Granuloma Annulare Anterior Uveitis

Purpose: To present a case of bilateral granuloma annulare anterior uveitis. Design: Case report. Methods: Clinical case presentation and review of literature. Results: A 72-year-old woman with a history of granuloma annulare (GA) presented with acute bilateral granulomatous anterior uveitis. General physical exam revealed hypo- and hyper-pigmented punctate and annular skin lesions on both arms characteristic of GA. Infectious and autoimmune workup revealed a mildly elevated angiotensin converting enzyme (ACE) level. Her uveitis resolved with topical prednisolone and homatropine. Conclusions: Granuloma annulare is a rare cause of anterior uveitis that is diagnosed by characteristic skin findings and may be associated with sarcoidosis.     

Chronic Anterior Uveitis in Children

Purpose: To describe the visual prognosis and remission rate of chronic anterior uveitis in pediatric patients.

Methods: A retrospective case series of children with chronic anterior uveitis treated in the University of Buenos Aires. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Uveitis remission was defined according to SUN criteria.

Results: There were 35 pediatric patients (61 eyes), mean age of uveitis onset was 7.69 ± 3 years, 60% were females and 74% had bilateral disease, median follow-up was 60 months (range: 12–192 months). JIA was more frequent in females (80.95 vs 21.43; p<0.0001) and oligoarthritis was the most common form. Remission rate was higher in males (HR = 4.99; 95% CI = 1.16–21.51; p = 0.031). More than 40 eyes remained with the same BCVA at 1 year of follow-up.

Conclusions: Although remission was not common and only occurred after long-term follow-up, visual prognosis was good

Received 30 August 2015; revised 6 March 2016; accepted 14 March 2016; published online 18 May 2016     

Multimodal Imaging in Anterior Uveitis

Anterior uveitis is the most common group of uveitis worldwide, with a diverse spectrum ranging from autoimmune and infectious to masquerade etiologies. Elucidation of the underlying etiology may be challenging, but it remains important, especially for recurrent uveitis. Multimodal imaging has improved our understanding and management of many posterior uveitis and panuveitis. Similarly, a wide variety of anterior segment ophthalmic imaging techniques are available to allow the monitoring of the structural changes that may develop during anterior uveitis. These include anterior segment photography, specular microscopy, in vivo confocal microscopy, anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), laser flare photometry, and less commonly used techniques such as anterior segment fluorescein and indocyanine green angiography, iris autofluorescence, and infrared imaging. This review recapitulates the past and recent application of these ophthalmic imaging modalities to the diagnosis and management of anterior uveitis.     

Chikungunya Virus Infection Associated with Encephalitis and Anterior Uveitis

Chikungunya virus (CHIKV) is an RNA virus transmitted by Aedes mosquitoes. The clinical manifestations include fever, arthralgia, rash, and other atypical clinical findings including ocular lesions. We report the case of a 57-year-old man with meningoencephalitis and anterior uveitis due to CHIKV. The patient had developed bilateral anterior uveitis with iris atrophy and a cotton wool spot on the left eye, and his serum, urine, saliva, and cerebrospinal fluid were positive for CHIKV by RT-PCR. The spectrum of the ophthalmologic manifestations and its pathophysiology in cases of CHIKV infections needs to be better understood. Additional studies examining the ocular lesions caused by CHIKV could improve the therapeutic goals of reducing the morbidity and sequels.     

Nonsteroidal Anti-inflammatory Therapy and Recurrent Acute Anterior Uveitis

Objective: To investigate oral nonsteroidal anti-inflammatory drug (NSAID) therapy in the prevention of recurrences of uveitis in patients with recurrent nongranulomatous, idiopathic, or HLA-B27-associated acute anterior uveitis (AAU).

Methods: Retrospective case series of 59 patients with recurrent AAU treated with celecoxib or diflunisal.

Results: The average duration of NSAID therapy was 21.2?±?5.7 months. The average number of relapses for all patients prior to systemic NSAID therapy was 2.84 per person-year follow-up. These relapses declined to 0.53 per person-year follow-up with NSAID therapy (p?<?.001). The relapse rates prior to and after treatment in the HLA-B27-positive group (n?=?21) were compared with the relapse rates prior to and after treatment in the HLA-B27-negative group (n?=?38) and were also statistically significant (p?<?.001).

Conclusion: Morbid attacks and the cumulative exposure to corticosteroids can be prevented with systemic NSAID therapy in patients with recurrent AAU.     

Anterior Uveitis Associated with High-dose Cytosine Arabinoside

Purpose:?To report a case of anterior uveitis associated with high-dose cytosine arabinoside (Ara-C) treatment.

Design:?Observational case report.

Methods:?A 14-year-old girl was seen for pain, redness, and photophobia shortly after finishing a cycle of high-dose Ara-C.

Results:?Portable slit-lamp examination revealed bilateral diffuse fine keratic precipitates, indicative of a nongranulomatous anterior uveitis. This was treated successfully with a course of topical prednisolone acetate 1%.

Conclusions:?Ophthalmologists who are asked to evaluate patients on high-dose Ara-C for a “red eye” should consider anterior uveitis as a potential diagnosis.     

Characteristics and Clinical Outcomes of Hypertensive Anterior Uveitis

ABSTRACT

Objective

The objective of this article is to determine characteristics and outcome of hypertensive anterior uveitis and prevalence of the Herpesviridae family.

Study: Retrospective cohort study.     

Topiramate-induced Bilateral Anterior Uveitis Associated with Hypopyon Formation

Purpose: To report a rare case of bilateral anterior uveitis with hypopyon formation following systemic topiramate use.

Materials and Methods: A 40-year-old woman with migraine headache who was under topiramate treatment referred with bilateral ocular pain and visual blurring. Physical examination disclosed shallow anterior chamber and high intraocular pressure in both eyes. Following discontinuation of topiramate a severe bilateral anterior uveitis with posterior synechiae and hypopyon developed.

Results: Ocular inflammation resolved with systemic and topical steroid. Because of severe cataract and synechiae formation she underwent phacoemulsification/posterior chamber intraocular lens implantation and visual acuity of both eyes improved to 20/25.

Conclusion: Topiramate should be added to the list of drugs that may cause anterior uveitis and hypopyon formation.     

Treatment of Cytomegalovirus Anterior Uveitis with Oral Valaciclovir

We report a patient with cytomegalovirus anterior uveitis who was treated with oral valaciclovir preventing recurrence of his uveitis. Valaciclovir appears to be a good alternative to valganciclovir for maintenance therapy in this condition.     

Emerging Viral Infections Causing Anterior Uveitis

Purpose: To review the systemic and ocular manifestations of specific emergent viral infectious diseases relevant to the ophthalmologist with particular emphasis on anterior uveitis

Methods: Review of literature.

Results: Arboviral diseases are among the most important emergent and resurgent human infections, occurring mostly in tropical and subtropical zones, but appearing in virtually all regions of the world as a result of climate change, travel, and globalization. Arboviral infections are transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. Systemic disease may range from asymptomatic to life-threatening. A wide variety of ocular manifestations, including uveitis, has been reported in association with these emerging viral diseases. Numerous viruses other than arboviruses also have been recently recognized as a potential cause of uveitis.

Conclusions: Proper clinical diagnosis of any emerging infectious disease is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by detection of virus-specific DNA or antivirus antibodies in serum.     

Chronic Anterior Uveitis in Common Variable Immunodeficiency

Purpose: To describe patients with uveitis and common variable immunodeficiency (CVID).

Design: Retrospective observational case series.

Methods: Retrospective review of patients with uveitis and CVID, specifically focusing on clinical presentation and treatment.

Results: Three patients with CVID and uveitis were identified. All patients had chronic anterior uveitis. Two required systemic immunosuppression to control uveitis, with one of these patients relapsing after discontinuation of immunoglobulin therapy. One improved on topical steroid therapy; however, follow-up on this patient did not extend beyond 4 months.

Conclusions: CVID can be associated with chronic anterior uveitis. Patients presenting with uveitis should be questioned about frequent infections and autoimmune disorders as part of the uveitis evaluation.     

Anterior and Intermediate Uveitis Following Yellow Fever Vaccination with Fractional Dose: Case Reports

Purpose: To describe two cases of anterior and intermediate uveitis following yellow fever vaccination with fractional dose.

Methods: Case report.

Results: Case 1: A 35 year-old healthy woman presented with unilateral anterior uveitis 10 days after the yellow fever vaccination. Testing excluded infectious and rheumatic diseases and the episode was fully recovered after a short course of topical treatment. Case 2: A 21 year-old previously healthy woman presented with blurred vision in the left eye (OS) 14 days after the yellow fever vaccination. The ophthalmic examination of the OS revealed intermediated uveitis. Testing excluded infectious and neurological diseases. After six weeks of treatment with oral prednisone, the ocular inflammation had resolved.

Conclusion: Physicians should be aware of the possibility of eye inflammation following the yellow fever vaccination.     

Clinical Features of CMV-Associated Anterior Uveitis

Cytomegalovirus (CMV) anterior uveitis is the most common ocular manifestation of CMV disease in immunocompetent individuals. It is thought to be due to a local reactivation of latent CMV and is usually unilateral. The acute form presents as Posner-Schlossman Syndrome, a recurrent hypertensive anterior uveitis with few granulomatous keratic precipitates. There are geographic differences in the chronic form of CMV anterior uveitis. Asian patients commonly present as Fuchs Uveitis Syndrome with diffuse stellate keratic precipitates, while the European patients present with a chronic hypertensive anterior uveitis with fewer keratic precipitates that are brown in color and located inferiorly. Characteristic features of CMV anterior uveitis include mild anterior chamber inflammation, elevated intraocular pressure, stromal iris atrophy. Synechiae, macular edema and retinitis are typically absent. CMV disease may also be associated with the development of corneal endotheliitis with a reduced endothelial cell count. Long-term complications include glaucomatous optic neuropathy and cataract formation.     

Anterior and Intermediate Uveitis with Retinal Vasculitis: An Unusual Manifestation of Post-Streptococcal Uveitis Syndrome

Purpose: To report a case of bilateral panuveitis with vasculitis, an unusual manifestation of post-streptococcal uveitis syndrome (PSU).

Methods: An 8-year-old patient consulted for bilateral red eye following acute tonsillitis. Exploration revealed bilateral anterior uveitis, vitritis, macular edema, and Frosted Branch Angiitis. Given a clinical suspicion of PSU, blood and serology tests were performed to rule out other causes of vasculitis and retinitis.

Results: Serologies came back negative except for highly elevated antistreptolysin-O titers. Topical and oral corticosteroids normalized the patient’s visual acuity and clinical findings within a few weeks. A subsequent anterior-only recurrence was successfully resolved with topical treatment.

Conclusions: Although PSU most commonly manifests as anterior uveitis, it may present with involvement of the posterior pole. To achieve a correct diagnosis, clinical suspicion and assessment of antistreptolysin-O titers as well as ruling out other conditions with similar clinical features are the mainstay approaches to diagnosis. Prognosis is generally good.     

Rubella Virus-associated Anterior Uveitis in a Vaccinated Patient: A Case Report

Rubella virus is involved in the pathogenesis of Fuchs heterochromic uveitis and almost all cases in Europe show an active antibody production in the aqueous humor against rubella virus. Herein we report a case of a fully vaccinated patient with common variable immunodeficiency who developed unilateral Fuchs heterochromic uveitis secondary to rubella virus which was proven by intraocular fluid examination. Awareness of rubella associated anterior uveitis should remain also in vaccinated patients, especially those without a fully competent immune system.     

Presumed Acquired Retinal Astrocytoma in Association with Anterior Uveitis

Purpose:To report a case of presumed acquired retinal astrocytoma in association with anterior uveitis. Methods:A 29-year-old man presented with mutton fat keratic precipitates in the inferiorlower cornea,with complicated cataract and a circumscribed,solitary,yellowish-white retinal lesion in the right eye.Phacoemulsification with intraocular lens implantation was performed, with election to observeand the lesion was observed periodically. The lesion was followed for over two years without any change in size, shape or, and appearance. The anterior uveitis has not recurred at the time of writing. Results:Systemic medical and laboratory evaluations, including chest computed tomography,cranial magnetic resonance imaging,and serum angiotensin converting enzyme level, were normal. The characteristic fundus, FA,OCT scan, ultrasound scan,and lack of other contributory laboratory findings strongly supported the diagnosis of acquired retinal astrocytoma in this patient. Conclusion:We hypothesized that anterior uveitis may contribute to the growth and maintenance of retinal lesions. (Eye Science 2013; 28:51-54)     

Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers

Purpose: To evaluate diagnostic methods and clinical signs of CMV anterior uveitis (AU), a rarely described entity in Europe.

Methods: We included patients with clinical characteristics of CMV AU and positive PCR and/or Goldmann-Witmer coefficient (GWc) for CMV.

Results: We report 21 patients with unilateral uveitis (100%) and signs of Posner-Schlossman syndrome (PSS) (n = 20, 95.2%), Fuchs uveitis syndrome (FUS) (n = 1, 4.7%), and endotheliitis (n = 4, 19,04%). PCR was positive in 15/21 (71.4%) and GWc in 8/9 patients (88.9%) in aqueous for CMV. GWc was the only positive test in 6/9 patients (66,6%). When PCR alone was performed (without GWc) in the first tap, repeated aqueous taps were needed, twice in five cases and thrice in one case.

Conclusion: Combining PCR and GWc were very helpful to confirm the clinical diagnosis of CMV AU. In case of very high clinical suspicion and negative results, repeated tap seems to be recommended.     

Differential Diagnosis of Viral-Induced Anterior Uveitis

Diagnosis of uveitis is often challenging, but can be easy in typical viral-induced anterior uveitis (VIAU). Associated symptoms and signs are an important source of information. Certain classical clinical features such as keratic precipitates (KPs) distribution, iris atrophy, elevated intraocular pressure (IOP), and unilaterality are commonly used to support the diagnosis of VIAU. However, many etiologies of anterior uveitis may to a certain extent mimic VIAU, especially the ones with unilateral granulomatous KPs and elevated IOP. This review begins with how the clinician can differentiate viral from nonviral anterior uveitis, and subsequently focuses on the key features which may aid in differentiating among the different viruses that cause VIAU.     

Chronic Anterior Uveitis Associated with Relapsing Polychondritis: A Case Report

ABSTRACT

Purpose: To report a case of chronic anterior uveitis associated with relapsing polychondritis (RP).

Case Report: A 43-year-old female patient presenting with bilateral progressive vision loss was diagnosed with bilateral anterior uveitis. According to her clinical signs and symptoms and biopsy results, RP was ultimately diagnosed. Her ocular inflammation was controlled with corticosteroids and systemic immunosuppressive treatment, and the symptoms related to RP improved.

Conclusion: Chronic uveitis is an inflammatory disease that may be associated with many systemic autoimmune diseases. RP should especially be considered in patients with bilateral chronic uveitis, and a relevant detailed history should be obtained for early and accurate diagnosis and treatment.     

Bilateral Anterior Uveitis Associated with Clomiphene Citrate

Purpose: To report a case of bilateral anterior uveitis associated with ovulation induction therapy using clomiphene citrate. Design: Retrospective case review. Methods: A single patient who developed uveitis while taking clomiphene citrate is described. Results: A 30-year-old woman with polycystic ovary syndrome developed bilateral anterior uveitis during ovulation induction therapy. Results of laboratory studies were normal and the patient was treated with topical therapy. Upon rechallenge with clomiphene 3 months later, she again developed bilateral anterior uveitis. Conclusions: Ovulation induction therapy with clomiphene citrate may precipitate uveitis.