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Affiliation(s)
- Roy Quinlan
- Biomedical Sciences, Department of Biosciences, The University of Durham, Upper Mountjoy Science Site, Durham, DH1 3LE, UK.
| | - Frank Giblin
- Biomedical Sciences Emeritus, Eye Research Institute, Oakland University, Rochester, MI, 48309, USA.
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Ren Y, Du S, Zheng D, Shi Y, Pan L, Yan H. Intraoperative intravitreal triamcinolone acetonide injection for prevention of postoperative inflammation and complications after phacoemulsification in patients with uveitic cataract. BMC Ophthalmol 2021; 21:245. [PMID: 34088282 PMCID: PMC8176712 DOI: 10.1186/s12886-021-02017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to evaluate the efficacy and safety of phacoemulsification with intravitreal 3 mg triamcinolone acetonide injection in preventing postoperative inflammation and complications in patients with non-infectious anterior uveitis and panuveitis complicated cataract. Method In this retrospective cohort study, 140 uveitic cataract patients who received phacoemulsification and intraocular lens implantation in Shanxi Eye hospital from January 2018 to January 2020 were reviewed. The IVTA group (51 eyes of 41 patients) received intravitreal injection of 3 mg triamcinolone acetonide (TA) at the end of surgery, and the control group (51 eyes of 41 patients) without injection matched by propensity score matching were enrolled. Outcome measures were best corrected visual acuity (BCVA), anterior chamber inflammation, intraocular pressure, corneal endothelial cell density, central macular thickness and complications within 3 months follow-up. Results The degree of postoperative anterior chamber inflammation in the IVTA group was lighter than that in the control group (P < 0.05). The postoperative logMAR BCVA of anterior uveitis was better and improved more quickly in the IVTA group(P < 0.05). Postoperative time of using corticosteroids was shorter in the IVTA group as compared to the control group (P < 0.05). The central macular thickness at postoperative month 1 was statistically significantly lower in the IVTA group (P < 0.05). There were no statistically significant differences between the two groups in postoperative corneal endothelial cell density and intraocular pressure (P > 0.05). Two of 51 eyes (3.9%) in the IVTA group and 8 of 51 eyes (15.7%) in the control group had recurrence of uveitis; 6 of 45 eyes (13.3%) in the control group developed cystoid macular edema but none in the IVTA group; 11 of 51 eyes (21.6%) in the IVTA group and 22 of 51 eyes (43.1%) in the control group developed posterior synechiae postoperatively. Conclusions Intraoperative Intravitreal injection of 3 mg TA is an effective and safe adjunctive therapy for preventing postoperative inflammation and complications to promote early recovery for anterior uveitis or panuveitis complicated cataract patients following phacoemulsification. Trial registration This retrospective cohort study was in accordance with the tenets of the Helsinki Declaration and was approved by the Shanxi Eye Hospital Ethics Committee. Written informed consent was obtained from all participants for their clinical records to be used in this study.
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Affiliation(s)
- Yan Ren
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin, 300052, China.,Department of Fundus Diseases, Shanxi Eye Hospital, Taiyuan, 030002, Shanxi, China
| | - Shufang Du
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin, 300052, China.,Department of Fundus Diseases, Shanxi Eye Hospital, Taiyuan, 030002, Shanxi, China
| | - Dongping Zheng
- Department of Fundus Diseases, Shanxi Eye Hospital, Taiyuan, 030002, Shanxi, China
| | - Yanyun Shi
- Department of Fundus Diseases, Shanxi Eye Hospital, Taiyuan, 030002, Shanxi, China
| | - Luping Pan
- Department of Fundus Diseases, Shanxi Eye Hospital, Taiyuan, 030002, Shanxi, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin, 300052, China.
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The ocular manifestations in IBD screening (OMIS) questionnaire: pilot study on detection of ocular involvement in inflammatory bowel diseases. Int Ophthalmol 2020; 40:2569-2576. [PMID: 32507951 DOI: 10.1007/s10792-020-01437-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the usefulness of a dedicated questionnaire for patients with inflammatory bowel diseases (IBD) treated with biological drugs for the detection of ocular extraintestinal manifestations (EIMs). IBD can cause extraintestinal symptoms including ocular complaints which are frequently ignored and may be associated with significant morbidity, including blindness. METHODS We developed a questionnaire, named Ocular Manifestations in IBD Screening (OMIS) questionnaire, after agreement between gastroenterologists and ophthalmologists. The questionnaire was administered by a non-ophthalmologist physician to 96 IBD patients treated with biological drugs. RESULTS 35 patients (36.5%) were selected for the ophthalmologic examination on the basis of a positive screening test. Ocular EIMs were detected in 29 of 35 patients (83%). CONCLUSION A specific questionnaire can be useful for non-ophthalmologist physicians in a real world setting in order to select patients to be addressed to an ophthalmological visit, creating an integrated multidisciplinary clinical team, to improve management of IBD in order to prevent disability and guarantee quality of life.
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An objective evaluation of crystalline lens density using Scheimpflug lens densitometry in different uveitis entities. Int Ophthalmol 2020; 40:2031-2040. [PMID: 32328923 DOI: 10.1007/s10792-020-01379-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/10/2020] [Indexed: 12/17/2022]
Abstract
AIM To measure lens densities with a Pentacam HR device in patients with active uveitis. Measurements were taken at the onset of the attack and after the treatment of inflammation. METHODS The study included 51 eyes with different anterior uveitis aetiologies and a control group of 48 eyes of age- and gender-matched healthy subjects. Lens densitometry measurements were taken with a Scheimpflug camera on a Pentacam HR device. All the examinations and measurements were performed on the first presentation with the onset of the attack and were repeated at 1st and 3rd months after treatment. Lens densitometry measurements were compared with those of the healthy control group and the healthy fellow eyes of the uveitic patients. RESULTS No statistically significant difference was determined between the groups in respect of age and gender (p > 0.05). At 3 months, Pentacam densitometry of zones 3 value was determined to be significantly high in the uveitic eyes compared to the healthy eyes (p = 0.018). The average lens density value (ALD) at 1 month was statistically significantly higher than the baseline value in the uveitic eyes (p = 0.034). There was no significant change in the ALD value at 3 months compared to the baseline and 1-month values (p = 0.386, p = 0.736, respectively). CONCLUSION Even if there is no cataract development that can be clinically observed in eyes with anterior uveitis, lens density in zone 3 showed a significant increase at the end of 3 months compared to the baseline value. This change can be evaluated objectively with Scheimpflug imaging.
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Abstract
Uveitis patients represent a unique subset of the population undergoing cataract surgery and pose several challenges that require special consideration and strategy. Maintenance of disease quiescence for at least three months prior to surgery maximizes postoperative outcomes, though these patients remain at increased risk for pseudophakic cystoid macular edema, which can be refractory to the traditional steroid treatments. In this review, we detail the pillars of preoperative optimization, intraoperative considerations, and postoperative management of uveitic cataracts, with special attention on the evidence surrounding prevention and treatment of refractory postoperative cystoid macular edema.
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Affiliation(s)
- Judy L Chen
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pooja Bhat
- Assistant Professor of Ophthalmology, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ann-Marie Lobo-Chan
- Assistant Professor of Ophthalmology, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
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Grzybowski A, Brockmann T, Kanclerz P, Pleyer U. Dexamethasone Intraocular Suspension: A Long-Acting Therapeutic for Treating Inflammation Associated with Cataract Surgery. J Ocul Pharmacol Ther 2019; 35:525-534. [DOI: 10.1089/jop.2019.0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrzej Grzybowski
- University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Tobias Brockmann
- Department of Ophthalmology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Garweg JG. [Pharmacological treatment strategies and surgical options for uveitis]. Ophthalmologe 2019; 116:942-950. [PMID: 30796601 DOI: 10.1007/s00347-019-0870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Modern treatment of uveitis aims at a complete control of inflammatory activity, preservation of visual function and the prevention of secondary organ damage as a consequence of the underlying inflammatory disease and its treatment. OBJECTIVE This article gives an update about the strategies of pharmacological and surgical options for uveitis. MATERIAL AND METHODS The outcomes reported here are based on a PubMed search using the terms <"uveitis" AND "therapy"> and <"uveitis" AND "surgery" OR "surgical treatment">. All prospective studies and case series with more than 20 cases as well as review articles from the last 5 years along with cited cross-references were evaluated. RESULTS Local and systemic corticosteroids form the foundation of treatment after exclusion of an infectious etiology. If uveitis activity is not controlled within 6 weeks or if the daily corticosteroid dosage is unacceptably high, a treatment escalation using immunomodulatory drugs is required. If a complete control of inflammatory activity is not achieved, in a third phase treatment is supplemented by antibody-based treatment or cytokines, so-called biologics, with the aim of complete long-term freedom from disease without local or systemic steroid treatment. This target is achieved in 65-80% and guarantees long-term functional stability and anatomical integrity. Early treatment escalation in cases of persisting or recurrent activity as a rule prevents new secondary organ damage. Surgical options are utilized for diagnostic purposes, the administration of intravitreal drugs and for treatment of secondary complications. CONCLUSION Just like the majority of immunological diseases, uveitis is a chronic disease requiring long-term and possibly lifelong treatment and remission (absence of inflammation without treatment) is achieved in only <20%. Surgical interventions can be performed with a good prognosis, if the optic nerve head and macula are not involved. They have a substantially lower complication rate when freedom from symptoms exists preoperatively for at least 3 months.
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Affiliation(s)
- Justus G Garweg
- Berner Augenklinik am Lindenhofspital, Affiliation: Klinik und Poliklinik für Augenheilkunde, Inselspital, Universität Bern, Bremgartenstr 119, 3012, Bern, Schweiz. .,Swiss Eye Institute, Rotkreuz, Schweiz.
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9
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Li AL, Berry DE, Shantha JG, Yeh S. Cataract management in Ebola virus disease survivors: clinical and scientific implications. Future Virol 2019; 14:55-59. [PMID: 32601524 DOI: 10.2217/fvl-2018-0198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
"The EVICT study was the first study to demonstrate a step-wise approach on how to safely screen EVD survivors for cataract surgery, providing evidence that vision restoration though surgical management was safe and feasible in this cohort of EVD survivors".
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Affiliation(s)
- Alexa L Li
- Uveitis & Vasculitis Service, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Duncan E Berry
- Uveitis & Vasculitis Service, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jessica G Shantha
- Uveitis & Vasculitis Service, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Steven Yeh
- Uveitis & Vasculitis Service, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, 30322, USA.,Emory Global Health Institute, Emory University, Atlanta, GA, 30322, USA
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Jinagal J, Gupta G, Agarwal A, Aggarwal K, Akella M, Gupta V, Suri D, Gupta A, Singh S, Ram J. Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis. Indian J Ophthalmol 2019; 67:69-74. [PMID: 30574896 PMCID: PMC6324120 DOI: 10.4103/ijo.ijo_713_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation. METHODS Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. RESULTS 8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema. CONCLUSION Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract.
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Affiliation(s)
- Jitender Jinagal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Madhuri Akella
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deepti Suri
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Anju Gupta
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Surjit Singh
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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