Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Refractive surprise after toric intraocular lens implantation: Graph analysis

PURPOSE: To determine the refractive cylinder effect of rotating a toric intraocular lens (IOL) and identify the sources of refractive astigmatic surprise after toric IOL implantation. SETTING: Private practice, Melbourne, Australia. DESIGN: Experimental study. METHODS: Vergence formulas using a standard reduced eye model were used to bring all lens powers to the corneal plane. Double-angle vector diagrams were then used to (1) determine the refractive cylinder effect of rotating a toric IOL and (2) show how the prevailing astigmatism and the various planning and surgical steps involved in implanting a toric IOL contribute to the postoperative manifest refractive cylinder. RESULTS: An example calculation is given to illustrate the method. CONCLUSIONS: Refractive cylinder surprises can occur after toric IOL implantation. Understanding the causes enables surgeons to address contributory factors and choose an appropriate surgical method for managing individual cases of refractive cylinder surprise. Financial Disclosure: Dr. Alpins and Mr. Stamatelatos have a financial interest in the Assort software program used to support the planning and analysis of astigmatic correction. Dr. Ong is an employee of Assort

Multifocal Choroidal Lesions -- A Rare Complication of Herpes Zosper Ophthalmicus

We document the case of a 76-year-old woman who developed mutifocal choroidal lesions as an unusual complication of herpes zoster ophthalmicus

I Have an Empty Sella, What Does This Mean? (PDF)

The sellar region is of extreme importance to neuro-ophthalmologists: the optic chiasm lies directly above the sella turcica and many pathological processes that arise in this region cause visual dysfunction. The sella turcica or "Turkish saddle" of sphenoid bone lies above and behind the sphenoid sinus. Anterolaterally on either side of the sella are the anterior clinoid processes, with the posterior limit being the dorsum sellae. The pituitary gland is contained within the sella and a sheet of dura called the diaphragma sellae frames the superior opening and connects the clinoid attachments of the tentorium cerebelli above the gland. The diaphragma sellae is perforated to allow the infundibular stalk of the pituitary gland to connect to the hypothalamus

Idiopathic Intracranial Hypertension: Management Challenges

In this session we will hear the international perspective on the diagnosis and management of two common neuro-ophthalmic presentations. First, we will discuss a case of optic neuritis. Each speaker will approach this case from the perspective of the underlying diagnosis and associated management that is most common in their local hospitals. Our European speaker will discuss ON related to multiple sclerosis. From America and Asia ON related to myelin oligodendrocyte glycoprotein and neuro-myelitis optica will be discussed. We will hear about infective optic neuritis and the presentations seen in an Indian setting. This will highlight all major causes of optic neuritis from an international perspective and provide an insight into management of patients that might come to our clinics from different geographical areas and ethnic backgrounds. Second, we will discuss a case of idiopathic intracranial hypertension (IIH). Our two speakers will discuss similarities and differences in management style between their institutions. This will allow us to critically evaluate our own practices and how the experience of other centers might help in our own management.IC-E10ai4-management-of-intracranial-hypertensio

Surgery for Congenital Cataract

The management of congenital cataract is very different to the treatment of a routine age-related cataract. In adults, surgery may be delayed for years without affecting the visual outcome. In infants, if the cataract is not removed during the first year of life, the vision will never be fully regained after surgery. In adults, if the aphakia is not corrected immediately, it can be corrected later. In young children, if the aphakia is not corrected, the vision will never develop normally

I Have an Empty Sella, What Does This Mean? (Video)

The sellar region is of extreme importance to neuro-ophthalmologists: the optic chiasm lies directly above the sella turcica and many pathological processes that arise in this region cause visual dysfunction. The sella turcica or "Turkish saddle" of sphenoid bone lies above and behind the sphenoid sinus. Anterolaterally on either side of the sella are the anterior clinoid processes, with the posterior limit being the dorsum sellae. The pituitary gland is contained within the sella and a sheet of dura called the diaphragma sellae frames the superior opening and connects the clinoid attachments of the tentorium cerebelli above the gland. The diaphragma sellae is perforated to allow the infundibular stalk of the pituitary gland to connect to the hypothalamus