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Shwani T, Zhang C, Owen LA, Shakoor A, Vitale AT, Lillvis JH, Barr JL, Cromwell P, Finley R, Husami N, Au E, Zavala RA, Graves EC, Zhang SX, Farkas MH, Ammar DA, Allison KM, Tawfik A, Sherva RM, Li M, Stambolian D, Kim IK, Farrer LA, DeAngelis MM. Patterns of Gene Expression, Splicing, and Allele-Specific Expression Vary among Macular Tissues and Clinical Stages of Age-Related Macular Degeneration. Cells 2023; 12:2668. [PMID: 38067097 PMCID: PMC10705168 DOI: 10.3390/cells12232668] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness, and elucidating its underlying disease mechanisms is vital to the development of appropriate therapeutics. We identified differentially expressed genes (DEGs) and differentially spliced genes (DSGs) across the clinical stages of AMD in disease-affected tissue, the macular retina pigment epithelium (RPE)/choroid and the macular neural retina within the same eye. We utilized 27 deeply phenotyped donor eyes (recovered within a 6 h postmortem interval time) from Caucasian donors (60-94 years) using a standardized published protocol. Significant findings were then validated in an independent set of well-characterized donor eyes (n = 85). There was limited overlap between DEGs and DSGs, suggesting distinct mechanisms at play in AMD pathophysiology. A greater number of previously reported AMD loci overlapped with DSGs compared to DEGs between disease states, and no DEG overlap with previously reported loci was found in the macular retina between disease states. Additionally, we explored allele-specific expression (ASE) in coding regions of previously reported AMD risk loci, uncovering a significant imbalance in C3 rs2230199 and CFH rs1061170 in the macular RPE/choroid for normal eyes and intermediate AMD (iAMD), and for CFH rs1061147 in the macular RPE/choroid for normal eyes and iAMD, and separately neovascular AMD (NEO). Only significant DEGs/DSGs from the macular RPE/choroid were found to overlap between disease states. STAT1, validated between the iAMD vs. normal comparison, and AGTPBP1, BBS5, CERKL, FGFBP2, KIFC3, RORα, and ZNF292, validated between the NEO vs. normal comparison, revealed an intricate regulatory network with transcription factors and miRNAs identifying potential upstream and downstream regulators. Findings regarding the complement genes C3 and CFH suggest that coding variants at these loci may influence AMD development via an imbalance of gene expression in a tissue-specific manner. Our study provides crucial insights into the multifaceted genomic underpinnings of AMD (i.e., tissue-specific gene expression changes, potential splice variation, and allelic imbalance), which may open new avenues for AMD diagnostics and therapies specific to iAMD and NEO.
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Affiliation(s)
- Treefa Shwani
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
| | - Leah A. Owen
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA; (A.S.); (A.T.V.)
- Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
| | - Akbar Shakoor
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA; (A.S.); (A.T.V.)
| | - Albert T. Vitale
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA; (A.S.); (A.T.V.)
| | - John H. Lillvis
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
| | - Julie L. Barr
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - Parker Cromwell
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
| | - Robert Finley
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
| | - Nadine Husami
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
| | - Elizabeth Au
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
| | - Rylee A. Zavala
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
| | - Elijah C. Graves
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
| | - Sarah X. Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - Michael H. Farkas
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - David A. Ammar
- Lion’s Eye Institute for Transplant & Research, Tampa, FL 33605, USA;
| | - Karen M. Allison
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, NY 14642, USA;
| | - Amany Tawfik
- Department of Foundational Medical Studies and Eye Research Center, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA;
- Eye Research Institute, Oakland University, Rochester, MI 48309, USA
| | - Richard M. Sherva
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (R.M.S.); (L.A.F.)
| | - Mingyao Li
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Dwight Stambolian
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Ivana K. Kim
- Retina Service, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA;
| | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (R.M.S.); (L.A.F.)
| | - Margaret M. DeAngelis
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (T.S.); (C.Z.); (L.A.O.); (J.H.L.); (J.L.B.); (P.C.); (R.F.); (N.H.); (E.A.); (R.A.Z.); (E.C.G.); (S.X.Z.); (M.H.F.)
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA; (A.S.); (A.T.V.)
- Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Genetics, Genomics and Bioinformatics Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
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Carletti P, Shah A, Bair C, Curran C, Mai A, Patel R, Moorthy R, Villate N, Davis JL, Vitale AT, Shakoor A, Hassman L. The spectrum of COVID-19-associated chorioretinal vasculopathy. Am J Ophthalmol Case Rep 2023; 31:101857. [PMID: 37255549 PMCID: PMC10193817 DOI: 10.1016/j.ajoc.2023.101857] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose Although conjunctivitis represents the most common ocular manifestation of COVID-19 infection, sight-threatening retinal involvement has been reported. Herein, we report and characterize with multimodal retinal imaging 5 cases of acute vision loss secondary to presumed chorioretinal vasculopathy temporally associated with COVID-19 infection with varying severity, visual morbidity, and treatment response, and review the available literature on the association between COVID-19 infection and retinal microvascular changes. Design Observational case series and literature review. Methods Multicenter case series of 5 patients who presented to academic centers and private offices with acute vision loss temporally associated with COVID-19 infection. A review of the literature was conducted using online databases. Results 10 eyes of 5 patients, 3 men and 2 women, with a mean age of 30.8 years (median 33, range 16-44) were described. All patients had a recently preceding episode of COVID-19, with symptomatology ranging from mild infection to life-threatening encephalopathy. Treatment for their retinal disease included topical, oral, intravitreal, and intravenous steroids, steroid-sparing immunosuppression, retinal photocoagulation, antivirals, and antiplatelet and anticoagulant agents. Treatment response and visual recovery ranged from complete recovery of baseline acuity to permanent vision loss and need for chronic immunosuppression. Conclusions and Importance Clinicians should be mindful of the potential for vision-threatening retinal involvement after COVID-19 infection. If found, treatment with both anti-inflammatory therapy and anticoagulation should be considered, in addition to close monitoring, as some patients with this spectrum of disease may require chronic immune suppression and/or anti-VEGF therapy.
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Affiliation(s)
- Piero Carletti
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aaditya Shah
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher Bair
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | | | - Anthony Mai
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Rachel Patel
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Ramana Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Indianapolis, IN, USA
| | - Natalia Villate
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Fort Lauderdale Eye Institute, Fort Lauderdale, FL, USA
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Albert T Vitale
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Akbar Shakoor
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Lynn Hassman
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Acharya NR, Vitale AT, Sugar EA, Holbrook JT, Burke AE, Thorne JE, Altaweel MM, Kempen JH, Jabs DA. Intravitreal Therapy for Uveitic Macular Edema-Ranibizumab versus Methotrexate versus the Dexamethasone Implant: The MERIT Trial Results. Ophthalmology 2023; 130:914-923. [PMID: 37318415 PMCID: PMC10524707 DOI: 10.1016/j.ophtha.2023.04.011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of 3 different intravitreal treatments for persistent or recurrent uveitic macular edema (ME): dexamethasone implant, methotrexate, and ranibizumab. DESIGN Single-masked, randomized controlled clinical trial. PARTICIPANTS Patients with minimally active or inactive uveitis and persistent or recurrent uveitic ME in one or both eyes. METHODS Patients at 33 centers were randomized 1:1:1 to receive 1 of the 3 therapies. Patients with bilateral ME received the same treatment in both eyes. MAIN OUTCOME MEASURES The primary outcome, measured at 12 weeks, was reduction in central subfield thickness (CST) expressed as a proportion of baseline (CST per CST at baseline) assessed with spectral-domain OCT by readers masked to treatment assignment. Secondary outcomes included improvement and resolution of ME, change in best-corrected visual acuity (BCVA), and elevations in intraocular pressure (IOP). RESULTS One hundred ninety-four participants (225 eligible eyes) were randomized to dexamethasone (n = 65 participants and 77 eyes), methotrexate (n = 65 participants and 79 eyes), or ranibizumab (n = 64 participants and 69 eyes). All received at least 1 injection of the assigned treatment. At the 12-week primary outcome point, each group showed significant reductions in CST relative to baseline: 35%, 11%, and 22% for dexamethasone, methotrexate, and ranibizumab, respectively. Reduction of ME was significantly greater in the dexamethasone group than for either methotrexate (P < 0.01) or ranibizumab (P = 0.018). Only the dexamethasone group showed a statistically significant improvement in BCVA during follow-up (4.86 letters; P < 0.001). Elevations of IOP by 10 mmHg, to 24 mmHg or more, or both were more common in the dexamethasone group; IOP spikes to 30 mmHg or more were uncommon overall and were not significantly different among groups. Reductions in BCVA of 15 letters or more were more common in the methotrexate group and typically were attributable to persistent ME. CONCLUSIONS At 12 weeks, in eyes with minimally active or inactive uveitis, dexamethasone was significantly better at treating persistent or recurrent ME than methotrexate or ranibizumab. Risk of IOP elevation was greater with dexamethasone, but elevations to levels of 30 mmHg or more were infrequent. 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)
- Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Epidemiology, University of California, San Francisco, San Francisco, California
| | - Albert T Vitale
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah
| | - Elizabeth A Sugar
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Janet T Holbrook
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alyce E Burke
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer E Thorne
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael M Altaweel
- The Wisconsin Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - John H Kempen
- Schepens Eye Research Institute, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts; MCM Eye Unit, Department of Ophthalmology, MCM Comprehensive Specialized Hospital and MyungSung Medical College, Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia; Sight for Souls, Bellevue, Washington
| | - Douglas A Jabs
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins 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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Conrady CD, Hu K, Shakoor A, Larochelle M, Sassalos T, Elner SG, Jayasundera T, Vitale AT. Reply. Ophthalmol Retina 2022; 6:437-438. [PMID: 35525579 DOI: 10.1016/j.oret.2021.12.009] [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: 12/06/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Katherine Hu
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Akbar Shakoor
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Marissa Larochelle
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Therese Sassalos
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Susan G Elner
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Thiran Jayasundera
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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Hu KS, Vitale AT, Shakoor A, Larochelle M, Sassalos T, Elner SG, Jayasundera T, Conrady CD. Pyramidal Inflammatory Deposits of the Retinal Pigment Epithelium and Outer Retina in Ocular Syphilis. Ophthalmol Retina 2022; 6:172-178. [PMID: 34224934 PMCID: PMC8813047 DOI: 10.1016/j.oret.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/31/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the role of OCT in the diagnosis of uveitis secondary to syphilis. DESIGN Consecutive, retrospective case series. PARTICIPANTS All patients 18 years of age or older with ocular syphilis from 2 tertiary referral centers. METHODS All patients who were diagnosed with intermediate uveitis, posterior uveitis, or panuveitis secondary to syphilis were included in the study (40 patients representing a total of 62 eyes) to identify important imaging features to aid in diagnosis. Patients underwent confirmatory serologic testing, OCT imaging, and dilated examination by a uveitis specialist. MAIN OUTCOME MEASURE Hyperreflective retinal lesions on OCT. RESULTS The mean age of the study population was 42.9 ± 12.16 years. Forty-five percent of the eyes included in this study harbored hyperreflective pyramidal lesions of the outer retina and retinal pigment epithelium on OCT. Fifty-four percent of eyes with these imaging findings did not show a placoid retinal lesion on examination. Sixty-eighty percent of the described outer retinal lesions on OCT resolved after treatment for syphilis. Visual acuity ranged from normal (20/20) to no light perception, with a mean of 20/43 at diagnosis, and improved significantly to a mean visual acuity of 20/26 after treatment (P < 0.05). Vision-threatening complications were seen in less than 5% of eyes and included both treatable and irreversible causes of vision loss, including retinal detachment, cystoid macular edema, and optic neuropathy. CONCLUSIONS Patients treated for uveitis secondary to syphilis achieve good visual recoveries. Outer retinal lesions seen on OCT are common and can serve as an additional imaging finding of the disease.
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Affiliation(s)
- Katherine S. Hu
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Albert T. Vitale
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Akbar Shakoor
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Marissa Larochelle
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Therese Sassalos
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Susan G. Elner
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Thiran Jayasundera
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Christopher D. Conrady
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Sassalos TM, Vitale AT, Conrady CD. Posterior scleritis and acute posterior multifocal placoid pigment epitheliopathy: A case of painful chorioretinitis and review of the current literature. Am J Ophthalmol Case Rep 2021; 23:101159. [PMID: 34278050 PMCID: PMC8261531 DOI: 10.1016/j.ajoc.2021.101159] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/20/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To describe a patient who developed concurrent acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and posterior scleritis. Observations We describe a middle-aged woman that developed eye pain and photopsia. She was found to have a “T-sign” on ultrasound of the right eye and multiple, nearly confluent, ill-defined subretinal whitish lesions in both eyes. After an extensive laboratory evaluation and neuroimaging, her photopsia, pain with eye movements, and subretinal lesions began to regress on high dose systemic corticosteroids. Conclusions and Importance This is the first reported case of bilateral APMPPE and concurrent posterior scleritis. Our case highlights the importance of performing a full review of systems, specifically eliciting neurological changes, and dilated eye examination in all new uveitis cases.
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Affiliation(s)
- Thérèse M Sassalos
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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Rosenbaum JT, Harrington CA, Searles RP, Fei SS, Zaki A, Arepalli S, Paley MA, Hassman LM, Vitale AT, Conrady CD, Keath P, Mitchell C, Watson L, Planck SR, Martin TM, Choi D. Identifying RNA Biomarkers and Molecular Pathways Involved in Multiple Subtypes of Uveitis. Am J Ophthalmol 2021; 226:226-234. [PMID: 33503442 DOI: 10.1016/j.ajo.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Uveitis is a heterogeneous collection of diseases. We tested the hypothesis that despite the diversity of uveitides, there could be common mechanisms shared by multiple subtypes, and that evidence of these common mechanisms may be detected as gene expression profiles in whole blood. DESIGN Cohort study. METHODS Ninety subjects with uveitis including axial spondyloarthritis (n = 17), sarcoidosis (n = 13), inflammatory bowel disease (n = 12), tubulointerstitial nephritis with uveitis (n = 10), or idiopathic uveitis (n = 38) as well as 18 healthy controls were enrolled, predominantly at Oregon Health & Science University. RNA-Seq data generated from peripheral, whole blood identified 19,859 unique transcripts. We analyzed gene expression pathways via Kyoto Encyclopedia of Genes and Genomes and Gene Ontology (GO). We validated our list of upregulated genes by comparison to a previously published study on peripheral blood gene expression among 50 subjects with diverse forms of uveitis. RESULTS Both the Kyoto Encyclopedia of Genes and Genomes and GO analysis identified multiple shared pathways or GO terms with a P value of <.0001. Almost all pathways related to the immune response and/or response to an infection. A total of 119 individual transcripts were upregulated by at least 1.5-fold and false discovery rate <.05, and 61 were downregulated by similar criteria. Comparing mRNA from our study with a false discovery rate <.05 and the prior report, we identified 10 common gene transcripts: ICAM1, IL15RA, IL15, IRF1, IL10RB, GSK3A, TYK2, MEF2A, MEF2B, and MEF2D. CONCLUSIONS Many forms of uveitis share overlapping mechanisms. These data support the concept that a single therapeutic approach could benefit diverse forms of this disease.
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Rosenbaum JT, Harrington CA, Searles RP, Fei SS, Zaki A, Arepalli S, Paley MA, Hassman LM, Vitale AT, Conrady CD, Keath P, Mitchell C, Watson L, Planck SR, Martin TM, Choi D. Revising the Diagnosis of Idiopathic Uveitis by Peripheral Blood Transcriptomics. Am J Ophthalmol 2021; 222:15-23. [PMID: 32941857 DOI: 10.1016/j.ajo.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To test the hypothesis that idiopathic uveitis can be categorized into subtypes based on gene expression from blood. DESIGN Case control study. METHODS We applied RNA-Seq to peripheral blood from patients with uveitis associated with 1 of 4 systemic diseases, including axial spondyloarthritis (n = 17), sarcoidosis (n = 13), inflammatory bowel disease (n = 12), tubulo-interstitial nephritis with uveitis (n = 10), or idiopathic uveitis (n = 38) as well as 18 healthy control subjects evaluated predominantly at Oregon Health and Science University. A high-dimensional negative binomial regression model implemented in the edgeR R package compared each disease group with the control subjects. The 20 most distinctive genes for each diagnosis were extracted. Of 80 genes, there were 75 unique genes. A classification algorithm was developed by fitting a gradient boosting tree with 5-fold cross-validation. Messenger RNA from subjects with idiopathic uveitis were analyzed to see if any fit clinically and by gene expression pattern with one of the diagnosable entities. RESULTS For uveitis associated with a diagnosable systemic disease, gene expression profiling achieved an overall accuracy of 85% (balanced average of sensitivity plus specificity, P < .001). Although most patients with idiopathic uveitis presumably have none of these 4 associated systemic diseases, gene expression profiles helped to reclassify 11 of 38 subjects. CONCLUSIONS Peripheral blood gene expression profiling is a potential adjunct in accurate differential diagnosis of the cause of uveitis. Validation of these results and characterization of the gene expression profile from additional discrete diagnoses could enhance the value of these observations.
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Affiliation(s)
- James T Rosenbaum
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA; Department of Cell Biology, Oregon Health and Science University, Portland, Oregon, USA; Legacy Devers Eye Institute, Portland, Oregon, USA.
| | - Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health and Science University, Portland, Oregon, USA; Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Robert P Searles
- Integrated Genomics Laboratory, Oregon Health and Science University, Portland, Oregon, USA
| | - Suzanne S Fei
- Bioinformatics and Biostatistics Core, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, USA
| | - Amr Zaki
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Sruthi Arepalli
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael A Paley
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Lynn M Hassman
- Department of Ophthalmology, Washington University, St Louis, Missouri, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Puthyda Keath
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Claire Mitchell
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Lindsey Watson
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Stephen R Planck
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Tammy M Martin
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | - Dongseok Choi
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA; Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
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9
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Suhler EB, Jaffe GJ, Fortin E, Lim LL, Merrill PT, Dick AD, Brezin AP, Nguyen QD, Thorne JE, Van Calster J, Cimino L, Adan A, Goto H, Kaburaki T, Kramer M, Vitale AT, Kron M, Song AP, Liu J, Pathai S, Douglas KM, Schlaen A, Muccioli C, Van Velthoven MEJ, Zierhut M, Rosenbaum JT. Long-Term Safety and Efficacy of Adalimumab in Patients with Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. Ophthalmology 2020; 128:899-909. [PMID: 33157077 DOI: 10.1016/j.ophtha.2020.10.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/21/2019] [Revised: 10/07/2020] [Accepted: 10/29/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate long-term efficacy and safety of extended treatment with adalimumab in patients with noninfectious intermediate, posterior, or panuveitis. DESIGN Open-label, multicenter, phase 3 extension study (VISUAL III). PARTICIPANTS Adults who had completed a randomized, placebo-controlled phase 3 parent trial (VISUAL I or II) without treatment failure (inactive uveitis) or who discontinued the study after meeting treatment failure criteria (active uveitis). METHODS Patients received subcutaneous adalimumab 40 mg every other week. Data were collected for ≤ 362 weeks. Adverse events (AEs) were recorded until 70 days after the last dose. MAIN OUTCOME MEASURES Long-term safety and quiescence; other efficacy variables included inflammatory lesions, anterior chamber cell and vitreous haze grade, macular edema, visual acuity, and dose of uveitis-related systemic corticosteroids. RESULTS At study entry, 67% of patients (283/424) showed active uveitis and 33% (141/424) showed inactive uveitis; 60 patients subsequently met exclusion criteria, and 364 were included in the intention-to-treat analysis. Efficacy variables were analyzed through week 150, when approximately 50% of patients (214/424) remained in the study. Patients showing quiescence increased from 34% (122/364) at week 0 to 85% (153/180) at week 150. Corticosteroid-free quiescence was achieved by 54% (66/123) and 89% (51/57) of patients with active or inactive uveitis at study entry. Mean daily dose of systemic corticosteroids was reduced from 9.4 ± 17.1 mg/day at week 0 (n = 359) to 1.5 ± 3.9 mg/day at week 150 (n = 181). The percentage of patients who achieved other efficacy variables increased over time for those with active uveitis at study entry and was maintained for those with inactive uveitis. The most frequently reported treatment-emergent AEs of special interest were infections (n = 275; 79 events/100 patient-years [PY]); AEs and serious AEs occurred at a rate of 396 events/100 PY and 15 events/100 PY, respectively. CONCLUSIONS Long-term treatment with adalimumab led to quiescence and reduced corticosteroid use for patients who entered VISUAL III with active uveitis and led to maintenance of quiescence for those with inactive uveitis. AEs were comparable with those reported in the parent trials and consistent with the known safety profile of adalimumab.
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Affiliation(s)
- Eric B Suhler
- Casey Eye Institute, Oregon Health & Science University, OHSU-PSU School of Public Health, and VA Portland Health Care System, Portland, Oregon.
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Eric Fortin
- Department of Ophthalmology, University of Montreal, Montreal, Canada
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Pauline T Merrill
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Andrew D Dick
- Translational Health Sciences (Ophthalmology), University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom, and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London, Institute of Ophthalmology, London, United Kingdom
| | - Antoine P Brezin
- Department of Ophthalmology, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - Quan Dong Nguyen
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Jennifer E Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, and Department of Epidemiology, Center for Clinical Trials, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | - Alfredo Adan
- Facultad de Medicina, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Hiroshi Goto
- Department of Ophthalmolgy, Medical University, Tokyo, Japan
| | | | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Martina Kron
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | | | - Sophia Pathai
- Johnson & Johnson Vision, Singapore, Republic of Singapore
| | | | - Ariel Schlaen
- Department of Ophthalmology, Austral University, Buenos Aires, Argentina
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Manfred Zierhut
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - James T Rosenbaum
- Departments of Ophthalmology and Medicine, Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
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10
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Larochelle RD, Larochelle MB, Aung YY, Linn T, Heiden D, Vitale AT. Bilateral Placoid Choroiditis in an HIV-Positive Patient With Cryptococcus neoformans Meningitis and Disseminated Cryptococcal Disease. Journal of VitreoRetinal Diseases 2020; 4:530-533. [PMID: 37007659 PMCID: PMC9976065 DOI: 10.1177/2474126420936191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: We report a presumptive case of bilateral placoid choroiditis secondary to disseminated Cryptococcus neoformans infection and review the literature on choroidal involvement of C neoformans. Methods: A case report is presented. Results: A 35-year-old HIV-positive man presented with disseminated cryptococcal infection. Cryptococcal meningitis was confirmed by lumbar puncture, and skin involvement was confirmed by microscopy of scrapings from a papular, umbilicated, ulcerated lesion. Ophthalmologic examination revealed intact visual acuity, clear vitreous, and multiple yellowish, placoid-appearing choroidal lesions in the posterior pole bilaterally. Conclusions: Multifocal choroiditis caused by C neoformans is an uncommon manifestation of disseminated infection, and placoid yellowish choroidal lesions are an unusual variant. These findings must be differentiated from choroidal tuberculosis and other infections. Multifocal choroiditis typically occurs in AIDS patients and may precede the presentation of meningitis. In such patients, choroidal lesions warrant investigation for systemic, life-threatening opportunistic infections.
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Affiliation(s)
| | - Marissa B. Larochelle
- Department of Ophthalmology and Visual Sciences, University of Utah,
Salt Lake City, UT, USA
| | | | | | | | - Albert T. Vitale
- Department of Ophthalmology and Visual Sciences, University of Utah,
Salt Lake City, UT, USA
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11
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Conrady CD, Shakoor A, Patel R, Larochelle M, Moshirfar M, Chaya CJ, Jacoby R, Vitale AT. Combined Phacoemulsification and Pars Plana Vitrectomy for the Treatment of Cataract in Patients With Noninfectious Uveitis. Journal of VitreoRetinal Diseases 2020; 4:393-400. [PMID: 37008298 PMCID: PMC9979025 DOI: 10.1177/2474126420930489] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: This work evaluates the role of combined phacoemulsification and vitrectomy surgery in the management of cataract associated with noninfectious uveitis. Methods: A retrospective chart review was conducted of all patients aged 7 years or older who underwent a combined surgical approach from 2005 to 2018. Results: Eighty-five eyes of 67 patients were included in the study; 10.7% of eyes had a best-corrected visual acuity (BCVA) of 20/40 or better at time of surgery. At 1-year follow-up, 63.4% of eyes had a BCVA 20/40 or better and 7.6% had a BCVA of 20/200 or worse. There was an overall decrease in cystoid macular edema after surgery compared with preoperatively (47.6% vs 34.5% presurgery and postsurgery, respectively). Complete inflammatory disease remission off immunomodulatory therapy and systemic steroids was achieved in 21.1% of patients. Conclusions: A combined surgical approach is effective in visual rehabilitation in patients with uveitic cataracts and may promote inflammatory disease remission specifically in intermediate uveitis.
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Affiliation(s)
- Christopher D. Conrady
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Akbar Shakoor
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Rachel Patel
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Marissa Larochelle
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Majid Moshirfar
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Craig J. Chaya
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Rachael Jacoby
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Albert T. Vitale
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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12
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Conrady CD, Feist RM, Vitale AT, Shakoor A. Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone. BMC Ophthalmol 2020; 20:181. [PMID: 32375683 PMCID: PMC7201644 DOI: 10.1186/s12886-020-01449-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/28/2019] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial. Methods This is a retrospective analysis from a single tertiary referral center of all patients older than 18 years old that developed presumed post-procedure endophthalmitis and were treated at our center from 2009 to 2018. Results Eighty-three patients were followed after being treated for post-procedural endophthalmitis that either received systemic steroids or did not around the time of diagnosis. Almost 30 % of all patients regained a final visual acuity of 20/40 or better, while 31.2% had poor visual outcomes of count fingers or worse. Non-clearing debris was the most significant long-term complication. Visual improvement plateaued in 67.7% by 1 month after diagnosis and initial treatment in both groups. There was no difference in visual outcomes when comparing the sixteen patients that received systemic steroids and the sixty-seven that did not; however, no enucleation or evisceration was required in patients receiving systemic steroids. Five patients that did not receive systemic steroids required an enucleation or evisceration due to a blind, painful eye. Conclusions The use of systemic steroids does not seem to worsen long-term outcomes of endophthalmitis compared to those patients that did not receive them and they may prove beneficial in the most severe cases by reducing the risk of losing the globe altogether.
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Affiliation(s)
- Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. .,Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI, 48103, USA.
| | - Richard M Feist
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Akbar Shakoor
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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13
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Rifkin LM, Vadboncoeur J, Minkus CC, Dunn EN, Moorthy RS, Bhatt N, Sen HN, Taggart MG, Vitale AT, Goldstein DA. The Utility of Lyme Testing in the Workup of Ocular Inflammation. Ocul Immunol Inflamm 2019; 29:149-153. [PMID: 31577476 DOI: 10.1080/09273948.2019.1657904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Lana M Rifkin
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Julie Vadboncoeur
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Caroline C Minkus
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Evan N Dunn
- Department of Ophthalmology, Associated Vitreoretinal and Uveitis Consultants, Indiana University, Indianapolis, IN, USA
| | - Ramana S Moorthy
- Department of Ophthalmology, Associated Vitreoretinal and Uveitis Consultants, Indiana University, Indianapolis, IN, USA
| | - Nirali Bhatt
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael G Taggart
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Albert T Vitale
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
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14
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Williams LB, Javed A, Sabri A, Morgan DJ, Huff CD, Grigg JR, Heng XT, Khng AJ, Hollink IHIM, Morrison MA, Owen LA, Anderson K, Kinard K, Greenlees R, Novacic D, Nida Sen H, Zein WM, Rodgers GM, Vitale AT, Haider NB, Hillmer AM, Ng PC, Shankaracharya, Cheng A, Zheng L, Gillies MC, van Slegtenhorst M, van Hagen PM, Missotten TOAR, Farley GL, Polo M, Malatack J, Curtin J, Martin F, Arbuckle S, Alexander SI, Chircop M, Davila S, Digre KB, Jamieson RV, DeAngelis MM. ALPK1 missense pathogenic variant in five families leads to ROSAH syndrome, an ocular multisystem autosomal dominant disorder. Genet Med 2019; 21:2103-2115. [PMID: 30967659 PMCID: PMC6752478 DOI: 10.1038/s41436-019-0476-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 11/06/2018] [Accepted: 02/25/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose To identify the molecular cause in five unrelated families with a distinct autosomal dominant ocular systemic disorder we called ROSAH syndrome due to clinical features of retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and migraine headache. Methods Independent discovery exome and genome sequencing in families 1, 2, and 3, and confirmation in families 4 and 5. Expression of wild-type messenger RNA and protein in human and mouse tissues and cell lines. Ciliary assays in fibroblasts from affected and unaffected family members. Results We found the heterozygous missense variant in the ɑ-kinase gene, ALPK1, (c.710C>T, [p.Thr237Met]), segregated with disease in all five families. All patients shared the ROSAH phenotype with additional low-grade ocular inflammation, pancytopenia, recurrent infections, and mild renal impairment in some. ALPK1 was notably expressed in retina, retinal pigment epithelium, and optic nerve, with immunofluorescence indicating localization to the basal body of the connecting cilium of the photoreceptors, and presence in the sweat glands. Immunocytofluorescence revealed expression at the centrioles and spindle poles during metaphase, and at the base of the primary cilium. Affected family member fibroblasts demonstrated defective ciliogenesis. Conclusion Heterozygosity for ALPK1, p.Thr237Met leads to ROSAH syndrome, an autosomal dominant ocular systemic disorder.
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Affiliation(s)
- Lloyd B Williams
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Asif Javed
- Genome Institute of Singapore, Singapore, Singapore.,School of Biomedical Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Amin Sabri
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Denise J Morgan
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chad D Huff
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John R Grigg
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Margaux A Morrison
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leah A Owen
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Krista Kinard
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rebecca Greenlees
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Danica Novacic
- National Institutes of Health, National Human Genome Research Institute, Undiagnosed Diseases Network, Bethesda, MD, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wadih M Zein
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - George M Rodgers
- Department of Hematology, Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Neena B Haider
- Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Pauline C Ng
- Genome Institute of Singapore, Singapore, Singapore
| | - Shankaracharya
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anson Cheng
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Linda Zheng
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Mark C Gillies
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Michael Polo
- Drs. Farley, Polo and Ho, Colonial Heights, VA, USA
| | - James Malatack
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Julie Curtin
- Department of Haematology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Frank Martin
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Susan Arbuckle
- Department of Pathology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Stephen I Alexander
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Megan Chircop
- Cell Cycle Unit, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Sonia Davila
- Genome Institute of Singapore, Singapore, Singapore
| | - Kathleen B Digre
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robyn V Jamieson
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia. .,Disciplines of Genomic Medicine, and Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. .,Department of Clinical Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia.
| | - Margaret M DeAngelis
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA. .,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Papangkorn K, Truett KR, Vitale AT, Jhaveri C, Scales DK, Foster CS, Montieth A, Higuchi JW, Brar B, Higuchi WI. Novel Dexamethasone Sodium Phosphate Treatment (DSP-Visulex) for Noninfectious Anterior Uveitis: A Randomized Phase I/II Clinical Trial. Curr Eye Res 2018; 44:185-193. [PMID: 30354530 DOI: 10.1080/02713683.2018.1540707] [Citation(s) in RCA: 5] [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] [Indexed: 12/20/2022]
Abstract
PURPOSE Frequent steroid drops represent a challenge in patient compliance. This study evaluated the safety and efficacy of 5 minute topical dexamethasone sodium phosphate-Visulex (DSP-Visulex) treatment regimen (two applications on the first week then weekly after) compared to daily prednisolone acetate 1% (PA) for noninfectious anterior uveitis. MATERIALS AND METHODS Forty-four patients were randomized to 8% DSP-Visulex with placebo eye drops (8% group, n = 14), 15% DSP-Visulex with placebo eye drops (15% group, n = 15), or Vehicle-Visulex with PA eye drops (PA group, n = 15). Patients received daily eye drops and Visulex treatments on days 1, 3, 8, and 15 with an optional treatment on day 22. Efficacy measures were change in anterior chamber cell (ACC) count from baseline and proportion of patients with zero ACC count at days 8, 15, and 29. Safety measures were adverse events (AEs), visual acuity, ocular symptoms, and intraocular pressure (IOP). RESULTS ACC resolution over time was similar among the three groups. The percentage of patients with clear ACC was 18%, 22%, and 15% on day 8; 27%, 56%, and 54% on day 15; and 90%, 88%, and 77% on day 29 for the 8%, 15%, and PA groups, respectively. The numbers of reported AEs were 10, 36, and 12 for the 8%, 15%, and PA groups, respectively. Ten patients among all groups experienced treatment-related AEs, which included headache, eye pain, corneal abrasion, conjunctival/corneal staining, conjunctivitis, visual acuity reduction, and keratitis all of which were resolved during the timeframe of patients' participation in the study. IOP elevation was noted in the PA group throughout the study, whereas IOP elevation in the DSP-Visulex groups was observed at day 3 but not thereafter. CONCLUSIONS The efficacy of the DSP-Visulex applications was comparable to the daily PA drops in the treatment of noninfectious anterior uveitis. Both 8% and 15% DSP-Visulex treatments were safe and well tolerated.
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Affiliation(s)
| | | | | | | | - David K Scales
- e Retina & Uveitis Consultants of Texas , San Antonio , TX , USA
| | - C Stephen Foster
- f Massachusetts Eye Research and Surgery Institution , Waltham , MA , USA
| | - Alyssa Montieth
- f Massachusetts Eye Research and Surgery Institution , Waltham , MA , USA
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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: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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Suhler EB, Adán A, Brézin AP, Fortin E, Goto H, Jaffe GJ, Kaburaki T, Kramer M, Lim LL, Muccioli C, Nguyen QD, Van Calster J, Cimino L, Kron M, Song AP, Liu J, Pathai S, Camez A, Schlaen A, van Velthoven MEJ, Vitale AT, Zierhut M, Tari S, Dick AD. Safety and Efficacy of Adalimumab in Patients with Noninfectious Uveitis in an Ongoing Open-Label Study: VISUAL III. Ophthalmology 2018; 125:1075-1087. [PMID: 29429764 DOI: 10.1016/j.ophtha.2017.12.039] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/17/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate safety and efficacy of adalimumab in patients with noninfectious intermediate, posterior, or panuveitis. DESIGN Phase 3, open-label, multicenter clinical trial extension (VISUAL III). PARTICIPANTS Adults meeting treatment failure (TF) criteria or who completed VISUAL I or II (phase 3, randomized, double-masked, placebo-controlled) without TF. METHODS Patients received adalimumab 40 mg every other week. Interim follow-up data were described from VISUAL III weeks 0 through 78. MAIN OUTCOME MEASURES Disease quiescence, steroid-free quiescence, active inflammatory chorioretinal/retinal vascular lesions, anterior chamber cell grade, vitreous haze grade, best-corrected visual acuity (BCVA), and corticosteroid dose. Binary data were reported using nonresponder imputation (NRI), continuous data using last observation carried forward and as-observed analysis, and corticosteroid dose using observed-case analysis. Adverse events (AEs) were reported from first adalimumab dose in VISUAL III through interim cutoff. RESULTS Of 424 patients enrolled, 371 were included in intent-to-treat analysis. At study entry, 242 of 371 (65%) patients had active uveitis; 60% (145/242, NRI) achieved quiescence at week 78, and 66% (95/143, as-observed) of those were corticosteroid free. At study entry, 129 of 371 (35%) patients had inactive uveitis; 74% (96/129, NRI) achieved quiescence at week 78, and 93% (89/96, as-observed) of those were corticosteroid free. Inflammatory lesions, anterior chamber grade, and vitreous haze grade showed initial improvement followed by decline in patients with active uveitis and remained stable in patients with inactive uveitis. BCVA improved in patients with active uveitis from weeks 0 to 78 (0.27 to 0.14 logMAR; left and right eyes; as-observed) and remained stable in patients with inactive uveitis. Mean corticosteroid dose decreased from 13.6 mg/day (week 0) to 2.6 mg/day (week 78) in patients with active uveitis and remained stable in those with inactive uveitis (1.5-1.2 mg/day). AEs (424 events/100 patient-years) and serious AEs (16.5 events/100 patient-years) were comparable with previous VISUAL trials. CONCLUSIONS Patients with active uveitis at study entry who received adalimumab therapy were likely to achieve quiescence, improve visual acuity, and reduce their daily uveitis-related systemic corticosteroid use. Most patients with inactive uveitis at study entry sustained quiescence without a systemic corticosteroid dose increase. No new safety signals were identified.
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Affiliation(s)
- Eric B Suhler
- Oregon Health & Science University, Casey Eye Institute, Portland, Oregon, and VA Portland Health Care System, Portland, Oregon.
| | | | | | | | | | | | | | - Michal Kramer
- Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | - Martina Kron
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | | | | | - Anne Camez
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | | | - Albert T Vitale
- John A. Moan Eye Center, University of Utah, Salt Lake City, Utah
| | | | | | - Andrew D Dick
- University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom, and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London, Institute of Ophthalmology, London, United Kingdom
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Böni C, Thorne JE, Spaide RF, Ostheimer TA, Sarraf D, Levinson RD, Goldstein DA, Rifkin LM, Vitale AT, Jaffe GJ, Holland GN. Fundus Autofluorescence Findings in Eyes With Birdshot Chorioretinitis. ACTA ACUST UNITED AC 2017; 58:4015-4025. [DOI: 10.1167/iovs.17-21897] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Christian Böni
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Jennifer E. Thorne
- Wilmer Eye Institute and the Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Richard F. Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York, United States
| | - Trucian A. Ostheimer
- Wilmer Eye Institute and the Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - David Sarraf
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States 4Greater Los Angeles VA Healthcare System, Los Angeles California, United States
| | - Ralph D. Levinson
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Debra A. Goldstein
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Lana M. Rifkin
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Albert T. Vitale
- Moran Eye Center and the Department of Ophthalmology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Glenn J. Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Gary N. Holland
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States 4Greater Los Angeles VA Healthcare System, Los Angeles California, United States
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Choi RY, Swan RJ, Hersh A, Vitale AT. Retinal Manifestations of Juvenile Dermatomyositis: Case Report of Bilateral Diffuse Chorioretinopathy with Paracentral Acute Middle Maculopathy and Review of the Literature. Ocul Immunol Inflamm 2017; 26:929-933. [DOI: 10.1080/09273948.2017.1305421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rene Y. Choi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Russell J. Swan
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Aimee Hersh
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Utah, Salt Lake City, Utah, USA
| | - Albert T. Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Abstract
PURPOSE To describe the treatment and outcomes of a cohort of pediatric intermediate uveitis (IU) patients, with a particular focus on the use of immunomodulatory therapy (IMT). METHODS The disease course, treatment, and outcomes of 39 pediatric IU patients treated in the Uveitis Clinic at the University of Utah from 1999 to 2012 were reviewed, retrospectively. RESULTS Mean age at presentation was 7.7 years (SD 3.1). In total, 95% had bilateral involvement. Out of 77 total eyes involved, the most frequent disease complications were ocular hypertension (0.71 events per person year, PPY), cataracts (events PPY = 0.39), and cystoid macular edema (events PPY = 0.33). A total of 20 patients received IMT; 19/20 were tapered off systemic corticosteroids without a uveitis recurrence; 75% of eyes had inactive disease at final follow-up (mean 37 months). CONCLUSIONS The use of IMT, including biologic therapies, may effectively manage disease inflammation and reduce steroid dosages in pediatric IU patients.
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Affiliation(s)
- Aimee O Hersh
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Spencer Cope
- b University of Texas San Antonio, Center for Health Sciences , San Antonio , Texas , USA
| | - John F Bohnsack
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Akbar Shakoor
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Albert T Vitale
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
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21
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Böni C, Thorne JE, Spaide RF, Ostheimer TA, Sarraf D, Levinson RD, Goldstein DA, Rifkin LM, Vitale AT, Jaffe GJ, Holland GN. Choroidal Findings in Eyes With Birdshot Chorioretinitis Using Enhanced-Depth Optical Coherence Tomography. ACTA ACUST UNITED AC 2016; 57:OCT591-9. [DOI: 10.1167/iovs.15-18832] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Christian Böni
- Ocular Inflammatory Disease Center UCLA Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Jennifer E. Thorne
- Wilmer Eye Institute and Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Richard F. Spaide
- Vitreous, Retina, Macula Consultants of New York, New York City, New York, United States
| | - Trucian A. Ostheimer
- Wilmer Eye Institute and Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - David Sarraf
- Ocular Inflammatory Disease Center UCLA Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Ralph D. Levinson
- Ocular Inflammatory Disease Center UCLA Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Debra A. Goldstein
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Lana M. Rifkin
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Albert T. Vitale
- Moran Eye Center and Department of Ophthalmology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Glenn J. Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Gary N. Holland
- Ocular Inflammatory Disease Center UCLA Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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22
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Holbrook JT, Sugar EA, Burke AE, Vitale AT, Thorne JE, Davis JL, Jabs DA, Jaffe GJ, Branchaud B, Hahn P, Koreen L, Lad E(NM, Lin P, Martel JN, (Shah) Serrano N, Skalak C, Vajzovic L, Baer C, Bryant J, Chavala S, Cusick M, Day S, Dayani P, Ehlers J, Kesen M, Lee A, Melamud A, Qureshi JA, Scott AW, See RF, Shuler RK, Wood M, Yeh S, Fernandes A, Gibbs D, Leef D, Martin DF, Srivastava S, Dunn JP, Begum H, Boring J, Brotherson KL, Burkholder B, Butler NJ, Cain D, Cook MA, Emmert D, Graul JR, Herring M, Laing A, Leung TG, Mahon MC, Moradi A, Nwankwo A, Ostheimer TL, Reed T, Arnold E, Barnabie PM, Belair ML, Bolton SG, Brodine JB, Brown DM, Brune LM, Galor A, Gan T, Jacobowitz A, Kapoor M, Kedhar S, Kim S, Leder HA, Livingston AG, Morton Y, Nolan K, Peters GB, Soto P, Stevenson R, Tarver-Carr M, Wang Y, Foster CS, Anesi SD, Linda Bruner, Ceron O, Hinkle DM, Persons N, Wentworth B, Acevedo S, Anzaar F, Cesca T, Contero A, Fitzpatrick K, Goronga F, Johnson J, Lebron KQ, Marvell D, Morgan C, Patel N, Pinto J, Siddique SS, Sprague J, Yilmaz T, Sen HN, Bono M, Cunningham D, Hayes D, Koutsandreas D, Nussenblatt RB, Sherry PR, Short GL, Smith W, Temple A, Bamji A, Coleman H, Davuluri G, Faia L, Gottlieb C, Jirawuthiworavong GV, Lew JC, Mercer R, Obiyor D, Perry CH, Potapova N, Weichel E, Wroblewski KJ, Yeh S, Latkany PA, Coonan C, Honda A, Lorenzo-Latkany M, Masini R, Morell S, Nguyen A, Badamo J, Boyd KM, Enos M, Gallardo J, Jarczynski J, Lee JY, McGrosky M, Nour A, Sanchez M, Steinberg K, Stawell RJ, Breayley L, D'Sylva C, Glatz E, Hodgson L, Lim L, Ling C, McIntosh R, Morrison (Ewing) J, Newton A, Sanmugasundram S, Smallwood R, Zamir E, Hunt N, Jones L, Koukouras I, Williams S, Merrill PT, Carns D, Richine L, Voskuil-Marre DL, Woo K, Gaynes B, Giannoulis C, Hulvey P, Kernbauer E, Khan HS, Levine SJ, Toennessen S, Tonner E, Wang RC, Aguado H, Arceneaux S, Duignan K, Fish GE, Hesse N, Jaramillo D, Mackens M, Arnwine J, Callanan D, Cummings K, Gray K, Howden S, Mutz K, Sanchez B, Lightman S, Ismetova F, Prytherch A, Seguin-Greenstein S, Tomkins O, Bar A, Edwards K, Joshi L, Moraji J, Samy A, Stubbs T, Taylor S, Towler H, Tronnberg R, Holland GN, Almanzor RD, Castellanos J, Hubschman JP, Johiro AK, Kukuyev A, Levinson RD, McCannel CA, Ransome SS, Gonzales CR, Gupta A, Kalyani PS, Kapamajian MA, Kappel PJ, Arcinue C, Chuang J, Barteselli G, Currie G, Mendoza V, Powell D, Clark T, Cochran DE, Freeman WR, Hedaya J, Kemper T, Kozak I, LeMoine JM, Loughran ME, Magana L, Mojana F, Morrison V, Nguyen V, Oster SF, Acharya N, Clay D, Lee S, Lew M, Margolis TP, Stewart J, Wong IG, Brown D, Khouri CM, Goldstein DA, Birnbaum A, Degillio A, Rosa GDL, Ramirez C, Simjanowski E, Skelly M, Castro-Malek AL, Crooke CE, Huntley M, Nash K, Niec M, Pyatetsky D, Ramirez M, Rozenbajgier Z, Tessler HH, Davis JL, Albini TA, Chin M, Castaño D, Elizondo A, Ho M, Kovach JL, Lin RCS, Mandelcorn E, Nguyen JKD, Pacini A, Pineda S, Pinto DA, Rebimbas J, Stepien KE, Teran C, Elner SG, Bernard H, Fournier L, Godsey L, Goings L, Hackel R, Hesselgrave M, Jayasundera KT, Prusak R, Titus P, Bergeron M, Blosser R, Brown R, Chrisman-McClure C, Gothrup JR, Saxe SJ, Sizemore D, Kempen JH, Berger J, Drossner S, DuPont JC, Maguire AM, Petner J, Engelhard S, Hopkins T, McCall D, McRay M, Will D, Xu W, Lo J, Salvo R, Windsor E, Weeney L, Pavan PR, Albritton K, Leto J, Madow B, Mayor L, Pautler SE, Saxon W, Soto J, Goldstein B, Klukoff A, Lambright L, McDonald K, Ortiz M, Scymanky S, Szalay DD, Rao N, Davis T, Douglass J, Linton J, Padilla M, Ramos S, Aguirre A, Chong L, Cisneros L, Corona E, Eliott D, Fawzi A, Garcia J, Khurana R, Lim J, Mead R, Tsai JH, Vitale A, Bernstein PS, Carlstrom B, Gilman J, Hanseen S, Morris P, Ramirez D, Wegner K, Sheppard JD, Anthony B, Casper A, Felix-Kent L, Fernandez J, Johnson T, Scoper SV, Cole RD, Crawford N, Franklin L, Hamelin K, Martin J, Marx R, Schultz G, Webb J, Yeager P, Kim RY, Benz MS, Brown DM, Chen E, Fish RH, Kegley E, Shawver L, Wong TP, De La Garza R, Friday (Hay) S, Mutz K, Rao PK, Adcock E, Apte RS, Baladenski A, Curtis R, Gould S, Hebden A, Kambarian J, Meyer C, Pistorius S, Quinn M, Rathert G, Blinder KJ, Hartz A, Light P, Shah GK, VanGelder R, Jabs DA, Altaweel MM, Kempen JH, Kurinij N, Jabs DA, Almanzor RD, Altaweel MM, Brown D, Dunn JP, Holland GN, Kempen JH, Kim RY, Kurinij N, Prusakowski N, Thorne JE, Bolton SG, Brune LM, Clark T, Gilman J, Hubbard L, Martin DF, Nussenblatt RB, Wittes J, Barlow WE, Hochberg M, Lyon AT, Palestine AG, Simon LS, Altaweel MM, Kurinij N, Rosenbaum JT, Smith H, Kempen JH, Jaffe GJ, Davis J, Dunn JP, Martin DF, Thorne J, Vitale A, Thorne JE, Acharya NR, Kempen JH, Latkany PA, Vitale AT, Nussenblatt RB, VanGelder R, Almanzor RD, Boring JA, Gibbs D, Lee S, Prusakowski N, Thorne JE, Alexander J, Ng WP, Friedman DS, Adler A, Alexander J, Burke A, Katz J, Kempen JH, Prusakowski N, Reed S, Ansari H, Cohen N, Modak S, Ng WP, Sugar EA, Burke AE, Drye LT, Van Natta ML, Frick K, Katz J, Louis TA, Modak S, Shade D, Jabs DA, Pascual K, Slutsky-Sanon JS, Glomp C, Nieves MA, Stevens M, Allen A, Hilal Y, Holbrook JT, Abreu F, Burke A, Casper AS, Drye LT, Ewing C, Friedman DS, Hart A, Lears A, Li S, Meinert J, Morrison V, Nowakowski D, Prusakowski N, Reyes G, Shade DM, Smith J, Steuernagle K, Van Natta M, Venugopal V, Yu T, Adler A, Alexander J, Boring J, Chen P, Cohen N, Collins K, Dodge J, Frick KD, Jackson R, Jimenez C, Katz J, Landers A, Livingston H, Louis TA, Meinert CL, Modak S, Ng WP, Rayapudi S, Shen W, Shiflett C, Smith R, Tieman A, Tonascia JA, Zheng R, Altaweel MM, Allan J, Benz WK, Domalpally A, Johnson KA, Myers DJ, Pak JW, Reed S, Reimers JL, Christianson DJ, Chambers G, Fleischli MA, Freund J, Glander KE, Goulding A, Gama V, Gangaputra S, Hafford D, Harris SE, Hubbard LD, Joyce JM, Kruse CN, Nagle L, Remm A, Padden-Lechten GE, Pohlman A, Shaw RA, Sivesind P, Thayer D, Treichel E, Warren KJ, Watson SM, Webster MK, White JK, Wilhelmson T, Zhang G. Dissociations of the Fluocinolone Acetonide Implant: The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. Am J Ophthalmol 2016; 164:29-36. [PMID: 26748056 DOI: 10.1016/j.ajo.2015.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial. DESIGN Randomized clinical trial with extended follow-up. METHODS Review of data collected on the first implant in the eye(s) of participants. Dissociation was defined as the drug pellet no longer being affixed to the strut and categorized as spontaneous or surgically related. RESULTS A total of 250 eyes (146 patients) had at least 1 implant placed. Median follow-up time after implant placement was 6 years (range 0.5-9.2 years). Thirty-four dissociations were reported in 30 participants. There were 22 spontaneous events in 22 participants; 6-year cumulative risk of a spontaneous dissociation was 4.8% (95% confidence interval [CI]: 2.4%-9.1%). The earliest event occurred 4.8 years after placement. Nine of 22 eyes with data had a decline in visual acuity ≥5 letters temporally related to the dissociation. Thirty-nine implant removal surgeries were performed, 33 with replacement. Twelve dissociations were noted during implant removal surgeries in 10 participants (26%, 95% CI 15%-48%); 5 of these eyes had a decline in visual acuity ≥5 letters after surgery. The time from implant placement to removal surgery was longer for the surgeries at which dissociated implants were identified than for those without one (5.7 vs 3.7 years, P < .001). Overall, visual acuity declined 15 or more letters from pre-implant values in 22% of affected eyes; declines were frequently associated with complications of uveitis or its treatment. CONCLUSION There is an increasing risk of dissociation of Retisert implants during follow-up; the risk is greater with removal/exchange surgeries, but the risk of both spontaneous and surgically related events increases with longevity of the implants. In 22% of affected eyes visual acuity declined by 15 letters. In the context of eyes with moderate to severe uveitis for years, this rate is not unexpected.
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Foster CS, Kothari S, Anesi SD, Vitale AT, Chu D, Metzinger JL, Cerón O. The Ocular Immunology and Uveitis Foundation preferred practice patterns of uveitis management. Surv Ophthalmol 2016; 61:1-17. [DOI: 10.1016/j.survophthal.2015.07.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/25/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
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Abstract
Birdshot retinochoroidopathy (BSRC) is an uncommon, but well-characterized chronic, bilateral posterior uveitis, which is uniquely associated with the human leukocyte antigen-A29 phenotype. The disease presents predominantly in middle-aged Caucasian females who complain of blurred vision, floaters, photopsias, paracentral scotomas and nyctalopia. While autoimmune mechanisms are thought to play an important role in the pathogenesis of BSRC, its etiology remains unknown. Important questions remain in our understanding of BSRC with respect to its pathogenesis, epidemiology, optimal treatment, and prognosis, including the determinants of remission and relapse, as well as the best strategy for monitoring disease activity, progression and response to therapy with electroretinographic and psychophysical testing, established and emerging imaging modalities, and peripheral cytokines profiles.
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Affiliation(s)
- Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Salt Lake City, UT, USA
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Vitale AT, Graham E, de Boer JH. Juvenile Idiopathic Arthritis-Associated Uveitis: Clinical Features and Complications, Risk Factors for Severe Course, and Visual Outcome. Ocul Immunol Inflamm 2013; 21:478-85. [DOI: 10.3109/09273948.2013.815785] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
AIM To describe the ophthalmologic findings in two patients with Muckle-Wells Syndrome, a phenotype of the Cryopyrin Associated Periodic Syndromes (CAPS) spectrum. There is currently sparse ophthalmic literature regarding the ocular manifestations of CAPS. We hope to increase awareness of this spectrum of diseases and the importance of proper treatment amongst eye care professionals. METHODS Interventional Case Series. RESULTS Patient 1 experienced resolution of aseptic meningitis, papilledema, and anterior uveitis following treatment with anikinra. Patient 2 experienced resolution of panuveitis following treatment with anikinra. CONCLUSIONS The severe ocular manifestations of the most severe CAPS phenotype, Chronic Infantile Neurological Cutaneous and Articular Syndrome/Neonatal Onset Multisystem Inflammatory Disease Syndrome (CINCA/NOMID) have been previously described. There is increasing evidence that patients may experience similar ocular disease with the milder phenotype of Muckle-Wells Sydnrome. There is also increasing evidence that appropriate therapy can have a profound effect on patient prognosis.
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Morshedi RG, Bettis DI, Moshirfar M, Vitale AT. Bilateral acute iris transillumination following systemic moxifloxacin for respiratory illness: report of two cases and review of the literature. Ocul Immunol Inflamm 2012; 20:266-72. [PMID: 22694259 DOI: 10.3109/09273948.2012.670359] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe two cases of bilateral acute iris transillumination following systemic administration of moxifloxacin and review the literature. METHODS Review of clinical records, and review of the literature using the PubMed database. RESULTS A 75 year-old man and 33 year-old woman presented with bilateral conjunctival injection, photophobia, and atonic, distorted pupils. The symptoms began acutely following a respiratory illness, for which both were treated with moxifloxacin. Both patients demonstrated profound iris transillumination, sectoral posterior bowing of the iris, corneal endothelial pigment dusting, and trabecular meshwork hyperpigmentation. One patient had a cotton-wool spot. A literature review identified 59 previous reports in 5 publications, including 17 patients with no antecedent fluoroquinolone use. CONCLUSIONS Increased awareness of this recently described clinical entity should lead to a decrease in unnecessary diagnostic evaluations. It is currently unclear whether this disease represents an adverse effect of fluoroquinolone use or a sequela of a systemic illness.
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Affiliation(s)
- R Grant Morshedi
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Tantravahi SK, Williams LB, Digre KB, Creel DJ, Smock KJ, DeAngelis MM, Clayton FC, Vitale AT, Rodgers GM. An inherited disorder with splenomegaly, cytopenias, and vision loss. Am J Med Genet A 2012; 158A:475-81. [PMID: 22307799 DOI: 10.1002/ajmg.a.34437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 11/21/2011] [Indexed: 12/13/2022]
Abstract
We describe a novel inherited disorder consisting of idiopathic massive splenomegaly, cytopenias, anhidrosis, chronic optic nerve edema, and vision loss. This disorder involves three affected patients in a single non-consanguineous Caucasian family, a mother and two daughters, who are half-sisters. All three patients have had splenectomies; histopathology revealed congestion of the red pulp, but otherwise no abnormalities. Electron microscopic studies of splenic tissue showed no evidence for a storage disorder or other ultrastructural abnormality. Two of the three patients had bone marrow examinations that were non-diagnostic. All three patients developed progressive vision loss such that the two oldest patients are now blind, possibly due to a cone-rod dystrophy. Characteristics of vision loss in this family include early chronic optic nerve edema, and progressive vision loss, particularly central and color vision. Despite numerous medical and ophthalmic evaluations, no diagnosis has been discovered.
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Affiliation(s)
- Srinivas K Tantravahi
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA
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Moshirfar M, Siddharthan KS, Meyer JJ, Espandar L, Wolsey DH, Vitale AT. Risk for uveitis after laser in situ keratomileusis in patients positive for human leukocyte antigen-B27. J Cataract Refract Surg 2008; 34:1110-3. [DOI: 10.1016/j.jcrs.2008.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 03/11/2008] [Indexed: 01/18/2023]
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Moshirfar M, Feiz V, Vitale AT, Wegelin JA, Basavanthappa S, Wolsey DH. Endophthalmitis after Uncomplicated Cataract Surgery with the Use of Fourth-Generation Fluoroquinolones. Ophthalmology 2007; 114:686-91. [PMID: 17184840 DOI: 10.1016/j.ophtha.2006.08.038] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [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: 12/08/2005] [Revised: 08/26/2006] [Accepted: 08/30/2006] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with 1 of 2 different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis. DESIGN Retrospective, multicenter, observational case series. PARTICIPANTS Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States. METHODS Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed. MAIN OUTCOME MEASURES Number and rate of endophthalmitis cases after uncomplicated cataract surgery. RESULTS During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3804 patients (19%) were treated with topical moxifloxacin as antiinfective prophylaxis. A total of 14 patients experienced endophthalmitis. The overall rate of endophthalmitis was 0.07%. There were 9 endophthalmitis patients in the gatifloxacin group and 5 endophthalmitis patients in the moxifloxacin group. The rate of endophthalmitis in the gatifloxacin group was 0.06% and the rate in the moxifloxacin group was 0.1%. The difference in the rate of endophthalmitis between the 2 groups was not statistically significant. In 10 of the patients, vitreous culture results were positive. Coagulase-negative staphylococci, followed by streptococci, species were the most commonly isolated organisms in the culture-positive patients. CONCLUSIONS The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as antiinfective prophylaxis was 0.07%. This rate was within the range of previously reported rates of endophthalmitis in the literature. The difference in the observed rate of postoperative endophthalmitis in patients treated with moxifloxacin versus gatifloxacin was not statistically significant.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Aaberg TM, Abdel-Rahman MH, Abrams GW, Agarwal A, Ai E, Albert DM, Alexander J, Anand R, Anastassiou G, Aylward GW, Barazi MK, Bingaman D, Bird AC, Blodi BA, Blumenkranz MS, Bolling JP, Bornfeld N, Bressler SB, Bressler NM, Brinton DA, Brown J, Brown GC, Brown JC, Buettner H, de Bustros S, Byrne SF, Cahill MT, Campochiaro PA, Carr RE, Chang S, Charles S, Chen J, Chen CA, Chew EY, Chorich LJ, Chow DR, Ciardella AP, Ciulla TA, Coscas GJ, Cruess AF, da Cruz L, Damato BE, Davidorf FH, Davis MD, Davis JL, Deutman AF, Dhaliwal RS, Do DV, Dugel PU, Earle JD, Edwards AO, Eliott D, Emerson GG, Fekrat S, Feldon SE, Ferris FL, Fine SL, Finkelstein D, Fisher SK, Flannery J, Folk JC, Foulds WS, Frank RN, Freeman WR, Friedlander M, Frishman LJ, Fu AD, Fujii GY, Gallemore RP, Garibaldi DC, Garcia-Valenzuela E, Gass JDM, Gautier S, Geller S, Goldberg MF, Gonzales CR, Gottlieb JL, Gragoudas ES, Green RL, Green WR, Gregor ZJ, Gregory-Evans K, Gross NE, Gullapalli VK, Guyer DR, Guymer R, Haller JA, Harbour JW, Harlan JB, Harris A, Hartnett ME, Hartzer MK, Hawkins BS, Heimann H, Hinton DR, Hinz BJ, Hoffmann S, Holekamp NM, Holland GN, Hoyng CB, Humayun MS, Ikuno Y, Jabs DA, Jaffe GJ, Jallet V, Jampol LM, Joffe L, Johnson RN, Joseph DP, de Juan E, Michael Jumper J, Kaplan HJ, Kelley JS, Khodair MA, Kirchhof B, Klais CM, Klein BE, Klein R, Kline RW, Knox DL, Kosobucki BR, Kreiger AE, Kunimoto DY, Kwun RC, Lakhanpal RR, Lam LA, Landers MB, Lane AM, Lee MS, Lee HC, Lewis H, Lewis GP, Lim WK, Lit ES, Loewenstein A, Lopez JM, Lutty GA, Madreperla S, Maguire AM, Mainster MA, Mansfield NC, Marmor MF, Martin BJ, Massey SC, Mavrofrides EC, McCuen BW, Richard McDonald H, Meier P, Merbs SL, Meredith TA, Mieler WF, Miller RF, Miller JW, Milne P, Mittra RA, Moshfeghi DM, Moshfeghi AA, Moshiri A, Mruthyunjaya P, Murata T, Murphree AL, Murphy RP, Nanda SK, Nguyen QD, Nussenblatt RB, Ober MD, Ober RR, Ogden TE, Oh KT, Ohji M, Olsen KR, Palanker D, Palmer EA, Parel JM, Park CH, Pederson JE, Pelzek CD, Pepose JS, Phelps DL, Phillips S, Pokorny J, Puliafito CA, Rao NA, Kumar Rao P, Recchia FM, Reh TA, Robertson DM, Robertson JE, Rubin GS, Ryan SJ, Sadda SR, Sadun AA, Sahel JA, de la Maza MS, Samuel MA, Sanborn GE, Sarks JP, Sarks SH, Schachat AP, Sebag J, Seddon JM, Sharma S, Sheffield VC, Shields CL, Shields JA, Singh A, Sjaarda RN, Slakter JS, Smith VC, Smith RE, Solomon SD, Soubrane G, Spencer R, Sternberg P, Stewart JM, Stone EM, Sugino IK, Sunness JS, Tano Y, Tasman WS, Thomas MA, Thompson JT, Thorne JE, Thumann G, Toth CA, Trese MT, Tsai LM, Turner PL, Tweito TH, Updike PG, Van Gelder RN, van Lith-Verhoeven JJ, Vaudaux JD, Villain F, Vitale AT, Walker JD, Walsh AC, Wang H, Webster AR, Weiland JD, Weiter JJ, Weleber RG, Wharam MD, Jeffrey Whitehead A, Wiedemann P, Wilkinson C, Williams GA, Willson JK, Wilson DJ, Win PH, Yannuzzi LA, Yoon YH, Young TA, Zarbin MA, Zhang K. Contributors. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE To report the course of uveitis disease activity during pregnancy and the postpartum period in women with noninfectious uveitis. DESIGN Observational case series. METHODS The medical records of women with noninfectious uveitis and pregnancy during follow-up at a large eye hospital were retrospectively reviewed. Patients with pregnancy were included in the study if follow-up was adequate to document the presence or absence of flare-ups in uveitis activity during the pregnancy and/or postpartum period. RESULTS Seventy-six pregnancies among 50 women were included in the study. Thirty-three pregnancies were in women with Vogt-Koyanagi-Harada disease, 19 were in women with Behcet disease, and 24 were in women with idiopathic uveitis. A flare-up in uveitis activity occurred within the first 4 months of pregnancy in 49 of 76 cases (64%) and later in pregnancy in 17 cases (22%); no flare-up occurred during pregnancy in 21 cases (28%). An early pregnancy flare-up was typical of Vogt-Koyanagi-Harada disease and idiopathic uveitis. A flare-up within 6 months of delivery occurred in 38 of 59 cases (64%) that had adequate examination data available from the postpartum period. The postpartum flare-up was especially typical of Behcet disease. CONCLUSIONS Many women with noninfectious uveitis will experience a flare-up in disease activity within the first 4 months of pregnancy. Later pregnancy appears to be a time of relative disease inactivity. Many will experience a rebound in activity within 6 months of delivery.
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Affiliation(s)
- Peter K Rabiah
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Abstract
PURPOSE To describe the authors' approach to the management of patients with recalcitrant, chronic, endogenous uveitis using low-dose Cyclosporin A (CSA) alone or in combination with other immunosuppressive agents with attention to the anti-inflammatory efficacy, visual outcome, and side effects of therapy. METHODS The authors reviewed the records of 50 patients (92 eyes) with uveitis of various etiologies who had been treated with low-dose CSA (2.5-5.0 mg/kg daily) alone or in combination with prednisone and/or azathioprine (1.5-2.0 mg/kg daily). The median follow-up on low-dose CSA was 16 months (range, 6-64 months). RESULTS Inflammatory control was achieved in 68 (73.9%) eyes, while persistent inflammatory activity was observed in 14 (15.2%). Thirty-eight (41%) eyes improved two Snellen lines or more, 43 (47.0%) stabilized, and 11 (12.0%) lost two lines or more. The CSA was discontinued because of nephrotoxicity in three patients and in each of two with systemic hypertension and constitutional intolerance to the drug, respectively. Thirteen patients enjoy inflammatory remission with this regimen. CONCLUSION Low-dose CSA used alone or in combination with other immunosuppressive agents is effective in achieving inflammatory control with a favorable visual outcome and provides a useful steroid-sparing strategy in the management of chronic endogenous uveitis. The CSA-associated toxicity may be reduced by initiating therapy at very low initial doses, with incremental dosage escalation to the desired target range.
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Affiliation(s)
- A T Vitale
- Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard University Medical School, Boston, 02114, USA
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Vitale AT, Pedroza-Seres M, Arrunategui-Correa V, Lee SJ, DiMeo S, Foster CS, Colvin RB. Differential expression of alternatively spliced fibronectin in normal and wounded rat corneal stroma versus epithelium. Invest Ophthalmol Vis Sci 1994; 35:3664-72. [PMID: 8088955] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The polymerase chain reaction was used to examine fibronectin (FN) expression during corneal scrape wounding with specific attention to the presence, absence, or gross changes of alternatively spliced FN as differentially expressed in the corneal stroma versus the epithelium in normal and wounded tissue. METHODS Specific FN cDNA sequences were synthesized from rat cornea with total RNA and were amplified using various sets of synthetic oligonucleotide primers. RESULTS The authors observed the presence and sustained the expression of total FN, EIIIA, EIIIB, and V-region FN mRNA in normal and injured corneal stroma for up to 3 weeks after scrape wounding. In contrast, complementary overlying epithelial samples were virtually devoid of FN message. CONCLUSIONS These data suggest that functionally different, alternatively spliced FN isoforms may be involved both in the maintenance of the normal cornea and in wound healing, and that their synthesis occurs in situ principally by the stroma rather than by the epithelium.
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Affiliation(s)
- A T Vitale
- Rhoads Molecular Immunology Laboratory Massachusetts Eye & Ear Infirmary, Boston 02114
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Abstract
INTRODUCTION Birdshot retinochoroidopathy is an uncommon uveitic syndrome of presumed autoimmune etiology. Therapy with systemic and periocular steroids is of inconsistent efficacy, attendant with numerous potential long-term side effects. Steroid-sparing strategies with more specific agents such as cyclosporine (Cyclosporin A, CSA) have been suggested as the first line treatment for this disease. PATIENTS AND METHODS The records of 19 patients (35 eyes) with the clinical diagnosis of birdshot retinochoroidopathy were examined. Age at onset ranged from 33 to 69 years (mean, 46.1 years) in nine men and ten women. The median follow-up from disease onset was 36 months. Eight patients were treated with low-dose (2.5-5 mg/kg daily) CSA alone, six required the addition of azathioprine (1.5-2 mg/kg daily), and six received no systemic immunosuppressive therapy. RESULTS HLA-A29 was positive in 94% (16 of 17) of patients tested. Vitreous inflammation was controlled in 23 (88.5%) treated eyes, with fewer bouts of recurrent inflammation, and a corresponding improvement or stabilization of visual acuity in 20 (83.3%) eyes. In contrast, intraocular inflammation never was controlled fully in untreated eyes, and visual acuity decreased in six (54.5%) eyes by an average of 2.5 Snellen lines. Nephrotoxic side effects of low-dose CSA therapy were not observed, but hypertension developed in two patients. CONCLUSION Although the definitive strategy for the management of birdshot retinochoroidopathy is unknown, control of intraocular inflammation with a favorable visual outcome, together with a lack of demonstrable CSA-associated nephrotoxicity and secondary side effects in these patients with birdshot retinochoroidopathy indicate that vision preservation is possible with low-dose CSA alone or in combination with other steroid-sparing immunosuppressive agents as an alternative to the long-term use of corticosteroids.
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Affiliation(s)
- A T Vitale
- Immunology and Uveitis Service, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston 02114
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Abstract
We examined three patients with acquired immunodeficiency syndrome who had frosted branch angiitis associated with small patches of cytomegalovirus retinitis. Each patient had a low CD4-helper T-lymphocyte count and a T-lymphocyte helper-suppressor ratio of less than 0.1. Treatment with intravenous anticytomegalovirus antibiotics caused the vascular sheathing to resolve within two weeks in all three patients, but each patient continued to have a smoldering retinitis. Retinal biopsy in one of the patients demonstrated virions whose morphologic characteristics were consistent with cytomegalovirus on electron microscopy and the identity of which was confirmed by immunohistochemistry. Although frosted branch angiitis in otherwise healthy patients responds to corticosteroids, similar treatment with corticosteroids for frosted branch angiitis associated with cytomegalovirus retinitis in patients with AIDS does not seem to be indicated. Before corticosteroid treatment is started for a patient with the clinical signs and symptoms of frosted branch angiitis, careful medical examination of the patient is necessary.
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Affiliation(s)
- R F Spaide
- Department of Ophthalmology, St. Vincent's Hospital and Medical Center of New York, New York 10011
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