Outcome of Nivolumab-Induced Vogt-Koyanagi-Harada Disease-Like Uveitis in a Patient Managed without Intravenous Methylprednisolone Therapy.

Background: In recent years, immune checkpoint inhibitors (ICI) have been often used for several types of cancers. Immune-related adverse events (irAEs) are autoimmune responses caused by ICI. Among the different types of irAEs, uveitis is common in ophthalmology. Moreover, there are reports on Vogt-Koyanagi-Harada (VKH) disease-like uveitis. In most cases, VKH, as in the usual VKH, is managed with intravenous methylprednisolone therapy. Case Report. A 72-year-old man was diagnosed with gastric cancer, and he was treated with nivolumab, a type of ICI. After eight cycles of nivolumab therapy, he developed fulminant type 1 diabetes mellitus and diabetic ketoacidosis. Thus, the treatment was discontinued. Subsequently, the patient was referred to our department due to bilateral blurry vision. He had decreased visual acuity in both eyes, and slit lamp examination revealed the presence of bilateral anterior chamber cells and keratic precipitates. Fundus examination showed bilateral serous retinal detachment (SRD), wavy retinal pigment epithelium (RPE), and choroidal thickening. Cerebrospinal fluid examination revealed prominent pleocytosis. Thus, we initiated eye drop therapy and subtenon injection of triamcinolone acetonide on the right eye only. After 1 month, SRD and wavy RPE disappeared, and the patient's visual acuity improved. Further, both eyes had similar improvements in visual acuity and abnormal findings. Oral prednisolone was subsequently administered for hearing loss. However, intravenous methylprednisolone was not used, and ophthalmologic findings and visual acuity did not change before and after systemic steroid therapy. One year after disease onset, SRD and wavy RPE did not relapse. Conclusion: Nivolumab-induced VKH disease-like uveitis can have good outcomes even in a patient managed without intravenous methylprednisolone therapy.

[Endogenous endophthalmitis following staphylococcus aureus meningitis].

Endogenous endophthalmitis is a rare complication of acute meningitis. A healthy 82-year-old woman suddenly developed septic bacteremia and meningitis owing to Staphylococcus aureus (methicillin-susceptible Staphylococcus aureus); she presented with a high fever and drowsiness. Improvement of these initial symptoms unveiled impaired bilateral visual acuity. Detailed ophthalmological assessments diagnosed it as probable endogenous endophthalmitis, which was immediately treated with vitrectomy. Subsequently, the patient totally recovered without any neurologic or ophthalmic sequela.

[Evaluating post-cataract surgery changes in bacterial culture tests with and without face-washing].

PURPOSE: To evaluate the changes in conjunctiva and eyelid culture test results before and after cataract surgery and their relation to face-washing. METHODS: 70 patients (109 eyes) who had cataract surgery at Nishi-Kobe Medical Center had conjunctiva and eyelid smears taken both preoperatively and postoperatively. They had cataract surgery by phacoemulsification and aspiration followed by intraocular lens implantation. The patients were separated into two groups. The Face-Washing group started to wash their faces on the day after the operation (POD 1). The Non Face-Washing group started to wash their faces two days after the operation (POD2). We compared the results of the Face-Washing group and the Non Face-Washing group. RESULTS: The percentage of culture-positive organisms in both the conjunctivae and eyelids dropped significantly postoperatively. In the conjunctivae, there were a few bacteria postoperatively, but in the eyelids, there were many Staphylococcus epidermidis (S. epidermidis) and Propionibacterium acnes (P. acnes) postoperatively. Only in the Non Face-Washing group, the number of S. epidermidis and P. acnes at POD2 increased significantly compared with POD1. CONCLUSION: There are S. epidermidis and P. acnes deep in the skin (hair follicle), so S. epidermidis and P. acnes can still be detected postoperatively. Postoperative face-washing may prove effective in keeping the eyelids clean.

[Visual prognosis of branch retinal vein occlusion with macular edema].

PURPOSE: To evaluate visual outcome and prognostic factors of branch retinal vein occlusion (BRVO) combined with macular edema, when no aggressive treatment is performed. PATIENTS AND METHODS: We retrospectively analyzed 80 eyes of 80 patients of BRVO associated with macular edema. The average age was 65.7 years and the average follow-up period was 32.1 months. Oral or instillation drug therapy was conducted in 42 eyes and peripheral scatter argon laser photocoagulation for the capillary non-perfusion area was carried out in 61 eyes (photocoagulation for macula was excluded). RESULTS: Baseline visual acuity(BVA) and final visual acuity(FVA) had a positive correlation (r= 0.60, p< 0.001). 69% of eyes with BVA of 0.1 or less remained at FVA 0.1 or worse, while 78% of eyes with BVA of 0.8 or better maintained FVA of 0.8 or better. Visual acuity improved in 26%, remained unchanged in 54%, and deteriorated in 20% during follow-up periods. In the eyes with visual loss the deterioration occurred in the early periode from onset, but in the eyes with visual improvement the visual acuity tended to improve steadily. CONCLUSIONS: Even if macular edema occurs, some of the BRVO eyes can attain good visual acuity. However, we recommend aggressive treatment when the best-corrected acuity is poor or when the visual acuity worsens gradually, because there is a strong possibility that the visual prognosis will be poor.