Curbside Consultation in Uveitis

C. Stephen Foster., MD, FACS, FACR was born and raised in West Virginia, received his Bachelor of Science Degree in Chemistry at Duke University, with Distinction and Phi Beta Kappa in 1965, and received his Doctor of Medicine Degree at Duke University Medical Center, in 1969, being elected to Alpha Omega Alpha. He trained in Internal Medicine at Duke University Hospital from 1969 to 1970, and at the National Heart and Lung Institute, at the National Institutes of Health in Bethesda, Maryland, from 1970 to 1972, during which time he also taught Internal Medicine, with an appointment as Instructor in Medicine at the George Washington University Hospital in Washington, DC. In 1972, Dr. Foster entered his Ophthalmology Residency training program at Washington University (Barnes Hospital), in St. Louis, Missouri, and having completed that in 1975, traveled to Boston to do 2 additional Fellowship trainings in Cornea and External Diseases, and in Ocular Immunology. He completed this training in 1977 and was invited to join the full- time faculty of the Department of Ophthalmology of Harvard Medical School, where he was a member of the Cornea Service and Director of the Residency Training Program at the Massachusetts Eye and Ear Infirmary. He began his independent research in 1977 and has since been continuously funded by grants from the National Institutes of Health. After 30 years on the full time faculty of Massachusetts Eye and Ear Infirmary, he decided to establish his own private practice—The Massachusetts Eye Research and Surgery Institution, a state of the art 12,000 square foot practice with its own chemo- therapy infusion suite and phlebotomy lab. Dr. Foster continues to direct a research labo- ratory at the Massachusetts Eye Research and Surgery Institution (MERSI), through the support of his newly created research foundation, The Ocular Immunology and Uveitis Foundation, and continues his teaching activities and training fellows as a Clinical Professor of Ophthalmology at Harvard Medical School. He has also authored over 600 published papers and 5 textbooks.

Contents Dedication Acknowledgments About the Editor About the Associate Editor.s Contr.ibuting Author.s Introduction Question 1 Are There Standard Laboratory Tests That Need to Be Ordered in a Patient With Uveitis? Neal P. Bar.ney, MD Question 2 What Is the Quality and Strength of Evidence in Peer-Reviewed Medical Literature on the Subject of Employment of Steroid-Sparing Immunomodulatory Therapy in the Care of Patients With Uveitis? C. Stephen Foster., MD, FACS, FACR Question 3 When Should I Refer a Patient With Uveitis to a Specialist? Yasir. J. Sepah, MBBS (co-author.ed with Quan Dong Nguyen, MD, MSc) Question 4 Are There Special Considerations in Treating a Child With Uveitis? Ron Neumann, MD Question 5 How Should I Treat a Patient With Uveitis and Diabetes Mellitus? Sana S. Siddique, MD Question 6 What Underlying Causes Should Be Foremost in the Differential Diagnosis of Acute Hypertensive Uveitis? Russell W. Read, MD, PhD Question 7 What Underlying Causes Should Be Foremost in the Differential Diagnosis of Acute Hypopyon Uveitis? Simon Taylor., MA, PhD, FHEA, FRCOphth (co-author.ed with Sue Lightman, PhD, FRCP, FRCOphth) Question 8 When Should I Consider Using Systemic Corticosteroids to Treat Uveitis? Alejandr.o Rodr./u00edguez-Gar.c/u00eda, MD Question 9 What Is the Single Most Important Source of Diagnostic Leads for Uncovering a Diagnosable Cause of Uveitis? Amr.o Ali, MD (co-author.ed with James T. Rosenbaum, MD) Question 10 What Is the Risk of Blindness Due to Uveitis in Patients Treated With Steroid Monotherapy? Aniki Rothova, MD, PhD Question 11 How Should One Properly Employ Topical Corticosteroid Therapy? Olivia L. Lee, MD (co-author.ed with C. Michael Samson, MD, MBA) Question 12 Is There a Difference Between the Various Topical Corticosteroid Preparations? Joseph Tauber., MD Question 13 How Do I Establish a Diagnosis When I Suspect Sarcoidosis to Be the Cause of Uveitis? Manfr.ed Zier.hut, MD, PhD Question 14 When and How Should Intermediate Uveitis Be Treated? John Randolph, MD (co-author.ed with Henr.y J. Kaplan, MD) Question 15 What Are Some Important Associations Between Human Leukocyte Antigen Phenotypes and Specific Uveitis Syndromes? Mar.k S. Dacey, MD Question 16 How Do I Diagnose and Treat Herpetic Uveitis? Dor.ine Makhoul, MD Question 17 When Should I Be Suspicious of Tuberculosis and What Testing Is Useful? Nar.sing A. Rao, MD Question 18 How Often Should I Examine a Child With Juvenile Idiopathic Arthritis? Sofia Andr.oudi, MD (co-author.ed with Evangelia Tsir.oni, MD and Per.iklis Br.azitikos, MD) Question 19 How Should I Use Topical Mydriatic and Cycloplegic Agents? Stephen D. Anesi, MD Question 20 What Are the Indications and Contraindications for the Use of Periocular Corticosteroid Injections? Ar.usha Gupta, MD (co-author.ed with Esen K. Akpek, MD) Question 21 When Should I Suspect and How Can I Tell if My Patient With Uveitis Has a Masquerade Syndrome Rather Than Autoimmune Uveitis? Annal Dhananjayan Meleth, MD, MS (co-author.ed with H. Nida Sen, MD, MHSc and Chi-Chao Chan, MD) Question 22 How Do I Treat Cytomegalovirus Retinitis in a Patient With AIDS? Sana S. Siddique, MD (co-author.ed with Muhammad Kashif Isr.ar., MBBS) Question 23 What Are the Causes of Keratouveitis? David S. Chu, MD Question 24 Which Medications Can Induce Uveitis? Nicholas J. Butler., MD (co-author.ed with Er.ic B. Suhler., MD, MPH) Question 25 How Do I Diagnose and Treat Fuchs’ Heterochromic Iridocyclitis? Debr.a A. Goldstein, MD, FRCSC Question 26 How Do I Treat a Patient With Ocular Toxoplasmosis? Gar.y N. Holland, MD Question 27 What Diseases Should I Consider in a Patient With Neuroretinitis? Emmett T. Cunningham Jr., MD, PhD, MPH Question 28 What Are My Options in Treating Syphilitic Uveitis in a Penicillin- Allergic Patient? Lama Mulki, MD Question 29 How Do I Treat a Pregnant Woman With a Macula-Threatening Toxoplasmosis Lesion? Rajiv Shah, MD Question 30 How Do You Treat Uveitis in Women Who Are Pregnant or Breastfeeding? Er.ik Letko, MD Question 31 How Do I Diagnose and Treat Acute Retinal Necrosis? Suzanne Katr.ina V. Palafox, MD Question 32 How Do I Diagnose and Treat Posner-Schlossman Syndrome? Howar.d H. Tessler., MD Question 33 What Is Immune Recovery Uveitis and How Do I Treat It? Jennifer. E. Thor.ne, MD, PhD Question 34 How Do I Evaluate and Treat a Patient With Retinal Vasculitis? William Ayliffe, FRCS, PhD Question 35 How Do I Approach a Patient With Exudative Retinal Detachment and Uveitis? Mar.gar.ita Calonge, MD Question 36 What Are the Indications for Vitrectomy in a Patient With Uveitis? Janet L. Davis, MD Question 37 How Do You Treat Uveitis-Associated Macular Edema? David M. Hinkle, MD Question 38 How Can I Differentiate Birdshot Retinochoroidopathy From the Other White Dot Syndromes? Phuc Lehoang, MD, PhD Question 39 Does B-Scan Ultrasonography Assist in Evaluating a Patient With Uveitis? Elisabetta Miser.occhi, MD Question 40 When Should I Order Fluorescein Angiography or Ocular Coherence Tomography in a Patient With Uveitis? E. Mitchel Opr.emcak, MD Question 41 What Is the Risk of Sterility in Patients With Uveitis Who Require Immunomodulatory Therapy? Manolette R. Roque, MD, MBA Question 42 How Do the Results of the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Apply to the Care of My Patients With Uveitis? John H. Kempen, MD, PhD Question 43 How Long Should I Wait to Perform Cataract Surgery Once an Eye With Uveitis Is Inflammation Free? Sar.ah Syeda, BSc(MedSci) (co-author.ed with Ellen N. Yu, MD) Question 44 How Do I Decide When to Place an Intraocular Lens Implant in a Patient With Uveitis? Khayyam Dur.r.ani, MD Question 45 How Do I Evaluate and Treat a Patient With Persistent Inflammation Following Intraocular Surgery? Zhi Jian Li, MD (co-author.ed with John J. Huang, MD) Question 46 What Is the Typical Clinical Presentation of a Patient With Intraocular Lymphoma? Wendy M. Smith, MD (co-author.ed with H. Nida Sen, MD, MHSc) Question 47 What Are the Causes of Sclerouveitis? Maite Sainz de la Maza, MD Question 48 How Do I Differentiate Uveitis From Endophthalmitis? Paul Yang, MD, PhD (co-author.ed with Alber.t T. Vitale, MD) Question 49 Should I Enucleate the Inciting Eye in a Patient With Sympathetic Ophthalmia? Jose Cuevas Fr.ancisco III, MD (co-author.ed with Har.vey Siy Uy, MD) Financial Disclosur.es Index