The relation between long latency cortical auditory evoked potentials and stuttering severity in stuttering school-age children.

BACKGROUND: Disturbances in auditory processing and feedback have been suggested to play a role in the pathogenesis of developmental stuttering. Long latency cortical auditory evoked potentials in response to non-linguistic and linguistic stimuli can be used to investigate these disturbances. There were differences between developmental stuttering patients. However, there is no solid evidence of these differences to date. OBJECTIVE: This study aims to determine whether there is a statistically significant difference in component P1-N1-P2 of long latency cortical auditory evoked potentials between stuttering school-aged children and non-stuttering children. In addition, the study aims to investigate the relationship between these potentials and objective quantitative measures of stuttering. METHOD: The study included two groups, patients and controls, consisting of 40 subjects aged 6-12 years. For the cases group, the severity of stuttering symptoms and P1-N1-P2 responses to a non-linguistic stimulus were evaluated. In addition, the P1-N1-P2 responses of the matched control group were evaluated. RESULTS: The P1-N1 responses were similar in both study groups, while P2 response was shorter in the patient group, but the difference was not statistically significant compared to the control group. N1 latency has the only statistically significant correlation with the percentage of repetitions, prolongation, and blocks. The female cases had a decreased, not statistically significant, latency than the male cases group. CONCLUSION: In contrast to the previous finding, the study revealed a non-statistically significant different P1-N1, a non-statistically significant reduced P2 response to a non-linguistic stimulus, in CWS, in as evidence for basic auditory processing. The study also revealed a significant correlation between N1 latency and proportion of the repetition symptoms.

Clinical Patterns and Causes of Intraocular Inflammation in a Uveitis Patient Cohort from Egypt.

Purpose: To analyze the patterns and causes of intraocular inflammation in patients attending uveitis referral clinics in Egypt. Methods: The study included 454 patients with uveitis examined both at the Department of Ophthalmology, Alexandria Faculty of Medicine, and tertiary uveitis referral clinics in Cairo and the International Eye Clinic in Upper Egypt, between August 2013 and March 2016. All patients had a comprehensive ocular examination and systemic work-up. Standard diagnostic criteria for uveitis syndromes were employed for all patients and ancillary ocular or systemic investigations were ordered as required by the suspected uveitis entity. Results: The mean age at presentation was 30 years (range: 4-75). The male to female ratio was 1.1:1. Panuveitis was the most common anatomic pattern (43%), followed by anterior (40.7%), posterior (9%), and intermediate uveitis (7.3%). Anterior uveitis was most commonly attributed to pediatric parasitic anterior chamber granulomas (22.2%). Intermediate uveitis was most commonly idiopathic (81.8%). Toxoplasma retinitis was the most common cause of posterior uveitis (31.7%). Behçet disease was the most common cause of panuveitis followed by Vogt-Koyanagi-Harada (VKH) disease (45.6% and 22.1%, respectively). Among non-infectious etiologies, Behçet disease was the most frequent etiology (28.6%), while for infectious causes, herpetic uveitis was found to be the most frequent cause (39.8%). Conclusions: In this uveitis patient population from Egypt, panuveitis was the most commonly encountered anatomic diagnosis. Behçet disease was the most common identified cause of uveitis followed by VKH disease. Herpes-related uveitides and parasitic granulomas represented the most evident causes of infectious uveitis.

Management of presumed trematode induced granulomatous uveitis in pediatric patients.

PURPOSE: To outline the management of newly identified trematode induced uveitis in pediatric patients STUDY DESIGN: Prospective interventional case series METHODS: Patients with distinctive uveitis were recruited to either receive steroid monotherapy or undergo surgical excision of the inflammatory lesions based on a scoring system. Outcome measures included best corrected visual acuity (BCVA), intraocular inflammatory activity, and incidence of ophthalmic complications RESULTS: 170 patients (174 eyes) were recruited. Mean age was 11.1 years. Mean initial decimal BCVA (± SD) was 0.58 (± 0.31). Of 116 eyes with disease scores <5, 109 were treated effectively with steroids (93.97%). Surgical excision was offered to 58 patients and proved curative in the treated eyes. Protracted inflammation with persistence of the granulomas was noted in 5 patients refusing surgery. Mean follow up period was 21.5 months. Mean final BCVA was 0.69 (±0.27). A significant change in BCVA was noted (p=0.002). There has not been a need for retreatment in any of the study patients, who were also given instructions on evading exposure to fresh water habitats. Larger lesions, mixed disease morphology, older age at presentation were associated with higher rates of ophthalmic complications and vision loss CONCLUSION: A novel waterborne trematode inducing uveitis has been identified in Egypt. A favorable response to steroid monotherapy is demonstrated in low grade disease, while surgical excision was found to be curative in patients with larger lesions or those showing suboptimal response to medical treatment.

Standard cross-linking versus photorefractive keratectomy combined with accelerated cross-linking for keratoconus management: a comparative study.

PURPOSE: To compare the safety and efficacy of standard 30 min epithelium-off cross-linking (CXL) versus photorefractive keratectomy (PRK) combined with accelerated epithelium-off cross-linking (AXL) for the treatment of progressive keratoconus (CXL-Plus). METHODS: This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL. Group B included 67 eyes treated with combined PRK and AXL. The recorded data included UDVA, CDVA, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow-up. RESULTS: In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (LogMAR±SD). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (LogMAR ± SD). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D. CONCLUSION: Surprisingly, standard CXL showed close results to CXL-Plus at the 24th follow-up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL-Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long-term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL.

Risk factors associated with the relapse of uveitis in patients with juvenile idiopathic arthritis: a preliminary report.

PURPOSE: To identify risk factors associated with relapse of uveitis in patients with recurrent uveitis associated with juvenile idiopathic arthritis (JIA) after treatment with immunomodulatory therapy (IMT) and durable remission of 1 year. METHODS: The medical records of 30 patients with JIA-associated uveitis who were successfully treated with IMT to a state of corticosteroid-free remission and subsequently remained in remission after discontinuation of IMT for a period of at least 1 year were retrospectively reviewed. In subsequent follow-up, some patients had relapse of uveitis, whereas others continued to be in remission. Remission was defined as <1 + cells in the anterior chamber and <1 + vitreous haze grading; relapse was defined as ≥ 1 + cell in the anterior chamber or ≥ 1 + vitreous haze grading. RESULTS: A total of 30 patients were included. Of these, 17 (56.7%) patients remained in uveitic remission, whereas 13 (43.3%) relapsed. The patients in remission received IMT earlier in the course of disease compared with patients who relapsed (median, 12 months vs 72 months; P = 0.002 [Mann-Whitney test]). Patients in remission had received treatment with IMT at a younger age compared with the relapse group (median age, 7 years vs 13 years; P = 0.02 [Mann-Whitney test]). None of the other factors studied revealed a statistically significant association. CONCLUSIONS: Patients with JIA-associated uveitis who were treated with IMT earlier in the course of disease and at a younger age were associated with a lower rate of relapse of uveitis after durable remission and 1 year of quiescence, compared with similar patients who relapsed.

Cytomegalovirus retinitis in immunocompetent patients: case reports and literature review.

PURPOSE: The purpose of this study was to examine 2 cases of cytomegalovirus (CMV) retinitis, occuring in 2 immunocompentent adult patients. METHODS: Case selection and literature review. RESULTS: Both patients cited significantly decreased vision despite systemic, topical, and/or local corticosteroid use. Neither patient was using high-dose immunosuppressant therapy at the time of diagnostic testing. Both patients exhibited confirmed CMV infection via polymerase chain reaction DNA testing. Oral antivirals were employed and have stabilized both patients. CONCLUSION: The cases described herein serve to inform ophthalmologists of the urgent need to include CMV in their differential when encountering an immunocompetent adult with significant comorbidities or with a history of previous exposure. Proper treatment is heavily reliant on proper diagnosis.

Bromfenac alone or with single intravitreal injection of bevacizumab or triamcinolone acetonide for treatment of uveitic macular edema.

PURPOSE: To evaluate the efficacy of bromfenac drops alone or with a single intravitreal injection of bevacizumab (IVB) or triamcinolone acetonide (IVTA) in the treatment of uveitic macular edema (UME). DESIGN: Comparative case series. STUDY PARTICIPANT: Sixty-seven eyes (of 55 patients) with UME that received either bromfenac drops alone (n = 34), IVB plus bromfenac (n = 21) or IVTA plus bromfenac (n = 12). METHODS: Chart review of patients at the Massachusetts Eye Research and Surgery Institution (MERSI) was done. Eyes that received either bromfenac drops alone (Br), IVB plus bromfenac (IVB/Br) or IVTA plus bromfenac (IVTA/Br), with follow-up of up to 3 months, were included. MAIN OUTCOME MEASURE: Visual acuity. RESULTS: There was no statistically significant effect seen in VA or CMT in the Br group, with 17 of 34 eyes (50 %) needing re-injection before 3 months of follow-up. Mean change in CMT at 4 weeks for the Br group was 5.06 µm. Compared to baseline, both the IVTA/Br and IVB/Br groups showed significant decrease in CMT and improvement in VA at 1 and 3 months follow-up. There was also a continuous decrease in CMT up to 3 months of follow-up with the IVTA/Br group, which was found to be significant in comparison with the IVB/Br group; this trend was not seen in the IVB/Br group at 3 months. The greatest mean change in CMT at 1 month was seen in the IVTA/Br group (154.33 ±178.22 µm), and this was statistically significant in comparison with the other groups (p = <0.0001). However, in terms of mean change in VA, there was no change in the Br group (0.01 ± 0.11 VA logMAR), and only 0.12 ± 0.19 and 0.15 ± 0.20 in the IVB/Br and IVTA/Br groups, respectively. CONCLUSION: IVB and IVTA are both effective in improving VA and decreasing CMT up to 3 months. Bromfenac is ineffective alone for UME treatment, but may have a synergistic effect with IVTA in reducing CMT up to 3 months of follow-up.

Comparison of two different combination immunosuppressive therapies in the treatment of Vogt-Koyonagi-Harada syndrome.

PURPOSE: To compare the efficacy and safety of cyclosporine/mycophenolate mofetil (CSA/MMF) and cyclosporine/azathioprine (CSA/AZT) in Vogt-Koyonagi-Harada (VKH) patients. METHODS: Retrospective comparative case series with follow-up period of at least 1 year. Outcomes include remission rate and corticosteroid-sparing effect. RESULTS: A total of 10 patients were included (5 patients in CSA/MMF, 5 patients in CSA/AZT). The remission rates for CSA/MMF and CSA/AZT were 5.3 and 5.6, respectively (p = .96). The median time to remission was 15 months for CSA/MMF group and 7 months for CSA/AZT group (p = .6419). The rates of corticosteroid-sparing effect were 7.9 and 5.0 for the CSA/MMF and CSA/AZT groups, respectively (p = .65). The median time to corticosteroid-sparing effect was faster in the CSA/AZT group (2 months) compared to the CSA/MMF group (13 months) (p = .9625). Approximately 50% of patients failed with the presented IMT combination regimens. CONCLUSIONS: No statistically significant difference was found in the two regimens from the study as presented, although the median time to remission and to corticosteroid-sparing effect was shorter for the CSA/AZT combination.

Acute unilateral toxoplasma retinochoroiditis associated with adalimumab, a tumor necrosis factor-α antagonist.

PURPOSE: The purpose of this study was to report a case of a patient with unilateral toxoplasma retinochoroiditis while on treatment with adalimumab, an anti-tumor necrosis factor α agent for ulcerative colitis. METHODS: This is a descriptive case report. RESULTS AND DISCUSSION: In addition to the patient with toxoplasma retinochoroiditis, there is one published report of two patients who developed toxoplasma chorioretinitis while on anti-tumor necrosis factor α therapy for rheumatoid arthritis: one was on adalimumab and methotrexate and the other one was on etanercept and methotrexate. CONCLUSION: The authors need to be aware of this potentially vision threatening risk with anti-tumor necrosis factor α therapy.