Purpose To assess the effectiveness of anti-tuberculous treatment in patients with chronic uveitis and either active systemic or latent tuberculosis (TB) in a non-endemic community. Methods Retrospective study of patients with chronic uveitis, non-ocular evidence of latent or active TB and no other identified cause of uveitis who underwent a 6-month course of standard anti-tuberculous chemotherapy. Response to treatment was assessed at 6 and 12 months after initiation of treatment. Results A total of 27 patients were included of whom 59% were female. In all, 19 were Asian, 4 Caucasian, and 4 Black. More than half of patients had a history of contact with another person treated for TB. Inflammation resolved after chemotherapy in 70.3% of patients, 18.5% had a change in the nature of their inflammation and 11.1% had no benefit. Conclusions There were no uveitis features characteristic of TB uveitis and a wide range of manifestations was seen ranging from non-granulomatous anterior uveitis to occlusive retinal vasculitis. TB is not endemic in the United Kingdom, therefore consideration of ethnicity, immigration, and history of TB contact remain important to direct investigations. In a patient with uveitis and latent TB, a full 6-month course of antituberculous chemotherapy is recommended although it may not be curative of the uveitis.

Background:The Pascal is a semiautomated photocoagulator that delivers a pattern array of multiple burns in a rapid predetermined sequence with a single foot pedal depression. Each burn is reduced to 10 or 20 ms to achieve this. The authors report their early experience with this system.Methods:75 procedures done in 60 patients divided into four groups—group A, patients undergoing panretinal photocoagulation (PRP); group B, patients undergoing focal or modified grid macular laser; group C, patients undergoing macular grid and group D, patients undergoing retinopexy—were retrospectively studied.Results:31/34 procedures in group A, 24/26 procedures in group B, 5/7 procedures in group C and all eight patients in group D had successful outcomes. Significantly higher powers were required with the Pascal than with conventional laser (p<0.001) in eyes that underwent PRP and focal/modified grid macular treatment with both systems. Single session PRP was successfully performed in five patients, and five were successfully treated with a macular grid using pattern arrays only. No adverse events were noted.Conclusion:Although the shorter pulse duration of the Pascal necessitates the use of a higher power, it is not associated with adverse effects. The results here suggest that the Pascal photocoagulator is safe and effective, and offer several potential advantages related to the brief exposure time.

ABSTRACT.Purpose: To establish safe laser parameter standards for 10-30 ms Pascal Ò laser in clinical practice and to evaluate clinical and visual outcomes using this 532-nm multi-spot photocoagulation system. Methods: Retrospective observational case series of 313 patients treated between 2006 and 2008. Evaluation of eight groups: A -panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR); B -focal laser treatment for clinically significant diabetic macular oedema; C -grid laser for diffuse diabetic macular oedema; D -sector PRP for ischaemic branch retinal vein occlusions (I-BRVO); E -full PRP for ischaemic central retinal vein occlusions (I-CRVO); F -macular laser treatment for macular oedema secondary to non-ischaemic BRVO; G -full PRP for rubeosis iridis and ⁄ or neovascular glaucoma (NVG) secondary to I-BRVO, I -CRVO or PDR; H -laser retinopexy for retinal breaks ⁄ degenerations. Results: Mean LogMAR visual acuity for all procedures improved postlaser (p = 0.065), and laser prevented visual loss in 85% eyes. Topical anaesthesia was only required. At mean follow-up of 5 months, 72% procedures had a successful clinical outcome. Significantly higher powers were required for PRP using Pascal Ò compared to conventional laser (p = 0.001) in PDR, I-BRVO, I-CRVO and NVG. Sixty-seven per cent of patients (15 ⁄ 20) were successfully treated with single-session 20-ms PRP using a mean 1952 burns. There were no laser-associated adverse effects or ocular complications associated with multi-spot PRP or macular Pascal Ò arrays. Conclusions: The clinical efficacy using 10-to 30-ms pulse duration Pascal Ò laser is comparable to conventional standard protocols used for the treatment of vascular retinal disorders. Higher power, 10-to 30-ms pulse duration laser may be safely and effectively used in clinical practice.

We report a case of bilateral persistent hyperplastic primary vitreous (PHPV) in a 5-month-old infant who presented with bilateral leukokoria. The child was referred for ocular ultrasound with a clinical suspicion of retinoblastoma. Grey-scale evaluation revealed an echogenic band in the posterior segment of the left globe extending from the posterior surface of the lens capsule to the optic disc. Doppler examination revealed the presence of blood flow in the band. Ultrasound assessment of the contralateral globe showed an elevated mass of echogenic tissue in the posterior segment, in contact with the optic disc. Most cases of PHPV are sporadic and unilateral. Bilateral PHPV is rare. In a study by Pollard of 83 cases, only two patients (2.4%) had bilateral PHPV. The imaging features in this case point toward the diagnosis of bilateral PHPV. We suggest that this entity, although rare, should be considered in the differential diagnosis while evaluating bilateral leukokoria.

patients with scleritis develop bilateral disease, 50% of whom have delayed onset in the fellow eye, mostly of the same type of scleritis. 8 A high index of suspicion may uncover this sight-threatening but treatable condition. Occasionally a patient with medical training will experience the symptoms of a disorder that may provide a unique opportunity to determine the exact nature of the symptom. This has occurred in the past with lightning flashes from posterior vitreous detachment (PVD) because Moore published the findings of his own photopsia in 1947. 1 We describe an ophthalmologist colleague who suffered bilateral PVD with specific symptoms of black flashes for a brief period before the onset of the typical lightning flashes. One of the authors (LW) a 51-year-old female ophthalmologist with À5.5 D right eye and À6.0 D left developed acute PVD in the left eye. The first symptoms she noticed were black coloured flashes in the inferotemporal periphery. These were momentary, vertically orientated and occurred in a flickering pattern before subsiding and then returning again. After 6 h, they were replaced by white flashes and floaters. She was examined by THW and found to have a PVD with Weis ring. Seven years later, she developed in the right eye a similar pattern of black flashes for 2 h before they were replaced by white flashes and floaters from PVD (confirmed by THW). We suspect that many patients forget or disregard this initial symptom because these flashes are soon replaced by white lightning flashes. Since the presentation by LW, we have on specific questioning found black flashes to be present in other individuals with PVD. The symptom may be due to traction on the axons of the surface of the optic nerve by the vitreous as the PVD process creates the Weis ring thus interrupting the signal from the retina. The fact that the PVD has not yet occurred is suggested by the appearance of floaters and white lightning flashes only after the black flashes have disappeared. Evidence that the PVD process can be traumatic to the optic nerve head can be seen in some patients who develop haemorrhages on the surface of the optic nerve head after PVD. 2,3 This is the first description of black photopsia in PVD that we are aware of. References

Purpose To establish whether there is a variation in the incidence of onset of acute anterior uveitis (AAU) in women during the phases of the menstrual cycle. Methods Prospective open study in women attending the Acute Referral Centre with a first or recurrent attack of AAU. Results There was a significant increase in the incidence of AAU during the late stages of the menstrual cycle. Conclusions The onset of AAU is partially dependent on the levels of either oestrogen or progesterone, or both. The withdrawal of the proven anti-inflammatory effects of these hormones may provoke the onset of uveitis.

HLA B27-associated uveitis may be unusually severe and may cause a panuveitis, mimicking infective endophthalmitis. The course may be prolonged and difficult with frequent complications including cataract.

Purpose To investigate the observed high prevalence of spontaneous sub-conjunctival haemorrhage (SCH) in patients using long-term topical steroid treatment. Patients and methods A cross sectional survey of the occurrence of SCH was carried out in 248 patients using steroid eye drops and in a comparison group of 113 patients using topical glaucoma medication. Results Twenty-four patients with uveitis (10% of total) experienced single or recurrent SCH. Of these 71% used prednisolone acetate 1% (compared with 75% for those unaffected). None of 113 glaucoma patients were affected. Conclusions The long-term use of topical steroid for chronic uveitis substantially increases the prevalence of spontaneous or minimal-trauma SCH. Steroid-induced vascular fragility is the likely cause.