Long-term Efficacy of Oral Valganciclovir in Presumed Cytomegalovirus Unilateral Hypertensive Anterior Uveitis.

PURPOSE: To describe long-term efficacy and safety of oral valganciclovir in the treatment of presumed cytomegalovirus (CMV) unilateral hypertensive anterior uveitis. METHODS: Retrospective review of 40 patients (40 eyes). RESULTS: All patients presented with high intraocular pressure (mean 39.35 ± 7.58 mmHg), associated with signs of mild anterior uveitis. Oral valganciclovir resulted in control of the intraocular pressures and inflammation in 35 eyes. At the dose of ≥450 mg twice daily, no relapses were documented. The follow-up period ranged from 12 to 108 months (24.45 ± 14.56). At the final follow-up, the intraocular pressure was reduced to 14.92 ± 2.43 mmHg (<0.001). Drug-related complications in the form of leukopenia and azoospermia were reported in one patient. CONCLUSIONS: Oral valganciclovir effectively and safely controls intraocular pressure and inflammation in presumed CMV anterior uveitis. A long-term treatment course seems necessary.

Prognostic value of pretreatment indocyanine green angiography in the acute uveitic phase of Vogt-Koyanagi-Harada disease.

PURPOSE: To investigate the prognostic value of pretreatment indocyanine green angiographic (ICGA) features in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS: Retrospective analysis of 84 patients (168 eyes). Main outcome measures were final visual acuity, development of 'sunset glow fundus' (SGF) and progression to chronic recurrent evolution. RESULTS: Thirty-eight patients (76 eyes) presented in the phase preceding anterior segment (AS) inflammation (early presentation) and 46 patients (92 eyes) had AS inflammation at presentation (late presentation). The mean number of hypofluorescent dark dots (HDDs) and frequency of disc hyperfluorescence were more in the late presentation group (p < 0.001 for both comparisons), whereas the early presentation group showed higher frequencies of peripapillary punctate choroidal hyperfluorescence (p < 0.001) and hypofluorescent patches involving macula corresponding to the areas of exudative retinal detachment (p = 0.012). The mean number of HDDs and the frequency of disc hyperfluorescence were higher among eyes that developed SGF (p < 0.001 for both comparisons) and eyes that progressed to chronic recurrent evolution (p < 0.001; p = 0.001, respectively). The frequencies of peripapillary punctate choroidal hyperfluorescence and hypofluorescent patches corresponding to the areas of exudative retinal detachment were less in the eyes that developed SGF (p = 0.019; p = 0.003, respectively). Punctate choroidal hyperfluorescence elsewhere was less frequent in the eyes that developed SGF (p < 0.001) and eyes that progressed to chronic recurrent evolution (p = 0.002). CONCLUSIONS: Pretreatment ICGA has a prognostic value in initial-onset acute uveitis associated with VKH disease.

Reversal of Peripheral Iris Depigmentation Associated with Vogt-Koyanagi-Harada Disease.

OBJECTIVE: To describe the reversal of peripheral iris depigmentation associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS: A retrospective report of two cases. RESULTS: Both patients were diagnosed with a chronic recurrent VKH disease and developed bilateral peripheral iris depigmentation (BPID). The first patient is an 8-year-old girl who was treated with systemic corticosteroids, methotrexate and adjuvant rituximab infusions that induced complete remission of uveitis and reversal of peripheral iris depigmentation at the last follow-up. The second was a 6-year-old who was treated with topical and systemic corticosteroids and oral methotrexate that induced complete remission of uveitis and reversal of peripheral iris depigmentation at the last follow-up. CONCLUSIONS: Adequate control of uveitis associated with chronic recurrent VKH disease with appropriate immunomodulatory agents and perhaps adjuvant rituximab can reverse BPID and improve the outcomes.

Therapeutic window of opportunity in the acute uveitic phase of Vogt-Koyanagi-Harada disease: Prevention of late autoimmune complications by early intervention.

PURPOSE: To determine relationship between timing of treatment initiation and disease outcomes and whether a therapeutic window of opportunity exists in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. METHODS: Retrospective analysis of 112 patients (224 eyes). Main outcome measures were final visual acuity, progression to chronic recurrent evolution, development of complications, particularly 'sunset glow fundus', and drug-free remission cure of uveitis. RESULTS: Forty-six patients (92 eyes) presented in the phase preceding anterior segment (AS) inflammation (early presentation) and 66 patients (132 eyes) had AS inflammation at presentation (late presentation). In significantly more eyes in the early presentation group (85.9%), final visual acuity of 20/20 was achieved compared with those in the late presentation group (66.7%) (p = 0.001). None of the eyes in the early presentation group progressed to chronic recurrent evolution and none developed 'sunset glow fundus', whereas in the late presentation group, 28.8% of the eyes progressed to chronic recurrent evolution (p < 0.001) and 56.1% developed 'sunset glow fundus' (p < 0.001). Patients in the early presentation group were able to discontinue treatment without relapse of inflammation at significantly shorter time intervals compared to patients in the delayed presentation group (p < 0.001). In the late presentation group, logistic regression analysis demonstrated that presenting clinical features predicting unfavourable outcomes were posterior synechiae (odds ratio = 4.03; 95% confidence interval [CI] = 1.29-12.23), bullous exudative retinal detachment extending to the periphery (odds ratio = 3.35; 95% CI = 1.53-7.32) and female gender (odds ratio = 2.05; CI = 1.08-3.90). CONCLUSIONS: Our findings suggest that the window of opportunity lies in the phase preceding AS inflammation and initiation of effective treatment during this phase results in cure of uveitis and prevents blinding complications.

Femtosecond laser assisted superficial lamellar keratectomy as a successful treatment of corneal opacity in a patient with Thiel Behnke corneal dystrophy.

INTRODUCTION AND IMPORTANCE: Thiel Behnke corneal dystrophy (TBCD) and Reis Buckler corneal dystrophy (RBCD) are Bowman's layer dystrophies with overlapping clinical features causing diagnostic confusion. However, each entity has typical histopathological features. We describe in this case the successful use of Femtosecond laser (FSL) in the treatment of TBCD-related corneal opacity. CASE PRESENTATION: We present a 54-year-old male with bilateral superficial corneal opacities consistent with TBCD based on clinical appearance, anterior segment optical coherence tomography (AS-OCT), and In vivo confocal microscopy. Management options were discussed with the patient before proceeding with Femtosecond Laser Assisted Superficial Lamellar Keratectomy (FSLASLK). The histopathological findings of the excised left anterior lamellar corneal flap were typical of TBCD and the patient had a satisfactory outcome. CLINICAL DISCUSSION: TBCD typically affects Bowman's layer centrally with progressive opacities involving the deeper layer of the corneal stroma and the periphery with advancing age. Histopathology typically shows subepithelial fibrosis with interrupted basement membrane and totally replaced Bowman's layer by uneven fibrous tissue forming the characteristic saw tooth pattern. The treatment of such cases is challenging with variable success and recurrence rates. Our case was managed successfully using FSL. CONCLUSION: TBCD, even though a rare type of dystrophy, should be suspected based on the appearance of the corneal opacities clinically. It can be diagnosed by typical AS-OCT findings supported by histopathological confirmation and can be successfully treated by FSASLK.

An incidental finding of intraocular choristoma in an enucleated microphthalmic globe: A histopathologic case report.

INTRODUCTION AND IMPORTANCE: Choristomas are benign growth of normal tissue in abnormal location and in the ophthalmic practice, they are more commonly found in the epibulbar region. Intraocular choristoma has been reported in different ocular structures but it is very rare especially in association with microphthalmos. CASE PRESENTATION: We present a 13-month-old child with bilateral microphthalmia with the left side being more significantly smaller than the right that required enucleation for introducing a larger silicone implant. The histopathological examination revealed an intraocular choristoma consisting of chondroid and adipose tissue with surrounding fibrosis. Other areas in the globe were also underdeveloped and dysplastic including the optic nerve, which was replaced by dense wavy collagen fibers and fibrovascular tissue. DISCUSSION: Even though choristomas are benign, they may be extensive interfering with visual development especially the ones involving the epibulbar area. Systemic disease can have choristomas as an ocular feature such as in Goldenhar-Gorlin syndrome. Choristomas inside the eye are rare and they commonly involve the uveal tissue and the optic nerve head mostly in the form of ectopic glandular tissue and choroidal osseous choristoma. Our case is unique in its intraocular retrolental location, composition of chondroid tissue and fat, in addition to the fact that it was found within a microphthalmic globe with other interesting histopathological findings. CONCLUSION: We report a case of an incidental finding of intraocular choristoma with associated microphthalmia, genetic testing may be useful for establishing a genetic etiology in such cases even in the absence of dysmorphic features.

Effect of 2019 Coronavirus Pandemic on Ophthalmologists Practicing in Saudi Arabia: A Psychological Health Assessment.

PURPOSE: To assess the psychological impact and mental health outcomes including depression, anxiety, and insomnia during COVID-19 crisis among ophthalmologists. METHODS: This was a simple random study in which ophthalmologists practicing in Saudi Arabia were asked to fill in a self-administered online survey during the period from March 28, 2020, to April 04, 2020. Four validated psychiatric assessment tools were used to detect symptoms of depression, anxiety, insomnia, and stress perception. RESULTS: One hundred and seven participants successfully completed the survey with a response rate of 30.6%. Males constituted 56.1% (n = 60). Ophthalmology residents constituted the majority (n = 66, 61.7%). About half of the physicians exhibited symptoms of depression (n = 56, 50.5%), anxiety (n = 50, 46.7%), and insomnia (n = 48, 44.9%). Symptoms of stress ranged between low (28%), moderate (68.2%), and high (3.7%). According to the cutoff values for severe symptoms, 29% were identified as having depression, 38.3% had anxiety, and 15% had insomnia.Depression was found to be more common among female ophthalmologists (P = 0.06), those living with an elderly (P = 0.003), and fellows (P = 0.006). Female ophthalmologists suffering from anxiety were significantly more than male ophthalmologists (P = 0.046). There was a trend toward suffering from anxiety in frontline health-care providers (P = 0.139) and in ophthalmologists who are living with an elderly (P = 0.149). Female participants exhibited significantly more moderate-to-high symptoms of stress (P = 0.018). CONCLUSIONS: Ophthalmologists' psychological needs, females in particular, should be addressed appropriately during the COVID-19 pandemic. Establishing psychological support units, especially for high-risk individuals, should be considered to minimize psychological adverse effects.