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Fink DJ, Dell J, Heinz C, Wintergerst MWM, Höller T, Berger M, Schmid M, Boden KT, Pleyer U, Reitsamer H, Deuter CME, Lohmann TK, Finger RP. Treatment exit options for non-infectious uveitis registry: participant characteristics at 3 years. Br J Ophthalmol 2024:bjo-2023-324927. [PMID: 38857972 DOI: 10.1136/bjo-2023-324927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/21/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE The Treatment exit Options For non-infectious Uveitis (TOFU) registry documents disease courses for non-anterior non-infectious uveitis entities with and without treatment to generate more evidence for clinical management recommendations including treatment exit strategies. In this article, we present the participants' baseline characteristics after the first 3 years. METHODS TOFU is an observational, prospective registry and recruits patients ≥18 years of age with non-anterior non-infectious uveitis with or without a history of previous disease-modifying antirheumatic drugs (DMARDs) treatment. The data are collected in the electronic data capture software REDCap and include ophthalmological and general medical history as well as clinical findings. RESULTS Between 24.10.2019 and 27.12.2022, 628 patients were enrolled at 25 clinical sites in Germany and Austria. Patients with intermediate uveitis were most frequently included (n=252; 40.1%) followed by posterior uveitis (181; 28.8%), panuveitis (n=154; 24.5%) and retinal vasculitis (n=41, 6.5%). At baseline, 39.6% were treated with systemic corticosteroids, 22.3% with conventional synthetic (cs) DMARDs, 20.5% with biological (b) DMARDs and 3.6% with other systemic treatments. Average best corrected visual acuity (BCVA) was 0.69 decimal. Patients with panuveitis had the worst BCVA with 0.63 decimal. Overall, only 8 patients (1.3%) suffered from severe visual impairment. CONCLUSIONS Less than half of participants required DMARD treatment at baseline, with csDMARDs used more frequently than bDMARDs. The presence of severe visual impairment was low, mostly affecting patients with panuveitis. These findings are in line with comparable monocentric cross-sectional studies of tertiary uveitis centres in Germany and will allow us to generate generalisable evidence in TOFU.
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Affiliation(s)
- David Julian Fink
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Jennifer Dell
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology at St. Franziskus-Hospital Muenster, Muenster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | | | - Tobias Höller
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Karl Thomas Boden
- Eye clinic, Knappschaftsklinikum Saar GmbH Krankenhaus, Sulzbach, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Herbert Reitsamer
- University Hospital Salzburg for Ophthalmology and Optometry, Salzburg, Austria
| | | | - Tibor K Lohmann
- Department of Ophthalmology, University Hospital RWTH Aachen, Aachen, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Abu Arif J, Knecht VA, Rübsam A, Lussac V, Jami Z, Pohlmann D, Müller B, Pleyer U. Fluocinolone Acetonide Implant for Uveitis: Dissecting Responder and Non-Responder Outcomes at a Tertiary Center. Biomedicines 2024; 12:1106. [PMID: 38791073 PMCID: PMC11117563 DOI: 10.3390/biomedicines12051106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Macular edema (ME) remains a primary cause of visual deterioration in uveitis. Visual acuity (VA) can often be maintained using corticosteroid depot systems. This study evaluated the efficacy of a fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN®) in treating non-infectious uveitis using real-world data. This retrospective analysis included 135 eyes subdivided into responders and non-responders. Central retinal thickness (CRT), VA, and intraocular pressure (IOP) were followed over time. A significant decrease in CRT and an increase in VA were observed in all eyes throughout the follow-up period (p < 0.01). An IOP increase (p = 0.028) necessitated treatment in 43% of eyes by Month 6. Non-responders were older (p = 0.004) and had been treated with more dexamethasone (DEX) implants (p = 0.04); 89.3% had a defect in the external limiting membrane (ELM) and inner/outer segment (IS/OS) zone (p < 0.001). Immunomodulatory therapy had no impact on treatment response. Pars plana vitrectomy (PPV) patients had a mean CRT reduction of 47.55 µm and a reduced effect by Month 24 (p = 0.046) versus non-PPV patients. We conclude that the FAc implant achieves long-term control of CRT and improves VA. Increases in IOP were manageable. Eyes with a previous PPV showed milder results. Data showed a correlation between older age, a damaged ELM and IS/OS zone, frequent DEX inserts, and poorer outcome measures.
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Affiliation(s)
- Jasmin Abu Arif
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Vitus André Knecht
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Anne Rübsam
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
| | - Vanessa Lussac
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Zohreh Jami
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Dominika Pohlmann
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
| | - Bert Müller
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Uwe Pleyer
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
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3
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Wu X, Tao M, Zhu L, Zhang T, Zhang M. Pathogenesis and current therapies for non-infectious uveitis. Clin Exp Med 2023; 23:1089-1106. [PMID: 36422739 PMCID: PMC10390404 DOI: 10.1007/s10238-022-00954-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
Non-infectious uveitis (NIU) is a disorder with various etiologies and is characterized by eye inflammation, mainly affecting people of working age. An accurate diagnosis of NIU is crucial for appropriate therapy. The aim of therapy is to improve vision, relieve ocular inflammation, prevent relapse, and avoid treatment side effects. At present, corticosteroids are the mainstay of topical or systemic therapy. However, repeated injections are required for the treatment of chronic NIU. Recently, new drug delivery systems that may ensure intraocular delivery of therapeutic drug levels have been highlighted. Furthermore, with the development of immunosuppressants and biologics, specific therapies can be selected based on the needs of each patient. Immunosuppressants used in the treatment of NIU include calcineurin inhibitors and antimetabolites. However, systemic immunosuppressive therapy itself is associated with adverse effects due to the inhibition of immune function. In patients with refractory NIU or those who cannot tolerate corticosteroids and immunosuppressors, biologics have emerged as alternative treatments. Thus, to improve the prognosis of patients with NIU, NIU should be managed with different drugs according to the response to treatment and possible side effects.
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Affiliation(s)
- Xue Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Mengying Tao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling Zhu
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ting Zhang
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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4
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Albahlal A, Khayyat W, Alsulaiman SM. Combined central retinal vein occlusion and cilioretinal artery occlusion as the initial presentation of frosted branch angiitis: a case report and literature review. J Ophthalmic Inflamm Infect 2023; 13:28. [PMID: 37227553 DOI: 10.1186/s12348-023-00340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/01/2023] [Indexed: 05/26/2023] Open
Abstract
PURPOSE To report a case of combined central retinal vein occlusion (CRVO) with cilioretinal artery occlusion (CLRAO) that heralded the development of frosted branch angiitis (FBA). CASE REPORT A 25-year-old healthy male presented with sudden painless visual loss in his left eye with a visual acuity (VA) of 20/300. Fundus exam and fluorescein angiography showed signs of combined CRVO and CLRAO. Without treatment, his vision gradually improved until it reached 20/30 within four months. Five months after initial presentation, he returned with severe visual loss (20/400) in the same eye and a clinical picture of severe occlusive periphlebitis resembling a frosted branch angiitis pattern associated with severe macular edema. This was promptly and successfully treated with systemic steroids and immunosuppressive medications. CONCLUSION CRVO in young population can have an unusual course and one should carefully rule out underlying uveitic etiologies in each visit. Clinical suspicion and close follow‑up are required for early detection and timely management of FBA.
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Affiliation(s)
- Abdullah Albahlal
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Khayyat
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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5
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Pohlmann D, Zur Bonsen L, Rübsam A, Pleyer U. [Noninfectious posterior uveitis : Clinical aspects, diagnostics, management and treatment]. DIE OPHTHALMOLOGIE 2023; 120:443-458. [PMID: 37022476 DOI: 10.1007/s00347-023-01833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 04/07/2023]
Abstract
Noninfectious posterior uveitis (NPU) comprises a heterogeneous group of vision-threatening, immune-mediated ocular and systemic diseases. It is predominantly bilateral and recurrent and, if not treated properly, leads to severe tissue damage that threatens the eyesight. In industrialized countries ca. 10-20% of all cases of blindness are caused by NPU. An NPU can occur at any age but is most common between the ages of 20 and 50 years. Laboratory diagnostic and imaging procedures enable an increasingly better differentiation of the disease spectrum. This makes it possible to better assess the course and prognosis of individual disease entities. An increasing repertoire of systemic and intravitreal forms of treatment has already led to more favorable long-term treatment outcomes. It can be expected that further progress can be achieved with better knowledge of the pathophysiology of the different clinical disorders and appropriate, targeted treatment.
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Affiliation(s)
- Dominika Pohlmann
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Lynn Zur Bonsen
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Anne Rübsam
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Uwe Pleyer
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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6
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Stübiger N, Farrokhi S, Gkanatsas Y, Deuter C, Kötter I. [Association of the different forms of uveitis with inflammatory rheumatic diseases and their treatment]. DIE OPHTHALMOLOGIE 2023; 120:223-236. [PMID: 36695880 DOI: 10.1007/s00347-023-01814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The etiology of uveitis greatly varies worldwide, whereby in industrial nations noninfectious causes occur relatively more frequently. In Germany, 44% of all cases of uveitis are due to systemic diseases. In rheumatology, uveitis or other kinds of ocular inflammation, such as scleritis or retinal vasculitis, most commonly occur in spondylarthritis, vasculitis and sarcoidosis. Vice versa, ophthalmologists often ask rheumatologists about an underlying rheumatic disease in patients with uveitis. It is of utmost importance to differentiate between the different forms of uveitis. This review article presents the associations with inflammatory rheumatic diseases as well as treatment options from the point of view of both ophthalmologists and rheumatologists.
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Affiliation(s)
- Nicole Stübiger
- Augenklinik, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Sanaz Farrokhi
- Augenklinik, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Yannik Gkanatsas
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander-Str. 26, 24576, Bad Bramstedt, Deutschland
| | - Christoph Deuter
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhrn-Str. 7, 72076, Tübingen, Deutschland
| | - Ina Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander-Str. 26, 24576, Bad Bramstedt, Deutschland.
- Sektion für Rheumatologie und Entzündliche Systemerkankungen, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland.
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7
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Stübiger N, Farrokhi S, Gkanatsas Y, Deuter C, Kötter I. [Association of the different forms of uveitis with inflammatory rheumatic diseases and their treatment]. Z Rheumatol 2022; 81:667-681. [PMID: 36040536 DOI: 10.1007/s00393-022-01244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
The etiology of uveitis greatly varies worldwide, whereby in industrial nations noninfectious causes occur relatively more frequently. In Germany, 44% of all cases of uveitis are due to systemic diseases. In rheumatology, uveitis or other kinds of ocular inflammation, such as scleritis or retinal vasculitis, most commonly occur in spondylarthritis, vasculitis and sarcoidosis. Vice versa, ophthalmologists often ask rheumatologists about an underlying rheumatic disease in patients with uveitis. It is of utmost importance to differentiate between the different forms of uveitis. This review article presents the associations with inflammatory rheumatic diseases as well as treatment options from the point of view of both ophthalmologists and rheumatologists.
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Affiliation(s)
- Nicole Stübiger
- Augenklinik, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Sanaz Farrokhi
- Augenklinik, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Yannik Gkanatsas
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander-Str. 26, 24576, Bad Bramstedt, Deutschland
| | - Christoph Deuter
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhrn-Str. 7, 72076, Tübingen, Deutschland
| | - Ina Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander-Str. 26, 24576, Bad Bramstedt, Deutschland.
- Sektion für Rheumatologie und Entzündliche Systemerkankungen, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland.
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8
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Patel S, Belamkar A, Hajrasouliha AR, Jusufbegovic D, Ciulla TA. Progress in the pharmacotherapy of uveitis: the art of personalized care. Expert Opin Pharmacother 2022; 23:1445-1455. [PMID: 35880543 DOI: 10.1080/14656566.2022.2104637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of inflammatory intraocular disorders which can lead to blindness, but prompt diagnosis and management can improve visual outcomes and reduce treatment burden. AREAS COVERED In this review, the authors provide an overview of commonly used treatments of the management of non-infectious uveitis. EXPERT OPINION Initially, the treatment of non-infectious uveitis was limited to corticosteroids which have a broad range of adverse ocular and systemic effects. Now new options, such as biological response modulators, are a novel yet exciting addition to this armory and have the potential to change the course of treatment as well as prognostic outcomes for uveitis patients. Additionally, further research is needed to evaluate the efficacy of this novel class of immunomodulators in uveitis therapy.
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Affiliation(s)
- Shivam Patel
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Aditya Belamkar
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Amir R Hajrasouliha
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Denis Jusufbegovic
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Thomas A Ciulla
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202.,Midwest Eye Institute, Springmill Medical Building, 10300 N. Illinois St., Suite 1000, Carmel, IN 46290, USA.,Clearside Biomedical, 900 North Point Pkwy # 200, Alpharetta, GA 30005
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9
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Feng KM, Chien WC, Chen YH, Sun CA, Chung CH, Chen JT, Chen CL. Increased Risk of Acute Coronary Syndrome in Ankylosing Spondylitis Patients With Uveitis: A Population-Based Cohort Study. Front Immunol 2022; 13:890543. [PMID: 35757729 PMCID: PMC9226308 DOI: 10.3389/fimmu.2022.890543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Uveitis, a sight-threatening ocular inflammatory state, is associated with autoimmune diseases and systemic inflammation. This prolonged systemic inflammation may cause plaque formation in coronary arteries, subsequently resulting in acute coronary syndrome (ACS). Methods This retrospective, population-based study (15-year period) used the Longitudinal Health Insurance Database based on the National Health Insurance Research Database in Taiwan. Chi-square and Student's t-tests were used to examine differences between the study and comparison cohorts for categorical and continuous variables, respectively. Fine and Gray's competing risk model was used to determine the hazard ratio of the risk of ACS. Furthermore, the cumulative risk of ACS was determined using Kaplan-Meier analysis. Results A total of 1,111 patients with AS and uveitis were enrolled in this study cohort, and 4,444 patients with AS without uveitis were enrolled in the comparison cohort. After adjustment for age, sex, and comorbidities, patients with AS and uveitis demonstrated an increased risk of ACS compared to those without uveitis (adjusted hazard ratio: 1.675, p<0.001). In addition, Kaplan-Meier analysis revealed that patients with AS and uveitis had a significantly higher risk of ACS than those without uveitis (p<0.001). Age, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, asthma, and systemic steroids were significant risk factors for ACS. Both anterior uveitis and posterior segment involvement were associated with an increased risk of ACS in patients with AS. All-cause mortality was higher in the uveitis group (9.81%) than in the non-uveitis group (8.10%) (p=0.015). Conclusion Our analysis revealed that uveitis could potentially be a predictor of ACS in patients with AS. However, further prospective controlled studies are required to assess the association between uveitis and ACS in patients with AS.
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Affiliation(s)
- Kathy Ming Feng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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10
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A Comprehensive Update on Retinal Vasculitis: Etiologies, Manifestations and Treatments. J Clin Med 2022; 11:jcm11092525. [PMID: 35566655 PMCID: PMC9101900 DOI: 10.3390/jcm11092525] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/18/2022] Open
Abstract
Retinal vasculitis is characterized by inflammatory involvement of retinal arterioles, venules and/or capillaries and can be associated with a myriad of systemic and ophthalmic diseases. In this review, we have comprehensively discussed the etiologies, clinical manifestations, and presentations of retinal vasculitis. We have also included newer advances in imaging in retinal vasculitis such as OCTA and widefield imaging.
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11
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Neri P, Aljneibi S, Pichi F. Rescue Treatment with Infliximab for a Bilateral, Severe, Sight Threatening Frosted Branch Angiitis Associated with Concomitant Acute Onset of Presumed Dermatomyositis. Ocul Immunol Inflamm 2022; 31:865-869. [PMID: 35394851 DOI: 10.1080/09273948.2022.2057333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report a severe bilateral frosted branch angiitis associated with acute onset of systemic dermatomyositis. METHOD History and clinical examination, laboratory evaluation, fundus' and skin's color pictures, fluorescein angiography (FA), optical coherence tomography (OCT). RESULTS A 32-year-old female was referred for a bilateral frosted branch angiitis and vitreitis, with skin rash, muscle pain, weakness, severe headache, compatible with dermatomyositis. After an initial improvement following an aggressive treatment by systemic steroids and mycophenolate mofetil, she was switched to intravenous infliximab (RemicadeTM, Janssen Biotech, Inc. USA) due to lack of efficacy. Nine months later, her visual acuity was improved up to 20/20 in OU, with both retinal vasculitis and vitreitis being solved. CONCLUSION Dermatomyositis is a severe multiorgan disease which might severely involve eye structures. Anti-TNF-Alpha agents, particularly Infliximab, might offer a rapid control and long-term remission.
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Affiliation(s)
- Piergiorgio Neri
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (USA), Cleveland, Ohio (USA).,College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | | | - Francesco Pichi
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (USA), Cleveland, Ohio (USA)
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12
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Papasavvas I, Tugal-Tutkun I, Herbort CP. Mechanisms, Pathophysiology and Current Immunomodulatory/Immunosuppressive Therapy of Non-Infectious and/or Immune-Mediated Choroiditis. Pharmaceuticals (Basel) 2022; 15:ph15040398. [PMID: 35455395 PMCID: PMC9031533 DOI: 10.3390/ph15040398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 12/19/2022] Open
Abstract
Non-infectious choroiditis comprises immune-mediated diseases resulting from diverse pathophysiological mechanisms. These conditions are sub-divided into two main groups, (1) diseases of the choriocapillaris and (2) diseases of the choroidal stroma. The purpose of this study is to expose the pathophysiology of the most common diseases of both these groups and recommend the optimal immunomodulatory/immunosuppressive therapy of each analyzed condition based on literature data and data from our own centers. Material and Methods: Narrative review. In the group of choriocapillaritis entities or primary inflammatory choriocapillaropathies (PICCPs) including multiple evanescent white dot syndrome (MEWDS), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), idiopathic multifocal choroiditis (MFC) and serpiginous choroiditis (SC), as well as secondary choriocapillaritides including acute syphilitic posterior multifocal placoid chorioretinitis (ASPMPC) and tuberculosis-related SC (TB-SC), were analyzed. In the group of stromal choroidites, HLA-A29 birdshot retinochoroiditis (BRC) and Vogt-Koyanagi-Harada (VKH) disease were included. For each entity a literature search, in the PubMed database, on treatment was performed and analyzed and the therapeutic attitudes of our own centers were presented. Management of immune-mediated choroiditis implies vigorous immunosuppressive therapy given in a prompt and prolonged fashion in most of these entities.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey;
| | - Carl P. Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
- Correspondence:
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Gupta S, Shyamsundar K, Agrawal M, Vichare N, Biswas J. Current Knowledge of Biologics in Treatment of Noninfectious Uveitis. J Ocul Pharmacol Ther 2022; 38:203-222. [DOI: 10.1089/jop.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Simple Gupta
- Department of Ophthalmology, Command Hospital, Pune, India
| | - K. Shyamsundar
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Mohini Agrawal
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Nitin Vichare
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Netralaya, Chennai, India
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Research Progress on the Mechanism of Natural Product Ingredients in the Treatment of Uveitis. J Immunol Res 2021; 2021:6683411. [PMID: 34778467 PMCID: PMC8585548 DOI: 10.1155/2021/6683411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background As the spectrum of ophthalmic diseases keeps changing, uveitis has gradually become one of the major blinding eye diseases in the world. In recent years, it has become a research hotspot to select effective components for uveitis treatment from natural drugs. Methods We searched PubMed and EMBASE databases for studies written in English as well as Chinese National Knowledge Infrastructure (CNKI), CQVIP, and Wan Fang database for studies written in Chinese (inception through 30 December 2020). Results Eight kinds of natural product ingredients were included in this article. They were found to not only regulate the expression of cytokines, proliferation, and differentiation of T help cells but also inhibit the damage of cytokines and inflammatory cells to uvea, blood aqueous barrier, and blood retinal barrier. Conclusion Natural product ingredients have their unique advantages in the treatment of uveitis. They have good anti-inflammatory effects without causing serious adverse reactions, which enables them to be promising choices for preventive and therapeutic strategy of uveitis.
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Girol AP, de Freitas Zanon C, Caruso ÍP, de Souza Costa S, Souza HR, Cornélio ML, Oliani SM. Annexin A1 Mimetic Peptide and Piperlongumine: Anti-Inflammatory Profiles in Endotoxin-Induced Uveitis. Cells 2021; 10:3170. [PMID: 34831393 PMCID: PMC8625584 DOI: 10.3390/cells10113170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Abstract
Uveitis is one of the main causes of blindness worldwide, and therapeutic alternatives are worthy of study. We investigated the effects of piperlongumine (PL) and/or annexin A1 (AnxA1) mimetic peptide Ac2-26 on endotoxin-induced uveitis (EIU). Rats were inoculated with lipopolysaccharide (LPS) and intraperitoneally treated with Ac2-26 (200 µg), PL (200 and 400 µg), or Ac2-26 + PL after 15 min. Then, 24 h after LPS inoculation, leukocytes in aqueous humor, mononuclear cells, AnxA1, formyl peptide receptor (fpr)1, fpr2, and cyclooxygenase (COX)-2 were evaluated in the ocular tissues, along with inflammatory mediators in the blood and macerated supernatant. Decreased leukocyte influx, levels of inflammatory mediators, and COX-2 expression confirmed the anti-inflammatory actions of the peptide and pointed to the protective effects of PL at higher dosage. However, when PL and Ac2-26 were administered in combination, the inflammatory potential was lost. AnxA1 expression was elevated among groups treated with PL or Ac2-26 + PL but reduced after treatment with Ac2-26. Fpr2 expression was increased only in untreated EIU and Ac2-26 groups. The interaction between Ac2-26 and PL negatively affected the anti-inflammatory action of Ac2-26 or PL. We emphasize that the anti-inflammatory effects of PL can be used as a therapeutic strategy to protect against uveitis.
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Affiliation(s)
- Ana Paula Girol
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
- Post Graduate Program in Structural and Functional Biology, Escola Paulista de Medicina (UNIFESP-EPM), Federal University of São Paulo, São Paulo 04023-062, SP, Brazil
| | - Caroline de Freitas Zanon
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Ícaro Putinhon Caruso
- Department of Phisics, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (Í.P.C.); (M.L.C.)
| | - Sara de Souza Costa
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Helena Ribeiro Souza
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Marinônio Lopes Cornélio
- Department of Phisics, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (Í.P.C.); (M.L.C.)
| | - Sonia Maria Oliani
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
- Post Graduate Program in Structural and Functional Biology, Escola Paulista de Medicina (UNIFESP-EPM), Federal University of São Paulo, São Paulo 04023-062, SP, Brazil
- Advanced Research Center in Medicine (CEPAM), União das Faculdades dos Grandes Lagos (Unilago), São José do Rio Preto 15030-070, SP, Brazil
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