Abstract: Noninfectious uveitis is a sight-threatening disease with an autoimmune or autoinflammatory basis. Systemic treatment is required if intraocular inflammation threatens a patient's vision or cannot be controlled locally and when it is associated with systemic rheumatic diseases. Corticosteroids and immunomodulatory chemotherapy are the conventional initial treatments. However, the various side effects of these therapies increase the burden on patients, not only physically but also mentally. Moreover, uncontrolled inflammation and poor visual outcomes have sometimes been recorded despite the combination of these medications or their high dosage. Antitumor necrosis factor-alpha (anti-TNF-α) and other biologic agents have been widely used to treat rheumatic diseases for >15 years. Randomized controlled clinical trials have demonstrated that anti-TNF-α can reduce and delay episodes of intraocular inflammation not only in patients with active uveitis but also in corticosteroid-dependent patients with inactive uveitis. The Taiwan Food and Drug Administration approved the use of adalimumab, an anti-TNF-α agent, for treating nonanterior noninfectious uveitis (NANIU) in 2017. This report provides a recommendation and a proposed stepladder approach for using anti-TNF-α agents to treat NANIU in Taiwan.

Presbyopia results from loss or insufficiency of the eye's accommodative ability, and clinically manifests as the inability to focus near objects on the retina. It is one of the most common causes of visual impairment worldwide especially in adults of productive or working age. Various means of compensating for the loss of accommodative ability have been devised from optical tools such as spectacles and contact lenses, to topical medications and to surgical procedures. A comprehensive search on journal articles about topical and surgical correction of presbyopia was undertaken. The various techniques for presbyopia correction, as enumerated in these articles, are discussed in this paper with the addition of our personal experience and perspective on the future of these techniques.

Context: Role of Ozurdex in macular edema due to various posterior segment pathologies. AIM: The aim of this study is to report outcome of Ozurdex implant in macular edema (ME) secondary to various posterior segment pathologies. SETTINGS AND DESIGN: This was a single-center, retrospective, interventional study. SUBJECTS AND METHODS: Patients of ME were treated with one or more Ozurdex implants (0.7 mg). Data collection included demographic details, best-corrected visual acuity (BCVA), central foveal thickness (CFT), duration of efficacy, and record of adverse events (if any) within 24 weeks. STATISTICAL ANALYSIS USED: Paired sample t-test, Stata data analysis, and statistical software, version 12.1, StataCorp, College Station, TX, USA, were used in the study. RESULTS: One hundred and sixteen eyes of 104 patients were studied which had a diagnosis of diabetic ME (n = 46), retinal vein occlusion (n = 40), and uveitis (n = 30). The average age of patients (mean ± standard deviation) was 50.2 ± 21.9 years. Baseline mean ± SD (standard deviation) logMAR BCVA, CFT, and intraocular pressure (IOP) were 0.636 ± 0.4, 527.8 ± 210.1 μm, and 15.3 ± 3.8 mmHg, respectively. The reinjection interval was around 12–18 weeks. Ozurdex proved its efficacy in improving mean logMAR visual acuity and reduction of CFT from baseline till 12 weeks' follow-up period (0.414 ± 0.5 and 301.5 ± 278.5, respectively; P < 0.05), and after 12 weeks' follow-up, it started worsening (0.530 ± 0.9 and 444.8 ± 375.2, respectively; P > 0.05). The most common reported adverse event was significant rise of IOP (>5 mmHg), with a total of 12 cases followed by cataract 9 cases. CONCLUSION: Ozurdex implant leads to a significant improvement in BCVA and CFT values till 12 weeks, followed by a gradual decline for all the pathologies studied together. No new safety concerns were observed with the Ozurdex implant. The duration of efficacy was found to be <24 weeks.

PURPOSE: The aim of this study is to evaluate the effectiveness and predictability of photorefractive keratectomy (PRK) for correcting residual refractive error following cataract surgery with premium intraocular lens (IOL) implantation. METHODS: We conducted a retrospective review of the medical records of patients who received PRK for correcting residual hyperopia, myopia, and/or astigmatism due to unsatisfied uncorrected distance visual acuity (UDVA) after cataract extraction with implantation of aspheric, diffractive multifocal, or toric IOL from September 2011 to December 2017. Pre-cataract surgery, pre- and post-PRK data including UDVA, best-corrected distance visual acuity, and refractive status were analyzed. RESULTS: A total of 18 consecutive eyes in 17 patients were included in this study. The UDVA after PRK improved 1 line or more in 10 eyes, remained unchanged in five eyes, and decreased in three eyes. The overall improvement in the logarithm of minimal angle of resolution (logMAR) UDVA after PRK was significant (P < 0.05). While dividing patients into subgroups based on IOL type, significant improvement in logMAR UDVA was found in patients with aspheric IOL or diffractive multifocal IOL implantation (P < 0.05). No significant improvement of UDVA was found in patients with toric IOL implantation. All eyes achieved ± 1.00 D of the attempted spherical correction, demonstrating good predictability of PRK. CONCLUSIONS: PRK was a safe and effective procedure to correct residual refractive error following cataract extraction with premium IOL implantation. Although satisfactory for all patients, the outcome is better and more predictable in patients with aspheric and diffractive multifocal IOL implantation and is less satisfactory and unpredictable in patients with toric IOL implantation.

PURPOSE: The aim of this study is to evaluate the clinical use of ultra-widefield angiography (UWFA) in uveitis. MATERIALS AND METHODS: We showed the UWFA and traditional 55° fluorescein angiography (FA) of four cases with Eales' disease, idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome, Behçet's disease, and idiopathic panuveitis in a tertiary medical center. Comparison of UWFA with traditional 55°FA in the diagnosis and management of uveitis and review of the literature is also presented. RESULTS: Ultra-widefield FA revealed far-peripheral vascular imaging. This information would not have been easily obtained from traditional FA. With more information of the peripheral retina, it may facilitate appropriate diagnosis and monitoring, and the management may be revised. CONCLUSION: UWFA played an important role to confirm the diagnosis of uveitis and to determine the corresponding treatment.

We report the rescue effects of adalimumab (HUMIRA^®) therapy in a case of refractory pediatric panuveitis complicated with steroid-induced glaucoma. A 13-year-old girl had suffered from blurred vision since January 2013. Bilateral idiopathic panuveitis with macular edema (ME) was diagnosed. She had previously been treated with systemic steroids, methotrexate, cyclosporine, and mycophenolate. All treatments had failed to suppress the ocular inflammation and ME persisted. Intravitreal dexamethasone implant injections were given to both eyes and ME subsided; however, complications with steroid-induced glaucoma and cataract occurred. ME also recurred following absorbance of the dexamethasone implant. After administration of subcutaneous adalimumab injections every 2 weeks, inflammatory activity was well controlled and ME subsided. Phacoemulsification and posterior intraocular lens implantation were performed in both eyes. Menorrhagia and anemia were noted 9 months after adalimumab treatment. Thereafter, adalimumab was reduced and her anemia improved. Her vision had remained 20/20 for 33 months. Refractory pediatric uveitis usually requires more aggressive treatment. Intraocular glucocorticoid releasing implant could be used to lessen the possible systemic side effects in children. Intravitreal dexamethasone implant was effective in treating the inflammatory ME but could be complicated with steroid glaucoma and cataract. Tumor necrosis factor-blocking agents have been used to treat chronic, refractory uveitis in adults as well as children. Adalimumab was a favorable biological agent in steroid-responding pediatric patient of refractory noninfectious uveitis but could be complicated with menorrhagia. Long-term follow-up and more cases are mandatory.

We report a young male patient with Behçet's disease who suffered from sight-threatening recurrences under treatment with azathioprine, cyclosporine, and prednisolone. His uveitis responded well to antitumor necrosis factor (TNF)-alpha (adalimumab) for 5 months subsequently. Severe uveitis recurred soon after discontinuation of anti-TNF alpha therapy and could not be controlled well with reinstitution of the anti-TNF alpha therapy. Interferon-α2a (IFN-α2a) was then given along with low-dose oral prednisone (10 mg/day), and the uveitis responded well to this therapy. We continued a maintenance dose with of IFN-α2a three times/week for 2 years. Sight-threatening uveitis did not recur under IFN-α2a therapy, and the visual acuity improved from “counting fingers” to 20/100 in the right eye, while remaining stable with 20/20 vision in the left eye. The patient had flu-like symptoms, fever, and severe depression during IFN therapy, but an attempt to discontinue INF led to relapse within 1 month. This case report suggests that IFN-α2a could be an option for treatment in Behçet's uveitis. Further study is needed to clarify the efficacy and appropriate strategy for IFN-α2a therapy for Behçet's uveitis in Taiwan.

Immune checkpoint blockade therapy is relatively a new treatment for cancer which has shown promising results. However, immune-related side effects including uveitis have occasionally been reported during this therapy. Herein, we report the case of a 65-year-old male who suffered bilateral anterior uveitis after immune checkpoint blockade therapy with pembrolizumab and ipilimumab for malignant melanoma. His symptoms and signs improved after topical treatment with corticosteroids. Clinicians should be aware that uveitis can be an immune-related adverse event of immunotherapy.

A 51-year-old man had experienced declining visual acuity for 4 months. His best-corrected visual acuity was 20/40 in both eyes. Ophthalmoscopic examination showed a yellowish placoid lesion over the macular area, and spectral-domain optical coherence tomography (SD-OCT) revealed subretinal fluid accumulation in the left eye, which resembled that seen with central serous chorioretinopathy (CSCR). Three days later, fluorescein angiography (FA) revealed fluorescein leakage, and indocyanine green angiography (ICGA) showed hypofluorescence over the lesion. Persistent ellipsoid zone loss as spontaneously resolved subretinal fluid was noted at the same time with SD-OCT. Laboratory examination disclosed positive rapid plasma reagin and Treponema pallidum particle agglutination tests (titer >1:1280), which confirmed the diagnosis of ocular syphilis. Acute syphilitic posterior placoid chorioretinopathy (ASPPC) could mimic CSCR with spontaneously resolved subretinal fluid observed in SD-OCT images. The acute loss of the ellipsoid zone, mismatched results from SD-OCT and FA, and picture of retinitis can also provide hints for differentiating the two diseases.