1/10. tacrolimus (FK506) in the treatment of posterior uveitis refractory to cyclosporine.OBJECTIVE: To assess the efficacy and side effects of tacrolimus, a potent immunosuppressive macrolide antibiotic, in the treatment of sight-threatening uveitis. DESIGN: A clinical study of tacrolimus in patients who required systemic immunosuppression for control of uveitis, but were refractory to cyclosporine. PARTICIPANTS: Six patients with uveitis were treated: three had Behcet disease, one had microscopic polyangiitis, one had pars planitis, and one had idiopathic retinal vasculitis. INTERVENTION: patients with sight-threatening uveitis refractory to cyclosporine were treated with tacrolimus. MAIN OUTCOME MEASURES: Intraocular inflammation, visual acuity (VA), neovascularization. Adverse effects of tacrolimus were documented. RESULTS: The posterior uveitis remained controlled in all patients while they were taking tacrolimus. Five of the six patients showed improvement, defined as improvement of two or more lines of Snellen acuity or a decrease in the binocular indirect ophthalmoscopy score (P < 0.05, Sign test). One patient with Behcet disease showed a marked improvement in best-corrected VA from 1/60 to 6/24. Two patients with Behcet disease showed a modest improvement in VA in the affected eye and had no disease activity in the other eye. The patient with microscopic polyangiitis was symptomatically improved, and there was no progression of the posterior uveitis. The patient with pars planitis had an improvement in VA from 6/18 to 6/9. The patient with retinal vasculitis showed partial regression of neovascularization on tacrolimus. Side effects were less troublesome than with cyclosporine. CONCLUSIONS: tacrolimus (FK506) has a useful role as an immunosuppressive agent for the treatment of sight-threatening uveitis in patients who did not respond to cyclosporine either because of lack of therapeutic effect or unacceptable adverse effects.- - - - - - - - - - ranking = 1keywords = retinal vasculitis, vasculitis (Clic here for more details about this article) |
2/10. High dose intravenous steroid therapy for severe posterior segment uveitis in Behcet's disease.AIM: To evaluate the safety and effectiveness of high dose intravenous steroid therapy (HDIST) in Behcet's disease patients with severe posterior segment uveitis attacks. methods: Five patients with ocular Behcet's disease were treated with HDIST for severe posterior segment attacks. Two patients had vasculitis, one patient had papillitis, and the other two had retinitis; four patients also had accompanying severe vitritis. The visual acuities and improvement in ocular signs after HDIST were evaluated. RESULTS: During HDIST, patients had no systemic complications caused by treatment. All patients responded to HDIST with evidence of a decrease in intraocular inflammatory activity and improved visual acuities within a mean time of 7 (1-15) days of commencing treatment. During follow up three out of five patients had new posterior segment attacks. CONCLUSION: HDIST is effective in controlling severe, vision threatening acute posterior segment Behcet's uveitis attacks and in improving visual function in a short period of time- - - - - - - - - - ranking = 0.0073023797869289keywords = vasculitis (Clic here for more details about this article) |
3/10. Two cases of uveitis with tubulointerstitial nephritis in HTLV-1 carriers.BACKGROUND: Although the tubulointerstitial nephritis and uveitis (TINU) syndrome has been reported, there are only a few reports in the ophthalmological literature. The ocular findings usually appear later than the renal findings, and a renal biopsy is required for a definitive diagnosis. CASES: Case 1 was a 15-year-old Japanese girl who was a carrier of the human T lymphotropic virus, type 1 (HTLV-1). She had tubulointerstitial nephritis, anterior uveitis, posterior retinal edema in the right eye, and peripheral vasculitis OU. Case 2 was a 56-year-old Japanese woman who was also a carrier of HTLV-1. Previously she had been diagnosed with Graves' disease, anterior uveitis, and vitreous opacity. Several years later tubulointerstitial nephritis was diagnosed. OBSERVATIONS: In both patients interstitial nephritis was diagnosed and systemic steroid therapy was effective. CONCLUSIONS: It is difficult for ophthalmologists to diagnose the TINU syndrome because the renal biopsy is performed by a pediatrician or an internist. This may be why ophthalmologic descriptions are rare in cases of TINU syndrome, even though the ocular findings reported in the literature are characteristic. This is the first case report of TINU syndrome in patients with HTLV-1. Ophthalmologists should pay more attention to the uveitis in the TINU syndrome.- - - - - - - - - - ranking = 0.0073023797869289keywords = vasculitis (Clic here for more details about this article) |
4/10. Infliximab in the treatment of refractory posterior uveitis.PURPOSE: To determine the efficacy and safety of infliximab in the treatment of refractory posterior uveitis. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Five patients with posterior uveitis were treated: 3 had Behcet's syndrome, and 2 had idiopathic posterior uveitis. INTERVENTIONS: patients with sight-threatening uveitis refractory to other immunosuppressive agents were treated with infliximab. MAIN OUTCOME MEASURES: Intraocular inflammation, by using binocular indirect ophthalmoscopy score, retinal vasculitis, and visual acuity. Adverse effects of infliximab were documented. RESULTS: Within 2 weeks of the first infusion of infliximab, 4 of 5 patients showed marked improvement in vitreous haze and visual acuity. By the 6-month follow-up, the same four patients had achieved remission of posterior uveitis and had successfully withdrawn all other immunosuppressive therapy. Further infusions of infliximab were required in 3 patients. One patient developed ocular and systemic tuberculosis, which responded to antituberculous treatment. CONCLUSIONS: Infliximab is effective in the treatment of sight-threatening refractory posterior uveitis. However, patients should be thoroughly screened for tuberculosis before treatment and followed up closely during and after therapy with infliximab.- - - - - - - - - - ranking = 0.5keywords = retinal vasculitis, vasculitis (Clic here for more details about this article) |
5/10. Nonnecrotizing herpetic retinopathies masquerading as severe posterior uveitis.OBJECTIVE: aqueous humor analysis can be performed in severe atypical forms of posterior uveitis unresponsive to conventional treatment to exclude a viral infection. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Thirty-seven immunocompetent patients seen with corticosteroid-resistant forms of posterior uveitis underwent extensive evaluation, including anterior chamber paracentesis, to rule out a nonnecrotizing viral retinopathy. INTERVENTION: Aqueous fluid samples were prospectively obtained. polymerase chain reaction (PCR) and serologic evaluation of intraocular antibody production against herpesviruses were performed by molecular techniques and enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: polymerase chain reaction and local antibody production for herpes simplex virus types 1 and 2, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus were determined on aqueous fluid samples. RESULTS: Viral infection was confirmed in 5 cases (13.5%). Clinical presentation included birdshot-like retinochoroidopathy, occlusive bilateral vasculitis, and cystoid macular edema. An antiviral regimen was initiated in all cases. inflammation was stabilized, and steroid dosage could be significantly reduced. CONCLUSIONS: Identification of a viral agent during severe posterior uveitis can dramatically change therapeutic management.- - - - - - - - - - ranking = 0.0073023797869289keywords = vasculitis (Clic here for more details about this article) |
6/10. Bilateral acute retinal necrosis in a 12-year-old girl.Acute retinal necrosis (ARN) is a severe ocular syndrome consisting of a moderate-to-severe anterior uveitis, vasculitis, and vaso-occlusive retinal necrosis. It can occur in healthy individuals at any age, but reports of this condition in children are rare.- - - - - - - - - - ranking = 0.0073023797869289keywords = vasculitis (Clic here for more details about this article) |
7/10. Elevated anti-human T-cell lymphotropic virus type I antibody in serum of patients with retinal vasculitis and uveitis living in Izumo area.Four patients with human T-lymphotropic virus type I associated myelopathy (HAM) were examined ophthalmologically, and serum titers to human T-lymphotropic virus type I (HTLV-I) in 11 patients with nonspecific retinal vasculitis or uveitis were determined. All of the patients lived in the Izumo area. All 4 patients with HAM (Cases 1 to 4) had vitreous opacities. Of the 11 patients with nonspecific retinal vasculitis or uveitis, 3 (Cases 5 to 7) had elevated titers to HTLV-I. We believe that HTLV-I infection may be involved in the causes of retinal vasculitis and uveitis in patients living not only in the endemic area but also outside the endemic area.- - - - - - - - - - ranking = 3.5keywords = retinal vasculitis, vasculitis (Clic here for more details about this article) |
8/10. Posterior segment ocular manifestations in patients with HLA-B27-associated uveitis.PURPOSE: To describe a series of patients with seronegative arthritic syndromes and HLA-B27-associated uveitis with severe, sight-threatening, posterior segment ocular manifestations. methods: The authors reviewed the records of 29 patients (17.4%) with posterior segment involvement from a cohort of 166 patients with HLA-B27-associated uveitis. The inclusion criteria included individuals with a positive HLA-B27 who had at least one of the following findings: (1) severe vitreous inflammation; (2) papillitis; (3) retinal vasculopathy; or (4) pars plana exudates. The study population comprised 13 men and 16 women with a mean age at onset of uveitis of 35.2 years. The average duration of the uveitis was 5.3 years, and the median follow-up time was 26 months. FINDINGS: Posterior segment involvement occurred in 34 eyes of the 29 patients. The most common findings included severe and diffuse vitritis in 93.1% of the patients and papillitis in 24 patients (82.7%). retinal vasculitis occurred in seven patients (24.1%), and pars plana exudates were present in two patients (6.8%). Cystoid macular edema (37.9%) and epiretinal membrane (17.2%) were common causes of visual impairment. Systemic immunosuppressive therapy was required for control of inflammation in 32% of the patients. CONCLUSION: HLA-B27-associated uveitis may be related to severe, sight-threatening posterior segment manifestations in some patients; this is an under-recognized phenomenon. These patients may require the use of aggressive systemic immunosuppressive therapy to control inflammation and preserve vision.- - - - - - - - - - ranking = 0.0073023797869289keywords = vasculitis (Clic here for more details about this article) |
9/10. Macular ischaemia in posterior uveitis.The commonest cause of visual morbidity in patients with posterior uveitis is cystoid macular oedema, which usually responds to immunosuppressive treatment. However, a small group of patients do not have a satisfactory visual outcome despite apparently adequate therapy. In a retrospective study of 345 angiograms of 135 patients with active non-occlusive retinal vasculitis 12 patients were identified by independent masked review as showing macular ischaemia on their fluorescein angiograms. Four patients had Behcet's disease, 4 sarcoidosis, and 4 idiopathic retinal vasculitis. Follow-up of these patients for an average of 36 months (range 6-120 months) showed that visual acuity failed to improve in 4 patients and dropped by an average of three lines Snellen in the other 8. We suggest that a poor visual outcome in some patients with posterior uveitis may be predicted by the presence of macular ischaemia on fluorescein angiography and that immunosuppressive therapy should be prescribed with caution in these patients.- - - - - - - - - - ranking = 1keywords = retinal vasculitis, vasculitis (Clic here for more details about this article) |
10/10. Three HLA-A29 positive patients with uveitis.We evaluated the ocular symptomatology in 3 HLA-A29 positive patients with uveitis. In two patients we saw bilateral flecked fundus lesions known as birdshot retinochoroidopathy. One patient with an idiopathic vasculitis had no depigmented fundus flecks. The differences and similarities in these 3 patients are described.- - - - - - - - - - ranking = 0.0073023797869289keywords = vasculitis (Clic here for more details about this article) |
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