An Investigation of the Disc Hyperfluorescence in Fuchs Uveitis Syndrome Using Optical Coherence Tomography Imaging

Abstract

Purpose: To identify the frequency of disc hyperfluorescence, and to use optical coherence tomography to look for vitreopapillary traction as a possible underlying cause.

Methods: Eight patients with presumed Fuchs uveitis syndrome were included. A complete ocular examination, fundus fluorescein angiography, and spectral-domain optical coherence tomography for optic nerve head were performed.

Results: There were 4 males and 4 female patients, and the mean age at diagnosis was 41.7 years. The most common ocular symptom was floaters (5/9). The range of initial visual acuity was 6/5–6/12. The most frequent clinical sign was inflammatory cells in the anterior chamber (9/9). Fundus fluorescein angiography showed disc hyperfluorescence in all but 1 patient. Optical coherence tomography did not show evidence of vitreopapillary traction in all eyes but one eye.

Conclusion: We think that the high frequency of disc hyperfluorescence on fundus fluorescein angiography is an indication of an inflammatory process rather than a mechanical one.     

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.     

Alteration of MCP-1 and MMP-9 in Aqueous Humor Is Associated with Secondary Glaucoma in Fuchs Uveitis Syndrome

ABSTRACT

Purpose

To analyze changes in concentrations of pro- or anti-inflammatory cytokines, chemokines, or metalloproteinases (MMP) in the aqueous humor (AH) in Fuchs uveitis syndrome (FUS) patients with (FUSwG) or without (FUSwoG) secondary glaucoma.     

Visual Prognosis and Associated Factors of Phacoemulsification and Intraocular Lens Implantation in Different Uveitis Entities in Han Chinese

Purpose: To address the visual prognosis and associated predictors of phacoemulsification and intraocular lens implantation in different uveitis entities in Han Chinese.

Methods: A retrospective review of the uveitis patients who underwent phacoemulsification and intraocular lens implantation in our center between 2004 and 2014.

Results: The 158 patients (226 eyes) included anterior uveitis (45 eyes), posterior/pan-uveitis (61 eyes), Vogt–Koyanagi–Harada disease (79 eyes) and Behçet disease (41 eyes). At 6 months after surgery, best-corrected visual acuity (BCVA) significantly improved (p < 0.001) in all uveitis groups with 134 (59.3%) eyes achieving 20/40 or better. The anterior uveitis and Behçet disease groups had significantly better and worse visual outcomes than other groups, respectively. Poor preoperative BCVA, macular lesions, and secondary glaucoma were independent variables that predicted a poor visual outcome.

Conclusions: Our current study revealed a generally favorable outcome and associated predictors of phacoemulsification and intraocular lens implantation in uveitic cataracts in Han Chinese.     

Fuchs综合征并发白内障的人工晶状体植入

目的　评价 Fuchs综合征并发白内障的手术方法。方法　对 11例 Fuchs综合征并发白内障患者行白内障囊外摘出 (ECCE)联合人工晶状体 (IOL)植入术。结果　 11例患者白内障囊外摘出联合人工晶状体植入术后无严重手术并发症 ,不同程度葡萄膜炎易被控制 ,无眼压增高 ,术后平均随访 18m o,矫正视力 0 .4～ 1.2 ,0 .5以上占 81.8% .结论　Fuchs综合征并发白内障的人工晶状体植入手术安全、疗效好     

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.     

伴有高眼压的前葡萄膜炎诊治中的一些问题

某些缺乏严重纤维素性渗出及虹膜后粘连的前葡萄膜炎如病毒性前葡萄膜炎、Fuchs综合征、青光眼睫状体炎综合征等均可表现为持续性或反复性眼压升高,对其治疗常较棘手。最近,新加坡学者对巨细胞病毒性前葡萄膜炎进行了系统分析,对伴有眼压升高的前葡萄膜炎患者提出了新的诊治思路。虽然Fuchs综合征、青光眼睫状体炎综合征与巨细胞病毒性前葡萄膜炎有类似表现,且后两者的发病机制中均有提到巨细胞病毒,但针对后两者的治疗目前仍以对症治疗为主,是否需加入抗病毒治疗,仍需长期的实践探讨。     

Anterior Segment Characteristics of Fuchs Uveitis Syndrome

Purpose: To evaluate the differences in the biometric parameters of the anterior segment in Fuchs' uveitis syndrome (FUS).

Methods: 30 eyes of 15 consecutive patients with unilateral FUS were examined. Anterior segment parameters were measured by rotating Scheimpflug imaging camera. Central endothelial cell count was measured by noncontact specular microscopy.

Results: The central cornea was thinner (p?p?p?p?Conclusions: Scheimpflug imaging method is a useful tool to analyze the anterior segment parameters in FUS. Endothelial cell loss, as well as decreased percentage of endothelial hexagonal cells, is obtained by noncontact specular microscopy in patients with FUS.     

Choroidal Thickness in Eyes with Fuchs Uveitis Syndrome

Purpose: This study measured the macular thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, subfoveal choroidal thickness (SFCT), and ganglion cell complex (GCC) thickness in eyes with Fuchs uveitis syndrome (FUS).

Methods: In total, 25 patients with unilateral FUS were enrolled. The diagnosis of FUS was based on the presence of several of the following clinical features: absence of acute symptoms and ciliary injection; small to medium-sized and stellate keratic precipitates (KP) diffusely scattered on the entire corneal endothelium; chronic low-grade anterior chamber inflammation; iris stromal atrophy with or without heterochromia; lack of posterior synechiae; iris nodules; and vitreous cells and debris. Spectral domain optical coherence tomography (SD-OCT; RTVue-100 OCT) was used to obtain the measurements. The SFCT, RNFL thickness, macular retinal thickness, and GCC thickness of the eyes with FUS were measured and compared with those of the uninvolved fellow eyes. A paired samples t-test was used for statistical analyses. A value of p<0.05 was considered to be statistically significant for all analyses.

Results: The mean age of the patients was 35.2 ± 4.8 years. Fifteen patients (60%) were male, and 10 (40%) were female. Small- to medium-sized stellate KPs and mild anterior chamber reactions were seen in all patients. Heterochromia was observed in 24% of the eyes, iris nodules in 36% of the eyes, lens opacity in 44% of the eyes, and vitreous cells and debris in 88% of the eyes. The mean SFCT was significantly thinner in eyes with FUS (296.47 ± 32.29 µm) than in the fellow eyes without FUS (324.47 ± 26.73 µm; p = 0.001). The mean average GCC thickness was found to be 101.09 ± 5.46 µm in eyes with FUS and 103.80 ± 6.65 µm in eyes without FUS (p = 0.023). There were no significant differences in the mean RNFL and macular thickness values.

Conclusions: We detected subfoveal choroidal thinning in eyes with FUS when compared with the uninvolved fellow eyes. In our opinion, thinning of the SFCT in FUS might be associated with autoimmune responses and chronic inflammatory processes.     

Fuchs’ Uveitis Syndrome: No Longer a Syndrome?

Purpose: Rubella virus (RV) has a central role in the etiopathogenesis of Fuchs’ uveitis syndrome (FUS). We aim to offer new insights by comprehensive analysis of recent laboratory and epidemiologic data.

Methods: We conducted a literature search for laboratory data and papers on etiopathogenesis.

Results: Aqueous humour samples of FUS patients show immunoreactivity to RV, in a specific and sensitive manner. Identification of RV genome confirm intraocular infection in a subset of FUS patients. Epidemiologic findings further support causality. The clinical spectrum of RV-associated uveitis is similar but not identical to FUS. FUS eyes exhibit a predominance of CD8?+?T cells, high IFN-? and IL-10 levels.

Conclusions: RV is the leading cause of FUS. Cytokine-based findings mirror a viral etiology and chronic low-grade inflammation. RV-associated FUS represents a common pathway of intraocular RV inoculation after congenital or acquired infection. Other causes, including HSV and CMV, may lead to FUS.     

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.     

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.     

PCR Multiplex for CMV Detection in Patients with Anterior Uveitis

Purpose: Describing the utility of Polymerase Chain Reaction for Cytomegalovirus (CMV-PCR) in the diagnosis of suspected viral anterior uveitis (AU).

Patients and methods: We analyzed aqueous humor (AH) CMV-PCR positivity and treatment modifications in 47 eyes of 46 patients with viral uveitis and its correlation with high intraocular pressure (HIOP), uveitis clinical characteristics and time intervals from samples to uveitis diagnosis and to relapse.

Results: CMV-PCR positive results occurred in 13 eyes (27.7%) of 12 patients. They were more frequent in HIOP eyes (34.2%, p = 0.047) and with Posner–Schlossman Syndrome (56.2%, p = 0.002). CMV-PCR positivity (p = 0.001) and HIOP (p = 0.038) increased the probability of treatment change. Although CMV-PCR positive results decreased over time (p = 0.002), they were not related to activity or proximity to inflammatory uveitis episode.

Conclusion: HIOP AU eyes should be considered for CMV-PCR AH analysis due to possible treatment modifications.     

Epidemiological Survey of Intraocular Inflammation in Japan

Purpose

To report the frequency and trend of intraocular inflammation based on a survey of new ophthalmology patient visits to university hospitals throughout Japan during 2002.

Methods

A questionnaire was sent to the departments of ophthalmology in 110 university hospitals nationwide to survey the total number of new patients who visited the outpatient clinics for the first time between 1 January and 31 December 2002, and also the number of patients diagnosed with intraocular inflammation during this period.

Results

The surveys completed by 41 university hospitals were analyzed in this study. During 2002, a total of 151 299 new ophthalmological patients presented at the 41 institutions, and 3060 (2.2%) of the new patients were diagnosed as having intraocular inflammation. The most frequent intraocular inflammatory disease identified was sarcoidosis (13.3%), followed by Vogt-Koyanagi-Harada (VKH) disease (6.7%), Behçet disease (6.2%), bacterial endophthalmitis (3.8%), herpetic iridocyclitis (3.6%), diabetic iritis (1.6%), human leukocyte antigen-B27-associated uveitis (1.5%), acute retinal necrosis (1.3%), ocular toxoplasmosis (1.1%), ocular toxocariasis (1.1%), uveitis associated with human T lymphotropic virus-1 (also known as HAU) (1.1%), and others. Infectious intraocular inflammation accounted for 16% of all uveitis cases.

Conclusions

Through the collaboration of a large number of institutions, some aspects of the epidemiology of intraocular inflammation in Japan were elucidated. However, the disease concept and diagnostic criteria remain ambiguous for a considerable number of diseases within the spectrum of intraocular inflammation, and the possibility that such factors may bias the present findings cannot be denied. In the future, a prospective survey based on well-defined, common diagnostic criteria is required to obtain more precise epidemiological data.?Jpn J Ophthalmol 2007;51:41–44 © Japanese Ophthalmological Society 2007     

葡萄膜炎并发白内障的人工晶状体植入术

目的探讨葡萄膜炎并发白内障的手术方式和疗效。方法对28例（28眼）葡萄膜炎并发白内障行白内障摘出及人工晶状体植人术，观察其视力变化及术中、术后并发症。结果术后26眼（92．86％）视力较术前提高。其中〉0．5者10眼，0．3。0．5者10眼，0．1。0．2者6眼，〈0．1者2眼。结论葡萄膜炎并发白内障植人人工晶状体。效果可靠。     

Orbital Inflammatory Syndrome and Anterior Uveitis: A Case Series

Purpose: To describe four cases of orbital inflammatory syndrome (OIS) with associated anterior uveitis that have presented within 2 years to our practice.

Methods: Charts of patients diagnosed with OIS from June 2013 to May 2015 were reviewed.

Results: Four patients, three children and one adult, presented with orbital swelling, pain, and varying degrees of vision loss. Treatment with intravenous methylprednisolone resulted in significant symptomatic improvement in all cases initially; when symptoms recurred, the patients had evidence of anterior uveitis. With continued systemic therapy and the addition of topical prednisolone, the patients all achieved control of their uveitis and OIS and are well controlled with regular outpatient follow-up.

Conclusions: Reports of OIS-associated with uveitis are relatively rare. The presentation of three pediatric patients and one adult patient to the same practice with OIS and secondary uveitis within a 2-year period may indicate that the association is underreported.     

Intraocular Lymphoma: Descriptive Data of 26 Patients Including Clinico-pathologic Features,Vitreous Findings,and Treatment Outcomes

Purpose: To describe clinical manifestations, diagnostic approaches, therapy, and outcomes of biopsy-proven intraocular lymphoma.

Methods: Review of tertiary referral center records between 2005 and 2015.

Results: A total of 51 eyes of 26 patients were included; mean age of onset was 60.42 years. Common ocular complaints included floaters (42%) and blurred vision (35%); 62% of patients had ocular and central nervous system involvement; 11% had systemic lymphoma; and 27% had only ocular involvement. Vitreous analysis was positive for malignant cells in 77% of patients on initial biopsy, and in 100% of patients on repeat biopsy. In total, 20/26 patients received systemic and topical treatment before IOL diagnosis was made; 25 patients received intravitreal methotrexate and/or rituximab; one patient received intracameral rituximab. All patients achieved remission by their final visit.

Conclusions: Intraocular lymphoma often masquerades as intraocular inflammation, resulting in delayed or misdiagnosis with subsequent inappropriate management. Optimal therapy is a challenge for oncologists and ophthalmologists.     

Clinical Profile,Ultra-Wide-Field Fluorescence Angiography Findings,and Long-Term Prognosis of Uveitis in Tubulointerstitial Nephritis and Uveitis Syndrome at One Tertiary Medical Institute in China

Purpose: To analyze the clinical features and long-term prognosis of uveitis in tubulointerstitial nephritis and uveitis (TINU) syndrome in a cohort of Chinese patients.

Methods: A total of 32 patients with TINU syndrome between 2000 - 2016 were analyzed retrospectively.

Results: Mild anterior inflammation was observed in all cases. Ultra-wide-field fluorescence angiography (UWFA) was conducted on 13 patients, and peripheral vascular leakage was observed in 22/26 eyes (84.62%) compared with active anterior chamber inflammation in 13/26 eyes (50%). Three patients received increased corticosteroid dosage therapy on their first episode of uveitis guided by UWFA had stopped steroids without recurrence.

Conclusion: The uveitis in TINU syndrome was mild. Corticosteroids were efficient in most cases, but a slower tapering and long-term treatment were required. UWFA is sensitive in detecting the activity of uveitis and might be useful in monitoring disease progression. Complete withdrawal of medication was difficult to achieve in some cases.     

Intravitreal Adalimumab for the Control of Breakthrough Intraocular Inflammation

Purpose: Investigate the efficacy of intravitreal adalimumab in breakthrough panuveitis in patients on systemic adalimumab for more than 3 months.

Methods: Retrospective study of patients on systemic adalimumab with breakthrough panuveitis requiring intravitreal adalimumab therapy.

Results: Seven eyes of four patients with Adamantiades–Behçet disease panuveitis were included and all were maintained on systemic adalimumab for 7.3 months (range 3–11) with inflammation controlled for 4.1 months (range 2–10) before breakthrough uveitis. The total number of attacks was 13 over 24.5 months (range 12–30). Resolution of attack was defined as return to baseline visual acuity with resolution of inflammatory markers. Three attacks resolved after only one injection and 10 attacks required an average of 2.4 injections (range 2–3). No systemic or ocular complications were noted.

Conclusions: Intravitreal adalimumab warrants further investigation as a potentially effective, practical and safe adjunctive therapy for the control of breakthrough inflammation in select patients maintained on systemic adalimumab.