1
|
Lobo-Antuña V, Cherti-Afailal A, García-Morales M, Ríos-Fernández R, de la Hera-Fernández FJ, García-Serrano JL, Callejas-Rubio JL. Rituximab-induced cystoid macular edema in a patient with systemic lupus erythematosus: A case report and literature review. Autoimmun Rev 2024; 23:103588. [PMID: 39128499 DOI: 10.1016/j.autrev.2024.103588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/02/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
Cystoid macular edema (CME) is considered a rare adverse effect of rituximab use, with only a limited number of cases published in the literature. Although its etiopathogenesis is still unknown, its mechanism seems to be related to a transient elevation of cytokines after rituximab infusion resulting in an increased permeability of retinal vessels. We report the first case of rituximab-induced CME in a patient with systemic lupus erythematosus (SLE), where rituximab was used to treat hematological complications. A month after the 2nd infusion, the patient developed blurred vision and decreased visual acuity in the right eye. An optic coherence tomography (OCT) was performed, being diagnosed with CME. Rituximab was then discontinued, exhibiting a complete resolution of the condition within 4 weeks. The aim of our work is to report the first case in a patient with SLE and also carry out a brief review of the subject comparing it to all previously published cases.
Collapse
Affiliation(s)
- Victoria Lobo-Antuña
- Internal Medicine Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | | | - Marta García-Morales
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Raquel Ríos-Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | | | - Jose Luis Callejas-Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| |
Collapse
|
2
|
Hsu CR, Hsieh YT, Yang CM, Lin CP. Single-dose Effect of Intravitreal Dexamethasone Implant for Post-vitrectomy Macular Edema under Silicone Oil. Ocul Immunol Inflamm 2023; 31:1587-1593. [PMID: 34477484 DOI: 10.1080/09273948.2021.1970779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the single-dose effect of intravitreal dexamethasone (DEX) implant for patients with post-vitrectomy macular edema (ME) under silicone oil (SO) tamponade. METHODS Twelve eyes diagnosed with ME after undergoing pars plana vitrectomy with SO injections were retrospectively reviewed. Each eye received a single intravitreal DEX implant (0.7-mg, Ozurdex; Allergan Inc) injection as treatment for recalcitrant ME. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. RESULTS Compared with baseline (1.24 ± 0.34), the mean LogMAR BCVA improved at 1 (1.14 ± 0.27), 3 (1.13 ± 0.22), and 6 (1.22 ± 0.30) months without statistical significance. Maximal CMT resolution was observed at 1 month after intravitreal injection. The CMT value improved significantly at 1 (P = .008), 3 (P = .006), and 6 (P = .009) months. IOP did not show significant elevation during follow-up. No serious adverse events were observed. CONCLUSION Single-dose treatment of DEX implant may have benefit for recalcitrant post-vitrectomy ME under SO tamponade.
Collapse
Affiliation(s)
- Cherng-Ru Hsu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
3
|
Arias JD, Kalaw FGP, Alex V, Yassin SH, Ferreyra H, Walker E, Wagner NE, Borooah S. Investigating the associations of macular edema in retinitis pigmentosa. Sci Rep 2023; 13:14187. [PMID: 37648803 PMCID: PMC10469217 DOI: 10.1038/s41598-023-41464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023] Open
Abstract
Macular edema (ME), the accumulation of intraretinal fluid in the macula, is a common sight affecting sequelae of retinitis pigmentosa (RP). However, it is unclear why some patients develop ME, and others do not. This study aims to identify associations between clinical-genetic factors in RP with ME. Patients with clinically confirmed RP cases were identified from the inherited retinal disease database at a large tertiary referral academic center. Demographic and genetic testing findings were noted. Additionally, optical coherence tomography volume scans were graded using a validated grading system. One hundred and six patients (73.1%) were found to have ME in at least one eye (OD = 88, mean = 37.9%, OS = 98, mean = 31.7%). Structurally, the presence of epiretinal membrane (ERM) (p < 0.007) and vitreo-macular traction (VMT) (p < 0.003) were significantly associated with ME. Additionally, X-linked (p < 0.032) and autosomal dominant inheritance (p < 0.039) demonstrated a significant association with ME, with RP1 (p < 0.045) and EYS (p < 0.017) pathogenic variants also significantly associated with ME. This study, in a large cohort of RP patients, confirms previous retinal structural associations for ME in RP and identifies potential new genetic associations.
Collapse
Affiliation(s)
- Juan D Arias
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
| | - Fritz Gerald P Kalaw
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Varsha Alex
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Shaden H Yassin
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Henry Ferreyra
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Evan Walker
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Naomi E Wagner
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Shyamanga Borooah
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA.
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA.
| |
Collapse
|
4
|
Alizadeh Ghavidel L, Mousavi F, Hashemi HS, Bagheri M. Optical coherence tomography angiography in intermediate uveitis-related cystoid macular edema. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2022; 11:19-26. [PMID: 37641694 PMCID: PMC10445323 DOI: 10.51329/mehdiophthal1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/22/2022] [Indexed: 08/31/2023]
Abstract
Background Cystoid macular edema (CME) is the leading cause of permanent visual impairment in patients with uveitis, particularly in patients with intermediate uveitis (IU). This study was aimed at comparing the changes in the macular microvasculature in patients with IU with uveitic non-responsive CME and without macular edema. Methods In this case-control study, 55 eyes of patients with IU were assessed for macular microvascular structures, including vascular density, foveal avascular zone (FAZ) measurement, and vascular morphological changes, using spectral-domain optical coherence tomography angiography (OCT-A) with the AngioVue OCT-A system. We divided patients into the following two groups: the case group, including 30 eyes with IU-related non-responsive CME, and the control group, including 25 eyes with IU without macular edema. Results Participants in the case and control groups had comparable age (P = 0.753) and sex (P = 0.124) distributions. Superficial capillary plexus vessel density in the case group was significantly decreased in the whole image (P = 0.027) and the parafoveal area (P = 0.001) compared to the control group. However, there were no statistically significant differences between the two groups in terms of foveal superficial vessel density, deep capillary plexus vessel density, FAZ area, FAZ perimeter, FAZ acircularity index, or foveal vessel density in a 300-µm-wide annulus around the FAZ (all P > 0.05). Vascular morphological changes, such as the capillary tuft, telangiectatic vessels, or micro-aneurism, were not different in the overview images of the OCT-A printout between the two groups. Conclusions The mean superficial capillary plexus vessel density was lower in eyes with IU-related nonresponsive CME than in those without macular edema. We observed more cystoid spaces in SCP than in DCP. Microcystic changes in the inner retina and ischemia may be the underlying cause in eyes with nonresponsive CME. Future prospective longitudinal studies with healthy, matched controls are warranted to confirm our findings.
Collapse
Affiliation(s)
| | - Farideh Mousavi
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hesam Sadat Hashemi
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Bagheri
- Department of Ophthalmology, Imam Khomeini Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
5
|
Blanchard C, O’Keefe G. Peri and Postoperative Management of Cataract Surgery in Eyes with Ocular Inflammation. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Update on the Management of Uveitic Macular Edema. J Clin Med 2021; 10:jcm10184133. [PMID: 34575244 PMCID: PMC8470573 DOI: 10.3390/jcm10184133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022] Open
Abstract
Uveitic macular edema (ME) is a frequent complication in 8.3% of uveitis patients and is a leading cause of serious visual impairment in about 40% of cases. Despite the numerous available drugs for its treatment, at least a third of patients fail to achieve satisfactory improvement in visual acuity. First-line drugs are steroids administered by various routes, but drug intolerance or ineffectiveness occur frequently, requiring the addition of other groups of therapeutic drugs. Immunomodulatory and biological drugs can have positive effects on inflammation and often on the accompanying ME, but most uveitic randomized clinical trials to date have not aimed to reduce ME; hence, there is no clear scientific evidence of their effectiveness in this regard. Before starting therapy to reduce general or local immunity, infectious causes of inflammation should be ruled out. This paper discusses local and systemic drugs, including steroids, biological drugs, immunomodulators, VEGF inhibitors, and anti-infection medication.
Collapse
|
7
|
Ramtohul P, Boulicot-Seguin C, Marc C. INTRAOCULAR JARISCH-HERXHEIMER REACTION IN LEMIERRE SYNDROME. Retin Cases Brief Rep 2021; 15:445-449. [PMID: 30074939 DOI: 10.1097/icb.0000000000000813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report an intraocular Jarisch-Herxheimer reaction induced by Lemierre syndrome antibiotherapy. METHODS Case report. RESULTS A 43-year-old-man presented with an acute onset of bilateral blurred vision few days after intravenous antibiotic administration for Lemierre syndrome. Best-corrected visual acuity was 20/32 in both eyes. Examination revealed bilateral cystoid macular edema and peripheral retinal vasculitis, persisting despite Lemierre syndrome recovery with antibiotics. Intravitreal injection of ranibizumab 0.5 mg (0.05 mL) was performed in both eyes. After 1 month, cystoid macular edema and retinal vasculitis were totally resolved, and best-corrected visual acuity increased to 20/20 in both eyes. The paradoxical worsening of the patient's best-corrected visual acuity after initiating antibiotherapy evokes a Jarisch-Herxheimer reaction. The result of this single intravitreal injection of ranibizumab was sustained; best-corrected visual acuity remained unchanged (20/20 in both eyes), and no recurrence of cystoid macular edema or retinal vasculitis was found after 4-year follow-up. CONCLUSION To the best of our knowledge, this is the first reported case of an isolated intraocular Jarisch-Herxheimer reaction induced by Lemierre syndrome antibiotherapy and successfully treated with a single intravitreal injection of ranibizumab.
Collapse
Affiliation(s)
- Prithvi Ramtohul
- Department of Ophthalmology, Centre Hospitalier Henri Duffaut d'Avignon, Avignon, France
| | | | | |
Collapse
|
8
|
Thapa R, Khanal S, Tan HS, Thapa SS, van Rens GHMB. Prevalence, Pattern and Risk Factors of Retinal Diseases Among an Elderly Population in Nepal: The Bhaktapur Retina Study. Clin Ophthalmol 2020; 14:2109-2118. [PMID: 32801619 PMCID: PMC7399464 DOI: 10.2147/opth.s262131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Retinal diseases are an emerging cause of visual impairment in the developing world. The aim of this study was to explore the prevalence, pattern, and risk factors of retinal diseases in Nepal. Methods This is a population-based, cross-sectional study conducted from 2013 to 2015. The sample size was 2100 subjects age 60 years and above from 30 clusters of Bhaktapur district, Nepal. Detailed history, visual acuity, and anterior and posterior segment examinations were performed. Blood sugar and blood pressure were measured. Results Complete information was available for 1860 (88.57%) subjects. Mean age was 69.64±7.31 years, ranging from 60 to 95 years. The prevalence of any retinal disorder was 52.37% (95% confidence interval (CI): 50.07–54.66%). The prevalence of retinal disorders increased with ageing: 51.26% between 60 and 69 years and 53.05% among those age 80 years and above. Age-related macular degeneration (AMD) was the most common retinal disease (35.43%), followed by hypertensive retinopathy (4.35%), epiretinal membrane (ERM) (3.66%), branch retinal vein occlusion (BRVO) (2.90%), and diabetic retinopathy (DR) (2.15%). Other rare retinal disorders included myopic fundus (0.86%), chorioretinal scar (0.54%), retinal holes (0.32%), retinitis pigmentosa (0.32%), retinal detachment (0.16%), and coloboma (0.11%). In multivariate logistic regression analysis, those with prior cataract surgery (odds ratio (OR), 1.71; 95% CI: 1.32–2.22, p < 0.001) and systemic hypertension (OR, 1.21; 95% CI: 1.001–1.47, p = 0.049) had significantly increased retinal disorders. Conclusion Prevalence of retinal disorder was 52.37% at age 60 years and above. AMD, hypertensive retinopathy, ERM, BRVO, and DR were the most common retinal disorders. Retinal disorders increased with ageing. Retinal disorders were found associated with hypertension and prior cataract surgery. Timely screening, control of blood sugar and high blood pressure, and regular eye check-ups could help to save vision from retinal diseases.
Collapse
Affiliation(s)
- Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Hendra Stevie Tan
- Department of Ophthalmology, Amsterdam University Medical Center, Vrije University Amsterdam, Amsterdam, the Netherlands
| | | | | |
Collapse
|
9
|
Effect of intracameral phenylephrine 1.0%–ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery. J Cataract Refract Surg 2020; 46:867-872. [DOI: 10.1097/j.jcrs.0000000000000193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
The Role of Subthreshold Micropulse Yellow Laser as an Alternative Option for the Treatment of Refractory Postoperative Cystoid Macular Edema. J Clin Med 2020; 9:jcm9041066. [PMID: 32283698 PMCID: PMC7230455 DOI: 10.3390/jcm9041066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and the safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic postoperative cystoid macular edema (PCME), which is refractory to standard therapies. METHODS A retrospective chart review of ten eyes of ten patients affected by refractory PCME who underwent SMYL was performed. Five PCME cases were subsequent to uncomplicated cataract surgery (CS), two cases to complicated CS (CCS) with posterior capsule rupture and three cases occurred after retinal detachment surgery (RD). All conditions were refractory to conventional treatments prior to SMYL interventions for at least 4 months, including nonsteroidal anti-inflammatory eyedrops, topical steroids, oral indomethacin, sub-Tenon's triamcinolone injections and Dexamethasone intravitreal implants. All patients underwent one or more treatments with 577 nm SMYL photo-stimulation, with 7 × 7 grids with confluent spots and a 5% duty cycle covering the whole edematous retina, including the foveal center. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were obtained using OCT, and evaluated before and after the treatment at 1, 2, 3 and 6-month follow-ups. RESULTS A complete subfoveal macular edema resolution was observed in all of the eyes, with statistically significant improvements in terms of BCVA and CMT in all of the follow-up timelines (at 6 months, p = 0.002 and p = 0.005, respectively). The mean number of laser treatments was 1.3. At the final follow-up, a complete subfoveal edema reabsorption was observed in all patients with visual acuity improvement. No complications were observed in any case. CONCLUSIONS SMYL seems to be a safe and effective treatment for the long-term resolution of refractory PCME and may be a useful alternative to expensive and invasive therapeutic options.
Collapse
|
11
|
Ozates S, Berker N, Cakar Ozdal P, Ozdamar Erol Y. Phacoemulsification in patients with uveitis: long-term outcomes. BMC Ophthalmol 2020; 20:109. [PMID: 32183739 PMCID: PMC7079372 DOI: 10.1186/s12886-020-01373-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To assess the long-term outcomes of phacoemulsification and intraocular lens (IOL) implantation in eyes with uveitis. METHODS One hundred and five eyes of 81 patients, who underwent phacoemulsification and IOL implantation between January 2009 and July 2016, were included in this study. The demographic data, preoperative clinical findings, postoperative outcomes, and intraoperative and postoperative complications were recorded. All collected data and risk factors with regard to visual prognosis were analyzed with the help of the Statistical Package for the Social Sciences version 20.0 software program (IBM Corp., Armonk, NY, USA). RESULTS During follow-up (mean: 35.2 ± 22.2 months), corrected distance visual acuity (CDVA) improved in 87.7% of all eyes and reached a level of 0.3 LogMAR or greater in 61.3% of eyes. Postoperative complications included posterior capsule opacification (50.9%), posterior synechiae (21.7%), cystoid macular edema (16%), epiretinal membrane (13.2%), glaucoma (11.3%), increased intraocular pressure (8.5%), and severe inflammation (6.6%). Uveitis recurred in 55.7% of all eyes. The risk for the development of cystoid macular edema was found to be associated with recurrence in the early postoperative period. Low visual acuity risk was 11.1-fold higher with macular scarring (p = 0.001) and 14-fold higher with optic atrophy (p < 0.001), respectively. CONCLUSIONS With appropriate management during the pre- and postoperative periods, phacoemulsification and IOL implantation surgery can be safe and effective in eyes with uveitis. However, great caution must be taken to prevent complications both before and after the surgery.
Collapse
Affiliation(s)
- Serdar Ozates
- Department of Ophthalmology, Kars Harakani State Hospital, Yenişehir Mahallesi, İsmail Aytemiz Blv. No:55, 36200, Merkez, Kars, Turkey.
| | - Nilufer Berker
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pinar Cakar Ozdal
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Yasemin Ozdamar Erol
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
12
|
Holló G, Aung T, Cantor LB, Aihara M. Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management. Surv Ophthalmol 2020; 65:496-512. [PMID: 32092363 DOI: 10.1016/j.survophthal.2020.02.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.
Collapse
Affiliation(s)
- Gábor Holló
- Glaucoma Unit, Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Opthalmology, National University of Singapore, Singapore
| | - Louis B Cantor
- Department of Opthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Makoto Aihara
- Department of Opthalmology, University of Tokyo, Tokyo, Japan
| |
Collapse
|
13
|
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
|
14
|
Anti-IL6-Receptor Tocilizumab in Refractory and Noninfectious Uveitic Cystoid Macular Edema: Multicenter Study of 25 Patients. Am J Ophthalmol 2019; 200:85-94. [PMID: 30660771 DOI: 10.1016/j.ajo.2018.12.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Cystoid macular edema (CME) is a leading cause of blindness. This study assessed the efficacy and safety of tocilizumab (TCZ) in refractory CME. DESIGN Retrospective case series. METHODS Patients with CME secondary to noninfectious uveitis who had inadequate response to corticosteroids and at least 1 conventional immunosuppressive drug, and in most cases to other biological agents, were studied. CME was defined as central retinal thickness greater than 300 μm. The primary outcome measure was macular thickness. Intraocular inflammation, best-corrected visual acuity (BCVA), and corticosteroid-sparing effect were also analyzed. RESULTS A total of 25 patients (mean ± standard deviation age 33.6 ± 18.9 years; 17 women) with CME were assessed. Underlying diseases associated with uveitis-related CME are juvenile idiopathic arthritis (n = 9), Behçet disease (n = 7), birdshot retinochoroidopathy (n = 4), idiopathic (n = 4), and sarcoidosis (n = 1). The ocular patterns were panuveitis (n = 9), anterior uveitis (n = 7), posterior uveitis (n = 5), and intermediate uveitis (n = 4). Most patients had CME in both eyes (n = 24). TCZ was used in monotherapy (n = 11) or combined with conventional immunosuppressive drugs. Regardless of the underlying disease, compared to baseline, a statistically significant improvement in macular thickness (415.7 ± 177.2 vs 259.1 ± 499.5 μm; P = .00009) and BCVA (0.39 ± 0.31 vs 0.54 ± 0.33; P = .0002) was obtained, allowing us to reduce the daily dose of prednisone (15.9 ± 13.6 mg/day vs 3.1 ± 2.3 mg/day; P = .002) after 12 months of therapy. Remission was achieved in 14 patients. Only minor side effects were observed after a mean follow-up of 12.7 ± 8.34 months. CONCLUSION Macular thickness is reduced following administration of TCZ in refractory uveitis-related CME.
Collapse
|
15
|
Kianersi F, Rezaeian-Ramsheh A, Pourazizi M, Kianersi H. Intravitreal diclofenac for treatment of refractory uveitis-associated cystoid macular oedema: A before and after clinical study. Acta Ophthalmol 2018; 96:e355-e360. [PMID: 29369543 DOI: 10.1111/aos.13604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 08/14/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cystoid macular oedema (CME) is one of the important complications of uveitis leading to irreversible blindness. Currently, there is no gold standard treatment for this condition. The aim of this study was to investigate the effects of single intravitreal diclofenac (IVD) injection on short-term outcome of refractory uveitis-associated CME. METHODS This was a prospective clinical study on 16 consecutive patients (16 eyes) with refractory uveitis-associated CME. Intravitreal injection of 500 μg/0.1 ml of diclofenac sodium was given to the patients. The clinical outcomes considered were best-corrected visual acuity (BCVA) change and central macular thickness (CMT) changes in the pre- and postinjection periods. Follow-up examinations were performed at 1 and 4 weeks after the injection. RESULTS Age of the patients varied from 18 to 59 years (mean ± SD: 39.5 ± 13.2 years). Ten patients (62.5%) were females. Statistically significant differences were found in the decrease of mean BCVA (logMAR) (p = 0.043) and mean CMT (p = 0.003) during the study period. There was no significant difference in the intraocular pressure (IOP) increase at the end of the study (p = 0.94). CONCLUSION Intravitreal diclofenac (IVD) may be a promising treatment for refractory uveitis-associated CME. Further clinical trials with a larger sample size should be conducted to confirm these findings and compare them with other treatments.
Collapse
Affiliation(s)
- Farzan Kianersi
- Department of Ophthalmology; Isfahan Eye Research Center; Isfahan University of Medical Sciences; Isfahan Iran
| | - Abdolreza Rezaeian-Ramsheh
- Department of Ophthalmology; Isfahan Eye Research Center; Isfahan University of Medical Sciences; Isfahan Iran
| | - Mohsen Pourazizi
- Department of Ophthalmology; Isfahan Eye Research Center; Isfahan University of Medical Sciences; Isfahan Iran
| | - Hamidreza Kianersi
- Faculty of medicine; Isfahan University of Medical Sciences; Isfahan Iran
| |
Collapse
|
16
|
Frampton GK, Kalita N, Payne L, Colquitt J, Loveman E. Accuracy of fundus autofluorescence imaging for the diagnosis and monitoring of retinal conditions: a systematic review. Health Technol Assess 2018; 20:1-108. [PMID: 27115052 DOI: 10.3310/hta20310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Natural fluorescence in the eye may be increased or decreased by diseases that affect the retina. Imaging methods based on confocal scanning laser ophthalmoscopy (cSLO) can detect this 'fundus autofluorescence' (FAF) by illuminating the retina using a specific light 'excitation wavelength'. FAF imaging could assist the diagnosis or monitoring of retinal conditions. However, the accuracy of the method for diagnosis or monitoring is unclear. OBJECTIVE To conduct a systematic review to determine the accuracy of FAF imaging using cSLO for the diagnosis or monitoring of retinal conditions, including monitoring of response to therapy. DATA SOURCES Electronic bibliographic databases; scrutiny of reference lists of included studies and relevant systematic reviews; and searches of internet pages of relevant organisations, meetings and trial registries. Databases included MEDLINE, EMBASE, The Cochrane Library, Web of Science and the Medion database of diagnostic accuracy studies. Searches covered 1990 to November 2014 and were limited to the English language. REVIEW METHODS References were screened for relevance using prespecified inclusion criteria to capture a broad range of retinal conditions. Two reviewers assessed titles and abstracts independently. Full-text versions of relevant records were retrieved and screened by one reviewer and checked by a second. Data were extracted and critically appraised using the Quality Assessment of Diagnostic Accuracy Studies criteria (QUADAS) for assessing risk of bias in test accuracy studies by one reviewer and checked by a second. At all stages any reviewer disagreement was resolved through discussion or arbitration by a third reviewer. RESULTS Eight primary research studies have investigated the diagnostic accuracy of FAF imaging in retinal conditions: choroidal neovascularisation (one study), reticular pseudodrusen (three studies), cystoid macular oedema (two studies) and diabetic macular oedema (two studies). Sensitivity of FAF imaging using an excitation wavelength of 488 nm was generally high (range 81-100%), but was lower (55% and 32%) in two studies using longer excitation wavelengths (514 nm and 790 nm, respectively). Specificity ranged from 34% to 100%. However, owing to limitations of the data, none of the studies provide conclusive evidence of the diagnostic accuracy of FAF imaging. LIMITATIONS No studies on the accuracy of FAF imaging for monitoring the progression of retinal conditions or response to therapy were identified. Owing to study heterogeneity, pooling of diagnostic outcomes in meta-analysis was not conducted. All included studies had high risk of bias. In most studies the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported how FAF images were interpreted. CONCLUSIONS Although already in use in clinical practice, it is unclear whether or not FAF imaging is accurate, and whether or not it is applied and interpreted consistently for the diagnosis and/or monitoring of retinal conditions. Well-designed prospective primary research studies, which conform to the paradigm of diagnostic test accuracy assessment, are required to investigate the accuracy of FAF imaging in diagnosis and monitoring of inherited retinal dystrophies, early age-related macular degeneration, geographic atrophy and central serous chorioretinopathy. STUDY REGISTRATION This study is registered as PROSPERO CRD42014014997. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Geoff K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Liz Payne
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | | | | |
Collapse
|
17
|
Karaca Adıyeke S, Türe G, Talay E. Intravitreal Dexamethasone Implant for Postvitrectomy Macular Edema: A Retrospective Cohort of Patients with Postvitrectomy Macular Edema Treatment. J Ocul Pharmacol Ther 2018; 34:335-339. [PMID: 29377756 DOI: 10.1089/jop.2017.0107] [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: 11/13/2022] Open
Abstract
PURPOSE To evaluate the clinical findings and the efficacy of dexamethasone intravitreal implant in patients with postvitrectomy macular edema. METHODS The records of 14 patients diagnosed with postvitrectomy macular edema unresponsive to first-line treatment, treated with intravitreal dexamethazone implant injection and followed at least 6 months between October 2011 and May 2016 were retrospectively reviewed. All patients underwent standard ophtalmological examination, fluorescein angiography, and optical coherence tomography. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressures (IOPs) were recorded at baseline, at first and sixth months after the injection. RESULTS The mean BCVA, which was 0.2 ± 0.14 logMAR at baseline significantly increased to 0.44 ± 0.2 logMAR at first month (P = 0.05) and to 0.4 ± 0.22 logMAR at sixth month of intravitreal dexamethazone implant injection (P = 0.01). CMT was also significantly decreased to 368.3 ± 90.4 μm at first month and to 323 ± 84.6 μm at sixth month from pre-injection value of 520.7 ± 90.3 μm (P = 0.001 and P = 0.002, respectively). IOP significantly increased from was 15 ± 2.1 mmHg at baseline to 20.6 ± 5.4 mmHg at first month of intravitreal dexamethazone implant injection (P = 0.01). CONCLUSION Dexamethazone implant treatment may reduce CMT and improve BCVA in cases with postvitrectomy macular edema. IOP should be regularly screened in these cases.
Collapse
Affiliation(s)
- Seda Karaca Adıyeke
- Ophthalmology Department, Tepecik Research and Training Hospital , Izmir, Turkey
| | - Gamze Türe
- Ophthalmology Department, Tepecik Research and Training Hospital , Izmir, Turkey
| | - Ekrem Talay
- Ophthalmology Department, Tepecik Research and Training Hospital , Izmir, Turkey
| |
Collapse
|
18
|
Lasave AF, Schlaen A, Zeballos DG, Díaz-Llopis M, Couto C, El-Haig WM, Arevalo JF. Twenty-Four Months Follow-Up of Intravitreal Bevacizumab Injection Versus Intravitreal Triamcinolone Acetonide Injection for the Management of Persistent Non-Infectious Uveitic Cystoid Macular Edema. Ocul Immunol Inflamm 2017; 27:294-302. [PMID: 29157128 DOI: 10.1080/09273948.2017.1400073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the efficacy of intravitreal bevacizumab (IVB) injection versus intravitreal triamcinolone acetonide (IVT) for persistent non-infectious uveitic cystoid macular edema (CME). METHODS Interventional retrospective comparative case series evaluated 37 consecutive patients (44 eyes) with completely controlled uveitis and recalcitrant CME. Patients received repeated injections of 1.25 mg of IVB or 4 mg of IVT. RESULTS Best-corrected visual acuity (BCVA) at baseline and 24 months was logMAR 1 and 0.8 respectively, in the IVB group (p = 0.002) and; logMAR of 1.1 and 0.6, in the IVT group (p = 0.001). Central macular thickness at baseline and 24 months was 399.2 µm and 333.7 µm (p < 0.0009), respectively, for the IVB group and; 464.4 µm and 316.5 µm in the IVT group (p = 0.044). Postoperatively, IOP increased in the IVT group. CONCLUSIONS Repeated injections with IVT improve BCVA as effectively as repeated injections with IVB in the long-term management of persistent uveitic CME.
Collapse
Affiliation(s)
- Andrés F Lasave
- a From the Retina and Vitreous Service , Clinica Privada de Ojos, Mar del Plata , Buenos Aires , Argentina
| | - Ariel Schlaen
- b Servicio de Oftalmología , Hospital Universitario Austral , Derqui-Pilar , Argentina
| | - David G Zeballos
- c Retina and Vitreous Service , Clinica Oftalmologica Centro Caracas , Caracas , Venezuela
| | - Manuel Díaz-Llopis
- d Consorcio Hospital , General Universitario de Valencia , Valencia , Spain
| | - Cristóbal Couto
- e Uveitis Clinics, Department of Ophthalmology , Universidad de Buenos Aires, Buenos Aires , Argentina
| | - Wael M El-Haig
- f Ophthalmology Department, Faculty of Medicine , Zagazig University , Zagazig , Egypt
| | - J Fernando Arevalo
- g The Retina Division, Wilmer Eye Institute , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| |
Collapse
|
19
|
Kozak I, Shoughy SS, Stone DU. Intravitreal Antiangiogenic Therapy of Uveitic Macular Edema: A Review. J Ocul Pharmacol Ther 2017; 33:235-239. [DOI: 10.1089/jop.2016.0118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Igor Kozak
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates
| | - Samir S. Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia
| | - Donald U. Stone
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
20
|
Palacio C, Fernández De Ortega L, Bustos FR, Chávez E, Oregon-Miranda AA, Mercado-Sesma AR. Bromfenac 0.09% bioavailability in aqueous humor, prophylactic effect on cystoid macular edema, and clinical signs of ocular inflammation after phacoemulsification in a Mexican population. Clin Ophthalmol 2016; 10:233-7. [PMID: 26869758 PMCID: PMC4734805 DOI: 10.2147/opth.s93530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the aqueous humor bioavailability and clinical efficacy of bromfenac 0.09% vs nepafenac on the presence of cystoid macular edema (CME) after phacoemulsification. MATERIAL AND METHODS A Phase II, double-blind, masked, active-controlled, multicenter, clinical trial of 139 subjects, randomized to either a bromfenac 0.09% ophthalmic solution (n=69) or nepafenac 0.1% (n=70). Subjects instilled a drop three times a day for a period of 30 days. Follow-up visits were on days 2, 7, 15, 30, and 60. Biomicroscopy, clinical ocular signs, and assessment of posterior segment were performed. The primary efficacy endpoints included the presence of CME evaluated by optical coherence tomography. Safety evaluation included intraocular pressure, transaminase enzymes, lissamine green, and fluorescein stain. RESULTS The demographic and efficacy variables were similar between groups at baseline. The presence of pain, photophobia, conjunctival hyperemia, chemosis, cellularity, and corneal edema disappeared by day 30 in both groups. The central retinal thickness did not show significant changes after treatment when compared to baseline as follows: in the bromfenac group (247.2±32.9 vs 252.0±24.9 μm; P=0.958) and in nepafenac group (250.8±34 vs 264.0±34.1 μm; P=0.137), respectively. A statistically significant difference was observed between bromfenac and nepafenac group: (252.0±24.9 vs 264.0±34.1 μm; P=0.022), at day 30, respectively; even though there was no clinical relevance in the presentation of CME. There were no significant alterations in intraocular pressure, either lissamine green or fluorescein stains. The adverse events were not related to the interventions. CONCLUSION Bromfenac 0.09% ophthalmic solution showed similar clinical efficacy to reduce the presentation of CME after phacoemulsification compared to nepafenac 0.01%.
Collapse
Affiliation(s)
- Claudia Palacio
- Anterior Segment Department, Fundación Hospital Nuestra Señora de la Luz, México City, México
| | - Lourdes Fernández De Ortega
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México, Hospital Dr Luis Sánchez Bulnes, México
| | - Francisco R Bustos
- Anterior Segment Department, Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - Eduardo Chávez
- Anterior Segment Department, Instituto de Oftalmología, Fundación de Asistencia Privada Conde de Valenciana, IAP, México
| | - Aldo A Oregon-Miranda
- Clinical Research Department, Laboratorios Sophia, SA de CV, Zapopan, Jalisco, México
| | - Arieh R Mercado-Sesma
- Clinical Research Department, Laboratorios Sophia, SA de CV, Zapopan, Jalisco, México
| |
Collapse
|
21
|
Georgalas I, Petrou P, Papakonstantinou D, Droumouchtsis V, Tservakis I. Post-operative refractory cystoid macular edema in a vitrectomized eye treated with slow-release dexamethasone implant (Ozurdex). Cutan Ocul Toxicol 2014; 34:257-9. [PMID: 25198407 DOI: 10.3109/15569527.2014.951450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The use of a slow-release dexamethasone implant (Ozurdex) for the treatment of post-operative macular edema (ME) in a vitrectomized eye has never been used before. We herein report a case of a 70-year-old woman with post-vitrectomy ME refractory to topical, sub-tenon's and intravitreal steroid administration that responded well to the implantation of a slow-release dexamethasone implant (Ozurdex) in a previously vitrectomized eye. METHODS Interventional case presentation. RESULTS One week post-implantation, the central retinal thickness was reduced to 383 μm from 640 μm and the best corrected visual acuity (BCVA) improved to 6/36 from counting fingers (CF). At six months' follow-up visit, the improvement of the ME was sustained as indicated by the optical coherence tomography (OCT) measurements and the BCVA remained stable. No serious topical or systemic adverse events were observed from the implantation of Ozurdex in the vitrectomized eye. CONCLUSION The use of Ozurdex in our case resulted in rapid improvement of the post-operative resistant ME. To the best of our knowledge, this is the first report in the literature demonstrating the use of the slow-release dexamethasone implant (Ozurdex) to treat post-operative ME in a vitrectomized eye.
Collapse
Affiliation(s)
- Ilias Georgalas
- Department of Ophthalmology, University of Athens , Athens , Greece and
| | | | | | | | | |
Collapse
|
22
|
Shoughy SS, Kozak I. Updates in uveitic macular edema. World J Ophthalmol 2014; 4:56-62. [DOI: 10.5318/wjo.v4.i3.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/21/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
Macular edema is one of the most common vision-threatening complications of uveitis noted in one third of patients with uveitis. The release of a number of inflammatory mediators induces retinal vascular hyperpermeability leading to uveitic macular edema (UME) which most commonly is of cystoid shape. Fluorescein angiography and non-invasive spectral-domain optical coherence tomography are standard procedures for diagnosis and follow-up of UME with some innovations such as scanning laser ophthalmoscope retro-mode imaging. Effective management of UME requires thorough understanding of the individual case. Proper control of intraocular inflammation is mandatory before targeting macular edema itself. Mainstay of treatment is immunosuppressive therapy with various drug delivery routes including topical, local subconjunctival, peribulbar and sub-Tenon’s, intravitreal and systemic. Clinical trials with biologics are under way to study the efficacy of these agents in suppressing intraocular inflammation and resolution of UME. Visual prognosis in UME depends on numerous factors. Younger age and better visual acuity at baseline are associated with more favorable visual outcome in most studies
Collapse
|
23
|
Katz LJ, Zangalli C, Clifford R, Leiby B. Combined cataract and glaucoma surgery: the effect of pupil enlargement on surgical outcomes (an American Ophthalmological Society thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2013; 111:155-168. [PMID: 24385672 PMCID: PMC3868408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine whether pupil enlargement during phacotrabeculectomy affects postoperative visual acuity and intraocular pressure (IOP) compared to combined surgery without pupil enlargement. METHODS A retrospective study of 74 patients who underwent combined phacotrabeculectomy with (37 eyes) or without (37 eyes) pupil enlargement was performed. Postoperative outcome measures included best-corrected visual acuity (BCVA), IOP, number of medications, and complications up to 6 months. Wilcoxon-Mann-Whitney test was used to compare outcomes between groups. RESULTS Demographic characteristics of the two groups were similar except for diagnosis; chronic angle-closure glaucoma and pseudoexfoliation syndrome were more common in the pupil enlargement group. Preoperatively, the pupil enlargement group had a mean IOP of 21.2 ± 6.6 mm Hg compared to 21.1 ± 6.4 mm Hg for the control group (P=.978, Wilcoxon-Mann-Whitney test). Mean preoperative logMAR equivalent (BCVA) was 0.68 ± 0.67 and 0.63 ± 0.59, respectively (P=.727, Wilcoxon-Mann-Whitney test). At 6 months, mean IOP was 15.5 ± 5.6 mm Hg in the study group and 13.3 ± 4.5 mm Hg in the control group (P=.039, Wilcoxon-Mann-Whitney test). Mean postoperative vision at 6 months was better in the control group (0.36 ± 0.48) vs pupil enlargement group (0.51 ± 0.66) but not statistically different (P=.324 Wilcoxon-Mann-Whitney test). The groups did not differ in number of postoperative glaucoma medications. Complications were rare in both groups. CONCLUSION The results of this study suggest that the outcomes of combined phacoemulsification and trabeculectomy are not adversely impacted by pupil enlargement, although IOP control may be relatively impaired.
Collapse
Affiliation(s)
- L Jay Katz
- Department of Ophthalmology (Dr Katz) and the Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (Dr Leiby), Jefferson Medical College, Thomas Jefferson University; Wills Eye Institute (Dr Katz and Dr Zangalli); and Drexel University College of Medicine (Mr Clifford)
| | - Camila Zangalli
- Department of Ophthalmology (Dr Katz) and the Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (Dr Leiby), Jefferson Medical College, Thomas Jefferson University; Wills Eye Institute (Dr Katz and Dr Zangalli); and Drexel University College of Medicine (Mr Clifford)
| | - Raymond Clifford
- Department of Ophthalmology (Dr Katz) and the Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (Dr Leiby), Jefferson Medical College, Thomas Jefferson University; Wills Eye Institute (Dr Katz and Dr Zangalli); and Drexel University College of Medicine (Mr Clifford)
| | - Benjamin Leiby
- Department of Ophthalmology (Dr Katz) and the Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (Dr Leiby), Jefferson Medical College, Thomas Jefferson University; Wills Eye Institute (Dr Katz and Dr Zangalli); and Drexel University College of Medicine (Mr Clifford)
| |
Collapse
|
24
|
Zarbin MA, Jampol LM, Jager RD, Reder AT, Francis G, Collins W, Tang D, Zhang X. Ophthalmic evaluations in clinical studies of fingolimod (FTY720) in multiple sclerosis. Ophthalmology 2013; 120:1432-9. [PMID: 23531349 DOI: 10.1016/j.ophtha.2012.12.040] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To report outcomes of ophthalmic evaluations in clinical studies of patients receiving fingolimod (Gilenya; Novartis Pharma AG, Basel, Switzerland) for multiple sclerosis (MS). DESIGN Analysis done on pooled safety data (N = 2615, all studies group) from 3 double-masked, randomized, parallel-group clinical trials (phase 2 core and extension >5 years, and phase 3 FREEDOMS and TRANSFORMS core and extension studies). PARTICIPANTS Patients aged 18 to 55 years (18-60 years in phase 2 study) diagnosed with relapsing-remitting MS were included. Patients with diabetes mellitus or macular edema (ME) at screening were excluded. INTERVENTION Participants received fingolimod (0.5/1.25 mg), placebo, or interferon beta for the respective study durations. Ophthalmic examination included detailed eye history (at screening), visual acuity (VA) assessment, dilated ophthalmoscopy, optical coherence tomography (OCT), and fluorescein angiography (FA). MAIN OUTCOME MEASURES Extensive ophthalmic monitoring was performed for all patients. While being studied, patients with abnormal findings on dilated ophthalmoscopy and OCT compatible with ME were further studied by FA. All locally diagnosed ME cases were centrally reviewed by the retina specialist (M.A.Z.) on the Data and Safety Monitoring Board. RESULTS Among 2615 patients assessed, 19 confirmed ME cases were observed in fingolimod-treated groups (0.5 mg: n = 4, 0.3%; 1.25 mg: n = 15, 1.2%). Most patients (n = 13, 68%) presented with blurred vision, decreased VA, or eye pain. Macular edema was diagnosed within 3 to 4 months of treatment initiation in most cases (n = 13, 68%); 2 patients had late onset (>12 months) ME. Of the 19 patients with ME, 5 (26%), all treated with fingolimod 1.25 mg, had a history of uveitis compared with 26 (1%) in the all studies group. In most cases (n = 16, 84%), ME resolved after discontinuing the study drug. Eleven patients required topical anti-inflammatory medications. No patient had further vision deterioration. CONCLUSIONS Fingolimod 0.5 mg is associated with a low incidence of ME in MS studies. Patients with a history of uveitis may be at an increased risk of developing ME. An ophthalmic examination before initiating fingolimod therapy and regular follow-up eye examinations during fingolimod therapy are recommended.
Collapse
Affiliation(s)
- Marco A Zarbin
- Institute of Ophthalmology & Visual Science, New Jersey Medical School, Newark, New Jersey 07103, USA.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Occhiutto ML, Freitas FR, Maranhao RC, Costa VP. Breakdown of the blood-ocular barrier as a strategy for the systemic use of nanosystems. Pharmaceutics 2012; 4:252-75. [PMID: 24300231 PMCID: PMC3834913 DOI: 10.3390/pharmaceutics4020252] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/17/2012] [Accepted: 05/05/2012] [Indexed: 12/14/2022] Open
Abstract
Several drug delivery systems have been proposed to overcome physiological barriers, improving ocular bioavailability. Systemic routes are seldom used due to the blood-ocular barrier. Novel drug delivery systems based on nanotechnology techniques have been developed to overcome ocular physiological barriers. This non-systematic review suggests the utilization of a transitory blood-ocular breakdown to allow the access of drugs by nanotechnology drug delivery systems via the systemic route. We discuss the possible ways to cause the breakdown of the blood-ocular barrier: acute inflammation caused by intraocular surgery, induced ocular hypotony, and the use of inflammatory mediators. The suitability of use of the systemic route and its toxic effects are also discussed in this article.
Collapse
Affiliation(s)
- Marcelo L. Occhiutto
- Heart Institute, Medical School Hospital, University of São Paulo, São Paulo 05403-000, Brazil; (M.L.O.); (F.R.F.); (R.C.M.)
| | - Fatima R. Freitas
- Heart Institute, Medical School Hospital, University of São Paulo, São Paulo 05403-000, Brazil; (M.L.O.); (F.R.F.); (R.C.M.)
| | - Raul C. Maranhao
- Heart Institute, Medical School Hospital, University of São Paulo, São Paulo 05403-000, Brazil; (M.L.O.); (F.R.F.); (R.C.M.)
- Faculty of Pharmaceutical Science, University of São Paulo, São Paulo 05508-000, Brazil
| | - Vital P. Costa
- Department of Ophthalmology, University of Campinas, Campinas, São Paulo 13083-887, Brazil
| |
Collapse
|