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Enwereji N, Santiago S, Jiang C, Durrani K, Chaudhry S, Lu J. Ocular and eyelid involvement in collagen vascular diseases. Part I. Sjögren syndrome and systemic lupus erythematosus. Clin Dermatol 2024; 42:3-8. [PMID: 37858778 DOI: 10.1016/j.clindermatol.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Collagen vascular disease is a heterogeneous group of autoimmune diseases that affect multiple organ systems. Sjögren syndrome, dermatomyositis, scleroderma, systemic lupus erythematosus, and sarcoidosis are collagen vascular diseases that often present with characteristic cutaneous manifestations. Although less known, various ocular manifestations that affect both external and internal structures of the eye can be seen in these conditions. Multidisciplinary management between dermatologists and ophthalmologists is essential in the early diagnosis and management of collagen vascular diseases affecting both the skin and eye. Part I of our series will discuss the ocular manifestations, their diagnosis, and therapeutic options in Sjögren syndrome and systemic lupus erythematosus.
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Affiliation(s)
- Ndidi Enwereji
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Sueheidi Santiago
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Christina Jiang
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Khayyam Durrani
- Division of Ophthalmology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Sona Chaudhry
- Division of Ophthalmology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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Santiago S, Enwereji N, Jiang C, Durrani K, Chaudhry S, Lu J. Ocular and eyelid involvement in collagen vascular diseases. Part II. Dermatomyositis, scleroderma, and sarcoidosis. Clin Dermatol 2024; 42:9-16. [PMID: 37913844 DOI: 10.1016/j.clindermatol.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Collagen vascular disease is a heterogeneous group of autoimmune diseases that affect multiple organ systems. Sjögren syndrome, dermatomyositis, scleroderma, systemic lupus erythematosus, and sarcoidosis are collagen vascular diseases that often present with characteristic cutaneous manifestations. Although less known, various ocular manifestations that affect both external and internal structures of the eye can also be seen in these conditions. Multidisciplinary management between dermatologists and ophthalmologists is essential in the early diagnosis and management of collagen vascular diseases affecting both the skin and eye. In part II of our series, we discuss the ocular manifestations, diagnosis, and therapeutic options of dermatomyositis, scleroderma, and sarcoidosis.
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Affiliation(s)
- Sueheidi Santiago
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Ndidi Enwereji
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Christina Jiang
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Khayyam Durrani
- Division of Ophthalmology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Sona Chaudhry
- Division of Ophthalmology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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Garcia CM, Maleki A, Look-Why S, Manhapra A, Durrani K, Foster CS. NONPARANEOPLASTIC AUTOIMMUNE RETINOPATHY VERSUS PERICENTRAL RETINAL DEGENERATION PHENOTYPE: WHICH CAME FIRST? A CASE REPORT. Retin Cases Brief Rep 2023; 17:384-388. [PMID: 34618714 DOI: 10.1097/icb.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report a case of nonparaneoplastic autoimmune retinopathy with phenotypical features of pericentral retinal degeneration (PRD) who responded to IV immunoglobulin therapy. METHODS A case report. A 27-year-old man presented with recent subacute progressive nyctalopia and photopsia. RESULTS Dilated fundoscopy demonstrated confluent yellow-white patches along the main temporal vascular arcades with sparing of the central island in the posterior pole. Color vision, fundus autofluorescence, fluorescein angiography, static visual field, and electroretinographic studies were inconclusive for retinal degeneration. Subsequent genetic testing for known mutations was negative. Workup for paraneoplastic autoimmune retinopathy was negative. Antiretinal antibodies were positive. The patient was diagnosed with nonparaneoplastic autoimmune retinopathy and was treated with IV immunoglobulin, which resulted in objective and subjective improvement on electroretinography, visual field, and optical coherence tomography of the retina. CONCLUSION Nonparaneoplastic autoimmune retinopathy may present in a patient with the clinical phenotype of PRD. It is essential to rule out nonparaneoplastic autoimmune retinopathy in patients with subacute changes in the natural course of pericentral retinal degeneration because treatment with IV immunoglobulin may be helpful.
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Affiliation(s)
- Cristina M Garcia
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
- Quirino Memorial Medical Center, Quezon City, Philippines
| | - Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Khayyam Durrani
- University of Connecticut Health, Farmington, Connecticut; and
| | - Charles S Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Anwar M, Qureshi M, Shafi M, Durrani K. Challenges in surgical management of peri-hilar cholangiocarcinoma: a case series on 9-year experience. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.253] [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: 11/16/2022] Open
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Durrani K, Kempen JH, Foster CS. Authors Reply to Letter to the Editor- In Response to: Comment on Durrani et al.'s "Adalimumab for Ocular Inflammation". Ocul Immunol Inflamm 2017; 27:71. [PMID: 29043914 DOI: 10.1080/09273948.2017.1379545] [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] [Indexed: 10/18/2022]
Affiliation(s)
- Khayyam Durrani
- a Division of Ophthalmology , University of Connecticut Health , Farmington , Connecticut , USA
| | - John H Kempen
- b Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.,c Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA.,d Discovery Eye Center , MyungSung Christian Medical Center and MyungSung Medical School , Addis Ababa , Ethiopia
| | - C Stephen Foster
- c Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA.,e Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA.,f Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA
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Durrani K, Kempen JH, Ying GS, Kacmaz RO, Artornsombudh P, Rosenbaum JT, Suhler EB, Thorne JE, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Foster CS, Systemic Immunosuppressive Therapy For Eye Diseases Site Research Group. Adalimumab for Ocular Inflammation. Ocul Immunol Inflamm 2016; 25:405-412. [PMID: 27003323 DOI: 10.3109/09273948.2015.1134581] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 01/07/2023]
Abstract
PURPOSE To evaluate adalimumab as an immunomodulatory treatment for non-infectious ocular inflammatory diseases. METHODS Characteristics of patients treated with adalimumab were abstracted in a standardized chart review. Main outcomes measured were control of inflammation, corticosteroid-sparing effect, and visual acuity. RESULTS In total, 32 patients with ocular inflammation were treated with adalimumab. The most common ophthalmic diagnoses were anterior uveitis, occurring in 15 patients (47%), and scleritis, occurring in 9 patients (28%). At 6 months of therapy, among 15 eyes with active inflammation, 7 (47%) became completely inactive, and oral prednisone was reduced to ≤10 mg/day in 2 of 4 patients (50%). On average, visual acuity decreased by 0.13 lines during the first 6 months of treatment. Adalimumab was discontinued because of lack of effectiveness in four patients within 6 months. CONCLUSIONS Adalimumab was moderately effective in controlling inflammation in a group of highly pre-treated cases of ocular inflammatory disease.
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Affiliation(s)
- Khayyam Durrani
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
| | - John H Kempen
- c Center for Preventive Ophthalmology and Biostatistics.,d Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology , Perelman School of Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | | | - R Oktay Kacmaz
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA
| | - Pichaporn Artornsombudh
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,c Center for Preventive Ophthalmology and Biostatistics
| | - James T Rosenbaum
- e Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,f Department of Medicine , Oregon Health and Science University , Portland , Oregon , USA
| | - Eric B Suhler
- e Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,f Department of Medicine , Oregon Health and Science University , Portland , Oregon , USA.,g Portland Veteran's Affairs Medical Center , Portland , Oregon , USA
| | - Jennifer E Thorne
- h Department of Ophthalmology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,i Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Douglas A Jabs
- i Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA.,j Department of Ophthalmology , Icahn School of Medicine at Mount Sinai , New York , New York , USA.,k Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Grace A Levy-Clarke
- l Laboratory of Immunology, National Eye Institute , Bethesda , Maryland , USA
| | | | - C Stephen Foster
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
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Abstract
Although the phenomenon of fundus autofluorescence has been known for decades, it has only recently been recognized as a measure of retinal pigment epithelial function and health. Characteristic fundus autofluorescence patterns have been described in eyes affected by inflammation of the posterior segment, and these patterns have provided insights into the pathogenesis of posterior uveitis entities. In addition, preliminary data indicate that fundus autofluorescence characteristics may serve as markers of disease activity, allow prediction of visual prognosis, and may help determine the adequacy of therapy. We provide an overview of the current state of fundus autofluorescence imaging technology and review our current knowledge of fundus autoflourescence findings and their clinical use in the posterior uveitis entities.
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Affiliation(s)
- Khayyam Durrani
- Massachusetts Eye Research & Surgery Institution, Ocular Immunology & Uveitis Foundation, and Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Grant CL, Caromile LA, Durrani K, Rahman MM, Claffey KP, Fong GH, Shapiro LH. Prostate specific membrane antigen (PSMA) regulates angiogenesis independently of VEGF during ocular neovascularization. PLoS One 2012; 7:e41285. [PMID: 22815987 PMCID: PMC3399825 DOI: 10.1371/journal.pone.0041285] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 06/19/2012] [Indexed: 11/18/2022] Open
Abstract
Background Aberrant growth of blood vessels in the eye forms the basis of many incapacitating diseases and currently the majority of patients respond to anti-angiogenic therapies based on blocking the principal angiogenic growth factor, vascular endothelial growth factor (VEGF). While highly successful, new therapeutic targets are critical for the increasing number of individuals susceptible to retina-related pathologies in our increasingly aging population. Prostate specific membrane antigen (PSMA) is a cell surface peptidase that is absent on normal tissue vasculature but is highly expressed on the neovasculature of most solid tumors, where we have previously shown to regulate angiogenic endothelial cell invasion. Because pathologic angiogenic responses are often triggered by distinct signals, we sought to determine if PSMA also contributes to the pathologic angiogenesis provoked by hypoxia of the retina, which underlies many debilitating retinopathies. Methodology/Principal Findings Using a mouse model of oxygen-induced retinopathy, we found that while developmental angiogenesis is normal in PSMA null mice, hypoxic challenge resulted in decreased retinal vascular pathology when compared to wild type mice as assessed by avascular area and numbers of vascular tufts/glomeruli. The vessels formed in the PSMA null mice were more organized and highly perfused, suggesting a more ‘normal’ phenotype. Importantly, the decrease in angiogenesis was not due to an impaired hypoxic response as levels of pro-angiogenic factors are comparable; indicating that PSMA regulation of angiogenesis is independent of VEGF. Furthermore, both systemic and intravitreal administration of a PSMA inhibitor in wild type mice undergoing OIR mimicked the PSMA null phenotype resulting in improved retinal vasculature. Conclusions/Significance Our data indicate that PSMA plays a VEGF-independent role in retinal angiogenesis and that the lack of or inhibition of PSMA may represent a novel therapeutic strategy for treatment of angiogenesis-based ocular diseases.
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Affiliation(s)
- Christina L. Grant
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Leslie A. Caromile
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Khayyam Durrani
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - M. Mamunur Rahman
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Kevin P. Claffey
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Guo-Hua Fong
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Linda H. Shapiro
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
- * E-mail:
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Durrani K, Zakka FR, Ahmed M, Memon M, Siddique SS, Foster CS. Systemic Therapy With Conventional and Novel Immunomodulatory Agents for Ocular Inflammatory Disease. Surv Ophthalmol 2011; 56:474-510. [DOI: 10.1016/j.survophthal.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 05/18/2011] [Accepted: 05/24/2011] [Indexed: 12/19/2022]
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Abstract
Adamanitiades-Behcet's disease (ABD) is a relapsing systemic vasculitis that may involve the eyes, skin, and almost all other organ systems. Current research on the pathogenesis of ABD suggests a genetic basis for the disease, with certain MHC genes such as those coding for HLA-B51 being the most obvious candidates. Environmental factors such as infectious disease are thought to be responsible for triggering an immunological reaction and systemic features of the disease in genetically susceptible individuals. Identification of genes responsible for this susceptibility may lead to more definitive diagnostic tests and new approaches to the management of this potentially blinding condition.
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Affiliation(s)
- K Durrani
- Harvard Medical School, Boston, MA 02114, USA
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Ahmed R, Shakir AH, Moizuddin SS, Haleem A, Ali S, Durrani K, Khan A, Baig S. Predictors of in-hospital mortality for intracerebral hemorrhage: a hospital-based study in Pakistani adults. J Stroke Cerebrovasc Dis 2007; 10:122-7. [PMID: 17903812 DOI: 10.1053/jscd.2001.25462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2000] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Intracerebral hemorrhages (ICHs) comprise 5% to 30% of all strokes with a case fatality rate of 30% to 50%. With an increasing elderly population, nontraumatic ICH is likely to present as a recurring medical emergency in Pakistan. There is scarce documentation in Pakistan regarding the predictors for mortality in patients with ICH that can guide physicians in their management. We conducted a hospital-based study to determine the predictors of in-hospital mortality from ICH in patients admitted to a tertiary care facility. MATERIALS AND METHODS We reviewed case records of patients above 17 years admitted to The Aga Khan University Hospital, Karachi, Pakistan, between July 1995 and December 1997, with the primary diagnosis of ICH confirmed on computed tomography scanning. Clinical and risk factors were also evaluated. RESULTS The data of 221 patients was analyzed. Seventy-one (32%) patients died during hospital stay, half of whom died during the first 2 days of hospitalization. Patients who died during hospital stay were more likely on admission to have intraventricular extension of the primary hemorrhage (odds ratio = 10.6, P < .01), a Glasgow Coma Score less than 12 on admission (odds ratio = 4.8, P < .01), and a systolic blood pressure greater than or equal to 180 mm Hg (odds ratio = 2.7, P = .03). CONCLUSIONS Our study suggests that Glasgow Coma Score and intraventricular extension are predictors of acute mortality, consistent with published results. Elevated systolic blood pressure at admission, also found to be a predictor of acute mortality from ICH, may be explained alternatively by internal and external stroke-induced stress factors. The actual mechanisms for high admission systolic blood pressure remain unclear.
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Affiliation(s)
- R Ahmed
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
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Durrani K, Ahmed M, Foster CS. Adamantiades-Behcet disease: diagnosis and current concepts in management of ocular manifestations. Compr Ophthalmol Update 2007; 8:225-233. [PMID: 17999836] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Adamantiades-Behcet disease is a relapsing systemic vasculitis that may involve the eyes, skin, and almost all other organ systems. The comprehensive ophthalmologist plays a key role by not only making the diagnosis but also by monitoring inflammatory status to guide systemic therapy. If left untreated, the disease has a high likelihood of causing blindness and death. Adamantiades-Behcet disease with retinal involvement is now considered an absolute indication for systemic immunomodulatory therapy. The diagnostic signs, potential complications, and treatment modalities currently available for ocular Adamantiades-Behcet disease are reviewed.
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Affiliation(s)
- Khayyam Durrani
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Kim IK, Husain D, Michaud N, Connolly E, Lane AM, Durrani K, Hafezi-Moghadam A, Gragoudas ES, O'Neill CA, Beyer JC, Miller JW. Effect of intravitreal injection of ranibizumab in combination with verteporfin PDT on normal primate retina and choroid. Invest Ophthalmol Vis Sci 2006; 47:357-63. [PMID: 16384985 DOI: 10.1167/iovs.04-0087] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the effect of intravitreal injection of a monoclonal antibody fragment (ranibizumab, also known as rhuFab V2 and Lucentis; Genentech, S. San Francisco, CA) directed against vascular endothelial growth factor (VEGF) in combination with verteporfin photodynamic therapy (PDT) on normal primate retina and choroid. METHODS Eight cynomolgus monkeys were treated with intravitreal ranibizumab in one eye and placebo in the other, alternating with verteporfin PDT in both eyes on a weekly basis for 6 to 7 weeks. Treatment effects were evaluated by color fundus photography, fluorescein angiography, and light and electron microscopy. RESULTS Over the course of the study, increasing retinal pigment epithelial changes, with corresponding window defects, developed in both eyes of all animals on fluorescein angiography over the course of the study. No complications attributable to the intravitreal injection of ranibizumab were observed. Histologic analysis revealed a similar reduction in choriocapillaris density in the irradiated area of eyes treated with PDT alone compared with those that received combination treatment. CONCLUSIONS In this limited study of normal monkey eyes, no severe adverse effects from the combination of intravitreal ranibizumab and verteporfin PDT were demonstrated compared with PDT alone.
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Affiliation(s)
- Ivana K Kim
- Angiogenesis and Laser Laboratory, Retina Research Institute, Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
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Abstract
PURPOSE To describe the clinical characteristics of uveitis occurring in patients with psoriasis and to compare them with patients with idiopathic anterior uveitis and HLA-B27-associated anterior uveitis. DESIGN Case-control study. METHODS The charts of 36 patients with a diagnosis of uveitis and psoriasis visiting the Immunology and Uveitis Service at the Massachusetts Eye and Ear Infirmary between January 2000 and December 2001 were reviewed. Clinical characteristics, therapy, and outcomes of uveitis were compared with 30 randomly selected patients with either idiopathic anterior uveitis or with HLA-B27-associated anterior uveitis. RESULTS The mean age at presentation for uveitis was significantly higher in patients with psoriasis compared with nonpsoriatic groups (44.6 years in HLA-B27-psoriatic patients vs 35.9 years in HLA-B27- nonpsoriatic patients, P = .034; 52.7 years in HLA-B27+ psoriatic vs 35.7 years in HLA-B27+ nonpsoriatic patients, P = .001). Uveitis in patients with psoriasis also tended to be bilateral (62%) and prolonged (11.2 weeks). HLA-B27+ patients with psoriasis required supplemental therapy with oral nonsteroidal anti-inflammatory drugs (95% confidence interval [CI] 1.41 to 5.36, P = .003) for anterior uveitis more often than did the HLA-B27+ nonpsoriatic group. Patients with psoriasis and uveitis who were HLA-B27+ required oral NSAIDs (95% CI 1.51 to 9.79, P = .001) for anterior uveitis more often than did HLA-B27- psoriatic patients. CONCLUSION Uveitis in patients with psoriasis may have distinguishing clinical features. Further epidemiologic studies are required to determine the strength of association between psoriasis without arthritis but with uveitis.
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Affiliation(s)
- Khayyam Durrani
- Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA
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Abstract
PURPOSE To assess the efficacy and short-term safety of appropriately monitored pulse IV cyclophosphamide therapy in the treatment of patients with severe or treatment-resistant autoimmune ocular inflammatory disease. DESIGN Retrospective noncomparative interventional case series. PARTICIPANTS Thirty-eight patients with severe or recalcitrant ocular inflammation of diverse etiologies. METHODS Charts of patients seen on the Ocular Immunology & Uveitis Service at the Massachusetts Eye & Ear Infirmary were reviewed. Thirty-eight consecutive patients treated with pulse IV cyclophosphamide between January 1995 and March 2002 were analyzed. MAIN OUTCOME MEASURES The control of inflammation, steroid-sparing effect, visual acuity, and adverse reactions. RESULTS A positive response to treatment occurred in 68% of patients during the study period, with 55% achieving complete quiescence. A steroid-sparing effect was achieved in all patients previously on systemic steroid, allowing successful discontinuation of the drug in 41%. Visual acuity was maintained in 66% and improved in 21% of involved eyes. The most common side effects observed were fatigue (63%), nausea (32%), and headache (22%). None required a permanent discontinuation of therapy. CONCLUSIONS Pulse IV cyclophosphamide is an effective therapeutic modality in patients with severe or treatment-resistant ocular inflammatory disease.
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Affiliation(s)
- Khayyam Durrani
- Immunology & Uveitis Service, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts 02114, USA
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Jawaid A, Asad A, Motiei A, Munir A, Bhutto E, Choudry H, Idrees K, Durrani K, Rahman M, Ahuja M, Nawab Q, Ahmed R, Ali S, Aslam S, Abbasi S, Feerasta S, Alam S, Ahmed U, Jehan I. Clinical scoring system: a valuable tool for decision making in cases of acute appendicitis. J PAK MED ASSOC 1999; 49:254-9. [PMID: 10647233] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Decision making in cases of acute appendicitis poses a clinical challenge specially in developing countries where advanced radiological investigations do not appear cost effective and so clinical parameters remain the mainstay of diagnosis. The aim of our study was to devise a scoring system from our local database and test its accuracy in the preoperative diagnosis of acute appendicitis. METHODS Clinical data from 401 patients having undergone appendectomy were collected to identify predictive factors that distinguished those with appendicitis from those who had a negative appendectomy. Ten such factors were identified and using Bayesian probability a weight was assigned to each and the results summated to get an overall score. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was then retrospectively applied to a second population of 99 patients in order to compare suggested actions (derived from the scoring system) to those actually taken by surgeons. The sensitivity, specificity and accuracy for the level of decision was then calculated. RESULTS Of the 99 patients, the method suggested immediate surgery for 65 patients, 63 of whom had acute appendicitis (3.1% diagnostic error rate). Of the 33 patients in whom the score suggested active observation, 18 had appendicitis. The accuracy of our scoring system was 82%. The method had a sensitivity of 78%, specificity 89% and a positive predictive value of 97%. The negative appendectomy rate determined by our study was 7% and the perforation rate 13%. CONCLUSION Scoring system developed from a local database can work effectively in routine practice as an adjunct to surgical decision making in questionable cases of appendicitis.
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Affiliation(s)
- A Jawaid
- Department of Community Health Sciences, Aga Khan University, Karachi
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Sultana M, Durrani K. Study of a method of prolonged conservative management of acute burn wounds in a Pakistani hospital. J PAK MED ASSOC 1976; 26:142-5. [PMID: 824472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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