Posterior Segment Inflammation Research Articles

Expeditious resolution of disc and iris neovascularization

Intraocular neovascularization is seen commonly as a response to retinal ischemia or less commonly due to inflammation. Inflammatory iris neovascularization responds well to topical steroids, whereas retinal neovascularization associated with uveitic conditions responds to systemic steroids or periocular depot injections. This case highlights an unusually rapid resolution of disc neovascularization along with iris neovascularization just with topical steroids in a middle-aged lady diagnosed with bilateral panuveitis and retinal vasculitis. We presume it may be due to a spontaneous decrease in posterior segment inflammation or due to systemic vascular remodeling.

Immune recovery uveitis in Whipple’s disease: an unusual ocular presentation

PurposeTo describe an unusual case of Whipple’s disease (WD) complicated by uveitis, and subsequent paradoxical worsening after effective antibiotic treatment targeting Tropheryma whipplei (TW).MethodsCase report.ResultsA 53-year-old male presented with bilateral knee arthritis, weight loss, chronic low-grade fever, and cognitive disorders. He was under treatment with tumor necrosis factor α inhibitors (TNFi) for seronegative spondyloarthritis. Given this unusual clinical presentation, further investigations were performed and revealed blood, saliva, stool, synovial fluid and cerebrospinal fluid positivity for TW, confirming the diagnosis of systemic WD. Ophthalmologic examination revealed bilateral posterior uveitis and an aqueous humor sample confirmed the presence of intraocular TW. TNFi were stopped, and the patient was subsequently treated with adequate antibiotics (ceftriaxone, followed by doxycycline and hydroxychloroquine), and subconjunctival corticosteroid injections. After a transient improvement of the ocular symptoms, he presented a recurrence of posterior segment inflammation, leading to repeated PCR testing for TW which were negative. Therefore, paradoxical worsening of the inflammation in the context of immune recovery uveitis (IRU) was thought to be the culprit. The patient was treated with systemic corticosteroid therapy, allowing for rapid improvement of the ocular findings.ConclusionsThis case underlines the possibility of IRU complicating WD. Ophthalmologists, rheumatologists, and internists should be aware of this rare complication, particularly in the context of previous immunosuppressive therapy.

Ocular Toxocariasis in Adult Caucasian Patients: Clinical Presentations and Treatment Outcomes

ABSTRACT Purpose To report the clinical features and treatment outcomes in adult Caucasians with ocular toxocariasis (OT) and investigate their prognosis depending on their serological status. Methods Retrospective observational cohort study (2016–2021) including consecutive adults with uveitis and positive western blot (WB) in the aqueous humor or vitreous. The presence of serum antibodies was not necessary for inclusion, allowing to compare the outcomes depending on the serological status. Results Seventeen eyes of 15 patients were included. Mean age at diagnosis was 51.9 years. Vitreous inflammation was the most frequent sign (100%). Vitreoretinal tractions (41.2%) and chorioretinal granulomas (58.8%) were less prevalent. Atypical features were: spontaneous intravitreal hemorrhage (23.5%), exudative retinal detachment (11.8%), isolated macular edema (17.6%), papillitis (29.4%) and vasculitis (47.1%). Twenty percent of patients had a positive serum serology. Baseline clinical features did not differ statistically depending on the serological status; however, the degree of inflammation was numerically higher in patients with negative serology. Overall, macular thickness, anterior and posterior segment inflammation improved significantly after treatment with oral albendazole, systemic ± local corticosteroids. Vitrectomy (47.1%) was performed in case of persistent vitritis (62.5%), retinal detachment (12.5%) and intravitreous hemorrhage (25%). Conclusion OT has no pathognomonic sign and atypical presentations were not infrequent in this adult Caucasian cohort. Serum antibodies were rarely positive, stressing on the importance of ocular sample analysis, especially in case of atypical features. Serum antibodies may prove useful in forecasting the rapidity of inflammation clearance. Antiparasitic and anti-inflammatory treatment was safe and efficient in most cases.

Nanostructured Lipid Carriers for Enhanced Transscleral Delivery of Dexamethasone Acetate: Development, Ex Vivo Characterization and Multiphoton Microscopy Studies

Corticosteroids, although highly effective for the treatment of both anterior and posterior ocular segment inflammation, still nowadays struggle for effective drug delivery due to their poor solubilization capabilities in water. This research work aims to develop nanostructured lipid carriers (NLC) intended for periocular administration of dexamethasone acetate to the posterior segment of the eye. Pre-formulation studies were initially performed to find solid and liquid lipid mixtures for dexamethasone acetate solubilization. Pseudoternary diagrams at 65 °C were constructed to select the best surfactant based on the macroscopic transparency and microscopic isotropy of the systems. The resulting NLC, obtained following an organic solvent-free methodology, was composed of triacetin, Imwitor® 491 (glycerol monostearate >90%) and tyloxapol with Z-average = 106.9 ± 1.2 nm, PDI = 0.104 ± 0.019 and zeta potential = -6.51 ± 0.575 mV. Ex vivo porcine sclera and choroid permeation studies revealed a considerable metabolism in the sclera of dexamethasone acetate into free dexamethasone, which demonstrated higher permeation capabilities across both tissues. In addition, the NLC behavior once applied onto the sclera was further studied by means of multiphoton microscopy by loading the NLC with the fluorescent probe Nile red.

Correlation between Widefield Fundus Fluorescein Angiography Leakage Score and Anterior Chamber Flare in Behçet Uveitis

ABSTRACT Aims To investigate the correlation between widefield fundus fluorescein angiography (WF-FA) and anterior chamber laser flare photometry (LFP-flare) in Behçet uveitis (BU). Methods Patients with BU who underwent Heidelberg WF-FA between March 2016 and March 2018 were included. Demographics, ocular findings, LFP-flare, central macular thickness were retrospectively analyzed. Results Eighty-six patients (162 eyes) were included. There was a high correlation between WF-FA leakage score and LFP-flare (rho: 0.691, p < .001). For a flare value of 5.75 ph/ms or higher, the sensitivity for predicting angiographic leakage was 70% and the specificity was 94% (AUC: 0.897, p < .001). Flare values that were equal or above 7.6 ph/ms were found to be 100% specific for leakage in the WF-FA. Conclusion A strong correlation was found between WF-FA leakage and LFP-flare in patients with BU. High LFP-flare levels indicate subclinical posterior segment inflammation in clinically inactive BU.

Bilateral uveitis following nivolumab and ipilimumab treatment for mesothelioma

AbstractPurpose: Case report of a patient presenting with sudden onset of painful decreased vision in both eyes, diagnosed with Intermediate uveitis and keratitis. We will review the diagnostic pathway and the management of this case, as well as the correlation with the systemic treatment of that time.Results: A 63‐year‐old male presented in the Emergency department with bilateral red painful eyes and blurred vision. The patient had a past ophthalmic history of keratouveitis in RE and medical history of mesothelioma for which he had recently started treatment with Nivolumab and Ipilimumab. The visual acuity on presentation was 6/9 in the RE and 6/6 in the LE. Upon examination BE were hyperaemic, there was a past corneal scar in the RE and bilateral KPs. RE had +1 AC inflammation and LE traces of AC inflammation. No signs of posterior segment inflammation were seen in both eyes. The patient was treated initially with oral Aciclovir 400 mg BD and Pred Forte 1% in BE QDS. One week after initiation of treatment symptoms improved and a tapering regime of the local steroid treatment was given. Four weeks later the visual acuity in the RE was 6/12 and 6/9 in the LE. Upon examination there was +1 AC activity in BE and +1 vitreous activity. OCT demonstrated bilateral macular oedema. An FFA revealed bilateral optic disc hyperfluorescence. Upon further discussion of the patient's medical history it was revealed that both episodes of intraocular activity coincided with his infusions of Nivolumab and Ipilimumab. The patient was advised to discontinue the oral Aciclovir treatment and was initiated on intensive regime of local steroids which was tapered on improvement of the vision and the inflammation. Our ocular findings were communicated the patient's oncology team that decided to discontinue the above treatment.Conclusions: Nivolumab is an anti‐programmed cell death protein‐monoclonal. It is used for cancer treatment but case reports have emerged of uveitis and ocular surface disease. Ipilimumab is a humanized CLTA‐4 antibody and it can be associated with immune related adverse events such as uveitis. Our patient was switched to a different treatment protocol without further ocular inflammation and excellent visual outcome. Clinicians should raise their index of suspicion in side effects around the timing of treatment.

Objective Quantification of Posterior Segment Inflammation: Measuring Vitreous Cells and Haze Using Optical Coherence Tomography

To objectively grade posterior segment inflammation by measuring vitreous cells and haze on optical coherence tomography (OCT) scans and to compare OCT-based results with clinical grading. Evaluation of a diagnostic test. OCT scans of patients with uveitis were collected at 3 timepoints: with active (T0), clinically improving (T1), and resolved (T2) inflammation. At each visit, visual acuity and clinical grading of the vitreous haze (National Eye Institute [NEI] scale) were assessed. The density of vitreous cells was calculated on each OCT scan manually and automatically through a bespoke algorithm. Vitreous haze was indirectly measured on OCT scans by calculating the vitreous/retinal pigmented epithelium (VIT/RPE)-relative intensity manually and automatically. The variation of OCT-derived measurements over time was assessed. OCT-derived measurements were compared with clinical grading. A total of 222 scans from 74 eyes were analyzed. Both vitreous cell density and VIT/RPE-relative intensity significantly decreased over time. Cell density correlated with the clinical grading with a significant increase at each grade of the NEI scale. By contrast, the VIT/RPE-relative intensity was positively correlated with the clinical grade overall but there was no significant difference when comparing contiguous grades of the NEI scale. Infectious uveitis had a higher cell density. The intraclass correlation coefficient between manual and automatic assessment was 0.83 for cell density and 0.423 for the VIT/RPE-relative intensity. Posterior segment inflammation could be objectively graded through OCT scans. Vitreous cell density was assessed manually and automatically with good agreement and correlated better with NEI clinical grading compared with VIT/RPE-relative intensity.

Eyeing up the pandemic: A literature review of the ocular manifestations of COVID-19

Background Since the onset of SARS-CoV-2, this novel virus has been the focus of many studies seeking to improve the ability of healthcare systems to withstand pandemics against it. COVID-19 haspulmonary and cardiovascular implications, but its ocular effects remain a subject of debate. Objectives The objective of our narrative review is to explore the ophthalmic manifestations of COVID-19, identify research gaps, and act as a guide for further research in the field. Methods The literature search involved original studies published from January 1, 2020, up until August 20, 2021, on the PubMed database. Title and abstract screening and full text review were conducted by two independent researchers, with a third researcher resolving conflicts. Studies that met the set inclusion criteria were used for data synthesis.Results The preliminary search generated 59 articles, with 25 being data extracted. Conjunctivitis, epiphora and ocular irritation were consistently stated anterior segment manifestations. Posterior segment implications were mostly subclinical, including cotton-wool spots and retinal nerve-fiber layer thinning, but some cases were more detrimental, such as central retinal vein occlusion, posterior segment inflammation, retinal hemorrhages, and fungal infiltration. RT-PCR tests were unreliable in detecting SARS-CoV-2 infection in ocular tissues, potentially due to methodological limitations.Conclusion Anterior segment findings were significant manifestations of the novel coronavirus, but a clear resolution of posterior segment findings is yet to be made. In the absence of reliable COVID-19 ocular sample tests, all links made to SARS-CoV-2 etiology remain tentative; further research must be directed to the field with modified testing strategies.

Real-Life Efficacy, Safety, and Use of Dexamethasone Intravitreal Implant in Posterior Segment Inflammation Due to Non-infectious Uveitis (LOUVRE2 Study).

IntroductionTo evaluate real-life efficacy, safety, and treatment patterns with the dexamethasone intravitreal implant (DEX) in posterior segment inflammation due to non-infectious uveitis (treatment-naïve or not) in French clinics.MethodsIn this prospective, multicenter, observational, non-comparative, post-reimbursement study, consecutive patients with posterior segment inflammation due to non-infectious uveitis were enrolled and evaluated at baseline (day 0). Those who received DEX on day 0 were re-evaluated at months 2, 6, and 18. Retreatment with DEX and/or alternative therapies was allowed during follow-up. Primary outcome: patients (%) with at least a 15-letter gain in best corrected visual acuity (BCVA) at 2 months. Secondary outcomes included patients (%) with at least 15-letter BCVA gains at 6 and 18 months; mean BCVA change from baseline at 2, 6, and 18 months; and patients (%) retreated, mean central retinal thickness (CRT), and adverse events (AEs) at all post-baseline visits.ResultsNinety-seven of 245 enrolled patients with posterior segment inflammation due to non-infectious uveitis (80% previously treated) and disease duration of 5 years (average) received DEX on day 0 and were included in efficacy analyses. At month 2 (n = 91), 20.5% of patients (95% CI 12.0–28.9) gained at least 15 letters from a baseline mean of 60.9 letters; the mean gain was 6.2 letters (95% CI 3.5–8.9). At month 6, 50.0% (n = 38/76) of patients did not receive alternative treatment or DEX retreatment, mostly because inflammation had sufficiently subsided (n = 27/38, 71.1%). Although early study termination prevented efficacy analysis at 18 months (n = 12), CRT reductions persisted throughout follow-up. From baseline to month 18, 21/245 (8.6%) patients had DEX-related AEs; 17/245 (6.9%) had ocular hypertension (most common AE).ConclusionLOUVRE 2 confirms DEX efficacy on visual acuity and CRT in predominantly DEX-pretreated patients with relatively old/stabilized uveitis. DEX tolerability was consistent with known/published data, confirming treatment benefits in posterior segment inflammation due to non-infectious uveitis.ClinicalTrials.gov IdentifierNCT02951975.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-022-00525-8.

Utilisation of composite endpoint outcome to assess efficacy of tocilizumab for non-infectious uveitis in the STOP-Uveitis Study

Background/aimsTo use a composite endpoint scoring system in assessing efficacy of two doses of intravenous tocilizumab (TCZ), in eyes with non-infectious uveitis.MethodsData from STOP-Uveitis Study (a phase 2 multicentre, randomised,...

Ocular findings in cats with blastomycosis: 19 cases (1978-2019).

To document ocular findings in cats with blastomycosis. 35 cats with blastomycosis. Medical records from 1978 through 2019 were reviewed to identify cats with confirmed Blastomyces infection. Cats were grouped as having or not having ocular involvement. Clinical signs, histopathologic findings, and response to treatment were evaluated. 21 of the 35 (60%) cats with confirmed blastomycosis had ocular abnormalities. Two of 21 cats with ocular abnormalities also had systemic hypertension and were excluded. Of the remaining 19 cats, 15 (79%) had bilateral ocular signs. Ten (53%) cats had inflammatory ocular lesions, and 9 (47%) had neuro-ophthalmic abnormalities. Six of the 19 (32%) cats appeared to be completely blind, and 5 (26%) appeared to be unilaterally blind. For the 10 cats with inflammatory ocular lesions, the most common lesions were anterior uveitis (9/20 eyes), active chorioretinitis (6/20 eyes), and retinal detachment (4/20 eyes). For the 9 cats with neuro-ophthalmic abnormalities, the most common abnormalities were a negative menace or tracking response (10/18 eyes) and negative pupillary light response (4/18 eyes). Results suggested that ocular involvement is common in cats with blastomycosis and that both inflammatory lesions and neuro-ophthalmic abnormalities can be seen. Blastomycosis should be considered in the differential diagnosis for cats with anterior uveitis, posterior segment inflammation, or neuro-ophthalmic abnormalities, and a complete ophthalmic examination should be performed in all cats with confirmed or suspected blastomycosis.

The Usefulness of Diagnostic Vitrectomy in Neoplastic and Non-Neoplastic Masquerade Syndrome: An Observational Study

Introduction: Masquerade intraocular inflammation may be considered neoplastic or non- neoplastic masquerades such as primary intraocular lymphoma, leukemia, infectious and inflammatory diseases. These pathologies require a definitive diagnosis, as the treatment modalities are different. The aim of our study was to investigate the safety and usefulness of diagnostic vitrectomy with vitreous humor flow cytometry in eyes with intraocular inflammation of unknown etiology. Methods: A retrospective observational study included 35 eyes of 29 patients with atypical intraocular inflammation unresponsive to corticosteroid therapy. In all cases diagnostic vitrectomy with flow cytometry analysis of the vitreous specimen was performed. Results: Among 35 eyes, the result of diagnostic vitrectomy analysis showed unspecific inflammatory response in 7 (20.0%) eyes, confirmed neoplastic diseases in 5 (14.3%) eyes. All of them it was intraocular lymphoma but one of the eyes with primarily diagnosed lymphoma and one of the eyes with primarily diagnosed unspecific inflammatory response in flow cytometry has been diagnosed finally as a choroidal melanoma after enucleation of the eyeball. Diagnostic vitrectomy excluded neoplastic disease in 7 eyes (20.0%). In 3 eyes (8.6%) bacterial infection, in 4 eyes (11.4%) viral infection. In 2 eyes (5.7%) we excluded bacterial infection, in 7 cases (20.0%) no conclusive results were obtained. The most common adverse event was cataract in patients (12 eyes, 34.3%). Conclusion: Diagnostic vitrectomy with flow cytometry of vitreous humor is helpful in confirming the clinical suspected diagnosis of posterior segment inflammation. Flow cytometry need to be complemented with other diagnostic test including cytopathology, especially in cases suspected of intraocular lymphoma. Flow cytometry of the vitreous humor in choroidal melanoma is not a useful diagnostic tool.

A Case History of Internal Ophthalmomyiasis, a Rare and Devastating Disease

To report a rare case of unilateral internal ophthalmomyiasis with complete visual loss. Method: An otherwise healthy 12 years old boy presented with redness and painful rapid loss of vision in his right eye for the past 12 days. There was no history of associated trauma. On examination, there was no perception of light in his right eye and normal vision in left eye. There was severe anterior and posterior segment inflammation which prevented the view of fundus. B-scan of the right eye showed diffuse choroidal and optic nerve thickening. Routine blood count and X-ray chest did not reveal any significant findings. In the midst of uncertainity regarding diagnosis and to relieve the patient from severe pain, enucleation of right eye was performed and histopathological examination of the specimen was done to confirm the diagnosis. Result: Histopathology report showed gross irregular inflammatory thickening of the choroid with severe granulomatous inflammation. There was an infective agent in the choroid having an outer cuticle and an irregular hyaline branching innner tube. These features were suggestive of ophthalmomyiasis of the choroid. Conclusion: Although rare, ophthalmomyiasis should be considered in the differential diagnosis of panuveitis. Early recognition of this condition, when tumour and other conditions are suspected, would avoid invasive surgical procedures, such as enucleation.

A Case of Bilateral Peripheral Ulcerative Keratitis

Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It may precede the diagnosis of the systemic condition and therefore these cases require urgent investigation. A 43-year-old woman presented with bilateral tearing and ocular pain persisting for 7 months. Visual acuity was 6/6 in both eyes. On biomicroscopic examination, presence of crescent shaped corneal ulcer with perilesional haziness. A tear film study demonstrated decreased Schirmer test results (5mm in both eyes) and tear film break-up time (5 sec in both eyes). The interrogation and the patient revealed he had recurrent skin lesions in both legs with chronic itching, and recurrent oral and genital ulcers healing spontaneously. The diagnosis of Behcet disease was proposed. Pathergy test was negative, HLA B51 was positif. Systemic therapy was started with colchicine at a dose of 2mg/day. Eye drops and systemic prednisolone at 1mg/kg/day was continued with progressive decrease. The follow up at 3 months and 6 months showed no signs of recurrence of ulceration in both eyes. Corneal manifestation has rarely been reported in Behcet’s disease. Combined intraocular anterior and posterior segment inflammation are most common features of ocular Behcet disease. Collaborative management of ophthalmic patients having systemic illness along with internists improves overall outcomes and prevents morbidity in such patients.

Widefield Fundus Fluorescein Angiography Features of Uveitis Associated with Juvenile Idiopathic Arthritis

ABSTRACT Purpose To evaluate the wide-field fundus fluorescein angiography (WFA) characteristics of uveitis associated with juvenile idiopathic arthritis (JIA-uveitis). Methods Retrospective review of records. WFA with Spectralis (Heidelberg) of JIA-uveitis patients were analyzed using the scoring system by Angiography Scoring for Uveitis Nomenclature. Results Thirty-seven eyes of 20 patients were studied. A total score of at least 1 was noted in 27 eyes (72.97%). WFA features included optic disc hyperfluorescence (51.35%), macular leakage (27.03%), retinal vascular staining/leakage at posterior pole (27.03%) and peripheral retina (64.86%), capillary leakage at the posterior pole (37.84%), and peripheral retina (59.46%). A decision to change the management plan was made in 8 of 9 patients with bilateral quiet anterior chambers after WFA results. Conclusion More than 70% of JIA-uveitis eyes showed some WFA-evidence of posterior segment inflammation, which changed the course of therapy for a major proportion of patients with no clinically active anterior chamber inflammation.

Posterior segment inflammatory outcomes assessed using fluorescein angiography in the STOP-UVEITIS study

BackgroundAlthough fluorescein angiography (FA) is a frequently used imaging modality in patients with non-infectious uveitis (NIU), it has not been reliably used for objective assessment of posterior segment inflammatory outcomes in these patients. In this index study we report the posterior segment inflammatory outcomes of two different doses of intravenous (IV) infusions of tocilizumab (TCZ), an IL-6 inhibitor, in eyes with NIU using a semi-quantitative FA scoring system.MethodsSTOP-Uveitis is a randomized, multi-center clinical trial conducted at 5 clinical centers across the United States. The study evaluated the role of TCZ in patients with NIU. Thirty-seven (37) patients with NIU were randomized into one of two treatment groups in a ratio of 1:1. Group 1 received IV infusions of 4 mg/kg TCZ and group 2 received IV infusions of 8 mg/kg TCZ. Infusions were given every 4 weeks in both groups until month 6 (primary endpoint). Posterior segment inflammatory outcomes were assessed by evaluating FA at baseline and month 6 by graders at a central reading center. A previously reported, semi-quantitative, scoring system for FA was used to assess signs that represent ongoing inflammatory processes in the posterior segment. These signs included optic disc hyperfluorescence, macular edema, retinal vascular staining and/or leakage, capillary leakage, retinal capillary nonperfusion, neovascularization of the optic disc, neovascularization elsewhere, pinpoint leaks, and retinal staining and/or subretinal pooling. Statistical significance was set at p < 0.05. Main outcome measures included change in posterior segment inflammation as assessed using FA at month 6.Results37 eyes (37 patients) were randomized in the STOP-Uveitis study. 30 eyes were found to be eligible for this sub-study based on study criteria. Seven eyes had ungradable images at either baseline or month 6 and were therefore excluded from the analysis. The reduction in FA inflammatory scores at month 6 were statistically significant in both groups (p < 0.05). The difference between the two groups was not significant (p = 0.351).ConclusionsIV infusions of tocilizumab (both 4 and 8 mg/kg) are effective in improving posterior segment inflammation in eyes with NIU. A semi-quantitative FA scoring system may be used as a reliable outcome measure for assessment of posterior segment inflammation.ClinicalTrials.gov Identifier: NCT01717170

One-port vs. three-port diagnostic vitrectomy for posterior segment diseases of unknown origin.

To compare the safety and the effectiveness of one-port vs. three-port diagnostic vitrectomy in undiagnosed cases of posterior segment inflammation. We retrospectively collected data from 80 consecutive diagnostic vitrectomies performed using a one-port (n = 40) or a three-port approach (n = 40). Cases of suspected postoperative endophthalmitis were not included in the study. Several variables were compared among groups, including length of surgery, postoperative best-corrected visual acuity (BCVA), diagnostic success and surgical complications. The mean duration of surgery was shorter in the one-port group when compared to the three-port group (15 ± 8min vs. 49 ± 30; p = 0.0001). The patients were observed for a mean follow-up of 19months (range 1-84). In the one-port group, the mean BCVA improved from 1.31 ± 0.96 to 0.57 ± 0.59 logarithm of minimum resolution (LogMAR) (p = 0.0009). In the three-port group, BCVA improved from 0.98 ± 0.76 to 0.51 ± 0.76 LogMAR (p = 0.0005). The difference in mean postoperative BCVA between groups was not significative at the last follow-up. One-port vitrectomy yields to a final diagnosis in 80% of the cases, and three-port vitrectomy in 48%. Most of the one-port vitrectomies were carried out under topical anesthesia. After surgery, in both groups three eyes developed a retinal detachment. In this pilot study, the one-port diagnostic vitrectomy has proven to be as effective and safe as the three-port approach, allowing a reduction in surgical times. One-port diagnostic vitrectomy might be considered as the first option for those cases where more complex surgical procedures are not needed.

Glaucome uvéitique dans la maladie de Behçet : quand tout se complique…

Behçet's disease is a systemic disease of unknown etiology. Its ocular manifestations are multiple and polymorphic, with uveitis at the top of the list. Classically, uveitis in Behçet's disease does not cause elevation of intraocular pressure. However, this may be found in 10 to 20% of cases, secondary to trabeculitis, trabecular obstruction by inflammatory cells, anterior or posterior synechiae, or induced by prolonged use of corticosteroids. Its occurrence is a major complication, the management of which is especially delicate when glaucoma occurs. The purpose of this study was to study the factors predictive of glaucoma in Behçet's disease. This is a retrospective study of all the charts of patients consecutively hospitalized for Behçet's disease over a period of 8years in the ophthalmology A department of the specialty hospital of Rabat university medical center. Fifty patients were treated for Behçet's disease during the study period. There were 41 men (82%), and 9 women (18%). Glaucoma was diagnosed in 11 patients (22%). The mean age of this subgroup was 31years, with a gender ratio of 6 women/5 men. The glaucoma was associated with anterior synechiae in 4 cases, primary open-angle glaucoma in 5 cases, neovascular glaucoma in 1 case and seclusio pupillae in 1 case. Therapeutically, all patients were on glaucoma eye drops, and five underwent filtering surgery. Statistically, on univariate analysis, ocular hypertension was observed particularly in patients with low initial visual acuity (less than 1/10) (P=0.001), with severe posterior segment involvement, especially retinal vasculitis (29% vs. 6%, P=0.04), macular edema (40% vs. 4%, P=0.001), and optic disc edema (50% vs. 15%, P=0.02). A high number of recurrences was also associated with glaucoma (1.0 vs. 3.0, P<0.0001). On multivariate analysis, low baseline visual acuity, presence of retinal vasculitis, and high number of recurrences were independent risk factors for ocular hypertension in our patients followed for Behçet's disease. Glaucoma can complicate the management of Behçet's disease. This glaucoma will be more difficult to manage in this delicate pathological context. It requires special vigilance in patients with severe posterior segment inflammation, to institute effective management to avoid its potentially blinding complications.

Choroby odzwierzęce w okulistyce. Część I – Toksoplazmozowe zapalenie siatkówki i naczyniówki

Toxoplasma gondii invasion is probably the most common parasitosis in the world. It estimated that up to half of the world population can be infected with it. This parasite is an opportunist and rarely causes disease symptoms that are unspecific, mild and quickly disappearing, so the existence of this disease is widely ignored. However, in Poland toxoplasmosis is the most common cause of posterior segment inflammation and estimated to affect about 300,000 people. Although ophthalmologists often see old, inactive toxoplasmosis scars, an active toxoplasmic lesion can cause some difficulties in diagnosis and treatment. This article is based on the latest and relevant literature to help ophthalmologists understand, diagnose and treat this disease.

Reactive uveitis, retinal vasculitis and scleritis as ocular end-stage of Acanthamoeba keratitis: a histological study.

We analysed histologically two Acanthamoeba keratitis (AK) eyes with anterior and posterior segment inflammation and blindness. Two enucleated eyes of 2 patients (age 45 and 51y) with AK (PCR of epithelial abrasion positive) were analysed. Histological analysis was performed using hematoxylin-eosin, periodic acid-Schiff and Gömöri-methenamine silver staining. We could not observe Acanthamoeba trophozoites or cysts neither in the cornea nor in other ocular tissues. Meanwhile, we found uveitis, retinal vasculitis and scleritis in these eyes, due to the long-standing, recalcitrant AK. So in this stage of AK, systemic immune suppression may be necessary for a longer time period.