Clinical Features of Acute Anterior Uveitis with Complicated Course in a Slovenian Patient Population

Purpose. To report on patients who needed hospitalization due to acute anterior uveitis (AAU) and within this group to compare clinical features and outcomes of treatment of HLA-B27+ and HLA-B27− AAU in the population of Slovenian patients. Methods. Retrospective study of hospitalized patients with AAU in the last 39 months at the Eye Hospital in Ljubljana. The data of AAU patients were retroactively studied and compared on the basis of HLA-B27 antigen presence: visual acuity upon admission, visual outcome, the presence of hypopyon, fibrinous reaction, posterior iris synechiae, and complications, such as elevated intraocular pressure, cataract, and cystoid macular edema (CME). We compared the investigations in the diagnostic process, the associated systemic disease, and the treatment administered. Statistical analyses included Student’s t-test Fisher’s exact test, and the Kolmogorov–Smirnov test. A p value of <0.05 was considered statistically significant. Results. A total of 37 hospitalized patients with AAU were included. HLA-B27 antigen was detected in 73% of patients. In the HLA-B27+ group, women were more commonly affected, while the males were more affected in the HLA-B27− group. The occurrence of fibrin was significantly more common in HLA-B27+ patients, as well as hypopyon and posterior synechiae; only fibrin reached the statistical significance (p<0.05). The incidence of cataracts, ocular hypertension, and glaucoma did not differ significantly between the two groups. HLA-B27+ AAU was more often associated with systemic diseases, and patients in this group were more frequently treated with systemic immunomodulatory drugs, however, no difference reached the statistical significance. We did not notice any major differences in the final visual acuity in the comparing groups. Conclusion. Almost ¾ of AAU patients that required hospitalization were HLA-B27+. In this group, disease was more severe, more frequently associated with ocular complications and systemic disease, but final visual acuity was the same in both groups. HLA-B27 typing has no prognostic value in our group of complicated AAU patients, but it eases the decision about necessary diagnostics and treatment

PRIMARNI VITREORETINALNI LIMFOM: STAV OFTALMOLOGA O DIJAGNOZI I LIJEČENJU

Primary vitreoretinal lymphoma (PVRL) is a rare subset of central nervous system lymphoma occurring primarily in the vitreous and retina. Often presenting as a masquerade syndrome mimicking infectious or non-infectious uveitis, PVRL presents a diagnostic and therapeutic challenge. A vitreal or retinal biopsy is essential for diagnosis. This paper reviews recent advances and updates in the diagnosis and treatment of PVRL with a focus on intravitreal chemotherapy. Current diagnostic techniques for PVRL are demanding and detailed clinical history, examination, ocular and central nervous system imaging with immunohistochemistry, fl ow cytometry, molecular and genetic analysis are needed. In the last few years, local intravitreal treatment in cases with isolated PVRL is the topic of many published papers, however, the number of patients involved is small and treatment recommendations are not standardized and unique.Primarni vitreoretinalni limfom (PVRL) rijetka je podskupina limfoma središnjega živčanog sustava (SŽS) koja se javlja ponajprije u staklastom tijelu i retini. Često se predstavlja kao maskirani sindrom koji oponaša infektivni ili neinfektivni uveitis pa je dijagnostički i terapijski izazov. Biopsija vitreusa ili retine bitna je za dijagnozu. Ovaj rad prikazuje nedavna dostignuća i ažuriranja u dijagnostici i liječenju PVRL s naglaskom na intravitrealnu kemoterapiju. Suvremene dijagnostičke tehnike za PVRL su zahtjevne. Potrebna je detaljna klinička anamneza, pregled, očna i SŽS slika s imunohistokemijom, protočna citometrija, molekularna i genetska analiza. Posljednjih nekoliko godina lokalno intravitrealno liječenje u slučajevima s izoliranim PVRL tema je brojnih objavljenih radova. Međutim, broj uključenih pacijenata je malen, a preporuke za liječenje- nisu standardizirane i jedinstvene

Update on the systemic management of noninfectious uveitis in children and adolescents

© 2023 Published by Elsevier Inc.Noninfectious uveitis (NIU) in children and adolescents is a rare but treatable cause of visual impairment in children. Treatments for pediatric NIU and their side effects, along with the risks of vision loss and the need for long-term disease monitoring, pose significant challenges for young patients and their families. Treatment includes local and systemic approaches and this review will focus on systemic therapies that encompass corticosteroids, conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and biological disease-modifying antirheumatic drugs (bDMARD). Treatment is generally planned in a stepwise approach. Methotrexate is well-established as the preferential csDMARD in pediatric NIU. Adalimumab, an antitumor necrosis factor (TNF) agent, is the only bDMARD formally approved for pediatric NIU and has a good safety and efficacy profile. Biosimilars are gaining increasing visibility in the treatment of pediatric NIU. Other bDMARD with some evidence in literature for the treatment of pediatric NIU include infliximab, tocilizumab, abatacept, rituximab and, more recently, Janus kinase inhibitors. Important aspects of managing children on these systemic therapies include vaccination issues, risk of infection, and psychological distress. Also, strategies need to address regarding primary nonresponse/secondary loss of response to anti-TNF treatment, biological switching, and monitoring regimens for these drugs. Optimal management of pediatric uveitis involves a multidisciplinary team, including specialist pediatric uveitis and rheumatology nurses, pediatric rheumatologists, psychological support, orthoptic and optometry support, and play specialists.info:eu-repo/semantics/publishedVersio