Structural and functional outcomes after treatment of uveitic macular oedema: An optical coherence tomography and multifocal electroretinogram study

Background: The aim was to evaluate the correlation between the anatomical and functional outcomes before and after treatment of uveitic macular oedema. Methods: Thirty-three eyes of 33 patients with uveitic macular oedema were included in the present study. Visual acuity (VA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were measured before and after treatment of the macular oedema. Correlation analyses between VA, OCT and mfERG parameters were performed. Results: The VA and mfERG measurements showed statistically significant improvement after treatment of the macular oedema (p < 0.01) and OCT-measured central foveal thickness decreased significantly from 434 ± 135μm before treatment to 267 ± 92μm after treatment (p < 0.001). Correlation analyses showed that uveitic central foveal thickness before treatment was correlated with mfERG N1 response amplitude of area 1 (Spearman's r = -0.62, p < 0.001). VA (logMAR) after treatment had a negative correlation with the mfERG N1 response amplitude of area 1 (Spearman's r = -0.56, p = 0.001). Also, there was no correlation between the final VA and pre-treatment OCT and mfERG measurements. Conclusion: This study deals with cystoid macular oedema associated with recurrent uveitis. In cystoid macular oedema, the value of mfERG before treatment is related to the central foveal thickness and VA. In contrast, after treatment the decrease of macular thickness is not always followed by an improvement of mfERG and VA. This supports the view that in uveitic macular oedema, the decrease in macular thickness after treatment may not be used as a predictor of improvement of macular function. © 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia

Biologic Treatment Options for Retinal Neovascularization in Behçet’s Disease

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. © 2019, © 2019 Taylor & Francis Group, LLC

Human herpes virus-6 as a cause of recurrent posterior uveitis in a hiv-positive patient

Purpose: To report a case of bilateral recurrent posterior uveitis caused by human herpes virus-6 (HHV-6) in a human immunodeficiency virus-positive individual. Methods: Comprehensive ophthalmic examination, including imaging with optical coherence tomography, fluorescein and indocyanine green angiography, and adequate laboratory tests were performed. A human immunodeficiency virus-positive patient without any AIDS defining condition, with a history of recurrent bilateral posterior uveitis referred to us with the diagnosis of retinal detachment. Results: Vitreous polymerase chain reaction detected an aberrant band for herpes viruses, which proved to be human herpes virus-6 by repeated polymerase chain reactions. Serum antibodies titer was positive for human herpes virus-6. The patient responded well to antiviral therapy with valacyclovir. Conclusion: This is the first case of human herpes virus-6-related bilateral posterior uveitis in a human immunodeficiency virus-positive individual without clinical manifestations of AIDS. © (c) 2000-2012 Ovid Technologies, Inc

Efficacy and safety of latanoprost in eyes with uveitic glaucoma

Background: To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis. Methods: Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment. Results: Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p=0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p=0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 ± 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 ± 0.7 for these patients (p=0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 ± 8.4 mmHg to 18.6 ± 5.3 mmHg (p<0.001) in the latanoprost group and from 28.2 ± 8.1 mmHg to 22.6 ± 10.1 mmHg (p<0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema. Conclusion: Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma. © Springer-Verlag 2009

The role of fundus autofluorescence imaging in the study of the course of posterior uveitis disorders

Background. To evaluate the correlation of fundus autofluorescence (FAF) with indocyanine green angiography (ICGA) in patients with various posterior uveitis disorders. Methods. Interventional case series including 23 eyes of 15 patients with diagnosis of a specific type of retinochoroiditis, such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous-like choroiditis, multifocal choroiditis (MFC), Harada disease, and syphilitic retinochoroiditis. Also, some cases with undefined retinochoroiditis were included. FAF and ICGA were performed and correlated at baseline and during follow-up after treatment. Results. In ICGA, early hypofluorescence was found to be the hallmark of acute choroidal inflammation, resolving in later stages and remaining in the late phase in areas with retinal pigment epithelium (RPE) damage. Poorly defined hyperautofluorescent areas correlated with acute choroidal lesions. Hypoautofluorescent delineation suggested the initiation of RPE healing processes, correlating well with the late phase of ICGA and delineating the RPE damage. Early hyperautofluorescence with late hypofluorescence in ICGA indicated the presence of primary RPE involvement. Conclusion. FAF contributes to the interpretation of RPE disease and may be a useful tool for the follow-up of progressive inflammatory disorders. Comparative evaluation of FAF and ICGA allows a characterization of the sequence of inflammatory events and the level of tissue affected. Copyright © 2015 Panagiotis Malamos et al

Evaluation of single-dose azithromycin versus standard azithromycin/ doxycycline treatment and clinical assessment of regression course in patients with adult inclusion conjunctivitis

Background: Single-dose azithromycin (AZT) has been proved efficient in treating various human Chlamydia infections. However, it has not been thoroughly tested in patients with adult inclusion conjunctivitis (AIC). It is the aim of this study to perform a comparative evaluation of efficacy and safety of one-day AZT with long-term AZT and doxycycline (DOX) regimens in AIC and to present a clinical profile of regression course of the disease. Materials: Eighty-three consecutive adults, with symptoms and signs of chronic conjunctivitis and positive Polymerase Chain Reaction (PCR) for chlamydia, were randomly assigned in four treatment groups; AZT 1-day 1000 mg orally, AZT 500 mg daily 9 and 14 days and DOX 200 mg 21 days orally. Follow-up visits were scheduled 1 and 2 weeks, 1, 3 and 6 months after treatment completion. PCR was repeated at the 2nd post-treatment week to confirm elimination of infectious agent. Detailed record of subjective symptoms and objective signs was performed at all visits. Retreatment rate among groups was evaluated as primary outcome. Regression rate of symptoms/signs among groups was recorded as secondary outcomes. Results: All treatment groups provided statistically equivalent results of retreatment rate. Statistically significant regression of symptoms/signs was documented, initially from the 1st post-treatment week in general, but 1 month was required for complete patients' relief. Follicles were the most common clinical sign with the earliest regression after successful treatment. Conclusion: Single-dose azithromycin should be considered as equally reliable treatment option, comparing to long-term alternative regimens for AIC. Patients should wait for one week, until first signs of significant regression become obvious and should consider approximately one month to total relief. Follicles could be reasonably used as a key sign for clinical assessment of treatment success. © Informa Healthcare USA, Inc

Evaluation of direct immunofluorescence assay and cytological examination in comparison to polymerase chain reaction of conjunctival swabs in patients with adult inclusion conjunctivitis

Purpose: To evaluate PCR, direct immunofluorescence assay (DIA) and cytological test of conjunctival swabs for the diagnosis of adult follicular conjunctivitis (AFC). Methods: Eighty-three adult patients with chronic conjunctivitis and sixteen healthy individuals were included. Conjunctival scrapings underwent PCR, DIA and cytological analysis. Exams were repeated two weeks after treatment application. Sensitivity, specificity and agreement rate with PCR of DIA and Cytology were evaluated and correlated with clinical symptoms/signs. Results: Cytology test was more sensitive than DIA and presented an acceptable agreement with PCR (K=0.44) in treatment-naîμ¥ patients, concerning especially the combination of both conventional exams (K=0.77). Inferior diagnostic performance of was detected post-treatment, considering the combination as well (K=0.40). Negative post-treatment PCR correlated well with significant relief of symptoms/signs. Conclusion: Combination of Cytology and DIA seems to be a useful diagnostic option for treatment naîμ¥ AFC patients. However, PCR remains the most reliable test for post-treatment evaluation. © 2013 Informa Healthcare USA, Inc