Demyelinating plaque-associated uveitis

PURPOSE

To report the clinical and fluorescein angiographic (FA) features of demyelinating plaque-associated uveitis (DPU), a subset of uveitis in which patients have demyelinating plaques on the brain/cervical magnetic resonance image (MRI) but do not meet the criteria for multiple sclerosis (MS).

METHODS

In this retrospective observational study, Persian Patients were diagnosed with DPU and included if (1) they never satisfied the MS criteria, (2) all other possible etiologies were excluded, and (3) they were followed for at least 2 years.

RESULTS

After a median follow-up of 3 years (interquartile range, 2.0-5.3), 8 out of 40 (20%) patients diagnosed with DPU were excluded as they subsequently met the MS criteria. Of remaining 32 patients studied, the mean age was 36.3±9.9 (range 20-56 years), and 30 (93.8%) were female. Twenty-four (75.0%) showed bilateral involvement and 27 (84.4%) had insidious-chronic course. Uveitis was classified as intermediate (with or without anterior uveitis) in 29 (90.6%) and isolated anterior in 3 (9.4%) patients. Nine (28.1%) patients had at least one systemic neurological complaint. Ocular findings were: granulomatous keratic precipitates in 43/44 (97.7%) eyes; snowballs in 25/52 (48.1%) eyes; snowbanks in 4/52 (7.7%) eyes; cystoid macular edema in 20/56 (35.7%) eyes; and optic neuritis in 5/56 (8.9%) eyes. Visual acuity was ≥ 20/40 in 39 eyes (69.6%) at presentation which improved to 46 eyes (81.2%) at 2-year follow up. The two most frequent findings in FA were optic disc leakage/staining in 44/52 (81.5%) eyes, and peripheral retinal perivascular leakage in 39/52 (76.9%) eyes, which in 14/52 (26.9%) eyes extended beyond the equator.

CONCLUSION

DPU usually presents as a bilateral chronic granulomatous intermediate and, less often, isolated anterior uveitis, especially in females. Most are neurologically asymptomatic. Visual outcome is generally favorable. In FA, peripheral retinal perivascular leakage is common. DPU patients have an increased tendency to develop MS and should be prohibited from anti-TNF treatment.

[Therapeutic options in juvenile idiopathic arthritis : Part 1: Nonsurgical treatment]

The treatment of children and adolescents with juvenile idiopathic arthritis (JIA) has progressed substantially during recent years. Multiple different factors have played a role in this advancement: improved medical treatment due to the introduction of new drugs, structural improvements with provision of units specializing in childhood rheumatology, multidisciplinary treatment concepts, structured educational programs for patients and parents, improved functional treatment including sports therapy, and selective surgical and orthopedic interventions improving functional capacities. Current treatment strategies in JIA are aimed at achieving disease remission, i.e., control of disease activity and re-establishment of age-appropriate functional capacities. This review summarizes important developments in the conservative treatment of JIA. Part 2 deals with orthopedic and surgical treatment strategies.

[Effect of 2% ganciclovir eye drops on cytomegalovirus positive Posner-Schlossman syndrome]

Objective: To observe the effect of 2% ganciclovir eye drops on Posner-Schlossman syndrome (PSS) patients with positive cytomegalovirus (CMV) in aqueous humor. Methods: Prospective study. The cases clinically diagnosed as PSS with positive CMV were enrolled from August 2017 to January 2018 at Department of Ophthalmology, Eye & ENT Hospital of Fudan University. All patients underwent aqueous and serum analysis for CMV by the enzyme linked immunosorbent assay and polymerase chain reaction. The history and clinical signs were noted, 2% ganciclovir eye drops were prescribed for topical use (4 times per day), and the patients were followed up. The Pearson Chi-square test was used for the comparison of factors including keratic precipitates (KPs), and the Tyndall, and paired t test or Wilcoxon rank sum test was used for factors like intraocular pressure (IOP), corticoid dosage, and IOP lowering medication dosage. Results: Fifty cases (31 males and 19 females) clinically diagnosed as PSS with positive CMV had an average age of (38±13) years. Some characteristics could help to identify CMV-positive PSS: iris depigmentation (96%, 48/50), coin-shaped KPs, loss of corneal endothelium (an average loss rate of 10.8%±5.5%), and high IOP during attack[(47.8±9.9)mmHg,1 mmHg=0.133 kPa]. After topical antivirus therapy with the mean time of (5.4±2.7) weeks, the clinical manifestations of CMV positive PSS cases improved. The granulomatous or middle-sized KPs decreased from 94%(47/50) to 52%(26/50), the coin-shaped KPs almost disappeared [from 22%(11/50) to 2%(1/50)], and the Tyndall reaction disappeared [from 12%(6/50) to 0]. The mean IOP value decreased from (26.2±10.9) mmHg to (15.5±3.6) mmHg. Furthermore, corticoid use decreased (from 3 times per day to 0 time per day, by median value), the number of cases that did not use corticoids increased from 6% (3 cases) to 60% (30 cases), and 17 (65%) out of those 26 corticoid dependent patients could withdraw corticoids. The number of IOP lowering eye drops used also decreased (from 2 to 0, by median value), and the proportion of cases without IOP lowering medication increased from 24% (12 cases) to 58% (29 cases). There were statistical differences between post-treatment and pre-treameat (all P<0.05).Thirteen cases that accepted CMV re-test of aqueous humor were all CMV DNA negative after treatment. Conclusion: Topical treatment with 2% ganciclovir eye drops has a good short-term effect on CMV-positive PSS patients by contributing to inflammation and IOP control. (Chin J Ophthalmol, 2018, 54: 833-838).