Interferon therapy appears to be an efficient strategy in severe and relapsing forms of Behçet's disease but also in other uveitic entities. However, it seems to act more to suspend rather than cure the disease. Therefore, IFN-alpha2a may be proposed as a secondline strategy after failure of conventional immunosuppressants.
The combination of the Schirmer I and PRT tests strongly improves the screening procedure to detect patients with ocular dryness related to Sjögren's syndrome or SAPS. It could be more widely used in daily clinical practice, aside from the Schirmer I test, to optimize the work-up of patients presenting with dry-eye subjective signs.
BackgroundCorneal hypoesthesia is the landmark of HSV and VZV keratitis and can lead to neurotrophic keratitis. Diffusion tensor imaging (DTI) is a new magnetic resonance imaging (MRI) derived technique, which offers possibilities to study axonal architecture. We aimed at assessing the potential impact of recurrent HSV or VZV-related keratitis on the axonal architecture of trigeminal nerves using DTI.DesignProspective non-interventional study.ParticipantsTwelve patients and 24 controls.MethodsDTI using MRI of the trigeminal fibers and corneal esthesiometry using the Cochet-Bonnet esthesiometer were acquired for patients affected by unilateral and recurrent HSV or VZV-related keratitis (3 months after the last corneal inflammatory event), and control subjects with no history of ocular or neuronal disease affecting the trigeminal pathways.Main Outcome MeasuresFractional anisotropy (FA) and apparent diffusion coefficient (ADC) were compared between the 2 eyes of both patients and controls, and correlated with corneal esthesiometry.ResultsFA was lower in the trigeminal fibers ipsilateral to the affected eye compared to the non-affected side (0.39±0.02 versus 0.46±0.04, P=0.03). This difference was more important than the intra-individual variability observed in controls. Concomitantly, the asymmetry in ADC results was significantly correlated with the loss of corneal sensitivity in the affected eye.ConclusionsCorneal hypoesthesia related to HSV and VZV keratitis is associated with persistent modifications in the architecture and functionality of the trigeminal fibers. These results add further explanation to the pathogenesis of HSV and VZV-induced neurotrophic keratitis, which may occur despite an apparent quiescence of the disease.
Purpose To determine the prevalence of intraocular hypertension (IOH) in 103 patients referred for uveitis in a tertiary care centre.
Methods 103 consecutive patients referred to our department for uveitis were included. Files were retrospectively analyzed for age at time of presentation, gender, type of uveitis (as definedy by International Uveitis Study Group) and etiology, time of IOH (primary or secondary to treatment) and filtering surgical procedure associated. IOP was measured using Goldmann aplanation tonometry and IOH was defined as intraocular pressure ≥ 21mmHg.
Results Among all patients, 36% of uveitis were related to a concomitant infectious disease (herpetic disease in 20% of cases and herpes‐zoster in 4%). No significant difference on age, gender was found between all 103 cases of uveitis. At least on episode of IOH was found during the acute phase of the disease in 27 patients (26.2%): anterior uveitis represented 74% of patients. Most of hypertensive cases were associated to herpetic disease (37%), than undetermined etiology in 6 patients (22%), toxoplasmosis uveitis in 2 patients (7,4%). Topical steroids and IOH were associated in 2 patients (7,4%). The IOH was controlled by topical hypotensive treatment in 74,1% of patients, and a filtering surgical procedure was found necessary in 7 patients (25,9%).
Conclusion This retrospective study confirms that IOH is a major complication of uveitis, especially in those involving the anterior chamber of the eye and/or related to viruses. Most of cases responded rapidly to combined topical steroids / antiglaucomatous therapy.
Introduction: Vitrectomy may improve visual acuity of hereditary transthyretin amyloidosis (ATTRv) patients presenting with vitreous opacities but is associated with severe complications. The objective of this study is to report visual outcomes, early and late complications of a series of ATTRv patients who underwent vitrectomy in the French ATTRv reference center. Methods: This retrospective, single-center study, included all ATTRv patients who underwent vitrectomy between 2002 and 2017. Data were collected on pre and postoperative best corrected visual acuity (BCVA) and early and late postoperative complications. Results: A total of 21 eyes from 15 patients were included. The mean postoperative follow-up was 40 ± 20 months (6–160 months). BCVA increased from 0.7 ± 0.4 LogMAR preoperatively to 0.3 ± 0.4 LogMAR ( p = 0.003) at last postoperative visit. During follow-up, all initially glaucomatous eyes worsened, with three eyes (37%) requiring filtering surgery and two eyes (25%) had further vision loss. Among non-glaucomatous patients, four eyes (31%) developed glaucoma with two requiring trabeculectomy and one eye (8%) had further vision loss. Three eyes (three patients) presented with complications of amyloid angiopathy. Three eyes (three patients) experienced recurrence of vitreous deposits requiring surgical revision. Conclusion: Due to the potential complications, vitrectomy in ATTRv requires specific perioperative management and life-long postoperative monitoring.
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