Patterns of uveitis in patients with proven systemic (pulmonary and extrapulmonary) tuberculosis.

PURPOSE: To report patterns of uveitis in patients with systemic tuberculosis. METHODS: Records of patients presenting at uvea clinic of a tertiary eye care centre were evaluated retrospectively, and 47 cases with proven systemic tuberculosis were analyzed for patterns of uveitis. Tuberculosis had been proven with a combination of radio imaging and detection of acid fast bacilli in body fluids. All patients had been reviewed by a specialist as applicable before diagnosing tuberculosis. These patients had undergone a thorough ocular workup. Pattern of uveitis was the primary outcome measure. RESULTS: Mean age was 35.34 ± 15.56 years. Lung was the commonest systemic focus, seen in nearly 75% of the cases. Anterior uveitis was the most common presentation (48.9%), followed by posterior (25.5%), panuveitis (10.6%) and intermediate uveitis (10.6%). Multifocal serpiginoid choroidopathy (MSC) was seen in only one patient, while granulomatous choroiditis was the commonest type of posterior uveitis. CONCLUSIONS: Anterior uveitis is the most frequent type of uveitis seen in patients with proven systemic tuberculosis. Rarity of MSC in such patients indicates possibility of etiologies other than tuberculosis in causing MSC.

Patterns of uveitis in children at the apex institute for eye care in India: analysis and review of literature.

AIM: To study patterns of uveitis in Indian children and compare with data sets published earlier in the literature. METHODS: Consecutive patients below 16 years of age presenting to the uvea clinic of a tertiary eye care center were included prospectively through the period of July 2009-August 2013. Children with retinal vasculitis, exogenous endophthalmitis and masquerade syndromes were excluded from analysis. Uveitis was classified as per the nomenclature system adopted by the International Uveitis Study Group. Hemogram, Mantoux test and chest X-ray were done for each patient, along with tailored investigations and pediatric review as per clinical profile. Clinical pattern and etiology were the main outcome measures. RESULTS: One hundred and thirty-four children were analyzed. Anterior uveitis (40%) was the commonest pattern followed by intermediate uveitis (25%), panuveitis (18%) and posterior uveitis (17%). Bilateral disease was present in 54%, 15% had infectious uveitis, 10% had granulomatous uveitis and 54% had idiopathic uveitis. Complications were present in half of the patients. Juvenile idiopathic arthritis (22), followed by toxoplasmosis (10) and tuberculosis (5), was the commonest etiology. Intermediate uveitis, non-granulomatous inflammation and older onset of disease had the high odds ratio of having idiopathic disease. CONCLUSION: Patterns of pediatric uveitis can vary between regions from even within the same geopolitical region. Anterior uveitis is commonest, and juvenile idiopathic arthritis and toxoplasmosis are the most frequent etiologies. Diagnosis of pediatric ocular tuberculosis is more difficult than in adults and needs better and well-defined criteria.

Surprises during intravitreal drug delivery-a report of three cases.

We describe 3 cases with unusual events during and after intravitreal injection of dexamethasone intravitreal implants and bevacizumab. In case 1, delayed release of the safety stop of a dexamethasone intravitreal implant injector led to impaction and retinal break formation. Timely recognition and laser treatment prevented further retinal complications. In case 2, reinjection of a second dexamethasone intravitreal implant from the same site as the first injection was noted to dislodge the remnant of the previous implant from the vitreous base. In case 3, translucent floating particles were noted in the vitreous after intravitreal injection of bevacizumab from ampules procured from our dispensing pharmacy.

Clinical profile of uveitis-related ocular hypertension.

The purpose of this article is to study the clinical and demographic profile of uveitis-related ocular hypertension (OHT) and evaluate risk factors predisposing to development of OHT in uveitis. Two hundred patients (200 eyes) with uveitis were evaluated for type of uveitis and the presence of OHT [IOP > 21 mmHg]. All patients underwent a complete ophthalmic examination and appropriate systemic evaluation. Patients with OHT were started on appropriate antiglaucoma medication and were followed up for minimum of 6 months. Forty-two eyes (21 %) were found to have OHT. Anterior uveitis alone was seen in 22 (52.4 %), granulomatous uveitis was seen in 8 (19.1 %) eyes, while 13 eyes (30.9 %) had active uveitis. On multiple logistic regression, age greater than 60 years (p = 0.025), peripheral anterior synechiae (PAS) > 180° (p = 0.029), and steroid use (p < 0.001) were found to have significant association with OHT. Mean IOP at baseline was 24.6 ± 10.1 mmHg which decreased to 17.3 ± 4.5 mmHg at 6 months (p < 0.001). At 6 months, 30 eyes were medically controlled (71.4 %), 5 eyes underwent trabeculectomy with MMC (11.9 %), and in 7 eyes, antiglaucoma medication could be discontinued. One-fifth of eyes with uveitis had OHT. Risk factors for IOP elevation included increased age, PAS > 180°, and corticosteroid use.

Managing bevacizumab-induced intraocular inflammation.

The outcome of four cases of sterile endophthalmitis that developed after intravitreal injections of bevacizumab has been reported here. All four eyes received 1.25 mg/0.05 ml intravitreal bevacizumab from 0.2-ml aliquots for different etiologies. The inflammation predominantly involved the anterior chamber with mild vitreous reaction. All patients were culture negative and regained preinjection visual acuity and were culture negative following intravitreal antibiotic administration. This report highlights that intravitreal bevacizumab can cause sterile endophthalmitis and this has to be kept in mind, and clinical judgment should be used to differentiate it from infective endophthalmitis.

Prospective evaluation of intravitreal triamcinolone acetonide in serpiginous choroiditis.

OBJECTIVE: To evaluate intravitreal triamcinolone acetonide (IVTA) in unilateral serpiginous choroiditis with macular involvement with special reference to effectiveness of treatment and its side effects. METHODS: In this prospective nonrandomized, consecutive, interventional case series, IVTA was given in 8 eyes of 8 patients of unilateral active serpiginous choroiditis. Treatment was evaluated on both subjective and objective parameters: any improvement or stabilization of visual acuity, fundus and fluorescein angiography (FA) and central macular thickness on optical coherence tomography (OCT). RESULT: The treatment induced rapid remission clinically and vision improved or stabilized. Mean visual acuity improved from 0.93 +/- 0.21 LogMAR units at baseline to 0.36 +/- 0.24 (p = 0.00) LogMAR units at 6 months. A 33.73% reduction in mean central macular thickness was observed at the 6-month follow-up from 294.63 +/- 17.84 to 195.25 +/- 5.49 mum (p = 0.00). Lesions healed rapidly with FA and OCT proving the clinical observation. CONCLUSION: Intravitreal triamcinolone may prove to be a promising therapeutic approach as a rescue therapy in this recurrent sight-threatening disorder by inducing rapid remission without the systemic side effects seen with systemic immunosuppression.

Natural history of sub-retinal triamcinolone acetonide deposition after triamcinolone-assisted vitrectomy.

PURPOSE: To describe the natural course of subretinal triamcinolone acetonide (TA) deposition after a TA-assisted vitrectomy for retinal detachment. METHODS: Observational case series. RESULTS: TA deposition was observed between the neurosensory retina and retinal pigment epithelium in the macular area at the conclusion of vitreoretinal surgery in three patients with retinal detachment. On follow up, TA granules gradually decreased over the next 2 weeks and resolved completely by 3 weeks. Two months after the operation, the retina was observed to be successfully attached and no ophthalmoscopic or functional damage was observed. CONCLUSION: As no apparent clinically detectable adverse effect was found in the three cases that demonstrated subretinal deposition of TA we opine that active surgical maneuvers to remove the same are not warranted during surgery.

Sympathetic-parasympathetic activity and reactivity in central serous chorioretinopathy: a case-control study.

PURPOSE: This case-control study was conducted to evaluate autonomic function activity and reactivity in patients with central serous chorioretinopathy (CSCR), because stress and type A personality, known risk factors, are also related to autonomic nervous system activity. METHODS: Patients with CSCR were selected from the outpatient department and medical retina services in one center. Control subjects were chosen from the healthy subjects of similar age group. The autonomic activity (both sympathetic and parasympathetic) in 45 patients with CSCR was evaluated and compared with that in 28 healthy control subjects, by using HRV (heart rate variability) analysis according to the guidelines laid down by the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Autonomic reactivity (both sympathetic and parasympathetic) was also evaluated in 32 patients with CSCR and compared with that in 28 healthy control subjects, by using standard autonomic function tests: HRV, as a measure of the resting sympathetic and parasympathetic activity (tone), and changes in blood pressure response and heart rate changes during various stressor stimuli in the tests as a measure of sympathetic and parasympathetic reactivity. RESULTS: Patients with CSCR showed significantly decreased parasympathetic activity (P = 0.002), significantly increased sympathetic activity (P = 0.005), and significantly increased sympathetic-parasympathetic balance (P = 0.004) as measured from different measures of beat-to-beat heart rate variability. The patients also showed significantly decreased parasympathetic reactivity (P = 0.03). Sympathetic reactivity showed a trend toward lessening. CONCLUSIONS: Autonomic function, both activity and reactivity components of sympathetic and parasympathetic system, is impaired in patients with CSCR. Because autonomic supply modulates the choroidal blood flow, there may be a correlation between measures of autonomic function and the presence of CSCR.

Optical coherence tomography findings in commotio retina.

A 16-year-old boy presented with diminished visual acuity of 6/60 following blunt trauma to his right eye with a cricket ball. Fundus examination showed commotio retinae. Optical coherence tomography (OCT) demonstrated increased reflectivity with small optically clear spaces in the area corresponding to the photoreceptor outer segment. At 2-month follow up the visual acuity improved to 6/6. A small area of retinal opacification persisted nasally, and OCT of the corresponding area continued to show increased reflectivity in the area of photoreceptor outer segment. Increased reflectivity on OCT in eyes with commotio retinae probably denotes photoreceptor outer segment disruption and seems to be reversible to a variable extent.

Limbal patch graft in surgically induced scleral necrosis.

BACKGROUND: Surgically induced scleral necrosis (SINS) is a rare consequence of ocular surgery. Various graft materials have been recommended for the repair of scleral necrosis. We report use of fresh cadaveric limbal graft for the same purpose. METHOD: A 42-year-old female presented with severe pain and buckle extrusion following external segmental buckling surgery for inferior retinal detachment. Buckle removal performed under general anesthesia revealed an area of scleral necrosis with uveal prolapse. Due to non-availability of other donor material a fresh cadaveric limbal graft remnant after keratoplasty was used for the repair after obtaining informed consent. RESULTS: Successful uptake of graft was observed and the globe integrity was restored. CONCLUSION: The case suggests that a fresh limbal graft may provide adequate tectonic support in eyes with SINS and can serve as an option for donor graft tissue in emergency situations.

Bilateral macular cysts following electric burn.

A 28-year-old man presented with bilateral acute loss of vision following a high-voltage injury. The visual acuity was 6/36 in the right eye and 6/24 in the left eye. Fundus examination revealed a well-defined round lesion simulating a full thickness macular hole in the right eye and yellow deposits in the macular area in the left eye. Optical coherence tomography (OCT) showed bilateral macular cysts, with intact outer and inner retinal layers. At 1 month follow up, OCT showed a persistent macular cyst in the right eye with spontaneous resolution of the macular cyst along with visual improvement in the left eye.