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Bunjo LJ, Bacchi S, Pietris J, Chan WO. Current management options for the treatment of refractory postoperative cystoid macular edema: A systematic review. Surv Ophthalmol 2024; 69:606-621. [PMID: 38490455 DOI: 10.1016/j.survophthal.2024.03.005] [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: 11/17/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
Post-operative cystoid macular edema (PCME) is an important complication following intraocular surgery that often resolves spontaneously without treatment. In some cases, PCME may persist despite initial medical therapy, which can adversely impact visual outcomes. Various topical, intraocular and systemic treatments exist for the prevention and management of cystoid macular edema; however, there is no consensus on treatment of refractory cases in the postoperative setting. In accordance with the PRISMA guidelines, we systematically reviewed 68 articles describing management options and their outcomes for treatment-resistant cases of PCME. The most commonly reported treatments included steroid (39 studies) and biological-based (17 studies) therapies. We provide an overview of the treatment options for refractory PCME.
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Affiliation(s)
- Layla J Bunjo
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Stephen Bacchi
- Lyell McEwin Hospital, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
| | - James Pietris
- University of Queensland, Herston, Queensland, Australia
| | - Weng Onn Chan
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Health and Medical Sciences Building, University of Adelaide, Adelaide, South Australia, Australia
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Younes AM, Hamza HS, Omar HA, Abdel-Kader AA, Abdelbaki AM, Elnahry AG. Intravitreal Infliximab for the Treatment of Proliferative Vitreoretinopathy (FIXER): A Randomized Controlled Phase 2 Trial. Ophthalmol Retina 2024:S2468-6530(24)00265-3. [PMID: 38823559 DOI: 10.1016/j.oret.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE To study the safety and efficacy of intravitreal infliximab administered at the conclusion of pars plana vitrectomy (PPV) in the treatment of proliferative vitreoretinopathy (PVR) associated with rhegmatogenous retinal detachment (RRD). DESIGN Randomized controlled phase 2 clinical trial. SUBJECTS Patients with primary RRD and Grade C PVR, according to the updated Retina Society Classification. METHODS Sixty-six Patients were randomized in a 1:1 ratio to undergo PPV and silicone oil (SO) injection with or without intravitreal injection of 1 mg/0.05 mL of infliximab in the air-filled globe before SO injection at PPV conclusion. Surgeons were masked to treatment allocation until PPV conclusion. MAIN OUTCOME MEASURES The primary outcome measure was anatomic success (defined as complete retinal reattachment without a tamponade at 6 months post SO removal). Secondary outcome measures were final best corrected visual acuity (BCVA), single operation success rate (SOSR), rate of recurrent detachment, central macular thickness (CMT) by macular optical coherence tomography (OCT), macular function by multifocal electroretinogram and macular vascular density (VD) by OCT angiography. RESULTS 60 eyes of 60 patients, 30 eyes in each group, completed the study. At baseline, there were no differences regarding age, gender, history of trauma, lens status, duration of RRD, BCVA, intraocular pressure (IOP), intra-ocular inflammation (IOI), detachment extent in clock hours, number/size of breaks, presence of vitreous hemorrhage, axial length, or grade/extent of PVR between both groups. For the outcome measures, 30 eyes in the infliximab group achieved anatomic success vs 29 eyes in the control group. The SOSR was higher in the infliximab group (26) vs the control (23), but this was not statistically significant (p = 0.317). Final BCVA was better in the infliximab group (mean logMAR (SD) = 0.96 (0.4), Snellen equivalent ≈ 20/180) vs the control (1.14 (0.4), Snellen equivalent ≈ 20/280) (p = 0.044). There were no differences regarding IOP, IOI, time of SO removal, macular function, CMT, or VD. CONCLUSION PPV with SO tamponade with or without intravitreal infliximab is effective in treating PVR-associated RRD. Infliximab may be associated with modest improvement in final visual outcomes but not anatomical outcomes.
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Affiliation(s)
- Ahmed M Younes
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany S Hamza
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hisham A Omar
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Abdel-Kader
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abdelbaki
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Sarici K, Vyas A, Iannaccone A. The double-edged sword of inflammation in inherited retinal degenerations: Clinical and preclinical evidence for mechanistically and prognostically impactful but treatable complications. Front Cell Dev Biol 2023; 11:1177711. [PMID: 37123408 PMCID: PMC10135873 DOI: 10.3389/fcell.2023.1177711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
We present retrospective data from our clinical research efforts of the past several years alongside a review of past and current clinical and preclinical data independently by several investigators supporting our clinical evidence for the importance of inflammation in inherited retinal degenerations (IRDs). We show how inflammation is a complicating factor in IRDs but, if recognized and managed, also a great opportunity to mitigate disease severity immediately, improve patient prognosis and quality of life, extend the treatment windows for gene-specific and agnostic therapeutic approaches, mitigate the impact of inflammatory complications on the accurate estimate of vision changes in IRD natural history studies, improve the chances of safer outcomes following cataract surgery, and potentially reduce the likelihood of inflammatory adverse events and augment the efficacy of viral vector-based treatment approaches to IRDs. Manuscript contribution to the field. Inflammation has been suspected to be at play in IRDs since the beginning of the 1900s and became a research focus through the early 1990s but was then largely abandoned in favor of genetic-focused research. Thanks to regained cognizance, better research tools, and a more holistic approach to IRDs, the recent reappraisal of the role of inflammation in IRDs has brought back to the surface its importance. A potential confounder in natural history studies and a limiting factor in clinical trials if not accounted for, inflammation can be managed and often offers an opportunity for immediately improved prognosis and outcomes for IRD patients. We present our retrospective clinical evidence for connections with a measurable secondary autoimmune component that can develop in IRDs and contribute to vision loss but is at least in part treatable. We also present ample lines of evidence from the literature corroborating our clinical observations at the preclinical level.
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Hasan N, Chawla R, Shaikh N, Kandasamy S, Azad SV, Sundar MD. A comprehensive review of intravitreal immunosuppressants and biologicals used in ophthalmology. Ther Adv Ophthalmol 2022; 14:25158414221097418. [PMID: 35602659 PMCID: PMC9121505 DOI: 10.1177/25158414221097418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/11/2022] [Indexed: 12/18/2022] Open
Abstract
Systemic immunosuppressants and biologicals have been a valuable tool in the
treatment of inflammatory diseases and malignancies. The safety profile of these
drugs has been debatable, especially in localized systems, such as the eye. This
has led to the search for fairly local approaches, such as intravitreal,
subconjunctival, and topical route of administration. Immunosuppressants have
been used as a second-line drug in patients intolerable to corticosteroids or
those who develop multiple recurrences on weaning corticosteroids. Similarly,
biologicals have also been used as the next line of therapy, when adequate
control of inflammation could not be attained or immunosuppressants were
contraindicated to patients. Intravitreal immunosuppressants, such as
methotrexate and sirolimus, have been extensively studied in noninfectious
posterior uveitis, whereas limited studies have established the efficacy of
intravitreal biologicals, such as infliximab and adalimumab. Most of these drugs
have shown good safety profile and tolerability in animal studies alone and have
not been studied further in human subjects. However, most of the studies in
literature are single-case reports or case series which limits the level of
evidence. In this comprehensive review, we discuss the mechanism of action,
pharmacodynamics, pharmacokinetics, indications, efficacy, and side effects of
different intravitreal immunosuppressants and biologicals that have been studied
in literature.
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Affiliation(s)
- Nasiq Hasan
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Rohan Chawla
- Associate Professor, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, New Delhi 110029, India
| | - Nawazish Shaikh
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | | | | | - M. Dheepak Sundar
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
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Ocular Injectable Treatment Options for Post-Cataract Macular Edema: A Systematic Review of Current Literature. J Cataract Refract Surg 2022; 48:1197-1202. [PMID: 35171142 DOI: 10.1097/j.jcrs.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT The incidence of pseudophakic cystoid macular edema (PCME) ranges from 0.1% to 20% and is the most common cause of post-procedure vision loss. Currently there is no widely accepted treatment for PCME. Topical non-steroidal anti-inflammatory (NSAID) drops given alone or in combination with topical corticosteroids are often used; however, there is a growing body of literature surrounding the off-label use of various ocular injectable medications. The purpose of this systematic literature review was to characterize the current evidence surrounding these treatments and conduct qualitative analysis to assess the risk for bias of each study. Eighteen total studies were found and evaluated to have moderate (n=3, 17%) to high risk (n=15, 83%) of bias. Although the growing body of real-world data favors improvements in visual acuity and anatomical outcomes with these injectable treatments, larger studies with better study design are needed to demonstrate their role in the management of PCME.
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Obis J, Arias L, Lorenzo D, Padron-Perez N, Garcia-Bru P, Cobos E, Morwani R, Caminal J. Topical NSAIDs, intravitreal dexamethasone and peribulbar triamcinolone for pseudophakic macular edema. BMC Ophthalmol 2021; 21:387. [PMID: 34740334 PMCID: PMC8570006 DOI: 10.1186/s12886-021-02132-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of this study is to assess the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (intravitreal dexamethasone and peribulbar triamcinolone) in treating pseudophakic macular edema (PME). Methods Retrospective study of 33 eyes. Variables included best corrected visual acuity (BCVA; logMAR scale) and central retinal thickness (CRT) and central choroidal thickness (CCT) assessed with swept-source OCT. All patients were initially prescribed topical NSAIDs and reevaluated after 2 months. If improvement in BCVA or CRT was noted, topical NSAIDs were continued until resolution. If no improvement was observed at 2 months or subsequent visits, intravitreal dexamethasone implant was performed. Patients who refused intravitreal treatment were offered peribulbar triamcinolone. Results After treatment with topical NSAIDs for a median of 2 months, BCVA increased significantly from 0.5 to 0.3 while CRT decreased significantly from 435 to 316 μm. PME resolved in 19 of the 33 eyes (57.6%). Of the 14 recalcitrant cases, 13 were treated with corticosteroids. Of these 13 cases, 9 (69.2%) resolved. BCVA increased non-significantly from 0.7 to 0.4. CRT and CCT decreased significantly from 492 to 317 μm and from 204 to 182 μm respectively. Conclusions The overall success rate of the treatment algorithm was greater than 80%, a remarkable finding considering that no randomized study has yet been conducted to determine the optimal therapeutic protocol for PME. This is the first study to evaluate choroidal thickness in PME using SS-OCT, which could play a key role in its pathophysiology and provide useful information to improve the management of PME.
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Affiliation(s)
- Javier Obis
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain.
| | - Luis Arias
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Lorenzo
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Noel Padron-Perez
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Garcia-Bru
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Estefania Cobos
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Rahul Morwani
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Jose Caminal
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
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Contemporary Outcomes and Prognostic Factors of 23-Gauge Vitrectomy for Retained Lens Fragments After Phacoemulsification. Am J Ophthalmol 2020; 219:271-283. [PMID: 32479808 DOI: 10.1016/j.ajo.2020.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To provide data on visual acuity (VA) outcomes and prognostic factors of microincision (23-gauge) vitrectomy surgery (MIVS) for retained lens fragments after complicated cataract surgery. DESIGN Retrospective, interventional case series from 2012 to 2017. METHODS Precataract surgery and intraoperative (vitrectomy) parameters, postvitrectomy complications, and best-corrected visual acuities (BCVAs) were identified. Vitrectomy was performed as early as corneal clarity permitted. Univariate and multivariate logistic regression were used to characterize factors associated with achieving VA better than 20/40, or worse than 20/200 at 6 months. RESULTS This study included 291 consecutive eyes (291 patients). LogMAR BCVA improved from 0.73 ± 0.70 before cataract surgery to 0.46 ± 0.63 (P < .001) after vitrectomy. The previtrectomy VA was 1.43 ± 0.79. At 6 months, 183 (62.9%) and 45 patients (15.5%) achieved BCVAs better than 20/40 and worse than 20/200, respectively. Most frequent complications were de novo ocular hypertension (29 eyes, 10%) and transient cystoid macular edema (25 eyes, 8.6%). Postvitrectomy retinal detachment occurred in 9 eyes (3.1%). Final VA of 20/40 or better was independently associated only with better precataract surgery VA, age <75 years, absence of preexisting diabetic macular edema (DME) or postvitrectomy persistent cystoid macular edema (P < .05). Only poorer precataract surgery VA, delaying vitrectomy to later than 2 weeks, and final aphakic status were independently predictive of 20/200 or worse VA (P < .05). CONCLUSION Contemporary VA outcomes of 23-gauge vitrectomy for retained lens fragments are comparable with that of prior predominantly non-MIVS cohorts, but fall short of benchmarks for uncomplicated cataract surgery. IOL type or timing of placement do not impact final VA.
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Aaronson A, Achiron A, Tuuminen R. Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac. J Clin Med 2020; 9:jcm9093034. [PMID: 32967137 PMCID: PMC7563612 DOI: 10.3390/jcm9093034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Department of Ophthalmology, Helsinki University Hospital, FI-00290 Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, 58100 Holon, Israel;
- Department of Ophthalmology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotkantie 41, FI-48210 Kotka, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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Sakalova ED. [Modern approaches to treatment of postsurgical macular edema]. Vestn Oftalmol 2020; 136:289-295. [PMID: 32880153 DOI: 10.17116/oftalma2020136042289] [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: 11/18/2022]
Abstract
Postsurgical macular edema, known as Irvine-Gass syndrome, is one of the possible causes of reduced visual acuity in ophthalmic surgery. The article reviews and summarizes data on the main approaches to the treatment of this pathology, discusses the main groups of drugs used to manage postoperative macular edema.
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Affiliation(s)
- E D Sakalova
- Research Institute of Eye Diseases, Moscow, Russia
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Pham BH, Hien DL, Matsumiya W, Tuong Ngoc TT, Doan HL, Akhavanrezayat A, Yaşar Ç, Nguyen HV, Halim MS, Nguyen QD. Anti-interleukin-6 receptor therapy with tocilizumab for refractory pseudophakic cystoid macular edema. Am J Ophthalmol Case Rep 2020; 20:100881. [PMID: 32875161 PMCID: PMC7452126 DOI: 10.1016/j.ajoc.2020.100881] [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: 06/17/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To describe the clinical course of a patient with refractory pseudophakic cystoid macular edema treated with interleukin-6 receptor antagonist tocilizumab. Observations An 80-year-old Caucasian man with past ocular history significant for glaucoma (right eye) and iritis presented with cystoid macular edema (CME) in the right eye (OD). His ocular surgery history was significant for cataract extraction with posterior chamber intraocular lenses in 1999 and YAG laser capsulotomy in 2014 in both eyes (OU). His medications at time of presentation included latanoprost and dorzolamide-timolol in OD for glaucoma, as well as prednisolone in OD for iritis. Upon examination, his visual acuity was 20/250 in OD and 20/20 in the left eye (OS). Intraocular pressure was 20 mmHg in OD and 10 mmHg in OS. Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed CME and a cup-to-disk ratio of 0.9 in OD and normal findings in OS. Initial spectral domain optical coherence tomography (SD-OCT) demonstrated intraretinal fluid in both outer and inner layers as well as mild subretinal fluid with an intact ellipsoid zone in OD. Fluorescein angiography revealed perifoveal leakage in OD. Laboratory evaluations, including infectious work-up, were unremarkable. While the patient's CME initially improved after initiation of therapy with topical prednisolone and oral acetazolamide, the CME later recurred after systemic acetazolamide was stopped due to intolerable side effects. Despite multiple therapeutic approaches, including topical and systemic corticosteroids (both oral and intravenous) and topical interferon α2b over the course of more than one year, the patient's visual acuity continued to worsen with increasing intra- and subretinal fluid in the macula. Due to the refractory CME, the patient was started on monthly infusions of anti-interleukin (IL)-6 receptor tocilizumab (8 mg/kg) with three days of methylprednisolone infusions (500 mg/day). After nine cycles of treatment, SD-OCT demonstrated restoration of normal foveal contour with complete resolution of CME. Conclusions and Importance IL-6 inhibition with tocilizumab may be a safe and effective treatment for refractory CME. Further studies are needed to elucidate the nature and extent of therapeutic IL-6 inhibition in CME.
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Affiliation(s)
| | - Doan Luong Hien
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | | | - Than Trong Tuong Ngoc
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | - Huy Luong Doan
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | - Çigdem Yaşar
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Huy Vu Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Corresponding author. Spencer Center for Vision Research Byers Eye Institute at Stanford University 2452 Watson Court Suite 200 Palo Alto, CA 94303, USA.
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The effects of intravitreal adalimumab injection on pseudophakic macular edema. BMC Res Notes 2020; 13:354. [PMID: 32711577 PMCID: PMC7382825 DOI: 10.1186/s13104-020-05197-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/18/2020] [Indexed: 01/12/2023] Open
Abstract
Objective Pseudophakic macular edema is a frequent complication following cataract surgery. Inflammation is a major etiologic factor in the development of pseudophakic cystoid macular edema. Tumor necrosis factor-alpha has an important role in ocular inflammation. Adalimumab (Humira) is an inhibitor of tumor necrosis factor-alpha that has been approved in the United States. An open-label, uncontrolled, prospective, interventional study of five consecutive patients (5 eyes) with cystoid macular edema who were treated with off-label intravitreal adalimumab at Khalili Hospital was conducted. Slit-lamp examination and optical coherence tomography were done for all patients. Results No statistically significant difference was detected between best corrected visual acuity and central macular thickness before and after injection in pseudophakic macular edema. One patient developed uveitis approximately 2 weeks after injection. Based on the results, adalimumab does not appear to be an effective treatment for pseudophakic macular edema, and it may cause uveitis. Caution should be exercised when using this drug. Trial registration Iranian Registry of Clinical Trials IRCT2016100430130N1, 2016.12.03, Retrospectively registered
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Durmaz Engin C, Cilaker Miçili S, Yilmaz O, Bağriyanik HA, Ergür BU, Önen F, Saatci AO. Ocular toxicity of intravitreal golimumab in a rabbit model. Turk J Med Sci 2020; 50:1111-1122. [PMID: 32151118 PMCID: PMC7379407 DOI: 10.3906/sag-1911-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/05/2020] [Indexed: 01/13/2023] Open
Abstract
Background/aim To investigate the effect of intravitreal golimumab on rabbit retina histopathology. Materials and methods Sixteen albino New Zealand rabbits were divided into three groups. The right eye of each rabbit in groups I, II, and III received a single intravitreal injection of 5 mg/0.05 mL (6 eyes), 10 mg/0.1 mL (6 eyes), or 20 mg/0.2 mL (4 eyes) golimumab, while left eyes served as controls with the same volume of a balanced salt solution injection. All animals were examined using slit-lamp biomicroscopy and indirect ophthalmoscopy before and after intravitreal injection and at days 1 and 7. Animals were euthanized on day 7 and the eyes were enucleated for immunohistochemistry evaluation and electron microscopic examination of the retinas. Results For groups I, II, and III, the number of cells in the outer nuclear layer and the inner nuclear layer was decreased compared to those in the control groups. In group I, the percentage of caspase-3 staining of the outer nuclear layer was significantly higher than that in the control. For groups II and III, TUNEL and caspase-3 staining percentages in the outer and inner nuclear layers were found to be significantly higher than those for the control groups. In the ganglion cell layer, for groups I, II, and III, neither TUNEL nor caspase-3 staining percentages showed any significant difference between two groups. No significant dose-dependent relationship was found for increasing doses of golimumab in all layers. Myelin figures and karyorrhexis in the photoreceptor cells were prominent in electron microscopy of the golimumab-injected eyes. Conclusion Golimumab caused apoptosis in both photoreceptors and bipolar cells of the rabbit retina. Potential retinal toxicity of intravitreal golimumab should be considered if an intravitreal administration is planned.
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Affiliation(s)
- Ceren Durmaz Engin
- Department of Ophthalmology, Karadeniz Ereğli State Hospital, Zonguldak, Turkey
| | - Serap Cilaker Miçili
- Department of Histology and Embryology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Osman Yilmaz
- Department of Laboratory Animals Science, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Hüsnü Alper Bağriyanik
- Department of Histology and Embryology, School of Medicine, Dokuz Eylül University, İzmir, Turkey,İzmir Biomedicine and Genome Center (iBG), İzmir, Turkey
| | - Bekir Uğur Ergür
- Department of Histology and Embryology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Fatoş Önen
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
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Holló G, Aung T, Cantor LB, Aihara M. Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management. Surv Ophthalmol 2020; 65:496-512. [PMID: 32092363 DOI: 10.1016/j.survophthal.2020.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.
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Affiliation(s)
- Gábor Holló
- Glaucoma Unit, Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Opthalmology, National University of Singapore, Singapore
| | - Louis B Cantor
- Department of Opthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Makoto Aihara
- Department of Opthalmology, University of Tokyo, Tokyo, Japan
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Erden B, Çakır A, Aslan AC, Bölükbaşı S, Elçioğlu MN. The Efficacy of Posterior Subtenon Triamcinolone Acetonide Injection in Treatment of Irvine-Gass Syndrome. Ocul Immunol Inflamm 2019; 27:1235-1241. [PMID: 31411519 DOI: 10.1080/09273948.2019.1620786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the efficacy and safety of posterior 40 mg subtenon triamcinolone acetonide (PST) injection in treating Irvine-Gass syndrome.Methods: The retrospective study included 21 patients (mean age: 76 ± 8.2) with a treatment-naïve eye subjected to topical anesthesia and injection of 40 mg/ml triamcinolone via a blunt tip SubTenon cannula through a single inferonasal peritomy. Best corrected visual acuity (BCVA; logMAR), intraocular pressure (IOP), biomicroscopic and funduscopic findings, and optical coherence tomography (OCT) measurements were recorded.Results: Baseline central macular thickness decreased from 431 ± 136 µm to 300 ± 67 µm (1st month; p = .002), to 292 ± 56 µm (3rd month; p = .002), and to 299 ± 66 µm (6th month; p = .005). Mean BCVA increased from 0.71 ± 0.23 to 0.27 ± 0.11, 0.19 ± 0.06, and 0.24 ± 0.17, respectively (all visits; p < 0.001). Mean IOP values did not change significantly (p = .12).Conclusion: PST injection is an effective and safe treatment for Irvine-Gass syndrome.
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Affiliation(s)
- Burak Erden
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Akın Çakır
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Selim Bölükbaşı
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Nuri Elçioğlu
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Donmez O, Yaman A, Ozturk T, Aktas S, Altun ZS, Yılmaz O. The efficacy of systemic and intravitreal infliximab treatments in an endotoxin-induced uveitis model. Cutan Ocul Toxicol 2019; 38:360-369. [PMID: 31213109 DOI: 10.1080/15569527.2019.1632883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: To compare the efficacy of systemic and intravitreal infliximab treatments in an experimental endotoxin-induced uveitis (EIU) model. Methods: Twenty-eight white New Zealand rabbits were equally divided into 4 groups. Group 1 received an intravitreal injection of 0.1 cc saline, group 2 received an intravitreal injection of 2 µg/0.1 cc lipopolysaccharide (LPS), group 3 received an intravitreal injection of 2 µg/0.1 cc LPS and 2 mg/0.1 cc infliximab, and group 4 received intravitreal injection of 2 µg/0.1 cc LPS and intravenous injection of 5 mg/kg infliximab. Clinical, biochemical (aqueous and vitreous humour protein levels and TNF-α concentrations), and histopathological evaluations were performed. Results: The clinical examination score was lower in group 4 than in group 2 (p = 0.006); but there was no significant difference between groups 2 and 3 (Bonferroni correction, p = 0.016). No statistically significant difference was found among groups 2, 3, and 4 for aqueous humour protein levels (p > 0.05). Significantly higher aqueous humour concentrations of TNF-α was measured in group 3 comparing to both group 1 and 4 (p = 0.003 and p = 0.002, respectively). No significant difference was found in vitreous protein levels or TNF-α concentrations among all study groups (Bonferroni correction, p = 0.026 and p = 0.101, respectively). Histopathological evaluation of the uveal tissue and anterior chamber reaction revealed the highest inflammation in group 3 (p < 0.001). In group 4, histopathological evaluation of uveal tissue was lower than in groups 2 and 3 (p < 0.001 and p = 0.001, respectively); whereas there was no difference in anterior chamber inflammation between groups 2 and 4 (p = 1.00). Conclusion: Intravitreal 2 mg/0.1 cc infliximab injection exacerbated inflammation in an EIU model; whereas systemic infliximab treatment at a dose of 5 mg/kg suppressed inflammation effectively and rapidly.
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Affiliation(s)
- Oya Donmez
- Department of Ophthalmology, Bayindir Kavaklidere Hospital , Ankara , Turkey
| | - Aylin Yaman
- Department of Ophthalmology, Dokuz Eylul University School of Medicine , Izmir , Turkey
| | - Taylan Ozturk
- Department of Ophthalmology, Dokuz Eylul University School of Medicine , Izmir , Turkey
| | - Safiye Aktas
- Department of Basic Oncology, Oncology Institute, Dokuz Eylul University School of Medicine , Izmir , Turkey
| | - Zekiye Sultan Altun
- Department of Basic Oncology, Oncology Institute, Dokuz Eylul University School of Medicine , Izmir , Turkey
| | - Osman Yılmaz
- Department of Experimental Animal Laboratory, Dokuz Eylul University School of Medicine , Izmir , Turkey
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16
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Guclu H, Pelitli Gurlu V. Comparison of topical nepafenac 0.1% with intravitreal dexamethasone implant for the treatment of Irvine-Gass syndrome. Int J Ophthalmol 2019; 12:258-267. [PMID: 30809482 DOI: 10.18240/ijo.2019.02.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/25/2018] [Indexed: 12/30/2022] Open
Abstract
AIM To compare safety and efficacy of intravitreal dexamethasone (IVD) implant with topical nepafenac (TN) 0.1% in previously untreated Irvine-Gass syndrome (IGS) in clinical practice. METHODS This was a retrospective study of 62 eyes with IGS after phacoemulsification with posterior chamber intraocular lens (IOL) implantation. None of the patients used treatment before IVD or TN. Best-corrected visual acuity (BCVA) with Early Treatment Diabetic Retinopathy Study chart (ETDRS), slit-lamp, intraocular pressure (IOP) measurement, fundus examination, spectral-domain optical coherence tomography (OCT) and fundus florescein angiography were performed to all subjects at baseline, 1, 3 and 6mo. RESULTS The mean BCVA of the IVD group was 49.3±6.8, and the mean BCVA of the TN group was 32.9±7.3 ETDRS letters in post-treatment month 6. The mean central macular thickness (CRT) of IVD group was 266.6±53.5 µm and the mean CRT of TN group was 364.9±56.3 µm in post-treatment month 6. Baseline BCVA has correlation with final BCVA in TN group however there was no correlation between baseline BCVA and final BCVA in IVD group. CONCLUSION IVD is found to be better than TN in controlling pseudophakic macular edema and improving visual acuity. IVD group also has significantly lower CRT however IOP is not significantly different between two groups in post-treatment month 6.
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Affiliation(s)
- Hande Guclu
- Department of Opthalmology, Trakya University, Faculty of Medicine, Edirne 22030, Turkey
| | - Vuslat Pelitli Gurlu
- Department of Opthalmology, Trakya University, Faculty of Medicine, Edirne 22030, Turkey
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17
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Hernandez-Gamez AG, Garcia-Bañuelos JJ, Armendariz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomes Topical Formulation for the Treatment of Cystoid Macular Edema After Cataract Surgery: A Pilot Study. J Ocul Pharmacol Ther 2019; 35:106-115. [PMID: 30614750 PMCID: PMC6450453 DOI: 10.1089/jop.2018.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: To report tolerability, safety, and efficacy of a topical triamcinolone acetonide-loaded liposomes formulation (TA-LF) in targeting the macular area in patients with refractory pseudophakic cystoid macular edema (PCME). Methods: For tolerability, safety and efficacy evaluation, 12 eyes of 12 patients with refractory PCME were exposed to one drop of TA-LF (TA at 0.2%) every 2 h for 90 days or until best-corrected visual acuity (BCVA) was achieved. Intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. Results: Patients with refractory PCME under TA-LF therapy showed a significant improvement in BVCA and CFT without significant IOP modification (P = 0.94). On average CFT decreased to 206.75 ± 135.72 μm and BCVA improved to 20.08 ± 10.35 letters (P < 0.0005). BCVA was achieved at 10.58 ± 6.70 weeks (range 2–18). TA-LF was well tolerated in all cases. Neither ocular surface abnormalities nor adverse events were recorded. Conclusion: TA-LF was well tolerated and improved BCVA and CFT on patients with refractory PCME.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Juan Carlos Altamirano-Vallejo
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | | | - Jesus Javier Garcia-Bañuelos
- 4 Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | | | - Arturo Santos
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
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18
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Sandhu HS, Kaplan HJ. Novel therapies in the treatment of noninfectious uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1477590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Harpal Singh Sandhu
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Henry J Kaplan
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Louisville, Louisville, KY, USA
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Zayit-Soudry S, Vainer I, Zemel E, Mimouni M, Rabena M, Pieramici DJ, Perlman I, Loewenstein A. Infliximab exerts a dose-dependent effect on retinal safety in the albino rabbit. Doc Ophthalmol 2017; 135:175-185. [PMID: 28825191 DOI: 10.1007/s10633-017-9606-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the retinal toxicity of an intravitreal injection of infliximab, a monoclonal antibody to tumor necrosis factor α, in a rabbit model. MATERIALS AND METHODS Two groups of adult albino rabbits (n = 5) received intravitreal injections of infliximab (0.1 ml) in the study eye and balanced salt solution (BSS, 0.1 ml) in the control eye at baseline. Group 1 was administered with 1.5 mg/0.1 ml, and group 2 was injected with 7.5 mg/0.1 ml of infliximab solution. Electroretinography (ERG) was performed at baseline and at 1, 7, 30, and 45 days after the injection. Visual evoked potentials (VEPs) were recorded at 7 and 45 days after the injection. After the last electrophysiological assessment, the rabbits were euthanized and retinal histopathology and immunhistochemistry for glial fibrillary acidic protein (GFAP) were performed. RESULTS ERG responses demonstrated no significant deficit in retinal function in eyes injected with infliximab. Mean dark-adapted a-wave and b-wave maximal amplitude and semi-saturation constant values at baseline and throughout the 45 days of follow-up after the injection indicated no remarkable difference in outer retinal function between the control and experimental eyes. VEP responses were similar at each time point (7 and 45 days). No difference was seen in retinal histopathology and immunocytochemistry sections in eyes receiving the 1.5 mg/0.1 ml dose compared to the control eyes. However, increased GFAP labeling in retinal Müller cells was detected in rabbit eyes treated with the 7.5 mg/0.1 ml dose. CONCLUSIONS Intravitreal injection of 1.5 mg/0.1 ml infliximab dose has no toxic effect on the integrity (functional or structural) of the retina in rabbits. A higher dose of 7.5 mg/0.1 ml may be slightly toxic as suggested by positive Müller cell GFAP expression. Additional studies of retinal toxicity at higher doses and after multiple injections are needed to establish the retinal safety of intravitreal infliximab therapy in humans.
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Affiliation(s)
| | - Igor Vainer
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Esther Zemel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Rappaport Institute for Biomedical Research, Technion Israel Institute of Technology, Haifa, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Melvin Rabena
- California Retina Consultants and Research Foundation, Santa Barbara, CA, USA
| | - Dante J Pieramici
- California Retina Consultants and Research Foundation, Santa Barbara, CA, USA
| | - Ido Perlman
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Rappaport Institute for Biomedical Research, Technion Israel Institute of Technology, Haifa, Israel
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bonfiglio V, Reibaldi M, Fallico M, Russo A, Pizzo A, Fichera S, Rapisarda C, Macchi I, Avitabile T, Longo A. Widening use of dexamethasone implant for the treatment of macular edema. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2359-2372. [PMID: 28860707 PMCID: PMC5566324 DOI: 10.2147/dddt.s138922] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Sustained-release intravitreal 0.7 mg dexamethasone (DEX) implant is approved in Europe for the treatment of macular edema related to diabetic retinopathy, branch retinal vein occlusion, central retinal vein occlusion, and non-infectious uveitis. The implant is formulated in a biodegradable copolymer to release the active ingredient within the vitreous chamber for up to 6 months after an intravitreal injection, allowing a prolonged interval of efficacy between injections with a good safety profile. Various other ocular pathologies with inflammatory etiopathogeneses associated with macular edema have been treated by DEX implant, including neovascular age-related macular degeneration, Irvine-Gass syndrome, vasoproliferative retinal tumors, retinal telangiectasia, Coats' disease, radiation maculopathy, retinitis pigmentosa, and macular edema secondary to scleral buckling and pars plana vitrectomy. We undertook a review to provide a comprehensive collection of all of the diseases that benefit from the use of the sustained-release DEX implant, alone or in combination with concomitant therapies. A MEDLINE search revealed lack of randomized controlled trials related to these indications. Therefore we included and analyzed all available studies (retrospective and prospective, comparative and non-comparative, randomized and nonrandomized, single center and multicenter, and case report). There are reports in the literature of the use of DEX implant across a range of macular edema-related pathologies, with their clinical experience supporting the use of DEX implant on a case-by-case basis with the aim of improving patient outcomes in many macular pathologies. As many of the reported macular pathologies are difficult to treat, a new treatment option that has a beneficial influence on the clinical course of the disease may be useful in clinical practice.
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Affiliation(s)
| | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Alessandra Pizzo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Stefano Fichera
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Carlo Rapisarda
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Iacopo Macchi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
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INTRAVITREAL INFLIXIMAB IN REFRACTORY UVEITIS IN BEHCET'S DISEASE: A Safety and Efficacy Clinical Study. Retina 2017; 36:2399-2408. [PMID: 27870802 DOI: 10.1097/iae.0000000000001109] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the safety and efficacy of intravitreal infliximab (1 mg/0.05 mL) in patients with refractory posterior uveitis in Behcet's disease. METHODS Twenty patients were included in this study. Best corrected visual acuity (BCVA), vitreous haze (graded 0-4), vasculitis, retinitis, and papillopathy (presence or absence) were assessed at baseline, Day 1 and Week 2, 4, 6, 8, 12, and 18. Optical coherence tomography (OCT) central foveal thickness, fluorescein angiography, and flash electroretinogram were done at baseline and 4, 12, and 18 weeks. RESULTS Mean baseline logMAR BCVA was 0.94 (20/160), had improved significantly by Week 2 to 0.6 (20/80) (P < 0.0001), and reached 0.36 (20/40) by Weeks 18 with three injections (P < 0.0001). Mean central foveal thickness OCT decreased significantly from baseline 361 μm to 180 μm at the end of follow-up (P < 0.0001). Profound decrease in mean vitreous haze gradings from two to 0.2 by the end follow-up (P < 0.05). There was a significant reduction in the number of patients with vasculitis (15 at baseline to 1 weeks at 18 weeks), retinitis (nine at baseline to none at 4 weeks), and papillitis (two at baseline to none at 4 weeks) (P < 0.05). No significant electrophysiological changes or ocular adverse inflammatory reactions were observed during the study period. CONCLUSION Intravitreal infliximab appeared to be safe and effective in treating uveitis in Behcet's disease and should be considered as an alternative to systemic therapies.
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Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine-Gass syndrome: a prospective case series. Eye (Lond) 2016; 30:1549-1557. [PMID: 27858937 DOI: 10.1038/eye.2016.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/15/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeTo determine the preliminary efficacy and safety of off-label dexamethasone implant for treatment of recurrent cystoid macular edema (CME) secondary to Irvine-Gass syndrome (IGS).Patients and methodsThis study was set in Raghudeep Eye Clinic, Ahmedabad and LV Prasad Eye Institute, Hyderabad (India). It is a Prospective Case Series. Prospective case series comprising of patients with uncomplicated pseudophakia and CME due to IGS who recurred after one course of topical steroids with NSAIDS and a sub-Tenon corticosteroid injection. A complete ocular and systemic exam, fluorescein angiography, and central subfield thickness (CST) on optical coherence tomography scans were performed. Follow-up visits were on days 1, 15, and 30 and then monthly for a year. Appropriate statistical analysis was done. The primary outcome measure was the change in CDVA at months 1, 6, and 12. Secondary outcome measures were recurrence of CME and complications if any as noted at months 1, 2, 6, and 12.ResultsAbout 27 patients (27 eyes) with 16 males were included. Median age: 63.24±5.62 years. At 1 month, the CDVA improved to 0.04±0.02 (20/25) logMAR from 0.52±0.12 logMAR (20/70) (P=0.001) with a reduction in CST from 454.2±45.3 to 218.32±38.15 microns(P=0.013). The CDVA was 0.04±0.03 logMAR(P<0.001) at month 6 and 0.05±0.02 logMAR(P<0.001) at month 12. The CST was 221±35.2 microns (P=0.013) at month 6 and 214±43.34 microns (P=0.0124) at month 12. All improvements were maintained for a year. Only one patient required a second injection. No complications were noted.ConclusionThe implant is safe and effective for the treatment of recurrent CME due to IGS.
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Grzybowski A, Sikorski BL, Ascaso FJ, Huerva V. Pseudophakic cystoid macular edema: update 2016. Clin Interv Aging 2016; 11:1221-1229. [PMID: 27672316 PMCID: PMC5025006 DOI: 10.2147/cia.s111761] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery, leading in some cases to a decrease in vision. Although the pathogenesis of PCME is not completely understood, the contribution of postsurgical inflammation is generally accepted. Consequently, anti-inflammatory medicines, including steroids and nonsteroidal anti-inflammatory drugs, have been postulated as having a role in both the prophylaxis and treatment of PCME. However, the lack of a uniformly accepted PCME definition, conflicting data on some risk factors, and the scarcity of studies comparing the role of nonsteroidal anti-inflammatory drugs to steroids in PCME prevention make the problem of PCME one of the puzzles of ophthalmology. This paper presents an updated review on the pathogenesis, risk factors, and use of anti-inflammatory drugs in PCME that reflect current research and practice.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Department of Ophthalmology, Poznań City Hospital, Poznań, Poland
| | - Bartosz L Sikorski
- Department of Ophthalmology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Valentín Huerva
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida, Spain; IRB Lleida, Lleida, Spain
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24
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Bellocq D, Pierre-Kahn V, Matonti F, Burillon C, Voirin N, Dot C, Akesbi J, Milazzo S, Baillif S, Soler V, Wolff B, Scemama C, Malclès A, Weber M, Kodjikian L. Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine-Gass syndrome: the EPISODIC-2 study. Br J Ophthalmol 2016; 101:333-341. [PMID: 27190126 DOI: 10.1136/bjophthalmol-2016-308544] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 11/04/2022]
Abstract
AIM To assess the effectiveness of intravitreal dexamethasone implants for treating postsurgical macular oedema (PSMO) including Irvine-Gass syndrome and determining the predictive factors of treatment response. METHODS Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. One hundred patients were included between April 2011 and June 2014, with a minimum of 1-year follow-up. Patients received dexamethasone implant 0.7 mg at baseline. Clinical characteristics, best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT) and intraocular pressure were measured at each visit. The main outcome measure was the change in BCVA (Early Treatment of Diabetic Retinopathy Study (ETDRS) letters: L). An analysis of predictive factors of treatment response is also provided. RESULTS Mean improvement in BCVA was 9.6 (±10.6) L at month 6 and 10.3 (±10.7) L at month 12 (p<0.001). The proportion of eyes with gains in BCVA of 15 or more letters was 32.5% and 37.5% at months 6 and 12, respectively. The mean reduction in CSMT was 135.2 and 160.9 µm at months 6 and 12, respectively (p<0.001). Thirty-seven per cent of patients did not need a second injection after the first injection during follow-up. The presence of at least one PSMO risk factor decreases the probability of a gain in visual acuity (VA) ≥10 L (p=0.006). Initial VA ≤50 L at baseline and non-naïve status decrease the probability of having only one injection during follow-up (p=0.044). CONCLUSIONS The significant gain in BCVA from baseline achieved at month 6 was maintained at month 12 after intravitreal injection of dexamethasone implant. Naïve status seems to be a good predictive factor of treatment response.
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Affiliation(s)
- David Bellocq
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,CNRS UMR 5510 Mateis, Villeurbanne, France
| | | | - Frédéric Matonti
- Department of Ophthalmology, Nord Hospital, Aix Marseille University, Institut de Neurosciences de la Timone, CNRS/ UMR7289, Marseille, France
| | - Carole Burillon
- Department of Ophthalmology, Edouard Herriot Hospital, University of Lyon I, Institut de Biologie et Chimie des Protéines, CNRS/ UMR5086, Lyon, France
| | - Nicolas Voirin
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive, CNRS, UMR 5558, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes military Hospital, University of Val de Grâce, Paris, France
| | - Jad Akesbi
- Department of Ophthalmology, XV XX Ophthalmic National Hospital Center, Paris, France
| | - Solange Milazzo
- Department of Ophthalmology, University of Picardie Jules Verne, CHU Amiens Picardie -Site Sud D408 Amiens cedex 1 80054 . France. Center n° 86 of network EVICR-net, Amiens, France
| | - Stéphanie Baillif
- Department of Ophthalmology, Saint Roch University Hospital, Nice Sophia Antipolis, France
| | - Vincent Soler
- Department of Ophthalmology, University Hospital, Toulouse, France
| | | | - Claire Scemama
- Department of Ophthalmology, Fondation Rotschild, Paris, France
| | - Ariane Malclès
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,CNRS UMR 5510 Mateis, Villeurbanne, France
| | - Michel Weber
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,CNRS UMR 5510 Mateis, Villeurbanne, France
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Fernández-Vega B, Fernández-Vega Á, Rangel CM, Nicieza J, Villota-Deleu E, Vega JA, Sanchez-Avila RM. Blockade of Tumor Necrosis Factor-Alpha: A Role for Adalimumab in Neovascular Age-Related Macular Degeneration Refractory to Anti-Angiogenesis Therapy? Case Rep Ophthalmol 2016; 7:154-62. [PMID: 27065854 PMCID: PMC4821150 DOI: 10.1159/000445102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS To report a case of wet age-related macular degeneration (wet-AMD) refractory to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in a patient who showed visual and anatomical improvement and stabilization after starting a subcutaneous treatment course with adalimumab, an anti-tumor necrosis factor-alpha (TNF-α) drug, for concomitant Crohn's disease. METHODS Observational case report of a female patient. Ophthalmological evaluation was performed by slit lamp and ophthalmoscopy (posterior pole and anterior segment). Best-corrected visual acuity (BCVA) was determined, and imaging was performed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). Intravitreal therapies used and treatment with anti-TNF-α were recorded. RESULTS A 64-year-old woman with wet-AMD was treated with fourteen intravitreal injections of ranibizumab (0.5 mg) for a period of 40 months with intervals of 1-6 months. She initially showed a good visual and anatomical response to periodic anti-VEGF treatment but during check visits, anatomical and functional responses deteriorated. At the 40-month follow-up, the patient had developed Crohn's disease, and her rheumatologist started treatment with adalimumab (40 mg subcutaneously every 2 weeks). During the 25 months of treatment with adalimumab, the patient did not require any additional intravitreal anti-VEGF treatments because her BCVA, clinical, and OCT findings improved and remained stable. CONCLUSIONS We described a case of a patient with wet-AMD refractory to anti-VEGF therapy, which clinically benefited from subcutaneous adalimumab therapy. Treatment with subcutaneous anti-TNF-α in combination with anti-VEGF therapy avoids the high cost and risks related to multiple intravitreal anti-VEGF injections with good functional and anatomic outcomes.
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Affiliation(s)
| | | | - Carlos Mario Rangel
- Instituto Oftalmológico Fernández-Vega, Oviedo, Spain; Fundación Oftalmológica de Santander, FOSCAL, Floridablanca, Colombia
| | | | | | - José A Vega
- Instituto Oftalmológico Fernández-Vega, Oviedo, Spain; Departamento de Morfología y Biología Celular, Universidad de Oviedo, Oviedo, Spain
| | - Ronald M Sanchez-Avila
- Instituto Oftalmológico Fernández-Vega, Oviedo, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain
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Meyer LM, Philipp S, Fischer MT, Distelmaier P, Paquet P, Graf NE, Haritoglou C, Schönfeld CL. Incidence of cystoid macular edema following secondary posterior chamber intraocular lens implantation. J Cataract Refract Surg 2015; 41:1860-6. [DOI: 10.1016/j.jcrs.2015.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/23/2014] [Accepted: 01/26/2015] [Indexed: 10/22/2022]
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Adalimumab Reduces Photoreceptor Cell Death in A Mouse Model of Retinal Degeneration. Sci Rep 2015; 5:11764. [PMID: 26170250 PMCID: PMC4501000 DOI: 10.1038/srep11764] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/02/2015] [Indexed: 12/29/2022] Open
Abstract
Growing evidence suggests that inflammation is involved in the progression of retinitis pigmentosa (RP) both in patients and in animal models. The aim of this study was to investigate the effect of Adalimumab, a monoclonal anti-TNFα antibody, on retinal degeneration in a murine model of human autosomal recessive RP, the rd10 mice at postnatal day (P) 18. In our housing conditions, rd10 retinas were seriously damaged at P18. Adalimumab reduced photoreceptor cell death, as determined by scoring the number of TUNEL-positive cells. In addition, nuclear poly (ADP) ribose (PAR) content, an indirect measure of PAR polymerase (PARP) activity, was also reduced after treatment. The blockade of TNFα ameliorated reactive gliosis, as visualized by decreased GFAP and IBA1 immunolabelling (Müller cell and microglial markers, respectively) and decreased up-regulation of TNFα gene expression. Adalimumab also improved antioxidant response by restoring total antioxidant capacity and superoxide dismutase activity. Finally, we observed that Adalimumab normalized energetic and metabolic pattern in rd10 mouse retinas. Our study suggests that the TNFα blockade could be a successful therapeutic approach to increase photoreceptor survival during the progression of RP. Further studies are needed to characterize its effect along the progression of the disease.
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Bellocq D, Korobelnik JF, Burillon C, Voirin N, Dot C, Souied E, Conrath J, Milazzo S, Massin P, Baillif S, Kodjikian L. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study. Br J Ophthalmol 2015; 99:979-83. [PMID: 25583283 DOI: 10.1136/bjophthalmol-2014-306159] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/26/2014] [Indexed: 11/03/2022]
Abstract
AIM To assess the effectiveness and safety of intravitreal dexamethasone implants for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments. METHODS Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. 50 patients were included in the study between March 2011 and June 2013 with a minimum 6 months follow-up. At baseline, each patient received a dexamethasone implant 0.7 mg (Ozurdex). Best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and intraocular pressure (IOP) were measured at baseline and then monthly. The main outcome measure was the mean change in BCVA (in ETDRS letters (Early Treatment Diabetic Retinopathy Study): L) RESULTS: Baseline mean±SD BCVA was 55.7±15.4 L. At month 2, BCVA was 71.8±10.5 L and 61.2% of patients had an increase of more than 15 letters. Baseline mean CSMT was 544±117.2 μm and this decreased to 302 μm at month 2. Anatomic and functional recurrences were both first detected from month 3 and continued throughout follow-up, with values consistently above baseline. The peak in IOP was reached in month 1 with mean IOP of 15.3±4.6 mm Hg. Of the 39/50 patients followed up for 12 months, 49% received a second injection. The anatomic and functional response and safety patterns were similar to that obtained with the first intravitreal injection, demonstrating Ozurdex's reproducibility. However, more than half of the patients followed-up for at least 1 year presented neither functional nor anatomical recurrence. CONCLUSIONS Ozurdex would appear to be an interesting alternative therapy for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments.
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Affiliation(s)
- David Bellocq
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France CNRS UMR 5510 Mateis, Villeurbanne, France
| | - Jean-François Korobelnik
- Université de Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France INSERM, ISPED, CHUde Bordeaux, France Service d'ophtalmologie, CHUde Bordeaux, France
| | - Carole Burillon
- Department of Ophthalmology, Edouard Herriot Hospital, University of Lyon I, Lyon, France Institut de Biologie et Chimie des Protéines, CNRS/UMR5086, Lyon, France
| | - Nicolas Voirin
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France Université de Lyon, Lyon, France Université Lyon 1, Villeurbanne, France CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes military Hospital, University of Val de Grâce, Lyon, France
| | - Eric Souied
- Hopital Intercommunal de Creteil, University Paris Est, Creteil, France
| | - John Conrath
- Centre d'Ophtalmologie Monticelli-Paradis, Marseille, France
| | - Solange Milazzo
- Department of Ophthalmology, University of Picardie Jules Verne, Clinic Saint Victor, 354, Boulevard of Beauville, Amiens, France Center n° 86 of network EVICR-net
| | - Pascale Massin
- Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris (AP-HP) Université Paris 7, Hôpital Lariboisière, Paris, France
| | - Stéphanie Baillif
- Departement of Ophthalmology, Saint Roch University Hospital, Nice Sophia Antipolis, Nice, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France CNRS UMR 5510 Mateis, Villeurbanne, France
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Ilhan N, Ustun N, Tuzcu EA, Coskun M, Yagiz AE, Ilhan O, Parlakfikirer N. Spectral domain-optical coherence tomographic findings in patients with ankylosing spondylitis under anti-tumor necrosis factor-alpha therapy. Cutan Ocul Toxicol 2014; 34:222-6. [PMID: 25363064 DOI: 10.3109/15569527.2014.956178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the effect of tumor necrosis factor-alpha (TNF-α) blockade on the thickness of the peripapillary retinal nerve fiber layer (RNFL), the ganglion cell-inner plexiform layers (GCIPL), and the macula in ankylosing spondylitis (AS) patients under anti-TNF-α therapy. MATERIALS AND METHODS Twenty-one patients with AS received etanercept, or adalimumab, or infliximab for at least 6 months. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were measured before and 6 months after the beginning of the treatment. Peripapillary RNFL, four regional fields (superior, inferior, nasal, and temporal), GCIPL, and macular thicknesses of the patients were analyzed by optical coherence tomography before the treatment, at 3 months and 6 months after the beginning of the treatment. RESULTS The mean BASDAI, ESR, and CRP values were 5.2 ± 1.5, 31.6 ± 21.7, and 15.7 ± 13.9, respectively, at the beginning of the treatment and 2.3 ± 1.7, 21.3 ± 15.1, and 10.1 ± 10.3, respectively, 6 months after the beginning of treatment. There were significant differences among the mean BASDAI, ESR, and CRP values at the beginning of treatment and 6 months later (p < 0.001, p = 0.007, and p = 0.009, respectively). There were no significant differences among peripapillary RNFL (p = 0.24), four regional fields (p = 0.98, p = 0.23, p = 0.09, p = 0.47), GCIPL (p = 0.25), or macular (p = 0.33) thicknesses of the patients during anti-TNF-α treatment. In addition, the mean intraocular pressure levels throughout the follow-up did not show significant variation on repeated-measures ANOVA (p = 0.77). CONCLUSIONS TNF-α blockade does not seem to influence RNFL, GCIPL, or macular thickness of patients with AS in the short term.
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Pascual-Camps I, Hernández-Martínez P, Monje-Fernández L, Dolz-Marco R, Gallego-Pinazo R, Wu L, Arévalo JF, Díaz-Llopis M. Update on intravitreal anti-tumor necrosis factor alpha therapies for ocular disorders. J Ophthalmic Inflamm Infect 2014; 4:26. [PMID: 25825604 PMCID: PMC4372686 DOI: 10.1186/s12348-014-0026-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/24/2014] [Indexed: 12/31/2022] Open
Abstract
Tumor necrosis factor alpha (TNF-?) is an important pro-inflammatory cytokine associated with a variety of ocular diseases. The currently available TNF-? inhibitors are etanercept, infliximab, adalimumab, golimumab, and certolizumab. Experimental and clinical studies on the intravitreal use of these agents have been reported with etanercept, infliximab, and adalimumab: etanercept has shown limited efficacy in scarce reports; infliximab has been associated with local safety concerns but appears to benefit certain cases; adalimumab has shown no efficacy in cases of age-related macular degeneration (AMD) or diabetic macular edema (DME), but the combination with bevacizumab may be effective in refractory cases of macular diseases. Further preclinical and clinical studies are warranted in order to be able to obtain a more robust conclusion on the use of intravitreal TNF-? inhibitors.
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Affiliation(s)
- Isabel Pascual-Camps
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Pablo Hernández-Martínez
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Laura Monje-Fernández
- Department of Ophthalmology, University Hospital Complex, Alto de Nava s/n, Leon, 24071, Spain
| | - Rosa Dolz-Marco
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Roberto Gallego-Pinazo
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Lihteh Wu
- Instituto de Cirugía Ocular, Paseo Colón, San José, PO BOX 3971-1000, Costa Rica
| | - J Fernando Arévalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore 21287, MD, USA ; Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al Arubah Rd, Umm AL Hamam AL Gharbi, Riyadh 12329, Saudi Arabia
| | - Manuel Díaz-Llopis
- Faculty of Medicine, University of Valencia, Av Blasco Ibañez, 15, Valencia, 46010, Spain
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Lee K, Bajwa A, Freitas-Neto CA, Metzinger JL, Wentworth BA, Foster CS. A comprehensive review and update on the biologic treatment of adult noninfectious uveitis: part II. Expert Opin Biol Ther 2014; 14:1651-66. [PMID: 25226284 DOI: 10.1517/14712598.2014.947957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Treatment of adult, noninfectious uveitis remains a major challenge for ophthalmologists around the world, especially in regard to recalcitrant cases. It is reported to comprise approximately 10% of preventable blindness in the USA. The cause of uveitis can be idiopathic or associated with infectious and systemic disorders. The era of biologic medical therapies provides new options for patients with otherwise treatment-resistant inflammatory eye disease. AREAS COVERED This two-part review gives a comprehensive overview of the existing medical treatment options for patients with adult, noninfectious uveitis, as well as important advances for the treatment ocular inflammation. Part I covers classic immunomodulation and latest information on corticosteroid therapy. In part II, emerging therapies are discussed, including biologic response modifiers, experimental treatments and ongoing clinical studies for uveitis. EXPERT OPINION The hazard of chronic corticosteroid use in the treatment of adult, noninfectious uveitis is well documented. Corticosteroid-sparing therapies, which offer a very favorable risk-benefit profile when administered properly, should be substituted. Although nothing is currently approved for on-label use in this indication, many therapies, through either translation or novel basic science research, have the potential to fill the currently exposed gaps.
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Affiliation(s)
- Kyungmin Lee
- Massachusetts Eye Research and Surgery Institution (MERSI) , 5 Cambridge Center, 8th Floor, Cambridge, MA 02142 , USA +1 617 621 6377 ; +1 617 494 1430 ;
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Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert Panel Recommendations for the Use of Anti–Tumor Necrosis Factor Biologic Agents in Patients with Ocular Inflammatory Disorders. Ophthalmology 2014; 121:785-96.e3. [DOI: 10.1016/j.ophtha.2013.09.048] [Citation(s) in RCA: 327] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 12/14/2022] Open
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He Y, Jia SB, Zhang W, Shi JM. New options for uveitis treatment. Int J Ophthalmol 2013; 6:702-7. [PMID: 24195053 DOI: 10.3980/j.issn.2222-3959.2013.05.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 08/08/2013] [Indexed: 01/28/2023] Open
Abstract
Uveitis is one of the most important causes of blindness worldwide. Its etiology and pathogenesis are complicated and have not been well understood. The treatment for uveitis is predominantly based on steroids and immunosuppressants. However, systemic side effects limit their clinical application. With the advancement of molecular biology, some intravitreal implants and biologic agents have been used for the treatment of uveitis. Additionally, novel techniques such as gene therapy and RNA interference are being studied for using as uveitis therapy. This paper reviews recent advances in uveitis treatment.
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Affiliation(s)
- Yu He
- Department of Ophthalmology, Fuling Center Hospital of Chongqing City, Chongqing 408000, China ; Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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