Brolucizumab-Associated Intraocular Inflammation in Eyes Without Retinal Vasculitis

Purpose: This work analyzes a series of eyes with brolucizumab-associated intraocular inflammation (IOI) without retinal vasculitis reported to the American Society of Retina Specialists. Methods: The American Society of Retina Specialists Research and Safety in Therapeutics Committee analyzed clinical characteristics from submitted reports of IOI after brolucizumab. Eyes with retinal vasculitis or that received intraocular antibiotics were excluded. Results: Forty-nine eyes of 45 patients were collected. Mean visual acuity (VA) at baseline was 20/49 (range, 20/20-5/200). Patients presented with IOI a mean of 24 days (range, 3-63 days) after their most recent brolucizumab injection; 61% presented for an unscheduled visit while 39% presented at routine follow-up. Mean VA at IOI presentation was 20/67 (range, 20/20-3/200). The most common symptoms were floaters (78%) and blurry vision (76%). Pain (20%) and redness (16%) were less common; 3 (6%) eyes were asymptomatic. IOI was anterior only in 18%, posterior only in 31%, and both anterior and posterior in 51% of eyes. Treatment included topical steroids alone in 67% of eyes, whereas 10% of eyes received no treatment. Mean VA at last follow-up was 20/56 (range, 20/20-1/200). Three (6%) eyes lost 3 or more lines and 1 (2%) eye lost 6 or more lines. Conclusions: Brolucizumab-associated IOI without retinal vasculitis typically presented with a delayed onset of a few weeks. Often, VA decline was relatively mild. Most symptoms resolved and nearly all had a return-to-baseline VA, but a small percentage of patients had a significant decrease in VA at last follow-up.

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Retinal Vasculitis Associated With Dermatomyositis Treated With Intravenous Steroids

Journal of VitreoRetinal Diseases ◽

10.1177/24741264211018960 ◽

2021 ◽

pp. 247412642110189

Author(s):

Austen N. Knapp ◽

Jawad I. Arshad ◽

Daniel F. Martin ◽

Rula Hajj-Ali ◽

Kimberly Baynes ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Retinal Vasculitis ◽

Subretinal Fluid ◽

Retrospective Case ◽

Hand Motion ◽

Frosted Branch Angiitis ◽

Intravenous Steroids

Purpose: This work aims to present treatment and long-term follow-up of a 31-year-old woman with dermatomyositis who presented with hemorrhagic retinal vasculitis and macular edema. Methods: A retrospective case report is presented. Results: A 31-year-old woman with dermatomyositis treated with systemic immunosuppression was evaluated for acute, reduced vision. Best-corrected visual acuity was hand motion in the right eye and 20/200 in the left eye. Fundus examination revealed diffuse intraretinal hemorrhages, cotton-wool spots, and vascular sheathing with a frosted branch angiitis–like appearance. Optical coherence tomography revealed significant macular edema and subretinal fluid that quickly resolved after admission and treatment with intravenous steroids. Multimodal imaging at 7-year follow-up disclosed long-term sequelae including peripheral nonperfusion and retinal neovascularization. Conclusions: When vasculitis associated with dermatomyositis is treated aggressively with intravenous steroids at initial presentation, good visual acuity outcomes can be achieved, but long-term consequences of retinal nonperfusion and neovascularization persist.

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Medical management of silicone oil associated acute postoperative ocular inflammation

BMJ Case Reports ◽

10.1136/bcr-2021-242251 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242251

Author(s):

Mariya Bashir Doctor ◽

Deepika Chennapura Parameswarappa ◽

Padmaja Kumari Rani

Keyword(s):

Medical Management ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Ocular Inflammation ◽

Intraocular Inflammation ◽

Topical Steroids ◽

Gradual Improvement ◽

Batch Number ◽

Oil Injection

We report a case of a 57-year-old man, who underwent right eye silicone oil injection as a part of his surgical treatment for rhegmatogenous retinal detachment. Following this, on the first postoperative day, he developed acute postoperative intraocular inflammation. There was circumciliary congestion, diffuse corneal oedema, anterior chamber (AC) reaction, hypopyon and a pupillary membrane. The AC had not been entered during the surgery. No patients, who had been operated on the same day, or with the materials having the same batch number, developed similar reactions. We started the patient on hourly topical steroids and cycloplegics after which the patient’s condition showed gradual improvement. At the 2 weeks follow-up appointment, his pupillary membrane had completely contracted and the AC was quiet. This case highlights a clinical picture of acute postoperative silicone oil-induced ocular inflammation, which was resolved through medical management.

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Diffuse Sterile Corneal Infiltration: An Unusual Complication Post Collagen Cross-linkage

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1111 ◽

2015 ◽

Vol 4 (3) ◽

pp. 115-119 ◽

Cited By ~ 1

Author(s):

Ritu Arora ◽

Sonal Dangda

Keyword(s):

Visual Acuity ◽

Rare Complication ◽

Cross Linking ◽

Unusual Complication ◽

Topical Steroids ◽

Poor Vision ◽

Corneal Clouding ◽

Cross Linkage

ABSTRACT Purpose Presenting the course of visually disabling corneal infiltration post uneventful collagen cross-linking (CXL) in a 23 years old male with bilateral keratoconus. Methods A 23 years old male with bilateral keratoconus underwent cross-linking of left eye with indigenous 0.1% riboflavin dye and 370 nm ultraviolet A irradiation. This patient had an uneventful successful cross-linking performed in right eye 6 months prior with good recovery of vision to LogMAR (6/9 Snellen). Results Patient developed diminution of vision, along with redness of eye, photophobia and watering on 3rd day after uneventful cross-linkage. Examination revealed very poor vision; diffuse corneal clouding with multiple superficial stromal infiltrates and incomplete corneal epithelization. A provisional diagnosis of infective keratitis was made, in situ bandage contact lens (BCL) removed and subjected to culture. Intensive fortified topical antibiotics were initiated and steroids withheld. After complete corneal re-epithelization on 6th day, the infiltrations did not decrease in either intensity or number. Response to antibiotics being inadequate, an immune etiology was suspected and full strength topical steroids reinstituted which resulted in slow resolution of infiltration over a 10 weeks period. Last follow-up at 9 months post-CXL, revealed a diffuse stromal haze with unaided visual acuity of LogMAR 0.8 6/36 and best-corrected visual acuity (BCVA) of 0.3 (6/12) with use of a rigid gas permeable lens. Conclusion Sterile infiltration post-CXL requiring intense topical steroids is a rare complication of CXL and needs to be differentiated from infective keratitis. How to cite this article Bhattacharyya M, Singh K, Mutreja A, Dangda S, Arora R. Diffuse Sterile Corneal Infiltration: An Unusual Complication Post Collagen Cross-linkage. Int J Kerat Ect Cor Dis 2015;4(3):115-119.

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Clinical characteristics of progressive nonarteritic anterior ischemic optic neuropathy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.04.06 ◽

2021 ◽

Vol 14 (4) ◽

pp. 517-522

Author(s):

Omer Y. Bialer ◽

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Color Vision ◽

Symptom Onset ◽

Systemic Risk ◽

Clinical Characteristics ◽

Visual Outcome ◽

Ischemic Optic Neuropathy ◽

Systemic Risk Factors

AIM: To study whether patients with progressive nonarteritic anterior ischemic optic neuropathy (NAION) present earlier than patients with stable NAION and to describe their clinical characteristics and visual outcome. METHODS: This was a retrospective chart review. All patients with NAION seen during the acute stage from January 2012 to December 2018 were reviewed. Patients were included if they had documented disc edema and follow up of at least 3mo. Patients with progressive NAION were identified if they worsened in 2 out of 3 parameters: visual acuity ≥3 Snellen lines; Color vision ≥4 Ishihara plates; the visual field defect involved a new quadrant. The clinical characteristics, time from symptom onset to presentation, systemic risk factors and visual outcome were compared to patients with stable NAION. RESULTS: Totally 122 NAION cases met the inclusion criteria. Mean age was 58.1y (range 22-74), 70% were men. Twenty cases (16.4%) had progressive NAION. Patients with progressive NAION did not differ from stable NAION in their demographics, systemic risk factors or in their initial visual deficit. At last follow up, median visual acuity was 1.0 logMAR (IQR 0.64-1.55) in patients with progressive NAION, vs 0.18 (IQR 0.1-0.63) in stable NAION (P&#x003C;0.001). Median color vision testing was 0 plates correct (IQR 0-2.5%) vs 92% plates correct (IQR 50%-100%) in the stable NAION group (P&#x003C;0.001). Patients with progressive NAION differed in the time from symptom onset to presentation (median 2d vs 5d, P=0.011). CONCLUSION: We find no identifiable risk factors associated with progressive NAION. Progressors arrive earlier for ophthalmological evaluation.

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Clinical Characteristics of Pregnancy-Associated Central Serous Chorioretinopathy in the Chinese Population

Journal of Ophthalmology ◽

10.1155/2021/5580075 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Jia Yu ◽

Lei Li ◽

Chunhui Jiang ◽

Qing Chang ◽

Gezhi Xu

Keyword(s):

Visual Acuity ◽

Central Serous Chorioretinopathy ◽

Chinese Population ◽

Clinical Characteristics ◽

Subretinal Fluid ◽

Symptom Duration ◽

Initial Visit ◽

Half Dose ◽

The Mean

Purpose. To investigate the clinical characteristics of pregnancy-associated central serous chorioretinopathy (CSC) in the Chinese population. Methods. The medical records of patients diagnosed with pregnancy-associated CSC from February 2012 to October 2019 were retrospectively reviewed. Best-corrected visual acuity (BCVA), symptom duration, pregnancy-related medical information, and optical coherence tomography (OCT) images were collected. Results. Nine patients (11 eyes) were included. Five women were in their first pregnancy and four were in their second pregnancy, two of whom experienced CSC in their first pregnancy as well. The mean age was 35.00 ± 3.97 years. The mean symptom duration at the initial visit was 19.73 ± 13.65 days. The mean gestational age at the time of development of CSC was 27.11 ± 2.09 weeks. The mean BCVA (logarithm of the minimum angle of resolution (logMAR)) at the initial visit was 0.36 ± 0.18 (Snellen 20/45, range 20/100–20/25). All eyes showed subretinal hyperreflective fibrin on OCT images at the initial visit. Four patients (4 eyes) were lost to follow-up before fluid resolution. The mean BCVA at the final visit was logMAR 0.10 ± 0.15 (Snellen 20/25, range 20/50–20/20)). One eye in the oldest patient had persistent subretinal fluid at 26 months postpartum. The subretinal fluid resolved completely after half-dose photodynamic therapy (PDT); however, the ellipsoid zone at the fovea remained discontinuous at 30 months after half-dose PDT. The remaining six eyes all showed spontaneous resolution of subretinal fluid around delivery and regained intact ellipsoid zone. Conclusions. Pregnancy-associated CSC in Chinese developed mostly in the third trimester and usually recovered spontaneously around delivery with good final visual acuity. However, patients might require long-term follow-up until complete resolution of subretinal fluid and to detect recurrences. Half-dose PDT can be administered early if there is little reduction in the amount of subretinal fluid after delivery.

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Intracameral Air and Fibrin Glue for the Management of Late Bleb Leak following Glaucoma Surgery

Case Reports in Ophthalmology ◽

10.1159/000496383 ◽

2019 ◽

Vol 10 (1) ◽

pp. 47-52

Author(s):

Mohammed R. Hayat ◽

Fatema S. Mollah ◽

Kamal Kishore

Keyword(s):

Visual Acuity ◽

Anterior Chamber ◽

Fibrin Glue ◽

Pars Plana Vitrectomy ◽

Glaucoma Surgery ◽

Steroid Injections ◽

Delayed Onset ◽

Pars Plana ◽

Bleb Leak

Background and Objectives: To report a case of delayed-onset bleb-associated endophthalmitis (BAE) with bleb leak successfully managed with pars plana vitrectomy, intravitreal antibiotics, intracameral air, and fibrin glue. Patient and Methods: A 66-year-old pseudophakic female presented with BAE and bleb leak. A 25-gauge pars plana vitrectomy, cultures, and intravitreal antibiotics and steroid injections were performed. The infusion was switched to air filling the anterior chamber and bleb with air. Fibrin glue (Tisseel®) was applied over the leaking bleb. Results: BAE and bleb leak resolved with return of visual acuity to 20/25 and a functioning bleb with no recurrence of bleb leak after 1 year of follow-up. Conclusion: The combination of intracameral air and fibrin glue may have a role in the management of bleb leaks.

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The Role of Subthreshold Micropulse Yellow Laser as an Alternative Option for the Treatment of Refractory Postoperative Cystoid Macular Edema

Journal of Clinical Medicine ◽

10.3390/jcm9041066 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1066

Author(s):

Tommaso Verdina ◽

Rossella D’Aloisio ◽

Andrea Lazzerini ◽

Cecilia Ferrari ◽

Edoardo Valerio ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Cystoid Macular Edema ◽

Retrospective Chart Review ◽

Topical Steroids ◽

Before And After ◽

Laser Treatments ◽

Posterior Capsule Rupture ◽

Yellow Laser

Background: To evaluate the efficacy and the safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic postoperative cystoid macular edema (PCME), which is refractory to standard therapies. Methods: A retrospective chart review of ten eyes of ten patients affected by refractory PCME who underwent SMYL was performed. Five PCME cases were subsequent to uncomplicated cataract surgery (CS), two cases to complicated CS (CCS) with posterior capsule rupture and three cases occurred after retinal detachment surgery (RD). All conditions were refractory to conventional treatments prior to SMYL interventions for at least 4 months, including nonsteroidal anti-inflammatory eyedrops, topical steroids, oral indomethacin, sub-Tenon’s triamcinolone injections and Dexamethasone intravitreal implants. All patients underwent one or more treatments with 577 nm SMYL photo-stimulation, with 7 × 7 grids with confluent spots and a 5% duty cycle covering the whole edematous retina, including the foveal center. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were obtained using OCT, and evaluated before and after the treatment at 1, 2, 3 and 6-month follow-ups. Results: A complete subfoveal macular edema resolution was observed in all of the eyes, with statistically significant improvements in terms of BCVA and CMT in all of the follow-up timelines (at 6 months, p = 0.002 and p = 0.005, respectively). The mean number of laser treatments was 1.3. At the final follow-up, a complete subfoveal edema reabsorption was observed in all patients with visual acuity improvement. No complications were observed in any case. Conclusions: SMYL seems to be a safe and effective treatment for the long-term resolution of refractory PCME and may be a useful alternative to expensive and invasive therapeutic options.

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The Efficacy and Safety of Infliximab in Refractory Noninfectious Uveitis: A Meta-Analysis of Observational Studies

Frontiers in Pharmacology ◽

10.3389/fphar.2021.620340 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anji Xiong ◽

Deng Liu ◽

Huini Chen ◽

Guancui Yang ◽

Chen Xiong ◽

...

Keyword(s):

Systematic Review ◽

Visual Acuity ◽

Observational Studies ◽

Fixed Effects ◽

Meta Analysis ◽

Intraocular Inflammation ◽

Cochrane Library ◽

Efficacy And Safety ◽

Serious Adverse Events

Background: Although infliximab has been recommended for the second-line treatment of seronegative spondyloarthropathy- or juvenile idiopathic arthritis-related uveitis, the issue of its systemic efficacy and safety in a broader diversity of refractory noninfectious uveitis is debatable. To assess the short-term and relatively long-term efficacy of infliximab in refractory noninfectious uveitis, we performed a systematic review and meta-analysis of observational studies.Methods: PubMed, Cochrane Library, EMBASE, and Wanfang Med Online were systematically searched from January 2005 to March 2020. Two investigators independently assessed eligibility. Data were independently collected by two investigators. The pooled proportions were estimated with patients for intraocular inflammation control and improvement of visual acuity. Pooled proportions with 95% credible intervals were computed. Study homogeneity was investigated using I2 statistics to quantify the percentage of variation across studies. To pool the results, the Mantel–Haenszel fixed-effects or random-effects models were used.Results: Of 2316 studies identified, 16 unique studies with 509 unique participants were included in the meta-analysis. The pooled proportions of intraocular inflammation control reached 92% (95% CI: 87%–98%; I2: 1%; p=0.42) and 95% (95% CI: 93%–97%; I2: 0%; p=0.91) in groups of ≤6- and ≥12-month follow-up durations. During the relatively long follow-up period, the pooled proportions of maintaining visual acuity stable or increasing at least one line reached 99% (95% CI: 96%–100%; I2: 0%; p=0.54) in the involved eyes. The corticosteroid-sparing effect of infliximab was also well demonstrated, with the proportion of corticosteroid-sparing success reaching 85.5% (112/131). Besides, about serious adverse events, 2.6% (13/500) of patients experienced hypersensitivity reactions, 2.4% (12/500) of patients experienced serious infections, 1.8% (9/500) of patients experienced autoimmune diseases, and 0.6% (3/500) of patients experienced neoplasia.Conclusions: This meta-analysis provided evidence that infliximab might be a promising choice in controlling inflammatory activity, gaining visual acuity, and sparing corticosteroid use with relatively few side effects when applied in treating refractory noninfectious uveitis.Systematic Review Registration: [website], identifier [registration number]

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Fluocinolone Implant for Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis Syndrome: A Case Report

Case Reports in Ophthalmology ◽

10.1159/000518011 ◽

2021 ◽

pp. 824-830

Author(s):

Lucía Moreno-Castro ◽

Gerardo Pedro García-García ◽

Joseba Artaraz ◽

Alex Fonollosa

Keyword(s):

Visual Acuity ◽

Treatment Options ◽

Antiangiogenic Therapy ◽

Retinal Vasculitis ◽

Fluocinolone Acetonide ◽

Panretinal Photocoagulation ◽

Peripheral Ischemia ◽

Intravitreal Implant ◽

Fluocinolone Acetonide Intravitreal Implant

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare and progressive disorder that predominantly affects both the eyes of young female individuals and can threaten visual function. Peripheral ischemia and macular exudation are common findings in patients. The treatment options include panretinal photocoagulation (PRP), systemic immunosuppression, and intravitreal antiangiogenic and corticosteroid therapy. Fluocinolone acetonide intravitreal implant is approved for the treatment of nonanterior noninfectious uveitis and diabetic macular edema (ME), with an estimated therapeutic duration of 3 years. We describe a case of IRVAN syndrome in a child with ME who had been previously treated with PRP, antiangiogenic therapy, and several dexamethasone intravitreal implants and received a fluocinolone acetonide intravitreal implant in her right eye. The patient showed stabilization of the visual acuity and a marked reduction of the macular thickness 1 month after the treatment. At 12-month follow-up, the patient required perifoveal focal photocoagulation due to a rebound of the ME. After 2 years of follow-up, visual acuity remains stable and macular retinal thickening under control. Local long-standing steroid therapy has proved to be quite efficient in controlling the progression of the disease in our patient.

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Tuberculosis related Neuroretinitis and Retinal Vasculitis in an Immunocompetent Patient

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v13i2.31212 ◽

2021 ◽

Vol 13 (2) ◽

pp. 219-224

Author(s):

Neha Goel

Keyword(s):

Visual Acuity ◽

Retinal Vasculitis ◽

Immunocompetent Patient ◽

Posterior Pole ◽

Ocular Involvement ◽

Tuberculosis Case ◽

Modest Improvement ◽

Systemic Steroids ◽

Disseminated Tuberculosis

Introduction: This study aimed to describe the occurrence of bilateral neuroretinitis and retinal vasculitis in an immunocompetent female with disseminated tuberculosis. Case description: A 25 year old female diagnosed with disseminated tuberculosis presented with sudden painful loss of vision bilaterally. On examination she was found to have bilateral neuroretinitis and retinal periphlebitis involving the posterior pole. She was prescribed systemic steroids in addition to the anti-tuberculous therapy that she was receiving. The fundus lesions gradually resolved over four months with modest improvement in visual acuity. There were no recurrences in the follow up period of 14 months. Conclusions: Ocular involvement in the form of neuroretinitis with concomitant retinal vasculitis can occur in patients with disseminated tuberculosis. Addition of systemic steroids to anti-tuberculous therapy leads to anatomical resolution with improvement in visual acuity.

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