Optic Disc Edema Is an Under-Recognized Feature of Birdshot Chorioretinitis.

BACKGROUND: Optic disc edema is a feature of many ophthalmic and neurologic conditions. It remains an underappreciated feature of birdshot chorioretinitis (BSCR), leading to delay in diagnosis and treatment. The purpose of our study was to identify clinical features that are concomitant with optic disc edema and suggest a diagnosis of BSCR. METHODS: Retrospective multicenter case series of 29 patients who were referred to a neuro-ophthalmologist or uveitis specialist for evaluation of disc edema and were ultimately diagnosed with BSCR. RESULTS: Fifty-four eyes of 30 patients, from the practices of 15 uveitis specialists, met the eligibility criteria. In addition to disc edema, concomitant features in all patients included vitritis, chorioretinal lesions, and retinal vasculitis. Visual recovery to 20/40 or better occurred in 26 of 29 patients. Visual acuity remained 20/100 or worse in 2 patients previously diagnosed with idiopathic intracranial hypertension, 1 patient previously diagnosed with optic neuritis, and 1 patient for whom treatment was delayed for years, leading to optic disc atrophy. CONCLUSIONS: Optic disc edema is a presenting feature in some cases of BSCR. A diagnosis of BSCR should be considered when disc edema occurs with vitritis, chorioretinal inflammation, and retinal vasculitis. Patients should be referred to a uveitis specialist for treatment.

Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer.

Aim: To evaluate the Falck Medical Applanation Tonometer 1 (FMAT-1) as a device for measuring intraocular pressure (IOP) and outflow facility (OF) in patients with uveitis after periocular triamcinolone injection in one eye. Materials and methods: Retrospective observational comparison. IOP and OF measurements were recorded and analyzed, comparing Goldmann tonometry and FMAT-1 readings. Records were reviewed for adult patients with uveitis who had undergone recent periocular triamcinolone injection in one eye. Results: A total of 19 patients' records were evaluated. In treated eyes, median IOPs (in mm Hg) by Goldmann and FMAT-1 were 21 and 21.0, respectively, and mean IOPs were 22.21 and 21.15, respectively. In untreated eyes, median IOPs by Goldmann and FMAT-1 were 15 and 15.7, respectively, and mean IOPs were 15.52 and 15.31, respectively. Median OF (in µL/mm Hg) in treated and untreated eyes was 0.17 and 0.22, respectively, and mean values were 0.17 and 0.23, respectively. Pearson correlation showed an inverse relationship between IOP and OF in treated eyes, and linear regression analysis showed that IOP strongly predicted outflow in this group. Conclusion: The FMAT-1 generates IOP results substantially similar to Goldmann and OF readings with greater ease than prior tonography devices. Clinical significance: The mechanism of corticosteroid-induced IOP elevation appears to be a reduction in aqueous OF, and its measurement is tonography. This technique has traditionally been cumbersome. FMAT-1 is a newly launched instrument that measures IOP and OF at the slit lamp simultaneously in a few seconds. How to cite this article: Staso FD, Gaudio PA. Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer. J Curr Glaucoma Pract 2023;17(4):197-204.

Repeat Conjunctival Biopsy after Immunomodulatory Therapy for Ocular Mucous Membrane Pemphigoid.

PURPOSE: To evaluate whether conjunctival biopsy findings in patients with ocular mucous membrane pemphigoid (MMP) persist as positive or revert to negative following treatment with immunomodulatory therapy (IMT). METHODS: Patients with biopsy-proven MMP were treated with IMT for at least 2 years before undergoing repeat conjunctival biopsy for immunofluorescence microscopy. Their records were reviewed and findings evaluated to ascertain which patients' biopsies showed antibody deposition on the conjunctival basement membrane. RESULTS: Following 2 years of IMT, conjunctival biopsies showed persistent antibody deposition in two patients, and were negative in four patients. CONCLUSIONS: Conjunctival biopsies in patients with ocular MMP may show reversion to inactive disease following IMT. Post-treatment biopsy might be clinically useful as a means of evaluating the efficacy of therapy in this chronic disease.

A review of evidence guiding the use of corticosteroids in the treatment of intraocular inflammation.

PURPOSE: To review the published laboratory and clinical studies pertaining to the efficacy of corticosteroids in the treatment of intraocular inflammation. METHODS: A Pubmed computer search was conducted of all publications focusing on the efficacy of corticosteroids in treating ocular inflammation, with an additional search of pertinent citations culled from these articles. RESULTS: Experimental evidence has established the efficacy of corticosteroid eyedrops in treating intraocular inflammation. The effectiveness of periocular corticosteroid injections as well as of systemic corticosteroids is supported by extensive clinical experience, although placebo-controlled trials are lacking. Few studies have documented differences in efficacy between the common corticosteroid agents or between the different routes of administration. Subconjunctival injection appears to achieve higher intraocular corticosteroid levels than do other routes of periocular injection or systemic therapy. Clinical experience with intravitreous corticosteroid injection is insufficient to firmly attest to its efficacy or safety. CONCLUSION: The efficacy of corticosteroids in treating intraocular inflammation is based on limited experimental evidence and considerable clinical experience.

Infliximab therapy for 2 patients with Vogt-Koyanagi-Harada syndrome.

PURPOSE: To report the authors' experience using infliximab to treat 2 patients with Vogt-Koyanagi-Harada disease (VKH). DESIGN: Interventional case series. METHODS: Medical records of the 2 patients were reviewed. RESULTS: After starting infliximab intravenous infusions, 5 mg/kg, both patients experienced rapid improvement in their VKH disease, and were able to taper and discontinue prednisone without disease recurrence for the several-month follow-up period. CONCLUSIONS: Infliximab may be effective treatment for VKH, and spares patients the side effects of corticosteroids and conventional immunosuppressive drugs.

Nocardia asteroides necrotizing scleritis associated with subtenon triamcinolone acetonide injection.

PURPOSE: To report a case of Nocardia asteroides infection after subtenon triamcinolone acetonide injection. DESIGN: Case report. RESULTS: An 80-year old female received a subtenon triamcinolone acetonide injection for postcataract surgery cystoid macular edema. Shortly after, the patient developed a chronic red eye that progressed to a fulminant necrotizing scleritis. Eventual scleral biopsy revealed Nocardia asteroides infection, which improved after 5 months of systemic antibiotic therapy. CONCLUSIONS: Subtenon triamcinolone acetonide injection should be recognized as a cause of serious infectious scleritis.

Treatment of serpiginous choroiditis with intravitreous fluocinolone acetonide implant.

PURPOSE: To describe a case in which a fluocinolone acetonide implant was used in a patient with serpiginous choroiditis. DESIGN: Case report. RESULTS: A 57-year-old woman with active serpiginous choroiditis threatening the fovea of her right eye received one intravitreous triamcinolone acetonide injection, leading to immediate disease control. An intravitreous fluocinolone acetonide implant was placed, and resulted in ongoing control of the disease as of her 14 months postoperative follow-up. CONCLUSIONS: Intravitreous fluocinolone acetonide implant should be recognized as a potential treatment option for serpiginous choroiditis.

Update on ocular syphilis.

PURPOSE OF REVIEW: The present review updates the reader on publications from the past 5 years relevant to ocular syphilis. RECENT FINDINGS: Articles from this period are easily grouped into three categories: descriptions of syphilitic ocular manifestations, ocular syphilis in the setting of HIV infection, and treatment of syphilitic ocular disease. While all of the entities described were previously recognized, many are unusual and their description in connection with syphilis is a reminder to be vigilant for this uncommon but everpresent disease. Ocular syphilis can be more severe in patients with HIV infection who are not taking highly active antiretroviral therapy, while with this treatment syphilis is an increasingly likely cause of ocular inflammation. Ocular syphilis should be treated like neurosyphilis, with daily intravenous or intramuscular penicillin for 2 weeks. The prevalence of syphilis has increased markedly in the past 5 years, most notably among men who have sex with men. The fluorescent treponemal antibody assay and similar tests remain the appropriate diagnostic tests for syphilis in patients with ocular inflammation. SUMMARY: Syphilis lingers on the differential diagnosis of all forms of ocular inflammation and should be considered when evaluating such patients.