Diagnosis and Treatment of Central Serous Chorioretinopathy in Patients with Scleritis.

Central serous chorioretinopathy (CSCR) is characterized by central neurosensory retinal detachment from the retinal pigment epithelium. While the association between CSCR and steroid use is widely recognized, it is difficult to distinguish whether the subretinal fluid (SRF) in ocular inflammatory disease results from steroid use or an inflammation-related uveal effusion. We report the case of a 40-year-old man who presented to our department with intermittent redness and dull pain in both eyes that had persisted for three months. He was diagnosed with scleritis with SRF in both eyes and steroid therapy was started. Inflammation improved with steroid use, but SRF increased. This indicated that the fluid was not caused by the posterior scleritis-related uveal effusion but by steroid use. SRF and clinical symptoms subsided after steroids were discontinued completely and immunomodulatory therapy was initiated. Our study highlights that steroid-associated CSCR must be considered in the differential diagnosis of patients with scleritis, and prompt diagnosis with an immediate shift from steroids to immunomodulatory therapy can resolve SRF and clinical symptoms.

Intravitreal injection versus systematic treatment in patients with uveitis undergoing cataract surgery: a systematic review and meta-analysis.

PURPOSE: Cataract surgery in patients with uveitis is challenging, and postoperative inflammation control is crucial for successful outcomes. No consensus exists regarding the optimal method of controlling postoperative inflammation. In this systematic review and meta-analysis, we compared the outcome of intravitreal injection (IVI), including steroid (triamcinolone acetonide) or steroid implant (dexamethasone), with systemic anti-inflammatory therapy (ST), such as systemic steroids with or without immunomodulatory therapy, in patients with uveitis undergoing cataract surgery. METHODS: We searched PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials (RCTs), comparative cohort studies, and case-control studies published through May 2021 that compared intraoperative IVI of triamcinolone acetonide or steroid implant with ST with or without immunomodulatory therapy. The following outcomes were evaluated: preoperative best-corrected visual acuity, intraocular pressure, laser flare photometry, central macular thickness and cystoid macular edema rate. RESULTS: Five studies were selected. Our analysis indicated that compared with ST, IVI treatment may be associated with less anterior chamber inflammation and a lower cystoid macular edema rate, but the difference in best-corrected visual acuity, intraocular pressure, or central macular thickness was not significant. CONCLUSIONS: IVI of steroid or steroid implants might be beneficial in controlling postoperative inflammation for uveitis cataract, especially in patients who cannot tolerate ST. To the best of our knowledge, this is the first meta-analysis to compare the efficacy of intraoperative IVI of steroids with standard-of-care treatment as a prophylaxis for uveitis cataract. However, large-scale RCTs are warranted to compare the IVI of steroid implants and steroids.

Association Between Ischemic Optic Neuropathy and Inflammatory Bowel Disease: A Population-Based Cohort Study in Taiwan.

Background: Ischemic optic neuropathy (ION) is a possible extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). We investigate the relation between IBD and ION and possible risk factors associated with their incidence. Methods: Medical records were extracted from the National Health Insurance Research Database (NHIRD) from January 1, 2000, to December 31, 2013. The main outcome was ION development. Univariate and multivariate Cox regression analyses were performed. Results: We enrolled 22,540 individuals (4,508 with IBD, 18,032 without). The cumulative risk of developing ION was significantly greater for patients with IBD vs. patients without (Kaplan-Meier survival curve, p = 0.009; log-rank test). Seven (5%) and five (0.03%) patients developed ION in the IBD and control groups, respectively. Patients with IBD were significantly more likely to develop ION than those without IBD [adjusted hazard ratio (HR) = 4.135; 95% confidence interval: 1.312-11.246, p = 0.01]. Possible risk factors of ION development were age 30-39 years, diabetes mellitus (DM), hypertension, ischemic heart disease (IHD), atherosclerosis, and higher Charlson comorbidity index revised (CCI_R) value. Conclusion: Patients with IBD are at increased risk of subsequent ION development. Moreover, for patients with comorbidities, the risk of ION development is significantly higher in those with IBD than in those without.

Association between Optic Neuritis and Inflammatory Bowel Disease: A Population-Based Study.

Extraintestinal manifestations are common in patients with inflammatory bowel disease (IBD), and optic neuritis (ON) is a rare but severe one. This study aimed to evaluate possible factors associated with ON in patients with IBD. Adult patients with IBD who were not with concomitant ON on the index date identified from the Taiwan National Health Insurance Research Database (NHIRD) from the years 2000 to 2013 were included. A four-fold matched group was selected using age, sex and year of index date for comparison. All the patients were followed up until the development of ON or the end of the study period. Data of included patients were extracted and analyzed statistically. The mean follow-up time for all patients was 7.13 ± 5.21 years. At the study period conclusion, eight (0.18%) and five (0.003%) patients with and without IBD, respectively, had developed ON (p = 0.001). Adjusted HRs showed that patients with IBD aged between 30 and 39 years, with comorbidities including neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), systemic lupus erythematosus (SLE) and with a higher Charlson Comorbidity Index, had a significantly higher risk of developing ON (all p < 0.005). Among the eight IBD patients who developed ON, only one patient was diagnosed with Crohn's disease, the male gender was slightly dominant, and two (25%) patients received antitumor necrosis factor α (anti-TNF α) treatment for IBD. Patients with IBD have a higher risk of developing ON compared to patients without IBD. ON occurs more frequently in IBD patients aged between 30 and 39 years, with comorbidities including NMO, ADEM and SLE. Other factors besides anti-TNF α treatment for IBD are more likely associated with the development of ON.

The impact of diabetes mellitus medication on the incidence of endogenous endophthalmitis.

PURPOSE: This study aimed to evaluate the relationship between diabetic mellitus (DM) treatment and the incidence rate of endogenous endophthalmitis (EE). DESIGN: This study used a matched cohort design. We utilized the Longitudinal Health Insurance Database to identify outpatients and inpatients who were diagnosed with DM and treated with medication from 2000 to 2010. METHODS: Several factors and different DM medications were also investigated. The influence of DM medication on the incidence of EE was examined by using Cox proportional hazards regression models, and the hazard ratios and 95% confidence intervals were determined. RESULTS: The cumulative incidence of EE was lower in DM patients treated with medication than in subjects in the control group (P = 0.002). The adjusted hazard ratio (AHR) was 0.47-fold lower in the treatment group than in the control group (P = 0.004). With respect to DM medication, single-agent therapy with insulin, metformin, gliclazide, glimepiride, or repaglinide and combination therapy with glimepiride/metformin or repaglinide/metformin were associated with decreased AHRs (0.257-0.544, all P<0.05). CONCLUSIONS: Diabetic patients treated with medication had lower AHRs than those in the control group. Further stratification indicated that liver abscess, liver disease DM patients who were treated with medication had a lower risk of developing EE. Several specific DM medications may decrease the incidence of EE.

Agreement of post-LASIK corneal power and corneal thickness measurements by pentacam and GALILEI corneal tomography systems.

BACKGROUND: Post-LASIK corneal conditions cannot be accurately measured by traditional optometric approaches. Therefore, we aimed to analyze the agreement of two rotating Scheimpflug cameras in corneal assessment. METHODS: Fifty otherwise healthy volunteers who had undergone LASIK were recruited in this study. The values of mean and central total corneal power (TCP), including TCP1, TCP2, and TCP-IOL, were measured by GALILEI Scheimpflug camera. The values of total corneal refractive power (TCRP) readings at both 2 mm ring and 3 and 4 mm zones were detected by Pentacam Scheimpflug camera. Central corneal thickness (CCT) and thinnest corneal thickness (TCT) were quantified by GALILEI and Pentacam respectively. Paired t-tests and Bland-Altman analyses were used to evaluate statistical differences between measurement results obtained by GALILEI and by Pentacam. RESULTS: Among these 50 subjects, the mean and central TCP1 values (37.31 ± 2.61 and 37.27 ± 2.64) derived from GALILEI measurements were consistent with the TCRP values (37.08 ± 2.76, 37.11 ± 2.74, and 37.19 ± 2.68; p > 0.05) determined by Pentacam at the 2 mm ring apex, 3 mm zone apex, and 4 mm zone apex. There were no statistically significant differences in central corneal thickness (CCT) values measured by the two cameras (463.64 ± 55.67 µm for GALILEI and 470.69 ± 44.04 µm for Pentacam, respectively; p > 0.05). However, the limits of agreement were wide when comparing mean TCP1 (-1.4 to 1.8 D, -1.4 to 1.8 D, and -1.3 to 1.6 D), central TCP1 (-1.2 to 1.6 D, -1.2 to 1.6 D, and -1.2 to 1.4 D) and CCT (-77.2-63.0 µm). CONCLUSION: Corneal power and corneal thickness are disparate post-LASIK evaluation parameters when comparing the utility of GALILEI with that of Pentacam.

Benefit of hyperbaric oxygen therapy treatment in direct traumatic optic neuropathy: case report.

Direct traumatic optic neuropathy (TON) is a devastating condition and clinical challenge. Its adequate treatment remains controversial. Hyperbaric oxygen (HBO2) therapy has been proposed as an adjunctive treatment for eye disease but has rarely been used in optic neuropathy. The patient was a 57-year-old woman who had direct TON and brain injury after contusion injury. After receiving delayed HBO2 therapy her visual acuity got better - from hand motion to 6/60 - along with improvement of visual field and color vision. She was treated at 2.5 atmospheres absolute for 100 minutes, five times a week, for a total of 61 sessions. Our case highlights that HBO2 may be beneficial as an alternative treatment for direct TON, particularly when combined with brain injury. Although this entity is promising, further randomized controlled trials will be needed to clarify the efficacy of HBO2 in the treatment of direct TON.

Amelioration of acute orbital compartment syndrome following transvenous embolization for an indirect carotid-cavernous fistula: A case report.

RATIONALE: Orbital compartment syndrome (OCS) is a rare occurrence after transvenous embolization of indirect carotid-cavernous fistula (CCF). A lateral canthotomy and cantholysis are the most commonly performed surgical interventions. In our case, as the acute OCS occurred immediately after an uneventful transvenous embolization, an orbital floor orbitectomy was performed. PATIENT CONCERNS: Here, we present a rare case of a 59-year-old patient who required a transvenous embolization of an indirect CCF and subsequently immediately developed an acute OCS. DIAGNOSES: An indirect CCF was revealed using brain magnetic resonance angiography and a transvenous embolization of the fistula was performed using coils. Post-embolization angiograms revealed an occlusion of the CCF. INTERVENTIONS: After the development of a relative afferent pupillary defect and acute OCS, we performed a lateral canthotomy, superior and inferior cantholysis, and an orbital floor orbitectomy. Subsequently, visual acuity and intraocular pressure improved. LESSONS: Our case is the first report of acute OCS occurring after transvenous embolization of a CCF that required further orbital floor decompression to prevent permanent visual loss. Moreover, our case demonstrates that acute OCS may rapidly develop after transvenous embolization due to superior ophthalmic venous (SOV) thrombosis and that an early intervention may reduce the risk of visual impairment.