Intermediate Uveitis Research Articles

Frequency and Treatment Regimens of Macular Edema in 1946 Consecutive Patients with Noninfectious Uveitis at a Tertiary Ophthalmic Center in Shaanxi, China.

We investigated the frequency of uveitic macular edema (UME) in patients with different types of noninfectious uveitis and present the primary treatment methods for UME at a specialized eye center in Shaanxi Province, China. We conducted a retrospective, noninterventional, observational survey involving 1946 patients with noninfectious uveitis (2816 eyes). The collected data included sex, age of uveitis onset, age of UME onset, anatomical classification of uveitis, and the treatment administered to UME patients. Of the 1946 patients with noninfectious uveitis, 929 (47.74%) were male and 1017 (52.26%) were female. The average age of all participants in the study was 42.19 ± 15.34years, with average age at uveitis onset of 39.50 ± 15.52years. Among the patients, 1003 (51.54%), 239 (12.28%), 410 (21.07%), and 294 (15.11%) had anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis, respectively. UME was observed in 134 (6.89%) of the uveitis patients. The average age of UME patients was 47.33 ± 17.17years, with average age at uveitis onset of 45.78 ± 17.20years. Out of the 134 UME patients, 3 (0.30%), 15 (6.28%), 47 (11.46%), and 69 (23.47%) had anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis, respectively. Among them, 37 were lost to follow-up, 44 received adalimumab (ADA) combined with low-dose prednisone and with or without conventional immunosuppressants, 19 received interferon-α2a therapy, 14 received intravitreal corticosteroid injections (such as dexamethasone implant or fluocinolone acetonide), 11 received low-dose corticosteroids combined with conventional immunosuppressants, 5 received only oral prednisone, and 4 received repeated peribulbar or subconjunctival injections of triamcinolone acetonide. At our tertiary ophthalmic center in Shaanxi Province, China, only 6.89% of patients with noninfectious uveitis were diagnosed with UME. The primary treatment modality for UME in our center is ADA, in accordance with treatment guidelines and the Chinese medical insurance reimbursement system.

Comparison of vitreous/retinal pigment epithelium relative intensity in proliferative vitreoretinopathy and uveitis

Background: Quantitative measurements of vitreous inflammation using vitreous/retinal pigment epithelium-relative intensity (VIT/RPE-Relative Intensity) have been described recently. In proliferative vitreoretinopathy (PVR), inflammation plays a central role in the pathogenesis, inducing retinal fibrosis and contraction. However, no attempts have yet to be made to analyze the severity of inflammation in PVR progression. Methods: A cross-sectional study was conducted by reviewing OCT image sets obtained from patients divided into four groups: (1) proliferative vitreoretinopathy, (2) intermediate and posterior uveitis, (3) panuveitis, (4) normal healthy eyes in Cipto Mangunkusumo Kirana Eye Hospital between April 2021 – December 2021. OCT images were then analyzed in the ImageJ software for VIT/RPE-relative intensity. Results: A total of 19 PVR eyes, 12 intermediate-posterior uveitis eyes, 16 panuveitis eyes, and 28 normal healthy eyes were recruited for this study. The VIT/RPE-Relative Intensity was significantly higher in PVR eyes (0.415±0.178) than in intermediate-posterior uveitis (0.236±0.043, p=0.002) and panuveitis eyes (0.30±0.07, p=0.023). Compared to the normal eyes, PVR and both uveitis groups have significantly higher VIT/RPE relative intensity (p = <0.001 in each group). Conclusions: VIT/RPE-relative intensity may offer quantitative measurements of vitreous inflammation in the role of the pathogenesis of PVR. Comparison with cellular inflammation in the vitreous is required to validate this finding.

Clinical characteristics of intermediate uveitis in adults according to criteria of the SUN working group.

To analyse the clinical characteristics of adult patients with pars planitis (PP-IU), non-pars planitis (NPP-IU) and multiple sclerosis-associated intermediate uveitis (MS-IU) and distinguish between groups. Seventy-three adult patients with intermediate uveitis (IU) reviewed retrospectively and divided as PP-IU, NPP-IU and MS-IU according to 'The standardization of uveitis nomenclature working group classification criteria.' Demographic and clinical characteristics, OCT and fluorescein angiography (FA) findings, complications and treatments were recorded. A total of 134 eyes of 73 patients were included, and 42 of the patients were classified as PP-IU, 12 as NPP-IU, and 19 as MS-IU. If a patient presenting with blurred vision, or tent-shaped vitreous band/snowballs/snowbank on examination, or vascular leakage on FA and accompanying neurological symptoms, the frequency of demyelinating plaque detection on cranial MRI and the risk of MS-IU increased. Mean BCVA was increased from 0.22 ± 0.30 logMAR to 0.19 ± 0.31 logMAR (p = 0.021). Gender, initial BCVA, snowbank formation, disc oedema and periphlebitis on examination, and disc leakage/occlusion on FA were found predictive of decreased BCVA at final visit (p < 0.05). The clinical features of these three groups are similar, some features that can guide the differential diagnosis. It may be recommended to periodically evaluate "suspicious" patients with MRI for MS.

Courses of uveal manifestations following surgical treatment of patients with ulcerative colitis in adults: Observation study

Purpose This study aimed to investigate the course of uveal manifestations in a cohort of patients who underwent surgery for ulcerative colitis (UC), highlighting the diverse spectrum of associated eye disorders and alerting clinicians of their significance. Patients and methods A retrospective observational study was conducted on 40 UC patients with ocular manifestations who underwent one-stage laparoscopic restorative proctocolectomy according to the European Crohn’s and Colitis Organization (ECCO) guidelines. Ophthalmic examinations were performed preoperatively and postoperatively during the 6-month follow-up period. Anterior uveitis attacks were graded based on the presence of cells or flares, vitreous haze indicates intermediate uveitis while posterior uveitis was indicated by retinitis or choroiditis, or both. Recurrence was a Standardization of Uveitis Nomenclature (SUN) grading system score greater than or equal to 2+ for anterior chamber cells or vitreous haze. Results Postoperatively, uveitis regression was observed in ∼60% of the patients, 25% showed a stationary course, and 15% exhibited progression. After surgery, more patients had lower Standardization of Uveitis Nomenclature grades for anterior chamber cells, flares, and vitreous haze than at baseline. Conclusion Ulcerative colitis can manifest with various ophthalmic manifestations ranging from nonspecific to severe, affecting visual prognosis or remaining asymptomatic. In our study most patients who underwent colonic surgery got benefits in the form of not only decreasing the severity of disease activity but also a decrease in the recurrence rate postsurgical.

Uveitis and immunosuppressive treatment: Experience in a multidisciplinary uveitis unit

IntroductionDue to its association with systemic diseases and treatment, uveitis requires a multidisciplinary approach; however, there are few studies in uveitis units in Latin America. ObjectiveTo describe the clinical and therapeutic features of patients treated in the Uveitis Unit of the Hospital de Clínicas Dr. Manuel Quintela in Montevideo, Uruguay. Materiales y métodosObservational, descriptive, cross-sectional study in patients aged ≥15 years, attended from October 2018 to January 2020 with an uveitis diagnosis. ResultsOne hundred and three patients were included, with a median age of 47 years, and 71 (68.9%; p < 0.01) were women. The anatomical classification was anterior uveitis 46.6%, intermediate 1%, posterior 7.8%, and panuveitis 44.7%. The etiology was identified in 58 (56.3%) patients, 32 (31.1%) were idiopathic and 13 (12.6%) were still under aetiological study. Systemic autoimmune diseases occurred in 26.2%, with Vogt-Koyanagi-Harada disease being the most frequent (5.8%). Spondyloarthritis accounted for 5.8% of the cases. Infectious etiology was observed in 19.4%, with ocular toxoplasmosis predominant in 10.7%. Seventy-one percent of non-infectious uveitis required systemic immunosuppressive treatment, with methotrexate being the most used in anterior (46.4%) and intermediate (100%) uveitis and azathioprine in posterior (100%) and panuveitis (42.9%). Eight patients (13.6%) required the combination of ≥2 drugs; of them, 37.5% had anterior uveitis associated with juvenile idiopathic arthritis, and 37.5% had idiopathic panuveitis. ConclusionsThe etiology was established in more than half the patients with uveitis. The most frequent were ocular toxoplasmosis, VKH disease, and associated SpA disease. A high percentage of non-infectious uveitis required systemic immunosuppressive treatment, with methotrexate and azathioprine being the most used.

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.

Brolucizumab Intravitreal Injections for Wet Age-Related Macular Degeneration: Real-Life Study on a Cohort of Italian Patients.

Background and Objectives: To report the real-life Brolucizumab therapeutical outcomes of treatment-naïve and non-treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) and to analyze the incidence of therapy-related adverse events. Materials and Methods: A total of 56 eyes of 54 patients diagnosed with nAMD were retrospectively evaluated over a 3-month follow-up. Naïve eyes received a 3-month loading phase, whereas non-naïve eyes were treated with one intravitreal injection + ProReNata scheme. The main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT) change. In addition, patients were stratified on the basis of fluid accumulation site, whether intra-retinal (IRF), sub-retinal (SRF), or sub-retinal pigmented epithelium (SRPE), to separately assess the eventual BCVA change in each subgroup. Finally, the incidence of ocular adverse events was evaluated. Results: In naïve eyes, a significant improvement of BCVA (LogMar) was observed at all timepoints from baseline (1 month-Mean Difference (MD): -0.13; 2 months MD: -0.17; 3 months MD: -0.24). In non-naïve eyes, a significant mean change was observed at all timepoints, with the exception of 1-month follow-up (2 months MD: -0.08; 3 months MD: -0.05). CRT significantly changed in both groups at all timepoints at a similar pace within the first two months, with naïve eyes displaying a larger overall thickness decrease at the end of the follow-up (Group 1 = MD: -123.91 µm; Group 2 = MD: -110.33 µm). With respect to the location of the edema, a significant BCVA change was observed in naïve patients with fluid in all three sites at the end of the follow-up (SRPE = MD: -0.13 (p = 0.043); SR = MD: -0.15 (p = 0.019); IR = MD: -0.19 (p = 0.041). Non-naïve patients exhibited significant mean BCVA changes only with respect to SR and IR fluid presence (SRPE = MD: -0.13 (p = 0.152); SR = MD: -0.15 (p = 0.007); IR = MD: -0.06 (p = 0.011). One naïve patient experienced acute-onset anterior and intermediate uveitis which completely resolved after therapy. Conclusions: Brolucizumab was demonstrated to be a safe and efficient alternative in improving both the anatomical and functional parameters of eyes with nAMD in this small, uncontrolled, series of patients.

Noninfectious Uveitis in Rheumatology: Patterns, Treatment, and Outcomes.

The present study aimed to determine the pattern and cause of noninfectious uveitisin rheumatology practice. The secondary objective was to identify the pattern of treatment and outcomes. This retrospective cross-sectional study was conducted in the Department of Rheumatology, National Hospital and Medical Centre, Lahore, Pakistan. After receiving consent, electronic medical records (EMRs) of all patients with a diagnosis of noninfectious uveitis (NIU) from November 2019 to January 2023 were reviewed,and a total of 52 patients labeled as having noninfectious uveitis were identified. The collected data included age at diagnosis, anatomical location of uveitis, associated systemic disease, used medications, and outcomes.All cases had been diagnosed and assessed mutually by a rheumatologist and an ophthalmologist using the International Uveitis Study Group classification system to classify the pattern of uveitis by location, clinical course, and laterality and rule out the possibility of other ophthalmologic diseases. Disease activity was defined using the Standardization of Uveitis Nomenclature (SUN) guidelines. Data was analyzed on SPSS Statistics version 23 (IBM Corp, Armonk, NY, USA). The mean age of the patients in this study was 36.02 ± 43.31 years, with31 (59.6%) male patients. Anterior uveitis was the most common type observed among the patients at 55.8%,panuveitis was found in 25%, intermediate uveitis and posterior uveitis were seen in 9.6% each. Based on laterality, unilateral eye involvement was identified in 53.8% of patients. Spondyloarthritis (SpA)and idiopathic uveitis were observedin 34.6% and 28.8%, respectively. In this study, 28 (54.9%) patients were on conventional disease-modifying antirheumatic drugs (cDMARDDs), and 23 (45.1%) were on biological DMARDs. In the biologics group, 82% of patients were in remission in comparison to 60% in the cDMARDs group. To the best of our knowledge, this is the first report onnoninfectious uveitis in the Pakistani population. The study concluded that anterior uveitis is the most common type of uveitis and is more common in males. Spondyloarthropathy is one of the most common underlying systemic diseases. Human leukocyte antigen (HLA)-B27is associated more with uveitis. Biologics are more effective than cDMARDs in controlling the disease.Collaborative work between different specialties resulted in early diagnosis of underlying systemic disease, better management plans, and disease outcomes. To obtain further details on noninfectiousuveitis, a population-based study is needed in Pakistan.

Ocular Inflammatory Events Following COVID-19 Vaccination in the Paediatric Population: A Multinational Case Series

ABSTRACT Background Ocular inflammatory events following COVID-19 vaccination have been reported in the adult population. Methods Multinational case series of patients under the age of 18 diagnosed with ocular inflammatory events within 28 days of COVID-19 vaccination. Results Twenty individuals were included. The most common event was anterior uveitis (n = 8, 40.0%), followed by intermediate uveitis (7 patients, 35%), panuveitis (4 patients, 20%), and posterior uveitis (1 patient, 5%). The event was noticed in the first week after vaccination in 11 patients (55.0%). Twelve patients (60.0%) had a previous history of intraocular inflammatory event. Patients were managed with topical corticosteroids (n = 19, 95.0%), oral corticosteroids (n = 10, 50.0%), or increased dose of immunosuppressive treatment (n = 6, 30.0%). Thirteen patients (65.0%) had a complete resolution of the ocular event without complications. All patients had a final visual acuity unaffected or less than three lines of loss. Conclusion Ocular inflammatory events may happen in the paediatric population following COVID-19 vaccination. Most events were successfully treated, and all showed a good visual outcome.

The pattern of sarcoid uveitis at a tertiary care center in Nepal.

A retrospective quantitative cross-sectional study was conducted at the uveitis clinic of the Institute of Medicine by obtaining medical data from the medical record section on sarcoid uveitis cases visiting from March 2018 to March 2021. Demographic profile, ocular findings, laboratory findings and treatment details were documented and statistical analysis was done via Statistical Program for Social Science (SPSS) version 23. Out of 50 eyes of 30 patients included in the study; 66.6% patients (n=20) had bilateral and 33.3% (n=10) had unilateral ocular involvement. Anterior with intermediate uveitis (26.7%) was the most common type of uveitis among the cases. Serum angiotensin converting enzyme was raised in 66.7%, Chest X-ray showed hilar changes in 63.33%, and high-resolution computed tomography showed mediastinal, hilar lymphadenopathy with or without the involvement of the lung in 63.33% of patients. Sarcoid uveitis may have varied ocular presentations, the commonest being anterior and intermediate uveitis. The commonest complications are cataract and cystoid macular oedema, which are associated with vision loss. Steroids and immunomodulators are the mainstays of treatment.

Uveitis in children assessed in the paediatric rheumatology clinic, a multicentre study

IntroductionUveitis is inflammation of the middle layer of the uveal tract. The paediatric population is at risk of chronic evolution and permanent visual loss. ObjectivesTo characterize children diagnosed with uveitis in 5 institutions in Bogotá city, evaluated by the paediatric rheumatology and ophthalmology service. Materials and methodsA retrospective cohort study in children with a previous uveitis diagnosis between January 2015 and January 2018 in 5 Institutions of Bogotá. A univariate and bivariate analysis of the demographic, clinical characteristics, complications, treatment, and evolution of the disease was performed. Results91 patient histories were analysed. Of the patients, 51.65% were male. The average age was 8.44 years (SD 3.66 years). Bilateral presentation (63.74%), intermediate location (35.16%), and uveitis (25.27%) were more frequent. Idiopathic and infectious aetiology predominated in intermediate uveitis. Bilateral presentation was greater in intermediate uveitis and unilateral in anterior uveitis. Unilateral involvement was more frequent in idiopathic aetiology (42.1%) and bilateral in autoimmune aetiology (60%) (p=0.005). Uveitis associated with juvenile idiopathic arthritis, corresponded to 45.2% of those secondary to autoimmunity. Infectious aetiology was more frequent in boys, while autoimmune aetiology was more frequent in girls. The most frequent infectious cause was tuberculosis in 44%. Of the children, 25.7% arrived with some complications on admission: 69.5% synechiae, 30.5% retinal detachment, and 26% glaucoma. ConclusionsPaediatric uveitis is an important disease in children, in our study the most frequent cause was idiopathic followed by an autoimmune disorder and infection. Almost half the patients had associated complications with a major impact on the children’s lives.

Surgical management for treatment-resistant cases of inflammatory exudative retinal detachment: Mission impossible?

To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD). A retrospective analysis of eyes with ERD that underwent vitrectomy. Twelve eyes (10 patients) with ERD, non-responsive to medical therapy, underwent vitrectomy. The mean age was 35.7 ± 17.7 years. Five eyes (42%) had Vogt-Koyanagi-Harada disease, three (25%) had presumed tuberculosis (TB), two (17%) pars planitis, and one (8%) had sympathetic ophthalmia. The mean time of vitrectomy was 6.76 ± 4.1 months after onset. Six (50%) eyes had a recurrence, two settled with medical treatment, and four underwent re-surgery. The mean follow-up was 2.7 years. At the last visit, 10 (83.3%) eyes had attached retina; the best-corrected visual acuity (BCVA) had reduced to 1.6 ± 0.7 logarithms of the minimum angle of resolution (logMAR) from 1.3 ± 0.7 at baseline. Vitrectomy in ERD can act as an adjuvant to conventional medical therapy and help maintain structural integrity. Early vitrectomy may help preserve visual function.

Clinical and Ophthalmological Findings in Patients with Behçet’s Uveitis at First Presentation

Aim: The present study attempted to demonstrate the clinical, demographic, and ophthalmological findings of patients with Behçet’s disease (BD) at first admission and relevant treatment modalities. Methods: We considered 161 eyes of 103 patients applying to the Uvea Unit of Ulucanlar Eye Training and Research Hospital between 2000-2012 and already suffering from BD or diagnosed with BD at their follow-ups. Then, we retrospectively investigated their clinical, demographic, and ophthalmological findings at first admission and the treatment modalities with the help of their medical records. Results: There were 70 (68%) male and 33 (32%) female patients, and 17 patients (16.5%) initially presented with ocular symptoms. While the patients’ mean diagnosis age was 26.79±9.24 years (4-61 years), it was 29.52±9.49 years (6-62 years) at the first eye attack. Eye involvement was bilateral in 58 patients (56.3%) and unilateral in 45 (43.7%). About half of the eyes (55.9%) were presented as panuveitis, 22.4% as posterior uveitis, 15.5% as anterior uveitis, and 6.2% as intermediate uveitis. While there were anterior chamber reaction + vitritis + retinitis and/or vasculitis (panuveitis) in 90 (55.9%) eyes, the others were characterized by isolated retinitis (12.4%) and isolated iridocyclitis (8.7%). Only two eyes (0.1%) had hypopyon at admission. We discovered at least one complication in 111 eyes (68.9%) at first admission. In particular, the most prevalent complication was found to be isolated macular edema in 45 eyes (28%) and isolated cataracts in 17 eyes (10.6%). On the other hand, topical steroid + systemic steroid + immunosuppressive (23.6%), topical + systemic steroid (16.8%), and systemic steroid + immunosuppressive (11.8%) became the most prevalently adopted medical treatments (with additions/alterations) at first admission, respectively. Conclusion: In a nutshell, BD is considered a multisystemic condition with frequent ocular manifestations. BD-associated uveitis often presents as panuveitis. Thus, early and efficient treatment of ocular complications seems to be critical for better visual prognosis.

Uveítis: estudio de 109 casos

PurposeAnalyse and describe the anatomical and etiological classification, clinical and epidemiological characteristics and most frequent symptoms of uveitis cases in our population. Patients and methodDescriptive, retrospective observational study of uveitis cases treated in the Ophthalmology Department of Virgen del Rocío University Hospital in 2021. The demographic and clinical characteristics were studied. ResultsA total of 109cases of uveitis were studied, 46 men and 63 women, with a mean age of 45.43±16.11 years. The most frequent symptoms were pain (74.31%), hyperemia (73.39%) and blurred vision (65.14%). The most frequent anatomical classification was anterior (55.96%), followed by panuveitis (18.35%), posterior (12.84%) and intermediate uveitis (7.34%). Regarding etiology, most uveitis were idiopathic (42.99%), followed by non-infectious (38.32%) and finally infectious (18.69%). ConclusionsIn southern España, the characteristics of uveitis are similar to other studies in Western countries.

The Role of the Retinal Nerve Fiber Layer Thickness on OCT in the Evaluation of Papillitis in Childhood Uveitis

To investigate the diagnostic value of using retinal nerve fiber layer thickness measured on optical coherence tomography (OCT-RNFL) to diagnose papillitis in pediatric uveitis. Retrospective cohort study. Demographic and clinical data were collected retrospectively for 257 children with uveitis (with 455 affected eyes). Receiver operating characteristic (ROC) analysis was performed to compare fluorescein angiography (FA, the diagnostic gold standard for papillitis) to OCT-RNFL in a subgroup of 93 patients. An ideal cut-off value for OCT-RNFL was then determined by calculating the highest Youden index. Finally, a multivariate analysis was applied to the clinical ophthalmological data. Based on a subset of 93 patients who underwent both OCT-RNFL and FA, the ideal cut-off OCT-RNFL for diagnosing papillitis was >130 µm, with 79% sensitivity and 85% specificity. Among the entire cohort, the prevalence of OCT-RNFL >130 µm was 19% (27/141), 72% (26/36), and 45% (36/80) in patients with anterior uveitis, intermediate uveitis, and panuveitis, respectively. Our multivariate analysis of the clinical data revealed that OCT-RNFL >130 µm was associated with a higher prevalence of cystoid macular edema, active uveitis, and optic disc swelling on fundoscopy, with odds ratios of 5.3, 4.3, and 13.7, respectively (all P < .001). OCT-RNFL can be a useful noninvasive additional imaging tool for diagnosing papillitis in pediatric uveitis with relatively high sensitivity and specificity. OCT-RNFL was >130 µm in approximately one-third of all children with uveitis and was particularly prevalent in cases of intermediate uveitis and panuveitis.

Presence of Choroidal Caverns in Patients with Posterior and Panuveitis.

Choroidal caverns (CCs) have been described in association with age-related macular degeneration and pachychoroid disease. However, it is unknown if caverns are found in patients with chronic non-infectious uveitis (NIU). Herein, we evaluated patients with NIU who had optical coherence tomography and indocyanine green angiography for CCs. Clinical and demographic characteristics were extracted from the chart review. Univariate and multivariate mixed-effects logistical models were used to assess the association between clinical and demographic factors and the presence of CCs. One hundred thirty-five patients (251 eyes) met the inclusion criteria: 1 eye had anterior uveitis, 5 had intermediate uveitis, 194 had posterior uveitis, and 51 had panuveitis. The prevalence of CCs was 10%. CCs were only observed in patients with posterior and panuveitis, with a prevalence of 10.8% and 7.8%, respectively. Multifocal choroiditis (MFC) was the type of uveitis where CCs were most frequently observed, with 40% of eyes with MFC having CCs. In addition, male sex (p = 0.024) was associated with CCs. There was no significant difference in the degree of intraocular inflammation or mean subfoveal choroidal thickness between CC+ and CC- eyes. This is the first study to describe CCs in uveitis. Overall, these findings suggest that caverns may be a sequela of structural and/or vascular perturbations in the choroid from uveitis.

Ocular Tuberculosis in Pediatrics: A Case Report

A 17-year-old male was taken to the emergency department for decreased left visual acuity and floaters beginning that same day. There was a history of exposure to pulmonary tuberculosis five years before (mother as index case) followed by a four-month period of isoniazid prophylaxis. The ophthalmic examination showed posterior and intermediate uveitis in the left eye. Laboratory tests were normal; IgG for herpes simplex 1 was positive and both the varicella-zoster virus and remaining serologic tests were negative. Chest radiography was normal. Two weeks later, an epiretinal membrane with risk of tractional retinal detachment was observed. The Mantoux tuberculin skin test showed an induration of 15 mm and the IGRA test was positive. Sputum and vitreous humor samples were collected. Quadruple therapy and prednisolone were started. Ten days later, a posterior vitreous detachment with underlying vitreous hematoma was observed. Posterior vitrectomy and peripheral endolaser were performed without complications. One month later, the microbiological results became available, with the identification of Mycobacterium tuberculosis. Corticosteroids were weaned progressively. Antituberculous drugs were maintained for six months. The patient made a full recovery.

Bilateral exudative retinal detachment, unusual pattern of uveitis with multiple sclerosis

MS (Multiple sclerosis) associated uveitis used to have limited phenotypes. Bilateral exudative retinal detachment has never been recognized as a pattern of MS-associated uveitis. We are reporting a patient with multiple sclerosis who presented initially with the usual pattern of intermediate uveitis and later developed bilateral exudative retinal detachment.

Effect of Intravitreal Dexamethasone Implant Injection in a Patient with Recurrent Nodular Anterior Scleritis

Purpose: To report the use of intravitreal dexamethasone implant injection in a patient with recurrent nodular anterior scleritis.Case summary: A 16-year-old patient presented with persistent eye pain and conjunctival injection in the left eye, which were diagnosed as nodular anterior scleritis. The clinical features improved with topical and systemic steroid treatment, but the patient developed side effects related to steroid use, including elevated intraocular pressure and skin rash. The steroid dose was reduced which led to frequent recurrence. Immunosuppressive agents were added to the treatment regimen, but there was no improvement; the patient developed intermediate uveitis and vitreous hemorrhage. Scleritis and intermediate uveitis continued despite vitrectomy; therefore, intravitreal dexamethasone implant injection was performed. There was no scleritis recurrence within 1 year after injection, which allowed tapering of steroids and immunosuppressive drugs.Conclusions: Intravitreal dexamethasone implant injection may be effective for recurrent nodular anterior scleritis in patients who exhibit complications, such as intermediate 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.