Epidemiology and Clinical Features of Anterior Uveitis: a Prospective Study

Purpose: To report the pattern, epidemiology, and clinical features of anterior uveitis (AU) in southern TaiwanMethods: A prospective case series was performed to recruit patients with AU at two medical centers (Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Veterans General Hospital) in southern Taiwan from December 1, 2018 to March 31, 2020. These patients enrolled were reviewed for clinical diagnoses, ocular presentations, and laboratory data, including aqueous polymerase chain reaction tests.Results: A total of 112 patients were included. The most common clinical diagnoses were idiopathic AU (37.5%), HLA-B27-associated acute AU (25.0%), and herpetic AU (18.8%); among herpetic etiology, cytomegalovirus (CMV) was the most common pathogen. Hypertensive AU was associated with older age, more males, and greater numbers of corneal edema, and fewer iris posterior synechiae. Compared with HLA-B27-associated acute AU, CMV AU was associated with older age, high intraocular pressure, more keratic precipitates, greater iris atrophy, more pseudophakia, and fewer pupil posterior synechiae. Conclusion: This prospective study identified the epidemiological and clinical features of AU in southern Taiwan. The most common etiologies were idiopathic AU, HLA-B27-associated acute AU, and herpetic (most CMV) AU.

Method of phacoemulsification of cataract in patients with angle-closure glaucoma

Purpose. To study of effectivity and safety the proposed method phacoemulsification cataract of patients with close-angle glaucoma. Methods. Under control was 76 patients (76 eyes) with different degree of tubidity of lens and close-angle glaucoma. Was allocated 3 clinical's groops: I patients with cataract and who was operated close-angle glaucoma, II patients with with cataract and not operated glaucoma, III control group. Results. Patients of I and II clinical group phacoemulsification cataract was carried out by the proposed method. In control group phacoemulsification was carried out by the classical technique. Ophtalmological examination was performed before surgery, on the first day after surgery and by the all period of staying in the hospital. Observation period – 6 months. Conclusion. Тhe proposed method allows to perform the phacoemulsification cataract of patients with close-angle glaucoma with shallow anterior camera and posterior synechiae. Authentically can say, that level of intoocular pressure in 1 and 2 groups dropped on 38% and 37%, in control group this index compose 23%. When performing an operation by the proposed method managed to reduce the proportion of inraoperative complications on 34%. The proposed method easy to performed and safe. Key words: close-angle glaucoma, cataract, phacoemulsification cataract, angle anterior camera, posterior synechiae, anterior camera.

Prevalence of Angle Closure Glaucoma in Vogt-Koyanagi-Harada Disease

Background: This study aims to determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease. We performed a retrospective, observational, and longitudinal study in VKH patients seen from 2001 to 2019. Demographic data, disease stage, glaucoma development, visual outcome, and management were analyzed. Results: A total of 305 eyes from 155 VKH patients, including 114 (74.4%) females and 39 (25.6%) males with a mean age of 38.8± 12.8 years, were analyzed. The median follow-up time was 22 months (range 7-60 months). Secondary glaucoma developed in 67 (22.0%) eyes, most of which had chronic recurrent VKH disease at presentation 43 eyes (62.4 %). Angle-closure was the most observed mechanism of glaucoma in 55 (82.1%) eyes, as shown by the development of peripheral anterior synechiae in 58 (86.6%) eyes and posterior synechiae in 51 eyes (76.1%). The combination of pupillary block and posterior synechiae resulted in iris bombé in 17 (25.4%) eyes with glaucoma. Forty-one (61.2%) eyes with glaucoma required either a laser or surgical procedure to control the intraocular pressure. At the last visit, visual acuity was significantly worse in eyes with glaucoma (p<0.001).Conclusions: As evidenced by the development of anterior and posterior synechiae, the angle-closure disease is a significant cause of secondary glaucoma in eyes with VKH. Eyes with glaucoma are more likely to present in the chronic recurrent stage of the disease. Most of the eyes with glaucoma required a surgical procedure to control intraocular pressure.

Microperipheral Iridectomy for Troublesome Posterior Synechiolysis in Secondary Intraocular Lens Implantation

Purpose. To introduce an effective method for separating extensive posterior synechiae and those located under or adjacent to surgical incisions. Methods. Pediatric patients who had been subjected to cataract surgery and developed troublesome posterior synechiae requiring secondary intraocular lens (IOL) implantation were recruited. All patients underwent microperipheral iridectomy at the 12 o’clock position. Then, an ophthalmic viscosurgical device was injected into the posterior chamber through the iris fistula to mechanically separate the posterior synechiae, using scissors to cut robust posterior synechiae if necessary. The results of posterior synechiolysis and the position of the implanted IOL were analyzed. Results. Sixteen patients (median age, 51.56 months; range, 28–80 months) were included. The scope of posterior synechia in clock was 4.42 (range, 1–10). All troublesome posterior synechiae were successfully separated using the microperipheral iridectomy method, and all patients underwent IOL implantation in the ciliary sulcus. There was one case of peripheral iridectomy-related early intraoperative bleeding; no bleeding was observed at the end of surgery. Conclusions. Microperipheral iridectomy is a useful method for the management of troublesome posterior synechiae during secondary IOL implantation in pediatric patients, which makes secondary IOL implantation an easier and safer method in some challenging cases.

Review of de novo uveitis in older adults presenting to a large tertiary centre

Background/aimsThe primary aim of this study was to describe the causes of de novo uveitis in individuals 60 years and older. Secondary objectives were to determine the incidence of intraocular lymphoma and the clinical predictors of lymphoma.MethodsRetrospective chart review of all subjects presenting to the uveitis service at Auckland District Health Board (Auckland, New Zealand) between January 2006 and October 2020Results686 subjects (900 eyes) were aged ≥60 years at first presentation with uveitis, representing 23.4% of all subjects with uveitis during the study period. Non-infectious aetiology occurred in 631 (70.1%) eyes and infectious etiologies occurred in 269 (29.9%) eyes. The most frequent causes were idiopathic (36.3%), herpes zoster (14.8%), HLAB27 (8.7%) and sarcoidosis (4.8%). Twenty (2.2%) eyes of 13 (1.9%) subjects had a diagnosis of lymphoma. Lymphoma represented 11.2% of all intermediate uveitis. Subjects diagnosed with lymphoma did not develop posterior synechiae, epiretinal membrane, cystoid macular oedema or ocular hypertension.ConclusionsIntraocular lymphoma was uncommon in the overall cohort, but an important cause of intermediate uveitis. A diagnosis of lymphoma needs to be considered in any older subject with de novo intermediate uveitis. The lack of posterior synechiae, cystoid macular oedema, epiretinal membrane and ocular hypertension further increases the suspicion for lymphoma.

Prevalence, risk factors and management of ocular hypertension or glaucoma in patients with Vogt-Koyanagi-Harada disease

Background/aimsThis study was performed to examine the prevalence, risk factors and treatment outcome of OHT/glaucoma in Chinese patients with Vogt-Koyanagi-Harada (VKH).MethodsRetrospective non-interventional case series were conducted on a total of 2281 patients with VKH referred from April 2008 to April 2019. Of these cases, 1457 had a minimum follow-up period of 3 months and were included for this study. Medical records were reviewed for demographic, ocular and treatment data.ResultsAmong 2914 eyes of 1457 patients with VKH, 695 (23.9%) eyes of 425 patients (29.2%) developed OHT/glaucoma. The risk factors of OHT/glaucoma included initial BCVA of 20/200 or worse (OR=4.826), final best-corrected visual acuity (BCVA) of 20/50–20/100 (OR=5.341) and final BCVA of 20/200 or worse (OR=4.235), the interval between uveitis attack and referral time interval being 2 months or more (OR=3.318), more than three recurrent episodes (OR=4.177) and posterior synechiae (OR=1.785). The main possible mechanisms of OHT/glaucoma were inflammatory factor-induced open-angle OHT/glaucoma in 277 eyes (39.9%) and pupillary block arising from complete posterior synechiae in 201 eyes (28.9%). In these 695 eyes with OHT/glaucoma, normalised intraocular pressure (IOP) was achieved in 389 eyes (56.0%) following medical treatment. In the remaining 306 eyes, various surgical interventions were performed and a normalised IOP could be achieved in 249 eyes (81.4%).ConclusionOHT/glaucoma is a common complication in Chinese patients with VKH. Risk factors of OHT/glaucoma included worse acuity at first and final visits, the longer interval between uveitis attack and referral, more recurrent episodes and posterior synechiae.