Mycophenolate Mofetil for Chronic Uveitis in Koreans

PURPOSE: To evaluate the therapeutic effect and safety of mycophenolate mofetil (MMF) on chronic uveitis in Korean patients. METHODS: This study included 25 patients with chronic uveitis who used MMF and were followed up more than 6 months in 2 referral centers from 2010 to 2014. The medical records were analyzed retrospectively. The therapeutic effect was assessed based on control of inflammation, corticosteroid sparing effects, and discontinuation of MMF, and the safety was assessed based on side effects. Control of inflammation was defined as no active inflammation observed on at least 2 consecutive visits 28 days apart or more. RESULTS: The 25 patients consisted of 18 males and 7 females. The mean age of the patients was 47.52 years. The etiology of uveitis was as follows: Behcet's disease in 15 patients (60%), Vogt-Koyanagi-Harada disease in 4 (16%), sympathetic ophthalmia in 2 (8%), systemic lupus erythematosus in 1 (4%), and idiopathic uveitis in 3 (12%). Anatomic classification was anterior uveitis in 20% and posterior uveitis or panuveitis in 80% of patients. Complete control of inflammation was achieved in 44% and 50% of patients within 6 months and 1 year, respectively. Systemic corticosteroid dosage was reduced to 10 mg of prednisone or less while maintaining sustained control of inflammation in 36% and 45% of patients for 6 months and 1 year, respectively. MMF was discontinued in 3 patients (12%) due to side effects and in 2 patients (8%) due to lack of effectiveness. CONCLUSIONS: MMF was effective and side effects were uncommon when managing chronic uveitis in Korean patients.

Evaluación farmacoterapéutica y evolutiva de uveítis crónicas y recurrentes no infecciosas / Pharmacological treatment evaluation and progression of non-infectious recurrent and chronic uveitis

OBJETIVOS: evaluar el tratamiento farmacológico e identificar los factores pronósticos en una evolución clínica desfavorable con uveítis crónicas y recurrentes no infecciosas, en el Instituto Cubano Oftalmología "Ramón Pando Ferrer" durante el período 2012-2013. MÉTODOS: se realizó un estudio de utilización de medicamentos. Se efectuó un diseño de cohorte retrospectivo evaluativo y un estudio transversal analítico de factores pronósticos. Fueron evaluados 116 pacientes. Las variables utilizadas correspondieron a la evaluación farmacoterapéutica: selección del medicamento, pauta de administración y causas de incumplimiento terapéutico. Para la evolución clínica desfavorable se analizaron variables sociodemográficas y clínicas. Se calcularon frecuencias absolutas y relativas. Se realizó un análisis univariado. Las variables significativas a la evolución se incluyeron en el modelo de regresión logística múltiple. RESULTADOS: no existieron errores en la prescripción en el 100 % de los evaluados. El 15,5 % de los pacientes no cumplieron con el tratamiento prescrito; 83,3 % se relacionó con la presencia de reacciones adversas y 33,3 % con la falta de disponibilidad. El 57 % presentó efectos adversos por corticoesteroides y el 39 % por inmunosupresores. El curso clínico crónico y la localización resultaron factores influyentes en una evolución desfavorable. CONCLUSIONES: la evaluación farmacoterapéutica en el caso de las uveítis crónicas es adecuada. No existen errores en la prescripción. Las causas más frecuentes de incumplimiento terapéutico son la suspensión del tratamiento por efectos adversos, la falta de disponibilidad de inmunosupresores y la alternativa biológica. El curso clínico crónico y la localización de las uveítis pueden considerarse como un factor pronóstico en la evolución desfavorable de esta enfermedad.

OBJECTIVES: to evaluate the pharmacological treatment and to identify the predictive factors in unfavorable clinical progression of patients with non-infectious recurrent and chronic uveitis at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology in the period of 2012 to 2013. METHODS: drug use study was conducted based on a design of retrospective evaluative cohort and a cross-sectional analytical study of predictive factors. One hundred and sixteen patients were evaluated. The variables corresponded to the pharmacological treatment evaluation: selection of drug, administration guidelines and causes of non-adherence to treatment. For the unfavorable clinical progression, the sociodemographic and clinical variables were considered. Absolute and relative frequencies were calculated; the univariate analysis was made and the significant variables for progression were included in the multiple logistic regression model. RESULTS: there was no error in prescribing 100 % of the evaluated cases. In the group, 15,5 % of patients did not adhere to the prescribed treatment; 83,3 % due to adverse reactions and 33,3 % to lack of drug availability. Fifty seven percent suffered adverse effects from corticosteroids and 39% from immunosupressors. The chronic clinical course and the location were the most influential factors in the unfavorable progression. CONCLUSIONS: the pharmacological treatment evaluation for the chronic uveitis is adequate. There are no errors in prescription. The most frequent causes of non-adherence to treatment are cessation of treatment on account of adverse effects, lack of availability of immunosupressors and biological alternative. The chronic clinical course and the location of uveitis can be considered as predictive factors in the unfavorable progression of the disease.

Pseudomonas aeruginosa endophthalmitis masquerading as chronic uveitis.

A 65-year-old male presented with decreased vision in the left eye of 15-day duration after having undergone an uneventful cataract surgery 10 months back. He had been previously treated with systemic steroids for recurrent uveitis postoperatively on three occasions in the same eye. B-scan ultrasonography showed multiple clumplike echoes suggestive of vitreous inflammation. Aqueous tap revealed Pseudomonas aeruginosa sensitive to ciprofloxacin. The patient was treated with intravitreal ciprofloxacin and vancomycin along with systemic ciprofloxacin with good clinical response. Even a virulent organism such as P.aeruginosa can present as a chronic uveitis, which, if missed, can lead to a delay in accurate diagnosis and appropriate management.

Factors Associated with Recurrence after Surgery for Epiretinal Membrane

PURPOSE: To evaluate the factors associated with the recurrence of epiretinal membrane (ERM) after surgery for ERM METHODS: We reviewed patients' medical records who received vitrectomy for ERM. The preoperative findings, best postoperative and final visual acuity, and intraoperative findings of eyes with recurred ERM were compared with those of eyes without recurrence after removal of ERM. RESULTS: Recurrence of ERM was high in eyes with ERM associated with chronic uveitis, compared with the eyes with idiopathic ERM (p=0.030, Cox regression analysis). Neither the type of membrane nor incomplete membrane removal during pars plana vitrectomy was correlated with the recurrence of ERM. CONCLUSIONS: Considering the recurrence of ERM after surgical removal being high in eyes with chronic uveitis, close follow up is recommended in these patients.

Fas/FasL Expression in the Anterior Chamber Cells of Patients with Chronic Noninfectious Uveitis

PURPOSE: Despite ocular immune privilege, noninfectious chronic uveitis is relatively common. To investigate spontaneous turning on and off of noninfectious chronic uveitis, we examined the nature and apoptosis of infiltrating inflammatory cells from the anterior chamber of patients with chronic uveitis. METHODS: Aqueous humors were obtained with consent from patients with chronic recurrent uveitis at the time of active intraocular inflammation. Apoptosis of the infiltrating cells in aqueous humor was analyzed by flow cytometry, using fluorescence-labeled anti-CD95 antibody, anti-CD95L antibody, and Annexin V. RESULTS: Of total 35 patients recruited, 19 patients had anterior uveitis, 4 patients had intermediate uveitis, and 12 patients had panuveitis. The proportions of Fas+cell and FasL+ cell were over 90% independent of clinical characteristics of uveitis. Annexin V+ cells occupied 31.3% of all cells in aqueous humor. CONCLUSION: The high proportions of CD95+ cell, CD95L+ cell, Annexin+ cell suggest that there is an active apoptosis of inflammatory cells in anterior chamber of noninfectious chronic uveitis.