Presumed tuberculous uveitis: diagnosis, management, and outcome.

PURPOSE: To assess the effectiveness of anti-tuberculous treatment in patients with chronic uveitis and either active systemic or latent tuberculosis (TB) in a non-endemic community. METHODS: Retrospective study of patients with chronic uveitis, non-ocular evidence of latent or active TB and no other identified cause of uveitis who underwent a 6-month course of standard anti-tuberculous chemotherapy. Response to treatment was assessed at 6 and 12 months after initiation of treatment. RESULTS: A total of 27 patients were included of whom 59% were female. In all, 19 were Asian, 4 Caucasian, and 4 Black. More than half of patients had a history of contact with another person treated for TB. Inflammation resolved after chemotherapy in 70.3% of patients, 18.5% had a change in the nature of their inflammation and 11.1% had no benefit. CONCLUSIONS: There were no uveitis features characteristic of TB uveitis and a wide range of manifestations was seen ranging from non-granulomatous anterior uveitis to occlusive retinal vasculitis. TB is not endemic in the United Kingdom, therefore consideration of ethnicity, immigration, and history of TB contact remain important to direct investigations. In a patient with uveitis and latent TB, a full 6-month course of anti-tuberculous chemotherapy is recommended although it may not be curative of the uveitis.

Spontaneous sub-conjunctival haemorrhage in patients using long-term topical corticosteroids.

PURPOSE: to investigate the observed high prevalence of spontaneous sub-conjunctival haemorrhage (SCH) in patients using long-term topical steroid treatment. PATIENTS AND METHODS: a cross sectional survey of the occurrence of SCH was carried out in 248 patients using steroid eye drops and in a comparison group of 113 patients using topical glaucoma medication. RESULTS: twenty-four patients with uveitis (10% of total) experienced single or recurrent SCH. Of these 71% used prednisolone acetate 1% (compared with 75% for those unaffected). None of 113 glaucoma patients were affected. CONCLUSIONS: the long-term use of topical steroid for chronic uveitis substantially increases the prevalence of spontaneous or minimal-trauma SCH. Steroid-induced vascular fragility is the likely cause.

Initial experience with the Pascal photocoagulator: a pilot study of 75 procedures.

BACKGROUND: The Pascal is a semiautomated photocoagulator that delivers a pattern array of multiple burns in a rapid predetermined sequence with a single foot pedal depression. Each burn is reduced to 10 or 20 ms to achieve this. The authors report their early experience with this system. METHODS: 75 procedures done in 60 patients divided into four groups-group A, patients undergoing panretinal photocoagulation (PRP); group B, patients undergoing focal or modified grid macular laser; group C, patients undergoing macular grid and group D, patients undergoing retinopexy-were retrospectively studied. RESULTS: 31/34 procedures in group A, 24/26 procedures in group B, 5/7 procedures in group C and all eight patients in group D had successful outcomes. Significantly higher powers were required with the Pascal than with conventional laser (p<0.001) in eyes that underwent PRP and focal/modified grid macular treatment with both systems. Single session PRP was successfully performed in five patients, and five were successfully treated with a macular grid using pattern arrays only. No adverse events were noted. CONCLUSION: Although the shorter pulse duration of the Pascal necessitates the use of a higher power, it is not associated with adverse effects. The results here suggest that the Pascal photocoagulator is safe and effective, and offer several potential advantages related to the brief exposure time.

Mycobacterium fortuitum keratitis.

We report a case of mycobacterial keratitis characterized by apparently spontaneous onset, delayed diagnosis, and eventually necessitating evisceration inspite of systemic antibiotics and repeated corneal grafts.

Bilateral persistent hyperplastic primary vitreous.

We report a case of bilateral persistent hyperplastic primary vitreous (PHPV) in a 5-month-old infant who presented with bilateral leukokoria. The child was referred for ocular ultrasound with a clinical suspicion of retinoblastoma. Grey-scale evaluation revealed an echogenic band in the posterior segment of the left globe extending from the posterior surface of the lens capsule to the optic disc. Doppler examination revealed the presence of blood flow in the band. Ultrasound assessment of the contralateral globe showed an elevated mass of echogenic tissue in the posterior segment, in contact with the optic disc. Most cases of PHPV are sporadic and unilateral. Bilateral PHPV is rare. In a study by Pollard of 83 cases, only two patients (2.4%) had bilateral PHPV. The imaging features in this case point toward the diagnosis of bilateral PHPV. We suggest that this entity, although rare, should be considered in the differential diagnosis while evaluating bilateral leukokoria.

Uveitis and the menstrual cycle.

PURPOSE: To establish whether there is a variation in the incidence of onset of acute anterior uveitis (AAU) in women during the phases of the menstrual cycle. METHODS: Prospective open study in women attending the Acute Referral Centre with a first or recurrent attack of AAU. RESULTS: There was a significant increase in the incidence of AAU during the late stages of the menstrual cycle. CONCLUSIONS: The onset of AAU is partially dependent on the levels of either oestrogen or progesterone, or both. The withdrawal of the proven anti-inflammatory effects of these hormones may provoke the onset of uveitis.