Cases Of Intraocular Inflammation Research Articles

Intravitreal faricimab for treatment naïve patients with neovascular age-related macular degeneration: a real-world prospective study

BackgroundIntravitreal faricimab, a bispecific antibody targeting both angiopoietin-2 (Ang-2) and vascular endothelial growth factor-A (VEGF-A), was recently introduced for the treatment of neovascular age-related macular degeneration (nAMD), diabetic macular oedema and cystoid macular oedema secondary to retinal vein occlusion. The aim of our study was to assess the efficacy, safety and durability of intravitreal faricimab in a real-world cohort of treatment-naïve patients with nAMD.MethodsSingle-centre, prospective cohort study of 21 eyes from 19 treatment-naïve nAMD patients who were treated with intravitreal faricimab from October 2022 to April 2024. Patients underwent a loading dose (LD) of 4 monthly faricimab injections followed by a treat-and-extend regimen. Primary outcomes included best-corrected visual acuity (BCVA) and structural parameters from spectral-domain optical coherence tomography (SD-OCT). Secondary outcomes included the proportion of eyes achieving a dry macula, maximal fluid-free interval and intended interval at last follow-up.ResultsThe study included 21 eyes of 19 patients (mean age 83.1 years). After LD, 93.3% of eyes achieved a dry macular SD-OCT scan within a median time of 8 weeks. At the first extension, 53% of eyes remained dry, while 47% showed fluid recurrence. Long-term analysis (n = 14) revealed significant reductions in macular volume (MV), central subfield thickness (CST), and pigment epithelial detachment (PED) height over a median follow-up of 64.9 weeks, with sustained visual and anatomical improvements. Median BCVA, CST, and MV at the final follow-up were significantly improved from baseline (p < 0.01). The intended interval between injections was ≥ 12 weeks in 42.86% of eyes. No cases of intraocular inflammation were observed, although 10% experienced retinal pigment epithelial tears.ConclusionsIntravitreal faricimab demonstrated favourable efficacy, safety, and durability outcomes in a real-world cohort of treatment-naïve nAMD patients.

Unexpected Intraocular Inflammation Following the Use of Anti-Adhesion Agents, Mediclore® - A Case Report

Several cases of unexpected intraocular inflammation have been reported following the use of anti-adhesion agents, including Mediclore®. However, anti-adhesion agents are now used in many surgeries because of their effectiveness in preventing postoperative adhesions. Awareness of the relationship between postoperative intraocular inflammation and anti-adhesion agents is important to avoid unnecessary evaluations. Two women experienced congestion and pain in both eyes after undergoing gynecological surgery using robotic and laparoscopic techniques under general anesthesia. They were diagnosed with anterior uveitis and episcleritis, and the cause was considered to be an anti-adhesion agent after excluding other factors and ophthalmic examinations. Here, we report two cases of intraocular inflammation after surgery and describe the clinical importance of anterior uveitis and episcleritis.

Real‐world experience with brolucizumab in pro re nata regimen in patients with neovascular age‐related macular degeneration previously treated with ranibizumab and aflibercept and without control of subretinal fluid

Aims/Purpose: to report real‐world outcomes in patients with neovascular age‐related macular degeneration (AMD) previously treated with ranibizumab and/or aflibercept and without control of subretinal fluid (SRF) receiving switch treatment to Brolucizumab in Pro Re Nata (PRN) regimen.Methods: Retrospective study including 11 patients with neovascular AMD previously treated with ranibizumab and/or aflibercept and without control of SRF were included. They received intravitreal treatment with standard 6‐mg intravitreal injections of brolucizumab between April 2022 and March 2023 in PRN regimen.Results: The mean follow‐up after the first injection of brolucizumab was 7.25 months (SD 2.18). The mean number of injections per month (IPM) of ranibizumab and/or aflibercept previous to switch treatment to brolucizumab was 0.81 with standard deviation (SD) of 9.81. The mean number of IPM after starting the treatment with brolucizumab was 0.49 (SD: 0.95). Therefore, the amount of IPM was significatively lower when switching to brolucizumab (p‐value = 0.0003). SRF control was achieved in 9/11 of patients (81.82%). The mean VA increased from was 0.59/1 (SD 0.273) before switch to brolucizumab to 0.64/1 (SD 0.253) (p &gt; 0.05). No cases of intraocular inflammation were described.Conclusions: Brolucizumab in PRN regimen was effective in achieving SRF control in patients with neovascular AMD previously treated with ranibizumab and aflibercept and without control of SRF. Furthermore, the amount of IPM was significatively lower when switching to brolucizumab compared to ranibizumab and/or aflibercept.

Hyperreflective foci (HRFs): A novel biomarker for intraocular inflammation (IOI) following intravitreal Brolucizumab

Intraocular inflammation (IOI) has been reported after intravitreal brolucizumab injection. We report one such case of IOI successfully managed with intravitreal dexamethasone implant and hyperreflective foci (HRFs) as a novel OCT biomarker for IOI after intravitreal brolucizumab injection. This is the first case report as per MEDLINE search to report this finding and intervention.

The real-world efficacy and safety of faricimab in neovascular age-related macular degeneration: the TRUCKEE study – 6 month results

Background/ObjectiveInvestigate real-world patients receiving faricimab for the treatment of neovascular age-related macular degeneration (nAMD).Subjects/MethodsMulticenter, retrospective chart review was conducted on patients treated with faricimab for nAMD from February 2022 to September 2022. Collected data includes background demographics, treatment history, best-corrected visual acuity (BCVA), anatomic changes, and adverse events as safety markers. The main outcome measures are changes in BCVA, changes in central subfield thickness (CST) and adverse events. Secondary outcome measures included treatment intervals and presence of retinal fluid.ResultsAfter one injection of faricimab, all eyes (n = 376), previously-treated (n = 337) and treatment-naïve (n = 39) eyes demonstrated a + 1.1 letter (p = 0.035), a + 0.7 letter (p = 0.196) and a + 4.9 letter (p = 0.076) improvement in BCVA, respectively, and a − 31.3 μM (p < 0.001), a − 25.3 μM (p < 0.001) and a − 84.5 μM (p < 0.001) reduction in CST, respectively. After three injections of faricimab, all eyes (n = 94), previously-treated (n = 81) and treatment-naïve (n = 13) eyes demonstrated a + 3.4 letter (p = 0.03), a + 2.7 letter (p = 0.045) and a + 8.1 letter (p = 0.437) improvement in BCVA, and a − 43.4 μM (p < 0.001), a − 38.1 μM (p < 0.001) and a − 80.1 μM (p < 0.204) reduction in CST, respectively. One case of intraocular inflammation was observed after four injections of faricimab and resolved with topical steroids. One case of infectious endophthalmitis was treated with intravitreal antibiotics and resolved.ConclusionsFaricimab has demonstrated improvement or maintenance of visual acuity for patients with nAMD, along with rapid improvement of anatomical parameters. It has been well-tolerated with low incidence of treatable intraocular inflammation. Future data will continue to investigate faricimab for real-world patients with nAMD.

Experience with Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration

Purpose: To assess efficacy and safety profile of intravitreal brolucizumab in patients with neovascular age-related macular degeneration (nAMD) in real clinical practice.Patients and Methods. This study enrolled 21 patients with nAMD (treatment-naïve), including 12 women, 9 men, mean age was 73.5 ± 9.8 years. One patient was excluded from the study after 3 intravitreal injection (IVI) due to the development of the intraocular inflammation (IOI). All patients received 5 IVI of brolucizumab (in total, 100 injections). All patients were determined best-corrected visual acuity (BCVA). Intraretinal fluid (IRF), subretinal fluid (SRF), central macular thickness (CMT), and pigment epithelial detachment (PED) were evaluated by optical coherence tomography. Intraocular pressure (IOP) was measured before IVI, after 1 minute, 30 minutes. Patients were examined before treatment, after 3 and 5 IVI.Results. The average follow-up period for patients was 31 ± 2.5 weeks, the average interval after 3 loading doses was 8.4 ± 1.2 weeks, the average interval between 4 IVI and 5 IVI was 10.7 ± 1.9 weeks. The BCVA improved significantly after 3 IVI and after 5 IVI of brolucizumab (p &lt; 0.001). There was a statistically significant decrease in CMT and PED height (p &lt; 0.001), as well as a resolution of all types of fluid (p &lt; 0.001). All patients showed a significant increase in IOP immediately after injection (1 min) with normalization of IOP after 30 min. One case of IOI was registered 16 weeks after the start of treatment, cured by IVI of dexamethasone implant Ozurdex.Conclusion. Patients with nAMD (treatment-naïve) who received 5 IVI of brolucizumab demonstrated a significant improvement of morphological and functional parameters. Brolucizumab has shown efficacy in the treatment of nAMD despite a small risk of IOI.

Reported Rates of Intraocular Inflammation with Intravitreal Aflibercept Administered via Pre-Filled Syringe or from Vials in Clinical Practice Between 2012 and 2022.

To determine the reported rates of intraocular inflammation (IOI) in patients treated with intravitreal aflibercept (IVT-AFL) 2 mg in routine clinical practice (ie, outside interventional studies), across all indications and within all countries (excluding the United States), with access to either the vial presentation or pre-filled syringe (PFS). A search was conducted using the Bayer EYLEA® Global Safety Pharmacovigilance Database for reported cases of IOI and IVT-AFL use between October 2012 and March 31, 2022. With more than 10 years of post-marketing experience with the IVT-AFL vial presentation (>25 million sold units), and over 2 years of experience with the PFS of IVT-AFL (>6.7 million sold units) the rate of any IOI, including endophthalmitis, outside the United States was 0.3 events per 10,000 units for the PFS and 1.2 events per 10,000 units for the vial presentation. The event rates specifically for endophthalmitis were 0.1 per 10,000 units for the IVT-AFL PFS and 0.6 per10,000 units for the IVT-AFL vial presentation. In patients with retinal diseases treated in routine clinical practice with IVT-AFL either from a vial or the PFS, medically important adverse events of IOI, and in particular, endophthalmitis, are infrequently reported events. Numerically, reported rates of IOI and endophthalmitis are low for the vial presentation and even lower for the PFS.

First Year Real Life Experience With Intravitreal Brolucizumab for Treatment of Refractory Neovascular Age-Related Macular Degeneration.

Purpose: To assess the morphological and functional outcomes within the first year of treatment with intravitreal brolucizumab for refractory neovascular age-related macular degeneration (nAMD). Methods: This retrospective study included 21 eyes from 19 patients with refractory nAMD followed for 12 months. All patients were switched to brolucizumab after treatment with at least two other anti-vascular endothelial growth factors (VEGF). All eyes received 3x brolucizumab 6 mg/0.05 ml intravitreal injections (IVI) monthly as an upload phase. Then eyes received an IVI every 8 weeks with interval adjustment to every 12 weeks if disease activity was not present. Main outcome measures: best corrected visual acuity (BCVA), central macular thickness (CMT) and retinal fluid distribution. In addition, we reported the adverse event rate. Results: The number of previous anti-VEGF IVIs/eye was 36 ± 22 before switching to brolucizumab. BCVA (ETDRS) was 51 ± 16 before treatment and 50 ± 19 at week 52 (p = 0.6). CMT was 374 ± 158 μm before treatment and 298 ± 92 μm at week 52 (p = 0.01). The number of IVIs/eye decreased from 9.6 ± 1.9 IVIs in the last year before switching to 6.4 ± 0.9 IVIs in the first year after switching to brolucizumab (p < 0.001). The rate of eyes with subretinal fluid and pigment epithelial detachment decreased at week 52. Finally, two cases of intraocular inflammation were observed as adverse events. Conclusion: In the first year of treatment, intravitreal brolucizumab was able to stabilize visual acuity with significantly less IVIs in patients with refractory nAMD. It also improved anatomic outcomes in these patients, particularly reducing subretinal fluid and pigment epithelial detachment and subsequently central macular thickness. However, two cases of intraocular inflammation were observed as adverse events.

Visual Outcomes after Anti-VEGF Therapy for Exudative Age-Related Macular Degeneration in a Real-Life Setting.

To report visual outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for exudative age-related macular degeneration (AMD) in a real-life setting. Retrospective case series of consecutive patients treated with either ranibizumab and/or aflibercept for monolateral or bilateral exudative AMD. A physician established the indication for treatment and administered the injections. An independent physician confirmed the indication for primary treatment. A Pro Re Nata and a Treat and Extend regimen were used. Assessment of subretinal and/or intraretinal fluid, retinal hemorrhage and increase in pigment epithelial detachment served as criteria for further treatment decisions. Visual acuity (VA) was measured in ETDRS letters at each examination and then analyzed using a specialized software. Evolution of mean VA was considered for all study eyes and subgroups of eyes with an initial VA ≥ 70 ETDRS letters (subgroup 1) and ≤ 69 ETDRS letters (subgroup 2). A total of 102 eyes of 76 patients (30 men, mean age 75.9 years; 46 women, mean age 81.5 years) were included. Subgroup 1 consisted of 47 eyes, and subgroup 2 of 55 eyes. Mean follow-up was 55 months (range 6 to 150 months). For the entire collective as for subgroups 1 and 2, the mean VA was 64, 77, or 51 ETDRS letters at baseline. Mean VA improved at month 12 (68, 80, or 58 ETDRES letters) and then slowly decreased over time until month 150 (62, 72, or 54ETDRS letters). Maximum improvement of + 5, + 3, or, + 9ETDRS letters occurred after 9, 8, or 10 months of follow-up. Atrophy and fibrosis were mainly responsible for VA decrease. Ten serious adverse events were reported to Swissmedic: two cases of cardiovascular events and eight cases of intraocular inflammation. Anti-VEGF therapy carried out in a real-life setting shows good VA outcomes with a favorable safety profile.

Potential pitfalls of anti-VEGF therapy of neovascular age-related macular degeneration

When administering anti-VEGF therapy for neovascular age-related macular degeneration (nAMD), it is necessary to take into account the fact that treatment outcomes - in addition to factors associated with the disease itself - may be affected by progressive concomitant conditions (for example, macular atrophy) and possible adverse events (AEs). The latter can be divided into two large groups: non-inflammatory and inflammatory. Intraocular inflammation (IOI) is a rare but potentially dangerous AE of anti-VEGF therapy, which can include endophthalmitis, early sterile inflammation and retinal vasculitis. Raising awareness about inflammatory AEs is becoming even more important due to the sheer number of intravitreal injections performed, as well as the frequency of cases of IOI when using new anti-VEGF drugs. The new anti-VEGF drug Brolucizumab is associated with the development of retinal vasculitis, which is considered a type III and IV hypersensitivity reaction (involving cellular and humoral immune responses, respectively). The article presents an overview of publications on the mechanisms, clinical manifestations, differentiation, and methods of treatment of various types of IOI.

Risk of Inflammation, Retinal Vasculitis, and Retinal Occlusion–Related Events with Brolucizumab: Post Hoc Review of HAWK and HARRIER

An independent Safety Review Committee (SRC), supported by Novartis Pharma AG, analyzed investigator-reported cases of intraocular inflammation (IOI), endophthalmitis, and retinal arterial occlusion in the phase 3 HAWK and HARRIER trials of brolucizumab versus aflibercept in neovascular age-related macular degeneration (nAMD). A post hoc analysis of a subset of data from two 2-year, double-masked, multicenter, active-controlled randomized phase 3 trials (NCT02307682, NCT02434328). Patients (N= 1817) with untreated, active choroidal neovascularization due to age-related macular degeneration in the study eye were randomized and treated in HAWK/HARRIER. The SRC reviewed data from cases of investigator-reported IOI (60/1088 brolucizumab-treated eyes; 8/729 aflibercept-treated eyes). The SRC received details and images (color fundus photography, fluorescein angiography, and OCT) for all investigator-determined cases of IOI, retinal arterial occlusion, and endophthalmitis. Cases were reviewed in detail by ≥2 readers, then adjudicated by the SRC as a group. Within this patient subset: incidence of IOI, signs and incidence of retinal vasculitis and/or retinal vascular occlusion, and visual acuity loss; time since first brolucizumab injection to IOI event onset; and frequency of visual acuity loss after brolucizumab injection by time of first IOI event onset. Fifty brolucizumab-treated eyes were considered to have definite/probable drug-related events within the spectrum of IOI, retinal vasculitis, and/or vascular occlusion. On the basis of these cases, incidence of definite/probable IOI was 4.6% (IOI+ vasculitis, 3.3%; IOI+ vasculitis+ occlusion, 2.1%). There were 8 cases (incidence 0.74%) of at least moderate visual acuity loss (≥15 ETDRS letters) in eyes with IOI (7 in eyes with IOI+ vasculitis+ occlusion). Of the 8 cases, 5 experienced their first IOI-related event within 3 months of the first brolucizumab injection (increasing to 7/8 within 6 months). Incidence of IOI in aflibercept-treated eyes was 1.1%, with at least moderate visual acuity loss in 0.14%. This analysis of IOI cases after brolucizumab injection identified signs of retinal vasculitis with or without retinal vascular occlusion and an associated risk of visual acuity loss. The findings will help physicians to evaluate the risks and benefits of brolucizumab treatment for nAMD.

Micropulse transscleral cyclophotocoagulation: initial results using a reduced energy protocol in refractory glaucoma.

This study evaluates the 6-month safety and efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma/ocular hypertension using a reduced energy protocol. Retrospective analysis of patients undergoing MP-TSCPC from January-April 2018 was carried out. Patients received up to 90s of laser with settings of 2000mW/Cm2 and a duty cycle of 31.3%. A total of 29 patients were included, with a mean age of 64.7 ± 15.1years. The most common diagnosis was primary open angle glaucoma (41.4%) with a mean Logmar visual acuity of 1.5 ± 1.2. All subjects had either undergone intraocular surgery (58.6% filtration surgery) or continuous wave diode laser prior to micropulse treatment. Mean pre-laser IOP was 26.2 ± 11.1mmHg. There was a significant reduction (p < 0.05) in IOP at 1month to 15.8 ± 5.4mmHg (39.7% reduction), at 3months to 15.04 ± 5.25mmHg (42.6% reduction) and at 6months to 18.19 ± 7.47mmHg (30.6% reduction). There was also a corresponding reduction (p < 0.05) in the number of topical agents required to control pressure from a baseline of 3.31 ± 0.97, to 2.72 ± 0.88 at 1month, 2.76 ± 0.91 at 3months and 2.90 ± 1.08 at 6months. Requirements for oral acetazolamide reduced from 41.3% (1/29) at baseline to 3.4% (1/29) at 6months. Success rates were 75.9% at 1month, 79.3% at 3months and 58.6% at 6months. There was no drop in the visual acuity, no change in central retinal thickness and no cases of intraocular inflammation. MP-TSCPC at a decreased duration is effective at reducing intraocular pressure in ethnically diverse glaucoma patients refractory to previous glaucoma laser or surgeries at 6months follow-up, with no significant complications. Further work is needed to confirm efficacy in the long term and to determine optimal settings.

Safety of 5914 intravitreal ziv-aflibercept injections.

To analyse the pooled safety data of intravitreal ziv-aflibercept (IVZ) therapy for various retinal conditions. This was a retrospective, observational study which included patients from 14 participating centres who received IVZ. The medical records of patients who received IVZ from March 2015 through October 2017 were evaluated. Patient demographics and ocular details were compiled. Ocular and systemic adverse events that occurred within 1 month of IVZ injections were recorded and defined as either procedure-related or drug-related. A total of 1704 eyes of 1562 patients received 5914 IVZ injections (mean±SD: 3.73±3.94) during a period of 2.5 years. The age of patients was 60.6±12.8 years (mean±SD) and included diverse chorioretinal pathologies. Both ocular (one case of endophthalmitis, three cases of intraocular inflammation, and one case each of conjunctival thinning/necrosis and scleral nodule) and systemic adverse events (two cases of myocardial infarction, one case of stroke and two deaths) were infrequent. This constitutes the largest pooled safety report on IVZ use and includes patients from 14 centres distributed across the globe. It shows that IVZ has an acceptable ocular and systemic safety profile with incidences of adverse events similar to those of other vascular endothelial growth factor inhibitory drugs. The analysis supports the continued use of IVZ in various retinal disorders.

Intraokulare Entzündung: autoimmun oder infektiös?

Presentation of 3 cases of intraocular inflammation: 1. 47-year old female patient with severe necrotising scleritis and uveitis with underlying granulomatous polyangiitis (formerly known as Wegener granulomatosis, in honour of the German pathologist Friedrich Wegener), known for 10 years. 2. 48-year old male patient with longstanding bilateral uveitis and granulomatous polyangiitis for 2 years. In the histopathological examination of the enucleation specimen, a retrolental tumour turned out to be a granuloma. 3. 57-year old male patient in status post renal transplantation with intraocular cellular infiltration suspicious for lymphoma, which surprisingly proved to be Toxoplasma gondii-associated uveitis. The clinical course and characteristic histological signs and therapeutic options are discussed.

Intravitreal Aflibercept for Macular Edema Following Branch Retinal Vein Occlusion: The 24-Week Results of the VIBRANT Study

To compare the efficacy and safety of intravitreal aflibercept injection (IAI) with macular grid laser photocoagulation for the treatment of macular edema after branch retinal vein occlusion (BRVO). The VIBRANT study was a double-masked, active-controlled, randomized, phase III trial. Treatment-naïve eyes with macular edema after BRVO were included in the study if the occlusion occurred within 12 months and best-corrected visual acuity (BCVA) was between ≤73 and ≥24 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (20/40-20/320 Snellen equivalent). Eyes (1 eye per patient) received either IAI 2 mg every 4 weeks (n=91) from baseline to week 20 or grid laser (n=92) at baseline with a single grid laser rescue treatment, if needed, from weeks 12 through 20. The primary outcome measure was the proportion of eyes that gained ≥15 ETDRS letters from baseline BCVA at week 24. Secondary end points included mean change from baseline BCVA and central retinal thickness (CRT) at week 24. The proportion of eyes that gained ≥15 ETDRS letters from baseline at week 24 was 52.7% in the IAI group compared with 26.7% in the laser group (P=0.0003). The mean improvement from baseline BCVA at week 24 was 17.0 ETDRS letters in the IAI group and 6.9 ETDRS letters in the laser group (P<0.0001). The mean reduction in CRT from baseline at week 24 was 280.5 μm in the IAI group and 128.0 μm in the laser group (P<0.0001). Traumatic cataract in an IAI patient was the only ocular serious adverse event (SAE) that occurred. There were no cases of intraocular inflammation or endophthalmitis. The incidence of nonocular SAEs was 8.8% in the IAI group and 9.8% in the laser group. One Anti-Platelet Trialists' Collaboration-defined event of nonfatal stroke (1.1%) and 1 death (1.1%) due to pneumonia occurred during the 24 weeks of the study, both in patients in the laser group. Monthly IAI provided significantly greater visual benefit and reduction in CRT at 24 weeks than grid laser photocoagulation in eyes with macular edema after BRVO.

Intravitreal aflibercept for macular oedema due to branch retinal vein occlusion

AbstractPurpose To evaluate the efficacy and safety of intravitreal aflibercept (IVT‐AFL) injection compared with macular grid laser photocoagulation for the treatment of macular oedema secondary to Branch Retinal Vein Occlusion (BRVO).Methods VIBRANT was a double‐masked, Phase 3 trial with a duration of 52 weeks in which patients with macular oedema secondary to BRVO were randomised 1:1 to receive IVT‐AFL 2 mg every 4 weeks or grid laser from baseline to Week 20. The primary efficacy endpoint was the proportion of eyes that gained ≥15 letters in best‐corrected visual acuity (BCVA) from baseline at Week 24.Results The proportion of eyes that gained ≥15 letters from baseline to Week 24 was 52.7% and 26.7% (P&lt;0.001) in the IVT‐AFL and laser groups, respectively. The mean improvement in BCVA from baseline to Week 24 was 17.0 and 6.9 letters (P&lt;0.0001), respectively. The most common ocular adverse events (AEs) in the IVT‐AFL and laser group were subconjunctival haemorrhage (19.8%) and eye pain (5.4%), respectively. There were no cases of intraocular inflammation in either treatment group. One death due to pneumonia and one Anti‐Platelet Trialists' Collaboration (APTC)‐defined event of nonfatal stroke occurred during the first 24 weeks of study, both in the laser group. Week 52 data will be presented.Conclusion In this study, monthly IVT‐AFL provided statistically significant and clinically meaningful visual benefits which were superior to macular grid laser photocoagulation in eyes with macular oedema due to BRVO over 24 weeks. Compared to IVT‐AFL’s known profile no new safety signals were observed. Commercial interest

Intraocular inflammation as the main manifestation of Rickettsia conorii infection

ObjectiveTo report the clinical features and management of seven cases of intraocular inflammation caused by Rickettsia infection and review published literature.MethodsRickettsia conorii or Rickettsia spp. infection was diagnosed based on the following criteria: (1) positive serology according to the European Guidelines, (2) titer normalization after specific treatment, and (3) complete resolution of ophthalmic disease and accompanying symptoms after antibiotic therapy.ResultsSeven patients were referred for uveitis of unknown etiology. All came from regions where Mediterranean spotted fever is prevalent. One patient met the European guidelines criteria for Rickettsia spp. infection, while the other six cases met the criteria for R. conorii infection. The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain. Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema. All patients required antibiotic treatment that resulted in the remission of the infection. Doxycycline was the first choice and the only antibiotic used to treat four patients. One patient needed ciprofloxacin as a second antibiotic after not responding to doxycycline. Two patients had doxycycline as a second antibiotic after not responding primarily to sulfonamides (which had been given after 2–3 days of doxycycline gastric intolerance); one of these patients needed ciprofloxacin as a third antibiotic.ConclusionIntraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection. It should be considered as a differential diagnosis for uveitis especially for patients living in countries where this infection is endemic in the world. Antibiotic treatment remains effective in the management of Rickettsia infection.

Amphotericin B and exogenous mycotic endophthalmitis after cataract extraction.

Fungus endophthalmitis was diagnosed on the basis of clinical criteria in two cases of intraocular inflammation that developed within two weeks after uneventful intracapsular cataract extraction. Aqueous humor aspirates revealed inflammatory cells but no fungal forms. Cultures of aqueous humor were negative for fungi in both patients. In both cases, a steady downhill course was reversed overnight by the episcleral (sub-Tenon's) injection of 5 mg of amphotericin B. Clinical improvement was progressive thereafter. In both cases, visual acuity improved from accurate light projection at the height of inflammation to a final level of 20/20+. A basis for the negative results of microbiological studies is delineated.