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Rossi C, Buizza A, Alessio G, Borselli M, Taloni A, Carnevali A, Carnovale Scalzo G, Lucisano A, Scorcia V, Giannaccare G. Ophthalmic Manifestations in Patients with Blood Malignancies. Hematol Rep 2024; 16:193-203. [PMID: 38651449 PMCID: PMC11036248 DOI: 10.3390/hematolrep16020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Ocular complications can occur in up to 90% of patients with blood malignancies. Such complications range from direct infiltration to local hemostatic imbalance and treatment-related toxicity. This narrative review is based on a systematic computerized search of the literature conducted until January 2024 and examines the common ocular complications associated with blood cancers. Ocular complications from primary disease include mass effects from ocular adnexal lymphomas and intraocular lymphomas, with B-cell lymphomas accounting for 95% of primary ocular presentations. Secondary disease involvement from systemic hematological malignancies can lead to a wide range of ocular manifestations, such as leukemic retinopathy. Furthermore, toxicity from antineoplastic therapies and ocular graft versus host disease (oGVHD) after hematopoietic stem cell transplantation present additional risks to ocular health. In conclusion, ocular complications in blood cancer patients are an integral part of patient management, requiring regular ophthalmic evaluations and close collaboration between oncologists and ophthalmologists. Advances in therapy and an increased focus on early symptom recognition are essential for preserving vision and enhancing patient quality of life.
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Affiliation(s)
- Costanza Rossi
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Alessandro Buizza
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy
| | - Giuseppe Alessio
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Adriano Carnevali
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Giovanna Carnovale Scalzo
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Andrea Lucisano
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (C.R.); (G.A.); (M.B.); (A.T.); (A.C.); (G.C.S.); (A.L.); (V.S.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09123 Cagliari, Italy
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Moon SS, Ovens CA, Reid G, Fraser CL. SD-OCT Imaging of Macular Changes in Fabry Disease: A Case Report. Neuroophthalmology 2024; 48:198-203. [PMID: 38756337 PMCID: PMC11095570 DOI: 10.1080/01658107.2024.2301921] [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: 07/26/2023] [Accepted: 01/02/2024] [Indexed: 05/18/2024] Open
Abstract
Fabry disease (FD) is a rare, X-linked lysosomal storage disorder that can result in fatal end-stage renal disease, heart failure, and cerebro-occlusive events. Vague clinical symptoms and rarity often mean diagnosis and potential treatment is delayed. Ophthalmic findings in FD patients can be helpful in establishing an early diagnosis and timely treatment. Spectral domain optical coherence tomography (SD-OCT) imaging in FD patients shows hyper-reflective foci (HRF) in characteristic patterns within the inner retinal layers. We found that the HRF was localised in linear distributions at the deep and superficial borders of the retinal inner nuclear layer, likely reflecting anatomic vascular plexuses and FD-related sphingolipid deposition within the vessel walls. These results highlight the potential use of SD-OCT in FD and how it may aid diagnosis in undifferentiated patients, prognostication, and disease monitoring.
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Affiliation(s)
- Stephanie S. Moon
- Concord Clinical School, The University of Sydney, Sydney, Australia
| | - Christopher A. Ovens
- Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
| | - Gerard Reid
- Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
| | - Clare L. Fraser
- Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
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Singh C, Jain N, Sharma S, Basu S, Shanbhag SS. Vortex Keratopathy as a Presenting Feature of Ocular Mucous Membrane Pemphigoid. Cornea 2023; 42:1454-1457. [PMID: 37318153 DOI: 10.1097/ico.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of this study was to describe the presenting feature of vortex keratopathy in 3 patients with biopsy-proven ocular mucous membrane pemphigoid (OMMP). METHODS The first patient was a 52-year-old woman with chronic redness and foreign body sensation for 3 years who presented with unilateral vortex keratopathy. Seven months later, in the same eye, she developed conjunctival signs suggestive of OMMP. The second patient was a 33-year-old woman with similar chronic symptoms that were exacerbated by pterygium surgery. Clinical examination revealed vortex keratopathy in the right eye with subtle conjunctival signs suggestive of OMMP. The third patient was a 70-year-old woman with complaints of repeated episodes of redness and foreign body sensation for 18 months who presented with vortex keratopathy in the right eye and conjunctival signs suggestive of OMMP in the same eye. To confirm the clinical diagnosis, bilateral conjunctival biopsy was performed in all patients. RESULTS OMMP was diagnosed based on conjunctival signs and confirmed on direct immunofluorescence positivity, demonstrating antibodies characteristic and diagnostic of OMMP in the basement membrane zone. A unique feature that preceded or coexisted with the conjunctival signs was unilateral vortex keratopathy seen in all 3 patients, independent of the stage of the disease at which they presented. CONCLUSIONS Vortex keratopathy can be a presenting feature in patients with OMMP. A complete ocular surface examination, especially checking the medial canthus for keratin and the inferior fornix for foreshortening, is necessary. Conjunctival biopsy should be performed in all cases to confirm the clinical diagnosis wherever required.
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Affiliation(s)
- Charul Singh
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Neha Jain
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Supriya Sharma
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Cornea and Anterior Segment Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India; and
- Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Christy J, Nair M, Tagare S. DICED - anti-depressant drug-induced corneal endothelial deposits. Indian J Psychiatry 2023; 65:1084-1086. [PMID: 38108057 PMCID: PMC10725205 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_422_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/18/2023] [Accepted: 09/03/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Josephine Christy
- Department of Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India E-mail:
| | - Megha Nair
- Department of Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India E-mail:
| | - Shivraj Tagare
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Pondicherry, India
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Araie M, Sugiyama K, Aso K, Kanemoto K, Iwata R, Hollander DA, Senchyna M, Kopczynski CC. Phase 3 Clinical Trial Comparing the Safety and Efficacy of Netarsudil to Ripasudil in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension: Japan Rho Kinase Elevated Intraocular Pressure Treatment Trial (J-ROCKET). Adv Ther 2023; 40:4639-4656. [PMID: 37603205 PMCID: PMC10499948 DOI: 10.1007/s12325-023-02550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/11/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION A clinical trial evaluated ocular hypotensive efficacy and safety of netarsudil 0.02% once daily (QD) relative to ripasudil 0.4% twice daily (BID). METHODS This was a single-masked, randomized, phase 3, superiority study. Japanese patients were randomized to either the netarsudil 0.02% group or the ripasudil 0.4% group in a 1:1 ratio and treated for 4 weeks. The primary efficacy variable was mean diurnal intraocular pressure (IOP) (average of diurnal time points at 09:00, 11:00, and 16:00) at Week 4. RESULTS A total of 245 patients were included in the primary analysis. At Week 4, least squares (LS) mean of diurnal IOP adjusted for baseline was 15.96 and 17.71 mmHg in the netarsudil 0.02% and ripasudil 0.4% groups, respectively, demonstrating the superiority of netarsudil 0.02% QD over ripasudil 0.4% BID by a margin of - 1.74 mmHg (p < 0.0001). Mean reduction from baseline in mean diurnal IOP at Week 4 was 4.65 and 2.98 mmHg, respectively. Adverse events (AEs) occurred less frequently in netarsudil 0.02% than in ripasudil 0.4%, with the incidence of ocular AEs being 59.8% and 66.7%, respectively. The most frequently reported AE was conjunctival hyperemia in both groups, with an incidence of 54.9% and 62.6%, respectively. No serious eye-related AEs were reported. CONCLUSION Netarsudil ophthalmic solution 0.02% dosed QD (p.m.) was well tolerated and more effective in reducing IOP than ripasudil ophthalmic solution 0.4% dosed BID. Netarsudil 0.02% QD may become an important option for the treatment of Japanese patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04620135.
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Affiliation(s)
- Makoto Araie
- Sekikawa Hospital, 1-4-1, Nishinippori, Arakawa-ku, Tokyo, Japan.
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
| | - Kenji Aso
- Aerie Pharmaceuticals, Ireland Ltd., Japan Branch, Tokyo, Japan
| | - Koji Kanemoto
- Aerie Pharmaceuticals, Ireland Ltd., Japan Branch, Tokyo, Japan
| | - Ryo Iwata
- Aerie Pharmaceuticals, Ireland Ltd., Japan Branch, Tokyo, Japan
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Türkel A, Özdoğan S, Yekedüz E, Şeyran E, Karaçin C, Ateş Ö. Vortex keratopathy associated with ribociclib. J Oncol Pharm Pract 2023; 29:230-232. [PMID: 35570741 DOI: 10.1177/10781552221101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors are the new generation drugs that have been started to be used in our clinical practice recently. These drugs have been shown to have better progression-free survival compared to standard therapy in patients with hormone receptor-positive (HR) and human epidermal growth factor receptor 2 (HER-2)-negative breast cancer. The most common side effects of CDK 4-6 inhibitors are neutropenia, nausea, leukopenia, fatigue, and diarrhea. This case demonstrated vortex keratopathy in both eyes, a rare condition in patients with breast cancer treated with ribociclib. CASE REPORT A 68-year-old female patient was diagnosed with locally advanced HR (+)/HER2 (-) breast cancer in March 2015. In June 2021, bone metastases were detected. The patient was started on ribociclib and fulvestrant. After three cycles of ribociclib and fulvestrant treatment, she was admitted with the complaint of blurred vision in her left eye. Slit-lamp biomicroscopy examination revealed subepithelial haze with central subepithelial whorls in both corneas, more in the left eye, and also a mild punctate epithelial staining was observed with the application of fluorescein dye. MANAGEMENT AND OUTCOME Ribociclib treatment was immediately discontinued and no changes were observed in the cornea and vision levels during the one-month follow-up. DISCUSSION Routine and regular follow-up eye examinations in breast cancer patients treated with ribociclib may benefit patients in our daily clinical practice and may help us to detect side effects at an early stage and to manage them more effectively.
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Affiliation(s)
- Alper Türkel
- Division of Medical Oncology, 146995Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Sibel Özdoğan
- Division of Ophthalmology, 146995Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Emre Yekedüz
- Division of Medical Oncology, 146995Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Erdoğan Şeyran
- Division of Medical Oncology, 146995Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Cengiz Karaçin
- Division of Medical Oncology, 146995Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Öztürk Ateş
- Division of Medical Oncology, 146995Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
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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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Qian Y, Zhou D, Zhu D, Shi T, Zou J, Ma X. Evaluation of Corneal and Retinal Toxicity in Rheumatoid Arthritis Patients Treated with Hydroxychloroquine. Ophthalmic Res 2022; 65:659-667. [PMID: 35705064 DOI: 10.1159/000525170] [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: 03/31/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The study aimed to assess the ocular toxicity of hydroxychloroquine (HCQ) by confocal microscopy, multifocal electroretinography (mfERG), and scanning laser polarimetry with variable corneal compensation (GDxVCC) in patients with rheumatoid arthritis (RA). METHODS A cross-sectional, comparative case series study was retrospectively conducted on 61 patients under HCQ treatment for RA without fundoscopic anomalies (group 1), 65 RA patients with no HCQ treatment (group 2), and 27 normal subjects (group 3). A comprehensive ophthalmological examination, including confocal microscopy, mfERG, and GDxVCC, was performed in the three groups. RESULTS In group 1, the duration of treatment ranged from 19 to 96 months (54.9 ± 15.2 months). The mean cumulative dose of HCQ was 446.1 ± 164.0 g (range 114-864 g). Confocal microscopy revealed hyper-reflective abnormal particles in 45 patients (73.8%) and beaded, tortuous fibers in 34 patients (55.7%) in group 1. No corneal change was observed in the other two groups. The mfERG responses in the 6 concentric rings (R1-R6) among the three groups differed except at R3 (all p < 0.05), and data from R1-R6 were not significantly different between groups 2 and 3. The retinal nerve fiber layer thicknesses were statistically thinner in group 1 than in groups 2 and 3 (all p < 0.05). CONCLUSIONS Early signs of corneal and neural retina structure changes were detected in patients with RA treated with HCQ. Whether these findings should be a mark of drug recession still needs further study and more evidence.
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Affiliation(s)
- Yiyong Qian
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China, .,Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China,
| | - Dan Zhou
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
| | - Dan Zhu
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
| | - Tingli Shi
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xiaoyun Ma
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
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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: 0] [Impact Index Per Article: 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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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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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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Araie M, Sugiyama K, Aso K, Kanemoto K, Kothapalli K, Kopczynski C, Senchyna M, Hollander DA. Phase 2 Randomized Clinical Study of Netarsudil Ophthalmic Solution in Japanese Patients with Primary Open-Angle Glaucoma or Ocular Hypertension. Adv Ther 2021; 38:1757-1775. [PMID: 33629227 PMCID: PMC8004483 DOI: 10.1007/s12325-021-01634-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Netarsudil reduces intraocular pressure (IOP) by increasing aqueous outflow through the trabecular meshwork (TM) pathway and decreasing episcleral venous pressure. The primary objective of this phase 2 study was to evaluate ocular hypotensive efficacy and safety of three netarsudil concentrations (0.01%, 0.02%, and 0.04%) relative to its placebo over 4 weeks in Japanese patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). METHODS Patients were randomized to one of four treatment arms, netarsudil ophthalmic solution 0.01%, 0.02%, 0.04%, or placebo, and treated once-daily (QD) in the evening (P.M.) for 4 weeks. The primary efficacy variable was mean diurnal IOP (average of diurnal time points at 9 A.M., 11 A.M., and 4 P.M.) at week 4. RESULTS A total of 215 patients were randomized and 207 (96.3%) completed the study. The mean of mean diurnal IOP at baseline ranged from 20.28 to 21.14 mmHg across groups. At week 4, least squares (LS) mean of mean diurnal IOP adjusted for baseline was 16.53, 15.82, 16.06, and 18.94 mmHg in the netarsudil 0.01%, 0.02%, 0.04%, and placebo groups, respectively, demonstrating the superiority of netarsudil (all concentrations) over placebo. At week 4, mean reduction (mean percentage reduction) from baseline in mean diurnal IOP was 4.10 (19.8%), 4.80 (23.5%), 4.81 (23.8%), and 1.73 mmHg (8.2%), respectively, demonstrating statistically significant reductions (p < 0.0001) in all netarsudil concentrations over placebo. Adverse events (AEs) occurred in a concentration-dependent manner, and the incidence of ocular AEs was 34.5%, 42.6%, 68.6%, and 9.1% in the netarsudil 0.01%, 0.02%, 0.04%, and placebo groups, respectively. The most frequently reported AE was conjunctival hyperemia, with an incidence of 23.6%, 37.0%, 56.9%, and 1.8%, respectively. No serious AEs were reported. CONCLUSION Netarsudil ophthalmic solutions 0.01%, 0.02%, and 0.04% dosed QD (P.M.) demonstrated superiority to placebo in terms of hypotensive effectiveness at week 4 and were found to be safe and generally well tolerated. Netarsudil 0.02% QD provided an optimal efficacy and safety profile for the treatment of Japanese patients with POAG or OHT. TRIAL REGISTRATION NCT03844945.
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Affiliation(s)
- Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan.
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Kenji Aso
- Aerie Pharmaceuticals Ireland Ltd. (Japan Branch), Tokyo, Japan
| | - Koji Kanemoto
- Aerie Pharmaceuticals Ireland Ltd. (Japan Branch), Tokyo, Japan
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15
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Erb C, Konieczka K. [Rho kinase inhibitors as new local therapy option in primary open angle glaucoma]. Ophthalmologe 2021; 118:449-460. [PMID: 33403458 DOI: 10.1007/s00347-020-01303-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 2014 in Japan and 2017 in the USA, the Rho-kinase inhibitors were approved as a new antiglaucomatous substance group and will now be launched in Europe. OBJECTIVE On this occasion the current state of knowledge on Rho-kinase inhibitors is presented. METHODS In intensive search in PubMed the relevant experimental and clinical literature on the Rho-kinase inhibitors ripasudil and netarsudil and the combination of netarsudil and latanoprost were selected and compiled for this review. RESULTS The intraocular pressure lowering efficacy of ripasudil and netarsudil is in the range of the beta blocker timolol and the prostaglandin analogue latanoprost. In the fixed combination netarsudil/latanoprost the intraocular pressure reduction is greater than that of the single components and reaches a target pressure of below 15 mm Hg in 32%. Conjunctival hyperemia with 53-65% is the most common local side effect. Systemic side effects are very rare and so far there are no contraindications. CONCLUSION The Rho-kinase inhibitors are an interesting new introduction for glaucoma therapy, as each new pressure-lowering therapy represents an additional chance to reach the individually defined target pressure level in a glaucoma patient with local therapy; however, many of the pleiotropic effects associated with Rho-kinase inhibitors have so far only been found experimentally and will require clinical confirmation in the future.
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Affiliation(s)
- C Erb
- Augenklinik am Wittenbergplatz, Kleiststr. 23-26, 10787, Berlin, Deutschland.
| | - K Konieczka
- Augenklinik, Universitätsspital, Mittlere Straße 91, 4056, Basel, Schweiz
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16
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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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17
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El-Eshmawy MM, Shahin M. Thyroid and Eye: Where They Meet in Clinical Practice. Endocr Metab Immune Disord Drug Targets 2020; 20:39-49. [PMID: 31237221 DOI: 10.2174/1871530319666190618120107] [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] [Received: 02/05/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Thyroid Hormones (TH) are essential for normal growth, development and continued optimal function of most of the body organs including the eye. TH signaling plays a central role in the regulation of retinal development and maturation. Deficiency in TH during fetal and early postnatal development impairs growth of the eye and proliferation of all retinal cell types. The present article reviews the most important topics of the different derangements in thyroid function and structure and its relation with eye diseases. METHODS A literature search strategy was conducted for all English-language literature. RESULTS From a clinical practice viewpoint, it should be mentioned that both hypothyroidism and hyperthyroidism are accompanied by ocular diseases i.e. thyroid-associated ophthalmopathy, diabetic retinopathy and age-related macular degeneration. Although the orbit and globe are not common sites for metastatic thyroid cancers, orbital metastasis may be the primary clinical manifestation of thyroid carcinoma. Finally, some medications as amiodarone may be accompanied by both thyroid dysfunction and adverse ocular events. CONCLUSION Thyroid disorders and eye diseases are interrelated through several mechanisms thus, awareness of this relation has a great impact on early diagnosis and treatment.
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Affiliation(s)
- Mervat M El-Eshmawy
- Internal Medicine Department, Mansoura Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Maha Shahin
- Ophthalmology Department, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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18
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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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McNutt PM, Mohan RR. The Need for Improved Therapeutic Approaches to Protect the Cornea Against Chemotoxic Injuries. Transl Vis Sci Technol 2020; 9:2. [PMID: 33200044 PMCID: PMC7645219 DOI: 10.1167/tvst.9.12.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
Cornea, a highly specialized transparent tissue, is the major refractive element of the eye. The cornea is highly susceptible to chemotoxic injury through topical exposure to vapors, microparticles, and aqueous drops, as well as through systemically absorbed chemicals that access the cornea via tear film, aqueous humor, and limbal vasculature. Corneal injury activates a carefully orchestrated series of repair processes capable of resolving minor lesions over time, but it often fails to overcome the menace of moderate, severe, and chronic injuries and secondary pathophysiologies that permanently impair vision. The most serious complications of chemical injuries-persistent corneal edema, neovascularization, scarring/haze, limbal stem cell deficiency, and corneal melting-often manifest over months to years, suggesting that a better understanding of endogenous regenerative mechanisms of corneal repair can lead to the development of improved treatments that may attenuate or prevent corneal defects and protect vision.
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Affiliation(s)
- Patrick M. McNutt
- United States Army Medical Research Institute of Chemical Defense, Gunpowder, MD, USA
| | - Rajiv R. Mohan
- Departments of Ophthalmology, Biomedical Sciences, and Veterinary Medicine & Surgery, University of Missouri, Columbia, MO, USA
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20
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Effraimidis G, Rasmussen ÅK, Bundgaard H, Sørensen SS, Feldt-Rasmussen U. Is the alpha-galactosidase A variant p.Asp313Tyr (p.D313Y) pathogenic for Fabry disease? A systematic review. J Inherit Metab Dis 2020; 43:922-933. [PMID: 32246457 DOI: 10.1002/jimd.12240] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
Abstract
The identification of pathogenic GLA variants plays a central role in the establishment of a definite Fabry disease (FD) diagnosis. We aimed to review and interpret the published data on the p.Asp313Tyr (p.D313Y) variant pathogenicity and clinical relevance. We performed a systematic review of peer-reviewed publications and case-reports on individuals and populations harbouring the p.Asp313Tyr variant. Overall, 35 studies were included in this review. We collected data regarding the clinical manifestations, alpha-galactosidase A enzyme activity, levels of the biomarkers globotriaosylceramide (Gb3 ) and sphingosine-globotriaosylceramide (lyso-Gb3 ) and histological findings of p.Asp313Tyr carriers. The prevalence of p.Asp313Tyr in populations at risk for FD (kidney, heart, neurologic disorders, or symptomatic populations) was calculated. We found high residual enzyme activity, low frequency of clinical features specific for FD, non-elevated lysoGb3 /Gb3 concentrations and lack of intracellular Gb3 accumulation in biopsies in the p.Asp313Tyr carriers. The prevalence of the variant in populations at risk for FD was comparable to the reported frequency in the general population. A possible higher frequency was only observed in neurologic disorders. p.Asp313Tyr can be classified as neutral or variant of unknown significance. Further investigations will be helpful to clarify a possible association between the variant and manifestations in the brain vessels.
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Affiliation(s)
- Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse K Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Capital Region's Unit of Inherited Cardiac Diseases, Faculty of Health and Medical Sciences, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Søren S Sørensen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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21
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Saeed D, Hussain A. Ribociclib-associated vortex keratopathy. Can J Ophthalmol 2020; 55:e140-e142. [DOI: 10.1016/j.jcjo.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/01/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022]
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22
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Farooq AV, Degli Esposti S, Popat R, Thulasi P, Lonial S, Nooka AK, Jakubowiak A, Sborov D, Zaugg BE, Badros AZ, Jeng BH, Callander NS, Opalinska J, Baron J, Piontek T, Byrne J, Gupta I, Colby K. Corneal Epithelial Findings in Patients with Multiple Myeloma Treated with Antibody-Drug Conjugate Belantamab Mafodotin in the Pivotal, Randomized, DREAMM-2 Study. Ophthalmol Ther 2020; 9:889-911. [PMID: 32712806 PMCID: PMC7708586 DOI: 10.1007/s40123-020-00280-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Patients with relapsed or refractory multiple myeloma (RRMM) represent an unmet clinical need. Belantamab mafodotin (belamaf; GSK2857916) is a first-in-class antibody-drug conjugate (ADC; or immunoconjugate) that delivers a cytotoxic payload, monomethyl auristatin F (MMAF), to myeloma cells. In the phase II DREAMM-2 study (NCT03525678), single-agent belamaf (2.5 mg/kg) demonstrated clinically meaningful anti-myeloma activity (overall response rate 32%) in patients with heavily pretreated disease. Microcyst-like epithelial changes (MECs) were common, consistent with reports from other MMAF-containing ADCs. METHODS Corneal examination findings from patients in DREAMM-2 were reviewed, and the clinical descriptions and accompanying images (slit lamp microscopy and in vivo confocal microscopy [IVCM]) of representative events were selected. A literature review on corneal events reported with other ADCs was performed. RESULTS In most patients receiving single-agent belamaf (72%; 68/95), MECs were observed by slit lamp microscopy early in treatment (69% had their first event by dose 4). However, IVCM revealed hyperreflective material. Blurred vision (25%) and dry eye (15%) were commonly reported symptoms. Management of MECs included dose delays (47%)/reductions (25%), with few patients discontinuing due to MECs (1%). The first event resolved in most patients (grade ≥2 MECs and visual acuity [each 77%], blurred vision [67%], and dry eye [86%]), with no reports of permanent vision loss to date. A literature review confirmed that similar MECs were reported with other ADCs; however, event management strategies varied. The pathophysiology of MECs is unclear, though the ADC cytotoxic payload may contribute to on- or off-target effects on corneal epithelial cells. CONCLUSION Single-agent belamaf represents a new treatment option for patients with RRMM. As with other ADCs, MECs were observed and additional research is warranted to determine their pathophysiology. A multidisciplinary approach, involving close collaboration between eye care professionals and hematologist/oncologists, is needed to determine appropriate diagnosis and management of these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT03525678.
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Affiliation(s)
- Asim V Farooq
- University of Chicago Medical Center, Chicago, IL, USA.
| | - Simona Degli Esposti
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Rakesh Popat
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | - Sagar Lonial
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | - Ajay K Nooka
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Douglas Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Brian E Zaugg
- Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Ashraf Z Badros
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | - Ira Gupta
- GlaxoSmithKline, Upper Providence, PA, USA
| | - Kathryn Colby
- University of Chicago Medical Center, Chicago, IL, USA
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Harada K, Uematsu M, Ueki R, Kusano M, Yamada Y, Mohamed YH, Kitaoka T. Intraocular deposits and cataracts after long-term rifabutin intake: A case report. Medicine (Baltimore) 2020; 99:e20049. [PMID: 32481272 PMCID: PMC7249992 DOI: 10.1097/md.0000000000020049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Rifabutin is a broad-spectrum antibiotic known to cause deposits on the corneal endothelium and lens. We report a patient in whom cataracts developed and progressive pigment deposits were seen on the corneal endothelium, lens, and iridocorneal angle. PATIENT CONCERNS The patient was a 45-year-old woman who had been received long-term treatment with a combination of various anti-mycobacterial drugs for multidrug-resistant tuberculosis starting in 2004. Rifabutin was started in 2009, and she was referred to our department in 2017 for detailed ophthalmological examination. DIAGNOSES Both eyes showed pigmented deposits over the entire corneal endothelium, the entire periphery of the iridocorneal angle, and the anterior surface of the lens. Mild cataracts were also diagnosed bilaterally. Pigment deposits on the anterior surface of the lens and the cataracts in both eyes gradually progressed. These lesions were assumed to be associated with long term rifabutin intake. INTERVENTIONS Rifabutin intake was discontinued after progression of intraocular deposits, cataracts, and ERG deterioration. OUTCOMES Visual acuity improved, although cataracts, deposits, and ERG deterioration remained. LESSONS Rifabutin may induce not only corneal endothelial deposits, but also cataracts and iridocorneal angle deposits.
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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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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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Asrani S, Robin AL, Serle JB, Lewis RA, Usner DW, Kopczynski CC, Heah T, Ackerman SL, Alpern LM, Asrani S, Bashford K, Bluestein EC, Boyce JD, Branch JD, Brubaker JW, Christie WC, Cohen JS, Collins NM, Corin SM, Daynes TE, Depenbusch M, Dixon ER, Duzman E, Flowers BE, Flynn WJ, Fong R, Gira JP, Goldberg DF, Greene B, Han SB, Henderson TT, Jerkins G, Jong KY, Katzen LB, Khemsara V, Klugo KL, Kozlovsky JF, Leonardo D, Liu Y, LoBue TD, Luchs JI, Malhotra RP, Mays A, McLaurin EB, McMenemy MG, Modi S, Moroi S, Mulaney J, Nagi K, Nicolau J, Parikh M, Patel JR, Peplinski LS, Perez BR, Piltz-Seymour J, Sadri E, Saltzmann RM, Schenker HI, Swanic MJ, Tekwani N, Teymoorian S, Thomas JW, Tyson FC, Vold S, Weiss MJ, Zaman F. Netarsudil/Latanoprost Fixed-Dose Combination for Elevated Intraocular Pressure: Three-Month Data from a Randomized Phase 3 Trial. Am J Ophthalmol 2019; 207:248-257. [PMID: 31229466 DOI: 10.1016/j.ajo.2019.06.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the ocular hypotensive efficacy and safety of a fixed-dose combination (FDC) of the Rho kinase inhibitor netarsudil and latanoprost vs monotherapy with netarsudil or latanoprost. DESIGN Three-month primary endpoint analysis of a randomized, double-masked, phase 3 clinical trial. METHODS Adults with open-angle glaucoma or ocular hypertension (unmedicated intraocular pressure [IOP] >20 and <36 mm Hg at 8:00 AM) were randomized to receive once-daily netarsudil/latanoprost FDC, netarsudil 0.02%, or latanoprost 0.005% for up to 12 months. The primary efficacy endpoint was mean IOP at 8:00 AM, 10:00 AM, and 4:00 PM at week 2, week 6, and month 3. RESULTS Mean treated IOP ranged from 14.8-16.2 mm Hg for netarsudil/latanoprost FDC, 17.2-19.0 mm Hg for netarsudil, and 16.7-17.8 mm Hg for latanoprost. Netarsudil/latanoprost FDC met the criteria for superiority to each active component at all 9 time points (all P < .0001), lowering IOP by an additional 1.8-3.0 mm Hg vs netarsudil and an additional 1.3-2.5 mm Hg vs latanoprost. At month 3, the proportion of patients achieving mean diurnal IOP ≤15 mm Hg was 43.5% for netarsudil/latanoprost FDC, 22.7% for netarsudil, and 24.7% for latanoprost. No treatment-related serious adverse events were reported; treatment-related systemic adverse events were minimal. The most frequent ocular adverse event was conjunctival hyperemia (netarsudil/latanoprost FDC, 53.4%; netarsudil, 41.0%; latanoprost, 14.0%), which led to treatment discontinuation in 7.1% (netarsudil/latanoprost FDC), 4.9% (netarsudil), and 0% (latanoprost) of patients. CONCLUSIONS Once-daily netarsudil/latanoprost FDC demonstrated IOP reductions that were statistically and clinically superior to netarsudil and latanoprost across all 9 time points through month 3, with acceptable ocular safety.
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Corneal vortex keratopathy in childhood-onset systemic lupus erythematosus (c-SLE). Clin Rheumatol 2019; 38:2851-2855. [DOI: 10.1007/s10067-019-04632-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/02/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022]
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Walters TR, Ahmed IIK, Lewis RA, Usner DW, Lopez J, Kopczynski CC, Heah T. Once-Daily Netarsudil/Latanoprost Fixed-Dose Combination for Elevated Intraocular Pressure in the Randomized Phase 3 MERCURY-2 Study. ACTA ACUST UNITED AC 2019; 2:280-289. [DOI: 10.1016/j.ogla.2019.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/06/2019] [Accepted: 03/21/2019] [Indexed: 11/17/2022]
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Khouri AS, Serle JB, Bacharach J, Usner DW, Lewis RA, Braswell P, Kopczynski CC, Heah T. Once-Daily Netarsudil Versus Twice-Daily Timolol in Patients With Elevated Intraocular Pressure: The Randomized Phase 3 ROCKET-4 Study. Am J Ophthalmol 2019; 204:97-104. [PMID: 30862500 DOI: 10.1016/j.ajo.2019.03.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the intraocular pressure (IOP)-lowering efficacy and safety of netarsudil once daily (QD) and timolol twice daily (BID). DESIGN Double-masked, randomized, phase 3, noninferiority study. METHODS Patients with open-angle glaucoma or ocular hypertension (unmedicated baseline IOP >20 to <30 mm Hg at 8:00 AM) were randomized to netarsudil ophthalmic solution 0.02% QD (PM) or timolol ophthalmic solution 0.5% BID. The primary endpoint was mean IOP at 8:00 AM, 10:00 AM, and 4:00 PM at week 2, week 6, and month 3 in patients with baseline IOP <25 mm Hg (per-protocol population). Safety was recorded over the 6-month treatment period. RESULTS A total of 186 patients from each treatment arm were included in the primary efficacy analysis. Netarsudil QD met the criteria for noninferiority to timolol BID. Mean treated IOP ranged from 16.3 to 17.9 mm Hg for netarsudil and 16.7 to 17.6 for timolol, with mean reductions from baseline of 3.9 to 4.7 mm Hg and 3.8 to 5.2 mm Hg, respectively. In prespecified secondary analyses, netarsudil demonstrated noninferiority to timolol in patients with baseline IOP <27 mm Hg and <30 mm Hg. The IOP-lowering effects of netarsudil were sustained over 6 months of treatment. No treatment-related serious adverse event (AE) was reported for either study drug. However, statistically significant reductions in mean heart rate were recorded at all study visits for the timolol group. The most frequent ocular AE among netarsudil-treated patients was conjunctival hyperemia (47.9%), which was predominately mild. CONCLUSIONS Netarsudil QD (PM), a first-in-class IOP-lowering medication, was noninferior to timolol BID and was associated with tolerable ocular AEs.
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Affiliation(s)
- Albert S Khouri
- Rutgers New Jersey School of Medicine, Newark, New Jersey, USA.
| | - Janet B Serle
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Dale W Usner
- Statistics & Data Corporation, Tempe, Arizona, USA
| | - Richard A Lewis
- Aerie Pharmaceuticals, Inc, Irvine, California, USA; Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Aerie Pharmaceuticals, Inc, Durham, North Carolina, USA; Sacramento Eye Consultants, Sacramento, California, USA
| | - Puiwah Braswell
- Aerie Pharmaceuticals, Inc, Irvine, California, USA; Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Aerie Pharmaceuticals, Inc, Durham, North Carolina, USA
| | - Casey C Kopczynski
- Aerie Pharmaceuticals, Inc, Irvine, California, USA; Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Aerie Pharmaceuticals, Inc, Durham, North Carolina, USA
| | - Theresa Heah
- Aerie Pharmaceuticals, Inc, Irvine, California, USA; Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Aerie Pharmaceuticals, Inc, Durham, North Carolina, USA
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Cruz-Cazarim ELC, Cazarim MS, Ogunjimi AT, Petrilli R, Rocha EM, Lopez RFV. Prospective insulin-based ophthalmic delivery systems for the treatment of dry eye syndrome and corneal injuries. Eur J Pharm Biopharm 2019; 140:1-10. [PMID: 31015020 DOI: 10.1016/j.ejpb.2019.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/10/2019] [Accepted: 04/19/2019] [Indexed: 12/18/2022]
Abstract
The presence of insulin (INS) receptors on the ocular surface (OS) and lacrimal gland (LG), and the high prevalence of dry eye syndrome (DES) and corneal lesions in diabetic patients suggest that INS is relevant for OS homeostasis and wound healing. The study aims at developing delivery systems for the topical administration of INS to the OS in order to improve INS local bioavailability and evaluate the influence of the delivery systems on DES in diabetic rats (DM) (n = 05/group). Chitosan microparticles (MP), chitosan/poloxamer gel (GEL) and MP-loaded GEL (GELMP), with or without INS were developed. Formulations were instilled into the eyes of diabetic rats (DM) for 15 days and the tear fluid volume, corneal cells morphology and cornea thickness were assessed and compared with an aqueous dispersion of INS (DISP-INS). All delivery systems had pH of about 6, osmolality suitable for topical application and positive zeta potential. The MPs with or without INS had sizes close to 4 μm, spherical morphology and INS encapsulation efficiency of 77 ± 6%. DISP-INS and GELMP-INS formulations produced tear secretion amounts significantly higher than those receiving formulations containing no INS and similar to healthy animals. Cornea surface impression cytology showed that treatment with INS-delivery systems and not DISP-INS almost normalized cells morphology. Treatment with GELMP-INS increased INS by 2.5 in the LG and eyeball as compared to the groups treated with GEL-INS and MP-INS, while treatment with DISP-INS left no traces of drug in the eye after treatment termination. GEL and GELMP containing INS were also able to normalize the thickness of the corneal epithelia. In conclusion, GELMP-INS normalized tear fluid volume, corneal thickness, protected corneal cells morphology and increased ocular bioavailability of INS, making it a promising treatment strategy for DES and corneal lesions.
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Affiliation(s)
- Estael L C Cruz-Cazarim
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Maurílio S Cazarim
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Abayomi T Ogunjimi
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Raquel Petrilli
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Eduardo M Rocha
- School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, 14049-900 Ribeirao Preto, SP, Brazil
| | - Renata F V Lopez
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil.
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Kahook MY, Serle JB, Mah FS, Kim T, Raizman MB, Heah T, Ramirez-Davis N, Kopczynski CC, Usner DW, Novack GD. Long-term Safety and Ocular Hypotensive Efficacy Evaluation of Netarsudil Ophthalmic Solution: Rho Kinase Elevated IOP Treatment Trial (ROCKET-2). Am J Ophthalmol 2019; 200:130-137. [PMID: 30653957 DOI: 10.1016/j.ajo.2019.01.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate netarsudil 0.02% ophthalmic solution in patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). DESIGN Double-masked, randomized, multicenter, parallel-group, noninferiority clinical study. METHODS After a washout of all prestudy ocular hypotensive medications, 756 eligible patients with elevated IOP were randomized to receive netarsudil 0.02% once a day (q.d.) (251); netarsudil 0.02% twice a day (b.i.d.) (254); or timolol 0.5% b.i.d. (251) for 12 months, as well as a noninterventional Corneal Observation Study (COS) for patients manifesting cornea verticillata. RESULTS On treatment, mean IOP at 8:00 AM decreased from a baseline IOP of 22.5-22.6 mm Hg to 17.9-18.8 mm Hg, 17.2-18.0 mm Hg, and 17.5-17.9 mm Hg for netarsudil q.d., netarsudil b.i.d., and timolol, respectively, over 12 months. The most frequently reported adverse events (AEs) were ocular, with the most frequent ocular AE being conjunctival hyperemia, with an incidence of 61%, 66%, and 14%, respectively. The next most frequent AEs were corneal deposits (corneal verticillata), with an incidence of 26%, 25%, and 1%, respectively, and conjunctival hemorrhage (typically petechial), with an incidence of 20%, 19%, and 1%, respectively. All 3 AEs were generally scored as mild, with conjunctival hyperemia and/or hemorrhage appearing sporadically during the study. In the observational follow-up component of this study, there was no clinically meaningful impact of corneal verticillata on visual function in affected patients. CONCLUSIONS In this randomized, double-masked trial, once-daily dosing of netarsudil 0.02% was effective, consistently lowering IOP through 12 months, and was tolerated by the majority of patients.
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Affiliation(s)
- Malik Y Kahook
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Janet B Serle
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Terry Kim
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Theresa Heah
- Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Durham, North Carolina, USA
| | - Nancy Ramirez-Davis
- Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Durham, North Carolina, USA
| | - Casey C Kopczynski
- Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Durham, North Carolina, USA
| | | | - Gary D Novack
- PharmaLogic Development, Inc, San Rafael, California, USA; Department of Ophthalmology, University of California Davis School of Medicine, Sacramento, California, USA.
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Hounkpatin AB, Kreidenweiss A, Held J. Clinical utility of tafenoquine in the prevention of relapse of Plasmodium vivax malaria: a review on the mode of action and emerging trial data. Infect Drug Resist 2019; 12:553-570. [PMID: 30881061 PMCID: PMC6411314 DOI: 10.2147/idr.s151031] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Tafenoquine is an 8-aminoquinoline with activity against all human life cycle stages of Plasmodium vivax, including dormant liver stages – so called hypnozoites. Its long half-life of ~15 days is allowing for a single exposure regimen. It has been under development since 1980 and received approval by the US Food and Drug Administration in summer 2018 as an anti-relapse drug for P. vivax malaria in patients aged 16 years and older and for prophylaxis of malaria caused by any Plasmodium species in adults. Prior to tafenoquine administration, glucose-6-phosphate dehydrogenase (G6PD) deficiency needs to be excluded by testing. Individuals with a deficient G6PD activity are at risk of tafenoquine-induced hemolysis – as is the case for primaquine, the mainstay drug for P. vivax radical cure. A wealth of clinical studies have been conducted and are still ongoing to assess the safety, tolerability, and efficacy of tafenoquine. This review focuses on data emerging from the latest clinical trials on P. vivax radical cure with tafenoquine, the key studies for regulatory approval of tafenoquine, and elucidates the latest hypothesis on the mode of action.
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Affiliation(s)
- Aurore B Hounkpatin
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany,
| | - Jana Held
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
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Eshraghi H, Mantopoulos D, Suh LH, Zaldana F, Fine HF. Corneal Toxicity Induced by ABT-414 Therapy for Glioblastoma Multiforme: A Case Report. Case Rep Ophthalmol 2018; 9:479-483. [PMID: 30631275 PMCID: PMC6323377 DOI: 10.1159/000494713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background To describe a case of corneal toxicity associated with the use of the epidermal growth factor receptor (EGFR) inhibitor ABT-414 in the treatment of glioblastoma multiforme. Case Presentation Case report of a 56-year-old male with glioblastoma multiforme who developed mild painless blurred vision after systemic treatment with the investigational EGFR inhibitor ABT-414. The patient had best corrected visual acuity of 20/60 right eye and 20/50 left eye. Ophthalmic examination revealed corneal toxicity with whorl-like opacities in the inferior interpalpebral cornea. The patient was treated with topical fluoromethalone and lifitegrast, and his ocular symptoms as well as the corneal findings improved. Conclusions The systemic use of EGFR inhibitor ABT-414 may be associated with corneal toxicity and the effects are reversible with treatment.
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Affiliation(s)
- Hamoon Eshraghi
- Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Dimosthenis Mantopoulos
- Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Leejee H Suh
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Francisco Zaldana
- Department of Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Howard F Fine
- Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Yamagiwa Y, Takei Y, Koizumi H, Nemoto S, Kurata M, Satoh H. Pathological Features of Corneal Phospholipidosis in Juvenile White Rabbits Induced by Ocular Instillation of Chloroquine or Amiodarone. Toxicol Pathol 2018; 47:26-34. [DOI: 10.1177/0192623318809000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cationic amphiphilic drugs (CADs) can induce phospholipidosis (PLD) in organs/tissues. Several ophthalmic pharmaceuticals containing CADs are marketed and used in children. To investigate the effect of PLD on the developing cornea, chloroquine and amiodarone, which are representative CADs, were applied topically to the eyes of juvenile rabbits, and the effects in juvenile rabbits were compared with those in young adult rabbits. Diffuse corneal cloudiness was observed in chloroquine- and amiodarone-treated eyes. Histopathologically, vacuolation was observed in the corneal epithelium and keratocytes. On ultrastructural examination, these vacuoles contained multilamellar inclusion bodies, which are a characteristic of PLD. The size of the vacuoles in the corneal epithelium was reduced in juveniles compared with young adults. Cytoplasmic lamellar bodies and exocytosis in the corneal endothelium were observed in young adult rabbits but not in juvenile rabbits. This study revealed that topical application of chloroquine or amiodarone induces corneal PLD in juvenile and young adult rabbits. Corneal endothelial changes occurred only in young adult rabbits, but ophthalmological changes were similar between juveniles and young adults. The results of the study suggest that the effects of corneal PLD were similar among age groups based on risk assessment.
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Affiliation(s)
- Yoshinori Yamagiwa
- Pharmacokinetics and Toxicology Laboratories, Senju Pharmaceutical Co., Ltd., Kobe, Hyogo, Japan
- Veterinary Pharmacology and Toxicology Laboratories, Graduate School of Veterinary Sciences, Iwate University, Iwate, Japan
| | - Yoshihiro Takei
- Clinical Pathology Department, Ina Research Inc., Nagano, Japan
| | - Haruko Koizumi
- Clinical Pathology Department, Ina Research Inc., Nagano, Japan
| | - Shingo Nemoto
- Pharmacokinetics and Toxicology Laboratories, Senju Pharmaceutical Co., Ltd., Kobe, Hyogo, Japan
| | - Masaaki Kurata
- Pharmacokinetics and Toxicology Laboratories, Senju Pharmaceutical Co., Ltd., Kobe, Hyogo, Japan
| | - Hiroshi Satoh
- Veterinary Pharmacology and Toxicology Laboratories, Graduate School of Veterinary Sciences, Iwate University, Iwate, Japan
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Maruf S, Nath P, Islam MR, Aktar F, Anuwarul A, Mondal D, Basher A. Corneal complications following Post Kala-azar Dermal Leishmaniasis treatment. PLoS Negl Trop Dis 2018; 12:e0006781. [PMID: 30222747 PMCID: PMC6160237 DOI: 10.1371/journal.pntd.0006781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/27/2018] [Accepted: 08/23/2018] [Indexed: 12/21/2022] Open
Abstract
Post Kala-azar Dermal Leishmaniasis (PKDL) is a sequel of Visceral Leishmaniasis (VL). The patients act as a reservoir for the causative parasite (i.e. Leishmania donovani) and thus should be diagnosed and treated with the utmost urgency to prevent the transmission of the disease. In this study, we tried to report the first instances of corneal complications supposedly associated with Miltefosine (MF), in PKDL patients and the probable pathophysiology of such events. The recently rejuvenated National Kala-azar Elimination Program in Bangladesh has put great emphasis on monitoring all the leishmaniasis patients to investigate possible adverse drug reactions (ADR). A total of 194 patients have received Miltefosine for the treatment of Post Kala-azar Dermal Leishmaniasis. So far five patients were found to have developed unilateral ophthalmic complications during the periods from May 2016 to October 2017, after being treated with MF for PKDL. Unfortunately, one of whom had to go through complete evisceration of the affected eyeball. Despite the fact that MF is the only oral formulation of choice to treat PKDL, occurrences of such unexpected ADRs after MF administration urges the exploration of the pathogenesis of such incidents and determine measures to avert such occurrences from happening in future.
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Affiliation(s)
- Shomik Maruf
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Proggananda Nath
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Muhammad Rafiqul Islam
- Department of Ophthalmology, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Fatima Aktar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Azim Anuwarul
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Dinesh Mondal
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ariful Basher
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
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Trad S, Bonnet C, Monnet D. Uvéite médicamenteuse et effets indésirables des médicaments en ophtalmologie. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
In recent years, there has been a rise in the number patients with CHD surviving into adulthood. Many have complications related to their CHD or its treatments, outside the heart, including ocular abnormalities. The objective of this review is to highlight the ocular abnormalities that occur in adults with CHD, either from their condition or related to the common drugs prescribed to manage it. In particular, we reviewed the effects of cyanosis, coarctation of the aorta, endocarditis, and the side effects of Sildenafil and Amiodarone. A change in the retinal vasculature is a common observation with cyanosis or coarctation of the aorta. Occlusion of the retinal vessels may also be observed in cyanotic patients, as well as those with infectious endocarditis. Sildenafil has established ocular side effects; here they are explored in the context of therapy for pulmonary hypertension. Similarly, Amiodarone has established ocular risks, which are summarised. The high prevalence of ocular consequences in adult CHD patients reinforces the need for knowledge of the risks involved and for frequent ophthalmological screening where appropriate.
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Abstract
PURPOSE To report a case of amiodarone-induced vortex keratopathy-associated anatomical findings and subjective visual perception before and after treatment with topical heparin eye drops. METHODS Case report. RESULTS A 76-year-old man complained of halos in his vision in both his eyes due to prominent bilateral cornea verticillata. For treatment of cornea verticillata, we prescribed unpreserved eye drops of a sterile, phosphate-free solution of 0.1% sodium hyaluronate with 1300 IU/mL heparin sodium 3 times daily to the left eye, whereas the other side served as the control. The area of corneal deposits was measured by 2 examiners before and at the 1- and 3-month examination. At last follow-up, cornea verticillata had been reduced from 6 to 2 mm in area by approximately 66% from grade-III to grade-II amiodarone keratopathy. CONCLUSIONS In patients using amiodarone, clearing of cornea verticillata may be achieved by topical use of unpreserved eye drops of a sterile, phosphate-free solution of 0.1% sodium hyaluronate with 1300 IU/mL heparin sodium.
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Kim S, Thomasy SM, Ramsey D, Zhao M, Mannis MJ, Murphy CJ. Whorl pattern keratopathies in veterinary and human patients. Vet Ophthalmol 2018; 21:661-667. [DOI: 10.1111/vop.12552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Soohyun Kim
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California Davis; Davis CA USA
| | - Sara M. Thomasy
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California Davis; Davis CA USA
- Department of Ophthalmology & Vision Science; School of Medicine; University of California Davis; Davis CA USA
| | - David Ramsey
- The Animal Ophthalmology Center; Williamston MI USA
| | - Min Zhao
- Department of Ophthalmology & Vision Science; School of Medicine; University of California Davis; Davis CA USA
- Department of Dermatology; School of Medicine; University of California Davis; Davis CA USA
| | - Mark J. Mannis
- Department of Ophthalmology & Vision Science; School of Medicine; University of California Davis; Davis CA USA
| | - Christopher J. Murphy
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California Davis; Davis CA USA
- Department of Ophthalmology & Vision Science; School of Medicine; University of California Davis; Davis CA USA
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Abstract
Degeneration is the process of change occurring in cells, their parts or intracellular matter that happens due to external factors affecting the life of an organism and results in gradual disruption of normal condition of the tissue or the organ, and possibly complete loss of its functionality. Corneal degenerations may be caused by age-related physiological changes, associated with a certain systemic disease or local inflammations, or be the consequence of chronic toxic action of unhealthy environmental factors on the eye. Unlike dystrophies, corneal degenerations cannot be inherited and do not onset early. When corneal degenerations significantly affect visual acuity, the treatment should aim at alleviating the primary disease before inducing changes in the cornea. The existence of such pathology is important to remember and timely differentiate from acute inflammatory processes of various etiology that require immediate treatment. The right diagnosis is the key factor in choosing effective treatment strategy and thus achieving positive clinical results.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E P Salovarova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L Yu Tekeeva
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Yamagiwa Y, Haranosono Y, Nemoto S, Atsumi I, Kurata M, Kito G, Hatakeyama H, Koizumi H, Sakaki H. Characteristics of corneal phospholipidosis induced by topical ocular application of chloroquine and amiodarone in rabbits. J Toxicol Pathol 2017; 30:135-143. [PMID: 28458451 PMCID: PMC5406592 DOI: 10.1293/tox.2016-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 11/01/2016] [Indexed: 11/22/2022] Open
Abstract
Several cationic-amphiphilic drugs such as chloroquine and amiodarone are known to induce phospholipidosis in the cornea by systemic administration. However, the characteristics of ophthalmological and pathological changes when phospholipidosis-inducing drugs are topically applied have not been well studied. This study was conducted to investigate the characteristics of corneal changes caused by topical application of chloroquine and amiodarone to Japanese white rabbits. The changes were evaluated by ophthalmological, histopathological, and ultrastructural examinations. An in vivo confocal microscopy was also applied to the chloroquine-treated corneas. In both chloroquine- and amiodarone-treated corneas, diffuse cloudiness was observed by slit-lamp biomicroscopy, and its transparency increased with duration of dosing. Confocal microscopy showed punctate dots in the corneal epithelium. Histopathologically, cytoplasmic vacuolation was found in the corneal epithelium and keratocytes in both chloroquine- and amiodarone-treated eyes. Furthermore, foamy cytoplasm of the corneal endothelium was observed in the chloroquine-treated eyes. Ultrastructural examination showed multi-lamellar inclusion bodies or membrane-like debris in the lysosome-like vacuoles in the cytoplasm of corneal cells, which is a characteristic of the lesions of phospholipidosis. These changes disappeared after a withdrawal period. Continuous dosing of chloroquine resulted in corneal erosion and focal corneal opacity as shown by gross observation and slit-lamp biomicroscopy. Confocal microscopy could detect the corneal changes prior to the appearance of these ophthalmological changes. The present study showed that phospholipidosis caused by ocular administration of chloroquine and amiodarone first induces reversible diffuse corneal cloudiness. Confocal microscopy is a useful method for monitoring induction of corneal phospholipidosis.
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Affiliation(s)
- Yoshinori Yamagiwa
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Yu Haranosono
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Shingo Nemoto
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Ikuyo Atsumi
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Masaaki Kurata
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Gakushi Kito
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Hirofumi Hatakeyama
- Clinical Pathology Department, Ina Research Inc., 2148-288 Nishi-minowa, Ina, Nagano 399-4501, Japan
| | - Haruko Koizumi
- Clinical Pathology Department, Ina Research Inc., 2148-288 Nishi-minowa, Ina, Nagano 399-4501, Japan
| | - Hideyuki Sakaki
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
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Drug-induced corneal epithelial changes. Surv Ophthalmol 2017; 62:286-301. [DOI: 10.1016/j.survophthal.2016.11.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 11/20/2022]
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Yılmaz M, Uçar S, Aşçı G, Canda E, Tan F, Hoşcoşkun C, Çoker M, Töz H. Preliminary Screening Results of Fabry Disease in Kidney Transplantation Patients: A Single-Center Study. Transplant Proc 2017; 49:420-424. [DOI: 10.1016/j.transproceed.2017.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hart C, Ferdinands M, Barnsley L. Ocular complications of rheumatic diseases. Med J Aust 2017; 206:224-228. [PMID: 28301794 DOI: 10.5694/mja16.00352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022]
Abstract
Rheumatic diseases are frequently complicated by extra-articular manifestations, often affecting the eye. Most of these ocular symptoms are benign and develop over long periods of time. Some ocular complications of rheumatic disease or the drugs used to treat the disease are rapidly sight-threatening. It is vital that sight-threatening complications are recognised quickly, so that appropriate diagnostic and therapeutic procedures, such as slit lamp examination and the initiation of immunosuppressive treatments, can occur in a timely fashion. Insight into the epidemiology, clinical presentation, common complications and treatment regimens of these ocular manifestations enables early detection and may prevent permanent loss of vision.
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Affiliation(s)
| | | | - Leslie Barnsley
- Rheumatology, Concord Repatriation General Hospital, Sydney, NSW
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Abstract
PURPOSE To report a case with refractory tamoxifen-induced keratopathy despite drug withdrawal. METHODS Case report. RESULTS A 50-year-old woman, diagnosed with bilateral breast cancer underwent mastectomy in 2005. She was treated with tamoxifen citrate from 2005 to 2012. According to her medical history, no corneal abnormalities had been documented during past ophthalmological examinations except low myopia, before initiation of tamoxifen treatment. In 2009, 4 years after start of treatment, she was diagnosed with subepithelium deposits compatible with drug-induced keratopathy. The patient was examined again in 2016, 4 years after withdrawal of the drug with persistent tamoxifen-induced keratopathy. CONCLUSIONS Contrary to current literature, it seems that tamoxifen-induced corneal abnormalities may persist for years after drug withdrawal.
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Patel DV. Systemic associations of corneal deposits: a review and photographic guide. Clin Exp Ophthalmol 2016; 45:14-23. [DOI: 10.1111/ceo.12790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/01/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
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Peponis V, Kyttaris VC, Tyradellis C, Vergados I, Sitaras NM. Ocular manifestations of systemic lupus erythematosus: a clinical review. Lupus 2016; 15:3-12. [PMID: 16482739 DOI: 10.1191/0961203306lu2250rr] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although the eye itself is regarded an ‘immune-privileged’ organ, systemic lupus erythematosus (SLE) can affect every ocular structure, leading, if left untreated, to significant visual loss or even blindness. Since ocular inflammation in SLE can antedate the diagnosis of the systemic disease and cause significant morbidity, prompt diagnosis and treatment of the underlying systemic autoimmune disease is imperative.
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Affiliation(s)
- V Peponis
- Department of Ophthalmology, General Hospital of Piraeus Tzaneion, Greece
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Riva A, Invernizzi A, Resnati C, Micheli V, Cattaneo D, Gervasoni C. Elvitegravir/cobicistat-associated toxic optical neuropathy in an HIV-infected patient: a call for caution? Antivir Ther 2016; 22:453-455. [PMID: 27328632 DOI: 10.3851/imp3058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
Ocular toxicity may not only be caused by medication overdoses and drug-drug interactions, but also by chronic administration of medications at recommended doses. We describe a case of an HIV-infected patient who experienced significant and sustained bilateral visual loss 2 months after starting treatment with elvitegravir/cobicistat/tenofovir/emtricitabine. Given the absence of any evidence of tenofovir- or emtricitabine-induced optical neuropathy after several years of clinical use, the antiretroviral therapy was promptly changed to tenofovir/emtricitabine plus atazanavir/ritonavir, which led to a progressive improvement in visual acuity. However, visual evoked potentials never returned to normal amplitudes. This is the first report of toxic optical neuropathy associated with the use of elvitegravir/cobicistat. It is imperative to recognize any signs of possible eye toxicity as rapidly as possible, and refer affected patients to an ophthalmologist promptly because early detection and the withdrawal of the offending agent are crucial in reversing this adverse ocular event.
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Affiliation(s)
- Agostino Riva
- 3rd Division of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy
| | - Chiara Resnati
- 3rd Division of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Valeria Micheli
- Clinical Microbiology, Virology and Diagnosis of Bioemergency, Luigi Sacco University Hospital, Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Luigi Sacco University Hospital, Milan, Italy
| | - Cristina Gervasoni
- 3rd Division of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
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Balci YI, Acer S, Yagci R, Kucukatay V, Sarbay H, Bozkurt K, Polat A. N-acetylcysteine supplementation reduces oxidative stress for cytosine arabinoside in rat model. Int Ophthalmol 2016; 37:209-214. [DOI: 10.1007/s10792-016-0259-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
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