RESUMEN
Cystoid Macular Edema [CME] is one of the most common and sight threatening complications of uveitis. Intravitreal injection of corticosteroids and anti-VEGF antibody are two routine options for treatment. To compare the effects of intravitreal injections of Bevacizumab and Triamcinolone Acetonide for the treatment of persistent macular edema in non-infectious uveitis. In a randomized clinical trial, sixty eyes of 55 patients were enrolled in the study. Patients were divided into two groups with randomized digits table. 29 eyes received 4 mg of intravitreal triamcinolone acetonide, and 31 eyes received 1.25 mg of intravitreal bevacizumab. Two main outcome measures were changes in visual acuity, measured with logarithm of minimal angle of resolution, and central macular thickness, measured with optical coherence tomography. The mean follow-up was 25.3 weeks. The best visual acuities were achieved 6 months after injection in both groups. Improvement in visual acuity at 6 months was achieved in 28/29 [96%] of eyes in Triamcinolone group and in 26/31 [83%] eyes in Bevacizumab group [p=0.196]. None of the eyes showed worsening of visual acuity after 6 months. Mean of central macular thickness in the pre-injection time for intravitreal triamcinolone acetonide [IVTA] group was 295.62 micro, and 309.87 micro in intravitreal bevacizumab [IVB] group, which were decreased after six months to 199.27 micro and 221.06 micro, respectively [p<0.001]. This study shows that IVT and IVB are both effective in improving vision in uveitic CME. Although effects of triamcinolone on Central Macular Thickness [CMT] are more apparent, this superiority is not seen on Best Corrected Visual Acuity [BCVA]
RESUMEN
The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery. In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients [8 of whom underwent cataract surgery at our center, and 62 who were referred]. Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significance During the study period, 7737 cataract surgeries were performed in this center. Eight [0.10%] of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated that extracapsular cataract extraction was associated with a fourfold higher risk of endophthalmitis compared with phacoemulsification. We found better initial visual acuity [VA] [>/=hand motion] [P<0.001] and negative cultures [P=0.021] were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect [RAPD] were associated with lower initial VA [P<0.001] and worse visual outcome [P=0.001]. Positive microbial cultures were found for 33 [42.9%] cases. Staphylococcus aureus was the most common organism isolated. Positive cultures were more frequently found in patients with RAPD. The "gram-positive coagulase-negative" and "no growth" groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration. The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of>/=20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment
RESUMEN
Idiopathic anterior uveitis is an anterior segment inflammation in which a detailed medical history, general and ocular physical examination is not associated with any defined clinical syndrome. Alterations in immune system parameters have been reported in patients with idiopathic posterior uveitis; however no data on the role of immune system in idiopathic anterior uveitis has yet been reported. In this study the immune system function in patients with idiopathic anterior uveitis was evaluated. To evaluate the immune system function in patients with idiopathic non-infectious anterior uveitis. 51 patients with anterior uveitis, 32 women [62.7%] and 19 men [37.3%], participated in this study. Intensity of intraocular inflammation was scored according to standard uveitis grading system. In all cases, serum levels of immunoglobulins A, G, M and E, C3 and C4 complement components, and autoantibodies against ds-DNA and ACLA, were measured using ELISA method. 49 patients out of 51 [96%] showed altered serum levels of immunological parameters, compared with normal values. Changes in serum immunoglobulin concentration were present in 44 patients, with increased IgA levels being the most common. Serum values of C3 and C4 complement proteins were also increased in 29 subjects. ds-DNA autoantibody was positive in 15 and equivocal in 19 cases. ACLA was positive and equivocal in 3 and 9 patients, respectively. Immune abnormalities found in serum of 49 patients with idiopathic anterior uveitis may play a role in the pathogenesis of this disorder