Panuveitis following Vaccination for COVID-19

Background: COVID-19 vaccination has been accompanied by reports of inflammatory events. This report details a case of panuveitis following vaccination for COVID-19 Case.Description: A 43 year old female developed panuveitis with decreased vision three days after her second dose of Pfizer-Biontech mRNA vaccine. The choroid was significantly thickened and there was anterior chamber and vitreous inflammation. Shortly after onset of ocular symptoms she was also found have an asymptomatic COVID-19 infection. Treatment with oral and topical corticosteroids resulted in improvement in the panuveitis, with a mild recurrence after the initial attempt to taper these drugs.Conclusion: This report demonstrates a likely occurrence of vaccine-related panuveitis secondary to the Pfizer-Biotech mRNA vaccine for COVID-19.

Dexamethasone Intravitreal Implant in the Treatment of Uveitic Macular Edema in the Perioperative Cataract Setting: A Case Series

PURPOSE

To examine the efficacy of the dexamethasone (DEX) intravitreal implant (Ozurdex; Allergan, Inc, Irvine, California, USA) in the control of uveitic macular edema in the perioperative setting of cataract surgery.

DESIGN

Retrospective observational case series.

METHODS

setting: Clinical practice.

PARTICIPANTS

A total of 17 eyes of 14 patients that received a DEX implant for cystoids macular edema (CME) associated with noninfectious uveitis who underwent subsequent phacoemulsification within 4 months.

INTERVENTION

Each patient was treated with a DEX 0.7 mg intravitreal implant and underwent phacoemulsification with intraocular lens placement.

MAIN OUTCOME MEASURES

Primary outcome measure was the change in central macular thickness (CMT) measured by optical coherence tomography (OCT), measured preoperatively and postoperatively.

RESULTS

Seventeen eyes (14 patients) were included for analysis. There was no statistically significant change from preoperative CMT (mean 302 μm) to postoperative CMT (307 μm) on OCT. In the subset of eyes that underwent phacoemulsification within 4 weeks of the DEX implant (8 eyes), the mean change in CMT was -47.0 μm, compared to +51.1 μm in those that received the DEX implant greater than 4 weeks prior to phacoemulsification (P = .005).

CONCLUSIONS

Intravitreal dexamethasone implant was shown to prevent the recurrence or worsening of macular edema in uveitic patients with a history of CME who underwent phacoemulsification. The mean CMT decreased in the subset of eyes that received the DEX implant within 4 weeks prior to cataract surgery.

Bilateral uveitis associated with fluoroquinolone therapy

CONTEXT

Retrospective case series, database study and literature review. Forty case reports are described.

OBJECTIVE

To report a possible association between fluoroquinolones and uveitis.

MATERIALS AND METHODS

Spontaneous reports from the National Registry of Drug-Induced Ocular Side effects, World Health Organization, and Food and Drug Administration were collected on uveitis associated with systemic fluoroquinolone therapy. A literature review was performed using keywords "uveitis", "fluoroquinolones", and each individual fluoroquinolone name. Additional case reports were collected from the practices of six uveitis subspecialists and one neuro-ophthalmologist.

MAIN OUTCOME MEASURES

Data garnered from the reports include the type of fluoroquinolone, age, gender, adverse drug reaction (ADR), dosage, duration of therapy until onset of uveitis, concomitant drugs, systemic disease, dechallenge and rechallenge data.

RESULTS

A total of 40 case reports of uveitis associated with fluoroquinolones were identified including 12 men, 27 women, and 1 case in which the gender was not specified. The median age was 54 years. Dosage varied between the different fluoroquinolone drugs, with the median dosage within the range recommended in the package insert for each different fluoroquinolone. Median time from beginning of therapy to appearance of the ADR was 13 days (range 0-20 days). Thirteen patients were 60 years or older, and one patient was taking systemic anti-inflammatory steroids. There were five positive dechallenge case reports.

DISCUSSION

According to World Health Organization criteria, the relationship between fluoroquinolone therapy and uveitis is "possible". Causality assessments are based on the time relationship of drug administration, uveitis development, and dechallenge data.

CONCLUSIONS

Clinicians should be aware of a possible bilateral fluoroquinolone-associated uveitis, particularly the finding of iris transillumination and pigment dispersion.

Cone photoreceptor function loss-3, a novel mouse model of achromatopsia due to a mutation in Gnat2

PURPOSE

To report a novel mouse model of achromatopsia with a cpfl3 mutation found in the ALS/LtJ strain.

METHODS

The effects of a cpfl3 mutation were documented using fundus photography, electroretinography (ERG), and histopathology. Genetic analysis was performed using linkage studies and PCR gene identification.

RESULTS

Homozygous cpfl3 mice had poor cone-mediated responses on ERG at 3 weeks that became undetectable by 9 months. Rod-mediated waveforms were initially normal, but declined with age. Microscopy of the retinas revealed progressive vacuolization of the photoreceptor outer segments. Immunocytochemistry with cone-specific markers showed progressive loss of labeling for alpha-transducin, but the cone outer segments in the oldest mice examined remained intact and positive with peanut agglutinin (PNA). The cpfl3 mapped to mouse chromosome 3 at the same location as human GNAT2, known to cause achromatopsia. Sequence analysis revealed a missense mutation due to a single base pair substitution in exon 6 in cpfl3.

CONCLUSIONS

The Gnat2(cpfl3) mutation leads to cone dysfunction and the progressive loss of cone alpha-transducin immunolabeling. Despite a poor cone ERG signal and loss of cone alpha-transducin label, the cones survive at 14 weeks as demonstrated by PNA staining. This mouse model of achromatopsia will be useful in the study of the development, pathophysiology, and treatment of achromatopsia and other cone degenerations. The gene symbol for the cpfl3 mutation has been changed to Gnat2(cpfl3).