Adalimumab in Elderly Patients with Non-Infectious Uveitis. Safety and Efficacy.

Purpose: To assess the efficacy and safety of adalimumab in elderly patients with noninfectious uveitis (NIU).Methods: An observational, retrospective, multicenter study was done. Changes in best-corrected visual acuity (BCVA), inflammatory activity parameters, central retinal thickness (CRT), and the occurrence of adverse events (AE) developed during follow-up were recorded.Results: A total of 82 eyes from 41 patients 60 years of age and older with noninfectious uveitis treated with adalimumab were included. A significant improvement in BCVA (71.5 to 75.4 letters, p = .001) and in CRT (311.1 µm to 265 µm, p = .001) was observed. Moreover, a significant decrease from baseline in the rate of patients with anterior chamber cell (ACC) >0+ (34.6% to 5.7%, p = <0.001) or vitreous haze>0+ (21.3% to 4.3%, p = .002) was determined. AEs were observed in 11 patients (26.8%).Conclusion: Adalimumab can be safe and efficacious for the treatment of NIU in patients 60 years of age and older.

Bilateral Acute Depigmentation of the Iris: Findings in Anterior Segment Swept-Source Optical Coherence Tomography.

Objective: To describe the clinical and Anterior Segment Swept-Source Optical Coherence Tomography (AS-SS OCT) findings in Bilateral Acute Depigmentation of the Iris (BADI).Design: Retrospective descriptive study of three clinical cases.Results: Three women diagnosed with BADI shared a history of bacterial infections treated with moxifloxacin. The AS-SS OCT showed damage from the collarette to the root of the iris, without affecting the pupillary area. In the affected areas, the anterior edge had lost its homogeneous hyper-reflectivity. The stroma was thinned and showed a patchy and diffused hyper-reflectivity. The pigmentary epithelium appeared unaffected.Conclusions: AS-SS OCT findings, not previously described, locate the damage in BADI in the anterior edge and iridian stroma, areas which are rich in melanocytes and permeable to aqueous humor.

PCR Multiplex for CMV Detection in Patients with Anterior Uveitis.

PURPOSE: Describing the utility of Polymerase Chain Reaction for Cytomegalovirus (CMV-PCR) in the diagnosis of suspected viral anterior uveitis (AU). PATIENTS AND METHODS: We analyzed aqueous humor (AH) CMV-PCR positivity and treatment modifications in 47 eyes of 46 patients with viral uveitis and its correlation with high intraocular pressure (HIOP), uveitis clinical characteristics and time intervals from samples to uveitis diagnosis and to relapse. RESULTS: CMV-PCR positive results occurred in 13 eyes (27.7%) of 12 patients. They were more frequent in HIOP eyes (34.2%, p = 0.047) and with Posner-Schlossman Syndrome (56.2%, p = 0.002). CMV-PCR positivity (p = 0.001) and HIOP (p = 0.038) increased the probability of treatment change. Although CMV-PCR positive results decreased over time (p = 0.002), they were not related to activity or proximity to inflammatory uveitis episode. CONCLUSION: HIOP AU eyes should be considered for CMV-PCR AH analysis due to possible treatment modifications.

Tomografía de coherencia óptica de dominio espectral en la toxicidad retiniana por Celestone® / Spectral domain optical coherence tomography in Celestone® retinal toxicity

CASO CLÍNICO: Tras la administración intravítrea inadvertida de Celestone® (betametasona acetato y fosfato sódico, cloruro de benzalconio) en una paciente, la tomografía de coherencia óptica de dominio espectral (OCT-SD) mostraba hiperreflectividad, adelgazamiento e irregularidad en espículas en las capas internas de la mácula. Estos hallazgos tempranos serían el resultado del efecto tóxico directo del fármaco o sus excipientes. La alteración en la línea de los elipsoides y la aparición de espacios quísticos tabicados fueron hallazgos tardíos. DISCUSIÓN: La OCT-SD puede ayudar a conocer mejor la fisiopatología del daño retiniano y a diagnosticar las complicaciones asociadas, aportando información con valor pronóstico

CASE REPORT: After inadvertent intravitreal injection of Celestone® (betamethasone sodium phosphate and acetate, benzalkonium chloride) in a patient, the macular spectral domain optical coherence tomography (SD-OCT) images showed hyper-reflectivity, thinning, and irregular spikes in the inner retinal layers. These early findings could explain the toxic secondary anatomical changes due to the drug itself and/or to its excipients. Late and permanent SD-OCT findings included changes in the ellipsoid zone and cystic-like spaces. DISCUSSION: In this case, SD-OCT images can help to better understand the pathophysiology of the retinal damage and to diagnose the associated complications, providing information with prognostic value

Spectral domain optical coherence tomography in Celestone® retinal toxicity.

CASE REPORT: After inadvertent intravitreal injection of Celestone® (betamethasone sodium phosphate and acetate, benzalkonium chloride) in a patient, the macular spectral domain optical coherence tomography (SD-OCT) images showed hyper-reflectivity, thinning, and irregular spikes in the inner retinal layers. These early findings could explain the toxic secondary anatomical changes due to the drug itself and/or to its excipients. Late and permanent SD-OCT findings included changes in the ellipsoid zone and cystic-like spaces. DISCUSSION: In this case, SD-OCT images can help to better understand the pathophysiology of the retinal damage and to diagnose the associated complications, providing information with prognostic value.

[Phacoemulsification and acrylic intraocular lens in uveitis: a comparative study]. / Facoemulsificación con implante de lente acrílica en pacientes con uveítis: estudio comparativo.

OBJECTIVE: To describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis METHODS: Descriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy (PC) and the pre- and post-surgical visual acuity (VA), were analysed. RESULTS: In both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors (P = .002, OR 6.83), the surgical difficulties and complications (P = .001, OR 7.54) and postsurgical complications (P = .069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91% respectively of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P = .357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P = .001), neither the location nor the uveitis course influenced the PC rate. CONCLUSIONS: The consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation.

Facoemulsificación con implante de lente acrílica en pacientes con uveítis: estudio comparativo / Phacoemulsification and acrylic intraocular lens in uveitis: a comparative study

Objetivo: Describir los resultados de la facoemulsificación con implante de lente acrílica en cataratas de pacientes adultos con y sin uveítis. Métodos: Estudio comparativo descriptivo retrospectivo de 35 pacientes (45 ojos) con uveítis (grupo 1) y 38 (44 ojos) sin uveítis (grupo 2) intervenidos por el mismo cirujano, homogéneos en cuanto a sexo, técnica quirúrgica, tipo de lente implantada (hidrofóbica o hidrofílica) y seguimiento. Se recogen las características pre-quirúrgicas de riesgo, dificultades y complicaciones intra-quirúrgicas y posquirúrgicas, la fecha de capsulotomía posterior y la agudeza visual previa y posterior a la cirugía. Resultados: En ambos grupos la facoemulsificación coaxial se utilizó en el 75% de los ojos, MICS bimanual en el 20% y microcoaxial en el resto. Los factores de riesgo prequirúrgicos (p=0,002, OR 6,83), las dificultades y complicaciones intraquirúrgicas (p=0,001, OR 7,54) y posquirúrgicas (p=0,069, OR 3,42) fueron más frecuentes en el grupo 1. El 93 y 91% respectivamente de ojos ganaron 2 o más líneas de AV. Tras un seguimiento medio de 4,9 años en ambos grupos, el 22,7 y el 32% (log-rank p=0,357) necesitaron capsulotomía posterior (CP). Las lentes hidrofílicas precisaron, en ambos grupos, capsulotomía más temprana que las hidrofóbicas (log rank P=0,001), ni la localización ni el curso de la uveítis se relacionaron con la necesidad de CP. Conclusiones: Las secuelas características de la inflamación previa hacen que la cirugía de la catarata en pacientes con uveítis sea más dificultosa, pero con complicaciones postquirúrgicas, resultados visuales y necesidad de CP similares al de nuestros pacientes sin inflamación(AU)

Objective: To describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis Methods: Descriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy (PC) and the pre- and post-surgical visual acuity (VA), were analysed. Results: In both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors (P=.002, OR 6.83), the surgical difficulties and complications (P=.001, OR 7.54) and postsurgical complications (P=.069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91% respectively of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P=.357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P=.001), neither the location nor the uveitis course influenced the PC rate. Conclusions: The consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation(AU)

[Complications of uveitis: prevalence and risk factors in a series of 398 cases]. / Complicaciones de las uveítis: prevalencia y factores de riesgo en una serie de 398 casos.

OBJECTIVE: To estimate the rate of complications and establish risk factors for their development in patients with uveitis. METHODS: Prospective study of a cohort of 398 patients (413 eyes) that were reviewed from January 2000 to October 2007 and monitored during a period of at least one month. Demographic data, laterality, course (acute, subacute, chronic), location, diagnosis (idiopathic, infectious, ocular origin, systemic origin, others) and development of complications (cataract, cystoid macular edema, macular complications, retinal complications and others) were evaluated. RESULTS: After a mean follow-up of 35.2 months (range 1-160), 25% of patients developed one or more of the following complications: cataract 8.5%, macular edema 6.1%, macular complications (epiretinal membranes, choroidal neovascular membranes, macular necrosis) 4.1%, retinal complications (retinal detachment, retinal neovascularization, vitreous hemorrhage, retinal tears, retinal vascular occlusions) 4.1%, glaucoma or ocular hypertension 3.6%, and others 1.5%. Risk factors for development of uveitis complications were chronic course OR 6.37 (3.25-12.47) P <0.0001, bilaterality OR 1.98 (1.03-3.08) P =0.039, subacute course OR 1.94 (0.02-4.08) P=0.08, and panuveitis OR 1,92 (0.99-4.80) P=0.161. CONCLUSIONS: In our patients, cases involving chronic and bilateral uveitis were more prone to develop complications, with cataracts being the most frequent complication (Arch Soc Esp Oftalmol 2009; 84: 523-528).

Complicaciones de las uveítis: prevalencia y factores de riesgo en una serie de 398 casos / Complications of uveitis: prevalence and risk factors in a serie of 398 cases

Objetivo: Estimar el porcentaje de complicacionesy establecer factores de riesgo para padecerlas enlos pacientes con uveítis.Método: Estudio prospectivo de cohortes de 398pacientes con seguimiento superior a 1 mes desdeEnero del 2000 hasta Octubre del 2007. Se evaluaronlos datos demográficos, lateralidad, curso (agudo,subagudo crónico), localización, diagnóstico(idiopática, infecciosa, de base ocular, de base sistémica,otras) y el desarrollo de complicaciones(catarata, edema macular quístico, complicacionesmaculares, complicaciones retinianas y otras).Resultados: Tras un seguimiento medio de 35,2meses (1-160), el 25% desarrollaron una o más delas siguientes complicaciones: catarata 8,5%, edemamacular 6,1%, complicaciones maculares(membrana epirretiniana, membrana neovascularcoroidea, necrosis macular) 4,1%, complicacionesretinianas (desprendimiento de retina, neovasosretinianos, hemovítreo, desgarros retinianos, oclusionesvasculares retinianas) 4,1%, glaucoma ohipertensión ocular 3,6% y otras 1,5%. Los factoresde riesgo para desarrollarlas fueron el curso crónicoOR 6,37 (3,25-12,47) P <0,0001, la bilateralidadOR 1,98 (1,03-3,08) P =0,039, el curso agudo recidivanteOR1,94 (0,02-4,08) P=0,08 y la panuveítisOR 1,92 (0,99-4,80) P=0,161.Conclusiones: En nuestros pacientes las uveítiscrónicas y las bilaterales son las que más riesgo tienende sufrir complicaciones de las que la catarataes la más frecuente(AU)

Objective: To estimate the rate of complicationsand establish risk factors for their development inpatients with uveitis.Methods: Prospective study of a cohort of 398patients (413 eyes) that were reviewed fromJanuary 2000 to October 2007 and monitoredduring a period of at least one month. Demographicdata, laterality, course (acute, subacute, chronic),location, diagnosis (idiopathic, infectious, ocularorigin, systemic origin, others) and development ofcomplications (cataract, cystoid macular edema,macular complications, retinal complications andothers) were evaluated.Results: After a mean follow-up of 35.2 months (range1-160), 25% of patients developed one or more ofthe following complications: cataract 8.5%, macularedema 6.1%, macular complications (epiretinal membranes,choroidal neovascular membranes, macularnecrosis) 4.1%, retinal complications (retinal detachment,retinal neovascularization, vitreous hemorrhage,retinal tears, retinal vascular occlusions) 4.1%,glaucoma or ocular hypertension 3.6%, and others1.5%. Risk factors for development of uveitis complicationswere chronic course OR 6.37 (3.25-12.47) P<0.0001, bilaterality OR 1.98 (1.03-3.08) P =0.039,subacute course OR 1.94 (0.02-4.08) P=0.08, andpanuveitis OR 1,92 (0.99-4.80) P=0.161. Conclusions: In our patients, cases involving chronicand bilateral uveitis were more prone to developcomplications, with cataracts being the most frequentcomplication(AU)

[Choroidal osteoma and choroidal neovascularization]. / Osteoma coroideo y neovascularización coroidea.

CLINICAL CASE: A 27-year-old woman with metamorphopsia was diagnosed with choroidal osteoma (CO); concurrently choroidal neovascularization (CNV) was also suspected. Neither fluorescein angiography (FA) nor indocyanine green angiography showed signs of CNV. A course of oral corticosteroids improved the symptoms, but when it was interrupted, both, the ophthalmoscopic and the FA findings showed a well defined CNV. Two years following green argon laser photocoagulation the CNV is still inactive. DISCUSSION: The clinical and angiographic heterogeneity of the CO can delay the diagnosis and treatment of an associated CNV.

Osteoma coroideo y neovascularización coroidea / Choroidal osteoma and choroidal neovascularization

Caso clínico: Mujer de 27 años con metamorfopsias, diagnosticada de osteoma coroideo (OC) y sospecha oftalmoscópica de membrana neovascular (MNV). Ni la angiografía fluoresceínica (AFG) ni el verde indocianina mostraron signos de neovascularización. La corticoterapia oral mejoró la sintomatología, pero, al interrumpirla, tanto la oftalmoscopia como la AFG mostraron una MNV extrafoveal; inactiva dos años después de la fotocoagulación con láser de argón verde.Discusión: La heterogeneidad angiográfica y clínica del OC pueden retrasar el diagnóstico y tratamiento de MNV asociadas (AU)

[Tuberculous peripheral multifocal choroiditis]. / Coroiditis multifocal periférica tuberculosa.

CASE REPORT: A healthy 57 year-old woman with past untreated pulmonary tuberculosis, disclosed a bilateral uveitic syndrome characte rized by iritis, vitreitis, multiple peripheral retinal punched-out lesions, and cystoid macular edema. Systemic evaluation was unremarkable except for a 30 mm tuberculin skin test. Relapses occurred after oral and periocular corticosteroids were interrupted, but the inflammation completely disappeared after a 6 month course of isoniazid, rifampicin and pyrazinamide. DISCUSSION: Intraocular tuberculosis should be considered as a treatable cause of peripheral multifocal choroiditis, after ruling out other etiologies.

Coroiditis multifocal periférica tuberculosa / Tuberculous peripheral multifocal choroiditis

Caso clínico: Mujer sana de 57 años, con antecedentes de tuberculosis pulmonar Mantoux de 30 mm, y clínica inflamatoria ocular bilateral caracterizada por : iridociclitis sinequiante, vitritis, lesiones retinianas redondeades blanquecinas periféricas adyacentes a cicatrices pigmentadas en sacabocados y edema macular quístico. Ante la escasa respuesta al tratamiento corticoideo local y sistémico, con recidivas tras su interrumpción, se instauró tratamiento durente 6 meses con isoniacida, rifampicina y pirimetamida, desapariciendo completamente el cuadro inflamatorio. Discusión: Una vez descartadas otras etiologías, la tuberculosis debe ser considerada como una causa tratable de coroiditis multifocal periférica (AU)

Retinopatía externa anular aguda: presentación de un caso / Acute annular outer retinopathy: report of a case

Caso clínico: Presentamos un caso de AAOR (Acute annular outer retinopathy), en una mujer de 24 años de edad. Discusión: Comprobamos el distinto comportamiento angiográfico del anillo blanquecino retiniano y de los puntos blancos del MEWDS. La ICG realizada a los 17 meses era normal a pesar del defecto funcional permanente, lo que apoyaría una lesión primaria de la retina externa en este caso (AU)

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Tratamiento de las endoftalmitis crónicas tras la cirugía de cataratas / Treatment of chronic postoperative pseudophaquic endophthalmitis

Objetivo: Describir nuestra experiencia en el tratamiento de las endoftalmitis crónicas tras la cirugía de cataratas. Métodos: Estudio descriptivo y retrospectivo de 6 casos consecutivos, 4 extracciones extracapsulares (EECC) con implante de lentes intraoculares (LIO) en cámara posterior, una facoemulsificación con LIO en cámara posterior y una EECC sin LIO. El abordaje terapéutico incluyó la asociación de alguna de las siguientes técnicas: la administración intravítrea, en la cámara anterior o en el saco capsular de vancomicina (1 mg en 0,1 ml); la vitrectomía por pars plana con capsulectomía total o capsulotomía en la zona de la placa blanquecina y el explante del saco capsular con la LIO por vía lumbar. El seguimiento mínimo fue de 8 meses. Resultados: En 2 casos se realizó inicialmente tratamiento con vancomicina intravítrea, asociándose en un tercer paciente una irrigación del saco capsular. Al no controlarse la inflamación a los 2 primeros pacientes, se les realizó vitrectomía más capsulotomía posterior en la zona de la placa blanquecina. Hubo un cuarto paciente en que realizamos esta última técnica quirúrgica de entrada. La extracción del saco capsular junto con el explante de la LIO más capsulectomía se realizó en 2 pacientes como terapéutica inicial y en otro tras el fracaso de la vitrectomía. El control del proceso inflamatorio se obtuvo en todos los pacientes, aunque en algunos tardo en establecerse precisando durante este período tratamiento esteroideo. Conclusiones: Las indicaciones para el tratamiento de las endoftalmitis crónicas postquirúrgicas no están claramente establecidas. En nuestra experiencia, los mejores resultados se obtienen con las técnicas que son capaces de eliminar totalmente la placa blanquecina o el saco capsular y la LIO (AU)

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[Acute annular outer retinopathy: report of a case]. / Retinopatía externa anular aguda: presentación de un caso.

CASE REPORT: We report a case of AAOR in a 24-year-old female. DISCUSSION: We confirm the different FA behaviour of the whitish ring in AAOR and the white dots in MEWDS. ICG performed in the healing phase was normal in spite of the permanent functional loss. This result suggest a primary outer retinal damage in this case.

[Retinitis caused by cytomegalovirus in patients with AIDS. Clinico-therapeutic aspects and relationship with HIV retinal microangiopathy in a series of 38 patients]. / Retinitis por citomegalovirus en pacientes con SIDA. Aspectos clínico-terapéuticos y relación con la microangiopatía retiniana VIH en una serie de 38 pacientes.

We evaluate retrospectively 38 patients with AIDS and Cytomegalovirus (CMV) retinitis. In 72.5% (45 from 62 eyes) it carried an important sight risk; 50% of the end of the follow-up. Evidence of extraocular illness in 28.5% of the patients. Using control groups the AIDS microvasculopathy is neither more frequent in CMV-retinitis nor associated with a special risk group (p greater than 0.05), we review treatment, follow-up and complications. The median survival was 6 months without significan differences (p greater than 0.05) with or without the finding of microvasculopathy, bilaterality or extraocular illness.