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Chen CY, Kuo HT, Hsu AY, Lin CJ, Hsia NY, Tien PT, Lai CT, Chen HS, Tsai YY. Prevalence of uveitis in syphilis patients in Taiwan. Emerg Microbes Infect 2024; 13:2290836. [PMID: 38047718 PMCID: PMC10810637 DOI: 10.1080/22221751.2023.2290836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
Few population-based studies have looked at the risk of uveitis among syphilis patients. Our study addresses the knowledge gap by reporting on uveitis risk in syphilis patients through a retrospective cohort study. The Taiwan National Health Insurance database was used for this study, covering the period from January 1st, 2009, to December 31st, 2020. We created a 1:4 propensity score matched cohort between the syphilis patients and controls, which accounted for gender, age, and comorbidities. The primary endpoint was the incidence of newly recorded uveitis. The assessment of uveitis risk in syphilis patients included the use of the Kaplan-Meier method and multivariate Cox proportional hazard model. A total of 31,597 syphilis patients and 126,379 matched comparisons were recruited. The uveitis incidence rate from our syphilis patients was 1.25 per 1000 person-years. The uveitis incidence rate from our non-syphilis group was 0.8 per 1000 person-years. After matching, the syphilis group was found to have a higher risk of developing uveitis (adjusted hazard ratio (aHR) [95% CI]: 1.57 [1.36-1.81], P < .001). Among males and individuals aged 20-34 years, subgroup analysis showed an increased risk of uveitis in the presence of syphilis infection. The Kaplan-Meier survival curve showed a significant difference in uveitis incidence between syphilis and non-syphilis groups (log-rank test P < .001). In summary, our study revealed that Taiwanese syphilis patients were at a higher risk of developing uveitis. These results highlight the need for regular ocular monitoring and screening in individuals with syphilis.
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Affiliation(s)
- Chia-Yun Chen
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hou-Ting Kuo
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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de-la-Torre A, Mejía-Salgado G, Cifuentes-González C, Rojas-Carabali W, Cuevas M, García S, Rangel CM, Durán C, Pachón-Suárez DI, Bustamante-Arias A. Epidemiology, clinical features, and classification of 3,404 patients with uveitis: Colombian Uveitis Multicenter Study (COL-UVEA). Graefes Arch Clin Exp Ophthalmol 2024; 262:2601-2615. [PMID: 38446198 PMCID: PMC11271433 DOI: 10.1007/s00417-024-06422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
PURPOSE To describe the epidemiology, clinical features, and classification of uveitis in a large cohort of Colombian patients. METHODS Data were collected from seven ophthalmological referral centers in the four main cities in Colombia. The study included patients with a confirmed diagnosis of uveitis from January 2010 to December 2022. Information on demographics, ophthalmic examination findings, uveitis classification, and etiology was recorded. RESULTS The study reviewed 3,404 clinical records of patients with uveitis. The mean age at diagnosis was 41.1 (SD 19.0) years, and 54.2% of the patients were female. Overall, 1,341(39.4%) were infectious, 626 (18.4%) non-infectious, and four masquerade syndromes (0.1%). The most common types of uveitis were unilateral (66.7%), acute (48.3%), and non-granulomatous (83%). Anterior uveitis was the most common anatomical localization (49.5%), followed by posterior uveitis (22.9%), panuveitis (22.3%), and intermediate uveitis (5.2%). A diagnosis was established in 3,252 (95.5%) cases; idiopathic was the most common cause (27.7%), followed by toxoplasmosis (25.3%) and virus-associated uveitis (6.4%). The age group between 30 and 50 exhibited the highest frequency of uveitis. CONCLUSION This multicenter study comprehensively describes uveitis characteristics in Colombian patients, providing valuable insights into its demographic and clinical features. The study findings emphasize the need to continue updating the changing patterns of uveitis to improve diagnosis and treatment strategies for diseases associated with intraocular inflammation.
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Affiliation(s)
- Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia.
| | - Germán Mejía-Salgado
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - Miguel Cuevas
- Department of Ophthalmology, School of Medicine and Health Sciences, Universidad de Antioquia, Medellín, Colombia
| | - Sandra García
- Department of Ophthalmology, School of Medicine and Health Sciences, Universidad Pontificia Javeriana, Cali, Colombia
| | - Carlos M Rangel
- Department of Ophthalmology, School of Medicine and Health Sciences, FOSCAL, Centro Oftalmológico Virgilio Galvis, Universidad Industrial de Santander, Universidad Autónoma de Bucaramanga, Floridablanca, Santander, Colombia
| | - Claudia Durán
- Ocular Immunology and Uveitis Department, School of Medicine and Health Sciences, Universidad CES, Medellín, Colombia
| | - Diana Isabel Pachón-Suárez
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
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Bromeo AJ, Karaca I, Ghoraba HH, Lyu X, Than NTT, Ongpalakorn P, Shin YU, Uludag G, Tran ANT, Thng ZX, Do DV, Or CMC, Nguyen QD. Risk factors for development of anti-adalimumab antibodies in non-infectious uveitis. Heliyon 2024; 10:e29313. [PMID: 38694084 PMCID: PMC11061690 DOI: 10.1016/j.heliyon.2024.e29313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 05/03/2024] Open
Abstract
Purpose To evaluate risk factors associated with development of anti-adalimumab antibodies (AAA) in patients with non-infectious uveitis treated with adalimumab. Methods A retrospective, cross-sectional, case-control study was done evaluating patients with non-infectious uveitis treated with adalimumab for at least 12 months and have undergone testing for AAA levels. Demographics, clinical characteristics, grading of ocular inflammation, and previous and concomitant immunomodulatory therapy were assessed. Univariate and multivariate analysis were done to estimate odds ratio (OR) with 95% confidence intervals for the various risk factors. Results A total of 31 patients were included in the analysis, in which 12 patients who tested positive (Group 1) were matched with 19 patients who tested negative for AAA (Group 2). The groups differed significantly in terms of sex (female) (91.7% vs 52.6%, p = 0.046), presence of systemic disease (91.7% vs 42.1%, p = 0.008), and presence of anterior chamber inflammation at baseline (100% vs 63.2%, p = 0.026). A history of interruption in anti-TNF therapy prior to starting or restarting adalimumab was found to have an increased odds for development of AAA (OR 16.89 [2.92, 107.11], p = 0.008), as well as flare-ups (reactivation of disease) during adalimumab therapy (OR 6.77 [1.80, 61.80], p = 0.027). Weekly dosing of adalimumab was shown to decrease odds of AAA development (OR 0.34 [0.02, 0.70], p = 0.040), while concomitant anti-metabolite therapy was not shown to be a statistically significant protective factor (OR 2.22 [0.50, 9.96], p = 0.148). Conclusions History of interruption in anti-TNF therapy and flare during adalimumab were associated with development of AAA, while weekly dosing of adalimumab was protective against AAA. Identification of those with higher risk of developing AAA may guide in clinical decision making to optimize management for these patients.
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Affiliation(s)
| | - Irmak Karaca
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Xun Lyu
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Prapatsorn Ongpalakorn
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Nopparat Rajathanee Hospital, Bangkok, Thailand
| | - Yong Un Shin
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea
| | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Diana V. Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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Hsu AY, Wang YH, Lin CJ, Li YL, Hsia NY, Lai CT, Kuo HT, Chen HS, Tsai YY, Wei JCC. Assessing Uveitis Risk following Pediatric Down Syndrome Diagnosis: A TriNetX Database Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:710. [PMID: 38792893 PMCID: PMC11123068 DOI: 10.3390/medicina60050710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The risks of uveitis development among pediatric patients with Down syndrome (DS) remain unclear. Therefore, we aimed to determine the risk of uveitis following a diagnosis of DS. Materials and Methods: This multi-institutional retrospective cohort study utilized the TriNetX database to identify individuals aged 18 years and younger with and without a diagnosis of DS between 1 January 2000 and 31 December 2023. The non-DS cohort consisted of randomly selected control patients matched by selected variables. This included gender, age, ethnicity, and certain comorbidities. The main outcome is the incidence of new-onset uveitis. Statistical analysis of the uveitis risk was reported using hazard ratios (HRs) and 95% confidence intervals (CIs). Separate analyses of the uveitis risk among DS patients based on age groups and gender were also performed. Results: A total of 53,993 individuals with DS (46.83% female, 58.26% white, mean age at index 5.21 ± 5.76 years) and 53,993 non-DS individuals (45.56% female, 58.28% white, mean age at index 5.21 ± 5.76 years) were recruited from the TriNetX database. Our analysis also showed no overall increased risk of uveitis among DS patients (HR: 1.33 [CI: 0.89-1.99]) compared to the non-DS cohort across the 23-year study period. Subgroup analyses based on different age groups showed that those aged 0-1 year (HR: 1.36 [CI: 0.68-2.72]), 0-5 years (HR: 1.34 [CI: 0.75-2.39]), and 6-18 years (HR: 1.15 [CI: 0.67-1.96]) were found to have no association with uveitis risk compared to their respective non-DS comparators. There was also no increased risk of uveitis among females (HR: 1.49 [CI: 0.87-2.56]) or males (HR: 0.82 [CI: 0.48-1.41]) with DS compared to their respective non-DS comparators. Conclusions: Our study found no overall increased risk of uveitis following a diagnosis of DS compared to a matched control population.
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Affiliation(s)
- Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (Y.-H.W.); (J.C.-C.W.)
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - You-Ling Li
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - Hou-Ting Kuo
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- Department of General Medicine, China Medical University Hospital, Taichung 40201, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung 43655, Taiwan;
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - James Cheng-Chung Wei
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (Y.-H.W.); (J.C.-C.W.)
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan
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Abu Serhan H, Abu Suilik H, Hassan AK, AlSamhori JF, Hassan AR, Siddiq A, Ahmed N, Elnahry AG. The characteristics of white dot syndromes following COVID-19 Vaccines: a systematic review. Int Ophthalmol 2024; 44:189. [PMID: 38652153 PMCID: PMC11039548 DOI: 10.1007/s10792-024-03119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To review all studies reporting the onset of white dot syndromes following COVID-19 vaccines. METHODS Our protocol was registered prospectively on PROSPERO [registration number: CRD42023426012]. We searched five different databases including PubMed, Scopus, Web of Science, Google Scholar, and Science Direct up to May 2023. All the studies that reported the occurrence of white dot syndrome following COVID-19 vaccines were included. All statistical tests were conducted with a 95% confidence interval and a 5% error margin. A p value of less than 0.05 was considered statistically significant. The methodological quality of included studies was performed using the IHE Quality Appraisal Checklist for Case Series studies and JBI Critical Appraisal Checklist for Case Reports. RESULTS Fifty studies involving seventy-one subjects were included. Multiple evanescent white dot syndrome (MEWDS) was the most common disease (n = 25, 35.2% %), followed by acute macular neuroretinopathy (AMN) (n = 22, 31.0%) and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) (n = 4, 5.6%). They were mostly unilateral (n = 50, 70.4%). The presenting symptoms were blurred vision (n = 26, 36.6%), paracentral scotoma (n = 19, 26.8%), visual field disturbance, and photopsia (n = 7, 9.9%). The mean duration for follow-up was 10.15 ± 14.04 weeks. Nineteen subjects (29.69%) received steroids with improvement reported in 68.4%. Eleven subjects (17.19%) were managed by observation only with reported full recovery and improvement. CONCLUSION White dot syndromes are very rare entities. Our findings highlight a possible association between COVID-19 vaccines and the occurrence of white dot syndromes. However, larger studies with good quality should be implemented to confirm these findings.
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Affiliation(s)
- Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Al Sadd, Al Rayyan St., PO: 3050, Doha, Qatar.
| | | | - Amr K Hassan
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | | | - Abdul Rhman Hassan
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Nagi Ahmed
- Department of Ophthalmology, Hamad Medical Corporations, Al Sadd, Al Rayyan St., PO: 3050, Doha, Qatar
| | - Ayman G Elnahry
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [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: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Felfeli T, Eshtiaghi A, Rhee J, Balas M, Tai F, Kaplan AJ, Christakis PG, Dzulynsky K, Monson H, Mandelcorn ED, Rubin LA, Bakshi NK, Derzko-Dzulynsky LA. Clinical characteristics of non-infectious uveitis treated with and without systemic immunomodulatory therapy. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00308-3. [PMID: 37972648 DOI: 10.1016/j.jcjo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To compare the patient characteristics and long-term outcomes for those treated with and without systemic immunomodulatory therapy (IMT) for non-infectious uveitis (NIU). DESIGN Retrospective cohort study. PARTICIPANTS All consecutive adults with NIU receiving care at 5 uveitis subspecialty tertiary care clinics between 2010 and 2021. METHODS Clinical outcomes were evaluated on initial presentation and at the last available follow-up. The main outcome measures were baseline characteristics and final visual acuity. RESULTS A total of 914 NIU patients (418 IMT, 496 non-IMT) with a median age of 51.0 years and 57.4% female were identified. Over half the patients had bilateral disease, with a significantly higher proportion of bilateral cases in the IMT group compared with the non-IMT group (p < 0.001). The IMT group was more likely to have chronic uveitis (p < 0.001), with a higher proportion of patients experiencing cataracts and cystoid macular edema (p < 0.001 for both). A significantly higher proportion of non-IMT patients had anterior uveitis and an idiopathic etiology (p < 0.001). Overall, visual acuity improved significantly from baseline to last follow-up in the entire cohort (p < 0.001), with a slightly better improvement in the IMT group. Multivariable linear regression analysis suggested that baseline visual acuity and panuveitis were significant predictors of final visual acuity (p < 0.001 for both). CONCLUSIONS NIU patients on IMT are often younger, suffer from bilateral and chronic uveitis, and are more likely to have ocular complications. Those in the non-IMT group are more likely to have anterior idiopathic NIU. Baseline visual acuity and panuveitis are the main predictors of final vision outcomes among patients with NIU.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON.
| | - Arshia Eshtiaghi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Jess Rhee
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Felicia Tai
- Division of Ophthalmology, McMaster University, Hamilton, ON
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Panos G Christakis
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Kira Dzulynsky
- Faculty of Engineering, McGill University, Montreal, Que
| | - Hayley Monson
- Faculty of Mathematics, McMaster University, Hamilton, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Laurence A Rubin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Division of Rheumatology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
| | - Nupura K Bakshi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Ophthalmology, Mount Sinai Hospital, Toronto, ON
| | - Larissa A Derzko-Dzulynsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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Alarfaj G, Alahmadi G, Alabdullah H, Al-Khars W, Al-Hammad F. Pattern of Uveitis at a Tertiary Eye Hospital in Eastern Province of Saudi Arabia and Comparison with Local Literature. Ocul Immunol Inflamm 2023; 31:1837-1841. [PMID: 36745705 DOI: 10.1080/09273948.2022.2128822] [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: 04/30/2022] [Accepted: 09/20/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the patterns of uveitis in a main ophthalmic referral center in the Eastern province of Saudi Arabia. METHODS A retrospective chart review of uveitis cases was conducted in a tertiary eye hospital for five years. In addition, a comprehensive review of Saudi publications about uveitis patterns in the literature. RESULTS Out of 222 patients included, 54.4% were females, with a mean age of 38.5 years. Uveitis was bilateral in 55.7%, non-granulomatous in 55.9%, and infectious in 11.3%. Most of the cases were anterior uveitis (51.1%), followed by panuveitis (26%), intermediate uveitis (12.8%), and posterior uveitis (10%). Apart from idiopathic cases (43.7%), the most common diagnoses were Vogt-Koyanagi-Harada disease (11.3%) and Behcet's disease (7.7%) in adults. Juvenile idiopathic arthritis (7.2%) was commonest among children. Posterior synechiae was the leading complication (32.0%), followed by cataracts (22.8%). CONCLUSIONS VKH and Behçet disease were the primary non-idiopathic etiologies in Saudi Arabia.
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Affiliation(s)
- Ghufran Alarfaj
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
| | - Ghaida Alahmadi
- Department of Ophthalmology, Ohud Hospital, Medina, Saudi Arabia
| | - Hend Alabdullah
- Department of Ophthalmology, King Fahad Specialist Hospital, Tabuk, Saudi Arabia
| | - Wajeeha Al-Khars
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
| | - Fatimah Al-Hammad
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
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9
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Wan GJ, Niewoehner J, Hayes K. Acthar Gel (RCI): A Narrative Literature Review of Clinical and Economic Evidence. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:499-512. [PMID: 37397803 PMCID: PMC10312382 DOI: 10.2147/ceor.s410082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
Acthar® Gel (repository corticotropin injection [RCI]) is a naturally sourced complex mixture of adrenocorticotropic hormone analogs and other pituitary peptides used to treat patients with serious and rare inflammatory and autoimmune conditions. This narrative review summarizes the key clinical and economic findings among 9 indications: infantile spasms (IS), multiple sclerosis (MS) relapses, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), dermatomyositis and polymyositis (DM/PM), ocular inflammatory diseases (primarily uveitis and severe keratitis), symptomatic sarcoidosis, and proteinuria in nephrotic syndrome (NS). Key studies of clinical efficacy and healthcare resource utilization and cost from 1956 to 2022 are discussed. Evidence supports the efficacy of RCI across all 9 indications. RCI is recommended as first-line treatment for IS and is associated with improved outcomes for the other 8 indications, including increased recovery rates in MS relapse; improved disease control in RA, SLE, and DM/PM; real-world effectiveness in patients with uveitis and severe keratitis; improved lung function and reduced corticosteroid use in symptomatic sarcoidosis; and increased rates of partial remission of proteinuria in NS. For many indications, RCI may improve clinical outcomes during exacerbations or when conventional treatments have failed to show a benefit. RCI is also associated with a reduction in the use of biologics, corticosteroids, and disease-modifying antirheumatic drugs. Economic data suggest RCI is a cost-effective, value-based treatment option for MS relapse, RA, and SLE. Other economic benefits have been demonstrated for IS, MS relapses, RA, SLE, and DM/PM, including reduced hospitalizations, lengths of stay, inpatient and outpatient services, and emergency department visits. RCI is considered safe and effective and features economic benefits for numerous indications. Its ability to control relapse and disease activity makes RCI an important nonsteroid treatment option that could help preserve functioning and well-being among patients with inflammatory and autoimmune conditions.
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Affiliation(s)
- George J Wan
- Mallinckrodt Pharmaceuticals, Bridgewater, NJ, USA
| | | | - Kyle Hayes
- Mallinckrodt Pharmaceuticals, Bridgewater, NJ, USA
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10
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Begaj T, Yuan A, Lains I, Li A, Han S, Susarla G, Parikh R, Sobrin L. Presence of Choroidal Caverns in Patients with Posterior and Panuveitis. Biomedicines 2023; 11:biomedicines11051268. [PMID: 37238939 DOI: 10.3390/biomedicines11051268] [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: 03/23/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Choroidal caverns (CCs) have been described in association with age-related macular degeneration and pachychoroid disease. However, it is unknown if caverns are found in patients with chronic non-infectious uveitis (NIU). Herein, we evaluated patients with NIU who had optical coherence tomography and indocyanine green angiography for CCs. Clinical and demographic characteristics were extracted from the chart review. Univariate and multivariate mixed-effects logistical models were used to assess the association between clinical and demographic factors and the presence of CCs. One hundred thirty-five patients (251 eyes) met the inclusion criteria: 1 eye had anterior uveitis, 5 had intermediate uveitis, 194 had posterior uveitis, and 51 had panuveitis. The prevalence of CCs was 10%. CCs were only observed in patients with posterior and panuveitis, with a prevalence of 10.8% and 7.8%, respectively. Multifocal choroiditis (MFC) was the type of uveitis where CCs were most frequently observed, with 40% of eyes with MFC having CCs. In addition, male sex (p = 0.024) was associated with CCs. There was no significant difference in the degree of intraocular inflammation or mean subfoveal choroidal thickness between CC+ and CC- eyes. This is the first study to describe CCs in uveitis. Overall, these findings suggest that caverns may be a sequela of structural and/or vascular perturbations in the choroid from uveitis.
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Affiliation(s)
- Tedi Begaj
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Amy Yuan
- Retina Department, University of Washington, Seattle, WV 98195, USA
| | - Ines Lains
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Ashley Li
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Samuel Han
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Gayatri Susarla
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Ravi Parikh
- Manhattan Retina and Eye Consultants, New York, NY 10075, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY 10016, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
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11
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Cherif YYS, Djeffal C, Abu Serhan H, Elnahhas A, Yousef H, Katamesh BE, Abdelazeem B, Abdelaal A. The Characteristics of COVID-19 Vaccine-Associated Uveitis: A Summative Systematic Review. Vaccines (Basel) 2022; 11:69. [PMID: 36679914 PMCID: PMC9860710 DOI: 10.3390/vaccines11010069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022] Open
Abstract
Numerous complications following COVID-19 vaccination has been reported in the literature, with an increasing body of evidence reporting vaccination-associated uveitis (VAU). In this systematic review, we searched six electronic databases for articles reporting the occurrence of VAU following COVID-19 vaccination. Data were synthesized with emphasis on patients' characteristics [age, gender], vaccination characteristics [type, dose], and outcome findings [type, nature, laterality, course, location, onset, underlying cause, and associated findings]. Data are presented as numbers (percentages) for categorical data and as mean (standard deviation) for continuous data. Sixty-five studies were finally included [43 case reports, 16 case series, four cohort, one cross-sectional, and one registry-based study]. VAU occurred in 1526 cases, most commonly in females (68.93%) and middle-aged individuals (41-50 years: 19.71%), following the first dose (49.35%) of vaccination, especially in those who received Pfizer (77.90%). VAU occurred acutely (71.77%) as an inflammatory reaction (88.29%) in unilateral eyes (77.69%), particularly in the anterior portion of the uvea (54.13%). Importantly, most cases had a new onset (69.92%) while only a limited portion of cases had a reactivation of previous uveitis condition. In conclusion, although rare, uveitis following COVID-19 vaccination should be considered in new-onset and recurrent cases presenting with either acute or chronic events.
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Affiliation(s)
| | - Chakib Djeffal
- Faculty of Medicine, University of Algiers, Algiers 16311, Algeria
| | - Hashem Abu Serhan
- Tanta Research Team, El-Gharbia 31516, Egypt
- Department of Ophthalmology, Hamad Medical Corporations, Doha 576214, Qatar
| | - Ahmed Elnahhas
- Tanta Research Team, El-Gharbia 31516, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Hebatallah Yousef
- Tanta Research Team, El-Gharbia 31516, Egypt
- Ophthalmology Department, Kafr Ash Shaykh Ophthalmology Hospital, Kafr Ash Shaykh 33511, Egypt
| | - Basant E. Katamesh
- Tanta Research Team, El-Gharbia 31516, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Basel Abdelazeem
- Tanta Research Team, El-Gharbia 31516, Egypt
- McLaren Health Care, Flint, MI 48532, USA
- Internal Medicine Department, Michigan State University, East Lansing, Michigan, MI 48824, USA
| | - Abdelaziz Abdelaal
- Tanta Research Team, El-Gharbia 31516, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Harvard Medical School, Postgraduate Medical Education, Boston, MA 02115, USA
- Doheny Eye Institute, University of California, Los Angeles, CA 90033, USA
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12
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Lu S, Wang H, Zhang J. Identification of uveitis-associated functions based on the feature selection analysis of gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment scores. Front Mol Neurosci 2022; 15:1007352. [PMID: 36157069 PMCID: PMC9493498 DOI: 10.3389/fnmol.2022.1007352] [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: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Uveitis is a typical type of eye inflammation affecting the middle layer of eye (i.e., uvea layer) and can lead to blindness in middle-aged and young people. Therefore, a comprehensive study determining the disease susceptibility and the underlying mechanisms for uveitis initiation and progression is urgently needed for the development of effective treatments. In the present study, 108 uveitis-related genes are collected on the basis of literature mining, and 17,560 other human genes are collected from the Ensembl database, which are treated as non-uveitis genes. Uveitis- and non-uveitis-related genes are then encoded by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment scores based on the genes and their neighbors in STRING, resulting in 20,681 GO term features and 297 KEGG pathway features. Subsequently, we identify functions and biological processes that can distinguish uveitis-related genes from other human genes by using an integrated feature selection method, which incorporate feature filtering method (Boruta) and four feature importance assessment methods (i.e., LASSO, LightGBM, MCFS, and mRMR). Some essential GO terms and KEGG pathways related to uveitis, such as GO:0001841 (neural tube formation), has04612 (antigen processing and presentation in human beings), and GO:0043379 (memory T cell differentiation), are identified. The plausibility of the association of mined functional features with uveitis is verified on the basis of the literature. Overall, several advanced machine learning methods are used in the current study to uncover specific functions of uveitis and provide a theoretical foundation for the clinical treatment of uveitis.
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Affiliation(s)
- Shiheng Lu
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Research Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- *Correspondence: Shiheng Lu,
| | - Hui Wang
- Department of Orthopedics, Shanghai Yangpu Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Jian Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Research Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Jian Zhang,
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Kouwenberg CV, Koopman‐Kalinina Ayuso V, de Boer JH. Clinical benefits and potential risks of adalimumab in non-JIA chronic paediatric uveitis. Acta Ophthalmol 2022; 100:e994-e1001. [PMID: 34532967 PMCID: PMC9290889 DOI: 10.1111/aos.15012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 01/29/2023]
Abstract
Purpose To describe the treatment results with adalimumab in chronic paediatric uveitis, not associated with juvenile idiopathic arthritis (JIA). Methods Medical records of children with non‐JIA‐uveitis were reviewed retrospectively. Children without an underlying systemic disease were pre‐screened with brain magnetic resonance imaging (MRI) to exclude white matter abnormalities/demyelination. Results Twenty‐six patients were pre‐screened with brain MRI, of whom adalimumab was contraindicated in six patients (23%) with non‐anterior uveitis. Forty‐three patients (81 eyes) were included. Disease inactivity was achieved in 91% of the patients after a median of three months (3–33). Best‐corrected visual acuity (BCVA) improved from 0.16 ± 0.55 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.05 ± 0.19 logMAR at 24 months (p = 0.015). The median dosage of systemic corticosteroids was reduced to 0 mg/day at 24 months of follow‐up (versus 10 mg/day at baseline; p < 0.001). Adalimumab was discontinued in thirteen children due to ineffectiveness (n = 8), side effects (n = 1), long‐term inactivity of uveitis (n = 3) or own initiative (n = 1). Relapse of uveitis occurred in 19 (49%) patients, 5 (26%) of them without an identifiable cause. Conclusion Adalimumab is effective in the treatment of non‐JIA‐uveitis in paediatric patients by achieving disease inactivity in the majority of the patients, improving BCVA and decreasing the dose of corticosteroids. Adverse events and side effects are limited. Pre‐screening with MRI of the brain is recommended in paediatric patients with intermediate and panuveitis.
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Affiliation(s)
- Carlyn V. Kouwenberg
- Department of Ophthalmology University Medical Centre Utrecht Utrecht The Netherlands
| | | | - Joke H. de Boer
- Department of Ophthalmology University Medical Centre Utrecht Utrecht The Netherlands
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14
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Lo TC, Chen YY, Chen HH. Risk of inflammatory bowel disease in uveitis patients: a population-based cohort study. Eye (Lond) 2022; 36:1288-1293. [PMID: 34155367 PMCID: PMC9151650 DOI: 10.1038/s41433-021-01645-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate the potential association between uveitis and an increased risk of developing inflammatory bowel disease (IBD). METHODS We conducted a retrospective cohort study by interrogating data from the Taiwan National Health Insurance Research Database entered between January 1, 2001 and December 31, 2013 to identify uveitis patients and age- and gender-matched controls. The cumulative incidence rates of subsequent IBD in the two groups were compared. The adjusted hazard ratio (HR) of IBD related to uveitis was generated by a multivariate cox regression model after adjustment for hypertension, diabetes, hyperlipidaemia, obesity and smoking. Furthermore, the HRs of the Crohn's disease (CD) and ulcerative colitis (UC) IBD subtypes were calculated separately. RESULTS A total of 198,923 subjects with uveitis and 397,846 controls were enroled. The mean age of the cohort was 47.7 ± 18.9 years. A significantly higher cumulative incidence of IBD was found in the uveitis group than in controls (4.13% vs. 1.48%, p < 0.0001). Under univariate cox regression analysis, uveitis patients had a significantly higher risk of IBD (HR = 1.47; 95% confidence interval (CI): 1.43-1.52, p < 0.0001). The association remained significant in the multivariate regression model, with an adjusted HR of 1.44 (95% CI: 1.39-1.49, p < 0.0001). Moreover, in subgroup analysis, uveitis was significantly associated with an increased risk of Crohn's disease (adjusted HR = 1.49; 95% CI: 1.44-1.54), but not with ulcerative colitis (adjusted HR = 1.03; 95% CI: 0.92-1.15). CONCLUSIONS Patients with uveitis are at significantly greater risk of developing IBD than individuals without uveitis.
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Affiliation(s)
- Tzu-Chen Lo
- grid.410764.00000 0004 0573 0731Department of Medical Education, Taichung Veterans General Hospital, Taichung, 407 Taiwan ,grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112 Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan. .,Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, 407, Taiwan. .,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan.
| | - Hsin-Hua Chen
- grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, 112 Taiwan ,grid.411641.70000 0004 0532 2041School of Medicine, Chung Shan Medical University, Taichung, 402 Taiwan ,grid.265231.10000 0004 0532 1428Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, 407 Taiwan ,grid.410764.00000 0004 0573 0731Division of Allergy, Immunology, and Rheumatology & Division of General Internal Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407 Taiwan ,grid.260542.70000 0004 0532 3749Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, 402 Taiwan
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15
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Kessler LJ, Łabuz G, Auffarth GU, Khoramnia R. Biomarkers to Predict the Success of Treatment with the Intravitreal 0.19 mg Fluocinolone Acetonide Implant in Uveitic Macular Edema. Pharmaceutics 2022; 14:pharmaceutics14040688. [PMID: 35456522 PMCID: PMC9028038 DOI: 10.3390/pharmaceutics14040688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 12/10/2022] Open
Abstract
To predict the need for additional local corticosteroids after receiving the 0.19 mg fluocinolone acetonide (FAc) implant in patients with macular edema secondary to non-infectious uveitis previously treated with local peribulbar corticosteroids. The number of corticosteroids required prior FAc, visual acuity, central retinal thickness, ellipsoid zone reflectivity ratio (EZR), and choroidal vascularity index (CVI) were compared between patients who did and did not require additional corticosteroids after FAc implantation. Pearson’s correlation coefficient (R) between putative predictors and the number of adjunctive corticosteroids after FAc implantation were measured; significant candidates were included in a generalized regression model. Patients who required additional corticosteroids after FAc had higher CVI and central retinal thickness as well as worse EZR at subsequent visits (p < 0.05). The number of corticosteroids required prior to FAc implantation (R: 0.49), CVI change from baseline to 6 months (R: −0.41), and central retinal thickness at baseline (R: −0.36) correlated to the number of additional corticosteroids (all p < 0.05). A higher number of corticosteroids per year before FAc implantation was predictive for an increase in corticosteroids required after FAc (odds ratio = 2.65), while a decrease in CVI from baseline to 6 months was inversely correlated (odds ratio = 0.82). Our results suggest that the more corticosteroids prior to FAc and the greater the short-term CVI reducing effect, the less is the chance to get additional corticosteroids after FAc.
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Affiliation(s)
- Lucy Joanne Kessler
- Department of Ophthalmology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (L.J.K.); (G.Ł.); (G.U.A.)
- HEIKA–Heidelberg Karlsruhe Strategic Partnership, Department of Ophthalmology, Heidelberg University, 69120 Heidelberg, Germany
| | - Grzegorz Łabuz
- Department of Ophthalmology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (L.J.K.); (G.Ł.); (G.U.A.)
| | - Gerd U. Auffarth
- Department of Ophthalmology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (L.J.K.); (G.Ł.); (G.U.A.)
| | - Ramin Khoramnia
- Department of Ophthalmology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (L.J.K.); (G.Ł.); (G.U.A.)
- HEIKA–Heidelberg Karlsruhe Strategic Partnership, Department of Ophthalmology, Heidelberg University, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-06221-56-4573
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16
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WANG QM, GAO J, ZHANG YL, WANG X, PANG YJ. Effects of Qingli Gandan decoction on IL-23/IL-17 in rats with experimental autoimmune uveitis. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.69122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Juan GAO
- Tianjin Key Laboratory of Ophthalmology and Visual Science, China
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Rosina S, Natoli V, Santaniello S, Trincianti C, Consolaro A, Ravelli A. Novel biomarkers for prediction of outcome and therapeutic response in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2021; 17:853-870. [PMID: 34139935 DOI: 10.1080/1744666x.2021.1945441] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The search for biomarkers in juvenile idiopathic arthritis (JIA) is a promising and rapidly expanding field of investigation. The biomarkers identified so far may help to dissect the clinical heterogeneity of the illness, measure the level of disease activity, predict clinical remission, relapse, response to medications, course over time, complications, and forestall disease flares. AREAS COVERED We provide a summary of the most recent advances in the development and application of biomarkers in JIA. We performed a PubMed search for significant articles combining predetermined keywords related to biomarkers in non-systemic and systemic JIA, chronic uveitis, and macrophage activation syndrome (MAS). The biomarkers available or under study are presented and discussed separately for non-systemic and systemic subtypes and for the two main disease complications, uveitis and MAS. EXPERT OPINION The incorporation of valid and reliable biomarkers in standard clinical care may help to design better patient-tailored treatment regimens and to improve the therapeutic strategies based on the treat-to-target approach. The establishment of biomarkers that predict the risk of disease flare may lead to define the optimal modalities for treatment discontinuation after the achievement of clinical remission.
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Affiliation(s)
- Silvia Rosina
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Valentina Natoli
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Stefania Santaniello
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Chiara Trincianti
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Alessandro Consolaro
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Angelo Ravelli
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
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18
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Wu S, Ma R, Zhong Y, Chen Z, Zhou H, Zhou M, Chong W, Chen J. Deficiency of IL-27 Signaling Exacerbates Experimental Autoimmune Uveitis with Elevated Uveitogenic Th1 and Th17 Responses. Int J Mol Sci 2021; 22:ijms22147517. [PMID: 34299138 PMCID: PMC8305313 DOI: 10.3390/ijms22147517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 07/11/2021] [Indexed: 01/31/2023] Open
Abstract
Human uveitis is an autoimmune disease of the central nervous system that is characterized by ocular inflammation with the involvement of uveitogenic Th1 and Th17 responses. In experimental autoimmune uveitis (EAU), the animal model for human uveitis, both responses are proven to be critical in disease development. Therefore, targeting both Th1 and Th17 cells has therapeutic implication for disease resolution. IL-27 is a multifunctional cytokine that can either promote or inhibit T cell responses and is implicated in both autoimmune and infectious diseases. The aim of this study is to characterize the role of IL-27/IL-27R signaling in regulating uveitogenic Th1/Th17 responses in EAU. By immunizing IL-27Rα-/- mice and their wild-type (WT) littermates for EAU, we demonstrated that IL-27 signaling deficiency exacerbated EAU with severe ocular inflammation and impairment of visual function. Furthermore, there was a significant increase in the eye-infiltrating Th1 and Th17 cells in IL-27Rα-/- EAU mice compared to WT. Their retinal antigen-specific Th1 and Th17 responses were also significantly increased, as represented by the elevation of their signature cytokines, IFN-γ and IL-17A, respectively. We also observed the upregulation of another pathogenic cytokine, granulocyte-macrophage colony-stimulating factor (GM-CSF), from effector T cells in IL-27Rα-/- EAU mice. Mechanistic studies confirmed that IL-27 inhibited GM-CSF production from Th17 cells. In addition, the induction of IL-10 producing type 1 regulatory T (Tr1) cells was impaired in IL-27Rα-/- EAU mice. These results identified that IL-27 signaling plays a suppressive role in EAU by regulating multiple CD4+ cell subsets, including the effector Th1 and Th17 cells and the regulatory Tr1 cells. Our findings provide new insights for therapeutic potential in controlling uveitis by enhancing IL-27 signaling.
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19
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Ruxolitinib Alleviates Uveitis Caused by Salmonella typhimurium Endotoxin. Microorganisms 2021; 9:microorganisms9071481. [PMID: 34361917 PMCID: PMC8307045 DOI: 10.3390/microorganisms9071481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022] Open
Abstract
Uveitis is characterized by inflammatory lesions of intraocular structures. It is one of the important manifestations in patients with Reiter’s syndrome, an inflammatory arthritis, which is caused by enteric infection with bacteria, including Salmonella typhimurium. Corticosteroids remain the most frequently used therapies against uveitis associating with inflammatory arthritis. However, the long-term administration of steroids results in many side effects, and some uveitis patients do not respond to steroid treatment. Non-steroidal treatments are needed for uveitis patients. Our previous study found that Janus kinase (JAK) 1/2 inhibitor, ruxolitinib could suppress the expression of proinflammatory mediators in the ciliary body and iris. However, the impacts of ruxolitinib on ophthalmic features in uveitic eyes are still unknown. In this study, Salmonella typhimurium endotoxin-induced uveitis (EIU) was induced in Sprague Dawley rats by the injection of lipopolysaccharide (LPS). Compared with LPS-induced rats treated with water, ruxolitinib significantly attenuated the clinical manifestations, infiltrating cells and protein exudation in the aqueous humor, and retina–choroid thickening. Amplitudes of b-wave in both scotopic and photopic electroretinogram (ERG), and the amplitude of a-wave in scotopic ERG in EIU animals were alleviated by ruxolitinib. Collectively, we propose ruxolitinib could attenuate endotoxin-induced uveitis and rescue visual functions in rats by inhibiting the JAK2-STAT3 pathway.
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Abstract
Purpose: Evaluate the prevalence and incidence, demographic characteristics, anatomical classification, concomitant complications and treatment of uveitis, as well as its association with systemic diseases in the northern Portuguese population referred to a tertiary care centre (São João Hospital, Porto).Methods: A retrospective observational study of 545 consecutive uveitis cases was performed between 12th April 2012 and the 26th October 2017. Uveitis was classified according to Standard Uveitis Nomenclature, while aetiology and complications were diagnosed by specific clinical and laboratory testing.Results: Prevalence was calculated to be 12,4 cases per 100,000 people while incidence was 3.9 cases per 100,000 people annual incidence. The ratio of females to males was 1.32:1 and the mean age at diagnosis was 47,86 years. Anterior uveitis was the most common classification making up 47.5%, followed by non-infectious posterior uveitis 18,0%, infectious posterior uveitis 8,4%, intermediate uveitis 5,5% and panuveitis 4,2%. Extra-uveal entities made up the rest of the causes (16.4%). In terms of aetiology, the majority of uveitis was idiopathic (32,1%) followed by axial spondylarthritis (12.1%), Behçet's disease (8,8%), sarcoidosis (6,1%), tuberculosis (5,5%), herpes (5,1%), toxoplasmosis (3,1%) among other less frequent causes.Conclusion: In our referral region, 72% of uveitis cases were correctly identified surpassing other studies. There was a higher rate of intermediate uveitis and lower number of panuveitis cases when compared to a previous Portuguese study. Extensive monitoring of the development of uveitis by international multicentre prospective studies could be useful for increasing practitioner awareness and diagnostic approach.
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Affiliation(s)
- Lukasz Hermann
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Ophthalmology, Hospital S. João, Porto, Portugal
| | - Luís Figueira
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Ophthalmology, Hospital S. João, Porto, Portugal.,Center for Drug Discovery and Innovative Medicines (Medinup), University of Porto, Porto, Portugal
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21
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Ulhaq ZS, Soraya GV, Budu, Wulandari LR. The role of IL-6-174 G/C polymorphism and intraocular IL-6 levels in the pathogenesis of ocular diseases: a systematic review and meta-analysis. Sci Rep 2020; 10:17453. [PMID: 33060644 PMCID: PMC7566646 DOI: 10.1038/s41598-020-74203-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/26/2020] [Indexed: 02/08/2023] Open
Abstract
Interleukin-6 (IL-6) is one of the key regulators behind the inflammatory and pathological process associated with ophthalmic diseases. The role of IL-6-174 G/C polymorphism as well as intraocular IL-6 levels among various eye disease patients differ across studies and has not been systematically reviewed. Thus, this study aims to provide a summary to understand the relationship between IL-6 and ophthalmic disease. In total, 8,252 and 11,014 subjects for IL-6-174 G/C and intraocular levels of IL-6, respectively, were retrieved from PubMed, Scopus and Web of Science. No association was found between IL-6-174 G/C polymorphisms with ocular diseases. Subgroup analyses revealed a suggestive association between the GC genotype of IL-6-174 G/C with proliferative diabetic retinopathy (PDR). Further, the level of intraocular IL-6 among ocular disease patients in general was found to be higher than the control group [standardized mean difference (SMD) = 1.41, 95% confidence interval (CI) 1.24-1.58, P < 0.00001]. Closer examination through subgroup analyses yielded similar results in several ocular diseases. This study thus indicates that the IL-6-174 G/C polymorphism does not predispose patients to ocular disease, although the GC genotype is likely to be a genetic biomarker for PDR. Moreover, intraocular IL-6 concentrations are related to the specific manifestations of the ophthalmic diseases. Further studies with larger sample sizes are warranted to confirm this conclusion.
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Affiliation(s)
- Zulvikar Syambani Ulhaq
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim State Islamic University of Malang, Batu, East Java, 65151, Indonesia.
| | - Gita Vita Soraya
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Budu
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Lely Retno Wulandari
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia
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22
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Bing SJ, Lyu C, Xu B, Wandu WS, Hinshaw SJ, Furumoto Y, Caspi RR, Gadina M, Gery I. Tofacitinib inhibits the development of experimental autoimmune uveitis and reduces the proportions of Th1 but not of Th17 cells. Mol Vis 2020; 26:641-651. [PMID: 33088168 PMCID: PMC7531779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 09/11/2020] [Indexed: 10/31/2022] Open
Abstract
Purpose Tofacitinib is a pan-Janus kinase (JAK) inhibitor that suppresses cytokine signaling and in turn, the cells that participate in inflammatory immunopathogenic processes. We examined the capacity of tofacitinib to inhibit the induction of experimental autoimmune uveitis (EAU) and related immune responses. Methods EAU was induced in B10.A mice with immunization with bovine interphotoreceptor retinoid-binding protein (IRBP), emulsified in complete Freund's adjuvant (CFA), and a simultaneous injection of pertussis toxin. Tofacitinib, 25 mg/kg, was administered daily, and the vehicle was used for control. EAU development was assessed by histological analysis of the mouse eyes, and related immune responses were assessed by (i) the levels of interferon (IFN)-γ and interleukin (IL)-17, secreted by spleen cells cultured with IRBP; (ii) flow cytometric analysis of intracellular expression by spleen, or eye-infiltrating CD4 or CD8 cells of IFN-γ, IL-17, and their transcription factors, T-bet and RORγt. In addition, the inflammation-related cell markers CD44 and CD62L and Ki67, a proliferation marker, were tested. The proportions of T-regulatory cells expressing FoxP3 were determined by flow cytometric intracellular staining, while levels of antibody to IRBP were measured with enzyme-linked immunosorbent assay (ELISA). Results Treatment with tofacitinib significantly suppressed the development of EAU and reduced the levels of secreted IFN-γ, but not of IL-17. Further, treatment with tofacitinib reduced in the spleen and eye-infiltrating cells the intracellular expression of IFN-γ and its transcription factor T-bet. In contrast, treatment with tofacitinib had essentially no effect on the intracellular expression of IL-17 and its transcription factor, RORγt. The selective effect of tofacitinib treatment was particularly evident in the CD8 population. Treatment with tofacitinib also increased the population of CD44, but reduced the populations of cells producing CD62L and Ki67. Treatment with tofacitinib had no effect on the proportion of FoxP3 producing regulatory cells and on the antibody production to IRBP. Conclusions Treatment with tofacitinib inhibited the development of EAU, reduced the production of IFN-γ, but had essentially no effect on the production of IL-17.
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Affiliation(s)
- So Jin Bing
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Cancan Lyu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Biying Xu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Wambui S. Wandu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Samuel J. Hinshaw
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Yasuko Furumoto
- Translational Immunology Section, Office of Science and Technology, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Rachel R. Caspi
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Massimo Gadina
- Translational Immunology Section, Office of Science and Technology, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Igal Gery
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
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23
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Baumal CR, Spaide RF, Vajzovic L, Freund KB, Walter SD, John V, Rich R, Chaudhry N, Lakhanpal RR, Oellers PR, Leveque TK, Rutledge BK, Chittum M, Bacci T, Enriquez AB, Sund NJ, Subong ENP, Albini TA. Retinal Vasculitis and Intraocular Inflammation after Intravitreal Injection of Brolucizumab. Ophthalmology 2020; 127:1345-1359. [PMID: 32344075 DOI: 10.1016/j.ophtha.2020.04.017] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate features and outcomes of eyes with retinal vasculitis and intraocular inflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration. DESIGN Retrospective case series. PARTICIPANTS Fifteen eyes from 12 patients identified from 10 United States centers. METHODS Review of patient demographics, ophthalmologic examination results, and retinal imaging findings. MAIN OUTCOME MEASURES Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies. RESULTS The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P = 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P = 0.033). CONCLUSIONS Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.
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Affiliation(s)
- Caroline R Baumal
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts.
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York
| | | | - K Bailey Freund
- Vitreous, Retina, Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University, New York, New York
| | | | - Vishak John
- Vistar Eye Center, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Ryan Rich
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado
| | - Nauman Chaudhry
- Department of Ophthalmology, Yale University School of Medicine, New Have, Connecticut
| | - Rohit R Lakhanpal
- The Retina Care Center, LLC, Associated Retinal Consultants, LLC, Union, New Jersey
| | - Patrick R Oellers
- Retina-Vitreous Surgeons of Central New York, PC, Liverpool, New York
| | - Thellea K Leveque
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Bryan K Rutledge
- Retina-Vitreous Surgeons of Central New York, PC, Liverpool, New York
| | - Mark Chittum
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado
| | - Tommaso Bacci
- Vitreous, Retina, Macula Consultants of New York, New York, New York
| | - Ana Bety Enriquez
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts
| | - Newman J Sund
- The Retina Care Center, LLC, Associated Retinal Consultants, LLC, Union, New Jersey
| | | | - Thomas A Albini
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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24
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Yalçindag N, Köse HC. Comparison of the Treatment Results for Behçet Uveitis in Patients Treated with Infliximab and Interferon. Ocul Immunol Inflamm 2019; 28:305-314. [PMID: 31268743 DOI: 10.1080/09273948.2019.1606256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To compare the efficacy and safety of infliximab and interferon in patients with refractory Behçet uveitis.Methods: Medical records of 20 patients treated with infliximab (IFX) and 33 patients treated with interferon (IFN) were retrospectively analyzed by evaluating the number of uveitis attacks, visual acuity and ocular inflammation at 6 and 12 months after initiation of treatment.Results: Mean duration of treatment was 22 ± 18 months in IFX group and 30.3 ± 22.5 months in IFN group. Sixteen patients of IFX group (80%) and 28 patients of IFN group (85%) achieved remission. In both groups, the mean best-corrected visual acuity and all inflammatory parameters improved. In terms of these parameters, there was no significant difference between the two groups.Conclusion: Infliximab and interferon improve control of ocular inflammation and efficiently decrease the relapse rate. Our results determined no significant difference between two agents in controlling intraocular inflammation.
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Affiliation(s)
- Nilüfer Yalçindag
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Helin Ceren Köse
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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25
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Pre-eclampsia/Eclampsia as a Risk Factor of Noninfectious Uveitis Among Postdelivery Women. Am J Ophthalmol 2019; 198:166-173. [PMID: 30316670 DOI: 10.1016/j.ajo.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE We sought to analyze the incidence and risk of noninfectious uveitis (NIU) among postdelivery women with a history of pre-eclampsia/eclampsia (PEE). DESIGN Population-based retrospective matched cohort study. METHODS All participant data were retrieved from the Longitudinal Health Insurance Database 2005. Two thousand seventy-three postdelivery women ≥20 years of age were diagnosed with PEE between January 1, 1997 and December 31, 2012 and were included in the study. We traced the occurrence of NIU during 5 years of follow-up. The primary outcome measure was the occurrence of NIU with the use of anti-inflammatory drugs and adjudication by an ophthalmologist. RESULTS NIU occurred in 14 of 2073 (0.7%) postdelivery women with PEE. The incidence rate of NIU was 1.5 and 0.5 per 1000 person-years among postdelivery women with and without PEE, respectively (incidence rate ratio 2.96 [95% confidence interval 1.48-5.90]; P = .002). Postdelivery women with PEE demonstrated a significant increase in the cumulative incidence of NIU compared with those without PEE (P = .001). The risk of the occurrence of NIU was significantly higher in the PEE group than in the non-PEE group (adjusted hazard ratio 2.96 [95% CI 1.48-5.92]; P = .002) after adjusting for age, income, urbanization, and comorbidities. CONCLUSIONS This is the first study to substantiate an association between PEE and NIU. Our results suggest that PEE could be a potential risk factor for the occurrence of NIU among postdelivery women.
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Lin M, Anesi SD, Ma L, Ahmed A, Small K, Foster CS. Characteristics and Visual Outcome of Refractory Retinal Vasculitis Associated With Antineutrophil Cytoplasm Antibody-Associated Vasculitides. Am J Ophthalmol 2018; 187:21-33. [PMID: 29258731 DOI: 10.1016/j.ajo.2017.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the clinical characteristics, therapies, visual outcomes, and prognoses of patients with retinal vasculitis associated with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). DESIGN Retrospective case series. METHODS Patients diagnosed with retinal vasculitis associated with AAV and at least 6 months of follow-up were included. Demographic data, systemic and ocular features, best-corrected visual acuity at the initial visit and latest visit, fluorescein angiography (FA) and indocyanine green angiography (ICGA) findings, therapy regimen, and outcome were collected from the Massachusetts Eye Research and Surgery Institution (MERSI) database from 2006 to 2017. RESULTS Fourteen patients (22 eyes) were identified. Twelve had granulomatosis with polyangiitis (GPA) and 1 each had microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). FA showed that AAV affected small-to-medium-size retinal vessels. Seven cases (50%) had both vein/venule and artery/arteriole involvement. Four cases co-presented with choroidal vasculitis. All of them failed various immunomodulatory therapies prior to referral to MERSI. Six patients received rituximab plus prednisone as their final therapy and 5 of them achieved remission. Four patients who failed cyclophosphamide previously were induced into remission by rituximab. Patients were followed for 33.4 ± 25.5 (range 6-84) months. Nine of 14 patients (64.3%) achieved remission at their latest visit. Seventeen of 22 eyes (77.3%) met the criteria for a good (≥20/40) visual outcome. CONCLUSION The majority of patients enjoyed a good visual outcome and achieved remission after aggressive treatment. Rituximab should be considered as an initial treatment for patients with refractory retinal vasculitis associated with AAV.
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Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C, Androudi S. A Focus on the Epidemiology of Uveitis. Ocul Immunol Inflamm 2016; 26:2-16. [PMID: 27467180 DOI: 10.1080/09273948.2016.1196713] [Citation(s) in RCA: 320] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Uveitis is a common, sight-threatening inflammatory ocular disease and includes multiple heterogeneous clinical entities. The prevalence of various types of uveitis depends upon multiple factors, such as age, sex, race, geographic distribution, environmental influence, genetics, and social habits. Epidemiologic research of uveitis is necessary to understand the etiology and immunopathogenesis of this group of diseases. The present study attempts to concentrate on the most recent information on the epidemiology of uveitis and compare it with previous knowledge. METHODS An extensive literature search was performed in the Medline database (PubMed) and included surveys completed until 2015. Articles that reported prevalence and incidence were studied. References cited in the articles were also studied. RESULTS The incidence and prevalence of uveitis differs based on age, anatomic location of the inflammatory process (anterior, intermediate, posterior uveitis, panuveitis), gender, histopathology (granulomatous, non-granulomatous), type of inflammatory process (acute, chronic, recurrent), and etiology (infectious, non-infectious). Prevalence differs by geographic location. Idiopathic anterior uveitis is the most common form of uveitis in the community. Infectious causes are common (30-60%) in the developing countries. Herpes and toxoplasmosis are the leading infectious causes of uveitis. Non-infectious uveitic conditions are generally more common in the developed world. An increase in the prevalence of infectious etiologies, including tuberculosis and syphilis, has been seen in developed countries. Introduction of new treatment options has also changed patterns of disease. CONCLUSIONS Introduction of new uveitis entities, changes in the incidence of already known disease and increased availability of diagnostic testing have all altered the epidemiology of uveitis in recent years. Knowledge of regional patterns of disease is essential. A more detailed classification of uveitis with the establishment of uniform diagnostic criteria and prospective population based studies would certainly benefit epidemiologic research and clinical practice.
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Affiliation(s)
- Theodora Tsirouki
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | - Anna Dastiridou
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | | | - Ourania Tounakaki
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | - Irini Brazitikou
- b 2nd Department of Ophthalmology , Papageorgiou Hospital , Thessaloniki , Greece
| | | | - Sofia Androudi
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
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Yalçındağ FN, Özdal PC, Özyazgan Y, Batıoğlu F, Tugal-Tutkun I. Demographic and Clinical Characteristics of Uveitis in Turkey: The First National Registry Report. Ocul Immunol Inflamm 2016; 26:17-26. [PMID: 27467500 DOI: 10.1080/09273948.2016.1196714] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the demographic and clinical profiles of uveitis patients seen at secondary and tertiary care centers in Turkey. METHODS A nationwide web-based registry of patients with uveitis was initiated in November 2008. We analyzed data from a single baseline registry-enrollment visit. RESULTS In 33 centers, 6967 eyes of 4863 consecutive patients were registered. The mean age at presentation was 36.6 ± 15.7 (1-92) years; 51.3% were male. Behçet disease was the leading diagnosis (24.9%), followed by ankylosing spondylitis and/or HLA-B27-associated anterior uveitis (9.7%), toxoplasmosis (7.1%), Fuchs uveitis (6.3%), and presumed herpetic anterior uveitis (6.0%). Visual acuity was 0.1 or worse in 22% of eyes. The most common ocular complications were posterior synechiae (16.2%) and cataract formation (16.2%). CONCLUSIONS Behçet disease is still the most common non-infectious etiology in Turkish uveitis patients, while ocular toxoplasmosis and herpetic anterior uveitis are the most common infectious uveitic entities.
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Affiliation(s)
- F Nilüfer Yalçındağ
- a Department of Ophthalmology , Ankara University, Faculty of Medicine , Ankara , Turkey
| | - Pınar C Özdal
- b Ulucanlar Eye Research and Training Hospital , Ankara , Turkey
| | - Yılmaz Özyazgan
- c Department of Ophthalmology , Istanbul University, Cerrahpasa Faculty of Medicine , Istanbul , Turkey
| | - Figen Batıoğlu
- a Department of Ophthalmology , Ankara University, Faculty of Medicine , Ankara , Turkey
| | - Ilknur Tugal-Tutkun
- d Department of Ophthalmology , Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey
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