Phakic intraocular lens as a temporary barrier in aphakic Descemet's membrane endothelial keratoplasty. - Shweikh, Yusrah; Vasquez-Perez, Alfonso; Allan, Bruce D. (European journal of ophthalmology, 2019)
BACKGROUND: Descemet's membrane endothelial keratoplasty has a lower risk of endothelial rejection than Descemet's stripping automated endothelial keratoplasty. In aphakic eyes requiring endothelial transplantation, approaches aimed at reducing the risk of posterior graft dislocation in Descemet's stripping automated endothelial keratoplasty are not transferable to Descemet's membrane endothelial keratoplasty. TECHNIQUE: Here we describe the use of an implantable collamer lens placed over the iris to provide a temporary intraoperative platform, to facilitate graft unfolding and to avoid posterior graft dislocation in an aphakic, vitrectomised eye with a fixed, dilated pupil in a young patient with chronic uveitis and previous failed Descemet's stripping automated endothelial keratoplasty.
Keywords: Female; Humans; Young Adult; Chronic Disease; Visual Acuity; Vitrectomy; *Lens Implantation, Intraocular; *Phakic Intraocular Lenses; aphakia; Aphakia, Postcataract/*etiology; Descemet Stripping Endothelial Keratoplasty/*methods; Descemet’s membrane endothelial keratoplasty; Endothelial keratoplasty; phakic intraocular lens; Uveitis, Intermediate/complications

Quantitative analysis of vitreous inflammation using optical coherence tomography in patients receiving sub-Tenon's triamcinolone acetonide for uveitic cystoid macular oedema. - Sreekantam, Sreekanth; Macdonald, Trystan; Keane, Pearse A.; Sim, Dawn A.; Murray, Philip I.; Denniston, Alastair K. (The British journal of ophthalmology, 2017)
BACKGROUND/AIMS: To evaluate the vitreous signals obtained on spectral domain optical coherence tomography (SD-OCT) in patients with uveitic cystoid macular oedema (CMO) and compare these signals before and after sub-Tenon's triamcinolone acetonide injection. METHODS: Retrospective study with standardised longitudinal imaging preintervention and postintervention. The study cohort comprises 22 patients (22 eyes) with uveitic CMO receiving a sub-Tenon's triamcinolone acetonide (STTA) injection. Post hoc analysis of SD-OCT images using custom software provided an 'absolute' measurement of vitreous signal intensity, which was expressed as a ratio to the retinal pigment epithelium intensity ('VIT/RPE-relative intensity') in arbitrary units. MAIN OUTCOME MEASURE: Difference in VIT/RPE-relative intensity before and after treatment. RESULTS: Treatment with STTA resulted in a significant reduction in VIT/RPE-relative intensity, which was associated with both a reduction in central retinal thickness (CRT) and improvement in visual acuity. Mean (SD) VIT/RPE-relative intensity pretreatment was 0.139 (0.074) versus 0.053 (0.028) post-treatment (p=3×10(-5)). Mean (SD) CRT was 581 μm (119 μm) pretreatment versus 333 μm (95 μm) post-treatment (p=2×10(-8)); the mean reduction in CRT was 248 (95% CI 189 to 306). The correlation coefficient between VIT/RPE-relative intensity and CRT was 0.534 (p=0.011) and between VIT/RPE-relative intensity and visual acuity was 0.702 (p=0.0001). CONCLUSIONS: This study provides evidence that the OCT-derived VIT/RPE-relative intensity may be useful as a quantitative and objective marker of disease activity and treatment response in uveitis complicated by CMO. This first longitudinal study of this novel OCT parameter is an encouraging step in the development of sensitive objective OCT-based endpoints for trials of efficacy in uveitis.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Young Adult; Longitudinal Studies; Visual Acuity; Injections, Intraocular; Triamcinolone Acetonide/*administration & dosage; Tomography, Optical Coherence/*methods; Anti-Inflammatory Agents/*administration & dosage; *Inflammation; *Diagnostic tests/Investigation; *Imaging; *Macula; *Vitreous; Inflammation/diagnostic imaging/drug therapy; Macular Edema/diagnostic imaging/*drug therapy; Uveitis/diagnostic imaging/*drug therapy; Vitreous Body/*diagnostic imaging/pathology

Unilateral proliferative diabetic retinopathy and uveitis in the fellow eye: report of a case. - Scialdone, A.; Menchini, U.; Pietroni, C.; Brancato, R. (Annals of ophthalmology, 1991)
We report the case of a young man with a 20-year history of insulin-dependent diabetes mellitus, proliferative diabetic retinopathy OD, and uveitis OS. None of the common reported causes contributing to this difference between eyes was present. No features of diabetic retinopathy appeared OS after a follow-up of 36 months. This is the first case, to our knowledge, in which uveitis appeared to be associated with an asymmetric presentation in diabetes.
Keywords: Humans; Male; Adult; Recurrence; Fluorescein Angiography; Fundus Oculi; Visual Acuity; Intraocular Pressure; Uveitis, Posterior/*complications; Light Coagulation; Uveitis, Anterior/*complications; Diabetes Mellitus, Type 1/complications; Diabetic Retinopathy/*complications/surgery

Dexamethasone posterior-segment drug delivery system in the treatment of macular edema resulting from uveitis or Irvine-Gass syndrome. - Williams, George A.; Haller, Julia A.; Kuppermann, Baruch D.; Blumenkranz, Mark S.; Weinberg, David V.; Chou, Connie; Whitcup, Scott M. (American journal of ophthalmology, 2009)
PURPOSE: To evaluate the effects of a dexamethasone intravitreous drug delivery system (dexamethasone DDS) in patients with persistent macular edema (ME) resulting from uveitis or Irvine-Gass syndrome. DESIGN: Randomized, prospective, single-masked, controlled trial. METHODS: Three hundred and fifteen patients with persistent (>or= 90 days) ME were randomized in a multicenter study to surgical placement of 350 or 700 microg dexamethasone DDS or observation. This study evaluated the subset of patients with uveitis or Irvine-Gass syndrome (n = 41). The primary outcome measure was the proportion of patients achieving a 10-letter or more improvement in best-corrected visual acuity (BCVA) at day 90. Change in fluorescein angiographic leakage and safety also were evaluated. RESULTS: At day 90, a 10-letter or more BCVA improvement was seen in 41.7% (5/12) of patients in the 350-microg group, in 53.8% (7/13) of patients in the 700-microg group, and in 14.3% (2/14) of patients in the observation group (P = .029 vs the 700-microg group). Improvement in visual acuity persisted to day 180. A 15-letter or more improvement was achieved in 53.8% (7/13) of 700-microg patients vs 7.1% (1/14) of observed patients (P = .008). There were significantly greater reductions in fluorescein leakage in treated patients than in observed patients. Dexamethasone DDS was well tolerated. Throughout the study, an increase in intraocular pressure of 10 mm Hg or more was seen in 5 of 13 patients in the 700-microg group, in 1 of 12 patients in the 350-microg group, and in no patients in the observation group. There were no reports of endophthalmitis. CONCLUSIONS: In patients with persistent ME resulting from uveitis or Irvine-Gass syndrome, 700-microg dexamethasone DDS was well tolerated and produced statistically significant improvements in visual acuity and fluorescein leakage.
Keywords: Female; Humans; Male; Aged; Prospective Studies; Follow-Up Studies; Treatment Outcome; Single-Blind Method; Fluorescein Angiography; Cataract Extraction/*adverse effects; Visual Acuity/physiology; Uveitis/*complications; Vitreous Body; Dexamethasone/*administration & dosage/adverse effects; Glucocorticoids/*administration & dosage/adverse effects; Macular Edema/*drug therapy/etiology/physiopathology; *Drug Delivery Systems

TREATMENT OF REFRACTORY TUBERCULAR SERPIGINOUS-LIKE CHOROIDITIS WITH INTRAVITREAL METHOTREXATE. - Tsui, Edmund; Fern, Craig M.; Goldberg, Naomi R. (Retinal cases & brief reports, 2021)
PURPOSE: To describe a case of tubercular serpiginous-like choroiditis that progressed, despite antitubercular medication, corticosteroids, and immunomodulatory treatment, which ultimately quieted after two intravitreal methotrexate injections. METHODS: Case report. RESULTS: A 35-year-old woman reported a shadow in the left eye for 2 weeks. She presented with tubercular serpiginous-like choroiditis in the right eye 2 years prior. At that time, she was started on antituberculosis therapy but was noncompliant and lost to follow-up. On re-presentation, there was a new active left-eye serpiginous lesion, with repeat positive QuantiFERON gold testing. Four antituberculosis drugs were started, followed by corticosteroids and azathioprine, with continued progression despite aggressive treatment. She was finally given 2 intravitreal methotrexate injections (400 μg/0.1 cc) 1 month apart, with final arrest of lesion extension. The uveitis remained quiet for over 24 months, and the patient was able to discontinue all systemic therapy. CONCLUSION: Intravitreal methotrexate injections halted progression of treatment-refractory tubercular serpiginous-like choroiditis.
Keywords: Female; Humans; Adult; Drug Therapy, Combination; Methotrexate/*therapeutic use; Immunosuppressive Agents/*therapeutic use; Visual Acuity; Intravitreal Injections; Tuberculosis, Ocular/diagnosis/*drug therapy/microbiology; Antitubercular Agents/therapeutic use; Tuberculin Test; Choroiditis/diagnosis/*drug therapy/microbiology

Ocular toxicity by latex of Calotropis procera (Sodom apple). - Basak, Samar K.; Bhaumik, Arup; Mohanta, Ayan; Singhal, Prashant (Indian journal of ophthalmology, 2009)
We report the spectrum of ocular toxicity following accidental inoculation of latex of Calotropis procera (Sodom apple) in 29 eyes between January 2003 and December 2006. All patients presented with sudden painless dimness of vision with photophobia. Twenty-five (86%) patients had initial visual acuity of less than 20/60. All eyes had conjunctival congestion and mild to severe corneal edema with Descemet's folds. Three (10%) eyes had an epithelial defect, nine (31%) had iridocyclitis, and seven (24%) had associated secondary glaucoma. After treatment with topical corticosteroids, antiglaucoma agents, cycloplegics, hypertonic saline and tears supplements, 27 (93%) eyes recovered completely within 3-14 days. After three months, 17 (74%) out of 23 eyes showed a significant low endothelial cell count compared to the normal fellow eye ( P 0.001). The latex of Calotropis procera causes significant ocular morbidity which may be preventable by simple health education. The long-term effect on corneal endothelium has to be studied further.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Antihypertensive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity; Mydriatics/therapeutic use; Vision Disorders/chemically induced; Calotropis/*adverse effects; Conjunctival Diseases/*chemically induced/diagnosis/drug therapy; Corneal Edema/*chemically induced/diagnosis/drug therapy; Glaucoma/*chemically induced/diagnosis/drug therapy; Iridocyclitis/*chemically induced/diagnosis/drug therapy; Latex/*adverse effects; Photophobia/chemically induced

Intravitreal dexamethasone implant for cystoid macular edema and inflammation after scleral buckling. - Bonfiglio, Vincenza; Fallico, Matteo R.; Russo, Andrea; De Grande, Vittorio; Longo, Antonio; Uva, Maurizio G.; Reibaldi, Michele; Avitabile, Teresio (European journal of ophthalmology, 2015)
PURPOSE: Cystoid macular edema may occur following scleral buckling and therefore deteriorate the visual outcome. Inflammation may be the major causative factor in the development of postoperative cystoid macular edema. This case demonstrates the effectiveness of a dexamethasone implant as a treatment after the onset of choroidal inflammation and cystoid macular edema 6 months following scleral buckling and having visual acuity restored. METHODS: A 59-year-old phakic woman treated with scleral buckling for macula-off retinal detachment presented 2 months after surgery with cystoid macular edema with choroidal inflammation. Optical coherence tomography and fluorescein angiography were performed. From the time of the diagnosis, the patient's condition had been nonresponsive to medical therapy and only partially responsive to sub-Tenon triamcinolone acetonide. An intravitreal implant with a sustained release of 0.7 mg dexamethasone was implanted. RESULTS: Following an intravitreal injection with a dexamethasone implant, the macular edema subsided completely and optical coherence tomography showed decreased foveal thickness from 510 μm to 220 μm. Choroidal fluorescein leakage disappeared. Best-corrected visual acuity improved from 0.70 to 0.20 logMAR, a condition maintained throughout the 6 months of follow-up. CONCLUSIONS: Cystoid macular edema and choroidal inflammation are difficult to treat, but the improvement observed in this case of post scleral buckling macular edema and choroidal inflammation showed how a dexamethasone implant proved to be useful during the 6-month follow-up.
Keywords: Female; Humans; Middle Aged; Fluorescein Angiography; Tomography, Optical Coherence; Visual Acuity/physiology; Macular Edema/diagnosis/*drug therapy/etiology; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; *Drug Implants; *Postoperative Complications; Triamcinolone Acetonide/administration & dosage; *Scleral Buckling; Choroiditis/diagnosis/*drug therapy/etiology; Retinal Detachment/surgery

[Punctate inner choroidopathy]. - Hoerauf, H.; Laqua, H. (Klinische Monatsblatter fur Augenheilkunde, 1994)
BACKGROUND Punctate inner choroidopathy is a rare disease, which involves the outer retina and inner choroid. The ethiology is still unknown. PATIENT The case of a 23-year-old female patient, who noticed a central scotoma on the right eye, is presented. A mild decreased visual acuity of 0.7 was noted and on ophthalmoscopy multiple, yellowish dots on the level of RPE and choroid near the fovea were found. Angiography showed a hyperfluorescence of the dots in the early phase and marked leakage in the late phase. TREATMENT Under systemic treatment with corticosteroids the acuity and the fundus changes improved. Two weeks after corticosteroidtherapy was finished, a new onset with massive exsudation occurred accompanied by a sudden decrease in vision in her right eye to 0.1. On the last examination a parafoveal suretinal scar was discovered. CONCLUSION Punctate inner choroidopathy recurrences are common. However secondary neovascular membranes are described, in general the visual outcome is good.
Keywords: Female; Humans; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Recurrence; Fluorescein Angiography; Prednisolone/administration & dosage; Visual Acuity/drug effects; Chorioretinitis/*diagnosis/drug therapy; Choroid/drug effects/pathology; Pigment Epithelium of Eye/drug effects/pathology

Adalimumab therapy for refractory uveitis: a pilot study. - Diaz-Llopis, Manuel; García-Delpech, Salvador; Salom, David; Udaondo, Patricia; Hernández-Garfella, Marisa; Bosch-Morell, Francisco; Quijada, Arturo; Romero, Francisco J. (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2008)
PURPOSE: The aim of this study was to assess the efficacy and safety of adalimumab in treating refractory autoimmune uveitis. METHODS: This work was a prospective, noncomparative, nonrandomized, clinical trial. Nineteen (19) patients meeting eligibility criteria received a 40-mg subcutaneous (s.c.) injection of adalimumab every other week during 1 year. RESULTS: All patients underwent an outcome assessment at month 12. Visual acuity improved by -0.3 logMar in 12 (31%) eyes of 38, and worsened by +0.3 logMar in 1 (2.6%) eye. All patients had an active intraocular inflammation at baseline, and 12 patients (63%) achieved control of their inflammation with adalimumab at the end of follow-up. After optic coherence tomography, 33 eyes (86%) had cystoid macular edema (CME) at baseline, and at the end of follow-up there was a complete resolution of CME in 18 of these 33 eyes (54.54%). All patients were able to reduce at least 50% of the dose of the concomitant immunosuppressive drugs at the end of follow-up. Adalimumab was well tolerated in all patients, and only local minor side effects at the s.c. injection site were observed. Nevertheless, 8 patients (42.10%) had relapses during the follow-up period that were controlled with 1 periocular steroid injection. CONCLUSIONS: Adalimumab seems to be an effective, safe therapy for the management of refractory uveitis and may provide the possibility to reduce the concomitant immunosuppressive drugs in these patients. Further long-term studies are warranted to determine the safety and efficacy of adalimumab in treating intraocular inflammation.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Prospective Studies; Follow-Up Studies; Treatment Outcome; Vision Tests; Drug Resistance; Adalimumab; Tomography, Optical Coherence; Injections, Subcutaneous; Anti-Inflammatory Agents/administration & dosage/adverse effects/*therapeutic use; Visual Acuity/drug effects; Uveitis/*drug therapy/physiopathology; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal/administration & dosage/adverse effects/*therapeutic use; Autoimmune Diseases/drug therapy; Eye/pathology; Inflammation/pathology; Macular Edema/drug therapy/pathology

Short-term Intensive Immunosuppression: A Randomized, Three-arm Study of Intravenous Pulse Methylprednisolone and Cyclophosphamide in Macular Serpiginous Choroiditis. - Venkatesh, Pradeep; Tayade, Akshay; Gogia, Varun; Gupta, Shikha; Shah, Bhavin M.; Vohra, Rajpal (Ocular immunology and inflammation, 2018)
PURPOSE: To compare the efficacy of pulse cyclophosphamide with pulse dexamethasone in acute macular serpiginous choroiditis (SC). METHODS: A total of 30 patients with macular SC were prospectively randomized into three treatment groups: group D (pulse dexamethasone); group C (pulse cyclophosphamide); and combination (pulse group DCP) administered for 3 days. Macular SC was defined as any active lesion involving/threatening macula. RESULTS: A total of 30 patients were enrolled, with 10 patients in each group. Lesions completely healed at median duration of 2 weeks in each group, with significant improvement in visual acuity compared with pretreatment levels (p<0.05). Pulse cyclophosphamide was most effective in faster healing of lesions compared with other groups. There was no difference in gain in visual acuity between any of the groups (p = 0.32). CONCLUSIONS: Cyclophosphamide may be an effective treatment modality for acute macular SC, though it may not have a long-term effect on disease relapse.
Keywords: Female; Humans; Male; Adult; Drug Therapy, Combination; Prospective Studies; Treatment Outcome; Single-Blind Method; Injections, Intravenous; Visual Acuity/physiology; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage; Immunosuppressive Agents/*administration & dosage; immunosuppression; Pulse Therapy, Drug; Cyclophosphamide/*administration & dosage; Choroiditis/*drug therapy/physiopathology; *Immunosuppression Therapy; Cyclophosphamide; pulse dexamethasone; serpiginous choroiditis

Parry-Romberg syndrome associated with anterior uveitis and retinal vasculitis. - Yildirim, Ozlem; Dinç, Erdem; Oz, Ozay (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2010)
Keywords: Female; Humans; Adult; Glucocorticoids/administration & dosage; Visual Acuity; Administration, Topical; Uveitis, Anterior/*complications/diagnosis/drug therapy; Facial Hemiatrophy/*complications/diagnosis/drug therapy; Retinal Vasculitis/*complications/diagnosis/drug therapy

Iridocyclitis associated with juvenile rheumatoid arthritis. - Key, S. N. 3rd; Kimura, S. J. (American journal of ophthalmology, 1975)
In a study of 45 patients, those with monarticular and pauciarticular juvenile rheumatoid arthritis, and with antinuclear antibodies, were likely also to have chronic, persistent iridocyclitis. In cases where iridocyclitis was present, topical mydriatics were used to prevent formation of posterior synechiae. Topical corticosteroids were used but discontinued if the uveitis failed to respond. Despite the generally poor prognosis for the vision of these patients, surgery for complicated cataract was often successful.
Keywords: Female; Humans; Male; Prognosis; Adult; Adolescent; Anti-Inflammatory Agents/therapeutic use; Child; Child, Preschool; Visual Acuity; Administration, Topical; Arthritis, Juvenile/*complications/diagnosis/drug therapy; Glucocorticoids; Cataract Extraction; Uveitis, Anterior/*complications/diagnosis/drug therapy; Glaucoma/surgery

Penetrating keratoplasty for the exciting eye in sympathetic ophthalmia. - Ramamurthi, Saraswathi; Cornish, Kurt S.; Steeples, Laura; Ramaesh, Kanna (Cornea, 2008)
PURPOSE: We report a case of sympathetic ophthalmitis where we performed penetrating keratoplasty on the exciting eye many years after the initial injury. METHODS: Case report. RESULTS: After penetrating keratoplasty, the patient achieved vision of 3/60 from preoperative perception of light. CONCLUSIONS: Our experience shows that penetrating keratoplasty can restore useful vision in the previously injured exciting eye in sympathetic ophthalmitis. This case highlights a unique example where the inciting eye has ultimately become the eye with the better vision as the damage was limited.
Keywords: Humans; Male; Adult; Time Factors; Recovery of Function; Visual Acuity; Postoperative Period; Eye Injuries, Penetrating/complications; *Keratoplasty, Penetrating; Medical Records; Ophthalmia, Sympathetic/etiology/physiopathology/*surgery

Intravitreal Dexamethasone Implant (Ozurdex) to Control Recurrent Severe Idiopathic Uveitis Leads to Improvement in Steroid-Induced Diabetes Mellitus. - Khan, Ashraf A.; Kontos, Georgios; Paterson-Brown, Sheila P.; Dhillon, Baljean (Ocular immunology and inflammation, 2018)
Steroid-induced diabetes mellitus (SIDM) poses a unique challenge for the physician and ophthalmologist when faced with chronic recurrent uveitis controlled only with systemic steroids. We report a unique case where SIDM improved significantly following administration of intravitreal dexamethasone. A 53-year-old female had a history of recurrent idiopathic anterior uveitis that required oral steroids for control despite orbital floor steroids and systemic immunosuppression. After 9 years of oral steroid treatment she was diagnosed with SIDM necessitating insulin therapy. Following intravitreal dexamethasone implant, her oral steroid use was tapered with subsequent improvement in her diabetes and eventual cessation of insulin. In uveitis, steroid sparing immunosuppression may be used to minimize systemic steroid exposure. In this case, we demonstrated that an intravitreal dexamethasone implant achieved this goal. We recommend considering the use of such implants in patients with recurrent uveitis, particularly when there are significant steroid-induced side effects.
Keywords: Female; Humans; Middle Aged; Recurrence; Insulin; uveitis; Visual Acuity; Administration, Ophthalmic; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Glucocorticoids/*administration & dosage/adverse effects; intravitreal dexamethasone; Diabetes Mellitus/chemically induced/*physiopathology; ozurdex; steroid-induced diabetes; Uveitis, Anterior/diagnosis/*drug therapy

Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis. - Hwang, Yih-Shiou; Lin, Ken-Kuo; Lee, Jiahn-Shing; Chang, Shirley H. L.; Chen, Kuan-Jen; Lai, Chi-Chun; Huang, Jerry Chien-Chieh; Kuo, Ya-Hui; Hsiao, Ching-Hsi (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2010)
BACKGROUND: A pilot study was conducted to evaluate the therapeutic results of intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir for the treatment of cytomegalovirus (CMV) anterior uveitis in immunocompetent patients. METHODS: Six consecutive patients in whom active CMV anterior uveitis was detected by polymerase chain reaction assay of the aqueous humor were enrolled between January 2006 and December 2008. These patients received an intravitreal injection of ganciclovir (2 mg/0.05 ml) as a loading dose. Subsequent use of oral valganciclovir (900 mg twice a day) was determined according to the severity of the post-injection aqueous inflammation. Immune status and anterior chamber reaction of individual patients, visual acuity, intraocular pressure (IOP) at study entry, and follow-up intervals were examined. RESULTS: The mean patient-month follow-up period after intravitreal injection was 14.7 months (range, 12-22 months). Two patients received only the intravitreal ganciclovir injection once and four patients had received the following oral valganciclovir for average 2.3 months (range, 1-4 months). With this treatment strategy, the best-corrected visual acuity of the patients improved or stabilized; the IOP and the inflammation of anterior chamber of the patients were well controlled at all time points and there were no treatment-associated complications by the end of follow-up. CONCLUSIONS: In patients with CMV anterior uveitis, intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir can control the inflammation and IOP well.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Follow-Up Studies; Treatment Outcome; Administration, Oral; Antiviral Agents/*administration & dosage; Valganciclovir; Visual Acuity; Injections, Intraocular; Vitreous Body; Immunocompetence; Cytomegalovirus Infections/*drug therapy/immunology; Ganciclovir/*administration & dosage/*analogs & derivatives; Uveitis, Anterior/*drug therapy/immunology/*virology

[Abnormal evolution of serous choroiditis]. - François, P.; Hache, J. C.; Constantinides, G. (Bulletin des societes d'ophtalmologie de France, 1973)
Keywords: Humans; Male; Adult; Visual Acuity; Light Coagulation; Choroiditis/*complications; Retinal Detachment/*etiology

Intravitreal bevacizumab as first local treatment for uveitis-related choroidal neovascularization: long-term results. - Julián, Karina; Terrada, Céline; Fardeau, Christine; Cassoux, Nathalie; Français, Catherine; LeHoang, Phuc; Bodaghi, Bahram (Acta ophthalmologica, 2011)
PURPOSE: To report long-term results of intravitreal (IVT) bevacizumab as first local treatment for choroidal neovascularization (CNV) secondary to uveitis. METHODS: Files of patients receiving 1.25 mg/0.05 ml bevacizumab as primary local treatment for CNV were retrospectively reviewed. Main outcomes were change in best-corrected visual acuity (BCVA) and central foveolar thickness (CFT), treatment-related adverse events, and number and frequency of injections. RESULTS: Fifteen eyes from fifteen patients were included. Multifocal choroiditis and panuveitis were the diagnosis in seven, ampiginous choroiditis in two, and for six remaining, serpiginous choroiditis, sympathetic ophthalmia, Vogt-Koyanagi-Harada syndrome, punctuate inner choroidopathy, tuberculosis and idiopathic inflammation. In 13 eyes, neovascularization was subfoveal, and peripapillary in two. Intraocular inflammation was strictly controlled in all cases by the time of injections. BCVA improved from logMar 0.53 to logMar 0.29 in 12 eyes (80%), while CFT decreased from 239.06 to 195.2 μm in 13 (87%). Twelve eyes received more than one injection; mean number in this group was 4.25 (2-8), and frequency 1 every 12.97 weeks. There were no adverse events related to bevacizumab or the procedure. Median follow-up was 17.6 months (8-25). CONCLUSIONS: First-intention IVT bevacizumab for inflammatory CNV showed transient improvement in BCVA and CFT, in eyes under controlled inflammation. Reinjection was needed in most cases. Further work should conclude about safety related to repeated injections.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Tomography, Optical Coherence; Visual Acuity/physiology; Intravitreal Injections; Uveitis/complications/*drug therapy; Fovea Centralis/pathology; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Antibodies, Monoclonal, Humanized; Bevacizumab; Angiogenesis Inhibitors/*administration & dosage/adverse effects; Antibodies, Monoclonal/*administration & dosage/adverse effects; Choroidal Neovascularization/*drug therapy/etiology

[Recurrent uveitis with bilateral exudative retinal detachment. 10-year-old boy with bilaterally impaired vision and eye pain. Vogt-Koyanagi-Harada syndrome]. - Kohnen, E.-M.; Pansdorf, Y.; Zubcov, A. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2004)
Keywords: Humans; Male; Drug Therapy, Combination; Follow-Up Studies; Dose-Response Relationship, Drug; Recurrence; Child; Ultrasonography; Fluorescein Angiography; Visual Acuity/drug effects; Diagnosis, Differential; Pigment Epithelium of Eye/pathology; Prednisone/administration & dosage/adverse effects; Uveitis/diagnosis/drug therapy/*etiology; Glucocorticoids/administration & dosage/adverse effects; Retinal Detachment/diagnosis/drug therapy/*etiology; Uveomeningoencephalitic Syndrome/*diagnosis/drug therapy; Vision Disorders/diagnosis/drug therapy/*etiology; Azathioprine/administration & dosage/adverse effects; Hearing Loss, High-Frequency/diagnosis; Immunosuppressive Agents/administration & dosage/adverse effects

Surgery for hypotony in patients with juvenile idiopathic arthritis-associated uveitis. - Yu, Ellen N.; Paredes, Ian; Foster, C. Stephen (Ocular immunology and inflammation, 2007)
PURPOSE: To describe the clinical response to cyclitic membrane excision of eyes with juvenile idiopathic arthritis (JIA)-associated uveitis and hypotony. METHODS: The clinical records of patients with JIA-associated uveitis in a tertiary referral center were reviewed. Those patients with JIA-associated uveitis and hypotony who underwent cyclitic membrane excision were included in the study. Patients with hypotony secondary to active inflammation, retinal detachment, and surgical intervention (filtering, cyclo-destructive procedures, and glaucoma valve implantation) were excluded. RESULTS: Two pediatric and two adult patients (4 eyes) were identified. The range of pre-operative intraocular pressure (IOP) was 0-5 mmHg. The two adult patients were noted to have atrophic ciliary processes intra-operatively, while the two pediatric patients had normal ciliary processes. At six months follow-up, the adult patients had IOPs of 5 mmHg, while the two pediatric patients had IOPs of 16 mmHg. At last consultation (mean duration of follow-up: 3.6 years), IOP was normal in all eyes. None of the eyes had a decrease in vision. CONCLUSIONS: Release of traction on the ciliary body by inflammatory membranes may play a role in the management of hypotony in patients with JIA-associated uveitis. However, even though the IOP was successfully elevated, preventing phthisis, vision remained poor due to the long-standing complications secondary to chronic uveitis. This emphasizes the critical importance of early diagnosis and appropriate treatment of the inflammation before vision-robbing complications occur.
Keywords: Female; Humans; Adult; Drug Therapy, Combination; Time Factors; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Antirheumatic Agents/therapeutic use; Methotrexate/therapeutic use; Child; Child, Preschool; Cyclophosphamide/therapeutic use; Visual Acuity; Intraocular Pressure/*physiology; Uveitis/*complications/drug therapy; Arthritis, Juvenile/*complications/drug therapy; Immunologic Factors/therapeutic use; Vitrectomy/*methods; Ocular Hypotension/etiology/physiopathology/*surgery; Sclerostomy/*methods

[Systemic acyclovir therapy in recurrent keratouveitis caused by herpes simplex virus]. - Bialasiewicz, A. A.; Jahn, G. J. (Klinische Monatsblatter fur Augenheilkunde, 1984)
High-dosage Acyclovir therapy with intravenous applications of 3 X 15 mg/kg/day is discussed with reference to 2 patients with herpetic keratouveitis. The inflammations resolved after 7 days of treatment.
Keywords: Female; Humans; Adult; Recurrence; Uveitis/*drug therapy; Corneal Transplantation; Visual Acuity/drug effects; Acyclovir/administration & dosage/*therapeutic use; Corneal Ulcer/drug therapy; Infusions, Parenteral; Keratitis, Dendritic/*drug therapy; Postoperative Complications/drug therapy

Vogt-Koyanagi-Harada syndrome. - Hammer, H.; Janáky, M.; Süveges, I. (Acta ophthalmologica, 1993)
The case history is presented of a 40-year-old White women with the Vogt-Koyanagi-Harada syndrome, who was successfully treated with a combination of low-dose prednisolone and cyclosporine. A. Cellular and humoral hypersensitivity to uveal and retinal antigens were demonstrated in the patient.
Keywords: Female; Humans; Adult; Drug Therapy, Combination; Cyclosporine/*therapeutic use; Prednisolone/*therapeutic use; Visual Acuity; Uveomeningoencephalitic Syndrome/diagnosis/*drug therapy; Cataract Extraction

[Krypton and argon laser coagulation in chorioretinitis centralis serosa]. - Makabe, R. (Klinische Monatsblatter fur Augenheilkunde, 1987)
Central serous chorioretinopathy was treated by laser photocoagulation of the site of fluorescein dye leakage. In 22 cases, in most of which the leakage was located in the nasal macular area or close to the foveola, krypton red was used, and in 85 cases argon blue-green. There was a significantly greater improvement after treatment with the krypton laser, and healing also tended to be faster than with the argon laser.
Keywords: Female; Humans; Male; Adult; Fluorescein Angiography; Visual Acuity; Laser Therapy/*methods; Argon; Chorioretinitis/diagnosis/*surgery; Krypton

Case Report: Posterior Uveitis after Divalent Human Papillomavirus Vaccination in an Asian Female. - Ye, Hongfei; Feng, Huazhang; Zhao, Peiquan; Fei, Ping (Optometry and vision science : official publication of the American Academy of Optometry, 2020)
SIGNIFICANCE: Vaccine-associated uveitis has appeared in recent years because of various vaccines, whereas cases for human papillomavirus (HPV) vaccination were rarely reported. With more and more females becoming aware of its importance and choosing HPV vaccination, much more attention should be paid on the adverse effects of it. PURPOSE: The purpose of this study was to report a rare case of posterior uveitis after divalent HPV vaccination in an Asian female. CASE REPORT: A 29-year-old woman presented with acute vision loss accompanied by symptoms of headache, tinnitus, and myalgia after the third injection of HPV vaccination. The best-corrected visual acuity dropped to 20/500 for both eyes, and optical coherence tomography revealed bilateral multifocal submacular fluid. A short course of oral prednisone as well as Ozurdex intravitreal injection resulted in the reversal of all signs and symptoms. CONCLUSIONS: Although this case resembled Harada disease, we diagnosed it as vaccine-induced uveitis rather than coincidental autoimmune disease based on the rapid response to a short course of systemic corticosteroids. Because vaccine-induced uveitis is rare and difficult to distinguish from coincidental autoimmune disease, our case reminds eye care providers to be aware of the possible association between vaccination and a Harada-like reaction and to ask appropriately directed questions when obtaining history from young patients with uveitis. Based on this case, we also suggest Ozurdex intravitreal injection as a potential therapeutic choice, especially for patients with contraindication or personal concern to systemic corticosteroid.
Keywords: Female; Humans; Adult; Administration, Oral; Prednisone/administration & dosage; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; Injections, Intramuscular; Visual Acuity/physiology; Vaccination/*adverse effects; Drug Implants; Intravitreal Injections; China/epidemiology; Dexamethasone/administration & dosage; Asians/ethnology; Vision Disorders/diagnosis/drug therapy/*etiology; Uveitis, Posterior/diagnosis/drug therapy/*etiology; Papillomaviridae/*immunology; Papillomavirus Infections/*prevention & control; Papillomavirus Vaccines/*adverse effects

Keratoconus. - Werb, A. (The British journal of ophthalmology, 1972)
Keywords: Humans; Male; Adult; Visual Acuity; Corneal Transplantation; Uveitis/etiology; Postoperative Complications; Sclera; Glaucoma/etiology; Drainage; Cysts/surgery; Descemet Membrane; Edema/complications; Iris; Keratoconus/*complications; Rupture, Spontaneous/complications

Intravitreal triamcinalone acetonide for refractory uveitic cystoid macular oedema: longterm management and outcome. - Angunawela, R. I.; Heatley, C. J.; Williamson, T. H.; Spalton, D. J.; Graham, E. M.; Antcliffe, R. J.; Stanford, M. R. (Acta ophthalmologica Scandinavica, 2005)
PURPOSE: To establish the role of intravitreal triamcinalone acetonide (TA) in the long term management of refractory uveitic cystoid macular oedema (CMO) and to determine the long term visual outcome in these patients. METHOD: This is a retrospective observational case series. All patients had resistant CMO and active inflammation. The primary outcome measure was complete resolution of CMO on ocular coherence tomography. Visual acuity and intraocular pressure were also monitored. Twelve eyes of twelve patients received 2 (n = 10) to 4 (n = 2) mg of intravitreal TA. All had previously been unresponsive to orbital floor steroids. Fluorescein angiography was performed where indicated. RESULTS: There was complete resolution of CMO in all patients. Nine patients had improvement in acuity at there final follow up (mean follow up 40.5 months). Seven had improved by 2 lines (58%). In 3 patients there was no visual improvement. These 3 failed to respond to re-treatment. Five other patients were re-treated because of recurring CMO and deteriorating VA (median time to re-treatment 4 mths). The mean number of re-treatments for this group with orbital floor TA was three. 41.6% of patients developed ocular hypertension (33.8 mhg mean). One required a trabeculectomy. CONCLUSIONS: 2 mg of intravitreal TA is effective even in cases of resistant uveitic CMO. Although re-treatment is often required, the initial response to treatment can be maintained by subsequent orbital floor steroid injections.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Glucocorticoids/administration & dosage/adverse effects/*therapeutic use; Recurrence; Fluorescein Angiography; Tomography, Optical Coherence; Injections; Visual Acuity/*physiology; Intraocular Pressure; Vitreous Body; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Retreatment; Triamcinolone Acetonide/administration & dosage/adverse effects/*therapeutic use

Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behçet Disease. - Yalcinbayir, Ozgur; Caliskan, Enver; Ucan Gunduz, Gamze; Gelisken, Oner; Kaderli, Berkant; Yucel, Ahmet Ali (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2019)
PURPOSE: Investigation of the efficacy of intravitreal dexamethasone implants (0.7 mg) in patients with Behçet disease (BD) who had cystoid macular edema (CME) despite immunomodulatory treatment. MATERIALS AND METHODS: Twenty-seven eyes of 20 patients who had intravitreal dexameth-asone implant injections and follow-up for more than 6 months were included in this study. Best corrected visual acuities (BCVA), intraocular pressures (IOP), and central macular thicknesses (CMT) were recorded. Systemic immunomodulatory treatment was noted. Injection-related complications and the need for recurrent injections were recorded. RESULTS: Statistically significant anatomical and functional success was achieved with a single injection. BCVA increased from 0.85 ± 0.72 to 0.45 ± 0.52 logMAR, while the mean CMT decreased from 406 ± 190 to 243 ± 101 µm at the sixth month. The peak of visual acuity gain was reached within the first 2 months and a substantial proportion of the patients gained 3 or more lines. There was no complication other than transient IOP elevation in 4 eyes and cataract surgery in 2 eyes. CONCLUSION: Adjuvant intravitreal dexamethasone implant injections offer promising results in cases of BD with CME. It is effective in preserving the macular anatomy and vision particularly in transition to biological agents.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Cross-Sectional Studies; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; *Visual Acuity; Fundus Oculi; Uveitis; Macular Edema/diagnosis/*drug therapy/etiology; Uveitis/*complications/diagnosis/drug therapy; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Behcet Syndrome/*complications/diagnosis/drug therapy; Dexamethasone implant; Cystoid macular edema; Adjuvant

Suspected simultaneous bilateral anterior ischemic optic neuropathy in a patient with Behçet's disease. - Yamauchi, Yasuyuki; Cruz, Jose M. C.; Kaplan, Henry J.; Goto, Hiroshi; Sakai, Jun-ichi; Usui, Masahiko (Ocular immunology and inflammation, 2005)
AIM: To report a 47-year-old Japanese woman with a one-year history of Behçet's disease who complained of sudden bilateral visual loss with concurrent anterior ischemic optic neuropathy (AION). CASE REPORT: The patient's Snellen visual acuity was 0.1 (OD) and 0.3 (OS) of onset. There was bilateral mild anterior chamber inflammation. Bilateral optic disc pale swelling was observed without retinal exudates and edema. Fluorescein angiography demonstrated bilateral hypofluorescence of the optic disc in early frames but with no distinct retinal vasculitis. Visual field showed bilateral relative central scotoma and right altitudinal hemianopsia. Laboratory examination revealed an ESR of 26 mm in the first hour with a C-reactive protein level of < 0.3 mg/dl. Periocular injection of triamcinolone acetonide in both eyes without systemic corticosteroid administration improved her visual acuity to 0.7 (OD) and 1.2 (OS) within 45 days of onset. Bilateral optic disc swelling gradually resolved. In the early stages, fluorescein angiography demonstrated normal optic disc filling in both eyes. There was a residual right central scotoma on visual field. CONCLUSION: We observed an extremely rare case of simultaneous bilateral AION with Behçet's disease with marked visual recovery within 45 days of onset.
Keywords: Female; Humans; Middle Aged; Fluorescein Angiography; Visual Fields; Injections; Glucocorticoids/therapeutic use; Visual Acuity; Behcet Syndrome/*complications/diagnosis/drug therapy; Triamcinolone Acetonide/therapeutic use; Functional Laterality; Optic Disk/pathology; Optic Neuropathy, Ischemic/*complications/diagnosis/drug therapy; Scotoma/complications/diagnosis/drug therapy

Peripheral Cryoablation for Treatment of Active Pars Planitis: Long-Term Outcomes of a Retrospective Study. - Sohn, Elliott H.; Chaon, Benjamin C.; Jabs, Douglas A.; Folk, James C. (American journal of ophthalmology, 2016)
PURPOSE: To compare the long-term outcomes of peripheral retinal cryoablation to conventional treatment for active pars planitis. DESIGN: Retrospective, interventional, comparative case series. METHODS: Review at a single institution was conducted to compare the effect of cryotherapy to eyes with pars planitis to those receiving conventional therapy (topical, regionally injected, or oral corticosteroid therapy). Best-corrected visual acuity (VA), complications, resolution of cystoid macular edema (CME), and anterior chamber and vitreous inflammation were assessed. RESULTS: One hundred thirty-six eyes were treated conventionally, 50 eyes were treated with cryotherapy. Median follow-up was 60.8 months (range 8.1-223.1 months) in the cryotherapy group and 45.0 months (range 3.1-339.0 months) in the controls. There were no significant differences in baseline VA, anterior chamber and vitreous inflammation, presence of CME, and prior use of regional corticosteroid injections. VA improved over time in the cryotherapy group (slope of -0.0018 logMAR units per month; P = .023) but declined in the controls (slope of +0.0011 logMAR units per month; P = .023). Kaplan-Meier survival estimates demonstrated faster times to resolution of anterior chamber cell, vitreous cell, and CME in the cryotherapy-treated eyes. Hazard ratios of remission (adjusted for confounding factors) for vitreous cell and CME for those treated with cryotherapy compared to controls were 4.73 (95% confidence interval 1.63, 13.63; P = .004) and 6.85 (95% confidence interval 1.06, 44.78; P = .044), respectively. No ocular complications were identified in the cryotherapy group. CONCLUSIONS: These data suggest that peripheral retinal cryoablation therapy is an effective treatment for active pars planitis and may be better than conventional regional corticosteroid injections and oral corticosteroid therapy for induction of remission.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Child; Visual Acuity/physiology; Vitreous Body/pathology; Eye Diseases/pathology; Macular Edema/physiopathology; Anterior Chamber/pathology; Cryotherapy/adverse effects/*methods; Pars Planitis/physiopathology/*therapy

Human recombinant interferon alfa-2a for the treatment of Behçet's disease with sight threatening posterior or panuveitis. - Kötter, I.; Zierhut, M.; Eckstein, A. K.; Vonthein, R.; Ness, T.; Günaydin, I.; Grimbacher, B.; Blaschke, S.; Meyer-Riemann, W.; Peter, H. H.; Stübiger, N. (The British journal of ophthalmology, 2003)
BACKGROUND: Behçet's disease is a multisystem vasculitis of unknown origin. Standard treatment mainly comprises systemic immunosuppressive agents. Ocular involvement, mostly posterior uveitis with retinal vasculitis, leads to blindness in 20-50% of the involved eyes within 5 years. The efficacy of interferon alfa-2a was studied in patients with sight threatening posterior uveitis or retinal vasculitis. METHODS: 50 patients were included in this open, non-randomised, uncontrolled prospective study. Recombinant human interferon alfa-2a (rhIFNalpha-2a) was applied at a dose of 6 million units subcutaneously daily. Dose reduction was performed according to a decision tree until discontinuation. Disease activity was evaluated every 2 weeks by the Behçet's disease activity scoring system and the uveitis scoring system. RESULTS: Response rate of the ocular manifestations was 92% (three non-responder, one incomplete response). Mean visual acuity rose significantly from 0.56 to 0.84 at week 24 (p<0.0001). Posterior uveitis score of the affected eyes fell by 46% every week (p<0.001). Remission of retinal inflammation was achieved by week 24. Mean Behçet's disease activity score fell from 5.8 to 3.3 at week 24 and further to 2.8 at week 52. After a mean observation period of 36.4 months (range 12-72), 20 patients (40%) are off treatment and disease free for 7-58 months (mean 29.5). In the other patients maintenance IFN dosage is three million units three times weekly. CONCLUSIONS: rhIFNalpha-2a is effective in ocular Behçet's disease, leading to significant improvement of vision and complete remission of ocular vasculitis in the majority of the patients.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Treatment Outcome; Patient Compliance; Recurrence; Remission Induction; Recombinant Proteins; Visual Acuity; Interferon alpha-2; Behcet Syndrome/complications/*drug therapy; Angiogenesis Inhibitors/adverse effects/*therapeutic use; Interferon-alpha/adverse effects/*therapeutic use; Panuveitis/*drug therapy/etiology; Retinal Vasculitis/drug therapy/etiology; Software Design; Uveitis, Anterior/drug therapy/etiology; Uveitis, Posterior/drug therapy/etiology

[The Vogt-Koyanagi-Harada uveomeningoencephalitic syndrome]. - Menger, H.; Neukäter, W.; Kroll, S.; Jörg, J. (Der Nervenarzt, 1994)
VKHS is an inflammatory system disease with a subacute chronic course. It has a very variable, selective involvement of certain pigment cells of the eye, skin, inner ear, and meninges. Due in part to the fact that its symptoms are responsive to immunosuppressive therapy, pathogenesis as an autoimmune disease is considered. The clinical course of one of our patients is discussed. Early diagnosis of VKHS, although often very difficult, is mandatory for appropriate and timely treatment.
Keywords: Humans; Male; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Magnetic Resonance Imaging; Visual Fields/drug effects; Fluorescein Angiography; Diagnosis, Differential; Azathioprine/administration & dosage; Autoimmune Diseases/diagnosis/drug therapy/immunology; Cortisone/administration & dosage; Leukocyte Count/drug effects; Uveomeningoencephalitic Syndrome/*diagnosis/drug therapy/immunology

Retinal Vasculitis and Intraocular Inflammation after Intravitreal Injection of Brolucizumab. - Baumal, Caroline R.; Spaide, Richard F.; Vajzovic, Lejla; Freund, K. Bailey; Walter, Scott D.; John, Vishak; Rich, Ryan; Chaudhry, Nauman; Lakhanpal, Rohit R.; Oellers, Patrick R.; Leveque, Thellea K.; Rutledge, Bryan K.; et al. (Ophthalmology, 2020)
PURPOSE: To evaluate features and outcomes of eyes with retinal vasculitis and intraocular inflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration. DESIGN: Retrospective case series. PARTICIPANTS: Fifteen eyes from 12 patients identified from 10 United States centers. METHODS: Review of patient demographics, ophthalmologic examination results, and retinal imaging findings. MAIN OUTCOME MEASURES: Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies. RESULTS: The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P = 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P = 0.033). CONCLUSIONS: Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.
Keywords: Female; Humans; Male; Prognosis; Aged; Aged, 80 and over; Follow-Up Studies; Retrospective Studies; Fluorescein Angiography; Tomography, Optical Coherence; *Visual Acuity; Fundus Oculi; Intravitreal Injections; Macula Lutea/pathology; Uveitis/*chemically induced/diagnosis; Antibodies, Monoclonal, Humanized/administration & dosage/*adverse effects; Retinal Vasculitis/*chemically induced/diagnosis

Intraoperative use of intravitreal triamcinolone in uveitic eyes having cataract surgery: pilot study. - Okhravi, Narciss; Morris, Ainsley; Kok, Howe Sen; Menezo, Victor; Dowler, Jonathan G. F.; Hykin, Phillip G.; Lightman, Sue (Journal of cataract and refractive surgery, 2007)
PURPOSE: To report the outcomes of cataract extraction with intraoperative intravitreal triamcinolone (IVTA) in eyes with a history of posterior uveitis. SETTING: Moorfields Eye Hospital Uveitis Service, London, United Kingdom. METHODS: Nineteen eyes of 17 patients with posterior uveitis thought to require systemic corticosteroid prophylaxis for cataract surgery were included. The use of systemic corticosteroids at the time of surgery would have been problematic in 7 of the patients, who had a history of systemic hypertension. Three of the 7 patients were also diabetic. All patients were not happy about using oral corticosteroids. RESULTS: Median visual acuity 1 day after surgery was 20/40 (range 20/20 to counting fingers). At final follow-up (mean 25.2 months; range 7 to 41 months), 17 eyes (89.5%) eyes achieved visual acuity of 20/40 or better; 2 eyes failed to achieve a final visual acuity of 20/40 or better, 1 as a result of optic atrophy and the other as a result of macular edema. No patient lost acuity and no eye developed macular edema within 4 months of surgery. Intraocular pressure elevation occurred after surgery in 3 eyes; all were controlled by topical medication that was discontinued after 3 months. One patient developed severe intraocular inflammation after surgery that resolved with intensive topical corticosteroid therapy within 1 week. CONCLUSIONS: Cataract extraction by phacoemulsification with concurrent IVTA appears a useful treatment option. Targeted delivery of corticosteroid is achieved without the risks of systemic corticosteroid prophylaxis. The incidence of postoperative macular edema was markedly reduced. Levels of visual acuity after cataract surgery, similar to those in eyes without uveitis, were achieved in eyes with posterior uveitis.
Keywords: Female; Humans; Male; Middle Aged; Pilot Projects; Adult; Aged; Prospective Studies; Treatment Outcome; Glucocorticoids/*therapeutic use; Injections; Visual Acuity; Intraocular Pressure; Vitreous Body; Intraoperative Care; Macular Edema/prevention & control; Uveitis, Posterior/*drug therapy; Triamcinolone Acetonide/*therapeutic use; *Phacoemulsification; *Lens Implantation, Intraocular

Ocular syphilis--back again: understanding recent increases in the incidence of ocular syphilitic disease. - Fonollosa, Alex; Giralt, Joan; Pelegrín, Laura; Sánchez-Dalmau, Bernat; Segura, Antonio; García-Arumí, José; Adan, Alfredo (Ocular immunology and inflammation, 2009)
PURPOSE: The clinical findings and outcomes of 12 cases of luetic uveitis are reported. METHODS: Review of clinical records. RESULTS: Patients included 10 men and 2 women; 7 were homosexual, 9 HIV-positive. Six patients presented a medical history suggestive of syphilis. All patients presented with iritis and vitritis. Visual acuity improved in 11 patients after treatment. CONCLUSIONS: Syphilis has reemerged in developed countries. This may be related to the post-AID S/HAART era, with a growing pool of HIV-positive men who oftenly practice unsafe sex. We underscore the importance of a high index of suspicion of ocular syphilis in patients with these characteristics.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Incidence; Visual Acuity; Syphilis Serodiagnosis; Spain/epidemiology; Uveitis/diagnosis/drug therapy/*epidemiology; Penicillins/therapeutic use; Antiretroviral Therapy, Highly Active; Eye Infections, Bacterial/diagnosis/drug therapy/*epidemiology; HIV Seropositivity/drug therapy/epidemiology; Homosexuality, Male/statistics & numerical data; Iritis/diagnosis/drug therapy/*epidemiology; Syphilis/diagnosis/drug therapy/*epidemiology

Pars plana vitrectomy in the treatment of severe complicated toxoplasmic retinochoroiditis. - Papadopoulou, Domniki N.; Petropoulos, Ioannis K.; Mangioris, George; Pharmakakis, Nikolaos M.; Pournaras, Constantin J. (European journal of ophthalmology, 2011)
PURPOSE: To present the anatomic and functional results of pars plana vitrectomy performed in severe complicated toxoplasmic retinochoroiditis. METHODS: Three patients, 2 women and 1 man aged 57, 22, and 57 years, are presented. The first patient was under immunosuppressive therapy for dermatomyositis and underwent diagnostic/therapeutic vitrectomy for severe toxoplasmic panuveitis with dense vitritis. The other 2 patients underwent vitrectomy for macula-off rhegmatogenous retinal detachment that developed after severe toxoplasmic panuveitis. RESULT: Preoperative visual acuity was hand movement for the first 2 patients and 20/400 for the third. All patients received pars plana vitrectomy with epiretinal membrane peeling, laser photocoagulation, and SF6 gas tamponade. The second and third patients needed 5 and 3 additional operations, respectively, including extensive retinotomies and silicone-oil tamponade, for recurrent retinal detachment due to proliferative vitreoretinopathy. At the end of the follow-up period (11, 5, and 1 year, respectively), the retina was attached and visual acuity was 20/30 for the first patient but counting fingers for the other 2 patients. CONCLUSIONS: Severe panuveitis and/or recurrent retinal detachment may develop in some cases of ocular toxoplasmosis, compromising the visual prognosis. Retinal detachment due to toxoplasmosis is generally complex, and long-acting tamponade with silicone oil should be contemplated for anatomic retinal reattachment.
Keywords: Female; Humans; Male; Middle Aged; Follow-Up Studies; Young Adult; Visual Acuity/physiology; *Vitrectomy; Epiretinal Membrane/surgery; Retinal Detachment/etiology/surgery; Laser Coagulation; Sulfur Hexafluoride/administration & dosage; Chorioretinitis/physiopathology/*surgery; Panuveitis/etiology/surgery; Silicone Oils/administration & dosage; Toxoplasmosis, Ocular/physiopathology/*surgery

Safety and efficacy of fluocinolone acetonide intravitreal implant (0.59 mg) in birdshot retinochoroidopathy. - Bajwa, Asima; Aziz, Kanza; Foster, C. Stephen (Retina (Philadelphia, Pa.), 2014)
PURPOSE: To report the treatment outcomes of the fluocinolone acetonide intravitreal implant (0.59 mg) in patients with birdshot retinochoroidopathy whose disease is refractory or intolerant to conventional immunomodulatory therapy. METHODS: A retrospective case series involving 11 birdshot retinochoroidopathy patients (11 eyes). Eleven patients (11 eyes) underwent surgery for fluocinolone acetonide implant (0.59 mg). Treatment outcomes of interest were noted at baseline, before fluocinolone acetonide implant, and then at 6 months, 1 year, 2 years, 3 years, and beyond 3 years. Disease activity markers, including signs of ocular inflammation, evidence of retinal vasculitis, Swedish interactive threshold algorithm-short wavelength automated perimetry Humphrey visual field analysis, electroretinographic parameters, and optical coherence tomography were recorded. Data on occurrence of cataract and raised intraocular pressure were collected in all eyes. RESULTS: Intraocular inflammation was present in 54.5, 9.9, 11.1, and 0% of patients at baseline, 6 months, 1 year, 2 years, 3 years, and beyond 3 years after receiving the implant, respectively. Active vasculitis was noted in 36.3% patients at baseline and 0% at 3 years of follow-up. More than 20% (47.61-67.2%) reduction in central retinal thickness was noted in all patients with cystoid macular edema at 6 months, 1 year, 2 years, and 3 years postimplant. At baseline, 54.5% patients were on immunomodulatory agents. This percentage decreased to 45.45, 44.4, and 14.28% at 1 year, 2 years, and 3 years postimplant, respectively. Adverse events included increased intraocular pressure (54.5%) and cataract formation (100%). CONCLUSION: The data suggest that fluocinolone acetonide implant (0.59 mg) helps to control inflammation in otherwise treatment-refractory cases of birdshot retinochoroidopathy. It is associated with significant side effects of cataract and ocular hypertension requiring treatment.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Follow-Up Studies; Retrospective Studies; Electroretinography; Tomography, Optical Coherence; Visual Fields; Visual Acuity; Drug Implants; Intravitreal Injections; Intraocular Pressure; Cataract/chemically induced; Glucocorticoids/*administration & dosage/adverse effects; Anti-Inflammatory Agents/*administration & dosage/adverse effects; Delayed-Action Preparations; Fluocinolone Acetonide/*administration & dosage/adverse effects; Chorioretinitis/*drug therapy/physiopathology; Ocular Hypertension/chemically induced; Birdshot Chorioretinopathy

Infliximab monotherapy versus infliximab and colchicine combination therapy in patients with Behçet's disease. - Takeuchi, Masaki; Asukata, Yuri; Kawagoe, Tatsukata; Ito, Norihiko; Nishide, Tadayuki; Mizuki, Nobuhisa (Ocular immunology and inflammation, 2012)
PURPOSE: To compare infliximab monotherapy with infliximab and colchicine combination therapy in Behçet's disease. METHODS: Clinical records of 14 Behçet's disease patients who were administered infliximab with or without colchicine were retrospectively reviewed. Patients who were given other immunosuppresants after initiation of infliximab therapy were excluded. The frequency of ocular attacks and best-corrected visual acuity were investigated. RESULTS: Seven patients received monotherapy and 7 received combination therapy. The mean frequency of ocular attacks significantly decreased from 2.14 to 0.22 per 6 months in monotherapy group and from 2.57 to 0.18 per 6 months in combination therapy group. No significant difference was observed between both groups in the frequency of ocular attacks and in changes in best-corrected visual acuity during 0 to 24 months. CONCLUSIONS: Infliximab is as efficacious as infliximab and colchicines together in Behçet's disease treatment. This study suggests that colchicine administration is not necessary in Behçet's disease patients receiving infliximab.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Antibodies, Monoclonal/*therapeutic use; Infliximab; Immunosuppressive Agents/*therapeutic use; Behcet Syndrome/*drug therapy; Visual Acuity/drug effects/physiology; Colchicine/*therapeutic use

Cataract surgery with primary intraocular lens implantation in children with uveitis: long-term outcomes. - Terrada, Celine; Julian, Karina; Cassoux, Nathalie; Prieur, Anne-Marie; Debre, Marianne; Quartier, Pierre; LeHoang, Phuc; Bodaghi, Bahram (Journal of cataract and refractive surgery, 2011)
PURPOSE: To report long-term outcomes of cataract surgery with primary posterior chamber intraocular lens (IOL) implantation in children with chronic uveitis. SETTING: Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France. DESIGN: Case series. METHODS: This case series comprised patients younger than 16 years with chronic uveitis who underwent phacoemulsification with primary implantation of a heparin surface-modified poly(methyl methacrylate) posterior chamber IOL in the capsular bag. The intraocular inflammation was fully controlled for at least 3 consecutive months before surgery in all cases. The main outcome measures were final corrected distance visual acuity (CDVA), postoperative inflammation, complications, and level of immunosuppressive treatment. RESULTS: Twenty-two eyes of 16 children (7 girls, 9 boys; median age at surgery 9.5 years old) were included. Underlying uveitic entities were juvenile idiopathic arthritis in 9 patients; idiopathic uveitis in 4; and Behçet disease, sarcoidosis, and varicella zoster-associated uveitis in 1 patient each. The final CDVA was 0.3 logMAR or better in all cases. Postoperative complications included posterior capsule opacification requiring laser capsulotomy in 2 eyes, glaucoma in 4 eyes, and cystoid macular edema/macular dysfunction in 3 eyes. The mean dose of oral prednisone was 29.5 mg/day preoperatively and 8.13 mg/day at the last follow-up. The median follow-up was 6 years (range 5 to 19 years). CONCLUSION: The results indicate that uveitis is not a formal contraindication to primary IOL implantation in the management of pediatric cataract surgery in cases with full control of intraocular inflammation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Keywords: Female; Humans; Male; Follow-Up Studies; Treatment Outcome; Adolescent; Chronic Disease; Child; Child, Preschool; Glucocorticoids/administration & dosage; Uveitis/*complications/drug therapy; *Phacoemulsification; Intraoperative Complications; Postoperative Complications; Laser Therapy; Lenses, Intraocular; *Lens Implantation, Intraocular; Capsule Opacification/etiology/surgery; Coated Materials, Biocompatible; Heparin; Lasers, Solid-State; Polymethyl Methacrylate

Choroiditis in systemic lupus erythematosus: systemic steroid therapy and focal laser treatment. - Shimura, Masahiko; Tatehana, Yuko; Yasuda, Kanako; Saito, Shin ichiro; Sasaki, Takeshi; Tamai, Makoto (Japanese journal of ophthalmology, 2003)
PURPOSE: To report a rare case of choroiditis in association with systemic lupus erythematosus (SLE). CASE: A 49-year-old woman with a 17-year history of SLE experienced acute vision impairment of her left eye during the remission stage of systemic SLE. Fundus examination revealed a gray-white subretinal exudate with serous retinal detachment. Angiographic examination disclosed choroidal inflammation at the macula and a breakdown of the blood retinal barrier. Retinal burns were applied to the subretinal exudate with an argon laser as in the treatment of central serous retinopathy. Afterward, her visual acuity showed prompt recovery due to the regression of the serous retinal detachment. However, the choroidal inflammation remained until the systemic condition was controlled with steroid therapy. RESULTS: Laser treatment of a subretinal exudate was helpful for the resolution of serous detachment and the prompt improvement of visual acuity, whereas systemic steroid therapy was effective for choroidal inflammation. CONCLUSIONS: Systemic steroid therapy is thought to be effective for SLE choroiditis; however, this therapy is also known to cause serous retinal detachment. Thus, in SLE choroiditis, laser photocoagulation at a leakage point, in addition to systemic steroid therapy, may be helpful for the prompt restoration of vision in patients with serous retinal detachment.
Keywords: Female; Humans; Middle Aged; Glucocorticoids/*therapeutic use; Combined Modality Therapy; Prednisone/*therapeutic use; Fluorescein Angiography; Visual Acuity; Capillary Permeability; Coloring Agents; Indocyanine Green; Blood-Retinal Barrier; *Laser Coagulation; Choroiditis/*drug therapy/etiology; Lupus Erythematosus, Systemic/*complications; Retinal Detachment/etiology/*surgery

The Use of Topical Non-steroidal Anti-inflammatory Drugs for Uveitic Cystoid Macular Edema. - Petrushkin, Harry; Rogers, Duncan; Pavesio, Carlos (Ocular immunology and inflammation, 2018)
The use of topical non-steroidal anti-inflammatory drugs in the management of uveitic cystoid macular edema is controversial. In this letter, we review the literature and report our results from a retrospective case series of 281 patients taking topical nepafenac 0.1% for uveitic cystoid macular edema between 2010 and 2016. Over a 4-month period, there was a modest improvement in best-corrected visual acuity (0.66 ± 3.7 logMAR) and central macular thickness (69.8 ± 132.5 μm). Patients with idiopathic anterior uveitis and HLA-B*27-associated anterior uveitis recovered more vision while taking topical nepafenac 0.1%, than those with other uveitides, however, this was not statistically significant. There is a need for controlled prospective studies to evaluate the efficacy of topical non-steroidal anti-inflammatory drugs in the management of uveitic cystoid macular edema. At present, clinicians have little evidence on which to base practice.
Keywords: Female; Humans; Male; Middle Aged; Tomography, Optical Coherence; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage; uveitis; *Visual Acuity; Macular Edema/diagnosis/*drug therapy/etiology; Macula Lutea/pathology; Uveitis/*complications; Administration, Topical; Cystoid macular edema; Benzeneacetamides/*administration & dosage; nepafenac; nevanac; non-steroidal anti-inflammatory drugs; NSAIDs; Phenylacetates/*administration & dosage; uveitic

Intravitreal bevacizumab versus triamcinolone acetonide for refractory uveitic cystoid macular edema: a randomized pilot study. - Soheilian, Masoud; Rabbanikhah, Zahra; Ramezani, Alireza; Kiavash, Victoria; Yaseri, Mehdi; Peyman, Gholam A. (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2010)
PURPOSE: To compare intravitreal bevacizumab (IVB) versus intravitreal triamcinolone acetonide (IVT) for treatment of refractory uveitic cystoid macular edema (CME). METHODS: In this randomized clinical trial, 31 eyes with uveitic CME were allocated into the IVB group-eyes that received 1-3 injections of 1.25 mg bevacizumab (15 eyes) and the IVT group-eyes that received 1-3 injections of 2 mg triamcinolone (16 eyes). Primary outcome measure was change in best-corrected visual acuity (VA) at 36 weeks. RESULTS: Visual acuity improvement compared with baseline values was meaningful in the IVB group at 12, 24, and 36 weeks (-0.35 + or - 0.45 logMAR [P = 0.016]) and in the IVT group at 24 and 36 weeks (-0.32 + or - 0.32 logMAR [P = 0.001]). A significant central macular thickness (CMT) reduction was observed only in the IVT group at week 36 (74.6 + or - 108.0 microm [P = 0.049]). Between-group analysis disclosed no significant difference in any outcome measure. By statistically removing the factor of cataract, the IVT group had more improvement in VA (P = 0.007). CONCLUSIONS: IVB was as effective as IVT in refractory uveitic CME regarding VA improvement up to 36 weeks. Irrespective of triamcinolone-induced cataract, a more beneficial effect of IVT may be attainable.
Keywords: Female; Humans; Male; Pilot Projects; Adult; Treatment Outcome; Injections; Visual Acuity/physiology; Triamcinolone Acetonide/*administration & dosage; Glucocorticoids/*administration & dosage; Vitreous Body; Retina/pathology; Macular Edema/*drug therapy/physiopathology; Uveitis/*drug therapy/physiopathology; Antibodies, Monoclonal, Humanized; Bevacizumab; Antibodies, Monoclonal/*administration & dosage; Angiogenesis Inhibitors/*administration & dosage; Vascular Endothelial Growth Factor A/*antagonists & inhibitors

The Role of Dexamethasone Implant in the Management of Tubercular Uveitis. - Agarwal, Aniruddha; Handa, Sabia; Aggarwal, Kanika; Sharma, Mansi; Singh, Ramandeep; Sharma, Aman; Agrawal, Rupesh; Sharma, Kusum; Gupta, Vishali (Ocular immunology and inflammation, 2018)
PURPOSE: To study the safety and efficacy of intravitreal injection of dexamethasone implant in the management of posterior segment involvement in tubercular uveitis (TBU). METHODS: In this study, retrospective analysis of safety and efficacy of intravitreal injection of dexamethasone implant for various indications such as cystoid macular edema (CME), vitritis, or paradoxical worsening in TB-related intermediate uveitis, retinal vasculitis, and multifocal serpiginoid choroiditis (MSC) was performed. RESULTS: The study included 17 patients (19 eyes; 7 males). IOP increased from 14.88 ± 2.68 mm Hg to 16.4 ± 5.82 mm Hg (p = 0.18) at 3 months. BCVA improved from 0.37 ± 0.35 to 0.27 ± 0.21 at 3 months (p = 0.03). CME resolved at 3 months and two patients with paradoxical worsening showed resolution within 1 month. CONCLUSION: Intravitreal dexamethasone implant is safe and efficacious as an adjunct to ATT in reducing the central macular thickness, vitritis, and progression of choroiditis lesions in paradoxical worsening of MSC.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Treatment Outcome; Young Adult; Tomography, Optical Coherence; Glucocorticoids/administration & dosage; *Visual Acuity; Drug Implants; Intravitreal Injections; Dexamethasone/*administration & dosage; Ozurdex; Dexamethasone Implant; Cystoid Macular Edema; Intraocular Tuberculosis; Retinal Vasculitis; Serpiginous Choroiditis; TB; Tuberculosis, Ocular/*complications/drug therapy; Uveitis, Intermediate/diagnosis/*drug therapy/etiology

[Rehabilitation methods for children with complicated cataract]. - Ivanov, G.; Cuşnir, V.; Septichina, Natalia; Cuşnir, Vitalie (Oftalmologia (Bucharest, Romania : 1990), 2010)
The work deals with the results of surgical treatment of 155 patients, who had uveal cataract, by method of facoemulsification with artificial crystalline lens transplanting. The age of the sick varied from 3 to 15 as a result of a complex treatment, involving determination of ethnic factor in the development of uveal cataract, before- and after-operation conservative medical treatment, surgical treatment of abscuration ambliopia 78.1% children and the keenness of sight 0.4 and 68.7% got binocularious sight. The study lot of posttraumatic cataract affected children included 189 patients, from them 68 with stationary cataract, 87 with intumescent cataract and 34 with postoperatorial aphakia. Age from 2 to 15 years. 76.3% cases of evolution without postoperatorial complications, in 13.7% intraoperatorial were observed different complications. The work presents the results of surgical treatment 196 of children, who had innate cataract, by the method of facoasoriation with soft intra-eyepiece lens transplanting from 133 patients who had two-sided cataract, 63 had monolateral cataract. All children underwent laser simulation and videocomputer auto-training in post-operation period. As a result of the treatment, 66.8% patients got the amelioration of sight with 0.4, and 58% got binocular sight. The children's age varied between 6 months and 15 years. This article presents a review of the treatment results of 213 children with posttraumatic, congenital and complicated cataracts. The rehabilitation of the patients with the lens pathology includes a complex of measures of early diagnosis, surgery, optimal correction, medical treatment before and after surgery, the prophilaxis and treatment of complications. This approach permits to increase the visual acuity in 83.8% and to restore the binocular vision in 71.4% patients.
Keywords: Humans; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Adolescent; Child; Child, Preschool; Infant; Early Diagnosis; Visual Acuity; Cataract Extraction/*methods; *Lens Implantation, Intraocular; Uveitis/complications/surgery; Vision Disorders/rehabilitation; Cataract/congenital/diagnosis/etiology/physiopathology/*rehabilitation; Orthoptics; Postoperative Care/*rehabilitation; Preoperative Period; Vision, Binocular

Azathioprine and low dose pulse cyclophosphamide in severe ocular lesions of Behçet's disease. A preliminary report. - Shahram, F.; Davatchi, F.; Chams, H.; Nadji, A.; Jamshidi, A.; Akbarian, M.; Gharibdoost, F. (Advances in experimental medicine and biology, 2003)
Keywords: Humans; Drug Therapy, Combination; Time Factors; Follow-Up Studies; Drug Administration Schedule; Prednisolone/therapeutic use; Immunosuppressive Agents/therapeutic use; Visual Acuity/drug effects; Behcet Syndrome/*drug therapy/physiopathology; Uveitis, Anterior/*drug therapy/etiology; Uveitis, Posterior/*drug therapy/etiology; Azathioprine/*therapeutic use; Cyclophosphamide/administration & dosage/*therapeutic use; Retinal Vasculitis/*drug therapy/etiology

[Photocoagulation of chorioretinitis centralis serosa]. - Kurimoto, S. (Nippon Ganka Gakkai zasshi, 1969)
Keywords: Female; Humans; Male; Middle Aged; Adult; Visual Field Tests; Fundus Oculi; Visual Acuity; *Light Coagulation; Chorioretinitis/*therapy

Acute posterior multifocal placoid pigment epitheliopathy-retinal "white dot syndrome". - Grković, Desanka; Oros, Ana; Bedov, Tatjana; Karadžić, Jelena; Gvozdenović, Ljiljana; Jovanović, Sandra (Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2013)
Acute posterior multifocal placoid pigment epitheliopathy- APMPPE is an acquired idiopathic inflammatory disease of the chorioretina. This case report presents a typical clinical manifestation of a very rare condition: a twenty ive-year old female complained of a sudden bilateral decrease of vision. She reported lu-like symptoms and taking antibiotics therapy. Fundus examination revealed numerous discrete yellow-white lesions at posterior pole involving the macula. After a period of 7 days oral prednisone treatment she was completely recovered. Usage of steroids is recommended for treating APMPPE in cases where macula is involved and in recurrent cases.
Keywords: Female; Humans; Adult; Treatment Outcome; Administration, Oral; Glucocorticoids/administration & dosage/*therapeutic use; Acute Disease; Visual Acuity/drug effects; Diagnosis, Differential; Syndrome; Macula Lutea/*pathology; Multifocal Choroiditis; Chorioretinitis/*diagnosis/*drug therapy; Choroiditis/diagnosis/drug therapy; Pigment Epithelium of Eye/*pathology; Prednisone/administration & dosage/*therapeutic use

Intravitreal triamcinolone in the treatment of serous retinal detachment in Vogt-Koyanagi-Harada syndrome. - Andrade, Rafael E.; Muccioli, Cristina; Farah, Michel E.; Nussenblatt, Robert B.; Belfort, Rubens Jr (American journal of ophthalmology, 2004)
PURPOSE: To report the use of intravitreal injection of triamcinolone acetonide during the acute phase of Vogt-Koyanagi-Harada disease. DESIGN: Prospective interventional case series. METHODS: Three eyes from two patients at the acute phase of Vogt-Koyanagi-Harada disease with serous retinal detachments were treated with a 4-mg intravitreal injection of triamcinolone acetonide. The following variables were evaluated: visual acuity, intraocular pressure, and height of the serous retinal detachment using optical coherence tomography. RESULTS: The optical coherence tomography images showed a marked decrease in the retinal detachment in the first week after the injection with subsequent return to normal retinal thickness in all eyes. CONCLUSIONS: Intravitreal triamcinolone acetonide provides short-term improvement in visual acuity and serous retinal detachments associated with Vogt-Koyanagi-Harada disease. These findings should be followed by future studies to evaluate long-term effects.
Keywords: Female; Humans; Middle Aged; Prospective Studies; Glucocorticoids/*therapeutic use; Tomography, Optical Coherence; Injections; Visual Acuity; Acute Disease; Intraocular Pressure; Vitreous Body; Triamcinolone Acetonide/*therapeutic use; Retinal Detachment/*drug therapy/etiology/pathology; Uveomeningoencephalitic Syndrome/complications/*drug therapy/pathology

Intravitreal and posterior subtenon triamcinolone acetonide for severe acute posterior multifocal placoid pigment epitheliopathy. - Vianna, Raul N. G.; Vanzan, Vinícius; Turchetti, Remo; Burnier, Miguel N. Jr (Arquivos brasileiros de oftalmologia, 2019)
A 21-year-old man presented with visual acuity of 20/200 in both eyes. The fundus picture, fluorescein angiography, and optical coherence tomography revealed severe bilateral acute posterior multifocal placoid pigment epitheliopathy and serous macular detachments. We treated the patient with triamcinolone acetonide, an intravitreal injection (4 mg/0.1 mL) in one eye and a posterior subtenon injection (40 mg/1 mL) in the other eye. Within 2 weeks the visual acuity was 20/80 in both eyes. At the 8-week follow-up visit his vision was 20/63 bilaterally. One year later the vision remained 20/63 in both eyes. In this patient, the triamcinolone acetonide injections, whether administered intravitreally or via the posterior subtenon route, achieved similar anatomic and functional recovery results.
Keywords: Humans; Male; Time Factors; Treatment Outcome; Young Adult; Fluorescein Angiography; Visual Acuity; Tomography, Optical Coherence/methods; Triamcinolone Acetonide/*administration & dosage; Anti-Inflammatory Agents/*administration & dosage; Intravitreal Injections/*methods; *Tenon Capsule; White Dot Syndromes/diagnostic imaging/*drug therapy/pathology

[Central serous choroiditis following renal transplantation]. - Snyers, B.; Kestens, C. (Bulletin de la Societe belge d'ophtalmologie, 1990)
Report of 5 cases of central serous choroidopathy (CSC) following kidney transplantation. The authors compare the clinical features, the fluorescein angiography, the color vision, the visual field and the electrophysiological tests of these 5 cases with 7 control patients. In the pathogenesis of the CSC, the authors briefly discuss about the risk factors associated with the transplantation.
Keywords: Female; Humans; Male; Adult; Risk Factors; Electroretinography; Fluorescein Angiography; Visual Fields; Electrooculography; Choroiditis/*diagnosis/etiology/physiopathology; Color Perception; Immunosuppressive Agents/adverse effects; Kidney Transplantation/*adverse effects/immunology

Angle-closure glaucoma secondary to inflammatory capsular block syndrome following routine cataract surgery. - Srinivasan, Sathish; Hanumanthu, Saileela; Varikkara, Mohan (Journal of cataract and refractive surgery, 2013)
A 78-year-old man had uneventful cataract surgery with implantation of a 1-piece plate-haptic intraocular lens in the capsular bag. Seven weeks later, he presented as an emergency with intense fibrinous uveitis and increased intraocular pressure (IOP). Examination revealed an inflammatory capsular block syndrome (CBS) causing fibrinous anterior uveitis and secondary angle-closure glaucoma. The glaucoma resolved and the patient's vision improved following neodymium:YAG laser posterior capsulotomy. Inflammatory CBS should be considered in pseudophakic patients presenting with fibrinous anterior uveitis, increased IOP, and secondary angle closure.
Keywords: Humans; Male; Aged; Tomography, Optical Coherence; Visual Acuity/physiology; Tonometry, Ocular; Intraocular Pressure; Gonioscopy; Lasers, Solid-State/therapeutic use; *Phacoemulsification; Lens Implantation, Intraocular; Laser Therapy; Capsulorhexis; Glaucoma, Angle-Closure/*etiology; Uveitis, Anterior/*etiology; Lens Capsule, Crystalline/*pathology/surgery; Lens Diseases/*complications/surgery

Drug monitoring in long-term treatment with adalimumab for juvenile idiopathic arthritis-associated uveitis. - Skrabl-Baumgartner, Andrea; Seidel, Gerald; Langner-Wegscheider, Beate; Schlagenhauf, Axel; Jahnel, Jörg (Archives of disease in childhood, 2019)
OBJECTIVES: Assessing influence of anti-adalimumab (ADA) antibodies (AAA) on serum trough ADA levels and uveitis activity in long-term ADA treatment of juvenile idiopathic arthritis (JIA)-associated uveitis. PATIENTS AND INTERVENTIONS: This prospective observational study included 20 patients from a single centre treated with ADA for active uveitis refractory to conventional disease-modifying antirheumatic drugs. AAA, serum ADA trough levels and uveitis activity were evaluated at regular intervals up to 6 years. RESULTS: AAA were detected in nine patients (45%). Permanent AAA in seven were associated with undetectable ADA trough levels and loss of response (LOR). Transient AAA were detected in four with measurable ADA trough levels and response of uveitis to treatment, followed in two by permanent AAA associated with LOR. Use of concomitant immunosuppression was significantly higher in patients without AAA (p<0.05). CONCLUSIONS: AAA-associated LOR frequently occurs in long-term treatment with ADA for JIA-associated uveitis. Concomitant immunosuppressive therapy significantly reduces the risk of LOR due to AAA.
Keywords: Female; Humans; Male; Prospective Studies; Treatment Outcome; Drug Administration Schedule; Child; Long-Term Care; Visual Acuity/physiology; Uveitis/*drug therapy/physiopathology; *uveitis; *adalimumab; Arthritis, Juvenile/*drug therapy/physiopathology; *antidrug antibodies; *juvenile idiopathic arthritis; Adalimumab/*administration & dosage/adverse effects/immunology; Anti-Inflammatory Agents/*administration & dosage/adverse effects/immunology; Antibodies/metabolism; Antirheumatic Agents/*administration & dosage/adverse effects/immunology; Drug Monitoring

Immunosuppressive therapy in serpiginous choroiditis--case report and brief review of the literature. - Vonmoos, F.; Messerli, J.; Moser, H. R.; Prünte, C.; Flammer, J.; Haefliger, I. O. (Klinische Monatsblatter fur Augenheilkunde, 2001)
BACKGROUND: At present there is no consensus regarding the efficacy of the immunosuppressive therapy in serpiginous choroiditis. PATIENT AND METHODS: We describe the case of a patient with a macular serpiginous choroiditis. Despite corticosteroid therapy the choroiditis was progressive and threatened the central vision. Therefore a triple immunosuppressive therapy with prednisone 1 mg/kg body weight/day (mg/kg/d), azathioprine 1.5 mg/kg/d, and low-dose cyclosporine A 4.5 mg/kg/d was introduced. RESULTS: Under this triple immunosuppressive therapy a prompt stabilisation of the chorioretinal process could be observed in fluorescein angiography. After five months of therapy the examination of the visual field shows an impressive recovery. No significant side effects have been noted. CONCLUSIONS: In the literature, until now only six patients with serpiginous choroiditis treated with a triple agent immunosuppressive therapy have been reported. In all cases this regimen seemed to have a positive influence on the disease. Our present observation corroborates the beneficial effect of a triple agent immunosuppressive therapy on the course of serpiginous choroiditis. However, the beneficial effect of such a therapeutic approach needs to be confirmed by further observations.
Keywords: Humans; Male; Adult; Drug Therapy, Combination; Disease Progression; Visual Fields/drug effects; Prednisone/administration & dosage; Fluorescein Angiography; Immunosuppressive Agents/*administration & dosage; Cyclosporine/administration & dosage; Azathioprine/administration & dosage; Choroiditis/diagnosis/*drug therapy

Biologic Treatment Options for Retinal Neovascularization in Behçet's Disease. - Markomichelakis, Nikos N.; Aissopou, Evaggelia K.; Maselos, Stelios; Tugal-Tutkun, Ilknur; Sfikakis, Petros P. (Ocular immunology and inflammation, 2019)
PURPOSE: Relapsing ocular inflammation occurs in about 70% of patients with Behçet's disease (BD) and can lead to permanent loss of vision. Neovascularization of the optic disc (NVD) or elsewhere in the retina (NVE) is a relatively uncommon but severe complication that lacks standardized treatment. METHODS: We report on the therapeutic use of anti-TNF monoclonal antibodies for BD-associated NVD and NVE in one pediatric patient (subcutaneous adalimumab) and one young man (intravenous infliximab). Also, we review the previously published experience on biologic therapeutic options, namely anti-TNF agents and interferon-alpha in a total of three and eight patients, respectively. RESULTS: A fast-onset therapeutic effect was observed in both patients leading to complete regression of neovascularizations. CONCLUSIONS: Both options may lead to regression of neovascularization, thus preventing loss of vision, but comparative studies need to determine the optimal treatment for this sight-threatening complication of BD.
Keywords: Humans; Male; Young Adult; Antirheumatic Agents/*therapeutic use; Administration, Oral; Child; Infliximab/*therapeutic use; Prednisone/therapeutic use; Azathioprine/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Uveitis/complications/*drug therapy; Adalimumab/*therapeutic use; Behcet Syndrome/complications/*drug therapy; Behçet’s disease; Anti-TNF agents; infliximab; interferon α-2a; retinal neovascularization; Retinal Neovascularization/*drug therapy/etiology

Association of systemic steroids and mycophenolate mofetil as rescue therapy for uveitic choroidal neovascularization unresponsive to the traditional immunosuppressants: interventional case series. - Neri, Piergiorgio; Manoni, Mara; Fortuna, Cinzia; Lettieri, Marta; Mariotti, Cesare; Giovannini, Alfonso (International ophthalmology, 2010)
To study the efficacy of systemic steroids (SS) associated with mycophenolate mofetil (MMF) for the control of juxta/sub-foveal uveitic choroidal neovascularization (CNV) unresponsive to the traditional immunosuppressive agents. Patients with juxta/sub-foveal uveitic CNV unresponsive to the traditional immunosuppressive drugs were treated with SS and MMF. The study was designed as a prospective, consecutive, open-label, interventional case series. Visual gain and loss were defined as improving or worsening of two or more lines of best-corrected visual acuity (BCVA), respectively. CNV size outcome was dichotomized as "increased" or "stable/reduced", if increased >200 μm(2), or reduced ≥ 200 μm(2) or not modified by 200 μm(2), respectively. Nine cases (12 eyes) have been considered; ages ranged from 27 to 56 years. The mean follow-up time was 18.2 ± 2.9 months (min: 14 months, max: 23 months). At base-line, the mean BCVA was 0.3 ± 0.17, improving up to 0.57 ± 0.25 and to 0.63 ± 0.22 (P < 0.001, paired t-test) at the 6 and 12-month follow-ups, respectively. At the last follow-up, all the patients had stable/improved BCVA (P < 0.0001, Fisher's exact test) and stable/reduced lesion size (P < 0.0001, Fisher's exact test). None of the patients complained of any severe adverse event during the treatment. The combination of SS and MMF seems to be a promising strategy in order to control uveitic CNVs unresponsive to the traditional immunosuppressive agents. Further studies are needed to validate the data of this case series.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Administration, Oral; Injections, Intravenous; Fluorescein Angiography; Prednisolone/administration & dosage; Methylprednisolone/administration & dosage; Visual Acuity; Glucocorticoids/*administration & dosage; Immunosuppressive Agents/*administration & dosage; Uveitis/complications/*drug therapy/physiopathology; Mycophenolic Acid/administration & dosage/*analogs & derivatives; *Salvage Therapy; Choroidal Neovascularization/complications/*drug therapy/physiopathology

Episodic acute hypotonia after Nd:YAG laser capsulotomy--retinal function and choroidal swelling. - Walter, P.; Brunner, R. A.; Widder, R. A.; Fischer, R. A. (Vision research, 1997)
In a patient with uveitis who had been treated with Nd:YAG laser capsulotomy after cataract surgery, several episodes of acute hypotonia occurred which were associated with changes in clinical tests of the eye and of visual function. Immunosuppressive and immunomodulating treatment appeared to reverse the changes in intraocular pressure and normalise the test results. The significance of these observations is discussed.
Keywords: Female; Humans; Adult; Electroretinography; Visual Acuity/physiology; Acute Disease; Intraocular Pressure; *Cataract Extraction; Retina/*physiopathology; Laser Therapy/*adverse effects; Lens Capsule, Crystalline/*surgery; Electrooculography; Choroid Diseases/*etiology/physiopathology; Ocular Hypotension/*etiology/physiopathology; Panuveitis/surgery

Pars planitis in children: epidemiologic, clinical, and therapeutic characteristics. - Romero, Ricardo; Peralta, Jesus; Sendagorta, Elena; Abelairas, Jose (Journal of pediatric ophthalmology and strabismus, 2007)
PURPOSE: To report the demographics and clinical characteristics, therapy logarithm, and prognosis of children with pars planitis. PATIENTS AND METHODS: The medical records were reviewed of all patients diagnosed with pars planitis between June 1995 and December 2005 in the Department of Pediatric Ophthalmology at Hospital Universitario La Paz, Madrid, Spain. A retrospective, descriptive, and longitudinal study of 30 eyes in 16 children was performed. RESULTS: Pars planitis was bilateral in 87.5% and more frequent in males (68.8%). Average age at onset was 9.2 years. The main ophthalmologic findings recorded were snowballs (96.7%) and vitritis (93.3%). Cataract formation was the most prevalent complication (36.7%). Mean initial and final best-corrected visual acuities were 0.640 and 0.840, respectively. Periocular corticosteroids were used in 33.3% of cases and cryotherapy or laser photocoagulation in 16.7%. Complications requiring surgical management occurred in 4 eyes (13.3%). CONCLUSION: Pars planitis treated with adequate medical and surgical procedures has a good prognosis in most cases.
Keywords: Female; Humans; Male; Prognosis; Retrospective Studies; Adolescent; Child; Glucocorticoids/therapeutic use; Visual Acuity; Age of Onset; Spain/epidemiology; Sex Distribution; Laser Coagulation; Cryotherapy; *Pars Planitis/diagnosis/epidemiology/therapy

Polypoidal choroidal vasculopathy associated with Doyne's familial choroiditis: treatment with thermal laser. - Ladas, I. D.; Karagiannis, D. A.; Georgalas, I.; Rouvas, A. A.; Moschos, M. M.; Apostolopoulos, M. (European journal of ophthalmology, 2004)
PURPOSE: To report the unusual occurrence of polypoidal choroidal vasculopathy (PCV) in a patient with Doyne's familial honeycomb choroiditis (DFHC) and its course after laser treatment. DESIGN: Interventional case report. METHODS: Indocyanine green (ICG) angiography guided laser was performed on active polypoidal lesions. RESULTS: A 45-year-old man with a 15-year history of bilateral DFCH and a scarred macular choroidal neovascularization in the right eye (RE) was referred to us with exudative maculopathy in the left eye (LE). His best-corrected visual acuity (BCVA) was 20/800 in the RE and 20/40 in the LE. ICG angiography revealed a picture that was characteristic for PCV in both eyes. ICG guided argon green laser was performed on the active parapapillary and perifoveal polypoidal lesions of the LE. Eight months after the laser photocoagulation treatment, the macular exudative lesions had subsided and the BCVA improved to 20/20. The favorable anatomic and functional results have remained stable over 3 years. CONCLUSIONS: This is, to our knowledge, the first case of a PCV that occurred secondary to DFHC.
Keywords: Humans; Male; Middle Aged; Fluorescein Angiography; Visual Acuity; Laser Coagulation/*methods; Coloring Agents; Indocyanine Green; Choroid Diseases/diagnosis/etiology/*surgery; Choroid/*blood supply; Choroiditis/complications/diagnosis/*surgery; Peripheral Vascular Diseases/diagnosis/etiology/*surgery

Long-Term Efficacy and Safety of Interferon Alpha-2a in the Treatment of Chinese Patients with Behçet's Uveitis Not Responding to Conventional Therapy. - Yang, Peizeng; Huang, Guo; Du, Liping; Ye, Zi; Hu, Ke; Wang, Chaokui; Qi, Jian; Liang, Liang; Wu, Lili; Cao, Qingfeng; Kijlstra, Aize (Ocular immunology and inflammation, 2019)
PURPOSE: To investigate the long-term efficacy and safety of interferon alpha-2a (IFNα-2a) in Chinese patients with Behçet's uveitis (BU) refractory to conventional therapy. METHODS: In a prospective observational cohort study, 127 patients were treated with an initial dosage of 3 million units per day in the first three months, followed by gradual tapering of the dose. RESULTS: After 3 months of treatment, IFNα-2a was shown to be effective in 115 cases (91%). At the end of the 1-year follow-up, the frequency of ocular relapses decreased to 1.59 ± 1.68 per year (ranging 0-6) (p < 0.001), as compared to 5.09 ± 2.51 per year (ranging 3-15). Moreover, the frequency of oral ulcer relapses also decreased to 2.49 ± 1.84 per year (ranging 0-6) (p < 0.001), as compared to 8.20 ± 3.72 per year (ranging 2-10). Visual improvement or stability was observed in 32 patients (59%) in these 54 patients. During a mean follow-up of 11 months (range 3-33), the mean final VA (logMAR) had progressed from 1.0 logMAR to 0.8 logMAR in all treated patients. CONCLUSIONS: Long-term low dose of IFNα-2a is useful in treating Chinese BU patients who do not respond adequately to conventional therapy.
Keywords: Female; Humans; Male; Middle Aged; Adult; Prospective Studies; Time Factors; Follow-Up Studies; Treatment Outcome; Young Adult; Incidence; Dose-Response Relationship, Drug; Adolescent; Glucocorticoids/*therapeutic use; Treatment; Drug Substitution; *Visual Acuity; Behçet’s uveitis; Interferon alpha-2/*administration & dosage; China/epidemiology; Antineoplastic Agents/administration & dosage; Behcet Syndrome/complications/*drug therapy/epidemiology; Biological agent; Interferon alpha-2a (IFNα-2a); Systemic corticosteroids; Uveitis/*drug therapy/epidemiology/etiology

Continuous progression of tubercular serpiginous-like choroiditis after initiating antituberculosis treatment. - Gupta, Vishali; Bansal, Reema; Gupta, Amod (American journal of ophthalmology, 2011)
PURPOSE: To describe the frequency, risk factors, management, and outcome of eyes with tubercular serpiginous-like choroiditis showing continued progression following initiation of antituberculosis treatment. DESIGN: Retrospective, comparative, interventional case series. SETTING: Institutional. PATIENT POPULATION: One hundred ten patients of serpiginous-like choroiditis with 1) complete records, 2) tuberculin skin test, 3) active lesions in at least 1 eye, and 4) minimum 18 months follow-up. INTERVENTION: Based on the positivity of tuberculin skin test, the patients were categorized in Group A (84 patients with positive tuberculin test) and Group B (26 patients with negative tuberculin test). Of the 84 patients in Group A, 19 received systemic corticosteroids while 65 also received 4-drug antituberculosis treatment in addition. All patients in Group B received corticosteroids. Patients with continued progression received an increased dose of corticosteroids with or without immunosuppressive agents. MAIN OUTCOME MEASURE: Development of continued progression. RESULTS: There were 61 men and 23 women in Group A and 19 men and 7 women in Group B. Continued progression was observed in 12 patients (14.28%) in Group A and none in Group B (P = .04). Of the 12 patients in Group A showing progression, 11 (16.9%) were receiving antituberculosis treatment and corticosteroids. The lesions responded in all eyes, and final visual acuity of 20/40 or better could be achieved in 10 eyes (75%). CONCLUSION: Continued progression of choroiditis lesions occurs in 14% of patients after initiating antituberculosis treatment in tubercular serpiginous-like choroiditis. Increased immunosuppression with continuation of antituberculosis treatment resulted in good outcome.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Drug Therapy, Combination; Retrospective Studies; Risk Factors; Treatment Outcome; Young Adult; Disease Progression; Adolescent; Glucocorticoids/*therapeutic use; Child; Visual Acuity/physiology; Antitubercular Agents/*therapeutic use; Tuberculin Test; Choroiditis/drug therapy/microbiology/*physiopathology; Tuberculosis, Ocular/drug therapy/microbiology/*physiopathology

Outcomes of cataract surgery with/without vitrectomy in patients with pars planitis and immunosuppressive therapy. - Albavera-Giles, Tania; Serna-Ojeda, Juan Carlos; Jimenez-Corona, Aida; Pedroza-Seres, Miguel (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2017)
BACKGROUND: The purpose of this study was to evaluate the characteristics and outcomes of cataract surgery with/without vitrectomy in patients with pars planitis who received immunosuppressive therapy. METHODS: This was a retrospective case series, single-center study. Twenty-two patients with pars planitis who received immunosuppressive therapy were included, with a median age at presentation of 9.5 years, having had cataract surgery. The following data was collected: age at presentation and at cataract surgery, time of follow-up, best-corrected visual acuity (BCVA) before the surgery and at 1 week, 1 and 6 months after the procedure, immunosuppressive therapy, complications and causes for failed visual improvement. The variables associated with an improvement in visual acuity were evaluated. RESULTS: All patients had phacoemulsification with intraocular lens implantation. The most common immunosuppressive therapy used for the patients was methotrexate in nine patients (40.9%). The BCVA improved from a median of 20/400 to 20/100 after 6 months of follow-up (p = 0.0005); 14 patients (63.6%) improved two lines of vision or more. No significant risk factors were found for the association with improvement in visual acuity after the surgery. No improvement in visual acuity was attributed to posterior segment manifestations or amblyopia; the most common complication was posterior capsule opacification in 11 eyes (50%). The median follow-up after the surgery was 32 months. CONCLUSION: Phacoemulsification was the procedure for all the patients. Visual acuity improved in patients with pars planitis treated with immunosuppressive drugs who underwent cataract surgery, except for the patients with posterior segment complications or amblyopia.
Keywords: Female; Humans; Male; Adult; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Young Adult; Adolescent; Child; Child, Preschool; Immunosuppressive Agents/*therapeutic use; *Visual Acuity; Immunosuppression Therapy/*methods; Cataract/*complications; Visual outcomes; Phacoemulsification; Phacoemulsification/*methods; Cataract surgery; Vitrectomy/*methods; Pars planitis; Immunosuppressive therapy; Lens Implantation, Intraocular/methods; Pars Planitis/*complications/diagnosis/therapy

Clinical Profile and Treatment Response of Patients with Ocular Inflammation due to Presumed Ocular Tuberculosis: A Retrospective Study. - Elangovan, Suma; Govindarajan, Senthamarai; Mayilvakanam, Lakshmi; Gunasekaran, Nithya (Turkish journal of ophthalmology, 2019)
OBJECTIVES: Ocular tuberculosis is an extrapulmonary tuberculous infection and has varying manifestations which pose a huge challenge to diagnosis and treatment. The purpose of this study is to describe the various clinical manifestations of ocular inflammations due to tuberculosis and to assess the response to treatment following antituberculous therapy (ATT) and corticosteroids in these patients. MATERIALS AND METHODS: We performed a retrospective analysis of 29 patients with presumed ocular tuberculosis who were started on ATT and completed follow-up of at least 6 months after ATT was initiated. The data collected were: age at presentation, sex, laterality, presence or absence of pulmonary/extrapulmonary tuberculosis, history of exposure to tuberculosis, site of ocular involvement and duration of illness, visual acuity at presentation and at 6-month follow-up, and response to treatment. RESULTS: Most of the patients were of economically productive age, between 21-60 years. This most common presentation in our study population was unilateral nongranulomatous anterior uveitis. In spite of the delay between symptom onset and start of therapy, favorable response was noted in 79.3% of patients at completion of 6 months of ATT. The various reasons for the delay in start of therapy were also evaluated. CONCLUSION: In this case series, we presented the various ocular manifestations and the difficulties faced in the diagnosis of presumed ocular tuberculosis. Outcomes of ATT were favorable in most of our patients. Thus, the clinician should exercise a very high degree of suspicion and should not withhold a trial of ATT.
Keywords: Female; Humans; Male; Middle Aged; Adult; Drug Therapy, Combination; Retrospective Studies; Young Adult; Glucocorticoids/therapeutic use; Visual Acuity; Macular Edema/*drug therapy/etiology; Adrenal Cortex Hormones/therapeutic use; Uveitis/*drug therapy/etiology; Antitubercular Agents/therapeutic use; *extrapulmonary tuberculosis; *ocular inflammation; *Presumed ocular tuberculosis; *tuberculosis; *Tuberculosis, Ocular/complications/drug therapy/pathology/physiopathology; Vision Disorders/drug therapy

Risk for uveitis after laser in situ keratomileusis in patients positive for human leukocyte antigen-B27. - Moshirfar, Majid; Siddharthan, K. S.; Meyer, Jay J.; Espandar, Ladan; Wolsey, Darcy H.; Vitale, Albert T. (Journal of cataract and refractive surgery, 2008)
PURPOSE: To assess the incidence of, risk for, and visual outcomes of acute anterior uveitis (AAU) in human leukocyte antigen (HLA)-B27 positive patients who had laser in situ keratomileusis (LASIK). SETTING: University-based center. METHODS: This study comprised 46 eyes of 23 HLA-B27 positive patients with a 5-year follow-up. Data on episodes of uveitis were reviewed retrospectively and the incidence rates calculated for LASIK and non-LASIK eyes. Kaplan-Meier survival probabilities were calculated for uveitis occurring during the final 36 to 60 months of the study. Survival probabilities between LASIK and non-LASIK eyes were compared. RESULTS: Twenty eyes (10 patients) had LASIK a mean of 36 months+/-2 (SD) after the diagnosis of HLA-B27. In the HLA-B27 positive patients, the incidence rates of uveitis between eyes that had and eyes that did not have LASIK were not significantly different. The incidence rates of uveitis after LASIK did not differ significantly between eyes with and eyes without episodes of uveitis before LASIK (P=.135). The probability of an eye having no episode of uveitis in the fourth and fifth year of follow-up was not significantly different between eyes that had LASIK and those that did not (P=.668). CONCLUSIONS: The occurrence rate of post-LASIK AAU in the HLA-B27 positive population was not higher than the general incidence in a similar HLA-B27 population without previous LASIK. A previous episode of uveitis did not appear to increase the risk for uveitis after LASIK in HLA-B27 positive patients.
Keywords: Humans; Follow-Up Studies; Retrospective Studies; Risk Factors; Treatment Outcome; Incidence; Visual Acuity; Acute Disease; HLA-B27 Antigen/*immunology; *Postoperative Complications; *Keratomileusis, Laser In Situ; Lasers, Excimer/*therapeutic use; Myopia/immunology/surgery; Uveitis, Anterior/epidemiology/*etiology/immunology

Laser photocoagulation of retinal neovascularization in intermediate uveitis. - Franklin, R. M. (Developments in ophthalmology, 1992)
Keywords: Female; Humans; Male; Adult; Follow-Up Studies; Treatment Outcome; Fluorescein Angiography; Fundus Oculi; Visual Acuity; Uveitis, Intermediate/*complications; *Light Coagulation; Retinal Neovascularization/etiology/*surgery

Prospective evaluation of intravitreal triamcinolone acetonide in serpiginous choroiditis. - Wadhwa, Neeraj; Garg, Sat Pal; Mehrotra, Abhas (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2010)
OBJECTIVE: To evaluate intravitreal triamcinolone acetonide (IVTA) in unilateral serpiginous choroiditis with macular involvement with special reference to effectiveness of treatment and its side effects. METHODS: In this prospective nonrandomized, consecutive, interventional case series, IVTA was given in 8 eyes of 8 patients of unilateral active serpiginous choroiditis. Treatment was evaluated on both subjective and objective parameters: any improvement or stabilization of visual acuity, fundus and fluorescein angiography (FA) and central macular thickness on optical coherence tomography (OCT). RESULT: The treatment induced rapid remission clinically and vision improved or stabilized. Mean visual acuity improved from 0.93 +/- 0.21 LogMAR units at baseline to 0.36 +/- 0.24 (p = 0.00) LogMAR units at 6 months. A 33.73% reduction in mean central macular thickness was observed at the 6-month follow-up from 294.63 +/- 17.84 to 195.25 +/- 5.49 mum (p = 0.00). Lesions healed rapidly with FA and OCT proving the clinical observation. CONCLUSION: Intravitreal triamcinolone may prove to be a promising therapeutic approach as a rescue therapy in this recurrent sight-threatening disorder by inducing rapid remission without the systemic side effects seen with systemic immunosuppression.
Keywords: Female; Humans; Male; Adult; Prospective Studies; Follow-Up Studies; Treatment Outcome; Fluorescein Angiography; Tomography, Optical Coherence; Injections; Visual Acuity/physiology; Vitreous Body; Glucocorticoids/*administration & dosage/adverse effects; Triamcinolone Acetonide/*administration & dosage/adverse effects; Choroiditis/diagnosis/*drug therapy/physiopathology

Cataract surgery under infliximab therapy in a patient with Behçet's disease. - Noda, Eriko; Yamanishi, Shigeki; Shiraishi, Atsushi; Ohashi, Yuichi (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2009)
PURPOSE: To report a case of a successful cataract surgery outcome in a patient with Behçet's disease (BD) without postoperative inflammation under infliximab therapy. CASE: A 40-year-old man who had frequent episodes of hypopyon uveitis despite immunosuppressive therapy underwent cataract surgery. Infliximab (5 mg/kg) was given intravenously to prevent inflammation during the perioperative period. After the initial administration, infliximab was given at 2 and 6 weeks, and then it was given at 8 weeks intervals thereafter. The patient underwent cataract surgery in both eyes at the midpoint of the 8 weeks duration schedule with an uneventful postoperative clinical course for up to 12 months except for the contraction of the anterior capsule in both eyes and posterior capsule opacification in 1 eye. CONCLUSIONS: Infliximab therapy may be effective when performing cataract surgery on BD patients who have uncontrollable uveitis.
Keywords: Humans; Male; Adult; Drug Administration Schedule; Infliximab; Postoperative Complications/*prevention & control; Antibodies, Monoclonal/*administration & dosage/therapeutic use; Visual Acuity; *Cataract Extraction; Cataract/*etiology; Lens Implantation, Intraocular; Anti-Inflammatory Agents/*administration & dosage/therapeutic use; Uveitis/drug therapy; Behcet Syndrome/*complications/drug therapy

HIV-induced uveitis: would you recognize it if it looked straight at you? - Smit, Derrick P.; Meyer, David (AIDS (London, England), 2017)
Keywords: Humans; Male; Adult; CD4 Lymphocyte Count; Visual Acuity; Uveitis, Anterior/diagnosis/*etiology; Antiretroviral Therapy, Highly Active/methods; HIV Infections/*complications/diagnosis/drug therapy

Relentless placoid chorioretinitis – A case report. - Obradović, Ljiljana; Jovanović, Svetlana; Petrović, Nenad; Srećković, Sunčica; Jovanović, Zorica (Srpski arhiv za celokupno lekarstvo, 2016)
INTRODUCTION: Relentless placoid chorioretinitis is an entity which belongs to the group of an atypical intermediate form of primary inflammatory choriocapillaropathies, resembling both acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis, but the retinal distribution and clinical course are not the same. Because of this similarity this entity was termed “AMPPiginous”. This entity was first described by Jones et al. in 2000. The aim of our case report is to present a very specific case where the clinical course was progressive, with loss of vision in the affected eye. CASE OUTLINE: A 31-year-old man, with no previous ophthalmic diseases, was hospitalized at the Clinic of Ophthalmology, Clinical Center Kragujevac, because of a reduction of vision in the right eye, and scotoma and metamorphopsia in the left eye. The clinical course of retinal lesions in the left eye resembled the changes observed in acute posterior multifocal placoid pigment epitheliopathy, and the right eye changes were between acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. The diagnosis of relentless placoid chorioretinitis was confirmed after clinical, laboratory, immunological, virological, and angiography examinations. CONCLUSION: The progressive clinical course of the disease, complemented by multimodal imaging and extensive laboratory diagnostics, has led us to the diagnosis of relentless placoid chorioretinitis. The combined anti-inflammatory and immunomodulatory therapy led to the stabilization of visual acuity of the left eye as opposed to the right, where there has been no recovery.
Keywords: Humans; Male; Adult; Drug Therapy, Combination; Fluorescein Angiography; Visual Acuity; Acute Disease; Diagnosis, Differential; Cyclosporine/administration & dosage; Adrenal Cortex Hormones/administration & dosage; Pigment Epithelium of Eye/*pathology; Chorioretinitis/*diagnosis/diagnostic imaging/drug therapy

[Treatment of serous central chorio-retinopathy using an argon laser]. - Haas, P.; Clergue, G.; Massin, M. (Archives d'ophtalmologie et revue generale d'ophtalmologie, 1975)
After a short survey of the symptoms of the serous central retinopathy, the authors describe its treatment by argon laser. Almost all their results have been good in so short a time that they think the best way to manage the disease is to photocoagulate the leakage point as soon as it is discovered. In this manner a long course will be prevented, which disables the patient and is not harmless for the retina.
Keywords: Humans; Radiography; Visual Acuity; *Laser Therapy; *Lasers; Chorioretinitis/complications/diagnostic imaging/*surgery; Retinal Artery/diagnostic imaging; Scotoma/etiology

Multifocal Choroiditis with Peripheral Subretinal Fibrosis and Optic Nerve Involvement. - Ali, Ferhina S.; Eller, Andrew W.; Dunn, James P. (Ophthalmology, 2017)
Keywords: Humans; Male; Young Adult; Administration, Oral; Fluorescein Angiography; Tomography, Optical Coherence; Glucocorticoids/therapeutic use; Visual Acuity; Multifocal Choroiditis; Choroiditis/*diagnosis/drug therapy; Fibrosis; Optic Nerve Diseases/*diagnosis/drug therapy; Retina/diagnostic imaging/*pathology

Clinical features and incidence rate of ocular complications in punctate inner choroidopathy. - Leung, Theresa G.; Moradi, Ahmadreza; Liu, Dianna; Nguyen, Quan D.; Dunn, James P.; Burkholder, Bryn; Butler, Nicholas J.; Ostheimer, Trucian; Thorne, Jennifer E. (Retina (Philadelphia, Pa.), 2014)
PURPOSE: To study the clinical features and incidence rate of ocular complications in patients with punctate inner choroidopathy. METHODS: This is a retrospective cohort study conducted in a single-center academic practice setting. Patients diagnosed with punctate inner choroidopathy at the Wilmer Eye Institute, Johns Hopkins University from 1984 to 2012 were identified. Demographics and clinical features including the presence of choroidal neovascularization (CNV) and structural complications were collected. Main outcome measures, including visual impairment and incidence rate of ocular complications, were analyzed. RESULTS: Thirty-one patients (59 eyes) were included in the study. Follow-up data were available for 24 patients (47 eyes) with a mean follow-up time of 3.4 years (range, 2 months to 8.7 years). In the affected eyes with follow-up, the incidence rate of visual impairment to 20/50 or worse was 0.06 per eye-year (EY) (95% confidence interval, 0.022/EY-0.114/EY). The incidence rate of visual loss to 20/200 or worse was 0.006/EY (95% confidence interval, 0.0001/EY-0.034/EY). Thirty-six eyes (77%) had an ultimate visual acuity of 20/40 or better. All of the 13 patients with more than ≥ 3 years of follow-up had a visual acuity of ≥ 20/40 in at least 1 eye at 3 years after presentation. Two thirds of the follow-up patients (67%) on immunomodulatory drug therapy did not have new or recurrent CNV. However, this was not a statistically significant difference. Three eyes with follow-up had recurrence of CNV for an incidence rate of 0.04/EY (95% confidence interval, 0.008/EY-0.12/EY). Two eyes developed new CNV during follow-up for an incidence rate of 0.02/EY (95% confidence interval, 0.002/EY-0.066/EY). CONCLUSION: The visual prognosis in most cases of punctate inner choroidopathy is very good. The incidence rate of new CNV and recurrent CNV was 0.02/EY and 0.04/EY, respectively.
Keywords: Female; Humans; Male; Middle Aged; Adult; Retrospective Studies; Young Adult; Incidence; Administration, Oral; Prevalence; Immunosuppressive Agents/therapeutic use; Glucocorticoids/therapeutic use; Visual Acuity/physiology; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Multifocal Choroiditis; Angiogenesis Inhibitors/therapeutic use; Choroidal Neovascularization/*diagnosis/*epidemiology; Choroiditis/*complications/diagnosis/drug therapy; Vision Disorders/diagnosis/epidemiology; Visually Impaired Persons/*statistics & numerical data

Twenty-four-month outcomes of inflammatory choroidal neovascularisation treated with intravitreal anti-vascular endothelial growth factors: a comparison between two treatment regimens. - Invernizzi, Alessandro; Pichi, Francesco; Symes, Richard; Zagora, Sophia; Agarwal, Aniruddha Kishandutt; Nguyen, Phuc; Erba, Stefano; Xhepa, Alba; De Simone, Luca; Cimino, Luca; Gillies, Mark C.; McCluskey, Peter J. (The British journal of ophthalmology, 2020)
BACKGROUND AND AIM: There is still no established treatment regimen for eyes with inflammatory choroidal neovascularisation (iCNV) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. This study compared the 24-month outcomes of two treatment regimens of anti-VEGF injections in eyes with iCNV. METHODS: Eyes with iCNV treated with anti-VEGF injections were divided into two groups: eyes treated with a loading phase of 3 monthly injections and then re-treated as needed (LOADING group) and eyes treated as needed from the beginning (PRN group). Visual acuity (VA), number of injections and iCNV recurrences at 24 months were compared between the groups. RESULTS: Eighty-two eyes were included, 42 in the LOADING and 40 in the PRN group. Baseline VA (mean(SD)) was 57.3 (15.8) letters in the LOADING vs 60.7 (15.6) letters in the PRN group (p=0.32). The VA (mean (95% CI)) increased at 3 months (+14.8 (10.6 to 18.9) and +11.2 (6.4 to 16) letters in the LOADING and PRN group, respectively) and remained significantly higher than baseline over the entire follow-up in both groups (all p<0.001). At 24 months, there was no difference in VA between the LOADING and PRN group (72.3 (14.0) vs 74.7 (11.3) letters, p=0.36) but the LOADING group received significantly more injections (median (Q1-Q3)) than the PRN (4.5 (3-7) vs 2.5 (2-3.2), p<0.0001). The iCNV recurrences were similar in both groups. CONCLUSIONS: iCNV responded well to anti-VEGF with significant and sustained VA improvement. The loading phase did not confer any advantage in terms of outcomes. PRN regimen from the beginning was as effective as more intensive treatment.
Keywords: Female; Humans; Male; Middle Aged; Adult; Time Factors; Retrospective Studies; Treatment Outcome; Glucocorticoids/*therapeutic use; *inflammation; Fluorescein Angiography; Tomography, Optical Coherence; Visual Acuity/physiology; Intravitreal Injections; Uveitis/*drug therapy/physiopathology; Angiogenesis Inhibitors/*therapeutic use; *uveitis; Coloring Agents/administration & dosage; Indocyanine Green/administration & dosage; Vascular Endothelial Growth Factor A/*antagonists & inhibitors; Choroidal Neovascularization/*drug therapy/physiopathology; *treatment; *aflibercept; *anti-VEGF; *bevacizumab; *CNV; *drugs; *inflammatory choroidal neovascularization; *neovascularisation; *ranibizumab; *regimen; *retina; Bevacizumab/administration & dosage/*therapeutic use

INTRAOCULAR PRESSURE OUTCOMES AFTER SURGERY FOR RHEGMATOGENOUS RETINAL DETACHMENT IN SCHWARTZ SYNDROME. - Philip, Reni; Balekudaru, Shantha; Vijaya, Lingam; George, Ronnie (Retina (Philadelphia, Pa.), 2020)
PURPOSE: To study intraocular pressure (IOP) outcomes after surgery for rhegmatogenous retinal detachment in Schwartz syndrome. METHODS: We reviewed records of 32 eyes of 32 patients with Schwartz syndrome (patients with rhegmatogenous retinal detachment, IOP above 21 mmHg, and open angles without angle recession, chronic steroid use or other secondary causes of increased IOP) who had undergone surgical treatment consisting of scleral buckling or vitrectomy. Intraocular pressure, number of medication, best-corrected visual acuity were compared at baseline and postsurgery visits and also studied association of various factors on long-term IOP. RESULTS: The median duration of rhegmatogenous retinal detachment was 2 months, and the inter quartile range was 1 to 12 months. Follow-up was 15 months (inter quartile range: 7-33 months). Sixteen (50%) had prior ocular trauma. Baseline IOP was 35 ± 8 mmHg, and 12% (4/32) of patients were on IOP-lowering medication at presentation. At the final visit, mean IOP was 17 ± 6 mmHg and 59% patients (19/32) required additional IOP-lowering medication or surgery for IOP control. CONCLUSION: Surgical management of rhegmatogenous retinal detachment resulted in significant reduction in IOP. At the final visit, 41% did not require any IOP-lowering medication or surgical intervention for IOP control.
Keywords: Female; Humans; Male; Adult; Retrospective Studies; Young Adult; Adolescent; Visual Acuity/physiology; Intraocular Pressure/*physiology; Tonometry, Ocular; Syndrome; *Vitrectomy; Endotamponade; Laser Coagulation; Retinal Detachment/physiopathology/*surgery; Iridocyclitis/*complications; *Scleral Buckling; Glaucoma, Open-Angle/*complications

Low-dose interferon alfa-2a therapy in severe uveitis associated with Behçet disease. - Onal, Sumru; Kazokoglu, Haluk; Direskeneli, Haner; Yavuz, Sule (American journal of ophthalmology, 2009)
Keywords: Humans; Drug Therapy, Combination; Treatment Outcome; Recurrence; Recombinant Proteins; Fluorescein Angiography; Visual Acuity; Uveitis/diagnosis/*drug therapy/etiology; Immunosuppressive Agents/*administration & dosage/adverse effects; Interferon alpha-2; Prednisone/administration & dosage/adverse effects; Behcet Syndrome/complications/diagnosis/*drug therapy; Infusions, Subcutaneous; Interferon-alpha/*administration & dosage/adverse effects; Methylprednisolone/administration & dosage/adverse effects

Effect of infliximab on sight-threatening panuveitis in Behçet's disease. - Sfikakis, P. P.; Theodossiadis, P. G.; Katsiari, C. G.; Kaklamanis, P.; Markomichelakis, N. N. (Lancet (London, England), 2001)
Permanent loss of vision resulting from relapsing ocular inflammation occurs frequently in patients with Behçet's disease, despite intensive, chronic immunosuppressive therapy. Since tumour necrosis factor (TNF) might have an important pathogenetic role in Behçet's disease, we decided to give a single infusion of infliximab-a monoclonal antibody against TNF-to five patients with relapsing panuveitis, at the immediate onset of last relapse. Remission of ocular inflammation was evident within the first 24 h, and complete suppression was seen 7 days after treatment in all patients. No side-effects were noted. We suggest that infliximab is a rapid and effective new therapy for sight-threatening ocular inflammation in Behçet's disease.
Keywords: Female; Humans; Male; Middle Aged; Adult; Infusions, Intravenous; Antirheumatic Agents/administration & dosage/*therapeutic use; Infliximab; Visual Acuity/drug effects; Behcet Syndrome/*complications; Antibodies, Monoclonal/administration & dosage/*therapeutic use; Panuveitis/*drug therapy/*etiology

Effects of the duration of initial oral corticosteroid treatment on the recurrence of inflammation in Vogt-Koyanagi-Harada disease. - Lai, T. Y. Y.; Chan, R. P. S.; Chan, C. K. M.; Lam, D. S. C. (Eye (London, England), 2009)
PURPOSE: To evaluate the effects of the duration of oral corticosteroid treatment on the recurrence of inflammation in Vogt-Koyanagi-Harada (VKH) disease. METHODS: Retrospective analysis of 35 VKH patients who received oral corticosteroid during the first attack of VKH with a minimum follow-up of 6 months. Patients were divided into two groups on the basis of the oral corticosteroid treatment duration of less than 6 months or 6 months or more. Kaplan-Meier survival and Cox-regression analyses were carried out to compare the recurrence rates of inflammation in the two groups. RESULTS: The mean age of onset was 42.5 years and the mean follow-up duration was 3.6 years. During the follow-up period, 10 (58.8%) of the 17 patients who received oral corticosteroid for less than 6 months compared with 2 (11.1%) of the 18 patients who had treatment for 6 months or more developed recurrence of inflammation (P=0.003). Cox-regression analysis showed that the duration of oral corticosteroid treatment for less than 6 months was the only significant risk factor for recurrence of VKH after adjustment for age, gender, and the initial dosage of oral corticosteroid treatment (adjusted odds ratio=8.8, P=0.008). Patients who received oral corticosteroid treatment for less than 6 months were also more likely to have one eye with visual acuity of 20/200 or worse (P=0.016). CONCLUSIONS: Early withdrawal of oral corticosteroid is associated with increased risk of recurrence of VKH and worse visual prognosis. Oral corticosteroid should be tapered off slowly and maintained for at least 6 months for the treatment of acute VKH.
Keywords: Female; Humans; Male; Middle Aged; Prognosis; Adult; Aged; Young Adult; Drug Administration Schedule; Adolescent; Administration, Oral; Recurrence; Child; Epidemiologic Methods; Acute Disease; Visual Acuity/drug effects; Uveomeningoencephalitic Syndrome/*drug therapy/physiopathology; Glucocorticoids/*administration & dosage/therapeutic use; Prednisolone/*administration & dosage/therapeutic use

[Central serous retinopathy (atypical forms)]. - Brancato, R.; Bandello, F. (Bulletin de la Societe belge d'ophtalmologie, 1991)
In comparison with the typical forms of the central serous chorioretinopathy (CSCR), atypical forms are characterized by an older age, the presence of multiple and bilateral foci, the higher tendency for recurrence and the more accentuated functional damages. They may take the form of DRPE (diffuse retinal pigment epitheliopathy) and of gravitational epitheliopathy. Sedative therapy is justified by the particular psychic background which often accompanies this disease. Photocoagulation must be performed only in very selected cases in order to reduce the damage at the level of the macular photoreceptors.
Keywords: Humans; Middle Aged; Prognosis; Adult; Recurrence; Fluorescein Angiography; Visual Acuity; Diagnosis, Differential; Light Coagulation; Aging; Chorioretinitis/diagnosis/*physiopathology/surgery; Pigment Epithelium of Eye/physiopathology

Outcomes of acute postoperative inflammation after cataract surgery. - Mohammadpour, M.; Jafarinasab, M. Reza; Javadi, M. Ali (European journal of ophthalmology, 2007)
PURPOSE: To determine characteristics and final visual and surgical outcomes of patients who experienced early onset postoperative inflammation after cataract surgery and their early and late complications. METHODS: This is a prospective case series of 126 patients out of 1500 cases who underwent cataract surgery and experienced early onset postoperative inflammation during the first 2 weeks after cataract surgery. All the patients received complete ocular examinations at onset of signs and symptoms of inflammation. A total of 110 patients with follow-up examinations between 3 and 30 months after recovery of early onset postoperative inflammation (mean follow-up 11.6 months) were enrolled in the next part of the study to evaluate the final visual and surgical outcomes. Background systemic and ocular diseases, type of surgery, type of intraocular lenses and viscoelastic agent, early and late complications, and final best-corrected visual acuity were studied. RESULTS: Among 1500 patients, 126 cases (8.4%) had early onset postoperative inflammation, 64 cases (50.7%) were male, and 62 cases (49.3%) were female. Early complications were posterior synechia in 9 cases (7.1%), pupillary block in 2 cases (1.5%), and acute rise of intraocular pressure in 6 cases (4.7%). Late complications consisted of posterior capsular opacity in 38 cases (34.5%) and cystoid macular edema in 4 cases (3.2%). Peak of signs and symptoms of inflammation was during 2 weeks after surgery and all patients responded well to topical steroids. Final best-corrected visual acuity (BCVA) was 20/30 and better in 76 cases (69%), between 20/40 and 20/80 in 24 cases (22%), and less than 20/80 in 10 cases (9%). All cases with BCVA less than 20/80 had ocular diseases like choroidal neovascularization scar or age-related macular degeneration, advanced glaucoma, or corneal opacity. CONCLUSIONS: Early onset postoperative inflammation causes pain, decreased vision, and patient anxiety in the acute phase but neither decreases final visual acuity nor has any significant or permanent ocular sequels.
Keywords: Female; Humans; Male; Middle Aged; Adult; Aged; Aged, 80 and over; Prospective Studies; Follow-Up Studies; Treatment Outcome; Adolescent; Glucocorticoids/therapeutic use; Acute Disease; Visual Acuity/*physiology; *Cataract Extraction; Administration, Topical; Mydriatics/therapeutic use; *Postoperative Complications; Anterior Chamber/*physiopathology; Anxiety Disorders/etiology/physiopathology; Betamethasone/therapeutic use; Pain, Postoperative/etiology/physiopathology; Uveitis, Anterior/drug therapy/etiology/*physiopathology; Vision Disorders/etiology/physiopathology

Chorioretinitis as the first sign of acquired toxoplasmosis transmitted from donor following kidney transplantation: case report and review of the literature. - Filloy, Alejandro; Garcia-Garcia, Olga; Fernández-Lorente, Loreto (Ocular immunology and inflammation, 2013)
PURPOSE: To report a case of chorioretinitis as the earliest manifestation of Toxoplasma gondii infection acquired through donor after kidney transplantation. DESIGN/METHODS: Three months after kidney transplantation thepatient referred for visual acuity loss in her left eye and was diagnosed withtoxoplasmicchorioretinitis. Systemic treatment was started. RESULTS: The evolution of visual acuity was satisfactory. Laboratory studies confirmed that the patient was seronegative for Toxoplasma gondiiprior to the surgery. CONCLUSIONS: The literature reports toxoplasmosis as an uncommon but dangerous source of morbidity and mortality after transplantation. This case highlights the value of the ophthalmologic examination when taking care of these patients.
Keywords: Female; Humans; Adult; Visual Acuity; Diagnosis, Differential; Animals; Chorioretinitis/diagnosis/*etiology; Kidney Transplantation/*adverse effects; Toxoplasma/*isolation & purification; Toxoplasmosis, Ocular/*complications/diagnosis

Non-Hodgkin lymphoma presenting with uveitis occurring after blunt trauma. - Soylu, Merih; Ozcan, Altan Atakan; Okay, Okan; Sasmaz, Ilgen; Tanyeli, Atilla (Pediatric hematology and oncology, 2005)
We report here an unusual patient suffering from visual loss with refractory uveitis which was occured after a blunt trauma to her left eye. While in the hospital cervical lymph node and anterior chamber aspiration cytology with immunohistochemical staining were performed. The histopathologic diagnosis was highly malignant B-cell non-Hodgkin lymphoma. After the inflammation of the eye was regressed with chemotherapy, pars plana vitrectomy-lensectomy was performed. She was free of inflammation and the best corrected visual acuity was increased. However, she had a refractory inflammatory episode with clumps of cells in the anterior chamber 10 months after the operation. Local radiotherapy to the left eye was applied. Radiotherapy provided local control and preservation of the vision. The present case is presented in order to emphasize the importance of systemic evaluation in uveitis and possible role of trauma leading migration of atypical cells into the eye.
Keywords: Female; Humans; Adolescent; Vitrectomy; Eye Injuries/*complications; Lens, Crystalline/pathology/surgery; Lymphoma, B-Cell/*etiology; Radiotherapy; Uveitis/*etiology/pathology/therapy

Acute posterior multifocal placoid pigment epitheliopathy. A recurrence. - Lewis, R. A. (Archives of ophthalmology (Chicago, Ill. : 1960), 1975)
Acute posterior multifocal placoid pigment epitheliopathy recurred in a 23-year-old white woman. Forty-two days after the onset of symptoms and following the complete resolution of the initial bilateral lesions, a second crop of ophthalmoscopically and biomicroscopically similar lesions were seen in each eye. The cause of the disorder is unknown, and corticosteroid therapy is of doubtful benefit.
Keywords: Female; Humans; Male; Middle Aged; Adult; Adolescent; Recurrence; Child; Fluorescein Angiography; Prednisone/therapeutic use; Injections; Fundus Oculi; Visual Acuity; Vision Disorders/etiology; *Uveitis/diagnosis/drug therapy; *Retinitis/diagnosis/drug therapy; Epithelium; Pigments, Biological; Triamcinolone/administration & dosage/therapeutic use

Local therapeutic options for uveitic cystoid macular edema. - Slean, Geraldine R.; Khurana, Rahul N. (International ophthalmology clinics, 2015)
Keywords: Humans; Drug Therapy, Combination; Anti-Inflammatory Agents/therapeutic use; Immunosuppressive Agents/therapeutic use; Visual Acuity; Drug Implants; Intravitreal Injections; Uveitis/*drug therapy; Macular Edema/*drug therapy; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Adrenal Cortex Hormones/therapeutic use; Angiogenesis Inhibitors/therapeutic use

Postsurgical Cystoid Macular Edema - Zur, Dinah; Loewenstein, Anat (Dev Ophthalmol, 2017)
Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of postsurgical CME. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity. Fluorescein angiography shows the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include age-related macular degeneration and other causes of CME such as diabetic macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids. Oral carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular corticosteroids present an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.

Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management - Holló, Gábor; Aung, Tin; Cantor, Louis B; Aihara, Makoto (Surv Ophthalmol, 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: bimatoprost; elevated intraocular pressure; glaucoma and cataract surgery; latanoprost; omidenepag isopropyl; postoperative complications; prostaglandin analogs; pseudophakic cystoid macular edema; tafluprost; travoprost

Drug-induced uveitis - Moorthy, Ramana S; Moorthy, Meena S; Cunningham, Emmett T, Jr (Curr Opin Ophthalmol, 2018)
PURPOSE OF REVIEW: Nearly one-half of all uveitis cases seen at tertiary referral centers have no identifiable cause. Many systemic, paraocular, intraocular, topical medications, and even vaccines can induce intraocular inflammation, scleritis, and rarely orbititis and are often overlooked as causes of uveitis. This review was undertaken to elucidate the strength of association of these medications with uveitis and to make clinicians aware of these associations, especially among newer medications. RECENT FINDINGS: Medication-induced uveitis has become particularly important and more frequently seen because of the advent of biologic therapies such as immune checkpoint inhibitors (ICPIs), BRAF, and MEK inhibitors, antivascular endothelial growth factor agents, and antitumor necrosis factor agents, as well as newer systemic bisphosphonates are strongly associated with uveitis. SUMMARY: The ever-broadening scope of pharmaceuticals now available to treat previously untreatable conditions, such as advanced metastatic cutaneous melanoma, have resulted in unintended ocular inflammatory diseases. Ophthalmologists must recognize that drugs such as ICPIs, BRAF, and MEK inhibitors, anti-vascular endothelial growth factor agents, tumor necrosis factor-α inhibitors, cidofovir, bisphosphonates, topical prostaglandin analogues, topical brimonidine, BCG vaccination can cause of uveitis. Utilizing a thorough review of systems, physicians may readily identify medications that may cause uveitis and avoid expensive and unnecessary laboratory testing.

Drug-induced ocular inflammation - Samalia, Priya; Sims, Joanne; Niederer, Rachael (N Z Med J, 2020)
AIM: Drug-induced ocular inflammation is rare and may be overlooked as a cause of uveitis. The main objective was to describe the causes of drug-induced ocular inflammation. Secondary objectives included uveitis complications and drug rechallenge reactions. METHODS: A retrospective chart review at Auckland District Health Board's tertiary uveitis clinic (Auckland, New Zealand) was performed. Participants were identified using the uveitis database, which consists of 2,750 subjects. Fifty eyes of 35 subjects had drug-induced inflammation. RESULTS: Drug-induced inflammation occurred in 1.3% of subjects with uveitis. Mean age was 66.8±15.6 years, and 25 subjects (71.4%) were female. Drugs responsible were bisphosphonates (24 subjects, 68.6%), brimonidine (one subject, 2.9%), etanercept (three subjects, 8.6%), immune checkpoint inhibitors (two subjects, 5.7%), BRAF inhibitors (three subjects, 8.6%), EGFR inhibitors (one subject, 2.9%) and allopurinol/perindopril (one subject, 2.9%). In subjects with bisphosphonate inflammation, anterior uveitis occurred in 22 (91.7%) and scleritis in two (8.3%). A positive rechallenge reaction occurred in two subjects with zoledronate and one with alendronate. Uveitis occurred in six subjects (17.1%) treated with cancer drugs including immune checkpoint inhibitors, BRAF inhibitors and EGFR protein kinase inhibitors. Subjects with cancer-drug-induced uveitis were managed with corticosteroids and five subjects were able to continue therapy; in one subject uveitis was uncontrollable and required drug cessation. CONCLUSIONS: Ocular inflammation caused by bisphosphonates is usually mild and resolves on medication withdrawal. Uveitis seen in association with newer cancer medications can be more severe, but in most cases it can be managed without medication cessation.

[Uveitic Secondary Glaucoma] - Lommatzsch, Claudia; Heinz, Carsten (Klin Monbl Augenheilkd, 2018)
An intraocular pressure increase with development of glaucomatous damage is a common complication of uveitis. The prevalence has a wide range depending on various factors such as the underlying uveitis type and the duration of the disease. Pathogenetically, a distinction must be made between a secondary angle closure component and the more frequently occurring open-angle glaucoma. In diagnostics, in addition to the clinical optic nerve head assessment, perimetry and tonometry, the use of imaging examination equipment, such as OCT and HRT, are recommended. In the context of uveitic glaucoma, it must be considered in the evaluation, because the glaucoma-typical changes are generally less pronounced or can be concealed by retinal swelling in comparison with other forms of glaucoma. Therapeutically, drug therapy in the form of eye drops continues to be a first-line recommendation, with the use of topical carbonic anhydrase inhibitors or beta-blockers primarily preferred, depending on the contraindications. An operative therapy follows after unsuccessful or inadequate conservative therapy: the adequate surgical technique depends on the respective finding and includes actually techniques such as filtering procedures and glaucoma drainage devices.

Inflammatory glaucoma - Bodh, Sonam A; Kumar, Vasu; Raina, Usha K; Ghosh, B; Thakar, Meenakshi (Oman J Ophthalmol, 2011)
Glaucoma is seen in about 20% of the patients with uveitis. Anterior uveitis may be acute, subacute, or chronic. The mechanisms by which iridocyclitis leads to obstruction of aqueous outflow include acute, usually reversible forms (e.g., accumulation of inflammatory elements in the intertrabecular spaces, edema of the trabecular lamellae, or angle closure due to ciliary body swelling) and chronic forms (e.g., scar formation or membrane overgrowth in the anterior chamber angle). Careful history and follow-up helps distinguish steroid-induced glaucoma from uveitic glaucoma. Treatment of combined iridocyclitis and glaucoma involves steroidal and nonsteroidal antiinflammatory agents and antiglaucoma drugs. However, glaucoma drugs can often have an unpredictable effect on intraocular pressure (IOP) in the setting of uveitis. Surgical intervention is required in case of medical failure. METHOD OF LITERATURE SEARCH: Literature on the Medline database was searched using the PubMed interface.
Keywords: uveitis; glaucoma; Intraocular pressure; inflammation

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 (Br J Ophthalmol, 2020)
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: uveitic glaucoma; IOP phasing; prospective clinical trials

Pediatric Glaucoma: Pharmacotherapeutic Options - Samant, Monica; Medsinge, Anagha; Nischal, Ken K (Paediatr Drugs, 2016)
Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.

Long-term prognosis for glaucoma in patients with Posner-Schlossman syndrome - Kim, Jin-Ho; Lee, Ji-Young; Choi, Jin A (Graefes Arch Clin Exp Ophthalmol, 2021)
BACKGROUND: The aim of this study is to investigate the long-term prognosis for glaucoma in patients with Posner-Schlossman syndrome (PSS). METHODS: In this retrospective case series study, a total of 98 patients with PSS from January 2014 to February 2019 were included in this study. Initial presentations and follow-up data were obtained from medical records. Vision-related quality of life (VR-QoL) was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire. RESULTS: Of the 98 patients included in the study, 66 (67%) presented with glaucoma, and among them, 21 (32%) required glaucoma surgery. The mean follow-up time was 50.1 months (range 1-263 months). Iris involvement was noted in 46 (46.9%) eyes; 26 (26.5%) had sectoral iris changes and 20 (20.4%) showed diffuse iris changes. Eyes with iris involvement had a significantly higher number of acute attacks of uveitis than those without (p = 0.010). The 5-year glaucoma surgery-free interval was 77.8% according to Kaplan-Meier analysis. Significant predictors of glaucoma surgery included iris involvement (hazard ratio [HR] = 5.215; confidence interval [CI] = 1.387-19.610), highest number of anti-glaucoma agents (HR = 5.069; CI = 1.848-13.905), baseline average retinal nerve fiber layer thickness (RNFLT) thickness (HR = 0.949; CI = 0.917-0.982), and disease duration (HR = 0.977; CI = 0.957-0.996). Overall complete surgical success and qualified success at 2 years was 35.3% and 75.5%, respectively. Patients with iris involvement, glaucoma surgery, and thinner average RNFLT had significantly poorer VR-QoL (all, p < 0.05). CONCLUSIONS: Patients with PSS and glaucoma required glaucoma surgery in a high rate. Iris involvement increased the probability of surgical treatment and lowered the VR-QoL of PSS patients.
Keywords: Uveitis; Glaucoma surgery; Posner–Schlossman syndrome; Vision-related quality of life

Drug-induced ocular inflammatory diseases - Fraunfelder, Frederick W (Drugs Today (Barc), 2007)
Ocular inflammation can arise in the form of conjunctivitis, uveitis, episcleritis and scleritis. The uveitides can be subdivided by anatomical location into anterior and posterior uveitis or categorized by location of inflammation, e.g., iritis, pars planitis or iridocyclitis. Multiple drugs have been associated with ocular inflammation and much has been written on the subject. Discussed here is a sampling of drugs representing classes of medication associated with ocular inflammation. However, this is not a comprehensive list and interested readers are encouraged to access the National Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute, Portland, Oregon, www.eyedrugregistry.com) or the textbook Drug-Induced Ocular Side Effects for further information (1). The agents discussed may be administered systemically, topically or intracamerally (inside the eye). The mechanism behind ocular inflammation is frequently unknown. Prevention and treatment are based upon physician recognition and withdrawal of the drug in some instances. Consultation with an ophthalmologist is recommended, as many types of ocular inflammation can threaten vision.

The use of prostaglandin analogs in the uveitic patient - Horsley, Michael B; Chen, Teresa C (Semin Ophthalmol, 2011)
Glaucoma is a disease process characterized by progressive optic nerve damage and corresponding visual field loss. It may be further categorized into either primary open-angle glaucoma or secondary glaucoma. These secondary glaucomas include glaucomas associated with uveitis and inflammation. Prostaglandin analogs (PGA) have been used to help lower intraocular pressure (IOP) in these often difficult to manage eyes. However, controversy exists concerning their use in uveitic patients due to the theoretically higher risk of anterior uveitis, development of cystoid macular edema (CME), and reactivation of herpes simplex keratitis (HSK). There is little evidence that PGA disrupt the blood-aqueous barrier and only anecdotal evidence suggesting an increased risk of these rare findings. PGA may be used in uveitic glaucoma when other topical treatments have not lowered IOP to the patient's target range.

The Effect of Latanaprost on Intraocular Inflammation and Macular Edema - Razeghinejad, M Reza (Ocul Immunol Inflamm, 2017)
There is debate concerning whether the use of Latanoprost in early postoperative period of cataract surgery and in glaucoma patients with uveitis as it may aggravate the inflammation and results in macular edema (ME), because of blood-ocular barrier disruption. However, there is no solid evidence for disruption of blood-ocular barrier with Latanoprost and aggravation of uveitis or ME formation. Similar to pseudophakic ME, the imaging ME in cases claimed to be secondary to Latanoprost is greater than clinical ME, happens mostly in complicated surgeries, and the vast majority resolve within weeks to months with using a non-steroidal anti-inflammatory drug. The current literature suggests that Latanoprost can be used in patients with uveitis and early after cataract surgery with or without concomitant topical non-steroidal anti-inflammatory drugs that are currently used by many ophthalmologists as a preventive measure for ME even in non-glaucoma uncomplicated cataract surgeries.
Keywords: Macular edema; Latanoprost; Iritis; Intraocular inflammation; Prostaglandin analogs

Postsurgical cystoid macular edema - Loewenstein, Anat; Zur, Dinah (Dev Ophthalmol, 2010)
Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of developing CME postoperatively. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity. Fluorescein angiography is indispensable in the workup of CME, showing the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include age-related macular degeneration and other causes of CME such as diabetic macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids. Oral carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular corticosteroids present an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.

[Prostaglandins in ophthalmology] - Erichev, V P (Vestn Oftalmol, 2022)
Prostaglandins are widely used in medicine as active physiological agents that form a new class of drugs for treatment of cardiovascular diseases, some forms of bronchial asthma, as well as in gynecology and ophthalmology. Development of aseptic inflammation is an example of intracellular process, in which the produced prostaglandins are able to and do cause vasodilatation, increased vascular permeability, pain and fever. These effects of prostaglandins and leukotrienes characterize the classic picture of inflammation, including the aseptic one. The use of non-steroidal anti-inflammatory drugs (NSAIDs) can provide therapeutic effect via inhibition of prostaglandin secretion. Prostaglandins play a special role in glaucoma treatment. Prostaglandin analogues are powerful agents that decrease IOP by 20-40% with a unique mechanism of action. Prostaglandin analogues have a well-balanced safety profile, which is why they are considered as a first line of therapy. However, patients with inflammatory diseases in anamnesis, such as uveitis, herpes, keratitis, as well as patients with planned cataract extraction should be careful when using prostaglandin analogues.
Keywords: glaucoma; intraocular pressure; non-steroidal anti-inflammatory drugs; aseptic inflammation; prostaglandins

A review of the use of latanoprost for glaucoma since its launch - Digiuni, Maurizio; Fogagnolo, Paolo; Rossetti, Luca (Expert Opin Pharmacother, 2012)
INTRODUCTION: Prostaglandins are increasingly used as first choice treatment for glaucoma because they are highly effective, lack relevant systemic side effects and require just once-daily administration. Latanoprost is an ester prodrug analog of prostaglandin F2α, which reduces intraocular pressure (IOP) by increasing uveoscleral outflow. Latanoprost 0.005% has received European and US approval as the first-line drug for reducing IOP in patients with open-angle glaucoma or ocular hypertension. Following the recent patent expiry for Xalatan®, a number of latanoprost generics have entered the glaucoma market. AREAS COVERED: This review, achieved through PubMed and Medline research methods, describes the composition, pharmacokinetics, mode of action, efficacy, side effects and safety profile of latanoprost. EXPERT OPINION: Latanoprost was the first prostaglandin analog introduced in glaucoma management and it dramatically changed the market of the disease thanks to its efficacy and safety. Conjunctival hyperemia, which is commonly found after latanoprost use, is associated with a minor efficacy and duration of trabeculectomy; yet, from the ophthalmologist's perspective, this side effect seems largely counterbalanced by the high efficacy and safety of this compound. It is always advisable to consider the pro-inflammatory mode of action of latanoprost because this may have negative effects in particular patients (i.e., those with uveitis and cystoid macular edema) for whom caution and close follow-up is necessary.

Clinical and Genetic Study of X-Linked Juvenile Retinoschisis in the Czech Population - Kousal, Bohdan; Hlavata, Lucia; Vlaskova, Hana; Dvorakova, Lenka; Brichova, Michaela; Dubska, Zora; Langrova, Hana; Vincent, Andrea L; Dudakova, Lubica; Liskova, Petra (Genes (Basel), 2021)
The aim of this study was to identify RS1 pathogenic variants in Czech patients with X-linked retinoschisis (XLRS) and to describe the associated phenotypes, including natural history, in some cases. Twenty-one affected males from 17 families were included. The coding region of RS1 was directly sequenced and segregation of the identified mutations was performed in available family members. In total, 12 disease-causing variants within RS1 were identified; of these c.20del, c.275G>A, c.[375_379del; 386A>T], c.539C>A and c.575_576insT were novel, all predicted to be null alleles. The c.539C>A mutation occurred de novo. Three patients (aged 8, 11 and 19 years) were misdiagnosed as having intermediate uveitis and treated with systemic steroids. Repeat spectral domain optical coherence tomography examinations in four eyes documented the transition from cystoid macular lesions to macular atrophy in the fourth decade of life. Four individuals were treated with topical dorzolamide and in two of them, complete resolution of the cystic macular lesions bilaterally was achieved, while one patient was noncompliant. Rebound phenomenon after discontinuation of dorzolamide for 7 days was documented in one case. Misdiagnosis of XLRS for uveitis is not uncommon; therefore, identification of disease-causing variants is of considerable benefit to the affected individuals.
Keywords: uveitis; novel variant; RS1; steroid treatment; X-linked retinoschisis

Gonioscopy-assisted transluminal trabeculotomy is an effective surgical treatment for uveitic glaucoma - Belkin, Avner; Chaban, Yuri Valere; Waldner, Derek; Samet, Saba; Ahmed, Iqbal Ike K; Gooi, Patrick; Schlenker, Matthew B (Br J Ophthalmol, 2021)
BACKGROUND: To assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG). METHODS: A retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications. RESULTS: Mean patient age (mean±SD) was 49±16 years (range: 18-79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up. CONCLUSION: GATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.
Keywords: glaucoma; treatment surgery

Retrobulbar vs peribulbar regional anesthesia techniques using bupivacaine in dogs - Shilo-Benjamini, Yael; Pascoe, Peter J; Maggs, David J; Hollingsworth, Steven R; Strom, Ann R; Good, Kathryn L; Thomasy, Sara M; Kass, Philip H; Wisner, Erik R (Vet Ophthalmol, 2018)
OBJECTIVE: To compare the effectiveness of retrobulbar anesthesia (RBA) and peribulbar anesthesia (PBA) in dogs. ANIMAL STUDIED: Six adult mixed-breed dogs (18-24 kg). PROCEDURES: In a randomized, masked, crossover trial with a 10-day washout period, each dog was sedated with intravenously administered dexmedetomidine and administered 0.5% bupivacaine:iopamidol (4:1) as RBA (2 mL via a ventrolateral site) or PBA (5 mL divided equally between ventrolateral and dorsomedial sites). The contralateral eye acted as control. Injectate distribution was evaluated by computed tomography. Following intramuscularly administered atipamezole, corneal and periocular skin sensation, intraocular pressure (IOP), and ocular reflexes, and appearance were evaluated for 24 hours. Comparisons were performed with mixed-effects linear regression (IOP) or the exact Wilcoxon signed rank test (scores). Significance was set at P ≤ .05. RESULTS: Injectate distribution was intraconal in 2/6 RBA- and 4/6 PBA-injected eyes. Eyes undergoing PBA had significantly reduced lateral, ventral, and dorsal periocular skin sensation for 2-3 hours, and significantly reduced corneal sensitivity for 4 hours, relative to control eyes. Chemosis and exophthalmos occurred in 33%-40% of eyes undergoing RBA and 83%-100% eyes undergoing PBA but resolved within 14 hours. Anterior uveitis developed in 2/6 and 1/6 eyes of RBA and PBA, respectively, of them corneal ulcer developed in one eye of each treatment. Both resolved 1-3 days following medical treatment. CONCLUSIONS: Peribulbar injection produced notable anesthesia more reliably than did retrobulbar injection. Both techniques may produce adverse effects, although the uveitis/ulcer could have resulted from the contrast agent used.
Keywords: analgesia; bupivacaine; dogs; ophthalmic regional anesthesia; peribulbar anesthesia; retrobulbar anesthesia

Urgent Management of Secondary Glaucoma in Uveitis Using the Xen-45 Gel Stent - Qureshi, Amreen; Jones, Nicholas P; Au, Leon (J 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.

Topical prostaglandin analogues and conjunctival inflammation in uveitic glaucoma - Taylor, Simon Rj; Gurbaxani, Avinash; Sallam, Ahmed; Lightman, Sue (Open Ophthalmol J, 2012)
PURPOSE: A pilot study to determine whether topical prostaglandin analogues alter the expression of conjunctival inflammatory markers in patients with uveitic glaucoma. METHODS: Prospective, single-masked case series of 20 patients with uveitis and secondary raised intraocular pressure. Participants were divided into four groups of five patients dependent on their use of topical medication: (1) prostaglandin analogues only, (2) corticosteroids only, (3) both prostaglandin analogues and corticosteroids, (4) no topical medication. Conjunctival cells were harvested by impression cytology and were examined for inflammatory markers (CD3, CD54, HLA-DR, CCR4, CCR5) by flow cytometry. A tear fluid sample was also examined for inflammatory cytokines (IL-12p70, IL-2, IL-10, IL-8, IL-6, IL-4, IL-5, IFN-gamma, IL-1beta, IFN-alpha, IFN-beta) by multiplex bead arrays. RESULTS: All groups demonstrated increased markers of conjunctival inflammation. There was no significant difference in levels of any inflammatory markers between the four groups, suggesting that the use of topical prostaglandin analogues does not increase conjunctival levels of inflammation beyond those already seen in uveitis. CONCLUSIONS: The use of topical prostaglandins does not appear to induce conjunctival inflammation over that which is already present in patients with uveitic glaucoma. This supports the use of topical prostaglandin analogues in patients with uveitic glaucoma, indicating that their use is unlikely to adversely affect subsequent glaucoma filtration surgery through the induction of chronic conjunctival inflammation.
Keywords: Uveitic glaucoma; conjunctival inflammation; prostaglandin analogues; trabeculectomy.

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 (Ocul Immunol Inflamm, 2018)
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: uveitis; Childhood uveitis; glaucoma; JIA; surgery

Suprachoroidally injected pharmacological agents for the treatment of chorio-retinal diseases: a targeted approach - Habot-Wilner, Zohar; Noronha, Glenn; Wykoff, Charles C (Acta Ophthalmol, 2019)
Delivery of pharmaceuticals to the posterior segment presents challenges that arise from the anatomy and clearance pharmacokinetics of the eye. Systemic and several local administration options [topical, periocular, intravitreal (IVT) and subretinal] are in clinical use, each with a unique benefit to risk profile shaped by factors including the administered agent, frequency of dosing, achievable pharmaceutical concentrations within posterior segment structures versus elsewhere in the eye or the body, invasiveness of the procedure and the inherent challenges with some administration methods. The use of the suprachoroidal space (SCS), which is the region between the sclera and the choroid, is being explored as a potential approach to target pharmacotherapies to the posterior segment via a minimally invasive injection procedure. Preclinical data on agents such as vascular endothelial growth factor inhibitors and triamcinolone acetonide (TA) indicate that administration via suprachoroidal injection results in more posterior distribution of the pharmacologic agent, with higher exposure to the sclera, choroid, retinal pigment epithelium cells and retina, and lesser exposure to the anterior segment, than observed with IVT administration. Based in part on these findings, clinical trials have explored the efficacy and safety of suprachoroidal administration of pharmacologic therapies in conditions affecting the posterior segment. Data on a proprietary formulation of TA administered by suprachoroidal injection show improvement in anatomic and visual outcomes in subjects with noninfectious uveitis, with the potential to mitigate the known risks of cataract and increased intraocular pressure (IOP) associated with the use of intraocular corticosteroids. Suprachoroidal administration appears to be a promising treatment modality and is also in the early stages of investigation for other possible applications, such as injection of antiglaucoma agents into the anterior SCS for long-lasting control of elevated IOP, and as a mode of delivery for gene- or cell-based therapies for retinal disorders.
Keywords: uveitis; macular edema; retina; macular oedema; choroid; pharmacotherapy; retinal vein occlusion; suprachoroidal; triamcinolone acetonide

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 (Arch Soc Esp Oftalmol (Engl Ed), 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: Uveitis; Uveítis; Ahmed valve; Enfermedades de la úvea; Glaucoma; Intraocular pressure; Presión intraocular; Uveal diseases; Válvula de Ahmed

The risk of uveitis due to prostaglandin analogs in pediatric glaucoma - Bello, Nicholas R; LaMattina, Kara C; Minor, Jade M; Utz, Virginia Miraldi; Dong, Kaylin; Levin, Alex V (J AAPOS, 2022)
PURPOSE: To examine the incidence of uveitis in children prescribed prostaglandin analogs (PGAs) for glaucoma. METHODS: In this dual-center cohort study, the medical records of consecutive patients <18 years old treated with a PGA between January 1, 2012, and December 31, 2018, were reviewed retrospectively. Patients with all forms of glaucoma, including those with a prior history of uveitis, were included. Patients who had been on a PGA prior to their first recorded visit were excluded. Patient charts were reviewed for new or recurrent uveitis during the first year of PGA therapy. RESULTS: A total of 103 children (147 eyes) were included, with a total PGA exposure of 1,352 child-months. Ninety-eight children (142 eyes) tolerated the PGA without an episode of uveitis. Five patients with a documented prior history of uveitis experienced a unilateral episode of uveitis. A review of their medical records identified prescribed or unscheduled decrease in topical steroids or immunosuppressive medication as the most likely cause of uveitis recurrence. CONCLUSIONS: This study provides further evidence that PGAs are unlikely to induce uveitis in children being treated for glaucoma and suggests that this may also be true in those with a history of uveitis. We are unable to evaluate whether PGAs make recurrence more likely or the tapering of steroids more difficult.

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

[Secondary glaucoma in childhood uveitis] - Heinz, C; Pleyer, U; Ruokonnen, P; Heiligenhaus, A (Ophthalmologe, 2008)
Ocular hypertension and secondary glaucoma are frequent and challenging complications in childhood uveitis. They are commonly found in patients with panuveitis or anterior uveitis and are often associated with juvenile idiopathic arthritis. Angle closure is rare, while secondary open angle glaucoma accounts for the majority of cases and often continues after the acute inflammation has healed. Monitoring should include tonometry, perimetry, and the objective assessment of the optic disc and nerve fibre layer. First-line therapy should consist of topical carbonic anhydrase inhibitors, followed by beta blockers, and then the alpha-2 agonists. Topical therapy must be monitored closely, as drug-related systemic side effects may preferentially occur in children. Because topical therapy in children is commonly ineffective, surgical interventions are often required. Reports on the use of trabeculectomy, goniosurgery, glaucoma drainage devices, and cyclodestructive procedures show higher failure rates than when used for primary open angle glaucoma in adults.

Four years later: a clinical update on latanoprost - Ravinet, E; Mermoud, A; Brignoli, R (Eur J Ophthalmol, 2003)
PURPOSE: Almost five years have elapsed since the introduction of latanoprost on several markets and considering the large number of publications dealing with it, the authors felt that it was worth re-evaluating the drug. METHODS: The criterion used to select trials for inclusion in the review was: all articles mentioning the drug in common electronic data-bases; these were then screened and considered, on the basis of methodological quality. RESULTS: Experimental data suggest that latanoprost acts by remodeling the extracellular matrix in the ciliary muscle, thus increasing the flow of aqueous humor through the ciliary muscle bundles of the uveoscleral pathway. POAG: Latanoprost persistently improves the pulsatile ocular blood flow in primary open angle glaucoma (POAG). Recent trials confirmed the greater IOP-lowering efficacy of latanoprost vs. timolol, dorzolamide, brimonidine and unoprostone. Trials lasting up to 24 months showed that latanoprost is effective in long-term treatment of POAG and ocular hypertension (OH), with no signs of loss of efficacy when compared to timolol or dorzolamide. Latanoprost provides better control of circadian IOP. Non-responders to beta-blockers should preferably be switched to latanoprost monotherapy before a combination therapy is started. The possibility of a fixed combination of latanoprost and timolol has been explored, with promising results. NTG: Latanoprost is effective in normal tension glaucoma (NTG), lowering IOP, improving pulsatile ocular blood flow and increasing ocular perfusion pressure. OTHER GLAUCOMAS: Latanoprost may provide effective IOP control in angle-closure glaucoma after iridectomy, in pigmentary glaucoma, glaucoma after cataract extraction and steroid-induced glaucoma. However, latanoprost was effective in only a minority of pediatric cases of glaucoma and is contraindicated in all forms of uveitic glaucoma. SAFETY: In the articles reviewed, new or duration-related adverse events were reported.

Prevalence of uveitic secondary glaucoma and success of nonsurgical treatment in adults and children in a tertiary referral center - Heinz, Carsten; Koch, Jorg M; Zurek-Imhoff, Beatrix; Heiligenhaus, Arnd (Ocul Immunol Inflamm, 2009)
PURPOSE: The aim of this study is to compare treatment strategies, the success of topical and systemic therapy, and the need for glaucoma surgery in children and adults with secondary uveitic glaucoma. METHODS: Retrospective observational case series with 1997 consecutive new uveitis patients. RESULTS: Overall, 176 patients (8.8%) suffered from secondary glaucoma (n = 126) or ocular hypertension (n = 50). All patients received topical therapy, and 107 (62%) patients also received systemic glaucoma therapy. Topical therapy was successful (IOP <or= 21 mmHg) in 24% of adults and 26% of children. Surgery was required in 59% of children and in 35% of adults (p =.02). The number of surgical interventions differed per patient with 2.6 procedures in children compared to 1.6 procedures in adults (p <.001). CONCLUSIONS: Only a limited number of patients with secondary uveitic glaucoma can be sufficiently controlled with topical and systemic antiglaucomatous therapy alone. There is a significantly higher need for glaucoma operations in children.

Intraocular pressure following four different intravenous sedation protocols in normal horses - Joyner, Rebekah L; Liu, Chin-Chi; Cremer, Jeannette; Carter, Renee T; Lewin, Andrew C (Equine Vet J, 2020)
BACKGROUND: Intravenous sedation is frequently necessary for ophthalmic examination in horses. Common sedation protocols have not been directly compared in terms of relative intraocular pressure (IOP) reduction, duration of IOP reduction and time to maximum IOP reduction. OBJECTIVES: To compare the effects of standing sedation protocols on IOP. STUDY DESIGN: Randomised cross-over experiment. METHODS: Twelve healthy horses received four intravenous sedation protocols with a 48 hours washout: 0.5 mg/kg xylazine and 0.01 mg/kg butorphanol (SED1); 10 µg/kg detomidine and 0.01 mg/kg of butorphanol (SED2); 10 µg/kg detomidine (SED3); 0.5 mg/kg xylazine (SED4). IOP was measured with rebound tonometry before sedation (Tpre) and 5, 10, 15, 30, 45 and 60 minutes post-sedation (Tpost). Post-sedation readings were taken with the head elevated to the Tpre position. Separately, IOP readings were also obtained following sedation with the head not elevated (TpostHeadDown). IOP values were compared using mixed ANOVA and ANCOVA models respectively with significance at P < .05. RESULTS: All protocols decreased IOP compared with baseline with greatest reduction at Tpost5. IOP at Tpre (mean ± SD) was 21.8 ± 4.4 mm Hg. At Tpost5, IOP was 16.3 ± 3.8 mm Hg (SED1), 14.5 ± 2.9 mm Hg (SED2), 17.1 ± 3.8 mm Hg (SED3) and 16.9 ± 4.2 mm Hg (SED4). SED2 Tpost5 IOP was lower than other treatments. Considering all time points following sedation, SED3 IOP readings were higher than other treatments. TpostHeadDown IOPs were higher than readings taken with the head elevated (P < .001). MAIN LIMITATIONS: Animals with ocular disease were not studied. No animals received mock sedation or equivalent. CONCLUSIONS: A combination of detomidine and butorphanol causes greater IOP reduction 5 minutes following sedation than other commonly used sedation protocols. IOP reduction is less pronounced when detomidine is used alone. Consideration of head height is important when performing IOP measurements in horses.
Keywords: uveitis; glaucoma; intraocular pressure; horse; sedatives

Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients - Rachmiel, Rony; Trope, Graham E; Buys, Yvonne M; Flanagan, John G; Chipman, Mary L (Can J Ophthalmol, 2008)
BACKGROUND: The poor long-term success rate of repeat trabeculectomies in refractory uveitic glaucoma (UG) patients has led to the use of glaucoma drainage devices (GDDs). However, the success and complication rates of GDDs in UG patients utilizing a control group with standard demographic data, design, and surgical technique have never been evaluated. METHODS: Fifteen patients (15 eyes) with chronic uveitis and 53 patients (53 eyes) with uncontrolled open-angle glaucoma (OAG) who underwent Ahmed glaucoma valve (AGV) implantation were included in a retrospective, comparative, case-controlled study. Postoperative intraocular pressure (IOP), number of antiglaucoma medications, visual acuity, and complications were compared. RESULTS: There was a significant difference between the UG versus the OAG group with respect to age only (59.3 years vs 68.4 years, p = 0.006). Regression analysis of the postoperative IOP controlled for age and glaucoma type, and preoperative IOP revealed significantly lower IOP in the UG group at 1 month (p = 0.04; 95% confidence interval [CI] -5.9 to 0.15) and 2 months (p = 0.008; 95% CI -6.0 to 0.97). No significant differences were found at 3, 6, 12, 24, and 30 months. The cumulative success rates at 3 to 30 months for the UG and OAG groups were 80% to 66.6% versus 84.9% to 57% (p = 0.713), respectively. The only complication between the 2 groups that was significantly different was tube removal, which occurred more often in the UG group (p = 0.018). INTERPRETATION: AGV implantation is an effective and safe procedure in the management of UG, similar to primary OAG.

The role of carbonic anhydrase inhibitors in the management of macular edema - Wolfensberger, T J (Doc Ophthalmol, 1999)
Medical treatment of cystoid macular edema (CME) with carbonic anhydrase inhibitors has been known for over a decade. Initial observations were based on experimental data which suggested that acetazolamide can increase fluid absorption across the retinal pigment epithelium. Carbonic anhydrase inhibitors (CAI) have also been shown to have other direct effects both on retinal and retinal pigment epithelial cell function by inducing an acidification of the subretinal space, a decrease of the standing potential as well as an increase in retinal adhesiveness. It is thought that acidification of the subretinal space is finally responsible for the increase in fluid resorption from the retina through the RPE into the choroid. Several clinical studies have suggested that patients with cystoid macular edema due to retinitis pigmentosa and uveitis may react more favorably to CAI treatment than other etiologies such as diabetic maculopathy or macular edema after retinal vein occlusion. The present working hypothesis is that diffuse leakage from the RPE responds more readily to CAI treatment than leakage from retinal vessels. This may be due to the modulation of membrane- bound CA IV in the RPE which may have lost its polarised distribution in the presence of macular edema. A normal clinical starting dose of CAI is 500 mg/day which should be continued for at least one month to see an effect. This dose may be reduced by the patients over the course of therapy. Metaphylaxis to the drug may occur with a rebound of the edema despite continuation of treatment.

Intermediate and Long-term Outcomes of Mitomycin C-enhanced Trabeculectomy as a First Glaucoma Procedure in Uveitic Glaucoma - Almobarak, Faisal A; Alharbi, Ali H; Morales, Jose; Aljadaan, Ibrahim (J Glaucoma, 2017)
OBJECTIVES: To evaluate the intermediate and long-term outcomes of mitomycin C-enhanced trabeculectomy as a first glaucoma procedure in uveitic glaucoma. MATERIALS AND METHODS: Retrospective cohort study included 70 eyes of 50 patients with uveitic glaucoma who underwent mitomycin C-enhanced trabeculectomy as a first glaucoma procedure at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1996 and 2014. The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the presence of visually threatening complications, and the need for further surgeries to control the IOP. Surgical outcome of each eye was classified as an absolute success, qualified success, or failure, based on the main outcome measures. RESULTS: The mean follow-up period was 77.0 months (±40.9). The IOP and number of antiglaucoma medications decreased significantly from a mean of 39.5 mm Hg (±8.9) and 3.7 (±0.8) to 14.4 mm Hg (±6.9) and 1 (±1.3) at the last follow-up, respectively (P<0.001 for both). The cumulative probabilities of success were 60% and 35.7% at 36 and 60 months postoperatively, respectively. The most common complications were cataract development and progression (45.3%), hypotony (IOP ≤5 mm Hg) (30%) and IOP spike≥30 mm Hg (10%). Eighteen eyes (25.7%) needed a second procedure to control the IOP. CONCLUSIONS: Although mitomycin C-enhanced trabeculectomy offers reasonable intermediate and long-term IOP control and safety in uveitic glaucoma, a significant number of patients needed further procedures to control the pressure. Thus, continuous monitoring of the pressure and inflammation are crucial.

Metoprolol responding uveitis - Kassif, Y; Rehany, U; Rumelt, S (Eye (Lond), 2004)
BACKGROUND: Noninfectious uveitis is usually managed by topical and systemic corticosteroids and in refractory cases by immunosuppressive drugs. OBJECTIVE: To describe a patient with noninfectious anterior and posterior uveitis, refractory to corticosteroids, and immunosuppressive therapy, which responded to systemic metoprolol. PATIENT AND METHODS: A 49-year-old patient was treated for 3 years with topical and systemic corticosteroids and systemic cyclosporin A for a bilateral anterior and posterior uveitis of unknown origin. The treatment did not result in resolution of the uveitis. A bilateral uveitic glaucoma developed and necessitated neodymium : YAG laser iridotomies and antiglaucoma medications. A systemic beta-blocker, metoprolol tartrate 50 mg b.i.d., was administered for palpitations because of idiopatic paroxysmal supraventricular tachycardia and short ventricular tachycardia. RESULTS: Following administration of metoprolol tartrate, the bilateral uveitis resolved. The corticosteroids and the cyclosporin A were withdrawn after 6 weeks without any recurrence. A trial to discontinue metoprolol after 6 months resulted in flare-up of the disease and only following its readministration the inflammation resolved. The patient is currently under metoprolol for a year without flare-ups. CONCLUSIONS: The use of metoprolol tartrate in this patient resulted in resolution of bilateral noninfectious uveitis. This is the first report of non-antiinfectious, antiinflammatory, or immunosuppressive drug effective for uveitis. It is possible that a subgroup of resistant uveitis may respond to drugs other than the traditional drugs, such as metoprolol, and that other forms of uveitis of unidentified origin exist.

Side effects associated with prostaglandin analog therapy - Alm, Albert; Grierson, Ian; Shields, M Bruce (Surv Ophthalmol, 2008)
Topical prostaglandin analogs, which have become first-line therapy in the medical management of glaucoma, have an excellent safety profile with regard to systemic side effects, but are associated with several ocular side effects. Some of these are common, with no apparent serious consequences other than cosmetic, whereas others are much less common but represent potentially sight-threatening side effects. The former group includes conjunctival hyperemia, elongation and darkening of eyelashes, induced iris darkening, and periocular skin pigmentation. The latter group of side effects, which are relatively rare and lack definitive causal relationship to prostaglandin analog therapy, includes iris cysts, cystoid macular edema, anterior uveitis, and reactivation of herpes simplex keratitis. Most of the literature regarding side effects associated with prostaglandin analogs involves the use of latanoprost, probably because it was the first to be studied. There is no evidence, however, aside from less conjunctival hyperemia with latanoprost, that the commercially available prostaglandin analogs differ significantly with regard to side effects.

Comparison of the ocular beta-blockers - Sorensen, S J; Abel, S R (Ann Pharmacother, 1996)
OBJECTIVE: To compare the similarities and differences among the ocular beta-blockers. Important considerations when comparing these agents are the differences in systemic adverse effects, local tolerability, and cost. DATA SOURCE: Information was retrieved from a MEDLINE search of the English-language literature and bibliographic reviews of review articles. Index terms included beta-blockers, glaucoma, timolol, levobunolol, betaxolol, metipranolol, and carteolol. STUDY SELECTION: Emphasis was placed on eyedrop studies, as well as properly designed and executed clinical trials that assessed dosage, dosing interval, therapeutic response, adverse effects, and cost. DATA EXTRACTION: Data from several studies were evaluated according to the study design, therapeutic response, and adverse effects. DATA SYNTHESIS: Timolol maleate, levobunolol, metipranolol, and carteolol have similar effectiveness in lowering intraocular pressure; however, levobunolol and timolol gel forming solution may have an advantage of once-daily dosing. Studies have not been published comparing the clinical efficacy of timolol hemihydrate with that of other ocular beta-blockers. Metipranolol is cost effective in treating primary open-angle glaucoma; however, it has been associated with more ocular burning, stinging, and granulomatous anterior uveitis than other agents. The intrinsic sympathomimetic activity of carteolol has not yet displayed a definite advantage over the other agents in terms of optic disk perfusion and systemic adverse effects. The control of intraocular pressure with betaxolol has not always been as good as with timolol; however, betaxolol has some advantages over timolol and the other topical beta-blockers in terms of systemic adverse effects. CONCLUSIONS: Considering cost, efficacy, and safety, timolol maleate is the recommended formulary agent because the other agents cannot consistently show an outstanding advantage.

[Hypertony and uveitis: 103 cases of uveitis] - Pogorzalek, N; de Monchy, I; Gendron, G; Labetoulle, M (J Fr Ophtalmol, 2011)
PURPOSE: To determine the prevalence of high intraocular pressure (HIOP) in 103 patients. METHODS: One hundred and three consecutive patients referred to our department for uveitis were included. Files were retrospectively analyzed for age at time of presentation, gender, type of uveitis (as defined by International Uveitis Study Group) and etiology, time of HIOP (primary or secondary to treatment), and associated filtering surgical procedure. Intraocular pressure (IOP) was measured using Goldmann applanation tonometry and HIOP was defined as intraocular pressure 21 mm Hg or higher. RESULTS: Among these patients, 36% of uveitis cases were related to a concomitant infectious disease (herpetic disease in 20% of cases and herpes zoster in 4%). No significant difference in age or gender was found between groups. At least one episode of HIOP was found during the acute phase of the disease in 27 patients (26.2%): anterior uveitis accounted for 74% of patients. Most hypertensive cases were associated with herpetic disease (37%), whereas steroid-induced HIOP was suspected in only two patients (7.4%). HIOP was controlled by topical hypotensive treatment in 74.1% of patients, and a filtering surgical procedure was found necessary in seven patients (25.9%). CONCLUSION: This retrospective study confirms that HIOP is a major complication of uveitis, especially in those involving the anterior chamber of the eye and/or related to viruses. Most cases responded rapidly to combined topical steroids/antiglaucomatous therapy.

Drugs, Inflammation, and the Eye - Cunningham, Emmett T, Jr; London, Nikolas J S; Moorthy, Ramana; Garg, Sunir J; Zierhut, Manfred (Ocul Immunol Inflamm, 2016)

Topical Corticosteroid-Resolved Rubeosis Iridis with Neovascular Glaucoma Caused by Noninfectious Granulomatous Uveitis - Sora, Daisuke; Takayama, Kei; Taguchi, Manzo; Sato, Tomohito; Sakurai, Yutaka; Kanda, Takayuki; Takeuchi, Masaru (Case Rep Ophthalmol, 2018)
PURPOSE: We report a case of topical corticosteroid treatment-resolved rubeosis iridis with neovascular glaucoma (NVG) caused by noninfectious granulomatous uveitis. CASE REPORT: A 61-year-old woman with left ocular pain and blurred vision was referred to our department. Visual acuity and intraocular pressure (IOP) were 20/60 and 37 mm Hg in the left eye, respectively. Inflammatory cells, hyphema, and rubeosis iridis were observed. All laboratory tests, including multiplex polymerase chain reaction for infection using aqueous humor, were negative, and there was neither retinal occlusive vasculitis nor retinal ischemia in the fundus. Our diagnosis was noninfectious granulomatous anterior uveitis-associated NVG. Topical corticosteroid treatment and anti-glaucoma agents resolved inflammation, rubeosis iridis, and NVG. IOP had decreased to 13 mm Hg by 1 month of treatment, and no recurrence was observed. CONCLUSION: Topical corticosteroid could resolve rubeosis iridis and NVG in an eye with noninfectious anterior uveitis. The pathogenesis of NVG in eyes with uveitis is still unknown, but inflammation might have a part in angiogenesis. Anti-inflammatory treatment can be selected as the first choice for anterior uveitis-associated NVG.
Keywords: Inflammation; Uveitis; Neovascular glaucoma; Rubeosis; Topical corticosteroid

The influence of mitomycin C concentration on the outcome of trabeculectomy in uveitic glaucoma - Almobarak, Faisal A; Alharbi, Ali H; Morales, Jose; Aljadaan, Ibrahim (Int Ophthalmol, 2017)
PURPOSE: To evaluate the influence of mitomycin C (MMC) concentration on the outcome of trabeculectomy in uveitic glaucoma. METHODS: Retrospective comparative study included 50 patients who underwent MMC-enhanced trabeculectomy for uncontrolled uveitic glaucoma. Patients were divided into two groups based on the concentration of MMC used during trabeculectomy (high [0.04%] or low [0.02%]). The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the need for further glaucoma surgeries, and trabeculectomy success. RESULTS: There were no differences in the IOP nor antiglaucoma medications. The success rates were 76.0 and 68.0%, while the failure rates were 24.0 and 32.0% in the 0.02 and 0.04% MMC groups, respectively. CONCLUSION: Trabeculectomy augmented with low (0.02%) MMC concentration seems to have comparable outcomes in uveitic glaucoma compared with high (0.04%) concentration.
Keywords: Uveitis; Trabeculectomy; Glaucoma; Mitomycin C; Outcome

Use of ocular hypotensive prostaglandin analogues in patients with uveitis: does their use increase anterior uveitis and cystoid macular oedema? - Chang, J H; McCluskey, P; Missotten, T; Ferrante, P; Jalaludin, B; Lightman, S (Br J Ophthalmol, 2008)
AIM: A retrospective comparative case series was studied to determine whether the use of prostaglandin (PG) analogues to treat raised intraocular pressure (IOP) in patients with uveitis resulted in an increase in the frequency of anterior uveitis or cystoid macular oedema (CMO). METHODS: 163 eyes of 84 consecutive patients with uveitis and raised IOP treated with a PG analogue at two tertiary referral uveitis clinics were identified over a 3-month period. Control eyes were selected as those uveitic eyes of the same patients, which were treated with topical IOP-lowering agent(s) other than a PG analogue. Pretreatment IOP was compared with the mean IOP during PG analogue treatment. The frequency of anterior uveitis and CMO during PG analogue treatment was compared with the frequency of these complications in the control eyes during non-PG IOP-lowering treatment. RESULTS: Significant IOP reductions were observed during PG analogue treatment. There was no significant difference in the frequency of anterior uveitis in those eyes treated with PG analogues and those treated with non-PG agents (p = 0.87, Fisher exact test). None of the 69 uveitic eyes without a previous history of CMO developed this complication. There was no increase in the frequency of visually significant CMO during PG treatment compared with that during non-PG treatment (p = 0.19, Fisher exact test). CONCLUSION: This study demonstrates that PG analogues are potent topical medications for lowering raised IOP in patients with uveitis and are not associated with increased risk of CMO or anterior uveitis.

[Secondary glaucoma in uveitis] - Deuter, C M E; Klinik, T; Müller, M; Geerling, G; Zierhut, M (Ophthalmologe, 2010)
Secondary glaucoma represents a frequent complication especially in chronic forms of uveitis. Different immunological and mechanical alterations can be responsible for the elevation of intraocular pressure (IOP). To enable a tailored treatment strategy the diagnostic process has to include the search for characteristic findings which can be indicative for the underlying uveitis entity. Sometimes it can be difficult to distinguish inflammatory glaucoma from primary non-inflammatory forms of glaucoma as well as from steroid-induced elevation of IOP. Treatment of secondary glaucoma due to uveitis has to include not only medicinal and surgical lowering of IOP but also control of the inflammation, e.g. by immunosuppressive or antiviral drugs. Under normal conditions, beta-receptor antagonists and carbonic anhydrase inhibitors will represent first-line topical treatment. Besides cyclodestructive and filtrating procedures, the use of drainage implants has gained importance in the surgical treatment of secondary glaucoma due to intraocular inflammation.

Putative side effects of prostaglandin analogs - Schumer, Robert A; Camras, Carl B; Mandahl, Agneta K (Surv Ophthalmol, 2002)
Anecdotal case reports describe the occurrence of cystoid macular edema, iritis, herpes simplex keratitis, periocular skin darkening, and headaches in patients treated with prostaglandin analogs for glaucoma. The purpose of this article is to critically analyze these anecdotal case reports in light of a few well-controlled, randomized clinical studies to determine whether conclusions can be made about a causal relationship between the use of prostaglandin analogs and the occurrence of these side effects. None of these putative side effects has been proven to be causally related to latanoprost therapy using valid scientific methodology. These possible side effects occur rarely. Cystoid macular edema, iritis, and herpes simplex keratitis occur in eyes with risk factors. To scientifically establish a causal relationship between drug therapy and rare side effects, repeated rechallenging with masked controls is required. With rare exception, such methodology has not been used with any of these putative side effects. Nevertheless, even without firm establishment of a causal relationship, caution is advised with the use of prostaglandin analogs in eyes with risk factors for cystoid macular edema, iritis, and herpes simplex keratitis until properly designed, large, controlled studies provide more definitive information.

[Uveitic macular edema and the pharmacotherapy] - Liu, Xinshu; Zhang, Meifen (Zhonghua Yan Ke Za Zhi, 2015)
Macular edema represents a major cause of visual loss in uveitis and its adequate management is crucial for the maintenance of useful vision in patients with uveitis. Corticosteroid is the first choice for UME treatment.Long term and sustained release implantation is the newest administration for medical therapy. The immunosuppressant such as cyclosporine, methotrexate, azathioprine and mycophenolate mofetil can be used specially for chronic and intractable UME. Moreover, these years, some newly developed biological agents, for example, anti-VEGF, interferon-α, anti-TNF and acetazolamide will provide new options for UME pharmacotherapy.

Uveitis following dengue fever - Gupta, A; Srinivasan, R; Setia, S; Soundravally, R; Pandian, D G (Eye (Lond), 2008)
OBJECTIVE: To report the occurrence of uveitis in patients with prior history of dengue fever. METHODS: A case series of patients with uveitis, presenting with ocular symptoms 3-5 months after contracting dengue fever during the dengue epidemic without any other attributable cause for uveitis. The dengue fever had subsided without any complication. None of the patients had any ocular complication during the acute dengue infection. They were treated on the lines of uveitis with local steroids, cycloplegic, and ocular hypotensive medications, when required, and oral steroid in case of posterior segment involvement. Patients' follow-up varied from 3-5 months. RESULTS: Six patients with serological evidence of prior dengue fever had presented with uveitis not attributable to any other disease. Seven eyes of six patients were affected. Anterior uveitis without any evidence of posterior segment involvement was present in six eyes of five patients whereas one patient had severe vitritis also. The most common symptom was progressive decrease in vision and only three out of seven eyes had evidence of ciliary congestion. All patients promptly responded to the treatment and visual acuity returned to 6/9 or better in five eyes, while 6/24 and 6/18 in other two eyes due to the presence of cataract. None of these patients had recurrence during the follow-up period. CONCLUSION: Uveitis in dengue infection is rare and ophthalmologists should be aware of these delayed ophthalmic complications. The prognosis of post-dengue uveitis is good.

Clinical review: Update on treatment of inflammatory macular edema - Ossewaarde-van Norel, Annette; Rothova, Aniki (Ocul Immunol Inflamm, 2010)
The aim of this review is to summarize the recent developments in the treatment of inflammatory macular edema (ME). Inflammatory ME represents a major cause of visual loss in uveitis and its adequate management is crucial for the maintenance of useful vision in patients with uveitis. Recent studies favor early treatment of inflammatory ME, even in patients with full visual acuity. After recapitulating the standard treatment modalities for inflammatory ME the authors address novel corticosteroid implants. They review the literature on the efficacy of anti-VEGF agents for inflammatory ME and point out their beneficial, but transient effects. Further, they present recent data on the value of systemic biologics in uveitic ME and evaluate the effectiveness of vitrectomy. Finally, they propose an algorithm for the treatment of inflammatory ME and point out that the individual risk-benefit ratio, especially with systemic immunosuppressive therapy, should always be considered.

Prolonged Ocular Inflammation in Endotoxin-Induced Uveitis in Lysosomal Phospholipase A2-Deficient Mice - Sawada, Kanako; Hiraoka, Miki; Abe, Akira; Kelly, Robert; Shayman, James A; Ohguro, Hiroshi (Curr Eye Res, 2016)
PURPOSE: The goal of present study was to elucidate the pathophysiological roles of lysosomal phospholipase A2 (LPLA2) in intraocular pressure (IOP) levels and ocular inflammation. METHODS: C57BL/6 (wild-type) and LPLA2-deficient mice with C57BL/6 background were employed. The IOPs were compared between wild-type and LPLA2-deficient mice during their aging, after topical administration of antiglaucoma medications such as travoprost, dorzolamide, or timolol maleate, or after induction of endotoxin-induced uveitis (EIU) using lipopolysaccharide (LPS). Concerning the EIU, ocular inflammation was also evaluated by immunohistochemical analysis by the anti-glial fibrillary acidic protein (GFAP) antibody. RESULTS: The LPLA2-deficient mice showed higher IOP levels than the wild-type mice until 2 months of age (P = 1.60E-06); in older mice there was no difference between the two groups. Significant differences in the IOP changes between groups in young mice were seen after administration of 0.5% timolol (P < 0.05). Upon induction of EIU by LPS, compared with wild-type mice (P < 0.05), IOPs were significantly elevated in LPLA2-deficient mice at maximum levels of the ocular inflammation (48 h). Immunohistochemical analysis indicated that LPLA2-deficient mice showed more prolonged expression of GFAP at the inner plexiform layer and inner nuclear layer by EIU than that found in the wild-type mice (P < 0.05). CONCLUSIONS: These results confirm that LPLA2 plays a significant role in the control of IOP during mouse ocular development or with ocular inflammation by facilitating the digestion of intraocular insoluble materials.
Keywords: intraocular pressure; Antiglaucoma medicines; endotoxin-induced uveitis; lysosomal phospholipase A2; mice

Assessing the cost-effectiveness of switching from a beta-blocker to latanoprost in the treatment of ocular hypertension - Costagliola, Ciro; Parmeggiani, Francesco; Sebastiani, Adolfo (Expert Opin Pharmacother, 2003)
Glaucoma is a pathological condition whose most important risk factor is increased intraocular pressure (IOP). The medical treatment of glaucoma essentially consists of compounds that are able to decrease the IOP. The compounds discussed in this review act in a different way, beta-blockers mainly inhibit the production of aqueous humor, whereas latanoprost decreases the resistance in the outflow channels. beta-Blockers are compounds with a well-known efficacy and safety profile and they are fairly inexpensive. Their systemic and local side effects are mainly cardiovascular and pulmonary adverse events, dry eye and keratopathy. Latanoprost, which has recently been introduced into the market, has been shown to be equally as effective, or better in lowering IOP in patients than timolol, although it is more expensive. Systemic reported side effects are anecdotal; local hyperaemia, keratopathy, hypertrichosis, increased pigmentation of eyelashes and iris, uveitis and cystoid macular oedema have been reported. A comparison of costs reveals that a 1-year therapy with timolol ophthalmic solution starts from 11.00 Euros and can reach 146.00 Euros for the most expensive preservative-free 1-day dispenser packages (approximately 13.5 times higher). For latanoprost once-daily administration, the cost for 1 years therapy is 98.55 Euros, approximately six times higher than generic or brand 0.5% timolol applied twice-daily. What are the factors influencing a change in therapy from beta-blockers to latanoprost? The only good reason is represented by a further deterioration in the visual field. This may occur, despite a significant reduction in IOP, because the reached IOP is not sufficient enough to avoid further deterioration because the patient's work or social activities do not allow a correct daily dosage of the compound (bad compliance); or as a result of treatment suspension, because of the development of systemic and/or local side effects. Changes in therapy must always be related to a failing control of the disease, as any therapeutic modification leading to an increase in the number of visits and additional examinations, consequently enhances the costs.

Additive effect of nitric oxide and prostaglandin-E2 synthesis inhibitors in endotoxin-induced uveitis in the rabbit - Bellot, J L; Palmero, M; García-Cabanes, C; Espí, R; Hariton, C; Orts, A (Inflamm Res, 1996)
The involvement of nitric oxide (NO) and prostaglandin E2 (PGE2) was investigated in a model of intraocular inflammation induced by intravitreal injection of endotoxin (lipopolysaccharide, LPS, 10 ng) in rabbits. The severity of uveitis, the myeloperoxidase (MPO) activity in iris-ciliary body, and the protein concentration in aqueous humor were determined. Nitric oxide synthase (NOS) and cyclooxygenase (COX) activities were assessed respectively by nitrite and PGE2 levels in aqueous humor. Treatment with inhibitors of NOS (NG-nitro-L-arginine methyl ester, L-NAME, 50 mg/kp i.p.) or COX (diclofenac, 30 micrograms, topically), alone or in combination, were compared to a saline-treated group. Diclofenac or L-NAME alone reduced or delayed the intensity of uveitis, and partially decreased the protein concentration in aqueous humor; diclofenac, but not L-NAME, partially reduced the polymorphonuclear leukocyte infiltration in the iris ciliary body as indicated by the MPO activity. Treatment with both inhibitors in combination diminished the clinical uveitis, the disruption of the blood-aqueous barrier and the MPO activity in the iris-ciliary body. We conclude that NO and PGE2 have additive effects in endotoxin-induced uveitis in rabbits, and that the inhibition of both pathways would improve the therapeutical management of uveitis.

The Influence of Phacoemulsification on Intraocular Pressure Control and Trabeculectomy Survival in Uveitic Glaucoma - Almobarak, Faisal A; Alharbi, Ali H; Morales, Jose; Aljadaan, Ibrahim (J Glaucoma, 2017)
OBJECTIVES: To evaluate the influence of phacoemulsification on intraocular pressure (IOP) control and survival of mitomycin C (MMC)-enhanced trabeculectomy in uveitic glaucoma (UG). MATERIALS AND METHODS: Retrospective case-control study included 54 eyes from 40 patients with UG who underwent MMC-enhanced trabeculectomy as an initial procedure to treat glaucoma at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 2002 and 2014. Eyes were divided into 2 groups: the first group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second group included eyes that did not have cataract surgery. The main outcome measures were changes in the IOP, the number of antiglaucoma medications, IOP control, and trabeculectomy survival. RESULTS: There were no differences in the overall trabeculectomy survival of eyes that underwent cataract surgery and those that did not (P=0.681, log-rank) nor the final IOP [15.54 mm Hg (±6.3) in the study group and 13.34 mm Hg (±5.6) in the control group, P=0.247]. However, more antiglaucoma medications were needed to control the IOP after cataract surgery at the last follow-up [1.59 medications (±1.4) in the study group and 0.50 medications (±0.7) in the control group; P=0.009]. CONCLUSIONS: UG eyes that underwent phacoemulsification following MMC-enhanced trabeculectomy required more medications to control the IOP than those that did not undergo cataract surgery and therefore less IOP control. Such changes in IOP control did not affect the overall trabeculectomy survival rate.

Brimonidine Induced Anterior Uveitis - Beltz, Jacqueline; Zamir, Ehud (Ocul Immunol Inflamm, 2015)
PURPOSE: To present the largest series reported so far of brimonidine induced granulomatous anterior uveitis. METHODS: Retrospective chart review of patients with chronic glaucoma on treatment with brimonidine presenting with anterior uveitis. RESULTS: 19 eyes of 12 patients with chronic glaucoma developed anterior uveitis with granulomatous keratic precipitates after being treated with brimonidine for periods of 7 days to 5 years (mean 19.7 months, +18.6 months). One patient had a gap of 1 year between onset in one eye and onset in the other. Ten eyes (52.6%) had concurrent granulomatous conjunctivitis; 16 eyes were pseudophakic. Stopping brimonidine led to complete, rapid resolution of uveitis in all patients, in most cases (11 eyes, 58%) without topical corticosteroids. No recurrences have occurred after withdrawal of brimonidine, over a follow-up period of 12-52 months (mean 27.9 months, +13.8 months). CONCLUSIONS: Ophthalmologists should be aware of this easily reversible uveitis syndrome that is induced by a common glaucoma medication. Familiarity with this entity is essential in making the correct diagnosis and avoiding unnecessary investigations and interventions.
Keywords: Brimonidine uveitis; drug induced uveitis

Outcomes of Trabeculectomy With Mitomycin-C in Uveitis Associated With Vogt-Koyanagi-Harada Disease - Almobarak, Faisal A; Alharbi, Ali H; Morales, Jose; Aljadaan, Ibrahim (J Glaucoma, 2016)
OBJECTIVES: To evaluate the outcomes of trabeculectomy with mitomycin-C (MMC) in uveitis associated with Vogt-Koyanagi-Harada disease (VKH). METHODS: Retrospective cohort study included 27 eyes of 15 patients with uveitic glaucoma associated with VKH disease who underwent trabeculectomy with MMC as a first glaucoma procedure at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1992 and 2011. The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the presence of visually threatening complications, and the need for further surgeries to control the IOP. RESULTS: The mean follow-up was 78.19 months. The IOP decreased significantly from a mean of 40.15±7.0 to 13.12±6.9 mm Hg on the last follow-up (P<0.01) as well as during the whole follow-up period. The number of medications needed to control the IOP also decreased significantly from 3.89±0.6 to 1.04±1.3. The cumulative probabilities of success were 77.8%, 74.1%, 63.0%, and 51.9% at 12, 24, 36, and 48 months postoperatively, respectively. The most common complications were cataract development and progression (53.8%), hypotony (IOP≤5 mm Hg) (33.3%), choroidal effusion (7.4%), and decompressive retinopathy (7.4%). Eight eyes (29.6%) needed a second procedure to control the IOP. CONCLUSIONS: Trabeculectomy with MMC offers an acceptable intermediate term success and IOP control in uveitic glaucoma associated with VKH. However, significant number of eyes needed further procedures to control the pressure. Therefore, continuous monitoring of the pressure is important.

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

Assessment of the Anterior Chamber Flare and Macular Thickness in Patients Treated with Topical Antiglaucomatous Drugs - Selen, Fırat; Tekeli, Oya; Yanık, Özge (J Ocul Pharmacol Ther, 2017)
PURPOSE: To determine the changes in the anterior chamber flare and central macular thickness (CMT) under topical antiglaucomatous therapy. METHODS: This study included 121 eyes of 73 patients and 36 eyes of 18 controls. Glaucoma patients were divided into 3 groups (timolol maleate, latanoprost, and bimatoprost). Control eyes did not receive any medications. Flare and CMT measurements were performed at baseline and follow-up visits (15th day, and 1st, 3rd, 6th, and 12th month). RESULTS: Statistically significant increases were detected in the flare values in the bimatoprost and latanoprost groups (P < 0.001, P = 0.011, respectively). Significant increases were also found in CMT values measured in these 2 groups (P < 0.001, P = 0.002, respectively). However, increased flare and CMT values were not clinically manifested as uveitis and macular edema. Flare and CMT values did not change statistically in the timolol maleate and control groups. CONCLUSIONS: Although the use of prostaglandin (PG) analogs was found to be associated with increased flare and CMT, these increases were not clinically significant. PG analog monotherapy may be safely and effectively used in the treatment of glaucoma.
Keywords: glaucoma; macular edema; central macular thickness; prostaglandins; flare

A preliminary risk-benefit assessment of latanoprost and unoprostone in open-angle glaucoma and ocular hypertension - Eisenberg, D L; Camras, C B (Drug Saf, 1999)
Latanoprost and unoprostone (isopropyl unoprostone) represent the first commercially available prostaglandin analogues to be used for the treatment of glaucoma. Both compounds reduce intraocular pressure by enhancing uveoscleral outflow. Latanoprost, when used once daily in the evening, produces a greater reduction in pressure than timolol. Latanoprost produces mild conjunctival hyperaemia compared with timolol in some patients. Darkening of the irides has been reported, especially in green-brown, yellow-brown and blue/grey-brown irides. Hypertrichosis and hyperpigmentation of the eyelashes have also been demonstrated. Although latanoprost has not been proven to cause uveitis or cystoid macular oedema, case reports of an association exist. Latanoprost does not produce systemic adverse effects nor does it alter routine blood analyses. Unoprostone, when given twice daily, produces less of a reduction in intraocular pressure than timolol or latanoprost. Three times daily use may be required to approach the effectiveness of timolol. Unoprostone may have a similar adverse effect profile to latanoprost, but may to cause more corneal epithelial problems. Unoprostone is also not known to cause systemic adverse effects. Both agents are welcome additions to the treatment of glaucoma. However, additional studies and more experience are needed with each agents.

Subfoveal serous retinal detachment in patients with uveitic macular edema - Ossewaarde-van Norel, Jeannette; Berg, Elize M; Sijssens, Karen M; Rothova, Aniki (Arch Ophthalmol, 2011)
OBJECTIVE: To assess the clinical characteristics and effect on visual acuity (VA) of a subfoveal serous retinal detachment (SRD) associated with macular edema (ME) in patients with uveitis. METHODS: Clinical and optical coherence tomograph characteristics were retrospectively assessed in 37 patients with uveitic ME with a subfoveal SRD (case individuals) and 61 patients with uveitic ME without a subfoveal SRD (control individuals), matched for uveitis location, sex, and age. Scans of the case and control individuals took place between September 19, 2003, and July 21, 2008. RESULTS: Patients with a subfoveal SRD had a shorter history of uveitis (P = .03) and ME (P = .03) and a lower VA (P = .003). Mean total retinal thickness (TRT) in cases exceeded that of controls (449 vs 326 μm; P < .001). The median subfoveal SRD duration was 2 months, and 29 of 36 SRDs (81%) had disappeared at the 3-month follow-up examination. The improvement in VA and the decrease in TRT after 3 months were better in the subfoveal SRD group than in the control group (P = .001 for VA and P = .001 for TRT), resulting in similar VA and TRT after 3 months. CONCLUSIONS: A subfoveal SRD was associated with lower VA and developed typically in the early stages of uveitis and ME. The subfoveal SRD and VA reacted favorably to treatment with periocular and systemic steroids and/or oral acetazolamide.

Evaluation of Efficacy and Safety of Latanoprost/Timolol versus Travoprost/Timolol Fixed Combinations for Ocular Hypertension Associated with Uveitis - Takeuchi, Masaru; Kanda, Takayuki; Taguchi, Manzo; Shibata, Masaki; Mine, Izumi; Sakurai, Yutaka (Ocul Immunol Inflamm, 2016)
PURPOSE: To compare latanoprost/timolol (LT) versus travoprost/timolol (TT) fixed combinations for ocular hypertension (OHT) associated with uveitis. METHODS: Thirty-six patients (55 eyes) who were treated with LT (28 eyes) or TT (27 eyes) for OHT associated with uveitis were reviewed retrospectively. Intraocular pressure (IOP) and inflammation scores at the initiation of treatment and at the last visit during therapy were analyzed. RESULTS: Although IOP was reduced significantly in both LT and TT groups, the reduction rate was significantly greater with TT group than with LT. The differences in the reduction of IOP between the groups remained significant when the cases were classified into inflammation-induced OHT and steroid-induced OHT. Inflammation score was not exacerbated by LT or TT treatment. CONCLUSIONS: Both LT and TT are safe and effective for the treatment of OHT associated with uveitis and greater IOP reduction may be achieved by TT than by LT treatment.
Keywords: uveitis; uveitic glaucoma; Ocular hypertension; prostaglandin (PG) analog; secondary glaucoma; β-blocker

Combined Ahmed valve and phacoemulsification with intraocular lens implantation under infliximab in refractory uveitic glaucoma - Parihar, Jitendra K S; Kaushik, Jaya; Jain, Vaibhav K; Trehan, Hemant S; Mishra, Avinash; Baranwal, Vinod K (Eur J Ophthalmol, 2017)
PURPOSE: To evaluate the outcome of combined Ahmed glaucoma valve (AGV) and phacoemulsification with posterior chamber intraocular lens implantation under infliximab in refractory uveitic glaucoma (UG). METHODS: In this prospective interventional case series, 26 eyes of 26 patients with refractory UG underwent surgery under intravenous infliximab. The success rate was defined as intraocular pressure (IOP) 5 to 21 mm Hg with or without antiglaucoma medications (AGM), without additional glaucoma surgical intervention. RESULTS: The mean IOP (37.8 ± 11.86 to 12.2 ± 2.8 mm Hg; p<0.0001) and mean number of AGM (3.4 ± 1.2 to 0.4 ± 0.1; p<0.001) were significantly reduced after surgery at 2 years. Kaplan-Meier survival analysis showed a cumulative probability of success for IOP control of 92% at 2 years of follow-up. CONCLUSIONS: Combined AGV and phacoemulsification is an effective treatment for controlling refractory UG with complicated cataract under infliximab.
Keywords: Infliximab; Uveitis; Behçet disease; Ahmed glaucoma valve; Postuveitic cataract and glaucoma; Uveitic glaucoma

One-year follow-up of the XEN® implant with mitomycin-C in pseudoexfoliative glaucoma patients - Ibáñez-Muñoz, Ana; Soto-Biforcos, Víctor Santiago; Chacón-González, María; Rúa-Galisteo, Oscar; Arrieta-Los Santos, Alexandra; Lizuain-Abadía, María Ester; Del Río Mayor, José Luis (Eur J Ophthalmol, 2018)
PURPOSE: To evaluate the intraocular pressure-lowering effect, the safety profile, and the success rate of the XEN45 Gel Stent (Allergan, Dublin, Ireland) in patients with pseudoexfoliative glaucoma. METHODS: Retrospective study conducted on patients with pseudoexfoliative glaucoma, with or without cataract, who underwent XEN45 implantation surgery with subconjunctival mitomycin-C and had a minimum postoperative follow-up period of 12 months. The primary outcome measure was intraocular pressure reduction at 1 year as compared to baseline. Complete success was defined as a postoperative intraocular pressure reduction of ⩾20% from preoperative baseline at 12 months without any glaucoma medications. Qualified success was defined as a postoperative intraocular pressure reduction of ⩾20% at 12 months with medications. RESULTS: Of the 24 screened patients, 21 eyes of 20 patients met the inclusion/exclusion criteria and were included in the study. A total of 13 (62%) eyes underwent XEN alone surgery and 8 (38%) eyes had combined XEN + cataract surgery. Mean intraocular pressure was significantly reduced from 21.1 (3.8) mmHg at baseline to 15.2 (3.9) mmHg at 1 year, p < 0.001. Mean antiglaucoma medications dropped from 2.95 (0.97) preoperatively to 1.23 (1.22) at month 12 (p < 0.001). Of the 21 eyes included in the study, 18 (85.7%) were considered as success, 6 (28.6%) as complete success, and 12 (57.1%) as qualified success. Five eyes required needling revision. Complications included uveitis, choroidal detachment, hyphema, and cystoid macular edema in 2, 1, 1, and 1 eye, respectively. CONCLUSION: XEN45 Gel Stent implant significantly reduced the intraocular pressure and the number of antiglaucoma medications in patients with pseudoexfoliative glaucoma.
Keywords: surgery; Glaucoma; pseudoexfoliation; pseudoexfoliative glaucoma; XEN implant

Pharmacological consequences of oxidative stress in ocular tissues - Ohia, Sunny E; Opere, Catherine A; Leday, Angela M (Mutat Res, 2005)
The eye is a unique organ because of its constant exposure to radiation, atmospheric oxygen, environmental chemicals and physical abrasion. That oxidative stress mechanisms in ocular tissues have been hypothesized to play a role in diseases such as glaucoma, cataract, uveitis, retrolental fibroplasias, age-related macular degeneration and various forms of retinopathy provides an opportunity for new approaches to their prevention and treatment, In the anterior uvea, both H2O2 and synthetic peroxides exert pharmacological/toxicological actions tissues of the anterior uvea especially on the sympathetic nerves and smooth muscles of the iris-ciliary bodies of several mammalian species. Effects produced by peroxides require the presence of trace amounts of extracellular calcium and the functional integrity of mitochondrial calcium stores. Arachidonic acid metabolites appear to be involved in both the excitatory action of peroxides on sympathetic neurotransmission and their inhibitory effect on contractility of the iris smooth muscle to muscarinic receptor activation. In addition to the peroxides, isoprostanes (products of free radical catalyzed peroxidation of arachidonic acid independent of the cyclo-oxygenase enzyme) can also alter sympathetic neurotransmission in anterior uveal tissues. In the retina, both H2O2 and synthetic peroxides produced an inhibitory action on potassium depolarization induced release of [3H] D-aspartate, in vitro and on the endogenous glutamate and glycine concentrations in vivo. Effects caused by peroxides in the retina are mediated, at least in part, by second messengers such as nitric oxide, prostaglandins and isoprostanes. The ability of H2O2 to alter the integrity of neurotransmitter pools from sympathetic nerves in the anterior uvea and glutaminergic nerves in the retina could underlie its role in the etiology of glaucoma.

Outcome of raised intraocular pressure in uveitic eyes with and without a corticosteroid-induced hypertensive response - Sallam, Ahmed; Sheth, Hiten G; Habot-Wilner, Zohar; Lightman, Susan (Am J Ophthalmol, 2009)
PURPOSE: To compare the management and outcome of raised intraocular pressure (IOP) in uveitis patients with a corticosteroid hypertensive response and those who are noncorticosteroid responders and to determine the impact of intraocular corticosteroid use on IOP in uveitic eyes. DESIGN: Retrospective study. METHODS: Eight hundred and ninety-one uveitis patients were observed in a specialized clinic over 3 months. The main outcome measures were frequency, characterization, management, and outcome of uveitis-related ocular hypertension and glaucoma. RESULTS: Of 891 patients with uveitis, 191 (275 eyes) had IOP elevation (21.4%). Of these, 95 (34.5%) eyes had glaucoma. IOP elevation attributed to corticosteroid-response (61.1%) was controlled more easily than that resulting from other causes (38.9%), requiring fewer eye drops (mean, 2.06 vs 2.52; P = .009) and less filtration surgery (8.9% vs 22.4%). Among eyes with uveitis and raised IOP, elevated IOP developed in 18 eyes (6.5%) after intravitreal triamcinolone, including 64.7% to 30 to 39 mm Hg and 35.3% to 40 mm Hg or more. Prostaglandin analogs were used in 49.2% of 246 eyes; no increase in inflammation was seen in these eyes. CONCLUSIONS: In this tertiary center series, most instances of raised IOP were attributable to corticosteroid response. Raised IOP induced by corticosteroid response was controlled more easily and less often resulted in optic nerve or visual field changes of glaucoma. Although intravitreous triamcinolone was associated with substantial risk of corticosteroid-response IOP elevation, all cases were controlled medically without experiencing glaucomatous injury. Prostaglandin-induced uveitis was not observed despite extensive use of prostaglandin IOP-lowering agents.

Management and outcomes of the small pupil in cataract surgery: iris hooks, Malyugin ring or phenylephrine? - Balal, Shafi; Jbari, Ahmed Said; Nitiahpapand, Rynda; Cook, Erica; Akhtar, Wasim; Din, Nizar; Sharma, Anant (Eye (Lond), 2020)
PURPOSE: To investigate outcomes for small versus large pupils in cataract surgery using different pupil expansion techniques. METHODS: Retrospective case-series reviewing 20,175 patients' cataract surgery electronic medical records at Moorfields Eye Clinic in Bedford Hospital NHS Trust from January 2010 to April 2020. Outcomes such as visual acuity (VA), intraocular pressure, intraoperative, post-operative complications were recorded and small pupil expansion device outcome. RESULTS: One thousand, four hundred twenty-six patients were identified as having small pupil (SP). Of these, 1110 patients (77.8%) had interventions to expand the pupil including 447 (31.3%) with intracameral phenylephrine (IC PE) alone, 194 (13.6%) with iris hooks and 469 (32.9%) with a Malyugin ring. The large pupil (LP) group had a statistically significant greater gain in VA than the SP group (p 0.05) except for a greater rate of iris tears in the Malyugin group (p < 0.05). CONCLUSION: To date, this is the largest reported case-series comparing Malyugin rings and iris hooks with other pupil expansion techniques. The various techniques to expand pupil size appear to be safe and equally effective in improving VA with a similar rate of complications except for a greater rate of iris tears with Malyugin ring.

Effects of topical adrenergic agents on prostaglandin E2-induced aqueous flare and intraocular pressure elevation in pigmented rabbits - Nakamura-Shibasaki, Momoko; Latief, Miftahul Akhyar; Ko, Ji-Ae; Funaishi, Kunihiko; Kiuchi, Yoshiaki (Jpn J Ophthalmol, 2016)
PURPOSE: To evaluate the effects of signals through adrenergic receptors on the changes in the aqueous flare and intraocular pressure (IOP) induced by topical prostaglandin E2 (PGE2) in pigmented rabbits. METHODS: Adrenergic agents were applied topically to pigmented Dutch rabbits, and PGE2 was then applied to induce an increase in the aqueous flare and IOP. The degree of aqueous flare was measured with a laser flare meter, and the IOP was measured with a rebound tonometer. Measurements were made every 30 min after the PGE2 had been applied for 2 h and at 4.0 and 4.5 h. Repeated measure analysis of variance and Dunnett's post hoc tests were used for the statistical analyses. RESULTS: The topical application of PGE-2 increased the aqueous flare for more than 4.5 h. The topical instillation of 1.0 % apraclonidine significantly inhibited the increase in the PGE2-induced aqueous flare by 75.1 %, of 0.1 % brimonidine by 57.2 %, of 0.04 % dipivefrin by 57.4 %, and a combination of 0.1 % brimonidine and 5 % phenylephrine by 78.9 %. Topical 5.0 % phenylephrine and 0.05 % isoproterenol had little effect on the aqueous flare elevation induced by PGE2. The IOP increased 0.5 h after the topical application of PGE-2. Topical 1.0 % apraclonidine, 0.1 % brimonidine, 0.1 % dipivefrin, and the combination of 0.1 % brimonidine and 5.0 % phenylephrine significantly inhibited the PGE2-induced IOP elevation. However, topical 5.0 % phenylephrine and 0.05 % isoproterenol did not significantly inhibit the IOP elevation caused by PGE2. CONCLUSIONS: Signaling by the α2 receptor inhibits both the PGE2-induced flare and IOP elevation caused by topical PGE2 application.
Keywords: Intraocular pressure; Adrenergic agents; Aqueous flare; Prostaglandin E2

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

A new, minimally invasive procedure for dogs with encapsulated Ahmed drainage implants and elevated intraocular pressures: A case series - Berkowski, William, Jr; Michau, Tammy; Stine, Jessica; Plummer, Caryn; Sherwood, Mark B (Vet Ophthalmol, 2020)
OBJECTIVE: To describe a novel, minimally invasive method for re-establishing aqueous humor outflow in dogs with refractory glaucoma after fibrous encapsulation of their Ahmed drainage implants. PROCEDURE: Three dogs (4 eyes) underwent trans-capsular implantation of an Alcon EX-PRESS(®) glaucoma filtration device under sedation (2 dogs) or general anesthesia (1 dog). After rotating the eye downwards, a 2 mm incision was made in the conjunctiva/Tenon's capsule overlying the encapsulated Ahmed plate, and later closed with absorbable suture. All eyes received subconjunctival mitomycin-C 0.02 mg. RESULTS: Mean post-operative follow-up was 341 days (range: 77-530). All eyes were hypertensive pre-operatively (mean IOP: 31.25 ± 7.14 mmHg) despite receiving topical latanoprost (4/4), timolol (4/4), carbonic anhydrase inhibitors (4/4), and demecarium bromide (2/4). Two eyes (dogs 1 and 2) were visual pre-operatively, while 2 eyes (dog 3) displayed equivocal or no vision. Post-operatively, all eyes received timolol and a carbonic anhydrase inhibitor. Other anti-hypertensive medications were discontinued. Immediately following surgery, all eyes were mildly hypotensive (mean IOP: 5.75 ± 1.71 mm Hg). Two of 4 eyes were normotensive and visual until days 90 (dog 2) and 530 (dog 1) (IOP range: 10-16 mm Hg). One eye (dog 3) was normotensive for approximately 150 days, and then hypertension returned. One eye (dog 3) from the start displayed severe uveitis, hypertensive episodes, and was phthisical by the end of follow-up. CONCLUSIONS: Trans-capsular EX-PRESS(®) implantation is a minimally invasive procedure for treatment of refractory glaucoma in dogs with encapsulated Ahmed drainage implants, and further investigation is warranted.
Keywords: 6 Glaucoma; Ahmed drainage implant; encapsulated bleb; EX-PRESS® implant; fibrous encapsulation

Cytomegalovirus anterior uveitis in immunocompetent individuals following topical prostaglandin analogues - Babu, Kalpana; Murthy, Gowri Jaydev (J Ophthalmic Inflamm Infect, 2013)
BACKGROUND: The aim of this study is to report two interesting cases of cytomegalovirus (CMV) anterior uveitis following topical prostaglandin analogue administration for glaucoma. Two retrospective case studies are presented. FINDINGS: A 40-year-old immunocompetent lady with a history of Fuchs heterochromic iridocyclitis with secondary glaucoma in the right eye since 2005 was diagnosed to have CMV anterior uveitis by a multiplex polymerase chain reaction (PCR) in 2009. She developed a reactivation of anterior uveitis following the addition of latanoprost 0.005% eye drops unknowingly by her local ophthalmologist. The pattern of endothelial deposits seen with this reactivation of uveitis was different from that seen in earlier or in subsequent reactivations. A 46-year-old immunocompetent lady with a history of primary open-angle glaucoma and no history of uveitis presented with anterior uveitis with medium-sized keratic precipitates following administration of travatoprost 0.004% eye drops. In both cases, the CMV antigen was demonstrated in the aqueous by multiplex PCR at the time of reactivation. Both cases required treatment with dexamethasone eye drops, ganciclovir 1% gel and oral valganciclovir for the control of inflammation along with antiglaucoma medications. CONCLUSIONS: We report two immunocompetent cases with the development of CMV-related anterior uveitis following administration with prostaglandin analogues. These cases increase the awareness of CMV anterior uveitis in immunocompetent individuals and the need to use prostaglandin analogues with caution.

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

Prostaglandin analogs and blood-aqueous barrier integrity: a flare cell meter study - Cellini, M; Caramazza, R; Bonsanto, D; Bernabini, B; Campos, E C (Ophthalmologica, 2004)
PURPOSE: To study, with an objective method, inflammation of the anterior segment of the glaucomatous eye after treatment with latanoprost, travoprost and bimatoprost. MATERIALS AND METHODS: Sixty patients with chronic open-angle glaucoma aged between 38 and 76 years (mean 64.0 +/- 12.2) were randomly assigned to latanoprost 0.005, travoprost 0.004 and bimatoprost 0.03%. The study period lasted 6 months. Intraocular pressure (IOP) was measured every 2 weeks. We studied the intraocular inflammation before and after 3 and 6 months of therapy with an instrument composed of a He-Ne laser beam system, a photomultiplier mounted on a slitlamp microscope and a computer. This flare meter allows objective determination of the flare and the number of cells in the aqueous of the anterior chamber. RESULTS: At the baseline, IOP was 26.4 +/- 3.6 mm Hg. After 3 months of treatment, mean IOP in the latanoprost group was 17.9 +/- 0.3 mm Hg (p < 0.001) with a mean cellularity of 12.638 +/- 3.284 photons/ms (p < 0.001). The travoprost group had an IOP of 17.2 +/- 0.3 mm Hg (p < 0.001) with a cellularity of 9.719 +/- 1.927 photons/ms (0.001). Finally, IOP in the bimatoprost group was 17.6 +/- 0.5 mm Hg (p < 0.001) with a cellularity of 6.138 +/- 1.475 photons/ms (p < 0.032). After 6 months of treatment, IOP in the latanoprost group was 18.1 +/- 0.3 (p < 0.001), in the travoprost group 17.3 +/- 0.3 (p < 0.001) and in the bimatoprost group 17.7 +/- 0.5 mm Hg (p < 0.001), whereas cellularity was 11.838 +/- 3.218 (p < 0.001), 8.950 +/- 3.692 (p < 0.001) and 7.617 +/- 2.603 photons/ms (p < 0.001), respectively. After 3 months, the travoprost (p < 0.013) and the bimatoprost groups (p < 0.001) had less flare compared with the latanoprost group and this remained so even at 6 months. When we compared the travoprost group with the bimatoprost group, we found significantly less flare at 3 months in the bimatoprost group (p < 0.001) but not at 6 months (p < 0.246). CONCLUSIONS: The flare meter analysis shows that the eyes treated with bimatoprost and travoprost have a less significantly broken blood-aqueous barrier and their anterior chamber is also significantly less inflamed.

Metipranolol-associated granulomatous iritis - Melles, R B; Wong, I G (Am J Ophthalmol, 1994)
PURPOSE: Topical metipranolol therapy for primary open-angle glaucoma has been associated with anterior granulomatous uveitis in the United Kingdom. We studied granulomatous uveitis reactions to topical metipranolol 0.3% therapy for primary open-angle glaucoma in two patients in the United States. METHODS: Two patients, aged 71 and 81 years, were given topical metipranolol 0.3% therapy for primary open-angle glaucoma. RESULTS: Both developed granulomatous uveitis. The iritis was associated with an increase in intraocular pressure in both patients and resolved on discontinuation of the drug. One patient was inadvertently rechallenged with metipranolol, and the iritis recurred. CONCLUSIONS: Topical metipranolol 0.3% therapy may be associated with the development of granulomatous uveitis and a paradoxical increase in intraocular pressure.

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

Clinical profile of uveitis-related ocular hypertension - Mahajan, Deepankur; Sharma, Reetika; Garg, Sat Pal; Venkatesh, Pradeep; Sihota, Ramanjit; Dada, Tanuj (Int Ophthalmol, 2014)
The purpose of this article is to study the clinical and demographic profile of uveitis-related ocular hypertension (OHT) and evaluate risk factors predisposing to development of OHT in uveitis. Two hundred patients (200 eyes) with uveitis were evaluated for type of uveitis and the presence of OHT [IOP > 21 mmHg]. All patients underwent a complete ophthalmic examination and appropriate systemic evaluation. Patients with OHT were started on appropriate antiglaucoma medication and were followed up for minimum of 6 months. Forty-two eyes (21 %) were found to have OHT. Anterior uveitis alone was seen in 22 (52.4 %), granulomatous uveitis was seen in 8 (19.1 %) eyes, while 13 eyes (30.9 %) had active uveitis. On multiple logistic regression, age greater than 60 years (p = 0.025), peripheral anterior synechiae (PAS) > 180° (p = 0.029), and steroid use (p 180°, and corticosteroid use.

Outcome of Ocular Steroid Hypertensive Response in Children - Kaur, Savleen; Dhiman, Indu; Kaushik, Sushmita; Raj, Srishti; Pandav, Surinder S (J Glaucoma, 2016)
PURPOSE: The aim of our study was to analyze the epidemiological profile and outcome of steroid-induced ocular hypertension in children below 12 years of age in a tertiary eye center. METHODS: Hospital records of patients attending the pediatric glaucoma clinic from July 2005 to December 2012 at our center were retrospectively reviewed. Steroid-induced ocular hypertension was defined as intraocular pressures (IOP)>21 mm Hg (or an increase of>6 mm from baseline) with or without associated glaucomatous optic neuropathy after intake of steroids in any form. Demographic data, management details and IOP, anterior segment, and posterior segment findings were recorded. The main outcome measure was the control of IOP after treatment. RESULTS: Of the acquired pediatric glaucoma patients, 24% were steroid-induced ocular hypertensives (36 of 150 patients) (mean age group 9.2 ± 2.4 y). We studied 57 eyes of 36 patients that had an IOP>21 mm Hg after steroid intake. Of the 36 patients, 22 had bilateral steroid hypertensive response. Of all the patients, 15 (41.6%) received steroids because of vernal conjunctivitis, 16 (22 eyes) could be managed by withdrawing steroids only, 13 (25 eyes) were controlled by medical therapy, and 7 (10 eyes) needed surgery. Favorable outcome (defined as<21 mm of Hg with/without topical antiglaucoma medications) was achieved in 80.5% at the last follow-up (mean 17.4 ± 23.47 mo; range 4 mo to 8 y). CONCLUSIONS: Our paper emphasizes on the ocular hypertensive side effects of steroids in children. There are many instances where one can avoid the use of steroids and consider nonsteroidal/anti-inflammatory alternatives. Withdrawal of steroids and antiglaucoma medicines are effective in controlling IOP in majority (80.5%).

Cystoid macular edema and anterior uveitis associated with latanoprost use. Experience and incidence in a retrospective review of 94 patients - Warwar, R E; Bullock, J D; Ballal, D (Ophthalmology, 1998)
OBJECTIVE: This study aimed to investigate the incidence of cystoid macular edema and anterior uveitis associated with the use of latanoprost. DESIGN: A retrospective review of patients treated with latanoprost in the authors' practice between September 1, 1996, and August 1, 1997, was performed. PARTICIPANTS: Ninety-four patients and 163 eyes were studied. INTERVENTION: Patients presenting with signs and symptoms of ocular inflammation while receiving latanoprost were noted, and their response to the discontinuation of the drug was recorded. MAIN OUTCOME MEASURES: The presence and degree of anterior uveitis and cystoid macular edema were measured. RESULTS: Six (6.4%) of 94 patients (8 [4.9%] of 163 eyes) had anterior uveitis develop, and 2 (2.1%) of 94 patients (2 [1.2%] of 163 eyes) had cystoid macular edema develop while being treated with latanoprost. CONCLUSION: Although latanoprost is an effective ocular-hypotensive agent, the authors' experience with the drug has shown a significant incidence of anterior uveitis and cystoid macular edema. To the authors' knowledge, this is the first study to report the incidence of both cystoid macular edema and anterior uveitis associated with latanoprost therapy. Treating physicians should be aware of these potential complicating side effects of latanoprost.

Tyrosol ameliorates lipopolysaccharide-induced ocular inflammation in rats via inhibition of nuclear factor (NF)-κB activation - Sato, Kazuaki; Mihara, Yuko; Kanai, Kazutaka; Yamashita, Yohei; Kimura, Yuya; Itoh, Naoyuki (J Vet Med Sci, 2016)
We evaluated the anti-inflammatory effect of tyrosol (Tyr) on endotoxin-induced uveitis (EIU) in rats. EIU was induced in male Lewis rats by subcutaneous injection of lipopolysaccharide (LPS). Tyr (10, 50 or 100 mg/kg) was intravenously injected 2 hr before, simultaneously and 2 hr after LPS injection. The aqueous humor (AqH) was collected 24 hr after LPS injection; the infiltrating cell number, protein concentration, and tumor necrosis factor (TNF)-α, prostaglandin (PG)-E2 and nitric oxide (NO) levels were determined. Histopathologic examination and immunohistochemical studies for nuclear factor (NF)-κB, inhibitor of κB (IκB)-α, cyclooxygenase (COX)-2 and inducible NO synthase (iNOS) in the iris-ciliary body (ICB) were performed at 3 or 24 hr after LPS injection. To further clarify the anti-inflammatory effects, RAW264.7 macrophages were stimulated with LPS in the presence or absence of Tyr. Tyr reduced, in a dose-dependent manner, the infiltrating cell number, protein concentration, and TNF-α, PGE2 and NO levels in AqH and improved histopathologic scores of EIU. Tyr also inhibited LPS-induced COX-2 and iNOS expression, IκB-α degradation and nuclear translocation of activated NF-κB in ICB. Tyr significantly suppressed inflammatory mediator production in the culture medium and COX-2 and iNOS expression and activated NF-κB translocation in LPS-stimulated RAW264.7 cells. These results suggest that Tyr suppresses ocular inflammation of EIU by inhibiting NF-κB activation and subsequent proinflammatory mediator production.

Ocular jellyfish stings - Glasser, D B; Noell, M J; Burnett, J W; Kathuria, S S; Rodrigues, M M (Ophthalmology, 1992)
BACKGROUND: Corneal stings from the sea nettle (Chrysaora quinquecirrha) indigenous to the Chesapeake Bay are usually painful but self-limited injuries, with resolution in 24 to 48 hours. METHODS: Five patients who developed unusually severe and prolonged iritis and intraocular pressure elevation after receiving corneal sea nettle stings were followed for 2 to 4 years. RESULTS: Decreased visual acuity, iritis, and increased intraocular pressure (32 to 48 mmHg) were noted in all cases. Iritis responded to topical corticosteroids and resolved within 8 weeks. Elevated intraocular pressure responded to topical beta blockers and oral carbonic anhydrase inhibitors. Mydriasis (4 of 5 cases), decreased accommodation (2 of 5 cases), peripheral anterior synechiae (2 of 5 cases), and iris transillumination defects (3 of 5 cases) also were noted. Mydriasis and decreased accommodation persisted for 5 months in 1 case and for more than 2 years in another. One patient has chronic unilateral glaucoma. Visual acuity returned to normal in all cases. CONCLUSIONS: The precise relationship between sea nettle venom and the observed clinical responses is not known. Corneal jellyfish stings usually produce a brief and self-limited reaction, but they do have the potential for long-term sequelae.

The additive effect of topical dorzolamide and systemic acetazolamide in pediatric glaucoma - Sabri, Kourosh; Levin, Alex V (J AAPOS, 2006)
BACKGROUND: The effect of adding oral to topical carbonic anhydrase inhibitors in the management of pediatric glaucoma is unknown. METHODS: We undertook a retrospective analysis of children with a diagnosis of glaucoma before the age of 16 years who initially were treated with topical dorzolamide or dorzolamide-timolol combination and then treated with oral acetazolamide. Children who had uveitic glaucoma or who had ocular surgery within 3 months before or during oral acetazolamide therapy were excluded. Various methods of intraocular pressure (IOP) measurement were used in the study. However, in each case, the IOP was measured using the same technique, once at the last visit before the addition of oral acetazolamide and once at the first examination after the addition of oral acetazolamide. RESULTS: Twenty-two patients were included in the study with an age range of 8 months to 15 years. Seventeen children were boys. Oral acetazolamide treatment was via a daily dose (13.3 to 30 mg/kg, mean 22.5 mg/kg), and duration (6 to 31 days, mean 18.1 days). The intraocular pressure (mean +/- SD) before acetazolamide (32.2 +/- 6.5 mm Hg) was significantly different than after acetazolamide (21.8 +/- 6.3 mm Hg) with a mean difference of 10.36 mm Hg (p < 0.0001) and a mean decrease in IOP of 29.6%. CONCLUSIONS: The addition of oral acetazolamide to topical dorzolamide may provide additional reduction in IOP in some children already being treated with topical carbonic anhydrase inhibitors. This possible additive effect has not been observed in adults treated with a combination of topical and systemic carbonic anhydrase inhibitors.

Secondary glaucoma in patients with uveitis - Merayo-Lloves, J; Power, W J; Rodriguez, A; Pedroza-Seres, M; Foster, C S (Ophthalmologica, 1999)
PURPOSE: To evaluate the prevalence of secondary glaucoma (SG), clinical forms of uveitis more frequently associated with glaucoma, and describe the treatment and complications encountered in a cohort of patients with glaucoma and uveitis during a 10-year period. METHODS: The hospital records of patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary for a decade were reviewed for cases of SG. RESULTS: One hundred and twenty of the 1,254 patients (9.6%) with uveitis developed SG. SG was more frequent in anterior uveitis (67%) but was also associated with posterior uveitis (13%) and pars planitis (4%). Herpetic keratouveitis (22%), Fuchs' iridocyclitis (19%), juvenile rheumatoid arthritis-associated iridocyclitis (16%), syphilis (14%), and sarcoidosis (12%) were the leading types of uveitis associated with SG. Despite aggressive medical and surgical therapy, SG was associated with progressive visual field loss and optic nerve damage in 39 patients (33%). CONCLUSION: SG is an underappreciated, vision-threatening complication in patients with uveitis. Increased vigilance for emergence of this complicating problem during the care of patients with uveitis is warranted, and medical and surgical treatment for reducing IOP should be especially aggressive in these patients. We hypothesize that earlier, more aggressive treatment of uveitis will reduce the presence of glaucoma as an additional vision-robbing complication of uveitis.

Comparison of intraocular pressure-lowering effects of ripasudil hydrochloride hydrate for inflammatory and corticosteroid-induced ocular hypertension - Yasuda, Mami; Takayama, Kei; Kanda, Takayuki; Taguchi, Manzo; Someya, Hideaki; Takeuchi, Masaru (PLoS One, 2017)
Ocular hypertension (OHT) caused by inflammation or corticosteroid treatment is a common complication of uveitis. Ripasudil hydrochloride hydrate (K-115) is reportedly efficacious for lowering intraocular pressure (IOP). We retrospectively compared the IOP-lowering effect of K-115 for inflammatory and corticosteroid-induced OHT associated with uveitis. Thirty-six consecutive eyes of 27 patients with uveitis-associated OHT (20 and 16 eyes with inflammation- and corticosteroid-induced OHT, respectively) were treated with K-115 with or without other anti-glaucoma agents. In the inflammation-induced OHT, mean IOP and aqueous flare significantly decreased (P < 0.001 and P = 0.035, respectively), changing from 26.4 ± 7.5 mmHg and 28.1 ± 15.0 photon counts per millisecond (pc/ms) at the initial assessment to 17.9 ± 5.4 mmHg and 17.1 ± 10.7 pc/ms at the last visit, respectively. In the corticosteroid-induced OHT, mean IOP significantly decreased (P = 0.0005), changing from 26.7 ± 7.8 mmHg and 18.7 ± 11.2 pc/ms to 18.6 ± 8.8 mmHg and 22.6 ± 15.3 pc/ms, respectively; conversely, aqueous flare remained unchanged. In the inflammation-induced OHT, K-115 was more efficacious in the eyes with higher IOP. Neither remarkable adverse effects nor exacerbation of uveitis were observed in the eyes of either group during the observation period. K-115 decreased IOP in both inflammation- and corticosteroid-induced OHT associated with uveitis and played a synergistic role in reducing ocular inflammation in uveitis treatment.

Outcome of intravitreal triamcinolone in uveitis - Kok, Howesen; Lau, Chun; Maycock, Nicholas; McCluskey, Peter; Lightman, Susan (Ophthalmology, 2005)
PURPOSE: To report the short-term outcome of intravitreal triamcinolone acetate (TA) in the treatment of uveitic cystoid macular edema (CME). DESIGN: Retrospective noncomparative (nonrandomized, uncontrolled) interventional case series. PARTICIPANTS: Sixty-five eyes of 54 patients with uveitis-related CME inadequately responsive to treatment combinations of oral corticosteroid, periocular orbital floor corticosteroid injections, and second-line immunosuppressive agents. INTERVENTION: Intravitreal injection of 4 mg/0.1 ml of TA. MAIN OUTCOME MEASURES: Visual acuity (VA), intraocular pressure (IOP), levels of inflammation, and immunosuppressive therapy were assessed. Other potential complications, including cataract progression, vitreous hemorrhage, endophthalmitis, and retinal detachment (RD), were looked for. RESULTS: The mean follow-up was 8.0 months (range, 3-51), and the mean improvement of VA after intravitreal TA was 0.26 (from 0.65 to 0.39 logarithm of the minimum angle of resolution; Snellen, 6/24-6/12, approximately). This occurred at a mean of 4 weeks (range, 1-30). The improvement in VA was more significant if the duration of CME before intravitreal TA was 10 mmHg. Patients younger than 40 years were more likely to experience this IOP rise than those older than 40. Thirty-three eyes (51%) were treated with antiglaucoma medications, with a mean duration of treatment of 17.4+/-13.3 weeks, and no patient required trabeculectomy or lost vision. The dosage of oral corticosteroids and/or second-line immunosuppressive medication was reduced or stopped altogether in 18 of 33 eyes (54.5%) during the study period. There were no cases of injection-related vitreous hemorrhage, endophthalmitis, or RD. CONCLUSIONS: In patients with uveitic CME, intravitreal TA can effectively reduce CME and improve VA and, in some eyes, allows the cessation and/or reduction of immunosuppressive therapy. The period of effectivity varies in different patients and, in some eyes, is limited. Treatment was associated in 43.1% with a rise in IOP, which was transient and treatable medically.

Hypotensive effect of carteolol on intraocular pressure elevation and secondary glaucoma associated with endogenous uveitis - Ohno, S; Ichiishi, A; Matsuda, H (Ophthalmologica, 1989)
The therapeutic effects of carteolol hydrochloride were evaluated in the treatment of 44 uveitis patients (51 eyes) with intraocular pressure elevation or secondary glaucoma. Carteolol ophthalmic solutions, either 1% or 2%, were given twice day for more than 4 weeks in glaucomatocyclitic crisis and for more than 8 weeks in other forms of uveitis. Intraocular pressure significantly decreased from week 1 of treatment and persisted within normal limits until week 8 in glaucomatocyclitic crisis. Similarly, intraocular pressure decreased significantly from week 2 in other forms of uveitis. Intraocular pressure was well controlled in patients with open-angle glaucoma, but the control was insufficient in patients with angle-closure glaucoma. No adverse reactions such as systemic hemodynamic effects or exacerbations of intraocular inflammation were observed during this study. Carteolol therefore seems to be effective for the treatment of intraocular pressure elevation and secondary glaucoma associated with endogenous uveitis.

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

Flare-up rates with bimatoprost therapy in uveitic glaucoma - Fortuna, Egidio; Cervantes-Castañeda, Rene A; Bhat, Pooja; Doctor, Priyanka; Foster, C Stephen (Am J Ophthalmol, 2008)
PURPOSE: To evaluate the rate of flares in patients with uveitic glaucoma treated with topical bimatoprost and to assess its effect on intraocular pressure (IOP) in this subset of patients. DESIGN: Retrospective case series. METHODS: All patients seen at one subspecialty uveitis practice with history of uveitic glaucoma treated with topical bimatoprost were identified and the data collected, which included onset, type, duration of uveitis, onset of secondary glaucoma, and previous therapies for glaucoma. The time of onset of bimatoprost therapy, the IOP, and flare-up rate before and after initiation of treatment with bimatoprost were recorded at one week and one, three, and six months of follow-up. RESULTS: Of the 42 patients (59 eyes) identified, 12 patients had used other topical lipid agents, which were replaced by bimatoprost. Twenty-three patients had not used any lipid agents and bimatoprost was added to their existing antiglaucoma regimen. Seven patients were newly diagnosed with uveitic glaucoma and were commenced with topical bimatoprost. The rate of uveitis flares while on other antiglaucoma therapy was 52 per 100 person-years follow-up, while on bimatoprost therapy it was 32.4 per 100 person-years follow-up (P = .206). The mean IOP prior to bimatoprost therapy was 27 +/- 13.2 mm Hg and after initiation of topical bimatoprost was 15 +/- 5.5 mm Hg at the end of six months (P = .0008). CONCLUSION: These data suggest that bimatoprost is an effective IOP-lowering agent in patients with uveitic glaucoma in whom the uveitis is controlled on immunomodulatory therapy, and it does not increase the rate of flares of uveitis in these patients.

Retrospective cohort study of 163 pediatric glaucoma patients - Bussières, Jean-François; Therrien, Roxane; Hamel, Patrick; Barret, Pierre; Prot-Labarthe, Sonia (Can J Ophthalmol, 2009)
OBJECTIVE: The aim of our study was to describe a cohort of pediatric glaucoma patients in Quebec. DESIGN: This study was a retrospective medical record review. PARTICIPANTS: The study included patients younger than 18 years who were diagnosed with glaucoma between 1980 and 2000 and monitored at the Ophthalmology Clinic of the Sainte-Justine University Hospital Centre (Centre Hospitalier Universitaire Sainte-Justine) and had ocular hypertension or glaucoma in at least 1 eye. METHODS: The data gathered concerned patients' information, the surgical procedures performed post diagnosis associated with the glaucoma diagnosis, and the drugs prescribed. RESULTS: The study included 163 patients (254 eyes), a total of 374 surgical procedures, and the use of 2885 antiglaucoma drug therapies. For the 4 most frequent pathologies, patients were monitored for 8.4 (SD 4.2) years for aphakic glaucoma/pseudophakic glaucoma, 10.0 (SD 5.5) years for congenital glaucoma, 9.0 (SD 5.2) years for Axenfeld-Rieger syndrome, and 7.5 (SD 3.4) years for uveitic glaucoma. In total, 113 patients had at least 1 surgical procedure (69.3%). Before 1985, only timolol, pilocarpine, epinephrine, acetazolamide, and dipivefrin were used. Other beta blockers then appeared (betaxolol, levobunolol between 1985 and 1990, and the timolol-pilocarpine association between 1990 and 1995). After 1995, we saw the arrival of a new class of prostaglandin F2 alpha analogues, with latanoprost and other carbonic acid anhydrase inhibitors such as dorzolamide and brinzolamide. CONCLUSIONS: This study illustrates the great variety of glaucoma diagnostic subgroups and the use of surgery and drug therapies.

Latanoprost-induced uveitis - Warwar, R E; Bullock, J D (Surv Ophthalmol, 1999)

Atypical Features of Fuchs Uveitis Syndrome - Phu, Jack; Trinh, William H; Chau-Vo, James Son; Nivison-Smith, Lisa; Kalloniatis, Michael (Optom Vis Sci, 2015)
PURPOSE: To review the atypical features of Fuchs uveitis syndrome. METHODS: A retrospective review of records of a private optometric practice of patients with diagnosed Fuchs uveitis syndrome was performed. RESULTS: Three atypical cases of Fuchs uveitis syndrome are presented. Patient 1 is a patient who required the use of topical corticosteroids to alleviate acute symptoms of uveitis. Patient 2 is a patient who presented at a very young age with aggressive Fuchs uveitis and who subsequently developed secondary open-angle glaucoma. Patient 3 presented with primary open-angle glaucoma, was treated with topical ocular hypotensive medications, but then subsequently presented with manifest Fuchs uveitis syndrome in the affected eye. Patient 3 was treated with topical prostaglandin analogs among other medical therapies. CONCLUSIONS: Fuchs uveitis syndrome has a diverse clinical spectrum. It is a syndrome that is diagnosed using a constellation of clinical signs. However, some cases may present atypically and clinicians should be prepared to use less conventional therapies such as topical corticosteroids and prostaglandin analogs in the treatment of acute uveitic attacks and secondary open-angle glaucoma, respectively.

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

Development of glaucoma after phacoemulsification for removal of cataracts in dogs: 22 cases (1987-1997) - Lannek, E B; Miller, P E (J Am Vet Med Assoc, 2001)
OBJECTIVE: To determine factors contributing to glaucoma after lens extraction via phacoemulsification in dogs. DESIGN: Retrospective study. ANIMALS: 22 dogs (29 eyes) with glaucoma and 21 dogs (30 eyes) without glaucoma after phacoemulsification. PROCEDURE: Medical record review. RESULTS: Eyes at increased risk for glaucoma included those of Boston Terriers, those with uveal or retinal abnormalities before surgery, and those with intraoperative intraocular hemorrhage. Significant differences between groups were not detected for incidence of preoperative lens-induced uveitis, presence of an intraocular lens, or frequency of an acute postoperative increase in intraocular pressure. Glaucoma developed (mean +/- SD) 12.8+/-14.1 months (median, 10 months; range, 0.25 to 55 months) after surgery. Eighteen of 29 (62%) eyes with potential for vision after onset of glaucoma retained vision for a mean of 16.5+/-12.8 months (median, 10.8 months; range, 1.5 to 37 months) after glaucoma was diagnosed. Most of these eyes still had vision at the conclusion of the study period. CONCLUSIONS AND CLINICAL RELEVANCE: Risk factors identified by this study will aid in preoperative counseling of clients and refining selection criteria for candidates for phacoemulsification. Careful follow-up for the remainder of the dog's life after surgery may improve long-term success rates by permitting early intervention before intraocular pressure increases substantially and vision is irreversibly lost. Surgery for cataracts may still be worthwhile in dogs with increased risk of glaucoma, especially if elderly, because of the lengthy period to onset of glaucoma after surgery and the beneficial effects of treatment after glaucoma develops.

Metoprolol responding uveitis - Masood, I (Eye (Lond), 2005)

Clinical Results and Utility of Herpesviruses Multiplex Polymerase Chain Reaction: Assessment of Aqueous Humor Samples From Patients With Corneal Endotheliitis and High Intraocular Pressure - Kim, Gyu-Nam; Cho, Min-Chul; Yoo, Woong-Sun; Kim, Rock-Bum; Chung, Jin-Kwon; Kim, Seong-Jae (J Glaucoma, 2018)
PURPOSE: The main purpose of this study was to evaluate herpesvirus infection in patients with corneal endotheliitis and high intraocular pressure (IOP) using multiplex polymerase chain reaction (PCR) in aqueous humor samples. MATERIALS AND METHODS: This was a retrospective, observational study of immunocompetent patients living in South Korea. Eligible subjects had typical corneal endotheliitis with an IOP≥21 mm Hg or required antiglaucoma medication. Multiplex PCR was performed using aqueous humor samples obtained at first visit to detect the DNA of 6 herpesviruses. RESULTS: Forty-two eyes from 42 patients with >6 months' follow-up were analyzed. Of these, 16 were herpesvirus-positive: 3 herpes simplex virus 1, 3 varicella-zoster virus, 9 cytomegalovirus, and 1 Epstein-Barr virus. Eyes with coin-shaped or fine keratic precipitates (kps), high IOP, and a low baseline endothelial cell count were more likely to show a positive result on multiplex PCR. Univariate analysis showed that male sex (P=0.014), a previous history of uveitic glaucoma (P=0.048), and the presence of fine kps (P=0.031) were significantly associated with a positive PCR result. On multivariate analysis, male sex (P=0.010) and a previous history of uveitic glaucoma (P=0.031) showed a significant positive association. CONCLUSIONS: Cytomegalovirus was the most commonly detected herpesvirus in patients with corneal endotheliitis and high IOP. A positive PCR result was seen more frequently in male individuals and patients with fine kps or a history of uveitic glaucoma.

Bilateral decompression retinopathy after deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome - Muñoz-Negrete, Francisco J; Díez-Álvarez, Laura; Garcia, Carlota Fuente; Rebolleda, Gema (Eur J Ophthalmol, 2019)
INTRODUCTION: To report the first case of bilateral ocular decompression retinopathy after uneventful non-perforating deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome. CASE DESCRIPTION: An 8-year-old girl affected by tubulointerstitial nephritis and uveitis syndrome developed ocular hypertension (45 mmHg in the right eye and 42 mmHg in the left eye) associated with recurrent episodes of uveitis and chronic use of steroids despite maximum hypotensive medical treatment. Bilateral non-perforating deep sclerectomy with mitomycin C (0.2 mg/mL, 1 min) was performed under general anesthesia without complications. The first postoperative day, the visual acuity was reduced to 0.6 in the right eye and 0.05 in the left eye and the intraocular pressure was 3 mmHg in both eyes. Fundoscopy revealed bilateral optic nerve swelling and diffuse retinal hemorrhages, some of them with scattered-white centers. About 2 months after surgery, the visual acuity was normal and the fundus examination showed complete resolution. CONCLUSION: The ocular decompression retinopathy is an uncommon complication after non-perforating deep sclerectomy. This is the first case of bilateral ocular decompression retinopathy reported after non-perforating deep sclerectomy in a child with ocular hypertension secondary to recurrent uveitis and chronic use of steroids associated with tubulointerstitial nephritis and uveitis syndrome.
Keywords: deep sclerectomy; Ocular decompression retinopathy; ocular hypertension; tubulointerstitial nephritis and uveitis syndrome

Effects of alpha(2)-adrenergic agonists on lipopolysaccharide-induced aqueous flare elevation in pigmented rabbits - Watanabe, K; Hayasaka, S; Hiraki, S; Matsumoto, M; Kadoi, C; Nagaki, Y (Jpn J Ophthalmol, 2001)
PURPOSE: To evaluate the effects of the alpha(2)-adrenergic agonists (clonidine, apraclonidine, and guanfacine) on lipopolysaccharide (LPS)-induced aqueous flare elevation in pigmented rabbits. METHODS: Anterior uveitis was induced with an intravenous injection of LPS (0.5 microg/kg) in an ear vein. The reproducibility of experimental uveitis induced by LPS (0.5 microg/kg) was also determined. Clonidine (0.01, 0.05, 0.25, or 1%), apraclonidine (1%), or guanfacine (1%) was topically instilled in the right eye 30 and 5 minutes before and 30 minutes after LPS application (N = 6 animals, respectively). Clonidine (0.25%) was topically administered three times at 30-minute intervals from 240 or 120 minutes before, or 120 or 240 minutes after LPS application (N = 6 animals, respectively). Then 1 mg/kg of yohimbine was injected into an ear vein 30 minutes before each topical three-time instillation of clonidine 1%, apraclonidine 1% or guanfacine 1% (N = 6 animals, respectively). Aqueous flare was measured with a laser flare-cell meter. Aqueous flare elevation was expressed as the area under the curve (AUC) in arbitrary units. Rabbits received the first LPS intravenous injection, and the control values of the AUC were obtained. Three months later, the alpha(2)-agonist and the second LPS administration were given to the same animals. RESULTS: The AUCs (5,184 +/- 1,255 units) after the first application of LPS were similar to those (5,033 +/- 1,290) after the second application 3 months after the first administration. Topical instillation of clonidine inhibited LPS-induced aqueous flare elevation in a dose-dependent manner (0.01-0.25%). Topical instillation of clonidine 1%, apraclonidine 1% or guanfacine 1% inhibited LPS-induced aqueous flare elevation by 98 +/- 2.0% (mean +/- SD), 86 +/- 14% and 94 +/- 5.7%, respectively. Pretreatment with intravenous yohimbine prevented the inhibitory effect on flare elevation induced by each agent. CONCLUSION: The present findings suggested that topical instillation of some alpha(2)-agonists may have an inhibitory effect on ocular inflammation, which is mediated in part by alpha(2)-receptors.

Tomographic assessment of therapeutic response to uveitic macular oedema - Sivaprasad, Sobha; Ikeji, Felicia; Xing, Wen; Lightman, Sue (Clin Exp Ophthalmol, 2007)
PURPOSE: To evaluate the therapeutic effects on the different morphological patterns of uveitic macular oedema and central macular thickness using optical coherence tomography (OCT). METHODS: Retrospective observational case series. Fifty consecutive patients with a clinical diagnosis of new or recurrent macular oedema due to uveitis were examined with serial OCTs for 1 year. The correlation between different patterns of macular oedema (diffuse macular oedema, inner cystoid oedema, outer cystoid oedema, oedema involving both inner and outer layers of retina and serous retinal detachment) and change in logMAR visual acuity and the recorded variables including age, gender, systemic disease associated with uveitis, location and duration of uveitis, and duration of macular oedema were examined. Response to treatment was measured as change in logMAR visual acuity and evolution of patterns of macular oedema. RESULTS: Diffuse macular oedema, external cystoid and serous retinal detachment responded well to treatment. Cysts in the inner retinal layers were more resistant to treatment. The cysts in the outer layers disappeared faster than cysts in the inner layers in patients with cysts in both layers at baseline. Multivariate analysis showed that cystoid macular oedema (all types) (P = 0.03) and inner cystoid oedema (P = 0.031) were the variables significantly associated with final visual acuity. CONCLUSION: Assessment of patterns of uveitic macular oedema by OCT gives useful information on the prognosis. Inner retinal cystoid oedema is more resistant to treatment than any other patterns of oedema.

Influence on intraocular pressure of anti-inflammatory treatments after selective laser trabeculoplasty - Champagne, S; Anctil, J-L; Goyette, A; Lajoie, C; Des Marchais, B (J Fr Ophtalmol, 2015)
INTRODUCTION: Selective laser trabeculoplasty (SLT) is an effective and safe procedure to lower intraocular pressure (IOP) in the management of open-angle glaucoma. The post-laser inflammatory reaction could be positively implicated in SLT efficacy and the relevance of postoperative use of topical anti-inflammatory remains controversial. The goal of this study is to determine the effect of various anti-inflammatory treatments on intraocular pressure and on side effects following SLT. MATERIAL AND METHODS: A prospective, randomized, double-blind study with a control group was conducted. Ninety-six eyes of 67 patients with primary open-angle glaucoma who underwent SLT were enrolled in this study between March 2009 and March 2012. Eyes recruited in the study were randomized to receive either prednisolone acetate 1%, diclofenac 0.1% or a placebo. The 3 treatments were administered 4 times a day for 5 days following SLT. The intraocular pressures were measured at regular intervals during the 6-months follow-up period. Side effects were also evaluated with a questionnaire as well as with the ocular exam. RESULTS: The analysis of the relative IOP decrease over the 6-months period revealed a significant difference between the time points of follow-up (P<0.0001), but no group effect (P=0.2980). No significant difference regarding anterior chamber inflammation and discomfort was observed between the 3 groups. CONCLUSION: There was no difference in intraocular pressure reduction, intraocular inflammation or ocular discomfort post-SLT when comparing the 3 treatment modalities.
Keywords: Intraocular pressure; Anti-inflammatoire; Anti-inflammatoire non stéroïdien; Anti-inflammatory; Glaucome à angle ouvert; Nonsteroidal anti-inflammatory; Open-angle glaucoma; Pression intraoculaire; Steroid; Stéroïde; Trabéculoplastie; Trabeculoplasty

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 (Ocul Immunol Inflamm, 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: treatment; uveitis; meta-analysis; Macular edema; management; pharmacological agents; systematic review

Comparison of iridial pigmentation between latanoprost and isopropyl unoprostone: a long term prospective comparative study - Chiba, T; Kashiwagi, K; Chiba, N; Ishijima, K; Furuichi, M; Kogure, S; Abe, K; Tsukahara, S (Br J Ophthalmol, 2003)
AIM: To compare incidence of iridial pigmentation prospectively induced by long term treatment with latanoprost and isopropyl unoprostone (hereafter, unoprostone) in Japanese patients with glaucoma. METHODS: Patients with glaucoma treated with prostaglandin (PG) related ophthalmic solutions were sequentially enrolled. Patients treated for more than 30 months with PG related ophthalmic solutions were subjected to analysis. The entry criteria were no history of intraocular surgery, laser iridotomy, and/or laser trabeculoplasty within 12 months before and after the enrolment; and no history of uveitis; no changes in antiglaucoma drugs within 6 months before and after the enrolment. Photographs of the irides were taken under the same conditions and three glaucoma specialists evaluated the iridial pigmentation with masking of patient information. The correlation of iridial pigmentation with the background factors and the reduction of intraocular pressure (IOP) before and after the treatment were investigated. RESULTS: 48 eyes in 48 patients satisfied the enrolment criteria (25 eyes in the latanoprost group, 23 eyes in the unoprostone group). At the end of the follow up period, iridial pigmentation was present in 15 patients (60.0%) in the latanoprost group and seven patients (30.4%) in the unoprostone group. The correlation between development of iridial pigmentation and age, sex, concurrent use of other ophthalmic solutions, and IOP reduction was not significant. CONCLUSIONS: The incidence of iridial pigmentation induced by latanoprost or unoprostone is high in the case of long term treatment. Iridial pigmentation did not affect PG related ophthalmic solution induced IOP reduction.

Ocular and concomitant cutaneous sporotrichosis - Vieira-Dias, D; Sena, C M; Oréfice, F; Tanure, M A; Hamdan, J S (Mycoses, 1997)
We report here the case of a 12-year-old girl with concomitant cutaneous and ocular sporotrichosis. Sporothrix schenckii was isolated from skin lesions and aqueous humour. The difficulty in the diagnosis and treatment of this form of mycosis is discussed and the data are compared with those published in the few reports available in the literature.

Efficacy of addition of nepafenac 0.1% to steroid eye drops in prevention of post-phaco macular edema in high-risk eyes - El Gharbawy, Shahenda A; Darwish, Essam A; Abu Eleinen, Khaled G; Osman, Moataz Hamed (Eur J Ophthalmol, 2018)
PURPOSE: To compare the efficacy of addition of nonsteroidal anti-inflammatory eye drops to steroidal eye drops with that of using postoperative steroidal anti-inflammatory eye drops alone in prevention of macular edema in high-risk patients. SETTING: Cairo University Hospital. DESIGN: This study was comparative prospective interventional randomized study. METHODS: This study included 100 cataractous eyes divided into five subgroups: 20 eyes of diabetic patients, 20 uveitic eyes, 20 traumatic cataracts, 20 glaucomatous eyes on topical prostaglandin analogs, and 20 eyes with posterior capsular rupture during phacoemulsification. Each subgroup of 20 was randomized between two groups of 10 eyes, group A received postoperative topical steroids alone and group B received both steroidal and nonsteroidal anti-inflammatory eye drops. RESULTS: There was significant increase in postoperative central foveal thickness as compared to preoperative values in both groups (60.9 ± 87.95 µ in group A and 25.52 ± 57.26 µ in group B) that was significantly more in group A (P value 0.016). There was significant difference in postoperative macular thickness between both groups (280.1 ± 86.0 µ and 246.80 ± 57.73 µ, respectively, in groups A and B) (P value = 0.012). There was no statistically significant difference between both groups in preoperative and postoperative corrected distance visual acuity and intraocular pressure. CONCLUSION: Addition of topical nepafenac eye drops to topical steroid drops significantly reduced the amount of pseudophakic macular edema after cataract surgery in high-risk eyes.
Keywords: high-risk eyes; Nepafenac eye drops; post-phaco macular edema; pseudophakic macular edema; steroid eye drops

Revisiting early postoperative follow-up after phacoemulsification - Ahmed, Iqbal Ike K; Kranemann, Christoph; Chipman, Mary; Malam, Faiz (J Cataract Refract Surg, 2002)
PURPOSE: To determine whether postoperative evaluation of routine phacoemulsification can be safely and effectively performed on the day of surgery and 4 days postoperatively and evaluate the incidence and management of early intraocular pressure (IOP) elevations 3 to 7 hours postoperatively in patients with or without glaucoma. SETTING: Community-based hospital. METHODS: This retrospective series comprised 465 consecutive patients who had phacoemulsification and intraocular lens implantation. All patients had postoperative follow-up on the day of surgery (3 to 7 hours postoperatively) and at 4 days. Patients were classified into 2 groups: nonglaucoma (NG), 396 patients; and glaucoma (GL), 69 patients. The main outcome measures were the incidence and management of postoperative complications including IOP spikes, wound leaks, uveitis, and endophthalmitis. RESULTS: Three to 7 hours postoperatively, 73 NG (18.4%) and 32 GL (46.4%) patients had IOP elevations greater than 28 mm Hg, a significant change from baseline (P <.0001). Fourteen NG (3.6%) and 13 GL (18.8%) patients had IOP elevations greater than 40 mm Hg (P <.0001). Significant IOP elevations were effectively managed with a paracentesis with or without short-term antiglaucoma medications on the day of surgery, with 75 NG (18.9%) and 39 GL (56.5%) patients requiring IOP intervention. There were no IOP elevations greater than 21 mm Hg on the next day or at 4 days. There were no complications that were missed at the same-day evaluation that may have been identified at the 1-day postoperative visit. CONCLUSIONS: The results indicate that after routine phacoemulsification, patients can be safely and effectively reviewed on the day of surgery and 4 days postoperatively to identify and manage early postoperative IOP spikes. A significant number of patients, particularly those with preexisting glaucoma, had potentially harmful IOP spikes 3 to 7 hours postoperatively.

Effects of anti-glaucoma drugs timolol and GLC756, a novel mixed dopamine D2 receptor agonist and D1 receptor antagonist, on endotoxin-induced-uveitis and -arthritis in rats - Laengle, U W; Court, M; Markstein, R; Germann, P G; Nogues, V; Roman, D (Exp Toxicol Pathol, 2005)
Anti-glaucoma drugs exhibiting anti-inflammatory properties are desirable for the long-term treatment of glaucoma since they may reduce the risk for treatment-related inflammatory processes in outer compartments of the eye. The purpose of this study was to evaluate potential anti-inflammatory effects of two topically and systemically applied anti-glaucoma drugs i.e. GLC 756, a novel mixed dopamine D2 receptor agonist and D1 receptor antagonist, and timolol a beta-adrenoceptor antagonist using endotoxin-induced uveitis (EIU) and arthritis in rats as an in vivo model. For EIU, 8-week-old Lewis rats were intravenously injected at 160 microg lipopolysaccharide (LPS) from Salmonella typhimurium. GLC756, timolol, or betamethasone, as a positive control, were either topically (0.4%, 0.5%, and 0.1%, respectively, 16-times 20 microL eye drops during 48 h) or systemically (1mg/kg subcutaneous for 5 days) administered. Cell infiltration in tissue of the eye and knee joint were assessed histopathologically and in special compartments of the eye by confocal microscopy 48 h after LPS-induction. Numerous infiltrating cells were detected in the eyes after LPS-induction and half of the animals showed arthritis. Topical and systemic pre-treatment with GLC756 and timolol resulted in reduced cell infiltration in the eye. In addition, GLC756 reduced, whereas timolol increased the incidence of arthritis. Betamethasone suppressed almost completely the cell infiltration in the eye and the incidence of arthritis. In conclusion, the observations that GLC756 reduced cell infiltration in the eye and the incidence of arthritis after LPS-induction is compatible with anti-inflammatory properties of this drug. By contrast, timolol produced no consistent anti-inflammatory effect since both inhibitory as well as stimulatory effects on inflammatory processes were seen.

Latanoprost 0.005% and anterior segment uveitis - Smith, S L; Pruitt, C A; Sine, C S; Hudgins, A C; Stewart, W C (Acta Ophthalmol Scand, 1999)
PURPOSE: To evaluate the association of latanoprost with anterior chamber uveitis in glaucoma patients. METHODS: We retrospectively reviewed 527 charts in latanoprost treated patients with: no prior uveitis (Group 1); prior uveitis but were inactive at the time of the study (Group 2); and active uveitis (Group 3). RESULTS: In Group 1 five (1.0%) of 505 patients developed uveitis after beginning latanoprost. The uveitis was trace to 1+ cell in severity and delayed in onset 99.8+/-73.9 days In Group 2 three of 13 (23.1%) patients developed delayed uveitis (trace to 1+ cell). In Group 3 zero of nine (0%) patients had worsened inflammation and the intraocular pressure remained unchanged (22.8+/-7.8 mmHg to 22.0+/-7.3 mmHg) after beginning latanoprost (p=0.38). CONCLUSION: In patients without a prior history a mild delayed uveitis with latanoprost treatment may develop rarely. In patients with a uveitis history, a mild delayed exacerbation potentially may occur and the intraocular pressure may not be decreased in active uveitis.

Incidence and management of glaucoma in Vogt-Koyanagi-Harada syndrome - Forster, D J; Rao, N A; Hill, R A; Nguyen, Q H; Baerveldt, G (Ophthalmology, 1993)
BACKGROUND: The Vogt-Koyanagi-Harada syndrome is a bilateral panuveitis associated with neurologic and dermatologic manifestations. METHODS: The authors reviewed the charts of all patients with Vogt-Koyanagi-Harada syndrome seen at their institution over the past decade to determine the incidence of glaucoma, as well as the results of medical and surgical therapy for glaucoma, in this group of patients. FINDINGS: Of 42 patients diagnosed with Vogt-Koyanagi-Harada syndrome, evidence of glaucoma requiring either medical or surgical intervention occurred in 16 patients (38.1%). Of these, nine (56.3%) had open-angle glaucoma and seven (43.7%) had angle-closure secondary to pupillary block. In 5 (31.3%) of the 16 patients, medical therapy alone was sufficient to control intraocular pressure. Eleven patients (68.7%) required surgical intervention, consisting of laser iridotomy, surgical iridectomy, trabeculectomy with or without 5-fluorouracil, and/or Molteno implantation. CONCLUSION: The relative success of each of these procedures in this group of patients is discussed. Glaucoma is a common complication in the Vogt-Koyanagi-Harada syndrome, and one that is often difficult to control.

Rate of pseudophakic cystoid macular edema using intraoperative and topical nonsteroidal antiinflammatory drugs alone without steroids - Walter, Keith; Kauffman, Levi; Hess, Justin (J Cataract Refract Surg, 2020)
PURPOSE: To determine the rate of postoperative cystoid macular edema (CME) in patients undergoing cataract surgery treated with intraoperative intracameral and postoperative topical nonsteroidal antiinflammatory drugs (NSAIDs) without steroids. SETTING: Academic outpatient surgery center Wake Forest Baptist Health in Bermuda Run, NC. DESIGN: Retrospective cohort study. METHODS: A retrospective chart review was performed. Patients were identified through a medical record search tool using criteria of the Current Procedural Terminology code (66984), a single surgeon, and a date range from January 1, 2016, through December 31, 2017. Medical records were reviewed to determine intraoperative and postoperative medication regimen, visual outcome, and development of postoperative CME. Patients with a history of uveitis, diabetic macular edema, retinal vein occlusions, epiretinal membranes, vitreomacular traction, or any prior macular edema were excluded. In addition, any patients with less than 6 weeks of postoperative follow-up were excluded. RESULTS: Overall, 824 patient records were reviewed, and the analysis included 504 eyes. Of these, 2 eyes developed postoperative CME (rate = 0.40%, 95% CI 0.0005 to 0.0143). CONCLUSIONS: The rate of CME in patients treated with intraoperative and postoperative NSAIDs without steroids was low and below the historical rates derived from a literature review of CME development with the use of steroids.

Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients - van Boxtel, Lonneke A A; van der Lelij, Allegonda; van der Meer, Johannes; Los, Leonoor I (Ophthalmology, 2007)
PURPOSE: To describe 7 cases of unilateral, chronic and/or recurrent anterior uveitis caused by cytomegalovirus (CMV) in immunocompetent patients; to identify specific ophthalmologic characteristics; and to evaluate the clinical effect of valganciclovir treatment. DESIGN: Retrospective observational case series. PARTICIPANTS: Immunocompetent patients (n = 7) with a history of chronic and/or recurrent unilateral anterior uveitis and a positive analysis for either CMV-DNA and/or antibodies against CMV in their aqueous humor (Goldmann-Witmer coefficient > 3). METHODS: Full ophthalmologic examination, anterior chamber fluid analysis, serologic examination, and systemic evaluation. Treatment modalities included topical steroids, topical and/or systemic antiglaucoma medications, glaucoma surgery, and systemic valganciclovir. MAIN OUTCOME MEASURES: Visual acuity, inflammation, and intraocular pressure (IOP). RESULTS: Chronic unilateral anterior uveitis was seen in 6 patients, whereas recurrent uveitis was observed in 1. Additional findings consisted of slight iris atrophy and secondary glaucoma (n = 3), secondary glaucoma without iris abnormalities (n = 3), and a slightly elevated IOP without iris abnormalities (n = 1). Examinations of the aqueous humor by polymerase chain reaction demonstrated CMV-DNA in 6 patients and were negative for other herpes viruses in all. Goldmann-Witmer coefficients were strongly positive in 4 out of 5 patients. Other laboratory investigations were within normal limits. No other causes for uveitis were identified. Because of the insufficient effect of topical steroids and antiglaucoma medications, 5 patients were treated with additional oral valganciclovir with good clinical response in terms of uveitis activity and IOP. Discontinuation of valganciclovir in 1 patient resulted in a prompt recurrence of uveitis activity. CONCLUSIONS: Cytomegalovirus may cause a chronic and/or recurrent anterior uveitis in otherwise healthy patients. Iris atrophy and glaucoma may accompany it, but an inflammatory reaction in the anterior chamber may be the only sign. Aqueous humor analysis is of the utmost importance in differentiating between CMV and other herpes viruses and in making a definite diagnosis in chronic anterior uveitis. Valganciclovir may be very effective in treating CMV anterior uveitis, but its exact role can only be determined in larger studies with a longer follow-up.

Effect of intracameral phenylephrine 1.0%-ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery - Visco, Denise M; Bedi, Raman (J Cataract Refract Surg, 2020)
PURPOSE: To assess the effectiveness of intracameral phenylephrine-ketorolac during cataract surgery compared with postoperative topical steroids in reducing the incidence of postoperative clinical cystoid macular edema (CME) confirmed via optical coherence tomography (OCT), breakthrough iritis, pain, and photophobia. SETTING: Ambulatory surgical center/clinical practice. DESIGN: Retrospective 2-cohort study. METHODS: This study of cataract surgery patients compared the incidence of postoperative CME, breakthrough iritis, pain, and photophobia between patients receiving either intracameral phenylephrine 1.0%-ketorolac 0.3% during surgery or topical loteprednol 0.5% 2 days preoperatively, tapered postoperatively. Patients with prior CME or at high risk for postoperative CME, combined cataract/glaucoma surgery, and medication protocols different from those studied here were excluded. All eyes received bromfenac 2 days preoperatively and 10 weeks postoperatively. RESULTS: The study enrolled 2218 eyes (n = 1402). The phenylephrine/ketorolac treatment group included 1334 eyes (n = 830) and the topical loteprednol control group included 884 eyes (n = 572). The groups were comparable in age, race, gender, and perioperative characteristics. Clinical CME incidence was significantly lower in the phenylephrine-ketorolac group (0.52% vs 1.47%, P = .021). The phenylephrine-ketorolac group also had significantly lower breakthrough iritis (1.72% vs 4.86%, P < .001) and pain (1.27% vs 4.19%, P < .001) than the topical loteprednol group. The incidence of photophobia trended lower for the phenylephrine/ketorolac group relative to the topical loteprednol group (0.90% vs 1.13%, respectively, P = .590) but was not statistically significant. CONCLUSIONS: Intracameral phenylephrine/ketorolac and topical nonsteroidal antiinflammatory drugs (NSAIDs) without postoperative topical steroids significantly reduced postoperative clinical CME, breakthrough iritis, and pain after cataract surgery when compared with conventional perioperative topical steroids and NSAIDs.

Eyelash trichomegaly: a systematic review of acquired and congenital aetiologies of lengthened lashes - Hutchison, D M; Duffens, A; Yale, K; Park, A; Cardenas, K; Mesinkovska, N A (J Eur Acad Dermatol Venereol, 2021)
Long eyelashes have been popularized and many commercially available products exist to achieve eyelash growth as a desired cosmetic effect. Eyelash trichomegaly may be induced by medications, procedures, or be related to medical conditions; however, the exact mechanisms that govern eyelash growth are not well elucidated. This study aims to identify and summarize aetiologies associated with eyelash trichomegaly. We report a systematic review of 148 clinical trials, prospective and retrospective studies, and case reports describing all evidence-based potential aetiologies of eyelash trichomegaly obtained from the Medline/PubMed and Cochrane Library through January 2021. Inclusion criteria were defined as (i) human studies involving congenital and acquired diseases in which eyelash trichomegaly is a characteristic or (ii) assessment of trichomegaly as an adverse or desired effect of a medication or procedure. Exclusion criteria included: animal studies, articles not available in English, outcomes unrelated to eyelash trichomegaly, and secondary review articles. Pharmacologic agents associated with eyelash trichomegaly included prostaglandin analogues (15-keto fluprostenol isopropyl ester, bimatoprost, latanoprost, and travoprost), epidermal growth factor receptor inhibitors (cetuximab, erlotinib, and panitumumab), interferon-alpha, and calcineurin inhibitors (tacrolimus and cyclosporine). Surgical procedures of the eyelid, as well as allergic rhinitis, atopic dermatitis, HIV, ichthyosis vulgaris (IV), uveitis, and vernal keratoconjunctivitis were also associated with increased eyelash growth. Congenital disorders associated with lengthened eyelashes included Cantú syndrome, CHOPS syndrome, Coffin-Siris syndrome, congenital heart disease, Cornelia de Lange syndrome, Costello syndrome, familial trichomegaly, Floating Harbor syndrome, Hermansky-Pudlak syndrome, Kabuki-Makeup syndrome, KBG syndrome, Oliver-McFarlane syndrome, Rubinstein-Taybi syndrome, and Smith-Magenis syndrome. While the most common cause of eyelash trichomegaly is topical bimatoprost use, better understanding of pathways implicated in eyelash trichomegaly may lead to the discovery of additional medications to stimulate eyelash growth and create avenues for future therapeutic interventions.

Ahmed valve implantation for uncontrolled pediatric uveitic glaucoma - Kafkala, Chrysanthi; Hynes, Alla; Choi, John; Topalkara, Aysen; Foster, C Stephen (J AAPOS, 2005)
PURPOSE: We sought to evaluate the safety and efficacy of Ahmed valve implantation for the management of glaucoma associated with chronic uveitis in pediatric patients. METHODS: A retrospective chart review was conducted of 6 pediatric patients (7 eyes) who underwent Ahmed valve implantation because of refractory uveitic glaucoma. Intraocular pressure (IOP) reduction, preoperative and postoperative visual acuities, the number of hypotensive medications required, and complications associated with the operation were evaluated. RESULTS: Mean follow-up was 36.8 months (range, 6-60). At the last visit, all 7 eyes had IOPs between 9 and 18 mm Hg (average, 12.1). IOP reduction averaged 69.6% (P = 0.0005, paired t-test). The number of hypotensive agents was reduced from an average of 3 to an average of 0.71 medicines per eye (P = 0.001). The only complication was hemorrhagic choroidal detachment postoperatively in two eyes; both resolved within one month. CONCLUSIONS: For children with good immunomodulatory control of their inflammation and appropriate follow-up, Ahmed valve implantation can be an effective and safe procedure for treating pediatric uveitic glaucoma.

Secondary glaucoma in patients with juvenile rheumatoid arthritis-associated iridocyclitis - Foster, C S; Havrlikova, K; Baltatzis, S; Christen, W G; Merayo-Lloves, J (Acta Ophthalmol Scand, 2000)
PURPOSE: The prevalence and management of glaucoma were evaluated in patients with juvenile rheumatoid arthritis (JRA)-associated iridocyclitis. METHODS: The records of 69 patients with JRA-associated iridocyclitis were reviewed. RESULTS: Twenty-nine (42%) of these patients had secondary glaucoma or ocular hypertension. Glaucoma was controlled with topical treatment in only 7 of the 41 affected eyes (17%); systemic carbonic anhydrase inhibitor therapy resulted in control of another 8 eyes. Surgery controlled all but one of the remainder. CONCLUSION: Glaucoma is a common complication of JRA-associated iridocyclitis. It results from prolonged, inadequately treated intraocular inflammation and in some instances, from steroid use. Medical and surgical therapy for the glaucoma associated with JRA-uveitis is challenging and incompletely effective. We suspect that a more aggressive approach to the treatment of JRA-associated uveitis, earlier in the course of the disease may reduce this vision robbing contribution to the process.

Stereo-isomer specific induction of renal cell apoptosis by synthetic muramyl dipeptide (N-acetylmuramyl-L-alanyl-D-isoglutamine) - Langford, Marlyn P; Chen, Dequan; Welbourne, Tomas C; Redens, Thomas B; Ganley, James P (Mol Cell Biochem, 2002)
The cytotoxicity of bacterial cell wall components, muramyl dipeptide (synthetic N-acetylmuramyl-L-alanyl-D-isoglutamine; L,D-MDP) and lipopolysaccharide (LPS), was investigated in several kidney cell lines. MDP and LPS were toxic to rabbit and monkey kidney cells, MDP was toxic to canine kidney cells, but not to human or porcine kidney cells. Notably, L,D-MDP was >100-fold more cytotoxic/microg than the D,D-MDP and L,L-MDP, as well as LPS. L,D-MDP and analogs containing L,D-MDP were the most widely cytotoxic of the MDP tested. The MDP-induced cytotoxicity was characterized as apoptosis by DAPI staining and DNA laddering. The acute rabbit kidney (RK13) cell apoptosis (cell death in 2 year-old) rabbits that apparently failed to quickly clear and excrete a uveitogenic dose of MDP within 24 h died in I week. The results indicate that minute amounts (5 ng/ml) of MDP containing L-alanyl-D-isoglutamine can induce renal cell apoptosis in vitro and support MDP-induced kidney cytotoxicity in rabbits. Also, the results indicate that MDP in sera can be detected utilizing the RK13 cell bioassay and that failure to rapidly clear and excrete L,D-MDP is associated with uveitis and death in aged rabbits.

The effects of 1% prednisolone acetate on pupil diameter and intraocular pressure in healthy dogs treated with 0.005% latanoprost - Kahane, Nili; Bdolah-Abram, Tali; Raskansky, Hilli; Ofri, Ron (Vet Ophthalmol, 2015)
PURPOSE: Prostaglandin analogs contribute to blood-aqueous barrier breakdown and may exacerbate uveitis. As these analogs induce de novo synthesis of endogenous prostaglandins, their therapeutic, hypotensive effect could potentially be inhibited by anti-inflammatory treatment. We therefore evaluated whether topical 1% prednisolone acetate alters the effects of 0.005% latanoprost on pupil diameter (PD) and intraocular pressure (IOP). ANIMALS STUDIED: Ten healthy Labrador retriever dogs from the Israel Guide Dog Center for the Blind. METHODS: Pupil diameter and IOP were measured hourly, 8 AM-4 PM, with the right and left eyes serving as control (CE) and treated (TE) eyes, respectively. Measurements were conducted during four sessions: (1) without treatment (n = 10), (2) following latanoprost treatment (n = 10) at 8 AM, (3) following prednisolone treatment (n = 7) at 8 AM, and (4) bilateral latanoprost treatment at 8 AM, prednisolone treatment in TE at 11 AM (n = 8). The different number of dogs in sessions 3 and 4 is because some dogs were matched with their new owners earlier than expected. RESULTS: Pupil diameters were not affected by the addition of prednisolone and, at 4 PM, were 3.82 ± 0.47 and 3.97 ± 0.36 mm in TE and CE, respectively (P = 0.175, Wilcoxon). IOPs were not affected by the addition of prednisolone and, at 4 PM, were 9.0 ± 0.8 and 9.3 ± 0.8 mm Hg in TE and CE, respectively (P = 0.339, Wilcoxon). CONCLUSION: Prednisolone did not alter latanoprost's miotic and hypotensive effects in normal dogs during this study period.
Keywords: uveitis; glaucoma; corticosteroids; prostaglandin; anti-inflammatory; IOP

Intraocular pressure after replacement of current dual therapy with latanoprost monotherapy in patients with open angle glaucoma - Pillunat, L E; Larsson, L-I; European and Canadian Latanoprost Study Group (Br J Ophthalmol, 2003)
AIMS: To evaluate the efficacy and safety of replacing current dual ocular hypotensive therapy with latanoprost 0.005% monotherapy in patients with open angle glaucoma. METHODS: This randomised, open label, parallel group, multinational study included 466 patients with open angle glaucoma currently on dual ocular hypotensive therapy, including a beta adrenergic receptor antagonist. Patients were assigned (1:3) to ongoing dual therapy or a switch to monotherapy with latanoprost 0.005% once daily for 6 months. Intraocular pressure (IOP) was measured at 10 am and 5 pm at baseline, month 3, and month 6. Groups were compared for differences in diurnal IOP change, IOP success rates (IOP < or =22 mm Hg with < or =15% increase from baseline), and clinical success rates (not requiring change in therapy). RESULTS: Baseline mean diurnal IOP was 17.8 (SD 2.0) mm Hg in the latanoprost group and 17.6 (2.1) mm Hg in the dual therapy group. After 6 months, mean diurnal IOP was reduced by 0.26 (0.18) (SEM 1.4%) mm Hg (p=0.153) in the group switched to latanoprost and by 0.37 (0.25) (2.1%) mm Hg (p=0.138) in those continuing dual therapy (difference: 0.11 mm Hg; p=0.641). Success rates defined by IOP criteria were 83% for latanoprost and 89% for continued dual therapy (difference: 6%; p=0.122). Clinical success rates were 97% for latanoprost and 99% for dual therapy (difference: 2%; p=0.161). Ocular adverse events were reported by 23% of patients in both treatment groups. CONCLUSION: Latanoprost monotherapy is a safe and effective alternative for many patients with open angle glaucoma requiring dual topical ocular hypotensive therapy for IOP control.

Unilateral uveitis in a dog with uveodermatologic syndrome - Sigle, Kelly J; McLellan, Gillian J; Haynes, Joseph S; Myers, Ronald K; Betts, Daniel M (J Am Vet Med Assoc, 2006)
CASE DESCRIPTION: A 7-year-old Siberian Husky-type dog with heterochromia irides was evaluated because of signs of pain associated with the right eye. CLINICAL FINDINGS: Unilateral panuveitis, iris bombé, and secondary glaucoma were detected in the right eye. Tear production was low bilaterally. Facial and truncal poliosis and vitiligo were also evident; skin biopsy specimens were obtained from the nasal planum. Uveodermatologic syndrome was diagnosed on the basis of histopathologic findings of a lichenoid interface dermatitis and pigmentary incontinence within the dermis. Immunohistochemical analysis was performed on skin samples retrospectively, and findings were inconclusive. TREATMENT AND OUTCOME: Treatment involved topical (ocular) and oral administration of corticosteroids, oral administration of azathioprine, and topical (ocular) administration of a carbonic anhydrase inhibitor and a lacrimostimulant. The secondary glaucoma was refractory to treatment, and the right eye was enucleated. Uveodermatologic syndrome was confirmed via histologic examination of ocular tissues. The left eye remained free of inflammation 16 months after the initial diagnosis. The periocular skin and skin of the nose partially regained pigment, but the hair did not. CLINICAL RELEVANCE: Some breeds in which uveodermatologic syndrome has been reported (eg, Siberian Huskies, Old English Sheepdogs, Australian Shepherds, and Shetland Sheepdogs) often have heterochromia irides. This case highlights the fact that dogs with asymmetric uveal pigmentation may have unilateral ocular changes; therefore, uveodermatologic syndrome should not be excluded as a differential diagnosis on the basis of unilateral clinical signs.

Intraocular Phenylephrine-Induced Takotsubo Syndrome - Madias, John E (Heart Lung Circ, 2017)

Behçet's Disease with Severe Autonomic Disorders Developing after Herpes Zoster - Koto, Serina; Umeda, Masataka; Kawano, Hiroaki; Endo, Yushiro; Shimizu, Toshimasa; Koga, Tomohiro; Ichinose, Kunihiro; Nakamura, Hideki; Mukaino, Akihiro; Higuchi, Osamu; Nakane, Shunya; Kawakami, Atsushi (Intern Med, 2020)
A 58-year-old Japanese woman with herpes zoster developed Behçet's disease (BD) with symptoms including orthostatic intolerance as an autonomic disorder. Multiple immune-suppressive therapies and a β-blocker successfully controlled both the disease activity of BD and the autonomic disorders. A cytokine multiplex analysis of her serum revealed the elevation of proinflammatory cytokines [interleukin (IL)-1, IL-6, IL-12, tumor necrosis factor alfa (TNFα), and interferon gamma (IFN-γ)] and a low IL-10 concentration. IL-10 production is reported to be important for defense against herpes zoster virus (VZV). Insufficient IL-10 production is reported in BD. The reactivation of VZV with this cytokine profile suggests that BD will develop with various symptoms, including severe autonomic disorders.
Keywords: Behçet's disease; autonomic disorder; herpes zoster; IL-10

Effects of antiglaucoma drugs timolol and GLC756, a novel dopamine D2 agonist and D1 antagonist, on endotoxin-induced-uveitis in rats - Laengle, Ulrich Wilhelm; Markstein, Rudolf; Schneider, Verena; Greiner, Brigitte; Roman, Danielle (Exp Eye Res, 2005)
Antiglaucoma drugs with anti-inflammatory properties may be of particular value for the long-term treatment of glaucoma since they may reduce the risk for treatment-related inflammatory processes in outer compartments of the eye. The purpose of this study was, to evaluate the effect of systemic and topical administration of GLC756, a novel mixed dopamine D(2) receptor agonist and D(1) receptor antagonist which lowered intraocular pressure in man, and timolol on endotoxin-induced-uveitis (EIU) in rats. For EIU, 8-week-old Lewis rats received an intravenous injection of 160 microg lipopolysaccharide (LPS) from Salmonella typhimurium. GLC756, timolol, or betamethasone, as positive control, were administered either topically (0.4, 0.5, and 0.1%, respectively, 16-times 20 microl eye drops during 48 hr) or systemically (1 mg kg(-1) subcutaneously for 5 days). Protein content, released TNF-alpha, the number of cells as well as cells expressing TNF-alpha were determined in aqueous humor 48 hr after LPS-injection and served as parameters for inflammation. LPS induced an increase of protein content, infiltrating cells and cells expressing TNF-alpha in the aqueous humor. Topical and systemic administration of GLC756 and betamethasone, almost completely suppressed the increase of protein content and betamethasone in addition also suppressed the number of cells in aqueous humor. In conclusion, the almost complete suppression of LPS-induced protein increase in aqueous humor by GLC756 suggests an additional anti-inflammatory potential of dopaminergic compounds in glaucoma treatment. Timolol did not show any effect on EIU in rats.

Evaluation the adjunctive use of combined bevacizumab and mitomycinc to trabeculectomy in management of recurrent pediatric glaucoma - Mahdy, R A; Al-Mosallamy, S M; Al-Aswad, M A; Bor'i, A; El-Haig, W M (Eye (Lond), 2015)
PURPOSETO evaluate the efficacy and safety of combined bevacizumab-mitomycin c (MMC) in recurrent cases of pediatric glaucoma.METHODSA prospective non-masked controlled study that included bilateral cases of 12 patients (24 eyes) with recurrent (had previous glaucoma surgery before) pediatric glaucoma. One eye in each patient (12 eyes) was assigned to trabeculectomy operation with combined application of MMC (0.4 mg/ml for 3 min) under and around the scleral flap before trabeculectomy and bevacizumab (avastin) (2.5 mg in 0.2 ml) injected subconjunctivally around the bleb after completing the surgery (group I). The other eye of each patient (12 eyes) was assigned to trabeculectomy operation with application of MMC (0.4 mg/ml for 3 min) only (group II). The mean follow-up period was 13±1 months.ResultsThe mean age was 2.16±1.5 (range 7 months to 4.1 years). No significant difference in preoperative intraoperative pressure (IOP) was observed between the groups (P>0.05). Recurrent primary congenital glaucoma represents 66.7% of the cases. Other cases included were recurrent aphakic and pseudophakic glaucoma 25% and recurrent post uveitic glaucoma 8.3%. The mean IOP was 12.1±4.2, 12.6±5.4, and 12.8±5.2 mm Hg in group I at 3, 6, and 12 months, respectively, and was 12.8±5.3, 13.7±6.7 and 15.6±5.9 mm Hg in group II at 3, 6, and 12 months, respectively. There was a statistically significant difference in the mean IOP between the studied groups at the 1-year follow-up visit (P<0.05). In addition, group I showed a higher statistically significant difference in absolute and total success (75 and 91.7%, respectively) compared with group II (58.3 and 75%, respectively) (P<0.05). The encountered complications included mild hyphema, which occurred in 8.33% in group 1, wound leakage, which occurred in 8.33% in each group, and shallow anterior chamber (AC), which occurred in 16.7% in each group and was the most common encountered complication in the study. One case of shallow AC in group I led to choroidal effusion (8.33%). One case in group II developed late bleb-related endophthalmitis after 3 months, which resulted in phthisis bulbi (8.33%).ConclusionThe additive effect of subconjunctival bevacizumab to MMC-augmented trabeculectomy in the case of recurrent pediatric glaucoma was beneficial in improving the success rate. Better IOP control and prolonging the bleb survivalvia reducing the long-term need of using anti-glaucoma drugs postoperatively without adding complications had also been achieved with this technique. This offers a promising alternative for the treatment of this type of glaucoma.

The Ahmed drainage implant in the treatment of pediatric glaucoma - Morad, Yair; Donaldson, Craig E; Kim, Yuri M; Abdolell, Mohamed; Levin, Alex V (Am J Ophthalmol, 2003)
PURPOSE: To report the safety and efficacy of Ahmed Glaucoma Valve (New World Medical, Inc., Rancho Cucamonga, California, USA) implantation for the management of pediatric glaucoma in the early and intermediate follow-up period. DESIGN: Consecutive interventional case series. METHOD: A retrospective chart review was conducted on 60 eyes (44 patients, age range at surgery 1.5 months to 16 years, average 6 +/- 4.9 years), with pediatric glaucoma that underwent Ahmed Glaucoma Valve implantation for medically uncontrolled intraocular pressure (IOP) between the years 1995 and 2000. Outcome measures were control of IOP below 21 mm Hg, the need for antiglaucoma medications after surgery, and loss of 2 or more lines of Snellen acuity. Complications were monitored. RESULTS: The postoperative follow-up period for each eye averaged 24.3 +/- 16 months (range, 3 to 60 months). At last follow-up, IOP was controlled in 44 eyes (73%), 11 of which did not need antiglaucoma therapy. Kaplan-Meier life-table analysis showed probability of success with or without medications of 93% (95% confidence interval [CI], 86%-100%), 86% (95% CI, 77%-96%), 71% (95% CI, 59%-87%), and 45% (95% CI, 28%-80%) after 12, 24, 36, and 48 months of follow-up. Average IOP decreased from 32.8 +/- 6.2 before surgery to 16.6 +/- 8.0 postoperatively (P <.0001). The average number of medications used decreased from 4.4 +/- 1.97 to 2.0 +/- 2.0 (P <.0001). Kaplan-Meier survival analysis did not reveal any difference in survival profiles related to specific diagnosis of glaucoma, age (above or below 18 months), or prior surgery. Complications occurred in 30 eyes (50%). Although most resolved or were treated successfully, four patients had severe visual loss during the follow-up. Uveitis was a significant risk factor for tube exposure (Fisher exact test, P =.006). CONCLUSIONS: Ahmed Glaucoma Valve implantation is an effective treatment for pediatric glaucoma, although patients frequently require antiglaucoma medications. However, a high rate of potentially sight-threatening postoperative complications warrants ongoing close follow-up.

[Cystoid macular edema in uveitis] - Thurau, S R (Ophthalmologe, 2005)
Cystoid macular edema (CME) is the most frequent cause of visual deterioration in uveitis patients. Intraocular inflammation disturbs the blood-retina barrier and leads to retinal edema. The basis of successful treatment is the anti-inflammatory and immunosuppressive therapy of uveitis. Restoration of the blood-retina barrier is mediated by corticosteroids and nonsteroidal anti-inflammatory agents. Resorption of extracellular fluid is improved by systemic carboanhydrase inhibitors. Despite aggressive therapy loss of visual acuity is frequent. Therefore, early diagnosis of CME and initiation of treatment, even if visual acuity is not yet impeded, is mandatory.

Randomized Prospective Study of the Use of Anti-Inflammatory Drops After Selective Laser Trabeculoplasty - De Keyser, Myrjam; De Belder, Maya; De Groot, Veva (J Glaucoma, 2017)
PURPOSE: Evaluating the use of Indomethacin, Dexamethasone, and no anti-inflammatory treatment immediately after selective laser trabeculoplasty (SLT). MATERIALS AND METHODS: Prospective randomized clinical trial of 132 eyes. Both eyes of the patient underwent SLT. One of the eyes was treated with Indomethacin 0.1% or Dexamethasone 0.1% 3 times daily for 1 week; the other eye did not receive any anti-inflammatory treatment. Intraocular pressure (IOP) and inflammatory parameters were recorded at 1 hour, 1 week, 1, 3, and 6 months. RESULTS: Cells in the anterior chamber were present in 57% to 71% of the patients after 1 hour. About 16% to 37% of the patients reported pain/discomfort after 1 hour. Redness was present before SLT in 29% to 34% of the patients, probably due to antiglaucoma medication. After 1 hour, the amount of redness recorded raised to 32% to 42%, but the amount of patients with redness returned to pretreatment levels after 1 week. An IOP peak of >5 mm Hg above baseline IOP 1 hour after laser was present in 3% to 9% of the patients. IOP lowered 11% to 21% compared with IOP at baseline. The number of medications needed changed from 1.45 to 1.49 before, to 0.23 to 0.45 six months after SLT.No differential effects based on the kind of anti-inflammatory treatment or no treatment were found for any of the parameters. CONCLUSIONS: SLT induces little inflammation: anti-inflammatory drops do not make a significant difference in pain, redness, cells in anterior chamber, or peak IOP following SLT.The IOP-lowering effect of the SLT is not influenced by the use of Indomethacin or Dexamethasone.

Effect of Brimonidine on the B Cells, T Cells, and Cytokines of the Ocular Surface and Aqueous Humor in Rat Eyes - Shin, Hye-Young; Lee, Hyun-Seung; Lee, Young Chun; Kim, Su-Young (J Ocul Pharmacol Ther, 2015)
PURPOSE: One serious ocular side effect associated with the long-term use of topical brimonidine tartrate is anterior uveitis. This study investigated the changes in the levels of several inflammatory cytokines, B cells, and T cells in rat eyes treated with topical brimonidine tartrate. METHODS: Twenty Sprague-Dawley male rats were divided into 2 groups of 10 rats each. In the brimonidine group, rats were treated with brimonidine 3 times per day for 10 months. The rat cytokine multiplex method was used to determine the levels of cytokines [interleukin (IL)-1α, IL-1β, IL-2, IL-6, tumor necrosis factor alpha (TNF-α)] in the conjunctiva, cornea, aqueous humor, and lens. The cornea and conjunctiva were subjected to immunohistochemical staining using anti-CD20 antibody and anti-CD3 antibody. RESULTS: The concentrations of IL-1β, IL-2, and IL-6 in the conjunctiva were significantly lower in the brimonidine group (P = 0.033, 0.017, and 0.016, respectively) than in the control group. Compared to the control group, the concentration of IL-2 in the cornea was also significantly lower in the brimonidine group (P = 0.037). However, in the analysis of the cytokines in the aqueous humor, the concentrations of IL-1β and IL-2 were significantly higher in the brimonidine group than in the control group (P = 0.016 and 0.008, respectively). There was no significant difference in CD20-positive B-cell and CD3-positive T-cell infiltration of the conjunctival biopsy specimens between the brimonidine group and the control group. Corneal specimens of both groups also showed no infiltration of CD20-positive B cells and CD3-positive T cells. CONCLUSIONS: These results suggest that the increase in some inflammatory cytokines in the aqueous humor after the long-term brimonidine treatment may contribute to the pathogenesis of brimonidine-induced uveitis.

Lysophosphatidyl choline and cataracts in uveitis - Cotlier, E; Baskin, M; Kim, J O; Lueck, K (Arch Ophthalmol, 1976)
In aqueous humor from rabbits with uveitis or after anterior chamber paracentesis, the levels of lysophosphatidyl choline (LPC) were 10.2mug/ml and 14.7mug/ml, respectively. These LPC levels induce early cataractous changes in the rabbit lens in culture. Analysis of the fatty acid composition of LPC showed that saturated fatty acids were more predominant in secondary aqueous humor than in primary aqueous humor. In vitro, natural LPC induced more pronounced gains in sodium ions and water by the lens than similar concentrations of synthetic L-alpha-lysopalmitoyl phosphatidyl choline. In contrast to prostaglandin E, the levels of LPC in aqueous humor of rabbits with uveitis are cataractogenic. Thus, LPC or its precursors, rather than prostaglandins, are involved in the production of cataracts in uveitis.

Cataract surgery under systemic infliximab therapy in patients with refractory uveitis associated with Behcet disease - Alfawaz, Abdullah; Alrashidi, Sultan; Kalantan, Hatem; Al-Mezaine, Hani; Abu, Ahmed M (Ann Saudi Med, 2014)
BACKGROUND AND OBJECTIVES: This study is to evaluate the outcome of cataract surgery in patients with refractory uveitis associated with Behçet disease (BD) treated with infliximab. DESIGN AND SETTINGS: A retrospective study in a university-based tertiary referral center in the period between July 2003 and November 2011. METHODS: This is a retrospective study of patients with refractory uveitis associated with BD who underwent phacoemulsification cataract surgery under systemic infliximab therapy between July 2003 and November 2011 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. RESULTS: Six patients (9 eyes), 5 of which were male and 1 female, were identified in this study. The mean (SD) age and follow-up period were 26.2 (6.6) years (range, 16-36 years) and 51.6 (28.8) months (range, 12.84 months), respectively. All the patients underwent phacoemulsification with intraocular lens implantation. Postoperatively, visual acuity improved in all eyes and was 20/40 or better in 7 eyes (77.8%). In the immediate postoperative period, anterior chamber inflammation ranged from 2+ to 3+ cells. None of the patients developed inflammation relapse postoperatively. The most common postoperative complication was posterior capsular opacification in 5 eyes (55%), 4 of which were managed with neodymium:yttrium-aluminum garnet laser capsulotomy. Three eyes had glaucoma, 2 of which underwent successful glaucoma surgery and one was managed with topical antiglaucoma medications. CONCLUSION: In patients with refractory uveitis associated with BD who are treated with infliximab, cataract surgery is safe and has a good prognosis.