Retinal detachment and uveitis at a tertiary center over 10 years: the King Khaled Eye Specialist Hospital (KKESH) Uveitis Survey Study Group.

PURPOSE: To evaluate the frequency, etiology, treatment, and visual prognosis of retinal detachment (RD) in patients with uveitis. METHODS: A retrospective review was performed in 707 consecutive patients (1042 eyes) with uveitis, of whom 97 (13.7%) (157 eyes [15.1%]) had RD. RESULTS: There were 126 (12.1%) eyes with exudative retinal detachment (ERD), 16 (1.5%) with tractional retinal detachment (TRD), and 15 (1.4%) with rhegmatogenous retinal detachment (RRD). Panuveitis was most commonly associated with RD (144 (91.1%) eyes). Infectious causes were more common in RRD, and non-infectious etiologies were most common in ERD and TRD. Oral prednisone was the initial therapy in ERD. Additionally, in these cases, cyclosporine was prescribed most frequently (47.1% patients), followed by azathioprine (26.4% patients). Fourteen (87.5%) eyes with TRD and all RRD cases underwent surgery. In patients with ERD, the mean best-corrected visual acuity (BCVA) was 1.1 ± 0.7 LogMAR at baseline and 0.6 ± 0.2 LogMAR at last visit (p = 0.001). In patients with TRD, mean BCVA was 0.7 ± 0.4 LogMAR at baseline and 0.6 ± 0.4 LogMAR at last visit (p = 0.056). In patients with RRD, mean BCVA was 1.6 ± 0.9 LogMAR at baseline and 20 1.3 ± 0.9 LogMAR at last visit (p = 0.185). CONCLUSION: In Saudi Arabia, ERD is observed in 12.1% of the eyes with uveitis, and less than 2% of eyes had TRD or RRD. Visual prognosis is usually good after ERD. Infection is the most frequent cause of RRD associated with uveitis and the visual prognosis is poor.

LONG-TERM OUTCOMES OF RITUXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS POSTERIOR UVEITIS REFRACTORY TO CONVENTIONAL IMMUNOSUPPRESSIVE THERAPY.

PURPOSE: To assess long-term effectiveness of rituximab therapy for refractory noninfectious uveitis affecting the posterior segment. METHODS: Retrospective case series. Patients diagnosed with recalcitrant noninfectious posterior uveitis who were treated with rituximab intravenous infusions between 2010 and 2015 were included. Patients underwent best-corrected visual acuity testing and fluorescein angiography evidence of disk or vascular staining at 6, 12, 18, and 24 months. Patients had at least 24 months of follow-up. RESULTS: Eleven patients (21 eyes) with refractory posterior uveitis treated with intravenous rituximab were included. Nine (81.8%) patients were female. Mean follow-up was 29.3 ± 7.8 months. rituximab was administered as complementary therapy because of previous inefficacy of other therapies in 7 (63.7%) patients, and it was the only treatment in four (36.3%) patients who did not tolerate other drugs. Inflammation signs by fluorescein angiography were controlled in nine (81.8%) patients at the end of follow-up. Baseline best-corrected visual acuity was 20/80 (logarithm of the minimal angle of resolution 0.6 ± 0.4), and final best-corrected visual acuity was 20/40 (0.3 ± 0.5) (P = 0.005). No significant side effects were reported. CONCLUSION: Rituximab therapy was associated with stability and remission of recalcitrant noninfectious posterior uveitis in patients who did not tolerate or did not respond to other therapies.

Rituximab in the treatment of ocular cicatricial pemphigoid: a retrospective cohort study.

PURPOSE: The purpose was to evaluate the effectiveness and safety of rituximab (RTX) for the treatment of patients with aggressive ocular cicatricial pemphigoid (OCP). METHODS: A review of patient records at a tertiary referral center with biopsy confirmed OCP who presented between 2006 and 2016. Sixty-one eyes of 32 patients with symptomatic OCP who received treatment with RTX monotherapy or RTX in combination with additional immunomodulatory treatment (IMT) were evaluated. Main outcomes included clinically evident remission of disease, the percentage of corticosteroid sparing patients, stage of OCP (Foster), best corrected visual acuity, and treatment complications. Remission was defined as absence of progressive scarring and active ocular inflammation for ≥ 2 months. Partial remission/responding was defined as disease control and clinical improvement for ≥ 2 months. RESULTS: Mean age at the initiation of RTX treatment was 59.1 years (range, 24-80 years) with a median follow-up time after RTX initiation of 32 months (range, 14 to 127 months). Twenty-six patients achieved clinical remission with an average sustained remission of 24.5 months (from 9 months to 84 months). RTX monotherapy was used in six patients, RTX in combination with intravenous immunoglobulin in 14 patients, and RTX with intravenous immunoglobulin and/or with other IMT agent in six patients. Seven eyes (11.5%) of six patients had favorable response to RTX and achieved response and partial remission, while inflammation remained active in the other seven eyes (11.5%) of four patients though there was no progressive scarring. At the last visit, three patients (9.4%) were on topical corticosteroid, three patients (9.4%) were treated with systemic corticosteroid treatments, and the other 26 patients (81.2%) achieved corticosteroid sparing therapy. Five eyes (8.2%) progressed one Foster stage. No other cicatrization progression or worsening of LogMAR visual acuity (p = 0.641) was observed during the follow-up period. Adverse events included leukopenia in three patients (9.4%), anemia in two patients (6.2%), liver enzyme elevation in three patients (9.4%) who were also on another concomitant IMT drug, and Epstein-Barr Virus infection and sinus infection in one patient each (3.1%). No other severe adverse events were noted during the follow-up period. CONCLUSIONS: These retrospective data suggest that RTX is efficacious and well tolerated when included for the treatment of OCP. Controlled studies are necessary to identify the role of this IMT agent in the therapeutic arsenal, especially its optimum dose and duration of administration.

INTRAVITREAL BEVACIZUMAB FOR PROLIFERATIVE DIABETIC RETINOPATHY: Results From the Pan-American Collaborative Retina Study Group (PACORES) at 24 Months of Follow-up.

PURPOSE: To evaluate the effects of intravitreal bevacizumab (IVB) on retinal neovascularization in patients with proliferative diabetic retinopathy (PDR). METHODS: Retrospective multicenter interventional case series. A chart review was performed of 81 consecutive patients (97 eyes) with retinal neovascularization due to PDR, who received at least 1 IVB injection. RESULTS: The mean age of the patients was 55.6 ± 11.6 years. The mean number of IVB injections was 4 ± 2.5 injections (range, 1-8 injections) per eye. The mean interval between IVB applications was 3 ± 7 months. The mean duration of follow-up was 29.6 ± 2 months (range, 24-30 months). Best-corrected visual acuity and optical coherence tomography improved statistically significantly (P < 0.0001, both comparisons). Three eyes without previous panretinal photocoagulation ("naive" eyes) and with vitreous hemorrhage did not require vitreoretinal surgery. Five (5.2%) eyes with PDR progressed to tractional retinal detachment requiring vitrectomy. No systemic adverse events were noted. CONCLUSION: Intravitreal bevacizumab resulted in marked regression of retinal neovascularization in patients with PDR and previous panretinal photocoagulation. Intravitreal bevacizumab in naive eyes resulted in control or regression of 42.1% of eyes without adjunctive laser or vitrectomy during 24 months of follow-up. There were no safety concerns during the 2 years of follow-up of IVB for PDR.

INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION: 5-Year Results of The Pan-American Collaborative Retina Study Group.

PURPOSE: To report the long-term anatomical and functional outcomes of patients with choroidal neovascularization secondary to age-related macular degeneration treated with intravitreal bevacizumab (IVB). METHODS: Retrospective case series. Patients diagnosed with subfoveal choroidal neovascularization secondary to age-related macular degeneration that were treated with at least 1 intravitreal injection of 1.25 mg of IVB and had a minimum follow-up of 60 months. Patients underwent best-corrected Snellen visual acuity testing, optical coherence tomography, and ophthalmoscopic examination at baseline and follow-up visits. RESULTS: Two hundred and forty-seven consecutive patients (292 eyes) were included. The mean number of IVB injections per eye was 10.9 ± 6.4. At 5 years, the BCVA decreased from 20/150 (logMAR 0.9 ± 0.6) at baseline to 20/250 (logMAR 1.1 ± 0.7) (P = <0.0001). The mean CMT decreased from 343.1+ 122.3 µm at baseline to 314.7 ± 128.8 µm at 60 months of follow-up (P = 0.009). Geographic atrophy (GA) was observed at baseline in 47 (16%) of 292 eyes. By 5 years, GA developed or progressed in 124 (42.5%) of 292 eyes (P < 0.0001). CONCLUSION: The early visual gains obtained from IVB were not maintained at 5 years of follow-up. In addition, IVB may play a role in the development or progression of GA.

Intravitreal bevacizumab plus grid laser photocoagulation or intravitreal bevacizumab or grid laser photocoagulation for diffuse diabetic macular edema: results of the Pan-american Collaborative Retina Study Group at 24 months.

PURPOSE: To evaluate the anatomical and functional outcomes at 24 months in patients with diffuse diabetic macular edema treated with primary intravitreal bevacizumab (IVB) plus grid laser photocoagulation (GLP) or primary IVB alone or GLP alone. METHODS: Retrospective, interventional, comparative, multicenter study. We included in this analysis 141 eyes of 120 patients with diffuse diabetic macular edema treated with primary IVB alone (Group A), 120 eyes of 94 patients with GLP therapy (Group B), and 157 eyes of 104 patients treated with IVB plus GLP (Group C). RESULTS: In all 3 groups, the authors observed improvement of Early Treatment Diabetic Retinopathy Study best-corrected visual acuity from baseline to 24-month follow-up (P < 0.0001). The improvement rate in Group A was statistically significantly better than in Group B (analysis of variance, P = 0.013). The authors also found a decrease in central macular thickness in all groups from baseline to the 24-month follow-up (P < 0.0001). The comparison among 3 groups showed higher central macular thickness decrease in Group A than in Groups B and C (analysis of variance, P < 0.001). CONCLUSION: The study provides evidence to support the use of primary IVB with or without GLP as treatment of diffuse diabetic macular edema. Primary IVB without GLP seems to be superior to GLP alone to provide stability or improvement in best-corrected visual acuity in patients with diffuse diabetic macular edema at 24 months.

Early-Phase Perceptions of COVID-19's Impact on Ophthalmology Practice Patterns: A Survey from the Pan-American Association of Ophthalmology.

Purpose: The COVID-19 pandemic affected medical practice worldwide due to interventions to prevent spreading. Its effect on ophthalmology practices in Latin America has not yet been explored. We aimed to assess the perceptions about the pandemic from countries' ophthalmological national and subspecialty retina societies affiliated to the Pan-American Association of Ophthalmology (PAAO). Patients and Methods: A survey-based study of leaders of national ophthalmological and retinal societies was conducted. The survey was sent by email to 30 societies, from which 20 responded (12 countries, 66.6% response rate). It included closed- and open-ended questions about (1) operational capacity and precautions, (2) telemedicine and virtual care, (3) procedures, and (4) post-pandemic considerations. Results: There was a marked decline in ophthalmology patient visits (80-95%) and elective surgeries (90%) during 2020 compared to before the pandemic. Precautions like temperature checks, mask usage, and social distancing were widely implemented while personal protective equipment (PPE) availability varied. Telemedicine use was limited due to lack of experience with it. Reopening plans focused on maintaining precautions and gradually resuming activities. Economic and security concerns were raised, and adherence to guidelines was emphasized. Respondents acknowledged the need to adapt to a "new normal". Long duration drugs, fewer imaging studies, and shorter wait times were preferred; however, availability of long duration drugs was limited. Conclusion: The pandemic impacted ophthalmology in Latin America, with reduced patient visits, procedures, and surgeries. Delayed treatment and complications were likely the result of the pandemic.

Rhegmatogenous retinal detachment after LASIK for myopia of up to -10 diopters: 10 years of follow-up.

BACKGROUND: The aim of this work was to characterize rhegmatogenous retinal detachment (RRD) in over 22,000 eyes after laser-assisted in situ keratomileusis (LASIK) for the correction of myopia ≤ -10.00 diopters (D), its characteristics, and its frequency at 10 years of follow-up. METHODS: This is a retrospective single-center interventional non-comparative case series. A total of 22,296 myopic eyes that underwent surgical correction of myopia ≤ -10.00 D were included. LASIK for the correction of myopia was performed in all eyes. Patients were followed for 10 years after LASIK. The clinical charts of patients that developed rhegmatogenous retinal detachment (RRD) after LASIK were reviewed. RESULTS: A total of 11,594 (52%) eyes came back for follow-up after LASIK at 10 years. Twenty-two eyes (19 patients) developed a RRD after LASIK at 10 years. Rhegmatogenous retinal detachments occurred between 1 month and 10 years (mean: 31.6 ± 39.3 months) after LASIK. Eyes that developed a RRD had from -1.50 to -9.75 D of myopia (mean: -4.81 ± 2.2 D) before LASIK. The frequency of RRD after LASIK determined in our study was 0.05% (11/22,296) at 1 year, 0.15% (18/11,371) at 5 years, and 0.19% (22/11,594) at 10 years. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for the correction of myopia ≤ -10.00 D is infrequent. The risk of RRD after LASIK is very low if you screen patients, and do prophylactic treatment as performed in this study. RRD, if managed promptly, will result in good vision. We recommend that patients scheduled for refractive surgery undergo a very thorough dilated indirect funduscopy with scleral depression and treatment of any retinal lesion predisposing to the development of a RRD before LASIK surgery should be performed.

intravitreal tumor necrosis factor inhibitors in the treatment of refractory diabetic macular edema: a pilot study from the Pan-American Collaborative Retina Study Group.

PURPOSE: The purpose of this study was to report the short-term visual and anatomical outcomes after intravitreal injections of two different tumor necrosis factor α inhibitors in eyes with refractory diabetic macular edema. METHODS: An interventional, retrospective, multicenter study of 39 eyes with refractory diabetic macular edema that were injected with adalimumab (n = 5 for 2 mg) or infliximab (n = 15 for 1 mg; n = 19 for 2 mg). The main outcome measures were the best-corrected visual acuity and the central macular thickness at 3 months of follow-up. RESULTS: In the 1-mg infliximab group, the logarithm of the minimal angle of resolution best-corrected visual acuity improved from 1.49 ± 0.58 at baseline to 1.38 ± 0.56 at 3 months (P = 0.6991). In the 2-mg infliximab group, the logarithm of the minimal angle of resolution best-corrected visual acuity worsened from 0.76 ± 0.54 to 1.03 ± 0.69 at 3 months (P = 0.5995). In the adalimumab group, the logarithm of the minimal angle of resolution best-corrected visual acuity improved from 1.44 ± 0.77 to 1.08 ± 0.85 at 3 months (P = 0.2500). The central macular thickness in the 1-mg infliximab group decreased from 459 ± 125 µm at baseline to 388 ± 131 µm at 3 months (P = 0.1178). In the 2-mg infliximab group, the central macular thickness remained unchanged from 378 ± 97 µm at baseline to 349 ± 118 µm at 3 months (P = 0.2162). In the adalimumab group, the central macular thickness remained unchanged from 521 ± 163 µm at baseline to 526 ± 390 µm at 3 months (P = 0.1250). There were no systemic side effects reported in any of the patients. However, laboratory markers for autoimmunity were not done. None of the eyes injected with either adalimumab or 1 mg of infliximab had adverse ocular events. In the 2-mg infliximab group, 42% (8 of 19) of eyes developed severe uveitis. Three of these eyes (37.5%) required pars plana vitrectomy. The uveitis in the remaining five eyes resolved with topical steroid therapy. CONCLUSION: Both intravitreal adalimumab and infliximab do not appear to benefit eyes with refractory diabetic macular edema. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.

Intravitreal clindamycin and dexamethasone for zone 1 toxoplasmic retinochoroiditis at twenty-four months.

PURPOSE: To report the anatomic and functional outcomes of intravitreal clindamycin and dexamethasone for the treatment of zone 1 toxoplasmic retinochoroiditis (TRC). Patients had 1 or more of the following indications for local therapy: intolerance to oral medication, contraindication to oral medication because of pregnancy, lack of response despite oral antimicrobial treatment, or treatment with concomitant oral and local therapy to avoid or limit foveal or optic disc involvement. DESIGN: Noncomparative, retrospective, multicentric interventional case series. PARTICIPANTS: We reviewed the medical records of 12 consecutive patients (eyes) with posterior pole (zone 1) TRC who were treated weekly or every 4 weeks (during pregnancy) with intravitreal injections of clindamycin (1.5 mg/0.1 ml) and dexamethasone (400 microg/0.1 ml). METHODS: Ophthalmic evaluation included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA); assessment of central macular thickness (CMT); resolution of inflammation by optical coherence tomography (OCT), clinical examination, and fluorescein angiography; and assessment of adverse events. Patients were followed for 24 months. MAIN OUTCOME MEASURES: Resolution of TRC, changes in BCVA, and OCT. RESULTS: Resolution of TRC was achieved in all cases with a mean number of injections of 3.6 (range: 2-5 injections) with a mean interval of 15.5+/-4 days. At 24 months a significant reduction in CMT by OCT was observed, from 387.6+/-70.1 microm to 185.2+/-44.7 microm (P = 0.0004). Baseline BCVA was logarithm of the minimal angle of resolution (logMAR) 1+/-0.4 (20/200), which improved to 0.5+/-0.4 (20/63) (P = 0.002) at the end of follow-up. Ten eyes (83.3%) improved > or =2 ETDRS lines of BCVA, and 2 eyes (20%) remained stable at 24 months. One patient's vision was limited because of macular scarring. No ocular or systemic adverse events were observed. No recurrences at 24 months of follow-up were observed. CONCLUSIONS: The combination of intravitreal clindamycin and dexamethasone was associated with resolution of zone 1 TRC and functional and anatomic improvement in patients who did not tolerate, had contraindications to, or did not respond to oral medications.

Surgical technique for approaching chronic or persistent macular holes: Two case reports.

PURPOSE: To report the anatomic and functional outcomes of an innovative surgical technique for either chronic or persistent macular holes (MHs). OBSERVATIONS: A consecutive retrospective interventional case series of 2 patients with chronic macular hole in one case and persistent macular hole in the other case were included. Surgical technique involves pars plana vitrectomy, use of triamcinolone acetonide for posterior hyaloid staining followed by internal limiting membrane peeling in case number 1, macula area is detached by means of subretinal injection of balanced salt solution (BSS) trough 3 puncture retinotomies strategically placed. Fluid-air exchange is done and gas tamponed is injected. Face-down position is required. Preoperative, and postoperative best corrected visual acuity was recorded. Spectral-domain optical coherence tomography (SD-OCT) scans were registered and compared. Case number 1 did not achieve a complete closure of the macular hole during a 6-month follow-up period. Case number 2 had successful hole closure after the procedure and was maintained for 12 months of follow up. No worsening in visual acuity was reported in neither eye, and improvement in visual acuity in case number 2 was observed from CF to 20/100 at the end of 12 months of follow up. CONCLUSIONS AND IMPORTANCE: This surgical technique has previously demonstrated to provide resolution of chronic, large and persistent MH. However, in our case series we observed a complete closure of the macular hole in only one of two patients. Therefore, in spite of being a very small case series these results suggest the need to perform further studies to identify the presence of risk factors which could decrease the probability of failure with this interesting surgical technique.

PHOTODYNAMIC THERAPY WITH VERTEPORFIN PLUS INTRAVITREAL BEVACIZUMAB FOR CIRCUMSCRIBED CHOROIDAL HEMANGIOMA: 4 YEARS OF FOLLOW-UP.

PURPOSE: To report the anatomical and functional response of combined photodynamic therapy and intravitreal injection of bevacizumab in a patient with symptomatic circumscribed choroidal hemangioma. METHODS: The patient received a single-session full-fluence photodynamic therapy immediately followed by an intravitreal injection of bevacizumab (1.25 mg/0.05 mL). RESULTS: One week after combined therapy, an improvement of best-corrected visual acuity from count fingers to 20/60 and a significant decrease in subretinal fluid were noted. One month later, we observed decreased leakage on fluorescein angiography in all phases of the study. Three months after treatment, the best-corrected visual acuity improved to 20/25 and spectral domain optical coherence tomography scans showed return to normal foveal architecture with no subretinal fluid and completely flat tumor. These findings were maintained during 4 years of follow-up. CONCLUSION: Combination therapy was associated with a rapid and persistent resolution of subretinal fluid, improvement of best-corrected visual acuity, and visual stability at 4 years of follow-up.

Long-term outcomes of systemic corticosteroid-sparing immunomodulatory therapy for Birdshot Retinochoroidopathy.

PURPOSE: To report the visual prognosis, electroretinography (ERG) and perimetry outcomes of systemic corticosteroid-sparing immunomodulatory treatment (IMT) for birdshot retinochoroidopathy (BSRC). METHODS: Retrospective non-comparative case series of 132 patients (264 eyes) with BSRC treated with IMT from Massachusetts Eye Research and Surgery Institution. RESULTS: The average follow-up time was 60.1 months. After one year on IMT, 39.4% showed no clinically active inflammation. After 5 years of IMT, 78.0% had no signs of clinical inflammation. No significant differences were observed on best-corrected visual acuity (BCVA), ERG parameters, and perimetry parameters between baseline and subsequent visits on IMT. CONCLUSION: Long-term systemic corticosteroid-sparing IMT was associated with a low rate of BSRC disease exacerbation. While differences were seen on testing parameters, they were not consistent trends and difference were attributed to variability of testing or fluctuation of inflammation that may be expected in the course of the disease.

SOLITARY RETINAL CAPILLARY HEMANGIOMA IN A PATIENT WITH BILATERAL CHORIORETINAL COLOBOMA.

PURPOSE: To report a case showing a very rare association of chorioretinal coloboma and retinal capillary hemangioma in a previously healthy patient. METHODS: Observational case report. RESULTS: A 21-year-old woman presented at our clinic for vision screening. She had a history of bilateral chorioretinal coloboma with amblyopia in her left eye. Her best-corrected visual acuity was 20/25 in her right eye and 20/200 in her left eye. On slit-lamp examination, iris coloboma was observed in the left eye. Fundus evaluation showed inferior chorioretinal coloboma in both eyes, and an elevated, round, and orange-red retinal lesion with feeder vessels localized in the midperipheral region of the right eye. The patient was diagnosed as having solitary retinal capillary hemangioma and underwent argon laser therapy for treating the tumoral lesion. Diagnostic studies were negative for von Hippel-Lindau disease. This is the first reported case of solitary retinal capillary hemangioma associated with bilateral chorioretinal coloboma. CONCLUSION: Chorioretinal coloboma is a congenital defect of the eye caused by improper closure of the embryonic fissure. Retinal capillary hemangioma is a vascular retinal tumor that may occur sporadically or as part of the von Hippel-Lindau syndrome. We report a rare association of chorioretinal coloboma and retinal capillary hemangioma in a previously healthy patient.

Twenty-Four Months Follow-Up of Intravitreal Bevacizumab Injection Versus Intravitreal Triamcinolone Acetonide Injection for the Management of Persistent Non-Infectious Uveitic Cystoid Macular Edema.

PURPOSE: To report the efficacy of intravitreal bevacizumab (IVB) injection versus intravitreal triamcinolone acetonide (IVT) for persistent non-infectious uveitic cystoid macular edema (CME). METHODS: Interventional retrospective comparative case series evaluated 37 consecutive patients (44 eyes) with completely controlled uveitis and recalcitrant CME. Patients received repeated injections of 1.25 mg of IVB or 4 mg of IVT. RESULTS: Best-corrected visual acuity (BCVA) at baseline and 24 months was logMAR 1 and 0.8 respectively, in the IVB group (p = 0.002) and; logMAR of 1.1 and 0.6, in the IVT group (p = 0.001). Central macular thickness at baseline and 24 months was 399.2 µm and 333.7 µm (p < 0.0009), respectively, for the IVB group and; 464.4 µm and 316.5 µm in the IVT group (p = 0.044). Postoperatively, IOP increased in the IVT group. CONCLUSIONS: Repeated injections with IVT improve BCVA as effectively as repeated injections with IVB in the long-term management of persistent uveitic CME.

Clinical Characteristics and Treatment of 308 Panuveitis Patients over 10 Years: Results from the KKESH Uveitis Survey Study Group.

Purpose: To describe the clinical characteristics and surgical outcomes of panuveitis over a 10-year period.Methods: Data were collected on panuveitis etiology, treatment, surgery and change in vision.Results: Overall, 308 patients (594 eyes) were evaluated, 54.9% with non-granulomatous and 45.1% with granulomatous uveitis. Fifty-four patients had infectious and 254 had non-infectious uveitis. In infectious panuveitis, vision remained unchanged at last visit. The most frequent diagnosis was presumed intraocular tuberculosis (PIOTB) uveitis (48.1%). In the non-infectious subgroup vision increased significantly by 2 lines at last visit (p = 0.020). The most common diagnose was Vogt-Koyanagi-Harada (VKH) disease (38.6%). Initial therapy was oral prednisone in 86.6% with non-infectious etiology followed by immunosuppressive agents. Surgery secondary to complications (mainly cataracts) was performed in 46.7% patients.Conclusion: In Saudi Arabia, panuveitis was mainly due to VHK. PIOTB was the most common etiology for infectious panuveitis. Immunosuppressive therapy and surgery maintained BCVA in non-infectious panuveitis.

Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial.

PURPOSE: To assess the effectiveness and safety of an intravitreal injection of 1.25 mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS: This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (<1 month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12 months. P < .05 was considered statistically significant. RESULTS: A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P = .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P = .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P = .0001). Mean surgical time was 71.3 ± 32.1 minutes in the study group and 83.6 ± 38.7 minutes in the control group (P = .061). CONCLUSION: Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Rituximab Induction and Maintenance Treatment in Patients with Scleritis and Granulomatosis with Polyangiitis (Wegener's).

AIMS: To evaluate the efficacy and safety of rituximab (RTX) induction and maintenance treatment for patients with scleritis and granulomatosis with polyangiitis (GPA), Wegener's. METHODS: Nine patients (12 eyes) with scleritis with GPA who did not respond to corticosteroids and more than one immunosuppressive agent who received ongoing maintenance RTX treatment were identified. Demographics and outcome measures were recorded. RESULTS: Median follow-up time of 30 months (range, 15 to 87 months). All 12 eyes achieved remission during the RTX maintenance period with a median time in remission of 14 months (range, 5-76 months), and median interval between RTX initiation and inactive disease of 5 months (range, 2-8 months). Two eyes in two patients relapsed. One received steroid eye drops, and the other received a short-term increased dose of intravenous corticosteroids. CONCLUSIONS: RTX was effective as an induction and maintenance treatment in our small cohort of patients with GPA-associated scleritis.