Complications in Intermediate Uveitis: Prevalence, Time of Onset, and Effects on Vision in Short-Term and Long-Term Follow-Up.

Purpose: To study the prevalence and time of onset of ocular complications in intermediate uveitis (IU) and to assess their effects on visual outcome in short-term and long-term follow-up. Methods: A retrospective cohort study of patients with IU who had a minimal follow-up of one year. Results: 96 patients (174 eyes, 70% females) were included with a mean age at presentation of 30 years. Children constituted 38% of all patients. Mean follow- up was 64.9 months. Pars planitis was the most common form followed by sarcoidosis and multiple sclerosis. Cystoid macular edema (CME), cataract, epiretinal membrane and posterior synechiae were the most prevalent complications. Posterior synechiae, band keratopathy, cataract and papillitis at presentation were associated with worse presenting visual acuity (VA). Of the late-onset complications, glaucoma/ocular hypertension (OHT) was the most significantly associated with worse long-term VA. Most sight-threatening complications (namely CME and glaucoma) were diagnosed at presentation while late complications predominantly affected the posterior segment and included among others peripheral retinal elevations, vasoproliferative tumors, and vitreous hemorrhage. Median LogMAR VA improved at short-term and long-term follow-up, from 0.2 to 0.1 (p<0.001). Subgroup analysis revealed significant VA improvement for eyes with all the different complications except for eyes with glaucoma/OHT. Conclusion: IU is a chronic low-grade uveitis that may be associated with protean early and late complications of the anterior or posterior segments or both. Optimal treatment regimens are imperative for the strict control of inflammation and proper management of complications thus allowing a favorable long-term prognosis.

Pars plana vitrectomy for vitreo-retinal complications of birdshot chorioretinopathy.

PURPOSE: To evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) in the treatment of vitreoretinal complications of birdshot chorioretinopathy (BCR). METHODS: The clinical records of 9 consecutive patients (16 eyes) with vitreo retinal complications in BCR refractory to medical therapy who underwent pars plana vitrectomy were reviewed. RESULTS: Indications for PPV were macular edema in 9 eyes (56.2%), and persistent vitreous opacities in 7 (43.8%). At a mean postoperative follow-up of 44.1 months, best-corrected visual acuity improved ≥2 Snellen lines in 9 eyes (56.2%), remained stable in 6 (37.5%) and worsened in 1 eye (11.1%). Systemic medication was significatively reduced after surgery (p = .020) and macular thickness on optical coherence tomography exams decreased significatively in eyes with macular edema (p= .0039). CONCLUSIONS: In this small series of eyes with limited follow-up PPV seems to be a safe and effective for treatment of vitreoretinal complications in patients with BCR.

Uveítis. Un reto para el internista / Uveítis. A challange for internist

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[Ocular changes in demyelinating diseases]. / Modificarile oculare în bolile demielinizante.

To synthetize the main ocular changes in the demyelinating diseases of CNS. The most important changes in this diseases are the neuro-ophthalmological ones: retrobulbar optic neuritis, papillitis, oculomotor nerves palsies. Also the demyelinating diseases can have an ophthalmological involvement represented by: retinal periphlebitis, pars planitis.

The appearance of pars planitis in multiple sclerosis.

The aim of the study was to investigate the clinical association of multiple sclerosis and pars planitis (or intermediate uveitis), as well as to determine the incidence of pars planitis in multiple sclerosis patients. During the period of one year authors examined 42 patients with multiple sclerosis divided into two groups. First group consisted of 23 patients with history of optic neuritis and the second group consisted of 19 patients who have never had optic neuritis. The mean age of patients in the first group was 31.7 +/- 5.1 years and in the second group 29.1 +/- 8.1 years. Pars planitis was found in 12 patients with multiple sclerosis. Age, sex and degree of neurological disability had no influence on the appearance of pars planitis. Although optic neuritis is considered to be the most common ocular manifestation of multiple sclerosis, the significant number of patients with multiple sclerosis has pars planitis.

Spectrum of clinical manifestations of West Nile virus infection in children.

Reports of clinical manifestations of West Nile virus (WNV) infections in children have been relatively rare. Four cases of WNV infection in children are described: the first report of prolonged encephalitis and fulminant hepatitis caused by WNV, and 3 other presentations of WNV, including the first report of ocular involvement in a child.

Multiple sclerosis-associated uveitis.

BACKGROUND/AIMS: To describe the clinical characteristics and course of 16 patients with uveitis associated with multiple sclerosis (MS). METHODS: The records of 1254 patients with uveitis were reviewed. Sixteen of these patients had MS. The history, review of systems, ocular findings, and clinical test results of each of these 16 subjects were analyzed. The mean follow-up time was 38 months. RESULTS: Most patients with MS-associated uveitis were white females between 20 and 50 years of age. The diagnosis of MS preceded the onset of uveitis in 56%, followed it in 25%, and was made concurrently in 19% of the cases. In 94%, the uveitis was bilateral. Pars planitis was the most frequent form of uveitis in our study population (81%); concomitant anterior chamber inflammation was common and was granulomatous in nature 56% of the time. Forty-one percent of the eyes with MS-associated uveitis had 20/30 or better initial visual acuity. Among these treated patients, significant loss of visual acuity was uncommon. CONCLUSIONS: MS-associated uveitis should be suspected in white female patients with bilateral uveitis, especially if pars planitis is present. These patients often retain useful vision for many years if treated.

Inflammatory bowel disease (Crohn's disease) in a Spanish patient with pars plana exudates: report of a new case and review of the literature.

Several ocular manifestations have been found in Crohn's disease patients, most often affecting the anterior segment. This paper presents the case of a young woman with pars plana exudates in whom Crohn's disease was later diagnosed. To the authors' knowledge, this is only the second report of Crohn's disease and concomitant pars plana exudates.

Lower eyelid herniation of orbital fat may complicate periocular corticosteroid injection.

PURPOSE: To report a case of lower eyelid herniation of orbital fat occurring after periocular corticosteroid injection. DESIGN: Interventional case report. METHODS: A 44-year-old man with asymmetrical pars planitis complicated by right cystoid macular edema was treated with multiple right orbital floor injections of triamcinolone through the lower eyelid. RESULTS: Right lower eyelid orbital fat herniation occurred during the course of the treatment. CONCLUSION: A herniation of orbital fat may complicate the injection of corticosteroid through the lower eyelid.

Ultrasound biomicroscopy in the diagnosis and management of pars planitis caused by caterpillar hairs.

PURPOSE: To report the use of ultrasound biomicroscopy in the detection of caterpillar hairs in the pars plana in a patient with unilateral pars planitis. METHOD: Ultrasound biomicroscopic imaging of the anterior segment of the eye. RESULTS: Ultrasound biomicroscopy located a hair in the posterior chamber at the first visit and five more in the pars plana 1 month later. This finding was confirmed intraoperatively. CONCLUSION: Ultrasound biomicroscopy is useful in the diagnosis and management of unilateral pars planitis of uncertain cause.

Pars planitis in a family.

The familial occurrence of pars planitis is rare. We have found ten cases reported previously. We describe a new case of pars planitis in a family. The affected members included a mother and two of her four children. The family was tested for HLA antigens in order to establish a comparison with others HLA types by different authors. We have not identified any cause for the familial occurrence of this disease. We discuss the role of genetic and ambiental factors.

[Results of pars plana vitrectomy in chronic uveitis in childhood]. / Ergebnisse der Pars plana-Vitrektomie bei chronischer Uveitis im Kindesalter.

During 1986-1991 vitreous surgery was performed in 5 girls and 8 boys (age range 2-15 years) with chronic uveitis. In 6 cases a combined lensectomy-vitrectomy was performed because cataract was present, so that the results generally refer to 19 eyes. We found a low rate of postoperative complications. During a follow-up period of 6 months to 5 years (average 2 years and 1 month), 12 of the 19 eyes showed a significant visual improvement. Preoperatively, 8 eyes were found to be affected by cystoid macular edema; in 7 of these cases remarkable regression of the edema was observed after surgery. In two-thirds of cases the intensity of the inflammation decreased, so that the dose of corticosteroids could be reduced postoperatively. Our results suggest that vitrectomy for chronic uveitis in children is a relatively safe and successful treatment. In order to prevent irreversible complications and amblyopia surgery should be performed in an early stage of the disease.