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Cummings OW, Meléndez-Montañez JM, Naraine L, Yavuz Saricay L, El Helwe H, Solá-Del Valle D. Crystalline keratopathy following long-term netarsudil therapy. Am J Ophthalmol Case Rep 2024; 35:102069. [PMID: 38799226 PMCID: PMC11126778 DOI: 10.1016/j.ajoc.2024.102069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/09/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose This case report highlights a possible association between netarsudil use and crystalline keratopathy. Observations Presented here is the case of a 72-year-old woman with primary open-angle glaucoma (POAG) who developed corneal crystalline keratopathy after taking netarsudil for 24 months. The patient's medical history was significant for dry eye syndrome, bilateral ptosis with surgical repair, and atopy (including asthma and various ocular and systemic allergies). The patient had previously undergone surgical repair for bilateral ptosis as well. During the interval between two routine visits, this patient experienced worsening vision with associated eye irritation. Further examination revealed crystal deposits on the anterior corneal surface in the left eye, the only eye undergoing netarsudil treatment. Conclusions and importance Long-term netarsudil use may be associated with crystalline keratopathy in the anterior stroma, with the potential to cause sight-threatening vision loss if located in the visual axis.
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Affiliation(s)
| | | | - Leah Naraine
- Glaucoma Service, Massachusetts Eye, and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - Leyla Yavuz Saricay
- Cornea Service, Massachusetts Eye, and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - Hani El Helwe
- Glaucoma Service, Massachusetts Eye, and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - David Solá-Del Valle
- Glaucoma Service, Massachusetts Eye, and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
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Pal B, Atem TD, Kumari S, Murti K, Kumar R, Pandey K, Siddiqui NA, Dhingra S, Chaudhary V. Ophthalmic adverse effects of miltefosine in the treatment of leishmaniasis: a systematic review. Cutan Ocul Toxicol 2024; 43:190-197. [PMID: 39023122 DOI: 10.1080/15569527.2024.2380311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/10/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Miltefosine stands as the sole oral medication approved for the treatment of leishmaniasis. The appearance of severe ophthalmic toxicities induced by miltefosine in the context of leishmaniasis treatment is a matter of significant concern. The main objective of this study is to present a comprehensive summary of the ophthalmic adverse effects associated with miltefosine when used in the treatment of leishmaniasis. METHODS A systematic search was performed on PubMed, ScienceDirect, Embase, Scopus, and Google Scholar, covering articles from inception up to June 2023, without language restrictions, to identify relevant studies documenting ocular toxicity following miltefosine treatment for leishmaniasis. RESULTS A total of eight studies involving 31 leishmaniasis patients who developed ocular toxicities while undergoing miltefosine treatment were included in the analysis. These studies were conducted in various regions, with five originating from India, two from Bangladesh, and one from Nepal. Patients presented a spectrum of ophthalmic complications, including uveitis, keratitis, scleritis, and Mooren's ulcer. Commonly reported symptoms included pain, redness, excessive tearing, partial vision impairment, permanent blindness, light sensitivity, and the appearance of white spots on the eye. On average, patients received miltefosine treatment for a duration of 47 days before experiencing the onset of ocular problems. It is important to note that the risk of ocular toxicities increases with prolonged use of miltefosine. CONCLUSIONS Therefore, to mitigate the potential for irreversible damage to the eyes, it is imperative that all individuals undergoing miltefosine therapy undergo regular eye examinations.
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Affiliation(s)
- Biplab Pal
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Tambe Daniel Atem
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Sweta Kumari
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Krishna Murti
- National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Rishikesh Kumar
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, IndiaConsultant (Biostatistics)
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, IndiaConsultant (Biostatistics)
| | - Niyamat Ali Siddiqui
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, IndiaConsultant (Biostatistics)
| | - Sameer Dhingra
- National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Vaibhav Chaudhary
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
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Lindgren ES, Yan R, Cil O, Verkman AS, Chan MF, Seitzman GD, Farooq AV, Huppert LA, Rugo HS, Pohlmann PR, Lu J, Esserman LJ, Pasricha ND. Incidence and Mitigation of Corneal Pseudomicrocysts Induced by Antibody-Drug Conjugates (ADCs). CURRENT OPHTHALMOLOGY REPORTS 2024; 12:13-22. [PMID: 38756824 PMCID: PMC11095972 DOI: 10.1007/s40135-024-00322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 05/18/2024]
Abstract
Purpose of Review This study is to highlight the incidence of corneal pseudomicrocysts in FDA-approved antibody-drug conjugates (ADCs), and success of preventive therapies for pseudomicrocysts and related ocular surface adverse events (AEs). Recent Findings ADCs are an emerging class of selective cancer therapies that consist of a potent cytotoxin connected to a monoclonal antibody (mAb) that targets antigens expressed on malignant cells. Currently, there are 11 FDA-approved ADCs with over 164 in clinical trials. Various AEs have been attributed to ADCs, including ocular surface AEs (keratitis/keratopathy, dry eye, conjunctivitis, blurred vision, corneal pseudomicrocysts). While the severity and prevalence of ADC-induced ocular surface AEs are well reported, the reporting of corneal pseudomicrocysts is limited, complicating the development of therapies to prevent or treat ADC-related ocular surface toxicity. Summary Three of 11 FDA-approved ADCs have been implicated with corneal pseudomicrocysts, with incidence ranging from 41 to 100% of patients. Of the six ADCs that reported ocular surface AEs, only three had ocular substudies to investigate the benefit of preventive therapies including topical steroids, vasoconstrictors, and preservative-free lubricants. Current preventive therapies demonstrate limited efficacy at mitigating pseudomicrocysts and other ocular surface AEs.
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Affiliation(s)
- Ethan S. Lindgren
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Rongshan Yan
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Onur Cil
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Alan S. Verkman
- Departments of Medicine and Physiology, University of California San Francisco, San Francisco, CA, USA
| | - Matilda F. Chan
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Gerami D. Seitzman
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Asim V. Farooq
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, USA
| | - Laura A. Huppert
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Hope S. Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Paula R. Pohlmann
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice Lu
- Department of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura J. Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Neel D. Pasricha
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
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García-Uribe PA, Preciado M. Crystalline keratopathy secondary to the use of ciprofloxacin after cataract surgery with confirmation by histopathological study: A case report and review of the literature. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:229-231. [PMID: 38710370 DOI: 10.1016/j.oftale.2024.05.001] [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: 02/02/2024] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE To report the case of a 75-year-old patient who presented crystalline keratopathy secondary to the use of topical ciprofloxacin with histopathological verification, after cataract surgery without complications. METHOD Case report with clinical and photographic follow-up, as well as slides with samples of epithelium and crystalline deposits. RESULTS Corneal deposits resolved after drug suspension, topical lubricant change, and subsequent surgical debridement. The histopathological examination reported epithelial cells and basophilic particles compatible with drug precipitates. CONCLUSIONS Crystalline keratopathy is a condition in which crystals of various kinds are deposited in the corneal epithelium and/or in the anterior stroma. It may have an infectious, pharmacological cause or, in rarer cases, corneal dystrophies. Certain factors such as a previous epithelial defect, systemic pathology with diabetes mellitus, ocular surgery and previous dry eye can favor the deposition of ciprofloxacin leading to the formation of a keratopathy.
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Affiliation(s)
- P A García-Uribe
- Asociación para Prevenir la Ceguera en México I. A. P., Mexico City, Mexico.
| | - M Preciado
- Asociación para Prevenir la Ceguera en México I. A. P., Mexico City, Mexico
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Jiao X, Qi Y, Gao N, Zhang C, Zhao S, Yang R. Exploration of efficacy and mechanism of 0.05% cyclosporine eye drops (II) monotherapy in allergic conjunctivitis-associated dry eye. Eye (Lond) 2024; 38:937-944. [PMID: 37904000 DOI: 10.1038/s41433-023-02807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE To explore the efficacy and relevant mechanism of 0.05% cyclosporine A (CsA) eye drops (II) monotherapy in patients with allergic conjunctivitis-associated dry eye (ACDE). METHODS Prospective, randomized, controlled study. Fifty-three patients with mild-to-moderate ACDE were randomly assigned to two groups. The CsA group received 0.05% CsA eye drops (II) monotherapy four times daily. The control group received 0.1% olopatadine twice daily combined with 0.1% preservative-free artificial tears four times daily. Clinical symptoms and signs, tear total IgE, and lymphotoxin-α (LT-α) concentrations were assessed at pre- and post-treatment days 7, 30, and 60. And we further measured six tear cytokines levels using a microsphere-based immunoassay. RESULTS The CsA group showed significant improvement in symptoms (Ocular Surface Disease Index and itching scores) and signs (conjunctival hyperaemia, conjunctival oedema, conjunctival papillae, tear break-up time (TBUT), corneal fluorescein staining, and goblet cell density) at each follow-up period compared to pre-treatment (all P < 0.050). And its improvement in itching scores (P7th < 0.001, P30th = 0.039, and P60th = 0.031) and TBUT (P7th = 0.009, P30th = 0.003, and P60th = 0.005) was more significant than the control group at all follow-up periods. The tear total IgE, interleukin (IL)-5, IL-6, periostin, eotaxin-3, and MMP-9 levels significantly decreased in the CsA group at day 60 after treatment (all P < 0.050). And the changed values in tear total IgE were positively correlated with the change in itching scores. CONCLUSIONS 0.05% CsA eye drops (II) monotherapy can rapidly improve the symptoms and signs, especially in ocular itching and TBUT, in patients with ACDE. And its efficacy is superior to 0.1% olopatadine combined with artificial tears. Moreover, CsA downregulates the expression levels of tear inflammatory cytokines, including tear total IgE, IL-5, IL-6, periostin, eotaxin-3, and MMP-9. Among that, the reduction in tear total IgE levels may reflect the improvement of ocular itching.
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Affiliation(s)
- Xiting Jiao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Yuanyuan Qi
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Ning Gao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Chen Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Shaozhen Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
| | - Ruibo Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
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Stalmans I, Lim KS, Oddone F, Fichtl M, Belda JI, Hommer A, Laganovska G, Schweitzer C, Voykov B, Zarnowski T, Holló G. MERCURY-3: a randomized comparison of netarsudil/latanoprost and bimatoprost/timolol in open-angle glaucoma and ocular hypertension. Graefes Arch Clin Exp Ophthalmol 2024; 262:179-190. [PMID: 37615697 PMCID: PMC10806046 DOI: 10.1007/s00417-023-06192-0] [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: 03/25/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE : To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS MERCURY-3 was a 6-month prospective, double-masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3. RESULTS Overall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%). CONCLUSIONS Once-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.
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Affiliation(s)
- Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Louvain, Belgium.
- Research Group of Ophthalmology, Department of Neurosciences, Catholic University KU Leuven, Louvain, Belgium.
| | - Kin Sheng Lim
- KCL Frost Eye Research Department, St Thomas' Hospital, London, UK
| | | | - Marek Fichtl
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and University Hospital Motol in Prague, Prague, Czech Republic
| | - Jose I Belda
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Torrevieja, Spain
| | - Anton Hommer
- Private Office for Ophthalmology and Optometry, Albertgasse 39/10, 1080, Vienna, Austria
| | - Guna Laganovska
- Riga Stradins University, P.Stradins Clinical University Hospital, Riga, Latvia
| | - Cédric Schweitzer
- CHU Bordeaux, Department of Ophthalmology, 33000, Bordeaux, France
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, 33000, Bordeaux, France
| | - Bogomil Voykov
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | - Tomasz Zarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Lublin, Poland
| | - Gábor Holló
- Tutkimusz Ltd, Solymár, Hungary
- Eye Center, Prima Medica Health Centers, Budapest, Hungary
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Geevarghese A, Kaiser A, Patel S, Saxena A, Belmont MH, Modi YS. Hydroxychloroquine Screening Guidelines: Best Evidence, Controversies, and Future Areas of Research. Int Ophthalmol Clin 2024; 64:195-207. [PMID: 38146891 DOI: 10.1097/iio.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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Domínguez-Llamas S, Caro-Magdaleno M, Mataix-Albert B, Avilés-Prieto J, Romero-Barranca I, Rodríguez-de-la-Rúa E. Adverse events of antibody-drug conjugates on the ocular surface in cancer therapy. Clin Transl Oncol 2023; 25:3086-3100. [PMID: 37454027 PMCID: PMC10514170 DOI: 10.1007/s12094-023-03261-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
Antibody-drug conjugates consist of a monoclonal antibody attached to a cytotoxic therapeutic molecule by a connector. This association allows a highly specific therapy, which increases their effectiveness and decreases their potential toxicity. This new therapy emerged approximately 20 years ago; since then, numerous combinations have appeared in the field of treatment-related neoplasms as an alternative for patients who do not achieve good results with conventional treatment options. Adverse effects of these drugs on the ocular surface are frequent and varied. Their prevalence ranges from 20 to 90% depending on the drug and administration condition, probably due to multiple receptor-mediated factors or mechanisms not mediated by specific receptors, such as macropinocytosis. These adverse events can greatly limit patients' comfort; thus, the objectives of this article were, in the first place, to compile the information currently available on different types of adverse effects of antibody-drug conjugates on the ocular surface, including pathophysiology, prevalence, and treatment, and in second place, to contribute to the correct identification and management of these events, which will result in a lower rate of cessation of treatment, which is necessary for the survival of candidate patients.
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Affiliation(s)
- Sandra Domínguez-Llamas
- Department of Ophthalmology, University Hospital Virgen Macarena, Políclínico 2a planta, Avda. Dr. Fedriani 3, 41009, Seville, Spain
| | - Manuel Caro-Magdaleno
- Department of Ophthalmology, University Hospital Virgen Macarena, Políclínico 2a planta, Avda. Dr. Fedriani 3, 41009, Seville, Spain.
- Department of Surgery, Ophthalmology Area, University of Seville, Seville, Spain.
| | - Beatriz Mataix-Albert
- Department of Ophthalmology, University Hospital Virgen Macarena, Políclínico 2a planta, Avda. Dr. Fedriani 3, 41009, Seville, Spain
| | - Javier Avilés-Prieto
- Department of Ophthalmology, University Hospital Virgen Macarena, Políclínico 2a planta, Avda. Dr. Fedriani 3, 41009, Seville, Spain
| | - Isabel Romero-Barranca
- Department of Ophthalmology, University Hospital Virgen Macarena, Políclínico 2a planta, Avda. Dr. Fedriani 3, 41009, Seville, Spain
| | - Enrique Rodríguez-de-la-Rúa
- Department of Ophthalmology, University Hospital Virgen Macarena, Políclínico 2a planta, Avda. Dr. Fedriani 3, 41009, Seville, Spain
- Department of Surgery, Ophthalmology Area, University of Seville, Seville, Spain
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LaLone V, Smith D, Diaz-Espinosa J, Rosania GR. Quantitative Raman chemical imaging of intracellular drug-membrane aggregates and small molecule drug precipitates in cytoplasmic organelles. Adv Drug Deliv Rev 2023; 202:115107. [PMID: 37769851 PMCID: PMC10841539 DOI: 10.1016/j.addr.2023.115107] [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: 07/16/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
Raman confocal microscopes have been used to visualize the distribution of small molecule drugs within different subcellular compartments. This visualization allows the discovery, characterization, and detailed analysis of the molecular transport phenomena underpinning the Volume of Distribution - a key parameter governing the systemic pharmacokinetics of small molecule drugs. In the specific case of lipophilic small molecules with large Volumes of Distribution, chemical imaging studies using Raman confocal microscopes have revealed how weakly basic, poorly soluble drug molecules can accumulate inside cells by forming stable, supramolecular complexes in association with cytoplasmic membranes or by precipitating out within organelles. To study the self-assembly and function of the resulting intracellular drug inclusions, Raman chemical imaging methods have been developed to measure and map the mass, concentration, and ionization state of drug molecules at a microscopic, subcellular level. Beyond the field of drug delivery, Raman chemical imaging techniques relevant to the study of microscopic drug precipitates and drug-lipid complexes which form inside cells are also being developed by researchers with seemingly unrelated scientific interests. Highlighting advances in data acquisition, calibration methods, and computational data management and analysis tools, this review will cover a decade of technological developments that enable the conversion of spectral signals obtained from Raman confocal microscopes into new discoveries and information about previously unknown, concentrative drug transport pathways driven by soluble-to-insoluble phase transitions occurring within the cytoplasmic organelles of eukaryotic cells.
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Affiliation(s)
- Vernon LaLone
- Cambium Analytica Research Laboratories, Traverse City, MI, United States
| | - Doug Smith
- Cambium Analytica Research Laboratories, Traverse City, MI, United States
| | - Jennifer Diaz-Espinosa
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Gus R Rosania
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States.
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Tabernero J, Bedard PL, Bang YJ, Vieito M, Ryu MH, Fagniez N, Chadjaa M, Soufflet C, Masson N, Gazzah A. Tusamitamab Ravtansine in Patients with Advanced Solid Tumors: Phase I Study of Safety, Pharmacokinetics, and Antitumor Activity Using Alternative Dosing Regimens. CANCER RESEARCH COMMUNICATIONS 2023; 3:1662-1671. [PMID: 37645622 PMCID: PMC10461573 DOI: 10.1158/2767-9764.crc-23-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
Purpose Tusamitamab ravtansine is an antibody-drug conjugate that targets carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) and delivers a cytotoxic maytansinoid payload. In a phase I dose-escalation study, the maximum tolerated dose (MTD) was 100 mg/m2 every 2 weeks (Q2W). Here we report results for two alternative schedules. Experimental Design Adults ages ≥18 years (range, 34-73) with locally advanced/metastatic solid tumors (N = 43; colon/rectum, 29; stomach, 7; pancreas, 4; other, 3) expressing/likely to express CEACAM5 received intravenous tusamitamab ravtansine 120-170 mg/m2 [loading dose (LD)], then 100 mg/m2 Q2W (Q2W-LD, n = 28), or 120-190 mg/m2 fixed dose [every 3 weeks (Q3W), n = 15]. The primary endpoint was dose-limiting toxicities (DLTs) during cycles 1-2 (Q2W-LD) and cycle 1 (Q3W). Results Reversible DLTs were observed in 2 of 9 patients (grade 2 keratopathy; grade 2 keratitis) with 170 mg/m2 in Q2W-LD and in 2 of 3 patients (grade 2 keratopathy; grade 3 transaminase elevation) with 190 mg/m2 in Q3W. Nineteen (67.9%) patients in Q2W-LD and 13 (86.7%) patients in Q3W experienced treatment-related adverse events (AE); 3 of 43 patients discontinued treatment because of AEs. The most common AEs were asthenia, gastrointestinal complaints, keratopathy, keratitis, and peripheral sensory neuropathy. In this small, heavily pretreated population, no confirmed responses were observed; however, stable disease occurred in 35.7% of patients in Q2W-LD and 40.0% of patients in Q3W. Conclusions Tusamitamab ravtansine had a favorable safety profile with both alternative administration schedules; MTDs were 170 mg/m2 (LD) followed by 100 mg/m2 Q2W, and 170 mg/m2 Q3W as a fixed dose. (NCT02187848). Significance The collective results of this phase I dose-escalation study will inform further studies of tusamitamab ravtansine in patients with solid tumors with CEACAM5 expression, including patients with non-small cell lung cancer.
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Affiliation(s)
- Josep Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), UVic-UCC, IOB-Quirón, Barcelona, Spain
| | - Philippe L. Bedard
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre—University Health Network, University of Toronto, Toronto, Canada
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Maria Vieito
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona, Spain
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Nathalie Fagniez
- Pharmacokinetics, Dynamics and Metabolism, Sanofi, Chilly-Mazarin, France
| | | | | | - Nina Masson
- IT&M STATS on behalf of Sanofi, Neuilly-sur-Seine, France
| | - Anas Gazzah
- Department of Drug Development (DITEP), Gustave Roussy, Villejuif Cedex, Villejuif, France
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11
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Yusuf IH, Charbel Issa P, Ahn SJ. Hydroxychloroquine-induced Retinal Toxicity. Front Pharmacol 2023; 14:1196783. [PMID: 37324471 PMCID: PMC10267834 DOI: 10.3389/fphar.2023.1196783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Long-term use of hydroxychloroquine can cause retinopathy, which may result in severe and progressive visual loss. In the past decade, hydroxychloroquine use has markedly increased and modern retinal imaging techniques have enabled the detection of early, pre-symptomatic disease. As a consequence, the prevalence of retinal toxicity in long-term hydroxychloroquine users is known to be higher than was previously estimated. The pathophysiology of the retinopathy is incompletely characterised, although significant advances have been made in understanding the disease from clinical imaging studies. Hydroxychloroquine retinopathy elicits sufficient public health concern to justify the implementation of retinopathy screening programs for patients at risk. Here, we describe the historical background of hydroxychloroquine retinopathy and summarize its current understanding. We review the utility and limitations of each of the mainstream diagnostic tests used to detect hydroxychloroquine retinopathy. The key considerations towards a consensus on the definition of hydroxychloroquine retinopathy are outlined in the context of what is known of the natural history of the disease. We compare the current screening recommendations for hydroxychloroquine retinopathy, identifying where additional evidence is required, and the management of proven cases of toxicity. Finally, we highlight the areas for further investigation, which may further reduce the risk of visual loss in hydroxychloroquine users.
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Affiliation(s)
- Imran H. Yusuf
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Peter Charbel Issa
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
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12
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Augustin VA, Blöck L, Hegenbart U, Auffarth GU, Khoramnia R. [Belantamab mafodotin-associated keratopathy-A common and treatment-affecting side effect]. DIE OPHTHALMOLOGIE 2023; 120:418-422. [PMID: 35925327 DOI: 10.1007/s00347-022-01660-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 04/29/2023]
Affiliation(s)
- Victor A Augustin
- Universitäts-Augenklinik Heidelberg, INF 400, David J. Apple International Laboratory for Ocular Pathology und International Vision Correction Research Centre (IVCRC), 69120, Heidelberg, Deutschland.
| | - Louise Blöck
- Universitäts-Augenklinik Heidelberg, INF 400, David J. Apple International Laboratory for Ocular Pathology und International Vision Correction Research Centre (IVCRC), 69120, Heidelberg, Deutschland
| | - Ute Hegenbart
- Medizinische Klinik V (Hämatologie/Onkologie), Amyloidose Zentrum Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Gerd U Auffarth
- Universitäts-Augenklinik Heidelberg, INF 400, David J. Apple International Laboratory for Ocular Pathology und International Vision Correction Research Centre (IVCRC), 69120, Heidelberg, Deutschland
| | - Ramin Khoramnia
- Universitäts-Augenklinik Heidelberg, INF 400, David J. Apple International Laboratory for Ocular Pathology und International Vision Correction Research Centre (IVCRC), 69120, Heidelberg, Deutschland
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13
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Wang S, He J, He X, Liu Y, Lin X, Xu C, Zhu L, Kang J, Wang Y, Li Y, Guo S, Zhang Y, Luo Z, Liu Z. AES-CSFS: an automatic evaluation system for corneal sodium fluorescein staining based on deep learning. Ther Adv Chronic Dis 2023; 14:20406223221148266. [PMID: 36798527 PMCID: PMC9926379 DOI: 10.1177/20406223221148266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/13/2022] [Indexed: 02/15/2023] Open
Abstract
Background Corneal fluorescein sodium staining is a valuable diagnostic method for various ocular surface diseases. However, the examination results are highly dependent on the subjective experience of ophthalmologists. Objectives To develop an artificial intelligence system based on deep learning to provide an accurate quantitative assessment of sodium fluorescein staining score and the size of cornea epithelial patchy defect. Design A prospective study. Methods We proposed an artificial intelligence system for automatically evaluating corneal staining scores and accurately measuring patchy corneal epithelial defects based on corneal fluorescein sodium staining images. The design incorporates two segmentation models and a classification model to forecast and assess the stained images. Meanwhile, we compare the evaluation findings from the system with ophthalmologists with varying expertise. Results For the segmentation task of cornea boundary and cornea epithelial patchy defect area, our proposed method can achieve the performance of dice similarity coefficient (DSC) is 0.98/0.97 and Hausdorff distance (HD) is 3.60/8.39, respectively, when compared with the manually labeled gold standard. This method significantly outperforms the four leading algorithms (Unet, Unet++, Swin-Unet, and TransUnet). For the classification task, our algorithm achieves the best performance in accuracy, recall, and F1-score, which are 91.2%, 78.6%, and 79.2%, respectively. The performance of our developed system exceeds seven different approaches (Inception, ShuffleNet, Xception, EfficientNet_B7, DenseNet, ResNet, and VIT) in classification tasks. In addition, three ophthalmologists were selected to rate corneal staining images. The results showed that the performance of our artificial intelligence system significantly outperformed the junior doctors. Conclusion The system offers a promising automated assessment method for corneal fluorescein staining, decreasing incorrect evaluations caused by ophthalmologists' subjective variance and limited knowledge.
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Affiliation(s)
| | | | | | | | - Xiang Lin
- Department of Ophthalmology, Xiang’an Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Changsheng Xu
- Institute of Artificial Intelligence, Xiamen University, Xiamen, China
- Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Linfangzi Zhu
- Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Jie Kang
- Department of Ophthalmology, Xiang’an Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Yuqian Wang
- Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Yong Li
- Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Shujia Guo
- Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Yunuo Zhang
- Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Zhiming Luo
- Institute of Artificial Intelligence, Xiamen University, Xiamen, China
- School of Informatics, Xiamen University, 422 Siming South Road, Xiamen 361005, Fujian, China
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14
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Fanlo P, Garralda A, Gómez-Cerezo JF, Echeverria M, López M, Heras H, Riera-Mestre A. Results of the screening program for Fabry disease in patients with cornea verticillata at the University Hospital of Navarre. Rev Clin Esp 2023; 223:25-31. [PMID: 36528303 DOI: 10.1016/j.rceng.2022.10.005] [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: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cornea verticillata (CV) or vortex keratopathy is characterized by the presence of spiral-shaped deposits in the corneal epithelium. The most frequent causes are antimalarial drugs and amiodarone and, among systemic causes, Fabry disease (FD). MATERIAL AND METHODS A multidisciplinary, prospective, descriptive study was conducted in a tertiary reference center in Spain's Autonomous Community of Navarre after the implementation of a FD screening program for patients attended to in the Ophthalmology Department. The study analyzed those diagnosed with CV, who were subsequently referred to the rare disease clinic of the University Hospital of Navarre's Internal Medicine Department for an FD study. RESULTS Two women and four men with a mean age of 76.8 years were diagnosed with CV out of a total of 17,280 patients evaluated in outpatient consultations by three ophthalmology specialists during the period from April 2018 to April 2020. One patient died before performing the screening study and no patients were diagnosed with FD. CONCLUSIONS Despite the fact that the University Hospital of Navarre's FD screening program for patients with CV did not confirm any cases of FD, ophthalmology specialists should consider the possible diagnosis of FD in patients with CV in their routine consultations.
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Affiliation(s)
- P Fanlo
- Unidad de Enfermedades Autoinmunes Sistémicas, Consulta de Enfermedades Minoritarias, Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, Spain.
| | - A Garralda
- Servicio de Oftalmología, Hospital Universitario de Navarra, Pamplona, Spain
| | - J F Gómez-Cerezo
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Docencia titular de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - M Echeverria
- Servicio de Oftalmología, Hospital Universitario de Navarra, Pamplona, Spain
| | - M López
- Unidad de Enfermedades Sistémicas Autoinmunes y Minoritarias, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - H Heras
- Servicio de Oftalmología, Hospital Universitario de Navarra, Pamplona, Spain
| | - A Riera-Mestre
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain
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15
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Knorring GY. [Use of dexpanthenol in corneal damage]. Vestn Oftalmol 2023; 139:122-128. [PMID: 38235638 DOI: 10.17116/oftalma2023139061122] [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: 01/19/2024]
Abstract
Issues of regeneration of the cornea, which is the most vulnerable structure of the eyeball, suffering from various diseases and injuries, burns, when wearing contact lenses and glaucoma, are highly relevant for ophthalmologists. It is also necessary to minimize damage and stimulate corneal epithelization during and after the use of steroidal and non-steroidal anti-inflammatory drugs, antibacterial drugs and antiseptics, which have a cytotoxic effect and often inhibit regeneration processes, potentially even leading to the development of corneal epithelial defects. This review analyzes the effectiveness of a promising drug 5% dexpanthenol in terms of improving the reparative processes and the function of epithelial cells.
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Affiliation(s)
- G Yu Knorring
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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16
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Ebeid WM, El-Shazly AAEF, Kamal NM, Fakhary EE, Mansour A, Ashour DM. New insights into amiodarone induced retinal and optic nerve toxicity: functional and structural changes. Ther Adv Ophthalmol 2023; 15:25158414231194159. [PMID: 37701727 PMCID: PMC10493063 DOI: 10.1177/25158414231194159] [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: 03/18/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023] Open
Abstract
Background Amiodarone is widely used for heart arrhytmia. Previous studies have suggested the possibility of optic neuropathy with the chronic use of this drug. Objectives To identify structural or functional changes in the retina and optic nerve in patients on chronic amiodarone therapy without visual complaints. Methods This observational study included 15 eyes of 15 patients with cardiac arrythmia on chronic amiodarone treatment and 15 healthy matched subjects as a control group. All subjects underwent electrophysiological tests [pattern visual evoked potential (PVEP), pattern electroretinogram (PERG), multifocal electroretinogram (mfERG), and optical coherence tomography (OCT) and angiography (OCTA)]. Results There were no statistically significant differences between the two groups regarding the PVEP, PERG, and the mfERG parameters. Macular and optic nerve head OCT and OCTA have not shown statistically significant differences except for the morphological parameters of the optic disc (p = 0.008 for the horizontal and p = 0.013 for vertical cup/disc ratio and p = 0.045 for rim area). Conclusion Patients on chronic amiodarone therapy have not shown evident structural or functional changes in the retinal or optic nerve as demonstrated by electrophysiological tests, OCT, and OCTA results compared to controls.
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Affiliation(s)
- Weam Mohamed Ebeid
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Armed Forces College of Medicine, Cairo, Egypt
| | | | - Norhan Mohamed Kamal
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Emad Effat Fakhary
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Mansour
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Doaa Maamoun Ashour
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University Hospitals, Ramsis Street, Abbasiya, Cairo 11591, Egypt
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17
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Singh NK, Sahu SK. Rho-kinase inhibitors: Role in corneal endothelial disorders. Semin Ophthalmol 2023; 38:9-14. [PMID: 35993293 DOI: 10.1080/08820538.2022.2112698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE This exhaustive review of published literature aims to put forth the current understanding, and experiences of the role Rho-kinase inhibitors play in the management of corneal endothelial disorders. METHODS A meticulous search for PubMed and Medline databases was carried out using keywords 'rho-kinase inhibitors', 'corneal endothelial disorders', 'rho-kinase inhibitors in corneal endothelial disorders', and 'fuchs endothelial corneal dystrophy'. The articles published in last five years relevant to the area of interest were selected and compiled in a chronological order to write this review. RESULTS Published research shows the proven role of rho-kinase inhibitors in promoting endothelial proliferation and suppressing its apoptosis. It has shown to be effective in the treatment of endothelial diseases and endothelial cell loss due to other causes in small clinical studies. It has also shown to promote growth of human corneal endothelial cell culture suitable for transplantation. The side effects of topical rho-kinase inhibitors are minimal and self-limiting. CONCLUSION Rho-kinase inhibitors show immense promise in providing a non-surgical therapy for treatment of endothelial disorders. If consistent results are demonstrated through large clinical trials then this can be a major breakthrough in treating endothelial decompensation and reduce our dependence on endothelial keratoplasty for the same.
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Affiliation(s)
- Nimish Kumar Singh
- Cornea & Anterior Segment Services, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Srikant Kumar Sahu
- Cornea & Anterior Segment Services, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
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18
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Flügel NT, Del Valle GS, Wasilewski D. Bilateral ocular deposit of chlorpromazine. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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19
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AlGhadeer H, AlHumaidan A. Bilateral toxic epithelial keratopathy following instillation of expired topical eye drops. J Clin Pharm Ther 2022; 47:2379-2382. [PMID: 36394117 DOI: 10.1111/jcpt.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Toxic corneal epitheliopathies are common, but the majority are probably so mild that they are subclinical. Clinically significant epithelial keratopathy can occur following a single drop of topical expired carboxymethylcellulose sodium eye drops. CASE SUMMARY This case presents A 34-year-old female who presented to the emergency department with a history of severe ocular pain and reduced vision after bilateral instillation of expired eye drops. Both eyes were diagnosed with toxic epithelial keratopathy. The presenting best corrected visual acuity (BCVA) was 20/100 in the right eye and 20/300 in the left eye. The BCVA at last follow-up was 20/20 in both eyes. WHAT IS NEW AND CONCLUSION The safe use and storage of ophthalmic drugs, including their use before the expiration date, should be reinforced to patients by all healthcare practitioners to avoid complications such as toxic keratopathy.
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Affiliation(s)
- Huda AlGhadeer
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdullah AlHumaidan
- Department of Pharmacy, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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20
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Fanlo P, Garralda A, Gómez-Cerezo J, Echeverria M, López M, Heras H, Riera-Mestre A. Resultados del programa de cribado de enfermedad de Fabry en pacientes con córnea verticillata en el Hospital Universitario de Navarra. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Chen XJ, Hu P, Yi S. High-concentration atropine induces corneal epithelial cell apoptosis via miR-30c-1/SOCS3. Kaohsiung J Med Sci 2022; 38:1113-1122. [PMID: 36156413 DOI: 10.1002/kjm2.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/22/2022] [Accepted: 08/16/2022] [Indexed: 11/12/2022] Open
Abstract
Atropine is an anticholinergic drug widely used in the field of ophthalmology, but its abuse can cause cytotoxicity to the cornea, resulting in blurred vision. This study used cultured human corneal epithelial cells (HCECs) to investigate the mechanism of high-concentration atropine-induced cytotoxicity. HCECs were treated with different concentrations of atropine. The expression levels of microRNA (miR)-30c-1 and suppressor of cytokine signaling 3 (SOCS3) were manipulated in HCECs treated with 0.1% atropine. Cell counting kit-8 assay and flow cytometry were used to assess the viability and apoptosis of HCECs. The relationship between miR-30c-1 and SOCS3 was obtained from an online database and validated using a dual-luciferase reporter assay and RNA immunoprecipitation method. The effect of atropine on the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling pathway was also investigated. High-concentration atropine inhibited the viability of HCECs and promoted their apoptosis. Moreover, atropine reduced miR-30c-1 expression and increased SOCS3 expression in a dose-dependent manner. It was found that miR-30c-1 targeted SOCS3. Overexpression of miR-30c-1-reduced atropine-induced HCEC cytotoxicity, whereas upregulation of SOCS3 reversed the effects of miR-30c-1 overexpression. High-concentration atropine inhibited activation of the JAK2/STAT3 signaling pathway via miR-30c-1/SOCS3. High-concentration atropine induces HCEC apoptosis by regulating the miR-30c-1/SOCS3 axis and JAK2/STAT3 signaling pathway.
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Affiliation(s)
- Xi-Jia Chen
- Department of Ophthalmology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Po Hu
- Department of Ophthalmology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Shu Yi
- Department of Ophthalmology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
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22
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White CA, Affeldt J. Topical cenegermin associated ocular surface and contact lens drug precipitate deposit formation. Am J Ophthalmol Case Rep 2022; 27:101584. [PMID: 35647393 PMCID: PMC9133754 DOI: 10.1016/j.ajoc.2022.101584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 04/19/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report for the first time drug precipitate deposit formation on both the ocular surface and bandage contact lens (BCL) of a patient treated with topical cenegermin. Observations A patient suffering from stage III neurotrophic keratitis developed extensive ocular surface and BCL deposits over the eight week course of her topical cenegermin therapy. The ocular surface deposits were weakly adherent, detaching and clearing from the cornea within minutes of BCL removal. They reappeared rapidly and repeatedly however after each of five BCL exchanges. Symptom wise, the patient was unaware of their presence. Of historical note, this patient: (1) developed BCL ciprofloxacin deposits while undergoing a traditional neurotrophic keratitis treatment regimen, (2) did not develop corneal drug precipitate deposits within the placebo arm of the cenegermin clinical trial (vehicle only without cenegermin or BCL), and (3) did not develop corneal deposits with a latter BCL-free cenegermin treatment course. Conclusions and Importance Topical cenegermin can produce extensive drug precipitate deposits on both the ocular surface and contact lens when used in conjunction with a bandage contact lens. Such deposits: (1) may represent an esthetic issue only as at least in our patient they were not symptom provoking, questionably interfered with the clinical course of the cenegermin therapy and did not require drug cessation, (2) may implicate both contact lenses and high frequency drug application as previously unidentified but formal risk factors for drug precipitate deposit formation, and (3) may act as a time-release medication reservoir enhancing drug delivery and long-term treatment efficacy.
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Affiliation(s)
- Craig A. White
- Loma Linda University Eye Institute, 11370 Anderson St, Ste 1800, Loma Linda, CA, 92354, USA
| | - John Affeldt
- Loma Linda University Eye Institute, 11370 Anderson St, Ste 1800, Loma Linda, CA, 92354, USA
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23
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Raloxifene induced keratopathy: A case report. Am J Ophthalmol Case Rep 2022; 27:101661. [PMID: 35859701 PMCID: PMC9289629 DOI: 10.1016/j.ajoc.2022.101661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/29/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose We report a case of corneal verticillata in a patient who had been taking raloxifene for a prolonged period. To our knowledge, this is the first case report of an ocular side effect of raloxifene. Observations A 69-year-old female patient presented to our clinic for her routine eye check-up. On slit-lamp examination, whorl-like subepithelial deposits were observed in the bilateral corneas. She was diagnosed with corneal verticillata (vortex keratopathy) caused by raloxifene. A follow-up evaluation was conducted after discontinuation of the drug; however, the corneal opacity did not improve. Conclusions and importance Patients with corneal verticillata should be asked regarding any intake of raloxifene for osteoporosis, as it may cause corneal verticillata.
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Panthagani J, MacDonald T, Bruynseels A, Madathilethu SC, Jenyon T. Deposition keratopathy. Br J Hosp Med (Lond) 2022; 83:1-13. [DOI: 10.12968/hmed.2021.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Material can be deposited in the cornea as a result of a wide range of systemic and ophthalmic diseases, as well as local and systemic therapies. Causes include local infection or trauma, systemic malignancy, a wide range of medications and a host of genetic and metabolic diseases. Some of these can be acutely life threatening, so generalists caring for both children and adults should have a basic awareness of the pattern and distribution of corneal deposits to facilitate timely diagnosis, investigation, management or onward referral to avoid significant morbidity or mortality. This article outlines causes of corneal deposits found in patients presenting to primary care, ophthalmic clinics or encountered on the wards to help generalists avoid missing serious pathology. It also provides insight into the natural history of underlying causative conditions and their possible treatments.
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Affiliation(s)
- Jesse Panthagani
- Birmingham and Midland Eye Centre, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Trystan MacDonald
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Ophthalmology, University Hospitals Birmingham, Birmingham, UK
| | - Alice Bruynseels
- Birmingham and Midland Eye Centre, Birmingham, UK
- Department of Ophthalmology, Royal Shrewsbury Hospital, Shrewsbury, UK
| | | | - Thomas Jenyon
- Department of Ophthalmology, University Hospitals Birmingham, Birmingham, UK
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25
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Mukhtar S, Jhanji V. Effects of systemic targeted immunosuppressive therapy on ocular surface. Curr Opin Ophthalmol 2022; 33:311-317. [PMID: 35779055 DOI: 10.1097/icu.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to give an overview of the corneal manifestations of targeted systemic immunotherapies and provide guidelines for management when applicable. RECENT FINDINGS The advent of newer systemic immunosuppressive therapy has resulted in the need for more awareness of potential ocular side effects. Side effects can range from vortex keratopathy as seen with the tyrosine kinase inhibitors, to epithelial microcysts as reported in the use of cytarabine and belantamab mafodotin, spontaneous corneal perforations have been reported with programmed death 1 inhibitors, while eyelid cicatrization has been reported epidermal growth factor inhibitors. Several immunomodulatory therapies result in conjunctivitis which tends to respond to topical lubrication and corticosteroid treatment. Most manifestations listed in the review are limited to the anterior segment; however, some may lead to retinal and optic nerve changes which can be permanently damaging. SUMMARY Ocular surface and corneal changes secondary to systemic immunosuppression can affect main components of the ocular surface. Although most adverse effects are reversible, few changes can be permanent and therefore close ophthalmologic monitoring is necessary.
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Affiliation(s)
- Sabrina Mukhtar
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Clement Freiberg J, von Spreckelsen A, Kolko M, Azuara-Blanco A, Virgili G. Rho kinase inhibitor for primary open-angle glaucoma and ocular hypertension. Cochrane Database Syst Rev 2022; 6:CD013817. [PMID: 35686679 PMCID: PMC9185806 DOI: 10.1002/14651858.cd013817.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Glaucoma is a group of optic neuropathies characterized by progressive degeneration of the retinal ganglion cells, axonal loss and irreversible visual field defects. Glaucoma is classified as primary or secondary, and worldwide, primary glaucoma is a leading cause of irreversible blindness. Several subtypes of glaucoma exist, and primary open-angle glaucoma (POAG) is the most common. The etiology of POAG is unknown, but current treatments aim to reduce intraocular pressure (IOP), thus preventing the onset and progression of the disease. Compared with traditional antiglaucomatous treatments, rho kinase inhibitors (ROKi) have a different pharmacodynamic. ROKi is the only current treatment that effectively lowers IOP by modulating the drainage of aqueous humor through the trabecular meshwork and Schlemm's canal. As ROKi are introduced into the market more widely, it is important to assess the efficacy and potential AEs of the treatment. OBJECTIVES To compare the efficacy and safety of ROKi with placebo or other glaucoma medication in people diagnosed with open-angle glaucoma (OAG), primary open-angle glaucoma (POAG) or ocular hypertension (OHT). SEARCH METHODS We used standard Cochrane methods and searched databases on 11 December 2020. SELECTION CRITERIA We included randomized clinical trials examining commercially available ROKi-based monotherapy or combination therapy compared with placebo or other IOP-lowering medical treatments in people diagnosed with (P)OAG or OHT. We included trials where ROKi were administered according to official glaucoma guidelines. There were no restrictions regarding type, year or status of the publication. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened studies, extracted data, and evaluated risk of bias by using Cochrane's RoB 2 tool. MAIN RESULTS: We included 17 trials with 4953 participants diagnosed with (P)OAG or OHT. Fifteen were multicenter trials and 15 were masked trials. All participants were aged above 18 years. Trial duration varied from 24 hours to 12 months. Trials were conducted in the USA, Canada and Japan. Sixteen trials were funded by pharmaceutical companies, and one trial provided no information about funding sources. The trials compared ROKi monotherapy (netarsudil or ripasudil) or combination therapy with latanoprost (prostaglandin analog) or timolol (beta-blocker) with placebo, timolol, latanoprost or netarsudil. Reported outcomes were IOP and safety. Meta-analyses were applied to 13 trials (IOP reduction from baseline) and 15 trials (ocular AEs). Of the trials evaluating IOP, seven were at low risk, three had some concerns, and three were at high risk of bias. Three trials found that netarsudil monotherapy may be superior to placebo (mean difference [MD] 3.11 mmHg, 95% confidence interval [CI] 2.59 to 3.62; I2 = 0%; 155 participants; low-certainty evidence). Evidence from three trials found that timolol may be superior to netarsudil with an MD of 0.66 mmHg (95% CI 0.41 to 0.91; I2 = 0%; 1415 participants; low-certainty evidence). Evidence from four trials found that latanoprost may be superior to netarsudil with an MD of 0.97 mmHg (95% CI 0.67 to 1.27; I2 = 4%; 1283 participants; moderate-certainty evidence). Evidence from three trials showed that, compared with monotherapy with latanoprost, combination therapy with netarsudil and latanoprost probably led to an additional pooled mean IOP reduction from baseline of 1.64 mmHg (95% CI -2.16 to -1.11; 1114 participants). Evidence from three trials showed that, compared with monotherapy with netarsudil, combination therapy with netarsudil and latanoprost probably led to an additional pooled mean IOP reduction from baseline of 2.66 mmHg (95% CI -2.98 to -2.35; 1132 participants). The certainty of evidence was moderate. One trial showed that, compared with timolol monotherapy, combination therapy with ripasudil and timolol may lead to an IOP reduction from baseline of 0.75 mmHg (95% -1.29 to -CI 0.21; 208 participants). The certainty of evidence was moderate. Of the trials assessing total ocular AEs, three were at low risk, four had some concerns, and eight were at high risk of bias. We found very low-certainty evidence that netarsudil may lead to more ocular AEs compared with placebo, with 66 more ocular AEs per 100 person-months (95% CI 28 to 103; I2 = 86%; 4 trials, 188 participants). We found low-certainty evidence that netarsudil may lead to more ocular AEs compared with latanoprost, with 29 more ocular AEs per 100 person-months (95% CI 17 to 42; I2 = 95%; 4 trials, 1286 participants). We found moderate-certainty evidence that, compared with timolol, netarsudil probably led to 21 additional ocular AEs (95% CI 14 to 27; I2 = 93%; 4 trials, 1678 participants). Data from three trials (1132 participants) showed no evidence of differences in the incidence rate of AEs between combination therapy with netarsudil and latanoprost and netarsudil monotherapy (1 more event per 100 person-months, 95% CI 0 to 3); however, the certainty of evidence was low. Similarly, we found low-certainty evidence that, compared with latanoprost, combination therapy with netarsudil and latanoprost may cause 29 more ocular events per 100 person-months (95% CI 11 to 47; 3 trials, 1116 participants). We found moderate-certainty evidence that, compared with timolol monotherapy, combination therapy with ripasudil and timolol probably causes 35 more ocular events per 100 person-months (95% CI 25 to 45; 1 trial, 208 participants). In all included trials, ROKi was reportedly not associated with any particular serious AEs. AUTHORS' CONCLUSIONS The current evidence suggests that in people diagnosed with OHT or (P)OAG, the hypotensive effect of netarsudil may be inferior to latanoprost and slightly inferior to timolol. Combining netarsudil and latanoprost probably further reduces IOP compared with monotherapy. Netarsudil as mono- or combination therapy may result in more ocular AEs. However, the certainty of evidence was very low or low for all comparisons except timolol. In general, AEs were described as mild, transient, and reversible upon treatment discontinuation. ROKi was not associated with any particular serious AEs. Future trials of sufficient size and follow-up should be conducted to provide reliable information about glaucoma progression, relevant IOP measurements and a detailed description of AEs using similar terminology. This would ensure the robustness and confidence of the results and assess the intermediate- and long-term efficacy and safety of ROKi.
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Affiliation(s)
| | | | - Miriam Kolko
- Department of Ophthalmology and Department of Drug Design and Pharmacology, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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Corneal Densitometry and In Vivo Confocal Microscopy in Patients with Monoclonal Gammopathy—Analysis of 130 Eyes of 65 Subjects. J Clin Med 2022; 11:jcm11071848. [PMID: 35407456 PMCID: PMC9000138 DOI: 10.3390/jcm11071848] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Corneal imaging may support an early diagnosis of monoclonal gammopathy. The goal of our study was to analyze corneal stromal properties using Pentacam and in vivo confocal cornea microscopy (IVCM) in subjects with monoclonal gammopathy. Patients and methods: In our cross-sectional study, patients with monoclonal gammopathy (130 eyes of 65 patients (40.0% males; age 67.65 ± 9.74 years)) and randomly selected individuals of the same age group, without hematological disease (100 eyes of 50 control subjects (40.0% males; age 60.67 ± 15.06 years)) were included. Using Pentacam (Pentacam HR; Oculus GmbH, Wetzlar, Germany), corneal stromal light scattering values were obtained (1) centrally 0–2 mm zone; (2) 2–6 mm zone; (3) 6–10 mm zone; (4) 10–12 mm zone. Using IVCM with Heidelberg Retina Tomograph with Rostock Cornea Module (Heidelberg Engineering, Heidelberg, Germany), the density of hyperreflective keratocytes and the number of hyperreflective spikes per image were manually analyzed, in the stroma. Results: In the first, second and third annular zone, light scattering was significantly higher in subjects with monoclonal gammopathy, than in controls (p ≤ 0.04). The number of hyperreflective keratocytes and hyperreflective spikes per image was significantly higher in stroma of subjects with monoclonal gammopathy (p ≤ 0.012). Conclusions: Our study confirms that increased corneal light scattering in the central 10 mm annular zone and increased keratocyte hyperreflectivity may give rise to suspicion of monoclonal gammopathy. As corneal light scattering is not increased at the limbal 10–12 mm annular zone in monoclonal gammopathy subjects, our spatial analysis provides evidence against the limbal origin of corneal paraprotein deposition. Using IVCM, stromal hyperreflective spikes may represent specific signs of monoclonal gammopathy.
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Sahyoun JY, Sabeti S, Robert MC. Drug-induced corneal deposits: an up-to-date review. BMJ Open Ophthalmol 2022; 7:e000943. [PMID: 35415268 PMCID: PMC8961126 DOI: 10.1136/bmjophth-2021-000943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
This review assesses different clinical aspects of the various known drug-induced corneal deposits, based on the corneal layer involved (epithelium, stroma and/or endothelium), and based on the drug class. The most well-known condition caused by drug deposits is vortex keratopathy, or corneal verticillata, which is a whorl-like opacity in the corneal epithelium. Vortex keratopathy is commonly caused by certain cationic amphiphilic drugs such as amiodarone, antimalarials, suramin, tamoxifen, chlorpromazine and non-steroidal anti-inflammatory drugs. These deposits usually occur once a certain dose of the drug is reached. Most cases present with mild to moderate symptoms with minimal visual impairment. Most of these deposits resolve automatically, after months to years of drug cessation. Notably, other drug classes can cause deposits in all three layers of the cornea. Chlorpromazine, gold, rifabutin, indomethacin and tyrosine kinase inhibitors can cause stromal deposits, with reduced visual acuity when the anterior stroma is involved. Chlorpromazine and rifabutin can also cause deposits in the endothelial layer of the cornea. Regardless of the type of corneal deposit, local therapies such as topical lubricants or corticosteroids may help improve symptoms. Drug cessation or modification can also be helpful but should be weighed against the systemic risks of the underlying disease.
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Affiliation(s)
- Jean-Yves Sahyoun
- Ophthalmology, Centre Hospitalier de l'Université de Montreal, Montreal, Québec, Canada
| | - Saama Sabeti
- Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
| | - Marie-Claude Robert
- Ophthalmology, Centre Hospitalier de l'Université de Montreal, Montreal, Québec, Canada
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Wang L, Zhang Y, Wei Z, Cao K, Su G, Hamrah P, Labbe A, Liang Q. Characteristics of Toxic Keratopathy, an In Vivo Confocal Microscopy Study. Transl Vis Sci Technol 2021; 10:11. [PMID: 34495329 PMCID: PMC8431974 DOI: 10.1167/tvst.10.11.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose Toxic keratopathy (TK) involves complex clinical manifestations and is difficult to differentiate from other ocular surface diseases by conventional slit-lamp examination. The challenge faced by clinicians in confidently diagnosing TK cannot be underestimated. This study aimed to explore the microstructural characteristics and diagnostic parameters by in vivo confocal microscopy (IVCM) in TK. Methods In this prospective, cross-sectional, comparative study, slit-lamp and IVCM examinations were performed on 20 normal eyes and 54 eyes with TK. Based on slit-lamp imaging, TK subjects were divided into four groups: superficial punctate keratitis (n = 10 eyes), pseudodendritic keratitis (n = 14 eyes), ulcerative keratitis (UK; n = 16 eyes), and ring keratitis (RK; n = 14 eyes). The microstructural characteristics of TK were described according to the following IVCM parameters: basal cell (BC) density, dendritiform cell (DC) density, DC size, corneal nerve fiber (CNF) length, nerve tortuosity, and keratocyte reflectivity. A receiver operating characteristic (ROC) curve model was also formulated to compare the predictive power of BC density, DC density, and CNF length. Results TK eyes showed significantly higher values for DC density (45.8 cells/mm2; range, 25.0–100.0) compared with normal eyes (24.0 cells/mm2; range, 20.8–32.3; P = 0.013; DC size (111.0 µm2; range, 92.0–137.8) compared with normal eyes (63.7 µm2; range, 47.7–70.3; P < 0.001); nerve tortuosity (0.08; range, 0.05–0.09) compared with normal eyes (0.04; range, 0.02–0.04; P < 0.001); and keratocyte reflectivity. BC density and CNF length values were found to be significantly less than those for normal controls (both P < 0.001). In all subgroups, CNF length appeared to be significantly lower than that of controls (all P < 0.001), and DC density was only statistically significantly higher in the UK (P = 0.003) and RK (P < 0.001) groups. Corneal fluorescein staining had no correlation with the analyzed IVCM parameters (all P ˃ 0.05). However, the increase in DC density and DC size showed negative correlations to CNF length (density: r = −0.325, P < 0.005; size: r = −0.493, P < 0.005), as well as positive correlations to duration and frequency of topical eye drops and DC size (density: r = 0.361, P < 0.05; size: r = 0.581, P < 0.05). A ROC curve showed that CNF length had the strongest predictive power, with the estimated area under the curve being 0.992 ± 0.008. Conclusions Lower BC density and CNF length, greater DC density and DC size, and greater keratocyte reflectivity were the microstructural characteristics of TK. The role of subbasal nerve, inflammatory response, and limbal stem cells in the progression of TK and the appropriate treatment of different TK stages are future research directions. Translational Relevance The evaluation of basal cells, subbasal nerve, and dendritiform cells is helpful to our understanding of the pathological process of TK.
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Affiliation(s)
- Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guanyu Su
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Pedram Hamrah
- Cornea Service, New England Eye Center, Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Antoine Labbe
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Reková P, Dostálová G, Kemlink D, Paulasová Schwabová J, Dubská Z, Vaneckova M, Mašek M, Kodet O, Poupětová H, Mazurová S, Rajdova A, Vlckova E, Táboříková A, Fafejtová Š, Nevsimalova M, Linhart A, Tomek A. Detailed Phenotype of GLA Variants Identified by the Nationwide Neurological Screening of Stroke Patients in the Czech Republic. J Clin Med 2021; 10:jcm10163543. [PMID: 34441839 PMCID: PMC8396867 DOI: 10.3390/jcm10163543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
Fabry disease (FD) is a rare X-linked disorder of glycosphingolipid metabolism caused by pathogenic variants within the alpha-galactosidase A (GLA) gene, often leading to neurological manifestations including stroke. Multiple screening programs seeking GLA variants among stroke survivors lacked detailed phenotype description, making the interpretation of the detected variant’s pathogenicity difficult. Here, we describe detailed clinical characteristics of GLA variant carriers identified by a nationwide stroke screening program in the Czech Republic. A total of 23 individuals with 8 different GLA variants were included in the study. A comprehensive diagnostic workup was performed by a team of FD specialists. The investigation led to the suggestion of phenotype reclassification for the G325S mutation from late-onset to classical. A novel variant R30K was found and was classified as a variant of unknown significance (VUS). The typical manifestation in our FD patients was a stroke occurring in the posterior circulation with an accompanying pathological finding in the cerebrospinal fluid. Moreover, we confirmed that cornea verticillata is typically associated with classical variants. Our findings underline the importance of detailed phenotype description and data sharing in the correct identification of pathogenicity of gene variants detected by high-risk-population screening programs.
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Affiliation(s)
- Petra Reková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
| | - Gabriela Dostálová
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, 128 08 Prague, Czech Republic; (G.D.); (A.L.)
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
- Correspondence: ; Tel.: +420-22-496-5512
| | - Jaroslava Paulasová Schwabová
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic; (J.P.S.); (A.T.)
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic
| | - Zora Dubská
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.V.); (M.M.)
| | - Martin Mašek
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.V.); (M.M.)
| | - Ondřej Kodet
- Department of Dermatovenerology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
- Biotechnology and Biomedicine Centre, Academy of Science, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy First Faculty of Medicine, Charles University in Prague, 128 08 Prague, Czech Republic
| | - Helena Poupětová
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (H.P.); (S.M.)
| | - Stella Mazurová
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (H.P.); (S.M.)
| | - Aneta Rajdova
- Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, 625 00 Brno, Czech Republic; (A.R.); (E.V.)
| | - Eva Vlckova
- Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, 625 00 Brno, Czech Republic; (A.R.); (E.V.)
| | - Alena Táboříková
- Department of Neurology and Stroke Centre, Country Hospital Chomutov, 430 12 Chomutov, Czech Republic;
| | - Štěpánka Fafejtová
- Department of Neurology and Stroke Centre, Hospital Karlovy Vary, 360 01 Karlovy Vary, Czech Republic;
| | - Miroslava Nevsimalova
- Department of Neurology, Hospital Ceske Budejovice, 370 01 České Budějovice, Czech Republic;
| | - Aleš Linhart
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, 128 08 Prague, Czech Republic; (G.D.); (A.L.)
| | - Aleš Tomek
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic; (J.P.S.); (A.T.)
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Matsumiya W, Karaca I, Ghoraba H, Akhavanrezayat A, Mobasserian A, Hassan M, Regenold J, Yasar C, Liedtke M, Kitazawa K, Nguyen QD. Structural changes of corneal epithelium in belantamab-associated superficial keratopathy using anterior segment optical coherence tomography. Am J Ophthalmol Case Rep 2021; 23:101133. [PMID: 34169181 PMCID: PMC8208963 DOI: 10.1016/j.ajoc.2021.101133] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 10/26/2022] Open
Abstract
Purpose To describe structural changes in corneal epithelium using anterior segment optical coherence tomography (AS-OCT) in two relapsed and refractory multiple myeloma (RRMM) patients with bilateral belantamab-associated superficial keratopathy (BASK). Observations case 1 A 56-year-old male who was diagnosed with RRMM and initiated on belantamab mafodotin, presented on day 42 (three weeks after the second infusion) with decreased pinhole visual acuity from 20/20 and 20/25 to 20/70 and 20/50 in the right eye and left eye, respectively. Slit-lamp examination revealed moderate superficial keratopathy with microcystic-like epithelial changes (MECs) in the paracentral cornea in both eyes. AS-OCT demonstrated increased bilateral heterogeneous signal intensity and hyperreflective lesions as well as increased thickness in the paracentral corneal epithelium with uninvolved central cornea. Given bilateral MECs, the third infusion was withheld, and then given on day 62 after five weeks of drug-free interval. Although MECs had improved on day 82, pinhole visual acuity remained at 20/50 and 20/40 in the right eye and the left eye. AS-OCT showed that hyperreflective lesions mostly resolved and corneal epithelial thickness returned to baseline, despite a slightly increased persisting heterogeneous signal intensity in the peripheral corneal epithelium in both eyes. Case 2 A 77-year-old male with RRMM was started on belantamab mafodotin infusions. His pinhole visual acuity decreased from 20/40 and 20/30 at baseline to 20/60 and 20/40 on day 41 (three weeks after the second infusion) in the right eye and left eye, respectively. Slit-lamp examination showed diffuse, moderate MECs in both eyes, which was more severe in the peripheral cornea. AS-OCT demonstrated increased bilateral heterogeneous signal intensity and hyperreflective lesions in the corneal epithelium, which are more severe in the right eye along with increased corneal epithelial thickness. Therefore, belantamab mafodotin was withheld. Conclusions and Impotance AS-OCT objectively demonstrated structural changes such as signal intensity and thickness alterations with hyperreflective lesions in the corneal epithelium related to BASK. AS-OCT might be useful for clinicians to monitor ocular surface adverse events in RRMM patients receiving belantamab mafodotin and to adjust therapeutic plans for the patients.
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Affiliation(s)
- Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Hassan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Michaela Liedtke
- Division of Hematology, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Koji Kitazawa
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Buck Institute for Research on Aging, Novato, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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Hinkovska-Galcheva V, Treadwell T, Shillingford JM, Lee A, Abe A, Tesmer JJG, Shayman JA. Inhibition of lysosomal phospholipase A2 predicts drug-induced phospholipidosis. J Lipid Res 2021; 62:100089. [PMID: 34087196 PMCID: PMC8243516 DOI: 10.1016/j.jlr.2021.100089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
Phospholipidosis, the excessive accumulation of phospholipids within lysosomes, is a pathological response observed following exposure to many drugs across multiple therapeutic groups. A clear mechanistic understanding of the causes and implications of this form of drug toxicity has remained elusive. We previously reported the discovery and characterization of a lysosome-specific phospholipase A2 (PLA2G15) and later reported that amiodarone, a known cause of drug-induced phospholipidosis, inhibits this enzyme. Here, we assayed a library of 163 drugs for inhibition of PLA2G15 to determine whether this phospholipase was the cellular target for therapeutics other than amiodarone that cause phospholipidosis. We observed that 144 compounds inhibited PLA2G15 activity. Thirty-six compounds not previously reported to cause phospholipidosis inhibited PLA2G15 with IC50 values less than 1 mM and were confirmed to cause phospholipidosis in an in vitro assay. Within this group, fosinopril was the most potent inhibitor (IC50 0.18 μM). Additional characterization of the inhibition of PLA2G15 by fosinopril was consistent with interference of PLA2G15 binding to liposomes. PLA2G15 inhibition was more accurate in predicting phospholipidosis compared with in silico models based on pKa and ClogP, measures of protonation, and transport-independent distribution in the lysosome, respectively. In summary, PLA2G15 is a primary target for cationic amphiphilic drugs that cause phospholipidosis, and PLA2G15 inhibition by cationic amphiphilic compounds provides a potentially robust screening platform for potential toxicity during drug development.
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Affiliation(s)
- Vania Hinkovska-Galcheva
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Taylour Treadwell
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan M Shillingford
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Angela Lee
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Akira Abe
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - John J G Tesmer
- Departments of Biological Sciences and Medicinal Chemistry and Pharmacology, Purdue University, West Lafayette, IN, USA
| | - James A Shayman
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.
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Abstract
PURPOSE OF REVIEW Rho kinase (ROCK) inhibitors are growing increasingly relevant in ophthalmology, and the goal of this review is to summarize their mechanisms of action and potential applications in the subspecialties of glaucoma, retina, and cornea. We will focus specifically on corneal endothelial wound healing, for which ROCK inhibition demonstrates particular promise. RECENT FINDINGS ROCK inhibition has been shown to promote corneal endothelial cell proliferation, increase intercellular adhesion, and suppress apoptosis. Topical ROCK inhibitor treatment has exhibited potential use in Fuchs endothelial dystrophy, corneal edema from acute surgical trauma and other etiologies, and tissue engineering therapy for the endothelial disease. Ripasudil and netarsudil, the two ROCK inhibitors available for ophthalmic use, are generally very well tolerated with mild and transient local side effects. SUMMARY ROCK inhibitors are revolutionizing the subspecialty of cornea, and further research is needed to compare long-term outcomes of ROCK inhibitor therapy to those of conventional endothelial keratoplasty, including visual acuity and endothelial cell density. Other possible avenues include the use of ROCK inhibitors to prolong corneal graft survival, and early data appears promising.
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Passidomo F, Pignatelli F, Addabbo G, Costagliola C. Topical Liposomal Ozonated Oil in Complicated Corneal Disease: A Report on Three Clinical Cases. Int Med Case Rep J 2021; 14:327-332. [PMID: 34017203 PMCID: PMC8131066 DOI: 10.2147/imcrj.s311839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Infectious and traumatic corneal diseases require adequate therapy against infection and promote re-epithelialization. The appearance of multidrug-resistant bacterial strains, induced by excessive use of antibiotics in the treatment of infectious diseases, has urged researchers to study new antimicrobial formulations. Ozonated oils have demonstrated antiseptic (antibacterial, antifungal and antiviral) and reparative properties and can be proposed for the prevention and treatment of acute and chronic local infections, as an alternative to conventional topical antimicrobials. In ocular treatment, ozonated oil can exert tissue repair and anti-inflammatory and bactericidal activity. Moreover, its specific formulation makes it well tolerated and biocompatible with the ocular surface. Herein, we report on three cases of corneal inflammation (dendritic epithelial keratitis, corneal injuries caused by olive leaves, and neurotrophic corneal ulcer), treated with liposomal ozonated oil (Ozodrop®, FB VISION S.p.a. San Benedetto del Tronto, Italy), successfully resolved using topical liposomal ozonated oil.
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Affiliation(s)
- Fedele Passidomo
- Comprehensive Ophthalmology Unit, S.S. Annunziata Hospital, Taranto, Italy
| | | | - Giuseppe Addabbo
- Comprehensive Ophthalmology Unit, S.S. Annunziata Hospital, Taranto, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
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Abstract
PURPOSE To report an unusual case of corneal whorl-like opacity patterns in a patient of primary localized conjunctival amyloidosis. METHODS Case report and review of literature. RESULTS A 35-year old man with a case of primary localized conjunctival amyloidosis presented with corneal whorl-like opacity patterns and underwent conjunctival and limbal biopsies. Histopathological evaluation showed dense deposition of amorphous, hyaline, eosinophilic material with week periodic acid-Schiff positivity and congophilia on congo red stain. There was birefringence under a polarized microscope. These findings were suggestive of amyloid deposition. tumor-associated calcium signal transducer-2 mutation was negative ruling out gelatinous drop-like corneal dystrophy. Systemic evaluation was negative for primary systemic amyloidosis. A diagnosis of primary localized conjunctival amyloidosis with corneal whorl-like opacity patterns was confirmed. CONCLUSIONS This is an unusual case report of primary localized conjunctival amyloidosis, presenting as corneal whorl-like opacity patterns. Primary localized conjunctival amyloidosis usually involves the fornix and then spreads to lids causing lid thickening, blepharoptosis, subconjunctival, or orbital mass. In our case, it probably started around limbus, involving palisades of Vogt and caused corneal whorl-like opacity patterns which were the presenting feature.
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Sharma A, Riaz KM, Gill MS, Patnaik A, Ulahannan SV, Wang JS, Gombos DS, Ang Q, Cicic D, Bergonio GR, Zhang C, Wirostko BM. Reversible HER2 antibody-drug conjugate-induced ocular toxicity. Can J Ophthalmol 2021; 57:118-126. [PMID: 33727105 DOI: 10.1016/j.jcjo.2021.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/23/2021] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To report 3 cases of reversible epitheliopathy induced by A166-a human epidermal growth factor receptor (HER2)-targeted antibody-drug conjugate (ADC) therapy for resistant HER2 tumours. METHODS Advanced HER2 tumour patients were enrolled in A166 phase I/II clinical trial using Bayesian logistic regression model dose escalation. Key exclusion criteria were ≥grade 2 (G2) corneal pathology, severe organ disease, and other cancer therapy within 4 weeks. Eye exams were performed at baseline, regularly scheduled intervals, and additionally upon A166-induced ocular symptoms. Topical therapy with autologous serum tears (ASTs) was implemented based on visual acuity, symptoms, and slit lamp exam. A166 was withheld if ≥G2 ocular toxicity developed; if status improved to ≤G1, A166 therapy was resumed. Visual acuity, corneal exam, and subjective comfort were recorded. RESULTS After ≥2 cycles of A166, 6 eyes of 3/23 enrolled patients developed whorl pattern epitheliopathy suggestive of limbal stem cell (LSC) dysfunction requiring cessation of A166 despite positive tumour response. Patients 1 and 3 received 3.6 mg/kg A166 dose, and patient 2 received 3.0 mg/kg. Topical steroids (2/4 eyes) failed to improve epitheliopathy. Adding ASTs improved vision, ocular comfort, and whorl pattern epitheliopathy in 6/6 eyes within 3 weeks. Patient 1 continues to improve on ASTs; patient 2 withdrew from the study; and patient 3 resumed A166 therapy. CONCLUSION A166 precipitates LSC dysfunction-like epitheliopathy. Combination therapy including aggressive lubrication, withholding drug, and ASTs help reverse toxicity. Recognizing that ADC-induced epitheliopathy can respond to ocular management may enable cancer patients to continue lifesaving therapy.
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Affiliation(s)
| | - Kamran M Riaz
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Okla..
| | - Mohsain S Gill
- University of Oklahoma Medical School, Oklahoma City, Okla
| | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, San Antonio, Tex
| | - Susanna V Ulahannan
- The University of Oklahoma Health Sciences Center/Sarah Cannon Research Institute, Oklahoma City, Okla
| | - Judy S Wang
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, Fla
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Abstract
Introduction: A century-long history in 8-aminoquinolines, the only anti-malaria drug class preventing malaria relapse, has resulted in the approval of tafenoquine by the U.S. Food and Drug Administration (FDA) and the Australian Therapeutic Goods Administration (TGA) and to date registration in Brazil and Thailand. Tafenoquine is an alternative anti-relapse treatment for vivax malaria and malaria prophylaxis. It should not be given in pregnancy, during lactation of infants with glucose-6-phosphate dehydrogenase (G6PD) unknown or deficient status, and in those with G6PD deficiency or psychiatric illness.Areas covered: This systematic review assesses tafenoquine associated adverse events in English-language, human clinical trials. Meta-analysis of commonly reported adverse events was conducted and grouped by comparison arms.Expert opinion: Tafenoquine, either for radical cure or prophylaxis, is generally well tolerated in adults. There is no convincing evidence for neurologic, ophthalmic, and cardiac toxicities. Psychotic disorder which has been attributed to higher doses is a contraindication for the chemoprophylaxis indication and psychiatric illness is a warning for the radical cure indication. Pregnancy assessment and quantitative G6PD testing are required. The optimal radical curative regimen including the tafenoquine dose along with its safety for parts of Southeast Asia, South America, and Oceania needs further assessment.
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Affiliation(s)
- Cindy S. Chu
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Jimee Hwang
- U.S. President’s Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
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38
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Non-infectious and non-hereditary diseases of the corneal epithelium. Exp Eye Res 2021; 202:108316. [DOI: 10.1016/j.exer.2020.108316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023]
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Gomes JÁP, Milhomens Filho JAP. Iatrogenic corneal diseases or conditions. Exp Eye Res 2020; 203:108376. [PMID: 33279524 DOI: 10.1016/j.exer.2020.108376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
Any prescribed or self-administered therapy carries inherent risks of secondary adverse events. While the volume of treatments being administered through healthcare systems has been increasing, scientific advancements in our understanding of the mechanisms of pharmaceutical side effects and complications from procedures now allow us to reduce the risk of non-intentional damage to ocular health. This review summarizes the most common and leading causes of iatrogenic visual impairment, corneal diseases, and conditions that present in a general ophthalmologic practice, including a comprehensive analysis of their pathophysiology and recommendations for management and prophylaxis.Iatrogenic corneal diseases and conditions can arise from topical drugs, contact lens use, eye surgeries and procedures, systemic drugs, non-ophthalmological events, and cosmetic procedures. Topical and systemic drugs may disturb tear film homeostasis or result in ocular surface deposits. The use of ill-fitted contact lenses can trigger eye discomfort and poor hygiene conditions that can predispose to severe infections. Procedures to the eye may result in a variety of anatomical and functional complications that ophthalmologists should be aware of how to avoid or at least be prepared to manage if they occur. Even non-ophthalmological events such as non-invasive ventilation, radiation therapies and, immune-based conditions, or cosmetic procedures such as eyelash growth and fillers, can result in unwanted damage to the ocular surface.
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Affiliation(s)
- José Álvaro Pereira Gomes
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - José Arthur Pinto Milhomens Filho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Li S, Siggel R, Guo Y, Loreck N, Rokohl AC, Kurschat C, Heindl LM. Corneal densitometry: a potential indicator for early diagnosis of Fabry disease. Graefes Arch Clin Exp Ophthalmol 2020; 259:941-948. [PMID: 33258999 PMCID: PMC8016749 DOI: 10.1007/s00417-020-05027-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 11/11/2022] Open
Abstract
Purpose To assess corneal densitometry in patients with Fabry disease (FD) and to compare corneal densitometry differences in FD patients to different corneal manifestations. Methods Ten participants (20 eyes) with FD and 10 age-matched healthy volunteers (20 eyes) were recruited. All participants were assessed by standardized ophthalmic examinations and the corneal densitometry analysis by Pentacam HR. Densitometry measurements were analyzed in standardized grayscale units. Results Seven patients developed conjunctival vessel tortuosity, cornea verticillata appeared in 6 patients, and two patients had Fabry cataract. Retinal vessel tortuosity occurred in 4 patients, and dilation of retinal vessels appeared in 3 patients, all symptoms occurred in both eyes. The first diagnosis of FD up to examination was 4.7 ± 3.23 years, and first ERT up to examination was 2.6 ± 2.27 years. The initial time to diagnosis was negatively related to the corneal densitometry value of the 0–2-mm (r = − 0.556, p = 0.011) and 2–6-mm (r = − 0.482, p = 0.032) zones in the posterior layer. FD group have significantly higher corneal densitometry in anterior 0–2-mm zone and 2–10-mm zone anterior and posterior layer than the control group (p ≤ 0.035, respectively). When divided into two groups by the existence of cornea verticillata, there was a statistically significant difference in the anterior layer, 6–10-mm zone (p = 0.031); in the central layer, 0–2 mm (p = 0.012), 2–6 mm (p = 0.001), 6–10 mm (p = 0.002), and total (p = 0.002); and in the posterior layer, 6–10 mm (p = 0.004) and total (p = 0.002). Conclusions FD patients show higher corneal densitometry, and corneal densitometry may have potential for early diagnosis and reminding progress of FD.
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Affiliation(s)
- Senmao Li
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Robert Siggel
- Department of Ophthalmology, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Yongwei Guo
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.,Eye Center, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Niklas Loreck
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Alexander C Rokohl
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Christine Kurschat
- Department II of Internal Medicine, Center for Molecular Medicine Cologne and Center for Rare Diseases Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.,CECAD, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany. .,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany.
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Maier JD, Siegfried S, Gültekin N, Stanga Z, Baird JK, Grobusch MP, Schlagenhauf P. Efficacy and safety of tafenoquine for malaria chemoprophylaxis (1998-2020): A systematic review and meta-analysis. Travel Med Infect Dis 2020; 39:101908. [PMID: 33227500 DOI: 10.1016/j.tmaid.2020.101908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In 2018, tafenoquine was approved for malaria chemoprophylaxis. We evaluated all available data on the safety and efficacy of tafenoquine chemoprophylaxis. METHODS This systematic review followed the PRISMA guidelines and was registered on PROSPERO (CRD42019123839). We searched PubMed, Embase, Scopus, CINAHL and Cochrane databases. Two authors (JDM, PS) screened all papers. RESULTS We included 44 papers in the qualitative and 9 in the quantitative analyses. These 9 randomized, controlled trials included 2495 participants, aged 12-60 years with 27.3% women. Six studies were conducted in Plasmodium spp.-endemic regions; two were human infection studies. 200 mg weekly tafenoquine and higher dosages lead to a significant reduction of Plasmodium spp. infection compared to placebo and were comparable to 250 mg mefloquine weekly with a protective efficacy between 77.9 and 100% or a total risk ratio of 0.22 (95%-CI: 0.07-0.73; p = 0.013) in favour of tafenoquine. Adverse events (AE) were comparable in frequency and severity between tafenoquine and comparator arms. One study reported significantly more gastrointestinal events in tafenoquine users (p ≤ 0.001). Evidence of increased, reversible, asymptomatic vortex keratopathy in subjects with prolonged tafenoquine exposures was found. A single, serious event of decreased macular sensitivity occurred. CONCLUSION This systematic review and meta-analysis of trials of G6PD-normal adults show that weekly tafenoquine 200 mg is well tolerated and effective as malaria chemoprophylaxis focusing primarily on Plasmodium falciparum but also on Plasmodium vivax. Our safety analysis is limited by heterogenous methods of adverse events reporting. Further research is indicated on the use of tafenoquine in diverse traveller populations.
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Affiliation(s)
- Julian D Maier
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Department of Public and Global Health, MilMedBiol Competence Centre, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Sandra Siegfried
- University of Zurich, Biostatistics Department at Epidemiology, Biostatistics and Prevention Institute, Switzerland
| | - Nejla Gültekin
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defence, Civil Protection and Sport DDPS, Swiss Armed Forces, Medical Services, Ittigen, Switzerland
| | - Zeno Stanga
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defence, Civil Protection and Sport DDPS, Swiss Armed Forces, Medical Services, Ittigen, Switzerland
| | - J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Patricia Schlagenhauf
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Department of Public and Global Health, MilMedBiol Competence Centre, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
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Ahmad TR, Ashraf DC, Seitzman GD. Corneal Deposits in a Patient With Anti-Interferon-γ Autoantibody Syndrome. JAMA Ophthalmol 2020; 138:310-311. [PMID: 31917440 DOI: 10.1001/jamaophthalmol.2019.4925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco
| | - Gerami D Seitzman
- Department of Ophthalmology, University of California, San Francisco.,Francis I. Proctor Foundation, University of California, San Francisco
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43
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Lee PY, Chou WY, Hsu CC, Lin PY, Chen KH. Bilateral corneal edema in an alcoholic male. Taiwan J Ophthalmol 2020; 11:175-178. [PMID: 34295624 PMCID: PMC8259528 DOI: 10.4103/tjo.tjo_50_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
Abstract
Pseudophakic bullous keratopathy and Fuchs' endothelial dystrophy are the two most common causes of corneal edema after cataract surgery. We report a 61-year-old alcoholic male with bilateral corneal edema that improved after his alcohol abstinence. He had uneventful bilateral cataract surgery 3 years ago and blurred vision in both eyes developed for weeks. As he had no history of endothelial dystrophy, the treatment for viral endotheliitis was used initially yet in vain. We asked him to stop alcohol and adjusted his psychiatric drugs, but he lied about stopping drinking. The corneal edema progressed, and finally, he underwent penetrating keratoplasty in his left eye 1 year later. During hospitalization for surgery, alcohol withdrawal syndrome was noted because he could not drink alcohol in our hospital. After he quit drinking for months, corneal edema in the right eye disappeared. Our case highlights that alcoholism can result in corneal edema, and stopping drinking is necessary in these patients.
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Affiliation(s)
- Peng-Yu Lee
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Yi Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ko-Hua Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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44
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Yoshinaka A, Chikama T, Kiuchi Y. Amantadine can induce intra-epithelial deposition in the cornea. Am J Ophthalmol Case Rep 2020; 19:100852. [PMID: 32875144 PMCID: PMC7452131 DOI: 10.1016/j.ajoc.2020.100852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/05/2020] [Accepted: 07/26/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Amantadine has been reported to cause various corneal complications, such as superficial punctate keratitis, corneal endothelial dysfunction, and corneal edema. However, there have been no reports of amantadine-induced deposits in the corneal epithelium. Here, we describe the first case with amantadine-induced deposits in the corneal epithelium proved by confocal biomicroscopy. Observations An 81-year-old woman presented with impaired vision in both eyes. She had been treated with amantadine for 9 years. Corrected visual acuity was 0.8 in both eyes. Furthermore, both eyes showed opacities in the corneal epithelial corneal layer. On confocal biomicroscopy, there were highly reflective deposits in corneal epithelial cells. There were no pathological findings in the stroma and endothelium. Two months after discontinuation of amantadine, corneal opacities disappeared, and visual acuity was 1.0 in both eyes. Conclusions Administration of amantadine can cause deposits in corneal epithelial cells.
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Affiliation(s)
- Asayo Yoshinaka
- Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Sendamachi, Naka-ku, Hiroshima-shi, Hiroshima, 730-0052, Japan
| | - Taiichiro Chikama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
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Kim J, Ji YS, Yoon KC. Bilateral Corneal Edema After Inhalation of Spray Paint. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.6.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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46
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Kaur S, Khurana S, Ram J. Abnormal corneal pigmentation by psychotropic drugs. Indian J Ophthalmol 2020; 68:917. [PMID: 32317486 PMCID: PMC7350451 DOI: 10.4103/ijo.ijo_1256_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Yang T, Fan TJ, Xu B. Norfloxacin induces apoptosis and necroptosis in human corneal epithelial cells. Toxicol In Vitro 2020; 66:104868. [PMID: 32320760 DOI: 10.1016/j.tiv.2020.104868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/30/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
Norfloxacin (NOR) is applied clinically to treat keratitis. However, NOR has brought severe side-effects for human corneal epithelium (HCEP) due to overdose and potential toxicity. In this study, two in vitro experimental models including monolayer HCEP cells and tissue-engineered human corneal epithelium (TE-HCEP) were used to explore the cytotoxicity and its related mechanisms. The HCEP cells treated with NOR at concentrations from 0.1875 to 3.0 mg/mL displayed abnormal morphology, declined viability, and increased plasma membrane permeability. Moreover, 0.75 mg/mL NOR induced chromatin condensation, S phase arrest, phosphatidylserine externalization, and formation of apoptotic body through activation of caspase-2/-8/-9/-3, downregulation of Bcl-2 and Bcl-xL, upregulation of Bad and Bax, mitochondrial transmembrane potential disruption and release of cytochrome c and apoptosis inducing factor into cytosol, whereas 1.5 mg/mL and 3.0 mg/mL NOR upregulated the expressions of receptor-interacting protein kinase 1 (RIPK1), RIPK3 and mixed lineage kinase domain-like (MLKL) together with inactivation of caspase-2/-8. Furthermore, 0.1875-3.0 mg/mL NOR destroyed the multilayer structure of TE-HCEP model due to a dose-dependent cytotoxicity, which validated the above results. Overall, low-dose (0.1875-0.75 mg/mL) NOR induced apoptosis through mitochondrion-dependent and death receptor-mediated pathways, and high-dose (1.5-3.0 mg/mL) NOR triggered necroptosis via RIPK1-RIPK3-MLKL cascade in HCEP cells.
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Affiliation(s)
- Ting Yang
- Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Shandong Province, Qingdao 266003, China
| | - Ting-Jun Fan
- Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Shandong Province, Qingdao 266003, China
| | - Bin Xu
- Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Shandong Province, Qingdao 266003, China.
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Short-term, high-dose hydroxychloroquine corneal toxicity. Am J Ophthalmol Case Rep 2020; 18:100713. [PMID: 32346653 PMCID: PMC7180161 DOI: 10.1016/j.ajoc.2020.100713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 01/27/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the corneal findings and management of a 61-year-old female with vortex keratopathy following short term, high dose hydroxychloroquine used in the setting of a clinical trial for recurrent breast cancer. Observations The patient was found to have significant corneal vortex keratopathy without retinal pathology within 3 months of 1200 mg daily hydroxychloroquine treatment as an adjuvant medication for cancer therapy. Cessation of the medication led to the resolution of the corneal verticillata within 1 month yet the vision did not return to baseline. Ultimately, remaining irregular astigmatism and ocular surface disease required a scleral contact lens to achieve a BSCVA of 20/25 OU. Conclusions and Importance Hydroxychloroquine-induced vortex keratopathy is largely considered dose and duration dependent and is uncommon with most standard treatment algorithms. However, with increasing use of high-dose hydroxychloroquine in adjunct cancer therapy, corneal findings are likely to become more frequent. Persistent visual impairment may occur, thus increased understanding of this pathology can aid in counseling patients and guiding treatment recommendations.
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Shin E, Lim DH, Han J, Nam DH, Park K, Ahn MJ, Kang WK, Lee J, Ahn JS, Lee SH, Sun JM, Jung HA, Chung TY. Markedly increased ocular side effect causing severe vision deterioration after chemotherapy using new or investigational epidermal or fibroblast growth factor receptor inhibitors. BMC Ophthalmol 2020; 20:19. [PMID: 31918686 PMCID: PMC6953164 DOI: 10.1186/s12886-019-1285-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022] Open
Abstract
Background We sought to describe corneal epithelial changes after using epidermal (EGFR) or fibroblast growth factor receptor (FGFR) inhibitors as chemotherapy and to clarify incidence and prognosis. Materials Retrospective chart review. Results Among 6871 patients and 17 EGFR or FGFR inhibitors, 1161 patients (16.9%) referred for ophthalmologic examination. In total, 1145 patients had disease-related or unrelated ocular complications. Among 16 patients with treatment-related ocular complications, three patients had treatment-related radiation retinopathy and one patient showed treatment-related corneal ulcer. Finally the authors identified that, in 12 patients, three EGFR inhibitors and two FGFR inhibitors caused corneal epithelial lesions. Vandetanib, Osimertinib, and ABT-414 caused vortex keratopathy in nine patients, while ASP-5878 and FPA-144 caused epithelial changes resembling corneal dysmaturation in three patients. The mean interval until symptoms appeared was 246 days with vandetanib, 196 days with osimertinib, 30 days with ABT-414, 55 days with ASP-5878, and 70 days with FPA-144. The mean of the lowest logarithm of minimal angle of resolution visual acuity results of the right and left eyes after chemotherapy were 0.338 and 0.413. The incidence rates of epithelial changes were 15.79% with vandetanib, 0.5% with osimertinib, 100% with ABT-414, 50.0% with ASP-5878, and 18.2% with FPA-144. After excluding deceased patients and those who were lost to follow-up or still undergoing treatment, we confirmed the reversibility of corneal lesions after the discontinuation of each agent. Seven patients showed full recovery of their vision and corneal epithelium, while three achieved a partial level of recovery. Although patients diagnosed with glioblastoma used prophylactic topical steroids before and during ABT-414 therapy, all developed vortex keratopathy. Conclusions EGFR and FGFR inhibitors are chemotherapy agents that could make corneal epithelial changes. Contrary to the low probability of ocular complication with old EGFR drugs, recently introduced EGFR and FGFR agents showed a high incidence of ocular complication with severe vision distortion. Doctors should forewarn patients planning chemotherapy with these agents that decreased visual acuity could develop due to corneal epithelial changes and also reassure them that the condition could be improved after the end of treatment without the use of steroid eye drops. Trial registration This study was approved by the institutional review board (IRB) of Samsung Medical Center (IRB no. 2019–04-027) and was conducted according to the principles expressed in the Declaration of Helsinki.
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Affiliation(s)
- Eunhae Shin
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Department of Preventive Medicine, Graduate School, Catholic University of Korea, Seoul, Republic of Korea.
| | - Jisang Han
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do-Hyun Nam
- Cancer Stem Cell Research Center, Department of Neurosurgery, Samsung Medical Center and Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Ki Kang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Cankurtaran V, Tekin K, Cakmak AI, Inanc M, Turgut FH. Assessment of corneal topographic, tomographic, densitometric, and biomechanical properties of Fabry patients with ocular manifestations. Graefes Arch Clin Exp Ophthalmol 2020; 258:1057-1064. [PMID: 31915973 DOI: 10.1007/s00417-019-04593-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 12/11/2022] Open
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