1
|
Logeswaran A, Azzopardi M, Demir B, D'Alonzo G, Chong YJ, Addison P, Pavesio C. Real-World Experience of Fluocinolone Acetonide 0.19 mg in the Management of Non-Infectious Uveitis. Ocul Immunol Inflamm 2024:1-6. [PMID: 39042811 DOI: 10.1080/09273948.2024.2375016] [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: 04/29/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE This study aims to evaluate the real-world efficacy and safety profile of fluocinolone acetonide (FAc) implants for the treatment of non-infectious uveitis (NIU). METHODS A retrospective, observational study was conducted at Moorfields Eye Hospital, London, involving patients who received FAc 0.19 mg implants (Iluvien®) for NIU. 2-year follow-up data on baseline characteristics, indications, and outcomes was collected. The primary indicator for treatment failure was defined as the need for rescue treatment with dexamethasone (DEX) implants, while secondary indicators included changes in steroid and systemic immunosuppression requirements, or the need for a second FAc implant before 3 years. The occurrence of complications was collected. RESULTS Of the 146 eyes treated with FAc implants, 24.0% experienced treatment failure requiring DEX implant within 2 years. About 42.9% required this within the first 6 months. There was an increase in the number of patients requiring steroids and/or systemic immunosuppression. Within the first 2 years post-FAc implant, only 13.7% experienced an IOP rise, with 4.1% requiring IOP-lowering surgery. About 57.9% of the phakic eyes developed cataracts. CONCLUSION This study provides valuable real-world evidence supporting the efficacy of FAc implant in NIU. It demonstrates a good safety profile at 2 years, with a significant reduction in uveitis recurrence rate and treatment burden. Our results are especially pertinent to the treatment of uveitic cystoid macular oedema (CMO), which was the primary indication in over 75% of our patients. Furthermore, it suggests that while FAc implant controls retinal inflammation effectively, choroidal inflammation would require alternative treatment.
Collapse
Affiliation(s)
- Abison Logeswaran
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Matthew Azzopardi
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Bahar Demir
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Giulia D'Alonzo
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Yu Jeat Chong
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore, Singapore
| | - Peter Addison
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Zhou Y, Zhen F, Wu J, Wang S, Lu X, Yang G, Hu Z, Chen F, Li Q, Dong S. Intravitreal Dexamethasone Implant (Ozurdex) for Ocular Toxocariasis. J Ophthalmol 2024; 2024:6685092. [PMID: 39041005 PMCID: PMC11262872 DOI: 10.1155/2024/6685092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/13/2023] [Accepted: 02/02/2024] [Indexed: 07/24/2024] Open
Abstract
This study aimed to evaluate the efficacy and safety of intravitreal dexamethasone implants in the treatment of ocular toxocariasis (OT). A retrospective analysis was performed on 6 cases in which laboratory tests diagnosed OT. All patients were administered with intravitreal dexamethasone implants with or without vitrectomy. The average follow-up time was 19.7 months. All operated eyes achieved anatomic success, and all patients' visual acuity was improved. Five of these six had a visual acuity of 20/100, and three had final acuity of 20/40 or even better. Intravitreal dexamethasone implants can be used to treat different types of OT, which not only effectively control inflammation and improve the patient's vision but also reduce the use of systemic glucocorticoids.
Collapse
Affiliation(s)
- Yongwei Zhou
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Fangyuan Zhen
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Jiahui Wu
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Shasha Wang
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Xiaoyan Lu
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Ge Yang
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Zhirou Hu
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Fei Chen
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Qiuming Li
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Shuqian Dong
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| |
Collapse
|
3
|
Zhang T, Liu Z, Li N. The application of dexamethasone implants in uveitis treatment. Front Med (Lausanne) 2024; 11:1402396. [PMID: 39005654 PMCID: PMC11239344 DOI: 10.3389/fmed.2024.1402396] [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: 03/17/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Uveitis refers to a group of ocular inflammatory diseases that can significantly impair vision. Although systemic corticosteroid therapy has shown substantial efficacy in treating uveitis, extensive use of corticosteroids is associated with significant adverse effects. Recently, a biodegradable, sustained-release implant, namely dexamethasone intravitreal implant (Ozurdex), has been reported for treating non-infectious and infectious uveitis. This review aims to summarize the experiences with Ozurdex treatment across various forms of uveitis and to assist readers in understanding the appropriate timing and potential side effects of Ozurdex in uveitis treatment, thereby maximizing patient benefits in uveitis management.
Collapse
Affiliation(s)
- Tian Zhang
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Zhutao Liu
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Na Li
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| |
Collapse
|
4
|
Mao X, Dai Z, Yang J, Wu Y, Xie F, Lu Y, Yu J, Chang F, Lu Y. Cost-Effectiveness Analysis of Fluocinolone Acetonide Intravitreal (FAI) Implant for Chronic Noninfectious Uveitis Affecting the Posterior Segment of the Eye (NIU-PS) in China. Ophthalmol Ther 2024; 13:1757-1772. [PMID: 38676875 PMCID: PMC11109073 DOI: 10.1007/s40123-024-00939-6] [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: 02/17/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION Chronic non-infectious uveitis affecting the posterior segment (NIU-PS), which can be recurrent and persistent for numerous years, mainly affects people of working age and significantly increases the risk of visual impairment. This study aimed to investigate the cost-effectiveness of fluocinolone acetonide intravitreal (FAI) implant in the treatment of patients with chronic NIU-PS from the Chinese healthcare perspective. METHODS A Markov model with a 2-week cycle was constructed from the perspective of the Chinese healthcare system over a lifetime time horizon. The model consists of four health states: on-treatment, treatment failure, blindness, and death. The outcomes for effectiveness were based on the Chinese real-world study (RWS). Utilities and mortality rates were derived from published literature and standard sources. Costs were determined from the MENET website, prices of medical service items at local providers, published literature, and expert surveys. Outcomes were measured in quality-adjusted life years (QALYs). Sensitivity analyses were performed to account for the impact of uncertainty. RESULTS It was estimated that in the base case, the FAI implant provided 0.43 incremental QALYs compared with the limited current practice (LCP) at an additional cost of $7503.72 (¥50,575.05), resulting in an incremental cost-effectiveness ratio (ICER) of $17,373.49 (¥117,097.33) per QALY gained. Parameters related to utility emerged as the primary influencers on the outcomes. In probabilistic sensitivity analysis (PSA), considering the willingness-to-pay (WTP) threshold of $19,072 (¥128,547) and $38,145 (¥257,094), the FAI implant had 67.70% and 99.50% probability of being cost-effective, respectively. As demonstrated in the scenario analysis, if the FAI implant aligns its price reduction with the average rate from the 2023 negotiation of the National Reimbursement Drug List (NRDL), it would result in lower costs and represent an absolute advantage. CONCLUSIONS The FAI implant, which can effectively reduce the recurrence rate and maintain the incremental costs within the WTP limit, is likely to be cost-effective in treating chronic NIU-PS in China.
Collapse
Affiliation(s)
- Xin Mao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Zhanjing Dai
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Jing Yang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Yuhang Wu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Fan Xie
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Yun Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Jie Yu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Feng Chang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China.
| | - Yuqiong Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China.
| |
Collapse
|
5
|
Cicinelli MV, Gerosolima C, Scandale P, Touhami S, Pohlmann D, Giocanti A, Rosenblatt A, Loewenstein A, Bandello F, Miserocchi E. Clinical and imaging biomarkers of response to intravitreal dexamethasone implant in eyes with non-infectious uveitic macular oedema. Eye (Lond) 2024; 38:910-916. [PMID: 37904001 DOI: 10.1038/s41433-023-02802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To investigate clinical and spectral-domain optical coherence tomography (SD-OCT) biomarkers correlating with pre-injection visual acuity (VA), post-injection VA, and the likelihood of macular oedema (MO) regression following dexamethasone (DEX) implant injection in non-infectious uveitic (NIU) patients. METHODS Patient data from Uveitis Services in Milan, Paris, and Berlin were analysed. Eligible participants were NIU patients aged >18 years with MO as the primary indication for DEX treatment. SD-OCT scans and clinical data were collected at the time of DEX injection (pre-injection visit) and after 3 months (post-injection visit). Multivariable regression models, adjusted for pre-injection VA and lens status, were employed to explore associations. MO regression was defined as the absence of intraretinal/subretinal fluid at the post-injection visit. RESULTS Our analysis comprised data from 173 DEX treatments, encompassing 103 eyes from 80 patients, with 38 eyes (37%) receiving repeated DEX injections. The absence of the ellipsoid zone (EZ) layer and disorganisation of the inner retinal layers (DRIL) were associated with worse pre- (+0.19 LogMAR, 95% CI 0.01-0.38, p = 0.06, and +0.10 LogMAR, 95% CI 0.02-0.21, p = 0.01) and post-injection VA (+0.33 LogMAR, 95% CI 0.08-0.57, p = 0.01, and +0.17 LogMAR, 95% CI 0.01-0.32, p = 0.04). EZ disruption and DRIL increased significantly (p = 0.01 and p = 0.04), and the chance of gaining ≥5 letters declined in eyes undergoing repeated DEX (p = 0.002). The rate of MO regression after each DEX was 67%. Prolonged MO duration (OR = 0.75/each year, p = 0.02) was associated with reduced likelihood of MO regression. Subretinal fluid was associated with higher rate of MO regression (OR = 6.09, p = 0.01). CONCLUSION Integrity of the inner and outer retina is associated with better visual response to DEX. Long-standing or recurrent MO is associated with less chance of both visual and anatomic response. Timely treatment is necessary to maximise the outcomes of MO in NIU patients.
Collapse
Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Claudia Gerosolima
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Scandale
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Touhami
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Dominika Pohlmann
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353, Berlin, Germany
| | - Audrey Giocanti
- INSERM, Bordeaux Population Health Research Center, UMR1219, Université de Bordeaux, Bordeaux, France
| | - Amir Rosenblatt
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
6
|
Sun L, Huang L, Li S, Lu J, Zheng S, Ding X. Safety and effectiveness of intravitreal dexamethasone implant in patients with ocular toxocariasis. Br J Ophthalmol 2024; 108:238-243. [PMID: 36596664 DOI: 10.1136/bjo-2022-322244] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/27/2022] [Indexed: 01/05/2023]
Abstract
AIMS To evaluate the safety and effectiveness of intravitreal dexamethasone (DEX) implant in patients with active uveitis due to ocular toxocariasis (OT). METHODS Seventy-eight patients with OT were recruited in this retrospective study, including 51 patients in DEX group treated with intravitreal DEX implant and 27 patients in control group without intervention. The reduction of vitreous haze scores (VHS), the best-corrected visual acuity (BCVA) changes, intraocular pressure (IOP) and cataract progression and formation were recorded at baseline (V0), 1 (V1), 3 (V3) and 6 months (V6) after treatment in DEX group, and V0 and V6 in control group. RESULTS There was no change in VHS and BCVA in control group between V0 and V6. Better VHS (p=0.001) and BCVA (p=0.022) was achieved in DEX group; the rate of VHS=0 was 0%, 67.4%, 42.9% and 44.9% at V0, V1, V3 and V6, respectively (p<0.001), and the mean BCVA was improved from logMAR 1.5±0.9 to 1.2±0.9 at V1, 1.4±1.0 at V3 and 1.4±1.2 at V6. A favourable BCVA at V1 was associated with older age (p=0.038) and uninvolved macula (p=0.000) in DEX group. No significant difference in IOP elevation ≥10 mm Hg, cataract progression and formation between groups. More eyes needed retinal surgery in control group (p<0.001). CONCLUSIONS This was the first study to investigate use of intravitreal DEX implant in OT patients, which can efficiently reduce ocular inflammation and improve BCVA in macular uninvolved patients.
Collapse
Affiliation(s)
- Limei Sun
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Li Huang
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Songshan Li
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jinglin Lu
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shuxin Zheng
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoyan Ding
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Sun Yat-Sen University Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Guangzhou, China
| |
Collapse
|
7
|
Ayaz Y, Erkan Pota Ç, Başol İ, Doğan ME, Türkoğlu Şen EB, Ünal M. Anterior segment complications after dexamethasone implantations:real world data. Int Ophthalmol 2023; 43:4279-4287. [PMID: 37707746 DOI: 10.1007/s10792-023-02838-4] [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: 01/02/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE We aim to contribute to the literature in terms of treatment safety with our real world data by examining the anterior segment complications and follow-up results of patients who underwent dexamethasone implants in our clinic. METHODS The records of patients treated with at least one intravitreal dexamethasone implant for various retinal diseases: diabetic macular edema (265 eyes), central retinal vein occlusion (45 eyes), retinal vein branch occlusion (91 eyes), postoperative cystoid macular edema (18 eyes), non-infectious uveitis (37 eyes) and other (14 eyes) between July 2013 and April 2020 were reviewed. RESULTS After 925 injections were applied to 470 eyes of a total of 383 patients, the eyes were controlled during a mean follow-up of 24 months. No complications were detected in 328 eyes. Intraocular pressure (IOP) above 25 mmHg was detected in 97 eyes (20.6%) that had no previous history of ocular hypertension. Of these 97 eyes, 71 (73.1%) eyes with increased IOP were treated with topical monotherapy, 26 (26.8%) eyes were treated with topical combined therapy and 1 (1.03%) patient had glaucoma surgery. Cataracts requiring surgical intervention developed in 55 (%21.73) of 253 phakic eyes. Three patients have anterior chamber dislocation of dexamethasone, 1 patient was hospitalized with sterile endophthalmitis on the 7th day after the injection, and pars plana vitrectomy was performed. CONCLUSION This study is the first long-term follow-up study in our country evaluating the safety of dexamethasone implant injections in various retinal diseases and presenting the first real world data. Cataract progression and increased IOP were found to be the most common side effects. We observed that the patient's diagnosis did not cause a statistically significant change in the observation of side effects. As a result of our findings, close follow-up of IOP after the injection of dexamethasone implants would be appropriate.
Collapse
Affiliation(s)
- Yusuf Ayaz
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Çisil Erkan Pota
- Department of Ophthalmology, Antalya Manavgat State Hospital, Antalya, Turkey.
| | - İbrahim Başol
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Mehmet Erkan Doğan
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
| | | | - Mustafa Ünal
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
| |
Collapse
|
8
|
Moll-Udina A, Hernanz I, Sainz-de-la-Maza M, Pelegrín L, Coelho-Borges AI, Pazos M, Adán A, Llorenç V. Intravitreal fluocinolone acetonide 0.19 mg (ILUVIEN®) in patients with non-infectious uveitis: real-world effectiveness and safety outcomes at 12 months. Int Ophthalmol 2023; 43:4181-4195. [PMID: 37698661 PMCID: PMC10520169 DOI: 10.1007/s10792-023-02828-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/27/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE This study assessed the effectiveness of the 0.19-mg fluocinolone acetonide (FAc) implant by multimodal measurements in patients with non-infectious uveitis (NIU) in a real-world setting in Spain. METHODS A prospective study of patients who had NIU including uveitic macular oedema (UME) with ≥ 12 months follow-up was done. Exclusion criteria include infectious uveitis and uncontrolled glaucoma or ocular hypertension requiring more than 2 medications. Effectiveness was assessed using a multicomponent outcome measure that included nine outcomes. Effectiveness was defined as all components being met at every timepoint. Secondary outcome measures were onset or progression of glaucoma and investigator-reported adverse events. RESULTS Twenty-six eyes from 22 patients were included, with 96.2% having an indication including UME. During the 12-month study, the FAc implant was effective in 15 (57.7%) eyes, reaching effectiveness as soon as 2 weeks post-implantation. Mean best-corrected visual acuity and mean central macular thickness (CMT) were significantly improved vs. baseline at all timepoints (all comparisons p < 0.01). During the 12-month study, inflammation markers (anterior chamber cells and vitreous haze) had also significantly declined. Factors predicting effectiveness at month 12 were systemic corticosteroid dose pre-FAc, higher immunomodulatory therapy (IMT) load at baseline and thicker retinal nerve fibre layer (RNFL) at baseline (all p < 0.05). Factors predicting failure were male gender, thinner RNFL at baseline and treatment ineffectiveness at 1 month (all p < 0.05). In parallel, corticosteroid and IMT use also declined significantly. No significant increase in IOP was detected. CONCLUSION The FAc implant is safe and effective at treating NIU over 12 months in a real-world setting in Spain.
Collapse
Affiliation(s)
- Aina Moll-Udina
- Facultat de Medicina, University of Barcelona, Barcelona, Spain.
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain.
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | | | - Maite Sainz-de-la-Maza
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laura Pelegrín
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Marta Pazos
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Victor Llorenç
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| |
Collapse
|
9
|
Pockar S, Leal I, Chhabra R, Jones NP, Steeples LR. Intravitreal Fluocinolone 0.19mg Implant in the Management of Chronic Non-Infectious Uveitis: 12-Month Outcomes from a Single Tertiary Centre. Ocul Immunol Inflamm 2023; 31:1572-1578. [PMID: 34124978 DOI: 10.1080/09273948.2021.1922707] [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: 12/28/2020] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
AIM To present efficacy and safety of 0.19 mg fluocinolone acetonide insert (FAi) to treat chronic noninfectious uveitis (NIU) in a single referral center. METHODS A retrospective observational clinical study of 11 eyes with NIU complicated by chronic cystoid macular edema (CMO). RESULTS The main indication for treatment was chronic CMO in all 11 eyes. The mean central retinal thickness (CRT) at baseline was 435 μm ± 176, improving to 296 μm ± 67 at 12 months. Raised intraocular pressure (IOP) was the commonest adverse event. An IOP >21 mmHg was observed in three eyes, and >30 mmHg in one eye, managed with topical therapy. The mean best corrected visual acuity (BCVA) was stable at 12 months. There were no observed recurrences of uveitis. Two eyes received adjunctive treatment for worsening CRT. CONCLUSIONS Our results suggest FAi is an effective maintenance treatment for NIU with favorable functional and anatomical outcomes.
Collapse
Affiliation(s)
- Sasa Pockar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Nicholas P Jones
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| |
Collapse
|
10
|
Gupta RB, Ilin J, Gottlieb CC. Efficacy of intravitreal dexamethasone implant used as monotherapy for the treatment of macular edema in non-infectious uveitis: a retrospective analysis. J Ophthalmic Inflamm Infect 2023; 13:42. [PMID: 37721556 PMCID: PMC10506974 DOI: 10.1186/s12348-023-00360-3] [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: 11/20/2022] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Uveitic macular edema is a complication of acute or chronic uveitis. Current treatment regiments frequently have numerous side effects, often requiring supplemental treatment. This study investigates the efficacy of dexamethasone (DEX) intravitreal implants as monotherapy for treatment of macular edema in non-infectious intermediate, posterior or panuveitis. METHODS AND RESULTS Retrospective chart review of thirty patients with intermediate, posterior and panuveitis treated with DEX. Outcomes measured were central retinal thickness (CRT) and best corrected visual acuity (BCVA). Baseline measurements of CRT and BCVA were measured within 1 month prior to intravitreal DEX implant and follow up measurements were collected until 1 year post implant. 48 implants on 39 eyes of 30 patients were included in this study; 64.1% of patients had an improvement in BCVA and 65.4% had a reduction in CRT. BCVA improved from 0.285 logMAR (SD: 0.312) at baseline to 0.175 logMAR (SD: 0.194) at 1 month and was sustained thereafter. Preliminary CRT data showed a decrease from 392 [Formula: see text] (SD: [Formula: see text]) at baseline to 303 [Formula: see text] (SD: [Formula: see text] at 1 month and 313 [Formula: see text] (SD: [Formula: see text] at 12 months. CONCLUSIONS The DEX implant as monotherapy for macular edema in non-infectious uveitis was associated with a reduction in CRT and improvement in BCVA. The DEX implant, used as a monotherapy in eyes with intermediate, posterior and panuveitis, has the potential to treat uveitis without oral corticosteroid or other immunomodulatory therapy.
Collapse
Affiliation(s)
- Rishi B Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Julius Ilin
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Chloe C Gottlieb
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| |
Collapse
|
11
|
Teabagy S, Wood E, Bilsbury E, Doherty S, Janardhana P, Lee DJ. Ocular immunosuppressive microenvironment and novel drug delivery for control of uveitis. Adv Drug Deliv Rev 2023; 198:114869. [PMID: 37172782 PMCID: PMC10330522 DOI: 10.1016/j.addr.2023.114869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Ocular immune privilege is a phenomenon described by Peter Medawar in relation to the indefinite survival of the placement of foreign tissue grafts into the eye. Several mechanisms have been described that contribute to ocular immune privilege, such as a blood-ocular barrier and lack of lymphatics in the eye, the production of immune-suppressing molecules inside the ocular microenvironment, and the induction of systemic regulatory immunity against antigens found in the eye. Because ocular immune privilege is not absolute, failure of it can result in uveitis. Uveitis is a group of inflammatory disorders that can lead to vision loss if not treated properly. The current uveitis treatments involve the use of immunosuppressive and anti-inflammatory medications. Researching mechanisms of ocular immune privilege and the development of novel treatments for uveitis is ongoing. This review discusses mechanisms of ocular immune privilege, followed by an overview of uveitis treatments and ongoing clinical trials.
Collapse
Affiliation(s)
- Sean Teabagy
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Emma Wood
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Evan Bilsbury
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sean Doherty
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Priya Janardhana
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Darren J Lee
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| |
Collapse
|
12
|
Menia NK, Mohan S, Agarwal A. Intravitreal immunotherapy in non-infectious uveitis: an update. Expert Rev Clin Pharmacol 2023; 16:959-976. [PMID: 37674332 DOI: 10.1080/17512433.2023.2256660] [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: 03/27/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION In the past several years, there have been numerous advances in pharmacotherapeutics for the management of uveitis and other ocular inflammatory diseases, including newer therapeutic agents and ocular drug delivery systems. One of the most attractive modes of drug delivery is the intravitreal route since it has proven to be safe and efficacious and prevents unwanted systemic adverse events related to the agent. AREAS COVERED In this review, intravitreal delivery of various pharmacotherapeutic agents for noninfectious uveitis has been described. An extensive review of the literature was performed using specific keywords on the PubMed database to identify clinical studies employing various pharmacotherapeutic agents with intravitreal drug delivery for noninfectious uveitis. The mode of action, safety, efficacy, and tolerability of these drugs have also been elucidated. EXPERT OPINION Several agents, including biologic response modifier agents, have been found to be safe and efficacious for various indications of uveitis, such as cystoid macular edema, active uveitis, and other conditions such as retinal vasculitis and vitreous haze. The use of intravitreal biological therapies, especially infliximab, has been fraught with potential safety signals such as photoreceptor toxicity. However, pharmacotherapeutic agents such as corticosteroids and anti-vascular endothelial growth factor agents are now widely used in the clinical management of uveitis and its complications.
Collapse
Affiliation(s)
- Nitin Kumar Menia
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jammu, India
| | - Sashwanthi Mohan
- Department of Ophthalmology, Medcare Eye Center, Dubai, United Arab Emirates
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
13
|
Koksaldi S, Kayabaşi M, Ayhan Z, Kaya M, Öztürk T, Yaman A, Saatci AO. Dexamethasone intravitreal implant for macular edema and some other rare indications in uveitis. MEDICINE INTERNATIONAL 2023; 3:39. [PMID: 37560325 PMCID: PMC10407465 DOI: 10.3892/mi.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
In the present study, 110 eyes of 81 patients with uveitis who underwent intravitreal dexamethasone implant (IDI) injection and had a follow-up of at least 6 months between January, 2012 and September, 2022, were retrospectively analyzed. A total of 298 IDI injections were administered (mean, 2.71±2.37; range, 1-12). The mean age of the patients was 49.44±16.67 years (range, 15-86 years). The mean follow-up time after the first IDI was 34.31±26.53 months (range, 6-115 months). In total, 77 (95.1%) patients had non-infectious uveitis, while 4 patients (4.9%) received IDI for uveitic macular edema in association with infectious uveitis (1 patient with acute retinal necrosis and 3 patients with systemic tuberculosis). IDI was injected under the umbrella of intravitreal ganciclovir injection in the patient with healed acute retinal necrosis for the associated pseudophakic cystoid macular edema. A total of 6 patients (7.4%) received IDI prior to phacoemulsification surgery to control the possible post-operative macular edema. In addition, 3 patients (3.7%) with Vogt-Koyanagi-Harada disease received bilateral IDI as the systemic therapy could not be administered due to side-effects of the systemic treatment. In total, 1 patient (1.2%) with idiopathic retinal vasculitis, aneurysms and neuroretinitis was treated with IDI injections in both eyes in addition to systemic therapy to reduce the ongoing inflammation. Of note, two eyes (1.8%) received simultaneous single IDI and anti-vascular endothelial growth factor administration for the treatment of unilateral extrafoveal macular neovascularization (one with active serpiginous choroiditis and one with sympathetic ophthalmia). IDI was administered for the treatment of uveitic macular edema in 68 patients (83.9%). Best-corrected visual acuity improved from 0.69±0.64 to 0.60±0.76 logMAR at the final visit (P=0.008). Baseline mean central macular thickness (CMT) was 499.74±229.60 µm (range, 187-1,187 µm) and the mean final CMT was 296.60±152.02 µm (range, 126-848 µm). Intraocular pressure elevation requiring topical antiglaucomatous eye drops occurred in 28 eyes (25.5%). During the follow-up period, bilateral glaucoma surgery was required in 1 patient (1.2%) and 25 of 65 phakic eyes (38.4%) underwent phacoemulsification. Retinal detachment occurred in one eye (0.9%), endophthalmitis in one eye (0.9%), and transient intravitreal hemorrhage occurred in three eyes (2.7%) after the IDI injections. On the whole, the present study demonstrates that although IDI is mostly employed in non-infectious uveitic eyes with macular edema, it can also be administered in cases with systemic therapy intolerance, pseudophakic macular edema prophylaxis, and with great caution, in selected cases involving infectious uveitis and macular edema.
Collapse
Affiliation(s)
- Seher Koksaldi
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Mustafa Kayabaşi
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Zıya Ayhan
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | | | - Taylan Öztürk
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Aylın Yaman
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| |
Collapse
|
14
|
Giani T, Luppino AF, Ferrara G. Treatment Options in Pediatric Behçet's Disease. Paediatr Drugs 2023; 25:165-191. [PMID: 36626047 PMCID: PMC9838500 DOI: 10.1007/s40272-022-00548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 01/11/2023]
Abstract
Behçet's disease is a rare and poorly understood vasculitis affecting blood vessels of all types and sizes. Uveitis and oral and genital ulcers represent the typical clinical triad. Populations along the ancient trading route connecting the Mediterranean basin with the Middle and Far East are most affected. Up to a quarter of the cases has a pediatric onset, typically around puberty. The aim of the treatment is early intervention to control inflammation, with symptom relief and prevention of relapses, damage, and complications. The heterogeneous clinical presentation often requires a multidisciplinary and tailored approach. Ocular, neurological, gastrointestinal, and vascular involvement is associated with a worse prognosis and needs more aggressive treatments. In young patients with expected prolonged disease, treatment should also focus on preventive measures and lifestyle advice. In recent years, the pharmacological armamentarium has grown progressively, although only a limited number of drugs are currently authorized for pediatric use. Most evidence for these drugs still derives from adult studies and experience; these are prescribed as off-label medications and are only available as adult formulations. Corticosteroids frequently represent the mainstay for the management of the initial acute phases, but their potential serious adverse effects limit their use to short periods. Different conventional disease-modifying anti-rheumatic drugs have long been used. Many other biologic drugs targeting different cytokines such as interleukin-1, interleukin-6, and interleukin-17 and treatments with small molecules including the phosphodiesterase 4 and Janus kinase inhibitors are emerging as novel promising therapeutic agents. In recent years, a growing interest has developed around anti-tumor necrosis factor agents that have often proven to be effective in severe cases, especially in those with a gastrointestinal and ocular involvement.
Collapse
|
15
|
Sève P, Jacquot R, El Jammal T, Bert A, Jamilloux Y, Kodjikian L, Giorgiutti S. [Sarcoid uveitis: Ophthalmologist's and internist's viewpoints]. Rev Med Interne 2023; 44:112-122. [PMID: 36642624 DOI: 10.1016/j.revmed.2022.10.001] [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: 09/05/2022] [Accepted: 10/01/2022] [Indexed: 01/15/2023]
Abstract
Sarcoidosis is one of the leading causes of inflammatory eye disease. All ocular structures can be affected, but uveitis is the main manifestation responsible for vision loss in ocular sarcoidosis. Typical sarcoid anterior uveitis presents with mutton-fat keratic precipitates, iris nodules, and posterior synechiae. Posterior involvement includes vitritis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence of sarcoid uveitis. Patients with clinically isolated uveitis at diagnosis rarely develop other organ involvement. Even though, ocular sarcoidosis can have a severe impact on visual prognosis, early diagnosis and a wider range of available therapies (including intravitreal implants) have lessened the functional impact of the disease, particularly in the last decade. Corticosteroids are the cornerstone of treatment for sarcoidosis, but up to 30% of patients achieve remission with requiring high-dose systemic steroids. In these cases, the use of steroid-sparing immunosuppressive therapy (such as methotrexate) is unavoidable. Among these immunosuppressive treatments, anti TNF-α drugs have been a revolution in the management of non-infectious uveitis.
Collapse
Affiliation(s)
- P Sève
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Hospices civils de Lyon, Pôle IMER, 69003 Lyon, France; Université de Lyon, Lyon, France; University Lyon, University Claude Bernard-Lyon 1, HESPER EA 7425, 69008 Lyon, France.
| | - R Jacquot
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - T El Jammal
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - A Bert
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - Y Jamilloux
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - L Kodjikian
- Service d'ophtalmologie, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, Lyon, France
| | - S Giorgiutti
- Service d'immunologie clinique et médecine interne, CNR RESO, maladies auto-immunes et systémiques rares, Nouvel Hôpital civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| |
Collapse
|
16
|
Butt F, Devonport H. Treatment of Non-Infectious Posterior Uveitis with Dexamethasone Intravitreal Implants in a Real-World Setting. Clin Ophthalmol 2023; 17:601-611. [PMID: 36814784 PMCID: PMC9940496 DOI: 10.2147/opth.s393662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose The present study aimed to assess the efficacy and safety associated to the treatment of patients with non-infectious posterior uveitis with intravitreal dexamethasone (DEX) implants in a real-world clinical setting. Patients and Methods This is a retrospective, single center analysis of the data from 29 patients with non-infectious posterior uveitis in whom 38 eyes were treated with dexamethasone intravitreal implants in routine clinical practice between January 2012 and October 2017. The parameters of visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were recorded 6 weeks after the first implant was administered, in accordance with the clinical guidelines for the use of these implants, and after a 6-month follow-up period. In addition, the formation of cataracts was evaluated at 12 months. Results Treatment with the DEX implant caused a significant improvement in the VA from baseline at 6 weeks in eyes treated with 2-6 implants and for eyes without cataracts. A significant decrease in CRT was observed relative to the baseline at 6 weeks for eyes treated with 1 and 2-6 implants, which was maintained at 6 months for those eyes treated with 2-6 implants. This significant improvement in CRT at 6 weeks and 6 months was evident in eyes with and without cataracts. During the study period, the IOP was found to increase significantly from baseline at 6 weeks in some eyes but this was managed topically, and no surgical intervention was necessary. Conclusion Intravitreal DEX implants represent an effective and safe therapy for the treatment of non-infectious uveitis in routine clinical practice, producing favorable visual and anatomical outcomes after the administration of just 2-6 DEX implants.
Collapse
Affiliation(s)
- Farhat Butt
- Opthalmology Department, Bradford Royal Infirmary, Duckworth Lane, BD9 6RJ, UK,Correspondence: Farhat Butt, Bradford Royal Infirmary, Duckworth Lane, BD9 6RJ, UK, Tel +44 7834 922022, Fax +44 1274 364786, Email
| | - Helen Devonport
- Opthalmology Department, Bradford Royal Infirmary, Duckworth Lane, BD9 6RJ, UK
| |
Collapse
|
17
|
Cai M, Xu Z, Zhou X, Li L, Hua X, Guo S, Yuan X. Long-acting acid-sensitive ketal-linked dexamethasone microcrystals for treating experimental autoimmune uveitis. APL Bioeng 2022; 6:046101. [PMID: 36313265 PMCID: PMC9612960 DOI: 10.1063/5.0118311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Corticosteroids have for some time been used as first-line drugs for the topical treatment of noninfectious uveitis, but poor ocular bioavailability and the rapid clearance of eye drops necessitate frequent dosing, reducing patient compliance. In this study, we used an acid-sensitive stearoxyl-ketal-dexamethasone pro-drug microcrystals (SKD MCs), which is consistently safe and effective in the control of uveitis inflammation in rats. We used a rat model of experimental autoimmune uveitis (EAU) to evaluate the effects of SKD MCs in terms of clinical manifestations, molecular biology, pathological histology, and visual electrophysiology compared to dexamethasone sodium phosphate injection or phosphate-buffered saline. SKD MCs significantly reduced inflammation in EAU, improved the ability to suppress inflammatory cytokines and to protect retinal function, and significantly reduced retinal microglia activation, with no increase in intraocular pressure throughout the treatment. Our results indicate that the SKD MCs formulation holds promise as a new strategy for the treatment of noninfectious uveitis and potentially other ocular inflammatory diseases.
Collapse
Affiliation(s)
- Maoyu Cai
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China,Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin 300020, China
| | - Zunkai Xu
- Key Laboratory of Functional Polymer Materials of Ministry of Education, State Key Laboratory of Medicinal Chemical Biology and Institute of Polymer Chemistry, College of Chemistry, Nankai University, Tianjin 300071, China
| | - Xueyan Zhou
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Liangpin Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China,Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin 300020, China
| | - Xia Hua
- Aier Eye Institute, Changsha 410015, China,Tianjin Aier Eye Hospital, Tianjin 300190, China,Authors to whom correspondence should be addressed:; ; and
| | - Shutao Guo
- Key Laboratory of Functional Polymer Materials of Ministry of Education, State Key Laboratory of Medicinal Chemical Biology and Institute of Polymer Chemistry, College of Chemistry, Nankai University, Tianjin 300071, China,Authors to whom correspondence should be addressed:; ; and
| | - Xiaoyong Yuan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China,Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin 300020, China,Authors to whom correspondence should be addressed:; ; and
| |
Collapse
|
18
|
Modugno RL, Testi I, Pavesio C. Intraocular therapy in noninfectious uveitis. J Ophthalmic Inflamm Infect 2021; 11:37. [PMID: 34632541 PMCID: PMC8502718 DOI: 10.1186/s12348-021-00267-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 09/19/2021] [Indexed: 12/29/2022] Open
Abstract
Systemic corticosteroids and immunosuppressant agents are the mainstay of therapy for non-infectious uveitis (NIU). However, the risks associated with systemic administration and the need of delivering an effective and safe anti-inflammatory treatment targeted to the site of inflammation have prompt the use of local therapy in the management of NIU. This review will analyse the different local treatment options available, including corticosteroids, anti-vascular endothelial growth factor (VEGF), methotrexate and the recent biologics.
Collapse
Affiliation(s)
- Rocco Luigi Modugno
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | - Ilaria Testi
- Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK. .,Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK.
| |
Collapse
|
19
|
Intravitreal Dexamethasone Implants for Refractory Macular Edema in Eyes with Noninfectious Uveitis. J Clin Med 2021; 10:jcm10173762. [PMID: 34501209 PMCID: PMC8432099 DOI: 10.3390/jcm10173762] [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: 06/23/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022] Open
Abstract
Macular edema (ME) is a common cause of visual loss among eyes with uveitis, and its management can be challenging. Steroids are an effective treatment for ME, and intravitreal dexamethasone (DEX) implants provide sustained steroid release. The purpose of this study is to evaluate intravitreal DEX implant on refractory ME in eyes with noninfectious uveitis. A retrospective study including 52 eyes of 37 patients with refractory uveitic ME was conducted from January 2011 through August 2017 at Linkou Chang Gung Memorial Hospital in Taiwan. Patients’ demographic characteristics were collected. In addition, clinical information, including corrected visual acuity (VA), intraocular pressure (IOP), and central retinal thickness (CRT) on optical coherence tomography, was recorded and analyzed. During the study period, affected eyes received a total of 110 intravitreal DEX implants (range, one to six in each eye). After the first DEX implant injection in all eyes, VA significantly improved at one and two months. CRT significantly decreased one month after a single DEX implant, and the effect lasted for six months and waned over time. Patients receiving multiple DEX implants still showed significant decreases in CRT one month after the first implant. Increases in IOP were noted one month after the DEX implant, but the IOP could be medically controlled. Intravitreal DEX implants can effectively treat refractory uveitic ME, improving both VA and CRT with an acceptable safety profile. Further studies are necessary to evaluate the effect of multiple implants and long-term outcomes.
Collapse
|
20
|
Conrady CD, Yeh S. A Review of Ocular Drug Delivery Platforms and Drugs for Infectious and Noninfectious Uveitis: The Past, Present, and Future. Pharmaceutics 2021; 13:1224. [PMID: 34452185 PMCID: PMC8399730 DOI: 10.3390/pharmaceutics13081224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Uveitis refers to a broad group of inflammatory disorders of the eye that often require medical and surgical management to improve or stabilize vision and prevent vision-threatening pathological changes to the eye. Drug delivery to the eye to combat inflammation and subsequent complications from uveitic conditions is complex as there are multiple barriers to absorption limiting availability of the needed drug in the affected tissues. As such, there has been substantial interest in developing new drugs and drug delivery platforms to help reduce intraocular inflammation and its complications. In this review, we discuss the challenges of drug delivery, novel technologies recently approved for uveitis patient care and promising drug delivery platforms for uveitis and sequelae of ocular inflammation.
Collapse
Affiliation(s)
- Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Center, University of Nebraska Medical Center, Omaha, NE 68105, USA
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Center, University of Nebraska Medical Center, Omaha, NE 68105, USA
| |
Collapse
|
21
|
Steeples LR, Pockar S, Jones NP, Leal I. Evaluating the Safety, Efficacy and Patient Acceptability of Intravitreal Fluocinolone Acetonide (0.2mcg/Day) Implant in the Treatment of Non-Infectious Uveitis Affecting the Posterior Segment. Clin Ophthalmol 2021; 15:1433-1442. [PMID: 33854297 PMCID: PMC8039205 DOI: 10.2147/opth.s216912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Long-acting, slow-release injectable fluocinolone intravitreal implants have been approved for the treatment of non-infectious uveitis affecting the posterior segment. We summarise the development of intravitreal fluocinolone implants and discuss the technology including pharmacokinetics. We conducted a systematic review of evidence for the efficacy, safety and patient acceptability of fluocinolone 0.18 mg and 0.19 mg injectable implants. We summarise evidence from the pivotal phase 3 studies that lead to the approval of these implants and evaluate real-world including disease-specific evidence. Safety including injection-related events and long-term adverse events is presented.
Collapse
Affiliation(s)
- Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Sasa Pockar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicholas P Jones
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Inês Leal
- Ophthalmology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
22
|
Abstract
PURPOSE To evaluate the real-life efficacy and safety of the intravitreal dexamethasone implant in uveitis. METHODS This retrospective observational multicentric study included 152 eyes treated exclusively by 358 dexamethasone implant injections. The main outcome measures included change in the best-corrected visual acuity, central macular thickness, and vitreous haze score. RESULTS Patients were treated with dexamethasone implant for macular edema (51.3%), vitritis with macular edema (40.1%), vitritis (5.3%), and other causes (3.3%). The mean duration of follow-up was 19.0 months. The mean gain in best-corrected visual acuity during follow-up was +12.1 letters. An improvement in best-corrected visual acuity ≥5, 10, and 15 letters was found in 64.5, 50.7, and 35.5% of cases, respectively. 59.7% of eyes with macular edema at baseline were found to be anatomical responders. Vitritis resolution (vitreous haze = 0+) was obtained in 81.4% of cases. Ocular hypertension (intraocular pressure ≥25 mmHg and/or gain ≥10 mmHg from baseline) occurred in 28.3% of patients. No filtering surgery/laser therapy was required. A total of 40.2% of phakic subjects underwent cataract surgery on average 11.2 months after the first injection. CONCLUSION This study confirms the efficacy and safety of the dexamethasone implant in noninfectious uveitis. Cataract and ocular hypertension were not uncommon but easily manageable.
Collapse
|
23
|
Li YT, Cui XX, Yang XT, Li B, Ren XJ, Li XR, Zhang XM. Utilizing dexamethasone intravitreal implant to control postoperative inflammation in refractory uveitis undergoing cataract surgery. Int J Ophthalmol 2021; 14:317-322. [PMID: 33614464 DOI: 10.18240/ijo.2021.02.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/30/2020] [Indexed: 12/25/2022] Open
Abstract
AIM To report the effectiveness of intravitreal implantation of dexamethasone implant (Ozurdex) after phacoemulsification and intraocular lens implantation in refractory uveitis patients. METHODS This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation. The main outcome measurements were best-corrected visual acuity (BCVA), central retinal thickness (CRT), grade of anterior chamber cell (AAC), intraocular pressure (IOP), and systemic/ocular adverse events. RESULTS Ten eyes of 7 patients were included. BCVA showed significant improvement at 1mo (P=0.004), 3mo (P=0.0004), and 6mo (P=0.001) post operation. There were no statistically significant differences in the postoperative CRT among follow-up groups (P>0.05). No significant differences were observed in the baseline IOP when compared to 1, 3, and 6mo (all P>0.05) post operation. One patient developed a transient elevated IOP post injection. Two eyes (20%) developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. In six patients (8 eyes, 71.4%), the systemic steroid usage was reduced to below 10 mg/d. The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6mo before operation and 0.7±0.48 in the 6mon post operation. The mean recurrence time was 13±0.58wk (range 12-14wk) post operation. In five of seven patients (7 out of 10 eyes), inflammation relapse was developed postoperatively. Only one patient (2 eyes) needed increased amounts of oral corticosteroids. Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids. CONCLUSION Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study. After the disappearance of Ozurdex's anti-inflammatory effects over time, in most cases the recurrent inflammation can be controlled by topical steroids.
Collapse
Affiliation(s)
- Yong-Tao Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xue-Xue Cui
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Tong Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Bing Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xin-Jun Ren
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Rong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Min Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| |
Collapse
|
24
|
Moll-Udina A, Figueras-Roca M, Oliveres J, Sala-Puigdollers A, Esquinas C, Alba-Linero C, Llorenç V, Adán A. Uveitic macular edema response to intravitreal dexamethasone implant is independent of optical coherence tomography findings. Int Ophthalmol 2020; 41:787-796. [PMID: 33184677 DOI: 10.1007/s10792-020-01631-x] [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: 06/17/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify predictive response optical coherence tomography (OCT) findings in uveitic macular edema (UME) treated with intravitreal dexamethasone implant (DEX). METHODS Retrospective study of 66 eyes (53 patients) treated with DEX for UME. SD-OCT macular scans were collected prior to DEX treatment and 6 weeks and 3 months after the DEX implant. OCT images were evaluated for qualitative and quantitative characteristics (central retinal thickness, CRT and macular volume, MV). A multivariate analysis of covariance (ANCOVA) was carried out to study the predictive influence of OCT and clinical covariates on outcomes. The main outcome was a composite endpoint based on the simultaneous gain of 5 or more letters associated with a 20% or more reduction in CRT. RESULTS A significant improvement in BCVA at 6 weeks (mean change from baseline -0.2, SD 0.3) and 3 months (mean -0.2, SD 0.4) was observed after the DEX implant. A significant decrease in CRT (change from baseline -187.7 μm at 3 months) and MV (change from baseline -1.7 mm3 at 3 months) were also observed. An association of ≥ 5-letter improvement in BCVA and a ≥ 20% CRT reduction was observed in 44.6% of cases at 6 weeks and 31.4% at 3 months. ANCOVA multivariate analyses found CRT at 3 months independent from baseline clinical variables but from CRT. CONCLUSION DEX implant is an effective treatment for UME independently of basal characteristics, producing both a gain of visual acuity and improvement of macular anatomy by OCT measures at 3 months.
Collapse
Affiliation(s)
- Aina Moll-Udina
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain. .,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - Marc Figueras-Roca
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Oliveres
- Hospital Vall D'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Esquinas
- Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
25
|
Wallsh J, Luths C, Kil H, Gallemore R. Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review. Clin Ophthalmol 2020; 14:3097-3108. [PMID: 33116361 PMCID: PMC7548337 DOI: 10.2147/opth.s264559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the initial ten years of results from the intravitreal dexamethasone implant (DEX) in patients treated for retinal vein occlusion (RVO), diabetic macular edema (DME) or uveitis. Methods Retrospective chart review of patients receiving DEX since its FDA approval. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure and cataract status were collected. Baseline data were collected from the initial DEX and post-treatment data at the visit at least four weeks after the last DEX. Results In total, 315 eyes received 1216 DEX over 63.9±4.6 weeks. In the branch RVO (n=90), central RVO (n=59) and DME (n=62) cohorts, BCVA improved significantly (p<0.05). The uveitis (n=154) cohort did not have a significant change in BCVA, 0.62±0.04 to 0.61±0.04 logMAR (p=0.34). Younger patients, vitrectomized eyes, and eyes without a history of glaucoma were associated with significantly better BCVA outcomes in the uveitis cohort (p<0.05). Overall, CMT decreased significantly from 376.6±6.8 to 322.7±5.0 µm (p<0.05). Intraocular pressure increased significantly (p<0.001) and the percentage of patients requiring anti-glaucoma medications increased from 33.0% to 67.6%. Of phakic eyes, 58.8% (n=63) had cataract progression or underwent surgery with those who underwent surgery experiencing a significant improvement in BCVA (p<0.05). Conclusion Repeated DEX over extended follow-up offers significant anatomic benefits to all cohorts. Visual benefits are only seen in RVO, DME and select uveitis demographics.
Collapse
Affiliation(s)
- Josh Wallsh
- Albany Medical Center, Department of Ophthalmology, Albany, NY, USA
| | - Charlotte Luths
- Retina Macula Institute and Research Center, Torrance, CA, USA
| | - Haily Kil
- Retina Macula Institute and Research Center, Torrance, CA, USA
| | - Ron Gallemore
- Retina Macula Institute and Research Center, Torrance, CA, USA
| |
Collapse
|
26
|
L Hefler J, M Bailey L, El Rahi C, C Schefler A, Bernicker EH. Panuveitis in patient on ipilimumab/nivolumab combination for small-cell lung cancer treated with an intravitreal dexamethasone implant. J Oncol Pharm Pract 2020; 27:1261-1264. [DOI: 10.1177/1078155220969792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BackgroundImmunotherapy with checkpoint inhibitors has demonstrated durable responses and remarkable antitumor effects in a variety of cancers. Although these agents are generally well-tolerated, patients can experience immune-related adverse events (irAEs) that require prompt recognition by healthcare providers. Immune-related ocular toxicities are rare, but serious adverse events have been reported with the use of checkpoint inhibitors. Case presentation: Here, we describe a rare case of panuveitis during Nivolumab and Ipilimumab combination treatment in a patient being treated for recurrent Small Cell Lung Cancer (SCLC). The patient was managed with an injection of Ozurdex (Allergan, Madison, NJ), a dexamethasone intravitreal implant. The patient had a resolution of inflammation and an improvement in her vision and was able to resume nivolumab monotherapy without recurrence of the panuveitis.ConclusionThis case highlights the importance of early recognition of ocular irAEs by ocular oncologists and the successful approach to treatment of immunotherapy-induced panuveitis in order to avoid permanent cessation of therapy.
Collapse
Affiliation(s)
- Jade L Hefler
- Department of Pharmacy, The University of Kansas Health System, Kansas, USA
| | - Lauren M Bailey
- Department of Pharmacy, Harris Health System, Houston, TX, USA
| | - Cynthia El Rahi
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Amy C Schefler
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Eric H Bernicker
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
27
|
Berkenstock MK, Mir TA, Khan IR, Burkholder BM, Chaon BC, Shifera AS, Thorne JE. Effectiveness of the Dexamethasone Implant in Lieu of Oral Corticosteroids in Intermediate and Posterior Uveitis Requiring Immunosuppression. Ocul Immunol Inflamm 2020; 30:741-749. [PMID: 33021854 DOI: 10.1080/09273948.2020.1826534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate dexamethasone intravitreal implant effectiveness in lieu of high-dose oral prednisone for short-term treatment of noninfectious intermediate and posterior uveitis in patients requiring immunosuppression. METHODS This is a proof-of-concept, open-label, non-comparative clinical trial with 12-month follow-up. The primary outcome was uveitis control without additional prednisone at 6 and 12 months. Secondary outcomes were need for multiple implants or additional prednisone, and safety data. RESULTS 20 patients (28 eyes) were enrolled- 16 eyes had control by 6 months; 20 by 12 months. No patients required high-dose prednisone. 6 patients enrolled on prednisone: 2 stopped; 4 tapered to 7.5 mg daily or less by 12 months. 16 eyes required multiple implants; five required cataract surgery; 12 required drops to control IOP; 2 underwent glaucoma surgery. CONCLUSIONS The dexamethasone implant was effective in lieu of high-dose prednisone although the majority required multiple implants. All patients decreased or discontinued prednisone during follow-up.
Collapse
Affiliation(s)
- Meghan K Berkenstock
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tahreem A Mir
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irfan R Khan
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bryn M Burkholder
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin C Chaon
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amde Selassie Shifera
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer E Thorne
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
28
|
de Vries VA, Bassil FL, Ramdas WD. The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis. Sci Rep 2020; 10:13248. [PMID: 32764619 PMCID: PMC7411061 DOI: 10.1038/s41598-020-70269-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/27/2020] [Indexed: 01/07/2023] Open
Abstract
The number of eye diseases treated with intravitreal injections is increasing. Obviously, an injection of fluid into the eye results in an increase of intraocular pressure (IOP), the main risk factor for glaucoma. However, the effect of these repeated IOP increases on the eye is unclear. Therefore, we performed a systematic review with meta-analyses. PubMed, Embase and Clinical Trials Registries were searched for articles investigating the relationship between intravitreal injections (anti-vascular endothelial growth factor [anti-VEGF] or steroids) and either IOP, retinal nerve fiber layer (RNFL)-thickness and glaucoma. Multiple meta-analyses were performed, combining data on intravitreal injection of anti-VEGF medication and dexamethasone implants. A total of 74 articles were eligible for meta-analyses. The short-term effect of an intravitreal injection of anti-VEGF showed a statistically significant increase in IOP. One day after injection of anti-VEGF, however, IOP was significantly lower than baseline. The long-term time-intervals showed no significant difference in IOP. After intravitreal injection of a dexamethasone implant, IOP was significantly higher than baseline 1 month post-injection. RNFL-thickness was significantly reduced 6 and 12 months post-injection of anti-VEGF, as well as at end of follow up. Caution is advised when using intravitreal medication, especially when treating patients with advanced glaucoma; in these cases, prophylactic IOP-lowering medication may be considered.
Collapse
Affiliation(s)
- Victor A de Vries
- Department of Ophthalmology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fabiana L Bassil
- Department of Ophthalmology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| |
Collapse
|
29
|
Iovino C, Mastropasqua R, Lupidi M, Bacherini D, Pellegrini M, Bernabei F, Borrelli E, Sacconi R, Carnevali A, D’Aloisio R, Cerquaglia A, Finocchio L, Govetto A, Erba S, Triolo G, Di Zazzo A, Forlini M, Vagge A, Giannaccare G. Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature. Pharmaceutics 2020; 12:pharmaceutics12080703. [PMID: 32722556 PMCID: PMC7466091 DOI: 10.3390/pharmaceutics12080703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.
Collapse
Affiliation(s)
- Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-070-609-2319
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
- Fondazione per la Macula Onlus, DINOMGI., University Eye Clinic, 16132 Genova, Italy
- Centre de l’Odéon, 113 Boulevard St Germain, 75006 Paris, France
| | - Daniela Bacherini
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
| | - Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Federico Bernabei
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Enrico Borrelli
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Riccardo Sacconi
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Adriano Carnevali
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
| | - Rossella D’Aloisio
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy;
| | - Alessio Cerquaglia
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
| | - Lucia Finocchio
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V2PD, UK
| | - Andrea Govetto
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS12LX, UK
| | - Stefano Erba
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Giacinto Triolo
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Campus Bio Medico University Hospital, 00128, Rome, Italy;
| | | | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy;
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
| |
Collapse
|
30
|
Kirkland KA, Uwaydat SH, Siddiqui MZ, Chancellor JR, Soliman MK, Kurup S, Sallam AB. Outcome of Intravitreal Dexamethasone Implant Use in Uveitic Eyes Undergoing Pars Plana Vitrectomy Surgery. Ocul Immunol Inflamm 2020; 29:1126-1131. [PMID: 32142385 DOI: 10.1080/09273948.2020.1726970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To report the outcomes in eyes with noninfectious uveitis receiving dexamethasone implant at the time of pars plana vitrectomy (PPV).Methods: Retrospective analysis of visual acuity (VA), intraocular pressure (IOP), vitreous haze score (VHS), and central subfield thickness (CST) at baseline and follow-up visits.Results: Fourteen eyes received dexamethasone implant at the time of PPV. The CST was improved from 469 ± 182 µm at baseline to 320 ± 60 at 6 months (p = .0112) and 295 ± 46 at 12 months (p = .0728). Vitritis only recurred in 2 eyes at 6 months (18.2%) and 1 eye at 12 months (14.3%). The probability of VA improvement of ≥0.3 logMAR was 57% at 6 months and 66% at 12 months. Therapy for IOP rise was initiated in 6 eyes (42.9%).Conclusions: Local delivery of dexamethasone implant with PPV is a feasible method to counteract postoperative inflammation and macular thickening.
Collapse
Affiliation(s)
- Kyle A Kirkland
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sami H Uwaydat
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mohammad Z Siddiqui
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John R Chancellor
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mohamed K Soliman
- Department of Ophthalmology, Assiut University, Assiut, Egypt.,Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
| | - Shree Kurup
- Department of Ophthalmology, University Hospital, Cleveland, Ohio, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
31
|
Hasanreisoğlu M, Özdemir HB, Özkan K, Yüksel M, Aktaş Z, Atalay HT, Özdek Ş, Gürelik G. Intravitreal Dexamethasone Implant in the Treatment of Non-infectious Uveitis. Turk J Ophthalmol 2020; 49:250-257. [PMID: 31650791 PMCID: PMC6823586 DOI: 10.4274/tjo.galenos.2019.81594] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the long-term results of intravitreal dexamethasone implant (DEX) for noninfectious uveitis. Materials and Methods: The study included 62 eyes of 44 patients treated with DEX implant due to noninfectious uveitis and followed up for at least a year. Best-corrected visual acuity (BCVA), central foveal thickness, intraocular pressure (IOP), vitreous haze score, indications, immunomodulatory therapy and steroid usage before/after injection, number of injections, and adverse events were analyzed retrospectively. Results: Average follow-up was 20 months (range 12-64 months). The female/male ratio was 29/15. Mean age was 50 years (range 22-75 years). The most frequent uveitis etiologies were idiopathic (25 patients, 40.3%) and Behçet’s uveitis. (17 patients, 27.4%) The signedmost common indication for DEX injection was cystoid macular edema together with resistant vitreous haze (26 eyes, 41.9%). Twenty-two eyes (30%) received more than one DEX injection. Mean BCVA was improved from 0.55 logMAR at baseline to 0.38, 0.32, and 0.35 after 1, 3, and 6 months, respectively (p<0.001 for each). Mean CFT was decreased from 386 μm at baseline to 288, 311, and 302 μm after 1, 3, and 6 months, respectively (p<0.001 for each). Mean IOP did not change significantly during follow-up. Five eyes (8%) received topical anti-glaucoma medication (IOP ≥25 mmHg). Eighteen (46%) of 39 phakic eyes underwent cataract surgery during follow-up. Similar efficacy of the DEX implant was observed in eyes that received multiple injections. Systemic immunomodulatory therapy did not change significantly during follow-up. Conclusion: Intravitreal DEX injection does not alter systemic immunomodulatory therapy, but may facilitate the management of noninfectious uveitis by suppressing local intraocular inflammation. Multiple injections yielded comparable visual and anatomical outcomes to single injections. Follow-up for ocular hypertension and cataract formation are important, especially in eyes receiving multiple injections.
Collapse
Affiliation(s)
- Murat Hasanreisoğlu
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Hüseyin Baran Özdemir
- University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Kaan Özkan
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Murat Yüksel
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Zeynep Aktaş
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Hatice Tuba Atalay
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Gökhan Gürelik
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| |
Collapse
|
32
|
Saincher SS, Gottlieb C. Ozurdex (dexamethasone intravitreal implant) for the treatment of intermediate, posterior, and panuveitis: a systematic review of the current evidence. J Ophthalmic Inflamm Infect 2020; 10:1. [PMID: 31925591 PMCID: PMC6954157 DOI: 10.1186/s12348-019-0189-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background This study aims to determine if the intravitreal dexamethasone implant (DEX implant, Ozurdex; Allergan, Inc., Irvine, California) is effective for treating intermediate, posterior, and panuveitis as a monotherapy or adjunctive treatment to systemic immunomodulatory therapies. Methods A systematic review using MEDLINE, EMBASE, and PubMed database searches was conducted with the Oxford Centre for Evidence-based Medicine Levels of Evidence criteria to select publications. Available background information and patient data from each study was tabulated. Outcomes studied were central retinal thickness (CRT), best corrected visual acuity, intraocular inflammation (anterior chamber cells, vitreous haze), number of patients with prior and concomitant immunomodulatory treatments, intraocular pressure (IOP) elevation (≥ 25 mmHg), and other adverse effects associated with the implant. Results One hundred ninety-five (61.51%) patients had previous immunomodulatory treatment while 232 (64.8%) were treated with concomitant immunomodulatory therapy with the DEX implant. CRT decreased by an average of 198.65 μm (42.74%). Visual acuity improved to an average of 0.451 (logMAR) or 20/57 (Snellen) which is a 43.11% improvement from baseline. One hundred seventy-three (59%) of eyes were quiescent at the end of the trials, of which 40 (13.7%) previously inflamed eyes became quiescent. Elevated IOP occurred in 91 (20.6%). The most common adverse events were cataract/posterior subcapsular opacities in 47 (11.03%) patients and conjunctival hemorrhage in 24 (5.44%) patients. Conclusions The DEX implant is an effective medication for the treatment of posterior segment uveitis, uveitic macular edema, and results in improved visual acuity. Development of elevated IOP and cataract should be closely monitored as they are tangible risks associated with the DEX implant. This study was not able to determine whether the DEX implant was more effective as a monotherapy or as an adjunctive therapy to systemic immunomodulatory treatment.
Collapse
Affiliation(s)
- Saanwalshah Samir Saincher
- Department of Health-Sciences, Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK. .,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Chloe Gottlieb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,University of Ottawa Eye Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW Box 307, Ottawa, Ontario, K1H 8L6, Canada
| |
Collapse
|
33
|
Biswas J, Pyare R. Dexamethasone implant – An update. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2020. [DOI: 10.4103/tjosr.tjosr_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
34
|
Pleyer U, Pohlmann D, Kardeş E, Poddubnyy D, Rademacher J. Emerging drugs for the treatment of noninfectious uveitis. Expert Opin Emerg Drugs 2019; 24:173-190. [PMID: 31498689 DOI: 10.1080/14728214.2019.1663823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Uveitis is a leading cause of visual impairment and a significant burden of blindness. Although corticosteroids and conventional immunosuppressive agents have been successfully used, these are non-specific, and their long-term use may induce significant adverse effects. Areas covered: This article discusses existing local and systemic applied treatments for ocular inflammation including corticosteroids, non-biologic, and biologic disease-modifying anti-rheumatic drugs (DMARD). Potential drugs being studied in clinical trials are introduced for both local and systemic use. Expert opinion: Treatment options for uveitis continue to expand. Still, more efforts and research are needed to better understand the mechanisms potentially leading to clinical trials.
Collapse
Affiliation(s)
- Uwe Pleyer
- Department of Ophthalmology, Campus Virchow, Charité , Berlin , Germany
| | - Dominika Pohlmann
- Department of Ophthalmology, Campus Virchow, Charité , Berlin , Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Esra Kardeş
- Department of Ophthalmology, University of Health Sciences, Umraniye Training and Research Hospital , Istanbul , Turkey
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology , Berlin , Germany.,Epidemiology Unit, German Rheumatism Research Centre , Berlin , Germany
| | - Judith Rademacher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany.,Department of Gastroenterology, Infectiology and Rheumatology , Berlin , Germany
| |
Collapse
|
35
|
Reiff A. Clinical Presentation, Management, and Long-Term Outcome of Pars Planitis, Panuveitis, and Vogt-Koyanagi-Harada Disease in Children and Adolescents. Arthritis Care Res (Hoboken) 2019; 72:1589-1596. [PMID: 31444859 DOI: 10.1002/acr.24056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior uveitis is the most commonly encountered ocular manifestation of rheumatic disease, little is known about the clinical presentation, management, and long-term outcome of more complex eye conditions such as pars planitis (PP), panuveitis (PU), and Vogt-Koyanagi-Harada disease (VKH). The present study was undertaken to comprehensively assess the long-term safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologics for the treatment of pediatric and adolescent patients with PP, PU, and VKH. METHODS We retrospectively reviewed a cohort of 75 children and adolescents with idiopathic PP (n = 50), PU (n = 12), and VKH (n = 14) followed by the Pediatric Rheumatology Core at Children's Hospital Los Angeles and evaluated referral patterns, clinical presentation, treatment response, and long-term clinical outcome. RESULTS Patients were followed for an average of 52 months. Their mean age at disease onset was 10 years. Bilateral eye involvement was seen in 87% of the patients. At first presentation to an ophthalmologist, glaucoma was noted in 21% of patients and vision loss (<20/40) in 87% of patients, while legal blindness (≤20/200 in the better-seeing eye) was diagnosed in 18 of 75 (24%) of patients (PP 22%, PU 36%, and VKH 21%). The average referral time to a pediatric rheumatologist was 13 months (range 1-96 months). Topical steroids were used in all patients, but 98% of patients required additional DMARDs, and 73% required therapy with biologics. After a mean of 52 months, 35% of patients across all disease groups had significant vision loss or were blind, and only 28% were in clinical remission without medications. The worst outcome was observed in children with PU. Regression analysis, young age at onset, delayed referral to a pediatric rheumatologist, and chronic disease were strong predictors for the risk of long-term blindness. CONCLUSION PP, PU, and VKH involve a high risk of permanent vision loss and should be managed by a skilled rheumatologist as early and as aggressively as possible.
Collapse
Affiliation(s)
- Andreas Reiff
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles
| |
Collapse
|
36
|
McCartney M, McCluskey P, Zagora S. Intravitreal dexamethasone implants for non-infectious uveitis. Clin Exp Ophthalmol 2019; 47:1156-1163. [PMID: 31412151 DOI: 10.1111/ceo.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Inflammatory-mediated cystoid macular oedema (CMO) is the most common inflammatory-mediated threat to vision in non-infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained-release dexamethasone (DEX) implant devices provide localized therapy. BACKGROUND The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort. DESIGN A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital. PARTICIPANTS Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies. METHODS Cases from March 2012 and March 2018 were retrospectively selected with follow-up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow-up was 32 weeks. MAIN OUTCOME MEASURES The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure and medication regimens. RESULTS Ninety-five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P < .01). Sixty-one percent demonstrated improved BCVA at week 8 (P < .05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low. CONCLUSIONS AND RELEVANCE In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort.
Collapse
Affiliation(s)
- Matthew McCartney
- Department of General Surgery, St Vincent's Hospital, Sydney, Victoria, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sophia Zagora
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
37
|
Kim M, Kim SA, Park W, Kim RY, Park YH. Intravitreal Dexamethasone Implant for Treatment of Sarcoidosis-Related Uveitis. Adv Ther 2019; 36:2137-2146. [PMID: 31140122 DOI: 10.1007/s12325-019-00989-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the efficacy and safety of intravitreal dexamethasone implant injection in the management of sarcoidosis-related uveitis. METHODS A retrospective analysis was performed of the efficacy and safety of intravitreal dexamethasone implant injection for indications such as intractable vitritis, vasculitis, or cystoid macular edema. RESULTS This study comprised 20 patients with sarcoidosis-related uveitis. A single injection was performed in 13 eyes (65%) and 35% required more than 2 injections during the follow-up period [median 16.5 months (range 6-32)]. The best-corrected visual acuity showed significant improvement at 1 month (P = 0.004) and 3 months (P = 0.001), but there was no significance at 6 months after implant injection (P = 0.186). One month after treatment, the central macular thickness decreased to 278.95 ± 52.20 μm (P = 0.023). It further decreased to 274.70 ± 55.88 μm at 3 months (P = 0.027), but there was no significance at 6 months (280.65 ± 64.48 μm, P = 0.074).The anterior chamber cell grade (P = 0.003) and vitreous haze (P = 0.001) were significantly decreased for up to 6 months after a single implant injection. The most common ocular complication was worsening of cataracts during the first 6 months. CONCLUSION Intravitreal dexamethasone implant injection is efficacious in reducing anterior chamber inflammation, vitreous haze, and cystoid macular edema in patients with sarcoidosis-related uveitis. Considering that sarcoidosis shows a chronic course of disease in a significant proportion of cases, intravitreal dexamethasone implant injection is a possible option to relieve intraocular inflammation.
Collapse
Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Ah Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wookyung Park
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Rae Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
38
|
Coulon C, Kodjikian L, Rochepeau C, Perard L, Jardel S, Burillon C, Broussolle C, Jamilloux Y, Seve P. Ethnicity and association with ocular, systemic manifestations and prognosis in 194 patients with sarcoid uveitis. Graefes Arch Clin Exp Ophthalmol 2019; 257:2495-2503. [PMID: 31302765 DOI: 10.1007/s00417-019-04415-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the ophthalmological and extra-ophthalmological clinical characteristics and visual prognosis of patients with sarcoid uveitis in different ethnic groups. METHODS We retrospectively analysed the data from patients with sarcoid uveitis seen at two departments of Ophthalmology between December 2003 and December 2017. Patients presented biopsy-proven sarcoidosis and/or presumed sarcoid uveitis based on the following criteria: compatible thoracic imaging, associated with elevated angiotensin-conversion enzyme (ACE) and/or lymphocytic alveolitis on bronchoalveolar lavage fluid analysis (> 15% lymphocytes and CD4/CD8 > 3.5). Ophthalmological and general characteristics, as well as visual and global prognoses, were compared in three pre-defined ethnic groups: White Europeans, North Africans and Afro-Caribbeans. RESULTS A total of 194 patients were included: 145 with biopsy-proven and 49 with presumed sarcoid uveitis. Overall, 68% were White Europeans while 20.6% were North Africans and 11.3% were Afro-Caribbeans. Sixty-nine per cent were women and the median age at presentation was 52.1 years. Median ages at first ocular manifestation of the disease in Afro-Caribbeans and North Africans were respectively 34.3 and 43.1 years, while it was 57.8 years in White Europeans (p < 0.001). Ocular involvement was bilateral in 77.8% (n = 151) of the cases and nearly half of the patients had panuveitis (48.5%). Anterior uveitis was more frequent in Afro-Caribbeans (59.1%; p < 0.0001), while White Europeans presented more frequently with intermediate uveitis. There was a significantly higher frequency of systemic involvement of sarcoidosis in North Africans while White Europeans showed a higher frequency of isolated ocular involvement at onset and during follow-up. Afro-Caribbeans, who had a complete visual recovery in 72.7% of the cases, had a better visual prognosis than other ethnic groups (p = 0.025). CONCLUSION In this large European series of sarcoid uveitis, we observed ethnicity-related differences regarding uveitis clinical presentation and visual outcome. Although good overall, the visual prognosis seems to be better in Afro-Caribbeans than in other ethnic groups.
Collapse
Affiliation(s)
- Charlotte Coulon
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,University Claude Bernard Lyon 1, Villeurbanne, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,University Claude Bernard Lyon 1, Villeurbanne, France
| | - Cédric Rochepeau
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Perard
- Department of Internal Medicine, Saint Joseph Saint Luc Hospital, Lyon, France
| | - Sabine Jardel
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Carole Burillon
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christiane Broussolle
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Yvan Jamilloux
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pascal Seve
- University Claude Bernard Lyon 1, Villeurbanne, France. .,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France. .,Service de Médecine Interne, Hôpital de la Croix-Rousse, France; Univ. Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France.
| |
Collapse
|
39
|
Al Zamil W, Yassin SA. Acute Bacterial Endophthalmitis Following Dexamethasone Intravitreal Implant: A Case Report. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:110-113. [PMID: 31080392 PMCID: PMC6503689 DOI: 10.4103/sjmms.sjmms_57_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 54-year-old male presented to our ophthalmology clinic with a diagnosis of the right central retinal vein occlusion with macular edema. The patient was treated with dexamethasone intravitreal implant. Three days after the implant insertion, the patient experienced pain, redness and blurred vision in the same eye. With a provisional diagnosis of acute endophthalmitis, a combination of ceftazidime 2.25 mg/0.1 ml and vancomycin 1 mg/0.1 ml was injected intravitreally. One week after the treatment, endophthalmitis signs and symptoms subsided. This report presents a case of endophthalmitis following dexamethasone intravitreal implant, with a favorable outcome after treatment with intravitreal antibiotic injection without removal of the implant.
Collapse
Affiliation(s)
- Waseem Al Zamil
- Department of Ophthalmology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sanaa A Yassin
- Department of Ophthalmology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
40
|
Rajesh B, Zarranz-Ventura J, Fung AT, Busch C, Sahoo NK, Rodriguez-Valdes PJ, Sarao V, Mishra SK, Saatci AO, Udaondo Mirete P, Querques G, Farah ME, Lanzetta P, Arevalo JF, Kodjikian L, Chhablani J. Safety of 6000 intravitreal dexamethasone implants. Br J Ophthalmol 2019; 104:39-46. [PMID: 31040132 DOI: 10.1136/bjophthalmol-2019-313991] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. METHODS Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. RESULTS A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. CONCLUSION This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.
Collapse
Affiliation(s)
| | - Javier Zarranz-Ventura
- Hospital Clínic de Barcelona Insi, Instituto Clinic de Barcelona, Instituto Clinic de Oftalmología (ICOF), Barcelona, Spain
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Sydney, Australian Capital Territory, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Catharina Busch
- Department of Ophthalmology, Universitatsklinikum Leipzig, Leipzig, Germany
| | - Niroj Kumar Sahoo
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Patricio J Rodriguez-Valdes
- Ophthalmology, Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, San Pedro Garza García, Mexico
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | | | | | | | | | - Michel Eid Farah
- Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - J Fernando Arevalo
- Retina and Vitreous, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela
| | - Laurent Kodjikian
- Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,CNRS UMR 5510 Mateis, University of Lyon, Lyon, France
| | - Jay Chhablani
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | | |
Collapse
|
41
|
Alba-Linero C, Sala-Puigdollers A, Romero B, Llorenç V, Adan A, Zarranz-Ventura J. Long-Term Intravitreal Dexamethasone Implant Outcomes in Uveitis. Ocul Immunol Inflamm 2019; 28:228-237. [PMID: 30994370 DOI: 10.1080/09273948.2019.1578380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: To describe the long-term clinical outcomes in a cohort of uveitic eyes treated with the intravitreal dexamethasone implant (Ozurdex; Allergan, Inc).Methods: Seventy-nine (63 patients) receiving 134 implant injections over 82 months were included. Indication, visual acuity (VA), intraocular pressure (IOP), vitreous haze score (VHS), central retinal thickness (CRT), time to reinjection, systemic treatments, and complications data were recorded.Results: The cumulative probability of VA improvement was 80% at 1 month and 90% at 12 months, and it was maintained until 60 months. Eyes with baseline vitritis (VHS >0.5; 68%) had a probability of VHS improvement of 33% at 1 month, 75% at 12 months, and 85% at 60 months. The probability of CRT improvement was 33% at 1 month, 75% at 12 months, and 85% at 60 months. The most frequent adverse event was moderate IOP elevation (≥25 mmHg) in 30.3%, no cases of retinal detachment or endophthalmitis were observed.Conclusions: The dexamethasone implant provides favorable VA, CRT, and VHS long-term outcomes in uveitis with a reduced rate of severe adverse events.
Collapse
Affiliation(s)
| | - Anna Sala-Puigdollers
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Victor Llorenç
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adan
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Javier Zarranz-Ventura
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
42
|
Squires H, Bermejo I, Poku EN, Cooper K, Stevens J, Hamilton J, Wong R, Denniston AK, Pearce I, Quhill FM. Dexamethasone implant for non-infectious uveitis: is it cost-effective? Br J Ophthalmol 2019; 103:1639-1644. [PMID: 30745307 DOI: 10.1136/bjophthalmol-2018-312765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/19/2018] [Accepted: 12/22/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Uveitis is inflammation inside the eye. The objective of this study is to assess the cost-effectiveness of a dexamethasone implant plus current practice (immunosuppressants and systemic corticosteroids) compared with current practice alone, in patients with non-infectious intermediate, posterior or pan-uveitis and to identify areas for future research. METHODS A Markov model was built to estimate the costs and benefits of dexamethasone. Systematic reviews were performed to identify available relevant evidence. Quality of life data from the key randomised-controlled trial (HURON) was used to estimate the interventions' effectiveness compared with the trial's comparator arm (placebo plus limited current practice (LCP)). The analysis took a National Health Service and Personal Social Services perspective. Costs were calculated based on standard UK sources. RESULTS The incremental cost-effectiveness ratio (ICER) of one dexamethasone implant compared with LCP is estimated as £19 509 per quality-adjusted life year (QALY) gained. The factors with the largest impact on the results were rate of blindness and relative proportion of blindness cases avoided by dexamethasone. Using plausible alternative assumptions, dexamethasone could be cost saving or it may be associated with an ICER of £56 329 per QALY gained compared with LCP. CONCLUSIONS Dexamethasone is estimated to be cost-effective using generally accepted UK thresholds. However, there is substantial uncertainty around these results due to scarcity of evidence. Future research on the following would help provide more reliable estimates: effectiveness of dexamethasone versus current practice (instead of LCP), with subgroup analyses for unilateral and bilateral uveitis, incidence of long-term blindness and effectiveness of dexamethasone in avoiding blindness.
Collapse
Affiliation(s)
- Hazel Squires
- Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Iñigo Bermejo
- Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith N Poku
- Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Cooper
- Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Pearce
- Clinical Eye Research Centre, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | |
Collapse
|
43
|
Zarranz-Ventura J, Sala-Puigdollers A, Velazquez-Villoria D, Figueras-Roca M, Copete S, Distefano L, Boixadera A, García-Arumi J, Adan A. Long-term probability of intraocular pressure elevation with the intravitreal dexamethasone implant in the real-world. PLoS One 2019; 14:e0209997. [PMID: 30608950 PMCID: PMC6319768 DOI: 10.1371/journal.pone.0209997] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/15/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the long-term cumulative probability of intraocular pressure (IOP) elevation with the intravitreal dexamethasone implant (IDI) when used to treat different indications: diabetic macular edema, uveitis, retinal vein occlusion. METHODS 705 IDI injections (429 eyes) were assessed and Kaplan-Meier graphs were generated to assess: the probability of different levels of IOP elevation (IOP≥21, ≥25 or ≥35 mmHg), IOP change ≥10 mmHg, initiation of IOP-lowering treatment, glaucoma surgery, IOP change with repeat injections and IOP elevation in eyes with glaucoma and ocular hypertension (OHT). RESULTS The cumulative probability of IOP ≥21, ≥25 and ≥35 mmHg was 50%-60%, 25%-30% and 6%-7% at 12-24 months, respectively. The probability of initiating IOP-lowering medication was 31%-54% at 12-24 months. Glaucoma and OHT eyes had a higher probability of mild IOP elevation (≥21 mmHg, 65.1%, 75% and 57.8%, p = 0.01), yet a similar moderate (≥25 mmHg, 22.3%, 28% and 30.2%, p = 0.91) and severe elevation of IOP (≥35 mmHg, 3.7%, 7.1% and 4%, p = 0.71) as normal eyes. Glaucoma surgery was required in only 0.9% cases (4/429). At baseline, 8.8% of the treated eyes had glaucoma, 6.7% OHT and 16.9% were already on IOP-lowering medication. CONCLUSIONS In the long-term (24 months), IOP elevation is common, generally mild (30% IOP, ≥25 mmHg) and well-tolerated, resolving with topical treatment (54%) and rarely requiring surgery (0.9%).
Collapse
Affiliation(s)
| | | | | | - Marc Figueras-Roca
- Institut Clínic d´Oftalmología (ICOF), Hospital Clinic, Barcelona, Spain
| | - Sergio Copete
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Laura Distefano
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Anna Boixadera
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Jose García-Arumi
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d´Oftalmología (ICOF), Hospital Clinic, Barcelona, Spain
| | | |
Collapse
|
44
|
Kim MJ, Jones N, Steeples LR. Miliary tuberculosis developing during adalimumab treatment for Behçet's disease with uveitis. BMJ Case Rep 2018; 11:11/1/e226772. [PMID: 30567192 DOI: 10.1136/bcr-2018-226772] [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] [Indexed: 12/29/2022] Open
Abstract
Tumour necrosis factor-alpha (TNF-α) is a key proinflammatory cytokine in non-infective uveitis (NIU). Adalimumab, an anti-TNF-α monoclonal antibody, is approved for the treatment of severe NIU by the European Medicines Agency. There is a recognised risk of serious infections, including tuberculosis (TB), during anti-TNF-α therapy in systemic immune-mediated diseases. We describe miliary pulmonary TB during adalimumab therapy for severe NIU. To our knowledge, this is the first detailed report of this complication in a patient with uveitis. We present the challenges of managing vision-threatening uveitis during life-threatening infection necessitating withdrawal of adalimumab and oral immunosuppression therapy. Uveitis activity was controlled during anti-TB therapy with oral corticosteroid therapy.
Collapse
Affiliation(s)
- Minji Jennifer Kim
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Nicholas Jones
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
45
|
Rice JB, White AG, Scarpati LM, Wan GJ, Nelson WW. The burden of non-infectious intraocular inflammatory eye diseases: a systematic literature review. Curr Med Res Opin 2018; 34:2095-2103. [PMID: 30112931 DOI: 10.1080/03007995.2018.1512961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Non-infectious inflammatory eye diseases (IEDs), although rare, are complex and varied and may result in detrimental effects. A systematic literature review was conducted on the clinical outcome and economic burden of IED. METHODS The Ovid search platform (Wolters Kluwer) was used to access scientific literature databases, including MEDLINE, Embase, Cochrane libraries, Health Technology Assessment and the NHS Economic Evaluation database. The search strategy targeted clinical and economic outcomes research in 2009-2016. Titles and abstracts resulting from inclusion criteria were screened, and two reviewers independently extracted relevant information from the selected full-text articles. RESULTS Thirty-nine papers met the inclusion criteria - 21 clinical trials, 7 database analyses, 6 non-systematic literature reviews with expert commentary, 3 chart reviews, and 2 surveys - which assessed steroids, immunosuppressants, implants and biologics. Patients experienced considerable morbidity, much of which was associated with corticosteroid use. The average annual healthcare costs of patients with IED were $13,728 to $32,268 in 2009 US dollars, which amounted to 3.1 to 8.3 times that of patients without IED. Steroid-releasing intraocular implants were associated with higher up-front costs, close monitoring requirements, potential for implant removal and increased rates of adverse ocular events than systemic steroids. CONCLUSIONS IEDs are rare and complex conditions that threaten eyesight and impose considerable morbidity as well as a substantial economic burden. This review confirms that further research is needed to more fully explore the burden of IED and treatment-related adverse events, as well as appropriate means for clinicians to intensify treatment.
Collapse
Affiliation(s)
| | | | | | - George J Wan
- b Mallinckrodt Pharmaceuticals , Bedminster , NJ , USA
| | | |
Collapse
|
46
|
Pérez-Sarriegui A, Casas-Llera P, Díez-Álvarez L, Contreras I, Moreno-López M, Figueroa MS, González-Martín-Moro J, Muñoz-Negrete FJ, Rebolleda G. Phaco-non-penetrating deep sclerectomy in ocular hypertension secondary to dexamethasone intravitreal implant. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:580-585. [PMID: 30266279 DOI: 10.1016/j.oftal.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate the characteristics and progression of patients treated with a 0.7mg dexamethasone intravitreal implant (Ozurdex®) and required glaucoma filtering surgery (phaco-non-penetrating deep sclerectomy) to control ocular hypertension (OHT). METHODS A retrospective observational study including patients treated with Ozurdex® in a tertiary-care university hospital from May 2011 to April 2016. RESULTS In five years of follow-up, 1.10% (4/363) of patients treated with 0.7mg dexamethasone intravitreal implant required phaco-non-penetrating deep sclerectomy (PNPDS) to control OHT refractory to topical treatment. All four patients started or increased previous antihypertensive topical treatment since the first dexamethasone intravitreal implant. Three or more dexamethasone intravitreal implants were injected in the four cases before intraocular pressure (IOP) became uncontrolled and PNPDS was performed. All four patients have a successfully controlled IOP without treatment after PNPDS. Two patients required additional treatment with dexamethasone intravitreal implants after PNPDS, maintaining IOP under control without treatment. CONCLUSIONS To the best of our knowledge, this is the first study describing the successful results of PNPDS in OHT secondary to dexamethasone intravitreal implant. All four patients have achieved controlled IOP without treatment. Re-treatment with dexamethasone intravitreal implant in those patients who underwent PNPDS is also possible, and IOP remains controlled.
Collapse
Affiliation(s)
- A Pérez-Sarriegui
- Departamento de Oftalmología, Hospital de Mendaro, Mendaro, Guipúzcoa, España
| | - P Casas-Llera
- Department of Glaucoma Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - L Díez-Álvarez
- Departamento de Oftalmología, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Ramón y Cajal, Madrid, España.
| | - I Contreras
- Departamento de Oftalmología, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Ramón y Cajal, Madrid, España
| | - M Moreno-López
- Departamento de Oftalmología, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Ramón y Cajal, Madrid, España
| | - M S Figueroa
- Departamento de Oftalmología, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Ramón y Cajal, Madrid, España
| | | | - F J Muñoz-Negrete
- Departamento de Oftalmología, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Ramón y Cajal, Madrid, España
| | - G Rebolleda
- Departamento de Oftalmología, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Ramón y Cajal, Madrid, España
| |
Collapse
|
47
|
Yalcinbayir O, Caliskan E, Ucan Gunduz G, Gelisken O, Kaderli B, Yucel A. Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behçet Disease. Ophthalmologica 2018; 241:190-194. [DOI: 10.1159/000490674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/06/2018] [Indexed: 11/19/2022]
|
48
|
Leal I, Rodrigues FB, Sousa DC, Romão VC, Duarte GS, Carreño E, Dick AD, Marques-Neves C, Costa J, Fonseca JE. Efficacy and safety of intravitreal anti-tumour necrosis factor drugs in adults with non-infectious uveitis - a systematic review. Acta Ophthalmol 2018; 96:e665-e675. [PMID: 29577629 DOI: 10.1111/aos.13699] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022]
Abstract
Anti-tumour necrosis factor (TNF) drugs have been extensively used in non-infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side-effects occur. However, systemic anti-TNF therapies are also associated with a myriad of side-effects. Therefore, intravitreal administration of anti-TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti-TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti-TNF drugs with a 4-week minimum follow-up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open-label, single-centre, prospective, non-randomized, interventional case series with a follow-up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti-TNF intravitreal injections, while one study revealed short-term improvement and one study revealed no efficacy of anti-TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti-drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti-TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti-TNF antibodies remains a possible treatment option to be explored through robust clinical investigation.
Collapse
Affiliation(s)
- Inês Leal
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Huntington's Disease Centre; University College London; London UK
| | - David Cordeiro Sousa
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Vasco C Romão
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Ester Carreño
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
| | - Andrew D Dick
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
- School of Clinical Sciences; Faculty of Medicine and Dentistry; University of Bristol; Bristol UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK
| | - Carlos Marques-Neves
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Evidence Based Medicine Centre; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Portuguese Collaborating Centre of the Cochrane Iberoamerican Network; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Eurico Fonseca
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| |
Collapse
|
49
|
Shah KK, Majumder PD, Biswas J. Intravitreal therapeutic agents in noninfectious uveitic macular edema. Indian J Ophthalmol 2018; 66:1060-1073. [PMID: 30038143 PMCID: PMC6080427 DOI: 10.4103/ijo.ijo_35_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The management of uveitis is challenging for most treating ophthalmologists. The treatment of uveitis often requires the use of high dose of systemic corticosteroid and immunosuppressive agents, which are almost always associated with potential side effects. Intravitreal medications have become a popular mode of drug administration in uveitis patients as they provide high volume of drug to the target tissues, eliminating the risk of systemic toxicity. There has been tremendous development in the intravitreal therapeutics over the last few years. With the advent of sustained-release technique, increasing patient compliance, biodegradable nature of the implant, and introduction of newer agents with better safety profile, the intravitreal medications have become more popular in recent years. This review presents evidence in the scientific literature supporting the use of intravitreal medications for the management of uveitis and its complications.
Collapse
Affiliation(s)
- Kunal Kaushik Shah
- Shri Bhagwan Mahavir VitreoRetinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Jyotirmay Biswas
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
50
|
Intravitreal Steroid Implants in the Management of Retinal Disease and Uveitis. Int Ophthalmol Clin 2018; 56:127-49. [PMID: 27575764 DOI: 10.1097/iio.0000000000000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|