Recurrent Anterior Uveitis Research Articles

Caractéristiques épidémiologiques et étiologiques des uvéites dans un centre hospitalier universitaire

The purpose of this study was to describe the epidemiologic characteristics of adult uveitis evaluated at the regional center of excellence specializing in systemic and autoimmune disease in the Nancy university medical center. The secondary objectives were to describe the progression over time of the various etiologies and to identify local specificities. We performed a retrospective epidemiological study of patients diagnosed with uveitis. All patients were referred to the regional center of excellence of the Nancy university medical center between January 1, 2005and December 31, 2016. Patients under 18years of age, patients with a first episode of acute anterior uveitis, as well as patients for whom the etiological diagnosis was made by the ophthalmologist with no need of internal medicine referral, were excluded. Age, gender, laterality, site of inflammation, clinical signs, etiology (infectious, non-infectious or idiopathic, as well as diagnosis), and date of first consultation were recorded. Six hundred and ninetypatients were included, with 59% women and a mean age of 49years. The uveitis was unilateral in 53% of cases. Panuveitis was the most common form (52%, N=358), followed by recurrent anterior uveitis (30%, N=205), posterior uveitis (16%, N=107), and intermediate uveitis (3%, N=20). Non-infectious etiologies accounted for 35% of all uveitis (the most common being HLA-B27uveitis, sarcoidosis, ankylosing spondylitis and Behçet's disease) and infectious etiologies for 13% (tuberculosis, toxoplasmosis and Lyme disease were the most frequent). The uveitis was idiopathic in 52%. A trend toward improvement in diagnostic yield was observed: 53% of uveitides were considered idiopathic prior to 2011compared to 50% after 2011 (P<0,01). We identified a majority of panuveitis, which is explained by our inclusion criteria. Fifty-two percent of our series remained idiopathic, with an improvement in the diagnostic yield over time. This could be related to both repeated etiological assessments and better diagnostic performance. The study of this large cohort of patients improved our knowledge of the characteristics of uveitis in our center.

Bilateral Anterior Uveitis in a Northern Saw-whet Owl (Aegolius acadicus) With a Metastatic Pectoral Malignant Mesenchymoma

A captive, adult, male northern saw-whet owl (Aegolius acadicus) was examined for blepharospasm of the left eye. The owl was diagnosed with bilateral anterior uveitis and a corneal ulceration in the left eye. It was treated with oral and topical nonsteroidal anti-inflammatory medications and a topical antibiotic. Multiple recheck examinations and medication adjustments were performed over the next 4 months, at the end of which time the bilateral anterior uveitis was controlled with a topical nonsteroidal anti-inflammatory applied 3 times per week to both eyes. The owl was re-examined 2 months later after 2 suspected neurologic episodes. On physical examination, the owl was quiet and had difficulty standing and ambulating. Five firm multilobular and immobile masses were identified overlying the pectoral muscle and sternum. Fine-needle aspiration from 1 mass revealed neoplastic cells consistent with a sarcoma. The owl was euthanatized. On the basis of results of histopathologic examination, the mass was diagnosed as a pleomorphic spindle cell sarcoma with features of rhabdomyosarcoma, liposarcoma, and osteosarcoma. Numerous tumor cells were immunopositive for myoglobin and desmin, indicating striated muscle origin. Although a metastatic lesion was present in 1 adrenal gland, lesions of inflammation or neoplasia were absent in either eye on histopathologic examination. This report describes an apparent ocular manifestation of systemic disease in an avian species with clinically diagnosed recurrent anterior uveitis.

Ocular Features in Chinese Patients with Blau Syndrome

ABSTRACT Purpose: To identify pathogenic gene variants in the NOD2 gene and assess the clinical features of a cohort of Chinese patients affected with Blau syndrome. Methods: Eight patients from seven unrelated families were enrolled. Detailed ophthalmological examinations were performed. Sanger sequencing was used to analyze the NOD2 gene. Results: The onset age of ocular manifestations varied from 2 to 24 years (median: 5.5 years). Best corrected visual acuity (BCVA) ranged from light perception (LP) to 1.0. One patient presented with recurrent anterior uveitis, six patients had panuveitis and one patient was at the phthisis bulbi stage. One novel disease-associated variant (c.2006A>G, p.His669Arg) and four previously reported disease-causing variants (c.1000C>T, p.Arg334Trp; c.1001G>A, p.Arg334Gln; c.1442G>A, p.Gly481Asp; c.1759C>T, p.Arg587Cys) in the NOD2 gene (NM_022162.1) were identified. Conclusions: Blau syndrome is a rare autosomal dominant multisystem disease caused by a NOD2 gene defect. Recurrent anterior uveitis and/or panuveitis are the characteristic ocular findings.

English

AIM OF THE STUDY: 1. To analyze about comparative effect of Trabeculectomy with Mitomycin C/ Trabeculectomy with Ologen implant/ Glaucoma drainage device surgery in 25 cases of Neovascular glaucoma. 2. To find out best method, control of intraocular pressure, visual outcome, post operative complications. 3. To find out the etiological factors, mode of presentation and associated systemic conditions. METHODS: In this pilot study, 25 patients of neovascular glaucoma were selected, evaluated and divided into 3 groups. Group 1: 10 patients were treated with Trabeculectomy with Mitomycin C. Group 2: 10 patients were treated with Trabeculectomy with Ologen implant. Group 3 : 5 patients were treated with drainage device surgery. All patients were re- examined first post operative day and then end of first week, 6 week and 12week. The control of intraocular pressure, visual outcome, post operative complications were assessed. Effect of different methods of treatment compared and best method of treatment was analysed. RESULTS: The major aetiological factors causing Neovascular glaucoma are proliferative diabetic retinopathy, central retinal vein occlusion, recurrent anterior uveitis. The mean age of presentation was 59.04 years with male preponderance. Neovascular glaucoma secondary to Central Retinal Vein Occlusion presented earlier than proliferation diabetic retinopathy which was presented relatively later. At most cases had corneal and iris involvement with new vessels extending into the angle with or without synechial angle closure. The mean pre treatment intra ocular pressure was 45.76mmHg. among the three modalities of treatment maximum mean reduction of IOP in the first week was seen in group III (drainage implant surgery). But at the end of 12 weeks of follow up all three groups showed statistically significant reduction of mean IOP. There is no significant gross difference between these groups at the end of 12 weeks. Group I -Trabeculectomy with Mitomycin - c showed more complication compare to other 2 groups, shallow anterior chamber and bleb related complications more common in group I. Group II- Trabeculectomy with ologen implant showed minimal complications.In Group III- drainage device surgery patients had complications like hyphaema, tube contact with cornea and pain intra operative bleeding is more common in neo vascular glaucoma patients. CONCLUSION: At the end of 12 weeks of follow up all three groups showed statistically significant reduction of mean IOP. There is no significant gross difference between these groups at the end of 12 weeks.In severely compromised eyes with Neovascular glaucoma, the main advantage of Keiki Metha Valve implantation is pain relief and avoidance of enucleation in addition to a significant reduction in intra ocular pressure. If the patients would have presented earlier and managed appropriately, this much dreaded complication of painful Neovascular glaucoma could be avoided earlier.

Prophylaxis of Recurrent Cytomegalovirus Uveitis with Topical Ganciclovir

Cytomegalovirus (CMV) can cause recurrent or chronic hypertensive anterior uveitis in immunocompetent patients. Antiviral treatment options include topical ganciclovir or systemic valganciclovir. However, recurrences are common after stopping treatment. We evaluated the efficacy of long-term topical ganciclovir therapy as prophylaxis for recurrent activity. Retrospective analysis of all CMV uveitis patients seen between 2011 and 2018 at Zurich University Hospital. Inclusion criteria were suspected viral anterior uveitis and a positive CMV polymerase chain reaction of the anterior chamber (AC) tap. After diagnosis, topical therapy with ganciclovir gel 5 × daily was started and tapered according to clinical activity. Topical steroids and glaucoma medication were used according to clinical assessment. An active episode was defined as increase in AC inflammatory activity and/or a uveitis-related rise in intraocular pressure (IOP) greater than 25 mmHg. Episodes were analysed before and after initiation of ganciclovir therapy. Six patients, median age 51 (range 24 - 62) years old, were included. All patients had hypertensive unilateral anterior uveitis and presented with small to medium sized endothelial precipitates and with 0.5+ to 2+ AC cells. Median IOP in the affected eye at initial presentation was 43 mmHg (range 36 - 60). Median time from first episode to diagnosis was 19.5 (range 5 - 193) months. Median number of episodes before ganciclovir treatment was 4 (2 - 20), corresponding to a mean of 3.04 episodes per year. Median follow-up time after initiation of ganciclovir medication was 26 (range 4 to 62) months. Median number of episodes under treatment was 1 (range 0 - 6), corresponding to a mean of 0.19 episodes per year (p = 0.04, 2-sided paired t-test). The median (range) for the individually chosen long-term prophylactic dose was ganciclovir gel 2 (0 - 4) times daily, and topical steroids 1 (0 - 2) times daily. Lower doses lead to recurrences in 3 patients (50%). Glaucoma and cataract surgery were performed in 2patients (33%). Although a rare entity in Central Europe, the important feature of CMV uveitis is its hypertensive and recurrent nature. In our cases, topical ganciclovir was found to be an effective treatment. Inflammatory activity was well controlled by using an individually assessed prophylactic dose. Larger studies assessing long-term prophylaxis are desirable.

Case report of secondary pigment dispersion glaucoma, recurrent uveitis and cystoid macular oedema following inadvertent implantation of an intraocular lens into the ciliary sulcus following cataract surgery

BackgroundThis case highlights the important sequelae that can occur following the inadvertent implantation of a single-piece intraocular lens into the ciliary sulcus during cataract surgery; secondary pigment dispersion glaucoma, recurrent anterior uveitis and macular oedema.Case presentationA 67-year-old lady underwent routine left cataract surgery in a separate unit but subsequently attended our eye casualty with recurrent hypertensive anterior uveitis. She was found to have secondary pigment dispersion glaucoma as the intraocular lens had been inadvertently placed into the ciliary sulcus. She underwent a trabeculectomy to control the intraocular pressure and initially settled well but 12 months later developed persistent anterior segment inflammation and macular oedema. She subsequently had the intraocular lens removed and the macular oedema was treated successfully with intravitreal Bevacizumab.ConclusionsWe provide a summary of the evidence and a discussion over the management options available in managing such a difficult case.

Complications and Safety Profile of Posterior SubTenon Injection of Triamcinolone Acetonide

Purpose: Posterior Sub-Tenon injection (PSTI) is a common route of drug delivery for triamcinolone acetonide (TA) for intraocular inflammation. The aim of this study was to evaluate indications, complications and safety of PSTI of TA for intraocular inflammation. Method: This is a retrospective study. The duration of study was from October 2007 to December 2016. The patients with minimum 1 year after PSTI of TA follow-up were included in the study. All complications of injection procedure and drug itself were included. Patients with pre-existing lenticular opacity, glaucoma, blepharoptosis, traumatic macular edema, subconjunctival hemorrhage, traumatic uveitis, postoperative uveitis, and retinal vascular occlusive disorder were excluded from the study. Results: A total of 112 eyes of 110 patients who were treated with PSTI of TA were included in the study group. The mean age was 50±8.4 years. Out of 110 patients, 80 (72.72%) were females and 30 (27.27%) males. The recurrent anterior uveitis was the most common indication (44.64%). Out of 112 eyes, 100 eyes (89.28%) were injected once, 10 eyes (8.92%) twice, and 2 eyes (1.78%) thrice. Following PSTI of TA, 14 eyes (12.5%) developed ocular hypertension 6 eyes (5.35%) ptosis, and 3 eyes (2.67%) cataract. Conclusion: PSTI of TA has higher risk of steroid-induced glaucoma; hence these patients should be monitored for intraocular pressure.

Recurrent anterior uveitis and subsequent incidence of ankylosing spondylitis: a nationwide cohort study from 2002 to 2013

BackgroundAnterior uveitis is the most common extra-articular manifestation of ankylosing spondylitis (AS). AS-related anterior uveitis frequently presents as acute, recurrent iridocyclitis; therefore, AS is often initially suspected by an ophthalmologist, not by a rheumatologist. In this study, we aimed to investigate the relationship between the recurrence of anterior uveitis and the subsequent incidence of AS.MethodsFrom a national sample cohort, 10,483 patients with new-onset uveitis between 2004 and 2013 and 52415 matched control subjects who had never experienced uveitis were selected. Among the patients with new-onset uveitis, a subpopulation of patients with recurrent uveitis, defined as a minimum 120-day reported interval between consecutive claims of uveitis (based on diagnostic codes) treated with local or systemic steroids or immune-modulating drugs, was identified. The incidence rates of AS were calculated according to the number of episodes of uveitis, and the incidence rate ratios (IRRs) were derived on the basis of the incidence rate in the control group.ResultsThe incidence rate per 100,000 person-years of AS after the first uveitis episode was 121.5, whereas the incidence in the control group was 16.9 (IRR, 7.40; 95% CI, 4.99–10.98); after the second uveitis episode, the IRR increased to 17.71 (95% CI, 10.44–30.06). In male and female patients with recurrent uveitis, the incidence rates of AS were 284.1 and 268.7 per 100,000 person-years, respectively. In patients aged under 40 years, the IRR of the recurrent uveitis group was 46.78 (95% CI, 19.61–111.61). In patients aged over 59 years, AS incidence in the recurrent uveitis group did not differ from that in the control group.ConclusionsThe risk of subsequent AS increased with the number of episodes of anterior uveitis. This quantitative evidence could contribute to the establishment of a rationale for ancillary workup for possible systemic associations in patients with recurrent uveitis.

Presumptive Diagnosis of Recurrent Herpes-induced Anterior Uveitis with Acute Hypopyon

Presumptive Diagnosis of Recurrent Herpes-induced Anterior Uveitis with Acute Hypopyon

CMV endotheliitis: a cause for recurrent failed corneal transplant.

Objective: To highlight the clinical presentation of CMV endotheliitis and the challenge in diagnosing this condition in recurrent failed penetrating keratoplasty (PK). Methods: Case seriesResults: There are 3 cases of recurrent failure in PK secondary to CMV endotheliitis presented. Case 1 and 2 were pseudophakic patients, while in case 3, the patient had a previous history of recurrent anterior uveitis. Case 1 and 3 had four and one previous failed PK respectively, while case 2 had endothelial keratoplasty twice before the diagnosis of CMV endotheliitis was made, following positive culture of aqueous humour. The visual acuity ranged from 1/60 to hand movement. All patients had pigmented KP, and two of them had typical coin-shaped KP. Oral valganciclovir was instituted for all patients consisting of 900 mg bidaily for two weeks, followed by 900 mg once daily for six months. Additionally, topical ganciclovir eyedrop 0.5% was given every four hours with topical dexaminim four times a day. Repeated anterior chamber (AC) tap after six months of treatment was negative for CMV in case 3 while cases 1 and 2 are still on treatment. CMV endotheliitis is an increasingly important cause of failed corneal transplant. We recommend anterior chamber tap in suspicious cases of repeatedly failed corneal transplant, regardless of the presence of coin-shaped KP or not. Minimum treatment with oral valganciclovir is important to eradicate the problem, before proceeding with another corneal transplant.Conclusion: It is important to make an accurate early diagnosis by good clinical judgement in preventing loss of corneal endothelial cells. High index of suspicion for CMV endotheliitis as a cause of graft failure must be made especially when the patient presents with coin-shaped KP. Therefore unnecessary treatment resulting from misdiagnosis in these patients can be prevented. Early recognition and treatment of this condition is important to prevent permanent endothelial cell loss and corneal decompensation.

Novel treatment regimen of Vogt–Koyanagi–Harada disease with a reduced dose of corticosteroids combined with immunosuppressive agents

ABSTRACTPurpose: To investigate the effectiveness, visual outcome, and prognostic factors of Vogt–Koyanagi–Harada (VKH) disease treatment with a reduced dose of corticosteroids combined with immunosuppressive agents.Methods: The clinical characteristics, auxiliary examinations, treatment result, visual outcome, and prognostic factors in VKH patients were analyzed.Results: A total of 998 VKH patients were divided into posterior uveitis group (Group1), anterior uveal involvement group (Group 2), and recurrent granulomatous anterior uveitis group (Group 3). Reduced doses of corticosteroids combined with immunosuppressive agents were used for 1–1.5 years. Uveitis was controlled in 100%, 100%, and 96.8% of these three groups, respectively. Visual improvement and stability was observed in 98.1%, 96.5%, and 88.3%, respectively. Treatment after disease onset, visual acuity at first visit, and 1 month after treatment was positively associated with BCVA at last visit (p < 0.05).Conclusion: A reduced dose of corticosteroids combined with immunosuppressive agents effectively controlled the intraocular inflammation and improved visual acuity in most Chinese VKH patients.

Sacroiliac Joint Magnetic Resonance Imaging in Asymptomatic Patients with Recurrent Acute Anterior Uveitis: A Proof-of-concept Study

Our aim was to quantify bone marrow edema (BME) and/or structural lesions in the sacroiliac joints (SIJ) of patients with recurrent acute anterior uveitis (rAAU) with or without back pain, to evaluate the frequency of axial (axSpA) and peripheral spondyloarthritis (pSpA) and to establish which criterion for magnetic resonance imaging (MRI) positivity best reflected the global assessment of SIJ MRI. A total of 50 patients with rAAU without prior rheumatologic diagnosis were included in our cross-sectional study, and these patients were compared to 21 healthy volunteers. SIJ MRI scans were read by 2 rheumatologists according to the Spondyloarthritis Research Consortium of Canada (SPARCC/MORPHO) protocol. Discrepant cases were adjudicated by a radiologist. Patients with rAAU were diagnosed with axSpA (Group 1, n = 20, 40%) and nonspecific back pain (Group 2, n = 6, 12%), or as being asymptomatic (Group 3, n = 24, 48%). Group 3 results showed 9 patients (37.5%) had SIJ MRI and/or were radiography-positive for axSpA (5 MRI and radiograph, 1 MRI, 3 radiograph). SIJ MRI scans that were compatible with SpA in groups 1 (n = 12) and 3 (n = 6) were similar in acute and structural lesions that were analyzed according to SPARCC/MORPHO. The best sensitivity/specificity criterion for defining a positive global MRI assessment was a BME score ≥ 3 (88%/94%). This is the first study evaluating SIJ MRI in patients with rAAU without back symptoms, showing positive findings for sacroiliitis. Moreover, a BME score ≥ 3 had better performance to define an SIJ MRI as positive for axSpA.

Acute Anterior Uveitis

A 36-year old female presents with acute (recurrent) anterior uveitis in the right eye, HLA-B27 positive. She has ahistory of bilateral recurrent non-granulomatous uveitis attacks since 2011, but she has no extraocular manifestation ofautoimmune disease. She has typical signs of acute anterior uveitis (the ciliary conjunctival injection, hypopyon leveland fibrin reaction at pupillary area as in Fig. A.). Fig. B shows signs of previous uveitic attack in the same eye as Fig.A (residual fibrin on the anterior lens surface is visible on slit lamp examination after pupillary dilatation). This case requirestreatment of combined periocular steroids injection and topical steroids plus cycloplegics to control the inflammation.

The Choroidal Vascularity Index Decreases and Choroidal Thickness Increases in Vogt–Koyanagi–Harada Disease Patients During a Recurrent Anterior Uveitis Attack

ABSTRACTPurpose: To measure changes in the choroidal vascularity index (CVI) in chronic Vogt–Koyanagi–Harada (VKH) disease during a recurrent anterior uveitis attack.Methods: Forty VKH patients and 40 normal controls were included in this study. Choroidal images were recorded before and during a recurrent anterior uveitis attack, as well as after appropriate treatment. CVI was measured by the binarization technique using ImageJ software (Bethesda, MD).Results: The CVI was 0.75 ± 0.09 in quiescent VKH patients, which was significantly higher compared to healthy controls (0.70 ± 0.05, p ＜ 0.0001). The CVI significantly decreased to 0.72 ± 0.09 when granulomatous anterior uveitis appeared in these patients. However, it returned to 0.75 ± 0.08 after uveitis resolved.Conclusions: A significant decrease of the CVI occurred during recurrent anterior uveitis in chronic VKH. CVI may provide a novel parameter to guide the treatment of VKH disease.

Ocular manifestations as first signs of systemic T cell lymphoma in two cases

BackgroundIntraocular involvement of systemic T-cell lymphomas are uncommon and have been broadly regarded as markers of poor prognosis. We reported two cases of uveitis patients finally diagnosed as systemic T cell lymphoma.Case presentationCase one is a 19-year-old female presented with fever and liver dysfunction, and was diagnosed as EBV-associated chronic active hepatitis. Fourteen months later, she suffered from recurrent granulomatous anterior uveitis in both eyes, which failed to respond to steroid and immunosuppressant therapy. A mass on the left side of pharynx was found and the final diagnosis was pharynx T cell non-Hodgkin’s lymphoma. After 13 cycles of chemotherapy, her systematic symptoms and uveitis relieved a lot, and eye condition is stable after cataract surgery. Case two is a 37-year-old male complaining bilateral blurred vision and recurrent abdominal pain. Panuveitis was diagnosed and anterior inflammation did not release after topical steroid. During the following days, the patient complained intermittent abdominal pain and fever, with rapidly progressive bilateral visual decrease. Final diagnosis was gallbladder type II enteropathy-associated T-cell lymphoma. The patient died of multiple organ failure 4 days after operation that was only 26 days after presenting to our hospital.ConclusionsOcular manifestations as first signs of systemic T cell lymphoma were rare. Diagnosis of lymphoma has to be suspected when patients have systemic manifestations including fever, fatigue, abdominal pain, EBV-associated liver disease, et al., and uveitis fails to respond to steroid therapy.

Craniofacial fibrous dysplasia: A 10-case series

ObjectivesFibrous dysplasia of bone is a rare sporadic benign congenital condition in which normal cancellous bone is replaced by fibro-osseous tissue with immature osteogenesis. Sarcomatous transformation is exceptional. Lesions may involve one bone (monostotic) or several (polyostotic). Fibrous dysplasia may be associated with café-au-lait skin macules and endocrinopathy in McCune-Albright syndrome, or with myxoma in Mazabraud's syndrome. MethodsWe report ten cases of patients followed up for craniofacial fibrous dysplasia in our center between 2010 and 2015. ResultsMean age was 43 years (range, 10–72 years). Clinical symptoms comprised headache (n=3) and sensorineural disorder: recurrent anterior uveitis (n=1), visual acuity loss, epiphora and vestibular syndrome (n=1), and hearing loss (n=1). All cases were monostotic. The sphenoid bone was most commonly involved (n=5), followed by the ethmoid (n=1), frontal (n=1), fronto-ethmoid (n=1), temporal (n=1) and fronto-ethmoido-sphenoid (n=1) bones. Five patients were treated with intravenous pamidronate, a bisphosphonate: evolution was favorable for 3 of them at 1–6 months after treatment initiation, with resolution of headache or vestibular syndrome; the other 2 patients were stable. Two patients were operated on. ConclusionDiagnosis of craniofacial fibrous dysplasia should be considered in case of headache, neuralgia, sensory disorder, functional disorder or infectious ENT complications. A medico-surgical approach is useful for these patients.

Autoimmune polyendocrine syndrome type IIIC and ankylosing spondylitis: a case report

Autoimmune polyendocrine syndrome (APS) is an autoimmune disorder defined by multiple endocrinopathies and the presence of other systemic or organ-specific autoimmunities. This case study, reports on a 46-year-old woman with confirmed idiopathic hyperparathyroidism, who was referred for inflammatory back pain. HLA-B27 positivity, recurrent anterior uveitis and radiologic findings led to ankylosing spondylitis (AS) diagnosis. By further investigations, a subclinical atrophic autoimmune thyroid disease (AITD) was also diagnosed for her in addition to a history of premature ovarian failure. According to the absence of adrenal insufficiency in addition to an AITD and systemic autoimmune disorder, APS type IIIC was the most probable diagnosis. To the best of our knowledge, this is the first case report of APS type III associated with AS.

Presumed Tuberculous Keratopathy: A Rare Presentation of “Serpiginious-Like” Keratic Precipitates in a Unilateral Anterior Uveitis Case

A 43-year-old lady with no underlying medical illness was referred for chronic recurrent unilateral anterior uveitis. She had no previous ocular trauma or surgical intervention to the eye. Upon presentation, she was found to have unilateral anterior uveitis with a very unusual “serpiginious-like” pattern of keratic precipitate. Initial investigations revealed no infective cause and patient was commenced on topical and oral steroids. Unfortunately, her ocular symptoms worsened and developed steroid induced glaucoma. A repeat infective screening revealed positive results for tuberculosis. Patient has since responded very well to treatment with antitubercular agents with complete resolution of the inflammation and good visual recovery. In this case report, we wish to emphasize that ocular tuberculosis presentation is highly variable and in such cases its best to employ a high index of suspicion to initiate the right treatment timely. An infective etiology should promptly be suspected in patients who are not showing response to topical or systemic steroids. Even in an immunosuppressed state, ocular tuberculosis may remain unilateral throughout the course of the disease, as seen in the patient. Injudicious use of steroid can make a simple anterior granulomatous uveitis progress to florid granulomatous uveitis with confluent keratic precipitates.

Cytomegalovirus as a cause of hypertensive anterior uveitis in immunocompetent patients.

BackgroundThe aims of this study are to investigate the clinical characteristics of patients with anterior hypertensive uveitis and to compare the characteristics between patients in cytomegalovirus (CMV)-positive and CMV-negative groups in their aqueous humor samples.Immunocompetent patients (n = 42) with a history of chronic and/or recurrent hypertensive anterior uveitis underwent ophthalmic examination and serological tests. Among the 42 patients with hypertensive anterior uveitis, aqueous humor sampling was performed in 21, and they were analyzed for viral deoxyribonucleic acids using the polymerase chain reaction (PCR).ResultsThe average age of the 42 patients with hypertensive anterior uveitis was 57.6 years, and 29 (69.0 %) of the subjects were males. Of the patients, 22 (52.4 %) underwent glaucoma surgery, and the average corneal endothelial cell counts were 1908 cells/mm2. Among the 21 patients who underwent an aqueous sampling, 6 were positive for CMV-DNA, while 15 were negative. The frequency of glaucoma surgery was similar between groups (CMV positive vs. CMV negative, 66.0 vs. 66.0 %, P = 0.701). However, 66.7 % of the CMV-positive group underwent glaucoma tube shunt surgery, whereas 80 % of the CMV-negative group underwent trabeculectomy or received an ExPRESS glaucoma filtration device (Alcon, Fort Worth, TX) for glaucoma surgery (P = 0.095). The corneal endothelial cell counts were significantly lower in the CMV-positive group (CMV positive vs. CMV negative, 1245 ± 560 vs. 1981 ± 387 cells/mm2; P = 0.009).ConclusionsCMV was found to be an etiological factor in patients with hypertensive anterior uveitis in Korea. Special caution is needed for patients with CMV-induced hypertensive anterior uveitis, considering its adverse effect on the corneal endothelium.Electronic supplementary materialThe online version of this article (doi:10.1186/s12348-016-0100-5) contains supplementary material, which is available to authorized users.

Unilateral Recurrent Anterior Uveitis as the Presenting Sign of Bladder Carcinoma.

A 79-year-old male patient was followed for unilateral uveitis with 3 attacks in 10 months, despite initial improvement with steroid therapy. The patient had visual acuity (VA) of counting fingers in right eye, hypopyon and vitritis with no chorioretinal lesions. The left eye was normal. The patient was evaluated for intraocular foreign body, intraocular lymphoma and associated systemic disease and malignancy. Computed tomography of the abdomen showed a mass in the bladder. Biopsy confirmed bladder carcinoma. After resection of the mass, intraocular inflammation improved completely and no attack was noted in the follow-up. In his last examination, two years after the operation, VA was light perception; seclusio pupilla and mature cataracts were seen on biomicroscopy. There was no sign of vitritis on ocular ultrasonography. Evidence is discussed that suggests a link and potential etiology between refractory uveitis with hypopyon and bladder carcinoma. This is the first case of unilateral recurrent uveitis with hypopyon as the initial presenting sign of bladder carcinoma.