Characterization of serous retinal detachments in uveitis patients with optical coherence tomography

To determine the prevalence of serous retinal detachments (SRD) using optical coherence tomography (OCT) in a large database of patients with uveitis from a tertiary referral setting, to describe clinical features of patients with SRD, and to ascertain retinal architectural features found in association with SRD. Main outcome measures Prevalence of SRD in uveitis patients imaged with OCT, correlation of visual acuity with SRD, anatomic subtypes of uveitis identified, and association of SRD with various subtypes of macular edema (focal and diffuse) and retinal architectural abnormalities. Design Retrospective, single-setting cross-sectional study of all OCTs in a digital imaging base ordered on patients from a tertiary referral uveitis clinic between July 2006 and March 2008. Results SRD were identified in 17 of 111 uveitis patients (15 %) reviewed; bilateral SRD were found in 5 of 17 patients (29 %). Intermediate uveitis was the most common disease association (47 %), but other conditions identified included Vogt-Koyanagi-Harada syndrome, multifocal choroiditis/panuveitis, and sarcoidosis. Retinal architectural features identified in association with SRD included focal macular edema (59 %), diffuse macular edema (50 %), any intraretinal edema (77 %), both diffuse and focal macular edema (32 %), and retinal pigment epithelial alteration (27 %). Moderate or severe visual impairment, defined as visual acuity 20/50 or poorer was seen in 71 % of patients with SRD. Poorer visual acuity was correlated with increased central subfield thickness in patients with SRD (r2=0.41, p<0.001). Conclusion SRD were present in 15 % of the uveitis patients reviewed. Moderate to severe vision impairment was present in the majority of eyes (71 %) with SRD. Diffuse macular edema and focal cystoid macular edema were the OCT features most commonly associated with SRD. Intermediate and panuveitis were the most common anatomic sites of inflammation. A variety of pathogenic mechanisms, both inflammatory and non-inflammatory, may be involved in SRD in uveitis patients; identification of the precise mechanism is important for appropriate therapy.This work is supported in part by an Unrestricted Grant from Research to Prevent Blindness (Casey Eye Institute, Emory Eye Center), the Stan and Madelle Rosenfeld Family Trust (JTR), the William and Mary Bauman Foundation (JTR), the William C. Kuzell Foundation (JTR), and the Ronald G. Michels Fellowship Foundation (SY)

The effectiveness of pharmacological agents for the treatment of uveitic macular oedema (UMO): a systematic review protocol

PRISMA-P 2015 checklist: recommended items to include in a systematic review protocol. a (PDF 153 kb

Regression of neovascular age-related macular degeneration following infliximab therapy

PURPOSE: To describe the effects of the antitumor necrosis factor (TNF) monoclonal antibody Infliximab systemic therapy on choroidal neovacularisation (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Prospective, noncomparative series of three patients. METHODS: A subretinal membrane secondary to AMD was documented by fluoroangiography at baseline in three elderly patients scheduled to receive Infliximab therapy for inflammatory arthritis (infusions of 5 mg/kg at weeks 0, 2, 6, and every 8 weeks thereafter). Follow-up was performed at three months post-baseline, as well as during 18 months of continuing treatment in the first patient. RESULTS: CNV regressed partially at three months and resolved at six months in the first patient. Best-corrected visual acuity (BCVA) increased from 0.05 to 0.2; this effect was sustained at 18 months. Regression of subretinal membrane and increase of BCVA was also documented in the other patients. No ocular or extra-ocular side effects were noted. CONCLUSIONS: These findings suggest a plausible pathogenetic role of TNF in CNV secondary to AMD. Additional patients should he studied to confirm the promising clinical results. (c) 2005 by Elsevier Inc. All rights reserved

Cystoid macular edema in a patient with acquired immunodeficiency syndrome and past ocular history of cytomegalovirus retinitis after initiation of protease inhibitors

Purpose: To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy. Method: A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis was placed on protease inhibitors when his CD4(+) T lymphocyte counts dropped to 8 cells/mm(3). Three months later, after his CD4(+) T lymphocyte counts had increased to 196 cells/mm(3) he complained of micropsia and metamorphopsia in his right eye of 1 week duration. The patient had a complete ocular examination including fluorescein angiography (FA). Results: Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transseptal injections of corticosteroids were administered 2 weeks apart in the right eye as treatment of the CME. The patient reported gradual visual improvement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically. Conclusions: CME in our case is associated with inactive CMV retinitis and gradually increasing number of CD4(+) T lymphocytes after initiation of treatment with protease inhibitors. It may be amenable to regional administration of corticosteroids without reactivation of retinitis

Twelve months of follow-up after intravitreal injection of ranibizumab for the treatment of idiopathic parafoveal telangiectasia

Alexandros Rouvas,1 Panagiotis Malamos,2 Maria Douvali,1 Amalia Ntouraki,1 Nikos N Markomichelakis1 12nd Department of Ophthalmology, Medical School of Athens University, Athens, Greece; 2Department of Ophthalmology, NHS, &ldquo;G Gennimatas&rdquo; General Hospital, Athens, Greece Aims: To report the anatomic and functional outcomes of intravitreal ranibizumab in idiopathic parafoveal telangiectasia (IPT). Material and methods: Four eyes of three patients were included in this interventional case series. One patient (two eyes) had bilateral IPT (type 2) and two patients (two eyes) had unilateral (type 1) IPT. Retreatment was scheduled in case of leakage persistence in combination with visual acuity (VA) deterioration. Fluorescein angiography and optical coherence tomography were performed together with a full ophthalmic examination at baseline, 1, 3, 6, 9, and 12 months after injection. Results: One intravitreal injection of ranibizumab was performed in all four eyes. Complete cessation of leakage was documented postintervention in three eyes and partial cessation in one eye, followed by improvement of best corrected VA in one of them. In all eyes, structural changes of the photoreceptor layer were detected in tomography and were responsible for visual loss, which was in most cases, refractory to the applied therapy. Conclusion: Use of ranibizumab might be efficient in eliminating leakage activity in the macular region in patients with IPT. Nevertheless, improvement in VA was infrequent. Preexisting early photoreceptor alteration in IPT might render such patients unable to improve VA. Keywords: idiopathic parafoveal telangiectasis, intravitreal ranibizumab, fluorescein angiography, high-definition optical coherence tomograph

Macular hole closure after peribulbar steroid injection

PURPOSE: To report the closure of a macular hole after a peribulbar corticosteroid injection in a patient with anterior uveitis associated with human leukocyte antigen B*27. DESIGN: Interventional case report. METHODS: The patient was evaluated by comprehensive ophthalmic check-up and optical coherence tomography. RESULTS: A healthy 50-year-old woman presented to our service with active human leukocyte antigen B*27, associated anterior uveitis, macular hole in the right eye and macular edema in the left eye. Visual acuity was 20/200 in both eyes. Peribulbar injections of triamcinolone acetonide were administered in both eyes. Three months later, visual acuity improved to 20/50 in both eyes, and the uveitis was in complete remission. Optical coherence tomography verified that the macular hole in the right eye was closed. CONCLUSIONS: Inflammation and macular edema might be contributing factors in macular hole formation in patients with uveitis. This case indicates that treatment of inflammation and macular edema might lead to macular hole closure in similar cases. (C) 2003 by Elsevier Inc. All rights reserved

Infliximab for chronic cystoid macular edema associated with uveitis

PURPOSE: To assess the efficacy of the anti-TNF monoclonal antibody infliximab in uveitis patients without clinically evident ocular inflammation and impaired visual acuity because of chronic cystoid macular edema (CME). DESIGN: Prospective, noncomparative, interventional case series. METHODS: Patients with refractory CME (14 eyes, mean duration of 14 months), associated with intermediate uveitis (n = 6), Adamantiades-Behcet disease (n = 2), adult-type vascular pseudotumor (n = 1), and HLAB27+-related uveitis (n = 1) received an intravenous infliximab infusion (5 mg/kg); five patients were retreated after 1 month. RESULTS: Macular thickness, measured by ocular coherence tomography, was reduced from 428 +/- 138 mum to 219 +/- 51 mum at 2 months postbaseline (P = .0001), while visual acuity increased from 0.41 +/- 0.18 to 0.83 +/- 0.17 (P &lt; .00001). Anatomic and functional improvement was sustained at 6 months in all. No ocular or extra-ocular side effects were noted. CONCLUSION: These promising results suggest that TNF may play an important pathogenetic role in chronic CME, thus, a controlled trial is warranted. (C) 2004 by Elsevier Inc. All rights reserved

Patterns of macular edema in patients with uveitis - Qualitative and quantitative assessment using optical coherence tomography

Purpose: To describe the morphologic characteristics of uveitic macular edema by the use of optical coherence tomography (OCT) and to investigate the correlation between tomographic features and visual acuity (VA). Design: Cross-sectional study. Participants: Seventy consecutive patients with uveitis in a university-based practice with a clinical diagnosis of macular edema in at least one eye. Inclusion criteria were: (1) verification of macular edema by OCT, (2) adequate media clarity for fundus visualization, and (3) absence of coexisting ocular disease limiting visual potential. Methods: Complete ophthalmic examination: best-corrected Snellen VA, slit-lamp examination, fundus biomicroscopy, indirect ophthalmoscopy, and OCT. Fluorescein angiography was performed in selected cases. Main Outcome Measures: Best-corrected Snellen VA and tomographic features of the macula, including macular thickness measurement and correlation of macular thickness with VA. Results: Eighty-four eyes of 60 patients met the inclusion criteria. The mean VA (Snellen test) was 20/36. There were 3 patterns of macular edema: diffuse macular edema (DME), cystoid macular edema (CME), and serous retinal detachment (RD). Serous retinal detachment was detected in 17 eyes (20.2%). Patients were classified into the following groups: DME (46 eyes, 54.8%), CME (21 eyes, 25%), DME and RD (5 eyes, 5.9%), CME and RD (12 eyes, 14.3%). Epiretinal membrane was detected by OCT in 34 eyes (40.5%). Eight eyes (9.5%) demonstrated vitreomacular traction. The mean retinal thickness at the central fovea was 333 +/- 171 mum (mean +/- standard deviation). Macular edema was located mainly in the outer retinal layers. Eyes with CME had significantly greater retinal thickness measurements than eyes with DME (P&lt;0.001). Multivariate analysis revealed that VA was negatively correlated with increased macular thickness, presence of CME, and RD (P&lt;0.05). Conclusions: Optical coherence tomography demonstrated 3 patterns of macular edema in patients with uveitis: DME, CME, and RD. Epiretinal membrane coexisted in a significant percentage of patients. In patients with uveitis with clear media, the morphologic features of macular edema and macular thickness correlated with VA. Ophthalmology 2004;111:946-953 (C) 2004 by the American Academy of Ophthalmology

Herpes simplex virus type 2: a cause of acute retinal necrosis syndrome

Purpose: To describe a case of herpes simplex virus type 2 (HSV-2) acute retinal necrosis syndrome (ARN) in a 13-year-old immunocompetent girl. Methods: Polymerase chain reaction (PCR), cultures, flow cytometry, and cytology were performed on the vitreous sample. Results: Both PCR studies and vitreous cultures revealed HSV-2 as the cause of ARN. Flow cytometry showed CD4+, CD8+, and natural killer cells. The visual outcome of the patient was 20/200. Conclusion: Successful culture of HSV-2 from the vitreous specimen in a patient with ARN proved HSV-2 to be one of the causes of ARN. The successful culture of HSV-2 has not been previously reported