RECURRENT ACUTE RETINAL PIGMENT EPITHELIITIS: SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES.

PURPOSE: To describe an atypical case of acute retinal pigment epitheliitis including spectral domain optical coherence tomography (OCT) and OCT angiography features. METHODS: We report a 41-year-old woman with 3 episodes of acute retinal pigment epitheliitis over a 3-year period. Spectral domain OCT and OCT angiography images were acquired with Cirrus 5,000 spectral domain OCT. RESULTS: Although acute retinal pigment epitheliitis is described as a benign, self-limited pathology, as this case shows, recurrences are possible. OCT angiography shows a choriocapillaris alteration and further recovery during the acute episodes. CONCLUSION: Acute retinal pigment epitheliitis can present as a recurrent disease.

Uso de fármacos inmunomoduladores en una consulta de uveítis / Use of immunomodulatory drugs at a uveitis clinic

OBJETIVO: En el tratamiento de las uveítis no infecciosas se emplean corticoides y fármacos inmunomoduladores. Su uso ha aumentado en los últimos años y se ha enriquecido con la aparición de nuevos tratamientos. Sin embargo, no existen guías ni protocolos claros de actuación. El objetivo es analizar la respuesta a los fármacos empleados y las características de los pacientes atendidos en una consulta multidisciplinaria de uveítis. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo de los pacientes atendidos desde enero de 2012 hasta diciembre de 2015. Se excluyen las uveítis infecciosas, posquirúrgicas, postraumáticas y los síndromes de enmascaramiento. RESULTADOS: Se incluyeron 216 pacientes. El 58,80% son uveítis sin afectación sistémica, la mayoría idiopáticas, y el 35,65% uveítis con afectación sistémica, asociadas principalmente a espondiloartritis. Las uveítis sin afectación sistémica y las uveítis anteriores se controlaron mejor que el resto con tratamiento local (p = 0,002 y p < 0,001, respectivamente). El 49,76% de los pacientes requirió tratamiento sistémico. De los pacientes tratados con inmunomoduladores, el 53,26% precisó un segundo fármaco y el 31,52%, un tercero. Las mujeres necesitaron inmunomoduladores con más frecuencia que los varones (p = 0,042). El inmunomodulador más empleado fue metotrexato. Las uveítis posteriores respondieron al segundo inmunomodulador peor que las anteriores (p = 0,006). CONCLUSIONES: Casi la mitad de los pacientes necesitaron un fármaco inmunomodulador y algunos precisaron varios cambios sucesivos de fármaco. Las uveítis intermedias resultaron las más refractarias al tratamiento

OBJECTIVE: The treatment of noninfectious uveitis includes steroids and immunomodulatory drugs, the use of which has increased in the last few years, and the options have been enriched with the development of new treatments. However, clear therapeutic guidelines and protocols have not been developed. The purpose is to analyze the response to the drugs used and the characteristics of the patients treated at a multidisciplinary uveitis clinic. MATERIAL AND METHODS: Observational and retrospective study of the patients attended to from January 2012 to December 2015. Infectious, posttraumatic and postoperative uveitis, as well as masquerade syndrome, were excluded. RESULTS: Two hundred six patients were included. Overall, 58.80% had uveitis without association of systemic disease, mostly idiopathic uveitis, and 35.65% had uveitis with systemic involvement, mainly related to spondyloarthritis. Uveitis without systemic association and anterior uveitis achieved disease control with local treatment more frequently than others (p=.002 and p <.001, respectively). In all, 49.76% of the patients required systemic treatment. Among those treated with immunomodulators, 53.26% needed a second drug and 31.52% needed a third drug. Women required immunomodulators more often than men (P=.042). Methotrexate was the most widely used immunomodulator. Posterior uveitis responded less favorably to the second immunomodulator than anterior uveitis (p=.006). CONCLUSIONS: Almost half of the patients needed an immunomodulatory drug and some of them required successive drug changes. Intermediate uveitis was the most treatment-refractory uveitis

Use of Immunomodulatory Drugs at a Uveitis Clinic. / Uso de fármacos inmunomoduladores en una consulta de uveítis.

OBJECTIVE: The treatment of noninfectious uveitis includes steroids and immunomodulatory drugs, the use of which has increased in the last few years, and the options have been enriched with the development of new treatments. However, clear therapeutic guidelines and protocols have not been developed. The purpose is to analyze the response to the drugs used and the characteristics of the patients treated at a multidisciplinary uveitis clinic. MATERIAL AND METHODS: Observational and retrospective study of the patients attended to from January 2012 to December 2015. Infectious, posttraumatic and postoperative uveitis, as well as masquerade syndrome, were excluded. RESULTS: Two hundred six patients were included. Overall, 58.80% had uveitis without association of systemic disease, mostly idiopathic uveitis, and 35.65% had uveitis with systemic involvement, mainly related to spondyloarthritis. Uveitis without systemic association and anterior uveitis achieved disease control with local treatment more frequently than others (p=.002 and p <.001, respectively). In all, 49.76% of the patients required systemic treatment. Among those treated with immunomodulators, 53.26% needed a second drug and 31.52% needed a third drug. Women required immunomodulators more often than men (P=.042). Methotrexate was the most widely used immunomodulator. Posterior uveitis responded less favorably to the second immunomodulator than anterior uveitis (p=.006). CONCLUSIONS: Almost half of the patients needed an immunomodulatory drug and some of them required successive drug changes. Intermediate uveitis was the most treatment-refractory uveitis.

Enthesis inflammation in recurrent acute anterior uveitis without spondylarthritis.

OBJECTIVE: To investigate whether patients with idiopathic recurrent acute anterior uveitis (AAU) have enthesis alterations comparable with those in patients with spondylarthritis (SpA). METHODS: A blinded, controlled study of enthesis evident on ultrasound (US) examination was performed in 100 patients and controls classified into 5 groups, as follows: patients with confirmed SpA (group 1), patients with recurrent AAU who were positive for HLA-B27 and did not have SpA (group 2), patients with recurrent AAU who were negative for HLA-B27 and did not have SpA (group 3), patients with forms of uveitis other than those related to SpA (group 4), and healthy controls (group 5). In total, 12 enthesis locations were explored in each patient and control subject by 2 ultrasonographers who were blinded with regard to the diagnosis. A newly developed US method, the Madrid Sonography Enthesitis Index (MASEI), in which the diagnosis of SpA is determined as a cutoff score of 18 points, was used. RESULTS: A total of 1,200 entheses were explored by US in 100 patients and controls. The MASEI cutoff limit was met or exceeded by 81%, 55.6%, 40%, 10%, and 19% of the subjects in the 5 groups, respectively. The MASEI score was significantly higher in groups 1 and 2 than in groups 4 and 5. The differences between groups 1 and 3 were also found to be significant. CONCLUSION: Our findings indicate that a high percentage of HLA-B27-positive patients with idiopathic recurrent AAU without features of SpA have enthesis lesions comparable with those seen in patients with SpA. These data suggest that patients with recurrent AAU, especially those who are HLA-B27 positive, have an abortive or incomplete form of SpA.

Sulfasalazine reduces the number of flares of acute anterior uveitis over a one-year period.

OBJECTIVE: To evaluate the efficacy of sulfasalazine (SSZ) in the prevention of recurrent flares of acute anterior uveitis (AAU). METHODS: We included patients seen from June 1997 to October 2000 in this prospective, open, longitudinal study who fulfilled the following inclusion criteria: either (1) > or = 3 flares of AAU in the previous year or (2) > or = 2 recurrences of uveitis within 3 months before starting the trial. We excluded uveitis of infectious or malignant origin or patients with contraindications to the drug. The response criteria were defined as absence of symptoms and the presence of a normal ophthalmologic examination. The major outcome was the number of flares of uveitis over a one-year period compared in the same group of patients with the flares along the previous year without SSZ. RESULTS: Three hundred ninety-four patients with uveitis were evaluated during the period of the study and 10 patients fulfilled the inclusion criteria. The mean number of flares in the pre-SSZ year was 3.4 (SD 0.5), which was significantly reduced to 0.9 (SD 1.1) in the year of treatment (p = 0.007). CONCLUSION: SSZ treatment seems to reduce the number of flares over a one year period in patients with recurrent AAU.