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Giralt L, Figueras-Roca M, Eguileor BDL, Romero B, Zarranz-Ventura J, Alforja S, Santiago F, Bolaños J, Lozano F, Dotti-Boada M, Sala-Puigdollers A, Dura P, Izquierdo-Serra J, Valero O, Adan A, Fonollosa A, Molins B. C-reactive protein-complement factor H axis as a biomarker of activity in early and intermediate age-related macular degeneration. Front Immunol 2024; 15:1330913. [PMID: 38633250 PMCID: PMC11021604 DOI: 10.3389/fimmu.2024.1330913] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose To determine and compare the serum levels of complement Factor H (FH), monomeric C-Reactive Protein (mCRP) and pentameric C-Reactive protein (pCRP) in patients with age-related macular degeneration (AMD) and to correlate them with clinical, structural and functional parameters. Methods Cross-sectional observational study. One hundred thirty-nine individuals (88 patients and 51 healthy controls) from two referral centers were included and classified into three groups: early or intermediate AMD (n=33), advanced AMD (n=55), and age and sex matched healthy controls (n=51). Serum levels of FH, mCRP, and pCRP were determined and correlated with clinical and imaging parameters. Results Patients with intermediate AMD presented FH levels significantly lower than controls [186.5 (72.1-931.8) µg/mL vs 415.2 (106.1-1962.2) µg/mL; p=0.039] and FH levels <200 µg/mL were associated with the presence of drusen and pigmentary changes in the fundoscopy (p=0.002). While no differences were observed in pCRP and mCRP levels, and mCRP was only detected in less than 15% of the included participants, women had a significantly higher detection rate of mCRP than men (21.0% vs. 3.8%, p=0.045). In addition, the ratio mCRP/FH (log) was significantly lower in the control group compared to intermediate AMD (p=0.031). Visual acuity (p<0.001), macular volume (p<0.001), and foveal thickness (p=0.034) were significantly lower in the advanced AMD group, and choroidal thickness was significantly lower in advanced AMD compared to early/intermediate AMD (p=0.023). Conclusion Intermediate AMD was associated in our cohort with decreased serum FH levels together with increased serum mCRP/FH ratio. All these objective serum biomarkers may suggest an underlying systemic inflammatory process in early/intermediate AMD patients.
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Affiliation(s)
- Lena Giralt
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Marc Figueras-Roca
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Beatriz De Luis Eguileor
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Barbara Romero
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Socorro Alforja
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisca Santiago
- Servei d’Immunologia, Centre de Diagnostic Biomèdic, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jennifer Bolaños
- Servei d’Immunologia, Centre de Diagnostic Biomèdic, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francisco Lozano
- Servei d’Immunologia, Centre de Diagnostic Biomèdic, Hospital Clínic Barcelona, Barcelona, Spain
- Group of Immunoreceptors of the Innate and Adaptive Systems, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Biomedicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Marina Dotti-Boada
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Paula Dura
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | | | - Oliver Valero
- Servei d’Estadística, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - Blanca Molins
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Araújo O, Casaroli-Marano RP, Hernández-Rodríguez J, Figueras-Roca M, Budi V, Morató M, Hernández-Negrín H, Ríos J, Adan A, Espinosa G, Pelegrín L, Cervera R. New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus. BMJ Open Ophthalmol 2024; 9:e001608. [PMID: 38499344 PMCID: PMC10953034 DOI: 10.1136/bmjophth-2023-001608] [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: 12/07/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity. METHODS A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations. RESULTS Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF. CONCLUSION Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.
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Affiliation(s)
- Olga Araújo
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Ricardo P Casaroli-Marano
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Marc Figueras-Roca
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Vanesa Budi
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Montse Morató
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Halbert Hernández-Negrín
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José Ríos
- Department of Medical Statistics Platform, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
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Fonollosa A, Pelegrín L, García-Morillo S, Buján-Rivas S, Distefano L, Robles-Maruenda A, Fernández-Martín J, González-García A, Garcia-Aparicio Á, Ortego-Centeno N, Llorenç V, Sainz de la Maza M, Pinedo C, Sopeña B, Cocho L, Carreño E, Blanco R, Antón J, Pérez-Quintana M, Marques-Soares JR, Artaraz J, Ruiz-Arruza I, Soto-Peleteiro A, Gómez-Caverzaschi V, Araújo O, Espinosa G, Adan A, Fabiani C, Cantarini L, Hernández-Rodríguez J. Ocular involvement in adult and paediatric patients with monogenic autoinflammatory diseases: a Spanish multicentre retrospective study. Clin Exp Rheumatol 2023; 41:2105-2114. [PMID: 37812477 DOI: 10.55563/clinexprheumatol/ukegcc] [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] [Received: 05/07/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Ophthalmologic involvement in monogenic autoinflammatory diseases has been explored mainly in paediatric patients. The aim of this study is to characterise ophthalmologic manifestations, therapeutic management and visual outcomes in a Spanish (UVESAI) cohort of adult/paediatric patients with monogenic autoinflammatory diseases. METHODS Multicentre and retrospective study of patients with monogenic autoinflammatory diseases and ocular involvement. Eye manifestations, structural complications, treatments used and visual outcomes were analysed, and compared with previous studies. RESULTS Forty-six patients (44/2 adults/children; 21/25 adult/paediatric-onset) with monogenic autoinflammatory diseases [cryopyrin associated periodic syndromes (n=13/28.3%), mainly Muckle-Wells syndrome (MWS) (n=11/24%); familial Mediterranean fever (FMF) (n=12/26%); TNF receptor-associated periodic syndrome (TRAPS); (n=9/20%); Blau syndrome (n=8/17%); hyperimmunoglobulin D syndrome (HIDS) (n=2/4.3%), deficiency of adenosine deaminase-2 and NLRC4-Autoinflammatory disease] (one each) were included. Conjunctivitis (n=26/56.5%) and uveitis (n=23/50%) were the most frequent ocular manifestations. Twelve (26.1%) patients developed structural complications, being cataracts (n=11/24%) and posterior synechiae (n=10/22%) the most frequent. Conjunctivitis predominated in TRAPS, FMF, MWS and HIDS (mainly in adults), and uveitis, in Blau syndrome. Seven (8%) eyes (all with uveitis) presented with impaired visual acuity. Local and systemic treatment led to good visual outcomes in most patients. Compared with previous studies mainly including paediatric patients, less severe ocular involvement was observed in our adult/paediatric cohort. CONCLUSIONS Conjunctivitis was the most common ocular manifestation in our TRAPS, FMF, MWS and HIDS patients, and uveitis predominated in Blau syndrome. Severe eye complications and poor visual prognosis were associated with uveitis. Adults with monogenic autoinflammatory diseases seem to exhibit a less severe ophthalmologic presentation than paediatric patients.
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Affiliation(s)
- Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo; Instituto Oftalmológico Bilbao, and Cooperative Health Network for Research in Ophthalmology (Oftared), National Institute of Health Carlos III, ISCIII, Madrid, Spain.
| | - Laura Pelegrín
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Salvador García-Morillo
- Autoimmune and Rare Diseases Unit, Department of Internal Medicine, Hospital Virgen del Rocío, Center of the Centros, Servicios y Unidades de Referencia (CSUR) in Autoinflammatory Diseases, Sevilla, Spain
| | - Segundo Buján-Rivas
- Autoinflammatory Diseases Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Laura Distefano
- Department of Ophthalmology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Angel Robles-Maruenda
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Julian Fernández-Martín
- Department of Internal Medicine, Hospital do Meixoeiro-Chuvi, Rare Diseases and Paediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Pontevedra, Spain
| | - Andres González-García
- Department of Internal Medicine, Autoimmune and Rare Diseases Unit, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, IRYCIS, Madrid, Spain
| | | | - Norberto Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario San Cecilio, University of Granada, Spain
| | - Victor Llorenç
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maite Sainz de la Maza
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Pinedo
- Paediatric Rheumatology Unit, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Bernardo Sopeña
- Department of Internal Medicine, Complejo Hospitalario Universitario de Santiago, University of Santiago de Compostela, Spain
| | - Lidia Cocho
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Spain
| | - Ester Carreño
- Department of Ophthalmology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Jordi Antón
- Division of Paediatric Rheumatology, Paediatric Immune Dysfunction Disease Study Group (GEMDIP), Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Esplugues de Llobregat, Barcelona, Spain
| | - Marta Pérez-Quintana
- Autoimmune and Rare Diseases Unit, Department of Internal Medicine, Hospital Virgen del Rocío, Center of the Centros, Servicios y Unidades de Referencia (CSUR) in Autoinflammatory Diseases, Sevilla, Spain
| | - Joana R Marques-Soares
- Autoinflammatory Diseases Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Ioana Ruiz-Arruza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Adriana Soto-Peleteiro
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Verónica Gómez-Caverzaschi
- Autoinflammatory Diseases Clin Unit & Vasculitis Research Unit, Dept of Autoimmune Diseases, Hosp Clínic Barcelona, Univ of Barcelona, Inst d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica(XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Olga Araújo
- Autoinflammatory Diseases Clin Unit & Vasculitis Research Unit, Dept of Autoimmune Diseases, Hosp Clínic Barcelona, Univ of Barcelona, Inst d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica(XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Gerard Espinosa
- Autoinflammatory Diseases Clin Unit & Vasculitis Research Unit, Dept of Autoimmune Diseases, Hosp Clínic Barcelona, Univ of Barcelona, Inst d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica(XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Siena, Italy
| | - José Hernández-Rodríguez
- Autoinflammatory Diseases Clin Unit & Vasculitis Research Unit, Dept of Autoimmune Diseases, Hosp Clínic Barcelona, Univ of Barcelona, Inst d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica(XUEC) for Autoinflammatory Diseases, Barcelona, Spain
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Valsero Franco S, Bernal-Morales C, Santos Zorrozua B, Aranzamendi Zalmumbide M, Artaraz Beobide J, Sainz-de-la-Maza M, Llorenç V, Adan A, Fonollosa A. Herpetic Anterior Uveitis Multicentre Longitudinal Study (The UVHER Project). Baseline Characteristics. Ocul Immunol Inflamm 2023; 31:1497-1504. [PMID: 35914310 DOI: 10.1080/09273948.2022.2103829] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE The aim of the UVHER project is to evaluate the risk of development of optic nerve damage in patients with herpetic anterior uveitis (AU) prospectively followed over 2 years. Herein, we described the baseline characteristics. METHODS This is a multicentre, prospective study. An aqueous humour tap was performed. Only patients with a positive PCR were included. Clinical characteristics, optical coherence tomography (OCT) parameters and visual field (VF) abnormalities were registered. RESULTS 27 patients were included: 18 Herpes Simplex (HSV), one Varicella Zoster (VVZ), and 8Cytomegalovirus (CMV). Patients with HSV-AU had severe inflammation, iris atrophy and corneal involvement. In patients with CMV-AU, less inflammation and medium-to-large keratic precipitates were observed. OCT showed a thinner RNFL and GCL in CMV-AU patients in comparison to HSV patients. VF showed abnormalities in six cases. CONCLUSIONS Patients in the UVHER cohort showed the typical clinical manifestations of herpetic AU. In CMV patients, optic nerve damage was observed at baseline, and in HSV patients, inflammation was more severe.
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Affiliation(s)
- Sonia Valsero Franco
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | | | | | | | - Joseba Artaraz Beobide
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | | | - Victor Llorenç
- Department of Ophthalmology, Clinic Hospital, Barcelona, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Clinic Hospital, Barcelona, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain
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5
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Sainz de La Maza M, Hernanz I, Moll-Udina A, Mesquida M, Adan A, Martinez JA, Espinosa G, Llorenç V. Presumed tuberculosis-related scleritis. Br J Ophthalmol 2023; 107:495-499. [PMID: 34799367 DOI: 10.1136/bjophthalmol-2021-319799] [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: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the clinical characteristics and therapeutic outcome of patients with recurrent scleritis of unknown demonstrable aetiology and positive QuantiFERON-TB Gold In-Tube test (QFT). METHODS Retrospective chart review of the demographic, clinical, laboratory and therapeutic outcome data of 15 patients. Clinical characteristics as well as remission rate after standard antituberculous therapy (ATT) were assessed. RESULTS There were 9 men and 6 women with a mean age of 48.9 years (range, 32-73). Scleritis was diffuse in 10 patients (66.6%) and nodular in 5 patients (33.3%), 1 of them with concomitant posterior scleritis. It was bilateral in 7 patients (46.6%) and recurrent in all of them. Scleritis appeared after prior uveitis (10 patients, 66.6%) and/or with concomitant uveitis (5 patients, 33.3%) or peripheral keratitis (5 patients, 33.3%). Previous ocular surgery was found in 7 patients (46.6%). Previous extraocular tuberculosis (TB) infection or previous TB contact was detected in 11 patients (73.3%). No radiologic findings of active extraocular TB were detected. ATT was used in 15 patients, sometimes with the addition of systemic corticosteroids (5 patients) and methotrexate (1 patient); 14 patients achieved complete remission (93.3%). CONCLUSION Presumed TB-related scleritis may appear in recurrent scleritis of unknown origin and positive QFT. It may occur after prior uveitis and/or concomitantly with uveitis or peripheral keratitis, and it may be triggered by previous ocular surgery. No patients had evidence of concurrent active extraocular infection, although many had previous TB infection or TB contact. ATT was effective, sometimes with the addition of systemic corticosteroids and methotrexate.
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Affiliation(s)
| | - Ines Hernanz
- Ophthalmology, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Aina Moll-Udina
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marina Mesquida
- Ophthalmology, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Alfredo Adan
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Gerard Espinosa
- Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Víctor Llorenç
- Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
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6
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Parrado-Carrillo A, Fernandez-Marron A, Ambrosioni J, Adan A. Cytomegalovirus retinitis in a patient with HIV and T CD4 + count > 300 cells/μL. J Fr Ophtalmol 2023; 46:e93-e94. [PMID: 36610866 DOI: 10.1016/j.jfo.2022.07.018] [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: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 01/07/2023]
Affiliation(s)
- A Parrado-Carrillo
- Hospital Clinic de Barcelona, Institut Clinic d'Oftalmologia (ICOF), Carrer de Sabino Arana, 1, 08028 Barcelona, Spain; Institut d'investigacions biomèdiques August Pi i Sunyer, Carrer del Rosselló, 149, 08036 Barcelona, Spain
| | | | - J Ambrosioni
- Hospital Clinic de Barcelona, Institut Clinic de Medicina interna i Dermatologia (ICMD), C. de Villarroel, 170, 08036 Barcelona, Spain
| | - A Adan
- Hospital Clinic de Barcelona, Institut Clinic d'Oftalmologia (ICOF), Carrer de Sabino Arana, 1, 08028 Barcelona, Spain; Institut d'investigacions biomèdiques August Pi i Sunyer, Carrer del Rosselló, 149, 08036 Barcelona, Spain
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Giralt L, Pérez-Fernández S, Adan A, Figueira L, Fonollosa A. Clinical Features and Outcomes of Tubulointerstitial Nephritis and Uveitis Syndrome in Spain and Portugal: The IBERTINU Project. Ocul Immunol Inflamm 2023; 31:286-291. [PMID: 35200067 DOI: 10.1080/09273948.2022.2026413] [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] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the clinical features, management and prognosis of patients diagnosed with tubulointerstitial nephritis and uveitis (TINU) syndrome in Spain and Portugal. METHODS Retrospective multicenter study, which included all patients diagnosed with TINU syndrome managed in 15 uveitis referral centers from Spain and Portugal. RESULTS Forty-eight subjects with a mean age at diagnosis of 25.0 [14.8; 49.5] years were included. Both eyes were affected in 43 patients (89.6%). The visual outcome was favorable, but immunosuppressive systemic therapy (IST) was needed in 26 (54.16%) due to relapses. Renal function normalized in 35 patients (72.9%). HLA-DQB1*05 was the most common genetic typing (57.1%). The mean follow-up time was 22.5 [11.0; 48.0] months. CONCLUSIONS Both visual and renal outcomes were favorable, although IST was frequently used. TINU is under- diagnosed, so further prospective studies would provide more knowledge about its recognition and management. EXPERT OPINION TINU Syndrome is underdiagnosed because ocular and renal disease are asynchronous. Outcomes are favorable so it has to be highly suspected in cases of bilateral anterior uveitis. According to literature and our experience, systemic immunosuppressive therapy is often required because of ocular relapses.This study adds to the previous knowledge that HLA-DQB1*05 could be an important HLA type amongst the TINU Syndrome Iberian population. HLA typing should be assessed in these patients in order to describe its phenotype-genotype relationship better. A considerable number of patients in our series were diagnosed in their sixties, so TINU Syndrome should also be suspected in elderly patients.
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Affiliation(s)
- Lena Giralt
- Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain
| | - Silvia Pérez-Fernández
- Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain
| | - Alfredo Adan
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Figueira
- Hospital S. University of Porto, Center for Drug Discovery and Innovative Medicines (MedInUP), Porto, Portugal
| | - Alex Fonollosa
- Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain
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Bernal-Morales C, Navarro-Angulo MJ, Rodriguez-Maqueda M, Velazquez-Villoria D, Cubero-Parra JM, Marticorena J, Hernández-Martínez A, Ruiz-Miguel M, Adan A, Ruiz-Casas D, Zarranz-Ventura J. Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit-Report 2. J Clin Med 2023; 12:jcm12020436. [PMID: 36675364 PMCID: PMC9862359 DOI: 10.3390/jcm12020436] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38-4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 ± 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases.
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Affiliation(s)
- Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | | | | | | | | | - Joaquín Marticorena
- Instituto Oftalmológico La Esperanza, HM La Esperanza, 15705 Santiago de Compostela, Spain
- Servicio de Oftalmología, Complejo Hospitalario Universitario, 15006 A Coruña, Spain
| | | | | | - Alfredo Adan
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Diego Ruiz-Casas
- Servicio de Oftalmología, Hospital Ramon y Cajal, 28029 Madrid, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Correspondence:
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Cifuentes-González C, Rojas-Carabali W, Pérez ÁO, Carvalho É, Valenzuela F, Miguel-Escuder L, Ormaechea MS, Heredia M, Baquero-Ospina P, Adan A, Curi A, Schlaen A, Urzua CA, Couto C, Arellanes L, de-la-Torre A. Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis. PLoS One 2023; 18:e0283845. [PMID: 37011101 PMCID: PMC10069780 DOI: 10.1371/journal.pone.0283845] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/19/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Ocular toxoplasmosis (OT) is caused by the parasite Toxoplasma gondii. OT is the leading cause of posterior uveitis globally; it is a recurrent disease that may result in visual impairment and blindness. This systematic review and meta-analysis aim to summarize and evaluate the risk factors for recurrences, visual impairment, and blindness described in the literature worldwide. METHODS AND FINDINGS We performed a systematic literature search in PubMed, Embase, VHL, Cochrane Library, Scopus, and DANS EASY Archive. All studies reporting patients with clinically and serologically confirmed OT presenting any clinical or paraclinical factor influencing recurrences, visual impairment, and blindness were included. Studies presenting secondary data, case reports, and case series were excluded. An initial selection was made by title and abstract, and then the studies were reviewed by full text where the eligible studies were selected. Then, the risk of bias was assessed through validated tools. Data were extracted using a validated extraction format. Qualitative synthesis and quantitative analysis were done. This study was registered on PROSPERO (CRD42022327836). RESULTS Seventy two studies met the inclusion criteria. Fifty-three were summarized in the qualitative synthesis in three sections: clinical and environmental factors, parasite and host factors, and treatment-related factors. Of the 72 articles, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America and Central America, respectively, and only one in Africa. A total of 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age, with similar distribution by sex. The frequency of recurrences in patients with OT was 49% (95% CI 40%-58%), being more frequent in the South American population than in Europeans. Additionally, visual impairment was presented in 35% (95% CI 25%-48%) and blindness in 20% (95% CI 13%-30%) of eyes, with a similar predominance in South Americans than in Europeans. On the other hand, having lesions near the macula or adjacent to the optic nerve had an OR of 4.83 (95% CI; 2.72-8.59) for blindness, similar to having more than one recurrence that had an OR of 3.18 (95% CI; 1.59-6.38). Finally, the prophylactic therapy with Trimethoprim/Sulfamethoxazole versus the placebo showed a protective factor of 83% during the first year and 87% in the second year after treatment. CONCLUSION Our Systematic Review showed that clinical factors such as being older than 40 years, patients with de novo OT lesions or with less than one year after the first episode, macular area involvement, lesions greater than 1 disc diameter, congenital toxoplasmosis, and bilateral compromise had more risk of recurrences. Also, environmental and parasite factors such as precipitations, geographical region where the infection is acquired, and more virulent strains confer greater risk of recurrences. Therefore, patients with the above mentioned clinical, environmental, and parasite factors could benefit from using prophylactic therapy.
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Affiliation(s)
- Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Álvaro Olate Pérez
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Érika Carvalho
- Clinical Research Laboratory of Infectious Diseases in Ophthalmogy, National Institute of Infectious Disease, INI-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Felipe Valenzuela
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lucía Miguel-Escuder
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - María Soledad Ormaechea
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Milagros Heredia
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Pablo Baquero-Ospina
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes" Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
| | - Alfredo Adan
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Andre Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmogy, National Institute of Infectious Disease, INI-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Cristhian Alejandro Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
- Faculty of Medicine, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Cristóbal Couto
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Lourdes Arellanes
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes" Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
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Guemes-Villahoz N, Diaz-Valle D, Fonollosa A, Jimenez-Santos M, Narvaez-Palazon C, Adan A. Spontaneous resolution of inflammatory epiretinal membrane: Case series and review of the literature. Eur J Ophthalmol 2023; 33:NP10-NP14. [PMID: 34334018 DOI: 10.1177/11206721211036291] [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] [Indexed: 01/11/2023]
Abstract
Epiretinal membrane (ERM) represents a common complication of uveitis that may contribute independently to vision loss in patients with uveitis. Although spontaneous idiopathic ERM separation has been previously reported, to the best of our knowledge there are only two case reports in the scientific literature that depicts spontaneous regression of an inflammation-associated ERM. Spontaneous ERM separation is a rare but possible event, which occurs most often subsequent to posterior vitreous detachment. We present a case series of three patients with uveitis that exhibit the formation and subsequent spontaneous resolution of an inflammatory ERM.
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Affiliation(s)
- Noemi Guemes-Villahoz
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Diaz-Valle
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC) IIORC, Universidad Complutense de Madrid, ISCIII (OFTARED), Madrid, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, Hospital de Cruces, Universidad del Pais Vasco, Vizcaya, Spain
| | - Maria Jimenez-Santos
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Narvaez-Palazon
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alfredo Adan
- Instituto Clínico de Oftalmología, Hospital Clínic, Barcelona, Spain
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García-Otero X, Mondelo-García C, Bandín-Vilar E, Gómez-Lado N, Silva-Rodríguez J, Rey-Bretal D, Victoria Otero-Espinar M, Adan A, González-Barcia M, Aguiar P, Otero-Espinar FJ, Fernández-Ferreiro A. PET study of intravitreal adalimumab pharmacokinetics in a uveitis rat model. Int J Pharm 2022; 627:122261. [DOI: 10.1016/j.ijpharm.2022.122261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/17/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022]
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Molins B, Mesquida M, Adan A. Bioengineering approaches for modelling retinal pathologies of the outer blood-retinal barrier. Prog Retin Eye Res 2022:101097. [PMID: 35840488 DOI: 10.1016/j.preteyeres.2022.101097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/23/2021] [Revised: 05/31/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
Alterations of the junctional complex of the outer blood-retinal barrier (oBRB), which is integrated by the close interaction of the retinal pigment epithelium, the Bruch's membrane, and the choriocapillaris, contribute to the loss of neuronal signalling and subsequent vision impairment in several retinal inflammatory disorders such as age-related macular degeneration and diabetic retinopathy. Reductionist approaches into the mechanisms that underlie such diseases have been hindered by the absence of adequate in vitro models using human cells to provide the 3D dynamic architecture that enables expression of the in vivo phenotype of the oBRB. Conventional in vitro cell models are based on 2D monolayer cellular cultures, unable to properly recapitulate the complexity of living systems. The main drawbacks of conventional oBRB models also emerge from the cell sourcing, the lack of an appropriate Bruch's membrane analogue, and the lack of choroidal microvasculature with flow. In the last years, the advent of organ-on-a-chip, bioengineering, and stem cell technologies is providing more advanced 3D models with flow, multicellularity, and external control over microenvironmental properties. By incorporating additional biological complexity, organ-on-a-chip devices can mirror physiologically relevant properties of the native tissue while offering additional set ups to model and study disease. In this review we first examine the current understanding of oBRB biology as a functional unit, highlighting the coordinated contribution of the different components to barrier function in health and disease. Then we describe recent advances in the use of pluripotent stem cells-derived retinal cells, Bruch's membrane analogues, and co-culture techniques to recapitulate the oBRB. We finally discuss current advances and challenges of oBRB-on-a-chip technologies for disease modelling.
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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), C/ Sabino de Arana 1, 08028, Barcelona, Spain.
| | - Marina Mesquida
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), C/ Sabino de Arana 1, 08028, Barcelona, Spain; Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Alfredo Adan
- Group of Ocular Inflammation: Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), C/ Sabino de Arana 1, 08028, Barcelona, Spain; Instituto Clínic de Oftalmología, Hospital Clínic Barcelona, C/ Sabino de Arana 1, 08028, Barcelona, Spain
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Martín-Varillas JL, Sanchez-Bilbao L, Calvo-Río V, Adan A, Hernanz Rodriguez I, Cordero-Coma M, Díaz Valle D, Fanlo Mateo P, De Dios-Jiménez Aberásturi J, García-Aparicio Á, Rodríguez Montero S, Jovani V, Moya P, Peña Sainz-Pardo E, Garijo Bufort M, Hernández JL, Blanco R. POS1351 CERTOLIZUMAB PEGOL VS ADALIMUMAB IN THE TREATMENT OF REFRACTORY CYSTOID MACULAR EDEMA DUE TO BEHÇET’S DISEASE. MULTICENTER STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCystoid Macular Edema (CME) is the leading cause of blindness in non-infectious uveitis. Behçet’s disease (BD) is one of the diseases most frequently associated with CME [1-4].Objectivesto compare the efficacy and safety of Certolizumab (CZP) and Adalimumab (ADA) in CME due to BD refractory to conventional therapy.Methodsmulticenter study of patients with CME secondary to BD refractory to glucocorticoids (GC) and at least 1 conventional immunosuppressant. All patients had CME (OCT>300µ) at baseline. Efficacy was assessed with the following ocular parameters: macular thickness (µm), visual acuity (BCVA) and GC-sparing effect. The efficacy of CZP vs. ADA was compared between the baseline visit, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with IBM SPSS Statistics v.23.ResultsWe studied 21 patients/38 affected eyes were studied. 10 patients were treated with CZP (200 mg c/2 weeks) and 11 with ADA (loading dose of 80 mg and subsequently 40 mg c/2 weeks).No statistically significant baseline differences were observed in both groups (CZP vs. ADA) in sex (♂/♀; 3/7 vs 5/6; p=0.65) and mean age (36.1±8.0 vs 42.2±8.6; p=0.10). However, CZP group was more severe with a longer time between EB diagnosis and biologic initiation (91.6±71.4 vs 34.4±21.3 months, p=0.02), and a greater median [IQR] number of previous biologic drugs (2 [0.75-3] vs 0 [0-0]). In CZP group, 8 patients were previously treated with ADA.Combined therapy with conventional DMARDs was used with ADA in 81.8% vs. 18.2% of CZP patients.Regarding the efficacy outcomes analyzed, a rapid and maintained improvement in macular thickness, measured by OCT, was observed after 2 years of follow-up in both groups with no statistically significant differences between them (Table 1). Improvement in visual acuity and a GC-sparing effect was also observed (Table 1).Table 1.main ocular parameters compared in the CZP-treated group and in the ADA-treated group.CZP(n=10)ADA(n=11)PBaseline
OCT (µm, mean±SD)380.7±96.4416.9±171.10.56 BCVA (mean±SD)0.72±0.300.57±0.200.21 Prednisone (mg/dl, mean±SD)13.1±11.434.1±18.90.071st month
OCT (µm, mean±SD)333.7±60.4302±44.20.19 BCVA (mean±SD)0.80±0.270.72±0.180.45 Prednisone (mg/dl, mean±SD)8.1±5.5112.1±6.40.316th month
OCT (µm, mean±SD)284.4±45.5272.8±38.90.53 BCVA (mean±SD)0.82±0.230.86±0.160.65 Prednisone (mg/dl, mean±SD)6.8±6.66.1±2.80.921st year
OCT (µm, mean±SD)269.0±46.8260.9±39.50.67 BCVA (mean±SD)0.82±0.230.89±0.170.48 Prednisone (mg/dl, mean±SD)6.2±3.05.8±2.10.872nd year
OCT (µm, mean±SD)289.4±49.3248.0±42.00.16 BCVA (mean±SD)0.87±0.200.87±0.171.0 Prednisone (mg/dl, mean±SD)3.7±1.23.1±2.30.90No serious adverse events were observed in either group.ConclusionOur study suggests that both CZP and ADA are effective in the treatment of CME due to BD refractory to conventional treatment. CZP was equally effective despite most patients were refractory to ADA.References[1]Schaap-Fogler M, et al. Graefes Arch Clin Exp Ophthalmol. 2014 Apr;252(4):633-40. doi: 10.1007/s00417-013-2552-8.[2]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451 doi: 10.1016/j.ophtha.2018.02.020[3]Martín-Varillas JL, et al. J Rheumatol. 2021;48:741-750. doi: 10.3899/jrheum.200300[4]Vegas-Revenga N et al Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019Disclosure of InterestsNone declared
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Martín-Varillas JL, Sanchez-Bilbao L, Calvo-Río V, Adan A, Hernanz Rodriguez I, Beltrán E, Castro S, Fanlo Mateo P, García Martos A, Torre-Salaberri I, Cordero-Coma M, De Dios-Jiménez Aberásturi J, García-Aparicio Á, Hernández-Garfella M, Sanchez-Andrade A, García-Valle A, Miguélez R, Maiz O, Rodríguez Montero S, Urruticoechea-Arana A, Veroz Gonzalez R, Conesa A, Fernández-Carballido C, Jovani V, Martínez González O, Moya P, Romero-Yuste S, Rubio Muñoz P, Peña Sainz-Pardo E, Garijo Bufort M, Hernández JL, Blanco R. POS1350 UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES TREATED WITH CERTOLIZUMAB PEGOL. MULTICENTER STUDY OF 80 PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAdalimumab remains the only biologic approved by the EMA and FDA for the treatment of non-infectious uveitis [1-6]. The reports on efficacy of other anti-TNF drugs such as Certolizumab Pegol (CZP) are scarce.Objectivesto determine the efficacy and safety of CZP in refractory uveitis secondary to Immune-mediated Inflammatory Diseases (IMIDs).Methodsnational multicenter study of 80 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants treated with CZP. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, vitritis, macular thickness and presence of retinal vasculitis. The efficacy of CZP was compared between the baseline visit, 1st week, 1st and 6th month, and 1st year. Statistical analysis was performed with IBM SPSS Statistics v.23.Resultswe studied 80 patients/111 affected eyes (33 men/47 women) with a mean age of 41.6±11.7 years. The IMIDs included were: spondyloarthritis (n=43), Behçet’s disease (10), psoriatic arthritis (8), Crohn’s disease (4), sarcoidosis (2), JIA (1), reactive arthritis (1), rheumatoid arthritis (1), relapsing polychondritis (1), TINU (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (6). Anterior was the most frequent uveitis pattern (n=61).In 20 patients, besides the presence of refractory uveitis, desire of pregnancy was the reason for CZP initiation.Prior to CZP, patients had received: methotrexate (n=38), sulfasalazine (28), azathioprine (14), cyclosporine (10), leflunomide (3), mycophenolate mofetil (4), and cyclophosphamide (1). Previous biologic therapy was administered in 52 patients (63%), with a median [IQR] of 2 [1-3] drugs per patient. The most used biologic was adalimumab (n=48), followed by infliximab (32), golimumab (15), tocilizumab (5), etanercept (7), rituximab (1), anakinra (1) and secukinumab (1). CZP was administered as monotherapy in 39 patients.After 24 [12-36] months of follow-up, all parameters analyzed showed a rapid and maintained improvement (Table 1). A decrease in the mean number of uveitis flares was observed before and after CZP, (2.6±2.3 vs. 0.6±0.4, p<0.001). CZP was discontinued in 16 patients due to: ocular remission (n=3), insufficient ocular response (4) and incomplete response of extraocular manifestations (9). No serious adverse effects were found.Table 1.main ocular parameters analyzed in 80 patients with uveitis due to IMID and treated with CZP.Baseline1st week1st month3rd month6th month1st yearBCVA (mean±SD)0.68±0.270.73±0.26*0.79±0.26*0.82±0.25*0.85±0.24*0.86±0.23*Tyndall improvement, n (%)Patients with Tyndall + at baseline (n=57)-23 (40.3)45 (78.9)47 (82.4)57 (100)57 (100)Vitritis improvement, n (%)Patients with Vitritis at baseline (n=14)-5 (35.7)8 (57.1)13 (92.8)14 (100)14 (100)OCT (µm) (mean±SD)297.5±48.1297.1±45.5286.5±39.8*277.6±43.3*271.5±38.6*269.0±38.8*Choroiditis, affected eyes, n (%)3 (2.4)3 (2.4)2 (1.6)2 (1.6)1 (0.8)1 (0.8)Retinal vasculitis, affected eyes, n (%)3 (2.4)2 (1.6)1 (0.8)0 (0)0 (0)0 (0)*p<0.01ConclusionCZP seems to be effective and safe in the control of uveitis associated to different IMIDs.References[1]Jaffe GJ, et al. N Engl J Med 2016;375:932-43. doi: 10.1056/NEJMoa1509852.[2]Nguyen QD, et al. Lancet 2016;388:1183-92. doi: 10.1016/S0140-6736(16)31339-3.[3]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451 doi: 10.1016/j.ophtha.2018.02.020[4]Martín-Varillas JL, et al. J Rheumatol. 2021;48:741-750. doi: 10.3899/jrheum.200300[5]Atienza-Mateo B. Arthritis Rheumatol. 2019;71:2081-2089. doi: 10.1002/art.41026.[6]Vegas-Revenga N et al Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019Disclosure of InterestsNone declared
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Fonollosa A, Hernández-Rodríguez J, Cuadros C, Giralt L, Sacristán C, Artaraz J, Pelegrín L, Olate-Pérez Á, Romero R, Pastor-Idoate S, Sobas Bsc EM, Fernández-Fidalgo S, Abraldes MJ, Oleñik A, Insausti-García A, Torres P, Porcar C, Lorca DR, Adan A. CHARACTERIZING COVID-19-RELATED RETINAL VASCULAR OCCLUSIONS: A Case Series and Review of the Literature. Retina 2022; 42:465-475. [PMID: 34914345 DOI: 10.1097/iae.0000000000003327] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/25/2022]
Abstract
PURPOSE To describe clinical and ophthalmologic features and outcomes of patients with coronavirus disease-19 with retinal vascular occlusions. METHODS Retrospective multicenter case series and PubMed review of cases reported from March 2020 to September 2021. Outcome measures are as follows: type of occlusion, treatments, best-corrected visual acuity, and central macular thickness on optical coherence tomography. RESULTS Thirty-nine patients were identified. Fifteen patients with a median age of 39 (30-67) years were included in the multicenter study. Vascular occlusions included central retinal vein occlusion (12 eyes), branch retinal vein occlusion (4 eyes), and central retinal artery occlusion (2 eyes). Three cases were bilateral. Baseline best-corrected visual acuity was 20/45 (no light perception-20/20). Baseline central macular thickness was 348.64 (±83) μm. Nine eyes received anti-vascular endothelial growth factor agents, dexamethasone intravitreal implant, or both. Final best-corrected visual acuity was 20/25 (no light perception-20/20), and central macular thickness was 273.7 ± 68 μm (follow-up of 19.6 ± 6 weeks). Among the 24 cases from the literature review, retinal vein occlusion was the predominant lesion. Clinical characteristics and outcomes were similar to those found in our series. CONCLUSION Coronavirus disease-19-associated retinal vascular occlusions tend to occur in individuals younger than 60 years. Retinal vein occlusion is the most frequent occlusive event, and outcomes are favorable in most cases.
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Affiliation(s)
- Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Instituto Oftalmológico Bilbao, Bilbao, Spain
- Cooperative Health Network for Research in Ophthalmology (Oftared), National Institute of Health Carlos III, ISCIII, Madrid, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit and Clinical Unit of Autoinflammatory Diseases, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlos Cuadros
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Lena Giralt
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Cristina Sacristán
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Álvaro Olate-Pérez
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rosa Romero
- CIENI (Centro de Investigación en enfermedades infecciosas)-INER (Instituto Nacional de Enfermedades Respiratorias), Méjico DF, Méjico
| | - Salvador Pastor-Idoate
- Cooperative Health Network for Research in Ophthalmology (Oftared), National Institute of Health Carlos III, ISCIII, Madrid, Spain
- Clinical University Hospital of Valladolid, Valladolid, Spain
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
| | | | | | - Maximino J Abraldes
- Cooperative Health Network for Research in Ophthalmology (Oftared), National Institute of Health Carlos III, ISCIII, Madrid, Spain
- Servicio de Oftalmología, Complexo Hospitalario Universitario de Santiago de Compostela
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | | | | | - Pedro Torres
- Hospital Oftalmológico Juan Domingo Perón, Buenos Aires, Argentina
| | - Carmela Porcar
- Department of Ophthalmology, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain; and
| | - Daniela Rego Lorca
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Pichi F, Carreño E, Pavesio C, Denniston AK, Grewal DS, Deak G, Khairallah M, Ruiz-Cruz M, de Oliveira Dias JR, Adan A, Burke T, Invernizzi A, Schlaen A, Tian M, Agarwal AK, Tucker WR, Sen HN, Lin P, Lim LL, Pepple KL, Munk MR. Consensus-based recommendations for optical coherence tomography angiography reporting in uveitis. Br J Ophthalmol 2022:bjophthalmol-2021-320021. [PMID: 35135783 DOI: 10.1136/bjophthalmol-2021-320021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/06/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To establish a consensus in the nomenclature for reporting optical coherence tomography angiography (OCTA findings in uveitis. METHODS The modified Delphi process consisted of two rounds of electronic questionnaires, followed by a face-to-face meeting conducted virtually. Twenty-one items were included for discussion. The three main areas of discussion were: wide field OCTA (WF-OCTA), nomenclature of OCTA findings and OCTA signal attenuation assessment and measurement. Seventeen specialists in uveitis and retinal imaging were selected by the executive committee to constitute the OCTA nomenclature in Uveitis Delphi Study Group. The study endpoint was defined by the degree of consensus for each question: 'strong consensus' was defined as >90% agreement, 'consensus' as 85%-90% and 'near consensus' as >80% but <85%. RESULTS There was a strong consensus to apply the term 'wide field' to OCTA images measuring over 70° of field of view, to use the terms 'flow void' and 'non-detectable flow signal' to describe abnormal OCTA flow signal secondary to vessels displacement and slow flow respectively, to use the terms 'loose' and 'dense' to describe the appearance of inflammatory choroidal neovascularisation, and to use the percentage of flow signal decrease to measure OCTA ischaemia with a threshold greater than or equal to 30% as a 'large area'. CONCLUSIONS This study sets up consensus recommendations for reporting OCTA findings in uveitis by an expert panel, which may prove suitable for use in routine clinical care and clinical trials.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Ester Carreño
- Ocular Inflammation Unit, Ophthalmology Department, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Dilraj S Grewal
- Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gabor Deak
- Department of Ophthalomology, Medical University Vienna, Vienna, Austria
| | - Moncef Khairallah
- Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | | | | | - Alfredo Adan
- Ophthalmology Department, Hospital Clinic, Barcelona, Spain
| | - Tomas Burke
- Bristol Eye Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Alessandro Invernizzi
- Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Ariel Schlaen
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Meng Tian
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Aniruddha Kishandutt Agarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - William R Tucker
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Kathryn L Pepple
- Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Marion R Munk
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland.,Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Udaondo P, Adan A, Arias-Barquet L, Ascaso FJ, Cabrera-López F, Castro-Navarro V, Donate-López J, García-Layana A, Lavid FJ, Rodríguez-Maqueda M, Ruiz-Moreno JM. Challenges in Diabetic Macular Edema Management: An Expert Consensus Report. Clin Ophthalmol 2021; 15:3183-3195. [PMID: 34349495 PMCID: PMC8327476 DOI: 10.2147/opth.s320948] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel. Methods A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients. Results Panel was mainly focused on therapeutic objectives in DME management; definition terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors. Conclusion This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients.
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Affiliation(s)
- Patricia Udaondo
- Department of Ophthalmology, Hospital Universitario y Politecnico la FE, Valencia, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Luis Arias-Barquet
- Department of Ophthalmology, University Complex Bellvitge, Barcelona, Spain
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Francisco Cabrera-López
- Department of Ophthalmology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | | | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos, Madrid, Spain
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Arriola-Villalobos P, Moll-Udina A, Carrasco-López-Brea M, Sacristan C, Capella MJ, Peiteado D, Garrote-Llordén A, Albert Fort M, Jódar Márquez M, Jacobo Gonzalez Guijarro J, Demetrio-Pablo R, Luis Sánchez Sevilla J, Carreño E, González-López J, Miguel-Escuder L, Cuadros C, Díaz-Valle D, Adan A, Benítez Del Castillo JM, Fonollosa A, Cordero M, Martínez Costa L, Blanco-Alonso R. Vogt-Koyanagi-Harada disease in Spain. Eur J Ophthalmol 2021; 32:1547-1554. [PMID: 34269103 DOI: 10.1177/11206721211033477] [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 To describe the clinical and epidemiological characteristics of patients with Vogt-Koyanagi-Harada (VKH) disease in Spain. METHODS This was a retrospective multicenter analysis of data from VKH patients followed for at least 6 months. The data collected were related to demographics, clinical manifestations, treatments, and complications. RESULTS Participants were 112 patients (224 eyes), from 13 tertiary referral centers, of mean age 37.5 ± 14.7 years; 83.9% were women. Ethnicities were 61.6% Caucasian and 30.4% Hispanic. The disease was classified as complete in 16.1%, incomplete in 55.4%, and probable in 28.6%. When seen for the first time, the clinical course was acute in 69.6%, recurrent chronic in 15.2%, and chronic in 14.3%. The most frequent treatment was corticosteroids (acute stage 42.2%, maintenance stage 55.6%). The most common complications were cataract (41.1%) and ocular hypertension (16.1%). In most eyes, visual acuity was improved (96.7%) or remained stable at the end of follow up. CONCLUSION VKH in Spain mostly affects women and presents as incomplete acute stage disease. Visual prognosis is good. Cataract and glaucoma are the two most frequent complications.
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Affiliation(s)
- Pedro Arriola-Villalobos
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain.,Hospital QuironSalud Madrid, Madrid, Spain
| | - Aina Moll-Udina
- Clinic Hospital of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mario Carrasco-López-Brea
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Sacristan
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - Maria Jose Capella
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diana Peiteado
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Garrote-Llordén
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, Leon, Spain
| | - Mara Albert Fort
- Servicio de Oftalmología, Hospital Universitari Doctor Peset, Valencia, Spain
| | - Margarita Jódar Márquez
- Servicio de Oftalmología, Hospital Regional Universitario de Málaga, Malaga, Andalusia, Spain
| | | | | | | | - Ester Carreño
- Servicio de Oftalmología, Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Julio González-López
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lucia Miguel-Escuder
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Carlos Cuadros
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - David Díaz-Valle
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Adan
- Clinic Hospital of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | - José M Benítez Del Castillo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Fonollosa
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - Miguel Cordero
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, Leon, Spain
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Atienza-Mateo B, Ferraz-Amaro I, Beltrán E, Adan A, Hernández-Garfella M, Martinez-Costa L, Cordero-Coma M, Díaz-Llopis M, Herreras JM, Maiz-Alonso O, Torre-Salaberri I, Díaz Valle D, Atanes-Sandoval A, Francisco F, Insua S, Sánchez J, Almodovar R, Ruiz-Moreno O, Gandia Martinez M, Nolla JM, Martín-Varillas JL, Calvo-Río V, Prieto-Peña D, González-Gay MA, Blanco R. OP0060 COMPARATIVE STUDY ON ANTI-TNF VS TOCILIZUMAB FOR TREATMENT OF REFRACTORY UVEITIC CYSTOID MACULAR EDEMA DUE TO BEHCET’S DISEASE. MULTICENTER STUDY OF 49 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Posterior segment involvement is the most serious affection of uveitis in Behçet’s disease (BD), with cystoid macular edema (CME) being the leading cause of blindness. Anti-TNF, especially adalimumab (ADA) and infliximab (IFX), have demonstrated efficacy as first-line biologic agents in BD-related uveitis [1,2]. Moreover, the anti-IL6R tocilizumab (TCZ) has shown excellent results in highly refractory BD-uveitis and noninfectious uveitic CME [3-6].Objectives:To compare the efficacy of ADA vs IFX vs TCZ in patients with refractory CME due to BD.Methods:Observational multicenter study of patients with BD-associated CME refractory to conventional and/or biological immunosuppressive drugs. From a cohort of 177 patients treated with anti-TNF and 14 patients treated with TCZ, we selected those with CME at baseline. CME was defined as macular thickness > 300μm (measured by optic coherence tomography). We analyzed in the 3 groups of treatment (ADA, IFX, TCZ) from baseline up to 4 years the evolution of macular thickness (main outcome) and best-corrected visual acuity (BCVA). Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the 3 groups.Results:A total of 49 patients were included. ADA was used in 25 patients (40 eyes with CME), IFX in 15 (21 eyes with CME) and TCZ in 9 (11 eyes with CME). No statistically significant baseline differences were observed between the 3 groups (Table) except for previous anti-TNF therapy, which was used only in patients treated with TCZ (5 patients received ADA, 1 received IFX and 2 received both ADA and IFX, in different times). Most patients from all groups had received several conventional immunosuppressive drugs. Biological therapy was used in monotherapy or combined with azathioprine (n=10, 5 and 1 in ADA, IFX and TCZ group, respectively), cyclosporine A (n=10, 5 and 1) or methotrexate (n=4, 2 and 3). Macular thickness progressively decreased in the 3 groups, with no signs of CME after 1 year of treatment. Similarly, BCVA improvement and inflammatory ocular remission was reached in all groups (Figure).Table 1.Demographic and clinical characteristics of 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ.ADA (n=25)IFX (n=15)TCZ (n=9)Eyes with cystoid macular edema, n402111Age, years41 ± 1138 ± 943 ± 16Sex, men/women12/137/85/4HLA–B51 +, n19106Duration of uveitis before anti-TNF/ anti-IL6R, months30 [12-82]15 [8-60]32 [24-144]Ocular features at start of anti-TNF/anti-IL6R Macular thickness, μm432 ± 118483 ± 126417 ± 113 Visual acuity, BCVA0.4 ± 0.20.3 ± 0.20.2 ± 0.2 Tyndall, inflammation grade2 [1-3]1 [0-1.5]1 [0-1.5] Vitritis, inflammation grade2.5 [1.5-3]1 [0-2]2 [1-2]Previous treatment, n Oral glucocorticoids // i.v. pulse methylprednisolone18 // 134 // 97 // 8 MTX //CsA //AZA13 // 22 // 148 // 13 // 88 // 6 // 2 ADA // IFX0 // 00 // 07 // 3Prednisone dosage at start of anti-TNF/anti-IL6R, mg/day45 [30-60]30 [20-60]30 [30-30]Combined treatment, n CsA // AZA // MTX10 // 10 // 45 // 5 // 21 // 1 // 3Data are presented as mean ± SD or median [IQR] when data were not normally distributed. ADA, adalimumab; AZA, azathioprine; CsA, cyclosporine A; MTX, methotrexate; IFX, infliximab; TCZ, tocilizumab.Figure 1.Evolution of ocular parameters in 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ.Conclusion:Refractory CME associated to BD’s uveitis can be effectively treated with ADA, IFX or TCZ. Moreover, TCZ is effective in patients resistant to anti-TNF therapy.References:[1]Arthritis Rheumatol. 2019;71(12):2081-2089. doi: 10.1002/art.41026[2]Ophthalmology. 2018;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020[3]Rheumatology (Oxford). 2018;57(5):856-864. doi: 10.1093/rheumatology/kex480[4]Am J Ophthalmol.2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019[5]Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7. PMID: 25005576[6]Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. PMID:27054359Disclosure of Interests:None declared
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Martín-Varillas JL, Calvo-Río V, Sanchez-Bilbao L, González-Mazón I, Adan A, Hernanz Rodríguez I, Gallego A, Beltrán E, Castro S, Fanlo P, García Martos A, Torre-Salaberri I, Cordero-Coma M, De Dios-Jiménez Aberásturi J, García-Aparicio Á, Hernández-Garfella M, Sanchez-Andrade A, García-Valle A, Maiz O, Miguélez R, Rodríguez Montero S, Urruticoechea-Arana A, Veroz Gonzalez R, Conesa A, Fernández-Carballido C, Jovani V, Martínez González O, Moya P, Romero-Yuste S, Rubio Muñoz P, Peña Sainz-Pardo E, González-Gay MA, Hernández JL, Blanco R. POS1340 MULTICENTER STUDY OF 71 PATIENTS WITH REFRACTORY UVEITIS RELATED TO IMMUNE-MEDIATED INFLAMMATORY DISEASES ON CERTOLIZUMAB PEGOL TREATMENT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Prognosis of non-infectious refractory uveitis has improved markedly with biologic therapy (BT) (1-5). Most data are with monoclonal anti-TNF drugs, especially Adalimumab (ADA) and Infliximab (IFX). However, there is not enough evidence for the use of Certolizumab Pegol (CZP).Objectives:To evaluate the efficacy and safety of CZP in refractory uveitis secondary to Immune-Mediated Inflammatory Diseases (IMID).Methods:Multicenter study of 71 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, vitritis, macular thickness and presence of retinal vasculitis. These outcomes were compared between baseline, 1st week, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with IBM SPSS Statistics v.23.Results:71 patients/100 affected eyes (29 men/42 women) with mean age of 40.0±11.3 years were studied. Underlying IMIDs were: spondyloarthritis (n=38), Behçet (10), psoriatic arthritis (8), Crohn disease (3), sarcoidosis (2), JIA (1), reactive arthritis (1), rheumatoid arthritis (1), relapsing polychondritis (1), TINU (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (3). Uveitis pattern was anterior (n=55), posterior (6), panuveitis (6) and intermediate (4).Prior to CZP, patients had received: methotrexate (37), sulfasalazine (26), azathioprine (14), cyclosporine (10), leflunomide (3), mycophenolate mofetil (3) and cyclophosphamide (1). Previous BT was administered in 48 (67.6%) patients, with a mean of 1.4±1.3 drugs per patient as follows: ADA (n=56), IFX (27), golimumab (14), tocilizumab (5) and etanercept (3). Pregnancy was the reason for prescribing CZP in 19 patients. CZP was administered in monotherapy (n=39) or combined with conventional immunosuppressants (n=32).After a mean follow-up of 27.1±21.1 months, most of the ocular variables showed a rapid and significantly improvement (Table 1). A decrease in the median number [IQR] of flares of uveitis before and after CZP, (3 [1-4] vs. 0 [0-1], p<0.001) was observed. CZP was discontinued in 15 patients due to remission (n=2), ocular insufficient response (2) and incomplete response of extraocular manifestations (11). No serious adverse events were reported.Conclusion:CZP seems to be effective and safe in patients with refractory uveitis due to IMID.References:[1]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451. doi: 10.1016/j.ophtha.2018.02.020.[2]Atienza-Mateo B, et al. Arthritis Rheumatol 2019; 71:2081-2089. doi: 10.1002/art.41026.[3]Santos-Gómez M, et al. Clin Exp Rheumatol 2016; 34(6 Suppl 102):S34-S40. PMID: 27054359[4]Vegas-Revenga N, et al. Am J Ophthalmol 2019; 200:85-94. doi: 10.1016/j.ajo.2018.12.019[5]Calvo-Río V, et al. Clin Exp Rheumatol. 2014; 32 (4 Suppl 84):S54-7. PMID: 25005576Table 1.Baseline1stweek1stMonth6thMonth1styear2ndyearBCVA (mean±SD)0.68±0.270.72±0.27*0.79±0.25*0.84±0.24*0.85±0.25*0.87±0.22*Improvement in AC Cells, n (%)Patients with AC cells at baseline (n=48)-21 (43.7)30 (62.5)*41 (85.4)*48 (100)*48 (100)*Improvement in Vitritis, n (%)Patients with vitritis at baseline (n=13)-3 (23.1)8 (61.5)*11 (84.6)*13 (100)*13 (100)*OCT (µ) (mean±SD)292.5±47.7294±47.4286.7±41.9*274.7±38.7*272.8±38.9*266.31±36.2*Choroiditis; affected eyes, n, (%)3 (4.2)3 (4.2)2 (2.8)2 (2.8)1 (1.4)0 (0)Retinal Vasculitis; affected eyes, n, (%)2 (2.8)0 (0)1 (1.4)0 (0)0 (0)0 (0)*p<0.001Disclosure of Interests:None declared
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Hernanz I, Larque AB, Quintana LF, Espigol-Frigole G, Espinosa G, Adan A, Sainz-de-la-Maza M. Scleritis and sclerokeratitis associated with IgA vasculitis: A case series. Am J Ophthalmol Case Rep 2021; 22:101100. [PMID: 33997470 PMCID: PMC8093897 DOI: 10.1016/j.ajoc.2021.101100] [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: 07/31/2020] [Revised: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 10/30/2022] Open
Abstract
Purpose To describe a case series of scleritis associated with IgA vasculitis (IgAV) at a tertiary referral center. Observations Three men with scleritis associated with IgAV were identified: one with anterior scleritis alone, one with anterior scleritis and peripheral ulcerative keratitis (sclerokeratitis), and one with anterior and posterior scleritis. Visual acuity was preserved except from the patient who developed posterior scleritis. Ocular pain was the main symptom at presentation. All patients had a previous history of palpable purpura, but only one was aware of his underlying IgAV. Laboratory results revealed microhematuria and proteinuria with normal urinary β2 microglobulin levels and negative serum ANCAs. Skin or kidney biopsy demonstrated leukocytoclastic vasculitis or glomerulonephritis with dominant IgA immune deposits. Conclusions and Importance Although uncommon, IgAV should be included in the differential diagnosis of anterior scleritis alone or associated with peripheral ulcerative keratitis or posterior scleritis, even in systemically asymptomatic patients. Urinalysis should not be underestimated in assessment of scleritis to detect early stages of glomerular disease. Scleritis may be the first manifestation whose study may lead to the diagnosis of IgAV. Multidisciplinary approach is necessary to prevent irreversible organ damage such as renal failure.
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Affiliation(s)
- I Hernanz
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A B Larque
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L F Quintana
- Department of Nephrology and Renal Transplantation, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - G Espigol-Frigole
- Department of Autoimmune Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - G Espinosa
- Department of Autoimmune Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - A Adan
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - M Sainz-de-la-Maza
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Fanlo P, Espinosa G, Adan A, Fonollosa A, Segura A. Multidisciplinary care and units for uveitis in the internal medicine departments in Spain: Survey of the Systemic Autoimmune Diseases Group. Rev Clin Esp 2021; 221:221-225. [PMID: 32111438 DOI: 10.1016/j.rce.2019.11.018] [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: 07/19/2019] [Revised: 10/22/2019] [Accepted: 11/02/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify the multidisciplinary uveitis units in which internal medicine departments participate in collaboration with ophthalmology departments in Spain. MATERIAL AND METHODS We conducted a multicentre, observational cross-sectional study that collected information using a structured survey sent by email to 1015 partners of the Systemic Autoimmune Diseases Workgroup of the Spanish Society of Internal Medicine (GEAS-SEMI) from the 1st to the 31st of March 2017. RESULTS We identified a total of 21 support units/consultations for the ophthalmology departments. Seventeen (81%) of the units were specific internal medicine-ophthalmology consultations, and 5 (24%) units had been created in the past 5 years. A median of 460 patients were assessed per unit by the end of the year. CONCLUSIONS This study shows, for the first time in Spain, the important and close collaboration between ophthalmologists and internists, especially in highly specialised national reference institutions.
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Affiliation(s)
- P Fanlo
- Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - G Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España
| | - A Adan
- Institut Clinic d́Oftalmologia, Hospital Clínic, Barcelona, España
| | - A Fonollosa
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - A Segura
- Servicio de Medicina Interna, Hospital Vall d́Hebron, Barcelona, España
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Zarranz-Ventura J, Romero-Núñez B, Bernal-Morales C, Velazquez-Villoria D, Sala-Puigdollers A, Figueras-Roca M, Copete S, Distefano L, Boixadera A, García-Arumi J, Adan A. Differential response to intravitreal dexamethasone implant in naïve and previously treated diabetic macular edema eyes. BMC Ophthalmol 2020; 20:443. [PMID: 33176749 PMCID: PMC7659223 DOI: 10.1186/s12886-020-01716-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/31/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting. Methods 342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ≥ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months. Results Mean number of injections was significantly lower in naïve vs PT DME eyes (1.40 ± 0.9 vs 1.82 ± 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving ≥4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 ± 4.0 vs 10.0 ± 5.5, p = 0.75, 13.2 ± 4.0 vs 16.0 ± 3.5, p = 0.21 and 21.7 ± 3.8 vs 19.7 ± 5.8, p = 0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates. Conclusion Naïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.
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Affiliation(s)
- Javier Zarranz-Ventura
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain. .,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Barbara Romero-Núñez
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Carolina Bernal-Morales
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | | | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sergio Copete
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Laura Distefano
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Anna Boixadera
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Jose García-Arumi
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Suhler EB, Jaffe GJ, Fortin E, Lim LL, Merrill PT, Dick AD, Brezin AP, Nguyen QD, Thorne JE, Van Calster J, Cimino L, Adan A, Goto H, Kaburaki T, Kramer M, Vitale AT, Kron M, Song AP, Liu J, Pathai S, Douglas KM, Schlaen A, Muccioli C, Van Velthoven MEJ, Zierhut M, Rosenbaum JT. Long-Term Safety and Efficacy of Adalimumab in Patients with Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. Ophthalmology 2020; 128:899-909. [PMID: 33157077 DOI: 10.1016/j.ophtha.2020.10.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/21/2019] [Revised: 10/07/2020] [Accepted: 10/29/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate long-term efficacy and safety of extended treatment with adalimumab in patients with noninfectious intermediate, posterior, or panuveitis. DESIGN Open-label, multicenter, phase 3 extension study (VISUAL III). PARTICIPANTS Adults who had completed a randomized, placebo-controlled phase 3 parent trial (VISUAL I or II) without treatment failure (inactive uveitis) or who discontinued the study after meeting treatment failure criteria (active uveitis). METHODS Patients received subcutaneous adalimumab 40 mg every other week. Data were collected for ≤ 362 weeks. Adverse events (AEs) were recorded until 70 days after the last dose. MAIN OUTCOME MEASURES Long-term safety and quiescence; other efficacy variables included inflammatory lesions, anterior chamber cell and vitreous haze grade, macular edema, visual acuity, and dose of uveitis-related systemic corticosteroids. RESULTS At study entry, 67% of patients (283/424) showed active uveitis and 33% (141/424) showed inactive uveitis; 60 patients subsequently met exclusion criteria, and 364 were included in the intention-to-treat analysis. Efficacy variables were analyzed through week 150, when approximately 50% of patients (214/424) remained in the study. Patients showing quiescence increased from 34% (122/364) at week 0 to 85% (153/180) at week 150. Corticosteroid-free quiescence was achieved by 54% (66/123) and 89% (51/57) of patients with active or inactive uveitis at study entry. Mean daily dose of systemic corticosteroids was reduced from 9.4 ± 17.1 mg/day at week 0 (n = 359) to 1.5 ± 3.9 mg/day at week 150 (n = 181). The percentage of patients who achieved other efficacy variables increased over time for those with active uveitis at study entry and was maintained for those with inactive uveitis. The most frequently reported treatment-emergent AEs of special interest were infections (n = 275; 79 events/100 patient-years [PY]); AEs and serious AEs occurred at a rate of 396 events/100 PY and 15 events/100 PY, respectively. CONCLUSIONS Long-term treatment with adalimumab led to quiescence and reduced corticosteroid use for patients who entered VISUAL III with active uveitis and led to maintenance of quiescence for those with inactive uveitis. AEs were comparable with those reported in the parent trials and consistent with the known safety profile of adalimumab.
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Affiliation(s)
- Eric B Suhler
- Casey Eye Institute, Oregon Health & Science University, OHSU-PSU School of Public Health, and VA Portland Health Care System, Portland, Oregon.
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Eric Fortin
- Department of Ophthalmology, University of Montreal, Montreal, Canada
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Pauline T Merrill
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Andrew D Dick
- Translational Health Sciences (Ophthalmology), University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom, and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London, Institute of Ophthalmology, London, United Kingdom
| | - Antoine P Brezin
- Department of Ophthalmology, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - Quan Dong Nguyen
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Jennifer E Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, and Department of Epidemiology, Center for Clinical Trials, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | - Alfredo Adan
- Facultad de Medicina, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Hiroshi Goto
- Department of Ophthalmolgy, Medical University, Tokyo, Japan
| | | | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Martina Kron
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | | | - Sophia Pathai
- Johnson & Johnson Vision, Singapore, Republic of Singapore
| | | | - Ariel Schlaen
- Department of Ophthalmology, Austral University, Buenos Aires, Argentina
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Manfred Zierhut
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - James T Rosenbaum
- Departments of Ophthalmology and Medicine, Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
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Martín-Varillas JL, Atienza-Mateo B, Calvo-Río V, Beltrán E, Adan A, Aurrecoechea E, Castañeda S, González-Gay MA, Hernández JL, Blanco R. SAT0264 LONG TERM FOLLOW-UP AND OPTIMIZATION OF INFLIXIMAB IN REFRACTORY UVEITIS DUE TO BEHÇET’S DISEASE. MULTICENTER STUDY OF 103 CAUCASIAN PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Biologic therapy has improved prognosis of Behçet Disease (BD) uveitis (1-5). Although infliximab (IFX) is approved in Japan, most data in Caucasian patients comes from small series. No data on optimization has been publishedObjectives:In a large series of Caucasian patients with refractory uveitis of BD, we assess:a) long-term efficacy and safety;b) IFX optimization when ocular remission was achievedMethods:Multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressants.103 patients were treated with IFX as 1st biologic as follows: 3-5 mg/kg i.v. at 0, 2, 6 and every 4-8 weeks. The main outcomes were anterior chamber cells, vitritis, retinal vasculitis, macular thickness, visual acuity, and glucocorticoids sparing effect; analysed at baseline, 1st week, 1st and 6th months and 1st and 2nd years. After remission, IFX optimization was performedResults:In whole series (n=103), main outcomes showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Severe side-effects were observed in 9 patients.Comparative study between optimized and non-optimized groups showed:a) no differences in clinical baseline characteristics;b) similar maintained improvement in most ocular outcomes;c) lower severe adverse events andd) lower IFX cost in optimized group (4826.52 vs 9854.13 euros/patient/year)(Table)Conclusion:IFX seems effective and safe in Caucasian patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effectiveReferences:[1]Martín-Varillas JL. Ophthalmology 2018;125:1444-1451.[2]Atienza-Mateo B: Arthritis Rheumatol. 2019;71:2081-2089[3]Santos-Gómez M. Clin Exp Rheumatol. 2016;34 (6 Suppl 102): S34-S40[4]Urruticoechea-Arana A. Rheumatol Int. 2019;39:47-58.[5]Atienza-Mateo B. Rheumatology (Oxford). 2018 1;57:856-864Table.OptimizedN=18Non OptimizedN=42PPatients/eyes affected, n/n18/3442/77Age, mean (SD), years39.5 (9.8)38.8 (10.5)0.82Men, %55.659.50.78Duration of uveitis before IFX, median [IQR] months38 [18-119]35 [10-48]0.11Ocular features at time of IFX onset-AC cells count, median [IQR]2 [1-4]2 [1-2]0.29-Vitritis, median [IQR]2 [1.5-3]2 [1-2]0.02-BCVA, mean (SD)0.32 (0.21)0.37 (0.26)0.51-OCT, mean (SD)303.5 (23.3)397.7 (155.7)0.12-Retinal vasculitis, n (%)9 (50)26 (66.7)0.23Uveitis pattern, n (%)-Bilateral/unilateral16/2 (88.9/11.1)35/7 (83.3/16.7)0.71-Anterior0 (0)6 (14.3)0.17-Posterior5 (27.8)8 (19.0)0.50-Panuveitis13 (72.2)28 (66.7)0.67Prednisone dose at IFX onset, mean (SD), mg/d40.3 (20.6)41.4 (15.5)0.81IFX therapyMonotherapy/combined treatment, n (%)15 (83.3)30 (71.4)0.33-AZA5 (27.8)4 (9.5)0.11-CsA9 (33.3)8 (19.0)0.32-MTX4 (22.2)15 (35.7)0.30Follow-up on IFX therapy, median [IQR], months48 [33-60]24 [6-60]0.007-Relapses, median (IQR)0 [0-1]0 [0-2]-Remission, %10075.60.46-Severe side effects, n (per 100 patients/year)0 (0)3 (0.78)0.02-Cost (mean), euros per year4826.529854.130.55–Disclosure of Interests:José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Belén Atienza-Mateo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Emma Beltrán: None declared, Alfredo Adan: None declared, Elena Aurrecoechea: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, J. Luis Hernández: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD
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Prieto-Peña D, Calderón-Goercke M, Adan A, Chamorro-López L, Maiz O, De Dios-Jiménez Aberásturi J, Veroz Gonzalez R, Blanco S, Santos JM, Navarro F, Gallego A, González-Suárez S, Conesa A, García-Valle A, Cordero-Coma M, Pardiñas-Barón N, Demetrio-Pablo R, Calvo-Río V, Mora-Cuesta VM, Castañeda S, Hernández JL, González-Gay MA, Blanco R. AB1055 CERTOLIZUMAB PEGOL: A SAFE AND EFFICIENT TREATMENT IN PATIENTS WITH UVEITIS DURING PREGNANCY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Anti-TNFα agents are useful in uveitis(1-5).Certolizumab pegol (CZP) differs from other anti-TNFα agents due to its limited placental transfer.Objectives:To assess efficacy and safety of CZP in women with uveitis during pregnancy.Methods:Multicenter study of women with uveitis under CZP during pregnancy and their neonates.Results:14 women (23 eyes); mean age 34.3±5.5 yrs (TABLE 1). Pattern of uveitis: 10 anterior, 2 posterior, 1 intermediate, 1 panuveitis. Uveitis was bilateral in 9 and chronic in 7. CZP was started before conception in 10 patients and after in 4. All patients obtained or maintained ocular remission throughout pregnancy (FIGURE). Prednisone was reduced from a mean dose of 21.7±19.7 mg/day to 4.1±3.8 mg/day at 6 months (p=0.03), leading to complete discontinuation in 4. 15 healthy infants were born. Only 1 woman presented a mild infection. No infections or malformations were found in neonates after a follow-up of 6 months. 6 infants were breastfed and all received scheduled vaccinations without complications (TABLE 2).TABLE 1.AgeUnderlying diseaseImmunosuppressants before CZPCombined treatment134SpAMTX, AZA, ADAAZA237SpAMTX, AZA, IFX, ADA, GOLI339SpAAZA, ADAAZA446SpACyA, ETN, ADA, IFX, GOLI532SpASSZ, ADASSZ636SpAMTX, HCQ, ADA740SpAMTX, LFN, HCQ, IFX, ADA, GOLIHCQ831IdiopathicMTX, MMF, CyA, ADA933IdiopathicMTX, AZA, ADA, ETN1032RAMTXAZA1123Vogt-Koyanagi-HaradaAZA, ADAAZA1236Juvenil Idiopathic ArthritisADA1332Punctate inner choroidopathyADA1429BehcetCyA, IFX, ADAConclusion:CZP seems to be effective and safe in female patients with uveitis during pregnancy and neonates.References:[1]Llorenç V et al. Certolizumab Pegol, a New Anti-TNF-α in the Armamentarium against Ocular Inflammation. Ocul Immunol Inflamm. 2016;24(2):167-72. doi: 10.3109/09273948.2014.967779[2]Urruticoechea-Arana A et al. Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review. Rheumatol Int. 2019 Jan;39(1):47-58. doi: 10.1007/s00296-018-4193-z[3]Martín-Varillas JL et al. Successful Optimization of Adalimumab Therapy in Refractory Uveitis Due to Behçet’s Disease Ophthalmology. 2018 Sep;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020[4]Santos-Gómez M et al. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behçet’s disease: results of a multicentre open-label study. Clin Exp Rheumatol. 2016. Sep-Oct;34(6 Suppl 102): S34-S40[5]Calvo-Río V et al. Golimumab in refractory uveitis related to spondyloarthritis. Multicenter study of 15 patients.Semin Arthritis Rheum. 2016 Aug;46(1):95-101. doi: 10.1016/j.semarthrit.2016.03.002Disclosure of Interests:D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Alfredo Adan: None declared, Lillian Chamorro-López: None declared, Olga Maiz: None declared, JR De Dios-Jiménez Aberásturi: None declared, Raul Veroz Gonzalez: None declared, Soledad Blanco: None declared, José M Santos: None declared, Francisco Navarro: None declared, Adela Gallego: None declared, Senen González-Suárez: None declared, Arantxa Conesa: None declared, Andrea García-Valle: None declared, Miguel Cordero-Coma: None declared, Nieves Pardiñas-Barón: None declared, Rosalía Demetrio-Pablo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Victor Manuel Mora-Cuesta: None declared, Santos Castañeda: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD
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Sainz-de-la-Maza M, Adan A, Ruiz I, Beltran E, Yago I, Jimenez R, Gomez Á, Martin A, Trilla A. Quality standards for Comprehensive Care Units for patients with uveitis of the Spanish Society of Ocular Inflammation (SEIOC). Med Clin (Barc) 2020; 156:76-80. [PMID: 32444325 DOI: 10.1016/j.medcli.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Alfredo Adan
- Instituto Clínico de Oftalmología, Hospital Clínic, Barcelona, España
| | - Iona Ruiz
- Departamento de Medicina Interna, Hospital de Cruces, Bilbao, España
| | - Emma Beltran
- Departamento de Reumatología, Hospital del Mar, Barcelona, España
| | - Inés Yago
- Departamento de Oftalmología, Hospital Virgen de la Arrixaca, Murcia, España
| | - Rosa Jimenez
- Departamento de Oftalmología, Hospital Virgen de la Salud, Toledo, España
| | - Ángela Gomez
- Departamento de Oftalmología, Hospital de Araba, Vitoria, España
| | - Ana Martin
- Departamento de Enfermería, Hospital General, Valencia, España
| | - Antoni Trilla
- Departamento de Medicina Preventiva y Epidemiología, Hospital Clínic, Barcelona, España
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Fanlo P, Espinosa G, Adan A, Fonollosa A, Segura A. Multidisciplinary care and units for uveitis in the internal medicine departments in Spain: Survey of the Systemic Autoimmune Diseases Group. Rev Clin Esp 2020; 221:221-225. [PMID: 33998501 DOI: 10.1016/j.rceng.2019.11.007] [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: 07/19/2019] [Accepted: 11/02/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify the multidisciplinary uveitis units in which internal medicine departments participate in collaboration with ophthalmology departments in Spain. MATERIAL AND METHODS We conducted a multicentre, observational cross-sectional study that collected information using a structured survey sent by email to 1015 partners of the Systemic Autoimmune Diseases Workgroup of the Spanish Society of Internal Medicine (GEAS-SEMI) from the 1st to the 31st of March 2017. RESULTS We identified a total of 21 support units/consultations for the ophthalmology departments. Seventeen (81%) of the units were specific internal medicine-ophthalmology consultations, and 5 (24%) units had been created in the past 5 years. A median of 460 patients were assessed per unit by the end of the year. CONCLUSIONS This study shows, for the first time in Spain, the important and close collaboration between ophthalmologists and internists, especially in highly specialized national reference institutions.
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Affiliation(s)
- P Fanlo
- Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.
| | - G Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Spain
| | - A Adan
- Institut Clinic d'Oftalmologia, Hospital Clínic, Barcelona, Spain
| | - A Fonollosa
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - A Segura
- Servicio de Medicina Interna, Hospital Vall d'Hebron, Barcelona, Spain
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Abstract
AbstractAimThe aim of this study was to examine the reliability of the Spanish version of Composite Scale of Morningness (CSM) and its ability to measure the circadian typology.Subjects and methodsVoluntary and unpaid psychology students (N = 391; 132 men and 259 women), aged between 17 and 33, completed the questionnaire between the months of September and December.ResultsThe total score was independent of age and gender, with a close to normal distribution and a non-significant negative skewness. The internal consistency was high (Cronbach’s α = 0.87) and factor analysis extracted three factors labeled Time of Retiring (items 2 and 7), Activity Planning (items 8, 9, and 13) and Morning Affect (items 3–6, and 10–12). With the 10th and 90th percentiles as cut-off scores, scorers below 22 (N = 40; 10.2%) are classified as evening-types and scorers above 39 as morning-types (N = 28; 7.2%).ConclusionThe Spanish questionnaire shares most of the good psychometric properties of other versions of the CSM, and thus can be used for Spanish-speaking student samples. Nevertheless, further studies of normative data in workers and aged subjects are needed in order to validate CSM.
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Affiliation(s)
- A Adan
- Department of Psychiatry and Clinical Psychobiology, School of Psychology, University of Barcelona, Passeig Vall d'Hebrón 171, 08035 Barcelona, Spain.
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Tonetti L, Adan A, Caci H, De Pascalis V, Fabbri M, Natale V. Morningness-eveningness preference and sensation seeking. Eur Psychiatry 2020; 25:111-5. [DOI: 10.1016/j.eurpsy.2009.09.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/23/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022] Open
Abstract
AbstractThe aim of this study was to explore the relationship between circadian preference and sensation seeking. To this aim 1041 university students (408 males and 633 females), ranging in age between 18 and 30 years, filled the reduced version of the Morningness-Eveningness Questionnaire (MEQr) and the Sensation Seeking Scale-Form V (SSS-V). Males scored higher than females in SSS-V total score and all subscales, except experience seeking (ES). As regards circadian preference, evening types scored higher than morning types in SSS-V total score and all subscales, except boredom susceptibility (BS) where they significantly differed only from intermediate types. On the whole our results highlight a significant relationship between circadian preference and sensation seeking.
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Zarranz-Ventura J, Barraso M, Alé-Chilet A, Hernandez T, Oliva C, Gascón J, Sala-Puigdollers A, Figueras-Roca M, Vinagre I, Ortega E, Esmatjes E, Adan A. Evaluation of microvascular changes in the perifoveal vascular network using optical coherence tomography angiography (OCTA) in type I diabetes mellitus: a large scale prospective trial. BMC Med Imaging 2019; 19:91. [PMID: 31752726 PMCID: PMC6873669 DOI: 10.1186/s12880-019-0391-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/25/2019] [Indexed: 02/01/2023] Open
Abstract
Background Diabetic retinopathy (DR) is the leading cause of blindness in type 1 Diabetes Mellitus (DM) patients, as a consequence of impaired blood flow in the retina. Optical coherence tomography angiography (OCTA) is a newly developed, non-invasive, retinal imaging technique that permits adequate delineation of the perifoveal vascular network. It allows the detection of paramacular areas of capillary non perfusion and/or enlargement of the foveal avascular zone (FAZ), representing an excellent tool for assessment of DR. The relationship of these microvascular changes with systemic factors such as metabolic control or duration of the disease still needs to be elucidated. Methods Prospective, consecutive, large-scale OCTA study. A complete ocular examination including a comprehensive series of OCTA images of different scan sizes captured with 2 OCT devices (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA, and Triton Deep Range Imaging OCT, Topcon Corp, Topcon, Japan) will be obtained as part of the yearly routine follow up visits in type 1 DM patients seen in the Diabetes Unit of the Endocrinology department which give written informed consent to participate in the project. The aim of this study is to investigate the relationship between OCTA-derived parameters and systemic factors, as metabolic control (Hb1Ac, lipid profile, cholesterol, etc), and other relevant clinical factors as demographics or duration of the disease. Discussion This study is directed to investigate the relationship between the status of the perifoveal vascular network and systemic markers of the disease, and in particular to study whether these changes reflect those occurring elsewhere in the body affected by diabetic microvascular disease, as the kidneys or the brain. If these relationships were demonstrated, early detection of these microvascular changes by OCTA could lead to modifications in the pharmacological management of type 1 diabetic patients, as a way to reduce the risk of future complications in both the eye and other organs. Trial registration ClinicalTrials.gov, trial number NCT03422965.
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Affiliation(s)
- Javier Zarranz-Ventura
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain. .,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Marina Barraso
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Anibal Alé-Chilet
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Teresa Hernandez
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Cristian Oliva
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Jesus Gascón
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Emilio Ortega
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Enric Esmatjes
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Mesquida M, Drawnel F, Lait PJ, Copland DA, Stimpson ML, Llorenç V, Sainz de la Maza M, Adan A, Widmer G, Strassburger P, Fauser S, Dick AD, Lee RWJ, Molins B. Modelling Macular Edema: The Effect of IL-6 and IL-6R Blockade on Human Blood-Retinal Barrier Integrity In Vitro. Transl Vis Sci Technol 2019; 8:32. [PMID: 31667008 PMCID: PMC6819001 DOI: 10.1167/tvst.8.5.32] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 04/17/2018] [Accepted: 08/22/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose Macular edema (ME) is a leading cause of visual loss in a range of retinal diseases and despite the use of antivascular endothelial growth factor (anti-VEGF) agents, its successful treatment remains a major clinical challenge. Based on the indirect clinical evidence that interleukin-6 (IL-6) is a key additional candidate mediator of ME, we interrogated the effect of IL-6 on blood–retinal barrier (BRB) integrity in vitro. Methods Human retinal pigment epithelial cell (ARPE-19) and human retinal microvascular endothelial cell (HRMEC) monolayers were used to mimic the outer and inner BRB, respectively. Their paracellular permeability was assessed by measuring the passive permeation of 40 kDa fluorescein isothiocyanate (FITC)-dextran across confluent cells in the presence of IL-6. Transendothelial/epithelial electrical resistance (TEER) then was measured and the distribution of the tight junction protein ZO-1 was assessed by immunofluorescence using confocal microscopy. Results Treatment with IL-6 for 48 hours significantly increased the diffusion rate of FITC-dextran, decreased TEER, and disrupted the distribution of ZO-1 in ARPE-19 cells, which constitutively express the IL-6 transmembrane receptor, and this was reversed with IL-6R blockade. In contrast, IL-6 did not affect the paracellular permeability, TEER, or ZO-1 distribution in HRMECs. Conclusions These in vitro data support the hypothesis that IL-6 reversibly disrupts the integrity of ARPE-19 cells, but it does not affect HRMECs. Translational Relevance IL-6 is a candidate therapeutic target in the treatment of outer BRB driven ME.
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Affiliation(s)
- Marina Mesquida
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Hospital Clínic de Barcelona, Spain.,Roche Pharma Research and Early Development, Roche Innocation Centre Basel, Switzerland
| | - Faye Drawnel
- Roche Pharma Research and Early Development, Roche Innocation Centre Basel, Switzerland
| | - Philippa J Lait
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, UK
| | - David A Copland
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Madeleine L Stimpson
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Victor Llorenç
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Hospital Clínic de Barcelona, Spain
| | - Maite Sainz de la Maza
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Hospital Clínic de Barcelona, Spain
| | - Alfredo Adan
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Hospital Clínic de Barcelona, Spain
| | - Gabriella Widmer
- Roche Pharma Research and Early Development, Roche Innocation Centre Basel, Switzerland
| | - Pamela Strassburger
- Roche Pharma Research and Early Development, Roche Innocation Centre Basel, Switzerland
| | - Sascha Fauser
- Roche Pharma Research and Early Development, Roche Innocation Centre Basel, Switzerland
| | - Andrew D Dick
- Academic Unit of Ophthalmology, Translational Health Sciences, 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
| | - Richard W J Lee
- Academic Unit of Ophthalmology, Translational Health Sciences, 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
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Hospital Clínic de Barcelona, Spain
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Atienza-Mateo B, Martín-Varillas JL, Calvo-Río V, Demetrio-Pablo R, Beltrán E, Sánchez-Bursón J, Mesquida M, Adan A, Hernández MV, Hernández-Garfella M, Valls-Pascual E, Martínez-Costa L, Sellas-Fernández A, Cordero-Coma M, Díaz-Llopis M, Gallego R, García-Serrano JL, Ortego-Centeno N, Herreras JM, Fonollosa A, Garcia-Aparicio ÁM, Maíz-Alonso O, Blanco A, Torre-Salaberri I, Fernandez-Espartero C, Jovaní V, Peiteado D, Pato E, Cruz J, Férnandez-Cid C, Aurrecoechea E, García-Arias M, Castañeda S, Caracuel-Ruiz MA, Montilla-Morales CA, Atanes-Sandoval A, Francisco F, Insua S, González-Suárez S, Sanchez-Andrade A, Gamero F, Linares Ferrando LF, Romero-Bueno F, García-González AJ, González RA, Muro EM, Carrasco-Cubero C, Olive A, Prior Á, Vázquez J, Ruiz-Moreno O, Jiménez-Zorzo F, Manero J, Muñoz Fernandez S, Fernández-Carballido C, Rubio-Romero E, Pages FA, Toyos-Sáenz de Miera FJ, Martinez MG, Díaz-Valle D, López Longo FJ, Nolla JM, Álvarez ER, Martínez MR, González-López JJ, Rodríguez-Cundin P, Hernández JL, González-Gay MA, Blanco R. Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behçet's Disease: National Multicenter Study of 177 Cases. Arthritis Rheumatol 2019; 71:2081-2089. [PMID: 31237427 DOI: 10.1002/art.41026] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first-line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behçet's disease (BD). METHODS We conducted an open-label multicenter study of IFX versus ADA for BD-related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first-line biologic agent based on physician and patient agreement. Patients received 3-5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4-8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups. RESULTS The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best-corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042). CONCLUSION Although both IFX and ADA are efficacious in refractory BD-related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Blanco
- Hospital Universitario de Donostia, San Sebastián, Spain
| | | | | | - Vega Jovaní
- Hospital General de Alicante, Alicante, Spain
| | | | | | - Juan Cruz
- Hospital de Pontevedra, Pontevedra, Spain
| | | | | | | | - Santos Castañeda
- Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
| | | | | | | | | | - Santos Insua
- Hospital Universitario Santiago de Compostela, A Coruña, Spain
| | | | | | | | | | - F Romero-Bueno
- Jiménez Díaz Foundation University Hospital, Madrid, Spain
| | | | | | | | | | | | - Águeda Prior
- Germans Trias i Pujol Hospital, Barcelona, Spain
| | | | | | | | - Javier Manero
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | | | | | | | | | | | - Joan M Nolla
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | | | | | | | | | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Fanlo P, Heras H, Espinosa G, Adan A. Complications and visual acuity of patients with uveitis: Epidemiological study in a reference unit in northern Spain. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:419-425. [PMID: 31277806 DOI: 10.1016/j.oftal.2019.05.005] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/20/2019] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe uveitis complications and visual acuity in a cohort of 500 patients in a multidisciplinary unit in northern Spain. MATERIAL AND METHODS Retrospective-prospective study of complications and visual acuity of 500 adult patients evaluated in the Multidisciplinary Unit of the Navarra Hospital Complex from the period January 2010 until March 2015. An analysis was made of the complications, visual acuity and visual loss, with a follow-up of one-year. A comparative study was also made of the complications with 2 previous series published in Madrid and Holland. RESULTS Moderate-severe visual loss was 13.5% in the right eye, and 13% in the left eye. Visual loss was associated with an age of 65 years or above. Complications were observed in 35% of patients, and cataract was the most frequent complication (10%), followed by synechiae (8%), and macular oedema (5%). Compared with the 2 other series, the present cohort showed a higher proportion of cataracts. CONCLUSIONS Visual loss was associated with older age and cataract was the most common complication in our study.
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Affiliation(s)
- P Fanlo
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra-B, Pamplona, Navarra, España.
| | - H Heras
- Servicio de Oftalmología, Complejo Hospitalario de Navarra-B, Pamplona, Navarra, España
| | - G Espinosa
- Servicio de Enfermedades Autoinmunes Sistémicas, Institut Clínic de Medicina Dermatologia, Hospital Clínic, Barcelona, Cataluña, España
| | - A Adan
- Institut Clínic d'Oftalmologia, Hospital Clínic, Barcelona, Cataluña, España
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Alba-Linero C, Sala-Puigdollers A, Romero B, Llorenç V, Adan A, Zarranz-Ventura J. Long-Term Intravitreal Dexamethasone Implant Outcomes in Uveitis. Ocul Immunol Inflamm 2019; 28:228-237. [PMID: 30994370 DOI: 10.1080/09273948.2019.1578380] [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: 12/21/2022]
Abstract
Purpose: To describe the long-term clinical outcomes in a cohort of uveitic eyes treated with the intravitreal dexamethasone implant (Ozurdex; Allergan, Inc).Methods: Seventy-nine (63 patients) receiving 134 implant injections over 82 months were included. Indication, visual acuity (VA), intraocular pressure (IOP), vitreous haze score (VHS), central retinal thickness (CRT), time to reinjection, systemic treatments, and complications data were recorded.Results: The cumulative probability of VA improvement was 80% at 1 month and 90% at 12 months, and it was maintained until 60 months. Eyes with baseline vitritis (VHS >0.5; 68%) had a probability of VHS improvement of 33% at 1 month, 75% at 12 months, and 85% at 60 months. The probability of CRT improvement was 33% at 1 month, 75% at 12 months, and 85% at 60 months. The most frequent adverse event was moderate IOP elevation (≥25 mmHg) in 30.3%, no cases of retinal detachment or endophthalmitis were observed.Conclusions: The dexamethasone implant provides favorable VA, CRT, and VHS long-term outcomes in uveitis with a reduced rate of severe adverse events.
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Affiliation(s)
| | - Anna Sala-Puigdollers
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Victor Llorenç
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adan
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Javier Zarranz-Ventura
- Hospital Clinic, Institut Clínicd´Oftalmología (ICOF), Barcelona, Spain.,Institut d´Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Matas J, Llorenç V, Fonollosa A, Esquinas C, Diaz-Valle D, Berasategui B, Mesquida M, Artaraz J, Rios J, Adan A. Predictors for functional and anatomic outcomes in macular edema secondary to non-infectious uveitis. PLoS One 2019; 14:e0210799. [PMID: 30677041 PMCID: PMC6345485 DOI: 10.1371/journal.pone.0210799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/02/2019] [Indexed: 11/18/2022] Open
Abstract
Aims We aimed to investigate predictive factors for visual and anatomic outcomes in patients with macular edema secondary to non-infectious uveitis. Material and methods We conducted a multicenter, prospective, observational, 12-month follow-up study. Participants included in the study were adults with non-infectious uveitic macular edema (UME), defined as central subfoveal thickness (CST) of >300 μm as measured by spectral domain optical coherence tomography (SD-OCT) and fluid in the macula. Demographic, clinical and tomographic data was recorded at baseline, 1, 3, 6 and 12 months. Foveal-centered SD-OCT exploration was set as the gold-standard determination of UME using a standard Macular Cube 512x128 A-scan, within a 6 x 6 mm2 area, and the Enhanced High Definition Single-Line Raster. To assess favorable prognosis, the main outcomes analyzed were the best-corrected visual acuity (BCVA) and the CST. Favorable prognosis was defined as sustained improvement of BCVA (2 lines of gain of the Snellen scale) and CST (decrease of 20% of the initial value or <300 μm) within a 12 month period. Results Fifty-six eyes were analyzed. The number of eyes with sustained improvement in the CST was 48 (86.2%), against 23 (41.1%) eyes with sustained improvement in BCVA. Favorable prognosis, as defined above, was observed in 18 (32.1%) eyes. UME prognosis was negatively correlated with baseline foveal thickening, alteration in the vitreo-macular interface and cystoid macular edema. In contrast, bilaterally, systemic disease and the presence of anterior chamber cells were predictive of favorable prognosis. Conclusion Available treatment modalities in UME may avoid chronic UME and improve anatomic outcome. However, the proportion of functional amelioration observed during 12 months of follow-up is lower. Thicker CST, alteration in the vitreo-macular interface and cystoid macular edema may denote less favorable prognosis. Conversely, bilaterally, systemic disease and anterior chamber cells may be associated with favorable prognosis in UME.
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Affiliation(s)
- Jessica Matas
- Clinic Institute of Ophthalmology (ICOF), Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Victor Llorenç
- Clinic Institute of Ophthalmology (ICOF), Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Health Research Institute, Hospital Cruces, University of the Basque Country, Baracaldo, Spain
| | - Cristina Esquinas
- Valle Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - David Diaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clinic of San Carlos, Madrid, Spain
| | - Barbara Berasategui
- Department of Ophthalmology, BioCruces Health Research Institute, Hospital Cruces, University of the Basque Country, Baracaldo, Spain
| | - Marina Mesquida
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Health Research Institute, Hospital Cruces, University of the Basque Country, Baracaldo, Spain
| | - Jose Rios
- Medical Statistics Core Facility, IDIBAPS, Barcelona, Spain
| | - Alfredo Adan
- Clinic Institute of Ophthalmology (ICOF), Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Zarranz-Ventura J, Sala-Puigdollers A, Velazquez-Villoria D, Figueras-Roca M, Copete S, Distefano L, Boixadera A, García-Arumi J, Adan A. Long-term probability of intraocular pressure elevation with the intravitreal dexamethasone implant in the real-world. PLoS One 2019; 14:e0209997. [PMID: 30608950 PMCID: PMC6319768 DOI: 10.1371/journal.pone.0209997] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/15/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the long-term cumulative probability of intraocular pressure (IOP) elevation with the intravitreal dexamethasone implant (IDI) when used to treat different indications: diabetic macular edema, uveitis, retinal vein occlusion. METHODS 705 IDI injections (429 eyes) were assessed and Kaplan-Meier graphs were generated to assess: the probability of different levels of IOP elevation (IOP≥21, ≥25 or ≥35 mmHg), IOP change ≥10 mmHg, initiation of IOP-lowering treatment, glaucoma surgery, IOP change with repeat injections and IOP elevation in eyes with glaucoma and ocular hypertension (OHT). RESULTS The cumulative probability of IOP ≥21, ≥25 and ≥35 mmHg was 50%-60%, 25%-30% and 6%-7% at 12-24 months, respectively. The probability of initiating IOP-lowering medication was 31%-54% at 12-24 months. Glaucoma and OHT eyes had a higher probability of mild IOP elevation (≥21 mmHg, 65.1%, 75% and 57.8%, p = 0.01), yet a similar moderate (≥25 mmHg, 22.3%, 28% and 30.2%, p = 0.91) and severe elevation of IOP (≥35 mmHg, 3.7%, 7.1% and 4%, p = 0.71) as normal eyes. Glaucoma surgery was required in only 0.9% cases (4/429). At baseline, 8.8% of the treated eyes had glaucoma, 6.7% OHT and 16.9% were already on IOP-lowering medication. CONCLUSIONS In the long-term (24 months), IOP elevation is common, generally mild (30% IOP, ≥25 mmHg) and well-tolerated, resolving with topical treatment (54%) and rarely requiring surgery (0.9%).
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Affiliation(s)
| | | | | | - Marc Figueras-Roca
- Institut Clínic d´Oftalmología (ICOF), Hospital Clinic, Barcelona, Spain
| | - Sergio Copete
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Laura Distefano
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Anna Boixadera
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Jose García-Arumi
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d´Oftalmología (ICOF), Hospital Clinic, Barcelona, Spain
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Mesquida M, Llorenc V, Adan A. Réplica. Med Clin (Barc) 2018. [DOI: 10.1016/j.medcli.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fernandez-Robredo P, Recalde S, Hernandez M, Zarranz-Ventura J, Molins B, Casaroli-Marano RP, Adan A, Saenz-de-Viteri M, García-Layana A. Novel Association of High C-Reactive Protein Levels and A69S at Risk Alleles in Wet Age-Related Macular Degeneration Women. Front Immunol 2018; 9:1862. [PMID: 30154790 PMCID: PMC6102554 DOI: 10.3389/fimmu.2018.01862] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/27/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose To explore the relationship between plasma C-reactive protein (CRP) levels, the main ARMS2 gene single nucleotide polymorphism (SNP), and gender in patients with neovascular age-related macular degeneration (wet AMD). Methods Our study included 131 patients with wetAMD [age-related eye disease study (AREDS) category 4] and 153 control participants (AREDS category 1) from two Spanish retinal units. CRP levels were determined on blood samples by high-sensitivity ELISA assay. According to their CRP level, subjects were categorized into three well-established CRP categories: low (<1.00 mg/L, L-CRP), moderate (1–2.99 mg/L, M-CRP), and high (>3.00 mg/L, H-CRP). Genomic DNA was extracted from oral swabs using QIAcube (Qiagen, Hilden, Germany) and the A69S; rs10490924 of ARMS2 gene was genotyped by allelic discrimination with validated TaqMan assays (Applied Biosystems, Foster City, CA, USA). Univariate and multivariate logistic regression adjusted for age was used to analyze the genomic frequencies and to calculate odds ratio (OR) using SNPStats software. Results Considering CRP risk categories, H-CRP group showed a significant [OR 4.0 (1.9–8.3)] association with wetAMD compared to L-CRP group. The risk genotypes of A69S (TT) SNPs showed an association with wetAMD risk [OR 14.0 (4.8–40.8)]. Interestingly, the gender stratification of the CRP categories showed a significant increase in CRP levels in wetAMD women compared with control women [OR 6.9 (2.2–22.3)] and with wetAMD men [OR 4.6 (1.3–16.9)]. In addition, the subgroup analysis of CRP within A69S genotype and gender showed a link in women between the A69S and CRP levels in the AMD group compared to controls [OR 4.2 (1.4–12.6)]. Conclusion Our study shows, for the first time, that a different genetic association related with gender could contribute to AMD risk. As a consequence, the risk of female gender in the different CRP levels and A69S SNP frequencies could be taken into consideration to the established risk relationship of high levels of CRP and its association with risk A69S genotype.
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Affiliation(s)
- Patricia Fernandez-Robredo
- Experimental Ophthalmology Laboratory, Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Sergio Recalde
- Experimental Ophthalmology Laboratory, Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Maria Hernandez
- Experimental Ophthalmology Laboratory, Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Javier Zarranz-Ventura
- Hospital Clínic, Institut Clínic d'Oftalmologia (ICOF), Barcelona, Spain.,Fundació Clínic per a la Recerca Biomèdica, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Blanca Molins
- Hospital Clínic, Institut Clínic d'Oftalmologia (ICOF), Barcelona, Spain
| | | | - Alfredo Adan
- Hospital Clínic, Institut Clínic d'Oftalmologia (ICOF), Barcelona, Spain.,Fundació Clínic per a la Recerca Biomèdica, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manuel Saenz-de-Viteri
- Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.,Royal Eye Infirmary, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Alfredo García-Layana
- Experimental Ophthalmology Laboratory, Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
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Miserocchi E, Iuliano L, Fogliato G, Modorati G, Couto C, Schlaen A, Hurtado E, Llorenç V, Adan A, Bandello F. Bilateral Acute Retinal Necrosis: Clinical Features and Outcomes in a Multicenter Study. Ocul Immunol Inflamm 2018; 27:1090-1098. [PMID: 30059636 DOI: 10.1080/09273948.2018.1501494] [Citation(s) in RCA: 12] [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: 10/28/2022]
Abstract
Purpose: To describe clinical features and outcome in bilateral acute retinal necrosis (BARN). Methods: Observational retrospective longitudinal review of ocular findings. Results: Thirty eyes of 15 patients (age 44.1 ± 15.8). Delay of involvement between eyes was 57.2 ± 105.2 months (median 3, range 0.5-360). Herpes simplex virus (HSV)-1 was the most frequent (20 eyes, 66.6%), followed by HSV-2 (five eyes, 16.7%) and varicella zoster virus (VZV, four eyes, 13.3%). Visual acuity worsened in 7 (23%) eyes, improved in 4 (13%), and remained stable in 19 (63%). Major complications included retinal detachment (11 eyes, 36%), optic atrophy (11 eyes, 33%), proliferative vitreoretinopathy (four eyes, 13.3%), neovascular glaucoma (four eyes, 13.3%), phthisis bulbi (three eyes, 10%). Symptoms-to-referral average time was 2.7 ± 1.0 weeks (range 1-4). Conclusions: In our study BARN was associated with severe visual outcome and high rate of ocular complications. Although BARN is a rare disease, the course is aggressive, regardless prompt referral in tertiary-care uveitis centers.
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Affiliation(s)
- Elisabetta Miserocchi
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Lorenzo Iuliano
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Giulio Modorati
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Cristobal Couto
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Ariel Schlaen
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Erika Hurtado
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Victor Llorenç
- Clínic Institute of Ophthalmology, Clínic Hospital, Universitat de Barcelona , Barcelona , Spain
| | - Alfredo Adan
- Clínic Institute of Ophthalmology, Clínic Hospital, Universitat de Barcelona , Barcelona , Spain
| | - Francesco Bandello
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
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Ahrne M, Adan A, Schytt E, Andersson E, Small R, Flacking R, Byrskog U. 7.3-O6Antenatal care for Somali born women in Sweden – perspectives from mothers, fathers and midwives. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.252] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Ahrne
- Karolinska Institutet, Stockholm, Sweden
| | - A Adan
- Dalarna University, School of Education, Health and Social Studies, Sweden
| | - E Schytt
- Center for Clinical Research Dalarna/Uppsala University, Sweden
| | | | - R Small
- Judith Lumley Centre (formerly Mother and Child Health Research) La Trobe University, Melbourne, Australia
| | - R Flacking
- Dalarna University, School of Education, Health and Social Studies, Sweden
| | - U Byrskog
- Dalarna University, School of Education, Health and Social Studies, Sweden
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Molins B, Romero-Vázquez S, Fuentes-Prior P, Adan A, Dick AD. C-Reactive Protein as a Therapeutic Target in Age-Related Macular Degeneration. Front Immunol 2018; 9:808. [PMID: 29725335 PMCID: PMC5916960 DOI: 10.3389/fimmu.2018.00808] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/15/2017] [Accepted: 04/03/2018] [Indexed: 01/26/2023] Open
Abstract
Age-related macular degeneration (AMD), a retinal degenerative disease, is the leading cause of central vision loss among the elderly population in developed countries and an increasing global burden. The major risk is aging, compounded by other environmental factors and association with genetic variants for risk of progression. Although the etiology of AMD is not yet clearly understood, several pathogenic pathways have been proposed, including dysfunction of the retinal pigment epithelium, inflammation, and oxidative stress. The identification of AMD susceptibility genes encoding complement factors and the presence of complement and other inflammatory mediators in drusen, the hallmark deposits of AMD, support the concept that local inflammation and immune-mediated processes play a key role in AMD pathogenesis that may be accelerated through systemic immune activation. In this regard, increased levels of circulating C-reactive protein (CRP) have been associated with higher risk of AMD. Besides being a risk marker for AMD, CRP may also play a role in the progression of the disease as it has been identified in drusen, and we have recently found that its monomeric form (mCRP) induces blood retinal barrier disruption in vitro. In this review, we will address recent evidence that links CRP and AMD pathogenesis, which may open new therapeutic opportunities to prevent the progression of AMD.
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Affiliation(s)
- Blanca Molins
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sara Romero-Vázquez
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pablo Fuentes-Prior
- Molecular Bases of Disease, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alfredo Adan
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Andrew D Dick
- Academic Unit of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.,Academic Unit of Ophthalmology, School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, University College London Institute of Ophthalmology, London, United Kingdom
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Adan A, Gibbons R, Patterson J, Goett H, Dai T, Costantino T. 115 Human Cadaver vs Simulator Nerve Model for Ultrasound-Guided Regional Anesthesia Resident Education. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Papa R, Consolaro A, Minoia F, Caorsi R, Magnano G, Gattorno M, Ravelli A, Picco P, Pillon R, Marafon DP, Meli L, Bracaglia C, Taddio A, De Benedetti F, Turan E, Kilic SS, Itoh Y, Shigemori T, Yamanishi S, Nagasaki H, Tarakci E, Arman N, Tarakci D, Akgul YS, Kasapcopur O, Wilson E, Lythgoe H, Smith E, Preston J, Beresford MW, Spiegel LR, Stinson J, Connelly M, Huber A, Luca N, Tsimicalis A, Luca S, Tajuddin N, Berard R, Barsalou J, Campillo S, Feldman B, Tse S, Dancey P, Duffy C, Johnson N, McGrath P, Shiff N, Tucker L, Victor C, Spiegel LR, Lalloo C, Harris L, Cafazzo J, Tucker L, Houghton K, Feldman B, Luca N, Laxer R, Stinson J, Arman N, Tarakci E, Kasapcopur O, Rooney M, Campbell R, Wright C, Armbrust W, Lelieveld O, Tuinstra J, Wulffraat N, Bos J, Cappon J, van Rossum M, Hagedoorn M, Vermé A, Lampela Y, Ozdogan AH, Ugurlu S, Barut K, Androvic A, Kasapçopu O, Wilson E, Etheridge J, Smith E, Dobson K, Kemp S, Beresford MW, Horne A, Palmblad K, Höglund M, Stepanenko N, Salugina S, Fedorov E, Nikishina I, Kaleda M, Arman N, Tarakci E, Barut K, Adrovic A, Sahin S, Kasapcopur O, Arman N, Tarakci E, Kasapcopur O, Toumoulin L, Frossard J, Archimbaut S, Paitier A, Guastalli R, Czitrom SG, Charuvanij S, Chaiyadech C, Miyamae T, Yamanaka H, Picard C, Thouvenin G, Kannengiesser C, Dubus JC, Jeremiah N, Rieux-Laucat F, Crestani B, Secq V, Ménard C, Reynaud-Gaubert M, Thivolet-Bejui F, Reix P, Belot A, Batu ED, Sonmez HE, Erden A, Taskiran EZ, Karadag O, Kalyoncu U, Oncel İ, Kaplan B, Arici ZS, Temucin CM, Topaloglu H, Bilginer Y, Alikasifoglu M, Ozen S, Van Eyck L, De Langhe E, Jéru I, Van Nieuwenhove E, Lagou V, Baker PJ, Garcia-Perez J, Dooley J, De Somer L, Sciot R, Jeandel PY, Ruuth-Praz J, Copin B, Medley-Hashim M, Megarbane A, Savic S, Goris A, Amselem S, Liston A, Masters S, Wouters C, Okamoto N, Sugita Y, Shabana K, Murata T, Tamai H, Ferenczová J, Banóova E, Mrážik P, Vargova V, Bajramovic D, Novacki KS, Potocki K, Frkovic M, Jelusic M, Nikishina I, Kostareva O, Arsenyeva S, Kaleda M, Shapovalenko A, Jans L, Herregods N, Jaremko J, Joos R, Dehoorne J, Herregods N, Jaremko J, Baraliakos X, Dehoorne J, Joos R, Jans L, Ramiro S, Casasola-Vargas JC, van der Heijde D, Landewé R, Burgos-Vargas R, Burgos-Vargas R, Tse SM, Horneff G, Unnebrink K, Anderson JK, Kisaarslan AP, Sözeri B, Gündüz Z, Zararsız G, Poyrazoğlu H, Düşünsel R, Ouchi K, Akioka S, Kubo H, Nakagawa N, Hosoi H, Lamot L, Borovecki F, Kapitanovic S, Gotovac K, Vidovic M, Lamot M, Bosak EP, Harjacek M, Russo RA, Katsicas MM, Vargas RB, Ortiz-Peyegahud AL, Pingping Z, Yikun M, Jun Q, Yutong J, Jieruo G, Kostik MM, Ekaterina S, Avrusin I, Korin Y, Kopchak O, Isupova E, Chikova I, Tatyana P, Dubko M, Masalova V, Snegireva L, Kornishina T, Kalashnikova O, Chasnyk V, Kostik MM, Chikova I, Isupova E, Dubko M, Masalova V, Snegireva L, Kornishina T, Likhacheva T, Kalashnikova O, Chasnyk V, Ruperto N, Brunner HI, Quartier P, Constantin T, Alexeeva E, Schneider R, Kone-Paut I, Schikler K, Marzan K, Wulffraat N, Padeh S, Chasnyk V, Wouters C, Kuemmerle-Deschner JB, Kallinich T, Lauwerys B, Haddad E, Nasonov E, Trachana M, Vougiouka O, Leon K, Speziale A, Lheritier K, Vritzali E, Martini A, Lovell D, Ter Haar N, Scholman R, de Jager W, Tak T, Leliefeld P, Vastert B, de Roock S, Ter Haar N, Scholman R, de Jager W, de Ganck A, Ryter N, Lavric M, Foell D, de Roock S, Vastert B, Modica RF, Lomax KG, Batzel P, Cassanas A, Elder ME, Denisova R, Alexeeva E, Valieva S, Bzarova T, Isayeva K, Sleptsova T, Lomakina O, Chomahidze A, Soloshenko M, Shingarova M, Kachshenko E, De Jager W, Vastert SJ, Mijnheer G, Prakken BJ, Wulffraat NM, Sönmez HE, Karhan AN, Batu ED, Bilginer Y, Arıcı ZS, Gümüş E, Demir H, Yüce A, Özen S, Ahluwalia J, Bharti B, Rajpal S, Uppal V, Walia A, Samlok SS, Kumar N, Valões CC, Molinari BC, Pitta ACG, Gormezano NW, Farhat SC, Kozu K, Sallum AM, Appenzeller S, Sakamoto AP, Terreri MT, Pereira RM, Magalhães CS, Barbosa CM, Gomes FH, Bonfá E, Silva CA, Ozturk K, Ekinci Z, Helal M, Cabrera N, Belot A, Lega JC, Drai J, Ecochard R, Shpitonkova OV, Podchernyaeva NS, Kostina YO, Dashkova NG, Osminina MK, Yucel G, Sahin S, Adrovic A, Barut K, Tarakci E, Arvas A, Moorthy N, Kasapcopur O, Dimou P, Midgley A, Peak M, Satchell SC, Wright RD, Beresford MW, Corkhill R, Smith EM, Beresford MW, Bhattad S, Rawat A, Singh S, Gupta A, Suri D, de Boer M, Kuijpers T, Bhattad S, Rawat A, Gupta A, Suri D, Pandiarajan V, Singh S, Sandal S, Rawat A, Gupta A, Singh S, Giraldo S, Sanguino R, Diaz AS, Uzuner S, Sahin S, Durcan G, Adrovic A, Barut K, Kilicoglu AG, Bilgic A, Bahali K, Kasapcopur O, Sahin S, Adrovic A, Barut K, Durmus S, Uzun H, Kasapcopur O, Sahin S, Adrovic A, Barut K, Canpolat N, Caliskan S, Sever L, Kasapcopur O, Sato T, Kimura F, Suwairi W, Abdwani R, Al Rowais A, Al qanatish J, Al Asiri A, Ozturk K, Ekinci Z, Gaidar E, Kostik M, Dubko M, Masalova V, Serogodskaya E, Snegireva L, Nikitina T, Chasnyk V, Kalashnikova O, Isupova E, Sardar E, Dusser P, Rousseau A, Labetoulle M, Barreau E, Bodaghi B, Kone-Paut I, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Angarita JMM, Bou R, de Vicuña CG, Hernandez MV, Adan A, Llorens V, Alcobendas R, Noval S, Robledillo JCL, Valls I, Pinedo MC, Fonollosa A, de Inocencio J, Tejada P, Bravo B, Torribio M, de Yebenes MJG, Antón J, Argolini LM, Pontikaki I, Borghi MO, Cesana L, Miserocchi E, Castiglioni B, Gattinara M, Meroni P, Quartier P, Despert V, Poignant S, Baptiste A, Elie C, Kone-Paut I, Belot A, Kodjikian L, Monnet D, Weber M, Bodaghi B, Moal L, Rousseau A, Pham L, Barreau E, Titah C, Dureau P, Labetoulle M, Bodaghi B, Czitrom SG, Cecchin V, Zannin ME, Ferrari D, Comacchio F, Pontikaki I, Bracaglia C, Cimaz R, Falcini F, Petaccia A, Viola S, Breda L, La Torre F, Vittadello F, Martini G, Zulian F, Galeotti C, Sarrabay G, Fogel O, Touitou I, Bodaghi B, Miceli-Richard C, Koné-Paut I, Etayari H, Soad H, El Kadry I, Eatamadi H, AlAlgawi K, Al Maini M, Khawaja K, Van den Berghe S, de Schryver I, Raes A, Joos R, Dehoorne J, Teixeira LLC, Duarte A, Sousa S, Vinagre F, Santos MJ, Shevchenko NS, Bogmat LF, Demyanenko MV, Ramchurn NR, Friswell M, James RA, Wedderburn LR, Edelsten C, Pattani R, Pilkington CA, Compeyrot-Lacassagne S, James RA, Compeyrot-Lacassagne S, Edelsten C, Pattani R, Pilkington CA, Wedderburn LR, Villarreal AV, Acevedo N, Faugier E, Maldonado R, Yılmaz D, Uysal HB, Fedorov E, Salugina S, Kamenets E, Zaharova E, Radenska-Lopovok S, Nascimento J, Sofia H, Zilhão C, Almeida R, Guedes M, Ozturk K, Deveci M, Ekinci Z, Rodionovskaya S, Vinnikova V, Salugina S, Fedorov E, Tsymbal I, Olesińska E, Postępski J, Mroczkowska-Juchkiewicz A, Pawłowska-Kamieniak A, Chrapko B, Ključevšek D, Emeršič N, Toplak N, Avčin T, Rokhlina F, Glazyrina G, Kolyadina N, Kim K, Eom S, Kim D, Rhim J, Ricci F, Montesano P, Bonafini B, Medeghini V, Parissenti I, Meini A, Cattalini M, Airò P, Panko N, Shevchenko N, Lebec I, Zajceva Y, Rostlund S, André M, Hara T, Kishi T, Tani Y, Hanaya A, Miyamae T, Nagata S, Yamanaka H, Selmanovic V, Omercahic-Dizdarevic A, Cengic A, Cosickic A, Dizdarević AO, Lepri G, Picco P, Malattia C, Bellucci E, Matucci-Cerinic M, Falcini F, Dubko M, Solovyev A, Fedotova E, Maldonado R, Faugier E, Villarreal AV, Acevedo N, Diaz T, Ramirez Y, Giani T, Marino A, Simonini G, Cimaz R, Hunt D, Al Obaidi M, Veli V, Papadopoulou C, Kammermeier J, Olesińska E, Poluha A, Postępski J, Bharmappanavara GC, Kelly A, Shaw L, Giani T, Ferrara G, Luzzati M, Marino A, Giovannini M, Simonini G, Cimaz R, Jurado L, Giraldo S, Chamorro J, Sarmiento L, Diaz AS, Medeghini V, Ricci F, Montesano P, Bonafini B, Parissenti I, Meini A, Conversano E, Cattalini M, Gicchino MF, Macchini G, Granato C, Tirelli A, Olivieri AN, Perica M, Bukovac LT, Bogmat LF, Shevchenko NS, Demyanenko MV, Sinaei R, Parvaneh VJ, Shiari R, Rahmani K, Mehregan FF, Yeganeh MH, Penadés IC, Montesinos BL, Fernández MIG, Vidal AR, Rao AP, Romana A, Raghuram J, Kumar A, Suri D, Gupta V, Rawat A, Singh S, Comak E, Aksoy GK, Yılmaz A, Atalay A, Koyun M, Artan R, Akman S, Gicchino MF, Macchini G, Granato C, Olivieri AN, Kaleda MI, Nikishina IP, Soloviev SK, Malievsky VA, Nikolaeva EV, Giani T, Marino A, Simonini G, Cimaz R, Gazda A, Kołodziejczyk B, Rutkowska-Sak L, Mauro A, Giani T, Simonini G, Cimaz R, Gicchino MF, Marzuillo P, Guarino S, Olivieri AN, La Manna A. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part three. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461520 DOI: 10.1186/s12969-017-0143-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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Fanlo P, Heras H, Pérez D, Tiberio G, Espinosa G, Adan A. Profile of patients with uveitis referred to a multidisciplinary unit in northern Spain. ACTA ACUST UNITED AC 2016; 92:202-209. [PMID: 27956325 DOI: 10.1016/j.oftal.2016.10.023] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/18/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the main characteristics of a cohort of patients with uveitis referred to a multidisciplinary unit in northern Spain. MATERIAL AND METHODS Retrospective analysis of clinical records of patients evaluated in the Multidisciplinary Unit of the Navarra Hospital Complex from the period January 2010 until March 2015. An analysis was performed on the demographic characteristics, origin, types of uveitis, laterality, and aetiology. The present series was also compared with 2 previous series from Castilla y León and Barcelona. RESULTS A total of 500 patients were identified, with a mean age of 47.9±16.4 years, with 50% women. The most frequent type of uveitis was anterior uveitis (65.4%), followed by posterior uveitis (17.6%), panuveitis (15.2%), and intermediate uveitis (1.8%). The origin was unclassifiable in 31.2%, followed by non-infectious systemic disease in 29.2%. Ankylosing spondylitis was the most frequent cause in 10.8% of patients, followed by herpes infection in 9.2%, and toxoplasmosis in 7.8%, respectively. Compared with the 2other cohorts, the present cohort showed a higher proportion of unilateral anterior uveitis. Furthermore, the patients from the Navarra series had a higher prevalence of unilateral and idiopathic uveitis compared to the series from Barcelona. CONCLUSIONS The main characteristics of the present cohort of patients with uveitis are similar to those of patients from other regions of our country. Unilateral anterior uveitis and idiopathic uveitis were the most frequent in our series.
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Affiliation(s)
- P Fanlo
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra-B, Pamplona, Navarra, España.
| | - H Heras
- Servicio de Oftalmología, Complejo Hospitalario de Navarra-B, Pamplona, Navarra, España
| | - D Pérez
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra-B, Pamplona, Navarra, España
| | - G Tiberio
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Navarra-B, Pamplona, Navarra, España
| | - G Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Cataluña, España
| | - A Adan
- Institut Clinic d́Oftalmologia, Hospital Clínic, Barcelona, Cataluña, España
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Sainz-de-la-Maza M, Molins B, Mesquida M, Llorenç V, Zarranz-Ventura J, Sala-Puigdollers A, Matas J, Adan A, Foster CS. Interleukin-22 serum levels are elevated in active scleritis. Acta Ophthalmol 2016; 94:e395-9. [PMID: 27009382 DOI: 10.1111/aos.13005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/07/2015] [Accepted: 01/07/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate serum cytokine profile from patients with active scleritis in a two-centre prospective case-control study. METHODS The serum of 20 active scleritis patients not treated with any local, periocular, or systemic immunomodulatory therapy (IMT) was analysed with multiplex assay to determine the levels of 11 cytokines interleukin (IL)-1β, IL-6, IL-2, IFN-γ, IL-10, IL-12p40, IL-13, IL-17A, IL-5, TNF-α, and TNF-β, and with ELISA to determine the levels of TGF-β1, IL-22, and IL-23. Twenty-five age-matched healthy volunteers were used as controls. In a subgroup of 13 patients with active disease, a second serum sample was obtained when the disease was inactive and levels of IL-22 were determined. Serum IL-22 levels from patients with active scleritis were correlated with type of scleritis (non-necrotizing and necrotizing), degree of inflammation (0-4+ :≤2+ and >2+), and associated systemic disease. RESULTS Serum levels of IL-22 were elevated in active scleritis patients compared to controls (6.41 ± 1.52 pg/ml versus 1.93 ± 0.39 pg/ml, p = 0.012) and significantly decreased after scleritis remission with the use of IMT (p = 0.005). There was no statistical association with scleritis type, degree of inflammation, or associated systemic disease. The serum levels of other cytokines were not significantly different from controls. CONCLUSION In our study cohort, IL-22 serum levels were significantly elevated in active scleritis patients compared to controls and decreased significantly after remission. Our results suggest that IL-22, a T helper (Th) 17- and Th22- derived cytokine, may play a critical role in the physiopathology of scleritis.
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Affiliation(s)
- Maite Sainz-de-la-Maza
- Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Molins
- The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marina Mesquida
- Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Victor Llorenç
- Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Javier Zarranz-Ventura
- Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Medical Retina and Uveitis Service, Moorfields Eye Hospital, London, UK
| | - Anna Sala-Puigdollers
- Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jessica Matas
- Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alfredo Adan
- Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, MA, USA
- Ocular Immunology and Uveitis Foundation (OIUF), Waltham, MA, USA
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Beltrán-Catalán E, Fernandez C, Blanco R, Calvo-Río V, Hernandez M, Mesquida M, Adan A, Hernandez V, Diaz D, Diaz G, Calvo I, Atanes A, Linares L, Modesto C, Gonzalez-Gay M. FRI0486 Tocilizumab Treatment for Uveitic Cystoid Macular Edema Refractory To Other Synthetic and Biological Immunosuppressive Drugs. Multicentre Study of 23 Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Beltrán-Catalán E, Calvo-Rio V, Blanco-Alonso R, Fernandez C, Rodriguez P, Hernandez M, Herreras J, Cordero M, Mesquida M, Adan A, Hernandez M, Diaz-Valle D, Torre I, Diaz M, Maiz O, Insua S, Francisco F, Almodovar R, Ruiz O, Jimenez F, Manero J, Gandia M, Nolla J, Gonzalez-Gay M. FRI0485 Comparative Study on Adalimumab vs Infliximab for Treatment of Uveitic Cystoid Macular Edema Due To Behcet's Disease. Multicentre Study of 34 Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zarranz-Ventura J, Keane PA, Sim DA, Llorens V, Tufail A, Sadda SR, Dick AD, Lee RW, Pavesio C, Denniston AK, Adan A, Adán A, Aslam T, Denniston AK, Dick AD, Karampelas M, Keane PA, Lee RW, Murray PI, Nussenblatt RB, Pavesio CE, Sadda SR, Sen HN, Sim DA, Tufail A, Zarranz-Ventura J. Evaluation of Objective Vitritis Grading Method Using Optical Coherence Tomography: Influence of Phakic Status and Previous Vitrectomy. Am J Ophthalmol 2016; 161:172-80.e1-4. [PMID: 26476212 DOI: 10.1016/j.ajo.2015.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate a proposed method for objective measurement of vitreous inflammation using a spectral-domain optical coherence tomography (SD OCT) device in a large cohort of uveitis eyes, including pseudophakic eyes and vitrectomized eyes. DESIGN Retrospective, observational cohort study. METHODS One hundred five uveitis eyes (105 patients) with different vitreous haze score grades according to standardized protocols and corresponding SD OCT images (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, California, USA) were included. Clinical data recorded included phakic status, previous vitreoretinal surgery, and anterior chamber (AC) cells and flare. SD OCT images were analyzed using custom software that provided absolute measurements of vitreous (VIT) and retinal pigment epithelium (RPE) signal intensities, which were compared to generate a relative optical density ratio with arbitrary units (VIT/RPE-relative intensity) and compared to VHS. RESULTS VIT/RPE-relative intensity showed a significant positive correlation with vitreous haze score (r = 0.535, P < .001) that remained significant after adjusting for factors governing media clarity, such as AC cells, AC flare, and phakic status (R(2)-adjusted = 0.424, P < .001). Significant differences were also observed between the different vitreous haze score groups (P < .001). Preliminary observation did not observe differences in VIT/RPE-relative intensity values between phakic and pseudophakic eyes (0.3522 vs 0.3577, P = .48) and between nonvitrectomized and vitrectomized eyes (0.3540 vs 0.3580, P = .52), overall and respectively for each vitreous haze score subgroup. CONCLUSIONS VIT/RPE-relative intensity values provide objective measurements of vitreous inflammation employing an SD OCT device. Phakic status and previous vitrectomy surgery do not appear to influence these values, although these preliminary findings need validation in future studies.
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Affiliation(s)
- Alex Fonollosa
- Department of Ophthalmology; BioCruces Health Research Institute; Cruces University Hospital; University of the Basque Country; Barakaldo Spain
| | - Marina Mesquida
- Institut Clínic d'Oftalmologia; Hospital Clinic de Barcelona; University of Barcelona; Barcelona Spain
| | - Alfredo Adan
- Institut Clínic d'Oftalmologia; Hospital Clinic de Barcelona; University of Barcelona; Barcelona Spain
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