Mycophenolate Mofetil for the Treatment of Multiple Sclerosis-associated Uveitis

Purpose: To report the efficacy of mycophenolate mofetil (MMF) as adjunctive therapy for the treatment of multiple sclerosis (MS)-associated uveitis.

Methods: In this retrospective, interventional case series, patients with MS-associated uveitis who were treated by MMF as an adjunct therapy to systemic corticosteroid were studied. Patients’ demographics, clinical course, response to treatment, and complications were assessed.

Results: A total of 30 eyes of 15 patients with a mean age of 34.5 ± 8.3 years were studied. In three patients (20%), onset of uveitis preceded the diagnosis of MS. The course of MS was relapsing–remitting in 11 patients (73.3%) and secondary progressive in four patients (26.7%). At 1 year after institution of MMF, all the patients were on oral prednisolone ≤ 7.5 mg/day, all eyes were quiet without macular edema, and 53.3% of eyes gained visual improvement. Supplemental periocular and intraocular injections were needed during the first 6 months after starting MMF therapy. The systemic adverse effects were transient and minor in severity.

Conclusions: MMF had beneficial effects on vision and intraocular inflammation with an acceptable safety profile.     

Early Relapse in Multiple Sclerosis-Associated Optic Neuritis Following the Use of Interferon b-1a in Chinese Patients

Purpose The incidence of multiple sclerosis (MS) is relatively rare in Chinese. The beneficial effect of interferon β-1a in modifying the disease course of MS has been rarely analyzed in Chinese patients. The aim of this study was to investigate the clinical response to interferon β1-a in Chinese patients with MS-associated optic neuritis (ON). Methods A retrospective case control study was conducted in 20 MS patients with optic nerve involvement. The interferon (IF) group comprised ten patients receiving interferon β-1a. The noninterferon (NIF) group comprised another ten MS patients with optic nerve involvement who did not receive interferon treatment. The clinical characteristics, laboratory data, management, and disease course were retrospectively analyzed. The main outcomes of the study were the annualized relapse rate (ARR) for MS, and final visual outcome data. Results The ARR did not differ between the pretreatment period and the posttreatment period within the IF group. There was also no significant decrease of ARR in the IF group when compared with the NIF group. However, we observed an early recurrence of ON in 50% of the IF cases following the use of interferon β-1a. The final visual outcome did not differ between the IF group and the NIF group. Conclusions The use of interferon β-1a should be carefully monitored because early relapse of ON may complicate the treatment course in this patient group.     

Uveitis tuberculosa

Zusammenfassung Die typische Augentuberkulose tritt im Zusammenhang mit nachweisbarer Allgemeintuberkulose auf; im Primärstadium der Tuberkulose kommt flüchtige Iritis serosa und Chorioiditis vor, im Sekundärstadium entwickelt sich die eigentliche Augentuberkulose in Form der Miliartuberkulose der Aderhaut und der Konglomerattuberkulose der vorderen Uvea. Im Tertiärstadium der Tuberkulose sind Augenmetastasen selten.Die atypische Tuberkulose ist ein nicht genau definierbarer und schwer abgrenzbarer Begriff. Bei atypischer Augentuberkulose fehlt meist eine nachweisbare Allgemeintuberkulose.Als diagnostische Verfahren zur Erkennung der Tuberkulose der Uvea werden erörtert die Diagnose aus dem Augenbefund, aus dem Allgemeinbefund, aus der Tuberkulin-Hautprobe und die serologische Diagnostik, von denen das letztgenannte Verfahren bei Verwendung der quantitativen Serologie des Kammerwassers nach Witmer die grösste Bedeutung hat. Als indirekte diagnostische Methoden werden die Diagnose per exclusionen und ex juvantibus erwähnt. Alle klinischen diagnostischen Methoden liefern nur einen Wahrscheinlichkeitsbeweis für Tuberkulose.

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Summary The typic ocular tuberculosis manifests itself in connection with demonstrable systemic tuberculosis. In the primary stage of tuberculosis a transient serous iritis and chorioiditis occur, in the secondary stage the actual ocular tuberculosis develops in the form of miliar tuberculosis of the choriod and conglomerate tuberculosis of the anterioruvea. In the tertiary stage of tuberculosis eye metastases are rare.The atypic tuberculosis is a term, which cannot be defined exactly, and is hard to outline. In the atypic ocular tuberculosis a demonstrable systemic tuberculosis is absent in most cases.As diagnostic methods for the recognition of uveal tuberculosis there are discussed the diagnosis from the ocular findings, the systemic findings, the tuberculin-skin-test and the serological diagnosis. Most important among these is the last one mentioned, employing the quantitative serology of the aqueous according to Witmer. As indirect diagnostic methods the diagnosis per exclusionem and ex iuvantibus are mentioned. All the clinical diagnostic methods supply only proof of tuberculosis on grounds of probability.

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Résumé La tuberculose oculaire typique se rencontre dans les tuberculoses générales décelables. Dans la première phase de la tuberculose on observe de légères iritis séreuses et des chorioditis, dans la deuxième phase évoluent les tuberculoses proprement dites sous forme de tuberculose miliaire de la cornée et de tuberculose conglomérée de l'uvée antérieure. Les métastases oculaires sont rares dans la troisième phase de la tuberculose.La notion de tuberculose atypique ne peut que difficilement être définie et limitée. Dans les tuberculoses oculaires atypiques la preuve d'une tuberculose générale fait le plus souvent défaut.L'auteur mentionne comme méthodes diagnostiques pour reconnaître la tuberculose uvéale l'interprétation des résultats de l'examen oculaire et de l'examen général, le test cutané à la tuberculine et les méthodes sérologiques. C'est à l'examen sérologique de l'humeur aqueuse selon Witmer (méthode quantitative) que revient la plus grande importance. On peut également procéder par exclusion et ex juvantibus, appliquant ainsi des méthodes indirectes de diagnostic. Aucune méthode clinique ne fournit des preuves irréfutables de tuberculose, elles ne permettent que des diagnostics de probabilité.

     

Drug-Induced Uveitis

Uveitis has been reported in association with a variety of topical, intraocular, periocular, and systemic medications. To establish causality of adverse events by drugs, in 1981, Naranjo and associates proposed seven criteria, which are related to the frequency and documentation of the event; circumstances of occurrence, recovery, and recurrence; and coexistence of other factors or medications. Rarely does a drug meet all seven criteria. The authors review reports of drug-associated uveitis, applying the seven criteria and examining possible mechanisms. Only systemically administered biphosphonates and, perhaps, topical metipranolol meet all seven criteria. Systemic sulfonamides, rifabutin, and topical glucocorticoids fulfill at least five criteria. (Surv Ophthalmol 42:557-570, 1998.     

Staphylococcus aureus Blepharitis Associated with Multiple Corneal Stromal Microabscess,Stromal Edema,and Uveitis

Abstract

We report a case of an immunocompetent woman with atypical marginal keratitis. She presented with recurrent episodes of multiples microabscess distributed in a triangular pattern associated with stromal oedema and anterior chamber uveitis, affecting both eyes, but not simultaneously. The episodes responded to steroid drops, corneal inflammation was coincidental with a worsening of her blepharitis in the affected eye and S. aureus was isolated from the lids.     

Vitrektomie bei Uveitis

Ohne Zusammenfassung     

Anti-TNF-Therapie bei Uveitis

Biologicals are selectively acting proteins that demonstrated high efficacy in the treatment of chronic disorders. In particular, biologicals blocking tumor necrosis factor α (TNF-α), an essential cytokine in chronic inflammatory diseases, have demonstrated great promise. Experimental and clinical data indicate that TNF-α plays an important role in intraocular inflammation. Neutralization of TNF-α might therefore be a promising strategy for prevention and treatment of uveitis. Here we review the principle effects, therapeutic value, and potential side effects of anti-TNF agents in uveitis.     

Anteriore virale Uveitis

Viren stellen eine bedeutende Ursache infektassoziierter intraokularer Entzündung dar. Dies trifft auch für die akute anteriore Uveitis (AAU) als häufigste Form der intraokularen Entzündung zu. Insbesondere Viren aus der Herpesgruppe kommen in Betracht. Während das Herpes-simplex- und Varizella-Zoster-Virus als Ursache für intraokulare Entzündungen gut bekannt sind, konnten neue Erkenntnisse für Zytomegalie- und Rubellavirusinfektionen gewonnen werden. Da die Therapie differiert, ist eine klare Diagnose anzustreben. Zudem müssen auch neue virale Erreger und andere Ätiologien bei AAU berücksichtigt werden, die ein ähnliches klinisches Erscheinungsbild imitieren können. Mit diesem Beitrag sollen die differenzialdiagnostischen Überlegungen zu den Virus-assoziierten AAU-Entzündungen dargestellt werden.