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Zhang Z, Griva K, Rojas-Carabali W, Patnaik G, Liu R, Sobrin L, Kempen JH, Finger RP, Gupta V, Ang B, Agrawal R. Psychosocial Well-Being and Quality of Life in Uveitis: A Review. Ocul Immunol Inflamm 2024; 32:1380-1394. [PMID: 37713271 DOI: 10.1080/09273948.2023.2247077] [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: 05/27/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE As a potentially sight-threatening disease with ocular, systemic, and treatment-related complications, uveitis diminishes quality of life (QOL) and affects psychosocial well-being. This review summarizes the existing tools for evaluating psychosocial well-being and/or QOL in patients with uveitis, explores the biological and non-biological factors affecting psychosocial well-being and/or QOL, and proposes future directions for incorporating these tools into clinical practice. METHODS A systematic search of the MEDLINE, Embase, and Cochrane databases from inception to June 8, 2022 was conducted, screening for articles focused on psychosocial well-being and/or QOL in patients with uveitis. Both quantitative and qualitative analyses were performed. RESULTS In uveitis research, the most frequently studied patient-reported outcome measures were vision-related QOL (e.g. Visual Function Questionnaire [VFQ-25]) and health-related QOL (e.g. Short Form Survey [SF-36]), followed by mental health indicators including depression and anxiety. Instruments have also been developed specific to the pediatric population (e.g. Effects of Youngsters' Eyesight on Quality of Life [EYE-Q]). Generally, studies report worse psychosocial outcomes and QOL in patients with uveitis compared to the general population. Contributory factors include both clinical (e.g. visual impairment, ocular comorbidities) and patient-related (e.g. older age, female sex) factors. CONCLUSION Given the heterogeneity of instruments used, it is worth considering standardization across large uveitis studies and trials. Beyond research, given the biopsychosocial effects on patients with uveitis, there are benefits to incorporating QOL and psychosocial assessments into clinical practice. Simplification of questionnaires into abridged forms, focusing on the most clinically relevant aspects of patient care, may be considered.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gazal Patnaik
- Sankara Netralaya, Medical Research Foundation, Chennai, India
| | - Renee Liu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM Comprehensive Specialized Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Robert P Finger
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bryan Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Amer R, Sharon Y. Ocular Complications of Intermediate Uveitis. Ocul Immunol Inflamm 2024:1-8. [PMID: 39024511 DOI: 10.1080/09273948.2024.2378370] [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: 04/08/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
Intermediate uveitis (IU) in an intraocular inflammation that predominantly affects the vitreous. It typically manifests as chronic low-grade inflammation, mainly affecting children and young adults. Uncontrolled chronic intraocular inflammation carries a high risk of visual loss. IU, despite being a low-grade inflammation, is among the sight-threatening conditions owing to its intrinsically-associated vision-robbing ocular complications. It can cause early and late-onset ocular complications affecting the anterior and posterior segments of the eye. 40-60% of the patients who suffer from IU will develop at least one ocular complication during the disease course. Prompt management and long-term monitoring are vital for the early detection of ocular complications and timely intervention. Proactive screening programs are essential in children because of the occult nature of IU in the pediatric age group and the high prevalence of complications at the initial visit. This review provides a comprehensive panorama of anterior segment complications, namely, band keratopathy, corneal endotheliopathy, posterior synechiae, and cataract as well as of posterior segment complications including macular edema, retinoschisis, retinal detachment, vitreous hemorrhage, vasoproliferative tumor, optic neuritis, and papillitis, in addition to glaucoma and hypotony.
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Affiliation(s)
- Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Sharon
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rong XS, Yao C. Computed tomography imaging and clinical significance of bacterium-positive pulmonary tuberculosis complicated with diabetes. World J Clin Cases 2024; 12:4230-4238. [PMID: 39015935 PMCID: PMC11235566 DOI: 10.12998/wjcc.v12.i20.4230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The increasing prevalence of tuberculosis (TB) and diabetes on a global scale poses a significant health challenge, particularly due to their co-occurrence, which amplifies the severity, recurrence and mortality rates associated with both conditions. This highlights the need for further investigation into their inter-relationship. AIM To explore the computed tomography (CT) imaging and clinical significance of bacterium-positive pulmonary TB (PTB) combined with diabetes. METHODS There were 50 patients with bacterium-positive PTB and diabetes, and 50 with only bacterium-positive PTB. The latter were designated as the control group. The CT imaging of the two groups of patients was compared, including lesion range, shape, density and calcification. RESULTS No significant differences were observed in age, gender, smoking and drinking history, high blood pressure, hyperlipidemia and family genetic factors between the groups. However, compared to the patients diagnosed solely with simple bacterium-positive PTB, those with concurrent diabetes showed a wider range of lesions and more complex and diverse morphology on CT images. Among them, intrapulmonary tuberculosis lesions were often accompanied by manifestations of pulmonary infection, such as cavity formation and bronchiectasis. At the same time, diabetes-related signs were often seen on CT images, such as pulmonary infection combined with diabetic pulmonary lesions. Logistic regression analysis identified age and medical history as significant factors influencing the degree of pulmonary infection and CT imaging outcomes in patients with both TB and diabetes. This suggests that older age and specific medical histories may increase the risk or severity of pulmonary damage in these patients. CONCLUSION CT imaging reveals more complex lesions in PTB patients with diabetes, emphasizing the need for careful evaluation and comprehensive analysis to enhance diagnostic accuracy.
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Affiliation(s)
- Xue-Song Rong
- Section 6, Department of Tuberculosis, Anhui Chest Hospital, Hefei 230022, Anhui Province, China
| | - Chao Yao
- Section 6, Department of Tuberculosis, Anhui Chest Hospital, Hefei 230022, Anhui Province, China
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Yargi-Ozkocak B, Altan C, Kemer-Atik B, Basarir B. Evaluation of Optical Coherence Tomography Angiography Findings in Pars Planitis and Multiple Sclerosis Associated Intermediate Uveitis in Remission. Curr Eye Res 2024; 49:717-724. [PMID: 38433455 DOI: 10.1080/02713683.2024.2323520] [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: 08/07/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To evaluate the microvasculature during remission in patients with pars planitis (PP-IU) and multiple sclerosis-associated intermediate uveitis (MS-IU) using optical coherence tomography angiography (OCT-A). METHODS Single-center, descriptive, case-control study was conducted. Adult patients (≥16 years) with IU in remission (PP-IU and MS-IU) and healthy age-sex matched healthy controls (HC) were enrolled to the study. Demographic/clinical features, best-corrected visual acuity (BCVA), ocular findings, neurological symptoms and preferred treatments were recorded. The presence of cystoid macular edema (CME) during follow-up was recorded. All IU patients in remission and HC subjects were scanned with OCT-A. Foveal avascular zone (FAZ) areas of superficial and deep capillary plexus (SCP/DCP) and vascular densities of SCP, DCP and choriocapillaris were obtained from OCT-A and compared between the groups. RESULTS Sixty-nine eyes of 37 IU patients in remission and 20 HC were included (44 eyes/23 patients in PP-IU, 25/14 in MS-IU, 40/20 in HC). No statistically significant differences were observed in terms of demographic or clinical characteristics of the patients. The vascular density in the SCP was significantly reduced in the PP-IU and MS-IU groups compared to the HC group (p < .05). Nevertheless, there were no significant changes in any of the OCTA parameters between the IU groups. Uveitis duration was found to be correlated with enlargement of the FAZ area in PP-IU (p = .039). CONCLUSION OCTA may not be useful in differentiating between PP-IU and MS-IU. Nevertheless, the primary implication in SCP potentially elucidates the pathogenesis of these two subtypes of IU, which are characterized by a shared pathogenesis. The monitoring of the FAZ area in the PP-IU group is valuable in terms of chronicity.
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Affiliation(s)
- Berru Yargi-Ozkocak
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Burcu Kemer-Atik
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Basarir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Samalia PD, Lim LL, Niederer RL. Insights into the diagnosis and management of sarcoid uveitis: A review. Clin Exp Ophthalmol 2024; 52:294-316. [PMID: 38385625 DOI: 10.1111/ceo.14366] [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: 08/03/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
Sarcoidosis is a leading cause of non-infectious uveitis that commonly affects middle-aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non-caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid-sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.
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Affiliation(s)
- Priya D Samalia
- Department of Opthalmology, Te Whatu Ora Southern, Dunedin, New Zealand
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lyndell L Lim
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Rachael L Niederer
- Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Tomkins-Netzer O, Niederer R, Greenwood J, Fabian ID, Serlin Y, Friedman A, Lightman S. Mechanisms of blood-retinal barrier disruption related to intraocular inflammation and malignancy. Prog Retin Eye Res 2024; 99:101245. [PMID: 38242492 DOI: 10.1016/j.preteyeres.2024.101245] [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: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
Blood-retinal barrier (BRB) disruption is a common accompaniment of intermediate, posterior and panuveitis causing leakage into the retina and macular oedema resulting in vision loss. It is much less common in anterior uveitis or in patients with intraocular lymphoma who may have marked signs of intraocular inflammation. New drugs used for chemotherapy (cytarabine, immune checkpoint inhibitors, BRAF inhibitors, EGFR inhibitors, bispecific anti-EGFR inhibitors, MET receptor inhibitors and Bruton tyrosine kinase inhibitors) can also cause different types of uveitis and BRB disruption. As malignant disease itself can cause uveitis, particularly from breast, lung and gastrointestinal tract cancers, it can be clinically difficult to sort out the cause of BRB disruption. Immunosuppression due to malignant disease and/or chemotherapy can lead to infection which can also cause BRB disruption and intraocular infection. In this paper we address the pathophysiology of BRB disruption related to intraocular inflammation and malignancy, methods for estimating the extent and effect of the disruption and examine why some types of intraocular inflammation and malignancy cause BRB disruption and others do not. Understanding this may help sort and manage these patients, as well as devise future therapeutic approaches.
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Affiliation(s)
- Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Centre, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Rachael Niederer
- Department of Ophthalmology, Te Whatu Ora, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - John Greenwood
- Institute of Ophthalmology, University College London, London, UK
| | - Ido Didi Fabian
- The Goldschleger Eye Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Serlin
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
| | - Alon Friedman
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada; Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben- Gurion University of the Negev, Beer-Sheva, Israel
| | - Sue Lightman
- Institute of Ophthalmology, University College London, London, UK
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Xue YQ, Xiao JA, Chen Y. Frequency and Treatment Regimens of Macular Edema in 1946 Consecutive Patients with Noninfectious Uveitis at a Tertiary Ophthalmic Center in Shaanxi, China. Ophthalmol Ther 2023; 12:2609-2619. [PMID: 37440091 PMCID: PMC10441883 DOI: 10.1007/s40123-023-00763-4] [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: 04/19/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION We investigated the frequency of uveitic macular edema (UME) in patients with different types of noninfectious uveitis and present the primary treatment methods for UME at a specialized eye center in Shaanxi Province, China. METHODS We conducted a retrospective, noninterventional, observational survey involving 1946 patients with noninfectious uveitis (2816 eyes). The collected data included sex, age of uveitis onset, age of UME onset, anatomical classification of uveitis, and the treatment administered to UME patients. RESULTS Of the 1946 patients with noninfectious uveitis, 929 (47.74%) were male and 1017 (52.26%) were female. The average age of all participants in the study was 42.19 ± 15.34 years, with average age at uveitis onset of 39.50 ± 15.52 years. Among the patients, 1003 (51.54%), 239 (12.28%), 410 (21.07%), and 294 (15.11%) had anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis, respectively. UME was observed in 134 (6.89%) of the uveitis patients. The average age of UME patients was 47.33 ± 17.17 years, with average age at uveitis onset of 45.78 ± 17.20 years. Out of the 134 UME patients, 3 (0.30%), 15 (6.28%), 47 (11.46%), and 69 (23.47%) had anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis, respectively. Among them, 37 were lost to follow-up, 44 received adalimumab (ADA) combined with low-dose prednisone and with or without conventional immunosuppressants, 19 received interferon-α2a therapy, 14 received intravitreal corticosteroid injections (such as dexamethasone implant or fluocinolone acetonide), 11 received low-dose corticosteroids combined with conventional immunosuppressants, 5 received only oral prednisone, and 4 received repeated peribulbar or subconjunctival injections of triamcinolone acetonide. CONCLUSIONS At our tertiary ophthalmic center in Shaanxi Province, China, only 6.89% of patients with noninfectious uveitis were diagnosed with UME. The primary treatment modality for UME in our center is ADA, in accordance with treatment guidelines and the Chinese medical insurance reimbursement system.
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Affiliation(s)
- Yan-Qi Xue
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University, No 21, Jiefang Road, Xi'an, 710004, Shaanxi, China
| | - Jin-An Xiao
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University, No 21, Jiefang Road, Xi'an, 710004, Shaanxi, China
| | - Ying Chen
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University, No 21, Jiefang Road, Xi'an, 710004, Shaanxi, China.
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Yargi-Ozkocak B, Altan C, Kemer-Atik B, Basarir B. Clinical characteristics of intermediate uveitis in adults according to criteria of the SUN working group. Int Ophthalmol 2023; 43:3681-3693. [PMID: 37395903 DOI: 10.1007/s10792-023-02778-z] [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: 03/25/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To analyse the clinical characteristics of adult patients with pars planitis (PP-IU), non-pars planitis (NPP-IU) and multiple sclerosis-associated intermediate uveitis (MS-IU) and distinguish between groups. METHODS Seventy-three adult patients with intermediate uveitis (IU) reviewed retrospectively and divided as PP-IU, NPP-IU and MS-IU according to 'The standardization of uveitis nomenclature working group classification criteria.' Demographic and clinical characteristics, OCT and fluorescein angiography (FA) findings, complications and treatments were recorded. RESULTS A total of 134 eyes of 73 patients were included, and 42 of the patients were classified as PP-IU, 12 as NPP-IU, and 19 as MS-IU. If a patient presenting with blurred vision, or tent-shaped vitreous band/snowballs/snowbank on examination, or vascular leakage on FA and accompanying neurological symptoms, the frequency of demyelinating plaque detection on cranial MRI and the risk of MS-IU increased. Mean BCVA was increased from 0.22 ± 0.30 logMAR to 0.19 ± 0.31 logMAR (p = 0.021). Gender, initial BCVA, snowbank formation, disc oedema and periphlebitis on examination, and disc leakage/occlusion on FA were found predictive of decreased BCVA at final visit (p < 0.05). CONCLUSIONS The clinical features of these three groups are similar, some features that can guide the differential diagnosis. It may be recommended to periodically evaluate "suspicious" patients with MRI for MS.
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Affiliation(s)
- Berru Yargi-Ozkocak
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Bereketzade Street Number: 2, Beyoglu, 3442, Istanbul, Turkey.
| | - Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Bereketzade Street Number: 2, Beyoglu, 3442, Istanbul, Turkey
| | - Burcu Kemer-Atik
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Bereketzade Street Number: 2, Beyoglu, 3442, Istanbul, Turkey
| | - Berna Basarir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Bereketzade Street Number: 2, Beyoglu, 3442, Istanbul, Turkey
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Al-Ani HH, Sims JL, Niederer RL. Long term complications and vision loss in HLA-B27 uveitis. Eye (Lond) 2023; 37:1673-1677. [PMID: 36038721 PMCID: PMC10219953 DOI: 10.1038/s41433-022-02216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/27/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the long term complications and vision loss in HLA-B27 uveitis. METHODS Retrospective review of subjects with HLA-B27 uveitis in a public tertiary centre between January 2008 and 2020. RESULTS 562 HLA-B27-positive subjects (834 eyes) had mean follow-up of 9.8 years (8173.2 eye-years). Median visual acuity at ten years was 0.1 logMAR (IQR 0.0-0.1). Complications occurred in 404 eyes (48.4%): posterior synechiae (39.7%), cataract (22.1%), elevated intraocular pressure (15.5%), cystoid macular oedema (6.0%). Permanent moderate vision loss ( ≤ 0.4 logMAR) due to uveitis occurred in 14 eyes (1.7%) and severe vision loss (≤ 1.0 logMAR) in 7 eyes (0.8%). Complications were more common with older age (OR 1.017 p = 0.016), chronic inflammation (OR 5.272 p < 0.001) and intermediate uveitis (OR 5.982 p < 0.001). CONCLUSIONS Complications are frequent in HLA-B27 uveitis, especially in older subjects, chronic inflammation and intermediate uveitis. Despite this, the majority of subjects maintain good visual prognosis.
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Affiliation(s)
- Haya H Al-Ani
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand.
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
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Iannetti L, Scarinci F, Alisi L, Armentano M, Sampalmieri L, La Cava M, Gharbiya M. Correlation between Morphological Characteristics of Macular Edema and Visual Acuity in Young Patients with Idiopathic Intermediate Uveitis. Medicina (B Aires) 2023; 59:medicina59030529. [PMID: 36984530 PMCID: PMC10054752 DOI: 10.3390/medicina59030529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/12/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Background and Objectives: Macular edema (ME) is a common complication of intermediate uveitis (IU). It is often responsible for a decrease in visual acuity (VA). Three distinct patterns of macular edema have been described in intermediate uveitis, namely, cystoid macular edema (CME), diffuse macular edema (DME), and serous retinal detachment (SRD). The current study aims to describe the characteristics of macular edema in young patients with idiopathic intermediate uveitis and to correlate its features with VA using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A total of 27 eyes from 18 patients with idiopathic IU complicated by ME were included in this retrospective study. All patients underwent SD-OCT; data were gathered at the onset of ME. Best-corrected VA (BCVA) was correlated with the morphological features of ME. Results: BCVA was negatively correlated with Ellipsoid Zone (EZ) disruption (p = 0.00021), cystoid pattern (p = 0.00021), central subfield thickness (CST) (p < 0.001), and serous retinal detachment (0.037). Conclusions: In ME secondary to idiopathic IU, VA negatively correlates with Ellipsoid Zone disruption and increases in CST. Moreover, vision is influenced by the presence of cysts in the inner nuclear and outer nuclear layers and by the neuroepithelium detachment.
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Affiliation(s)
- Ludovico Iannetti
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-3388635417
| | | | - Ludovico Alisi
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Marta Armentano
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Maurizio La Cava
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Magda Gharbiya
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
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Niederer RL, Sharief L, Tomkins-Netzer O, Lightman SL. Uveitis in Sarcoidosis - Clinical Features and Comparison with Other Non-infectious Uveitis. Ocul Immunol Inflamm 2023; 31:367-373. [PMID: 35201961 DOI: 10.1080/09273948.2022.2032189] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Comparison of sarcoid uveitis with other non-infectious uveitis treatment and visual outcomes. METHODS Retrospective study of 287 eyes with sarcoid uveitis and 1517 eyes with other non-infectious uveitis (15,029 eye-years follow-up). RESULTS Sarcoid uveitis patients presented at age 43.1 ± 0.8 years, and 66.2% were female. Panuveitis was the most frequent presentation (48.3%), and 90.1% were bilateral. Moderate visual loss (≤20/50) developed in 19 eyes (6.6%), and severe visual loss (≤20/200) in 13 eyes (4.5%). Sarcoid uveitis had better visual outcomes than other non-infectious uveitis (10-year BCVA anterior uveitis 0.06 vs 0.24 p = .002; posterior disease 0.17 vs 0.38 p = .001). Oral corticosteroid use was more common with sarcoid uveitis (anterior uveitis 45.9% vs 16.4% p < .0005; posterior disease 64.0% vs 61.7% p = .635), but second-line immunosuppression was required less frequently (p = .008). CONCLUSIONS Compared to other non-infectious uveitis, sarcoid uveitis has better visual acuity outcomes and is less likely to require second-line immunosuppression.
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Affiliation(s)
| | | | - Oren Tomkins-Netzer
- Uveitis Service, Ophthalmology Department, Lady Davis Carmel Medical Center, Haifa, Israel.,Ruth and Bruch Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Jordan CA, Townend S, Allen N, Sims J, McGhee CN, Niederer RL. Navigating Coronavirus Disease 2019 Vaccination and Uveitis: Identifying the Rates and Risk of Recurrent Uveitis after Coronavirus Disease Vaccination. Ophthalmology 2022; 130:501-508. [PMID: 36538991 PMCID: PMC9758064 DOI: 10.1016/j.ophtha.2022.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To identify rates of uveitis reactivation both before and after the coronavirus disease (COVID) 2019 vaccine in subjects with a previous diagnosis of uveitis. DESIGN Retrospective study. PARTICIPANTS Subjects were identified from the Inflammatory Eye Disease Registry at Auckland District Health Board diagnosed with uveitis between January 1, 2010, and December 31, 2020. METHODS Date of COVID vaccination was determined from the patient clinical record. Rate of flare was calculated for 3 months before vaccination and 3 months after each vaccination. MAIN OUTCOME MEASURE Uveitis flare was defined as the presence of new uveitis activity or increased activity that required a change in uveitis treatment. RESULTS A total of 4184 eyes of 3008 patients were included in the study with a total of 8474 vaccinations given during the study period. Median age was 54.8 years, and 1474 (49.0%) were female. Noninfectious etiology was most common, occurring in 2296 patients (76.3%) and infectious etiology occurring in 712 patients (23.7%). Rate of uveitis flare was 12.3 per 1000 patient-months at baseline, 20.7 after the first dose, 15.0 after the second dose, 12.8 after the third dose, and 23.9 after the fourth dose. The median period of quiescence before flare was 3.9 years. An increase in uveitis flare was seen in both infectious uveitis (baseline 13.1 compared with 20.2 after first dose, 154% increase) and noninfectious uveitis (baseline 12.4 compared with 20.9 after first dose, 169% increase). Risk factors for uveitis flare were identified to be recurrent uveitis, chronic uveitis, shorter period of quiescence, and first dose of vaccine. Median time to uveitis flare was 0.53 months after the first vaccination, 1.74 months after the second vaccination, and 1.35 months after the third vaccination. CONCLUSIONS The current study demonstrates an increased risk of uveitis flare after the first dose of COVID vaccination. This risk was highest in those with previous recurrences, chronic uveitis, and shorter period of quiescence. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | - Stephanie Townend
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Natalie Allen
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Joanne Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Charles N.J. McGhee
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand,Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L. Niederer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand,Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand,Correspondence: Rachael Niederer, PhD, FRANZCO, Department of Ophthalmology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Teo AYT, Betzler BK, Hua KLQ, Chen EJ, Gupta V, Agrawal R. Intermediate Uveitis: A Review. Ocul Immunol Inflamm 2022:1-20. [PMID: 35759636 DOI: 10.1080/09273948.2022.2070503] [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: 10/17/2022]
Abstract
PURPOSE This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU). METHODS Narrative literature review. RESULTS IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice. CONCLUSIONS IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.
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Affiliation(s)
| | | | - Keith Low Qie Hua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Singapore Eye Research Institute, Singapore.,Duke NUS Medical School, Singapore
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14
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Prieto del Cura MDM, Gonzalez-Guijarro JJ. Impact of Ocular Complications on Visual Outcomes in Adult Patients With Uveitis. Cureus 2022; 14:e21370. [PMID: 35070586 PMCID: PMC8765332 DOI: 10.7759/cureus.21370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background In this study, we aimed to assess the impact of ocular complications on visual outcomes in uveitis. Methodology We conducted a retrospective cohort study of 474 uveitis patients (655 eyes) with a mean age of 52.4 years who were followed for a median of 32 months (range: 8-80 months). Results At least one ocular complication was found in 317 eyes (48.4%), 161 of which were present at the time of diagnosis (prevalent complication). Although having an ocular complication was associated with a mean loss of 1.7 Early Treatment Diabetic Retinopathy Study (ETDRS) lines, the best-corrected visual acuity increased at the end of the study. Complications causing a decrease of ≥2 ETDRS lines were prevalent macular and peripheral retinal diseases, as well as new-onset corneal lesions, intraocular pressure alterations, and peripheral retinal diseases. Conclusions The impact of the most frequent complications (cataract and macular edema) did not reach two ETDRS lines. Macular diseases at presentation were the main risk factor for visual loss at the end of follow-up.
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15
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Casselman P, Cassiman C, Casteels I, Schauwvlieghe P. Insights into multiple sclerosis-associated uveitis: a scoping review. Acta Ophthalmol 2021; 99:592-603. [PMID: 33326162 DOI: 10.1111/aos.14697] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE This paper is a scoping review of research on multiple sclerosis (MS)-associated uveitis to determine its epidemiology, pathophysiology, clinical features and treatment. METHODS A comprehensive search of the medical databases MEDLINE (PubMed), EMBASE, Web of Science and Cochrane was carried out on 25 November 2019, to identify papers published between 1980 and 2019 that focus on patients with MS-associated uveitis. RESULTS Based on large cohort studies (n ≥ 1000), the prevalence of uveitis in patients with MS is estimated to be 0.53-1.34% (mean = 0.83%), and MS is diagnosed in 0.52-3.20% (mean = 1.30%) of patients with uveitis. The condition is most frequent among middle-aged women. Patients usually complain of floaters and/or blurred vision, with bilateral intermediate uveitis (with retinal vasculitis) as the most frequent ophthalmological finding. Both MS and intermediate uveitis are associated with HLA-DRB1*15:01 and IL-2RA gene polymorphism rs2104286 A > G, suggesting a common genetic background. T cells, and possibly B cells, play an important role in both autoimmune disorders. Multiple sclerosis (MS)-related uveitis is classically treated as non-infectious uveitis, with corticosteroids as the first treatment step. Other treatments include immunosuppressants, cryotherapy, laser photocoagulation and vitrectomy. These treatment options have a limited, if any, effect on the course of MS and can be complicated by side-effects. As treatment strategies for MS have increased in the last decade, it would be interesting to evaluate the efficacy of these new treatments during the course of uveitis. Moreover, the correlation between retinal periphlebitis and MS could be established more accurately with the recently developed techniques of wide-field fluorescein angiography in a large cohort of MS patients. CONCLUSION MS-associated uveitis is a rare, highly discussed pathology about which much is still unknown. Large epidemiological studies and extrapolation of new MS treatments to this condition are warranted.
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Affiliation(s)
| | | | - Ingele Casteels
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
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16
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Risk of Cataract in Intermediate Uveitis. Am J Ophthalmol 2021; 229:200-209. [PMID: 33713679 DOI: 10.1016/j.ajo.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the incidence of and predictive factors for cataract in intermediate uveitis. DESIGN Retrospective cohort study. METHODS Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status. RESULTS Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk. CONCLUSIONS Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.
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Niederer RL, Ma SP, Wilsher ML, Ali NQ, Sims JL, Tomkins-Netzer O, Lightman SL, Lim LL. Systemic Associations of Sarcoid Uveitis: Correlation With Uveitis Phenotype and Ethnicity. Am J Ophthalmol 2021; 229:169-175. [PMID: 33737030 DOI: 10.1016/j.ajo.2021.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine systemic associations of sarcoid uveitis and association with uveitis clinical phenotype and ethnicity. DESIGN Retrospective cross-sectional study. SUBJECTS A total of 362 subjects with definite or presumed sarcoid uveitis from Moorfields Eye Hospital, Royal Victorian Eye and Ear, and Auckland District Health Board. METHODS Data were collected from the review of clinical notes, imaging, and investigations. Sarcoidosis was diagnosed in accordance with the International Workshop on Ocular Sarcoidosis guidelines. MAIN OUTCOME MEASURE Diagnosis of associated systemic disease secondary to sarcoidosis. RESULTS A total of 362 subjects with sarcoid uveitis were identified. Median age was 46 years, and 226 (62.4%) were female. Granulomatous anterior uveitis (47.8%), intermediate uveitis with snowballs (46.4%), and multifocal choroiditis (43.1%) were the most frequent clinical presentations, and disease was bilateral in 313 (86.5%). Periphlebitis was observed in 21.0%, and solitary optic nerve or choroidal granuloma in 11.3%. Lung parenchymal disease was diagnosed in 200 subjects (55.2%), cutaneous sarcoid in 98 (27.1%), sarcoid arthritis in 57 (15.7%), liver involvement in 21 (5.8%), neurosarcoid in 49 (13.5%), and cardiac sarcoid in 16 subjects (4.4%). Subjects with cardiac sarcoid were less likely to have granulomatous anterior uveitis (P = .017). Caucasian subjects were older at presentation (48 vs 41 years; P = .009), had less granulomatous anterior uveitis (26.4% vs 51.7%; P < .001), and were less likely to present with cutaneous involvement (23.1% vs 35.4%; P = .040). CONCLUSIONS Ophthalmologists need to be aware of the systemic associations of sarcoid uveitis, in particular potentially life-threatening complications such as cardiac sarcoidosis. Differences observed in uveitis phenotype and between ethnicities require further investigation.
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Affiliation(s)
- Rachael Louise Niederer
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.).
| | - Shirley P Ma
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Margaret L Wilsher
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Noor Q Ali
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Joanne L Sims
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Oren Tomkins-Netzer
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Sue L Lightman
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Lyndell L Lim
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
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Affiliation(s)
- Emmett T E Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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Ma T, Sims JL, Bennett S, Chew S, Niederer RL. High rate of conversion from ocular hypertension to glaucoma in subjects with uveitis. Br J Ophthalmol 2021; 106:1520-1523. [PMID: 34020941 DOI: 10.1136/bjophthalmol-2021-318809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/31/2021] [Accepted: 05/05/2021] [Indexed: 11/03/2022]
Abstract
AIMS To examine presentation, management and long-term sequelae of ocular hypertension and uveitic glaucoma. METHODS Retrospective observational study of all subjects with uveitic glaucoma or ocular hypertension seen in Auckland uveitis clinics over the last 10 years. RESULTS A total of 188 eyes of 139 subjects with uveitic glaucoma or ocular hypertension were included for analysis. Total follow-up was 1854.5 eye years (mean 9.9 years). The mean age at uveitis diagnosis was 49.3 years. 52.5% of subjects were male. The most common diagnoses were idiopathic uveitis (29.3%), sarcoidosis (13.3%), herpes zoster (6.9%), HLA-B27 uveitis (6.9%), tuberculosis (5.9%) and Posner-Schlossmann or cytomegalovirus (CMV) uveitis (5.3%). Median intraocular pressure (IOP) at diagnosis was 35 mm Hg (IQR 29-45). 144 eyes (77.0%) developed glaucoma during the follow-up period, of whom 41 lost some central vision due to glaucoma. Oral acetazolamide was required for IOP control in 64.5%, 50 eyes underwent trabeculectomy, 18 eyes required a tube and 6 underwent minimally invasive glaucoma surgery. CONCLUSION Rapid progression was observed from ocular hypertension to uveitic glaucoma. Uveitic glaucoma is aggressive, with high likelihood of requiring surgical management and high risk of central vision loss. Close collaboration between uveitis and glaucoma specialists is required to maximise outcomes for these patients.
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Affiliation(s)
- Tiffany Ma
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Sonya Bennett
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Shenton Chew
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand .,Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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20
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Li B, Li H, Zhang L, Zheng Y. Efficacy and Safety of Adalimumab in Noninfectious Uveitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2021; 12:673984. [PMID: 33981245 PMCID: PMC8109175 DOI: 10.3389/fphar.2021.673984] [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: 02/28/2021] [Accepted: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Patients with noninfectious uveitis (NIU) are at risk of systemic side effects of long-term glucocorticoid therapy and uncontrolled inflammatory complications. In urgent need to identify more aggressive therapies, adalimumab (ADA) may be the right choice. Objectives: To summarize the current evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of ADA in the treatment of NIU. Methods: We searched Pubmed, Embase, Web of Science, Cochrane Library databases, and Clinical Trials Registry for qualifying articles from their inception to November 19, 2020, with no language restriction. Randomized controlled trials comparing ADA with conventional routine treatment in noninfectious uveitis patients of any age, gender, or ethnicity were included. The primary outcome was the time to treatment failure (TF). The secondary outcomes were the change in best-corrected visual acuity (BCVA), change in the anterior chamber (AC) cell grade, change in vitreous haze (VH) grade, and adverse events (AEs). Main results: The six studies comprised 605 participants in all, and the sample size of each study ranged from 16 to 225. The overall pooled results of the primary outcome (HR = 0.51; 95% CI, 0.41 to –0.63) showed that ADA nearly halved the risk of treatment failure compared to placebo for NIU patients. The pooled mean difference of change in BCVA was -0.05 (95% CI, −0.07 to −0.02). The pooled mean difference of change in AC cell grade and VH grade was −0.29 (95% CI, −0.62 to −0.05) and −0.21 (95% CI, −0.32 to −0.11), respectively. The incidence of AEs in the ADA group was numerically higher than that of AEs in the placebo group (2,237 events and 9.40 events per patient-year, equivalent to 1,257 events and 7.79 events per patient-year). Conclusion: This meta-analysis of six RCTs further confirmed that ADA considerably lowered the risk of treatment failure or visual loss, and moderately reduced AC cell grades and VH grades with slightly more AEs, as compared to placebo. ADA is both effective and safe in treating NIU. Systematic Review Registration: [https://clinicaltrials.gov], identifier [CRD42020217909].
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Affiliation(s)
- Biao Li
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haoran Li
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Zhang
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanlin Zheng
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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22
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Wintergerst MWM, Finger RP. Comment on 'Swept-source optical coherence tomography angiography reveals vascular changes in intermediate uveitis'. Acta Ophthalmol 2020; 98:e390-e392. [PMID: 31736253 DOI: 10.1111/aos.14309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/31/2019] [Indexed: 01/14/2023]
Affiliation(s)
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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23
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Al-Ani HH, Sims JL, Tomkins-Netzer O, Lightman S, Niederer RL. Vision loss in anterior uveitis. Br J Ophthalmol 2020; 104:1652-1657. [PMID: 32245851 DOI: 10.1136/bjophthalmol-2019-315551] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate the long-term risk of permanent vision loss in subjects with anterior uveitis. METHODS Retrospective study of subjects attending uveitis clinic at Auckland District Health Board and Moorfields Eye Hospital between 2008 and 2018. Main outcome measures were: best corrected visual acuity (BCVA); moderate vision loss (MVL ≤20/50); and severe vision loss (SVL ≤20/200). RESULTS 2526 eyes of 1814 subjects were included with a mean follow-up of 6.8 years (17 235.4 eye-years of follow-up). MVL occurred in 240 eyes (9.5%) during the follow-up period, of which 97 (3.8%) had permanent MVL due to uveitis. The incidence of permanent MVL due to uveitis was 0.006 per eye-year with a cumulative risk at 10 years of 6.6% (5.2%-8.4%). The most common cause of permanent MVL due to uveitis was uveitic glaucoma (31.3%), followed by cystoid macular oedema (27.1%) and corneal scar (21.9%). SVL occurred in 80 eyes (3.2%) during the follow-up period, of which 39 (1.5%) had permanent SVL due to uveitis. The incidence of permanent SVL due to uveitis was 0.002 per eye-year with a cumulative risk at 10 years of 2.6% (1.8%-3.7%). Multivariate analysis showed older age at presentation, chronic anterior uveitis (CAU), infectious aetiology and poor presenting BCVA were all risk factors for permanent MVL due to uveitis. CONCLUSIONS Although vision loss is an uncommon complication in anterior uveitis, the risk is greatest in those with CAU, infectious aetiology and poor presenting BCVA. Uveitic glaucoma is the most common cause of vision loss.
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Affiliation(s)
- Haya H Al-Ani
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Joanne L Sims
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | | | - Susan Lightman
- Clinical Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Rachael L Niederer
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand .,Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Al-Ani HH, Niederer RL. Reply To: “Abd El Latif Et Al. Pattern of Intermediate Uveitis in an Egyptian Cohort”. Ocul Immunol Inflamm 2020; 28:532. [DOI: 10.1080/09273948.2020.1712434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Haya H. Al-Ani
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Niederer RL, Sims JL. Utility of Screening Investigations for Systemic Sarcoidosis in Undifferentiated Uveitis. Am J Ophthalmol 2019; 206:149-153. [PMID: 31009595 DOI: 10.1016/j.ajo.2019.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/01/2019] [Accepted: 04/13/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE To establish the utility of screening investigations for systemic sarcoidosis in a large cohort of subjects presenting with undifferentiated uveitis. DESIGN Evaluation of a diagnostic test. METHODS Retrospective review of consecutive subjects presenting to Auckland District Health Board with undifferentiated uveitis who underwent screening for sarcoidosis. RESULTS Seven hundred nine subjects were included in the study. Systemic sarcoidosis was identified in 10.7%, and was biopsy proven in 43.4%. Sensitivity and specificity were highest for computed tomography (CT) of the chest (98.0% and 100%) and for chest radiograph (CXR; 57.6% and 100%). Serum ACE was elevated in 43 subjects, of whom 29 (67.4%) had systemic sarcoidosis. Sensitivity of serum ACE was 38.2% and specificity 97.8%, with an area under the curve (AUC) of 0.801. Lymphopenia was observed in 40 subjects, of whom 18 (45.0%) had systemic sarcoidosis. Sensitivity of lymphopenia was 23.7%, with specificity 96.5% and AUC 0.761. All subjects with elevated ACE and lymphopenia had evidence of systemic sarcoidosis. Biopsy was performed in 50 subjects, positive in 33 subjects (66.0%). Mediastinal biopsy was the most frequent (26 subjects). Skin biopsy was performed in 11 subjects (positive in 8). Only 1 subject with a positive skin biopsy had elevated ACE, lymphopenia, and bihilar lymphadenopathy on CXR. CONCLUSIONS Sensitivity and specificity were highest for chest CT. Although CXR had excellent specificity, CXR screening alone would still miss many cases of sarcoidosis. Combined elevated ACE and lymphopenia were strongly suggestive of systemic sarcoidosis, and biopsy of skin lesions may detect patients otherwise missed by routine screening tests.
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Al-Janabi A, El Nokrashy A, Sharief L, Nagendran V, Lightman S, Tomkins-Netzer O. Long-Term Outcomes of Treatment with Biological Agents in Eyes with Refractory, Active, Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. Ophthalmology 2019; 127:410-416. [PMID: 31607412 DOI: 10.1016/j.ophtha.2019.08.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/30/2019] [Accepted: 08/28/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To examine a large cohort of patients treated with biologic agents for active noninfectious intermediate uveitis, posterior uveitis, or panuveitis (NIPPU) and to compare their efficacy and long-term effect. DESIGN Retrospective, longitudinal study. PARTICIPANTS Eighty-two patients (156 eyes) with active NIPPU after failure of treatment with corticosteroids and a second-line immunosuppression drug and treated with biologic agents who were treated at Moorfields Eye Hospital between 2001 and 2016. METHODS Information was gathered from the clinical notes of all patients. MAIN OUTCOME MEASURES Time to first disease flare, rate of treatment failure, best-corrected visual acuity, and risk factors for treatment failure. RESULTS Patients were followed on average for 4.7±0.4 years (724 eye-years). All patients demonstrated active uveitis at baseline, and 34 patients (41.5%) demonstrated a coexisting active systemic disease. Control of ocular inflammation was achieved in 136 eyes (87.2%). The average oral prednisolone dose at baseline was 16.4±1.7 mg/day, and by 6 months reduced to 6.5±0.7 mg/day (P < 0.0001), remaining stable for up to 5 years follow-up. Best-corrected visual acuity at baseline was 0.5±0.1 logarithm of the minimum angle of resolution (logMAR), improved to 0.4±0.1 logMAR (P = 0.008) at 3 months, and remained stable during follow-up. After baseline, 42.3% of eyes experienced flares, and the average number of flares reduced from 1.8±0.1 flares/year to 0.6±0.1 flares/year (P < 0.0001). Median time to first flare was 5.4 years (95% confidence interval [CI], 2.2-5.4 years) with a 5-year survival rate of 58.7%. Treatment failed in 37 eyes (23.7%), with a 5-year survival rate of 68.0% and an estimated time to 75% survival of 2.9 years (95% CI, 2.1-4.4 years). The risk for treatment failure was lower when treatment used adalimumab (odds ratio, 0.4; 95% CI, 0.2-0.9; P = 0.03) but was greater when systemic disease also was active at baseline (odds ratio, 3.2; 95% CI, 1.5-7.1; P = 0.004). CONCLUSIONS Overall, eyes treated with biologic agents after failure of treatment with corticosteroids and a second-line immunosuppression drug experienced satisfactory disease control (87.2%), reduced use of systemic immunosuppression, stable visual acuity, and a 23.7% risk of disease relapse. After multivariate adjustment, older age, treatment with adalimumab (versus infliximab), and inactive concomitant systemic disease were associated with a lower risk of treatment failure.
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Affiliation(s)
- Ahmed Al-Janabi
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Amgad El Nokrashy
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom; Mansoura Ophthalmic Center, Mansoura University, Cairo, Egypt
| | - Lazha Sharief
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Vivekka Nagendran
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Sue Lightman
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom; Technion, Institute of Technology, Bnai Zion Medical Center, Haifa, Israel.
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PERIVASCULAR THICKENING ON OPTICAL COHERENCE TOMOGRAPHY AS A MARKER OF INFLAMMATION IN BIRDSHOT RETINOCHOROIDITIS. Retina 2019. [DOI: 10.1097/iae.0000000000002038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Accorinti M, Okada AA, Smith JR, Gilardi M. Epidemiology of Macular Edema in Uveitis. Ocul Immunol Inflamm 2019; 27:169-180. [DOI: 10.1080/09273948.2019.1576910] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Annabelle A. Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Justine R. Smith
- Flinders University College of Medicine & Public Health, Adelaide, Australia
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Chawla R, Tripathy K, Temkar S, Venkatesh P, Kumar A. An imaging-based treatment algorithm for posterior focal retinitis. Ther Adv Ophthalmol 2018; 10:2515841418774423. [PMID: 29998221 PMCID: PMC6016964 DOI: 10.1177/2515841418774423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/15/2018] [Indexed: 11/15/2022] Open
Abstract
Background: In this paper, our aim was to describe an imaging-based empirical approach for categorizing and initiating treatment of immunocompetent patients with posterior focal retinitis, prior to the availability of results of expensive laboratory investigations. Materials and methods: The hospital records of 13 patients with posterior focal retinitis were reviewed. Results: Of the 13 patients, 9 were women and 4 were men. The mean age was 24 ± 8 years. Based on similarities in clinical presentation and imaging, we categorized our cases into three groups with different first-line therapeutic strategies. In the first group, patients had presumed toxoplasmosis (treated with oral cotrimoxazole); in the second group, patients had presumed viral (herpetic) etiology (treated with oral valacyclovir); and in the third group, patients had presumed nonherpetic, nontoxoplasma retinitis (treated with oral doxycycline). Positive serology results included Rickettsia (two patients), Borrelia (one patient), Toxoplasma (two patients), and herpes simplex virus (one patient). Conclusion: An empirical approach for early initiation of therapy in retinitis cases based on imaging features is described.
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Affiliation(s)
- Rohan Chawla
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Koushik Tripathy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Shreyas Temkar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Atul Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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Suhler EB, Adán A, Brézin AP, Fortin E, Goto H, Jaffe GJ, Kaburaki T, Kramer M, Lim LL, Muccioli C, Nguyen QD, Van Calster J, Cimino L, Kron M, Song AP, Liu J, Pathai S, Camez A, Schlaen A, van Velthoven MEJ, Vitale AT, Zierhut M, Tari S, Dick AD. Safety and Efficacy of Adalimumab in Patients with Noninfectious Uveitis in an Ongoing Open-Label Study: VISUAL III. Ophthalmology 2018; 125:1075-1087. [PMID: 29429764 DOI: 10.1016/j.ophtha.2017.12.039] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/17/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate safety and efficacy of adalimumab in patients with noninfectious intermediate, posterior, or panuveitis. DESIGN Phase 3, open-label, multicenter clinical trial extension (VISUAL III). PARTICIPANTS Adults meeting treatment failure (TF) criteria or who completed VISUAL I or II (phase 3, randomized, double-masked, placebo-controlled) without TF. METHODS Patients received adalimumab 40 mg every other week. Interim follow-up data were described from VISUAL III weeks 0 through 78. MAIN OUTCOME MEASURES Disease quiescence, steroid-free quiescence, active inflammatory chorioretinal/retinal vascular lesions, anterior chamber cell grade, vitreous haze grade, best-corrected visual acuity (BCVA), and corticosteroid dose. Binary data were reported using nonresponder imputation (NRI), continuous data using last observation carried forward and as-observed analysis, and corticosteroid dose using observed-case analysis. Adverse events (AEs) were reported from first adalimumab dose in VISUAL III through interim cutoff. RESULTS Of 424 patients enrolled, 371 were included in intent-to-treat analysis. At study entry, 242 of 371 (65%) patients had active uveitis; 60% (145/242, NRI) achieved quiescence at week 78, and 66% (95/143, as-observed) of those were corticosteroid free. At study entry, 129 of 371 (35%) patients had inactive uveitis; 74% (96/129, NRI) achieved quiescence at week 78, and 93% (89/96, as-observed) of those were corticosteroid free. Inflammatory lesions, anterior chamber grade, and vitreous haze grade showed initial improvement followed by decline in patients with active uveitis and remained stable in patients with inactive uveitis. BCVA improved in patients with active uveitis from weeks 0 to 78 (0.27 to 0.14 logMAR; left and right eyes; as-observed) and remained stable in patients with inactive uveitis. Mean corticosteroid dose decreased from 13.6 mg/day (week 0) to 2.6 mg/day (week 78) in patients with active uveitis and remained stable in those with inactive uveitis (1.5-1.2 mg/day). AEs (424 events/100 patient-years) and serious AEs (16.5 events/100 patient-years) were comparable with previous VISUAL trials. CONCLUSIONS Patients with active uveitis at study entry who received adalimumab therapy were likely to achieve quiescence, improve visual acuity, and reduce their daily uveitis-related systemic corticosteroid use. Most patients with inactive uveitis at study entry sustained quiescence without a systemic corticosteroid dose increase. No new safety signals were identified.
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Affiliation(s)
- Eric B Suhler
- Oregon Health & Science University, Casey Eye Institute, Portland, Oregon, and VA Portland Health Care System, Portland, Oregon.
| | | | | | | | | | | | | | - Michal Kramer
- Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | - Martina Kron
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | | | | | - Anne Camez
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | | | - Albert T Vitale
- John A. Moan Eye Center, University of Utah, Salt Lake City, Utah
| | | | | | - Andrew D Dick
- University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom, and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London, Institute of Ophthalmology, London, United Kingdom
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Sancho L, Kramer M, Koriat A, Eiger-Moscovich M, Sharon Y, Amer R. Complications in Intermediate Uveitis: Prevalence, Time of Onset, and Effects on Vision in Short-Term and Long-Term Follow-Up. Ocul Immunol Inflamm 2018; 27:447-455. [DOI: 10.1080/09273948.2017.1420203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ligia Sancho
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Koriat
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Maya Eiger-Moscovich
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Sharon
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
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Tripathy K. Regarding successful use of 23G cutter for anterior vitrectomy and scleral-fixated intraocular lens implantation. Int J Ophthalmol 2017; 10:1947-1948. [PMID: 29259921 DOI: 10.18240/ijo.2017.12.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/26/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Koushik Tripathy
- ICARE Eye Hospital & Postgraduate Institute, Uttar Pradesh 201301, India
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Niederer RL, Ahmed Talat Sharief L, Bar A, Lightman SL, Tomkins-Netzer O. Reply. Ophthalmology 2017. [DOI: 10.1016/j.ophtha.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tripathy K. Re: Niederer et al.: Predictors of long-term visual outcome in intermediate uveitis ( Ophthalmology . 2017;124:393-398). Ophthalmology 2017. [DOI: 10.1016/j.ophtha.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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