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Chang YC, Kao TE, Chen CL, Lin YC, Hwang DK, Hwang YS, Lin CJ, Chan WC, Lin CP, Chen SN, Sheu SJ. Use of corticosteroids in non-infectious uveitis - expert consensus in Taiwan. Ann Med 2024; 56:2352019. [PMID: 38747459 PMCID: PMC11097703 DOI: 10.1080/07853890.2024.2352019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/21/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To offer consensus on the utilization of corticosteroids (CS) for treating non-infectious uveitis in the context of clinical practice in Taiwan. This entails examining the different administration methods, their advantages and disadvantages, and considering alternative treatments according to the prevailing evidence and health policies. METHODS Ten ophthalmologists and one rheumatologist convened on December 11, 2022, to review and discuss literature on the topic. The databases explored were the Central Cochrane library, EMBASE, Medline, PUBMED, and Web of Science using relevant keywords. The search spanned from January 1996 to June 2023. After the initial results of the literature review were presented, open voting determined the final statements, with a statement being accepted if it secured more than 70% agreement. This consensus was then presented at significant meetings for further discussions before the final version was established. RESULTS A flow chart and nine statements emerged from the deliberations. They address the importance of CS in uveitis management, guidelines for using topical CS, indications for both periocular or intravitreal and systemic therapies, and tapering and discontinuation methods for both topical and systemic CS. CONCLUSION While CS are a cornerstone for non-infectious uveitis treatment, their administration requires careful consideration, depending on the clinical situation and the specific type of uveitis. The consensus generated from this article provides a guideline for practitioners in Taiwan, taking into account local health policies and the latest research on the subject. It emphasizes the significance of strategic tapering, the potential for alternative therapies, and the importance of patient-centric care.
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Affiliation(s)
- Yo-Chen Chang
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzu-En Kao
- Cheng Ching International Eye Hospital, Kaohsiung, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chih Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - De-Kuang Hwang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen Branch, Xiamen, China
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Optometry, Asia University, Taichung, Taiwan
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Chun Chan
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Cao F, Liang K, Tang WW, Ni QY, Ji ZY, Zha CK, Wang YK, Jiang ZX, Hou S, Tao LM, Wang X. Polyvinylpyrrolidone-curcumin nanoparticles with immune regulatory and metabolism regulatory effects for the treatment of experimental autoimmune uveitis. J Control Release 2024; 372:551-570. [PMID: 38914206 DOI: 10.1016/j.jconrel.2024.06.047] [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: 02/28/2024] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024]
Abstract
Uveitis comprises a cluster of intraocular inflammatory disorders characterized by uncontrolled autoimmune responses and excessive oxidative stress leading to vision loss worldwide. In the present study, curcumin (CUR) was conjugated with polyvinylpyrrolidone (PVP) to form PVP-CUR nanoparticles with significantly elevated solubility and outstanding multiple radical scavenging abilities. In vitro studies revealed that PVP-CUR nanoparticles markedly mitigated oxidative stress and reduced apoptosis in a H2O2-induced human retinal pigment epithelial cell line (ARPE-19) and promoted phenotypic polarization from M1 to M2 in an LPS-induced human microglial cell line (HMC3). Further in vivo studies demonstrated the prominent therapeutic effects of PVP-CUR nanoparticles on experimental autoimmune uveitis (EAU), which relieved clinical and pathological progression, improved perfusion and tomographic manifestations of retinal vessels, and reduced blood-retinal barrier (BRB) leakage; these effects may be mediated by mitigating oxidative stress and attenuating macrophage/microglia-elicited inflammation. Notably, treatment with PVP-CUR nanoparticles was shown to regulate metabolite alterations in EAU rats, providing novel insights into the underlying mechanisms involved. Additionally, the PVP-CUR nanoparticles showed great biocompatibility in vivo. In summary, our study revealed that PVP-CUR nanoparticles may serve as effective and safe nanodrugs for treating uveitis and other oxidative stress- and inflammation-related diseases.
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Affiliation(s)
- Fan Cao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China; Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei 230032, PR China
| | - Kun Liang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China
| | - Wei-Wei Tang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China
| | - Qin-Yu Ni
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China; Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei 230032, PR China
| | - Zhi-Yu Ji
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China; Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei 230032, PR China
| | - Chen-Kai Zha
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei 230032, PR China
| | - Ya-Kun Wang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Zheng-Xuan Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China.
| | - Shengping Hou
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, PR China.
| | - Li-Ming Tao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China.
| | - Xianwen Wang
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China; School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei 230032, PR China.
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Ros-Sánchez E, Oliver-Gutierrez D, Buck P, Goncharova T, Distefano L, Kirkegaard-Biosca E. Purpureocillium lilacinum-related endophthalmitis: case report. J Ophthalmic Inflamm Infect 2024; 14:27. [PMID: 38867117 PMCID: PMC11169429 DOI: 10.1186/s12348-024-00412-2] [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: 04/06/2024] [Accepted: 06/07/2024] [Indexed: 06/14/2024] Open
Abstract
PURPOSE To report a case of Purpureocillium lilacinum endophthalmitis. METHODS The case of a fungal endophthalmitis caused by Purpureocillium lilacinum documented in an immunocompetent patient with no apparent trigger. RESULTS A 64-year-old male with a two-month history of panuveitis in his left eye was referred to our hospital. Initially misdiagnosed as sympathetic ophthalmia due to a previous surgery on his right eye 4 months before the onset of the left ocular picture, the patient received corticosteroid treatment, leading to a rapid deterioration of the left eye condition. An urgent exploratory vitrectomy was performed to identify the underlying cause, revealing endophthalmitis. Microbiological investigation yielded Purpureocillium lilacinum as the causative agent. Despite intensive treatment, including intravitreal antibiotics and antifungals, along with another surgical intervention, clinical evolution remained unfavourable, ultimately leading to the evisceration of the affected eye. CONCLUSIONS Purpureocillium lilacinum poses a rare yet sever threat as a causative agent of fungal endophthalmitis. Managing such cases is challenging due to the delayed identification, fungus's resistance to common antifungals, and its association with prior corticosteroid misuse in most patients. This case underscores the crucial importance of heightened clinical suspicion, early diagnosis, and the exploration of alternative treatment strategies in addressing Purpureocillium lilacinum endophthalmitis. The challenges posed by this rare fungal pathogen emphasize the need for a multidisciplinary approach and continued research to improve outcomes in these complex cases.
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Affiliation(s)
- Elena Ros-Sánchez
- Ophthalmology department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 129, Barcelona, 08035, Spain.
| | - David Oliver-Gutierrez
- Ophthalmology department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 129, Barcelona, 08035, Spain
| | - Paul Buck
- Ophthalmology department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 129, Barcelona, 08035, Spain
| | - Tetiana Goncharova
- Ophthalmology department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 129, Barcelona, 08035, Spain
| | - Laura Distefano
- Ophthalmology department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 129, Barcelona, 08035, Spain
| | - Eric Kirkegaard-Biosca
- Ophthalmology department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 129, Barcelona, 08035, Spain
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Dolinko AH, Morvey DE, Apoorva S, Chikovsky M, Anesi SD, Foster CS. Effects of non-medical infliximab biosimilar switching in ocular inflammatory diseases: A case series from a tertiary care center. Eur J Ophthalmol 2024; 34:774-780. [PMID: 37671431 DOI: 10.1177/11206721231199778] [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] [Indexed: 09/07/2023]
Abstract
PURPOSE To describe the course of care and outcomes for 3 uveitis patients formerly on Remicade that were non-medically switched to Inflectra. DESIGN Retrospective observational case series. METHODS •Setting: Tertiary care clinical practice.•Patient population: 3 Uveitis patients, observing both eyes for inflammation as applicable. Patients included if they had been on Inflectra for ≥2 infusions and history of Remicade use. Patients described herein had at least 1 adverse reaction to Inflectra and were switched to Remicade for medical necessity. Patients excluded if they were lost to follow-up or not examined for over 6 months during therapy.•Observation procedures/Interventions: Patients observed for adverse changes in clinical course while on Inflectra. Patients developing these changes on Inflectra were started or restarted on Remicade. RESULTS The 3 patients described herein developed adverse complications while on Inflectra that required switching to Remicade. They were originally on Remicade, and their clinical course worsened beyond what had been controlled with Remicade alone. Our findings are limited by our small sample size, and further investigation is necessary to explore the scope of effects of non-medical biosimilar switching. CONCLUSION Non-medical biosimilar switching from Remicade to Inflectra may induce detrimental side-effects and significant worsening of inflammation in patients with uveitis. Non-medical biosimilar switching from Remicade to Inflectra should be discouraged, and physician input should be sought in establishing an effective and medically-necessary treatment plan for patients with uveitis.
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Affiliation(s)
- Andrew H Dolinko
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - Diana Edem Morvey
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - Shimy Apoorva
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - Max Chikovsky
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
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Pesoa Y, Palevski D, Tiosano A, Erlich R, Schaap Fogler M, Hadayer A, Levy I, Dotan A. Posterior synechia formation after phacovitrectomy - Predicting factors and the role of short-acting mydriatics. Acta Ophthalmol 2024; 102:e352-e357. [PMID: 37681397 DOI: 10.1111/aos.15760] [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: 05/21/2023] [Revised: 08/03/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE To evaluate the influence of topical short-acting mydriatics on the formation of posterior synechia after phacovitrectomy surgery of pars plana vitrectomy and phacoemulsification with intraocular lens implantation. METHODS A prospective randomised controlled trial. Fifty-seven adult (>18 years old) patients (57 eyes) who underwent phacovitrectomy surgery at a single tertiary hospital, were randomly divided into two groups. The control group (29 eyes) received standard postoperative treatment (topical antibiotics and steroids). The study group (28 eyes) received short-acting mydriatics together with standard therapy. Patients were followed until 24 months after surgery. The primary outcome measure was the formation of posterior synechia during the follow-up period. RESULTS A total of 7 patients developed posterior synechia during the follow-up period (12%), 3 in the study group (11%) and 4 in the control group (14%). There was no statistical difference between the groups. Significant associations for the development of posterior synechia were surgery for retinal detachment, longer surgery duration (>93 min) and the use of tamponade, in particular silicone oil. CONCLUSIONS The use of topical short-acting mydriatic drops after phacovitrectomy surgery, in addition to standard post-operative treatment, did not reduce the formation of posterior synechia. However, we identified several factors that may influence or act as predictors for the development of posterior synechia: surgery for retinal detachment, using silicone oil tamponade and a longer surgery duration. Our findings may aid in the standardisation of post-phacovitrectomy surgery treatment and define potential at-risk patients who should be monitored more closely.
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Affiliation(s)
- Yair Pesoa
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dahlia Palevski
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Tiosano
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rita Erlich
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Schaap Fogler
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Hadayer
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Issac Levy
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Dotan
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Smith JR, Thorne JE, Flaxel CJ, Jain N, Kim SJ, Maguire MG, Patel S, Weng CY, Yeh S, Kim LA. Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology. Ophthalmology 2024:S0161-6420(24)00158-1. [PMID: 38647511 DOI: 10.1016/j.ophtha.2024.02.019] [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: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. METHODS A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. RESULTS This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. CONCLUSIONS The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Jennifer E Thorne
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christina J Flaxel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Nieraj Jain
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Christina Y Weng
- Vitreoretinal Diseases & Surgery, Baylor College of Medicine, Cullen Eye Institute, Houston, Texas
| | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Leo A Kim
- Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Butler L, Tomkins-Netzer O, Reiser O, Niederer RL. Management of Scleritis in Older Adults. Drugs Aging 2024; 41:287-302. [PMID: 38441778 PMCID: PMC11021297 DOI: 10.1007/s40266-024-01105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/17/2024]
Abstract
Scleritis, an inflammatory disease of the eye affecting scleral tissue, presents unique challenges in the older adult population. Unlike their younger counterparts, older individuals manifest a distinct spectrum of the disease with different underlying etiologies, co-morbidities, altered immune function, and an increased risk of systemic side effects from medication choices. Addressing these complexities necessitates a comprehensive and multidisciplinary approach. Treatment of choice will depend on any underlying cause but generally involves non-steroidal anti-inflammatory drugs, systemic or local corticosteroids, and potentially disease-modifying anti-rheumatic drugs. Utilization of these therapeutic agents in older adults warrants careful consideration because of their potential side-effect profiles. This article critically examines the specific concerns for the use of these drugs in older patients and reviews the existing literature on their use in this specific cohort.
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Affiliation(s)
- Laura Butler
- Department of Ophthalmology, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - 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
| | - Or Reiser
- Department of Ophthalmology, Lady Davis Carmel Medical Centre, Haifa, Israel
| | - Rachael L Niederer
- Department of Ophthalmology, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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Esteban-Ortega M, Steiner M, Andreu-Vázquez C, Thuissard-Vasallo I, Díaz-Rato A, Muñoz-Fernández S. An Observational Study in the Real Clinical Practice of the Treatment of Noninfectious Uveitis. J Clin Med 2024; 13:1402. [PMID: 38592203 PMCID: PMC10933845 DOI: 10.3390/jcm13051402] [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: 12/29/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The aim of this study was to describe the characteristics of patients with uveitis associated with an immunologic or idiopathic disease that requires immunosuppressive treatment and the response to such treatments in real clinical practice. METHODS An observational, descriptive, longitudinal, and retrospective study of a cohort of patients diagnosed with noninfectious uveitis was performed. To assess the response to treatment, we evaluated the change in visual acuity, vitritis, and the presence of macular edema. RESULTS We included 356 patients. Overall, 12% required treatment with systemic corticosteroids, and 66 patients (18.5%) required immunosuppressive/biological treatment, with methotrexate being the most used (55%). Immunosuppressive drugs were used in 59 cases (in 56 patients, as the first choice of treatment and for 3 patients as the second choice after treatment with biologics). Treatment with biologics was the first choice in 10 patients out of 66 (15%), and 34 (48%) required them at some time during the disease, with adalimumab being the most commonly used. Thirty-five patients (53%) needed to switch drugs due to a lack of response to the first one. There were no differences between different drugs in the resolution of vitritis and improvement in vision. CONCLUSIONS The use of systemic corticosteroids and immunosuppressive/biologics was necessary for a high number of patients with noninfectious uveitis. In our series, tocilizumab was significantly more effective in the resolution of macular edema.
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Affiliation(s)
- Mar Esteban-Ortega
- Department of Ophthalmology, Infanta Sofía University Hospital, FIIB HUIS HHEN, Universidad Europea, 28702 Madrid, Spain;
| | - Martina Steiner
- Department of Rheumatology, Infanta Sofía University Hospital, FIIB HUIS HHEN, Universidad Europea, 28702 Madrid, Spain; (M.S.); (S.M.-F.)
| | - Cristina Andreu-Vázquez
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea, 28702 Madrid, Spain; (C.A.-V.); (I.T.-V.)
| | - Israel Thuissard-Vasallo
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea, 28702 Madrid, Spain; (C.A.-V.); (I.T.-V.)
| | - Alvaro Díaz-Rato
- Department of Ophthalmology, Infanta Sofía University Hospital, FIIB HUIS HHEN, Universidad Europea, 28702 Madrid, Spain;
| | - Santiago Muñoz-Fernández
- Department of Rheumatology, Infanta Sofía University Hospital, FIIB HUIS HHEN, Universidad Europea, 28702 Madrid, Spain; (M.S.); (S.M.-F.)
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9
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Thng ZX, Regenold J, Bromeo AJ, Akhavanrezayat A, Than NTT, Khatri A, Mohammadi SS, Tran ANT, Shin YU, Karaca I, Ghoraba HH, Or CCM, Nguyen QD. Challenges for further successful development of tumor necrosis factor targeting therapies for uveitis. Expert Opin Investig Drugs 2024; 33:95-104. [PMID: 38299551 DOI: 10.1080/13543784.2024.2311186] [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: 10/10/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of ocular conditions characterized by inflammation of the uveal tract and is one of the leading causes of vision impairment. In developed countries, noninfectious uveitis (NIU) represents most cases and is challenging to treat due to its severity, chronicity, and high recurrence rates. The advent of anti-tumor necrosis factor-α (anti-TNF-α) agents have dramatically improved outcomes and changed treatment paradigms in NIU. AREAS COVERED The index article summarizes the present experience of anti-TNF-α agents in NIU pharmacotherapy and highlights the barriers to further research and development of anti-TNF-α agents for uveitis. Common challenges faced in NIU clinical drugs trials, specific difficulties in anti-TNF-α drug development, and promising competitor drug candidates are discussed and evaluated. EXPERT OPINION Anti-TNF-α agents have revolutionized NIU pharmacotherapy and greatly improved outcomes with good safety profiles. The great success of systemic infliximab and adalimumab in NIU treatment has resulted in little impetus for further development of this class of medication. Attempts have been made to deliver anti-TNF-α agents intravitreally but that has not been successful thus far. With expiring patents, competition from biosimilars and newer, novel molecules, it may not be viable to continue pursuing anti-TNF-α drug development.
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Affiliation(s)
- Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jonathan Regenold
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Albert John Bromeo
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Asian Eye Institute, Makati, Philippines
| | | | - Ngoc T T Than
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar, Nepal
| | | | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Irmak Karaca
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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Pichi F, Smith SD, Goldstein DA, Baddar D, Gerges TKA, Janetos TM, Ruiz-Cruz M, Elena Concha-Del-Río L, Maruyama K, Carina Ten Berge J, Rombach SM, Cimino L, Bolletta E, Miserocchi E, Scandale P, Serafino M, Camicione P, Androudi S, Gonzalez-Lopez JJ, Lim LL, Singh N, Gupta V, Gupta N, Amer R, Dodds EM, Inchauspe S, Munk MR, Donicova E, Carreño E, Takeuchi M, Chee SP, Chew MC, Agarwal A, Schlaen A, Gómez RA, Couto CA, Khairallah M, Neri P. The Humira in Ocular Inflammations Taper (HOT) Study. Am J Ophthalmol 2024; 258:87-98. [PMID: 37734639 DOI: 10.1016/j.ajo.2023.09.012] [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: 06/12/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To assess factors that impact the risk of relapse in patients with noninfectious uveitis (NIU) who undergo adalimumab tapering after achieving remission. DESIGN Retrospective study. METHODS In this multicenter study, patients with NIU were treated with adalimumab and subsequently tapered. Patient demographics, type of NIU, onset and duration of disease, the period of inactivity before tapering adalimumab, and the tapering schedule were collected. The primary outcome measures were independent predictors of the rate of uveitis recurrence after adalimumab tapering. RESULTS Three hundred twenty-eight patients were included (54.6% female) with a mean age of 34.3 years. The mean time between disease onset and initiation of adalimumab therapy was 35.2 ± 70.1 weeks. Adalimumab tapering was commenced after a mean of 100.8 ± 69.7 weeks of inactivity. Recurrence was observed in 39.6% of patients at a mean of 44.7 ± 61.7 weeks. Patients who experienced recurrence were significantly younger than those without recurrence (mean 29.4 years vs 37.5 years, P = .0005), and the rate of recurrence was significantly higher in younger subjects (hazard ratio [HR] = 0.88 per decade of increasing age, P = .01). The lowest rate of recurrence was among Asian subjects. A faster adalimumab taper was associated with an increased recurrence rate (HR = 1.23 per unit increase in speed, P < .0005). Conversely, a more extended period of remission before tapering was associated with a lower rate of recurrence (HR = 0.97 per 10-weeks longer period of inactivity, P = .04). CONCLUSIONS When tapering adalimumab, factors that should be considered include patient age, race, and duration of disease remission on adalimumab. A slow tapering schedule is advisable.
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Affiliation(s)
- Francesco Pichi
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA.
| | - Scott D Smith
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA
| | - Debra A Goldstein
- Department of Ophthalmology (D.A.G., T.M.J.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dina Baddar
- Watany Eye Hospital (D.B., T.K.A.G.), Cairo, Egypt; Research Institute of Ophthalmology (D.B.), Giza, Egypt
| | | | - Timothy M Janetos
- Department of Ophthalmology (D.A.G., T.M.J.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matilde Ruiz-Cruz
- Asociación Para Evitar la Ceguera en México (M.R-C., L.E.C.), I. A. P., Mexico City, Mexico
| | | | - Kazuichi Maruyama
- Department of Vision Informatics (K.M.), Graduate School of Medicine, Osaka University, Osaka, Japan; Institute for Open and Transdisciplinary Research Initiatives (K.M.), Integrated Frontier Research for Medical Science Division, Osaka University, Osaka, Japan
| | - Josianne Carina Ten Berge
- Department of Ophthalmology (J.C.), Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Saskia M Rombach
- Department of Internal Medicine, Allergy and Clinical Immunology (S.M.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Luca Cimino
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine (L.C.), University of Modena and Reggio Emilia, Reggio Emilia, Italy; Ocular Immunology Unit (L.C., E.B.), Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elena Bolletta
- Ocular Immunology Unit (L.C., E.B.), Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Miserocchi
- School of Medicine (E.M., P.S.), Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology (E.M., P.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Scandale
- School of Medicine (E.M., P.S.), Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology (E.M., P.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimiliano Serafino
- Department of Surgical Science (M.S., P.C.), Division of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Camicione
- Department of Surgical Science (M.S., P.C.), Division of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sofia Androudi
- Department of Ophthalmology (S.A.), University of Thessaly, Thessaly, Greece
| | - Julio J Gonzalez-Lopez
- Ophthalmology Department (J.J.G-L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lyndell L Lim
- Centre for Eye Research Australia (L.L.L., N.S.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia
| | - Nandini Singh
- Centre for Eye Research Australia (L.L.L., N.S.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia
| | - Vishali Gupta
- Advance Eye Center (V.G., N.G.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Gupta
- Advance Eye Center (V.G., N.G.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radgonde Amer
- Department of Ophthalmology (R.A.), Hadassah Medical Center, Jerusalem, Israel
| | - Emilio M Dodds
- Consultores Oftalmológicos (E.M.D., S.I.), Buenos Aires, Argentina
| | | | - Marion R Munk
- Inselspital (M.R.M., E.D.), University Hospital Bern, Bern, Switzerland; Augenarzt-Praxisgemeinschaft Gutblick AG (M.R.M.), Bern, Switzerland; Feinberg School of Medicine (M.R.M.), Northwestern University, Chicago, Illinois, USA
| | - Emilia Donicova
- Inselspital (M.R.M., E.D.), University Hospital Bern, Bern, Switzerland
| | - Ester Carreño
- Hospital Universitario Fundación Jiménez Díaz (E.C.), Madrid, Spain
| | - Masaru Takeuchi
- Department of Ophthalmology (M.T.), National Defense Medical College, Namiki Tokorozawa Saitama, Japan
| | - Soon-Phaik Chee
- Singapore National Eye Centre (S-P.C., M.C.C.), Singapore; Department of Ophthalmology (S-P.C., M.C.C.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute (S-P.C.), Singapore; Department of Ophthalmology and Visual Sciences Academic Clinical Program (S-P.C.), Duke-NUS Medical School, Singapore
| | - Milton C Chew
- Singapore National Eye Centre (S-P.C., M.C.C.), Singapore; Department of Ophthalmology (S-P.C., M.C.C.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aniruddha Agarwal
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA
| | - Ariel Schlaen
- Hospital Universitario Austral (A.S.), Buenos Aires, Argentina; Hospital De Clinicas "José de San Martín" (A.S., R.A.G., C.A.C.), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ramiro A Gómez
- Hospital De Clinicas "José de San Martín" (A.S., R.A.G., C.A.C.), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Cristobal A Couto
- Hospital De Clinicas "José de San Martín" (A.S., R.A.G., C.A.C.), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Moncef Khairallah
- Department of Ophthalmology (M.K.), Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Tunisia
| | - Piergiorgio Neri
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA
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11
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Chao YJ, Hung JH, Lin CP, Kuo HK, Chen SN, Hwang YS, Li KJ, Lin CJ, Hwang DK, Sheu SJ. Diagnosis, Treatment, and Prevention of Noninfectious Acute Anterior Uveitis with or without Human Leukocyte Antigen B27 in Adults - Expert Consensus in Taiwan. Ocul Immunol Inflamm 2024; 32:226-233. [PMID: 36701640 DOI: 10.1080/09273948.2023.2165113] [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: 10/23/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anterior uveitis is the most common anatomical type of uveitis. Patients with noninfectious anterior uveitis may develop various ocular complications and eventually visual impairment. Appropriately differentiating the etiologies can help clinicians to predict the outcome, arrange clinical follow-up, and decide the treatment or prevention strategy. Adequate treatment and effective prevention strategies can reduce the frequency of recurrence and the risk of developing complications. Human leukocyte antigen (HLA)-B27 is the most common positive finding in patients with noninfectious AAU in many countries including Taiwan. PURPOSE To report a consensus from experienced uveitis specialists and rheumatologists was made in Taiwan. METHODS A panel of nine ophthalmologists from nine different referral centers with expertise in the management of uveitis and an experienced rheumatologist was held on January 16, 2022. A comprehensive literature review was performed. Differential diagnoses for etiologies, general treatments, and prevention strategies were discussed. Each statement in the consensus was made only if more than 70% of the experts agreed. RESULTS A flow chart and seven statements regarding the differential diagnoses for etiologies, treatments and preventions, and co-management with rheumatologists were included in the consensus. CONCLUSIONS This article discusses the general diagnosis, treatment, and prevention of noninfectious acute anterior uveitis, with or without HLA-B27, in adults for general ophthalmologists to improve overall outcomes of these patients.
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Affiliation(s)
- Yu-Jang Chao
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
| | - San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
- Department of Medication, China Medical University, Taichung, Taiwan, ROC
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
- Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen Branch, Xiamen, China
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
- Department of Optometry, Asia University, Taichung, Taiwan, ROC
| | - De-Kuang Hwang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Taghe S, Mirzaeei S, Bagheri M. Preparation of polycaprolactone and polymethacrylate nanofibers for controlled ocular delivery of ketorolac tromethamine: Pharmacokinetic study in Rabbit's Eye. Eur J Pharm Sci 2024; 192:106631. [PMID: 37951316 DOI: 10.1016/j.ejps.2023.106631] [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: 05/06/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 11/13/2023]
Abstract
Ophthalmitis is an inflammation of the eye triggered by various conditions including diseases, allergy, trauma, or surgery. Management of this condition usually includes administration of topical anti-inflammatory eye drops such as nonsteroidal anti-inflammatory drugs. To overcome the challenges of conventional eye drops such as frequent administration and low intraocular bioavailability, nanofibrous inserts of Ketorolac tromethamine (KET) were developed in this study. Polycaprolactone and polymethacrylate containing KET were electrospun to prepare biocompatible and biodegradable nanofibers. The inserts were studied for morphology, drug-polymer interaction, physicochemical properties, cell viability, in vitro drug release study and pharmacokinetic study in rabbit's eye. Uniform nanofibers with mean diameters < 350 nm were developed. Suitable mechanical properties with tensile strength up to 2.8 MPa indicated high strength and flexibility of inserts. Nanofibers exhibited controlled drug release for up to 140 h at a concentration more than 50 μg/ml in tears without causing any damage or irritation to the eye. Formulations indicated enhanced pharmacokinetics with 6- to 8-times higher Area Under the Curve (AUC0-144) compared to KET eye drop. Acceptable cell viability confirmed the safety of inserts. Due to the fact that this preservative-free polymer insert can obtain therapeutic concentration in the tear film without fluctuation, it can be a suitable alternative for the treatment of intraocular inflammations with less complications, easier use, and even higher intraocular penetration.
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Affiliation(s)
- Shiva Taghe
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Pharmaceutical Sciences Research Center, Rahesh Daru Novine, Kermanshah 6715847141, Iran; Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahla Mirzaeei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Pharmaceutical Sciences Research Center, Rahesh Daru Novine, Kermanshah 6715847141, Iran; Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masood Bagheri
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Ophthalmology, Imam Khomeini Eye Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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13
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Shareef Khan M, Rao Ravi P, Shrikant Dhavan D. Design, optimization and pharmacokinetic evaluation of PLGA phosphatidylcholine hybrid nanoparticles of triamcinolone acetonide loaded in situ gel for topical ocular delivery. Int J Pharm 2023; 647:123530. [PMID: 37858638 DOI: 10.1016/j.ijpharm.2023.123530] [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: 07/15/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Posterior uveitis (PU), which often has an autoimmune origin, can be treated effectively with synthetic glucocorticoid triamcinolone acetonide (TAA). Due to the limitations of topical TAA administration reaching the posterior segment of the eye, the drug is injected directly into the eye through an intravitreal injection. In this study, we prepared TAA loaded poly(lactic-co-glycolic acid) phosphatidylcholine hybrid nanoparticles (TAA-PLHNPs) using the principles of design of experiments (DoE) for topical ocular administration. The mean particle size (nm) and drug loading efficiency (LE%) for the optimized formulations were 163 ± 2.8 nm and 39 ± 1.9%, respectively. The TAA-PLHNPs were then loaded into the dual responsive in situ gel that we reported in our previous work. In vitro assessments were done to show that the formulations are safe for ocular administration. Finally, in vivo ocular pharmacokinetic studies were performed to compare pharmacokinetic parameters of TAA-PLHNPs and TAA-PLHNPs loaded in situ gel with each other and with the previously reported conventional formulation of TAA (aqueous suspension of TAA with 20% hydroxypropyl β-cyclodextrin (TAA-HP-β-CD-Susp)). TAA-PLHNPs loaded dual responsive in situ gel (TAA-PLHNP-ISG) achieved higher concentrations of TAA in the vitreous humor (Cmax of 946.53 ng/mL) and sustained (MRT0-∞ of 16.26 h) the drug concentrations for longer period of time compared to aqueous suspension of TAA-PLHNPs (TAA-PLHNP-Susp) and TAA-HP-β-CD-Susp.
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Affiliation(s)
- Mohammed Shareef Khan
- Department of Pharmacy, BITS-Pilani, Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal (District), Hyderabad 500078, India
| | - Punna Rao Ravi
- Department of Pharmacy, BITS-Pilani, Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal (District), Hyderabad 500078, India.
| | - Divya Shrikant Dhavan
- Department of Pharmacy, BITS-Pilani, Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal (District), Hyderabad 500078, India
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Zhang Y, Zhang XJ, Yuan N, Wang YM, Ip P, Chen LJ, Tham CC, Pang CP, Yam JC. Secondhand smoke exposure and ocular health: A systematic review. Surv Ophthalmol 2023; 68:1166-1207. [PMID: 37479063 DOI: 10.1016/j.survophthal.2023.07.001] [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: 01/18/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
The toxicology of secondhand smoke (SHS), along with the harm of its exposure to human health, has been generally acknowledged; however, specific evidence is lacking on the association between SHS exposure and ocular health. In this systematic review (PROSPERO registration number: CRD42022247992), we included 55 original articles published by 12 May 2023, which dealt with SHS exposure and ocular disorders, such as eye irritation, conjunctivitis, dry eye diseases, uveitis, myopia, astigmatism, contact lens discomfort, age-related macular degeneration, glaucoma, and thyroid eye disease that addressed the ocular neurovascular structures of the macular, retinal nerve fiber layer, choroid, and corneal biomechanical parameters. We found compelling correlational evidence for eye irritation, conjunctivitis, and dry eye symptoms-supporting that SHS exposure was positively associated with inflammatory and allergic changes in the eyes. Yet, evidence about the associations between SHS exposure and other ocular disorders, structures, and parameters is still limited or controversial. Given the limitations of existing literature, more investigations with high quality and rigorous design are warranted to elucidate the potentially harmful effects of SHS exposure on ocular health.
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Affiliation(s)
- Youjuan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China
| | - Nan Yuan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Kunming Bright Eye Hospital, Kunming, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Neurobiology, Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
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15
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Bajraktari G, Jukić T, Kalauz M, Oroz M, Radolović Bertetić A, Vukojević N. Early and Late Complications after Cataract Surgery in Patients with Uveitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1877. [PMID: 37893595 PMCID: PMC10608233 DOI: 10.3390/medicina59101877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Uveitis, a prevalent eye disorder characterized by inflammatory processes, often leads to cataract formation and significant visual impairment. This study aimed to evaluate preoperative conditions and postoperative outcomes following cataract surgery in uveitis patients. Materials and Methods: A retrospective study was conducted at the University Hospital Center Rebro Zagreb, Croatia, involving uveitis patients who underwent cataract surgery between 2013 and 2022. Eligible patients had uveitic cataracts affecting visual acuity or posterior segment visualization in a "quiet eye" and were disease-inactive for at least three months. Patients with certain pre-existing ocular conditions were excluded. The data collected included patient demographics, uveitis type, preoperative therapy, preexisting lesions, and postoperative outcomes such as visual acuity, intraocular pressure, central macular thickness, and complications. Statistical analysis was performed to identify risk factors associated with complications. Results: This study included 105 patients. The most common uveitis types were idiopathic uveitis, HLA-B27-associated uveitis, and JIA uveitis. After cataract surgery, there was a significant improvement in visual acuity at various time points, with 90% of eyes showing improvement. Intraocular pressure decreased over time. Central macular thickness increased at three months post-surgery but remained stable thereafter. Early and late complications were observed in 52.4% and 63.8% of eyes, respectively. The most common complications were posterior capsular opacification (53.3%), macular edema (26.6%), and epiretinal membrane formation (9.52%). The factors associated with complications varied between early and late stages but included age, age at the onset of uveitis, and the uveitis type. Conclusions: In patients with quiescent uveitis undergoing cataract surgery, significant visual improvement was achieved. This study highlights the importance of careful patient selection, preoperative and postoperative inflammation management, and precise surgical techniques. Although complications were common, the risk of capsular opacification, macular edema, and epiretinal membrane formation after surgery increased. However, future investigations should address this study's limitations and further refine perioperative strategies.
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Affiliation(s)
- Gentian Bajraktari
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Clinic of Ophthalmology, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo
| | - Tomislav Jukić
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Miro Kalauz
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Martin Oroz
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | | | - Nenad Vukojević
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
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16
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Tan H, Feng X, Yang P. Association between uveitis onset and economic development in mainland China. BMC Public Health 2023; 23:1711. [PMID: 37667273 PMCID: PMC10476315 DOI: 10.1186/s12889-023-16591-x] [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: 03/11/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Economic prosperity has fostered numerous changes that may translate into better or worse outcomes across all domains of health. This study aims to explore the associations of economic development with uveitis onset in mainland China. METHODS We used Poisson regression with generalized estimated equations to quantify the associations of per capita gross domestic product (GDP) with uveitis onset in 31 provinces of mainland China from 2006 to 2017. We further estimated the effects mediated by economic growth on the temperature-uveitis and PM2.5-uveitis associations established in our previous studies. RESULTS A total of 12,721 uveitis patients from 31 provinces of mainland China were studied. Overall, every 10,000 Chinese yuan ($ 1491.278, 2006-2017) increase in per capita GDP, with no weighted value or weighted by population, corresponded to 1.85% (95% confidence interval, 1.19-2.52%) and 1.43% (95% confidence interval, 0.37-2.51%) lnRR decrease in the uveitis onsets. Stratified analysis showed this negative association between per capita GDP and uveitis onset, only existed in male patients (P < .001), individuals aged 20-50 years (P < 0 .05), non-infectious uveitis, uveitis with systemic disease, and Bechet's disease (all P < 0 .05). Moreover, the increased per capita GDP, if above the national level, could reinforce both temperature-uveitis and PM2.5-uveitis association (both P < 0.001). CONCLUSIONS The findings suggest that economic development is negatively associated with uveitis onset. However, it may facilitate the uveitis onset mediated by both increased temperature and PM2.5 exposure if the per capita GDP is above national level.
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Affiliation(s)
- Handan Tan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Xiaojie Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China.
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17
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Zhou Y, Zhou A, Philip AM, Margolis M, Babiker F, Chang PY, Anesi SD, Foster CS. Vision Outcomes of Long-Term Immunomodulatory and Steroid Therapy in Sympathetic Ophthalmia. Am J Ophthalmol 2023; 253:152-159. [PMID: 37150338 DOI: 10.1016/j.ajo.2023.05.004] [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: 01/25/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To compare vision acuity outcomes of long-term steroid therapy compared with immunomodulatory therapy for treatment of sympathetic ophthalmia. DESIGN Single-center, retrospective, comparative clinical study. METHODS Patients with sympathetic ophthalmia treated from March 2005 to October 2022 with at least 1 year of follow-up were included. Visual acuity outcomes were compared by steroid and immunomodulatory treatment modality. RESULTS Thirty-five patients with sympathetic ophthalmia were included in the study, with follow-up ranging from 1 to 17 years. Higher rates of vision loss correlated with longer periods of active uveitis and steroid treatment. Lower rates of vision loss correlated with longer periods of uveitis remission on immunomodulatory therapy alone and drug-free remission. Treatment with alkylating agents or combination therapy with an antimetabolite, a biologic-response modifier, and cyclosporine are more likely to result in sympathetic ophthalmia remission. CONCLUSION Immunomodulatory therapy leads to superior vision outcomes in cases of steroid-resistant or recurrent sympathetic ophthalmia. Steroid therapy may be useful for acute or recalcitrant sympathetic uveitis but is insufficient for long-term inflammatory control. PRéCIS: This manuscript describes a retrospective analysis of vision outcomes in patients with sympathetic ophthalmia. Results indicate that long-term immunomodulatory therapy is associated with better vision outcomes than long-term steroid therapy for sympathetic ophthalmia treatment.
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Affiliation(s)
- Yujia Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Avery Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Andrew M Philip
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Michael Margolis
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Fatima Babiker
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Peter Y Chang
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Stephen D Anesi
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - C Stephen Foster
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); Department of Ophthalmology, Harvard Medical School, Boston, MA, USA (C.S.F).
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18
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Shi H, Huai S, Wei H, Xu Y, Lei L, Chen H, Li X, Ma H. Dissolvable hybrid microneedle patch for efficient delivery of curcumin to reduce intraocular inflammation. Int J Pharm 2023; 643:123205. [PMID: 37422141 DOI: 10.1016/j.ijpharm.2023.123205] [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: 03/26/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
Intraocular inflammation seriously impairs vision, and the effectiveness of intraocular drug delivery is hampered by various physiological barriers, such as the corneal barrier. In this paper, we present a simple approach to fabricating a dissolvable hybrid microneedles (MNs) patch for the efficient delivery of curcumin to treat intraocular inflammatory disorders. Water-insoluble curcumin was first encapsulated into polymeric micelles with high anti-inflammatory capacities, and then were combined with hyaluronic acid (HA) to create a dissolvable hybrid MNs patch using a simple micromolding method. Curcumin was amorphously dispersed within the MNs patch as indicated by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), and X-ray diffraction (XRD) analyses. According to an in vitro drug release study, the proposed MNs patch provided sustainable drug release over 8 h. Following its in vivo topical application, the MNs patch demonstrated an extended pre-corneal retention time over 3.5 h and exhibited great ocular biocompatibility. Additionally, such MNs patch could reversibly penetrate the corneal epithelium, generating an array of microchannels on the corneal surface, thereby increasing ocular bioavailability. Of greater significance, the use of MNs patch demonstrated the improved therapeutic effectiveness in treating endotoxin-induced uveitis (EIU) in a rabbit model compared to curcumin eye drops via a significant reduction in the infiltration of inflammatory cells such as CD45+ leukocytes and CD68+ macrophages. Overall, the topical application of the MNs patch as an efficient ocular drug delivery system could potentially serve as a promising approach for treating different types of intraocular disorders.
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Affiliation(s)
- Hui Shi
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Shuo Huai
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Huiling Wei
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Ying Xu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lei Lei
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Hao Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Xingyi Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
| | - Huixiang Ma
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
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19
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Wu X, Tao M, Zhu L, Zhang T, Zhang M. Pathogenesis and current therapies for non-infectious uveitis. Clin Exp Med 2023; 23:1089-1106. [PMID: 36422739 PMCID: PMC10390404 DOI: 10.1007/s10238-022-00954-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
Non-infectious uveitis (NIU) is a disorder with various etiologies and is characterized by eye inflammation, mainly affecting people of working age. An accurate diagnosis of NIU is crucial for appropriate therapy. The aim of therapy is to improve vision, relieve ocular inflammation, prevent relapse, and avoid treatment side effects. At present, corticosteroids are the mainstay of topical or systemic therapy. However, repeated injections are required for the treatment of chronic NIU. Recently, new drug delivery systems that may ensure intraocular delivery of therapeutic drug levels have been highlighted. Furthermore, with the development of immunosuppressants and biologics, specific therapies can be selected based on the needs of each patient. Immunosuppressants used in the treatment of NIU include calcineurin inhibitors and antimetabolites. However, systemic immunosuppressive therapy itself is associated with adverse effects due to the inhibition of immune function. In patients with refractory NIU or those who cannot tolerate corticosteroids and immunosuppressors, biologics have emerged as alternative treatments. Thus, to improve the prognosis of patients with NIU, NIU should be managed with different drugs according to the response to treatment and possible side effects.
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Affiliation(s)
- Xue Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Mengying Tao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling Zhu
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ting Zhang
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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20
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Rujkorakarn P, Zhou A, Babiker F, Chang PY. Suprachoroidal Triamcinolone Injection in Posterior Scleritis: A Case Report. Ocul Immunol Inflamm 2023:1-4. [PMID: 37450640 DOI: 10.1080/09273948.2023.2232447] [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: 03/04/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
Suprachoroidal triamcinolone acetonide (SCS-TA) injections were recently approved to treat macular edema secondary to noninfectious uveitis. However, its use in managing posterior scleritis has not been reported. We report the first case of SCS-TA used in the treatment of posterior scleritis. A 67-year-old woman with posterior scleritis complicated by exudative retinal detachment, diagnosed by spectral-domain optical coherence tomography scan (OCT), presented with pain, decreased vision, and redness in the left eye for 8 months. She was previously prescribed topical prednisolone and oral prednisone with minimal improvement. She also had a history of rheumatoid arthritis treated with multiple systemic immunosuppressive agents. After SCS-TA, the patient's pain resolved and visual acuity improved. OCT demonstrated significant reduction in sclerochoroidal thickening. Via its novel delivery method, SCS-TA may be an effective treatment for posterior scleritis. Further studies are needed to establish long-term efficacy and safety of this treatment modality.
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Affiliation(s)
- Ploysai Rujkorakarn
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Department of Ophthalmology, Suddhavej Hospital, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
| | - Avery Zhou
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
| | - Fatima Babiker
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
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21
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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 DOI: 10.1016/j.addr.2023.114869] [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: 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.
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Affiliation(s)
- Sean Teabagy
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Emma Wood
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Evan Bilsbury
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sean Doherty
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Priya Janardhana
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Darren J Lee
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
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22
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Brown JE, Thomas AS, Armbrust KR, Boyd K, Berkenstock M, Kopplin LJ. Therapeutic Outcomes of Non-Infectious Scleritis Treated with Tumor Necrosis Factor-Alpha Inhibitors. Ocul Immunol Inflamm 2023:1-7. [PMID: 37043601 DOI: 10.1080/09273948.2023.2191712] [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: 04/14/2023]
Abstract
PURPOSE We determine the efficacy of tumor necrosis factor-α (TNF) inhibitors in establishing scleritis quiescence. METHODS We conducted a multicenter retrospective chart review of patients with non-infectious scleritis treated with a TNF inhibitor for at least 6 months. The primary endpoint was scleritis quiescence at 6 months. Secondary endpoints included scleritis quiescence at 12 months, TNF inhibitor effects on concurrent doses of systemic corticosteroids and visual acuity outcomes at 6 and 12 months. RESULTS At 6 months, 82.2% (37/45) of subjects obtained scleritis quiescence with TNF inhibition. At 12 months, 76.2% (32/42) of subjects remained quiescent. Baseline daily corticosteroid use (21.5 ± 21.6 mg) decreased to 5.4 ± 8.3 mg by 6 months (p < 0.0001) and 2.8 ± 6.1 mg by 12 months (p < 0.001). There was no significant difference between the baseline and 6-month BCVA (p = 0.52). CONCLUSIONS TNF inhibitors are an effective scleritis therapy with significant systemic corticosteroid sparing effect.
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Affiliation(s)
- Jaime E Brown
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Karen R Armbrust
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kelly Boyd
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Meghan Berkenstock
- Ocular Immunology Division, Johns Hopkins School of Medicine, Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Laura J Kopplin
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
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23
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Gómez-Gómez A, Madrid-Garcia A, Borrego-Sanz L, Álvarez-Hernández P, Arriola-Villalobos P, Pérez-Sancristobal I, Benítez Del Castillo JM, Mendez-Fernandez R, Pato-Cour E, Díaz-Valle D, Rodriguez-Rodriguez L. Therapeutic Response After Immunosuppressive Drug Prescription in Non-infectious Uveitis: A Survival Analysis. Ophthalmol Ther 2023; 12:139-153. [PMID: 36266560 PMCID: PMC9834496 DOI: 10.1007/s40123-022-00587-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/23/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION To identify factors affecting the response rate to immunosuppressive drugs (ISDs) in patients with non-infectious uveitis (NIU). METHODS This longitudinal retrospective cohort study included patients from the Hospital Clinico San Carlos Uveitis Clinic diagnosed with NIU from 1992 to 2016. Subjects were followed up from ISD prescription until the achievement of good therapeutic response (GTR), ISD treatment change, or up to 12 months. GTR was defined as the complete resolution of the eye inflammatory manifestations with a corticosteroid dose ≤ 10 or ≤ 5 mg per day of prednisone or equivalent (GTR10 and GTR5, respectively) maintained for at least 28 days. Kaplan-Meier curves were estimated for GTR. Demographic, clinical, and treatment-related factors were analyzed using Cox robust regression. RESULTS A total of 73 patients (100 episodes of ISD prescription) were analyzed. In 44 and 41 episodes, GTR10 and GTR5 were achieved, respectively. A lower hazard for both GTRs was associated with uveitic macular edema at prescription and with a higher "highest oral corticosteroid dose prescribed in the year before ISD prescription". GTR10 was higher if cyclosporine was prescribed (compared to other ISDs), and if a higher number of ISDs had been previously prescribed. GTR5 hazard was lower for patients with posterior uveitis or if the ISDs were prescribed before 2008, and higher if periocular corticosteroids had been administered before ISD prescription, or if the duration of the posterior segment activity was shorter. CONCLUSIONS Factors associated with GTR to ISDs may help to identify patients with NIUs who could benefit from a thorough follow-up.
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Affiliation(s)
- Alejandro Gómez-Gómez
- School of Medicine, Universidad Complutense de Madrid, Plaza Ramón y Cajal, s/n, 28040, Madrid, Spain
- Rheumatology Department, Hospital Universitario Vall d'Hebron, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Alfredo Madrid-Garcia
- Musculoskeletal Pathology Group, Rheumatology Department, Health Research Institute (IdISSC), Hospital Clínico San Carlos, c\ Prof. Martín Lagos, s/n, 20840, Madrid, Spain
| | - Lara Borrego-Sanz
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Paula Álvarez-Hernández
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Pedro Arriola-Villalobos
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Inés Pérez-Sancristobal
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - José M Benítez Del Castillo
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Rosalía Mendez-Fernandez
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Esperanza Pato-Cour
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Musculoskeletal Pathology Group, Rheumatology Department, Health Research Institute (IdISSC), Hospital Clínico San Carlos, c\ Prof. Martín Lagos, s/n, 20840, Madrid, Spain.
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24
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Rivera PA, Gupta A, Kombo N. Treatment of non-infectious retinal vasculitis. Ther Adv Ophthalmol 2023; 15:25158414231152761. [PMID: 37077655 PMCID: PMC10107051 DOI: 10.1177/25158414231152761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
Retinal vasculitis (RV) refers to an entity in which the retinal vasculature is inflamed, frequently with indications of inflammation elsewhere in the eye. Non-infectious RV can be idiopathic or associated with systemic disease, ocular conditions, and malignancy. It can also be classified based on the vessel affected: artery, vein, or both. Due to the lack of strong evidence-based treatment trials and algorithms for RV, physicians must often rely on their experience, which creates great variability in treating this entity. This article provides an overview of various treatment modalities used in the management of non-infectious RV, with a focus on immunomodulatory therapies. We outline a potential stepwise approach of starting with steroids to control the acute inflammation and subsequently changing to immunomodulatory therapy (IMT) for long-term treatment.
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Affiliation(s)
- Paola A. Rivera
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Akash Gupta
- Department of Medicine, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
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25
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Haydinger CD, Ferreira LB, Williams KA, Smith JR. Mechanisms of macular edema. Front Med (Lausanne) 2023; 10:1128811. [PMID: 36960343 PMCID: PMC10027768 DOI: 10.3389/fmed.2023.1128811] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Macular edema is the pathological accumulation of fluid in the central retina. It is a complication of many retinal diseases, including diabetic retinopathy, retinal vascular occlusions and uveitis, among others. Macular edema causes decreased visual acuity and, when chronic or refractory, can cause severe and permanent visual impairment and blindness. In most instances, it develops due to dysregulation of the blood-retinal barrier which permits infiltration of the retinal tissue by proteins and other solutes that are normally retained in the blood. The increase in osmotic pressure in the tissue drives fluid accumulation. Current treatments include vascular endothelial growth factor blockers, corticosteroids, and non-steroidal anti-inflammatory drugs. These treatments target vasoactive and inflammatory mediators that cause disruption to the blood-retinal barrier. In this review, a clinical overview of macular edema is provided, mechanisms of disease are discussed, highlighting processes targeted by current treatments, and areas of opportunity for future research are identified.
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26
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Miraldi Utz V, Angeles-Han ST, Mwase N, Cassedy A, Hennard T, Lovell DJ, Lopper S, Brunner HI, Dosunmu EO, Grom AA, Henrickson M, Huggins JL, Sisk RA, Ting TV, Kaufman AH. Alternative Biologic Therapy in Children Failing Conventional TNFα Inhibitors for Refractory, Noninfectious, Chronic Anterior Uveitis. Am J Ophthalmol 2022; 244:183-195. [PMID: 35863492 DOI: 10.1016/j.ajo.2022.06.024] [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: 03/29/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE A significant number of children with noninfectious, chronic anterior uveitis (CAU) fail to respond to conventional therapy; however, successful alternative biologic treatments (ABT) have not been well described. This study aims to review the clinical and treatment characteristics of children with CAU who require ABT. DESIGN Retrospective, nonrandomized clinical study. METHODS Setting: Tertiary center. STUDY POPULATION Children with noninfectious CAU. OBSERVATION PROCEDURES Clinical characteristics, uveitis course, complications, and treatment were compared among patients treated with methotrexate (MTX) monotherapy, conventional TNFα inhibitors (cTNFi), and ABT for >3 months. MAIN OUTCOME MEASURE Success of ABT (abatacept, tocilizumab, and/or golimumab) in children failing conventional treatment. RESULTS Of the 52 children with CAU, 75% had juvenile idiopathic arthritis. CAU was controlled in 15 children receiving MTX monotherapy, 28 receiving cTNFi, and 9 receiving ABT (n = 1, abatacept; n = 3, tocilizumab; n = 5, golimumab). Patients in the ABT group had a greater number of total ocular complications per person before ABT than those in the control groups (3.4 vs 0.7 [MTX], P < .001, and 1.5 [cTNFi], P < .001, respectively). In all 9 children on ABT, treatment led to control of CAU and topical glucocorticoids tapered to ≤2 drops/d with no new ocular complications. CONCLUSIONS In this study, alternative biologics (abatacept, golimumab, and tocilizumab) were useful for treating CAU in children who fail MTX and cTNFi therapy. Patients who were controlled on ABT had more disease activity, ocular complications, and anti-cTNFi neutralizing antibodies (before ABT) than those managed with conventional therapy. Larger studies are required to confirm these findings.
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Affiliation(s)
- Virginia Miraldi Utz
- From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.)
| | - Sheila T Angeles-Han
- From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Department of Ophthalmology (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.).
| | - Najima Mwase
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.)
| | - Amy Cassedy
- University of Cincinnati, and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center (A.C.)
| | - Theresa Hennard
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.)
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.)
| | - Sarah Lopper
- From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Department of Ophthalmology (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.)
| | - Hermine I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.)
| | - Eniolami O Dosunmu
- From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Department of Ophthalmology (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.)
| | - Alexei A Grom
- From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.)
| | - Michael Henrickson
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.)
| | - Jennifer L Huggins
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.)
| | - Robert A Sisk
- From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Department of Ophthalmology (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Cincinnati Eye Institute (R.A.S., A.H.K.), Cincinnati, Ohio, USA
| | - Tracy V Ting
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics (S.T.A.-H., N.M., T.H., D.J.L., H.I.B., A.A.G., M.H., J.L.H., T.V.T.)
| | - Adam H Kaufman
- From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Department of Ophthalmology (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.); Cincinnati Eye Institute (R.A.S., A.H.K.), Cincinnati, Ohio, USA
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Layús BI, Gerez CL, Rodriguez AV. Development of an ophthalmic formulation with a postbiotic of Lactiplantibacillus plantarum CRL 759. Benef Microbes 2022; 13:417-426. [PMID: 36377582 DOI: 10.3920/bm2022.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The term postbiotics has acquired great interest in recent years. Numerous studies have shown a potential beneficial effect of its use in many inflammatory pathologies. However, it has not been much explored in ocular inflammatory diseases. The aims of this study were to develop and characterise an ophthalmic formulation with a postbiotic of Lactiplantibacillus plantarum CRL 759, and to evaluate its anti-inflammatory actions on murine macrophage stimulated with lipopolysaccharides (LPS) in vitro. First, we evaluated the ability of L. plantarum CRL 759 to generate a supernatant with anti-inflammatory property using different buffers. Then, we studied the stability at different temperatures and storage times of the generated postbiotic. In vitro assays showed that incubation of L. plantarum CRL 759 in modified phosphate buffer according to Sorensen (called POF-759), generated a supernatant that significantly reduced the production of interleukin-6, tumour necrosis factor-α, and nitric oxide by RAW 264.7 cells stimulated with LPS. Furthermore, POF-759 maintained its anti-inflammatory activity at room temperature, 4 and -20 °C, up to 30 days of storage. From the studies reported here, a postbiotic product with anti-inflammatory properties and optimal characteristics for the formulation of eye drops was obtained.
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Affiliation(s)
- B I Layús
- Centro de Referencia para Lactobacilos (CERELA-CONICET). Chacabuco 145, San Miguel de Tucumán, Argentina
| | - C L Gerez
- Centro de Referencia para Lactobacilos (CERELA-CONICET). Chacabuco 145, San Miguel de Tucumán, Argentina
| | - A V Rodriguez
- Centro de Referencia para Lactobacilos (CERELA-CONICET). Chacabuco 145, San Miguel de Tucumán, Argentina
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Pyare R, Dutta Majumder P, Shah M, Kaushik V, Agarwal M, Biswas J. Tofacitinib in Scleritis: A Case Series. Ocul Immunol Inflamm 2022:1-7. [PMID: 36126052 DOI: 10.1080/09273948.2022.2113805] [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: 04/11/2022] [Revised: 07/09/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the use of tofacitinib in ten patients with scleritis where the traditional immunomodulation was not successful or could not be used. METHOD A retrospective chart review. RESULT Tofacitinib was successful in the treatment of scleritis in patients either recalcitrant to or intolerant to conventional therapy in 9 out of 10 cases reported here. Two patients had developed reactivation of herpetic infection after 1 month of starting tofacitinib. The duration from diagnosis of scleritis to the institution of tofacitinib therapy varied from 1 month to 60 months. Duration of follow-up varies from 2 months to 11 months. CONCLUSION Tofacitinib can be used as an important future option for managing recurrent and recalcitrant cases of scleritis.
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Affiliation(s)
- Richa Pyare
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India
| | | | - Mauli Shah
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India
| | | | - Mamta Agarwal
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India
| | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India
- Department of Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India
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29
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Hwang DK, Hung JH, Chang YC, Chen CL, Chen SN, Cheng CK, Hwang YS, Kuo HK, Li AF, Lin CJ, Yang CH, Sheu SJ, Lin CP. Step-wise diagnostic approach for patients with uveitis - Experts consensus in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:573-580. [PMID: 35361552 DOI: 10.1016/j.jmii.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/10/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023]
Abstract
Uveitis is a sight-threatening disease that can be associated with many different etiologies. Successful treatment of uveitis relies on accurate diagnosis and prompt efficient therapy. History taking, physical and ocular examinations, systemic evaluations, and response to treatment provide crucial information to differentiate possible etiologies involved in the pathophysiology of intraocular inflammation. This article provides recommendations for a step-wise approach to patients with uveitis in Taiwan based on an expert meeting and consensus. Systemic evaluations for uveitis should be performed step-by-step and include investigation of patients' general systemic conditions, ruling out infectious etiologies, and obtaining evidential biomarkers to diagnose a specific disease entity.
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Affiliation(s)
- De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan; Department of Optometry, Da-Yeh University, Changhua, Taiwan
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Catholic Fu-Jen University, New Taipei, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen Branch, Xiamen, China
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan; Chang-Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Fei Li
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Optometry, Asia University, Taichung, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Taiwan.
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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30
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Patel S, Belamkar A, Hajrasouliha AR, Jusufbegovic D, Ciulla TA. Progress in the pharmacotherapy of uveitis: the art of personalized care. Expert Opin Pharmacother 2022; 23:1445-1455. [PMID: 35880543 DOI: 10.1080/14656566.2022.2104637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of inflammatory intraocular disorders which can lead to blindness, but prompt diagnosis and management can improve visual outcomes and reduce treatment burden. AREAS COVERED In this review, the authors provide an overview of commonly used treatments of the management of non-infectious uveitis. EXPERT OPINION Initially, the treatment of non-infectious uveitis was limited to corticosteroids which have a broad range of adverse ocular and systemic effects. Now new options, such as biological response modulators, are a novel yet exciting addition to this armory and have the potential to change the course of treatment as well as prognostic outcomes for uveitis patients. Additionally, further research is needed to evaluate the efficacy of this novel class of immunomodulators in uveitis therapy.
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Affiliation(s)
- Shivam Patel
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Aditya Belamkar
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Amir R Hajrasouliha
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Denis Jusufbegovic
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Thomas A Ciulla
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202.,Midwest Eye Institute, Springmill Medical Building, 10300 N. Illinois St., Suite 1000, Carmel, IN 46290, USA.,Clearside Biomedical, 900 North Point Pkwy # 200, Alpharetta, GA 30005
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31
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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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Moreira Castro BF, Nunes da Silva C, Barbosa Cordeiro LP, Pereira de Freitas Cenachi S, Vasconcelos-Santos DV, Machado RR, Dias Heneine LG, Silva LM, Silva-Cunha A, Fialho SL. Low-dose melittin is safe for intravitreal administration and ameliorates inflammation in an experimental model of uveitis. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2022; 3:100107. [PMID: 35647524 PMCID: PMC9130091 DOI: 10.1016/j.crphar.2022.100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022] Open
Abstract
Uveitis is a group of sight-threatening ocular inflammatory disorders, whose mainstay of therapy is associated with severe adverse events, prompting the investigation of alternative treatments. The peptide melittin (MEL) is the major component of Apis mellifera bee venom and presents anti-inflammatory and antiangiogenic activities, with possible application in ophthalmology. This work aims to investigate the potential of intravitreal MEL in the treatment of ocular diseases involving inflammatory processes, especially uveitis. Safety of MEL was assessed in retinal cells, chick embryo chorioallantoic membranes, and rats. MEL at concentrations safe for intravitreal administration showed an antiangiogenic activity in the chorioallantoic membrane model comparable to bevacizumab, used as positive control. A protective anti-inflammatory effect in retinal cells stimulated with lipopolysaccharide (LPS) was also observed, without toxic effects. Finally, rats with bacille Calmette-Guerin- (BCG) induced uveitis treated with intravitreal MEL showed attenuated disease progression and improvement of clinical, morphological, and functional parameters, in addition to decreased levels of proinflammatory mediators in the posterior segment of the eye. These effects were comparable to the response observed with corticosteroid treatment. Therefore, MEL presents adequate safety profile for intraocular administration and has therapeutic potential as an anti-inflammatory and antiangiogenic agent for ocular diseases. Melittin at low concentration is safe for intravitreal administration. The antiangiogenic effect of melittin on the chorioallantoic membrane model is comparable to bevacizumab. Melittin protects retinal cells from inflammatory response induced by lipopolysaccharide. Melittin improves clinical, functional and morphological signs of inflammation in rats with BCG-induced uveitis.
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Gupta S, Shyamsundar K, Agrawal M, Vichare N, Biswas J. Current Knowledge of Biologics in Treatment of Noninfectious Uveitis. J Ocul Pharmacol Ther 2022; 38:203-222. [DOI: 10.1089/jop.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Simple Gupta
- Department of Ophthalmology, Command Hospital, Pune, India
| | - K. Shyamsundar
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Mohini Agrawal
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Nitin Vichare
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Netralaya, Chennai, India
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Abdel-Aty A, Gupta A, Del Priore L, Kombo N. Management of noninfectious scleritis. Ther Adv Ophthalmol 2022; 14:25158414211070879. [PMID: 35083421 PMCID: PMC8785299 DOI: 10.1177/25158414211070879] [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: 08/04/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Scleritis is a manifestation of inflammatory eye disease that involves the sclera. It can be divided into multiple subtypes, including diffuse anterior, nodular anterior, necrotizing, and posterior scleritis. In many cases, scleritis is restricted to the eye; however, it can occur in the context of systemic illness, particularly autoimmune and infectious conditions. Patients with autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and polyangiitis with granulomatosis, may develop scleritis flares that may require topical and systemic therapy. Initial therapy typically involves oral nonsteroidal anti-inflammatory drugs (NSAIDs); however, it is important to address the underlying condition, particularly if systemic. Other treatment regimens typically involve either local or systemic steroids or the use of immunomodulatory agents, which have a wide range of efficacy and documented use in the literature. There is a myriad of immunomodulatory agents used in the treatment of scleritis including antimetabolites, calcineurin inhibitors, biologics, and alkylating agents. In this review, we highlight the various subtypes of noninfectious scleritis and explore each of the mainstay agents used in the management of this entity. We explore the use of steroids and NSAIDs in detail and discuss evidence for various immunomodulatory agents.
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Affiliation(s)
- Ahmad Abdel-Aty
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Akash Gupta
- Department of Medicine, School of Medicine, Yale University, 20 York Street, New Haven, CT 06510, USA
| | - Lucian Del Priore
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
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35
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José-Vieira R, Ferreira A, Menéres P, Sousa-Pinto B, Figueira L. Efficacy and safety of intravitreal and periocular injection of corticosteroids in non-infectious uveitis: a systematic review. Surv Ophthalmol 2021; 67:991-1013. [PMID: 34896190 DOI: 10.1016/j.survophthal.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Uveitis is among the leading causes of visual loss in the working age population. In non-infectious uveitis, corticosteroids are the first line therapy. We sought to review systematically the evidence regarding the regional corticosteroid delivery modalities in the treatment of non-infectious uveitis. A five-database search (Pubmed, ISI Web of Science, Cochrane, ClinicalTrials.gov, and Scopus) was performed from inception to February, 2021. Nineteen studies with a total of 1935 eyes of 1753 patients were selected from 8922 abstracts retrieved by the initial search. The most frequently compared regimens were intravitreal triamcinolone acetonide injection and orbital floor triamcinolone acetonide injection (2 studies), intravitreal triamcinolone acetonide injection and posterior sub-Tenon triamcinolone acetonide injection (2 studies), and posterior sub-Tenon triamcinolone acetonide injection with the intravitreal dexamethasone implant (2 studies). Our results show that the intravitreal injection of corticosteroids is more effective, but is associated with more adverse events, than periocular injection. Some evidence supports the use of subconjunctival triamcinolone acetonide over intravitreal/periocular triamcinolone acetonide. Moreover, the overall results of 0.59 mg dosage of the intravitreal fluocinolone acetonide implant were superior to those from the 2.1 mg dose. The evidence, however, is not robust and further studies with standardized outcomes are warranted.
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Affiliation(s)
- Rafael José-Vieira
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal; RISE-Health Research Network, Porto, Portuga.
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Ophthalmology, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal; RISE-Health Research Network, Porto, Portuga
| | - Luís Figueira
- Department of Ophthalmology, University Hospital Center of S. João, Porto, Portugal; Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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López-Machado A, Díaz N, Cano A, Espina M, Badía J, Baldomà L, Calpena AC, Biancardi M, Souto EB, García ML, Sánchez-López E. Development of topical eye-drops of lactoferrin-loaded biodegradable nanoparticles for the treatment of anterior segment inflammatory processes. Int J Pharm 2021; 609:121188. [PMID: 34655707 DOI: 10.1016/j.ijpharm.2021.121188] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/26/2022]
Abstract
Ocular inflammation is one of the most common comorbidities associated to ophthalmic surgeries and disorders. Since conventional topical ophthalmic treatments present disadvantages such as low bioavailability and relevant side effects, natural alternatives constitute an unmet medical need. In this sense, lactoferrin, a high molecular weight protein, is a promising alternative against inflammation. However, lactoferrin aqueous instability and high nasolacrimal duct drainage compromises its potential effectiveness. Moreover, nanotechnology has led to an improvement in the administration of active compounds with compromised biopharmaceutical profiles. Here, we incorporate lactoferrin into biodegradable polymeric nanoparticles and optimized the formulation using the design of experiments approach. A monodisperse nanoparticles population was obtained with an average size around 130 nm and positive surface charge. Pharmacokinetic and pharmacodynamic behaviour were improved by the nanoparticles showing a prolonged lactoferrin release profile. Lactoferrin nanoparticles were non-cytotoxic and non-irritant neither in vitro nor in vivo. Moreover, nanoparticles exhibited significantly increased anti-inflammatory efficacy in cell culture and preclinical assays. In conclusion, lactoferrin loaded nanoparticles constitute a safe and novel nanotechnological tool suitable for the treatment of ocular inflammation.
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Affiliation(s)
- Ana López-Machado
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | - Natalia Díaz
- Department of Biochemistry & Physiology, Faculty of Pharmacy & Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Biomedicine, University of Barcelona (IBUB), Barcelona, Spain; Institut de Recerca Sant Joan de Deu (IRSJD), Barcelona, Spain
| | - Amanda Cano
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Marta Espina
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | - Josefa Badía
- Department of Biochemistry & Physiology, Faculty of Pharmacy & Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Biomedicine, University of Barcelona (IBUB), Barcelona, Spain; Institut de Recerca Sant Joan de Deu (IRSJD), Barcelona, Spain
| | - Laura Baldomà
- Department of Biochemistry & Physiology, Faculty of Pharmacy & Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Biomedicine, University of Barcelona (IBUB), Barcelona, Spain; Institut de Recerca Sant Joan de Deu (IRSJD), Barcelona, Spain
| | - Ana Cristina Calpena
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | | | - Eliana B Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Portugal; CEB-Centre of Biological Engineering, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal
| | - María Luisa García
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
| | - Elena Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain; Institute of Biomedicine, University of Barcelona (IBUB), Barcelona, Spain.
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37
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Zając H, Turno-Kręcicka A. Ocular Manifestations of Behçet's Disease: An Update on Diagnostic Challenges and Disease Management. J Clin Med 2021; 10:jcm10215174. [PMID: 34768694 PMCID: PMC8584626 DOI: 10.3390/jcm10215174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Behçet's disease is a systemic vasculitis that affects multiple organs. The most common manifestations are oral and genital ulcerations and recurrent uveitis. Uveitis can be an initial symptom in 10-20% of cases and leads to blindness in 16-25% of patients. The management of this disease is evolving due to the clinical phenotypes recently described in the literature and increasing focus on the detection of subclinical inflammation to enable correct therapeutic decisions. The first line treatment is azathioprine, followed by various immunosuppressive and biological agents as alternatives in severe or refractory cases. This review summarizes scientific articles about the etiology of, diagnostic tools for and treatment of the ocular manifestations of Behçet's disease available in the PubMed database from 1 January 2016 to 1 May 2021. A multidisciplinary approach is necessary to effectively prevent permanent damage and thus improve the life quality of the patients. Therefore, it is crucial to raise awareness of the common clusters of symptoms, use of modern imaging methods, such as ocular computed tomography and fluorescein angiography, and novelty treatment algorithms to enable early diagnosis and appropriate management.
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Affiliation(s)
- Hanna Zając
- Department of Ophthalmology, University Clinical Hospital in Wroclaw, 50-556 Wroclaw, Poland
- Correspondence: (H.Z.); (A.T.-K.)
| | - Anna Turno-Kręcicka
- Department of Ophthalmology, University Clinical Hospital in Wroclaw, 50-556 Wroclaw, Poland
- Department of Ophthalmology, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence: (H.Z.); (A.T.-K.)
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Paulbuddhe V, Addya S, Gurnani B, Singh D, Tripathy K, Chawla R. Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies? Clin Ophthalmol 2021; 15:4201-4218. [PMID: 34707340 PMCID: PMC8542579 DOI: 10.2147/opth.s289688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 01/05/2023] Open
Abstract
Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen-Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.
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Affiliation(s)
- Vivek Paulbuddhe
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Sujit Addya
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Bharat Gurnani
- Department of Cornea, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, Puducherry, India
| | - Dheerendra Singh
- Department of Retina, ASG Eye Hospital, Bhopal, 462016, Madhya Pradesh, India
| | - Koushik Tripathy
- Department of Vitreoretina, ASG Eye Hospital, Kolkata, 700058, West Bengal, India
| | - Rohan Chawla
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Mu Y, Xu W, Liu J, Wang Y, Chen J, Zhou Q. Mesenchymal stem cells moderate experimental autoimmune uveitis by dynamic regulating Th17 and Breg cells response. J Tissue Eng Regen Med 2021; 16:26-35. [PMID: 34674378 DOI: 10.1002/term.3259] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022]
Abstract
Mesenchymal stem cells (MSCs) are adult stem cells from mesoderm with multi potential differentiation, and are being widely studied as a promising treatment for autoimmune diseases. The main inflammatory factors of experimental autoimmune uveitis (EAU) are T helper type 1 (Th1) and Th17. Regulatory B cells (Bregs) are a newly designated B cell subgroup, which has been proved to play a key role in regulating inflammation, autoimmunity and cancer. In this regard, we establish the EAU model by injecting interphotoreceptor retinoid-binding protein combined with complete Freund's adjuvant into the tail vein and bilateral thighs of rats, and inject MSCs or equal volume of phosphate buffer saline intraperitoneally on the day of immunization. Dynamic changes of cell subsets and cytokine expression are tested at different time periods to explore the relationship between MSCs treatment and disease prognosis during EAU course. Our results suggest that compared with the model control group, MSCs treatment can significantly reduce the production of Th1 and Th17 cytokines during EAU, while the production of regulatory B cells (Bregs) cytokines is significantly increased. At the same time, MSCs can reduce the proportion of Th17 in lymphocytes while the proportion of Bregs is elevated, thus inhibiting the differentiation and activity of interleukin in EAU rats. All this results provide more powerful evidence for cell therapy of autoimmune uveitis.
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Affiliation(s)
- Yajun Mu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei Xu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Ophthalmology, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Jue Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yingwei Wang
- Department of Pathophysiology, School of Medicine, Jinan University, Guangzhou, China
| | - Jian Chen
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qing Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Development of Lactoferrin-Loaded Liposomes for the Management of Dry Eye Disease and Ocular Inflammation. Pharmaceutics 2021; 13:pharmaceutics13101698. [PMID: 34683990 PMCID: PMC8539938 DOI: 10.3390/pharmaceutics13101698] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/13/2022] Open
Abstract
Dry eye disease (DED) is a high prevalent multifactorial disease characterized by a lack of homeostasis of the tear film which causes ocular surface inflammation, soreness, and visual disturbance. Conventional ophthalmic treatments present limitations such as low bioavailability and side effects. Lactoferrin (LF) constitutes a promising therapeutic tool, but its poor aqueous stability and high nasolacrimal duct drainage hinder its potential efficacy. In this study, we incorporate lactoferrin into hyaluronic acid coated liposomes by the lipid film method, followed by high pressure homogenization. Pharmacokinetic and pharmacodynamic profiles were evaluated in vitro and ex vivo. Cytotoxicity and ocular tolerance were assayed both in vitro and in vivo using New Zealand rabbits, as well as dry eye and anti-inflammatory treatments. LF loaded liposomes showed an average size of 90 nm, monomodal population, positive surface charge and a high molecular weight protein encapsulation of 53%. Biopharmaceutical behaviour was enhanced by the nanocarrier, and any cytotoxic effect was studied in human corneal epithelial cells. Developed liposomes revealed the ability to reverse dry eye symptoms and possess anti-inflammatory efficacy, without inducing ocular irritation. Hence, lactoferrin loaded liposomes could offer an innovative nanotechnological tool as suitable approach in the treatment of DED.
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Nguyen QD, Anesi SD, Chexal S, Chu DS, Dayani PN, Leng T, Meleth AD, Sallam AA, Sheppard JD, Silverstein SM, Toyos M, Wang RC, Foster CS. Management of repository corticotropin injection therapy for non-infectious uveitis: a Delphi study. Acta Ophthalmol 2021; 99:669-678. [PMID: 33751822 PMCID: PMC10863995 DOI: 10.1111/aos.14702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Diagnosis and management of non-infectious uveitis (NIU), a major cause of blindness worldwide, are challenging. Corticosteroids, the cornerstone of therapy, are not appropriate for long-term use, and while non-biologic and biologic immunomodulators may be used for some patients, data on their efficacy and safety in this population are limited. Repository corticotropin injection (RCI), believed to affect uveitis by multiple mechanisms, has received regulatory approval for treatment of ophthalmic diseases including posterior uveitis, but is not widely used or discussed in guidelines for the management of uveitis and ocular inflammatory diseases. METHODS The index study employed a modified Delphi process with a panel of 14 US-based ophthalmologists. Consensus recommendations were developed through a series of three questionnaires. Panellists rated statements on a Likert scale from -5 (strongly disagree) to +5 (strongly agree). RESULTS The Delphi panel provided consensus recommendations on examinations and testing needed for diagnosis, treatment goals, and the use of corticosteroids, as well as the use of non-biologic and biologic immunomodulators. The panel reached consensus that RCI may be considered for posterior and pan-uveitis, and dosing should be individualized for each patient. Dose reduction/discontinuation should be considered for excessive RCI-related toxicity, hyperglycaemia and/or diabetic complications, excessive costs, or remission ≥ 2 years. Patients should be weaned from RCI if uveitis is stable and well controlled. Adverse events during RCI therapy can be managed by appropriate interventions, with dose reduction/discontinuation considered if events are severe or recurrent. CONCLUSIONS Expert consensus suggests RCI may be an appropriate treatment option for some patients with uveitis when other therapies are ineffective or intolerable.
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Affiliation(s)
- Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Stephen D. Anesi
- Massachusetts Eye Research & Surgery Institution (MERSI), Waltham, MA, USA
| | | | - David S. Chu
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
- Metropolitan Eye Research and Surgery Institute, Palisades Park, NJ, USA
| | - Pouya N. Dayani
- Retina-Vitreous Associates Medical Group, Los Angeles, CA, USA
| | - Theodore Leng
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Ahmed A. Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Değirmenci MFK, Yalçındağ FN, Tugal-Tutkun İ. COVID-19 and the Use of Immunomodulatory Agents in Ophthalmology. Turk J Ophthalmol 2021; 51:231-242. [PMID: 34461710 PMCID: PMC8411289 DOI: 10.4274/tjo.galenos.2021.68252] [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] [Indexed: 12/01/2022] Open
Abstract
Immunomodulatory agents are often used in the systemic treatment of non-infectious uveitis. These drugs consist of corticosteroids, conventional immunosuppressives, and biological agents. As it is known that they suppress the immune system, the most important concern associated with immunomodulatory therapy (IMT) is the increased risk of infection. The World Health Organization declared COVID-19 a pandemic on 11 March 2020. Although severe acute respiratory distress syndrome secondary to SARS-CoV-2 infection may develop in all people, patients who receive IMT may be at higher risk in terms of both the transmission of the infection and more severe disease course. Therefore, guidelines on the management of patients receiving IMT due to uveitis during the pandemic are needed. In this review, we examined the immunomodulatory drugs used in the treatment of uveitis in terms of infectious complications and the data of patients who received IMT during the COVID-19 pandemic and discussed recommendations for the use of these drugs. According to the latest information, patients who receive IMT may continue their treatment as long as there are no disruptions in regular complete blood count (especially white blood cell count >4,000/μL) and liver and kidney function tests. Patients diagnosed with COVID-19 should be managed with a multidisciplinary approach.
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Affiliation(s)
| | - F Nilüfer Yalçındağ
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İlknur Tugal-Tutkun
- İstanbul University, İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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Guo X, Chen Z, Xing Y. Immune-mediated uveitis and lifestyle factors: A review. Ophthalmic Res 2021; 64:687-695. [PMID: 34348329 DOI: 10.1159/000518496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Xiaoyu Guo
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China,
| | - Zhen Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yiqiao Xing
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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Gandhi JS. Aspects of Treating Uveitis With Local and Systemic Therapies. Asia Pac J Ophthalmol (Phila) 2021; 10:335. [PMID: 34261101 DOI: 10.1097/apo.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jagdeep Singh Gandhi
- Worcester Royal Eye Unit, Worcestershire Royal Hospital, Worcester WR5 1DD, United Kingdom
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Shome A, Mugisho OO, Niederer RL, Rupenthal ID. Blocking the inflammasome: A novel approach to treat uveitis. Drug Discov Today 2021; 26:2839-2857. [PMID: 34229084 DOI: 10.1016/j.drudis.2021.06.017] [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: 01/25/2021] [Revised: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
Uveitis is a complex ocular inflammatory disease often accompanied by bacterial or viral infections (infectious uveitis) or underlying autoimmune diseases (non-infectious uveitis). Treatment of the underlying infection along with corticosteroid-mediated suppression of acute inflammation usually resolves infectious uveitis. However, to develop more effective therapies for non-infectious uveitis and to better address acute inflammation in infectious disease, an improved understanding of the underlying inflammatory pathways is needed. In this review, we discuss the disease aetiology, preclinical in vitro and in vivo uveitis models, the role of inflammatory pathways, as well as current and future therapies. In particular, we highlight the involvement of the inflammasome in the development of non-infectious uveitis and how it could be a future target for effective treatment of the disease.
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Affiliation(s)
- Avik Shome
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Odunayo O Mugisho
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; Auckland District Health Board, Auckland, New Zealand
| | - Ilva D Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
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Abdel-Aty A, Kombo N. Factors affecting the resolution of acute non-infectious anterior scleritis. Br J Ophthalmol 2021; 106:1672-1677. [PMID: 34210671 DOI: 10.1136/bjophthalmol-2021-318808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Tumor necrosis factor alpha (TNF-⍺) inhibitors are increasingly being used to treat scleritis, however, their efficacy has not been compared to older treatments. Additionally, few studies have assessed differences in the course of scleritis among different patient groups. We identify demographic factors, comorbidities and treatments associated with the resolution of acute scleritis. METHODS The records of patients with non-infectious anterior scleritis who presented between 1 January 2013 and 1 January 2018 were retrospectively reviewed. RESULTS A total of 141 patients (169 eyes) with anterior scleritis were identified. 92.9% had diffuse anterior scleritis, 5.0% had nodular anterior scleritis and 2.1% had necrotising scleritis. Topical corticosteroids were used in 66.7% of patients, systemic non-steroidal anti-inflammatory drugs (NSAIDs) in 48.9% and systemic corticosteroids in 37.6%. Non-corticosteroid immunomodulatory therapies were required in 37.6% of patients. In a Cox proportionate hazards model, factors positively associated with the resolution of an episode of scleritis included NSAID use (HR=2.145; 95% CI 1.200 to 3.832), Hispanic race (HR=2.991; 95% CI 1.115 to 7.341) and lupus erythematous (HR=6.175; 95% CI 1.774 to 21.489). Bilateral scleritis was negatively associated with resolution (HR=0.437; 95% CI 0.196 to 0.972). TNF-⍺ inhibitors (HR=3.346; 95% CI 1.277-8.763), NSAID use (HR=2.558; 95% CI 1.383 to 4.729), lupus erythematosus (HR=5.251; 95% CI 1.478 to 18.659) and Hispanic race (HR=3.198; 95% CI 1.022 to 10.005) were significantly positively associated with steroid sparing resolution. CONCLUSION Patient characteristics including a lupus diagnosis and Hispanic race were associated with faster times to symptom resolution and steroid sparing resolution, as were treatments including systemic NSAIDs and TNF-⍺ inhibitors. Due to limitations in the available data, this analysis did not account for disease severity. Future prospective studies will further elucidate the relationship between these factors and patient outcomes.
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Affiliation(s)
- Ahmad Abdel-Aty
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Zhu L, Chen B, Su W. A Review of the Various Roles and Participation Levels of B-Cells in Non-Infectious Uveitis. Front Immunol 2021; 12:676046. [PMID: 34054864 PMCID: PMC8160461 DOI: 10.3389/fimmu.2021.676046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
Non-infectious uveitis is an inflammatory disorder of the eye that accounts for severe visual loss without evident infectious agents. While T cells are supposed to dominate the induction of inflammation in non-infectious uveitis, the role of B cells in the pathogenesis of this disease is obscure. Therefore, this review aimed to discuss diverse B-cell participation in different non-infectious uveitides and their roles in the pathogenesis of this disease as well as the mechanism of action of rituximab. Increasing evidence from experimental models and human non-infectious uveitis has suggested the participation of B cells in non-infectious uveitis. The participation levels vary in different uveitides. Furthermore, B cells play multiple roles in the pathogenic mechanisms. B cells produce autoantibodies, regulate T cell responses via antibody-independent functions, and constitute ectopic lymphoid structures. Regulatory B cells perform pivotal anti-inflammatory functions in non-infectious uveitis. Rituximab may work by depleting pro-inflammatory B cells and restoring the quantity and function of regulatory B cells in this disease. Identifying the levels of B-cell participation and the associated roles is beneficial for optimizing therapy. Diversified experimental model choices and emerging tools and/or methods are conducive for future studies on this topic.
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Affiliation(s)
- Lei Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Binyao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Lin M, Anesi SD, Chang PY, Eggenschwiler L, Manhapra A, Walsh M, Foster CS. Clinical features, visual outcome, and poor prognostic factors in occlusive retinal vasculitis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 57:207-213. [PMID: 33838140 DOI: 10.1016/j.jcjo.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the clinical features, treatment, and visual outcome of occlusive retinal vasculitis (ORV), with a focal analysis on prognostic factors associated with poor visual outcome. METHODS We conducted a retrospective cohort study in patients diagnosed with ORV with at least 6 months of follow-up. Demographic data, ocular features, best corrected visual acuity (BCVA), fluorescein angiography, therapy regimens, and outcomes were collected from the Massachusetts Eye Research and Surgery Institution database from 2006 to 2017. Multivariate logistic regression was performed to analyze the factors independently predicting poor visual outcome. RESULTS Fifty-two patients (69 eyes) were enrolled, 42 with noninfectious cause, 9 with infectious cause, and 1 with masquerade uveitis. Systemic inflammatory diseases, including necrotizing vasculitis, sarcoidosis, multiple sclerosis, systemic lupus erythematosus, and Behçet's disease comprised the causes of ORV. Forty of the 42 patients with noninfectious ORV received immunomodulatory therapy (IMT), and 35 patients (87.5%) were able to achieve steroid-free remission. Compared with the BCVA at the initial visit (0.66 [±0.11] logMAR), there was significant improvement at the most recent visit (0.37 [±0.07] logMAR, p = 0.001). A multivariate analysis demonstrated that optic nerve atrophy, macular ischemia, and poor BCVA at initial presentation were independently correlated with poor visual outcome. CONCLUSIONS ORV could be caused by a wide spectrum of systemic inflammatory diseases. Aggressive IMT is preferred to achieve a steroid-free durable remission for noninfectious ORV. Optic nerve atrophy, macular ischemia, and poor BCVA at the initial visit predict a poor visual outcome.
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Affiliation(s)
- Miaoli Lin
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass.; C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Laura Eggenschwiler
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Marisa Walsh
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass.; Harvard Medical School, Boston, Mass..
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Layús BI, Gomez MA, Cazorla SI, Rodriguez AV. Drops of Lactiplantibacillus plantarum CRL 759 culture supernatant attenuates eyes inflammation induced by lipopolysaccharide. Benef Microbes 2021; 12:163-174. [PMID: 33769229 DOI: 10.3920/bm2020.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anti-inflammatory effect of soluble secreted compounds of probiotic bacteria was widely demonstrated as therapy for different inflammatory diseases, but was not investigated in inflammatory eye disorders. The aim of this study was to determine whether Lactiplantibacillus plantarum CRL759 cell-free supernatant reduced inflammatory parameters and clinical signs in ocular inflammations. First, we evaluated the effect of L. plantarum CRL759 supernatant in vitro on human retinal cell line, ARPE-19 cells, stimulated with lipopolysaccharide (LPS). Then, we investigated in vivo its capacity to decrease inflammation by local administration on the eyes of mice with endotoxin induced inflammation. In vitro assays demonstrated that L. plantarum CRL759 supernatant reduced the production of interleukin (IL)-6, IL-8, nitric oxide and thiobarbituric acid reactive substances in LPS-stimulated ARPE-19 cells. Our in vivo data proved that L. plantarum supernatant significantly reduced the clinical score of endotoxin treated mice and diminished levels of tumour necrosis factor alpha, interferon gamma and protein concentration in aqueous humour. Histological examination showed reduction of infiltrating inflammatory cells in the posterior segment of the eyes. As far as we know, this is the first report showing that Lactobacillus spp. supernatant administered as drops reduces some parameters of ocular inflammation. This promising strategy is safe and could alleviate symptoms and signs of ocular inflammation in people that are refractories to the conventional therapies.
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Affiliation(s)
- B I Layús
- CONICET, CERELA, Batalla de Chacabuco 145, 4000 San Miguel de Tucumán, Argentina
| | - M A Gomez
- Hospital Ángel C. Padilla, Juan Bautista Alberdi 550, 4000 San Miguel de Tucumán, Argentina
| | - S I Cazorla
- CONICET, CERELA, Batalla de Chacabuco 145, 4000 San Miguel de Tucumán, Argentina
| | - A V Rodriguez
- CONICET, Cell Signaling Laboratory, Batalla de Chacabuco 145, 4000 San Miguel de Tucumán, Argentina
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Paiva MRBD, Vasconcelos-Santos DVD, Coelho MM, Machado RR, Lopes NP, Silva-Cunha A, Fialho SL. Licarin A as a Novel Drug for Inflammatory Eye Diseases. J Ocul Pharmacol Ther 2021; 37:290-300. [PMID: 33761287 DOI: 10.1089/jop.2020.0129] [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] [Indexed: 01/16/2023] Open
Abstract
Purpose: This study investigated the safety and therapeutic efficacy of licarin A (LCA) in the treatment of intraocular inflammation. Methods: In vitro safety of LCA in retinal pigmented epithelial cells (ARPE-19) and human embryonic stem cell derived-retinal pigmented epithelial cells (hES-RPE) was evaluated using CellTiter-Blue® kit. The chorioallantoic membrane (CAM) assay was used to investigate LCA safety and antiangiogenic activity. In vivo safety of intravitreal LCA was accomplished by clinical examination (including assessment of intraocular pressure), electroretinography (ERG), and histopathology. Uveitis was induced in rats by subcutaneous and intravitreal injection of bacillus Calmette-Guérin (BCG) antigen of Mycobacterium bovis. Intraocular inflammation was graded by slit-lamp and fundus examination, ERG, and histopathology. Results: LCA was safe to cells and to the CAM at concentration below 12.0 μM. LCA significantly reduced the percentage of blood vessels in the CAM. Retinal safety and anti-inflammatory efficacy of intravitreal injection of LCA 6.0 μM were confirmed through clinical, functional, and histopathological evaluation. Significant reduction of inflammatory cytokines (tumor necrosis factor-α and interleukin-6) was also found, when compared to untreated animals. Conclusion: The results suggest that LCA is a potential new drug for the treatment of inflammatory eye disease.
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Affiliation(s)
| | | | - Márcio Matos Coelho
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Norberto Peporine Lopes
- NPPNS, Department of Biomolecular Sciences, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Armando Silva-Cunha
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Silvia Ligório Fialho
- Pharmaceutical Research and Development, Ezequiel Dias Foundation, Belo Horizonte, Brazil
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