1
|
Shyriaiev H, Sar S, Tomkins-Netzer O. [CLINICAL MANIFESTATIONS OF AUTOIMMUNE DISEASES]. Harefuah 2024; 163:305-309. [PMID: 38734944] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Ocular inflammation, uveitis, represents over 40 distinct diseases, caused by infectious or non-infectious etiologies. Non-infectious uveitis may be related to systemic autoimmune diseases. Most uveitis patients are of working age, and prolonged disease may affect their independence and ability to work. Uveitis has various clinical manifestations and may result in the development of ocular complications and vision loss. Uveitis accounts for 10-15% of blindness in the developed world. Autoimmune diseases are increasing globally and often involve the eyes. Most cases occur in young active people and therefore any ocular changes have a longer effect. Symptoms may be mild but they might be severe, even blindness. It accounts for 10% to 15% of all causes of blindness among people of working age in the developed world. OBJECTIVES To describe the ocular manifestation of uveitis related to systemic autoimmune diseases. We will describe ocular signs related to the disease and discuss the treatment approach to prevent the development of ocular complications and vision loss. METHODS Review of clinical findings and treatment approach to non-infectious uveitis. CONCLUSIONS Ocular involvement is commonly found in many autoimmune diseases. The severity of ocular disease varies between cases and complications may result in vision loss. Early diagnosis and treatment may prevent the development of ocular complications, maintaining visual acuity and patient independence.
Collapse
Affiliation(s)
- Hana Shyriaiev
- Ophthalmology Department, HaEmek Medical Center, Afula, Ophthalmology Department, Carmel Medical Center, Haifa
| | - Shaul Sar
- Ophthalmology Department, Carmel Medical Center, Haifa
| | - Oren Tomkins-Netzer
- Ophthalmology Department, Carmel Medical Center, Haifa, The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
| |
Collapse
|
2
|
Butler L, Tomkins-Netzer O, Reiser O, Niederer RL. Management of Scleritis in Older Adults. Drugs Aging 2024; 41:287-302. [PMID: 38441778 PMCID: PMC11021297 DOI: 10.1007/s40266-024-01105-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/17/2024]
Abstract
Scleritis, an inflammatory disease of the eye affecting scleral tissue, presents unique challenges in the older adult population. Unlike their younger counterparts, older individuals manifest a distinct spectrum of the disease with different underlying etiologies, co-morbidities, altered immune function, and an increased risk of systemic side effects from medication choices. Addressing these complexities necessitates a comprehensive and multidisciplinary approach. Treatment of choice will depend on any underlying cause but generally involves non-steroidal anti-inflammatory drugs, systemic or local corticosteroids, and potentially disease-modifying anti-rheumatic drugs. Utilization of these therapeutic agents in older adults warrants careful consideration because of their potential side-effect profiles. This article critically examines the specific concerns for the use of these drugs in older patients and reviews the existing literature on their use in this specific cohort.
Collapse
Affiliation(s)
- Laura Butler
- Department of Ophthalmology, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Centre, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Or Reiser
- Department of Ophthalmology, Lady Davis Carmel Medical Centre, Haifa, Israel
| | - Rachael L Niederer
- Department of Ophthalmology, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| |
Collapse
|
3
|
Tomkins-Netzer O, Niederer R, Greenwood J, Fabian ID, Serlin Y, Friedman A, Lightman S. Mechanisms of blood-retinal barrier disruption related to intraocular inflammation and malignancy. Prog Retin Eye Res 2024; 99:101245. [PMID: 38242492 DOI: 10.1016/j.preteyeres.2024.101245] [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: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
Blood-retinal barrier (BRB) disruption is a common accompaniment of intermediate, posterior and panuveitis causing leakage into the retina and macular oedema resulting in vision loss. It is much less common in anterior uveitis or in patients with intraocular lymphoma who may have marked signs of intraocular inflammation. New drugs used for chemotherapy (cytarabine, immune checkpoint inhibitors, BRAF inhibitors, EGFR inhibitors, bispecific anti-EGFR inhibitors, MET receptor inhibitors and Bruton tyrosine kinase inhibitors) can also cause different types of uveitis and BRB disruption. As malignant disease itself can cause uveitis, particularly from breast, lung and gastrointestinal tract cancers, it can be clinically difficult to sort out the cause of BRB disruption. Immunosuppression due to malignant disease and/or chemotherapy can lead to infection which can also cause BRB disruption and intraocular infection. In this paper we address the pathophysiology of BRB disruption related to intraocular inflammation and malignancy, methods for estimating the extent and effect of the disruption and examine why some types of intraocular inflammation and malignancy cause BRB disruption and others do not. Understanding this may help sort and manage these patients, as well as devise future therapeutic approaches.
Collapse
Affiliation(s)
- Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Centre, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Rachael Niederer
- Department of Ophthalmology, Te Whatu Ora, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - John Greenwood
- Institute of Ophthalmology, University College London, London, UK
| | - Ido Didi Fabian
- The Goldschleger Eye Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Serlin
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
| | - Alon Friedman
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada; Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben- Gurion University of the Negev, Beer-Sheva, Israel
| | - Sue Lightman
- Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
4
|
Hijazi N, Gazitt T, Haddad A, Elias M, Kassem S, Feldhamer I, Cohen AD, Sar S, Tomkins-Netzer O, Saliba W, Zisman D. The risk factors for uveitis among psoriatic arthritis patients: a population-based cohort study. Clin Rheumatol 2024; 43:1053-1061. [PMID: 38082206 DOI: 10.1007/s10067-023-06834-y] [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: 07/05/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To assess the frequency of uveitis in patients with psoriatic arthritis (PsA) in the era of biologics and to identify risk factors associated with uveitis. METHODS A retrospective matched cohort study was conducted within the database of a large healthcare provider. Newly diagnosed 6147 adult PsA patients between 2005 and 2020 were matched by the index date of PsA diagnosis, age, sex, and ethnicity to 23,999 randomly selected controls. This cohort was used to examine the association between PsA and uveitis. An additional analysis was conducted within the PsA group to identify uveitis risk factors, using two analytic approaches: a retrospective cohort study and a nested case-control study. RESULTS Uveitis was diagnosed in 107 patients in the PsA group (1.7%) vs 187 (0.8%) patients in the control group (adjusted HR, 2.38, 95% CI 1.80-3.15, p<0.005) and was similar when the analysis was confined to patients without past uveitis. Uveitis was diagnosed more in females (2.1% vs 1.3%, HR 1.61, 95% CI 1.09-2.40, p<0.05), and was acute in all cases. Anterior uveitis was documented in 41.1% of the cases, 64.5% unilateral, and 9.3% bilateral. In the PsA group, using nested case control approach, only past uveitis [adjusted OR 136.4 (95% CI 27.38-679.88), p<0.005] and treatment with etanercept [adjusted OR 2.57 (95% CI 1.45-4.57), p=0.001] were independently associated with uveitis. Only one PsA patient with uveitis (out of 107) required systemic oral treatment with prednisone, while the rest of the patients were treated with topical glucocorticosteroids only. CONCLUSION PsA is associated with increased risk of uveitis. Past uveitis and treatment with etanercept were associated with higher risk of uveitis. Key Points • Psoriatic arthritis (PsA) is a major risk factor for uveitis with hazard ratio of 2.38 compared to healthy individuals without PsA. • Among PsA patients, the past event of uveitis and treatment with etanercept are risk factors for uveitis. • Uveitis in patients treated with biologics for their PsA requires topical therapy only in most of the cases.
Collapse
Affiliation(s)
- Nizar Hijazi
- Department of medicine A and Rheumatology Unit, Carmel Medical Center, Michal 7 St., 3436212, Haifa, Israel.
| | - Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
- Division of Rheumatology, University of Washington Medical Center, Seattle, USA
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Sameer Kassem
- Department of medicine A, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Feldhamer
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Arnon Dov Cohen
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shaul Sar
- Opthalmology department, Carmel Medical Center, Haifa, Israel
| | | | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
5
|
Niederer RL, Samalia PD, Chen YH, Goh JK, Cornish EE, Guest S, McCluskey PJ, Lim LL, Sims JL, Lightman S, Tomkins-Netzer O. Acute posterior multifocal placoid pigment epitheliopathy: clinical presentation and risk of stroke and transient ischaemic attack. Br J Ophthalmol 2024; 108:398-404. [PMID: 36657959 DOI: 10.1136/bjo-2022-321517] [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: 03/23/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS Acute posterior multifocal placoid pigment epitheliopathy is a rare but important disease that can be associated with life-threatening complications due to cerebral vasculitis. The primary objective was to determine the incidence of neurological complications and risk factors for stroke and transient ischaemic attack (TIA) associated with acute posterior multifocal placoid pigment epitheliopathy. Secondary objectives included the clinical presentation, visual outcomes and recurrence rates. METHODS This was a multicentre retrospective case series including 111 eyes from 60 subjects presenting from January 2009 to June 2020. RESULTS Median age at presentation was 29 years (IQR 24.7-35.1) and 36 subjects (60.0%) were male. 20 subjects (33.3%) reported a viral prodrome. Stroke and TIA were observed in seven subjects (11.7%). Older age was the only significant risk factor for stroke/TIA (p=0.042). Vision loss occurred in seven eyes, with four eyes (3.6%) having final visual acuity 6/15-6/60 and three eyes (2.7%) having visual acuity of 6/60 or worse. Recurrence occurred in 10 subjects (16.7%). CONCLUSIONS The presence of headache cannot reliably predict those at risk of stroke/TIA. Individuals presenting with acute posterior multifocal pigment epitheliopathy should therefore undergo a clinical neurological review and work-up for cerebral vasculitis as deemed appropriate by the treating ophthalmologist and collaborating neurologist.
Collapse
Affiliation(s)
- Rachael L Niederer
- Ophthalmology, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Priya D Samalia
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Yi-Hsing Chen
- Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jonathan Ks Goh
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Elisa Eleanor Cornish
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Guest
- Ophthalmology, Waikato District Health Board, Hamilton, New Zealand
| | - Peter J McCluskey
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lyndell L Lim
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Joanne L Sims
- Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Susan Lightman
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital, London, England
| | - Oren Tomkins-Netzer
- Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, Lady David Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
6
|
Tomkins-Netzer O, Niederer R, Lightman S. The role of statins in diabetic retinopathy. Trends Cardiovasc Med 2024; 34:128-135. [PMID: 36464210 DOI: 10.1016/j.tcm.2022.11.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
Diabetes mellitus is a growing global public health issue estimated to affect around 600 million people by 2040 [1]. It occurs in populations throughout the world, is increasing in both the developing world and high-income countries and also affects young, working-age people. Ocular involvement in diabetes occurs early in the disease and is present in over a third of diabetes mellitus Type 2 patients at the time of diagnosis. Blindness due to diabetic retinopathy (DR) remains a leading cause of adult-onset blindness, [1] which results from disruption of retinal vasculature, ischemia and its consequences and exudation causing macular edema. The prevalence of diabetic retinopathy is increasing at a greater rate than other causes of blindness including cataract, refractive errors, age-related macular degeneration and glaucoma. Compared to cataract and refractive error, management of diabetic retinopathy requires vast medical resources, including trained medical practitioners able to perform ocular injections and ophthalmologists for laser treatments and retinal surgery. This creates a significant burden on medical services as care for these patients lasts decades.
Collapse
Affiliation(s)
- Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Rachael Niederer
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Susan Lightman
- UCL Institute of Ophthalmology, London, UK; UHI Centre for Health Sciences. Department of Optometry, Inverness, UK.
| |
Collapse
|
7
|
Al-Janabi A, Sharief L, Al Qassimi N, Chen YH, Ding T, Ambler G, Ladas D, Lightman S, Tomkins-Netzer O. Can Simvastatin Reduce the Need for Immunomodulatory Drugs to Treat Uveitis?: A Prospective, Randomized, Placebo-Controlled Trial. Ophthalmol Sci 2023; 3:100333. [PMID: 37449048 PMCID: PMC10336795 DOI: 10.1016/j.xops.2023.100333] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023]
Abstract
Objective To assess the efficacy of simvastatin 80 mg/day versus placebo in patients with noninfectious nonanterior uveitis receiving prednisolone ≥ 10 mg/day. Design Randomized, double-masked, controlled trial. Subjects Adult patients with noninfectious nonanterior uveitis on oral prednisolone dose of ≥ 10 mg/day. Methods Patients were randomly assigned at a 1:1 ratio to receive either simvastatin 80 mg/day or placebo. A total of 32 patients were enrolled (16 in each arm), all of whom completed the primary end point, and 21 reached the 2-year visit (secondary end points). Main Outcome Measures The primary end point was mean reduction in the daily prednisolone dose at 12 months follow-up. Secondary end points were mean reduction in prednisolone dose at 24 months, percent of patients with a reduction in second-line immunomodulatory agents, time to disease relapse, and adverse events. Results Our results show that simvastatin 80 mg/day did not have a significant corticosteroid-sparing effect at 12 months (estimate: 3.62; 95% confidence interval [CI]: -8.15 to 15.38; P = 0.54). There was no significant difference between the groups with regard to prednisolone dose or change in dose at 12 and 24 months. There was no difference between the 2 groups in percent of patients with reduction in second-line agent by 24 months. Among patients who achieved disease quiescence, the median time to first relapse was longer for those receiving simvastatin (38 weeks, 95% CI: 14-54) than placebo (14 weeks, 95% CI: 12-52), although this was not statistically significant. There was no significant difference in adverse events or serious adverse events between the 2 groups. Conclusions Simvastatin 80 mg/day did not have an effect on the dose reduction of corticosteroids or conventional immunomodulatory drugs at 1 and 2 years. The results suggest that it may extend the time to disease relapse among those who achieve disease quiescence. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Ahmed Al-Janabi
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Lazha Sharief
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Noura Al Qassimi
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Yi-Hsing Chen
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Tao Ding
- Department of Statistical Science, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Dimitris Ladas
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Sue Lightman
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
- Department of Ophthalmology, Carmel Medical Center, Technion, Haifa, Israel
| |
Collapse
|
8
|
Woronkowicz M, Hamilton R, Lightman S, Zagora S, Tomkins-Netzer O. Comparison of anatomical and functional outcomes of treating myopic choroidal neovascularization with bevacizumab or ranibizumab. Int Ophthalmol 2023; 43:3499-3507. [PMID: 37318668 DOI: 10.1007/s10792-023-02755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To compare results of treatment with bevacizumab and ranibizumab injections in myopic choroidal neovascularization (mCNV). METHODS Retrospective, observational case series. PARTICIPANTS patients with mCNV treated with bevacizumab or ranibizumab injections. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) on optical coherence tomography (OCT) scans were collected at baseline, after 3, 6, 12, 24 months and the last visit. MAIN OUTCOME MEASURES mean change in BCVA and CRT. RESULTS We included 85 eyes treated with bevacizumab and 125 eyes treated with ranibizumab. There was no difference between the groups regarding BCVA and CRT change. CNV recurrence occurred at the mean time of 66.1 ± 3.7 and 57.3 ± 6.4 months in the bevacizumab- and ranibizumab-treated eyes, respectively (p = 0.006). During the first year 6.9% eyes in the bevacizumab group vs. 27.5% in the ranibizumab group had CNV recurrence (p = 0.001). Risk factors for recurrence of CNV were baseline CNV area (aHR 1.20, 95%CI 1.0-1.32, p = 0.04), subfoveal CNV (aHR 2.13, 95% CI 1.16-3.93, p = 0.01) and ranibizumab treatment (aHR 2.31, 95% CI 1.16-3.93, p = 0.008). CONCLUSION Eyes treated with bevacizumab and ranibizumab can achieve similar anatomical and functional improvement. CNV recurrence may occur earlier and more frequently during the first year in eyes treated with ranibizumab.
Collapse
Affiliation(s)
- Malgorzata Woronkowicz
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
- UCL Institute of Ophthalmology, London, UK.
| | - Robin Hamilton
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
| | - Sue Lightman
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
| | - Sophia Zagora
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- Sydney Eye Hospital, Sydney, Australia
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
9
|
Abbasnejad A, Tomkins-Netzer O, Winter A, Friedman A, Cruess A, Serlin Y, Levy J. A fluorescein angiography-based computer-aided algorithm for assessing the retinal vasculature in diabetic retinopathy. Eye (Lond) 2023; 37:1293-1301. [PMID: 35643792 PMCID: PMC10170131 DOI: 10.1038/s41433-022-02120-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/07/2021] [Revised: 04/24/2022] [Accepted: 05/20/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To present a fluorescein angiography (FA)‒based computer algorithm for quantifying retinal blood flow, perfusion, and permeability, in patients with diabetic retinopathy (DR). Secondary objectives were to quantitatively assess treatment efficacy following panretinal photocoagulation (PRP) and define thresholds for pathology based on a new retinovascular function (RVF) score for quantifying disease severity. METHODS FA images of 65 subjects (58 patients and 7 healthy volunteers) were included. Dye intensity kinetics were derived using pixel-wise linear regression as a measure of retinal blood flow, perfusion, and permeability. Maps corresponding to each measure were then generated for each subject and segmented further using an ETDRS grid. Non-parametric statistical analyses were performed between all ETDRS subfields. For 16 patients, the effect of PRP was measured using the same parameters, and an amalgam of RVF was used to create an RVF index. For ten post-treatment patients, the change in FA-derived data was compared to the macular thickness measured using optical coherence tomography. RESULTS Compared to healthy controls, patients had significantly lower retinal and regional perfusion and flow, as well as higher retinal permeability (p < 0.05). Moreover, retinal flow was inversely correlated with permeability (R = -0.41; p < 0.0001). PRP significantly reduced retinal permeability (p < 0.05). The earliest marker of DR was reduced retinal blood flow, followed by increased permeability. FA-based RVF index was a more sensitive indicator of treatment efficacy than macular thickness. CONCLUSIONS Our algorithm can be used to quantify retinovascular function, providing an earlier diagnosis and an objective characterisation of disease state, disease progression, and response to treatment.
Collapse
Affiliation(s)
- Amir Abbasnejad
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
- Emagix, Inc., Halifax, NS, Canada
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Faculty of Medicine, Carmel Medical Center, Technion, Haifa, Israel
| | - Aaron Winter
- Department of Ophthalmology, QEII Hospital, Dalhousie University, Halifax, NS, Canada
| | - Alon Friedman
- Emagix, Inc., Halifax, NS, Canada
- Departments of Medical Neuroscience and Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alan Cruess
- Department of Ophthalmology, QEII Hospital, Dalhousie University, Halifax, NS, Canada
| | - Yonatan Serlin
- Neurology Residency Training Program and Department of Neurology and Neurosurgery, Jewish General Hospital (J.M.), McGill University, Montreal, QC, Canada
| | - Jaime Levy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| |
Collapse
|
10
|
Ostrovsky M, Rosenblatt A, Iriqat S, Shteiwi A, Sharon Y, Kramer M, Vishnevskia-Dai V, Sar S, Boulos Y, Tomkins-Netzer O, Lavee N, Ben-Arie-Weintrob Y, Pizem H, Hareuveni-Blum T, Schneck M, Gepstein R, Masarwa D, Nakhoul N, Bakshi E, Shulman S, Goldstein M, Ramon D, Anouk M, Habot-Wilner Z. Ocular Behçet Disease-Clinical Manifestations, Treatments and Outcomes According to Age at Disease Onset. Biomedicines 2023; 11:biomedicines11020624. [PMID: 36831160 PMCID: PMC9952940 DOI: 10.3390/biomedicines11020624] [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: 12/27/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Behçet disease (BD) is a multisystemic disease that commonly involves the eyes. Although it affects patients in all age groups, data on ocular disease by age of onset are limited. This retrospective, multicenter study aimed to compare epidemiology, systemic and ocular manifestations, treatments and outcomes between three age groups: juvenile (<18 years), adult (18-39 years) and late (≥40 years) disease onset. The study included 175 ocular BD patients (303 eyes) from Israel and Palestine: juvenile-onset (n = 25, 14.3%), adult-onset (n = 120, 68.6%) and late-onset (n = 30, 17.1%). Most patients in all groups were male. Systemic manifestations were similar in all groups. Systemic co-morbidities were more common in late-onset patients. Bilateral panuveitis was the most common ocular manifestation in all patients. Non-occlusive retinal vasculitis, peripheral vessel occlusions, cataract and elevated intraocular pressure were found more commonly among juvenile-onset eyes. Anterior uveitis and macular ischemia were most common among late-onset eyes, while branch retinal vein occlusion was most common in adult and late-onset eyes. All patients were treated with corticosteroids. Methotrexate, immunomodulatory combinations and biologic treatments were more commonly used for juvenile-onset patients. All groups had a similar visual outcome. Our study showed that patients with ocular BD have varied ocular manifestations and require different treatments according to age of disease onset, but visual outcome is similar.
Collapse
Affiliation(s)
- Michael Ostrovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Rosenblatt
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Salam Iriqat
- St. John of Jerusalem Eye Hospital Group, East Jerusalem 91198, Palestine
| | - Abdallah Shteiwi
- St. John of Jerusalem Eye Hospital Group, East Jerusalem 91198, Palestine
| | - Yael Sharon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 4941492, Israel
| | - Michal Kramer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 4941492, Israel
| | - Vicktoria Vishnevskia-Dai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Goldschleger Eye Institute, Department of Ophthalmology, Sheba Medical Center, Ramat-Gan 52620, Israel
| | - Shaul Sar
- Department of Ophthalmology, Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3436212, Israel
| | - Yosif Boulos
- Department of Ophthalmology, Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3436212, Israel
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3436212, Israel
| | - Natalie Lavee
- Department of Ophthalmology, HaEmek Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 183411, Israel
| | - Yael Ben-Arie-Weintrob
- Department of Ophthalmology, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525408, Israel
| | - Hadas Pizem
- Department of Ophthalmology, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525408, Israel
| | - Tamar Hareuveni-Blum
- Department of Ophthalmology, Galilee Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Galilee 22100, Israel
| | - Marina Schneck
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Raz Gepstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Ophthalmology, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Dua Masarwa
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 7830604, Israel
| | - Nakhoul Nakhoul
- Department of Ophthalmology, Baruch Padeh Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Galilee 15280, Israel
| | - Erez Bakshi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Ophthalmology, Assaf Harofeh Medical Center, Tzrifin 70300, Israel
| | - Shiri Shulman
- Ophthalmology institute, Assuta Medical Centers, Tel Aviv 6789140, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Michaella Goldstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Dan Ramon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Marina Anouk
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Zohar Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-3-6973408
| |
Collapse
|
11
|
Ostrovsky M, Ramon D, Iriqat S, Shteiwi A, Sharon Y, Kramer M, Vishnevskia-Dai V, Sar S, Boulos Y, Tomkins-Netzer O, Lavee N, Ben-Arie-Weintrob Y, Pizem H, Hareuveni-Blum T, Schneck M, Gepstein R, Masarwa D, Nakhoul N, Bakshi E, Shulman S, Goldstein M, Anouk M, Rosenblatt A, Habot-Wilner Z. Retinal vascular occlusions in ocular Behçet disease - a comparative analysis. Acta Ophthalmol 2023. [PMID: 36750991 DOI: 10.1111/aos.15645] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The literature on retinal vascular occlusions in Behçet disease (BD) patients is limited. The aim of this study is to thoroughly investigate retinal vascular occlusions among ocular BD patients. METHODS Retrospective, multicentre case-control study. Three-hundred and three eyes of 175 patients with ocular BD, from 13 hospitals in Israel and Palestine, were included. Patients were assigned into two groups according to the presence of retinal vascular occlusion. Epidemiology, systemic and ocular manifestations, treatments and outcomes were compared between the groups and risk factors for retinal vascular occlusions were identified. RESULTS One hundred twenty-five patients (71.4%) were male. The mean age at presentation was 28.2 ± 0.86 years. Retinal vascular occlusions were found in 80 eyes of 54 (30.9%) patients, including branch retinal vein occlusion (51.3%), peripheral vessels occlusions (32.5%), central retinal vein occlusion (13.8%) and arterial occlusions (7.5%). Systemic manifestations were similar among both groups. Anterior uveitis was more common in non-occlusive eyes (p < 0.01). Non-occlusive retinal vasculitis (p = 0.03) and ocular complications were more common in occlusive eyes (p < 0.01). Treatments including mycophenolate mofetil, Infliximab or a combination therapy of anti-metabolite and calcineurin inhibitor were more commonly used by occlusive patients (p < 0.05). Occlusive patients underwent more cataract surgeries (p = 0.03). The occlusive group had worse mean best-corrected visual acuity (BCVA) throughout follow-up (p < 0.01). Risk factors for retinal vascular occlusions included male sex and Jewish ethnicity (p < 0.05). CONCLUSION Retinal vascular occlusions were found in a third of ocular BD patients. Occlusive eyes had a worse prognosis. Risk factors for vascular occlusions were identified.
Collapse
Affiliation(s)
| | - Dan Ramon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Salam Iriqat
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, Palestine
| | - Abdallah Shteiwi
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, Palestine
| | - Yael Sharon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | - Michal Kramer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | - Vicktoria Vishnevskia-Dai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Goldschleger Eye Institute, Department of Ophthalmology, Sheba Medical Center, Ramat-Gan, Israel
| | - Shaul Sar
- Department of Ophthalmology, Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Yosif Boulos
- Department of Ophthalmology, Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Natalie Lavee
- Department of Ophthalmology, HaEmek Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Yael Ben-Arie-Weintrob
- Department of Ophthalmology, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Hadas Pizem
- Department of Ophthalmology, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tamar Hareuveni-Blum
- Department of Ophthalmology, Galilee Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Marina Schneck
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Raz Gepstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Dua Masarwa
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Nakhoul Nakhoul
- Department of Ophthalmology, Baruch Padeh Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Tiberias, Israel
| | - Erez Bakshi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Shiri Shulman
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michaella Goldstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Marina Anouk
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Rosenblatt
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zohar Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
12
|
Niederer RL, Sharief L, Tomkins-Netzer O, Lightman SL. Uveitis in Sarcoidosis - Clinical Features and Comparison with Other Non-infectious Uveitis. Ocul Immunol Inflamm 2023; 31:367-373. [PMID: 35201961 DOI: 10.1080/09273948.2022.2032189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Comparison of sarcoid uveitis with other non-infectious uveitis treatment and visual outcomes. METHODS Retrospective study of 287 eyes with sarcoid uveitis and 1517 eyes with other non-infectious uveitis (15,029 eye-years follow-up). RESULTS Sarcoid uveitis patients presented at age 43.1 ± 0.8 years, and 66.2% were female. Panuveitis was the most frequent presentation (48.3%), and 90.1% were bilateral. Moderate visual loss (≤20/50) developed in 19 eyes (6.6%), and severe visual loss (≤20/200) in 13 eyes (4.5%). Sarcoid uveitis had better visual outcomes than other non-infectious uveitis (10-year BCVA anterior uveitis 0.06 vs 0.24 p = .002; posterior disease 0.17 vs 0.38 p = .001). Oral corticosteroid use was more common with sarcoid uveitis (anterior uveitis 45.9% vs 16.4% p < .0005; posterior disease 64.0% vs 61.7% p = .635), but second-line immunosuppression was required less frequently (p = .008). CONCLUSIONS Compared to other non-infectious uveitis, sarcoid uveitis has better visual acuity outcomes and is less likely to require second-line immunosuppression.
Collapse
Affiliation(s)
| | | | - Oren Tomkins-Netzer
- Uveitis Service, Ophthalmology Department, Lady Davis Carmel Medical Center, Haifa, Israel.,Ruth and Bruch Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | |
Collapse
|
13
|
El Nokrashy A, Lightman S, Tomkins-Netzer O. Efficacy of Infliximab in Disease Control of Refractory Orbital Myositis. Ocul Immunol Inflamm 2023; 31:153-157. [PMID: 34781805 DOI: 10.1080/09273948.2021.2001663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Orbital myositis is a common cause of orbital inflammation with localized involvement of the extra ocular muscles. This study aimed to assess the value of infliximab in controlling orbital myositis and reducing its relapse rate. METHODS We conducted a retrospective review of the medical records of all consecutive patients with orbital myositis treated with infliximab between 2007 and 2016. We examined change in corticosteroid and immunomodulatory doses as well as relapse rates following treatment with infliximab. RESULTS The study included seven patients with an average follow up of 19 ± 13.4 months. The mean dose of systemic corticosteroid was reduced from 28.57 ± 14.35 mg/day at the time of infliximab initiation to 7.00 ± 6.83 mg/day at final follow-up (p = .003). Long-term remission was achieved in 85.7% (n = 6). CONCLUSION This study supports the role of infliximab in treating refractory orbital myositis and this was associated with clinical improvement, decreasing relapse rate with dose reduction of conventional treatment.
Collapse
Affiliation(s)
| | - Sue Lightman
- Moorfields Eye Hospital, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, UK.,Institute of Ophthalmology, University College London, London, UK.,Department of Ophthalmology, Lady Davis Carmel Medical Center, Technion, Haifa, Israel
| |
Collapse
|
14
|
Sar S, Tomkins-Netzer O. [OCULAR MANIFESTATIONS IN BEHÇET DISEASE]. Harefuah 2022; 161:633-636. [PMID: 36315211] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Ocular involvement in Behçet disease occurs is most patients and can be the presenting organ. Intra-ocular inflammation (uveitis) related to Behçet disease is mainly a panuveitis including an occlusive retinal vasculitis. Recurrent inflammation can result in the development of ocular complications, including macular edema and retinal neovascularization, with up to a quarter of eyes developing vision loss. Diagnosis is based on clinical ophthalmic findings and ocular imaging including retinal fluorescein angiography and optical coherence tomography. Early diagnosis and treatment may prevent the development of ocular complications and vision loss. Treatment is based primarily on systemic corticosteroids and 2nd-line immunosuppressive agents, particularly anti-tumor necrosis factor α agents. Extensive treatment, prevention of relapses and complications can result in long term stable vision.
Collapse
Affiliation(s)
- Shaul Sar
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
15
|
Wu XN, Chen YH, Sharief L, Al-Janabi A, Al Qassimi N, Lightman S, Tomkins-Netzer O. Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis. Antibiotics (Basel) 2022; 11:antibiotics11070843. [PMID: 35884097 PMCID: PMC9311540 DOI: 10.3390/antibiotics11070843] [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: 04/25/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Examining the effect of antibiotic resistance, use of intravitreal antibiotics and systemic corticosteroids on visual outcome of eyes with acute endophthalmitis. Methods: We included 226 eyes with acute endophthalmitis, treated using a standardized protocol. Visual outcome up to 12 months was assessed related to biopsy results, antibiotics resistance and treatment regimens. Results: Vitreous biopsies were more likely to be culture-positive (41.1%) than anterior chamber biopsies (21.6%, p < 0.0001). Antibiotic resistance for amikacin was found in 19 eyes (24.7%), vancomycin in 29 eyes (31.5%) and moxiflocacin in 14 eyes (16.1%). At presentation 91.53% of eyes had BCVA < 20/40, reducing by 1 month to 69.94% (p < 0.0001) and remaining stable at 12 months. There was no difference in visual outcome for those receiving early systemic corticosteroids. Endophthalmitis following cataract surgery (OR 1.66, 1.04−2.66 95% CI, p = 0.03) and receiving intravitreal vancomycin (OR 3.15, 1.18−8.42 95% CI, p = 0.02) were associated with a greater chance of final BCVA ≥ 20/40. Conclusion: Using vitreous taps with intravitreal antibiotics, despite an increase in resistance to both vancomycin and moxifloxacin, results in a final BCVA > 20/200 in half of eyes and ≥20/40 in a third. Early treatment with intravitreal antibiotics should not be delayed.
Collapse
Affiliation(s)
- Xia-Ni Wu
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Yi-Hsing Chen
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 10507, Taiwan
| | - Lazha Sharief
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Ahmed Al-Janabi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Nura Al Qassimi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
| | - Sue Lightman
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Oren Tomkins-Netzer
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
- Correspondence:
| |
Collapse
|
16
|
Kim JE, Tomkins-Netzer O, Elman MJ, Lally DR, Goldstein M, Goldenberg D, Shulman S, Benyamini G, Loewenstein A. Evaluation of a self-imaging SD-OCT system designed for remote home monitoring. BMC Ophthalmol 2022; 22:261. [PMID: 35689210 PMCID: PMC9186475 DOI: 10.1186/s12886-022-02458-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare identification rates of retinal fluid of the Notal Vision Home Optical Coherence Tomography (OCT) device (NVHO) when used by people with age-related macular degeneration (AMD) to those captured by a commercial OCT. METHODS Prospective, cross-sectional study where patients underwent commercial OCT imaging followed by self-imaging with either the NVHO 2.5 or the NVHO 3 in clinic setting. Outcomes included patients' ability to acquire analyzable OCT images with the NVHO and to compare those with commercial images. RESULTS Successful images were acquired with the NVHO 2.5 in 469/531 eyes (88%) in 264/290 subjects (91%) with the mean (SD) age of 78.8 (8.8); 153 (58%) were female with median visual acuity (VA) of 20/40. In the NVHO 3 cohort, 69 eyes of 45 subjects (93%) completed the self-imaging. Higher rates of successful imaging were found in eyes with VA ≥ 20/320. Positive percent agreement/negative percent agreement for detecting the presence of subretinal and/or intraretinal fluid when reviewing for fluid in three repeated volume scans were 97%/95%, respectively for the NVHO v3. CONCLUSION Self-testing with the NVHO can produce high quality images suitable for fluid identification by human graders, suggesting the device may be able to complement standard-of-care clinical assessments and treatments.
Collapse
Affiliation(s)
- Judy E Kim
- The Eye Institute, Medical College of Wisconsin, 925 N. 87th street, Milwaukee, WI, 53226, USA.
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - David R Lally
- Retina Research Institute at New England Retina Consultants, Springfield, MA, USA
| | | | | | | | | | | |
Collapse
|
17
|
Tomkins-Netzer O, Sar S, Barnett-Griness O, Friedman B, Shyriaieva H, Saliba W. Association between vaccination with the BNT162b2 mRNA COVID-19 vaccine and non-infectious uveitis: a population-based study. Ophthalmology 2022; 129:1087-1095. [PMID: 35643168 PMCID: PMC9132378 DOI: 10.1016/j.ophtha.2022.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 12/22/2022] Open
|
18
|
Gutkovich E, Zahavi A, Man Peles I, Tomkins-Netzer O, Borisovsky N, Bejar J, Goldenberg-Cohen N, Vardizer Y. The Management of Congenital Microphthalmia With Orbital Cyst: A Case Series. J Pediatr Ophthalmol Strabismus 2022; 59:192-199. [PMID: 34928774 DOI: 10.3928/01913913-20210929-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a series of patients treated for congenital microphthalmia associated with orbital cyst and recommend a management protocol. METHODS This retrospective case series comprised 6 patients (7 eyes) who attended an oculoplastic tertiary medical center from 2001 to 2018. Clinical, treatment, and outcome data were collected from the electronic files. Main outcome measures were preservation of vision and cosmetic appearance. RESULTS Four patients were diagnosed at birth. Six cysts were located inferiorly and one superiorly. Two patients had a visual potential of light perception or better in the affected eye. In 4 eyes, the cyst was initially retained and the eye was fitted with a custom-made conformer. In 1 eye, the fornices were too shallow for a conformer, warranting fornix reconstruction and cyst excision. Early surgery was required in 1 eye for an expanded cyst and large orbit volume, and in another eye the cyst had overgrown the orbit, causing bone erosion and remodeling. Cosmetic results were good in 3 of the eyes in which the cyst was retained in early childhood, stimulating orbital growth. CONCLUSIONS Congenital microphthalmia with orbital cyst is rare. Management should focus on preserving visual potential, especially in unilateral cyst cases when the other eye is also microphthalmic. Otherwise cosmetic symmetry is the main concern; cyst retention combined with ocular conformers may stimulate socket expansion. The authors found that, in most cases, if treated early, enucleation was avoidable during cyst excision. Early assessment, meticulous follow-up, and individually tailored treatment are warranted. [J Pediatr Ophthalmol Strabismus. 2022;59(3):192-199.].
Collapse
|
19
|
Woronkowicz M, Niederer R, Lightman S, Tomkins-Netzer O. Intravitreal Antivascular Endothelial Growth Factor Treatment for Inflammatory Choroidal Neovascularization in Noninfectious Uveitis. Am J Ophthalmol 2022; 236:281-287. [PMID: 34289337 DOI: 10.1016/j.ajo.2021.07.010] [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] [Received: 07/03/2020] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare visual outcome and recurrence rates of eyes with noninfectious inflammatory choroidal neovascularization (CNV) treated with or without anti-vascular endothelial growth factor (VEGF) injections and immunosuppression. DESIGN Retrospective, nonrandomized clinical study. METHODS Participants: Patients with CNV secondary to noninfectious inflammatory causes who attended uveitis clinics at Moorfields Eye Hospital between January 2000 and April 2016. Data were gathered from the clinical notes of all subjects examined in clinic. MAIN OUTCOME MEASURES change in best-corrected visual acuity (BCVA), mean time to CNV recurrence, moderate vision loss (≤20/50), and severe vision loss (≤20/200). RESULTS A total of 166 patients (204 eyes) with noninfectious inflammatory CNV were included in this study with a median follow-up of 6.9 years (interquartile range: 2.9-11.7; 1652 eye-years). The mean BCVA at the time of CNV diagnosis was 0.38 ± 0.05 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent 20/47) in the eyes that received the first-line anti-VEGF treatment and 0.44 ± 0.03 logMAR (Snellen equivalent 20/55) in the eyes on other treatment modalities (P = .39). Eyes treated first with anti-VEGF (n = 55) received the mean of 4.35 ± 0.53 injections and showed a statistically significant improvement in vision at all time points (P < .001) except for a 5-year visit (P = .25). The rest of the eyes demonstrated no significant change in vision throughout follow-up (all P > .05). At the final visit, the mean BCVA was 0.26 ± 0.11 logMAR (Snellen equivalent 20/36) in the former and 0.35 ± 0.06 logMAR (Snellen equivalent 20/44) in the latter. The mean time to CNV recurrence was 186 ± 15.1 months, and the risk was significantly reduced by treatment with oral corticosteroids (adjusted hazard ratio = 0.32, confidence interval: 0.17-0.59, P < .001) or anti-VEGF injections (adjusted hazard ratio = 0.31, confidence interval: 0.18-0.52, P < .001). CONCLUSIONS Eyes that developed inflammatory CNV were at risk of vision loss. Those receiving early anti-VEGF injections achieved a better visual outcome and had a reduced risk of CNV recurrence. Oral corticosteroids also had an effect that reduces the risk of recurrence in eyes previously treated.
Collapse
|
20
|
Niederer RL, Ma SP, Wilsher ML, Ali NQ, Sims JL, Tomkins-Netzer O, Lightman SL, Lim LL. Systemic Associations of Sarcoid Uveitis: Correlation With Uveitis Phenotype and Ethnicity. Am J Ophthalmol 2021; 229:169-175. [PMID: 33737030 DOI: 10.1016/j.ajo.2021.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/02/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine systemic associations of sarcoid uveitis and association with uveitis clinical phenotype and ethnicity. DESIGN Retrospective cross-sectional study. SUBJECTS A total of 362 subjects with definite or presumed sarcoid uveitis from Moorfields Eye Hospital, Royal Victorian Eye and Ear, and Auckland District Health Board. METHODS Data were collected from the review of clinical notes, imaging, and investigations. Sarcoidosis was diagnosed in accordance with the International Workshop on Ocular Sarcoidosis guidelines. MAIN OUTCOME MEASURE Diagnosis of associated systemic disease secondary to sarcoidosis. RESULTS A total of 362 subjects with sarcoid uveitis were identified. Median age was 46 years, and 226 (62.4%) were female. Granulomatous anterior uveitis (47.8%), intermediate uveitis with snowballs (46.4%), and multifocal choroiditis (43.1%) were the most frequent clinical presentations, and disease was bilateral in 313 (86.5%). Periphlebitis was observed in 21.0%, and solitary optic nerve or choroidal granuloma in 11.3%. Lung parenchymal disease was diagnosed in 200 subjects (55.2%), cutaneous sarcoid in 98 (27.1%), sarcoid arthritis in 57 (15.7%), liver involvement in 21 (5.8%), neurosarcoid in 49 (13.5%), and cardiac sarcoid in 16 subjects (4.4%). Subjects with cardiac sarcoid were less likely to have granulomatous anterior uveitis (P = .017). Caucasian subjects were older at presentation (48 vs 41 years; P = .009), had less granulomatous anterior uveitis (26.4% vs 51.7%; P < .001), and were less likely to present with cutaneous involvement (23.1% vs 35.4%; P = .040). CONCLUSIONS Ophthalmologists need to be aware of the systemic associations of sarcoid uveitis, in particular potentially life-threatening complications such as cardiac sarcoidosis. Differences observed in uveitis phenotype and between ethnicities require further investigation.
Collapse
Affiliation(s)
- Rachael Louise Niederer
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.).
| | - Shirley P Ma
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Margaret L Wilsher
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Noor Q Ali
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Joanne L Sims
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Oren Tomkins-Netzer
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Sue L Lightman
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Lyndell L Lim
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| |
Collapse
|
21
|
Vardizer Y, Sobeh T, Prat DL, Ben Simon GJ, Tomkins-Netzer O. Assessing the results of anophthalmic prostheses. Indian J Ophthalmol 2021; 69:1876-1881. [PMID: 34146048 PMCID: PMC8374791 DOI: 10.4103/ijo.ijo_2682_20] [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] [Indexed: 11/04/2022] Open
Abstract
Purpose Anophthalmic sockets cause disfigurement that may result in emotional and social distress. The choice of procedure and implant is based upon the surgeon's experience. There remains no standardization of cosmetic result. We sought to identify quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and to determine correlations between self-reported and third-party assessment of cosmetic success. Methods This was a prospective observational study, which included 107 adult patients (50.1% female; age 53.08 ± 18.64 years, range 18-89) with acquired anophthalmia following prosthesis fitting. Patients completed a self-assessment questionnaire on self-perception of body image and ocular properties. Three independent examiners assessed cosmetic score. Assessed variables included prosthesis movement, eyelid symmetry, prosthesis stability, and socket fullness. Results The general cosmetic result was 8.1 ± 2.19 (on a predetermined scale of 1-10) as perceived by the patients and 7.2 ± 0.19 by the examiners. Interexaminer correlation was high for all variables (P < 0.05). A good cosmetic result was correlated with prosthesis movement (P = 0.02), eyelid symmetry (P = 0.001), and prosthesis stability (P = 0.01). Factors that correlated with a good cosmetic result on multivariate analysis were prosthesis movement (odds ratio [OR] 4.95, P = 0.004), eyelid symmetry (OR 4.51, P = 0.006), and socket fullness (OR 3.56, P = 0.005). No correlation was observed between patients' perceptions of the overall cosmetic result and those of the examiners. Conclusion The cosmetic result of prosthesis use among anophthalmic patients is generally good, as perceived by both patients and examiners. Good eyelid position and symmetry, orbital fullness, and prosthesis motility were associated with a better cosmetic result.
Collapse
Affiliation(s)
- Yoav Vardizer
- Ophthalmology Department, Bnei Zion Medical Center; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology; Vardizer Ocularist Clinic, Haifa, Israel
| | - Tamer Sobeh
- Ophthalmology Department, Bnei Zion Medical Center, Haifa; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Landau Prat
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Tomkins-Netzer
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology; Ophthalmology Department, Lady Davis Carmel Medical Center, Haifa, Israel
| |
Collapse
|
22
|
Niederer R, Bar A, Al-Ani H, Sharief L, Sar S, Segal A, Lightman S, Tomkins-Netzer O. Management of inflammatory choroidal neovascular membranes. Expert Review of Ophthalmology 2020. [DOI: 10.1080/17469899.2021.1842196] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael Niederer
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Centre, Tel Aviv-Yafo, Israel
| | - Haya Al-Ani
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Lazha Sharief
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Shaul Sar
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Adi Segal
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
23
|
Tomkins-Netzer O, Lightman SL, Burke AE, Sugar EA, Lim LL, Jaffe GJ, Altaweel MM, Kempen JH, Holbrook JT, Jabs DA. Seven-Year Outcomes of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial and Follow-up Study Results. Ophthalmology 2020; 128:719-728. [PMID: 32918964 DOI: 10.1016/j.ophtha.2020.08.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the long-term outcomes of uveitic macular edema (ME). DESIGN Longitudinal follow-up of a cohort of participants in a randomized clinical trial. PARTICIPANTS A total of 248 eyes of 177 participants with uveitic ME enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. METHODS OCT measurements, taken at baseline and annually, were graded by reading center graders masked to clinical data. Macular edema was defined as a center macular thickness (CMT) ≥240 μm on time-domain OCT or time-domain OCT equivalent. Resolution of ME was defined as normalization of macular thickness on OCT. Relapse of ME was defined as increase in macular thickness to ≥240 μm in an eye that previously had resolution. Visual acuity was measured at each visit with logarithmic visual acuity charts. MAIN OUTCOME MEASURES Resolution and relapse of ME. Visual acuity. RESULTS Among 227 eyes with ME followed ≥1 year, the cumulative percent of eyes with ME resolving at any point during 7 years was 94% (95% confidence interval [CI], 89-97). Epiretinal membranes on OCT were associated with a lower likelihood of ME resolution (hazard ratio [HR], 0.74; 95% CI, 0.55-1.01; P = 0.05). Among 177 eyes with resolved ME, the cumulative percent with relapse within 7 years was 43% (95% CI, 32-51). Eyes in which ME resolved gained a mean of 6.24 letters (95% CI, 4.40-8.09; P < 0.001) compared with eyes that remained free from ME during the 1-year follow-up intervals, whereas eyes in which ME did not resolve experienced no gain in vision (mean change -1.30 letters; 95% CI, -2.70 to 0.09; P = 0.065), and eyes that developed ME during the year (incident or relapsed) experienced a mean loss of -8.65 letters (95% CI, -11.5 to -5.84, P < 0.001). CONCLUSIONS Given sufficient time and treatment, nearly all uveitic ME resolves, but episodes of relapse were common. Visual acuity results were better among eyes with resolved ME, suggesting that control of inflammation and resolution of ME might be visually relevant treatment targets.
Collapse
Affiliation(s)
- Oren Tomkins-Netzer
- Institute of Ophthalmology, University College London, and Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Susan L Lightman
- Institute of Ophthalmology, University College London, and Moorfields Eye Hospital, London, United Kingdom
| | - Alyce E Burke
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth A Sugar
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lyndell L Lim
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Michael M Altaweel
- Department of Ophthalmology and Reading Center, University of Wisconsin, Madison, School of Medicine and Public Health, Madison, Wisconsin
| | - John H Kempen
- Department of Ophthalmology Harvard Medical School and Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; MCM Eye Unit, Myung Sung Christian Medical Center General Hospital and Medical School, Addis Ababa, Ethiopia
| | - Janet T Holbrook
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas A Jabs
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | |
Collapse
|
24
|
Woronkowicz M, Lightman S, Tomkins-Netzer O. The prognostic value of total macular external limiting membrane and ellipsoid zone damage for clinical outcome in treatment-resistant neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020; 258:2373-2378. [PMID: 32778909 DOI: 10.1007/s00417-020-04869-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To examine the prognostic value of the extent of damage to the ellipsoid zone (EZ) and external limiting membrane (ELM) in response to the treatment of age-related macular degeneration (AMD) eyes switched from ranibizumab to aflibercept. METHODS This is a retrospective study of patients with neovascular AMD resistant to ranibizumab defined as having persistent intra- or subretinal fluid on OCT scans despite at least 6-month treatment and switched to aflibercept. Clinical data was collected and quantitative measurements of the area of EZ and ELM damage were obtained, on en-face optical coherence tomography images, at the time of switch to aflibercept (baseline) and up to 6 months of follow-up. RESULTS The study included 71 eyes (52.1% right eye) of 71 patients. At baseline, there was a correlation between the size of the EZ and ELM damaged area and BCVA (R = -0.39, p = 0.001 and R = -0.47, p < 0.001, respectively). The EZ and ELM damaged areas maintained correlation with BCVA at 6 months (R = -0.28, p = 0.01 and R = -0.39, p = 0.001, respectively). Central retinal thickness did not correlate with BCVA at the time of switch (p = 0.38) or at 6 months (p = 0.36). CONCLUSIONS The extent of damage to the EZ and ELM correlates with BCVA following a switch in treatment.
Collapse
Affiliation(s)
- Malgorzata Woronkowicz
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Sue Lightman
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK. .,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK. .,Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. .,Ophthalmology Department, Lady Davis Carmel Medical Centre, Haifa, Israel.
| |
Collapse
|
25
|
Busool Abu Eta Y, Tomkins-Netzer O, Mimouni M, Hamed Azzam S, Shehadeh Mashour R. Predicting factors of ocular hypertension following keratoplasty: Indications versus the procedure. Eur J Ophthalmol 2020; 31:1749-1753. [PMID: 32762247 DOI: 10.1177/1120672120948757] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the incidence of ocular hypertension (OHTN) following penetrating keratoplasty (PKP) versus deep anterior lamellar keratoplasty (DALK) corneal transplant surgeries, and to assess the impact of indication for transplantation versus surgery type on OHTN development. METHODS A retrospective study of 76 eyes of 76 patients who underwent PKP or DALK between 1 January 2009 and 1 September 2014. Data included: preoperative intraocular pressure (IOP), indication and type of surgery, post-surgical IOP at 1 to 5, 14 to 21 days, 3, 6 months, 1 year and at the last follow up. Primary outcome was post-operative OHTN (defined as IOP >21 mm Hg). RESULTS A total of 13 patients (17.1%) developed OHTN of whom 9 (20.45%) underwent PKP and 4 (12.5%) DALK (p = 0.33). OHTN occurred after an average of 16.46 ± 8.47 months (0.1-58 months). Twenty-one keratoconus patients (39.62%) underwent PKP and 32 (60.37%) underwent DALK. Patients with indications other than keratoconus all underwent PKP. Keratoconus patients were less likely to develop OHTN (9.43% vs 34.78%, p = 0.02). Among patients developing OHTN, mean age of the non-keratoconus group was significantly higher (63.25±16.7 vs 33 ± 10, p = 0.01). No significant difference in OHTN among keratoconus patients undergoing DALK versus PKP (12.5% vs 4.76%, respectively, p = 0.35) was found. PKP was associated with less OHTN in keratoconus eyes (4.76% vs 34.78%, p = 0.02). CONCLUSION Patients who underwent keratoplasty due to keratoconus are at a lower risk to develop OHTN than those who underwent surgery for other indications.
Collapse
Affiliation(s)
- Yumna Busool Abu Eta
- Department of Ophthalmology, University Hospitals of Leicester, Leicester, UK.,Department of Ophthalmology, Saint Vincent de Paul Hospital, Nazareth, Affiliated to the Faculty of Medicine, Bar Ilan university, Israel
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Micheal Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Shireen Hamed Azzam
- Department of Ophthalmology, the Baruch Padeh Medical Center, Poriya, Israel
| | | |
Collapse
|
26
|
Sharief L, Chen YH, Lightman S, Tomkins-Netzer O. Prospective study of morphologic and functional parameter changes post intravitreal therapy for macular edema. Graefes Arch Clin Exp Ophthalmol 2020; 258:1941-1947. [PMID: 32361803 DOI: 10.1007/s00417-020-04715-7] [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: 01/23/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Retinal sensitivity (RS) can be a valuable indicator of retinal function in response to intravitreal steroid or anti-VEGF treatment in the eyes with diabetic macular edema (DME), macular edema post retinal vein occlusion (RVO), or uveitis. METHODS This prospective longitudinal study included 68 patients (96 eyes) with macular edema (ME) secondary to diabetes mellitus (42 eyes), uveitis (36 eyes), or RVO (18 eyes). In addition to best corrected visual acuity (BCVA) and retinal thickness, Nidek MP1 microperimetry was used to quantify RS at baseline visit and to look at the mean difference (MD) at 3-6 months and 1-2 years post intravitreal therapy with corticosteroids or anti-VEGF. RESULTS There was a significant negative correlation between the central RS and BCVA (r = - 0.47, p < 0.001), including DME (r = - 0.42, p = 0.006) and uveitis (r = - 0.60, p < 0.001), but not RVO (r = - 0.37, p = 0.12). At 2-year follow-up, the overall CST was reduced from baseline (MD - 147 μm, 95% C.I - 192 to - 102, p < 0.001) with improved BCVA (MD - 0.12 LogMAR, 95% C.I - 0.23 to - 0.01, p = 0.01), but no improvement in the RS in any of the disorders. Both anti-VEFG and steroid groups showed significant improvement in CST at 2 years from baseline (MD - 101 μm, p = 0.001 and - 167 μm, p < 0.001, respectively) with only improvement in BCVA among anti-VEGF group (MD - 0.16 LogMAR, 95% C.I - 0.26 to - 0.07, p = 0.008). CONCLUSION The long-term follow-up of ME cases did not show a significant improvement in RS following treatment even with reduced macular thickness at 2-year follow-up.
Collapse
Affiliation(s)
- Lazha Sharief
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Yi-Hsing Chen
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sue Lightman
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, UK. .,UCL Institute of Ophthalmology, London, UK. .,Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
27
|
Gilbert RM, Niederer RL, Kramer M, Sharief L, Sharon Y, Bar A, Lightman S, Tomkins-Netzer O. Differentiating Multifocal Choroiditis and Punctate Inner Choroidopathy: A Cluster Analysis Approach. Am J Ophthalmol 2020; 213:244-251. [PMID: 32027868 DOI: 10.1016/j.ajo.2020.01.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 08/12/2018] [Revised: 09/30/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To develop a robust approach to clinical phenotyping of multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC). DESIGN Cross-sectional and longitudinal observational study. METHODS This multicenter study included sites in the United Kingdom and Israel. The study population included 343 eyes of 185 subjects with hospital record diagnoses of MFC or PIC. Eyes were observed over a period of 5 years for clinically relevant characteristics, including demographics and multimodal imaging features, by observers masked to the original diagnoses. Multivariate 2-step cluster analysis was used to identify clusters of eyes in the database with similar clinical phenotypes, which were then analyzed for between-group differences. The primary outcome measure was the difference between clinical phenotype clusters identified using clinical criteria from the multivariate cluster analysis. RESULTS Subjects ranged from 11 to 89 years of age, with a baseline best-corrected visual acuity of 2.3 to -0.2 logarithm of minimal angle of resolution. Eighty-two percent of eyes were from females, 74% were myopic with a refractive error of +3.00 to -17.00 diopters (spherical equivalent). Cluster analysis prioritized clinical criteria of chorioretinal lesion location and intraocular inflammation and identified 2 distinct phenotype clusters resembling the original descriptions of MFC and PIC. During the 5-year period of observation, the initial clinical diagnosis remained stable for most eyes and only 1 eye (0.3%) changed diagnosis from PIC to MFC because of newly developed peripheral lesions. There were significant between-group differences in clinical characteristics, for example, in choroidal neovascular membrane development and treatment received. CONCLUSIONS Cluster analysis of this large cohort of eyes identified peripheral lesions and intraocular inflammation as distinct clinical phenotypes of MFC and PIC. The initial diagnosis remained stable for most eyes. This methodology could be useful for future uveitis classification and management.
Collapse
Affiliation(s)
- Rose M Gilbert
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom.
| | - Rachael L Niederer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Greenlane Medical CentreAuckland District Health Board, Auckland, New Zealand
| | - Michal Kramer
- Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lazha Sharief
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Yael Sharon
- Rabin Medical Center, Petah Tikva, Israel; Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey, USA
| | - Asaf Bar
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Wolfson Medical Centre, Holon, Tel Aviv-Yafo, Israel
| | - Sue Lightman
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Carmel Medical Center, Haifa, Israel
| |
Collapse
|
28
|
Chen YH, Gepstein R, Sharief L, Tseng HJ, Wei R, Zhang X, Lightman S, Tomkins-Netzer O. Outcome and risk of ocular complications of managing children with chronic anterior uveitis with topical rimexolone 1. Int Ophthalmol 2020; 40:1061-1068. [PMID: 32318939 DOI: 10.1007/s10792-020-01358-9] [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: 01/08/2019] [Accepted: 11/08/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the efficacy and safety of 1% rimexolone ophthalmic suspension in children with chronic anterior uveitis under real-life conditions in a tertiary center. METHODS This is a retrospective longitudinal study. Medical records were analyzed at baseline, 1, 3, 6 and 12 months before and after switching to rimexolone for best-corrected visual acuity (BCVA), oral steroid use, number of flares, IOP and anti-glaucoma management. RESULTS Twenty-four patients (41 eyes) diagnosed with either anterior uveitis (n = 25, 60.0%) or panuveitis (n = 16, 40%) were enrolled. The mean age was 10.5 years (4-16 years). The number of patients requiring oral prednisolone reduced from 8 patients (32.0%) at baseline to 3 patients (20.0%) at 12 months (P < 0.001). Following baseline, the median number of uveitis flares reduced from 2.0 (inter-quartile range (IQR) 1.0-2.75) to 1.0 (IQR 0.0-1.0) compared to the 12 months before baseline (P < 0.001). The mean IOP reduced from baseline (22.0 ± 7.3 mmHg) to 1 month (18.8 ± 8.7 mmHg, P = 0.01) and remained stable up to 12 months (15.9 ± 5.0 mmHg, P < 0.001). Average BCVA, dose of oral prednisolone and anti-glaucoma treatments did not change compared to the baseline. The development for IOP ≥ 30 mmHg was associated with a known corticosteroid response [odds ratio (OR) 6.8, P = 0.003] and a dose > 7.5 mg/day oral prednisolone (OR 4.4, P = 0.033). CONCLUSIONS Rimexolone 1% ophthalmic suspension is an effective and safe topical steroid for pediatric anterior uveitis.
Collapse
Affiliation(s)
- Yi-Hsing Chen
- Institute of Ophthalmology, University College of London, London, UK.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Moorfields Eye Hospital, London, UK
| | | | - Lazha Sharief
- Institute of Ophthalmology, University College of London, London, UK.,Moorfields Eye Hospital, London, UK
| | - Hsiao-Jung Tseng
- Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Xiaozhe Zhang
- Institute of Ophthalmology, University College of London, London, UK
| | - Sue Lightman
- Institute of Ophthalmology, University College of London, London, UK.,Moorfields Eye Hospital, London, UK
| | - Oren Tomkins-Netzer
- Institute of Ophthalmology, University College of London, London, UK. .,Moorfields Eye Hospital, London, UK. .,Ophthalmology Department, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
29
|
Al-Ani HH, Sims JL, Tomkins-Netzer O, Lightman S, Niederer RL. Vision loss in anterior uveitis. Br J Ophthalmol 2020; 104:1652-1657. [PMID: 32245851 DOI: 10.1136/bjophthalmol-2019-315551] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate the long-term risk of permanent vision loss in subjects with anterior uveitis. METHODS Retrospective study of subjects attending uveitis clinic at Auckland District Health Board and Moorfields Eye Hospital between 2008 and 2018. Main outcome measures were: best corrected visual acuity (BCVA); moderate vision loss (MVL ≤20/50); and severe vision loss (SVL ≤20/200). RESULTS 2526 eyes of 1814 subjects were included with a mean follow-up of 6.8 years (17 235.4 eye-years of follow-up). MVL occurred in 240 eyes (9.5%) during the follow-up period, of which 97 (3.8%) had permanent MVL due to uveitis. The incidence of permanent MVL due to uveitis was 0.006 per eye-year with a cumulative risk at 10 years of 6.6% (5.2%-8.4%). The most common cause of permanent MVL due to uveitis was uveitic glaucoma (31.3%), followed by cystoid macular oedema (27.1%) and corneal scar (21.9%). SVL occurred in 80 eyes (3.2%) during the follow-up period, of which 39 (1.5%) had permanent SVL due to uveitis. The incidence of permanent SVL due to uveitis was 0.002 per eye-year with a cumulative risk at 10 years of 2.6% (1.8%-3.7%). Multivariate analysis showed older age at presentation, chronic anterior uveitis (CAU), infectious aetiology and poor presenting BCVA were all risk factors for permanent MVL due to uveitis. CONCLUSIONS Although vision loss is an uncommon complication in anterior uveitis, the risk is greatest in those with CAU, infectious aetiology and poor presenting BCVA. Uveitic glaucoma is the most common cause of vision loss.
Collapse
Affiliation(s)
- Haya H Al-Ani
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Joanne L Sims
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | | | - Susan Lightman
- Clinical Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Rachael L Niederer
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand .,Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
30
|
Al-Janabi A, El Nokrashy A, Sharief L, Nagendran V, Lightman S, Tomkins-Netzer O. Long-Term Outcomes of Treatment with Biological Agents in Eyes with Refractory, Active, Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. Ophthalmology 2019; 127:410-416. [PMID: 31607412 DOI: 10.1016/j.ophtha.2019.08.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/30/2019] [Accepted: 08/28/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To examine a large cohort of patients treated with biologic agents for active noninfectious intermediate uveitis, posterior uveitis, or panuveitis (NIPPU) and to compare their efficacy and long-term effect. DESIGN Retrospective, longitudinal study. PARTICIPANTS Eighty-two patients (156 eyes) with active NIPPU after failure of treatment with corticosteroids and a second-line immunosuppression drug and treated with biologic agents who were treated at Moorfields Eye Hospital between 2001 and 2016. METHODS Information was gathered from the clinical notes of all patients. MAIN OUTCOME MEASURES Time to first disease flare, rate of treatment failure, best-corrected visual acuity, and risk factors for treatment failure. RESULTS Patients were followed on average for 4.7±0.4 years (724 eye-years). All patients demonstrated active uveitis at baseline, and 34 patients (41.5%) demonstrated a coexisting active systemic disease. Control of ocular inflammation was achieved in 136 eyes (87.2%). The average oral prednisolone dose at baseline was 16.4±1.7 mg/day, and by 6 months reduced to 6.5±0.7 mg/day (P < 0.0001), remaining stable for up to 5 years follow-up. Best-corrected visual acuity at baseline was 0.5±0.1 logarithm of the minimum angle of resolution (logMAR), improved to 0.4±0.1 logMAR (P = 0.008) at 3 months, and remained stable during follow-up. After baseline, 42.3% of eyes experienced flares, and the average number of flares reduced from 1.8±0.1 flares/year to 0.6±0.1 flares/year (P < 0.0001). Median time to first flare was 5.4 years (95% confidence interval [CI], 2.2-5.4 years) with a 5-year survival rate of 58.7%. Treatment failed in 37 eyes (23.7%), with a 5-year survival rate of 68.0% and an estimated time to 75% survival of 2.9 years (95% CI, 2.1-4.4 years). The risk for treatment failure was lower when treatment used adalimumab (odds ratio, 0.4; 95% CI, 0.2-0.9; P = 0.03) but was greater when systemic disease also was active at baseline (odds ratio, 3.2; 95% CI, 1.5-7.1; P = 0.004). CONCLUSIONS Overall, eyes treated with biologic agents after failure of treatment with corticosteroids and a second-line immunosuppression drug experienced satisfactory disease control (87.2%), reduced use of systemic immunosuppression, stable visual acuity, and a 23.7% risk of disease relapse. After multivariate adjustment, older age, treatment with adalimumab (versus infliximab), and inactive concomitant systemic disease were associated with a lower risk of treatment failure.
Collapse
Affiliation(s)
- Ahmed Al-Janabi
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Amgad El Nokrashy
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom; Mansoura Ophthalmic Center, Mansoura University, Cairo, Egypt
| | - Lazha Sharief
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Vivekka Nagendran
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Sue Lightman
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom; Technion, Institute of Technology, Bnai Zion Medical Center, Haifa, Israel.
| |
Collapse
|
31
|
Eiger-Moscovich M, Tomkins-Netzer O, Amer R, Habot-Wilner Z, Kasb A, Friling R, Kramer M. Visual and Clinical Outcome of Macular Edema Complicating Pediatric Noninfectious Uveitis. Am J Ophthalmol 2019; 202:72-78. [PMID: 30772346 DOI: 10.1016/j.ajo.2019.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/30/2018] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the clinical course and visual outcome of macular edema (ME) in pediatric patients with chronic noninfectious uveitis. DESIGN Retrospective case series. METHODS The databases of the uveitis clinics of 4 tertiary medical centers in Israel and the UK were searched for all children treated for uveitic ME in the years 2005-2015. Data were collected from the medical records as follows: demographics, diagnosis, visual acuity, clinical and imaging findings, and treatment given specifically for ME. Findings at baseline and at 3, 6, 12, and 24 months were evaluated. RESULTS The cohort included 25 children (33 eyes) of mean age 8.5 ± 3.4 years. The most common diagnosis was intermediate uveitis, in 14 children (7 idiopathic, 7 pars planitis). Uveitis was active at ME diagnosis in 28 eyes (84.8%). Median duration of follow-up was 48 months. Median time to resolution of ME was 6 months, with complete resolution in 25 eyes (75.8%) by 24 months. Baseline visual acuity was ≥20/40 in 8 eyes (24.2%), increased to 57.6% at 3 months (P < .0001), and remained stable thereafter. Treatment regimens included corticosteroids (systemically and/or locally), immunosuppression, and biologic therapies. No correlation was found between outcome and either structural characteristics of ME or specific treatment strategy. CONCLUSIONS The prognosis of pediatric uveitic ME is favorable despite its chronic course. Larger randomized controlled trials are needed to define differences among treatment regimens.
Collapse
Affiliation(s)
- Maya Eiger-Moscovich
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, University College London, London, United Kingdom; Department of Ophthalmology, Bnei Zion Medical Center, Israel Institute of Technology-Technion, Haifa, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah University Hospital, Hadassah Medical School, Jerusalem, Israel
| | - Zohar Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ahmed Kasb
- Moorfields Eye Hospital, University College London, London, United Kingdom
| | - Ronit Friling
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
32
|
Niederer RL, Al-Janabi A, Lightman SL, Tomkins-Netzer O. Serum Angiotensin-Converting Enzyme Has a High Negative Predictive Value in the Investigation for Systemic Sarcoidosis. Am J Ophthalmol 2019; 201:89. [PMID: 30739719 DOI: 10.1016/j.ajo.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
|
33
|
Lightman S, Niederer R, Sharma S, Hooper C, Tomkins-Netzer O, Kramer M, Damato EM, Peebo B, McCluskey P. Re: Hughes et al.: Cost-effectiveness analysis of adalimumab for the treatment of uveitis associated with juvenile idiopathic arthritis (Ophthalmology. 2019;126:415-424). Ophthalmology 2019; 126:e22-e24. [PMID: 30803528 DOI: 10.1016/j.ophtha.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/28/2018] [Accepted: 12/03/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sue Lightman
- University College London, Moorfields Eye Hospital, London, United Kingdom
| | | | - Srilakshmi Sharma
- Oxford Eye Hospital, Nuffield Laboratory of Ophthalmology, Oxford University hospitals NHS Trust, Oxford, United Kingdom
| | - Claire Hooper
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Oren Tomkins-Netzer
- University College London, Moorfields Eye Hospital, London, United Kingdom; Bnai Zion Medical Center, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Michal Kramer
- Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Erika Marie Damato
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Sydney, Australia
| |
Collapse
|
34
|
Niederer RL, Al-Janabi A, Lightman SL, Tomkins-Netzer O. Serum Angiotensin-Converting Enzyme Has a High Negative Predictive Value in the Investigation for Systemic Sarcoidosis. Am J Ophthalmol 2018; 194:82-87. [PMID: 30053466 DOI: 10.1016/j.ajo.2018.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To examine whether measurement of serum angiotensin-converting enzyme (ACE) is useful in diagnosing sarcoidosis in undifferentiated uveitis. DESIGN Evaluation of a diagnostic test. METHODS Data collection was performed from 1035 consecutive subjects presenting with uveitis to Moorfields Eye Hospital undergoing measurement of serum ACE as part of baseline investigations for underlying systemic disease. The main outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of elevated serum ACE. RESULTS Mean age of the sample was 41.7 years and 56.1% of subjects were female. Sarcoidosis was the underlying cause for the uveitis in 110 subjects (10.6%) and was more common in adults, female subjects, black subjects, and subjects with intermediate uveitis or panuveitis. ACE was elevated in 196 subjects (18.9%) and elevated levels were observed in 85 subjects eventually diagnosed with underlying sarcoidosis (true positive 77.3%) and in 111 subjects with an alternate diagnosis (false positive 12.0%). In adult subjects, sensitivity of serum ACE was 78.1%, specificity 90.0%, and PPV 43.6%, but the NPV was 97.0%. The test performed well, with area under curve (AUC) 0.897 (95% confidence interval [CI] 0.854-0.941). Serum ACE performed less well in distinguishing sarcoid uveitis in pediatric subjects, with sensitivity 60.0%, specificity 78.5%, and PPV 10.0%, but again NPV was high at 96.9% and AUC was 0.828 (95% CI 0.571-1.000). CONCLUSIONS Serum ACE had a very high negative predictive value for sarcoid uveitis, eliminating the need for further screening tests in subjects with normal serum ACE, unless clinical suspicion was high.
Collapse
|
35
|
Sharief L, Lightman S, Baltinas J, Tomkins-Netzer O. Long-term effect of cataract phacoemulsification on the inflammation control and clinical outcome in uveitis patients .. Clin Exp Ophthalmol 2018; 46:1048-1054. [PMID: 30073744 DOI: 10.1111/ceo.13369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Cataract is one of the most common complications associated with uveitis, and is the leading cause of vision loss in these patients. BACKGROUND The study aimed to evaluate the effect of phacoemulsification on the long-term clinical outcome and inflammation control in uveitis patients. DESIGN Longitudinal study. PARTICIPANTS Of 1907 eyes with uveitis, 309 eyes underwent phacoemulsification were compared to a control group of 300 phakic eyes with uveitis. METHOD The risk of vision loss and macular oedema in pseudophakic eyes were compared to the phakic group. The rates of corticosteroids administration and uveitis relapse were also measured in pseudophakic eyes and compared to preoperative period. MAIN OUTCOME MEASURES Change in uveitis activity post phacoemulsification by measuring rate of uveitis relapse and use of topical and systemic steroids. Also, to measure the risk of vision loss and macular oedema post surgery. RESULTS Over a median follow-up time of 6.7 years or 2249 eye-years (EY), pseudophakic eyes had a greater risk of vision loss (hazard ratio [HR] 2.4, CI 1.4 to 4.0; P < 0.001) and macular oedema (HR 2.2, CI 1.4 to 3.4, P < 0.001) compared to the phakic uveitis group. Over 5 years post-surgery, the annual rate of uveitis relapses was less than the same period pre surgery (-1.2, 95% CI -2.0 to -0.2, P = 0.012) with no significant change in the annual rate of using topical and systemic prednisolone >7.5 mg/day. CONCLUSIONS AND RELEVANCE There was no significant increase in uveitis relapse rate post-phacoemulsification with the use of current prophylactic inflammation control measures.
Collapse
Affiliation(s)
- Lazha Sharief
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,College of Medicine, Hawler Medical University, Erbil, Iraq
| | | | - Julijana Baltinas
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
36
|
Tomkins-Netzer O, Leong BCS, Zhang X, Lightman S, McCluskey PJ. Effect of Antituberculous Therapy on Uveitis Associated With Latent Tuberculosis. Am J Ophthalmol 2018; 190:164-170. [PMID: 29604284 DOI: 10.1016/j.ajo.2018.03.032] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the clinical features of patients with uveitis associated with latent tuberculosis (TB) and examine the effect of anti-TB treatment (ATT) on uveitis outcome. DESIGN Retrospective cohort study. METHODS One hundred ninety-nine eyes of 129 patients diagnosed with uveitis associated with latent TB were evaluated for recurrence of disease following treatment. Eighty-nine of the patients (69%) received ATT and information was gathered retrospectively regarding clinical outcome, vision, and treatment. Outcome measures included best-corrected visual acuity (BCVA) and rate of disease recurrence. RESULTS This study included 89 patients (69%) who received ATT and 40 patients who did not. The uveitis was treated with local and systemic anti-inflammatory and immunosuppressive therapy in all patients. The mean change in BCVA following treatment was 4.5 ± 1.4 letters over the follow-up period, with no difference between eyes of patients receiving ATT and those who did not. Sixty-eight eyes (34.9%) had a recurrence of uveitis (0.64 ± 0.08 recurrences per year), with eyes of patients receiving ATT less likely to develop a recurrence compared to those not receiving ATT (29.5% vs 48.2%, odds ratio 0.47, 95% confidence interval 0.29-0.77, P = .003). Eyes treated with ATT recurred at an estimated median of 120 months, compared with 51 months in eyes with no treatment (P = .005). CONCLUSIONS Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB.
Collapse
Affiliation(s)
- Oren Tomkins-Netzer
- UCL/Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Technion, Institute of Technology, Bnai Zion Medical Center, Haifa, Israel.
| | | | - Xiaozhe Zhang
- UCL/Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom
| | - Peter J McCluskey
- Save Sight Institute, Sydney Medical School, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia
| |
Collapse
|
37
|
Gilbert RM, Zhang X, Sampson RD, Ehrenstein MR, Nguyen DX, Chaudhry M, Mein C, Mahmud N, Galatowicz G, Tomkins-Netzer O, Calder VL, Lightman S. Clinical Remission of Sight-Threatening Non-Infectious Uveitis Is Characterized by an Upregulation of Peripheral T-Regulatory Cell Polarized Towards T-bet and TIGIT. Front Immunol 2018; 9:907. [PMID: 29774027 PMCID: PMC5943505 DOI: 10.3389/fimmu.2018.00907] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 09/30/2017] [Accepted: 04/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background Non-infectious uveitis can cause chronic relapsing and remitting ocular inflammation, which may require high dose systemic immunosuppression to prevent severe sight loss. It has been classically described as an autoimmune disease, mediated by pro-inflammatory Th1 and Th17 T-cell subsets. Studies suggest that natural immunosuppressive CD4+CD25+FoxP3+ T-regulatory cells (Tregs) are involved in resolution of inflammation and may be involved in the maintenance of clinical remission. Objective To investigate whether there is a peripheral blood immunoregulatory phenotype associated with clinical remission of sight-threatening non-infectious uveitis by comparing peripheral blood levels of Treg, Th1, and Th17, and associated DNA methylation and cytokine levels in patients with active uveitic disease, control subjects and patients (with previously active disease) in clinical remission induced by immunosuppressive drugs. Methods Isolated peripheral blood mononuclear cells (PBMC) from peripheral blood samples from prospectively recruited subjects were analyzed by flow cytometry for CD3, CD4, FoxP3, TIGIT, T-bet, and related orphan receptor γt. Epigenetic DNA methylation levels of FOXP3 Treg-specific demethylated region (TSDR), FOXP3 promoter, TBX21, RORC2, and TIGIT loci were determined in cryopreserved PBMC using a next-generation sequencing approach. Related cytokines were measured in blood sera. Functional suppressive capacity of Treg was assessed using T-cell proliferation assays. Results Fifty patients with uveitis (intermediate, posterior, and panuveitis) and 10 control subjects were recruited. The frequency of CD4+CD25+FoxP3+ Treg, TIGIT+ Treg, and T-bet+ Treg and the ratio of Treg to Th1 were significantly higher in remission patients compared with patients with active uveitic disease; and TIGIT+ Tregs were a significant predictor of clinical remission. Treg from patients in clinical remission demonstrated a high level of in vitro suppressive function compared with Treg from control subjects and from patients with untreated active disease. PBMC from patients in clinical remission had significantly lower methylation levels at the FOXP3 TSDR, FOXP3 promoter, and TIGIT loci and higher levels at RORC loci than those with active disease. Clinical remission was also associated with significantly higher serum levels of transforming growth factor β and IL-10, which positively correlated with Treg levels, and lower serum levels of IFNγ, IL-17A, and IL-22 compared with patients with active disease. Conclusion Clinical remission of sight-threatening non-infectious uveitis has an immunoregulatory phenotype characterized by upregulation of peripheral Treg, polarized toward T-bet and TIGIT. These findings may assist with individualized therapy of uveitis, by informing whether drug therapy has induced phenotypically stable Treg associated with long-term clinical remission.
Collapse
Affiliation(s)
- Rose M Gilbert
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Xiaozhe Zhang
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Robert D Sampson
- Flow Cytometry Core Facility, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Michael R Ehrenstein
- Division of Medicine, Centre for Rheumatology, University College London (UCL), London, United Kingdom
| | - Dao X Nguyen
- Division of Medicine, Centre for Rheumatology, University College London (UCL), London, United Kingdom
| | - Mahid Chaudhry
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Charles Mein
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Nadiya Mahmud
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Grazyna Galatowicz
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Oren Tomkins-Netzer
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Virginia L Calder
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Sue Lightman
- Ocular Immunology, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
38
|
Sharief LAT, Lightman S, Tomkins-Netzer O. Using Local Therapy to Control Noninfectious Uveitis. Ophthalmology 2018; 125:329-331. [DOI: 10.1016/j.ophtha.2017.09.033] [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: 07/25/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022] Open
|
39
|
Deitch I, Amer R, Tomkins-Netzer O, Habot-Wilner Z, Friling R, Neumann R, Kramer M. The effect of anti-tumor necrosis factor alpha agents on the outcome in pediatric uveitis of diverse etiologies. Graefes Arch Clin Exp Ophthalmol 2018; 256:801-808. [DOI: 10.1007/s00417-018-3928-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/14/2022] Open
|
40
|
Niederer RL, Gilbert R, Lightman SL, Tomkins-Netzer O. Risk Factors for Developing Choroidal Neovascular Membrane and Visual Loss in Punctate Inner Choroidopathy. Ophthalmology 2018; 125:288-294. [DOI: 10.1016/j.ophtha.2017.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/27/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022] Open
|
41
|
Niederer RL, Ahmed Talat Sharief L, Bar A, Lightman SL, Tomkins-Netzer O. Reply. Ophthalmology 2017. [DOI: 10.1016/j.ophtha.2017.02.010] [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: 11/29/2022] Open
|
42
|
Tomkins-Netzer O, Seguin-Greenstein S, Woronkowicz M, Lightman S. Aflibercept improves outcome in eyes with poor vision from neovascular age-related macular degeneration. Acta Ophthalmol 2017; 95:e342-e344. [PMID: 27654888 DOI: 10.1111/aos.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Oren Tomkins-Netzer
- Moorfields Eye Hospital; London UK
- UCL Institute of Ophthalmology; London UK
- Royal Surrey County Hospital; Guildford Surrey UK
- Bnai Zion Medical Center; Haifa Israel
| | | | | | - Sue Lightman
- Moorfields Eye Hospital; London UK
- UCL Institute of Ophthalmology; London UK
- Royal Surrey County Hospital; Guildford Surrey UK
| |
Collapse
|
43
|
Blum-Hareuveni T, Seguin-Greenstein S, Kramer M, Hareuveni G, Sharon Y, Friling R, Sharief L, Lightman S, Tomkins-Netzer O. Risk Factors for the Development of Cataract in Children with Uveitis. Am J Ophthalmol 2017; 177:139-143. [PMID: 28257832 DOI: 10.1016/j.ajo.2017.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 11/25/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the risk factors for the development of cataract in children with uveitis of any etiology. DESIGN Cohort study. METHODS Two hundred forty-seven eyes of 140 children with uveitis were evaluated for the development of vision-affecting cataract. Demographic, clinical, and treatment data were collected between the time of presentation and the first instance cataract was recorded or findings at final follow-up. Main outcome measures included the prevalence of cataract and distribution by type of uveitis, incidence of new onset cataract time to cataract development, and risk factors for the development of cataract. RESULTS The prevalence of cataract in our cohort was 44.2% and was highest among eyes with panuveitis (77.1%), chronic anterior uveitis (48.3%), and intermediate uveitis (48.0%). The overall incidence of newly diagnosed cataract was 0.09 per eye-year, with an estimated 69% to develop uveitis-related cataract with time. The main factors related with cataract development were the number of uveitis flares per year (hazard ratio [HR] = 3.06 [95% confidence interval {CI}, 2.15-4.35], P < .001), cystoid macular edema (HR = 2.87 [95% CI, 1.41-5.82], P = .004), posterior synechia at presentation (HR = 2.85 [95% CI, 1.53-5.30], P = .001), and use of local injections of corticosteroids (HR = 2.37 [95% CI, 1.18-4.75], P = .02). Treatments with systemic and topical corticosteroids were not significant risk factors. CONCLUSIONS In this study, we found that development of cataract is common among pediatric eyes with uveitis and is most strongly related to the extent of inflammation recurrences and ocular complications. We suggest that controlling the inflammation, even using higher doses of systemic and topical corticosteroids, is of importance in preventing ocular complications, such as cataract.
Collapse
Affiliation(s)
- Tamar Blum-Hareuveni
- Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, Galilee Medical Center, Naharia, Israel
| | | | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Hareuveni
- Department of Ophthalmology, Galilee Medical Center, Naharia, Israel
| | - Yael Sharon
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | - Ronit Friling
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petah-Tikva, Israel
| | - Lazha Sharief
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Sue Lightman
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, Bnai Zion Medical Center, Technion, Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
44
|
Gilbert R, Al-Janabi A, Tomkins-Netzer O, Lightman S. Statins as anti-inflammatory agents: A potential therapeutic role in sight-threatening non-infectious uveitis. Porto Biomed J 2017; 2:33-39. [PMID: 32258583 PMCID: PMC6806973 DOI: 10.1016/j.pbj.2017.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 10/05/2016] [Accepted: 01/05/2017] [Indexed: 12/29/2022] Open
Abstract
In addition to the known lipid-lowering effects, statins are now widely accepted to have anti-inflammatory and immunomodulatory effects. Adjunctive use of statins has proven beneficial in the context of a wide range of inflammatory diseases, including rheumatoid arthritis. Evidence also suggests that statins may also have utility in the management of uveitis, a form of sight threatening inflammation which occurs in the eye. In this article, we outline our rationale behind a clinical trial of simvastatin as a steroid-sparing agent in uveitis, to which patient recruitment started last year. Potential risks associated with the clinical use of statins, including putative effects on the eyes, are discussed.
Collapse
Affiliation(s)
- Rose Gilbert
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
| | - Ahmed Al-Janabi
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
| | - Sue Lightman
- Moorfields Eye Hospital, London, UK
- University College London (UCL) Institute of Ophthalmology, London, UK
| |
Collapse
|
45
|
Niederer RL, Sharief L, Bar A, Lightman SL, Tomkins-Netzer O. Predictors of Long-Term Visual Outcome in Intermediate Uveitis. Ophthalmology 2016; 124:393-398. [PMID: 28017424 DOI: 10.1016/j.ophtha.2016.11.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/02/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To describe factors that predict visual loss and complications in intermediate uveitis. DESIGN Cross-sectional study. PARTICIPANTS Subjects with intermediate uveitis were identified from a database of 1254 uveitis patients seen in the clinic of a single consultant (S.L.L.) between 2011 and 2013. METHODS Information was gathered from the clinical notes of all subjects examined in clinic. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), moderate visual loss (MVL; ≤20/50), severe visual loss (SVL; ≤20/200). RESULTS Three hundred and five subjects (550 eyes) were included in the study, comprising 24.3% of subjects seen in clinic. Mean (± standard deviation) age at diagnosis was 40.9±16.9 years, and 64.6% of subjects were female. Median follow-up was 8.2 years (mean, 9.7 years, 5452 eye-years). Systemic diagnosis was made in 36.1% of patients, with sarcoidosis (22.6%) and multiple sclerosis (4.6%) the most frequent systemic associations. Median BCVA was 20/30 (mean logarithm of the minimum angle of resolution [logMAR] 0.26±0.38, n = 550 eyes) at presentation, 20/30 (mean logMAR 0.22±0.42, n = 430) at 5 years, and 20/30 (mean logMAR 0.23±0.46, n = 260) at 10 years. Macular edema was observed in 224 eyes (40.7%) and was associated with idiopathic disease (P = 0.001) and diabetes (P = 0.001). Topical therapy was used in 82.7%, and 34.2% received local injections of corticosteroids. A total of 50.5% required oral steroids and 13.8% required second-line immunosuppression. Subjects with a diagnosis of sarcoidosis were less likely to require a second-line agent (4.3% vs. 16.2%, P = 0.011). On multivariate analysis, visual acuity at referral, retinal pigment epithelial atrophy, and macular scarring were associated with increased risk of MVL; and visual acuity at referral, local therapy, macular scarring, retinal detachment, and hypotony and phthisis were associated with increased risk of SVL. CONCLUSIONS Intermediate uveitis has a long disease course with frequent complications and often requires systemic treatment. Despite this, most subjects are still able to achieve good long-term visual outcomes.
Collapse
Affiliation(s)
- Rachael L Niederer
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; University College London (UCL), Institute of Ophthalmology, London, United Kingdom
| | - Lazha Sharief
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; University College London (UCL), Institute of Ophthalmology, London, United Kingdom
| | - Asaf Bar
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Sue L Lightman
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; University College London (UCL), Institute of Ophthalmology, London, United Kingdom
| | - Oren Tomkins-Netzer
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; University College London (UCL), Institute of Ophthalmology, London, United Kingdom; School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
46
|
Abstract
Vogt–Koyanagi–Harada syndrome is a cause of noninfectious panuveitis, leading to significant vision loss in many patients. It is an autoimmune disease occurring in genetically susceptible individuals and clinically presents as bilateral panuveitis with serous retinal detachments and hyperemic, swollen optic discs, which are associated with neurological and auditory manifestations. Early diagnosis and prompt and adequate treatment with immunosuppressive agents (corticosteroids and other immunosuppressive drugs) may halt disease progression and prevent recurrences and vision loss. This review summarizes the current knowledge on the variable clinical aspects of this disease, highlighting diagnostic and treatment strategies.
Collapse
Affiliation(s)
- Abeir Baltmr
- Uveitis Service, Moorfields Eye Hospital, London, UK
| | - Sue Lightman
- Uveitis Service, Moorfields Eye Hospital, London, UK; Department of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Uveitis Service, Moorfields Eye Hospital, London, UK; Department of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, UK; Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
47
|
Joshi L, Bar A, Tomkins-Netzer O, Yaganti S, Morarji J, Vouzounis P, Seguin-Greenstein S, Taylor SR, Lightman S. Intravitreal bevacizumab injections for diabetic macular edema - predictors of response: a retrospective study. Clin Ophthalmol 2016; 10:2093-2098. [PMID: 27799737 PMCID: PMC5085296 DOI: 10.2147/opth.s109809] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Outcomes of intravitreal antivascular endothelial growth factor injections are variable among patients with diabetic macular edema (DME). The aim of this study was to determine the ocular and systemic predictors of DME response to intravitreal bevacizumab (IVB). Methods Retrospective review over 2 years of 78 eyes from 54 patients. An anatomical response to IVB was defined as a 20% reduction in central macula thickness after the first course (three injections) of IVB. Results Twenty-eight percent of patients had an anatomical response after the first course of IVB. Systemic hypertension (odds ratio, 95% confidence interval: 12.1, 0.7–21) was a statistically significant predictor (P=0.025) of a good response to IVB, whereas previous macular laser was a statistically significant (P=0.0005) predictor of a poor response (0.07, 0.01–0.32). Sixty-eight percent of eyes underwent subsequent treatment for DME after the first course of IVB. The visual acuity gain at 24 months in hypertensive (0.7±3.6 letters) and nonhypertensive (5.2±3.7 letters) patients was not significantly different (P=0.41). Conclusion Hypertension and previous macular laser were positive and negative predictors of response to IVB, respectively. However, long-term visual acuity changes were not significantly different between eyes with and without systemic hypertension.
Collapse
Affiliation(s)
- Lavnish Joshi
- Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; Ophthalmology Department, Ashford & St Peter's NHS Foundation Trust, Ashford, Middlesex, UK; Ophthalmology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Asaf Bar
- Ophthalmology Department, Wolfson Medical Center, Holon Israel
| | - Oren Tomkins-Netzer
- Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; Ophthalmology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Satish Yaganti
- Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK
| | - Jiten Morarji
- Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK
| | - Panayiotis Vouzounis
- Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK
| | - Sophie Seguin-Greenstein
- Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; Ophthalmology Department, Wolfson Medical Center, Holon Israel
| | - Simon R Taylor
- Ophthalmology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; Ophthalmology Department, University of Surrey, Guildford, Surrey, UK
| | - Sue Lightman
- Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; Ophthalmology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| |
Collapse
|
48
|
Din NM, Talat L, Isa H, Tomkins-Netzer O, Barton K, Lightman S. Difference in glaucoma progression between the first and second eye after consecutive bilateral glaucoma surgery in patients with bilateral uveitic glaucoma. Graefes Arch Clin Exp Ophthalmol 2016; 254:2439-2448. [PMID: 27495303 PMCID: PMC5116308 DOI: 10.1007/s00417-016-3460-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/15/2016] [Accepted: 06/26/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine whether the second eyes (SE) of patients with bilateral uveitic glaucoma undergoing filtration surgery have more glaucomatous progression in terms of visual acuity, visual field (VF) and optic nerve changes compared to the first eyes (FE). METHODS This retrospective study analysed data of 60 eyes from 30 patients with bilateral uveitic glaucoma who had undergone glaucoma surgery in both eyes on separate occasions. Humphrey VF progression was assessed using the Progressor software. RESULTS The pre-operative IOP between the FE (43.1 ± 7.7 mmHg) and SE (40 ± 8.7 mmHg) was not statistically significant (p = 0.15). IOP reduction was greater in the FE (64 %) than SE (59.7 %) post-operatively, but the mean IOP at the final visit in the FE (12.3 ± 3.9 mmHg) and SE (14.5 ± 7 mmHg) was not statistically different (p = 0.2). There was no significant change in mean logMAR readings pre and post-operatively (0.45 ± 0.6 vs 0.37 ± 0.6, p = 0.4) or between the FE and SE. The number of SE with CDR > 0.7 increased by 23 % compared to the FE. From 23 available VFs, five SE (21.7 %) progressed at a median of five locations (range 1-11 points) with a mean local slope reduction of 1.74 ± 0.45 dB/year (range -2.39 to -1.26), whereas only one FE progressed. However, there was no significant difference between mean global rate of progression between the FE (-0.9 ± 1.6 dB/year) and SE (-0.76 ± 2.1 dB/year, p = 0.17) in the Humphrey VF. CONCLUSION In eyes with bilateral uveitic glaucoma requiring glaucoma surgery, the SEs had more progressed points on VF and glaucomatous disc progression compared to FEs at the final visit.
Collapse
Affiliation(s)
- Norshamsiah Md Din
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL UK
- UCL Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD UK
- Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Lazha Talat
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL UK
- UCL Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD UK
| | - Hazlita Isa
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL UK
- UCL Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD UK
- Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Oren Tomkins-Netzer
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL UK
- UCL Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD UK
| | - Keith Barton
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL UK
- UCL Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Sue Lightman
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL UK
- UCL Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD UK
| |
Collapse
|
49
|
Abstract
Corticosteroids are the cornerstone of treating intraocular inflammation, but may be inadequate in controlling the disease, or related side effects preclude long-term treatment. Additional immunosuppressive drugs are used in these cases to augment the effect of corticosteroids and allow for their reduction to safe levels while maintaining control of the ocular inflammation. Here we review the different classes of immunosuppressive drugs and discuss their effect on ocular inflammation.
Collapse
|
50
|
Isa H, Luthert P, Rose G, Verity D, Pusey C, Tomkins-Netzer O, Md Din N, Teak TL, Taylor S, Lightman S. Tissue Interleukin-17 and Interleukin-23 as Biomarkers for Orbital Granulomatosis with Polyangiitis. Ophthalmology 2015; 122:2140-2. [DOI: 10.1016/j.ophtha.2015.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/26/2022] Open
|