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      Appraisal, Work-Up and Diagnosis of Anterior Uveitis: A Practical Approach

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          Abstract

          This article presents a comprehensive approach of the diagnosis of anterior uveitis and appropriate investigational tests based on clinical signs.

          Uveitis has classically been presented by uveitis specialists as an obscure and complicated field in ophthalmology that was supposed to be restricted to the happy few who had the knowledge, which in some countries was even prevented from being diffused. The effect was that ophthalmologists turned away from uveitis or were not correctly armed when they chose to take care of uveitis patients. The consequences of this situation often fell upon the patients. Since more than 15 years our group has been represented by the Society for Ophthalmo-Immunoinfectiology in Europe (SOIE), which has been working to alter this image of uveitis and ensure that the knowledge of the basics of uveitis reaches the practicing ophthalmologist. Our firm believe is that up to 70% of uveitis cases, especially anterior uveitis, can be taken care of by the practicing ophthalmologist following a structured approach in the appraisal of the uveitis case. Judging from the attendance obtained, the response to our approach in every country (where we organise courses) has been inversely proportional to the previous disinterest since we started publicizing it.

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          Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome.

          Tubulointerstitial nephritis and uveitis syndrome (TINU) is a specific form of uveitis that is unfamiliar to most ophthalmologists. Thus, it is frequently overlooked in differential diagnosis. We hypothesized that recognition of subsets of uveitis can facilitate the diagnosis of rare entities such as TINU. Retrospective case series. One thousand nine hundred eighty-five patients with uveitis. We performed a computerized database analysis of patients evaluated for uveitis at the Casey Eye Institute from September 1985 until May 2005. The database includes details about ocular inflammation, including specific diagnosis, anatomic location, laterality, continuity, onset, complications, HLA-B27 status, and relative diagnostic certainty. Additionally, we reviewed all charts of patients diagnosed with TINU or with a presentation of uveitis that was typical of TINU (i.e., bilateral sudden-onset anterior uveitis). Prevalence of TINU in identifiable subsets of patients with uveitis, visual acuity (VA), and renal function. Individuals with TINU (n = 33) represented 1.7% of all patients with uveitis. However, TINU was diagnosed in 32 of the 316 patients (10%) presenting with bilateral sudden-onset anterior uveitis and in 20 of 62 of these patients (32%) who were younger than 20 years. Creatinine levels were more likely to be elevated in patients older than 40. Most patients maintained excellent VA and did not develop clinically significant renal impairment. Tubulointerstitial nephritis and uveitis syndrome is a common cause of uveitis among patients who present with bilateral sudden-onset anterior uveitis. The size of this series clarifies the understanding of the relationship between renal and ocular disease; facilitates recognition of the syndrome; and adds to the knowledge on prognosis, complications, and role of antecedent medications.
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            Signs and symptoms of uveitis. I. Anterior uveitis.

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              Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis.

              To describe the diagnostic and therapeutic management of cytomegalovirus (CMV) anterior uveitis unassociated with retinal necrosis in immunocompetent patients. Patients referred between 2001 and 2003 for management of unilateral, chronic, recurrent uveitis associated with secondary glaucoma underwent extensive investigation including laboratory tests for herpes virus infections. Specific antiviral treatment was initiated in all cases and the level of ocular inflammation was evaluated during the follow up. Five patients, three men and two women, were included. Median age was 50 years old (range 30-80 years). Anterior unilateral uveitis without iris atrophy was observed in all cases. Uveitis was chronic in three cases and recurrent in two cases. Glaucoma was observed in all patients with a median intraocular pressure of 30 mm Hg (range 22-43 mm Hg). Five patients responded initially to specific anti-CMV therapy. Even though glaucoma surgery was necessary in two cases, both ocular inflammation and glaucoma were controlled in all cases. Relapses occurred in three cases after cessation of therapy, requiring prolonged maintenance therapy with valganciclovir. CMV infection and specific antiviral therapy should be considered in all cases of relapsing or chronic iridocyclitis and secondary glaucoma. Maintenance regimens of valganciclovir may be necessary to prevent further relapses.
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                Author and article information

                Journal
                Middle East Afr J Ophthalmol
                MEAJO
                Middle East African Journal of Ophthalmology
                Medknow Publications (India )
                0974-9233
                0975-1599
                Oct-Dec 2009
                : 16
                : 4
                : 159-167
                Affiliations
                Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care and University of Lausanne, Lausanne, Switzerland
                Author notes
                Corresponding Author: Dr. Carl P. Herbort, Retinal, Inflammatory and External Eye Diseases, Centre for Specialized Ophthalmic Care (COS), 6, Rue de la Grotte, CH-1003 Lausanne, Switzerland. E-mail: carl.herb@ 123456bluewin.ch
                Article
                MEAJO-16-159
                10.4103/0974-9233.58416
                2855658
                20404984
                4a33fcb8-b70e-4eee-adf5-7fe223a10a1c
                © Middle East African Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Symposium - Uveitis Update

                Ophthalmology & Optometry
                non-granulomatous uveitis,uveitis work-up,granulomatous uveitis,anterior uveitis

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