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Khan HM, Wirth MA, Dolman PJ, Yeung SN, Iovieno A. Long-term outcomes of fornix reconstruction and cicatricial entropion repair in ocular mucous membrane pemphigoid and drug-related secondary pemphigoid. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e200-e205. [PMID: 37028445 DOI: 10.1016/j.jcjo.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To investigate the long-term outcomes of fornix reconstruction and cicatricial entropion repair in patients with ocular mucous membrane pemphigoid (MMP) and secondary MMP. METHODS Retrospective chart review of patients with MMP undergoing either fornix reconstruction (with amniotic membrane or buccal mucosal graft) or Wies cicatricial entropion repair between January 1, 2000, and September 1, 2020. Patients had a positive mucosal biopsy and (or) clinical features of MMP or secondary MMP. The primary outcome was overall success of fornix reconstruction based on fornix depth maintenance at latest follow-up. Secondary outcomes included resolution of trichiasis, visual acuity, and improvement of subjective symptoms. RESULTS Eight patients (10 eyes) with a diagnosis of MMP (3 males and 5 females; median age, 71 years) and 4 patients (4 eyes) with a diagnosis of secondary MMP (2 females and 2 male; median age, 87 years) were enrolled. Mean follow-up was 22.7 months (range, 0.3-87.5 months) for MMP patients and 15.4 months (range, 3.0-43.9 months) for secondary MMP patients. For MMP eyes, 30.0% underwent fornix reconstruction, 60.0% underwent entropion repair, and 10.0% received both. Re-formation of symblepharon and loss of fornix depth occurred in all MMP eyes at an average of 6.4 ± 7.0 months postoperatively, and trichiasis recurred in all patients at the last follow-up visit. In secondary MMP patients, 75.0% of the eyes showed recurrence of symblepharon, and 66.7% re-formed trichiasis. Both MMP and secondary MMP patients had short-term symptom improvements. CONCLUSIONS Fornix reconstruction and cicatricial entropion repair in our cohort of MMP and secondary MMP patients resulted in short-term symptomatic improvement, but recurrence was seen, on average, at 6 months postoperatively.
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Affiliation(s)
- Haaris M Khan
- Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Magdalena A Wirth
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - Sonia N Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC..
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Ruiz-Lozano RE, Colorado-Zavala MF, Ramos-Dávila EM, Quiroga-Garza ME, Azar NS, Mousa HM, Hernández-Camarena JC, Stinnett SS, Daluvoy M, Kim T, Sainz-de-la-Maza M, Hall RP, Rodriguez-Garcia A, Perez VL. Ocular Mucous Membrane Pemphigoid: The Effect of Risk Factors at Presentation on Treatment Outcomes. Ophthalmology 2024:S0161-6420(24)00167-2. [PMID: 38452874 DOI: 10.1016/j.ophtha.2024.02.028] [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: 09/27/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Analyze the influence of risk factors at presentation in the long-term immunosuppressive therapy (IMT) outcomes of ocular mucous membrane pemphigoid (OMMP). DESIGN Retrospective multicenter study. PARTICIPANTS Patients with OMMP seen at the Duke Eye Center, Tecnologico de Monterrey, and Hospital Clinic of Barcelona from 1990 to 2022. METHODS Data at presentation on demographics, direct immunofluorescence, ocular findings, sites of extraocular manifestations (EOMs), and previous treatments in patients with a clinical or laboratory diagnosis of OMMP, were analyzed with multivariable analysis and Kaplan-Meier plots to identify factors associated with adverse outcomes. MAIN OUTCOME MEASURES (1) Inflammatory control (no conjunctival inflammation in both eyes at 3 months on IMT); (2) relapse (new-onset inflammation after absolute control in either eye); (3) progression (≥ 1 cicatrizing stage progression in either eye); and (4) vision loss (≥ 2 Snellen lines). RESULTS A total of 117 patients (234 eyes), 61% (71/117) of whom were women, with a mean age of 66.6 (SD: 12.4) years (range: 37-97 years) and median follow-up of 34 months (interquartile range: 16-66 months; range: 3-265 months), were enrolled. Inflammatory control was achieved in 57% of patients (67/117), with high-risk EOM (HR-EOM), including esophageal, nasopharyngeal, and/or genital involvement (adjusted odds ratio [aOR]: 12.51; 95% confidence interval [CI]: 2.61-59.99; P = 0.002) and corneal scarring (aOR: 3.06; 95% CI, 1.15-8.14; P = 0.025), as significant risk factors for persistent inflammation. Disease relapse, progression, and vision loss occurred in 20% of patients (23/117), 12% of patients (14/117), and 27% of patients (32/117), respectively. Baseline corneal scarring was a risk factor for relapse (adjusted hazard ratio: 4.14; 95% CI: 1.61-10.62; P = 0.003), progression (aOR: 11.46; 95% CI: 1.78-73.75; P = 0.010), and vision loss (aOR: 3.51; 95% CI: 1.35-9.10; P = 0.010). HR-EOM was associated with stage progression (aOR, 34.57; 95% CI, 6.57-181.89; P<0.001) and vision loss (aOR, 8.42; 95% CI, 2.50-28.42; P = 0.001). No significant differences were found between IMT regimes and relapse (P = 0.169). CONCLUSIONS Ocular mucous membrane pemphigoid presenting with HR-EOMs and corneal scarring has an increased risk of stage progression and vision loss. Corneal scarring and severe inflammation at baseline were associated with an increased risk of relapse. A disease progression staging system incorporating both the HR-EOMs and corneal involvement is required to predict the visual outcome of OMMP better. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Maria F Colorado-Zavala
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Eugenia M Ramos-Dávila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Manuel E Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Nadim S Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Hazem M Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Julio C Hernández-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Sandra S Stinnett
- Associate Professor of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Melissa Daluvoy
- Department of Ophthalmology, Cornea and External Disease Service at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Terry Kim
- Department of Ophthalmology, Cornea and External Disease Service at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Maite Sainz-de-la-Maza
- Department of Ophthalmology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Russell P Hall
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico.
| | - Victor L Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
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Ringer A, Smichowski AM, Gómez R, Virasoro B, Martínez L, Bertiller E, Siegrist C, Abdala B, Chulibert S, Grossi G, Rubín E, Kostianovsky A, Muñoz SA, Lutgen S, Gandino IJ. Ocular cicatricial pemphigoid: is there an association with autoimmune diseases? Int Ophthalmol 2024; 44:99. [PMID: 38376602 DOI: 10.1007/s10792-024-02939-8] [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] [Received: 03/03/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE To assess the prevalence of autoimmune diseases (ADs) associated with ocular cicatricial pemphigoid (OCP) and analyze clinical, laboratory, and treatment associations between these entities. METHODS A multicentre cross-sectional study of patients with an OCP diagnosis. The population was divided into two groups according to their association with other ADs or not. Clinical, laboratory and treatment variables were described and compared between groups. A multivariable logistic regression analysis was performed to identify variables that could suggest the association between OCP and ADs. RESULTS Eighty-eight patients were recruited, with a mean age at diagnosis of 64.3 years (SD 11.9). Biopsy was performed in 86.8% of the patients. There was a median delay of 2 years from the onset of symptoms to diagnosis. Extraocular involvement was evidenced in 11.5%. The group associated with ADs included 24 patients (27.3%). The most prevalent diagnosis was Sjögren´s syndrome. Hypergammaglobulinemia was associated with ADs and OCP, adjusted for age, sex, smoking, skin and mucosal involvement, and erythrocyte sedimentation rate (OR 8.7; 95%CI 1.6-46.8; p = 0.012). CONCLUSIONS Due to OCP's autoimmune nature, it could coexist with other ADs. This study observed that more than a quarter of the population presented with this association, and hypergammaglobulinemia could suggest it.
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Affiliation(s)
- Ariana Ringer
- Rheumatology Unit, National University of Rosario, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina.
- Rheumatology and Internal Medicine Unit, Consultorios Médicos y Laboratorio de Análisis Bioquímicos e Inmunológicos (CM/LABI), Rosario, Santa Fe, Argentina.
| | - Andrea María Smichowski
- Rheumatology Unit, Hospital Militar Central, 601 Cirujano Mayor Doctor Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ramiro Gómez
- Rheumatology Unit, Hospital Nacional Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
| | - Belén Virasoro
- Consultorio de Enfermedades Autoinmunes (CEA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Liliana Martínez
- Internal Medicine Unit, Hospital General de Agudos Juan Antonio Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Emmanuel Bertiller
- Internal Medicine Unit, Hospital General de Agudos Juan Antonio Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos Siegrist
- Rheumatology and Internal Medicine Unit, Consultorios Médicos y Laboratorio de Análisis Bioquímicos e Inmunológicos (CM/LABI), Rosario, Santa Fe, Argentina
| | - Brian Abdala
- Rheumatology Unit, National University of Rosario, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - Serenela Chulibert
- Rheumatology Unit, National University of Rosario, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - German Grossi
- Ophtalmology Unit, Hospital Provincial del Centenario, Rosario, Provincia de Santa Fe, Argentina
| | - Eduardo Rubín
- Ophtalmology Unit, Hospital Provincial del Centenario, Rosario, Provincia de Santa Fe, Argentina
| | - Alex Kostianovsky
- Consultorio de Enfermedades Autoinmunes (CEA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sebastián Andrés Muñoz
- Consultorio de Enfermedades Autoinmunes (CEA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sophia Lutgen
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ignacio Javier Gandino
- Internal Medicine Unit, Hospital General de Agudos Juan Antonio Fernández, Ciudad Autónoma de Buenos Aires, Argentina
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Jakubowska B, Pietrzyk E, Maciejewicz P, Kowalewski C, Wozniak K. Diagnostic and prognostic values of conjunctival and oral biopsies analyzed by direct immunofluorescence in patients with mucous membrane pemphigoid. Front Med (Lausanne) 2023; 10:1257288. [PMID: 38020098 PMCID: PMC10663220 DOI: 10.3389/fmed.2023.1257288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Mucous membrane pemphigoid (MMP) is diagnosed on the basis of a characteristic clinical picture (a predilection for mucosal involvement and scarring in the affected tissues) and a positive direct immunofluorescence (DIF) result. Methods In this study, we compare the diagnostic and prognostic values of conjunctival and oral biopsies analyzed by DIF in patients with MMP. Sixteen patients with MMP and mucosal involvement as a predominant symptom were classified into three groups based on the clinical picture. Oral and conjunctival DIF were performed on all patients. Results Our study showed that patients with simultaneous oral and conjunctival involvement had a positive oral DIF in 83% and a positive ocular DIF in 100% of the examined cases, respectively. Patients with isolated ocular MMP had a positive oral DIF in 50% and a positive ocular DIF in 66% of the examined cases, respectively. Patients with only oral involvement with MMP had a positive oral DIF in 100% and a positive ocular DIF in 50% of the examined cases, respectively. Discussion Oral biopsy should be performed first and is usually sufficient for the diagnosis, even in patients with exclusively ocular MMP, whereas in patients without clinical ocular involvement, ocular DIF is positive in half of the cases and may be a predictive factor for ocular lesions in the future.
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Affiliation(s)
- Beata Jakubowska
- Department of Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Ewelina Pietrzyk
- Department of Immunodermatology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland
| | - Piotr Maciejewicz
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Cezary Kowalewski
- Department of Immunodermatology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland
| | - Katarzyna Wozniak
- Department of Immunodermatology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland
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Singh C, Jain N, Sharma S, Basu S, Shanbhag SS. Vortex Keratopathy as a Presenting Feature of Ocular Mucous Membrane Pemphigoid. Cornea 2023; 42:1454-1457. [PMID: 37318153 DOI: 10.1097/ico.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of this study was to describe the presenting feature of vortex keratopathy in 3 patients with biopsy-proven ocular mucous membrane pemphigoid (OMMP). METHODS The first patient was a 52-year-old woman with chronic redness and foreign body sensation for 3 years who presented with unilateral vortex keratopathy. Seven months later, in the same eye, she developed conjunctival signs suggestive of OMMP. The second patient was a 33-year-old woman with similar chronic symptoms that were exacerbated by pterygium surgery. Clinical examination revealed vortex keratopathy in the right eye with subtle conjunctival signs suggestive of OMMP. The third patient was a 70-year-old woman with complaints of repeated episodes of redness and foreign body sensation for 18 months who presented with vortex keratopathy in the right eye and conjunctival signs suggestive of OMMP in the same eye. To confirm the clinical diagnosis, bilateral conjunctival biopsy was performed in all patients. RESULTS OMMP was diagnosed based on conjunctival signs and confirmed on direct immunofluorescence positivity, demonstrating antibodies characteristic and diagnostic of OMMP in the basement membrane zone. A unique feature that preceded or coexisted with the conjunctival signs was unilateral vortex keratopathy seen in all 3 patients, independent of the stage of the disease at which they presented. CONCLUSIONS Vortex keratopathy can be a presenting feature in patients with OMMP. A complete ocular surface examination, especially checking the medial canthus for keratin and the inferior fornix for foreshortening, is necessary. Conjunctival biopsy should be performed in all cases to confirm the clinical diagnosis wherever required.
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Affiliation(s)
- Charul Singh
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Neha Jain
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Supriya Sharma
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Cornea and Anterior Segment Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India; and
- Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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6
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Hong M, Tong L, Mehta JS, Ong HS. Impact of Exposomes on Ocular Surface Diseases. Int J Mol Sci 2023; 24:11273. [PMID: 37511032 PMCID: PMC10379833 DOI: 10.3390/ijms241411273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Ocular surface diseases (OSDs) are significant causes of ocular morbidity, and are often associated with chronic inflammation, redness, irritation, discomfort, and pain. In severe OSDs, loss of vision can result from ocular surface failure, characterised by limbal stem cell deficiencies, corneal vascularisation, corneal opacification, and surface keratinisation. External and internal exposomes are measures of environmental factors that individuals are exposed to, and have been increasingly studied for their impact on ocular surface diseases. External exposomes consist of external environmental factors such as dust, pollution, and stress; internal exposomes consist of the surface microbiome, gut microflora, and oxidative stress. Concerning internal exposomes, alterations in the commensal ocular surface microbiome of patients with OSDs are increasingly reported due to advancements in metagenomics using next-generation sequencing. Changes in the microbiome may be a consequence of the underlying disease processes or may have a role in the pathogenesis of OSDs. Understanding the changes in the ocular surface microbiome and the impact of various other exposomes may also help to establish the causative factors underlying ocular surface inflammation and scarring, the hallmarks of OSDs. This review provides a summary of the current evidence on exposomes in various OSDs.
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Affiliation(s)
- Merrelynn Hong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Louis Tong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore 168751, Singapore
- Ocular Surface Group, Singapore Eye Research Institute, Singapore 169856, Singapore
- Department of Ophthalmology and Visual Science, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Jodhbir S Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology and Visual Science, Duke-NUS Medical School, Singapore 169857, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore
| | - Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology and Visual Science, Duke-NUS Medical School, Singapore 169857, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore
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Soleimani M, Ebrahimi Z, Ebrahimi KS, Farhadian N, Shahlaei M, Cheraqpour K, Ghasemi H, Moradi S, Chang AY, Sharifi S, Baharnoori SM, Djalilian AR. Application of biomaterials and nanotechnology in corneal tissue engineering. J Int Med Res 2023; 51:3000605231190473. [PMID: 37523589 PMCID: PMC10392709 DOI: 10.1177/03000605231190473] [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: 08/02/2023] Open
Abstract
Corneal diseases are among the most common causes of blindness worldwide. Regardless of the etiology, corneal opacity- or globe integrity-threatening conditions may necessitate corneal replacement procedures. Several procedure types are currently available to address these issues, based on the complexity and extent of injury. Corneal allograft or keratoplasty is considered to be first-line treatment in many cases. However, a significant proportion of the world's population are reported to have no access to this option due to limitations in donor preparation. Thus, providing an appropriate, safe, and efficient synthetic implant (e.g., artificial cornea) may revolutionize this field. Nanotechnology, with its potential applications, has garnered a lot of recent attention in this area, however, there is seemingly a long way to go. This narrative review provides a brief overview of the therapeutic interventions for corneal pathologies, followed by a summary of current biomaterials used in corneal regeneration and a discussion of the nanotechnologies that can aid in the production of superior implants.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Zohreh Ebrahimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kosar Sadat Ebrahimi
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Negin Farhadian
- Substance Abuse Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Shahlaei
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghasemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajad Moradi
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arthur Y Chang
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sina Sharifi
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Seyed Mahbod Baharnoori
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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8
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Kurzeja M, Olszewska M, Grzybowski A, Rudnicka L. Ocular involvement in autoimmune bullous diseases. Clin Dermatol 2023; 41:481-490. [PMID: 37586570 DOI: 10.1016/j.clindermatol.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Autoimmune bullous diseases represent a heterogenous group of disorders caused by autoantibodies against adhesion molecules; the location of the target protein determines the level of cleft formation. The spectrum of ocular lesions in autoimmune bullous diseases can range from mild symptoms to severe involvement with sight impairment and even, in some cases, blindness. In pemphigus vulgaris, the prevalence of ocular involvement has been reported to be between 7% and 26%. The most common clinical sign of ocular pemphigus vulgaris is bilateral conjunctivitis with hyperemia. Ocular involvement also occurs in 41% to 70% of patients with paraneoplastic pemphigus. The main ocular manifestations are bilateral cicatrizing conjunctivitis with symblepharon formation, and shortening of the fornices. In mucous membrane pemphigoid, ocular involvement is seen in 61% to 70% of patients; the most frequent ocular finding is cicatricial conjunctivitis. Patients with autoimmune bullous diseases having common ocular involvement should be assessed by an ophthalmologist to avoid serious complications. Diagnostic procedures and treatment require multidisciplinary care based on the close cooperation between dermatologists and ophthalmologists.
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Affiliation(s)
- Marta Kurzeja
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
| | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznań, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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9
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Moshirfar M, Masud M, Harvey DH, Payne C, Bruce E, Ronquillo YC, Hoopes PC. The Multifold Etiologies of Limbal Stem Cell Deficiency: A Comprehensive Review on the Etiologies and Additional Treatment Options for Limbal Stem Cell Deficiency. J Clin Med 2023; 12:4418. [PMID: 37445454 DOI: 10.3390/jcm12134418] [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: 04/22/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Given the various ocular manifestations of limbal stem cell insufficiency, an awareness of the genetic, acquired, and immunological causes and associated additional treatments of limbal stem cell deficiency (LSCD) is essential for providers. We performed a comprehensive review of the literature on the various etiologies and specific therapies for LSCD. The resources utilized in this review included Medline (PubMed), Embase, and Google Scholar. All English-language articles and case reports published from November 1986 through to October 2022 were reviewed in this study. There were collectively 99 articles on these topics. No other exclusion criteria were applied. Depending on the etiology, ocular manifestations of limbal stem cell deficiency range from dry eye syndrome and redness to more severe outcomes, including corneal ulceration, ocular surface failure, and vision loss. Identifying the source of damage for LSCD is critical in the treatment process, given that therapy may extend beyond the scope of the standard protocol, including artificial tears, refractive surgery, and allogeneic stem cell transplants. This comprehensive review of the literature demonstrates the various genetic, acquired, and immunological causes of LSCD and the spectrum of supplemental therapies available.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
- John A. Moran Eye Center, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
| | - Maliha Masud
- School of Medicine, University of Nevada Reno, Reno, NV 89557, USA
| | - Devon Hori Harvey
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Carter Payne
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
| | - Elayna Bruce
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | - Philip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
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Posarelli M, Romano D, Tucci D, Giannaccare G, Scorcia V, Taloni A, Pagano L, Borgia A. Ocular-Surface Regeneration Therapies for Eye Disorders: The State of the Art. BIOTECH 2023; 12:48. [PMID: 37366796 DOI: 10.3390/biotech12020048] [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: 05/08/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
The ocular surface is a complex structure that includes cornea, conjunctiva, limbus, and tear film, and is critical for maintaining visual function. When the ocular-surface integrity is altered by a disease, conventional therapies usually rely on topical drops or tissue replacement with more invasive procedures, such as corneal transplants. However, in the last years, regeneration therapies have emerged as a promising approach to repair the damaged ocular surface by stimulating cell proliferation and restoring the eye homeostasis and function. This article reviews the different strategies employed in ocular-surface regeneration, including cell-based therapies, growth-factor-based therapies, and tissue-engineering approaches. Dry eye and neurotrophic keratopathy diseases can be treated with nerve-growth factors to stimulate the limbal stem-cell proliferation and the corneal nerve regeneration, whereas conjunctival autograft or amniotic membrane are used in subjects with corneal limbus dysfunction, such as limbal stem-cell deficiency or pterygium. Further, new therapies are available for patients with corneal endothelium diseases to promote the expansion and migration of cells without the need of corneal keratoplasty. Finally, gene therapy is a promising new frontier of regeneration medicine that can modify the gene expression and, potentially, restore the corneal transparency by reducing fibrosis and neovascularization, as well as by stimulating stem-cell proliferation and tissue regeneration.
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Affiliation(s)
- Matteo Posarelli
- St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Davide Romano
- Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, 25123 Brescia, Italy
- Eye Unit, University Hospitals of Leicester, NHS Trust, Leicester LE1 5WW, UK
| | - Davide Tucci
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, S. Maria Della Misericordia Hospital, University of Perugia, 06123 Perugia, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Luca Pagano
- St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Alfredo Borgia
- St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
- Eye Unit, Humanitas-Gradenigo Hospital, 10153 Turin, Italy
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11
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Johnson KB, Rosenbaum JT, Yarter JT, Broadbent T, Michels KS. A 10-Year Review of the Management of Ocular Mucous Membrane Pemphigoid: A Private Practice Experience. Cornea 2023; 42:565-571. [PMID: 37000702 DOI: 10.1097/ico.0000000000003071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Ocular mucous membrane pemphigoid (OcMMP) is a rare and potentially blinding condition for which consensus treatment guidelines do not exist. The purpose of this study was to assess the effectiveness and safety of various immunomodulatory agents in the treatment of OcMMP in a private practice setting. METHODS We conducted a 10-year retrospective chart review of patients managed with OcMMP (n = 22). The median age at diagnosis was 73 (range: 35-91) years, and 59% (13/22) of patients were female. Visual acuity, Foster stage, and adverse effects (AEs) were documented. Treatment outcomes for each treatment episode were qualified at 3 months as complete response (CR), response (R), or failure (F). After 3 months, CR was then further subqualified as sustained CR, reactivation after initial CR, or AE after initial CR. The Fisher exact test P values were calculated for each outcome in comparison with mycophenolate. RESULTS Twenty patients were treated with an immunomodulatory agent for a total of 55 treatment episodes. In comparison to dapsone, mycophenolate was more likely to achieve sustained CR (50% vs. 0%, P = 0.022) and R (100% vs. 50%, P = 0.007), and less likely to fail (0% vs. 50%, P = 0.007). Dapsone was also more likely to be discontinued because of AEs than mycophenolate (40% vs. 6%, P = 0.041). CONCLUSIONS Mycophenolate is a superior first-line agent to dapsone in the treatment of OcMMP. Although not statistically significant, mycophenolate trends toward superiority over methotrexate as well. Mycophenolate is very effective when used in combination with rituximab. Azathioprine remains a reasonable second-line agent.
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Affiliation(s)
- Kasey B Johnson
- Washington State University, Elson S. Floyd College of Medicine, Spokane, WA
| | - James T Rosenbaum
- Oregon Health and Science University, Casey Eye Institute, School of Medicine, Portland, OR
- Legacy Health System, Devers Eye Institute, Portland, OR
| | - Jason T Yarter
- University of Washington, School of Medicine, Spokane, WA; and
| | | | - Kevin S Michels
- Washington State University, Elson S. Floyd College of Medicine, Spokane, WA
- Northwest Eyelid and Orbital Specialists, Spokane, WA
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12
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Diagnostic Algorithm for Surgical Management of Limbal Stem Cell Deficiency. Diagnostics (Basel) 2023; 13:diagnostics13020199. [PMID: 36673009 PMCID: PMC9858342 DOI: 10.3390/diagnostics13020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Limbal stem cell deficiency (LCSD) presents several challenges. Currently, there is no clearly defined systematic approach to LSCD diagnosis that may guide surgical tactics. METHODS The medical records of 34 patients with LSCD were analyzed. Diagnostic modalities included standard (visometry, tonometry, visual field testing, slit-lamp biomicroscopy with corneal fluorescein staining, Schirmer test 1, ultrasonography) and advanced ophthalmic examination methods such as anterior segment optical coherence tomography, in vivo confocal microscopy, impression cytology, and enzyme-linked immunoassay. RESULTS Standard ophthalmological examination was sufficient to establish the diagnosis of LSCD in 20 (58.8%) cases, whereas advanced evaluation was needed in 14 (41.2%) cases. Depending on the results, patients with unilateral LSCD were scheduled to undergo glueless simple limbal epithelial transplantation (G-SLET) or simultaneous G-SLET and lamellar keratoplasty. Patients with bilateral LSCD with normal or increased corneal thickness were enrolled in the paralimbal oral mucosa epithelium transplantation (pLOMET) clinical trial. CONCLUSIONS Based on the diagnostic and surgical data analyzed, the key points in LSCD diagnosis were identified, helping to guide the surgeon in selecting the appropriate surgical procedure. Finally, we proposed a novel step-by-step diagnostic algorithm and original surgical guidelines for the treatment of patients with LSCD.
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13
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Current progress in preservative-free topical ophthalmic formulations. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Shi L, Li X, Qian H. Anti-Laminin 332-Type Mucous Membrane Pemphigoid. Biomolecules 2022; 12:biom12101461. [PMID: 36291670 PMCID: PMC9599625 DOI: 10.3390/biom12101461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022] Open
Abstract
Anti-laminin (LM) 332-type mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease and was originally discovered as anti-epiligrin cicatricial pemphigoid. Anti-LM332-type MMP has clinical manifestations similar to those of other types of MMP and can only be distinguished through the detection of circulating autoantibodies against LM332. Our group and others have established a number of immunological methods with varying sensitivity and specificity for detection of anti-LM332 autoantibodies; however, none of the established methods has been widely used for clinical diagnosis. There is currently no unified standard treatment, and it is very difficult to completely cure anti-LM332-type MMP. In addition, an increasing body of evidence suggests that there may be a strong correlation between anti-LM332-type MMP and tumors. In this article, we review the current progression of diagnosis and treatment of anti-LM332-type MMP, as well as the possible correlation between anti-LM332-type MMP and tumors.
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Affiliation(s)
- Luhuai Shi
- Dermatology Hospital of Jiangxi Province, Jiangxi Provincial Clinical Research Center for Skin Diseases, Candidate Branch of National Clinical Research Center for Skin Diseases, Dermatology Institute of Jiangxi Province, The Affiliated Dermatology Hospital of Nanchang University, Nanchang 330001, China
| | - Xiaoguang Li
- Department of Laboratory Medicine, Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China
| | - Hua Qian
- Department of Laboratory Medicine, Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China
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Furundaoturan O, Akçay P, Selver OB. Use of Systemic Mycophenolate Mofetil Therapy in Ocular Surface Inflammatory Pathologies at the Initiative and Responsibility of the Ophthalmologist. Middle East Afr J Ophthalmol 2022; 29:209-215. [PMID: 38162558 PMCID: PMC10754105 DOI: 10.4103/meajo.meajo_109_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE The purpose of the study was to evaluate the efficacy and safety of systemic mycophenolate mofetil (MMF) treatment in ocular surface inflammatory diseases. METHODS For this retrospective study, patients who were treated with systemic MMF for ocular surface inflammatory diseases between March 2020 and March 2022 were evaluated. Apart from demographic data, examination notes including MMF treatment indication and systemic side effect interrogation and routine laboratory examinations during drug treatment were extracted from the patient records. Detailed staging scores were performed according to the diagnosis including Foster and Mondino for ocular mucous membrane pemphigoid (MMP) and limbal stem cell deficiency scoring for limbal transplantation. For thorough evaluation, anterior segment pictures were used. RESULTS Fourteen patients were enrolled to the study, with a mean age of 58 ± 12. MMP (6, 42.8%) and limbal allograft transplantation (6, 42.8%) constituted the main indications for the MMF treatment, followed by keratitis-ichthyosis-deafness (KID) syndrome (1, 7.2%) and Mooren's ulcer (1, 7.2%). Five of six patients with MMP regressed according to both staging systems. Only one remained stable which was evaluated as Stage 3. Furthermore, while all limbal transplant groups (6) stabilized and showed regression according to the individualized limbal stem cell deficiency staging system with no rejection during follow-up. Furthermore, patients with Mooren's ulcer and KID syndrome showed control of the inflammation and stabilization after MMF treatment. No significant systemic side effects apart from constipation and nausea (3) were observed in patients whose routine laboratory tests were stable throughout the follow-up. CONCLUSION MMF has the potential to be a valuable and safe systemic agent of first choice in the control of ocular surface inflammatory disorders, especially when topical treatment is not effective. With such studies, it is predicted that MMF may reach wider usage areas with the increase in its effectiveness and safety in its use for ocular surface inflammatory pathologies.
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Affiliation(s)
| | - Pelin Akçay
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ozlem B. Selver
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
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16
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Ahmed AR, Aksoy M, Kinane TB. Pemphigoid of the pulmonary system (POPS): A review of a less recognized feature. Clin Exp Rheumatol 2022; 21:103180. [PMID: 35981700 DOI: 10.1016/j.autrev.2022.103180] [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: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/02/2022]
Abstract
This review of Pemphigoid of the Pulmonary System (POPS) is a comprehensive description of pulmonary involvement in patients with mucous membrane pemphigoid (MMP), which is an orphan autoimmune blistering disease. The objective of the review was to analyze clinical features of pulmonary involvement in MMP. This POPS review is a case series in which multiple search engines were utilized from inception to June 2022 for cases of MMP with biopsy and immunopathology proven tracheal and bronchial pemphigoid. Clinical profiles prior to pulmonary involvement, bronchoscopy findings, clinical course and therapy were recorded and cause of death was analyzed. Patients with documented MMP who developed tracheal, bronchial and pulmonary involvement were included in the POPS review. Histology and immunopathology documentation were essential diagnostic criteria. Comparison groups were not possible. Patients were treated with immunosuppressive therapy. Some required surgical interventions. Six of the 11 patients attained complete or partial remission on or off therapy. Five patients died from pulmonary complications. The POPS review had six females and five males. The mean age at onset was 20 years (range 4-76), while 80% of the patients were under 40 years. All had severe widespread MMP involving three to five mucosal tissues. 100% had oral, 82% had ocular and cutaneous involvement. Pulmonary involvement occurred at 24 mo (range 2-372) after the onset of MMP. Bronchoscopy revealed acute inflammation during active disease and scarring of the trachea and bronchi in the later stages. Systemic infections occurred in 45%, while pulmonary infection occurred in 36%. Mortality due to respiratory failure, at the median age of 20 years (range 18-76), occurred in 45% of the patients, and was considered disease related. In spite of the young age, while there are some similarities in the clinical profile and response to systemic therapy, there are definitive differences from other patients with MMP. Early diagnosis with appropriate management could produce better clinical outcomes and prevent mortality in this orphan disease. Consequently, there is a critical need for early identification and diagnosis of POPS.
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Affiliation(s)
- A Razzaque Ahmed
- Center for Blistering Diseases, Department of Dermatology, Tufts University School of Medicine, Boston, MA, USA.
| | - Merve Aksoy
- Center for Blistering Diseases, Department of Dermatology, Tufts University School of Medicine, Boston, MA, USA
| | - T Bernard Kinane
- Chief Pediatric Pulmonary Medicine, Mass General Hospital, Harvard Medical School, Boston, MA, USA
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17
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He Y, Quan Z, Zhang R, Ji Z, Jia J, Liu H, Zhang C, He B, Ren Y, Feng Y. Perioperative Management and Long-Term Outcomes in Ocular Cicatricial Pemphigoid Patients Undergoing Cataract Surgery. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2496649. [PMID: 35535356 PMCID: PMC9078804 DOI: 10.1155/2022/2496649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
Abstract
Objective To observe the outcomes of cataract surgery in ocular cicatricial pemphigoid (OCP) patients and explore routine perioperative medical treatments. Design Retrospective case series. Methods Fourteen eyes of 8 patients were included in the study. Foster's stage 1-4 OCP patients were given human intravenous immunoglobulin, whereas patients with active inflammation were treated with prednisone tablets and methotrexate. Those who were intolerant to methotrexate and had severe inflammatory symptoms were treated with cyclophosphamide. Cataract surgery was performed for all patients after three months of systemic treatment under stable conditions. The conjunctival biopsy was evaluated by immunofluorescence microscopy. Then, patients were divided into individuals with or without ankyloblepharon. Records were reviewed for OCP stage, type of surgery, best-corrected visual acuity (BCVA), Schirmer I test, corneal fluorescein sodium staining, meibomian gland coloboma range, and ocular surface disease index (OSDI) scores. Follow-up was for the duration of taking topical and systemic medication. Results Nine female (64.29%) and 4 male (35.71%) eyes were diagnosed with OCP by biopsy. The mean follow-up time was 60.64 ± 35.62 months. Thirteen eyes (92.86%) of 7 patients underwent phacoemulsification. One eye underwent phacoemulsification combined with amniotic membrane transplantation. The intracapsular extraction of cataract was applied to one eye. The BCVA improved significantly in all the patients, which remained stable until the last follow-up. The Schirmer I test was higher than that before the surgery. Corneal fluorescein sodium staining after surgery showed a decrease in score compared to the preoperative score. The BCVA of the patients after surgery increased significantly. The OSDI scores of patients with ankyloblepharon were significantly higher than for those without it. Postoperative symblepharon showed no significant difference compared to the preoperative symblepharon. Conclusions In this series, OCP patients with cataracts were able to undergo phacoemulsification surgery, whereas routine use of immunosuppression and closed postoperative follow-up were necessary.
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Affiliation(s)
- Yuan He
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Zhuoya Quan
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Ruixue Zhang
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Zhi Ji
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Jun Jia
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Huifeng Liu
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Chuntao Zhang
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Beilei He
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Yuan Ren
- The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China
| | - Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
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18
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Patzelt S, Pigors M, Steenbock H, Diel L, Boch K, Chakievska L, Künzel S, Busch H, Fähnrich A, Brinckmann J, Schmidt E. Increased Fibrosis in a Mouse Model of Anti-Laminin 332 Mucous Membrane Pemphigoid Remains Unaltered by Inhibition of Aldehyde Dehydrogenase. Front Immunol 2022; 12:812627. [PMID: 35197965 PMCID: PMC8858800 DOI: 10.3389/fimmu.2021.812627] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/31/2021] [Indexed: 12/30/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease characterized by autoantibodies against the basal membrane zone of skin and surface-close epithelia and predominant mucosal lesions. The oral cavity and conjunctivae are most frequently affected, albeit clinical manifestations can also occur on the skin. MMP-associated lesions outside the oral cavity typically lead to scarring. Mechanisms underlying scarring are largely unknown in MMP and effective treatment options are limited. Herein, we assessed the collagen architecture in tissue samples of an antibody-transfer mouse model of anti-laminin-332 MMP. In MMP mice, increased collagen fibril density was observed in skin and conjunctival lesions compared to mice injected with normal rabbit IgG. The extracellular matrix of MMP skin samples also showed altered post-translational collagen cross-linking with increased levels of both lysine- and hydroxylysine-derived collagen crosslinks supporting the fibrotic phenotype in experimental MMP compared to control animals. In addition, we evaluated a potential anti-fibrotic therapy in experimental anti-laminin-332 MMP using disulfiram, an inhibitor of the aldehyde dehydrogenase (ALDH), which has been implicated in immune-mediated mucosal scarring. In addition, disulfiram also acts as a copper chelator that was shown to block lysyl oxidase activity, an enzyme involved in formation of collagen crosslinks. Topical use of disulfiram (300 μM in 2% [w/v] methocel) did not improve ocular lesions in experimental MMP over the 12-day treatment period in disulfiram-treated mice compared to vehicle-treated mice (n=8/group). Furthermore, C57BL6/J mice (n=8/group) were treated prophylactically with 200 mg/kg p.o. disulfiram or the solvent once daily over a period of 12 days. Systemic treatment did not show any reduction in the severity of oral and ocular lesions in MMP mice, albeit some improvement in skin lesions was observed in disulfiram- vs. vehicle-treated mice (p=0.052). No reduction in fibrosis was seen, as assessed by immunohistochemistry. Whilst blocking of ALDH failed to significantly ameliorate disease activity, our data provide new insight into fibrotic processes highlighting changes in the collagenous matrix and cross-linking patterns in IgG-mediated MMP.
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Affiliation(s)
- Sabrina Patzelt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Manuela Pigors
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Heiko Steenbock
- Institute of Virology and Cell Biology, University of Lübeck, Lübeck, Germany
| | - Leonard Diel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany
| | - Lenche Chakievska
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Sven Künzel
- Max Planck Institute for Evolutionary Biology, Plön, Germany
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany,Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Anke Fähnrich
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany,Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Jürgen Brinckmann
- Institute of Virology and Cell Biology, University of Lübeck, Lübeck, Germany,Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany,Department of Dermatology, Allergology and Venerology, University of Lübeck, Lübeck, Germany,*Correspondence: Enno Schmidt,
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19
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Du G, Patzelt S, van Beek N, Schmidt E. Mucous membrane pemphigoid. Clin Exp Rheumatol 2022; 21:103036. [PMID: 34995762 DOI: 10.1016/j.autrev.2022.103036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/01/2022] [Indexed: 12/19/2022]
Abstract
Mucous membrane pemphigoid (MMP) is a clinically and immunopathologically heterogenous disease with an incidence of about 2/million inhabitants/year in central Europe. Pemphigoid diseases are characterized by autoantibodies against structural proteins of the epidermis and/or surface-close epithelia. MMP has been defined as pemphigoid disease with predominant mucosal lesions. Most frequently, the oral cavity and the conjunctivae are affected. Lesions outside the mouth tend to heal with scarring leading to visual impairment and finally blindness, as well as, more rarely, impairment of breathing and food intake. Autoantibodies target BP180 (collagen type XVII), laminin 332, BP230 (nearly always in conjunction with other antigens), and type VII collagen in about 75%, 10-20%, 10-30%, and <5% of MMP patients, respectively. While the main autoantibody isotype is IgG, additional, and less frequently, exclusive IgA autoantibodies can be detected in the majority of patients. Assaying for anti-laminin 332 reactivity is pivotal, since in about a quarter of patients with anti-laminin 332 MMP, a malignancy, mainly solid cancers, is associated. The pathophysiology of MMP is yet incompletely understood. A recent mouse model of anti-laminin 332 MMP replicating characteristic clinical and immunopathological findings of the human disease may be helpful to close this knowledge gap. Diagnosis is established by the clinical picture with predominant mucosal lesions and visualization of tissue-bound anti-basement membrane zone antibodies by direct immunofluorescence microscopy. In recent S3 guidelines initiated by the European Academy of Dermatology and Venereology, the clinical spectrum and diagnostic strategies are detailed. In addition, treatment regimens for different clinical situations including patients with exclusive oral or ocular involvement are outlined. Future studies are needed to better understand the clinal complexity and associations as well as to establish widely available diagnostic assays and evidence-based therapeutic strategies.
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Affiliation(s)
- Gefei Du
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany; Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Sabrina Patzelt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany; Department of Dermatology, University of Lübeck, Lübeck, Germany.
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Besagar S, London AO, Jairam MP, Trief D, Dagi Glass LR. Chronic Early-Stage Ocular Cicatricial Pemphigoid. Ophthalmic Plast Reconstr Surg 2021; 37:e209-e213. [PMID: 34293790 DOI: 10.1097/iop.0000000000002021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ocular cicatricial pemphigoid (OCP) represents an insidious, autoimmune-mediated disease of the conjunctiva, initially presenting as chronic conjunctivitis and progressing to fibrosis, cicatrization, and eventually blindness secondary to corneal keratinization. This series reports 3 cases presenting with chronic conjunctivitis lasting an average of 10 years without cicatrix formation, ultimately diagnosed as OCP based on direct immunofluorescence of conjunctival biopsy samples. This chronic conjunctivitis without fibrosis suggests the possibility of an OCP subtype with a prolonged early stage or prodrome prior to cicatrization, which may benefit from early diagnosis and treatment to prevent complications of this disease.
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Affiliation(s)
- Sonya Besagar
- Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - Ashley O London
- Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - Meghan P Jairam
- Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - Danielle Trief
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, U.S.A
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Abstract
PURPOSE OF REVIEW Ocular surface disease is a prevalent, diverse group of conditions that cause patient discomfort and decreased visual acuity and present considerable expense to both patients and healthcare systems. Autologous serum eye drops are a topical treatment modality derived from the patient's own blood. Use of serum eye drops for ocular surface disease has been promising due to biochemical similarities to endogenous tears. RECENT FINDINGS Use of serum eye drops for moderate to severe ocular surface diseases such as dry eye, corneal epithelial defects, and inflammatory conditions has become more prevalent. Recent studies have demonstrated that the use of serum eye drops is well-tolerated by patients and associated with improvement in patient-reported outcomes and objective dry eye parameters. Production of serum eye drops may vary, treatment costs can be significant, and the quality of evidence for serum eye drop use published from randomized controlled trials is modest, particularly for long-term treatment. Accessibility remains an area for improvement and may be complemented by allogeneic serum eye drops. SUMMARY Serum eye drops are frequently used as a safe, well-tolerated, and effective treatment for ocular surface disease. Further research is needed to assess long-term outcomes and improve accessibility.
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Wang L, He X, Wang Q, Wu T, Liu A, Huang Y. Long-term outcomes of the MICOF keratoprosthesis surgery. Ocul Surf 2021; 21:178-185. [PMID: 34118425 DOI: 10.1016/j.jtos.2021.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate long-term anatomical and functional outcomes of the MICOF keratoprosthesis to treat end-stage corneal blindness. DESIGN Retrospective review of consecutive clinical case series. PARTICIPANTS Between October 2000 and October 2015, at the Department of Ophthalmology of Chinese PLA General Hospital (PLAGH), a total of 132 eyes of 131 patients had undergone a MICOF keratoprosthesis implantation. Of those, 91 eyes of 90 patients were included in this study. METHODS Preoperative information, surgical procedures, and postoperative data were collected for each included eye. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), keratoprosthesis retention, and significant postoperative complications were reported. RESULTS The most common indications for surgery were chemical or thermal burns (68.1%, 62 of 91 eyes) and explosive injury (12.1%, 11 of 91 eyes), followed by Stevens-Johnson Syndrome (10.0%, 9 of 91 eyes), Sjögren's syndrome (4.4%, 4 of 91 eyes), mucous membrane pemphigoid (3.3%, 3 of 91 eyes) and multi-penetrating keratoplasty failure (2.2%, 2 of 91 eyes). The mean follow-up duration was 8.38 ± 3.22 years (range: 5-17.25 years, median: 7.67 years). All patbients had a preoperative visual acuity of hand motions or worse. A MICOF keratoprosthesis significantly improved patients' visual function with bilateral end-stage corneal blindness. Postoperative visual acuity improved to 20/200 or better in 41 eyes (45.1%, of 91 eyes) and to 20/100 or better in 32 eyes (35.2% of 91 eyes) at the last follow-up visit. Preexisting glaucoma was present in 17 (18.7% of 91 eyes). The most common postoperative complications were overgrowth of the surface mucosa (31.9%, 29 of 91 eyes), glaucoma (25.3%, 23 of 91 eyes), retro-prosthetic membrane (15.4%, 14 of 91 eyes), keratoprosthesis device extrusion (15.4%, 14 of 91 eyes), superficial tissue thinning (14.3%, 13 of 91 eyes), endophthalmitis (13.2%, 12 of 91 eyes), titanium frame exposure (13.2%, 12 of 91 eyes), optical cylinder ante-displacement (13.2%, 12 of 91 eyes), cornea melting (7.7%, 7 of 91 eyes), retinal detachment (6.6%, 6 of 91 eyes) and aqueous humour leakage (2.2%, 2 of 91 eyes). 84.6% (77 of 91 eyes) of the eyes retained their initial keratoprosthesis at the latest follow-up. CONCLUSIONS A MICOF keratoprosthesis is a reliable approach to rescue vision in end-stage corneal blinded patients and has better retention than a Boston Kpro TypeⅡ.
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Affiliation(s)
- Liqiang Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Xiezhou He
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China; Medical College, Nankai University, Tianjin, China
| | - Qun Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Tengyun Wu
- Air Force Medical Center of PLA, Beijing, China
| | - Anqi Liu
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yifei Huang
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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Bai J, Li Y, Li M, Tan S, Wu D. IL-37 As a Potential Biotherapeutics of Inflammatory Diseases. Curr Drug Targets 2021; 21:855-863. [PMID: 32348214 DOI: 10.2174/1389450121666200429114926] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022]
Abstract
Interleukin-37 (IL-37) was discovered as a new member of pro-inflammatory IL-1 superfamily. However, further studies suggested that IL-37 plays a critical anti-inflammatory role in innate and adaptive immunity. IL-37 may suppress the inflammatory process via intracellular SMAD family member 3 (SMAD3) and extracellular IL-18 Receptor alpha (IL-18Rα) signaling pathway, respectively. Meanwhile, the abnormal expression of IL-37 was observed in immune-mediated inflammatory diseases, such as inflammatory bowel disease, rheumatoid arthritis, atherosclerosis, systemic lupus erythematosus, asthma, and multiple sclerosis, which suggest IL-37 is a potential therapeutic target for these diseases. In this review, we summarize the anti-inflammatory mechanism of IL-37 and discuss the critical roles of IL-37 in the pathogenesis of these diseases. Further studies are required to confirm the effectiveness of IL-37 as a novel target for these inflammatory diseases.
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Affiliation(s)
- Junhui Bai
- Department of Histology and Embryology, University of South China, Institute of Clinical Anatomy & Reproductive Medicine, Hengyang, 421001, Hunan, China
| | - Yukun Li
- Department of Histology and Embryology, University of South China, Institute of Clinical Anatomy & Reproductive Medicine, Hengyang, 421001, Hunan, China
| | - Meixiang Li
- Department of Histology and Embryology, University of South China, Institute of Clinical Anatomy & Reproductive Medicine, Hengyang, 421001, Hunan, China
| | - Sijie Tan
- Department of Histology and Embryology, University of South China, Institute of Clinical Anatomy & Reproductive Medicine, Hengyang, 421001, Hunan, China
| | - Daichao Wu
- Department of Histology and Embryology, University of South China, Institute of Clinical Anatomy & Reproductive Medicine, Hengyang, 421001, Hunan, China
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24
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James H, Paley GL, Brasington R, Custer PL, Margolis TP, Paley MA. Tofacitinib for refractory ocular mucous membrane pemphigoid. Am J Ophthalmol Case Rep 2021; 22:101104. [PMID: 34007952 PMCID: PMC8111584 DOI: 10.1016/j.ajoc.2021.101104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/18/2021] [Accepted: 04/11/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose To report the successful use of tofacitinib in the treatment of refractory ocular mucous membrane pemphigoid (MMP). Observations Two patients with ocular MMP presented with refractory disease after failure of multiple therapies. Treatment with tofacitinib led to durable control of conjunctival inflammation within 8 weeks and no apparent progression of sub-conjunctival fibrosis. One patient maintained absence of apparent disease activity over 16 months of follow-up. Cessation of tofacitinib in the other patient led to disease relapse which was reversed by re-initiation of therapy. Conclusions and importance Small molecule inhibitors of Janus kinases, such as tofacitinib, may offer an effective treatment option for refractory ocular MMP.
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Affiliation(s)
- Hayley James
- Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis, Center for Outpatient Health, 6th floor, 4901 Forest Park Avenue, Saint Louis, MO, 63110, USA
| | - Grace L Paley
- Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis, Center for Outpatient Health, 6th floor, 4901 Forest Park Avenue, Saint Louis, MO, 63110, USA
| | - Richard Brasington
- Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis, Center for Outpatient Health, 6th floor, 4901 Forest Park Avenue, Saint Louis, MO, 63110, USA.,Division of Rheumatology, Department of Medicine, Washington University in Saint Louis, Center for Advanced Medicine, 5th floor Suite C, 4921 Parkview Place, Saint Louis, MO, 63110, USA
| | - Philip L Custer
- Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis, Center for Outpatient Health, 6th floor, 4901 Forest Park Avenue, Saint Louis, MO, 63110, USA
| | - Todd P Margolis
- Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis, Center for Outpatient Health, 6th floor, 4901 Forest Park Avenue, Saint Louis, MO, 63110, USA
| | - Michael A Paley
- Division of Rheumatology, Department of Medicine, Washington University in Saint Louis, Center for Advanced Medicine, 5th floor Suite C, 4921 Parkview Place, Saint Louis, MO, 63110, USA
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25
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Figus M, Agnifili L, Lanzini M, Brescia L, Sartini F, Mastropasqua L, Posarelli C. Topical preservative-free ophthalmic treatments: an unmet clinical need. Expert Opin Drug Deliv 2020; 18:655-672. [PMID: 33280452 DOI: 10.1080/17425247.2021.1860014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: The main role of preservatives in eyedrops is to ensure sterility and microbiological integrity of the drug, and to facilitate the penetration of active compounds into the eye. However, several studies documented significant toxic effects induced by preservatives, especially on the ocular surface. Consequently, most of the ophthalmic medications became progressively available in preservative-free (PF) formulations.Areas covered: We analyzed pre-clinical and clinical studies on PF eyedrops with particular attention to common chronic diseases such as dry eye and glaucoma. We discussed about the pros and cons of using PF eyedrops, in terms of efficacy, safety, and social-economic aspects.Expert opinion: There are still unresolved issues that make hard for PF medications to definitively conquer the drug market. Despite robust pre-clinical evidences of less toxicity, the low number of randomized clinical trials does not permit to state that PF eyedrops have, in clinical practice, a similar efficacy or a higher safety compared to preserved forms. These aspects limit their use to chronic diseases requiring long-term therapies with multiple daily instillations, especially in the presence of concomitant ophthalmic diseases that expose to a risk of ocular surface worsening.
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Affiliation(s)
- Michele Figus
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Manuela Lanzini
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Francesco Sartini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Posarelli
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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26
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de la Sen-Corcuera B, Montero-Iruzubieta J, Sánchez-Ávila RM, Orive G, Anitua E, Caro-Magdaleno M, Merayo-Lloves J. Plasma Rich in Growth Factors for the Treatment of Cicatrizing Conjunctivitis. Clin Ophthalmol 2020; 14:1619-1627. [PMID: 32606577 PMCID: PMC7306461 DOI: 10.2147/opth.s252253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The objective was to evaluate the clinical results obtained from the use of immunosafe plasma rich in growth factors (isPRGF) in the treatment of patients with cicatrizing conjunctivitis (CC) who had not responded to the usual therapy. Patients and Methods This is a retrospective study that included patients diagnosed with CC, in whom isPRGF was used in different phases (I: eye drops; II: eye drops and injectable; III: eye drops, injectable and surgical treatment) to achieve control of the inflammation. As a clinical follow-up of the patients, the better corrected visual acuity (BCVA), degree of inflammation (measured from 1 to 4), the severity of the CC, Schirmer I test, IOP and TBUT were analyzed. The adverse events were also evaluated. Results Ten eyes (6 patients) were evaluated, 50% corresponded to Stevens–Johnson Syndrome and 50% to ocular mucous membrane pemphigoid. The mean age was 59.7 ± 16.5 (39–80) years, and 50% were women. Fifty per cent of the cases were initially considered severe CC, and 10% of the cases (one eye of one patient) were considered severe CC at the end of the treatment (p = 0.046). The initial degree of inflammation was 2 in 4 eyes, 3 in two eyes, and 4 in 4 eyes, and final inflammation degree was 1 in all cases (p = 0.004). Twenty per cent of the cases achieved stability in Phase I of the treatment with immunosafe PRGF, 70% with both Phases I and II, and only one case underwent Phase III to achieve stability. The IOP improved significantly (p = 0.027) though the BCVA, TBUT and Schirmer I test showed no significant changes. The follow-up time was 23.1 ± 6.7 (13.6–30.3) months. No adverse effects were reported. Conclusion Treatment with PRGF technology in its injectable and topical immunosafe formulations may be a novel alternative for the treatment of patients with CC, given its complement activity modulating effect, as well as its anti-inflammatory, antifibrotic and regenerative properties.
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Affiliation(s)
- Borja de la Sen-Corcuera
- Biotechnology Institute (BTI), Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - Jesús Montero-Iruzubieta
- Clínica Cartujavisión, Sevilla, Spain.,Hospital Universitario Virgen de Macarena, Sevilla, Spain
| | - Ronald M Sánchez-Ávila
- Biotechnology Institute (BTI), Vitoria, Spain.,Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain
| | - Gorka Orive
- Biotechnology Institute (BTI), Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - Eduardo Anitua
- Biotechnology Institute (BTI), Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | | | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain
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27
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Lucero Saá F, Cremona FA, Mínguez NX, Rinaudo CP, Chiaradía P. Ectodermal Dysplasia: Association with Anti-Basement Membrane Autoantibodies. Ocul Immunol Inflamm 2020; 28:703-707. [PMID: 31268817 DOI: 10.1080/09273948.2019.1609526] [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: 10/26/2022]
Abstract
Ectodermal dysplasia (ED) is a group of several genetic conditions with absence or dysgenesis of at least two ectodermal derivatives: teeth, skin and its appendages including hair, nails, eccrine and sebaceous glands. The most important clinical findings in patients with ED are hypodontia, hypotrichosis, and hypohidrosis, which can lead to episodes of hyperthermia. Few reports have focused on the progressive keratopathy in ED. Cicatrizing conjunctivitis associated with anti-basement membrane autoantibodies has been described. We report a series of three ectodermal dysplasia patients with an ocular phenotype typically seen in ocular mucous membrane pemphigoid; conjunctival immunohistopathology revealed anti-basement membrane autoantibodies in all of them, and systemic immunosuppression proved to be effective in improving symptoms and helping to stabilize ocular surface disease.
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Affiliation(s)
- Francisco Lucero Saá
- Department of Ophthalmology, Hospital de Clínicas José de San Martin, Universidad de Buenos Aires (UBA) , Buenos Aires, Argentina
| | - Federico Andrés Cremona
- Department of Ophthalmology, Hospital de Clínicas José de San Martin, Universidad de Buenos Aires (UBA) , Buenos Aires, Argentina
| | - Natalia Ximena Mínguez
- Department of Ophthalmology, Hospital de Clínicas José de San Martin, Universidad de Buenos Aires (UBA) , Buenos Aires, Argentina
| | - Carina Paola Rinaudo
- Department of Ophthalmology, Hospital de Clínicas José de San Martin, Universidad de Buenos Aires (UBA) , Buenos Aires, Argentina
| | - Pablo Chiaradía
- Department of Ophthalmology, Hospital de Clínicas José de San Martin, Universidad de Buenos Aires (UBA) , Buenos Aires, Argentina
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28
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Abdallah Y, Ogra S, Madge SN. Aggressive mucous membrane pemphigoid: a cross-specialty dilemma. Br J Hosp Med (Lond) 2020; 81:1-3. [DOI: 10.12968/hmed.2019.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Simon N Madge
- Victoria Eye Unit, Wye Valley NHS Trust, Hereford, UK
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29
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Russo R, Cozzani E, Gasparini G, Parodi A. Targeting interleukin 4 receptor α: A new approach to the treatment of cutaneous autoimmune bullous diseases? Dermatol Ther 2020; 33:e13190. [PMID: 31863534 PMCID: PMC7154653 DOI: 10.1111/dth.13190] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
Bullous pemphigoid, mucous membrane pemphigoid, and pemphigus vulgaris are different cutaneous autoimmune blistering diseases, with complex pathogenic mechanisms. In all of them, a type-2 response is thought to have a central role. Interleukin 4 and Interleukin 13 are crucial cytokines in type-2 response. Treatment of these conditions is often challenging. Dupilumab, a recombinant fully human IgG4 monoclonal antibody with binding specificity to human interleukin-4 receptor IL-4Rα, has the potential to inhibit both IL-4 and IL-13. We propose IL-4Rα as a theoretical drug target for cutaneous autoimmune bullous diseases.
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Affiliation(s)
- Roberto Russo
- Di.S.SAL Section of DermatologyUniversity of Genoa, Via Pastore 1GenoaItaly
- Section of Dermatology, IRCCS San Martino Policlinic HospitalGenoaItaly
| | - Emanuele Cozzani
- Di.S.SAL Section of DermatologyUniversity of Genoa, Via Pastore 1GenoaItaly
- Section of Dermatology, IRCCS San Martino Policlinic HospitalGenoaItaly
| | - Giulia Gasparini
- Di.S.SAL Section of DermatologyUniversity of Genoa, Via Pastore 1GenoaItaly
- Section of Dermatology, IRCCS San Martino Policlinic HospitalGenoaItaly
| | - Aurora Parodi
- Di.S.SAL Section of DermatologyUniversity of Genoa, Via Pastore 1GenoaItaly
- Section of Dermatology, IRCCS San Martino Policlinic HospitalGenoaItaly
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30
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Wetzel M, Owen CE, Callen JP. Paraneoplastic Syndromes for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Taurone S, Spoletini M, Ralli M, Gobbi P, Artico M, Imre L, Czakò C, Kovàcs I, Greco A, Micera A. Ocular mucous membrane pemphigoid: a review. Immunol Res 2019; 67:280-289. [DOI: 10.1007/s12026-019-09087-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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