1
|
Brown JP, Wing K, Evans SJ, Leyrat C, Mansfield KE, Smeeth L, Wong AYS, Yorston D, Galwey NW, Douglas IJ. Systemic Fluoroquinolone Use and Risk of Uveitis or Retinal Detachment. JAMA Ophthalmol 2024; 142:636-645. [PMID: 38814618 PMCID: PMC11140578 DOI: 10.1001/jamaophthalmol.2024.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/07/2024] [Indexed: 05/31/2024]
Abstract
Importance Fluoroquinolone use has been associated with increased risk of uveitis and retinal detachment in noninterventional studies, but the findings have been conflicting and causality is unclear. Objective To estimate the association of systemic fluoroquinolone use with acute uveitis or retinal detachment, using multiple analyses and multiple databases to increase the robustness of results. Design, Setting, and Participants This cohort study used data from the Clinical Practice Research Datalink Aurum and GOLD UK primary care records databases, which were linked to hospital admissions data. Adults prescribed a fluoroquinolone or a comparator antibiotic, cephalosporin, between April 1997 and December 2019 were included. Adults with uveitis or retinal detachment were analyzed in a separate self-controlled case series. Data analysis was performed from May 2022 to May 2023. Exposures Systemic fluoroquinolone or comparator antibiotic. Main Outcomes and Measures The primary outcome was a diagnosis of acute uveitis or retinal detachment. Hazard ratios (HRs) were estimated in the cohort study for the association of fluoroquinolone prescription with either uveitis or retinal detachment, using stabilized inverse probability of treatment weighted Cox regression. Rate ratios (RRs) were estimated in the self-controlled case series, using conditional Poisson regression. Estimates were pooled across databases using fixed-effects meta-analysis. Results In total, 3 001 256 individuals in Aurum (1 893 561 women [63.1%]; median [IQR] age, 51 [35-68] years) and 434 754 in GOLD (276 259 women [63.5%]; median [IQR] age, 53 [37-70] years) were included in the cohort study. For uveitis, the pooled adjusted HRs (aHRs) for use of fluoroquinolone vs cephalosporin were 0.91 (95% CI, 0.72-1.14) at first treatment episode and 1.07 (95% CI, 0.92-1.25) over all treatment episodes. For retinal detachment, the pooled aHRs were 1.37 (95% CI, 0.80-2.36) at first treatment episode and 1.18 (95% CI, 0.84-1.65) over all treatment episodes. In the self-controlled case series, for uveitis, the pooled adjusted RRs (aRRs) for fluoroquinolone use vs nonuse were 1.13 (95% CI, 0.97-1.31) for 1 to 29 days of exposure, 1.16 (95% CI, 1.00-1.34) for 30 to 59 days, and 0.98 (95% CI, 0.74-1.31) for 60 days for longer. For retinal detachment, pooled aRRs for fluoroquinolone use vs nonuse were 1.15 (95% CI, 0.86-1.54) for 1 to 29 days of exposure, 0.94 (95% CI, 0.69-1.30) for 30 to 59 days, and 1.03 (95% CI, 0.59-1.78) for 60 days or longer. Conclusions and Relevance These findings do not support an association of systemic fluoroquinolone use with substantively increased risk of uveitis or retinal detachment. Although an association cannot be completely ruled out, these findings indicate that any absolute increase in risk would be small and, hence, of limited clinical importance.
Collapse
Affiliation(s)
- Jeremy P Brown
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen J Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clémence Leyrat
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angel Y S Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Yorston
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Nicholas W Galwey
- Research and Development, GSK Medicines Research Centre, GSK, Stevenage, United Kingdom
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Gendelman O, Tripto-Shkolnik L, Vered I, Lidar M. Bisphosphonates Related Ocular Side Effects: A Case Series and Review of Literature. Ocul Immunol Inflamm 2022; 30:1995-1999. [PMID: 34014797 DOI: 10.1080/09273948.2021.1922705] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To describe the clinical features of patients with bisphosphonate related ocular side effects (BROSE). METHODS The medical records of all patients with BROSE between January 2009 and December 2019 were reviewed. RESULTS Nine cases with BROSE were identified. All subjects were female. Median age at diagnosis was of 69 years. The leading indication for bisphosphonate treatment was osteoporosis (n=7), Paget's disease of bone (n=1) and breast cancer (n=1). Six (66.67%) patients presented with uveitis, one (11%) episcleritis and two (22%) with orbital inflammation. Five events (55.5%) occurred within 10 days of initiating the bisphosphonate and the rest (44.44%) developed within 2 weeks to 3 years later. Four (44.44%) patients had concurrent thyroid disease. An association was found between underlying thyroid disease or autoimmunity. CONCLUSION BROSE is an uncommon complication of bisphosphonate therapy occurring more frequently in patients with an autoimmune predisposition.
Collapse
Affiliation(s)
- Omer Gendelman
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Liana Tripto-Shkolnik
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Vered
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
3
|
Samalia P, Sims J, Niederer R. Response To: "Bisphosphonates Related Ocular Side Effects: A Case Series and Review of Literature". Ocul Immunol Inflamm 2022; 30:2072. [PMID: 34228603 DOI: 10.1080/09273948.2021.1936567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Priya Samalia
- Ophthalmology Department, Auckland District Health Board, Greenlane Clinical Centre, Epsom, New Zealand
| | - Joanne Sims
- Ophthalmology Department, Auckland District Health Board, Greenlane Clinical Centre, Epsom, New Zealand
| | - Rachael Niederer
- Ophthalmology Department, Auckland District Health Board, Greenlane Clinical Centre, Epsom, New Zealand
- Department of Ophthalmology, University of Auckland, Grafton, New Zealand
| |
Collapse
|
4
|
Sato T, Nihei R, Sora D, Nishio Y, Takeuchi M. Case report: Bilateral panuveitis resembling Vogt-Koyanagi-Harada disease after second dose of BNT162b2 mRNA COVID-19 vaccine. Front Immunol 2022; 13:967972. [PMID: 36248859 PMCID: PMC9556971 DOI: 10.3389/fimmu.2022.967972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/08/2022] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a serious pandemic. COVID-19 vaccination is urgent needed for limiting SARS-CoV-2 outbreaks by herd immunity. Simultaneously, post-marketing surveillance to assess vaccine safety is important, and collection of vaccine-related adverse events has been in progress. Vision-threatening ophthalmic adverse events of COVID-19 vaccines are rare but are a matter of concern. We report a 45-year-old Japanese male with positive for HLA-DR4/HLA-DRB1*0405, who developed bilateral panuveitis resembling Vogt-Koyanagi-Harada (VKH) disease after the second dose of Pfizer-BioNTech COVID-19 mRNA (BNT162b2) vaccine. Glucocorticosteroid (GC) therapy combined with cyclosporine A (CsA) readily improved the panuveitis. The immune profile at the time of onset was analyzed using CyTOF technology, which revealed activations of innate immunity mainly consisting of natural killer cells, and acquired immunity predominantly composed of B cells and CD8+ T cells. On the other hand, the immune profile in the remission phase was altered by GC therapy with CsA to a profile composed primarily of CD4+ cells, which was considerably similar to that of the healthy control before the vaccination. Our results indicate that BNT162b2 vaccine may trigger an accidental immune cross-reactivity to melanocyte epitopes in the choroid, resulting in the onset of panuveitis resembling VKH disease.
Collapse
|
5
|
Kvopka M, Smith JR, Koczwara B, Lake SR. Bilateral intermediate uveitis following treatment with paclitaxel in a patient with invasive ductal carcinoma of the breast. Int J Retina Vitreous 2022; 8:63. [PMID: 36068624 PMCID: PMC9450362 DOI: 10.1186/s40942-022-00415-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case of bilateral intermediate uveitis without cystoid macular edema secondary to paclitaxel therapy, and its successful management with oral corticosteroids. CASE PRESENTATION A 66-year-old female developed bilateral intermediate uveitis with reduced best corrected visual acuity to 20/40 right and 20/200 left, following 12 cycles of paclitaxel therapy for breast carcinoma. Optical coherence tomography demonstrated no cystoid macular edema in either eye, and fundus fluorescein angiography showed localized retinal vascular leakage. Resolution of uveitis and improvement of visual acuity followed treatment with oral prednisolone for two months. Fourteen months after presentation, right and left visual acuities had returned to 20/32 and 20/40, respectively, and there was no recurrence of the uveitis. CONCLUSIONS This is the first reported case of bilateral intermediate uveitis in a patient treated with paclitaxel. Drug-induced uveitis should be considered in patients with visual symptoms in the setting of taxane chemotherapy, and oral corticosteroids are a safe and effective treatment.
Collapse
Affiliation(s)
- Michael Kvopka
- Ophthalmology Unit, Division of Surgery, Flinders Medical Centre, Adelaide, Australia. .,Eye & Vision Health, Flinders University College of Medicine and Public Health, Flinders Medical Centre Room, Flinders Drive, Bedford Park, SA, 5042, Australia.
| | - Justine R Smith
- Ophthalmology Unit, Division of Surgery, Flinders Medical Centre, Adelaide, Australia.,Flinders University College of Medicine and Public Health, Adelaide, Australia.,Eye & Vision Health, Flinders University College of Medicine and Public Health, Flinders Medical Centre Room, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre and Flinders University College of Medicine and Public Health, Adelaide, Australia.,Eye & Vision Health, Flinders University College of Medicine and Public Health, Flinders Medical Centre Room, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Stewart R Lake
- Ophthalmology Unit, Division of Surgery, Flinders Medical Centre, Adelaide, Australia.,Flinders University College of Medicine and Public Health, Adelaide, Australia.,Eye & Vision Health, Flinders University College of Medicine and Public Health, Flinders Medical Centre Room, Flinders Drive, Bedford Park, SA, 5042, Australia
| |
Collapse
|
6
|
Bleicher ID, Brill D, Wu F, Sobrin L, Patel N. Acute Idiopathic Maculopathy Following SARS-CoV-2 Vaccination. Ocul Immunol Inflamm 2022:1-4. [PMID: 36053888 DOI: 10.1080/09273948.2022.2114915] [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: 10/14/2022]
Abstract
A 49-year-old man presented with acute unilateral blurred vision one week after SARS-CoV-2 vaccination. A unilateral serous detachment of the macula, intraretinal hemorrhages, vitritis, and anterior chamber cell was found. Diagnostic testing was negative for infectious and inflammatory causes, and a diagnosis of acute idiopathic maculopathy (AIM) was made. Symptoms and serous detachment resolved over 12 weeks, with residual retinal pigment epithelial changes consistent with the disease course. AIM is a rare diagnosis that presented in close proximity to SARS-CoV-2 vaccination without evidence of coxsackievirus infection. Further research is necessary to clarify an association between this vaccine and uveitis.
Collapse
Affiliation(s)
- Isaac D Bleicher
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Brill
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Frances Wu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimesh Patel
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Pierce ES, Barkhaus P, Beauchamp M, Bromberg M, Carter GT, Goslinga J, Greeley D, Kihuwa-Mani S, Levitsky G, Lund I, McDermott C, Pattee G, Pierce K, Polak M, Ratner D, Wicks P, Bedlack R. ALSUntangled #66: antimycobacterial antibiotics. Amyotroph Lateral Scler Frontotemporal Degener 2022:1-5. [PMID: 35913017 DOI: 10.1080/21678421.2022.2104650] [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: 11/01/2022]
Abstract
Several infections have been associated with motor neuron diseases resembling ALS, including species of viruses, bacteria, and parasites. Mycobacterium avium subspecies paratuberculosis (MAP), most known for its probable etiologic association with Crohn's disease, has been suggested as another possible infectious cause of motor neuron disease. Two published case reports describe the successful treatment of ALS-like symptoms with antimycobacterial antibiotics. Both cases had atypical features. Based on these, we believe it would be reasonable to begin performing chest imaging in PALS who have features of their history or exam that are atypical for ALS such as pain, fevers, or eye movement abnormalities. If the chest imaging is abnormal, more specific testing for mycobacteria may be indicated. Until there is more clear evidence of an association between mycobacteria and ALS, we cannot endorse the widespread use of potentially toxic antimycobacterial antibiotics for PALS.
Collapse
Affiliation(s)
| | - Paul Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan Beauchamp
- UNC Neurosciences Clinical Trials Unit, University of North Carolina, Chapel Hill, NC, USA
| | - Mark Bromberg
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Gregory T Carter
- Department of Rehabilitation, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Jill Goslinga
- Department of Neurology, University of California, San Francisco, CA, USA
| | - David Greeley
- Northwest Neurological Associates, PLLC, Spokane, WA, USA
| | | | | | - Isaac Lund
- Undergraduate, Green Hope High School, Cary, NC, USA
| | | | - Gary Pattee
- Department of Neurology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kaitlyn Pierce
- Department of Neuroscience, University of North Carolina, Chapel Hill, NC, USA
| | - Meraida Polak
- Department of Neurology, Emory University School of Medicine, Emory, GA, USA
| | - Dylan Ratner
- Undergraduate, Longmeadow High School, Longmeadow, MA, USA
| | - Paul Wicks
- Independent Consultant, Lichfield, England, UK
| | | |
Collapse
|
8
|
O'Boyle H, Varghese S. Uveitis and Renal Dysfunction in a 16-year-old Boy. Pediatr Rev 2022; 43:229-232. [PMID: 35362029 DOI: 10.1542/pir.2020-004150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Sarah Varghese
- Emory University School of Medicine, Atlanta, GA.,Children's Healthcare of Atlanta, Atlanta, GA
| |
Collapse
|
9
|
Jain M, Vadboncoeur J, Garg SJ, Biswas J. Bacille Calmette-Guérin: An ophthalmic perspective. Surv Ophthalmol 2022; 67:307-320. [PMID: 34343536 PMCID: PMC8325561 DOI: 10.1016/j.survophthal.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 01/20/2023]
Abstract
Vaccines such as bacille Calmette-Guérin (BCG) are known for their heterologous effects mediated through a number of mechanisms, including trained immunity constituted by monocyte-macrophage based innate immunity. Other events such as direct hematogenous spread and induction of autoimmunity are also described. There has been a resurgent interest in harnessing some of the benefits of trained immunity in the management of COVID-19, even as several specific vaccines have been approved. We summarize the current knowledge of ocular effects of BCG. Potential effect of granulomatous inflammation on angiotensin converting enzyme activity and accentuation of cytokine storm that may result in undesirable ocular and systemic effects are also discussed.
Collapse
Affiliation(s)
- Manish Jain
- Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, UK, India
| | - Julie Vadboncoeur
- Department of Ophthalmology, Université de Montréal, Montréal, Uveitis Service, University Ophthalmology Center, Maisonneuve-Rosemont Hospital, Montréal, Canada
| | - Sunir J Garg
- Thomas Jefferson University, Philadelphia, PA USA
| | - Jyotirmay Biswas
- Director of Uveitis & Ocular Pathology Department, Sankara Nethralaya, Chennai, TN, India
| |
Collapse
|
10
|
Cipriano M, Schlünder K, Probst C, Linke K, Weiss M, Fischer MJ, Mesch L, Achberger K, Liebau S, Mesquida M, Nicolini V, Schneider A, Giusti AM, Kustermann S, Loskill P. Human immunocompetent choroid-on-chip: a novel tool for studying ocular effects of biological drugs. Commun Biol 2022; 5:52. [PMID: 35027657 PMCID: PMC8758775 DOI: 10.1038/s42003-021-02977-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Disorders of the eye leading to visual impairment are a major issue that affects millions of people. On the other side ocular toxicities were described for e.g. molecularly targeted therapies in oncology and may hamper their development. Current ocular model systems feature a number of limitations affecting human-relevance and availability. To find new options for pharmacological treatment and assess mechanisms of toxicity, hence, novel complex model systems that are human-relevant and readily available are urgently required. Here, we report the development of a human immunocompetent Choroid-on-Chip (CoC), a human cell-based in vitro model of the choroid layer of the eye integrating melanocytes and microvascular endothelial cells, covered by a layer of retinal pigmented epithelial cells. Immunocompetence is achieved by perfusion of peripheral immune cells. We demonstrate controlled immune cell recruitment into the stromal compartments through a vascular monolayer and in vivo-like cytokine release profiles. To investigate applicability for both efficacy testing of immunosuppressive compounds as well as safety profiling of immunoactivating antibodies, we exposed the CoCs to cyclosporine and tested CD3 bispecific antibodies.
Collapse
Affiliation(s)
- Madalena Cipriano
- Institute for Biomedical Engineering, Eberhard Karls University Tübingen, Tübingen, Germany
- 3R-Center for In vitro Models and Alternatives to Animal Testing, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Katharina Schlünder
- Institute for Biomedical Engineering, Eberhard Karls University Tübingen, Tübingen, Germany
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Christopher Probst
- Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany
| | - Kirstin Linke
- Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany
| | - Martin Weiss
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Department of Women's Health, Research Institute for Women's Health, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Mona Julia Fischer
- Institute for Biomedical Engineering, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Lena Mesch
- Department of Women's Health, Research Institute for Women's Health, Eberhard Karls University Tübingen, Tübingen, Germany
- Institute of Neuroanatomy & Developmental Biology (INDB), Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kevin Achberger
- Institute of Neuroanatomy & Developmental Biology (INDB), Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stefan Liebau
- Institute of Neuroanatomy & Developmental Biology (INDB), Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marina Mesquida
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Valeria Nicolini
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Anneliese Schneider
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Zurich, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Anna Maria Giusti
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Zurich, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Stefan Kustermann
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland.
| | - Peter Loskill
- Institute for Biomedical Engineering, Eberhard Karls University Tübingen, Tübingen, Germany.
- 3R-Center for In vitro Models and Alternatives to Animal Testing, Eberhard Karls University Tübingen, Tübingen, Germany.
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany.
| |
Collapse
|
11
|
Rabinovitch T, Ben-Arie-Weintrob Y, Hareuveni-Blum T, Shaer B, Vishnevskia-Dai V, Shulman S, Newman H, Biadsy M, Masarwa D, Fischer N, Yovel O, Goldfeather-Ben Zaken S, Habot-Wilner Z. UVEITIS AFTER THE BNT162b2 mRNA VACCINATION AGAINST SARS-CoV-2 INFECTION: A Possible Association. Retina 2021; 41:2462-2471. [PMID: 34369440 DOI: 10.1097/iae.0000000000003277] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe uveitis cases after the BNT162b2 mRNA SARS-CoV-2 vaccination. METHODS This is a multicenter, retrospective study. Vaccine-related uveitis diagnosis was supported by the classification of the World Health Organization Adverse Drug Terminology and the Naranjo criteria. RESULTS Twenty-one patients (23 eyes) with a mean age of 51.3 years (23-78 years) were included. Eight of the 21 patients had a known history of uveitis. The median time from previous to current attack was 1 year (0.5-15 years). There were 21 anterior uveitis cases, two with bilateral inflammation. Eight cases occurred after the first vaccination and 13 after the second vaccination. All but three presented as mild to moderate disease. Two patients developed multiple evanescent white dot syndrome after the second vaccination. The mean time from vaccination to uveitis onset was 7.5 ± 7.3 days (1-30 days). At final follow-up, complete resolution was achieved in all but two eyes, which showed significant improvement. One case of severe anterior uveitis developed vitritis and macular edema after the second vaccination, which completely resolved after an intravitreal dexamethasone injection. CONCLUSION Uveitis may develop after the administration of the BNT162b2 mRNA vaccine. The most common complication was mild to moderate anterior uveitis, while multiple evanescent white dot syndrome can also occur less frequently.
Collapse
Affiliation(s)
- Tamar Rabinovitch
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Ben-Arie-Weintrob
- Department of Ophthalmology, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine,Technion, Israel Institute of Technology, Haifa, Israel
| | - Tamar Hareuveni-Blum
- Department of Ophthalmology, Galilee Medical Center, Bar Ilan University, Faculty of Medicine in the Galilee, Israel
| | - Boaz Shaer
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Vicktoria Vishnevskia-Dai
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Shulman
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Newman
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Biadsy
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Dua Masarwa
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Naomi Fischer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Oren Yovel
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shalhevet Goldfeather-Ben Zaken
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Zhang A, Gupta RR, Shuba L. Bilateral Hypopyon in a Patient With Glaucoma. JAMA Ophthalmol 2021; 139:1315-1316. [PMID: 34709362 DOI: 10.1001/jamaophthalmol.2021.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Angela Zhang
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - R Rishi Gupta
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Lesya Shuba
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
13
|
Regenold J, Ghoraba H, Akhavanrezayat A, Matsumiya W, Mobasserian A, Karaca I, Zaidi M, Pham B, Nguyen QD. Unilateral acute anterior uveitis with macular edema following the use of sildenafil citrate in a patient with HLA-B27 positivity. Am J Ophthalmol Case Rep 2021; 24:101228. [PMID: 34761138 PMCID: PMC8566933 DOI: 10.1016/j.ajoc.2021.101228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/09/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To present a case of acute anterior uveitis with macular edema associated with sildenafil citrate use in an HLA-B27 positive patient. Observations A 54-year-old Caucasian male presented at an ophthalmology tertiary center with complaint of pinkish discoloration, irritation, and photophobia in the left eye (OS). He noted that these symptoms appeared one day after using sildenafil for the first time to treat his erectile dysfunction. The patient had no significant ocular history besides refractive surgery in both eyes (OU) and his medical history was insignificant. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and 20/25 in OS. Slit-lamp-examination (SLE) demonstrated trace cells and 1+ flare in the anterior chamber (AC) in OS and was nonrevealing in AC in OD. Spectral domain optical coherence tomography (SD-OCT) showed parafoveal subretinal hyperreflective deposits in OU. The patient was diagnosed with acute anterior uveitis (AAU) in the left eye and was placed on topical prednisolone acetate.At 2-week follow-up, the patient reported that his eye symptoms had improved since starting topical steroids but worsened again two days after he had used sildenafil for a second time. In OS, best-corrected visual acuity (BCVA) worsened to 20/40, and SLE revealed 1+ cells and 1+ flare in AC. SD-OCT revealed cystoid macular edema only in OS. Fluorescein angiography showed mild staining around the optic disc and significant macular leakage in OS and minimal macular leakage in OD. Uveitis evaluations revealed that the patient was human leukocyte antigen-27 (HLA-B27) positive. The patient was asked to remain off sildenafil and continue topical prednisolone acetate. At 3-month follow-up, BCVA improved to 20/20 in OS with no evidence of active inflammation. Conclusions and importance Sildenafil citrate use might be associated with new onset of intraocular inflammation in predisposed patients. Further studies are necessary to establish this relationship.
Collapse
Affiliation(s)
- Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Moosa Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Brandon Pham
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
14
|
Affiliation(s)
- Aarti Jain
- Consultant Vitreoretina, Shree Ganesh Vinayak Eye Hospital, Pachpedi Naka, Raipur, Chhattisgarh, India
| | - Charudutt Kalamkar
- Head Cataract and Glaucoma, Shree Ganesh Vinayak Eye Hospital, Pachpedi Naka, Raipur, Chhattisgarh, India
| |
Collapse
|
15
|
Oya Y, Futami H, Nakazawa T, Ishijima K, Umemiya K, Takizawa F, Imai N, Kitamura H, Matsumura R. Tubulointerstitial nephritis and uveitis syndrome following meningitis and systemic lymphadenopathy with persistent Toxoplasma immunoglobulin M: a case report. J Med Case Rep 2021; 15:482. [PMID: 34556154 PMCID: PMC8461971 DOI: 10.1186/s13256-021-02909-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
Background Tubulointerstitial nephritis and uveitis syndrome is a rare lymphocyte-related oculorenal inflammatory disease presumed to be associated with drug use and infectious agents. Toxoplasma gondii is one of such pathogens that could exhibit encephalitis, meningitis, and uveitis in immunocompromised or in some immunocompetent individuals. If the immunoglobulin M of Toxoplasma is positive on screening, the interpretation of the result is not simple, especially when immunoglobulin M stays positive persistently. Case presentation A 34-year-old Asian male developed fever, headache, and lymphadenopathy with tenderness, which was initially diagnosed as meningitis. Antibiotics were started, and diclofenac sodium was used for the fever. Although his symptoms were alleviated in a week by the treatment, gradual decline in renal function was noted, prompting a renal biopsy that indicated acute granulomatous interstitial nephritis. A week later, tenderness in both eyes with blurred vision appeared and revealed iritis and keratic precipitations in both eyes; hence, the diagnosis of acute tubulointerstitial nephritis and bilateral uveitis syndrome was made. Toxoplasma gondii-specific immunoglobulin G and immunoglobulin M titers were both positive. Although we could not rule out recent infection of Toxoplasma gondii, which may cause uveitis initially, Toxoplasma immunoglobulin G avidity test indicated a distant infection, which allowed us to rule out meningitis and uveitis as responsible for the complication of recent Toxoplasma gondii infection. Drug-induced lymphocyte stimulation test, or lymphocyte transformation test of diclofenac sodium, was solely positive among the tested drugs. Uveitis was alleviated only with ophthalmic steroid, and renal function returned to normal without administration of systemic steroid. Conclusions We experienced a case of diclofenac-induced tubulointerstitial nephritis and uveitis syndrome. In ruling out infections, Toxoplasma immunoglobulin M was persistently positive, and Toxoplasma immunoglobulin G avidity test indicated a “distant” infection. From these two results, we ruled out recent infection. However, it should be noted that “distant” infection indicated by commercial immunoglobulin G avidity is still a multiplex profile consisting of reinfection, reactivation, and latent infection. Narrowing down the infection profile of Toxoplasma is challenging in some cases. Therefore, careful diagnosis and extended follow-up of such patients are needed.
Collapse
Affiliation(s)
- Yoshihiro Oya
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan. .,Laboratory of Autoimmune diseases, Department of Clinical Research, National Hospital Organization Chibahigashi National Hospital, Chiba City, Chiba, 260-8712, Japan.
| | - Hidekazu Futami
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Takuya Nakazawa
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Kazuyuki Ishijima
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Keiko Umemiya
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Fumiyoshi Takizawa
- Department of Internal Medicine, Seikeikai Chiba Medical Center, Chiba City, Chiba, 260-0842, Japan
| | - Naoki Imai
- Department of Ophthalmology, National Hospital Organization Chibahigashi National Hospital, Chiba City, Chiba, 260-8712, Japan
| | - Hiroshi Kitamura
- Department of Pathology, National Hospital Organization Chibahigashi National Hospital, Chiba City, Chiba, 260-8712, Japan
| | - Ryutaro Matsumura
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| |
Collapse
|
16
|
Agarwal M, Dutta Majumder P, Babu K, Konana VK, Goyal M, Touhami S, Stanescu-Segall D, Bodaghi B. Drug-induced uveitis: A review. Indian J Ophthalmol 2021; 68:1799-1807. [PMID: 32823396 PMCID: PMC7690475 DOI: 10.4103/ijo.ijo_816_20] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Uveitis maybe induced by the use of various medications known as drug-induced uveitis (DIU), though rare it is an important cause of uveitis which one needs to be aware of. The drugs may be administered through any route including systemic, topical, and intravitreal. Ocular inflammation can be in the form of anterior, intermediate, posterior or pan uveitis, and rarely may present as episcleritis and scleritis. Identification of drug as the offending agent of uveitis is important as many a times stopping the drug may help recover the uveitis or the concomitant use of corticosteroids. An extensive literature review was done using the Pubmed. An overview of DIU is provided as it is important for us to be aware of this clinical entity.
Collapse
Affiliation(s)
- Manisha Agarwal
- Vitreoretina and Uveitis Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Kalpana Babu
- Department of Uveitis and Ocular Inflammation, Vittala International Institute of Ophthalmology, Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | | | - Mallika Goyal
- Department of Ophthalmology, IHU FOReSIGHT, Pitie-Salpetriere Universtiy Hospital, Paris, France
| | - Sara Touhami
- Department of Ophthalmology, IHU FOReSIGHT, Pitie-Salpetriere Universtiy Hospital, Paris, France
| | - Dinu Stanescu-Segall
- Department of Ophthalmology, IHU FOReSIGHT, Pitie-Salpetriere Universtiy Hospital, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Pitie-Salpetriere Universtiy Hospital, Paris, France
| |
Collapse
|
17
|
Iseki M, Kaburaki T, Aihara M, Sawamura H. Late-onset Ocular Toxicity Presenting as Uveitis Caused by Crizotinib. Neuroophthalmology 2021; 46:44-49. [DOI: 10.1080/01658107.2021.1876099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Megumi Iseki
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiromasa Sawamura
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
18
|
Chen YC, Gad SF, Chobisa D, Li Y, Yeo Y. Local drug delivery systems for inflammatory diseases: Status quo, challenges, and opportunities. J Control Release 2021; 330:438-460. [PMID: 33352244 DOI: 10.1016/j.jconrel.2020.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
Inflammation that is not resolved in due course becomes a chronic disease. The treatment of chronic inflammatory diseases involves a long-term use of anti-inflammatory drugs such as corticosteroids and nonsteroidal anti-inflammatory drugs, often accompanied by dose-dependent side effects. Local drug delivery systems have been widely explored to reduce their off-target side effects and the medication frequency, with several products making to the market or in development over the years. However, numerous challenges remain, and drug delivery technology is underutilized in some applications. This review showcases local drug delivery systems in different inflammatory diseases, including the targets well-known to drug delivery scientists (e.g., joints, eyes, and teeth) and other applications with untapped opportunities (e.g., sinus, bladder, and colon). In each section, we start with a brief description of the disease and commonly used therapy, introduce local drug delivery systems currently on the market or in the development stage, focusing on polymeric systems, and discuss the remaining challenges and opportunities in future product development.
Collapse
Affiliation(s)
- Yun-Chu Chen
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Sheryhan F Gad
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Dhawal Chobisa
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Integrated product development organization, Innovation plaza, Dr. Reddy's Laboratories, Hyderabad 500090, India
| | - Yongzhe Li
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning 110016, PR China
| | - Yoon Yeo
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.
| |
Collapse
|
19
|
Iqbal KM, Hay MW, Emami-Naeini P. Medication-induced Uveitis: An Update. J Ophthalmic Vis Res 2021; 16:84-92. [PMID: 33520131 PMCID: PMC7841282 DOI: 10.18502/jovr.v16i1.8254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
Drug-induced uveitis is an uncommon but important cause of ocular inflammation. Uveitis can be seen in association with various systemic, topical, and intraocular medications. In this article, we review common medications associated with uveitis. Most cases of drug-induced uveitis resolve with termination of the suspected medication with or without administration of topical or systemic steroids. It is important for clinicians to readily identify medications that may cause uveitis in order to provide rapid treatment, avoid consequences of longstanding inflammation, and prevent costly and excessive laboratory testing.
Collapse
Affiliation(s)
- Kashif M Iqbal
- (KM Iqbal and MW Hay contributed equally to this paper.)
| | - Madeline W Hay
- University of California Riverside School of Medicine, Riverside, CA
| | | |
Collapse
|
20
|
Ayasse M, Lockshin B, Do BK, Kaiser R, Silverberg JI. A case report of uveitis secondary to dupilumab treatment for atopic dermatitis. JAAD Case Rep 2020; 7:98-99. [PMID: 33364278 PMCID: PMC7750710 DOI: 10.1016/j.jdcr.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Marissa Ayasse
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Brian K Do
- The Retina Group of Washington, Chevy Chase, Maryland
| | - Rachel Kaiser
- Arthritis and Rheumatism Associates, Chevy Chase, Maryland
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| |
Collapse
|
21
|
Hopf S, Mercieca K, Pfeiffer N, Prokosch-Willing V. Brimonidine-associated uveitis - a descriptive case series. BMC Ophthalmol 2020; 20:489. [PMID: 33334316 PMCID: PMC7745535 DOI: 10.1186/s12886-020-01762-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background Anterior uveitis secondary to topical brimonidine administration is rare and not well-defined. In glaucoma patients using brimonidine, one must consider this phenomenon to avoid mis-diagnosis and over-treatment with topical steroids which in turn may increase intraocular pressure (IOP). This is the largest case series including the longest patient follow-up in the current literature. Methods Sixteen patients (26 eyes) with consultant diagnosed brimonidine-associated anterior uveitis in a tertiary referral glaucoma clinic presenting between 2015 and 2019 were included in this retrospective case series. Clinical records were taken for descriptive analysis. Main outcome measures were the key clinical features, and disease course (therapy, IOP control, patient outcome). Results Key features were conjunctival ciliary injection and mutton fat keratic precipitation in all eyes. The findings were bilateral in 10 patients. Time between initiation of brimonidine treatment and presentation was 1 week to 49 months. Glaucoma sub-types were mostly pseudo-exfoliative and primary open angle glaucoma. Brimonidine treatment was stopped immediately. Additionally, topical corticosteroids were prescribed in 18 eyes and tapered down during the following 4 weeks. Thirteen eyes did not need surgical or laser treatment (median follow-up time 15 months). No patient showed recurrence of inflammation after cessation of brimonidine. Conclusions This type of anterior uveitis is an uncommon but important manifestation which should always be considered in glaucoma patients on brimonidine treatment. Although treatable at its root cause, problems may persist, especially with respect to IOP control. The latter may necessitate glaucoma surgery after the resolved episode of the uveitis. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-020-01762-w.
Collapse
Affiliation(s)
- Susanne Hopf
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Karl Mercieca
- Manchester University Hospitals NHS Trust, Manchester Royal Eye Hospital, M13 9WH, Manchester, UK.,Faculty of Biology, Medicine and Health School of Health Sciences, University of Manchester, Manchester, UK
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Verena Prokosch-Willing
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| |
Collapse
|
22
|
Sudharshan S, Nair N, Curi A, Banker A, Kempen JH. Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy - An update. Indian J Ophthalmol 2020; 68:1787-1798. [PMID: 32823395 PMCID: PMC7690468 DOI: 10.4103/ijo.ijo_1248_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.
Collapse
Affiliation(s)
| | - Nivedita Nair
- Department of Uveitis, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Andre Curi
- André Luiz Land Curi, National Institute of Infectious Diseases - INI/ Fiocruz, Brazil
- Clinical Research Laboratory of Infectious, Diseases in Ophthalmology - INI / Fiocruz, Brazil
| | - Alay Banker
- Banker's Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, Ethiopia
- Schepens Eye Research Institute, Boston, Massachusetts, USA
- MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
23
|
Anquetil C, Salem JE, Lebrun-Vignes B, Touhami S, Desbois AC, Maalouf G, Domont F, Allenbach Y, Cacoub P, Bodaghi B, Saadoun D. Evolving spectrum of drug-induced uveitis at the era of immune checkpoint inhibitors results from the WHO's pharmacovigilance database. J Autoimmun 2020; 111:102454. [PMID: 32303423 DOI: 10.1016/j.jaut.2020.102454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Drug-induced uveitis is a rare but sight-threatening condition. We seek to determine the spectrum of drug-induced uveitis at the era of immune checkpoint inhibitors (ICI). METHODS Retrospective pharmacovigilance study based on adverse drug reactions reported within VigiBase, the WHO international pharmacovigilance database. We included deduplicated individual case safety reports (ICSRs) reported as 'uveitis' at Preferred Term level according to the Medical Dictionary for Drug Regulatory Activities between 1967 and 04/28/2019. We performed a case/non-case analysis to study if suspected drug-induced uveitis were differentially reported for each suspected treatment compared to the full database. We excluded drugs with potential indication bias. RESULTS 1404 ICSRs corresponding to 37 drugs had a significant over-reporting signal with a median age of 57 [42-68] years and 45.7% of males. We identified five major groups of treatments: bisphosphonates (26.9%), non-antiviral anti-infectious drugs (25.4%), protein kinase inhibitors (15.5%), ICI (15.0%), and antiviral drugs (11.1%). Severe visual loss was reported in 12.1% of cases. ICI and protein kinase inhibitors were the most recently emerging signals. The time to onset between first infusion and uveitis was significantly different between groups ranging from 5 days [2-19] in the bisphosphonate group to 138.5 [47.25-263.75] in protein kinase inhibitors group (p < 0.0001). Anti-Programmed Cell death 1 represented more than 70% of ICI-induced uveitis. We identified Vogt-Koyanagi-Harada (VKH)-like syndrome as being associated with ICI use. CONCLUSIONS The spectrum of drug-induced uveitis has changed with the evolution of pharmacopeia and the recent emergence of ICIs. VKH-like syndrome has been reported with ICI and protein kinase inhibitors therapy.
Collapse
Affiliation(s)
- Céline Anquetil
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS974, Paris, France
| | - Joe-Elie Salem
- Regional Pharmacovigilance Centre, Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Bénédicte Lebrun-Vignes
- Regional Pharmacovigilance Centre, Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Sara Touhami
- Department of Ophtalmology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Anne-Claire Desbois
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Georgina Maalouf
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre national de référence maladies auto-immunes systémiques rares, Centre national de référence maladies auto-inflammatoires et amylose, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunothérapie, i3, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS974, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre national de référence maladies auto-immunes systémiques rares, Centre national de référence maladies auto-inflammatoires et amylose, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunothérapie, i3, France
| | - Bahram Bodaghi
- Department of Ophtalmology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre national de référence maladies auto-immunes systémiques rares, Centre national de référence maladies auto-inflammatoires et amylose, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunothérapie, i3, France.
| |
Collapse
|
24
|
Dermarkarian CR, Patel NA, Villegas VM, Harbour JW. Bilateral uveitis associated with nivolumab therapy for metastatic non-small cell lung cancer. Am J Ophthalmol Case Rep 2020; 18:100691. [PMID: 32322748 PMCID: PMC7168346 DOI: 10.1016/j.ajoc.2020.100691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 01/31/2019] [Accepted: 04/02/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To report a case of bilateral uveitis secondary to intravenous nivolumab therapy in a patient with stage IV non-small cell lung cancer. Observations A 53-year-old male with stage IV non-small cell lung cancer presented with gradual onset of blurry vision in the left eye for nine days after completion of the first cycle of intravenous nivolumab chemotherapy. At initial presentation, best-corrected visual acuity was 20/25 in the right eye and 20/30 in the left eye. Slit lamp biomicroscopy examination of the left eye showed temporal injection of the conjunctiva and sclera, granulomatous keratic precipitates, and vitreous cells in the posterior segment. Imaging studies, including fundus photography, fluorescein angiography, fundus autofluorescence, optical coherence tomography, iridocyanine green angiography, and B scan ultrasonography, demonstrated acute inflammation in the posterior segment of the right eye and anterior, intermediate and posterior segments of the left eye. Nivolumab was discontinued and the patient received a course of corticosteroids resulting in resolution of visual complaints. The patient subsequently developed elevated and sustained intraocular pressures and decreased visual acuity in the left eye secondary to treatment complications. The patient was then lost to follow-up. Conclusions and Importance To our best knowledge, this is a rare case of bilateral uveitis secondary to intravenous nivolumab use and the sixteenth reported case of nivolumab-induced uveitis. Physicians should be aware of possible ocular complications associated with the use of nivolumab and provide prompt treatment when necessary.
Collapse
Affiliation(s)
| | - Nimesh A Patel
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
| | - Victor M Villegas
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
| | - J William Harbour
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
| |
Collapse
|
25
|
Leibowitz JA, Woods AT, Kesselman MM, Mayi BS. Uveitis as a Predictor of Predisposition to Autoimmunity. Cureus 2020; 12:e7451. [PMID: 32351830 PMCID: PMC7186109 DOI: 10.7759/cureus.7451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The right environmental trigger can lead to immune system activation, which, in turn, can create an autoimmune reaction. Although each autoimmune disease is characterized by specific symptoms, many nonspecific symptoms can make these conditions difficult to diagnose. In this literature review, we seek an association between immunization-induced uveitis and an autoimmune diagnosis and/or autoimmune flare-up in patients. Our goal is to consider adverse reactions to vaccines as a possible warning sign of current or future autoimmune disease. If an immunization-induced adverse reaction is known to be a predictor of an autoimmune disease, the clinician could raise suspicion for autoimmune disease when a patient presents with vaccine-associated uveitis. While no direct correlations can be made yet, our review supports closer scrutiny of the association of immunizations and autoimmune disorders. The occurrence of uveitis across several autoimmune diseases could mean a possible link between vaccine-induced uveitis and undiagnosed autoimmune disease. Researchers can, therefore, perform retrospective studies on vaccinated patients and investigate the occurrence of uveitis, along with the timeframe of resolution and presenting symptoms at the time of the diagnosis of autoimmune disease.
Collapse
Affiliation(s)
- Jillian A Leibowitz
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Arden T Woods
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Marc M Kesselman
- Rheumatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Bindu S Mayi
- Basic Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| |
Collapse
|
26
|
Massa H, Pipis SY, Adewoyin T, Vergados A, Patra S, Panos GD. Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges. Clin Ophthalmol 2019; 13:1761-1777. [PMID: 31571815 PMCID: PMC6750710 DOI: 10.2147/opth.s180580] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
Macular edema (ME) is the most common sight-threatening complication in uveitis. The diagnostic and therapeutic management of the uveitic macular edema (UME) might be challenging due to the complex diagnostic workup and the difficulties physicians face to find the underlying cause, and due to its usually recurrent nature and the fact that it can be refractory to conventional treatment. Some of the mild cases can be treated with topical steroids, which can be combined with non-steroid anti-inflammatory drugs. However, immunomodulators such as methotrexate, tacrolimus, azathioprine, cyclosporine and mycophenolate mofetil together with anti-tumor necrosis factor-α (anti-TNF alpha) monoclonal antibodies such as adalimumab and infliximab, may be required to control the inflammation and the associated ME in refractory cases, or when an underlying disease is present. This review of the literature will focus mostly on the non-infectious UME.
Collapse
Affiliation(s)
- Horace Massa
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Spyros Y Pipis
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Temilade Adewoyin
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Athanasios Vergados
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Sudeshna Patra
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Georgios D Panos
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
27
|
Fotiadou C, Lazaridou E. Psoriasis and uveitis: links and risks. PSORIASIS (AUCKLAND, N.Z.) 2019; 9:91-96. [PMID: 31696050 PMCID: PMC6717847 DOI: 10.2147/ptt.s179182] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/01/2019] [Indexed: 01/10/2023]
Abstract
Uveitis, an inflammatory disorder of the mid-portion of the eye, is considered a relatively rare but very serious ocular complication of psoriasis. Data on the specific characteristics of uveitis in the background of psoriasis are extremely limited. The presence of uveitis in the context of psoriasis has been estimated to occur in 7-20% of the psoriasis cases. This incidence tends to be higher in patients suffering from psoriasis and psoriatic arthritis (PsA) or PSA alone. Psoriatic uveitis is usually bilateral, chronic, and severe. In term of pathogenesis, both psoriasis and uveitis are considered as paradigms of T-helper 1/T-helper 17 (Th1/Th17) inflammatory reactions. Certain cytokines such as tumor necrosis factor-α (TNF- α), Interleukin-17 (IL-17), IL-23, and IL-6 play a significant role in the pathogenesis of both psoriasis and uveitis. As uveitis shares common pathogenetic mechanisms with psoriasis in certain circumstances, both diseases may benefit from the same targeted biologic therapies. Undiagnosed and under-treated cases of psoriatic uveitis may cause significant morbidity and even vision loss. Larger prospective studies are needed in order to further investigate the association between these two entities.
Collapse
Affiliation(s)
- Christina Fotiadou
- Second Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- Second Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| |
Collapse
|
28
|
Stoyukhina AS. [Local choroiditis after influenza vaccination (a clinical case study)]. Vestn Oftalmol 2019; 135:108-112. [PMID: 31215541 DOI: 10.17116/oftalma2019135021108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article describes a difficult case of differential diagnosis of local choroiditis developed after influenza (flu) vaccination in a patient with bronchial asthma who receives systemic steroid therapy.
Collapse
Affiliation(s)
- A S Stoyukhina
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| |
Collapse
|
29
|
Cunningham ET, Moorthy RS, Fraunfelder FW, Zierhut M. Vaccine-Associated Uveitis. Ocul Immunol Inflamm 2019; 27:517-520. [DOI: 10.1080/09273948.2019.1626188] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Emmett T. Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Ramana S. Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Indianapolis, Indiana, USA
- St. Vincent Hospital and Health Services, Indianapolis, Indiana, USA
- Department of Ophthalmology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Frederick W. Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri, Columbia, Missouri, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
| |
Collapse
|
30
|
Abstract
A 25-year-old female presented with a decrease of vision and redness in both eyes. She had a history of nodular melanoma in her right shoulder, which was excised surgically and she was under oral vemurafenib treatment. She was diagnosed with moderately severe bilateral panuveitis and hospitalized for systemic investigation and workup. The laboratory test results were unremarkable and systemic workup failed to reveal an etiology. The condition was considered vemurafenib-induced uveitis, as the drug is known to be associated with uveitis. After reevaluation with the oncology department, vemurafenib was stopped and topical and systemic corticosteroid therapy was started. The uveitis resolved and her vision returned to normal. No sign of recurrence was detected at 8-month follow-up.
Collapse
Affiliation(s)
- Selçuk Sızmaz
- Çukurova University Faculty of Medicine, Department of Ophthalmology, Adana, Turkey
| | - Nuhkan Görkemli
- Çukurova University Faculty of Medicine, Department of Ophthalmology, Adana, Turkey
| | - Ebru Esen
- Çukurova University Faculty of Medicine, Department of Ophthalmology, Adana, Turkey
| | - Nihal Demircan
- Çukurova University Faculty of Medicine, Department of Ophthalmology, Adana, Turkey
| |
Collapse
|
31
|
Hassan M, Maleki A, Ying Q, Nguyen N, Halim MS, Sepah YJ, Do DV, Nguyen QD. Alendronate induced chorioretinitis: The importance of meticulous assessments. Am J Ophthalmol Case Rep 2019; 14:21-25. [PMID: 30809598 PMCID: PMC6374782 DOI: 10.1016/j.ajoc.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 12/11/2018] [Accepted: 01/08/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose To report a case of presumed bilateral chorioretinitis secondary to alendronate therapy. Observations A 71-year-old female presented to the clinic in July 2017 with six months history of difficulty in reading along with floaters in both eyes which were more severe in the right eye. Past medical and surgical history revealed a history of hypertension, gout, hyperthyroidism, osteoporosis, and humerus fracture. She was started on alendronate three months before developing ocular symptoms. On ocular examination, best corrected visual acuity was 20/30 in the right and 20/25 in the left eye. Slit-lamp examination demonstrated normal anterior chamber examination in both eyes. Dilated fundus examination revealed geographic chorioretinal lesions around the optic nerve head in both eyes, more extensively in the right eye; and superior and temporal to the macula in the right eye. Past ocular records in February 2015 did not reveal any such findings. Fundus autofluorescence demonstrated hyper-autofluorescence in the peripapillary lesions in both eyes. The lesion adjacent to the macula in right eye displayed mixed hyper and hypo-autofluorescence. Fluorescein angiography showed combined hyper- and hypo-fluorescence compatible with window defect, staining and blockage. However, no leakage was appreciated in the macula, peripapillary, and peripheral lesions in both eyes. Optical coherence tomography scan showed septate hyporeflective intraretinal spaces in the right eye. Conclusion and importance The index report underscore the importance of considering alendronate as an etiologic cause of chorioretinitis, especially in subjects with atypical lesions developing after alendronate therapy. We, therefore, recommend discontinuation of this medication in subjects who develop chorioretinitis after employing this medication.
Collapse
Affiliation(s)
- Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Arash Maleki
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Qian Ying
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Nam Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | |
Collapse
|
32
|
|
33
|
Khalili MR, Amini AH, Abbaszadeh Hasiri M, Baghaei Moghaddam E, Eghtedari M, Azizzadeh M, Zare M, Yasemi M. Evaluation of intravitreal injection of pentoxifylline in experimental endotoxin-induced uveitis in rabbits. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2018; 9:239-244. [PMID: 30357062 PMCID: PMC6198157 DOI: 10.30466/vrf.2018.32083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Abstract
The objective of the present study was to investigate the clinical and histopathological effects of intravitreal injection of pentoxifylline (PTX) the management of an experimental model of uveitis. Fifty-two rabbits were divided randomly into six intravitreal treated groups as below: 1) Balanced salt solution (BSS), 2) Salmonella typhimurium lipopolysaccharide endotoxin (LPS) + BSS, 3) LPS + PTX 100 μg, 4) LPS + PTX 500 μg, 5) BSS + PTX 100 μg and 6) BSS + PTX 500 μg. Inflammation was evaluated by clinical examinations using slit lamp on days 1, 3, 5 and 7 post injections and histopathological examinations were also performed at the end of the study. Clinical examinations demonstrated a statistically significant difference between group 1 and group 2 on day 5 and day 7. Moreover, the comparison of clinical severity scores of group 1 with groups 3, 4, 5 and 6, on third, fifth and seventh post-injection days showed statistically significant differences. The mean histopathological inflammation intensity score in groups 5 and 6 was significantly higher than group 1. The mean histopathological inflammation intensity score in groups 3, 4, 5 and 6 was significantly higher than group 2. Intravitreal injection of PTX in an experimental model of uveitis in rabbits not only does not reduce inflammation but also leads to inflammation when used alone or in combination with LPS.
Collapse
Affiliation(s)
- Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Hossein Amini
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | | | - Effat Baghaei Moghaddam
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Masoomeh Eghtedari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Azizzadeh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mousa Zare
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masood Yasemi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
34
|
Groen-Hakan F, Babu K, Tugal-Tutkun I, Pathanapithoon K, de Boer JH, Smith JR, de Groot-Mijnes JD, Rothova A. Challenges of Diagnosing Viral Anterior Uveitis. Ocul Immunol Inflamm 2017; 25:710-720. [DOI: 10.1080/09273948.2017.1353105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fahriye Groen-Hakan
- Department of Ophthalmology, Faculty of Medicine, Erasmus University, Rotterdam, The Netherlands
| | - Kalpana Babu
- Prabha Eye Clinic & Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kessara Pathanapithoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Joke H. de Boer
- Department of Ophthalmology, Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Justine R. Smith
- Eye & Vision Health, Flinders University School of Medicine, Adelaide, Australia
| | | | - Aniki Rothova
- Department of Ophthalmology, Faculty of Medicine, Erasmus University, Rotterdam, The Netherlands
| |
Collapse
|
35
|
Krishna U, Ajanaku D, Denniston AK, Gkika T. Uveitis: a sight-threatening disease which can impact all systems. Postgrad Med J 2017; 93:766-773. [PMID: 28942431 DOI: 10.1136/postgradmedj-2017-134891] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/31/2017] [Accepted: 08/20/2017] [Indexed: 02/06/2023]
Abstract
Uveitis describes a group of conditions characterised by intraocular inflammation. The term uveitis technically describes inflammation of the uvea which comprises the iris, ciliary body and choroid, however now encompasses inflammation of adjacent intraocular structures such as the retina, vitreous and optic nerve. Uveitis is a significant cause of blindness worldwide, but its impact is generally underappreciated due to a lack of awareness and understanding of the condition among the public and most non-ophthalmic healthcare professionals. In this review, we provide an introduction to uveitis for the non-specialist, outlining the clinical presentations that should raise the suspicion of the disease, the signs that should be looked for and a framework in which to understand the condition. We show how a logical approach to classifying uveitis by aetiology and anatomical focus of disease provides the basis for treatment strategies (drug and route of administration) and clinical presentation and prognosis. We also show why understanding uveitis is helpful to clinicians working in almost every speciality due to the wide-ranging associations with systemic disease.
Collapse
Affiliation(s)
- Unnat Krishna
- Department of Ophthalmology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Deji Ajanaku
- Department of Ophthalmology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK
| | - Theodora Gkika
- Department of Ophthalmology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
36
|
Rangel CM, Parra MM, Frederick G, Tello A, Varón CL. An unusual case of bilateral anterior uveitis related to moxifloxacin: the first report in Latin America. GMS OPHTHALMOLOGY CASES 2017; 7:Doc18. [PMID: 28706771 PMCID: PMC5506693 DOI: 10.3205/oc000069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To report a case of bilateral anterior uveitis secondary to oral moxifloxacin. Methods: Case report. Results: A 54-year-old female presented bilateral anterior uveitis following a 10-day course of oral moxifloxacin. She developed a bilateral anterior uveitis associated with pigment dispersion syndrome and iris transillumination. Conclusions: Drug-induced uveitis is one of the causes of anterior uveitis. Uveitis related to fluoroquinolones is a rare entity, there are few cases reported in the literature, this is the first case reported in Latin America.
Collapse
Affiliation(s)
- Carlos M Rangel
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - M Margarita Parra
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Gabriel Frederick
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Alejandro Tello
- Anterior Segment and Refractive Surgery Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Clara L Varón
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| |
Collapse
|
37
|
RELATIONSHIP BETWEEN UVEITIS, DIFFERENT TYPES OF VIRAL HEPATITIS, AND LIVER CIRRHOSIS: A 12-Year Nationwide Population-Based Cohort Study. Retina 2017; 36:2391-2398. [PMID: 27870801 PMCID: PMC5181127 DOI: 10.1097/iae.0000000000001103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE This study investigates whether patients with viral hepatitis and cirrhosis are at risk of uveitis in the years following hepatitis. METHODS We used data from Taiwan National Health Insurance system. The cases were patients newly diagnosed with viral hepatitis from 2000 to 2011. The end point of interest was a diagnosis of uveitis. A chi-square test was used for the difference of demographic characteristics between viral hepatitis and comparison. The risk of uveitis in hepatitis was stratified using Cox proportional hazard regression. RESULTS We selected 17,389 patients with viral hepatitis and 34,778 matched comparison. The risk of uveitis in hepatitis cohort was 1.30-fold (95% confidence interval = 1.01-1.69). Patients with hepatitis B virus and hepatitis C virus coinfection had the highest risk (hazard ratio = 2.88; 95% confidence interval = 1.07-7.78), and followed by only hepatitis C virus infection (hazard ratio = 1.75; 95% confidence interval = 1.10-2.79). Patients with cirrhosis had a higher risk in the multivariable model but did not attach statistic difference. CONCLUSION Patients with hepatitis B virus and hepatitis C virus coinfection had the highest risk of uveitis. In patients with hepatitis C virus and/or hepatitis B virus infection, the symptoms of uveitis should be alerted. Although these epidemiologic studies yielded informative results, the underlying mechanisms and the host's genetic factors remain to be investigated.
Collapse
|
38
|
Kocak ED, Wang BZ, Hall AJ. Bilateral uveitis following intravenous immunoglobulin administration. Am J Ophthalmol Case Rep 2017; 6:74-76. [PMID: 29260064 PMCID: PMC5722169 DOI: 10.1016/j.ajoc.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/09/2017] [Accepted: 03/01/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose To report a case of bilateral acute anterior uveitis in an adult female occurring following the administration of intravenous immunoglobulin (IVIG). Observations A 44-year-old female patient was commenced on IVIG following presentation to hospital with upper limb neuropathic pain. Within two days, she developed bilateral red, painful photophobic eyes. Examination revealed bilateral acute anterior uveitis and IVIG was ceased. Investigations for autoimmune or infective causes for the uveitis were unremarkable. Complete resolution of the uveitis was achieved with topical corticosteroids and cessation of IVIG. Conclusions and importance Clinicians should be aware of the possibility of uveitis as an adverse effect of IVIG. Early identification of the offending medication and its cessation in this case were associated with a good visual prognosis.
Collapse
Affiliation(s)
- Enis D Kocak
- Department of Ophthalmology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Bob Z Wang
- Department of Ophthalmology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Department of Ophthalmology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| |
Collapse
|
39
|
Karlin J, Gentzler R, Golen J. Bilateral Anterior Uveitis Associated with Nivolumab Therapy. Ocul Immunol Inflamm 2016; 26:283-285. [PMID: 27599197 DOI: 10.1080/09273948.2016.1215473] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Justin Karlin
- a Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
| | - Ryan Gentzler
- b Department of Hematology and Oncology , University of Virginia , Charlottesville , Virginia , USA
| | - Jeffrey Golen
- a Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
| |
Collapse
|
40
|
Cunningham ET, London NJS, Moorthy R, Garg SJ, Zierhut M. Drugs, Inflammation, and the Eye. Ocul Immunol Inflamm 2016; 24:125-7. [DOI: 10.3109/09273948.2016.1160683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
41
|
Todokoro D, Itakura H, Ibe T, Kishi S. Anterior Uveitis Caused by Ocular Side Effects of Afatinib: A Case Report. Case Rep Ophthalmol 2016; 7:74-8. [PMID: 26933433 PMCID: PMC4772633 DOI: 10.1159/000444047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Afatinib is a second-generation epidermal growth factor receptor (EGFR) inhibitor that has been shown to be effective against EGFR-mutated non-small cell lung cancer (NSCLC) resistant to conventional EGFR inhibitors such as gefitinib and erlotinib. Although ocular side effects of gefitinib and erlotinib have been reported, those for afatinib have yet to be definitively established. This report presents details on the first case of unilateral iridocyclitis associated with the side effects of afatinib therapy. A 75-year-old Japanese male ex-smoker with EGFR-mutated NSCLC underwent afatinib therapy for multiple metastases. At 2 weeks, bilateral conjunctivitis developed. Topical medication and a 1-week afatinib washout period resulted in the improvement of the conjunctivitis. However, 3 days after the resumption of afatinib, the patient developed unilateral granulomatous anterior uveitis in his right eye. Best-corrected visual acuity (BCVA) measurement indicated a decimal visual acuity of 0.2, while the slit-lamp findings were characterized by granulomatous inflammation, keratic precipitates, Koeppe nodules and posterior synechiae. There was no evidence suggesting other intraocular inflammatory disease or metastatic tumor. The left eye was intact. The use of topical medication including steroids and a washout of afatinib resulted in a gradual subsiding of the anterior uveitis. After resolution of the anterior uveitis, oral afatinib was resumed. BCVA of the right eye finally recovered to a decimal acuity of 1.0. Ophthalmologists should be aware of the possibility that side effects associated with afatinib could cause granulomatous anterior uveitis.
Collapse
Affiliation(s)
- Daisuke Todokoro
- Department of Ophthalmology, Gunma University Graduate School of Medicine, and Departments of, Maebashi Red Cross Hospital, Maebashi, Japan
| | | | - Takashi Ibe
- General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University Graduate School of Medicine, and Departments of, Maebashi Red Cross Hospital, Maebashi, Japan
| |
Collapse
|
42
|
Benage M, Fraunfelder FW. Vaccine-Associated Uveitis. MISSOURI MEDICINE 2016; 113:48-52. [PMID: 27039491 PMCID: PMC6139748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
All of the widely administered vaccines have been reported to cause uveitis. The ocular inflammation is usually temporary and resolves with topical ocular steroids. During a 26-year period, a total of 289 cases of vaccine-associated uveitis were reported to three adverse reaction reporting databases. Hepatitis B vaccine, either alone or administered with other vaccines, appears to be the leading offender. Clinicians are encouraged to report cases of vaccine- or drug-associated ocular adverse reactions to www.eyedrugregistry.com.
Collapse
|
43
|
Manusow JS, Rai A, Yeh S, Mandelcorn ED. Two cases of panuveitis with orbital inflammatory syndrome after influenza vaccination. Can J Ophthalmol 2015; 50:e71-4. [DOI: 10.1016/j.jcjo.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 05/10/2015] [Accepted: 05/26/2015] [Indexed: 01/23/2023]
|
44
|
|
45
|
Draganova D, Kerger J, Caspers L, Willermain F. Severe bilateral panuveitis during melanoma treatment by Dabrafenib and Trametinib. J Ophthalmic Inflamm Infect 2015; 5:17. [PMID: 26078801 PMCID: PMC4460117 DOI: 10.1186/s12348-015-0049-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report a case of severe bilateral panuveitis during melanoma therapy with a combination of Dabrafenib, a B-raf (BRAF) inhibitor, and Trametinib, a mitogen/extracellular signal-regulated kinase (MEK) inhibitor. Both of these drugs are effectors in the mitogen-activated protein kinase (MAPK) pathway, which plays an important role in the physiopathology of melanoma. Dabrafenib and Trametinib have shown improved survival of patients with metastatic melanoma but they have also been associated with the development of uveitis. FINDINGS Our patient was a 55-year-old woman with metastatic melanoma who presented with sudden onset of bilateral painless visual loss. She had been treated with Dabrafenib and Trametinib. Trametinib was discontinued at the onset of symptoms but there was no improvement. Ophthalmological examination revealed severe bilateral non-granulomatous panuveitis, with choroidal thickening, chorio-retinal folds, and multiple serous retinal detachments (SRDs). Topical corticosteroid treatment was initiated, and Dabrafenib was discontinued. A good response was obtained with a recovery of visual acuity of 20/25 on both eyes and an almost complete resolution of the SRDs. CONCLUSIONS This case highly suggests that MAPK pathway inhibition can lead to severe uveitis. Dabrafenib and Trametinib could have both played a role in inducing the disease. Further studies are needed to evaluate the possible role of the combination of these drugs in inducing uveitis and SRD.
Collapse
Affiliation(s)
- Dafina Draganova
- Department of Ophthalmology, Saint Pierre University Hospital, rue Haute 322, Brussels, 1000 Belgium
| | - Joseph Kerger
- Jules Bordet Institute, Boulevard de Waterloo 121, Brussels, 1000 Belgium
| | - Laure Caspers
- Department of Ophthalmology, Saint Pierre University Hospital, rue Haute 322, Brussels, 1000 Belgium
| | - François Willermain
- Department of Ophthalmology, Saint Pierre University Hospital, rue Haute 322, Brussels, 1000 Belgium
| |
Collapse
|
46
|
Prete M, Dammacco R, Fatone MC, Racanelli V. Autoimmune uveitis: clinical, pathogenetic, and therapeutic features. Clin Exp Med 2015; 16:125-36. [PMID: 25820692 DOI: 10.1007/s10238-015-0345-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/07/2015] [Indexed: 01/18/2023]
Abstract
Autoimmune uveitis (AU), an inflammatory non-infectious process of the vascular layer of the eye, can lead to visual impairment and, in the absence of a timely diagnosis and suitable therapy, can even result in total blindness. The majority of AU cases are idiopathic, whereas fewer than 20 % are associated with systemic diseases. The clinical severity of AU depends on whether the anterior, intermediate, or posterior part of the uvea is involved and may range from almost asymptomatic to rapidly sight-threatening forms. Race, genetic background, and environmental factors can also influence the clinical picture. The pathogenetic mechanism of AU is still poorly defined, given its remarkable heterogeneity and the many discrepancies between experimental and human uveitis. Even so, the onset of AU is thought to be related to an aberrant T cell-mediated immune response, triggered by inflammation and directed against retinal or cross-reactive antigens. B cells may also play a role in uveal antigen presentation and in the subsequent activation of T cells. The management of AU remains a challenge for clinicians, especially because of the paucity of randomized clinical trials that have systematically evaluated the effectiveness of different drugs. In addition to topical treatment, several different therapeutic options are available, although a standardized regimen is thus far lacking. Current guidelines recommend corticosteroids as the first-line therapy for patients with active AU. Immunosuppressive drugs may be subsequently required to treat steroid-resistant AU and for steroid-sparing purposes. The recent introduction of biological agents, such as those targeting tumor necrosis factor-α, is expected to remarkably increase the percentages of responders and to prevent irreversible sight impairment. This paper reviews the clinical features of AU and its crucial pathogenetic targets in relation to the current therapeutic perspectives. Also, the largest clinical trials conducted in the last 12 years for the treatment of AU are summarized and critically discussed.
Collapse
Affiliation(s)
- Marcella Prete
- Internal Medicine Unit, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Rosanna Dammacco
- Department of Otorhinolaryngology and Ophthalmology, University of Bari Medical School, Bari, Italy
| | - Maria Celeste Fatone
- Internal Medicine Unit, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Vito Racanelli
- Internal Medicine Unit, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, 70124, Bari, Italy
| |
Collapse
|
47
|
|
48
|
Abstract
INTRODUCTION Drug-induced uveitis is a well described but often overlooked and/or misdiagnosed adverse reaction to medication. There are an increasing number of medications that have been related to the onset of intraocular inflammation. Identification of these inciting agents may decisively help the diagnostic algorithm involving new cases of uveitis. AREAS COVERED This review intends to be an updated comprehensive, practical guide for practitioners regarding the main drugs that have been associated with uveitis. A classification proposed by Naranjo et al. in 1981 for establishing potential causality is applied examining possible mechanisms of action. A guide for clinicians about the rationale of these observations when dealing with patients with uveitis is provided. EXPERT OPINION Several agents with different routes of administration (systemic, topical and/or intraocular) may cause intraocular inflammation. The mechanism behind ocular inflammation is frequently unknown. Clinicians should be aware of the potential drug effect to optimize diagnosis and management of such patients.
Collapse
Affiliation(s)
- Miguel Cordero-Coma
- Department of Ophthalmology, University Hospital of León , León , Spain +34 987237400 ; +34 987233322 ;
| | | | | | | |
Collapse
|
49
|
Diagnostic and therapeutic challenges. Retina 2014; 35:590-6. [PMID: 25077531 DOI: 10.1097/iae.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Glading JA, Lake SR, Craig JE, Supramaniam D. Delayed onset panuveitis following intravitreal aflibercept injection. BMJ Case Rep 2014; 2014:bcr-2013-202515. [PMID: 24920511 DOI: 10.1136/bcr-2013-202515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Aflibercept has been listed on the Australian Pharmaceutical Benefit Scheme for the past year for neovascular age-related macular degeneration. Since that time there have not been any reports of delayed onset panuveitis. We present two cases of anterior and posterior uveitis that have occurred 4 weeks or more after first intravitreal injection of aflibercept. Both patients had received other vascular endothelial growth factor inhibitors prior to aflibercept administration without signs of inflammation and both cases had sterile endophthalmitis. On resolution of the inflammation the patients were recommenced on ranibizumab without further incident.
Collapse
Affiliation(s)
- Jodi A Glading
- Department of Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Stewart R Lake
- Department of Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia, Australia Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia, Australia Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
| | - Devaraj Supramaniam
- Department of Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| |
Collapse
|