Multimodal Imaging in Anterior Uveitis

Wide-Field Fluorescein Angiography in Patients with Idiopathic Acute Anterior Uveitis

PURPOSE

To elucidate whether wide-field fluorescein angiography (WFFA) can yield additional information in patients with newly diagnosed idiopathic acute anterior uveitis (AAU).

METHODS

The WFFA was performed in patients with idiopathic AAU, and the findings were analyzed according to the scoring system by Angiography Scoring for Uveitis Nomenclature.

RESULTS

Forty-four eyes of 30 patients (22 eyes of 13 patients in the pediatric group and 22 eyes of 17 patients in the adult group) were studied. The mean age was 12.41 ± 3.92 (range, 5-18) years in the pediatric group and 42.36 ± 32.07 (range, 24-68) years in the adult group. Thirteen eyes (59%) of pediatric patients and 12 eyes (54%) of adult patients showed some evidence of posterior segment activity on the WFFA (p = .764).     Systemic treatment was administered in 53.8% of the pediatric and 5.9% of adult patients, depending on the disease severity.

CONCLUSION

Pediatric patients with idiopathic AAU may have subtle posterior segment manifestations more than adult patients, and posterior segment findings may affect the treatment preferences of physicians.

The Value of Laser Flare Photometry as a Monitoring Tool for Uveitis

Laser flare (LF) photometry (P) is used to quantify the protein concentration in the aqueous humor, and therefore assess the blood-aqueous humor barrier. LFP is more reliable than the clinical assessment of the Tyndall effect, and is thus especially useful in the follow-up of uveitis patients. In active uveitis, LFP correlates well with the anterior chamber cell grading. Various studies have shown that high LF values are associated with an increased risk of uveitic complications, such as macular edema, glaucoma, and posterior synechiae. LFP can also be used to assess the response to anti-inflammatory treatments as well as the optimal timing and selection of the surgical technique for intraocular surgeries.

Evaluation of corneal endothelial cell morphology by specular microscopy in patients with acute anterior uveitis

PURPOSE

To determine the structure and morphology of corneal endothelial cell layer in patients with acute anterior uveitis.

METHODS

Thirty-four eyes of 34 acute anterior uveitis patients and 34 eyes of 34 healthy subjects were included. Mean cell density, coefficient of variation, maximum cell area, minimum cell area, average cell area and hexagonality ratio values were evaluated by non-contact specular microscopy. Parameters recorded in both groups were compared.

RESULTS

The mean maximum cell area was 1054,44 ± 251,14 µm², minimum cell area was 152.29 ± 53.65 µm² and average cell area was 386.91 ± 41.73 µm² in acute anterior uveitis group and the mean maximum cell area was 1057.65 ± 261.23 µm², minimum cell area was 147.26 ± 20.45 µm² and average cell area was 383.53 ± 43.12 µm² in the control group. There were no significant differences between the two groups in terms of maximum, minimum and average cell area (respectively, p = 0.080, p = 0.72, p = 0.62, p = 0.67). The mean cell density was 2607.74 ± 277.63 cells/ µm² in acute anterior uveitis group and 2669.35 ± 265.22 cells/µm² in the control group. (p = 0.358). In acute anterior uveitis group the mean coefficient of variation was 31.68 ± 8.16, hexagonality ratio was 63.85 ± 11.14 and mean central corneal thickness was 571.47 ± 55.99 µm; in control group the mean coefficient of variation was 25.29 ± 3.00, mean hexagonality ratio was 72.6 ± 4.80% and mean central corneal thickness was 534.82 ± 33.84 µm. Statistically significant differences were seen between the two groups (respectively, P = 0,00, P = 0,00, P = 0.02).

CONCLUSION

The mean central corneal thickness and coefficient of variation values were found higher, and the hexagonality ratio was found lower in acute anterior uveitis group. Our findings suggest that intraocular inflammation in anterior chamber negatively affects the endothelial function in patients with acute anterior uveitis.

Case Report: Ocular Manifestations and Treatments of Ciliary Body Involvement by Lymphoma

Purpose

To describe the ocular clinical features, histopathological findings, and treatment outcomes of lymphomas involving the ciliary body.

Methods

We demonstrate three cases of ciliary body involvement by lymphoma from 2013 to 2019 in Peking Union Medical College Hospital (PUMCH). All patients underwent examinations including best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscope, ultrasound biomicroscopy (UBM), and diagnostic vitrectomy. In addition, cytopathology, immunohistochemistry, gene rearrangement, cytometric immunophenotypic, or in-situ hybridization were used for determining the pathological type of lymphoma.

Results

The patients were a 25-year-old man, a 52-year-old woman, and a 54-year-old man. Two patients had unilateral involvement, and one patient had bilateral involvement. All patients presented with anterior uveitis and elevated intraocular pressure. Ciliary body masses or infiltration were found in 3 patients. Two patients had diffuse large B-cell lymphoma and one patient had natural killer/T-cell lymphoma. All patients received 0.4 mg methotrexate intravitreal injections, and the ciliary body lesions regressed completely.

Conclusion

Lymphomatous involvement of the ciliary body usually presents as an atypical anterior chamber reaction. Vitreous biopsy should be considered in these patients for diagnosis. Methotrexate intravitreal injection combine with chemotherapy or radiotherapy, might extend the survival time and preserve visual acuity for patients with ciliary body involvement by lymphoma.

Structural Endpoints and Outcome Measures in Uveitis

Most uveitis entities are rare diseases but, taken together, are responsible for 5-10% of worldwide visual impairment which largely affects persons of working age. As with many rare diseases, there is a lack of high-level evidence regarding its clinical management, partly due to a dearth of reliable and objective quantitative endpoints for clinical trials. This review provides an overview of available structural outcome measures for uveitis disease activity and damage in an anatomical order from the anterior to the posterior segment of the eye. While there is a multitude of available structural outcome measures, not all might qualify as endpoints for clinical uveitis trials, and thorough testing of applicability is warranted. Furthermore, a consensus on endpoint definition, standardization, and "core outcomes" is required. As stipulated by regulatory agencies, endpoints should be precisely defined, clinically important, internally consistent, reliable, responsive to treatment, and relevant for the respective subtype of uveitis. Out of all modalities used for assessment of the reviewed structural outcome measures, optical coherence tomography, color fundus photography, fundus autofluorescence, and fluorescein/indocyanine green angiography represent current "core modalities" for reliable and objective quantification of uveitis outcome measures, based on their practical availability and the evidence provided so far.

Uveitis Specialists Harnessing Disruptive Technology during the COVID-19 Pandemic and Beyond

Spurred by the coronavirus disease pandemic and shortage of eye care providers, telemedicine is transforming the way ophthalmologists care for their patients. Video conferencing, ophthalmic imaging, hybrid visits, intraocular inflammation quantification, and portable technology are evolving areas that may allow more uveitis patients to be evaluated via telemedicine. Despite these promising disruptive technologies, there remain significant technological limitations, legal barriers, variable insurance coverage for virtual visits, and lack of clinical trials for uveitis specialists to embrace telemedicine.