Ocular Inflammatory Events Following COVID-19 Vaccination in the Paediatric Population: A Multinational Case Series.

BACKGROUND: Ocular inflammatory events following COVID-19 vaccination have been reported in the adult population. METHODS: Multinational case series of patients under the age of 18 diagnosed with ocular inflammatory events within 28 days of COVID-19 vaccination. RESULTS: Twenty individuals were included. The most common event was anterior uveitis (n = 8, 40.0%), followed by intermediate uveitis (7 patients, 35%), panuveitis (4 patients, 20%), and posterior uveitis (1 patient, 5%). The event was noticed in the first week after vaccination in 11 patients (55.0%). Twelve patients (60.0%) had a previous history of intraocular inflammatory event. Patients were managed with topical corticosteroids (n = 19, 95.0%), oral corticosteroids (n = 10, 50.0%), or increased dose of immunosuppressive treatment (n = 6, 30.0%). Thirteen patients (65.0%) had a complete resolution of the ocular event without complications. All patients had a final visual acuity unaffected or less than three lines of loss. CONCLUSION: Ocular inflammatory events may happen in the paediatric population following COVID-19 vaccination. Most events were successfully treated, and all showed a good visual outcome.

Cytokine and chemokine tear levels in patients with uveitis.

PURPOSE: To determine whether the levels of cytokines and chemokines in tears differ in uveitis patients and healthy subjects. METHODS: Ninety-two uveitis patients (mean age 46.4 years) and 157 control healthy subjects (mean age 49.5 years) were recruited. Subjects with ocular surface diseases such as dry eye were excluded from the study. Using multiplex bead-based assays, tears (4 µl) were analysed for the concentration of interleukin (IL)-1ß, IL-1RA, IL-2, IL-6, IL-7, IL-8/CXCL8, IL-10, IL-12p70, IL-15, IL-17A, IL-23, epidermal growth factor (EGF), fractalkine/CX3CL1, interferon-γ, IP-10/CXCL10, monocyte chemo-attractant protein (MCP)-1/CCL2, tumour necrosis factor-α, vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-ß1, TGF-ß2 and TGF-ß3. Tear molecule levels were compared between the groups and among the different forms of uveitis and disease severity. RESULTS: Epidermal growth factor, IL-1RA, IL-7, IL-8/CXCL8, IP-10/CXCL10, MCP-1/CCL2, TGF-ß2 and VEGF were detected in more than 75% of the samples in both groups. Statistically significant differences in percentage of detection between control and patient groups were found for IL-23, IL-1ß, IL-15, EGF, fractalkine/CX3CL1 and MCP-1/CCL2. The concentrations of IL-1RA, IL-8/CXCL8, fractalkine/CX3CL1, IP-10/CXCL10, VEGF and TGF-ß2 in uveitis tear samples were elevated compared to controls (p < 0.05). Significant differences in tear levels of those molecules and also EGF were also present depending on the anatomic classification of uveitis. CONCLUSION: There were significant differences in the levels of several cytokines and chemokines in tears of patients with uveitis compared with healthy subjects. These results can help understand the underlying pathophysiology of the uveitis and could potentially aid in diagnosis.

Corneal inflammation from pine processionary caterpillar hairs.

PURPOSE: Hairs from the caterpillar of the pine processionary moth, Thaumetopoea pityocampa, located in the pine forests of southern Europe and elsewhere, can become embedded in the cornea and conjunctiva. Disorders produced by the urticating hairs can be classified into a broad spectrum of severity from mild keratoconjunctivitis to anaphylactic shock. This report presents 3 cases that illustrate the range of corneal responses to embedded hairs of the processionary moth caterpillar. METHODS: Case series and review of the literature. RESULTS: A 51-year-old man (case 1), a 46-year-old woman (case 2), and a 67-year-old man (case 3) presented different manifestations as a result of contact with pine processionary caterpillar hairs. Case 1 had acute keratitis with decreased vision. He was treated with a corneal depot steroid 4 times daily for 3 months. After 4 months, he was asymptomatic. Case 2 had acute keratitis without vision symptoms. She was released without treatment, and 1 month later was asymptomatic. Case 3 experienced dry gritty sensations, probably because of blepharitis, but also presented asymptomatic caterpillar hairs embedded in the corneal stroma. He was instructed regarding lid hygiene for his blepharitis, and after 3 months the embedded caterpillar hairs had disappeared. CONCLUSIONS: The most common ocular presentation of embedded hairs from the pine processionary moth caterpillar is keratitis. The urticating hairs can cause corneal infiltrates that disappear progressively over time. Steroid eye drops accelerate the resorption of these infiltrates.

Distinctive clinical features of idiopathic versus infectious serpiginous choroidopathy.

PURPOSE: Serpiginous choroidopathy (SC) is an inflammatory disease of unknown etiology. Infectious diseases that mimic SC are termed serpiginous-like choroidopathy (SLC). The aim of this study is to determine the clinical features of infectious SLC in comparison to SC. METHODS: Multicenter case series. Variables analyzed were age, gender, laterality, visual acuity, intraocular inflammation, multifocal pattern, choroidal neovascularization, involvement of juxtapapillary area, and posterior pole. Statistical significance was assessed by Mann-Whitney U test and Fisher's exact test. RESULTS: Twenty-four patients had SC and 5 patients had SLC. Mean ages were 50 and 46 years (SC and SLC, respectively). In the SC group, 54% of the patients were males, and in the SC group, 80% were males. The disease was bilateral in 87.5% in the SC group and in 80% in the SLC group. The juxtapapillary area was involved in 91% in SC eyes and 0% in the SLC group (p < .05). CONCLUSIONS: In cases where the peripapillary area is disease-free, an infectious etiology has to be strongly suspected, as an immunomodulatory treatment could have severe consequences.

Update on twice-daily bromfenac sodium sesquihydrate to treat postoperative ocular inflammation following cataract extraction.

Ophthalmic bromfenac sodium sesquihydrate is a topically applied selective cyclooxygenase (COX)-2 inhibitor. It is similar to amfenac, except for a bromine atom at the C(4) of the benzoyl ring position, which markedly affects its in vitro and in vivo potency, extends the duration of anti-inflammatory activity, and enhances its inhibitory effect on COX-2 absorption across the cornea and penetration into ocular tissues. The United States Food and Drug Administration approved bromfenac in 2005 for the treatment of postoperative inflammation and the reduction of ocular pain in patients who have undergone cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs), and among them bromfenac, could be even more effective than steroids at reestablishing the blood-aqueous barrier, as revealed by flare on slit-lamp examination and as quantitatively measured using ocular fluorophotometry. Similar to other NSAIDs, it has a role in inhibiting intraoperative miosis during cataract surgery. However, bromfenac also seems to be useful in other situations, such as refractive surgery, allergic conjunctivitis (not useful in dry eye), choroidal neovascularization, and even ocular oncology. No reports of systemic toxicity have been published and bromfenac has good topical tolerance with a low incidence of adverse effects.

Frosted branch angiitis diagnosed as neuro-behçet: a diagnostic and etiologic dilemma.

PURPOSE: To report a case of frosted branch angiitis (FBA) secondary to neuro-Behçet. METHODS: Description, diagnosis, angiogram imaging and follow-up of a 28-year-old female with FBA. RESULTS: 'Frosted branch angiitis' is a clinical term applied to three conditions: infiltration of vessels by malignant cells, and sheathing of vessels either secondary to an active disorder or subsequently to a previous inflammatory disease. Our patient's history of two optic neuropathies and the lack of demyelinating signs in neuroimaging made us consider FBA in the context of neuro-Behçet. CONCLUSION: Recognition of the category of FBA from the clinical signs is essential to establish the correct diagnosis and prescribe the appropriate treatment.

Surgical outcomes of uveitic glaucoma.

PURPOSE: Secondary glaucoma is a difficult and frequent complication of uveitis. The aim of this study is to describe the results of surgery in uveitic glaucoma and to identify situations linked to a high risk of failure of the surgery. METHODS: Retrospective observational study. Clinical and surgical data from 27 cases of uveitic glaucoma that underwent glaucoma surgery over a period of 9 years were collected. RESULTS: The main diagnosis and aetiology were anterior uveitis (61.90%) and herpes (38.10%) respectively. Trabeculectomy with mitomycin C was performed in 51.9% of the cases. An intraocular pressure lower than 16 mmHg and managed with less than two drugs was achieved in 48.15% of the cases. Higher risks of surgical failure were associated with intermediate uveitis, idiopathic uveitis, Fuchs' cyclitis, combined surgery with phacoemulsification, omission of mitomycin C, intraocular inflammation at surgery and relapse of the uveitis. CONCLUSIONS: There are some situations linked to a high risk of failure of surgery in uveitic glaucoma, which should be avoided when possible, mainly the association of higher risk with combined approaches.