Wakako Taki

Enhanced depth imaging optical coherence tomography of the choroid in Vogt-Koyanagi-Harada disease.

Purpose: Optical coherence tomography (OCT) using enhanced depth imaging (EDI) allows evaluation of choroidal thickness. Our objective was to analyze subfoveal choroidal thickness by EDI-OCT before and after the initiation of high-dose corticosteroid treatment in 8 patients (16 eyes) with new-onset acute Vogt–Koyanagi–Harada (VKH) disease. Methods: Retrospective review of clinical records. Results: The outer border of the choroid was not evident by EDI-OCT in any patients at presentation. Subfoveal choroidal thickness was measurable by 1 week after the initiation of treatment (mean, 578 &mgr;m) and decreased thereafter (mean at 1 month, 397 &mgr;m; 3 months, 392 &mgr;m; 6 months, 384 &mgr;m; 12 months, 332 &mgr;m). Rebound of choroidal thickening was observed in three patients (five eyes) during corticosteroid tapering in the absence of other evidence of increased inflammation. Peripapillary atrophy was present at 12 months in 6 of 6 eyes that had a choroidal thickness >550 &mgr;m at 1 week after initiating treatment, in contrast to none of the 8 eyes with a choroidal thickness ⩽550 &mgr;m (P = 0.0003). Conclusion: Enhanced depth imaging–optical coherence tomography revealed decreasing choroidal thickness with high-dose corticosteroid treatment in our patients. Choroidal thickness as measured by EDI-OCT may serve as a marker for degree of choroidal inflammation in acute VKH disease.

Decreased ocular inflammatory attacks and background retinal and disc vascular leakage in patients with Behçet's disease on infliximab therapy

Aim To evaluate the efficacy of infliximab treatment in patients with refractory uveoretinitis associated with Behçets disease. Methods Clinical records of 14 patients were retrospectively reviewed. Patients received infliximab infusions (5 mg/kg) at weeks 0, 2 and 6, and every 8 weeks thereafter. The main outcome measures were frequency of clinically observable ocular inflammatory attacks, background retinal and disc vascular leakage as assessed by fluorescein angiography during periods of clinical quiescence, visual acuity and adverse effects. Results The median follow-up after initiating infliximab therapy was 19 months (range 12–29 months). At 12 months, eight of 14 patients (57%) had experienced no inflammatory attacks, and the frequency of attacks was significantly reduced when compared with the 6-month period just prior to infliximab use. Background retinal and disc vascular leakage assessed at 12 months improved in 11 of 14 patients (79%). Visual acuity improved or remained unchanged at 12 months in 26 of 28 eyes (93%). Infliximab therapy was terminated in two patients owing to infusion reactions. However, no serious adverse effects were observed. Conclusion Infliximab over the first year of treatment appeared effective in reducing ocular inflammatory attacks, as well as background retinal and disc vascular leakage, in patients with refractory uveoretinitis associated with Behçets disease.

Frequency and clinical features of intraocular inflammation in Tokyo

Background:  To investigate frequencies and clinical features of intraocular inflammation (uveitis) in Tokyo, Japan.

Effect of infliximab on gene expression profiling in Behcet's disease.

PURPOSE Recent studies have demonstrated that a new anti-tumor necrosis factor (TNF)-α antibody, infliximab, is effective in controlling ocular inflammatory attacks in Behçets disease. In this study, the effect of infliximab on gene expression patterns in peripheral blood mononuclear cells of Behçets disease patients was investigated before and after initiation of infliximab treatment. METHODS A human whole-genome microarray of 54,359 genes was used to analyze mRNA expression profiles of peripheral blood mononuclear cells obtained from four patients (three women, one man, 21-64 years at age) at baseline and at 22 weeks after initiation of infliximab. Quantitative polymerase chain reaction (PCR) analysis was performed for selected up- or downregulated genes, to confirm the microarray results. RESULTS Anti-TNF-α therapy reduced the frequency of ocular episodes in three of four patients. Among inflammatory cytokine-related genes, TNF blockade reduced expression of interleukin (IL)-1 receptor type 2, interferon-γ receptors, IL6, IL6 receptor, gp130, and IL17 receptors. Furthermore, gene expression of Toll-like receptor 2 (TLR2), receptor for mycobacterial glycolipid (C-type lectin domain family 4, member E: CLEC4E), and complexin 2 (CPLX2) was downregulated in all patients. CONCLUSIONS Several up- or downregulated genes identified in this study may be candidates for further investigation in identifying the molecular mechanism of infliximab in the treatment of Behçets disease with refractory uveoretinitis.

Clinical features and visual outcomes of Japanese patients with scleritis

Purpose To analyse clinical features, systemic associations, treatment and visual outcomes in Japanese patients with scleritis. Methods Clinical records of 83 patients with scleritis who presented between 1998 and 2008 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo, were reviewed. Results Of the 83 patients, 57 (69%) had diffuse anterior scleritis, 9 (11%) had nodular anterior scleritis, 8 (10%) had necrotising anterior scleritis and 9 (11%) had posterior scleritis. There was a slight predominance of women (55%) and unilateral disease (53%). Mean age at presentation was 51 years (range 12–82 years). Secondary ocular complications were observed in 78% of patients, including anterior uveitis in 25% and increased intraocular pressure in 40%. Investigation revealed a systemic disease association in 24 patients (29%), including six patients (7.2%) with tuberculosis and 18 patients (22%) with rheumatologic disease. Thirty-five patients (42%) received systemic corticosteroid treatment and 19 patients (23%) received immunosuppressive agents. All 17 patients with necrotising anterior scleritis or posterior scleritis were treated with oral corticosteroids and/or immunosuppressive drugs. Visual outcomes were generally good; however, poorer outcomes were observed in eyes with necrotising scleritis, mostly due to corneal ulceration or corneal opacification. Conclusions A systemic disease association was identified in 29% of Japanese patients with scleritis. Roughly one-half of patients received oral corticosteroids and/or immunosuppressive drugs to control inflammation, with generally good visual outcomes.

Long-term efficacy of infliximab on background vascular leakage in patients with Behçet’s disease

PurposeTo evaluate the effect of infliximab over the initial 4 years of treatment on inflammatory ocular attacks and background retinal/disc vascular leakage in patients with refractory uveoretinitis associated with Behçet’s disease.MethodsClinical records of nine patients were retrospectively reviewed. The main outcomes analyzed were frequency of ocular inflammatory attacks, background retinal and disc vascular leakage as assessed by fluorescein angiography during periods of clinical quiescence, best-corrected visual acuity, and adverse effects.ResultsThe median follow-up on infliximab was 50 months (range 48–58 months). Mean frequency of attacks decreased significantly in years 1, 2, 3, and 4 compared with the baseline 1-year period before infliximab use. Mean background retinal and disc vascular leakage scores also decreased significantly at the end of each 1-year period compared with baseline. Visual acuity improved or was unchanged at the end of 4 years in 17 of 18 eyes. No serious adverse effects were observed.ConclusionInfliximab reduced the mean frequency of ocular attacks and mean background retinal/disc vascular leakage in a long-term sustained manner over 4 years of treatment in Behçet’s disease patients.

Enhanced depth imaging optical coherence tomography of the choroid in recurrent unilateral posterior scleritis

Dear Editor, Posterior scleritis is a painful and potentially destructive ocular inflammation caused by infectious agents or noninfectious immune reactions [1]. Recently, spectral-domain optical coherence tomography (OCT) using enhanced depth imaging (EDI) has been shown to reliably visualize the full thickness of choroid in normal and highly myopic eyes [2, 3]. In this report, we describe two patients with recurrent unilateral posterior scleritis in whom thinning of the choroid was observed by EDI–OCT.

Intravitreal bevacizumab for iris metastasis of small-cell lung carcinoma with neovascular glaucoma

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Clinical features of uveitis in children and adolescents at a tertiary referral centre in Tokyo

Objectives To analyse clinical features, systemic associations, treatment and visual outcomes of uveitis in children and adolescents at a tertiary centre in Tokyo. Methods Clinical records of 64 patients under the age of 20 years who presented between 2001 and 2013 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo were reviewed retrospectively. Results Of the 64 patients, there was a predominance of girls (70%) and bilateral disease (81%). Mean age at presentation was 12.9 years (4–19 years). Mean follow-up was 46 months (3–144 months). Anterior uveitis was present in 56.3% of patients, panuveitis in 28.1% and posterior uveitis in 15.6%. No patients had intermediate uveitis. The most common diagnostic designation was unclassified uveitis (57.8%). Systemic associations were observed in 10.9% and no patients were diagnosed with juvenile idiopathic arthritis. Ocular complications were observed in 71.9% of patients, including optic disc hyperemia/oedema (40.6%), vitreous opacification (23.4%), posterior synechia (18.7%), increased intraocular pressure (17.1%) and cataract (14.1%). Six patients underwent intraocular surgery, five for cataract extraction and two for glaucoma control. Twelve patients (18.7%) received some form of systemic therapy either corticosteroids, immunosuppressive drugs or biologic agents. The percentage of eyes with a visual acuity of 1.0 or better was 87.1% at baseline, 91.3% at 6 months, 89.6% at 12 months and 87.5% at 36 months. Conclusions The majority of children and adolescents who presented to us with uveitis had bilateral disease and no systemic disease associations. Only one-fifth of patients required systemic therapy to control their ocular inflammation, and most eyes had a good visual outcome.

Macular edema from distant branch retinal vein occlusion improved after vitrectomy

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