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Molins B, Rodríguez A, Llorenç V, Adán A. Biomaterial engineering strategies for modeling the Bruch's membrane in age-related macular degeneration. Neural Regen Res 2024; 19:2626-2636. [PMID: 38595281 DOI: 10.4103/nrr.nrr-d-23-01789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/06/2024] [Indexed: 04/11/2024] Open
Abstract
Age-related macular degeneration, a multifactorial inflammatory degenerative retinal disease, ranks as the leading cause of blindness in the elderly. Strikingly, there is a scarcity of curative therapies, especially for the atrophic advanced form of age-related macular degeneration, likely due to the lack of models able to fully recapitulate the native structure of the outer blood retinal barrier, the prime target tissue of age-related macular degeneration. Standard in vitro systems rely on 2D monocultures unable to adequately reproduce the structure and function of the outer blood retinal barrier, integrated by the dynamic interaction of the retinal pigment epithelium, the Bruch's membrane, and the underlying choriocapillaris. The Bruch's membrane provides structural and mechanical support and regulates the molecular trafficking in the outer blood retinal barrier, and therefore adequate Bruch's membrane-mimics are key for the development of physiologically relevant models of the outer blood retinal barrier. In the last years, advances in the field of biomaterial engineering have provided novel approaches to mimic the Bruch's membrane from a variety of materials. This review provides a discussion of the integrated properties and function of outer blood retinal barrier components in healthy and age-related macular degeneration status to understand the requirements to adequately fabricate Bruch's membrane biomimetic systems. Then, we discuss novel materials and techniques to fabricate Bruch's membrane-like scaffolds for age-related macular degeneration in vitro modeling, discussing their advantages and challenges with a special focus on the potential of Bruch's membrane-like mimics based on decellularized tissue.
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Affiliation(s)
- Blanca Molins
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Andrea Rodríguez
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Víctor Llorenç
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic Barcelona, Spain
| | - Alfredo Adán
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic Barcelona, Spain
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Raad F, Luque P, García Ledo S, Alda Lozano A, Llorens V, Espejo A, Heras H, Santana L, Trapiella L, Fanlo P, Adán A, Espinosa G, Navarrete N. Adalimumab for the Treatment of Non-Infectious Uveitis: A Real Life Experience. Ocul Immunol Inflamm 2024:1-7. [PMID: 38691840 DOI: 10.1080/09273948.2024.2344712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To describe the efficacy and safety of adalimumab for the treatment of non-infectious uveitis (NIU) in four Uveitis Units from tertiary Spanish hospitals. METHODS Multicenter and retrospective clinical cohort study including all patients with NIU treated with adalimumab from January 2012 to October 2022 in four uveitis units was performed. Efficacy was measured with the number of relapses, ocular inflammation and reduction in immunosuppression and corticosteroid dosage before and after adalimumab use. We collected data regarding adverse effects and examined the immunogenicity of adalimumab. RESULTS One hundred and twenty-two patients (59% females), with a mean age of 48.6 years (SD = 14.8) accounting for 217 eyes were included. The majority (92.6%) were Caucasian. Uveitis analyzed were predominantly panuveitis (34.7%), bilateral (77.9%), acute (41.5%), and non-granulomatous (90%). Most of them were immune mediated (42.6%), and the main reason to initiate adalimumab was refractory disease (96.7%). The analysis was statistically significant due to the reduction in the number of immunosuppressive drugs as well as the dose of oral corticosteroids and the number of relapses during follow-up (p < 0.001). The decrease in ocular inflammation parameters and the improvement in visual acuity (p < 0.05) were also significant. There were no deaths due to the drug and only one reported case of serious infection. In total, 10.9% of 73 patients tested developed anti-adalimumab antibodies and 4.1% lupus-like. CONCLUSIONS We consider adalimumab as a leading drug in the treatment of NIU with high safety and efficacy.
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Affiliation(s)
- Fátima Raad
- Department of Internal Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Paula Luque
- Department of Internal Medicine, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Sofía García Ledo
- Department of Internal Medicine, Hospital Universitario San Agustín, Avilés, Spain
| | | | - Víctor Llorens
- Department of Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Espejo
- Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Henar Heras
- Department of Ophthalmology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Lucía Santana
- Department of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Trapiella
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Patricia Fanlo
- Internal Medicine Department, Systemic Autoimmune Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gerard Espinosa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems-Member of ERNReCONNET, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Navarrete
- Department of Internal Medicine, University Hospital Complex of Granada, Granada, Spain
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Araújo O, Hernández-Negrín H, Casaroli-Marano RP, Hernández-Rodríguez J, Adán A, Espinosa G, Pelegrín L, Cervera R. Factors associated with early hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06461-6. [PMID: 38578332 DOI: 10.1007/s00417-024-06461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Hydroxychloroquine is currently recommended for the treatment of systemic lupus erythematosus (SLE), but it can cause irreversible retinal toxicity. This study aimed to identify factors associated with early hydroxychloroquine-induced retinal toxicity in patients with SLE from a single centre for 20 years. METHODS SLE patients diagnosed between 1998 and 2017 and followed up for at least 1 year were included. Demographic, clinical, laboratory and therapeutic data were collected from the electronic medical records and retrospectively analysed. Early hydroxychloroquine-induced retinal toxicity was defined as the development of macular toxicity within the first 5 years of hydroxychloroquine treatment. RESULTS A total of 345 patients followed for a median of 15 years were analysed; 337 (97.7%) patients received hydroxychloroquine, 38 (11.3%) of them presented with retinal toxicity, and 10 (3%) developed early retinal toxicity. These patients had a mean treatment duration of 3.3 years with a mean cumulative dose of 241 g. Patients were diagnosed by visual field (VF) and fundoscopy, and two were also assessed using spectral domain optical coherence tomography (SD-OCT). The median (IQR) age of patients with early toxicity was 56 (51-66) years, and 80% were female. Factors independently associated with early hydroxychloroquine-induced retinal toxicity were lupus anticoagulant positivity (OR 4.2; 95% CI 1.2-15.5) and hypercholesterolaemia (OR 5.6; 95% CI 1.5-21.5). CONCLUSION Our results suggest that lupus anticoagulant positivity and hypercholesterolaemia among SLE patients may be risk factors for early hydroxychloroquine-induced retinal toxicity, regardless of the dose or duration of treatment.
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Affiliation(s)
- Olga Araújo
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Halbert Hernández-Negrín
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Ricardo P Casaroli-Marano
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
| | - Laura Pelegrín
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
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Chang-Sotomayor M, Gϋell JL, de Rojas Silva MV, Corretger X, Bandeira F, Mendez-Mourelle A, Veillet LZ, Adán A, Figueras-Roca M. Comparison of intraocular lens tilt after capsular sutured scleral fixation with capsular segments versus uneventful cataract surgery. Eur J Ophthalmol 2024:11206721231223997. [PMID: 38179681 DOI: 10.1177/11206721231223997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
PURPOSE To evaluate and compare intraocular lens (IOL) tilt between uneventful phacoemulsification with in-the-bag IOL implantation and sutured scleral fixation (SSF) of the lens bag with a capsular tension segment (type 6 D / Morcher) using a Sheimpflug camera. SETTING Clinical Practice, Hospital. Barcelona and A Coruña, Spain. DESIGN Retrospective, comparative multicenter study. METHODS IOL tilt was compared between patients who underwent sutured scleral fixation with a capsular tension segment in a single eye (SSF group, n = 15) with patients who underwent uneventful IOL implantation (control group, n = 12) that were matched by biometric measurements. Post-operative refractive accuracy of biometric formulas by means of mean absolute error (MAE) was also reported. All patients underwent a general ophthalmic evaluation, anterior segment photography, and postoperative optical biometry (Zeiss IOLMaster® 500). In addition, IOL tilt was measured with a Scheimpflug camera (Pentacam R, Oculus Optikgerate Gmbh). RESULTS Mean vertical tilt was similar in both groups (2.20+/-2.47° SSF vs 1.97 +/- 1.79° control; p = 0.836) but mean horizontal tilt tended to higher values in the SSF series (2.09 +/- 2.74° vs 0.94 +/- 1.17°; p = 0.139). Considering post-operative refractive error in diopters by MAE calculations, there was an underestimation of IOL power in the SSF group which was only statistically significant for Barrett Universal II (1.07 vs 0.32; p = 0.028) and Hill-RBF (0.95 vs 0.26; p = 0.024) formulas, but not for SRK/T (0.99 vs 0.42; p = 0.285) and Kane (0.96 vs 0.33; p = 0.083). CONCLUSION Sutured scleral fixation of capsular tension segments in the presence of zonular instability does not seem to induce clinically significant IOL tilt compared to uneventful cataract extraction cases.
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Affiliation(s)
- Meilin Chang-Sotomayor
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | - José L Gϋell
- Instituto de Microcirugía Ocular (IMO), Cornea and Refractive Surgery unit, Barcelona, Spain, 08035
| | | | - Xavier Corretger
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | - Francisco Bandeira
- São Gonçalo Eye Hospital, Cornea and Refractive Surgery unit, Rio de Janeiro, Brasil, 8600-502
| | - Andrea Mendez-Mourelle
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | | | - Alfredo Adán
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | - Marc Figueras-Roca
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
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Ruiz-Moreno JM, Adán A, Lafuente M, Asencio Durán M, Arias Barquet L, García Layana A, Araiz Iribarren J. Effectiveness and safety of fluocinolone acetonide intravitreal implant in diabetic macular edema patients considered insufficiently responsive to available therapies (REACT): a prospective, non-randomized, and multicenter study. Int Ophthalmol 2023; 43:4639-4649. [PMID: 37697082 PMCID: PMC10724319 DOI: 10.1007/s10792-023-02864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To assess the effectiveness and safety of the intravitreal fluocinolone-acetonide implant (FAc-i) in patients with chronic diabetic macular edema who did not sufficiently respond to other available therapies. METHODS This was a multicenter, prospective, non-randomized, and phase-IV observational study conducted on patients with recurrent-DME who were insufficient responders to currently available therapies (REACT-Study). The primary end-point was the mean change in best-corrected-visual-acuity from baseline to month-24 values. RESULTS Thirty-one eyes from 31 patients were included in the study. Mean age was 68.0 ± 7.7 years, and 10 (32.3%) were women. Study patients had received 5.3 ± 7.3 previous DME treatments before starting the study. In the overall study sample, BCVA improved from 56.1 ± 12.3 letters at baseline to 62.4 ± 17.0 letters at month-24 (p = 0.0510). The eyes with a baseline BCVA < 70 ETDRS letters had a significant improvement in BCVA from 53.2 ± 10.2 letters at baseline to 61.5 ± 17.9 letters at month-24 (p = 0.0165). In the overall study population, central-subfoveal-thickness (CST) was significantly reduced from 474.0 ± 135.1 µm at baseline to 333.4 ± 135.6 at month-24 (p < 0.0001). Similarly, macular-volume (MV) was significantly reduced from 10.7 ± 2.7 mm3 at baseline to 9.6 ± 2.9 mm3 (p = 0.0027) at month-24. Among the 31 study eyes, 19 (61.3%) required an additional treatment for DME. Throughout the study, 9 (29.0%) eyes required ocular hypotensive medication for controlling their intraocular-pressure and 5 (16.1%) eyes underwent cataract surgery. CONCLUSIONS In DME eyes who did not sufficiently respond to previous therapies, the FAc-i was associated with an improvement in visual and anatomic outcomes. There were no unexpected adverse-events. TRIAL REGISTRATION NUMBER EudraCT identifier: 2016-001680-37.
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Affiliation(s)
- José María Ruiz-Moreno
- Puerta de Hierro-Majadahonda University Hospital, Joaquín Rodrigo, 2, 28222, Majadahonda, Madrid, Spain.
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.
- , Miranza, Spain.
| | | | - María Lafuente
- Virgen de la Arraixaca University Hospital, Murcia, Spain
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Moll-Udina A, Hernanz I, Sainz-de-la-Maza M, Pelegrín L, Coelho-Borges AI, Pazos M, Adán A, Llorenç V. Intravitreal fluocinolone acetonide 0.19 mg (ILUVIEN®) in patients with non-infectious uveitis: real-world effectiveness and safety outcomes at 12 months. Int Ophthalmol 2023; 43:4181-4195. [PMID: 37698661 PMCID: PMC10520169 DOI: 10.1007/s10792-023-02828-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/27/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE This study assessed the effectiveness of the 0.19-mg fluocinolone acetonide (FAc) implant by multimodal measurements in patients with non-infectious uveitis (NIU) in a real-world setting in Spain. METHODS A prospective study of patients who had NIU including uveitic macular oedema (UME) with ≥ 12 months follow-up was done. Exclusion criteria include infectious uveitis and uncontrolled glaucoma or ocular hypertension requiring more than 2 medications. Effectiveness was assessed using a multicomponent outcome measure that included nine outcomes. Effectiveness was defined as all components being met at every timepoint. Secondary outcome measures were onset or progression of glaucoma and investigator-reported adverse events. RESULTS Twenty-six eyes from 22 patients were included, with 96.2% having an indication including UME. During the 12-month study, the FAc implant was effective in 15 (57.7%) eyes, reaching effectiveness as soon as 2 weeks post-implantation. Mean best-corrected visual acuity and mean central macular thickness (CMT) were significantly improved vs. baseline at all timepoints (all comparisons p < 0.01). During the 12-month study, inflammation markers (anterior chamber cells and vitreous haze) had also significantly declined. Factors predicting effectiveness at month 12 were systemic corticosteroid dose pre-FAc, higher immunomodulatory therapy (IMT) load at baseline and thicker retinal nerve fibre layer (RNFL) at baseline (all p < 0.05). Factors predicting failure were male gender, thinner RNFL at baseline and treatment ineffectiveness at 1 month (all p < 0.05). In parallel, corticosteroid and IMT use also declined significantly. No significant increase in IOP was detected. CONCLUSION The FAc implant is safe and effective at treating NIU over 12 months in a real-world setting in Spain.
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Affiliation(s)
- Aina Moll-Udina
- Facultat de Medicina, University of Barcelona, Barcelona, Spain.
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain.
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | | | - Maite Sainz-de-la-Maza
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laura Pelegrín
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Marta Pazos
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Victor Llorenç
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
- Clínic Institute of Ophthalmology, Clínic Hospital of Barcelona, Sabino de Arana Str., 1, 2Nd Floor (Maternity Hospital), 08028, Barcelona, PC, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Hernanz I, Moll-Udina A, Garcia-Tirado A, Garcia-Fernandez M, Gutierrez-Ezquerro R, Garcia-Arumi C, Llorenç V, Cuadros C, Fonollosa A, Sainz-de-la-Maza M, Adán A. The retinal bacillary layer detachment: Clinical features and outcomes in posterior uveitis. J Fr Ophtalmol 2023; 46:916-920. [PMID: 37210295 DOI: 10.1016/j.jfo.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 05/22/2023]
Abstract
PURPOSE To describe the clinical characteristics, presentation and response to treatment in posterior uveitis patients with bacillary layer detachment (BLD) seen on optical coherence tomography (OCT). MATERIALS AND METHODS Retrospective review of patients with posterior uveitis and SD-OCT scans consistent with BLD. Data collected included demographics, uveitic etiology, treatment and duration of follow-up. Outcome measures included macular volume, central subfoveal thickness and visual acuity. RESULTS Sixteen patients (20 eyes) were included. Twelve were female (75%). The mean age was 43.68 ± 14.7 years. The most frequent etiology of the uveitis was Vogt-Koyanagi-Harada (VKH) disease (n=10), followed by sympathetic ophthalmia (n=2). BLD was bilateral in four patients. Eight patients were treated with intravenous methylprednisolone boluses. Immunosuppressive therapies were required in 8 patients. The mean follow-up was 70 months (range: 2.0-216.0). CONCLUSION BLD was observed in a series of posterior uveitis cases of various etiologies, showing functional and structural resolution with treatment in most cases.
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Affiliation(s)
- I Hernanz
- Department of ophthalmology, Fundación Jiménez Diaz Hospital, Avenue Reyes Católicos 2, 28003 Madrid, Spain.
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Garcia-Tirado
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | | | - C Garcia-Arumi
- Departmentofophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - C Cuadros
- Department of ophthalmology, Oviedo University Hospital, Oviedo, Spain
| | - A Fonollosa
- Department of ophthalmology, Cruces University Hospital, Bilbao, Spain
| | - M Sainz-de-la-Maza
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Pelegrín L, Morató M, Araújo O, Figueras-Roca M, Zarranz-Ventura J, Adán A, Cervera R, Casaroli-Marano RP, Budi V, Barrera-López L, Ríos J, Hernández-Rodríguez J, Espinosa G. Preclinical ocular changes in systemic lupus erythematosus patients by optical coherence tomography. Rheumatology (Oxford) 2023; 62:2475-2482. [PMID: 36331348 DOI: 10.1093/rheumatology/keac626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/18/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE The aim of the present study was to detect preclinical changes in SLE patients in retinal microvascularization or retinal and optical nerve structure by optical coherence tomography. METHODS This cross-sectional, single-centre study aimed to describe structural changes [macular and retinal nerve fibre layer (RNFL) thickness] by structural spectral-domain optical coherence tomography (SD-OCT) and perifoveal vascular [vessel density (VD) and vascular perfusion (VP) and foveal avascular zone (FAZ) structural parameters] findings by OCT angiography (OCTA) in 78 SLE patients and 80 healthy volunteers. In addition, we analysed their association with clinical and laboratory parameters, medications received, disease duration, and SLE activity and damage. RESULTS Structural parameters by SD-OCT and perifoveal vascular parameters by OCTA were decreased in SLE patients compared with controls. OCTA parameters (VD, VP and FAZ circularity) and macular thickness were also decreased in patients with longer disease duration (>10 years). The presence of aPLs was associated with a decreased RNFL thickness, mainly in the inferior quadrants. Patients developing APS also showed decreased RNFL thickness and OCTA flow changes. SD-OCT and OCTA results were not associated with disease activity. Foveal structural parameters were lower in patients with higher damage score. CONCLUSION SD-OCT and OCTA can detect preclinical structural and microcirculatory changes in SLE patients. Structural and perifoveal vascular macular changes in SLE patients are related to disease duration. Macular structural parameters were impaired in patients with higher disease damage. APS seems to be associated with preclinical damage to the optic nerve and impairment of the perifoveal microvasculature.
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Affiliation(s)
- Laura Pelegrín
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Montse Morató
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Olga Araújo
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marc Figueras-Roca
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Javier Zarranz-Ventura
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ricardo P Casaroli-Marano
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Vanesa Budi
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lucía Barrera-López
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José Ríos
- Department of Medical Statistics Platform, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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9
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Pazos M, Riera J, Moll-Udina A, Catala A, Narvaez S, Fuertes I, Dotti-Boada M, Petiti G, Izquierdo-Serra J, Maldonado E, Chang-Sotomayor M, Garcia D, Camós-Carreras A, Gilera V, De Loredo N, Peraza-Nieves J, Ventura-Abreu N, Spencer F, Del Carlo GF, Torras J, Nicolas JM, Adán A, Vilella A, Puig S, Martinez E, Martinez MJ, Sánchez-Dalmau B, Blanco JL. Characteristics and Management of Ocular Involvement in Individuals with Mpox Disease. Ophthalmology 2023; 130:655-658. [PMID: 36804274 PMCID: PMC10046120 DOI: 10.1016/j.ophtha.2023.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
Ocular complications of mpox infection have a prevalence of 1% in the current outbreak. Although conjunctivitis is the most common presentation, corneal involvement may occur. Tecovirimat is recommended for severe ocular mpox involvement.
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Affiliation(s)
- Marta Pazos
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Riera
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Aina Moll-Udina
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alba Catala
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Sofia Narvaez
- Department of Microbiology, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Irene Fuertes
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Marina Dotti-Boada
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Gisela Petiti
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Jordi Izquierdo-Serra
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Enrique Maldonado
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Meilin Chang-Sotomayor
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - David Garcia
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Anna Camós-Carreras
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Vanessa Gilera
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Nicolas De Loredo
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Jorge Peraza-Nieves
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nestor Ventura-Abreu
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Felipe Spencer
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Guillerima F Del Carlo
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Josep Torras
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Josep Maria Nicolas
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of ICU, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Vilella
- Department of Epidemiology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Susana Puig
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Esteban Martinez
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel J Martinez
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Microbiology, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Bernardo Sánchez-Dalmau
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José L Blanco
- Institut d'Investigacions Mèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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10
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Molins B, Figueras-Roca M, Valero O, Llorenç V, Romero-Vázquez S, Sibila O, Adán A, García-Vidal C, Soriano A. C-reactive protein isoforms as prognostic markers of COVID-19 severity. Front Immunol 2023; 13:1105343. [PMID: 36741367 PMCID: PMC9893772 DOI: 10.3389/fimmu.2022.1105343] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/26/2022] [Indexed: 01/21/2023] Open
Abstract
C-reactive protein (CRP), an active regulator of the innate immune system, has been related to COVID-19 severity. CRP is a dynamic protein undergoing conformational changes upon activation in inflammatory microenvironments between pentameric and monomeric isoforms. Although pentameric CRP is the circulating isoform routinely tested for clinical purposes, monomeric CRP shows more proinflammatory properties. Therefore, we aimed to determine the potential of monomeric CRP in serum as a biomarker of disease severity in COVID-19 patients (admission to intensive care unit [ICU] and/or in-hospital mortality). We retrospectively determined clinical and biological features as well as pentameric and monomeric CRP levels in a cohort of 97 COVID-19 patients within 72h of hospital admission. Patients with severe disease had higher levels of both pentameric and monomeric CRP. However, multivariate analysis showed increased mCRP but not pCRP to be independently associated to disease severity. Notably, mCRP levels higher than 4000 ng/mL (OR: 4.551, 95% CI: 1.329-15.58), together with number of co-morbidities, low lymphocyte count, and procalcitonin levels were independent predictors of disease severity in the multivariate model. Our results show the potential of mCRP levels as a marker of clinical severity in COVID-19 disease.
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Affiliation(s)
- Blanca Molins
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain,*Correspondence: Blanca Molins,
| | - Marc Figueras-Roca
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain,Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Oliver Valero
- Statistical Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor Llorenç
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain,Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Sara Romero-Vázquez
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Oriol Sibila
- Respiratory Department, Hospital Clinic of Barcelona-IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain,Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Carolina García-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain,CIBERINF, Barcelona, Spain
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11
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Miguel-Escuder L, Olate-Pérez Á, Sala-Puigdoners A, Moll-Udina A, Figueras-Roca M, Navarro-Angulo MJ, Adán A, Pelegrín L. Intravitreal fluocinolone acetonide implant for the treatment of persistent post-surgical cystoid macular edema in vitrectomized eyes. Eur J Ophthalmol 2023; 33:NP23-NP27. [PMID: 34836464 DOI: 10.1177/11206721211046718] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cystoid macular edema (CME) is the most common cause of decreased visual acuity after both vitrectomy and cataract surgery. Various strategies have been used for its treatment, such as intravitreal corticosteroids. The intravitreal fluocinolone acetonide implant (Iluvien®) is approved for the treatment of persisting diabetic macular edema and for the prevention of recurrence of non-infectious uveitis affecting the posterior segment. There are very few reports about its off-label use for post-surgical CME. We present four clinical cases of post-surgical CME (three following vitrectomy and one following cataract surgery in a vitrectomized eye 2 years ago). All of them had been previously treated with an average of four injections of intravitreal dexamethasone implant (Ozurdex®), with repeated recurrence of CME. After treatment with Iluvien, three cases showed improvement of both visual acuity and macular anatomy, with resolution of the macular edema. One patient required additional treatment with Ozurdex during follow-up, further improving CME. Two of the cases required topical pressure lowering treatment, and none required filtering surgery. Iluvien could be an effective therapeutic option for persistent non-diabetic macular edema after vitrectomy or cataract surgery refractory to other intravitreal therapies, with the benefit of being able to provide longer recurrence-free periods.
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Affiliation(s)
- Lucia Miguel-Escuder
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Álvaro Olate-Pérez
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Anna Sala-Puigdoners
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Aina Moll-Udina
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Alfredo Adán
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Pelegrín
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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12
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Moll-Udina A, Alba-Linero C, Llorenç V, Adán A. MULTI-MODAL IMAGING IN DIFFUSE SUBRETINAL FIBROSIS WITH UVEITIS SYNDROME. Retin Cases Brief Rep 2023; 17:13-17. [PMID: 33394959 DOI: 10.1097/icb.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To describe clinical features including multimodal imaging in a case of diffuse subretinal fibrosis and uveitis syndrome. METHODS A young patient presented with counting fingers in both eyes due to posterior uveitis and unresponsive to systemic corticosteroids. Ultra-wide field pseudo-color and autofluorescence imaging, optical coherence tomography angiography (OCT-A), en-face OCT-A, and spectral-domain optical coherence were performed. RESULTS Clinical examination revealed a bilateral fibrosis plaque in both fovea and macular multifocal choroidal lesions associated, with no vitritis. Ultra-wide field-autofluorescence allowed us to determine activity showing a hyperfluorescent pattern. En-face OCT-A at the level of the ellipsoid layer showed multiple hyperreflective lesions surrounding a hyperreflective fibrosis plaque in both eyes, which improved and stabilized during the follow-up. Optical coherence tomography angiography at the level of retina pigmentary epithelium-choriocapillaris revealed neocapillary network changes along the chronification of the disease. The patient required the addition of intravitreal dexamethasone implants (Ozurdex) to control the acute rebounds and anti-TNFα to control the underlying inflammatory process. CONCLUSION This is the first diffuse subretinal fibrosis with uveitis syndrome reported with a complete En-face OCT-A and OCT-A examination. This multi-modal imaging will improve the monitoring of the disease's activity and the chronicity changes.
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Affiliation(s)
- Aina Moll-Udina
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
| | - Victor Llorenç
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Hospital Clínic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; and
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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13
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Martín-Varillas JL, Sanchez-Bilbao L, Calvo-Río V, Adán A, Hernanz I, Gallego-Flores A, Beltran-Catalan E, Castro-Oreiro S, Fanlo P, Garcia Martos A, Torre I, Cordero-Coma M, De Dios JR, García-Aparicio Á, Hernández-Garfella M, Sánchez-Andrade A, García-Valle A, Maiz O, Miguélez R, Rodríguez-Montero S, Urruticoechea A, Veroz R, Conesa A, Fernández-Carballido C, Jovaní V, Mondejar JJ, Martínez González O, Moya Alvarado P, Romero-Yuste S, Rubio-Muñoz P, Peña-Sainz-Pardo E, Garijo-Bufort M, Demetrio-Pablo R, Hernández JL, Blanco R. Long-term follow-up of certolizumab pegol in uveitis due to immune-mediated inflammatory diseases: multicentre study of 80 patients. RMD Open 2022; 8:rmdopen-2022-002693. [PMID: 36597972 PMCID: PMC9730404 DOI: 10.1136/rmdopen-2022-002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate effectiveness and safety of certolizumab pegol (CZP) in uveitis due to immune-mediated inflammatory diseases (IMID). METHODS Multicentre study of CZP-treated patients with IMID uveitis refractory to conventional immunosuppressant. Effectiveness was assessed through the following ocular parameters: best-corrected visual acuity, anterior chamber cells, vitritis, macular thickness and retinal vasculitis. These variables were compared between the baseline, and first week, first, third, sixth months, first and second year. RESULTS We studied 80 (33 men/47 women) patients (111 affected eyes) with a mean age of 41.6±11.7 years. The IMID included were: spondyloarthritis (n=43), Behçet's disease (n=10), psoriatic arthritis (n=8), Crohn's disease (n=4), sarcoidosis (n=2), juvenile idiopathic arthritis (n=1), reactive arthritis (n=1), rheumatoid arthritis (n=1), relapsing polychondritis (n=1), CONCLUSIONS: CZP seems to be effective and safe in uveitis related to different IMID, even in patients refractory to previous biological drugs.
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Affiliation(s)
| | - Lara Sanchez-Bilbao
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Vanesa Calvo-Río
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Alfredo Adán
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Inés Hernanz
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | - Patricia Fanlo
- Internal Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | | | - Juan Ramon De Dios
- Department of Rheumatology, Araba University Hospital, Vitoria-Gasteiz, Spain
| | | | | | | | | | - Olga Maiz
- Rheumatology, Hospital of Donostia, San Sebastian, Spain
| | - Roberto Miguélez
- Rheumatology, Hospital Universitario de Mostoles, Mostoles, Spain
| | | | | | - Raúl Veroz
- Rheumatology, Hospital de Merida, Merida, Spain
| | - Arantxa Conesa
- Rheumatology, Hospital General Universitari de Castello, Castellon de la Plana, Spain
| | | | - Vega Jovaní
- Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Jose J Mondejar
- Ophthalmology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Susana Romero-Yuste
- Rheumatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | | | | | - José L Hernández
- Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain,Medicine and Psychiatry Department, Universidad de Cantabria, Santander, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
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14
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Fonollosa A, Gallego-Pinazo R, Sararols L, Adán A, López-Gálvez M, Figueroa MS. Guidance on brolucizumab management recommendations. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:S2173-5794(22)00084-6. [PMID: 35882576 DOI: 10.1016/j.oftale.2022.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Brolucizumab, a new generation anti-VEGF, has demonstrated efficacy and safety in AMD in the pivotal HAWK and HARRIER trials. Post-marketing, previously undetected adverse events related to intraocular inflammation have been reported. An independent post hoc review of the pivotal trials puts the rate of IOI at 4.6%. The aim of this paper is to propose a set of recommendations for implementing the management of brolucizumab in clinical practice. METHODS The recommendations made by the authors are based on their clinical experience, critical review of (i) the pivotal trials, the post-hoc analysis of the Safety Review Committee, (ii), and (iii) the published literature. RESULTS In the pivotal trials, brolucizumab showed sustained functional gains, superior anatomical outcomes with potentially longer intervals between injections and a well-tolerated overall safety profile. Adverse events reported post-marketing include retinal vasculitis and retinal vascular occlusion. Based on the available information, experts recommend (i) ruling out non-recommended patient profiles (prior history of ORI), (ii) screening the patient prior to each injection to rule out active ORI, (iii) monitoring the patient for early warning signs, and (iv) treating immediately should any adverse events develop. CONCLUSIONS The adverse events reported are rare, but may be associated with severe and irreversible loss of visual acuity. The recommendations made are intended to facilitate the management of brolucizumab in the routine practice of retinologists, to ensure patient safety and, should any adverse events occur, to minimise their impact on vision.
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Affiliation(s)
- A Fonollosa
- Servicio de Oftalmología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain; Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - R Gallego-Pinazo
- Unidad de Mácula y Ensayos Clínicos, Clínica Oftalvist, Valencia, Spain
| | - L Sararols
- Servicio de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitario General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain
| | - A Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M López-Gálvez
- Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain; Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - M S Figueroa
- Unidad de Retina, Clínica Baviera, Madrid, Spain; Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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15
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Bernal-Morales C, Velazquez-Villoria D, Cubero-Parra JM, Keane PA, Sim DA, Adán A, Tufail A, Zarranz-Ventura J. Paracentral acute middle maculopathy after uneventful ocular surgery with local anaesthetic blocks. Eye (Lond) 2022; 36:219-227. [PMID: 33686235 PMCID: PMC8727570 DOI: 10.1038/s41433-021-01481-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the role of local anaesthetic blocks as a potential cause of paracentral acute middle maculopathy (PAMM) after uneventful ocular surgery. METHODS Retrospective, observational, international, multicentre case series. Nine cases of PAMM with associated visual loss following uneventful ocular surgery with local anaesthetic blocks were observed in a 9-year period (2011-2020). Demographic, ocular and systemic data, anaesthetic data and surgical details were collected. Visual acuity (VA), fundus photography, fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images were reviewed. RESULTS All nine cases were associated with decreased VA at 24 h postoperative check (ranging from hand movement to 20/200). A hyperreflective band within the middle retinal layers was observed in the structural OCT in the acute phase, evolving to thinning and atrophy of the inner retinal layers in sequential follow-up scans performed. Fluorescein angiography showed delayed perfusion in early arterial phase with normal perfusion in late venous phases. OCTA showed decreased perfusion in the deep capillary plexus. Visual recovery was variable between cases during follow-up (ranging from count fingers to 20/20). CONCLUSIONS A combination of a vasoconstrictive effect of the anaesthetic agent, an intraocular pressure spike and a mechanical effect of the volume of anaesthetic injected may result in decreased retinal artery perfusion and be evidenced as PAMM in OCT scans. PAMM may present as a potential complication of local anaesthetic blocks in cases of unexpected visual loss after uneventful ocular surgery.
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Affiliation(s)
- Carolina Bernal-Morales
- grid.410458.c0000 0000 9635 9413Clinic Institute of Ophthalmology (ICOF), Hospital Clinic, Barcelona, Spain
| | | | | | - Pearse A. Keane
- grid.451056.30000 0001 2116 3923NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dawn A. Sim
- grid.451056.30000 0001 2116 3923NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Alfredo Adán
- grid.410458.c0000 0000 9635 9413Clinic Institute of Ophthalmology (ICOF), Hospital Clinic, Barcelona, Spain ,grid.10403.36Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Adnan Tufail
- grid.10403.36Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Zarranz-Ventura
- grid.410458.c0000 0000 9635 9413Clinic Institute of Ophthalmology (ICOF), Hospital Clinic, Barcelona, Spain ,grid.451056.30000 0001 2116 3923NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK ,grid.10403.36Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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16
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Alé-Chilet A, Bernal-Morales C, Barraso M, Hernández T, Oliva C, Vinagre I, Ortega E, Figueras-Roca M, Sala-Puigdollers A, Esquinas C, Gimenez M, Esmatjes E, Adán A, Zarranz-Ventura J. Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus-Report 2: Diabetic Kidney Disease. J Clin Med 2021; 11:197. [PMID: 35011940 PMCID: PMC8745787 DOI: 10.3390/jcm11010197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study is to investigate potential associations between optical coherence tomography angiography (OCTA) parameters and diabetic kidney disease (DKD) categories in type 1 diabetes mellitus (T1DM) patients and controls. A complete ocular and systemic examination, including OCTA imaging tests and bloods, was performed. OCTA parameters included vessel density (VD), perfusion density (PD), foveal avascular zone area (FAZa), perimeter (FAZp) and circularity (FAZc) in the superficial vascular plexus, and DKD categories were defined according to glomerular filtration rate (GFR), albumin-creatinine ratio (ACR) and KDIGO prognosis risk classifications. A total of 425 individuals (1 eye/1 patient) were included. Reduced VD and FAZc were associated with greater categories of GFR (p = 0.002, p = 0.04), ACR (p = 0.003, p = 0.005) and KDIGO risk prognosis classifications (p = 0.002, p = 0.005). FAZc was significantly reduced in greater KDIGO prognosis risk categories (low risk vs. moderate risk, 0.65 ± 0.09 vs. 0.60 ± 0.07, p < 0.05). VD and FAZc presented the best diagnostic performance in ROCs. In conclusion, OCTA parameters, such as VD and FAZc, are able to detect different GFR, ACR, and KDIGO categories in T1DM patients and controls in a non-invasive, objective quantitative way. FAZc is able to discriminate within T1DM patients those with greater DKD categories and greater risk of DKD progression.
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Affiliation(s)
- Aníbal Alé-Chilet
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Marina Barraso
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Teresa Hernández
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Cristian Oliva
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Irene Vinagre
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Emilio Ortega
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08036 Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Cristina Esquinas
- Respiratory Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Marga Gimenez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
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Miguel-Escuder L, Garcia Tirado A, Sainz-de-la-Maza M, Espinosa G, Moll-Udina A, Llorenç V, Parrado-Carrillo A, Adán A. Anti-TNF-alpha-induced lupus in patients with non-infectious uveitis. Eur J Ophthalmol 2021; 33:11206721211054705. [PMID: 34755548 DOI: 10.1177/11206721211054705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Anti-TNF-α-induced lupus (ATIL) is a rare condition considered as a drug-induced lupus (DIL) in patients under anti-TNF-α therapies. Nowadays it is still unclear if ATIL is a classical DIL or represent a distinct syndrome. Some characteristics of DIL have been described specifically associated with patients with lupus-like syndrome receiving anti-TNF-α therapy: the severity of the disease, incidence/prevalence of dsDNA antibodies (anti-dsDNA) and hypocomplementaemia. The objective of this study is to describe the development of ATIL in patients with non-infectious uveitis in a single tertiary center. METHODS Retrospective description of a case series. RESULTS We describe three patients with noninfectious uveitis (NIU) of different etiologies who developed antinuclear antibody (ANA) and anti-dsDNA antibody positivity, arthritis and, in one case, skin lesions under adalimumab treatment. The condition resolved in all of them after adalimumab withdrawal. Corticosteroids were required in one patient, non-steroidal anti-inflammatory drugs in two patients, and hydroxychloroquine in one of them. None required another immunosuppressive drug. A subsequent control of the NIU could continue to be carried out without anti-TNF-α therapy in two patients and in the remaining a switch was made to another anti-TNF-α (golimumab). CONCLUSION The current report describes three cases of ATIL in patients with different types of NIU which share some common features: ANA positivity, articular symptoms, and a temporal relationship between symptoms onset and anti-TNF-α treatment. A review of the literature and comparison with the few previous reported ATIL cases was conducted as well.
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Affiliation(s)
| | | | | | - Gerard Espinosa
- Department of Autoimmune Diseases, 16493Hospital Clinic, Barcelona, Spain
| | - Aina Moll-Udina
- Clínic Institute of Ophthalmology, 16493Hospital Clinic, Barcelona, Spain
| | - Víctor Llorenç
- Clínic Institute of Ophthalmology, 16493Hospital Clinic, Barcelona, Spain
| | | | - Alfredo Adán
- Clínic Institute of Ophthalmology, 16493Hospital Clinic, Barcelona, Spain
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Bernal-Morales C, Alé-Chilet A, Martín-Pinardel R, Barraso M, Hernández T, Oliva C, Vinagre I, Ortega E, Figueras-Roca M, Sala-Puigdollers A, Gimenez M, Esmatjes E, Adán A, Zarranz-Ventura J. Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 4: Glycated Haemoglobin. Diagnostics (Basel) 2021; 11:1537. [PMID: 34573883 PMCID: PMC8472643 DOI: 10.3390/diagnostics11091537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate specifically the relationship between glycated haemoglobin (HbA1c) levels and retinal optical coherence tomography (OCT) and OCT angiography (OCTA) parameters in type 1 Diabetes Mellitus (DM). A total of 478 type 1 DM patients and 115 controls were included in a prospective OCTA trial (ClinicalTrials.gov NCT03422965). Subgroup analysis was performed for controls, no diabetic retinopathy (DM-no DR) and DR patients (DM-DR), and HbA1c levels. OCT and OCTA measurements were compared with HbA1c levels (current and previous 5 years). DM-no DR patients with HbA1c levels >7.5% showed lower VD than DM-DR and controls (20.16 vs. 20.22 vs. 20.71, p < 0.05), and showed a significant correlation between HbA1c levels and FAZc (p = 0.04), after adjusting for age, gender, signal strength index, axial length, and DM disease duration. DM-DR patients with HbA1c > 7.5% presented greater CRT than DM-no DR and controls (270.8 vs. 260 vs. 251.1, p < 0.05) and showed a significant correlation between HbA1c and CRT (p = 0.03). In conclusion, greater levels of HbA1c are associated with OCTA changes in DM-no DR patients, and with structural OCT changes in DM-DR patients. The combination of OCTA and OCT measurements and HbA1c levels may be helpful to identify patients at risk of progression to greater stages of the diabetic microvascular disease.
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Affiliation(s)
- Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
| | - Aníbal Alé-Chilet
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Ruben Martín-Pinardel
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
| | - Marina Barraso
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Teresa Hernández
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
| | - Cristian Oliva
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
| | - Irene Vinagre
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Emilio Ortega
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08036 Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Marga Gimenez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (C.B.-M.); (A.A.-C.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (R.M.-P.); (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
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Fanlo P, Espinosa G, Adán A, Arnáez R, Fonollosa A, Heras H, Oteiza J, Del Carmelo Gracia Tello B, Sáez Comet L, Pallarés L. Impact of novel coronavirus infection in patients with uveitis associated with an autoimmune disease: Result of the COVID-19-GEAS patient survey. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:347-352. [PMID: 34217471 PMCID: PMC8133494 DOI: 10.1016/j.oftale.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023]
Abstract
Introduction The objective of these study is to know the characteristics of COVID-19 in patients with uveitis associated with Systemic Autoimmune Disease (SAD) through telematic survey. Material and methods Internal Medicine Society and Group of Systemic Autoimmune disease conducted a telematic survey of patients with SAD to learn about the characteristics of COVID-19 in this population. Results A total of 2,789 patients answered the survey, of which 28 had a diagnosis of uveitis associated with SAE. The majority (82%) were female and caucasian (82%), with a mean age of 48 years. The most frequent SAEs were Behçet’s disease followed by sarcoidosis and systemic lupus erythematosus. 46% of the patients were receiving corticosteroid treatment at a mean prednisone dose of 11 mg/day. Regarding infection, 14 (50%) patients reported symptoms compatible with SARS-CoV-2 infection. RT-PCR was performed on the nasopharyngeal smear in two patients and in one of them (4%) it was positive. Conclusions Both asymptomatic and symptomatic COVID-19 patients with ASD-associated UNI had received similar immunosuppressive treatment.
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Affiliation(s)
- P Fanlo
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, Spain.
| | - G Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatología, Hospital Clínic, Barcelona, Spain
| | - A Adán
- Institut Clínic de Oftalmología, Hospital Clínic, Barcelona, Spain
| | - R Arnáez
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A Fonollosa
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Spain
| | - H Heras
- Servicio de Oftalmología, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Oteiza
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - B Del Carmelo Gracia Tello
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Clínico Lozano Blesa, Zaragoza, Spain
| | - L Sáez Comet
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - L Pallarés
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Son Espases, Balearic Islands, Spain
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Figueras-Roca M, Matas J, Llorens V, Sala-Puigdollers A, Navarro M, Zarranz-Ventura J, Adán A, Molins B. Systemic contribution of inflammatory mediators to the severity of diabetic and uveitic macular edema. Graefes Arch Clin Exp Ophthalmol 2021; 259:2695-2705. [PMID: 33710470 DOI: 10.1007/s00417-021-05149-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/24/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To assess whether serum cytokine and growth factor levels are associated with diabetic macular edema (DME) and uveitic macular edema (UME) objective severity. METHODS Cross-sectional observational study of 81 patients (1 eye/patient) with DME (n=48) and UME (n=33). Macular edema (ME) was defined upon central macular thickness (CMT) ≥ 300 μm on spectral domain optical coherence tomography (OCT). Serum samples were obtained from peripheral blood and IL-1β, IL-6, IL-8, IL-10, MCP-1, TNF-α, and VEGF levels were determined by Luminex analysis. Main outcome measure was the correlation between mediators' levels and CMT and macular volume (MV) on OCT for ME cases. RESULTS In DME, IL-6 levels were found to significantly correlate with MV (r=0.324; p=0.028) whereas in UME, IL-8 was significantly associated with both CMT (r=0.401; p=0.021) and MV (r=0.391; p=0.024). IL-8 independently correlated with CMT (ß=177.2; p=0.033) and MV (ß=3.17; p=0.008) in UME multivariate model. CONCLUSION Peripheral blood IL-6 and IL-8 levels could play a role in the severity of DME and UME, respectively. IL-8 even seems to be independently associated with CMT and MV in UME cases. Such systemic implications could enforce DME and UME personalized diagnostic and therapeutic approaches.
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Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Jessica Matas
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Víctor Llorens
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Manuel Navarro
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Molins
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Bernal-Morales C, Velazquez-Villoria D, Cubero-Parra JM, Keane PA, Sim DA, Adán A, Tufail A, Zarranz-Ventura J. Paracentral acute middle maculopathy after uneventful ocular surgery with local anaesthetic blocks. Eye (Lond) 2021. [PMID: 33686235 DOI: 10.1038/s41433-021-01481-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the role of local anaesthetic blocks as a potential cause of paracentral acute middle maculopathy (PAMM) after uneventful ocular surgery. METHODS Retrospective, observational, international, multicentre case series. Nine cases of PAMM with associated visual loss following uneventful ocular surgery with local anaesthetic blocks were observed in a 9-year period (2011-2020). Demographic, ocular and systemic data, anaesthetic data and surgical details were collected. Visual acuity (VA), fundus photography, fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images were reviewed. RESULTS All nine cases were associated with decreased VA at 24 h postoperative check (ranging from hand movement to 20/200). A hyperreflective band within the middle retinal layers was observed in the structural OCT in the acute phase, evolving to thinning and atrophy of the inner retinal layers in sequential follow-up scans performed. Fluorescein angiography showed delayed perfusion in early arterial phase with normal perfusion in late venous phases. OCTA showed decreased perfusion in the deep capillary plexus. Visual recovery was variable between cases during follow-up (ranging from count fingers to 20/20). CONCLUSIONS A combination of a vasoconstrictive effect of the anaesthetic agent, an intraocular pressure spike and a mechanical effect of the volume of anaesthetic injected may result in decreased retinal artery perfusion and be evidenced as PAMM in OCT scans. PAMM may present as a potential complication of local anaesthetic blocks in cases of unexpected visual loss after uneventful ocular surgery.
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Affiliation(s)
| | | | | | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Alfredo Adán
- Clinic Institute of Ophthalmology (ICOF), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Adnan Tufail
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Zarranz-Ventura
- Clinic Institute of Ophthalmology (ICOF), Hospital Clinic, Barcelona, Spain.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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22
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García Tirado A, Sánchez-Dalmau B, Adán A. Impact on elective ophthalmic surgery caused by the COVID-19 pandemic after the lockdown at the Clinical Institute of Ophthalmology of the Hospital Clinic de Barcelona. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:397-398. [PMID: 34217480 PMCID: PMC7894069 DOI: 10.1016/j.oftale.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- A García Tirado
- Servicio de Oftalmología, Instituto Clínico de Oftalmología, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - B Sánchez-Dalmau
- Servicio de Oftalmología, Instituto Clínico de Oftalmología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Adán
- Servicio de Oftalmología, Instituto Clínico de Oftalmología, Hospital Clínic de Barcelona, Barcelona, Spain
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23
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Prieto-Peña D, Calderón-Goercke M, Adán A, Chamorro-López L, Maíz-Alonso O, De Dios-Jiménez Aberásturi JR, Veroz R, Blanco S, Martín-Santos JM, Navarro F, Gallego A, González-Suárez S, Conesa A, García-Valle A, Cordero-Coma M, Pardiñas-Barón N, Demetrio R, Calvo-Río V, Martínez-Taboada VM, Castañeda S, Hernández JL, González-Gay MA, Blanco R. Efficacy and safety of certolizumab pegol in pregnant women with uveitis. Recommendations on the management with immunosuppressive and biologic therapies in uveitis during pregnancy. Clin Exp Rheumatol 2021; 39:105-114. [DOI: 10.55563/clinexprheumatol/j9ysbm] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/16/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Diana Prieto-Peña
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Mónica Calderón-Goercke
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Alfredo Adán
- Clinic Institute of Ophthalmology (ICOF), Hospital Clinic of Barcelona, Spain
| | | | - Olga Maíz-Alonso
- Rheumatology, Hospital Universitario de Donostia, San Sebastián, Spain
| | | | | | | | | | - Francisco Navarro
- Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Adela Gallego
- Rheumatology, Hospital Universitario de Badajoz, Spain
| | | | - Arantxa Conesa
- Rheumatology, Hospital General Universitari de Castelló, Castellón de la Plana, Spain
| | | | | | | | - Rosalía Demetrio
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Vanesa Calvo-Río
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Víctor M. Martínez-Taboada
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, and University of Cantabria, School of Medicine, Santander, Spain
| | - Santos Castañeda
- Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
| | - José L. Hernández
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Miguel A. González-Gay
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, University of Cantabria, School of Medicine, Santander, Spain, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ricardo Blanco
- Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
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24
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Fanlo P, Espinosa G, Adán A, Arnáez R, Fonollosa A, Heras H, Oteiza J, Del Carmelo Gracia Tello B, Comet LS, Pallarés L. Impact of novel coronavirus infection in patients with uveitis associated with an autoimmune disease: result of the COVID-19-GEAS patient survey. ACTA ACUST UNITED AC 2021; 96:347-352. [PMID: 34629695 PMCID: PMC7826000 DOI: 10.1016/j.oftal.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023]
Abstract
Introducción El objetivo de este estudio es conocer las características de la COVID-19 en pacientes con uveítis asociada a enfermedades autoinmunes sistémicas (EAS) mediante una encuesta telemática. Material y métodos La Sociedad Española de Medicina Interna por medio del Grupo de Trabajo de Enfermedades Autoinmunes realizó una encuesta telemática a pacientes con EAS para conocer las características de la COVID-19 en esta población. Resultados Un total de 2.789 pacientes contestaron la encuesta, de los que 28 tenían un diagnóstico de uveítis asociada a una EAS. La mayoría (82%) eran mujeres y caucásicas (82%), con una media de 48 años. Las EAS más frecuentes fueron la enfermedad de Behçet seguida de la sarcoidosis y del lupus eritematoso sistémico. El 46% de los pacientes estaban recibiendo tratamiento con corticoides a una dosis media de prednisona de 11 mg/día. Respecto a la infección, 14 (50%) pacientes referían síntomas compatibles con infección por SARS-CoV-2. Se realizó RT-PCR en el frotis nasofaríngeo en dos pacientes y en uno de ellos (4%) fue positivo. Conclusiones Los pacientes con UNI asociada a EAS tanto los asintomáticos como los sintomáticos de COVID-19 habían recibido de forma similar tratamiento inmunosupresor.
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Affiliation(s)
- P Fanlo
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, España.
| | - G Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatología, Hospital Clínic, Barcelona, España
| | - A Adán
- Institut Clínic de Oftalmología, Hospital Clínic, Barcelona, España
| | - R Arnáez
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, España
| | - A Fonollosa
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, España
| | - H Heras
- Servicio de Oftalmología, Complejo Hospitalario de Navarra, Pamplona, España
| | - J Oteiza
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, España
| | - B Del Carmelo Gracia Tello
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Clínico Lozano Blesa, Zaragoza, España
| | - L Sáez Comet
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | - L Pallarés
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Son Espases, Islas Baleares, España
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25
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Affiliation(s)
- Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Alfredo Adán
- The Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Quan Dong Nguyen
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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26
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Sarmiento-Monroy JC, Espinosa G, Londoño MC, Meira F, Caballol B, Llufriu S, Carrasco JL, Moll-Udina A, Quintana LF, Giavedoni P, Ramírez J, Inciarte-Mundo J, Solana E, Blanco Y, Martinez-Hernandez E, Sepúlveda M, Llorenç V, Prieto-González S, Espígol-Frigolé G, Milisenda JC, Cid MC, Mascaró JM, Blanco I, Barberá JA, Sibila O, Gratacos-Ginès J, Adán A, Agustí A, Sanmartí R, Panés J, Cervera R, Vila J, Soriano A, Gómez-Puerta JA. A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center. J Autoimmun 2020; 117:102580. [PMID: 33338707 PMCID: PMC7836738 DOI: 10.1016/j.jaut.2020.102580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
Background and aim There is increasing interest regarding SARS-CoV-2 infection in patients with autoimmune and immune-mediated inflammatory diseases (AI/IMID) with some discrepancies in different cohorts about their risk and outcomes. The aim was to describe a multidisciplinary cohort of patients with AI/IMID and symptomatic SARS-CoV-2 infection in a single tertiary center and analyze sociodemographic, clinical, and therapeutic factors associated with poor outcomes. Methods A retrospective observational study was conducted from the 1st of March until May 29th, 2020 in a University tertiary hospital in Barcelona, Spain. Patients with an underlying AI/IMID and symptomatic SARS-CoV-2 infection were identified in our local SARS-CoV-2 infection database. Controls (2:1) were selected from the same database and matched by age and gender. The primary outcome was severe SARS-CoV-2 infection, which was a composite endpoint including admission to the intensive care unit (ICU), need for mechanical ventilation (MV), and/or death. Several covariates including age, sex, and comorbidities among others were combined into a multivariate model having severe SARS-CoV-2 as the dependent variable. Also, a sensitivity analysis was performed evaluating AID and IMID separately. Results The prevalence of symptomatic SARS-CoV-2 infection in a cohort of AI/IMID patients was 1.3%. Eighty-five patients with AI/IMID and symptomatic SARS-CoV-2 were identified, requiring hospitalization in 58 (68%) cases. A total of 175 patients admitted for SARS-CoV-2 (58 with AI/IMID and 117 matched-controls) were analyzed. In logistic regression analysis, a significant inverse association between AI/IMID group and severe SARS-CoV-2 (OR 0.28; 95% CI 0.12–0.61; p = 0.001), need of MV (OR 0.20; IC 95% 0.05–0.71; p = 0.014), and ICU admission (OR 0.25; IC 95% 0.10–0.62; p = 0.003) was found. Conclusions Patients with AI/IMID who require admission for SARS-CoV-2 infection have a lower risk of developing severe disease, including the need to stay in the ICU and MV. Patients with AI/IMID fwho required admission for SARS CoV2 infection have a lower risk of developing severe disease. Among patients with AID and IMID, there were no differences in terms of severity. According to the 7-category ordinal scale, maximum oxygen requirement was lower among AI/IMID group.
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Affiliation(s)
| | - Gerard Espinosa
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria-Carlota Londoño
- Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Fernanda Meira
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Berta Caballol
- Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Sara Llufriu
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Josep Lluis Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Catalonia, Spain
| | - Aina Moll-Udina
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Priscila Giavedoni
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Julio Ramírez
- Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | | | - Elisabeth Solana
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Yolanda Blanco
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Maria Sepúlveda
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Victor Llorenç
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Sergio Prieto-González
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jose C Milisenda
- Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | - Maria C Cid
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jose M Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Joan Albert Barberá
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Oriol Sibila
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Alfredo Adán
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Alvaro Agustí
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Raimon Sanmartí
- Rheumatology Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Julian Panés
- Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, Biomedical Diagnostic Center, Hospital Clinic, Barcelona Institute for Global Health, University of Barcelona, Barcelona, Catalonia, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
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Hernanz I, Miguel Escuder L, Chamorro L, Moll-Udina A, Espinosa G, Sainz de la Maza M, Llorenç V, Adán A. Tuberculosis-Related Uveitis in Patients under Anti-TNF-alpha Therapy: A Case Series. Ocul Immunol Inflamm 2020; 30:839-844. [PMID: 33216652 DOI: 10.1080/09273948.2020.1834588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tumor necrosis factor inhibitors (anti-TNF) have emerged as an effective treatment in noninfectious uveitis (NIU). Anti-TNF may increase the predisposition to infectious disease as tuberculosis (TB). TB-related uveitis in the context of an uveitogenic concurrent systemic immune-mediated disease under anti-TNF treatment remain a diagnostic challenge, deserving special focus on this rare context. Retrospective chart review of patients on anti-TNF drugs for systemic immune-mediated diseases that developed a multicentric microbiologically confirmed active TB with concurrent intraocular involvement.Three patients were recorded. Screening for TB before starting anti-TNF resulted negative in two patients. The other patient had received anti-tuberculous treatment in the past. All showed a microbiologically confirmed extraocular TB after unexpected atypical reactivation of the uveitis shifting to chronic granulomatous pattern.Specialists should be aware of TB reactivation, even with previous negative screening, when ocular uveitis signs and activity do not match with the expected pattern in a patient on anti-TNF drugs.
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Affiliation(s)
- I Hernanz
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - L Miguel Escuder
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - L Chamorro
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - A Moll-Udina
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - G Espinosa
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - M Sainz de la Maza
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - V Llorenç
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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28
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Moll-Udina A, Figueras-Roca M, Oliveres J, Sala-Puigdollers A, Esquinas C, Alba-Linero C, Llorenç V, Adán A. Uveitic macular edema response to intravitreal dexamethasone implant is independent of optical coherence tomography findings. Int Ophthalmol 2020; 41:787-796. [PMID: 33184677 DOI: 10.1007/s10792-020-01631-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify predictive response optical coherence tomography (OCT) findings in uveitic macular edema (UME) treated with intravitreal dexamethasone implant (DEX). METHODS Retrospective study of 66 eyes (53 patients) treated with DEX for UME. SD-OCT macular scans were collected prior to DEX treatment and 6 weeks and 3 months after the DEX implant. OCT images were evaluated for qualitative and quantitative characteristics (central retinal thickness, CRT and macular volume, MV). A multivariate analysis of covariance (ANCOVA) was carried out to study the predictive influence of OCT and clinical covariates on outcomes. The main outcome was a composite endpoint based on the simultaneous gain of 5 or more letters associated with a 20% or more reduction in CRT. RESULTS A significant improvement in BCVA at 6 weeks (mean change from baseline -0.2, SD 0.3) and 3 months (mean -0.2, SD 0.4) was observed after the DEX implant. A significant decrease in CRT (change from baseline -187.7 μm at 3 months) and MV (change from baseline -1.7 mm3 at 3 months) were also observed. An association of ≥ 5-letter improvement in BCVA and a ≥ 20% CRT reduction was observed in 44.6% of cases at 6 weeks and 31.4% at 3 months. ANCOVA multivariate analyses found CRT at 3 months independent from baseline clinical variables but from CRT. CONCLUSION DEX implant is an effective treatment for UME independently of basal characteristics, producing both a gain of visual acuity and improvement of macular anatomy by OCT measures at 3 months.
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Affiliation(s)
- Aina Moll-Udina
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain. .,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - Marc Figueras-Roca
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Oliveres
- Hospital Vall D'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Esquinas
- Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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29
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Alba-Linero C, Liscombe-Sepúlveda JP, Llorenç V, GiraltJosa J, Adán A. Use of ultra-wide field retinal imaging and optical coherence tomography angiography in the diagnosis of incomplete Susac syndrome. Eur J Ophthalmol 2020; 31:3238-3247. [PMID: 33106042 DOI: 10.1177/1120672120965482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe clinical findings through ultra-wide field (UWF) images and optical coherence tomography angiography (OCT-A), in Susac's syndrome (SS). METHODS SS patients were retrospectively analyzed in a single center. Clinical features, ultra-wide-field retinographies (UWF-PR), UWF fluorescein angiographies (UWF-FA), and optical coherence tomography angiography & en face (OCT-A/EF) were reviewed. RESULTS Twelve eyes from six patients with a mean follow-up of 35.66 months ± SD 36.88 were included. UWF-PR showed areas of retinal whitening and cotton-wool spots in all the eyes after acute attack. Segmentary mid peripheral arteriolitis could be observed in five eyes by UWF-FA in acute and convalescent stages. OCT-A revealed capillary density changes in all of the affected eyes. During the acute phase there was a well-preserved superficial capillary network, while deep retinal plexus showed a lower density in the affected areas. OCT-A/EF revealed deep retinal plexus drop-out and surrounding edematous retina in acute attacks, becoming atrophic over time. Conversely, superficial plexus was much less affected. Perifoveal reperfusion was seen in seven eyes after the acute attack. CONCLUSIONS UWF-PR/FA and OCT-A/EF might be helpful to stablish an early diagnosis and to monitor SS progression.
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Affiliation(s)
| | | | - Victor Llorenç
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
| | - Joan GiraltJosa
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
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Hernanz I, Moll-Udina A, Dotti-Boada M, Carrión MT, Llorenç V, Adán A. Non-pharmacological complications associated with Intravitreal dexamethasone implant injection. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:471-477. [PMID: 32654825 DOI: 10.1016/j.oftal.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Intravitreal dexamethasone implant (IID) is an effective and safe treatment for macular oedema as described in the literature. Ocular hypertension and cataracts are the most frequent complications. The indications of IID in the last few years have led to the retrospective reporting of rare complications, with potential visual impact related to the injection procedure. METHODS A case series is presented of fifteen patients treated with IID for macular oedema who developed non-pharmacological complications related to the injection procedure or the implant itself, including, among others anterior chamber migration, intracrystalline injection, endophthalmitis, or segmentation. Differentiation was made between true complications and those that did not lead to any ocular damage. Epidemiological and baseline data were collected along with the treatment and outcome in each case. An analysis was made of multimodal imaging available. RESULTS The incidence of complications was 0.65% in this series Anterior chamber migration was the most frequent complication (n=4), followed by intracrystalline injection, and endophthalmitis (n=2). The times between the injection and complications were variable. Visual impairment was the most common symptom (n=6). However, despite the complications found, IID was an effective treatment in most of the reported cases. CONCLUSIONS Clinicians should be aware of these rare non-pharmacological complications so that they may be prevented and detected early, avoiding irreversible ocular damage.
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Affiliation(s)
- I Hernanz
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España.
| | - A Moll-Udina
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M Dotti-Boada
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M T Carrión
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - V Llorenç
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - A Adán
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
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Martín-Varillas JL, Atienza-Mateo B, Calvo-Rio V, Beltrán E, Sánchez-Bursón J, Adán A, Hernández-Garfella M, Valls-Pascual E, Sellas-Fernández A, Ortego N, Maíz O, Torre I, Fernández-Espartero C, Jovani V, Peiteado D, Valle DD, Aurrecoechea E, Caracuel MA, García-González AJ, Álvarez ER, Vegas-Revenga N, Demetrio-Pablo R, Castañeda S, González-Gay MA, Hernández JL, Blanco R. Long-term Follow-up and Optimization of Infliximab in Refractory Uveitis Due to Behçet Disease: National Study of 103 White Patients. J Rheumatol 2020; 48:741-750. [PMID: 33004539 DOI: 10.3899/jrheum.200300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In a large series of White patients with refractory uveitis due to Behçet disease (BD) being treated with infliximab (IFX), we assessed (1) long-term efficacy and safety of IFX, and (2) IFX optimization when ocular remission was achieved. METHODS Our multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressant agents treated 103 patients/185 affected eyes with IFX as first biologic therapy in the following intervals: 3-5 mg/kg intravenous at 0, 2, 6, and then every 4-8 weeks. The main outcome variables were analyzed at baseline, first week, first month, sixth month, first year, and second year of IFX therapy. After remission, based on a shared decision between patient and clinician, IFX optimization was performed. Efficacy, safety, and cost of IFX therapy were evaluated. RESULTS In the whole series (n = 103), main outcome variables showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Serious adverse events were observed in 9 patients: infusion reactions (n = 4), tuberculosis (n = 1), Mycobacterium avium pneumonia (n = 1), severe oral ulcers (n = 1), palmoplantar psoriasis (n = 1), and colon carcinoma (n = 1). In the optimization subanalysis, the comparative study between optimized and nonoptimized groups showed (1) no differences in clinical characteristics at baseline, (2) similar maintained improvement in most ocular outcomes, (3) lower severe adverse events, and (4) lower mean IFX costs in the optimized group (€4826.52 vs €9854.13 per patient/yr). CONCLUSION IFX seems to be effective and relatively safe in White patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective.
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Affiliation(s)
- José Luis Martín-Varillas
- J.L. Martín-Varillas, MD, B. Atienza-Mateo, MD, V. Calvo-Rio, MD, PhD, R. Demetrio-Pablo, MD, PhD, M.A. González-Gay, MD, PhD, J.L. Hernández, MD, PhD, R. Blanco, MD, PhD, Rheumatology, Internal Medicine and Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, University of Cantabria
| | - Belén Atienza-Mateo
- J.L. Martín-Varillas, MD, B. Atienza-Mateo, MD, V. Calvo-Rio, MD, PhD, R. Demetrio-Pablo, MD, PhD, M.A. González-Gay, MD, PhD, J.L. Hernández, MD, PhD, R. Blanco, MD, PhD, Rheumatology, Internal Medicine and Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, University of Cantabria
| | - Vanesa Calvo-Rio
- J.L. Martín-Varillas, MD, B. Atienza-Mateo, MD, V. Calvo-Rio, MD, PhD, R. Demetrio-Pablo, MD, PhD, M.A. González-Gay, MD, PhD, J.L. Hernández, MD, PhD, R. Blanco, MD, PhD, Rheumatology, Internal Medicine and Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, University of Cantabria
| | - Emma Beltrán
- E. Beltrán, MD, Rheumatology, Hospital del Mar, Barcelona
| | - Juan Sánchez-Bursón
- J. Sánchez-Bursón, MD, PhD, Rheumatology, Hospital Universitario Virgen de Valme, Sevilla
| | - Alfredo Adán
- A. Adán, MD, PhD, Rheumatology and Ophthalmology, Hospital Clinic de Barcelona, Barcelona
| | | | - Elia Valls-Pascual
- E. Valls-Pascual, MD, Rheumatology, Hospital Universitario Doctor Peset, Valencia
| | | | - Norberto Ortego
- N. Ortego, MD, PhD, E. Raya Álvarez, MD, PhD, Autoimmune Diseases, Hospital Universitario San Cecilio, Granada
| | - Olga Maíz
- O. Maíz, MD, Rheumatology, Hospital Universitario de Donostia, San Sebastián
| | - Ignacio Torre
- I. Torre, MD, Rheumatology, Hospital Universitario Basurto, Bilbao
| | | | - Vega Jovani
- V. Jovani, MD, PhD, Rheumatology, Hospital General Universitario de Alicante, Alicante
| | - Diana Peiteado
- D. Peiteado, MD, PhD, Rheumatology, Hospital Universitario La Paz
| | - David Díaz Valle
- D. Díaz Valle, MD, PhD, Ophthalmology, Hospital Clínico San Carlos, Madrid
| | - Elena Aurrecoechea
- E. Aurrecoechea, MD, PhD, Rheumatology, Hospital Sierrallana, Torrelavega
| | - Miguel A Caracuel
- M.A. Caracuel, MD, PhD, Rheumatology, Hospital Universitario Reina Sofía, Córdoba
| | | | - Enrique Raya Álvarez
- N. Ortego, MD, PhD, E. Raya Álvarez, MD, PhD, Autoimmune Diseases, Hospital Universitario San Cecilio, Granada
| | | | - Rosalía Demetrio-Pablo
- J.L. Martín-Varillas, MD, B. Atienza-Mateo, MD, V. Calvo-Rio, MD, PhD, R. Demetrio-Pablo, MD, PhD, M.A. González-Gay, MD, PhD, J.L. Hernández, MD, PhD, R. Blanco, MD, PhD, Rheumatology, Internal Medicine and Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, University of Cantabria
| | - Santos Castañeda
- S. Castañeda, MD, PhD, Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Miguel A González-Gay
- J.L. Martín-Varillas, MD, B. Atienza-Mateo, MD, V. Calvo-Rio, MD, PhD, R. Demetrio-Pablo, MD, PhD, M.A. González-Gay, MD, PhD, J.L. Hernández, MD, PhD, R. Blanco, MD, PhD, Rheumatology, Internal Medicine and Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, University of Cantabria
| | - José Luis Hernández
- J.L. Martín-Varillas, MD, B. Atienza-Mateo, MD, V. Calvo-Rio, MD, PhD, R. Demetrio-Pablo, MD, PhD, M.A. González-Gay, MD, PhD, J.L. Hernández, MD, PhD, R. Blanco, MD, PhD, Rheumatology, Internal Medicine and Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, University of Cantabria;
| | - Ricardo Blanco
- J.L. Martín-Varillas, MD, B. Atienza-Mateo, MD, V. Calvo-Rio, MD, PhD, R. Demetrio-Pablo, MD, PhD, M.A. González-Gay, MD, PhD, J.L. Hernández, MD, PhD, R. Blanco, MD, PhD, Rheumatology, Internal Medicine and Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, University of Cantabria
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Barraso M, Alé-Chilet A, Hernández T, Oliva C, Vinagre I, Ortega E, Figueras-Roca M, Sala-Puigdollers A, Esquinas C, Esmatjes E, Adán A, Zarranz-Ventura J. Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 1: Diabetic Retinopathy. Transl Vis Sci Technol 2020; 9:34. [PMID: 33062397 PMCID: PMC7533741 DOI: 10.1167/tvst.9.10.34] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose The purpose of this study was to evaluate specifically in type 1 diabetes mellitus (DM) individuals the relationship between perifoveal superficial capillary plexus (SCP) parameters assessed by optical coherence tomography angiography (OCTA) and diabetic retinopathy (DR) grade. Methods Cross-sectional analysis of a large scale prospective OCTA trial cohort (ClinicalTrials.gov NCT03422965). A total of 1186 eyes (593 individuals), 956 type 1 DM eyes (478 patients), and 230 control eyes (115 healthy volunteers) were included in this study. DR stage was graded according to the International Classification. OCTA imaging was performed with a commercially available device (Cirrus HD-OCT). Vessel density (VD), perfusion density (PD), and foveal avascular zone (FAZ) area, perimeter and circularity measurements were quantified in the SCP and receiver operating characteristic (ROC) curves were constructed for each OCTA parameter. Results VD and PD (in both 3 × 3 and 6 × 6 mm captures) were inversely associated with DR stage (P < 0.001 in all cases) in a multiple regression analysis after controlling by age, gender, signal strength index, axial length, and DM duration. Greater FAZ area and perimeter and conversely lower circularity measurements were observed as DR severity increased in both scanning protocols (P < 0.05 in all cases). Conclusions In type 1 DM individuals, OCTA provides an objective, continuous, and reliable method for accurate quantification of VD, PD, and FAZ parameters in the SCP, which ultimately correlate with DR stages. Translational Relevance Objective OCTA measurements of the retinal microvasculature could substitute the clinical DR classification in patients with type 1 DM, identify patients at risk of DR progression, and inform treatment decisions to modify the evolution of the disease.
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Affiliation(s)
- Marina Barraso
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Aníbal Alé-Chilet
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Teresa Hernández
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Cristian Oliva
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Emilio Ortega
- Diabetes Unit, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Cristina Esquinas
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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33
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Figueroa-Vercellino JP, Palma-Carvajal F, Garcia-Mendieta M, Lorenzo D, Moll-Udina A, Adán A, Caminal JM. Multimodal imaging in amelanotic choroidal melanoma. J Fr Ophtalmol 2020; 44:126-128. [PMID: 33008640 DOI: 10.1016/j.jfo.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Affiliation(s)
- J P Figueroa-Vercellino
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain.
| | - F Palma-Carvajal
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain
| | - M Garcia-Mendieta
- Instituto de oftalmología, hospital universitario de Bellvitge, Barcelona, Spain
| | - D Lorenzo
- Instituto de oftalmología, hospital universitario de Bellvitge, Barcelona, Spain
| | - A Moll-Udina
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain
| | - A Adán
- Instituto de oftalmología, universidad de Barcelona, hospital clinic de Barcelona, Barcelona, Spain
| | - J M Caminal
- Instituto de oftalmología, hospital universitario de Bellvitge, Barcelona, Spain
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Matas J, Llorenç V, Fonollosa A, Díaz-Valle D, Esquinas C, de la Maza MTS, Figueras-Roca M, Artaraz J, Berasategui B, Mesquida M, Adán A, Molins B. Systemic Regulatory T Cells and IL-6 as Prognostic Factors for Anatomical Improvement of Uveitic Macular Edema. Front Immunol 2020; 11:579005. [PMID: 33101305 PMCID: PMC7545109 DOI: 10.3389/fimmu.2020.579005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/14/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate whether systemic immune mediators and circulating regulatory T cells (Tregs) could be prognostic factors for anatomic outcomes in macular edema secondary to non-infectious uveitis (UME). Methods Multicenter, prospective, observational, 12-month follow-up study of 60 patients with UME. Macular edema was defined as central subfield thickness (CST) > 300 μm measured with spectral domain optical coherence tomography (SD-OCT). Serum samples and peripheral blood mononuclear cells (PBMC) were obtained from venous blood extraction at baseline. Serum levels of IL-1β, IL-6, IL-8, IL-17, MCP-1, TNF-α, IL-10, and VEGF were determined by Luminex. Tregs population, defined as CD3+CD4+FoxP3+ in PBMC, was determined by flow cytometry. Main outcome measure was the predictive association between searched mediators and CST sustained improvement, defined as CST < 300 microns or a 20% CST decrease, at 6 months maintained until 12-months compared to baseline levels. Results Multivariate logistic regression analysis showed an association between CST sustained improvement at 12 months follow-up and IL-6 and Tregs baseline levels. Higher IL-6 levels were associated with less events of UME improvement (OR: 0.67, 95% CI (0.45–1.00), P = 0.042), whereas higher levels of Tregs favored such improvement (OR: 1.25, 95% CI: 1.12–2.56, P = 0.049). Conclusions Increased levels of Tregs and reduced levels of IL-6 in serum may be prognostic factors of sustained anatomical improvement in UME. These findings could enforce the opportunity to develop more efficient and personalized therapeutic approaches to improve long-term visual prognosis in patients with UME.
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Affiliation(s)
- Jessica Matas
- Group of Ocular Inflammation, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Group of Ocular Inflammation, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Health Research Institute, Hospital Cruces, University of the Basque Country, Baracaldo, Spain
| | - David Díaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinic of San Carlos, Madrid, Spain
| | - Cristina Esquinas
- Valle Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria Teresa Sainz de la Maza
- Group of Ocular Inflammation, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marc Figueras-Roca
- Group of Ocular Inflammation, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Health Research Institute, Hospital Cruces, University of the Basque Country, Baracaldo, Spain
| | - Barbara Berasategui
- Department of Ophthalmology, BioCruces Health Research Institute, Hospital Cruces, University of the Basque Country, Baracaldo, Spain
| | - Marina Mesquida
- Group of Ocular Inflammation, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Group of Ocular Inflammation, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Blanca Molins
- Group of Ocular Inflammation, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
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Adán A, Cabrera F, Figueroa MS, Cervera E, Ascaso FJ, Udaondo P, Abraldes M, Reyes MÁ, Pazos M, Pessoa B, Armadá F. Clinical-Decision Criteria to Identify Recurrent Diabetic Macular Edema Patients Suitable for Fluocinolone Acetonide Implant Therapy (ILUVIEN ®) and Follow-Up Considerations/Recommendations. Clin Ophthalmol 2020; 14:2091-2107. [PMID: 32801618 PMCID: PMC7398681 DOI: 10.2147/opth.s252359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022] Open
Abstract
Current management of diabetic macular edema (DME) predominantly involves treatment with short-acting intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs) and/or corticosteroids; however, short-acting therapies (lasting between 1 and 6 months) require frequent injections to maintain efficacy, meaning a considerable treatment burden for diabetic patients with multiple comorbidities. Continuous injections needed in some cases are an economic burden for patients/healthcare system, so real-life clinical practice tends to adopt a reactive approach, ie, watch and wait for worsening symptoms, which consequently increases the risk of undertreatment and edema recurrence. On March 7th 2019, a group of experts in retinal medicine and surgery held a roundtable meeting in Madrid, Spain to discuss how to (1) optimize clinical outcomes through earlier use of fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients with persistent or recurrent DME despite therapy; and, (2) to provide guidance to assist physicians in deciding which patients should be treated with ILUVIEN. In this regard, a 36-month follow-up consensus protocol is presented. In conclusion, patients that achieve a complete or partial anatomical, and preferably functional, response following one or two intravitreal dexamethasone implants, but with recurrence of edema after 3-4 months, are deemed by the authors most likely to benefit from ILUVIEN, and the switch to FAc implant should not be delayed more than 12 months after the initiation of at least the first dexamethasone implant.
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Affiliation(s)
| | - Francisco Cabrera
- Complejo Hospitalario Universitario Insular Materno-Lnfantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Francisco J Ascaso
- Hospital Clínico Universitario Lozano Blesa de Zaragoza, Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Patricia Udaondo
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Maximino Abraldes
- Complexo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Miguel Ángel Reyes
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Pazos
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Bernardete Pessoa
- Centro Hospitalar e Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
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Romero-Vázquez S, Adán A, Figueras-Roca M, Llorenç V, Slevin M, Vilahur G, Badimon L, Dick AD, Molins B. Activation of C-reactive protein proinflammatory phenotype in the blood retinal barrier in vitro: implications for age-related macular degeneration. Aging (Albany NY) 2020; 12:13905-13923. [PMID: 32673285 PMCID: PMC7425453 DOI: 10.18632/aging.103655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/20/2020] [Indexed: 12/14/2022]
Abstract
The retinal pigment epithelium (RPE) is considered one of the main targets of age-related macular degeneration (AMD), the leading cause of irreversible vision loss among the ageing population worldwide. Persistent low grade inflammation and oxidative stress eventually lead to RPE dysfunction and disruption of the outer blood-retinal barrier (oBRB). Increased levels of circulating pentameric C-reactive protein (pCRP) are associated with higher risk of AMD. The monomeric form (mCRP) has been detected in drusen, the hallmark deposits associated with AMD, and we have found that mCRP induces oBRB disruption. However, it is unknown how mCRP is generated in the subretinal space. Using a Transwell model we found that both pCRP and mCRP can cross choroidal endothelial cells and reach the RPE in vitro and that mCRP, but not pCRP, is able to cross the RPE monolayer in ARPE-19 cells. Alternatively, mCRP can originate from the dissociation of pCRP in the surface of lipopolysaccharide-damaged RPE in both ARPE-19 and primary porcine RPE lines. In addition, we found that the proinflammatory phenotype of mCRP in the RPE depends on its topological localization. Together, our findings further support mCRP contribution to AMD progression enhancing oBRB disruption.
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Affiliation(s)
- Sara Romero-Vázquez
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marc Figueras-Roca
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mark Slevin
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Gemma Vilahur
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Institute Carlos III, Barcelona, Spain
| | - Lina Badimon
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Institute Carlos III, Barcelona, Spain
| | - Andrew D Dick
- Academic Unit of Ophthalmology, School of Clinical Sciences and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Blanca Molins
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
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Moll-Udina A, Miguel Escuder L, Hernanz I, Llorenç V, Fonollosa A, Cordero Coma M, Sainz de la Maza M, Espinosa G, González Guijarro JJ, Lopez Lopez F, Alba-Linero C, Hernández M, Martínez Costa L, Celdrán Vivancos D, Giralt L, Artaraz J, Soler Bartrina P, Jódar Márquez M, García de Vicuña R, Esquinas C, Adán A. Adalimumab in Elderly Patients with Non-Infectious Uveitis. Safety and Efficacy. Ocul Immunol Inflamm 2020; 29:1591-1598. [PMID: 32657649 DOI: 10.1080/09273948.2020.1769139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy and safety of adalimumab in elderly patients with noninfectious uveitis (NIU). METHODS An observational, retrospective, multicenter study was done. Changes in best-corrected visual acuity (BCVA), inflammatory activity parameters, central retinal thickness (CRT), and the occurrence of adverse events (AE) developed during follow-up were recorded. RESULTS A total of 82 eyes from 41 patients 60 years of age and older with noninfectious uveitis treated with adalimumab were included. A significant improvement in BCVA (71.5 to 75.4 letters, p = .001) and in CRT (311.1 μm to 265 μm, p = .001) was observed. Moreover, a significant decrease from baseline in the rate of patients with anterior chamber cell (ACC) >0+ (34.6% to 5.7%, p = <0.001) or vitreous haze>0+ (21.3% to 4.3%, p = .002) was determined. AEs were observed in 11 patients (26.8%). CONCLUSION Adalimumab can be safe and efficacious for the treatment of NIU in patients 60 years of age and older.
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Affiliation(s)
- Aina Moll-Udina
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lucía Miguel Escuder
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Inés Hernanz
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Health Research Institute, Cruces Hospital, University of Basque Country, Leioa, Spain
| | - Miguel Cordero Coma
- Department of Ophthalmology, University Hospital of León, IBIOMED, University of León, León, Spain
| | - Maite Sainz de la Maza
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Carmen Alba-Linero
- Department of Ophthalmology, Regional University Hospital of Málaga, University of Malaga, Málaga, Spain
| | - Marisa Hernández
- Department of Ophthalmology, General Hospital of Valencia, Valencia, Spain
| | | | | | - Lena Giralt
- Department of Ophthalmology, BioCruces Health Research Institute, Cruces Hospital, University of Basque Country, Leioa, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Health Research Institute, Cruces Hospital, University of Basque Country, Leioa, Spain
| | | | - Margarita Jódar Márquez
- Department of Ophthalmology, Regional University Hospital of Málaga, University of Malaga, Málaga, Spain
| | | | - Cristina Esquinas
- Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Ophthalmology Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Figueroa-Vercellino JP, Miguel L, Moll-Udina A, Alba-Linero C, Llorenç V, Adán A. Atypical toxoplasmic retinochoroiditis in patients with malignant hematological diseases. ACTA ACUST UNITED AC 2020; 96:152-156. [PMID: 32651033 DOI: 10.1016/j.oftal.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022]
Abstract
In immunocompromised patients, toxoplasmosis may have atypical presentation with bilateral, extensive or multifocal involvement. We report a case series of atypical toxoplasmic retinocoroiditis in patients with malignant hematological diseases who are usually immunosuppressed. Four patients were diagnosed of atypical toxoplasmic retinochoroiditis, all of them had immunosuppression (100%) and half of them (50%) had received a bone marrow transplant. The polymerase chain reaction for toxoplasma was positive in 75% of cases, and in one case (25%) the diagnosis was made with clinical and serological criteria. One patient presented ocular toxoplasmosis despite being on prophylactic treatment with atovaquone. Patients with atypical ocular toxoplasmosis and hematological diseases are generally immunocompromised, but they do not always have history of a bone marrow transplant. The presentation may be due to a primary infection or a reactivation of the disease. The aqueous humor and/or vitreous polymerase chain reaction allow confirming the diagnosis to perform a proper treatment.
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Affiliation(s)
- J P Figueroa-Vercellino
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España.
| | - L Miguel
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - A Moll-Udina
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - C Alba-Linero
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - V Llorenç
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - A Adán
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
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Figueras-Roca M, Sabater-Cruz N, Hereu M, Sánchez-Dalmau B, Gómez M, Adán A, Font D. Integración de la oftalmología primaria en el ámbito hospitalario: análisis comparativo de resultados. Aten Primaria 2020; 52:281-282. [PMID: 31776043 PMCID: PMC7118566 DOI: 10.1016/j.aprim.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | | | - Mireia Hereu
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España
| | - Bernardo Sánchez-Dalmau
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Mónica Gómez
- Departamento de Estrategia y Planificación, Hospital Clínic, Barcelona, España
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - David Font
- Departamento de Estrategia y Planificación, Hospital Clínic, Barcelona, España
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Figueras-Roca M, Figueroa MS, Calvo P, Garay-Aramburu G, García-Martínez JR, Fernández AM, Pou A, Adán A. Optimization of Diabetic Macular Edema Management in the Real World: A Model of Excellence in Retina Units: The EMUREX Initiative. Ophthalmologica 2020; 243:379-390. [PMID: 32015240 DOI: 10.1159/000506311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To define and develop a model of excellence for the clinical management of diabetic macular edema (DME) patients in a real-world setting. METHODS A multidisciplinary joint commission (5 ophthalmologists, 1 nurse, and 1 pharmaceutic) established a series of preliminary recommendations based on clinical guidelines and DME activity results from 8 Pilot Hospitals (PH). These were validated by members of each PH and a group of DME patients in discussion workshops. Thus, the validated guideline (VG) took into consideration different aspects, namely, main core points (ranging 0-100), criteria, and indicators. Finally, each PH own setting was compared to the VG in order to settle down a starting point to clinical excellence. RESULTS Mean PH score was 51.5 (range 30-65). As compared to their maximum, main points that showed best scores were Clinical Guidelines and Protocols (78%) and Portfolio of Services (73%). Topics reaching close to 50% scoring included Resources (55%), Innovation (54%), Care Process (53%), Organization (52%), and Leadership (50%). Lowest scores were observed in the Strategic Alliances (46%) and Staff (37%) points. CONCLUSIONS Analysis of each PH by the VG delivered a global vision of the starting situation, especially focused in the identification of the different improvement areas. In order to further extend this model into the Public Health System, the effect of implementing it in different hospitals should be assessed to analyze its impact on daily clinical practice and health economics.
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Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain,
| | | | - Pilar Calvo
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | - Aránzazu Pou
- Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
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Alba-Linero C, Barberi GE, Lloren Ç V, Adán A. Diagnostic vitrectomy: a case series in a single referral center. ACTA ACUST UNITED AC 2019; 94:529-535. [PMID: 31606240 DOI: 10.1016/j.oftal.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. METHODS A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. RESULTS Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. CONCLUSIONS Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.
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Affiliation(s)
- C Alba-Linero
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España.
| | - G Espinosa Barberi
- Ophthalmology Department, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, España
| | - V Lloren Ç
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España
| | - A Adán
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España
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Adán A, Moll-Udina A, Ramirez J, Llorenç V. Subcutaneous Tocilizumab for Cystoid Macular Edema Secondary to Juvenile Idiopathic Arthritis (JIA)-associated Uveitis: A Case Report. Ocul Immunol Inflamm 2019; 29:6-8. [PMID: 31589540 DOI: 10.1080/09273948.2019.1644350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report a case of cystoid macular edema (CME) secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.Case report: 26-year-old female patient presented with CME in both eyes. CME became refractory and TCZ-IV was initiated. After 12 infusions was stopped because grade 1 neuropenia developed. On examination,visual acuity of the right eye was 20/80. Spectral domain optical coherence tomography (SD-OCT) of the right eye revealed CME. Subcutaneous (TCZ-SC) was initiated. After six injections of TCZ-SC, ophthalmic examination revealed no signs of active inflammation, and central foveal thickness decreased.Conclusion: TCZ-SC seems to have a role in the treatment of CME secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.
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Affiliation(s)
- Alfredo Adán
- Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
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Molins B, Mora A, Romero-Vázquez S, Pascual-Méndez A, Rovira S, Figueras-Roca M, Balcells M, Adán A, Martorell J. Shear stress modulates inner blood retinal barrier phenotype. Exp Eye Res 2019; 187:107751. [DOI: 10.1016/j.exer.2019.107751] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/28/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
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Figueras-Roca M, Sala-Puigdollers A, Zarranz-Ventura J, Alba-Linero C, Alforja S, Esquinas C, Molins B, Adán A. Anatomic Response to Intravitreal Dexamethasone Implant and Baseline Aqueous Humor Cytokine Levels in Diabetic Macular Edema. Invest Ophthalmol Vis Sci 2019; 60:1336-1343. [PMID: 30933261 DOI: 10.1167/iovs.18-26215] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine whether baseline cytokine aqueous humor (AH) levels are associated with diabetic macular edema (DME) anatomic response to dexamethasone intravitreal implant (DEX) injection. Methods This was a prospective cohort study of DME cases receiving DEX treatment. Seventy patients were recruited with center-involving DME with spectral-domain (SD) optical coherence tomography (OCT) detection of central macular thickness (CMT) ≥300 μm on macular cube 518 × 128-μm scan protocol (Cirrus SD-OCT). DEX injection and anterior chamber tap to obtain an AH sample were performed at the same time. Multiplex immunoassay was carried out for interleukin (IL)-1β, IL-3, IL-6, IL-8, IL-10; monocyte chemoattractant protein (MCP)-1; interferon gamma-induced protein (IP)-10; tumor necrosis factor (TNF)-α; and vascular endothelial growth factor (VEGF). A follow-up visit and OCT exam were undertaken 6 to 8 weeks afterward. The association between AH cytokine baseline levels and change in CMT and macular volume (MV) was defined as main outcome measure. Results Multivariate linear regression analysis showed a higher decrease in MV to be associated (Rs of 0.512) with four baseline items: higher MCP-1 (β = -0.4; P = 0.028), higher CMT (β = -0.003; P = 0.024), decreased visual acuity (β = -0.7; P = 0.040), and a diffuse retinal thickening (DRT) OCT pattern (β = -1.3; P < 0.001). Logistic regression found DRT also to be associated with higher odds of a good MV response (odds ratio, 31.96; 95% confidence interval [CI] 7.11-143.72; P < 0.001). Conclusions Even though visual acuity response and anatomic effect are not always correlated in DME, we found that baseline elevated MCP-1 AH levels and DRT pattern were biomarkers that predicted a future favorable anatomic response to DEX.
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Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carmen Alba-Linero
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Socorro Alforja
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Cristina Esquinas
- Respiratory Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Blanca Molins
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Affiliation(s)
- Alfredo Adán
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Juan Pablo Figueroa-Vercellino
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
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Leszczynska A, Molins B, Fernández E, Adán A, Ortiz-Perez S. Cytokine production in thyroid eye disease: in vitro effects of dexamethasone and IL-6 blockade with tocilizumab. Graefes Arch Clin Exp Ophthalmol 2019; 257:2307-2314. [DOI: 10.1007/s00417-019-04419-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 12/31/2022] Open
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Alba-Linero C, Barberi GE, Llorens V, Socorro Alforja Castella M, Adán A. Multimodal image characterization of paravenous atrophy. GMS Ophthalmol Cases 2019; 9:Doc27. [PMID: 31355125 PMCID: PMC6637453 DOI: 10.3205/oc000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: The objective is to describe a clinical case of paravenous atrophy using a multimodal image. Methods: A 48-year-old man was visited and followed in the ophthalmology department of Hospital Clinic (Barcelona). Visual acuity, slit-lamp exam, retinography, autofluorescence, visual field, optical coherence tomography, and electrophysiology test were performed. Results: The patient had a history of Behcet's disease. Autofluorescence revealed hypoautofluorescence at the paravenous region, th visual field was also altered and electrophysiologic test were reduced. Conclusion: Paravenous atrophy is a rare entity not well described currently. Patients are frequently misdiagnosed. Multimodal image could help to characterize this condition properly and improve the management.
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Affiliation(s)
- Carmen Alba-Linero
- Clinic Institute of Ophthalmology, Clinic Hospital of Barcelona, Spain,*To whom correspondence should be addressed: Carmen Alba-Linero, Clinic Institute of Ophthalmology, Clinic Hospital of Barcelona, Sabino Arana 1, PC 08028, Barcelona, Spain, E-mail:
| | - Glenda Espinosa Barberi
- Ophthalmology Department, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Victor Llorens
- Clinic Institute of Ophthalmology, Clinic Hospital of Barcelona, Spain
| | | | - Alfredo Adán
- Clinic Institute of Ophthalmology, Clinic Hospital of Barcelona, Spain
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García Layana A, Adán A, Ascaso FJ, Cabrera F, Donate J, Escobar Barranco JJ, Peralta G, Reyes García R, Rodríguez Maqueda M, Ruiz-Moreno JM, Vinagre I. Use of intravitreal dexamethasone implants in the treatment of diabetic macular edema: Expert recommendations using a Delphi approach. Eur J Ophthalmol 2019; 30:1042-1052. [DOI: 10.1177/1120672119861623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: The aim of this study is to develop guidance on the use of intravitreal dexamethasone implants in the treatment of diabetic macular edema. Method: The study was performed using the modified Delphi method to obtain a consensus among a panel of experts on management of patients with diabetic macular edema and use of intravitreal dexamethasone implants in clinical practice. Thirty-seven panel members, experts on retina, from different Spanish centers were invited to participate. Individual and anonymous opinions were asked by answering a 76-item questionnaire across 11 topic areas (two rounds were done). Level of agreement was assessed using a Likert-type scale of 9 points. Results: Agreement on “consensus” was reached during the first round in 63 items. The 13 remaining items underwent a second round of voting. After the second round, agreement on “consensus” was reached on five items. Finally, eight items remained without consensus. Conclusion: Intravitreal dexamethasone implants are useful in the treatment of patients with diabetic macular edema with different profiles, for example, pseudophakic, poor-adherents, vitrectomized, candidates for cataract surgery, patients with high inflammatory component, and with a history of cardiovascular events. The use of intravitreal dexamethasone reduces the number of visits and facilitates compliance. Experts thought that the switch from anti-vascular endothelial growth factor therapy to intravitreal dexamethasone implants should be done preferably after three injections. Also, pro re nata treatment provides better results in diabetic macular edema patients as it helps to prevent undertreatment. Finally, experts concluded that clinical guidelines and treatment protocols for diabetic macular edema need to be updated.
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Affiliation(s)
- Alfredo García Layana
- Clínica Universitaria de Navarra, Pamplona, Spain
- RETICS de Oftalmología Oftared, Red Temática de Investigación Cooperativa en Salud: “Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica” (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Adán
- RETICS de Oftalmología Oftared, Red Temática de Investigación Cooperativa en Salud: “Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica” (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Clínic, Barcelona, Spain
| | - Francisco Javier Ascaso
- Hospital Clínico Universitario “Lozano Blesa”, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Francisco Cabrera
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Juan Donate
- RETICS de Oftalmología Oftared, Red Temática de Investigación Cooperativa en Salud: “Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica” (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Clínico San Carlos, Madrid, Spain
| | - José Juan Escobar Barranco
- RETICS de Oftalmología Oftared, Red Temática de Investigación Cooperativa en Salud: “Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica” (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Dos de Maig, Barcelona, Spain
| | - Gema Peralta
- Fundación Rossend Carrasco i Formiguera, Barcelona, Spain
| | | | | | - José María Ruiz-Moreno
- RETICS de Oftalmología Oftared, Red Temática de Investigación Cooperativa en Salud: “Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica” (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
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Moll-Udina A, Figueroa-Vercellino JP, Llorenç V, Miguel L, Adán A. Angiography and En Face Optical Coherence Tomography Findings in Acute Syphilitic Posterior Placoid Chorioretinopathy. Case Rep Ophthalmol 2019; 10:165-171. [PMID: 31692487 PMCID: PMC6760361 DOI: 10.1159/000500239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/07/2019] [Indexed: 11/19/2022] Open
Abstract
Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is one of the rarest ocular manifestations of syphilis. The pathophysiology of this entity is still unknown. We report the outer retinal findings on en face optical coherence tomography (OCT) and the alteration of choriocapillaris flow findings on OCT angiography in a patient with ASPPC at the time of presentation, after penicillin treatment completion and during follow-up.
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Affiliation(s)
- Aina Moll-Udina
- Uveitis Unit, Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
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Puig L, Ruiz de Morales JG, Dauden E, Andreu JL, Cervera R, Adán A, Marsal S, Escobar C, Hinojosa J, Palau J, Arraiza A, Casado P, Codesido M, Pascual C, Saldaña R, Gil Á. [Prevalence of ten Immune-mediated inflammatory diseases (IMID) in Spain]. Rev Esp Salud Publica 2019; 93:e201903013. [PMID: 30907380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE Immune-mediated inflammatory diseases (IMID) are chronic and highly disabling diseases that share inflammatory sequences and immunological dysregulations. Considered as a disease in itself, the prevalence of IMID is virtually unknown. The aim of this study was to assess the prevalence of 10 selected UDI, including rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, hidradenitis suppurativa, sarcoidosis and uveitis in Spain. METHODS cross-sectional epidemiological study of point prevalence was made. This study was carried out through a series of computerized interviews in households chosen at random in 17 autonomous communities in Spain. A structured questionnaire was used to determine the frequency of diagnosis and the concurrence of 10 IMID in the respondents and other individuals belonging to the same family nucleus. The point prevalence estimates were used and compared with the objective of determining the frequency of IMID by age, sex and communities. The data were processed using Excel 2016 (Microsoft, Redmond, WA, USA) and the SPSS V.019 system (IBM Corp. Armonk, NY, USA) for statistical analysis using the usual statistical tests in this type of studies. RESULTS Of the 7,980 respondents, 510 were diagnosed with an IMID, representing a cross-sectional study of 6.39% (95% CI: 6.02-6.76). One, two, three or more members of the family were affected in 87.2%, 7.8% and 5% of positive relatives in IMID, respectively. The most recurrent diseases were psoriasis (2.69% [95% CI: 2.32-3.06]) and rheumatic arthritis (1.07% [95% CI: 0.70-1.44]). There were differences in prevalence due to sex (p = 0.004) and age (p = 0.000). No significant differences were identified related to geographic location (p = 0.819). Attendance of at least 2 IMID was reported in 8.9% of respondents. CONCLUSIONS The overall prevalence was of the IMID studied was 6.39%, psoriasis being the most frequent with 2.69%. This study constitutes an initial step to consider IMID as an independent disease within the health system..
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Affiliation(s)
- Lluís Puig
- Servicio de Dermatología. Hospital de la Santa Creu i Sant Pau. Barcelona. España
| | | | - Esteban Dauden
- Servicio de Dermatología. Hospital Universitario de La Princesa. Madrid. España
| | - José Luís Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro-Majadahonda. Madrid. España
| | - Ricard Cervera
- Servicio de Enfermedades Autoinmunes. Hospital Clínic de Barcelona. Barcelona. España
| | - Alfredo Adán
- Instituto de Oftalmología. Hospital Clinic de Barcelona. Barcelona. España
| | - Sara Marsal
- Grupo de Investigación de Reumatología. Institut de Recerca. Hospital Universitari Vall d'Hebron. Barcelona. España
| | - Carina Escobar
- UNIMID (Asociación de Personas con Enfermedades Crónicas Inflamatorias Inmunomediadas). Madrid. España
| | - Joaquín Hinojosa
- Servicio de Medicina Digestiva. Hospital de Manises. Valencia. España
| | - Javier Palau
- Departamento de Salud de La Ribera. Valencia. España
| | - Antonio Arraiza
- Asistencia Sanitaria. Dirección General. Osakidetza. Vitoria-Gasteiz. España
| | - Paloma Casado
- Calidad y Cohesión. Ministerio de Sanidad, Servicios Sociales e Igualdad. Madrid. España
| | - María Codesido
- Calidad y Cohesión. Ministerio de Sanidad, Servicios Sociales e Igualdad. Madrid. España
| | | | - Roberto Saldaña
- Confederación ACCU (Confederación de afectados por Crohn y Colitis Ulcerosa). Madrid. España
| | - Ángel Gil
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
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