The utility of routine tuberculosis screening in county hospital patients with uveitis.

BACKGROUND/AIM: To evaluate the utility of tuberculosis (TB) screening in diagnosing ocular TB in uveitis patients in a government-funded hospital. METHODS: The charts of 142 consecutive patients seen during August 2011-July 2012 at the Los Angeles County Hospital uveitis clinic were reviewed for manifestation/laterality of uveitis, purified protein derivative (PPD) test results, interferon γ release assay, chest x-ray, birthplace, treatment history and diagnosis. 'Presumed TB-uveitis' was diagnosed when patients had positive TB screening and favourable response to anti-TB therapy, and definite ocular TB when Mycobacterium tuberculosis' presence was demonstrated. Post-test probabilities were determined. RESULTS: TB screening was positive in 21.1%. Six patients were diagnosed with TB-related uveitis: one definite, four presumed and one systemic TB with uveitis. With regard to PPD positivity, being foreign-born was the only statistically significant factor with OR of 2.26 (95% CI 1.01 to 5.13; p<0.01) if born in Mexico and 4.90 (95% CI 1.74 to 13.83; p<0.01) if born in other foreign countries. The post-test probabilities of a positive PPD in a uveitis patient showed a 17.2% (overall) or 30.3% (foreign-born patients) chance of ocular TB. CONCLUSIONS: PPD skin test plays an important role in the diagnosis of TB-associated uveitis in high-risk groups, such as immigrants from TB endemic regions.

Role of ultra-widefield fluorescein angiography in the management of uveitis.

OBJECTIVE: To discuss and illustrate the role of ultra-widefield fluorescein angiography (UWFFA) in the diagnosis and management of peripheral retinal vasculitis. DESIGN: Retrospective case series. PARTICIPANTS: Four consecutive patients in whom UWFFA showed far peripheral vasculitis were included. All patients were seen between May 2011 and May 2012 at the Doheny Eye Institute. METHODS: Conventional fluorescein angiogram (FA) images or areas determined by the Early Treatment of Diabetic Retinopathy Study Group protocol for imaging the posterior pole and peripheral retina were superimposed on the UWFFA images. The ability to detect the extent and severity of vasculitis and vascular occlusion using both conventional FA and UWFFA was compared by 2 investigators, and any discrepancies were adjudicated by a third investigator. RESULTS: In none of the cases was the full extent of vasculitis and capillary occlusion visible in the fields normally portrayed by conventional FA. In contrast, capillary nonperfusion and peripheral vasculitis were detectable by UWFFA in all cases. In 2 cases, the posterior extent of vasculitis could have been detected by conventional FA. CONCLUSIONS: Detection and depiction of the extent and severity of peripheral vascular changes are enhanced with UWFFA, aiding in the management of vasculitis in the retinal periphery.

Repeat selective laser trabeculoplasty.

PURPOSE: To evaluate the efficacy of repeat 360-degree selective laser trabeculoplasty (SLT) in glaucoma patients with prior successful 360-degree SLT. DESIGN: Retrospective chart review. METHODS: Forty-four eyes of 35 patients, > or =18 years of age, with open-angle glaucoma (primary open-angle, pseudoexfoliation, or pigmentary glaucoma), uncontrolled on maximum tolerable medical therapy, underwent an initial 360-degree SLT (SLT1), which was successful for > or =6 months, but eventually lost efficacy and was followed by a repeat 360-degree SLT (SLT2). Patients with prior argon laser trabeculoplasty or other glaucoma surgery, before or during the study period, were excluded. Intraocular pressure (IOP) measurements were recorded before each procedure and 1 to 4 weeks, 1 to 3 months, and 5 to 8 months posttreatment and 15 to 21 weeks after the initial SLT. RESULTS: Reduction in IOP after SLT1 and SLT2 was significantly less with repeat treatment at 1 to 3 months, with average decreases of -5.0 and -2.9 mm Hg, respectively (P=0.01), but there were no statistically significant differences between treatments at the other equivalent time points. Using a definition of "success" as > or =20% peak IOP reduction, success rates for SLT1 and SLT2 were not significantly different. There was also no significant difference in eyes that received SLT2 6 to 12 months after SLT1 compared with those that received SLT2 12 months or more after SLT1. CONCLUSIONS: Our findings suggest that repeat 360-degree SLT may be safe and effective after an initially successful 360-degree SLT has failed. These results may be achieved as early as 6 months after the first treatment.