Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Multifocal Choroidal Lesions -- A Rare Complication of Herpes Zosper Ophthalmicus

We document the case of a 76-year-old woman who developed mutifocal choroidal lesions as an unusual complication of herpes zoster ophthalmicus

Surgery for Congenital Cataract

The management of congenital cataract is very different to the treatment of a routine age-related cataract. In adults, surgery may be delayed for years without affecting the visual outcome. In infants, if the cataract is not removed during the first year of life, the vision will never be fully regained after surgery. In adults, if the aphakia is not corrected immediately, it can be corrected later. In young children, if the aphakia is not corrected, the vision will never develop normally

Terrible TB

In this global community, where travel to and from countries outside America is becoming more frequent, it is increasingly likely that doctors will be seeing patients with diseases that would otherwise not be common in their country. This symposium is designed to; introduce five systemic infections that can have devastating consequences for the patient and their vision.; Each presenter will highlight a challenging case from their practice, they will update us on the current thoughts of how to diagnose,; investigate and manage that infection. Neuroradiology interpretation will be provided by Dr. Chavda. In the closing minutes of their; presentation there will be comments to the future and anticipation of any changes that we can expect in the coming years for the; infectious disease described. There will be ample time for questions and reflections from the floor after each presentation.; At the conclusion of this course, the attendees should be able to: 1) recognize and distinguish five common infectious diseases that; affect the central nervous system and eye; 2) plan an appropriate series of investigations and evaluate the results regarding such; diseases and; 3) recommend treatment plans for these diseases

Evidence for the Effectiveness of Interventions for Congenital, Infantile and Childhood Cataract

Certain groups are often excluded from trials of new interventions, typically pregnant women and children, but also people unable to give informed consent. Children are not included perhaps because of a distaste for experimenting on little ones and a reluctance to admit to clinical uncertainty when faced with anxious parents

Terrible TB

In this global community, where travel to and from countries outside America is becoming more frequent, it is increasingly likely that doctors will be seeing patients with diseases that would otherwise not be common in their country. This symposium is designed to; introduce five systemic infections that can have devastating consequences for the patient and their vision.; Each presenter will highlight a challenging case from their practice, they will update us on the current thoughts of how to diagnose,; investigate and manage that infection. Neuroradiology interpretation will be provided by Dr. Chavda. In the closing minutes of their; presentation there will be comments to the future and anticipation of any changes that we can expect in the coming years for the; infectious disease described. There will be ample time for questions and reflections from the floor after each presentation.; At the conclusion of this course, the attendees should be able to: 1) recognize and distinguish five common infectious diseases that; affect the central nervous system and eye; 2) plan an appropriate series of investigations and evaluate the results regarding such; diseases and; 3) recommend treatment plans for these diseases

Keratoconus with Corneal ‘Pips’

Keratoconus is a common ectatic corneal disorder. There are several causes of corneal opacity in keratoconic patients. This case illustrates two different causes, in the same patient, in either eye, and diagnostic imaging characteristics on Fourier-domain optical coherence tomography (FD-OCT) that aided surgical management

Ocular 'Roid Rage

Corticosteroids use can cause raised intraocular pressure (IOP), leading to glaucoma. We present a case report of steroid induced glaucoma in a young male with keratoconjunctivitis (VKC). Our patient was uncompliant with instructions to stop steroid use, initially started for VKC treatment, and required aggressive medical and surgical intervention for IOP control. He eventually progressed to severe glaucomatous optic neuropathy and eventual tunnel vision. Steroid induced glaucoma is an important and frequently encountered condition in ophthalmology clinics. This report serves to remind all physicians of the dangers of steroid eye drop usage

Comparative Analysis of 10-2 Test on Advanced Vision Analyzer and Humphrey Perimeter in Glaucoma

Purpose: To evaluate diagnostic precision and prove equivalence of 2 devices, Advanced vision analyzer (AVA, Elisar Vision Technology) and Humphrey field analyzer (HFA, Zeiss) for the detection of glaucoma on 10-2 program. Design: Prospective, cross-sectional, observational study. Participants: Threshold estimates of 1 eye each of 66 patients with glaucoma, 36 control participants, and 10 glaucoma suspects were analyzed on 10-2 test with AVA and HFA. Methods: Mean sensitivity (MS) values of 68 points and central 16 test points were calculated and compared. Intraclass correlation (ICC), Bland–Altman (BA) plots, linear regression of MS, mean deviation (MD), and pattern standard deviation (PSD) were computed to assess the 10-2 threshold estimate of the devices. Receiver operating characteristic curves were generated for MS and MD values, and the area under the curve (AUC) was compared with assessing diagnostic precision. Main Outcome Measures: Mean sensitivity values of 68 points and central 16 points, AUC for MS and MD values, ICC values, BA plots, and linear-regression analysis. Results: Bland–Altman plot showed significant correlation for MS, MD, and PSD values for both devices. For MS, the overall ICC value was 0.96 (P 0.05). The AUC for MS values for AVA was 0.89 and for HFA was 0.92 (P = 0.188); whereas it was similar at 0.88 for MD values (P = 0.799). Advanced vision analyzer and HFA identically discriminated between healthy and patients with glaucoma (P 0.05). Conclusions: Statistical results denote adequate equivalence between AVA and HFA because threshold estimates of AVA strongly correlate with HFA for 10-2 program. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references