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Zhang T, Liu Z, Li N. The application of dexamethasone implants in uveitis treatment. Front Med (Lausanne) 2024; 11:1402396. [PMID: 39005654 PMCID: PMC11239344 DOI: 10.3389/fmed.2024.1402396] [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: 03/17/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Uveitis refers to a group of ocular inflammatory diseases that can significantly impair vision. Although systemic corticosteroid therapy has shown substantial efficacy in treating uveitis, extensive use of corticosteroids is associated with significant adverse effects. Recently, a biodegradable, sustained-release implant, namely dexamethasone intravitreal implant (Ozurdex), has been reported for treating non-infectious and infectious uveitis. This review aims to summarize the experiences with Ozurdex treatment across various forms of uveitis and to assist readers in understanding the appropriate timing and potential side effects of Ozurdex in uveitis treatment, thereby maximizing patient benefits in uveitis management.
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Affiliation(s)
- Tian Zhang
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Zhutao Liu
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Na Li
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
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Xu Q, Gong C, Yang X, Li J, Zhang Z, Sheng A, Zhang Y, Feng R, Liu Y, Qiao L, Li Y, Li S. The Consistency of Anti-Toxocara IgG Between the Aqueous Humor and Vitreous of Patients With Clinically Suspected Ocular Toxocariasis. Am J Ophthalmol 2024; 267:90-99. [PMID: 38871266 DOI: 10.1016/j.ajo.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To assess the consistencies of anti-Toxocara IgG (T-IgG) and Goldmann-Witmer coefficient (GWC) between paired aqueous humor (AH) and vitreous samples from patients with clinically suspected ocular toxocariasis (OT). DESIGN Inter-test reliability assessment. METHODS A total of 47 patients with clinically suspected OT who underwent vitrectomy were included. AH, vitreous, and serum samples from each patient were collected, and levels of specific T-IgG in them were detected. The association and agreement of T-IgG and GWC between AH and vitreous were evaluated. The area under the receiver operating characteristic curve was generated to assess the diagnostic performance of AH. RESULTS The T-IgG levels and GWC values in vitreous were higher than those in AH (P = .023 and P = .029, respectively), but similar positivity rates in the T-IgG (P = 1.000) and GWC >3 (P = 1.000) were apparent between vitreous and AH. In addition, there was a positive correlation between the AH and vitreous T-IgG levels (rs = 0.944, P < .001) and the GWC values (rs = 0.455, P = .022). Moreover, the consistencies between AH and vitreous samples in their T-IgG and GWC positivity rates were almost perfect (both, κ = 0.915, 95% CI = 0.799-1.000) in both. The area under the receiver operating characteristic curve reached 0.991, with a 95% confidence interval of 0.971 to 1.000. The best cut-off value for accurate OT diagnosis was found at 1.434, yielding 96% sensitivity and 100% specificity. CONCLUSIONS Our findings demonstrate that AH and vitreous samples had significant correlations and perfect agreements for both T-IgG and GWC, suggesting that the AH may serve as a proxy for vitreous to provide a safer, earlier, and more convenient screening of OT.
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Affiliation(s)
- Qing Xu
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Chaoju Gong
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Xiao Yang
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Jie Li
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Zhengpei Zhang
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Aiqin Sheng
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Yipeng Zhang
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Ruifang Feng
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Yalu Liu
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Lei Qiao
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Yanlian Li
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Suyan Li
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China; Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China.
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Desurmont MG, Bourdin A, Paris L, Toutée A, Faudi E, Fardeau C, Bodaghi B, Touhami S. Ocular Toxocariasis in Adult Caucasian Patients: Clinical Presentations and Treatment Outcomes. Ocul Immunol Inflamm 2023:1-8. [PMID: 38133947 DOI: 10.1080/09273948.2023.2295530] [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: 07/06/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To report the clinical features and treatment outcomes in adult Caucasians with ocular toxocariasis (OT) and investigate their prognosis depending on their serological status. METHODS Retrospective observational cohort study (2016-2021) including consecutive adults with uveitis and positive western blot (WB) in the aqueous humor or vitreous. The presence of serum antibodies was not necessary for inclusion, allowing to compare the outcomes depending on the serological status. RESULTS Seventeen eyes of 15 patients were included. Mean age at diagnosis was 51.9 years. Vitreous inflammation was the most frequent sign (100%). Vitreoretinal tractions (41.2%) and chorioretinal granulomas (58.8%) were less prevalent. Atypical features were: spontaneous intravitreal hemorrhage (23.5%), exudative retinal detachment (11.8%), isolated macular edema (17.6%), papillitis (29.4%) and vasculitis (47.1%). Twenty percent of patients had a positive serum serology. Baseline clinical features did not differ statistically depending on the serological status; however, the degree of inflammation was numerically higher in patients with negative serology. Overall, macular thickness, anterior and posterior segment inflammation improved significantly after treatment with oral albendazole, systemic ± local corticosteroids. Vitrectomy (47.1%) was performed in case of persistent vitritis (62.5%), retinal detachment (12.5%) and intravitreous hemorrhage (25%). CONCLUSION OT has no pathognomonic sign and atypical presentations were not infrequent in this adult Caucasian cohort. Serum antibodies were rarely positive, stressing on the importance of ocular sample analysis, especially in case of atypical features. Serum antibodies may prove useful in forecasting the rapidity of inflammation clearance. Antiparasitic and anti-inflammatory treatment was safe and efficient in most cases.
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Affiliation(s)
- Marie-Gwenola Desurmont
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Alexandre Bourdin
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Luc Paris
- Department of Parasitology, Sorbonne Université, Paris, France
| | - Adélaide Toutée
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Emilien Faudi
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Christine Fardeau
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Sara Touhami
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
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Curi ALL, de-la-Torre A, Schlaen A, Mahendradas P, Biswas J. Pediatric Posterior Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1944-1954. [PMID: 38096404 DOI: 10.1080/09273948.2023.2284990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS Review of the literature. RESULTS The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
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Affiliation(s)
- André Luiz Land Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Disease - INI/Fiocruz, Rio de Janeiro, Brazil
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Derqui-Pilar, Argentina
| | | | - Jyortimay Biswas
- Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India
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Galvis V, Prada AM, Tello A, Parra MM, Camacho PA, Polit MP. Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:3215-3221. [PMID: 37227478 PMCID: PMC10587335 DOI: 10.1007/s00417-023-06095-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Angelica Maria Prada
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia.
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia.
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia.
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
| | - Maria Margarita Parra
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
| | - Paul Anthony Camacho
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - María Paz Polit
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
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Zhang X, Hou X, Zhang Y, Liu J, Zhang Z. Case report: Ultrasound biomicroscopy as a guide for the selection of injection sites for dexamethasone intravitreal implant (Ozurdex) for peripheral granulomatous ocular toxocariasis in children. Front Med (Lausanne) 2023; 10:1176585. [PMID: 37261126 PMCID: PMC10227508 DOI: 10.3389/fmed.2023.1176585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Purpose This article aims to report a case of successful treatment of peripheral granulomatous ocular toxocariasis (OT) in an 8-year-old patient using intravitreal injection of dexamethasone (DEX) implant (Ozurdex) under ultrasound biomicroscopy (UBM) guidance. Case presentation A previously healthy 8-year-old boy with a history of long-term close contact with dogs complained of blurring of vision in the right eye for a year. Ophthalmic examination of his right eye showed chronic uveitis. Notably, UBM examination identified granulomas and peripheral vitreous strand in the ciliary body from 3 to 8 o'clock positions. Enzyme-linked immunosorbent assay (ELISA) results of the intraocular fluid (IF) and serum showed increased anti-Toxocara immunoglobulin G (IgG) levels, leading to a diagnosis of peripheral granulomatous OT in the right eye. Intraocular surgery was not indicated in this case. The treatment goal was to alleviate uveitis, improve visual acuity, and prevent complications. He was treated with an intravitreal injection of DEX implant, administered as a single dose every three months, total two doses, combined with albendazole, an oral anthelmintic. Under preoperative UBM guidance, two injections were performed at the 12 and 10 o'clock positions in the pars plana where there were no granulomas and peripheral vitreous strand, successfully preventing complications associated with intravitreal injection. After two injections, the patient's right eye vision improved significantly, with the best-corrected visual acuity (BCVA) increasing from 20/400 to 20/50. Vitreous opacity and retinal edema were reduced, preretinal proliferative membrane was stabilized, and no adverse events occurred. Conclusion UBM can accurately determine the location and extent of peripheral granulomas in OT patients, facilitating the avoidance of granulomas during intravitreal injection and preventing complications associated with intravitreal injection. Under the close follow-up and strict adherence to indications, preoperative UBM-guided intravitreal injections of DEX implant treatment for pediatric peripheral granulomatous OT are safe and effective, providing a new therapeutic option for pediatric peripheral granulomatous OT.
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Affiliation(s)
- Xin Zhang
- The Second School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinzhu Hou
- The Second School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yan Zhang
- The Second School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jingjie Liu
- The Second School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhiyong Zhang
- The Second School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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