Unilateral subretinal fibrosis and uveitis syndrome.

Subretinal fibrosis and uveitis syndrome is a rare, potentially devastating, posterior uveitis of unknown aetiology, characterised bilaterally by initial multifocal choroiditis with later progressive subretinal fibrosis. We report a rare case of unilateral subretinal fibrosis and uveitis syndrome. To date, there are only two case reports of unilateral disease. Our patient presented with unilateral blur and was found to have reduced visual acuity. A Bartonella profile was positive and a diagnosis of Bartonella posterior uveitis was made. Several positive ocular findings in the anterior chamber and on fundoscopy consistent with the syndrome were found. When steroid therapy alone could no longer control active inflammation, the immunosuppressive agent mycophenolate was added. Over time subretinal fibrosis became established sparing the macula and associated complications occurred, but with mycophenolate, at four years, our patient's visual acuity had improved and remains stable. Moreover, four years after her initial presentation, her condition remains strictly unilateral.

Two rare cases of retinal vasculitis following vaccination.

We write to report two rare cases of retinal vasculitis following administration of vaccinations. Both patients received recent vaccinations (within 4 weeks and 2 months respectively) and presented with unilateral visual loss due to retinal arteriolar vasculitis. Investigations did not reveal any other causes of vasculitis. The first patient's ocular inflammation settled following periocular steroid injection, whereas the second patient required the additional use of oral corticosteroid. Both patients had improved vision following treatment. Vaccinations can cause an autoimmune reaction. Systemic vasculitis has previously been described, whereas ocular vasculitic involvement is also possible but extremely rare. When seeing a patient with visual loss due to retinal vasculitis of unknown aetiology, a history of any recent vaccinations should be elicited.

Long-term impact of retinal screening on significant diabetes-related visual impairment in the working age population.

AIMS: Diabetic retinopathy has long been regarded as the commonest preventable cause of blindness in the working age population. The aim was to determine if consistent annual screening for treatable retinopathy decreased the incidence of new blindness. METHODS: We collated the causes of blindness for a 5-year period between 2001 and 2005 for the 16- to 64-year age group in a district that had operated systematic retinal screening in diabetes since 1986. RESULTS: Diabetic retinopathy was found to be the second commonest cause of blindness, with optic atrophy being the commonest cause in Newcastle District. This differs from national data showing diabetic retinopathy to be the commonest cause. Diabetic retinopathy was also the second commonest cause of partial sightedness registrations, with stroke being the commonest cause. Overall, stroke disease accounted for 16.2% and diabetic retinopathy for 15.4% of registrations. The annual incidence of blindness was 0.22 per 1000 with diabetes and of partial sightedness 0.43 per 1000 with diabetes. CONCLUSIONS: In a district that has operated retinal screening since 1986, diabetic retinopathy was not the commonest cause of blindness in the working age population, consistent with an effect of systematic annual screening.

Management of incidental hyperglycaemia in acute medical emergencies.

AIMS: To assess whether compliance with management guidelines for hyperglycaemia in acute medical emergencies was affected by prior diagnosis of diabetes, and to assess the effect of an educational campaign upon management. METHODS: Prospective study of management of adult patients admitted to an acute medical admissions unit in 2002, with repeat in 2003 after an educational campaign. RESULTS: The management of 251 patients in 2002 and 357 patients in 2003 was examined. In patients with no prior diagnosis of diabetes, unsatisfactory management was observed in 60% compared with only 30% of those with known diabetes (P < 0.02). In 2003 these proportions fell to 46 and 16%, respectively, but remained significantly different (P < 0.02). Overall, 30 of 70 (42.9%) patients with hyperglycaemia were managed strictly according to the guidelines in 2002 compared with 33 out of 59 (55.9%) in 2003 (P = 0.14). Satisfactory management was delivered in 55.7% in 2002 and 78% in 2003 (P < 0.01). CONCLUSIONS: The reluctance of doctors to manage incidental hyperglycaemia in acute medical admissions was especially common when the patient was not known to have diabetes. This was only modestly improved by an educational campaign, even though this group are known to have a greater response in terms of morbidity and mortality. Widespread debate of this issue is required to minimize morbidity and mortality due to hyperglycaemia.