D Makhoul

Broncho-alveolar Lavage (BAL) for the Diagnosis of Sarcoidosic Uveitis

Abstract Purpose: To evaluate the use of BAL for the diagnosis of sarcoidosic uveitis. Methods: Retrospective study of 109 consecutive patients with uveitis and minimum 2 signs of ocular sarcoidosis who had a BAL and chest imaging. BAL+ was defined as an alveolar (a) lymphocytosis (L) aL > 15% with aCD4/CD8 > 3.5. Serum angiotensin converting enzyme (sACE), tuberculin skin test and gallium scan were tested in 83, 95 and 24 patients. Results: BAL was + in 26.6% of patients (86.2% females, mean age 50.8y) with mean aL = 46.8% and mean aCD4/CD8 = 8.5 which significantly differed form BAL− patients: 62.5% females, p < 0.02, mean age 43.6y, p < 0.05, mean aL = 17.2%, p < 0.001 and mean aCD4/CD8 = 1.8, p < 0.001. BAL+ patients had 31% of bilateral hilar adenopathy (BHL+), and 59.1% of elevated sACE which significantly differed form BAL− patients: 8.8%, p = < 0.01 and 14.8% p < 0.001. Conclusion: Our findings suggest that BAL have a high diagnostic value and might be a useful additional test for the diagnosis of sarcoidosic uveitis, even with normal chest imaging.

Clinical Outcome of Hypertensive Uveitis

Purpose. To review the clinical outcome of patients with hypertensive uveitis. Methods. Retrospective review of uveitis patients with elevated intraocular pressure (IOP) > 25 mmHg and >1-year follow-up. Data are uveitis type, etiology, viral (VU) and nonviral uveitis (NVU), IOP, and medical and/or surgical treatment. Results. In 61 patients, IOP values are first 32.9 mmHg (SD: 9.0), highest 36.6 mmHg (SD: 9.9), 3 months after the first episode 19.54 mmHg (SD: 9.16), and end of follow-up 15.5 mmHg (SD: 6.24). Patients with VU (n = 25) were older (50.6 y/35.7 y, p = 0.014) and had more unilateral disease (100%/72.22%  p = 0.004) than those with NVU (n = 36). Thirty patients (49.2%) had an elevated IOP before topical corticosteroid treatment. Patients with viral uveitis might have higher first elevated IOP (36.0/27.5 mmHg, p = 0,008) and maximal IOP (40.28/34.06 mmHg, p = 0.0148) but this was not significant when limited to the measurements before the use of topical corticosteroids (p = 0.260 and 0.160). Glaucoma occurred in 15 patients (24.59%) and was suspected in 11 (18.03%) without difference in viral and nonviral groups (p = 0.774). Conclusion. Patients with VU were older and had more unilateral hypertensive uveitis. Glaucoma frequently complicates hypertensive uveitis. Half of the patients had an elevated IOP before topical corticosteroid treatment.

Sickle Cell Crisis Presenting as a Masquerade Syndrome Complicated by Macular Ischemia

Objective: To report the case of a young boy, homozygous for the hemoglobin S, who presented a pseudouveitis in the setting of severe sickle cell retinopathy complicated by macular infarction. Methods: Case report. Results: A 15 year-old boy with a history of hypertensive uveitis of two months duration was reffered to our institution. He was treated with topical prednisolone acetate, beta-blockers and acetazolamide.The visual acuity was 20/200 RE and 20/25 LE. Anterior inflammation included fine inferior keratic precipitates with 2+ cells RE and 1+ cells LE. Vitreous haze was 2+ preventing clear vieuw of subretinal infiltrates scattered around the posterior pole and midperipheral retina, some of them having a salmon patch appearence. Fluorescein angiograms revealed multiple preretinal haemorrahge and some areas of retinal ischemia. Fundus examination of the left eye was normal. A diagnosis of panuveitis was done and a sickle cell retinopathy was suspected. Systemic workup showed an hemoglobin at 8,2 mg/dl and sickle cells on direct examination. Two days later he developped sudden loss of vision in the right eye. Funduscopy an angiogram revealed macular infarction with occlusion of the retinal arterioles surrounding the foveal avascular zone. The clinical picture was not improved by erythrocyte transfusion. Intraocular pressure raised again after few days, and was finally controlled by anterior chamber paracentesis. The patient was later found to be homozygous for HbS. Conclusions: Sickle cell retinopathy can rarely masquerade as panuveitis, and can lead to severe ocular complications as an irreversible macular ischemia.

Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers

ABSTRACT Purpose: To evaluate diagnostic methods and clinical signs of CMV anterior uveitis (AU), a rarely described entity in Europe. Methods: We included patients with clinical characteristics of CMV AU and positive PCR and/or Goldmann-Witmer coefficient (GWc) for CMV. Results: We report 21 patients with unilateral uveitis (100%) and signs of Posner-Schlossman syndrome (PSS) (n = 20, 95.2%), Fuchs uveitis syndrome (FUS) (n = 1, 4.7%), and endotheliitis (n = 4, 19,04%). PCR was positive in 15/21 (71.4%) and GWc in 8/9 patients (88.9%) in aqueous for CMV. GWc was the only positive test in 6/9 patients (66,6%). When PCR alone was performed (without GWc) in the first tap, repeated aqueous taps were needed, twice in five cases and thrice in one case. Conclusion: Combining PCR and GWc were very helpful to confirm the clinical diagnosis of CMV AU. In case of very high clinical suspicion and negative results, repeated tap seems to be recommended.

Role of Enhanced Depth Imaging Optical Coherence Tomography in the Diagnosis and Follow-up of Presumed Choroidal Tuberculomas

Tuberculosis (TB) is a multisystem infectious disease, which primarily affects the lungs but may also spread into other organs such as the eye. The hallmark of the disease is the formation of granulomas. Although TB has a wide variety of manifestations in the eye, the choroid is the most commonly affected tissue in ocular TB. Choroidal tubercles are well-known lesions in ocular TB, and usually present as yellow-white lesions with ill-defined borders. Recent advances in optical coherence tomography, namely enhanced depth imaging optical coherence tomography (EDI-OCT), have allowed a better visualization of the choroid. To our knowledge, in uveitis, this technique has mostly been used to investigate changes in choroidal thickness during intraocular inflammation. However, a number of reports have also mentioned its utility in the diagnosis and follow-up of tuberculosis and sarcoidosis granulomas. Here, we report two cases of presumed ocular tuberculosis with choroidal granulomas, diagnosed and followed by EDI-OCT.

Distribution of uveitis in a Belgian university referral center for ocular inflammation

Purpose : To study the clinical characteristics of patients with uveitis seen in our center.