Eric L. Crowell

Correlation between intraocular pressure and body mass index in the seated and supine positions.

Purpose:Examine the relationship between intraocular pressure (IOP) and body mass index (BMI) in the seated and supine positions. Patients and Methods:A prospective observational study was conducted in which the IOP was measured with a Tono-Pen (Reichert Inc., Depew, NY) in seated and supine positions in eligible participants with a wide range of BMI (18 to 70 kg/m2). The paired t test was used to compare seated to supine IOP. Stepwise regression analyses were used to investigate the correlation between IOP and BMI at these positions after adjusting for confounding variables of increased IOP, including age, race, mean arterial blood pressure, and central corneal thickness (&mgr;m). Results:The mean sitting IOP (16.3±2.9 mm Hg) was statistically lower than the mean supine IOP (17.7±3.1 mm Hg; P<0.0001). For each 10 unit increase in BMI, there was an increase of 0.55±0.23 mm Hg (P=0.0184) in IOP in the seated position and an increase of 0.49±0.24 mm Hg in IOP in the supine position (P=0.0409). BMI did not have a significant effect on the amount of increase in IOP observed in changing from the seated to supine position. Conclusions:Higher BMI is correlated with higher IOP in both the seated and supine positions. However, BMI has no significant effect on the amount of increase in IOP observed in changing from the seated to supine position.

Idiopathic Central Nervous System Inflammatory Disease in the Setting of HLA-B27 Uveitis

ABSTRACT Purpose: The purpose of the article is to describe a novel case of idiopathic central nervous system inflammatory disease with bilateral human leukocyte antigen (HLA)-B27-positive anterior uveitis. Methods/Results: A 15-year-old African American boy with bilateral HLA-B27-positive anterior uveitis controlled with topical and oral steroids for 8 months acutely developed headaches, left eyelid ptosis, and binocular diplopia. Imaging showed lesions in the right midbrain, superior colliculus, cerebellar peduncles, and cerebellar vermis and leptomeningeal enhancement along the vermian foliae. Cerebral spinal fluid tests showed mild lymphohistiocytic pleocytosis with negative cytology; inflammatory and infectious workup were negative. He received intravenous methylprednisolone without initial symptomatic improvement; repeat magnetic resonance imaging (MRI) showed reduced lesion burden. Oral steroids were continued; his symptoms resolved in 1 month. Repeat MRI 2 months after presentation showed almost complete lesion resolution. Conclusions: Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) was diagnosed. HLA-B27 positivity may represent a novel association with CLIPPERS.

Reply to Tobin and Keegan’s “Reply to Idiopathic Central Nervous System Inflammatory Disease in the Setting of HLA-B27 Uveitis”

Dear Sir, We thank Drs Tobin and Keegan for their interest in our case report and appreciate the opportunity to respond to their letter regarding our article. In the case report, we describe a young man with a human leukocyte antigen (HLA)-B27-associated uveitis who develops an idiopathic central nervous system inflammation responsive to steroids. While the presenting imaging is not classic for Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS), the clinical history, location of imaging abnormalities, and clinical response to steroid treatment is most consistent with this diagnosis. While the presenting images show confluent lesions in the brainstem and cerebellum, later MRI Brain imaging demonstrates a punctate hyperintensity as the inflammation resolves (Figures 3–4 in Crowell et al). 1 This is more similar to that seen in classic CLIPPERS cases (Figure 1 in Drs Tobin and Keegan’s letter), although it is not diffuse and may just be a residual nidus of signal change as inflammation resolves. As the patient was tapered off corticosteroids, his inflammatory symptoms recurred, and corticosteroid sparing immunomodulatory therapy was required. We feel that we sufficiently considered and ruled out other disease processes in our workup as was feasible and focused our discussion on the two most likely alternative diagnoses of neurosarcoidosis and Behçet’s disease. This being said, we are aware that our case is not completely consistent with the imaging characteristics of CLIPPERS and may represent another disease entity. We again, do appreciate the comments of Drs Tobin and Keegan and welcome their thoughts on the differential diagnosis.

Orbital Inflammatory Syndrome and Anterior Uveitis: A Case Series

ABSTRACT Purpose: To describe four cases of orbital inflammatory syndrome (OIS) with associated anterior uveitis that have presented within 2 years to our practice. Methods: Charts of patients diagnosed with OIS from June 2013 to May 2015 were reviewed. Results: Four patients, three children and one adult, presented with orbital swelling, pain, and varying degrees of vision loss. Treatment with intravenous methylprednisolone resulted in significant symptomatic improvement in all cases initially; when symptoms recurred, the patients had evidence of anterior uveitis. With continued systemic therapy and the addition of topical prednisolone, the patients all achieved control of their uveitis and OIS and are well controlled with regular outpatient follow-up. Conclusions: Reports of OIS-associated with uveitis are relatively rare. The presentation of three pediatric patients and one adult patient to the same practice with OIS and secondary uveitis within a 2-year period may indicate that the association is underreported.