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Dohlman TH, Singh RB, Amparo F, Carreno-Galeano T, Dastjerdi M, Coco G, Di Zazzo A, Shikari H, Saboo U, Sippel K, Ciralsky J, Yoo SH, Sticca M, Wakamatsu TH, Murthy S, Hamrah P, Jurkunas U, Ciolino JB, Saeed H, Gomes JA, Perez VL, Yin J, Dana R. Suppression of Neovascularization by Topical and Subconjunctival Bevacizumab After High-Risk Corneal Transplantation. Ophthalmol Sci 2024; 4:100492. [PMID: 38682029 PMCID: PMC11046200 DOI: 10.1016/j.xops.2024.100492] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 05/01/2024]
Abstract
Purpose To assess the effectiveness of topical and subconjunctival bevacizumab in suppressing vascularization in graft and host bed after high-risk corneal transplantation. Design Secondary analysis of prospective, randomized, double-blind, placebo-controlled multicentric clinical trial. Participants The study includes patients aged > 18 years who underwent high-risk penetrating keratoplasty, which was defined as corneal vascularization in ≥ 1 quadrants of the corneal graft and host bed, excluding the limbus. Methods Patients were randomized to treatment and control groups. The patients in the treatment group received subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) on the day of the procedure, followed by topical bevacizumab (10 mg/ml) 4 times per day for 4 weeks. The patients in control group received injection of vehicle (0.9% sodium chloride) on the day of procedure, followed by topical vehicle (carboxymethylcellulose sodium 1%) 4 times a day for 4 weeks. Main Outcome Measures Vessel and invasion area of vessels in the corneal graft and host beds. Results This study included 56 eyes of 56 patients who underwent high-risk corneal transplantation, with equal numbers in the bevacizumab and vehicle (control) treatment groups. The mean age of patients who received bevacizumab was 61.2 ± 15.9 years, and the mean age of those treated with vehicle was 60.0 ± 16.1 years. The vessel area at baseline was comparable in the bevacizumab (16.72% ± 3.19%) and control groups (15.48% ± 3.12%; P = 0.72). Similarly, the invasion areas were also similar in the treatment (35.60% ± 2.47%) and control (34.23% ± 2.64%; P = 0.9) groups at baseline. The reduction in vessel area was significantly higher in the bevacizumab-treated group (83.7%) over a period of 52 weeks compared with the control group (61.5%; P < 0.0001). In the bevacizumab-treated group, invasion area was reduced by 75.8% as compared with 46.5% in the control group. The vessel area was similar at 52 weeks postprocedure in cases of first (3.54% ± 1.21%) and repeat (3.80% ± 0.40%) corneal transplantation in patients who received bevacizumab treatment. In the vehicle-treated patients, the vessel area was significantly higher in repeat (9.76% ± 0.32%) compared with first (8.06% ± 1.02%; P < 0.0001) penetrating keratoplasty. In the bevacizumab treatment group, invasion areas at week 52 were comparable in first (11.70% ± 3.38%) and repeat (11.64% ± 1.74%) procedures, whereas invasion area was significantly higher in repeat (27.87% ± 2.57%) as compared with first (24.11% ± 2.17%) penetrating keratoplasty in vehicle-treated patients. Conclusions In patients undergoing vascularized high-risk corneal transplantation, bevacizumab is efficacious in reducing vascularization of corneal graft and host bed, thereby reducing the risk of corneal graft rejection in vascularized host beds. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Thomas H. Dohlman
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rohan Bir Singh
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Francisco Amparo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tatiana Carreno-Galeano
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mohammad Dastjerdi
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Giulia Coco
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Antonio Di Zazzo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hasanain Shikari
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ujwala Saboo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Kimberly Sippel
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Jessica Ciralsky
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Matheus Sticca
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tais H. Wakamatsu
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Somasheila Murthy
- Cornea Service, The Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Pedram Hamrah
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Ula Jurkunas
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joseph B. Ciolino
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hajirah Saeed
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jose A.P. Gomes
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Victor L. Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Jia Yin
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Reza Dana
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Ruiz-Lozano RE, Ramos-Dávila EM, Colorado-Zavala MF, Quiroga-Garza ME, Azar NS, Mousa HM, Perez VL, Sainz-de-la-Maza M, Foster CS, Rodriguez-Garcia A. Clinical Course and Outcomes of Autoimmune Versus Non-Autoimmune Surgically Induced Scleral Necrosis: A Multicentric Comparative Study. Ocul Immunol Inflamm 2024:1-7. [PMID: 38759224 DOI: 10.1080/09273948.2024.2349914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND To analyze the clinical course and outcomes of autoimmune vs. non-autoimmune surgically induced scleral necrosis (SISN). METHODS Multicentric, retrospective, comparative cohort study. Eighty-two eyes of 70 patients with SISN were classified according to pathogenic mechanism into autoimmune vs. non-autoimmune. Main outcome measures included necrosis onset, type of surgery, associated systemic disease, visual acuity, and treatment were analysed in patients followed for ≥ 6 months. RESULTS Forty-six (65.7%) patients were women, and the median age was 66 (range: 24-90) years. Most patients (82.9%) had unilateral disease. The median time between surgery and SISN onset was 58 (1-480) months. Thirty-one (37.8%) eyes were classified as autoimmune, and 51 (62.2%) as non-autoimmune SISN. Autoimmune SISN was associated with a shorter time between the surgical procedure and SISN onset than non-autoimmune cases (median of 26 vs. 60 months, p = 0.024). Also, autoimmune SISN was associated with cataract extraction (93.5% vs. 25.5%, p < 0.001), severe scleral inflammation (58.1% vs. 17.6%, p < 0.001), and higher incidence of ocular complications (67.7% vs. 33.3%, p = 0.002) than non-autoimmune cases. Remission was achieved with medical management alone in 44 (86.3%) eyes from the non-autoimmune and in 27 (87.1%) from the autoimmune group (p = 0.916). Surgical management was required in 11 (13.4%) eyes, including two requiring enucleations due to scleral perforation and phthisis bulbi. CONCLUSIONS Eyes with autoimmune SISN had a higher rate of cataract surgery, severe scleral inflammation, and ocular complications. Early SISN diagnosis and appropriate management, based on clinical features and pathogenic mechanisms, are critical to avoid sight-threatening complications.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eugenia M Ramos-Dávila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Maria F Colorado-Zavala
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Manuel E Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nadim S Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Victor L Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - C Stephen Foster
- Harvard Medical School, Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
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Perez VL, Mousa HM, Miyagishima KJ, Reed AA, Su AJA, Greenwell TN, Washington KM. Retinal transplant immunology and advancements. Stem Cell Reports 2024:S2213-6711(24)00113-9. [PMID: 38729155 DOI: 10.1016/j.stemcr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Several gaps and barriers remain for transplanting stem cells into the eye to treat ocular disease, especially diseases of the retina. While the eye has historically been considered immune privileged, recent thinking has identified the immune system as both a barrier and an opportunity for eye stem cell transplantation. Recent approaches leveraging scaffolds or cloaking have been considered in other tissues beyond immune suppression. This perspective paper outlines approaches for transplantation and proposes opportunities to overcome barriers of the immune system in stem cell transplantation in the eye.
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Affiliation(s)
- Victor L Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Hazem M Mousa
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | | | - Amberlynn A Reed
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - An-Jey A Su
- Department of Surgery, University of Colorado School of Medicine, CU Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Thomas N Greenwell
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kia M Washington
- Department of Surgery, University of Colorado School of Medicine, CU Anschutz Medical Campus, Aurora, CO 80045, USA.
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Quiroga-Garza ME, Ruiz-Lozano RE, Rodriguez-Gutierrez LA, Khodor A, Ma S, Komai S, Mohamed-Noriega K, Perez VL. Lessons Learned From Ocular Graft versus Host Disease: An Ocular Surface Inflammatory Disease of Known Time of Onset. Eye Contact Lens 2024; 50:212-221. [PMID: 38518064 DOI: 10.1097/icl.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/24/2024]
Abstract
ABSTRACT The ocular surface inflammatory disorders (OSIDs) comprise a group of conditions characterized by persistent inflammation of the ocular surface and adnexal tissues. Systemic autoimmune diseases and hypersensitivity reactions cause them, and, if left untreated, can result in severe inflammatory dry eye, corneal damage, and vision loss. Ocular graft-versus-host disease (oGVHD) forms part of the ocular surface inflammatory disease umbrella. It is a condition occurring after allogeneic hematopoietic stem cell or bone marrow transplantation, usually in chronic graft-versus-host disease. oGVHD can virtually affect any ocular adnexal tissue, especially the meibomian glands, and cause persistent inflammation, tissue fibrosis, and subsequent chronic, severe dry eye disease. Among the OSIDs, oGVHD has the particularity that it has a "time zero," meaning we know when the disease started. As such, preclinical models have leveraged this to investigate the molecular mechanisms involved in the damage oGVHD causes to the ocular surface. In oGVHD, establishing a "time zero" allows for predicting the clinical course and establishing adequate treatment. This is also possible because the inflammatory infiltration occurs in ocular surface tissues, which are readily accessible. Using oGVHD, we might be able to understand the immune response mechanisms in other OSIDs better (i.e., Sjögren syndrome, Stevens-Johnson syndrome, among others). This review presents an up-to-date overview of the pathogenesis, clinical presentation, and treatment of oGVHD. In addition, we will discuss the value of the "time zero" concept in the study of oGVHD.
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Affiliation(s)
- Manuel E Quiroga-Garza
- Department of Ophthalmology (M.E.Q.-G., R.E.R.-L., S.M., S.K., V.L.P.), Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC; Bascom Palmer Eye Institute (M.E.Q.-G., R.E.R.-L., L.A.R.-G., A.K., S.M., S.K., V.L.P.), University of Miami, Miami, FL; and Department of Ophthalmology (K.M.-N.), University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey, Mexico
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Beatty CJ, Ruiz-Lozano RE, Quiroga-Garza ME, Perez VL, Jester JV, Saban DR. The Yin and Yang of non-immune and immune responses in meibomian gland dysfunction. Ocul Surf 2024; 32:81-90. [PMID: 38224775 DOI: 10.1016/j.jtos.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
Meibomian gland dysfunction (MGD) is a leading cause of dry eye disease and one of the most common ophthalmic conditions encountered in eye clinics worldwide. These holocrine glands are situated in the eyelid, where they produce specialized lipids, or meibum, needed to lubricate the eye surface and slow tear film evaporation - functions which are critical to preserving high-resolution vision. MGD results in tear instability, rapid tear evaporation, changes in local microflora, and dry eye disease, amongst other pathological entities. While studies identifying the mechanisms of MGD have generally focused on gland obstruction, we now know that age is a major risk factor for MGD that is associated with abnormal cell differentiation and renewal. It is also now appreciated that immune-inflammatory disorders, such as certain autoimmune diseases and atopy, may trigger MGD, as demonstrated through a T cell-driven neutrophil response. Here, we independently discuss the underlying roles of gland and immune related factors in MGD, as well as the integration of these two distinct mechanisms into a unified perspective that may aid future studies. From this unique standpoint, we propose a revised model in which glandular dysfunction and immunopathogenic pathways are not primary versus secondary contributors in MGD, but are fluid, interactive, and dynamic, which we likened to the Yin and Yang of MGD.
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Affiliation(s)
- Cole J Beatty
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA; Duke Eye Center, Duke University School of Medicine, Foster Center for Ocular Immunology at Duke Eye Center, Durham, NC, USA
| | - Raul E Ruiz-Lozano
- Duke Eye Center, Duke University School of Medicine, Foster Center for Ocular Immunology at Duke Eye Center, Durham, NC, USA
| | - Manuel E Quiroga-Garza
- Duke Eye Center, Duke University School of Medicine, Foster Center for Ocular Immunology at Duke Eye Center, Durham, NC, USA
| | - Victor L Perez
- Duke Eye Center, Duke University School of Medicine, Foster Center for Ocular Immunology at Duke Eye Center, Durham, NC, USA.
| | - James V Jester
- Department of Ophthalmology and Biomedical Engineering, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA.
| | - Daniel R Saban
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA; Duke Eye Center, Duke University School of Medicine, Foster Center for Ocular Immunology at Duke Eye Center, Durham, NC, USA.
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Ayres BD, Bloomenstein MR, Loh J, Chester T, Saenz B, Ehegoyen J, Kannarr SR, Perez VL, Rodriguez TC, Dickerson JE. A Randomized, Controlled Trial Comparing Tearcare ® and Cyclosporine Ophthalmic Emulsion for the Treatment of Dry Eye Disease (SAHARA) [Response To Letter]. Clin Ophthalmol 2024; 18:885-886. [PMID: 38525381 PMCID: PMC10961084 DOI: 10.2147/opth.s468297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
| | | | | | | | - Bobby Saenz
- Rosenberg School of Optometry, San Antonio, TX, USA
- LASIK San Antonio, Kerrville, TX, USA
| | - Julio Ehegoyen
- Gordon Schanzlin New Vision Institute, La Jolla, CA, USA
| | | | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
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Ruiz-Lozano RE, Colorado-Zavala MF, Ramos-Dávila EM, Quiroga-Garza ME, Azar NS, Mousa HM, Hernández-Camarena JC, Stinnett SS, Daluvoy M, Kim T, Sainz-de-la-Maza M, Hall RP, Rodriguez-Garcia A, Perez VL. Ocular Mucous Membrane Pemphigoid: The Effect of Risk Factors at Presentation on Treatment Outcomes. Ophthalmology 2024:S0161-6420(24)00167-2. [PMID: 38452874 DOI: 10.1016/j.ophtha.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Analyze the influence of risk factors at presentation in the long-term immunosuppressive therapy (IMT) outcomes of ocular mucous membrane pemphigoid (OMMP). DESIGN Retrospective multicenter study. PARTICIPANTS Patients with OMMP seen at the Duke Eye Center, Tecnologico de Monterrey, and Hospital Clinic of Barcelona from 1990 to 2022. METHODS Data at presentation on demographics, direct immunofluorescence, ocular findings, sites of extraocular manifestations (EOMs), and previous treatments in patients with a clinical or laboratory diagnosis of OMMP, were analyzed with multivariable analysis and Kaplan-Meier plots to identify factors associated with adverse outcomes. MAIN OUTCOME MEASURES (1) Inflammatory control (no conjunctival inflammation in both eyes at 3 months on IMT); (2) relapse (new-onset inflammation after absolute control in either eye); (3) progression (≥ 1 cicatrizing stage progression in either eye); and (4) vision loss (≥ 2 Snellen lines). RESULTS A total of 117 patients (234 eyes), 61% (71/117) of whom were women, with a mean age of 66.6 (SD: 12.4) years (range: 37-97 years) and median follow-up of 34 months (interquartile range: 16-66 months; range: 3-265 months), were enrolled. Inflammatory control was achieved in 57% of patients (67/117), with high-risk EOM (HR-EOM), including esophageal, nasopharyngeal, and/or genital involvement (adjusted odds ratio [aOR]: 12.51; 95% confidence interval [CI]: 2.61-59.99; P = 0.002) and corneal scarring (aOR: 3.06; 95% CI, 1.15-8.14; P = 0.025), as significant risk factors for persistent inflammation. Disease relapse, progression, and vision loss occurred in 20% of patients (23/117), 12% of patients (14/117), and 27% of patients (32/117), respectively. Baseline corneal scarring was a risk factor for relapse (adjusted hazard ratio: 4.14; 95% CI: 1.61-10.62; P = 0.003), progression (aOR: 11.46; 95% CI: 1.78-73.75; P = 0.010), and vision loss (aOR: 3.51; 95% CI: 1.35-9.10; P = 0.010). HR-EOM was associated with stage progression (aOR, 34.57; 95% CI, 6.57-181.89; P<0.001) and vision loss (aOR, 8.42; 95% CI, 2.50-28.42; P = 0.001). No significant differences were found between IMT regimes and relapse (P = 0.169). CONCLUSIONS Ocular mucous membrane pemphigoid presenting with HR-EOMs and corneal scarring has an increased risk of stage progression and vision loss. Corneal scarring and severe inflammation at baseline were associated with an increased risk of relapse. A disease progression staging system incorporating both the HR-EOMs and corneal involvement is required to predict the visual outcome of OMMP better. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Maria F Colorado-Zavala
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Eugenia M Ramos-Dávila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Manuel E Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Nadim S Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Hazem M Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Julio C Hernández-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico
| | - Sandra S Stinnett
- Associate Professor of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Melissa Daluvoy
- Department of Ophthalmology, Cornea and External Disease Service at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Terry Kim
- Department of Ophthalmology, Cornea and External Disease Service at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Maite Sainz-de-la-Maza
- Department of Ophthalmology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Russell P Hall
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Ocular Immunology and Uveitis Service, Monterrey, Mexico.
| | - Victor L Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
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Donnenfeld E, Baudouin C, Galor A, Weissgerber G, He Y, Perez VL. Pharmacogenomic Analysis of Response to Topical Tumor Necrosis Factor α Antagonist Licaminlimab (OCS-02) in Dry Eye Disease. Cornea 2024:00003226-990000000-00501. [PMID: 38416549 DOI: 10.1097/ico.0000000000003510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/10/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the pharmacogenomics of response to topical ocular tumor necrosis factor α (TNFα) inhibitor licaminlimab in patients with DED. METHODS Three single-nucleotide polymorphisms (SNPs) associated with Sjögren syndrome, 3 in the TNFα gene and 1 in the TNF receptor 1 (TNFR1) gene, were assessed for association with response to licaminlimab in participants from a randomized, vehicle-controlled, Phase 2 study in which adults with DED and severe ocular discomfort persisting despite treatment with artificial tears received licaminlimab or vehicle for 6 weeks. Response was assessed for change from baseline in Global Ocular Discomfort score at Day 29 of treatment. The pharmacogenomic analysis was a prospectively specified exploratory objective of the study. mRNA expression for TNFα, interleukin (IL) 1β, and IL8 in conjunctival epithelium cells was determined. The relationship between SNPs and response to licaminlimab was assessed using a mixed model repeated measures analysis. RESULTS SNP rs1800693 in the TNFR1 gene showed a significant effect on response to licaminlimab (P < 0.0001, initial association test); no effect was seen for any of the other SNPs tested. The CC genotype of rs1800693 was associated with much greater response to licaminlimab than the CT or TT genotypes: LS mean changes from baseline to Day 29 in Global Ocular Discomfort score were -29.5, -0.09, and -3.90, in patients with the CC, CT, and TT genotypes, respectively (P < 0.0001). No significant effect was observed in vehicle-treated patients. Improvements from baseline were seen in 3/4 licaminlimab-treated participants with the CC genotype. Conjunctival epithelium cell levels of mRNA for TNFα, IL1β, and IL8 decreased from baseline in participants with the CC genotype, but not with the CT or TT genotypes. Between-genotype differences in mRNA levels were not observed in participants receiving vehicle. CONCLUSIONS The CC genotype of rs1800693, relatively common in patients with DED, was strongly associated with response to licaminlimab and decreased inflammatory cytokine gene expression in ocular surface cells during treatment. This study is one of the first to our knowledge to investigate pharmacogenomics in the treatment of DED.
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Affiliation(s)
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Anat Galor
- Miami Veteran Affairs Medical Center and Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | | | | | - Victor L Perez
- Foster Center for Ocular Immunology at Duke Eye Center, Duke University, Durham, NC
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Arboleda A, Prajna NV, Lalitha P, Srinivasan M, Rajaraman R, Krishnan T, Mousa HM, Feghali J, Acharya NR, Lietman TM, Perez VL, Rose-Nussbaumer J. Validation of the C-DU(KE) Calculator as a Predictor of Outcomes in Patients Enrolled in Steroids for Corneal Ulcer and Mycotic Ulcer Treatment Trials. Cornea 2024; 43:166-171. [PMID: 37335849 DOI: 10.1097/ico.0000000000003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/10/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE The aim of this study was to validate the C-DU(KE) calculator as a predictor of treatment outcomes on a data set derived from patients with culture-positive ulcers. METHODS C-DU(KE) criteria were compiled from a data set consisting of 1063 cases of infectious keratitis from the Steroids for Corneal Ulcer Trial (SCUT) and Mycotic Ulcer Treatment Trial (MUTT) studies. These criteria include corticosteroid use after symptoms, visual acuity, ulcer area, fungal etiology, and elapsed time to organism-sensitive therapy. Univariate analysis was performed followed by multivariable logistic regressions on culture-exclusive and culture-inclusive models to assess for associations between the variables and outcome. The predictive probability of treatment failure, defined as the need for surgical intervention, was calculated for each study participant. Discrimination was assessed using the area under the curve for each model. RESULTS Overall, 17.9% of SCUT/MUTT participants required surgical intervention. Univariate analysis showed that decreased visual acuity, larger ulcer area, and fungal etiology had a significant association with failed medical management. The other 2 criteria did not. In the culture-exclusive model, 2 of 3 criteria, decreased vision [odds ratio (OR) = 3.13, P < 0.001] and increased ulcer area (OR = 1.03, P < 0.001), affected outcomes. In the culture-inclusive model, 3 of 5 criteria, decreased vision (OR = 4.9, P < 0.001), ulcer area (OR = 1.02, P < 0.001), and fungal etiology (OR = 9.8, P < 0.001), affected results. The area under the curves were 0.784 for the culture-exclusive model and 0.846 for the culture-inclusive model which were comparable to the original study. CONCLUSIONS The C-DU(KE) calculator is generalizable to a study population from large international studies primarily taking place in India. These results support its use as a risk stratification tool assisting ophthalmologists in patient management.
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Affiliation(s)
- Alejandro Arboleda
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA
| | | | - Prajna Lalitha
- Aravind Eye Care System, Aravind Eye Hospital, Tamil Nadu, India
| | | | | | | | - Hazem M Mousa
- Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC
| | - James Feghali
- Department of Ophthalmology and Francis I. Proctor Foundation, University of California, San Francisco, CA
| | - Nisha R Acharya
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Thomas M Lietman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Victor L Perez
- Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC
| | - Jennifer Rose-Nussbaumer
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD; and
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Ayres BD, Bloomenstein MR, Loh J, Chester T, Saenz B, Echegoyen J, Kannarr SR, Perez VL, Rodriguez TC, Dickerson Jr JE. A Randomized, Controlled Trial Comparing Tearcare ® and Cyclosporine Ophthalmic Emulsion for the Treatment of Dry Eye Disease (SAHARA). Clin Ophthalmol 2023; 17:3925-3940. [PMID: 38143559 PMCID: PMC10741761 DOI: 10.2147/opth.s442971] [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: 10/25/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose We compare outcomes in eyes with dry eye disease (DED) treated with TearCare (TC) or topical cyclosporine 0.05% (RESTASIS; CsA). Setting Nineteen ophthalmic and optometric practices in 11 US states. Design Multicenter, randomized, assessor-masked, controlled IRB-approved trial. Eligible subjects: ≥22 years of age, dry eye symptoms within 3-6 months, Tear Break-up Time (TBUT) ≥1 to ≤7 s, Meibomian Gland Secretion Score (MGSS) ≤12, Ocular Surface Disease Index (OSDI) of 23-79. Randomized (1:1) to TC or CsA. TC subjects treated at baseline and month 5; CsA was twice daily for 6 months. Methods Follow-up visits were scheduled for Day 1, Week 1, Months 1, 3, and 6 with primary inference at Month 6. Primary outcomes: TBUT and OSDI; secondary outcomes: MGSS, conjunctival and corneal staining, eye dryness score (EDS), symptoms assessment in dry eye (SANDE) score, and Schirmer tear score (STS). Safety assessments included adverse events, best corrected visual acuity, intraocular pressure, and slit-lamp findings. Results Overall, 345 subjects, 172 TC and 173 CsA. TBUT improved at all time points in both groups (p<0.0001), with statistically greater improvement for TC versus CsA (p=0.0006). OSDI improved significantly at all time points in both groups (p<0.0001) with no significant differences between treatments. MGSS and other measures of meibomian gland function improved significantly more with TC eyes versus CsA; other secondary outcomes showed significant improvements in both groups with no difference between groups. Treatment-related adverse events were uncommon (10 total, 8 in the CsA group consistent with prior CsA studies); most (9/10) mild. Conclusion TC provides statistically superior and sustained improvement in TBUT and multiple measures of meibomian gland secretion, and non-inferior improvement in OSDI, corneal and conjunctival staining, SANDE, EDS, and STS versus CsA. TC should be a preferred treatment for DED associated with MGD.
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Affiliation(s)
| | | | | | | | - Bobby Saenz
- Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, TX, USA
- LASIK San Antonio, Kerrville, TX, USA
| | | | | | - Victor L Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | | | - Jaime E Dickerson Jr
- Sight Sciences, Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
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11
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Carletti P, Sepulveda Beltran PA, Levine H, Dubovy SR, Perez VL, Amescua G. Long-Term Comprehensive Management of Bilateral Limbal Stem Cell Deficiency Secondary to Severe Chemical Burn: 10 Years of Follow-Up. Ocul Immunol Inflamm 2023; 31:1629-1634. [PMID: 35816015 DOI: 10.1080/09273948.2022.2090965] [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: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe the long-term management of bilateral limbal stem cell deficiency secondary to a severe chemical burn. METHODS Descriptive case report. IMPORTANCE This case highlights the importance of early intervention in ocular chemical burns for the preservation of tissue integrity and avoidance of perforation. We also review the use of proper ocular surface reconstructive techniques to restore the function of the limbal area, as well as the immunomodulatory strategies and follow-up needed for these interventions.
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Affiliation(s)
- Piero Carletti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Harry Levine
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor L Perez
- Duke Eye Center, Duke University, Durham, North Carolina, USA
- Foster Center for Ocular Immunology, Duke University, Durham, North Carolina, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Zemborain ZZ, Soifer M, Azar NS, Murillo S, Mousa HM, Perez VL, Farsiu S. Open-Source Automated Segmentation of Neuronal Structures in Corneal Confocal Microscopy Images of the Subbasal Nerve Plexus With Accuracy on Par With Human Segmentation. Cornea 2023; 42:1309-1319. [PMID: 37669422 PMCID: PMC10635613 DOI: 10.1097/ico.0000000000003319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/24/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE The aim of this study was to perform automated segmentation of corneal nerves and other structures in corneal confocal microscopy (CCM) images of the subbasal nerve plexus (SNP) in eyes with ocular surface diseases (OSDs). METHODS A deep learning-based 2-stage algorithm was designed to perform segmentation of SNP features. In the first stage, to address applanation artifacts, a generative adversarial network-enabled deep network was constructed to identify 3 neighboring corneal layers on each CCM image: epithelium, SNP, and stroma. This network was trained/validated on 470 images of each layer from 73 individuals. The segmented SNP regions were further classified in the second stage by another deep network as follows: background, nerve, neuroma, and immune cells. Twenty-one-fold cross-validation was used to assess the performance of the overall algorithm on a separate data set of 207 manually segmented SNP images from 43 patients with OSD. RESULTS For the background, nerve, neuroma, and immune cell classes, the Dice similarity coefficients of the proposed automatic method were 0.992, 0.814, 0.748, and 0.736, respectively. The performance metrics for automatic segmentations were statistically better or equal as compared to human segmentation. In addition, the resulting clinical metrics had good to excellent intraclass correlation coefficients between automatic and human segmentations. CONCLUSIONS The proposed automatic method can reliably segment potential CCM biomarkers of OSD onset and progression with accuracy on par with human gradings in real clinical data, which frequently exhibited image acquisition artifacts. To facilitate future studies on OSD, we made our data set and algorithms freely available online as an open-source software package.
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Affiliation(s)
| | - Matias Soifer
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Nadim S. Azar
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Sofia Murillo
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Victor L. Perez
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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13
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Steven P, Perez VL, Sharma A. Murine models of graft versus host disease (GVHD): Focus on ocular GVHD. Ocul Surf 2023; 30:179-186. [PMID: 37742740 PMCID: PMC10841907 DOI: 10.1016/j.jtos.2023.09.006] [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] [Received: 07/02/2023] [Revised: 09/12/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Abstract
Graft versus host disease (GVHD) remains a major and serious complication of allogeneic hematopoietic stem cell transplantation. Based on the time of onset, clinical phenotypes, progression kinetics, and pathophysiology, GVHD is stratified into acute, chronic, and overlapping types. The eyes are among the most commonly affected organs in GVHD. Mouse models have played an important role in understanding the several key elements of GVHD pathobiology. The current review discusses the immunology, pathology, and key phenotypic features of mouse models of systemic GVHD. Furthermore, a critical appraisal of mouse models of ocular GVHD (oGVHD) is provided. The disease mechanisms underlying the ocular surface, meibomian gland, and lacrimal gland injury in these models are reviewed, and the relevance of oGVHD murine models to clinical oGVHD is also included.
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Affiliation(s)
- Philipp Steven
- Department of Ophthalmology, Division for Dry-Eye and Ocular GVHD, Medical Faculty, University of Cologne, Cologne, Germany
| | - Victor L Perez
- Foster Center for Ocular Immunology, Department of Ophthalmology, Duke University School of Medicine, United States
| | - Ajay Sharma
- Chapman University School of Pharmacy, Chapman University, Irvine, CA, United States.
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14
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Azar NS, Ruiz-Lozano RE, Quiroga-Garza ME, Soifer M, Mousa HM, Komai S, Leverenz DL, Perez VL. Delayed presentation of surgically induced scleral necrosis after I-BRITE procedure treated with immunosuppressive therapy. Digit J Ophthalmol 2023; 29:77-82. [PMID: 37780039 PMCID: PMC10539002 DOI: 10.5693/djo.02.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Surgically induced scleral necrosis (SISN) is an uncommon complication of ocular procedures. Cosmetic eye-whitening surgery involves conjunctival and Tenon's capsule dissection, cautery, and mitomycin C application. We report the case of a 36-year-old white woman referred to our clinic for severe pain, scleral inflammation, and necrosis in both eyes 9 years after I-BRITE, an elective eye-whitening procedure. An extensive workup yielded negative results. The patient improved with aggressive lubrication and topical and high-dose systemic prednisone (60 mg), with recurrence upon steroid tapering. Concomitant weekly methotrexate was added, resulting in inflammatory control and allowing discontinuance of topical and oral steroids.
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Affiliation(s)
- Nadim S. Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of M and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Manuel E. Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Matias Soifer
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Hazem M. Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Seitaro Komai
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - David L. Leverenz
- Department of Medicine, Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina
| | - Victor L. Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
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15
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Ruiz-Lozano RE, Azar NS, Mousa HM, Quiroga-Garza ME, Komai S, Wheelock-Gutierrez L, Cartes C, Perez VL. Ocular surface disease: a known yet overlooked side effect of topical glaucoma therapy. Front Toxicol 2023; 5:1067942. [PMID: 37547228 PMCID: PMC10403269 DOI: 10.3389/ftox.2023.1067942] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/14/2023] [Indexed: 08/08/2023] Open
Abstract
Ocular surface disease (OSD), a disorder affecting the lacrimal and meibomian glands and the corneal and conjunctival epithelium, is a well-known complication of topical glaucoma therapy. OSD can present as a new or pre-existing condition that virtually any anti-glaucoma formulation can exacerbate. As such, both glaucoma and OSD frequently coexist. Typical OSD symptoms include ocular discomfort, redness, burning, and dryness, whereas signs include periorbital and eyelid skin pigmentation, conjunctival scarring, and superficial punctate keratitis. Pressure-lowering eyedrops can cause toxic, allergic, and inflammatory reactions on the ocular surface. The latter can result from either preservatives or direct toxicity from the active molecule. Although usually mild, OSD can cause significant symptoms that lead to poor quality of life, decreased compliance to therapy, glaucoma progression, and worse visual outcomes. Given the chronic nature of glaucoma, lack of curative therapy, and subsequent lifelong treatment, addressing OSD is necessary. This manuscript aims to provide an up-to-date overview of OSD's signs, symptoms, and pathogenic mechanisms from glaucoma therapy toxicity.
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Affiliation(s)
- Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Monterrey, Mexico
| | - Nadim S. Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | - Hazem M. Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | - Manuel E. Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | - Seitaro Komai
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | | | - Cristian Cartes
- Unidad Oftalmología, Departamento de Especialidades, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Victor L. Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
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16
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [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: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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17
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Snyder AJ, Mousa HM, Soifer M, Jammal AA, Aggarwal S, Perez VL. Increasing Rates of Herpes Zoster Ophthalmicus and the COVID-19 Pandemic. Res Sq 2023:rs.3.rs-2891711. [PMID: 37215036 PMCID: PMC10197788 DOI: 10.21203/rs.3.rs-2891711/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose This epidemiologic study evaluates the variance in incidence of Herpes Zoster (HZ) and Herpes Zoster Ophthalmicus (HZO) within a single healthcare system with an aim to analyze their relationship to the COVID-19 pandemic. Methods All patients attending the Duke University Health System (DUHS) from January 1, 2018, to December 31, 2021, were included. General and COVID-related trends of HZO and HZ were analyzed based on new ICD-9 or ICD-10 diagnosis codes, compared with the total number of patients seen at DUHS during this period, and the number of reported COVID-19 cases in North Carolina obtained using the CDC data tracker. Results This study included 16,287 cases of HZ of whom 1,294 (7.94%) presented with HZO. The overall incidence of HZO showed an average yearly increase of 5.6%, however HZ incidence decreased by 5.3% per year. When comparing incidence rates of HZO in the 12-months before and after the COVID-19 pandemic onset in the United States (March 2020), the average incidence from March 2020 to February 2021 was 27.6 ± 11.6 compared to 18.0 ± 2.7 from March 2019 to February 2020 (p = 0.01). Moreover, 10/12 (83.3%) of the months had a higher incidence rate of HZO in the post-COVID onset year compared to their corresponding month in the pre-COVID year. Conclusion The results show HZO incidence may be increasing, despite an overall lower HZ incidence. This could suggest a distinct mechanism for HZO appearance. The COVID pandemic, directly or indirectly, may have accelerated the already increasing HZO incidence.
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18
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Ruiz-Lozano RE, Salan-Gomez M, Rodriguez-Garcia A, Quiroga-Garza ME, Ramos-Dávila EM, Perez VL, Azar NS, Merayo-Lloves J, Hernandez-Camarena JC, Valdez-García JE. Wessely corneal ring phenomenon: An unsolved pathophysiological dilemma. Surv Ophthalmol 2023:S0039-6257(23)00041-3. [PMID: 36882129 DOI: 10.1016/j.survophthal.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
The cornea is a densely innervated, avascular tissue showing exceptional inflammatory and immune responses. The cornea is a site of lymphangiogenic and angiogenic privilege devoid of blood and lymphatic vessels that limits the entry of inflammatory cells from the adjacent and highly immunoreactive conjunctiva. Immunological and anatomical differences between the central and peripheral cornea are also necessary to sustain passive immune privilege. The lower density of antigen-presenting cells in the central cornea and the 5:1 peripheral-to-central corneal ratio of C1 are 2 main features conferring passive immune privilege. C1 activates the complement system by antigen-antibody complexes more effectively in the peripheral cornea and, thus, protects the central corneas' transparency from immune-driven and inflammatory reactions. Wessely rings, also known as corneal immune rings, are non-infectious ring-shaped stromal infiltrates usually formed in the peripheral cornea. They result from a hypersensitivity reaction to foreign antigens, including those of microorganism origin. Thus, they are thought to be composed of inflammatory cells and antigen-antibody complexes. Corneal immune rings have been associated with various infectious and non-infectious causes, including foreign bodies, contact lens wear, refractive procedures, and drugs. We describe the anatomical and immunologic basis underlying Wessely ring formation, its causes, clinical presentation, and management.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Marcelo Salan-Gomez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Manuel E Quiroga-Garza
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, United States
| | - Eugenia M Ramos-Dávila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Victor L Perez
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, United States
| | - Nadim S Azar
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, United States
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernández Vega, Universidad de Oviedo, Oviedo, Spain
| | - Julio C Hernandez-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Jorge E Valdez-García
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico.
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Abstract
Inflammation is an important driver of dry eye disease (DED) pathogenesis. An initial insult that results in the loss of tear film homeostasis can initiate a nonspecific innate immune response that leads to a chronic and self-sustaining inflammation of the ocular surface, which results in classic symptoms of dry eye. This initial response is followed by a more prolonged adaptive immune response, which can perpetuate and aggravate inflammation and result in a vicious cycle of chronic inflammatory DED. Effective anti-inflammatory therapies can help patients exit this cycle, and effective diagnosis of inflammatory DED and selection of the most appropriate treatment are therefore key to successful DED management and treatment. This review explores the cellular and molecular mechanisms of the immune and inflammatory components of DED, and examines the evidence base for the use of currently available topical treatment options. These agents include topical steroid therapy, calcineurin inhibitors, T cell integrin antagonists, antibiotics, autologous serum/plasma therapy, and omega-3 fatty acid dietary supplements.
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Affiliation(s)
- Victor L Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina. USA
| | - Francis S Mah
- Scripps Clinic Torrey Pines, La Jolla, California, USA
| | - Mark Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stephen Pflugfelder
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
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Perez VL, Mousa HM, Soifer M, Beatty C, Sarantopoulos S, Saban DR, Levy RB. Meibomian Gland Dysfunction: A Route of Ocular Graft-Versus-Host Disease Progression That Drives a Vicious Cycle of Ocular Surface Inflammatory Damage. Am J Ophthalmol 2023; 247:42-60. [PMID: 36162534 PMCID: PMC10270654 DOI: 10.1016/j.ajo.2022.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Received: 03/31/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate the role of aggressive meibomian gland dysfunction (MGD) in the immune pathogenesis of ocular graft-vs-host disease (GVHD). METHODS In mice, an allogeneic GVHD model was established by transferring bone marrow (BM) and purified splenic T cells from C57BL/6J mice into irradiated C3-SW.H2b mice (BM+T). Control groups received BM only. Mice were scored clinically across the post-transplantation period. MGD severity was categorized using the degree of atrophy on harvested lids. Immune disease was analyzed using flow cytometry of tissues along with fluorescent tracking of BM cells onto the ocular surface. In humans, parameters from 57 patients with ocular GVHD presenting to the Duke Eye Center were retrospectively reviewed. MGD was categorized using the degree of atrophy on meibographs. Immune analysis was done using high-parameter flow cytometry on tear samples. RESULTS Compared with BM only, BM+T mice had higher systemic disease scores that correlated with tear fluid loss and eyelid edema. BM+T had higher immune cell infiltration in the ocular tissues and higher CD4+-cell cytokine expression in draining lymph nodes. BM+T mice with worse MGD scores had significantly worse corneal staining. In patients with ocular GVHD, 96% had other organs affected. Patients with ocular GVHD had abnormal parameters on dry eye testing, high matrix metalloproteinase-9 positivity (92%), and abundance of immune cells in tear samples. Ocular surface disease signs were worse in patients with higher MGD severity scores. CONCLUSIONS Ocular GVHD is driven by a systemic, T-cell-dependent process that causes meibomian gland damage and induces a robust form of ocular surface disease that correlates with MGD severity. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Victor L Perez
- Foster Center for Ocular Immunology, Department of Ophthalmology (V.L.P., H.M.M., M.S.); Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.).
| | - Hazem M Mousa
- Foster Center for Ocular Immunology, Department of Ophthalmology (V.L.P., H.M.M., M.S.); Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Matias Soifer
- Foster Center for Ocular Immunology, Department of Ophthalmology (V.L.P., H.M.M., M.S.); Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Cole Beatty
- Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Stefanie Sarantopoulos
- Division of Hematological Malignancies and Cellular Therapy, Duke University Department of Medicine, Duke Cancer Institute (S.S.) Durham, North Carolina
| | - Daniel R Saban
- Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Robert B Levy
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida (R.B.L.), USA
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Quiroga-Garza ME, Ruiz-Lozano RE, Azar NS, Mousa HM, Komai S, Sevilla-Llorca JL, Perez VL. Noxious effects of riot control agents on the ocular surface: Pathogenic mechanisms and management. Front Toxicol 2023; 5:1118731. [PMID: 36733462 PMCID: PMC9887149 DOI: 10.3389/ftox.2023.1118731] [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: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Riot Control Agents (RCAs) are chemical compounds used by law enforcement agencies to quell violent demonstrations as an alternative to lethal force and as part of police/military training. They are also known as tear gases because of the hallmark ocular irritation and lacrimation they cause. The most common RCAs include oleoresin capsicum (contained in Mace and pepper spray), chlorobenzylidene malononitrile, dibenzoxazepine, and chloroacetophenone (previously the main content of Mace); some of which have been in use for decades. Their immediate incapacitating effects are mediated through polymodal afferent fibers innervating the corneal surface, inducing the release of peptides that cause neurogenic inflammation. Although previously thought to have only transient effects on exposed patients more severe complications such as corneal stromal opacities, corneal neovascularization, neurotrophic keratopathy, conjunctival necrosis, and pseudopterygium can occur. Concerningly, the lack of research and specific therapies restrict the current management to decontamination and symptom-tailored support. This manuscript will provide an overview of the toxic mechanisms of RCAs, their clinical manifestations, and current therapy after exposure to tear gases.
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Affiliation(s)
- Manuel E. Quiroga-Garza
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Nadim S. Azar
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Seitaro Komai
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Jose L. Sevilla-Llorca
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Victor L. Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States,*Correspondence: Victor L. Perez,
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22
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Navas A, Graue-Hernández EO, Perez VL, Garfias Y. Editorial: Dry eye disease syndrome. Front Med (Lausanne) 2023; 9:1104593. [PMID: 36687451 PMCID: PMC9846630 DOI: 10.3389/fmed.2022.1104593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Alejandro Navas
- Cell and Tissue Biology and Cornea Departments, Instituto de Oftalmología Fundación de Asistencia Privada Conde de Valenciana, I.A.P, Mexico City, Mexico,*Correspondence: Alejandro Navas ✉
| | - Enrique O. Graue-Hernández
- Cell and Tissue Biology and Cornea Departments, Instituto de Oftalmología Fundación de Asistencia Privada Conde de Valenciana, I.A.P, Mexico City, Mexico,Enrique O. Graue-Hernández ✉
| | - Victor L. Perez
- Department of Ophthalmology, School of Medicine, Duke University, Durham, NC, United States,Victor L. Perez ✉
| | - Yonathan Garfias
- Cell and Tissue Biology and Cornea Departments, Instituto de Oftalmología Fundación de Asistencia Privada Conde de Valenciana, I.A.P, Mexico City, Mexico,Department of Biochemistry, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico,Yonathan Garfias ✉
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23
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Xie J, Gao Q, Del Prado ZN, Venkateswaran N, Mousa HM, Salero E, Ye J, De Juan-Pardo EM, Sabater AL, Perez VL. Establishment of a bi-layered tissue engineered conjunctiva using a 3D-printed melt electrowritten poly-(ε-caprolactone) scaffold. Int Ophthalmol 2023; 43:215-232. [PMID: 35932420 PMCID: PMC9902434 DOI: 10.1007/s10792-022-02418-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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To utilize melt electrowriting (MEW) technology using poly-(ε-caprolactone) (PCL) coupled with a 2-step co-culturing strategy for the development of a conjunctival bi-layer synthetic construct. METHODS Melt electrowritten scaffolds using PCL were fabricated using an in-house-built MEW printer. Human conjunctival stromal cells (CjSCs) and epithelial cells (CjECs) were isolated from donor tissue. A 2-step co-culture method was done by first seeding the CjSCs and culturing for 4 weeks to establish a stromal layer, followed by CjECs and co-culturing for 2 more weeks. Cultured cells were each characterized by morphology and marker expression on immunofluorescence and qPCR. The produced construct was assessed for cellular proliferation using viability assays. The bi-layer morphology was assessed using scanning electron microscopy (SEM), confocal microscopy, and immunofluorescence imaging. The expression of extracellular matrix components and TGF-b was evaluated using qPCR. RESULTS CjSCs were spindle-shaped and vimentin + while CjECs were polygonal and CK13 + . CjSCs showed consistent proliferation and optimal adherence with the scaffold at the 4-week culture mark. A 2-layered construct consisting of a CjSC-composed stromal layer and a CjEC-composed epithelial layer was appreciated on confocal microscopy, SEM, and immunofluorescence. CjSCs secreted collagens (types I, V, VI) but at differing amounts from natural tissue while TGF-b production was comparable. CONCLUSION The 3D-printed melt electrowritten PCL scaffold paired with the 2-step co-culturing conditions of the scaffold allowed for the first approximation of a bi-layered stromal and epithelial reconstruction of the conjunctiva that can potentially improve the therapeutic arsenal in ocular surface reconstruction.
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Affiliation(s)
- Jiajun Xie
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Gao
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zelmira Nuñez Del Prado
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nandini Venkateswaran
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology, Distinguished Stephen and Frances Foster Chair in Ocular Immunology, Duke Eye Center, 2351 Erwin Road, Durham, NC, 27705, USA
| | - Enrique Salero
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan Ye
- Department of Ophthalmology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Elena M De Juan-Pardo
- Institute for Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Alfonso L Sabater
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victor L Perez
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Ophthalmology, Foster Center for Ocular Immunology, Distinguished Stephen and Frances Foster Chair in Ocular Immunology, Duke Eye Center, 2351 Erwin Road, Durham, NC, 27705, USA.
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Soifer M, Azar NS, Blanco R, Mousa HM, Ghalibafan S, Tovar A, Mettu PS, Allingham MJ, Cousins SW, Sabater AL, Perez VL. Fluorescein CorneoGraphy (FCG): Use of a repurposed fluorescein imaging technique to objectively standardize corneal staining. Ocul Surf 2023; 27:77-79. [PMID: 36464234 PMCID: PMC10037539 DOI: 10.1016/j.jtos.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
Punctate epithelial erosion (PEE) is a corneal sign of dry eye disease (DED), which is observable via staining with fluorescein on slit lamp as a standard of clinical practice and clinical research. There are currently many limitations for detecting PEE, such as lack of optimal excitation with cobalt blue light, difficulty to focus on the whole cornea, observer dependency and no available automatized quantification. We propose to reduce these limitations through repurposing the use of fluorescein angiography mode of optical coherence tomography (OCT, Heidelberg Spectralis II, Germany), as “fluorescein corneography” (FCG) for imaging PEE. A standard methodology was created using 50 patients with corneal staining and 10 healthy volunteers who were imaged on both slit lamp and FCG on two centers. Subsequently, two masked cornea specialists graded slit lamp and FCG images of 15 patients using the National Eye Institute (NEI) scale. FCG showed both a higher interobserver agreement (IOA), and a higher intraclass correlation coefficient (ICC) than slit lamp (0.96 vs 0.86, p<0.001). Light- colored iris patients showed a statistically significant lower mean of epitheliopathy on slit lamp compared to FCG (6.11 vs 8.94; p=0.026), which was not the case with dark-colored iris patients (8.16 vs 8.25; p=0.961) In conclusion we present an OCT-FA system for robust detection of PEE which has major implications in both clinical practice and research endpoints since it is highly sensitive, rigorous, reproducible in different facilities and offers potential for a numerical quantification and automatization of dry-eye corneal staining
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Affiliation(s)
- Matias Soifer
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA; National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nadim S Azar
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Ricardo Blanco
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Seyyedehfatemeh Ghalibafan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arianna Tovar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Priyatham S Mettu
- Duke Center for Macular Diseases, Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Michael J Allingham
- Duke Center for Macular Diseases, Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Scott W Cousins
- Duke Center for Macular Diseases, Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Alfonso L Sabater
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victor L Perez
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA.
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Ogawa Y, Dana R, Kim S, Jain S, Rosenblatt MI, Perez VL, Clayton JA, Alves M, Rocha EM, Amparo F, Seo KY, Wang Y, Shen J, Oh JY, Vanathi M, Nair S, Na KS, Riemens A, Sippel K, Soifer M, Wang S, Trindade M, Kim MK, Yoon CH, Yagi R, Hiratsuka R, Ogawa M, Shimizu E, Sato Y, Pflugfelder S, Tsubota K. Multicenter prospective validation study for international chronic ocular graft-versus-host disease consensus diagnostic criteria. Ocul Surf 2022; 26:200-208. [PMID: 36130695 DOI: 10.1016/j.jtos.2022.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To validate the international chronic ocular graft-versus-host disease (GVHD) diagnostic criteria (ICCGVHD) compared to the National Institute of Health diagnostic criteria 2014 (NIH2014) for chronic ocular GVHD. METHODS Between 2013 and 2019, the study enrolled 233 patients with or without chronic ocular GVHD combined with the presence or absence of systemic chronic GVHD in an internationally prospective multicenter and observational cohort from 9 institutions. All patients were evaluated for four clinical parameters of ICCGVHD. RESULTS The relation between the ICCGVHD score (0-11) and NIH2014 eye score (0-4) was relatively high (r = 0.708, 95% CI: 0.637-0.767, p < 0.001). The sensitivity and specificity of ICCGVHD for NIH 2014 for 233 patients were 94.3% (95% CI: 89.6%-98.1%) and 71.7% (95% CI: 63.0-79.5%), respectively (cutoff value of the ICCGVHD score = 6). The positive predictive value was 77.1% (95% CI: 71.1%-82.1%), and the negative predictive value was 87.0% (95% CI:81.6-92.5%). For the patients with systemic GVHD (n = 171), the sensitivity and specificity were 94.2% and 67.2%, respectively (ICCGVHD-score cutoff value = 6). By receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.903 (95% CI: 0.859-0.948). For patients without systemic GVHD (n = 62), the sensitivity and specificity were 100% and 76.7%, respectively (ICCGVHD-score cutoff value = 6). The AUC was 0.891 (95% CI 0.673-1.000). CONCLUSIONS Good sensitivity, specificity, predictive value and correlation were found between ICCGVHD and NIH2014. ICCGVHD scores ≥6 can be useful to diagnose ocular GVHD with or without systemic GVHD for clinical research.
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Affiliation(s)
- Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Reza Dana
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Massachusetts, USA
| | - Stella Kim
- Department of Ophthalmology & Visual Science, University of Texas Health Science Center, Texas, USA; MD Anderson Cancer Center, Texas, USA
| | - Sandeep Jain
- Department of Ophthalmology and Visual Sciences, Illinois University Chicago, Illinois, USA
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois University Chicago, Illinois, USA
| | - Victor L Perez
- Department of Ophthalmology, Bascom Parmer Institute, Miami, USA; Department of Ophthalmology, Duke University, North Carolina, USA
| | - Janine A Clayton
- Department of Ophthalmology, National Institute of Health, Maryland, USA
| | - Monica Alves
- Department of Ophthalmology, School of Medical Sciences University of Campinas, Campinas, Brazil
| | | | - Francisco Amparo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Massachusetts, USA
| | - Kyoung Yul Seo
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yan Wang
- Department of Ophthalmology, Fudan University, Eye and ENT Hospital, Shanghai, China
| | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic, Arizona, USA
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Murugesan Vanathi
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sridevi Nair
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kyung-Sun Na
- Department of Ophthalmology & Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Anjo Riemens
- Department of Ophthalmology, University of Utrecht, Utrecht, the Netherlands
| | - Kimberly Sippel
- Department of Ophthalmology, Weill Cornell Medical School, New York, New York, USA
| | - Matias Soifer
- Department of Ophthalmology, Duke University, North Carolina, USA
| | - Shudan Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Massachusetts, USA
| | - Marilia Trindade
- Department of Ophthalmology, School of Medical Sciences University of Campinas, Campinas, Brazil
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ryuichiro Yagi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ryo Hiratsuka
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Stephen Pflugfelder
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Tsubota Laboratory, Inc., Tokyo, Japan
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Dohlman TH, McSoley M, Amparo F, Carreno-Galeano T, Wang M, Dastjerdi M, Singh RB, Coco G, Di Zazzo A, Shikari H, Saboo U, Sippel K, Ciralsky J, Yoo SH, Sticca M, Wakamatsu TH, Murthy S, Hamrah P, Jurkunas U, Ciolino JB, Gomes JAP, Perez VL, Yin J, Dana R. Bevacizumab in High-Risk Corneal Transplantation: A Pilot Multicenter Prospective Randomized Control Trial. Ophthalmology 2022; 129:865-879. [PMID: 35358592 PMCID: PMC10742165 DOI: 10.1016/j.ophtha.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To determine the efficacy of local (subconjunctival and topical) bevacizumab (Avastin) treatment in patients undergoing vascularized high-risk corneal transplantation. DESIGN Pilot, prospective, randomized, double-blind, placebo-controlled clinical trial conducted at 5 clinical centers in the United States, India, and Brazil. PARTICIPANTS Patients aged > 18 years undergoing high-risk penetrating keratoplasty, defined as corneal neovascularization (NV) in 1 or more quadrants ≥2 mm from the limbus or extension of corneal NV to the graft-host junction in a previously failed graft. METHODS Patients were randomized to receive subconjunctival bevacizumab (2.5 mg/0.1 ml) or placebo at the time of surgery, followed by topical bevacizumab (10 mg/ml) or topical placebo, administered 4 times per day for 4 weeks. MAIN OUTCOME MEASURE The 52-week endothelial immune rejection rate. RESULTS Ninety-two patients were randomized to receive bevacizumab (n = 48) or control (n = 44). The 52-week endothelial rejection rate was 10% in the bevacizumab group and 19% in the control group (P = 0.20). Post hoc, extended follow-up at the lead study site showed an endothelial rejection rate of 3% in the bevacizumab group and 38% in the control group (P = 0.003). Treatment with bevacizumab was found to have a hazard ratio of 0.15 (95% confidence interval, 0.03-0.65, P = 0.01) in a post hoc Cox regression analysis. CONCLUSIONS In patients undergoing vascularized high-risk corneal transplantation, there was no statistically significant difference in the rate of endothelial rejection at 1 year in the bevacizumab treatment group compared with the control group. This study may have been underpowered to detect a difference between treatment groups, and taken together, our data suggest that, in the current trial design, bevacizumab has a positive but not (yet) significant effect on endothelial rejection.
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Affiliation(s)
- Thomas H Dohlman
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Matthew McSoley
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Francisco Amparo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tatiana Carreno-Galeano
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mengyu Wang
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mohammad Dastjerdi
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rohan Bir Singh
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Giulia Coco
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Antonio Di Zazzo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hasanain Shikari
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ujwala Saboo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Kimberly Sippel
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Jessica Ciralsky
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Matheus Sticca
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tais H Wakamatsu
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Somasheila Murthy
- Cornea Service, The Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Pedram Hamrah
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Ula Jurkunas
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joseph B Ciolino
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jose A P Gomes
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Foster Center for Ocular Immunology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Jia Yin
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Reza Dana
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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Soifer M, Azar NS, Mousa HM, Perez VL. Ocular Surface Inflammatory Disorders (OSID): A Collective of Systemic Etiologies Which Cause or Amplify Dry Eye Syndrome. Front Med (Lausanne) 2022; 9:949202. [PMID: 35872765 PMCID: PMC9301237 DOI: 10.3389/fmed.2022.949202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
The ocular surface inflammatory disorders (OSID) are caused by systemic disorders that conduct a persistent inflammatory reaction in the ocular adnexal connective tissues, such as the conjunctiva, lacrimal gland (LG) and meibomian glands (MGs), which cause an inflammatory dry eye. The etiologies of OSID are a subset of systemic pathologies such as graft versus host disease, Sjögren’s syndrome, allergies, cicatrizing conjunctivitis, and more. These cause a purely inflammatory dry eye syndrome as a consequence of the persistent surrounding inflammation in the adnexal tissues, which is distinct from the age-related dry eye disease. A limitation toward management of these conditions is the lack of available biomarkers that can detect presence of inflammation and quantify damage on the conjunctiva and LG, even though these are considered to be drivers of the inflammatory milieu. The OSID and dry eye syndrome are caused by different immune cells which are not exclusively limited to T cell lymphocytes, but rather derive from an orchestrated multicellular immunologic response. Recognition of this syndrome is crucial to direct research in a direction that clarifies the potential role of inflammation and its associated immune phenotype on the conjunctiva and adnexal ocular tissues in OSID and dry eye syndrome. On this paper, we review the basic and clinical research evidence for the existence of OSID with focus on the different immune cells involved, the target tissues and potential consequences and OSIDs diagnostic and therapeutic implications.
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Affiliation(s)
- Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Nadim S. Azar
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Hazem M. Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Victor L. Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
- *Correspondence: Victor L. Perez,
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Copsel SN, Wolf D, Pfeiffer B, Barreras H, Perez VL, Levy RB. Recipient Tregs: Can They Be Exploited for Successful Hematopoietic Stem Cell Transplant Outcomes? Front Immunol 2022; 13:932527. [PMID: 35799783 PMCID: PMC9253768 DOI: 10.3389/fimmu.2022.932527] [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: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 02/03/2023] Open
Abstract
Human and mouse CD4+FoxP3+ T cells (Tregs) comprise non-redundant regulatory compartments which maintain self-tolerance and have been found to be of potential therapeutic usefulness in autoimmune disorders and transplants including allogeneic hematopoietic stem cell transplantation (allo-HSCT). There is substantial literature interrogating the application of donor derived Tregs for the prevention of graft versus host disease (GVHD). This Mini-Review will focus on the recipient's Tregs which persist post-transplant. Although treatment in patients with low dose IL-2 months post-HSCT are encouraging, manipulating Tregs in recipients early post-transplant is challenging, in part likely an indirect consequence of damage to the microenvironment required to support Treg expansion of which little is understood. This review will discuss the potential for manipulating recipient Tregs in vivo prior to and after HSCT (fusion proteins, mAbs). Strategies that would circumvent donor/recipient peripheral blood harvest, cell culture and ex-vivo Treg expansion will be considered for the translational application of Tregs to improve HSCT outcomes.
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Affiliation(s)
- Sabrina N. Copsel
- Department of Microbiology and Immunology, University of Miami School of Medicine, Miami, FL, United States
| | - Dietlinde Wolf
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States
| | - Brent Pfeiffer
- Department of Pediatrics, University of Miami School of Medicine, Miami, FL, United States
| | - Henry Barreras
- Department of Microbiology and Immunology, University of Miami School of Medicine, Miami, FL, United States
| | - Victor L. Perez
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, United States
| | - Robert B. Levy
- Department of Microbiology and Immunology, University of Miami School of Medicine, Miami, FL, United States,Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States,Department of Ophthalmology, University of Miami School of Medicine, Miami, FL, United States,*Correspondence: Robert B. Levy,
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Soifer M, Tovar A, Wang M, Mousa HM, Yennam S, Sabater AL, Pflugfelder S, Perez VL. A multicenter report of the use of plasma rich in growth factors (PRGF) for the treatment of patients with ocular surface diseases in North America. Ocul Surf 2022; 25:40-48. [PMID: 35489588 DOI: 10.1016/j.jtos.2022.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 01/27/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the efficacy and safety of plasma rich in growth factors (PRGF) eyedrops in the management of patients with ocular surface diseases in North America. METHODS Multicenter interventional case series of patients using PRGF eyedrops for the first time. A cohort of patients was analyzed for corneal staining score at initial visit and at 3 months of therapy with PRGF. Another cohort responded to a 10-item questionnaire that evaluated patients' satisfaction and safety, which included the symptom assessment questionnaire in dry eye (SANDE) score, after 6 months of PRGF treatment. RESULTS A total of 153 patients were analyzed. Of these, 102 were reviewed for corneal epitheliopathy and 99 patients responded to the questionnaire. The mean (±SD) age of the population was 63.7 ± 17 years and 72.5% were female. The clinical indications for PRGF usage were dry eye (60%), neurotrophic keratopathy (15%), dormant corneal ulcers (12%), limbal stem cell deficiency (10%), and cicatrizing conjunctivitis (4%). At the final visit, 74.3% of patients showed an improvement of their corneal staining. Those who had punctate epithelial erosions or epithelial defects were reduced from 76.5% to 47% and 23.5%-7.8% respectively (p < 0.0001). Symptoms, measured via SANDE score, significantly decreased from a median of 90 to 34.6 out of 100 points on follow-up (p < 0.0001). Only one patient (0.98%) complained of ocular burning sensation as a side effect. CONCLUSIONS This multicentric study demonstrates the safety and efficacy of the use of PRGF for treating signs and symptoms in patients with significant ocular surface diseases.
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Affiliation(s)
- Matias Soifer
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Arianna Tovar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret Wang
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Sowmya Yennam
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Alfonso L Sabater
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Victor L Perez
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA.
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Murillo SE, Soifer M, Perez VL. Ocular Graft Versus Host Disease: Just a Severe Form of Dry Eye or Something More? Curr Ophthalmol Rep 2022. [DOI: 10.1007/s40135-022-00281-9] [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: 11/24/2022]
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Song A, Mousa HM, Soifer M, Perez VL. Recognizing vitamin A deficiency: special considerations in low-prevalence areas. Curr Opin Pediatr 2022; 34:241-247. [PMID: 35125379 PMCID: PMC8891082 DOI: 10.1097/mop.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas. RECENT FINDINGS Vitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in at-risk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD. SUMMARY Even in well resourced countries, VAD should remain on the differential in patients with risk factors who present with relevant signs and symptoms. Early diagnosis and appropriate involvement of a multidisciplinary care team can help prevent morbidity and mortality associated with VAD.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, NC, USA
| | - Hazem M Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
| | - Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
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Ortiz-Morales G, Loya-Garcia D, Colorado-Zavala MF, Gomez-Elizondo DE, Soifer M, Srinivasan B, Agarwal S, Rodríguez-Garcia A, Perez VL, Amescua G, Iyer G. The evolution of the modified osteo-odonto-keratoprosthesis, its reliability, and long-term visual rehabilitation prognosis: An analytical review. Ocul Surf 2022; 24:129-144. [DOI: 10.1016/j.jtos.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
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Birnbaum FA, Mirzania D, Swaminathan SS, Davis AR, Perez VL, Herndon LW. Risk Factors for Corneal Striae in Eyes After Glaucoma Surgery. J Glaucoma 2022; 31:116-122. [PMID: 34049351 DOI: 10.1097/ijg.0000000000001888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Eyes with corneal striae had steeper cornea, induced astigmatism, and higher corneal hysteresis (CH), which implies a relationship between striae, corneal shape, and the cornea's resistance to deformation at low intraocular pressures (IOPs). BACKGROUND Anterior corneal striae (ACS) are associated with low IOP. However, the clinical significance of ACS is unclear. Here, we aim to evaluate differences in eyes with striae compared with eyes without striae. METHODS Adults with ACS (cases) and without ACS (controls) ≥8 weeks after glaucoma surgery with an IOP ≤10 mm Hg were enrolled. Optical coherence tomography and optical biometry were performed. CH, defined as the difference in pressure between corneal indentation and reformation in response to an air jet, was obtained by the ocular response analyzer. Hypotony maculopathy (HM) was defined as optic disc swelling, vascular tortuosity attributed to hypotony, or clinical presence of chorioretinal folds confirmed on OCT. RESULTS One hundred sixteen eyes (76 cases, 40 controls) were included. Cases had a lower IOP compared with controls (6.5±2.3 vs. 8.5±1, P<0.0001). A 1 mm Hg increase in CH increased ACS odds [odds ratio (OR)=1.51, P=0.01]. A 1 D increase in the flattest presurgical and postsurgical corneal power increased ACS odds by 1.83 (P=0.01) and 1.41 (P=0.02), respectively. Astigmatism increased in eyes with ACS by 1.11 D (P<0.001). ACS odds were increased with every 1 minute increase in mitomycin-C duration (OR=1.58, P=0.047) and decreased with the use of topical glaucoma medication (OR=0.62, P=0.03). Visual acuity decreased from logarithm of the minimal angle of resolution 0.22 (20/33 Snellen) presurgery to 0.28 (20/38) postsurgery (P=0.008), independent of ACS. HM occurred in 19% of cases (P=0.05). A higher postsurgical CH increased HM odds (OR=1.8, P=0.003). HM predicted a 0.41 mm decrease in axial length (P<0.0001), independent of IOP. CONCLUSION ACS were associated with a steeper cornea, induced astigmatism, and higher CH, suggesting a relationship between striae, corneal shape, and the cornea's ability to resist deformations at lower IOP. CH, HM, and axial length shortening were associated independently of IOP.
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Affiliation(s)
| | | | - Swarup S Swaminathan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
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Levy RB, Mousa HM, Lightbourn CO, Shiuey EJ, Latoni D, Duffort S, Flynn R, Du J, Barreras H, Zaiken M, Paz K, Blazar BR, Perez VL. Analyses and Correlation of Pathologic and Ocular Cutaneous Changes in Murine Graft versus Host Disease. Int J Mol Sci 2021; 23:184. [PMID: 35008621 PMCID: PMC8745722 DOI: 10.3390/ijms23010184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
Abstract
Graft versus host disease (GVHD) is initiated by donor allo-reactive T cells activated against recipient antigens. Chronic GVHD (cGVHD) is characterized by immune responses that may resemble autoimmune features present in the scleroderma and Sjogren's syndrome. Unfortunately, ocular involvement occurs in approximately 60-90% of patients with cGVHD following allo-hematopoietic stem cell transplants (aHSCT). Ocular GVHD (oGVHD) may affect vision due to ocular adnexa damage leading to dry eye and keratopathy. Several other compartments including the skin are major targets of GVHD effector pathways. Using mouse aHSCT models, the objective was to characterize cGVHD associated alterations in the eye and skin to assess for correlations between these two organs. The examination of multiple models of MHC-matched and MHC-mismatched aHSCT identified a correlation between ocular and cutaneous involvement accompanying cGVHD. Studies detected a "positive" correlation, i.e., when cGVHD-induced ocular alterations were observed, cutaneous compartment alterations were also observed. When no or minimal ocular signs were detected, no or minimal skin changes were observed. In total, these findings suggest underlying cGVHD-inducing pathological immune mechanisms may be shared between the eye and skin. Based on the present observations, we posit that when skin involvement is present in aHSCT patients with cGVHD, the evaluation of the ocular surface by an ophthalmologist could potentially be of value.
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Affiliation(s)
- Robert B. Levy
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (C.O.L.); (S.D.); (H.B.)
| | - Hazem M. Mousa
- School of Medicine, Duke University, Durham, NC 27708, USA; (H.M.M.); (E.J.S.); (D.L.)
| | - Casey O. Lightbourn
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (C.O.L.); (S.D.); (H.B.)
| | - Eric J. Shiuey
- School of Medicine, Duke University, Durham, NC 27708, USA; (H.M.M.); (E.J.S.); (D.L.)
| | - David Latoni
- School of Medicine, Duke University, Durham, NC 27708, USA; (H.M.M.); (E.J.S.); (D.L.)
| | - Stephanie Duffort
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (C.O.L.); (S.D.); (H.B.)
| | - Ryan Flynn
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapy, University of Minnesota, Minneapolis, MN 55455, USA; (R.F.); (J.D.); (M.Z.); (K.P.); (B.R.B.)
| | - Jing Du
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapy, University of Minnesota, Minneapolis, MN 55455, USA; (R.F.); (J.D.); (M.Z.); (K.P.); (B.R.B.)
| | - Henry Barreras
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (C.O.L.); (S.D.); (H.B.)
| | - Michael Zaiken
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapy, University of Minnesota, Minneapolis, MN 55455, USA; (R.F.); (J.D.); (M.Z.); (K.P.); (B.R.B.)
| | - Katelyn Paz
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapy, University of Minnesota, Minneapolis, MN 55455, USA; (R.F.); (J.D.); (M.Z.); (K.P.); (B.R.B.)
| | - Bruce R. Blazar
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapy, University of Minnesota, Minneapolis, MN 55455, USA; (R.F.); (J.D.); (M.Z.); (K.P.); (B.R.B.)
| | - Victor L. Perez
- School of Medicine, Duke University, Durham, NC 27708, USA; (H.M.M.); (E.J.S.); (D.L.)
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Soifer M, Gomez-Caraballo M, Venkateswaran N, Jay GW, Perez VL. Associated Neurotrophic Keratopathy in Complex Regional Pain Syndrome. Cornea 2021; 40:1600-1603. [PMID: 33591037 DOI: 10.1097/ico.0000000000002684] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of neurotrophic keratopathy (NK) in a patient with complex regional pain syndrome (CRPS) with ipsilateral facial involvement. METHODS Case report. RESULTS An 18-year old woman with a 5-year history of CRPS type I, a systemic disorder with a neuropathic component with associated limb and right facial involvement, presented with an insidious onset of blurred vision and pain in the right eye. Ocular examination revealed decreased corneal sensation, as measured by Cochet-Bonnet testing, associated with recurrent epithelial defects and whorl-like superficial corneal epitheliopathy. NK was suspected and confirmed by in vivo confocal microscopy (IVCM), which revealed rarefaction of the subbasal nerve plexus in the affected eye. To enhance corneal nerve health, plasma rich in growth factors drops were used. Persistence of NK prompted a superficial keratectomy with placement of an amniotic membrane graft and a course of cenegermin 0.002% (Oxervate; Dompé Farmaceutici SpA, Italy) in the postoperative period. This combination therapy resulted in successful epithelial closure and vision improvement after 8 weeks of therapy with no recurrence of disease for 11 months. Importantly, at that final visit, IVCM demonstrated growth of corneal nerves for the first time in this patient. CONCLUSIONS This is the first case report of NK occurring in the context of CRPS, a neuropathy with ipsilateral facial pain involvement. IVCM was important in the diagnosis of NK, which responded successfully to ocular surface treatments focused on nerve health stimulation that ultimately resulted in corneal nerve growth.
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Affiliation(s)
- Matias Soifer
- Duke Eye Center, Duke University, Durham, NC
- Foster Center for Ocular Immunology, Duke University, Durham, NC
| | | | - Nandini Venkateswaran
- Duke Eye Center, Duke University, Durham, NC
- Foster Center for Ocular Immunology, Duke University, Durham, NC
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA; and
| | - Gary W Jay
- Department of Neurology, Division: Headache/Pain, University of North Carolina, Chapel Hill
| | - Victor L Perez
- Duke Eye Center, Duke University, Durham, NC
- Foster Center for Ocular Immunology, Duke University, Durham, NC
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Gao Q, Xie J, Salero E, Nuñez Del Prado Z, Hutmacher DW, Ye J, De Juan-Pardo EM, Sabater AL, Perez VL. Tissue engineering of corneal stroma via melt electrowriting. J Tissue Eng Regen Med 2021; 15:841-851. [PMID: 34327854 DOI: 10.1002/term.3235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 11/07/2022]
Abstract
The cornea serves as the main refractive component of the eye with the corneal stroma constituting the thickest component in a stratified layered system of epithelia, stroma, and endothelium. Current treatment options for patients suffering from corneal diseases are limited to transplantation of a human donor cornea (keratoplasty) or to implantation of an artificial cornea (keratoprosthesis). Nevertheless, donor shortage and failure of artificial corneas to integrate with local tissue constitute important problems that have not been yet circumvented. Recent advances in biofabrication have made great progress toward the manufacture of tailored biomaterial templates with the potential of guiding partially or totally the regeneration process of the native cornea. However, the role of the corneal stroma on current tissue engineering strategies is often neglected. Here, we achieved a tissue-engineered corneal stroma substitute culturing primary keratocytes on scaffolds prepared via melt electrowriting (MEW). Scaffolds were designed to contain highly organized micrometric fibers to ensure transparency and encourage primary human keratocytes to self-orchestrate their own extracellular matrix deposition and remodeling. Results demonstrated reliable cell attachment and growth over a period of 5 weeks and confirmed the formation of a dense and highly organized de novo tissue containing collagen I, V, and VI as well as Keratocan, which resembled very closely the native corneal stoma. In summary, MEW brings us closer to the biofabrication of a viable corneal stroma substitute.
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Affiliation(s)
- Qi Gao
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Ophthalmology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiajun Xie
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Ophthalmology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Enrique Salero
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zelmira Nuñez Del Prado
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dietmar W Hutmacher
- Translational 3D Printing Laboratory for Advanced Tissue Engineering (T3mPLATE), Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Juan Ye
- Department of Ophthalmology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Elena M De Juan-Pardo
- Translational 3D Printing Laboratory for Advanced Tissue Engineering (T3mPLATE), Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.,Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Western Australia, Australia
| | - Alfonso L Sabater
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor L Perez
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Eleiwa T, Elsawy A, Ozcan E, Chase C, Feuer W, Yoo SH, Perez VL, Abou Shousha MF. Prediction of corneal graft rejection using central endothelium/Descemet's membrane complex thickness in high-risk corneal transplants. Sci Rep 2021; 11:14542. [PMID: 34267265 PMCID: PMC8282599 DOI: 10.1038/s41598-021-93892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/08/2021] [Indexed: 11/09/2022] Open
Abstract
To determine whether measurements of Endothelium/Descemet complex thickness (En/DMT) are of predictive value for corneal graft rejection after high-risk corneal transplantation, we conducted this prospective, single-center, observational case series including sixty eyes (60 patients) at high risk for corneal graft rejection (GR) because of previous immunologic graft failure or having at least two quadrants of stromal vascularization. Patients underwent corneal transplant. At 1st, 3rd, 6th, 9th, and 12th postoperative month, HD-OCT imaging of the cornea was performed, and the corneal status was determined clinically at each visit by a masked cornea specialist. Custom-built segmentation tomography algorithm was used to measure the central En/DMT. Relationships between baseline factors and En/DMT were explored. Time dependent covariate Cox survival regression was used to assess the effect of post-operative En/DMT changes during follow up. A longitudinal repeated measures model was used to assess the relationship between En/DMT and graft status. Outcome measures included graft rejection, central Endothelium/Descemet's complex thickness, and central corneal thickness (CCT). In patients with GR (35%), the central En/DMT increased significantly 5.3 months (95% CI: 2, 11) prior to the clinical diagnosis of GR, while it remained stable in patients without GR. During the 1-year follow up, the rejected grafts have higher mean pre-rejection En/DMTs (p = 0.01), compared to CCTs (p = 0.7). For En/DMT ≥ 18 µm cut-off (at any pre-rejection visit), the Cox proportional hazard ratio was 6.89 (95% CI: 2.03, 23.4; p = 0.002), and it increased to 9.91 (95% CI: 3.32, 29.6; p < 0.001) with a ≥ 19 µm cut-off. In high-risk corneal transplants, the increase in En/DMT allowed predicting rejection prior to the clinical diagnosis.
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Affiliation(s)
- Taher Eleiwa
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA.,Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Amr Elsawy
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA.,Electrical and Computer Engineering, University of Miami, Miami, FL, USA
| | - Eyup Ozcan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA
| | - Collin Chase
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - William Feuer
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA
| | - Victor L Perez
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Mohamed F Abou Shousha
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA. .,Electrical and Computer Engineering, University of Miami, Miami, FL, USA. .,Biomedical Engineering, University of Miami, Miami, FL, USA.
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Soifer M, Mousa HM, Levy RB, Perez VL. Understanding Immune Responses to Surgical Transplant Procedures in Stevens Johnsons Syndrome Patients. Front Med (Lausanne) 2021; 8:656998. [PMID: 34095169 PMCID: PMC8175970 DOI: 10.3389/fmed.2021.656998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023] Open
Abstract
Stevens Johnsons syndrome (SJS) is a mucocutaneous disorder caused by an autoimmune response most commonly to medications. Unless it is properly managed in the acute setting, this entity can affect the ocular surface causing chronic cicatrizing conjunctivitis with limbal stem cell deficiency and lid anomalies which ultimately result in corneal opacities that may limit patients' visual acuity. When this stage is reached, some patients might need to undergo some form of corneal and/or limbal stem cell transplantation that exposes an already sensitized immune system to a new alloantigen. While the innate immunity plays a role in corneal graft survival, adaptive immune responses play a major part in corneal graft rejection and failure, namely through CD4+ T cell lymphocytes. Hence, the management of the immune response to surgical transplant procedures in SJS patients, involves a dual approach that modulates the inflammatory response to a new alloantigen in the context of an autoimmune sensitized patient. This review will explore and discuss current perspectives and future directions in the field of ocular immunology on how to manage SJS immune responses to ocular surgical procedures, reviewing systemic and local immunosuppressive therapies and protocols to adequately manage this debilitating condition.
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Affiliation(s)
- Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States,Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Hazem M. Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States,Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Robert B. Levy
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Victor L. Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States,Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,*Correspondence: Victor L. Perez
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Hatcher JB, Soifer M, Morales NG, Farooq AV, Perez VL, Shieh C. Aftermarket effects of cenegermin for neurotrophic keratopathy in pediatric patients. Ocul Surf 2021; 21:52-57. [PMID: 33887453 DOI: 10.1016/j.jtos.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Neurotrophic keratopathy (NK) is a rare condition characterized by poor corneal sensation and healing. Cenegermin (topical recombinant nerve growth factor) has gained traction as a medical therapy for NK in recent years, and is FDA-approved for patients over two years old. However, no major trials have demonstrated the drug's efficacy in children. This study reviews the outcomes of cenegermin therapy in a pediatric patient population. METHODS Retrospective case series of patients from three tertiary referral institutions who 1) initiated an 8-week course of cenegermin therapy, and 2) were 18 years or less at time of treatment initiation. RESULTS Eight pediatric patients, with a total of nine affected eyes, underwent cenegermin therapy. All eight patients had previously trialed other NK-specific treatments, none of which had been entirely successful. Five patients (63%) completed the full eight-week therapy course. Five patients (63%) experienced clinical improvement not attributed to another treatment, through improved corneal ulcer stage (n = 5) and best-corrected visual acuity (n = 2). Clinical improvements persisted through a mean recurrence-free period of 10 months. Adverse effects reported during therapy included ocular pain, difficulty sleeping, and continued corneal thinning. CONCLUSION The results provide modest support for the use of cenegermin in pediatric patients with neurotrophic keratopathy. The primary benefit was an improvement in corneal epithelial stability. Clinicians should be aware that pre-existing corneal scarring in NK may significantly limit the ability of cenegermin alone to improve visual acuity, and should closely monitor the corneal epithelial status during therapy in pediatric patients.
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Affiliation(s)
| | - Matias Soifer
- Department of Ophthalmology, Duke Eye Center, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Center, Durham, NC, USA
| | | | - Asim V Farooq
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, USA
| | - Victor L Perez
- Department of Ophthalmology, Duke Eye Center, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Center, Durham, NC, USA
| | - Christine Shieh
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, TN, USA.
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Qian R, McNabb RP, Zhou KC, Mousa HM, Saban DR, Perez VL, Kuo AN, Izatt JA. In vivo quantitative analysis of anterior chamber white blood cell mixture composition using spectroscopic optical coherence tomography. Biomed Opt Express 2021; 12:2134-2148. [PMID: 33996220 PMCID: PMC8086441 DOI: 10.1364/boe.419063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Anterior uveitis is the most common form of intraocular inflammation, and one of its main signs is the presence of white blood cells (WBCs) in the anterior chamber (AC). Clinically, the true composition of cells can currently only be obtained using AC paracentesis, an invasive procedure to obtain AC fluid requiring needle insertion into the AC. We previously developed a spectroscopic optical coherence tomography (SOCT) analysis method to differentiate between populations of RBCs and subtypes of WBCs, including granulocytes, lymphocytes and monocytes, both in vitro and in ACs of excised porcine eyes. We have shown that different types of WBCs have distinct characteristic size distributions, extracted from the backscattered reflectance spectrum of individual cells using Mie theory. Here, we further develop our method to estimate the composition of blood cell mixtures, both in vitro and in vivo. To do so, we estimate the size distribution of unknown cell mixtures by fitting the distribution observed using SOCT with a weighted combination of reference size distributions of each WBC type calculated using kernel density estimation. We validate the accuracy of our estimation in an in vitro study, by comparing our results for a given WBC sample mixture with the cellular concentrations measured by a hemocytometer and SOCT images before mixing. We also conducted a small in vivo quantitative cell mixture validation pilot study which demonstrates congruence between our method and AC paracentesis in two patients with uveitis. The SOCT based method appears promising to provide quantitative diagnostic information of cellular responses in the ACs of patients with uveitis.
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Affiliation(s)
- Ruobing Qian
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Ryan P. McNabb
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Kevin C. Zhou
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Daniel R. Saban
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Victor L. Perez
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Anthony N. Kuo
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
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Singh PP, Yu C, Mathew R, Perez VL, Saban DR. Meibomian gland dysfunction is suppressed via selective inhibition of immune responses by topical LFA-1/ICAM antagonism with lifitegrast in the allergic eye disease (AED) model. Ocul Surf 2021; 21:271-278. [PMID: 33812087 DOI: 10.1016/j.jtos.2021.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The etiology of meibomian gland dysfunction (MGD) is incompletely understood, despite being a common ophthalmic condition and an area of unmet medical need. It is characterized by an insufficiency in glandular provision of specialized lipids (meibum) to the tear film and is a major cause of dry eye. Work in the allergic eye disease (AED) mouse model has revealed an immunopathogenic role in MGD causation, now raising interest in the applicability of immunomodulatory therapies. As such, we herein ask whether inhibition of lymphocyte function associated antigen (LFA)-1/intracellular adhesion molecules (ICAM)-1 signaling via topical lifitegrast administration has a therapeutic effect on MGD in AED mice. METHODS Mice were induced with AED by i.p. injection of ovalbumin (OVA) mixed with alum and pertussis toxin, followed 2 weeks later by once daily topical OVA challenges for 7 days. Mice were treated topically with 5% lifitegrast ophthalmic solution or vehicle (PBS) 30 min prior to challenge. We developed a clinical ranking method to assess MGD severity, and also scored clinical allergy. Conjunctivae and draining lymph nodes were collected for flow cytometry. RESULTS Topical lifitegrast significantly inhibited clinical MGD severity, which was associated with diminished pathogenic TH17 cell and neutrophil numbers in the conjunctiva. No significant change in conjunctival TH2 cells or eosinophils, and only marginal differences in ocular allergy were observed. CONCLUSIONS In AED mice, lifitegrast inhibited MGD severity marked by a reduction in select immune populations in the conjunctiva. Our findings warrant future examination of lifitegrast in the treatment of patients with forms of MGD.
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Affiliation(s)
- Pali P Singh
- Duke University School of Medicine, Durham, NC, USA
| | - Chen Yu
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rose Mathew
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Daniel R Saban
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA; Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, 27710, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Sabater AL, Mousa HM, Quinones X, Valenzuela F, Sanchez Avila RM, Orive G, Anitua E, Merayo J, Perez VL. Use of autologous plasma rich in growth factors fibrin membrane in the surgical management of ocular surface diseases. Int Ophthalmol 2021; 41:2347-2358. [PMID: 33745034 DOI: 10.1007/s10792-021-01788-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of the surgical use of autologous plasma rich in growth factors fibrin membrane (mPRGF) in improving corneal wound healing and regeneration in a variety of complex ocular surface defects. METHODS Chart review on 15 eyes of 14 included patients undergoing ocular surface intervention using intraoperative mPRGF at the Bascom Palmer Eye Institute and at the Instituto Oftalmológico Fernández-Vega was performed. Patients were grouped based on type of intervention or condition (penetrating keratoplasty, superficial keratectomy, neurotrophic or persistent corneal ulcers, and corneal perforation). Patients were followed for an average of 11 ± 5 months. Main outcomes measured were mPRGF dissolving time, best-corrected visual acuity, and evidence of any persistent epithelial defects, rejections, or complications. RESULTS All 15 eyes underwent successful placement of mPRGF. Average dissolving time for fibrin membrane was 21 ± 3 days. mPRGF resulted in total healing of the corneal defects in 13/15 (86.7%) of the treated eyes and partial healing in 2/15 (13.3%) eyes in which persistent epithelial defects were noted on follow-up. Visual acuity improvement was seen in 9/15 (60%) of the cases. CONCLUSION The use of autologous mPRGF in the healing and regeneration of the ocular surface is a secure and efficacious surgical option. Our data demonstrate that PRGF fibrin membrane should be contemplated as an important tool to optimize ocular surface regeneration in complex cases.
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Affiliation(s)
- Alfonso L Sabater
- Department of Ophthalmology, Bascom Palmer Eye Institute, Ocular Surface Center, University of Miami Miller School of Medicine, Miami, USA
| | - Hazem M Mousa
- Steven and Frances Foster Distinguished Chair in Ocular Immunology, Duke Eye Center for Ocular Immunology, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Xavier Quinones
- Department of Ophthalmology, Bascom Palmer Eye Institute, Ocular Surface Center, University of Miami Miller School of Medicine, Miami, USA
| | - Felipe Valenzuela
- Department of Ophthalmology, Bascom Palmer Eye Institute, Ocular Surface Center, University of Miami Miller School of Medicine, Miami, USA
| | | | - Gorka Orive
- Foundation Eduardo Anitua, Victoria, Spain.,Biotechnology Institute (BTI), Victoria, Spain.,NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, 01006, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - Eduardo Anitua
- Foundation Eduardo Anitua, Victoria, Spain.,Biotechnology Institute (BTI), Victoria, Spain
| | - Jesús Merayo
- Fernández-Vega University Institute, Ophthalmologic Research Foundation, University of Oviedo, Oviedo, Spain
| | - Victor L Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, Ocular Surface Center, University of Miami Miller School of Medicine, Miami, USA. .,Steven and Frances Foster Distinguished Chair in Ocular Immunology, Duke Eye Center for Ocular Immunology, Duke University School of Medicine, Durham, NC, 27705, USA.
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Lightbourn CO, Wolf D, Copsel SN, Wang Y, Pfeiffer BJ, Barreras H, Bader CS, Komanduri KV, Perez VL, Levy RB. Use of Post-transplant Cyclophosphamide Treatment to Build a Tolerance Platform to Prevent Liquid and Solid Organ Allograft Rejection. Front Immunol 2021; 12:636789. [PMID: 33737937 PMCID: PMC7962410 DOI: 10.3389/fimmu.2021.636789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Corneal transplantation (CT) is the most frequent type of solid organ transplant (SOT) performed worldwide. Unfortunately, immunological rejection is the primary cause of graft failure for CT and therefore advances in immune regulation to induce tolerance remains an unmet medical need. Recently, our work and others in pre-clinical studies found that cyclophosphamide (Cy) administered after (“post-transplant,” PTCy) hematopoietic stem cell transplantation (HSCT), i.e., liquid transplants is effective for graft vs. host disease prophylaxis and enhances overall survival. Importantly, within the past 10 years, PTCy has been widely adopted for clinical HSCT and the results at many centers have been extremely encouraging. The present studies found that Cy can be effectively employed to prolong the survival of SOT, specifically mouse corneal allografts. The results demonstrated that the timing of PTCy administration is critical for these CT and distinct from the kinetics employed following allogeneic HSCT. PTCy was observed to interfere with neovascularization, a process critically associated with immune rejection of corneal tissue that ensues following the loss of ocular “immune privilege.” PTCy has the potential to delete or directly suppress allo-reactive T cells and treatment here was shown to diminish T cell rejection responses. These PTCy doses were observed to spare significant levels of CD4+ FoxP3+ (Tregs) which were found to be functional and could readily receive stimulating signals leading to their in vivo expansion via TNFRSF25 and CD25 agonists. In total, we posit future studies can take advantage of Cy based platforms to generate combinatorial strategies for long-term tolerance induction.
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Affiliation(s)
- Casey O Lightbourn
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Dietlinde Wolf
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Sabrina N Copsel
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ying Wang
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Brent J Pfeiffer
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Henry Barreras
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Cameron S Bader
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Krishna V Komanduri
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Victor L Perez
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Foster Center for Ocular Immunology at Duke Eye Center, Duke University, Durham, NC, United States
| | - Robert B Levy
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States.,Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
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Mousa HM, Saban DR, Perez VL. The cornea IV immunology, infection, neovascularization, and surgery chapter 1: Corneal immunology. Exp Eye Res 2021; 205:108502. [PMID: 33607075 DOI: 10.1016/j.exer.2021.108502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE of Review: This review offers an informed and up-to-date insight on the immune profile of the cornea and the factors that govern the regulation of such a unique immune environment. SUMMARY The cornea is a unique tissue that performs the specialized task of allowing light to penetrate for visual interpretation. To accomplish this, the ocular surface requires a distinct immune environment that is achieved through unique structural, cellular and molecular factors. Not only must the cornea be able to fend off invasive infectious agents but also control the inflammatory response as to avoid collateral, and potentially blinding damage; particularly of post-mitotic cells such as the corneal endothelium. To combat infections, both innate and adaptive arms of the inflammatory immune response are at play in the cornea. Dendritic cells play a critical role in coordinating both these responses in order to fend off infections. On the other side of the spectrum, the ocular surface is also endowed with a variety of anatomic and physiologic components that aid in regulating the immune response to prevent excessive, potentially damaging, inflammation. This attenuation of the immune response is termed immune privilege. The balance between pro and anti-inflammatory reactions is key for preservation of the functional integrity of the cornea. RECENT FINDINGS The understanding of the molecular and cellular factors governing corneal immunology and its response to antigens is a growing field. Dendritic cells in the normal cornea play a crucial role in combating infections and coordinating the inflammatory arms of the immune response, particularly through coordination with T-helper cells. The role of neuropeptides is recently becoming more highlighted with different factors working on both sides of the inflammatory balance.
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Affiliation(s)
- Hazem M Mousa
- Foster Center for Ocular Immunology at Duke Eye Center, Duke University Medical Center, Durham, NC, USA
| | - Daniel R Saban
- Foster Center for Ocular Immunology at Duke Eye Center, Duke University Medical Center, Durham, NC, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology at Duke Eye Center, Duke University Medical Center, Durham, NC, USA.
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Al-Lozi A, Cai S, Chen X, Perez VL, Venkateswaran N. Granulicatella Adiacens as an Unusual Cause of Microbial Keratitis and Endophthalmitis: A Case Series and Literature Review. Ocul Immunol Inflamm 2021; 30:1181-1185. [PMID: 33426987 DOI: 10.1080/09273948.2020.1860233] [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: 10/22/2022]
Abstract
Purpose: To report two cases of microbial keratitis and/or endophthalmitis involving Granulicatella adiacens.Methods: Case series.Results: 24-year-old female with a history of Herpes simplex virus 1 (HSV-1) and Candida parapsilosis keratitis presented with a geographic epithelial defect and infiltrate in the left eye. Cultures were positive for HSV-1 and G. adiacens. Keratitis resolved with topical vancomycin and oral valacyclovir. A 65-year-old female with a history of type II diabetes and failed therapeutic penetrating keratoplasty presented with inferior corneal graft haze and vitreous inflammation of the right eye. Therapeutic penetrating keratoplasty and pars plana vitrectomy were performed, and the corneal button returned positive for G. adiacens. The patient was treated with topical and intravitreal vancomycin as well as topical and systemic steroids.Conclusions: These cases expand the literature on G. adiacens keratitis and endophthalmitis and corroborate the role of steroid use and prior surgery as paramount risk factors.
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Affiliation(s)
- Amal Al-Lozi
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Sophie Cai
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Xi Chen
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Victor L Perez
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Nandini Venkateswaran
- Department of Ophthalmology, Duke University, Durham, NC, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Abstract
Most patients with chronic dry eye disease (DED) have episodic flares, which can be triggered by a variety of activities and environmental stresses. These flares are typically associated with rapid exacerbation of discomfort symptoms, followed by prolonged elevation of inflammation. In an acute flare, ocular surface inflammation begins with a nonspecific innate immune response, in some cases followed by a slower but more specific adaptive immune response. At the ocular surface, epithelial cells are central to the innate immune response, and we discuss their role in DED flares alongside the other core components. Epithelial cells and other cells of the innate response (neutrophils, monocytes, macrophages and dendritic cells) trigger flares in response to increased osmolarity, detected via pattern receptors on their cell surface. Ultimately, downstream signaling pathways activate innate and adaptive immune responses, with consequent inflammation and symptoms. In chronic DED, pathogenic T cells have infiltrated the ocular surface tissues. The established adaptive immune response is likely to lead to flare-ups at lower thresholds of stress, with inflammation maintained over a longer period. Increased understanding of the inflammatory cascades activated during a flare may guide management and improve outcomes.
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Affiliation(s)
- Victor L Perez
- Duke University School of Medicine, Durham, NC, United States
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Soifer M, Mousa HM, Stinnett SS, Galor A, Perez VL. Matrix metalloproteinase 9 positivity predicts long term decreased tear production. Ocul Surf 2020; 19:270-274. [PMID: 33098983 DOI: 10.1016/j.jtos.2020.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate long-term correlations between Matrix Metalloproteinase-9 (MMP-9) testing and dry eye (DE) parameters. Additionally, to evaluate variability in MMP-9 results over time and with anti-inflammatory treatment. METHODS Retrospective cohort study of DE patients with equal MMP-9 testing results (positive or negative) in both eyes and a minimum of 6 months of follow up. Our main outcome measure was to examine whether initial MMP-9 status affected change in DE parameters over time. Secondarily, we evaluated the frequency of MMP-9 status change over time and examined whether MMP-9 status change was impacted by treatment. RESULTS 67 patients (76% female) fit the inclusion criteria. Mean age was 63 years with a mean follow up of 10.6 months. The majority (37/67, 55%) had concomitant systemic immune disease. MMP-9 testing was positive in both eyes in 39 individuals (58%) and negative in both eyes in 27 (42%) individuals. Of all DE parameters, initial MMP status predicted change in tear production. Individuals in the MMP-9 positive group had a greater decrease in production from baseline to final visit compared to the negative group (-2.6 vs 2.1, P = 0.013). In those initially MMP-9 positive, the frequency of becoming MMP-9 negative was higher in eyes treated with anti-inflammatory therapy compared to artificial tears (22.9% vs 3.3%, P = 0.106). However, only Lifitegrast 5% showed statistical significance compared to artificial tears (31.3% vs 3.3%, P = 0.044). CONCLUSIONS Eyes with detectable MMP-9 had significantly decreased tear production over time compared to those without detectable MMP-9. Anti-inflammatory treatment more frequently normalized MMP-9 compared to PFATs.
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Affiliation(s)
- Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA
| | - Hazem M Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA.
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Periman LM, Perez VL, Saban DR, Lin MC, Neri P. The Immunological Basis of Dry Eye Disease and Current Topical Treatment Options. J Ocul Pharmacol Ther 2020; 36:137-146. [PMID: 32175799 PMCID: PMC7175622 DOI: 10.1089/jop.2019.0060] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/29/2019] [Indexed: 12/13/2022] Open
Abstract
Homeostasis of the lacrimal functional unit is needed to ensure a well-regulated ocular immune response comprising innate and adaptive phases. When the ocular immune system is excessively stimulated and/or immunoregulatory mechanisms are disrupted, the balance between innate and adaptive phases is dysregulated and chronic ocular surface inflammation can result, leading to chronic dry eye disease (DED). According to the Tear Film and Ocular Surface Society Dry Eye Workshop II definition, DED is a multifactorial disorder of the ocular surface characterized by impairment and loss of tear homeostasis (hyperosmolarity), ocular discomfort or pain, and neurosensory abnormalities. Dysregulated ocular immune responses result in ocular surface damage, which is a further contributing factor to DED pathology. Several therapeutics are available to break the vicious circle of DED and prevent chronic disease and progression, including immunosuppressive agents (steroids) and immunomodulators (cyclosporine and lifitegrast). Given the chronic inflammatory nature of DED, each of these agents is commonly used in clinical practice. In this study, we review the immunopathology of DED and the molecular and cellular actions of current topical DED therapeutics to inform clinical decision making.
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Affiliation(s)
| | - Victor L. Perez
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Daniel R. Saban
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Meng C. Lin
- School of Optometry, Clinical Research Center, University of California, Berkeley, California
| | - Piergiorgio Neri
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Mousa HM, Starr CE, Soifer M, Savarain C, Perez VL. Ocular Cicatricial Pemphigoid. Curr Ophthalmol Rep 2020. [DOI: 10.1007/s40135-020-00226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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