Chronic Posterior Uveitis Research Articles

Corticosteroid implants for chronic non-infectious uveitis.

Uveitis is a term used to describe a heterogeneous group of intraocular inflammatory diseases of the anterior, intermediate, and posterior uveal tract (iris, ciliary body, choroid). Uveitis is the fifth most common cause of vision loss in high-income countries, accounting for 5% to 20% of legal blindness, with the highest incidence of disease in the working-age population.Corticosteroids are the mainstay of acute treatment for all anatomical subtypes of non-infectious uveitis and can be administered orally, topically with drops or ointments, by periocular (around the eye) or intravitreal (inside the eye) injection, or by surgical implantation. To determine the efficacy and safety of steroid implants in people with chronic non-infectious posterior uveitis, intermediate uveitis, and panuveitis. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to November 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 15 April 2013), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for studies. We last searched the electronic databases on 6 November 2015.We also searched reference lists of included study reports, citation databases, and abstracts and clinical study presentations from professional meetings. We included randomized controlled trials comparing either fluocinolone acetonide (FA) or dexamethasone intravitreal implants with standard-of-care therapy with at least six months of follow-up after treatment. We included studies that enrolled participants of all ages who had chronic non-infectious posterior uveitis, intermediate uveitis, or panuveitis with vision that was better than hand-motion. Two review authors independently reviewed studies for inclusion. Two review authors independently extracted data and assessed the risk of bias for each study. We included data from two studies (619 eyes of 401 participants) that compared FA implants with standard-of-care therapy. Both studies used similar standard-of-care therapy that included administration of prednisolone and, if needed, immunosuppressive agents. The studies included participants from Australia, France, Germany, Israel, Italy, Portugal, Saudi Arabia, Spain, Switzerland, Turkey, the United Kingdom, and the United States. We assessed both studies at high risk of performance and detection bias.Only one study reported our primary outcome, recurrence of uveitis at any point during the study through 24 months. The evidence, judged as moderate-quality, showed that a FA implant probably prevents recurrence of uveitis compared with standard-of-care therapy (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.14 to 0.59; 132 eyes). Both studies reported safety outcomes, and moderate-quality evidence showed increased risks of needing cataract surgery (RR 2.98, 95% CI 2.33 to 3.79; 371 eyes) and surgery to lower intraocular pressure (RR 7.48, 95% CI 3.94 to 14.19; 599 eyes) in the implant group compared with standard-of-care therapy through two years of follow-up. No studies compared dexamethasone implants with standard-of-care therapy. After considering both benefits and harms reported from two studies in which corticosteroids implants were compared with standard-of-care therapy, we are unable to conclude that the implants are superior to traditional systemic therapy for the treatment of non-infectious uveitis. These studies exhibited heterogeneity in design and outcomes that measured efficacy. Pooled findings regarding safety outcomes suggest increased risks of post-implant surgery for cataract and high intraocular pressure compared with standard-of-care therapy.

SOCS1 Mimetic Peptide Suppresses Chronic Intraocular Inflammatory Disease (Uveitis).

Uveitis is a potentially sight-threatening disease characterized by repeated cycles of remission and recurrent inflammation. The JAK/STAT pathway regulates the differentiation of pathogenic Th1 and Th17 cells that mediate uveitis. A SOCS1 mimetic peptide (SOCS1-KIR) that inhibits JAK2/STAT1 pathways has recently been shown to suppress experimental autoimmune uveitis (EAU). However, it is not clear whether SOCS1-KIR ameliorated uveitis by targeting JAK/STAT pathways of pathogenic lymphocytes or via inhibition of macrophages and antigen-presenting cells that also enter the retina during EAU. To further investigate mechanisms that mediate SOCS1-KIR effects and evaluate the efficacy of SOCS1-KIR as an investigational drug for chronic uveitis, we induced EAU in rats by adoptive transfer of uveitogenic T-cells and monitored disease progression and severity by slit-lamp microscopy, histology, and optical coherence tomography. Topical administration of SOCS1-KIR ameliorated acute and chronic posterior uveitis by inhibiting Th17 cells and the recruitment of inflammatory cells into retina while promoting expansion of IL-10-producing Tregs. We further show that SOCS1-KIR conferred protection of resident retinal cells that play critical role in vision from cytotoxic effects of inflammatory cytokines by downregulating proapoptotic genes. Thus, SOCS1-KIR suppresses uveitis and confers neuroprotective effects and might be exploited as a noninvasive treatment for chronic uveitis.

Primary CNS lymphoma.

Despite recent progress, the diagnosis of primary CNS lymphoma (PCNSL) remains a challenge and is often delayed by several months. Treatment options are still debated and the prognosis of PCNSL lymphoma is poor for most patients. This review will describe recent progress and future orientations for diagnosis of PCNSL and report on the recent trends regarding therapeutic options. PCNSL must be suspected in cases of chronic posterior uveitis, especially in patients over 50 years old. Diagnosis is based on cytology and molecular analysis of clonality of vitreous samples. Intraocular interleukin (IL)-10 level has proved to be a valuable tool for screening purposes in cases where there is a suspicion of primary vitreoretinal lymphoma. Intraocular cytokine dosage could also be a useful marker to follow the therapeutic response of patients with PCNSL. Treatment of PCNSL remains under debate. Diagnosis of PCNSL is challenging. Suspicion relies on clinical history and on IL-10 and IL-6 levels in ocular fluid samples. Definite diagnosis is based on cytology and molecular analysis of clonality. New diagnostic and prognostic markers are currently evaluated. Whether isolated vitreoretinal lymphoma should be treated locally or with systemic treatment remains highly controversial.

Hyperreflective Dots in Spectral Domain Optical Coherence Tomography as Phenotypic Marker in Uveitis‐Associated Cystoid Macular Edema

PurposeTo evaluate the agreement between hyperreflective dots (HRD) in retina layers by spectral domain optical coherence tomography (SD‐OCT) and laser flare photometry associated with best‐corrected visual acuity (BCVA) results in patients with uveitic cystoid macular edema (CME).MethodsAll patients referred to our tertiary care center for posterior uveitis had full examination including: BCVA, laser flare photometry, SD‐OCT, fluorescein and infracyanine angiography. §Causes of uveitis were multiple: infectious, inflammatory and unknown. The characteristics of the HRD were evaluated in all SD‐OCT scans. HRD were defined as small focal hyperreflective material scattered mainly in outer retinal layers but also spreading to all retinal layers observed in at least one available scan. Two different ophthalmologists counted HRD using a horizontal B scan cross section through the fovea. They were classified on the basis of quantity (i.e. absent, few if less than 10, moderate if between 10 and 20, or numerous if more than 20). Central macular thickness (CMT) was also evaluated.Results24 eyes of 18 patients were included. 8 men and 10 women with posterior uveitis were examined. Mean flare measurement was 25.1 (3–62). Mean BCVA was 20/63. Mean central macular thickness was 463 μm. 2 subgroups were identified. 13 eyes presented decreased BCVA, normal or elevated Flare, numerous HRD and increased CMT, corresponding to active posterior uveitis. Other 11 eyes presented decreased BCVA, increased CMT, normal laser Flare photometry, those results corresponding to chronic posterior uveitis. The difference with the two groups was numerically significant.ConclusionsHRD are correlated to CMT and BCVA but not with anterior chamber flare in active posterior uveitis. A large prospective study is needed in order to confirm these results.

Reply to Hall J: "Use of the Fluocinolone Acetonide Intravitreal Implant for the Treatment of Noninfectious Posterior Uveitis: 3-Year Results of a Randomized Clinical Trial in a Predominantly Asian Population" : Virender S. Sangwan, P. Andrew Pearson, Hemanth Paul, Timothy L. Comstock.

I read with interest Dr. Hall’s letter. While the article titled “Use of the Fluocinolone Acetonide Intravitreal Implant for the Treatment of Noninfectious Posterior Uveitis (NIPU): 3-Year Results of a Randomized Clinical Trial in a Predominantly Asian Population” [1] clearly identified Retisert® (fluocinolone acetonide intravitreal implant) 0.59 mg as the marketed product used in the study, we appreciate Dr. Hall’s concern that there may be some potential confusion regarding the features of Retisert compared with those of Iluvien® (fluocinolone acetonide intravitreal implant) 0.19 mg, as they both contain fluocinolone acetonide as the active ingredient, and we are in support of a letter outlining their differences [2]. However, we disagree with the promotional implication that Iluvien is an “improvement” over Retisert as there are no head-to-head clinical trials comparing these two products to merit that claim. Indeed, in addition to the approval for treatment of chronic non-infectious posterior uveitis, clinical studies have shown Retisert to be effective in reducing diabetic macular edema (DME) and improving visual acuity in patients with DME [3]. Retisert has also shown efficacy in the management of macular edema secondary to retinal vein occlusion in small studies [4, 5]. However, as Dr. Hall correctly stated, Retisert is not approved either in the US or in Europe for these latter indications. Baldo Scassellati Sforzolini, MD, PhD, MBA Vice President Development, Eye Care, Valeant Pharmaceuticals Bridgewater, NJ, USA Baldo.Sforzolini@bausch.com

Diagnostics and treatment of primary vitreoretinal lymphoma

Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, mostly a diffuse large B-cell lymphoma. The PVRL, previously called primary intraocular lymphoma (PIOL), is a subset of primary central nervous system lymphoma (PCNSL). The diagnosis of PVRL is often difficult as it often mimics chronic intermediate or posterior uveitis; therefore, PVRL requires various procedures for the diagnostics, e.g. immunohistochemistry, cytology, pathology, molecular pathology and cytokine analysis (interleukin 10) after surgically obtaining ocular specimens. Treatment forms that are effective for systemic lymphomas have not been reliably successful for PVRL and PCNSL. Current management of PVRL consists of chemotherapy, such as methotrexate or rituximab, possibly combined with external beam radiation whereby both chemotherapeutic agents are administered systemically as well as intravitreally. Intravitreal treatment alone is recommended solely in the case of monocular PVRL, which is highly controversial. A PVRL usually responds well to initial treatment; however, relapse rates and CNS involvement are high, resulting in a poor prognosis and limited survival.

The immunopathogenesis of birdshot chorioretinopathy; a bird of many feathers.

Birdshot chorioretinopathy (BSCR) is a bilateral chronic intraocular inflammation or posterior uveitis that preferentially affects middle-aged Caucasians. BSCR is characterized by distinctive multiple choroidal hypopigmented lesions in combination with retinal vasculitis and vitritis, and the extraordinary feature that virtually all patients are HLA-A29 positive. Its pathophysiology is still poorly understood. BSCR is the strongest documented association between HLA and disease in humans, which makes it an excellent model for studying the underlying immuno-genetic mechanisms of HLA class I-associated diseases. Although the association with HLA-A29 suggests that it is directly involved in the presentation of peptide antigens to T cells, the exact contribution of HLA-A29 to the pathophysiology of BSCR remains enigmatic. This article revisits the HLA-A29 peptidome using insights from recent studies and discusses why HLA-A29 can be considered a canonical antigen presenting molecule. The first genome-wide association study facilitated novel concepts into a disease mechanism beyond HLA-A29 that includes strong genetic predisposition for the ERAP2 gene that affects antigen processing for HLA class I. Furthermore, patients manifest with pro-inflammatory cytokine profiles and pathogenic T cell subsets that are associated with IL-17-linked inflammation. We are beginning to understand that the underlying biology of BSCR comprises various pathologic aspects branched into multiple molecular pathways. We propose to employ Systems Medicine to reveal their dynamic interplay for a holistic view of the immunopathology of this intriguing archetypal HLA class I-associated disease.

Cystoid macular edema and ocular toxocariasis in adult patients

AbstractPurpose To report clinical features in proven ocular Toxocariasis in adult patients.Methods This retrospective study included 14 adults suffering from chronic uveitis whose clinical signs suggested an ocular toxocariasis, secondarely confirmed by semi‐quantitative western blot (WB) in aqueous or vitreous humor. The clinical characteristics and signs of uveitis had been analysed, especially : anterior chamber flare meter measurement, vitreous aspect, presence of retinal granuloma, retinal haemorrhages or cystoid macular edema.Results We had included 6 women and 8 men. The average age of patients at diagnosis was 45.6 years with an average time of diagnosis of 15.1 months. Uveitis was unilateral. All patients having a vitreous inflammation whose 11 also had a panuveitis. The main clinical signs observed were : one or more active focal deep whitish lesions in retinal periphery (78%), retinal hemorrhages (36%) or vitreoretinal tractions (64%). The main posterior segment complication observed was a chronic macular edema (71%). Patients had been followed during an average of 21.4 months.Conclusion Ocular toxocariasis could induce chronic unilateral posterior uveitis in adults. The presence of a vitreous cellular inflammation is consistenly found. While whitish peripheral granuloma and vitreoretinal tractions appear very suggestive, a chronic cystoid macular edema is found as main complication. This diagnosis could be delayed in atypical forms so aqueous humor and vitreous sampling for testing toxocariasis by semi‐quantitative WB remains still helpful.

Development and Validation of Quality-of-Life Questionnaires for Birdshot Chorioretinopathy

Birdshot chorioretinopathy (BCR) is a rare form of chronic posterior uveitis, usually requiring long-term, systemic immunosuppression.1 The severe impact of the disease on acuity, visual field, color discrimination, and electrodiagnostics is well-documented,1 ; 2 but studies on quality of life (QoL) have been limited. Furthermore, existing QoL tools fail to capture the unique and wide range of symptoms associated with BCR and BCR medications.

Tuberculous uveitis in China

To assess tuberculous uveitis in Chinese patients. The hospital-based observational case series study included patients who attended a third-referral hospital and presented with chronic and recurrent uveitis without primarily detected aetiology. The patients underwent the tuberculin skin test (TST) and/or interferon gamma release test (IGRA). Patients with positive test results received standard antituberculous therapy. Patients who responded to the therapy and did not show recurrence of uveitis in the follow-up period were diagnosed as tuberculous uveitis and formed the study group. The remaining patients were diagnosed as non-tuberculous uveitis and formed the control group. The clinical characteristics were compared between both groups. The study group with tuberculous uveitis included 46 patients and the non-tuberculous group 38 patients. Multifocal choroiditis [n = 9 (20%) versus n = 1(3%); p = 0.04] and retinal vasculitis [n = 25(54%) versus 8 = (21.1%); p = 0.002] were significantly more common in the study group. Of 25 patients with retinal vasculitis in the study group, 11 patients (44%) additionally showed choroiditis lesions, compared with only one (13%) of eight patients in the control group (p = 0.01). In multivariate regression analysis, multifocal choroiditis [odds ratio (OR): 32.1], choroidal granuloma (OR: 21.4) and retinal vasculitis (OR: 11.2) were independent predictors of tubercular uveitis. About 50% of a group of 84 patients with primarily unexplained chronic posterior uveitis had tuberculosis and showed multifocal choroiditis, choroidal granuloma and retinal vasculitis. These features had a high predictive value for the diagnosis of tuberculous uveitis. Tuberculosis is an important part in the differential diagnosis of unexplained uveitis.

Birdshot uveitis: clinical features and treatment

Uveitis, is the term used to describe inflammation of the uveal tract, i.e. iris, ciliary body, choroid. Birdshot uveitis is a chronic posterior uveitis which is an inflammatory, autoimmune disease. It tends to affect both eyes which may not happen initially but over a few years it normally does. It is sight threatening if left untreated. It involves choroid and retinal vessels and optic disc. This article will provide an overview of birdshot uveitis, its clinical features and treatment.

Indocyanine Green Angiography: A Perspective on Use in the Clinical Setting

To review the history of indocyanine green (ICG) angiography and to present a personal perspective on its use in the clinical setting today. Perspective with literature review and opinions based on personal experience. To acquire views from international retinal physicians experienced with the technique on uses in their facilities and to compare them to the author's personal standards. The author and contributing retinal physicians had surprisingly similar views for most, but not all, applications for ICG angiography use in the clinical setting. ICG angiography is recommended for a few highly selective chorioretinal disorders, including certain forms of neovascularization in age-related macular degeneration, other neovascular maculopathies, chronic central serous chorioretinopathy, choroidal hemangiomas, and posterior uveitis.

Combined Fluocinolone Acetonide Intravitreal Insertion and Glaucoma Drainage Device Placement for Chronic Uveitis and Glaucoma

To determine whether a fluocinolone acetonide sustained-release intravitreal drug delivery system can be implanted safely at the same time that a glaucoma drainage device is placed for eyes with uveitis and elevated intraocular pressure (IOP) receiving maximum tolerated IOP-lowering therapy. Retrospective, observational case series. Subjects had chronic noninfectious intermediate or posterior uveitis and elevated IOP while receiving maximum tolerated medical therapy. Fluocinolone acetonide implantation and glaucoma tube shunt placement were performed in a single surgical session. The main outcome measures were inflammatory recurrences, visual acuity (VA), use of adjunctive anti-inflammatory therapy, IOP, and adverse events. Seven eyes of 5 patients were studied. The average number of recurrences 12 months before implantation was 3 episodes per eye; of the 3 eyes followed up for more than 30 months, none had an inflammatory recurrence within 30 months after implantation. The mean Snellen visual acuity 12 months after the combined surgery was 20/114, compared with 20/400 at baseline. Adjunctive steroid use decreased. Average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg 12 months after the combined surgery (P = .019). The favorable results observed in all eyes suggest that fluocinolone acetonide implantation can be safely combined with glaucoma tube shunt placement in a single surgical session in eyes with uveitis and elevated IOP receiving maximum tolerated IOP-lowering therapy. Uveitis recurrences decreased, visual acuity improved, and IOP decreased. There were no adverse events during insertion of the fluocinolone acetonide implant and placement of the glaucoma tube shunt.

The value of an immune response to Mycobacterium tuberculosis in patients with chronic posterior uveitides revisited: utility of the new IGRAs

To explore the utility of a specific immune response to Mycobacterium tuberculosis in a population of immunosuppressed idiopathic chronic posterior uveitis patients, by means of a tuberculosis-specific interferon-gamma release assay. Prospective, interventional case series. A total of 31 referred patients with severe idiopathic chronic uveitis or panuveitis and 52 controls were screened for a specific immune response to tuberculosis. After ruling-out specific uveitis entities, presumed tuberculosis-related uveitis was initially considered when ophthalmologic findings were consistent with tubercular uveitis, and a specific immune response to M. tuberculosis confirmed by QuantiFERON, despite inability to detect M. tuberculosis. Clinical responses to antitubercular treatment were recorded. The prevalence of an immune response to M. tuberculosis was 15.38% in controls and 32.25% in uveitis patients (OR=2.619, P=0.07). Two patients were QuantiFERON indeterminate (6.4%). After excluding seven specific uveitis entities (OR=3.66, P=0.03), eight QuantiFERON-positive and one QuanTIFERON-negative uveitis patients were initially treated for presumed tuberculosis-related uveitis. All but one had no evidence of active systemic involvement. None had been previously diagnosed with tuberculosis, but unsuccessfully treated with immunosuppressors. After a 9-month tuberculostatic treatment, seven QuantiFERON -positive and one QuantiFERON-negative patients exhibited decreased intraocular inflammation, visual acuity improvement, and no relapses. Estimated QuantiFERON sensitivity and specificity were 82 and 100%, respectively, with a PPV=100% and an NPV=86%. QuantiFERON was useful for antituberculous treatment decision-making in chronic posterior uveitis immunosuppressed patients from areas with an intermediate-high prevalence of tuberculosis.

OUTCOME OF FLUOCINOLONE ACETONIDE IMPLANT (RETISERT™) REIMPLANTATION FOR CHRONIC NONINFECTIOUS POSTERIOR UVEITIS

In Brief Purpose: To evaluate outcomes of repeat intravitreal fluocinolone acetonide implant (Retisert™) in patients with chronic noninfectious posterior uveitis. Methods: Retrospective, observational case series of 10 eyes (10 patients) with recurrent noninfectious posterior uveitis who underwent a second fluocinolone acetonide implant in the same eye. Recurrence rate of ocular inflammation in the implanted eye was evaluated before and after the first and second implants. Surgical complications, visual acuity changes, need for adjunctive therapy, and safety were also assessed. Results: After first fluocinolone acetonide implantation, the visual acuity was stable or improved in 100% of patients and the median time to first recurrence was 32.5 months (range, 17.5–54 months). After second implantation, the median follow-up was 16.8 months, the visual acuity was stable or improved in 100% of patients, and four eyes had recurrences during the follow-up period (median, 18.3 months; range, 11–29.5 months). Kaplan-Meier estimate of time to recurrence following second implant was approximately 25 months to 30 months. All four phakic eyes underwent cataract extraction following the first implant and before the second implant. Five eyes required glaucoma surgery after the first implant and one eye after the second implant. Other complications included one case of vitreous hemorrhage after first implant and one rhegmatogenous retinal detachment at the site of second implant. Conclusions: Fluocinolone acetonide reimplantation for chronic noninfectious posterior uveitis offers similar control of ocular inflammation and complications profile as the first implantation. Fluocinolone acetonide implant (RetisertTM) appears to control inflammation, stabilize vision, and reduce the need for adjunctive therapy in patients with noninfectious posterior uveitis, whether used as primary implantation or following reimplantation. In 10 patients requiring reimplantation, the median time to recurrence was 32.5 months.

Simvastatin-Induced Rhabdomyolysis Following Cyclosporine Treatment for Uveitis

The purpose of this study was to heighten awareness of a potentially life-threatening drug interaction in patients with chronic uveitis treated with cyclosporine. A 69-year-old female with chronic posterior uveitis was treated with cyclosporine while on concomitant oral simvastatin for hypercholesterolemia. Rhabdomyolysis developed with acute renal failure from the probable interaction between these drugs. Discontinuation of simvastatin and cyclosporine resulted in resolution of rhabdomyolysis and normalization of renal function. Statins are associated with a small, dose-related risk of myopathy, myositis, and rhabdomyolysis. Cyclosporine is a potent inhibitor of simvastatin metabolism, and may therefore facilitate simvastatin-induced rhabdomyolysis. Concomitant use of statins and cyclosporine should be avoided.

Efectos secundarios de la triamcinolona en pacientes jóvenes

Intravitreal triamcinolone is being increasingly employed for the treatment of macular diseases. We report two cases of intraocular pressure elevation and cataract formation after intravitreal triamcinolone therapy, and wonder if these complications are more likely when this agent is used in young patients. Intravitreal triamcinolone was injected into both eyes of the two young patients with chronic posterior and intermediate uveitis refractory to peribulbar and oral corticosteroid therapy. Chronic cystoid macular edema improved in both patients, however the intraocular pressure increased, requiring topical antihypertensive therapy, and this was followed by accelerated cataract formation. Young age and chronic inflammation could be associated with an intraocular pressure rise and subsequent cataract development after intravitreal triamcinolone.

Therapeutic and Toxicological Evaluations of Cyclosporine A Microspheres as a Treatment Vehicle for Uveitis in Rabbits

This study was undertaken to investigate the therapeutic efficacy and the toxicity of the intravitreal biodegradable poly(dl-lactide-co-glycolide)co-polymer microspheres containing cyclosporin A (CsA-PLGA-MS) on experimental uveitis in rabbits. CsA-PLGA-MS that had been prepared by a solvent evaporation approach were characterized for morphology, particle size, entrapment efficiency, and in vitro release profile of CsA-PLGA-MS. Therapeutic efficacy of the CsA-PLGA-MS was evaluated by scoring of the inflammation, aqueous leukocyte counting, aqueous protein determination, and histological examination in the experimental rabbits with artificial uveitis induced by the injection of lipopolysaccharide. The toxicity was investigated by slit-lamp examination, indirect ophthalmoscopy, and electroretinography (ERG) in the noninflamed rabbit eye. The CsA-PLGA-MS were spherical in shape, with an average particle size of nearly 50 microm and an entrapment efficiency of more than 80%. The compositions of the formulation that was most effective in the in vivo studies included CsA, PLGA, and 3% Pluronic F68. In vitro released cyclosporine A from the optimized microspheres was approximately 25% during the 60-day incubation at 37 degrees C. It was demonstrated that the intravitreal injection of the optimized CsA-PLGA-MS decreased significantly the severity of the inflammatory signs, cellular infiltrate, aqueous leukocyte counts, and protein levels in the eyes of experimental rabbits with uveitis, compared to other formulations. Also, the preparation did not cause obvious toxicity in the noninflamed eyes of rabbits, except that the ERG b-wave amplitude for the test eyes was reversibly depressed, compared to those of the control eyes at 2 weeks, which almost recovered at the end of 6 weeks. The CsA-PLGA-MS preparation might be useful in the treatment of patients with severe chronic posterior uveitis who cannot tolerate systemic or periocular therapy.

Use of intravitreal triamcinolone in the management of birdshot retinochoroidopathy associated with cystoid macular oedema: a case study over a three‐year period

Birdshot retinochoroidopathy is a bilateral, chronic posterior uveitis of likely autoimmune aetiology characterized by multiple depigmented choroidal lesions scattered throughout the post-equatorial retina. It has been managed with variable results using systemic immunosuppression. Herein, a case is described in which the patient, aware of the side-effects of systemic immunosuppression, refused this form of treatment and was successfully managed over a 3-year period with intravitreal triamcinolone. She developed the ocular complications of cataract and increased intraocular pressures, but maintained good vision while avoiding any systemic side-effects.

Incidence of secondary glaucoma in Behcet’s disease

The authors performed a retrospective and prospective study to determine the incidence of secondary glaucoma in 230 eyes of 129 patients (90 male, 39 female) with Behcet’s disease. The mean patient age was 34.2 ± 7.4 years (range, 18 to 55 years). Episodes of acute recurrent iridocyclitis only were present in 122 eyes (53%), while 108 eyes (47%) developed chronic posterior uveitis, including vitreitis, retinitis, vasculitis, or optic nerve involvement. Secondary glaucoma was present in 25 eyes (10.9%) eyes, including 11 eyes (44%) with steroid or inflammation induced open angle glaucoma, 6 eyes (24%) with partial angle-closure glaucoma and/or peripheral anterior synecchia, 5 eyes (20%) with angle closure glaucoma, peripheral anterior synecchia, and/or pupillary block, and 3 eyes (12%) with neovascular glaucoma.