Signs Of Intraocular Inflammation Research Articles

Ocular Toxocariasis in The Anterior Chamber of The Eye

Introduction : Ocular toxocariasis (OT) is a zoonotic infection caused by Toxocara canis and Toxocara cati. Dogs and cats, the definitive hosts of the roundworm, pass unembryonated eggs via their feces into the environment (often into the soil). Transmission to humans occurs through ingestion of soil or contaminated food, or the fecal– oral route.
 Case Illustration : A 14 years old male presented with pain and redness in the right eye 2 months prior to the visit. Complaints are redness, itching, and pain especially in the night on the right eye. The patient had habits of eating raw meat and walking around in dirt without any footwear. Ophthalmologic examination showed a toxocara sp. larvae in the anterior chamber of the right eye. This patient treated with surgical removal of the worm, given antihelminth and topical corticosteroid.
 Discussion : Toxocariasis results from infection with Toxocara cati (an intestinal parasite of cats) or Toxocara canis (an intestinal parasite of dogs). Children acquire the disease by close association with pets and by eating dirt (pica) contaminated with Toxocara ova. The ingested ova form larvae that penetrate the intestinal mucosa and gain access to the systemic circulation and finally to the eye. Systemic or local corticosteroids should be given when there is evidence of significant intraocular inflammation.
 Conclusion : This case described a patient who was diagnosed with a living worm as foreign bodies in the right eye.

Delayed noninfectious intraocular inflammation and retinal vasculitis after single intravitreal Brolucizumab® injection for polypoidal choroidal vasculopathy

A 52-year-old woman with extrafoveal polypoidal choroidal vasculopathy (PCV) in her right eye was treated with a single intravitreal injection of 6 mg/0.05 ml brolucizumab (BZB) and focal thermal laser therapy. The patient complained of redness and blurred vision in her right eye for the previous week at the 4-week follow-up visit. PCV-related clinical findings revealed complete regression. There was circumcorneal congestion, diffuse nongranulomatous keratic precipitates, grade 2+ anterior chamber flare and cells, grade 1+ vitreous haze, posterior vitreous cells, hyperemic disc with perivascular sheathing, and retinal vasculitis. Following treatment with topical and systemic steroids, the intraocular inflammation (IOI) worsened, and vision was reduced to 6/60 after a week of steroid therapy at a subsequent follow-up visit. A pars plana vitrectomy was performed, and vitreous cytology revealed small lymphocytes with no evidence of intraocular infection. At the 6-month follow-up visit, the patient’s vision had improved to 6/6 and the signs of IOI had resolved. This case demonstrates that even after a single intravitreal injection of BZB, an eye that had previously received no antivascular endothelial growth factor injection can develop IOI.

Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery – a case report

BackgroundIntraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis.Case presentationA 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200.ResultsThe retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved.ConclusionThis report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.

Injectable Devices for Delivery of Liquid or Solid Protein Formulations

Sustained delivery of protein therapeutics remains a largely unsolved problem across anatomic locations. Miniaturized devices that can provide sustained delivery of protein formulations have the potential to address this challenge via minimally invasive administration. In particular, methodologies that can optimize protein formulation independent of device manufacture have the greatest potential to provide a platform suitable for wide applications. The techniques developed here demonstrate the fabrication of tubular devices for sustained release of protein therapeutics. Utilizing a dip-casting process, fine-scale tubes can be reliably produced with wall thickness down to 30 μm. Techniques were developed that enabled effective loading of either solid or liquid formulations, while maintaining a cylindrical form-factor compatible with placement in a 22-gauge needle. Further, highly compacted protein pellets that approach the expected density of the raw materials were produced with a diameter (∼300 μm) suitable for miniaturized devices. Release from a solid-loaded device was capable of sustaining release of a model protein in excess of 400 days. Given significant interest in ocular applications, intravitreal injection was demonstrated in a rabbit model with these devices. In addition, to simulate repeated injections in ocular applications, serial intravitreal injection of two devices in a rabbit model demonstrated acceptable ocular safety without significant intraocular inflammation from clinical exam and histology.

Risk Factors for Cytomegalovirus Retinitis in a National Survey in Sweden

ABSTRACT Purpose To investigate predisposing immunosuppressive conditions causing cytomegalovirus retinitis (CMVr) and risk factors for delayed diagnosis in patients diagnosed between 2008 and 2018 in the Swedish population of 10 million. Results Sixty-three consecutive patients (100 eyes) were diagnosed with CMVr. The most common immunosuppressive state predisposing for CMVr was hematopoietic stem cell transplant recipients (27%) and hematological malignancy (24%). Two patients (3.2%) had no other predisposing factor than diabetes mellitus (DM). Patients with delayed diagnosis (≤30 days) were older than those with earlier diagnosis, mean age 68.7 (±9.8) and 48.8 (±17.6), respectively, p = .001. Signs of intraocular inflammation (IOI) were seen in 42 (70%) of cases and more common in delayed than early diagnosis, 16 (89%) and 21 (60%) respectively (p = .03). Conclusion Delayed diagnosis was more common in older individuals with signs of IOI. DM may be a risk factor for CMVr, and clinical signs can be mistaken for diabetic retinopathy.

Metallic intraocular foreign body removal assisted through the extrusion line

AbstractPurpose: To describe an alternative vitreoretinal surgical manoeuvre, to remove metallic intraocular foreign bodies.Methods: Two patients, at different time lines, underwent vitrectomy to remove a metallic intraocular foreign body (IOFB). A 3‐port vitrectomy was performed, a 23‐G constellation vitrectomy equipment was used in both procedures, careful core vitrectomy was first done, vitreous adhesions and vitreous detachment was carefully done, retina was partially detached at the IOFB location, vitreous adhesions were cut and released gently not to increase the retinal detachment. Liquid prefluorocarbon was placed on the macula. As the vitreous adherences were cut, the IOFB was free from all potential tractional forces, the soft silicone tip cannula was held on to its surface, and at maximal vacuum aspiration, the IOFB was brought up to the anterior chamber, switching the light pipe for forceps in the other hand, and removed out of the eye. A complete as possible vitrectomy was performed, intraocular laser around the retinal brakes was performed, an intraocular lens was placed in the ciliary sulcus with the optic within the anterior capsule, and silicone oil was used as tamponade.Results: No signs of intraocular inflammation were recorded postoperatively. Intraocular silicone oil removal was done at the third post‐operative month in both cases, retina remained attached through follow up, both patients had over 9 months follow‐up visits, visual acuity improved from initial presentation, and also improved after the silicone oil tamponade removal.Conclusions: Active aspiration through the soft silicon tip cannula can be used to reach, and assist removal of metallic intraocular foreign bodies, being this manoeuvre safe, reproducible, possibly time‐saving, and also it could potentially avoid the risk of IOFB mobilization, avoiding further damage to the retina.

Neuroprotection in ophthalmology. Targets in the most frequent diseases. A clinician's point of view

AbstractObjectives: To briefly review the most frequent ocular diseases in which a neuroprotective treatment would be needed and to present the results of a translational research based on the neuroprotective capacities of allogeneic bone marrow‐derived mesenchymal stem cells (MSCs) in an ocular disease that currently lacks treatment, the non‐arteritic acute anterior ischemic optic neuropathy. (NA‐AION) considered as an infarct of the optic nerve head.Methods: After extensive preclinical evaluation of safety in rabbits, a prospective, non‐randomized, phase II clinical trial (Eudra CT number 2016–003029‐40 and ClinicalTrials.gov NCT03173638) was approved. Five patients with acute unilateral NA‐AION diagnosed within the first 2 weeks after symptom onset were included. After informed consent, patients received an intravitreal injection of 0.05 ml containing 150 μl of isotonic medium composed of Ringer's lactate, 0.5% human albumin, and 5 mM glucose, with a cell concentration of 1.5 × 106 cells/ml. The injection was administered using a 25‐gauge needle via the pars plana after topical anaesthesia. Patients were followed on days 1, 7, 30, 90, 180 and 1 year after injection. Safety was defined as the absence of an inflammatory reaction. The best‐corrected visual acuity, visual evoked potentials (VEP) and retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thicknesses were measured.Results: No patients had signs of intraocular inflammation at any time. An epiretinal membrane (ERM) developed in one patient. One phakic patient had a retrolental aggregate that did not progress to cataract. Four patients had visual improvement and three had increased amplitudes on the VEP recordings after treatment. The RNFL and GCL thicknesses decreased significantly in parallel with the visible papillary atrophy that developed during the follow‐up period.Conclusions: Despite development of an ERM in one patient and a possible cellular deposit in the retrolental space, the functional results are encouraging. A larger multicentre study of treated patients that includes a control group is currently running. The paracrine capacities of allergenic MSCs should be more extensively investigated in the clinic, taking advantage of their non‐immunogenicity, their ease of obtaining and their apparent safety.Financial support: Funded by Strategic Action in Health of the Institute of Health Carlos III (PIC18/00018), the Department of Regional Health of the Castilla y Léon Government (GRS 1928/A/19), and the Department of Education of the Castilla y León Regional Government (Grant VA077P17).

Safety and tolerability of intravitreal cetuximab in young and adult rabbits

To assess safety and tolerability of intraocularly applied cetuximab as epidermal growth factor receptor antibody, we conducted the experimental study which consisted of groups of adult rabbits (body weight: 2.4 kg) and young rabbits (body weight: 1.6 kg). All animals received three intravitreal injections of 0.5 mg cetuximab (Erbitux) (0.10 mL; 5 mg cetuximab/mL) into their right eyes in 4-week intervals, while the contralateral eyes received intravitreal injections of Ringer's solution. All animals underwent regular ophthalmological examinations at baseline and two-week intervals. Four weeks after the last injection, the animals were sacrificed, and the eyes were enucleated, fixed and examined by light microscopy. The study included 10 adult rabbits (age: 18 weeks; range: 17–19 weeks) and 8 young rabbits (age: 8 weeks; range: 7–10 weeks). Biometric measurements of axial length, anterior chamber depth and lens thickness and intraocular pressure readings did not differ significantly (all P > 0.05, Bonferroni corrected) between the right (study) eyes and the left (control) eyes, neither in the young nor in the adult rabbit group. Signs of intraocular inflammation or fundus peculiarities were not detected. Thickness of the outer nuclear layer, inner nuclear layer, combined outer and inner nuclear layer and outer plexiform layer, and total retina, measured at the posterior pole, posterior pole/equator midpoint, equator, and ora serrata region, did not vary significantly between study eyes and control eyes (all P > 0.05, Bonferroni corrected). The results suggest that repeated intravitreal application of cetuximab did not result in any detected intraocular toxic or destructive effect in young and adult rabbits, concurring with the notion of an intraocular tolerability of cetuximab.

Inflammation after Voretigene Neparvovec Administration in Patients with RPE65-Related Retinal Dystrophy

To report on the prevalence of intraocular inflammation after subretinal voretigene neparvovec (VN) administration. Retrospective review of medical files. All patients receiving VN in Denmark. Twelve patients received VN gene therapy as standard of care for biallelic RPE65-related retinal disease. Bilateral treatment was performed in 11 patients and unilateral treatment in 1 patient. Patients were followed clinically before and after VN administration using functional measurements (visual acuity, full-field scotopic threshold test, visual fields) and structural evaluations (fundus imaging [color and autofluorescence], OCT, slit-lamp). Signs of intraocular inflammation, including vitritis and outer retinal infiltrates. Vitritis was observed in 9 of 23 eyes receiving VN. The median time to resolution of vitritis from the time of treatment was 89 days. Four eyes also presented with outer retinal infiltrates at the time of vitritis. Inflammation subsided on immunosuppressant therapy. The presence of inflammation did not adversely affect visual outcome after VN therapy. In 1 eye, outer retinal infiltrates were demonstrated to precede later development of atrophy. Patients undergoing subretinal gene therapy need to be closely monitored for signs of inflammation. Although we did not observe a detrimental effect on visual function in eyes with inflammation, it seems wise to treat it appropriately because it may lead to atrophy of the retinal pigment epithelium and outer retina. Also, it seems advisable to reduce the inflammatory load, such as using a surgical technique that minimizes residual viral vectors in the vitreous body.

A CONSENSUS ON RISK MITIGATION FOR BROLUCIZUMAB IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Patient Selection, Evaluation, and Treatment.

Brolucizumab has high efficacy in retinal fluid resolution and provides the possibility for longer dosing intervals in the treatment of neovascular age-related macular degeneration. However, brolucizumab has been associated with events of retinal vasculitis and retinal vascular occlusion typically in the presence of other signs of intraocular inflammation (IOI). The purpose of this report is to provide guidance on the use of brolucizumab for neovascular age-related macular degeneration to a global audience. A literature review was conducted on adverse events related to IOI after administration of brolucizumab in eyes with neovascular age-related macular degeneration. Possible risk factors for IOI and retinal vascular occlusion after brolucizumab should be considered before administering brolucizumab. Patients who receive brolucizumab should be educated on the symptoms, signs, and time course of IOI after brolucizumab. Before each injection of brolucizumab, physicians should assess the eye for any signs of inflammation and not treat with brolucizumab if inflammation is detected. Treatment of IOI should be prompt and provided with particular attention to the posterior segment. Careful patient selection, patient education, assessment for inflammation, and intensive treatment of possible inflammation are important when using brolucizumab in patients with neovascular age-related macular degeneration.

Susac Syndrome: A Case Series.

Susac syndrome (SS) is an autoimmune disorder that involves the eyes, the brain, and the ears. It is a rare cause of recurrent branch retinal artery occlusion. The purpose of this study was to report cases of SS, highlighting the clinical presentations, therapeutic options, and their outcome. Retrospective case series of patients seen at our institution for SS between 2005 and 2020. Demographics, clinical characteristics, treatment, and outcome were studied. Four patients (3 females, mean age 29 years old) were included in the study. According to the recently revised diagnostic criteria, three patients had definite and one patient had probable SS (distinctive ophthalmological and brain involvement without ear involvement). Initial visual acuity (VA) was normal in all eyes, but two patients had unilateral visual field impairment. Gass plaques (defined as yellow-white plaques found in the arteriolar wall away from arterial bifurcations) were observed on fundus examination in all patients. Fluorescein angiography revealed arteriolar wall hyperfluorescence and branch retinal arterial occlusions (BRAOs) in the absence of other signs of intraocular inflammation in all patients. Initial treatment consisted of a high-dose corticosteroid (intravenous or oral) with additional immunosuppressive therapy (azathioprine, intravenous immunoglobulins, mycophenolate mofetil, and/or cyclophosphamide). Residual symptoms were present in all patients and included scotoma (n = 2) and hearing loss (n = 3). SS is a rare disease with characteristic ophthalmological manifestation. The majority of patients present a crude form of the triad, and retinal findings may be the first initial manifestation. Ophthalmologists should consider the possibility of an SS in all young patients presenting with BRAOs.

A Case of Unilateral Choroidal Granuloma as a Sole Presentation of Sarcoidosis

<strong>Introduction:</strong> Sarcoidosis is an inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands. It is one of the leading causes of inflammatory eye disease. The most common ocular manifestations are uveitis and conjunctival involvement. However, it can involve any part of the eye and its adnexal tissues and cause episcleritis/scleritis, eyelid abnormalities, conjunctival granuloma, optic neuropathy, lacrimal gland enlargement and orbital inflammation. Rarely, it can present as bilateral choroidal granuloma. However, choroidal granuloma without other signs of intraocular inflammation and/or systemic involvement is an extremely rare manifestation. <strong>Case Description:</strong> A 38-year-old African American woman came to the ophthalmology service with the primary complaint of decreased visual acuity in her right eye and right eye pain. Upon examination, a serous macular detachment secondary to central serous retinopathy and a solitary choroidal granuloma were observed. On physical examination, she had eyelid enlargement and facial papules. Laboratory findings showed elevated ACE, while ANA, ANCA, Lyme, Syphilis, anti-dsDNA, QuantiFERON, RF, IL-2 R and lysozyme were all negative. A CT of the chest showed only mildly increased mediastinal lymph nodes in the right paratracheal region. Ophthalmology, rheumatology, and pulmonary teams were involved in further management. Treatment was started with daily oral prednisone and consequent addition of methotrexate which eventually resulted in reduced size of granuloma, resolution of the eye pain and improvement in vision. <strong>Discussion:</strong> There is no single way to diagnose sarcoidosis. Primary occurrence is, most often, between 20 and 40 years of age, with women being diagnosed more frequently than men. The disease is 10 to 17 times more common in African Americans than in Caucasians. The main diagnostic tools include Chest X-rays and high-resolution CT scan to look for pulmonary infiltrates or lymphadenopathy. Some patients with sarcoidosis may have elevated serum calcium levels, angiotensin converting enzyme (ACE) and/or lysozyme. The gold standard for the diagnosis is a tissue biopsy. However, suspected lesions may not be easily accessible, as in this case where only the eye was affected. Ocular sarcoidosis can involve any part of the eye and its adnexal tissues. A solitary choroidal granuloma is one of the manifestations recognized in sarcoidosis, though the much more common manifestation is bilateral uveitis (reported in 30–70% of cases) and conjunctival nodules (found in 40% of cases). Ophthalmic manifestations can be isolated but most patients have evidence of systemic involvement at the time of the initial examination and have bilateral ocular presentation, unlike this patient who had solitary, unilateral choroidal granuloma without other signs of intraocular inflammation and systemic involvement. <strong>Conclusion:</strong> There are several cases of sarcoidosis reporting choroidal granuloma with either other ocular involvements and/or associated hilar lymphadenopathy and other systemic manifestations. This patient is a rare case where the sole presentation of sarcoidosis is a unilateral solitary granuloma. Biopsy was not feasible due to location of the lesion. This case shows the importance of a multi-disciplinary approach in rare cases where the gold standard for diagnosis is not possible.

Ocular manifestations of Chikungunya fever in the chronic phase.

To identify ocular manifestations in patients with Chikungunya fever in the chronic phase and describe their sociodemographic profile. Patients with serologic confirmation of Chikungunya infection were included in this transverse study. All subjects underwent a comprehensive ophthalmologic evaluation, including specific lacrimal function tests (tear break-up time test, Schirmer test, and lissamine green). Overall, 64 eyes of 32 patients were evaluated. Most patients were women (71.9%), with the mean age of 50.0 ±13.7 years. The mean interval between serologic confirmation and the examination was 12.7 ±7.7 months. Twenty patients (62%) presented with dry eye. No statistically significant association was observed between dry eye and infection diagnosis time (p=0.5546), age (p=0.9120), sex (p=1.00), race (p=0.2269), arthralgia in acute infection (p=0.7930), retro-orbital pain (p=0.3066), and conjunctivitis (p=1.00). Dry eye was the most prevalent manifestation observed. No signs of intraocular inflammation and affected visual acuity were observed.

Ophthalmic safety profile of antiangiogenic therapy

Antiangiogenic therapy with inhibitors of vascular endothelial growth factor (anti-VEGF) has not only fundamentally changed the treatment outcomes of vasoproliferative eye diseases, but also became the most common ophthalmic surgical manipulation. At the same time, in 36-48% of bilateral lesions there is a need to perform injections in both eyes, making relevant the issues of safety and prevention of severe complications that threaten irreversible loss of visual function. The article reviews the results of randomized clinical trials and real clinical practice, analyzes the incidence and causes of its most dangerous complication - endophthalmitis, characterizes the clinical course depending on the type of drug used, and considers the possibility of reducing the risk of this complication occurring. Special attention is paid to the safety profile of a new VEGF inhibitor - brolucizumab - which has received registration for the treatment of neovascular age-related macular degeneration (nAMD). Specialists dealing with retinal pathologies acknowledge the need to monitor the state of the anterior and posterior parts of the eye in order to detect the signs of intraocular inflammation as quickly and early as possible. Drug efficacy, treatment regimen, duration of action and safety are the main characteristics that should determine the personalized approach in each clinical case.

En Face OCT of Type 2 Neovascularization:A Reappraisal of the Pitchfork Sign.

To describe a new en face optical coherence tomography (OCT) imaging feature of type 2 choroidal neovascularization (CNV) and illustrate the OCT angiographic (OCTA) findings in these eyes. Multimodal images of patients with type 2 CNV who displayed the typical "pitchfork" sign with cross-sectional OCT were reviewed. Corresponding en face structural OCT and OCTA images were analyzed to correlate the finding before and after anti-vascular endothelial growth factor (VEGF) therapy. Five eyes of five patients, including two females and three males with a median age of 13 years (range: 8 years to 84 years), were studied. The etiology for type 2 CNV was laser-induced maculopathy in two eyes, idiopathic in two eyes, and age-related macular degeneration in one eye. None of the eyes had evidence of inflammatory ocular disease. En face OCT displayed a characteristic wreath-like pattern of hyperreflective spikes surrounding the type 2 neovascular membrane that originated from the ellipsoid zone and extended into the outer nuclear layer. Wreath-like spikes resolved with intravitreal anti-VEGF injection with good visual outcomes and transformation of the neovascular lesion from a type 2 to type 1 morphology. Type 2 CNV associated with the pitchfork sign with cross-sectional OCT displayed a characteristic wreath-like pattern of hyperreflective spikes with en face OCT that resolved with anti-VEGF therapy. This form of type 2 neovascularization may occur in eyes with different underlying etiologies and without signs of intraocular inflammation and is not limited to pediatric patients. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:719-725.].

Primary open angle glaucoma treated by high intensity focused ultrasound (HIFU): results at 18 months of a prospective pilot study on patients treated with the 2nd generation probe

PurposeTo assess the safety and efficacy of Ultrasound Ciliary Plasty (UCP procedure) using HIFU (high intensity focused ultrasound) with a second‐generation probe which increases the treatment surface area and the firing duration in patients with primary open angle glaucoma.MethodsProspective clinical series performed in two University Hospitals, on twenty eyes of twenty patients with primary open‐angle glaucoma, treated with the EyeOP1 medical device equipped with six miniaturized cylindrical piezoelectric transducers of a new generation with an increased lesion volume. All eyes were treated with an 8‐s exposure time per transducer. The main assessment criteria were safety and efficacy measured by the incidence of complications and IOP reduction. Ophthalmic examination and ultrasound biomicroscopy were performed before treatment and during clinical follow‐up at D7, M1, M3, M6, M12, M18 and M24.ResultsNo major intra‐ or post‐operative complications were observed during follow‐up period. Clinical examination showed no lesions of ocular structures other than the ciliary body and no or few signs of intraocular inflammation after treatment. The mean intraocular pressure was significantly reduced from 29.1 ± 5.4 mmHg before treatment to 17.8 ± 6.2 mmHg at last follow‐up. Five patients have needed a second ultrasound procedure and two patients a third procedure. With a mean follow‐up of 18 months, success rate, as defined by an IOP reduction &gt;20% after one or more UCP procedures was 67%. The mean IOP reduction achieved in responding patients was 44%.ConclusionsCoagulation of the ciliary body using high intensity focused ultrasound carried out with the new‐generation of miniaturized transducers is a simple, well‐tolerated procedure which enables to significantly reduce the intraocular pressure in patients with Open Angle Glaucoma.

Biocompatibility of a Novel Microfistula Implant in Nonprimate Mammals for the Surgical Treatment of Glaucoma.

The purpose of this study was to evaluate the ocular safety of a novel microfistula implant and its composite materials in an animal model. The anterior chambers of 12 rabbit eyes were injected with either glutaraldehyde cross-linked porcine gelatin extract or balanced salt solution and were followed by serial slit lamp examinations over 3 days. The eyes of 18 canines underwent microfistula implantation or a sham procedure. The animals were monitored over the subsequent 12 months, using serial slit lamp examinations, indirect ophthalmoscopy, tonometry, specular microscopy, and high-resolution ultrasonography. Ocular tissues were examined histopathologically on postoperative days 7, 30, 90, 180, and 365. Glutaraldehyde cross-linked porcine gelatin did not induce significant intraocular inflammation in the rabbit model. The microfistula implant was well tolerated and did not stimulate significant tissue response in the canine eye. The microfistula tube did not undergo structural change or degradation over the course of the study. In nonprimate mammals, the material composing the microfistula implant and the implant itself do not induce significant inflammation or tissue reaction.

Antibiotics versus no treatment for toxoplasma retinochoroiditis.

Acute toxoplasma retinochoroiditis causes transient symptoms of ocular discomfort and may lead to permanent visual loss. Antibiotic treatment aims primarily to reduce the risk of permanent visual loss, recurrent retinochoroiditis, and the severity and duration of acute symptoms. There is uncertainty about the effectiveness of antibiotic treatment. To compare the effects of antibiotic treatment versus placebo or no treatment for toxoplasma retinochoroiditis. We searched CENTRAL (which contains the Cochrane Eyes and Vision group Trials Register) (2016, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2016), EMBASE (January 1980 to February 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to February 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 22 February 2016. We searched the reference lists of identified articles and contacted pharmaceutical companies for unpublished trials. We included randomised controlled trials that compared any antibiotic treatment against placebo or no treatment. We excluded trials that included immunocompromised participants. We considered any antibiotic treatment known to be active against Toxoplasma gondii. Antibiotic treatment could be given in any dose orally, by intramuscular injection, by intravenous infusion, or by intravitreal injection. The primary outcomes for this review were visual acuity at least three months after treatment and risk of recurrent retinochoroiditis. Secondary outcomes were improvement in symptoms and signs of intraocular inflammation, size of lesion, and adverse events. We used standard methodological procedures expected by Cochrane. Four trials that randomised a total of 268 participants met the inclusion criteria. In all four studies antibiotic was administered orally.One study conducted in Brazil in both adults and children compared trimethoprim-sulfamexacocol over 20 months to no treatment and was judged to be at high risk of performance, detection, and attrition bias. The other three studies compared antibiotic treatment to placebo. We judged these three studies to be at a mixture of low or unclear risk of bias due to poor reporting. One study conducted in the US in adults studied pyrimethamine-trisulfapyrimidine for eight weeks; one study conducted in the UK in children and adults evaluated pyrimethamine for four weeks; and one study conducted in Brazil in adults investigated trimethoprim-sulfamethoxazole for 12 months. In the last study, all participants had active retinochoroiditis and were treated with antibiotics for 45 days prior to randomisation to trimethoprim-sulfamethoxazole versus placebo.Only the study in Brazil of trimethoprim-sulfamethoxazole over 12 months, in participants with healed lesions, reported the effect of treatment on visual acuity. People treated with antibiotics may have a similar change in visual acuity compared with people treated with placebo at one year (mean difference -1.00 letters, 95% confidence interval (CI) -7.93 to 5.93 letters; 93 participants; low-quality evidence).Treatment with antibiotics probably reduces the risk of recurrent retinochoroiditis compared with placebo (risk ratio (RR) 0.26, 95% CI 0.11 to 0.63; 227 participants; 3 studies; I(2) = 0%; moderate-quality evidence); similar results were seen for acute and chronic retinochoroiditis.The UK study of pyrimethamine for four weeks reported an improvement in intraocular inflammation in treated compared with control participants (RR 1.76, 95% CI 0.98 to 3.19; 29 participants; low-quality evidence). The study in Brazil of trimethoprim-sulfamethoxazole for 12 months stated that the severity of inflammation was higher in the comparator group when compared to the antibiotic-treated group but did not provide further details. In the US study of pyrimethamine-trisulfapyrimidine for eight weeks intraocular inflammation had almost completely resolved by eight weeks in all participants, however in this study all participants received steroid treatment.Two studies (UK and US studies) reported an increased risk of adverse events in treated participants. These were a fall in haemoglobin, leucocyte, and platelet count, nausea, loss of appetite, rash, and arthralgia. Treatment with antibiotics probably reduces the risk of recurrent toxoplasma retinochoroiditis, but there is currently no good evidence that this leads to better visual outcomes. However, absence of evidence of effect is not the same as evidence of no effect. Further trials of people with acute and chronic toxoplasma retinochoroiditis affecting any part of the retina are required to determine the effects of antibiotic treatment on visual outcomes.

Long-term Outcomes of Limited Vogt-Koyanagi-Harada Syndrome

To describe the long-term outcomes of patients with limited Vogt-Koyanagi Harada syndrome (VKH), characterized by steroid-responsive serous retinal detachments without other signs of intraocular inflammation. Retrospective case series. Consecutive patients from the Royal Victorian Eye and Ear Hospital with acute bilateral serous retinal detachments without anterior chamber inflammation, with no previous ocular history or trauma, and with negative screening for vasculitis and other systemic autoimmune disease were included. Serous retinal detachment was confirmed on optical coherence tomography (OCT) and fundus fluorescein angiography. Visual acuity, treatment regimen, complications, and duration of follow-up were recorded. Nine patients (6 male, median age 29 years [interquartile range (IQR) 27-36 years]) from January 2010 through May 2014 were studied. Median presenting logMAR visual acuity (VA) was 0.48 (IQR-0.1 to 3.0). Six patients were initially commenced on intravenous methylprednisolone for 3days, followed by oral prednisolone. All received a course of tapering oral prednisolone (1mg/kg prior to taper). Median duration of treatment was 9weeks (IQR 8-14weeks). Median time to complete resolution of subretinal fluid on OCT was 3.7weeks (range, 2-12weeks), with a corresponding improvement in VA (median logMAR 0.00; range,-0.08 to 0.04). There was no recurrence after a mean follow-up of 145.2weeks (95% confidence interval 72.5-217.9). In contrast to typical VKH, patients with limited VKH in our series appear to have good outcomes with systemic corticosteroid treatment. They have a marked improvement of VA and no episodes of relapse after cessation of corticosteroid treatment.

Three-month outcome of ziv-aflibercept for exudative age-related macular degeneration

PurposeIn vitro and in vivo studies did not detect toxicity to the retinal pigment epithelium cells using intravitreal ziv-aflibercept. Our purpose is to ascertain the 3-month safety and efficacy in...