Idiopathic Intermediate Uveitis Research Articles

Treatment of Intermediate Uveitis-associated Retinal Vasoproliferative Tumors: A Case Series.

To report the use of combination intravitreal pharmacotherapy using anti-vascular endothelial growth factor (VEGF) and short and long-term corticosteroid implants for the treatment of retinal vasoproliferative tumors (VPT) associated with intermediate uveitis. Retrospective chart review of patients with VPT secondary to idiopathic intermediate uveitis that underwent combination intravitreal pharmacotherapy at a single center was performed. Multimodal imaging including ultrawide field color fundus photography, ultrawide field fluorescein angiography, and optical coherence tomography obtained before and after treatment were reviewed. Four eyes of 4 patients were treated with multiple injections of a combination of aflibercept, dexamethasone, and fluocinolone acetonide implants for VPT associated with intermediate uveitis. All 4 patients had improvement in visual acuity, intraocular inflammation, central macular thickness, and retinal vascular leakage, as well as regression of the VPT and reduction in lesion leakage on follow-up. Combination intravitreal anti-VEGF and corticosteroid implants may be a useful approach for the treatment of intermediate uveitis-associated VPTs and can lead to both functional and structural improvement.

An Overview of Pediatric Uveitis.

Uveitis in childhood poses a distinct challenge, mainly because of the insidious onset and chronic course of intraocular inflammation in most cases, which may result in permanent visual loss due to delayed diagnosis and treatment. Although anterior uveitis, frequently associated with juvenile idiopathic arthritis, is the most common form of ocular involvement, idiopathic intermediate uveitis (pars planitis) is also a common uveitic entity in childhood. Posterior or panuveitis of a variety of noninfectious or infectious etiologies may be seen as well. Pediatric uveitis needs to be closely monitored since serious ocular complications such as intraocular pressure elevation, cataract, and macular edema may rapidly develop due to inadequately controlled inflammation and/or the use of corticosteroids. Methotrexate is generally the first- line corticosteroid-sparing agent, and adalimumab is the first-line biologic in refractory cases of noninfectious uveitis. A multidisciplinary approach is essential to monitor systemic disease associations, treatment response, and adverse events in children with uveitis.

Uveitis In Children

Uveitis in children is rarer than in adults, has variable clinical aspects, depending on etiopathogenesis, many forms are asymptomatic, and there can be difficulties in diagnosis and treatment. Uveitis in children can cause significant eye morbidity, with vision loss in 25/30% of cases, through complications, such as: cataract, glaucoma, band keratopathy. Uveitis in children is more frequently bilateral, with persistent, recurrent chronic evolution, resistant to conventional treatment and can be anterior, intermediate, posterior, panuveitis, acute or chronic. Juvenile idiopathic arthritis (JIA) is the most common cause of anterior uveitis in children 60% (girls, under 6 years old), in which uveitis is unilateral, non-granulomatous, with chronic evolution, associated with positive ANA. Uveitis in JIA has multiple complications and sequelae, with decreased vision. The prognosis of the disease is dependent on the establishment of an adequate early treatment in which the first line of therapy is topical, periocular, systemic, intravitreal corticotherapy, with possible side effects of steroid medication. Immunosuppressive treatment – the second line of therapy, is instituted if children do not respond to steroids, are cortico-dependent or have ocular and/or systemic complications – Methotrexate, Azathioprine, Cyclophosphamide, Cyclosporine, Chlorambucil, antiTNF alfa which are administered to patients at high risk of decreased vision – Infliximab, Adalimumab. The objective remains the treatment of complications: phacoemulsification in cataract with/without IOL (per primam, per secundam), medical and surgical treatment of glaucoma. Intermediate uveitis in children (10-25%) is manifested by myodesopsia, with a white eye, the most common etiology being idiopathic intermediate uveitis. Posterior uveitis represents almost 30% of cases, with multiple etiology, infectious inflammatory diseases (bacterial, viral, parasitic) non-infectious diseases (sarcoidosis, Behcet, VKH). Panuveitis in children may be present in acute tubulointerstitial nephritis in adolescents. Pseudouveitis is uveitis in retinoblastoma, leukemia. Uveitis in children is a serious disease, in which the diagnosis must be established quickly, with an appropriate (even aggressive) treatment, because the complications and sequelae present in the prolonged evolution of uveitis are accompanied by decrease/loss of vision. Ocular and systemic monitoring and screening of the disease are necessary for a favourable prognosis of the disease.

Correlation between Morphological Characteristics of Macular Edema and Visual Acuity in Young Patients with Idiopathic Intermediate Uveitis.

Background and Objectives: Macular edema (ME) is a common complication of intermediate uveitis (IU). It is often responsible for a decrease in visual acuity (VA). Three distinct patterns of macular edema have been described in intermediate uveitis, namely, cystoid macular edema (CME), diffuse macular edema (DME), and serous retinal detachment (SRD). The current study aims to describe the characteristics of macular edema in young patients with idiopathic intermediate uveitis and to correlate its features with VA using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A total of 27 eyes from 18 patients with idiopathic IU complicated by ME were included in this retrospective study. All patients underwent SD-OCT; data were gathered at the onset of ME. Best-corrected VA (BCVA) was correlated with the morphological features of ME. Results: BCVA was negatively correlated with Ellipsoid Zone (EZ) disruption (p = 0.00021), cystoid pattern (p = 0.00021), central subfield thickness (CST) (p < 0.001), and serous retinal detachment (0.037). Conclusions: In ME secondary to idiopathic IU, VA negatively correlates with Ellipsoid Zone disruption and increases in CST. Moreover, vision is influenced by the presence of cysts in the inner nuclear and outer nuclear layers and by the neuroepithelium detachment.

Clinical features of inflammatory vitreous haemorrhage: A comparative study between children and adults

AbstractPurpose: To compare clinical findings and visual outcomes of vitreous haemorrhage (VH) associated with inflammatory ocular conditions between children and adults patients.Methods: Retrospective study including 46 patients (56 eyes) diagnosed with VH associated with inflammatory ocular conditions in Department of ophthalmology, Fattouma Bourguiba university hospital, Tunisia. Demographics, clinical findings, etiologies, treatment modalities, and visual outcomes were compared between adults and children. Mean follow‐up period was 18 months.Results: There were 10 children (12 eyes) and 36 adults (44 eyes) patients. Mean age was 9.5 years in the children group (six males and four females) and 35 years in the adult group (26 males and 10 females). Comparative study showed that VH in the paediatric group was associated with a significantly lower presenting visual acuity, more frequently vitritis and fern‐like capillaritis, whereas VH in the adult group were more associated with vascular sheathing and retinal haemorrhages. The main mechanism of bleeding was inflammatory optic disc neovessels (NV) in the children group (66.6%, p ≤ 0.001) and ischemic posterior segment NV in the adult group (81.8%, p ≤ 0.001). Idiopathic intermediate uveitis (40%) was the leading cause of VH in the children group. However, tuberculosis (41.7%), Behçet's (19.4%) disease and sarcoidosis (11.1%) were the most common etiologies in the adult group. The mean final visual acuity was significantly higher in the paediatric group (20/25) than the adult group (20/50) (p = 0.045).Conclusions: Inflammatory VH has a distinctive clinical and etiological profile between children and adults.

Predictive Factors for Magnetic Resonance Imaging Changes Suggestive of Demyelination in Adult Patients with Uveitis Scanned Prior to Commencing Adalimumab Therapy

ABSTRACT Purpose To report the predictive clinical factors for abnormal magnetic resonance imaging (MRI) scans suggestive of demyelination by analysis of MRI’s performed for adult non-infectious uveitic patients prior to commencing adalimumab therapy. Methods Retrospective case review of 240 patients was conducted in a single tertiary institution between November 2017 and March 2020. Aetiology of underlying disease, clinical characteristics, and MRI outcomes were analysed. Results The presence of bilateral idiopathic intermediate uveitis (IIU) (p = .0048) and neurological symptoms (p = .028) were highly predictive of an abnormal MRI strongly suggestive of demyelination (MRSSD); 5 out of 64 scans (7.8%) with these clinical characteristics had MRSSD. Conclusions Tumor necrosis factor antagonist-induced demyelination is a concern in adalimumab use. We propose an MRI screening protocol to identify those at high risk of demyelination; positive results can be maximised by screening all patients with IIU and those with neurological symptoms.

Long-Term Outcomes of Pediatric Idiopathic Intermediate Uveitis

To describe the course of childhood-onset intermediate uveitis without associated systemic disease, and investigate determinants of outcomes. A retrospective clinical cohort study METHODS: This study was conducted in an institutional setting. A total of 125 children (221 eyes) aged 16 years and less participated. Outcomes of interest were visual acuity, severity of inflammation, and the occurrence of sight-threatening complications. Variables examined included age and clinical findings at presentation, treatment, and duration of follow-up. Multivariable analysis was undertaken to investigate potential predictors of outcomes. The median follow-up duration was 57 months. At presentation, best-corrected visual acuity worse than 20/160 was recorded in 11 (4.4%) eyes and significant vitreous haze (≥2+Standardisation of Uveitis Nomenclature (SUN)) in 35 (14%) eyes. Corticosteroid-sparing agents were used in 41 children (33%), with methotrexate most commonly used (27 children, 21.6%). The most frequent complications were raised intraocular pressure (n=65; 29.4%), cataract (n=41; 18.5%), and cystoid macular edema (n=29; 13.1%). At the last visit, 116 (92.8%) patients achieved best-corrected vision of 20/40 or better with quiescent uveitis. The absence of the use of a steroid-sparing immunomodulatory agent was the strongest predictive factor for the development of new macular edema (odds ratio=6.3, 95% CI=2.3-16.9, P < .001) or glaucoma (odds ratio=6.6, 95% CI=2.5-17.9, P < .001) over the period of observation. The visual outcomes of childhood-onset idiopathic intermediate uveitis are favorable. The frequency of sight-threatening sequelae of inflammation, which confer a lifelong risk of further visual loss, is high. The use of immunomodulatory therapy is associated with a lower risk of developing macular edema and ocular hypertension.

Clinical Course and Treatment Paradigms for JIA-related Uveitis and Pars Planitis Uveitis Using Precise Ocular Investigational Methods.

The aim of this study was to report on the disease course and management modalities in patients with juvenile idiopathic arthritis-related uveitis (JIA uveitis) or intermediate uveitis of the pars planitis type (PP) who were followed up using precise ocular investigational techniques. This is a retrospective single-centre study. All charts of patients seen in our centre over 15 years (2005 - 2019) with a diagnosis of JIA uveitis or PP were retrieved and analysed for clinical course, severity of inflammation, type of management, and the role played by precise investigational techniques (laser flare photometry [LFP], optical coherence tomography [OCT] and fluorescein angiography [FA]) in therapeutic decisions. 26 out of a total of 64 patients with sufficient data could be included in the study. Mean age was 11.2 years (SD ± 5.4). 13/26 (50%) patients presented with JIA uveitis and 13/26 (50%) with PP. PP patients had a more benign course (mean LFP values at presentation 9.9 ± 3.2 ph/ms), and at the end of follow-up, only 2/13 PP patients (15%) still needed systemic treatment. In contrast, JIA uveitis as a whole was more severe, although benign forms were present (LFP values at presentation 105.9 ± 19.5 ph/ms), and at the end of follow-up, 5/13 patients (38%) still needed systemic treatment. Complications were also more severe and frequent in JIA uveitis patients. In 6/26 patients (24%, 3 JIA and 3 PP patients), the precise monitoring methods allowed unjustified systemic treatment to be discontinued, and to avoid such a treatment, it was recommended that it should be replaced by topical treatment or observation. Nowadays, new investigational techniques have made precise follow-up of uveitis possible. We determined the precise inflammatory pattern of JIA uveitis and PP, which is crucial information to determine the therapeutic intervention. As these two entities are common in young and paediatric patients, such precise monitoring is essential to determine adequate treatment paradigms and avoid unnecessary systemic treatment, especially corticosteroids. When the ophthalmic status requires it, multidisciplinary collaboration between the ophthalmologist, the paediatrician and the rheumatologist may be needed to offer optimal management to the patient. In cases of purely ocular involvement, it is the ophthalmologist who should determine the management.

The Pattern of Uveitis in Sri Lanka

ABSTRACTPurpose: To describe the pattern of uveitis at a tertiary uveitis referral clinic in Sri Lanka.Methods: Consecutive charts identified from a registry between January 2010 and December 2014 at the Mediclinic Hospital, Colombo were retrospectively reviewed.Results: Among 750 patients, anterior uveitis (AU) was the most common (285, 38%), followed by posterior uveitis (187, 25%), intermediate uveitis (150, 20%), and panuveitis (128, 17%). 485 (65%) were idiopathic. The top identified causes of AU were seronegative-spondyloarthropathy-related-AU (37, 13%), HLA-B27-related-AU without systemic associations (25, 9%), herpetic-AU (18, 6%), and trematode uveitis (8, 3%). The main posterior uveitis were toxoplasmosis (34, 18%), tuberculosis (21, 11%), and sarcoidosis (17, 9%). 78% of intermediate uveitis were idiopathic, with 12 (8%) tuberculosis, and 10 (7%) sarcoidosis. The most common panuveitis were sarcoidosis (18, 14%), tuberculosis (14, 11%), and Vogt–Koyanagi–Harada disease (10, 8%). Among children (≤12 years) accounting for 25 (3%) of cases, the most common presentations were idiopathic intermediate uveitis (7, 28%), idiopathic-AU (4, 16%), toxoplasmosis (4, 16%), trematode uveitis (3, 12%), and toxocariasis (2, 8%).Conclusions: An infectious etiology must be considered in posterior uveitis and uveitis among children in the Sri Lankan population.

Analysis of clinical features and visual outcomes of pars planitis.

To evaluate the demographic characteristics, clinical features, treatment and outcomes of patients with pars planitis in a tertiary referral center in Turkey. Medical records of patients with pars planitis were retrospectively reviewed. The data including demographic and ocular features and treatment outcomes were recorded. The distribution of clinical findings and complications were evaluated according to age and gender groups. The changes in final BCVA compared to the initial BCVA were noted. Statistical analysis was performed using SPSS software (Version 18.0, SPSS Inc., Chicago, USA). Twenty-seven patients (54 eyes) were included in this study. 16 patients were male (59.3%), and 11 were female (40.7%). Mean age at diagnosis was 12.84±8.26 (range 4-36)years. Mean follow-up period was 61.3±52.15 (range 9-172)months. Mean BCVA was 0.58±0.36 (range 0.03-1.00) (0.40±0.45 logMAR) at presentation, and 0.81±0.28 (range 0.10-1.00) (0.14±0.27 logMAR) at final visit (P=0.001). Vitreous inflammation (100%), vitreous haze (92.6%), snowballs (74.1%), snowbanks (66.7%), anterior chamber cells (66.7%) and peripheral retinal vascular sheathing (48.1%) were the most common presentations. Ocular complications included vitreous condensation (51.9%), cystoid macular edema (22.2%), cataract (18.5%), inferior peripheral retinal detachment (11.1%), glaucoma (5.6%) and vitreous hemorrhage (3.7%). Treatments included topical, periocular, intravitreal and systemic corticosteroids, immunosuppressives, peripheral laser photocoagulation and pars plana vitrectomy when needed. Pars planitis is an idiopathic chronic intermediate uveitis mostly affecting children and adolescents. In spite of its chronic nature with high potential of causing ocular complications, adequate treatment and close follow-up lead to favorable visual outcomes.

Descriptive Case Series on Optical Coherence Tomography Angiography Findings of Patients with Idiopathic Intermediate Uveitis in a Referral Ophthalmological Centre at Mexico City

Purpose: To identify signs of inflammatory activity in patients with idiopathic intermediate uveitis (IIU) using OCT angiography (OCTA). Methods: This is a descriptive case series at the Asociacion para Evitar la Ceguera en Mexico, comparing OCTA images in patients with the diagnosis of IUU with their clinical and fluorescein angiography (FA) findings. Results: Seventeen eyes of nine patients were recruited into the study, OCTA images were not useful to distinguish between patients with active or inactive inflammation. Eyes with cystic macular edema (CME) had foveal avascular zones smaller than other patients. Conclusion: At the time OCTA does not provide any useful information on patients with IIU. Our findings regarding CME correlate with those previously reported.

Phenotypic changes of peripheral blood mononuclear cells upon corticosteroid treatment in idiopathic intermediate uveitis

We analyzed phenotype and function of peripheral blood mononuclear cells in 9 patients with active idiopathic intermediate uveitis (IIU) before and after 6 and 12weeks of systemic corticosteroid (CS) treatment and compared to 28 healthy individuals. Monocytes from IIU patients showed increased MHCII expression compared with controls (p=0.09). Treatment reduced expression of MHCII, CD86, CD39 and CD124 (all p<0.05), whereas the percentage of CD121b-expressing monocytes was increased by week 6 (p=0.039). Patients showed alterations in T cell polarization (Th1/Th2 ratio: patients 5.2 versus controls 3.1, p=0.054; Th17/Treg ratio: 3.0 versus 1.7, p=0.027). S100A12 serum levels were higher in active IIU (p=0.057). Phagocytosis, oxidative burst and serum cytokine levels did not differ between patients and controls, and were not altered by treatment. In conclusion, monocytes from patients with active IIU show increased co-stimulatory capacities, which are modulated by systemic CS treatment, whereas innate immune cell functions are not altered.

Patterns of Uveitis in a Tertiary Care Referral Institute in Saudi Arabia

ABSTRACTPurpose: To present the pattern, causes and complications of uveitis in one of the tertiary eye centers in Saudi Arabia.Methods: In this retrospective study, clinical records of randomly selected cases of uveitis attending the King Khaled Eye Specialist Hospital, Saudi Arabia, from 2001 to 2010, were reviewed.Results: Our series included 888 out of 1286 cases of uveitis. Among them, there were 390 men (43.9%) with a mean age of 39.6 ± 11 (range: 6–94 years). The prevalence of uveitis among all eye patients was 1.5% and the annual incidence was 129 cases. Uveitis was bilateral in 567 patients (63.8%), mainly anterior in 27.3%, intermediate in 12.7%, posterior in 7.1%, while 52.9% were panuveitis. Infective etiology was seen in 180 patients (20.3%), of which presumed tuberculous uveitis (PTU) was the commonest cause in 94 patients (52%), followed by herpetic in 46 (26%) and toxoplasmosis in 29 (16%). Vogt–Koyanagi–Harada (VKH) 22%, Behçet uveitis (BU) 14.6%, idiopathic anterior uveitis 12.5%, presumed tuberculous uveitis (PTU) 10.6%, and idiopathic intermediate uveitis (10.1%) accounted for the majority of cases, whereas other diagnostic entities accounted for 30%. The most common cause of anterior uveitis was idiopathic uveitis (101; 41.7%), followed by herpetic (46; 19%). Toxoplasmosis was the most frequent cause of posterior uveitis (29; 46.3%). Intermediate uveitis was most commonly idiopathic (86; 76.1%). VKH disease was the most common cause of panuveitis (195; 41.5%), followed by Behçet disease (118; 25.1%). The common complications of uveitis were glaucoma (34.1%), posterior synechiae (22.3%) and cataract (15.1%).Conclusions: The most common anatomic diagnosis was panuveitis. VKH disease and Behçet disease were the most frequent causes and glaucoma was the most common complication of uveitis.

Results of intravitreal dexamethasone implant 0.7 mg (Ozurdex®) in non-infectious posterior uveitis.

To evaluate the safety and efficacy of dexamethasone implant in patients with non-infectious posterior uveitis with cystoid macular edema (CME). Retrospective analysis of patients reports with CME secondary to non-infectious uveitis treated with dexamethasone implant. Data included type of posterior uveitis, any systemic immunosuppressive therapy, Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT) and signs of intraocular inflammation at baseline and then at 2wk postoperatively and monthly thereafter. Follow-up is up to 10mo. Any per-operative and post-operative complications were recorded. Six eyes of 4 patients with CME due to non-infectious posterior uveitis treated with dexamethasone implant. Diagnosis included idiopathic panuveitis, birdshot chorioretinopathy and idiopathic intermediate uveitis. At baseline mean ETDRS BCVA was 63 letters and mean CMT 556 µm at 2wk postoperatively mean ETDRS BCVA improved to 70 letters and mean CMT decreased to 329 µm. All eyes showed clinical evidence of decreased inflammation. The duration of effect of the implant was 5 to 6mo and retreatment was required in 2 eyes. Two patients required antiglaucoma therapy for increased intraocular pressures. In patients with non-infectious posterior uveitis dexamethasone implant can be a short-term effective treatment option for controlling intraocular inflammation.

Possession of the HLA-DRB1*1501 allele and visual outcome in idiopathic intermediate uveitis.

Possession of the HLA-DRB1*1501 allele and visual outcome in idiopathic intermediate uveitis.

Association analysis of TGFBR3 gene with Behçet's disease and idiopathic intermediate uveitis in a Caucasian population

BackgroundTransforming growth factor β (TGFβ) is an important immunoregulatory cytokine in regulatory T cell (Treg) and Th17-mediated pathology, including uveitis due to Behçet's disease (BD). Of the three isoforms, TGFβ2...

Pars Planitis: Epidemiology, Clinical Characteristics, Management and Visual Prognosis.

Pars planitis is an idiopathic chronic intermediate uveitis which predominantly affects children and adolescents, and accounts for 5-26.7% of pediatric uveitis. Although an autoimmune process with a genetic predisposition has been suggested, its etiology still remains unknown. The most common presenting symptoms are floaters and blurred vision. Diffuse vitreous cells, haze, snowballs and snowbanks are typical findings of pars planitis. Peripheral retinal vasculitis, optic disc edema and anterior segment inflammation are other well-known findings. Although pars planitis is known to be a benign form of uveitis in most cases, it may become a potentially blinding disease due to complications including cataract, cystoid macular edema, vitreous opacities and optic disc edema. Cystoid macular edema is the most common cause of visual morbidity. Band keratopathy, epiretinal membrane formation, vitreous condensation, neovascularizations, vitreous hemorrhage, retinal detachment, cyclitic membranes, glaucoma and amblyopia may develop as a consequence of the chronic course of the disease. Exclusion of infectious and non-infectious causes which may present with intermediate uveitis is of utmost importance before starting treatment. Treatment of pars planitis has been a controversial issue. There is no consensus specifically for treatment of cases with minimal inflammation and relatively good visual acuity. However, current experience shows that pars planitis may cause severe inflammation and needs an aggressive treatment. A stepladder approach including corticosteroids, immunosupressive agents, anti-tumor necrosis factor-alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Adequate control of inflammation and prompt detection of associated complications are crucial in order to improve the overall prognosis of the disease.

Causes of Uveitis in a Tertiary Center in Chile: A Cross-sectional Retrospective Review

Purpose: To describe the pattern of uveitis in a tertiary center in Santiago, Chile.Methods: We reviewed all of the case records with a presumptive diagnosis of uveitis from patients referred to the Uveitis Department of Hospital del Salvador between 2002 and 2012. Initial assessment was standardized. We tested for association among causes, gender, and age groups.Results: Anterior uveitis was the leading anatomical location of the inflammation (40.4%). A specific etiology was demonstrated in 59% of cases (28.7% infectious). Vogt-Koyanagi-Harada syndrome (VKH) was the most frequent cause of uveitis (17.2%). We found association between idiopathic intermediate uveitis, toxocariasis, juvenile idiopathic arthritis, VKH, toxoplasmosis, diabetes mellitus (DM)-associated uveitis, tuberculosis, and idiopathic anterior uveitis and age groups. VKH, DM-associated uveitis, and syphilis-associated uveitis were associated with gender.Conclusions: Our sample shows a distribution of causes of uveitis similar to those in developed countries. The prevalence of VKH is higher than expected.

Topical dexamethasone–cyclodextrin microparticle eye drops for uveitic macular oedema

Cystoid macular oedema (CME) is the main cause of visual loss in patients with uveitis (Rothova 2007). The mainstay of treatment of uveitic CME is corticosteroids and to be effective, steroid needs to be given periocularly, intravitreally or systemically. Topical steroid generally is of little benefit for the treatment of posterior segment diseases. Dexamethasone eye drops containing γ-cyclodextrin-based nanoparticles, however, have recently been shown to be effectively delivered to the posterior part of the eye to treat diabetic CME (Loftsson & Stefánsson 2002; Loftsson et al. 2007; Tanito et al. 2011). Therefore, it seems tempting to examine the effect of this dexamethasone eye drop formulation for the treatment of uveitis with posterior manifestations. We have treated three patients with uveitic CME with 1.5% dexamethasone–cyclodextrin ophthalmic solution (Oculis ehf., Reykjavik, Iceland) after obtaining informed consent from each patient. A 54-year-old female with bilateral, chronic, idiopathic intermediate uveitis and CME. Left eye was previously vitrectomized. Visual acuity was reduced to 0.4 (in decimals) on both eyes. She had pronounced CME and slight vitritis (+1) in both eyes. The CME and vitritis resolved on treatment with systemic prednisone in high dose and visual acuity increased to 0.63 in both eyes. CME on the left eye, however, recurred 3 months after tapering prednisone (Fig. 1A), and visual acuity dropped down to 0.5. The patient was then treated with 1.5% dexamethasone–cyclodextrin ophthalmic solution four times daily for 1 month in the left eye. Visual acuity increased to 0.63 and the CME resolved (Fig. 1B). As dexamethasone–cyclodextrin eye drops are not available in Denmark, she then continued treatment with commercial dexamethasone eye drops, Maxidex ® (Dexamethasone 0.1%; Alcon Inc, Fort Worth, TX, USA) 4 times daily in the left eye. After 1 month, the CME in the left eye had recurred (Fig. 1C), and she was subsequently treated with periocular triamcinolone acetonide and systemic prednisone in a low dose. A 84-year-old woman with bilateral vitritis and CME. Vitritis resolved after initating systemical treatment with mycophenolate mofetil. CME was persistent in both eyes (foveal thickness 357/332 μm). Visual acuity was 0.5 in both eyes. Right eye was treated with dexamethasone–cyclodextrin eye drops two drops four times daily tapered to one drop three times daily after 3 weeks. Left eye was treated with an intravitreal dexamethasone implant (Ozurdex; Allergan, Inc., Irvine, CA, USA). After 6 weeks of treatment, visual acuity was 0.8 in the right eye and 0.63 in the left eye, and the CME had resolved in both eyes (foveal thickness 315/317 μm). A 47-year-old woman with chronic, bilateral, posterior uveitis and CME. She was treated with Ozurdex in both eyes, but the CME recurred after 3 months. The Ozurdex implantation was repeated on the left eye. The right eye was treated with dexamethasone–cyclodextrin eye drops one drop six times daily for 1 week and then four times daily for 1 week. After 2 weeks of treatment, the CME in the right eye was increased further, and the eye received a new Ozurdex implant. The present cases indicate that topical dexamethasone–cyclodextrin nanoparticle eye drops may be effective for the treatment of uveitic CME in some patients. In the first two cases, the CME was resolved after 1 month of treatment with this topical steroid formulation and recurred 1 month after treatment with conventional steroid eye drops. It therefore seems worth to explore the potential of dexamethasone–cyclodextrin nanoparticle eye drops for the treatment of uveitis with posterior manifestations as an alternative to periocular, intravitreal and systemic treatment with steroid. Periocular and intravitreal steroid carry a potential risk of ocular complications, and treatment with systemic steroid involves a considerable risk of serious systemic side-effects. Moreover, in children, the possibility of topical steroid treatment for uveitis with posterior manifestations would be of great benefit as treatment with periocular and intravitreal steroid in these patients requires a general anaesthetic prior to administration.

Characterisation of uveitis in association with multiple sclerosis

PurposeTo characterise uveitis in association with multiple sclerosis (MS).MethodsWe conducted a retrospective chart review of patients with uveitis and MS at two uveitis centres (Portland, Oregon, USA and Heidelberg, Germany)....