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Sanlés González I, Napal Lecumberri JJ, Pérez-Montes R, Cerveró Varona A, Casado Rojo A, Hernández Hernández JL. Retinal vein occlusion in patients under 50 years. Analysis of vascular risk factors, thrombophilia, carotid ultrasound findings and uncommon aetiologies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:443-449. [PMID: 35618638 DOI: 10.1016/j.oftale.2021.12.002] [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: 10/14/2021] [Accepted: 12/21/2021] [Indexed: 06/15/2023]
Abstract
INTRODUTION Retinal vein occlusion (RVO) has been related to vascular risk factors and thrombophilia. METHODS This is a prospective cohort study of all patients diagnosed with RVO and referred to an Internal Medicine clinic of a tertiary teaching hospital during a 10-year period. Clinical, laboratory and supra-aortic trunks ultrasound variables were analysed and compared according to age. RESULTS Some 309 patients diagnosed with RVO were included, 25 of them younger than 50 years. The prevalence of high blood pressure, dyslipidaemia, diabetes mellitus, hyperhomocysteinemia, and carotid plaque was significantly higher in patients >50 years than in those below. However, the prevalence of inherited thrombophilia was higher in the younger group (32.0% vs 11.4%; p = 0.005). Uncommon diseases related to RVO such as hepatitis C, thalassemia minor, Lyme disease, vasculitis, and periphlebitis were observed in young patients without vascular risk factors. CONCLUSION We suggest performing a genetic thrombophilia study in RVO patients younger than 50 years, while an exhaustive control of vascular risk factors is always recommended in all RVO patients. Moreover, we suggest bearing in mind uncommon diseases related to RVO, especially in young patients without vascular risk factors.
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Affiliation(s)
- I Sanlés González
- Departmento de Medicina Interna, Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - J J Napal Lecumberri
- Departmento de Medicina Interna, Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - R Pérez-Montes
- División de Hematología, Hospital Marqués de Valdecilla, Santander, Spain
| | - A Cerveró Varona
- Departamento de Oftalmología, Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - A Casado Rojo
- Departamento de Oftalmología, Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
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Retinal toxicities of systemic anticancer drugs. Surv Ophthalmol 2021; 67:97-148. [PMID: 34048859 DOI: 10.1016/j.survophthal.2021.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 01/07/2023]
Abstract
Newer anticancer drugs have revolutionized cancer treatment in the last decade, but conventional chemotherapy still occupies a central position in many cancers, with combination therapy and newer methods of delivery increasing their efficacy while minimizing toxicities. We discuss the retinal toxicities of anticancer drugs with an emphasis on the mechanism of toxicity. Uveitis is seen with the use of v-raf murine sarcoma viral oncogene homolog B editing anticancer inhibitors as well as immunotherapy. Most of the cases are mild with only anterior uveitis, but severe cases of posterior uveitis, panuveitis, and Vogt-Koyanagi-Harada-like disease may also occur. In the retina, a transient neurosensory detachment is observed in almost all patients on mitogen-activated protein kinase kinase (MEK) inhibitors. Microvasculopathy is often seen with interferon α, but vascular occlusion is a more serious toxicity caused by interferon α and MEK inhibitors. Crystalline retinopathy with or without macular edema may occur with tamoxifen; however, even asymptomatic patients may develop cavitatory spaces seen on optical coherence tomography. A unique macular edema with angiographic silence is characteristic of taxanes. Delayed dark adaptation has been observed with fenretinide. Interestingly, this drug is finding potential application in Stargardt disease and age-related macular degeneration.
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Ophthalmic manifestations of coronavirus disease 2019 and ocular side effects of investigational pharmacologic agents. Curr Opin Ophthalmol 2020; 31:403-415. [DOI: 10.1097/icu.0000000000000682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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M Castillejo Becerra C, Ding Y, Kenol B, Hendershot A, Meara AS. Ocular side effects of antirheumatic medications: a qualitative review. BMJ Open Ophthalmol 2020; 5:e000331. [PMID: 32154367 PMCID: PMC7045116 DOI: 10.1136/bmjophth-2019-000331] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/29/2019] [Accepted: 11/09/2019] [Indexed: 12/29/2022] Open
Abstract
Topic This paper reviews the ocular side effects of medications used in the treatment of rheumatological conditions. Clinical relevance Rheumatic diseases are inflammatory conditions that may affect the skin, blood vessels, joints, muscles and internal organs. Immunosuppressive agents are often used as treatment and while powerful, they carry side effects and toxicities that need careful monitoring. Ophthalmic complications have been reported with the use of antirheumatic medications; however, there is a lack of literature synthesising these reports. This paper addresses this gap and hopes to inform both rheumatologists and ophthalmologists as they work together on the management of patients with rheumatological conditions. Methods PubMed literature search was conducted from November to September 2019 searching for ocular side effects with the use of 25 rheumatological drugs. Results A total of 111 papers were included in this review. Adverse side effects were divided into non-infectious and infectious causes. Traditional disease-modifying antirheumatic drugs (DMARDs) were associated with pruritus, irritation and dryness of the conjunctiva while biologic DMARDS showed reports of new-onset/recurrent uveitis and demyelinating conditions. Infectious side effects included episodes of cytomegalovirus retinitis, toxoplasmic chorioretinitis and endophthalmitis. Other serious side effects were encountered and included in this review. Conclusion The goal of this paper is to inform healthcare providers about potential ocular side effects from rheumatological medications. Healthcare providers are encouraged to learn more about these ophthalmic complications and find relevance within their clinical practice.
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Affiliation(s)
| | - Yue Ding
- Division of Rheumatology and Immunology, Ohio State University, Columbus, Ohio, USA
| | - Beatrice Kenol
- Division of Rheumatology and Immunology, Ohio State University, Columbus, Ohio, USA
| | - Andrew Hendershot
- Department of Ophthalmology, Ohio State University, Columbus, Ohio, USA
| | - Alexa Simon Meara
- Division of Rheumatology and Immunology, Ohio State University, Columbus, Ohio, USA
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Anti-interleukin-6 receptor antibody therapy-induced retinopathy in a patient with rheumatoid arthritis. Case Rep Rheumatol 2012; 2012:270315. [PMID: 23424706 PMCID: PMC3540646 DOI: 10.1155/2012/270315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/27/2012] [Indexed: 11/18/2022] Open
Abstract
Tocilizumab, a humanized anti-human interleukin-6 (IL-6) receptor monoclonal antibody, is beneficial for treating autoimmune conditions such as rheumatoid arthritis (RA). The most common adverse event is upper respiratory tract infection; ocular side effects are rare. We describe a case of skin ulceration and bilateral retinopathy with multifocal cotton-wool spots and retinal hemorrhages in a patient with RA treated with tocilizumab. Tocilizumab administration increased the serum level of IL-6 without affecting the IL-8 levels. We could not exclude the possibility of blood coagulation or retinal vascular changes caused by tocilizumab. The current case highlights the need to consider that ocular adverse effects can develop in patients treated with tocilizumab.
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Watanabe M, Ogasawara S, Takahashi A, Takada J, Tanaka Y, Okuwaki Y, Minamino T, Hidaka H, Nakazawa T, Shibuya A, Koizumi W. Branch retinal artery occlusion and central retinal vein occlusion associated with pegylated interferon plus ribavirin combination therapy for chronic hepatitis C. Cutan Ocul Toxicol 2012; 31:253-7. [PMID: 22172047 DOI: 10.3109/15569527.2011.641197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 62-year-old male treated with pegylated interferon α-2b plus ribavirin for chronic hepatitis C complained of sudden painless decreased visual acuity. This patient was diagnosed as having simultaneous occlusions of the branch retinal artery and central retinal vein, although he had no history of major risk factors for retinal vessel (artery and vein) occlusion. Unfortunately, visual acuity did not completely recover. Furthermore, the patient was heterozygous for interleukin (IL) 28B genetic polymorphisms. The etiology of interferon-associated retinal vessel occlusion is not yet clear. However, a review based on previous case reports suggested that some factors including ribavirin might act as a risk or cause of retinal vessel occlusion.
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Affiliation(s)
- Masaaki Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.
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Gilbar P, Sorour N. Retinal vein thrombosis in a patient with metastatic colon cancer receiving XELOX chemotherapy combined with bevacizumab pre-hepatic resection. J Oncol Pharm Pract 2011; 18:152-4. [PMID: 21427141 DOI: 10.1177/1078155211401455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Retinal vein thrombosis is a common vascular occlusive disorder of the retina responsible for varying degrees of vision impairment. It is an adverse effect rarely associated with cancer and its treatment. We report the case of a patient with metastatic colon cancer who developed central retinal vein thrombosis (CRVT) in the right eye following two cycles of chemotherapy with capecitabine and oxaliplatin (XELOX) plus bevacizumab given prior to hepatic resection. Despite cessation of chemotherapy, vision has not improved. The etiology of the CRVT in this case is not clear due to risk factors for venous thrombotic events including colonic malignancy and previous major surgery. However, the proximity of chemotherapy administration to the initial development of symptoms suggests the possibility of a medication-related cause, with bevacizumab and capecitabine the most likely suspects.
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Affiliation(s)
- Peter Gilbar
- Cancer Care Services, Toowoomba Hospital, PMB 2, Toowoomba, Australia.
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Such Díaz A, Barrueco N, Esteban Alba C, Escobar Rodríguez I. Retinal vein thrombosis associated with peginterferon alpha 2b plus ribavirin in a chronic hepatitis C patient. FARMACIA HOSPITALARIA 2011; 35:93-4. [PMID: 20615736 DOI: 10.1016/j.farma.2010.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/27/2010] [Accepted: 01/28/2010] [Indexed: 10/19/2022] Open
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Salgado JP, Khoramnia R, Maier MM, Lohmann CP, Winkler von Mohrenfels C. [Acute loss of vision during therapy of chronic hepatitis C]. Ophthalmologe 2011; 108:561-4. [PMID: 21271253 DOI: 10.1007/s00347-010-2327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A patient undergoing combined therapy of chronic hepatitis C with pegylated interferon-α-2a (PEG-IFN-α-2a) and ribavirin suddenly developed severe loss of visual acuity. A central vein occlusion with macular edema was found and intravitreal injections of bevacizumab were initiated. Retinal occlusion is a known complication of therapy with pegylated interferon-α-2a and ribavirin. An interdisciplinary assessment of patients treated for a chronic hepatitis C as well as an early anti-VEGF administration can be helpful in the therapy of this complication of chronic hepatitis C.
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Affiliation(s)
- J P Salgado
- Augenklinik und Poliklinik, Universität Würzburg, Josef-Schneider-Strasse 11, Würzburg, Germany.
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Subconjunctival/perilesional recombinant interferon α2b for ocular surface squamous neoplasia: a 10-year review. Ophthalmology 2011; 117:2241-6. [PMID: 20619462 DOI: 10.1016/j.ophtha.2010.03.052] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 03/15/2010] [Accepted: 03/24/2010] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the biologic effect of subconjunctival recombinant interferon α2b (IFNα2b) for the treatment of ocular surface squamous neoplasia (OSSN). DESIGN Retrospective study. PARTICIPANTS Patients with primary or recurrent OSSN treated with subconjunctival injections of recombinant IFNα2b were studied retrospectively. INTERVENTION Patients were given perilesional subconjunctival injections of 3 million international units in 0.5 ml of IFNα2b (Intron; Schering-Plough, Kenilworth, NJ) until tumor resolution. MAIN OUTCOME MEASURES Patients were followed up clinically and photographically for evidence of tumor resolution and were monitored for evidence of tumor recurrence. RESULTS The authors present a series of 15 eyes (14 patients) that were treated with perilesional, subconjunctival, recombinant IFNα2b. Clinical resolution of the tumor occurred in 13 of 15 eyes. The median time to resolution was 1.4 months (range, 0.6-5.7). In the time of follow-up after lesion resolution (median, 55 months), only 1 of the 15 eyes in the study exhibited disease recurrence, and this occurred 4 months after clinical resolution. CONCLUSIONS Perilesional subconjunctival recombinant IFNα2b may be a viable medical alternative for the treatment of OSSN. Future studies will be needed to evaluate the ideal treatment regimen of IFNα2b.
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Kwon YD, Lim JW. Clinical Features of Retinopathy in Chronic Hepatitis B Patients With Treated With Peginterferon. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Dae Kwon
- Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Ji Won Lim
- Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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Ophthalmologic complications in children with chronic hepatitis C treated with pegylated interferon. J Pediatr Gastroenterol Nutr 2010; 51:183-6. [PMID: 20512062 PMCID: PMC2910798 DOI: 10.1097/mpg.0b013e3181b99cf0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Interferon treatment for chronic viral hepatitis C (HCV) has been associated with the development of retinopathy in 19% to 29% of adults. Our purpose is to describe the ophthalmologic complications of pegylated interferon-alpha2a with either placebo or ribavirin in children with chronic HCV (the PEDS-C trial). MATERIALS AND METHODS Prospective, comprehensive ophthalmologic examinations including slit lamp at enrollment and after 24 and 48 weeks of treatment of 114 children participating in a randomized clinical trial. RESULTS One hundred and twenty-eight children were screened for entry, of whom 123 had an eye examination and no child had existing retinal disease. One hundred fourteen children were eligible and were treated. One hundred ten children had an eye examination at 24 weeks and 103 children at 48 weeks. Three of 114 subjects (2.6%) developed documented (n = 2) or possible (1) serious eye complications. One subject developed evidence of ischemic retinopathy (cotton-wool spots) by week 24, 1 developed uveitis by week 48, and 1 reported at week 48 transient (<4 hours) monocular blindness that had occurred at week 36 with a subsequent normal examination at week 48. CONCLUSIONS Ophthalmologic complications are infrequent in children who are treated with pegylated interferon-alpha2a for HCV (2%-3%). Because of the potential severity of ischemic retinopathy and uveitis, prospective ocular assessment should remain part of the monitoring strategy for children who are treated with interferon for HCV.
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Karp CL, Galor A, Lee Y, Yoo SH. Pegylated Interferon Alpha 2b for Treatment of Ocular Surface Squamous Neoplasia: A Pilot Study. Ocul Immunol Inflamm 2010; 18:254-60. [DOI: 10.3109/09273948.2010.486687] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Monterrubio Villar J, Córdoba López A. [Mesenteric vein thrombosis and protein C and S deficiency in a patient with chronic hepatitis C on treatment with interferon and ribavirin]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:271-3. [PMID: 17493436 DOI: 10.1157/13101976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We describe the case of a 67 year old male with chronic hepatitis C on treatment with pegylated interferon and ribavirin who, after two and a half months of combined treatment, presented with a picture of acute mesenteric vein thrombosis that required urgent surgery. It re-occurred several days later and was his cause of death. In the thrombophilia study carried out immediately after surgery a decrease in protein C and S was considered as a cause of hypercoagulability. Protein C and S deficiency, natural anticoagulants synthesised in the liver, in patients without hepatic disease is a known cause of mesenteric thrombosis. Its decrease has also been described in the context of chronic hepatic diseases, including C virus chronic hepatitis, although it is not known for sure if this hypercoagulability state is a primary or secondary manifestation. Chronic hepatitis C and treatment with interferon has often been associated with a procoagulant state, and on many occasions due to different factors and mechanisms.
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Affiliation(s)
- Jesús Monterrubio Villar
- Unidad de Cuidados Intensivos, Hospital Don Benito-Villanueva, D. 06400 Don Benito, Badajoz, Spain.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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