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Pleyer U, Hazirolan D, Winterhalter S, Stübiger N. [Behcet's disease--ophthalmological and general aspects: Part 2: Therapy]. Ophthalmologe 2013; 110:273-84. [PMID: 23504099 DOI: 10.1007/s00347-012-2780-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Behcet's disease (also called Admantiades-Behcet syndrome) is a chronic vasculitis. The disease is characterized by exacerbations and remissions of symptoms and organ manifestations and may produce only mild mucocutaneous lesions, whereas ocular lesions can cause blindness. In addition, involvement of the gastrointestinal tract, central nervous system (CNS) and large blood vessels is sometimes life-threatening. Cyclosporin A is the only agent for treatment of ocular lesions registered in Germany; however, the neurotoxicity and nephrotoxicity restrict usage of the drug. In patients suffering from severe uveitis, biologics have been a breakthrough. Interferon (IFN) alpha therapy has shown significant efficacy for intraocular inflammation. Monoclonal antibodies to TNF-alpha and interleukin-1 have been successful in clinical trials and are approved in some countries. This article summarizes the current state of knowledge and emphasizes the important role of the ophthalmologist in the therapy of Behcet's disease.
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Pleyer U, Hazirolan D, Winterhalter S, Stübiger N. [Behçet's disease - ophthalmological and general aspects part I : etiology, pathogenesis and diagnostics]. Ophthalmologe 2013. [PMID: 23179819 DOI: 10.1007/s00347-012-2698-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Behçet's disease (also known as morbus Behcet or Admantiades-Behcet syndrome) is a chronic vasculitis mainly characterized by recurrent mucocutaneous lesions and sight threatening uveitis. It may also involve joints, vessels of all sizes and the central nervous system. Because of its severe morbidity and considerable mortality early diagnosis and treatment is important. Treatment and prognosis of this disorder have profited considerably in recent years following the introduction of biologic agents. This article summarizes the current state of knowledge and emphasizes the important role of the ophthalmologist in the diagnosis and therapy of Behçet's disease.
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Rübsam A, Klein JP, Pleyer U. [Ocular cicatricial pemphigoid - state of the art in clinic and therapy for a problematic disease]. Klin Monbl Augenheilkd 2013; 230:796-803. [PMID: 23959511 DOI: 10.1055/s-0032-1328748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The ocular cicatricial pemphigoid (OCP) belongs to a family of chronically progressive autoimmune disorders, predominantly affecting mucous membranes (mucous membrane pemphigoids). It is an immunopathologically heterogeneous group of disorders with variable phenotypes that share the unique feature of a subepidermal blistering, through disruption of the adhesion between epidermis and dermis. A key feature is the chronically active inflammation with consecutive fibrosis, leading to a partial or complete loss of function of the affected organ. The ocular disease as a chronic cicatrising conjunctivitis is a common manifestation of the mucous membrane pemphigoid. The identification of the subtle pathology and the prompt initiation of an appropriate therapy are of pivotal importance. One purpose is to prevent further vision loss due to extensive corneal scarring and life-threatening systemic complications, such as the formation of oesophageal or tracheal strictures. So far there are no prospective, randomised studies, regarding the therapy guidelines with an evidence level more than III. The autoimmune nature of the disease implies that systemic immunosuppression is the only effective treatment option, most notably in extended stages. The aim of our study is to give a guideline for a stage adjusted therapy with conventional immunosuppressants and to give a perspective for alternative therapies, especially for recalcitrant disease.
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Bertelmann E, Torun N, Pleyer U. [Present state of the art in topical and systemic immunosuppression after keratoplasty]. Klin Monbl Augenheilkd 2013; 230:505-11. [PMID: 23695847 DOI: 10.1055/s-0032-1328549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Today MMF can be considered as standard treatment besides cyclosporin A for immunosuppression after high-risk perforating keratoplasty. The efficacy of systemic MMF for this indication has been documented in several clinical studies including multicentre designs. Whether or not MPA therapy offers further advantages is currently under discussion. Sirolimus and tacrolimus are effective but could not achieve clinical importance due to higher rates of side effects. An additional benefit of combination therapies is not proven by clinical studies up to date. Everolimus shows pre-clinically a promising immunosuppressive and antiproliferative effect. Topical preparations of immunosuppressants as monotherapy are obviously insufficient as alternatives for systemic immunosuppressive therapy. Whether or not topical combination therapies will become established as alternatives to systemic treatment has to be demonstrated in the following years.
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Mänz M, Fels G, Metzner S, Haziloran D, Pleyer U. Okuläre Toxoplasmose (OT): Der Einfluss des Patientenalters auf klinisch relevante Parameter des Krankheitsverlaufs. Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1331515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pleyer U, Willerding G, Herwig M, Guthoff R, Lüke M, Meyer-ter-Vehn T, Thiel E, Korfel A, Joussen AM, Stübiger N, Winterhalter S, Jahnke K. Primäres intraokulares Lymphom (PIOL): Ergebnisse des prospektiven, multizentrischen Patientenregisters. Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1331541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Winterhalter S, Joussen A, Pleyer U, Stübiger N. Inflammatorische choroidale Neovaskularisationen. Klin Monbl Augenheilkd 2012; 229:897-904. [DOI: 10.1055/s-0032-1315249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chronopoulos A, Pleyer U, Mockenhaupt M. Okuläre Beteiligung bei Stevens-Johnson-Syndrom und Toxisch epidermaler Nekrolyse. Klin Monbl Augenheilkd 2012; 229:534-9. [DOI: 10.1055/s-0031-1299530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pleyer U, Metzner S, Winterhalter S, Ruokonen P. Infektassoziierte anteriore Uveitis: Einsichten und Aussichten. Klin Monbl Augenheilkd 2011. [DOI: 10.1055/s-0031-1297330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Mergler S, Sahlmüller M, Pleyer U. Das „trockene Auge„: Neue Erkenntnisse zur Pathophysiologie. Klin Monbl Augenheilkd 2011. [DOI: 10.1055/s-0031-1297301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Gonnermann J, Klein JP, Klamann MKJ, Maier AK, Pleyer U, Joussen AM, Bertelmann E. Evaluation des trockenen Auges bei Patienten nach tarsokonjunktivalen Lidrekonstruktionen mittels Tomey TG-1000 Thermographer. Klin Monbl Augenheilkd 2011. [DOI: 10.1055/s-0031-1297300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Jahnke K, Willerding GD, Pleyer U. Das primäre intraokuläre Non-Hodgkin-Lymphom: ein Chamäleon in der Ophthalmologie. Klin Monbl Augenheilkd 2011. [DOI: 10.1055/s-0031-1297337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Mänz M, Hazirolan D, Fels G, Torun N, Johnsen J, Winterhalter S, Grigg M, Pleyer U. Okuläre Toxoplasmose: Indikatoren des klinischen Verlaufs. Klin Monbl Augenheilkd 2011. [DOI: 10.1055/s-0031-1297332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U, Niehues T, Baus H, Becker M, Bertram B, Dannecker G, Deuter C, Foeldvari I, Frosch M, Ganser G, Gaubitz M, Gerdes G, Horneff G, Illhardt A, Mackensen F, Minden K, Pleyer U, Schneider M, Wagner N, Zierhut M. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int 2011; 32:1121-33. [DOI: 10.1007/s00296-011-2126-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/22/2011] [Indexed: 12/14/2022]
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Winterhalter S, Ruokonen P, van der Velden KH, Pleyer U, Joussen AM. [Intravitreal implants: drug carriers and carriers of hope?]. Ophthalmologe 2011; 108:222-9. [PMID: 21424918 DOI: 10.1007/s00347-010-2264-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Immunosuppressive agents are used for the therapy of noninfectious uveitis if intraocular quiescence and freedom from recurrences are not achievable with oral steroids at a low dosage. Partially, severe side effects are tolerated to preserve visual acuity even if the disease is limited to the eyes. Because of this a therapy would be desirable which is highly effective, limited to the eyes and with few side effects. For this fluocinolone acetonide and dexamethasone drug delivery systems were developed. Dexamethasone implants were already approved for the therapy of retinal vein occlusions and are used successfully. Diabetic macular edema would be another possible indication for dexamethasone implants.
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Pleyer U, Mackensen F, Winterhalter S, Stübiger N. [Anti-TNF-α treatment for uveitis. Analysis of the current situation]. Ophthalmologe 2011; 108:13-20. [PMID: 21181169 DOI: 10.1007/s00347-010-2256-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Biologicals are selectively acting proteins that demonstrated high efficacy in the treatment of chronic disorders. In particular, biologicals blocking tumor necrosis factor α (TNF-α), an essential cytokine in chronic inflammatory diseases, have demonstrated great promise. Experimental and clinical data indicate that TNF-α plays an important role in intraocular inflammation. Neutralization of TNF-α might therefore be a promising strategy for prevention and treatment of uveitis. Here we review the principle effects, therapeutic value, and potential side effects of anti-TNF agents in uveitis.
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Mergler S, Pleyer U. Physiologie des humanen Hornhautendothels – neue Erkenntnisse durch elektrophysiologische Untersuchungen. Klin Monbl Augenheilkd 2011; 228:520-4. [DOI: 10.1055/s-0031-1273254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Negraszus N, Pleyer U. Tuberkuloseassoziierte Uveitis posterior. Ophthalmologe 2011; 108:368-71. [DOI: 10.1007/s00347-010-2270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pleyer U. Biologika. Ophthalmologe 2011; 108:201-3. [DOI: 10.1007/s00347-010-2259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stübiger N, Winterhalter S, Pleyer U, Doycheva D, Zierhut M, Deuter C. [Janus-faced?: Effects and side-effects of interferon therapy in ophthalmology]. Ophthalmologe 2011; 108:204-12. [PMID: 21350868 DOI: 10.1007/s00347-010-2261-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Interferon alpha (IFN-α) and interferon beta (IFN-β) are naturally occurring cytokines, which belong to the type I interferons and share the same receptor leading to very similar therapeutic effects. The immunomodulatory effect of type I interferons includes modulation of antibody production, inhibition of lymphocyte proliferation, inhibition of delayed-type hypersensitivity and enhancement of T-cell and NK-cell cytotoxicity. An increasing number of open clinical studies and case reports have demonstrated the efficacy of IFN-α for severe ocular inflammation in patients with Behçet's disease and of interferon-β, which has been used mainly for the treatment of multiple sclerosis.
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Prada J, Schruender S, Ngo-Tu T, Baatz H, Hartmann C, Pleyer U. Expression of tumor necrosis factor-α and interleukin-6 in corneal cells after excimer laser ablation in Wistar rats. Eye (Lond) 2011; 25:534-6. [PMID: 21293497 DOI: 10.1038/eye.2011.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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72
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Pleyer U. Biologika in der Augenheilkunde. Ophthalmologe 2011; 108:5-6. [DOI: 10.1007/s00347-010-2254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pleyer U, Ruokonen P. Kammerwasseranalyse in der Diagnostik intraokularer Entzündungen. Klin Monbl Augenheilkd 2010; 227:953-60. [DOI: 10.1055/s-0029-1245927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Klein JP, Gonnermann J, Klamann M, Maier AKB, Pleyer U. Thermografie der Augenoberfläche: Erste Erfahrungen mit dem Thermografiegerät TG 1000. Klin Monbl Augenheilkd 2010. [DOI: 10.1055/s-0030-1270000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Klamann MKJ, Maier AKB, Gonnermann J, Pavant T, Klein JP, Pleyer U. Temperaturgradient des Filterkissens als Erfolgskontrolle nach Trabekulektomie: Ergebnisse der Filterkissenbeurteilung mittels Thermografie TG 1000. Klin Monbl Augenheilkd 2010. [DOI: 10.1055/s-0030-1270026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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