Severe Anterior Segment Inflammation Research Articles

Lens-induced uveitis following pars plana vitrectomy

Background: To report an unusual case of severe anterior segment inflammation with nodular iris infiltration 2 weeks after an uncomplicated Pars Plana Vitrectomy (ppvit) masquerading as endophthalmitis.

Commentary: Blockchain technology and its current importance in toxic anterior segment syndrome outbreak in India.

Commentary: Blockchain technology and its current importance in toxic anterior segment syndrome outbreak in India.

Endophthalmitis or toxic anterior segment syndrome?

Severe anterior segment inflammation after cataract surgery often alerts the ophthalmologist to two main differential diagnoses – toxic anterior segment syndrome (TASS) and acute post‐operative end...

Chronic Recurrent Vogt–Koyanagi–Harada Disease and Development of ‘Sunset Glow Fundus’ Predict Worse Retinal Sensitivity

ABSTRACTPurpose: To investigate prognostic factors for retinal sensitivity assessed by microperimetry in patients with Vogt–Koyanagi–Harada (VKH) disease.Methods: In total, 34 patients with initial-onset acute disease and 19 patients with chronic recurrent disease were retrospectively evaluated.Results: The mean follow-up period was 40.4 ± 40.5 months. Sensitivity was significantly worse in eyes with more severe anterior segment inflammation at presentation, as indicated by the presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, and posterior synechiae. Chronic recurrent presentation, development of complications, and ‘sunset glow fundus’ were significantly associated with worse sensitivity. Using logistic regression analysis, better sensitivity was significantly associated with initial-onset acute presentation (odds ratio, OR = 6.9; 95% confidence interval, CI = 1.53–9.66).Conclusions: Chronic recurrent presentation and development of complications and ‘sunset glow fundus’ are associated with a worse sensitivity outcome.

Prognostic factors for clinical outcomes in patients with Vogt-Koyanagi-Harada disease treated with high-dose corticosteroids

To determine prognostic factors in patients with Vogt-Koyanagi-Harada (VKH) disease who were treated with high-dose corticosteroids. Retrospective analysis of 87 patients (174 eyes). At presentation, there were 53 patients with initial-onset acute VKH disease and 34 patients with chronic recurrent VKH disease. Chronic recurrent presentation was significantly associated with more severe anterior segment inflammation at presentation as indicated by presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, iris nodules and posterior synechiae (p < 0.001 for all comparisons), less exudative retinal detachment at presentation (p < 0.001), more complications during the follow-up period (p < 0.001) and a worse visual outcome (p < 0.001). The use of immunomodulatory therapy (cyclosporine and mycophenolate mofetil) as first-line therapy significantly reduced the development of complications in the whole study group (p = 0.006) and in initial-onset acute group (p = 0.024) and improved visual outcome in the whole study group (p = 0.004) and in chronic recurrent group (p = 0.024). In the whole study group, final visual acuity of 20/20 was significantly associated with good initial visual acuity of >20/200 [odds ratio = 4.25; 95% Confidence interval (CI) = 1.53-11.89] and age older than 16 years was significantly associated with the development of complications (odds ratio = 3.15; 95% CI = 1.04-9.48). Chronic recurrent VKH disease is significantly associated with more severe anterior segment inflammation and less exudative retinal detachment at presentation, more ocular complications and a worse visual outcome than initial-onset acute VKH disease. Use of immunomodulatory therapy significantly improved the clinical outcomes.

Ketorolac tromethamine 0.5% ophthalmic solution in the treatment of moderate to severe ocular inflammation after cataract surgery:: A randomized, vehicle-controlled clinical trial

PURPOSE: To investigate the efficacy and safety of ketorolac tromethamine 0.5% ophthalmic solution (Acular; Allergan, Inc, Irvine, California) in the treatment of moderate to severe anterior segment inflammation developing after unilateral cataract surgery with intraocular lens implantation. METHODS: Only patients who exhibited moderate or greater levels of cells and flare 1 day after surgery were included in this multicenter, double-masked, randomly assigned, parallel-group study. Topical ketorolac or vehicle solution (Allergan, Inc) was administered to the treated eye four times daily, starting the day after surgery and continuing for 14 days. RESULTS: Ketorolac was significantly more effective than the vehicle solution in reducing anterior chamber cells ( P ≤ .030) and flare ( P ≤ .025), conjunctival erythema ( P ≤ .046), ciliary flush ( P ≤ .006), tearing ( P ≤ .012), photophobia ( P ≤ .014), and pain ( P ≤ .049). Half as many patients from the ketorolac group (14/51) were discontinued from the study for lack of efficacy, compared with the vehicle group (28/51; P = .005). There was no significant difference between ketorolac and the vehicle solution in changes in visual acuity, intraocular pressure, biomicroscopic or ophthalmoscopic variables, or adverse events. CONCLUSIONS: Ketorolac tromethamine 0.5% ophthalmic solution is safe and provides substantial anti-inflammatory activity in the treatment of moderate to severe anterior segment inflammation developing after cataract surgery and intraocular lens implantation.

Severe Anterior Segment Inflammation Following Corneal Surgery for Keratoconus

We present three keratoconus patients who experienced severe anterior segment inflammation, two following penetrating keratoplasty, and one following epikeratoplasty. A favorable response to indomethacin therapy in the second eyes of these patients suggests that the inflammation in the first ones was prostaglandin mediated.

Alloplastic Implants for the Correction of Refractive Errors

Convex-shaped, hydrophilic lenticles of various water content were implanted into microkeratome-dissected corneal pockets in a baboon model. Freshly trephined, cryolathed, and factory-lathed hydrogels were evaluated for periods exceeding 15 months, documenting clinical response, corneal curvature shifts, and morphologic features. Previously implanted hydrogels were subsequently removed, documenting the reversibility of the procedure while allowing the corneas to return to their preoperative condition. Various alloplastic materials were then reimplanted into the same intrastromal pockets. Medium and high water content lenses produced good results without affecting the recipient cornea, whereas thick or low water content materials extruded or produced severe anterior segment inflammation. The use of medium and high water content, convex-shaped lenticles for the correction of aphakia is possible using current techniques.