Amanda Rey

Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients.

Purpose: To evaluate the safety and efficacy of Ozurdex (dexamethasone intravitreal implant) 0.7 mg in the treatment of uveitic macular edema in vitrectomized eyes. Methods: Data from 13 patients (17 eyes) with persistent uveitic cystoid macular edema and a history of pars plana vitrectomy in the study eyes that were treated with intravitreal injection of 0.7-mg dexamethasone implant were reviewed retrospectively. Main outcome measures were changes in central retinal thickness measured by optical coherence tomography and changes in best-corrected visual acuity. Results: The median age of patients was 61 years (range, 19–81 years). The median duration of uveitic macular edema was 12 months (range, 2–72 months). The mean baseline central retinal thickness (95% confidence interval) was 461.6 &mgr;m (403.8–519.4), decreased to 277.2 &mgr;m (244.6–309.8) at 4 weeks (P < 0.01), remained low at 349.9 &mgr;m (281.8–418.0) at 3 months (P = 0.01), and then reached 394.1 &mgr;m (328.3–459.8) at 6 months (P = 0.14). After 3 months, there was a median improvement of 2 lines of best-corrected visual acuity, with 52.9% of eyes gaining 2 lines or more (P < 0.01). At 6 months, there were 5 eyes that maintained the 2 lines gain and none had lost >1 line from baseline (P = 0.03). In 8 eyes (47.1%), reinjection of the implant was performed at a mean of 6.5 months. Ocular hypertension (47.1%), hypotony (11.8%), anterior chamber displacement of the implant (5.9%), and glaucoma, which required filtration surgery (5.9%), were the most common adverse events. Mean follow-up was 9.6 months (range, 6–17 months). Conclusion: In this small case series of eyes with limited follow-up, treatment with dexamethasone intravitreal implant injection for uveitic macular edema in vitrectomized eyes was associated with favorable visual outcomes and had an acceptable safety profile.

Indirect supportive evidence for diagnosis of tuberculosis-related uveitis: from the tuberculin skin test to the new interferon gamma release assays.

Purpose:  To evaluate clinical and paraclinical parameters for the indirect diagnosis of tuberculosis‐related uveitis (TRU).

Natural Course and Surgical Management of High Myopic Foveoschisis

Purpose: To describe the spectral-domain optical coherence tomographic characteristics, natural course and surgical management for eyes with myopic foveoschisis. Methods: The medical records of 39 consecutive patients (56 eyes) with myopic foveoschisis were retrospectively reviewed. Pars plana vitrectomy with internal limiting membrane peeling and Brilliant Blue G staining was performed on 16 symptomatic eyes (14 patients). Results: Optical coherence tomography at baseline showed an isolated foveoschisis in 62.5%, foveal detachment in 21.4%, and a lamellar hole in 16.1% of the eyes. After a mean follow-up period of 15.7 months, 1.8% of the eyes developed a full-thickness macular hole and 28.5% of the eyes required surgery. The mean preoperative visual acuity (VA) was 20/63 and the mean central retinal thickness (CRT) was 507.6 µm. The mean postoperative VA was 20/40 and the mean CRT 282.9 µm. Anatomical success was achieved in 75% of the eyes at a mean of 3.3 months after surgery, and 81.2% of the eyes had an improvement of 2 lines of VA. Conclusion: Myopic foveoschisis remained stable in most eyes; however, 28.5% of the eyes had decreases in VA secondary to progression of the foveoschisis and required surgery.

Spanish multicenter tafluprost tolerability study

Aim To evaluate the ocular surface symptoms and signs associated with preservative-free 0.0015% tafluprost in patients with glaucoma or ocular hypertension (OHT). Methods Prospective non-interventional, multicentre, observational study on 134 patients, naive or on previous treatment with another prostaglandin analogue. In each visit (V1 baseline visit, V2 at 1 month and V3 at 3 months), patients evaluated five ocular surface symptoms as: absent, mild, moderate and severe. Parallelly, the ophthalmologist assessed the tear break-up time, keratitis, conjunctival hyperaemia, blepharitis, Schirmer test and tear meniscus. Results Patients with OHT (n=71, 53%) experienced a statistically significant improvement of all symptoms: stinging/burning/irritation, itching, foreign body sensation, tearing and dryness sensation at V3, while glaucoma patients improved all symptoms at both V2 and V3. In patients with OHT, all signs except Schirmer test improved and the decrease in hyperaemia was statistically significant. Eyes with glaucoma ameliorated the keratitis, hyperaemia and tear meniscus at V2 and V3 and the break-up time and blepharitis at V3. In the subset of patients with previous treatment (n=79, 58.9%), patients with OHT presented significant improvement of hyperaemia, yet the rest of signs did not decrease significantly or remained unchanged, while in patients with glaucoma all signs improved significantly at both visits. The intraocular pressure (IOP) drop in naive eyes was 22.2% (24.7–19.7 mm Hg) in OHT and 29.5% (33.7–25.3 mm Hg) in glaucoma eyes. In previously treated eyes, no statistically significant change in IOP was found. Conclusion Preservative-free tafluprost is a well tolerated hypotensive agent that can be used in eyes with surface problems and in naive eyes.

Clinical pattern of toxoplasmic retinochoroiditis in a Spanish referral center.

Background/Aims: To analyze the clinical pattern of ocular toxoplasmosis in a referral center in Spain. Methods: The medical records of consecutive patients with ocular toxoplasmosis admitted from a single referral center for uveitis in Barcelona (Spain) were retrospectively analyzed between January 2005 and January 2011. Results: One hundred and thirteen eyes from 113 patients (74 Spanish and 39 South American) with active ocular toxoplasmosis were analyzed with a 12-month follow-up. Final BCVA ≤20/200 was found in 30 eyes (26.5%). The most frequent complications were macular edema (16.8%) and epiretinal membrane (11.5%). Anterior chamber cell scores of ≥2+ (p = 0.003), vitreous cell scores of ≥2+ (p = 0.001), and the presence of cataracts (p = 0.047) or serous retinal detachment (p = 0.008) were more common among the South American than Spanish cohort. Active macular lesions (p < 0.001) with an initial BCVA ≤20/200 (p < 0.001) and advanced age (p = 0.019) were predictors for final BCVA ≤20/200, whereas female gender (p = 0.021) and an initial BCVA ≤20/200 (p = 0.045) were predictors for ocular complications. Moreover, a BCVA ≤20/200 (p < 0.001) and a vitreous cell score of ≥2+ (p = 0.045) at the initial examination were predictors of an eventual need for ocular surgery. Conclusion: The clinical features of ocular toxoplasmosis in Spanish patients differ from those of South American patients. In general, active macular lesions with an initial BCVA ≤20/200 and advanced age were shown to be predictors for final BCVA ≤20/200 in our patient cohort.

SURGICAL OUTCOME OF LATE IN-THE-BAG INTRAOCULAR LENS DISLOCATION TREATED WITH PARS PLANA VITRECTOMY.

Purpose: To present the visual outcome and postoperative complications of pars plana vitrectomy and intraocular lenses (IOL) removal with or without IOL exchange of late in-the-bag IOL dislocation after uneventful cataract surgery. Methods: Retrospective analysis of a consecutive series of 83 eyes with late in-the-bag dislocated IOL treated with pars plana vitrectomy and anterior chamber IOL (25 eyes), transscleral suture-fixated posterior chamber IOL (38 eyes), or aphakia (20 eyes). Results: High myopia was the major predisposing factor (40%). The interval between cataract surgery and the dislocation was 10.9 years. The complication rate after the second surgery was 43%; being transient hypotony (19%) and hypertension (15%) the most frequent. Postoperative best-corrected visual acuity improvement was statistically significant (P < 0.001), with a mean of 3 Snellen lines. This improvement was also significant in 2 subgroups, patients with sutured posterior chamber IOL (20/80–20/40; P < 0.001) and in patients with anterior chamber IOL (20/125–20/40; P < 0.001). However, best-corrected visual acuity did not improve in aphakic patients (20/63–20/63; P = 0.13). Postoperative astigmatism increased significantly (P < 0.001), with a mean of −1 D. Mean follow-up was 24 months. Conclusion: The major predisposing factor for late in-the-bag IOL dislocation is myopia. Despite a complication rate of 43%, mostly minor and transient, IOL exchange surgery is an effective procedure with a good visual outcome (mean 3 Snellen lines improvement). There were no statistically significant differences in the final best-corrected visual acuity or complication rate between anterior chamber IOL and sutured posterior chamber IOL, thus, both surgical techniques may be considered to treat this condition.

Simple technique to treat pupillary capture after transscleral fixation of intraocular lens

&NA; We describe a simple surgical technique to manage pupillary capture after previous transscleral fixation of an intraocular lens. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Cytokine profiling reveals decreased serum levels of CCL2 in active ocular toxoplasmosis

Background Toxoplasma gondii infection is an important cause of ocular disease. Although parasite-mediated host cell lysis is probably the principal cause of tissue destruction in immunodeficiency states, hypersensitivity and inflammatory responses may underlie severe disease in otherwise immunocompetent individuals. The purpose of the current investigation was to study the cytokine profiles in serum from patients with ocular toxoplasmosis and to compare them with those obtained from healthy control subjects. Methods Using a multiplex assay, we determined the serum concentration of granulocyte colony-stimulating factor (GCSF), interferon γ (IFNγ), interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, chemokine (C-C motif) ligand 2 (CCL2) and tumour necrosis factor α (TNFα) in patients with inactive ocular toxoplasmosis (n=48), active ocular toxoplasmosis (n=21), and an age-matched and sex-matched healthy control group (n=25). In a subgroup of 17 patients with active disease, a second serum sample was obtained when the disease was inactive. Cytokine profiles were correlated with disease activity, severity and visual outcome. Results Levels of CCL2 were significantly reduced in patients with active ocular toxoplasmosis compared to the control group (564±42 pg/mL vs 455±35 pg/mL, p<0.05). Moreover, CCL2 levels were significantly lower during active ocular toxoplasmosis compared to inactive disease (569±32 pg/mL vs 433±32 pg/mL, p<0.01). GCSF and TNFα were elevated in patients with toxoplasmosis with poor visual outcome. No significant correlations were found with specific cytokine profiles and disease severity. Conclusions Decreased serum levels of CCL2 may be associated with active ocular toxoplasmosis and could therefore serve as a marker of disease activity.

Adalimumab in Serpiginous Choroiditis

Institut d´Investigacions Biome`diques August Pi i Sunyer(IDIBAPS), Hospital Cli´nic de Barcelona, Barcelona, SpainDear Editor,Serpiginous choroiditis (SC) is a rare form of uveitisthat tends to affect both eyes in patients worldwide.The course is relapsing and progressive, starting atthe papilla and spreading centrifugally with geo-graphic chorio-retinal plaques. Yellow creamy edgesgo on expanding and leaving atrophic central scars.SC etiology is not clear, but an immune-mediatedhypersensitivity reaction triggered by tuberculousantigens has been postulated.

Late spectral-domain optical coherence tomography findings in sub-internal limiting membrane hemorrhage.

PURPOSE To report spectral-domain optical coherence tomographic (OCT) findings during the natural history of a sub-internal limiting membrane (sub-ILM) hemorrhage. METHODS Observational case report of a 20-year-old man with myeloid acute leukemia who presented a spontaneous resolution of a premacular hemorrhage, which was demonstrated by OCT. During the 12-month follow-up, periodic ophthalmologic and OCT examinations were performed. RESULTS A premacular hemorrhage was revealed in fundus examination, and spectral-domain OCT demonstrated a highly hyperreflective band just above the premacular hemorrhage consistent with the ILM. At 6-month follow-up, the macula was free of blood. The OCT scans after spontaneous resolution of the hemorrhage showed a thickened hyperreflective membrane (ILM) and a prominent hyporeflective premacular cavity. Six months later, this premacular cavity had resolved. CONCLUSION These late OCT findings in sub-ILM hemorrhage have not been described in spontaneous evolution and confirm the sub-ILM location of a premacular hemorrhage.