Rubella virus-associated uveitis: The essentiality of aqueous humor virological analysis.

AIMS / BACKGROUND: Rubella virus-associated uveitis (RVAU) classically presents with the clinical features of Fuchs uveitis syndrome (FUS). We report a series RVAU, and discuss the relevance of available diagnostic strategies, and how vaccination could potentially prevent disease. METHODS: We retrospectively included patients with RV-positive aqueous humor (AH) with RT-PCR and/or intraocular RV-IgG production, between January 2014 and December 2019. RV-IgG titers from AH and serum were compared with other virus-specific IgG titers (VZV and/or CMV and/or HSV-1), to determine the derived Goldmann-Witmer coefficient (GWC'). Clinical findings at presentation and during follow-up are reported, as well as the anti-RV vaccination status. RESULTS: All 13 included patients demonstrated intraocular synthesis of RV-IgG (median GWC': 9.5; 3.2-100). RV-RNA was detected in one patient while PCR results were negative for other HSV1, VZV and CMV. The mean delay in diagnosis was 13 ± 12.6 years, with an initial presentation of FUS in only 3 patients (23%). Only four patients had been vaccinated, but all after the recommended age. CONCLUSION: As RVAU is a pleiomorphic entity, virological analysis (RV RT-PCR and GWC') of aqueous humor is essential to improve the diagnosis and management of this entity. Improper vaccination against RV appears to be implicated in RVAU.

Ischemic stroke and retinal artery occlusion after carotid aneurysm embolization.

We present the case of a 72-year-old male with a right carotid aneurysm incidentally discovered after an ischemic stroke. After management of the stroke, stent-assisted coil embolization was performed to treat the aneurysm. Two simultaneous and early complications occurred: new ischemic strokes and branch retinal artery occlusions, respectively in the right occipital lobe and in the right eye. Treatment of unruptured carotid aneurysm using stent-assisted coil embolization can lead to severe complications involving both the brain and the retina. Multidisciplinary and close surveillance of patients should be performed to diagnose adverse effects of this endovascular treatment.

Clinical Features and Diagnosis of Anterior Segment Inflammation Related to Cytomegalovirus in Immunocompetent African, Asian, and Caucasian Patients.

Objective: To report the clinical features and treatment outcomes in immunocompetent patients with anterior segment inflammation (ASI) related to human cytomegalovirus (HCMV) depending on their ethnic origin.Material and Methods: Multicenter retrospective study of 38 patients with at least one test, either HCMV-positive PCR or GWc.Results: Features of Posner-Schlossman syndrome were observed in 50% of the eyes, Fuchs heterochromic iridocyclitis in 13% of the eyes, chronic nonspecific anterior uveitis in 21% of the eyes, and corneal endotheliitis in 18% of the eyes. PCR and GWc were positive for HCMV in 50% and 96.2% of the eyes, respectively. Glaucoma was diagnosed in 50% of eyes. Treatment was oral valganciclovir in about half of the patients. Other treatments were intravenous ganciclovir and/or ganciclovir topical ointment and/or intravitreal ganciclovir.Conclusions: No obvious association of specific clinical features with individual ethnicity could be identified. We found a high rate of glaucoma in all ethnic groups. There was a delay in diagnosis and specific treatment of HCMV in most patients.

Risk assessment of sudden visual loss following non-penetrating deep sclerectomy in severe and end-stage glaucoma.

BACKGROUND/OBJECTIVES: To assess the risk of immediate sudden visual loss ("wipe-out" phenomenon) following non-penetrating deep sclerectomy (NPDS) for end-stages glaucoma within the first 6-months postoperative period. SUBJECTS/METHODS: Monocenter database study. We reviewed the results for 73 eyes with severe or end-stage glaucoma that underwent NPDS. End-stage glaucoma (stage 5) was defined by the inability of patients to perform the Humphrey visual field test or by a visual acuity <20/200 due to glaucoma, according to the Glaucoma Staging System classification. Severe glaucoma (stage 4) was defined by a mean deviation (MD) <-20 dB by the preoperative 24-2 Humphrey visual field assessment. All eyes had a severe defect on the central 10° visual field: only a central island of vision remained. "Wipe-out" was defined as the permanent postoperative reduction of visual acuity to <20/200 or to "counting fingers" or less if preoperative visual acuity was <20/200. RESULTS: The mean age was 60 years (range 22-86). Before surgery, the average MD (Humphrey 24-2) was -25.6 ± 3.8 dB, the MD (Humphrey 10-2) -19.9 ± 7.0 dB, and the VFI 24.6 ± 13%. There were no cases of postoperative flat anterior chamber. No patients experienced "wipe-out" within the first 6 months following surgery. At the six-month visit, intraocular pressure (IOP) had decreased significantly from 22.0 ± 8.8 to 13.5 ± 4.5 mmHg (P<0.001). There were no significant changes in mean visual acuity after 6 months (P = 6). CONCLUSIONS: In our study, NPDS provided considerable IOP decrease with no occurrences of "wipe-out" and few other complications. Consideration of NPDS in end-stage and severe glaucoma is advisable given its low risk of intraoperative and postoperative complications and the low risk of wipe out. This surgery should probably be offered with less apprehension about the risk of "wipe-out" in end-stages glaucoma.

Outcomes of Laser Goniopuncture Following Nonpenetrating Deep Sclerectomy With Mitomycin C: A Large Retrospective Cohort Study.

PURPOSE: To report on the frequency, efficacy, and safety of laser goniopuncture (LGP) in lowering intraocular pressure (IOP) following mitomycin-C-augmented nonpenetrating deep sclerectomy (NPDS) in a large cohort of eyes. MATERIALS AND METHODS: This is a monocenter database retrospective study. We reviewed records of 350 eyes that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). We recorded the incidence of LGP, the time between NPDS and LGP, IOP efficacy, and the occurrence of complications. The success of the LGP was defined by an IOP<15 mm Hg without hypotonic treatment. RESULTS: The mean postoperative follow-up period was 19±15.9 months after the NPDS (range, 6 to 58). LGP was performed in 125 eyes (35.7%) in a mean time after NPDS of 7.4±7.6 months (range, 1 d to 36 mo). Most LGP procedures were performed during the first year (97 eyes, 77.6%). The survival analysis using the Kaplan-Meier method showed a 50% incidence of LGP by 2 years. The mean IOP before LGP was 23.8±7.1 mm Hg. LGP resulted in immediate (day 8) and significant IOP lowering by up to 15±6.8 mm Hg. This decrease was maintained throughout the follow-up period, and the Kaplan-Meier survival success rate at 2 years was 48.9% (95% confidence interval, 39.4-60.8). The most common complication was iris incarceration, which occurred in 22 eyes of 125 LGP (17.6%). CONCLUSIONS: Most of the eyes that underwent NPDS may require LGP to reduce the IOP to below the target value. Most often, this procedure was performed in the first year after NPDS (77.6%). LGP lowered IOP<15 mm Hg without any hypotonic medication for at least 2 years in 50% of cases. Goniopuncture is associated with potentially significant complications, of which the most common is iris incarceration. We identified 2 predicting factors for iris incarceration: high IOP before LGP and early LGP after NPDS.

Correction to: Central 10-degree visual field change following non-penetrating deep sclerectomy in severe and end-stage glaucoma: preliminary results.

The published online version contain mistake in the author list. The correct presentation is also given above.

Central 10-degree visual field change following non-penetrating deep sclerectomy in severe and end-stage glaucoma: preliminary results.

PURPOSE: To report the impact of non-penetrating deep sclerectomy (NPDS) in severe and end-stage glaucoma treatment on the central 10° visual field progression (mean deviation, four central points, foveal threshold) and assess the risk of sudden visual loss. METHODS: Monocenter database study. We reviewed records of 34 eyes with severe or end-stage glaucoma that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). Severe and end-stage glaucoma were defined according to the Bascom Palmer Modified Glaucoma Staging System classification. All eyes had a constricted visual field < 10° (severe injury by the Humphrey visual field automated (HVFA) 10-2). Visual fields were recorded every 6 months after the procedure. Data from the last visit was used for the statistical analysis. RESULTS: The mean follow-up duration was 29 months (range 6 to 54) and 33 (97%) eyes were followed for more than 1 year. There were no cases of postoperative sudden visual loss. The intraocular pressure (IOP) decreased from 21.9 ± 8.1 to 15.0 ± 5.4 mmHg (P < .001). Twenty-eight (82%) eyes had an IOP < 21 mmHg and 19 (56%) an IOP < 16 mmHg. The MD 10-2 remained stable (- 19.8 ± 7.4 to - 19.4 ± 8.1 dB, non-significant improvement of + 0.4 dB, P = .1). The MD 10-2 slope showed an insignificant improvement of + 0.25 ± 1.8 dB per year (dB/y) (P = 0.1), but this slope was significantly better when the IOP was reduced to < 16 mmHg than when the IOP was ≥ 16 mmHg at the last visit (+ 0.84  1.2 versus - 0.48 ± 2.2 dB/y, P = .05). The mean number of the four central test points with sensitivity ≤ 5 dB and the change in mean sensitivity of the four central field points remained stable. There were no significant changes in the VFI (from 25.4% ± 13 to 25.8% ± 20) and in foveal threshold. CONCLUSION: NPDS appears to provide stability of the central 10° visual field (with a trend towards improvement but non-significant) with no occurrence of "wipe-out" phenomenon and few other complications. Consideration of NPDS in end-stage and severe glaucoma is advisable given its low risk of complications and its considerable IOP decrease with a relative stability of the central visual field.