Azathioprine as a treatment option for uveitis in patients with juvenile idiopathic arthritis.

AIM: To investigate the therapeutic value of azathioprine as monotherapy or combined with other immunosuppressive drugs for uveitis in patients with juvenile idiopathic arthritis (JIA). METHODS: A retrospective multicentre study including 41 children with JIA (28 (68.2%) female) with unilateral or bilateral (n=28) chronic anterior uveitis. Azathioprine was used to treat uveitis that was active in patients receiving topical or systemic corticosteroids, methotrexate or other immunosuppressive drugs. The primary end point was assessment of uveitis inactivity. Secondary end points comprised dose sparing of topical steroids and systemic corticosteroids, and immunosuppression. RESULTS: At 1 year, uveitis inactivity was achieved in 13/17 (76.5%) patients by using azathioprine as systemic monotherapy and in 5/9 (56.6%) as combination therapy. During the entire azathioprine treatment period (mean 26 months), inactivity was obtained in 16/26 patients (61.5%) with monotherapy and in 10/15 (66.7%) when combined with other immunosuppressives (p=1.0). With azathioprine, dosages of systemic immunosuppression and steroids could be reduced by ≥ 50% (n=12) or topical steroids reduced to ≤ 2 drops/eye/day in six patients. In three patients (7.3%), azathioprine was discontinued because of nausea and stomach pain. Conclusions Azathioprine may be reconsidered in the stepladder approach for the treatment of JIA-associated uveitis. The addition of azathioprine may also be beneficial for patients not responding properly to methotrexate.

[Clinical presentation of zoster ophthalmicus]. / Klinik des Zoster Ophthalmicus.

BACKGROUND: Zoster ophthalmicus (ZO) is a common disease, in particular in elderly and immunocompromised patients. In addition to the characteristic dermal lesions and to the postherpetic neuralgia, the clinical appearance may include very different forms of eye involvement. METHODS: This article reviews the clinical features of ZO as well as the typical eye complications and therapy. RESULTS: 50 % of ZO patients have eye involvement. The acute phase of ZO is characterised by lid exanthema, conjunctivitis and epithelial keratitis (up to 65 %). In the late phase, stromal keratitis (up to 25 %), anterior uveitis (up to 50 %), and acute retinal necrosis (ARN) may occur. Typical complications are eyelid malposition, neurotrophic keratopathy (up to 25 %) and glaucoma. The diagnosis is usually based on the characteristic dermal lesions. In atypical cases, immunohistochemistry and PCR are tools for virus detection. All ZO patients should immediately receive systemic antiviral therapy. Corticosteroid therapy is essential for the management of the concomitant immune reaction that is relevant for the long-term prognosis, especially in stromal keratitis, uveitis, scleritis and ARN. CONCLUSIONS: All patients should receive systemic antiviral treatment to avoid complications and visual impairment. With appropriate medical and surgical therapy the prognosis is usually good. Postherpetic neuralgia is often the major issue in the later course. For the prevention of ZO and its complications, a vaccination is useful.

[Corticosteroid therapy and secondary elevated intraocular pressure in patients with Fuchs heterochromic cyclitis and idiopathic chronic anterior uveitis]. / Kortikosteroidtherapie und sekundäre Augeninnendruckerhöhung bei Fuchs-Heterochromiezyklitis und idiopathischer chronischer anteriorer Uveitis.

BACKGROUND: Due to different influences on anterior chamber angle structures, corticosteroids have a significant impact on secondary elevated intraocular pressure. This study examines the influence of corticosteroid therapy on the incidence of secondary elevated intraocular pressure in patients with Fuchs heterochromic cyclitis (FHC) and chronic anterior uveitis. MATERIALS AND METHODS: Retrospective chart analyses of patients undergoing topical and systemic corticosteroid therapy were carried out. RESULTS: Overall, data of 54 FHC and 49 CAU patients were analysed. Patients did not differ with respect to age, gender distribution and follow-up period. Seventeen (37 %) of the FHC patients and eight (18 %) of the CAU patients had secondary elevated intraocular pressure (p = 0.08). Number of months with topical therapy (54 vs. 20 months, p = 0.025) and number of months multiplicated with the frequency of topical maintenance therapy (158 vs. 61 p = 0.027) were significantly higher in the FHC patients. Only in the FHC group was an association with age (OR 1.16; 95 % CI 1.03 - 1.2; p = 0,006) and in the CAU group with the number of topical corticosteroid therapies (OR 1.15; 95 % CI 0.99 - 1.34; p = 0.03) evident in the multivariate analysis. CONCLUSIONS: Pathomechanisms, resulting in secondary elevated intraocular pressure in patients with FHC and CAU, must be different as only in CAU patients was an association to corticosteroid therapy found.

[Effect of intravitreal and orbital floor triamcinolone acetonide injection on intraocular inflammation in patients with active non-infectious uveitis]. / Einfluss von intravitrealem und parabulbärem Triamcinolon Acetonid auf die intraokulare Entzündung bei aktiver nicht infektiöser Uveitis.

BACKGROUND: Currently, triamcinolone acetonide (TA) is frequently used to treat inflammation in non-infectious uveitis. The aim of this study was to compare the effect of TA on intraocular inflammation after a single intravitreal or orbital floor injection of the drug in patients with non-infectious uveitis. PATIENTS AND METHODS: This was a monocentre, retrospective study in 114 eyes (103 patients). Twenty eyes were treated with intravitreal and 94 eyes with orbital floor TA. The main outcome measure was cells in the anterior chamber and anterior vitreous. Secondary outcome measures included protein accumulation in the aqueous humor (according to laser-flare photometry), best-corrected visual acuity, and complications. Follow-up evaluations were performed at 1, 3, and 6 months after TA injection. RESULTS: After either intravitreal or orbital floor TA injection, the intraocular inflammation in the anterior chamber and vitreous decreased (p < 0.001, for both administration forms, and at all follow-up time points). Laser-flare values decreased in both groups. One month after injection, the visual acuity in the intravitreally treated patients was increased (p < 0.01), whereas the poor visual acuity persisted in the orbital floor group. The effect on macular oedema after intravitreal TA was better than in the orbital floor group (p < 0.01). Progression and increased cataract incidence were detected in 50 % after intravitreal and in 29 % after orbital floor TA. CONCLUSIONS: After both intravitreal and orbital floor TA injection, the intraocular inflammation decreased. The effect of intravitreal TA on macular oedema and visual acuity was better than that of orbital floor TA, but intraocular pressure elevation and progressive cataract were more often observed in this group.

MRI of the knee: how do field strength and radiologist's experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

Accuracy of MRI reports is taken for granted. In this paper the inter-observer reliability in the interpretation of meniscal lesions, degree of chondropathy, and integrity of the ACL was analyzed while taking the radiologist's experience and field strength into account. Fifty-two MRI studies of knees were interpreted by 11 radiologists independently. Twenty-two were acquired on 1.0-T, 20 on 1.5-T, and 10 on 3.0-T systems. Four of the radiologists had more than 5 years and seven had 3 to 5 years of experience in interpreting MRI studies. The findings were compared with the intra-operative findings. Inter-observer variance, specificity, and sensitivity were evaluated for each field strength. Inter-observer correlation ranged between 0.370 for cartilage lesions and 0.597 for meniscal tears. Correlation values did not increase with experience or field strength. The number of false reports was dependent on the observer, but not on field strength. The rate of false interpretations was significantly higher for most criteria in the less experienced group. In conclusion, inter-observer correlation was low, although the diagnostic criteria were defined. The use of the classification scheme should be standardized by uniform training. Radiologist experience seems to be more important than field strength.

Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis.

AIMS: Juvenile idiopathic arthritis (JIA) is often associated with severe chronic anterior uveitis (CAU), and immunosuppressive therapy may be required. In this study, the value of cyclosporine A (CsA) as monotherapy or as combination therapy for treating uveitis was studied in a large cohort of JIA children. METHODS: Multicentre retrospective study including 82 JIA children (girls n=60) suffering from unilateral or bilateral (n=55) CAU. The indication for CsA was active uveitis, although patients were on topical or systemic corticosteroids, MTX, or other immunosuppressive drugs. RESULTS: Inactivity of uveitis during the entire treatment period (mean 3.9 years) was obtained with CsA monotherapy in 6 of 25 (24%) patients, but more often when CsA was combined with the immunosuppressives (35/72 patients; 48.6%, P=0.037), or MTX (18/37 patients, 48.6%, P=0.065), which had already been given. With CsA (mean dosage 2.9 mg/kg), systemic immunosuppressive drugs and steroids could be reduced by >or=50% (n=19) or topical steroids reduced to

Orbital floor triamcinolone acetonide injections for the management of active non-infectious uveitis.

PURPOSE: To evaluate the effect of orbital floor triamcinolone acetonide (OFTA) injections on inflammation and visual acuity in active non-infectious uveitis. METHODS: Monocentre, retrospective study in 94 eyes (86 patients) with acute non-infectious uveitis receiving a single OFTA (40 mg) injection. Outcome measures were anterior chamber (AC) and vitreous cell counts, laser flare photometry, best-corrected visual acuity (BCVA), and complications over a 6-month follow-up period. RESULTS: The number of patients with >or=1+ cells in AC and vitreous was significantly lower after treatment than at baseline (each, P<0.01 at the follow-up examinations). The anti-inflammatory effect lasted for the 6-month follow-up period. Laser flare photometry values were also significantly lower than the baseline levels at 3 (P<0.01) and 6 (P=0.034) months. BCVA did not differ before and after treatment. Macular oedema was reduced in 27%, unchanged in another 59%, and worse in 14%. Within 6 months, ocular hypertension was observed in up to 8% and progressing cataract was noted in 29%.ConclusionsOFTA injections improved AC and vitreous inflammation, but the effect on visual acuity and macular oedema was limited.

Leptin decreases postprandially in people with type 2 diabetes, an effect reduced by the cooking method.

Leptin modulates satiety and increases in obesity and type 2 diabetes mellitus in parallel with leptin resistance. Postprandial leptin regulation has been previously postulated to depend on meal composition, but data are controversial. The hypothesis of our study was that in people with type 2 diabetes mellitus, a postprandial leptin regulation exists that can be regulated not only by meal composition but also by the cooking method. In 20 inpatients with type 2 diabetes (mean age: 55.9 years), the acute effects of 2 meals, a high-heat-processed meal HHPM or a low-heat-processed meal LHPM, on leptin levels were studied on 2 different days in a randomized, crossover design. Both test meals had similar ingredients and differed only in the cooking method used. Parameters were measured after an overnight fast and at 2, 4, and 6 h postprandially. The HHPM induced a marked decrease in leptin levels, from 8 717+/-2 079 pg/ml at baseline to 6 788+/-1 598 pg/ml at 2 h postprandially (-1 929 pg/ml, -22%*), an effect significantly reduced by the LHPM, where values were 8 563+/-1 900 pg/ml at baseline and 7 425+/-1 591 pg/ml at 2 h postprandially (-1 138 pg/ml, -13%* (double dagger)) (*p<0.05 vs. baseline, (double dagger)p<0.05 vs. HHPM). Parameters of oxidative stress and blood AGEs increased only following the HHPM, while postprandial glucose, triglycerides, and insulin excursions were similar between meals. Postprandial leptin decreases following a HHPM meal in people with T2DM, an effect reduced by the cooking method.

Computer generated optical holographic fringe patterns for the analysis of vibrating structures.

Optical holographic interference fringe patterns on rods and bars vibrating in ultrasonic resonance (standing waves) are predicted by computer simulations. The simulations are based on a combination of finite element calculations with calculations based on the theory of holographic interference fringe generation. The hypothetical fringe patterns are then compared to holographic fringe images obtained by the experiment (time average holograms). The holographic arrangement and the mechanical part of the ultrasonic system (transducer, horn and specimen) were fixed on a commercial rigid optical table supported on air bags to isolate it from ground vibrations. Thus it is shown that the scope of the study can be reached with a minimum of experimental effort, i.e., with basic laser optical equipment. It is shown that provided the system operates in the desired mode, good agreement between the theoretical and the real image is given. Finally examples of the possible influence of defects or of parasitic modes of vibration on the appearance of the fringe patterns are given.

Cell cycle parameters in dedifferentiating iris epithelial cells.

After lentectomy of the adult newt eye, non-dividing iris epithelial cells re-enter the cell cycle. Some of the iris epithelial cells become completely depigmented while they are in the cell cycle, and then differentiate into lens cells. The remaining iris epithelial cells become partially depigmented in the induced cell cycle, but resynthesize melanosomes and recover the normal state of iris epithelial cells. The two groups of cells are spatially separated within the iris epithelium. The cell cycle parameters of both groups of iris epithelial cells were estimated by a mathematical procedure on a computerized programme from the percentage of labelled mitotic cells as a function of time after peritoneal injection of [3H]methyl-thymidine on day 6 after lentectomy. The total cell cycle time was found significantly shorter in the cell population with complete depigmentation as compared with that with partial depigmentation. Based on these results the possible role of differential cell cycle time in the control of dedifferentiation was discussed. Grafting of unlabelled iris into the optic cavity of host animals injected 6 h beforehand with [3H]methyl-thymidine, followed by a study of radioactivity of iris epithelial cells of the graft demonstrated incorporation at a low level during the whole period of experiment in which the cell cycle parameters were estimated. The data used for the estimation were corrected for the delayed incorporation.