Results of intravitreal dexamethasone implant 0.7 mg (Ozurdex^(█)) in non-infectious posterior uveitis

· AIM: To evaluate the safety and efficacy of dexamethasone implant in patients with non-infectious posterior uveitis with cystoid macular edema(CME).·METHODS: Retrospective analysis of patients reports with CME secondary to non-infectious uveitis treated with dexamethasone implant. Data included type of posterior uveitis, any systemic immunosuppressive therapy, Early Treatment Diabetic Retinopathy Study(ETDRS) best-corrected visual acuity(BCVA), central macular thickness(CMT) on optical coherence tomography(OCT) and signs of intraocular inflammation at baseline and then at 2wk postoperatively and monthly thereafter. Follow-up is up to 10 mo. Any per-operative and post-operative complications were recorded.·RESULTS: Six eyes of 4 patients with CME due to non-infectious posterior uveitis treated with dexamethasone implant. Diagnosis included idiopathic panuveitis, birdshot chorioretinopathy and idiopathic intermediate uveitis. At baseline mean ETDRS BCVA was63 letters and mean CMT 556 μm at 2wk postoperatively mean ETDRS BCVA improved to 70 letters and mean CMT decreased to 329 μm. All eyes showed clinical evidence of decreased inflammation. The duration of effect of the implant was 5 to 6mo and retreatment was required in 2 eyes. Two patients required antiglaucoma therapy for increased intraocular pressures.·CONCLUSION: In patients with non-infectious posterior uveitis dexamethasone implant can be a short-term effective treatment option for controlling intraocular inflammation.

Update on the diagnosis and treatment of Vogt-Koyanagi-Harada syndrome

Vogt-Koyanagi-Harada syndrome(VKH)is a bilateral granulomatous panuveitis associated with serous retinal detachments and vitritis,and can be associated with extraocular manifestations of meningismus,poliosis,vitiligo,hearing loss,and headaches.It is mediated by CD4+T cells that target melanocytes in the eye,ear,meninges,and skin.It classically presents in 4 different phases:prodromal,uveitic,convalescent,and recurrent.There have been considerable advances in our understanding of the disease in recent years,and options for treatment have also expanded beyond systemic corticosteroids though these remain the mainstay of therapy in patients with VKH.This brief review will focus on updates in the diagnosis and treatment of VKH,specifically advances in imaging techniques including the use of optical coherence tomography angiography(OCTA)and enhanced depth imaging(EDI)optical coherence tomography(OCT).OCT parameters that are diagnostically predictive of acute VKH compared to other exudative maculopathies include the presence of subretinal membranous structures,a high retinal detachment,subretinal hyperreflective dots,and RPE folds.Evaluations of choroidal thickness using EDI-OCT demonstrate predominant involvement of the outer choroid in the acute inflammatory phase of VKH,consistent with histopathological analysis.OCTA may emerge as an alternative to fluorescein angiography(FA)and indocyanine angiography(ICGA)but is limited at this time due to its small field of view.While the mainstay of treatment of acute VKH continues to be systemic corticosteroids,biological response modifiers(BRMs)such as adalimumab and infliximab have been shown to be effective in the management of adult and pediatric VKH with one benefit being a faster onset of action compared to conventional immunosuppression.Literature Search:A literature search was done in PubMed using the words“Vogt Koyanagi Harada”“imaging”“diagnosis”“treatment”“therapy“posterior uveitis”.

Unilateral focal lesions in the macula as an early presentation of syphilis

A 55-year-old male complained of right eye blurry vision for 3 days. His best-corrected visual acuity(BCVA) was 0.2 for the right eye and 1.0 for the left eye. Anterior segment and vitreous body examinations of both eyes were normal. Yellowish-white focal lesions in the macula of the right eye were observed and subtly changes of lesions were found along the superotemporal and inferotemporal arcades in the macula two days later. Fluorescein fundus angiography(FFA) revealed slight fluorescent leakage from the lesions in the macula of the right eye, and segmental venous leakage and optic disc hyperfluorescence were observed in both eyes. Indocyanine green angiography(ICGA) demonstrated that the lesions in the macula of the right eye had hypofluorescence at a late stage and spectral domain optical coherence tomography(SD-OCT) imaging of the macula showed focal impairment of the inner segment and outer segment(IS/OS). The blood investigation indicated a positive treponema pallidum hemagglutination assay(TPPA) and a rapid plasma reagin test(RPR) of 1:32. After antisyphilitica treatment for 6 weeks, the yellowish-white lesions had vanished and the BCVA was 1.2 followed by restoration of the IS/OS for the right eye, with an RPR of 1:4. In conclusion, ophthalmologists should alert unilateral focal lesions in the macula may be the first sign of syphilis. Prompt treatment is highly effective in resolving vision.