Jay Siak

The Pattern of Uveitis among Chinese, Malays, and Indians in Singapore

ABSTRACT Purpose: To describe the pattern of uveitis among Chinese, Malays, and Indians at a tertiary referral institution in Singapore. Methods: Charts between January 1997 and December 2010 were retrospectively reviewed. Charts between January 2014 and December 2014 were prospectively reviewed. Results: A total of 1249 and 148 charts were retrospectively and prospectively reviewed, respectively. The top causes of anterior uveitis (AU) were HLA-B27, idiopathic, and CMV AU. The top known causes of intermediate uveitis were tuberculosis, primary intraocular lymphoma, and sarcoidosis. The top causes of posterior uveitis were CMV retinitis, toxoplasmosis, and dengue maculopathy. The top causes of panuveitis were VKH, idiopathic panuveitis, tuberculosis, and Behçet disease. HLA-B27 and CMV AU were more frequent among Chinese (21% vs 9% (non-Chinese); p<0.001; 10% vs 5% (non-Chinese); p<0.001, respectively). Tuberculous uveitis was more frequent among Malays and Indians (12% (non-Chinese) vs 5% (Chinese), p<0.001). Conclusions: Different uveitis patterns were encountered among patients of different races.

Anterior Chamber Angle and Intraocular Pressure Changes After Phacoemulsification: A Comparison Between Eyes With Closed-angle and Open-angle Glaucoma.

Purpose:To compare the angle and intraocular pressure (IOP) changes after phacoemulsification between eyes with closed-angle or open-angle glaucoma. Methods:Angle measurements using Visante AS-OCT imaging was performed for a prospective cohort of 24 subjects with closed-angle and 30 subjects with open-angle glaucoma before and 3 months after phacoemulsification. IOP measurement was measured at 6 and 12 months after surgery using Goldmann applanation tonometry as secondary outcome measures. Results:Eyes with closed angles were smaller than those with open angles (mean axial length 22.88 vs. 24.11 mm, P<0.001). Mean anterior chamber depth, area, volume, AOD500, AOD750, ARA, TISA500, and TISA750 increased after phacoemulsification in all eyes regardless of preexisting angle status (all P<0.001). Increase in AOD500, AOD750, TISA500, and TISA750 were greater in eyes with open angles compared with closed angles (P=0.03, 0.04. 0.04, 0.04, respectively). Mean IOP decreased by 1.8 and 2.1 mm Hg at 6 and 12 months, respectively, after phacoemulsification for all eyes (P<0.001 for both timepoints compared with preoperative baseline). However, postoperative reduction in the mean IOP was not significantly different between eyes with closed and open angles (Mann-Whitney test P=0.32 at 6 mo and P=0.75 at 12 mo postsurgery compared with preoperative). Conclusions:Angle opening postphacoemulsification was considerable in all eyes. A similar IOP reduction after phacoemulsification was observed in all eyes regardless of angle status.

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative

TOPIC An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. CLINICAL RELEVANCE The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. METHODS An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. RESULTS In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. CONCLUSIONS Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.

The Spectrum of Uveitis in Southern Vietnam

ABSTRACT Purpose: To describe the pattern of uveitis among Vietnamese at two eye hospitals in Southern Vietnam. Methods: We retrospectively reviewed the charts of 212 consecutive uveitis cases that presented to two eye hospitals in Ho Chi Minh City, Vietnam, from July 2011 to February 2015. The patients were identified from a database maintained by the hospitals. Patients with keratitis, episcleritis, orbital inflammation, post-surgical endophthalmitis, traumatic iritis, and corneal graft rejection were excluded. Data collected included demographic, clinical, and laboratory findings. Results: Uveitis was seen most commonly in the 21–60-year-old age group. Gender distribution was not significantly different among the various age groups. Anterior uveitis was the most common (46%), followed by posterior uveitis (22%), panuveitis (18%), and intermediate uveitis (14%). Infectious etiologies were observed in 27%. Idiopathic uveitis (36%) was the most common non-infectious uveitis, followed by Vogt–Koyanagi–Harada disease (14%) and Behçet disease (7%). Tuberculous uveitis was the most common infectious etiology (9%), followed by toxocariasis (6%) and herpetic uveitis (6%), and cytomegalovirus anterior uveitis (4%). Conclusions: In southern Vietnam, infectious uveitis, such as tuberculosis, toxocariasis, and herpetic infection, are common but toxoplasmosis is rare. Idiopathic uveitis, Vogt–Koyanagi–Harada disease, and Behçet disease are the most common non-infectious uveitis, with a notable absence of birdshot retinochoroidopathy.

Cytomegalovirus Anterior Uveitis Following Topical Cyclosporine A

ABSTRACT Cytomegalovirus (CMV) anterior uveitis and endotheliitis occurs among immunocompetent individuals and may manifest as Posner–Schlossman syndrome or Fuchs uveitis syndrome. The condition may first present following ophthalmic surgery, the use of a fluocinolone-sustained steroid drug delivery implant, or the use of topical prostaglandin analogues for the treatment of glaucoma. We report the first case of a non-human immunodeficiency virus-infected individual who presented with CMV anterior uveitis after the use of topical cyclosporine A 0.05% ophthalmic emulsion for the treatment of symptomatic dry eyes.

The Pattern of Uveitis in Sri Lanka

ABSTRACT Purpose: To describe the pattern of uveitis at a tertiary uveitis referral clinic in Sri Lanka. Methods: Consecutive charts identified from a registry between January 2010 and December 2014 at the Mediclinic Hospital, Colombo were retrospectively reviewed. Results: Among 750 patients, anterior uveitis (AU) was the most common (285, 38%), followed by posterior uveitis (187, 25%), intermediate uveitis (150, 20%), and panuveitis (128, 17%). 485 (65%) were idiopathic. The top identified causes of AU were seronegative-spondyloarthropathy-related-AU (37, 13%), HLA-B27-related-AU without systemic associations (25, 9%), herpetic-AU (18, 6%), and trematode uveitis (8, 3%). The main posterior uveitis were toxoplasmosis (34, 18%), tuberculosis (21, 11%), and sarcoidosis (17, 9%). 78% of intermediate uveitis were idiopathic, with 12 (8%) tuberculosis, and 10 (7%) sarcoidosis. The most common panuveitis were sarcoidosis (18, 14%), tuberculosis (14, 11%), and Vogt–Koyanagi–Harada disease (10, 8%). Among children (≤12 years) accounting for 25 (3%) of cases, the most common presentations were idiopathic intermediate uveitis (7, 28%), idiopathic-AU (4, 16%), toxoplasmosis (4, 16%), trematode uveitis (3, 12%), and toxocariasis (2, 8%). Conclusions: An infectious etiology must be considered in posterior uveitis and uveitis among children in the Sri Lankan population.

Epidemiology and Treatment Trend of Endophthalmitis in Asia

Asia is one of the most populous continents with a diversity of countries ranging from developing countries like India, Myanmar, and China with a reliance on agricultural economy to developed countries like Japan, South Korea, and Singapore. Infectious endophthalmitis is a rare intraocular infection that results from the introduction of an infectious pathogen into the eye. Acute endophthalmitis is a potentially blinding condition, and prompt recognition and management are critical as this affects the eventual visual outcome. The cause of endophthalmitis is predominantly bacterial or fungal infection, from direct inoculation (exogenous endophthalmitis) as a complication of ocular surgery or trauma through an infected cornea or spread via the bloodstream from a distal source (endogenous endophthalmitis) such as a pyogenic liver abscess or endocarditis. In this chapter, we will review studies on exogenous and endogenous endophthalmitis that highlight the perspective of Asian populations.

Multimodal Imaging in Anterior Uveitis

ABSTRACT Anterior uveitis is the most common group of uveitis worldwide, with a diverse spectrum ranging from autoimmune and infectious to masquerade etiologies. Elucidation of the underlying etiology may be challenging, but it remains important, especially for recurrent uveitis. Multimodal imaging has improved our understanding and management of many posterior uveitis and panuveitis. Similarly, a wide variety of anterior segment ophthalmic imaging techniques are available to allow the monitoring of the structural changes that may develop during anterior uveitis. These include anterior segment photography, specular microscopy, in vivo confocal microscopy, anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), laser flare photometry, and less commonly used techniques such as anterior segment fluorescein and indocyanine green angiography, iris autofluorescence, and infrared imaging. This review recapitulates the past and recent application of these ophthalmic imaging modalities to the diagnosis and management of anterior uveitis.

Diabetes Mellitus and Glaucoma

Glaucoma is a leading cause of blindness with multiple risk factors, including elevated intraocular pressure, optic nerve head ischemia, nocturnal hypotension, and systemic hypoxia. As diabetes mellitus is a major systemic cause of microvasculopathy with an increasing epidemic in the world, it is important to understand whether our diabetic patients are facing an increased risk of blindness from glaucoma besides the various complications of diabetic retinopathy.