Scleral Buckling for Rhegmatogenous Retinal Detachment Associated with Pars Planitis.

Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis. Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups. Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement (p < 0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%, p = 0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors. Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB.

Spontaneous malignant glaucoma in a longstanding hypotonous eye.

A 38-year-old man with longstanding low intraocular pressure (IOP) in his right aphakic eye presented with severe pain and high IOP (35 mm Hg). On examination, visual acuity was light perception. The central and peripheral portions of the iris were directly opposed to the posterior corneal surface and synechial closure of the pupil margin. B-scan ultrasonography showed posterior vitreous detachment. The patient was treated with topical cycloplegics, a topical beta-blocker, and a systemic hyperosmotic agent. After 1 week, the anterior chamber was deep centrally, with peripheral synechiae between the iris and the cornea. The IOP of the right eye was 4 mm Hg. This case is an unusual spontaneous malignant glaucoma occurring in a longstanding hypotonous eye.

Morphologic changes in the anterior segment in patients with initial-onset or recurrent Vogt-Koyanagi-Harada disease.

PURPOSES: To investigate morphologic changes in anterior segments based on inflammatory phases of Vogt-Koyanagi-Harada (VKH). METHODS: The author recruited 76 consecutive eyes of 38 patients with initial-onset VKH and 52 eyes of 26 patients with recurrent VKH. Morphologic changes in anterior segments were measured by ultrasound biomicroscopy (UBM). UBM parameters and intraocular pressure (IOP) were compared between two groups. RESULTS: Ciliary thickness and area significantly increased in the recurrent group compared with the initial-onset group. Twelve patients (31%) in the initial-onset group showed supraciliary effusions, but no patients in the recurrent group had supraciliary effusions. Angle opening and anterior chamber depth were significantly decreased in the initial-onset group compared with the recurrent group. High IOP > 30 mmHg was found in 7 patients with initial-onset disease, while low IOP < 10 mmHg was detected in 6 patients with recurrent disease. CONCLUSIONS: The results indicate that morphologic changes associated with IOP alterations depend on inflammatory phases of VKH disease.

Emergent risk factors associated with eyeball loss and ambulatory vision loss after globe injuries.

BACKGROUND: The objective of this study was to evaluate risk factors associated with eyeball loss and ambulatory vision loss on emergent examination of patients with ocular trauma. METHODS: We reviewed the medical records of 1,875 patients hospitalized in a single tertiary referral center between January 2003 and December 2007. Emergent examinations included a history of trauma, elapsed time between injury and hospital arrival, visible intraocular tissues, and initial visual acuity (VA) using a penlight. The main outcome measures were ocular survival and ambulatory vision survival (>20/200) at 1 year after trauma using univariate and multivariate regression analysis. RESULTS: The ocular trauma scores were significantly higher in open globe injuries than in closed globe injuries (p < 0.01). In open globe injuries, initial VA less than light perception (LP) and a history of golf ball injury were the significant risk factors associated with eyeball loss. Elapsed time more than 12 hours and visible intraocular tissues were the significant risk factors associated with ambulatory vision loss. The most powerful predictor of eyeball loss and ambulatory vision loss was eyeball rupture. In closed globe injuries, there were no significant risk factors of eyeball loss, whereas initial vision less than LP and the presence of relative afferent pupillary defect were the significant risk factors associated with ambulatory vision loss. CONCLUSIONS: An initial VA less than LP using a penlight, a history of golf ball injury, and elapsed time more than 12 hours between ocular trauma and hospital arrival were associated with eyeball loss and ambulatory vision loss. Physicians should bear these factors in mind so that they can more effectively counsel patients with such injuries.

Aqueous vascular endothelial growth factor levels are associated with serous macular detachment secondary to branch retinal vein occlusion.

PURPOSE: The purpose of this study was to determine whether aqueous levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) are associated with developments of serous retinal detachment (SRD) secondary to branch retinal vein occlusion. METHODS: We recruited 102 patients with branch retinal vein occlusion and 10 controls. We divided patients into two groups according to optical coherence tomography images of the macula. Forty-six of 102 patients showed SRD defined as being subretinal fluid accumulation with low reflectivity, and the remaining 56 patients presented only cystoid macular edema (CME) defined as being hyporeflective intraretinal cavities. We measured the extent of vascular leakage (disk areas) by digital fluorescein angiography and evaluated the retinal ischemia defined as capillary nonperfusion. Aqueous concentrations of VEGF and pigment epithelium-derived factor were measured by enzyme-linked immunosorbent assay and compared between the two groups. RESULTS: The incidence of major branch retinal vein occlusion was higher in the SRD group (38 of 46, 83%) than in the CME group (32 of 56, 66%, P = 0.01). The incidences of ischemic vein occlusion and macular ischemia was similar between the SRD group (18 of 46 and 20 of 46) and the CME group (20 of 56 and 24 of 56), whereas vascular leakage areas were larger in the SRD group than in the CME group (P = 0.02). Aqueous VEGF levels were higher in the SRD group than in the CME group (P < 0.001), whereas aqueous pigment epithelium-derived factor levels were similar. Vascular endothelial growth factor levels were positively correlated with pigment epithelium-derived factor levels (P < 0.001). CONCLUSION: Our results indicate that excessive increase in vascular permeability because of VEGF upregulation may contribute to the development of SRD secondary to branch retinal vein occlusion.

Effect of 10-mm superior oblique posterior tenectomy combined with frenulum dissection in A-pattern with superior oblique overaction.

PURPOSE: To evaluate the effect of 10-mm tenectomy of the posterior fibers of the superior oblique (SO) tendon combined with dissection of the frenulum for correction of A-pattern deviation and vertical deviation with SO overaction. DESIGN: Retrospective, interventional case series. METHODS: Seventy-five patients with A-pattern strabismus associated with SO overaction who underwent surgery between March 1, 2004 and August 31, 2007. Retrospective analysis of A-pattern strabismus patients with SO overaction who underwent unilateral or bilateral 10-mm SO posterior tenectomy combined with frenulum dissection and who underwent at least 12 months of follow-up. RESULTS: The mean preoperative amount of A-pattern for all patients was 21.20 +/- 7.25 prism diopters (PD), with a mean postoperative collapse of 17.63 +/- 5.33 PD (range, 10 to 30 PD), which was statistically significant (P = .001). After surgery, the mean A-pattern correction was 22.12 +/- 6.30 PD in the group that underwent bilateral posterior tenectomy and 13.33 +/- 5.20 PD in the group that underwent unilateral posterior tenectomy. The mean degree of preoperative vertical deviation in the group that underwent unilateral posterior tenectomy was 11.50 +/- 3.96 PD, and the mean correction was 9.21 +/- 4.22 PD (P = .01). There were no surgical complications, except in 5 patients, who manifested mild inferior oblique overaction. CONCLUSIONS: We believe that 10-mm SO posterior tenectomy combined with frenulum dissection effectively collapses A-pattern deviation of less than 25 PD with mild to moderate SO overaction and reduces associated vertical deviation of 10 PD.

Changes in aqueous vascular endothelial growth factor and pigment epithelium-derived factor after ranibizumab alone or combined with verteporfin for exudative age-related macular degeneration.

PURPOSE: To investigate changes in aqueous vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) after ranibizumab (Lucentis; Genentech Inc, South San Francisco, California, USA) monotherapy or combined with photodynamic therapy (PDT). DESIGN: Prospective, interventional, case-control study. METHODS: We recruited 34 patients with CNV secondary to AMD and 10 controls. Baseline examinations, including visual acuity (VA), central macular thickness (CMT), fluorescein angiography, and indocyanine angiography, were performed, and the measurements of VA and CMT were repeated 1 month after treatments. Seventeen of 34 patients received a single intravitreal injection of 0.5 mg ranibizumab, and the remaining 17 patients underwent combined PDT on the same day. Aqueous samples were collected at the time of injection and 1 month after treatment and were measured by enzyme-linked immunosorbent assay. Main outcomes measures were the changes in VA and CMT and the changes in VEGF and PEDF levels. RESULTS: Demographic features, lesion characteristics, and mean changes in VA and CMT were similar between the two groups. Aqueous VEGF and PEDF levels were reduced significantly 1 month after treatment in all patients. The reduction levels of VEGF and PEDF were similar between the two groups. There was a positive correlation between the reduction levels of aqueous VEGF and the reduction levels of aqueous PEDF. The reduction levels of VEGF and PEDF were correlated positively with the decrease in CMT, but were not positively correlated with the improvements in VA. CONCLUSIONS: Ranibizumab therapy for CNV secondary to AMD is associated with reduced levels of aqueous VEGF and PEDF regardless of combined therapy with PDT. The reduction levels of VEGF and PEDF are correlated with anatomic improvements in the macula.

Morphologic changes in the anterior segment after phacovitrectomy for proliferative diabetic retinopathy.

PURPOSE: To determine whether combined phacoemulsification and intraocular lens implantation with pars plana vitrectomy (PPV) (phacovitrectomy) in patients with proliferative diabetic retinopathy (PDR) causes morphologic changes in the anterior segment and to evaluate whether there is a relationship between the anatomic changes and inflammatory complications. SETTING: Department of Ophthalmology, Chonnam National University Hospital, Gwangju, South Korea. METHODS: Patients who had uneventful surgery for PDR were divided into 2 groups (phacovitrectomy and PPV only). Morphologic changes in the ciliary regions were measured by ultrasound biomicroscopy (UBM) 1 day before surgery and 1, 2, 3, 5 days, 2 weeks, 1 and 2 months after surgery. The UBM parameters and inflammatory complications in the 2 groups were compared. RESULTS: The study comprised 60 patients; 30 had phacovitrectomy and 30, PPV only. The frequency of supraciliary effusions was higher in the phacovitrectomy group (24/30, 80%) than in the PPV-only group (14/30, 46%) (P = .015). The decrease in angle opening and anterior chamber depth was more prominent after phacovitrectomy. The incidence of complications was higher in the phacovitrectomy group than in the PPV-only group (60% versus 30%, abnormal intraocular pressure; 30% versus 7%, intraocular fibrin and posterior synechia formation); the complications were associated with supraciliary effusions. CONCLUSIONS: The results indicate that phacovitrectomy for PDR may induce more morphologic changes in the anterior segment. Supraciliary effusions were associated with inflammatory complications. Appropriate control of postsurgical inflammation is necessary in phacovitrectomy for PDR.

Intravitreal triamcinolone reduces the morphologic changes of ciliary body after pars plana vitrectomy for retinal vascular diseases.

PURPOSE: To investigate the early postoperative changes in ciliary body after pars plana vitrectomy (PPV) for retinal vascular disease and to determine whether intravitreal triamcinolone acetonide (IVTA) affects postvitrectomy changes of the ciliary body. DESIGN: Prospective interventional case-control study. METHODS: We recruited 46 patients who underwent uncomplicated PPV for retinal vascular disease (35 with proliferative diabetic retinopathy (PDR) and 11 with branch retinal vein occlusion) and divided the patients into two groups according to the use of IVTA at the end of the PPV. The morphologic changes of the anterior segments were measured by ultrasound biomicroscopy (UBM) one day before and one day, two days, three days, five days, two weeks, one month, and two months after the PPV. The main outcome measures were the thickness and area of the ciliary body, the frequency of supraciliary effusions (SEs), angle-opening, and anterior chamber depth (ACD). We compared the UBM parameters between the two groups. RESULTS: The thickness and area of the ciliary body significantly increased from day 1 to day 5 postoperatively. Nineteen of 46 eyes had SEs that were frequently associated with divergent alterations of postoperative intraocular pressure (IOP). The angle-opening and ACD were significantly decreased and dependent upon the findings of ciliary body thickness and SEs. The degree of the morphologic changes of the ciliary body and the frequency of SEs were significantly lower and of shorter duration in the IVTA group compared to the non-IVTA group. CONCLUSIONS: The PPV for retinal vascular disease induces the morphologic changes of the ciliary body associated with postoperative abnormalities in IOP during the early postoperative period. Administration of IVTA at the end of the PPV effectively reduces or shortens the duration of the postvitrectomy changes of the ciliary body.

An epidemic of chronic pseudophakic endophthalmitis due to Ochrobactrum anthropi: clinical findings and managements of nine consecutive cases.

PURPOSE: To report an epidemic of O. anthropi pseudophakic endophthalmitis. METHODS: The medical records of nine patients with culture-proven O. anthropi endophthalmitis were reviewed. RESULTS: The presenting features were compatible to chronic endophthalmitis. Two patients showed coinfections with P. acnes. Antibiotics sensitivity test revealed susceptibility to quinolones. Pars plana vitrectomy (PPV) with partial capsulectomy (PC) cured infections in seven patients without coinfection of P. acnes. Final visual acuity was 20/40 or better in five patients. CONCLUSIONS: O. anthropi should be considered in cases with chronic pseudophakic endophthalmitis. PPV with PC should be the initial therapeutic option for O. anthropi endophthalmitis.

Human leukocyte antigen B27 and B51 double-positive Behçet uveitis.

OBJECTIVES: To describe the clinical characteristics of human leukocyte antigen (HLA) B27 and B51 double-positive Behçet uveitis and to determine whether the coexistence of HLA-B27 can affect Behçet uveitis. METHODS: We retrospectively reviewed the medical records of patients with Behçet uveitis and patients with HLA-B27-associated non-Behçet uveitis who underwent HLA-B27 and HLA-B51 typing and were followed up for more than 3 years. We divided the patients into 3 groups according to HLA-B27/B51 status and compared the clinical outcomes. Main outcome measures were demographic features, uveitis characteristics, complications, treatments, and visual prognosis. RESULTS: Fourteen patients with HLA-B27(+)B51(+) Behçet uveitis, 43 patients with HLA-B27(-)B51(+) Behçet uveitis, and 41 patients with HLA-B27(+)B51(-) non-Behçet uveitis were identified. HLA-B27(+)B51(+) Behçet uveitis showed the demographic features similar to HLA-B27(-) counterparts. However, HLA-B27(+)B51(+) Behçet uveitis showed less involvement of posterior segments, a less chronic course, fewer complications in posterior segments, and less use of systemic medication or surgical intervention for inflammatory control, similar to HLA-B27(+)B51(-) non-Behçet uveitis. The long-term vision prognosis of HLA-B27(+)B51(+) Behçet uveitis was more favorable than that of HLA-B27(-)B51(+) Behçet uveitis. CONCLUSIONS: Our results indicate that HLA-B27(+)B51(+) Behçet uveitis is a benign subgroup of Behçet uveitis. The positivity of HLA-B27 may be a good prognostic factor in Behçet uveitis.

Photodynamic therapy with verteporfin for corneal neovascularization.

PURPOSE: To investigate the efficacy of photodynamic therapy with verteporfin for the treatment of patients with corneal neovascularization. DESIGN: Prospective interventional case series. METHODS: Eighteen eyes of 18 patients with stable corneal neovascularization who were refractory to conventional treatment were treated with photodynamic therapy with verteporfin (6 mg/m(2)). Five patients were treated following penetrating keratoplasty (PK), and two patients were treated before PK. Anterior segment photography was performed before and after treatment. Best-corrected visual acuity (BCVA) and area of corneal neovascularization were measured. RESULTS: At the one-year follow-up, 14 eyes (77.8%) showed a decrease in corneal neovascularization, and nine eyes (50.0%) showed complete vascular occlusion. In five patients who had corneal allograft, complete or partial occlusion was achieved in all eyes. Two patients who underwent subsequent keratoplasty did not manifest allograft rejection or revascularization. Seventeen eyes (94.4%) had stable or improved vision. The mean area of corneal neovascularization significantly decreased from 25.5 +/- 14.2 mm(2) to 14.9 +/- 14.6 mm(2) (P < .01), respectively. No significant complications associated with photodynamic therapy were observed except mild stromal haze in one eye. CONCLUSION: Photodynamic therapy with verteporfin may be effective for the treatment of corneal neovascularization.

Early versus late intravitreal triamcinolone acetonide for macular edema associated with branch retinal vein occlusion.

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of or 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.

Phacotrabeculectomy with mitomycin C in patients with uveitis.

PURPOSE: To evaluate the safety and efficacy of combined phacoemulsification, intraocular lens implantation, and trabeculectomy with mitomycin C for the management of uveitic complications. DESIGN: Retrospective case-control study. METHODS: We conducted a retrospective review of the records of 23 consecutive eyes with chronic noninfectious uveitis (uveitic group) and 43 nonuveitic eyes (control group) that had received primary phacotrabeculectomy. Mitomycin C was used in all the uveitic eyes. Considering the high preoperative intraocular pressure (IOP) of the uveitic group, nonuveitic eyes that had a preoperative IOP of >or=20 mm Hg or that had been given two or more medications were included in the control group. All patients were followed for at least one year. The main outcome measures were postoperative vision, IOP control, complications, and acute uveitis relapse rates. RESULTS: Visual outcome of the uveitic group was similar to the control group. In the uveitic group, the success rate of IOP control (91.3% at one year, 84.8% at two years) was favorable but was significantly lower than in the control group (P = .0423). Complications were comparable between the groups. Primary surgical failure in the uveitic group was associated with the postoperative acute uveitis attack. In the uveitic group, the acute uveitis attack rate showed no change after surgery (P = .283). CONCLUSION: With adequate inflammation suppression, phacotrabeculectomy with mitomycin C is an effective and safe therapeutic option for the management of secondary cataract and glaucoma in uveitic eyes. A lower surgical success rate of the uveitic group might be attributable to the postoperative inflammation recurrence.

Combined low dose cyclosporine and prednisone down-regulate natural killer cell-like effector functions of CD8brightCD56+ T cells in patients with active Behçet uveitis.

PURPOSE: To investigate the changes of effector-related phenotypic markers and the natural killer (NK)-like effector functions of CD8(bright)CD56+ T cells in patients with Behçet uveitis after combined cyclosporine and prednisone (Cs/Pd) treatment. METHODS: Ten patients with active Behçet panuveitis and 10 healthy controls were prospectively recruited in this study. The effector-related surface markers (CD27, CD62L, CD11b, HLA-DR, CD94, NKG2D), chemokine receptors (CXCR1, CXCR3, CCR4, CCR5), and intracellular perforin of circulating CD8(bright)CD56+ T cells were determined by flow cytometric analysis before and after two months' treatment. NK-like cytotoxicity of ex vivo CD8(bright)CD56+ T cells against K562 was measured by standard 51Cr release assay. RESULTS: The expression levels of effector-related molecules on CD8(bright)CD56+ T cells normalized after treatment. The expression levels of CXCR1 and CCR5 were down-regulated on CD8(bright)CD56+ T cells after treatment. The amounts of preformed intracellular perforin of CD8(bright)CD56+ T cells were reduced to the normal levels. Furthermore, the NK-like cytolytic capacities of CD8(bright)CD56+ T cells were decreased after treatment. CONCLUSIONS: Our results suggest that the combined Cs/Pd treatments in active Behçet uveitis may downregulate the NK-like effector functions of CD8(bright)CD56+ T cells.

Intraocular cytokine environment in active Behçet uveitis.

PURPOSE: To determine cytokine profiles in aqueous humor and peripheral blood from patients with Behçet uveitis. DESIGN: Prospective, experimental, and case-control study. METHODS: Aqueous humor and peripheral blood samples from 24 patients with Behçet uveitis, 28 patients with other causes of endogenous uveitis, and 20 healthy subjects after uncomplicated cataract surgery were obtained. Cytokines (interferon gamma (IFN-gamma), interleukin [IL]-2, IL-4, IL-10, IL-12, IL-15, and tumor necrosis factor alpha (TNF-alpha)) were measured by enzyme-linked immunosorbent assay and compared between the uveitis groups. RESULTS: Aqueous interferon gamma (IFN-gamma) levels were higher in patients with Behçet uveitis in contrast to higher concentrations of IL-4 in patients without Behçet uveitis. Aqueous levels of tumor necrosis factor alpha (TNF-alpha) were higher in patients with Behçet uveitis than in patients without Behçet uveitis. Aqueous and serum IL-10 were detected in all patients without Behçet uveitis, but were below detection limits in all patients with Behçet uveitis. Furthermore, IL-15 was exclusively increased in the aqueous humor of Behçet uveitis. The aqueous IL-2 or IL-12 levels were similar regardless of the presence of Behçet uveitis. CONCLUSIONS: Our results showed that an extreme Th1 polarization, a high proinflammatory condition, a low immunosuppressive status, and the presence of natural killer (NK) or CD8+ T cell-activating cytokine were unique features in aqueous humor with Behçet uveitis, suggesting that different immunopathogenic mechanisms may be involved in the ongoing intraocular inflammation of Behçet uveitis.

Vitrectomy for persistent panuveitis in Behçet's disease.

PURPOSE: To determine whether vitrectomy is safe and effective for the management of vitreoretinal complications in Behçet's patients with persistent panuveitis. METHODS: Patients who had undergone therapeutic vitrectomy for Behçet's panuveitis were reviewed retrospectively. Those patients who had shown persistent uveitis despite maximum medical therapy were included. Surgical outcomes were measured by an improvement in vision of 0.3 logarithm of minimum angle of resolution, acute relapse rates, and postoperative complications. RESULTS: Twenty-one patients with a mean postoperative follow-up of 30 months were identified. For almost all patients visual acuity and inflammatory control were significantly improved after vitrectomy. However, patients with optic disc neovascularization (NVD) showed no improvement in their vision or inflammatory control. The postoperative rise of intraocular pressure was frequently associated with intravitreal triamcinolone acetonide injections. CONCLUSIONS: Our study suggests that vitrectomy may be both safe and effective for the management of vitreoretinal complications in Behçet's patients with persistent uveitis. Patients with NVD, however, may have poor outcomes.

CD8brightCD56+ T cells are cytotoxic effectors in patients with active Behcet's uveitis.

Behçet's uveitis, characterized by chronic recurrent uveitis and obliterating retinal vasculitis, frequently causes bilateral blindness. Intraocular infiltration of TCRalphabeta+CD8brightCD56+ cells was a distinct feature in Behçet's uveitis. However, phenotypic natures and effector functions of the cells have remained elusive. This study was conducted to determine phenotypic and functional characteristics and cytotoxic mechanisms of CD8brightCD56+ T cells in Behçet's uveitis. CD11b+CD27-CD62L- phenotypes of CD8brightCD56+ T cells were increased in patients with active Behçet's uveitis compared with inactive Behcet's patients and normal controls. Interestingly, CD45RAdimCD45RO- phenotypes were expanded, and CD94 expression was markedly up-regulated in contrast to the down-regulation of NKG2D. Furthermore, these subsets were polarized to produce IFN-gamma and contained high amounts of preformed intracellular perforin while exclusively expressing surface FasL upon PI stimulation. Moreover, the cytolytic functions of freshly isolated CD8brightCD56+ T cells were up-regulated against both K562 (NK-sensitive) and Raji (NK-resistant) cells, which were effectively inhibited by perforin inhibitor (concanamycin A). Their cytolytic activity against HUVECs was also increased and was effectively suppressed by Fas ligand inhibitor (brefeldin A) and partly by perforin inhibitor. Furthermore, cytolytic functions of PMA and ionomycin-stimulated CD8brightCD56+ T cells against HUVECs were greatly enhanced, by pretreatment of recombinant human IFN-gamma on HUVECs. Therefore, CD8brightCD56+ T cells in Behçet's uveitis are characterized by cytotoxic effector phenotypes with functional NK receptors and function as strong cytotoxic effectors through both Fas ligand-dependent and perforin-dependent pathways.