The Department of Ophthalmology at Johns Hopkins University School of Medicine conducted this retrospective cohort study to estimate the incidences of ocular complications and vision loss in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, to describe risk factors for vision loss and to describe the association between therapy and complications and vision loss.

The study included 75 patients with JIA-associated uveitis evaluated between July 1984 and August 2005. The patients’ clinical data were analyzed, and outcome measures included the occurrence of ocular complications and visions of 20/50 or worse and 20/200 or worse.

Over a median follow-up of three years, the incidence of any ocular complication was 0.33/eye-year (EY). Rates of vision loss to 20/50 or worse was 0.10/EY and vision loss to 20/200 or worse was 0.08/EY. Risk factors at presentation for incident vision loss included presence of posterior synechiae, anterior chamber flare 1+ or greater, and abnormal intraocular pressure (IOP). During follow-up, ocular inflammation 0.5+ cells or greater was associated with an increased risk of visual impairment and of blindness. Immunosuppressive drug therapy reduced the risk of hypotony by 74 percent, epiretinal membrane formation by 86 percent, and blindness in the better eye by 60 percent.

Based on results, it appeared that incident vision loss and complications were common. Presence of posterior synechiae, anterior chamber flare 1+ or greater and abnormal IOP at presentation were associated with vision loss during follow-up. Use of immunosuppressive drugs reduced the risk of some ocular complications and of blindness in the better-seeing eye.

Investigators at the University of California at San Francisco characterize the susceptibility of filamentous fungi isolated from keratitis to amphotericin B, natamycin, caspofungin acetate, itraconazole, voriconazole and posaconazole.

Ninety isolates from fungal keratitis cases at Aravind Eye Hospital in South India were tested using macrobroth dilution for susceptibility to amphotericin B, natamycin, caspofungin, itraconazole, voriconazole and posaconazole. The minimum inhibitory concentration (MIC) median and 90th percentile were determined.

The 90 isolates included 41 Aspergillus species, 38 Fusarium species and 11 others. The triazoles and caspofungin had the lowest MICs against Aspergillus species; voriconazole, amphotericin B and posaconazole had the lowest MICs against Fusarium species; and none of the Fusarium species were inhibited by itraconazole or caspofungin. Amphotericin B had significantly lower MICs compared with natamycin, but after investigators corrected for the typical prescription dose, results showed that natamycin was superior.

Fungal ulcers are commonly treated empirically; drugs are typically selected without regard to susceptibility data. The nonocular infectious disease literature suggests modern fungal susceptibility methods are clinically relevant, but ocular studies are limited. Our results suggest antifungal therapy might be tailored to individual organisms.