Clinical features of patients with diabetic anterior uveitis.

AIM: To describe clinical features and outcomes of new-onset anterior uveitis associated with poorly controlled or undiagnosed diabetes mellitus. METHODS: Retrospective analysis of 25 eyes of 18 patients (14 men, 4 women; mean age 44 years) who presented between December 2001 and October 2016 to the Kyorin Eye Center. RESULTS: Ocular findings at presentation included posterior synechiae (15 eyes, 60%), anterior chamber fibrin (13 eyes, 52%), keratic precipitates (10 eyes, 40%), Descemet membrane folds (7 eyes, 28%) and hypopyon (3 eyes, 12%). Seven cases were bilateral. Intraocular pressure >21 mm Hg (7 eyes, 28%) and diabetic retinopathy (7 eyes, 28%, all non-proliferative) were also noted. The mean random blood glucose was 332 mg/dL (range 135-604 mg/dL) and the mean haemoglobin A1c was 12.6% (range 9.7%-16.7%). Seven patients (39%) were unaware of their hyperglycaemic state, and the remainder had either poor glucose control or had discontinued their diabetes treatment. Systemic examination and ancillary testing ruled out other possible causes of the uveitis. The ocular inflammation was managed in all cases using local corticosteroid therapy (drops and subconjunctival injections) in addition to internal medicine intervention for the diabetes. The best-corrected visual acuity (BCVA) was improved or maintained in all eyes at 3 months. The BCVA was ≤0.5 in two eyes due to both cataract and diabetic macular oedema. CONCLUSIONS: We characterised new-onset anterior uveitis in 18 patients in association with poorly controlled or undiagnosed diabetes mellitus. The uveitis was managed in all cases with local corticosteroid therapy in addition to proper diabetes systemic treatment.

Clinical features of uveitis in children and adolescents at a tertiary referral centre in Tokyo.

OBJECTIVES: To analyse clinical features, systemic associations, treatment and visual outcomes of uveitis in children and adolescents at a tertiary centre in Tokyo. METHODS: Clinical records of 64 patients under the age of 20 years who presented between 2001 and 2013 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo were reviewed retrospectively. RESULTS: Of the 64 patients, there was a predominance of girls (70%) and bilateral disease (81%). Mean age at presentation was 12.9 years (4-19 years). Mean follow-up was 46 months (3-144 months). Anterior uveitis was present in 56.3% of patients, panuveitis in 28.1% and posterior uveitis in 15.6%. No patients had intermediate uveitis. The most common diagnostic designation was unclassified uveitis (57.8%). Systemic associations were observed in 10.9% and no patients were diagnosed with juvenile idiopathic arthritis. Ocular complications were observed in 71.9% of patients, including optic disc hyperemia/oedema (40.6%), vitreous opacification (23.4%), posterior synechia (18.7%), increased intraocular pressure (17.1%) and cataract (14.1%). Six patients underwent intraocular surgery, five for cataract extraction and two for glaucoma control. Twelve patients (18.7%) received some form of systemic therapy either corticosteroids, immunosuppressive drugs or biologic agents. The percentage of eyes with a visual acuity of 1.0 or better was 87.1% at baseline, 91.3% at 6 months, 89.6% at 12 months and 87.5% at 36 months. CONCLUSIONS: The majority of children and adolescents who presented to us with uveitis had bilateral disease and no systemic disease associations. Only one-fifth of patients required systemic therapy to control their ocular inflammation, and most eyes had a good visual outcome.

Enhanced depth imaging optical coherence tomography of the choroid in Vogt-Koyanagi-Harada disease.

PURPOSE: Optical coherence tomography (OCT) using enhanced depth imaging (EDI) allows evaluation of choroidal thickness. Our objective was to analyze subfoveal choroidal thickness by EDI-OCT before and after the initiation of high-dose corticosteroid treatment in 8 patients (16 eyes) with new-onset acute Vogt-Koyanagi-Harada (VKH) disease. METHODS: Retrospective review of clinical records. RESULTS: The outer border of the choroid was not evident by EDI-OCT in any patients at presentation. Subfoveal choroidal thickness was measurable by 1 week after the initiation of treatment (mean, 578 µm) and decreased thereafter (mean at 1 month, 397 µm; 3 months, 392 µm; 6 months, 384 µm; 12 months, 332 µm). Rebound of choroidal thickening was observed in three patients (five eyes) during corticosteroid tapering in the absence of other evidence of increased inflammation. Peripapillary atrophy was present at 12 months in 6 of 6 eyes that had a choroidal thickness >550 µm at 1 week after initiating treatment, in contrast to none of the 8 eyes with a choroidal thickness ≤550 µm (P = 0.0003). CONCLUSION: Enhanced depth imaging-optical coherence tomography revealed decreasing choroidal thickness with high-dose corticosteroid treatment in our patients. Choroidal thickness as measured by EDI-OCT may serve as a marker for degree of choroidal inflammation in acute VKH disease.

Effect of infliximab on gene expression profiling in Behcet's disease.

PURPOSE: Recent studies have demonstrated that a new anti-tumor necrosis factor (TNF)-α antibody, infliximab, is effective in controlling ocular inflammatory attacks in Behçet's disease. In this study, the effect of infliximab on gene expression patterns in peripheral blood mononuclear cells of Behçet's disease patients was investigated before and after initiation of infliximab treatment. METHODS: A human whole-genome microarray of 54,359 genes was used to analyze mRNA expression profiles of peripheral blood mononuclear cells obtained from four patients (three women, one man, 21-64 years at age) at baseline and at 22 weeks after initiation of infliximab. Quantitative polymerase chain reaction (PCR) analysis was performed for selected up- or downregulated genes, to confirm the microarray results. RESULTS: Anti-TNF-α therapy reduced the frequency of ocular episodes in three of four patients. Among inflammatory cytokine-related genes, TNF blockade reduced expression of interleukin (IL)-1 receptor type 2, interferon-γ receptors, IL6, IL6 receptor, gp130, and IL17 receptors. Furthermore, gene expression of Toll-like receptor 2 (TLR2), receptor for mycobacterial glycolipid (C-type lectin domain family 4, member E: CLEC4E), and complexin 2 (CPLX2) was downregulated in all patients. CONCLUSIONS: Several up- or downregulated genes identified in this study may be candidates for further investigation in identifying the molecular mechanism of infliximab in the treatment of Behçet's disease with refractory uveoretinitis.

Decreased ocular inflammatory attacks and background retinal and disc vascular leakage in patients with Behcet's disease on infliximab therapy.

AIM: To evaluate the efficacy of infliximab treatment in patients with refractory uveoretinitis associated with Behçet's disease. METHODS: Clinical records of 14 patients were retrospectively reviewed. Patients received infliximab infusions (5 mg/kg) at weeks 0, 2 and 6, and every 8 weeks thereafter. The main outcome measures were frequency of clinically observable ocular inflammatory attacks, background retinal and disc vascular leakage as assessed by fluorescein angiography during periods of clinical quiescence, visual acuity and adverse effects. RESULTS: The median follow-up after initiating infliximab therapy was 19 months (range 12-29 months). At 12 months, eight of 14 patients (57%) had experienced no inflammatory attacks, and the frequency of attacks was significantly reduced when compared with the 6-month period just prior to infliximab use. Background retinal and disc vascular leakage assessed at 12 months improved in 11 of 14 patients (79%). Visual acuity improved or remained unchanged at 12 months in 26 of 28 eyes (93%). Infliximab therapy was terminated in two patients owing to infusion reactions. However, no serious adverse effects were observed. CONCLUSION: Infliximab over the first year of treatment appeared effective in reducing ocular inflammatory attacks, as well as background retinal and disc vascular leakage, in patients with refractory uveoretinitis associated with Behçet's disease.

Frequency and clinical features of intraocular inflammation in Tokyo.

BACKGROUND: To investigate frequencies and clinical features of intraocular inflammation (uveitis) in Tokyo, Japan. METHODS: Records of 834 consecutive new referral patients (352 men, 482 women) examined at the Kyorin University Hospital from April 2000 to December 2007 were retrospectively reviewed. RESULTS: Mean age at onset was 44.8 years for men and 47.0 years for women. By anatomical classification, 229 patients (27.4%) had anterior uveitis, 10 (1.2%) had intermediate uveitis, 183 (21.9%) had posterior uveitis and 412 (49.4%) had panuveitis. The most common diagnoses were Vogt-Koyanagi-Harada (VKH) disease (11.0%), sarcoidosis (6.9%), acute anterior uveitis (6.5%), Behçet's disease (5.8%) and tuberculosis (4.3%). In the third and fourth decades, the most common diseases were Behçet's disease for men and VKH for women, whereas over 60 years of age, the most common diseases were VKH for men and sarcoidosis for women. Systemic corticosteroids were used in 25.5% of patients, and other immunomodulatory agents were required in 8.7% of patients. CONCLUSIONS: The most frequent diagnoses were sarcoidosis, VKH disease, acute anterior uveitis, Behçet's disease and tuberculosis, with Behçet's disease being common in young men and sarcoidosis being common in elderly women. One-fourth of patients received systemic corticosteroids and 8.7% of patients required other immunomodulatory agents.