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Hapca MC, Muntean GA, Nemeș-Drăgan IA, Vesa ȘC, Nicoară SD. Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy. J Clin Med 2023; 12:6981. [PMID: 38002596 PMCID: PMC10671993 DOI: 10.3390/jcm12226981] [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: 10/04/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
AIM The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs). METHODS Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010-31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1. RESULTS The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1. CONCLUSION RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.
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Affiliation(s)
- Mădălina-Claudia Hapca
- Doctoral School of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania;
- Ophthalmology Clinic, Emergency County Hospital, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania;
| | - George-Adrian Muntean
- Doctoral School of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania;
| | - Iulia-Andrada Nemeș-Drăgan
- Ophthalmology Clinic, Emergency County Hospital, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania;
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Simona-Delia Nicoară
- Doctoral School of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania;
- Ophthalmology Clinic, Emergency County Hospital, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania;
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania
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2
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Hasanreisoglu M, Halim MS, Kesim C, Doan HL, Tran ANT, Nguyen W, Besalti Z, Lajevardi S, Hassan M, Akhavanrezayat A, Ahmed MI, Do DV, Sepah YJ, Nguyen QD. Longitudinal Comparative Analysis of Semi-Automated Aqueous Flare Measurements with Clinical Grading and Visual Outcomes in Uveitic Eyes. Ocul Immunol Inflamm 2023; 31:1819-1824. [PMID: 36170559 PMCID: PMC10870827 DOI: 10.1080/09273948.2022.2123365] [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: 06/01/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the correlation between longitudinal changes in aqueous flare measured by laser flare photometer (LFP), best-corrected visual acuity (BCVA), and clinical grade using both Standardization of Uveitis Nomenclature (SUN) and modified SUN (MSUN) scales uveitis patients. METHODS Patients were classified according to both SUN and MSUN grading scales. LFP measurements were acquired (Kowa FM-700) at each visit. Mean change in LFP was assessed longitudinally, comparing with those in visual acuity, SUN, and MSUN grading scales. RESULTS Mean change in LFP was correlated to those in BCVA (p = .018), SUN scale (p < .001), and MSUN scale (p = .008). Cases within same initial SUN (0 and 1+) and MSUN (0.5+ and 1+) grades and different longitudinal flare prognosis (decreased/unchanged/increased) had significantly different initial LFP values (all p < .05). CONCLUSIONS LFP measurement is beneficial in monitoring inflammatory activity. Cases of identical clinical flare scores with different clinical prognosis may be predicted by LFP.
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Affiliation(s)
- Murat Hasanreisoglu
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
- KUTTAM, Koç University Research Center for Translational Medicine, Istanbul, Turkey
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Cem Kesim
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
| | - Hien Luong Doan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anh N. T. Tran
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Will Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Zelal Besalti
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Sherin Lajevardi
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | | | - Mohamed Ibrahim Ahmed
- Department of Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Diana V. Do
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Yasir J. Sepah
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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3
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Oo HH, Mohan M, Song W, Rojas-Carabali W, Tsui E, de-la-Torre A, Cifuentes-González C, Rousselot A, Srinivas SP, Aslam T, Gupta V, Agrawal R. Anterior chamber inflammation grading methods: A critical review. Surv Ophthalmol 2023:S0039-6257(23)00135-2. [PMID: 37804869 DOI: 10.1016/j.survophthal.2023.10.005] [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: 05/27/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023]
Abstract
Assessing anterior chamber inflammation is highly subjective and challenging. Although various grading systems attempt to offer objectivity and standardization, the clinical assessment has high interobserver variability. Traditional techniques, such as laser flare meter and fluorophotometry, are not widely used since they are time-consuming. With the development of optical coherence tomography with high sensitivity, direct imaging offers an excellent alternative to assess objectively inflammation with the potential for automated analysis. We describe various anterior chamber inflammation grading methods and discuss their utility, advantages, and disadvantages.
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Affiliation(s)
- Hnin Hnin Oo
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Madhuvanthi Mohan
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Wenjun Song
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Edmund Tsui
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Andres Rousselot
- Consultorios Oftalmológicos Benisek Ascarza, Capital Federal, Argentina
| | | | - Tariq Aslam
- School of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Duke NUS Medical School, Singapore, Singapore.
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4
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Halim MS, Hasanreisoglu M, Onghanseng N, Tran ANT, Hassan M, Yilmaz M, Segawa A, Gurelik G, Afridi R, Ormaechea MS, Uludag G, Kesim C, Nguyen NV, Bae JH, Park JH, Do DV, Ibrahim MA, Sepah YJ, Nguyen QD. Correlation of Clinical Aqueous Flare Grading to Semi-Automated Flare Measurements Using Laser Flare Photometry. Ocul Immunol Inflamm 2022; 30:1906-1912. [PMID: 35081012 PMCID: PMC10863987 DOI: 10.1080/09273948.2021.1971723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare laser flare photometry (LFP) measurements of aqueous flare with Standardization of Uveitis Nomenclature (SUN) and modified SUN grading. METHODS In this prospective study with multicenter design, uveitis patients were classified according to SUN and modified SUN grading scales. LFP was performed with Kowa FM-700 flaremeter. Mean LFP values were compared with SUN and MSUN scores. RESULTS The study included 475 LFP measurements, of which 216, 48, 150, 31, 28 and 2 had 0, 0.5+, 1+, 1.5+, 2+ and 3+ flare, respectively. LFP values were significantly different between each two consecutive steps for both clinical gradings (all P < .05). Cut-off values for modified SUN grading steps were defined as 5.7, 9.7, 15.7 and 43.2 for 0/0.5+, 0.5+/ 1+, 1+/1.5+ and 1.5/2+ borders of clinical flare, respectively. CONCLUSIONS LFP proves to be an objective measurement in analyzing aqueous flare comparable to both SUN and MSUN clinical grading systems.
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Affiliation(s)
- Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Murat Hasanreisoglu
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkey
- KUTTAM, Koç University Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Mervenur Yilmaz
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Asadu Segawa
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Gokhan Gurelik
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Maria Soledad Ormaechea
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Cem Kesim
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkey
| | - Nam V Nguyen
- Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Jeong Hun Bae
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Jung Huynh Park
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Mohamed A Ibrahim
- Ophthalmology, Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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5
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Yoshihara N, Terasaki H, Shiihara H, Funatsu R, Yamashita T, Sakamoto T. Quantification of Anterior Chamber Particles Using Anterior Segment Optical Coherence Tomography in Angle-Closure Glaucoma Patients after Laser Iridotomy. J Clin Med 2022; 11:jcm11154379. [PMID: 35955996 PMCID: PMC9369109 DOI: 10.3390/jcm11154379] [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: 05/17/2022] [Revised: 06/11/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose: To determine whether the degree of particle density in the anterior chamber can be evaluated objectively and quantitatively by anterior segment optical coherence tomography (AS-OCT) in cases after laser iridotomy (LI). Methods: This was a retrospective observational study. All of the subjects who received LI for angle-closure glaucoma between January 2018 and May 2019 at Kagoshima University Hospital were studied. AS-OCT recordings were made before, immediately after, and one week after LI in 22 eyes of 14 consecutive patients. The anterior chamber particle (ACP) index was defined as the ratio of the number of particles in the anterior chamber to the total area of the anterior chamber. The ACP index was determined by binarization of the AS-OCT images and analysis with the ImageJ program. Results: The mean age of the participants was 75.4 ± 8.9 years, with a range of 61−91 years. The ACP index before the LI was 0.78 ± 0.68, and it was significantly increased to 7.72 ± 2.64 immediately after the LI (paired t-test, p < 0.01). The ACP index returned to the pre-LI density of 0.92 ± 0.48 one week after the LI. Conclusions: We successfully quantified the degree of anterior chamber particles accumulation by analyzing images obtained by AS-OCT. This simple and repeatable technique should be useful because the particles, including inflammatory cells, in the anterior chamber can be evaluated non-invasively and objectively.
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Affiliation(s)
| | - Hiroto Terasaki
- Correspondence: ; Tel.: +81-99-275-5402; Fax: +81-99-265-4894
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Hasanreisoglu M, Kesim C, Yalinbas D, Yilmaz M, Uzunay NS, Aktas Z, Halim MS, Sepah YJ, Nguyen QD, Sahin A. Effect of light backscattering from anterior segment structures on automated flare meter measurements. Eur J Ophthalmol 2022; 32:2291-2297. [PMID: 34382443 PMCID: PMC10919547 DOI: 10.1177/11206721211039350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To evaluate effect of maximal anterior cortical lens density, iris scatter and anterior chamber depth on laser flare photometry. METHODS Patients diagnosed with clinical uveitis were enrolled in the study. Clinical flare gradings were recorded upon the Standardization of Uveitis Nomenclature. Aqueous flare was measured with an automated device (Kowa FM-700). Back-scattering from anterior cortical lens and anterior iris surface was calculated from Scheimpflug images. A curvilinear regression model was used to calculate estimated values for each clinical grade. These values were used to split cases in Group I (laser flare photometry lower than estimated) and Group II (laser flare photometry higher than estimated). Mean anterior chamber depth, pupil aperture, maximal anterior cortical lens density and iris scatter values were compared between two groups. A stepwise multiple regression analysis was performed to determine the effect of clinical flare gradings and ocular parameters on aqueous flare measurements. RESULTS The study included 228 eyes of 114 cases. Scheimpflug images were obtained from 105 eyes. Estimated aqueous flare measurements (in photons/milliseconds) were 4.87, 8.50, 14.81, 25.83, 45.04 and 136.93 for 0, 0.5+, 1+, 1.5+, 2+ and 3+ clinical flare respectively. Group II had higher maximal anterior cortical lens density than Group I (96.6 ± 37.1 vs 77.9 ± 17.1 pixel unit, p = 0.001). The measured aqueous flare was significantly related to clinical flare, maximal anterior cortical lens density and pupil aperture (adjusted R2: 0.480, p < 0.001). CONCLUSION The back-scattered light from anterior cortical lens could affect laser flare photometry measurements. This effect might be quantified by Scheimpflug imaging.
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Affiliation(s)
- Murat Hasanreisoglu
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
- Koç University Research Centre for Translational Medicine, Istanbul, Turkey
| | - Cem Kesim
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
| | - Duygu Yalinbas
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
| | - Mervenur Yilmaz
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
| | | | - Zeynep Aktas
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
| | - Muhammad Sohail Halim
- Ocular Imaging Research and Reading Centre, Sunnyvale, CA, USA
- Spencer Centre for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Yasir J Sepah
- Ocular Imaging Research and Reading Centre, Sunnyvale, CA, USA
- Spencer Centre for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Centre for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Afsun Sahin
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
- Koç University Research Centre for Translational Medicine, Istanbul, Turkey
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7
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Aaronson A, Taipale C, Achiron A, Aaltonen V, Grzybowski A, Tuuminen R. Relationship Between Prolonged Intraocular Inflammation and Macular Edema After Cataract Surgery. Transl Vis Sci Technol 2021; 10:15. [PMID: 34125145 PMCID: PMC8212433 DOI: 10.1167/tvst.10.7.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose To assess whether aqueous flare is related to an increased risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery in nondiabetic and diabetic patients. Methods A post hoc analysis of five consecutive randomized clinical trials in the Department of Ophthalmology, Kymenlaakso Central Hospital, Finland. Aqueous flare levels were recorded in 448 eyes of 448 patients before surgery, and after the course of topical anti-inflammatory treatment 28 days and three months after cataract surgery. Results Aqueous flare increase of <50%, ≥50%, ≥100%, and ≥200% associated in central subfield macular thickness (CSMT) increase across the groups at 28 days and three months after surgery. Increase of aqueous flare ≥100% compared to those with <100% was associated with increased CSMT (P = 0.022 at 28 days, and P = 0.027 at three months). At three months, macular thickening (at least 10% CSMT increase) was observed in 12.7% compared to 4.6% of eyes when using a cutoff value of 100% increase in aqueous flare (P = 0.033). Although diabetic patients presented higher aqueous flare levels at baseline compared to nondiabetic patients (12.9 ± 11.8 vs. 9.8 ± 8.2 photon units/ms P < 0.001), the postoperative levels illustrated a similar profile in aqueous flare increase between the two groups. Conclusions At 28 days, aqueous flare increase was associated with macular thickening. A 100% cutoff value could potentially be used when studying anti-inflammatory efficacy of different treatment protocols. Flare values exceeding this cutoff value could be considered as an indication for extending anti-inflammatory therapy. Translational Relevance A 100% increase in aqueous flare at 28 days after cataract surgery from baseline predicted macular thickening up to three months postoperatively. Identifying a correlation between increased aqueous flare levels and pseudophakic cystoid macular edema may allow recognition of the most vulnerable patients, development of prophylactic treatment strategies and reduction of the number and severity of postoperative complications.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Claudia Taipale
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Israel.,Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Vesa Aaltonen
- Department of Ophthalmology, Turku University Hospital, Turku, Finland.,Department of Ophthalmology, University of Turku, Turku, Finland
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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8
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Bradley LJ, Ward A, Hsue MCY, Liu J, Copland DA, Dick AD, Nicholson LB. Quantitative Assessment of Experimental Ocular Inflammatory Disease. Front Immunol 2021; 12:630022. [PMID: 34220797 PMCID: PMC8250853 DOI: 10.3389/fimmu.2021.630022] [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: 11/17/2020] [Accepted: 05/28/2021] [Indexed: 11/25/2022] Open
Abstract
Ocular inflammation imposes a high medical burden on patients and substantial costs on the health-care systems that mange these often chronic and debilitating diseases. Many clinical phenotypes are recognized and classifying the severity of inflammation in an eye with uveitis is an ongoing challenge. With the widespread application of optical coherence tomography in the clinic has come the impetus for more robust methods to compare disease between different patients and different treatment centers. Models can recapitulate many of the features seen in the clinic, but until recently the quality of imaging available has lagged that applied in humans. In the model experimental autoimmune uveitis (EAU), we highlight three linked clinical states that produce retinal vulnerability to inflammation, all different from healthy tissue, but distinct from each other. Deploying longitudinal, multimodal imaging approaches can be coupled to analysis in the tissue of changes in architecture, cell content and function. This can enrich our understanding of pathology, increase the sensitivity with which the impacts of therapeutic interventions are assessed and address questions of tissue regeneration and repair. Modern image processing, including the application of artificial intelligence, in the context of such models of disease can lay a foundation for new approaches to monitoring tissue health.
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Affiliation(s)
- Lydia J Bradley
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Amy Ward
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Madeleine C Y Hsue
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Jian Liu
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - David A Copland
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D Dick
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom.,Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom.,University College London, Institute of Ophthalmology, London, United Kingdom
| | - Lindsay B Nicholson
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
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9
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Wintergerst MWM, Liu X, Terheyden JH, Pohlmann D, Li JQ, Montesano G, Ometto G, Holz FG, Crabb DP, Pleyer U, Heinz C, Denniston AK, Finger RP. Structural Endpoints and Outcome Measures in Uveitis. Ophthalmologica 2021; 244:465-479. [PMID: 34062542 DOI: 10.1159/000517521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
Most uveitis entities are rare diseases but, taken together, are responsible for 5-10% of worldwide visual impairment which largely affects persons of working age. As with many rare diseases, there is a lack of high-level evidence regarding its clinical management, partly due to a dearth of reliable and objective quantitative endpoints for clinical trials. This review provides an overview of available structural outcome measures for uveitis disease activity and damage in an anatomical order from the anterior to the posterior segment of the eye. While there is a multitude of available structural outcome measures, not all might qualify as endpoints for clinical uveitis trials, and thorough testing of applicability is warranted. Furthermore, a consensus on endpoint definition, standardization, and "core outcomes" is required. As stipulated by regulatory agencies, endpoints should be precisely defined, clinically important, internally consistent, reliable, responsive to treatment, and relevant for the respective subtype of uveitis. Out of all modalities used for assessment of the reviewed structural outcome measures, optical coherence tomography, color fundus photography, fundus autofluorescence, and fluorescein/indocyanine green angiography represent current "core modalities" for reliable and objective quantification of uveitis outcome measures, based on their practical availability and the evidence provided so far.
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Affiliation(s)
| | - Xiaoxuan Liu
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Dominika Pohlmann
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jeany Q Li
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Giovanni Montesano
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Giovanni Ometto
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Uwe Pleyer
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Miserocchi E, Giuffrè C, Cicinelli MV, Marchese A, Gattinara M, Modorati G, Bandello F. Oral phospholipidic curcumin in juvenile idiopathic arthritis-associated uveitis. Eur J Ophthalmol 2019; 30:1390-1396. [PMID: 31801359 DOI: 10.1177/1120672119892804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the efficacy and the safety of curcumin-phosphatidylcholine complex in children affected by juvenile idiopathic arthritis-associated uveitis as an adjunctive treatment to chronic systemic immunosuppressive therapy. METHODS In this retrospective, longitudinal study, we treated patients affected by juvenile idiopathic arthritis-associated uveitis with residual low-grade inflammatory activity in the anterior chamber with one tablet of curcumin-phosphatidylcholine complex per day, over a year. Low-grade inflammatory activity was characterized by flare 1+ at slit-lamp examination and 10-50 photon counts per ms) at the FC500 laser flare meter. Inactivity of uveitis was defined as complete disappearance of flare at the slit-lamp examination and values <10 ph/ms at laser flare meter. Conversely, recurrence of the uveitis was defined as a one-step increase from baseline in anterior chamber cells levels or laser flare meter measurements >50 ph/ms. RESULTS A total of 22 out of 27 patients (81%) achieved inactivity at the end of the study. Five patients (19%) did not show a significant reduction in anterior chamber flare, remaining stable throughout the follow-up. Only three episodes of flare-ups in three different patients were recorded. Overall, the treatment was well tolerated by all patients and no ocular discomfort, ocular side effects, or allergic reactions were registered. CONCLUSION Adjunctive therapy with curcumin in patients affected by juvenile idiopathic arthritis-associated uveitis improves mild chronic anterior chamber flare and presents a good safety profile. Despite being mild, anterior chamber inflammation should be minimized to avoid the development of sight-threatening complications in these patients.
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Affiliation(s)
- Elisabetta Miserocchi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Giuffrè
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Maurizio Gattinara
- Department of Rheumatology, Pediatric Rheumatology Unit, Istituto Ortopedico G. Pini, University of Milan, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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High frequency of secondary, but not primary ocular manifestations of inflammatory bowel disease in patients treated at a tertiary care center. Eur J Gastroenterol Hepatol 2018; 30:1502-1506. [PMID: 30148806 DOI: 10.1097/meg.0000000000001248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Ocular manifestations of inflammatory bowel disease (IBD) are relevant complications of IBD. Only a few prospective studies are available on the characteristics of these manifestations. The aim of this study was to characterize the frequency of eye disease in patients with IBD, including primary and secondary ocular manifestations of IBD, and to identify patients who may need specialized ophthalmologic care. PATIENTS AND METHODS In a prospective observational study, patients with IBD were examined for ocular symptoms in comparison with control participants without IBD. All patients with IBD underwent a thorough ophthalmologic examination (including slit-lamp, tonometry, tear breakup time, Schirmer's test, and coherence tomography). The results were analyzed with respect to sociodemographic and disease-related characteristics. RESULTS A total of 61 patients (33 women, 39 Crohn's disease, 22 ulcerative colitis, age 43.3±12.9 years, disease duration 12.4±9.3 years) were included. Ophthalmologic symptoms were reported by 53 patients (86.9%, most frequently deterioration of vision 42.6%, foreign body sensation 36.1%) compared with 60.6% in healthy controls (P=0.001). A clinically relevant, previously undetected ophthalmologic diagnosis was identified in 56 patients (91.8% - dry eye syndrome 75.4%, cataract 67.2%, blepharitis 45.9%, fundus hypertonicus 14.8%, other 16.4%). CONCLUSION Although primary ocular manifestations of IBD are rare in intensively treated patients, the high frequency of unrecognized secondary manifestations should give reason to refer especially patients with longstanding or complicated IBD to an eye specialist - irrespective of ocular symptoms.
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Early versus late traumatic cataract surgery and intraocular lens implantation. Eye (Lond) 2017; 31:1199-1204. [PMID: 28409771 DOI: 10.1038/eye.2017.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/24/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeTo determine the proper time for traumatic cataract surgery after open globe injuries.SettingFarabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.DesignRandomized clinical trial.Patients and methodsIn a randomized clinical trial, 30 eyes with traumatic cataract after open globe injury with IOL implantation underwent early (in the first week after the trauma) and 30 eyes underwent late cataract surgery (from the first to second month after the trauma). We excluded patients who were under 12-year-old. All patients were visited at 1 week, 4 weeks, 12 weeks, and 6 months after surgery. In each visit, patients were examined regarding visual acuity, intraocular pressure (IOP), anterior chamber inflammation, IOL position, and posterior synechiae. In addition, posterior segment evaluation and fundoscopy were performed. Intraoperative complication including posterior capsular rupture, anterior vitrectomy, and zonulysis as well as the site of IOL implantation were documented and post-operative complications including raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were listed.ResultsBest-corrected visual acuity 6 months after surgery was not different between the two groups. Also in early cataract surgery group, the rate of posterior capsular rupture was not significantly higher than the late surgery group (P=0.069). On the other hand, zonulysis was significantly higher in the late procedure group (P=0.039). Other complications including anterior vitrectomy, raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were not different in the two groups.ConclusionsEarly and late traumatic cataract surgery and IOL implantation after open globe injuries, have no significant difference regarding the post-surgical BCVA and prominent intraoperative and post-operative complications.
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