Retinal vascular involvement in uveitis and new treatment options

The retinal blood vessels can become occluded due to both inflammation and thromboembolic diseases, and the main aim of this thesis is to examine the features of retinal vein occlusion (RVO) in patients with co-existing ocular inflammation to determine risk factors for the development of RVO, risk factors predictive of a poor visual outcome in uveitis, the prevalence of anti phospholipid antibody-based disease and the role of antiphospholipid antibody (aPL) testing. In this thesis, I also explore the efficacy of new treatments for retinal vein occlusion, particularly the Ozurdex intravitreal dexamethasone implant, which can also be used to treat uveitis and uveitis macular oedema. Demographic and clinical variables were extracted from the medical notes of three separate sample groups of patients attending Moorfields Eye hospital including: 1) patients attending a Uveitis clinic between 2009-2011 with a new or past history of RVO; 2) any patient who had aPL testing performed during 2010; 3) patients recruited onto the initial Ozurdex for uveitis phase III clinical trial. 34 RVO events were recorded during a two year period with an overall clinic prevalence of 1.83%. Presenting ocular features and risk factors for RVO in uveitis patients were explored. aPL testing was commonly performed on patients with RVO in an Ophthalmology setting, and the usefulness of this and its relation to RVO events were examined. Finally, follow up data for uveitis patients treated with a single Ozurdex implant were explored to determine the longer-term outcome of this treatment, and the strategies employed as and when patients relapsed, comparing these outcomes with those of the Ozurdex implant.