Single Low-dose Suprachoroidal Triamcinolone Acetonide Injection in Macular Edema Secondary to Noninfectious Posterior Uveitis.

PURPOSE: The purpose was to study the anatomical and functional outcome following single low-dose suprachoroidal triamcinolone acetonide (LD-SCTA) (2 mg) injection in noninfectious posterior uveitis. METHODS: Eleven patients with macular edema (ME) more than 280 µ secondary to noninfectious uveitis were included in the study. A single LD-SCTA (0.5 ml) injection was performed in the study eye with the help of a novel suprachoroidal microneedle (Pricon, Iscon Surgicals, Jodhpur, Rajasthan, India). The study parameters were noted at 4 and 12 weeks post LD-SCTA injection. RESULTS: Ten of 11 patients had a significant decrease in central macular thickness (CMT). The mean CMT measurement at baseline was 513.6 ± 191.73 µm for the 10 patients who responded to the treatment, which reduced significantly to 265.1 ± 34.72 µm (P < 0.003) and 260.6 ± 34.72 µm (P < 0.002) at 4 and 12 weeks, respectively. The mean best-corrected visual acuity (BCVA) at baseline was 0.84 ± 0.41 logMAR unit which improved to 0.52 ± 0.33 (P < 0.001) and 0.25 ± 0.22 (P < 0.000) at weeks 4 and 12, respectively. The mean intraocular pressure at baseline recorded was 16.36 ± 2.97 mmHg, 19.45 ± 4.80 mmHg (P = 0.06) at 4 weeks, and 17.27 ± 2.53 mmHg (P = 0.35) at 12 weeks. One eye which did not respond to LD-SCTA was a case of recurrent Vogt-Koyanagi-Harada disease. CONCLUSION: Single LD-SCTA injection is efficacious in reducing CMT in ME, improving BCVA, and controlling the inflammation in noninfectious posterior uveitis. LD-SCTA can be used as a first-line therapy in noninfectious uveitis over other routes of steroid administration with a favorable outcome and safety profile.

Sífilis ocular imitando una retinopatía oculta externa zonal aguda (AZOOR) / Ocular Syphilis mimicking Acute Zonal Occult Outer Retinopathy (AZOOR)

La sífilis ocular puede simular diversas patologías oftálmicas con múltiples hallazgos oftálmicos posibles. El tratamiento oportuno de estos pacientes puede minimizar el daño visual pero su diagnóstico es a menudo un desafío para el oftalmólogo. Revisamos un caso clínico de un hombre de 45 años, con una presentación rara y atípica de sífilis ocular, sus características clínicas y de imagen, diagnóstico, tratamiento y evolución. El paciente se presentaba con pérdida de visión bilateral indolora, fotopsia y escotomas periféricos con aproximadamente 1 semana de evolución. No eran visibles signos de inflamación ocular. El estudio oftalmológico reveló una presentación similar a retinopatía oculta externa zonal aguda (AZOOR). La sífilis ocular no siempre se presenta con inflamación ocular. Su presentación "similar a AZOOR" es muy rara. Por eso, siempre debemos mantener un alto índice de sospecha de esta afección, ya que el diagnóstico y tratamiento tempranos son esenciales para un mejor pronóstico

Ocular syphilis can simulate various ophthalmic pathologies with multiple possible ophthalmic findings. Timely treatment of these patients can minimize visual damage, but its diagnosis is often a challenge for the ophthalmologist. We review a case report of a 45-year-old man with a rare and atypical clinical presentation of ocular syphilis, its clinical and imaging characteristics, its diagnosis, treatment and evolution. The patient presented with bilateral painless loss of vision, photopsia and peripheral scotomas with about 1 week evolution. There were no signs of ocular inflammation. The complementary ophthalmic study revealed an acute zonal occult outer retinopathy-like ("AZOOR-like") presentation. Ocular syphilis does not always present with ocular inflammation and its presentation as "AZOOR-like" is very rare. So, we should always maintain a high index of suspicion for this condition, as early diagnosis and treatment are essential for a better prognosis

Tuberculosis miliar y tuberculoma coroideo en una niña de 3 meses: diagnóstico y seguimiento de un caso / Miliary tuberculosis and choroidal tuberculoma in a three-month old baby girl: Diagnosis and follow-up of a case

Se presenta a una niña de 3 meses de edad con un cuadro febril sin foco y con empeoramiento. La exploración fundoscópica mostró una lesión coroidea en el ojo izquierdo junto con lesiones en otros órganos sugestivas de tuberculosis diseminada. La evolución fue favorable tras tratamiento con cuádruple terapia antibiótica asociada a corticoterapia. La tuberculosis diseminada debe tenerse en cuenta ante un cuadro febril de tórpida evolución. La exploración oftalmológica de estos pacientes es fundamental, ya que, aunque es poco frecuente, los signos característicos de las uveítis posteriores nos orientarán hacia el diagnóstico y tratamiento precoz de esta enfermedad

A three-month old baby girl presented with fever of unknown origin and with signs of worsening of this episode. Funduscopy showed a solitary choroidal lesion in her left eye, as well as extraocular lesions suggesting disseminated tuberculosis. A favourable outcome was achieved after quadruple antibiotic course and cortisone therapy. Disseminated tuberculosis should be considered in cases of fever of unknown origin in children with an unsatisfactory evolution. Ocular examination is mandatory, due to the possible posterior uveitis signs that can help with early diagnosis and treatment of some diseases

Tratamiento de las uveítis tuberculosas presuntas del segmento posterior: confirmación diagnóstica y resultados a largo plazo / Treatment of presumed tuberculous uveitis affecting the posterior segment: diagnostic confirmation and long term outcomes

Objetivo: Describir el grado de coincidencia con el diagnóstico de presunción así como los resultados clínicos obtenidos a largo plazo tras el tratamiento antituberculoso (ATT) en un grupo de pacientes con uveítis tuberculosas presuntas (UTBP) que afectaban al segmento posterior. Métodos: Estudio retrospectivo. Serie de pacientes. Resultados: Se incluyeron a 17 pacientes con distintos tipos de uveítis del segmento posterior, crónicas, refractarias o de reciente diagnóstico y diversas manifestaciones clínicas, en los que, tras establecerse el diagnóstico de UTBP, se completó ATT. La media de seguimiento fue de 34 meses (rango 2-60). Hubo control de la inflamación en 14/17 pacientes (82,3%) durante el periodo de tratamiento y solo 4/17 pacientes (23,5%) experimentaron una recidiva de su enfermedad a lo largo del periodo de seguimiento tras ATT. Todos los pacientes que sufrieron recidivas (4/4), pero ninguno de los que no las sufrieron (0/13) requirieron terapia inmunosupresora de algún tipo tras ATT. La respuesta al ATT sirvió para confirmar el diagnóstico de UTBP en 14/17 pacientes (82,3%). Conclusiones: En pacientes con sospecha de UTBP que afecta al segmento posterior, el ATT puede ser una eficaz medida para confirmar el diagnóstico y resolver el cuadro inflamatorio. En este contexto, el ATT puede ofrecer otras potenciales ventajas como prevenir futuras reactivaciones de tuberculosis secundarias a tratamiento inmunosupresor o disminuir la frecuencia o la severidad de recaídas en algunos pacientes. La confirmación de estas y otras ventajas requiere trabajos prospectivos, aleatorizados con mayor número de pacientes (AU)

Objective: To determine the level of agreement with the presumed diagnosis and long term clinical outcomes after antituberculous therapy (ATT) in a group of patients with presumed tuberculous uveitis (PTU) affecting the posterior segment. Methods: Retrospective case series. Results: A total of 17 patients with chronic refractory or newly diagnosed uveitis affecting the posterior segment were included. All included patients were diagnosed with PTU and received ATT. Median follow-up after ATT was 34 months (range 2-60). Complete control of inflammation was observed in 14/17 patients (82.3%) during the treatment period, and only 4/17 patients (23.5%) had a uveitis relapse over the entire follow-up period after ATT. All patients who had uveitis relapses (4/4), but none from the remaining group (0/13), required immunosuppressive therapy of some kind after ATT. The response to ATT was able to confirm diagnosis of PTU in 14/17 (82.3%) included patients. Conclusion: When a clinical suspicion of PTU affecting the posterior segment exists, ATT may be highly effective for both confirming the diagnosis and resolving the inflammatory process. Thus, ATT may offer additional advantages, such as preventing latent-tuberculosis reactivations due to immunosuppressive therapy, and decreasing the number and/or severity of uveitis relapses in some patients. Prospective, randomized studies including a larger number of patients are required to support these and other potential advantages of ATT in such patients (AU)

Cesión controlada de fármacos en el segmento posterior. Nuevas tendencias / New trends in controlled drug delivery to posterior segment

No disponible

Sistemas de cesión controlada por vía intraocular / Intraocular drug delivery systems

No disponible

Tratamiento a medio y largo plazo con infliximab y metotrexato en uveítis posteriores y/o crónicas rebeldes al tratamiento convencional / Medium-long term treatment with infliximab and methotrexate in posterior and/or chronic uveitis refractory to conventional treatment

No disponible

Triamcinolone-Induced Intraocular Pressure Elevation: Intravitreal Injection for Macular Edema and Posterior Subtenon Injection for Uveitis

PURPOSE: To assess the effect of intravitreal and posterior subtenon injections of triamcinolone acetonide (TA) on intraocular pressure (IOP). METHODS: we reviewed 42 consecutive eyes after intravitreal TA injection (IVTA) and 43 eyes following posterior subtenon TA injection (PSTA). All cases had a minimum follow-up time of three months. After injection, the value and time of the maximal IOP, the amount of IOP elevation and the needs of the medication were assessed. RESULTS: The IOP increased significantly (p<0.001) from 16.3+/-2.5 mmHg preoperatively to a mean maximum of 21.7+/-5.3 mmHg in the IVTA group, and from 15.3+/-4.5 mmHg to 20.6+/-3.0 mmHg in the PSTA group. An elevation in the IOP of more than 5 mmHg from the baseline IOP was seen in 52.4% of the IVTA group at a mean time of 3.1 weeks postoperatively, and 44.2% of the PSTA group displayed an IOP elevation at 5.9 weeks. CONCLUSIONS: Both developed significant elevations of IOP, but this appeared at a later date in the PSTA group. Careful follow-up after local injection of steroids is necessary.