Recurrent Anterior Uveitis Research Articles

Use of intraocular human recombinant tissue plasminogen activator as an adjunct treatment of posterior synechiae in patients with uveitis.

To evaluate the effect of intracameral injection of small doses of human recombinant tissue plasminogen activator (hr-tPA) as an adjunct to lysing extensive recent-onset posterior synechiae associated with uveitis in the setting of impending pupillary seclusion. This is an interventional retrospective case series involving three patients. All patients received an intracameral injection of hr-tPA while on maximum antiinflammatory therapy. Two patients had unilateral acute anterior uveitis with extensive (270°-360°) recent-onset posterior synechiae, while 1 patient had chronic recurrent anterior uveitis complicated by recent and preexisting posterior synechiae. Two patients with acute uveitis had rapid and complete synechiolysis (360°) after an intracameral injection of hr-tPA within 24 hours. One patient with acute reactivation of recurrent uveitis had subtotal (270°) synechiolysis because of incomplete lysis of chronic synechiae. With resolution of inflammation, all patients regained their preuveitis visual acuity. No cataract or glaucoma was reported at 12-month follow-up. We evaluated the role of intracameral hr-tPA injections as an adjunct to maximum antiinflammatory therapy. We conclude that a low-dose (3 μg) low-volume (0.05 mL) intracameral injection of hr-tPA in patients with extensive recent-onset posterior synechiae associated with uveitis leads to rapid lysis of synechiae, reducing the risk of pupillary seclusion and associated glaucoma.

Uveitis preceding Crohn’s disease by 8 years

We report the clinical history of a child affected by Crohn's disease in which uveitis precedes intestinal involvement by years and occurs with the atypical features of anterior chronic inflammation complicated by unilateral optic disc edema, rather than recurrent anterior uveitis with sudden onset which has been more widely reported in inflammatory bowel diseases. The uveitis onset occurred 8years before symptoms of the primary intestinal disease, while in inflammatory bowel diseases the intestinal inflammation typically precedes ocular symptoms, and ocular inflammation only occasionally precedes inflammatory involvement of the bowel.

Cytomegalovirus-associated anterior segment infection

Cytomegalovirus (CMV) has increasingly been found as a cause of anterior segment infection in immunocompetent patients. This may manifest as an endotheliitis or as an acute episodic or chronic recurrent anterior uveitis, which is often associated with ocular hypertension. Its diagnosis is based on aqueous analysis for CMV DNA by PCR or for CMV-specific antibodies. Although it has a high response rate to systemic, intravitreal and ganciclovir implant, the relapse rate is also high, and patients may require prolonged treatment. Topical ganciclovir gel has a lower response rate but also a lower relapse rate and fewer adverse effects. The main cause of visual loss in CMV anterior uveitis is glaucoma, and endothelial failure in endotheliitis. Therefore, early diagnosis and treatment is vital, and glaucoma therapy is an important adjunctive modality of management.

The treatment of recurrent uveitis with TNFα inhibitors

Uveitis is a severe manifestation of rheumatic diseases since it can lead to visual impairment and even blindness. Ocular involvement is frequently a clinical challenge because its occurrence often requires changes of the therapeutic strategy. There are growing evidence that tumor necrosis factor alpha (TNFalpha) inhibitors may be an effective treatment of refractory uveitis. Purpose of this study was to evaluate the efficacy and safety of TNFalpha blocking agents in patients with seronegative spondylo-arthropathies (SNSA) and Behcet disease (BD) associated relapsing uveitis. Five consecutive patients with chronic or relapsing uveitis were prospectively studied. Two patients with SNSA had recurrent anterior uveitis and three patients had BD associated uveitis (one anterior, two posterior uveitis). All of the patients were taking systemic and topical corticosteroids and three of them were also treated with DMARDs (methotrexate, cyclosporine, sulphasalazine) without clinical benefit. Four patients received infliximab, an anti-TNFalpha monoclonal antibody, at a dosage of 5 mg/kg body weight and one patient was treated with etanercept, a TNFalpha receptor p75-Fc fusion protein, at a dosage of 25 mg twice weekly. Both infliximab and etanercept induced a marked improvement in uveitis and none relapse was observed throughout all the study. Systemic corticosteroids were progressively tapered and stopped in all patients. Also methotrexate and sulphasalazine were discontinued, while cyclosporine dose has been reduced by 30%. No side effects were observed. Therapy with TNFalpha blockers, infliximab and etanercept, was effective and safe in the treatment of rheumatic disease associated uveitis. A complete remission was achieved even in patients with severe steroid resistant uveitis. Further controlled studies on larger number of patients are needed to better define the different forms of ocular involvement that can benefit from the therapy with TNFalpha inhibitors.

Skin tattoos and the development of uveitis

AbstractPurpose To report a case of recurrent non‐granulomatous anterior uveitis associated with tattoo inflammation.Methods A 28‐year‐old female presented to our ophthalmology department with a sharp shooting pain, photophobia and redness in both eyes but more pronounced in the right eye. A bilateral anterior uveitis was noticed. Simultaneously she experienced a rash at the site of her skin tattoos. The patient had her skin tattooed quite extensively at the chest, the back and around the umbilicus, between 13 years and one year ago.Results Investigations for causes of anterior uveitis, including general and infectious serologic testing, ACE, HLA‐B27 and chest X‐ray were normal. Clinical pneumological examination, thoracic CT and abdominal ultrasound showed no arguments for sarcoidosis. A tattoo biopsy showed a granulomatous response of lymphocytes and histiocytes around tattoo pigment, there was no histological evidence for sarcoidosis.Conclusion Tattoo granulomas can be a manifestation of sarcoidosis but may also be a delayed hypersensitivity reaction to pigment containing metallic tattoo compounds. The association of recurrent anterior uveitis with swelling of skin tattoos is an unusual occurrence. Similar cases of uveitis associated with tattoo inflammation have been reported in the literature.

Resolved Recurrent Bilateral Anterior Uveitis With Discontinuation of Bisphosphonate

Resolved Recurrent Bilateral Anterior Uveitis With Discontinuation of Bisphosphonate

Feline Leukocyte Adhesion Deficiency.

AbstractAbstract 3779Leukocyte adhesion deficiency (LAD) caused by CD18 deficiency is an autosomal recessive immunodeficiency which has been described in humans, Irish Setter dogs, Holstein cattle, and transgenic mice. We report here on the characterization of the clinical features and leukocyte function abnormalities of a novel feline model of leukocyte adhesion deficiency.The proband was a 5 year old male domestic longhair cat with a life-long history of infections, inflammation and granulomas. Severe gingivitis was recognized at 8 weeks of age which progressed to peridontitis and loss of all deciduous and adult teeth before 1 year of age. Over the next years this cat experienced recurrent severe upper respiratory infections, gastroenteritis, anterior uveitis, various abscesses, and epidermal sloughing with sepsis secondary to small grooming lacerations. The various illnesses seemed to be responsive to various long-term antibiotic as well as glucocorticoid treatments. Complete blood cell counts revealed a persistent severe leukocytosis (50-91,000/μl) due to mature neutrophilia with few toxic changes, and mild lymphocytosis, monocytosis and eosinophilia. Serum immunoglobulin concentrations were normal.Compared to feline control cells, neutrophils of the proband did not express any CD18 on the cell surface as determined with two monoclonal anti-CD18 antibodies but normal CD45 expression. Adhesion of affected neutrophils with and without PMA activation was severally impaired; the adhesion of normal feline neutrophils could be completely blocked by the anti-CD18 antibody. In a proliferation assay the proband's T-cells responded weakly at 1 pg SEA but near normally at 100 pg SEA, suggesting a CD18-independent T-cell response in cats. Sequencing of the feline CD18 β-integrin gene is being completed.In conclusion, this naturally-occurring feline model of CD18 deficiency exhibits similar features to LAD in other species. However, feline LAD seems clinically milder allowing for a longer life expectancy possibly due to T-cell independent activities. This LAD model may be helpful in developing and assessing novel therapies. Disclosures:No relevant conflicts of interest to declare.

Cytomegalovirus anterior uveitis: outcome of treatment

AimTo determine the outcome of antiviral treatment of cytomegalovirus (CMV) anterior uveitis.MethodsA retrospective review of patients from Singapore National Eye Centre with CMV anterior uveitis diagnosed by aqueous polymerase chain...

Bimatoprost 0.03% gel for cosmetic eyelash growth and enhancement

To evaluate a bimatoprost gel for enhancing eyelash growth, adverse effects, and change in intraocular pressure (IOP). Prospective, double-masked, randomized controlled study. Fifty-two patients without ocular disease were assigned a control or bimatoprost 0.03% gel to apply to the eyelid margin once a day. The adjusted mean change in eyelash length from baseline to 6 months was 0.77 mm in the bimatoprost group and -0.12 mm in the control group (P = 0.004). Adverse effects were experienced by 2 of 16 patients (12.5%) in the control group and 9 of 36 patients (25%) in the bimatoprost gel group. Mean change in IOP from baseline to 6 months was 0.685 mmHg in the control group and -2.04 mmHg in the bimatoprost group (P = 0.009). Bimatoprost gel was effective in enhancing eyelash growth. The most common adverse effect for the bimatoprost gel was conjunctival and eyelid hyperemia, while the most severe was recurrent anterior uveitis. Mean IOP was reduced in subjects using the bimatoprost gel.

Trabeculectomy in the Management of Glaucomatocyclitic Crisis with Visual Field Defect

Purpose: To investigate the effect of trabeculectomy in the management of glaucomatocyclitic crisis with uncontrolled intraocular pressures (IOPs) and visual field defects.Methods: Trabeculectomy was performed in 8 patients (2 males and 6 females) who had unilateral glaucomatocyclitic crisis with uncontrolled intraocular pressure (IOP) and visual field defects. After the surgeries the patients were followed up for 30.00 ± 17.24 (mean ± SD, the same below) months with best-corrected visual acuity (BCVA) and IOP measurements, keratic precipitates (KP), bleb and anterior chamber exams, and visual field tests.Results: Preoperative IOP of these patients was 50.13 ± 4.58 mmHg. By the end of follow-up, IOP in all patients was reduced to normal level (14.63 ± 2.33 mmHg) without any anti-glaucoma medications. Three patients had type I blebs, and 5 patients had type II blebs. Six patients had no recurrent attacks during the entire follow-up period, while recurrent anterior uveitis was observed in the other 2 patients (2 and 3 times, respectively). No visual acuity loss or further visual field loss was found in any of these patients at the end of follow-up.Conclusions: Trabeculectomy is a safe and effective method for the management of glaucomatocyclitic crisis with uncontrolled IOPs and visual field defects.

Clinical Features and Prognosis of HLA B27-associated Acute Anterior Uveitis in an Italian Patient Population

Purpose: To report clinical features and prognosis of HLA B27 acute anterior uveitis.Methods: 165 patients with recurrent acute anterior uveitis were divided into two groups: HLA B27-positive (group 1, 60 patients) and HLA B27-negative (group 2, 105 patients). A comparison between the two groups was performed.Results: Unilateral involvement was higher in group 1 (p = .046), and more simultaneous bilateral cases occurred in group 2 (p = .004). Group 1 was more correlated to systemic diseases than group 2 (50 versus 17.1%, p < .001), particularly to ankylosing spondylitis (35 versus 3.8%, p < .001). Uveitis was diagnosed before spondylitis in 57% of patients. In groups 1 and 2 an immunosuppressive therapy was administered to 20 and 9.5% of patients but was exclusively given to control uveitis in 1.6 and in 2.8% of cases, respectively.Conclusions: A strong association between HLA B27 uveitis and ankylosing spondylitis was confirmed and usually uveitis preceded rheumatological involvement.

Evolution and Management of a Post-Uveitis Macular Hole.

The case of a 44-year-old woman who was under treatment for bilateral recurrent anterior uveitis with chronic cystoid macular edema for two and a half years. She presented with an acute visual decline in her left eye, and was found to have a lamellar macular hole in the right eye and a full-thickness macular hole in the left eye. She underwent vitrectomy, internal limiting membrane peeling and perfluoropropane (C(3)F(8)) gas tamponade with simultaneous cataract extraction in the left eye. Her best-corrected visual acuity improved from 4/60 to 6/36 postoperatively, with closure of macular hole. Four months following vitrectomy, she developed cystoid macular edema in the operated eye, with a drop in vision to 6/60. An intravitreal injection of triamcinolone acetonide resulted in recovery of visual acuity 6/24, which was maintained till the last follow-up.

Cytomegalovirus as a Cause of Recurrent Anterior Uveitis in Immunocompetent Patients

Purpose: This study aimed to identify various infectious causes in unilateral recurrent hypertensive anterior uveitis in immunocompetent individuals. Methods: Twenty eyes of 20 patients diagnosed with recurrent hypertensive anterior uveitis, who had negative systemic uveitis lab results, were enrolled. Polymerase chain reaction (PCR) was performed in the aqueous humor and peripheral blood specimens to detect the following infectious agents: cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), varicella zoster virus (VZV), toxoplasma. Results: The mean age of 20 patients was 41.8 15.9 year (19-77 year), and 14 (70%) patients were male. CMV was positive in 7 eyes (35%) and was detected only in aqueous humor. HSV-1 was positive in 5 (25%) eyes; only in aqueous humor in 2 eyes, only in blood in 1 eye, and in both specimens in 2 eyes. Only 1 (5%) eye was positive for toxoplasma in the aqueous humor. Conclusions: This study demonstrated that CMV might be another major infectious cause in recurrent hypertensive anterior uveitis in immunocompetent patients. If CMV is detected, it might be reasonable to add appropriate antiviral agents, rather than treating only with immunosuppresive and hypotensive drugs.

Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up.

Curcumin has been successfully applied to treat inflammatory conditions in experimental research and in clinical trials. The purpose of our study is to evaluate the efficacy of an adjunctive-to-traditional treatment with Norflo tablets (curcumin-phosphatidylcholine complex; Meriva) administered twice a day in recurrent anterior uveitis of different etiologies. The study group consisted of 106 patients who completed a 12-month follow-up therapeutic period. We divided the patients into three main groups of different uveitis origin: group 1 (autoimmune uveitis), group 2 (herpetic uveitis), and group 3 (different etiologies of uveitis). The primary end point of our work was the evaluation of relapse frequency in all treated patients, before and after Norflo treatment, followed by the number of relapses in the three etiological groups. Wilcoxon signed-rank test showed a P < 0.001 in all groups. The secondary end points were the evaluation of relapse severity and of the overall quality of life. The results showed that Norflo was well tolerated and could reduce eye discomfort symptoms and signs after a few weeks of treatment in more than 80% of patients. In conclusion, our study is the first to report the potential therapeutic role of curcumin and its efficacy in eye relapsing diseases, such as anterior uveitis, and points out other promising curcumin-related benefits in eye inflammatory and degenerative conditions, such as dry eye, maculopathy, glaucoma, and diabetic retinopathy.

A significant association of viral loads with corneal endothelial cell damage in cytomegalovirus anterior uveitis

AimThe aim of the study was to investigate the correlation between the clinical manifestation and the cytomegalovirus (CMV) viral load in the aqueous humour of patients with CMV anterior uveitis.MethodsSeven...

Recurrent anterior uveitis in Henoch Schonlein’s vasculitis

Uveitis is an important component of many rheumatic diseases. The main causes of recurrent uveitis are seronegative spondylarthropathies and Behçet's disease. We describe a rare case of Henoch Schönlein vasculitis (HSV) along with multiple recurrences of acute anterior uveitis. In cases of skin rash and recurrent anterior uveitis, HSV should be considered in the differential diagnosis.

Late-onset Severe Diffuse Lamellar Keratitis Associated With Uveitis After LASIK in a Patient With Ankylosing Spondylitis

To report a case of diffuse lamellar keratitis (DLK) associated with acute anterior uveitis that occurred 3 years after uneventful LASIK in a patient with a history of ankylosing spondylitis and recurrent acute anterior uveitis. A 36-year-old man presented with pain and decreased vision in the left eye. Left eye visual acuity was 20/100. He had undergone bilateral LASIK 3 years prior to presentation to treat moderate myopia. Slit-lamp examination revealed aqueous flare and cells, vertical corneal folds, and cell aggregates at the central interface. Flattening and thinning of the cornea were observed with Pentacam (Oculus Optikgeräte GmbH). Diffuse lamellar keratitis stage III was diagnosed and intensive corticosteroid and anticollagenolytic treatment was started with satisfactory results. Acute anterior uveitis may be a predisposing factor for late-onset DLK after LASIK surgery. Indication of LASIK in patients at high risk of developing recurrent flares of acute anterior uveitis, such as those with spondyloarthropathies, should be carefully considered.

Enthesis inflammation in recurrent acute anterior uveitis without spondylarthritis

To investigate whether patients with idiopathic recurrent acute anterior uveitis (AAU) have enthesis alterations comparable with those in patients with spondylarthritis (SpA). A blinded, controlled study of enthesis evident on ultrasound (US) examination was performed in 100 patients and controls classified into 5 groups, as follows: patients with confirmed SpA (group 1), patients with recurrent AAU who were positive for HLA-B27 and did not have SpA (group 2), patients with recurrent AAU who were negative for HLA-B27 and did not have SpA (group 3), patients with forms of uveitis other than those related to SpA (group 4), and healthy controls (group 5). In total, 12 enthesis locations were explored in each patient and control subject by 2 ultrasonographers who were blinded with regard to the diagnosis. A newly developed US method, the Madrid Sonography Enthesitis Index (MASEI), in which the diagnosis of SpA is determined as a cutoff score of 18 points, was used. A total of 1,200 entheses were explored by US in 100 patients and controls. The MASEI cutoff limit was met or exceeded by 81%, 55.6%, 40%, 10%, and 19% of the subjects in the 5 groups, respectively. The MASEI score was significantly higher in groups 1 and 2 than in groups 4 and 5. The differences between groups 1 and 3 were also found to be significant. Our findings indicate that a high percentage of HLA-B27-positive patients with idiopathic recurrent AAU without features of SpA have enthesis lesions comparable with those seen in patients with SpA. These data suggest that patients with recurrent AAU, especially those who are HLA-B27 positive, have an abortive or incomplete form of SpA.

Intraocular lens exchange with removal of the optic only

To evaluate the clinical outcomes of intraocular lens (IOL) exchange in patients with an opacified ACRL-C160 intraocular lens (IOL) using an optic-only removal technique. Department of Ophthalmology, Soonchunhyang University Hospital, Seoul, Korea. The study comprised eyes with previous phacoemulsification and implantation of a single-piece hydrophilic acrylic IOL in the capsular bag and subsequent development of severe late opacification of the IOL. In all eyes, the IOL optic was explanted; any haptic with firm adhesions was left in the capsular bag. This was followed by placement of a new IOL. The perioperative complications were evaluated, and the best corrected visual acuity (BCVA) before surgery and after surgery was compared. Twenty-three eyes of 20 patients were evaluated. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 9 eyes (39.1%) and in the sulcus in 13 eyes (56.5%), with posterior capsule rupture in 2 eyes (8.7%). One eye (4.3%) developed zonular dehiscence, and scleral IOL fixation was performed. The mean BCVA was 0.64 +/- 0.35 logMAR before IOL exchange and 0.24 +/- 0.20 logMAR after IOL exchange. During 41 months of follow-up, 1 eye (4.3%) each was affected by recurrent anterior uveitis and delayed zonular dehiscence. The final mean BCVA was 0.38 +/- 0.40 logMAR. There was no corneal decompensation or infectious keratitis. The optic-only removal technique was a safe and helpful procedure that allowed recovery of visual acuity because it decreased the intraoperative complication of zonular dehiscence.

Two differing presentations of chronic bilateral anterior uveitis

Background Bilateral, recurrent, or chronic anterior uveitis requires a diagnostic evaluation to rule out any systemic cause. An understanding of the possible etiologies and their diagnostic criteria is needed to manage these patients. Treating any systemic cause can decrease the recurrent or chronic nature of the uveitis and favorably alter the course. Many possible systemic conditions are capable of causing anterior uveitis, including sarcoidosis. Case reports Two cases of chronic, recurrent, bilateral uveitis are presented. Both were evaluated for any systemic etiology. After extensive systemic workups, the first case had no identifiable systemic etiology, whereas the second case was associated with systemic sarcoidosis. Conclusion Although a medical workup may be necessary, it will not always lead to a systemic diagnosis. The literature indicates that up to about 50% of uveitic cases have no identified causes.