Combined fluocinolone acetonide intravitreal insertion and glaucoma drainage device placement for chronic uveitis and glaucoma

PURPOSE

To determine whether a fluocinolone acetonide sustained-release intravitreal drug delivery system can be implanted safely at the same time that a glaucoma drainage device is placed for eyes with uveitis and elevated intraocular pressure (IOP) receiving maximum tolerated IOP-lowering therapy.

DESIGN

Retrospective, observational case series.

METHODS

Subjects had chronic noninfectious intermediate or posterior uveitis and elevated IOP while receiving maximum tolerated medical therapy. Fluocinolone acetonide implantation and glaucoma tube shunt placement were performed in a single surgical session. The main outcome measures were inflammatory recurrences, visual acuity (VA), use of adjunctive anti-inflammatory therapy, IOP, and adverse events.

RESULTS

Seven eyes of 5 patients were studied. The average number of recurrences 12 months before implantation was 3 episodes per eye; of the 3 eyes followed up for more than 30 months, none had an inflammatory recurrence within 30 months after implantation. The mean Snellen visual acuity 12 months after the combined surgery was 20/114, compared with 20/400 at baseline. Adjunctive steroid use decreased. Average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg 12 months after the combined surgery (P = .019).

CONCLUSIONS

The favorable results observed in all eyes suggest that fluocinolone acetonide implantation can be safely combined with glaucoma tube shunt placement in a single surgical session in eyes with uveitis and elevated IOP receiving maximum tolerated IOP-lowering therapy. Uveitis recurrences decreased, visual acuity improved, and IOP decreased. There were no adverse events during insertion of the fluocinolone acetonide implant and placement of the glaucoma tube shunt.

Somatostatin for Uveitic Cystoid Macular Edema (CME)

PURPOSE

To report the favorable response of bilateral recalcitrant uveitic cystoid macular edema (CME) to treatment with a somatostatin analog.

METHODS

Medical ophthalmic history and the results of ophthalmic examinations were recorded. Fluorescein angiography (FA) studies were reviewed.

RESULTS

A 52-year-old white female with intermediate uveitis developed bilateral recalcitrant CME. Treatment with subcutaneous injections of the somatostatin analog octreotide resulted in partial resolution of the CME and improvement of visual acuity.

CONCLUSIONS

Somatostatin may play a role in the treatment of CME secondary to uveitis.

Intermediate Uveitis

Intermediate uveitis is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases: multiple sclerosis, idiopathic optic neuritis, autoimmune corneal endotheliopathy, sarcoidosis, thyroid diseases and inflammatory bowel diseases. Symptoms are blurry vision, floaters and distortion of central vision. The syndrome is bilateral in 80% of the patients and chronic with periods of exacerbation and remission. Clinical presentation includes: mild to moderate anterior chamber inflammation, thin keratic precipitates in the inferior portion of the cornea, autoimmune endotheliopathy, vitreitis, vasculitis in the peripheral retina, intravitreal "snowballs," retinal "snowbanking," optic neuritis and cystoid macular edema. Cataract and glaucoma are frequent complications. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulation of the peripheral retina are options in patients with snowbanking when there is an insufficient response to periocular or systemic corticosteroids. Imunosuppression may also be used when other therapies fail, and Cyclosporin A is the first drug of choice. Pars plana vitrectomy is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous hemorrhage, tractional retinal detachment and epiretinal membranes. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications. Patients can often maintain a vision of 20/50 or better.

[Vitrectomy in vitreo-retinal complications associated with intermediate uveitis]

OBJECTIVE

To investigate the effects of vitrectomy in vitreo-retinal complications associated with intermediate uveitis.

METHODS

Retrospective case series of sixteen eyes of 16 patients in vitreo-retinal disease associated with intermediate uveitis in a 3-year period from Mar 2002 to Jun 2005 were included in the study. They were treated with vitrectomy and the mean follow-up was (14.25 +/- 7.90) months (range: 5-32 months). Visual acuity in final follow-up, post-operative complications and the recurrence of intermediate uveitis were retrospectively reviewed.

RESULTS

Four patients were associated with tuberculosis, rheumatoid arthritis, multiple sclerosis or Behcet disease, respectively. The remaining 12 cases had idiopathic diseases. Pre-operatively, all patients were treated with steroids for a long time and the mean treatment time was (9.94 +/- 2.67) months (range: 6-16 months). Pre-operative vitreo-retinal complications included severe vitreous organization (5 eyes), tractional retinal detachment (6 eyes), rhegmatogenous retinal detachment (1 eye), vitreous hemorrhages (2 eyes), epimacular membrane (2 eyes) accompanied with vitreous tissue, and peripheral retinal neovascularization (16 eyes). In the post-operative period, tractional retinal detachment in one eye and complicated cataract in 3 eyes were observed. Post-operatively, only 4 cases need long-term immunosuppression therapy (more than 6 months). Fourteen of 16 eyes achieved a final visual acuity equal to or better than baseline (X2 = 4.923, P < 0.05). Recurrent intermediate uveitis was not found in these patients.

CONCLUSIONS

The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the intermediate uveitis which was severe or uncontrolled by immunosuppressive drugs and accompanied with vitreo-retinal complications. The beneficial effects include improving visual acuity, reducing need for long-term immunosuppression treatment.

Safety and efficacy of intraoperative intravitreal injection of triamcinolone acetonide injection after phacoemulsification in cases of uveitic cataract

PURPOSE

To evaluate the safety and efficacy of a single intraoperative intravitreal injection of triamcinolone acetonide after phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis.

SETTING

Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

METHODS

This prospective randomized controlled study included 40 eyes (40 patients) with chronic idiopathic anterior uveitis or intermediate uveitis that had phacoemulsification with intraocular lens implantation. Twenty eyes received an intravitreal injection of triamcinolone acetonide (4 mg/0.1 mL) intraoperatively (triamcinolone acetonide group), and 20 received oral steroids (steroid group) postoperatively. Outcome measures were Early Treatment Diabetic Retinopathy Study best corrected visual acuity (BCVA), anterior chamber reaction, intraocular pressure (IOP) by applanation tonometry, and central macular thickness by optical coherence tomography.

RESULTS

The mean BCVA (decimal) improved from a baseline of 0.13 +/- 0.14 to 0.64 +/- 0.32 in the triamcinolone acetonide group and from 0.05 +/- 0.06 to 0.61 +/- 0.36 in the steroid group (P = .74). There were no statistically significant differences between the 2 groups in postoperative anterior chamber reaction, IOP, or central macular thickness. Four patients in the triamcinolone acetonide group and 5 in the steroid group had recurrence of uveitis; 5 patients in the triamcinolone acetonide group had ocular hypertension. One patient in the triamcinolone acetonide group and 3 in the steroid group had cystoid macular edema postoperatively.

CONCLUSION

A single intraoperative intravitreal injection of triamcinolone acetonide seemed to be a safe and efficacious route of steroid delivery during phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis and is recommended as a substitute for postoperative oral steroid administration.

INTERFERON ALFA-2A: A NEW TREATMENT OPTION FOR LONG LASTING REFRACTORY CYSTOID MACULAR EDEMA IN UVEITIS?

PURPOSE

To perform a prospective pilot study to evaluate interferon alfa-2a (IFN alfa-2a) for the treatment of refractory cystoid macular edema (CME) in endogenous uveitis.

METHODS

IFN alfa-2a was administered at an initial dose of 3 or 6 million IU (depending on body weight) per day subcutaneously. Afterwards IFN alfa-2a was tapered slowly over 6 months and finally discontinued. If CME relapsed IFN alfa-2a was reinstituted and tapered slowly again to evaluate the lowest maintenance dose to keep remission.

RESULTS

A total of 15 eyes of 8 patients with refractory CME due to intermediate or posterior uveitis were included. Ineffective pretreatment consisted of systemic steroids and acetazolamide (all patients) and at least one additional immunosuppressant (6 patients). Six of 8 patients (11 eyes) responded well to IFN alfa-2a and CME resolved completely during 6 months treatment. One patient was lost to follow-up after IFN alfa-2a was stopped. In 1 patient (1 eye) even 19 months after cessation of IFN alfa-2a no recurrence of CME occurred. In 4 patients (8 eyes) IFN alfa-2a had to be reinstituted because CME relapsed. All 4 patients responded again. During a mean follow-up period of 16.4 months since restart of therapy we succeeded in all 4 patients to taper IFN alfa-2a to maintenance doses between 1.5 million IU every second and every sixth day without a recurrence of CME in any of the 8 eyes.

CONCLUSION

IFN alfa-2a can be a treatment option for patients with otherwise treatment resistant uveitic CME.

Prospective optical coherence tomographic evaluation of the efficacy of oral and posterior subtenon corticosteroids in patients with intermediate uveitis

PURPOSE

To prospectively evaluate the efficacy of oral corticosteroids and posterior subtenon injection in the treatment of macular edema in patients with intermediate uveitis using optical coherence tomography (OCT).

METHODS

Twenty-two patients with intermediate uveitis were treated with posterior subtenon injection when the disease was unilateral (group A, n=11) or with oral steroids when the disease was bilateral (group B, n=11). Changes in macular thickness from baseline was determined using OCT in both groups at day 0, day 3, day 14, 6 weeks and 12 weeks.

RESULTS

Statistically significant improvement in Snellen visual acuity in group A was seen at 6 weeks and in group B at 2 weeks. In patients receiving oral corticosteroids, foveal thickness decreased by 63% by day 3. In those treated with posterior subtenon injection, even at day 14 only a 55% reduction of foveal thickness was evident. Spearman's correlation coefficient for visual acuity and foveal thickness was found to be significant.

CONCLUSION

OCT confirms a significantly more rapid decrease in macular edema in patients treated with oral corticosteroids. A short course of oral steroids may be useful in enabling earlier visual recovery in patients treated with posterior subtenon injection for unilateral uveitic macular edema.

The effect of pars plana vitrectomy on cystoid macular oedema associated with chronic uveitis: a randomised, controlled pilot study

AIM

To evaluate the efficacy of pars plana vitrectomy (PPV) in the management of chronic uveitic cystoid macular oedema (CMO).

METHODS

A prospective, interventional, randomised, controlled, pilot study. 23 eyes of 23 patients with CMO secondary to chronic intermediate or posterior uveitis unresponsive to medical treatment were randomised into a surgical (group S) or medical group (group M). 12 patients in group S underwent PPV as opposed to 11 patients in group M who received systemic corticosteroid and/or immunosuppressive treatment during the study period. The primary outcome measures of the study were change in visual acuity and angiographic appearance of CMO at 6 months.

RESULTS

Mean visual acuity in group S improved significantly from 1.0 (0.62) at baseline to 0.55 (0.29) at 6 months following vitrectomy (p = 0.011), with five (42%) eyes reaching vision of 20/40 or better. Conversely, mean visual acuity in group M improved only marginally by 0.03 (0.27) (p = 0.785). CMO after vitrectomy was angiographically improved in four (33%) eyes, remained unchanged in seven (58%) eyes, and deteriorated in one (8%) eye. In the medical group, fluorescein leakage decreased in one eye, did not alter in four eyes, and deteriorated in two eyes.

CONCLUSION

PPV for macular oedema secondary to chronic uveitis despite angiographic improvement in only one third of the patients, seems to have a significant beneficial effect on visual function. This study provides enough evidence to justify a large scale trial which would define the role of vitrectomy in uveitic macular oedema.

Visusmindernde Komplikationen bei Uveitis im Kindesalter

PURPOSE

We analyzed the epidemiologic data and vision-threatening complications in different forms of childhood uveitis.

METHODS

This retrospective study included 187 consecutive patients with onset of uveitis before the age of 16 years classified as anterior (AU), intermediate (IU), posterior (PU), and panuveitis (PanU). We analyzed the epidemiologic data as well as visual acuity, uveitic complications and the conservative and surgical therapy.

RESULTS

Associated disease was observed in 85 of 187 patients. The most common complications in AU patients were cataract, posterior synechiae, band keratopathy and CME. IU was accompanied by dense vitreous opacities, cataract and CME. Macular scars were the most frequent cause for visual loss in PU. PanU was complicated by dense vitreous opacities, cataract, retinal detachment, CME and phthisis bulbi.

CONCLUSIONS

Childhood uveitis is frequently associated with systemic immune-mediated diseases. The diverse uveitis types have different but typical complications.

[The nature of changes in the local and systemic fibrinolytic activity in patients with retinal angiitis of various genesis]

The mechanism responsible for the development of occlusive processes on the fundus of the eye in different forms of retinal angiitis remains unknown. So the purpose of this study was to investigate the local and systemic fibrinolytic activity in 10 patients with optic disk vasculitis (ODV), 16 patients with peripheral uveitis (PU), 21 patients with isolated retinal angiitis (IRA), 17 patients with systemic lupus erythematosus (SLE) versus 8 healthy donors (a control group). Fibrinolytic activity was determined by the area of lysis, which appeared on the fibrin plate around the 2x2-mm filter paper previously placed in tear or blood. Fibrinolytic activity was ascertained to be decreased if the area of lysis was less than 30 mm2. There was a significant reduction in local fibrinolytic activity in the eyes with occlusive retinal vasculitis (RV) compared with the eyes with RV without occlusions by PU (60 and 9.1%, respectively; p = 0.0048), IRA (61.5 and 12.5%, respectively; p = 0.0056), and as compared to the eyes without vasculitis by ODV (70 and 0%, respectively, p = 0.0031). In SLE, the decrease in local fibrinolytic activity was detected significantly less frequently (33.3 and 16.6% with and without retinal vascular occlusion (RVO), respectively). Blood fibrinolytic activity was lowered only in patients with SLE (with 100 and 16.7% with and without RVO, respectively; p = 0.0151) and remained unchanged in those with ODV, PU, and IRA (more than 50 mm2). Thus, RVO is associated with impaired local reactions in patients with PU, ODV, and IRA and with impaired systemic reactions in those with SLE.

Bilateral uveitis in a patient with autoimmune lymphoproliferative syndrome

PURPOSE

We report a case of autoimmune lymphoproliferative syndrome (ALPS) presenting with bilateral uveitis.

DESIGN

Observational case report.

METHODS

Review of case record, serum and aqueous IL-10 and IL-6 cytokine results, and immunosuppressive treatment of a patient with a mutation in the gene encoding Fas.

RESULTS

Control of the intermediate uveitis required sustained doses of topical and periocular corticosteroids as well as systemic cyclosporine. The serum IL-10 level was elevated, as commonly seen in ALPS, but the aqueous IL-10 was not.

CONCLUSIONS

Despite a Th2 immune predominance in ALPS, uveitis, a Th1-mediated disease, may still manifest in these patients. The pathogenesis of uveitis in ALPS may differ from that of the systemic disease overall. Long-term follow-up is required for patients with uveitis associated with ALPS.

Die optische Koh�renztomographie (OCT) als Diagnose- und Verlaufsparameter bei uveitisbedingtem Makula�dem

BACKGROUND

Optical coherence tomography (OCT) is a relatively new, noninvasive method and has been well established as an effective diagnostic procedure for the investigation of several macular diseases. Knowledge about the efficacy of OCT in the diagnosis and follow-up of macular edema in uveitis patients is still limited.

PATIENTS AND METHODS

In the first part of the study, OCT was performed in 22 eyes of 18 patients with anterior or intermediate uveitis who showed angiographic and fundoscopic evidence of macular edema. The OCT results were compared with the visual acuity and fundoscopic and angiographic appearance of macular edema. In the second part of the study, the same patients were followed over a period of approximately 5 months (+/-2 months) and OCT was repeated at different time points during treatment of uveitic macula edema.

RESULTS

OCT investigation also showed clear evidence of macular edema in all eyes and was not compromised by a low or medium degree of optical haze. Furthermore, OCT investigation revealed marked differences in the individual degree of macular edema (foveal heights 168-810 microm). Diffuse macular edema ( n = 4 ) and different types of cystoid macular edema (several distinguished cysts n = 6, partially or completely confluent cysts n = 11, one marked cyst n = 1) were observed. During the follow-up of the patients, OCT results, visual acuity, and fundoscopic appearance of the macula showed a comparable behavior. In some eyes, a stable visual acuity was accompanied by changes of foveal edema demonstrated by OCT.

CONCLUSION

Optical coherence tomography is a safe and highly effective method in the diagnosis of macular edema in uveitis associated with low or medium haze of the optical media. Furthermore, OCT investigation seems to be useful in the follow-up of uveitic macular edema under treatment.

Atypical Vogt-Koyanagi-Harada disease or new uveomeningitic syndrome?

PURPOSE

To report on a patient affected by bilateral intermediate uveitis (IU) as the initial sign of an uveomeningitic syndrome.

METHODS

Thorough history, physical examination and ancillary laboratory and radiological testing were performed in this observational case study.

RESULTS

A 23-year-old Caucasian man developed bilateral IU, primarily diagnosed as "idiopathic" since a detailed etiologic work-up was not indicative of underlying disease. Seven months later, he presented with poliosis and vitiligo. Lumbar puncture revealed cerebrospinal fluid pleocytosis. Optical coherence tomography showed bilateral subclinical macular edema (ME). The visual acuity was still 20/20 in both eyes. Clinical, laboratory and radiological results did not fit into any known syndrome.

CONCLUSIONS

According to all the tests performed, the disease in our patient is a uveomeningitic disease with IU and ME which could be interpreted as an atypical form of Vogt-Koyanagi-Harada disease or a new uveomeningitic syndrome because there is no evidence for any other known disease.

[Mesangial glomerulonephritis and intermediate uveitis]

Uveitis in children are less frequent than in adults. Their prognosis is variable because it may be found as an isolated and idiophatic condition or in association with definite clinical entities. The associated noninfectious diseases with predominantly renal involvement are tubulointerstitial nephritis and uveitis syndrome (TINU syndrome), mesangial glomerulonephritis isolated or in association with Behçet's disease. A case of 14-years-old girl with intermediate uveitis (pars planitis) and mesangial glomerulonephritis is presented. The ocular symptoms was eye redness and ocular pain and she has snow-banks in pars plana. She showed microscopic hematuria and intermitent proteinuria that increased during the ocular clinical exacerbation. Renal biopsy revealed both mild mesangial matrix increase and mesangial celullarity with normal tubulointerstitial structure and mesangial deposition of IgA and IgG immunoglobulins. This case is de first pediatric patient report in the literature with intermediate uveitis and mesangial glomerulonephritis with immune deposition. Mesangial glomerulonephritis were observed in patients whit Behçet disease, known etiological cause of uveitis in adults and children. These findings may suggest that uveitis and glomerulonephritis have common immunological pathogenesis including circulatory immune complexes. In uveitis patients, screening for associated extra-ocular and renal manifestations is mandatory and should have careful long-term follow-up with regular systemic evaluation.

Bilateral dislocation of in-the-bag posterior chamber intraocular lenses in a patient with intermediate uveitis

We present a case of bilateral dislocation of in-the-bag intraocular lenses (IOLs) in a patient with intermediate uveitis. The IOLs dislocated into the vitreous cavity 24 and 41 months postoperatively. A complete pars plana vitrectomy with sutured posterior chamber IOL implantation was performed after each dislocation. The final visual acuity was 20/20(-) in each eye.

Is granuloma annulare related to intermediate uveitis with retinal vasculitis?

AIM

To report on eight patients with severe idiopathic intermediate uveitis (IU) and granuloma annulare (GA), a self limiting cutaneous condition of unknown aetiology.

METHODS

Retrospective case series. Clinical ophthalmic and dermatological data were studied and fluorescein angiography and skin biopsies were reviewed.

RESULTS

All patients with idiopathic IU had similar ocular features (eight with vitritis, seven with retinal vasculitis) and developed complications such as cystoid macular oedema (n=5), cataract (n=4), and glaucoma (n=3). Systemic diseases were not found, but a localised type of GA was observed in all.

CONCLUSION

Seven out of eight patients with IU and GA developed severe retinal vasculitis. Further studies are needed for a better understanding of this association, a common pathogenesis, and its eventual clinical consequences.

Pars plana vitrectomy in patients with intermediate uveitis

OBJECTIVE

To describe the effect of pars plana vitrectomy in patients with intermediate uveitis.

METHODS

Retrospective analysis of the clinical course and visual outcome following pars plana vitrectomy in patients with intermediate uveitis.

RESULTS

Thirty-two patients (43 eyes) were included in the study. Pars plana vitrectomy was combined with cataract surgery in 22 of 43 eyes. The intermediate uveitis was associated with sarcoidosis in 16 eyes and multiple sclerosis in five eyes, and was idiopathic in 22 eyes. The mean (+/-SD) follow-up was 45.6 (+/-38) months (range: 6-146 months). In 19 of 43 eyes (44.1%), there was improvement in the course of uveitis, allowing the discontinuation of immunosuppressive treatment in seven patients. Cystoid macular edema resolved in 12 of 37 eyes (32.4%). Forty of 43 eyes achieved a better or retained their initial visual acuity. The remaining three eyes deteriorated by two or more lines in the Snellen chart due to the progression of cataract, chronic cystoid macular edema, and glaucomatous optic atrophy, respectively.

CONCLUSIONS

The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the course of uveitis and the associated complications of cystoid macular edema, thereby reducing the need for long-term immunosuppression. Pars plana vitrectomy combined with simultaneous cataract surgery can improve the visual outcome in these patients.

Pars-plana vitrectomy in cystoid macular edema associated with intermediate uveitis

BACKGROUND

Cystoid macular edema (CME) is a common complication in the course of intermediate uveitis. In spite of systemic therapy with steroids or carbonic anhydrase inhibitors, persistence of CME is observed. Pars plana vitrectomy (PPV) is known to influence the course of intermediate uveitis positively. The present study was performed to investigate the role of PPV in the therapy of CME in intermediate uveitis.

MATERIALS AND METHODS

Forty-two eyes of 32 patients were re-examined after PPV for CME. In all eyes fluorescein angiography was performed. Average age at the time of surgery was 31.9 years (range 6-64 years). All patients had received systemic corticosteroid and/or immunosuppressive treatment during the course of their disease. In some patients systemic therapy with carbonic anhydrase inhibitors was performed. The mean duration of postoperative follow-up was 20.2 months (range 6-102 months).

RESULTS

Preoperative visual acuity (VA) in all eyes was between 1/10 and 0.5. Total regression of CME after surgery was observed in 18 of 42 eyes (42.8%), partial improvement in 7 eyes (16.7%). In 13 of 42 eyes (30.9%) the CME remained unchanged. Twenty-one of 42 eyes (50.0%) experienced a postoperative improvement of VA of 2 lines or more. In 18 of 42 eyes (42.8%) there was no change; in 3 eyes (7.2%) VA was less. In the long-term follow-up the corresponding results were slightly worse (17/17/8 eyes) due to secondary complications. In the majority of patients systemic medical therapy could be reduced or discontinued.

CONCLUSION

Pars-plana vitrectomy led to regression of CME in 59% of cases and to subsequent improvement of VA in 50% of eyes with intermediate uveitis. PPV should be considered soon after medical therapy has been shown to be ineffective.

Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis

PURPOSE

To report the safety and efficacy of intravitreal triamcinolone in the treatment of inflammatory cystoid macular oedema (CMO) in six patients who were resistant to other forms of therapy.

METHODS

An open-label unmasked prospective nonrandomized pilot study of six patients with idiopathic uveitis and visually significant macular oedema, resistant to periocular and/or systemic corticosteroid treatment, was carried out. Baseline examination and investigations were performed, including fundus fluorescein angiography, and the patients were given a single intravitreal injection of triamcinolone (4 mg/0.1 mL). The primary outcome measure was angiographic resolution of CMO. Patients were reviewed at intervals of 2-4 weeks for 12 months.

RESULTS

A single intravitreal injection of triamcinolone induced clinical and angiographic resolution of inflammatory macular oedema in all patients for varying periods of time up to 6 months. Five patients experienced increased intraocular pressure to 30 mmHg or greater which required treatment. Two patients developed posterior subcapsular cataract.

CONCLUSION

One injection of intravitreal triamcinolone was an effective short-term treatment for resistant CMO in uveitis. As with steroids given by other routes, raised intraocular pressure and cataract may occur. As it was so effective in these eyes with resistant CMO, a larger study is warranted to evaluate this form of therapy.

Optical coherence tomography in uveitis patients

PURPOSE

To evaluate optical coherence tomography in allergy-prone uveitis patients.

METHODS

Thirty-four patients (43 eyes) with posterior uveitis (31 eyes) and intermediate uveitis (12 eyes) were evaluated by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Follow-up examinations used optical coherence tomography in allergy-prone patients.

RESULTS

Optical coherence tomography identified epiretinal membranes, which were removed surgically (three eyes); persistent cystoid macular edema, which resolved with cytotoxic treatment (12 eyes); and juxtafoveolar membranes, which were treated by diode laser (six eyes) and excision (two eyes).

CONCLUSION

Optical coherence tomography may provide useful information on complications developing in uveitis patients.

Medical treatment of macular edema in patients with uveitis

PURPOSE

To determine the efficacy of medical treatment of cystoid macular edema (CME) in patients with uveitis.

METHODS

Retrospective study of 40 patients (57 eyes) with uveitis and CME. Inclusion criteria were presence of CME with minimal and no macular pathology, or vascular disease which could account for CME. Patients who had undergone intraocular surgery or had visual acuity (VA) of > or = 20/40 were excluded. The diagnosis of CME was based on clinical and/or angiographic findings. Three treatment groups were defined: (1) transseptal injection of steroids (n=13 eyes); (2) systemic non steroidal anti-inflammatory drugs (NSAIDs) (n=11 eyes); both 1 and 2 (n=33 eyes).

RESULTS

Overall, 79% of eyes improved 3 or more lines of Snellen VA after treatment: 51% improved 4 or more lines. The average number of lines improved was 3.8 for eyes treated with transseptal injections of steroids, 2.9 for eyes treated with NSAIDs, and 4 for eyes treated with both. For all 3 treatment groups between 60-70% of eyes improving 2 or more lines reached best VA only after a minimum of 6 months of follow up.

CONCLUSIONS

CME, a vision threatening complication of uveitis, respond fairly well to medical treatment; however, the best VA is achieved after several months. The improvement in VA did not differ markedly among the three treatment groups.