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Xie JS, Ocampo V, Kaplan AJ. Anterior uveitis for the comprehensive ophthalmologist. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00238-2. [PMID: 39128830 DOI: 10.1016/j.jcjo.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/08/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
Anterior uveitis presents a diagnostic challenge due to its wide array of etiologies and clinical manifestations. This narrative review aims to equip general ophthalmologists with a comprehensive understanding of anterior uveitis epidemiology, diagnosis, and treatment. Particular emphasis is placed on developing a tailored and stepwise strategy, rather than a one-size-fits-all approach, for the workup and treatment of anterior uveitis. Chest radiography and serologic testing for syphilis, human leukocyte antigen B27, and angiotensin-converting enzyme are appropriate routine investigations in cases of severe, bilateral, recurrent, or chronic anterior uveitis. Additional testing should be guided by clinical findings and regional epidemiology, especially when considering expensive and invasive modalities. Investigations that are obtained in the absence of clinical and epidemiologic orientation are of limited utility and incur significant costs to patients and health care systems. Most cases of anatomically isolated anterior uveitis resolve with topical corticosteroids, but some patients require escalation to systemic immunomodulatory therapy (IMT). IMT should be considered in patients who respond poorly to corticosteroids, develop side effects related to corticosteroids that limit their use, require high doses to maintain disease remission, or have concomitant systemic inflammatory disease. Comprehensive ophthalmologists should feel comfortable comanaging patients that require conventional disease-modifying antirheumatic drugs/antimetabolite therapy (i.e., methotrexate, azathioprine, and mycophenolate mofetil) with rheumatologists and providing guidance on ocular dosing. When uveitis quiescence cannot be achieved despite maximally tolerated antimetabolite therapy, patients should be referred to a uveitis specialist for consultation and consideration of IMT escalation. The timing of uveitis referral may depend on local factors specific to health care jurisdictions.
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Affiliation(s)
- Jim S Xie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Ocampo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Scarborough Health Network, Rheumatology Department, Scarborough, Ontario, Canada
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Pato-Cour E, Borrego-Sanz L, Domínguez-Álvaro M, Sánchez-Alonso F, Rodríguez-González F, Tejera-Santana M, Esteban-Ortega M, García-Lozano I, Martínez-Costa L, González-Ocampo S, Sainz-de-la-Maza M, Moll-Udina A, Plaza Z, Fonollosa A, Artaraz J, Díaz-Valle T, Gurrea-Almela M, Díaz-Valle D, Méndez-Fernández R. Interobserver Reliability and Sensitivity to Change of a Composite Ocular Inflammatory Activity Index: UVEDAI ©. Ophthalmol Ther 2024; 13:1669-1682. [PMID: 38635137 PMCID: PMC11109075 DOI: 10.1007/s40123-024-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION This was a multicenter, prospective, longitudinal, observational study involving eight Spanish tertiary hospitals to determine the interobserver reliability of an uveitis disease activity index, (UVEDAI) and assess its sensitivity to change in patients with receiving pharmacologic treatment. METHODS Patients aged ≥ 18 years diagnosed with active noninfectious uveitis were included. A complete baseline assessment was performed by two ophthalmologists who determined ocular inflammatory activity using the UVEDAI index independently of each other. The principal ophthalmologist made a new visit at 4 weeks to determine the change in inflammatory activity. The interobserver reliability analysis was performed by calculating the intraclass correlation coefficient (ICC), with the values of the variables and the UVEDAI obtained by both ophthalmologists in the more active eye at the baseline visit. Sensitivity to change in the UVEDAI index was assessed at 4 weeks from the start of pharmacologic treatment by determining the clinically relevant change, defined as a change in UVEDAI of ≥ 0.8 points over baseline. The mean change between both measures was compared using the repeated-measures t-test. RESULTS A total of 111 patients were included. In the interobserver reliability analysis, the ICC for the UVEDAI value was 0.9, and, when compared with the mean UVEDAI values obtained by the ophthalmologists, no statistically significant differences were found (p value > 0.05). As for the sensitivity to change in UVEDAI, statistically significant differences (p value = 0.00) were found for the mean values of the index compared with baseline. In all cases, the index value decreased by > 1 point at the 4-week visit. CONCLUSIONS The interobserver reliability of the UVEDAI was high in the total sample. Furthermore, the index was sensitive in determining the change in inflammatory activity after treatment. We believe that UVEDAI is a disease activity index that enables objective comparison of results in clinical practice and trials.
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Affiliation(s)
- Esperanza Pato-Cour
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.
| | - Lara Borrego-Sanz
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Marta Tejera-Santana
- Ophthalmology Department, Hospital de Gran Canaria Doctor Negrin, Gran Canaria, Spain
| | - Mar Esteban-Ortega
- Ophthalmology Department, Hospital Universitario Infanta Sofia, Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | - Aina Moll-Udina
- Ophthalmology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Zulema Plaza
- Research Unit of Spanish Society of Rheumatology, Madrid, Spain
| | - Alejandro Fonollosa
- Ophthalmology Department, BioCruces-Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Joseba Artaraz
- Ophthalmology Department, BioCruces-Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Teresa Díaz-Valle
- Ophthalmology Department, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Maria Gurrea-Almela
- Ophthalmology Department, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosalía Méndez-Fernández
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
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Klaska IP, Yu T, Fordyce R, Kamoi K, Cornall RJ, Martin-Granados C, Kuffova L, Forrester JV. Targeted delivery of autoantigen to dendritic cells prevents development of spontaneous uveitis. Front Immunol 2023; 14:1227633. [PMID: 37727784 PMCID: PMC10505613 DOI: 10.3389/fimmu.2023.1227633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023] Open
Abstract
Restoration of immunological tolerance to self antigens has been a major drive in understanding the mechanisms of, and developing new treatments for, autoimmune and autoinflammatory disease. Sessile dendritic cells (DC) are considered the main instruments underpinning immunological tolerance particularly the CD205+ (DEC205+) cDC1 subset in contrast to DCIR2+ cDC2 which mediate immunogenicity. Targeting DC using autoantigen peptide-antibody fusion proteins has been a well explored methodology for inducing tolerance. Here we show that subcutaneous (s.c.) inoculation of hen-egg lysozyme (HEL)-DEC205 Ig fusion prevents the development of spontaneous uveoretinitis (experimental autoimmune uveoretinitis, EAU) in a transgenic mouse model generated by crossing interphotoreceptor retinol binding protein (IRBP)-HEL (sTg HEL) with HEL specific TCR (sTg TCR) mice. Prolonged suppression of EAU required injections of HEL-DEC205 Ig once weekly, reflecting the half life of s.c. DC. Interestingly, HEL-DCIR2 Ig also had a suppressive effect on development of EAU but less so than DEC205 Ig while it had minimal effect on preventing the retinal atrophy associated with EAU. In addition, HEL-DEC205 Ig was only effective when administered s.c. rather than systemically and had no effect on EAU induced by adoptive transfer of HEL-activated T cells. These data demonstrate the importance of systemic (lymph node) rather than local (eye) antigen presentation in the development of EAU as well as suggest a potential therapeutic approach to controlling sight-threatening immune-mediated uveitis provided relevant antigen(s) can be identified.
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Affiliation(s)
- Izabela P. Klaska
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Tian Yu
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Rosie Fordyce
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Koju Kamoi
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Richard J. Cornall
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Lucia Kuffova
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - John V. Forrester
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Automated Quantitative Analysis of Anterior Segment Inflammation Using Swept-Source Anterior Segment Optical Coherence Tomography: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12112703. [PMID: 36359546 PMCID: PMC9689595 DOI: 10.3390/diagnostics12112703] [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: 10/10/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The aim of this study is to develop an automated evaluation of anterior chamber (AC) cells in uveitis using anterior segment (AS) optical coherence tomography (OCT) images. Methods: We analyzed AS swept-source (SS)-OCT (CASIA 2) images of 31 patients (51 eyes) with uveitis using image analysis software (Python). An automated algorithm was developed to detect cellular spots corresponding to hyper-reflective spots in the AC, and the correlation with Standardization of Uveitis Nomenclature (SUN) grading AC cells score was evaluated. The approximated AC grading value was calculated based on the logarithmic approximation curve between the number of cellular spots and the SUN grading score. Results: Among 51 eyes, cellular spots were automatically segmented in 48 eyes, whereas three eyes (all SUN grading AC cells score: 4+) with severe fibrin formation in the AC were removed by the automated algorithm. The AC cellular spots increased with an increasing SUN grading score (p < 0.001). The 48 eyes were split into training data (26 eyes) and test data (22 eyes). There was a significant correlation between the SUN grading score and the number of cellular spots in 26 eyes (rho: 0.843, p < 0.001). There was a significant correlation between the SUN grading score and the approximated grading value of 22 eyes based on the logarithmic approximation curve (rho: 0.774, p < 0.001). Leave-one-out cross-validation analysis demonstrated a significant correlation between the SUN grading score and the approximated grading value of 48 eyes (rho: 0.748, p < 0.001). Conclusions: This automated anterior AC cell analysis using AS SS-OCT showed a significant correlation with clinical SUN grading scores and provided SUN AC grading values as a continuous variable. Our findings suggest that automated grading of AC cells could improve the accuracy of a quantitative assessment of AC inflammation using AS-OCT images and allow the objective and rapid evaluation of anterior segment inflammation in uveitis. Further investigations on a large scale are required to validate this quantitative measurement of anterior segment inflammation in uveitic eyes.
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Kale AU, Serrano A, Liu X, Balasubramaniam B, Keane PA, Moore DJ, Llorenç V, Denniston AK. Measuring Inflammation in the Vitreous and Retina: A Narrative Review. Ocul Immunol Inflamm 2022; 31:768-777. [PMID: 35412855 DOI: 10.1080/09273948.2022.2049316] [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: 10/18/2022]
Abstract
Uveitis consists of a group of syndromes characterised by intraocular inflammation, accounting for up to 15% of visual loss in the western world and 10% worldwide. Assessment of intraocular inflammation has been limited to clinician-dependent, subjective grading. Developments in imaging technology, such as optical coherence tomography (OCT), have enabled the development of objective, quantitative measures of inflammatory activity. Important quantitative metrics including central macular thickness and vitreous signal intensity allow longitudinal monitoring of disease activity and can be used in conjunction with other imaging modalities enabling holistic assessment of ocular inflammation. Ongoing work into the validation of instrument-based measures alongside development of core outcome sets is crucial for standardisation of clinical trial endpoints and developing guidance for quantitative multi-modal imaging approaches. This review outlines methods of grading inflammation in the vitreous and retina, with a focus on the use of OCT as an objective measure of disease activity.
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Affiliation(s)
- Aditya U Kale
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alba Serrano
- Ocular Infection & Inflammation, Clínic Institute of Ophthalmology Clínic Hospital of Barcelona, Barcelona, Spain
| | - Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
| | - Balini Balasubramaniam
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Victor Llorenç
- Ocular Infection & Inflammation, Clínic Institute of Ophthalmology Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer, Clínic Hospital of Barcelona, Barcelona, Spain
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Rivas AB, Lopez-Picado A, Calamia V, Carreño E, Cocho L, Cordero-Coma M, Fonollosa A, Francisco Hernandez FM, Garcia-Aparicio A, Garcia-Gonzalez J, Mondejar JJ, Lojo-Oliveira L, Martínez-Costa L, Munoz S, Peiteado D, Pinto JA, Rodriguez-Lozano B, Pato E, Diaz-Valle D, Molina E, Tebar LA, Rodriguez-Rodriguez L. Efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis: a protocol for a multicentre, randomised, parallel three arms, active-controlled, phase III open label with blinded outcome assessment study. BMJ Open 2022; 12:e051378. [PMID: 35318229 PMCID: PMC8943738 DOI: 10.1136/bmjopen-2021-051378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Non-infectious uveitis include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational studies showed that the use of ISDs in combination could be more effective than and as safe as their use in monotherapy. However, a direct comparison between these two treatment strategies has not been carried out yet. METHODS AND ANALYSIS The Combination THerapy with mEthotrexate and adalImumAb for uveitis (CoTHEIA) study is a phase III, multicentre, prospective, randomised, single-blinded with masked outcome assessment, parallel three arms with 1:1:1 allocation, active-controlled, superiority study design, comparing the efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis. We aim to recruit 192 subjects. The duration of the treatment and follow-up will last up to 52 weeks, plus 70 days follow-up with no treatment. The complete and maintained resolution of the ocular inflammation will be assessed by masked evaluators (primary outcome). In addition to other secondary measurements of efficacy (quality of life, visual acuity and costs) and safety, we will identify subjects' subgroups with different treatment responses by developing prediction models based on machine learning techniques using genetic and proteomic biomarkers. ETHICS AND DISSEMINATION The protocol, annexes and informed consent forms were approved by the Reference Clinical Research Ethic Committee at the Hospital Clínico San Carlos (Madrid, Spain) and the Spanish Agency for Medicines and Health Products. We will elaborate a dissemination plan including production of materials adapted to several formats to communicate the clinical trial progress and findings to a broad group of stakeholders. The promoter will be the only access to the participant-level data, although it can be shared within the legal situation. TRIAL REGISTRATION NUMBER 2020-000130-18; NCT04798755.
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Affiliation(s)
- Ana Belen Rivas
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Departamento de Enfermería. Facultad Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Amanda Lopez-Picado
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Valentina Calamia
- Unidad de Proteómica. Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, and Universidade da Coruña, A Coruna, Galicia, Spain
| | - Ester Carreño
- Department of Ophthalmology, University Hospital Fundacion Jimenez Diaz, and University Hospital Rey Juan Carlos, Madrid, Madrid, Spain
| | - Lidia Cocho
- Department of Ophthalmology, IOBA (Institute of Applied OphthalmoBiology), University of Valladolid, and Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain
| | - Miguel Cordero-Coma
- Uveitis Unit, University Hospital of León, IBIOMED, and University of León, Leon, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, País Vasco, Spain
| | - Felix M Francisco Hernandez
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Javier Garcia-Gonzalez
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | - Jose Juan Mondejar
- Department of Ophthalmology, Hospital General Universitario de Alicante, Alicante, Comunidad Valenciana, Spain
| | | | - Llucí Martínez-Costa
- Department of Ophthalmology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Munoz
- Department of Rheumatology, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | - Diana Peiteado
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jose Antonio Pinto
- Department of Rheumatology, Complexo Hospitalario Universitario de A Coruña, A Coruna, Galicia, Spain
| | - Beatriz Rodriguez-Lozano
- Department of Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canarias, Spain
| | - Esperanza Pato
- Department of Rheumatology, Hospital Clínico San Carlos, IdISSC, Madrid, Madrid, Spain
| | - David Diaz-Valle
- Department of Ophthalmology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Elena Molina
- Department of Pathology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Alberto Tebar
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Musculoskeletal Pathology Group, Fundacion para la Investigacion Biomedica del Hospital Clinico San Carlos, IdISSC, Madrid, Spain
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Liu Z, Tao QQ, Li XR, Zhang XM. Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with macular edema secondary to uveitis. Int J Ophthalmol 2021; 14:725-731. [PMID: 34012888 DOI: 10.18240/ijo.2021.05.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/26/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the correlation between disorganization of the retinal inner layers (DRIL) and best-corrected visual acuity (BCVA) in patients with uveitis and macular edema (UME) who underwent systemic treatment using optical coherence tomography (OCT). METHODS A retrospective clinical study of 23 patients (30 eyes) with DRIL and 23 patients (31 eyes) without DRIL secondary to UME were included. All patients underwent comprehensive ophthalmic examinations at baseline, 3, 6, and 12mo after local and systemic treatment. The OCT-based parameters included foveal center point thickness (FCPT), mean thickness (MT), and diameters of DRIL in horizontal and vertical directions. BCVA and OCT-based parameters were compared between the two groups. The relationship between each OCT parameter and BCVA was evaluated using linear correlation and regression analysis. RESULTS At the initial visit, the mean baseline FCPT was 441.03±128.68 µm in the eyes with DRIL and 337.26±99.31 µm in the eyes without DRIL (P=0.001). No significant differences were observed in MT (P=0.357). The mean size of transverse and vertical diameters of DRIL was 684.07±267.51 and 267.07±104.61 µm at baseline, respectively. There was significant improvement in BCVA and OCT-based parameters at 3, 6, and 12mo in all cases (P<0.001 for each timepoint). In addition, significant differences were detected in BCVA and OCT parameters between eyes with and without DRIL at each time point (P<0.01 for each timepoint). A greater DRIL range at baseline was associated with a worse baseline BCVA (transverse diameter of DRIL: r=0.875, P<0.001; vertical diameter of DRIL: r=0.622, P<0.001). The transverse diameter of baseline DRIL was found to be significantly correlated with the final BCVA (P=0.003). CONCLUSION The improvement in BCVA is associated with DRIL in patients with UME. DRIL is an easy-to-determine and robust imaging biomarker that could help predict BCVA prognosis in eyes with UME.
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Affiliation(s)
- Zheng Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China.,Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
| | - Qing-Qin Tao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Rong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Min Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
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8
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García-Aparicio Á, García de Yébenes MJ, Otón T, Muñoz-Fernández S. Prevalence and Incidence of Uveitis: A Systematic Review and Meta-analysis. Ophthalmic Epidemiol 2021; 28:461-468. [PMID: 33557663 DOI: 10.1080/09286586.2021.1882506] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Although the impact of uveitis on people's lives is clear, the frequency of this condition is unclear.Objective: To estimate the prevalence and incidence of uveitis.Methods: A systematic review with meta-analysis was conducted. Medline, Embase, and Cochrane Library were searched from inception to January 2019. The quality of the included studies was critically appraised with a grading system based on the Oxford Levels of Evidence. A detailed description of the populations studied and of factors affecting estimates was undertaken. Pooled analyses were conducted using a random-effects approach and expressed as incidence rates per 100,000 with 95% confidence intervals. Subgroup analyses by geographical region were conducted along with meta-regression to analyze possible factors for heterogeneity.Results: A total of 49 studies were included and critically appraised. Twenty-two were population-based, and 27 hospital-based. Heterogeneity was substantial in terms of populations studied, methods for ascertaining uveitis, including definitions, and reporting of results. This was especially important in prevalence studies, with data ranging from 9 to 730 cases per 100,000. For incidence studies, the meta-analysis yielded a pooled incidence of 50.45 per 100.000. The meta-regression showed the geographic region as an important explanatory factor of the heterogeneity between studies.Conclusion: Population-based estimates of the epidemiology of uveitis vary widely, owing to methodologies employed, definitions of uveitis and geographical regions; the representativeness and generalizability of many epidemiological studies of uveitis are limited.
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Affiliation(s)
- Ángel García-Aparicio
- Department of Rheumatology, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | | - Teresa Otón
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Santiago Muñoz-Fernández
- Department of Rheumatology, Infanta Sofía University Hospital, San Sebastián de los Reyes, and Biomedical Science and Health Faculty, Universidad Europea, Madrid, Spain
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Tallouzi MO, Mathers JM, Moore DJ, Bucknall N, Calvert MJ, Murray PI, Denniston AK. Development of a Core Outcome Set for Clinical Trials in Non-infectious Uveitis of the Posterior Segment. Ophthalmology 2021; 128:1209-1221. [PMID: 33515595 DOI: 10.1016/j.ophtha.2021.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To develop an agreed upon set of outcomes known as a "core outcome set" (COS) for noninfectious uveitis of the posterior segment (NIU-PS) clinical trials. DESIGN Mixed-methods study design comprising a systematic review and qualitative study followed by a 2-round Delphi exercise and face-to-face consensus meeting. PARTICIPANTS Key stakeholders including patients diagnosed with NIU-PS, their caregivers, and healthcare professionals involved in decision-making for patients with NIU-PS, including ophthalmologists, nurse practitioners, and policymakers/commissioners. METHODS A long list of outcomes was developed based on the results of (1) a systematic review of clinical trials of NIU-PS and (2) a qualitative study of key stakeholders including focus groups and interviews. The long list was used to generate a 2-round Delphi exercise of stakeholders rating the importance of outcomes on a 9-point Likert scale. The proportion of respondents rating each item was calculated, leading to recommendations of "include," "exclude," or "for discussion" that were taken to a face-to-face consensus meeting of key stakeholders at which they agreed on the final COS. MAIN OUTCOME MEASURE Items recommended for inclusion in the COS for NIU-PS. RESULTS A total of 57 outcomes grouped in 11 outcome domains were presented for evaluation in the Delphi exercise, resulting in 9 outcomes directly qualifying for inclusion and 15 outcomes being carried forward to the consensus meeting, of which 7 of 15 were agreed on for inclusion. The final COS contained 16 outcomes organized into 4 outcome domains comprising visual function, health-related quality of life, treatment side effects, and disease control. CONCLUSIONS This study builds on international work across the clinical trials community and our qualitative research to construct the world's first COS for NIU-PS. The COS provides a list of outcomes that represent the priorities of key stakeholders and provides a minimum set of outcomes for use in all future NIU-PS clinical trials. Adoption of this COS can improve the value of future uveitis clinical trials and reduce noninformative research. Some of the outcomes identified do not yet have internationally agreed upon methods for measurement and should be the subject of future international consensus development.
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Affiliation(s)
- Mohammad O Tallouzi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Jonathan M Mathers
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Melanie J Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaboration West Midlands at the University Hospitals Birmingham NHS Foundation Trust, and the University of Birmingham, Birmingham, United Kingdom
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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10
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Quantitative Analysis of Anterior Chamber Inflammation Using the Novel CASIA2 Optical Coherence Tomography. Am J Ophthalmol 2020; 216:59-68. [PMID: 32251654 DOI: 10.1016/j.ajo.2020.03.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We evaluated the clinical utility of a novel anterior segment optical coherence tomography (AS-OCT) device, CASIA2, to evaluate parameters indicative of anterior chamber (AC) inflammation severity in uveitis, including AC cell number, flare, and keratic precipitates (KPs). DESIGN Prospective evaluation of a diagnostic device. METHODS Uveitis eyes were classified into active and inactive groups. The number of hyperreflective dots representing AC cells and optical density ratio (aqueous-to-air relative intensity [ARI] index) for flare qualification were calculated from AS-OCT images. In addition, a program was designed to quantify the posterior corneal surface smoothness (PCSS) of each image for KPs evaluation. The maximum, minimum, and average PCSS values were calculated from 128 images per eye and compared among active uveitis, inactive uveitis, and control eyes. Correlations between Standardization of Uveitis Nomenclature grade and both hyperreflective dot number and ARI index were evaluated. Receiver operating characteristic (ROC) curves were constructed to test the values of these indicators for uveitis diagnosis. RESULTS AC hyperreflective dot count, ARI index, and maximum and average PCSS values were all significantly higher in the active uveitis group than in the inactive and control groups. Hyperreflective dot count and ARI index were associated with Standardization of Uveitis Nomenclature cell and flare grade. According to ROC curve analysis, maximum PCSS was the best indicator for the diagnosis of uveitis involving the anterior segment, meanwhile the hyperreflective dot number was the best to identify active AC inflammation from the inactive. CONCLUSIONS Quantification of AC cell number, flare, and KPs using the CASIA2 device is a promising strategy for the objective assessment of AC inflammation.
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11
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McNally TW, Liu X, Beese S, Keane PA, Moore DJ, Denniston AK. Instrument-based tests for quantifying aqueous humour protein levels in uveitis: a systematic review protocol. Syst Rev 2019; 8:287. [PMID: 31771628 PMCID: PMC6878617 DOI: 10.1186/s13643-019-1206-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Inflammation in anterior uveitis is characterised by breakdown of the blood-ocular barrier, which allows leakage of blood constituents of higher molecular weight into the aqueous humour. In routine clinical care, increase in aqueous protein levels can be observed at the slit lamp as 'flare' and the severity can be graded using various clinical grading systems, of which the Standardization of Uveitis Nomenclature (SUN) grading system is most commonly used. Alternative instrument-based technologies are available, which can detect aqueous protein levels in an objective and quantifiable way. This review will identify instruments capable of measuring anterior chamber inflammation in this way, their level of reliability, and how well the measurements correlate with clinical grading and/or actual aqueous protein concentration. METHODS Standard systematic review methodology will be used to identify, select and extract data from studies that report the use of any instrument-based technology in the assessment of aqueous protein levels. Searches will be conducted through bibliographic databases (MEDLINE, EMBASE and Cochrane Library), clinical trial registries and the grey literature. No restrictions will be placed on language or year of publication. The outcomes of interest are the level of correlation between identified instrument-based test measurements, clinical grading and/or actual aqueous protein concentration, as well as the reliability of each index test identified. Study quality assessment will be based on QUADAS2. Correlation and reliability outcomes will be pooled and meta-analysed if appropriate. DISCUSSION The assessment of inflammation in anterior chamber protein levels currently relies on crude and subjective clinical examination. The findings of this review will identify non-invasive technologies which show good correlation with actual protein concentration, which could be used in routine clinical practice for objective monitoring of AC inflammation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017084167. Study screening stage has just been completed.
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Affiliation(s)
- Thomas W McNally
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Birmingham, UK
| | - Sophie Beese
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Birmingham, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. .,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Birmingham, UK. .,Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK.
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12
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Liu X, Solebo AL, Faes L, Beese S, Braithwaite T, Round ME, Panthagani J, Kale AU, McNally TW, Abdulla D, Keane PA, Moore DJ, Denniston AK. Instrument-based Tests for Measuring Anterior Chamber Cells in Uveitis: A Systematic Review. Ocul Immunol Inflamm 2019; 28:898-907. [PMID: 31418609 PMCID: PMC7497279 DOI: 10.1080/09273948.2019.1640883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose New instrument-based techniques for anterior chamber (AC) cell counting can offer automation and objectivity above clinician assessment. This review aims to identify such instruments and its correlation with clinician estimates. Methods Using standard systematic review methodology, we identified and tabulated the outcomes of studies reporting reliability and correlation between instrument-based measurements and clinician AC cell grading. Results From 3470 studies, 6 reported correlation between an instrument-based AC cell count to clinician grading. The two instruments were optical coherence tomography (OCT) and laser flare-cell photometry (LFCP). Correlation between clinician grading and LFCP was 0.66–0.87 and 0.06–0.97 between clinician grading and OCT. OCT volume scans demonstrated correlation between 0.75 and 0.78. Line scans in the middle AC demonstrated higher correlation (0.73–0.97) than in the inferior AC (0.06–0.56). Conclusion AC cell count by OCT and LFP can achieve high levels of correlation with clinician grading, whilst offering additional advantages of speed, automation, and objectivity.
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Affiliation(s)
- Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Ameenat L Solebo
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London, UK.,Institute of Child Health, University College London , London, UK
| | - Livia Faes
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London, UK.,Department of Ophthalmology, Cantonal Hospital Lucerne , Lucerne, Switzerland
| | - Sophie Beese
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Tasanee Braithwaite
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK.,Moorfields Eye Hospitals NHS Foundation Trust , London, UK
| | - Matthew E Round
- Sandwell and West Birmingham Hospitals NHS Trust , Birmingham, UK
| | - Jesse Panthagani
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK
| | - Aditya U Kale
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK
| | - Thomas W McNally
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK
| | - Didar Abdulla
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London, UK.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK.,Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners , Birmingham, UK
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13
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Braithwaite T, Davis N, Galloway J. Cochrane corner: why we still don't know whether anti-TNF biologic therapies impact uveitic macular oedema. Eye (Lond) 2019; 33:1830-1832. [PMID: 31189993 DOI: 10.1038/s41433-019-0481-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tasanee Braithwaite
- Ophthalmology Department (Uveitis), King's College Hospital NHS Foundation Trust, London, UK. .,Ophthalmology Department (Neuro-ophthalmology), Moorfields Eye Hospital NHS Foundation Trust London, London, UK. .,Olivia's Vision Research Fellow, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | | | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
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Tallouzi MO, Moore DJ, Barry RJ, Calvert M, Mathers J, Murray PI, Denniston AK. The Effectiveness of Pharmacological Agents for the Treatment of Uveitic Macular Edema (UMO): A Systematic Review. Ocul Immunol Inflamm 2019; 27:658-680. [PMID: 30811272 DOI: 10.1080/09273948.2019.1569243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: To conduct a systematic review of effectiveness of pharmacological therapies for treatment of Uveitic Macular Edema (UMO). Method/Design: Comparative studies of pharmacological therapies in patients with UMO were identified in Cochrane CENTRAL/MEDLINE/EMBASE/CINAHL/trials registers (February 2017). PROSPERO registration: CRD42015019170. Results: Thirty-one studies were included. Corticosteroids were the most frequently studied (n = 20). Corticosteroids (all forms) were consistently of greater/equal efficacy to active comparators; for anti-VEGF (n = 4) improvement, best-corrected visual acuity (BCVA) and central macular thickness (CMT) were mostly less than local corticosteroid injection; for interferon (n = 1) improvement BCVA and CMT were greater than the comparator of methotrexate; for topical indomethacin (n = 1) improvement, BCVA and CMT were greater than placebo. Non-steroidal anti-inflammatory drugs, carbonic anhydrase inhibitors, and vitamin E (n = 5) were not effective for these outcomes. Conclusion: The review highlights areas where the evidence base is still lacking, and appropriately focused trials are needed to inform best treatment to tackle this sight-threatening condition.
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Affiliation(s)
- Mohammad O Tallouzi
- a Academic Unit of Ophthalmology, Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK.,b Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - David J Moore
- c Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Robert J Barry
- d Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Melanie Calvert
- b Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK.,c Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Jonathan Mathers
- b Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK.,c Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Philip I Murray
- d Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Alastair K Denniston
- b Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK.,e Department of Ophthalmology, Queen Elizabeth Hospital Birmingham , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
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15
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Liu X, Solebo AL, Keane PA, Moore DJ, Denniston AK. Instrument-based tests for measuring anterior chamber cells in uveitis: a systematic review protocol. Syst Rev 2019; 8:30. [PMID: 30670103 PMCID: PMC6341598 DOI: 10.1186/s13643-019-0946-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Uveitis describes a group of inflammatory conditions affecting the eye. The ability to monitor inflammatory changes in anterior uveitis is crucial in clinical practice for making treatment decisions and in clinical trials for testing therapeutic agents. The current standard for quantifying anterior segment inflammation is clinical slit-lamp examination findings classified using the Standardisation of Uveitis Nomenclature (SUN) grading system. Such clinical grading systems rely on a subjective estimation using the slit lamp and are often non-linear and non-continuous scales, with large increases in cell count between each grade. Novel instrument-based technologies have emerged over the last few decades, which can provide objective and quantifiable measurements. This review will evaluate the reliability of such technologies and their level of agreement with anterior chamber (AC) cell count using clinical slit-lamp examination. METHODS Standard systematic review methodology will be used to identify, select and extract data from studies that report the use of any instrument-based technology in the assessment of AC cells. Searches will be conducted through bibliographic databases (MEDLINE, EMBASE and Cochrane Library), clinical trial registries and the grey literature. No restrictions will be placed on language or year of publication. The outcomes of interest are the correlation of index test measurements of AC cells with clinical grading systems using slit-lamp examination and the reliability of each index test identified. Quality assessment will be undertaken using QUADAS2. Degree of correlation between the index and reference test measures will be pooled and meta-analysed if appropriate. DISCUSSION A number of instrument-based tools are available for measuring AC cells. This review will evaluate the technologies available and measure the level of correlation of these alternative methods with clinical grading systems as well as their performance in reliability and repeatability. The findings of this review will identify those objective, instrument-based technologies which show good utility for measuring AC cells in a quantifiable way and which warrant further exploration for their sensitivity and reliability over the current standard. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017084156 (Liu X, Moore DJ, Denniston AK). Instrument-based tests for measuring anterior chamber (AC) cells in uveitis: a systematic review. 2017). Study screening stage is complete. Data extraction stage has not yet commenced.
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Affiliation(s)
- Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Ameenat L Solebo
- Institute of Child Health, University College London, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. .,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. .,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. .,Centre for Rare Diseases, Birmingham Health Partners, Institute of Translational Medicine, Birmingham, UK.
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16
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Barry RJ, Tallouzi MO, Bucknall N, Mathers JM, Murray PI, Calvert MJ, Moore DJ, Denniston AK. Anti-tumour necrosis factor biological therapies for the treatment of uveitic macular oedema (UMO) for non-infectious uveitis. Cochrane Database Syst Rev 2018; 12:CD012577. [PMID: 30562409 PMCID: PMC6516996 DOI: 10.1002/14651858.cd012577.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-infectious uveitis describes a heterogenous group of ocular disorders characterised by intraocular inflammation in the absence of infection. Uveitis is a leading cause of visual loss, most commonly due to uveitic macular oedema (UMO). Treatment is aimed at reducing disease activity by suppression of the intraocular inflammatory response. In the case of macular oedema, the aim is to restore macular architecture as quickly as possible, in order to prevent irreversible photoreceptor damage in this area. Acute exacerbations are typically managed with corticosteroids, which may be administered topically, locally or systemically. Whilst these are often rapidly effective in achieving disease control, long-term use is associated with significant local and systemic side effects, and 'steroid sparing agents' are typically used to achieve prolonged control in severe or recalcitrant disease. Anti-tumour necrosis factor (TNF) drugs block a critical cytokine in the inflammatory signalling process, and have emerged as effective steroid-sparing immunomodulatory agents in a wide range of non-ocular conditions. There is mechanistic data to suggest that they may provide a more targeted approach to disease control in UMO than other agents, but to date, these agents have predominantly been used 'off label' as the majority are not licensed for ocular use. This review aims to summarise the available literature reporting the use of anti-TNF therapy in UMO, thus developing the evidence-base on which to make future treatment decisions and develop clinical guidelines in this area. OBJECTIVES To assess the efficacy of anti-TNF therapy in treatment of UMO. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Ovid Embase; LILACS; Web of Science Conference Proceedings Citation Index- Science (CPCI-S); System for Information on Grey Literature in Europe (OpenGrey); the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 29 March 2018. SELECTION CRITERIA We planned to include all relevant randomised controlled trials assessing the use of anti-TNF agents in treatment of UMO. No limits were applied to participant age, gender or ethnicity. The primary comparisons of this review were: anti-TNF versus no treatment or placebo; anti-TNF versus another pharmacological agent; comparison of different anti-TNF drugs; comparison of different doses and routes of administration of the same anti-TNF drug. The primary outcome measure that we assessed for this review was best-corrected visual acuity (BCVA) in the treated eye. Secondary outcome measures were anatomical macular change, clinical estimation of vitreous haze and health-related quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts retrieved through the database searches. We retrieved full-text reports of studies categorised as 'unsure' or 'include' after we had reviewed the abstracts. Two review authors independently reviewed each full-text report for eligibility. We resolved discrepancies through discussion. MAIN RESULTS We identified no completed or ongoing trial that was eligible for this Cochrane Review. AUTHORS' CONCLUSIONS Our review did not identify any evidence from randomised controlled trials for or against the role of anti-TNF agents in the management of UMO. Although there are a number of high-quality randomised controlled trials that demonstrate the efficacy of anti-TNF agents in preventing recurrence of inflammation in uveitis, the reported study outcomes do not include changes in UMO. As a result, there were insufficient data to conclude whether there was a significant treatment effect specifically for UMO. Future trials should be designed to include quantitative measures of UMO as primary study outcomes, for example by reporting the presence or absence of UMO, or by measuring central macular thickness for study participants. Furthermore, whilst UMO is an important complication of uveitis, we acknowledge that uveitis is associated with many significant structural and functional complications. It is not possible to determine treatment efficacy based on a single outcome measure. We recommend that future reviews of therapeutic interventions in uveitis should use composite measures of treatment response comprising a range of potential complications of disease.
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Affiliation(s)
- Robert J Barry
- College of Medical and Dental Sciences, University of BirminghamAcademic Unit of Ophthalmology, Institute of Inflammation and AgeingBirminghamUKB15 2TT
| | - Mohammad O Tallouzi
- University of BirminghamInstitute of Applied Health Research, College of Medical and Dental SciencesBirminghamUKB15 2TT
| | | | - Jonathan M Mathers
- University of BirminghamInstitute of Applied Health Research, College of Medical and Dental SciencesBirminghamUKB15 2TT
| | - Philip I Murray
- College of Medical and Dental Sciences, University of BirminghamAcademic Unit of Ophthalmology, Institute of Inflammation and AgeingBirminghamUKB15 2TT
| | - Melanie J Calvert
- University of BirminghamCentre for Patient Reported Outcomes Research, Institute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research CentreBirminghamUKB15 2TT
| | - David J Moore
- University of BirminghamInstitute of Applied Health ResearchPublic Health BuildingEdgbastonBirminghamWest MidlandsUKB15 2TT
| | - Alastair K Denniston
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation TrustDepartment of OphthalmologyBirminghamUKB15 2WB
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Squires H, Poku E, Bermejo I, Cooper K, Stevens J, Hamilton J, Wong R, Denniston A, Pearce I, Quhill F. A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults. Health Technol Assess 2018; 21:1-170. [PMID: 29183563 DOI: 10.3310/hta21680] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Non-infectious intermediate uveitis, posterior uveitis and panuveitis are a heterogeneous group of inflammatory eye disorders. Management includes local and systemic corticosteroids, immunosuppressants and biological drugs. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of subcutaneous adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) and a dexamethasone intravitreal implant (Ozurdex®; Allergan Ltd, Marlow, UK) in adults with non-infectious intermediate uveitis, posterior uveitis or panuveitis. DATA SOURCES Electronic databases and clinical trials registries including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the World Health Organization's International Clinical Trials Registry Platform were searched to June 2016, with an update search carried out in October 2016. REVIEW METHODS Review methods followed published guidelines. A Markov model was developed to assess the cost-effectiveness of dexamethasone and adalimumab, each compared with current practice, from a NHS and Personal Social Services (PSS) perspective over a lifetime horizon, parameterised with published evidence. Costs and benefits were discounted at 3.5%. Substantial sensitivity analyses were undertaken. RESULTS Of the 134 full-text articles screened, three studies (four articles) were included in the clinical effectiveness review. Two randomised controlled trials (RCTs) [VISUAL I (active uveitis) and VISUAL II (inactive uveitis)] compared adalimumab with placebo, with limited standard care also provided in both arms. Time to treatment failure (reduced visual acuity, intraocular inflammation, new vascular lesions) was longer in the adalimumab group than in the placebo group, with a hazard ratio of 0.50 [95% confidence interval (CI) 0.36 to 0.70; p < 0.001] in the VISUAL I trial and 0.57 (95% CI 0.39 to 0.84; p = 0.004) in the VISUAL II trial. The adalimumab group showed a significantly greater improvement than the placebo group in the 25-item Visual Function Questionnaire (VFQ-25) composite score in the VISUAL I trial (mean difference 4.20; p = 0.010) but not the VISUAL II trial (mean difference 2.12; p = 0.16). Some systemic adverse effects occurred more frequently with adalimumab than with placebo. One RCT [HURON (active uveitis)] compared a single 0.7-mg dexamethasone implant against a sham procedure, with limited standard care also provided in both arms. Dexamethasone provided significant benefits over the sham procedure at 8 and 26 weeks in the percentage of patients with a vitreous haze score of zero (p < 0.014), the mean best corrected visual acuity improvement (p ≤ 0.002) and the percentage of patients with a ≥ 5-point improvement in VFQ-25 score (p < 0.05). Raised intraocular pressure and cataracts occurred more frequently with dexamethasone than with the sham procedure. The incremental cost-effectiveness ratio (ICER) for one dexamethasone implant in one eye for a combination of patients with unilateral and bilateral uveitis compared with limited current practice, as per the HURON trial, was estimated to be £19,509 per quality-adjusted life-year (QALY) gained. The ICER of adalimumab for patients with mainly bilateral uveitis compared with limited current practice, as per the VISUAL trials, was estimated to be £94,523 and £317,547 per QALY gained in active and inactive uveitis respectively. Sensitivity analyses suggested that the rate of blindness has the biggest impact on the model results. The interventions may be more cost-effective in populations in which there is a greater risk of blindness. LIMITATIONS The clinical trials did not fully reflect clinical practice. Thirteen additional studies of clinically relevant comparator treatments were identified; however, network meta-analysis was not feasible. The model results are highly uncertain because of the limited evidence base. CONCLUSIONS Two RCTs of systemic adalimumab and one RCT of a unilateral, single dexamethasone implant showed significant benefits over placebo or a sham procedure. The ICERs for adalimumab were estimated to be above generally accepted thresholds for cost-effectiveness. The cost-effectiveness of dexamethasone was estimated to fall below standard thresholds. However, there is substantial uncertainty around the model assumptions. In future work, primary research should compare dexamethasone and adalimumab with current treatments over the long term and in important subgroups and consider how short-term improvements relate to long-term effects on vision. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041799. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hazel Squires
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Inigo Bermejo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Ian Pearce
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Fahd Quhill
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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18
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Gilbert RM, Zhang X, Sampson RD, Ehrenstein MR, Nguyen DX, Chaudhry M, Mein C, Mahmud N, Galatowicz G, Tomkins-Netzer O, Calder VL, Lightman S. Clinical Remission of Sight-Threatening Non-Infectious Uveitis Is Characterized by an Upregulation of Peripheral T-Regulatory Cell Polarized Towards T-bet and TIGIT. Front Immunol 2018; 9:907. [PMID: 29774027 PMCID: PMC5943505 DOI: 10.3389/fimmu.2018.00907] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 04/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background Non-infectious uveitis can cause chronic relapsing and remitting ocular inflammation, which may require high dose systemic immunosuppression to prevent severe sight loss. It has been classically described as an autoimmune disease, mediated by pro-inflammatory Th1 and Th17 T-cell subsets. Studies suggest that natural immunosuppressive CD4+CD25+FoxP3+ T-regulatory cells (Tregs) are involved in resolution of inflammation and may be involved in the maintenance of clinical remission. Objective To investigate whether there is a peripheral blood immunoregulatory phenotype associated with clinical remission of sight-threatening non-infectious uveitis by comparing peripheral blood levels of Treg, Th1, and Th17, and associated DNA methylation and cytokine levels in patients with active uveitic disease, control subjects and patients (with previously active disease) in clinical remission induced by immunosuppressive drugs. Methods Isolated peripheral blood mononuclear cells (PBMC) from peripheral blood samples from prospectively recruited subjects were analyzed by flow cytometry for CD3, CD4, FoxP3, TIGIT, T-bet, and related orphan receptor γt. Epigenetic DNA methylation levels of FOXP3 Treg-specific demethylated region (TSDR), FOXP3 promoter, TBX21, RORC2, and TIGIT loci were determined in cryopreserved PBMC using a next-generation sequencing approach. Related cytokines were measured in blood sera. Functional suppressive capacity of Treg was assessed using T-cell proliferation assays. Results Fifty patients with uveitis (intermediate, posterior, and panuveitis) and 10 control subjects were recruited. The frequency of CD4+CD25+FoxP3+ Treg, TIGIT+ Treg, and T-bet+ Treg and the ratio of Treg to Th1 were significantly higher in remission patients compared with patients with active uveitic disease; and TIGIT+ Tregs were a significant predictor of clinical remission. Treg from patients in clinical remission demonstrated a high level of in vitro suppressive function compared with Treg from control subjects and from patients with untreated active disease. PBMC from patients in clinical remission had significantly lower methylation levels at the FOXP3 TSDR, FOXP3 promoter, and TIGIT loci and higher levels at RORC loci than those with active disease. Clinical remission was also associated with significantly higher serum levels of transforming growth factor β and IL-10, which positively correlated with Treg levels, and lower serum levels of IFNγ, IL-17A, and IL-22 compared with patients with active disease. Conclusion Clinical remission of sight-threatening non-infectious uveitis has an immunoregulatory phenotype characterized by upregulation of peripheral Treg, polarized toward T-bet and TIGIT. These findings may assist with individualized therapy of uveitis, by informing whether drug therapy has induced phenotypically stable Treg associated with long-term clinical remission.
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Affiliation(s)
- Rose M Gilbert
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Xiaozhe Zhang
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Robert D Sampson
- Flow Cytometry Core Facility, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Michael R Ehrenstein
- Division of Medicine, Centre for Rheumatology, University College London (UCL), London, United Kingdom
| | - Dao X Nguyen
- Division of Medicine, Centre for Rheumatology, University College London (UCL), London, United Kingdom
| | - Mahid Chaudhry
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Charles Mein
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Nadiya Mahmud
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Grazyna Galatowicz
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Oren Tomkins-Netzer
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Virginia L Calder
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Sue Lightman
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Tallouzi MO, Mathers JM, Moore DJ, Murray PI, Bucknall N, Blazeby JM, Calvert M, Denniston AK. COSUMO: study protocol for the development of a core outcome set for efficacy and effectiveness trials in posterior segment-involving uveitis. Trials 2017; 18:576. [PMID: 29191216 PMCID: PMC5709828 DOI: 10.1186/s13063-017-2294-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022] Open
Abstract
Background Uveitis, a group of disorders characterised by intraocular inflammation, causes 10–15% of total blindness in the developed world. The most sight-threatening uveitis affects the posterior segment of the eye (posterior-segment involving uveitis (PSIU)). Numerous different outcomes have been used in clinical trials evaluating alternative treatments for uveitis, limiting inter-trial comparison and aggregation of data. We aim to develop a core outcome set (COS) that would provide a standardised set of outcomes to be measured and reported in all effectiveness trials for PSIU. Methods A three-phase design will be used informed by recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) initiative. Phase 1: a comprehensive list of outcomes will be identified through both a systematic review of effectiveness trials of PSIU and qualitative research with stakeholders. The qualitative study will comprise focus groups with patients and their carers in parallel with one-to-one telephone interviews with health professionals and policy-makers. In the focus groups, patients will be grouped according to whether or not their uveitis is complicated by the sight-threatening condition uveitic macular oedema (UMO) since it is hypothesised that the presence of UMO may significantly impact on patient experience of PSIU. Phase 2: Delphi methodology will be used to reduce the range of potential outcomes for the core set. Up to three Delphi rounds will be used through an online survey. Participants will be asked to rate the importance of each outcome on a 9-point Likert scale where 9 is most important. Phase 3: a consensus meeting will be held with key stakeholders to discuss the Delphi results and ratify the final outcomes to be included in the COS. Discussion The development of an agreed COS for PSIU would help ensure that outcomes which matter to key stakeholders are captured and reported in a consistent way. A COS for PSIU would allow greater comparison and aggregation of data across trials for the better evaluation of established and emerging therapies through evidence synthesis and meta-analysis to inform clinical guidelines and health policy. Trial registration COMET. http://comet-initiative.org/studies/details/640. August 2015.
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Affiliation(s)
- Mohammad O Tallouzi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Jonathan M Mathers
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Nicholas Bucknall
- Patient Involvement Group in Uveitis (PInGU), Birmingham, B15 2TT, UK
| | - Jane M Blazeby
- Centre for Surgical Research, School of Social & Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - Melanie Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB, UK.,NIHR Biomedical Research Centre at Moorefield's Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
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20
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Tallouzi MO, Barry RJ, Bucknall N, Mathers JM, Murray PI, Calvert MJ, Moore DJ, Denniston AK. Anti-tumour necrosis factor biological therapies for the treatment of uveitic macular oedema (UMO) for non-infectious uveitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mohammad O Tallouzi
- University of Birmingham; Institute of Applied Health Research, College of Medical and Dental Sciences; Birmingham UK B15 2TT
| | - Robert J Barry
- University of Birmingham; Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences; Birmingham UK B15 2TT
| | | | - Jonathan M Mathers
- University of Birmingham; Institute of Applied Health Research, College of Medical and Dental Sciences; Birmingham UK B15 2TT
| | - Philip I Murray
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham; Academic Unit of Ophthalmology; Birmingham UK B15 2TT
| | - Melanie J Calvert
- University of Birmingham; Institute of Applied Health Research, College of Medical and Dental Sciences; Birmingham UK B15 2TT
| | - David J Moore
- University of Birmingham; Institute of Applied Health Research, College of Medical and Dental Sciences; Birmingham UK B15 2TT
| | - Alastair K Denniston
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust; Department of Ophthalmology; Birmingham UK B15 2WB
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21
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Kelly MEM, Lehmann C, Zhou J. The Endocannabinoid System in Local and Systemic Inflammation. ACTA ACUST UNITED AC 2017. [DOI: 10.4199/c00151ed1v01y201702isp074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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22
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Arriola-Villalobos P, Abásolo L, García-Feijoo J, Fernández-Gutiérrez B, Méndez-Fernández R, Pato E, Díaz-Valle D, Rodriguez-Rodriguez L. Vision-related Quality of Life in Patients with Non-infectious Uveitis: A Cross-sectional Study. Ocul Immunol Inflamm 2017; 26:717-725. [DOI: 10.1080/09273948.2017.1285034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Lydia Abásolo
- Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain
- Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Julián García-Feijoo
- Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain
- Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Esperanza Pato
- Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain
- Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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23
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Gilbert R, Al-Janabi A, Tomkins-Netzer O, Lightman S. Statins as anti-inflammatory agents: A potential therapeutic role in sight-threatening non-infectious uveitis. Porto Biomed J 2017; 2:33-39. [PMID: 32258583 PMCID: PMC6806973 DOI: 10.1016/j.pbj.2017.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/05/2017] [Indexed: 12/29/2022] Open
Abstract
In addition to the known lipid-lowering effects, statins are now widely accepted to have anti-inflammatory and immunomodulatory effects. Adjunctive use of statins has proven beneficial in the context of a wide range of inflammatory diseases, including rheumatoid arthritis. Evidence also suggests that statins may also have utility in the management of uveitis, a form of sight threatening inflammation which occurs in the eye. In this article, we outline our rationale behind a clinical trial of simvastatin as a steroid-sparing agent in uveitis, to which patient recruitment started last year. Potential risks associated with the clinical use of statins, including putative effects on the eyes, are discussed.
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Affiliation(s)
- Rose Gilbert
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
| | - Ahmed Al-Janabi
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
| | - Sue Lightman
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
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24
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Altaweel MM, Gangaputra SS, Thorne JE, Dunn JP, Elner SG, Jaffe GJ, Kim RY, Rao PK, Reed SB, Kempen JH. Morphological assessment of the retina in uveitis. J Ophthalmic Inflamm Infect 2016; 6:33. [PMID: 27613274 PMCID: PMC5017967 DOI: 10.1186/s12348-016-0103-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/29/2016] [Indexed: 11/21/2022] Open
Abstract
Background The objective of this study is to describe a system for color photograph evaluation in uveitis and report baseline morphologic findings for the Multicenter Uveitis Steroid Treatment (MUST) Trial. Four-hundred seventy-nine eyes of 255 subjects with intermediate, posterior, and panuveitis had stereoscopic color fundus photographs obtained by certified photographers and evaluated by certified graders using standardized procedures to evaluate morphologic characteristics of uveitis. The posterior pole was evaluated for macular edema, vitreoretinal interface abnormalities, and macular pigment disturbance/atrophy; the optic disk was assessed for edema, pallor, or glaucomatous changes. The presence of neovascularization, vascular occlusion, vascular sheathing, and tractional retinal changes was determined. A random subset of 77 images was re-graded to determine the percentage agreement with the original grading on a categorical scale. Results At baseline, 437/479 eyes had images available to grade. Fifty-three eyes were completely ungradable due to media opacity. Common features of intermediate and posterior/panuveitis were epiretinal membrane (134 eyes, 35 %), and chorioretinal lesions (140 eyes, 36 %). Macular edema was seen in 16 %. Optic nerve head and vascular abnormalities were rare. Reproducibility evaluation found exact agreement for the presence of chorioretinal lesions was 78 %, the presence and location of macular edema was 71 %, and the presence of epiretinal membrane was 71 %. Vertical cup-to-disk ratio measurement had intra-class correlation of 0.75. Conclusions The MUST system for evaluating stereoscopic color fundus photographs describes the morphology of uveitis and its sequelae, in a standardized manner, is highly reproducible, and allows monitoring of treatment effect and safety evaluation regarding these outcomes in clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/s12348-016-0103-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael M Altaweel
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA. .,Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 2870 University Ave. Suite 206, Madison, WI, 53705, USA.
| | - Sapna S Gangaputra
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, The Johns Hopkins University, Baltimore, MD, USA
| | - James P Dunn
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | | | - Rosa Y Kim
- Retina Consultants of Houston, Houston, TX, USA
| | - P Kumar Rao
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, MO, USA
| | - Susan B Reed
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA
| | - John H Kempen
- Departments of Ophthalmology and Biostatistics & Epidemiology and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
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Tallouzi MO, Moore DJ, Calvert M, Murray PI, Bucknall N, Denniston AK. The effectiveness of pharmacological agents for the treatment of uveitic macular oedema (UMO): a systematic review protocol. Syst Rev 2016; 5:29. [PMID: 26872918 PMCID: PMC4752778 DOI: 10.1186/s13643-016-0203-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/02/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Macular oedema (MO) describes the accumulation of fluid in the central part of the retina, known as the 'macula' which provides central vision. MO is the leading cause of sight loss in patients with intraocular inflammation (uveitis). There is a lack of consensus over the treatment of uveitic macular oedema (UMO). The proposed systematic review will evaluate the evidence on the effectiveness of pharmacological agents used to treat UMO. All systemic, local, or topical pharmacological agents will be included. METHOD/DESIGN Standard systematic review methodology will be employed to identify, select and extract data from comparative studies (randomised/non-randomised trials and observational studies) of the pharmacological interventions in patients with UMO. Searches will be conducted through bibliographic databases (Cochrane Library, MEDLINE, EMBASE and CINAHL) and clinical trials registers. No restriction will be placed on either language or year of publication. Translation of non-English language articles will be undertaken to minimise selection bias. The primary outcome of interest will be best corrected visual acuity and secondary outcomes will be adverse events, health-related quality of life, assessment of UMO using central macular thickness (e.g. by optical coherence topography (OCT)), clinical and angiographic assessment of UMO, clinical estimation of vitreous haze. Risk of bias assessment appropriate to each study design will be undertaken. Data will be grouped by comparison, tabulated and narratively synthesised. Meta-analysis will be undertaken where clinical and methodological homogeneity exists. Subgroup and sensitivity analyses, also network analyses and intra/inter-pharmacological class analyses will be undertaken where deemed appropriate. DISCUSSION A number of published studies have investigated the effectiveness of the pharmacological agents used to treat UMO. However, there is no recent systematic review that synthesises this evidence. This systematic review will analyse the effectiveness of systemic, local and topical therapies to treat UMO. The findings will provide important evidence to inform clinical and health policy decision-making for the treatment of UMO. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42015019170.
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Affiliation(s)
- Mohammad O Tallouzi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Melanie Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Philip I Murray
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | | | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2WB, UK.
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Denniston AK, Holland GN, Kidess A, Nussenblatt RB, Okada AA, Rosenbaum JT, Dick AD. Heterogeneity of primary outcome measures used in clinical trials of treatments for intermediate, posterior, and panuveitis. Orphanet J Rare Dis 2015; 10:97. [PMID: 26286265 PMCID: PMC4545540 DOI: 10.1186/s13023-015-0318-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/06/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Uveitis describes a heterogeneous group of conditions characterized by intraocular inflammation. Since most of the sight-threatening forms of uveitis are individually rare, there has been an increasing tendency for clinical trials to group distinct uveitis syndromes together despite clear variations in phenotype which may reflect real aetiological and pathogenetic differences. Furthermore this grouping of distinct syndromes, and the range of manifestations within each uveitis syndrome, leads to a wide range of possible outcome measures. In this study we wished to review the degree of consensus or otherwise in the choice of primary outcome measures for registered clinical trials related to uveitis. METHODS Systematic review of data provided in clinical trial registries describing clinical trials dealing with medical treatment of intermediate, posterior, or panuveitis through 01 October 2013. We reviewed 15 on-line clinical trial registries approved by the International Committee of Medical Journal Editors. We identified all that met the following inclusion criteria: prospective, interventional design; target populations with intermediate, posterior or panuveitis; and one or more pre-specified outcome measures that were related to uveitis. Primary outcome measures were classified in terms of type (efficacy or safety or both; single, composite, or multiple); dimension (disease activity, disease damage, measured or patient-reported visual function); and domain (the specific study variable being measured). RESULTS Of 195 registered uveitis studies, we identified 104 clinical trials that met inclusion criteria. There were 14 different domains used as primary outcome measures. Among clinical trials that utilized primary outcome measures of treatment efficacy (n = 94), 70 (74 %) used a measure of disease activity (vitreous haze in 40/70 [57 %]; macular oedema in 19/70 [27 %]) and 49 (70 %) used a measure of visual function (visual acuity in all cases). Multiple primary outcome measures were used in 23 (22 %) of 104 clinical trials. With regard to quality, in 12 (12 %) of 104 clinical trials, outcome measures were poorly defined. No clinical trial utilized a patient-reported study variable as primary outcome measure. CONCLUSIONS This systematic review highlights the heterogeneity of outcome measures used in recent clinical trials for intermediate, posterior, and panuveitis. Current designs prioritize clinician-observed measures of disease activity and measurement of visual function as outcome measures. This apparent lack of consensus regarding outcome measures for the study of uveitis is a concern, as it prevents comparison of studies and meta-analyses, and weakens the evidence available to stake-holders, from patients to clinicians to regulators, regarding the efficacy and value of a given treatment.
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Affiliation(s)
- Alastair K Denniston
- Institute of Translational Medicine, Birmingham Health Partners, University of Birmingham, Birmingham, UK.
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Gary N Holland
- UCLA Stein Eye Institute and the Department of Ophthalmology, Ocular Inflammatory Disease Center, David Geffen School of Medicine at UCLA, 100 Stein Plaza, UCLA, Los Angeles, CA, 90095-7000, USA
| | - Andrej Kidess
- Institute of Translational Medicine, Birmingham Health Partners, University of Birmingham, Birmingham, UK
| | | | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, USA Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Andrew D Dick
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Academic Unit of Ophthalmology, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Schewitz-Bowers LP, Lee RWJ, Dick AD. Immune mechanisms of intraocular inflammation. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.09.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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28
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Forrester JV, Xu H. Good news-bad news: the Yin and Yang of immune privilege in the eye. Front Immunol 2012; 3:338. [PMID: 23230433 PMCID: PMC3515883 DOI: 10.3389/fimmu.2012.00338] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/23/2012] [Indexed: 12/27/2022] Open
Abstract
The eye and the brain are prototypical tissues manifesting immune privilege (IP) in which immune responses to foreign antigens, particularly alloantigens are suppressed, and even completely inhibited. Explanations for this phenomenon are numerous and mostly reflect our evolving understanding of the molecular and cellular processes underpinning immunological responses generally. IP is now viewed as a property of many tissues and the level of expression of IP varies not only with the tissue but with the nature of the foreign antigen and changes in the limited conditions under which privilege can operate as a mechanism of immunological tolerance. As a result, IP functions normally as a homeostatic mechanism preserving normal function in tissues, particularly those with highly specialized function and limited capacity for renewal such as the eye and brain. However, IP is relatively easily bypassed in the face of a sufficiently strong immunological response, and the privileged tissues may be at greater risk of collateral damage because its natural defenses are more easily breached than in a fully immunocompetent tissue which rapidly rejects foreign antigen and restores integrity. This two-edged sword cuts its swathe through the eye: under most circumstances, IP mechanisms such as blood-ocular barriers, intraocular immune modulators, induction of T regulatory cells, lack of lymphatics, and other properties maintain tissue integrity; however, when these are breached, various degrees of tissue damage occur from severe tissue destruction in retinal viral infections and other forms of uveoretinal inflammation, to less severe inflammatory responses in conditions such as macular degeneration. Conversely, ocular IP and tumor-related IP can combine to permit extensive tumor growth and increased risk of metastasis thus threatening the survival of the host.
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Affiliation(s)
- John V. Forrester
- Laboratory of Immunology, Lion’s Eye Institute, University of Western AustraliaPerth, WA, Australia
- Ocular Immunology Laboratory, Section of Immunology and Infection, Institute of Medical Sciences, University of AberdeenAberdeen, UK
| | - Heping Xu
- Laboratory of Immunology, Lion’s Eye Institute, University of Western AustraliaPerth, WA, Australia
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Therapeutic dosing of fingolimod (FTY720) prevents cell infiltration, rapidly suppresses ocular inflammation, and maintains the blood-ocular barrier. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 180:672-81. [PMID: 22119714 DOI: 10.1016/j.ajpath.2011.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/14/2011] [Accepted: 10/11/2011] [Indexed: 01/23/2023]
Abstract
Fingolimod (FTY720) is an FDA-approved therapeutic drug with efficacy demonstrated in experimental models of multiple sclerosis and in phase III human multiple sclerosis trials. Fingolimod prevents T-cell migration to inflammatory sites by decreasing expression of the sphingosine-1 phosphate receptor normally required for egress from secondary lymphoid tissue. As a preclinical model of human uveitis, experimental autoimmune uveoretinitis permits assessment of immunotherapeutic efficacy. Murine experimental autoimmune uveoretinitis is induced by activation of retinal antigen-specific CD4(+) T cells that infiltrate the eye. High-dose fingolimod treatment administered before disease onset reduces ocular infiltration within hours of administration and suppresses clinicopathologic expression of experimental autoimmune uveoretinitis. In the present investigation of the efficacy of fingolimod treatment for established disease, single-dose treatment was effective and immunosuppressive ability was maintained through a dose range, demonstrating significant and rapid reduction in CD4(+) cell infiltration at clinically relevant therapeutic doses of fingolimod. A repeated-treatment regimen using a dose similar to that in current multiple sclerosis patient protocols significantly reduced infiltration within 24 hours of administration; importantly, repeated doses did not compromise the vascular integrity of the blood-ocular barrier. On withdrawal of fingolimod, drug-induced remission was lost and recrudescence of clinical disease was observed. These results support a strong therapeutic potential for fingolimod as an acute rescue therapy for the treatment of ocular immune-mediated inflammation.
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A Cross-sectional Study of the Current Treatment Patterns in Noninfectious Uveitis among Specialists in the United States. Ophthalmology 2011; 118:184-90. [DOI: 10.1016/j.ophtha.2010.03.029] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 01/24/2010] [Accepted: 03/10/2010] [Indexed: 11/22/2022] Open
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Miserocchi E, Modorati G, Mosconi P, Colucci A, Bandello F. Quality of Life in Patients with Uveitis on Chronic Systemic Immunosuppressive Treatment. Ocul Immunol Inflamm 2010; 18:297-304. [DOI: 10.3109/09273941003637510] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lyon F, Gale RP, Lightman S. Recent developments in the treatment of uveitis: an update. Expert Opin Investig Drugs 2010; 18:609-16. [PMID: 19388878 DOI: 10.1517/14728220902852570] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of complex uveitis is often based around the use of oral corticosteroids. To spare the side effects of corticosteroids, second-line oral immunosuppressant drugs are used. Newer systemic immunosuppressive drugs, including biologics, and locally delivered treatments are being evaluated. This article reviews current conventional treatments, discusses their limitations and evaluates newer treatment strategies. Current theories about the pathogenesis of uveitis and potential targets for treatment are discussed in this context. We are still in search of a low-risk, where possible, locally delivered and targeted treatment for uveitis.
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Affiliation(s)
- Fiona Lyon
- Academic Unit of Ophthalmology, York Hospital, Wigginton Road, York YO318HE, UK
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Das D, Bhattacharjee H, Bhattacharyya PK, Jain L, Panicker MJ, Das K, Deka AC. Pattern of uveitis in North East India: a tertiary eye care center study. Indian J Ophthalmol 2009; 57:144-6. [PMID: 19237790 PMCID: PMC2684416 DOI: 10.4103/0301-4738.45506] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We conducted an institutional-based retrospective study on 308 uveitic patients and analyzed the pattern of uveitis in Northeastern India. Anterior uveitis was the most common type (47.07%) followed by posterior (29.87%), intermediate (12.98%) and panuveitis (10.06%). Toxoplasmosis (40.21%) had the highest incidence among posterior uveitis cases. Harada's form of Vogt Koyanagi Harada's disease is a frequent occurrence in this subset of the population.
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Affiliation(s)
- Dipankar Das
- Sri Sankaradeva Nethralaya, Guwahati, Assam, India.
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