Methotrexate: an option for preventing the recurrence of acute anterior uveitis.

AIMS: To evaluate the efficacy of methotrexate (MTX) in preventing the recurrence of acute anterior uveitis (AAU). METHODS: This prospective, open, longitudinal study included patients from June 2002 to March 2005 who had either three or more episodes of AAU in the previous year, or a recurrence of AAU within 3 months before starting the trial. We excluded uveitis of infectious origin, masquerade syndromes, and patients with contraindications to MTX. The response criteria were defined as an absence of symptoms and the presence of a normal ophthalmologic examination. The study outcome compared the number of flare-ups of uveitis over an MTX-treated for 1 year to the number of flare-ups of the same group during the previous year without MTX. RESULTS: A total of 571 patients with uveitis were evaluated during the period of the study, and 10 fulfilled the inclusion criteria. One patient refused the treatment, and nine completed the study. The mean number of recurrences in the pre-MTX year was 3.4 (SD: 0.52), which was significantly reduced to 0.89 (SD: 1.17) in the year of treatment (P=0.011). CONCLUSION: MTX treatment seems to reduce the number of flare-ups in patients with recurrent AAU.

[Two cases of syphilitic uveitis and HIV]. / Dos casos de uveítis sifilítica y VIH.

CASE REPORTS: Case 1: HIV+ patient presenting unilateral panuveitis. Physical examination showed secondary signs of syphilis. The condition was treated with an excellent result. Case 2: Patient with bilateral panuveitis having received different treatments in another centre for a period of months. In the anamnesis we detected risk factors for AIDS and ordered appropriate tests to be done, with the patient resulting positive for HIV and syphilis. We proceeded to treat. DISCUSSION: The incidence of syphilis is rising in developed countries and its manifestations in HIV+ patients can be atypical. An adequate clinical history is fundamental for an early diagnosis. Macrolides can be an alternative treatment in penicillin-allergic patients.

Dos casos de uveítis sifilítica y VIH / Two cases of syphilitic uveitis and HIV

Casos clínicos: Caso 1: paciente VIH+ que presenta una panuveítis unilateral. La exploración física muestra signos de sífilis secundaria. Se trata con excelente respuesta. Caso 2: Paciente con panuveítis bilateral que ha recibido varios tratamientos durante meses en otro centro. En la anamnesis se detectaron factores de riesgo para SIDA, se realizan serologías que son positivas para VIH y sífilis y se procede al tratamiento. Discusión: La sífilis está aumentando en los países desarrollados y sus manifestaciones en pacientes VIH+ pueden ser atípicas. Una historia clínica adecuada es fundamental para un diagnóstico precoz. Los macrólidos pueden ser una alternativa en pacientes alérgicos a penicilina

Case reports: Case 1: HIV+ patient presenting unilateral panuveitis. Physical examination showed secondary signs of syphilis. The condition was treated with an excellent result. Case 2: Patient with bilateral panuveitis having received different treatments in another centre for a period of months. In the anamnesis we detected risk factors for AIDS and ordered appropriate tests to be done, with the patient resulting positive for HIV and syphilis. We proceeded to treat. Discussion: The incidence of syphilis is rising in developed countries and its manifestations in HIV+ patients can be atypical. An adequate clinical history is fundamental for an early diagnosis. Macrolides can be an alternative treatment in penicillin-allergic patients (Arch Soc Esp Oftalmol 2008; 83: 197-200)