[Intravitreal triamcinolone acetonide in chronic refractory uveitis]

To evaluate the effect of intravitreal triamcinolone acetonide injection for management of chronic refractory uveitis in terms of inflammation, visual acuity and macular thickness. This interventional case series was conducted on uveitic eyes with no remission despite proper administration of periocular and/or systemic steroids. After systemic and rheumatologic evaluations and confirmation of non-infectious nature of uveitis, 18 eyes of 10 patients underwent intravitreal injection of 4 mg triamcinolone acetonide. Changes in intraocular inflammation, bestcorrected visual acuity [BCVA], intraocular pressure [IOP] and macular thickness on optical coherence tomography were assessed during six months of follow-up. Mean BCVA increased from a baseline value of 0.81 +/- 0.29 to 0.35 +/- 0.33 LogMAR one week and to 0.17 +/- 0.07 LogMAR one month after the injection, respectively [P<0.001]. It decreased thereafter to 0.46 +/- 0.3 LogMAR at the sixth month visit, but was still significantly greater than the baseline value [P<0.001]. Mean IOP reached its maximum level one month post-injection with an increase of 7.36 +/- 0.48 mmHg compared to the baseline value, however only two eyes had IOP>22 mmHg which were successfully controlled using topical IOP-lowering medication. Mean central macular thickness decreased from 339.8 +/- 24.1 microm to its minimum value [197.18 +/- 12.7 microm] one month after the injection [P<0.001] and then increased to 203.57 +/- 9.06 microm at sixth month visit, still less than the baseline value [P< 0.001]. Intravitreal injection of triamcinolone acetonide in chronic refractory uveitis improves visual acuity and decreases central macular thickness which is sustained for at least six months. The only noticeable complication, transient IOP elevation can be controlled with topical medications

[Alport syndrome: report of three cases in one family]

Purpose: to report three cases of Alport syndrome in one family with anterior lenticonus and retinal flecks

Patients and findings: three members of one family with consanguineous parents are presented who had renal and ocular involvement. They had anterior lenticonus and a beaten bronze appearance in the macula. Reduced visual acuity and photophobia were the chief complaints of these patients. Despite correction of her refractive error, one of them underwent clear lens extraction with intraocular lens implantation due to severe impairment of visual acuity. Two patients had severe renal failure with subsequent renal transplantation. Biopsy of one of them confirmed the diagnosis of Alport syndrome

Conclusion: despite the rarity of ocular involvement in Alport syndrome, especially in females, all three patients had anterior lenticonus and retinal flecks. Regardless of macular involvement, the main cause of decreased visual acuity was lenticular anomaly. Clear lens extraction with intraocular lens implantation was an effective treatment modality in these patients