Download ARVO 2015 Annual Meeting Abstracts 518 Clinical studies in ocular

ARVO 2015 Annual Meeting Abstracts
518 Clinical studies in ocular infection and immunity
Thursday, May 07, 2015 8:30 AM–10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 5754–5800/C0215–C0261
Organizing Section: Immunology/Microbiology
Contributing Section(s): Anatomy/Pathology, Clinical/
Epidemiologic Research, Eye Movements/Strabismus/Amblyopia/
Neuro-Ophthalmology
Program Number: 5754 Poster Board Number: C0215
Presentation Time: 8:30 AM–10:15 AM
A Case-Control Study of Herpes Zoster Ophthalmicus: Bronx
Epidemiology of HIV Eye Studies (BEHIVES)
Marianna Atiya1, David Poulsen1, Ethan K. Sobol1, Grace Honik2,
Jose Diaz1, Jonathan Powell2, David C. Gritz2, 1. 1Albert Einstein
College of Medicine, Bronx, NY; 2Ophthalmology and Visual
Sciences, Montefiore Medical Center, Bronx, NY.
Purpose: Herpes zoster ophthalmicus (HZO) has an estimated
incidence of 1.5 to 6.4 cases per 100,000 persons per year in the
general population. The purpose of this retrospective case-control
study is to examine the risk of developing HZO among patients who
are positive for human immunodeficiency virus (HIV), and among
patients with history of atopic disease.
Methods: This study utilized hospital-based controls for the study
period from May 1, 2006 to May 31, 2014. Inclusion criteria involved
Bronx residents diagnosed with new-onset HZO during the eight-year
study period at Montefiore Medical Center. Hospital-based controls
were drawn from unique outpatients visits at Montefiore Medical
Center during the study period. Controls were chosen randomly in
a 4:1 ratio and were time-matched to HZO cases. Medical records
were reviewed to confirm inclusion criteria and the data were used
to calculate odds ratios for developing HZO in HIV-positive patients
and in patients with history of atopic disease.
Results: 170 patients were diagnosed with new-onset HZO during
the study period. Compared to hospital-based controls (n=680), HIV
infection was shown to increase the odds of HZO by 6.63 (95% CI
2.96-14.8, p<0.001), and history of atopic disease was shown to
increase the odds of HZO by 2.55 (95% CI 1.50-4.37, p=0.001).
Conclusions: Infection with HIV and history of atopic disease are
significant risk factors for having a new-onset case of HZO. This is a
particularly important association in the Bronx, where the prevalence
of HIV infection is over 3.6 times greater than in the United States
overall.
Commercial Relationships: Marianna Atiya, None; David
Poulsen, None; Ethan K. Sobol, None; Grace Honik, None; Jose
Diaz, None; Jonathan Powell, None; David C. Gritz, None
Program Number: 5755 Poster Board Number: C0216
Presentation Time: 8:30 AM–10:15 AM
Incidence of Herpes Simplex Eye Disease: Results from the
Pacific Ocular Inflammation (POI) Study
Durga S. Borkar1, 2, Vivien M. Tham3, John V. Parker4, Aileen
Uchida4, Aleli C. Vinoya4, Nisha Acharya1. 1F I Proctor
Foundation, Univ of California, San Francisco, San Francisco, CA;
2
Massachusetts Eye and Ear Infirmary, Boston, MA; 3Pacific Vision
Institute of Hawaii, Honolulu, HI; 4Kaiser Permanente Hawaii,
Honolulu, HI.
Purpose: To provide a population-based estimate of the incidence of
herpes simplex eye disease with comparisons across racial, gender,
and age groups.
Methods: The electronic medical record of Kaiser Permanente
Hawaii between January 1, 2006 and December 31, 2007, was
searched for International Classification of Diseases, 9th Edition
(ICD9) codes corresponding to herpes simplex eye disease. Chart
review was performed to confirm a diagnosis of herpes simplex eye
disease and to collect information on specific ocular manifestations.
Incidence rates were calculated per 100,000 person-years for the
entire population, as well as for age-, gender-, and race-specific
subgroups using a dynamic population model.
Results: In the Kaiser Hawaii population of 217,061 people,
ninety-four cases of herpes simplex eye disease were identified.
The overall incidence was 21.7 per 100,000 person-years (95%
confidence interval (CI): 17.5-26.5). For people 65 years of age and
over, the incidence rate was 37.4 per 100,000 person-years (95%
CI: 22.8-57.7), approximately twice the remainder of the population
(p=0.01). The most common manifestation of herpes simplex eye
disease was keratitis, followed by dermatitis and conjunctivitis. The
incidence of herpes simplex eye disease for Asians was 15.2 per
100,000 person-years (95% CI: 10.3- 22.0), which was significantly
lower than the rate for non-Asians (p=0.02). Prior and current use
of immunosuppressant medications were found to be risk factors for
herpes simplex eye disease.
Conclusions: These results provide a population-based estimate
of herpes simplex eye disease in the Hawaiian population and
demonstrate differences across age and racial subgroups. Various
genetic and environmental factors may explain these differences.
Commercial Relationships: Durga S. Borkar, None; Vivien M.
Tham, None; John V. Parker, None; Aileen Uchida, None; Aleli C.
Vinoya, None; Nisha Acharya, None
Support: Nisha Acharya, MD, MS: NEI U10 EY021125-01, UCSF
Research Evaluation and Allocation Committee Award; UCSF
Department of Ophthalmology: NEI EY02162, Research to Prevent
Blindness unrestricted grant
Program Number: 5756 Poster Board Number: C0217
Presentation Time: 8:30 AM–10:15 AM
Herpes zoster ophthalmicus and associations with ocular
complications: Bronx Epidemiology of HIV Eye Studies
(BEHIVES)
Jonathan Powell, Marianna Atiya, David Poulsen, Ethan K. Sobol,
Jose Diaz, David C. Gritz. Ophthalmology, Albert Einstein College
of Medicine/Montefiore Medical Center, Bronx, NY.
Purpose: Herpes zoster ophthalmicus (HZO) has potentially serious
ocular complications. There is little data published on the strength
of association of risk factors for developing ocular complications.
We explored several risk factors potentially associated with
the development of iritis, keratitis, blepharoconjunctivitis, and
postherpetic neuralgia (PHN) for individuals with HZO.
Methods: A comparative, retrospective investigation among HZO
patients in the Bronx was performed. Cases of HZO from June 1,
2006 through May 31, 2014 were identified using Montefiore’s
Clinical Looking Glass software (CLG), which compiles medical
information for all individuals within the hospital outpatient system.
The inclusion criteria consisted of a clinical diagnosis of HZO and
Bronx residency. Relevant demographic and clinical information
was extracted from the CLG database and confirmed through chart
review. Potential associations evaluated included age, gender,
HIV status, diagnosis of diabetes and atopy, and presence of the
Hutchinson’s sign. Firth logistic regression modeling was used to
determine any significant associations between HIV status and other
potential risk factors for each outcome of interest. Odds ratios (OR)
and 95% confidence intervals (95% CI) were calculated to estimate
relative risk.
Results: The study group included 155 patients with HZO. While
controlling for confounders, HIV status was significantly associated
with the development of iritis (p=0.0275) and keratitis (p = 0.0013).
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
The adjusted OR estimates for iritis and keratitis manifestations
among HIV cases were 3.163 (95% CI: 1.146 to 8.648) and 5.230
(95% CI: 1.963 to 14.389) respectively. Also, HIV infection
had an estimated OR of 4.067 (95% CI: 1.469 to 12.910) for the
development of at least one of the four ocular complications while
adjusting for Hutchinson’s sign and age.
Conclusions: The presence of HIV was correlated with an increased
risk of developing various ocular complications for individuals with
HZO. To our knowledge, this study represents the first time the
strength of association has been measured between HIV status and
the onset of iritis, keratitis, blepharoconjunctivitis, and PHN among
HZO cases.
Commercial Relationships: Jonathan Powell, None; Marianna
Atiya, None; David Poulsen, None; Ethan K. Sobol, None; Jose
Diaz, None; David C. Gritz, None
Program Number: 5757 Poster Board Number: C0218
Presentation Time: 8:30 AM–10:15 AM
Herpes simplex virus disease of the anterior segment in children
Juan Carlos Serna-Ojeda, Arturo J. Ramirez-Miranda, Alejandro
Navas, Aida Jimenez-Corona, Enrique O. Graue. Ophthalmology,
Institute of Ophthalmology “Conde de Valenciana””, Mexico City,
Mexico.
Purpose: To analyze the clinical presentation, characteristics,
treatment with topic and oral acyclovir, recurrences and final
outcomes and complications of patients aged 17 or younger with
herpes simplex virus disease of the anterior segment.
Methods: An observational and retrospective study was performed
with review of the medical records of all the children with
diagnosis of herpes simplex infection of the anterior segment at an
ophthalmologic reference center in Mexico City, from 2002 to 2012.
Patients were diagnosed based in history and examination, and in
specific cases with viral culture and polymerase chain reaction test.
Patients were treated with topical or oral acyclovir according to the
clinical presentation. Recurrent disease was analyzed with KaplanMeier curves. Main outcome measures included: final visual acuity,
bilaterality, recurrent disease and surgical procedures performed.
Results: One hundred and three patients were included with a median
age at presentation of 9 years, from which 6 had a bilateral and
simultaneous disease. The median follow up time was 18 months
(range 18 days - 12 years). The most common clinical manifestation
was epithelial dendritic keratitis in 42 eyes (38.5%) with 15 patients
presenting multiple forms of herpes simplex virus disease. Recurrent
disease was evident in 42 (38.5%) of the eyes. Eight patients
underwent a penetrating keratoplasty at a median age of 15 years.
The median final visual acuity in the group of patients was 20/40.
Conclusions: In this paper, one of the largest series of pediatric
population with herpes simplex virus of the anterior segment, we
conclude that these patients have a high rate of epithelial dendritic
manifestation and recurrent disease.
Commercial Relationships: Juan Carlos Serna-Ojeda, None;
Arturo J. Ramirez-Miranda, None; Alejandro Navas, None; Aida
Jimenez-Corona, None; Enrique O. Graue, None
Methods: Retrospective review of uveitis cases seen at the
University of Virginia from 1984-2014. Descriptive statistics, and,
where applicable, Fisher’s exact test and exact logistic regression
analysis were used to report demographics, anatomical/etiological
classification of uveitis, clinical features, and management.
Results: 491 patients (644 eyes) were included. Mean age was 47
years (±21) at presentation. 278 (56.6%) patients were female, 153
(31.2%) patients had bilateral disease. 60.5% were Caucasian, 28.3%
were African American. Mean duration of follow-up was 5 years
(±6.7). The most frequent anatomic type was undifferentiated anterior
uveitis (n=126, 25.7%), followed by undifferentiated panuveitis
(n=21, 4.3%). The most common etiology was post-traumatic (n=60,
12.2%) followed by post-procedural (n=49, 10.0%) and herpetic
anterior uveitis (n=39, 7.9%). Herpetic disease was more common
among Caucasians (n=32, 10.8%) than African Americans (n=2,
1.5%) (gender-adjusted odds ratio (OR): 7.69, 95% CI [2.12, 50.00]),
and sarcoidosis was more common among African Americans (n=23,
17.2%) than Caucasians (n=9, 3.0%) (gender-adjusted OR: 6.54, 95%
CI [2.98, 15.29]). Herpetic anterior uveitis was more common among
females (n=30, 10.8%) than males (n=9, 4.2%) (race-adjusted OR:
3.03, 95% CI [1.32, 7.71]). Mean logMAR acuity was 0.54 and 0.52
at initial and final visits, respectively (P=0.002). 388 (79%) and 133
(27.3%) patients received local and systemic steroids, respectively.
52 (10.6%) patients received an antimetabolite.116 (23.7%) patients
were managed with topical glaucoma medication. 43 (8.8%), 129
(26.4%), and 46 (9.4%) patients underwent glaucoma surgery,
cataract surgery, and vitrectomy, respectively.
Conclusions: Undifferentiated anterior, traumatic, post-procedural,
herpetic disease, HLA-B27 disease, and sarcoidosis were most
common causes of uveitis. Sarcoidosis was more commonly seen
in African American males, herpetic anterior uveitis was more
frequently seen in Caucasian females. Mean visual acuity improved
significantly for the cohort from initial to final visit with majority
receiving local or systemic corticosteroids.
Program Number: 5758 Poster Board Number: C0219
Presentation Time: 8:30 AM–10:15 AM
Epidemiology of Uveitis at a Tertiary Eye Center in the MidAtlantic United States.
Susan Osmanzada, Diba Osmanzada, Asima Bajwa, James Patrie,
xin wenjun, Ashvini Reddy. Ophthalmology, University of Virginia,
Charlottesville, VA.
Purpose: To report demographic, etiologic, and clinical features of
patients with uveitis seen at a tertiary care center in central Virginia.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Table 1: Specific uveitis diagnoses
Table 2: Multivariate analysis for race and gender
Commercial Relationships: Susan Osmanzada, None; Diba
Osmanzada, None; Asima Bajwa, None; James Patrie, None; xin
wenjun, None; Ashvini Reddy, None
Program Number: 5759 Poster Board Number: C0220
Presentation Time: 8:30 AM–10:15 AM
Validation of ICD-9 Codes Used in the Pacific Ocular
Inflammation (POI) Study
Priya Janardhana1, Nisha Acharya1, Durga S. Borkar1, Vivien M.
Tham2, John V. Parker3, Aleli C. Vinoya3, Aileen Uchida3, Erica
Browne1. 1Ophthalmology, Proctor Foundation, UCSF, San Francisco,
CA; 2Pacific Vision Institue of Hawaii, Honolulu, HI; 3Kaiser
Permanente Hawaii, Honolulu, HI.
Purpose: To assess the validity of International Classification
of Diseases, 9th Edition (ICD9) codes used in the Pacific Ocular
Inflammation Study, a population-based study using the electronic
medical records of Kaiser Permanente Hawaii to investigate the
epidemiology of ocular inflammatory disease in the Hawaiian islands.
Methods: The electronic record system of Kaiser Permanente Hawaii
was searched for any visit from January 1, 2006 to December 31,
2007 that referenced an ICD9 code that might be associated with a
diagnosis of uveitis. The inclusive list of diagnosis codes used for this
study was adapted from two prior uveitis incidence and prevalence
studies using administrative data. A subset of these ICD9 codes
included all diagnoses codes pertinent to herpes zoster ophthalmicus
(HZO). Subsequently, all charts from this electronic query were
individually reviewed by a uveitis specialist (NRA) to confirm a
diagnosis of uveitis, as well as HZO.
Results: Of the 873 patients identified as possibly having uveitis
by ICD9 codes, 224 cases were confirmed as uveitis patient after
medical record review. In our study, the most accurate ICD9 codes
in identifying uveitis cases were herpes simplex iridocyclitis,
54.44 (75%), histoplasmosis retinitis, 115.92 (100 %), panuveitis,
360.12 (92%), disseminated chorioretinitis, 363.13 (100%), pars
planitis, 363.21 (100%), Harada disease, 363.22 (100%), recurrent
iridocyclitis, 364.02 (96%), and granulomatous uveitis, 364.1 (81%).
Sixty-nine patients had an accurate uveitis diagnosis using ICD9 code
364.04, secondary iridocyclitis noninfectious. However, using this
ICD9 code also contributed 122 patients with an inaccurate diagnosis
of uveitis after chart review and only had an accuracy of 36%. Using
ICD9 codes specific to HZO yielded 152 patients through electronic
search. After chart review, 138 had a confirmed diagnosis of HZO.
Overall, HZO codes had an accuracy of 91%.
Conclusions: With the increased use of data from electronic
medical records for research, it is important to validate whether
ICD9 diagnoses are accurate. These results suggest that in Kaiser
Permanente Hawaii, using ICD9 codes alone to capture uveitis
diagnoses is not always accurate. Chart review, as was done in
this study, can help further elucidate accurate diagnoses. However,
electronic search for ICD9 codes alone can be an accurate method for
identifying cases of HZO.
Commercial Relationships: Priya Janardhana, None; Nisha
Acharya, None; Durga S. Borkar, None; Vivien M. Tham, None;
John V. Parker, None; Aleli C. Vinoya, None; Aileen Uchida,
None; Erica Browne, None
Program Number: 5760 Poster Board Number: C0221
Presentation Time: 8:30 AM–10:15 AM
Management and Outcomes of Uveitis in a Tertiary Eye Center
Over 30 Years
Chang Sup Lee1, Asima Bajwa1, James Patrie2, Wenjun Xin2, Ashvini
Reddy1. 1Ophthalmology, University of Virginia, Charlottesville, VA;
2
Biostatistics, University of Virginia, Charlottesville, VA.
Purpose: To report the long-term, clinical outcomes of patients with
uveitis managed in a tertiary medical center at University of Virginia
over a 30 year period.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Methods: Retrospective, observational study of patients with uveitis
seen at the University of Virginia from 1984-2014. Descriptive
statistics and, where appropriate, Wilcoxon Rank Sum test and
Pearson’s Exact Chi-Square test were used to analyze demographics,
laterality, anatomic location, etiology, total number of visits, change
in best-corrected visual acuity (BCVA), management, intraocular
pressure (IOP), and cataract.
Results: The study included 644 eyes of 491 patients. 153 patients
(31.2%) had bilateral disease and 213 (43.4%) were male. Mean age
was 51.7±1.1 (SE) years at presentation. The mean number of visits
per patient was 11.2±14.8 (median 6.0; range, 1.0–155).
The mean BCVA was 0.54±0.03 logMAR at initial presentation and
0.52±0.04 logMAR (P=0.002) at last follow-up. Change in mean
visual acuity from presentation to last follow-up was not statistically
significant for anterior (0.44±0.04 to 0.45±0.04, P=0.058), posterior
(1.07±0.13 to 0.99±0.13, P=0.197) and panuveitis (0.43±0.05 to
0.45±0.08, P=0.216). For patients with intermediate uveitis, the
mean BCVA significantly improved by the final visit (0.61±0.17 and
0.27±0.07, P=0.038). Severe vision loss (>1.0 logMAR) was rarely
seen with traumatic uveitis and HLA-B27-associated anterior uveitis.
Local steroids were given to 365 patients (74.6%) and systemic
steroids to 133 (27.3%). Antimetabolites were used in 52 (10.6%)
patients and anti-tumor necrosis factor agents in 17 (3.5%).
Intravitreal injection was given to 54 patients (11.1%); subtenon
injection was given to 23 (4.7%). Vitrectomy was performed in 46
patients (9.4%). Mean initial IOP was 15.8±6.4 mmHg, and mean
final IOP was 14.9±5.0 mmHg. 116 (23.7%) patients received
medical treatment for ocular hypertension (IOP>21 mmHg), and 43
(8.8%) patients underwent glaucoma surgery. 129 (26.4%) patients
underwent cataract surgery.
Conclusions: In this large series of patients with uveitis, mean
BCVA improved from initial presentation to last follow-up, and this
improvement was statistically significant. Patients with intermediate
uveitis had a better final visual acuity than those with anterior,
posterior or panuveitis. The majority of patients were managed
with local or systemic steroids, and many developed glaucoma and
cataract requiring treatment.
Commercial Relationships: Chang Sup Lee, None; Asima Bajwa,
None; James Patrie, None; Wenjun Xin, None; Ashvini Reddy,
None
Program Number: 5761 Poster Board Number: C0222
Presentation Time: 8:30 AM–10:15 AM
Pediatric uveitis in a reference Centre in Mexico.
BEATRIZ VALADEZ BLANCO, Miguel Pedroza Seres. Uvea,
INSTITUTO DE OFTALMOLOGIA FUNDACION CONDE DE
VALENCIANA, Mexico, Mexico.
Purpose: Uveitis (intraocular inflammation) is an important cause of
blindness in México, 5% to 10% of the cases occurs in children. We
performed this study to know about the relative occurrence of uveítis,
the disease characteristics and its causes in pediatric population.
Methods: Observational and retrospective clinical study was
performed, we analyzed the data of 8 years (January 2007 to August
2014) from 357 patients with uveitis in a reference centre in Mexico
City and included 286 patients diagnosed from 0 to 18 years of
age, with more than one visit and specific diagnosis. Data retrieved
included age of diagnosis, gender, uveitis diagnosis, anatomic
location, and laterality. Detailed clinical information regarding the
course of uveitis included visual acuity, treatments, and if they were
already treated. The Standardization of Uveitis Nomenclature criteria
was used to report the clinical data.
Results: Out of the 276 patients with uveitis 64.69% were male and
35.31% female with a male to female ratio of 1.8 to 1, median age
at diagnosis was 10.4 years + 3.8 years, 61.54% had bilateral ocular
involvement. Intermediate uveitis was the most common diagnosis
61.54%, followed by posterior uveitis 22.38%, anterior uveitis
14.69% and panuveitis 1.40%. The underlying cause for uveitis was
evaluated as non-infectious 70.63%, infectious 21.27% and idiopathic
2.10%. The most common etiology was pars planitis for intermediate,
parasite infestation for infectious association and the systemic disease
association was juvenile idiopathic arthritis diagnosed in 1.39%
of these children, The prevalence of legal blindness was 24.1% at
baseline and at the end of treatment 20.27%. We treated 40.91% with
corticosteroids (topical, periocular, intraocular, oral or intravenous),
38.81% received immunosuppressive drugs.
Conclusions: The results from this cohort show the spectrum of
disease in pediatric patients. There are no many studies about uveitis
in mexican population, far less in children, with this study we can
determine the clinical characteristics of uveitis in this population that
when compared with other studies there are different outcomes, like
variations in the types of uveitis; we found a high rate of pars planitis.
Commercial Relationships: BEATRIZ VALADEZ BLANCO,
None; Miguel Pedroza Seres, None
Program Number: 5762 Poster Board Number: C0223
Presentation Time: 8:30 AM–10:15 AM
Ocular complications of pediatric uveitis at a reference center in
Mexico city.
Olegario Ivan Castro Vite. uvea, Instituto de Oftalmologia Conde de
Valenciana, mexico DF, Mexico.
Purpose: To determine the rate of complications in pedriatic patients
with uveitis at a reference center.
Methods: Retrospective review of medical records of children with
uveitis diagnosed before the age of 18 years, from 2007 to 2014 in
the Department of Uveitis and Ocular Immunology at Institute of
Ophthalmology Conde de Valenciana. Age, etiological diagnosis and
development of ocular complications were evaluated.
Results: From a total of 357 patients, 276 patients were included in
the analysis. We excluded patients that had only one visit and loss of
follow-up.
Main types of uveitis were: pars planitis in 175 patients (63.4%),
toxoplasmosis in 45 patients (16.3%), herpes keratouveitis in 16
patients (5.8%), toxocariasis in 12 patients (4.3%) and idiopathic
non-granulomatous anterior uveitis in 10 patients (3.6%). One
hundred sixty-five patients (59.8%) developed one or more of the
following complications: cataract in 78 patients (19.8%), band
keratophaty in 40 patients (10.15%), epiretinal membrane in 26
patients (6.6%), glaucoma in 19 patients (4.8%) and macular edema
in 17 patients (4.3%).
Complications in the group of pars planitis (175) were: cataract in
45 patients (25.7%), band keratophaty in 22 patients (12.57%) and
epiretinal membrane in 16 patients (9.14%). The most common
complication of toxoplasmosis (45) was choroidal neovascular
membrane in 2 patients (4.4%).
In the herpes keratouveitis group (16) 5 patients (31.25%) had
corneal scarring. From the 12 patients with toxocariasis, 2 (16.6%)
developed glaucoma and 1 (8.3%) retinal detachment.
Conclusions: We found that more than 50% of pediatric patients with
uveitis developed ocular complications in the course of their disease,
one of the main reasons is because we received patients time long
after they were treated with several previous inadequate medications,
and because of the chronicity of uveitis in pediatric population.
Commercial Relationships: Olegario Ivan Castro Vite, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 5763 Poster Board Number: C0224
Presentation Time: 8:30 AM–10:15 AM
Clinical features of syphilitic uveitis in an ophthalmologic
reference center in Mexico City
Rosalva Y. Bobadilla, Ricardo Blas Medina, Daniela Castro Farias,
Elsa Maria Flores Reyes, Miguel Pedroza-Seres. Uveitis and Ocular
Inmunology, Hospital Conde de Valenciana, Coacalco, Mexico.
Purpose: To describe demographic data of patients with diagnosis of
ocular syphilis in the department of uveitis and ocular immunology
at Hospital Conde de Valenciana, an ophthalmologic reference center
in Mexico
Methods: we analize all the electronic records from January 2004
to November 2014, selecting those diagnosed with ocular syphilis.
Epidemiological data included: age at diagnosis, gender, affected
eye, follow-up period, type of uveitis, laboratory test used, treatment,
visual acuity and intraocular pression in the first and last visit, and
ocular complications.
Results: Of the 4493 patients seen in the service of uveitis and ocular
immunology from January 2004 to November 2014, 50 (1.11%)
cases were diagnosed with ocular syphilis. Thirty three (66 %) were
female and 17 (34%) men. The average age was 56.34 years (16- 87
years). Of the 50 patients, 7 (14 %) had disease only in the right eye,
12 (24 %) in the left eye, and 31 (62 %) had both eyes afected. The
clinical manifestations were: scleritis in 2 (4%) patients, anterior
uveitis in 3 (6%) patients, intermediate uveitis in 1 (2%) patient,
posterior uveitis 0 (0 %) patients and panuveitis in 44 (88%) patients.
The initial and final visual acuity was classified into 5 groups,
excellent, good, regular, bad and no functional. With T -student test
0.603.The intraocular pressure of 82 eyes was averaged in 14.47
mmHg, and the averaged of the last visit was 13.66 mm Hg, all by
Goldman tonometry .Treatments applied were: benzathine penicillin
intravenously in 9 (18%) patients, intramuscular benzathine penicillin
in 33 (66%) patients, erythromycin in 6 (12%) patients and 2 (4%)
that did not returned. Within the complications more frequently
reported were: glaucoma in 13 (26%) patients, cataract in 12 (24%),
macular edema in 5 (10%) patients, ocular hypertension in 2 (4%),
macular hole in 2 (4%), band keratopathy in 2 (4%), tractional retinal
detachment in 2 (4%) patients.
Conclusions: Uveitis caused by syphilis is a pathology observed less
frequently due to public health programs, however when present,
clinical suspicion, appropriate interrogatory and laboratory test
are important to make the diagnosis, specially in patients without
previous systemic diagnosis that have bilateral panuveitis.
Commercial Relationships: Rosalva Y. Bobadilla, None; Ricardo
Blas Medina, None; Daniela Castro Farias, None; Elsa Maria
Flores Reyes, None; Miguel Pedroza-Seres, None
Program Number: 5764 Poster Board Number: C0225
Presentation Time: 8:30 AM–10:15 AM
Fuchs Syndrome: A cross sectional study in a tertiary university
center in Argentina
Juan Pablo Fernandez1, Matias Portela1, Mariana Ingolotti1, Anahi
Lupinacci1, Cristobal A. Couto2, Mario J. Saravia1, Bernardo A.
Schlaen1. 1Ophthalmology, Hospital Universitario Austral, Buenos
Aires, Argentina; 2Oftalmologia, Universidad de Buenos Aires,
Buenos Aires, Argentina.
Purpose: To describe clinical features of patients with diagnosis of
Fuchs Syndrome in Argentina
Methods: Patients with diagnosis of Fuchs Syndrome who were seen
at Hospital Universitario Austral between June 2009 and October
2014 were included. Data recorded included, age, sex, presence
of keratic precipitates, anterior chamber cells, iris atrophy, and
complications.
Statistical analysis was carried out using excel 2012. Chi square and
Fisher exact tests were used as appropriate.
Results: Thirty three patients (12 females, 21 males) with diagnosis
of Fuchs Syndrome were included. This represented 8.04% of the
patients with diagnosis of uveitis who were seen during this period.
Average age was 41 ± 13.34 years. Bilaterality was seen in 5 patients
(15.15%). Characteristic keratic precipitates were seen in 23 out of
27 eyes (85.19%). Ten out of 33 eyes (30.3%) had 2+ or more of
anterior chamber cells. Eight out of 24 eyes (33.33%) had 2+ or more
of vitreous haze. Twenty out of 30 (66.6%) eyes had cataract. Eleven
out of 20 eyes (55.5%) underwent cataract surgery. Eyes with 2+ or
more vitreous haze had a statistically significant greater proportion
of cataract occurrence (Fisher exact test: 0.04). Eleven out of 38 eyes
had ocular hypertension (28.95%).
Conclusions: Fuchs syndrome is common in our country. Greater
degree of vitreous inflammation seems to be associated with greater
proportion of cataract occurrence.
Commercial Relationships: Juan Pablo Fernandez, None; Matias
Portela, None; Mariana Ingolotti, None; Anahi Lupinacci, None;
Cristobal A. Couto, None; Mario J. Saravia, None; Bernardo A.
Schlaen, None
Program Number: 5765 Poster Board Number: C0226
Presentation Time: 8:30 AM–10:15 AM
Clinical and Epidemiologic characteristics of Fuchs
Heterochromic Iridocyclitis in Hispanic population
ETHEL B. GUINTO ARCOS, Miguel Pedroza-Seres, Janet S. SilvaOrtiz. UVEA AND INFLAMMATORY DISEASES, INSTITUTO
DE OFTALMOLOGIA CONDE DE VALENCIANA, Mexico City,
Mexico.
Purpose: Report clinical features and epidemiologic characteristics
of the disease in a Hispanic population attending a Uveitis Service in
an Ophthalmology Center in Mexico
Methods: Retrospective case series study.We reviewed
electronicrecords from patients attending Uvea and Ocular
Inflammation Department at Instituto de Oftalmologia Fundacion
Conde de Valenciana in Mexico City from January 1st 2001
to December 1st 2014 with diagnosis of Fuchs Heterochromic
Iridocyclitis. Records had to comply with clinical data based on
criteria of Kimura. Other causes of infectious or noninfectious uveitis
were excluded
Results: We reviewed a total of 209 electronic records.We enrolled
142 eyes of 136 patients with the diagnosis of Fuch’s Heterochromic
Iridocyclitis who completed a minimum of 6 months follow
up.The mean follow up was 16±14.5 months (range 6- 60 months).
Males predominated (72/136,52.9%).The most common form
of presentation was unilateral (95.6%).The age at presentation
was 35.8±11.6 (range 12–64) years. On the clinical findings,
25.4%(36/142) showed heterochromia.All patients showed fine
stellate filamentary keratic precipitates and 70.4% (100/142) showed
mild (1-2+ cellularity and flare) anterior chamber inflammation.
Iris atrophy was seen in 67.6% (96/142) eyes. Koeppe and Bussaca
nodules were seen in 36.6%(52/142).Iris vessels were present in
3.5%(5/142).Vitreous opacities were found in 90 eyes (63.4%).
31 eyes presented elevated intraocular pressure (21.8%). 120 eyes
(84.5%) had developed cataracts, of which 38.5% (43/120) were
posterior subcapsular cataracts and 31.7% total opacities (38/120).
Best corrected visual acuity was hand movement in the majority
of cases (33.1%) at the moment of first consultation.93 eyes (65%)
underwent cataract surgery.Best corrected visual acuity was 0.5 or
better in 120/142(84.5%) of eyes at the final follow up
Conclusions: Based on the predominant clinical findings, unilateral
cataracts, fine keratic precipitates, subtle iris atrophy and mild
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
anterior chamber inflammation along with vitreous opacities
could lead to the diagnosis of Fuch’s Heterochromic Iridocyclitis
in our population. As a predominantly brown eyed population,
heterochromia is not the most prevalent feature. Recognition of this
disease in any patient of any complexion is important. This is the
first report of clinical and epidemiological features of the disease in
Hispanic Mexican population
Commercial Relationships: ETHEL B. GUINTO ARCOS, None;
Miguel Pedroza-Seres, None; Janet S. Silva-Ortiz, None
Program Number: 5766 Poster Board Number: C0227
Presentation Time: 8:30 AM–10:15 AM
Hypertension in uveitis: a case series study
Mariana Ingolotti1, Bernardo A. Schlaen1, Mario J. Saravia1, Juan
Pablo Fernandez1, Matias Portela1, Cristobal A. Couto2, Anahi
Lupinacci1. 1Hospital Universitario Austral, Pilar, Argentina;
2
Hospital de Clinicas, Capital Federal, Argentina.
Purpose: To present a case series of uveitis with ocular hypertension
and analyze the etiologies and mechanisms.
Methods: A retrospective cross-sectional study between June 2009
and October 2014 was performed. Patients with diagnosis of any
type of uveitis and IOP over 21mmHg were included. Collected data
from patients included age at presentation, gender, acute or chronic
infection, anatomic classification, etiology of the uveitis, IOP at
presentation, mechanism of IOP increase and treatment received.
Data was recorded in Microsoft Excel 2011. Odds Ratio and chi
square analysis were chosen for statistical analysis.
Results: A total of 413 patients with uveitis diagnosis were recruited.
One hundred and twenty-four (30%) patients with elevated IOP
were encountered. The anatomic distribution was anterior (52%),
diffuse (28%), posterior (18%) and intermediate (2%). The most
frequent etiologies among the anterior uveitis were herpetic (31%),
idiopathic (22%) and Fuchs iridocyclitis (14%); among the posterior
toxoplasmosis (54%) and VKH (40%) in the diffuse cases. The
most common mechanism of IOP increase was the use of corticoid
therapy (71 cases). The proportion of hypertensive uveitis was 30,6
%. Hypertensive uveitis was most commonly infectious (chi 2: 44.75
p<0.01). Chronic uveitis more frequently developed hypertension
than acute presentation (chi 2 14.10 p<0.01). One hundred and four
cases received medical treatment whereas 27 needed a surgical
intervention as well.
Conclusions: Ocular hypertension in uveitis is a common finding
that requires close follow-up and treatment. hypertensive uveitis is
more common in cases of infectious etiology.
Commercial Relationships: Mariana Ingolotti, None; Bernardo
A. Schlaen, None; Mario J. Saravia, None; Juan Pablo Fernandez,
None; Matias Portela, None; Cristobal A. Couto, None; Anahi
Lupinacci, None
62/77 patients (81%) had unilateral uveitis, and 60 patients (80%)
had insidious onset. Anterior uveitis was the most common anatomic
classification (39 patients, 51%) followed by panuveitis (20 patients,
26%), and posterior uveitis (18 patients, 23%).
The most common infectious etiology was herpetic anterior uveitis
(37 patients, 48%) followed by toxoplasma uveitis (14 patients,
18%). The most prevalent viral pathogen was herpes zoster (VZV)
(21 patients, 27%) followed by herpes simplex (HSV) (20 patients,
26%). Acute retinal necrosis (ARN) was diagnosed in 14 patients
(18%). Aqueous humor was analyzed in all 14 patients with ARN
and was positive in 7 patients (50%). Of the 14 patients with ARN,
4 tested positive for cytomegalovirus (CMV) and 3 for VZV. Only 5
patients had classic CMV retinitis (6%). 3 patients (4%) had fungal
endophthalmitis, one had syphilitic chorioretinitis (1%), and one had
tuberculous uveitis (1%).
The age distribution among different types of uveitis is shown in
Table 1. On presentation, 43 patients (56%) had a VA better than
20/40 and 17 (22%) had a VA worse than 20/200. VA at last f/u was
better than 20/40 in 39 patients (51%) and worse than 20/200 in 22
patients (29%).
Table 2 shows the VA at last f/u among the different types of uveitis.
16 (21%) and 10 (13%) of the eyes required cataract and vitrectomy
surgery, respectively. 14 of the eyes (18%) were on IOP-lowering
medications and four (5%) needed glaucoma surgery.
Conclusions: The most common type of infectious uveitis seen
over the study period was herpetic anterior uveitis secondary to
VZV or HSV, found to be most prevalent in patients above 60 yrs
old. This finding is comparable to other American epidemiologic
studies. Ocular toxoplasmosis and ARN were also common causes
of infectious uveitis. PCR of intraocular fluid yielded an etiologic
diagnosis in 50% of ARN cases. 51% of patients had a VA better than
20/40 at last f/u which could be secondary to prompt referral and
appropriate treatment.
Program Number: 5767 Poster Board Number: C0228
Presentation Time: 8:30 AM–10:15 AM
Infectious Uveitis in Virginia
Zeina A. Haddad2, Asima Bajwa2, James Patrie1, xin wenjun1, Ashvini
Reddy2. 1University of Virginia, Charlottesville, VA; 2Ophthalmology,
University of Virginia, Charlottesville, VA.
Purpose: To report the causes, clinical features, and outcomes of
infectious uveitis seen at the University of Virginia (a tertiary care
center) from 1984-2014.
Methods: Retrospective review of 491 uveitis patients. Descriptive
statistics were used to report and analyze demographic features,
diagnoses, visual acuity (VA), laboratory findings, and outcomes.
Results: 77/491 pts (16%) had infectious uveitis (mean age 58 yrs,
71% F, 77% Caucasian). Mean f/u was 5 yrs (range 4 d–30 yrs).
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Commercial Relationships: Zeina A. Haddad, None; Asima
Bajwa, None; James Patrie, None; xin wenjun, None; Ashvini
Reddy, None
Program Number: 5768 Poster Board Number: C0229
Presentation Time: 8:30 AM–10:15 AM
Characteristics, Management, and Outcomes of Traumatic
Uveitis in Virginia
John Prenshaw, Asima Bajwa, James Patrie, xin wenjun, Ashvini
Reddy. Ophthalmology, University of Virginia, Charlottesville, VA.
Purpose: To report the clinical findings, management, and outcomes
of patients with post-traumatic uveitis seen at a tertiary referral center
over a 30 year-period.
Methods: Retrospective review of patients with ocular inflammation
following blunt trauma seen at the University of Virginia from
1984 to 2014. Descriptive statistics were used to report patient
historical information, clinical findings, therapy, and outcomes.
When applicable, the paired and unpaired T-test was used to compare
subgroups.
Results: A total of 57 patients (59 eyes) were included. Age at
presentation ranged from 6 to 84 years (mean, 42.8 years). Thirtyfour patients (60%) received topical steroids, 2 (3.5%) received
systemic steroids, 5 (8.7%) required cataract surgery, 5 (8.7%)
required glaucoma medications, and 1 (1.7%) required glaucoma
surgery. Average duration of follow up was 4.48 years. Mean visual
acuity (VA) at presentation of 20/50 (logMAR 0.424) improved to
20/40 (logMAR 0.284) by the final visit, and this difference was
statistically significant (P =0.015). Poor final VA (worse than 20/50)
was associated with black race (P = 0.04), but not age at presentation
(P = 0.405) or gender (P= 0.095). Mean intraocular pressure (IOP)
did not change significantly (15.4 mmHg to 15.1mmHg, p=0.681)
over the length of follow-up. Compared to 434 patients (585 eyes)
with non-traumatic uveitis managed over the same time period, mean
final VA 20/60 (0.50 LogMAR) and IOP (14.9mm Hg) were not
significantly different (P = 0.0686 and P = 0.7697, respectively).
Conclusions: Conclusions:
Traumatic uveitis is commonly encountered and carries a visual
acuity prognosis that is not significantly different from other
forms of uveitis, though black race was associated with poorer
outcomes. Intraocular pressure was not significantly different than
in nontraumatic uveitis eyes and tends to be well-controlled. Most
patients are managed with topical steroid therapy. Glaucoma surgery
is rarely needed.
Commercial Relationships: John Prenshaw, None; Asima Bajwa,
None; James Patrie, None; xin wenjun, None; Ashvini Reddy,
None
Program Number: 5769 Poster Board Number: C0230
Presentation Time: 8:30 AM–10:15 AM
Characteristics, Management, and Outcomes of Non-infectious
Post-Procedural Uveitis in a Tertiary Care Center
Eric Liss1, Asima Bajwa1, James Patrie2, Wenjun Xin2, Ashvini
Reddy1. 1Ophthalmology, University of Virginia, Charlottesville, VA;
2
Biostatistics, University of Virginia, Charlottesville, VA.
Purpose: To report the characteristics, management, and outcomes
of noninfectious, post-procedural uveitis seen in a tertiary care center
over a 30-year period.
Methods: A retrospective chart review was performed on a database
of 492 eyes diagnosed with uveitis over a 30-year period. From this
larger cohort, 39 eyes from 36 patients were identified as having noninfectious, post-procedural uveitis (defined as ocular inflammation
following intraocular surgery, laser, or intravitreal injection).
Descriptive statistics were used to analyze and characterize the type
of procedures involved, anatomic location of inflammation, medical
management, surgical management, and visual acuity (VA).
Results: Of the 39 eyes identified, 19 (48.7%) were diagnosed
post-cataract extraction and IOL placement, 4 (10.3%) were postintravitreal injection, 6 (15.4%) were post-cornea surgery, 3 (7.7%)
were post-laser procedures, 6 (15.4%) were post-retina surgery, and 1
(2.6%) was following glaucoma surgery. No patients were diagnosed
with infection. There were 33 cases of anterior uveitis (84.6%)
and 6 cases of panuveitis (15.4%). All patients required treatment
for inflammation, with 34 (87.2%) using topical steroids, 3 (7.7%)
using systemic steroids, 9 (23.1%) using intravitreal or sub-tenon’s
injection, and 2 (5.2%) taking a systemic anti-metabolite agent. Mean
baseline VA was 0.759 logMAR (20/115 Snellen) and mean final
VA was 0.849 (20/140 Snellen) with a p value of <0.05. Final VA
was decreased by one line or more in 17 (43.6%) eyes. Additional
interventions included cataract extraction in 28 (71.8%) eyes, medical
management of increased IOP in 11 (28.2%) eyes, and glaucoma
surgery in 2 (5.1%) eyes.
Conclusions: Post-procedural uveitis can present following
intraocular surgery, laser therapy, or intravitreal injection, and
patients may require long-term steroids or steroid-sparing therapy for
control. It is also associated with secondary issues such as cataract
formation and IOP elevation. In this series, post-procedural uveitis
was associated with a clinically and statistically significant decrease
in final visual acuity relative to presentation.
Commercial Relationships: Eric Liss, None; Asima Bajwa, None;
James Patrie, None; Wenjun Xin, None; Ashvini Reddy, None
Program Number: 5770 Poster Board Number: C0231
Presentation Time: 8:30 AM–10:15 AM
Epidemiological characteristics of Vogt-Koyanagi-Harada
syndrome in a mexican population
Daniel Rangel-O’Shea, Pablo J. Guzman-Salas, Miriam G. ArellanoGanem, Miguel Pedroza-Seres. Instituto de Oftalmologia Conde de
Valenciana, Mexico City, Mexico.
Purpose: Report the number of patients with Vogt-Koyanagi-Harada
syndrome attending a Uveitis Department and analyze different
epidemiological characteristics of this disease.
Methods: Retrospective case series study in an uveitis department
with 103 patients with Vogt-Koyanagi-Harada syndrome from
2001 to 2013. We reviewed medical records from patients at
Instituto de Oftalmologia “Conde de Valenciana“ in Mexico. We
collected information of: gender, age, visual acuity –before and after
treatment-, ocular manifestations, neurological signs, auditory signs,
cutaneous changes, number of inflammatory episodes and diagnosis
criteria.
Results: We analyzed 103 patients, with average age of 37.71±12.76
years, with 80 females and 23 males.
Average inicial visual acuity was 0.96±1.01 logMAR on right eye
and 0.92±0.93 logMAon left eye, Average final visual acuity was
0.48±0.63 logMAR on right eye and 0.55±0.77 logMAR on left
eye.Final visual acuity improved on 79 patients after treatment.
Number of acute episodes were diferent on patients, 30 patients
had only 1 episode of inflamation, 32 patients had two episodes, 23
patients had 3 episodes and 18 patients has more than three episodes.
Ocular findings were variable, 44(42.71%) patients showed serous
retinal detachment, 38 (36.89%) patients showed macular edema,
85 (82.52%)patients showed sunset fundus, 66 (64.07%) showed
optic disc swelling, 21 (20.38%) showed cutaneous changes, 31
(30.09%) had auditory signs and 37 (35.92%) had neurological signs.
27 ( 26.21%) patients had criteria for probale VKH, 9 (8.73%) for
incomplete VKH and 4 (3.88%) for complete VKH.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Conclusions: This is the first study in Mexico, with this number of
patients, describing VKH epidemiologic data.
The information obtained help us to understand better this patology in
mexican population and could predict future clinical course.
Commercial Relationships: Daniel Rangel-O’Shea, None; Pablo
J. Guzman-Salas, None; Miriam G. Arellano-Ganem, None;
Miguel Pedroza-Seres, None
Program Number: 5771 Poster Board Number: C0232
Presentation Time: 8:30 AM–10:15 AM
Choroidal involvement in presumed ocular tuberculosis: Report
from a population in a low endemic area
Ioanna Triantafyllopoulou1, Julio J. González-López1, Bhaskar
Gupta2, Farzana Rahman1, Peter Addison1, Mark C. Westcott1,
Carlos Pavesio1, Rupesh Agrawal1, 3. 1NIHR Moorfields Biomedical
Research Centre, Moorfields Eye Hospital NHS Foundation Trust and
UCL Institute of Ophthalmology, London, United Kingdom; 2Royal
Devon and Exeter NHS trust, Exeter, United Kingdom; 3National
Healthcare Group Institute Tan Tock Seng Hospital, Singapore,
Singapore.
Purpose: We performed a retrospective, observational study to
describe the epidemiology, clinical manifestations, treatment and
outcome of choroidal involvement in TB in a tertiary care hospital in
a low endemic area.
Methods: Seventy-seven patients with presumed TB associated
choroidal lesions who underwent Quantiferon-TB Gold In Tube
(QFT) test were included. Patients without choroidal involvement
or with less than 6 months of follow-up were excluded. Treatment
failure was defined as inability to taper oral corticosteroids to less
than 10mg/day or topical steroids to less than twice a day, inability
to stop oral immunosuppressive agents or persistence or recurrence
of inflammation within the first six months of completion of
antitubercular therapy (ATT). For the patients not on ATT, failure was
defined by the inability to taper medications as above.
Results: Mean age was 45.5±15.7 years. Fourty-four (57.1%) were
male, and 51 (66.2%) presented with bilateral disease. Thirty-nine
patients were of Asian descent, 21 Caucasians and 17 Africans.
Multifocal choroiditis was the most frequent clinical presentation
(24 patients-31%), followed by serpiginous-like choroiditis (16
patients-21%), choroidal granuloma (16 patients-21%) and unifocal
choroiditis (11 patients-14%). QFT was negative in 9 (12%), and
indeterminate in 3.
Fifty patients received ATT, 58 oral corticotherapy and 16 oral
immunosupresants. ATT was given for 6 months to 22 patients, for
9 months to 5 and for 12 months to 23. Sixteen patients developed
cystoid macular oedema at any point during the follow-up period.
Sixteen developed glaucoma, 2 developed choroidal neovascular
membranes, and 8 required cataract surgery.
Binary logistic regression analysis correcting by age, sex and ATT
revealed that a positive QFT decreased the risk of treatment failure
(OR=0.09; p=0.020) and oral corticosteriods increased that risk
(OR=17.87; p=0.017). No statistical association was found between
ATT and failure rate(p=0.483) in the logistic regression model.
Conclusions: Multifocal choroiditis, choroidal tuberculoma and
serpiginous-like choroiditis were the most common presentations.
Treatment failure rates (i.e inablility to taper steroids) were
equivalent between ATT and non ATT treated groups. Patients with
positive QFT showed treatment failure less frequently, while those
receiving oral corticotherapy had an increased risk of failure.
Commercial Relationships: Ioanna Triantafyllopoulou, None;
Julio J. González-López, None; Bhaskar Gupta, None; Farzana
Rahman, None; Peter Addison, None; Mark C. Westcott, None;
Carlos Pavesio, None; Rupesh Agrawal, None
Program Number: 5772 Poster Board Number: C0233
Presentation Time: 8:30 AM–10:15 AM
Diagnostic Criteria And Clinical Manifestations Of Presumed
Latent Tuberculosis-Related Uveitis In A Bacille Calmette-Guerin
Vaccinatinated Community
Ozlem Gurses2, 1, Eda Karaismailoglu3. 1Ophthalmology, Middle
East Technical University, Oran ankara, Turkey; 2ophthalmology/
uveitis, dunyagoz hospital, Ankara, Turkey; 3Biostatistics, Hacettepe
University Medical Faculty, Ankara, Turkey.
Purpose: The wide range of clinical manifestations of presumed
latent tuberculosis-related uveitis (TRU) make its diagnosis difficult
in an endemic community. We described the ocular manifestations
of patients with TRU, and we evaluated the correlation between
skin induration value of tuberculin skin test (TST) and tuberculosis
antigens tube value of QuantiFERON®-TB Gold (QFT) test in a
Bacille Calmette-Guerin
(BCG) vaccinated community.
Methods: This was a prospective 1-year study in a tertiary referral
center. 85 patients,47 (55.3 %) female diagnosed with TRU were
included. Mean (standard deviation, SD) age was 52.9 (13.6) years.
TST, QFT and pulmonary X-ray were performed. Other possible
etiologies of uveitis were ruled-out. Standard anti-tuberculosis
therapy (ATT) was started, and response to ATT was monitored.
Statistical analysis was performed by
using SPSS for Windows 13.0.1 (SPSS Inc., Chicago, IL, USA)
Pearson correlation coefficient (r) was used for analysis. p < 0.05 was
considered as significant.
Results: 43 patients (50.6%) had bilateral involvement. The most
common ocular manifestation was anterior uveitis (78.8 %) followed
by vitritis, panuveitis, papillitis, vasculitis, chorioretinitis and
scleritis. The mean (SD) value of TST was 16.53 (6.05) mm and
the mean (SD) value of QFT was 8.06 (4.53) IU/ml. Pulmonary
X-ray results were normal. All the patients responded to ATT. No
statistically significant correlation was found between TST and QFT.
(r= 0.105, p=0.498)
Conclusions: There is no pathognomonic clinical manifestation
of TRU in an endemic, BCG vaccinated community. Presence of
bilateral anterior uveitis, positive results for both TST and QFT,
and positive response to ATT support the diagnosis of TRU in an
endemic, BCG vaccinated community.
Commercial Relationships: Ozlem Gurses, None; Eda
Karaismailoglu, None
Program Number: 5773 Poster Board Number: C0234
Presentation Time: 8:30 AM–10:15 AM
Prevalence and Risk Factors of Epiretinal membrane in the
Multicenter Uveitis Steroid Treatment (MUST) Trial
Lyndell L. Lim1, 2, Francis Abreu8, Elizabeth A. Sugar8, Alyce Burke3,
Michael M. Altaweel4, P. Kumar Rao7, Janet T. Holbrook3, Susan
G. Elner6, Richard Stawell1, 2, John H. Kempen5. 1Centre for Eye
Research Australia, University of Melbourne, Melbourne, VIC,
Australia; 2Royal Victorian Eye and Ear Hospital, Melbourne, VIC,
Australia; 3Center for Clinical Trials, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD; 4Ophthalmology
and Vision Sciences, University of Wisconsin, Madison, WI;
5
Ophthalmology Biostatistics & Epidemiology, Scheie Eye Institute,
University of Pennsylvania, Philadelphia, PA; 6Ophthalmology,
Kellogg Eye Center, University of Michigan, Ann Arbor, MI;
7
Ophthalmology and Visual Sciences, Washington University School
of Medicine, St Louis, MO; 8Department of Biostatistics, Bloomberg
School of Public Health, Johns Hopkins University, Baltimore, MD.
Purpose: To report baseline prevalence and associated risk factors
of epiretinal membrane (ERM) in patients with severe active non-
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
infectious intermediate, posterior or panuveitis recruited into the
Multicenter Uveitis Steroid Treatment (MUST) Trial.
Methods: All participants underwent a standardized interview,
systemic examination and ophthalmic examination. Baseline OCT
images were graded at the Reading Center according to the presence
and severity of ERM, plus any other associated ERM complications
such as macular traction. Generalized estimating equations were
used to fit logistic regression models to assess risk factors while
accounting for between eye correlation in patients with bilateral
uveitis.
Results: Of the 479 eyes with uveitis in the MUST Trial, 435 eyes
(91%) from 243 individuals had OCT images that were gradable for
ERM at randomization. Time from uveitis onset > 5 years, posterior
synechiae, visual acuity (VA) < 20/100, prior IOP-lowering surgery,
cataract, active uveitis, and any systemic disease were associated with
increased risk of inability to assess ERM with OCT.
Of the 435 gradeable eyes, 126 (29%) had an ERM. In a
multivariable analysis, having diabetes (OR=2.21, p=0.043), age >
50 years (OR = 2.95, p < 0.001), the presence of retinal vasculitis
(OR=2.68, p=0.013), macular edema (OR=1.87, p=0.013) and uveitis
activity (OR = 1.83, p = 0.050) were associated with the presence
of ERM. VA worse than 20/100, cataract [including prior cataract
surgery], and Vogt-Koyanagi Harada disease were associated with
increased ERM prevalence; however the association was abrogated
by adjustment for other risk factors in the final multivariable model.
Conclusions: Detection of ERM by OCT in patients with uveitis
may be limited by the optical impact of uveitic complications such
as cataract and posterior synechiae. ERM is a common complication
of intermediate, posterior and panuveitis, and was associated with
increasing age, diabetes, macular edema and retinal vasculitis at
randomization. Additional analysis of longitudinal data is needed to
estimate the incidence of ERM and determine the residual impact of
ERM on VA (once uveitis activity has been treated) and its outcome
over time.
Commercial Relationships: Lyndell L. Lim, None; Francis Abreu,
None; Elizabeth A. Sugar, None; Alyce Burke, None; Michael M.
Altaweel, None; P. Kumar Rao, None; Janet T. Holbrook, None;
Susan G. Elner, None; Richard Stawell, None; John H. Kempen,
None
Support: NEI Grant U10EY014655, NEI Grant U10EY014660,
NEI Grant U10EY014656, Bausch and Lomb provided support in
the form of donation of fluocinolone implants for those patients
randomsied to this therapy who otherwise would not have access to
these implants.
Clinical Trial: NCT00132691
Purpose: To evaluate the risks and quality of life outcomes of
fluocinolone acetonide implant therapy versus systemic corticosteroid
therapy supplemented with immunosuppression when indicated for
intermediate, posterior, and panuveitis.
Methods: 255 subjects with intermediate, posterior, or panuveitis
(479 eyes) randomized to systemic treatment or implant were
followed for 54 months. Local and systemic potential complications
of the therapies and self-reported health utility, vision-related
and generic health-related quality of life (QoL) were studied
prospectively.
Results: Over 54 months, phakic eyes developed cataract and
required cataract surgery more often in the implant group (hazard
ratio (HR)=2.2, p=0.003 and HR=4.0, p<0.0001). IOP elevation
measures occurred more frequently in the implant group (range
of HR’s=3.7-5.6, p<0.0001), and glaucoma occurred more
frequently (26.3% vs. 10.2%, HR=3.0, p=0.0002). In contrast,
potential complications of systemic therapy including measures
of hypertension, hyperlipidemia, diabetes, bone disease, and
hematological and serum chemistry indicators of immunosuppression
toxicity did not differ significantly between groups. Indices of quality
of life initially favored implant therapy by a modest margin, but
summary measures of health utility and vision-related or generic
health-related QoL were minimally different by 54 months. The SF36 physical component summary score favored implant by a small
margin (3.17 on a scale of 100, p=0.01). Mean QoL results were
favorable in both groups.
Conclusions: Fluocinolone acetonide implant therapy is associated
with a clinically important increased risk of glaucoma and cataract
with respect to systemic therapy. These complications potentially
can be addressed surgically. Despite regular follow-up and available
treatment, the implant group had a 16% excess risk of glaucoma,
suggesting that careful monitoring and early intervention is
warranted to prevent progression. A treatment regimen of systemic
corticosteroid and immunosuppressive therapies following consensus
recommendations was well tolerated with minimal toxicities. Selfreported QoL measures initially favored implant therapy, but over
time the measures converged, with generally favorable QoL in both
groups.
Commercial Relationships: Michael M. Altaweel, None; John
H. Kempen, None; Lea T. Drye, None; Janet T. Holbrook, None;
Douglas A. Jabs, None; Elizabeth A. Sugar, None; Jennifer E.
Thorne, None
Support: NIH Grants U10EY014655, U10EY014660, and
U10EY014656
Clinical Trial: NCT00132691
Program Number: 5774 Poster Board Number: C0235
Presentation Time: 8:30 AM–10:15 AM
Risks and Quality of Life associated with Fluocinolone Acetonide
Intraocular Implant Versus Systemic Anti-inflammatory Therapy
for Intermediate, Posterior or Panuveitis: 4.5 year results of The
Multicenter Uveitis Steroid Treatment Trial and Follow-up Study
Michael M. Altaweel1, John H. Kempen2, Lea T. Drye3, Janet T.
Holbrook4, 3, Douglas A. Jabs5, Elizabeth A. Sugar4, Jennifer E.
Thorne3, 6. 1Ophthalmology & Visual Science, Univ of WisconsinMadison, Madison, WI; 2Center for Preventive Ophthalmology and
Biostatistics, Scheie Eye Institute, Philadelphia, PA; 3Center for
Clinical Trials, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD; 4Departments of Epidemiology and Biostatistics,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
5
Ophthalmology and Medicine, Mount Sinai School of Medicine,
New York, NY; 6Ophthalmology, Johns Hopkins University School of
Medicine, Baltimore, MD.
Program Number: 5775 Poster Board Number: C0236
Presentation Time: 8:30 AM–10:15 AM
Interim Analyses of the SAVE-2 Study: Sirolimus as a
Therapeutic Approach for UVEitis: A Phase 2, Open-label,
Randomized Study to Assess the Safety, Tolerability, and
Bioactivity of Two Doses of Intravitreal Injection of Sirolimus in
Patients with Non-infectious Uveitis
Yasir J. Sepah1, Mohammad A. Sadiq1, Mohamed K. Soliman1, 2,
Mohamed Ibrahim1, Mostafa S. Hanout1, Salman Sarwar1, Aniruddha
Agarwal1, Diana V. Do1, Quan Dong Nguyen1. 1University of
Nebraska Medical Center, Omaha, MA; 2Ophthalmology, Assiut
University, Assiut, Egypt.
Purpose: To report the interim analyses of the efficacy of 2 different
doses of intravitreal (IVT) sirolimus in eyes with non-infectious
posterior, intermediate, or panuveitis in the SAVE-2 Study at the
primary endpoint.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Methods: SAVE-2 is a randomized, phase 2, open-label study
conducted at 3 clinical centers in the United States. At least 28, but
not more than 32, subjects are to be enrolled. Key inclusion criteria
were: 1) diagnosis of non-infectious uveitis; 2) active uveitis, defined
as having at least 1+ vitreous haze (NEI scale) and/or at least 1+
vitreous cell count (SUN scale); 3) best-corrected ETDRS visual
acuity of 20/400 or better in the study eye. Eligible subjects were
randomized into one of two treatment arms in a ratio of 1:1. Group
1 received IVT 440 mg of sirolimus in study eyes on Days 0, 30, 60,
90, 120, and 150; group 2 received 880 mg of sirolimus on Days 0,
60, and 120. Fellow eyes are also eligible to receive sirolimus (of
opposite dose to that of study eye) in SAVE-2. Primary endpoint of
the study is at M6. Starting at M6, both study and fellow eyes can be
retreated based on retreatment criteria with originally assigned doses.
Patients are followed until M12.
Results: 25 subjects have been randomized in SAVE-2 and are
included in the analysis. Baseline characteristics are shown in Table.
Vitreous haze (VH) decreased (M6 compared to baseline) by 1 step
or more in 81.8% and 92.9% of patients in group 1 (low dose) and 2
(high dose), respectively at M6 (p=0.564). VH decreased by 2 steps
or more in 63.6% and 50% of patients in groups 1 and 2, respectively
at M6 (p=0.695). Mean change in VA for subjects who completed
M6 visit was +3.66 and -2.91 ETDRS letters in group 1 and 2,
respectively. Among subjects with macular edema at baseline (n=13),
the mean change in foveal thickness was -89.42 mm in group 1 and
+81.5 mm in group 2 at M6.
Conclusions: Both low and high doses of IVT sirolimus are found to
decrease vitreous haze in eyes with non-infectious uveitis. Low dose
(440 mg) sirolimus administered monthly may be more efficacious in
reducing uveitic macular edema than high dose (880 mg) administered
every 2 months.
Table – Baseline Characteristics of Subjects in the SAVE-2 Study
Commercial Relationships: Yasir J. Sepah, None; Mohammad
A. Sadiq, None; Mohamed K. Soliman, None; Mohamed
Ibrahim, None; Mostafa S. Hanout, None; Salman Sarwar, None;
Aniruddha Agarwal, None; Diana V. Do, None; Quan Dong
Nguyen, Santen (S)
Support: Unrestricted educational grant SANTEN
Clinical Trial: NCT01280669
Program Number: 5776 Poster Board Number: C0237
Presentation Time: 8:30 AM–10:15 AM
Long-Term Safety of Intravitreal Sirolimus for the Treatment of
Non-infectious Uveitis (NIU) of the Posterior Segment: 12-Month
Results from SAKURA Study 1
Pauline T. Merrill1, Yang Yang2. 1Ophthalmology, Rush University,
Chicago, IL; 2Santen Inc., Emeryville, CA.
Purpose: The SAKURA trial is a Phase III, randomized, multicenter,
24-month, multinational study assessing the safety and efficacy of
intravitreal sirolimus as monotherapy for the treatment of active
NIU of the posterior segment. In the 6-month double-masked period
of SAKURA Study 1, bimonthly injections of intravitreal sirolimus
preserved subjects’ best corrected visual acuity while significantly
improving vitreous haze (VH) scores. Here, we report the long-term
safety of intravitreal sirolimus during the first 12 months of treatment
(the double-masked period combined with the open-label period).
Methods: Subjects with active NIU of the posterior segment were
randomized in 1:1:1 fashion to receive 44 μg, 440 μg, or 880 μg
injections of intravitreal sirolimus, administered every 2 months (Day
1 and Months 2 and 4; double-masked period). Primary efficacy was
assessed at Month 5. At Month 6, subjects eligible to receive further
intravitreal sirolimus received 880 mg injections every 2 months
(Months 6-10; open-label treatment period) under the then current
amendment.
Results: Of the 346 randomized and treated subjects, 287 entered the
open-label period and completed the VH assessment at Month 12. Of
these, 211 received at least 1 injection of intravitreal sirolimus. The
most common reasons for premature discontinuation prior to Month
12 were subject withdrawal (n=16), adverse event (n=12), and loss
to follow-up (n=11). The adverse events in the open-label period
were similar to those reported in the double-masked period. Over
the first 12-month treatment period, the most common serious ocular
adverse events (≥2%) were worsening of uveitis (7.2%), worsening
of choroiditis (4.0%), cataract (3.8%), non-infectious endophthalmitis
(2.9%), medication residue (2.3%), and increased intraocular pressure
(2.0%). The incidence of post-injection endophthalmitis was 1.2%,
all with the 880 μg dose (1 culture positive, 3 culture negative).
Conclusions: Intravitreal sirolimus was associated with a low
incidence of serious ocular adverse events over 12 months in this
diverse population of subjects with NIU of the posterior segment. The
types of adverse events in the open-label period of SAKURA Study 1
were similar to those observed in the double-masked period.
Commercial Relationships: Pauline T. Merrill, Abbvie (C), Abbvie
(F), Santen (C), Santen (F); Yang Yang, Santen Inc. (E)
Clinical Trial: NCT01358266
Program Number: 5777 Poster Board Number: C0238
Presentation Time: 8:30 AM–10:15 AM
Relationships between HIV-related Neuroretinal Disorder and
Measures of Vision-Specific Quality of Life among People with
AIDS
Davin Ashraf1, Kevin P. May2, Gary N. Holland1, Mark L. Van
Natta2, Albert Wu2, 3, Jennifer E. Thorne4, Douglas A. Jabs5, 6. 1Ocular
Inflammatory Disease Center, UCLA Stein Eye Institute and the
Department of Ophthalmology, David Geffen School of Medicine
at UCLA, Los Angeles, CA; 2Department of Epidemiology, Johns
Hopkins University Bloomberg School of Public Health, Baltimore,
MD; 3Department of Health Policy and Management, Johns Hopkins
University Bloomberg School of Public Health, Baltimore, MD;
4
Department of Ophthalmology, Wilmer Eye Institute at Johns
Hopkins, Baltimore, MD; 5Department of Ophthalmology, Icahn
School of Medicine at Mount Sinai, New York, NY; 6Department of
Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Purpose: Some HIV-infected individuals have evidence of optic
nerve or retinal dysfunction, even with good visual acuity, that
manifests as decreased contrast sensitivity (CS), and is termed
neuroretinal disorder (NRD). HIV-related NRD is a risk factor for
vision impairment, blindness, and mortality, but its effect on visionspecific quality of life (QOL) has not been explored.
Methods: We performed a cross-sectional study of participants
in the Longitudinal Study of the Ocular Complications of AIDS
(LSOCA) at initial completion of the National Eye Institute 25-item
Visual Function Questionnaire (VFQ-25) who met the following
inclusion criteria: no evidence of ocular opportunistic infection or
cataract and best corrected visual acuity (BCVA) of 20/40 or better.
Those with contrast sensitivity <1.50 logCS in either eye were
considered to have NRD. QOL was compared between individuals
with and those without NRD, with adjustment for age, BCVA,
CD4+ T-lymphocyte count, and interval since AIDS diagnosis. The
eleven VFQ-25 subscales and composite score were scored from 0 to
100, with higher scores representing better QOL. The relationships
between NRD and VFQ-25 scores, and between logCS and VFQ-25
scores, were assessed using multiple linear regression and Spearman
correlation, respectively.
Results: A total of 811 individuals met study criteria, 39 (4.8%)
of whom had NRD. After adjustment, individuals with NRD had a
significantly lower mean VFQ-25 composite score than those without
NRD (79 vs. 87, respectively, p=0.0006). NRD was also significantly
associated with lower mean scores in the following VFQ-25
subscales: near activities (78 vs. 86, p=0.009); distance activities
(85 vs. 91, p=0.04); social functioning (89 vs. 96, p=0.001); mental
health (76 vs. 87, p=0.0007); dependency (81 vs. 94, p<0.0001);
and color vision (90 vs. 97, p<0.0001). Among those with NRD, the
correlation between logCS and VFQ-25 composite score was 0.35
(p=0.03).
Conclusions: HIV-related NRD is associated with reduced visionspecific QOL among people with AIDS. Among those with NRD,
decreasing contrast sensitivity is associated with lower VFQ-25
composite scores.
Commercial Relationships: Davin Ashraf, None; Kevin P. May,
None; Gary N. Holland, Genentech (C), Novartis International AG
(C), Santen Pharmaceutical (C), Xoma (US) LLC (C); Mark L. Van
Natta, None; Albert Wu, None; Jennifer E. Thorne, Gilead (C),
National Eye Institute (F), National Institute of Allergy and Infectious
Diseases (F); Douglas A. Jabs, Applied Genetic Technologies, Inc.
(S), Novartis Pharmaceutical Corp. (S), Santen Pharmaceutical (C)
Support: U10 EY 08052, U10 EY 08057, U10 EY 08067
Program Number: 5778 Poster Board Number: C0239
Presentation Time: 8:30 AM–10:15 AM
Comparison of the expression of TGFβ2 activating molecules in
conjunctival inflammation
Laura Soriano-Romani1, 2, Laura Contreras-Ruiz3, Laura GarciaPosadas1, 2, Antonio Lopez-Garcia1, 2, Sharmila Masli3, Yolanda
Diebold1, 2. 1Ocular Surface Group, IOBA - University of Valladolid,
Valladolid, Spain; 2CIBER-BBN (Biomedical Research Networking
Center on Bioengineering, Biomaterials and Nanomedicine),
Valladolid, Spain; 3Ophthalmology, Boston University School of
Medicine, Boston, MA.
Purpose: Increased expression of TGFβ2 is reported in the
conjunctiva of dry eye patients despite the decline in TGFβ2expressing goblet cells suggesting a lack of anti-inflammatory
activity of TGFβ2 in the context of conjunctival inflammation. While
integrins expressed in inflamed tissue are unable to activate this
isoform of TGFβ, Thrombospondin-1 (TSP1) is known to activate it
efficiently via ligation of its receptor CD36. Our aim was to compare
expression of molecules associated with TGFβ2 activation during
murine conjunctival inflammation and assess their correlation with
inflammatory conjunctival epithelial apoptosis.
Methods: Human conjunctival tissue from cadaveric donors, primary
human conjunctival epihelial, stromal cells and murine conjunctiva
were immunostained for CD36, TSP1 or latent TGFβ2. Inflamed
conjunctival tissues were obtained from scopolamine-injected
C57BL/6 (WT) mice induced to develop Experimental Dry Eye
(EDE) with 5 days of desiccating conditions and TSP1 deficient
(TSP1-/-) mice, which spontaneously develop Sjögren’s syndrome
associated conjunctival inflammation with age. Immunostaining
intensities were compared with ImageJ analysis. Apoptosis was
assessed by detecting activated caspase-3/7 using CellEvent detection
kit (Life Technologies).
Results: Both CD36 and TSP1 were detectable in human
conjunctival tissue as well as primary conjunctival epithelial and
stromal cells just as in normal WT mouse conjunctiva that lacked
caspase-3/7 positive cells. However, epithelial cells positively
stained from caspase-3/7 were detected in conjunctiva derived from
both EDE and TSP1-/- mice indicative of apoptosis in line with
local inflammation. Increased immunostaining of latent TGFβ2 was
detected in TSP1-/- as compared with WT mice, supporting lack of its
activation in inflamed murine conjunctiva. Interestingly, compared to
WT conjunctiva increased TSP1 and reduced CD36 immunostaining
was detected in EDE mice. Conversely increased CD36
immunostaining was seen in TSP1-/- conjunctiva in comparison to
WT mice.
Conclusions: The absence or reduced expression of one of the
molecules, CD36 or TSP1, involved in TGFβ2 activation supports
pro-inflammatory conditions in the conjunctiva that lead to apoptotic
cell death of conjunctival epithelial cells. Therapeutic strategies
directed towards restoring activation of latent TGFβ2 may help treat
chronic conjunctival inflammation.
Commercial Relationships: Laura Soriano-Romani, None; Laura
Contreras-Ruiz, None; Laura Garcia-Posadas, None; Antonio
Lopez-Garcia, None; Sharmila Masli, None; Yolanda Diebold,
None
Support: FEDER-CICYT Grant MAT2013-47501-C02-1-R (YD),
Regional JCyL Scholarship/European Social Fund Program (LSR),
FPI Scholarship Program (LGP), NEI grant EY015472 (SM)
Program Number: 5779 Poster Board Number: C0240
Presentation Time: 8:30 AM–10:15 AM
Clinical features of glaucoma in cytomegalovirus corneal
endotheliitis
Hideaki Yokogawa1, Akira Kobayashi1, Natsuko Yamazaki1, Yoshiaki
Saito2, Kazuhisa Sugiyama1. 1Ophthalmology, Kanazawa University
Graduate School of Medical Science, Kanazawa, Japan; 2Saito Eye
Clinic, Kanazawa, Japan.
Purpose: Recently, diagnostic criteria of cytomegalovirus (CMV)
corneal endotheliitis was established by the Japan Corneal
Endotheliitis Study Group. However, clinical features of ocular
hypertension / secondary glaucoma associated with the disease
had not been well understood. We performed a retrospective,
observational clinical study to reveal manifestations of glaucoma
associated with CMV corneal endotheliitis.
Methods: Eighteen eyes of 18 patients with CMV corneal
endotheliitis (14 eyes with typical CMV endotheliitis and 4 eyes with
atypical CMV endotheliitis) were enrolled this study. We analyzed the
clinical manifestations highlighting the glaucoma status, including
onset of glaucoma, fellow eye glaucoma, intraocular pressure,
gonioscopic findings, visual field, and glaucoma surgery.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Results: Mean age was 70.4±11.5 years. Seventeen cases (94.4%)
were male. All 18 eyes had glaucoma history which had been
treated for long duration (9.6±9.0 years). Eight eyes (44.4%) had
been diagnosed as Posner-Schlosmann syndrome by previous
ophthalmologist. Nine cases (50.0%) had the fellow eye glaucoma.
All 18 eyes had received antiglaucoma agents and topical steroid
treatment with (6 eyes) or without (12 eyes) aciclovir / valaciclovir.
At initial visit, intraocular pressure was 21.5±10.9mmHg, and all
sixteen eyes excluded 2 post-glaucoma surgery or keratoplasty eyes
had open angle. Normal visual field or normal optic disc was noted
in 5 eyes (27.8%), and visual field defects were early stage (MD>6dB) in 4 eyes (22.2%), middle stage (-6dB>MD>-12dB) in 2 eyes
(11.1%), and late stage (MD<-12dB, Kosaki classification) in 7 eyes
(38.9%). After we made diagnosis of CMV corneal endotheliitis, we
treated all cases with anti-CMV drug including systemic ganciclovir
/ valganciclovir, topical ganciclovir, and topical corticosteroids. Five
eyes (27.8%) required glaucoma surgeries, including trabeculectomy
(3 eyes), and 360-degree trabeculotomy (2 eyes).
Conclusions: All cases with CMV corneal endotheliitis had
glaucoma history. In cases with refractory glaucoma due to PosnerSchlosmann syndrome or anterior uveitis, CMV corneal endotheliitis
should be concerned as one of the differential diagnosis.
Commercial Relationships: Hideaki Yokogawa, None; Akira
Kobayashi, None; Natsuko Yamazaki, None; Yoshiaki Saito, None;
Kazuhisa Sugiyama, None
Support: Grant-in-Aid for Scientific Research KAKENHI, Japan
(No. 25462705).
Program Number: 5780 Poster Board Number: C0241
Presentation Time: 8:30 AM–10:15 AM
Cytomegalovirus as a cause of acute endothelial cell loss in
immunocompetent patients with hypertensive anterior uveitis
Jin A Choi, Ku Sub Kim, Chan Kee Park. Ophthalmology, Catholic
university of Korea, Suwon, Korea (the Republic of).
Purpose: Virus has been known to play a role in the idiopathic
anterior uveitis associated with ocular hypertension. In this study,
we investigated the clinical characteristics of patients with anterior
hypertensive uveitis and compared the characteristics between
patients in cytomegalovirus (CMV)-positive group and those in
CMV-negative group in their aqueous humor sample.
Methods: Medical records of forty-two patients with hypertensive
anterior uveitis were analyzed retrospectively. All patients underwent
slit lamp biomicroscopy examination, specular microscopy,
gonioscopy, and serological test. Among 42 patients with
hypertensive anterior uveitis, an aqueous sampling was done in 22
patients, and their aqueous analyzed for viral deoxyribonucleic acid
by polymerase chain reaction.
Results: The average age of 42 patients with hypertensive anterior
uveitis 57.6 years and 29 (69.0%) of subjects were male. Twentytwo patients (52.4%) underwent glaucoma surgery, and the average
corneal endothelial cell counts were 1,908 cells/ mm2. Among 22
patients having an aqueous sampling, 6 patients showed the CMVPCR positive, whereas 16 patients showed the CMV-PCR negative.
The CMV-positive group were significantly younger (CMV-positive
vs.CMV-negative: 47.5 ± 14.8 yrs vs. 67.6 ±11.8 yrs; P = 0.006)
and more myopic compared with the CMV-negative group (-3.6
± 4.2 vs. 0.0 ± 1.6D; P = 0.031). The frequency of glaucoma
surgery was similar between groups (66.0% vs 66.0%, P = 0.701).
However, 66.7% of CMV-positive group had glaucoma tube shunt
surgery, whereas majority of CMV-negative group (80%) underwent
trabeculectomy as a glaucoma surgery. Interestingly, the corneal
endothelial cell counts were significantly lower in CMV-positive
group, compared with CMV-negative group (1245 ± 560 cells/mm2
vs 1981 ± 387 cells/mm2; P = 0.009). In the CMV-positive group,
systemic ganciclovir therapy was used in 2 patients. After a 1month
of gangiclovir therapy, the aqueous CMV-PCR titer was dramatically
decreased in both patients. However, extensive corneal endothelial
cell loss was found after 5 months later, despite the ganciclovir
therapy.
Conclusions: CMV was found to be one of the etiologic factors
in patients with hypertensive anterior uveitis. Special cautions are
needed for patients with CMV-positive hypertensive anterior uveitis,
considering its adverse effect on corneal endothelium.
Commercial Relationships: Jin A Choi, None; Ku Sub Kim, None;
Chan Kee Park, None
Program Number: 5781 Poster Board Number: C0242
Presentation Time: 8:30 AM–10:15 AM
Keratic precipitate morphology in uveitic eyes of various
etiologies using RTVue-100 fourier-domain corneal anterior
module OCT system
Noriyasu Hashida, Shizuka Koh, Takeshi Soma, Kohji Nishida.
Ophthalmology, Osaka University Graduate School of Medicine,
Suita, Japan.
Purpose: To identify the morphologic appearance of keratic
precipitate (KP) with RTVue-100 fourier-domain corneal anterior
module optical coherence tomography (OCT) system (RTVue)
(optovue, USA) for the diagnosis of uveitic eyes of various
etiologies.
Methods: RTVue OCT scan was performed on consecutive 23
eyes of 19 patients with different types of uveitis to investigate the
morphologic appearance of KPs. The study included sarcoidosis in
5 eyes, herpetic iridocyclitis in 8, Fuchs heterochromic iridocyclitis
(FHI) in 3, idiopathic granulomatous uveitis in 2, tubulointerstitial
nephritis and uveitis in 1, and masquerade syndrome with primary
vitreoretinal lymphoma in 4. RTVue was used to analyze the
differences in types of KPs between various uveitic groups.
Results: Mean age of the patients was 58.0 ± 19.9 (range, 23-96)
years, and 11 (52.6 %) were female. Bilateral involvement was
observed in 4 cases (21.0 %). In all cases, the slit-lamp examination
revealed various pattern such as whitish and/or brownish KPs. Those
KPs also showed various morphologies such as vaguely-outlined,
round, and dendriform appearance. In RTVue examination, intensity
of KPs demonstrated various patterns. Morphologic features of KPs
also showed various patterns such as globular, dome-shaped, sawedged, rectangle-shaped appearance protruded from the retrocornea.
Especially, stippled, small and dendriform KPs were observed in FHI
cases. In contrast, round, big and high intensity KPs were observed
in cytomegalovirus (CMV) positive iridocyclitis cases. In herpetic
iridocyclitis cases, KPs were diffusely scattered over the corneal
endothelium, but, through the course of antiviral treatment, they
aggregated each other and deposited dispersedly. By the limitation of
number of cases, no significant difference was observed, however;
RTVue images in various type of disease showed characteristic and
specific morphological patterns.
Conclusions: The morphology of KPs in various uveitic eye diseases
showed characteristic images in slit-lamp and RTVue examination.
RTVue examination is non-invasive and repeatable methods for
diagnosis of uveitis by evaluating the KPs morphologies.
Commercial Relationships: Noriyasu Hashida, None; Shizuka
Koh, None; Takeshi Soma, None; Kohji Nishida, None
Clinical Trial: UMIN000010096
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 5782 Poster Board Number: C0243
Presentation Time: 8:30 AM–10:15 AM
Dendritic cells in non-infectious anterior uveitis
Micheal O’Rourke1, 2, Mary Canavan2, Ursula Fearon2, Conor C.
Murphy1. 1Ophthalmology, Royal College of Surgeons in Ireland,
Dublin 2, Ireland; 2St Vincent’s University Hospital, Dublin, Ireland.
Purpose: Innate immunity is triggered when toll-like receptors
(TLRs) on antigen presenting cells become activated leading to
subsequent activation of inflammatory cascades. Dendritic cells
(DC) are professional antigen presenting cells (APCs), which can
be divided into 2 major subsets – myeloid (mDC) and plasmacytoid
(pDC). TLRs promote maturation of APCs by the production of
pro-inflammatory cytokines and up-regulation of co-stimulatory
molecules. This study compared APC percentage, activation
status and intracellular cytokine production of mDC and pDC
in the circulation of AU patients to healthy controls (HCs). The
inflammatory cell profile in inflamed aqueous humor (AqH) of AU
patients was also carried investigated.
Methods: Circulating DC were defined as HLADR+, Lineageand further subdivided as myeloid (CD11c+) or plasmacytoid DC
(CD123+). CD40, CD80 and CD83 cell surface expression was used
to assess activation and maturation status of each subtype. After cell
permeabilisation, intracellular cytokine staining was carried out for
IL-10 and TNFa under basal, TLR4 (LPS), TLR7/8 (Resiquimod)
and TLR9 (CpG) stimulated conditions. To examine the local
inflammatory response, approximately 250uL of inflamed AqH from
active AU patients was centrifuged to obtain a cell pellet and stained
for CD45, HLA DR and CD11c.
Results: AU patients (n=5) had a decrease in circulating mDC and
pDC compared to healthy controls (HC) (p<0.05). CD40 expression
on mDC in AU patients was increased (p<0.05) with no differences
in CD80 and CD83. There was no difference in IL10 or TNFa
production under basal conditions. However, pDC showed hyporesponsiveness to TLR4 stimulation with lower IL10 and TNFa
production in AU compared to controls (p<0.05). Inflamed AqH cells
were CD45+ with approximately 1% being HLA DR+ CD11c+.
Conclusions: These results provide evidence that DCs are recruited
to the eye from the circulation during AU with decreased numbers
in circulation and a population of DC present in the inflamed AqH.
Circulating DC may be tolerised to TLR4 stimulation with decreased
cytokine production on stimulation. Current work is profiling
cytokine concentration in AqH and the functional effect of inflamed
AqH on HC monocyte derived DC model co-cultured with T cells.
Commercial Relationships: Micheal O’Rourke, None; Mary
Canavan, None; Ursula Fearon, None; Conor C. Murphy, None
Program Number: 5783 Poster Board Number: C0244
Presentation Time: 8:30 AM–10:15 AM
Circulating regulatory T cells as biomarkers for macular edema
associated with non-infectious uveitis
Blanca Molins1, 2, Jessica Matas2, Alex Fonollosa3, Victor Llorens2,
Marina Mesquida2, David Díaz-Valle4, Barbara Berasategui3,
Maite Sainz De La Maza2, Pilar Calvo5, Alfredo Adan Civera2, 1.
1
Ophthalmology, IDIBAPS, Barcelona, Spain; 2Hospital Clinic de
Barcelona, Barcelona, Spain; 3Hospital de Cruces, Bilbao, Spain;
4
Hospital Clinico San Carlos, Madrid, Spain; 5Hospital Universitario
Miguel Servet, Zaragoza, Spain.
Purpose: To evaluate the profile of circulating levels of regulatory T
cells (Treg) in patients with macular edema (ME) related to noninfectious uveitis and its relationship with central retinal thickness
(CRT), anatomical classification, and therapeutical management.
Methods: Twenty-one patients with ME associated with noninfectious uveitis and 10 healthy subjects from 3 tertiary referral
centers in Spain were included. Blood samples were obtained at
baseline (T0) when patients presented with ME (considered as CRT >
300 μm, measured by optical coherence tomography [OCT]) and also
when ME improved after treatment (T1, CRT <300 μm). Peripheral
blood mononuclear cells (PBMCs) were obtained by Ficoll gradient
from heparinized blood and Treg (CD3+CD4+Foxp3+CD25hi) levels
in PBMCs were determined by flow cytometry.
Results: Patients with ME at T0 had significantly lower Treg levels
than controls (2.08±0.24 % vs. 3.13±0.39 %, P<0.05). Resolution
of ME seemed to be accompanied by an increase in Treg levels,
although the difference did not reach statistical significance (T0
2.08±0.24 %, vs T1 2.98±0.83 %, P=0.247). Remarkably, patients
who received systemic immunomodulatory therapy (IMT) showed
a significant increase in Treg levels compared to those who received
local therapy (dexamethasone intravitreal implant, periocular
triamcinolone injection), (82±40 % improvement vs. -17±7 %,
P<0.05).
Conclusions: Our preliminary data suggest that Treg levels may
serve as biomarkers of ME associated with non-infectiuos uveitis,
as patients with ME showed reduced levels of Treg compared to
healthy subjects. Moreover, ME resolution appeared to correlate with
an increase in Treg levels, particularly in those patients receiving
systemic IMT.
Commercial Relationships: Blanca Molins, None; Jessica Matas,
None; Alex Fonollosa, None; Victor Llorens, None; Marina
Mesquida, None; David Díaz-Valle, None; Barbara Berasategui,
None; Maite Sainz De La Maza, None; Pilar Calvo, None; Alfredo
Adan Civera, None
Support: This work was supported by the Ministry of Science and
Innovation of Spain, “Instituto de Salud Carlos III”, “Fondo de
Investigación Sanitaria” (PI13/00217).
Program Number: 5784 Poster Board Number: C0245
Presentation Time: 8:30 AM–10:15 AM
Characterization of Ophthalmic and Rheumatologic Features in
Patients with Psoriasis and Psoriatic Arthritis
Anton M. Kolomeyer1, Ashwinee Ragam4, Natasha V. Nayak2,
Christina Yu4, Sergio Schwartzman3, David S. Chu4. 1Ophthalmology,
UPMC, Pittsburgh, PA; 2Ophthalmology, NYEEI, New York, NY;
3
Rheumatology, HSS, New York, NY; 4Rutgers University, Newark,
NJ.
Purpose: To characterize and describe ophthalmic and rheumatologic
findings.
Methods: Retrospective chart review of ophthalmic and
rheumatologic manifestations in patients with psoriasis (n=6) and
psoriatic arthritis (n=15) from two tertiary care centers in the United
States specializing in autoimmune ophthalmic disease. Data was
collected on age, gender, ethnicity, associated autoimmune disease,
visual acuity (VA), intraocular pressure (IOP), type and grade of
inflammation, ocular and rheumatologic characteristics of disease,
systemic immunomodulating agents, and ocular therapy.
Results: Twenty-one patients were included (mean ± SD age was
51.1 ± 14.4 years; mean follow-up, 48.5 months; 76% were female;
and 86% were Caucasian). Six (29%) patients had an associated
systemic disease (three each with sarcoidosis and rheumatoid
arthritis). None of the eyes experienced a change in Snellen VA by
two or more lines. Mean ± SD initial and final IOP was 14.6 ± 4.4
mm Hg and 14.5 ± 4.1 mm Hg, respectively. Ocular manifestations
included anterior uveitis (n=9 [43%]), panuveitis (n=5 [24%]),
scleritis (n=4 [19%]), peripheral ulcerative keratitis (n=2 [9.5%]),
retinal vasculitis (n=1 [4.8%], and multifocal choroiditis (n=1
[4.8%]). Most common patterns of musculoskeletal involvement
were oligoarthritis (n=7 [33%]), polyarthritis (n=3 [14%]), and axial
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
(n=2 [9.5%]), while three (14%) had no articular involvement. All
patients required systemic immunomodulatory therapy, with 11
(52%) requiring more than one agent.
Conclusions: Psoriasis and psoriatic arthritis resulted in a wide
variety of chronic anterior and posterior segment inflammation, the
most common of which was anterior uveitis. The oligoarticular form
of psoriatic arthritis was the most likely to result in the development
of ophthalmic disease. Presence of associated systemic autoimmune
disease was common. The majority of patients required more than
one immunomodulatory agent to achieve inflammation control.
Commercial Relationships: Anton M. Kolomeyer, None;
Ashwinee Ragam, None; Natasha V. Nayak, None; Christina Yu,
None; Sergio Schwartzman, None; David S. Chu, None
Program Number: 5785 Poster Board Number: C0246
Presentation Time: 8:30 AM–10:15 AM
Psoriatic uveitis : a potentially severe and sight-threatening
entity?
Céline Mebsout, Audrey Fel, Christine Fardeau, Phuc Lehoang,
Bahram Bodaghi. Ophtalmologie, Hôpital La Pitié Salpétrière Paris,
Paris, France.
Purpose: To describe the clinical characteristics and therapeutic
management of psoriatic uveitis.
Methods: A retrospective study of patients with psoriatic uveitis
referred to the Ophthalmology clinic of Pitié-Salpétrière Hospital.
Clinical characteristics, therapy, complications and severity of uveitis
were reviewed. Complications and the visual outcome have been
evaluated in this group.
Results: Nine patients were finally included with a mean followup of 10.4 years. The mean age at presentation was 38.6 years.
Among them, only 33.3% (3 of 9 patients) were HLA-B27 positive
and 66.7% (6/9) had psoriatic arthritis. Uveitis was bilateral in 6
patients (66.7%). Posterior involvement was noted in 55.6% (5/9) of
cases, (3 patients with vitritis, 3 with cystoid macular edema, 2 with
papillitis and 1 with retinal vasculitis). Secondary glaucoma occurred
in 2 patients (22.2%) with severe consequences. Twenty percent
of affected eyes (3 of 15 eyes) developed legal blindness (visual
acuity less than 20/400). The final visual acuity ranged from 20/20
to no light perception; with a mean visual acuity of 20/40. Uveitis
was considered severe in 7 patients (77.8%). Three patients (33.3%)
received long-term oral corticosteroids and 44.4% (4/9) required
intravenous pulses of methylprednisolone. Methotrexate therapy was
necessary in 6 patients (66.7%) and TNFα blockers were introduced
in 5 patients (55.6%). Two patients needed other immunosuppressive
agents (cyclosporine, azathioprine, mycophenolate mofetil, abatacept,
anakinra and tocilizumab). Dexamethasone intravitreal implant was
used in each eye of one patient for cystoid macular edema. Severe
complications of therapy (skin carcinoma and severe infections)
occurred in one patient.
Conclusions: In this case series, most of the patients had a severe
psoriatic uveitis. Larger multicentre studies are needed in order to
confirm these results and clearly identify this entity as a worrying
condition, requiring an appropriate therapeutic strategy.
Commercial Relationships: Céline Mebsout, None; Audrey Fel,
None; Christine Fardeau, None; Phuc Lehoang, None; Bahram
Bodaghi, None
Program Number: 5786 Poster Board Number: C0247
Presentation Time: 8:30 AM–10:15 AM
Ocular Hypotension and Hypertension as Determinants of
Outcomes in Uveitis
Rabia Aman1, Asima Bajwa1, patrie james1, Wenjun Xin2,
Ashvini Reddy1. 1Dept of Ophthalmology, University of Virginia,
Charlottesville, VA; 2BioStatistics, University of Virginia,
Charlottesville, VA.
Purpose: To report outcomes associated with ocular hypotony and
hypertension in a cohort of uveitis patients managed over a 30 year
period.
Methods: Retrospective review of 461 patients (481 eyes) with
uveitis managed at the University of Virginia from 1984 – 2014.
Ocular hypotony and hypertension were defined as baseline
intraocular pressure (IOP) less than 8 mmHg or greater than
21 mmHg, respectively. Primary outcome measures were final
visual acuity and final IOP. Demographics, clinical findings, and
management were analyzed for statistical significance.
Results: Twenty-six eyes of 25 patients had baseline ocular
hypotony, which was not significantly associated with age (P=0.963),
race (P =1.00), gender (P=0.537), or anatomical classification of
uveitis (P=0.826). Of these patients, 18 (72%), 4 (16%), and 2 (8%)
were treated with local steroids, combination local and systemic
steroids, and antimetabolites, respectively. One patient received no
treatment. Final visual acuity of eyes with ocular hypotension was
20/150, which was not significantly different from normotensive
eyes (P=0.0748). Final IOP of eyes with baseline hypotony was
14.9 mmHg, which was not significantly different than that of
normotensive uveitic eyes (P=0.8829).
110 eyes of 85 patients had baseline ocular hypertension, which
was associated with anterior uveitis (76%, P=0.072), but not age
(P=0.9407), race (P =0.072) or gender (P=0.628?). 70 ocular
hypertension patients (82%) had been treated with topical steroid
during study (p=0.093). 27 patients (32%) were managed with
glaucoma medications, 3 patients (4%) glaucoma surgery, and
15 patients (18%),combination medical and surgical glaucoma
management. Final visual acuity of eyes with baseline ocular
hypertension was Snellen 20/90, which was not significantly different
than that of 356 normotensive uveitic eyes (P=0.2237). Final IOP
of eyes with baseline hypertension was 15.0 mmHg, which was
not significantly different than that of eyes with normal baseline
intraocular pressure (P=0.9868).
Conclusions: Neither baseline hypotony nor hypertension in
uveitis was associated with poorer visual acuity and lower final IOP
compared to patients with normal baseline IOP. Uveitic patients with
abnormal IOP can expect final vision and pressure similar to uveitic
patients who are normotensive at baseline.
Commercial Relationships: Rabia Aman, None; Asima Bajwa,
None; patrie james, None; Wenjun Xin, None; Ashvini Reddy,
None
Program Number: 5787 Poster Board Number: C0248
Presentation Time: 8:30 AM–10:15 AM
Clinical characteristics of ocular syphilis in patients with and
without HIV infection
Vincent Cheng, Sun Young Lee, Narsing A. Rao. USC Eye Institute,
University of Southern California, Los Angeles, CA.
Purpose: To compare clinical and laboratory findings of ocular
syphilis between HIV positive and negative patients.
Methods: Medical records of patients diagnosed with ocular syphilis
with serologic confirmation from 2008 to 2014 were retrospectively
reviewed.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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ARVO 2015 Annual Meeting Abstracts
Results: Sixteen consecutive patients (10 HIV-positive vs 6 HIVnegative) with 29 eyes were included. All patients were male and
the mean age of onset was 43 (mean 42.65 ± 13.13). Regardless of
HIV status, ocular findings of ocular syphilis were variable including
anterior uveitis (4 eyes), posterior uveitis (8 eyes), panuveitis (13
eyes), isolated papillitis (4 eyes) and CN III and VII palsy (1 eye).
However, panuveitis was the most common feature (12/18 eyes,
67%) in HIV-positive patients whereas posterior uveitis was the
predominant feature (6/11 eyes, 55%) in HIV-negative patients.
Significantly higher serum rapid plasma reagin (RPR) titers were
found in HIV-positive patients (range 1:64-1:16,348 in HIV-positive
vs 1:2-1.8 except 1 patient with 1:2,048 in HIV-negative, p =
0.019). A higher proportion of HIV-positive patients tested positive
for cerebrospinal fluid fluorescent treponemal antibody absorbed
(CSF FTA-ABS) or venereal disease research laboratory (VDRL)
than HIV-negative patients (70% in HIV-positive vs 16% in HIVnegative). CD4 cell count in HIV-positive patients at onset was
typically ranged from 127 to 535 (mean 237 ± 142). These patients
responded to 10-14 days of intravenous penicillin with relatively
good visual outcome.
Conclusions: HIV status in patients with syphilis plays a role
in ocular manifestations, primarily presenting with pan uveitis
associated with positive CSF FTA-ABS or VDRL and high serum
RPR titers compared to non-HIV syphilis. These findings indicate
that HIV positive individuals with ocular manifestations of syphilis
should be treated for neuro-syphilis.
Commercial Relationships: Vincent Cheng, None; Sun Young
Lee, None; Narsing A. Rao, None
Support: An Unrestricted grant from Research to Prevent Blindness,
New York, NY 10022
Program Number: 5788 Poster Board Number: C0249
Presentation Time: 8:30 AM–10:15 AM
Retinoschisis in Pars Planitis
Julia Malalis1, Pooja Bhat2, Sarah Escott1, Michael Shapiro2, 3, Debra
A. Goldstein1. 1Ophthalmology, Northwestern University, Chicago,
IL; 2Ophthalmology, University of Illinois at Chicago, Chicago, IL;
3
Retina Consultants Ltd, Des Plaines, IL.
Purpose: Retinoschisis is a well-recognized complication of pars
planitis, yet little data is available regarding its prevalence and
course. The purpose of this study is to determine the incidence,
presentation, and course of retinoschisis in patients with pars planitis.
Methods: Retrospective chart review was performed on all patients
with pars planitis meeting Standardization of Uveitis Nomenclature
disease definition seen by the Uveitis service of one of the authors
from July 2012 - September 2014.
Results: 34 patients (68 eyes) who met disease definition were
included. 21 patients were female (62%). The majority of patients
were Caucasian (n=23, 68%); the remainder were Hispanic (n=10,
29%) and Asian (n=1, 3%). 13 eyes (19%) developed retinoschisis.
In all cases, schisis was inferiorly located, posterior to the snowbank.
In 6 patients (86%) the schisis was bilateral. 4 patients with schisis
were Caucasian (57%), 2 were Hispanic (29%) and 1 was Asian
(14%). 4 patients were female (57%). Average follow-up of patients
with schisis was 7 years (3.7 - 9.6 years); average visual acuity of
eyes with schisis was 20/22 at last follow-up. 5 eyes of 5 patients
underwent pars plana vitrectomy. 3 had vitrectomy for disease control
with scleral buckle placement to reduce residual traction. In one eye,
the schisis did not progress despite active vitreous inflammation,
while the other developed schisis while inflammation was
uncontrolled. The third was only noted to have schisis at the time of
vitrectomy. Two eyes of two patients required pars plana vitrectomy
for retinal detachment with progressive schisis despite control of
uveitis. Silicone oil was used in these cases. 8 eyes with retinoschisis
remained stable without need for surgical intervention.
Conclusions: Retinoschisis is a common complication in patients
with pars planitis at a tertiary referral practice. It is typically
bilateral, inferior, and may develop in eyes with both controlled
and uncontrolled disease. Even in eyes that require surgical
management of progressive schisis, visual outcome can be favorable.
While inflammatory mediators may play a role in development
and progression of schisis, the presence of inflammation may not
correlate with progression of schisis. In all cases schisis was adjacent
to a snowbank, suggesting that mechanical forces may lead to
development of schisis and retinal detachment even in patients with
inactive disease.
Commercial Relationships: Julia Malalis, None; Pooja Bhat,
None; Sarah Escott, None; Michael Shapiro, None; Debra A.
Goldstein, None
Program Number: 5789 Poster Board Number: C0250
Presentation Time: 8:30 AM–10:15 AM
Vaccine Associated Uveitis
Matthew Benage, Rick W. Fraunfelder. Department of
Ophthalmology, University of Missouri, Columbia, MO.
Purpose: To describe a series of case reports of uveitis following
vaccination with hepatitis A, hepatitis B, HPV, BCG, brucella, DPT,
herpes, influenza, measles, MMR, pneumococcal, smallpox, tetanus,
varicella, and zoster.
Methods: Reports from the National Registry of Drug-Induced
Ocular Side Effects (Columbia, Missouri), WHO, and the FDA were
collected on vaccine associated with uveitis between 1988 and 2014.
We also performed a Medline literature search using the keywords of
uveitis, or iritis, in combination with vaccines, hepatitis A, hepatitis
B, HPV, BCG, brucella, DPT, herpes, influenza, measles, MMR,
pneumococcal, smallpox, tetanus, varicella, and zoster vaccine.
Results: A total of 290 cases of uveitis following vaccine
administration were reported following the use of vaccinations.
199 cases were female and 77 cases were male; 12 did not disclose
gender. The mean age was 30 years (0.2-86). The mean number of
days until uveitis was reported after vaccination was 141 days (1 day6 years). 14 were still recovering, while 22 did not recover. 166 cases
did not report resolution status. The most prolific vaccine associated
uveitis is hepatitis B, with a total of 115 cases reported. Additionally,
forty-four cases of uveitis were reported following HPV vaccination;
five cases were reported following hepatitis A vaccination; twentyone cases of uveitis were reported following BCG vaccination;
twenty-seven cases of uveitis were reported following influenza
vaccination; and thirteen cases of uveitis were reported following
MMR vaccination. Thirty-five cases of uveitis were reported
following administration of multiple vaccines. Two cases of uveitis
were reported after smallpox vaccination and one case of brucella,
DPT, herpes, measles, pneumococcal, and tetanus were reported to be
associated with uveitis, respectively.
Conclusions: All commonly administered vaccinations are associated
with uveitis. Inflammation is temporary and resolves with topical
ocular steroids usually without long term damage to the eye. The
mechanism is unclear, however, various hypotheses have been
suggested. The proposed mechanisms are molecular mimicry
secondary to close resemblance of vaccine peptide fragments and
uveal self-peptides, delayed-type hypersensitivity with deposition of
immune complexes, and immune reaction to vaccination adjuvants.
Despite mechanistic uncertainty, clinicians are encouraged to be
aware of vaccine-associated uveitis for prompt diagnosis, treatment,
and reporting.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Commercial Relationships: Matthew Benage, None; Rick W.
Fraunfelder, None
Program Number: 5790 Poster Board Number: C0251
Presentation Time: 8:30 AM–10:15 AM
Unusual Manifestations of Zoster Vasculitis
Andrew Mincey, Steven A. Newman. Ophthalmology, University of
Virginia, Charlottesville, VA.
Purpose: Herpes zoster has had a myriad of potential effects
involving the visual pathways including ophthalmoplegia, acute
retinal necrosis, and severe post herpetic neuralgia. The propensity
of this DNA virus to involve vessels makes other forms of vasculitis
possible.
Methods: Review of 2 unusual cases of zoster causing vascular
occlusive disease affecting the ophthalmic artery and branches of the
central retinal artery occlusion were reviewed.
Results: In one of these 2 unusual cases, a central retinal artery
occlusion occurred following typical zoster uveitis. The presence of
a cilioretinal artery sparred central fixation. The second patient was
misdiagnosed with giant cell arteritis. A substantial delay in diagnosis
was made because of failure to order fat sat with gadolinium. When
the MRI was repeated prominent enhancement was seen of the optic
nerve sheath.
Conclusions: Varicella virus has a propensity for involving the
vascular system potentially producing occlusive ischemic changes
involving both the optic nerve and the retina. Recognition can be
difficult if the zoster is not considered.
Commercial Relationships: Andrew Mincey, None; Steven A.
Newman, None
Program Number: 5791 Poster Board Number: C0252
Presentation Time: 8:30 AM–10:15 AM
OPHTHALMIC AND SYSTEMIC MANIFESTATIONS
OF IgG4 RELATED DISEASE : ABOUT 6 PATIENTS IN A
SINGLE CENTER
Nathalie Butel1, 2, Mathieu ZMUDA2, Olivier Galatoire2. 1hôpital pitié
salpetriere, Boulogne, France; 2fondation Rotschild, Paris, France.
Purpose: We presented a french descriptive dataset of orbital, eyelid
and systemic manifestations in lymphoproliferative disorder of IgG4
related disease (IgG4-RD) in 6 patients. The main manifestation is
a non-specific inflammatory orbitopathy which is cortico-sensitive.
This recent syndrome, underknown, often makes a Masquerade
syndrome, responsible of misdiagnosis.
Methods: Retrospective and monocentric descriptive evaluation
conducted between 2012 and 2013 in a tertiary center in Paris,
including patients with orbital or eyelid impairment in IgG4-RD
according to the Kawa et al criteria.
Results: 6 patients (4 men, 2 women) were included. 2 patients
were childrens. Median age was 45 years (9-62 years). The average
diagnostic delay between the onset ocular symptoms and immuno
histo chemical confirmation was 18 months (2-72 months). Mean
follow-up was 32 months (2-72 months). 1 patient (age 9) had
a single eye-lid reached, while 5/6 patients also had systemic
involvement like parotidis,affected lymph node and tonsil, thyroiditis,
aortitis, skin involvement. In 2 cases we found an infraorbital nerve
enlargement. All patients had a permanent or transient clinical
improvement with corticotherapy.
Conclusions: IgG4-RD is rarely described in children, this study
shows that it is important to think about it in an orbital or eyelid
unexplained inflammatory disease, even in children. Involvement of
cranial nerves in IgG4-RD was once described in the literature. We
found 2 patients with infra orbital nerve enlargement which seems to
be a very typical manifestations in IgG4-RD.
Commercial Relationships: Nathalie Butel, None; Mathieu
ZMUDA, None; Olivier Galatoire, None
Program Number: 5792 Poster Board Number: C0253
Presentation Time: 8:30 AM–10:15 AM
Assessment of macular pigment optical density in patients with
sunset glow fundus in Vogt-Koyanagi-Harada disease
Taro Seino, Kouhei Hashizume, Mana Nagasawa, Yasunori Nishida,
Daijiro Kurosaka. Ophthalmology, Iwate Medical University,
Morioka, Japan.
Purpose: To compare the macular pigment optical density (MPOD)
of eyes with sunset glow fundus in Vogt-Koyanagi-Harada (VKH)
disease with the MPOD of eyes without retinal disease.
Methods: The MPOD of 19 eyes with sunset glow fundus of VKH
was measured and compared with the MPOD of 25 eyes without
any signs of retinal disease. None of subjects was under carotenoid
supplementation. The MPOD was measured with Macular pigment
screener (MPS II) from Elektron Technology.
Results: Eyes with sunset glow of VKH have significantly lower
level of MPOD than eyes without retinal disease (0.486 ± 0.184
versus 0.625 ± 0.176, p = 0.016, Student’s t test). Thirteen eyes of
19 eyes were treated with initial steroid pulse therapy, 1000 mg of
intravenous methylprednisolone for 3 days. Eyes with VKH not
treated with initial steroid therapy have significantly lower level of
MPOD than eyes with VKH treated with initial steroid therapy (0.257
± 0.075 versus 0.592 ± 0.100, p < 0.001, Student t test), and there
was no significant difference between the level of MPOD of eyes
with VKH treated with initial steroid therapy and eyes without retinal
disease (p = 0.551, Student t test) There was no significant correlation
between MPOD and visual acuity in VKH patients (p = 0.064,
Pearson’s correlation coefficient).
Conclusions: Inflammation decreased MPOD in patients with VKH.
Initial steroid therapy prevented loss of MPOD in patients with VKH.
But relation between loss of macular pigment and visual function
remains unclear.
Commercial Relationships: Taro Seino, None; Kouhei Hashizume,
None; Mana Nagasawa, None; Yasunori Nishida, None; Daijiro
Kurosaka, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 5793 Poster Board Number: C0254
Presentation Time: 8:30 AM–10:15 AM
Fundus autofluorescence imaging in Vogt-Koyanagi-Harada
disease from acute onset in a 12-month follow-up
CELSO MORITA, Viviane M. Sakata, Ever E. Rodriguez, Smairah F.
Abdallah, Carlos E. HIrata, Maria K. Oyamada, Joyce H. Yamamoto.
Ophthalmology, University of São Paulo, São Paulo, Brazil.
Purpose: Vogt-Koyanagi-Harada disease (VKHD), an autoimmune
aggression against melanocytes, is characterized by an acute
bilateral diffuse choroiditis with extraocular manifestations. Disease
inflammation and therapy are monitored based on clinical and
fundus imaging, i.e. fluorescein angiography and indocyanine green
angiography. Fundus autofluorescence imaging (FAF) may indicate
retinal pigment epithelium (RPE) functional and metabolic changes:
blue autofluorescence (BL-FAF) may indicate lipofuscin abnormality;
near-infrared light (NIR-FAF) may indicate melanin and melanin
compounds abnormalities. The present study aimed to evaluate
fundus autofluorescence imaging in patients with VKHD during a
12-month follow-up from disease onset.
Methods: Retrospective longitudinal study including 9 patients
(18 eyes) with VKHD, diagnosed according to Revised Diagnostic
Criteria, followed from disease onset for a minimum 12 months. All
patients were treated with methylprednisolone 3-day pulsetherapy
followed by oral prednisone (1mg/kg/day) with a slow 12-15 month
tapper. Fundus autofluorescence (BL-FAF and NIR-FAF) was carried
out as part of a multimodal fundus imaging analysis (Spectralis
HRA+OCT, Heidelberg Engineering, Germany) alongside functional
exams (RETI-port system; Roland Consult, Germany). Images
obtained at M0, M1, M3, M6 and M12 were analysed by two readers.
Autofluorescence changes were classified into hyper (Hy) and hypo
(Ho) changes and into the patterns: diffuse (D), plaque (PL), granular
(G) and reticular (R). The study was approved by the Institutional
Ethics Committee.
Results: Nine patients (7F/2M), with median age of 33 y/o and
median time to treatment of 12 days (3-46), were included. FAF at
M1 disclosed two distinct patterns, a mild granular Hy-FAF with
progressive return to normal (mild FAF) and a exuberant plaque and/
or diffuse Hy-FAF with or not plaque Ho-FAF (severe FAF) (Figure).
According to this classification, 8 eyes had mild FAF and 10 eyes
had severe FAF. Severe FAF group had thicker subfoveal choroidal
thickness at M1 (p=0.017); had more subretinal neovascular
membrane (p=0.034) and more deranged full-field electroretinogram
parameters (kappa=0.667; CI95%0.324-1.000) at M12.
Conclusions: FAF pattern at M1 can be a method for detection of
severe RPE abnormalities and may be useful for managing treatment.
FAF imaging-mild pattern
FAF imaging-severe pattern
Commercial Relationships: CELSO MORITA, None; Viviane M.
Sakata, None; Ever E. Rodriguez, None; Smairah F. Abdallah,
None; Carlos E. HIrata, None; Maria K. Oyamada, None; Joyce
H. Yamamoto, None
Support: FAPESP 2011/50936-7;2011/19194-4;2014/01222-0
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 5794 Poster Board Number: C0255
Presentation Time: 8:30 AM–10:15 AM
Functional Correlations of Optical Coherence Tomography
Findings in Birdshot Chorioretinoopathy
Gokul Kumar, Jessica Shantha, Purnima Patel, Steven Yeh.
Ophthalmology, Emory University, Decatur, GA.
Purpose: To evaluate SD-OCT findings in patients with birdshot
chorioretinopathy and correlate them with visual acuity, kinetic
perimetry, and electroretinography.
Methods: We performed a retrospective analysis of patients with
clinical diagnosis of birdshot chorioretinopathy who had concurrent
OCT, kinetic perimetry, and ERG. All OCT scans were evaluated
for external limiting membrane (ELM) integrity, ellipsoid zone (EZ)
integrity, and presence of cystoid macular edema (CME). These were
compared to select functional measures – rod and cone function on
ERG, visual acuity, and visual field abnormalities.
Results: Thirteen encounters of eleven patients were analyzed. 12
(46.2%) OCT images showed ELM disruption; 14 (53.9%) images
showed EZ disruption; 9 (35.6%) images showed CME. 20 Goldman
visual fields (76.9%) showed abnormalities, including enlarged
blind spots and areas of relative scotomas. On ERG, 14 studies
had normal rod function (53.9%) and 3 had normal cone function
(11.5%). 7 studies had mild rod dysfunction (26.9%), 3 moderate
(11.5%) and 2 severe (7.7%). 6 studies had mild cone dysfunction
(23.1%), 15 moderate (23.1%), and 2 severe (7.7%). Visual acuities
were categorized as normal (20/20 Snellen acuity), mild impairment
(20/25-20/40), moderate impairment (20/50-20/150), or severe
(20/200 or below). 5 studies were normal (19.2%), 10 had mild
impairment (38.5%), and 11 had moderate impairment (42.3%). The
relationship between EZ disruption and visual acuity (p=0.023) and
the relationship between EZ disruption and cone function on ERG
testing (p=0.025) appeared statistically significant by Chi-square
test of independence. The relationship between ELM disruption
and presence of visual field loss (p=0.017) appeared statistically
significant by Fisher’s exact test. The relationship between ELM
disruption and visual acuity (p=0.051) and the relationship between
presence of CME and visual acuity (p=0.051) approached statistical
significance.
Conclusions: SD-OCT imaging of the fovea can be a useful adjunct
test in birdshot chorioretinopathy. Changes in ELM and EZ on OCT
may relate to important functional measures, including visual field
loss and visual acuity impairment. However, some functional changes
appear to be independent of the anatomical changes noted on foveal
OCT.
Commercial Relationships: Gokul Kumar, None; Jessica
Shantha, None; Purnima Patel, None; Steven Yeh, None
Program Number: 5795 Poster Board Number: C0256
Presentation Time: 8:30 AM–10:15 AM
The efficacy and safety of immunosuppressive agents in the
treatment of necrotizing scleritis - A multi-center retrospective
analysis in Korea
Hyun Sun Jeon1, Mee Kum Kim2, 3, Joon-Young Hyon1, 3.
1
Ophthalmology, Seoul National University Bundang Hospital,
Seoungnamsi, Korea (the Republic of); 2Ophthalmology, Seoul
National University Hospital, Seoul, Korea (the Republic of); 3Seoul
National University College of Medicine, Seoul, Korea (the Republic
of).
Purpose: Necrotizing scleritis is the most severe form of scleritis,
however there have been only several small case reports regarding its
treatment. We performed a multi-center, retrospective, case series
study to investigate the efficacy and safety of immunosuppressive
agents (ISA) in the treatment of necrotizing scleritis.
Methods: Medical charts of fifty-two patients treated with ISA for
necrotizing scleritis from June 2002 to May 2012 at eleven tertiarycare centers were reviewed. Patient characteristics, clinical features,
risk factors, and treatment results were analyzed. The efficacy and
safety was evaluated and compared between cyclophosphamide
and other ISA (azathioprine, cyclosporine, methotrexate, and
mycophenolate mofetil). Efficacy was assessed by remission rate,
relapse rate, visual loss (more than 2 lines) rate and steroid sparing
rate. Safety was assessed by occurrence of adverse effects and
discontinuation of medication from its adverse effects.
Results: Of 52 patients, 50 who treated with ISA within 3 months
periods were included. The mean age was 65.8 ± 10.5 years.
Complete or partial remission was achieved in 90% of patients
by 6 months and 95% by 12 months. Patients who were initially
treated with ISA showed significantly better complete remission
rate (P=0.043). There were no significant differences in remission
rate, relapse rate, visual loss rate, and steroid sparing rate between
cyclophosphamide group and other ISA group. Incidence of adverse
effects were comparable between cyclophosphamide and other ISA
(61.9% vs. 41.4%, P=0.152), however, incidence of leukopenia,
hemorrhagic cystitis, and discontinuation of medication from adverse
effects were much higher in cyclophosphamide group (P<0.001,
P<0.001, P=0.05, respectively).
Conclusions: Initial treatment with ISA showed clinical benefit in
the treatment of necrotizing scleritis. Although overall incidences of
adverse effects were not different among agents, side effects related
medication discontinuation was much higher with cyclophosphamide.
Commercial Relationships: Hyun Sun Jeon, None; Mee Kum
Kim, None; Joon-Young Hyon, None
Support: This research was supported by a grant (12172MFDS231)
from Ministry of Food and Drug safety in 2012.
Program Number: 5796 Poster Board Number: C0257
Presentation Time: 8:30 AM–10:15 AM
Long-term efficacy of interferon in severe uveitis associated with
Behçet’s disease
Eleonore Diwo1, David Saadoun1, Julie Gueudry2, Phuc Lehoang1,
Bahram Bodaghi1. 1Paris, Pitie Salpetriere Hospital, Paris, France;
2
Rouen Hospital, Rouen, France.
Purpose: To retrospectively assess the frequency of ocular relapse
and the possibility of long-term remission in patients who were
treated with interferon (IFN) alpha for severe uveitis associated with
Behçet’s disease (BD)
Methods: All patients with severe uveitis associated with BD and
referred to Pitié-Salpêtrière Hospital, France, between June 1994
and January 2010 and treated by interferon alpha, whatever the
treatment duration, were included in our retrospective cohort study.
All patients were treated with initial dosage of IFN alpha 3 million
IU thrice a week, increased to 6 million IU thrice a week in case
of relapse or discontinued in case of stable clinical examination.
All patients had active severe uveitis : refractory to at least one
conventional immunosuppressive drug and/or requiring high doses
oral corticosteroids (> 10mg per day). All patients whose compliance
with medication could not be established were excluded.The main
assessment criterion was the number of relapses per patient per year
before and after initiation of IFN and after discontinuation of IFN.
Best visual acuity, anterior segment inflammation, vitritis, presence
of vasculitis, macular edema, papillitis and retinitis were assessed at
initiation and at 2, 4 and 9 years after the initiation of IFN.
Results: Of 36 patients (67 eyes), 31 (86.1%) responded to IFN.
For responders, the mean relapse per person per year decreased
significantly from 1.39 to 0.0496 (p = 1.82*10^-10) during treatment
period. After cessation of IFN, possible for 21 patients, the mean
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
annual incidence of relapse remained at 0.057 relapses per person per
year. The mean period from the initiation of IFN to the date of the
last follow-up consultation was 8.19 years (range, 6 to 216 months).
Thirty three, 25 and 18 patients were followed respectively at 2, 4
and 9 years. Visual acuity was stable or improved for 90.3% of all
patients. For the group “9 years”, anterior segment inflammation
and vitreous haze were reduced during the first year. The prevalence
of macular edema and the prevalence of retinitis and papilledema
plummeted to zero at 4 years and 1 year after IFN initiation.
Conclusions: The incidence of relapses in severe uveitis associated
with Behçet’s disease decreases under IFN alpha treatment. This
treatment also seems to permit a long-term remission even after
discontinuation. It is an efficient treatment for vasculitis, cystoid
macular edema and papilledema.
Commercial Relationships: Eleonore Diwo, None; David
Saadoun, None; Julie Gueudry, None; Phuc Lehoang, None;
Bahram Bodaghi, None
Program Number: 5797 Poster Board Number: C0258
Presentation Time: 8:30 AM–10:15 AM
Treating autoimmune retinopathy (AIR) with
immunosuppressive therapy: results of a retrospective singlecenter study.
Armin Maghsoudlou1, Naira Khachatryan2, 1, Ninani Kombo1,
3
, C Stephen Foster1. 1Massachusetts Eye Research and Surgery
Institutition(MERSI), Cambridge, MA; 2The Scheie Eye Institute,The
University of Pennsylvania Perelman School of Medicine,
Philadelphia, PA; 3Ophthalmology, Yale School of Medicine, New
Haven, CT.
Purpose: The autoimmune retinopathy (AIRs) is characterized by
progressive vision loss, an abnormal Electroretinogram (ERG) and
circulating antibodies directed against retina proteins. This study
aimed to investigate the results of treatment of AIR patients with
immunosuppressive therapy.
Methods: This is a retrospective study of AIR patients who were
treated with systemic immunosuppressants. Treatment outcomes
were assessed by the following parameters: visual acuity (VA), mean
deviation (MD) and pattern standard deviation (PSD) parameters
in Humphrey visual field (HVF), implicit time and amplitude
parameters in Ganzfield Electroretinograpy (ERG) and serologic
findings for anti-retina and anti-optic nerve antibodies
Results: The study included 15 eyes of 8 participants with a mean
age at entry of 52.9 (± 14.0) years. Four study participants (63%)
were female. The mean follow up time was 2.3 years (± 1.2 years).
During the course of treatment, of all participants, one (13%) had
worsening in serology findings for both anti-retina and anti-optic
nerve antibodies, four (50%) improved (reduction or became
negative), and two (25%) completely resolved.
Of seven participants with ERG measurements, four (57%)
improved in one or both eyes. Of seven participants with HVF MD
measurements, five (71%) reported stable or improved MD in one or
both eyes. Of all participants, five (63%) reported stable or improved
VA in one or both eyes. Three study participants (37.5%) improved
by 3 or 4 parameters, three (37.5%) were stable or improved by 2
parameters only, and two (25%) worsened by all parameters.
Of those improved by 3-4 parameters, two participants were
treated with a combination of Rituxan with Prednisone and either
Cyclosporine or Cyclophosphamide, and one participant was treated
with a combination of Rituxan and Cyclophosphamide. Of those
stable or improved by 2 parameters only, two participants were
treated with Rituxan only and one participant with combination of
Rituxan and Velcade.
Conclusions: This study reported that the majority (n=6; 77%) of
the patients with AIR treated with immunosuppressants were stable
or improved by two or more parameters. Further studies with larger
sample size and longer follow up are needed to investigate long term
results of the treatment of AIR patients with immunosuppressive
therapy.
Commercial Relationships: Armin Maghsoudlou, None; Naira
Khachatryan, None; Ninani Kombo, None; C Stephen Foster,
None
Program Number: 5798 Poster Board Number: C0259
Presentation Time: 8:30 AM–10:15 AM
Cataract surgery in patients with pars planitis and
immunosuppressive therapy
Tania Albavera-Giles, Juan Carlos Serna-Ojeda, Miguel PedrozaSeres. Instituto de Oftalmologia Conde de Valenciana, Distrito
federal, Mexico.
Purpose: To evaluate the characteristics and outcomes of
cataract surgery in patients with pars planitis who received
immunosuppressive therapy in a tertiary institution of ophthalmology
in Mexico.
Methods: We reviewed our database between January 2003 and
November 2014 of 374 patients with pars planitis, and from the
49 patients that received immunosuppressive therapy, we included
the patients with cataract surgery. A retrospective analysis was
performed, and the following data was collected: age at presentation,
age at cataract surgery, follow-up, visual acuity before, 1 week,
1 month and 6 months after the surgery, inflammation after the
surgery, immunosuppressive therapy used for each case, surgical
and postoperative complications and causes for failed visual
improvement.
Results: Sixteen patients were included, with a median age at
presentation of 10.5 years and with a median age at the moment of
the cataract surgery of 11 years (range 4-26 years). All the patients
had no inflammation before the surgery for at least 2 months. The
immunosuppressive therapy used for the patients were methotrexate
in 15 patients (93.7%) and azathioprine in 6 (37.5%), with 5 patients
requiring a combination of drugs. Thirteen patients received the
immunosuppressive therapy before the surgery for a median time of
8 months, and 3 patients received only previously systemic steroids,
and the immunosuppressors were administered after the surgery.
All the patients had phacoemulsification with intraocular lens
implantation in the capsular bag in 15 patients (93.7%) and 9 patients
(56.25%) required anterior vitrectomy. The visual acuity improved
from a median of 20/800 (range 20/60 to hand movements), to 20/100
(range 20/25 to 20/2000) after 6 months of follow up; 14 patients
(87.5%) improved two lines of vision or more and the other 2 patients
remained the same visual acuity. No improvement in visual acuity
was attributed to posterior segment manifestations or amblyopia.
The median follow up after the surgery was 32 months (range 4 to 91
months) and with immunosuppressive therapy was 18 months (range
2 to 56 months).
Conclusions: Phacoemulsification was the procedure for all the
patients in this study, with a high rate of anterior vitrectomy. Visual
acuity improved in 87.5% of patients with pars planitis treated with
immunosuppressive drugs who underwent cataract surgery.
Commercial Relationships: Tania Albavera-Giles, None; Juan
Carlos Serna-Ojeda, None; Miguel Pedroza-Seres, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 5799 Poster Board Number: C0260
Presentation Time: 8:30 AM–10:15 AM
Characteristics of Non-Infectious Persistent Postoperative
Inflammation
Russell W. Read, Kinley Beck. Ophthalmology, University of
Alabama at Birmingham, Birmingham, AL.
Purpose: To determine the characteristics of patients diagnosed
with non-infectious persistent postoperative inflammation and to
determine if this diagnosis occurs more often in various subgroups
(race and gender.)
Methods: Retrospective chart review of all patients seen between
2007 and 2010 (inclusive) at a single tertiary care academic
uveitis center. Patients with non-infectious persistent postoperative
inflammation were identified and compared to patients with other
categories of uveitis. Characteristics were compared between groups
using t-test and chi-square test for continuous and categorical
variables, respectively.
Results: 732 patients were identified, 28 of which were diagnosed
with non-infectious persistent postoperative inflammation (PPI)
(3.8% of all patients). All but 3 cases followed cataract surgery and
lens implantation. Of the 3 non-cataract cases, 2 were following
trabeculectomy and one following SLT. All 28 had anterior disease,
so comparison to non-PPI patients was limited to those with
anterior uveitis (n = 485). The mean age at disease onset for PPI
was 62 years (range 10-74) versus 45 years (range 1-94) for nonPPI patients (p=0.00001). Of patients with PPI, 29% were male,
71% female as compared to 33% male and 67% female for non-PPI
patients (p = 0.64). Of PPI patients, African Americans comprised
61%, Caucasians 36%, and “Other” 4% versus for non-PPI, African
Americans comprised 41%, Caucasians 57%, and “Other” 2% (p =
0.079). PPI patients manifested bilateral disease in 25% of cases,
unilateral in 75% versus in non-PPI disease bilateral cases were 37%
and unilateral 63% (p = 0.19). Of PPI patients with bilateral disease,
86% were African American and 14% were Caucasian. Of PPI
patients with unilateral disease, 55% were African American and 45%
were Causcian. Stated conversely, of African American PPI patients,
35% had bilateral disease, 65% unilateral disease. Of Caucasian PPI
patients, 10% had bilateral disease, 90% unilateral disease (p = 0.15).
Conclusions: Persistent postoperative inflammation occurs most
commonly following cataract surgery and is anterior. Females are
more likely to be affected but not to a greater degree than in nonPPI anterior uveitis. A trend towards a higher frequency in African
Americans was found and African Americans were more likely to
have bilateral PPI, though not to a statistically significant degree.
Commercial Relationships: Russell W. Read, None; Kinley Beck,
None
Support: Research to Prevent Blindness Physician Scientist Award;
Unrestricted departmental grants from Research to Prevent Blindness
and the EyeSight Foundation of Alabama
development of retinal detachment, types of surgical interventions
and the occurrence of recurrent retinal detachment after surgical
repair. We compared the rates of recurrent detachment between those
receiving and not receiving intravitreal foscarnet using Fisher’s exact
test.
Results: We identified 32 eyes from 27 patients with ARN (5 with
bilateral disease). Mean follow up was 51.8 months (range 7-206).
All subjects received systemic treatment with either intravenous
followed by oral acyclovir or oral valacyclovir alone and a subset
of eyes (50%) were treated with intravitreal foscarnet. Fifteen eyes
(46.9%) developed retinal detachments and 13 under went surgical
repair. Primary intervention consisted of pars plana vitrectomy with
silicone oil in 7 cases (53.8%), pars plana vitrectomy in combination
with scleral buckle and silicone oil in 4 cases (30.8%) and pars plana
vitrectomy with either scleral buckle (1 case) or cryotherapy (1 case).
Recurrent retinal detachment developed in 7 eyes (53.8%) occurring
35 days to 10 months after the primary retinal surgery. There was no
difference in the rate of recurrent detachment between eyes treated
with or without intravitreal foscarnet (p=0.74), although sample
size limits comparison. Three recurrent detachments happened
after removal of silicone oil (between 1 day and 3.5 months after
the procedure). At final follow up, all retinas that underwent repair
remained attached. Acuities at the last recorded visit ranged from
20/40 to no light perception; vision improved in 30.8% of patients
who underwent retinal repair.
Conclusions: We found a rate of retinal detachment secondary
to ARN similar to that previously reported. Recurrent retinal
detachment after primary surgical repair was a frequent complication
and the rate of recurrent detachment did not differ based on prior
treatment with foscarnet. Overall, visual prognosis was poor despite
surgical intervention.
Commercial Relationships: Laura J. Kopplin, None; Stephanie
Cramer, None; Steven Yeh, None; Christina J. Flaxel, None
Support: Institutional grant from Research to Prevent Blindness
Program Number: 5800 Poster Board Number: C0261
Presentation Time: 8:30 AM–10:15 AM
Long-term surgical outcomes of acute retinal necrosis
Laura J. Kopplin1, Stephanie Cramer1, Steven Yeh2, Christina J.
Flaxel1. 1Casey Eye Institute, Portland, OR; 2Emory Eye Center,
Atlanta, GA.
Purpose: To assess the long-term visual, anatomic and surgical
outcomes in patients with acute retinal necrosis (ARN), including
rates of recurrent detachment following primary surgical repair. To
determine if prior intravitreal foscarnet therapy reduced the rate of
recurrent retinal detachment.
Methods: We conducted a single center retrospective chart review
from 2001-2012 of patients diagnosed with ARN. We assessed the
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].