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Mehmedovic A, Sofic-Drino V, Biscevic A, Ahmedbegovic-Pjano M. Intravitreal Sustained-release Dexamethasone Implant in Treatment for Chronic Macular Edema in Syphilis Infection: a Case Report. Med Arch 2023; 77:405-408. [PMID: 38299085 PMCID: PMC10825741 DOI: 10.5455/medarh.2023.77.405-408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/15/2023] [Indexed: 02/02/2024] Open
Abstract
Background Macular edema results from many conditions, such as diabetic retinopathy, macular degeneration, inflammatory diseases, cataract operation, trauma, and tumors. Specifically, the capillary filtration rate should equal the speed of fluid removal from extracellular retinal tissue, such as the glial and retinal pigment epithelium cells layer (RPE). Once these forces are imbalanced, fluid accumulates in cystoid spaces within the inner layers of the retina. Objective The main purpose of this case report is to show that macular edema caused by any inflammation, either bacteria, virus, or autoimmune origin, can be treated successfully, even if it is chronic. Case report A 31-year-old man has been reported to our clinic with symptoms of blurry vision in the left eye, which occurred during the last year. Essential examinations included CDVA, IOP measurement, slit-lamp examination, indirect ophthalmoscopy, and OCT scan that showed significant macular edema (central foveal thickness of 353 microns). We initiated laboratory searches, such as blood, serology, and immunology testing for the next three months after his first visit, together with prescribed topical and periocular corticosteroid therapy. The test to VDRL (venereal disease research laboratory) for Syphilis and Toxocariasis came positive. We took the best decision and recommended further treatment with the intravitreal application of Dexamethasone Implant 0.7mg. One week after the intravitreal application of corticosteroids on the control exam, there were normal findings on the posterior segment with no macular edema (central foveal thickness of 269 microns). Conclusion It is unexclusive that infection by Treponema pallidum (TP) causes isolated macular edema without any other symptoms on the anterior segment of the eye. It has indirect action on the macula, not just causing papilledema, retinal vasculitis, retinochoroiditis, and inflammatory disc edema, as expected. TP or the bacteria transmembrane protein (treponemal ligands) directly acting on vascular endothelial cells of the RPE cells, will be the key to the most certain mechanism of this condition. It is related to the possibility of the secretion of cytokines and the interactions between immune cells indirectly.
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Affiliation(s)
- Azra Mehmedovic
- Specialty Eye Hospital Svjetlost, Sarajevo, Bosnia and Herzegovina
| | | | - Alma Biscevic
- Specialty Eye Hospital Svjetlost, Sarajevo, Bosnia and Herzegovina
- University Eye Hospital Svjetlost, Zagreb, Croatia
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Tsui E, Rathinam SR, Gonzales JA, Thundikandy R, Kanakath A, Balamurugan S, Vedhanayaki R, Lim LL, Suhler EB, Al-Dhibi HA, Doan T, Keenan J, Ebert CD, Kim E, Madow B, Porco TC, Acharya NR. Outcomes of uveitic macular edema in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial. Ophthalmology 2022; 129:661-667. [PMID: 35143800 DOI: 10.1016/j.ophtha.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the outcomes of uveitic macular edema at 6 months and 12 months in patients treated with methotrexate or mycophenolate mofetil. DESIGN Subanalysis of a block-randomized, observer-masked, multi-center clinical trial. SUBJECTS/PARTICIPANTS Patients were enrolled into the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial between August 2013 and August 2017. METHODS/INTERVENTION/TESTING Patients were randomized to oral methotrexate 25mg weekly or mycophenolate mofetil 1.5g twice daily for 12 months, along with a corticosteroid taper. In addition to standardized clinical examination, all patients underwent spectral domain optical coherence tomography imaging at each visit. At the 6-month primary endpoint, patients who achieved treatment success continued the same treatment for a subsequent 6 months and treatment failures switched to the other treatment group. MAIN OUTCOME MEASURES Pre-specified primary outcome at 6 months and 12 months outcomes of central subfield thickness and visual acuity. RESULTS Of 216 patients in the FAST Trial, 42 eyes of 30 patients in the methotrexate group and 55 eyes of 41 patients in the mycophenolate group had uveitic macular edema. Baseline median central subfield thickness was 359μm and 342μm in the methotrexate and mycophenolate groups, respectively. At 12 months, for those who stayed on the same treatment, macular thickness decreased from baseline by 23 μm (IQR, -39.0 to 13) and 18 μm (IQR, -68.5 to 9), in the methotrexate and mycophenolate groups, respectively, (P=0.76). In patients who switched treatment at 6 months, macular thickness decreased from baseline by 12.5 μm (IQR, -29.8 to -2.3) and 92 μm (IQR, -240 to -18) in the methotrexate and mycophenolate groups, respectively, (P=0.23). At 12 months, 7/19 (37%) eyes on methotrexate had resolution of macular edema compared to 15/25 (60%) eyes on mycophenolate (P=0.10). For those that switched treatments, 8/17 (47%) eyes on methotrexate and 6/11 (55%) eyes on mycophenolate had improvement of macular edema, (P=0.92) CONCLUSIONS: Treatment with methotrexate or mycophenolate mofetil for uveitic macular edema results in similar improvements in macular thickness at 6 and 12 months. At 12 months, approximately half of eyes in each antimetabolite group still had persistent macular edema.
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Affiliation(s)
- Edmund Tsui
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Stein Eye Institute at University of California, Los Angeles, California and David Geffen School of Medicine at University of California, Los Angeles, California
| | - Sivakumar R Rathinam
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - John A Gonzales
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Radhika Thundikandy
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Anuradha Kanakath
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - S Balamurugan
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - R Vedhanayaki
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Eric B Suhler
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hassan A Al-Dhibi
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Thuy Doan
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Jeremy Keenan
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Caleb D Ebert
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Eric Kim
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Brian Madow
- Department of Ophthalmology, University of South Florida, Tampa, Florida
| | - Travis C Porco
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
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Safety and Tolerability of Topical Ophthalmic Triamcinolone Acetonide-Loaded Liposomes Formulation and Evaluation of Its Biologic Activity in Patients with Diabetic Macular Edema. Pharmaceutics 2021; 13:pharmaceutics13030322. [PMID: 33801366 PMCID: PMC7998140 DOI: 10.3390/pharmaceutics13030322] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/01/2023] Open
Abstract
Intravitreal injections (IVTs) of corticosteroids as triamcinolone acetonide (TA) are frequently used for the treatment of many vitreous and retinal disorders. However, IVTs are related to severe ocular complications. Lately, a topical ophthalmic TA-loaded liposomes formulation (TALF) was designed to transport TA into the posterior segment of the eye when instilled on the ocular surface. To evaluate the safety, tolerability, and biological activity of TALF, an animal study and a phase I clinical assay were performed. Moreover, four patients with diabetic macular edema (DME) were treated with TALF in order to explore the biological activity of the formulation. No inflammation, lens opacity, swelling, or increase in intraocular pressure were recorded after the instillation of TALF in any of the animal or clinical studies. Mainly, mild and transient adverse events such as dry eye and burning were reported. TALF significantly improves visual acuity and diminishes central foveal thickness in patients with DME. The current data demonstrate the safety, tolerability, and biological activity of TALF. It seems that TALF can be used topically to treat vitreous and retinal diseases that respond to TA such as DME, avoiding the use of corticosteroid IVTs and their associated hazards.
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Tomkins-Netzer O, Lightman SL, Burke AE, Sugar EA, Lim LL, Jaffe GJ, Altaweel MM, Kempen JH, Holbrook JT, Jabs DA. Seven-Year Outcomes of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial and Follow-up Study Results. Ophthalmology 2020; 128:719-728. [PMID: 32918964 DOI: 10.1016/j.ophtha.2020.08.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the long-term outcomes of uveitic macular edema (ME). DESIGN Longitudinal follow-up of a cohort of participants in a randomized clinical trial. PARTICIPANTS A total of 248 eyes of 177 participants with uveitic ME enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. METHODS OCT measurements, taken at baseline and annually, were graded by reading center graders masked to clinical data. Macular edema was defined as a center macular thickness (CMT) ≥240 μm on time-domain OCT or time-domain OCT equivalent. Resolution of ME was defined as normalization of macular thickness on OCT. Relapse of ME was defined as increase in macular thickness to ≥240 μm in an eye that previously had resolution. Visual acuity was measured at each visit with logarithmic visual acuity charts. MAIN OUTCOME MEASURES Resolution and relapse of ME. Visual acuity. RESULTS Among 227 eyes with ME followed ≥1 year, the cumulative percent of eyes with ME resolving at any point during 7 years was 94% (95% confidence interval [CI], 89-97). Epiretinal membranes on OCT were associated with a lower likelihood of ME resolution (hazard ratio [HR], 0.74; 95% CI, 0.55-1.01; P = 0.05). Among 177 eyes with resolved ME, the cumulative percent with relapse within 7 years was 43% (95% CI, 32-51). Eyes in which ME resolved gained a mean of 6.24 letters (95% CI, 4.40-8.09; P < 0.001) compared with eyes that remained free from ME during the 1-year follow-up intervals, whereas eyes in which ME did not resolve experienced no gain in vision (mean change -1.30 letters; 95% CI, -2.70 to 0.09; P = 0.065), and eyes that developed ME during the year (incident or relapsed) experienced a mean loss of -8.65 letters (95% CI, -11.5 to -5.84, P < 0.001). CONCLUSIONS Given sufficient time and treatment, nearly all uveitic ME resolves, but episodes of relapse were common. Visual acuity results were better among eyes with resolved ME, suggesting that control of inflammation and resolution of ME might be visually relevant treatment targets.
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Affiliation(s)
- Oren Tomkins-Netzer
- Institute of Ophthalmology, University College London, and Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Susan L Lightman
- Institute of Ophthalmology, University College London, and Moorfields Eye Hospital, London, United Kingdom
| | - Alyce E Burke
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth A Sugar
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lyndell L Lim
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Michael M Altaweel
- Department of Ophthalmology and Reading Center, University of Wisconsin, Madison, School of Medicine and Public Health, Madison, Wisconsin
| | - John H Kempen
- Department of Ophthalmology Harvard Medical School and Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; MCM Eye Unit, Myung Sung Christian Medical Center General Hospital and Medical School, Addis Ababa, Ethiopia
| | - Janet T Holbrook
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas A Jabs
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Jauregui-Garcia GD, Acosta-Gonzalez R, Ibanez-Hernandez MA, Mora-Gonzalez GF, Armendáriz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomal Topical Formulation Improves Contrast Sensitivity Outcome After Femtosecond Laser-Assisted Cataract Surgery. J Ocul Pharmacol Ther 2019; 35:512-521. [PMID: 31486694 PMCID: PMC6839423 DOI: 10.1089/jop.2019.0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: To assess visual results, macular modifications, and the incidence of clinically significant macular edema (CSME) in patients using a topical triamcinolone acetonide-loaded liposomal formulation (TA-LF) after femtosecond laser-assisted cataract surgery (FLACS). Methods: Fifty-six eyes after FLACS were selected. Twenty-eight eyes in the combined therapy group (P + N) were treated with prednisolone 1% and nepafenac 0.1% for 21 days postoperatively, whereas 28 eyes in the TA-LF group received a liposomal formulation containing 2 mg/mL of TA (0.2%) for the same period of time. Follow-up visits at 1 day, 6 weeks, and 12 weeks after surgery consisted of visual acuity, contrast sensitivity (CS), central foveal thickness (CFT), total macular volume (TMV) measurements, and the detection of CSME. Results: CS improved in the TA-LF group (basal value: 1.087 ± 0.339 vs. 1.276 ± 0.147 at week 12, P = 0.0346), whereas in the P + N group, CS was not different from the baseline (basal value: 1.130 ± 0.331 vs. 1.274 ± 0.133 at week 12, P = 0.1276). There were similar increases in postoperative CFT and TMV in both groups. CFT and TMV significantly correlate with CS only in the TA-LF group. The r2 for CFT and CS was 0.1963 (P = 0.0206), whereas the r2 for TMV and CS was 0.3615 (P = 0.0007) at 12 weeks. No difference was observed in the incidence of CSME between the groups. Conclusion: TA-LF is associated with better CS outcomes compared to combined therapy after FLACS.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Jose Navarro-Partida
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Juan Carlos Altamirano-Vallejo
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Gerardo Daniel Jauregui-Garcia
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | | | | | | | - Juan Armendáriz-Borunda
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Arturo Santos
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Hernandez-Gamez AG, Garcia-Bañuelos JJ, Armendariz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomes Topical Formulation for the Treatment of Cystoid Macular Edema After Cataract Surgery: A Pilot Study. J Ocul Pharmacol Ther 2019; 35:106-115. [PMID: 30614750 PMCID: PMC6450453 DOI: 10.1089/jop.2018.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: To report tolerability, safety, and efficacy of a topical triamcinolone acetonide-loaded liposomes formulation (TA-LF) in targeting the macular area in patients with refractory pseudophakic cystoid macular edema (PCME). Methods: For tolerability, safety and efficacy evaluation, 12 eyes of 12 patients with refractory PCME were exposed to one drop of TA-LF (TA at 0.2%) every 2 h for 90 days or until best-corrected visual acuity (BCVA) was achieved. Intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. Results: Patients with refractory PCME under TA-LF therapy showed a significant improvement in BVCA and CFT without significant IOP modification (P = 0.94). On average CFT decreased to 206.75 ± 135.72 μm and BCVA improved to 20.08 ± 10.35 letters (P < 0.0005). BCVA was achieved at 10.58 ± 6.70 weeks (range 2–18). TA-LF was well tolerated in all cases. Neither ocular surface abnormalities nor adverse events were recorded. Conclusion: TA-LF was well tolerated and improved BCVA and CFT on patients with refractory PCME.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Juan Carlos Altamirano-Vallejo
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | | | - Jesus Javier Garcia-Bañuelos
- 4 Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | | | - Arturo Santos
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
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Thorne JE, Sugar EA, Holbrook JT, Burke AE, Altaweel MM, Vitale AT, Acharya NR, Kempen JH, Jabs DA. Periocular Triamcinolone vs. Intravitreal Triamcinolone vs. Intravitreal Dexamethasone Implant for the Treatment of Uveitic Macular Edema: The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial. Ophthalmology 2018; 126:283-295. [PMID: 30269924 DOI: 10.1016/j.ophtha.2018.08.021] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the comparative effectiveness of 3 regional corticosteroid injections for uveitic macular edema (ME): periocular triamcinolone acetonide (PTA), intravitreal triamcinolone acetonide (ITA), and the intravitreal dexamethasone implant (IDI). DESIGN Multicenter, randomized clinical trial. PARTICIPANTS Patients with uveitic ME. METHODS Patients were randomized 1:1:1 to receive 1 of the 3 therapies. Patients with bilateral ME were assigned the same treatment for both eyes. MAIN OUTCOME MEASURES The primary outcome was the proportion of baseline (PropBL) central subfield thickness (CST) at 8 weeks (CST at 8 weeks/CST at baseline) assessed with OCT by masked readers. Secondary outcomes included ≥20% improvement and resolution of ME, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) events over 24 weeks. RESULTS All treatment groups demonstrated improved CST during follow-up. At 8 weeks, each group had clinically meaningful reductions in CST relative to baseline (PropBL: 0.77, 0.61, and 0.54, respectively, which translates to reductions of 23%, 39%, and 46% for PTA, ITA, and IDI, respectively). Intravitreal triamcinolone acetonide (PropBL ITA/PropBL PTA, hazard ratio [HR], 0.79; 99.87% confidence interval [CI], 0.65-0.96) and IDI (PropBL IDI/PropBL PTA, HR, 0.69; 99.87% CI, 0.56-0.86) had larger reductions in CST than PTA (P < 0.0001). Intravitreal dexamethasone implant was noninferior to ITA at 8 weeks (PropBL IDI/PropBL ITA, HR, 0.88; 99.87% CI, 0.71-1.08). Both ITA and IDI treatments also were superior to PTA treatment in improving and resolving uveitic ME. All treatment groups demonstrated BCVA improvement throughout follow-up. Both ITA and IDI groups had improvements in BCVA that was 5 letters greater than in the PTA group at 8 weeks (P < 0.004). The risk of having IOP ≥24 mmHg was higher in the intravitreal treatment groups compared with the periocular group (HR, 1.83; 95% CI, 0.91-3.65 and HR, 2.52; 95% CI, 1.29-4.91 for ITA and IDI, respectively); however, there was no significant difference between the 2 intravitreal treatment groups. CONCLUSIONS Intravitreal triamcinolone acetonide and the IDI were superior to PTA for treating uveitic ME with modest increases in the risk of IOP elevation. This risk did not differ significantly between intravitreal treatments.
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Affiliation(s)
- Jennifer E Thorne
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Clinical Trials and Data Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
| | - Elizabeth A Sugar
- Center for Clinical Trials and Data Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Center for Clinical Trials and Data Synthesis, Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Janet T Holbrook
- Center for Clinical Trials and Data Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Alyce E Burke
- Center for Clinical Trials and Data Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael M Altaweel
- The Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Albert T Vitale
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah
| | - Nisha R Acharya
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Epidemiology, University of California, San Francisco, San Francisco, California
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Eye Unit, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Douglas A Jabs
- Center for Clinical Trials and Data Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Schallhorn JM, Niemeyer KM, Browne EN, Chhetri P, Acharya NR. Difluprednate for the Treatment of Uveitic Cystoid Macular Edema. Am J Ophthalmol 2018; 191:14-22. [PMID: 29580977 DOI: 10.1016/j.ajo.2018.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe clinical outcomes associated with the use of topical difluprednate in treating uveitic cystoid macular edema. DESIGN Retrospective, interventional case series. METHODS Setting: Medical record review in a tertiary care uveitis center. PATIENT POPULATION Fifty-eight patients (72 eyes) with uveitic cystoid macular edema (CME) treated with difluprednate 0.05% ophthalmic solution between June 2012 and May 2016. MAIN OUTCOME MEASURES Macular central subfield thickness (CST) determined by optical coherence tomography, improvement of CME (≥20% reduction in CST or resolution), and resolution of CME (CST ≤ 320 μm with no cysts) at 30 days after starting treatment. Outcomes were assessed up to 90 days. RESULTS CST on average decreased by 17% (95% CI: -33%, -7%) for eyes using only difluprednate (n = 43) and by 6% (95% CI: -17%, -2%) for eyes in patients using concomitant systemic immunosuppressive therapy (n = 29) at 30 days, a 12% difference between groups (95% CI: 2%, 21%, P = .02). Of eyes on difluprednate alone, 76% had improvement and 48% had resolution of CME. In patients using systemic therapy, 37% of eyes had improvement and 17% had resolution. Eight eyes (11%) had an intraocular pressure (IOP) > 24 mm Hg within the first 30 days. By 90 days, CME had improved in 69% of all eyes and resolved in 43% of eyes, with only 9 patients starting or increasing systemic immunosuppressive medications and 2 patients receiving periocular corticosteroid injections. CONCLUSIONS Difluprednate was associated with an improvement in uveitic CME and could be a reasonable first-line therapy. IOP should be closely monitored.
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Affiliation(s)
- Julie M Schallhorn
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Katherine M Niemeyer
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Erica N Browne
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Parth Chhetri
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
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Altamirano-Vallejo JC, Navarro-Partida J, Gonzalez-De la Rosa A, Hsiao JH, Olguín-Gutierrez JS, Gonzalez-Villegas AC, Keller BC, Bouzo-Lopez L, Santos A. Characterization and Pharmacokinetics of Triamcinolone Acetonide-Loaded Liposomes Topical Formulations for Vitreoretinal Drug Delivery. J Ocul Pharmacol Ther 2018; 34:416-425. [PMID: 29584529 DOI: 10.1089/jop.2017.0099] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To achieve a safer alternative to intravitreal injection of corticosteroids, we developed and characterized triamcinolone acetonide-loaded liposomes formulations (TA-LFs) to be used topically for vitreoretinal drug delivery. METHODS Four different 0.2% TA-LFs (TA-LF1 to TA-LF4) were generated and submitted to physicochemical characterization. Posteriorly, an ex vivo diffusion assay was performed using rabbit corneas as membranes. Finally, concentrations of triamcinolone acetonide (TA) were determined by high-performance liquid chromatography in ocular tissues from New Zealand white rabbits after multiple topical doses of TA-LF2 (6 times per day, 14 days). In addition, toxicity and tolerability of TA-LF2 was evaluated by cell viability assay and eye examination of study animals, respectively. RESULTS TA-LF2 was the most stable formulation maintaining a stable hidrogenion potential (pH) at 30 and 40°C and even improving encapsulation with higher temperature. TA-LF2 and TA-LF3 presented the best diffusion performance in vitro reaching the highest TA concentrations after 8 h of follow-up. In vivo diffusion and pharmacokinetics analysis showed that concentrations of TA in retina and vitreous reached the highest peak at 12 h after topical administration of TA-LF2 (252.10 ± 90.00 ng/g and 32.6 ± 10.27 ng/g, respectively) and subsequently decline to 24.0 ± 11.72 ng/g and 19.5 ± 13.14 ng/g, respectively, at 14 days of follow-up. Finally, cell viability was unaffected by TA-LF2, and no increase in intraocular pressure nor ocular alterations were observed after topical administration of this formulation in rabbits. CONCLUSION TA-loaded liposomes, administered topically, can deliver TA in the vitreous cavity and reach the retina efficiently.
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Affiliation(s)
- Juan C Altamirano-Vallejo
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
| | - Jose Navarro-Partida
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
| | - Alejandro Gonzalez-De la Rosa
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
| | | | | | | | | | | | - Arturo Santos
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
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10
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PROSPECTIVE EVALUATION OF A SUSTAINED-RELEASE DEXAMETHASONE INTRAVITREAL IMPLANT FOR CYSTOID MACULAR EDEMA IN QUIESCENT UVEITIS. Retina 2018; 37:1692-1699. [PMID: 27893624 DOI: 10.1097/iae.0000000000001406] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc) in the treatment of uveitic cystoid macular edema that had persisted in the absence of intraocular inflammation. METHODS In this prospective interventional case series, 10 patients with uveitic cystoid macular edema and quiescent uveitis were treated with dexamethasone intravitreal implant at baseline and evaluated monthly for one year. Patients were retreated whenever cystoid macular edema recurred. The primary outcome measure was best-corrected visual acuity (BCVA) at day 90. RESULTS At day 90, mean improvement from baseline BCVA was 14.4 letters (P = 0.0003), 70% of patients had a ≥10 letter BCVA improvement, 50% of patients had a ≥15 letter BCVA improvement, and the mean decrease from baseline central subfield retinal thickness was 140 μm (P = 0.008). Improvements were maintained through day 360 with retreatment as needed. At day 360, mean improvement in BCVA was 16.5 letters (P = 0.006) and the mean decrease in central subfield retinal thickness was 158 μm (P = 0.002). One patient experienced intraocular pressure >25 mmHg (managed with topical medication). Two phakic patients (2/8; 25%) had worsening of lens opacity requiring cataract extraction. CONCLUSION Dexamethasone intravitreal implant may be an effective treatment for patients with persistent cystoid macular edema in quiescent uveitis.
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11
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Fardeau C, Champion E, Massamba N, LeHoang P. Uveitic macular edema. Eye (Lond) 2016; 30:1277-1292. [PMID: 27256304 DOI: 10.1038/eye.2016.115] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/23/2016] [Indexed: 02/06/2023] Open
Abstract
Macular edema (ME) may complicate anterior, intermediate, and posterior uveitis, which may be because of various infectious, neoplastic or autoimmune etiologies. BRB breakdown is involved in the pathogenesis of Uveitic ME (UME). Optical coherence tomography has become a standard tool to confirm the diagnosis of macular thickening, due to its non-invasive, reproducible, and sensitive features. Retinal fluorescein and indocyanine green angiography is helpful to study the macula and screen for associated vasculitis, detect ischemic areas and preretinal, prepapillary or choroidal neovascular complications, and it may provide information about the etiology and be needed to assess the therapeutic response. UME due to an infection or neoplastic infiltration may require a specific treatment. If it remains persistent or occurs in other etiologies, immunomodulatory treatments may be needed. Intravitreal, subconjunctival, or subtenon corticosteroids are widely used. Their local use is contraindicated in glaucoma patients and limited by their short-lasting action. In case of bilateral sight-threatening chronic posterior uveitis, systemic treatments are usually needed, and corticosteroids are used as the standard first-line therapy. In order to reduce the daily steroid dose, immunosuppressive or immunomodulatory agents may be added, some of them being now available intravitreally. Ongoing prospective studies are assessing biotherapies and immunomodulators to determine their safety and efficacy in this indication.
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Affiliation(s)
- C Fardeau
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
| | - E Champion
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
| | - N Massamba
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
| | - P LeHoang
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
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12
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Pichi F, Nucci P, Baynes K, Lowder CY, Srivastava SK. Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis. Int Ophthalmol 2016; 37:221-228. [PMID: 27221263 DOI: 10.1007/s10792-016-0265-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to review the results of treatment of juvenile idiopathic arthritis-related uveitis with the use of intravitreal dexamethasone implant. Sixteen eyes with Juvenile idiopathic arthritis (JIA)-associated uveitis received intravitreal dexamethasone implant to treat recalcitrant anterior segment inflammation (43.7 %), chronic macular edema (6.2 %), or a combination of both (50 %). One month after injection, mean visual acuity had improvement to 39.6 ± 11 ETDRS letters (p < 0.001). Mean AC cells measure at 1 month was 0.79 and 0.75 at 3 months. One month after injection, there was a significant reduction of central retinal thickness (CRT) to 342.4 ± 79.3 µm (p < 0.01). One month after the second implant, 11 eyes (91.6 %) achieved improved activity of the anterior uveitis, and mean best-corrected visual acuity improved to 44.6 ± 8.1 ETDRS letters (p < 0.01). At 1 month after the second injection, 4/5 eyes had resolution of macular edema with CRT of 250.4 ± 13.7 µm (p < 0.01). Of the 16 eyes, 12 eyes received a second injection at mean of 7.5 ± 3.1 months after the first treatment, and 5 eyes received a third Ozurdex injection on average 7 ± 4.6 months after the second injection. Of the 16 eyes, five eyes were pseudophakic prior to injection. Of the remaining 11 eyes, 8 (73 %) developed worsening posterior subcapsular cataract at a mean of 7.3 ± 1.2 months after the first injection. After the first injection, only one eye required topical antiglaucoma therapy with maximum pressure of 25 mmHg. In patients with recalcitrant JIA-associated active uveitis, injection of sustained-release dexamethasone can achieve control of anterior inflammation and resolution of macular edema.
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Affiliation(s)
- Francesco Pichi
- Cole Eye Institute, Cleveland Clinic, E 105th st, 9500 Euclid Avenue, Cleveland, OH, 44106, USA. .,San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, Milan, Italy.
| | - Paolo Nucci
- San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, Milan, Italy
| | - Kimberly Baynes
- Cole Eye Institute, Cleveland Clinic, E 105th st, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Careen Y Lowder
- Cole Eye Institute, Cleveland Clinic, E 105th st, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Sunil K Srivastava
- Cole Eye Institute, Cleveland Clinic, E 105th st, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
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Outcome of Treating Pediatric Uveitis With Dexamethasone Implants. Am J Ophthalmol 2016; 161:110-5.e1-2. [PMID: 26478217 DOI: 10.1016/j.ajo.2015.09.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the outcome in children of eyes with uveitis following repeated treatment with dexamethasone (Ozurdex) implants. DESIGN Retrospective, interventional study. METHODS Twenty-two eyes of 16 pediatric patients with uveitis were treated with 35 dexamethasone implants at a tertiary referral center. Following implantations, anatomic and functional outcomes, as well as ocular complications, were noted. Main outcome measures included best-corrected visual acuity, central retinal thickness, number and dosage of systemic immunosuppression drugs, vitreous haze score, and presence of raised intraocular pressure or cataract. RESULTS Following the first implantation, average best-corrected visual acuity improved significantly from 0.55 ± 0.08 logMAR to 0.37 ± 0.08 logMAR (P = .024), central retinal thickness decreased by 219 ± 55 μm (P = .01), and the percentage of eyes achieving a vitreous haze score of 0 increased from 41% to 88% (P = .006). The median time to relapse following the first injection was 9 months, with a similar response achieved after each repeat implantation. Children previously requiring systemic immunosuppression at the time of the first implantation were able to stop or significantly reduce the dose and number of drugs. In total there were 4 instances of cataract progression that were not visually significant and did not require surgical treatment and 6 cases of raised IOP, 5 of which were treated pharmacologically with no surgical intervention required and 1 that required revision of a previous filtration surgery. There were no cases of implant migration into the anterior chamber, endophthalmitis, or retinal detachment. CONCLUSIONS The use of dexamethasone implants in children results in improved retinal thickness and reduction in ocular inflammation, which can improve vision for several months. Repeat implantations result in continued control of the inflammation, allowing for reduction of systemic immunosuppression with few ocular complications.
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Knickelbein JE, Armbrust KR, Kim M, Sen HN, Nussenblatt RB. Pharmacologic Treatment of Noninfectious Uveitis. Handb Exp Pharmacol 2016; 242:231-268. [PMID: 27848029 DOI: 10.1007/164_2016_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Uveitis encompasses a spectrum of diseases whose common feature is intraocular inflammation, which may be infectious or noninfectious in etiology (Nussenblatt and Whitcup 2010). Infectious causes of uveitis are typically treated with appropriate antimicrobial therapy and will not be discussed in this chapter. Noninfectious uveitides are thought have an autoimmune component to their etiology and are thus treated with anti-inflammatory agents.
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Affiliation(s)
- Jared E Knickelbein
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Karen R Armbrust
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Meredith Kim
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA.
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15
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Tomkins-Netzer O, Lightman S, Drye L, Kempen J, Holland GN, Rao NA, Stawell RJ, Vitale A, Jabs DA. Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results. Ophthalmology 2015; 122:2351-9. [PMID: 26359188 PMCID: PMC4624003 DOI: 10.1016/j.ophtha.2015.07.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the 2-year outcomes of uveitic macular edema. DESIGN Longitudinal follow-up of a randomized cohort. PARTICIPANTS At baseline, 148 eyes of 117 patients enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial had macular edema, and 134 eyes of 108 patients completed 2-year follow-up. METHODS Patients enrolled in the study were randomized to either systemic immunosuppression or intravitreal fluocinolone acetonide implant therapy. Macular edema was defined as thickening of the retina (center point thickness≥240 μm) on time-domain optical coherence tomography (OCT) of macula. MAIN OUTCOME MEASURES Improvement in macular edema (≥20% reduction in central point thickness on OCT), resolution of macular edema (normalization of thickness on OCT), and best-corrected visual acuity (BCVA). RESULTS Between randomization and 2-years' follow-up, 62% and 25% of eyes in the systemic and implant groups, respectively, received at least 1 supplemental regional corticosteroid injection. By 2-years' follow-up, macular edema improved in 71% of eyes and resolved in 60%. There were no differences between treatment groups in the proportion of eyes with macular edema improving (systemic therapy vs. implant, 65% vs. 77%; P=0.20) and resolving (52% vs. 68%; P=0.28), but eyes randomized to implant had more improvement in macular thickness (median decrease of 180 vs. 109 μm in the systemic therapy group; P=0.04). Eyes with baseline fluorescein angiographic leakage were more likely to improve than those without (76% vs. 58%; P=0.03). Overall, there was a mean 5-letter (1 line) improvement in BCVA at 2 years. Mean changes in BCVA from baseline at 2 years by macular edema response status were: resolution, +10 letters; improvement without resolution, +10 letters (P=0.92); little to no change, 6 letters (P=0.19); and worsening, -16 letters (worsening acuity; P=0.0003). CONCLUSIONS About two thirds of eyes with uveitic macular edema were observed to experience improvement in the edema and visual acuity with implant or systemic treatment. Fluocinolone acetonide implant therapy was associated with a greater quantitative improvement in thickness. Fluorescein angiography leakage was associated with a greater likelihood of improvement in macular edema.
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Affiliation(s)
- Oren Tomkins-Netzer
- The Institute of Ophthalmology, University College London, London, United Kingdom
| | - Susan Lightman
- The Institute of Ophthalmology, University College London, London, United Kingdom
| | - Lea Drye
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - John Kempen
- The Departments of Ophthalmology and Epidemiology, the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gary N Holland
- UCLA Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Narsing A Rao
- Department of Ophthalmology, USC Eye Institute, University of Southern California, Los Angeles, California
| | - Richard J Stawell
- Department of Ophthalmology, Royal Victorian Eye & Ear Hospital, East Melbourne, Australia
| | - Albert Vitale
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Departments of Ophthalmology and Medicine, the Icahn School of Medicine at Mount Sinai, New York, New York.
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Shulman S, Jóhannesson G, Stefánsson E, Loewenstein A, Rosenblatt A, Habot-Wilner Z. Topical dexamethasone-cyclodextrin nanoparticle eye drops for non-infectious Uveitic macular oedema and vitritis - a pilot study. Acta Ophthalmol 2015; 93:411-415. [PMID: 25988730 DOI: 10.1111/aos.12744] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/05/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of 1.5% dexamethasone nanoparticle (DexNP) drops in eyes with non-infectious uveitic macular oedema and vitritis. METHODS In a prospective pilot study, DexNP drops were administered four times a day for 4 weeks followed by drops tapering over a period of another 4 weeks. Follow-up time was 12 weeks. RESULTS Five eyes with macular oedema and three eyes with vitritis were included in the study. Best corrected visual acuity (BCVA) significantly improved from a median of 0.2 logMAR to a median of 0.15 logMAR at 4 weeks' time (p < 0.05). Median BCVA was 0.175 logMAR and 0.2 logMAR, at week 8 and 12, respectively (p > 0.05). Macular oedema significantly improved at all time-points as compared to baseline (p < 0.05) and resolved in all eyes during follow-up. One eye had macular oedema relapse at week 12. Vitritis improved in all eyes and resolved completely in two eyes. One eye had intraocular pressure (IOP) elevation which was well controlled with topical antihypertensive treatment, and one eye had cataract progression. CONCLUSION This short pilot study demonstrates favourable effect of 1.5% DexNP eye drops on eyes with non-infectious uveitic macular oedema and vitritis. Further comparative long-term studies are warranted to assess this effect.
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Affiliation(s)
- Shiri Shulman
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gauti Jóhannesson
- Department of Clinical Science, Ophthalmology; Umeå University; Umeå Sweden
| | - Einar Stefánsson
- Department of Ophthalmology; National Hospital Reykjavik; University of Iceland; Reykjavik Iceland
| | - Anat Loewenstein
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Amir Rosenblatt
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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[Statement of the German Ophthalmological Society, the Retina Society and the Professional Association of German Ophthalmologists for intravitreal treatment of macular edema in uveitis: Date: 02/07/2014]. Ophthalmologe 2015; 111:740-8. [PMID: 25118844 DOI: 10.1007/s00347-014-3130-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Sen HN, Vitale S, Gangaputra SS, Nussenblatt RB, Liesegang TL, Levy-Clarke GA, Rosenbaum JT, Suhler EB, Thorne JE, Foster CS, Jabs DA, Kempen JH. Periocular corticosteroid injections in uveitis: effects and complications. Ophthalmology 2014; 121:2275-86. [PMID: 25017415 PMCID: PMC4254355 DOI: 10.1016/j.ophtha.2014.05.021] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 05/21/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS A total of 914 patients (1192 eyes) who had received ≥ 1 periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. METHODS Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. MAIN OUTCOME MEASURES Control of inflammation, improvement of visual acuity (VA) to ≥ 20/40, improvement of VA loss attributed to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery. RESULTS Among 914 patients (1192 eyes) who received ≥ 1 periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤ 6 months, 72.7% (95% CI, 69.1-76.3) of the eyes achieved complete control of inflammation and 49.7% (95% CI, 45.5-54.1) showed an improvement in VA from <20/40 to ≥ 20/40. Among the subset with VA <20/40 attributed to ME, 33.1% (95% CI, 25.2-42.7) improved to ≥ 20/40. By 12 months, the cumulative incidence of ≥ 1 visits with an intraocular pressure of ≥ 24 mmHg and ≥ 30 mmHg was 34.0% (95% CI, 24.8-45.4) and 15.0% (95% CI, 11.8-19.1) respectively; glaucoma surgery was performed in 2.4% of eyes (95% CI, 1.4-3.9). Within 12 months, among phakic eyes initially ≥ 20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2% (95% CI, 15.9-25.6); cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes (95% CI, 11.1-17.2). CONCLUSIONS Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, VA improved in one half of the patients at some point within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.
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Affiliation(s)
- H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
| | - Susan Vitale
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Sapna S Gangaputra
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Teresa L Liesegang
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; Tampa Bay Uveitis Center, Tampa, Florida
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Veterans' Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John H Kempen
- Department of Ophthalmology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Tomkins-Netzer O, Talat L, Bar A, Lula A, Taylor SRJ, Joshi L, Lightman S. Long-term clinical outcome and causes of vision loss in patients with uveitis. Ophthalmology 2014; 121:2387-92. [PMID: 25178807 DOI: 10.1016/j.ophtha.2014.07.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/20/2014] [Accepted: 07/07/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the long-term clinical and functional outcome, risks, and causes of vision loss and burden of disease among patients with uveitis. DESIGN Cross-sectional study. PARTICIPANTS The study included 1076 patients diagnosed with uveitis who attended the uveitis clinic at Moorfields Eye Hospital, London, United Kingdom, between 2011 and 2013. METHODS Information was gathered from the notes of all patients who were examined in the clinic. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), causes of moderate vision loss (MVL; 20/50-20/120), and severe vision loss (SVL; ≤ 20/200). RESULTS The study included 1799 eyes of 1076 patients with an average follow-up of 7.97 ± 0.17 years (median, 5.6 years; range, 1 month-54 years; 8159 patient-years; 14 226 eye-years). Average BCVA remained stable for patients with anterior uveitis (20/30 at baseline to 20/33 at 10 years), as well as for those with nonanterior uveitis (20/50 at baseline to 20/47 at 10 years). Vision loss was noted in 19.2% of eyes, with an incidence for MVL of 0.01 per eye-year or 0.02 per patient-year and for SVL of 0.01 per eye-year or 0.02 per patient-year. Patients were more at risk of vision loss if they had non-anterior uveitis disease, vitreous opacities, retinal detachment, cystoid macular edema (CME), macular scarring, macular hole, optic neuropathy, or macular ischemia. Chronic CME was the most common cause of MVL (3.55%), and macular scarring was the most common cause for irreversible SVL (4%). Among 525 patients (48.7%) who received oral prednisolone, 320 (61%) required a dose of more than 40 mg/day and 130 (24.8%) also required 1 or more second-line agents. Patients were reviewed on average 33.7 ± 0.7 times or 5.9 ± 0.46 times/year. CONCLUSIONS Long-term functional outcome among uveitis patients is good, with BCVA remaining stable for more than 10 years of follow-up. In cases when vision loss occurs, it is related mainly to retinal changes. The burden on clinical services is similar regardless of the severity of disease or the risk of vision loss.
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Affiliation(s)
- Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Lazha Talat
- Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Asaf Bar
- Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Albert Lula
- Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Simon R J Taylor
- Royal Surrey County Hospital, Egerton Road, Guildford, United Kingdom; Division of Immunology & Inflammation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lavnish Joshi
- Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Sue Lightman
- Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College of London, London, United Kingdom.
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Shi H, Gao J, Pei H, Liu R, Hu WK, Wan X, Li T, Li B. Adeno-associated virus-mediated gene delivery of the human ND4 complex I subunit in rabbit eyes. Clin Exp Ophthalmol 2012; 40:888-94. [PMID: 22612072 DOI: 10.1111/j.1442-9071.2012.02815.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To assess intravitreal injection dose and safety of recombinant adeno-associated virus-mediated gene delivery of human NADH dehydrogenase subunit 4 (ND4) in rabbit eyes. METHODS An open reading frame for human ND4 or adeno-associated virus-green fluorescent protein were fused to the mitochondrial targeting sequence and packed into separate adeno-associated virus capsids. Rabbits of three treatment groups were administered 0.1 mL adeno-associated virus-ND4, 0.1 mL adeno-associated virus-green fluorescent protein or 0.1 mL vehicle via intravitreal injection, respectively. The safety of recombinant adenoassociated virus-mediated gene delivery of human ND4 in rabbit eyes was assessed with a slit-lamp microscope and direct ophthalmoscope, measurements of intraocular pressure and flash visual evoked potential, and optical coherence tomography. The mRNA and protein expressions of human ND4 in the retina of rabbits were determined with real-time polymer chain reaction (PCR), immunofluorescence and Western blot. RESULTS No complications occurred in any of the three treatment groups after the intravitreal injection. At 1-month post-injection, no significant difference in the mean thickness of retinal nerve fibre layer was found among the three groups. Results of the visual evoked potential test showed that there was no difference in the latency of the visual P100 wave among the three groups. Real-time PCR, immunofluorescence and Western blot analyses verified the expressions of ND4 and green fluorescent protein in the retinal nerve fibre layer. CONCLUSIONS Intravitreal injection of adeno-associated virus-ND4 expression vectors was effectively and safely performed in our study. The data on the dose and method of intravitreal injection from our study will provide a valuable reference for clinical intravitreal injection of adeno-associated virus-ND4 for the treatment of Leber's hereditary optic neuropathy.
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Affiliation(s)
- Hui Shi
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Vadlapudi AD, Patel A, Cholkar K, Mitra AK. Recent Patents on Emerging Therapeutics for the Treatment of Glaucoma, Age Related Macular Degeneration and Uveitis. RECENT PATENTS ON BIOMEDICAL ENGINEERING 2012; 5:83-101. [PMID: 25414810 PMCID: PMC4235159 DOI: 10.2174/1874764711205010083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Advancements in the field and rising interest among pharmaceutical researchers have led to the development of new molecules with enhanced therapeutic activity. Design of new drugs which can target a particular pathway and/or explore novel targets is of immense interest to ocular pharmacologists worldwide. Delivery of suitable pharmacologically active agents at proper dose (within the therapeutic window) to the target tissues without any toxicity to the healthy ocular tissues still remain an elusive task. Moreover, the presence of static and dynamic barriers to drug absorption including the corneal epithelium (lipophilic), corneal and scleral stroma (hydrophilic), conjunctival lymphatics, choroidal vasculature and the blood-ocular barriers also pose a significant challenge for achieving therapeutic drug concentrations at the target site. Although many agents are currently available, new compounds are being introduced for treating various ocular diseases. Deeper understanding of the etiology and complex mechanisms associated with the disease condition would aid in the development of potential therapeutic candidates. Novel small molecules as well as complex biotechnology derived macromolecules with superior efficacy, safety and tolerability are being developed. Therefore, this review article provides an overview of existing drugs, treatment options, advances in emerging therapeutics and related recent patents for the treatment of ocular disorders such as glaucoma, age related macular degeneration (AMD) and uveitis.
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Affiliation(s)
- Aswani Dutt Vadlapudi
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
| | - Ashaben Patel
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
| | - Kishore Cholkar
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
| | - Ashim K. Mitra
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
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Abstract
PURPOSE OF REVIEW To review new clinically relevant data regarding the intraocular treatment of noninfectious uveitis. RECENT FINDINGS Triamcinolone acetonide, the most commonly used intravitreal corticosteroid for treatment of uveitis and uveitic macular oedema has a limited duration of action and is associated with a high risk of corticosteroid-induced intraocular pressure (IOP) rise and cataract. Recent advances have led to the development of sustained-release corticosteroid devices using different corticosteroids such as dexamethasone and fluocinolone acetonide. Treatment options for patients who have previously exhibited corticosteroid hypertensive response have also expanded through the use of new noncorticosteroid intravitreal therapeutics such as methotrexate and antivascular endothelial growth factor (anti-VEGF) agents. SUMMARY Ozurdex dexamethasone implant appears to have a better safety profile, and a slightly long-lasting effect than triamcinolone acetonide. The Retisert implant allows the release of corticosteroids at a constant rate for 2.5 years, but it requires surgical placement and its use is associated with a very high risk of cataract and requirement for IOP-lowering surgery. For patients who are steroid responders, methotrexate may offer a better alternative to corticosteroid treatment than anti-VEGF agents, but controlled trials are required to confirm this.
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Understanding uveitis: The impact of research on visual outcomes. Prog Retin Eye Res 2011; 30:452-70. [DOI: 10.1016/j.preteyeres.2011.06.005] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 01/01/2023]
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