1
|
Pato-Cour E, Borrego-Sanz L, Domínguez-Álvaro M, Sánchez-Alonso F, Rodríguez-González F, Tejera-Santana M, Esteban-Ortega M, García-Lozano I, Martínez-Costa L, González-Ocampo S, Sainz-de-la-Maza M, Moll-Udina A, Plaza Z, Fonollosa A, Artaraz J, Díaz-Valle T, Gurrea-Almela M, Díaz-Valle D, Méndez-Fernández R. Interobserver Reliability and Sensitivity to Change of a Composite Ocular Inflammatory Activity Index: UVEDAI ©. Ophthalmol Ther 2024; 13:1669-1682. [PMID: 38635137 PMCID: PMC11109075 DOI: 10.1007/s40123-024-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION This was a multicenter, prospective, longitudinal, observational study involving eight Spanish tertiary hospitals to determine the interobserver reliability of an uveitis disease activity index, (UVEDAI) and assess its sensitivity to change in patients with receiving pharmacologic treatment. METHODS Patients aged ≥ 18 years diagnosed with active noninfectious uveitis were included. A complete baseline assessment was performed by two ophthalmologists who determined ocular inflammatory activity using the UVEDAI index independently of each other. The principal ophthalmologist made a new visit at 4 weeks to determine the change in inflammatory activity. The interobserver reliability analysis was performed by calculating the intraclass correlation coefficient (ICC), with the values of the variables and the UVEDAI obtained by both ophthalmologists in the more active eye at the baseline visit. Sensitivity to change in the UVEDAI index was assessed at 4 weeks from the start of pharmacologic treatment by determining the clinically relevant change, defined as a change in UVEDAI of ≥ 0.8 points over baseline. The mean change between both measures was compared using the repeated-measures t-test. RESULTS A total of 111 patients were included. In the interobserver reliability analysis, the ICC for the UVEDAI value was 0.9, and, when compared with the mean UVEDAI values obtained by the ophthalmologists, no statistically significant differences were found (p value > 0.05). As for the sensitivity to change in UVEDAI, statistically significant differences (p value = 0.00) were found for the mean values of the index compared with baseline. In all cases, the index value decreased by > 1 point at the 4-week visit. CONCLUSIONS The interobserver reliability of the UVEDAI was high in the total sample. Furthermore, the index was sensitive in determining the change in inflammatory activity after treatment. We believe that UVEDAI is a disease activity index that enables objective comparison of results in clinical practice and trials.
Collapse
Affiliation(s)
- Esperanza Pato-Cour
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.
| | - Lara Borrego-Sanz
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Marta Tejera-Santana
- Ophthalmology Department, Hospital de Gran Canaria Doctor Negrin, Gran Canaria, Spain
| | - Mar Esteban-Ortega
- Ophthalmology Department, Hospital Universitario Infanta Sofia, Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | - Aina Moll-Udina
- Ophthalmology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Zulema Plaza
- Research Unit of Spanish Society of Rheumatology, Madrid, Spain
| | - Alejandro Fonollosa
- Ophthalmology Department, BioCruces-Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Joseba Artaraz
- Ophthalmology Department, BioCruces-Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Teresa Díaz-Valle
- Ophthalmology Department, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Maria Gurrea-Almela
- Ophthalmology Department, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosalía Méndez-Fernández
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
2
|
Validation of UVEDAI: An Index for Evaluating the Level of Inflammatory Activity in Uveitis. Ophthalmol Ther 2023; 12:1045-1055. [PMID: 36683123 PMCID: PMC10011271 DOI: 10.1007/s40123-023-00654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/11/2023] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Uveitis is the inflammation of the middle layer of the eye, the uvea, and is a major cause of blindness. None of the instruments used in clinical practice are, in themselves, sufficient to evaluate the course of uveitis. Therefore, it is necessary to develop instruments enabling standardized measurement of inflammatory activity. We developed a composite disease activity index for patients with uveitis known as UVEDAI, which considers the overall activity of the eye. The objective of this study was to validate the composite index of ocular inflammation, UVEDAI. METHODS A multicenter cross-sectional study involving eight Spanish tertiary hospitals. Sixty-two patients aged ≥ 18 years with acute uveitis were recruited. Participants gave informed consent before participating in the study. A full ophthalmological examination was performed by two ophthalmologists to determine inflammatory activity: one used the UVEDAI score and the other used clinical judgment. The ophthalmologists did not share their findings with each other to avoid introducing bias into the analysis. Construct validity was established by means of factor analysis. The criterion validity of the index was determined using an ordinal multivariate regression model, in which the dependent variable was the degree of uveal inflammation (mild, moderate, or high/severe). Cut-off points were determined for the UVEDAI and for the receiver operating characteristic (ROC) curves. RESULTS Sixty-two patients were included. Total variance with the three components accounted for 80.32% of the construct validity. Each of the three components identified one type of eye involvement. The discriminatory capacity of UVEDAI was 0.867 (95% CI 0.778; 0.955 p < 0.001) for mild versus moderate-high and 0.946 (95% CI 0.879; 1.000 p < 0.001) for high versus mild-moderate. CONCLUSIONS The variables included in UVEDAI enable ocular inflammatory activity to be described with a high degree of accuracy. The index may be used to evaluate and classify this activity with considerable discriminatory power.
Collapse
|
3
|
Abstract
PURPOSE Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible. METHODS A comprehensive literature review of SO and globe rupture was performed. RESULTS SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. CONCLUSION Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.
Collapse
|
4
|
Chen YC, Gad SF, Chobisa D, Li Y, Yeo Y. Local drug delivery systems for inflammatory diseases: Status quo, challenges, and opportunities. J Control Release 2021; 330:438-460. [PMID: 33352244 DOI: 10.1016/j.jconrel.2020.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
Inflammation that is not resolved in due course becomes a chronic disease. The treatment of chronic inflammatory diseases involves a long-term use of anti-inflammatory drugs such as corticosteroids and nonsteroidal anti-inflammatory drugs, often accompanied by dose-dependent side effects. Local drug delivery systems have been widely explored to reduce their off-target side effects and the medication frequency, with several products making to the market or in development over the years. However, numerous challenges remain, and drug delivery technology is underutilized in some applications. This review showcases local drug delivery systems in different inflammatory diseases, including the targets well-known to drug delivery scientists (e.g., joints, eyes, and teeth) and other applications with untapped opportunities (e.g., sinus, bladder, and colon). In each section, we start with a brief description of the disease and commonly used therapy, introduce local drug delivery systems currently on the market or in the development stage, focusing on polymeric systems, and discuss the remaining challenges and opportunities in future product development.
Collapse
Affiliation(s)
- Yun-Chu Chen
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Sheryhan F Gad
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Dhawal Chobisa
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Integrated product development organization, Innovation plaza, Dr. Reddy's Laboratories, Hyderabad 500090, India
| | - Yongzhe Li
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning 110016, PR China
| | - Yoon Yeo
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.
| |
Collapse
|
5
|
Alba-Linero C, Barberi GE, Lloren Ç V, Adán A. Diagnostic vitrectomy: a case series in a single referral center. ACTA ACUST UNITED AC 2019; 94:529-535. [PMID: 31606240 DOI: 10.1016/j.oftal.2019.07.017] [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] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. METHODS A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. RESULTS Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. CONCLUSIONS Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.
Collapse
Affiliation(s)
- C Alba-Linero
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España.
| | - G Espinosa Barberi
- Ophthalmology Department, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, España
| | - V Lloren Ç
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España
| | - A Adán
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España
| |
Collapse
|
6
|
Mahajan S, Invernizzi A, Agrawal R, Biswas J, Rao NA, Gupta V. Multimodal Imaging in Sympathetic Ophthalmia. Ocul Immunol Inflamm 2016; 25:152-159. [PMID: 27960610 DOI: 10.1080/09273948.2016.1255339] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To show the current status of multimodal imaging and its role in supporting an early diagnosis of sympathetic ophthalmia. METHODS The diagnosis is mainly clinical supported with ancillary investigations; mainly fluorescein angiography and others, including indocyanine angiography optical coherence tomography (OCT), OCT enhanced depth imaging, autofluorescence imaging, and ultrasonography. RESULTS Various imaging modalities such as OCT, autofluorescence imaging and angiography are critical in the diagnosis and management of sympathetic ophthalmia. The clinician must make adequate use of such ancillary investigations in the management of the patients. CONCLUSIONS Sympathetic ophthalmia is a rare, bilateral inflammation of the uveal tract following penetrating trauma or surgery in one eye. The intraocular inflammation requires a prompt diagnosis so that the treatment can be initiated as early as possible.
Collapse
Affiliation(s)
- Sarakshi Mahajan
- a Advanced Eye Centre , Post Graduate Institute of Medical Education & Research , Chandigarh , India
| | - Alessandro Invernizzi
- b Uveitis and Ocular Infectious Diseases Service - Eye Clinic, Department of Biomedical and Clinical Science , "Luigi Sacco" Liuigi Sacco Hospital, University of Milan , Milan , Italy.,c Department of Clinical Sciences and Community Health , University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico , Milan , Italy
| | - Rupesh Agrawal
- d National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
| | - Jyotirmay Biswas
- e Uveitis and Ocular Pathology Department , Sankara Nethralya , Chennai , India
| | - Narsing A Rao
- f USC Roski Eye Institute, Keck School of Medicine, University of Southern California , Los Angeles , California , USA
| | - Vishali Gupta
- a Advanced Eye Centre , Post Graduate Institute of Medical Education & Research , Chandigarh , India
| |
Collapse
|
7
|
Abstract
Fundus autofluorescence (FAF) is a relatively new imaging technique that can be used to study retinal diseases. It provides information on retinal metabolism and health. Several different pathologies can be detected. Peculiar AF alterations can help the clinician to monitor disease progression and to better understand its pathogenesis. In the present article, we review FAF principles and clinical applications.
Collapse
Affiliation(s)
| | | | - Paolo Lanzetta
- Department of Medical and Biological Sciences - Ophthalmology, University of Udine, Udine; Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| |
Collapse
|
8
|
Pato E, Martin-Martinez MA, Castelló A, Méndez-Fernandez R, Muñoz-Fernández S, Cordero-Coma M, Martinez-Costa L, Valls E, Reyes M, Francisco F, Esteban M, Fonollosa A, Sanchez-Alonso F, Fernández-Espartero C, Diaz-Valle T, Carrasco JM, Beltran-Catalán E, Hernández-Garfella M, Hernández MV, Pelegrin L, Blanco R, Diaz-Valle D. Development of an activity disease score in patients with uveitis (UVEDAI). Rheumatol Int 2016; 37:647-656. [PMID: 27815703 PMCID: PMC5357298 DOI: 10.1007/s00296-016-3593-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/22/2016] [Indexed: 12/17/2022]
Abstract
To develop a disease activity index for patients with uveitis (UVEDAI) encompassing the relevant domains of disease activity considered important among experts in this field. The steps for designing UVEDAI were: (a) Defining the construct and establishing the domains through a formal judgment of experts, (b) A two-round Delphi study with a panel of 15 experts to determine the relevant items, (c) Selection of items: A logistic regression model was developed that set ocular inflammatory activity as the dependent variable. The construct “uveitis inflammatory activity” was defined as any intraocular inflammation that included external structures (cornea) in addition to uvea. Seven domains and 15 items were identified: best-corrected visual acuity, inflammation of the anterior chamber (anterior chamber cells, hypopyon, the presence of fibrin, active posterior keratic precipitates and iris nodules), intraocular pressure, inflammation of the vitreous cavity (vitreous haze, snowballs and snowbanks), central macular edema, inflammation of the posterior pole (the presence and number of choroidal/retinal lesions, vascular inflammation and papillitis), and global assessment from both (patient and physician). From all the variables studied in the multivariate model, anterior chamber cell grade, vitreous haze, central macular edema, inflammatory vessel sheathing, papillitis, choroidal/retinal lesions and patient evaluation were included in UVEDAI. UVEDAI is an index designed to assess the global ocular inflammatory activity in patients with uveitis. It might prove worthwhile to motorize the activity of this extraarticular manifestation of some rheumatic diseases.
Collapse
Affiliation(s)
- Esperanza Pato
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.
| | | | - Adela Castelló
- Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosalía Méndez-Fernandez
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Muñoz-Fernández
- Rheumatology Department, Hospital Universitario Infanta Sofia, Universidad Europea de Madrid, San Sebastian de los Reyes, Madrid, Spain
| | | | | | - Elia Valls
- Rheumatology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Miguel Reyes
- Ophthalmolgy Department, Hospital de Gran Canaria Doctor Negrin, Gran Canaria, Spain
| | - Félix Francisco
- Rheumatology Department, Hospital de Gran Canaria Doctor Negrin, Gran Canaria, Spain
| | - Mar Esteban
- Ophthalmology Department, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | - Alex Fonollosa
- Ophthalmology Department, BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | | | | | - Teresa Diaz-Valle
- Ophthalmology Department, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - José Miguel Carrasco
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Emma Beltran-Catalán
- Rheumatoloy Department, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Laura Pelegrin
- Ophthalmology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ricardo Blanco
- Rheumatology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - David Diaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
9
|
Medzhidova SR. [Uveitis: RESULTS of a prospective randomized clinical and immunological study]. Vestn Oftalmol 2016; 132:15-22. [PMID: 27030429 DOI: 10.17116/oftalma2016132115-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM to evaluate the RESULTS of a randomized prospective clinical and immunological study conducted during 2012-2014 in patients with uveitis. MATERIAL AND METHODS The main group consisted of 200 randomly selected patients with uveitis including 114 men (57%) and 86 women (42%) aged 19-57 years. A comprehensive ophthalmic and immunological examination was performed in all patients regardless of them having a relapse or remission. To assess patient's immune status, we investigated parameters of cellular and humoral immunity as well as complement components C3 and C4 levels. RESULTS Systemic connective tissue disorders appeared to be the main cause of uveitis among the patients examined - 32% of cases. But if to consider distinct nosological entities, first place goes to herpes virus infection - 22% of cases. In general, infectious uveitis was diagnosed in 43.5% of cases, underlying systemic conditions were found in other 46%, and finally, in some patients, uveitis was identified as posttraumatic (4.5%) or idiopathic (6%). A total of 60.5% of patients showed clinical and functional improvement under treatment. Irreversible blindness in 9 patients was due to one of the following: secondary glaucoma (4 cases, 2%), retinal detachment (3 cases, 1.5%), or ocular subatrophy (2 cases, 1%). Late referral (i.e. after the development of irreversible secondary complications) should be named as one of the main causes of low vision in patients with uveitis. As to laboratory changes, only those in cellular and congenital immunity factors were statistically significant. CONCLUSION In order to minimize the risk of proliferative secondary complications, a tool should be created such as a single database of uveitis patients, according to which they could be followed up. Long-term immunosuppressive therapy for uveitis may lead to herpesvirus reactivation. The complex nature of immune disorders justifies certain corrective measures in uvetis patients but only with account to their current immune status.
Collapse
Affiliation(s)
- S R Medzhidova
- National Centre of Ophthalmology named after acad. Zarifa Aliyeva, 32/15 Javadkhan St., Baku, Azerbaijan, AZ 1114
| |
Collapse
|
10
|
Local (topical and intraocular) therapy for ocular Adamantiades−Behçetʼs disease. Curr Opin Ophthalmol 2015; 26:546-52. [DOI: 10.1097/icu.0000000000000210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
11
|
Jeroudi A, Angeles-Han ST, Yeh S. Efficacy of adalimumab for pediatric Vogt-Koyanagi-Harada syndrome. Ophthalmic Surg Lasers Imaging Retina 2015; 45:332-4. [PMID: 25037015 DOI: 10.3928/23258160-20140709-09] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 04/09/2014] [Indexed: 11/20/2022]
Abstract
Pediatric Vogt-Koyanagi-Harada syndrome (VKH) is rare, with limited cases of corticosteroid-sparing immunosuppression use reported. A 15-year-old Hispanic girl was referred for bilateral intraocular inflammation. Her initial best corrected visual acuity (BCVA) was 20/30 in the right eye and 20/200 in the left eye, with granulomatous keratic precipitates, anterior chamber and vitreous cell, optic disc edema, and nummular depigmented chorioretinal lesions on examination consistent with VKH after an unrevealing work-up. Inflammation was recurrent despite oral prednisone and methotrexate. Adalimumab, a TNF-alpha inhibitor, led to rapid resolution of inflammation, successful dose reduction of prednisone and methotrexate, and final BCVA of 20/25 in the right eye and 20/40 in the left at 26-month follow-up.
Collapse
|
12
|
|
13
|
Kim JB, Jeroudi A, Angeles-Han ST, Grossniklaus HE, Yeh S. Adalimumab for pediatric sympathetic ophthalmia. JAMA Ophthalmol 2014; 132:1022-4. [PMID: 25010359 DOI: 10.1001/jamaophthalmol.2014.426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Joon-Bom Kim
- Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Abdallah Jeroudi
- Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Sheila T Angeles-Han
- Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia2Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia3Children's Hospital of Atlanta, Atlanta, Georgia
| | - Hans E Grossniklaus
- Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Steven Yeh
- Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
14
|
|
15
|
Role of autofluorescence in inflammatory/infective diseases of the retina and choroid. J Ophthalmol 2014; 2014:418193. [PMID: 24800061 PMCID: PMC3995316 DOI: 10.1155/2014/418193] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/10/2014] [Accepted: 03/04/2014] [Indexed: 11/29/2022] Open
Abstract
Fundus autofluorescence (FAF) has recently emerged as a novel noninvasive imaging technique that uses the fluorescent properties of innate fluorophores accumulated in the retinal pigment epithelium (RPE) to assess the health and viability of the RPE/photoreceptor complex. Recent case reports suggest FAF as a promising tool for monitoring eyes with posterior uveitis helping to predict final visual outcome. In this paper we review the published literature on FAF in these disorders, specifically patterns in infectious and noninfectious uveitis, and illustrate some of these with short case histories.
Collapse
|
16
|
|
17
|
|
18
|
Abstract
The purpose of this article is to highlight evidence about the medical and surgical management of intermediate uveitis (IU). Updated understandings of the immunopathology of IU were reviewed in this retrospective literature review. Literature selection for this review was based on the PubMed database (National Library of Medicine) and OVID database (Wolters Kluwer). Articles deemed relevant were selected and highlighted. Intermediate uveitis is most often a benign form of uveitis. Since intermediate uveitis has been described in association with different systemic disorders, the initial diagnostic evaluation should serve to exclude masquerade syndromes and infectious diseases in which immunosuppression may be ineffective or contraindicated. Although the pathogenesis of intermediate uveitis is not fully understood, identification of proinflammatory molecules involved in the IU has contributed to the development and implementation of new therapies. Studies about the use of various immunosuppressants, biological agents and surgical treatment on IU have provided more evidence for managing IU. Nevertheless, corticosteroids remain the mainstay of treatment. The treatment options of intermediate uveitis are evolving, with the development of various immunosuppressants and biological agents. The management of intermediate uveitis should be tailored individually, based on specific causes of the disease and associated complications.
Collapse
Affiliation(s)
- Frank H P Lai
- From the Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | | | | |
Collapse
|
19
|
Tempest-Roe S, Joshi L, Dick AD, Taylor SRJ. Local therapies for inflammatory eye disease in translation: past, present and future. BMC Ophthalmol 2013; 13:39. [PMID: 23914773 PMCID: PMC3750406 DOI: 10.1186/1471-2415-13-39] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/01/2013] [Indexed: 12/18/2022] Open
Abstract
Despite their side-effects and the advent of systemic immunosuppressives and biologics, the use of corticosteroids remains in the management of patients with uveitis, particularly when inflammation is associated with systemic disease or when bilateral ocular disease is present. The use of topical corticosteroids as local therapy for anterior uveitis is well-established, but periocular injections of corticosteroid can also be used to control mild or moderate intraocular inflammation. More recently, intraocular corticosteroids such as triamcinolone and steroid-loaded vitreal inserts and implants have been found to be effective, including in refractory cases. Additional benefits are noted when ocular inflammation is unilateral or asymmetric, when local therapy may preclude the need to increase the systemic medication. Implants in particular have gained prominence with evidence of efficacy including both dexamethasone and fluocinolone loaded devices. However, an appealing avenue of research lies in the development of non-corticosteroid drugs in order to avoid the side-effects that limit the appeal of injected corticosteroids. Several existing drugs are being assessed, including anti-VEGF compounds such as ranibizumab and bevacizumab, anti-tumour necrosis factor alpha antibodies such as infliximab, as well as older cytotoxic medications such as methotrexate and cyclosporine, with varying degrees of success. Intravitreal sirolimus is currently undergoing phase 3 trials in uveitis and other inflammatory pathways have also been proposed as suitable therapeutic targets. Furthermore, the advent of biotechnology is seeing advances in generation of new therapeutic molecules such as high affinity binding peptides or modified high affinity or bivalent single chain Fab fragments, offering higher specificity and possibility of topical delivery.
Collapse
|
20
|
Abstract
Although the phenomenon of fundus autofluorescence has been known for decades, it has only recently been recognized as a measure of retinal pigment epithelial function and health. Characteristic fundus autofluorescence patterns have been described in eyes affected by inflammation of the posterior segment, and these patterns have provided insights into the pathogenesis of posterior uveitis entities. In addition, preliminary data indicate that fundus autofluorescence characteristics may serve as markers of disease activity, allow prediction of visual prognosis, and may help determine the adequacy of therapy. We provide an overview of the current state of fundus autofluorescence imaging technology and review our current knowledge of fundus autoflourescence findings and their clinical use in the posterior uveitis entities.
Collapse
Affiliation(s)
- Khayyam Durrani
- Massachusetts Eye Research & Surgery Institution, Ocular Immunology & Uveitis Foundation, and Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
21
|
Pato E, Muñoz-Fernández S, Francisco F, Abad MA, Maese J, Ortiz A, Carmona L. Systematic Review on the Effectiveness of Immunosuppressants and Biological Therapies in the Treatment of Autoimmune Posterior Uveitis. Semin Arthritis Rheum 2011; 40:314-23. [DOI: 10.1016/j.semarthrit.2010.05.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 05/17/2010] [Accepted: 05/20/2010] [Indexed: 12/14/2022]
|
22
|
|
23
|
Adamus G, Karren LJ, Mooney J, Burrows GG. A promising therapeutic approach for treatment of posterior uveitis: recombinant T cell receptor ligand protects Lewis rats from acute and recurrent experimental autoimmune uveitis. Ophthalmic Res 2010; 44:24-33. [PMID: 20145422 DOI: 10.1159/000281815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 11/11/2009] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Chronic autoimmune uveitis is a major cause of vision loss from intraocular inflammation in humans. In this study we report that a recombinant TCR ligand (RTL220) composed of the alpha1 and beta1 domains of MHC class II molecules linked to the uveitogenic interphotoreceptor retinoid-binding protein (IRBP) 1177-1191 peptide is effective in the suppression of acute and recurrent experimental autoimmune uveitis (EAU). MATERIAL AND METHODS EAU was induced with IRBP1177-1191 peptide or by adoptive transfer of specific T cells in Lewis rats. The rats received 5 doses of RTL220 subcutaneously every other day starting at the onset of clinic signs of EAU. RESULTS The administration of RTL220 resulted in a delayed onset and a significant amelioration of the disease severity at clinical levels and showed protection of the retina from inflammatory damage at histological levels. In treatment of recurrent EAU, RTL220 administrated at the first or second onset of clinical disease significantly inhibited EAU, modulated immune responses and provided protection from relapses of uveitis. The systemic and local proinflammatory cytokines were significantly reduced, including IL-17. There was local and systemic increase in IL-10 and reduction in the expression of the proinflammatory chemokines CCL2, CCL3 and CCL5. CONCLUSIONS Our studies demonstrate a successful treatment of acute and recurrent EAU with RTL220, which effectively suppressed the recurrence of inflammation and reversed clinical and histological EAU by altering cytokine and chemokine expression. These findings strongly support a possible clinical application of this novel class of peptide/MHC class II drugs for patients with autoimmune uveitis.
Collapse
Affiliation(s)
- Grazyna Adamus
- Ocular Immunology Laboratory, Department of Ophthalmology, Oregon Health and Science University, Portland, OR 97239, USA. adamusg @ ohsu.edu
| | | | | | | |
Collapse
|
24
|
Lyon F, Gale RP, Lightman S. Recent developments in the treatment of uveitis: an update. Expert Opin Investig Drugs 2010; 18:609-16. [PMID: 19388878 DOI: 10.1517/14728220902852570] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of complex uveitis is often based around the use of oral corticosteroids. To spare the side effects of corticosteroids, second-line oral immunosuppressant drugs are used. Newer systemic immunosuppressive drugs, including biologics, and locally delivered treatments are being evaluated. This article reviews current conventional treatments, discusses their limitations and evaluates newer treatment strategies. Current theories about the pathogenesis of uveitis and potential targets for treatment are discussed in this context. We are still in search of a low-risk, where possible, locally delivered and targeted treatment for uveitis.
Collapse
Affiliation(s)
- Fiona Lyon
- Academic Unit of Ophthalmology, York Hospital, Wigginton Road, York YO318HE, UK
| | | | | |
Collapse
|
25
|
Camelo S, Lajavardi L, Bochot A, Goldenberg B, Naud MC, Brunel N, Lescure B, Klein C, Fattal E, Behar-Cohen F, de Kozak Y. Protective effect of intravitreal injection of vasoactive intestinal peptide-loaded liposomes on experimental autoimmune uveoretinitis. J Ocul Pharmacol Ther 2009; 25:9-21. [PMID: 19232006 DOI: 10.1089/jop.2008.0074] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the effect of a single intravitreal (i.v.t.) injection of vasoactive intestinal peptide (VIP) loaded in rhodamine-conjugated liposomes (VIP-Rh-Lip) on experimental autoimmune uveoretinitis (EAU). METHODS An i.v.t. injection of VIP-Rh-Lip, saline, VIP, or empty-(E)-Rh-Lip was performed simultaneously, either 6 or 12 days after footpad immunization with retinal S-antigen in Lewis rats. Clinical and histologic scores were determined. Immunohistochemistry and cytokine quantification by multiplex enzyme-linked immunosorbent assay were performed in ocular tissues. Systemic immune response was determined at day 20 postimmunization by measuring proliferation and cytokine secretion of cells from inguinal lymph nodes (ILNs) draining the immunization site, specific delayed-type hypersensitivity (DTH), and the serum concentration of cytokines. Ocular and systemic biodistribution of VIP-Rh-Lip was studied in normal and EAU rats by immunofluorescence. RESULTS The i.v.t. injection of VIP-Rh-Lip performed during the afferent, but not the efferent, phase of the disease reduced clinical EAU and protected against retinal damage. No effect was observed after saline, E-Rh-Lip, or VIP injection. VIP-Rh-Lip and VIP were detected in intraocular macrophages and in lymphoid organs. In VIP-Rh-Lip-treated eyes, macrophages expressed transforming growth factor-beta2, low levels of major histocompatibility complex class II, and nitric oxide synthase-2. T-cells showed activated caspase-3 with the preservation of photoreceptors. Intraocular levels of interleukin (IL)-2, interferon-gamma (IFN-gamma), IL-17, IL-4, GRO/KC, and CCL5 were reduced with increased IL-13. At the systemic level, treatment reduced retinal soluble autoantigen lymphocyte proliferation, decreased IL-2, and increased IL-10 in ILN cells, and diminished specific DTH and serum concentration of IL-12 and IFN-gamma. CONCLUSIONS An i.v.t. injection of VIP-Rh-Lip, performed during the afferent stage of immune response, reduced EAU pathology through the immunomodulation of intraocular macrophages and deviant stimulation of T-cells in ILN. Thus, the encapsulation of VIP within liposomes appears as an effective strategy to deliver VIP into the eye and is an efficient means of the prevention of EAU severity.
Collapse
Affiliation(s)
- Serge Camelo
- INSERM, U872 Physiopathology of Ocular Disease, Therapeutic Innovations, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|