Prospective microperimetry and OCT evaluation of efficacy of repeated intravitreal bevacizumab injections for persistent clinically significant diabetic macular edema.

To prospectively investigate morphologic and functional changes after intravitreal bevacizumab for persistent diffuse and clinically significant diabetic macular edema. In total, 26 eyes in 26 patients were treated with three intravitreal injections of bevacizumab (Avastin™) given at 4-week intervals. Study parameters included: visual acuity (VA), perceived visual improvement, central macular thickness as measured by Spectralis OCT, macular sensitivity and fixation pattern as measured by MP-1 microperimetry, and the incidence of ocular and systemic side-effects. At the time of follow-up, 76.9 % of eyes showed a significant improvement in VA (p = 0.012), 38.4 % showed a one-line improvement on the ETDRS chart compared with VA at day 0, 30.7 % showed a two-line improvement, and 7.6 % showed at least a three-line improvement. The mean central macular thickness was 447 microns at day 0 and 311.1 microns at follow-up (p = 0.003). The mean baseline macular sensitivity, by MP-1 microperimetry, was 8.29 dB; at follow -up, macular sensitivity had improved to 14.26 dB (p = 0.025). These results support further controlled trials on the efficacy of intravitreal bevacizumab in treating diabetic macular edema. Microperimetry and OCT are important tools in managing diabetic patients, providing a detailed study of the macular region, particularly when it is necessary to monitor the morphological and functional outcome after various interventions. A good correlation between retinal sensitivity and perceived visual performance was found.

Uveitis with retinal occlusive vasculitis and sensorineural hypoacusia as first symptoms of relapsing polychondritis.

We herein describe an atypical case of relapsing polychondritis, presenting initially with isolated ocular signs characterised by uveitis and retinal occlusive vasculitis preceded by 10 years of auricular and laringothracheal chondritis. This case highlights the importance of considering connective tissue inflammatory conditions in any retinal vasculitis. A systemic enquiry is invaluable in order to avoid a delayed diagnosis and the subsequent associated complications and mortality.

Spectral-domain optical coherence tomography in uveitic macular edema: morphological features and prognostic factors.

AIM: To assess the morphological characteristics of uveitic macular edema studied with Spectralis optical coherence tomography (OCT) and to investigate the correlation between the tomographic features and visual acuity. METHODS: 71 eyes of 55 patients underwent examination with Spectralis OCT (Heidelberg Engineering, Germany). Data was correlated with logMAR best-corrected visual acuity (BCVA). RESULTS: Two morphological patterns were observed: cystoid macular edema (CME) in 69% and diffuse macular edema in 31% of eyes. BCVA was 0.2 in CME, 0.1 in diffuse edema (p = 0.008). Foveal thickness was 413.4 ± 212 µm in CME, 311.27 ± 53 µm in diffuse edema (p = 0.03). BVCA was 0.3 in eyes with serous retinal detachment (SRD), 0.2 in eyes without SRD (p = 0.02). BCVA was 0.4 in eyes with inner segment/outer segment (IS/OS) disruption, 0.1 in eyes with integrity of the IS/OS junction (p = 0.01). CONCLUSIONS: BCVA is negatively correlated with cystoid pattern, foveal thickening and SRD. Disruption of the IS/OS junction is associated with poor vision in uveitic macular edema.

Uveitis preceding Crohn's disease by 8 years.

We report the clinical history of a child affected by Crohn's disease in which uveitis precedes intestinal involvement by years and occurs with the atypical features of anterior chronic inflammation complicated by unilateral optic disc edema, rather than recurrent anterior uveitis with sudden onset which has been more widely reported in inflammatory bowel diseases. The uveitis onset occurred 8 years before symptoms of the primary intestinal disease, while in inflammatory bowel diseases the intestinal inflammation typically precedes ocular symptoms, and ocular inflammation only occasionally precedes inflammatory involvement of the bowel.

Uveitis and internuclear ophthalmoplegia as ocular manifestations of sarcoidosis.

Sarcoidosis is a multisystemic granulomatous chronic disease of unknown etiology with a wide range of clinical presentations. Diagnosis of sarcoidosis in patients with ocular manifestations can be challenging. We first describe a case of sarcoidosis presented with pulmonary involvement and both uveitis and internuclear ophthalmoplegia as ocular manifestations. A 55-year-old caucasian woman with non-productive cough and weakness presented with bilateral granulomatous anterior uveitis. Few days later, the patient presented again complaining of horizontal diplopia due to internuclear ophthalmoplegia. The diagnosis of sarcoidosis was made as a result of clinical examination and systemic investigations. Particularly, high-resolution computed tomography scanning of the chest was able to identify bilateral hilar lymphadenopathy not previously detected by chest X-ray. Biopsy confirmed diagnosis showing classic non-caseating granulomas.

Fuchs' Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis.

Purpose. To study epidemiology, clinical findings and visual prognosis of patients with Fuchs' Heterochromic Iridocyclitis (FHI). Methods. A retrospective analysis was performed on 158 patients with FHI. Thirty-five patients were observed only once; the remaining 123 had a mean follow-up of 30.7 months (50 of them had a mean follow-up of 63.5 months) and in those we assessed complications, medical and surgical treatment, and long-term visual prognosis. Results. Average age at uveitis diagnosis was 27.2 years and 18.3% of patients were children. Blurred vision (54.5%) and floaters (40.5%) were the most frequent presenting symptoms. Small to medium-sized keratic precipitates (95.6%), iris atrophy (86.8%), and vitreous opacities (91.2%) were the most common signs; the prevalence of cataract and IOP increase was 63.5% and 20.1%, respectively, and their incidence was 0.1 and 0.06 eye/year. Significant risk factor for visual loss was IOP increase at presentation (p = 0.02). At final examination 98% of the eye had a visual acuity ≥ 0.6, and topical (p < 0.001) and systemic (p < 0.001) corticosteroids therapy were used less frequently than before referral. Conclusions. FHI has a good visual prognosis, despite the significant incidence of cataract and glaucoma. A correct and prompt diagnosis might avoid unnecessary therapies and provide excellent visual outcomes.

Severe macular edema in patients with juvenile idiopathic arthritis-related uveitis.

Purpose. To report the onset of severe macular edema in adolescent female patients affected by juvenile idiopathic arthritis (JIA). Methods. Four female patients affected by JIA-related chronic anterior uveitis (CAU), complicated by severe macular edema, were retrospectively analyzed. Macular area was evaluated by fluorescein angiography and optical coherence tomography (OCT). Results. CAU was bilateral in three patients. Mean age of uveitis and arthritis onset was, respectively, 4.5 ± 1.7 years and 6.0 ± 3.9 years. All patients underwent cataract extraction surgery. Despite ocular inflammation being controlled by topical/systemic therapy, during adolescence (mean age of appearance/diagnosis: 12.7 ± 3.9 years) patients developed severe unilateral macular edema. OCT revealed massive macular thickening (range from 550 µ m to 1214 µ m). Conclusions. Macular edema appeared in female adolescent patients in eyes with long-dating CAU submitted to cataract surgery. In such patients, in presence of age-related microvascular changes due to the enhancer effect of sex hormones, cataract extraction should be a factor triggering the retinal complication.

Central serous chorioretinopathy as a presenting symptom of endogenous Cushing syndrome: a case report.

PURPOSE: To report a case of Cushing syndrome due to adrenocortical adenoma revealed by central serous chorioretinopathy. MATERIALS AND METHODS: A 45-year-old man presented with blurred vision and metamorphopsia in the left eye. He reported few episodes of high blood pressure in the last 3 months. RESULTS: Visual acuity was 20/40 in the left eye. Fundus oculi examination revealed central serous chorioretinopathy in the left eye. Grade 1 hypertension was found. Increased serum and urinary levels of cortisol and reduced serum levels of ACTH were observed. Diagnosis of Cushing syndrome was made. Computed tomography scan revealed a right adrenal mass that was surgically removed; histologic examination showed an adrenocortical adenoma. Three months after surgical treatment, visual acuity improved to 20/20 and central serous chorioretinopathy completely resolved. CONCLUSIONS: Central serous chorioretinopathy may be the presenting symptom of Cushing syndrome in a patient with adrenocortical adenoma.

Intermediate uveitis in a pediatric Italian population.

PURPOSE: To investigate clinical data, outcome, and treatment of intermediate uveitis in children. METHODS: Retrospective cohort study, including 116 children affected by intermediate uveitis. RESULTS: Sixty-two percent of patients were males. Ocular involvement was bilateral in 84%. Mean age at uveitis onset was 10.3 ± 3.6 years and 12.2 ± 7 years at first visit. Ninety-seven percent were classified as having idiopathic uveitis. The incidence of ocular complications during follow-up was 0.131/eye-year. Macular edema or a marked vitreous haze at presentation may be risks factors for incident visual loss. The most frequent causes of visual loss were macular edema (64%) and cataract (21%). CONCLUSIONS: Most cases are idiopathic (pars planitis); only few children presented associated systemic disease. Macular edema and severe vitritis at presentation are associated with increased risk of visual impairment. Cystoid macular edema is the main cause of visual impairment.

Retinal complications of juvenile idiopathic arthritis-related uveitis: a microperimetry and optical coherence tomography study.

PURPOSE: To evaluate ocular complications of juvenile idiopathic arthritis (JIA)-related uveitis; to study macular morphology and sensitivity. METHODS: Retrospective chart review of 67 patients. Fourteen consecutive patients (24 eyes) observed from January to December 2008 were submitted to optical coherence tomography study (OCT) and microperimetry MP-1 examination. RESULTS: Most frequent complications were posterior synechiae (63.0%), band keratopathy (53.9%), and cataract (31.8%). Posterior complications were documented in 37.0% of eyes: 13.8% macular edema, 12.0% papillitis, 6.8% epiretinal membranes, 2.5% retinal vasculitis, 1.7% retinal detachment. At OCT examination 25.0% of eyes presented macular edema; macular sensitivity by MP-1 was < or = 16.5 dB in 25.0% of eyes. CONCLUSIONS: Visual prognosis is good despite ocular complications. Incidence of macular edema seems to be higher when using OCT. Microperimetry may represent a useful tool in detecting alteration in retinal sensitivity that may supplement visual acuity in the follow-up of macular edema.

Uveitis in childhood: an Italian clinical and epidemiological study.

PURPOSE: To investigate demographics, causes, features, and visual outcomes of pediatric uveitis. METHODS: Retrospective cohort study including 257 patients younger than 16 years. RESULTS: Mean age at onset of uveitis was 8.54 +/- 3.98 years; 54.5% of the patients were girls. Anterior uveitis occurred in 47.8%, intermediate in 19.4%, posterior in 24.9%, panuveitis in 7.8%. Ocular involvement was bilateral in 67.8%. Infectious uveitis represented 31% of all cases. Causes of severe visual loss were cataract, macular scars, macular edema/maculopathy, and secondary glaucoma. At follow-up 79.3% of eyes maintained a visual acuity between 20/32 and 20/20. CONCLUSIONS: Uveitis is rarer in children than in adults. Patients with anterior uveitis comprised the largest group. Posterior uveitis in the pediatric population has a lower incidence than some decades ago. Visual prognosis of pediatric uveitis is improving, owing to an earlier diagnosis and a correct treatment.