Sun Ho Lee

Clinical Outcomes of Cyclosporine Treatment for Noninfectious Uveitis

Purpose To assess the clinical outcomes of cyclosporine treatment for noninfectious uveitis. Methods A retrospective review of medical records was completed for 182 noninfectious uveitis patients who were treated with cyclosporine between January 2001 and August 2010. Data was obtained relevant to demographic characteristics, anatomic classification, and laterality of uveitis, associated systemic disorder, dosage of cyclosporine and prednisolone, usage of other immunosuppressive drugs, visual acuity (VA), control of uveitic activity, and adverse effects during the cyclosporine use. Results Uveitic activity was controlled to a level of minimal inflammation in 89.0% and completely in 78.6% of patients by the median duration of 49 and 98 days, respectively. Prednisolone-sparing (dose ≤10 mg) control of inflammation equal to or less than the minimal activity was achieved in 75.3% of patients. VA was aggravated more than 0.2 logarithm of the minimum angle of resolution in 17.3% of eyes in spite of cyclosporine treatment for the mean follow-up of 698.4 days. Dose reduction and cessation of cyclosporine was required only in 3.3% and 9.3%, respectively, due to the intolerable toxicity, although 44.0% of patients experienced mild to moderate adverse effects. Conclusions Cyclosporine combined with corticosteroids or other immunosuppressive drugs as needed is an effective treatment for noninfectious uveitis, thus minimizing the adverse effects of corticosteroids and other toxic drugs. However, careful monitoring for the toxicity of cyclosporine is needed, because a small group of patients cannot tolerate its toxicity.

Corneal tattooing method using dye injection into the anterior stroma infiltrated with small air bubbles

Editor, C orneal tattooing is classifiable into two categories according to the dye delivery method: the dye is inoculated directly and repeatedly in the conventional anterior stromal puncture technique, and in the other method, the dye is injected in a lamellar channel. The conventional tattooing method of dye injection with anterior stromal puncture is limited by the staining homogeneity; further, the repeated manipulation is timeconsuming and sometimes causes recurrent corneal erosion and the phagocytosis of tattoo pigment by keratocytes (Sekundo et al. 1999; Fogla et al. 2010). The manual lamellar pocket method had some risk of uneven tissue dissection or perforation (Kim et al. 2009; Kymionis et al. 2009). Here, we describe a novel technique for corneal tattooing by anterior stromal air bubble infiltration. Corneal tattooing following anterior stromal air bubble infiltration method was applied for six eyes of six patients who wanted cosmetic improvement of chronic total leukoma without visual potentials. Average age of the patient was 64 years. We began the surgery by applying 0.5% proparacaine hydrochloride for topical anaesthesia. By using a 20-gauge microvitreoretinal blade, we made slit entrance at the superior limbus and reached the paracentral anterior stroma of the cornea. Thereafter, we inserted a 25-gauge bent cannula attached to a 3-ml airfilled syringe through the entrance and, with the cannula tip secured, injected air in the syringe, which infiltrated the anterior stroma with small air bubbles. After we visualized the air bubble spread over entire cornea as a whitish opaque delineation, the cannula was attached with a commercially available tissue-marking dye (Davidson Marking System, Bradley Products, Inc., Bloomington, MN, USA). The dye injection stained the anterior stromal layer, replacing the preformed space made by the small air bubbles. If some part of the peripheral cornea was not stained, the same procedure was repeated 1–3 times in the unstained area. We prescribed topical administration of levofloxacin and 1% prednisolone acetate 4 times per day for 2 weeks. There was no intraoperative complication during the corneal tattooing procedure using small air bubble infiltration. Postoperative intraocular pressure was within normal range. In slit lamp examination, it could be identified that the dye had spread uniformly, and there was no complaint for pain. The average of stromal dye stain depth was 284 lm. All patients were satisfied with the cosmetic effect of corneal tattooing. In actual environment, tattooing discoloration was darker at a distance than discoloration from anterior segment photographs with bright illumination. Most optimal tattooing discoloration could be achieved when the dye was spread at 200–300 lm depth of cornea. Average period of follow-up was 14 months, and no adverse events occurred during the follow-up. This tattooing technique differs from the previous lamellar channel methods. Our technique did not involve mechanical dissection or incision of the corneal stromal layers. Instead, we infiltrated the corneal