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Maccora I, Guly C, de Libero C, Caputo R, Ramanan AV, Simonini G. Childhood Chronic Idiopathic Uveitis in a Multicentre International Cohort. Ocul Immunol Inflamm 2024; 32:310-319. [PMID: 36802984 DOI: 10.1080/09273948.2023.2169715] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/31/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/23/2023]
Abstract
IMPORTANCE Idiopathic uveitis makes up around 50% of non-infectious uveitis but the clinical characteristics in children are poorly understood. OBJECTIVE To report the demographic, clinical characteristics, and outcomes of children with idiopathic non-infectious uveitis (iNIU) in a multicentric retrospective study. RESULTS There were 126 (61 female) children with iNIU. The median age at diagnosis was 9.3 years (3-16 years) . Uveitis was bilateral in 106 patients and anterior in 68.At onset,impaired visual acuity and blindness in the worse eye were reported, in 24.4% and 15.1% patients but at 3 years of follow-up, there was a significant improvement in visual acuity (mean 0.11 SD ±0.50 vs 0.42 SD ± 0.59 p < .001). CONCLUSIONS AND RELEVANCE There is a high rate of visual impairment at presentation in children with idiopathic uveitis. The majority of patients have a significant improvement in vision, but 1 in 6 had impaired vision or blindness in their worse eye at 3 years.
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Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA department, University of Florence, Florence, Italy
| | | | - Cinzia de Libero
- Pediatric Ophthalmology Unit, Meyer Children University Hospital, Florence, Italy
| | - Roberto Caputo
- Pediatric Ophthalmology Unit, Meyer Children University Hospital, Florence, Italy
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA department, University of Florence, Florence, Italy
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Caputo R, Di Grande L, de Libero C, Marziali E, Mori F, Masini M. Efficacy of a Cationic Emulsion of Cyclosporine in Moderate Vernal Keratoconjunctivitis. Cornea 2024; 43:228-232. [PMID: 37747690 DOI: 10.1097/ico.0000000000003368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/06/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The aim of this study was to demonstrate the efficacy of cyclosporine A 0.1% cationic emulsion (CsA CE) eye drops 4 times a day in pediatric patients affected by a moderate form of vernal keratoconjunctivitis (VKC). METHODS This was a prospective study of pediatric patients, aged 5-16 years, with an active moderate form of VKC who were poor responders to topical antihistamines treatment and were treated 4 times a day with CsA CE. The clinical signs were graded for analysis as follows: hyperemia, tarsal papillae, and limbal papillae. RESULTS Twenty-eight patients (22 males and 6 females) with a minimum follow-up period of 3 months were included in the analysis. Statistical analysis excluded tarsal papillae because of the very low baseline value. The clinical score of hyperemia and limbal papillae improved from the first evaluation and was maintained over the follow-up. No side effects were noted. CONCLUSION CsA CE has been proposed as a treatment for severe forms of VKC. This study has shown that administration 4 times a day is also effective in the treatment of moderate forms of VKC in children.
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Affiliation(s)
- Roberto Caputo
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy; and
| | - Laura Di Grande
- Pediatric Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Cinzia de Libero
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy; and
| | - Elisa Marziali
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy; and
| | - Francesca Mori
- Pediatric Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Marzio Masini
- Pediatric Allergy Unit, Meyer Children's Hospital, Florence, Italy
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Maccora I, Marrani E, Pagnini I, Mastrolia MV, de Libero C, Caputo R, Simonini G. Challenges and management of childhood non-infectious chronic uveitis. Expert Rev Clin Immunol 2023; 19:599-611. [PMID: 36996498 DOI: 10.1080/1744666x.2023.2198210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Childhood uveitis is a sight-threatening condition, because if not properly recognized and treated can lead to several ocular complications and blindness. It represents a real challenge not only from an etiologic/diagnostic point of view, but also for management and therapy. AREAS COVERED In this review we will discuss the main etiologies, the diagnostic approach, risk factors associated to childhood non-infectious uveitis (cNIU), and the difficulties in eye examination in childhood. Moreover, we will discuss the treatment of cNIU in term of therapeutic choice, timing of initiation and withdrawal. EXPERT OPINION Identification of specific diagnosis is mandatory to prevent severe complications, thus a thorough differential diagnosis is essential. Pediatric eye examination may be extremely challenging due to the scarce collaboration, but novel techniques and biomarkers will help in identify low grade of inflammation, eventually modify long-term outcomes. Once identified the appropriate diagnosis, recognition of children who may benefit of a systemic treatment is crucial. What, When and how long are the key questions to address in this field. Current evidence and future results of ongoing clinical trials will help in driving treatment. A proper ocular screening, not only in the context of systemic disease, should be discussed by experts.
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Affiliation(s)
- Ilaria Maccora
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA department, University of Florence, Florence, Italy
| | - Edoardo Marrani
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ilaria Pagnini
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | | | - Roberto Caputo
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy
| | - Gabriele Simonini
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA department, University of Florence, Florence, Italy
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Marziali E, Pasqualetti R, Bacci G, de Libero C, Caputo R. Acute Rejection Following COVID-19 Vaccination in Penetrating Keratoplasty in a Young Male - A Case Report and Review of Literature. Ocul Immunol Inflamm 2022:1-4. [PMID: 35914312 DOI: 10.1080/09273948.2022.2106248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To report a case of a boy with acute keratoplasty rejection manifesting 12 days after receiving BNT162b2 messenger RNA (mRNA) vaccine for COVID-19. STUDY DESIGN A case report. RESULTS A 15-year-old boy with a history of penetrating keratoplasty due to acanthamoeba keratitis developed corneal decompensation 12 days after BNT162b2 messenger RNA vaccine for COVID-19 disease. One-week treatment with topical Dexamethasone 2% eye drops resulted in a complete resolution of corneal edema. CONCLUSIONS This case suggests that BNT162b2 messenger RNA (mRNA) vaccine can be associated with acute keratoplasty rejection in children, which responds completely to topical steroids. Ophthalmologists should be aware of this risk of cornea decompensation after COVID-19 vaccine in children who received a cornea transplant.
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Affiliation(s)
- Elisa Marziali
- Pediatric Ophthalmology Unit A, Meyer Children's Hospital, Florence, Italy
| | | | - Giacomo Bacci
- Pediatric Ophthalmology Unit A, Meyer Children's Hospital, Florence, Italy
| | - Cinzia de Libero
- Pediatric Ophthalmology Unit A, Meyer Children's Hospital, Florence, Italy
| | - Roberto Caputo
- Pediatric Ophthalmology Unit A, Meyer Children's Hospital, Florence, Italy
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Maccora I, Abu Rumeileh S, Curci F, de Libero C, Marrani E, Mastrolia MV, Pagnini I, Simonini G. Tocilizumab and Abatacept for the Treatment of Childhood Chronic Uveitis: A Monocentric Comparison Experience. Front Pediatr 2022; 10:851453. [PMID: 35498797 PMCID: PMC9039300 DOI: 10.3389/fped.2022.851453] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Our study aimed to evaluate the efficacy of Tocilizumab and Abatacept for treating Childhood Chronic non-infectious Uveitis (CCU), resistant to anti-tumor necrosis factor (anti-TNF) treatment. METHODS This is a monocentric retrospective charts review study (January 2010-April 2021) recruiting CCU, refractory to anti-TNF. To be included, children should have active uveitis at the time of Tocilizumab (8 mg/kg, every 4 weeks) or Abatacept (10 mg/kg, every 4 weeks). The main outcome was the achievement of ocular remission on treatment defined as the absence of flares for ≥ 6 months. RESULTS In this study, 18 patients with CCU (14 F), previously treated with Methotrexate and Adalimumab, were enrolled: 15 had juvenile idiopathic arthritis (JIA) (83.3%), 2 idiopathic (11.1%), and 1 Behçet (5.6%). Furthermore, ten patients received Abatacept and 8 patients received Tocilizumab. The mean duration of treatment on Abatacept was 31.6 months (SD ± 30.8), on Tocilizumab 25.25 months (SD ± 17.8). In total, 13 children (72.2%) achieved remission, with a better remission rate for the Tocilizumab group (8/8) compared to the Abatacept group (5/10) (χ2 5.53, p = 0.019). No difference was evaluated between the two groups in the proportion of patients who showed flares during the treatment (2/6 Abatacept vs. 1/8 Tocilizumab). A significant difference was evaluated in the proportion of patients who flared after treatment discontinuation: 3/3 Abatacept vs. 0/3 Tocilizumab (χ2 3.8, p = 0.025). CONCLUSION Even though this is a monocentric retrospective study, in a relatively small group, our study suggests a superior efficacy of Tocilizumab over Abatacept for treating anti-TNF refractory CCU.
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Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy.,NeuroFARBA Department, University of Florence, Florence, Italy
| | - Sarah Abu Rumeileh
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Franco Curci
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Cinzia de Libero
- Ophthalmology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy.,NeuroFARBA Department, University of Florence, Florence, Italy
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Maccora I, Maniscalco V, Marrani E, de Libero C, Pagnini I, Mastrolia MV, Simonini G. Successful treatment of adalimumab in a child with Vogt-Koyanagi-Harada: which is the best available systemic treatment? Clin Exp Rheumatol 2021; 39:1453-1454. [DOI: 10.55563/clinexprheumatol/fz25go] [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: 01/31/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Meyer Children’s University Hospital, Florence, and Neurofarba Department, University of Florence, Italy.
| | - Valerio Maniscalco
- Rheumatology Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Cinzia de Libero
- Ophthalmology Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Maria Vincenza Mastrolia
- Rheumatology Unit, Meyer Children’s University Hospital, Florence, and Neurofarba Department, University of Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children’s University Hospital, Florence, and Neurofarba Department, University of Florence, Italy
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Abstract
RATIONALE Studies performed in animal models of corneal neovascularization suggested the possible efficacy of a treatment with propranolol. Corneal neovascularization is one of the most feared complications of Stevens-Johnson syndrome that frequently involves ocular surface. We report the first 2 patients with severe ocular neo-vascularization treated with different degrees of success, with propranolol eye drops. PATIENT CONCERNS Two patients with corneal neovascularization complicating the Stevens-Johnson syndrome, not responsive to steroids and cyclosporine, were treated with propranolol eye drops. DIAGNOSES Corneal neovascularization was detected by ophthalmoscopic evaluation. INTERVENTIONS Topical treatment with propranolol eye drops at different concentrations. OUTCOMES Both patients reported dramatic subjective benefits (reduction of photophobia and discomfort) without adverse effects, and in the patient with a less advanced disease, an objective reduction of neovascularization and an improved visual acuity was observed. LESSONS This experience suggests that propranolol might be an inexpensive, safe and effective treatment in counteracting the progression of corneal neovascularization.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department
| | - Cinzia de Libero
- Pediatric Ophthalmology Unit, “A. Meyer” University Children's Hospital, Florence
| | | | - Pina Fortunato
- Pediatric Ophthalmology Unit, “A. Meyer” University Children's Hospital, Florence
| | - Elena Piozzi
- Pediatric Ophthalmology Unit, Niguarda Ca’ Granda Metropolitan Hospital, Milan, Italy
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Caputo R, Pasti M, de Libero C, Mori F, Barni S, Danti G, Buonvicino D, Urru M, Chiarugi A, Pucci N. Increased Lacrimal Fluid Level of HMGB1 in Vernal Keratoconjunctivitis. Ocul Immunol Inflamm 2018; 27:808-812. [PMID: 29847189 DOI: 10.1080/09273948.2018.1467465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Purpose: The aim of the present prospective study was to evaluate the lacrimal fluid concentration of HMGB1 in young patients affected by Vernal Keratoconjunctivitis (VKC) compared to a control group of healthy subjects of same age. Methods: Tear fluids was collected in a group of VKC patients and compared to a control group of healthy subjects. HMGB1 concentration was measured using the HMGB1 ELISA II test both in VCK and control subjects. Results: The mean concentration of HMGB1 in tear fluids of 45 VKC patients was 0,977 ± 0,72 ng/ml whereas in the control group was 0,24 ± 0,25 ng/ml and the difference was statistically significant (p = 0,000106) Conclusion: The concentration of HMGB1 in VCK patients was found to be significantly increased, suggesting a possible role of this protein in the inflammatory mechanism of VKC.
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Affiliation(s)
- Roberto Caputo
- a Department of Pediatric Ophthalmology, AOU Meyer , Florence , Italy
| | - Mattia Pasti
- a Department of Pediatric Ophthalmology, AOU Meyer , Florence , Italy
| | | | - Francesca Mori
- b Department of Allergology, AOU Meyer , Florence , Italy
| | - Simona Barni
- b Department of Allergology, AOU Meyer , Florence , Italy
| | - Gioia Danti
- a Department of Pediatric Ophthalmology, AOU Meyer , Florence , Italy
| | - Daniela Buonvicino
- c Department of Health Sciences, Clinical Pharmacology Section, Università degli Studi di Firenze , Florence , Italy
| | - Matteo Urru
- c Department of Health Sciences, Clinical Pharmacology Section, Università degli Studi di Firenze , Florence , Italy
| | - Alberto Chiarugi
- c Department of Health Sciences, Clinical Pharmacology Section, Università degli Studi di Firenze , Florence , Italy
| | - Neri Pucci
- b Department of Allergology, AOU Meyer , Florence , Italy
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Caputo R, Versaci F, Pucci N, de Libero C, Danti G, De Masi S, Mencucci R, Novembre E, Jeng BH. Very Low Prevalence of Keratoconus in a Large Series of Vernal Keratoconjunctivitis Patients. Am J Ophthalmol 2016; 172:64-71. [PMID: 27640005 DOI: 10.1016/j.ajo.2016.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the prevalence of keratoconus (KC) and other corneal abnormalities by means of videokeratography and tomography in a large series of patients affected by vernal keratoconjunctivitis (VKC). DESIGN Cross-sectional study. METHODS Setting: Single-center children's hospital. STUDY POPULATION A total of 651 consecutive patients with VKC and a control group of 500 were prospectively recruited between May 1, 2012 and September 30, 2013, with a minimum follow-up of 12 months. OBSERVATION PROCEDURE All patients were evaluated by means of a Scheimpflug camera combined with a Placido corneal topographer. Keratoconus, suspected keratoconus, or its absence were determined in each patient. The corneal symmetry index of front (SIf) and back curvature (SIb), shape indices, and thicknesses were compared between the 2 groups. MAIN OUTCOME MEASURES Prevalence of keratoconus and corneal indices modifications. RESULTS Five out of 651 patients (0.77%) demonstrated topographic signs of KC. Two of them were bilateral. All patients were older than 7 years of age, and the mean age was 11.54 years. Four other patients (0.61%) were classified as KC suspects by the screening program. Of 304 patients older than 11 years (mean age 14.4 years), 4 (1.32%) were found to have KCN, and 4 (1.32%) were KC suspects. The corneal indices of patients in the VKC group were extremely similar to those in the control group. (P > .05). CONCLUSIONS The prevalence of KC in our patient population, compared with previous reports in the literature, is much lower. The similar corneal indices in both groups suggest the absence of permanent corneal deformation due to VKC.
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Affiliation(s)
- Roberto Caputo
- Pediatric Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | | | - Neri Pucci
- Pediatric Allergology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Cinzia de Libero
- Pediatric Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Gioia Danti
- Pediatric Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Salvatore De Masi
- Statistics and Epidemiology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Rita Mencucci
- Ophthalmology Unit, Careggi Hospital, Florence, Italy
| | - Elio Novembre
- Pediatric Allergology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
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Marrani E, Paganelli V, de Libero C, Cimaz R, Simonini G. Long-term efficacy of abatacept in pediatric patients with idiopathic uveitis: a case series. Graefes Arch Clin Exp Ophthalmol 2015; 253:1813-6. [DOI: 10.1007/s00417-015-3140-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/09/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022] Open
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Pucci N, Caputo R, di Grande L, de Libero C, Mori F, Barni S, di Simone L, Calvani A, Rusconi F, Novembre E. Tacrolimus vs. cyclosporine eyedrops in severe cyclosporine-resistant vernal keratoconjunctivitis: A randomized, comparative, double-blind, crossover study. Pediatr Allergy Immunol 2015; 26:256-261. [PMID: 25712437 DOI: 10.1111/pai.12360] [Citation(s) in RCA: 38] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a chronic sight-threatening ocular disease. Topical cyclosporine A (Cyc) has been widely administered as a steroid-sparing drug, although in about 7-10% of cases, it has been ineffective. The purpose of this study was to evaluate the efficacy of 0.1% topical tacrolimus (Tcr) in patients with severe VKC who failed to respond to 1% Cyc eyedrops. METHODS Consecutive patients with severe, Cyc-resistant VKC were enrolled in a double-blind, comparative, crossover (DBCO) trial; all patients were treated with 1% Cyc in one eye and 0.1% Tcr in the other eye for 3 wk. After a washout period of 7 days, patients were instructed to cross over the medications for three additional weeks. Objective ocular score, subjective score, and quality-of-life questionnaires (QoLQ) were collected during the trial. Blood samples were drawn to assess several safety parameters. RESULTS Thirty patients have been enrolled (mean age 9.05 ± 2.12 yr). In each of the two phases of the DBCO trial, a significant improvement in objective and subjective scores was observed in the eyes treated with 0.1% Tcr (p < 0.001). Likewise, the quality of life significantly improved despite only half the eyes being successfully treated. Serum creatinine and blood parameters were constantly within the normal range, and both blood Cyc and Tcr concentrations remained below the lowest detectable levels. CONCLUSIONS Topical Tcr is very effective and safe in the short term for patients suffering from severe VKC resistant to topical Cyc.
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Affiliation(s)
- Neri Pucci
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Roberto Caputo
- Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | | | - Cinzia de Libero
- Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Lorena di Simone
- Pharmaceutical Service, A. Meyer Children's Hospital, Florence, Italy
| | - Annamaria Calvani
- Pharmaceutical Service, A. Meyer Children's Hospital, Florence, Italy
| | - Franca Rusconi
- Epidemiology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Elio Novembre
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
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Simonini G, Bracaglia C, Cattalini M, Taddio A, Brambilla A, de Libero C, Marafon DP, Caputo R, Cimaz R. Predictors of relapse after discontinuing systemic treatment in autoimmune chronic uveitis. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184156 DOI: 10.1186/1546-0096-12-s1-o6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Stagi S, Pucci N, di Grande L, de Libero C, Caputo R, Pantano S, Seminara S, de Martino M, Novembre E. Increased prevalence of growth hormone deficiency in patients with vernal keratoconjuntivitis; an interesting new association. Hormones (Athens) 2014; 13:382-8. [PMID: 25079463 DOI: 10.14310/horm.2002.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Vernal keratoconjunctivitis (VKC) is a chronic conjunctivitis that mainly affects children living in temperate areas. The notable difference between genders and VKC's resolution with puberty have persistently suggested a role of hormonal factors in VKC development. OBJECTIVE To describe six cases of males with VKC and growth hormone deficiency (GHD) reported as a long-term follow-up during rhGH treatment. METHODS Six consecutive male patients (median age at GHD diagnosis 9.7, range 7.9 to 13.1 years) with VKC, were recruited from July 2005 to July 2013 at the Paediatric Endocrinology Unit of Anna Meyer Children's Hospital in Florence, Italy. In these patients, anthropometric data were collected periodically. In three of these patients, data were collected to near-adult or adult height. RESULTS Familial history was uneventful for all patients. The target height was normal, ranging from 0.65 standard deviation scores (SDS) to 2.01 SDS. The patients showed a normal birth-weight (from -1.21 to 1.35 SDS) and birth-length (from -0.93 to 1.21 SDS). At GHD diagnosis, all of the patients exhibited demonstrated important growth retardation (from -2.05 to -2.78 SDS). Plasmatic concentrations of IGF-1 and IGFBP-3 were low (from -1.85 to -3 SDS and from -1.81 to -2.76 SDS, respectively). GH stimulation tests showed classic GHD symptoms in all of the patients. Pubertal onset was normal. All of the patients treated with rhGH responded well to rhGH treatment. Adult height, evaluated in three patients, was in accordance with their target height. CONCLUSIONS To our current knowledge, we have described for the first time six patients affected by VKC with GH deficiency, in some of whom we performed a long-term follow-up to adult height. Further studies will be needed to establish whether GHD may be a common feature of VKC patients. Nevertheless, it appears to be useful to carefully follow statural growth of VKC patients, while the possibility of a GH deficiency must to be taken into account in the presence of growth failure.
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Affiliation(s)
- Stefano Stagi
- Department of Health's Sciences, University of Florence,Florence, Italy
| | - Neri Pucci
- Department of Health's Sciences, University of Florence,Florence, Italy
| | - Laura di Grande
- Department of Health's Sciences, University of Florence,Florence, Italy
| | - Cinzia de Libero
- Clinical Ophthalmology Unit; Anna Meyer Children's University Hospital; Florence, Italy
| | - Roberto Caputo
- Clinical Ophthalmology Unit; Anna Meyer Children's University Hospital; Florence, Italy
| | - Stefano Pantano
- Department of Health's Sciences, University of Florence,Florence, Italy
| | | | | | - Elio Novembre
- Department of Health's Sciences, University of Florence,Florence, Italy
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Stagi S, Pucci N, Di Grande L, de Libero C, Caputo R, Pantano S, Mattei I, Mori F, de Martino M, Novembre E. Increased incidence of thyroid dysfunction and autoimmunity in patients with vernal keratoconjunctivitis. Int J Endocrinol 2014; 2014:804870. [PMID: 25140177 PMCID: PMC4130298 DOI: 10.1155/2014/804870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/06/2014] [Indexed: 11/29/2022] Open
Abstract
Hormones may play a role in the pathophysiology of vernal keratoconjunctivitis (VKC). An increased incidence of thyroid autoantibodies was recently observed in VKC, although there were no data on thyroid function. Two hundred and eighty-eight patients (202 males, 86 females; range 5.5 to 16.9 years) with VKC were evaluated and compared with 188 normal age- and sex-matched subjects. In all subjects, serum concentrations of free T4, TSH, thyroperoxidase, thyroglobulin, and TSHr autoantibodies were evaluated. In VKC, the family history of thyroid diseases showed no significant differences compared to the controls (9.4 versus 8.6%), whereas the family history of autoimmune diseases was significantly higher (13.2% versus 6.3%; P<0.05). Subclinical hypothyroidism was diagnosed in 6.6% (versus 1.6% of the controls; P<0.05) and overt hypothyroidism in 0.7% (versus 0.0% of the controls; P = NS). Finally, 5.2% of patients were positive for thyroid autoantibodies, which were significantly higher with respect to the controls (0.5%, P<0.05). In the patients positive for thyroid autoantibodies, 80% showed a sonography pattern that suggested autoimmune thyroiditis. Thyroid function and autoimmunity abnormalities are frequently present in children with VKC. Children with VKC should be screened for thyroid function and evaluated for thyroid autoimmunity.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Neri Pucci
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- *Neri Pucci:
| | - Laura Di Grande
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Cinzia de Libero
- Clinical Ophthalmology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Roberto Caputo
- Clinical Ophthalmology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Stefano Pantano
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Ivan Mattei
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Francesca Mori
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Elio Novembre
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
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Simonini G, Taddio A, Cattalini M, Caputo R, de Libero C, Parentin F, Pagnini I, Lepore L, Cimaz R. Superior efficacy of Adalimumab in treating childhood refractory chronic uveitis when used as first biologic modifier drug: Adalimumab as starting anti-TNF-α therapy in childhood chronic uveitis. Pediatr Rheumatol Online J 2013; 11:16. [PMID: 23587261 PMCID: PMC3637103 DOI: 10.1186/1546-0096-11-16] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/22/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nonetheless biologic modifier therapies are available treatment strategies for sight-threatening uveitis in children, the lack of evidence from head-to-head randomized controlled studies limits our understanding of timing of therapy when to commence therapy, which agent to choose and how long to continue treatment, and, in case of failure, if switching to another anti-TNF-α strategy might be eventually an option. Our aim was to compare the efficacy of Adalimumab when used as first anti-TNFα therapy versus Adalimumab used after the failure of a previous anti-TNFα (Infliximab) in an open-label, comparative, multi-center, cohort study of childhood chronic uveitis. METHODS 26 patients (14 F, 12 M; median age: 8.6 years) with refractory, non-infectious active uveitis were enrolled. Due to the refractory course of uveitis to previous DMARD treatment, Group 1 received Adalimumab (24 mg/sq mt, every 2 weeks), as first anti-TNFα choice; Group 2 received Adalimumab, as second anti-TNFα drug, due to the loss of efficacy of Infliximab, administered after a period of at least 1 year. Both groups received Adalimumab for at least 1 year of treatment. Primary outcome was, once remission was achieved, the time to a first relapse. RESULTS 14 children (10 with JIA, 3 with idiopathic uveitis, 1 with Behçet's disease) were recruited in Group 1; 12 children (7 with JIA, 3 with idiopathic uveitis, 1 with early-onset sarcoidosis, 1 with Behçet's disease) in Group 2. Group 2 showed a lower probability to steroid discontinuation during the first 12 months of treatment (Mantel-Cox χ(2)4.12, p<0.04). In long-term follow-up, Group 1 had higher probability of uveitis remission during the time of treatment on Adalimumab (median ±SE: 18 ±1.1 vs 4 ±0.6 months, CI 95%: 15.6-27.5 vs 2.7-5.2, Mantel-Cox χ(2)10.12, p<0.002). CONCLUSIONS Even if limited to a relatively small group, our study suggests a better efficacy of Adalimumab when used as first anti-TNFα treatment in childhood chronic uveitis.
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Affiliation(s)
- Gabriele Simonini
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital, University of Florence, Viale Pieraccini, Firenze 24 50139, Italy
| | - Andrea Taddio
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” – Trieste, University of Trieste, Trieste, Italy
| | | | - Roberto Caputo
- Department of Pediatrics, Ophthalmology Unit, Anna Meyer Children’s Hospital, University of Florence, Firenze, Italy
| | - Cinzia de Libero
- Ophthalmology Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” – Trieste, University of Trieste, Trieste, Italy
| | - Fulvio Parentin
- Ophthalmology Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” – Trieste, University of Trieste, Trieste, Italy
| | - Ilaria Pagnini
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital, University of Florence, Viale Pieraccini, Firenze 24 50139, Italy
| | - Loredana Lepore
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” – Trieste, University of Trieste, Trieste, Italy
| | - Rolando Cimaz
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital, University of Florence, Viale Pieraccini, Firenze 24 50139, Italy
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16
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Taddio A, Cimaz R, Caputo R, de Libero C, Di Grande L, Simonini G, Mori F, Novembre E, Pucci N. Childhood chronic anterior uveitis associated with vernal keratoconjunctivitis (VKC): successful treatment with topical tacrolimus. Case series. Pediatr Rheumatol Online J 2011; 9:34. [PMID: 22047067 PMCID: PMC3221618 DOI: 10.1186/1546-0096-9-34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 11/02/2011] [Indexed: 11/19/2022] Open
Abstract
Uveitis treatment involves topical corticosteroids along with cycloplegic-mydriatics. Particularly severe cases may require systemic corticosteroids and immunosuppressive drugs. Vernal keratoconjunctivitis (VKC) treatment consists of a brief period of topical corticosteroids and/or cyclosporine. In patients refractory to traditional treatment, the use of 0.1% topical ophtalmic FK- 506 (tacrolimus) ointment has been occasionally reported.This is the first report of the coexistence of uveitis and VKC. The documented response to topical tacrolimus eyedrop of uveitis and VKC is also of interest, in particular since to our knowledge there are no published reports on its clinical use in uveitis.
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Affiliation(s)
- Andrea Taddio
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste and University of Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy.
| | - Rolando Cimaz
- Rheumatology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
| | - Roberto Caputo
- Clinical Ophthalmology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
| | - Cinzia de Libero
- Clinical Ophthalmology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
| | - Laura Di Grande
- Allergy and Clinical Immunology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
| | - Francesca Mori
- Allergy and Clinical Immunology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
| | - Elio Novembre
- Allergy and Clinical Immunology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
| | - Neri Pucci
- Allergy and Clinical Immunology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini, 24 Careggi, 50134. Florence, Italy
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