Evelyne Cohen

Cyclosporine Eyedrops for the Treatment of Severe Vernal Keratoconjunctivitis

Twelve children with severe chronic vernal keratoconjunctivitis participated in a pilot study aimed at evaluating the effect of 2% cyclosporine eyedrops on the clinical course and symptoms of this disease. Eleven of the 12 children showed improvement after the first week of treatment. Nine patients demonstrated persistent improvement at the completion of the treatment schedule after six weeks. However, although seven of the children were symptom-free while being treated, only three were free of disease two months after cessation of the cyclosporine eyedrops. The other nine showed rapid recurrence of their symptoms.

Cataract surgery in children with chronic uveitis

OBJECTIVE To evaluate the visual outcome of cataract surgery in childrens eyes with chronic uveitis and the feasibility of intraocular lens (IOL) implantation in these cases. DESIGN Retrospective noncomparative case series. PARTICIPANTS Seventeen children (20 eyes) with chronic uveitis, dense cataract, and a preoperative visual acuity of 6/120 or less with follow-up of 5 years after the initial cataract surgery. METHODS In 10 eyes of 10 children (five with juvenile rheumatoid arthritis [JRA] and five with non-JRA-associated uveitis) with uniocular or markedly unequal binocular disease, surgery was carried out through the limbus and a posterior chamber IOL was implanted. In seven children (10 eyes), three with JRA and four with non-JRA-associated disease, a pars plana approach was used, and contact lenses or glasses (for the bilateral cases) were prescribed. RESULTS The postoperative course and immediate restored visual acuities were similar whether an IOL was implanted or not. One month after the surgery, visual acuity improved in all operated eyes. After monocular surgery, in the younger children, contact lenses were poorly tolerated and their use discontinued. These aphakic eyes remained with low vision, developing strabismus on longer follow-up. Children with JRA-associated uveitis were younger, demonstrated an active intraocular inflammation for an extended period after surgery, and tended to have secondary membranes develop, necessitating a second surgical intervention. Five years after the initial surgery, only two of nine eyes (22%) in the JRA group (one aphakic of a bilaterally affected child and one pseudophakic in a child undergoing cataract surgery in one eye) retained a visual acuity of 6/9 and 6/6, respectively. In the other seven eyes, the visual acuity was 6/60 in one pseudophakic eye and 6/240 or less in six eyes (three aphakic and three pseudophakic). In children with non-JRA-associated uveitis, 6 (four aphakic in two patients bilaterally affected and two pseudophakic) of 11 eyes (54.5%) retained a vision of 6/12 or better. CONCLUSIONS Cataract surgery in childrens eyes with uveitis may be beneficial. IOL implantation seems preferable to correction with contact lenses in young children needing surgery in one eye. In children with JRA-associated uveitis, the final visual results remain guarded because of irreversible amblyopia and a more complicated postoperative course. For these cases, a modified management approach and a better surgical technique are needed.

Traumatic cataract in children: correction of aphakia by contact lens or intraocular lens.

PURPOSE To compare the postoperative complications, visual outcome, and incidence of strabismus in children suffering from traumatic cataract corrected with contact lens or intraocular lens and to follow up the refractive changes in these eyes for an extended period of time. METHODS Forty children, 2 to 13 years old at time of surgery for unilateral traumatic cataract, were followed up for 1.5 to 11 years. Seventeen children were corrected with contact lenses and 23 with intraocular lenses. Thirty-two underwent a primary posterior capsulectomy and anterior vitrectomy. RESULTS The mean follow-up after surgery was 7.4 years for the children with contact lenses and 6.2 years for those with intraocular lenses. The incidence of secondary surgical interventions was higher among the children corrected with contact lenses. The eight children (five with contact lenses, three with intraocular lenses) who did not undergo primary posterior capsulectomy had Nd:YAG capsulectomy within 1 year after surgery. Fifteen of the 23 children with intraocular lenses (65.2%) achieved a best-corrected visual acuity of 20/40, and 17 children (73.9%) had a final visual acuity of 20/50, but only five of 17 children with contact lenses (35.3%) achieved this level of visual acuity. CONCLUSIONS Correction of unilateral aphakia by intraocular lens in children after traumatic cataracts results in better final visual acuities and binocularity with a smaller incidence of strabismus than when correction is carried out by contact lens. Intraocular lens implantation should be considered the primary aphakic correction in children with traumatic cataract.

Effect of Cyclosporine a on the Hearing Loss in Behçet's Disease:

Thirty-five patients with Behçets disease (20 under cyclosporine A [CyA] treatment and 15 under the conventional therapy), 12 patients suffering from endogenous uveitis, and 35 normal subjects were evaluated audiologically before entering the study and were followed up for at least a year. Twenty-eight Behçet patients (80%) showed some degree of hearing loss. The averaged pure tone audiogram of the Behçet group showed statistically significant auditory deficits in comparison with that of the control group. None of either the Behçet group or the uveitis group showed any hearing deterioration during the follow-up period. Five Behçet patients under CyA therapy demonstrated improvement in their hearing. The difference between the two groups of Behçet patients (CyA versus conventional treatment) was found to be statistically significant (p < .05). Thus, CyA might serve as an important mode of treatment of sensorineural hearing loss on an inflammatory “autoimmune” background.

Increased intraocular pressure during treatment for chronic uveitis

Abstract• Objectives: (1) To prospectively evaluate the incidence of increased intraocular pressure (IOP) in patients suffering from chronic uveitis. (2) To identify the main factors responsible for an increase in the IOP among these patients. • Methods: Two hundred and one patients suffering from chronic uveitis were included. Enrolled patients had an initial IOP of 8–18 mmHg. The patients were treated and clinically monitored during a period of 4 years. The IOP was measured at each visit and its changes followed prospectively. All patients were followed up for at least 12 months after enrollment. • Results: Twenty-four (12%) of the 201 patients had IOP higher than 24 mmHg at two or more consecutive visits. Of these 24 patients, 19 suffered from bilateral uveitis and 5 had unilateral disease. Four of the 19 patients with bilateral uveitis developed a constant IOP higher than 24 mmHg in both eyes, while in 15 patients an IOP higher than 24 mmHg persisted only in one eye. A close association between the increased IOP and the use of corticosteroids was found in 18 of the 24 cases (75%). This association was ascertained in 16 of these patients by the decrease in IOP levels on discontinuation of the corticosteroid regimen and the renewed increase in IOP on rechallenge. The increased IOP was due to pupillary block in three cases (12.5%), to iris and angle neovascularization in two (8.3%), and to the inflammatory process per se in one case only (4.2%). • Conclusions: This study demonstrates that a persistent elevation of the IOP in patients suffering from chronic uveitis is, in the majority of cases, associated with the use of corticosteroids.

Spontaneous involution of autologous lenses and phacoanaphylaxis reaction in Stickler syndrome.

Stickler syndrome is a “hereditary progressive arthro-ophthalmopathy”1 caused in the majority of cases by mutations of the COL2A1 gene encoding for type II collagen.2 The disease is transmitted as an autosomal dominant trait with high penetrance but variable expressivity.3 Most common ocular manifestations of the disease are myopia, vitreous veils and degeneration, early cataract, retinal peripheral breaks and retinal detachment.3,4 This patient had typical ocular and extraocular clinical manifestations of Stickler syndrome. She was fitted with contact lenses (−17.00 dioptres) at the age of 1 month. Despite the relatively poor vision, hearing impairment and skeletal problems, she developed well mentally and attended regular school. With glasses (−15.00) the visual acuity (VA) was stable, around 6/21 (20/75) for distance and J2 for near in both eyes. A mild central opacity of the posterior lens capsule was initially observed in both eyes when she was 7 years old (fig 1A). The IOP was 12 mm Hg, …

Evaluation of Conventional Therapy Versus Cyclosporin a in Behcet’s Disease

Originally identified as a disease whose main manifestations consist of aphthous stomatitis, genital ulcers and visual disturbances (1), Behcet disease affects many organs (2–4). A great variability in intensity of affection of the different organs is observed and is responsible for the admission of Behcet’s patients at the various disciplines’ departments (5–7). A high percentage of these patients suffer from ocular involvement. When present, it is one of the most detrimental affections that lead to inexorable blindness early during the course of the disease (8). Characteristically, exacerbations and remission periods are unpredictable, making treatment evaluation very difficult (3). Clinical as well as laboratory observations support the concept of possible involvement of the immune system in Behcet disease (3,9,10). With the emergence of Cyclosporin A (CsA) as a non cytotoxic modulator of the immune response (11), a preliminary evaluation of its effect on Behcet disease has been carried out (12).