Optimising drug therapy for non-infectious uveitis.

INTRODUCTION: Uveitis encompasses a wide variety of sight-threatening diseases characterized by intraocular inflammation. It is often classified as infectious and non-infectious uveitis. Unlike infectious uveitis, a distinct infectious agent cannot be identified in non-infectious uveitis and disease origin is usually autoimmune, drug related, or idiopathic. THE ISSUE AT HAND: Non-infectious uveitis can often have a relapsing-remitting course, making it difficult to treat, and poses a significant challenge to ophthalmologists. The autoimmune nature of non-infectious uveitis warrants the use of anti-inflammatory and immunomodulatory agents for disease control. However, a subset of patients has persistent or recurrent ocular inflammation despite appropriate treatment, stressing the need for newer therapies aimed at more specific inflammatory targets such as tumour necrosis factor (TNF) alpha agents, anti-interleukin agents, and anti-interleukin receptor agents. OBJECTIVES: This article discusses the various medical options available for the treatment of non-infectious uveitis in the light of the most recent evidence. CONCLUSION: Successful management of non-infectious uveitis requires the clinician carefully balance advantages and disadvantages of each new and old therapy while considering individual circumstances. Counselling regarding the benefits and complications of each therapy can help patients make an informed choice.

Management of Rapunzel Syndrome in a Four-month Pregnant Female with Twins: The First Reported Case?

A bezoar is a collection of packed indigestible matter that accumulates in the gastrointestinal tract after ingestion by the patient. It may be made of hair (trichobezoar), vegetable or fruit (phytobezoar), or other indigestible materials. Trichobezoars are thought to form due to hair's natural enduring nature, as they get matted and stick together in the gut. We present the case of a young female who was 16-weeks pregnant with twins presenting to the general surgery clinic with abdominal pain, vomiting and a palpable abdominal mass, which eventually turned out to be a massive trichobezoar manifesting as Rapunzel syndrome. Rapunzel syndrome is a large trichobezoar extending from the stomach into the small intestine. This is perhaps the first reported case of Rapunzel syndrome in a patient pregnant with twins.