Uveítis asociada a la artritis idiopática juvenil / Uveitis associated to juvenile idiopathic arthritis

Objetivo: Caracterizar las uveítis asociadas a la artritis idiopática juvenil. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, donde se evaluaron las variables edad, raza, sexo, lateralidad de la uveítis, clasificación anatómica, agudeza visual mejor corregida, presencia de complicaciones y tratamiento. Resultados: Predominaron los mayores de seis años, el sexo femenino y la raza blanca. En cuanto a la lateralidad hubo mayor predominio de las bilaterales, con localización anatómica anterior. En los resultados visuales sobresalieron los que presentaban una agudeza visual mejor corregida ≥ 0,5. Las complicaciones más frecuentes fueron: la pérdida visual, la hipertensión ocular y la queratopatía en banda. Con respecto al tratamiento, la mayoría de los pacientes tenían asociado metotrexate al tratamiento tópico y oral con esteroides. Conclusión: La uveítis asociada a la artritis idiopática juvenil sigue siendo un problema importante de salud en la infancia a pesar de los avances en los programas de atención a esta enfermedad; por tanto, el diagnóstico precoz, el seguimiento estricto y el tratamiento adecuado son los pilares para una mejor evolución(AU)

Objective: Characterize uveitis associated to juvenile idiopathic arthritis. Methods: A cross-sectional observational descriptive study was conducted based on evaluation of the following variables: age, race, sex, laterality of uveitis, anatomical classification, best corrected visual acuity, presence of complications and treatment. Results: A predominance was observed of patients aged over six years, female sex and white race. Bilateral uveitis prevailed, with anterior anatomical location. Patients with a best corrected visual acuity ≥ 0.5 stood out for their visual results. The most common complications were visual loss, ocular hypertension and band keratopathy. Most patients had methotrexate associated to topical and oral treatment with steroids. Conclusion: Uveitis associated to juvenile idiopathic arthritis continues to be an important health problem in childhood, despite the progress in the care of this condition. Therefore, early diagnosis, strict follow-up and appropriate treatment are the pillars of a better evolution(AU)

Lupus eritematoso sistémico / Systemic lupus erythematosus

El lupus eritematoso sistémico es una enfermedad autoinmune, de curso crónico con afectación multisistémica. Las manifestaciones oculares del lupus eritematoso sistémico pueden afectar cualquier estructura del ojo. La formación de catarata y la aparición de la diabetes secundaria asociada con el tratamiento esteroideo prolongado es frecuente en estos pacientes. Se presenta el caso de una paciente femenina de 69 años, con antecedentes de lupus eritematoso sistémico de más de 20 años de evolución, tratada con 5 mg diarios de prednisona oral en dosis de mantenimiento. Refiere, además, diabetes mellitus tipo 2 controlada de más de 10 años de evolución. Asiste a la consulta de Oftalmología por disminución de la visión y se diagnostica catarata en el ojo derecho. Se realiza facoemulsificación con implante de lente intraocular plegable, previa profilaxis para la endoftalmitis. La catarata asociada a la diabetes secundaria en los pacientes con lupus eritematoso sistémico justifica el uso de profilaxis antinflamatoria con esteroides tópicos y sistémicos para asegurar una mínima inflamación posoperatoria y mejorar el pronóstico visual(AU)

Systemic lupus erythematosus is a chronic autoimmune disease of multisystemic involvement. Ocular manifestations of systemic lupus erythematosus may present in any structure of the eye. Cataract formation and the appearance of secondary diabetes associated to prolonged steroid therapy are common in these patients. A case is presented of a female 69-year-old patient with a history of systemic lupus erythematosus of more than 20 years' evolution, treated with 5 mg daily of oral prednisone at maintenance doses. The patient also reports controlled diabetes mellitus type 2 of more than ten years' evolution. Her main concern in attending Ophthalmology consultation is vision reduction. Cataract is diagnosed in her right eye. The treatment indicated is phacoemulsification with foldable intraocular lens implantation following prophylaxis for endophthalmitis. Cataract associated to secondary diabetes in patients with systemic lupus erythematosus justifies the use of anti-inflammatory prophylaxis with topical and systemic steroids to ensure minimum postoperative inflammation and improve visual prognosis(AU)

Progress in the correlation between mucin and ocular surface diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Mucin is the key factor to determine the stability of tear film and is crucial to maintain ocular surface homeostasis. Goblet cells can alter the secretion of mucin in corneal and conjunctival epithelial cells, contributing to dry eye disease and ocular surface inflammation. Based on the understanding of mucin biology, this review makes a summary on the potential relationship between mucin dysfunction and ocular surface diseases, and we hope to deepen the understanding of the importance of mucin and select the most appropriate treatment plan on the basis of ocular surface diseases.

Recomendaciones pediátricas para el manejo de la uveítis no infecciosa en Costa Rica / Pediatric recommendations for the management of non-infectious uveitis in Costa Rica

Resumen Justificación: La uveítis idiopática y la asociada a artritis idiopática juvenil son condiciones oculares que llevan a deterioro visual. En Costa Rica, la incidencia en pediatría se desconoce; aunque existe una clínica especializada en el Hospital Nacional de Niños para el manejo de estas patologías, no hay guías ni recomendaciones de manejo que hayan sido publicadas. Objetivos: Resumir las recomendaciones de manejo vigentes para uveítis no infecciosas y ofrecer una guía adaptada a la realidad costarricense, específicamente para población pediátrica. Métodos: Se efectuó una revisión no sistemática de bibliografía médica indexada en las plataformas PubMed y Scielo, sobre el diagnóstico y manejo de uveítis no infecciosa orientado a población pediátrica y en artritis idiopática juvenil. Se revisaron las guías recomendadas en Europa y se ajustaron a lo que se realiza en la Clínica de Uveítis del Hospital Nacional de Niños. Conclusiones: Se realiza una propuesta de manejo que incluye una valoración oftalmológica oportuna, diagnóstico certero, y tratamiento temprano y agresivo para prevención de complicaciones y minimizar secuelas.

Summary Importance: Idiopathic uveitis and that associated with juvenile idiopathic arthritis are ocular conditions that lead to visual impairment. In Costa Rica, the incidence in pediatric population is unknown; although there is a specialized clinic at the National Children's Hospital for the management of these pathologies, there are no guidelines or recommendations published in our country. Aims: To summarize the current management recommendations for non-infectious uveitis and offer a guide adapted to the Costa Rican reality, specifically for the pediatric population. Methods: A non-systematic review of indexed medical literature on PubMed and Scielo platforms was carried out on the diagnosis and management of non-infectious uveitis aimed to pediatric patients and in juvenile idiopathic arthritis. The recommended guidelines in Europe were reviewed and adjusted to what is done at the Uveitis Clinic of the National Children's Hospital. Conclusions: A management proposal is made that includes a timely ophthalmological evaluation, accurate diagnosis; early and aggressive treatment to prevent complications and minimize sequelae

Recomendaciones médicas para uveítis no infecciosas en adultos

Justificación: Las uveítis no infecciosas constituyen una importante causa de pérdida visual a nivel mundial; por su complejidad y gravedad de complicaciones requieren un abordaje temprano y multidisciplinario. En Costa Rica se desconoce hasta el momento la incidencia global de estas entidades y todavía no existe ningún consenso en cuanto a su manejo. Objetivos: Resumir las recomendaciones terapéuticas vigentes para uveítis no infecciosas en adultos y ofrecer una guía adaptada a la realidad costarricense. Métodos: Se efectuó una revisión no sistemática de bibliografía médica indexada en las plataformas PubMed y Scielo, sobre el manejo médico de las uveítis no infecciosas. De igual manera, se compararon los esquemas terapéuticos recomendados actualmente en América y Europa con el abordaje realizado en los centros hospitalarios costarricenses, para crear una guía adaptada a la realidad nacional. En la elaboración de estas recomendaciones participaron médicos especialistas de todas las clínicas multidisciplinarias especializadas en uveítis del país. Conclusiones: En Costa Rica se cuenta con la mayoría de las opciones disponibles para el tratamiento de uveítis idiopáticas en el sistema público de salud. Se logró la creación de algoritmos de tratamiento para las diferentes patologías.

Summary Background: Noninfectious uveitis represents an important cause of visual loss worldwide, which in view of the severity and complexity of complications demands an early and multidisciplinary approach to therapy. In Costa Rica there is no statistical records of incidence nor consensus of management of these entities to this date. Objectives: To summarize the therapeutic recommendations for non-infectious uveítis according to the scientific evidence and adapt them to the Costa Rican conditions. Methods: A non-systematic review of medical literature indexed on PubMed and Scielo, concerning medical and surgical management of non-infectious uveitis was carried out. Likewise, the recommended therapeutic schemes in America and Europe were compared to the approach used in the Costa Rican hospital centers. In the elaboration of these recommendations participated physicians, specialists of all multidisciplinary clinics for uveitis of the country. Conclusions: In Costa Rica, the majority of alternatives available for the treatment of idiopathic uveitis in the public health system are available. It was possible to create therapeutic algorithms for the different diseases.

The prognosis of ocular inflammation index after pterygium surgery based on Oculus Keratograph(R) 5M and Visual analogue scale / 中华实验眼科杂志

Objective To investigate the characteristics of ocular surface inflammation index after pterygium excision by using Oculus Keratograph(R) 5M and Visual analogue scale and evaluated the effectiveness of antiinflammatory treatment.Methods A prospective case control study was performed.Eighteen patients (6 males and 12 females) who suffered from primary pterygium were recruited in Zhongshan Ophthalmic Center from June to September 2016.All patients were treated with monocular pterygium excision combined with amniotic membrane transplantation.Anti-inflammatory treatment was given after surgery,and the ocular inflammation index was evaluated at preoperative and 1st,3rd,7th,10th,30th and 60th day postoperative.The temporal conjunctival hyperemia index (TCHI) was assessed by Oculus Keratograph(R) 5M with a red eye index analysis software.Ocular symptom scores (OSS) and visual analogue scale (VAS) were used to analyze the subjective symptoms of the patients.Fluorescein staining was used to detect the epithelization of corneal and scleral wound.The best corrected visual acuity (BCVA),intraocular pressure and complications were evaluated in this study.This study was approved by the Medical Ethics Committee of Zhongshan Ophthalmic Center of Sun Yat-sen University (2016KYPJ024).All patients signed informed consent for clinical research.Results No drug-related ocular and systemic adverse events were found during the follow-up.Corneal epithelial defect was recovered on 10th day,and conjunctival epithelization was observed in sclera exposed area on 30th day.The BCVA on the 60th day was 0.12±0.17,which was significantly lower than 0.34±0.36 preoperatively (t =3.401,P =0.003).Compared with those before surgery,OSS and VAS were significantly increased on 1 st day (OSS:Z =-4.255,P =0.000;VAS:Z =-5.256,P =0.000).The OSS on 7th day was not significantly different from that before surgery (Z=-0.958,P=0.372).VAS decreased to baseline on 30th day.The OSS on 60th day after surgery was significantly lower than that before surgery (Z =-2.397,P =0.037).TCHI was higher than 1.2 preoperatively,and increased to the highest on 1 st day after surgery,with significant difference between them (t=-6.620,P=0.000).The TCHI decreased to baseline on 7th day,no significant difference were obtained when compared with preoperative TCHI (t =-1.050,P =0.310),and TCHI on 60th day after surgery was lower than that before surgery,with significant difference between them (t =2.758,P =0.020).Conclusions The subjective symptoms combined with conjunctival hyperemia can be more accurate assessment of ocular surface inflammation in the perioperative period of pterygium surgery,which can be used as an evaluation index to assess the effectiveness of anti-inflammatory treatment.

Effects of sodium hyaluronate on ocular inflammatory response and dry eye after phacoemulsification combined with IOL implantation for cataract / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the effect of sodium hyaluronate eye drops on ocular inflammatory response and dry eye after phacoemulsification combined with intraocular lenses (IOL) implantation for age-related cataract. ·METHODS: The clinical data of age-related cataract patients treated with phacoemulsification combined with IOL implantation in 200 cases (200 eyes) of our hospital from June 2016 to July 2017 were retrospectively analyzed. According to the different postoperative application of eye drops they were divided into observation group and control group (100 cases each). The observation group was given sodium hyaluronate eye drops and the control group was given tobramycin dexamethasone eye drops. The results of BUT,FL,proteins concentration in aqueous and ocular surface disease index (OSDI) score were compared before and at the first day,the seventh day and the fourteenth day after the operation. And the incidence of conjunctival hyperemia and ciliary hyperemia was compared between 1d after surgery and 14d after surgery. ·RESULTS: There was no significant difference in OSDI scores between the two groups before and at 1d after surgery (P>0.05). The OSDI score of the two groups was higher than that before the operation on the first, the seventh and the fourteenth day after surgery (P<0.05). The OSDI score of the two groups decreased gradually after reaching the highest level on the first day after surgery (P<0.05). The OSDI scores of the observation group on the 7 and 14d after surgery were lower than those in the control group (P<0. 05). There was no significant difference in the BUT between the two groups before and at 1d after surgery (P>0.05). The levels of BUT in the two groups were lower than those before operation on the first,the seventh and the fourteenth day after surgery (P < 0. 05). BUT levels in both groups increased gradually after reaching the lowest level on the first day (P<0.05), the levels of BUT in the observation group were higher than those in the control group on the 7 and 14d after operation (P< 0. 05). There was no significant difference in FL level between the two groups before and the first day after operation (P>0.05). The levels of FL in the two groups were different from those before operation (P<0.05) on the first, the seventh and the fourteenth day after operation (P<0.05). FL levels in the two groups decreased gradually after reaching the highest level on the first day after surgery (P<0.05), the levels of FL in the observation group on the 7th day and the 14th day after operation were lower than those in the control group (P < 0. 05). There was no significant difference in the incidence of conjunctival hyperemia and ciliary congestion between the two groups on the first day after operation (P>0.05); the incidence of conjunctival hyperemia and ciliary hyperemia in the two groups on the fourteenth day after surgery was lower than that on the first day after surgery (P<0.05). However, the incidence of conjunctival hyperemia and ciliary congestion on the fourteenth day after operation was significantly lower in the control group than in the observation group (P<0.05). Postoperatively 1,7,14d, aqueous humor protein concentration in the two groups of patients compared with preoperative had difference (P< 0. 05), and two groups of patients with aqueous humor at postoperatively 1d after reaching the highest protein concentration decreased ( P < 0. 05 ), aqueous humor protein concentrations of the control group 7,14d after operation were lower than the observation group (P<0.05). ·CONCLUSION: The effect of sodium hyaluronate eye drops on improving dry eye after age-related cataract phacoemulsification combined with IOL implantation is greater than that of tobramycin dexamethasone eye drops, but it is less effective for eye inflammation than tobramycin dexamethasone eye drops.After comprehensive consideration, for the patients with light inflammation, small incision phacoemulsification combined with IOL implant, sodium hyaluronate eye drops is a good selection.

Análise retrospectiva e caracterização epidemiológica dos casos de uveíte em hospital terciário / Epidemiological analysis of cases of uveitis in a tertiary Hospital

Resumo Objetivo: Analisar a distribuição dos casos de uveíte em pacientes atendidos no Setor de Uveíte do Serviço de Oftalmologia do Hospital Federal Servidores do Estado do Rio de Janeiro. Métodos: Estudo epidemiológico retrospectivo, transversal e descritivo pela análise de prontuários de 63 pacientes atendidos no Serviço de Oftalmologia do Hospital Federal dos Servidores do Estado do Rio de Janeiro, no Setor de Uveíte, no período de Março a Outubro de 2016. Resultados: A média de idade foi de 45,54 (±15,8), sendo 50,8% do sexo feminino e 49,2% do masculino. Uveítes anteriores corresponderam à 63,49% dos casos, intermediárias 1,58% posterior 19,04% e panuveíte 15,87%. Apenas 33,3% dos pacientes encontravam-se com processo inflamatório ativo no momento da avaliação. Cerca de 74,6% das uveítes tinham causas não infecciosas e em 12,69% não foi possível a determinação etiológica. A causa isolada mais frequente foi Espondilite Anquilosante, responsável por 28,57% dos casos. Demonstrou-se que 55,5% dos pacientes tinham acometimento bilateral e 71,14% apresentavam uveíte não granulomatosa. Conclusões: Estudos epidemiológicos que tratam de uveíte são, em geral, realizados em centros terciários de atendimento, que por vezes apresentam perfil etiológico destas inflamações intra-oculares diferente da população geral.

Abstract Objective: To analyze the distribution of uveitis in patients at Uveitis Sector of Federal Hospital of Servants of Rio de Janeiro State. Methods: Retrospective epidemiological study of 63 appointments performed by ophthalmologist of Uveitis Sector at Federal Hospital of Servants of Rio De Janeiro State, between March and October of 2016. Results: The mean age was 45.54 (±15.8). 50.5% were female. Anterior uveitis corresponded to 63.49%. Only 33.3% of patient had an active inflammation at the moment of medical avaliation. 74.6% of uveitis had non-infeccious causes, and in 12.69% the etiology could not be determined. Ankylosing spondylitis was the most frequent cause, responsible for 28.57% of cases. 55.5% of patients had a bilateral uveitis, and 71.14% non-granulomatous uveitis. Conclusions: Epidemiological studies about uveitis are usually made in terciary hospitals, which do not reflect the epidemiological profile of population in general.

The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery

PURPOSE: To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery. MATERIALS AND METHODS: A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation. RESULTS: Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30+/-4.25, 4.87+/-6.03, and 12.47+/-12.24 microm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant. CONCLUSION: Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.

Managing bevacizumab-induced intraocular inflammation.

The outcome of four cases of sterile endophthalmitis that developed after intravitreal injections of bevacizumab has been reported here. All four eyes received 1.25 mg/0.05 ml intravitreal bevacizumab from 0.2-ml aliquots for different etiologies. The inflammation predominantly involved the anterior chamber with mild vitreous reaction. All patients were culture negative and regained preinjection visual acuity and were culture negative following intravitreal antibiotic administration. This report highlights that intravitreal bevacizumab can cause sterile endophthalmitis and this has to be kept in mind, and clinical judgment should be used to differentiate it from infective endophthalmitis.

Resolution of Recalcitrant Uveitic Optic Disc Edema Following Administration of Methotrexate: Two Case Reports

A 13-year-old male and a 15-year-old female presented with optic disc edema associated with chronic recurrent uveitis. While the ocular inflammation responded to high doses of oral prednisolone, the disc edema showed little improvement. After oral administration of methotrexate, the disc edema and ocular inflammation were resolved, and the dose of oral corticosteroid could be reduced.

Peripheral ulcerative keratitis in Sweet syndrome

Objective@#To present a case of peripheral ulcerative keratitis (PUK) in a patient with Sweet syndrome (acute febrile neutrophilic dermatosis) and discuss its etiopathogenesis, clinical presentation, course, and management.@*Method@#This is a case report.@*Results@#A 31-year-old male, diagnosed with Sweet syndrome, was referred for redness, photophobia, and severe, deep, boring pain in the right eye. Visual acuity was 20/20 bilaterally. Inferior sectoral conjunctival and scleral hyperemia were present in the right eye. Initial treatment included topical and oral nonsteroidal antiinflammatory drugs (NSAIDs), a topical immunosuppressive agent, and an antibiotic. One month after treatment, the pain decreased but patient developed peripheral corneal thinning that gradually spread circumferentially and centrally in the right eye. Vision decreased to 20/400. A similar inferior sectoral injection was noted in the left eye. Oral prednisone was started, followed by oral immunosuppressive agent. Resolution of the PUK was noted after 1 month of immunosuppressive treatment with improvement of the vision.@*Conclusion@#PUK is a potentially blinding disorder that can be seen in Sweet syndrome. With proper knowledge of the underlying disease, close monitoring and management, PUK can be treated and cured.

Pharmacodynamic Studies on Matrine Eye Drops for Experimental Ocular Inflammation in Rabbits / 中药新药与临床药理

Objective To investigate the therapeutic effects of matrine eye drops (MED) on experimental ocular inflammation in rabbits. Methods The effects of 0. 5 % and 1.0% MED, dexamethasone eye drops, saline solution were e-valuated in the rabbits with ocular inflammation induced by paracentesis of anterior chamber and capsicum tincture respectively. Results MED could significantly inhibited the increase of protein concentration in aqueous humor induced by anterior chamber paracentesis, and the anti - inflammatory effect of MED on capsicum - tincture - induced extra ocular and intraocular inflammation was similar to dexamethasone eye drops. There were no significant difference between 1.0% MED and dexamethasone eye drops. Conclusion MED has a good effect on experimental ocular inflammation in rabbits.

Clinical Efficacy of Laser Flare-Cell Meter

Aqueous flare, the scattering of light by the Tyndall phenomenon, have been applied for the assessment of aqueous protein by the ophthalmologists. Since the intensity of flare ultimately reflects the severity of ocular inflammation. Laser flare-cell meter was developed to determine protein concentration and number of cells in the aqueous with non-invasive technique. The principle of evaluation was similar to that of slit-lamp examination in the viewpoint of scattering of light. The significant linear correlation was observed between the values of concentration for protein and photon counts, in the range from 5mg/100ml to 2,500ml/100ml in boine serum albumin (BSA) and from 5mg/100ml to 1,000mg/100ml in human gamma globulin (HGG), the valuses of HGG was three times higher than those of BSA in the same concentration. In experiments for WBC, RBC and latex particles with diameter of 2.95 micrometer, although somewhat differences was observed according to the sort of cells, significant linear correlation was shown between the number of detected peaks and that of cells.