Anterior Chamber Cells Research Articles

Preventive Inflammation Management with Steroids before Retreatment with Anti-VEGF after Severe Inflammation due to Brolucizumab.

We report two successful cases of treatment by steroids after severe inflammation due to an intravitreal injection (IVI) of brolucizumab and their retreatment with another type of anti-vascular endothelial growth factor (VEGF), with steroid treatments to prevent severe inflammatory recurrence in patients with exudative age-related macular degeneration (AMD). CLINICAL CASES, CASE 1: An 88-year-old woman with exudative AMD in her left eye who had persistent subretinal fluid despite receiving an IVI, including ranibizumab and, subsequently, aflibercept. A switch to brolucizumab was decided. Two weeks after the third dose, she had a visual loss decreasing from 20/40 to counting fingers at 50 cm. Fundus examination revealed retinal whitening and perivenous sheathing. Fluoresceine angiography confirmed retinal arterial occlusion. Differential diagnoses were ruled out. She was treated with intravenous methylprednisolone and prednisolone eye drops. Three months after the treatment, visual acuity improved to 20/80 with no intraocular inflammation but subretinal fluid recurred. IVI of ranibizumab was rescheduled with preventive treatment by oral and local prednisolone without any inflammation recurrence. CASE 2: An 80-year-old man with exudative AMD in his right eye who had persistent subretinal fluid despite an IVI of aflibercept. Switching him to brolucizumab was decided. Two months after the third dose, he had blurred vision with no pain. Visual acuity decreased from 20/20 to 20/25. Examination showed 1+ anterior chamber cells and hyalitis. We confirmed the diagnosis of anterior uveitis with hyalitis. Differential diagnoses were ruled out. Treatment by prednisolone eye drops was initiated every 30 minutes for 1 day with a gradual decrease for 6 weeks. One week later, visual acuity improved to 20/20 with no inflammation. Three weeks later, subretinal fluid due to AMD increased. The patient was retreated by aflibercept with prednisolone eye drops, 48 hours before and after the IVI, with no recurrence of inflammation. Brolucizumab is one of the latest FDA-approved anti-VEGF agents for wet AMD. Since its wider use, few cases of severe ocular inflammation have been reported in post-marketing analysis. Because wet AMD recurrences should be expected after intraocular inflammation, insight is needed into treatment tolerance in cases that received further IVI retreatment. Our cases demonstrate that an IVI reinjection with a different anti-VEGF drug for exudative AMD recurrence can be safely reperformed. The use of local steroids could be effective in preventing recurrence of ocular inflammation after severe intraocular inflammation due to brolucizumab.

Great imitator — ocular syphilis

We examined a 44-year-old woman without any known systemic disease with a decreased vision of a month duration in her left eye. She had undergone left uneventful cataract surgery with intraocular lens implantation elsewhere 14 years ago. On examination, her Snellen visual acuity was 1.0 (with the correction of –0.50–0.25 × 120) in the right eye and 0.4 (with the correction of +0.75–2.25 × 115) in the left. There was left hypochromic heterochromia. While the right anterior segment was unremarkable, there were small to medium-sized keratic precipitates, 3+ anterior chamber cells, a posterior chamber intraocular lens with an intact posterior capsule, and a few vitreous cells in the left eye. Fundus autofluorescence imaging revealed peripapillary hyperautofluorescence in the left eye, and fluorescein angiography revealed a marked optic nerve head and perivascular leakage at the posterior pole. The findings were not compatible with Fuchs uveitis, so the full infectious panel was worked out. Serologic investigations yielded the presence of syphilis, and the patient was treated successfully with systemic antibiotics. Our case demonstrates the mimicking nature of ocular syphilis and the importance of high clinical suspicion when reaching the correct diagnosis.

Early vs Deferred Non–Messenger RNA COVID-19 Vaccination Among Chinese Patients With a History of Inactive Uveitis

Improper host response to COVID-19 vaccines could trigger immune-mediated adverse events. The question remains whether COVID-19 vaccination should be postponed until complete remission in patients with uveitis, a preexisting immune-related condition. To compare recommendations for early and deferred COVID-19 vaccination with respect to uveitis outcomes. This open-label, randomized clinical trial at a large, specialized teaching center for uveitis care in China enrolled unvaccinated patients with inactive uveitis between August 10, 2021, and February 22, 2022, with follow-up to June 6, 2022. Participants were randomly assigned to receive recommendation for early or deferred COVID-19 vaccination after complete remission of uveitis. Non-messenger RNA (non-mRNA) COVID-19 vaccines were available in China during the trial. The primary outcome was the time to symptomatic uveitis worsening during 3 months of follow-up. Secondary outcomes included uveitis activity and best-corrected visual acuity at 3 months. Of the 543 participants (304 women [56.0%]; median age, 35 [IQR, 26-49] years), 262 were recommended for early vaccination and 281 for deferred vaccination. By month 3, 109 patients (41.6%) in the early group had been vaccinated compared with 14 (5.0%) in the deferred recommendation group. In the intention-to-treat population, the time to symptomatic uveitis worsening was shorter in the early group than in the deferred group (hazard ratio, 1.68 [95% CI, 1.09-2.59]; P = .01 by log-rank test). Changes in anterior chamber cells, vitreous haze, and best-corrected visual acuity from baseline to month 3 appeared similar in the 2 groups in the evaluable population after the month 3 in-person visit. In this randomized clinical trial of patients with inactive uveitis, recommendation for early non-mRNA COVID-19 vaccination resulted in a higher incidence of self-reported symptomatic uveitis worsening with possible reporting bias compared with recommendation for deferred vaccination, but no adverse effects were observed in disease and visual prognosis at 3 months. These findings would be useful to guide the individual timing choices of non-mRNA COVID-19 vaccination in this clinically vulnerable population. Chinese Clinical Trial Registry: ChiCTR2100049467.

A Period of Macular Hyperemia and Subclinical Edema Caused by Phacoemulsification Surgery in Noninfectious Uveitis

ABSTRACT Purpose To identify the changes in macular microvasculature in uveitic patients following phacoemulsification. Methods A prospective cohort study was conducted by enrolling uveitic patients who underwent phacoemulsification at the Eye Hospital. Macular vessel densities (VD) of superficial and deep capillary plexus (SCP and DCP) and retinal thickness (RT) were quantified by optical coherence tomographic angiography (OCTA). Results Twenty-one eyes obtained satisfactory OCTA scans at all the follow-up visits. After surgery, an increasing trend in SCP VD was found (p = .037) and reached its maximum (+2.79 ± 4.86%) at post-3 months (M). RT increased synchronously. The increases in SCP VD at post-3 M were significantly correlated with the changes in anterior chamber cells (ACCs) at post-1 M and 2 M (r = 0.450, p = .041; r = 0.477, p = .029, respectively). Conclusions Inflammation generates a long-term effect on retina demonstrated as an increase in SCP VD and RT which are associated with synchronous ACCs changes after phacoemulsification.

Microsporidia-Associated Anterior Uveitis After Keratoconjunctivitis.

The aim of this study was to describe the clinical features and management of uveitis associated with microsporidial keratoconjunctivitis (MKC). The medical records of clinically diagnosed or microbiologically proven patients with MKC between July 2016 and August 2021 were reviewed. Patients with documented evidence of keratic precipitates (KPs) or anterior chamber cells were analyzed for their demography, clinical features, and treatment. Patients with microsporidial stromal keratitis and herpes simplex virus keratouveitis were excluded from the study. Of the 2212 patients reviewed within the study period 171 of 172 eyes (7.7%) had documented evidence of KPs and/or anterior chamber cells. The patients' mean age was 43.8 ± 13.8 years, and there were more men (n = 120). The mean duration of appearance of KPs was 6.9 ± 5.5 days, and 28% (n = 48 of 171) appeared on the day of presentation. Superficial punctate keratitis was central and diffuse in 48 and 49 patients, respectively. The treatment was either lubricant alone (45.3%; 78 eyes) or combined with topical steroids (54.7%; 94 eyes). The mean duration of the resolution was longer in the "corticosteroid" than "no corticosteroid" group: KPs: 15.3 ± 6.5 days versus 12.3 ± 5.8 days ( P = 0.007) and superficial punctate keratitises: 15.4 ± 9.4 days versus 11.7 ± 6.2 days ( P = 0.01). The presenting visual acuity with a pinhole was 0.26 ± 0.26 (logMAR) and it improved to 0.03 ± 0.07 on resolution ( P < 0.0001, paired t test). Uveitis after MKC is a self-limiting entity that often resolves without corticosteroid. One must exercise caution in using steroids in the presence of active corneal lesions.

Pediatric uveitis complicating in cataract formation regained normal visual acuity – a challenging case

Background: Pediatric uveitis and its complications are important causes of child blindness. Strong inflammatory response and unstable treatment compliance result in worse treatment outcome than adults and frequent recurrence. However, effective anti-inflammatory treatment can still lead to good result. Case report: We report a case of pan-uveitis in a 13-year-old patient, complicating in cataract formation who was successfully treated and regained 20/20 final visual acuity. The patient was admitted to us due to blurry vision, pain and redness on her left eye, with best-corrected visual acuity 12/20, intraocular pressure 15 mmHg, ciliary flush, anterior chamber cell and constricted pupil with poor light reflex. Her left eye was diagnosed with anterior uveitis and treated with topical prednisone acetate along with peri-orbital injection of dexamethasone. At 1-week follow-up, her left eye showed significant progress with best-corrected visual acuity being 16/20 and no inflammatory reaction detected. Due to social distancing in Covid-19 pandemic, she was unable to have follow-up examinations; her condition worsened to pan-uveitis which complicated in cataract formation and her visual acuity fell down to counting finger 0.5m. She was then treated with systemic methylprednisolone in 2 weeks and local corticosteroids in 6 months, including 3 consecutive peri-orbital injections of triamcinolone acetate with monthly interval and topical prednisone acetate; after that she underwent cataract surgery with anterior vitreous humor removed and intraocular lens implanted in the ciliary sulcus. At 1-month follow-up, best-correct visual acuity of her left eye was 20/20 and intraocular pressure was 16 mmHg, the inflammatory response of her left eye was completely in control. Conclusion: Effective anti-inflammatory treatment even after surgery (if existed) takes the decisive role in regaining patient’s vision. Cataract removal surgery on pediatric uveitis patients should combine with vitrectomy and the surgeon should be prepared to place the intraocular lens in the ciliary sulcus.

Clinical Outcomes of Cataract Surgery in Patients with Sjögren's Syndrome.

This study compared the biometric accuracy and refractive outcomes, and ocular surface changes after cataract surgery in patients with Sjögren’s syndrome (SS, S group), non-SS dry eye patients (D group), and healthy controls (C group). The medical records of patients who underwent cataract surgery and met certain inclusion criteria were reviewed. In total, 167 eyes of 87 patients were enrolled. Refractive parameters were analyzed via optical biometry and combined ultrasound biometry and automated refractokeratometry. The mean absolute errors (MAEs), the uncorrected distance visual acuities (UDVAs), changes in the ocular staining score (OSS), and anterior chamber cell grades were compared for 12 months postoperatively. The S group evidenced more severe and persistent OSS exacerbation after cataract surgery; the OSS returned to baseline by 3 months postoperatively. The mean keratometric values showed a significant linear correlation. There was no significant intergroup difference in either the MAEs (p > 0.530) or anterior chamber inflammation (p > 0.436). The postoperative UDVA of the S group was poorer than that of the C group from 3 months postoperatively (p < 0.047) but not different from that of the D group (p > 0.311). With preoperative ocular surface optimization and optimal postoperative treatment of superficial keratitis, the refractive outcomes of SS patients were comparable to those of other groups and the postoperative UDVA was not inferior to that of non-SS dry eye patients.

Efficacy and Safety of Tocilizumab in the Management of Non-Infectious Uveitis Failed with Conventional Immunomodulatory and Anti-TNFα Therapies

ABSTRACT Purpose To determine the outcomes of intravenous (IV) tocilizumab (TCZ) in patients with non-infectious uveitis who failed with conventional immunomodulatory and anti-TNFα therapies. Methods Records of seven patients with non-infectious uveitis treated with monthly IV TCZ (4–10 mg/kg) or biweekly IV TCZ (8 mg/kg) were reviewed. Outcome measures were changes in visual acuity, anterior chamber cell and flare grade, vitreous haze, central subfield thickness (CST), and fluorescein angiography (FA) score. Results Ten eyes of seven patients received TCZ therapy. Median age of patients was 14 (range, 7–24) years. Median duration of TCZ therapy was 15 (range, 5–32) months. Mean CST reduced from 373 ± 101.0 μm to 298.2 ± 40.3 μm. Mean FA score reduced from 12.5 ± 4.3 to 3.6 ± 2.6. One patient developed elevated liver transaminases. Conclusion IV TCZ is a potentially effective and safe therapeutic option for the management of refractory non-infectious uveitis.

The Value of Laser Flare Photometry as a Monitoring Tool for Uveitis.

Laser flare (LF) photometry (P) is used to quantify the protein concentration in the aqueous humor, and therefore assess the blood-aqueous humor barrier. LFP is more reliable than the clinical assessment of the Tyndall effect, and is thus especially useful in the follow-up of uveitis patients. In active uveitis, LFP correlates well with the anterior chamber cell grading. Various studies have shown that high LF values are associated with an increased risk of uveitic complications, such as macular edema, glaucoma, and posterior synechiae. LFP can also be used to assess the response to anti-inflammatory treatments as well as the optimal timing and selection of the surgical technique for intraocular surgeries.

Influence of 0.002% Omidenepag Isopropyl on Intraocular Pressure and the Cornea in Normal Tension Glaucoma.

Although Omidenepag isopropyl drops elicited stable intraocular pressure reductions in NTG patients, transient changes in refraction and corneal endothelial cells, significant increase of central corneal thickness, and corneal erosion should be considered. To analyze the efficacy and safety of 0.002% omidenepag Isopropyl (OMDI) eye drops in patients with normal tension glaucoma (NTG). Medical records for 62 eyes treated with OMDI for ≥6 months were analyzed. Intraocular pressure (IOP), refraction, keratometry, central corneal thickness (CCT), endothelial cell count, coefficient of variation of endothelial cell area (CV), corneal erosion, and central retinal thickness were compared at baseline and 1, 3, and 6 months. IOP significantly decreased from 13.4±3.8 to 11.9±3.0, 11.7±2.9, and 12.2±3.3mmHg at each follow-up ( P <0.001). Endothelial cell count did not change, but CV transiently increased from 12.6 to 17.0 at 1 month, CCT increased from 531.5 to 538.4μm, myopia changed from -1.5 to -1.9 D, and keratometry changed from 44.5 to 44.7 D. CV, myopia, and keratometry recovered to baseline at 6 months; however, CCT remained high. Significant corneal erosion was observed at 6 months. Central retinal thickness changes were not observed. There were improvements in prostaglandin-associated skin pigmentation (86.7%), eyelash elongation (40.0%), and deepening of the upper eyelid sulcus and ptosis (~30%) at 3 months after exchange to OMDI. Adverse reactions were corneal erosion (27.4%), corneal thickening (21.0%), conjunctival hyperemia (11.3%), photophobia (5.7%), blurred vision (5.7%), and anterior chamber cells (4.8%). OMDI eye drops elicited significant and stable IOP reductions after 6 months in NTG patients with low IOP. However, transient myopic and corneal endothelial cell changes, development of corneal thickening, and corneal erosion should be considered when using OMDI.

Complications and visual outcome of cataract surgery in pseudoexfoliation patients

Pseudoexfoliation syndrome is a multifactorial diffuse disease and is diagnosed clinically on slit lamp examination of the eye by the deposition of white, dandruff like material on different structures in anterior segment i:e corneal endothelium, iris, pupillary margin, anterior lens capsule, zonules and trabecular meshwork. The aim of study was to study demographic features, intraoperative and postoperative complications and the visual outcome of cataract surgery in pseudoexfoliation patients. 93 eyes of 93 patients with pseudoexfoliation posted for cataract surgery were included in the study. 79.56% patients were of more than 60 years of age group.43 patients were male and 50 patients were female. 44 patients had pseudoexfoliation syndrome in both eyes and 49 patients had either right eye or left eye involvement. Intraoperative problems encountered were poor pupillary dilatation, capsular bag prolapse, zonular dehiscence, posterior capsular rent, residual cortical matter and positive vitreous pressure. Postoperative complications reported were corneal edema, raised intraocular pressure, significant anterior chamber cell reaction, left cortical matter and exudative membrane. Best corrected visual acuity was more than 6/18 in 67 eyes, between 6/60-6/24 in 16 eyes, and less than 6/60 in 10 eyes. At 1 month, best corrected visual acuity was more than 6/18 in 92 eyes. Cataract surgery in pseudoexfoliation patients is associated with high risk of complications. Use of iris hooks and capsule tension rings where required during the surgery can decrease the intraoperative complications and thus will give better visual outcome.

15 years of PVRL‐experience of Prague uveitis Centre

AbstractIntravitreal lymphoma is a malignant masquerade syndrome which is crucial to identify among uveitis patients because of its life‐threatening nature.A total of 35 immunocompetent patients, 15 men and 20 women, were observed with vitreoretinal lymphoma in the Centre for Diagnosis and Treatment of Uveitis in Prague between the years 2003 to 2019. Primary vitreoretinal lymphoma (PVRL) was diagnosed in 15 patients, 6 patients from this group did not show any CNS involvement nor had an intraocular relapse during the observation period. The clinical manifestation of lymphoma in our patients was usually the vitreous haze, sometimes accompanied by retinal lesions and anterior chamber cells with or without keratic precipitates. In our observation, the diagnosis was determined by cytology or/and flow cytometry from vitreous analysis in all patients with exception of 4 patients with clinically highly suspicious finding of vitreous. Beside the vitritis, retinal infiltration was present in 3 of these 4 patients. From this group of 4 patients, the diagnosis was confirmed from brain biopsy in 3 patients and lung biopsy in 1 patient. The vitreous analysis was negative for lymphoma in 2 patients and in 2 patients' vitreous analysis was not performed. Over the years, the sensitivity of VRL detection from vitreous sample became very high, in our observation 94%.All patients diagnosed with VRL by vitreous analysis were sent to haemato‐oncologist work‐up. Treatment was decided by the consensus of a haemato‐oncologist and an ophthalmologist according to the clinical manifestation. Combination of intravitreal and systemic chemotherapy is recommended in many reports. There has been a decline in ocular and brain radiotherapy in recent years because of the unpredictable and irreversible nature of its side effects. Autologous stem cell transplantation (ASCT) following systemic chemotherapy was indicated in 3 patients. The relapse of lymphoma was observed in 13 patients, first relapse was after 11–120 months (median 32 months).Supported by research project AZV MZ CR NU20‐03‐00253.

Long-term follow-up of certolizumab pegol in uveitis due to immune-mediated inflammatory diseases: multicentre study of 80 patients

ObjectivesTo evaluate effectiveness and safety of certolizumab pegol (CZP) in uveitis due to immune-mediated inflammatory diseases (IMID).MethodsMulticentre study of CZP-treated patients with IMID uveitis refractory to conventional immunosuppressant. Effectiveness was...

Mystery of changing choroidal thickness.

Mystery of changing choroidal thickness.

OCS-01 (Novel Topical Dexamethasone Formulation) in Inflammation and Pain Post Cataract Surgery: A Randomized, Double-Masked, Vehicle-Controlled Study

The goal of this study was to compare topical dexamethasone 1.5% in a novel formulation (OCS-01) once daily and BID versus vehicle for the treatment of inflammation and pain after cataract surgery. This was a Phase II, double-masked, vehicle-controlled, randomized multicenter study. Adult patients with planned unilateral uncomplicated cataract surgery were randomized to receive OCS-01 once daily (n=51), OCS-01 BID (n=51), or matching vehicle (n=51) for 15 days postsurgery. Primary end points were absence of anterior chamber cells (ACC; cells=0) at Day 15 and absence of pain (score of "0") at postoperative Day 4. The Pearson χ2 test with a two-sided alpha=0.1 was used to compare treatments. Safety was assessed in terms of adverse events and changes in intraocular pressure. Treatment arms were generally similar in their baseline characteristics, with mean age ranging from 66 to 68 years, the proportion of male patients ranging from 29% to 37%, and 82% to 92% of each arm being White. On Day 15, a greater reduction in the percentage of eyes with ACC grade 0 was observed in the OCS-01 once daily (51%) and BID (66.7%) arms than in the vehicle arm (19.6%) (P=0.0009 and P < 0.0001, respectively, using a Pearson χ2 test). On Day 4, the percentage of eyes with no pain was 72.5% (OCS-01 once daily), 62.7% (OCS-01 BID), and 45.1% (vehicle); statistical significance was reached for OCS-01 once daily (P=0.005) and OCS-01 BID (P=0.074) compared with vehicle. OCS-01 was well tolerated. A higher proportion of treatment-emergent adverse events, including ocular adverse events, were reported for the placebo group than for either OCS-01 group. OCS-01 once daily and BID were more effective than vehicle and well tolerated in the treatment of inflammation and pain after cataract surgery. gov identifier: NCT04130802.

Efficacy and safety of adalimumab for inflammatory flare prevention in paediatric non-infectious anterior uveitis with peripheral retinal vascular leakage: a study protocol for a single-centre, randomised controlled trial

IntroductionPaediatric patients with chronic anterior uveitis are more prone to suffer from the chronic course of intraocular inflammation and adverse effects of long-term immunomodulatory therapy, either topical glucocorticosteroids or systemic...

Six-month outcomes of infliximab and tocilizumab therapy in non-infectious retinal vasculitis.

To evaluate the efficacy of infliximab (IFX, 5-10 mg/kg) (Group 1) and tocilizumab (TCZ, 4-8 mg/kg) (Group 2) infusions in non-infectious retinal vasculitis (RV) using Angiographic Scoring for the Uveitis Working Group fluorescein angiography (FA) scoring system. Records of 14 patients (24 eyes) in Group 1 and 8 patients (11 eyes) in Group 2 were retrospectively evaluated to assess visual acuity (VA), anterior chamber cell and flare, vitreous haze, central subfield thickness (CST), and FA scoring at baseline and 6 months of follow-up. The measurements were employed to grade in each group. In Group 1 and 2, respectively, there was no underlying disease in 9 (60%) and 3 (42.9%) patients. Three (42.9%) patients in Group 2 had juvenile idiopathic arthritis (JIA) as the most common identified cause. Mean improvement in VA (log MAR) and CST were 0.04 ± 0.14 and 40.3 ± 78.5 µm in Group 1; 0.04 ± 0.09 and 47.3 ± 82.3 µm in Group 2, respectively. Mean FA scores were significantly reduced from 12.4 ± 5.2 and 11.6 ± 4.4 at baseline to 6.4 ± 5.0 and 5.8 ± 3.9 at 6-month in Group 1 and 2, respectively. In Group 2, 9 eyes of 6 patients (75%) had the history of IFX use prior to TCZ initiation. There was no significant safety concern requiring treatment discontinuation during the follow-up in either group. IFX and TCZ infusions showed statistically significant improvement of non-infectious RV as shown by ASUWOG FA Scoring System. TCZ, as well as IFX, appeared to be effective treatment options for non-infectious RV.

Multifocal electroretinographic findings in angiographic macular leakage in the setting of intermediate, posterior, or panuveitis

ObjectifÉvaluer les retombées fonctionnelles de l'exsudat maculaire visible à l'angiographie en l'absence de liquide intrarétinien lors de la tomographie par cohérence optique (OCT) dans des yeux présentant une uvéite intermédiaire, une uvéite postérieure ou encore une panuvéite. MéthodesIl s'agit d'une étude rétrospective portant sur des patients qui ont reçu un diagnostic d'uvéite intermédiaire, d'uvéite postérieure ou encore de panuvéite. Ont été inclus les patients qui ont fait l'objet d'une angiographie à la fluorescéine, d'une OCT et d'une électrorétinographie multifocale (ERGmf) selon un échéancier déterminé. Les données démographiques et cliniques comprenaient le type d'inflammation oculaire, la meilleure acuité visuelle corrigée (MAVC) et les résultats de l'OCT, de l'angiographie à la fluorescéine et de l'ERGmf. Les patients ont été répartis en 2 groupes en fonction de la présence d'un exsudat maculaire visible à l'angiographie et d'un œdème maculaire: groupe 1 (aucun œdème maculaire ni exsudat maculaire) et groupe 2 (présence d'un exsudat maculaire sans œdème maculaire). RésultatsAu total, 29 patients (43 yeux) ont été inclus dans l’étude : 13 patients (17 yeux) dans le groupe 1 et 16 patients (26 yeux) dans le groupe 2. On n'a pas noté de différence statistiquement significative entre les 2 groupes au chapitre des paramètres suivants : âge, sexe, cellules de la chambre antérieure, état du cristallin, cellules du vitré, flou vitréen, MAVC ou épaisseur sous-fovéale centrale moyenne. Aucune des mesures obtenues à l'ERGmf, notamment l'amplitude et les temps de culmination des ondes N1 et P1 dans les anneaux 1–5, n'a différé de manière statistiquement significative entre les 2 groupes. Enfin, aucune corrélation n'a pu être établie entre la MAVC ou l’épaisseur sous-fovéale centrale moyenne et l'une ou l'autre des mesures obtenues à l'ERGmf pour les anneaux 1–3. ConclusionsDans des yeux atteints d'uvéite exempts d’œdème maculaire, l'atteinte de la fonction maculaire n'est pas nécessairement pire en présence d'un exsudat maculaire visible à l'angiographie.

Automated Quantitative Analysis of Anterior Segment Inflammation Using Swept-Source Anterior Segment Optical Coherence Tomography: A Pilot Study.

The aim of this study is to develop an automated evaluation of anterior chamber (AC) cells in uveitis using anterior segment (AS) optical coherence tomography (OCT) images. We analyzed AS swept-source (SS)-OCT (CASIA 2) images of 31 patients (51 eyes) with uveitis using image analysis software (Python). An automated algorithm was developed to detect cellular spots corresponding to hyper-reflective spots in the AC, and the correlation with Standardization of Uveitis Nomenclature (SUN) grading AC cells score was evaluated. The approximated AC grading value was calculated based on the logarithmic approximation curve between the number of cellular spots and the SUN grading score. Among 51 eyes, cellular spots were automatically segmented in 48 eyes, whereas three eyes (all SUN grading AC cells score: 4+) with severe fibrin formation in the AC were removed by the automated algorithm. The AC cellular spots increased with an increasing SUN grading score (p &lt; 0.001). The 48 eyes were split into training data (26 eyes) and test data (22 eyes). There was a significant correlation between the SUN grading score and the number of cellular spots in 26 eyes (rho: 0.843, p &lt; 0.001). There was a significant correlation between the SUN grading score and the approximated grading value of 22 eyes based on the logarithmic approximation curve (rho: 0.774, p &lt; 0.001). Leave-one-out cross-validation analysis demonstrated a significant correlation between the SUN grading score and the approximated grading value of 48 eyes (rho: 0.748, p &lt; 0.001). This automated anterior AC cell analysis using AS SS-OCT showed a significant correlation with clinical SUN grading scores and provided SUN AC grading values as a continuous variable. Our findings suggest that automated grading of AC cells could improve the accuracy of a quantitative assessment of AC inflammation using AS-OCT images and allow the objective and rapid evaluation of anterior segment inflammation in uveitis. Further investigations on a large scale are required to validate this quantitative measurement of anterior segment inflammation in uveitic eyes.

Ophthalmic Manifestations of ROSAH (Retinal Dystrophy, Optic Nerve Edema, Splenomegaly, Anhidrosis, and Headache) Syndrome, an Inherited NF κB–Mediated Autoinflammatory Disease with Retinal Dystrophy

We aimed to characterize the ocular phenotype of patients with ROSAH (retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and headache) syndrome and their response to therapy. Single-center observational case study. Eleven patients with a diagnosis of ROSAH syndrome and mutation in ALPK1 were included. Patients with molecularly confirmed ROSAH syndrome underwent ophthalmic evaluation, including visual acuity testing, slit-lamp and dilated examinations, color fundus and autofluorescence imaging, fluorescein angiography, OCT, and electrophysiologic testing. Visual acuity, electrophysiology, fluorescein angiography, and OCT findings. Eleven individuals (6 female and 5 male patients) from 7 families ranging in age from 7.3 to 60.2 years at the time of the initial evaluation were included in this study. Seven patients were followed up for a mean of 2.6 years (range, 0.33-5.0 years). Best-corrected visual acuity at baseline ranged from 20/16 to no light perception. Variable signs or sequelae of intraocular inflammation were observed in 9 patients, including keratic precipitates, band keratopathy, trace to 2+ anterior chamber cells, cystoid macular edema, and retinal vasculitis on fluorescein angiography. Ten patients were observed to show optic disc elevation and demonstrated peripapillary thickening on OCT. Seven patients showed retinal degeneration consistent with a cone-rod dystrophy, with atrophy tending to involve the posterior pole and extending peripherally. One patient with normal electroretinography findings and visual evoked potential was found to have decreased Arden ratio on electro-oculography. Leveraging insights from the largest single-center ROSAH cohort described to date, this study identified 3 main factors as contributing to changes in visual function of patients with ROSAH syndrome: optic nerve involvement; intraocular inflammation, including cystoid macular edema; and retinal degeneration. More work is needed to determine how to arrest the progressive vision loss associated with ROSAH syndrome. Proprietary or commercial disclosure may be found after the references.