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Xie JS, Ocampo V, Kaplan AJ. Anterior uveitis for the comprehensive ophthalmologist. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00238-2. [PMID: 39128830 DOI: 10.1016/j.jcjo.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/08/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
Anterior uveitis presents a diagnostic challenge due to its wide array of etiologies and clinical manifestations. This narrative review aims to equip general ophthalmologists with a comprehensive understanding of anterior uveitis epidemiology, diagnosis, and treatment. Particular emphasis is placed on developing a tailored and stepwise strategy, rather than a one-size-fits-all approach, for the workup and treatment of anterior uveitis. Chest radiography and serologic testing for syphilis, human leukocyte antigen B27, and angiotensin-converting enzyme are appropriate routine investigations in cases of severe, bilateral, recurrent, or chronic anterior uveitis. Additional testing should be guided by clinical findings and regional epidemiology, especially when considering expensive and invasive modalities. Investigations that are obtained in the absence of clinical and epidemiologic orientation are of limited utility and incur significant costs to patients and health care systems. Most cases of anatomically isolated anterior uveitis resolve with topical corticosteroids, but some patients require escalation to systemic immunomodulatory therapy (IMT). IMT should be considered in patients who respond poorly to corticosteroids, develop side effects related to corticosteroids that limit their use, require high doses to maintain disease remission, or have concomitant systemic inflammatory disease. Comprehensive ophthalmologists should feel comfortable comanaging patients that require conventional disease-modifying antirheumatic drugs/antimetabolite therapy (i.e., methotrexate, azathioprine, and mycophenolate mofetil) with rheumatologists and providing guidance on ocular dosing. When uveitis quiescence cannot be achieved despite maximally tolerated antimetabolite therapy, patients should be referred to a uveitis specialist for consultation and consideration of IMT escalation. The timing of uveitis referral may depend on local factors specific to health care jurisdictions.
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Affiliation(s)
- Jim S Xie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Vanessa Ocampo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Scarborough Health Network, Rheumatology Department, Scarborough, ON, Canada
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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2
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Li B, Xie T, Nawy S, Shen Y. The development and the genetic diseases of the ciliary body. CELL INSIGHT 2024; 3:100162. [PMID: 38595769 PMCID: PMC11002873 DOI: 10.1016/j.cellin.2024.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
The ciliary body, located at the junction of the choroid and iris, is crucial in the development of the embryonic eye. Notch2 signalling, Wnt signalling, transforming growth factor β (TGF-β) signalling, and Pax6 signalling are critical for coordinating the ciliary body formation. These signalling pathways are coordinated with each other and participate in the ciliary body development, ensuring the precise formation and optimal functioning of the eye structure. Although rare, ciliary body hypoplasia, ciliary tumours, and genetic-related iritis indicate the intricate nature of ciliary body development. Given the ciliary body's important biological significance and potential medical relevance, we aim to provide a comprehensive overview of the developmental molecular mechanisms governing ciliary body formation and function. Here, we focus on the intricate signalling pathways governing ciliary body development and corresponding genetic ciliary diseases.
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Affiliation(s)
- Baige Li
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Ting Xie
- Division of Life Science, The Hong Kong University of Science and Technology, Kowloon, Hong Kong Special Administrative Region (SAR), China
| | - Scott Nawy
- University of California Berkeley, Department of Molecular and Cell Biology, Berkeley, CA, USA
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Frontier Science Center for Immunology and Metabolism, Medical Research Institute, School of Medicine, Wuhan University, Wuhan, Hubei, China
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3
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Evans W, Mathew C, Richardson-May J, Arora R. A Case Report of Fedratinib-Associated Uveitis. Cureus 2024; 16:e52373. [PMID: 38361691 PMCID: PMC10867717 DOI: 10.7759/cureus.52373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Drug-induced uveitis is a rare but important subgroup of uveitis particularly among newer drugs in the market. Establishing a diagnosis can be challenging and requires the physician to have a high index of suspicion and a holistic approach with consideration being afforded to history, clinical examination, and investigations. In this case report, we describe a case of hypopyon uveitis in a 64-year-old male with a background of myelofibrosis for which he was started on fedratinib. A thorough history, negative investigation panel, and temporal association between the start of the drug and uveitis helped establish the diagnosis. A literature review showed no other published cases of uveitis secondary to fedratinib. While he could not be withdrawn from the drug, collaboration with the medical team enabled close monitoring and follow-up. He recovered following a course of steroids and remains under observation.
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Affiliation(s)
- William Evans
- Ophthalmology, Salisbury District Hospital, Salisbury, GBR
| | | | | | - Rashi Arora
- Ophthalmology, Salisbury District Hospital, Salisbury, GBR
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Dankiewicz-Fares I, Jeka D, Barczyńska T. Ocular involvement in rheumatic diseases. Reumatologia 2023; 61:389-394. [PMID: 37970118 PMCID: PMC10634405 DOI: 10.5114/reum/172767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/01/2023] [Indexed: 11/17/2023] Open
Abstract
Rheumatic diseases are associated with a significant decline in quality of life, which is not only related to the progression of the underlying disease but also to the development of coexisting conditions. One of the possible complications in this group of diseases is ocular involvement. Impaired vision is strongly associated with a significant decline in quality of life and can also exacerbate problems related to physical functioning. Consequently, it can lead to serious complications in the treatment of the underlying disease. Additionally, from a clinical point of view, it is also important to note that ocular diseases may precede the occurrence of inflammatory joint and spinal diseases, as well as organ involvement in systemic connective tissue disorders. Therefore, paying attention to ocular symptoms can help in early diagnosis and thus improve patient prognosis. For the aforementioned reasons, ocular diseases should be carefully considered in routine rheumatologic practice.
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Affiliation(s)
- Iwona Dankiewicz-Fares
- Department and Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
| | - Daniel Jeka
- Kliniczne Terapie Innowacyjne, Torun, Poland
| | - Tacjana Barczyńska
- Department and Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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Matsumiya W, Kusuhara S, Sotani N, Kim KW, Nishisho R, Sotani R, Imai H, Uji A, Nakamura M. Characteristics of Cellular Infiltration into Posterior Vitreous in Eyes with Uveitis on the Classification Basis Assessed Using Optical Coherence Tomography. Clin Ophthalmol 2023; 17:165-174. [PMID: 36660310 PMCID: PMC9843505 DOI: 10.2147/opth.s394441] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To evaluate the characteristics of posterior vitreous cells in patients with uveitis on the classification basis using spectral domain optical coherence tomography (SD-OCT). Methods In this retrospective chart review, all eyes were classified into three groups: infectious uveitis (IFU, n=7), noninfectious granulomatous uveitis (NIGU, n=13), and noninfectious nongranulomatous uveitis (NINGU, n=13). We measured the size, number, and density of vitreous hyperreflective particles in the posterior vitreous area that was defined as the space between the vitreous top and the internal limiting membrane on OCT. The correlations between vitreous haze and vitreous particles were also evaluated. Results Thirty-three eyes from 23 patients with active posterior uveitis were included. IFU had significantly more particles than NIGU and NINGU (P=0.03 and P<0.001, respectively). The vitreous particle density was higher in IFU than in NIGU and NINGU (P=0.03 and P=0.003, respectively). The mean largest particle size was greater in IFU and NIGU than in NINGU (P=0.01 and P=0.03, respectively). The median vitreous haze of 2+ in IFU, 1+ in NIGU and NINGU showed no significant difference among three groups (P=0.21). Conversely, the correlation of the largest particle size with vitreous haze was significant at ρ= 0.44 (P=0.01). Conclusion SD-OCT may be useful for assessing ocular inflammation based on morphological characteristics of vitreous particles on the uveitis classification basis.
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Affiliation(s)
- Wataru Matsumiya
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan,Correspondence: Wataru Matsumiya, Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan, Tel +81-78-382-6048, Fax +81-78-382-6059, Email
| | - Sentaro Kusuhara
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Sotani
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyung Woo Kim
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryuto Nishisho
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Rei Sotani
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisanori Imai
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akihito Uji
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
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Cohen D, Litofsky NS. Diagnosis and Management of Pineal Germinoma: From Eye to Brain. Eye Brain 2023; 15:45-61. [PMID: 37077304 PMCID: PMC10108908 DOI: 10.2147/eb.s389631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
Pineal germinomas can be very complex in terms of presentation, diagnosis, and management. This review attempts to simplify this complexity in an organized manner, addressing the anatomic relationships that provide the basis for the uniqueness of pineal germinoma. Ocular findings and signs and symptoms of elevated intracranial pressure are the keys to suspecting the diagnosis and obtaining the necessary imaging and cerebrospinal fluid studies. Other symptoms can suggest spread beyond the pineal region. Surgery may only be needed to obtain tissue for a definitive diagnosis, as germinoma is highly responsive to chemotherapy and focused radiation therapy. Hydrocephalus, usually related to tumor obstruction of the cerebral aqueduct, may also need to be addressed. Outcome for pineal germinoma is usually excellent, but relapse can occur and may require additional intervention. These issues are detailed in this review.
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Affiliation(s)
- David Cohen
- Department of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
| | - N Scott Litofsky
- Department of Neurosurgery, University of Missouri School of Medicine, Columbia, MO, USA
- Correspondence: N Scott Litofsky, Department of Neurosurgery, One Hospital Drive, MC, 321, Columbia, MO, 65212, USA, Tel +1-573-882-4908, Fax +1-573-884-5184, Email
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Petrillo F, Petrillo A, Sasso FP, Schettino A, Maione A, Galdiero M. Viral Infection and Antiviral Treatments in Ocular Pathologies. Microorganisms 2022; 10:2224. [PMID: 36363815 PMCID: PMC9694090 DOI: 10.3390/microorganisms10112224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 08/27/2023] Open
Abstract
Ocular viral infections are common and widespread globally. These infectious diseases are a major cause of acute red eyes and vision loss. The eye and its nearby tissues can be infected by several viral agents, causing infections with a short course and limited ocular implications or a long clinical progression and serious consequences for the function and structure of the ocular region. Several surveillance studies underline the increased emergence of drug resistance among pathogenic viral strains, limiting treatment options for these infections. Currently, in the event of resistant infections, topical or systemic corticosteroids are useful in the management of associated immune reactions in the eye, which contribute to ocular dysfunction. Many cases of viral eye infections are misdiagnosed as being of bacterial origin. In these cases, therapy begins late and is not targeted at the actual cause of the infection, often leading to severe ocular compromises, such as corneal infiltrates, conjunctival scarring, and reduced visual acuity. The present study aims at a better understanding of the viral pathogens that cause eye infections, along with the treatment options available.
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Affiliation(s)
- Francesco Petrillo
- Azienda Ospedaliera Universitaria-Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | | | | | - Antonietta Schettino
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Angela Maione
- Department of Biology, University of Naples Federico II, 80126 Naples, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Dubchak E, Obasanmi G, Zeglinski MR, Granville DJ, Yeung SN, Matsubara JA. Potential role of extracellular granzyme B in wet age-related macular degeneration and fuchs endothelial corneal dystrophy. Front Pharmacol 2022; 13:980742. [PMID: 36204224 PMCID: PMC9531149 DOI: 10.3389/fphar.2022.980742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Age-related ocular diseases are the leading cause of blindness in developed countries and constitute a sizable socioeconomic burden worldwide. Age-related macular degeneration (AMD) and Fuchs endothelial corneal dystrophy (FECD) are some of the most common age-related diseases of the retina and cornea, respectively. AMD is characterized by a breakdown of the retinal pigment epithelial monolayer, which maintains retinal homeostasis, leading to retinal degeneration, while FECD is characterized by degeneration of the corneal endothelial monolayer, which maintains corneal hydration status, leading to corneal edema. Both AMD and FECD pathogenesis are characterized by disorganized local extracellular matrix (ECM) and toxic protein deposits, with both processes linked to aberrant protease activity. Granzyme B (GrB) is a serine protease traditionally known for immune-mediated initiation of apoptosis; however, it is now recognized that GrB is expressed by a variety of immune and non-immune cells and aberrant extracellular localization of GrB substantially contributes to various age-related pathologies through dysregulated cleavage of ECM, tight junction, and adherens junction proteins. Despite growing recognition of GrB involvement in multiple age-related pathologies, its role in AMD and FECD remains poorly understood. This review summarizes the pathophysiology of, and similarities between AMD and FECD, outlines the current knowledge of the role of GrB in AMD and FECD, as well as hypothesizes putative contributions of GrB to AMD and FECD pathogenesis and highlights the therapeutic potential of pharmacologically inhibiting GrB as an adjunctive treatment for AMD and FECD.
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Affiliation(s)
- Eden Dubchak
- Department of Ophthalmology and Visual Sciences, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Gideon Obasanmi
- Department of Ophthalmology and Visual Sciences, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Matthew R. Zeglinski
- ICORD Centre and Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Research Institute, UBC, Vancouver, BC, Canada
| | - David J. Granville
- ICORD Centre and Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Research Institute, UBC, Vancouver, BC, Canada
| | - Sonia N. Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Joanne A. Matsubara
- Department of Ophthalmology and Visual Sciences, University of British Columbia (UBC), Vancouver, BC, Canada
- *Correspondence: Joanne A. Matsubara,
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Ayón C, Castán D, Mora A, Naranjo D, Obando F, Mora JJ. Monoclonal Antibodies: A Therapeutic Option for the Treatment of Ophthalmic Diseases of the Eye Posterior Segment. BORNEO JOURNAL OF PHARMACY 2022. [DOI: 10.33084/bjop.v5i3.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The eye is an organ that allows us to observe the outside world. Pathologies of the eye's posterior segment, such as glaucoma, macular degeneration, diabetic retinopathy, uveitis, and retinoblastoma, cause vision loss. Traditional treatments consist of applying topical medications that do not penetrate properly or using high doses that generate adverse effects. Different laser surgeries stop the pathology's progression but do not allow visual improvement. So, an alternative is to use monoclonal antibodies, proteins produced by different processes that selectively bind to metabolites associated with diseases, reducing the adverse effects of traditional treatments and improving the application of the drug in the area. The two main molecular targets are TNF (adalimumab, infliximab, and certolizumab pegol) and VEGF (bevacizumab and ranibizumab); other possibilities are under investigation.
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Weng TH, Ke CC, Huang YS. Anti-Inflammatory Effects of GM1 Ganglioside on Endotoxin-Induced Uveitis in Rats. Biomolecules 2022; 12:biom12050727. [PMID: 35625654 PMCID: PMC9138562 DOI: 10.3390/biom12050727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Exogenous ganglioside GM1 has been reported to exert an immunomodulatory effect. We investigated the anti-inflammatory effect of GM1 ganglioside on endotoxin-induced uveitis (EIU) in rats and RAW 264.7 macrophages. Methods: EIU was induced in Lewis rats by administering a subcutaneous injection of lipopolysaccharide (LPS). GM1 was injected intraperitoneally for three consecutive days prior to the LPS injection. Twenty-four hours after the LPS injection, the integrity of the blood-aqueous barrier was evaluated by determining the protein concentration and number of infiltrating cells in the aqueous humor (AqH). Immunohistochemical and Western blot analyses of the iris-ciliary body (ICB) were performed to evaluate the effect of GM1 on the LPS-induced expression of cyclooxygenase-2 (COX-2) and intercellular adhesion molecule-1 (ICAM-1). The effect of GM1 on proinflammatory mediators and signaling cascades was examined in LPS-stimulated RAW 264.7 cells using Western blotting and immunofluorescence staining to further clarify the underlying anti-inflammatory mechanism. Results: GM1 significantly reduced the protein concentration and number of infiltrating cells in the AqH of rats with EIU. GM1 also decreased the LPS-induced expression of the ICAM-1 and COX-2 proteins in the ICB. In RAW 264.7 cells, GM1 inhibited the proinflammatory mediators induced by LPS, including inducible nitric oxide synthase (iNOS), COX-2, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6), and this inhibitory effect was potentially mediated by suppressing transforming growth factor-β-activated kinase 1 (TAK1) and reactive oxygen species (ROS)-mediated activation of nuclear factor-κB (NF-κB) and mitogen-activated protein kinases (MAPKs). Conclusions: Based on this study, GM1 may be a potential anti-inflammatory agent for ocular inflammatory diseases.
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Affiliation(s)
- Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.W.); (C.-C.K.)
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chang-Chih Ke
- Department of Ophthalmology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.W.); (C.-C.K.)
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yuahn-Sieh Huang
- Department of Biology and Anatomy, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: ; Tel.: +886-87923100 (ext. 18735)
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Mao Y, Lin S, Zhu C, Liu X, Wu H, Ou S. Cytokine Changes in the Aqueous Humor in Rubella-Related Fuchs Heterochromic Iridocyclitis. DISEASE MARKERS 2022; 2022:8906752. [PMID: 35178133 PMCID: PMC8843966 DOI: 10.1155/2022/8906752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
This retrospective study is aimed at determining the correlation between cytokine levels and virus status in the aqueous humor of 38 patients with Fuchs heterochromic iridocyclitis (FHI) with/without a viral presence between May 2017 and January 2020. The levels of cytokines were analyzed in the groups with and without virus-related FHI. Among the patients, 50% had rubella virus, 5.26% had cytomegalovirus, and 2.63% had herpes simplex virus infections. The expression of interleukin-6 (IL-6) and IL-8 was significantly higher, and that of basic fibroblast growth factor (bFGF) was significantly lower in the virus-positive group than in the virus-negative group (P = 0.015, P = 0.001, and P = 0.001, respectively). Although there was no significant difference in the mean expression of vascular cell adhesion protein 1 (VCAM-1), IL-10, and vascular endothelial growth factor (VEGF), that of VCAM-1 and IL-10 was higher (M = 1338 and M = 1390, respectively; M = 6.225 and 10.600, respectively) and that of VEGF was lower (M = 134.5 and M = 38.70, respectively) in the virus-positive group than in the virus-negative group. Similar findings were observed for the expressions of IL-6, IL-8, and bFGF in the rubella-positive and rubella-negative groups. Viral presence was highly related to FHI, especially that of the rubella virus. High levels of inflammatory cytokines and low levels of neovascularization-related factors are involved in rubella-related FHI. These study findings could be helpful in the diagnosis and treatment of FHI.
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Affiliation(s)
- Yi Mao
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Sijie Lin
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Chengfang Zhu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Xiaodong Liu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Huping Wu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Shangkun Ou
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
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12
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Shivpuri A, Turtsevich I, Solebo AL, Compeyrot-Lacassagne S. Pediatric uveitis: Role of the pediatrician. Front Pediatr 2022; 10:874711. [PMID: 35979409 PMCID: PMC9376387 DOI: 10.3389/fped.2022.874711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
The challenges of childhood uveitis lie in the varied spectrum of its clinical presentation, the often asymptomatic nature of disease, and the evolving nature of the phenotype alongside normal physiological development. These issues can lead to delayed diagnosis which can cause significant morbidity and severe visual impairment. The most common ocular complications include cataracts, band keratopathy, glaucoma, and macular oedema, and the various associated systemic disorders can also result in extra-ophthalmic morbidity. Pediatricians have an important role to play. Their awareness of the various presentations and etiologies of uveitis in children afford the opportunity of prompt diagnosis before complications arise. Juvenile Idiopathic Arthritis (JIA) is one of the most common associated disorders seen in childhood uveitis, but there is a need to recognize other causes. In this review, different causes of uveitis are explored, including infections, autoimmune and autoinflammatory disease. As treatment is often informed by etiology, pediatricians can ensure early ophthalmological referral for children with inflammatory disease at risk of uveitis and can support management decisions for children with uveitis and possible underling multi-system inflammatory disease, thus reducing the risk of the development of irreversible sequelae.
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Affiliation(s)
- Abhay Shivpuri
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Inga Turtsevich
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ameenat Lola Solebo
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom.,University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sandrine Compeyrot-Lacassagne
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom
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13
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Katz G, Harvey L, Stone JH. Granulomatous uveitis secondary to IgG4-related disease. Rheumatol Adv Pract 2021; 5:rkab084. [PMID: 34881356 PMCID: PMC8648148 DOI: 10.1093/rap/rkab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Guy Katz
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Liam Harvey
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - John H Stone
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
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Torres Rives B, Martínez Téllez G, Mataran Valdés M, Collazo Mesa T, Colás González R, Frutos Ambou I. Serum immunoglobulin levels, complement components 3 and 4, HLA-B27 allele and spondyloarthropathy in patients with non-infectious anterior uveites. REUMATOLOGIA CLINICA 2021; 17:575-581. [PMID: 34823824 DOI: 10.1016/j.reumae.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/08/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify the relationship between serum immunoglobulin levels, complement components 3 and 4, the presence of the HLA-B27 allele and diagnosis of spondyloarthropathies in patients with non-infectious anterior uveitis. MATERIALS AND METHODS The participants were 197 patients with a non-infectious anterior uveitis. The concentrations of serum immunoglobulins, C3 and C4 proteins of the complement were determined by turbidimetry. The personal history of suspected immunodeficiency, ophthalmological complications, arthralgia, family history of spondyloarthropathies and the presence of the HLA-B27 allele were collected. RESULTS A family history of spondyloarthropathy, axial arthralgias, and ophthalmological complications were more frequent in HLA-B27 positive patients (P=.0005, P≤.0001, P≤.0001 respectively) and in patients with spondyloarthropathy diagnoses (P≤.0001, P≤.0001, P≤.0001 respectively). A personal history of recurrent sepsis, and gastrointestinal abnormalities was associated with the presence of the HLA-B27 allele (P≤.0001, P=.0240 respectively) and with the diagnosis of spondyloarthropathy (P=.0492, P=.0017 respectively). IgG decrease was observed (χ2=18.5, OR=5.03, 95% CI=2.32-10.89, P=.0001) and M (OR=7.13, 95% CI=1.40-36.4; P=.0128) in patients positive for the HLA-B27 allele and in patients with a diagnosis of SpA (P=.0364 and P=.0028 respectively). The decrease of C3 proteins (OR=4.82; CI 95%=1.35-17.11; P=.0328) and C4 (OR=9.09; CI 95%=2.13-38.88; P=.0074) were associated with a spondyloarthropathies diagnosis. CONCLUSIONS Patients with non-infectious anterior uveitis, positive for the HLA-B27 allele and diagnosed with spondyloarthropathies have alterations in serum immunoglobulin levels and complement components 3 and 4, which could contribute to the perpetuation and worse clinical course of this disease.
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Affiliation(s)
- Bárbara Torres Rives
- Laboratorio de Inmunología, Centro Nacional de Genética Médica, La Habana, Cuba.
| | | | | | - Teresa Collazo Mesa
- Laboratorio de Biología Molecular, Centro Nacional de Genética Médica, La Habana, Cuba
| | - Rosa Colás González
- Laboratorio de Biología Molecular, Centro Nacional de Genética Médica, La Habana, Cuba
| | - Isabel Frutos Ambou
- Departamento de Uveítis, Instituto Cubano de Oftalmología Ramón Pando Ferrer, La Habana, Cuba
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15
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Girol AP, de Freitas Zanon C, Caruso ÍP, de Souza Costa S, Souza HR, Cornélio ML, Oliani SM. Annexin A1 Mimetic Peptide and Piperlongumine: Anti-Inflammatory Profiles in Endotoxin-Induced Uveitis. Cells 2021; 10:3170. [PMID: 34831393 PMCID: PMC8625584 DOI: 10.3390/cells10113170] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Abstract
Uveitis is one of the main causes of blindness worldwide, and therapeutic alternatives are worthy of study. We investigated the effects of piperlongumine (PL) and/or annexin A1 (AnxA1) mimetic peptide Ac2-26 on endotoxin-induced uveitis (EIU). Rats were inoculated with lipopolysaccharide (LPS) and intraperitoneally treated with Ac2-26 (200 µg), PL (200 and 400 µg), or Ac2-26 + PL after 15 min. Then, 24 h after LPS inoculation, leukocytes in aqueous humor, mononuclear cells, AnxA1, formyl peptide receptor (fpr)1, fpr2, and cyclooxygenase (COX)-2 were evaluated in the ocular tissues, along with inflammatory mediators in the blood and macerated supernatant. Decreased leukocyte influx, levels of inflammatory mediators, and COX-2 expression confirmed the anti-inflammatory actions of the peptide and pointed to the protective effects of PL at higher dosage. However, when PL and Ac2-26 were administered in combination, the inflammatory potential was lost. AnxA1 expression was elevated among groups treated with PL or Ac2-26 + PL but reduced after treatment with Ac2-26. Fpr2 expression was increased only in untreated EIU and Ac2-26 groups. The interaction between Ac2-26 and PL negatively affected the anti-inflammatory action of Ac2-26 or PL. We emphasize that the anti-inflammatory effects of PL can be used as a therapeutic strategy to protect against uveitis.
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Affiliation(s)
- Ana Paula Girol
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
- Post Graduate Program in Structural and Functional Biology, Escola Paulista de Medicina (UNIFESP-EPM), Federal University of São Paulo, São Paulo 04023-062, SP, Brazil
| | - Caroline de Freitas Zanon
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Ícaro Putinhon Caruso
- Department of Phisics, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (Í.P.C.); (M.L.C.)
| | - Sara de Souza Costa
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Helena Ribeiro Souza
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Marinônio Lopes Cornélio
- Department of Phisics, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (Í.P.C.); (M.L.C.)
| | - Sonia Maria Oliani
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
- Post Graduate Program in Structural and Functional Biology, Escola Paulista de Medicina (UNIFESP-EPM), Federal University of São Paulo, São Paulo 04023-062, SP, Brazil
- Advanced Research Center in Medicine (CEPAM), União das Faculdades dos Grandes Lagos (Unilago), São José do Rio Preto 15030-070, SP, Brazil
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16
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Liao W, Zhong Z, Su G, Feng X, Du L, Li FZ, Dai L, Kijlstra A, Yang P. Surveillance of liver function in uveitis with or without chronic HBV infection. Ophthalmic Res 2021; 65:94-103. [PMID: 34781291 DOI: 10.1159/000520835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Immunosuppressive therapy for uveitis may cause liver damage. METHODS To investigate incidence of liver damage during uveitis treatment, we compared serological Hepatitis B core antibody (HBcAb) status with risk of liver dysfunction in all participants (n=992), in anterior uveitis (AU) (n=489) and combined of intermediate, posterior or panuveitis patients (IPPU) (n=503). The primary endpoint was incidence of elevated serum ALT level above two-fold upper limits of normal (ULN) within 6 months. RESULTS The incidence rate of primary endpoint for HBcAb negative and positive patients was 65 and 212 per 1,000 person years, respectively. The absolute rate difference was 147 (95% CI, 80-213) per 1,000 person years. HBcAb positivity was associated with a higher risk for primary endpoint in all participants (aHR, 3.53; 95% CI, 1.79-6.99; P value = 2.8×10-4) and in IPPU (aHR, 3.80; 95% CI, 1.61-9.01; P value = 0.002). No significant association with primary endpoint was observed for HBcAb positivity in AU (aHR, 3.21; 95% CI, 0.94-10.95; P value = 0.063). AU was mainly treated with topical eye drops (74.0%) whereas IPPU cases received systemic therapy including prednisone (94.0%), cyclosporine (80.9%) or other additionally combined immunomodulatory agents (14.9%). CONCLUSION Non-infectious uveitis cases with HBcAb positivity have an increased risk of liver damage. This association was predominantly driven by IPPU but was not significant in AU suggesting that the association is mediated by systemic therapy.
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Affiliation(s)
- Weiting Liao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xiaojie Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Liping Du
- The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Zhengzhou, China
| | - Fu-Zhen Li
- The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Zhengzhou, China
| | - Lingyu Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
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17
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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.
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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
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18
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Mofidfar M, Abdi B, Ahadian S, Mostafavi E, Desai TA, Abbasi F, Sun Y, Manche EE, Ta CN, Flowers CW. Drug delivery to the anterior segment of the eye: A review of current and future treatment strategies. Int J Pharm 2021; 607:120924. [PMID: 34324989 PMCID: PMC8579814 DOI: 10.1016/j.ijpharm.2021.120924] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 01/03/2023]
Abstract
Research in the development of ophthalmic drug formulations and innovative technologies over the past few decades has been directed at improving the penetration of medications delivered to the eye. Currently, approximately 90% of all ophthalmic drug formulations (e.g. liposomes, micelles) are applied as eye drops. The major challenge of topical eye drops is low bioavailability, need for frequent instillation due to the short half-life, poor drug solubility, and potential side effects. Recent research has been focused on improving topical drug delivery devices by increasing ocular residence time, overcoming physiological and anatomical barriers, and developing medical devices and drug formulations to increase the duration of action of the active drugs. Researchers have developed innovative technologies and formulations ranging from sub-micron to macroscopic size such as prodrugs, enhancers, mucus-penetrating particles (MPPs), therapeutic contact lenses, and collagen corneal shields. Another approach towards the development of effective topical drug delivery is embedding therapeutic formulations in microdevices designed for sustained release of the active drugs. The goal is to optimize the delivery of ophthalmic medications by achieving high drug concentration with prolonged duration of action that is convenient for patients to administer.
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Affiliation(s)
| | - Behnam Abdi
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Samad Ahadian
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, USA
| | - Ebrahim Mostafavi
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University, CA, USA
| | - Tejal A Desai
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Farhang Abbasi
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Yang Sun
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Edward E Manche
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Christopher N Ta
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Charles W Flowers
- USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA.
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19
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Anthony CL, Costarides AP, Yeh S, Shantha JG. Varicella zoster virus anterior uveitis complicated by thalamic stroke. J Ophthalmic Inflamm Infect 2021; 11:13. [PMID: 33931827 PMCID: PMC8087730 DOI: 10.1186/s12348-021-00243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
We report a case of varicella zoster virus (VZV)-associated anterior uveitis in a patient with weight loss, arthritis and signs of inflammatory bowel disease. Her clinical course included the development of a thalamic stroke secondary to VZV cerebral vasculopathy. Following antiviral therapy, the patient's neurologic symptoms recovered and her ophthalmic findings improved.
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Affiliation(s)
- Casey L Anthony
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, 30322, USA.,Truhlsen Eye Institute, University of Nebraska Medical Center College of Medicine, Omaha, NE, 68105, USA
| | - Jessica G Shantha
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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20
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Qian R, McNabb RP, Zhou KC, Mousa HM, Saban DR, Perez VL, Kuo AN, Izatt JA. In vivo quantitative analysis of anterior chamber white blood cell mixture composition using spectroscopic optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2021; 12:2134-2148. [PMID: 33996220 PMCID: PMC8086441 DOI: 10.1364/boe.419063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Anterior uveitis is the most common form of intraocular inflammation, and one of its main signs is the presence of white blood cells (WBCs) in the anterior chamber (AC). Clinically, the true composition of cells can currently only be obtained using AC paracentesis, an invasive procedure to obtain AC fluid requiring needle insertion into the AC. We previously developed a spectroscopic optical coherence tomography (SOCT) analysis method to differentiate between populations of RBCs and subtypes of WBCs, including granulocytes, lymphocytes and monocytes, both in vitro and in ACs of excised porcine eyes. We have shown that different types of WBCs have distinct characteristic size distributions, extracted from the backscattered reflectance spectrum of individual cells using Mie theory. Here, we further develop our method to estimate the composition of blood cell mixtures, both in vitro and in vivo. To do so, we estimate the size distribution of unknown cell mixtures by fitting the distribution observed using SOCT with a weighted combination of reference size distributions of each WBC type calculated using kernel density estimation. We validate the accuracy of our estimation in an in vitro study, by comparing our results for a given WBC sample mixture with the cellular concentrations measured by a hemocytometer and SOCT images before mixing. We also conducted a small in vivo quantitative cell mixture validation pilot study which demonstrates congruence between our method and AC paracentesis in two patients with uveitis. The SOCT based method appears promising to provide quantitative diagnostic information of cellular responses in the ACs of patients with uveitis.
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Affiliation(s)
- Ruobing Qian
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Ryan P. McNabb
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Kevin C. Zhou
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Daniel R. Saban
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Victor L. Perez
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Anthony N. Kuo
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
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21
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Bengani LC, Kobashi H, Ross AE, Zhai H, Salvador-Culla B, Tulsan R, Kolovou PE, Mittal SK, Chauhan SK, Kohane DS, Ciolino JB. Steroid-eluting contact lenses for corneal and intraocular inflammation. Acta Biomater 2020; 116:149-161. [PMID: 32814140 PMCID: PMC8040324 DOI: 10.1016/j.actbio.2020.08.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/15/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Abstract
Ocular inflammation is one of the leading causes of blindness worldwide, and steroids in topical ophthalmic solutions (e.g. dexamethasone eye drops) are the mainstay of therapy for ocular inflammation. For many non-infectious ocular inflammatory diseases, such as uveitis, eye drops are administered as often as once every hour. The high frequency of administration coupled with the side effects of eye drops leads to poor adherence for patients. Drug-eluting contact lenses have long been sought as a potentially superior alternative for sustained ocular drug delivery; but loading sufficient drug into contact lenses and control the release of the drug is still a challenge. A dexamethasone releasing contact lens (Dex-Lens) was previously developed by encapsulating a dexamethasone-polymer film within the periphery of a hydrogel-based contact lens. Here, we demonstrate safety and efficacy of the Dex-Lens in rabbit models in the treatment of anterior ocular inflammation. The Dex-Lens delivered drug for 7 days in vivo (rabbit model). In an ocular irritation study (Draize test) with Dex-Lens extracts, no adverse events were observed in normal rabbit eyes. Dex-Lenses effectively inhibited suture-induced corneal neovascularization and inflammation for 7 days and lipopolysaccharide-induced anterior uveitis for 5 days. The efficacy of Dex-Lenses was similar to that of hourly-administered dexamethasone eye drops. In the corneal neovascularization study, substantial corneal edema was observed in rabbit eyes that received no treatment and those that wore a vehicle lens as compared to rabbit eyes that wore the Dex-Lens. Throughout these studies, Dex-Lenses were well tolerated and did not exhibit signs of toxicity. Dexamethasone-eluting contact lenses may be an option for the treatment of ocular inflammation and a platform for ocular drug delivery. STATEMENT OF SIGNIFICANCE: Inflammation of the eye can happen either on the ocular surface (i.e. the cornea) or inside the eye, both of which can result in loss of vision or even blindness. Ocular inflammation is normally treated by steroid eye drops. Depending on the type and severity of inflammation, patients may have to take drops every hour for days at a time. Such severe dosing regimen can lead to patients missing doses. Also, more than 95% drug in an eye drop never goes inside the eye. Here we present a contact lens that release a steroid (dexamethasone) for seven days at a time. It is much more efficient than eye drops and a significant improvement since once worn, the patient will avoid missing doses.
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Affiliation(s)
- Lokendrakumar C Bengani
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States
| | - Hidenaga Kobashi
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States
| | - Amy E Ross
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States
| | - Hualei Zhai
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States
| | - Borja Salvador-Culla
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States; Department of Anesthesiology, Boston Children's Hospital, Boston, MA, United States
| | - Rekha Tulsan
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States; Department of Anesthesiology, Boston Children's Hospital, Boston, MA, United States
| | - Paraskevi E Kolovou
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States; Department of Anesthesiology, Boston Children's Hospital, Boston, MA, United States
| | - Sharad K Mittal
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States
| | - Sunil K Chauhan
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States
| | - Daniel S Kohane
- Department of Anesthesiology, Boston Children's Hospital, Boston, MA, United States.
| | - Joseph B Ciolino
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute at Massachusetts Eye & Ear, 325 Charles Street, Boston 02114, MA, United States.
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22
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Torres Rives B, Martínez Téllez G, Mataran Valdés M, Collazo Mesa T, Colás González R, Frutos Ambou I. Serum Immunoglobulin Levels, Complement Components 3 and 4, HLA-B27 Allele and Spondyloarthropathy in Patients with Non-Infectious Anterior Uveites. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30191-1. [PMID: 32891541 DOI: 10.1016/j.reuma.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify the relationship between serum immunoglobulin levels, complement components 3 and 4, the presence of the HLA-B27 allele and diagnosis of spondyloarthropathies in patients with non-infectious anterior uveitis. MATERIALS AND METHODS The participants were 197 patients with a non-infectious anterior uveitis. The concentrations of serum immunoglobulins, and C3 and C4 proteins of the complement were determined by turbidimetry. The personal history of suspected immunodeficiency, ophthalmological complications, arthralgia, family history of spondyloarthropathies and the presence of the HLA-B27 allele were collected. RESULTS A family history of spondyloarthropathy, axial arthralgias, and ophthalmological complications were more frequent in HLA-B27 positive patients (P=.0005, P≤.0001, and P≤.0001, respectively) and in patients with spondyloarthropathy diagnoses (P≤.0001, P≤.0001, and P≤.0001, respectively). A personal history of recurrent sepsis, and gastrointestinal abnormalities was associated with the presence of the HLA-B27 allele (P≤.0001, and P=.0240, respectively) and with the diagnosis of spondyloarthropathy (P=.0492, and P=.0017, respectively). IgG decrease was observed (χ2=18.5, OR 5.03, 95% CI 2.32-10.89; P=.0001) and IgM (OR 7.13, 95% CI 1.40-36.4; P=.0128) in patients positive for the HLA-B27 allele and in patients with a diagnosis of spondyloarthropathies (P=.0364 and P=.0028, respectively). The decrease of C3 proteins (OR 4.82; CI 95% 1.35-17.11; P=.0328) and C4 (OR 9.09; CI 95% 2.13-38.88; P=.0074) were associated with a spondyloarthropathies diagnosis. CONCLUSIONS Patients with non-infectious anterior uveitis, positive for the HLA-B27 allele and diagnosed with spondyloarthropathies have alterations in serum immunoglobulin levels and complement components 3 and 4, which could contribute to the perpetuation and worse clinical course of this disease.
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Affiliation(s)
- Bárbara Torres Rives
- Laboratorio de Inmunología, Centro Nacional de Genética Médica, La Habana, Cuba.
| | | | | | - Teresa Collazo Mesa
- Laboratorio de Biología Molecular, Centro Nacional de Genética Médica, La Habana, Cuba
| | - Rosa Colás González
- Laboratorio de Biología Molecular, Centro Nacional de Genética Médica, La Habana, Cuba
| | - Isabel Frutos Ambou
- Departamento de Uveítis, Instituto Cubano de Oftalmología Ramón Pando Ferrer, La Habana, Cuba
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Recent advances in the management of non-infectious posterior uveitis. Int Ophthalmol 2020; 40:3187-3207. [PMID: 32617804 DOI: 10.1007/s10792-020-01496-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To review the current regimens and novel therapeutic modalities in various stages of research and development for the management of non-infectious posterior uveitis (NIPU). METHODS We performed a thorough review of current literature using PubMed, Google Scholar and Clinicaltrials.gov to identify the published literature about the available therapeutics and novel drugs/therapies in different stages of clinical trials. RESULTS The current management regimen for non-infectious posterior uveitis includes corticosteroids, immunomodulatory therapies and anti-metabolites. However, NIPU requires long-term management for efficacious remission of the disease and to prevent disease relapse. Long-term safety issues associated with steroids have led to efforts to develop novel therapeutic agents including biological response modulators and immunosuppressants. The current therapeutic agents in various stages of development include calcineurin inhibitors, biologic response modifiers and a more a comprehensive modalities like ocular gene therapy as well as novel drug delivery mechanisms for higher bioavailability to the target tissues, with minimal systemic effects. CONCLUSION Novel efficacious therapeutic modalities under development will help overcome the challenges associated with the traditional therapeutic agents.
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Iontophoretic Dexamethasone Phosphate Compared to Topical Prednisolone Acetate 1% for Noninfectious Anterior Segment Uveitis. Am J Ophthalmol 2020; 211:76-86. [PMID: 31726034 DOI: 10.1016/j.ajo.2019.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of dexamethasone phosphate ophthalmic solution (EGP-437) delivered by a transscleral iontophoresis delivery system (EyeGate II) compared to that of topical prednisolone acetate 1% (PA 1%) in subjects with noninfectious anterior uveitis. DESIGN Prospective, randomized, double-masked, parallel group, noninferiority clinical trial. METHODS A total of 193 subjects with active noninfectious anterior uveitis (anterior chamber [AC] cell count ≥11 cells) were randomized to EGP-437 delivered by iontophoresis (days 0 and 7) or self-administered PA 1% daily (tapered schedule, days 0-28). Masking was maintained with placebo iontophoresis or eye drops. The primary efficacy endpoint was the proportion of subjects with an AC cell count of zero on day 14. Noninferiority of EGP-437 was defined if the lower limit of the confidence interval (CI) for the difference (EGP-437 minus PA 1%) was less than -10%. RESULTS At day 14, 32 of 96 EGP-437 subjects (33.3%) and 32 of 97 PA 1% subjects (33.0%) had an AC cell count of zero (difference, 0.34; 95% CI, -12.94 to 13.63; P = 0.064). Efficacy trended better with EGP-437 among patients with more severe baseline uveitis (AC cell count >25). Safety and tolerability were good with both treatments. EGP-437 subjects experienced fewer IOP elevations ≥6 mm Hg versus PA 1% subjects (13 vs 24 incidents, respectively, through day 28). CONCLUSIONS Despite clinically similar response rates, statistical noninferiority of EGP-437 versus a tapered regimen of PA 1% was not achieved. Numerical trends suggesting fewer IOP elevations with EGP-437, similar efficacy overall, and possibly better efficacy in more severe disease warrant further study.
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Gonzalez-Pizarro R, Parrotta G, Vera R, Sánchez-López E, Galindo R, Kjeldsen F, Badia J, Baldoma L, Espina M, García ML. Ocular penetration of fluorometholone-loaded PEG-PLGA nanoparticles functionalized with cell-penetrating peptides. Nanomedicine (Lond) 2019; 14:3089-3104. [DOI: 10.2217/nnm-2019-0201] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: Development of fluorometholone-loaded PEG-PLGA nanoparticles (NPs) functionalized with cell-penetrating peptides (CPPs) for the treatment of ocular inflammatory disorders. Materials & methods: Synthesized polymers and peptides were used for elaboration of functionalized NPs, which were characterized physicochemically. Cytotoxicity and ability to modulate the expression of proinflammatory cytokines were evaluated in vitro using human corneal epithelial cells (HCE-2). NPs uptake was assayed in both in vitro and in vivo models. Results: NPs showed physicochemical characteristics suitable for ocular administration without evidence of cytotoxicity. TAT-NPs and G2-NPs were internalized and displayed anti-inflammatory activity in both HCE-2 cells and mouse eye. Conclusion: TAT-NPs and G2-NPs could be considered a novel strategy for the treatment of ocular inflammatory diseases of the anterior and posterior segment.
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Affiliation(s)
- Roberto Gonzalez-Pizarro
- Department of Pharmacy, Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
- Institute of Nanoscience & Nanotechnology (IN2UB), University of Barcelona, 08028 Catalonia, Spain
| | - Graziella Parrotta
- Department of Biochemistry & Molecular Biology, Faculty of Science, University of Southern Denmark, 5230 Southern Denmark, Denmark
| | - Rodrigo Vera
- Department of Biochemistry & Physiology, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
- Institute of Biomedicine, University of Barcelona (IBUB), 08028 Catalonia, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), 08950 Catalonia, Spain
| | - Elena Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
- Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
- Institute of Nanoscience & Nanotechnology (IN2UB), University of Barcelona, 08028 Catalonia, Spain
| | - Ruth Galindo
- Department of Pharmacy, Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
| | - Frank Kjeldsen
- Department of Biochemistry & Molecular Biology, Faculty of Science, University of Southern Denmark, 5230 Southern Denmark, Denmark
| | - Josefa Badia
- Department of Biochemistry & Physiology, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
- Institute of Biomedicine, University of Barcelona (IBUB), 08028 Catalonia, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), 08950 Catalonia, Spain
| | - Laura Baldoma
- Department of Biochemistry & Physiology, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
- Institute of Biomedicine, University of Barcelona (IBUB), 08028 Catalonia, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), 08950 Catalonia, Spain
| | - Marta Espina
- Department of Pharmacy, Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
- Institute of Nanoscience & Nanotechnology (IN2UB), University of Barcelona, 08028 Catalonia, Spain
| | - María L García
- Department of Pharmacy, Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Catalonia, Spain
- Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
- Institute of Nanoscience & Nanotechnology (IN2UB), University of Barcelona, 08028 Catalonia, Spain
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Rosenbaum JT, Bodaghi B, Couto C, Zierhut M, Acharya N, Pavesio C, Tay-Kearney ML, Neri P, Douglas K, Pathai S, Song AP, Kron M, Foster CS. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum 2019; 49:438-445. [DOI: 10.1016/j.semarthrit.2019.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 04/18/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
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