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Will optical coherence tomography angiography (OCTA) replace invasive imaging techniques like fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography entirely? While OCTA is being increasingly applied in the field of medical retina, will we see this change in the subspeciality of uveitis? In this article, five uveitis specialists with renowned imaging expertise answer to 10 specific questions to address this issue. The final verdict based on the comments of the experts suggests that FFA and ICG cannot be replaced by OCTA in uveitis, at least for now. While OCTA can offer new insights into the pathogenesis of certain inflammatory conditions and help in the diagnosis of complications like inflammatory choroidal neovascularisation, multimodal imaging is still the preferred approach in the assessment of patients with uveitis. [ABSTRACT FROM AUTHOR]

The aim is to unravel the mechanism of mesalazine (5-ASA) on proinflammatory cytokines in PBMCs of patients with HLA-B27 +and HLA-B27 -acute anterior uveitis (AAU), and whether this may explain the different effects of 5-ASA in both disoders. PBMCs from 12 HLA-B27+ and 4 HLA-B27- AAU patients were preincubated with 5-ASA and stimulated with LPS. As mesalazine (5-ASA) could be involved in ER stress, proinflammatory and ER stress-associated cytokines and markers were measured. Mesalazine (5-ASA) suppressed IL-6 mRNA in healthy donors and in HLA-B27+ and HLA-B27- patients but did not lead to induction and secretion of IL-1β. In HLA-B27 + or – patients the ER stress-associated markers CHOP (DDIT3) and ATF6 were suppressed. Here we show that mesalazine (5-ASA) inhibits the transcription of proinflammatory and (ER) stress associated cytokines and markers, independently of the HLA-B27 status. Results show the similarities of both AAU types but do not decipher the mechanism why the HLA-B27 status determines the therapeutic response to mesalazine in AAU. [ABSTRACT FROM AUTHOR]

To study the epidemiological and clinical features of uveitis post-COVID-19 vaccination. Retrospective chart review of patients presenting with uveitis after COVID-19 vaccination in tertiary uveitis services. In total, 25 patients, 76% females, mean age 43.2 years, were included. Uveitis occurred after Pfizer, Moderna, Astra-Zeneca and Covaxin vaccination. Anterior uveitis was the most frequent type of uveitis (56%). History of uveitis was found in 19 cases (76%), among whom 90.9% of the tested patients developed anti-Sars-CoV-2 spike antibodies after vaccination. In a mean follow-up of 5 months, one-line decrease in visual acuity was found in 12% of patients. During post-vaccine uveitis, 15.8% of cases needed an increase in their systemic therapy. According to Naranjo score, new-onset uveitis had a higher probability of being associated with vaccination (p <.01). COVID-19 vaccination can cause uveitis but has no significant impact on the visual prognosis after resolution. [ABSTRACT FROM AUTHOR]

To present a case of necrotizing sclerokeratitis in a patient with multidrug-resistant tuberculosis and study the challenges in diagnosis and management of anterior tuberculous scleritis. Retrospective observational case report and review of anterior tuberculous scleritis. A 28-year-old woman, previously diagnosed as presumed tubercular panuveitis, presented with necrotizing sclerokeratitis and progressed to develop panophthalmitis. Laboratory investigations revealed multidrug-resistant Mycobacterium tuberculosis as the etiological agent. We reviewed cases of anterior tuberculous scleritis published in the literature, with regards to clinical features, microbiological investigations, treatment, and outcomes. Treatment includes standard antitubercular therapy, with or without systemic corticosteroids. Poor response to treatment is seen either due to delayed diagnosis or drug resistance, and the significance of the same is highlighted in our case. Diagnosis of tuberculous scleritis is a challenge. Therapeutic failure must alert the clinician for drug resistance which is diagnosed early, can prevent the devastating outcomes. [ABSTRACT FROM AUTHOR]

to evaluate new onset uveitis or reactivated uveitis by biologic agents and characterize their features. This is a multicenter, retrospective case series. Patients under biologic therapy were included if they developed uveitis for the first time or experienced intraocular inflammation which was different in location or laterality to previous inflammation. Sixteen patients were identified. The underlying disorders included ankylosing spondylitis, juvenile idiopathic arthritis, rheumatoid arthritis, and Behçet's Disease. The biologic agents associated with a first episode of uveitis (n = 11) or with a new recurrence of uveitis (n = 5) were etanercept, adalimumab, abatacept, infliximab, and golimumab. Sarcoidosis based on bihilar lymphadenopathy, other computer tomography-findings, or biopsy was diagnosed in five patients under therapy with etanercep, adalimumab, and abatacept. Additionally, seven patients developed clinical changes in their uveitis pattern, suggesting sarcoid uveitis. Biologic treatment-induced uveitis often presents as granulomatous disease. [ABSTRACT FROM AUTHOR]

Ocular rosacea is a chronic potentially sight-threatening inflammatory condition, which can occur in approximately 20% of patients without skin involvement. However, an accurate diagnosis of ocular rosacea has not been defined yet due to its rather nonspecific symptoms and clinical findings. Therefore, this article updates the current recommendations for diagnosis and treatment of ocular rosacea and the previously published consensus recommendations from the ROSCO expert panel on the management of rosacea. [ABSTRACT FROM AUTHOR]

Viral agents are the most common cause of infectious anterior uveitis worldwide. The purpose of this review is to analyze the frequency, gender and racial differences of viral anterior uveitis (VAU) in various populations. Systematized literature review of epidemiological reports of VAU cited in PubMed, EMBASE and the Cochrane Library database published until June 30th, 2020. A total of 12 clinical studies on epidemiology of definite VAU and 36 clinical studies of presumed VAU were identified. Members of Herpesviridae family represent the most common causes of VAU. Other less frequently reported causes, such as rubella and endemic viruses (HTLV-1, Chikungunya, Dengue, Ebola, Zika virus) were also analyzed. HSV, VZV are prevalent worldwide. CMV is more frequent in Asia, and rubella in the West. However, due to globalization and air travel, HTLV-1, Chikungunya, Dengue and Ebola may become important causes of VAU across the world. [ABSTRACT FROM AUTHOR]

Purpose: To assess efficacy of adalimumab versus placebo in patients with active or inactive noninfectious intermediate, posterior, or panuveitis across different etiologies. Methods: VISUAL I (V–I) and VISUAL II (V–II) clinical trials included adults with active or inactive uveitis, respectively, randomized to receive adalimumab or placebo. In a post hoc subgroup analysis, time to treatment failure (TTF) starting at week 6 (V–I) or week 2 (V–II) was analyzed using the Kaplan–Meier method. Hazard ratios (HR) for TTF with 95% CI were calculated with Cox proportional hazards regression. Results: The analysis included 217 V–I patients and 226 V–II patients. Treatment failure occurred later and risk was significantly lower in patients with idiopathic uveitis receiving adalimumab versus those receiving placebo in V–I (HR = 0.50 [CI, 0.30–0.84]; P =.006) and V–II (HR = 0.43 [CI, 0.22–0.83]; P =.010). Conclusions: Treatment failure risk was lower in patients with idiopathic noninfectious uveitis receiving adalimumab versus those receiving placebo. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has galvanized the development of new vaccines at an unprecedented pace. Since the widespread implementation of vaccination campaigns, reports of ocular adverse effects after COVID-19 vaccinations have emerged. This review summarizes ocular adverse effects possibly associated with COVID-19 vaccination, and discusses their clinical characteristics and management. Narrative Literature Review. Ocular adverse effects of COVID-19 vaccinations include facial nerve palsy, abducens nerve palsy, acute macular neuroretinopathy, central serous retinopathy, thrombosis, uveitis, multiple evanescent white dot syndrome, Vogt-Koyanagi-Harada disease reactivation, and new-onset Graves' Disease. Studies in current literature are primarily retrospective case series or isolated case reports – these are inherently weak in establishing association or causality. Nevertheless, the described presentations resemble the reported ocular manifestations of the COVID-19 disease itself. Hence, we hypothesize that the human body's immune response to COVID-19 vaccinations may be involved in the pathogenesis of the ocular adverse effects post-COVID-19 vaccination. Ophthalmologists and generalists should be aware of the possible, albeit rare, ocular adverse effects after COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of once-daily topical treatment of ocular and cutaneous rosacea with ivermectin 1% cream (Soolantra®, Galderma). Methods: Ten patients with rosacea were evaluated in a retrospective monocentric pilot study. Subjective symptoms (measured with the Ocular Surface Disease Index), skin findings, and ocular changes (blepharitis with telangiectasia and meibomian gland dysfunction, conjunctival redness, tear breakup time (TBUT), and fluorescein staining of the cornea) were evaluated. The follow-up was 8 months (range: 5–12 months). Results: The OSDI score decreased in the 8th week of treatment (38.5 ± 21.7, P =.004). After 16 weeks, blepharitis (P =.004), and conjunctival redness (P =.008) had strongly improved, and grade 1 was seen in all patients until the end of follow-up. Fluorescein staining of the cornea (P =.001) and TBUT (P =.016) showed significant improvement until the last follow-up visit. No side effects were observed. Conclusion: Topical ivermectin cream 1% given daily is an effective and safe therapy against rosacea. [ABSTRACT FROM AUTHOR]

Treatments varied considerably, but included: systemic plus intravitreal chemotherapy (16 patients; 51/6%); systemic chemotherapy with full-brain radiation (12 patients; 38.7%); systemic chemotherapy alone (8 patients; 25.8%); autologous hematopoietic stem cell transplantation (8 patients; 25.8%); intravitreal chemotherapy alone (3 patients; 9.7%); and systemic plus intrathecal chemotherapy (2 patients; 6.5%). The use of EBV therapy with foscarnet or ganciclovir has been suggested by some, but is not universally employed.[28] The review reminds us to consider VRL in HIV-positive patients with intermediate or posterior uveitis and, conversely, to consider HIV infection is those found to have VRL with or without PCNSL. While clinical and ophthalmic imaging findings often suggest the diagnosis, additional testing typically involves contrast-enhanced CNS or full-body CT or CT/PET imaging to evaluate for extraocular involvement in patients suspected of having VRL or uveal lymphoma, respectively. The 2017 World Health Organization (WHO) Classification of Tumors and Hematopoietic and Lymphoid Tissues recognized five main categories of lymphoid neoplasms: 1) precursor lymphoid neoplasms; 2) mature B-cell neoplasms; 3) mature T- and NK-cell neoplasms; 4) Hodgkin lymphomas; and 5) immunodeficiency-associated lymphoproliferative disorders.[[1]] Intraocular lymphomas are generally uncommon, but when they do occur, are almost always non-Hodgkin, B-cell in type, and one of two broad categories. [Extracted from the article]

For example, Robinson and colleagues[40] found genes specifically associated with uveitis, but not joint disease in HLA B27-associated anterior uveitis. The authors acknowledged the prior, corroborative work of El-Asrar et al,[33] who showed that aqueous humor IL-6 levels were significantly higher in uveitis patients who were HLA-B27-positive or who had Behçet disease (BD) compared to patients with Vogt-Koyanagi-Harada (VKH) disease, ocular sarcoidosis (OS), or idiopathic granulomatous uveitis ( I P i <.0001), and suggested that measurement of tear IL-6 and IL-10 levels might offer a noninvasive way to predict disease recurrences over time in HLA-B27-positive patients with uveitis. Anukul et al[25] compared the frequency of HLA-DRB1 and DQB1 class II allele genotypes in 23 patients with VKH disease to 20 patients with other forms of uveitis seen in a referral clinic in Northern Thailand. [Extracted from the article]

Limited data suggest that subcutaneous administration of TCZ may be less effective than intravenous dosing in patients with ocular inflammatory disease, although several patients have experienced control of their inflammation with subcutaneous delivery and this route may be better tolerated. Four patients discontinued therapy due to TCZ-associated side effects, including neutropenia, persistent dizziness and nausea, angioedema, and severe abdominal pain. Tocilizumab (TCZ; Actemra®; Roche/Genentech in the US; Chugai Pharmaceutical Co. in Japan) is a recombinant, humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor and currently approved by the Food and Drug Administration (FDA) and the European Commission to treat adults with moderately to severely active rheumatoid arthritis (RA) and pediatric patients with polyarticular Juvenile Idiopathic Arthritis (JIA) or systemic JIA. The authors concluded that intravenous TCZ can be a safe and effective treatment for patients with refractory JIA-associated uveitis and that selected patients may be successfully switched from monthly intravenous to weekly subcutaneous TCZ following a prolonged period of control. [Extracted from the article]

Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Classical I Klebsiella pneumoniae i (c I KP i ) is a common Gram-negative nosocomial pathogen well-known to cause pneumonia, urinary tract infections, meningitis and sepsis in immunocompromised hosts.[1] Approximately 100 years after the identification of c I KP i by the German pathologist and microbiologist Carl Friedländer in 1882, Liu et al[2] described a series of seven patients from Taiwan with a particularly aggressive form of I KP i associated with hepatic abscesses, sepsis, and distant organ metastasis - including endophthalmitis. Endogenous endophthalmitis associated with pyogenic liver abscess caused by Klebsiella pneumoniae. 16 Li S, Yu S, Peng M. Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases. [Extracted from the article]

Retinal vasculitis (RV) is a common complication of both intermediate and panuveitis.[[1]] Clinically, RV tends to be diffuse, venous, and non-occlusive, and is often accompanied by both optic disc and macular edema. All patients who present with uveitis and RV should be tested for tuberculosis, sarcoidosis and syphilis with chest imaging, a complete blood cell count with differential, and a treponemal antibody test. While patients with systemic vasculitis should undergo routine dilated eye examinations, the occurrence of RV in such settings is uncommon. Patients with retinal vasculitis rarely suffer from systemic vasculitis. [Extracted from the article]

Introduction: Uveitic macular edema (UME) is a significant cause of visual impairment in all uveitis types. Methods: Reports that were cited in the MEDLINE database, that analyzed the effectiveness of biologics for UME in at least five patients, with a minimum follow-up of 3 months, published prior to April 1, 2019 were included. Reports that did not compare UME findings before and after the therapy, using either OCT or fluorescein angiography, were excluded. Results: Case series that analyzed the efficacy of intravitreal anti-VEGF agents showed modest, short-term benefit. Studies that investigated systemic anti-TNF agents in patients with noninfectious uveitis reported a therapeutic effect on UME. Anti-IL-6 antibodies have shown promising results for most severe cases of noninfectious UME. Interferon represents an option for patients with persistent UME in infectious and noninfectious uveitis. Conclusion: Multicenter, randomized controlled trials are needed to assess the effectiveness of each group of biologic agents in sufficient number of patients. [ABSTRACT FROM AUTHOR]

Purpose: Overview of the evolving epidemiology of human immunodeficiency virus (HIV)-related ocular disease over time. Method: Narrative review. Results: HIV enhances susceptibility to opportunistic eye infections, has direct pathogenic effects, and places patients at risk of immune recovery inflammatory syndromes in previously infected eyes after starting highly-active antiretroviral therapy (HAART). Widespread availability of HAART has resulted in a decrease of infectious ocular conditions such as cytomegalovirus retinitis, toxoplasmic retinitis, squamous cell carcinoma of the conjunctiva, and microvascular retinopathy. However, large coexisting burdens of tuberculosis, herpesvirus infection and syphilis (among others) continue to contribute to the burden of ocular disease, especially in low-resource settings. Growing risks of cataract, retinopathy and retinal nerve fiber thinning can affect patients with chronic HIV on HAART; thought due to chronic inflammation and immune activation. Conclusion: The changing epidemic of ocular disease in HIV-infected patients warrants close monitoring and identification of interventions that can help reduce the imminent burden of disease [ABSTRACT FROM AUTHOR]

In eyes with OT, 24/32 (75.0%) tested had anti I T. canis i IgG antibodies in the aqueous humor, 23/26 (88.5%) had anti I T. canis i IgG antibodies in the vitreous, and elevated levels of vascular endothelial growth factor (VEGF, nominal I p i =.012), and of IL-6, IL-8, and IL-10 (nominal I p i <.001). Infection is common and affects approximately 20% of the world's population, with seroprevalence rates surpassing 80% in some tropical and subtropical regions in Africa[3] and Asia.[4] While many I Toxocara i infections are asymptomatic, moderate to severe systemic, neurologic, and/or ocular infections can occur. Toxocariasis is a zoonotic infection of global importance.[1],[2] Transmission is typically fecal-oral and results from accidental exposure to food, water, or soil contaminated by either dog or, less commonly, cat roundworms - the helminths I Toxocara canis i and I Toxocara cati i , respectively. Atypical presentations of OT also exist.[[5]] One metanalysis,[9] three original articles, SP 10-12 sp and one letter[10] in this issue of I Ocular Immunology & Inflammation i (OII) address aspects of the prevalence, presentation, treatment and outcome of OT. [Extracted from the article]

Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. The risk of such vision loss seems to be less when patients are treated by uveitis subspecialists, leading some to suggest that early subspeciality referral might bode best for all but the most mild or routine cases, particularly since both perceived and measured vision loss appear to materially diminish the quality of life of patients with uveitis. Uveitis accounts for 10% to 20% of blindness in the United States and Europe, and perhaps as much as 25% in the developing world.[[1], [3]] Vision Loss in patients with uveitis is common and appears to be related most directly to the severity, location and duration of the inflammation, and to the occurrence of secondary, vision-threatening complications such as cataract, macular edema, and glaucoma.[[5], [7], [9], [11], [13]] Prompt and complete control of inflammation is important, therefore, to limit both vision loss and its psychosocial impact. The authors identified 93 subjects with anterior uveitis (1.0%) and 48 with non-anterior uveitis (0.53%) who met their criteria of blindness in at least one eye, and 13 with anterior uveitis and 7 with non-anterior uveitis who met their blindness criteria bilaterally. [Extracted from the article]

This document summarizes the experience of the International Uveitis Study Group (IUSG), the Intraocular Inflammation Society (IOIS), and the Foster Ocular Inflammation Society (FOIS) and can aid as a guide for the treatment of uveitis patients in the era of COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB. [ABSTRACT FROM AUTHOR]

After the outbreak of the disease COVID-19, it has reached pandemic proportions within a very short time. It is mainly transmitted human-to-human through direct contact with secretions from an infected person or through inhalation of droplets containing SARS-CoV-2. It is controversial whether the virus may be transmitted via tears. Exposed ocular surface can serve as a gateway in transmission and acquiring respiratory diseases. Considering the reported cases on healthcare workers indicating nosocomial transmission and the anatomical and physiological aspects it is perceived that ophthalmic healthcare professionals are at higher risk of contracting the virus by virtue of their job. In this narrative review we discuss current evidence around detection of SARS-CoV-2 in human tears and forms of transmissions reported to date. We also provide a comprehensive approach that may be implemented in an ophthalmic care facility to protect healthcare personnel, as well as patients, from contracting the virus. [ABSTRACT FROM AUTHOR]

Epstein-Barr Virus (EBV), also known as Human HerpesVirus-4 (HHV-4), is a -type herpesvirus with a global infection prevalence of over 95%.[1],[2] Infection, which occurs nasopharyngeally via either aerosol or direct contact, tends to be asymptomatic in children, but may be associated with the development of infectious mononucleous (IM) in 50% or more of adolescents and young adults. Such observations, together with the fact that a molecular resemblance exists between several EBV proteins and selected self-antigens, has led some experts to propose that EBV reactivation followed by bystander leukocyte activation with epitope spreading and/or molecular mimicry between EBV and self-proteins might contribute to the pathogenesis of autoimmune disease in some patients. Several studies[23] [31] have assessed intraocular levels of EBV DNA and/or anti-EBV antibodies in patients with uveitis, providing evidence for the presence of EBV in up to 10% of eyes with active inflammation. A similar case of purported bilateral EBV-associated scleritis complicated by perforation in a 71-year-old Japanese woman with elevated serum anti-EBV antibody titers has been reported.[54] The authors suggested that the serologic and PCR-based test results, together with the slow therapeutic response to combined corticosteroids and an anti-viral agent, supported the causal association with EBV. [Extracted from the article]

Purpose: To assess the efficacy and safety of systemic interferon alpha-2a (IFN) for refractory pseudophakic cystoid macular edema (PCME).Methods: Retrospective observational study. The primary outcome was the decrease of central retinal thickness (CRT). Secondary endpoints were the improvement of best-corrected visual acuity (BCVA) and the assessment of IFN-related side effects.Results: Twenty-four eyes of 20 patients were included. The median CRT was 513 µm (range 220-980 µm) at baseline and decreased to 190 µm (range 140-520 µm) at the last follow-up visit (p < 0.001). Reduction of CRT greater than 100 µm was observed in 22 eyes (92%). The median BCVA (logMAR) increased statistically significant from 0.5 (range 0.2-1.5) at baseline to 0.3 (0-0.8) at the last follow-up (p < 0.001). The BCVA improved in 18 eyes (75%) and remained stable in five eyes (21%). No severe treatment-related side effects occurred.Conclusion: IFN is a very effective agent for treatment of refractory PCME. [ABSTRACT FROM AUTHOR]

Longer-term systemic immunosuppression has been employed successfully in eyes with frequent recurrences.[1],[2],[38],[39] Anti-microbial therapy should be added in eyes with CNV in the setting of active toxoplasmic or tuberculous retinochoroiditis. Thirteen eyes (32.5%) had CNV at first visit, whereas four eyes developed CNV during follow up, and eyes with CNV tended to have worse vision at both presentation and last visit. Focal choroidal excavation (FCE) was observed in five eyes with CNV (31.3%) verses 10 eyes without CNV (41.7%; I p i =.44). Subretinal fibrosis was noted in four eyes with CNV (25.0%) verses no eyes without CNV (0.0%; I p i =.02). [Extracted from the article]

19 Mobini N, Dhillon R, Dickey J, Spoon J, Sadrolashrafi K. Exclusive cutaneous and subcutaneous sarcoidal granulomatous inflammation due to immune checkpoint inhibitors: report of two cases with unusual manifestations and review of the literature. Whether such patients experience reactivation of previously asymptomatic systemic sarcoidosis or develop sarcoidosis I de novo i following tattoo placement was not known. Both patients were found to have evidence of previously undiagnosed systemic sarcoidosis with elevated serum angiotensin converting enzyme levels and lung involvement - including mild interstitial involvement in one patient and hilar adenopathy in the second. The word "tattoo" was introduced into the English language in the mid-eighteenth century through the writings of James Cook, a British naval officer who sailed and explored the South Pacific. [Extracted from the article]

Keywords: Classification; definition; dry eye; inflammation; symptoms EN Classification definition dry eye inflammation symptoms 521 523 3 07/28/21 20210501 NES 210501 Dry eye symptoms affect between 7% and 34% of the global population, with lower rates reported in the US (7%) and higher rates in Taiwan and Japan (34%).[1] A population-based cohort study has shown that dry eye disease is most common in women and the elderly.[2] The same study showed the association of dry eye symptoms with past and current smoking and various conditions including a history of arthritis, thyroid disease, gout, diabetes, and hypercholesterolemia.[2] The definition of dry eye disease has evolved over time. For example, while patients with dry eye disease associated with Sjogren's syndrome or photorefractive surgery present with similar symptoms, dry eye disease associated with Sjogren's syndrome is unlikely to improve significantly over time. [Extracted from the article]

The authors talk about vaccine-associated uveitis monitored by Vaccine Adverse Event Reporting System (VAERS) by referring to three articles published within the issue. Topics include molecular mimicry and antigen-specific cell and antibody-mediated hypersensitivity reactions, inflammation induced by adjuvants, Shoenfeld syndrome, and a case study of a 43-year-old man of mixed White and American Indian ancestry who developedbilateral uveitis three days after intradermal hepatitis B virus.

An editorial is presented on the ultra-wide-field (UWF) imaging for diagnosing uveitis, single-frame photographic access.

Macular edema (ME) is a leading cause of vision loss in both children and adults with uveitis.1-7 Reported rates of uveitic ME (UME) from tertiary referral clinics have ranged from roughly 20% to 30%,8-13 with the vast majority of cases occurring in the setting of intermediate, posterior, or panuveitis--although ME occurs occasionally in eyes with anterior uveitis, especially when inflammation spills over to involve the vitreous. Corticosteroid-induced ocular complications were common and included cataract in eight of 17 phakic eyes (47.1%), intraocular pressure (IOP) elevation to or above 21mmHg in 20 eyes (45.4%) and IOP above 30 mmHg in three eyes (6.8%). Ratra et al.24 retrospectively assessed the tolerability and efficacy of the dexamethasone intravitreal implant (OZURDEX®) for the retreatment of refractory UME in 42 eyes of 34 patients seen at a uveitis referral clinic in Chennai, India, between April, 2011, and December, 2015. Multicenter uveitis steroid treatment trial research group. outcome of treatment of uveitic macular edema: the multicenter uveitis steroid treatment trial 2-year results. [Extracted from the article]

Diagnosis of uveitis is often challenging, but can be easy in typical viral-induced anterior uveitis (VIAU). Associated symptoms and signs are an important source of information. Certain classical clinical features such as keratic precipitates (KPs) distribution, iris atrophy, elevated intraocular pressure (IOP), and unilaterality are commonly used to support the diagnosis of VIAU. However, many etiologies of anterior uveitis may to a certain extent mimic VIAU, especially the ones with unilateral granulomatous KPs and elevated IOP. This review begins with how the clinician can differentiate viral from nonviral anterior uveitis, and subsequently focuses on the key features which may aid in differentiating among the different viruses that cause VIAU. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the response to treatment in patients with tubulointerstitial nephritis and uveitis (TINU) syndrome over a long-term follow-up period.Methods: Nine patients with TINU syndrome were retrospectively reviewed. The mean follow-up was 54.8 months (range: 24-133 months).Results: The mean number of recurrences per year declined from 1.7 in the 1st year to 0.66 in the 2nd year of treatment. The ocular inflammation responded to local corticosteroids in two patients, systemic corticosteroids in two patients, immunosuppressive therapy in four patients, and anti-TNF-α blocking agent in one patient. The therapy could be discontinued in six (67%) patients after a mean treatment period of 29.5 months. In five patients, remission with the recurrence-free period of 12.8 months was achieved.Conclusions: TINU syndrome was characterized by limited responsiveness to corticosteroid therapy and less by severe complications. A long-term course of immunosuppressants or biologics was necessary to control the uveitis and led to induction of remission. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses the articles in the issue on topics including issues relating to the endogenous endophthalmitis disease, recurrence of HIV infection, and the intraocular and systemic antibiotics.

The authors reflects on studies that highlight the distinctive tendency for primary intraocular lymphoma (PIOL) and selected infections to localize to the subretinal space. They cite the conclusion of Abusamra et al that biopsy should be considered in eyes with suspected intraocular lymphoma. Also noted is the conclusion in Cho et al that patients with vitreoretinal and brain involvement appear to have a median survival up to 50% shorter than those with vitreoretinal lymphoma (VRL).

An introduction is presented in which the editors discuss various reports in the issue on topics including the rate of rhegmatogenous retinal detachment (RRD), orbital apex syndrome (OAS), and presentation of uveitis in patients with Herpes Zoster Ophthalmicus (HZO).

The authors concluded that PIRT is a not uncommon component of the full TRC lesion spectrum and that MMI can be useful to confirm the diagnosis, as with PORT.[13] Conrady et al[12] retrospectively described eight patients who developed active TRC following exposure to wild game. The lesions were differentiated anatomically from the better known punctate outer retinal toxoplasmosis (PORT) lesions based on primary involvement of the inner versus outer retina on OCT, with PIRT lesions extending to the outer plexiform layer and/or sparing the outer nuclear layer. The primary measures were lesion area using various imaging modalities and detection of so-called "satellite dark dots" (SDD) on OCTA and ICGA imaging of the choroid. [Extracted from the article]

Purpose: To analyze the efficacy of tocilizumab in uveitic macular edema (ME) resistant to various immunomodulatory drugs.Methods: Patients received tocilizumab every 4 weeks intravenously. Central foveal thickness (CFT) was assessed by optical coherence tomography (OCT).Results: Five patients (8 eyes) who were ineffectively pretreated with systemic prednisolone, at least one immunosuppressive drug, and at least one biologic drug for uveitic macular edema were included in the study. At 3 months, a response of ME (≥25% reduction in CFT) was observed in 6 eyes (75.0%) of 5 patients. During follow-up, complete resolution of ME was achieved in 5 eyes (62.5%) of 4 patients. Improvement of BCVA was observed in 3 eyes of 3 patients, and stabilization in 3 eyes of 3 patients. Tocilizumab was well tolerated, and no severe side effects occurred.Conclusions: Treatment with tocilizumab can be considered in chronic uveitic macular edema even if previous immunomodulatory therapy has failed. [ABSTRACT FROM AUTHOR]

The author reflects on Behcet Uveitis (BU). Topics discussed include Behcet disease (BD) as a systemic disorder; and ocular complications of BU that are edema, non-perfusion, neovascularization, and atrophy of the retina and optic disc. Also being discussed are tumor necrosis factor (TNF) inhibitor or interferon, conventional immunosuppressive therapy, and indocyanine green angiography (ICGA) and fundus autofluroescence (FAF).

An introduction is presented in which the authors discuss various reports within the issue on topics including infectious uveitis, the use of optical coherence tomography angiography (OCT-A) to diagnose multifocal serpiginoid choroiditis (MSC) lesion, and the use azathioprine for uveitis treatment.

Purpose: To analyze the preferred practice respective diagnosis, treatment, and complications in patients with acute retinal necrosis in Germany.Methods: The uveitis-section of the German Ophthalmologic Society developed a questionnaire with 12 questions concerning patients with acute retinal necrosis seen in the 5 years up to August 2009.Results: In total, 35 eye hospitals answered the questionnaire and reported 213 patients with acute retinal necrosis. Diagnosis was made clinically in 86%. Anterior chamber tap, vitreous biopsy, diagnostic vitrectomy, and serology were performed for confirmation. Therapy was started with acyclovir in all institutions, and continued with ganciclovir, foscarnet and brivudine in some cases. Intravitreal injections were performed in 46%. Additional oral steroids were given in 80%. A following oral antiviral treatment was performed in 94%.Conclusions: Relevant variations were seen in diagnosis and treatment practices. The survey outlines the need for a unique diagnostic and therapeutic guideline. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss articles within the issue on topics related to the management and diagnosis of ocular involvement by systemic lupus erythematosus (SLE).

9 Golzarri MF, Cheja-Kalb R, Concha-Del-Río LE, Gonzalez-Salinas R, Arellanes-García L. Risk factors for subretinal fibrosis in patients with Vogt Koyanagi Harada syndrome. As recognized more than 70 years ago by Adalbert Fuchs, son of acclaimed eye pathologist Ernst Fuchs,[1] subretinal fibrosis (SRF) in eyes with uveitis is an uncommon complication that occurs most frequently in the setting of serious retinal detachment (SRD) or chorioretinitis.[2] Fuchs called this condition "choroiditis proliferans,"[3] whereas others have referred to "progressive subretinal fibrosis and uveitis", "subretinal fibrosis syndrome", and 'subretinal fibrosis and uveitis syndrome.[[4], [6]] Rojas provided a very thorough and thoughtful review of this topic nearly 20 years ago[7] and agreed with the original observations of Fuchs; specifically that uveitic SRD, occurring most often in the setting of Vogt-Koyanagi-Harada (VKH) disease or sympathetic ophthalmia (SO), and chorioretinitis, due most frequently to multifocal choroiditis/punctate inner choroiditis (MFC/PIC), are the most common clinical causes of uveitic SRF.[8] Disease-specific risk factors for the development of SRF in eyes with SRD or chorioretinitis have yet to be fully explored. 12 Kuo IC, Rechdouni A, Rao NA, Johnston RH, Margolis TP, Cunningham ET Jr. Subretinal fibrosis in patients with Vogt-Koyangi-Harada disease. [Extracted from the article]

An introduction is presented in which editor discusses articles including overview of pathogenesis of familial Mediterranean fever, occurrence of ocular complications in juvenile idiopathic arthritis patients and a case study of a 62-year-old woman with tubulointerstitial nephritis with uveitis.

Purpose: To summarize the available published data regarding the treatment of JIA-associated chronic uveitis.Methods: Available peer-reviewed publications regarding the treatments of JIA-associated uveitis were read by multiple authors (RMA, EM, JET, and DH) and the data from these reports were synthesized for this review.Results: Juvenile idiopathic arthritis (JIA)-associated chronic uveitis is a significant cause of ocular morbidity and visual impairment in children, often resulting in more frequent complications and worse visual outcomes than other types of pediatric uveitis. Since not all patients respond to the first medication introduced, it is useful to have a wide range of available treatment modalities to address recalcitrant disease. Treatment options for JIA-associated uveitis have increased substantially over the past decade, particularly with the availability of newer biological agents in addition to established medication classes such as anti-inflammatories (including topical and systemic corticosteroids) and antimetabolites.Conclusions: Although data are increasing regarding biologic agents, definitive randomized prospective clinical trials would be helpful to determine their optimal dose, frequency, treatment duration, and long-term safety in children. [ABSTRACT FROM AUTHOR]

An introduction is presented in which editor discusses various articles within the issue on topics including features of patients diagnosed with posterior scleritis, use of enhanced depth anterior segment optical coherence tomography and use of oral flurbiprofen to treat patients of scleritis.