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PubMedDate not supplied

Safety and efficacy of intravitreal triamcinolone acetonide for uveitic macular edema.

BACKGROUND: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (TA) for treating macular edema secondary to non-infectious uveitis. METHODS: Retrospective review of sixteen patients (20 eyes) with chronic cystoid macular edema (CME) as a consequence of controlled intermediate uveitis, posterior uveitis, or panuveitis who received at least one intravitreal injection of TA. Main outcome measures were visual acuity (VA), intraocular pressure (IOP), formation or progression of an existing cataract, and CME resolution during the follow-up period. RESULTS: At last follow-up, VA showed improvement (compared to baseline) in 11 eyes (55%), deterioration in three eyes (15%), remained completely unchanged in one eye (5%), and showed improvement initially but returned to baseline levels in five eyes (25%). At last follow-up, CME had relapsed or was still present in 10 of the eyes (50%). The remaining eyes showed complete resolution of the CME, without evidence of recurrence during the follow-up time. Mean VA at last follow-up showed statistically significant improvement (p = 0.02) in nonvitrectomized eyes (mean baseline VA: 1.14 +/- 0.58; mean final VA: 0.96 +/- 0.66) compared to the almost unaltered mean visual acuity for vitrectomized eyes (mean baseline VA: 0.76 +/- 0.41; mean final VA: 0.71 +/- 0.48)(p = 0.40, paired samples t-test). Elevation of IOP was transient in all cases and responded well to topical medications, except for one patient who required placement of an Ahmed valve. Preexisting cataract progressed in three of the 15 phakic eyes (20%). One patient developed a retinal detachment and required additional surgery to reattach it. Patients were followed for a mean of 34 weeks (median: 32 weeks; range: 19-56 weeks). CONCLUSIONS: Intravitreal TA may play a role in the treatment of uveitis-related CME. Further controlled studies are necessary to test this hypothesis.

Adult↗

PubMed1997

Incidence and prevalence of different uveitis entities in Finland.

We studied the case records of 1122 patients with endogenous uveitis including 418 new cases treated at the University Eye Clinic in Turku during the years 1980-1982 and 1988. The mean annual incidence and prevalence rates (per 100,000 population) of idiopathic acute anterior uveitis were 17.1 and 48.5, respectively, sarcoid anterior uveitis 0.5 and 1.5, Posner-Schlossman syndrome 0.4 and 1.9, herpes zoster uveitis 0.4 and 0.7, idiopathic chronic anterior uveitis 0.3 and 7.3, herpes simplex keratouveitis 0.3 and 0.5, juvenile rheumatoid arthritis 0.2 and 2.4, Fuchs' heterochromic iridocyclitis 0.2 and 0.5, intermediate uveitis 0.3 and 1.4, and of toxoplasmic retinochoroiditis 0.3 and 2.4. The incidence and prevalence rates of acute anterior uveitis associated with ankylosing spondylitis were 2.0 and 10.3 per 100,000 population, respectively, and this disease association occurred more often in men than in women (p < 0.001). The mean annual incidence of idiopathic acute anterior uveitis was significantly lower in the age group 0-19 years than in the other age groups (p < 0.001).

Adolescent↗

PubMedDate not supplied

[The value of electroretinography in uveitis].

The involvement of the retina in the inflammation being one important factor in severe uveitis, the authors have tested the "ganzfeld" electroretinogram (ERG) in various forms of uveitis, especially in cases having opaque media. In Fuchs' syndrome and chronic anterior uveitis, the ERG is normal or only slightly altered, while important reduction of the potentials can occur even in case of good vision in intermediate uveitis, probably indicating concomitant retinal vasculitis. In Behçet's disease, ERG is mostly useful in testing the efficacy of therapy. ERG can be rather deceiving in idiopathic vasculitis, where the potentials are not always as reduced as expected. On the contrary, this test seems to allow differential diagnosis between Harada's disease and acute multifocal placoid pigment epitheliopathy. However, one must bear in mind that concurrent steroid treatment can elevate the amplitude of the potentials, a phenomenon which has to be taken into account when interpreting ERG results.

Behcet Syndrome↗

PubMed2005

Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop.

PURPOSE: To begin a process of standardizing the methods for reporting clinical data in the field of uveitis. DESIGN: Consensus workshop. METHODS: Members of an international working group were surveyed about diagnostic terminology, inflammation grading schema, and outcome measures, and the results used to develop a series of proposals to better standardize the use of these entities. Small groups employed nominal group techniques to achieve consensus on several of these issues. RESULTS: The group affirmed that an anatomic classification of uveitis should be used as a framework for subsequent work on diagnostic criteria for specific uveitic syndromes, and that the classification of uveitis entities should be on the basis of the location of the inflammation and not on the presence of structural complications. Issues regarding the use of the terms "intermediate uveitis," "pars planitis," "panuveitis," and descriptors of the onset and course of the uveitis were addressed. The following were adopted: standardized grading schema for anterior chamber cells, anterior chamber flare, and for vitreous haze; standardized methods of recording structural complications of uveitis; standardized definitions of outcomes, including "inactive" inflammation, "improvement'; and "worsening" of the inflammation, and "corticosteroid sparing," and standardized guidelines for reporting visual acuity outcomes. CONCLUSIONS: A process of standardizing the approach to reporting clinical data in uveitis research has begun, and several terms have been standardized.

Humans↗

PubMed2003

[Pars plana vitrectomy in cystoid macular edema of different forms of chronic uveitis].

BACKGROUND: Cystoid macular edema (CME) is a common complication in different forms of chronic uveitis. In spite of immunosuppressive and anti-inflammatory therapy, chronic or relapsing courses can occur which may have a negative impact on visual prognosis. Pars plana vitrectomy (PPV) is known to positively influence chronic uveitis. This retrospective study was performed to investigate the role of PPV in the therapy refractive uveitic CME. PATIENTS AND METHODS: PPV for CME was performed in eyes with CME in intermediate uveitis (IMU, n=42), chronic iridocyclitis in juvenile rheumatoid arthritis (CIC, n=14) and multifocal chorioretinitis (MFC, n=12). In none of the eyes had immunosuppressive and/or anti-inflammatory therapy or anti-edema treatment (e.g.acetazolamide) led to regression of the CME. After a postoperative follow-up period of 7 and 106 months all patients were re-examined. RESULTS: Postoperative complete or partial regression of CME was observed as follows: IMU: 25/42 (59.5%), CIC: 8/14 (57.1%),MFC: 5/12 (41.7%). A significant increase in visual acuity of 2 lines and more was observed in 50%,71.4% and 41.7% of eyes, respectively. In the long-term follow-up best functional results were achieved in eyes with IMU. CONCLUSIONS: Response to PPV was variable according to the type of underlying form of uveitis. The lowest success rate could be observed in eyes with MFC. Although the postoperative regression rate of CME was satisfactory in eyes with CIC, long-term visual acuity results were disappointing due to secondary complications of CIC in this young age group. Best results were achieved in patients with IMU (statistically not significant). A multicenter study in a larger series of patients is needed to investigate the exact role of PPV in different forms of chronic uveitis.

Adolescent↗

PubMed2001

Patients with Multiple Sclerosis and concomitant uveitis/periphlebitis retinae are not distinct from those without intraocular inflammation.

Recent models of experimental autoimmune encephalomyelitis (EAE) have indicated that antigens co-expressed in the retina and uvea might be of pathogenetic relevance in Multiple Sclerosis (MS). We investigated the clinical spectrum and magnetic resonance imaging of 11 MS patients with concomitant uveitis, and determined the frequency of clinically silent intraocular inflammation in a prospective series of 50 patients. Two of the 11 patients had panuveitis, seven had anterior, and the remaining two had intermediate uveitis. The onset of uveitis preceded that of neurological symptoms by a mean of 8.5 years (range 1-20). None of the 50 MS patients studied prospectively by using slit lamp examinations and dilated funduscopy showed any evidence of uveitis but six patients had signs of retinal inflammation ("periphlebitis retinae"). Cranial MRI did not reveal "atypical" lesional distribution in MS patients with uveitis or periphlebitis retinae. No correlation between the type of MS and uveitis, or between the degree of neurological disability and the type of uveitis was found.

Adult↗

PubMed1983

[Fuchs heterochromic cyclitis: current concepts].

The clinical features of Fuchs' heterochromic cyclitis (F.H.C.) were described thoroughly by him in 1906. Supplementary data was then supplied by Amsler and Verrey with respect to the vascular characteristics of this disease. Fuchs' disease is not a frequent affection and accounts for no more than 1-2% of the total cases of uveitis. The diagnosis is very difficult to establish at an early stage of the disease. Incomplete or atypical forms are frequent and differential diagnosis is difficult from other cases of cyclitis and/or intermediate uveitis. Furthermore, heterochromia is recognized with difficulty in brown-eyed people. The time of onset of the 3 main symptoms (cataract, heterochromia and cyclitis) varies considerably and the possibility that each of the symptoms follows an individual course at least for a certain period, cannot be excluded. Paraclinical and biological methods for investigating the disease are still limited. However immunological techniques have established the frequent incidence of immune complexes in the aqueous, while some anomalies in the vascular system have been detected on fluoroangiography of the iris. A congenital predisposition to this disease may explain the fact that F.H.C. is generally unilateral. Additionally it might explain Amsler's findings. The way to establish a link both in time and space between all these findings (so as to build up a unique theory which could explain different symptoms) is still unknown, but the so-called sympathetic theory and its theoretical consequences could be rejected permanently in the future.

Ciliary Body↗

PubMedDate not supplied

Uveitis in children.

Uveitis is diagnosed more often in adults than in children but in children the prevalence of chronic inflammation and the difficulty of an early diagnosis may worsen the visual prognosis. The different incidence of the presumed or defined etiologies in the various ages is probably responsible for the better classification of uveitis in childhood (71% versus 55% in adult patients). Juvenile rheumatoid arthritis is the most common identifiable etiology of pediatric anterior uveitis (28%). However, its long-term prognosis is not satisfactory and ophthalmic surveillance protocols are necessary especially for ANA and HLA DR11 positive girls with the pauci articular form of the disease. Intermediate uveitis is idiopathic in 98% of the cases and accounts for 20-26% of all pediatric uveitis; cystoid macular edema in these patients is the leading cause of visual impairment. Toxoplasmosis is the most frequent cause of posterior uveitis (43%) and of uveitis in childhood (12%); involvement is bilateral in 50-60% of cases. Diffuse uveitis forms are uncommon in children, but their course is particularly severe. They may either be the natural evolution of a posterior uveitis or the presenting sign of a systemic disease typical of the third decade of life, such as sarcoidosis, Behçet's disease, Vogt-Koyanagi-Harada's disease. Masquerade syndromes including retinoblastoma, leukemia and lymphoma, intraocular foreign body, retinitis pigmentosa may contribute to confusion in the differential diagnosis of inflammatory disease of the uveal tract in childhood.

Adolescent↗

PubMed2004

Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis.

OBJECTIVE: To assess the efficacy and safety of the anti-tumor necrosis factor alpha agent infliximab in treatment-resistant uveitis and scleritis. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Seven patients with noninfectious ocular inflammatory disease that was refractory to alternative immunosuppression. These included one patient with idiopathic retinal vasculitis and panuveitis, one patient with intermediate uveitis, one patient with chronic juvenile anterior uveitis, three patients with scleritis, and one patient with scleritis and peripheral ulcerative keratitis. Four patients had an underlying systemic disease that was in remission in three cases. INTERVENTION: Infusions of infliximab, 200 mg, were given at 4-week to 8-week intervals, depending on the clinical response. MAIN OUTCOME MEASURES: Clinical response, including symptoms, visual acuity, degree of scleral vascular engorgement, corneal thinning, anterior chamber activity, and posterior segment inflammation, reduction in concomitant immunosuppression, and adverse effects. RESULTS: The mean patient age was 47 years (range, 24-78), and four patients were female. The mean number of infliximab infusions was seven (range, 2-19), and the mean follow-up period was 12 months (range, 4-22 months). Six patients experienced a clinical improvement, with five achieving remission and significant reduction in immunosuppression. One patient showed an initial response but developed a delayed hypersensitivity response that precluded further treatment. No other adverse effects occurred. CONCLUSIONS: Infliximab seems to be an effective and safe treatment for noninfectious uveitis and scleritis and may be indicated as rescue therapy for relapses of ocular inflammation or as maintenance therapy when conventional immunosuppression has failed. Further investigation of infliximab for treatment-resistant scleritis and uveitis is warranted.

Adult↗

PubMed1990

[Purification of retinal S-antigen and its uveiticogenic activity].

Retinal S-antigen, a soluble protein present in the photosensory layer of the retina, has been shown to be involved in the pathogenesis of some uveitis. The procedure for the isolation of S-antigen has been continually improved and perfected. In light of the method of A1-Mahdawi and coworkers, with some modification, we obtained good yields of highly purified S-antigen (0.325 mg per retina) from bovine retinas. Experimental auto-immune uveitis (EAU) was successfully induced by injecting the S-antigen into the hind footpad of guinea pigs. The EAU was characterized by lymphocyte infiltration in the pars plana and vitreous base, a counterpart of human intermediate uveitis.

Animals↗

PubMed2004

Infliximab for chronic cystoid macular edema associated with uveitis.

PURPOSE: To assess the efficacy of the anti-TNF monoclonal antibody infliximab in uveitis patients without clinically evident ocular inflammation and impaired visual acuity because of chronic cystoid macular edema (CME). DESIGN: Prospective, noncomparative, interventional case series. METHODS: Patients with refractory CME (14 eyes, mean duration of 14 months), associated with intermediate uveitis (n = 6), Adamantiades-Behcet disease (n = 2), adult-type vascular pseudotumor (n = 1), and HLAB27+-related uveitis (n = 1) received an intravenous infliximab infusion (5 mg/kg); five patients were retreated after 1 month. RESULTS: Macular thickness, measured by ocular coherence tomography, was reduced from 428 +/- 138 microm to 219 +/- 51 microm at 2 months postbaseline (P = .0001), while visual acuity increased from 0.41 +/- 0.18 to 0.83 +/- 0.17 (P < .00001). Anatomic and functional improvement was sustained at 6 months in all. No ocular or extra-ocular side effects were noted. CONCLUSION: These promising results suggest that TNF may play an important pathogenetic role in chronic CME, thus, a controlled trial is warranted.

Adult↗

PubMed1984

[Climatotherapy in chronic inflammations of the uvea].

Treatment of uveitis depends on the inhibition of the inflammatory reaction by corticosteroids or immunosuppressive agents. "Climatotherapy" remains a controversial subject and is generally not accepted. To test its efficacy a pilot study was undertaken. Children with chronic iridocyclitis or intermediate uveitis were sent to Israel for 3 weeks. During the follow-up period of 26 months there was an initial regression of the inflammatory reaction in most cases, followed by varied courses depending on the severity of the disease. Although no definite conclusions can be drawn owing to the small number of patients (5) there might been a beneficial effect. It seems very difficult to prove the efficacy of such "treatment", since not only the climate but also many other environmental factors were changed.

Adolescent↗

PubMed2002

[Macular cystoid edema in eyes with secondary glaucoma after surgery].

The authors a case of a 53 year old patient who has been under observation of the Ophthalmologic Department from lassy Railway Hospital since September 2000. The the diagnosis was on both eyes: Operate Inflammatory Secondary Glaucoma. Incipient Cataract. Anterior Uveiti Sechelae. Cicatricial Corioretinitis. In January 2001 this patient came in our clinic on the right eye with acute decrease of visual acuity from 1/6 to 1/25 on white, unpainful eye, with marked ocular hipotony. The suspected etiologic diagnosis was initially RE: Intermediate Uveitis. After local and general treatment with corticosteroid antiinflammatory agents the inflammatory phenomena was decreased but the visual acuity remained unchanged. After that we suspected macular cystoid edema. The cause of the visual acuity decrease remains obscure and this case underlines the difficulties meeting on the therapeutic management of the glaucoma on an eye with numerous associated diseases.

Anti-Inflammatory Agents↗

PubMed1987

Changing patterns of uveitis.

We conducted a retrospective analysis of 600 patients with uveitis seen at the Estelle Doheny Eye Center to determine the frequency of occurrence of the various forms of uveitis and to see if the causes of uveitis have changed as compared with previous studies. In 402 cases (67.0%) we established a specific diagnosis based on history, physical findings, and laboratory studies: 167 cases (27.8%) involved primarily the anterior segment, 230 (38.4%) the posterior segment, and 111 (18.4%) occurred as panuveitis. Intermediate uveitis (pars planitis) was the single most frequently diagnosed uveitic entity and accounted for 92 cases (15.4%). We compared our findings with those of previously published studies and found that, as new diseases occur and improved diagnostic techniques become available, the differential diagnosis of uveitis continues to change.

Choroiditis↗

PubMed1985

Uveitis with allergy to candidin.

By skin testing, 21 patients with uveitis were more reactive to Candida extracts than a control group of patients during the same 15-year follow-up period. Skin testing with candidin induced an obvious and transient change of the course of the ocular disease in 19 patients and led to systemic symptoms in 15 patients; 11 were atopic, 17 had intermediate uveitis. Antifungal treatment and/or desensitization improved the ocular condition in 16 patients. The real pathogeny of these uveitides remains hypothetical.

Adult↗

PubMed1995

[Incidence of uveitis at Tokyo Medical College Hospital].

We reviewed the records of 980 patients with endogenous uveitis who were followed in the uveitis clinic of the Tokyo Medical College Hospital, Department of Ophthalmology. A group of 693 patients examined within a 5-year period from January, 1989 through December, 1993 (Group A) were compared to an earlier group of 287 patients examined within a 3-year period from January, 1982 through December, 1984 (Group B). The incidence of Behçet's disease, intermediate uveitis, and toxoplasmosis showed an apparent decrease. In contrast, the incidence of sarcoidosis and acute anterior uveitis increased. In comparison to Group B, Group A showed an increased number of patients with virus-associated uveitis, toxocariasis, and uveitis caused by fungal infection. The changes observed in the prevalence of certain uveitic diseases in the patient population we followed may be related to changing environment and/or life style, in addition to various advances in diagnostic testing. In the future, the classification of uveitis will become more varied according to the establishment of new concepts.

Adolescent↗

PubMed1992

[Cyclosporin A in therapy of chronic uveitis].

48 patients with chronic severe uveitis of pressumed noninfectious origin resistent to corticosteroids have been treated with Cyclosporin A. All patients had an initial loading dose of 5 mg/kg/day followed by a dose reduction according to ocular inflammatory activity and tolerability and according the guidelines by BenEzra, Nussenblatt and Timonen. Most of the patients received additional corticosteroids in a low dose. 35 out of these 48 patients (13 suffering from intermediate uveitis, 11 from retinal vasculitis, 5 panuveitis, 4 "pressumed histoplasmosis" and 2 sympathetic ophthalmia) were treated for 1 year and observed after withdrawing of Sandimmun for at least 6 months. The majority of these patients have manifested a positive therapeutic response to Cyclosporine, in particular patients suffering from vasculitis, panuveitis and sympathetic ophthalmia. All 35 patients were treated before for a long time with steroids without success, 19 out of these 35 in addition with cytotoxic agents. The immunosuppressive effect of Cyclosporine was not permanent, frequently the inflammation relapsed on reduction of dosage or withdrawing of the drug. Guidelines for combined regimen (Cyclosporine and corticosteroids and vitrectomy) were given. Although a large variety of side effects were reported the compliance was good.

Administration, Oral↗

PubMed1987

[Juvenile uveitis].

Chronic anterior uveitis in children suffering from juvenile rheumatoid arthritis may develop very early, when the patient is as young as two or three years old; it affects twice as many girls as boys. The arthritis is often localized in one joint (pauciarticular or oligoarticular form); Still's syndrome is very rare. Local treatment with cycloplegics and steroids has to be combined with systemic immunosuppressive medication with cyclophosphamide. Chronic intermediate uveitis (pars planitis) usually affects teenagers in good health. Peripheral fundus changes can be detected most easily by biomicroscopy with the three-mirror contact lens. Cystoid macular edema is frequent and, together with vitreous opacities, is responsible for a deterioration in central vision. In most cases local treatment with subconjunctival injection of depot steroids is sufficient. Immunosuppressive treatment or surgical intervention is only indicated in severe cases where there is a risk of complete loss of vision.

Arthritis, Juvenile↗