Vitreous Haze Research Articles

Following the migration of a Toxocara larva in the retina by optical coherence tomography and fluorescein angiography

The Toxocara larva is known to migrate across the retina, but the layer in which it migrates and its effect on the retina has been unknown. An ocular Toxocara infection was diagnosed by an immunological test on a vitreous sample from a patient with a retinal lesion that had migrated. Optical coherence tomography (OCT) and fluorescein angiography (FA) were used in this investigation. Many small lesions were first detected in the peripheral retina, and vitrectomy was performed because of vitreous haze. Two peripapillary lesions were found during the vitrectomy. OCT of one lesion demonstrated a highly reflective mass located in the nerve fiber layer, and FA showed dye leakage from the lesion as well as hyperfluorescence of the disc. Three weeks later, another lesion was found in the macular area, and OCT and FA findings were the same as for the first lesions. Fluorescein leakage was also observed along the presumed path of the migrating larva. The movement of the lesion from the peripapillary area to the macular area suggested that a Toxocara larva had migrated across the retina. OCT images indicated that the larva moved in the nerve fiber layer, and FA showed that it caused severe inflammation along its pathway.

RETINAL DETACHMENT IN ATOPIC DERMATITIS CAN MASQUERADE AS ACUTE PANUVEITIS WITH RAPIDLY PROGRESSIVE CATARACT

To report two cases of retinal detachment in young patients with atopic dermatitis masquerading as acute panuveitis. Retrospective observational clinical case reports. Patients with atopic dermatitis presenting with acute panuveitis and subsequently diagnosed with retinal detachment at the Singapore National Eye Centre. A review of the clinical case records. Two young patients aged 19 and 21 years with a history of atopic dermatitis presented with acute unilateral moderately severe panuveitis. Both developed rapidly progressing cataracts that made detailed visualization of the fundus difficult. Hypotony persisted in one eye despite partial response of uveitis to therapy. The other patient developed ocular hypertension when the vision in the affected eye suddenly deteriorated. Both eyes demonstrated partial response to steroid therapy. The diagnosis of shallow retinal detachment with anteriorly located incriminating retinal breaks was made after partial resolution of vitreous haze in one case and on repeated ultrasonography in the other case. A high index of suspicion is required when examining young patients with atopic dermatitis who present with acute panuveitis and a rapidly progressive cataract, which may mask the presence of a shallow retinal detachment.

Neonatal candidiasis: ophthalmologic infection

Endophthalmitis results from hematogenous seeding of the eye in preterm infants with candidiasis. Early systemic therapy decreases the frequency of eye involvement, now only about 6% in infants with systemic candidiasis. Eye disease can occur on the first day, but is more likely with prolonged candidemia. Candida albicans and C tropicalis predominate in newborns. Indirect ophthalmoscopy will identify the characteristic unilateral or bilateral, yellow-white, fluffy, retinal or vitreal balls with frequent hemorrhage or inflammatory vitreous haze. Systemic antifungal therapy alone usually results in good visual outcome, but unresponsive or recurrent lesions are reported. Lens abscesses presenting as cataracts may be seeded before regression of the tunica vasculosa lentis, leaving an infection nidus in a subsequently avascular structure that is poorly reached by antifungal drugs. Lensectomy may be required to clear the visual field and the infection. Candidemia is also implicated in progression of retinopathy of prematurity to stage 3 or beyond, possibly due to induction of cytokines or angiogenic factors.

Infliximab in the treatment of refractory posterior uveitis

Purpose To determine the efficacy and safety of infliximab in the treatment of refractory posterior uveitis. Design Noncomparative interventional case series. Participants Five patients with posterior uveitis were treated: 3 had Behçet’s syndrome, and 2 had idiopathic posterior uveitis. Interventions Patients with sight-threatening uveitis refractory to other immunosuppressive agents were treated with infliximab. Main outcome measures Intraocular inflammation, by using binocular indirect ophthalmoscopy score, retinal vasculitis, and visual acuity. Adverse effects of infliximab were documented. Results Within 2 weeks of the first infusion of infliximab, 4 of 5 patients showed marked improvement in vitreous haze and visual acuity. By the 6-month follow-up, the same four patients had achieved remission of posterior uveitis and had successfully withdrawn all other immunosuppressive therapy. Further infusions of infliximab were required in 3 patients. One patient developed ocular and systemic tuberculosis, which responded to antituberculous treatment. Conclusions Infliximab is effective in the treatment of sight-threatening refractory posterior uveitis. However, patients should be thoroughly screened for tuberculosis before treatment and followed up closely during and after therapy with infliximab.

Features associated with surgical outcome in patients with stages 4 and 5 retinopathy of prematurity.

To present ocular features associated with surgical outcomes in infants with stages 4 and 5 retinopathy of prematurity (ROP). Twenty-two infants (35 eyes) were referred for vitreoretinal surgery for stages 4 and 5 ROP. The following ocular features recorded before the development of retinal detachment requiring surgical intervention were analyzed: clock hour extent of ridge elevation, vitreous state, plus disease, prominent iris vessels, neovascularization, and the presence of exudates. Surgical procedures included scleral buckle, lensectomy-vitrectomy, and lens-sparing vitrectomy. Univariate and multivariate analyses were used to determine features associated with failure to achieve retinal reattachment as the main outcome variable. Of the 35 eyes that underwent at least one surgical procedure, nine had successful retinal reattachment after the first surgery, and 18 achieved it at the end of follow-up. After accounting for the correlation between the eyes, features significantly associated with surgical failure after the first surgery were vitreous haze, hemorrhage, or organization; plus disease; and neovascularization. The presence of exudates was significantly associated with a successful outcome. When eyes were analyzed by stage at the first procedure, vitreous organization and plus disease were associated with failed retinal reattachment in stage 4 eyes, whereas at least 6 clock hours of ridge elevation and plus disease were significant in stage 5 eyes. The need to perform a lensectomy-vitrectomy was associated with a poor surgical outcome. Neither stage nor number of procedures performed was associated with the development of phthisis. Vitreous haze, neovascularization, and plus disease are associated with a poor surgical outcome in eyes that progress after treatment for threshold ROP requiring surgical intervention for retinal detachment. When eyes were divided by stage of ROP at first surgery, plus disease remained a significant variable associated with failed retinal reattachment. Close observation of eyes after laser treatment for threshold ROP is necessary. If neovascularization and plus disease persist and progression of ROP is noted, additional laser should be considered before surgery for retinal detachment. Additional studies with a larger patient sample will be necessary to further define ocular features associated with surgical outcome for ROP.

Infliximab for severe ocular inflammation in patients with Behcet's disease

A single infusion of the anti-tumour necrosis factor monoclonal antibody Infliximab, given in five patients with Behcet's disease (BD) and sight-threatening panuveitis relapse, resulted in rapid and effective suppression of ocular inflammation [1]. Until May 2003, a single Infliximab infusion (5 mg/kg) has been given in a total of 24 such patients (bilateral relapse or unilateral relapse in 18 and six patients, respectively). At day 1 post-treatment, a significant improvement of visual acuity, a striking decrease of anterior chamber cells, and a 50% decrease of vitreous haze was evident in all patients but one. Within 2 weeks, acute ocular inflammation, including retinal lesions and vasculitis, resolved completely in 26 eyes, and by 80–90% in six eyes. Visual acuity returned to the prerelapse levels (at least) in all. We are currently looking at the safety and efficacy of continuous Infliximab infusions (at week 0, weeks 3–4, and every 6–8 weeks thereafter, at 5 mg/kg) in patients who do not respond, or in patients with an inadequate response to prednisolone (nine patients), combined either with cyclosporin A (six patients) and/or azathioprin (five patients), or cyclophosphamide (one patient). In the 17 affected eyes, visual acuity has improved by a mean of three lines in the Shnellen chart at 6 months compared with at baseline. This effect has been sustained during further follow-up (6 months-2 years). Concomitant immunosuppressive therapy has been significantly tapered in all. No patient has experienced an ocular relapse requiring other than topical treatment, or a major extra-ocular relapse of the disease. No possible side effects, including opportunistic infections or an exacerbation of previous neurological disease (present in three of nine patients), have been noted. Similar results have been obtained in a parallel study looking at safety and efficacy of continuous Infliximab infusions as monotherapy in previously untreated patients, which is also underway. Since conventional immunosuppressive treatment BD-associated acute ocular relapse is often unable to rapidly control ocular inflammation, which is critical to avoid development of chronic lesions, we suggest that a single infusion of Infliximab with observation for objective improvement is the treatment of choice in these patients, and that continuous treatment of Infliximab is a safe, effective and immunosuppressive therapy-sparing approach for patients with refractory, relapsing ocular disease.

Management of rhegmatogenous retinal detachment without detectable breaks.

To evaluate the causes of failure to find retinal breaks, the anatomical and functional outcomes of patients with rhegmatogenous retinal detachment (RD) without detectable breaks (Group I), to compare the results with detectable breaks (Group II). Forty-five out of 258 eyes that had RD without detectable breaks were analysed retrospectively. The causes of failure to find retinal breaks were aphakia/pseudophakia in 22 eyes, small pupil without any eye disease in four eyes, corneal opacity in two eyes, cataract in two eyes, vitreous haze in two eyes, choroidal detachment in one eye, and unknown cause in 12 eyes. After a single scleral buckling procedure, anatomical re-attachment of the retina successfully occurred in 62.2% of group I and 78.9% of group II patients. After repeated surgery, final anatomical success rates were 87.2% and 90.2%, respectively. The best corrected visual acuity was 6/60 or better in 53.9% in Group I and 52.5% in Group II. The main cause of failure to find the retinal break was aphakia or pseudophakia. Although the rates of retinal reattachment in eyes without detectable breaks in primary buckling surgery was lower than detectable breaks and reoperations were required more frequently, final success rates were satisfactory and similar in both groups.

Delayed endophthalmitis in a child following an Ahmed glaucoma valve implant

J AAPOS 2002;6:123-5.

Preclinical Evaluation of a Phosphorothioate Oligonucleotide in the Retina of Rhesus Monkey

Overexpression of vascular endothelial growth factor (VEGF) has been strongly implicated in the development of choroidal neovascularization (CNV) in patients with age-related macular degeneration. In this study, a phosphorothioate oligonucleotide (PS-oligo) targeting both human and rat VEGF165 genes upstream of the translation initiation code, named DS135 in this study, was evaluated for its uptake dynamics and retinal tolerance after intravitreal (IV) and subretinal (SR) injections in the rhesus monkey. Intravitreal and SR injections of a fluorescent-labeled DS135 (FL-DS135) resulted in both dose- and time-dependent uptake and persistence, and FL-DS135 remained detectable in the retina for at least 3 weeks after injection. Ophthalmic examination showed transient vitreous haze after IV delivery of a high dose but not with a low dose of FL-DS135. Histologic examination showed no evidence of retinal degeneration with respect to IV delivery. After SR delivery, however, dose-related cellular infiltration, transient residual fluid, and slight distortion of the neuroretina were observed. The biologic efficacy of DS135 was further assessed in a laser-induced CNV model, and development of CNV was determined by fluorescein angiography and histologic examination. Incomplete inhibition of CNV formation was observed after IV and SR injection of DS135, but no statistically significant difference was achieved when compared with dose-matched control of PS-oligo. Analysis of fluorescein angiogram and histologic examination showed less than 30% incidence of CNV development in this monkey model. Our study demonstrated that PS-oligos can be successfully introduced into the retina, although with potential limitations, after SR delivery. DS135, a PS-oligo targeting the VEGF gene upstream of the translation initiation code, partially inhibited CNV formation. An improved CNV model is necessary for further confirmation of the full therapeutic potency of DS135 before clinical application.

The safety and efficacy of chicken type II collagen on uveitis associated with juvenile rheumatoid

Purpose: To investigate the safety and efficacy of chicken type II collagen in treating uveitis associated with juvenile rheumatoid arthritis (JRA). Methods: A prospective dose-ranging (60 and 540µg) pilot study of orally administered chicken type II collagen in 13 participants, aged 2-18 years, with JRA and uveitis and without prior exposure to collagens. Anterior chamber cells, flare, vitreous haze, visual acuity, and concomitant anti-inflammatory medications were the ophthalmic outcomes. Arthritis outcomes included the American College of Rheumatology (ACR) core set. Results: No serious or related adverse events were reported. Four participants (2 low dose, 2 high dose) experienced improvement in ophthalmic outcome, while two participants (1 in each group) worsened (p > 0.5). According to ACR criteria, six participants showed improvement in JRA. Conclusions: Although appearing safe, clearly demonstrating the efficacy of this treatment for JRA or uveitis remains a challenge. Based on the results from this pilot study, a large positive treatment effect on uveitis is unlikely.

The effect of pars plana vitrectomy in the management of Fuchs heterochromic cyclitis.

Fuchs heterochromic cyclitis (FHC) is characterized by a unilateral chronic iridocyclitis of insidious onset and uncertain cause. Our aim was to evaluate the effect of vitreous surgery in patients with FHC and clinically significant visual symptoms caused by inflammatory vitreous debris. This study was a review of 12 eyes of 12 consecutive patients with FHC who underwent pars plana vitrectomy for visually significant vitreous opacities. Cataract extraction with posterior chamber lens implantation had been performed on four eyes preoperatively. Four eyes had a concomitant lensectomy for cataracts, and one had a surgical posterior capsulotomy. Visual and anatomic data were recorded before surgery and for at least 6 months after surgery. Visual acuity improved in all patients from an average logMAR of 0.57 to 0.007 (P = 0.0004) and by more than 2 Snellen lines in 8 of 12 of the eyes (P < 0.05). Symptoms of floaters resolved in all 11 patients in whom they were a symptom. Vitreous haze was cleared completely from an average Nussenblatt grade of 1.7 to 0 after 1 week (P = 0.0001). Pars plana vitrectomy is a safe and effective treatment for the visual symptoms associated with FHC and can be combined safely with a lensectomy if required.

Circulating antibodies to inducible heat shock protein 70 in patients with uveitis

Heat shock proteins with molecular weight 70 kDa (hsp70) are highly conserved immunogenic intracellular molecules. There are two main subtypes: one is expressed constitutively (hsc70), while the other is induced under stressful conditions (ihsp70). Using an ELISA directed against recombinant human ihsp70, antibody titers were determined in patients with defined ocular inflammatory conditions (Behçet's disease, Vogt-Koyanagi-Harada (VKH), pars planitis, and sarcoidosis) as well as in a group of age-matched normal volunteers. In comparison to healthy controls (n = 14, absorbance 0.269), levels were significantly elevated in Behçet's disease (n = 18; 0.412), sarcoidosis (n = 15; 0.432), and pars planitis (n = 13; 0.346), but not in VKH (n = 10; 0.263). A correlation was also noted for treatment versus no treatment in pars planitis (p = 0.028), but not in other inflammatory conditions. There was no correlation with the level of intraocular disease activity as defined by vitreous haze and vision drop. Since pars planitis is a purely ocular condition, circulating levels of ihsp antibodies likely reflect the extent of disease involvement within the eye.

Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy

PURPOSE: To investigate the clinical features associated with immune recovery in human immunodeficiency virus (HIV)–infected patients with cytomegalovirus retinitis who are taking highly active antiretroviral therapy. METHODS: Sixteen patients were evaluated prospectively at the National Eye Institute, Bethesda, Maryland. Evaluation included a medical history and a complete ophthalmologic examination. The examination included best-corrected visual acuity score measured by means of logarithmic charts, slit-lamp biomicroscopy, dilated retinal examination, retinal photography, and fluorescein angiography. Immune-recovery uveitis was defined as the ocular inflammation associated with clinical immune recovery in patients taking potent antiretroviral regimens. The ophthalmic characteristics of immune-recovery uveitis were identified, and their effect on visual acuity was statistically analyzed. RESULTS: The mean CD4+ T-lymphocyte count for the 16 patients taking highly active antiretroviral therapy at the time of evaluation was 393 cells/μl (range, 97–1,338 cells/μl). Immune-recovery uveitis was characterized by vitreitis and optic disk and macular edema. Clinically important complications of immune-recovery uveitis included cataract and epiretinal membrane formation. The visual acuity scores were significantly worse in the 23 eyes with cytomegalovirus retinitis (mean, 67.2 letters, 20/50) than in the nine eyes without cytomegalovirus retinitis (mean, 89.8 letters, 20/16) ( P < .001). Regression analysis showed that a lower visual acuity score was associated with the presence of moderate to severe macular edema on fluorescein angiography and vitreous haze ( P ≤ .001). CONCLUSIONS: Immune-recovery uveitis is an important cause of visual morbidity in HIV-infected patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Although immune recovery associated with highly active antiretroviral therapy has allowed some patients to discontinue specific anticytomegalovirus therapy, the rejuvenated immune response can be associated with sight-threatening inflammation.

Inhibition of diclofenac formulated in hyaluronan on angiogenesis in vitro and its intraocular tolerance in the rabbit eye.

To investigate the effect of diclofenac, a potent nonsteroidal anti-inflammatory drug, formulated in hyaluronan (diclofenac/HA) on angiogenesis in vitro and its intraocular toxicity in vivo. The effect of diclofenac/HA on angiogenesis was determined by choriocapillary endothelial cells on Matrigel stimulated by vascular endothelial growth factor (VEGF). The tube areas were quantified by image digital analysis. For toxicity study, diclofenac/HA was injected intravitreally with a dose range from 100 to 1080 microg in 26 rabbits following gas compression vitrectomy. Potential toxicity was assessed by indirect ophthalmoscopy and by histological studies (light and electron microscopy). Retinal function was monitored by electroretinography (ERG) in six rabbits that received 400 microg of diclofenac/HA. Diclofenac/HA, 180, 90 microg/ml, inhibited tube formation to 24% and 55% of the standard group (Media Ham's F12 plus 5% fetal calf serum and 50 ng/ml VEGF) respectively (P<0.01). Intravitreal injection of 540 microg or higher doses of diclofenac/HA resulted in ocular toxicity in the rabbit, demonstrated as cataract, vitreous haze and retinal damage observed by indirect ophthalmoscopy and light- and electron-microscopic examinations. No toxicity was observed in the eyes that received 400 microg or less diclofenac/HA, which was further supported by the normal ERG examined at 4 and 25 days post injection. Diclofenac/HA inhibits tube formation in vitro and is non-toxic to the rabbit retina at concentrations that are inhibitory to tube formation. Our results suggest diclofenac/HA may be an effective candidate to inhibit ocular neovascularisation related to granulomatous reaction in the eye.

Intraocular inflammatory reactions without focal necrotizing retinochoroiditis in patients with acquired systemic toxoplasmosis

PURPOSE: To describe the occurrence of intraocular inflammatory reactions as the sole ophthalmic manifestation of acquired systemic toxoplasmosis. METHODS: Review of medical records for 10 patients with uveitis and evidence of recent Toxoplasma gondii infection. RESULTS: Patient ages ranged from 3 to 51 years. Ocular symptoms were present in each of eight adult patients. Inflammation was unilateral in nine patients; it manifested as vitreous humor cells and haze (10 patients), anterior chamber cells (seven patients), and retinal vasculitis (seven patients). No patient had necrotizing retinochoroiditis upon initial examination. Inflammation resolved in each of nine patients who had follow-up examinations. Foci of retinitis or inactive retinochoroidal scars were seen in four of these nine patients during follow-up examinations, at intervals of 2.0 weeks to 2.5 years after initial examination. CONCLUSIONS: Retinal vasculitis and associated inflammatory reactions may be the only ophthalmic disorder during the early stages of a newly acquired T. gondii infection. Later development of retinitis or scars consistent with toxoplasmic retinochoroiditis in the same eyes suggests that the initial, isolated inflammation may be caused by the presence of parasites in retinal tissue. These cases may have implications for understanding the original source of retinal infection in patients who have recurrent toxoplasmic retinochoroiditis and for treatment of newly acquired T gondii infection.

EXPERIMENTAL PROPHYLAXIS OF STAPHYLOCOCCUS AUREUS ENDOPHTHALMITIS AFTER VITRECTOMY: The Use of Antibiotics in Irrigating Solution

Purpose: To test the efficacy of clindamycin and gentamicin in irrigating solution during vitrectomy to prevent experimental Staphylococcus aureus endophthalmitis. Materials and Methods: Thirty-six New Zealand white rabbits were divided into six groups. Vitrectomy using two different irrigating solutions was followed by intravitreal injection of S. aureus: Group 1, balanced salt solution (BSS) followed by 1,000 colonyforming units (CFU) S. aureus; Group 2, BSS fortified with clindamycin, 10 ˆg/mL, and gentamicin, 8 μg/mL (CGBSS), followed by intravitreal injection of 1,000 CFU S. aureus; Group 3, BSS followed by 2,000 CFU S. aureus; Group 4, CGBSS followed by 2,000 CFU S. aureus; Group 5, BSS followed by 4,000 CFU S. aureus; and Group 6, CGBSS followed by 4,000 CFU S. aureus. The eyes were examined clinically after surgery. Vitreous samples were cultured and histologic studies were performed. Results: Severe endophthalmitis developed in all eyes in Groups 1, 3, and 5 (not given antibiotics). No endophthalmitis developed in Group 2. In Group 4, five of the six eyes were normal and one eye had endophthalmitis. In Group 6, one eye had clear vitreous and fundus, three eyes had moderate vitreous haze, and the other four eyes demonstrated severe endophthalmitis. Bacterial growth in Groups 1,2,3, 4, 5, and 6 were 4/4, 0/4, 6/6, 1/6, 4/6, and 2/8 eyes, respectively. Conclusion: When 1,000 to 2,000 CFU S. aureus were injected after vitrectomy, clindamycin and gentamicin in the irrigating solution significantly diminished the intraocular inflammation and the rate of positive bacterial culture. Clindamycin and gentamicin in the irrigating solution were not significantly effective when 4,000 CFU bacteria was injected; however, the degree of inflammation was less severe than in the control group. RETINA 19:223-229, 1999

Cystoid macular oedema and cytomegalovirus retinitis in patients with HIV disease treated with highly active antiretroviral therapy

BACKGROUNDAlthough cystoid macular oedema (CMO) is a rare cause of visual loss in AIDS related cytomegalovirus (CMV) retinitis, nine cases are reported of CMO occurring in HIV infected patients with...

Experimental prophylaxis of Staphylococcus aureus endophthalmitis after vitrectomy: the use of antibiotics in irrigating solution.

To test the efficacy of clindamycin and gentamicin in irrigating solution during vitrectomy to prevent experimental Staphylococcus aureus endophthalmitis. Thirty-six New Zealand white rabbits were divided into six groups. Vitrectomy using two different irrigating solutions was followed by intravitreal injection of S. aureus: Group 1, balanced salt solution (BSS) followed by 1,000 colony-forming units (CFU) S. aureus; Group 2, BSS fortified with clindamycin, 10 microg/mL, and gentamicin, 8 microg/mL (CGBSS), followed by intravitreal injection of 1,000 CFU S. aureus; Group 3, BSS followed by 2,000 CFU S. aureus; Group 4, CGBSS followed by 2,000 CFU S. aureus; Group 5, BSS followed by 4,000 CFU S. aureus; and Group 6, CGBSS followed by 4,000 CFU S. aureus. The eyes were examined clinically after surgery. Vitreous samples were cultured and histologic studies were performed. Severe endophthalmitis developed in all eyes in Groups 1, 3, and 5 (not given antibiotics). No endophthalmitis developed in Group 2. In Group 4, five of the six eyes were normal and one eye had endophthalmitis. In Group 6, one eye had clear vitreous and fundus, three eyes had moderate vitreous haze, and the other four eyes demonstrated severe endophthalmitis. Bacterial growth in Groups 1, 2, 3, 4, 5, and 6 were 4/4, 0/4, 6/6, 1/6, 4/6, and 2/8 eyes, respectively. When 1,000 to 2,000 CFU S. aureus were injected after vitrectomy, clindamycin and gentamicin in the irrigating solution significantly diminished the intraocular inflammation and the rate of positive bacterial culture. Clindamycin and gentamicin in the irrigating solution were not significantly effective when 4,000 CFU bacteria was injected; however, the degree of inflammation was less severe than in the control group.

Vitritis as the primary manifestation of ocular syphilis in patients with HIV infection

To describe dense vitritis as the primary manifestation of ocular syphilis in three human immunodeficiency virus (HIV)-positive patients and to determine the response of these patients to the established regimen for neurosyphilis. Anti-Toxoplasma gondii IgM and IgG antibody titers, tuberculin skin test, chest radiograph, and serum angiotensin-converting enzyme level were obtained because tuberculosis, sarcoidosis, and toxoplasmosis were in the differential diagnosis. Two of the three patients were not known to have HIV infection at the time of initial examination and consented to HIV testing. Treponemal and nontreponemal tests were performed on serum and cerebrospinal fluid to establish a definitive diagnosis. Treatment for neurosyphilis was initiated, and daily ophthalmic examinations were performed, with careful attention to signs commonly associated with syphilitic eye disease. All three patients exhibited improvement in visual acuity and resolution of vitreous haze. There was no evidence of other signs of posterior uveitis. The one patient for whom there has been a 6-month follow-up showed no sequelae of his eye disease. Human immunodeficiency virus-positive patients with syphilis may present atypically dense vitritis. In these patients, vitritis may be the first manifestation of syphilis. The regimen for neurosyphilis provides effective therapy. Moreover, in some patients, syphilitic vitritis may be the initial manifestation of HIV disease.

The Efficacy of Cyclosporin-A in the Treatment of Behçet's Disease

We used cyclosporin A (CA) to treat 14 patients (25 eyes) with Behçet's disease characterized by severe retinal vasculitis and active intraocular inflammation. All of the patients had been treated previously with corticosteroids, colchicine, and immunosuppressives, without satisfactory results. The patients were given an initial oral dose of 5 mg/kg/day. All medication was tapered and eventually completely stopped after 12 months. The number and severity of ocular attacks (anterior and/or posterior uveitis with vitreous haze) were significantly reduced below pretreatment levels during therapy (Kolmogorov Smirnov two-pair test: P < .05). Visual acuity improved in 32% and remained unchanged in 44%. No ocular attacks recurred in 11 eyes; they recurred 1 time in 8 eyes; 2 times in 3 eyes; and 3 times in 3 eyes during CA therapy. There were no significant changes in the level of retinal vasculitis. In two cases with vaso-obstructive changes, treatment with CA was not effective and laser photocoagulation was performed. Based on our study, we recommend that an initial dose of 5 mg/kg/day CA be used in the systemic medical treatment of ocular Behçet's disease. The CA can be continued at this low dosage for an unspecified time. If intraocular inflammation does not totally resolve at this dosage or the inflammatory process recurs, combining the CA with low doses of a steroid should be considered.