Anterior uveitis complications

The main side effect associated with oral acyclovir, valacyclovir, and femciclovir is intestinal disturbance such as nausea and vomiting. Acyclovir is available in an 800-mg tablet that does not contain lactose therefore it is less likely to cause lactose-related diarrhea. Lower dosages are recommended for treatment of elderly patients with impaired creatinine clearance. Perhaps the most significant factor in fevor of antivirals is that they minimize the common complications of the disease, including dendriform keratopathy, stromal keratitis, and anterior uveitis. 

Additional findings in EKC can include pseudomembrane formation (Figure 26-46) and corneal epithelial sloughing. Symblepharon, scleritis, and anterior uveitis rarely develop. Nasolacrimal system obstruction due to inflammation or adhesion of opposing surfaces, as occurs in symblepharon formation, also is a rare complication. 

Systemic antiviral therapy promotes resolution of HZO skin lesions and reduces the incidence and severity of dendriform keratopathy, anterior uveitis, and stromal keratitis by decreasing the rate of virus replication. All patients with acute HZO should receive antiviral therapy with the goal of minimizing ocular complications. Acyclovir, valacyclovir, and femciclovir are FDA approved for management of herpes zoster. Acyclovir usually is administered orally in dosages of 800 mg five times per day far 7 days. Valacyclovir has better bioavailability when taken orally and can be used with a recommended dosage of 1 g three times a day for 7 days. Famciclovir, which has bioavailability similar to valacyclovir, has an increased half-life and also has the advantage of less frequent administration than acyclovir 500 mg three times a day for 7 days. 

Complications associated with anterior uveitis may include cataracts, glaucoma, band keratopathy, and CME. Posterior subcapsular cataracts are the most commonly encountered lenticular change associated with chronic uveitis. Additionally, it is well known that long-term topical steroid use can induce or accelerate posterior subcapsular cataract development. 

Ocular complications are rare with systemic use of this class of drugs. Lid edema, conjunctivitis, chemosis, anterior uveitis, and scleral reactions have been reported with high-dose administration of sulfenilamide. The observed reactions appear to be analogous to systemic hypersensitivity reactions, such as urticaria and edema, seen in some patients who are allergic to sulfonamides. Several cases of Stevens-Johnson syndrome have been reported in patients of Japanese or Korean descent who were given oral metha-zolamide, a sulfonamide used to decrease lOP. Stevens-Johnson syndrome tends to show acute ocular involvement in 69% of affected individuals.This is stratified into mild ocular involvement in 40%, moderate in 25%, and severe in 4%. Late complications can occin and are usually in the form of severe ocular surfece disease and trichiasis. 

Ocular complications are of particular importance iritis can be induced by dying microfilariae and may call for topical or systemic glucocorticoid treatment. Associated complications include chorioretinitis, anterior uveitis, and punctate keratitis. Changes can also occur in the posterior... 

Karavellas MP, Song M, Macdonald JC, Freeman WR. Long-term posterior and anterior segment complications of immune recovery uveitis associated with cytomegalovirus retinitis. Am J Ophthalmol 2000 130 57-64. 

RFB is a semisynthetic derivative of rifampin that is effective for the prophylaxis and treatment of Mycobacterium avimn complex (MAC) infection as well as M. tuberculosis [55 ]. Anterior uveitis and hypopyon are well-recognised and frequently reported complications of RFB treatment however, posterior involvement is relatively rare. Severe cases may develop dense vitritis with large yellow-white opacities or panuveitis resembling endophthalmitis [56 ]. 

A link between ophthalmic complications and the zoster vaccine has been proposed. An 86-year-old man, with previous herpes zoster ophthalmicus, developed anterior uveitis following administration of Zostavax . This was treated successfully with topical steroids [76 ]. 

It is important to perform gonioscopy only in recalcitrant cases of intermediate uveitis to rule out complications such as peripheral anterior synechia and neovascularization. Otherwise, this test is superfluous. 

A subsequent Phase II, multicenter, randomized, double-masked, placebo-controlled clinical trial was performed in patients undergoing phacoemulsification and intraocular lens implantation (18). Only one eye per patient was eligible for treatment and exclusion criteria included previous uveitis, concurrent anterior segment disease or intraoperative surgical complications. Patients were randomized in a 2 1 ratio into an active treatment group or a control group. Patients in the two... 

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