Non-invasive biomarkers for close activity monitoring in birdshot chorioretinitis: Optical coherence tomography angiography and beyond.

PURPOSE: The purpose of the study was to identify non-invasive imaging biomarkers potentially useful for close activity monitoring in birdshot chorioretinitis (BSCR). METHODS: Cross-sectional study of BSCR eyes included as per Levinson's and/or SUN criteria. Eyes were blindly classified into active or inactive groups per clinical inflammatory parameters, ultra-widefield (UWF) pseudocolour images, UWF fluorescein angiography (FA) and macular optical coherence tomography (OCT) cube. Qualitative and quantitative OCT and OCT-angiography (OCT-A) parameters at the fundus, superonasal and inferonasal fields were compared between active and inactive eyes. RESULTS: Thirty consecutive BSCR patients (60 eyes) were analysed. 28 eyes (46.66%) were from women and the overall mean age was 59.7 ± 12.3 years. Active eyes showed an abnormal retinal thickening at inferonasal field (nasal retinal thickness) and a higher averaged thickened retinal index (ATRI) (72.36 active vs. 20.12 inactive, p < 0.0001). A significant moderate correlation was observed between ATRI and FA scores (r = 0.259, p = 0.022). Macular vascular loops were more frequent in the superficial vascular plexus of OCT-A in the active eyes (p = 0.028). The vascular perfusion index tended to be higher in all subfields of active eyes but did not reach statistical significance. CONCLUSION: Multimodal imaging could be key to discerning activity in BSCR eyes. Higher ATRI and the presence of vascular loops in the superficial plexus are potential non-invasive activity biomarkers for the close monitoring of BSCR.

Utility of Ultra-Widefield Retinal Imaging in the Follow-up and Management of Patients with Cytomegalovirus Retinitis.

Cytomegalovirus (CMV) retinitis is an opportunistic infection classically described in patients with acquired immune deficiency syndrome and other immune-compromising situations. As the diagnosis is based on clinical findings, classic retinal imaging montages have been a useful tool, being able to detect up to 140º of the retina. Since ultra-widefield (UWF) imaging systems have been available we can now detect more area of peripheral lesions in the diagnosis and follow-up of patients' response to antiviral treatment. We present a series of cases in which UWF was used as the main tool for diagnosis, monitoring, and management in patients with CMV retinitis.In all the cases presented, UWF imaging with fundus autofluorescence was able to capture peripheral CMV retinitis areas and discern active from inactive lesions. This, added to the comfort of use, seem to make UWF imaging a useful tool to detect changes in the follow-up of patients with CMV retinitis.

Multimodal retinal imaging of familial amyloid polyneuropathy.

Background: Retinal amyloid angiopathy is a sight-threatening complication of familial amyloid polyneuropathy (FAP) caused by pathological deposition of transthyretin. The purpose of this report is to present ocular findings in patients with FAP using a combination of novel non-invasive retinal imaging techniques, including first time published images of optical coherence tomography angiography (OCT-A) in FAP.Materials and methods: Observational cross-sectional study of retinal images in patients with FAP using: fundus ultra wide-field photography (UWF); autofluorescence (AF); optical coherence tomography (OCT); and, OCT-A. Fifteen eyes of eight patients with FAP from a tertiary center were included. A descriptive analysis of obtained images and clinical data was performed.Results: Amyloid vitreous and retinal deposits were easily identified using OCT scans, AF, and UWF images, especially in the red-free modality. OCT-A allowed quality reconstruction of posterior pole vasculature, foveal avascular zone, and areas of ischemia.Conclusions: Different modalities of currently available non-invasive retinal imaging techniques, including OCT-A scans described for the first time in FAP, are safe and useful in detecting and analyzing retinal amyloidosis. Retinopathy in FAP in the studied group was more frequent than previously reported.

Aqueous Humour Cytokine Changes with Intravitreal Dexamethasone Implant Injection for Diabetic Macular Edema.

Purpose: To assess changes in aqueous humor (AH) levels of cytokines following dexamethasone intravitreal implant (DEX) injection for diabetic macular edema (DME).Methods: Sixteen DME and cataract cases series study. Anterior chamber AH sampling was performed at baseline at DEX injection time (T1), cataract surgery 8 weeks afterward (T2), and whenever DME relapsed (T3) in order to assess changes in IL-1ß, IL-3, IL-6, IL-8, IL-10, MCP-1, IP-10, TNF-α, and VEGF levels.Results: IP-10 and MCP-1 levels significantly decreased at T2 (p = .034 and p = .044, respectively) compared to baseline (T1). Relapsed DME cases (T3) showed significantly higher levels of IL-6 (p = .028), IL-8 (p = .005), IP-10 (p = .013) and MCP-1 (p = .005) compared to T2.Conclusion: IP-10 and MCP-1 AH levels seem to be related to DEX intraocular action, decreasing after injection and increasing when DME relapses. In addition, IL-6 and IL-8 may play a role in DME late evolution and clinical relapse beyond DEX effect.

Carga y costes directos de la uveítis no infecciosa en España / Burden and direct costs of non infectious uveitis in Spain

OBJETIVOS: No existen datos actualizados sobre la epidemiología y los costes asociados de la uveítis no infecciosa (UNI) en España. Este estudio investiga la frecuencia de los tipos de uveítis y el coste de los recursos utilizados en su manejo en 2011. Material y método. Se recogió información mediante búsqueda bibliográfica de datos epidemiológicos y de costes directos de la UNI. La información se completó mediante consenso de 2 paneles de expertos y cuestionario a oftalmólogos y reumatólogos especialistas en esta enfermedad. Los costes de los recursos se obtuvieron de la base de datos Oblikue, de una sociedad médica y de los precios de los medicamentos aprobados en España. RESULTADOS: En 2011 se diagnosticaron 9.398 nuevos pacientes de UNI (45% hombres, el 70% entre 16 y 65 años). La incidencia por tipos fue: uveítis anterior aguda (UAA) 55%, uveítis posterior (UP) y panuveítis (PU) 15% y uveítis anterior crónica en edad adulta, uveítis anterior crónica pediátrica y uveítis intermedia 5%. Del total de costes calculados (77.834.282,10 €), el tratamiento farmacológico inicial fue el recurso más costoso (43.602.359,29 €), seguido del tratamiento quirúrgico de las complicaciones (8.367.420,43 €). Respecto a los tipos de uveítis, los costes asociados más elevados fueron los de la PU (26.692.948,29 €), la UP (22.283.330,50 €) y la UAA (14.336.755,38 €). CONCLUSIONES: La UNI en España genera unos elevados costes tanto de diagnóstico como de tratamiento. Un diagnóstico y tratamiento precoz de la enfermedad permitirían un ahorro sustancial al Sistema Nacional de Salud

OBJECTIVES: There is no updated information on epidemiology and cost of management of non infectious uveitis (NIU) in Spain. This study assessed the frequency of various types of uveítis as well as associated costs of resources used in their management. Material and method. NIU epidemiological data and direct costs were collected from a literature search. This was complemented with consensus information from 2 expert panel meetings and data from questionnaires to ophthalmologists and rheumatologists, experts on these conditions. Healthcare resources costs were obtained from the Oblikue database, from a medical society and from approved drug prices in Spain. RESULTS: During 2011 the estimate number of NIU was 9,398 (45% male, 70% aged 16-65 years). Incidence per type of uveitis was: acute anterior uveitis (AAU) 55%; posterior uveitis (PU) and pan-uveitis (PanU) 15% each; adult chronic anterior uveitis, paediatric chronic anterior uveitis and intermediate uveitis 5% each. Among total costs (77,834,282.10€), initial drug therapy was the highest (43,602,359.29€), followed by surgical treatment of complications (8,367,420.43€). With respect to types of uveitis, PanU (26,692,948.29€), PU (22,283,330.50€) and AAU (14,336,755.38€) showed the highest associated costs. CONCLUSIONS: Non infectious uveitis is associated to high costs in Spain, both in its diagnosis and in its treatment. Early diagnosis and treatment should allow for substantial savings for the National Health System

Burden and direct costs of non infectious uveitis in Spain. / Carga y costes directos de la uveítis no infecciosa en España.

OBJECTIVES: There is no updated information on epidemiology and cost of management of non infectious uveitis (NIU) in Spain. This study assessed the frequency of various types of uveítis as well as associated costs of resources used in their management. MATERIAL AND METHOD: NIU epidemiological data and direct costs were collected from a literature search. This was complemented with consensus information from 2 expert panel meetings and data from questionnaires to ophthalmologists and rheumatologists, experts on these conditions. Healthcare resources costs were obtained from the Oblikue database, from a medical society and from approved drug prices in Spain. RESULTS: During 2011 the estimate number of NIU was 9,398 (45% male, 70% aged 16-65 years). Incidence per type of uveitis was: acute anterior uveitis (AAU) 55%; posterior uveitis (PU) and pan-uveitis (PanU) 15% each; adult chronic anterior uveitis, paediatric chronic anterior uveitis and intermediate uveitis 5% each. Among total costs (77,834,282.10€), initial drug therapy was the highest (43,602,359.29€), followed by surgical treatment of complications (8,367,420.43€). With respect to types of uveitis, PanU (26,692,948.29€), PU (22,283,330.50€) and AAU (14,336,755.38€) showed the highest associated costs. CONCLUSIONS: Non infectious uveitis is associated to high costs in Spain, both in its diagnosis and in its treatment. Early diagnosis and treatment should allow for substantial savings for the National Health System.

Clinical Course of a Presumed Metastatic Uveal Melanoma to the Contralateral Choroid.

We present the ultrasound and optic coherence tomography follow-up of a presumed choroidal metastasis from a contralateral melanoma. A 53-year-old male was diagnosed with uveal melanoma with extraescleral extension in his left eye. A year later, the fundus examination revealed a flat, gray-green, pigmented choroidal lesion in the right eye. The ultrasonography showed a mass, almost flat, and all these findings were compatible with a choroidal melanocytic lesion with risk factors for growth. One month later, melanocytic skin lesions appeared on the scalp, as well as small tumors. Three months later, an ultrasonography on B scan showed a growth of the tumor size. The patient developed a progressive deterioration and died. Three possibilities can explain the occurrence of a choroidal pigmented tumor in the contralateral eye: first, bilateral primary choroidal melanomas; second, both choroidal tumors are metastatic in origin from an unknown primary melanoma; and third, the contralateral tumor is a metastatic tumor from the primary choroidal melanoma.

Caracterización de las uveítis diagnosticadas en un centro de referencia del área de Barcelona / Uveitis diagnosis characterization at a referral centre in the area of Barcelona, Spain

Fundamento y objetivo: Conocer el patrón uveítico de nuestra área geográfica. Los recientes cambios demográficos, ecológicos y científicos pueden determinar cambios epidemiológicos en las uveítis, que nos hemos propuesto investigar. Pacientes y método: Corte transversal desde el 1-01-2009 al 30-06-2010. Se incluyeron todos los pacientes atendidos por uveítis en nuestro centro. Se analizaron el tipo anatómico (IUSG & SUN), la etiología (tests «a medida»), la edad, el sexo, la procedencia y la lateralidad. Los resultados entre las «primeras visitas» y los controles fueron comparados estadísticamente mediante los tests de ANOVA y ji al cuadrado. Resultados: De 416 pacientes incluídos, 150 (36%) fueron uveítis anteriores, 128 (31%) posteriores, 101 (24%) panuveítis y 37 (9%) uveítis intermedias (UI). Un 56% (236) fueron bilaterales, la edad media fue de 46 años (extremos 6-87) y un 58% fueron mujeres. El 14% (58) fueron pacientes extranjeros. Por etiología, un 20% fueron inclasificables, un 31% infecciosas, un 26% asociadas a enfermedades sistémicas y un 23% oculares específicas. Entre las causas conocidas, la herpética (11%), Toxoplasma (8%), Behçet (8%) y tuberculosis (6%) fueron las más frecuentes. Las UI afectaron significativamente por primera vez a más extranjeros (p=0,018), afectaron a pacientes más jóvenes (p=0,008) y fueron más frecuentemente crónicas (p=0,003) e inclasificables (p=0,024). Conclusión: En nuestro medio, un 80% de las uveítis pueden ser correctamente clasificadas. Las UI han incrementado su frecuencia en población extranjera, suelen ser inclasificables y crónicas. La tuberculosis (6%) y la enfermedad de Birdshot (4%) deben ser tenidas en cuenta como causa de uveítis (AU)

Background and objective: To describe the uveitis pattern in our geographic area. Recent demographic, environmental and scientific changes can determine uveitis pattern changes, which we aim to investigate. Patients and methods: A cross-sectional study between 1st January 2009 and 30th June 2010 was done. All uveitis patients visited at our institution were included. Anatomical (IUSG & SUN) and aetiological patterns (by "tailored" tests), age, sex, origin and laterality were analyzed. Results from first visits and controls were compared statistically, by chi-square and ANOVA tests. Results:From 416 patients included, 150 (36%) were anterior uveitis, 128 (31%) posterior, 101 (24%) panuveitis and 37 (9%) intermediate uveitis (IU). Fifty-six percent (236) were bilateral, mean age was 46 years (6-87) and 58% were women. Fourteen percent (58) were from non-Spanish origin. By aetiology, 20% were unclassifiable, 31% infectious, 26% associated with systemic immune diseases and 23% were ocular specific syndromes. Among classified causes, herpes virus (11%), Toxoplasma (8%), Behçet (8%) and tuberculosis (6%) were the most common. IU were diagnosed more frequently at first time in foreign patients (P=.018); they affected younger patients (P=.008), were more chronic (P=.003) and unclassifiable (P=.024). Conclusion: In our area, 80% of uveitis can be correctly classified. IU have an increased frequency among foreigners, and they use to be unclassifiable and chronic. Tuberculosis (6%) and Birdshot chorio-retinopathy (4%) must be kept in mind as uveitis causes (AU)

[Uveitis diagnosis characterization at a referral centre in the area of Barcelona, Spain]. / Caracterización de las uveítis diagnosticadas en un centro de referencia del área de Barcelona.

BACKGROUND AND OBJECTIVE: To describe the uveitis pattern in our geographic area. Recent demographic, environmental and scientific changes can determine uveitis pattern changes, which we aim to investigate. PATIENTS AND METHODS: A cross-sectional study between 1(st) January 2009 and 30(th) June 2010 was done. All uveitis patients visited at our institution were included. Anatomical (IUSG & SUN) and aetiological patterns (by "tailored" tests), age, sex, origin and laterality were analyzed. Results from first visits and controls were compared statistically, by chi-square and ANOVA tests. RESULTS: From 416 patients included, 150 (36%) were anterior uveitis, 128 (31%) posterior, 101 (24%) panuveitis and 37 (9%) intermediate uveitis (IU). Fifty-six percent (236) were bilateral, mean age was 46 years (6-87) and 58% were women. Fourteen percent (58) were from non-Spanish origin. By aetiology, 20% were unclassifiable, 31% infectious, 26% associated with systemic immune diseases and 23% were ocular specific syndromes. Among classified causes, herpes virus (11%), Toxoplasma (8%), Behçet (8%) and tuberculosis (6%) were the most common. IU were diagnosed more frequently at first time in foreign patients (P=.018); they affected younger patients (P=.008), were more chronic (P=.003) and unclassifiable (P=.024). CONCLUSION: In our area, 80% of uveitis can be correctly classified. IU have an increased frequency among foreigners, and they use to be unclassifiable and chronic. Tuberculosis (6%) and Birdshot chorio-retinopathy (4%) must be kept in mind as uveitis causes.