Faculty Bibliography

PURPOSE/OBJECTIVE:To determine whether electroretinogram results can help predict the success in tapering of immunosuppressive medication in patients with birdshot retinochoroidopathy. METHODS:Fifteen patients with birdshot retinochoroidopathy who had at least three serial electroretinograms (ERG) during the course of their disease were included in the study. Charts of patients seen at the Immunology and Uveitis Service at the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts were retrospectively reviewed. Seven parameters of the ERGs were examined: dim scotopic amplitude, bright scotopic amplitude, bright scotopic implicit time, single-flash photopic amplitude, single-flash photopic implicit time, 30 Hz flicker amplitudes, and 30 Hz flicker implicit times. For each parameter the patients were divided into two groups, those with normal and those with abnormal responses at the time their immunosuppressive medication taper was initiated. The percentage of patients in each group who were able to successfully taper their immunosuppressive medication was calculated. A successful taper of medication was defined as no recurrence of disease signs or symptoms for at least 1 year after the medication was terminated. RESULTS:Abnormalities in the bright scotopic response amplitudes and 30 Hz flicker implicit times were associated with recurrence of inflammation as immunosuppressive therapy was tapered. CONCLUSION/CONCLUSIONS:ERG can serve as a useful adjunct in helping determine when to initiate tapering of immunosuppressive therapy in patients with birdshot retinochoroidopathy.

OBJECTIVE:The goal of this study was to describe the outcome of limbal stem cell transplantation (LSCT) in patients with severe ocular surface disease caused by underlying chronic inflammatory eye disease. DESIGN/METHODS:Retrospective noncomparative case series. PARTICIPANTS/METHODS:Nine patients with limbal stem cell deficiency caused by an underlying ocular inflammatory disease who underwent LSCT. METHODS:The authors reviewed the records of 11 eyes of 9 patients with immunologically mediated ocular surface disease that underwent LSCT. MAIN OUTCOME MEASURES/METHODS:The main outcome measures were reepithelialization of the corneal surface, restoration of corneal surface, and improvement in visual acuity. RESULTS:A total of 11 eyes underwent either autologous (n = 1) or HLA-matched living related donor (n = 10) LSCT for ocular surface disease secondary to inflammatory disease. Reepithelialization of the corneal surface in the immediate postoperative period occurred in 10 eyes (91%) within an average of 10 days (range, 3-21 days). Long-term restoration of the corneal surface was achieved in six (55%) eyes. Visual acuity improved in six eyes (55%). Reasons for poor outcomes included microbial infection, limbal stem cell graft rejection, and corneal ulceration. No donor eyes had complications. CONCLUSIONS:Patients with underlying immunologically mediated diseases, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or ocular cicatricial pemphigoid, who undergo LSCT have lower success rates than do those patients with noninflammatory ocular surface diseases.

PURPOSE/OBJECTIVE:To evaluate various available intraocular lenses (IOL) (PMMA, acrylic, heparin coated PMMA, and silicone) in patients with cataracta complicata and evaluate IOL tolerance, post-operative inflammation, cystoid macular edema, and posterior capsular opacification(PCO) requiring Nd:YAG capsulotomy. DESIGN/METHODS:randomized, double masked clinical trial. PARTICIPANTS/METHODS:Patients evaluated in the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary and deemed to need cataract surgery by standard criteria were asked to participate in the clinical trial. Patients had to have a diagnosis of chronic uveitis, which was inactive for 3 months prior to cataract surgery. RESULTS:Acrylic lenses appeared to provide the best overall results when evaluated for post-operative inflammation, PCO rates, visual acuity, and cystoid macular edema (CME) (compared to PMMA, silicone, and heparin coated PMMA).