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At least 19 recordsLinked to original sources
PubMed1991

Use of steroids and immunosuppressive drugs in the management of posterior uveitis.

Posterior uveitis can occur in all age-groups and often has devastating effects on vision. The visual loss can have a variety of causes including cataract formation, vitritis, optic nerve damage and macular oedema. In patients with active inflammatory disease resulting in reduced vision, steroids are still the best drug but cyclosporin is becoming widely used in combination with steroid therapy, in patients who do not respond to steroids alone or in whom the dose of steroids required to control the disease process is unacceptably high. Cyclosporin works specifically on activated T-lymphocytes and does not therefore result in bone marrow suppression like the more conventional immunosuppressive drugs. This paper discusses the indications for treatment in patients with posterior uveitis and how to use steroids, cyclosporin and other immunosuppressive drugs in the management of this condition.

Administration, Oral↗
PubMed2004

Experience with cyclosporine in endogenous uveitis posterior.

Treatment with cyclosporine (CsA) has considerably improved the visual prognosis of patients suffering from endogenous posterior uveitis (EPU). However, the therapeutic benefits of CsA are partially outweighed by its many side effects, most notably nephrotoxicity and hypertension. Low-dose CsA regimens have reduced toxicity but have not been able to completely eliminate this problem. New therapeutic approaches, such as anti-tumor necrosis factor alpha treatment or immunosuppression with drugs including tacrolimus, sirolimus, and interleukin-2 receptor antibodies, are currently under evaluation. Hopefully such strategies will further reduce the morbidity of EPU and minimize the adverse effects associated with conventional therapies.

Cyclosporine↗
PubMed1996

Tubulo-interstitial nephritis-uveitis (TINU)-syndrome with posterior uveitis.

A case of TINU-syndrome with complications in the posterior segment is reported. A 15-year old boy presented, eight months after an acute tubulo-interstitial nephritis, a bilateral anterior uveitis, followed by an unilateral posterior uveitis with papillitis. The treatment with oral and topical corticosteroids was successful.

Acute Disease↗
PubMed1992

Quantification of the ocular response to treatment in posterior uveitis.

Twenty patients with posterior uveitis were studied by anterior segment fluorophotometry to determine whether there was a relationship between the degree of breakdown of the blood-aqueous barrier and the clinical recovery of posterior uveitis. In individual eyes the degree of breakdown and recovery of the blood-aqueous barrier (as measured by changes in the anterior chamber fluorescein concentration) followed the resolution and relapse of disease making it possible to quantify the ocular response to treatment.

Adult↗
PubMed1997

The differential diagnosis of posterior uveitis.

The diagnosis of posterior uveitis can be established in most cases on the basis of (1) morphology of the lesion, (2) the mode of onset and course of the disease, and (3) the association with other systemic diseases. The differential diagnosis of posterior uveitis include the following entities: (1) the viral infections, (2) the bacterial infections, (3) the parasitic infections, (4) the fungal infections, (5) the autoimmune diseases, and (6) the diseases of unknown origin.

Autoimmune Diseases↗
PubMed1989

An investigation of the general immune status and specific immune responsiveness to retinal-(S)-antigen in patients with chronic posterior uveitis.

Immunological abnormalities in endogenous posterior uveitis are widely reported but difficult to verify. We have therefore studied several immunological parameters in 14 patients with chronic posterior uveitis and compared the results with 14 healthy controls. Both the general immune status and the specific immune responsiveness to retinal S-antigen have been investigated. Results for the patient group as a whole were not significantly different from the control group. However the patients with severe eye disease (n = 4) had a reduced proliferative response to streptokinase-streptodornase antigen and two further individuals showed a general deficiency in functional cell mediated immunity. Circulating T-helper cells were marginally but not significantly reduced in patients. Responsiveness to bovine retinal S-antigen varied to a similar degree in both the patient and control groups. These findings indicate that, although severe uveitis may be associated with functional defects in cellular immunity in certain cases, in general the measurement of immune responsiveness of peripheral blood lymphocytes is unlikely to aid in the diagnosis or management of chronic posterior uveitis.

Adolescent↗
PubMed2003

Vitreous surgery in the management of chronic endogenous posterior uveitis.

OBJECTIVES: There is evidence that pars plana vitrectomy (PPV) has a beneficial effect on the clinical course of chronic endogenous posterior uveitis (EPU) possibly by physically removing any resident inflammatory cells with the vitreous. We assessed the anatomical and therapeutic effects of PPV performed on patients with chronic EPU for any indication. PATIENTS AND METHODS: Retrospective review of 41 eyes of 38 consecutive patients with EPU who underwent a PPV for any reason, over a 5-year period. The mean age of the patients was 36.2 years, 46% of the eyes had intermediate uveitis, 32% panuveitis, and 22% posterior uveitis. The visual acuity, disease activity, and the requirement for medications to control it were recorded for 12 months pre- and postoperatively. RESULTS: Overall, 61% of the eyes gained more than 2 Snellen lines (P<0.001) and the incidence of cystoid macular oedema (CMO) significantly reduced from 44 to 20% (P<0.05). Postoperatively, there was a significant decrease in the recurrence rate of intermediate uveitis, posterior uveitis, and panuveitis (P<0.001). The use of systemic and local depot immunosuppressive agents did not change over the study period, although the use of topical agents increased (P<0.05). CONCLUSION: PPV appears to have a beneficial effect on the clinical course of EPU in selected cases. This may be mediated by the physical clearance of inflammatory debris, the anti-inflammatory effect of replacing vitreous by aqueous humour, by a reduction of CMO and/or the anatomical correction of sight-threatening retinal pathology.

Adolescent↗
PubMed2006

Pseudouveitis--analysis of cases misdiagnosed as posterior uveitis.

PURPOSE: Analysis of non-uveitic entities that were referred as posterior uveitis to a uveitis referral center. METHODS: We came across and analyzed 32 cases of non-uveitic entities (1.12%) that had been misdiagnosed and referred as posterior uveitis out of 2846 outpatient cases of posterior uveitis registered from 1990 to June 2002. The final diagnosis was achieved by history, slit-lamp biomicroscopy, meticulous fundus evaluation, imaging, and ancillary studies. RESULTS: The finally diagnosed 32 non-uveitic entities that mimicked posterior uveitis were multiple leak central serous retinopathy (n = 8; 25%), choroidal neovascular membrane (n = 6; 18.75%), typical central serous retinopathy (n = 4; 12.5%), dry form of age-related macular degeneration (n = 3; 9.3%), retinitis pigmentosa (n = 3; 9.3%), heredomacular degeneration (n = 3; 9.3%), myelinated nerve fibers (n = 2; 6.2%), malignant melanoma of the choroid (n = 1; 3.1%), old spontaneously reattached retinal detachment (n = 1; 3.1%), and subhyaloid hemorrhage (n = 1; 3.1%). CONCLUSION: The purpose of the study was to underline the fact that there are some non-uveitic entities that mimic posterior uveitis and that an ophthalmologist can be deceived. The study highlights the problems diagnosing posterior uveitis and presents an algorithm of diagnostic approach to avoid misdiagnosis.

Adult↗
PubMed1994

T lymphocyte effector mechanisms in the retina in posterior uveitis.

Loss of vision in posterior uveitis is often the consequence of chronic retinal oedema and immune-mediated damage to the retinal parenchyma. Research in other putative autoimmune diseases such as rheumatoid arthritis, and in animal models of autoimmune disease, has uncovered a number of mechanisms which may contribute to the development of inflammatory disease within the eye. With recent developments in specific anti-cytokine therapy an understanding of these mechanisms, most of which are cytokine-mediated, is essential in order to plan more effective therapeutic strategies. In this paper we review recent research investigating the functional characteristics of the T cells which are recruited into the retina in experimental autoimmune uveoretinitis, including activation status, antigen-specific proliferation in vitro and cytokine mRNA production in the inflamed retina.

Animals↗
PubMed1992

Immunopathology and altered immunity in posterior uveitis in man: a review.

Posterior uveitis is thought to be a T-cell mediated disease since active foci of inflammation, identified in eyes enucleated for the complications of intraocular inflammation, are found to be predominantly composed of CD4+ T-cells. Few B-cells and little immunoglobulin are found suggesting that antibody and immune complex deposition do not play a major role in perpetuating the inflammatory process. As ocular biopsy is not a feasible method for monitoring disease activity and response to treatment, parameters of T-cell activation and retinal damage have been studied in the peripheral blood. These have included antibody and T-cell sensitisation to retinal S-antigen, serum soluble IL-2 receptors and IL-2 receptors on activated T-cells. none of these parameters, however, have been found to be useful in the monitoring of ocular disease activity alone or in the prediction of disease relapse.

Antigen-Antibody Complex↗
PubMed2003

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 Behçet'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.

Adult↗
PubMed2001

Syphilitic posterior uveitis: correlative findings and significance.

Twenty-one patients with syphilitic posterior uveitis were investigated retrospectively to study the disease spectrum, associations with neurosyphilis, and therapeutic implications. Ophthalmologic manifestations of syphilitic posterior uveitis are differentiated into acute and chronic uveitides. The several distinct acute uveitic syndromes are usually florid and are associated with early syphilis, with VDRL-positive syphilitic meningitis, and frequently with human immunodeficiency virus coinfection. The chronic posterior uveitides are often insidious, a manifestation of late syphilis, and associated commonly with subclinical neurosyphilis. All patients with acute cases and 54% of patients with chronic cases in our study received penicillin therapy appropriate for neurosyphilis. The frequent association of syphilitic posterior uveitis with neurosyphilis and the analogous spirochetal sequestration beyond the blood-brain and the blood-ocular barriers suggest that all patients with syphilitic posterior uveitis, irrespective of ocular disease intensity, should undergo evaluation of cerebrospinal fluid and be treated with penicillin regimens appropriate for neurosyphilis.

Acute Disease↗
PubMed1996

[Indocyanine green angiography in posterior uveitis].

BACKGROUND: Indocyanine-green (ICG) angiography gives additional information in posterior inflammatory conditions by enabling to analyse the choroid. It may become a useful work-up procedure in inflammatory diseases predominantly involving the choroid. Our purpose was to analyse ICG findings and correlate them to fluorescein angiographic and clinical findings in posterior uveitis. PATIENTS AND METHODS: In patients with posterior uveitis involving the choroid, ICG angiography is performed routinely in addition to the usual uveitis work-up. We report on the ICG angiography features found in sarcoidoses (6 cases), birdshot chorioretinopathy (4 cases), multiple evanescent white dot syndrome (MEWDS, 2 cases), Vogt-Koyanagi-Harada disease (2 cases) and multifocal choroiditis (2 cases). RESULTS: The hypofluorescent lesions characteristic for choroidal lesions were seen in all 5 analyzed entities. They corresponded either to active inflammatory lesions or to atrophic areas of the choroid. To distinguish between these 2 situations correlation between clinical findings, fluorescein angiography and ICG angiography was necessary. Except for multifocal choroidits where hypofluorescent areas corresponded essentially to atrophic areas, ICG angiography showed inflammatory choroidal lesions not seen clinically or by fluorescein angiography. ICG hyperfluorescence in the late phase of angiography seemed to be a sign for recent or acute inflammatory involvement. CONCLUSION: ICG angiography was helpful to assess choroidal involvement and disease progression in 4 of the posterior inflammatory disorders examined and will probably prove useful in the work-up of most posterior uveitis involving the choroid.

Angiography↗
PubMed1992

Distribution of IL-2R and CD45Ro expression on CD4+ and CD8+ T-lymphocytes in the peripheral blood of patients with posterior uveitis.

Different lines of evidence support a major role for activated T-lymphocytes in the pathogenesis of posterior uveitis. The initial site of activation of these autoreactive T-cells, either locally in the eye or in the peripheral immune compartment, is still unknown. This study was undertaken to investigate whether with currently available techniques, it is possible to detect alterations in the levels and subsets of activated T-cells in the peripheral blood of patients with posterior uveitis. For this reason, 3-colour immunofluorescent staining was performed to assess the distribution of IL-2 receptors (IL-2R) and the CD45RO-antigen on CD4+ and CD8+ subsets of peripheral blood lymphocytes (PBLs) from patients with posterior uveitis (n = 29). Only the subgroup of patients with posterior uveitis as part of a systemic immune-mediated disease (sarcoidosis, Behçet's disease) (n = 9) showed a significant increase in IL-2R expression on peripheral blood lymphocytes (p less than 0.005) when compared to normals (n = 12). This increased expression was reflected much more significantly in the CD4+ (p less than 0.0005) rather than in the CD8+ subset (p less than 0.05) of lymphocytes. In contrast, no significant increase in CD45RO expression on either subset of T lymphocytes was found in any subgroup of posterior uveitis in comparison with normals.

Antibodies, Monoclonal↗
PubMed2004

Clinical trial to compare efficacy and side-effects of injection of posterior sub-Tenon triamcinolone versus orbital floor methylprednisolone in the management of posterior uveitis.

AIM: To compare the efficacy and side-effects of posterior sub-Tenon injection of triamcinolone acetonide (Kenalog) with orbital floor injection of methylpredisolone acetate (Depomedrone) in the management of posterior uveitis. METHODS: Non-randomized comparative prospective clinical study. Sixty-four eyes from 60 consecutive patients with non-infectious posterior uveitis requiring treatment were allocated on an alternate 1:1 basis to receive either orbital floor methylprednisolone or sub-Tenon triamcinolone using standard procedures and assessed at 6 and 12 weeks. RESULTS: After five eyes of five patients who had received the same treatment bilaterally were excluded from the statistical analysis, 14 out of 29 eyes treated with orbital floor methylprednisolone and 10 out of the 30 eyes given sub-Tenon triamcinolone improved at 6 weeks. There was no statistically significant difference in the improvement rate between the two groups. However, two patients given triamcinolone had prolonged upper lid ptosis, which required surgery, and another two developed markedly raised intraocular pressure, neither of which occurred in the methylprednisolone-treated group. CONCLUSIONS: Although the two drugs and routes compared were of similar efficacy, lid ptosis occurred in the triamcinolone-treated but not the methylprednisolone group. This should be borne in mind when choosing the preferred route of delivery of periocular corticosteroid in the treatment of posterior uveitis.

Blepharoptosis↗
PubMed1998

[Comparative laser tyndallometry and fluorophotometry in anterior and posterior uveitis].

UNLABELLED: Recent studies have sought to quantify aqueous flare by laser flare measurement. An increase in aqueous flare caused by a rise of protein concentration was frequently found both in anterior and posterior segment disease. This has been interpreted as a break-down of the blood--aqueous barrier (BAB). By measuring the diffusion coefficient of the BAB compared to the aqueous flare value in patients with anterior and posterior uveitis, the extent to which the increase in flare value was related to a possible break down of the BAB was examined. PATIENTS: Thirty-nine normal eyes (23-78 years; 41.6 +/- 18.6), 18 eyes with anterior uveitis (iritis, iridocyclitis; 18-57 years; 35.2 +/- 12.4) and 29 eyes with posterior uveitis (chorioretinitis or retinochorioditis; 18-51 years; 31.7 +/- 10.5). The diffusion coefficient P(a) of the BAB was measured fluorophotometrically, while the flare value was quantified by laser flare measurement. RESULTS: Flare values (1/ms) were found to be significantly increased (p < 0.001) compared to normal eyes (4.6 +/- 1.7) both in anterior uveitis (20.9 +/- 8.5) and in posterior uveitis (17.4 +/- 8.3) but did not significantly differ between them (p = 0.43). The diffusion coefficient P(a) (10(-3)/min) of the BAB was not significantly different (p > 0.05) between normal eyes (0.5 +/- 0.2) and eyes with posterior uveitis (0.9 +/- 0.7), whereas it was significantly increased (p < 0.001) in anterior uveitis (6.5 +/- 5.4) compared to the other groups. CONCLUSIONS: (1) In posterior uveitis, an increased flare value is not necessarily correlated with a breakdown of the BAB; proteins may enter the aqueous from posterior. (2) Assessing the function of the BAB in posterior segment disease using laser measurement should be carried out with caution; if possible, permeability measurements of the BAB should be undertaken separately.

Adolescent↗
PubMedDate not supplied

[Etiopathogenic characteristics of posterior uveitis in children].

Nine children with acute posterior uveitis were treated for period of 3 years (3.2% of all children treated during that period). The authors speak in favor of the investigation of the HLA-system and the analysis of humoral and cellular immunologic parameters. In this study they present the relationship between these characteristics and the clinical diagnosis. Three of 9 children have with eye diseases associated HLA-B5 and HLA-B12 antigens and grave consequences for the sight of both eyes already as children. The results of immunologic tests in the examined group compared to the control group differ significantly in the total number of lymphocytes, total number of B lymphocytes and serum values of IgG, as well as C3 values of complement component (P < 0.05). Seen in percentage, however, the ratio of T to B lymphocytes, as well as the total number of leukocytes don't show significant differences. We consider that a proper and well-aimed history and complete etiologic detection according to the protocol have contributed to a clearer understanding and better insight into the prognosis of our patients.

Acute Disease↗
PubMed2006

Rapid progression of diabetic retinopathy in eyes with posterior uveitis.

PURPOSE: To report on two patients who developed rapid progression of asymmetric diabetic retinopathy (DRP) in eyes affected by posterior uveitis in contrast to their fellow eyes not affected by uveitis. DESIGN: Observational case report. METHODS: Two patients with diabetes mellitus (DM) and unilateral uveitis underwent repeated ophthalmologic examinations and fluorescein angiography. RESULTS: Two patients with DM and unilateral posterior uveitis developed proliferative DRP in eyes with previous uveitis within 3 months after the uveitis subsided. In contrast, the retinal findings of nonuveitic eyes remained unchanged on follow-up of several years. CONCLUSIONS: Since the pathogenesis of intraocular inflammation and diabetic retinopathy acts through similar biochemical mediators and pathways, it is feasible that posterior uveitis accelerates the progression of diabetic retinopathy. Our results support this hypothesis and point out a risk for rapid retinopathy development in eyes affected with posterior uveitis.

Adult↗