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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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Coste N, Bocquet A, Labarere J, Semecas R, Aptel F, Deroux A, Bouillet L, Chiquet C. Tolerance and efficacy of anti-TNF currently used for severe non-infectious uveitis. Autoimmun Rev 2021; 20:102752. [PMID: 33476820 DOI: 10.1016/j.autrev.2021.102752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Nicolas Coste
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France
| | - Alexis Bocquet
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - José Labarere
- Quality of Care Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Univ. Grenoble Alpes, Grenoble F-38043, France
| | - Rachel Semecas
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France; Hypoxia and Physiopathology Laboratory HP2, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Florent Aptel
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France; Hypoxia and Physiopathology Laboratory HP2, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Alban Deroux
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurence Bouillet
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France.
| | - Christophe Chiquet
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France; Hypoxia and Physiopathology Laboratory HP2, INSERM U1042, University Grenoble Alpes, Grenoble, France
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Wakefield D, Clarke D, McCluskey P. Recent Developments in HLA B27 Anterior Uveitis. Front Immunol 2021; 11:608134. [PMID: 33469457 PMCID: PMC7813675 DOI: 10.3389/fimmu.2020.608134] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023] Open
Abstract
There has been steady progress in understanding the pathogenesis, clinical features, and effective treatment of acute anterior uveitis (AU) over the past 5 years. Large gene wide association studies have confirmed that AU is a polygenic disease, with overlaps with the seronegative arthropathies and inflammatory bowel diseases, associations that have been repeatedly confirmed in clinical studies. The role of the microbiome in AU has received increased research attention, with recent evidence indicating that human leukocyte antigen B27 (HLA B27) may influence the composition of the gut microbiome in experimental animals. Extensive clinical investigations have confirmed the typical features of acute AU (AAU) and its response to topical, regional and systemic immunosuppressive treatment. Increased understanding of the role of cytokines has resulted in studies confirming the value of anti-cytokine therapy [anti-tumor necrosis factor (anti-TNF) and interleukin 6 (IL-6) therapy] in severe and recurrent cases of AAU, particularly in subjects with an associated spondyloarthopathy (SpA) and in juvenile idiopathic arthritis (JIA)-associated AAU.
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Affiliation(s)
- Denis Wakefield
- Faculty of Medicine, University of NSW Sydney, Kensington, NSW, Australia
- NSW Health Pathology and South Eastern Sydney, LHD, Sydney, NSW, Australia
| | - Daniel Clarke
- Department of Medicine, South Eastern Sydney, LHD, Sydney, NSW, Australia
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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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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Biotherapies in Uveitis. J Clin Med 2020; 9:jcm9113599. [PMID: 33171664 PMCID: PMC7695328 DOI: 10.3390/jcm9113599] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
Non-infectious uveitis (NIU) represents one of the leading causes of blindness in developed countries. The therapeutic strategy aims to rapidly control intra-ocular inflammation, prevent irremediable ocular damage, allow corticosteroid sparing and save the vision, and has evolved over the last few years. Anterior NIU is mostly managed with topical treatment in adults. However, for intermediate, posterior and pan-uveitis, notably when both eyes are involved, systemic treatment is usually warranted. Biotherapies are recommended in case of inefficacy or non-tolerance of conventional immunosuppressive drugs in non-anterior NIU. Anti-tumor necrosis factor alpha (anti-TNF-α) agents are by far the most widely used, especially adalimumab (ADA) and infliximab (IFX). In case of sight-threatening uveitis in Behçet's disease or in case of risk of severe recurrences, respectively IFX and ADA may be recommended as first-line therapy. Many questions are left unanswered; how long to treat NIU, how to discontinue anti-TNF-α agents, what biologic to use in case of anti-TNF-α failure? The objective of this review is to present an updated overview of knowledge on the use of biological treatments in NIU.
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Berkenstock MK, Mir TA, Khan IR, Burkholder BM, Chaon BC, Shifera AS, Thorne JE. Effectiveness of the Dexamethasone Implant in Lieu of Oral Corticosteroids in Intermediate and Posterior Uveitis Requiring Immunosuppression. Ocul Immunol Inflamm 2020; 30:741-749. [PMID: 33021854 DOI: 10.1080/09273948.2020.1826534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate dexamethasone intravitreal implant effectiveness in lieu of high-dose oral prednisone for short-term treatment of noninfectious intermediate and posterior uveitis in patients requiring immunosuppression. METHODS This is a proof-of-concept, open-label, non-comparative clinical trial with 12-month follow-up. The primary outcome was uveitis control without additional prednisone at 6 and 12 months. Secondary outcomes were need for multiple implants or additional prednisone, and safety data. RESULTS 20 patients (28 eyes) were enrolled- 16 eyes had control by 6 months; 20 by 12 months. No patients required high-dose prednisone. 6 patients enrolled on prednisone: 2 stopped; 4 tapered to 7.5 mg daily or less by 12 months. 16 eyes required multiple implants; five required cataract surgery; 12 required drops to control IOP; 2 underwent glaucoma surgery. CONCLUSIONS The dexamethasone implant was effective in lieu of high-dose prednisone although the majority required multiple implants. All patients decreased or discontinued prednisone during follow-up.
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Affiliation(s)
- Meghan K Berkenstock
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tahreem A Mir
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irfan R Khan
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bryn M Burkholder
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin C Chaon
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amde Selassie Shifera
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer E Thorne
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Espinosa G, Herreras JM, Muñoz-Fernández S, García Ruiz de Morales JM, Cordero-Coma M. Recommendations statement on the immunosuppressive treatment of non-infectious, non-neoplastic, non-anterior uveitis. Med Clin (Barc) 2020; 155:220.e1-220.e12. [PMID: 32199631 DOI: 10.1016/j.medcli.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To generate recommendations on the use of immunomodulators in patients with non-infectious, non-neoplastic intermediate uveitis (IU), posterior uveitis (PU) and panuveitis (PanU) based on best evidence and experience. METHODS A multidisciplinary panel of 5 experts was established, who defined the scope, users, and sections of the document. A systematic literature review (SLR) was performed to assess the efficacy and safety of immunomodulatory drugs in patients with non-infectious, non-neoplastic, non-anterior uveitis. The results of the SLR were presented and discussed during an expert meeting in which 34 recommendations were generated. The level of agreement with the recommendations was also tested in 25 additional experts following a Delphi process. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of the experts voted ≥7. The level of evidence and grade or recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS The SLR included 33 articles. The 34 recommendations were accepted after 2 Delphi rounds (3 of them were modified after the first round). They include specific recommendations on patients with non-infectious, non-neoplastic, PU and PanU, as well as different treatment guidelines. CONCLUSIONS In patients with non-infectious, non-neoplastic, non-anterior uveitis these recommendations might help treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.
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Affiliation(s)
- Gerard Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España
| | - José M Herreras
- IOBA (Instituto Universitario de Oftalmobiología), Universidad de Valladolid, Valladolid, España; Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Santiago Muñoz-Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Universidad Europea, San Sebastián de los Reyes, Madrid, España
| | - José M García Ruiz de Morales
- Unidad de Uveítis, Servicio de Inmunología, Complejo Asistencial Universitario de León, León, España; Instituto de Biomedicina, Universidad de León (IBIOMED), León, España
| | - Miguel Cordero-Coma
- Instituto de Biomedicina, Universidad de León (IBIOMED), León, España; Unidad de uveítis, Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España.
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58
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Park JG, Callaway NF, Ludwig CA, Mahajan VB. Intravitreal methotrexate and fluocinolone acetonide implantation for Vogt-Koyanagi-Harada uveitis. Am J Ophthalmol Case Rep 2020; 19:100859. [PMID: 32793845 PMCID: PMC7415829 DOI: 10.1016/j.ajoc.2020.100859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 06/14/2020] [Accepted: 07/26/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To report a case of intravitreal methotrexate treatment and fluocinolone acetonide (Retisert®) implantation in a patient with Vogt-Koyanagi-Harada syndrome (VKH). Observations A 34-year-old male was referred for worsening vision and bilateral panuveitis consistent with VKH. He was treated with prednisone, mycophenolate mofetil, prednisolone acetate eye drops, and injections of triamcinolone and adalimumab. He failed to improve with these therapies and developed multiple adverse effects, including hepatotoxicity, severe eye pain, cataracts, and cystoid macular edema. We treated him with intravitreal methotrexate injections in both eyes, which rapidly improved his eye pain, inflammation, and vision. He subsequently underwent fluocinolone acetonide (Retisert®) implantation, cataract extraction with intraocular lens insertion, and Ahmed tube placement for long-term intraocular pressure control. His vision improved from hand motions to 20/30, intraocular pressure remained stable at 17, there was complete resolution of his panuveitis and uveitic macular edema, and his systemic medications were able to be discontinued. Conclusions /Importance: This case demonstrates intravitreal methotrexate may successfully treat intraocular inflammation, pain, and macular edema in VKH. Excellent long-term vision and reduction of adverse effects of systemic medications were also achieved with subsequent fluocinolone acetonide implantation. Combining these two targeted therapies may be an effective strategy in treating VKH in patients who have severe pain and cannot tolerate systemic therapy.
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Affiliation(s)
- Jong G Park
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Natalia F Callaway
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Vinit B Mahajan
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Wang G, Peng X. A Review of Clinical Applications and Side Effects of Methotrexate in Ophthalmology. J Ophthalmol 2020; 2020:1537689. [PMID: 32850138 PMCID: PMC7439192 DOI: 10.1155/2020/1537689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
Methotrexate (MTX) is a folate analog widely used against a range of diseases including malignancies and autoimmune disorders. Its high effectiveness-price ratio also won extensive application in ophthalmology. On the other hand, although MTX has an excellent pharmacological efficacy, MTX associated side effects in clinical use, which vary from patient to patient, are nonnegligible. There is no comparatively systematic review on MTX associated side effects and its risk factors. This review aimed to reveal novel clinical approaches of MTX and its adverse effects in order to provide a reference for ophthalmic scholars in clinical application of MTX.
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Affiliation(s)
- Ge Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Xiaoyan Peng
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
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Hossain IT, Sanghi P, Manzouri B. Pharmacotherapeutic management of atopic keratoconjunctivitis. Expert Opin Pharmacother 2020; 21:1761-1769. [PMID: 32602382 DOI: 10.1080/14656566.2020.1786534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Atopic keratoconjunctivitis (AKC) is a form of allergic eye disease that can have sight threating implications. Prevalence is underestimated due to scarce published data and treatment is expanding as a result of limitations of current strategies. This article aims to provide an up-to-date overview of AKC and summarize current and upcoming management. AREAS COVERED The authors provide history, immunopathogenesis, and summary of the clinical manifestations of AKC as well as presenting a review of the evidence in relation to treatment options including mast cell stabilizers, antihistamines, corticosteroids, and immunomodulatory drugs based on clinical trials. Future trends, drug targets, and novel delivery drug systems are also highlighted in this review. EXPERT OPINION Previously established treatment strategies of AKC had relied on corticosteroids, but the side effects of long-term therapy resulted in the expansion into the use of immunomodulatory drugs such as tacrolimus and ciclosporin. However, these too provide limited success due to the suboptimal structural properties of the current molecules. The ideal molecule should generate maximum permeability across the multi-layered structure of the cornea, be able to be formulated into eye drops for ease of application with minimal dosing and for maximal clinical effect.
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Affiliation(s)
- Ibtesham T Hossain
- Department of Ophthalmology, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, UK
| | - Priyanka Sanghi
- Department of Ophthalmology, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, UK
| | - Bita Manzouri
- Department of Ophthalmology, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, UK
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Leclercq M, Langlois V, Girszyn N, Le Besnerais M, Benhamou Y, Levesque H, Muraine M, Gueudry J. Comparison of conventional immunosuppressive drugs versus anti-TNF-α agents in non-infectious non-anterior uveitis. J Autoimmun 2020; 113:102481. [PMID: 32586650 DOI: 10.1016/j.jaut.2020.102481] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of Disease-modifying antirheumatic drugs (DMARDs) and anti-TNF-α agents in patients with non-infectious non-anterior uveitis. METHODS Single center retrospective study including adult patients with non-infectious intermediate, posterior or pan-uveitis. Outcomes were compared between patients treated with DMARDs or anti-TNF-α agents. The primary outcome was treatment failure or occurrence of serious adverse events. Treatment failure was determined by ophthalmologic criteria. RESULTS Seventy-three patients were included, mostly female (52%). Among them, 39 were treated with DMARDs and 34 with anti-TNF-α agents. The main uveitis causes were idiopathic (30%), birdshot chorio-retinopathy (25%), sarcoidosis (16%) and Behçet's disease (14%). The primary outcome was observed in 56% of patients treated with anti-TNF-α agents versus 59% of patients treated with DMARDs (p = 0.82). Median time to observe the primary outcome was 16 months (anti-TNF-α group) versus 21 months (p = 0.52). There was no significant difference between the two groups in terms of treatment failure, corticosteroid sparing effect, visual acuity improvement or adverse events. Earlier control of ocular inflammation was achieved with anti-TNF-α agents than with DMARDs (p = 0.006). In relapsing patients, anti-TNF-α agents allowed better corticosteroid sparing (p = 0.06). CONCLUSION DMARDs could still be used as first-line therapy for non-infectious non-anterior uveitis after corticosteroid therapy. However, anti-TNF-α agents could be proposed as an alternative in cases of severe inflammation or initial high level of steroid dependency.
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Affiliation(s)
- Mathilde Leclercq
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France.
| | - Vincent Langlois
- Internal Medicine Department, Hospital Jacques Monod, Le Havre, France
| | - Nicolas Girszyn
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France
| | - Maëlle Le Besnerais
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Ygal Benhamou
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Hervé Levesque
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Marc Muraine
- Ophthalmology Department, Hospital Charles Nicolle, Rouen, France
| | - Julie Gueudry
- Ophthalmology Department, Hospital Charles Nicolle, Rouen, France; EA7510, UFR Santé, Rouen University, Rouen, France
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EMT and EndMT: Emerging Roles in Age-Related Macular Degeneration. Int J Mol Sci 2020; 21:ijms21124271. [PMID: 32560057 PMCID: PMC7349630 DOI: 10.3390/ijms21124271] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
Epithelial–mesenchymal transition (EMT) and endothelial–mesenchymal transition (EndMT) are physiological processes required for normal embryogenesis. However, these processes can be hijacked in pathological conditions to facilitate tissue fibrosis and cancer metastasis. In the eye, EMT and EndMT play key roles in the pathogenesis of subretinal fibrosis, the end-stage of age-related macular degeneration (AMD) that leads to profound and permanent vision loss. Predominant in subretinal fibrotic lesions are matrix-producing mesenchymal cells believed to originate from the retinal pigment epithelium (RPE) and/or choroidal endothelial cells (CECs) through EMT and EndMT, respectively. Recent evidence suggests that EMT of RPE may also be implicated during the early stages of AMD. Transforming growth factor-beta (TGFβ) is a key cytokine orchestrating both EMT and EndMT. Investigations in the molecular mechanisms underpinning EMT and EndMT in AMD have implicated a myriad of contributing factors including signaling pathways, extracellular matrix remodelling, oxidative stress, inflammation, autophagy, metabolism and mitochondrial dysfunction. Questions arise as to differences in the mesenchymal cells derived from these two processes and their distinct mechanistic contributions to the pathogenesis of AMD. Detailed discussion on the AMD microenvironment highlights the synergistic interactions between RPE and CECs that may augment the EMT and EndMT processes in vivo. Understanding the differential regulatory networks of EMT and EndMT and their contributions to both the dry and wet forms of AMD can aid the development of therapeutic strategies targeting both RPE and CECs to potentially reverse the aberrant cellular transdifferentiation processes, regenerate the retina and thus restore vision.
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Maleki A, Ueberroth JA, Walsh M, Foster F, Chang PY, Anesi SD, Foster CS. Combination of Intravenous Methotrexate and Methylprednisolone Therapy in the Treatment of Severe Ocular Inflammatory Diseases. Ocul Immunol Inflamm 2020; 29:1559-1563. [PMID: 32406782 DOI: 10.1080/09273948.2020.1746356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To evaluate the efficacy of intravenous methotrexate and methylprednisolone in severe, sight-threatening ocular inflammatory conditions.Methods: This was a retrospective observational case series. Patients who had received intravenous methotrexate for ocular inflammation with at least 24 months of follow-up were included in the study.Results: Ten patients (20 eyes) were included in this study. Mean age of the patients was 47.2 ± 17.7 (range:19-74). At 1-month follow-up visit, nine patients showed improvement and one patient failed treatment. At 12-month follow-up visit, all patients were in remission. Two patients were only on intravenous methotrexate infusions. At twenty-four-month follow-up visit, only one patient, in remission, was on intravenous methotrexate therapy. Leukopenia was the only adverse effect observed.Conclusion: Intravenous methotrexate and methylprednisolone infusions can be an effective method of treatment in patients with severe, sight-threatening ocular inflammatory conditions.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Jordan A Ueberroth
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Marisa Walsh
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Frances Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Charles Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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Tran J, Tsui E. Assessment of the Readability, Availability, and Quality of Online Patient Education Materials Regarding Uveitis Medications. Ocul Immunol Inflamm 2020; 29:1507-1512. [PMID: 32275173 DOI: 10.1080/09273948.2020.1737144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To assess the availability, quality, and readability of online patient education materials regarding uveitis medications.Methods: The top 10 Google search results for 10 commonly prescribed uveitis medications (prednisone, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, chlorambucil, cyclophosphamide, adalimumab, and infliximab) were analyzed for readability and accountability. Readability was assessed with the Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Simple Measure of Gobbledygook Index, and Coleman Liau Index. JAMA benchmarks were used to assign websites accountability scores. Statistical analysis was performed with two-tailed t-tests.Results: Of 100 search results, none complied with the recommended sixth-grade reading level across all readability formulas. Only one website satisfied all 4 JAMA benchmarks, two websites were able to satisfy three benchmarks, and the remainder achieved two or less.Conclusions: Online information regarding uveitis medications lacks accountability and is not written at an appropriate level for the average patient.
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Affiliation(s)
- Joseph Tran
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Edmund Tsui
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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Traitement des uvéites intermédiaires, postérieures et panuvéites non infectieuses. J Fr Ophtalmol 2020; 43:341-361. [DOI: 10.1016/j.jfo.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 01/01/2023]
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66
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Noninfectious Autoimmune Scleritis: Recognition, Systemic Associations, and Therapy. Curr Rheumatol Rep 2020; 22:11. [DOI: 10.1007/s11926-020-0885-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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67
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Varela-Fernández R, Díaz-Tomé V, Luaces-Rodríguez A, Conde-Penedo A, García-Otero X, Luzardo-Álvarez A, Fernández-Ferreiro A, Otero-Espinar FJ. Drug Delivery to the Posterior Segment of the Eye: Biopharmaceutic and Pharmacokinetic Considerations. Pharmaceutics 2020; 12:E269. [PMID: 32188045 PMCID: PMC7151081 DOI: 10.3390/pharmaceutics12030269] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 01/22/2023] Open
Abstract
The treatment of the posterior-segment ocular diseases, such as age-related eye diseases (AMD) or diabetic retinopathy (DR), present a challenge for ophthalmologists due to the complex anatomy and physiology of the eye. This specialized organ is composed of various static and dynamic barriers that restrict drug delivery into the target site of action. Despite numerous efforts, effective intraocular drug delivery remains unresolved and, therefore, it is highly desirable to improve the current treatments of diseases affecting the posterior cavity. This review article gives an overview of pharmacokinetic and biopharmaceutics aspects for the most commonly-used ocular administration routes (intravitreal, topical, systemic, and periocular), including information of the absorption, distribution, and elimination, as well as the benefits and limitations of each one. This article also encompasses different conventional and novel drug delivery systems designed and developed to improve drug pharmacokinetics intended for the posterior ocular segment treatment.
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Affiliation(s)
- Rubén Varela-Fernández
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Neurosciences Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Victoria Díaz-Tomé
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Andrea Luaces-Rodríguez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Andrea Conde-Penedo
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Paraquasil Group, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Xurxo García-Otero
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Molecular Imaging Group. University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Asteria Luzardo-Álvarez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Paraquasil Group, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Francisco J. Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Paraquasil Group, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
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Kitano M, Tanaka R, Kaburaki T, Nakahara H, Shirahama S, Suzuki T, Komae K, Aihara M. Clinical Features and Visual Outcome of Uveitis in Japanese Patients Younger than 18 Years. Ocul Immunol Inflamm 2020; 29:1280-1286. [DOI: 10.1080/09273948.2020.1726972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Marie Kitano
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Medical Center, Itabashi-Ku, Tokyo, Japan
| | - Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Ophthalmology, Jichi Ika University Saitama Medical Center, Omiya, Saitama, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Shintaro Shirahama
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takafumi Suzuki
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Keiko Komae
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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69
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Chen SN, Chen YL, Yang BCL. Long-term Outcome of Zonal Outer Retinopathy in Punctate Inner Choroidopathy or Multifocal Choroiditis. Ocul Immunol Inflamm 2020; 29:865-870. [DOI: 10.1080/09273948.2019.1698749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan
- Department of Optometry, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
- College of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Yi-Ling Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan
| | - Benjamin Chi-Lan Yang
- Department of Medical Education, Chung-Shan Medical University Hospital, Taichung, Taiwan
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Methotrexate as an Adjuvant in Severe Thyroid Eye Disease: Does It Really Work as a Steroid-Sparing Agent? Ophthalmic Plast Reconstr Surg 2019; 35:369-373. [PMID: 30624412 DOI: 10.1097/iop.0000000000001279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare the efficacy and safety of adjunctive oral methotrexate with intravenous pulsed methylprednisolone against methylprednisolone alone in the treatment of severe thyroid eye disease. METHODS Retrospective review of clinical data of patients with severe sight-threatening thyroid eye disease with compressive optic neuropathy treated with methylprednisolone with and without methotrexate. Eye disease outcome measures (e.g., VISA inflammatory score and vision) at 0, 3, 6, 12, and 18 months were recorded. RESULTS There were 72 subjects including 33 who had methylprednisolone alone and 39 with methylprednisolone with methotrexate. There were no statistical differences in demographics and baseline measures of disease activity or vision between the 2 treatment groups. No significant statistical differences in the cumulative dosage of methylprednisolone or occurrence of restrictive myopathy, raised intraocular pressure, proptosis, and exposure keratopathy between the groups at 0, 3, 6, 12, and 18 months were found. However, subjects who received methylprednisolone with methotrexate had better visual acuity of more than 2 lines on Snellen chart (p = 0.026) and VISA inflammatory score (p = 0.034) at 3 months, but no differences at 6, 12, and 18 months. Three patients who received methylprednisolone with methotrexate had transient worsening of liver function. No patient developed severe adverse reaction. CONCLUSIONS The results demonstrated improved vision and disease activity at 3 months in the combination treatment group. This may suggest that the addition of methotrexate to methylprednisolone is beneficial for accelerating suppression of disease activity and hastens visual recovery. Addition of methotrexate to methylprednisolone did not reduce the requirement for steroids.
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Schnabel A, Unger E, Brück N, Berner R, Range U, Holl-Wieden A, Morbach H, Leszczynska A, Bau V, Hedrich CM. High-dose intravenous methylprednisolone in juvenile non-infectious uveitis: A retrospective analysis. Clin Immunol 2019; 211:108327. [PMID: 31863906 DOI: 10.1016/j.clim.2019.108327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
Abstract
Non-infectious uveitis is associated with visual impairment and blindness. Non-biologic treatment for non-infectious uveitis is not based on strong evidence. A retrospective chart review was conducted to investigate treatment response to high-dose intravenous methylprednisolone (IVMP) in children with non-infectious uveitis. Fifty-six patients (93 eyes affected) were included. In 29% uveitis was associated with juvenile idiopathic arthritis. Uveitis predominately affected the anterior segment, was bilateral and recurrent. Complications were common and included visual loss, synechiae, cataract and/or retinal lesions. Patients received up to 5 IVMP at monthly intervals. Visual acuity improved at 3 and 6 months. Anterior chamber cells, synechiae, keratic precipitates, papillary and/or macular edema improved at 3 months. Children treated with ≥3 IVMP (vs 1 IVMP) experienced trends towards fewer relapses, fewer cataracts and less frequently required treatment with biologic agents. High-dose IVMP induce rapid improvement in children with non-infectious uveitis. Prospective randomized trials are required to confirm results.
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Affiliation(s)
- Anja Schnabel
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany.
| | - Elisabeth Unger
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Normi Brück
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Reinhard Berner
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Annette Holl-Wieden
- Pediatric Rheumatology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Henner Morbach
- Pediatric Rheumatology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Anna Leszczynska
- Department of Ophthalmology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Viktoria Bau
- Department of Ophthalmology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Christian M Hedrich
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany; Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom.
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Ujiie H, Iwata H, Yamagami J, Nakama T, Aoyama Y, Ikeda S, Ishii N, Iwatsuki K, Kurosawa M, Sawamura D, Tanikawa A, Tsuruta D, Nishie W, Fujimoto W, Amagai M, Shimizu H. Japanese guidelines for the management of pemphigoid (including epidermolysis bullosa acquisita). J Dermatol 2019; 46:1102-1135. [PMID: 31646663 DOI: 10.1111/1346-8138.15111] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
The pemphigoid group is a category of autoimmune subepidermal blistering diseases in which autoantibodies deposit linearly at the epidermal basement membrane zone (BMZ). The main subtypes of pemphigoid mediated by immunoglobulin G autoantibodies are bullous pemphigoid (BP), mucous membrane pemphigoid (MMP) and epidermolysis bullosa acquisita (EBA). To establish the first guidelines approved by the Japanese Dermatological Association for the management of pemphigoid diseases, the Committee for Guidelines for the Management of Pemphigoid Diseases (Including EBA) was founded as part of the Study Group for Rare Intractable Skin Diseases under the Ministry of Health, Labor and Welfare Research Project on Overcoming Intractable Diseases. These guidelines aim to provide current information for the management of BP, MMP and EBA in Japan. Based on evidence, the guidelines summarize the clinical and immunological manifestations, pathophysiologies, diagnostic criteria, disease severity determination criteria, treatment algorithms and treatment recommendations. Because of the rarity of these diseases, there are few clinical studies with a high degree of evidence, so several parts of these guidelines were established based on the opinions of the Committee. To further optimize these guidelines, periodic revision in line with the new evidence is necessary.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takekuni Nakama
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Shigaku Ikeda
- Department of Dermatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daisuke Sawamura
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akiko Tanikawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Fujimoto
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Gangaputra SS, Newcomb CW, Joffe MM, Dreger K, Begum H, Artornsombudh P, Pujari SS, Daniel E, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Jabs DA, Nussenblatt RB, Rosenbaum JT, Levy-Clarke GA, Kempen JH. Comparison Between Methotrexate and Mycophenolate Mofetil Monotherapy for the Control of Noninfectious Ocular Inflammatory Diseases. Am J Ophthalmol 2019; 208:68-75. [PMID: 31344346 DOI: 10.1016/j.ajo.2019.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare mycophenolate mofetil (MMF) to methotrexate (MTX) as corticosteroid-sparing therapy for ocular inflammatory diseases. DESIGN Retrospective analysis of cohort study data. METHODS Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained via medical record review. The study included 352 patients who were taking single-agent immunosuppression with MTX or MMF at 4 tertiary uveitis clinics. Marginal structural models (MSM)-derived statistical weighting created a virtual population with covariates and censoring patterns balanced across alternative treatments. With this methodological approach, the results estimate what would have happened had none of the patients stopped their treatment. Survival analysis with stabilized MSM-derived weights simulated a clinical trial comparing MMF vs MTX for noninfectious inflammatory eye disorders. The primary outcome was complete control of inflammation on prednisone ≤10 mg/day, sustained for ≥30 days. RESULTS The time to success was shorter (more favorable) for MMF than MTX (hazard ratio = 0.68, 95% confidence interval: 0.46-0.99). Adjusting for covariates, the proportion achieving success was higher at every point in time for MMF than MTX from 2 to 8 months, then converges at 9 months. The onset of corticosteroid-sparing success took more than 3 months for most patients in both groups. Outcomes of treatment (MMF vs MTX) were similar across all anatomic sites of inflammation. The incidence of stopping therapy for toxicity was similar in both groups. CONCLUSIONS Our results suggest that, on average, MMF may be faster than MTX in achieving corticosteroid-sparing success in ocular inflammatory diseases.
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Affiliation(s)
- Sapna S Gangaputra
- Vanderbilt Eye Institute, Nashville, Tennessee, USA; Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Craig W Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marshall M Joffe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kurt Dreger
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hosne Begum
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pichaporn Artornsombudh
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Department of Ophthalmology, Somdech Phra Pinkloa Hospital, Royal Thai Navy, Bangkok, Thailand; Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | - Siddharth S Pujari
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Siddharth Netralaya, Belgaum, Karnataka, India
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA; Portland Veteran's Affairs Medical Center, Portland, Oregon, USA
| | - Jennifer E Thorne
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nirali P Bhatt
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Departments of Ophthalmology and Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA; Legacy Devers Eye Institute, Portland, Oregon, USA
| | | | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; MCM Eye Unit/Ophthalmology, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
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Gómez-Gómez A, García-González J, Peiteado D, Borrego-Sanz L, Arriola-Villalobos P, Esteban-Ortega M, Martín-López M, Ventura-Hidalgo M, Perez-Blazquez E, Pato E, Díaz-Valle D, Muñoz-Fernández S, Rodriguez-Rodriguez L. Inflammatory Relapses after Immunosuppressive Drug Discontinuation in Uveitis Patients: A Survival Analysis. Ocul Immunol Inflamm 2019; 29:376-387. [PMID: 31710514 DOI: 10.1080/09273948.2019.1681469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To estimate the incidence rate (IR) and identify risk factors associated to inflammatory relapse after immunosuppressive drug (ISD) discontinuation in noninfectious uveitis patients.Methods: Multicenter longitudinal retrospective study, including patients from four uveitis clinics followed-up until December 2018. Hazard ratios for different variables were estimated using multivariable Cox models.Results: 32 patients (34 episodes of ISD discontinuation) were analyzed (median and maximum follow-up time: 2.4 and 19.2 years, respectively). Fourteen patients presented at least one relapse: anterior (8 patients), intermediate (5) and posterior (8). IR (95% confidence interval) of the first relapse was 14.3 (8.6-23.8) episodes per 100 patient-years (median survival time: 4.8 years). Early use of ISDs, panuveitis, and higher oral corticosteroid dosage at discontinuation were associated with higher hazards of relapse in multivariable analysis.Conclusions: Relapse is a frequent and early event after ISD discontinuation. Identifying relapse risk factors could support the physician's decision regarding ISD discontinuation.
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Affiliation(s)
- Alejandro Gómez-Gómez
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Rheumatology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | - Diana Peiteado
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Lara Borrego-Sanz
- Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Mar Esteban-Ortega
- Ophthalmology Department, Hospital Universitario Infanta Sofía, Madrid, Spain.,Medicine Department, Universidad Europea, Madrid, Spain
| | - María Martín-López
- Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Esperanza Pato
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Luis Rodriguez-Rodriguez
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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Clavel G, Gabison E, Semerano L. Corneal and scleral involvement in inflammatory rheumatic disease: Rheumatologists and ophthalmologists exchanging views. Joint Bone Spine 2019; 86:699-705. [DOI: 10.1016/j.jbspin.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
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76
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Pleyer U, Pohlmann D, Kardeş E, Poddubnyy D, Rademacher J. Emerging drugs for the treatment of noninfectious uveitis. Expert Opin Emerg Drugs 2019; 24:173-190. [PMID: 31498689 DOI: 10.1080/14728214.2019.1663823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Uveitis is a leading cause of visual impairment and a significant burden of blindness. Although corticosteroids and conventional immunosuppressive agents have been successfully used, these are non-specific, and their long-term use may induce significant adverse effects. Areas covered: This article discusses existing local and systemic applied treatments for ocular inflammation including corticosteroids, non-biologic, and biologic disease-modifying anti-rheumatic drugs (DMARD). Potential drugs being studied in clinical trials are introduced for both local and systemic use. Expert opinion: Treatment options for uveitis continue to expand. Still, more efforts and research are needed to better understand the mechanisms potentially leading to clinical trials.
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Affiliation(s)
- Uwe Pleyer
- Department of Ophthalmology, Campus Virchow, Charité , Berlin , Germany
| | - Dominika Pohlmann
- Department of Ophthalmology, Campus Virchow, Charité , Berlin , Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Esra Kardeş
- Department of Ophthalmology, University of Health Sciences, Umraniye Training and Research Hospital , Istanbul , Turkey
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology , Berlin , Germany.,Epidemiology Unit, German Rheumatism Research Centre , Berlin , Germany
| | - Judith Rademacher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany.,Department of Gastroenterology, Infectiology and Rheumatology , Berlin , Germany
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Rathinam SR, Gonzales JA, Thundikandy R, Kanakath A, Murugan SB, Vedhanayaki R, Lim LL, Suhler EB, Al-Dhibi HA, Doan T, Keenan JD, Rao MM, Ebert CD, Nguyen HH, Kim E, Porco TC, Acharya NR. Effect of Corticosteroid-Sparing Treatment With Mycophenolate Mofetil vs Methotrexate on Inflammation in Patients With Uveitis: A Randomized Clinical Trial. JAMA 2019; 322:936-945. [PMID: 31503307 PMCID: PMC6737523 DOI: 10.1001/jama.2019.12618] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Methotrexate and mycophenolate mofetil are commonly used immunomodulatory therapies for achieving corticosteroid-sparing control of noninfectious uveitis, but there is uncertainty about which drug is more effective. OBJECTIVE To compare the effect of methotrexate and mycophenolate for achieving corticosteroid-sparing control of noninfectious intermediate uveitis, posterior uveitis, and panuveitis. DESIGN, SETTING, AND PARTICIPANTS The First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial screened 265 adults with noninfectious uveitis requiring corticosteroid-sparing immunosuppressive therapy from 9 referral eye centers in India, the United States, Australia, Saudi Arabia, and Mexico between August 22, 2013, and August 16, 2017. Follow-up ended on August 20, 2018. INTERVENTIONS Patients were randomized to receive oral methotrexate, 25 mg weekly (n = 107), or oral mycophenolate mofetil, 3 g daily (n = 109). MAIN OUTCOMES AND MEASURES The primary outcome was treatment success at 6 months, which was defined as having control of inflammation in both eyes, no more than 7.5 mg prednisone daily and less than or equal to 2 drops of prednisolone acetate 1%, and no treatment failure due to safety or intolerability. Patients underwent follow-up to 12 months while receiving the same treatment or switched to the other antimetabolite, depending on their 6-month outcome. RESULTS Among 216 patients who were randomized (median age, 38 years; 135 (62.5%) women), 194 (89.8%) completed follow-up through 6 months. Treatment success occurred in 64 (66.7%) patients in the methotrexate group vs 56 (57.1%) in the mycophenolate group (difference, 9.5% [95% CI, -5.3% to 21.8%]; odds ratio [OR], 1.50 [95% CI, 0.81 to 2.81]; P = .20). Among patients with posterior uveitis or panuveitis, treatment success was achieved in 58 (74.4%) in the methotrexate group vs 42 (55.3%) in the mycophenolate group (difference, 19.1% [95% CI, 3.6% to 30.6%]; OR, 2.35 [95% CI, 1.16 to 4.90]; P = .02); whereas among patients with intermediate uveitis treatment success occurred in 6 (33.3%) in the methotrexate group vs 14 (63.6%) in the mycophenolate group (difference, -30.3% [95% CI, -51.6% to 1.1%]; OR, 0.29 [95% CI, 0.08 to 1.05]; P = .07; P for interaction = .004). Elevated liver enzymes were the most common nonserious laboratory adverse event, occurring in 14 patients (13.0%) in the methotrexate group and 8 patients (7.4%) in the mycophenolate group. CONCLUSIONS AND RELEVANCE Among adults with noninfectious uveitis, the use of mycophenolate mofetil compared with methotrexate as first-line corticosteroid-sparing treatment did not result in superior control of inflammation. Further research is needed to determine if either drug is more effective based on the anatomical subtype of uveitis. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01829295.
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Affiliation(s)
- 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
- Department of Ophthalmology, University of California, San Francisco
| | - 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
| | - Lyndell L. Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Eric B. Suhler
- Casey Eye Institute, Portland, Oregon
- Oregon Health and Science University, Portland
- OHSU-PSU School of Public Health, and VA Portland 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
| | - Thuy Doan
- F. I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Jeremy D. Keenan
- F. I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Maya M. Rao
- F. I. Proctor Foundation, University of California, San Francisco
| | - Caleb D. Ebert
- F. I. Proctor Foundation, University of California, San Francisco
| | - Hieu H. Nguyen
- F. I. Proctor Foundation, University of California, San Francisco
| | - Eric Kim
- F. I. Proctor Foundation, University of California, San Francisco
| | - Travis C. Porco
- F. I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Nisha R. Acharya
- F. I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Lambert NG, Wilson DJ, Albert DM, Chamberlain WD. Intravitreal Methotrexate for Recurrent Epithelial Downgrowth. JAMA Ophthalmol 2019; 137:1082-1083. [PMID: 31246261 DOI: 10.1001/jamaophthalmol.2019.2151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nathan G Lambert
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Daniel M Albert
- Casey Eye Institute, Oregon Health & Science University, Portland
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McCartney M, McCluskey P, Zagora S. Intravitreal dexamethasone implants for non-infectious uveitis. Clin Exp Ophthalmol 2019; 47:1156-1163. [PMID: 31412151 DOI: 10.1111/ceo.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Inflammatory-mediated cystoid macular oedema (CMO) is the most common inflammatory-mediated threat to vision in non-infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained-release dexamethasone (DEX) implant devices provide localized therapy. BACKGROUND The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort. DESIGN A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital. PARTICIPANTS Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies. METHODS Cases from March 2012 and March 2018 were retrospectively selected with follow-up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow-up was 32 weeks. MAIN OUTCOME MEASURES The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure and medication regimens. RESULTS Ninety-five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P < .01). Sixty-one percent demonstrated improved BCVA at week 8 (P < .05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low. CONCLUSIONS AND RELEVANCE In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort.
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Affiliation(s)
- Matthew McCartney
- Department of General Surgery, St Vincent's Hospital, Sydney, Victoria, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sophia Zagora
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
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80
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Ridolo E, Kihlgren P, Pellicelli I, Nizi MC, Pucciarini F, Incorvaia C. Atopic Keratoconjunctivitis: Pharmacotherapy for the Elderly. Drugs Aging 2019; 36:581-588. [PMID: 31055787 DOI: 10.1007/s40266-019-00676-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Among the different forms of allergic conjunctivitis, atopic keratoconjunctivitis has distinct characteristics, defined by a more common onset in late adolescence or early adulthood, but also affecting the elderly, and with a higher prevalence in male individuals. However, the prevalence of atopic keratoconjunctivitis is scarcely investigated, and the data are often uncertain because other allergic nasal or respiratory disorders occur concomitantly. Mast cells, eosinophils, basophils, and T cells are involved in the pathogenesis of atopic keratoconjunctivitis. Despite its denomination as atopic, negative responses to skin tests or in-vitro immunoglobulin E tests are common. In fact, atopic keratoconjunctivitis can be attributed to a combination of T-helper-1 and T-helper-2 responses, but a higher prominence for T-helper-1 cells was found. The most common symptoms of atopic keratoconjunctivitis are bilateral ocular itching, burning, and tearing with a perennial presentation, although some patients may have seasonal exacerbations in winter or summer. Other symptoms such as photophobia, blurred vision, and mucous chewy discharge, owing to the accumulation of cells and mucin, may occur. The diagnosis of atopic keratoconjunctivitis is mainly clinical, as accepted diagnostic criteria or laboratory tests are not available. The treatment of atopic keratoconjunctivitis is aimed at controlling symptoms, decreasing relapse and exacerbations, and reducing vision loss. Therapeutic options comprise topical ophthalmic drops, including cromones, antihistamines, corticosteroids, and calcineurin inhibitors. Topical ointments are also available for corticosteroids and calcineurin inhibitors. Severe forms may require systemic medications including antihistamines, corticosteroids, and calcineurin inhibitors. Atopic keratoconjunctivitis therapy in the elderly does not differ from the adult population, but the occurrence of multi-morbidities and concomitant drug treatment, which are common in this age group, requires a careful evaluation to determine appropriate and personalized treatment.
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Affiliation(s)
- Erminia Ridolo
- Allergy and Clinical Immunology, Department of Medicine and Surgery, University of Parma, Via Gramsci n.14, 43126, Parma, Italy.
| | - P Kihlgren
- Allergy and Clinical Immunology, Department of Medicine and Surgery, University of Parma, Via Gramsci n.14, 43126, Parma, Italy
| | - I Pellicelli
- Allergy and Clinical Immunology, Department of Medicine and Surgery, University of Parma, Via Gramsci n.14, 43126, Parma, Italy
| | - M C Nizi
- Allergy and Clinical Immunology, Department of Medicine and Surgery, University of Parma, Via Gramsci n.14, 43126, Parma, Italy
| | - F Pucciarini
- Allergy and Clinical Immunology, Department of Medicine and Surgery, University of Parma, Via Gramsci n.14, 43126, Parma, Italy
| | - C Incorvaia
- Cardiac/Pulmonary Rehabilitation Unit, ASST Pini-CTO, Milan, Italy
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81
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Adán A, Moll-Udina A, Alba-Linero C, Figueroa-Vercellino JP, Llorenç V. Recent progress in the treatment of uveitic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1644168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Alfredo Adán
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Juan Pablo Figueroa-Vercellino
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
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Abstract
Medical registries and registry studies are frequently used for health services research as they represent a valuable means of capturing real-life data. Registry studies are particularly suitable for rare diseases for which epidemiological population-based or randomized controlled clinical studies are difficult. The are many examples of successful medical registries that have not only contributed to both epidemiological and clinical research, but which have also improved health service delivery. Only few ophthalmological medical registries are currently available. For non-infectious uveitis in children and adolescents with juvenile idiopathic arthritis (JIA), a rare disease entity, there is a need for data on, e.g., treatment, long-term outcomes, and risk factors for progression. The advantages for this disease of a registry with uveitis module from which numerous scientific publications and guidelines have been derived has been proven. Thus, we use the example of non-infectious uveitis to discuss the benefits of registries for other areas of ophthalmology.
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Affiliation(s)
- J Li
- Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland
| | - C Heinz
- Augenzentrum, St. Franziskus Krankenhaus Münster, Münster, Deutschland.,Universitäts-Augenklinik Essen-Duisburg, Essen, Deutschland
| | - R P Finger
- Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland.
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84
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Adelowo OO, Akpabio AA, Oderinlo O, Okonkwo ON, Raphael J. Case Series and Literature Review of Ophthalmologic Disorders Seen in a Specialist Rheumatology Clinic in Lagos, Nigeria. Ocul Immunol Inflamm 2019; 27:905-911. [PMID: 31314623 DOI: 10.1080/09273948.2019.1611873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: To highlight the pattern and treatment outcomes of ophthalmologic disorders referred to a private specialist rheumatology clinic. Methods: Retrospective review (January 2015-December 2016) of referrals from Eye Foundation Hospital, Lagos to Arthrimed Specialist Clinic, Lagos. Case records were retrieved and relevant information extracted. Ethical standards were observed. Results: Twenty-two referrals (35 eyes) were received out of 643 patients (3.4%) seen during the study period. The majority were female (63.6%) with mean age 48.9 ± 19.3 years and bilateral disease (59%). Diagnoses included uveitis (45.5%), optic neuritis (36.4%), non-specific autoimmune eye disease (9.1%), keratoconjunctivitis sicca (4.5%), and giant cell arteritis (4.5%). Treatment was with steroids and immunosuppressive agents. Fourteen patients improved (63.6%), five remained unchanged (22.7%), while three worsened (13.6%). Conclusions: Our patients were mostly fourth-decade females with bilateral disease. Uveitis was the commonest presentation, and two-thirds of the treated patients improved after treatment. Early specialist referral and co-management of severe autoimmune eye diseases are desirable.
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Affiliation(s)
- Olufemi O Adelowo
- Internal Medicine Department, Lagos State University Teaching Hospital , Ikeja , Lagos , Nigeria.,Arthrimed Specialist Clinic , Ikeja , Lagos , Nigeria
| | - Akpabio A Akpabio
- Internal Medicine Department, University of Uyo Teaching Hospital , Uyo , Akwa Ibom State , Nigeria
| | | | | | - John Raphael
- Internal Medicine Department, Delta State University Teaching Hospital , Oghara , Delta State , Nigeria
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85
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Touhami S, Diwo E, Sève P, Trad S, Bielefeld P, Sène D, Abad S, Brézin A, Quartier P, Koné Paut I, Weber M, Chiquet C, Errera MH, Sellam J, Cacoub P, Kaplanski G, Kodjikian L, Bodaghi B, Saadoun D. Expert opinion on the use of biological therapy in non-infectious uveitis. Expert Opin Biol Ther 2019; 19:477-490. [PMID: 30888881 DOI: 10.1080/14712598.2019.1595578] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Conventional immunosuppressive drugs, anti-TNF alpha treatments and biotherapies are increasingly being used in non-infectious uveitis. AREAS COVERED The present work was led by a multidisciplinary panel of experts, including internal medicine specialists, rheumatologists and ophthalmologists, and proposes an extensive review on the use of biological agents in non-infectious uveitis. EXPERT OPINION In case of dependency to steroids or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or biological therapies such as anti-TNF alpha treatments (adalimumab, infliximab) can be used to achieve and maintain disease quiescence. Interferon is an efficient immunomodulatory drug that can be proposed as second-line therapy in specific indications (eg. refractory macular edema, sight-threatening Behçet's uveitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (steroids, sirolimus etc.) can be used as adjuvant therapies in case of unilateral relapse. Therapeutic response must always be evaluated by clinical examination and appropriate ancillary investigations.
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Affiliation(s)
- Sara Touhami
- a Ophthalmology Department , DHU ViewRestore, Pitié Salpêtrière Hospital , Paris , France
| | - Eléonore Diwo
- a Ophthalmology Department , DHU ViewRestore, Pitié Salpêtrière Hospital , Paris , France
| | - Pascal Sève
- b Internal Medicine Department , Hôpital de la Croix-Rousse, Hospices Civils de Lyon , Lyon Cedex 04 , France.,c Faculté de Médecine Lyon-Sud , Université Claude Bernard-Lyon 1 , Lyon , France
| | - Salim Trad
- d Internal Medicine Department , Hôpital Ambroise Paré , Boulogne-Billancourt , France
| | - Philip Bielefeld
- e Internal Medicine and systemic diseases department (Médecine Interne 2) , Dijon University hospital , Dijon , France
| | - Damien Sène
- f Internal Medicine Department , Lariboisière Hospital , Paris , France.,g INSERM UMR , Paris Diderot University , Paris , France
| | - Sebastien Abad
- h Internal Medicine Department , Hopital Avicenne , Bobigny , France.,i Sorbonne Paris Cité, Faculté de Médecine SMBH , Université Paris 13 , Bobigny , France.,j Faculté de médecine , Université Paris 13, Sorbonne Paris Cité , Bobigny , France
| | - Antoine Brézin
- k Ophthalmology Department, Hôpital Cochin , Paris Descartes University , Paris , France
| | - Pierre Quartier
- l Unité d'Immunologie-Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants Malades , Paris-Descartes University, Institut IMAGINE, Centre de référence des maladies rhumatologiques inflammatoires et auto-immunes systémiques rares de l'enfant (RAISE) , Paris , France
| | - Isabelle Koné Paut
- m Paediatric Rheumatology Department , centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, Bicêtre Hospital , Le Kremlin-Bicêtre , France
| | - Michel Weber
- n Ophthalmology Department , Nantes University Hospital , Nantes , France
| | - Christophe Chiquet
- o Ophthalmology Department , Grenoble Alpes University Hospital , La Tronche , France
| | - Marie-Hélène Errera
- p Ophthalmology Department , Quinze-Vingts National Eye Hospital , Paris , France
| | - Jérémie Sellam
- q Rheumatology Department, Saint-Antoine Hospital, AP-HP, CRSA Inserm UMRS_938, DHU i2B , Sorbonne Université , Paris , France
| | - Patrice Cacoub
- r Inflammation-Immunopathology-Biotherapy Department (DHU i2B) , Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 , Paris , France.,s Inflammation-Immunopathology-BiotherapyDepartment , INSERM, UMR_S 959 , Paris , France.,t Inflammation-Immunopathology-BiotherapyDepartment , CNRS, FRE3632 , Paris , France.,u Department of Internal Medicine and Clinical Immunology, Centre national de référence des maladies autoimmunes systémiques rares, Centre national de référence des maladies autoinflammatoires et de l'amylose , AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
| | - Gilles Kaplanski
- v Internal Medicine and Clinical immunology Department, Hôpital de la Conception , Aix-Marseille Université , Marseille , France
| | - Laurent Kodjikian
- w Department of Ophthalmology , Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I , Lyon , France.,x CNRS UMR 5510 Mateis , France
| | - Bahram Bodaghi
- a Ophthalmology Department , DHU ViewRestore, Pitié Salpêtrière Hospital , Paris , France
| | - David Saadoun
- r Inflammation-Immunopathology-Biotherapy Department (DHU i2B) , Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 , Paris , France
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Biologics for the treatment of noninfectious uveitis: current concepts and emerging therapeutics. Curr Opin Ophthalmol 2019; 30:138-150. [PMID: 30844945 DOI: 10.1097/icu.0000000000000562] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW There is mounting evidence supporting the use of biologic therapeutics for the management of noninfectious uveitis (NIU). This review highlights: biologics with documented efficacy in NIU; agents with ongoing evaluation for efficacy in uveitis; and therapeutics for which investigation for efficacy in NIU is warranted. RECENT FINDINGS The tumor necrosis factor-alpha (TNF-α) inhibitor adalimumab has recently gained approval by the Food and Drug Administration for the treatment of noninfectious intermediate, posterior, and panuveitis. There is mounting evidence supporting the use of tocilizumab and rituximab in NIU. There is developing interest in evaluating the interleukin (IL)-23 inhibitors for efficacy in NIU. SUMMARY The TNF-α inhibitors adalimumab and infliximab have the greatest body of data supporting their use in NIU. These agents are considered second-line therapy for most forms of NIU but may be considered first-line therapy for uveitis associated with Behçet's disease and juvenile idiopathic arthritis. The B-cell inhibitor rituximab and the IL-6 inhibitor tocilizumab also have documented efficacy in NIU. Tocilizumab and interferon therapy may be particularly efficacious in the management of uveitic macular edema. The IL-23 inhibitors and janus kinase inhibitors are agents whose efficacy in NIU will likely be determined in the near future.
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Koronis S, Stavrakas P, Balidis M, Kozeis N, Tranos PG. Update in treatment of uveitic macular edema. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:667-680. [PMID: 30858697 PMCID: PMC6387597 DOI: 10.2147/dddt.s166092] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Macular edema (ME) represents the most common cause for visual loss among uveitis patients. The management of uveitic macular edema (UME) may be challenging, due to its often recalcitrant nature. Corticosteroids remain the mainstay of treatment, through their capability of effectively controlling inflammation and the associated ME. Topical steroids may be effective in milder cases of UME, particularly in edema associated with anterior uveitis. Posterior sub-Tenon and orbital floor steroids, as well as intravitreal steroids often induce rapid regression of UME, although this may be followed by recurrence of the pathology. Intra-vitreal corticosteroid implants provide sustained release of steroids facilitating regression of ME with less frequent injections. Topical nonsteroidal anti-inflammatory drugs may provide a safe alternative or adjuvant therapy to topical steroids in mild UME, predominantly in cases with underlying anterior uveitis. Immunomodulators including methotrexate, mycophenolate mofetil, tacrolimus, azathioprine, and cyclosporine, as well as biologic agents, notably the anti-tumor necrosis factor-α monoclonal antibodies adalimumab and infliximab, may accomplish the control of inflammation and associated ME in refractory cases, or enable the tapering of steroids. Newer biotherapies have demonstrated promising outcomes and may be considered in persisting cases of UME.
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Damodaran K, Sridharan S. Immunosuppressives and biologicals in uveitis: The way forward – Current concepts. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2019. [DOI: 10.4103/tjosr.tjosr_14_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Abbaszadeh Hasiri M, Baghaei Moghaddam E, Khalili MR, Hossein Amini A, Eghtedari M, Azizzadeh M, Razmi H. Intra-vitreal injection of methotrexate in experimental endotoxin-induced uveitis in rabbit. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2018; 9:315-321. [PMID: 30713609 PMCID: PMC6346491 DOI: 10.30466/vrf.2018.33110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/09/2018] [Indexed: 11/14/2022]
Abstract
Uveitis is a major cause of vision loss. Methotrexate (MTX) has been widely used in uveitis due to its relatively safe profile. The purpose of this study was to evaluate the effects of two different dosages of MTX via intra-vitreal administration for treatment of endotoxin induced uveitis (EIU) in an experimental model. Thirty-five healthy rabbits were randomly divided into four groups and all animals were tolerated intra-vitreal injections. The first group received normal saline (NS), the second group received normal saline plus Salmonella typhimurium lipopolysaccharide endotoxin (LPS), (NS+LPS), the third group received 400 μg MTX plus LPS (LPS+MTX 400) and the fourth group received 800 μg MTX plus LPS (LPS+MTX 800). Intra-ocular inflammation was evaluated by clinical examination scoring during 7 post-injection days and histopathological examination at the end of study. Kruskal-Wallis and Mann-Whitney U tests were used to compare the histopathological and clinical scores. According to the clinical examinations, all groups demonstrated higher uveitis score than group 1 on first post-injection day. Also, groups 2 and 3 showed greater uveitis score than group 4. On the third, fifth and seventh post-injection days, clinical uveitis score in groups 2, 3 and 4 was significantly higher than group 1. The mean histopathological inflammation intensity scores in groups 2, 3 and 4 were significantly higher than group 1. Single intra-vitreal injection of 400 μg and 800 μg of MTX did not show significant anti-inflammatory effects on EIU in rabbits.
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Affiliation(s)
| | - Effat Baghaei Moghaddam
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Hossein Amini
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Masoomeh Eghtedari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Azizzadeh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Hooman Razmi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
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90
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Ocular features of the HLA-B27-positive seronegative spondyloarthropathies. Curr Opin Ophthalmol 2018; 29:552-557. [DOI: 10.1097/icu.0000000000000525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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91
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The Management of Acute Anterior Uveitis Complicating Spondyloarthritis: Present and Future. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9460187. [PMID: 30406148 PMCID: PMC6204187 DOI: 10.1155/2018/9460187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/05/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022]
Abstract
Spondyloarthropathies (SpA) encompass a group of chronic inflammatory diseases sharing common genetic and clinical features, including the association with HLA-B27 antigen, the involvement of both the axial and the peripheral skeleton, the presence of dactylitis, enthesitis, and typical extra-articular manifestations such as psoriasis, inflammatory bowel disease, and acute anterior uveitis (AAU). The latter is commonly reported as a noninfectious acute inflammation of the anterior uveal tract and its adjacent structures. AAU may affect more than 20% of SpA patients representing the most common extra-articular manifestation of the disease. Considering the potential consequences of untreated AAU, early diagnosis and aggressive treatment are crucial to avoid complications of remittent or chronic eye inflammation, such as visual loss and blindness. The management of SpA has dramatically improved over the last decades due to the development of new treat-to-target strategies and to the introduction of biologic disease modifying antirheumatic drugs (bDMARDs), particularly tumor necrosis factor alpha inhibitors (TNFis), currently used for the treatment of nonresponder patients to conventional synthetic agents. Along with the improvement of musculoskeletal features of SpA, bDMARDs provided an additional effect also in the management of AAU in those patients who are failures to topical and systemic conventional therapies. Nowadays, five TNFis, one interleukin-17, and one interleukin 12/23 blocker are licensed for the treatment of SpA, with different proven efficacy in preventing and treating ocular involvement. The aim of this review is to summarize the current options and to analyze the future perspectives for the management of SpA-associated AAU.
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92
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Ruiz-Medrano J, Díaz-Valle D, Cuiña R, Gegúndez J, Chhablani J, Majumder P, Gutierrez-Bonet R. The role of tocilizumab in the treatment of inflammatory diseases of the eye and orbit: A useful alternative. J Fr Ophtalmol 2018; 41:759-766. [DOI: 10.1016/j.jfo.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 01/18/2018] [Accepted: 02/16/2018] [Indexed: 12/20/2022]
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93
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Smith JR, David LL, Appukuttan B, Wilmarth PA. Angiogenic and Immunologic Proteins Identified by Deep Proteomic Profiling of Human Retinal and Choroidal Vascular Endothelial Cells: Potential Targets for New Biologic Drugs. Am J Ophthalmol 2018; 193:197-229. [PMID: 29559410 PMCID: PMC6109601 DOI: 10.1016/j.ajo.2018.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Diseases that involve retinal or choroidal vascular endothelial cells are leading causes of vision loss: age-related macular degeneration, retinal ischemic vasculopathies, and noninfectious posterior uveitis. Proteins differentially expressed by these endothelial cell populations are potential drug targets. We used deep proteomic profiling to define the molecular phenotype of human retinal and choroidal endothelial cells at the protein level. METHODS Retinal and choroidal vascular endothelial cells were separately isolated from 5 human eye pairs by selection on CD31. Total protein was extracted and digested, and peptide fractions were analyzed by reverse-phase liquid chromatography tandem mass spectrometry. Peptide sequences were assigned to fragment ion spectra, and proteins were inferred from openly accessible protein databases. Protein abundance was determined by spectral counting. Publicly available software packages were used to identify proteins that were differentially expressed between human retinal and choroidal endothelial cells, and to classify proteins that were highly abundant in each endothelial cell population. RESULTS Human retinal and/or choroidal vascular endothelial cells expressed 5042 nonredundant proteins. Setting the differential expression false discovery rate at 0.05, 498 proteins of 3454 quantifiable proteins (14.4%) with minimum mean spectral counts of 2.5 were differentially abundant in the 2 cell populations. Retinal and choroidal endothelial cells were enriched in angiogenic proteins, and retinal endothelial cells were also enriched in immunologic proteins. CONCLUSIONS This work describes the different protein expression profiles of human retinal and choroidal vascular endothelial cells, and provides multiple candidates for further study as novel treatments or drug targets for posterior eye diseases. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Justine R Smith
- Flinders University, Adelaide, Australia; Oregon Health & Science University, Portland, Oregon, USA.
| | - Larry L David
- Flinders University, Adelaide, Australia; Oregon Health & Science University, Portland, Oregon, USA
| | - Binoy Appukuttan
- Flinders University, Adelaide, Australia; Oregon Health & Science University, Portland, Oregon, USA
| | - Phillip A Wilmarth
- Flinders University, Adelaide, Australia; Oregon Health & Science University, Portland, Oregon, USA
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94
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LaMattina KC, Escott SM, Malalis JF, Mai D, Harada Y, Goldstein DA. The Influence of Race and Sex on the Side Effect Profile of Methotrexate in the Treatment of Uveitis. Ocul Immunol Inflamm 2018; 27:1160-1164. [DOI: 10.1080/09273948.2018.1498905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kara C. LaMattina
- Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sarah M. Escott
- Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia F. Malalis
- Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Mai
- Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Debra A. Goldstein
- Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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95
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Cann M, Ramanan AV, Crawford A, Dick AD, Clarke SLN, Rashed F, Guly CM. Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J 2018; 16:51. [PMID: 30081917 PMCID: PMC6080499 DOI: 10.1186/s12969-018-0266-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is a paucity of data on the ocular outcomes in paediatric non-infectious uveitis since the introduction of the biologic agents. The purpose of this study was to outline the clinical characteristics of children with non-infectious uveitis and determine the visual outcomes and ocular complication rates in the modern era. METHODS Children with non-infectious uveitis from January 2011 to December 2015 were identified. Data was collected at baseline, 1, 3, 5, and 10 years post diagnosis. The incidence rates of visual impairment, structural ocular complications and surgical intervention were calculated. Using logistic regression the association between various baseline characteristics and later visual impairment was investigated. RESULTS Of the 166 children, 60.2% (n = 100) had a systemic disease association. 72.9% (n = 121) children received methotrexate, 58 children progressed to a biologic. The incidence rates of visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60) were 0.05/Eye Year (EY) and 0.01/EY, respectively. Visual outcomes in the Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) and Idiopathic Uveitis cohorts were not statistically significant. Of the 293 affected eyes, posterior synechiae was the predominant complication on presentation, while cataract had the highest incidence rate (0.05/EY). On direct comparison, children with JIA-U were statistically significantly more likely to develop glaucoma while children with Idiopathic Uveitis were statistically significantly more likely to develop macular oedema. CONCLUSION One third of children received a biological therapy, reflecting increasing utilisation and importance of biological agents in the management of inflammatory conditions. Rates of visual impairment and ocular complications are an improvement on previously published data.
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Affiliation(s)
- Megan Cann
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Athimalaipet V. Ramanan
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK
| | - Andrew Crawford
- 0000 0004 1936 7988grid.4305.2BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK ,0000 0004 1936 7603grid.5337.2MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Andrew D. Dick
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfield Eye Hospital, London, UK ,0000000121901201grid.83440.3bUniversity College London Institute of Ophthalmology, London, UK
| | - Sarah L. N. Clarke
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,0000 0004 1936 7603grid.5337.2MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Fatima Rashed
- Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK
| | - Catherine M. Guly
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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96
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Zu Hoerste MM, Walscheid K, Tappeiner C, Zurek-Imhoff B, Heinz C, Heiligenhaus A. The effect of methotrexate and sulfasalazine on the course of HLA-B27-positive anterior uveitis: results from a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 2018; 256:1985-1992. [PMID: 30069748 DOI: 10.1007/s00417-018-4082-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/05/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate the effect of methotrexate (MTX) or sulfasalazine (SSZ) on the course of HLA-B27-positive, remitting acute anterior uveitis (AAU). METHODS Forty-six patients with HLA-B27-positive AAU with or without associated systemic rheumatic disease either receiving MTX (n = 20), SSZ (n = 13), or no systemic immunomodulating treatment (Ctrl; n = 13) were studied retrospectively. Best-corrected visual acuity (BCVA), AAU relapse rate, and occurrence of uveitis-related ocular complications were analyzed at baseline (BL) and at 12-month follow-up (FU). RESULTS Groups did not differ regarding age, gender, and presence of associated systemic diseases. BCVA at baseline was significantly worse in patients receiving MTX (logMAR 0.39 ± 0.4) than in those treated with SSZ (0.17 ± 0.2; P = 0.05) or in controls (Ctrl; 0.14 ± 0.2; P = 0.009). At the 12-month endpoint, MTX treatment was associated with significantly improved BCVA (0.18 ± 0.4 logMAR; P = 0.004). In contrast, BCVA did not significantly change in patients treated with SSZ (0.17 ± 0.3 logMAR) or in the controls (0.11 ± 0.2 logMAR). The annual uveitis relapse rate significantly decreased with MTX (BL 3.6 ± 2.4 relapses to FU 0.7 ± 0.8; P = 0.0001) and SSZ (BL 3.6 ± 1.9 to FU 1.8 ± 2.4, P < 0.01), but not in the controls (BL 1.9 ± 1.4 vs 1.9 ± 1.7 FU). The complication rate was slightly reduced with MTX (BL 1.75 ± 1.2 complications present versus FU 1.3 ± 1.2, P = 0.09) but not with SSZ (BL 0.9 ± 0.8 to FU 1.3 ± 1.4; P = 0.4) or in the controls (BL and FU 1.0 ± 0.95; P = 0.7). CONCLUSIONS MTX and SSZ reduced the uveitis relapse rate in HLA-B27-positive AAU patients, with MTX showing a beneficial effect on AAU-related macular edema.
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Affiliation(s)
- Melissa Meyer Zu Hoerste
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany
| | - Karoline Walscheid
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beatrix Zurek-Imhoff
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany
| | - Carsten Heinz
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.,University of Duisburg-Essen, Duisburg, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.,University of Duisburg-Essen, Duisburg, Germany
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97
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Shahab MA, Mir TA, Zafar S. Optimising drug therapy for non-infectious uveitis. Int Ophthalmol 2018; 39:1633-1650. [PMID: 29961190 DOI: 10.1007/s10792-018-0984-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Uveitis encompasses a wide variety of sight-threatening diseases characterized by intraocular inflammation. It is often classified as infectious and non-infectious uveitis. Unlike infectious uveitis, a distinct infectious agent cannot be identified in non-infectious uveitis and disease origin is usually autoimmune, drug related, or idiopathic. THE ISSUE AT HAND Non-infectious uveitis can often have a relapsing-remitting course, making it difficult to treat, and poses a significant challenge to ophthalmologists. The autoimmune nature of non-infectious uveitis warrants the use of anti-inflammatory and immunomodulatory agents for disease control. However, a subset of patients has persistent or recurrent ocular inflammation despite appropriate treatment, stressing the need for newer therapies aimed at more specific inflammatory targets such as tumour necrosis factor (TNF) alpha agents, anti-interleukin agents, and anti-interleukin receptor agents. OBJECTIVES This article discusses the various medical options available for the treatment of non-infectious uveitis in the light of the most recent evidence. CONCLUSION Successful management of non-infectious uveitis requires the clinician carefully balance advantages and disadvantages of each new and old therapy while considering individual circumstances. Counselling regarding the benefits and complications of each therapy can help patients make an informed choice.
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98
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LONG-TERM OUTCOMES OF RITUXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS POSTERIOR UVEITIS REFRACTORY TO CONVENTIONAL IMMUNOSUPPRESSIVE THERAPY. Retina 2018; 38:395-402. [PMID: 28225369 DOI: 10.1097/iae.0000000000001563] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess long-term effectiveness of rituximab therapy for refractory noninfectious uveitis affecting the posterior segment. METHODS Retrospective case series. Patients diagnosed with recalcitrant noninfectious posterior uveitis who were treated with rituximab intravenous infusions between 2010 and 2015 were included. Patients underwent best-corrected visual acuity testing and fluorescein angiography evidence of disk or vascular staining at 6, 12, 18, and 24 months. Patients had at least 24 months of follow-up. RESULTS Eleven patients (21 eyes) with refractory posterior uveitis treated with intravenous rituximab were included. Nine (81.8%) patients were female. Mean follow-up was 29.3 ± 7.8 months. rituximab was administered as complementary therapy because of previous inefficacy of other therapies in 7 (63.7%) patients, and it was the only treatment in four (36.3%) patients who did not tolerate other drugs. Inflammation signs by fluorescein angiography were controlled in nine (81.8%) patients at the end of follow-up. Baseline best-corrected visual acuity was 20/80 (logarithm of the minimal angle of resolution 0.6 ± 0.4), and final best-corrected visual acuity was 20/40 (0.3 ± 0.5) (P = 0.005). No significant side effects were reported. CONCLUSION Rituximab therapy was associated with stability and remission of recalcitrant noninfectious posterior uveitis in patients who did not tolerate or did not respond to other therapies.
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99
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Diwo E, Sève P, Trad S, Bielefeld P, Sène D, Abad S, Brézin A, Quartier P, Koné Paut I, Weber M, Chiquet C, Errera MH, Sellam J, Cacoub P, Kaplanski G, Kodjikian L, Bodaghi B, Saadoun D. [Therapeutic strategy for the treatment of non-infectious uveitis proposed by an expert panel]. Rev Med Interne 2018; 39:687-698. [PMID: 29610003 DOI: 10.1016/j.revmed.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/01/2018] [Indexed: 02/07/2023]
Abstract
Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).
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Affiliation(s)
- E Diwo
- Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Faculté de médecine Lyon-Sud, université Claude Bernard-Lyon 1, France
| | - S Trad
- Service de médecine interne, hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | - P Bielefeld
- Internal medicine and systemic diseases department, médecine interne 2, university hospital Dijon Bourgogne, France; Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - D Sène
- Internal medicine department, Lariboisière hospital, AP-HP, Paris, France; Inserm UMR 1149, Paris Diderot university, Paris, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - A Brézin
- Service d'ophtalmologie, hôpital Cochin, université Paris Descartes, Paris, France
| | - P Quartier
- Unité d'immunologie-hématologie et rhumatologie pédiatriques, institut IMAGINE, centre de référence des maladies rhumatologiques inflammatoires et autoimmunes systémiques rares de l'enfant (RAISE), université Paris-Descartes university, hôpital Necker-Enfants-Malades, Assistance publique Hôpitaux de Paris, Paris, France
| | - I Koné Paut
- Paediatric rheumatology department, centre de références des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, university of Paris Sud, Bicêtre hospital, AP-HP, Paris, France
| | - M Weber
- Department of ophthalmology, Nantes university, Nantes university hospital, Nantes, France
| | - C Chiquet
- Department of ophthalmology, Grenoble-Alpes university, Grenoble Alpes university hospital, Grenoble, France
| | - M H Errera
- Department of ophthalmology at Quinze-Vingts National Eye Hospital and DHU Sight Restore, Paris, France; Sorbonne universities, UPMC université Paris 06, Paris, France
| | - J Sellam
- Service de rhumatologie, CRSA Inserm UMRS_938, DHU i2B, hôpital Saint-Antoine, Sorbonne Université, AP-HP, France
| | - P Cacoub
- Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France
| | - G Kaplanski
- Service de médecine interne et immunologie clinique, Aix-Marseille université, hôpital de la conception, 147, boulevard Baille, 1305 Marseille, France
| | - L Kodjikian
- Department of ophthalmology, Croix-Rousse university hospital, Hospices Civils de Lyon, university of Lyon I, 69004 Lyon, France; CNRS UMR 5510 Mateis, 69621 Villeurbanne, France
| | - B Bodaghi
- Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France.
| | - D Saadoun
- Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France.
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100
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Bielefeld P, Saadoun D, Héron E, Abad S, Devilliers H, Deschasse C, Trad S, Sène D, Kaplanski G, Sève P. [Scleritis and systemic diseases: What should know the internist?]. Rev Med Interne 2018; 39:711-720. [PMID: 29496270 DOI: 10.1016/j.revmed.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/02/2018] [Indexed: 12/27/2022]
Abstract
Scleritis is an inflammatory disease of the sclera; outer tunic of the eye on which the oculomotor muscles are inserted. It can be associated with a systemic disease up to one time out of 3. These associated diseases are mainly rheumatoid arthritis, vasculitis, including granulomatosis with polyangiitis in the first line and spondyloarthropathies. Before mentioning such an etiology, it is necessary to eliminate an infectious cause, mainly herpetic, which is regularly underestimated. The classification of scleritis is clinical. We distinguish between anterior scleritis and posterior scleritis. Anterior scleritis is diffuse or nodular, usually of good prognosis. Anterior necrotizing scleritis with inflammation is often associated with an autoimmune disease, necrotizing scleritis without inflammation usually reflects advanced rheumatoid arthritis. The treatment of these conditions requires close collaboration between internists and ophthalmologists to decide on the use of corticosteroid therapy with or without immunosuppressors or biotherapies.
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Affiliation(s)
- P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - D Saadoun
- Service de médecine interne, DHU I2B, inflammation, immunopathology, biotherapy, centre national de référence des maladies auto-immunes et systémiques rares, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie-Paris 6, AP-HP, 75013 Paris, France.
| | - E Héron
- Service de médecine interne, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex 12, France.
| | - S Abad
- Service de médecine interne, hôpital Avicenne, AP-HP, université Paris 13, Sorbonne Paris Cité, 93009 Bobigny cedex, France.
| | - H Devilliers
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - C Deschasse
- Service d'ophtalmologie, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, université de Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
| | - D Sène
- Service de médecine interne, GH Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisère, AP-HP, université Sorbonne Paris Cité Paris Diderot, 75475 Paris cedex 10, France.
| | - G Kaplanski
- Service de médecine interne et immunologie clinique, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, 69100 Lyon, France.
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