Bone marrow sarcoidosis associated with long-term interferon-β treatment for multiple sclerosis

The Effect of Prostaglandin Analogs on Central Corneal Thickness of Patients with Glaucoma or Ocular Hypertension: A Systematic Review

BACKGROUND

Prostaglandin analogs (PGAs) are first-line antiglaucoma agents that appear to either decrease or increase central cornea thickness (CCT), creating controversy regarding the benefits of PGAs in treating CCT.

PURPOSE

We performed the first meta-analysis of observational studies to evaluate the effects of PGAs on CCT in patients with glaucoma or ocular hypertension (OHT).

METHODS

This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A literature search was performed of the PubMed, Embase, Cochrane Library, System for Information on Grey Literature in Europe (Open Grey), and ClinicalTrials.gov databases and the references of retrieved studies. Only observational studies were included in the meta-analysis. The final CCT of patients and 95% confidence interval (CI) of each study were extracted. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ). A fixed-effects model was used to calculate the weighted mean difference (WMD) and 95% CI. Subgroup analyses based on several stratified factors such as public bias (Begg's test) and sensitivity analyses were performed.

RESULTS

Five cohort, 5 case-control, and three cross-sectional studies including 2,722 subjects were included. The pooled effect of all thirteen studies showed that PGAs reduced the CCT of patients with glaucoma or OHT slightly but significantly (WMD = -9.37; 95% CI [-12.18, -6.57]; p = 0.00; I2 = 45.5%). Significant effects were also observed in all three study designs: cohort (WMD = -5.17; 95% CI [-9.52, -0.82]), case-control (WMD = -15.31; 95% CI [-22.66, -7.97]), and cross-sectional (WMD = -8.65; 95% CI [-17.30, -0.01]). In addition, subgroup analysis of exposure time showed the effect of PGAs to be more obvious in the first (WMD = -5.81; 95% CI [-9.49, -2.14]) and second (WMD = -13.73; 95% CI [-20.19, -7.28]) years.

CONCLUSIONS

The pooled effects of previously reported studies suggest that PGA use can reduce the CCT of patients with glaucoma or OHT slightly but significantly, with this effect more pronounced in the first 2 years. These findings suggest that clinicians must closely monitor changes in CCT in the first 2 years of PGA use to identify cases of intraocular pressure misestimation and the efficacy of PGAs.

An update on the diagnosis and management of ocular sarcoidosis

PURPOSE OF REVIEW

Ocular sarcoidosis is one of the most common causes of uveitis worldwide. The diagnosis and treatment of patients with ocular sarcoidosis remains challenging in some cases. It is important for clinicians to keep up to date with new diagnostic and treatment tools for this disease.

RECENT FINDINGS

The International Workshop on Ocular Sarcoidosis diagnostic criteria were first proposed in 2009 and revised in 2017. The new criteria contained two parts: ocular presentation and systemic investigation. The diagnostic value of liver enzymes was reduced in the new criteria, whereas the value placed of lymphopenia and the CD4/CD8 ratio in bronchoalveolar lavage fluid were increased. Despite not being included in the criteria, recent studies have also highlighted the diagnostic value of serum soluble interleukin-2 receptors. Recent ophthalmologic imaging also provides useful insights for the differential diagnosis.Many new treatments for ocular sarcoidosis have been developed in recent years. The introduction of biological immunomodulatory agents for uveitis treatment represents a big improvement. Antitumor necrosis factor-alpha antibodies, including adalimumab, have been proven to be effective for treating ocular sarcoidosis. Many studies have also suggested that other biological agents could be effective and well tolerated. Newer intravitreal dexamethasone and fluocinolone implants have been developed. Patients treated with these implants have experienced good and sustained control of their intraocular inflammation.

SUMMARY

Diagnosis and treatment options for ocular sarcoidosis have changed over time. However, challenges still exist in some difficult patients. Future studies should focus on finding more sensitive biomarkers and developing more effective immunomodulatory treatments with longer efficacy and less side effects.

The influence of topical non-steroidal anti-inflammatory drugs on the intraocular pressure lowering effect of topical prostaglandin analogues-A systemic review and meta-analysis

PURPOSE

This study aimed to review previous articles and evaluate the influence of topical non-steroidal anti-inflammatory drugs (NSAIDs) on intraocular pressure (IOP) in glaucoma patients who were treated with prostaglandin analogues (PGs).

METHOD

The presenting study was designed as a meta-analysis of previous research. Databases include PubMed, Web of science, Cochrane library, and Embase were searched with keywords of "intraocular pressure, prostaglandin analogues, NSAIDs, latanoprost, travoprost, bimatoprost, tafluprost, unoprostone, latanoprostene bunod, ketorolac, diclofenac, nepafenac, bromfenac, flurbiprofen". Inclusion criteria were: 1. Study population were glaucoma patients; 2. Comparison between PGs monotherapy and PGs in combination with topical NSAIDs; 3. Changes of IOP as final outcomes. Studies with non-randomized design, treatments combining other anti-glaucomatous drugs, or unavailable absolute IOP were excluded from the analysis. Estimated difference in IOP were calculated using STATA 14.0.

RESULT

Seven studies were retrieved for this meta-analysis. Since there is a significant heterogeneity (I2 = 94%) in these studies, random-effect model was used to calculate pooled standardized mean differences (SMD). Our results showed a significantly favorable IOP lowering effect in glaucoma patients treated with combination of topical NSAIDs and PGEs (SMD: 1.3 and -0.03, 95% CI: 0.29 to 2.38 and -0.32 to 0.26, Z = 2.50 and 0.23, p = 0.013 and 0.820, respectively).

CONCLUSION

Results of our meta-analysis suggested that topical NSAIDs may enhance the IOP lowering effect of topical PGs in glaucoma patients.

Acute sarcoidosis in a multiple sclerosis patient after alemtuzumab treatment

Background:

Understanding the long-term effect of alemtuzumab on the immune system of multiple sclerosis (MS) patients is crucial.

Objective:

To report a case of acute sarcoidosis (Löfgren’s syndrome) in a relapsing-remitting MS patient, 1.5 years after the second course of alemtuzumab treatment.

Case report:

Sarcoidosis was confirmed dermatohistologically, radiologically, and serologically. Analysis of the lymphocyte subpopulations showed a persistent effect of alemtuzumab treatment (CD4/CD8 ratio increased, absolute lymphocyte count of CD19-positive cells increased while CD3/4/8-positive cells were decreased).

Conclusion:

Our case highlights the profound effect of alemtuzumab on the immune system and its possible risk for autoimmune complications.

Sarcoidosis and colon cancer: a possible association

Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas which mainly affect the pulmonary lymphatic system and lungs; although any organs can be interested. The association between sarcoidosis and cancer is still controversial, but many studies demonstrated an increased risk of cancer in patients with sarcoidosis, whereas few cases of sarcoidosis occurring after cancer have been reported. This report outlines and describes clinical, biologic and radiologic features of 3 patients with a history of surgical treatment and adjuvant chemotherapy for colon cancer, followed by a diagnosis of sarcoidosis some years later. The history of cancer and the lymph nodes positivity found through PET scan induced us to hypothesize a relapsing cancer disease. However, this hypothesis was not confirmed by the lymph nodes biopsy, which is the core method of diagnosis of sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 376-380).