasts usually several weeks and diminishes within 3 months in the majority of patients. The anterior chamber shows typically severe cellular reaction and flare, as well as a fibrinous exudate. Frequently, posterior synechiae are formed and occasionally hypopyon is present. The pattern of the disease is recurrent with a full remission between the attacks. Intraocular pressure during active periods is typically low due to inflammation of ciliary body and decreased aqueous production. Less typical presentations are also recognized and include the development of chronic inflammation, posterior segment involvement, episcleritis, and scleritis. An isolated retinal vasculitis in HLA-B27-positive patients may develop, mostly in those with inflammatory bowel disease. Chronic AU, which may be either unilateral or bilateral affects up to 20% of patients. Ocular complications of HLA-B27-associated AU are diverse and include commonly posterior synechiae, cataract, glaucoma and/or hypotony. The visual outcome and complications of HLA-B27-associated AAU are frequently being compared with HLA B27-negative patients with AU and show that the prognosis of HLA-B27-associated uveitis is rather favorable, as <2% developed legal blindness and <5% visual impairment. A novel algorithm called the "Dublin Uveitis Evaluation Tool (DUET)" has been proposed to guide ophthalmologists to refer appropriate HLA-B27-positive patients with uveitis to rheumatologists.

The effects of prostaglandin analogues on the blood aqueous barrier and corneal thickness of phakic patients with primary open-angle glaucoma and ocular hypertension. - Arcieri ES; Pierre Filho PT; Wakamatsu TH; Costa VP (Eye (London, England), 2008)
PURPOSE: To evaluate the effects of topical latanoprost, travoprost, and bimatoprost on the blood-aqueous barrier and central corneal thickness (CCT) of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). DESIGN: Prospective, randomized, masked-observer, crossover clinical trial. METHODS: A total of 34 phakic patients with POAG or OHT with no previous history of intraocular surgery or uveitis completed the study. Patients were randomized to use latanoprost 0.005%, travoprost 0.004%, or bimatoprost 0.03% once daily (2000 hours) for 1 month, followed by a washout period of 4 weeks between each drug. Aqueous flare was measured with a laser flare metre. CCT was calculated as the average of five measurements using ultrasound pachymetry. All measurements were performed by a masked observer (1000 h). RESULTS: There were no statistically significant differences between baseline mean IOP, mean CCT, and mean flare values among the groups. There was no statistically significant increase in mean flare values from baseline in all groups (P>0.05). There were no statistically significant differences between mean flare values among the groups (P>0.05). All medications significantly reduced the mean IOP from baseline (P<0.0001). IOP reduction obtained with travoprost (7.3+/-3.8 mmHg) was significantly higher than that obtained with latanoprost (4.7+/-4.2 mmHg) (P=0.01). A statistically significant reduction in mean CCT (0.6+/-1.3%) from baseline was observed when patients instilled bimatoprost (P=0.01). CONCLUSIONS: Latanoprost, travoprost, and bimatoprost had no statistically significant effect on the blood-aqueous barrier of phakic patients with POAG or OHT. Bimatoprost may be associated with a clinically irrelevant reduction in mean CCT.

Prevalence and management of elevated intraocular pressure after placement of an intravitreal sustained-release steroid implant. - Bollinger KE; Smith SD (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.

Case Report: Significant Complications of Cosmetic Iris Implantation. - Hatcher JB; De Castro-Abeger A; Brown EN; Robinson JL; Shieh C (Optometry and vision science : official publication of the American Academy of Optometry, 2021)
SIGNIFICANCE: The complications of cosmetic iris implantation may result in irreversible vision loss. Patients who obtain these implants against general medical consensus may present to providers when sequelae develop. In symptomatic patients, providers must recognize the imminent risk to vision and mitigate further ocular damage. PURPOSE: This is an observational clinical case report of a patient with significant, progressive, vision-threatening ocular pathology from prior cosmetic iris implantation, despite medical and surgical efforts to preserve vision. CASE REPORT: A 35-year-old HIV-positive man with a history of cosmetic iris implants in India 16 months prior was referred to our center. He had a history of 4 months of steroid-refractory uveitis and secondary glaucoma, with IOP measurements of more than 50 mmHg in the outpatient setting. Slit-lamp examination revealed ciliary flush, pannus formation, corneal edema, and keratic precipitates. Optical coherence tomography suggested possible retinal nerve fiber layer loss in the left eye. He was diagnosed with uveitis and glaucoma, and after a short course of IOP-lowering medication, the implants were removed sequentially. Post-operatively, his course was complicated by IOP elevation, cataract development, and corneal decompensation. This led to bilateral Ahmed tube placement, Descemet's stripping endothelial keratoplasty of the right eye, and pending cataract surgery because of now-dense bilateral cataracts. CONCLUSIONS: This case emphasizes the vision-threatening dangers of cosmetic iris implantation. It also demonstrates that sequelae may persist and develop despite implant removal and anticipatory management. Providers managing similar patients should carefully monitor for disease progression and maintain a low threshold for referral and/or decisive surgical intervention.

Cataract surgery and intraocular lens implantation in children with juvenile rheumatoid arthritis associated uveitis. - Petric I; Loncar VL; Vatavuk Z; Iveković R; Sesar I; Mandić Z (Collegium antropologicum, 2005)
Clinical records of 6 children (7 eyes) with juvenile rheumatoid arthritis (JRA) who underwent cataract surgery with IOL implantation between January 1998 and December 2002 were reviewed. The median age at the time of cataract surgery was 8 years (range 5-14 years). The median follow up was 48 months (range 26 to 60 months). Five of six children (6 eyes) were on systemic immunosuppressive or anti-inflammatory therapy. Glaucoma was present in three eyes before surgery, and all three eyes underwent combined cataract surgery and trabeculectomy with mitomycin C. A final best corrected visual acuity of 0.5 or better was achieved in all eyes Postoperative complications included posterior capsule opacification (n = 5), glaucoma (n = 1), and cystoid macular edema (n = 1). Intraocular lens implantation in children with control of preoperative and postoperative ocular inflammation could lead to favorable visual results.

Outcome of phacoemulsification in 71 cats: A multicenter retrospective study (2006-2017). - Fenollosa-Romero E; Jeanes E; Freitas I; Enache AE; Lockhart R; Fleming L; Knott TNL; Dawson C; Smith K; Busse C (Veterinary ophthalmology, 2020)
PURPOSE: To assess outcome of phacoemulsification in cats. METHODS: Records of 71 cats (82 eyes) from five referral centers were reviewed. Groups were divided by cause of cataract (congenital/juvenile [n = 32], traumatic [n = 33], and secondary to uveitis [n = 6]), and group comparisons were performed for the most common complications: postoperative ocular hypertension (POH), uveitis, corneal ulceration, synechia/dyscoria, and posterior capsular opacity (PCO) in three different time periods: immediately postoperatively, at 1-90 days, and at >90 days. RESULTS: Median follow-up was 198 days (interquartile range 64-518 days). The overall visual success rate of the cats with a 12-month follow-up was 92.6% (25/27 eyes). POH occurred in 35/82 (42.6%) eyes. Immediately postoperatively, uveitis was the most common complication in 28/82 eyes (34.1%) followed by corneal ulceration in 22/82 eyes (26.8%). At 1-90 days, uveitis in 41/81 eyes (50.6%) remained the most common complication, followed by synechia/dyscoria in 21/81 eyes (25.9%), corneal ulceration in 16/81 eyes (19.7%), and PCO in 15/81 eyes (18.5%). At >90 days, PCO in 17/47 eyes (36.1%), followed by synechia/dyscoria in 16/47 eyes (34%), was the most common complications. The number of eyes with synechia/dyscoria in the trauma group was higher (13/33 [39.3%]) than in the congenital/juvenile group (5/31 [16.1%]) at 1-90 days (P = .039). No statistical difference was found for the other group comparisons. Three eyes in total were enucleated owing to endophthalmitis, post-traumatic ocular sarcoma, and secondary glaucoma. CONCLUSION: Uveitis in the short-term and PCO and synechia/dyscoria in the long-term were the most common complications following phacoemulsification in cats.

Noncontact transscleral Nd:YAG cyclophotocoagulation: a long-term follow-up of 500 patients. - Shields MB; Shields SE (Transactions of the American Ophthalmological Society, 1994)
Long-term experience with transscleral cyclophotocoagulation in 500 patients suggests that this operation is the cyclodestructive procedure of choice. It offers a reasonable surgical option in the high-risk glaucoma population, which includes patients with neovascular glaucoma, glaucomas with active uveitis, glaucomas in aphakia or pseudophakia, and other cases in which filtering surgery has failed or is felt to have a low chance for success. Satisfactory intraocular pressure reduction was achieved in 62% of the patients with one treatment session. After one or more repeated procedures in 21% of the study group, the final intraocular pressure was below baseline in 94%, with a mean final reduction of 24 mm Hg, which was judged to be adequate for 87% of the patients. However, visual loss remains a significant postoperative complication, with some degree of reduced vision occurring in 39% of the study population. Patients with neovascular glaucoma had the greatest percentage of visual loss at 46%, compared with 34% and 38% for patients with glaucomas in pseudophakia and aphakia, respectively. While it is hard to know how many of these cases of visual loss were a direct result of the cyclophotocoagulation, the procedure should be used with caution in eyes with a potential for good central vision. Further study is needed to determine the relative indications for transcleral cyclophotocoagulation and the various operations to increase aqueous outflow in the management of patients in the high-risk glaucoma population.

Changing patterns of ocular manifestations in HIV seropositive patients treated with HAART. - Accorinti M; Pirraglia MP; Corradi R; Corsi C; Fabiani C; Pivetti-Pezzi P (European journal of ophthalmology, 2006)
PURPOSE: To report the changing patterns of ocular manifestations in human immunodeficiency virus (HIV) seropositive patients treated with highly active antiretroviral therapy (HAART). METHODS: The clinical charts of HIV seropositive patients, 735 examined from 1997 to 2003 and treated with HAART for at least 2 months (Group 1), and 838 untreated examined from 1988 to 1995 (Group 2), were reviewed to assess the frequency of ocular manifestations. RESULTS: HIV-related retinal microangiopathy and opportunistic retinal infections (cytomegalovirus retinitis and toxoplasmic retinochoroiditis) were significantly higher in Group 2 than 1 (p<0.0001), while in patients treated with HAART a statistically significant increase in the frequency of chalazion (p<0.0001), diabetic and hypertensive retinopathy (p<0.0001), lipid arc of the cornea (p<0.0001), cataract and glaucoma (p<0.0001), and uveitis (p=0.026) was observed. CONCLUSIONS: HAART therapy has induced a dramatic decrease in the incidence of HIV-related microangiopathy and opportunistic retinal infection and the occurrence of new lesions related both to the metabolic alterations induced by HAART and to immune reconstitution, such as uveitis.

Clinical comparison of semiconductor diode versus neodymium: YAG non-contact cyclo photocoagulation. - Ulbig MW; McHugh DA; McNaught AI; Hamilton AM (The British journal of ophthalmology, 1995)
AIMS: The advent of diode lasers has allowed their use in transscleral cyclo photocoagulation for refractory glaucoma. A trial was performed to compare the ocular hypotensive and inflammatory effects of cyclo photocoagulation using a continuous wave diode (810 nm) and a free running neodymium:yttrium aluminium garnet (Nd:YAG) laser (1064 nm). METHODS: Forty patients with refractory glaucoma were randomised to receive either diode or Nd:YAG therapy. The intraocular pressure (IOP) and inflammatory response to treatment were monitored over 3 months. RESULTS: There was no significant laser related difference in the effect on IOP after one treatment. There was, however, a difference in effect in retreatments with the IOP lowering effect significantly less, but equally sustained in diode retreatment patients. Severe postoperative complications such as hyphaema or fibrinous anterior uveitis only occurred in the Nd:YAG group. CONCLUSION: The degree and duration of the ocular hypotensive response to cyclo photocoagulation appears to be related to the available power output of the system used, and the extent of tissue damage.

Safety profile of intravitreal triamcinolone acetonide. - Baath J; Ells AL; Crichton A; Kherani A; Williams RG (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2007)
BACKGROUND: There is currently a widespread use of intravitreal triamcinolone acetonide (IVTA) for age-related macular degeneration, diabetic macular edema, cystoid macular edema secondary to retinal vein occlusions, and uveitis. The aim of this investigation was to assess the rates of various complications associated with this treatment and to determine which factors are associated with the development of these complications. METHODS: A retrospective interventional case series of all patients from one retina specialist undergoing IVTA was conducted in a clinical setting from 2002 to 2005. All disease entities were included. Patients were followed for a mean of 9.5 months after receiving 4 mg (0.1 mL) of nonfiltered triamcinolone acetonide (TA). All complications associated with the injection procedure or with the TA were noted. RESULTS: Two hundred and twenty-three (223) eyes of 192 patients received a total of 336 IVTA injections between 2002 and 2005. The mean age was 73.3 years and mean follow-up was 9.5 months. A single injection was performed in 144 eyes (64.6%); 2 IVTAs in 55 eyes (24.7%); 3 IVTAs in 16 eyes (7.2%), and 3.6% of eyes had more than 3 injections at a minimal interval of 3 months. The only immediate complication was a single injection (0.3%) associated with a temporary occlusion of the central retinal artery, which opened immediately following anterior paracentesis. Late complications included endophthalmitis in 1 of 336 (0.3%) injections and a steroid response requiring glaucoma medication in 60 of 192 patients (31.3%). In patients with preexisting glaucoma, 58.8% required additional glaucoma medication. Glaucoma-filtering surgery was required in 2 of 192 patients (1.0%). CONCLUSIONS: In the study center, the IVTA is extremely safe in patients without a history of glaucoma. However, patients with preexisting glaucoma with progressive optic neuropathy must be treated with great caution.

Ocular disorders in adult patients with tuberculosis in a tertiary care hospital in Nigeria. - Egbagbe EE; Omoti AE (Middle East African journal of ophthalmology, 2008)
OBJECTIVES: To determine the ocular disorders in adult tuberculosis (TB) patients in Benin City, Nigeria. METHODS: A prospective study of adult TB patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria, between March 2006 and October 2006 was undertaken. The patients were interviewed and examined by the authors and the ocular findings recorded. RESULTS: There were 92 patients (45 males and 47 females) with mean age 37.9 years (SD±15.6). Only one (1.1 percent) was HIV positive. Among the ocular findings in patients with TB, 8 patients had monocular blindness that included cataracts in 3 (37.5 percent), glaucoma in 2 (25 percent), optic atrophy, retinal vasculitis and maculopathy accounting for one case each (12.5 percent). Ocular disorders due to TB occurred in 9 patients (9.8 percent). These include cataract in 2 cases (2.2 percent), phlyctenular conjunctivitis in 2 cases (2.2 percent), glaucoma, anterior uveitis, chorioretinitis, retinal vasculitis, maculopathy, and optic atrophy each occurring in 1 case (1.1 percent). CONCLUSION: Tuberculosis is a cause of ocular morbidity, visual impairment and blindness. Prevention, early diagnosis and early treatment of TB may prevent avoidable visual loss.

Vitamin D and Ocular Diseases: A Systematic Review. - Chan HN; Zhang XJ; Ling XT; Bui CH; Wang YM; Ip P; Chu WK; Chen LJ; Tham CC; Yam JC; Pang CP (International journal of molecular sciences, 2022)
The contributory roles of vitamin D in ocular and visual health have long been discussed, with numerous studies pointing to the adverse effects of vitamin D deficiency. In this paper, we provide a systematic review of recent findings on the association between vitamin D and different ocular diseases, including myopia, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), dry eye syndrome (DES), thyroid eye disease (TED), uveitis, retinoblastoma (RB), cataract, and others, from epidemiological, clinical and basic studies, and briefly discuss vitamin D metabolism in the eye. We searched two research databases for articles examining the association between vitamin D deficiency and different ocular diseases. One hundred and sixty-two studies were found. There is evidence on the association between vitamin D and myopia, AMD, DR, and DES. Overall, 17 out of 27 studies reported an association between vitamin D and AMD, while 48 out of 54 studies reported that vitamin D was associated with DR, and 25 out of 27 studies reported an association between vitamin D and DES. However, the available evidence for the association with other ocular diseases, such as glaucoma, TED, and RB, remains limited.

Appraisal and management of ocular hypotony and glaucoma associated with uveitis. - Tran VT; Mermoud A; Herbort CP (International ophthalmology clinics, 2000)

Prospective Randomized Study Comparing Ex-PRESS to Trabeculectomy: 1-Year Results. - Wagschal LD; Trope GE; Jinapriya D; Jin YP; Buys YM (Journal of glaucoma, 2015)
PURPOSE: To compare the efficacy and safety of the Ex-PRESS glaucoma shunt with standard trabeculectomy. PATIENTS AND METHODS: Consenting patients with medically uncontrolled open-angle glaucoma were prospectively randomized to trabeculectomy or Ex-PRESS shunt both with mitomycin-C. Exclusion criteria included previous ocular surgery with the exception of clear cornea phaco or 1 previous trabeculectomy, uveitis, and vitreous in the anterior chamber. Standardized data collection sheets were completed at baseline and postoperative day 1, weeks 1 and 2, and months 1, 2, 3, 6, and 12. Primary outcome was intraocular pressure (IOP). Complete success was defined as an IOP between 5 and 18 mm Hg and a 20% reduction from baseline without medication. A sample size calculation determined that 52 eyes were required to detect a 2.0 mm Hg IOP difference with a power of 80%. RESULTS: Sixty-four subjects were enrolled, 33 in the Ex-PRESS and 31 in the trabeculectomy group. IOP was not statistically significantly different between groups. Baseline and 1-year mean IOP was 22.0±6.8 versus 22.7±10.3 mm Hg (P=0.76) and 11.6±4.5 versus 11.3±4.5 mm Hg (P=0.81) in the trabeculectomy versus Ex-PRESS groups, respectively. Complete success was 57% versus 70% (P=0.28) in the trabeculectomy versus Ex-PRESS groups, respectively. There were no statistically significant differences in surgical time, number of glaucoma medications, visual acuity, central corneal thickness, endothelial cell counts, complications, interventions, or bleb morphology between the trabeculectomy and the Ex-PRESS groups. CONCLUSIONS: There was no statistically significant difference between the trabeculectomy and Ex-PRESS groups regarding IOP, success rates, complications, additional interventions, and bleb morphology.

Postoperative results of cosmetic iris implants. - Galvis V.; Tello A.; Corrales M.I. (Journal of Cataract and Refractive Surgery, 2016)
The purpose of this review was to evaluate the postoperative results of cosmetic iris implants. A systematic review of studies reporting postoperative outcomes of cosmetic iris implants identified 26 studies and 3 videos, comprising 128 eyes. In 88 (68.8%) of the eyes, the device required explantation due to complications. Secondary glaucoma occurred in 59 eyes, uveitis in 39 eyes, cataract in 22 eyes, and severe endothelial cell loss or corneal decompensation in 44 eyes. In 8 eyes, the final corrected distance visual acuity was counting fingers or worse. The review showed that cosmetic iris implants resulted in a substantial number of cases with severe complications. The finding strongly suggests that this cosmetic surgical technique should be avoided. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Low vision in Nigerians with diabetes mellitus. - Nwosu SN (Documenta ophthalmologica. Advances in ophthalmology, 2000)
OBJECTIVES: To determine the prevalence and causes of low vision in diabetes mellitus patients in Nigeria. MATERIALS AND METHODS: All consecutive new patients seen at the Diabetic Eye Clinic, Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria, between March 1997 and September 1998 were the subjects of the study. Examination methods included interviewer-administered structured questionnaire, visual acuity test, external eye examination, refraction, tonometry, gonioscopy, binocular indirect ophthalmoscopy and slit lamp fundus examination with 78D non-contact lens. RESULTS: Of the 100 new patients examined, 47 (47%) did not know that diabetes could lead to visual loss; 53 (53%) had not been examined by any eye health worker. Eighteen patients (18%) were bilaterally blind and 26 (26%) had monocular blindness; visual impairment was present in the better eyes of 30 patients (30%), with 20 (20%) having bilateral visual impairment. Glaucoma, cataract, diabetic retinopathy, central retinal vein occlusion, age-related macular degeneration, and leukoma were the causes of blindness. Visual impairment was due to diabetic macular edema, ametropia, cataract, age-related macular degeneration, glaucoma, uveitis and branch retinal vein occlusion. CONCLUSION: The causes of low vision in the patients are treatable and visual defects from them are thus avoidable. It is recommended that (a) all diabetics be made aware that diabetic complications cause visual loss; (b) laser photocoagulation facilities be provided for treating diabetic retinopathy.

Ocular manifestations in herpes zoster ophthalmicus. - Puri LR; Shrestha GB; Shah DN; Chaudhary M; Thakur A (Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH, 2011)
BACKGROUND: Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications. AIM: To identify the pattern of ocular manifestation in herpes zoster ophthalmicus. MATERIALS AND METHODS: A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation. RESULTS: Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %. CONCLUSION: Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination.

Pars plana lensectomy and vitrectomy for complicated cataracts in juvenile rheumatoid arthritis. - Flynn HW; Davis JL; Culbertson WW (Ophthalmology, 1988)
Anterior surgical approaches to cataracts in juvenile rheumatoid arthritis (JRA) patients are compromised by chronic anterior and posterior uveitis, miotic pupils, and posterior synechiae. The authors retrospectively reviewed the results of pars plana lensectomy and vitrectomy in ten eyes from seven JRA patients with cataracts associated with chronic iridocyclitis and vitritis. Visual acuities improved from 20/100 or worse preoperatively to 20/60 or better postoperatively. Transient postoperative hypotony lasting 1 week to 4 months occurred in four of the ten eyes. Patients with glaucoma continued to require antiglaucoma therapy after surgery. Pars plana lensectomy and vitrectomy provides a theoretically preferrable approach to complicated cataracts and vitritis in JRA patients because it allows removal of peripheral lens material in the presence of a miotic pupil, eliminates the potential for synechiae to the posterior capsule and/or anterior hyaloid, and clears the visual axis of inflammatory debris.

Impact of the COVID-19 Lockdown on Ophthalmological Assistance in the Emergency Department at a Spanish Primary Level Hospital. - González-Martín-Moro J; Guzmán-Almagro E; Izquierdo Rodríguez C; Fernández Hortelano A; Lozano Escobar I; Gómez Sanz F; Contreras I (Journal of ophthalmology, 2021)
PURPOSE: To analyze the changes in ophthalmological emergencies during the COVID-19 pandemic lockdown at a Spanish primary level hospital. METHODS: The number and type of emergencies attended in the emergency department of Hospital Universitario del Henares between March 10 and August 31, 2020 (COVID-19 cohort) were compared with the emergencies attended during the same period of 2019 (pre-COVID-19 cohort). Data on the diagnosis, patient age, and gender was retrospectively collected from the electronic medical records of the hospital. The different diagnoses were organized into "clusters," which include those conditions that affect the same ocular tissue and that have similar clinical expression. RESULTS: The number of ophthalmological emergencies during the study period was 841, compared to 1343 during the same month of 2019, which represents a reduction of 37.4%. The percentage reduction in each cluster was as follows: conjunctiva (-65.4%), cornea (-35.8%), uveitis (-3.6%), eyelid and orbital and lacrimal (-35.5%), strabismus (-60%), neuro-ophthalmology (-11.8%), retina (-10.6%), cataract (+16.4%), glaucoma (-37%), and miscellaneous (-45.1%). The number of people seen with viral conjunctivitis decreased by -87.1% compared to 2019. Patients with complications due to conjunctivitis also decreased: patients with pseudomembranes dropped from 16 to 4 cases and patients with corneal subepithelial infiltrates from 9 to 3 cases. CONCLUSIONS: Most diagnostic clusters showed a similar decrease. Clusters that included vision-threating conditions (retina, neuro-ophthalmology, and uveitis) remained mostly stable. During the COVID-19 lockdown, the diagnosis of adenoviral conjunctivitis decreased nearly 10 times. This fact may represent a decrease in the transmission of these infections.

Intermediate-term results of a randomized clinical trial of the 350- versus the 500-mm2 Baerveldt implant. - Lloyd MA; Baerveldt G; Fellenbaum PS; Sidoti PA; Minckler DS; Martone JF; LaBree L; Heuer DK (Ophthalmology, 1994)
BACKGROUND: The Baerveldt glaucoma implant is a large equatorial aqueous shunting device that is installed through a single-quadrant conjunctival incision. The intermediate-term results of a randomized study comparing the 350- and 500-mm2 Baerveldt implants are reported. METHODS: Seventy-three patients with medically uncontrollable, nonneovascular glaucomas associated with aphakia, pseudophakia, or failed filters were enrolled in a randomized, prospective study comparing 350- and 500-mm2 Baerveldt implants. Surgical success was defined as 6 mmHg < or = final intraocular pressure < or = 21 mmHg without glaucoma reoperation or devastating complication. RESULTS: Of patients with 350- and 500-mm2 implants, 93% and 88%, respectively, achieved surgical success (18-month life-table analysis, P = 0.93). The 500-mm2 implants afforded intraocular pressure control with significantly fewer medications (0.7 versus 1.3; P = 0.006). The postoperative visual acuities remained within one line of the preoperative visual acuities or improved in 62% and 66% of patients in the 350- and 500-mm2 groups, respectively (P = 0.93). Complication rates were statistically similar. The most frequent ones in the 350- and 500-mm2 groups, respectively, were serous choroidal effusion (16% and 32%), strabismus (16% and 19%), anterior uveitis (14% and 11%), and corneal or corneal graft edema (11% each). CONCLUSION: The intermediate-term results of the 350- and 500-mm2 Baerveldt implants were statistically comparable with respect to surgical and visual outcomes, as well as complications, although the larger implant was associated with a higher rate of some complications. However, the 500-mm2 Baerveldt implant afforded intraocular pressure control with fewer medications than the 350-mm2 implant.

Cyclophosphamide vs. Infliximab for Refractory Idiopathic Scleritis (CIRIS) - Hospices Civils de Lyon (clinicaltrials.gov, 2017)
This study will evaluate the Efficacy and Safety of Infliximab versus Cyclophosphamide in Subjects with Idiopathic Refractory Scleritis. The term scleritis describes a chronic inflammation that involves the outermost cost and skeleton of the eye. Scleritis is classified anatomically as either anterior or posterior based on the principal location of the inflammation. Thirty to forty percent of scleritis cases are associated with systemic autoimmune conditions including rheumatoid arthritis and granulomatosis with polyangiitis. Infectious causes including herpes virus and varicella zoster account for 5 to 10% of patients. The remaining 50% of cases are classified as idiopathic. CIRIS, is the first prospective randomized, head to head study, comparing infliximab to cyclophosphamide in refractory idiopathic scleritis. There is no firm evidence or randomized controlled trials directly addressing the best biologic agent in severe and refractory idiopathic scleritis. If left untreated or insufficiently treated, scleritis can progress to peripheral ulcerative keratitis, uveitis and glaucoma. Visual loss occurs in approximately 10% of patients with anterior scleritis and in up to 75% of patients with posterior scleritis. The incidence of burden in ocular inflammation (uveitis and scleritis) has been dramatically reduced in the recent years with the use of biologics, raising the question of whether these compounds should be used earlier in the treatment of severe non infectious scleritis. Contrasting with other immunosuppressors, cyclophosphamide and infliximab act rapidly and are highly effective in steroid's sparing. Despite a strong rationale, these compounds are not yet approved in idiopathic refractory scleritis, which guarantees the innovative nature of this study that aims selecting or dropping any arm when evidence of efficacy already exists.

Intraocular lens implantation in eyes with Fuchs' heterochromic iridocyclitis. - Milazzo S; Turut P; Borhan M; Kheireddine A (Journal of cataract and refractive surgery, 1996)
PURPOSE: To evaluate the results of cataract surgery with intraocular lens (IOL) implantation in eyes with Fuchs' heterochromic iridocyclitis. SETTING: Saint-Victor Hospital, Amiens, France. METHODS: We reviewed the charts of 93 patients (94 eyes) with heterochromic iridocyclitis who had cataract extraction and IOL implantation by the same surgeon. In six patients, the IOL was placed in the anterior chamber; 9 received Binkhorst four-loop IOLs sutured at the 12 and 6 o'clock positions, and 79 received posterior chamber IOLs, 15 in the sulcus and 64 in the capsular bag. Follow-up was from 6 months to 10 years (mean 41 months). RESULTS: Precipitates on the IOL surface and white keratic precipitates were detected in 65.5% of eyes. Most eyes had minimal anterior segment activity. No severe uveitis was observed. The major problem, observed in 12.3% of the patients, was glaucoma. Best corrected postoperative visual acuity was 20/40 or better in 76.6% of eyes. CONCLUSION: Eyes with heterochromic iridocyclitis responded well to cataract extraction with IOL implantation. The restoration of satisfactory binocular vision justifies IOL implantation in patients with Fuchs' unilateral syndrome.

[Ocular changes in hemorrhagic fever with renal syndrome]. - Tedeschi-Reiner E; Mandić Z; Grgić D (Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti, 2003)
Hemorrhagic fever with renal syndrome (HFRS) is a rodent-originating zoonotic disease caused by Puumala and Dobrava viruses, which belong to the genus Hantavirus. The most prominent ocular change in HFRS is transient myopia, which lasts for up to one week and is due to a forward movement of the ocular anterior diaphragm and thickening of the lens. Other ophthalmic manifestations of HFRS are eyelid edema, conjunctival injection with or without hemorrhages, chemosis, anterior uveitis, retinal edema with or without hemorrhages, and photophobia. Acute glaucoma attacks, which are rare, could be explained by the increased intraocular pressure (IOP) due to edema and hemorrhage in the ciliary body, causing anterolateral rotation, relaxation of the zonules, and anterior movement of the lens. They are treated with mydriatic-cycloplegic and corticosteroid eye drops and with furosemide. However, there are also controversial reports on decreased IOP during the acute phase of HFRS. Despite the fact that ocular symptoms in HFRS are common generally they do not require any medical therapy and the recovery of the patients is complete.

Optical coherence tomography angiography in primary eye care. - Coffey AM; Hutton EK; Combe L; Bhindi P; Gertig D; Constable PA (Clinical & experimental optometry, 2020)
Optical coherence tomography angiography (OCT-A) is a non-invasive imaging modality for assessing the vasculature within ocular structures including the retina, macula, choroid and optic nerve. OCT-A has a wide range of clinical applications in various optometric conditions which have been independently reported in the literature. This paper aims to present a review of the current literature on the clinical application of OCT-A in optometric practice as well as to analyse and evaluate the quality of the available evidence. This review included 78 articles from a literature search conducted on 26 May 2019 across the following databases: Cochrane Library of Systematic Reviews, Medline, Scopus and Web of Science. Primary ocular pathologies discussed in this review include glaucoma, diabetic retinopathy, age-related macular degeneration, myopia, acquired and congenital macular dystrophies, epiretinal membrane, retinal vein occlusion, retinitis pigmentosa, choroidal melanoma, uveitis, central serous chorioretinopathy, amblyopia and optic neuropathies. Primary outcome variables included vessel density, foveal avascular zone area and diameter, flow velocity and flow index. This review aims to evaluate the evidence available for OCT-A applications in diagnosis and prognosis of ocular conditions in an optometric setting.

"Therapeutic uses of natural astaxanthin: An evidence-based review focused on human clinical trials". - Donoso A; González J; Muñoz AA; González PA; Agurto-Muñoz C (Pharmacological research, 2021)
Astaxanthin is a natural C40 carotenoid with numerous reported biological functions, most of them associated with its antioxidant and anti-inflammatory activity, standing out from other antioxidants as it has shown the highest oxygen radical absorbance capacity (ORAC), 100-500 times higher than ⍺-tocopherol and a 10 times higher free radical inhibitory activity than related antioxidants (α-tocopherol, α-carotene, β -carotene, lutein and lycopene). In vitro and in vivo studies have associated astaxanthin´s unique molecular features with several health benefits, including neuroprotective, cardioprotective and antitumoral properties, suggesting its therapeutic potential for the prevention or co-treatment of dementia, Alzheimer, Parkinson, cardiovascular diseases and cancer. Benefits on skin and eye health promotion have also been reported, highlighting its potential for the prevention of skin photo-aging and the treatment of eye diseases like glaucoma, cataracts and uveitis. In this review, we summarize and discuss the currently available evidence on astaxanthin benefits, with a particular focus on human clinical trials, including a brief description of the potential mechanisms of action responsible for its biological activities.

The prevalence of anxiety symptoms and disorders among ophthalmic disease patients. - Ulhaq ZS; Soraya GV; Dewi NA; Wulandari LR (Therapeutic advances in ophthalmology, 2022)
BACKGROUND: Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients. METHODS: Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients. RESULTS: The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463-2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168-4.454, p = 0.016). CONCLUSION: Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.

Environmental tobacco smoke exposure and eye disease. - Lois N; Abdelkader E; Reglitz K; Garden C; Ayres JG (The British journal of ophthalmology, 2008)
AIM: To undertake a systematic review of the literature on the effect of environmental tobacco smoke (ETS) and eye disease. METHODS: Medline (1950-January Week 2 2007), EMBASE (1980 to 2007 Week 07), SCOPUS and Science Direct were searched on ETS exposure and eye disease using various combinations of the following terms: passive smoking, environmental tobacco smoke, sidestream smoke, involuntary smoking, secondhand smoke; with eye, conjunctiva, sclera, episclera, cornea, lens, iris, retina, choroid, uvea, optic nerve, uveitis, iritis, blindness, visual loss, cataract, thyroid eye disease, conjunctivitis, age-related macular degeneration, dry eye, tears. The above terms were also used to search abstracts published on The Association for Research in Vision and Ophthalmology Annual Meeting abstracts, from 1995 to 2006, and the grey literature, including PhD and MSc theses/dissertations. A search was further conducted specifically on eye diseases where active smoking has been proposed to be a risk factor, including age-related macular degeneration, Graves ophthalmology, glaucoma, uveitis, refractive errors, strabismus, tobacco-alcohol amblyopia, non-arteritic ischaemic optic neuropathy, Leber optic neuropathy and diabetic retinopathy. Given the scarce number of studies found through the above search, all articles found on ETS and eye disease were included in this review. RESULTS: Seven studies evaluated the possible relationship between ETS and an eye disease. These studies referred to refractive errors in children (n = 2), cataract (n = 1), age-related macular degeneration (n = 3) and Grave ophthalmopathy (n = 1). The data available were insufficient to establish conclusive relationships between ETS and these eye diseases. CONCLUSION: Very scarce data exist in the literature on the effect of ETS on diseases of the eye. It seems appropriate that ETS should be included in future studies addressing the effect of smoking on eye disease.

Ocular Abnormalities in Patients with Vitiligo: A Systematic Review and Meta-Analysis. - Ma SH; Wu PC; Chang JY; Chang YT; Dai YX (Dermatology (Basel, Switzerland), 2022)
BACKGROUND: Vitiligo is a skin depigmentation disorder that results from the autoimmune destruction of cutaneous melanocytes. Several ocular abnormalities, including uveitis, dry eye, glaucoma, and retinal diseases, have been reported in patients with vitiligo. The aim of our study was to investigate the association of ocular abnormalities with vitiligo. METHODS: This meta-analysis was registered in PROSPERO (CRD42021224167) and adhered to MOOSE checklist and PRISMA guidance for all processes. PubMed, Embase, Web of Science, and Cochrane databases were searched for studies examining the association between ocular abnormalities and vitiligo from inception to December 10, 2020. Studies recruiting patients with Sjogren's syndrome or Vogt-Koyanagi-Harada syndrome were excluded. The primary outcomes were the Schirmer test, tear film break-up time (TBUT), and ocular surface disease index (OSDI) of vitiligo patients compared to the controls. The risk of bias of the selected studies was assessed using the Newcastle-Ottawa Scale (NOS) of case-control studies. RESULTS: This meta-analysis of 16 case-control studies showed that patients with vitiligo had significantly lower Schirmer test values (mean difference [MD], -1.65; 95% CI, -2.81 to -0.49), shorter TBUTs (MD, -4.66; 95% CI, -7.05 to -2.26), higher ocular surface disease indices (MD, 18.02; 95% CI, 5.7-30.35), and thinner subfoveal choroidal thicknesses (MD, -53.10; 95% CI, -69.84 to -36.36). No significant differences were found in the prevalence of glaucoma and the level of intraocular pressure. CONCLUSIONS: Our study supports an association between dry eye and thinner subfoveal choroidal thickness in patients with vitiligo. Dermatologists should be aware of these possible comorbidities and refer vitiligo patients with ocular symptoms to ophthalmologists for further management.

Comparison of the double-plate Molteno drainage implant with the Schocket procedure. - Smith MF; Sherwood MB; McGorray SP (Archives of ophthalmology, 1992)
A randomized, prospective study was undertaken to compare the results of the double-plate Molteno implant with those of the anterior chamber tube shunt to encircling band (ACTSEB) procedure, described by Schocket, for eyes with complicated glaucoma. One surgeon performed all the procedures. For statistical analysis there were 21 eyes in the ACTSEB group and 19 eyes in the Molteno group, with at least 6 months of follow-up (mean follow-up, 26 months; range, 6 to 49 months). Eyes with aphakia/pseudophakia, uveitis, previous penetrating keratoplasty, previous unsuccessful trabeculectomy, and neovascular glaucoma were evenly distributed between the two groups. Mean preoperative intraocular pressures in the ACTSEB and Molteno groups were 35.2 and 34.6 mm Hg, respectively. With the exclusion of one phthisical eye in each group final mean intraocular pressure in the ACTSEB group was 15.1 mm Hg, with a mean of 0.43 medications, and 14.4 mm Hg, with a mean of 0.95 medications, in the Molteno group. Seven (33%) of 21 eyes and 13 (68%) of 19 eyes in the ACTSEB and Molteno groups, respectively, were receiving additional antiglaucoma medication at the most recent visit (P = .027). Final visual acuity was stable (within one Snellen line of baseline visual acuity) or improved in 10 (48%) of 21 eyes in the ACTSEB group compared with 13 (68%) of 19 eyes in the Molteno group. Complications or inadequate pressure control requiring further surgical intervention were seen in nine (47%) of 19 eyes in the Molteno group and 12 (57%) of 21 eyes in the ACTSEB group.Complications in six (32%) of 19 eyes in the Molteno group and 9 (43%) of 21 eyes in the ACTSEB group appeared causally related to the surgery.

Ophthalmology in Luanda (Angola): a hospital based report. - Carreras FJ; Rodríguez-Hurtado F; David H (The British journal of ophthalmology, 1995)
AIMS/BACKGROUND: As part of a 4 year Spanish development aid programme, an ophthalmic hospital was set up in Luanda in 1991 for the in situ training of local ophthalmologists. Presented here are the data obtained from 4201 patients treated during the first 2 years of the project. METHODS: Patients were referred to the institute from the emergency ward at the Luanda General Hospital, selected mainly according to the severity of their disease. The following data were collected from the clinical reports: age, sex, diagnosis (single or multiple), type of treatment (medical or surgical), acuity of the best eye at the time of diagnosis, and main disease group. RESULTS: The main causes of blindness treated were: cataracts; glaucoma; optic nerve diseases (neuritis and atrophy); trauma; xerophthalmia; uveitis; hereditary retinal diseases (degenerative myopia, retinitis pigmentosa, albinism, and Stargardt's disease); retinal detachment; and diabetic retinopathy. CONCLUSIONS: Sanitary resources in Angola are generally inadequate, and ophthalmic care is no exception to this. Owing to the high percentage of preventable or treatable blinding diseases in this environment, a campaign of social education should always be held along with any medical programme, in order to optimise the available resources.

Ocular Manifestations of Buerger's Disease - A Review of Current Knowledge. - Szydełko-Paśko U; Przeździecka-Dołyk J; Małecki R; Szuba A; Misiuk-Hojło M (Clinical ophthalmology (Auckland, N.Z.), 2022)
Buerger's disease, also known as thromboangiitis obliterans, is a disorder of primarily small and medium arteries and veins of the arms and legs. We have failed to find a comprehensive review discussing a possible link between the disease and the eyes. The aim of this study is to review current knowledge on the topic of ocular manifestations in the course of Buerger's disease. The Medline and Web of Science databases were searched without a time or language limit. We have managed to review 13 articles, describing the involvement of the eyes in thromboangiitis obliterans. It appears that patients suffering from Buerger's disease may develop non-arteritic anterior ischemic optic neuropathy (NAION), occlusive retinal vasculitis and periphlebitis, papillophlebitis, central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), normal tension glaucoma (NTG), uveitis, chorioretinal atrophy, retinitis, papillitis, optic atrophy, changes typical for hypertensive retinopathy. Additionally the abnormalities in electroretinography might be present. The treatment options and the possible outcome depend on the type of ocular manifestations, so it seems impossible to propose a universal therapy. We would like to raise awareness of the possible ocular manifestations in the course of Buerger's disease.

Endophthalmitis induced by atypical mycobacterial infection. - Grenzebach UH; Busse H; Tötsch M; Dockhorn-Dworniczak B (German journal of ophthalmology, 1996)
Granulomatous uveitis induced by Mycobacterium tuberculosis infection has been less frequently encountered over the last 20 years. Differential diagnosis of M. tuberculosis and other atypical mycobacteria is nevertheless of particular interest in patients with acquired immune deficiency syndromes. We present the case of a 60-year-old man who was referred to our clinic because of therapy-refractive endophthalmitis. Diagnostic vitrectomy including microbiological examination as well as further extensive serological examinations did not reveal any further information on the etiology. Despite intensive anti-inflammatory treatment, the eye became blind and developed secondary glaucoma. Evisceration of the globe had to be performed. Histopathological examination showed a granulomatous inflammation without the tuberculosis-typical development of central caseous necrosis. Further molecular pathological investigations had to be performed with regard to differential diagnostic aspects. By means of the polymerase chain reaction we could detect mycobacterial gene sequences that corresponded to atypical mycobacteria. The diagnosis of atypical mycobacterial infection was confirmed Molecular-genetics examination techniques, especially those involving the polymerase chain reaction, will become more important in routine histopathological examination. These techniques can be performed on paraffin-fixed or formalin-embedded material for further differential diagnostic considerations.

Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review. - Dammacco R; Guerriero S; Alessio G; Dammacco F (International ophthalmology, 2021)
PURPOSE: To provide an overview of the ocular features of rheumatoid arthritis (RA) and of the ophthalmic adverse drug reactions (ADRs) that may be associated with the administration of antirheumatic drugs. METHODS: A systematic literature search was performed using the PubMed, MEDLINE, and EMBASE databases. In addition, a cohort of 489 RA patients who attended the Authors' departments were examined. RESULTS: Keratoconjunctivitis sicca, episcleritis, scleritis, peripheral ulcerative keratitis (PUK), and anterior uveitis were diagnosed in 29%, 6%, 5%, 2%, and 10%, respectively, of the mentioned cohort. Ocular ADRs to non-steroidal anti-inflammatory drugs are rarely reported and include subconjunctival hemorrhages and hemorrhagic retinopathy. In patients taking indomethacin, whorl-like corneal deposits and pigmentary retinopathy have been observed. Glucocorticoids are frequently responsible for posterior subcapsular cataracts and open-angle glaucoma. Methotrexate, the prototype of disease-modifying antirheumatic drugs (DMARDs), has been associated with the onset of ischemic optic neuropathy, retinal cotton-wool spots, and orbital non-Hodgkin's lymphoma. Mild cystoid macular edema and punctate keratitis in patients treated with leflunomide have been occasionally reported. The most frequently occurring ADR of hydroxychloroquine is vortex keratopathy, which may progress to "bull's eye" maculopathy. Patients taking tofacitinib, a synthetic DMARD, more frequently suffer herpes zoster virus (HZV) reactivation, including ophthalmic HZ. Tumor necrosis factor inhibitors have been associated with the paradoxical onset or recurrence of uveitis or sarcoidosis, as well as optic neuritis, demyelinating optic neuropathy, chiasmopathy, and oculomotor palsy. Recurrent episodes of PUK, multiple cotton-wool spots, and retinal hemorrhages have occasionally been reported in patients given tocilizumab, that may also be associated with HZV reactivation, possibly involving the eye. Finally, rituximab, an anti-CD20 monoclonal antibody, has rarely been associated with necrotizing scleritis, macular edema, and visual impairment. CONCLUSION: The level of evidence for most of the drug reactions described herein is restricted to the "likely" or "possible" rather than to the "certain" category. However, the lack of biomarkers indicative of the potential risk of ocular ADRs hinders their prevention and emphasizes the need for an accurate risk vs. benefit assessment of these therapies for each patient.

Intraocular pressure monitoring post intravitreal steroids: a systematic review. - Kiddee W; Trope GE; Sheng L; Beltran-Agullo L; Smith M; Strungaru MH; Baath J; Buys YM (Survey of ophthalmology, 2013)
The use of intravitreal (IVT) corticosteroids for treatment of posterior segment diseases has increased significantly over the last decade. A commonly recognized complication of IVT steroids is secondary ocular hypertension (OHT) that can occur immediately secondary to direct intraocular volume increase or weeks to months later as a result of increased outflow resistance. We performed a meta-analysis and found 32% (95% confidence interval, 28.2-36.3) of individuals developed OHT following 4 mg IVT triamcinolone, 66% (50.2-78.8) and 79% (72.2-84.5) following 0.59 and 2.1 mg fluocinolone implant, respectively, and 11% (6.4-17.9) and 15% (9.2-24.3) following 0.35 and 0.7 mg dexamethasone implant, respectively. Risk factors included pre-existing glaucoma, higher baseline intraocular pressure (IOP), younger age, OHT following previous injection, uveitis, higher steroid dosage, and fluocinolone implant. Most cases of OHT can be controlled medically; up to 45% following fluocinolone implant require surgery, however. We suggest a protocol to monitor IOP after IVT steroid injection/implantation that includes checking IOP within 30 minutes after injection, followed by 1 week after IVT triamcinolone and 2 weeks after implant insertion, then every 2 weeks for the first month and monthly for up to 6 months after IVT triamcinolone and dexamethasone implantation and 9 months after fluocinolone implantation.

Therapeutic sclerokeratoplasty versus therapeutic penetrating keratoplasty in refractory corneal ulcers. - Panda A; Sharma N; Angra SK; Singh R (Australian and New Zealand journal of ophthalmology, 1999)
PURPOSE: To assess the efficacy of newer surgical technique of sclerokeratoplasty in cases of refractory corneal ulcers of the cornea and to compare it with therapeutic penetrating keratoplasty. METHODS: A randomized, prospective clinical trial in 20 eyes with refractory corneal ulcers was undertaken. Ten eyes each underwent sclerokeratoplasty (group I) or therapeutic penetrating keratoplasty (group II). Infections were considered cured if there was no evidence of corneal infiltration for 1 month following keratoplasty. Postoperative complications, visual acuity (VA), keratometry and graft status were evaluated with both the procedures after a minimum follow up of 1 year. RESULTS: Postoperative complications included epithelial defects, shallow anterior chamber, uveitis and secondary glaucoma, which were present following both procedures, with no significant difference in the frequency of complications between the two techniques (P < 005), Graft clarity and VA with both procedures were comparable. Significantly reduced astigmatism of < 1 D was seen in six eyes in group II in comparison with group I, where astigmatism of > 1.5 D was present in six eyes. Two eyes in group II developed re-infection, of which one was re-operated on, and the other developed endophthalmitis. CONCLUSIONS: Sclerokeratoplasty is a useful alternative to therapeutic penetrating keratoplasty in cases of refractory corneal ulcers with optimum clinical and useful visual outcome.

Prevalence of eye disease in Brazilian patients with psoriatic arthritis. - Lima FB; Abalem MF; Ruiz DG; Gomes Bde A; Azevedo MN; Moraes HV; Yeskel AS; Kara-Junior N (Clinics (Sao Paulo, Brazil), 2012)
OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal). Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%), and the majority had polyarticular disease (57.5%). Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

The prevalence and causes of visual loss among HIV-infected individuals in Uganda. - Otiti-Sengeri J; Colebunders R; Kempen JH; Ronald A; Sande M; Katabira E (Journal of acquired immune deficiency syndromes (1999), 2010)
AIM: To determine the prevalence of loss of visual acuity and to describe the ocular diseases associated with vision loss among HIV-infected individuals in Uganda.Methods: One thousand two hundred twelve HIV-positive individuals aged 18 years or older attending an HIV treatment site in Kampala,Uganda, were consecutively screened for loss of visual acuity using a Snellen chart. Those found to have a visual acuity of 6/9 or less in 1 or both eyes had a detailed ocular diagnostic evaluation.Results: One hundred thirty-six patients [11.2%; 95% confidence interval (CI): 9.49–13.13] had a visual acuity of 6/9 or less in at least 1 eye, with 74 (6.1%; 95% CI: 8.54–12.21) having bilaterally reduced presenting visual acuity. Eighty-eight (7.3%; 95% CI: 8.57–12.28)had a visual acuity of 6/18 or worse in at least 1 eye. Ocular diseases associated with reduced vision included cataract 16 (11.8%), optic nerve disease 20 (14.7%), refractive errors 35 (24.3%), and uveitis 44 (32.3%). Other diagnoses observed included diabetic retinopathy,maculopathies, corneal scars, glaucoma, and squamous cell carcinoma of the conjunctiva.Conclusions: Visual impairment and ocular disease affect a large proportion of HIV-infected individuals presenting for HIV care in Uganda. Most causes of vision loss were treatable or could have been prevented with appropriate ophthalmic and medical care.

Intravitreal dexamethasone implant as an alternative to systemic steroids as prophylaxis for uveitic cataract surgery: a randomized trial. - Sudhalkar A; Vasavada A; Bhojwani D; Vasavada V; Vasavada S; Vasavada V; Srivastava S (Eye (London, England), 2020)
PURPOSE: To determine the utility of the dexamethasone implant (IVD) as an alternative to systemic steroids as prophylaxis against cystoid macular edema (CMO) in patients with chronic, recurrent CMO associated intermediate or posterior uveitis (IU/PU), and cataract undergoing cataract surgery. METHODS: This was a randomized, parallel design, and clinical trial. Patients with IU/PU and cataract scheduled for cataract surgery were randomly assigned to receive the IVD concurrently with cataract surgery (Group 1: 20 patients) or systemic steroids (Group 2: 23 patients) tapered over 4-6 weeks along with uneventful cataract surgery and routine postoperative care. Patients with glaucoma/contraindications to steroids were excluded. All patients were followed up for 6 months. OUTCOME MEASURE: Primary-incidence of postoperative CMO. Secondary-the change in BCVA (corrected distance visual acuity) and Central Subfield thickness (CST) and complications. Appropriate statistical analysis was done. RESULTS: The median age was 47.3 ± 4.23 years (group 1) and 49.12 ± 5.32 years (Group 2). One patient (Group 1) and two (Group 2) developed CMO. The BCVA improved significantly in both groups (p = 0.013). The CST change was insignificant. Four patients (Group 1) required intraocular pressure (IOP) lowering medications. Three patients (Group 2) required early steroid taper. CONCLUSIONS: IVD is a good alternative as prophylaxis in IU/PU and cataract in preventing postoperative CMO.

Sclerokeratoplasty versus penetrating keratoplasty in anterior staphyloma. - Panda A; Sharma N; Angra SK; Singh R (Ophthalmic surgery and lasers, 1999)
BACKGROUND AND OBJECTIVE: To assess the efficacy of the newer surgical technique of sclerokeratoplasty in spherical anterior staphyloma of the cornea and to compare it with total penetrating keratoplasty. PATIENTS AND METHODS: A randomized, prospective clinical trial in 20 eyes with acquired spherical anterior staphylomas was undertaken. Ten eyes each underwent sclerokeratoplasty (group 1) or total penetrating keratoplasty (group 2). The parameters evaluated were visual acuity, keratometry, graft status, and complications. Patients were observed for a minimum of 1 year. RESULTS: Best spectacle-corrected visual acuity of 6/60 or better with astigmatism of less than 3 D was achieved in all but one patient in group 1 in contrast to 5 cases in group 2. Postoperative complications included epithelial defects, shallow anterior chamber, hyphema, and uveitis, which did not significantly vary between the 2 procedures. Secondary glaucoma was significant associated with group 2 as compared with group 1. At the end of 1 year, no significant difference in the graft clarity was present. Grafts were clear 3+ or more in 8 eyes in group 1 and in 5 eyes in group 2. Good cosmetic results were achieved in cases of sclerokeratoplasty due to the absence of corneal opacification and suture marks. CONCLUSION: Sclerokeratoplasty is a useful alternative to total penetrating keratoplasty in cases of acquired spherical anterior staphylomas of the cornea with good anatomic and useful visual outcome.

Biocompatibility and blood-aqueous barrier impairment in at-risk eyes with heparin-surface-modified or unmodified lenses. - Mester U; Strauss M; Grewing R (Journal of cataract and refractive surgery, 1998)
PURPOSE: To evaluated the influence of heparin-surface-modified (HSM) versus unmodified poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) on the blood-aqueous barrier (BAB) in at-risk eyes. SETTING: Department of Ophthalmology, Bundesknappschaft's Hospital, Sulzbach Germany. METHODS: This study comprised 100 patients with predisposing risk factors for BAB destabilization (e.g., diabetes mellitus with or without retinopathy, glaucoma, pseudoexfoliation, uveitis). One eye in each patient received an HSM IOL and the fellow eye, a conventional unmodified PMMA IOL after phacoemulsification by the same surgeon. Anterior chamber flare was measured with the Kowa 500 laser flare meter 1 day before and 1 day, 1 and 6 weeks, and 3 months after surgery. RESULTS: For most risk factors, mean flare was lower in the HSM group than in the PMMA group at most follow-ups. Significantly lower flare values (difference between postoperative and preoperative mean values) were seen in eyes with the HSM IOL at 6 weeks (P < .004) and 3 months (P < .003; Student's t-test). In the group with preoperative elevated flare values, the eyes with the HSM IOL had significantly better results 6 weeks (P < .0006) and 3 months (P < .01) postoperatively. The values in the HSM IOL eyes were also significantly higher in the diabetic with retinopathy group at 3 months (P < .003). CONCLUSION: The results confirm the efficacy of IOL surface modification in reducing postoperative intraocular reaction in at-risk eyes.

Characterizing the microbiota of instrumentation in ophthalmology clinics during and beyond the COVID-19 pandemic. - Mahjoub H; Zhang SX; Wang J; Memon W; Mostafa H; Breazzano MP (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2022)
PURPOSE: Increased ophthalmology-specific risk of novel coronavirus 2019 (SARS-CoV-2) transmission is well-established, increasing the fear of infection and causing associated decreased rates of procedures known to save vision. However, the potential transmission from exposure to clinic instrumentation is unknown, including which additional pathogens may be spreading in this context. This study seeks to fill this gap by characterizing the microbiota of instrumentation in ophthalmology clinics during the COVID-19 pandemic and identifying potential sources of pathogenic spread encountered by patients and healthcare workers. METHODS: Thirty-three samples were captured using standard cultures and media. Ten positive and negative controls were used to confirm proper technique. Descriptive statistics were calculated for all samples. Samples were collected from the retina (N = 17), glaucoma (N = 6), cornea (N = 6), and resident (N = 4) clinics with rigorous disinfection standards at a tertiary academic medical center. Standard media cultures and/or polymerase chain reaction (PCR) was performed for each sample. RESULTS: From 33 samples, more than half (17/33, 51.5%) yielded bacterial growth. Using two different molecular methods, three samples (3/33, 9%) tested positive for SARS-CoV-2 (cycle thresholds 36.48, 37.14, and 37.83). There was no significant difference in bacterial growth (95% confidence interval [95% CI]: - 0.644-0.358, p = 0.076) among different clinics (retina, glaucoma, cornea, resident). Staphylococcus (S.) epidermidis grew most frequently (12/35, 34%), followed by S. capitis (7/35, 20%), Micrococcus luteus (2/35, 5.7%), Corynebacterium tuberculostearicum (2/35, 5.7%), and Cutibacterium ([C.], Propionibacterium) acnes (2/35, 5.7%). C. acnes growth was more frequent with imaging device forehead rests (2/7, 28.6%) than other surfaces (0/26, 0%, 95% CI: 0.019-0.619, p = 0.040). No samples isolated fungus or adenovirus. CONCLUSIONS: Most samples across subspecialty clinic instrumentation grew bacteria, and several tested positive for SARS-CoV-2. Many isolated pathogens have been implicated in causing infections such as endophthalmitis, conjunctivitis, uveitis, and keratitis. The clinical implications of the ophthalmology microbiome for transmitting nosocomial infections warrant optimization of disinfection practices, strategies for mitigating spread, and additional study beyond the pandemic.

Ocular characteristics in nephropathia epidemica or Puumala virus infection. - Kontkanen M; Puustjärvi T; Kauppi P; Lähdevirta J (Acta ophthalmologica Scandinavica, 1996)
PURPOSE: We documented the largest series so far concerning the ocular characteristics of nephropathia epidemica. METHODS: A total of 37 consecutive nephropathia epidemica patients underwent a comprehensive ophthalmic examination during hospitalization for systemic infection, and a control examination after recovery. RESULTS: The most common ocular symptoms were: frontal headache or periocular pain (75.6%), blurred vision (54.1%) and photophobia (10.8%). The best corrected visual acuity of 7 patients (18.9%) was reduced during the acute phase as compared to the later control examination. Myopic shift was found in 15 patients (40.5%), three of whom (8.1%) developed real transient myopia. There were no attacks of angle closure glaucoma in this series. On the contrary, the intraocular pressure was decreased in 49 eyes (66.2%) during the acute stage of the disease. Lid edema was present in 28 eyes (37.8%), conjunctival injection in 20 eyes (27.0%), chemosis in 8 eyes (10.8%) and subconjuctival bleeding in 3 eyes (4.1%). Signs of acute anterior uveitis were found in 10 eyes (13.5%), however, this resolved without treatment. In one eye retinal edema with hemorrhages was detected. Ultrasonography revealed narrowing of the anterior chamber during the acute phase in 69 eyes (93.2%) and thickening of the crystalline lens in 64 eyes (86.5%). CONCLUSION: Ophthalmic findings in nephropathia epidemica are not uncommon. The symmetry of the clinical manifestations reflects the systemic nature of the underlying infection.

Randomized study of the blood-aqueous barrier reaction after phacoemulsification and extracapsular cataract extraction. - Laurell CG; Zetterström C; Philipson B; Syrén-Nordqvist S (Acta ophthalmologica Scandinavica, 1998)
PURPOSE: To compare the blood-aqueous barrier (BAB) breakdown after endocapsular phacoemulsification and extracapsular cataract extraction (ECCE). METHODS: Forty-two patients (64-82 years) enrolled for cataract surgery were randomly assigned to phacoemulsification (group I) or ECCE (group II). Patients with pseudoexfoliation syndrome, small pupils, glaucoma, uveitis, dark brown irides, diabetes, treatment with eye drops or anti-inflammatory drugs were excluded. In group I the patients were operated with continuous curvilinear capsulorhexis (CCC), phacoemulsification and implantation of a poly-(methyl methacrylate) (PMMA) intraocular lens (IOL) through a 5.2 mm self-sealing incision. In group II linear capsulotomy, nucleus expression and PMMA IOL implantation through a large incision (10-11 mm) were performed. The incision was sutured. Before surgery and three days and three months after surgery postoperative inflammation and BAB reaction were measured by laser flare photometry and anterior chamber fluorophotometry after intravenous administration of fluorescein. The BAB diffusion coefficient was calculated. Laser flare photometry was performed also after one and two years. RESULTS: According to fluorophotometry, ECCE induced significantly more postoperative BAB breakdown than did phacoemulsification at three days (p=0.00016) and three months (p=0.00829). Laser flare photometry showed more inflammation in the ECCE group than in the phacoemulsification group at three days postoperatively (p=0.00005). CONCLUSIONS: This study suggests that cataract surgery performed with a small, self-sealing incision, CCC and phacoemulsification induces a reduced surgical trauma with less BAB breakdown compared to ECCE using a large sutured incision, linear capsulotomy and nucleus expression.

Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. - Chen CL; Wang TY; Cheng JH; Tai MC; Lu DW; Chen JT (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift für Augenheilkunde, 2008)
PURPOSE: To investigate the clinical features, visual acuity outcomes and the most appropriate intervention time in patients with retained lens fragments managed by pars plana vitrectomy. METHODS: This was a retrospective review of the records of 78 patients who underwent pars plana vitrectomy for retained lens fragments at the Tri-Service General Hospital from January 1, 2000, to December 31, 2006. RESULTS: The mean age of the patients was 70 years (range, 24-92 years). There were 40 men (51%) and 38 women (49%). The mean follow-up period after surgery was 13.8 months. Forty-five patients (58%) had vitrectomy within 1 day of phacoemulsification (group A), 22 (28%) within 1 week (group B) and 11 (14%) after more than 1 week (group C). No patients in group A developed complications, and 76% achieved a final visual acuity of 6/12 or better. In group B, all patients had elevated intraocular pressure, and 45% achieved a final visual acuity of 6/12 or better. In group C, all patients presented with corneal edema, moderate or severe uveitis, and elevated intraocular pressure. Of these patients, 27% had cystoid macular edema, 36% developed retinal detachment, and 27% had a final visual acuity of 6/12 or better. CONCLUSION: Pars plana vitrectomy performed immediately after cataract surgery for retained lens fragments is a viable option and may achieve a better visual outcome, with reduced risk of secondary glaucoma, retinal detachment or cystoid macular edema.

Bilateral arteritis with cytomegalovirus retinitis in a patient infected with human immunodeficiency virus. - Babu K; Murthy KR; Sudarshan S; Biswas J (Retinal cases & brief reports, 2010)
PURPOSE: To report an interesting ocular finding and course of bilateral arteritis with cytomegalovirus retinitis in a patient infected with the human immunodeficiency virus (HIV). METHODS: Retrospective single case report. RESULTS: A 39-year-old HIV-positive man on highly active antiretroviral therapy presented with a history of diminution of vision in both eyes of 1-month duration. Fundus examination showed vitritis, sheathing, and a cordlike appearance of the arteries with veins unaffected in both eyes. A patch of cystomegalovirus retinitis was noted temporally in the right eye. Fluorescein angiography showed gross areas of capillary nonperfusion in both eyes. Polymerase chain reaction of the aqueous tap was positive for cytomegalovirus in both eyes. Despite aggressive treatment with intravitreal ganciclovir followed by a course of intravenous ganciclovir, the right eye progressed to neovascularization, vitreous hemorrhage, neovascular glaucoma, and no perception of light. Segmentation and recanalization of arteries were noted in the left eye. Immune recovery uveitis developed in the left eye after 2 months and was treated with oral steroids and intravenous ganciclovir followed by a maintenance dose of valganciclovir. At 3 years follow up, his vision and ocular condition in the left eye is stable. CONCLUSION: An interesting finding of bilateral arteritis with cystomegalovirus retinitis in an HIV-positive patient is reported. The arteritis did not respond very well to intravitreal ganciclovir and required a course of intravenous ganciclovir. Early treatment with intravenous ganciclovir and laser photocoagulation in such cases may reduce visual morbidity.

Transient vitreous inflammatory reactions associated with combination antiretroviral therapy in patients with AIDS and cytomegalovirus retinitis. - Zegans ME; Walton RC; Holland GN; O'Donnell JJ; Jacobson MA; Margolis TP (American journal of ophthalmology, 1998)
PURPOSE: To report the observation that a transient vitreous inflammatory reaction may develop in the eyes of patients with acquired immunodeficiency syndrome (AIDS), cytomegalovirus retinitis, and an increased CD4+ T-lymphocyte count during treatment with antiretroviral therapy including a protease inhibitor. METHODS: We reviewed the medical records of eight patients with AIDS and cytomegalovirus retinitis who developed vitreous inflammatory reactions greater than those usually seen with this disease. RESULTS: Vitreous inflammatory reactions obscured the view of the posterior pole in all patients. No iris nodules, synechiae, glaucoma, or cystoid macular edema were observed. Six patients had unilateral cytomegalovirus retinitis, and, in each, the inflammation occurred only in the eye with cytomegalovirus retinitis. The vitreous inflammatory reactions were associated with clinically inactive cytomegalovirus retinitis in six patients, with disease reactivation in one patient, and were present at diagnosis of active disease in one patient. Cytomegalovirus retinitis has not recurred in any of these patients since their episodes of vitreous inflammation. Vitreous inflammation developed in all eight patients after a substantial increase in CD4+ T-lymphocyte counts caused by combination antiretroviral therapy. Five patients had CD4+ T-lymphocyte counts of greater than 100 cells per microl at the time the vitreous inflammatory reaction developed. No other causes of uveitis were found. CONCLUSIONS: Patients with AIDS and cytomegalovirus retinitis may develop transient intraocular inflammation associated with combination antiretroviral therapy. We believe that this inflammation reflects an improved immune response against cytomegalovirus.

Three-year results of accelerated transepithelial cross-linking (30 mW/cm2 × 3 min) for keratoconus: a prospective study. - Ishii H; Yoshida J; Toyono T; Yamagami S; Usui T; Miyai T (BMJ open ophthalmology, 2022)
OBJECTIVE: To assess the long-term efficacy and safety of accelerated transepithelial corneal cross-linking (ATE-CXL) with 30 mW/cm2 × 3 min. METHODS AND ANALYSIS: Thirty-four eyes of 23 patients with progressive keratoconus (KCN) recruited within a single centre were enrolled in this prospective interventional study. Exclusion criteria included: history of Descemet's membrane rupture, glaucoma, uveitis, severe dry eye, concurrent corneal infections, and systemic disease that could affect corneal healing. ATE-CXL was performed with 3 min of ultraviolet-A continuous irradiation (30 mW/cm2). Follow-up examinations were scheduled on postoperative day 1; 1 and 2 weeks; 1, 3 and 6 months; and 1, 2 and 3 years. Main outcome measures were maximum corneal power (Kmax), average corneal power (AvgK), steepest corneal power (Ks), central corneal thickness, thinnest corneal thickness, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA) and endothelial cell density. RESULTS: Mean Kmax, AvgK, Ks, UCVA, BCVA and endothelial cell density did not significantly change over 3 years. The speed of progression obtained by linear regression analysis on corneal parameters (Kmax, AvgK, Ks) improved after ATE-CXL. All baseline parameters correlated with the postoperative Kmax slope. Two eyes underwent ATE-CXL redo because of continued progression after the primary CXL. CONCLUSION: This is the first report of 3-year results of ATE-CXL with 30 mW/cm2 × 3 min. ATE-CXL (30 mW/cm2 × 3 min) was safe and effective for slowing down KCN progression. TRIAL REGISTRATION NUMBER: This study was registered with ID UMIN000009372 in UMIN-Clinical Trials Registry.

Does the use of trypan blue during phacoemulsification affect the intraocular pressure? - Ziakas NG; Boboridis K; Nakos E; Mikropoulos D; Margaritis V; Konstas AG (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2009)
OBJECTIVE: The purpose of the study was to evaluate the effect of trypan blue on intraocular pressure (IOP) after small-incision cataract surgery. DESIGN: Prospective, randomized study. PARTICIPANTS: Fifteen patients (30 eyes) with bilateral, dense, age-related cataracts. METHODS: Patients with glaucoma, ocular hypertension, exfoliation, pigment dispersion syndrome, history of uveitis, recent use of topical or systemic steroids, and previous ocular surgery were excluded. The patients were randomly assigned to receive trypan blue during cataract surgery for enhancing capsulorrhexis in 1 of their eyes, while in the other eye, trypan blue was not used. Cataract surgery was performed in an identical fashion in both eyes, with a sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The same viscoelastic (sodium hyaluronate) was used in all cases and was thoroughly aspirated at the end of the procedure. All patients received a single dose of 250 mg acetazolamide 8 hours after surgery. No other antiglaucomatous agent was used during surgery or postoperatively. The intraocular pressure (IOP) was measured preoperatively and at 24 hours, 1 week, 1 month, and 3 months postoperatively. RESULTS: IOP values were similar in both groups at all 4 postoperative measurements. There was no statistically significant difference in postoperative IOP values between the eyes in which trypan blue was used and the control eyes. CONCLUSIONS: The use of trypan blue during small-incision cataract surgery does not have any effect on IOP during the immediate and early postoperative period.

A 6-month assessment of bimatoprost 0.03% vs timolol maleate 0.5%: hypotensive efficacy, macular thickness and flare in ocular-hypertensive and glaucoma patients. - Martin E; Martinez-de-la-Casa JM; Garcia-Feijoo J; Troyano J; Larrosa JM; Garcia-Sanchez J (Eye (London, England), 2007)
AIM: To compare 6 months of treatment with bimatoprost and timolol in terms of their hypotensive efficacy and secondary effects, including changes in macular thickness and the inflammatory reaction induced in the anterior chamber. METHODS: A prospective, randomized, parallel-group trial performed on 30 eyes of 30 patients per group. The main outcome measure was the difference between the IOP value taken between the baseline visit and the 6-month-visit. Macular thickness determined through optical coherence tomography and anterior chamber inflammation estimated using the laser flare meter was also evaluated. Adverse events were recorded during the study period. RESULTS: Bimatoprost treatment gave rise to a significantly lower mean IOP than timolol in all follow-up visits as from the first month (P<0.05). Bimatoprost achieved high percentage IOP reductions from baseline in a significantly higher proportion of patients (P<0.05). Macular thickness and anterior chamber flare failed to vary significantly both between the two groups and within each group during the 6-month evaluation (P>0.05). CONCLUSIONS: Bimatoprost 0.03% once daily showed a greater efficacy then timolol 0.05% twice daily in patients with elevated IOP. No significant differences were detected in macular thickness or anterior uveitis using optical coherence tomography and laser flare photometry.

Intravitreal triamcinolone acetonide in the management of cystoid macular edema in Behçet's disease. - Atmaca LS; Yalçindağ FN; Ozdemir O (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 2007)
PURPOSE: To determine the efficacy of intravitreal triamcinolone acetonide (ivTA) injection in the management of cystoid macular edema (CME) due to uveitis in patients with Behçet's disease. METHODS: Ten eyes of seven patients with CME associated with Behçet's disease were included in the study. A quantity of 4 mg of triamcinolone acetonide was injected intravitreally in all of the eyes. The maculas of the patients were evaluated with optical coherence tomography (OCT) and fluorescein angiography (FA). The change in visual acuity, fluorescein leakage, macular thickness, and potential complications were assessed. RESULTS: The mean follow-up was 15.6 months (range 7-19 months). There was an increase of more than two Snellen lines in the visual acuity in seven of the ten eyes (70%) at the last examination. Macular edema regressed completely in eight of the ten eyes (80%) at the last visit on OCT and FA. The mean central macular thickness assessed by OCT was 406 mum before treatment and 186.9 mum at the last visit. The intraocular pressure (IOP) exceeded 21 mmHg in six eyes of five patients (60%) during the follow-up. At the last visit, the IOP was less than 21 mmHg in five eyes with medication. One eye underwent glaucoma filtration surgery. Four eyes of three patients had cataract progression. In four eyes of four patients (40%), a second ivTA injection was given due to relapsing CME. CONCLUSION: Intravitreal triamcinolone acetonide (ivTA) may be beneficial in the management of CME in patients with Behçet's disease. Repeated ivTA injections might be required if CME reoccurs.

Intraocular lens implantation in patients with juvenile rheumatoid arthritis. - Probst LE; Holland EJ (American journal of ophthalmology, 1996)
PURPOSE: To study intraocular lens implantation in patients with cataracts associated with juvenile rheumatoid arthritis. METHODS: We reviewed the records of seven patients (eight eyes) with juvenile rheumatoid arthritis who had undergone cataract extraction by phacoemulsification with intraocular lens implantation. Initial and final visual acuities, preoperative and postoperative medications, and early and late complications were recorded. RESULTS: Posterior subcapsular cataracts and non-visually disabling peripheral band keratopathy were found in all eyes. The median postoperative follow-up was 17.5 months (mean, 16.6 months; range, nine to 36 months). Five patients were adults, and two patients were less than 10 years old. A best-corrected visual acuity of 20/40 or better was attained in all eyes, and the last recorded visual acuity was 20/40 or better in seven of eight eyes. Early complications included posterior synechiae formation in two eyes, one of which required reoperation. Late complications included visually disabling posterior capsular opacification in one eye and new glaucoma in two eyes. Preoperative corticosteroids were reduced postoperatively in five eyes, were the same in two eyes, and increased in one eye. Persistent postoperative inflammation, posterior synechiae, and a pupillary membrane occurred in one of the children in this study, suggesting that intraocular lens implantation in this age group may have more complications. CONCLUSIONS: Results of this study suggest that, in selected adults, cataracts caused by juvenile rheumatoid arthritis-associated uveitis can be treated by the standard phacoemulsification technique with intraocular lens implantation and can have excellent results. Intraocular lens implantation in children with juvenile rheumatoid arthritis merits further investigation.

The use of immunohistochemistry and the polymerase chain reaction for detection of feline leukemia virus and feline sarcoma virus in six cases of feline ocular sarcoma. - Cullen CL; Haines DM; Jackson ML; Peiffer RL; Grahn BH (Veterinary ophthalmology, 1998)
Ocular sarcoma was diagnosed by light microscopic examination in enucleated globes (n = 4), orbital tissue biopsy (n = 1) and ocular evisceration contents (n = 1) from six cats. To determine if feline leukemia virus (FeLV) or a replication-defective FeLV, feline sarcoma virus (FeSV), was present in these ocular sarcomas, immunohistochemistry (IHC) and polymerase chain reaction (PCR) for FeLV were utilized. Immunohistochemical staining for FeLV glycoprotein 70 (gp70) was performed on all six formalin-fixed, paraffin-embedded tumors using an avidin-biotin complex technique. DNA was extracted from each specimen and a 166 bp region of the FeLV long-terminal repeat (LTR) was amplified by PCR. All tumors were composed primarily of spindle cells; two neoplasms had PAS-positive basement membrane enveloping areas of spindle cells. All tumors involved the uvea and five of six tumors showed transcleral extension, one of which invaded the optic nerve. Immunohistochemical staining for FeLV gp 70 was negative. PCR to amplify a portion of the FeLV LTR was negative. Based on these findings of these limited number of cases, FeLV/FeSV may not play a role in the tumorigenesis of feline ocular sarcomas. However, additional tumors representing all morphological subtypes should be investigated for the presence of viral antigen and DNA. It is important to determine the etiology and pathogenesis of these malignant ocular sarcomas. If the cell of origin and pathogenesis involve ocular and lenticular injury, and FeLV/FeSV is not present, then the clinical management of cases of feline ocular trauma, uveitis and glaucoma may prevent the development of this tumor.

Posterior continuous curvilinear capsulorhexis and postoperative inflammation. - Zaczek A; Petrelius A; Zetterström C (Journal of cataract and refractive surgery, 1998)
PURPOSE: To evaluate the influence of posterior continuous curvilinear capsulorhexis (PCCC) on inflammation after phacoemulsification and implantation of a foldable silicone intraocular lens (IOL) in the capsular bag. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: Fifty patients were enrolled in this prospective, randomized study. Eyes with diabetes mellitus, glaucoma, uveitis, exfoliation syndrome, other previous ocular diseases, or an axial length greater than 26.0 mm were excluded. One group comprised 25 eyes of 25 patients (median age 76 years) in which phacoemulsification and implantation of a silicone IOL in the capsular bag were performed. The other group consisted of 25 eyes of 25 patients (median age 77 years) who received the same surgical procedure in addition to PCCC. The aqueous protein concentration was measured using a laser flare meter (FC 500, Kowa Co.) preoperatively and 1 day, 1 week, and 1 and 3 months after surgery. RESULTS: Surgical trauma significantly increased aqueous flare values 1 day, 1 week, and 1 month after surgery in both groups (P < .05). Three months postoperatively, flare values in both groups were not different from preoperative values. No difference between the 2 groups was found in flare intensity measurements or in best corrected visual acuity before and after uneventful surgery. The incidence of postoperative clinical cystoid macular edema was 8% (2 eyes) in the control group and 4% (1 eye) in the group with PCCC. CONCLUSION: Postoperative flare intensity after phacoemulsification with PCCC and implantation of a foldable silicone IOL was not significantly different than postoperative flare measurements in a control group.

Bevacizumab for neovascular ocular diseases. - Lynch SS; Cheng CM (Annals of Pharmacotherapy, 2007)
OBJECTIVE: To review the efficacy and safety of off-label use of bevacizumab for neovascular ocular diseases. DATA SOURCES: A PubMed (1966-January 2007) search was conducted using the terms human, intravitreal, bevacizumab, macular, and retinopathy. Meeting abstracts from the American Academy of Ophthalmology, Retina Society, Macula Society, and Association for Research in Vision and Ophthalmology were reviewed. STUDY SELECTION AND DATA EXTRACTION: Controlled studies, unpublished reports involving 100 or more subjects, and published reports describing 5 or more subjects were reviewed. Only English-language articles were considered. DATA SYNTHESIS: Intravitreal bevacizumab has been evaluated in 133 patients in unpublished controlled studies. Over 3500 patients have been evaluated in open-label studies with duration of follow-up ranging from 3 months to 1 year. The most common use was neovascular age-related macular degeneration (AMD). Other conditions studied included diabetic retinopathy, pathological myopia, neovascular glaucoma, and macular edema due to diabetes, retinal vein occlusion, or uveitis. Statistically significant improvements in visual acuity, as well as decreases in retinal thickness and the extent of choroidal neovascularization, were noted. Intravitreal bevacizumab was well tolerated over the short term. In a registry compiling adverse experiences of 7113 intravitreal injections, rates of adverse events were less than or equal to 0.21%. CONCLUSIONS: Uncontrolled studies support a benefit of intravitreal bevacizumab in neovascular AMD for 3 months to 1 year. Low cost is a significant advantage of bevacizumab. Patients should discuss the potential risks and benefits of intravitreal bevacizumab and other available therapies with their physicians before receiving treatment. Controlled trials are needed to characterize the safety and efficacy of intravitreal bevacizumab and determine the optimal treatment regimen.

Assessment of low-vault cases with an implantable collamer lens. - Kato S; Shimizu K; Igarashi A (PloS one, 2020)
This study aimed to examine clinical results in low-vault eyes after implementation of a Hole implantable collamer lens (KS-AquaPORT™, STAAR Surgical Company) in terms of visual outcomes and complications over a one-year follow-up period. This was a retrospective cohort study of subjects who underwent Hole implantable collamer lens surgery at Sanno Hospital, exhibited low vault, and were followed up for 1 year. Patients were included if they met the following criteria: 20≤ age ≤55 years; stable refraction ≥6 months; -1.0 to -20.0 diopters of myopia; endothelial cell density ≥1800 cells/mm2; and no history of ocular surgery, progressive corneal degeneration, cataract, glaucoma, or uveitis. Main outcome measurements were the safety and efficacy indices, predictability, and vault. Values were indicated as the mean ± standard deviation. Subjects included 16 patients (age: 38 ± 8 years; 6 males; 25 eyes). Toric lenses were utilized for 10 eyes. Implantable collamer lens size was 12.1, 12.6, and 13.2 mm for 18, 6, and 1 eye(s), respectively. One year postoperatively, the safety index was 1.07; for 22 eyes with a target refraction of that of emmetropic eyes, the efficacy index was 0.90; and 96% of eyes were within ± 0.50 diopters of attempted versus achieved spherical equivalent correction. Postoperative vault was 142 ± 60 μm. One year postoperatively, no additional surgery was required for rotation of toric implantable collamer lens, and no advanced cataracts, increased intraocular pressure, or decreased endothelial cells were observed. In conclusion, Hole implantable collamer lens yielded satisfactory visual outcomes and no postoperative complications for low-vault eyes, suggesting its suitability for such cases.

Scope of practice of optometrists working in the UK Hospital Eye Service: Second national survey. - Gunn PJG; Creer RC; Bowen M; Tromans C; Jackson AJ; Tompkin AP; Harper RA (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2022)
PURPOSE: As the landscape in ophthalmology and related commissioning continues to change, there is a pressing need to re-evaluate the current scope of practice of hospital optometrists working within secondary care in the UK. We aim to establish if the skills or services delivered by optometrists have changed to meet varying demands, and to better understand what changes in practice may have arisen as a result of COVID-19. METHOD: A survey developed from that used in 2015 was disseminated to 129 optometry Hospital Eye Service (HES) leads in September 2020, including questions on department workforce; core services; extended roles; procedures undertaken within extended roles; level of autonomy; arrangements for prescribing; training and accreditation, and service changes in response to COVID-19. RESULTS: Ninety responses were received (70% response rate) from within England (76%), Scotland (22%) and Northern Ireland (2%). Whole time equivalents within units ranged from 0.4-79.2 (median of 2.5). In comparison to the 2015 survey, there was an increase in the proportion of units delivering extended roles, with glaucoma (88%) remaining the most common extended role, and new areas of practice in uveitis (21%) and vitreoretinal (13%) services. There was increased use of independent prescribing (67%) in comparison to 18% in 2015 and there was an increase in optometrists delivering laser interventions. In response to COVID-19, optometrists were increasingly delivering telephone consultations and there were new collaborations between primary and secondary care. CONCLUSIONS: Optometrists' scope of practice continues to develop in the HES with an increased variety of roles and an apparent increase in the number of units employing optometrists, often working in roles historically performed by medical practitioners. Such changes appear necessary in recovery and transformation within ophthalmology, alongside wider optometry changes arising at the interface of primary and secondary care.

Impact of the Topical Ophthalmic Corticosteroid Loteprednol Etabonate on Intraocular Pressure. - Sheppard JD; Comstock TL; Cavet ME (Advances in therapy, 2016)
Corticosteroids are a mainstay therapeutic option for the treatment of ocular inflammation. However, safety remains a concern for clinicians, particularly with long-term use. Though highly effective at suppressing inflammatory and allergic responses, topical ophthalmic corticosteroids carry an inherent risk of side effects, including elevated intraocular pressure (IOP), a risk factor for the development of glaucoma. The corticosteroid loteprednol etabonate (LE) contains an ester rather than a ketone at the C-20 position, minimizing the potential for side effects, including IOP elevation. In early pivotal clinical trials of LE ophthalmic suspension for conjunctivitis (allergic, giant papillary), anterior uveitis, and post-operative inflammation, LE had minimal impact on IOP over short-term (<28 days) and long-term (≥28 days) use. Since then, new LE formulations-including a gel, an ointment, and a suspension of LE in combination with tobramycin-have become commercially available. Multiple studies evaluating the safety and efficacy of LE for inflammatory conditions have been reported, including those requiring longer-term treatment such as photorefractive keratectomy, corneal transplantation, and dry eye disease. We review the available published data on the effect of LE on IOP and report on the cumulative incidence of clinically significant IOP elevations (≥10 mm Hg from baseline) with short-term and long-term LE use. In all studies, LE consistently demonstrated a low propensity to elevate IOP, regardless of formulation, dosage regimen, or treatment duration, including in known steroid responders. The cumulative proportion of patients exhibiting clinically significant IOP increases was 0.8% (14/1725 subjects) in studies evaluating short-term LE treatment and 1.5% (21/1386 subjects) in long-term studies. Furthermore, use of LE was associated with significantly lower rates of IOP elevation ≥10 mm Hg as compared to prednisolone acetate or dexamethasone (when used in combination with tobramycin). The cumulative data to date substantiates a favorable IOP-safety profile for LE with both short-term and long-term use.

Eye Care During the COVID-19 Pandemic: A Report on Patients' Perceptions and Experiences, an Asian Perspective. - Low R; Lee JM; Lai SS; Rousselot A; Agarwal M; Agrawal R (Ophthalmology and therapy, 2021)
INTRODUCTION: To elucidate the perceptions on eye care of patients affected by the disruption of outpatient and surgical ophthalmological services during the COVID-19 pandemic. METHODS: A cross-sectional questionnaire-based survey was conducted during the reopening of outpatient services at two tertiary eye care centres in Singapore and North India. Consecutive patients were recruited from general and specialist eye clinics in June 2020. RESULTS: A total of 326 patients were recruited, 200 patients from Singapore and 126 patients from New Delhi, India. The most common eye conditions were diabetic retinopathy and uveitis or ocular inflammatory conditions in the Indian centre, whereas the most common in the Singaporean centre were cataract in the pre- or postoperative stage and glaucoma. For patients from the Indian centre, 61.9% felt that COVID-19 had negatively impacted their eye disease, 58.7% were more distressed by their eye disease, 70.8% could not access appropriate eye care, 66.6% were afraid of contracting COVID-19 in the clinic, and 61.9% were accepting of teleconsultations. For patients from the Singaporean centre, 13.5% felt that COVID-19 had negatively impacted their eye disease, 19.5% were more distressed by their eye disease, 21.5% could not access appropriate eye care, 35% were afraid of contracting COVID-19 in the clinic, and only 31% were accepting of teleconsultations. CONCLUSION: Patients from India appear to have been more negatively affected by the pandemic compared to patients from Singapore. This study highlights patients' perceptions of the impact of COVID-19 on eye care, perceived risks, ease of access to care and attitudes towards eye care during the pandemic. Patients' perceptions are integral in developing strategies for the best care possible. There were heterogeneous responses amongst our patients; hence, there may be a role for more individualized healthcare strategies in the future.

Ocular Hypotensive Effect of ONO-9054, an EP3/FP Receptor Agonist: Results of a Randomized, Placebo-controlled, Dose Escalation Study. - Harris A; Ward CL; Rowe-Rendleman CL; Ouchi T; Wood A; Fujii A; Serle JB (Journal of glaucoma, 2016)
PURPOSE: To assess pharmacodynamic and safety profiles of ONO-9054 following single and multiple day dosing in subjects with ocular hypertension or open-angle glaucoma. MATERIALS AND METHODS: This was a phase I, single-center, randomized, double-masked, placebo-controlled dose-escalation study. Nine subjects were randomized to each of ONO-9054 3, 10, 20, 30 μg/mL and 12 to placebo. Subjects received a single drop to each eye at 07:00±30 minutes (single dose). Following a 4-day no-treatment period, subjects were dosed once daily for 14 consecutive days (multiple day dosing). Intraocular pressure (IOP) was measured regularly and compared with baseline measurements. Ocular examinations assessed safety and tolerability. RESULTS: Mean IOP decreased dose dependently. Following single dosing, IOP decreased from 22.9±4.0 to 15.9±2.3 mm Hg (ONO-9054, 30 μg/mL) at peak effect 9 hours postdose; the reduction in placebo-treated subjects was from 22.3±2.4 to 21.5±3.3 mm Hg. Following multiple day dosing, the greatest reduction in IOP occurred 1 hour postdose on day 18, from 23.3±0.6 to 15.1±2.4 mm Hg (ONO-9054, 10 μg/mL); the smallest reduction at this time was from 23.9±0.8 to 18.6±2.0 mm Hg (ONO-9054, 3 μg/mL). Pressures remained reduced on day 19, 25 hours after the last dose, when the lowest measurement was 15.8±2.1 mm Hg (ONO-9054, 10 μg/mL). Anterior uveitis and vitreous detachment were each reported in 2 subjects and considered moderate by the Investigator. Ocular hyperemia and tolerability symptoms were generally mild and transient. CONCLUSIONS: ONO-9054 was well-tolerated and elicited dose-dependent reductions in IOP, which were sustained for at least 24 hours following 2 weeks of consecutive daily dosing.

The singapore 5-Fluorouracil trabeculectomy study: effects on intraocular pressure control and disease progression at 3 years. - Wong TT; Khaw PT; Aung T; Foster PJ; Htoon HM; Oen FT; Gazzard G; Husain R; Devereux JG; Minassian D; Tan SB; Chew PT; et al. (Ophthalmology, 2009)
PURPOSE: To report 3-year results of a randomized, controlled trial comparing the use of a single application of 5-fluorouracil (5-FU) with placebo in trabeculectomy surgery. DESIGN: Prospective, randomized, double-blinded treatment trial. PARTICIPANTS: Two hundred forty-three Asian patients with primary open-angle or primary angle-closure glaucoma undergoing primary trabeculectomy. METHODS: One eye of each patient was randomized to receive either intraoperative 5-FU or normal saline (placebo) during trabeculectomy. MAIN OUTCOME MEASURES: Primary outcome measure was the level of intraocular pressure (IOP). Secondary outcomes were progression of visual field loss, rates of adverse events, and interventions after surgery. RESULTS: Of the 288 eligible patients, 243 were enrolled and 228 completed 3 years follow-up; 120 patients received 5-FU and 123 received placebo. Trial failure, according to predefined IOP criteria, was lower in the 5-FU group compared with the placebo group, although the difference was only significant with a failure criterion of IOP >17 mmHg (P = 0.0154). There was no significant difference in progression of optic disc and/or visual field loss over 36 months between 5-FU and placebo (relative risk [RR], 0.67; 95% confidence interval [CI], 0.34-1.31; P = 0.239). Uveitis occurred more often in the 5-FU-treated group (14/115 [12%] vs 5/120 [4%]; P = 0.032). CONCLUSIONS: This is the first masked, prospective, randomized trial reporting the effect of adjunctive 5-FU in trabeculectomy surgery in an East Asian population. The trial shows that an increased success rate can be achieved for several years after a single intraoperative treatment with 5-FU. We conclude that 5-FU is relatively safe and can be routinely used in low-risk East Asian patients. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

The clinical study of Healon 5 in phacoemulsification and IOL implantation. - Yang H; Zheng D; Huang J; Huang Y; Zhang Z (Yan ke xue bao = Eye science, 2001)
PURPOSE: To compare a new ophthalmic viscoelastic device (OVD) Healon 5 with two other kinds of OVDs commonly used in China during phacoemulsification and intraocular lens (IOL) implantation in terms of removal time, intraocular pressure, corneal and anterior chamber response. METHODS: This prospective randomized study, in which patients and observers are masked, comprises niety eyes. They were randomly divided into 3 groups with different OVDs. Healon 5 (sodium hyaluronate 5,000 2.3%) was compared with Healon GV (sodium hyaluronate 7,000 1.4%) and Iviz (sodium hyaluronate 1.0%). The surgeries were performed with temporal corneal incision, phacoemulsification in situ and foldable lens intracapsular implantation. The characteristic and the removal time of the viscoelastic material as well as the postoperative IOP, corneal reaction and anterior chamber reactions of the eyes were observed preoperatively and 24 hrs postoperatively. Exclusion criteria were glaucoma, a preoperative dilated pupil diameter smaller than 5.0 mm, proliferative diabetic retinopathy, significant corneal pathology or a history of uveitis. RESULTS: The removal time was 47.42 +/- 13.09 seconds in Healon 5, 16.50 +/- 5.45 in Healon GV and 15.83 +/- 7.40 in Iviz. The removal time of Healon 5 group was significantly longer than that of the other groups (P = 0.000). There is no significant IOP change 24 hours postoperatively and the difference of intraocular pressure among three groups was not significant (P > 0.05). Healon 5 group had the slightest corneal and anterior chamber response, followed by Healon GV and Iviz. CONCLUSION: Although takes longer time to remove, Healon 5 is an ideal viscoelastic material for its superior space maintenance capacity and high dispersity which provides superior protection of endothelial cells compared to Healon GV and Iviz.

Randomised controlled trial of anterior-chamber intraocular lenses. - Hennig A; Evans JR; Pradhan D; Johnson GJ; Pokhrel RP; Gregson RM; Hayes R; Wormald RP; Foster A (Lancet, 1997)
BACKGROUND: There are an estimated 16 million people blind in both eyes with cataracts. Most live in rural areas of developing countries where surgical resources are scarce. There is no consensus on the most appropriate type of intraocular lens in situations where high-volume low-cost surgery is required. This study was undertaken to evaluate the safety of multiflex open-loop anterior-chamber lenses (ACIOLs). METHODS: 2000 people attending Lahan Eye Hospital, southern Nepal, with bilateral cataracts reducing vision to 6/36 or less were randomly allocated to receive standard surgery--intracapsular extraction (ICCE) with aphakic correction--or ICCE with an ACIOL in their first operated eye. The primary outcome was a visual acuity of less than 6/60 in the operated eye at 1 year follow-up. Visual acuity was measured for 91% of the cohort at 1 year. The sample size was estimated to detect a doubling in poor visual outcome from an estimated rate of 4% in the standard surgery (control) group. FINDINGS: The median (range) time taken to do the surgery was 6.0 (3.0-17.2) min for the ACIOL group and 4.1 (2.4-10.3) min for the control group. 1 year after surgery, 5.0% of the ACIOL group and 5.4% of controls had functional vision less than 6/60 (OR 0.93 [0.60-1.43], p = 0.71). The causes of poor vision in the ACIOL and control groups were: correctable refractive error (22 and 29), uveitis/secondary glaucoma (13 and two), endophthalmitis (four and seven), pre-existing eye disease (four and five), retinal detachment (none and four), cystoid macular oedema (two and none), corneal ulcer (one and one), and corneal decompensation (none and one). INTERPRETATION: This study provides evidence that, in rural areas of developing countries, multiflex open-loop ACIOLs can be implanted safely by experienced ophthalmologists after routine ICCE, avoiding the disadvantages of aphakic spectacle correction. Further follow-up is planned.

Intraocular Lens Implantation in the Absence of Zonular Support: An Outcomes and Safety Update: A Report by the American Academy of Ophthalmology - Shen J.F.; Deng S.; Hammersmith K.M.; Kuo A.N.; Li J.Y.; Weikert M.P.; Shtein R.M. (Ophthalmology, 2020)
PURPOSE: To review the published literature on the visual acuity results and complications of different surgical techniques for intraocular lens (IOL) implantation in the absence of zonular support. METHODS: Peer-reviewed literature searches were conducted last in PubMed and the Cochrane Library in July 2019. The searches yielded 734 citations of articles published in English. The panel reviewed the abstracts of these mostly retrospective case series studies, and 45 were determined to be relevant to the assessment objectives. Three articles were rated as level II evidence, and 42 articles were rated as level III evidence. RESULTS: Eight different types of IOL fixation techniques with at least 6-month follow-up were evaluated: anterior chamber IOL (ACIOL), iris-claw IOL, retropupillary iris-claw IOL, 10-0 polypropylene iris-sutured posterior chamber IOL (PCIOL), 10-0 polypropylene scleral-sutured PCIOL, 8-0 polypropylene scleral-sutured PCIOL, CV-8 polytetrafluoroethylene, and intrascleral haptic fixation (ISHF). Eight articles reported data comparing 2 techniques. The 45 studies had insufficient statistical power to compare the techniques conclusively. A qualitative analysis of similar types showed that trends in visual acuity outcomes were not inferior to those of ACIOL implantation, but the severity of preoperative pathologic features was not controlled for. Compared with ACIOL, complications of cystoid macular edema were higher in 10-0 polypropylene iris-sutured PCIOL and 8-0 polypropylene scleral-sutured PCIOL. Non-anterior chamber IOL techniques were less likely to report chronic uveitis. Chronic glaucoma was highest in the 8-0 polypropylene scleral-sutured PCIOL group. Although retinal detachment was infrequent overall, it was twice as common in both iris- and scleral-sutured PCIOLs (except CV-8 polytetrafluoroethylene suture) compared with nonsutured methods: ACIOL, iris-clipped IOL, and ISHF PCIOL. CONCLUSIONS: The evidence reviewed shows no superiority of any single IOL implantation technique in the absence of zonular support. The various techniques seem to have equivalent visual acuity outcomes and safety profiles. Each technique has its own profile of inherent risk of postoperative complications. Surgeons must educate patients on the importance of close, long-term follow-up as a result of the uncertain nature of these techniques. Large prospective studies are needed to confirm the long-term complication profiles of these various IOL implantation techniques.

[Value of anterior chamber lenses in developing countries. Results of a clinical study]. - Hennig A; Pradhan D; Evans JR; Johnson GJ; Foster A (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 1998)
UNLABELLED: There are estimated to be 20 million people blinded by cataracts, 80-90% of whom live in rural areas of developing countries where expert surgical resources are scarce. The majority of all cataract operations are still intracapsular extractions (ICCE). Aphakic correction using spectacles is problematical in developing countries. This study was undertaken to evaluate the safety of multiflex open loop anterior chamber intraocular lenses (AC IOLs). METHODS: A total of 2000 people attending Lahan Eye Hospital, South-east Nepal, with bilateral cataract were randomly allocated to receive in their first eye either ICCE with AC IOL (AC IOL group) or ICCE with aphakic correction (control group). All operations were performed by two ophthalmologists using a standardized technology and 4.5 x operating loupe magnification. Functional and best corrected vision was recorded. The primary outcome measure was poor vision after surgery, which was defined as a visual acuity of less than 6/60 at 1 year follow-up (WHO definition for severe visual impairment and blindness). FINDINGS: The median time needed to perform ICCE was 4.1 min and to perform ICCE with AC IOL 6 min. Of all study patients 91% were examined after 1 year. Five percent of the AC IOL group and 5.4% of the control group had a functional visual acuity of less than 6/60. Causes of reduced vision in the AC IOL group versus the control group were: correctable refractive error (22 vs 29), uveitis/secondary glaucoma (13 vs 2), endophthalmitis (4 vs 7), pre-existing eye diseases (4 vs 5), retinal detachment (0 vs 4), and corneal decompensation (0 vs 1). Of the control group, 24 patients were found to be functionally blind in the operated eye (vision < 3/60) because they did not wear their aphakic spectacles. Normal vision (WHO definition: > or = 6/18) was achieved best corrected in 89.9% of the AC IOL group and 93.2% of the control group. Analysis of additional long-term follow-ups (2-5 years post-operatively) has not yet been completed. INTERPRETATION: This study provides evidence that in developing countries well-manufactured multiflex open loop AC IOLs can be implanted safely by experienced ophthalmologists after routine ICCE, avoiding the disadvantages of aphakic spectacle correction.

The effect of a topical antioxidant formulation including N-acetyl carnosine on canine cataract: a preliminary study. - Williams DL; Munday P (Veterinary ophthalmology, 2006)
OBJECTIVE: To determine the efficacy of a topical antioxidant formulation including N-acetyl carnosine in the treatment of canine cataract in a preliminary nonplacebo, controlled, unmasked study. ANIMALS STUDIED: Thirty dogs of varying breeds and ages with a spectrum of lens opacities ranging from nuclear sclerosis to total mature cataract. METHODS: Dogs were treated three times daily with topical 2% N-acetyl carnosine in a buffered vehicle containing the antioxidants glutathione, cysteine ascorbate, L-taurine and riboflavin (Ocluvet, Practivet, Phoenix, AZ, USA). Dogs were examined prior to treatment and at 2, 4 and 8 weeks during treatment, by direct and indirect ophthalmoscopy and slit-lamp biomicroscopy after pharmacologic pupil dilation. Photographic documentation of lens opacity was achieved by retroillumination photography, with three photographs taken at each examination time-point. A lens opacification index (LOI), determined by integration of the grayscale level of each pixel across the image, was evaluated by computerized image analysis of digitized images. Alteration in mean LOI was determined for each animal, having normalized the initial LOI. RESULTS: Fifty-eight eyes of 30 dogs were evaluated, 22 with mature cataract, 13 with immature cataract, 9 with cataract associated with other intraocular disease such as uveitis and 14 with nuclear sclerosis alone. One dog was unilaterally anophthalmic after previous enucleation and one had a phthytic eye after previous uveitis-induced glaucoma. Image analysis showed a reduction in mean LOI in all cataract groups (mean resolution in opacity of 2.3 +/- 0.33% for all cataracts), although this was only statistically significant in those eyes with immature cataract (mean resolution of opacity 4.5 +/- 0.33%) or nuclear sclerosis (mean decrease in opacity 5 +/- 0.37%). Reduction in lens opacity was seen in eyes with mature cataract (0.5 +/- 0.4%) and in miscellaneous cataract associated with intraocular inflammation (1.3 +/- 0.4%), but these changes were not statistically significant. Owner evaluation of visual capability, however, suggested improvement in vision in 80% of cases by the end of the study. CONCLUSIONS: This study demonstrates some marginal reduction in lens opacification in a substantial number of cases of canine cataract with the use of a topical nutritional antioxidant formulation including N-acetyl carnosine. Lens opacification was improved with treatment in eyes with immature cataract or nuclear sclerosis while in eyes with mature cataract or cataract with associated intraocular inflammatory pathology less reduction was seen.

[Analysis of intra-operative and early post-operative complications and safety in non-penetrating trabecular surgery]. - Wang N; Wu H; Ye T; Chen X; Zeng M; Fan Z ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2002)
OBJECTIVE: To evaluate the safety, effectiveness and complications of non-penetrating trabecular surgery (NPTS). METHODS A total of 168 patients ( 258 eyes) of primary open angle glaucoma were divided into 2 groups randomly, and they were matched according to the age, sex and severity of disease. NPTS with reticulated hyaluronic acid implant was taken in one group, and traditional trabeculectomy was taken in the other. Pre-a2operative mean intraocular pressure (IOP) in the NPTS group and trabeculectomy group was (31.85 +/- 4.83) and (32.59 +/- 4.62) mm Hg (1a(c)mm Hg = 0.133 kPa), respectively. The post-operative IOP and complications in these 2 groups were compared. RESULTS: (1) IOP: The mean IOP on post-operative 7th, 14th day, 1st, 3rd and 6th month was (6.67 +/- 2.43), (11.42 +/- 2.89), (12.59 +/- 2.24), (15.45 +/- 1.82), and (17.99 +/- 1.80) mm Hg respectively in the NPTS group, while that in the trabeculectomy group for the same time a(c)series was (4.87 +/- 1.65), (10.48 +/- 2.38), (12.01 +/- 2.83), (15.01 +/- 2.66), an.d (17.48 +/- 2.97) mm Hg respectively. Statistically significant differences between these 2 groups were found on the post-operative 7th day and 14th day (t = 7.03, 2.89; P < 0.000 1, P = 0.004). However, significant difference was not noted for pre-operative and other post-operative IOP in the follow-up (t = 1.28, 1.78, 1.55, 1.60; P = 0.202, 0.077, 0.124, 0.112). (2) Visual acuity: There were no statistical differences of visual acuity between the 2 groups (kappa(2) = 0.135, 0.151, 0.024, 0.076; P = 0.935, 0.927, 0.988, 0.963). (3) Complications: I and II degree shallow anterior chamber was encountered in 57 eyes in the NPTS group, while that in the trabeculectomy group was 70. Twelve eyes with III degree shallow anterior chamber were found exclusively in the trabeculectomy group. Ciliary body or choroidal detachment was found in 66 and 70 eyes respectively in the NPTS and trabeculectomy group. Hypotony was encountered in 5 eyes exclusively in the trabeculectomy group. Complications were found to be statistically different in 2 groups (kappa(2) = 9.95, 15.27, 4.60, 6.19; P < 0.05). Hyphema was found in 2 and 6 eyes respectively in the NPTS and trabeculectomy group. Light anterior uveitis was found in 5 and 9 eyes respectively in the NPTS and trabeculectomy group. Vitreous extrusion was experienced in 1 eye of trabeculectomy group. Some complications (16.2%) related to operative skill were also experienced in the NPTS group. CONCLUSIONS: Over-filtration and surgical injury related complications are significantly reduced in the NPTS group compared to those in the trabeculectomy group. NPTS is safer than traditional trabeculectomy. Mastering surgical skills is required for reducing complications of NPTS.

The use of biologic therapies in uveitis. - Duica, Ilona; Voinea, Liliana-Mary; Mitulescu, Costin; Istrate, Sinziana; Coman, Ioana-Cristina; Ciuluvica, Radu (Romanian journal of ophthalmology, 2018)
PURPOSE: Non-infectious uveitis has been long controlled with the use of corticosteroids with many side effects and poor control in some cases. The purpose of this paper was to assess the different biologic agents (in this case infliximab and adalimumab) and to compare their efficacy in the treatment of uveitis. RESULTS: Adalimumab has been proven very successful in replacing or aiding corticosteroid therapy in different autoimmune mediated uveitis (Juvenile Idiopathic Arthritis, Rheumatoid arthritis, sarcoidosis) whereas infliximab has been used intravenously and recently intravitreally with very promising results in controlling Behcet's related uveitis. CONCLUSION: Biologic Response Modifiers represent the future of therapy in immune-mediated uveitis. Abbreviations AU = Anterior Uveitis, BCVA = Best Corrected Visual Acuity, BRM = Biologic Response Modifiers, CME = Cystoid Macular Oedema, CPR = C Protein Reactive, ESR = Erythrocyte Sediment Rate, HSV = Herpes Simplex Virus, ICAM = Intercellular Adhesion Molecules, IMT = Immunomodulatory Therapy, JIA = Juvenile Idiopathic Arthritis, MMP = Matrix Metalloproteinases, MTX = Methotrexate, RA = Rheumatoid Arthritis, TB = Tuberculosis, VCAM = Vascular Adhesion Molecules.
Keywords: Humans; Treatment Outcome; *Biological Therapy; *Adalimumab/therapeutic use; *Uveitis/drug therapy/etiology; Arthritis, Juvenile/complications; biologic response modifiers; intravitreal biologic agents; Macular Edema; uveitis

Immunosuppression for the Uveitides. - Jabs, Douglas A. (Ophthalmology, 2018)
The uveitides are a collection of more than 30 diseases characterized by intraocular inflammation. Many cases of juvenile idiopathic arthritis-associated uveitis, many cases of intermediate uveitis, and most cases of posterior and panuveitides requiring treatment are treated with corticosteroids and immunosuppression. Disease-specific, time-updated modeling of clinical data for several uveitides suggests superior prevention of ocular complications and visual outcomes with immunosuppression. These studies also suggest that oral corticosteroids at doses low enough for safe long-term therapy (i.e., <7.5 mg/day) are ineffective, implying that immunosuppression should be part of the initial regimen. The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study was a randomized comparative effectiveness trial comparing systemic therapy with oral corticosteroids and immunosuppression with regional corticosteroid treatment. It demonstrated that, when used properly, oral corticosteroids and immunosuppression can be given safely for up to 7 years with no evident increased risk of systemic side effects compared with regional corticosteroid therapy, except for greater antibiotic use for infections. The Systemic Treatment for Eye Diseases (SITE) Cohort Study suggested long-term safety for this approach, when the immunosuppressive agents were antimetabolites or calcineurin inhibitors. Thus, oral corticosteroids and immunosuppression may be a preferred initial therapy for many noninfectious, intermediate, posterior, and panuveitides. Nonalkylating-agent immunosuppression has a low rate of sustained, drug-free remissions, <10%/year. Nonalkylating-agent immunosuppression for >3 years with control of the inflammation for >2 years is associated with a decreased risk of relapse after discontinuing immunosuppression. Alkylating agents can induce sustained drug-free remissions but likely increase the lifetime risk of cancer. Biologics, which target specific cytokines and pathways, hold promise for the future. Monoclonal antibodies directed against tumor necrosis factor (TNF)-α have been studied most often, and one, adalimumab, is U.S. Food and Drug Administration approved for the treatment of noninfectious, intermediate, posterior, and panuveitides.
Keywords: Humans; Immunosuppressive Agents/*therapeutic use; *Visual Acuity; Immunosuppression Therapy/*methods; Uveitis/physiopathology/*therapy

Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management. - Holló, Gábor; Aung, Tin; Cantor, Louis B.; Aihara, Makoto (Survey of ophthalmology, 2020)
Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.
Keywords: Humans; *Disease Management; bimatoprost; Cataract Extraction/*adverse effects; elevated intraocular pressure; Fluorescein Angiography/*methods; Fundus Oculi; glaucoma and cataract surgery; latanoprost; Macular Edema/diagnosis/*etiology/therapy; omidenepag isopropyl; Ophthalmic Solutions; postoperative complications; prostaglandin analogs; Prostaglandins, Synthetic/administration & dosage/*adverse effects; pseudophakic cystoid macular edema; tafluprost; travoprost; Visual Acuity

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative. - Dick, Andrew D.; Rosenbaum, James T.; Al-Dhibi, Hassan A.; Belfort, Rubens Jr; Brézin, Antoine P.; Chee, Soon Phaik; Davis, Janet L.; Ramanan, Athimalaipet V.; Sonoda, Koh-Hei; Carreño, Ester; Nascimento, Heloisa; Salah, Sawsen; et al. (Ophthalmology, 2018)
TOPIC: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. CLINICAL RELEVANCE: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. METHODS: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. RESULTS: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. CONCLUSIONS: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.
Keywords: Humans; Time Factors; Immunosuppressive Agents/*therapeutic use; Surveys and Questionnaires; Risk Assessment; Glucocorticoids/therapeutic use; *Immunomodulation; Evidence-Based Medicine; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology

Acute Uveitis following COVID-19 Vaccination. - ElSheikh, Reem H.; Haseeb, Abid; Eleiwa, Taher K.; Elhusseiny, Abdelrahman M. (Ocular immunology and inflammation, 2021)
PURPOSE: To describe a case of juvenile idiopathic arthritis (JIA)-associated anterior uveitis after receiving the Sinopharm COVID-19 vaccine. METHODS: A retrospective case report. RESULTS: An 18-year-old girl, with a history of antinuclear antibody positive oligoarticular JIA, presented with bilateral anterior uveitis 5 days after the second dose of the Sinopharm COVID-19 vaccine. Ocular examination revealed anterior uveitis with reduced visual acuity in both eyes. Anterior segment optical coherence tomography showed hyperreflective dots in the anterior chamber (AC) and fine endothelial granularities representing the circulating cells in the AC. Uveitis in both eyes resolved gradually after topical steroid treatment without recurrence. CONCLUSION: This report demonstrates a potential causal association of COVID-19 vaccine with anterior uveitis.
Keywords: *SARS-CoV-2; Female; Humans; Retrospective Studies; Adolescent; COVID-19/*prevention & control; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Ophthalmic Solutions; Visual Acuity/physiology; Acute Disease; Administration, Ophthalmic; COVID-19 Vaccines/*adverse effects; Uveitis, Anterior/diagnosis/drug therapy/*etiology; Vaccination/*adverse effects

Long-Term Safety and Efficacy of Adalimumab in Patients with Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. - Suhler, Eric B.; Jaffe, Glenn J.; Fortin, Eric; Lim, Lyndell L.; Merrill, Pauline T.; Dick, Andrew D.; Brezin, Antoine P.; Nguyen, Quan Dong; Thorne, Jennifer E.; Van Calster, Joachim; Cimino, Luca; Adan, Alfredo; et al. (Ophthalmology, 2021)
PURPOSE: To evaluate long-term efficacy and safety of extended treatment with adalimumab in patients with noninfectious intermediate, posterior, or panuveitis. DESIGN: Open-label, multicenter, phase 3 extension study (VISUAL III). PARTICIPANTS: Adults who had completed a randomized, placebo-controlled phase 3 parent trial (VISUAL I or II) without treatment failure (inactive uveitis) or who discontinued the study after meeting treatment failure criteria (active uveitis). METHODS: Patients received subcutaneous adalimumab 40 mg every other week. Data were collected for ≤ 362 weeks. Adverse events (AEs) were recorded until 70 days after the last dose. MAIN OUTCOME MEASURES: Long-term safety and quiescence; other efficacy variables included inflammatory lesions, anterior chamber cell and vitreous haze grade, macular edema, visual acuity, and dose of uveitis-related systemic corticosteroids. RESULTS: At study entry, 67% of patients (283/424) showed active uveitis and 33% (141/424) showed inactive uveitis; 60 patients subsequently met exclusion criteria, and 364 were included in the intention-to-treat analysis. Efficacy variables were analyzed through week 150, when approximately 50% of patients (214/424) remained in the study. Patients showing quiescence increased from 34% (122/364) at week 0 to 85% (153/180) at week 150. Corticosteroid-free quiescence was achieved by 54% (66/123) and 89% (51/57) of patients with active or inactive uveitis at study entry. Mean daily dose of systemic corticosteroids was reduced from 9.4 ± 17.1 mg/day at week 0 (n = 359) to 1.5 ± 3.9 mg/day at week 150 (n = 181). The percentage of patients who achieved other efficacy variables increased over time for those with active uveitis at study entry and was maintained for those with inactive uveitis. The most frequently reported treatment-emergent AEs of special interest were infections (n = 275; 79 events/100 patient-years [PY]); AEs and serious AEs occurred at a rate of 396 events/100 PY and 15 events/100 PY, respectively. CONCLUSIONS: Long-term treatment with adalimumab led to quiescence and reduced corticosteroid use for patients who entered VISUAL III with active uveitis and led to maintenance of quiescence for those with inactive uveitis. AEs were comparable with those reported in the parent trials and consistent with the known safety profile of adalimumab.
Keywords: 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; Anti-Inflammatory Agents/administration & dosage; *Visual Acuity; *Adalimumab; *Noninfectious uveitis; *treatment-emergent adverse event; *Uveitis; Adalimumab/*administration & dosage; Injections, Subcutaneous; Panuveitis/diagnosis/*drug therapy; Uveitis, Intermediate/diagnosis/*drug therapy; Uveitis, Posterior/diagnosis/*drug therapy

Anterior uveitis onset after bnt162b2 vaccination: is this just a coincidence? - Renisi, Giulia; Lombardi, Andrea; Stanzione, Massimo; Invernizzi, Alessandro; Bandera, Alessandra; Gori, Andrea (International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2021)
BACKGROUND: Uveitis is a vision-threatening inflammation and is considered an ophthalmic emergency. It generally arises as a result of autoimmune conditions, infections, or ocular trauma, but it may also occur as an isolated disorder. Over the past decades, several cases of vaccine-associated uveitis have been described, with the hepatitis B virus vaccine being the leading cause. CLINICAL CASE: A case of anterior uveitis in a 23-year-old male, with onset 14 days after the second dose of BNT162b2 COVID-19 vaccine, is reported here. Initial symptoms were pain, photophobia, and red eye. Ocular examination showed pericheratic and conjunctival hyperaemia, posterior synechiae, and anterior chamber cells ± keratic precipitates in the lower quadrants. The posterior segment did not show any alteration, and optical coherence tomography ruled out the presence of cystoid macular oedema. After a 10-day treatment course of topical steroids and cycloplegic eye drops, the ocular inflammatory signs disappeared and visual acuity was completely restored. Even if causality remains presumed, a warning should be given to physicians about the possibility of eye inflammation following SARS-CoV-2 vaccination.
Keywords: *COVID-19; Humans; Male; SARS-CoV-2; Adult; Young Adult; *Uveitis; *Uveitis, Anterior/chemically induced/diagnosis; Adverse event; BNT162 Vaccine; BNT162b2 vaccine; COVID-19 Vaccines; Uveitis; Vaccination/adverse effects

Efficacy and Safety of Suprachoroidal CLS-TA for Macular Edema Secondary to Noninfectious Uveitis: Phase 3 Randomized Trial. - Yeh, Steven; Khurana, Rahul N.; Shah, Milan; Henry, Christopher R.; Wang, Robert C.; Kissner, Jennifer M.; Ciulla, Thomas A.; Noronha, Glenn (Ophthalmology, 2020)
PURPOSE: Injection of pharmacotherapy into the suprachoroidal space, between the sclera and choroid, is an alternative delivery technique developed with the rationale of providing higher drug concentrations to posterior ocular structures compared with other intraocular and periocular injection procedures. This study was conducted to evaluate the safety and efficacy of suprachoroidally injected triamcinolone acetonide formulation (CLS-TA), a suspension of triamcinolone acetonide, in improving vision among patients with noninfectious uveitis complicated by macular edema (ME). DESIGN: Phase 3 masked, randomized trial. PARTICIPANTS: One hundred sixty patients with ME secondary to noninfectious uveitis. Patients were required to have a best-corrected visual acuity (BCVA) of 5 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letters (Snellen equivalent, 20/800) and 70 or fewer ETDRS letters read (Snellen equivalent, 20/40) in the study eye. METHODS: Patients were randomized 3:2 to suprachoroidally injected CLS-TA or sham treatment, with administrations at day 0 and week 12. MAIN OUTCOME MEASURES: The primary end point was improvement from baseline of 15 or more ETDRS letters in BCVA at week 24. The secondary end point was reduction from baseline in central subfield thickness (CST) at week 24. RESULTS: In the CLS-TA arm, 47% of patients gained 15 or more ETDRS letters in BCVA versus 16% in the control arm (P < 0.001), meeting the primary end point. Mean reductions in CST from baseline were 153 μm versus 18 μm (P < 0.001). No serious adverse events (AEs) related to treatment were reported. Corticosteroid-associated AEs of elevated intraocular pressure occurred in 11.5% and 15.6% of the CLS-TA and control groups, respectively. Cataract AE rates were comparable (7.3% and 6.3%, respectively). CONCLUSIONS: Patients in the CLS-TA study arm experienced clinically significant improvement in vision relative to the sham procedure, demonstrating the efficacy of suprachoroidal injection of CLS-TA for the treatment of ME in a vision-threatening disorder.
Keywords: Female; Humans; Male; Middle Aged; Treatment Outcome; Glucocorticoids/administration & dosage; *Visual Acuity; Choroid; Injections, Intraocular; Macular Edema/diagnosis/*drug therapy/etiology; Tomography, Optical Coherence/methods; Triamcinolone Acetonide/*administration & dosage; Uveitis/*complications/diagnosis/drug therapy

MUST Beg to Differ. - Albini, Thomas; Callaway, Natalia F.; Jaffe, Glenn J.; Feuer, William; Davis, Janet; Goldstein, Debra; Lowder, Careen; Lin, Phoebe; Nguyen, Quan; Srivastava, Sunil; Callanan, David; Galor, Anat; et al. (Ophthalmic surgery, lasers & imaging retina, 2019)
The authors provide a significant interpretation of the National Eye Institute-sponsored Multicenter Uveitis Steroid Treatment study, in which patients with severe, non-infectious intermediate, posterior, or panuveitis were randomly assigned to receive local treatment using the sutured intravitreal fluocinolone acetonide implant or systemic treatment consisting of oral steroids and conventional steroid-sparing immunosuppression, with a primary outcome of visual acuity at 2 years of follow-up. The authors also present evidence-based guidance for the treatment of noninfectious posterior segment involving uveitis. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:266-268.].
Keywords: Humans; Treatment Outcome; Drug Implants; Fluocinolone Acetonide/administration & dosage/*analogs & derivatives; Intravitreal Injections; Uveitis/*drug therapy

Tattoo-associated uveitis. - Ostheimer, Trucian A.; Burkholder, Bryn M.; Leung, Theresa G.; Butler, Nicholas J.; Dunn, James P.; Thorne, Jennifer E. (American journal of ophthalmology, 2014)
PURPOSE: To describe the clinical presentation of uveitis with coincident onset of raised and indurated tattooed skin. DESIGN: Case series. METHODS: Seven consecutive patients were evaluated at a tertiary ophthalmologic facility with coincident uveitis and cutaneous tattoo induration over an 18-month period. All subjects underwent complete ophthalmic examination and a focused systemic medical evaluation including serologic testing and imaging studies. Two participants underwent biopsy of their tattoos. The patients' clinical courses and responses to treatment over a follow-up period of 1-20 months are reported (mean follow-up = 9 months). Main outcome measures included degree of intraocular inflammation, ocular complications, visual acuity, clinically observable tattooed skin changes, and biopsy results. RESULTS: Five of 7 patients had bilateral nongranulomatous anterior uveitis: 4 with chronic and 1 with recurrent disease. The remaining 2 patients had bilateral chronic granulomatous panuveitis. Biopsies of raised and indurated tattoos were performed in 2 patients and demonstrated noncaseating granulomatous inflammation surrounding tattoo ink in the dermis. The skin changes resolved in all patients, with a faster response noted in those treated with high-dose oral prednisone for intraocular inflammation. Five patients subsequently experienced recurrent flares of intraocular inflammation in conjunction with the recurrence of raised and indurated tattoos. CONCLUSIONS: These cases represent a subset of patients in whom skin tattooing may have incited an immune response leading to simultaneous inflammation of the eyes and tattooed skin.
Keywords: Female; Humans; Male; Prognosis; Adult; Follow-Up Studies; Retrospective Studies; Young Adult; Recurrence; Biopsy; Glucocorticoids/therapeutic use; Visual Acuity; Uveitis, Anterior/diagnosis/drug therapy/*etiology; Fluocinolone Acetonide/*therapeutic use; Skin/drug effects/pathology; Tattooing/*adverse effects

Treatment of Uveitis and Outcomes of Glaucoma Drainage Implant Surgery: A Meta-Analysis. - Chaku, Meenakshi; Bajwa, Asima; Lee, Jae K.; Netland, Peter A. (Ocular immunology and inflammation, 2020)
PURPOSE: We performed a meta-analysis to evaluate the effect of uveitis treatment on glaucoma drainage implant surgical outcomes. METHODS: We included 16 articles in the meta-analysis. Two groups were defined based on medical therapy of uveitis: Group 1: poorly controlled uveitis, and Group 2: well-controlled uveitis including use of immunomodulatory medications. RESULTS: The two groups were similar in comparisons of follow-up time, age, gender, and etiology of uveitis. Meta-analysis demonstrated significantly greater success in Group 2 (95.1%) compared to Group 1 (81.6%) at 1 year after glaucoma drainage implant surgery (P = .001). The final success was significantly greater (P 0.014) in group 2 compared with group 1 (86.1% and 74.3%, respectively). CONCLUSION: Surgical success was significantly higher in uveitic glaucoma patients treated with more intensive immunosuppressive therapy before and after glaucoma drainage implant surgery. The level of control of uveitis perioperatively appears to influence glaucoma drainage implant surgery outcomes.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Treatment Outcome; *Immunomodulation; Visual Acuity/physiology; *Glaucoma Drainage Implants; Glaucoma drainage implant; glaucoma surgical outcomes; Glaucoma/etiology/*physiopathology/*surgery; immunomodulatory therapy; Intraocular Pressure/*physiology; meta-analysis; uveitic glaucoma; Uveitis/complications/*drug therapy

Combined Dexamethasone Intravitreal Implant and Glaucoma Drainage Device Placement for Uveitic Glaucoma. - Nguyen, Tran; Kim, Han; Mielke, Christy; Momont, Anna C.; Brandt, James D.; Liu, Yao (Journal of glaucoma, 2020)
PRECIS: At 1-year postoperative follow-up, concurrent placement of a dexamethasone intravitreal implant and glaucoma drainage device effectively controlled intraocular pressure (IOP) and inflammation in eyes with uveitic glaucoma with no changes in systemic immunomodulatory therapy. PURPOSE: The purpose of this study was to assess 1-year postoperative outcomes in eyes with uncontrolled uveitic glaucoma following concurrent placement of a dexamethasone intravitreal implant and glaucoma drainage device. MATERIALS AND METHODS: This is a retrospective, observational case series of patients with chronic, noninfectious uveitis and uveitic glaucoma uncontrolled on maximal tolerated medical therapy with at least 1-year postoperative follow-up. The main outcomes were visual acuity, IOP, number of glaucoma medications, recurrent inflammation, frequency of topical steroids, systemic immunomodulatory therapy, and adverse events. Success was defined as IOP <21 mm Hg and IOP reduced by >20% from baseline on at least 2 consecutive visits after 3 months either with or without glaucoma medications (ie, partial or complete success, respectively). RESULTS: Eight eyes in 6 patients met the inclusion criteria. The average age was 44.1±19.7 years (range: 10 to 68 y) and 50% were female. At 1-year, there was no significant change in visual acuity. No eyes lost ≥3 lines of vision. The majority of eyes (87.5%) achieved complete (n=2) or partial success (n=5) with a decrease in average IOP from 36.5 to 11.8 mm Hg (P=0.002). Glaucoma medication use decreased from 3.0 to 1.3 medications (P=0.04). There was a significant decrease in the number of episodes of recurrent inflammation in the 6 months following surgery compared with the 6 months before surgery (P=0.004). CONCLUSION: In this small case series, dexamethasone intravitreal implant combined with Ahmed glaucoma drainage device appears to be an effective approach for the management of uncontrolled uveitic glaucoma.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Combined Modality Therapy; Child; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; *Glaucoma Drainage Implants; Dexamethasone/*administration & dosage; Glaucoma/drug therapy/physiopathology/surgery/*therapy; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Prosthesis Implantation; Tonometry, Ocular; Uveitis/drug therapy/physiopathology/surgery/*therapy

Efficacy and Safety of Interferon Alpha 2A and Pegylated Interferon Alpha 2A in Inflammatory Macular Edema. - Couret, Chloé; Servant, Marion; Lebranchu, Pierre; Hamidou, Mohamed; Weber, Michel (Ocular immunology and inflammation, 2020)
Purpose: The aim of this study was to further explore the efficacy and safety of interferon-α in refractory non-infectious inflammatory macular edema and to compare interferon-α2a and pegylated interferon-α2b.Methods: 34 patients with refractory non-infectious uveitic macular edemaunder interferon-α were retrospectively reviewed.Results: Mean baseline best-corrected visual acuityimproved from 0.55 logMar to 0.37 logMAR (P < 0.001) at month (M) 1 and 0.40 logMAR (P < 0.001) at M6. The mean baseline CMT decreased from 554 µm to 367 µm (P < 0.001) at M1 and 394 µm (P < 0.001) at M6. Clinical adverse effects (AEs) were observed in a third of patients, leading to treatment discontinuation because of frequent mild AEs and few severe AE. No statistically significant difference was found between both molecules.Conclusions: Anatomically and functionally, interferon-α was rapidly effective despite a low dosage regimen and no difference in efficacy and tolerance was observed between interferon-α2a and pegylated interferon-α2b.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; uveitis; *Visual Acuity; Injections, Subcutaneous; Macular Edema/diagnosis/*drug therapy/etiology; Tomography, Optical Coherence/methods; Efficacy and safety; interferon; Interferon-alpha/*administration & dosage; Polyethylene Glycols/*administration & dosage; Recombinant Proteins/administration & dosage; refractory macular edema; Uveitis/*complications/diagnosis

Tattoo associated retinochoroiditis. - Orellana Rios, J.; Verdaguer Díaz, J. I.; Agee, J.; Theodore Smith, R. (Archivos de la Sociedad Espanola de Oftalmologia, 2018)
CLINICAL CASE: A young woman was referred to our offices with impairment of visual acuity after she received a third tattoo on her arm. Systemic medical and laboratory work-up were performed in order to exclude an infectious agent or inflammatory disease. A yellowish juxtafoveal lesion in left eye along with a plaque-like outer retinal disruption and focal pigmentary defects was assessed using multi-modal diagnostic imaging. DISCUSSION: Ophthalmologists treating uveitis should consider this uncommon association and question patients regarding tattoos and tattoo inflammation given the rise of subjects undergoing artistic tattooing.
Keywords: Female; Humans; Young Adult; Uveitis; Tattooing/*adverse effects; Chorioretinitis/diagnostic imaging/*etiology; Coroiditis multifocal; Multifocal choroiditis; Retinochoroiditis; Retinocoroiditis; Tattoo; Tatuaje; Uveítis

Ocular Manifestations and Visual Outcomes of Behçet's Uveitis in a Thai population. - Pathanapitoon, Kessara; Kunavisarut, Paradee; Saravuttikul, Fa-Arun; Rothova, Aniki (Ocular immunology and inflammation, 2019)
PURPOSE: To report on ocular manifestations and visual outcomes of Thai patients with Behçet's Uveitis (BU). METHODS: We reviewed medical records of 50 BU patients (31 males and 19 females). Ocular manifestations, treatment modalities, complications, and visual outcomes were registered. RESULTS: Ocular involvement was bilateral in 76% of patients, resulting in 89 affected eyes. Panuveitis and posterior uveitis were the most common types. Retinal vasculitis was noted in majority of affected eyes and specifically arteritis was noticed in 32/57(56%). Most patients received combination therapy of systemic corticosteroids and immunosuppressive agents (azathioprine 72%). At final visit, VA ≤20/200 was observed in 25 affected eyes (28%). Risk factors for poor visual outcome were poor visual acuity at presentation (p < 0.001) and development of optic atrophy (p = 0.01). CONCLUSIONS: Typical ocular manifestations of Thai patients with BU consisted of bilateral uveitis affecting posterior eye segment with high rate of complications and frequent visual loss.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Young Adult; Adolescent; Child; Thailand; Azathioprine/therapeutic use; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Tonometry, Ocular; Age of Onset; Behcet Syndrome/*complications/drug therapy/physiopathology; Behçet’s uveitis; complications; ocular manifestations; Ophthalmoscopy; Retinal Vasculitis/*complications/drug therapy/physiopathology; Uveitis, Posterior/*complications/drug therapy/physiopathology; Visual Acuity/*physiology; visual outcomes

The Results of Interferon-Alpha Treatment in Behçet Uveitis. - Eser-Ozturk, Hilal; Sullu, Yuksel (Ocular immunology and inflammation, 2020)
Purpose: To assess the efficacy and tolerability of interferon alpha (IFN-α) treatment in patients with refractory Behçet uveitis (BU).Methods: The patients with BU who were treated with subcutaneous IFN-α were divided into groups according to treatment response. Demographic features, best corrected visual acuity (BCVA), central macular thickness (CMT) value, and fluorescein angiography (FA) scores were compared between the groups.Results: Twenty-one (84%) of the 25 patients responded to IFN-α treatment. Active inflammation resolved at the first month's visit in all patients. The improvement in mean BCVA and CMT achieved at the first month's visit in all groups; however, the improvement in mean CMT in the non-responder group could not be maintained at the last visit. Main FA score significantly decreased in both the complete and partial remission group; however, it decreased minimally in the non-responder group.Conclusion: IFN-α seems an effective and safe treatment option in the management of refractory BU.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Dose-Response Relationship, Drug; Fluorescein Angiography; Fundus Oculi; Visual Acuity; Injections, Subcutaneous; Interferon-alpha/*administration & dosage; Behçet disease; Behcet Syndrome/*complications/diagnosis/drug therapy; Behçet uveitis; Immunologic Factors/administration & dosage; interferon-alpha; Macula Lutea/pathology; Uveitis/diagnosis/*drug therapy/etiology

Corneal Decompensation in Uveitis Patients: Incidence, Etiology, and Outcome. - Wong, Shiao W.; Carley, Fiona; Jones, Nicholas P. (Ocular immunology and inflammation, 2021)
Purpose: To identify the prevalence, etiology, management and visual outcomes of treatment in uveitis-related corneal decompensation.Patients and methods: This is a retrospective study of patients with corneal decompensation identified from a large cohort with uveitis in a tertiary referral clinic setting.Results: Between March 1991 and May 2018, 4132 new patients with uveitis were seen in Manchester Uveitis Clinic. Of these, 25 patients (0.6%) were identified with corneal decompensation of which 9 (0.2%) were affected bilaterally (total 34 eyes). The mean interval between uveitis diagnosis and decompensation was 23 months (range 0-117 m). Ten patients (41%) had associated glaucoma. Seventeen eyes (50%) had undergone intraocular surgery prior to decompensation. For eyes with no history of raised intraocular pressure or intraocular surgery, keratouveitis (presumed autoimmune or tuberculous) was the most common cause of corneal decompensation. Fourteen eyes (41%) required corneal graft and of these, five required repeat grafting.Conclusions: Corneal decompensation in eyes with uveitis is a rare but significant complication. Direct endothelial inflammation may alone cause decompensation, but in most eyes with uveitis, prior raised intraocular pressure or intraocular surgery are required to precipitate the cornea into decompensation. Outcomes of corneal transplantation in this group may be disappointing.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Treatment Outcome; Incidence; Adolescent; Child; Child, Preschool; Prevalence; uveitis; Visual Acuity/physiology; Cornea; corneal decompensation; Corneal Edema/*epidemiology/etiology/surgery; corneal graft; corneal oedema; corneal transplant; Corneal Transplantation; endothelium; Intraocular Pressure; Uveitis/*complications

Dexamethasone for ocular inflammation. - Saraiya, Nehali V.; Goldstein, Debra A. (Expert opinion on pharmacotherapy, 2011)
INTRODUCTION: Corticosteroids, administered systemically and periocularly, have long been used to treat intermediate and posterior segment noninfectious uveitis. In addition to systemic immunosuppressive medications, these therapies are used to reduce inflammation, prevent structural complications and prevent long-term visual loss in patients with uveitis. While systemic immunosuppressive therapies carry their own set of side effects, treatment with local steroids is associated with the risk of development of cataract and glaucoma. AREAS COVERED: Intravitreal delivery of fluocinolone acetonide via a sustained-release implant (Retisert) was approved by the FDA in 2005 for the treatment of noninfectious intermediate and posterior uveitis. Recently, the FDA also approved the biodegradable dexamethasone implant (Ozurdex) for the treatment of noninfectious uveitis involving the posterior segment. EXPERT OPINION: The single injection, 26-week data indicate that the implant is well tolerated and produces meaningful improvements in intraocular inflammation and visual acuity that persist through 6 months. The available 6-month data also indicate that this implant confers much less of a risk of ocular hypertension than other forms of intraocular steroid therapy. However, future longer-term trials are needed to evaluate the efficacy and safety data in patients who receive multiple injections. The newly approved dexamethasone implant, Ozurdex, is a useful addition to our local armamentarium in the treatment of noninfectious intermediate and posterior uveitis given its efficacy, safety, and ease of use in the outpatient setting.
Keywords: Humans; Injections; Visual Acuity; Drug Implants; Uveitis/*drug therapy; Adrenal Cortex Hormones/*administration & dosage/adverse effects/*therapeutic use; Anti-Inflammatory Agents/administration & dosage/adverse effects/*therapeutic use; Cataract/chemically induced; Dexamethasone/administration & dosage/adverse effects/*therapeutic use; Drug Delivery Systems; Inflammation/*drug therapy; Vision, Ocular; Vitreous Body

UVEITIS TREATED WITH DEXAMETHASONE IMPLANT. - Mathis, Thibaud; Cerquaglia, Alessio; Weber, Michel; Guillarme-Sallit, Rébecca; Malclès, Ariane; Voirin, Nicolas; Servant, Marion; Sudhalkar, Aditya; Bilgic, Alper; Denis, Philippe; Sève, Pascal; Bodaghi, Bahram; et al. (Retina (Philadelphia, Pa.), 2021)
PURPOSE: To evaluate the real-life efficacy and safety of the intravitreal dexamethasone implant in uveitis. METHODS: This retrospective observational multicentric study included 152 eyes treated exclusively by 358 dexamethasone implant injections. The main outcome measures included change in the best-corrected visual acuity, central macular thickness, and vitreous haze score. RESULTS: Patients were treated with dexamethasone implant for macular edema (51.3%), vitritis with macular edema (40.1%), vitritis (5.3%), and other causes (3.3%). The mean duration of follow-up was 19.0 months. The mean gain in best-corrected visual acuity during follow-up was +12.1 letters. An improvement in best-corrected visual acuity ≥5, 10, and 15 letters was found in 64.5, 50.7, and 35.5% of cases, respectively. 59.7% of eyes with macular edema at baseline were found to be anatomical responders. Vitritis resolution (vitreous haze = 0+) was obtained in 81.4% of cases. Ocular hypertension (intraocular pressure ≥25 mmHg and/or gain ≥10 mmHg from baseline) occurred in 28.3% of patients. No filtering surgery/laser therapy was required. A total of 40.2% of phakic subjects underwent cataract surgery on average 11.2 months after the first injection. CONCLUSION: This study confirms the efficacy and safety of the dexamethasone implant in noninfectious uveitis. Cataract and ocular hypertension were not uncommon but easily manageable.
Keywords: Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Glucocorticoids/administration & dosage; *Visual Acuity; Intravitreal Injections; Dexamethasone/*administration & dosage; Vitreous Body; *Drug Implants; Macula Lutea/*diagnostic imaging; Uveitis/diagnosis/*drug therapy

[Macular Edema in Uveitis - Steroids or VEGF Inhibitors?]. - Heinz, Carsten; Heiligenhaus, Arnd (Klinische Monatsblatter fur Augenheilkunde, 2018)
Macular edema in uveitis patients is certainly the most frequent complication leading to a permanent and irreversible reduction in vision during the course of the disease. Thanks to optical coherence tomography (OCT) technology and fluorescein angiography (FAG), significantly more macular edemas are detected. Macular edema can be found in various uveitis varieties and can show different clinical patterns. All macular edema should be treated. Macular edema with active inflammation usually reacts very well to general uveitis treatment. In the case of eyes without visible inflammation, however, the response to such therapy is usually less effective. According to the latest treatment recommendations, dexamethasone implants should be used as the first intravitreal therapy. Vascular endothelial growth factor inhibitors (VEGF inhibitors) are second-line treatment regimens. The choice of therapy is, therefore, primarily based on the degree of inflammation and the individual complications, such as glaucoma, lens situation or previous increase in IOP after steroid administration. These individual complications may allow using VEGF inhibitors as first line treatment. An improvement in the macular edema can be achieved with both groups of active substances.
Keywords: Humans; Fluorescein Angiography; Tomography, Optical Coherence; Visual Acuity; Intravitreal Injections; *Macular Edema/drug therapy; *Uveitis/drug therapy; *Vascular Endothelial Growth Factor A/antagonists & inhibitors; Angiogenesis Inhibitors; Steroids/*therapeutic use

Intraocular pressure changes following topical ocular hypotensive medications washout. - Ho, Henrietta; Daas, Arij; Ho, Jason; Alaghband, Pouya; Galvis, Elizabeth Angela; de Antonio Ramirez, Alba; Grassi, Piergiacomo; Lim, Rongxuan; Lim, Kin Sheng (The British journal of ophthalmology, 2021)
BACKGROUND: To review the changes in intraocular pressure (IOP) following topical hypotensive medications washout in patients with primary open angle glaucoma (POAG), ocular hypertension (OHT) and uveitic glaucoma (UG)/OHT. METHODS: The study included 120 patients with POAG, OHT and UG recruited from prospective clinical trials between February 2013 and July 2017. We excluded 20 eyes with IOP of ≤21 mm Hg, 11 eyes with previous incisional surgery and 17 eyes with incomplete data. UG eyes with active inflammation and on steroid treatment were excluded. Participants underwent a 1-month washout period from topical ocular hypotensive medications before IOP phasing. Comparisons were made between pre/post-washout IOP, and highest-recorded (peak) and post-washout IOP. RESULTS: A total of 110 eyes with POAG, 33 eyes with OHT and 43 eyes with UG were included for analysis. The mean pre-washout IOP was 18.1±3.3 mm Hg in POAG, 18.8±3.3 mm Hg in OHT and 17.9±8.8 mm Hg in UG; the mean post-washout IOP was 26.6±4.8 mm Hg, 26.4±3.9 mm Hg, 23.1±10.1 mm Hg in POAG, OHT and UG, respectively. The mean increase in IOP after washout was significantly lower in UG compared with POAG and OHT eyes (p=0.01). The percentage of eyes with post-washout IOP <22 mm Hg was 12.7% in POAG, 6.1% in OHT and 51.2% in UG. CONCLUSION: Active inflammation and steroid treatment contributes to elevated IOP in uveitis. Therefore, IOP may revert to normal once inflammation subsides. We recommend ocular hypotensive treatment washout to be considered in UG eyes that have IOP under control in the absence of recurrence of uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Prospective Studies; Treatment Outcome; Visual Field Tests; Ophthalmic Solutions; Visual Acuity/physiology; Administration, Ophthalmic; Intraocular Pressure/*physiology; Tonometry, Ocular; *IOP phasing; *prospective clinical trials; *uveitic glaucoma; Antihypertensive Agents/*therapeutic use; Glaucoma, Open-Angle/*drug therapy/physiopathology; Ocular Hypertension/drug therapy/physiopathology; Uveitis/drug therapy/physiopathology; Visual Fields/physiology; Withholding Treatment

Keratoplasty Outcomes in Patients With Uveitis. - Hennein, Lauren; Lambert, Nathan G.; Chamberlain, Winston; Hirabayashi, Kristin; Rose-Nussbaumer, Jennifer; Schallhorn, Julie M. (Cornea, 2021)
PURPOSE: To examine the corneal transplant failure rates and associations with uveitic eye disease. METHODS: The retrospective chart review identified 70 eyes from 42 patients with uveitis that underwent 40 primary transplants and 30 repeat transplants at 2 major academic centers over a 9-year period. The graft failure rate was calculated. Variables hypothesized to be associated with graft failure were analyzed as covariates using a Cox proportional hazards analysis clustered by the patients to determine their association with failure rates. RESULTS: Of the 70 grafts, the mean duration of follow-up for patients was 40.6 months (range 4-90 months) and the median survival time was 24.1 months (interquartile range of 9-290 months). Twenty-two patients (52%) had graft failure. There was a higher rate of graft failure in patients with infectious uveitis as compared to those with noninfectious uveitis (hazard ratio 2.46, P = 0.031). Patients with successful grafts had their inflammation controlled for a longer period of time before transplantation as compared to those with failed grafts (38.6 vs. 13.6 months, P = 0.004). Worse preoperative visual acuities were significantly associated with graft failure (P < 0.001). CONCLUSIONS: There is limited knowledge of corneal transplant outcomes in uveitic patients in the current literature. In our study, over half of the grafts failed. Infectious uveitis (especially viral) was a strong predictor of graft failure. A shorter period of inflammation control before transplantation, previously failed grafts, and worse preoperative visual acuity were also associated with graft failure.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Proportional Hazards Models; Uveitis/*complications/diagnosis; Corneal Diseases/*surgery; Descemet Stripping Endothelial Keratoplasty/*statistics & numerical data; Graft Rejection/*epidemiology; Graft Survival/*physiology; Keratoplasty, Penetrating/*statistics & numerical data

Interferon Alpha-2a for the Treatment of Post-Infectious Uveitis Secondary to Presumed Intraocular Tuberculosis. - Invernizzi, Alessandro; Iannaccone, Franca; Marchi, Sylvia; Mastrofilippo, Valentina; Coassin, Marco; Fontana, Luigi; Salvarani, Carlo; McCluskey, Peter; Cimino, Luca (Ocular immunology and inflammation, 2019)
Purpose: To assess the efficacy and tolerability of interferon (IFN) alpha-2a in post-infectious uveitis secondary to presumed intraocular tuberculosis (IOTB). Methods: Patients with chronic uveitis secondary to presumed IOTB who, after completing an antitubercular treatment, showed poor response to treatments or recurred after tapering oral corticosteroids to ≤7.5 mg/day were enrolled. All patients were treated with IFN alpha-2a subcutaneous injections. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and inflammatory signs were compared between baseline and follow-up visits up to six months. Results: Twelve eyes (six patients) were enrolled. Mean BCVA improved from 0.64 ± 0.55 logMAR at baseline to 0.32 ± 0.31 logMAR at 6 months (p = 0.03). Mean CRT decreased from 372 ± 132.2 μm to 274.66 ± 34.9 μm at six months (p = 0.01). Inflammatory signs (vitritis, vasculitis) also decreased overtime. No major complications or tuberculosis reactivations were recorded. Conclusions: IFN alpha-2a was efficacious and safe in treating chronic post-infectious uveitis secondary to presumed IOTB.
Keywords: Female; Humans; Male; Middle Aged; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Dose-Response Relationship, Drug; Chronic Disease; Fluorescein Angiography; Tomography, Optical Coherence; uveitis; *Visual Acuity; Fundus Oculi; Injections, Subcutaneous; interferon; Uveitis/diagnosis/*drug therapy/etiology; Eye Infections, Bacterial/*complications/diagnosis; Infectious; Interferon alpha-2/*administration & dosage; Retina/pathology; therapy; tuberculosis; Tuberculosis, Ocular/*complications/diagnosis

High-dose intravenous methylprednisolone in juvenile non-infectious uveitis: A retrospective analysis. - Schnabel, Anja; Unger, Elisabeth; Brück, Normi; Berner, Reinhard; Range, Ursula; Holl-Wieden, Annette; Morbach, Henner; Leszczynska, Anna; Bau, Viktoria; Hedrich, Christian M. (Clinical immunology (Orlando, Fla.), 2020)
Non-infectious uveitis is associated with visual impairment and blindness. Non-biologic treatment for non-infectious uveitis is not based on strong evidence. A retrospective chart review was conducted to investigate treatment response to high-dose intravenous methylprednisolone (IVMP) in children with non-infectious uveitis. Fifty-six patients (93 eyes affected) were included. In 29% uveitis was associated with juvenile idiopathic arthritis. Uveitis predominately affected the anterior segment, was bilateral and recurrent. Complications were common and included visual loss, synechiae, cataract and/or retinal lesions. Patients received up to 5 IVMP at monthly intervals. Visual acuity improved at 3 and 6 months. Anterior chamber cells, synechiae, keratic precipitates, papillary and/or macular edema improved at 3 months. Children treated with ≥3 IVMP (vs 1 IVMP) experienced trends towards fewer relapses, fewer cataracts and less frequently required treatment with biologic agents. High-dose IVMP induce rapid improvement in children with non-infectious uveitis. Prospective randomized trials are required to confirm results.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Adolescent; Anti-Inflammatory Agents/*therapeutic use; Child; Child, Preschool; *Uveitis; Uveitis/*drug therapy; *Childhood; *Corticosteroid; *Juvenile; *Methylprednisolone; *Ocular inflammation; *Treatment; Administration, Intravenous; Adrenal Cortex Hormones/*therapeutic use; Arthritis, Juvenile/drug therapy; Methylprednisolone/*therapeutic use

Ocular side effects of novel anti-cancer biological therapies. - Vishnevskia-Dai, Vicktoria; Rozner, Lihi; Berger, Raanan; Jaron, Ziv; Elyashiv, Sivan; Markel, Gal; Zloto, Ofira (Scientific reports, 2021)
To examine the ocular side effects of selected biological anti-cancer therapies and the ocular and systemic prognosis of patients receiving them. We retrospectively reviewed all medical records of patients who received biological anti-cancer treatment from 1/2012 to 12/2017 and who were treated at our ocular oncology service. The following data was retrieved: primary malignancy, metastasis, type of biological therapy, ocular side effects, ophthalmic treatment, non-ocular side effects, and ocular and systemic disease prognoses. Twenty-two patients received biological therapies and reported ocular side effects. Eighteen patients (81.8%) had bilateral ocular side effects, including uveitis (40.9%), dry eye (22.7%), and central serous retinopathy (22.7%). One patient (4.5%) had central retinal artery occlusion (CRAO), and one patient (4.5%) had branch retinal vein occlusion (BRVO). At the end of follow-up, 6 patients (27.27%) had resolution of the ocular disease, 13 patients (59.09%) had stable ocular disease, and 3 patients (13.64%) had progression of the ocular disease. Visual acuity improved significantly at the end of follow-up compared to initial values. Eighteen patients (81.8%) were alive at study closure. Biological therapies can cause a wide range of ocular side effects ranging from dry eye symptoms to severe pathologies that may cause ocular morbidity and vision loss, such as uveitis, CRAO and BRVO. All patients receiving biological treatments should be screened by ophthalmologists before treatment, re-screened every 4-6 months during treatment, and again at the end of treatment. Patients on biological treatment who have ocular complaints should be urgently referred to ocular consultation for early identification and early intervention.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Aged, 80 and over; Retrospective Studies; Neoplasm Staging; Antineoplastic Agents/*adverse effects/therapeutic use; Biological Therapy/*adverse effects/methods; Neoplasm Metastasis; Neoplasms/*drug therapy/pathology; Retinal Artery Occlusion/chemically induced/pathology; Retinal Vein Occlusion/chemically induced/pathology; Uveitis/chemically induced/pathology; Visual Acuity/drug effects

Effect of Antituberculous Therapy on Uveitis Associated With Latent Tuberculosis. - Tomkins-Netzer, Oren; Leong, Belinda C. S.; Zhang, Xiaozhe; Lightman, Sue; McCluskey, Peter J. (American journal of ophthalmology, 2018)
PURPOSE: To describe the clinical features of patients with uveitis associated with latent tuberculosis (TB) and examine the effect of anti-TB treatment (ATT) on uveitis outcome. DESIGN: Retrospective cohort study. METHODS: One hundred ninety-nine eyes of 129 patients diagnosed with uveitis associated with latent TB were evaluated for recurrence of disease following treatment. Eighty-nine of the patients (69%) received ATT and information was gathered retrospectively regarding clinical outcome, vision, and treatment. Outcome measures included best-corrected visual acuity (BCVA) and rate of disease recurrence. RESULTS: This study included 89 patients (69%) who received ATT and 40 patients who did not. The uveitis was treated with local and systemic anti-inflammatory and immunosuppressive therapy in all patients. The mean change in BCVA following treatment was 4.5 ± 1.4 letters over the follow-up period, with no difference between eyes of patients receiving ATT and those who did not. Sixty-eight eyes (34.9%) had a recurrence of uveitis (0.64 ± 0.08 recurrences per year), with eyes of patients receiving ATT less likely to develop a recurrence compared to those not receiving ATT (29.5% vs 48.2%, odds ratio 0.47, 95% confidence interval 0.29-0.77, P = .003). Eyes treated with ATT recurred at an estimated median of 120 months, compared with 51 months in eyes with no treatment (P = .005). CONCLUSIONS: Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Glucocorticoids/*therapeutic use; Recurrence; Child; Child, Preschool; Immunosuppressive Agents/*therapeutic use; Visual Acuity/physiology; Antitubercular Agents/*therapeutic use; Ethambutol/therapeutic use; Interferon-gamma Release Tests; Isoniazid/therapeutic use; Latent Tuberculosis/diagnosis/*drug therapy/microbiology; Pyrazinamide/therapeutic use; Rifampin/therapeutic use; Tuberculosis, Ocular/diagnosis/*drug therapy/microbiology; Uveitis/diagnosis/*drug therapy/microbiology

Risk of Noninfectious Uveitis with Female Hormonal Therapy in a Large Healthcare Claims Database. - Sobrin, Lucia; Yu, Yinxi; Susarla, Gayatri; Chan, Weilin; Xia, Tian; Kempen, John H.; Hubbard, Rebecca A.; VanderBeek, Brian L. (Ophthalmology, 2020)
PURPOSE: To determine if female hormonal therapy (FHT) increases the incidence of noninfectious uveitis. DESIGN: Retrospective cohort study. PARTICIPANTS: Women exposed to FHT and matched women unexposed to FHT enrolled in a national insurance plan. METHODS: Estimation of noninfectious uveitis incidence used multivariable Cox proportional hazards regression. To account for differences between the exposed and unexposed cohorts, a propensity score for being prescribed FHT was created using logistic regression, and inverse probability of treatment weighting was performed. MAIN OUTCOME MEASURES: Incidence of noninfectious uveitis. For the primary outcome, incident noninfectious uveitis was defined as a new diagnosis code for noninfectious uveitis followed by a second instance of a noninfectious uveitis code within 120 days. For the alternative outcome definition, a corticosteroid prescription or code for an ocular corticosteroid injection within 120 days of the uveitis diagnosis code was used instead of the second uveitis diagnosis code. RESULTS: There were 217 653 women exposed to FHT and 928 408 women not unexposed to FHT. For the primary outcome, the hazard ratio (HR) for incident noninfectious uveitis was not significantly different between the FHT and unexposed cohorts (HR, 0.99; 95% confidence interval [CI], 0.83-1.17; P = 0.87). With the alternative outcome definition, the FHT cohort was more likely to develop uveitis (HR, 1.21; 95% CI, 1.04-1.41; P = 0.01). When examined by anatomic subtype, for anterior uveitis there was a greater likelihood of incident uveitis in the exposed cohort (HR, 1.23; 95% CI, 1.05-1.45; P = 0.01) for the alternative outcome definition but not for the primary outcome. With age stratification, women exposed to FHT aged ≥45 years at the time of FHT prescription were more likely to develop uveitis (HR, 1.23; 95% CI, 1.03-1.47; P = 0.03) for the alternative outcome definition. A similar HR (1.22) was seen for women aged ≤44 years at the time of prescription, but this association did not meet statistical significance (P = 0.20). CONCLUSIONS: Exposure to FHT increases the rate of incident noninfectious uveitis when uveitis is defined on the basis of both diagnostic codes and documentation of corticosteroid treatment. However, the risk is modest and FHT is likely safe with regard to noninfectious uveitis risk in the majority of patients exposed to these drugs.
Keywords: Female; Humans; Middle Aged; Follow-Up Studies; Retrospective Studies; Risk Factors; Incidence; *Visual Acuity; Delivery of Health Care/*statistics & numerical data; Hormone Replacement Therapy/*adverse effects; Risk Assessment/*methods; United States/epidemiology; Uveitis/chemically induced/*epidemiology

Vogt-Koyanagi-Harada Disease Managed With Immunomodulatory Therapy Within 3 Months of Disease Onset. - Oo, Ei Ei Lin; Chee, Soon-Phaik; Wong, Kelvin Kin Yan; Htoon, Hla Myint (American journal of ophthalmology, 2020)
PURPOSE: To study the outcome of high-dose corticosteroids with early addition of immunomodulatory therapy (IMT) in patients with Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective, interventional case series. METHODS: Patients with VKH seen at Singapore National Eye Centre from 2008-2018 were studied. The standardized clinical protocol was intravenous methyl prednisolone followed by/or oral prednisolone 1 mg/kg daily with slow taper plus IMT within 3 months. We collected data on demographics, clinical features, and indocyanine green angiography (ICGA). Uveitis activity was assessed clinically and by ICGA. Results were compared when IMT was given before vs after 6 weeks (late IMT) and with historical data (IMT added when uveitis uncontrolled). RESULTS: Fifty-eight eyes of 29 patients were studied. Half of the patients were Chinese (15, 51.7%). The mean age ± standard deviation was 42.2 ± 13.3 years. Twenty-five patients required 1 IMT and 4 needed 2 drugs. Sunset glow fundus occurred in 34 of 58 eyes (58.6%). Uveitis resolved in 24 of 58 eyes (41.4%), became chronic in 30 (51.7%), and required chronic recurrent in 4 eyes (6.9%). Eyes with IMT initiated within 6 weeks had better visual outcome that was significant at 4 years (P = .036; Mann-Whitney U test) but had a similar occurrence of sunset glow fundus and uveitis. Compared with historical data, visual outcome was better and was significant at 3 years (P = .04; t test), and significantly fewer patients developed chronic recurrent disease (P < .001; χ(2) test). CONCLUSION: High-dose corticosteroids with IMT within 3 months resulted in improved visual outcomes and a reduced risk of developing chronic recurrent uveitis compared with IMT given as clinically indicated.
Keywords: Female; Humans; Male; Middle Aged; Adult; Follow-Up Studies; Retrospective Studies; Immunosuppressive Agents/*therapeutic use; *Visual Acuity; *Disease Management; Fundus Oculi; *Immunomodulation; Fluorescein Angiography/methods; Uveomeningoencephalitic Syndrome/diagnosis/*drug therapy

The Effectiveness of Pharmacological Agents for the Treatment of Uveitic Macular Edema (UMO): A Systematic Review. - Tallouzi, Mohammad O.; Moore, David J.; Barry, Robert J.; Calvert, Melanie; Mathers, Jonathan; Murray, Philip I.; Denniston, Alastair K. (Ocular immunology and inflammation, 2019)
Purpose: To conduct a systematic review of effectiveness of pharmacological therapies for treatment of Uveitic Macular Edema (UMO). Method/Design: Comparative studies of pharmacological therapies in patients with UMO were identified in Cochrane CENTRAL/MEDLINE/EMBASE/CINAHL/trials registers (February 2017). PROSPERO registration: CRD42015019170. Results: Thirty-one studies were included. Corticosteroids were the most frequently studied (n = 20). Corticosteroids (all forms) were consistently of greater/equal efficacy to active comparators; for anti-VEGF (n = 4) improvement, best-corrected visual acuity (BCVA) and central macular thickness (CMT) were mostly less than local corticosteroid injection; for interferon (n = 1) improvement BCVA and CMT were greater than the comparator of methotrexate; for topical indomethacin (n = 1) improvement, BCVA and CMT were greater than placebo. Non-steroidal anti-inflammatory drugs, carbonic anhydrase inhibitors, and vitamin E (n = 5) were not effective for these outcomes. Conclusion: The review highlights areas where the evidence base is still lacking, and appropriately focused trials are needed to inform best treatment to tackle this sight-threatening condition.
Keywords: Humans; Treatment Outcome; Glucocorticoids/*therapeutic use; treatment; uveitis; *Visual Acuity; meta-analysis; Anti-Inflammatory Agents, Non-Steroidal/*pharmacology; Macular edema; Macular Edema/*drug therapy/etiology; management; pharmacological agents; systematic review; Uveitis/*complications/drug therapy

Phacotrabeculectomy in Eyes With Uveitic Glaucoma: A Retrospective Case-Control Study. - Wadke, Vidya; Lingam, Vijaya; George, Ronnie; George, Amala E.; Ganesh, Sudha K.; Biswas, Jyotirmay; Balekudaru, Shantha (Journal of glaucoma, 2019)
PRECIS: Phacotrabeculectomy with adjunctive mitomycin C is a good option for the management of coexisting cataract and glaucoma. Strict preoperative control of inflammation and close follow-up are essential in the management of eyes with uveitic glaucoma (UG). PURPOSE: The purpose of this study was to compare the outcomes of phacotrabeculectomy with adjunctive antimetabolites in the management of patients with UG and patients with primary open-angle glaucoma (POAG). MATERIALS AND METHODS: A retrospective case-control study of 112 patients with UG and 120 patients with POAG who underwent phacotrabeculectomy with mitomycin C and had a follow-up of ≥12 months between January 2000 and June 2015 was performed. Patients who had undergone intraocular surgery or cyclodestructive procedures earlier were excluded. The primary outcome was intraocular pressure (IOP) control; secondary outcomes included visual acuity and complication rates. RESULTS: IOP control was similar at the final visit in the UG group (14.52±6.74 mm Hg) and the POAG group (14.39±4.18 mm Hg) (P=0.867). Kaplan-Meier survival analysis showed a cumulative probability of survival (IOP: 6 to 18 with or without medications) in 71% and 77% at the end of 5 years (P=0.094) in the UG and POAG groups, respectively. Visual outcomes were worse in the UG group (0.5±0.68 logMAR units), as compared with the POAG group (0.27±0.47 logMAR units) (P=0.002). Complications such as cystoid macular edema (P=0.025) and posterior capsular opacification (P=0.004) were more common in the UG group. Recurrence of inflammation occurred in 34 eyes (30.04%) in the UG group. CONCLUSION: Meticulous control of perioperative and postoperative inflammation could have contributed to the favorable long-term outcomes of phacotrabeculectomy in UG, as compared with POAG.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Case-Control Studies; Retrospective Studies; Treatment Outcome; Young Adult; Combined Modality Therapy; Visual Acuity; Intraocular Pressure; Glaucoma, Open-Angle/drug therapy/epidemiology/surgery; Glaucoma/complications/drug therapy/epidemiology/*surgery; Mitomycin/therapeutic use; Phacoemulsification/adverse effects/*methods; Postoperative Complications/epidemiology; Tonometry, Ocular/adverse effects; Trabeculectomy/adverse effects/*methods; Uveitis/complications/drug therapy/epidemiology/*surgery

Long-term outcomes of systemic corticosteroid-sparing immunomodulatory therapy for Birdshot Retinochoroidopathy. - You, Caiyun; Lasave, Andres F.; Kubaisi, Buraa; Syeda, Sarah; Ma, Lina; Wai, Kelvin Cheng Kah; Diaz, Mikhail Hernandez; Walsh, Marisa; Stephenson, Andrew; Montieth, Alyssa; Foster, C. Stephen (Ocular immunology and inflammation, 2020)
PURPOSE: To report the visual prognosis, electroretinography (ERG) and perimetry outcomes of systemic corticosteroid-sparing immunomodulatory treatment (IMT) for birdshot retinochoroidopathy (BSRC). METHODS: Retrospective non-comparative case series of 132 patients (264 eyes) with BSRC treated with IMT from Massachusetts Eye Research and Surgery Institution. RESULTS: The average follow-up time was 60.1 months. After one year on IMT, 39.4% showed no clinically active inflammation. After 5 years of IMT, 78.0% had no signs of clinical inflammation. No significant differences were observed on best-corrected visual acuity (BCVA), ERG parameters, and perimetry parameters between baseline and subsequent visits on IMT. CONCLUSION: Long-term systemic corticosteroid-sparing IMT was associated with a low rate of BSRC disease exacerbation. While differences were seen on testing parameters, they were not consistent trends and difference were attributed to variability of testing or fluctuation of inflammation that may be expected in the course of the disease.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Electroretinography; Fluorescein Angiography; Visual Field Tests; Glucocorticoids/therapeutic use; *Immunomodulation; Visual Acuity/physiology; immunomodulatory therapy; Visual Fields/physiology; Birdshot Chorioretinopathy/diagnosis/*drug therapy/physiopathology; Birdshot retinochoroidopathy; electroretinography; perimetry; remission; Slit Lamp Microscopy

Prognosis of Ocular Tuberculosis Following Long-Term Antitubercular Therapy. - Jiang, Tingting; Zhang, Xiaozhe; Zhou, Min; Jiang, Rui; Chang, Qing (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2021)
Purpose: This study presents clinical features and prognosis after long-term (12-18 months) antitubercular therapy (ATT) in patients with ocular tuberculosis (OTB) in East China, an endemic area of tuberculosis. Methods: This retrospective study reviewed data from OTB patients treated at the Eye and ENT Hospital of Fudan University from 2008 to 2018. All the patients completed a minimum follow-up of 6 months after the cessation of ATT. Results: Sixty-six patients with OTB were studied. The ocular manifestations included retinal vasculitis (51.6%), choroiditis (24.2%), panuveitis (23.2%), intermediate uveitis (7.4%), scleritis (5.3%), anterior uveitis (2.1%), and optic neuropathy (1%). Except for two patients (ATT for 6 months), all other patients (64/66, 96.97%) received ATT for at least 12 months (6 patients for 12 months, 30 patients for 15 months, and 28 patients for 18 months). Treatment in conjunction with oral corticosteroids was used in 48 patients (72.7%). The average initial best-corrected visual acuity (BCVA) was 0.8 ± 0.64 (LogMAR), which improved to 0.31 ± 0.35 (LogMAR) at the last follow-up (P < 0.05). The final BCVA was significantly associated with the initial BCVA and the duration of clinical symptoms. A complete remission of uveitis was achieved in 97% of the patients. Conclusions: This study observed a favorable prognosis with long-term ATT regimens. Patients with better baseline visual acuity and a shorter duration of clinical symptoms before diagnosis had a better prognosis.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Drug Therapy, Combination; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Administration, Oral; *anti-tuberculosis treatment; *choroiditis; *ocular tuberculosis; *retinal vasculitis; Adrenal Cortex Hormones/administration & dosage/*adverse effects/therapeutic use; Antitubercular Agents/*adverse effects/therapeutic use; China/epidemiology; Choroiditis/diagnosis/epidemiology/etiology; Optic Nerve Diseases/diagnosis/epidemiology/etiology; Panuveitis/diagnosis/epidemiology/etiology; Retinal Vasculitis/diagnosis/epidemiology/etiology; Scleritis/diagnosis/epidemiology/etiology; Tuberculosis, Ocular/complications/diagnosis/*drug therapy; Uveitis, Anterior/diagnosis/epidemiology/etiology; Uveitis, Intermediate/diagnosis/epidemiology/etiology; Visual Acuity/*drug effects

Dexamethasone Inserts in Noninfectious Uveitis: A Single-Center Experience. - Pohlmann, Dominika; Vom Brocke, Gerrit A.; Winterhalter, Sibylle; Steurer, Theresa; Thees, Sabrina; Pleyer, Uwe (Ophthalmology, 2018)
PURPOSE: To report the effectiveness of repeated intravitreal dexamethasone (DEX) inserts in noninfectious uveitis patients. DESIGN: Prospective, single-center, interventional clinical trial between February 2010 and March 2015. PARTICIPANTS: Patients with noninfectious uveitis with cystoid macular edema and/or vitreitis. METHODS: Patients were treated with a 700-μg intravitreal DEX insert (Ozurdex; Allergan, Inc., Irvine, CA). Follow-up visits were scheduled 1, 3, and 6 months after injection. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze (VH) score, intraocular pressure (IOP), and adverse events were recorded. MAIN OUTCOME MEASURES: Primary outcome was the reduction of CRT. Secondary outcome was the improvement in BCVA and reduction of VH. RESULTS: In total, 109 eyes of 76 patients received 298 DEX inserts. Fifty-two patients were women (68%). The mean age of all participants was 57 years (range, 24-88 years). More than 3 DEX inserts were injected into 44% of eyes. Mean number of injections were 1.54±0.5 (standard deviation [SD]), 1.98±0.84, and 2.46±1.1 over 12, 18, and 24 months, respectively. Central retinal thickness decreased significantly (P < 0.001) from 465 μm at baseline to 318, 342, and 388 μm after 1, 3, and 6 months, respectively. Similar trends were seen in eyes receiving a second, third, and fourth DEX insert. Patients with idiopathic uveitis and sarcoidosis benefited well from DEX inserts. The greatest overall benefit was achieved in patients with no systemic treatment and patients receiving antimetabolites and cyclosporin A. A significant VH score reduction was documented in 44% of eyes after 1 month. A gain of more than 3 lines in BCVA was recorded in 31% to 37%, 26% to 39%, and 8% to 32% of eyes after 1, 3, and 6 months, respectively. A transient rise in mean IOP after 1 month (P < 0.001) and after 3 months (P = 0.001) was seen. CONCLUSIONS: The repeated longer-term administration of DEX inserts in noninfectious uveitis patients, either alone or in combination with other therapies, led to improved CRT, BCVA, and VH. Underlying diseases and concomitant systemic therapy seem to have an impact on overall treatment benefit. Ocular complications were reversible and were managed by local treatment, with exception of cataract formation.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Prospective Studies; Young Adult; Uveitis/diagnosis/*drug therapy/physiopathology; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Intraocular Pressure/physiology; Dexamethasone/*administration & dosage/adverse effects; Eye Diseases/diagnosis/drug therapy/physiopathology; Glucocorticoids/*administration & dosage/adverse effects; Macular Edema/diagnosis/drug therapy/physiopathology; Vitreous Body/drug effects

Long-Term Intravitreal Dexamethasone Implant Outcomes in Uveitis. - Alba-Linero, Carmen; Sala-Puigdollers, Anna; Romero, Barbara; Llorenç, Victor; Adan, Alfredo; Zarranz-Ventura, Javier (Ocular immunology and inflammation, 2020)
Purpose: To describe the long-term clinical outcomes in a cohort of uveitic eyes treated with the intravitreal dexamethasone implant (Ozurdex; Allergan, Inc).Methods: Seventy-nine (63 patients) receiving 134 implant injections over 82 months were included. Indication, visual acuity (VA), intraocular pressure (IOP), vitreous haze score (VHS), central retinal thickness (CRT), time to reinjection, systemic treatments, and complications data were recorded.Results: The cumulative probability of VA improvement was 80% at 1 month and 90% at 12 months, and it was maintained until 60 months. Eyes with baseline vitritis (VHS >0.5; 68%) had a probability of VHS improvement of 33% at 1 month, 75% at 12 months, and 85% at 60 months. The probability of CRT improvement was 33% at 1 month, 75% at 12 months, and 85% at 60 months. The most frequent adverse event was moderate IOP elevation (≥25 mmHg) in 30.3%, no cases of retinal detachment or endophthalmitis were observed.Conclusions: The dexamethasone implant provides favorable VA, CRT, and VHS long-term outcomes in uveitis with a reduced rate of severe adverse events.
Keywords: Female; Humans; Male; Middle Aged; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Dose-Response Relationship, Drug; Glucocorticoids/administration & dosage; uveitis; Visual Acuity; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Uveitis/diagnosis/*drug therapy; Dexamethasone implant; intravitreal; long-term; outcome; Retina/*pathology; Tomography, Optical Coherence/*methods

Intravenous Ceftriaxone for Syphilitic Uveitis. - Agostini, Fernanda A.; Queiroz, Rafael P.; Azevedo, Danuza O. M.; Henriques, Juliana F.; Campos, Wesley R.; Vasconcelos-Santos, Daniel V. (Ocular immunology and inflammation, 2018)
PURPOSE: Report of clinical/multimodal imaging outcomes of patients with syphilitic uveitis alternatively treated with intravenous(IV) ceftriaxone, due to unavailability of penicillin G. METHODS: Chart review of all cases of syphilitic uveitis presenting to Hospital São Geraldo/HC-UFMG and treated with intravenous ceftriaxone, between January and August 2014. Clinical, serological and ophthalmological data were collected. RESULTS: Twelve consecutive patients with syphilitic uveitis receiving IV ceftriaxone were identified. All 24 eyes had active intraocular inflammation on clinical examination. All patients received IV ceftriaxone (2-4 g daily) for 14-21 days, supplemented with oral corticosteroid as needed in 9 patients (75%), after documented clinical response. Improvement in intraocular inflammation was seen in all 24 eyes, with median best-corrected visual acuity (BCVA) increasing from 20/50 to 20/20, after a mean follow-up of 5.3 months. CONCLUSION: IV ceftriaxone may be an effective alternative for treatment of syphilitic uveitis, in the setting of unavailability of penicillin G.
Keywords: Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Administration, Oral; Infusions, Intravenous; Anti-Bacterial Agents/*administration & dosage; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; uveitis; Visual Acuity/physiology; Ceftriaxone; Ceftriaxone/*administration & dosage; Chorioretinitis/diagnosis/*drug therapy/physiopathology; Complementary Therapies; Eye Infections, Bacterial/diagnosis/*drug therapy/physiopathology; multimodal imaging; Multimodal Imaging; neurosyphilis; syphilis; Syphilis Serodiagnosis; Syphilis/diagnosis/*drug therapy/physiopathology; Uveitis, Posterior/diagnosis/*drug therapy/physiopathology

Anti-IL6-Receptor Tocilizumab in Refractory and Noninfectious Uveitic Cystoid Macular Edema: Multicenter Study of 25 Patients. - Vegas-Revenga, Nuria; Calvo-Río, Vanesa; Mesquida, Marina; Adán, Alfredo; Hernández, María Victoria; Beltrán, Emma; Valls Pascual, Elia; Díaz-Valle, David; Díaz-Cordovés, Gisela; Hernandez-Garfella, Marisa; Martínez-Costa, Lucía; Calvo, Inmaculada; et al. (American journal of ophthalmology, 2019)
PURPOSE: Cystoid macular edema (CME) is a leading cause of blindness. This study assessed the efficacy and safety of tocilizumab (TCZ) in refractory CME. DESIGN: Retrospective case series. METHODS: Patients with CME secondary to noninfectious uveitis who had inadequate response to corticosteroids and at least 1 conventional immunosuppressive drug, and in most cases to other biological agents, were studied. CME was defined as central retinal thickness greater than 300 μm. The primary outcome measure was macular thickness. Intraocular inflammation, best-corrected visual acuity (BCVA), and corticosteroid-sparing effect were also analyzed. RESULTS: A total of 25 patients (mean ± standard deviation age 33.6 ± 18.9 years; 17 women) with CME were assessed. Underlying diseases associated with uveitis-related CME are juvenile idiopathic arthritis (n = 9), Behçet disease (n = 7), birdshot retinochoroidopathy (n = 4), idiopathic (n = 4), and sarcoidosis (n = 1). The ocular patterns were panuveitis (n = 9), anterior uveitis (n = 7), posterior uveitis (n = 5), and intermediate uveitis (n = 4). Most patients had CME in both eyes (n = 24). TCZ was used in monotherapy (n = 11) or combined with conventional immunosuppressive drugs. Regardless of the underlying disease, compared to baseline, a statistically significant improvement in macular thickness (415.7 ± 177.2 vs 259.1 ± 499.5 μm; P = .00009) and BCVA (0.39 ± 0.31 vs 0.54 ± 0.33; P = .0002) was obtained, allowing us to reduce the daily dose of prednisone (15.9 ± 13.6 mg/day vs 3.1 ± 2.3 mg/day; P = .002) after 12 months of therapy. Remission was achieved in 14 patients. Only minor side effects were observed after a mean follow-up of 12.7 ± 8.34 months. CONCLUSION: Macular thickness is reduced following administration of TCZ in refractory uveitis-related CME.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Infusions, Intravenous; Tomography, Optical Coherence; Immunosuppressive Agents/therapeutic use; Arthritis, Juvenile/complications; Visual Acuity/physiology; Antibodies, Monoclonal, Humanized/adverse effects/*therapeutic use; Chorioretinitis/complications; Macula Lutea/diagnostic imaging/pathology; Macular Edema/diagnostic imaging/*drug therapy/etiology; Receptors, Interleukin-6/*antagonists & inhibitors; Sarcoidosis/complications; Uveitis/complications/diagnostic imaging/*drug therapy

Management of cataract in the setting of uveitis: a review of the current literature. - Moshirfar, Majid; Somani, Anisha N.; Motlagh, Mahsaw N.; Ronquillo, Yasmyne C. (Current opinion in ophthalmology, 2020)
PURPOSE OF REVIEW: This review aims to cover the preoperative planning, intraoperative considerations, and postoperative management that aids in successful outcomes of patients with cataract and uveitis. Disease-specific management and pediatric management will also be addressed. RECENT FINDINGS: Dexamethasone implants appear to be a safe and effective addition to standard steroid treatment in decreasing the incidence of postoperative cystoid macular edema (CME). Intravitreal steroids and topical difluprednate have shown utility in CME treatment. SUMMARY: Cataract surgery in eyes with uveitis is generally safe and effective if inflammation is well controlled; however, complication rates are still higher than in eyes without uveitis. Future investigations should delineate outcomes for eyes with different etiologies of uveitis, and further research is needed to adequately control inflammation and avoid postoperative complications.
Keywords: Humans; Glucocorticoids/administration & dosage; Visual Acuity/physiology; Administration, Ophthalmic; Drug Implants; Intravitreal Injections; Uveitis/*complications/drug therapy; *Cataract Extraction; Cataract/*complications; Dexamethasone/administration & dosage; Fluprednisolone/administration & dosage/analogs & derivatives; Intraoperative Care; Macular Edema/prevention & control; Postoperative Care; Preoperative Care

Non-malignant uveitis masquerade syndromes. - Kubicka-Trzaska, Agnieszka; Romanowska-Dixon, Bozena (Klinika oczna, 2008)
The Uveitis Masquerade Syndromes (UMS) are a group of ocular diseases that mimic chronic intraocular inflammation. Many non-malignant conditions may result in an appearance mimicking an uveitis. The authors review most common non-malignant conditions which may be considered masquerades such as: retained intraocular foreign body, rhegmatogenous retinal detachment, myopic degeneration, pigment dispersion syndrome, ocular ischemic syndrome, infectious intraocular inflammation, retinitis pigmentosa, multiple sclerosis and drug and post-vaccination reactions.
Keywords: Humans; Visual Acuity; Vaccination/adverse effects; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Exfoliation Syndrome/diagnosis; Eye Diseases/*diagnosis; Eye Foreign Bodies/diagnosis; Inflammation/chemically induced/diagnosis; Multiple Sclerosis/diagnosis; Myopia, Degenerative/diagnosis; Pigment Epithelium of Eye/pathology; Retinal Detachment/diagnosis; Retinal Diseases/diagnosis; Retinitis Pigmentosa/diagnosis; Uveitis/*diagnosis

Association Between Visual Function Response and Reduction of Inflammation in Noninfectious Uveitis of the Posterior Segment. - Lescrauwaet, Benedicte; Miserocchi, Elisabetta; Thurau, Stephan; Bodaghi, Bahram; Duchateau, Luc; Verstraeten, Thomas; Srivastava, Sunil (Investigative ophthalmology & visual science, 2017)
PURPOSE: To examine the association between visual function response (VFR) and inflammation reduction in active noninfectious uveitis of the posterior segment (NIU-PS). METHODS: Phase 3 SAKURA Study 1 randomized 347 subjects in a double-masked fashion to receive injections of intravitreal sirolimus 44 μg (n = 117); 440 μg (n = 114); or 880 μg (n = 116) every other month. Vitreous haze (VH) response, a measure of inflammation reduction, was defined as a VH score of 0 or 0.5+ at month 5 based on the modified Standardized Uveitis Nomenclature Scale. Visual function was assessed with best-corrected visual acuity (BCVA) and the National Eye Institute (NEI) Visual Function Questionnaire-25 (VFQ-25). In this post-hoc analysis, principal component analysis was used to reduce the information in the multidimensional visual function outcome to a restricted number of independently relevant VFR measures. Minimal clinically important differences (MCID) for the VFQ-25-derived components were based on the standard error of measurements. Overall VFR was defined as either a BCVA improvement of ≥2 lines, or an improvement exceeding the MCID in the VFQ-25 based visual function measures. RESULTS: The VFQ-25 composite score (VFQCS) and mental health subscale score (VFQMHS) were retained as relevant VFRs, with MCIDs of 4.3 and 11.7 points, respectively. A vitreous haze response was significantly associated with each VFR measure: VFQCS (odds ratio [OR] = 2.23; P = 0.0004); VFQMHS (OR = 2.84; P < 0.0001); BCVA (OR = 2.60; P = 0.0009), and overall VFR (OR = 2.65; P < 0.0001). CONCLUSIONS: Inflammation reduction to a VH score of 0 or 0.5+ was significantly associated with improved visual function. Achieving a VH response of 0 or 0.5+ is a patient-relevant outcome.
Keywords: Double-Blind Method; Female; Humans; Male; Middle Aged; Surveys and Questionnaires; Intravitreal Injections; Visual Acuity/*physiology; Eye Infections/physiopathology; Immunosuppressive Agents/administration & dosage/*therapeutic use; Inflammation/*drug therapy/physiopathology; Patient Reported Outcome Measures; Sickness Impact Profile; Sirolimus/administration & dosage/*therapeutic use; Uveitis, Posterior/*drug therapy/physiopathology; Vitreous Body/pathology

Micropulse Trans-scleral Cyclophotocoagulation in Patients With Glaucoma: 1- and 2-Year Treatment Outcomes. - de Crom, Ronald M. P. C.; Slangen, Caroline G. M. M.; Kujovic-Aleksov, Stefani; Webers, Carroll A. B.; Berendschot, Tos T. J. M.; Beckers, Henny J. M. (Journal of glaucoma, 2020)
PRéCIS:: Micropulse trans-scleral cyclophotocoagulation (TSCPC) is an effective and safe IOP-lowering treatment for patients with primary or secondary glaucoma. PURPOSE: To investigate the 1-year and 2-year effect on intraocular pressure (IOP) and safety profile of micropulse TSCPC in patients with glaucoma. METHODS: Patients with glaucoma underwent a standardized micropulse TSCPC (MicroPulse P3 probe, Iridex cyclo G6 laser system, Mountain View, CA) at the University Eye Clinic Maastricht from November 2016 to May 2018. Patients with at least 12 months of follow-up were included. RESULTS: A total of 141 eyes of 136 patients were included. The mean age was 67.2±14.5 years, and 56.6% of patients were male individuals. The glaucoma subtypes treated were primary glaucoma (n=99) and secondary glaucoma (n=42). Prior glaucoma surgery was performed in 59 of 141 eyes (41.8%). The mean preoperative IOP was 23.5±9.4 mm Hg. The mean postoperative IOP dropped to 16.8±8.4, 17.0±7.8, and 16.8±9.2 mm Hg, after 12, 18, and 24 months, respectively. The mean number of IOP-lowering medications used preoperatively was 3.3±1.4. The mean number of medications used at 12, 18, and 24 months was respectively 2.6±1.5, 2.5±1.4, and 2.2±1.5. Postoperative complications included cystic macular edema (n=2), hypotony maculopathy (n=1), fibrinous/uveitic reaction (n=1), and rejection of corneal graft (n=1), all reversible after treatment. One patient developed persisting hypotony in the late postoperative period. CONCLUSIONS: Micropulse TSCPC is a safe and effective treatment for lowering both IOP and the number of IOP-lowering medications. Micropulse TSCPC can also be considered as a good alternative treatment option for patients after failed incisional glaucoma surgery or patients who are at high risk for incisional surgery.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Prospective Studies; Treatment Outcome; Adolescent; Visual Acuity/physiology; Intraocular Pressure/physiology; Tonometry, Ocular; Ciliary Body/*surgery; Glaucoma/physiopathology/*surgery; Laser Coagulation/*methods; Postoperative Period; Sclera/*surgery

Dexamethasone Intravitreal Implant Injection in Eyes with Comorbid Hypotony. - Kong, Xiangbin; Psaras, Catherine; Stewart, Jay M. (Ophthalmology. Retina, 2019)
PURPOSE: To evaluate outcomes in patients with hypotony treated with intravitreal dexamethasone implant (Ozurdex). DESIGN: Retrospective cohort study. PARTICIPANTS: Thirteen patients (15 eyes) that received a total of 99 dexamethasone implant injections on occasions at which the intraocular pressure was low, meeting the definition of statistical hypotony. METHODS: The medical records of 13 patients (15 consecutive eyes) receiving 1 or more intravitreal dexamethasone implants between December 2014 and April 2017 were reviewed retrospectively. Hypotony was defined as intraocular pressure less than 6.5 mmHg. The indications for intravitreal dexamethasone implant injection were intermediate or posterior uveitis (86.7%), diabetic macular edema (13.3%), and/or cystoid macular edema (6.7%). MAIN OUTCOME MEASURES: The primary outcome measures were safety outcomes and best visual acuity within 6 months of the final intravitreal dexamethasone implant injection in a hypotonous eye. RESULTS: In 15 eyes (13 patients), 99 injections were administered to eyes under circumstances of hypotony. Uveitic cystoid macular edema or diabetic macular edema was reduced after treatment in all cases. No complications were noted during the injection procedure. Three complications were noted in 2 patients after injection. Pseudophakodonesis and mild vitreous hemorrhage immediately after injection were noted in 1 patient, and a case of delayed-onset vitreous hemorrhage with pigment release was noted in another. All 3 complications resolved without intervention. The primary end point of this study-mean visual acuity-was stable over the follow-up period. In patients with hypotony whose intraocular pressure normalized during the follow-up period, this was attributable to management of glaucoma surgery-related complications rather than an effect of the intravitreal dexamethasone implant. CONCLUSIONS: Intravitreal dexamethasone implant injection is a reasonable treatment option for patients with comorbid hypotony in whom clinical findings warrant treatment with a sustained-delivery intravitreal steroid implant. Further studies, including imaging of zonules before and after intravitreal dexamethasone implant injection in a hypotonous eye, could help define risks to intraocular lens stability with this procedure.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Retrospective Studies; Comorbidity; Visual Acuity/physiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Intraocular Pressure/physiology; Diabetic Retinopathy/*drug therapy/physiopathology; Macular Edema/*drug therapy/physiopathology; Ocular Hypotension/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology

An Experience with Intravitreal Dexamethasone Implant for Uveitic Macular Oedema. - Kharel Sitaula, Ranju; Shrestha, Saurav Man (Journal of Nepal Health Research Council, 2021)
Intravitreal steroid implants are the latest trend for uveitis macular oedema treatment. Dexamethasone intravitreal implants are new in our contexts but we report 2 cases of uveitic cystoid macular oedema where this implant proved very useful in the treatment of recalcitrant macular oedema where other treatment modality fails. Two cases of non-infectious uveitis and intermediate uveitis with recalcitrant uveitic macular oedema underwent dexamethasone intravitreal implantation. Their central macular thickness and central macular volume reduced significantly with the implant. With the reduction in macular parameters, the best-corrected visual acuity also improved and visual rehabilitation was achieved. Thus, dexamethasone intravitreal implant helps in sustained drug delivery inside the vitreous leading to resolution of uveitic macular oedema in recalcitrant cases.  Keywords: Macular oedema; ozurdex; steroid; uveitis; vision.
Keywords: Humans; Retrospective Studies; Treatment Outcome; Glucocorticoids/therapeutic use; Visual Acuity; Intravitreal Injections; *Macular Edema/drug therapy; *Uveitis/drug therapy; Dexamethasone/therapeutic use; Drug Implants/therapeutic use; Nepal

Urgent Management of Secondary Glaucoma in Uveitis Using the Xen-45 Gel Stent. - Qureshi, Amreen; Jones, Nicholas P.; Au, Leon (Journal of glaucoma, 2019)
PRECIS: The Xen-45 implant is an effective and safe treatment option for patients with medically uncontrolled glaucoma in the setting of uveitis, including those where urgent surgical intervention is required. PURPOSE: The purpose of this study was to report the efficacy and safety of the Xen-45 gel stent in eyes with glaucoma secondary to uveitis. METHODS: Retrospective observational case series of 37 eyes, with medically uncontrolled glaucoma in uveitis using Xen-45 implantation. All patients had at least 12 months follow-up. Primary outcome measures included visual acuity, intraocular pressure (IOP), degree of inflammation and ocular hypotensive medications. In addition, the time taken from the decision to surgery was recorded. Data were collected preoperatively and 1 day, 1 week, 1, 3, 6, and 12 months postoperatively. Postoperative complications included hypotony and decompressive retinopathy. The requirement for further glaucoma surgery, including bleb needling, and failure were documented. RESULTS: The mean follow-up time was 16.7 months (range: 12 to 32 mo). Preoperatively all patients were on >3 ocular hypotensive medications and 75.7% were on oral acetazolamide. Systemic immunosuppression was used in 62.2% and all were on topical steroids. Mean preoperative IOP was 36.1 mm Hg (±SD 9.6) on an average 3.69 (±SD 0.47) drops. The median time from decision to operate to surgery was 5.5 days (range: 1 to 120 d). Mean postoperative IOP was 12.6 mm Hg (±SD 4.1) with an average 0.62 (±SD 1.1) drops at 1 year representing a 65% drop in IOP and 83% reduction in IOP-lowering medication. Bleb needling with 5-fluorouracil was performed on 5 eyes (13.5%). Symptomatic hypotony occurred in 7 eyes requiring further interventions. No decompressive retinopathy was found at last follow-up. Five eyes (13.5%) failed, needing drainage tube surgery or trabeculectomy. CONCLUSIONS: The Xen-45 implant is an effective treatment for hypertensive crises in glaucoma in uveitis, offering dramatic IOP lowering without significant uveitis flare-up. In this group of patients with uveitis, needling rates are lower than reported in primary open-angle glaucoma. However, complications including hypotony can still occur.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Antihypertensive Agents/therapeutic use; Visual Acuity/physiology; *Glaucoma Drainage Implants; Intraocular Pressure/physiology; Tonometry, Ocular; Uveitis/*complications; Visual Fields/physiology; Glaucoma, Open-Angle/etiology/physiopathology/*surgery; Gonioscopy; Trabeculectomy; Vision Disorders/physiopathology

Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy. - Cann, Megan; Ramanan, Athimalaipet V.; Crawford, Andrew; Dick, Andrew D.; Clarke, Sarah L. N.; Rashed, Fatima; Guly, Catherine M. (Pediatric rheumatology online journal, 2018)
BACKGROUND: There is a paucity of data on the ocular outcomes in paediatric non-infectious uveitis since the introduction of the biologic agents. The purpose of this study was to outline the clinical characteristics of children with non-infectious uveitis and determine the visual outcomes and ocular complication rates in the modern era. METHODS: Children with non-infectious uveitis from January 2011 to December 2015 were identified. Data was collected at baseline, 1, 3, 5, and 10 years post diagnosis. The incidence rates of visual impairment, structural ocular complications and surgical intervention were calculated. Using logistic regression the association between various baseline characteristics and later visual impairment was investigated. RESULTS: Of the 166 children, 60.2% (n = 100) had a systemic disease association. 72.9% (n = 121) children received methotrexate, 58 children progressed to a biologic. The incidence rates of visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60) were 0.05/Eye Year (EY) and 0.01/EY, respectively. Visual outcomes in the Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) and Idiopathic Uveitis cohorts were not statistically significant. Of the 293 affected eyes, posterior synechiae was the predominant complication on presentation, while cataract had the highest incidence rate (0.05/EY). On direct comparison, children with JIA-U were statistically significantly more likely to develop glaucoma while children with Idiopathic Uveitis were statistically significantly more likely to develop macular oedema. CONCLUSION: One third of children received a biological therapy, reflecting increasing utilisation and importance of biological agents in the management of inflammatory conditions. Rates of visual impairment and ocular complications are an improvement on previously published data.
Keywords: Female; Humans; Male; Prognosis; Follow-Up Studies; Retrospective Studies; Risk Factors; Incidence; Adolescent; Child; Child, Preschool; Uveitis; Biological Therapy/*methods; Biologics; Databases, Factual; Paediatrics; Uveitis/complications/*therapy; Vision Disorders/*epidemiology/etiology; Visual outcomes

Glaucoma Secondary to Uveitis in Children in a Tertiary Care Referral Center. - Gautam Seth, Natasha; Yangzes, Sonam; Thattaruthody, Faisal; Singh, Ramandeep; Bansal, Reema; Raj, Srishti; Kaushik, Sushmita; Gupta, Vishali; Pandav, Surinder Singh; Ram, Jagat; Gupta, Amod (Ocular immunology and inflammation, 2019)
Purpose: To study outcome of secondary glaucoma in pediatric uveitis patients. Methods: Retrospective analysis of records of uveitis patients ≤16 years. Results: Of 182 pediatric uveitis patients, secondary glaucoma was seen in 48 patients (75 eyes, 26.23%) with female preponderance (F:M-29:19) . JIA was the most common etiology (35.71%). BCVA of ≥20/40 was seen in 22 eyes at presentation and in 38 eyes at final follow up (p<0.001). Twenty eight children (66.67%) received systemic antiglaucoma therapy while 17 children (21 eyes) required surgery (60.71%). Logistic regression showed pseudophakia could predict the higher use of oral antiglaucoma medication (p=0.03) while anatomical site of involvement was predictive of higher chances of surgery (p=0.003). Overall success was seen in 82.10% and 71.64% using IOP limit of 21 and 18 mmHg respectively at mean follow-up of 3.9 years. Conclusion: Pediatric uveitic glaucoma though require multitude of therapies, can be managed effectively with appropriate therapy.
Keywords: Female; Humans; Male; Follow-Up Studies; Retrospective Studies; Incidence; Adolescent; India/epidemiology; Antihypertensive Agents/therapeutic use; Child; Child, Preschool; uveitis; *Visual Acuity; Intraocular Pressure/*physiology; Uveitis/*complications/diagnosis; *Referral and Consultation; *Tertiary Care Centers; Childhood uveitis; Filtering Surgery/methods; glaucoma; Glaucoma/epidemiology/*etiology/therapy; JIA; surgery

Changing biological disease modifying treatment for paediatric uveitis in the real world. - Oh, Lawrence J.; Nguyen, Chu L.; Phan, Kevin; Wong, Eugene; Zagora, Sophia; Singh-Grewal, Davinder; Chaitow, Jeffrey; Grigg, John R.; McCluskey, Peter (Clinical & experimental ophthalmology, 2019)
IMPORTANCE: Paediatric uveitis is a severe sight-threatening uveitis due to disease progression and treatment failure. Biological agents are a promising new treatment. This study provides real-world data on their use from Sydney, Australia. BACKGROUND: Traditionally corticosteroids and non-biological immunosuppressive agents were used to treat paediatric uveitis, often with poor outcomes. DESIGN: Retrospective, chart review over an 8-year period at a tertiary referral eye hospital. PARTICIPANTS: A total of 27 paediatric uveitis patients treated with biological agents. METHODS: Chart review of demographic data and treatment outcomes. MAIN OUTCOME MEASURES: Treatment efficacy (corticosteroid-sparing effect, topical steroid cessation/reduction, reduction in systemic-steroid sparing agents, change in intraocular inflammation, visual acuity and central macular thickness); treatment failure; and adverse events. Data were collected at biological initiation, 6 weeks, 6 months and 12 months. RESULTS: Biological therapy over 1 year was effective with prednisolone dose reduced to <5 mg/day in five of six patients (83%), number of systemic steroid-sparing agents was reduced to ≤1 in two of four patients (50%) and cessation of topical steroid achieved in 12/41 of eyes (29%). Improvement of anterior chamber cells by two grades occurred in 20/25 eyes (80%), improvement of logMAR to ≤0.3 occurred in 12/18 eyes (67%) and macular oedema decreased in 4/5 eyes (80%). Treatment failure occurred in six eyes (13.01%) and five patients (18.5%) developed an adverse reaction. CONCLUSIONS AND RELEVANCE: Biological therapy was effective in paediatric patients with uveitis. Intraocular inflammation improved with maintained visual acuity, systemic corticosteroid dose decreased and there was a low frequency of adverse events.
Keywords: Female; Humans; Male; Retrospective Studies; Treatment Outcome; Antirheumatic Agents/*therapeutic use; Drug Substitution; Child; Child, Preschool; Australia; Infliximab/therapeutic use; Prednisolone/*therapeutic use; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/physiology; *biological agent; *disease modifying anti-rheumatic drug; *juvenile idiopathic arthritis-associated uveitis; *paediatric uveitis; Adalimumab/therapeutic use; Interleukin 1 Receptor Antagonist Protein/therapeutic use; Uveitis/classification/*drug therapy/physiopathology

Efficacy and Safety of Intravitreal Sirolimus for Noninfectious Uveitis of the Posterior Segment: Results from the Sirolimus Study Assessing Double-Masked Uveitis Treatment (SAKURA) Program. - Merrill, Pauline T.; Clark, W. Lloyd; Banker, Alay S.; Fardeau, Christine; Franco, Pablo; LeHoang, Phuc; Ohno, Shigeaki; Rathinam, Sivakumar R.; Ali, Yusuf; Mudumba, Sri; Shams, Naveed; Nguyen, Quan Dong (Ophthalmology, 2020)
PURPOSE: To evaluate the efficacy and safety of intravitreal sirolimus in the management of noninfectious uveitis of the posterior segment (NIU-PS). DESIGN: Combined analysis of 2 phase 3, randomized, double-masked, multinational, 6-month studies. PARTICIPANTS: Adults with active NIU-PS (intermediate uveitis, posterior uveitis, or panuveitis; defined as vitreous haze [VH] ≥1.5+ on modified Standardization of Uveitis Nomenclature scale). METHODS: Patients were randomized 1:1:1 to receive intravitreal sirolimus 44 μg (n = 208), 440 μg (n = 208), or 880 μg (n = 177) on days 1, 60, and 120. Patients discontinued medications for NIU-PS except for systemic corticosteroids, which were tapered according to protocol. Enrollment in the 880-μg group was terminated after interim results found no significant difference in efficacy compared with the 440-μg dose. MAIN OUTCOME MEASURES: The primary efficacy end point was the percentage of patients with VH of 0 at month 5 in the study eye without the use of rescue therapy. Secondary efficacy end points included VH of 0 or 0.5+, corticosteroid-tapering success, and changes in best-corrected visual acuity (BCVA). Safety measures included ocular and nonocular adverse events. RESULTS: A total of 592 patients were randomized. Significantly higher proportions of patients treated with 440 μg compared with 44 μg intravitreal sirolimus achieved VH of 0 (21.2% vs. 13.5%; P = 0.038) and VH of 0 or 0.5+ (50.0% vs. 40.4%; P = 0.049) at month 5. Best-corrected visual acuity was stable (absolute change <5 ETDRS letters) or improved >5 letters in 80.1% and 80.2% of patients in the 440-μg and 44-μg groups, respectively. At month 5, corticosteroids were tapered successfully in 69.6% and 68.8% of patients in the 440-μg and 44-μg groups, and among these patients, VH of 0 or 0.5+ was achieved by 43.5% and 28.1% in the 440-μg and 44-μg groups. Both doses were generally well tolerated. Mean changes from baseline intraocular pressure (IOP) in the study eye at each analysis visit were minimal in all treatment groups. CONCLUSIONS: Intravitreal sirolimus 440 μg improved ocular inflammation, as measured by VH, compared with the 44-μg dose, with minimal impact on IOP, while preserving BCVA.
Keywords: Double-Blind Method; Female; Humans; Male; Aged; Follow-Up Studies; Dose-Response Relationship, Drug; Immunosuppressive Agents/administration & dosage; Uveitis, Posterior/diagnosis/*drug therapy; Tomography, Optical Coherence/methods; Intravitreal Injections; Intraocular Pressure/drug effects; Posterior Eye Segment/*diagnostic imaging; Sirolimus/*administration & dosage

The effectiveness of pharmacological agents for the treatment of uveitic macular oedema (UMO): a systematic review protocol. - Tallouzi, Mohammad O.; Moore, David J.; Calvert, Melanie; Murray, Philip I.; Bucknall, Nicholas; Denniston, Alastair K. (Systematic reviews, 2016)
BACKGROUND: Macular oedema (MO) describes the accumulation of fluid in the central part of the retina, known as the 'macula' which provides central vision. MO is the leading cause of sight loss in patients with intraocular inflammation (uveitis). There is a lack of consensus over the treatment of uveitic macular oedema (UMO). The proposed systematic review will evaluate the evidence on the effectiveness of pharmacological agents used to treat UMO. All systemic, local, or topical pharmacological agents will be included. METHOD/DESIGN: Standard systematic review methodology will be employed to identify, select and extract data from comparative studies (randomised/non-randomised trials and observational studies) of the pharmacological interventions in patients with UMO. Searches will be conducted through bibliographic databases (Cochrane Library, MEDLINE, EMBASE and CINAHL) and clinical trials registers. No restriction will be placed on either language or year of publication. Translation of non-English language articles will be undertaken to minimise selection bias. The primary outcome of interest will be best corrected visual acuity and secondary outcomes will be adverse events, health-related quality of life, assessment of UMO using central macular thickness (e.g. by optical coherence topography (OCT)), clinical and angiographic assessment of UMO, clinical estimation of vitreous haze. Risk of bias assessment appropriate to each study design will be undertaken. Data will be grouped by comparison, tabulated and narratively synthesised. Meta-analysis will be undertaken where clinical and methodological homogeneity exists. Subgroup and sensitivity analyses, also network analyses and intra/inter-pharmacological class analyses will be undertaken where deemed appropriate. DISCUSSION: A number of published studies have investigated the effectiveness of the pharmacological agents used to treat UMO. However, there is no recent systematic review that synthesises this evidence. This systematic review will analyse the effectiveness of systemic, local and topical therapies to treat UMO. The findings will provide important evidence to inform clinical and health policy decision-making for the treatment of UMO. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42015019170.
Keywords: Humans; Treatment Outcome; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Immunosuppressive Agents/*therapeutic use; Uveitis/complications/*drug therapy; Adrenal Cortex Hormones/*therapeutic use; Macular Edema/*drug therapy/etiology; Angiogenesis Inhibitors/*therapeutic use; Carbonic Anhydrase Inhibitors/*therapeutic use; Systematic Reviews as Topic

Ahmed glaucoma drainage implant surgery in the management of refractory uveitic glaucoma: Long-term follow up. - Valenzuela, F.; Oportus, M. J.; Pérez, C. I.; Mellado, F.; Cartes, C.; Villarroel, F.; López-Ponce, D.; López-Solís, R.; Traipe, L. (Archivos de la Sociedad Espanola de Oftalmologia, 2018)
OBJECTIVE: To examine the long-term efficacy, safety and complications of Ahmed glaucoma drainage implant surgery in patients with refractory uveitic glaucoma. METHODS: Retrospective review of consecutive cases of patients with refractory uveitic glaucoma who underwent Ahmed glaucoma drainage implant surgery between 2004-2014. Demographic characteristics of the study population, visual acuity, intraocular pressure (IOP), number of antiglaucoma medications and operative and postoperative complications were recorded. Complete success was defined as IOP≥5 and ≤18mmHg without any medication, as qualified success if IOP≤18mmHg with one or more medications. Patients with less than 12 months of follow-up were excluded. RESULTS: 21 patients (26 eyes) were included. The mean postoperative follow-up was 53.5±31 months. Eight eyes (30%) had at least one previously failed glaucoma surgery. IOP was reduced from a mean of 30.0mmHg to 14.0mmHg at the last follow-up visit (P<.001). The number of IOP-lowering medications was reduced from a median of 2.9 preoperatively to 1.1 at the last follow-up (P<.001). Overall, 7 eyes (27%) were classified as complete success, 13 eyes (50%) were considered as qualified success, and 6 eyes (23%) met the criteria for failure. The most common postoperative complication was hypertensive phase in 12 eyes (46%). Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 65% at 84 months. CONCLUSIONS: Ahmed glaucoma drainage implant surgery may be considered a long-term effective and safety surgical option for patients with refractory uveitic glaucoma.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Antihypertensive Agents/therapeutic use; Visual Acuity; Uveitis; Uveítis; Intraocular Pressure; Uveitis/*complications; Postoperative Complications/epidemiology; *Glaucoma Drainage Implants/adverse effects; Ahmed valve; Enfermedades de la úvea; Glaucoma; Glaucoma/etiology/*surgery; Intraocular pressure; Presión intraocular; Reoperation; Uveal diseases; Uveomeningoencephalitic Syndrome/complications; Válvula de Ahmed

Intravitreal dexamethasone implants for non-infectious uveitis. - McCartney, Matthew; McCluskey, Peter; Zagora, Sophia (Clinical & experimental ophthalmology, 2019)
IMPORTANCE: Inflammatory-mediated cystoid macular oedema (CMO) is the most common inflammatory-mediated threat to vision in non-infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained-release dexamethasone (DEX) implant devices provide localized therapy. BACKGROUND: The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort. DESIGN: A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital. PARTICIPANTS: Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies. METHODS: Cases from March 2012 and March 2018 were retrospectively selected with follow-up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow-up was 32 weeks. MAIN OUTCOME MEASURES: The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure and medication regimens. RESULTS: Ninety-five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P < .01). Sixty-one percent demonstrated improved BCVA at week 8 (P < .05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low. CONCLUSIONS AND RELEVANCE: In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; uveitis; *Visual Acuity; Macular Edema/diagnosis/*drug therapy/etiology; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; dexamethasone implant; intermediate uveitis; non-infectious uveitis; Ozurdex; Uveitis/complications/diagnosis/*drug therapy

Seven-Year Outcomes of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial and Follow-up Study Results. - Tomkins-Netzer, Oren; Lightman, Susan L.; Burke, Alyce E.; Sugar, Elizabeth A.; Lim, Lyndell L.; Jaffe, Glenn J.; Altaweel, Michael M.; Kempen, John H.; Holbrook, Janet T.; Jabs, Douglas A. (Ophthalmology, 2021)
PURPOSE: To evaluate the long-term outcomes of uveitic macular edema (ME). DESIGN: Longitudinal follow-up of a cohort of participants in a randomized clinical trial. PARTICIPANTS: A total of 248 eyes of 177 participants with uveitic ME enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. METHODS: OCT measurements, taken at baseline and annually, were graded by reading center graders masked to clinical data. Macular edema was defined as a center macular thickness (CMT) ≥240 μm on time-domain OCT or time-domain OCT equivalent. Resolution of ME was defined as normalization of macular thickness on OCT. Relapse of ME was defined as increase in macular thickness to ≥240 μm in an eye that previously had resolution. Visual acuity was measured at each visit with logarithmic visual acuity charts. MAIN OUTCOME MEASURES: Resolution and relapse of ME. Visual acuity. RESULTS: Among 227 eyes with ME followed ≥1 year, the cumulative percent of eyes with ME resolving at any point during 7 years was 94% (95% confidence interval [CI], 89-97). Epiretinal membranes on OCT were associated with a lower likelihood of ME resolution (hazard ratio [HR], 0.74; 95% CI, 0.55-1.01; P = 0.05). Among 177 eyes with resolved ME, the cumulative percent with relapse within 7 years was 43% (95% CI, 32-51). Eyes in which ME resolved gained a mean of 6.24 letters (95% CI, 4.40-8.09; P < 0.001) compared with eyes that remained free from ME during the 1-year follow-up intervals, whereas eyes in which ME did not resolve experienced no gain in vision (mean change -1.30 letters; 95% CI, -2.70 to 0.09; P = 0.065), and eyes that developed ME during the year (incident or relapsed) experienced a mean loss of -8.65 letters (95% CI, -11.5 to -5.84, P < 0.001). CONCLUSIONS: Given sufficient time and treatment, nearly all uveitic ME resolves, but episodes of relapse were common. Visual acuity results were better among eyes with resolved ME, suggesting that control of inflammation and resolution of ME might be visually relevant treatment targets.
Keywords: Female; Humans; Male; Middle Aged; Adult; Time Factors; Follow-Up Studies; Treatment Outcome; Administration, Oral; Tomography, Optical Coherence; Visual Acuity/physiology; Glucocorticoids/*administration & dosage; *Drug Implants; *macular edema; *uveitis; Epiretinal Membrane/physiopathology; Fluocinolone Acetonide/*administration & dosage; Macular Edema/diagnostic imaging/*drug therapy/physiopathology; Uveitis/diagnostic imaging/*drug therapy/physiopathology

Pediatric Uveitis in a Well-Defined Population: Improved Outcomes with Immunosuppressive Therapy. - Curragh, David S.; O'Neill, Marie; McAvoy, Clara E.; Rooney, Madeleine; McLoone, Eibhlin (Ocular immunology and inflammation, 2018)
PURPOSE: The aim of this study is to assess the incidence, etiology, visual outcomes, and complication rates of pediatric uveitis patients at a dedicated multidisciplinary uveitis clinic in Northern Ireland. METHODS: Data were collected from charts of all patients attending the clinic at the Belfast Health and Social Care Trust between 2011 and 2015. Demographics, disease characteristics, treatments, visual acuity, and complications were recorded. RESULTS: There were 94 patients with uveitis onset before the age of 16 years. Etiology was mixed with JIAU the leading cause accounting for 48% of patients. Thirty-seven percent of patients had known complications at presentation and 65% by final visit. Systemic treatments were used in 65% of cases. Ninety-two percent of eyes had a final visual acuity ≥ 6/12 at a mean follow-up of 5 years. CONCLUSIONS: The etiology of uveitis in this pediatric population is mixed. With close monitoring, most patients maintain good vision.
Keywords: Female; Humans; Male; Follow-Up Studies; Retrospective Studies; Risk Factors; Young Adult; Incidence; Adolescent; Infant, Newborn; Child; Child, Preschool; Infant; Immunosuppressive Agents/*therapeutic use; Inflammation; uveitis; *Visual Acuity; Immunosuppression Therapy/*methods; JIA; Northern Ireland; Northern Ireland/epidemiology; pediatric; Uveitis/*drug therapy/epidemiology