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Kong CL, Kelly NK, Sundararajan M, Rathinam S, Gonzales JA, Thundikandy R, Vedhanayaki R, Kanakath A, Murugan B, Doan T, Goldstein D, Al-Dhibi HA, Acharya NR. Comparison of CD4 Counts with Mycophenolate Mofetil versus Methotrexate from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial. Ocul Immunol Inflamm 2022; 30:198-202. [PMID: 32779952 PMCID: PMC7876156 DOI: 10.1080/09273948.2020.1774906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Sub-analysis of the FAST Trial comparing change in CD4 (∆CD4) from baseline through 12 months in uveitis patients treated with mycophenolate mofetil (MMF) and methotrexate (MTX). METHODS Patients were randomly allocated to 1.5 g twice daily MMF or 25 mg weekly MTX. Individuals with CD4 counts at baseline, 6 months (or treatment failure prior), and 12 months (or treatment failure between 6 and 12 months) were included. The association between treatment and ∆CD4 (cells/μL) was analyzed using multivariable linear regression. RESULTS There was no significant difference in ∆CD4 between MMF and MTX at 6 months (-31.7 cells/μL for MMF compared to MTX; 95% CI: -358.2 to 294.8, P = .85) and 12 months (-78.3 cells/μL for MMF compared to MTX; 95% CI: -468.0 to 311.3; P = .69). CONCLUSION There was no significant difference in ∆CD4 between MMF and MTX from baseline to 12 months, suggesting that MMF does not confer additional risk of CD4 lymphopenia in uveitic patients.ClinicalTrials.gov Identifier: NCT01829295.
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Affiliation(s)
- Christina L. Kong
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Nicole K Kelly
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Miel Sundararajan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - S.R Rathinam
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - John A. Gonzales
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA,Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Radhika Thundikandy
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Rajesh Vedhanayaki
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Anuradha Kanakath
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Bala Murugan
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Thuy Doan
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA,Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Debra Goldstein
- Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
| | - Hassan A. Al-Dhibi
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Nisha R. Acharya
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA,Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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Time to Uveitis Control with Methotrexate and Mycophenolate Mofetil. Ophthalmology 2022; 129:721-723. [DOI: 10.1016/j.ophtha.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/23/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
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Harada Y, Hiyama T, Kiuchi Y. Methotrexate Effectively Controls Ocular Inflammation in Japanese Patients With Non-infectious Uveitis. Front Med (Lausanne) 2021; 8:732427. [PMID: 34869426 PMCID: PMC8636923 DOI: 10.3389/fmed.2021.732427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
This single-center retrospective study investigated the clinical characteristics and efficacy of methotrexate (MTX) for the treatment of non-infectious uveitis for more than 6 months at Hiroshima University, from February 2016 to May 2021. Outcome variables included changes in systemic immunosuppressive treatment and intraocular inflammation. Out of 448 patients with non-infectious uveitis, 35 patients (14 male patients and 21 female patients; 65 eyes) treated with MTX for more than 6 months were analyzed. There were 15 patients with anterior uveitis and 20 with posterior and panuveitis. The mean dose of systemic corticosteroids decreased from 12.1 mg/day at baseline to 1.3 mg/day at 6 months and 0.6 mg at 12 months after starting MTX, and approximately 90% of patients were corticosteroid-free at 12 months. The percentage of eyes with inactive uveitis at 6, 12, and 24 months was 49.2%, 59.6%, and 90.0%, respectively. Mean relapse rate score also significantly decreased from 2.88 at baseline to 0.85 at 12 months (p < 0.001). Inflammatory control was achieved with MTX doses of 8-16 mg/week, with a median dose of 12 mg/week. Adverse effects of MTX were observed in 34.3% of patients, and 11.4% required discontinuation; most commonly hepatotoxicity (58.3%), followed by fatigue (25.0%), and hair loss (16.7%). No significant differences were found between the survival curves of patients with anterior uveitis and posterior/panuveitis (Wilcoxon rank-sum test). The percentage of eyes without IOP-lowering eye drops was significantly higher in patients with posterior/panuveitis at 24 months (p = 0.001). Our study suggests that MTX is effective in controlling ocular inflammation for Japanese patients with non-infectious uveitis. Relatively high incidence of MTX-related adverse effects in the Japanese population indicates that careful monitoring and dose adjustments are crucial for the long-term use of this therapy.
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Affiliation(s)
- Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Efficacy and Safety of Immunosuppressant Therapy for Noninfectious Uveitis: A Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1933604. [PMID: 34527074 PMCID: PMC8437623 DOI: 10.1155/2021/1933604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
Objective To analyze efficacy and safety of immunosuppressant therapy for noninfectious uveitis. Methods A network search of PubMed, ResearchGate, and EMBASE databases was conducted for relative literature and studies from the inception of each database to April 2021. Primary outcomes were efficacy and time to treatment failure of immunosuppressant for noninfectious uveitis. Secondary outcome was incidence of adverse events (AEs). Cochrane risk of bias tool was used to assess risk of bias of included studies. Fixed effects model or random effects model was implemented to assess statistical heterogeneity. Subgroup analysis was employed to analyze heterogeneous sources. Results Eight studies were deemed eligible for inclusion with a total of 848 patients. Six studies were randomized controlled trials (RCTs). Among them, a single-blind RCT had relatively high measurement bias and performance bias. Immunosuppressant presented favorable efficacy for noninfectious uveitis than placebo, and RR was 1.43 (95% CI: 1.12-1.82). Immunosuppressant for noninfectious uveitis prolonged the time before failure, and HR was 0.43 (95% CI: 0.32-0.54). AEs increased after immunosuppressant was applied. Compared with immunosuppressant, RR of AEs with placebo was 0.88 (95% CI: 0.71-1.08). Conclusion Immunosuppressant contributed to controlling progression of noninfectious uveitis to some extent. Compared with placebo, it increased incidence of AEs. More studies with low heterogeneity are warranted for stronger evidence in clinical.
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Li Puma MC, Diehl KA. The use of systemic mycophenolate in canine immune‐mediated ophthalmic disease. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Margaret C. Li Puma
- Department of Small Animal Medicine and Surgery University of Georgia College of Veterinary Medicine Athens Georgia USA
| | - Kathryn A. Diehl
- Department of Small Animal Medicine and Surgery University of Georgia College of Veterinary Medicine Athens Georgia USA
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Cost-Utility Analysis of Mycophenolate Mofetil versus Methotrexate for Noninfectious Uveitis. Ophthalmol Retina 2021; 5:1281-1282. [PMID: 34411777 DOI: 10.1016/j.oret.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022]
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Conrady CD, Yeh S. A Review of Ocular Drug Delivery Platforms and Drugs for Infectious and Noninfectious Uveitis: The Past, Present, and Future. Pharmaceutics 2021; 13:1224. [PMID: 34452185 PMCID: PMC8399730 DOI: 10.3390/pharmaceutics13081224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Uveitis refers to a broad group of inflammatory disorders of the eye that often require medical and surgical management to improve or stabilize vision and prevent vision-threatening pathological changes to the eye. Drug delivery to the eye to combat inflammation and subsequent complications from uveitic conditions is complex as there are multiple barriers to absorption limiting availability of the needed drug in the affected tissues. As such, there has been substantial interest in developing new drugs and drug delivery platforms to help reduce intraocular inflammation and its complications. In this review, we discuss the challenges of drug delivery, novel technologies recently approved for uveitis patient care and promising drug delivery platforms for uveitis and sequelae of ocular inflammation.
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Affiliation(s)
- Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Center, University of Nebraska Medical Center, Omaha, NE 68105, USA
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Center, University of Nebraska Medical Center, Omaha, NE 68105, USA
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Kramer M, Brichova M, Tugal-Tutkun I, Panchenko M, Gormezano N, Koenigsbauer F, Franco P, Muccioli C, Hasanreisoglu M. Noninfectious Intermediate, Posterior, or Panuveitis: Results from the Retrospective, Observational, International EyeCOPE Study. Ophthalmol Ther 2021; 10:565-580. [PMID: 34117983 PMCID: PMC8319263 DOI: 10.1007/s40123-021-00351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction The EyeCOPE study characterized noninfectious intermediate posterior, or panuveitis (NIIPPU) before biologic agents were widely available. Methods This retrospective, observational study included adults with NIIPPU attending a routine ophthalmological visit. Data were collected from the study visit and medical records. Results Of 565 patients, 58.8% were female, and the mean age was 41.3 years; 33.8% had idiopathic uveitis and 45.8% had panuveitis. The median time from symptom onset to diagnosis and treatment was 27.0 and 30.5 days, respectively. Patients received immunosuppressants and systemic/local corticosteroids. Most patients experienced substantial decline in ocular function (mean best corrected visual acuity, 0.4 logMAR). Mean total work productivity impairment among employed patients was 31.0%. Most patients reported ocular complications (70.8%) such as vision loss and cataracts. Conclusions Despite treatment, most patients with NIIPPU experienced a decline in ocular function and ocular complications. There is an unmet need for additional NIIPPU treatment, such as targeted monoclonal antibodies. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00351-4.
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Affiliation(s)
- Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michaela Brichova
- Department of Ophthalmology, Charles University and General University Hospital, Prague, Czech Republic
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mykola Panchenko
- Department of Ophthalmology, Kharkiv National Medical University, Kharkiv, Ukraine
| | | | | | - Pablo Franco
- Organización Médica de Investigación, Buenos Aires, Argentina
| | - Cristina Muccioli
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Murat Hasanreisoglu
- Department of Ophthalmology, Faculty of Medicine, Gazi University, 13th Floor, Besevler, Cankaya, 06500, Ankara, Turkey.
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Brahmer JR, Abu-Sbeih H, Ascierto PA, Brufsky J, Cappelli LC, Cortazar FB, Gerber DE, Hamad L, Hansen E, Johnson DB, Lacouture ME, Masters GA, Naidoo J, Nanni M, Perales MA, Puzanov I, Santomasso BD, Shanbhag SP, Sharma R, Skondra D, Sosman JA, Turner M, Ernstoff MS. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2021; 9:e002435. [PMID: 34172516 PMCID: PMC8237720 DOI: 10.1136/jitc-2021-002435] [Citation(s) in RCA: 300] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.
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Affiliation(s)
- Julie R Brahmer
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Hamzah Abu-Sbeih
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Paolo Antonio Ascierto
- Unit of Melanoma Cancer Immunotherapy and Innovative Therapy, National Tumour Institute IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - Jill Brufsky
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura C Cappelli
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frank B Cortazar
- Massachusetts General Hospital, Boston, Massachusetts, USA
- New York Nephrology Vasculitis and Glomerular Center, Albany, New York, USA
| | - David E Gerber
- Department of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lamya Hamad
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Eric Hansen
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory A Masters
- Department of Medicine, Helen F. Graham Cancer Center, Newark, Delaware, USA
| | - Jarushka Naidoo
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
- Department of Oncology, Beaumont Hospital Dublin, The Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Michele Nanni
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Bianca D Santomasso
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Satish P Shanbhag
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Cancer Specialist of North Florida, Fleming Island, Florida, USA
| | - Rajeev Sharma
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Michelle Turner
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Marc S Ernstoff
- Division of Cancer Treatment & Diagnosis, National Cancer Institute, Rockville, Maryland, USA
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Hamamoto Filho PT, Fragoso G, Sciutto E, Fleury A. Inflammation in neurocysticercosis: clinical relevance and impact on treatment decisions. Expert Rev Anti Infect Ther 2021; 19:1503-1518. [PMID: 33794119 DOI: 10.1080/14787210.2021.1912592] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neurocysticercosis is caused by the localization of Taenia solium larvae in the central nervous system. The disease remains endemic in most countries of Latin America, Asia and Africa. While major improvements have been made in its diagnosis and treatment, uncertainties persist regarding the clinical implications and treatment of the inflammatory reaction associated with the disease. AREAS COVERED In this review, based on PubMed searches, the authors describe the characteristics of the immune-inflammatory response in patients with neurocysticercosis, its clinical implications and the treatment currently administered. The dual role of inflammation (participating in both, the death of the parasite, and the precipitation of serious complications) is discussed. New therapeutic strategies of potential interest are presented. EXPERT OPINION Inflammatory reaction is the main pathogenic mechanism associated to neurocysticercosis. Its management is mainly based on corticosteroids administration. This strategy had improved prognostic of patients as it allows for the control of most of the inflammatory complications. On the other side, it might be involved in the persistence of parasites in some patients, despite cysticidal treatment, due to its immunosuppressive properties. New strategies are needed to improve therapeutical management, particularly in the severest presentations.
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Affiliation(s)
- Pedro T Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, UNESP-Univ Estadual Paulista, Botucatu Medical School, Botucatu, Brazil
| | - Gladis Fragoso
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Edda Sciutto
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Agnès Fleury
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Neurocysticercosis Clinic, Instituto Nacional de Neurología Y Neurocirugía, Ciudad de México, Mexico, mexico.,Neuroinflammation Unit, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México/INNN/Facultad de Medicina-UNAM, Ciudad de México, Mexico
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Lin M, Anesi SD, Chang PY, Eggenschwiler L, Manhapra A, Walsh M, Foster CS. Clinical features, visual outcome, and poor prognostic factors in occlusive retinal vasculitis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 57:207-213. [PMID: 33838140 DOI: 10.1016/j.jcjo.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the clinical features, treatment, and visual outcome of occlusive retinal vasculitis (ORV), with a focal analysis on prognostic factors associated with poor visual outcome. METHODS We conducted a retrospective cohort study in patients diagnosed with ORV with at least 6 months of follow-up. Demographic data, ocular features, best corrected visual acuity (BCVA), fluorescein angiography, therapy regimens, and outcomes were collected from the Massachusetts Eye Research and Surgery Institution database from 2006 to 2017. Multivariate logistic regression was performed to analyze the factors independently predicting poor visual outcome. RESULTS Fifty-two patients (69 eyes) were enrolled, 42 with noninfectious cause, 9 with infectious cause, and 1 with masquerade uveitis. Systemic inflammatory diseases, including necrotizing vasculitis, sarcoidosis, multiple sclerosis, systemic lupus erythematosus, and Behçet's disease comprised the causes of ORV. Forty of the 42 patients with noninfectious ORV received immunomodulatory therapy (IMT), and 35 patients (87.5%) were able to achieve steroid-free remission. Compared with the BCVA at the initial visit (0.66 [±0.11] logMAR), there was significant improvement at the most recent visit (0.37 [±0.07] logMAR, p = 0.001). A multivariate analysis demonstrated that optic nerve atrophy, macular ischemia, and poor BCVA at initial presentation were independently correlated with poor visual outcome. CONCLUSIONS ORV could be caused by a wide spectrum of systemic inflammatory diseases. Aggressive IMT is preferred to achieve a steroid-free durable remission for noninfectious ORV. Optic nerve atrophy, macular ischemia, and poor BCVA at the initial visit predict a poor visual outcome.
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Affiliation(s)
- Miaoli Lin
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass.; C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Laura Eggenschwiler
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Marisa Walsh
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass.; Harvard Medical School, Boston, Mass..
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Kelly NK, Chattopadhyay A, Rathinam SR, Gonzales JA, Thundikandy R, Kanakath A, Murugan SB, Vedhanayaki R, Cugley D, Lim LL, Suhler EB, Al-Dhibi HA, Ebert CD, Berlinberg EJ, Porco TC, Acharya NR. Health- and Vision-Related Quality of Life in a Randomized Controlled Trial Comparing Methotrexate and Mycophenolate Mofetil for Uveitis. Ophthalmology 2021; 128:1337-1345. [PMID: 33675850 DOI: 10.1016/j.ophtha.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate changes in health-related and vision-related quality of life (VRQoL) among patients with noninfectious uveitis who were treated with antimetabolites. DESIGN Secondary analysis of a randomized controlled trial. PARTICIPANTS Patients with noninfectious uveitis from India, the United States, Australia, Saudi Arabia, and Mexico. METHODS From 2013 through 2017, 216 participants were randomized to receive 25 mg weekly oral methotrexate or 1.5 g twice daily oral mycophenolate mofetil. Median changes in quality of life (QoL) were measured using Wilcoxon signed-rank tests, and differences between treatment groups were measured using linear mixed models, adjusting for baseline QoL score, age, gender, and site. Among Indian patients, VRQoL scores from a general scale (the National Eye Institute Visual Function Questionnaire [NEI-VFQ]) and a culturally specific scale (the Indian Visual Function Questionnaire [IND-VFQ]) were compared using Pearson correlation tests. MAIN OUTCOME MEASURES Vision-related QoL (NEI-VFQ and IND-VFQ) and health-related QoL (HRQoL; physical component score [PCS] and mental component score [MCS] of the Medical Outcomes Study 36-Item Short Form Survey [SF-36v2]) were measured at baseline, the primary end point (6 months or treatment failure before 6 months), and the secondary end point (12 months or treatment failure between 6 and 12 months). RESULTS Among 193 participants who reached the primary end point, VRQoL increased from baseline by a median of 12.0 points (interquartile range [IQR], 1.0-26.1, NEI-VFQ scale), physical HRQoL increased by a median of 3.6 points (IQR, -1.4 to 14.9, PCS SF-36v2), and mental HRQoL increased by a median of 3.0 points (IQR, -3.7 to 11.9, MCS SF-36v2). These improvements in NEI-VFQ, SF-36v2 PCS, and SF-36v2 MCS scores all were significant (P < 0.01). The linear mixed models showed that QoL did not differ between treatment groups for each QoL assessment (NEI-VFQ, IND-VFQ, PCS SF-36v2, and MCS SF-36v2; P > 0.05 for all). The NEI-VFQ and IND-VFQ scores for Indian participants were correlated highly at baseline and the primary and secondary end points (correlation coefficients, 0.87, 0.80, and 0.90, respectively). CONCLUSIONS Among patients treated with methotrexate or mycophenolate mofetil for uveitis, VRQoL and HRQoL improved significantly over the course of 1 year and did not differ by treatment allocation. These findings suggest that antimetabolites could improve overall patient well-being and daily functioning.
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Affiliation(s)
- Nicole K Kelly
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Aheli Chattopadhyay
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - S R Rathinam
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - John A Gonzales
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Radhika Thundikandy
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Anuradha Kanakath
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - S Bala Murugan
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - R Vedhanayaki
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Dean Cugley
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Eric B Suhler
- Casey Eye Institute, Oregon Health and Science University, OHSU-PSU School of Public Health, and Portland Veterans' Affairs Health Care System, Portland, Oregon
| | - Hassan A Al-Dhibi
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Caleb D Ebert
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Elyse J Berlinberg
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Travis C Porco
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Nisha R Acharya
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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Van Bentum RE, Van den Berg JM, Wolf SE, Van der Bijl J, Tan HS, Verbraak FD, van der Horst‐Bruinsma IE. Multidisciplinary management of auto-immune ocular diseases in adult patients by ophthalmologists and rheumatologists. Acta Ophthalmol 2021; 99:e164-e170. [PMID: 32749781 PMCID: PMC7984222 DOI: 10.1111/aos.14548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 12/27/2022]
Abstract
Purpose Management of chronic vision threatening auto‐immune ocular diseases (AIOD, e.g. uveitis, scleritis) can be challenging. Guidelines recommend a multidisciplinary approach (MDA) with ophthalmologists and rheumatologists, to enhance the recognition of systemic diseases and guide the use of immunosuppressives. However, the indications and results of such an approach have not yet been studied. Methods A monocentre, retrospective chart review of all patients treated in a MDA between ophthalmologists and rheumatologists, in a Dutch tertiary center. The collaboration was twofold: a combined multidisciplinary team meeting every 2 weeks, and an ophthalmology‐dedicated rheumatology outpatient clinic. Primary endpoints of this descriptive study were as follows: indications for MDA, new diagnoses of systemic auto‐immune diseases and changes in systemic immunosuppression and prednisone dosages. Results In total, 157 adults (mean age 46 years, 57% female, median disease duration 19 months) were included, mainly with uveitis (74%) and scleritis (12%). Multidisciplinary approach (MDA)‐indications included diagnostic workup (32%), treatment support (44%), diagnostic‐and‐treatment support (10%) and side effects (8%). A systemic disease was newly diagnosed in eight and already present in 34 patients. At baseline, 54 patients used oral prednisone at >7.5 mg/day. Non‐corticoid immunosuppressives, mostly methotrexate, were started in 41% of the patients. During follow‐up, systemic prednisone was lowered to ≤7.5 mg/day in 68% of the patients. Conclusion This evaluation of an MDA‐programme in the management of AIOD demonstrated its added value. Mainly, it addressed the high demand for support in managing systemic immunosuppression, resulting in significant corticosteroid tapering. In addition, it resulted in the recognition of underlying systemic diseases.
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Affiliation(s)
- Rianne Elise Van Bentum
- Departments of Rheumatology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - Jesse M. Van den Berg
- Departments of Rheumatology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - Sanne E. Wolf
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
- Department of Ophthalmology Bergman Clinics Location Zaandam the Netherlands
| | - Joyce Van der Bijl
- Departments of Rheumatology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - H. Stevie Tan
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - Frank D. Verbraak
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
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65
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Hassman LM, Paley MA, Esaulova E, Paley GL, Ruzycki PA, Linskey N, Laurent J, Feigl-Lenzen L, Springer L, Montana CL, Hong K, Enright J, James H, Artyomov MN, Yokoyama WM. Clinicomolecular Identification of Conserved and Individualized Features of Granulomatous Uveitis. OPHTHALMOLOGY SCIENCE 2021; 1:100010. [PMID: 35937550 PMCID: PMC9352144 DOI: 10.1016/j.xops.2021.100010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 12/17/2022]
Abstract
Objective To identify molecular features that distinguish individuals with shared clinical features of granulomatous uveitis. Design Cross-sectional, observational study. Participants Four eyes from patients with active granulomatous uveitis. Methods We performed single-cell RNA-sequencing with antigen-receptor sequence analysis to obtain an unbiased gene expression survey of ocular immune cells and identify clonally expanded lymphocytes. Main Outcomes Measures For each inflamed eye, we measured the proportion of distinct immune cell types, the amount of B or T cell clonal expansion, and the transcriptional profile of T and B cells. Results Each individual had robust clonal expansion arising from a single T or B cell lineage, suggesting distinct, antigen-driven pathogenic processes in each patient. This variability in clonal expansion was mirrored by individual variability in CD4 T cell populations, whereas ocular CD8 T cells and B cells were more transcriptionally similar between patients. Finally, ocular B cells displayed evidence of class-switching and plasmablast differentiation within the ocular microenvironment, providing additional support for antigen-driven immune responses in granulomatous uveitis. Conclusions Collectively, our study identified both conserved and individualized features of granulomatous uveitis, illuminating parallel pathophysiologic mechanisms, and suggesting that future personalized therapeutic approaches may be warranted.
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Affiliation(s)
- Lynn M. Hassman
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Michael A. Paley
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ekaterina Esaulova
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Grace L. Paley
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Philip A. Ruzycki
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Nicole Linskey
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer Laurent
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Lacey Feigl-Lenzen
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Luke Springer
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Cynthia L. Montana
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Karen Hong
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer Enright
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Hayley James
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Maxim N. Artyomov
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Wayne M. Yokoyama
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
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He X, Yuan Z, Gaeke S, Kao WWY, Li SK, Miller D, Williams B, Park YC. Laser-Activated Drug Implant for Controlled Release to the Posterior Segment of the Eye. ACS APPLIED BIO MATERIALS 2021; 4:1461-1469. [PMID: 35014495 DOI: 10.1021/acsabm.0c01334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To treat chronic posterior eye diseases, frequent intravitreal injections or sustained-release drug implants are the current standard of care. Sustained-release drug implants often involve burst release of the drugs and the dosage from the implants cannot be controlled after implantation, which may lead to local side effects. The present study attempts to develop a dosage-controllable drug delivery implant that consists of a nanoporous biodegradable PLGA capsule and light-activated liposomes. Controllable drug release from the implant was achieved using a pulsed near-infrared (NIR) laser both in vitro and in vivo. The in vitro drug release kinetics from two different initial dose implants, 1000 and 500 μg, was analyzed by fitting zero-order and first-order kinetics, as well as the Korsmeyer-Peppas and Higuchi models. The 1000 and 500 μg implants fit the first-order and zero-order kinetics model, respectively, the best. The multiple drug releases in the vitreous were determined by an in vivo fluorimeter, which was consistent with the in vitro data. The dose released was also clinically relevant. Histology and optical and ultrasound imaging data showed no abnormality in the eyes received implant treatment, suggesting that the drug delivery system was safe to the retina. This on-demand dose-controllable drug delivery system could be potentially used for long-term posterior eye disease treatment to avoid frequent invasive injections.
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Affiliation(s)
- Xingyu He
- Department of Chemical & Environment Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, Ohio 45221, United States
| | - Zheng Yuan
- Department of Chemical & Environment Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, Ohio 45221, United States
| | - Samantha Gaeke
- Department of Chemical & Environment Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, Ohio 45221, United States
| | - Winston W-Y Kao
- Department of Ophthalmology, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, Ohio 45267, United States
| | - S Kevin Li
- College of Pharmacy, University of Cincinnati, 3255 Eden Avenue, Cincinnati, Ohio 45229, United States
| | - Daniel Miller
- Department of Ophthalmology, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, Ohio 45267, United States.,Cincinnati Eye Institute, 1945 CEI Drive, Cincinnati, Ohio 45242, United States
| | - Basil Williams
- Department of Ophthalmology, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, Ohio 45267, United States.,Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229, United States
| | - Yoonjee C Park
- Department of Chemical & Environment Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, Ohio 45221, United States.,Department of Ophthalmology, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, Ohio 45267, United States
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Abstract
The uveitides are a heterogeneous group of diseases characterized by inflammation inside the eye. The uveitides are classified as infectious or non-infectious. The non-infectious uveitides, which are presumed to be immune mediated, can be further divided into those that are associated with a known systemic disease and those that are eye limited,-ie, not associated with a systemic disease. The ophthalmologist identifies the specific uveitic entity by medical history, clinical examination, and ocular imaging, as well as supplemental laboratory testing, if indicated. Treatment of the infectious uveitides is tailored to the particular infectious organism and may include regional and/or systemic medication. First line treatment for non-infectious uveitides is corticosteroids that can be administered topically, as regional injections or surgical implants, or systemically. Systemic immunosuppressive therapy is used in patients with severe disease who cannot tolerate corticosteroids, require chronic corticosteroids at >7.5 mg/day prednisone, or in whom the disease is known to respond better to immunosuppression. Management of many of these diseases is optimized by coordination between the ophthalmologist and rheumatologist or internist.
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Affiliation(s)
- Bryn M Burkholder
- Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Rodríguez Vicente L, Martín-García E, Chavarri-García JJ, Jiménez-Del Río B, Ortega-Renedo I, Ibañez-Muñoz A, Del Río-Mayor JL. Cystoid macular edema refractory to treatment. J Fr Ophtalmol 2021; 44:e211-e213. [PMID: 33451867 DOI: 10.1016/j.jfo.2020.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 11/20/2022]
Affiliation(s)
- L Rodríguez Vicente
- Department of Ophthalmology, San Pedro Hospital, Piqueras street, 98, 26006 Logroño, La Rioja, Spain.
| | - E Martín-García
- Department of Ophthalmology, San Pedro Hospital, Piqueras street, 98, 26006 Logroño, La Rioja, Spain
| | - J J Chavarri-García
- Department of Ophthalmology, San Pedro Hospital, Piqueras street, 98, 26006 Logroño, La Rioja, Spain
| | - B Jiménez-Del Río
- Department of Ophthalmology, San Pedro Hospital, Piqueras street, 98, 26006 Logroño, La Rioja, Spain
| | - I Ortega-Renedo
- Department of Ophthalmology, San Pedro Hospital, Piqueras street, 98, 26006 Logroño, La Rioja, Spain
| | - A Ibañez-Muñoz
- Department of Ophthalmology, San Pedro Hospital, Piqueras street, 98, 26006 Logroño, La Rioja, Spain
| | - J L Del Río-Mayor
- Department of Ophthalmology, San Pedro Hospital, Piqueras street, 98, 26006 Logroño, La Rioja, Spain
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69
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Huang Z, Li W, Su W. Tregs in Autoimmune Uveitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1278:205-227. [PMID: 33523450 DOI: 10.1007/978-981-15-6407-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Uveitis is a chronic disease with relapsing and remitting ocular attack, which requires corticosteroids and systemic immunosuppression to prevent severe vision loss. Classically, uveitis is referred to an autoimmune disease, mediated by pro-inflammatory Th17 cells and immunosuppressive CD4+CD25+FoxP3+ T-regulatory cells (Tregs). More and more evidence indicates that Tregs are involved in development, resolution, and remission of uveitis. Clinically, many researchers have conducted quantitative and functional analyses of peripheral blood from patients with different subtypes of uveitis, in an attempt to find the changing rules of Tregs. Consistently, using the experimental autoimmune uveitis (EAU) model, researchers have explored the development and resolution mechanism of uveitis in many aspects. In addition, many drug and Tregs therapy investigations have yielded encouraging results. In this chapter, we introduced the current understanding of Tregs, summarized the clinical changes in the number and function of patients with uveitis and the immune mechanism of Tregs involved in EAU model, as well as discussed the progress and shortcomings of Tregs-related drug therapy and Tregs therapy. Although the exact mechanism of Tregs-mediated uveitis protection remains to be elucidated, the strategy of Tregs regulation may provide a specific and meaningful way for the prevention and treatment of uveitis.
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Affiliation(s)
- Zhaohao Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenli Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Rao NA. Editorial on Uveitis and Intraocular Inflammations. Asia Pac J Ophthalmol (Phila) 2021; 10:3-4. [PMID: 33512824 DOI: 10.1097/apo.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Narsing A Rao
- Department of Ophthalmology, University of Southern California, US, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA
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71
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Niederer R, Bar A, Al-Ani H, Sharief L, Sar S, Segal A, Lightman S, Tomkins-Netzer O. Management of inflammatory choroidal neovascular membranes. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1842196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael Niederer
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Centre, Tel Aviv-Yafo, Israel
| | - Haya Al-Ani
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Lazha Sharief
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Shaul Sar
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Adi Segal
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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72
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Dutta Majumder P, Agrawal R, McCluskey P, Biswas J. Current Approach for the Diagnosis and Management of Noninfective Scleritis. Asia Pac J Ophthalmol (Phila) 2020; 10:212-223. [PMID: 33290287 DOI: 10.1097/apo.0000000000000341] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT Scleritis is a rare, vision-threatening inflammation of the sclera that is often associated with life-threatening systemic illnesses. Rheumatoid arthritis remains the most common associated systemic rheumatic disease and the commonest systemic association of scleritis. Granulomatosis with polyangiitis is the most common cause of vasculitis-associated scleritis. The etiopathogenesis of scleritis remains unclear, but can be immune complex-mediated or due to a local delayed hypersensitivity reaction. Scleritis can involve either the anterior or posterior sclera, and has a wide spectrum of clinical presentations. Among the subtypes of scleritis, necrotizing scleritis has an increased risk of complications and is more commonly associated with anterior uveitis and peripheral ulcerative keratitis. Posterior scleritis is often not diagnosed or missed due to its subtle clinical signs and protean manifestations. Meticulous history taking, detailed ocular examination, and a targeted array of investigations with a multi-disciplinary approach to find any underlying systemic disease are crucial for the management of a case of scleritis. Corticosteroids remain the mainstay of short-term treatment of scleritis; mild to moderate scleral inflammation may respond well to treatment with nonsteroidal antiinflammatory drug or topical corticosteroid. Corticosteroid-sparing immunosuppressive therapies are useful in cases with an inadequate response or failure to provide long-term control of inflammation, and to prevent recurrence of scleritis. Biologic agents are increasingly used in the management of scleritis, not responding to the conventional therapies. This review provides an overview of the various subtypes of scleritis and its systemic associations and evaluates current trends in the diagnosis and management of noninfective scleritis.
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Affiliation(s)
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Peter McCluskey
- Ocular Infections and Antimicrobials Research Group, Singapore Eye Research Institute, Singapore
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
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Tugal-Tutkun I, Çakar Özdal P. Behçet's disease uveitis: is there a need for new emerging drugs? Expert Opin Emerg Drugs 2020; 25:531-547. [PMID: 33147420 DOI: 10.1080/14728214.2020.1847271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Behçet's disease uveitis (BDU) is a potentially blinding disorder. Systemic treatment with disease-modifying anti-rheumatic drugs (DMARDs) is mandatory in patients with intraocular inflammation involving the posterior segment of the eye. Areas covered: This article discusses existing systemic treatment with corticosteroids and conventional and biologic DMARDs as well as adjunctive local therapy in BDU. An overview is provided for a wide range of biologic DMARDs that have shown promise or investigated in clinical trials. Most recently introduced biologic DMARDs and targeted synthetic DMARDs are also reviewed for their potential in the treatment of BDU. Expert opinion: The prognosis of patients with BDU has remarkably improved after the introduction of biologic DMARDs. An expanding therapeutic armamentarium will allow treatment of most refractory cases. The ultimate goal is to provide drug-free remission with preservation of 20/20 vision.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey
| | - Pinar Çakar Özdal
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital , Ankara, Turkey
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74
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Rahman N, Petrushkin H, Solebo AL. Paediatric autoimmune and autoinflammatory conditions associated with uveitis. Ther Adv Ophthalmol 2020; 12:2515841420966451. [PMID: 33225212 PMCID: PMC7649876 DOI: 10.1177/2515841420966451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Childhood uveitis comprises a collection of heterogenous ocular phenotypes which are associated with a diverse range of childhood autoimmune and autoinflammatory disorders. Of these genetic and/or acquired disorders, juvenile idiopathic arthritis is the most common, affecting 30-80% of children with uveitis. Up to a third of children with uveitis have 'isolated' idiopathic disease and do not have an associated systemic disease which manifests in childhood. However, uveitis may be the presenting manifestation of disease; thus, the apparently well child who presents with uveitis may have isolated idiopathic disease, but they may have an evolving systemic disorder. The diagnosis of most of the associated disorders is reliant on clinical features rather than serological or genetic investigations, necessitating detailed medical history taking and systemic examination. Adequate control of inflammation is key to good visual outcomes, and multidisciplinary care is key to good broader health outcomes.
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Affiliation(s)
- Najiha Rahman
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ameenat Lola Solebo
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Abstract
PURPOSE OF REVIEW Ocular sarcoidosis is one of the most common causes of uveitis worldwide. The diagnosis and treatment of patients with ocular sarcoidosis remains challenging in some cases. It is important for clinicians to keep up to date with new diagnostic and treatment tools for this disease. RECENT FINDINGS The International Workshop on Ocular Sarcoidosis diagnostic criteria were first proposed in 2009 and revised in 2017. The new criteria contained two parts: ocular presentation and systemic investigation. The diagnostic value of liver enzymes was reduced in the new criteria, whereas the value placed of lymphopenia and the CD4/CD8 ratio in bronchoalveolar lavage fluid were increased. Despite not being included in the criteria, recent studies have also highlighted the diagnostic value of serum soluble interleukin-2 receptors. Recent ophthalmologic imaging also provides useful insights for the differential diagnosis.Many new treatments for ocular sarcoidosis have been developed in recent years. The introduction of biological immunomodulatory agents for uveitis treatment represents a big improvement. Antitumor necrosis factor-alpha antibodies, including adalimumab, have been proven to be effective for treating ocular sarcoidosis. Many studies have also suggested that other biological agents could be effective and well tolerated. Newer intravitreal dexamethasone and fluocinolone implants have been developed. Patients treated with these implants have experienced good and sustained control of their intraocular inflammation. SUMMARY Diagnosis and treatment options for ocular sarcoidosis have changed over time. However, challenges still exist in some difficult patients. Future studies should focus on finding more sensitive biomarkers and developing more effective immunomodulatory treatments with longer efficacy and less side effects.
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Affiliation(s)
- De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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76
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Hien DL, Pham BH, Nguyen QD. How Do We Manage HLA-B27-associated Ocular Inflammation Refractory or Intolerant to Conventional Immunomodulatory Therapy? J Ophthalmic Vis Res 2020; 15:442-445. [PMID: 33133433 PMCID: PMC7591831 DOI: 10.18502/jovr.v15i4.7777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is an Editorial and does not have an abstract.
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Affiliation(s)
- Doan Luong Hien
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Pham Ngoc Thach University of Medicine, Saigon, Vietnam
| | - Brandon Huy Pham
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
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77
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Porco TC, Kim E, Acharya NR. Stratification Clarification for Methods for Randomized Clinical Trials. JAMA Ophthalmol 2020; 138:800-801. [DOI: 10.1001/jamaophthalmol.2020.1551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Travis C. Porco
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Eric Kim
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Nisha R. Acharya
- F. I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
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78
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Jabs DA. Stratification Clarification for Methods for Randomized Clinical Trials—Reply. JAMA Ophthalmol 2020; 138:801. [DOI: 10.1001/jamaophthalmol.2020.1864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Douglas A. Jabs
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University of Medicine, Baltimore, Maryland
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79
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Pavesio CE. Conventional immunosuppression: the search for scientific evidence. Eye (Lond) 2020; 34:1945-1946. [PMID: 32341535 DOI: 10.1038/s41433-020-0875-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Carlos E Pavesio
- Moorfields Eye Hospital NHS Foundation Trust and Biomedical Research Centre, Institute of Ophthalmology, London, UK.
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80
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Affiliation(s)
- Douglas A. Jabs
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
Juvenile localized scleroderma (jLS) is an orphan disease that can lead to cosmetic disfiguration and orthopedic problems. Two recent publications review the current recommendations regarding diagnosis, assessment, follow up and treatment of pediatric localized scleroderma cases, both of which suggest the Localized Scleroderma Cutaneous Assessment Tool as an important instrument to assess activity and damage. This review focuses on the systemic treatment of jLS. Systemic treatment includes synthetic and biologic disease-modifying antirheumatic drugs. Systemic therapy is indicated if the lesion crosses any joint, or leads to potential cosmetic disfiguration or orthopedic problems. The only controlled trial of systemic treatment has shown the efficacy of methotrexate, which is the first choice of treatment. It appears superior to phototherapy according to a recently published meta-analysis. In case of methotrexate intolerance, mycophenolate mofetil is an option. In case of methotrexate nonresponse, addition of mycophenolate mofetil, tocilizumab or abatacept seems to be effective. Future treatment options derived and extrapolated from adult trials regarding treatment of skin involvement of systemic scleroderma or fibrosis are promising, as the final pathway in the skin seems to be similar in both diseases.
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Affiliation(s)
- Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence, Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, Budapest, An der Schön Klinik Hamburg-Eilbek, Dehnhaide 120, 22081, Hamburg, Germany.
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