Dexamethasone Intravitreal Implant (Ozurdex) in Paediatric Patients with Non-infectious Intermediate Uveitis and Related Cystoid Macular Oedema: Evaluation of Macular Morphology and Function with Six-month Follow-up; a Deeper Role of MfERG?

A Period of Macular Hyperemia and Subclinical Edema Caused by Phacoemulsification Surgery in Noninfectious Uveitis

PURPOSE

To identify the changes in macular microvasculature in uveitic patients following phacoemulsification.

METHODS

A prospective cohort study was conducted by enrolling uveitic patients who underwent phacoemulsification at the Eye Hospital. Macular vessel densities (VD) of superficial and deep capillary plexus (SCP and DCP) and retinal thickness (RT) were quantified by optical coherence tomographic angiography (OCTA).

RESULTS

Twenty-one eyes obtained satisfactory OCTA scans at all the follow-up visits. After surgery, an increasing trend in SCP VD was found (p = .037) and reached its maximum (+2.79 ± 4.86%) at post-3 months (M). RT increased synchronously. The increases in SCP VD at post-3 M were significantly correlated with the changes in anterior chamber cells (ACCs) at post-1 M and 2 M (r = 0.450, p = .041; r = 0.477, p = .029, respectively).

CONCLUSIONS

Inflammation generates a long-term effect on retina demonstrated as an increase in SCP VD and RT which are associated with synchronous ACCs changes after phacoemulsification.

Case report: Ultrasound biomicroscopy as a guide for the selection of injection sites for dexamethasone intravitreal implant (Ozurdex) for peripheral granulomatous ocular toxocariasis in children

Purpose

This article aims to report a case of successful treatment of peripheral granulomatous ocular toxocariasis (OT) in an 8-year-old patient using intravitreal injection of dexamethasone (DEX) implant (Ozurdex) under ultrasound biomicroscopy (UBM) guidance.

Case presentation

A previously healthy 8-year-old boy with a history of long-term close contact with dogs complained of blurring of vision in the right eye for a year. Ophthalmic examination of his right eye showed chronic uveitis. Notably, UBM examination identified granulomas and peripheral vitreous strand in the ciliary body from 3 to 8 o'clock positions. Enzyme-linked immunosorbent assay (ELISA) results of the intraocular fluid (IF) and serum showed increased anti-Toxocara immunoglobulin G (IgG) levels, leading to a diagnosis of peripheral granulomatous OT in the right eye. Intraocular surgery was not indicated in this case. The treatment goal was to alleviate uveitis, improve visual acuity, and prevent complications. He was treated with an intravitreal injection of DEX implant, administered as a single dose every three months, total two doses, combined with albendazole, an oral anthelmintic. Under preoperative UBM guidance, two injections were performed at the 12 and 10 o'clock positions in the pars plana where there were no granulomas and peripheral vitreous strand, successfully preventing complications associated with intravitreal injection. After two injections, the patient's right eye vision improved significantly, with the best-corrected visual acuity (BCVA) increasing from 20/400 to 20/50. Vitreous opacity and retinal edema were reduced, preretinal proliferative membrane was stabilized, and no adverse events occurred.

Conclusion

UBM can accurately determine the location and extent of peripheral granulomas in OT patients, facilitating the avoidance of granulomas during intravitreal injection and preventing complications associated with intravitreal injection. Under the close follow-up and strict adherence to indications, preoperative UBM-guided intravitreal injections of DEX implant treatment for pediatric peripheral granulomatous OT are safe and effective, providing a new therapeutic option for pediatric peripheral granulomatous OT.

Sympathetic ophthalmia after vitreoretinal surgery: a report of two cases

Sympathetic ophthalmia (SO) is a panuveitis that usually occurs after trauma to one eye. We describe two cases of SO occurring after 23-gauge vitrectomy. Case 1 involved a 66-year-old woman who underwent pars plana vitrectomy (PPV) for a rhegmatogenous retinal detachment. Two months later, she presented with decreased visual acuity (VA) and bilateral uveitis. Case 2 involved a 43-year-old woman who underwent a second PPV for recurrent retinal detachment. Two months later, she presented with bilateral panuveitis. Both patients were diagnosed with SO and were treated with methylprednisolone and cyclosporine. The first patient was further treated with a dexamethasone intravitreal implant (Ozurdex®) owing to the side effects of methylprednisolone. The VA and symptoms improved significantly after treatment in both patients. Bilateral granulomatous panuveitis following PPV should alert surgeons to consider SO. Appropriate interventions for SO can produce positive outcomes.