A white man in his 70s was referred for evaluation of a rapidly enlarging fleshy nodule of the right nasal conjunctiva. The patient noted redness, pain, and a foreign body sensation on his right eye for 2 weeks. The general ophthalmologist prescribed a 3-week course of oral prednisone, 20 mg/d, that reduced surrounding inflammation and pain, but the lesion did not change in appearance. The chest radiographic findings and blood work results were unremarkable. The lack of response to oral prednisone therapy led to suspicion of a possible malignant neoplasm, and the patient was referred for our opinion.The patient's medical history was notable for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with transformation to large B-cell lymphoma that was treated with rituximab, adriamycin, vincristine sulfate, and prednisone chemotherapy 4 years earlier. Two years before referral, bladder cancer was diagnosed and was treated surgically and with multiple rounds of intravesical BCG immunotherapy. The most recent BCG treatment was 5 months before presentation to the
A 68-year-old man with a history of keratoconus was referred for evaluation of a choroidal lesion in his left eye. Fundus autofluorescence demonstrated hyperautofluorescence in a leopard-spotting pattern. What would you do next?
Uveitis-Glaucoma-Hyphema (UGH) syndrome is characterized by episodes of anterior chamber inflammation, elevated intraocular pressure and hyphema. It is caused by a mechanical chaffing of the iris or ciliary body typically by a malpositioned intraocular lens. We present a rare case of UGH syndrome related to the insertion of a Hydrus Microstent. Due to the increased number of microinvasive glaucoma surgeries being performed and a reduction of UGH syndrome patients related to the insertion of intraocular lenses, it is an important diagnosis to consider in patients with recurrent post-operative inflammation.
Précis
When comparing patients on systemic immunosuppressive therapy to those without, there was no difference in IOP early after SLT; however, at one-year following SLT, IOP was higher in the immunosuppression group compared to controls.
Purpose:
To determine whether patients taking systemic immunosuppressive medications have a different intraocular pressure (IOP)-lowering response to selective laser trabeculoplasty (SLT) compared to a control group of patients.
Patients and methods:
All patients who underwent SLT at Mayo Clinic 2017–2021 were identified. Patients on systemic immunosuppressive medications at the time of SLT were compared to control patients not receiving systemic immunosuppressive medications. The primary endpoints of this study were the percentage IOP reduction at 1–2, 3–6, and 12 months. Additional analyses included percentage of patients who did not require additional therapy at each time-point.
Results:
There were 108 eyes of 72 patients that underwent SLT in the immunosuppressed group and 1997 eyes of 1417 patients in the control group. There was no significant difference in age-adjusted change in IOP between groups at the first post-operative visit 1-2 months following SLT (−18.8±20.7% vs. −16.0±16.5%, P=0.256) or 3–6 months following SLT (−15.2±21.6% vs. −18.3±23.2%, P=0.062). However, at 12 months following SLT, the IOP reduction in the immunosuppressive therapy group was significantly less compared to the control group (−15.1±21.2% vs. −20.3±22.9%, P=0.045). There was no difference between groups in number of additional treatments during the study intervals.
Conclusion:
Patients in the systemic immunosuppressive therapy group showed equivalent early IOP-lowering after SLT compared to a control group, but the treatment response was diminished at one year. Further studies investigating IOP regulation after SLT in immunosuppressed patients are needed.
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