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Zhou A, Fernández-Santos C, Dolinko A, Philip AM, Foster CS. Outcomes of IVIG monotherapy on non-paraneoplastic autoimmune retinopathy. Can J Ophthalmol 2024; 59:e101-e104. [PMID: 37683692 DOI: 10.1016/j.jcjo.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/16/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Avery Zhou
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Carla Fernández-Santos
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Andrew Dolinko
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Andrew M Philip
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA; Harvard Medical School, Boston, MA.
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Philip AM, Stephenson A, Al-Dabbagh A, Ramezani K, Fernandez-Santos CC, Foster CS. Ocular Cicatricial Pemphigoid With IgM-Positive Biopsy. Cornea 2023; 42:1503-1505. [PMID: 36728301 DOI: 10.1097/ico.0000000000003235] [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: 08/30/2022] [Accepted: 12/02/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to investigate the prevalence of IgM along the basement membrane zone (BMZ) of patients with ocular cicatricial pemphigoid (OCP) and the outcomes of these patients with immunomodulatory therapy. METHODS This study is a retrospective chart review of patients with conjunctival biopsy-proven OCP. Clinical data, including the presence of linear IgM deposition along the BMZ on either direct immunofluorescence or avidin-biotin complex immunohistochemistry, were recorded. Response to IMT was also recorded. RESULTS A total of 817 patients with documented conjunctival biopsies were identified, with 93 (11.4%) positive for OCP with linear IgM deposition along the BMZ. Forty-six patients with sufficient follow-up were evaluated for clinical outcomes, with 35 (76.1%) able to achieve durable remission an average of 24.3 months after initiation of IMT. Most of these patients, 82.9%, were able to achieve durable remission with first-line antimetabolite therapy. Three patients were identified with solely IgM-positive conjunctival biopsies. CONCLUSIONS Our study suggests that IgM positivity is seen in a minority of patients with OCP and that outcomes are comparable for these patients to the general OCP patient population.
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Affiliation(s)
- Andrew M Philip
- The Ocular Immunology and Uveitis Foundation, Waltham, MA
- Massachusetts Eye Research and Surgery Institution, Waltham, MA
| | - Andrew Stephenson
- University of Cincinnati College of Medicine, Department of Ophthalmology, Cincinnati, OH, USA; and
| | - Alaa Al-Dabbagh
- The Ocular Immunology and Uveitis Foundation, Waltham, MA
- Massachusetts Eye Research and Surgery Institution, Waltham, MA
| | - Koosha Ramezani
- The Ocular Immunology and Uveitis Foundation, Waltham, MA
- Massachusetts Eye Research and Surgery Institution, Waltham, MA
| | - Carla C Fernandez-Santos
- The Ocular Immunology and Uveitis Foundation, Waltham, MA
- Massachusetts Eye Research and Surgery Institution, Waltham, MA
| | - C Stephen Foster
- The Ocular Immunology and Uveitis Foundation, Waltham, MA
- Massachusetts Eye Research and Surgery Institution, Waltham, MA
- Harvard Medical School, Department of Ophthalmology, Boston, MA
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Philip AM, Anesi SD, Foster CS, Chang P. Ocular Inflammatory Complications of Treatment for Metastatic Melanoma. Ocul Immunol Inflamm 2023; 31:1669-1673. [PMID: 35914291 DOI: 10.1080/09273948.2022.2098147] [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: 10/08/2021] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To characterize various ocular inflammatory complications arising from metastatic cutaneous melanoma therapies and their management. METHODS Retrospective case series of patients who were referred to a tertiary uveitis practice for ophthalmic exam All patients received targeted metastatic cutaneous melanoma treatment, including BRAF/MEK inhibitors and various immunotherapies. RESULTS 109 patients were identified, with 43 (39.4%) having 65 definitive instances of OIAE. Sixteen different OIAE were identified. Ipilimumab monotherapy and ipilimumab/nivolumab combination therapy were most commonly associated. Anterior uveitis was the most common OIAE (18/65, 27.7%). Thirty patients (69.8%) were managed with observation or topical steroid therapy. Only 4 patients required further therapies for OIAE, with one patient not attaining resolution. CONCLUSIONS AND RELEVANCE While a broad range of OIAE was identified, most were not vision-threatening and did not require discontinuation of the associated therapy.
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Affiliation(s)
- Andrew M Philip
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
| | - Stephen D Anesi
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
| | - C Stephen Foster
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Chang
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
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Maleki A, Fernandez CC, Philip AM, Manhapra A, Chang PY, Foster CS. Acute macular neuroretinopathy in a patient with birdshot chorioretinopathy after intravitreal triamcinolone suspension injection. Eur J Ophthalmol 2023; 33:NP35-NP40. [PMID: 36062613 DOI: 10.1177/11206721221124653] [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: 11/16/2022]
Abstract
PURPOSE To report a case of acute macular neuroretinopathy (AMN) after intravitreal triamcinolone acetonide (TRIESENCE®) injection for cystoid macular edema secondary to birdshot chorioretinopathy. METHOD A case report. PATIENT A 62-year-old female. RESULTS The patient presented with acutely decreased vision and a ring scotoma around her central vision three days after intravitreal triamcinolone acetonide (TRIESENCE®) injection for cystoid macular edema in her right eye (OD) secondary to birdshot chorioretinopathy. She had undergone pars plana vitrectomy, cataract extraction, and secondary intraocular lens implantation OD three months prior to the recent injection. Best-corrected visual acuity (BCVA) was 20/1000 OD and 20/50 OS. Intraocular pressure was 21 mmHg OD and 12 mmHg OS. Fluorescein angiography demonstrated a hypofluorescent area in the perifoveal zone OD. Optical coherence tomography OD depicted hyperreflective areas in the outer nuclear layer, outer plexiform layer, and retinal pigment epithelium. We diagnosed her with AMN OD and started her on brimonidine three times a day OD. She came back a week later with resolved scotoma and her vision improved to 20/60 OD. Five weeks later, BCVA was 20/40 and Intraocular pressures (IOP) was 12 mmHg OD. CONCLUSIONS AND IMPORTANCE Intravitreal triamcinolone injection may be a cause of AMN with cystoid macular edema (CME) and borderline-high intraocular pressure. Brimonidine may be an effective treatment for these patients in the early course of the disease.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Carla C Fernandez
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Andrew M Philip
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Zhou Y, Zhou A, Philip AM, Margolis M, Babiker F, Chang PY, Anesi SD, Foster CS. Vision Outcomes of Long-Term Immunomodulatory and Steroid Therapy in Sympathetic Ophthalmia. Am J Ophthalmol 2023; 253:152-159. [PMID: 37150338 DOI: 10.1016/j.ajo.2023.05.004] [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: 01/25/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To compare vision acuity outcomes of long-term steroid therapy compared with immunomodulatory therapy for treatment of sympathetic ophthalmia. DESIGN Single-center, retrospective, comparative clinical study. METHODS Patients with sympathetic ophthalmia treated from March 2005 to October 2022 with at least 1 year of follow-up were included. Visual acuity outcomes were compared by steroid and immunomodulatory treatment modality. RESULTS Thirty-five patients with sympathetic ophthalmia were included in the study, with follow-up ranging from 1 to 17 years. Higher rates of vision loss correlated with longer periods of active uveitis and steroid treatment. Lower rates of vision loss correlated with longer periods of uveitis remission on immunomodulatory therapy alone and drug-free remission. Treatment with alkylating agents or combination therapy with an antimetabolite, a biologic-response modifier, and cyclosporine are more likely to result in sympathetic ophthalmia remission. CONCLUSION Immunomodulatory therapy leads to superior vision outcomes in cases of steroid-resistant or recurrent sympathetic ophthalmia. Steroid therapy may be useful for acute or recalcitrant sympathetic uveitis but is insufficient for long-term inflammatory control. PRéCIS: This manuscript describes a retrospective analysis of vision outcomes in patients with sympathetic ophthalmia. Results indicate that long-term immunomodulatory therapy is associated with better vision outcomes than long-term steroid therapy for sympathetic ophthalmia treatment.
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Affiliation(s)
- Yujia Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Avery Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Andrew M Philip
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Michael Margolis
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Fatima Babiker
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Peter Y Chang
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Stephen D Anesi
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - C Stephen Foster
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); Department of Ophthalmology, Harvard Medical School, Boston, MA, USA (C.S.F).
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Maleki A, Look-Why S, Manhapra A, Asgari S, Philip AM, Chang PY, Anesi SD, Foster CS. Late recurrence in birdshot chorioretinopathy. Can J Ophthalmol 2023; 58:77-81. [PMID: 34534507 DOI: 10.1016/j.jcjo.2021.08.006] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the demographic, clinical, ancillary testing, and multimodal imaging characteristics of birdshot chorioretinopathy (BSCR) patients with late recurrence and birdshot patients with durable remission. PATIENTS AND METHODS This was a retrospective observational case series. The above-mentioned parameters were studied in BSCR patients with late recurrence (group 1) and BSCR patients with durable remission (group 2). RESULTS Fifty-five patients were included in this study. The average age of patients was 62.1 ± 11.1 years (range, 35-88 years). Groups 1 and 2 included 20 (36.4%) and 35 (63.6%) patients, respectively. In group 1, the average age of patients was 60.5 ± 10.39 years (range, 35-79 years). The female-to-male ratio was 16:4. In group 2, the average age of patients was 63.1 ± 11.6 years (range, 37-88 years). The female-to-male ratio was 22:13. None of the demographic, clinical, ancillary testing, and multimodal imaging parameters were statistically significantly different between the two groups. Using a receiver operating characteristics (ROC) curve, we found that the ideal duration of successful therapy to induce durable remission was 30 months with 70% sensitivity and 40% specificity (ideal point on the curve). A Kaplan-Meier survival curve demonstrated that late recurrence was seen within 30 months after stopping successful treatment of patients with BSCR. CONCLUSION There are no demographic, clinical, ancillary testing, or multimodal imaging characteristics that can predict late recurrence in BSCR patients. However, we found that 30 months of successful treatment may be ideal and recommended.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Soheila Asgari
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Andrew M Philip
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA; Harvard Medical School, Boston, MA.
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Zhou A, Babiker F, Philip AM, Anesi SD, Foster CS. Response to "Similarities in clinical course and outcome between juvenile idiopathic arthritis (JIA)-associated and ANA-positive idiopathic anterior uveitis: data from a population-based nationwide study in Germany". Arthritis Res Ther 2023; 25:41. [PMID: 36918966 PMCID: PMC10012478 DOI: 10.1186/s13075-023-03021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
We have read the article entitled "Similarities in clinical course and outcome between juvenile idiopathic arthritis (JIA)-associated and ANA-positive idiopathic anterior uveitis: data from a population-based nationwide study in Germany" by Heiligenhaus et al. While we appreciate the work conducted by the authors, we have several comments we would like to address. First, the follow-up interval of 2 years is too short to conclude that the clinical course between two chronic pathologies is not significantly different. Second, remission status was determined by uveitis inactivity during the 2-year follow-up visit without any mention of flare frequency or length of remission, which is not a reliable measure of uveitis control. Third, ANA-positive idiopathic anterior uveitis is not a classification with a distinct clinical phenotype, and additional reports of serologic investigations would have been helpful.
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Affiliation(s)
- Avery Zhou
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
- Massachusetts Eye Research and Surgery Institution, 1440 Main St. Ste. 201, Waltham, MA, 02451, USA
| | - Fatima Babiker
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
- Massachusetts Eye Research and Surgery Institution, 1440 Main St. Ste. 201, Waltham, MA, 02451, USA
| | - Andrew M Philip
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
- Massachusetts Eye Research and Surgery Institution, 1440 Main St. Ste. 201, Waltham, MA, 02451, USA
| | - Stephen D Anesi
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
- Massachusetts Eye Research and Surgery Institution, 1440 Main St. Ste. 201, Waltham, MA, 02451, USA
| | - C Stephen Foster
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA.
- Massachusetts Eye Research and Surgery Institution, 1440 Main St. Ste. 201, Waltham, MA, 02451, USA.
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Abstract
PURPOSE We describe a retrospective cohort study investigating the prevalence of pentosan polysulfate sodium (PPS) maculopathy in patients with PPS exposure, as well as the relationship between cumulative PPS exposure and the presence of PPS-maculopathy. METHODS Patients were identified through review of the electronic medical record system. Available diagnostic imaging was reviewed for signs of PPS-maculopathy. Patients were also contacted to determine cumulative exposure. RESULTS Of the 335 identified eligible patient records, 84 had sufficient diagnostic imaging. Sixteen patients had definitive signs of PPS-maculopathy, 6 had likely signs of PPS-maculopathy, and 62 had no signs. The mean cumulative PPS exposure and standard error of the mean (SEM) for patients with any signs of PPS-maculopathy was 1946.0 g (396.0 g), significantly higher than the mean cumulative PPS exposure for patients without such signs of 782.3 g (105.3 g). No significant difference in BCVA was noted. The odds ratio (OR, 95% confidence interval (95% CI)) of PPS-maculopathy was significantly elevated in patients with cumulative PPS exposures of 1500-2000 g [OR 4.72 (0.856-26.02 95% CI)] and greater than 2000 g [OR 28.33 (2.388-336.1, 95% CI)]. Logistic regression analysis confirmed a positive dose response relationship. CONCLUSIONS We describe the concerning incidence of PPS-maculopathy in a multispecialty ophthalmology practice's patient population and investigate the dose-dependency of PPS-maculopathy. Patients with PPS-maculopathy were shown to have a higher average exposure to PPS than those without the maculopathy. Patients with cumulative PPS exposures greater than 1500 g were shown to have an increased risk of PPS-maculopathy.
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Affiliation(s)
- Andrew M Philip
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kendall W Wannamaker
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Eye Institute, Cincinnati, Ohio, USA
| | - Daniel M Miller
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Eye Institute, Cincinnati, Ohio, USA
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Zhou Y, Philip AM, Chikovsky MN, Nolan J, Anesi SD. Implantation of XEN gel stent in a patient with ocular cicatricial pemphigoid. Am J Ophthalmol Case Rep 2023; 29:101801. [PMID: 36793792 PMCID: PMC9923176 DOI: 10.1016/j.ajoc.2023.101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/23/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
Purpose Herein, we report a case of XEN gel stent implantation in a patient with ocular cicatricial pemphigoid that successfully reduced glaucoma topical medication at one year. Observations A 76-year-old male patient presented with severe ocular cicatricial pemphigoid and advanced glaucoma who required several topical medications to control intraocular pressure. Despite successful reduction of ocular inflammation with immunomodulatory therapy, his topical medication regimen prevented total remission of ocular inflammation. One year after XEN gel stent implantation, his intraocular pressures were controlled without any topical medication, and he had no ocular inflammation off any immunomodulatory therapy. Conclusions and Importance The XEN gel stent represents a useful intervention for glaucoma treatment even in the setting of severe ocular surface disease and can improve outcomes for concurrent inflammatory and glaucomatous pathology.
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Affiliation(s)
- Yujia Zhou
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA,Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - Andrew M. Philip
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA,Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - Max N. Chikovsky
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA,Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
| | - John Nolan
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Stephen D. Anesi
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA,Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA,Corresponding author. FACS Massachusetts Eye Research and Surgery Institution 1440 Main St. Ste. 201, Waltham, MA, 02451, USA.
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Philip AM, Fry MV, Hermanson ME, Kelly LD. Massive spontaneous subconjunctival hemorrhage in a patient on therapeutic warfarin: A case report. Am J Ophthalmol Case Rep 2021; 22:101049. [PMID: 33732947 PMCID: PMC7937659 DOI: 10.1016/j.ajoc.2021.101049] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/03/2021] [Accepted: 02/21/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe a case of massive spontaneous subconjunctival hemorrhage in a patient taking warfarin with a therapeutic international normalized ratio (INR). Observations Massive circumferential hemorrhagic chemosis, extensive periorbital and facial ecchymosis, and active arterial extravasation in the subconjunctiva which required cessation and reversal of anticoagulation. Findings gradually resolved over several months after discharge. Conclusions and importance While subconjunctival hemorrhage, even in anticoagulated patients, is usually benign, rare examples of severe presentations exist. We present, to our knowledge, the first documented case of a subconjunctival hemorrhage necessitating cessation and reversal of anticoagulation in the setting of a therapeutic INR.
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Affiliation(s)
- Andrew M Philip
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH, 45267, USA
| | - Matthew V Fry
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH, 45267, USA
| | - Meghan E Hermanson
- Department of Ophthalmology, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH, 45267, USA
| | - Lisa D Kelly
- Department of Ophthalmology, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH, 45267, USA
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