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Moll-Udina A, Dotti-Boada M, Miguel L, Rodríguez A, Gascón J, Sainz de la Maza M, Adán Civera AM, Molins B, Llorenç V. Non-invasive biomarkers for close activity monitoring in birdshot chorioretinitis: Optical coherence tomography angiography and beyond. Acta Ophthalmol 2024; 102:e302-e313. [PMID: 37551920 DOI: 10.1111/aos.15744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The purpose of the study was to identify non-invasive imaging biomarkers potentially useful for close activity monitoring in birdshot chorioretinitis (BSCR). METHODS Cross-sectional study of BSCR eyes included as per Levinson's and/or SUN criteria. Eyes were blindly classified into active or inactive groups per clinical inflammatory parameters, ultra-widefield (UWF) pseudocolour images, UWF fluorescein angiography (FA) and macular optical coherence tomography (OCT) cube. Qualitative and quantitative OCT and OCT-angiography (OCT-A) parameters at the fundus, superonasal and inferonasal fields were compared between active and inactive eyes. RESULTS Thirty consecutive BSCR patients (60 eyes) were analysed. 28 eyes (46.66%) were from women and the overall mean age was 59.7 ± 12.3 years. Active eyes showed an abnormal retinal thickening at inferonasal field (nasal retinal thickness) and a higher averaged thickened retinal index (ATRI) (72.36 active vs. 20.12 inactive, p < 0.0001). A significant moderate correlation was observed between ATRI and FA scores (r = 0.259, p = 0.022). Macular vascular loops were more frequent in the superficial vascular plexus of OCT-A in the active eyes (p = 0.028). The vascular perfusion index tended to be higher in all subfields of active eyes but did not reach statistical significance. CONCLUSION Multimodal imaging could be key to discerning activity in BSCR eyes. Higher ATRI and the presence of vascular loops in the superficial plexus are potential non-invasive activity biomarkers for the close monitoring of BSCR.
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Affiliation(s)
- Aina Moll-Udina
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marina Dotti-Boada
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
| | - Lucía Miguel
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Anabel Rodríguez
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
| | - Jesús Gascón
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
| | - Maite Sainz de la Maza
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Manuel Adán Civera
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Molins
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Victor Llorenç
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Pato-Cour E, Borrego-Sanz L, Domínguez-Álvaro M, Sánchez-Alonso F, Rodríguez-González F, Tejera-Santana M, Esteban-Ortega M, García-Lozano I, Martínez-Costa L, González-Ocampo S, Sainz-de-la-Maza M, Moll-Udina A, Plaza Z, Fonollosa A, Artaraz J, Díaz-Valle T, Gurrea-Almela M, Díaz-Valle D, Méndez-Fernández R. Interobserver Reliability and Sensitivity to Change of a Composite Ocular Inflammatory Activity Index: UVEDAI ©. Ophthalmol Ther 2024:10.1007/s40123-024-00943-w. [PMID: 38635137 DOI: 10.1007/s40123-024-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION This was a multicenter, prospective, longitudinal, observational study involving eight Spanish tertiary hospitals to determine the interobserver reliability of an uveitis disease activity index, (UVEDAI) and assess its sensitivity to change in patients with receiving pharmacologic treatment. METHODS Patients aged ≥ 18 years diagnosed with active noninfectious uveitis were included. A complete baseline assessment was performed by two ophthalmologists who determined ocular inflammatory activity using the UVEDAI index independently of each other. The principal ophthalmologist made a new visit at 4 weeks to determine the change in inflammatory activity. The interobserver reliability analysis was performed by calculating the intraclass correlation coefficient (ICC), with the values of the variables and the UVEDAI obtained by both ophthalmologists in the more active eye at the baseline visit. Sensitivity to change in the UVEDAI index was assessed at 4 weeks from the start of pharmacologic treatment by determining the clinically relevant change, defined as a change in UVEDAI of ≥ 0.8 points over baseline. The mean change between both measures was compared using the repeated-measures t-test. RESULTS A total of 111 patients were included. In the interobserver reliability analysis, the ICC for the UVEDAI value was 0.9, and, when compared with the mean UVEDAI values obtained by the ophthalmologists, no statistically significant differences were found (p value > 0.05). As for the sensitivity to change in UVEDAI, statistically significant differences (p value = 0.00) were found for the mean values of the index compared with baseline. In all cases, the index value decreased by > 1 point at the 4-week visit. CONCLUSIONS The interobserver reliability of the UVEDAI was high in the total sample. Furthermore, the index was sensitive in determining the change in inflammatory activity after treatment. We believe that UVEDAI is a disease activity index that enables objective comparison of results in clinical practice and trials.
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Affiliation(s)
- Esperanza Pato-Cour
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.
| | - Lara Borrego-Sanz
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Marta Tejera-Santana
- Ophthalmology Department, Hospital de Gran Canaria Doctor Negrin, Gran Canaria, Spain
| | - Mar Esteban-Ortega
- Ophthalmology Department, Hospital Universitario Infanta Sofia, Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | - Aina Moll-Udina
- Ophthalmology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Zulema Plaza
- Research Unit of Spanish Society of Rheumatology, Madrid, Spain
| | - Alejandro Fonollosa
- Ophthalmology Department, BioCruces-Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Joseba Artaraz
- Ophthalmology Department, BioCruces-Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Teresa Díaz-Valle
- Ophthalmology Department, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Maria Gurrea-Almela
- Ophthalmology Department, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosalía Méndez-Fernández
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, and Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
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Izquierdo-Serra J, Martin-Pinardel R, Moll-Udina A, Bernal-Morales C, Garay-Aramburu G, Sanchez-Monroy J, Arruabarrena C, Fernandez-Hortelano A, Figueroa MS, Abraldes M, Lavid de Los Mozos FJ, Zapata MA, Ruiz-Moreno JM, Broc-Iturralde L, Gonzalez-Guijarro J, Escobar-Barranco JJ, Gallego-Pinazo R, Parrado-Carrillo A, Dotti-Boada M, Alforja S, Figueras-Roca M, Barthelmes D, Gillies MC, Casaroli-Marano RP, Zarranz-Ventura J. Macular Neovascularization Type Influence on Anti-VEGF Intravitreal Therapy Outcomes in Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:350-359. [PMID: 37924946 DOI: 10.1016/j.oret.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To evaluate the influence of macular neovascularization (MNV) lesion type on 12-month clinical outcomes in treatment-naive eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF drugs nationwide. DESIGN Multicenter national nAMD database observational study. SUBJECTS One thousand six hundred six treatment-naive nAMD eyes (1330 patients) undergoing anti-VEGF therapy for 12 months nationwide. METHODS Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution letters, number of injections and visits were was collected using a validated web-based tool. Neovascular lesion phenotype was classified as type 1 (T1, n = 711), type 2 (T2, n = 505), type 3 (T3, n = 315), and aneurysmal type 1 (A-T1, n = 75), according to the new proposed consensus classification. MAIN OUTCOME MEASURES Mean VA change at 12 months, final VA at 12 months, number of injections, time to lesion inactivation. RESULTS A total of 1606 treatment-naive nAMD eyes (1330 patients) received a median of 7 injections over 12 months. Mean (± standard deviation) baseline VA was significantly lower for T2 (49.4 ± 23.5 letters) compared with T1 (57.8 ± 20.8) and T3 (58.2 ± 19.4) (both P < 0.05) lesions. Mean VA change at 12 months was significantly greater for A-T1 (+9.5 letters) compared with T3 (+3.1 letters, P < 0.05). Patients with T3 lesions had fewer active visits (24.9%) than those with other lesion types (T1, 30.5%; T2, 32.6%; A-T1, 27.5%; all P < 0.05). Aflibercept was the most used drug in A-T1 lesions (70.1%) and ranibizumab in T1 (40.7%), T2 (57.7%), and T3 (47.6%) lesions. CONCLUSIONS This study highlights the relevance of MNV type on clinical outcomes in nAMD and reports significant differences in baseline VA, VA change, and lesion activity at 12 months. This report provides data about lesion-specific clinical features, which may guide the management of nAMD cases and potentially support personalized clinical decision making for these patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Jordi Izquierdo-Serra
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ruben Martin-Pinardel
- Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Aina Moll-Udina
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Carolina Bernal-Morales
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Jorge Sanchez-Monroy
- Miguel Servet Ophthalmology Research Group (GIMSO), Miguel Servet University Hospital, Aragón Institute for Health Research (IIS-Aragón), Zaragoza, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Alba Parrado-Carrillo
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marina Dotti-Boada
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Socorro Alforja
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Ricardo P Casaroli-Marano
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Spain
| | - Javier Zarranz-Ventura
- Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Spain.
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Martin-Pinardel R, Izquierdo-Serra J, De Zanet S, Parrado-Carrillo A, Garay-Aramburu G, Puzo M, Arruabarrena C, Sararols L, Abraldes M, Broc L, Escobar-Barranco JJ, Figueroa M, Zapata MA, Ruiz-Moreno JM, Moll-Udina A, Bernal-Morales C, Alforja S, Figueras-Roca M, Gómez-Baldó L, Ciller C, Apostolopoulos S, Mosinska A, Casaroli Marano RP, Zarranz-Ventura J. Artificial intelligence-based fluid quantification and associated visual outcomes in a real-world, multicentre neovascular age-related macular degeneration national database. Br J Ophthalmol 2024; 108:253-262. [PMID: 36627173 DOI: 10.1136/bjo-2022-322297] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/27/2022] [Indexed: 01/12/2023]
Abstract
AIM To explore associations between artificial intelligence (AI)-based fluid compartment quantifications and 12 months visual outcomes in OCT images from a real-world, multicentre, national cohort of naïve neovascular age-related macular degeneration (nAMD) treated eyes. METHODS Demographics, visual acuity (VA), drug and number of injections data were collected using a validated web-based tool. Fluid compartment quantifications including intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) in the fovea (1 mm), parafovea (3 mm) and perifovea (6 mm) were measured in nanoliters (nL) using a validated AI-tool. RESULTS 452 naïve nAMD eyes presented a mean VA gain of +5.5 letters with a median of 7 injections over 12 months. Baseline foveal IRF associated poorer baseline (44.7 vs 63.4 letters) and final VA (52.1 vs 69.1), SRF better final VA (67.1 vs 59.0) and greater VA gains (+7.1 vs +1.9), and PED poorer baseline (48.8 vs 57.3) and final VA (55.1 vs 64.1). Predicted VA gains were greater for foveal SRF (+6.2 vs +0.6), parafoveal SRF (+6.9 vs +1.3), perifoveal SRF (+6.2 vs -0.1) and parafoveal IRF (+7.4 vs +3.6, all p<0.05). Fluid dynamics analysis revealed the greatest relative volume reduction for foveal SRF (-16.4 nL, -86.8%), followed by IRF (-17.2 nL, -84.7%) and PED (-19.1 nL, -28.6%). Subgroup analysis showed greater reductions in eyes with higher number of injections. CONCLUSION This real-world study describes an AI-based analysis of fluid dynamics and defines baseline OCT-based patient profiles that associate 12-month visual outcomes in a large cohort of treated naïve nAMD eyes nationwide.
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Affiliation(s)
- Ruben Martin-Pinardel
- IDIBAPS, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Martin Puzo
- Miguel Servet Ophthalmology Research Group (GIMSO), Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Laura Sararols
- Fundació Privada Hospital Asil Granollers, Granollers, Spain
| | | | - Laura Broc
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | | | - Aina Moll-Udina
- IDIBAPS, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Socorro Alforja
- IDIBAPS, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Ricardo P Casaroli Marano
- IDIBAPS, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - Javier Zarranz-Ventura
- IDIBAPS, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
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Moll-Udina A, Hernanz I, Sainz-de-la-Maza M, Pelegrín L, Coelho-Borges AI, Pazos M, Adán A, Llorenç V. Intravitreal fluocinolone acetonide 0.19 mg (ILUVIEN®) in patients with non-infectious uveitis: real-world effectiveness and safety outcomes at 12 months. Int Ophthalmol 2023; 43:4181-4195. [PMID: 37698661 PMCID: PMC10520169 DOI: 10.1007/s10792-023-02828-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/27/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE This study assessed the effectiveness of the 0.19-mg fluocinolone acetonide (FAc) implant by multimodal measurements in patients with non-infectious uveitis (NIU) in a real-world setting in Spain. METHODS A prospective study of patients who had NIU including uveitic macular oedema (UME) with ≥ 12 months follow-up was done. Exclusion criteria include infectious uveitis and uncontrolled glaucoma or ocular hypertension requiring more than 2 medications. Effectiveness was assessed using a multicomponent outcome measure that included nine outcomes. Effectiveness was defined as all components being met at every timepoint. Secondary outcome measures were onset or progression of glaucoma and investigator-reported adverse events. RESULTS Twenty-six eyes from 22 patients were included, with 96.2% having an indication including UME. During the 12-month study, the FAc implant was effective in 15 (57.7%) eyes, reaching effectiveness as soon as 2 weeks post-implantation. Mean best-corrected visual acuity and mean central macular thickness (CMT) were significantly improved vs. baseline at all timepoints (all comparisons p < 0.01). During the 12-month study, inflammation markers (anterior chamber cells and vitreous haze) had also significantly declined. Factors predicting effectiveness at month 12 were systemic corticosteroid dose pre-FAc, higher immunomodulatory therapy (IMT) load at baseline and thicker retinal nerve fibre layer (RNFL) at baseline (all p < 0.05). Factors predicting failure were male gender, thinner RNFL at baseline and treatment ineffectiveness at 1 month (all p < 0.05). In parallel, corticosteroid and IMT use also declined significantly. No significant increase in IOP was detected. CONCLUSION The FAc implant is safe and effective at treating NIU over 12 months in a real-world setting in Spain.
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Affiliation(s)
- Aina Moll-Udina
- Facultat de Medicina, University of Barcelona, Barcelona, Spain.
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain.
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | | | - Maite Sainz-de-la-Maza
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laura Pelegrín
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Marta Pazos
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Victor Llorenç
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Hernanz I, Moll-Udina A, Garcia-Tirado A, Garcia-Fernandez M, Gutierrez-Ezquerro R, Garcia-Arumi C, Llorenç V, Cuadros C, Fonollosa A, Sainz-de-la-Maza M, Adán A. The retinal bacillary layer detachment: Clinical features and outcomes in posterior uveitis. J Fr Ophtalmol 2023; 46:916-920. [PMID: 37210295 DOI: 10.1016/j.jfo.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 05/22/2023]
Abstract
PURPOSE To describe the clinical characteristics, presentation and response to treatment in posterior uveitis patients with bacillary layer detachment (BLD) seen on optical coherence tomography (OCT). MATERIALS AND METHODS Retrospective review of patients with posterior uveitis and SD-OCT scans consistent with BLD. Data collected included demographics, uveitic etiology, treatment and duration of follow-up. Outcome measures included macular volume, central subfoveal thickness and visual acuity. RESULTS Sixteen patients (20 eyes) were included. Twelve were female (75%). The mean age was 43.68 ± 14.7 years. The most frequent etiology of the uveitis was Vogt-Koyanagi-Harada (VKH) disease (n=10), followed by sympathetic ophthalmia (n=2). BLD was bilateral in four patients. Eight patients were treated with intravenous methylprednisolone boluses. Immunosuppressive therapies were required in 8 patients. The mean follow-up was 70 months (range: 2.0-216.0). CONCLUSION BLD was observed in a series of posterior uveitis cases of various etiologies, showing functional and structural resolution with treatment in most cases.
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Affiliation(s)
- I Hernanz
- Department of ophthalmology, Fundación Jiménez Diaz Hospital, Avenue Reyes Católicos 2, 28003 Madrid, Spain.
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Garcia-Tirado
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | | | - C Garcia-Arumi
- Departmentofophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - C Cuadros
- Department of ophthalmology, Oviedo University Hospital, Oviedo, Spain
| | - A Fonollosa
- Department of ophthalmology, Cruces University Hospital, Bilbao, Spain
| | - M Sainz-de-la-Maza
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Sainz de La Maza M, Hernanz I, Moll-Udina A, Mesquida M, Adan A, Martinez JA, Espinosa G, Llorenç V. Presumed tuberculosis-related scleritis. Br J Ophthalmol 2023; 107:495-499. [PMID: 34799367 DOI: 10.1136/bjophthalmol-2021-319799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the clinical characteristics and therapeutic outcome of patients with recurrent scleritis of unknown demonstrable aetiology and positive QuantiFERON-TB Gold In-Tube test (QFT). METHODS Retrospective chart review of the demographic, clinical, laboratory and therapeutic outcome data of 15 patients. Clinical characteristics as well as remission rate after standard antituberculous therapy (ATT) were assessed. RESULTS There were 9 men and 6 women with a mean age of 48.9 years (range, 32-73). Scleritis was diffuse in 10 patients (66.6%) and nodular in 5 patients (33.3%), 1 of them with concomitant posterior scleritis. It was bilateral in 7 patients (46.6%) and recurrent in all of them. Scleritis appeared after prior uveitis (10 patients, 66.6%) and/or with concomitant uveitis (5 patients, 33.3%) or peripheral keratitis (5 patients, 33.3%). Previous ocular surgery was found in 7 patients (46.6%). Previous extraocular tuberculosis (TB) infection or previous TB contact was detected in 11 patients (73.3%). No radiologic findings of active extraocular TB were detected. ATT was used in 15 patients, sometimes with the addition of systemic corticosteroids (5 patients) and methotrexate (1 patient); 14 patients achieved complete remission (93.3%). CONCLUSION Presumed TB-related scleritis may appear in recurrent scleritis of unknown origin and positive QFT. It may occur after prior uveitis and/or concomitantly with uveitis or peripheral keratitis, and it may be triggered by previous ocular surgery. No patients had evidence of concurrent active extraocular infection, although many had previous TB infection or TB contact. ATT was effective, sometimes with the addition of systemic corticosteroids and methotrexate.
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Affiliation(s)
| | - Ines Hernanz
- Ophthalmology, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Aina Moll-Udina
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marina Mesquida
- Ophthalmology, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Alfredo Adan
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Gerard Espinosa
- Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Víctor Llorenç
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
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Pazos M, Riera J, Moll-Udina A, Catala A, Narvaez S, Fuertes I, Dotti-Boada M, Petiti G, Izquierdo-Serra J, Maldonado E, Chang-Sotomayor M, Garcia D, Camós-Carreras A, Gilera V, De Loredo N, Peraza-Nieves J, Ventura-Abreu N, Spencer F, Del Carlo GF, Torras J, Nicolas JM, Adán A, Vilella A, Puig S, Martinez E, Martinez MJ, Sánchez-Dalmau B, Blanco JL. Characteristics and Management of Ocular Involvement in Individuals with Mpox Disease. Ophthalmology 2023; 130:655-658. [PMID: 36804274 PMCID: PMC10046120 DOI: 10.1016/j.ophtha.2023.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
Ocular complications of mpox infection have a prevalence of 1% in the current outbreak. Although conjunctivitis is the most common presentation, corneal involvement may occur. Tecovirimat is recommended for severe ocular mpox involvement.
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Affiliation(s)
- Marta Pazos
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Riera
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Aina Moll-Udina
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alba Catala
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Sofia Narvaez
- Department of Microbiology, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Irene Fuertes
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Marina Dotti-Boada
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Gisela Petiti
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Jordi Izquierdo-Serra
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Enrique Maldonado
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Meilin Chang-Sotomayor
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - David Garcia
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Anna Camós-Carreras
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Vanessa Gilera
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Nicolas De Loredo
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Jorge Peraza-Nieves
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nestor Ventura-Abreu
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Felipe Spencer
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Guillerima F Del Carlo
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Josep Torras
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Josep Maria Nicolas
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of ICU, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Vilella
- Department of Epidemiology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Susana Puig
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Esteban Martinez
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel J Martinez
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Microbiology, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Bernardo Sánchez-Dalmau
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José L Blanco
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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9
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Miguel-Escuder L, Olate-Pérez Á, Sala-Puigdoners A, Moll-Udina A, Figueras-Roca M, Navarro-Angulo MJ, Adán A, Pelegrín L. Intravitreal fluocinolone acetonide implant for the treatment of persistent post-surgical cystoid macular edema in vitrectomized eyes. Eur J Ophthalmol 2023; 33:NP23-NP27. [PMID: 34836464 DOI: 10.1177/11206721211046718] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cystoid macular edema (CME) is the most common cause of decreased visual acuity after both vitrectomy and cataract surgery. Various strategies have been used for its treatment, such as intravitreal corticosteroids. The intravitreal fluocinolone acetonide implant (Iluvien®) is approved for the treatment of persisting diabetic macular edema and for the prevention of recurrence of non-infectious uveitis affecting the posterior segment. There are very few reports about its off-label use for post-surgical CME. We present four clinical cases of post-surgical CME (three following vitrectomy and one following cataract surgery in a vitrectomized eye 2 years ago). All of them had been previously treated with an average of four injections of intravitreal dexamethasone implant (Ozurdex®), with repeated recurrence of CME. After treatment with Iluvien, three cases showed improvement of both visual acuity and macular anatomy, with resolution of the macular edema. One patient required additional treatment with Ozurdex during follow-up, further improving CME. Two of the cases required topical pressure lowering treatment, and none required filtering surgery. Iluvien could be an effective therapeutic option for persistent non-diabetic macular edema after vitrectomy or cataract surgery refractory to other intravitreal therapies, with the benefit of being able to provide longer recurrence-free periods.
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Affiliation(s)
- Lucia Miguel-Escuder
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Álvaro Olate-Pérez
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Anna Sala-Puigdoners
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Aina Moll-Udina
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Alfredo Adán
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Pelegrín
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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10
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Moll-Udina A, Alba-Linero C, Llorenç V, Adán A. MULTI-MODAL IMAGING IN DIFFUSE SUBRETINAL FIBROSIS WITH UVEITIS SYNDROME. Retin Cases Brief Rep 2023; 17:13-17. [PMID: 33394959 DOI: 10.1097/icb.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To describe clinical features including multimodal imaging in a case of diffuse subretinal fibrosis and uveitis syndrome. METHODS A young patient presented with counting fingers in both eyes due to posterior uveitis and unresponsive to systemic corticosteroids. Ultra-wide field pseudo-color and autofluorescence imaging, optical coherence tomography angiography (OCT-A), en-face OCT-A, and spectral-domain optical coherence were performed. RESULTS Clinical examination revealed a bilateral fibrosis plaque in both fovea and macular multifocal choroidal lesions associated, with no vitritis. Ultra-wide field-autofluorescence allowed us to determine activity showing a hyperfluorescent pattern. En-face OCT-A at the level of the ellipsoid layer showed multiple hyperreflective lesions surrounding a hyperreflective fibrosis plaque in both eyes, which improved and stabilized during the follow-up. Optical coherence tomography angiography at the level of retina pigmentary epithelium-choriocapillaris revealed neocapillary network changes along the chronification of the disease. The patient required the addition of intravitreal dexamethasone implants (Ozurdex) to control the acute rebounds and anti-TNFα to control the underlying inflammatory process. CONCLUSION This is the first diffuse subretinal fibrosis with uveitis syndrome reported with a complete En-face OCT-A and OCT-A examination. This multi-modal imaging will improve the monitoring of the disease's activity and the chronicity changes.
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Affiliation(s)
- Aina Moll-Udina
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
| | - Victor Llorenç
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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11
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Miguel-Escuder L, Garcia Tirado A, Sainz-de-la-Maza M, Espinosa G, Moll-Udina A, Llorenç V, Parrado-Carrillo A, Adán A. Anti-TNF-alpha-induced lupus in patients with non-infectious uveitis. Eur J Ophthalmol 2021; 33:11206721211054705. [PMID: 34755548 DOI: 10.1177/11206721211054705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Anti-TNF-α-induced lupus (ATIL) is a rare condition considered as a drug-induced lupus (DIL) in patients under anti-TNF-α therapies. Nowadays it is still unclear if ATIL is a classical DIL or represent a distinct syndrome. Some characteristics of DIL have been described specifically associated with patients with lupus-like syndrome receiving anti-TNF-α therapy: the severity of the disease, incidence/prevalence of dsDNA antibodies (anti-dsDNA) and hypocomplementaemia. The objective of this study is to describe the development of ATIL in patients with non-infectious uveitis in a single tertiary center. METHODS Retrospective description of a case series. RESULTS We describe three patients with noninfectious uveitis (NIU) of different etiologies who developed antinuclear antibody (ANA) and anti-dsDNA antibody positivity, arthritis and, in one case, skin lesions under adalimumab treatment. The condition resolved in all of them after adalimumab withdrawal. Corticosteroids were required in one patient, non-steroidal anti-inflammatory drugs in two patients, and hydroxychloroquine in one of them. None required another immunosuppressive drug. A subsequent control of the NIU could continue to be carried out without anti-TNF-α therapy in two patients and in the remaining a switch was made to another anti-TNF-α (golimumab). CONCLUSION The current report describes three cases of ATIL in patients with different types of NIU which share some common features: ANA positivity, articular symptoms, and a temporal relationship between symptoms onset and anti-TNF-α treatment. A review of the literature and comparison with the few previous reported ATIL cases was conducted as well.
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Affiliation(s)
| | | | | | - Gerard Espinosa
- Department of Autoimmune Diseases, 16493Hospital Clinic, Barcelona, Spain
| | - Aina Moll-Udina
- Clínic Institute of Ophthalmology, 16493Hospital Clinic, Barcelona, Spain
| | - Víctor Llorenç
- Clínic Institute of Ophthalmology, 16493Hospital Clinic, Barcelona, Spain
| | | | - Alfredo Adán
- Clínic Institute of Ophthalmology, 16493Hospital Clinic, Barcelona, Spain
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12
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Arriola-Villalobos P, Moll-Udina A, Carrasco-López-Brea M, Sacristan C, Capella MJ, Peiteado D, Garrote-Llordén A, Albert Fort M, Jódar Márquez M, Jacobo Gonzalez Guijarro J, Demetrio-Pablo R, Luis Sánchez Sevilla J, Carreño E, González-López J, Miguel-Escuder L, Cuadros C, Díaz-Valle D, Adan A, Benítez Del Castillo JM, Fonollosa A, Cordero M, Martínez Costa L, Blanco-Alonso R. Vogt-Koyanagi-Harada disease in Spain. Eur J Ophthalmol 2021; 32:1547-1554. [PMID: 34269103 DOI: 10.1177/11206721211033477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the clinical and epidemiological characteristics of patients with Vogt-Koyanagi-Harada (VKH) disease in Spain. METHODS This was a retrospective multicenter analysis of data from VKH patients followed for at least 6 months. The data collected were related to demographics, clinical manifestations, treatments, and complications. RESULTS Participants were 112 patients (224 eyes), from 13 tertiary referral centers, of mean age 37.5 ± 14.7 years; 83.9% were women. Ethnicities were 61.6% Caucasian and 30.4% Hispanic. The disease was classified as complete in 16.1%, incomplete in 55.4%, and probable in 28.6%. When seen for the first time, the clinical course was acute in 69.6%, recurrent chronic in 15.2%, and chronic in 14.3%. The most frequent treatment was corticosteroids (acute stage 42.2%, maintenance stage 55.6%). The most common complications were cataract (41.1%) and ocular hypertension (16.1%). In most eyes, visual acuity was improved (96.7%) or remained stable at the end of follow up. CONCLUSION VKH in Spain mostly affects women and presents as incomplete acute stage disease. Visual prognosis is good. Cataract and glaucoma are the two most frequent complications.
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Affiliation(s)
- Pedro Arriola-Villalobos
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain.,Hospital QuironSalud Madrid, Madrid, Spain
| | - Aina Moll-Udina
- Clinic Hospital of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mario Carrasco-López-Brea
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Sacristan
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - Maria Jose Capella
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diana Peiteado
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Garrote-Llordén
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, Leon, Spain
| | - Mara Albert Fort
- Servicio de Oftalmología, Hospital Universitari Doctor Peset, Valencia, Spain
| | - Margarita Jódar Márquez
- Servicio de Oftalmología, Hospital Regional Universitario de Málaga, Malaga, Andalusia, Spain
| | | | | | | | - Ester Carreño
- Servicio de Oftalmología, Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Julio González-López
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lucia Miguel-Escuder
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Carlos Cuadros
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - David Díaz-Valle
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Adan
- Clinic Hospital of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | - José M Benítez Del Castillo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Fonollosa
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - Miguel Cordero
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, Leon, Spain
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13
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Sarmiento-Monroy JC, Espinosa G, Londoño MC, Meira F, Caballol B, Llufriu S, Carrasco JL, Moll-Udina A, Quintana LF, Giavedoni P, Ramírez J, Inciarte-Mundo J, Solana E, Blanco Y, Martinez-Hernandez E, Sepúlveda M, Llorenç V, Prieto-González S, Espígol-Frigolé G, Milisenda JC, Cid MC, Mascaró JM, Blanco I, Barberá JA, Sibila O, Gratacos-Ginès J, Adán A, Agustí A, Sanmartí R, Panés J, Cervera R, Vila J, Soriano A, Gómez-Puerta JA. A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center. J Autoimmun 2020; 117:102580. [PMID: 33338707 PMCID: PMC7836738 DOI: 10.1016/j.jaut.2020.102580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
Background and aim There is increasing interest regarding SARS-CoV-2 infection in patients with autoimmune and immune-mediated inflammatory diseases (AI/IMID) with some discrepancies in different cohorts about their risk and outcomes. The aim was to describe a multidisciplinary cohort of patients with AI/IMID and symptomatic SARS-CoV-2 infection in a single tertiary center and analyze sociodemographic, clinical, and therapeutic factors associated with poor outcomes. Methods A retrospective observational study was conducted from the 1st of March until May 29th, 2020 in a University tertiary hospital in Barcelona, Spain. Patients with an underlying AI/IMID and symptomatic SARS-CoV-2 infection were identified in our local SARS-CoV-2 infection database. Controls (2:1) were selected from the same database and matched by age and gender. The primary outcome was severe SARS-CoV-2 infection, which was a composite endpoint including admission to the intensive care unit (ICU), need for mechanical ventilation (MV), and/or death. Several covariates including age, sex, and comorbidities among others were combined into a multivariate model having severe SARS-CoV-2 as the dependent variable. Also, a sensitivity analysis was performed evaluating AID and IMID separately. Results The prevalence of symptomatic SARS-CoV-2 infection in a cohort of AI/IMID patients was 1.3%. Eighty-five patients with AI/IMID and symptomatic SARS-CoV-2 were identified, requiring hospitalization in 58 (68%) cases. A total of 175 patients admitted for SARS-CoV-2 (58 with AI/IMID and 117 matched-controls) were analyzed. In logistic regression analysis, a significant inverse association between AI/IMID group and severe SARS-CoV-2 (OR 0.28; 95% CI 0.12–0.61; p = 0.001), need of MV (OR 0.20; IC 95% 0.05–0.71; p = 0.014), and ICU admission (OR 0.25; IC 95% 0.10–0.62; p = 0.003) was found. Conclusions Patients with AI/IMID who require admission for SARS-CoV-2 infection have a lower risk of developing severe disease, including the need to stay in the ICU and MV. Patients with AI/IMID fwho required admission for SARS CoV2 infection have a lower risk of developing severe disease. Among patients with AID and IMID, there were no differences in terms of severity. According to the 7-category ordinal scale, maximum oxygen requirement was lower among AI/IMID group.
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Affiliation(s)
| | - Gerard Espinosa
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria-Carlota Londoño
- Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Fernanda Meira
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Berta Caballol
- Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Sara Llufriu
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Josep Lluis Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Catalonia, Spain
| | - Aina Moll-Udina
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Priscila Giavedoni
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Julio Ramírez
- Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | | | - Elisabeth Solana
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Yolanda Blanco
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Maria Sepúlveda
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Victor Llorenç
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Sergio Prieto-González
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jose C Milisenda
- Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | - Maria C Cid
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jose M Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Joan Albert Barberá
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Oriol Sibila
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Alfredo Adán
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Alvaro Agustí
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Raimon Sanmartí
- Rheumatology Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Julian Panés
- Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, Biomedical Diagnostic Center, Hospital Clinic, Barcelona Institute for Global Health, University of Barcelona, Barcelona, Catalonia, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
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14
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Figueras-Roca M, Parrado-Carrillo A, Nguyen V, Casaroli-Marano RP, Moll-Udina A, Gillies MC, Barthelmes D, Zarranz-Ventura J. Treat-and-extend versus fixed bimonthly treatment regimens for treatment-naive neovascular age-related macular degeneration: real world data from the Fight Retinal Blindness registry. Graefes Arch Clin Exp Ophthalmol 2020; 259:1463-1470. [PMID: 33219442 DOI: 10.1007/s00417-020-05016-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/31/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To compare the outcomes of two different antivascular endothelial growth factor treatment regimens for treatment-naive eyes with neovascular age-related macular degeneration in routine clinical care at 12 and 24 months in Spain. METHODS Observational study using the Fight Retinal Blindness (FRB) outcomes registry platform. Eyes were treated with fixed bimonthly (FB) aflibercept group at one center and a treat-and-extend (TAE) regimen using either aflibercept or ranibizumab at the other center. RESULTS We included 192 eyes. Of these, 160 eyes (83%) completed 12 months (86 TAE and 74 FB) and 79 (41%) completed 24 months (46 for TAE and 33 for FB) of follow-up. No statistically significant differences (p > 0.05) were found regarding mean visual acuity (VA, logMAR letters) at baseline (12 month cohort TAE 59.6 vs FB 57.9; 24 month cohort TAE 61.7 vs FB 62.6), final mean VA (12 month cohort TAE 61.1 vs FB 63.0; 24 month cohort TAE 64.8 vs FB 66.4), and median number of injections (12 months TAE 7 vs FB 7; 24 months TAE 11 vs FB 12). However, the distribution of injection frequencies for the TAE group was larger, with 35% of TAE eyes receiving ≤ 6 injections at 12 months compared with only 19% of FB eyes (p = 0.024). CONCLUSION Similar VA results were observed with TAE and FB regimens, with no differences in the median number of injections. However, the TAE approach seemed to deliver a wider distribution of injection frequencies due to its individualized approach, which may help reduce the burden of injections in some eyes.
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Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, C/Sabino de Arana 1, 08028, Barcelona, Spain. .,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Alba Parrado-Carrillo
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, C/Sabino de Arana 1, 08028, Barcelona, Spain
| | - Vuong Nguyen
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, Australia
| | - Ricardo P Casaroli-Marano
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, C/Sabino de Arana 1, 08028, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Surgery, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, C/Sabino de Arana 1, 08028, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mark C Gillies
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, Australia
| | - Daniel Barthelmes
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, Australia.,Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, C/Sabino de Arana 1, 08028, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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15
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Hernanz I, Miguel Escuder L, Chamorro L, Moll-Udina A, Espinosa G, Sainz de la Maza M, Llorenç V, Adán A. Tuberculosis-Related Uveitis in Patients under Anti-TNF-alpha Therapy: A Case Series. Ocul Immunol Inflamm 2020; 30:839-844. [PMID: 33216652 DOI: 10.1080/09273948.2020.1834588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tumor necrosis factor inhibitors (anti-TNF) have emerged as an effective treatment in noninfectious uveitis (NIU). Anti-TNF may increase the predisposition to infectious disease as tuberculosis (TB). TB-related uveitis in the context of an uveitogenic concurrent systemic immune-mediated disease under anti-TNF treatment remain a diagnostic challenge, deserving special focus on this rare context. Retrospective chart review of patients on anti-TNF drugs for systemic immune-mediated diseases that developed a multicentric microbiologically confirmed active TB with concurrent intraocular involvement.Three patients were recorded. Screening for TB before starting anti-TNF resulted negative in two patients. The other patient had received anti-tuberculous treatment in the past. All showed a microbiologically confirmed extraocular TB after unexpected atypical reactivation of the uveitis shifting to chronic granulomatous pattern.Specialists should be aware of TB reactivation, even with previous negative screening, when ocular uveitis signs and activity do not match with the expected pattern in a patient on anti-TNF drugs.
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Affiliation(s)
- I Hernanz
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - L Miguel Escuder
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - L Chamorro
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - A Moll-Udina
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - G Espinosa
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - M Sainz de la Maza
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - V Llorenç
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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16
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Moll-Udina A, Figueras-Roca M, Oliveres J, Sala-Puigdollers A, Esquinas C, Alba-Linero C, Llorenç V, Adán A. Uveitic macular edema response to intravitreal dexamethasone implant is independent of optical coherence tomography findings. Int Ophthalmol 2020; 41:787-796. [PMID: 33184677 DOI: 10.1007/s10792-020-01631-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify predictive response optical coherence tomography (OCT) findings in uveitic macular edema (UME) treated with intravitreal dexamethasone implant (DEX). METHODS Retrospective study of 66 eyes (53 patients) treated with DEX for UME. SD-OCT macular scans were collected prior to DEX treatment and 6 weeks and 3 months after the DEX implant. OCT images were evaluated for qualitative and quantitative characteristics (central retinal thickness, CRT and macular volume, MV). A multivariate analysis of covariance (ANCOVA) was carried out to study the predictive influence of OCT and clinical covariates on outcomes. The main outcome was a composite endpoint based on the simultaneous gain of 5 or more letters associated with a 20% or more reduction in CRT. RESULTS A significant improvement in BCVA at 6 weeks (mean change from baseline -0.2, SD 0.3) and 3 months (mean -0.2, SD 0.4) was observed after the DEX implant. A significant decrease in CRT (change from baseline -187.7 μm at 3 months) and MV (change from baseline -1.7 mm3 at 3 months) were also observed. An association of ≥ 5-letter improvement in BCVA and a ≥ 20% CRT reduction was observed in 44.6% of cases at 6 weeks and 31.4% at 3 months. ANCOVA multivariate analyses found CRT at 3 months independent from baseline clinical variables but from CRT. CONCLUSION DEX implant is an effective treatment for UME independently of basal characteristics, producing both a gain of visual acuity and improvement of macular anatomy by OCT measures at 3 months.
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Affiliation(s)
- Aina Moll-Udina
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain. .,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - Marc Figueras-Roca
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Oliveres
- Hospital Vall D'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Esquinas
- Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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17
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Hernanz I, Moll-Udina A, Dotti-Boada M, Carrión MT, Llorenç V, Adán A. Non-pharmacological complications associated with Intravitreal dexamethasone implant injection. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:471-477. [PMID: 32654825 DOI: 10.1016/j.oftal.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Intravitreal dexamethasone implant (IID) is an effective and safe treatment for macular oedema as described in the literature. Ocular hypertension and cataracts are the most frequent complications. The indications of IID in the last few years have led to the retrospective reporting of rare complications, with potential visual impact related to the injection procedure. METHODS A case series is presented of fifteen patients treated with IID for macular oedema who developed non-pharmacological complications related to the injection procedure or the implant itself, including, among others anterior chamber migration, intracrystalline injection, endophthalmitis, or segmentation. Differentiation was made between true complications and those that did not lead to any ocular damage. Epidemiological and baseline data were collected along with the treatment and outcome in each case. An analysis was made of multimodal imaging available. RESULTS The incidence of complications was 0.65% in this series Anterior chamber migration was the most frequent complication (n=4), followed by intracrystalline injection, and endophthalmitis (n=2). The times between the injection and complications were variable. Visual impairment was the most common symptom (n=6). However, despite the complications found, IID was an effective treatment in most of the reported cases. CONCLUSIONS Clinicians should be aware of these rare non-pharmacological complications so that they may be prevented and detected early, avoiding irreversible ocular damage.
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Affiliation(s)
- I Hernanz
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España.
| | - A Moll-Udina
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M Dotti-Boada
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M T Carrión
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - V Llorenç
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - A Adán
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
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18
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Figueroa-Vercellino JP, Palma-Carvajal F, Garcia-Mendieta M, Lorenzo D, Moll-Udina A, Adán A, Caminal JM. Multimodal imaging in amelanotic choroidal melanoma. J Fr Ophtalmol 2020; 44:126-128. [PMID: 33008640 DOI: 10.1016/j.jfo.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Affiliation(s)
- J P Figueroa-Vercellino
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain.
| | - F Palma-Carvajal
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain
| | - M Garcia-Mendieta
- Instituto de oftalmología, hospital universitario de Bellvitge, Barcelona, Spain
| | - D Lorenzo
- Instituto de oftalmología, hospital universitario de Bellvitge, Barcelona, Spain
| | - A Moll-Udina
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain
| | - A Adán
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain
| | - J M Caminal
- Instituto de oftalmología, hospital universitario de Bellvitge, Barcelona, Spain
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19
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Abstract
PURPOSE To report five cases of ocular Toxocariasis (OT) in which ultrawide-field (UWF) imaging was helpful in diagnosis and assessment. OT is an underdiagnosed condition triggered by the ocular invasion of Toxocara larvae. Typical features are peripheral granuloma or endophthalmitis.Methods: A retrospective case series of 10 outpatients were studied by complete ophthalmologic examination and complementary tests. UWF retinal imaging, fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SDOCT) were retrospectively analyzed. Five patients with suspected OT were included.Results: UWF imaging and FAF was able to detect all retinal lesions in a single rapid capture. Two patients showed positive serology for Toxocara. An image suggesting the larva in the vitreous cavity was shown in one patient. Antihelmintic 15 treatment along with steroids was prescribed in two patients.Conclusion: UWF imaging and SDOCT provide a more efficient approach and follow-up in OT, raising final standards of care.
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Affiliation(s)
- I Hernanz
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Belles V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Civera A Adan
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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20
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Moll-Udina A, Miguel Escuder L, Hernanz I, Llorenç V, Fonollosa A, Cordero Coma M, Sainz de la Maza M, Espinosa G, González Guijarro JJ, Lopez Lopez F, Alba-Linero C, Hernández M, Martínez Costa L, Celdrán Vivancos D, Giralt L, Artaraz J, Soler Bartrina P, Jódar Márquez M, García de Vicuña R, Esquinas C, Adán A. Adalimumab in Elderly Patients with Non-Infectious Uveitis. Safety and Efficacy. Ocul Immunol Inflamm 2020; 29:1591-1598. [PMID: 32657649 DOI: 10.1080/09273948.2020.1769139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy and safety of adalimumab in elderly patients with noninfectious uveitis (NIU). METHODS An observational, retrospective, multicenter study was done. Changes in best-corrected visual acuity (BCVA), inflammatory activity parameters, central retinal thickness (CRT), and the occurrence of adverse events (AE) developed during follow-up were recorded. RESULTS A total of 82 eyes from 41 patients 60 years of age and older with noninfectious uveitis treated with adalimumab were included. A significant improvement in BCVA (71.5 to 75.4 letters, p = .001) and in CRT (311.1 μm to 265 μm, p = .001) was observed. Moreover, a significant decrease from baseline in the rate of patients with anterior chamber cell (ACC) >0+ (34.6% to 5.7%, p = <0.001) or vitreous haze>0+ (21.3% to 4.3%, p = .002) was determined. AEs were observed in 11 patients (26.8%). CONCLUSION Adalimumab can be safe and efficacious for the treatment of NIU in patients 60 years of age and older.
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Affiliation(s)
- Aina Moll-Udina
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lucía Miguel Escuder
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Inés Hernanz
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Health Research Institute, Cruces Hospital, University of Basque Country, Leioa, Spain
| | - Miguel Cordero Coma
- Department of Ophthalmology, University Hospital of León, IBIOMED, University of León, León, Spain
| | - Maite Sainz de la Maza
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Carmen Alba-Linero
- Department of Ophthalmology, Regional University Hospital of Málaga, University of Malaga, Málaga, Spain
| | - Marisa Hernández
- Department of Ophthalmology, General Hospital of Valencia, Valencia, Spain
| | | | | | - Lena Giralt
- Department of Ophthalmology, BioCruces Health Research Institute, Cruces Hospital, University of Basque Country, Leioa, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Health Research Institute, Cruces Hospital, University of Basque Country, Leioa, Spain
| | | | - Margarita Jódar Márquez
- Department of Ophthalmology, Regional University Hospital of Málaga, University of Malaga, Málaga, Spain
| | | | - Cristina Esquinas
- Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
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21
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Figueroa-Vercellino JP, Miguel L, Moll-Udina A, Alba-Linero C, Llorenç V, Adán A. Atypical toxoplasmic retinochoroiditis in patients with malignant hematological diseases. ACTA ACUST UNITED AC 2020; 96:152-156. [PMID: 32651033 DOI: 10.1016/j.oftal.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022]
Abstract
In immunocompromised patients, toxoplasmosis may have atypical presentation with bilateral, extensive or multifocal involvement. We report a case series of atypical toxoplasmic retinocoroiditis in patients with malignant hematological diseases who are usually immunosuppressed. Four patients were diagnosed of atypical toxoplasmic retinochoroiditis, all of them had immunosuppression (100%) and half of them (50%) had received a bone marrow transplant. The polymerase chain reaction for toxoplasma was positive in 75% of cases, and in one case (25%) the diagnosis was made with clinical and serological criteria. One patient presented ocular toxoplasmosis despite being on prophylactic treatment with atovaquone. Patients with atypical ocular toxoplasmosis and hematological diseases are generally immunocompromised, but they do not always have history of a bone marrow transplant. The presentation may be due to a primary infection or a reactivation of the disease. The aqueous humor and/or vitreous polymerase chain reaction allow confirming the diagnosis to perform a proper treatment.
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Affiliation(s)
- J P Figueroa-Vercellino
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España.
| | - L Miguel
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - A Moll-Udina
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - C Alba-Linero
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - V Llorenç
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - A Adán
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
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22
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R Andrade A, Moll-Udina A, Martin R, Cilveti E, Subirà O, Disfetano L, García-Arumí J. Retinal Vasculitis Secondary to Durvalumab. Case Rep Ophthalmol 2020; 11:161-166. [PMID: 32508622 PMCID: PMC7250381 DOI: 10.1159/000507609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/30/2020] [Indexed: 11/19/2022] Open
Abstract
Ocular manifestations are very rarely reported as side effects to checkpoint inhibitors. We present a case of a 64-year-old Caucasian man in treatment with durvalumab for non-small-cell lung carcinoma who presented a retinal vasculitis with macular edema. After three boluses of methylprednisolone, the retinal vasculitis resolved and macular edema improved during follow-up. There was no need for durvalumab to be withdrawn.
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Affiliation(s)
- Antonio R Andrade
- Ophthalmology Department, Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Ophthalmology Department, Hospital Clínic de Barcelona, Instituto Clínic de Oftalmología, Barcelona, Spain
| | - Ruth Martin
- Ophthalmology Department, Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Cilveti
- Ophthalmology Department, Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olaia Subirà
- Ophthalmology Department, Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Disfetano
- Ophthalmology Department, Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose García-Arumí
- Ophthalmology Department, Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Adán A, Moll-Udina A, Ramirez J, Llorenç V. Subcutaneous Tocilizumab for Cystoid Macular Edema Secondary to Juvenile Idiopathic Arthritis (JIA)-associated Uveitis: A Case Report. Ocul Immunol Inflamm 2019; 29:6-8. [PMID: 31589540 DOI: 10.1080/09273948.2019.1644350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report a case of cystoid macular edema (CME) secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.Case report: 26-year-old female patient presented with CME in both eyes. CME became refractory and TCZ-IV was initiated. After 12 infusions was stopped because grade 1 neuropenia developed. On examination,visual acuity of the right eye was 20/80. Spectral domain optical coherence tomography (SD-OCT) of the right eye revealed CME. Subcutaneous (TCZ-SC) was initiated. After six injections of TCZ-SC, ophthalmic examination revealed no signs of active inflammation, and central foveal thickness decreased.Conclusion: TCZ-SC seems to have a role in the treatment of CME secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.
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Affiliation(s)
- Alfredo Adán
- Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
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24
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Affiliation(s)
- Alfredo Adán
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Juan Pablo Figueroa-Vercellino
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
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25
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Moll-Udina A, Figueroa-Vercellino JP, Llorenç V, Miguel L, Adán A. Angiography and En Face Optical Coherence Tomography Findings in Acute Syphilitic Posterior Placoid Chorioretinopathy. Case Rep Ophthalmol 2019; 10:165-171. [PMID: 31692487 PMCID: PMC6760361 DOI: 10.1159/000500239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/07/2019] [Indexed: 11/19/2022] Open
Abstract
Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is one of the rarest ocular manifestations of syphilis. The pathophysiology of this entity is still unknown. We report the outer retinal findings on en face optical coherence tomography (OCT) and the alteration of choriocapillaris flow findings on OCT angiography in a patient with ASPPC at the time of presentation, after penicillin treatment completion and during follow-up.
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Affiliation(s)
- Aina Moll-Udina
- Uveitis Unit, Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
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