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Ngathaweesuk Y, Janthayanont S, Keorochana N. Characteristics and outcomes of the duration of treatment with adjunctive corticosteroids in intraocular tuberculosis. J Clin Tuberc Other Mycobact Dis 2024; 35:100439. [PMID: 38646417 PMCID: PMC11031803 DOI: 10.1016/j.jctube.2024.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Introduction Intraocular tuberculosis (IOTB) is a common site of extrapulmonary tuberculosis and a main cause of infectious uveitis. It can result in severe visual morbidity if not recognized and treated properly. The clinical manifestations of IOTB are varied, and the duration of treatment is unclear. This study describes the clinical characteristics and outcomes of patients with IOTB and compares the duration of antituberculosis therapy (ATT) and steroid use. Method An 8-year retrospective study of IOTB patients in an endemic area of a tertiary hospital in Thailand. All patients had a complete treatment of ATT at least for 6 months. Results Forty-three patients with 57 eyes and a mean age of 43.72 years were included. Panuveitis (38.6 %), retinal phlebitis (31.6 %), and posterior uveitis (15.8 %) were common clinical characteristics. A significant difference between initial and final best corrected visual acuity (BCVA) after ATT in 6 months for therapy and at least 9 months for therapy was observed (p = 0.004, 0.003, respectively). Ninety point nine percent of patients who received ATT for 9 months achieved a successful treatment outcome, while 66.7 % of patients who received ATT for 6 months did (p = 0.056). Patients who received systemic and/or regional corticosteroids therapy during treatment had a higher rate of treatment failure (p < 0.001). Conclusion IOTB had a variety of clinical manifestations, including nongranulomatous inflammation. Patients who completed treatment with ATT for at least 6 months improved their final BCVA. There was no difference in treatment outcomes regarding the duration of treatment. Combined treatment with systemic and/or regional corticosteroids was significantly associated with failed treatment outcomes.
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Affiliation(s)
- Yaninsiri Ngathaweesuk
- Ocular inflammatory and uveitis division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Narumon Keorochana
- Ocular inflammatory and uveitis division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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Gaggiano C, Tufan A, Guerriero S, Ragab G, Sota J, Gentileschi S, Costi S, Almaghlouth IA, Hinojosa-Azaola A, Tharwat S, Sfikakis PP, Lopalco G, Piga M, Conti G, Fragoulis G, Mauro A, Batu ED, Ozen S, Tarsia M, La Torre F, Kawakami-Campos PA, Vitale A, Caggiano V, Kardaş RC, Tosi GM, Frediani B, Avčin T, Hernández-Rodríguez J, Cantarini L, Fabiani C. Ocular Manifestations in Juvenile Behçet's Disease: A Registry-Based Analysis from the AIDA Network. Ophthalmol Ther 2024:10.1007/s40123-024-00916-z. [PMID: 38563868 DOI: 10.1007/s40123-024-00916-z] [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: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION This study aims to characterize ocular manifestations of juvenile Behçet's disease (jBD). METHODS This was a registry-based observational prospective study. All subjects with jBD from the Autoinflammatory Diseases Alliance (AIDA) Network BD Registry showing ocular manifestations before 18 years were enrolled. RESULTS We included 27 of 1000 subjects enrolled in the registry (66.7% male patients, 45 affected eyes). The median (interquartile range [IQR]) age at ocular involvement was 14.2 (4.7) years. Uveitis affected 91.1% of eyes (anterior 11.1%, posterior 40.0%, panuveitis 40.0%), retinal vasculitis 37.8% and other manifestations 19.8%. Later onset (p = 0.01) and male predominance (p = 0.04) characterized posterior involvement. Ocular complications occurred in 51.1% of eyes. Patients with complications had earlier onset (p < 0.01), more relapses (p = 0.02) and more prolonged steroidal treatment (p = 0.02). The mean (standard deviation [SD]) central macular thickness (CMT) at the enrolment and last visit was 302.2 (58.4) and 293.3 (78.2) μm, respectively. Fluorescein angiography was pathological in 63.2% of procedures, with a mean (SD) Angiography Scoring for Uveitis Working Group (ASUWOG) of 17.9 (15.5). At the last visit, ocular damage according to the BD Overall Damage Index (BODI) was documented in 73.3% of eyes. The final mean (SD) best corrected visual acuity (BCVA) logMAR was 0.17 (0.47) and blindness (BCVA logMAR < 1.00 or central visual field ≤ 10°) occurred in 15.6% of eyes. At multivariate regression analysis, human leukocyte antigen (HLA)-B51 + independently predicted a + 0.35 change in the final BCVA logMAR (p = 0.01), while a higher BCVA logMAR at the first assessment (odds ratio [OR] 5.80; p = 0.02) independently predicted blindness. CONCLUSIONS The results of this study may be leveraged to guide clinical practice and future research on this rare sight-threatening condition.
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Affiliation(s)
- Carla Gaggiano
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
- Faculty of Medicine, New Giza University, Giza, Egypt
| | - Jurgen Sota
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy
| | - Stefania Costi
- Unit of Pediatric Rheumatology, Azienda Socio-Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Milan, Italy
| | - Ibrahim A Almaghlouth
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- College of Medicine Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andrea Hinojosa-Azaola
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Mansoura University, Mansoura, Egypt
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], National and Kapodistrian University of Athens, Athens, Greece
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliero Universitaria (AOU) G Martino, Messina, Italy
| | - George Fragoulis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], National and Kapodistrian University of Athens, Athens, Greece
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Mauro
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - Ezgi D Batu
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Maria Tarsia
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Francesco La Torre
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Perla A Kawakami-Campos
- Department of Ophthalmology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy
| | - Valeria Caggiano
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy
| | - Riza C Kardaş
- Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University of Ljubljana and University Medical Centre Ljubljana [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Ljubljana, Slovenia
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy.
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
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Douros S, Mostafavi D, Danias M. Retinal vasculitis following intravitreal pegcetacoplan administration. Am J Ophthalmol Case Rep 2024; 33:101999. [PMID: 38298266 PMCID: PMC10828598 DOI: 10.1016/j.ajoc.2024.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/04/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose To describe a case of retinal vaso-occlusive vasculitis with associated lid edema and conjunctivitis following intravitreal pegcetacoplan administration in a patient with geographic atrophy (GA). Observation A 78 year old Caucasian woman presented with complaints of lid edema, conjunctival injection, loss of vision, and mild ocular discomfort eleven days after receiving an intravitreal pegcetacoplan injection in the left eye for geographic atrophy. Visual acuity on presentation was decreased to 20/400 from 20/200 previously in that eye. Eyelid edema and conjunctival injection were present with minimal anterior chamber reaction. Dilated fundus examination revealed hemorrhages throughout the retina and signs of retinal vasculitis. The patient subsequently developed hyphema and vitreous hemorrhage. Laboratory evaluations for common infectious and inflammatory causes including aqueous and vitreous cultures for bacteria and Herpes simplex PCR were normal or negative. A delayed hypersensitivity to pegcetacoplan was suspected and was treated with topical, oral subconjunctival and intravitreal steroids. Conclusion This index report illustrates a case of retinal vaso-occlusive vasculitis associated with intravitreal pegcetacoplan associated with lid edema and conjunctival injection and subsequent hyphema and vitreous hemorrhage. Therapy with steroids topically, systemically, periocularly and intravitreally were used to treat the inflammatory process and prevent further visual loss.
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Affiliation(s)
- Stella Douros
- Stella Douros, M.D., P.C., Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Mostafavi
- SUNY Downstate Medical Center, Brooklyn, NY, USA
- Mostafavi Eye Institute, Staten Island, NY, USA
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Lequain H, Abramowicz S, Seiller J, Abukhashbah A, Burillon C, Vignot E, Brunet O, Sève P. Immune recovery uveitis in Whipple's disease: an unusual ocular presentation. J Ophthalmic Inflamm Infect 2024; 14:10. [PMID: 38347376 PMCID: PMC10861419 DOI: 10.1186/s12348-024-00390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE To describe an unusual case of Whipple's disease (WD) complicated by uveitis, and subsequent paradoxical worsening after effective antibiotic treatment targeting Tropheryma whipplei (TW). METHODS Case report. RESULTS A 53-year-old male presented with bilateral knee arthritis, weight loss, chronic low-grade fever, and cognitive disorders. He was under treatment with tumor necrosis factor α inhibitors (TNFi) for seronegative spondyloarthritis. Given this unusual clinical presentation, further investigations were performed and revealed blood, saliva, stool, synovial fluid and cerebrospinal fluid positivity for TW, confirming the diagnosis of systemic WD. Ophthalmologic examination revealed bilateral posterior uveitis and an aqueous humor sample confirmed the presence of intraocular TW. TNFi were stopped, and the patient was subsequently treated with adequate antibiotics (ceftriaxone, followed by doxycycline and hydroxychloroquine), and subconjunctival corticosteroid injections. After a transient improvement of the ocular symptoms, he presented a recurrence of posterior segment inflammation, leading to repeated PCR testing for TW which were negative. Therefore, paradoxical worsening of the inflammation in the context of immune recovery uveitis (IRU) was thought to be the culprit. The patient was treated with systemic corticosteroid therapy, allowing for rapid improvement of the ocular findings. CONCLUSIONS This case underlines the possibility of IRU complicating WD. Ophthalmologists, rheumatologists, and internists should be aware of this rare complication, particularly in the context of previous immunosuppressive therapy.
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Affiliation(s)
- Hippolyte Lequain
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 103 Grande-Rue de La Croix-Rousse, 69004, Lyon, France
| | - Stéphane Abramowicz
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 103 Grande-Rue de La Croix-Rousse, 69004, Lyon, France
| | - Julien Seiller
- Department of Rheumatology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Amro Abukhashbah
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
- Department of Ophthalmology, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Carole Burillon
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emmanuelle Vignot
- Department of Rheumatology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Olivier Brunet
- Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pascal Sève
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 103 Grande-Rue de La Croix-Rousse, 69004, Lyon, France.
- Université Claude Bernard Lyon 1, Research On Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.
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5
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Hedayatfar A, Anvari P, Herbort CP, Chee SP. Demyelinating plaque-associated uveitis. Graefes Arch Clin Exp Ophthalmol 2024; 262:575-582. [PMID: 37855958 DOI: 10.1007/s00417-023-06270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To report the clinical and fluorescein angiographic (FA) features of demyelinating plaque-associated uveitis (DPU), a subset of uveitis in which patients have demyelinating plaques on the brain/cervical magnetic resonance image (MRI) but do not meet the criteria for multiple sclerosis (MS). METHODS In this retrospective observational study, Persian Patients were diagnosed with DPU and included if (1) they never satisfied the MS criteria, (2) all other possible etiologies were excluded, and (3) they were followed for at least 2 years. RESULTS After a median follow-up of 3 years (interquartile range, 2.0-5.3), 8 out of 40 (20%) patients diagnosed with DPU were excluded as they subsequently met the MS criteria. Of remaining 32 patients studied, the mean age was 36.3±9.9 (range 20-56 years), and 30 (93.8%) were female. Twenty-four (75.0%) showed bilateral involvement and 27 (84.4%) had insidious-chronic course. Uveitis was classified as intermediate (with or without anterior uveitis) in 29 (90.6%) and isolated anterior in 3 (9.4%) patients. Nine (28.1%) patients had at least one systemic neurological complaint. Ocular findings were: granulomatous keratic precipitates in 43/44 (97.7%) eyes; snowballs in 25/52 (48.1%) eyes; snowbanks in 4/52 (7.7%) eyes; cystoid macular edema in 20/56 (35.7%) eyes; and optic neuritis in 5/56 (8.9%) eyes. Visual acuity was ≥ 20/40 in 39 eyes (69.6%) at presentation which improved to 46 eyes (81.2%) at 2-year follow up. The two most frequent findings in FA were optic disc leakage/staining in 44/52 (81.5%) eyes, and peripheral retinal perivascular leakage in 39/52 (76.9%) eyes, which in 14/52 (26.9%) eyes extended beyond the equator. CONCLUSION DPU usually presents as a bilateral chronic granulomatous intermediate and, less often, isolated anterior uveitis, especially in females. Most are neurologically asymptomatic. Visual outcome is generally favorable. In FA, peripheral retinal perivascular leakage is common. DPU patients have an increased tendency to develop MS and should be prohibited from anti-TNF treatment.
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Affiliation(s)
- Alireza Hedayatfar
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattar khan St., Niayesh Ave, Tehran, 14455-364, Iran.
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
| | - Pasha Anvari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattar khan St., Niayesh Ave, Tehran, 14455-364, Iran
| | - C P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Lausanne, Switzerland
- Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Grewal DS, Wykoff CC, D’Souza D, Jehl V, Alecu I, Jaffe GJ. Imaging Features of Retinal Vasculitis and/or Retinal Vascular Occlusion after Brolucizumab Treatment in the Postmarketing Setting. Ophthalmol Sci 2024; 4:100361. [PMID: 37869023 PMCID: PMC10587630 DOI: 10.1016/j.xops.2023.100361] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/01/2023] [Accepted: 06/23/2023] [Indexed: 10/24/2023]
Abstract
Purpose The aim of this analysis was to characterize the spectrum of inflammatory changes arising from brolucizumab use in routine clinical practice. Design Retrospective analysis of fluorescein angiography (FA), fundus photography (FP) and OCT images taken at the time of adverse event. Subjects Brolucizumab-treated patients with neovascular age-related macular degeneration with retinal vasculitis (RV) and/or retinal vascular occlusion (RO) reported to Novartis Patient Safety between February 2020 and January 2021. Methods Ocular images were reviewed by an external reading center using predefined grading lists for FA, FP, and OCT. Main Outcome Measures Classification of images, the most common imaging features of RV and/or RO by each imaging modality, and the anatomical location of the adverse event in relation to the macula. Results Gradable images (N = 475; 222 eyes; 198 patients) were classified as RV only (n = 72); RO only (n = 9), RV + RO (n = 63); posterior segment intraocular inflammation (n = 31); or none by imaging (n = 47). Of the 144 eyes with RV and/or RO, the most common imaging features were vascular leakage on FA, perivascular sheathing on FP, and hyperreflective dots in the vitreous humor on OCT. Retinal vascular occlusion was mainly branched and arterial, affecting multiple vessels. Conclusions Although no distinct inflammatory phenotype pathognomonic to brolucizumab-related inflammation was identified, this study increases our understanding of the spectrum of posterior segment inflammatory changes that may occur in brolucizumab-treated neovascular age-related macular degeneration patients, highlighting the potential value of widefield retinal imaging and angiography to detect these inflammatory adverse events. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Dilraj S. Grewal
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Divya D’Souza
- Novartis Pharmaceuticals Corp., East Hanover, New Jersey
| | | | | | - Glenn J. Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
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7
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Jayadev C, Gupta A, Gadde SG, Venkatesh R. Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery - a case report. BMC Ophthalmol 2023; 23:464. [PMID: 37974099 PMCID: PMC10655314 DOI: 10.1186/s12886-023-03212-9] [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: 08/31/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Intraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis. CASE PRESENTATION A 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200. RESULTS The retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved. CONCLUSION This report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.
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Affiliation(s)
- Chaitra Jayadev
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India
| | - Aditi Gupta
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India
| | - Santosh Gopikrishna Gadde
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India.
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Zubricky R, McCoy J, Donkor R, Miller DG, Sonbolian N, Heaney A, Bilano V, Karcher H, Coney JM. Real-World Frequency and Management of Ocular Adverse Events in Eyes with Neovascular Age-Related Macular Degeneration Treated with Brolucizumab. Ophthalmol Ther 2023; 12:2397-2408. [PMID: 37310683 PMCID: PMC10442012 DOI: 10.1007/s40123-023-00741-w] [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: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Intraocular inflammation (IOI)-related adverse events (AEs) that may result in severe vision loss have been associated with the anti-vascular endothelial growth factor brolucizumab. In this study, we investigate the timing, management and resolution of IOI-related AEs in a large cohort of patients treated with at least one injection of brolucizumab in routine clinical practice. METHODS Retrospective review of medical records from patients with neovascular age-related macular degeneration treated with ≥ 1 brolucizumab injection between October 2019 and November 2021 at the Retina Associates of Cleveland, Inc. clinics. RESULTS Of the 482 eyes included in the study, IOI-related AEs occurred in 22 (4.6%) eyes. Four (0.8%) eyes developed retinal vasculitis (RV) and of these, 2 (0.4%) had concomitant retinal vascular occlusion (RO). Most eyes [14/22 (64%)] developed the AE within 3 months and 4/22 (18%) within 3-6 months of the first brolucizumab injection. The median [interquartile range (IQR)] time from the last brolucizumab injection to development of the IOI-related AE was 13 (4-34) days. At the time of event, 3 (0.6%) eyes with IOI (no RV/RO) developed severe vision loss of ≥ 30 ETDRS letters, and a further 5 (1.0%) eyes (1 with IOI + RV, 1 with IOI + RV + RO) developed moderate vision loss of ≥ 15 letters compared with their last visual acuity (VA) prior to the AE. The median (IQR) vision loss was -6.8 (-19.9, -0.0) letters. Taking the best VA at either 3 or 6 months after AE resolution (or stability for occlusive events), VA decreased by ≥ 5 letters compared with prior to the AE in 3 (14%) of the 22 affected eyes, and was preserved (< 5-letter loss) in 18 (82%) eyes. CONCLUSIONS In this real-world study, most IOI-related AEs occurred early after brolucizumab treatment initiation. With appropriate monitoring and management of IOI-related AEs, vision loss associated with brolucizumab may be limited.
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Affiliation(s)
| | - Jasmyne McCoy
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA
| | - Richard Donkor
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA
| | - David G Miller
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA
| | | | | | | | | | - Joseph M Coney
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA.
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9
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Terao R, Obata R, Okubo A, Aoki S, Azuma K, Ahmed T, Inoda S, Hashimoto Y, Takahashi R, Yoshida H, Misawa M, Takahashi H, Takahashi H. Cytokine profiles in the aqueous humor following brolucizumab administration for exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2023; 261:2465-2476. [PMID: 37000271 DOI: 10.1007/s00417-023-06038-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To identify the inflammatory cytokine profile in the aqueous humor (AH) of patients with intraocular inflammation (IOI) after intravitreal administration of brolucizumab (IVBr) for neovascular age-related macular degeneration. METHODS Eight eyes from seven patients with IOI after initial IVBr (IVBrIOI +) were enrolled. Sixteen eyes from 16 patients without IOI after IVBr (IVBrIOI -) and aflibercept (IVA) were used as controls. AH samples were analyzed using a multiplex immunoassay. RESULTS C-C motif chemokine ligand (CCL)2, C-X-C motif chemokine ligand (CXCL)1, CXCL10, CXCL13, interleukin (IL)-6, IL-8, IL-10, matrix metalloproteinase (MMP)-1, MMP-9, granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), intercellular adhesion molecule (ICAM)-1, E-selectin, and P-selectin levels were significantly higher in IVBrIOI + than in IVBrIOI - and IVA. Vascular endothelial growth factor (VEGF) was significantly lower in IVBrIOI - compared to that in IVBrIOI + and IVA. In the IVBrIOI + group, there were significant correlations between CCL2, CXCL1, IL-6, IL-8, IL-10, G-CSF, GM-CSF, ICAM-1, and E-selectin, which also exhibited significant correlations in the IVBrIOI - group. CONCLUSION The number of inflammatory cytokines increases during IOI, which is associated with type IV hypersensitivity and vascular inflammation. Some cytokines exhibit correlations even in non-inflamed eyes, indicating a subclinical response to IVBr.
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Affiliation(s)
- Ryo Terao
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | - Atsushi Okubo
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tazbir Ahmed
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Yuto Hashimoto
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Ryota Takahashi
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Hana Yoshida
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Manami Misawa
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
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10
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Fabozzi L, Testi I, De Benito-Llopis L, Pavesio C. Cytomegalovirus anterior uveitis and occlusive retinal vasculitis without retinitis in a patient on immunomodulatory therapy. J Ophthalmic Inflamm Infect 2023; 13:34. [PMID: 37540447 PMCID: PMC10403449 DOI: 10.1186/s12348-023-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To describe unusual clinical features and therapeutic management of a case of cytomegalovirus (CMV) ocular disease in a patient on immunomodulatory therapy. SETTING/VENUE Moorfields Eye Hospital NHS Foundation Trust, London, UK. METHODS Medical history, clinical findings, investigation results, and multimodal imaging were retrospectively collected. RESULTS A 61-year-old, South-East Asian man, developed CMV-related endotheliitis and occlusive retinal vasculitis, diagnosed by wide-angle fluorescein angiography. No retinitis was present on the fundus examination. Suspicion of CMV etiology was based on anterior segment findings, especially the presence of coin-shaped endothelial lesions. The diagnosis was confirmed by aqueous polymerase chain reaction (PCR) analysis which was positive for CMV DNA. The combined use of topical and systemic valganciclovir resulted in significant improvement of the picture. CONCLUSIONS CMV can manifest in the eye as occlusive retinal vasculitis without the presence of typical retinitis.
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Affiliation(s)
- Lorenzo Fabozzi
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Ilaria Testi
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
- Rheumatology Department, Great Ormond Street Hospital for Children, London, UK
| | - Laura De Benito-Llopis
- Department of External Diseases, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK.
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11
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Reddy AK, Miller DC, Sura AA, Rathinam SR, Gonzales JA, Thundikandy R, Kanakath A, Murugan B, Vedhanayaki R, Lim LL, Suhler EB, Doan T, Al-Dhibi HA, Goldstein DA, Arellanes-Garcia L, Acharya NR. Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial. J Ophthalmic Inflamm Infect 2023; 13:29. [PMID: 37294447 DOI: 10.1186/s12348-023-00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/20/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The antimetabolites methotrexate (MTX) and mycophenolate mofetil (MMF) are commonly used as initial corticosteroid-sparing treatment for uveitis. There is little data examining risk factors for failing both MTX and MMF. The objective of this study is to determine risk factors for failing both MTX and MMF in patients with non-infectious uveitis. MAIN BODY This is a sub-analysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial, which was an international, multicenter, block-randomized, observer-masked, comparative effectiveness trial comparing MTX and MMF as initial treatments for non-infectious uveitis. This study was undertaken at multiple referral centers in India, the United States, Australia, Saudi Arabia and Mexico between 2013 and 2017. A total of 137 patients who completed all 12 months of follow-up from the FAST trial, were included in this study. The primary outcome was failing both antimetabolites over the 12 months of the trial. Potential predictors included: age, sex, bilateral involvement, anatomic location of the uveitis, presence of cystoid macular edema (CME) and retinal vasculitis at baseline visit, uveitis duration, and country/study sites as risk factors for failing both MTX and MMF. The presence of retinal vasculitis posterior to the equator on fluorescein angiogram was associated with failing both MTX and MMF. CONCLUSION Retinal vasculitis may be a risk factor for failing multiple antimetabolites. Clinicians could consider more quickly advancing these patients to other medication classes, such as biologics.
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Affiliation(s)
- Amit K Reddy
- F.I. Proctor Foundation, University of California, San Francisco, 490 Illinois St Fl 2, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - D Claire Miller
- F.I. Proctor Foundation, University of California, San Francisco, 490 Illinois St Fl 2, San Francisco, CA, 94158, USA
| | - Amol A Sura
- F.I. Proctor Foundation, University of California, San Francisco, 490 Illinois St Fl 2, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - S R Rathinam
- Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Uvea Services, Madurai, India
| | - John A Gonzales
- F.I. Proctor Foundation, University of California, San Francisco, 490 Illinois St Fl 2, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Radhika Thundikandy
- Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Uvea Services, Madurai, India
| | - Anuradha Kanakath
- Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Uvea Services, Coimbatore, India
| | - Bala Murugan
- Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Uvea Services, Pondicherry, India
| | - Rajesh Vedhanayaki
- Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Uvea Services, Madurai, India
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Eric B Suhler
- Casey Eye Institute, Oregon Health and Science University, Potland, OR, USA
| | - Thuy Doan
- F.I. Proctor Foundation, University of California, San Francisco, 490 Illinois St Fl 2, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Hassan A Al-Dhibi
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, 490 Illinois St Fl 2, San Francisco, CA, 94158, USA.
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatics, University of California, San Francisco, San Francisco, CA, USA.
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12
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Garweg JG, Blum CA, Copt RP, Eandi CM, Hatz K, Prünte CF, Seelig E, Somfai GM. Brolucizumab in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: Ophthalmology and Diabetology Treatment Aspects. Ophthalmol Ther 2023; 12:639-655. [PMID: 36633780 PMCID: PMC10011261 DOI: 10.1007/s40123-023-00647-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Anti-vascular endothelial growth factor (anti-VEGF) therapies have become the standard of care in the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), resulting in a remarkable decrease in disease-related vision loss. However, the need for regular injections places a significant burden on patients, caregivers, and the healthcare system and improvements in vision may not be maintained long term. As a result of its drying potency and duration of action, brolucizumab, an intravitreal anti-VEGF therapy approved for the treatment of nAMD and DME, could decrease injection frequency for patients and provide an efficacious treatment; however, balancing its benefits and risks can be challenging. There have been reports of intraocular inflammation (IOI) in patients treated with brolucizumab, which, if left untreated, may result in severe vision loss. Recent evidence, however, indicates that early recognition of IOI and prompt and aggressive systemic corticosteroid treatment in response to posterior segment involvement can lead to favorable outcomes in these relatively rare but severe cases. A series of consensus meetings were conducted in 2022 between Swiss medical retina experts and diabetologists, discussing the current data for brolucizumab and exploring various challenges to its use, including the associated risk of IOI. The outcome is a collation of practical insights and guidance for ophthalmologists on the use of brolucizumab in patients with nAMD and DME, including patient selection and assessment, treatment regimen and monitoring, and the recognition and management of adverse events.
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Affiliation(s)
- Justus G Garweg
- Berner Augenklinik, Zieglerstrasse 29 (Y), 3012, Bern, Switzerland. .,Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland. .,Swiss Eye Institute, Luzernerstrasse 1, 6343, Rotkreuz, Switzerland.
| | - Claudine A Blum
- University of Basel, Basel, Switzerland.,Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Chiara M Eandi
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital - Fondation Asile des Aveugles, Lausanne, Switzerland.,Department of Surgical Science, Eye Clinic, University of Torino, Turin, Italy
| | - Katja Hatz
- University of Basel, Basel, Switzerland.,Department of Ophthalmology, Vista Augenklinik, Binningen, Switzerland
| | - Christian F Prünte
- Department of Ophthalmology, University Clinic, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology (IOB), Basel, Switzerland
| | - Eleonora Seelig
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Gábor M Somfai
- Department of Ophthalmology, Stadtspital Zürich, 8063, Zurich, Switzerland.,Spross Research Institute, 8063, Zurich, Switzerland.,Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085, Budapest, Hungary
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13
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Igwe F, Lodha A, Ravindran A. Trends in the Cumulative Post-Marketing Reporting Rates of Retinal Vasculitis and/or Retinal Vascular Occlusion and Associated Vision Loss with Brolucizumab. Ophthalmol Ther 2023; 12:593-598. [PMID: 36469211 PMCID: PMC9834481 DOI: 10.1007/s40123-022-00617-5] [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: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Brolucizumab, a low-molecular weight anti-vascular endothelial growth factor, was approved in the USA in October 2019 for the treatment of neovascular age-related macular degeneration. Following post-marketing reports of vasculitis, including retinal occlusive vasculitis, a safety signal of retinal vasculitis (RV) and/or retinal vascular occlusion (RO) that may result in severe vision loss was confirmed. This brief communication reviews the trends in the cumulative reporting rates of RV and/or RO and associated vision loss from May 2020 to September 2022. METHODS This is a descriptive analysis of the cumulative post-marketing reporting rates of RV and/or RO cases, and associated vision loss included in the Novartis safety database between May 2020 and September 2022, utilizing an enhanced pharmacovigilance program. RESULTS The RV-alone rates demonstrated an upward trend, rising to 5.1 events per 10,000 injections by October 2020 and subsequently remained stable until July 2021. Thereafter, the rate for RV-alone events increased modestly until October 2021 and then remained stable until September 2022. The RO-alone rates increased to 3.4 events per 10,000 injections by January 2021 and subsequently remained stable until September 2022. The combined reports of RV and RO showed an upward trend until December 2020 (7.5 events per 10,000 injections), followed by a plateau until September 2021 and then a downward trend until September 2022. Vision loss associated with RV and/or RO progressively increased until December 2020 (5.9 events per 10,000 injections) followed by a declining trend until September 2022 to the most recent reporting rate of 4.1 events per 10,000 injections. CONCLUSION The cumulative post-marketing reporting rates of vision loss associated with RV and/or RO, following brolucizumab treatment, have shown a declining trend after an initial rise in the reporting rates immediately after identification of the safety signal.
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Affiliation(s)
| | - Amit Lodha
- Novartis Pharmaceuticals Corp., East Hanover, USA
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14
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Kim DJ, Jin KW, Han JM, Lee SH, Park YS, Lee JY, Lee EK, Lee JS, Kim ST, Shin MH, Lee CS, Jung HH, Jang JY, Kim M, Kim YH, Kim JH, Park KH, Park SJ, Joo K, Ji YS, Sagong M, Woo SJ. Short-Term Safety and Efficacy of Intravitreal Brolucizumab Injections for Neovascular Age-Related Macular Degeneration: A Multicenter Retrospective Real-World Study. Ophthalmologica 2023; 246:192-202. [PMID: 36720210 DOI: 10.1159/000529410] [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: 08/26/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of the study was to determine the short-term real-world safety and efficacy of intravitreal brolucizumab injections in Korean patients with neovascular age-related macular degeneration (nAMD). METHODS This multicenter retrospective study involved 294 eyes (treatment naïve 20 eye [6.8%] and nontreatment naïve 274 eyes [93.2%]) of 290 patients from 13 hospitals or retinal centers in South Korea. Patients with nAMD who received brolucizumab injection(s) between April 1 and November 30, 2021, with a follow-up ≥1 month, were included. Primary outcomes were safety, incidence of intraocular inflammation (IOI), and potential risk factors. The secondary outcome was efficacy, i.e., change in best-corrected visual acuity (BCVA) and optical coherence tomography-measured macular thickness and retinal fluid. RESULTS The mean age was 71.63 ± 8.66. The follow-up period was 2.38 ± 0.79 months. The mean number of brolucizumab injections during the follow-up was 1.52 ± 0.58. The overall incidence of IOI was 13.9% (n = 41 eyes). Most IOI cases were of anterior uveitis (8.8%, 26 eyes), followed by retinal vasculitis (2.4%, seven eyes) and occlusive retinal vasculitis (0.3%, one eye). Most eyes showed IOI resolution (n = 40, 97.5%) and BCVA restoration (n = 39, 95.1%) with or without corticosteroid treatment during the follow-up. Age, sex, IOI history, or other anti-vascular endothelial growth factor injection histories were not associated with the occurrence of IOI. However, only thin subfoveal choroidal thickness (SFCT) was associated with the occurrence of IOI (odds ratio = 0.995, p = 0.020). BCVA at 1 month improved from baseline (baseline 0.518 ± 0.356 vs. 1 month 0.503 ± 0.383, p = 0.023), but the improvement was not maintained. Anatomical improvement was significant after 3 months. CONCLUSION In Korean patients with nAMD, the incidence of IOI following brolucizumab injections was 13.9%. IOI was well-controlled with or without steroid treatment. Most IOI eyes (95.1%) were restored to the level of vision before. IOI occurrence and occlusive vasculitis was rare. In the short term, brolucizumab injection effectively improved vision at 1 month and dried retinal fluid for 3 months.
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Affiliation(s)
- Dong Ju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Won Jin
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Republic of Korea
| | - Jeong Mo Han
- Kong Eye Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Sung Lee
- Parangsae Eye clinic, Gwangju, Republic of Korea
| | - Seong Taeck Kim
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Min Ho Shin
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yung Hui Kim
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Sok Ji
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Dhirachaikulpanich D, Chanthongdee K, Zheng Y, Beare NAV. A systematic review of OCT and OCT angiography in retinal vasculitis. J Ophthalmic Inflamm Infect 2023; 13:1. [PMID: 36715778 PMCID: PMC9886715 DOI: 10.1186/s12348-023-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Retinal vasculitis is a component of uveitis for which the Standardisation of Uveitis Nomenclature (SUN) working group has no standard diagnostic criteria or severity grading. Fluorescein angiography is the gold standard test to assess retinal vasculitis, but is invasive and time-consuming. Optical coherence tomography (OCT) provides non-invasive detailed imaging of retinal structures and abnormalities, including blood vessel architecture and flow with OCT angiography (OCT-A). However, use of OCT in retinal vasculitis beyond assessing macular oedema, is not well established. We conducted a systematic review to understand the features of retinal vasculitis in OCT, Enhanced-depth imaging OCT (OCT-EDI) and OCT-A imaging. METHODS The systematic search was done in March 2022 and updated in January 2023, through PubMed, EMBASE and the Web of Science database for studies related to OCT, OCT-EDI and OCT-A findings and retinal vasculitis. Bias assessment was assessed using JBI Critical Appraisal Checklist, and any findings associated with retinal vasculitis were extracted by qualitative analysis. RESULTS We identified 20 studies, including 8 articles on OCT, 6 on OCT-EDI and 6 on OCT-A. The studies included analytical retrospective studies, case-series, and a case-control study. Five OCT studies reported secondary complications could be detected, and four reported retinal thickness alteration in retinal vasculitis. Five studies explored choroidal thickness alteration in OCT-EDI, and four explored capillary density alterations in retinal vasculitis using OCT-A. The heterogeneity in the studies' analysis and design precluded a meta-analysis. DISCUSSION There were no clear OCT, OCT-EDI or OCT-A findings that demonstrated potential to supersede fluorescein angiography for assessing retinal vasculitis. Some signs of macular structural effects secondary to retinal vasculitis may help prognostication for vision. The OCT signs of inflamed retinal vessels and perivascular tissue is an unexplored area.
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Affiliation(s)
- Dhanach Dhirachaikulpanich
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.416009.aFaculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanat Chanthongdee
- grid.10223.320000 0004 1937 0490Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yalin Zheng
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.415992.20000 0004 0398 7066Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nicholas A. V. Beare
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.10025.360000 0004 1936 8470St Paul’s Eye Unit, Liverpool University Hospitals NHS Trust, Liverpool, UK
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Kilmartin DJ. Literature review and proposal of best practice for ophthalmologists: monitoring of patients following intravitreal brolucizumab therapy. Ir J Med Sci 2023; 192:447-456. [PMID: 35102497 PMCID: PMC9892069 DOI: 10.1007/s11845-022-02929-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/19/2022] [Indexed: 02/05/2023]
Abstract
Brolucizumab is a novel humanised, single-chain, variable fragment inhibitor of Vascular Endothelial Growth Factor-A for the treatment of neurovascular age-related macular degeneration. Brolucizumab gained US Food and Drug Administration and European Medicines Agency approval following the Phase III HAWK (NCT02307682) and HARRIER (NCT02434328) trials which compared brolucizumab with aflibercept, presenting a tolerable safety and favourable efficacy profile. The mean change (least squares [LS] mean ± standard error) in best-corrected visual acuity letters from baseline to week 96 in the HAWK trial was 5.9 ± 0.78 for brolucizumab (6 mg) versus 5.3 ± 0.78 for aflibercept, and in the HARRIER trial, 6.1 ± 0.73 (6 mg) for brolucizumab (6 mg) and 6.6 ± 0.73 for aflibercept. Within both trials, greater reductions were noted in the central subfield thickness from baseline to week 96 in the brolucizumab (6 mg) groups versus the aflibercept group. Subsequent post-marketing reports detailed intraocular inflammation (IOI) after brolucizumab treatment and in response an independent safety review committee conducted a post hoc data review. While comparable, the rate of brolucizumab-associated IOI was higher in the post hoc analysis than the trials (4.6% and 4.4%, respectively). Findings from trials and real-world data indicate there may be pre-defining risk factors that predispose patients to IOI following brolucizumab treatment. With a thorough understanding of IOI classification and best practice management, ophthalmologists can use brolucizumab confidently and, should a case arise, they should act quickly to prevent vision loss. Herein, we provide information and guidance to support clinical decision-making related to brolucizumab use.
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Affiliation(s)
- Dara J. Kilmartin
- grid.416227.40000 0004 0617 7616Royal Victoria Eye & Ear Hospital, Adelaide Road, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, Dublin, Ireland
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Abroug N, Khairallah M, Ksiaa I, Ben Amor H, Zina S, Attia S, Jelliti B, Khochtali S, Khairallah M. A Comparative Study between Occlusive and Non-occlusive Retinal Vasculitis: Data from a Referral Center in Tunisia, North Africa. Ocul Immunol Inflamm 2023; 31:97-104. [PMID: 34644223 DOI: 10.1080/09273948.2021.1986726] [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] [Indexed: 01/27/2023]
Abstract
PURPOSE To compare clinical profile and visual outcomes of occlusive versus non-occlusive retinal vasculitis (RV). METHODS A retrospective comparative study. RESULTS 284 patients were enrolled, including 124 patients with occlusive RV (ORV) and 160 patients with non-occlusive RV (NORV). Patients with ORV were older (p ≤ 10-3), predominantly male (p ≤10-3), with less bilateral involvement (31.5% vs 53,4%; p ≤ 10-3). Infectious RV was more frequently diagnosed in the ORV group than in the NORV group (48.8% vs 32.9%, p = .006). Behçet disease and ocular tuberculosis were the leading causes of ORV. Idiopathic RV, Behçet disease, and sarcoidosis were the most common causes of NORV. Independent predictive factors of poor visual outcome were worse baseline visual acuity in both groups (p = .006 and p ≤ 10-3, respectively), and retinal hemorrhages (p = .048) and optic atrophy (p = .040) in the ORV group. CONCLUSION Occlusive and non-occlusive RV have distinctive clinical and etiological profile.
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Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Ishihara R, Khan Y, Halim MS, Akhavanrezayat A, Onghanseng N, Levin MH, Nguyen QD. Acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis. Am J Ophthalmol Case Rep 2022; 29:101760. [PMID: 36561880 PMCID: PMC9763352 DOI: 10.1016/j.ajoc.2022.101760] [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: 06/02/2022] [Revised: 11/05/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To report the clinical and anatomical features of an unusual case of acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis. Observations A 39-year-old patient, who was a known case of chronic headache with nonspecific visual symptoms for nine years, developed scotomas in her right eye. She was initially diagnosed with AIBSES which had been stable, but later worsened with symptoms of subsequent blind spot enlargement and photopsia on the left eye a year later. Increase in the size of the blind spot over the left eye and stability of the blind spot enlargement over the right eye was documented on Humphrey visual field (HVF) testing. Due to the rapid onset and severity of symptoms, an inflammatory etiology was entertained and this prompted referral to our clinic. At initial presentation, fluorescein angiogram (FA) revealed moderate diffuse vasculitis and disc leakage in the left eye, which existed alongside the enlarged blind spot. Corticosteroid treatment was suggested and initiated. The patient was found to have a reduction in the size of her blind spot and a decrease in severity of retinal vasculitis a month later. Unfortunately, the patient was then lost to follow up and had stopped steroid treatment of her own accord. After nine months without treatment, the patient's blind spot increased to a larger size than her initial presentation, as documented on HVF, with recurrence of vasculitis in the left eye. Conclusion and Importance This is an unusual case of AIBSES which presented with vasculitis and rapid progression and has responded to steroids. Though monocular AIBSES has been shown to later affect the contralateral eye, concurrent vasculitis with AIBSES has not previously been reported. Furthermore, the response to treatment with reduction in blind spot enlargement is unusual for AIBSES. These findings stress the need for regular monitoring in cases of AIBSES.
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Affiliation(s)
- Rhys Ishihara
- University of Texas Medical Branch, Department of Ophthalmology and Visual Sciences, Galveston, TX, USA
| | - Youan Khan
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA,Ocular Imaging Research and Reading Center (OIRRC), Sunnyvale, CA, USA
| | | | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Marc Harris Levin
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA,Corresponding author. Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, 94303, USA.
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Abstract
Purpose To describe a patient presenting with frosted branch angiitis soon after small-pox vaccination. Observations Frosted branch angiitis (FBA) is an acute onset retinal vasculitis featuring prominent perivascular sheathing in otherwise healthy individuals. FBA has been associated with noninfectious and infectious etiologies. This report describes a twenty-year-old African American female who developed bilateral frosted branch angiitis one week after small-pox vaccination. At presentation, the patient had bilateral, para-central visual field defects and subjective visual disturbances. On dilated exam, the patient demonstrated diffuse vasculitis bilaterally. The patient's field defects and clinical exam responded dramatically to oral prednisone therapy. Conclusions and Importance Acute idiopathic frosted branch angiitis is a rare condition which was temporally associated with small-pox vaccination.
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Affiliation(s)
- Kristen Collister
- Dean McGee Eye Institute, Oklahoma University Health Science Center, Oklahoma City, OK, USA
| | - Sam S. Dahr
- Dean McGee Eye Institute, Oklahoma University Health Science Center, Oklahoma City, OK, USA
- Corresponding author. Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L Young Blvd , Oklahoma City, Oklahoma, 73104, USA.
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Fonollosa A, Gallego-Pinazo R, Sararols L, Adán A, López-Gálvez M, Figueroa MS. Guidance on brolucizumab management recommendations. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:S2173-5794(22)00084-6. [PMID: 35882576 DOI: 10.1016/j.oftale.2022.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Brolucizumab, a new generation anti-VEGF, has demonstrated efficacy and safety in AMD in the pivotal HAWK and HARRIER trials. Post-marketing, previously undetected adverse events related to intraocular inflammation have been reported. An independent post hoc review of the pivotal trials puts the rate of IOI at 4.6%. The aim of this paper is to propose a set of recommendations for implementing the management of brolucizumab in clinical practice. METHODS The recommendations made by the authors are based on their clinical experience, critical review of (i) the pivotal trials, the post-hoc analysis of the Safety Review Committee, (ii), and (iii) the published literature. RESULTS In the pivotal trials, brolucizumab showed sustained functional gains, superior anatomical outcomes with potentially longer intervals between injections and a well-tolerated overall safety profile. Adverse events reported post-marketing include retinal vasculitis and retinal vascular occlusion. Based on the available information, experts recommend (i) ruling out non-recommended patient profiles (prior history of ORI), (ii) screening the patient prior to each injection to rule out active ORI, (iii) monitoring the patient for early warning signs, and (iv) treating immediately should any adverse events develop. CONCLUSIONS The adverse events reported are rare, but may be associated with severe and irreversible loss of visual acuity. The recommendations made are intended to facilitate the management of brolucizumab in the routine practice of retinologists, to ensure patient safety and, should any adverse events occur, to minimise their impact on vision.
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Affiliation(s)
- A Fonollosa
- Servicio de Oftalmología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain; Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - R Gallego-Pinazo
- Unidad de Mácula y Ensayos Clínicos, Clínica Oftalvist, Valencia, Spain
| | - L Sararols
- Servicio de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitario General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain
| | - A Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M López-Gálvez
- Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain; Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - M S Figueroa
- Unidad de Retina, Clínica Baviera, Madrid, Spain; Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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21
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Maalouf G, Andrillon A, Leclercq M, Sève P, Bielefeld P, Gueudry J, Sené T, Titah C, Moulinet T, Rouvière B, Sène D, Desbois AC, Domont F, Touhami S, Thibault T, Chamieh CE, Cacoub P, Kodjikian L, Biard L, Bodaghi B, Saadoun D. Lower Relapses Rate With Infliximab Versus Adalimumab in Sight-Threatening Uveitis: A Multicenter Study of 330 Patients. Am J Ophthalmol 2022; 238:173-180. [PMID: 35172172 DOI: 10.1016/j.ajo.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the relapse rate of sight-threatening noninfectious uveitis (NIU) in patients treated with infliximab (IFX) or adalimumab (ADA). DESIGN Observational retrospective multicenter study. METHODS A total of 330 patients (median age, 36 years; interquartile range, 27-54), 45.2% men) with sight-threatening NIU (ie, retinal vasculitis and/or macular edema) treated with anti-tumor necrosis factor [TNF]-α agents (IFX intravenously at 5 mg/kg at weeks 0, 2, 6, and every 4 to 6 weeks or ADA subcutaneously at 80 mg, then 40 mg every 2 weeks). Data were obtained retrospectively from patients' medical records. Main outcome measures were relapse rate, complete response of NIU, corticosteroid sparing effect, and safety. RESULTS Main etiologies of uveitis included Behçet disease (27%), idiopathic juvenile arthritis (5.8%), and sarcoidosis (5.5%). The estimated relapse rate at 6 months after introduction of biological agents was 13% (95% CI = 0.009-0.16). IFX was associated with less relapse risk than ADA (hazard ratio [HR] = 0.52, 95% CI = 0.36- 0.77, P = .001). ADA and IFX were comparable in terms of complete response rate of NIU as well as corticosteroid-sparing effect. Behçet disease was associated with higher odds of complete response (HR = 2.04, 95% CI = 1.16 -3.60, P = .01] and lower relapse rate (HR = 0.53, 95% CI = 0.33-0.85, P = .009) than other causes of NIU with anti-TNF-α agents. CONCLUSIONS In sight-threatening NIU, IFX seems to be associated with a lower relapse rate than ADA.
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Affiliation(s)
- Georgina Maalouf
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Anaïs Andrillon
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Mathilde Leclercq
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France; Internal Medicine Department, CHU Rouen, Rouen, France
| | - Pascal Sève
- Internal Medicine Department, Hôpital de la Croix- Rousse, Hospices Civils de Lyon, Lyon Cedex, France; Faculté de Médecine Lyon-Sud, Université Claude Bernard-Lyon 1, Lyon, France
| | - Philip Bielefeld
- Internal Medicine and Systemic Diseases Department (Medicine Interne 2), Dijon University hospital, Dijon, France
| | - Julie Gueudry
- Ophthalmology Department, Hospital Charles Nicolle, CHU Rouen, Rouen, France; EA7510, UFR Santé, Rouen University, Rouen, France
| | - Thomas Sené
- Internal Medicine Department, Fondation Rothschild, Paris, France
| | - Cherif Titah
- Ophthalmology Department, Fondation Rothschild, Paris, France
| | - Thomas Moulinet
- Department of Internal Medicine, CHRU de Nancy, Nancy, France; Université de Lorraine, Inserm UMR_S 1116, Nancy, France
| | - Bénédicte Rouvière
- Internal Medicine and Pneumology Department, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Damien Sène
- Internal Medicine Department, Lariboisière Hospital, Paris, France; INSERM UMR, Paris Diderot University, Paris, France
| | - Anne-Claire Desbois
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Fanny Domont
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Sara Touhami
- Ophthalmology Department, DHU View Restore, Pitié Salpêtrière Hospital, Paris, France
| | - Thomas Thibault
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Patrice Cacoub
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Laurent Kodjikian
- Ophthalmology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon Cedex, France; Faculté de Médecine Lyon-Sud, Université Claude Bernard-Lyon 1, Lyon, France
| | - Lucie Biard
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, DHU View Restore, Pitié Salpêtrière Hospital, Paris, France
| | - David Saadoun
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France.
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Wu PY, Kao CC, Sheu SJ. Cooperation with rheumatologists on intensive systemic treatment for psoriatic arthritis-related panuveitis with retinal vasculitis: a case report. BMC Ophthalmol 2022; 22:90. [PMID: 35197003 PMCID: PMC8867625 DOI: 10.1186/s12886-022-02313-1] [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: 11/16/2021] [Accepted: 02/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Patients with psoriatic arthritis (PsA) may develop uveitis, a potentially serious ocular complication. PsA-related uveitis may result in significant morbidity and even vision loss if underdiagnosed or under-treated. We presented a case with long-standing recurrent uveitis and retinal vasculitis successfully managed by fortified systemic immunomodulators for systemic PsA. Case presentation A 47-year-old woman was referred under the impression of acute anterior uveitis in her right eye in recent one month. Ocular examinations showed panuveitis in both eyes with intense vitreous opacity in her right eye. Fundus fluorescence angiography revealed retinal vasculitis in both eyes. Systemic surveys excluded the possibility of infection but showed an elevated inflammation marker. With intensive immunosuppressive treatment, inflammation resolved and the vision improved. Conclusion Our case highlights not only the importance of intensified systemic therapy in treating PsA-related uveitis but the importance of multidisciplinary collaboration. Recurrent uveitis may be an indicator of disease activity prior to other inflammatory markers.
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Affiliation(s)
- Po-Ying Wu
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chen Kao
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Sumethkul K, Urailert I, Kitumnuaypong T, Angthararak S, Silpa-Archa S. The incidence, risk factor, and time to develop rheumatologic diseases after isolated inflammatory eye diseases: a 12-year cohort study. Clin Rheumatol 2022; 41:1003-1012. [PMID: 35001319 DOI: 10.1007/s10067-021-06005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/14/2021] [Accepted: 11/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The incidence, risk factors, and time to diagnosis of rheumatologic disease (RD) in patients with isolated inflammatory eye diseases (IED) were investigated. MATERIAL AND METHODS A 12-year bidirectional cohort study was conducted in IED patients who were tested for antinuclear antibody (ANA) and rheumatoid factor (RF). Patients with prior RD were excluded. Impacts of relevant symptoms, signs, and laboratory investigations were analyzed. RESULTS Seventy-five patients presented with IED including scleritis, anterior uveitis (AU), retinal vasculitis (RV), keratopathy, and optic neuritis (OP). AU, RV, keratopathy, and OP were associated with RD development. The incidence of RD was 36% during 12 years. RD developed most frequently in AU (55.5%) and RV (22.2%). The longest duration for RD development was 5.5 years. Prevalence of positive ANA and RF were 57.3% and 13.3%, respectively. The three most common RDs developed after IEDs were spondyloarthropathy (44.4%), systemic lupus erythematosus (SLE) (18.5%), and Sjogren's syndrome (pSS) (11.1%). The risk factors of RD from univariate analysis were age below 35 years old at onset of IED [relative risk (RR) 3.45; 95% CI (1.13-10.55), p =0.026], positive pertinent findings from history [RR 2.125; 95% CI (1.39-3.25), p<0.001], and physical examination [RR 3.23; 95% CI (1.84-5.66), p<0.001]. Multivariable logistic regression showed that bilateral eye involvement of IED was the significant risk of RD [RR 4.33; 95% CI (1.57-11.96), p=0.004]. IED patients with bilateral eye involvement had shorter time to develop RD (p=0.018). Positive ANA was the predictor for SLE and pSS in RV or OP patients [RR 2.00; 95% CI (1.14-3.52), p=0.04]. CONCLUSIONS IED with bilateral eye involvement was the risk of RD development. Positive ANA was the predictor of RD in RV and OP patients, but not for the other IEDs. Follow-up period of at least 5 years was required to identify RD. KEY POINTS •Bilateral involvement of isolated inflammatory eye disease was a significant risk factor of rheumatologic disease development.
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Affiliation(s)
- Kittiwan Sumethkul
- Rheumatology and Allergy Unit, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400, Thailand.
| | - Indhira Urailert
- Rheumatology and Allergy Unit, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400, Thailand
| | - Tassanee Kitumnuaypong
- Rheumatology and Allergy Unit, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400, Thailand
| | - Sungchai Angthararak
- Rheumatology and Allergy Unit, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400, Thailand
| | - Sukhum Silpa-Archa
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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Khoramnia R, Figueroa MS, Hattenbach LO, Pavesio CE, Anderesi M, Schmouder R, Chen Y, de Smet MD. Manifestations of intraocular inflammation over time in patients on brolucizumab for neovascular AMD. Graefes Arch Clin Exp Ophthalmol 2021. [PMID: 34932153 DOI: 10.1007/s00417-021-05518-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022] Open
Abstract
PURPOSE To describe the adverse events associated with brolucizumab, in particular the sequence of intraocular inflammation (IOI), retinal vasculitis (RV), and/or retinal vascular occlusion (RO). METHODS This was an unmasked post hoc analysis of the randomized HAWK/HARRIER clinical trials. Patients with neovascular AMD in the brolucizumab arms of the trials were included. IOI-related adverse events reported by study investigators were analyzed to determine early signs and the time course of IOI-related adverse events, using a subgroup of patients with definite/probable IOI cases identified in an independent unmasked post hoc review by an external safety review committee. A limited literature review on IOI following anti-VEGF therapy was also conducted. RESULTS Among 50 patients with definite/probable IOI cases identified by the safety review committee, 12 had RV or RO adverse events reported by the investigators. For 6 of 12, IOI (other than RV) was reported before RV or RO. The duration from the first IOI adverse event to the first RV or RO adverse event ranged from 16 to 171 days for 5 patients and was 553 days for 1 patient. Four of the 6 patients received ≥ 1 brolucizumab injection on or after the date of the first IOI adverse event and before the first RV or RO adverse event. CONCLUSIONS IOI may precede RV or RO in some patients treated with brolucizumab.
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Sota J, Gentileschi S, Perfetti MO, Frediani B, Tosi GM, Cantarini L, Fabiani C. Role of Adalimumab Biosimilar in the Treatment of Non-Anterior Uveitis Associated with Behçet's Syndrome. Ophthalmol Ther 2021; 10:1129-1135. [PMID: 34458968 PMCID: PMC8589899 DOI: 10.1007/s40123-021-00387-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/09/2021] [Accepted: 08/09/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION To evaluate the efficacy of SB5, an adalimumab biosimilar, in the management of Behçet's syndrome (BS)-related uveitis. METHODS Data from eight BS patients (16 eyes) with active non-anterior uveitis and/or systemic uncontrolled disease or performing non-medical switch to SB5 were retrospectively collected and analyzed. RESULTS Complete control of uveitis was observed in all 16 eyes without relapses during follow-up. The number of relapses 12 months prior to SB5 initiation and at last follow-up was 100 and 0 per 100 patients/year, respectively (p = 0.010). At baseline, four eyes had active retinal vasculitis, whereas at 3 months and at last follow-up, retinal vasculitis had resolved in all of them (p = 0.018). Median visual acuity did not vary significantly between baseline and last follow-up visit (p = 0.109). No ocular complications emerged during treatment. CONCLUSIONS SB5 is effective in the treatment of BS-related non-anterior uveitis. It reduces uveitis relapses and controls retinal vasculitis while allowing preservation of visual acuity.
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Affiliation(s)
- Jurgen Sota
- Rheumatology Unit, Policlinico "Le Scotte", Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit, Policlinico "Le Scotte", Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Maria Orsetta Perfetti
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Policlinico "Le Scotte", Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Policlinico "Le Scotte", Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Rahman EZ, Beck KD, Waldman CW, Sohn JH. Unusual presentation of CREST retinal vasculitis. Am J Ophthalmol Case Rep 2021; 23:101172. [PMID: 34368496 PMCID: PMC8326344 DOI: 10.1016/j.ajoc.2021.101172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 04/18/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To report a case of CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias) syndrome-induced retinal vasculitis in the setting of ocular inflammation soon after recent micropulse cyclophotocoagulation (mTS-CPC). Observations Our patient developed CREST associated retinal vasculitis in both eyes (right > left) eight days after receiving mTS-CPC in her left eye. There was initial concern for sympathetic ophthalmia due to the resulting bilateral inflammation. The patient was treated with prednisone with resolution of her symptoms. Conclusions This is the first case of CREST retinal vasculitis that appears to be directly triggered by inflammation caused by mTS-CPC.
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Affiliation(s)
- Effie Z Rahman
- University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Kinley D Beck
- University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Corey W Waldman
- University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Jeong-Hyeon Sohn
- University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
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Jung EE, Lin M, Ryu C, Moysidis SN, Burkemper B, Murgai R, Arbabi A, Ameri H. Association of the Pattern of Retinal Capillary Non-Perfusion and Vascular Leakage with Retinal Neovascularization in Proliferative Diabetic Retinopathy. J Curr Ophthalmol 2021; 33:56-61. [PMID: 34084958 PMCID: PMC8102955 DOI: 10.4103/joco.joco_234_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose: To explore the correlation between retinal capillary non-perfusion and the distribution of retinal neovascularization and vascular leakage (VL) in patients with proliferative diabetic retinopathy (PDR). Methods: Ultra-widefield angiograms of 96 eyes of 69 patients with PDR were reviewed for the proportion of non-perfused area to total gradable area, and for the presence of neovascularization and VL. Results: Retinal neovascularization was distributed as such: neovascularization elsewhere (NVE), 57.3%; neovascularization of the disc (NVD), 11.5%; both neovascularization of the disc and elsewhere (NVED), 31.3%. The proportion of non-perfused retina, so-called ischemic index, was greater in eyes with NVED compared to eyes with NVE only, but not when compared to NVD only. Overall, 83% of eyes had VL. The presence and the extent of VL correlated with the proportion of the ischemic index. While VL and ischemic index were more severe in the mid-periphery and far-periphery, the majority of NVE was located in the posterior pole. Conclusions: The presence of both NVD and NVE is associated with a greater ischemic index than NVE alone. Although both VL and ischemic index is significantly higher in peripheral zones, the majority of neovascularization occurs at the posterior pole.
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Affiliation(s)
- Eric E Jung
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle Lin
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christine Ryu
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stavros N Moysidis
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rajan Murgai
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amirmohsen Arbabi
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hossein Ameri
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Baumal CR, Bodaghi B, Singer M, Tanzer DJ, Seres A, Joshi MR, Feltgen N, Gale R. Expert Opinion on Management of Intraocular Inflammation, Retinal Vasculitis, and Vascular Occlusion after Brolucizumab Treatment. Ophthalmol Retina 2021; 5:519-527. [PMID: 33007521 DOI: 10.1016/j.oret.2020.09.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Recent reports have described a spectrum of uncommon findings of intraocular inflammation (IOI), retinal vasculitis, or retinal vascular occlusion in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal injection (IVI) of brolucizumab. We present guidance on the clinical presentation of this spectrum and propose recommendations for management of these events. DESIGN PubMed literature review and expert opinion panel. PARTICIPANTS A working group of international medical experts and Novartis medical personnel. METHODS The working group deliberated on the clinical presentations and used a 3-pronged approach to develop management recommendations based on (1) critical appraisal of scientific literature; (2) clinical insights from the HAWK and HARRIER trials, postmarketing reports, and assessments from an independent Safety Review Committee (SRC); and (3) their clinical experience. MAIN OUTCOME MEASURES Management recommendations for a spectrum of ocular inflammatory events after treatment with brolucizumab or other anti-vascular endothelial growth factors (VEGFs). RESULTS Based on insights gained from the available information and the expertise of the contributors, recommendations were proposed for ocular examinations, imaging modalities, and treatment strategies for management of this spectrum of events. Patients should be educated to promptly report any relevant or persistent symptoms after IVI to facilitate timely intervention. Patients diagnosed with IOI should be evaluated for concomitant retinal vasculitis or retinal vascular occlusive events. Clinical examination can be augmented with multimodal imaging techniques, including widefield imaging, fluorescein angiography (with peripheral sweeps), and OCT. Once confirmed, the ongoing brolucizumab treatment should be suspended and intensive treatment with potent corticosteroids (topical, subtenon, intravitreal, or systemic) is recommended, which may be supplemented with other treatment strategies depending on the severity. Based on the clinical outcome of these events, individualized treatment with locally available standard of care should be considered for the underlying nAMD. CONCLUSIONS These recommendations emphasize the need for early diagnosis, prompt and timely intervention, intensive treatment, and frequent monitoring to minimize the risk of progression of these events. The proposed recommendations may facilitate a consistent management approach of this spectrum of ocular inflammatory events should they arise in nAMD after treatment with brolucizumab or other anti-VEGFs.
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Affiliation(s)
- Caroline R Baumal
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts.
| | - Bahram Bodaghi
- Ophthalmology, IHU FOReSIGHT, Sorbonne University, APHP, Paris, France
| | - Michael Singer
- Medical Center of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas
| | - David J Tanzer
- Novartis Pharmaceutical Corporation, East Hanover, New Jersey
| | | | - Mayur R Joshi
- Novartis Pharmaceuticals UK Limited, London, United Kingdom
| | | | - Richard Gale
- York Teaching Hospital NHS Foundation Trust, University of York, York, United Kingdom
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Tsui J, Ho M, Lui G, Li T, Chen L, Iu L, Brelen M, Young AL. The clinical presentation and treatment outcomes of ocular tuberculosis: a 5-year experience in an endemic area. Int Ophthalmol 2021; 41:3199-3209. [PMID: 34037904 DOI: 10.1007/s10792-021-01886-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the clinical presentations of ocular tuberculosis infection (OTB) and the treatment regimen and outcome in an endemic area. METHODS This is a retrospective case series of patients with presumed OTB treated in a tertiary teaching hospital in Hong Kong in 2014-2019. RESULTS Among the nineteen patients recruited, the most common clinical presentation of OTB was retinal vasculitis (42.1%), followed by scleritis, intermediate uveitis, and choroidal tuberculoma (15.8% respectively). 94.7% and 94.4% of the subjects were treated with ATT and steroid, respectively, and 31.6% were put on systemic immunosuppressant prior to the initiation of ATT. Apart from those suffering from intermediate uveitis, most demonstrated good clinical response within 8 weeks of ATT initiation. CONCLUSION Ocular involvement of TB has been increasingly recognized, especially in endemic regions like Hong Kong. High index of suspicion is recommended for OTB in typical clinical phenotypes or recurrent/resistant ocular inflammation unresponsive to conventional therapy. TB retinal vasculitis was the most common presentation of OTB in this study and OTB generally requires treatment with either regional or systemic steroid together with ATT.
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Affiliation(s)
- Jolly Tsui
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Lui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lijia Chen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Huvard MJ, Pecen PE, Palestine AG. The Clinical Characteristics of Noninfectious Occlusive Retinal Vasculitis. Ophthalmol Retina 2021; 6:43-48. [PMID: 33901715 DOI: 10.1016/j.oret.2021.04.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/21/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To characterize the clinical features of occlusive retinal vasculitis (ORV). DESIGN Retrospective case series. PARTICIPANTS Forty-two patients with ORV. METHODS A retrospective chart review identified all patients with ORV seen at the University of Colorado uveitis service between January 2013 and April 2020. All included patients demonstrated noninfectious uveitis and evidence of vascular occlusion in the presence of retinal vascular inflammation on widefield fluorescein angiography. MAIN OUTCOME MEASURES Demographic data, visual acuity, clinical findings, and fluorescein angiography findings. RESULTS We identified 73 eyes from 42 patients (15 men, 27 women) with ORV. Thirty-one of 42 patients had bilateral disease. Most eyes (54/73) showed mixed arteriolar and venous vasculitis compared with primarily arteriolar (6/73) or venous (15/73) vasculitis. Thirteen of 42 patients had an underlying systemic condition, most commonly granulomatosis with polyangiitis; however, bilaterality was not associated with a systemic condition. Retinal nonperfusion was present equally in zone 2 (28/73) and zone 3 (28/73) compared with zone 1 (16/73). Retinal or iris neovascularization was present in 25 of 73 eyes. Eighteen of 42 patients required more than 1 immunosuppressive medication (average, 1.33) to prevent progressive vascular occlusive disease. CONCLUSIONS Occlusive retinal vasculitis is a heterogeneous entity with significant risk of visual impairment. Systemic disease was more prevalent in this specific cohort compared with cohorts from prior studies of retinal vasculitis.
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Affiliation(s)
- Michael J Huvard
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paula E Pecen
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.
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Zito R, Micelli Ferrari T, Di Pilato L, Lorusso M, Ferretta A, Micelli Ferrari L, Accorinti M. Clinical course of choroidal neovascular membrane in West Nile virus chorioretinitis: a case report. J Med Case Rep 2021; 15:206. [PMID: 33875008 PMCID: PMC8056646 DOI: 10.1186/s13256-021-02700-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background This report describes the clinical course of choroidal neovascular membrane (CNV) in West Nile virus-associated chorioretinitis. Case presentation A 28-year-old Italian woman was referred to our institution because of reduced visual acuity in the left eye dating back 4 months. A diagnosis of retinal vasculitis in the right eye and chorioretinitis with CNV in the left eye was made. A complete workup for uveitis revealed positivity only for anti-West Nile virus immunoglobulin M (IgM), while immunoglobulin G (IgG) was negative. Whole-body computed tomography and nuclear magnetic resonance imaging of the brain were also negative. Therefore, the patient was treated with a combination of oral prednisone (starting dose 1 mg/kg per day) and three intravitreal injections of bevacizumab 1.25 mg/0.05 ml, 1 month apart. Fourteen days from starting corticosteroid therapy and after the first intravitreal injection, the patient experienced increased visual acuity to 0.4. Response to therapy was monitored by clinical examination, ocular coherence tomography (OCT), OCT angiography and retinal fluorescein angiography. Three months later, resolution of CNV in the left eye was achieved and no signs of retinal vasculitis were detected in the right eye, while serum IgM for West Nile virus turned negative and IgG positive. Conclusion CNV may be a complication of West Nile virus-associated chorioretinitis, and only subclinical retinal vasculitis may also be found even in non-endemic regions.
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Affiliation(s)
- Roberta Zito
- Department of Ophthalmology, Hospital "F. Miulli", Acquaviva delle Fonti, 70124, Bari, Italy.
| | - Tommaso Micelli Ferrari
- Department of Ophthalmology, Hospital "F. Miulli", Acquaviva delle Fonti, 70124, Bari, Italy
| | - Luigi Di Pilato
- Department of Ophthalmology, Hospital "F. Miulli", Acquaviva delle Fonti, 70124, Bari, Italy
| | - Massimo Lorusso
- Department of Ophthalmology, Hospital "F. Miulli", Acquaviva delle Fonti, 70124, Bari, Italy
| | - Anna Ferretta
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Luisa Micelli Ferrari
- Department of Ophthalmology, Azienda Ospedaliero-Universitaria, Policlinico, Bari, Italy
| | - Massimo Accorinti
- Department of Ophthalmology, Ocular Immunovirology Service, Sapienza University of Rome, Rome, Italy
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Wang P, Chin EK, Almeida DR. Idiopathic retinal arterial occlusive vasculitis in the setting of multiple arterial occlusions. Am J Ophthalmol Case Rep 2021; 22:101086. [PMID: 33912730 PMCID: PMC8065184 DOI: 10.1016/j.ajoc.2021.101086] [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: 11/11/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose We present a patient with vaso-occlusive retinal vasculitis to summarize this uncommon entity and review the clinical features and management challenges applicable to patients with retinal vasculitis. Observations A 76-year-old male presented with sudden-onset severe central vision loss. On examination, vitreous hemorrhage, neovascularization of the optic nerve, peripheral segmental periphlebitis, vessel sclerosis, vascular sheathing, and retinal hemorrhages were observed, and a diagnosis of active vaso-occlusive retinal vasculitis was made. The patient then underwent a complete infectious, inflammatory, and neoplastic workup which returned negative. The patient was treated with locally with a sub-Tenon's injection of 40 mg triamcinolone on presentation and later with oral prednisone. At three-month follow-up, vision improved to 20/300 with regressing neovascularization and clearing of vitreous hemorrhage in the right eye (OD). Conclusions Considering novel associations of occlusive retinal vasculitis, it is important to recognize that idiopathic occlusive retinal vasculitis, although uncommon, can occur and represents a prototypical disease form. It is imperative that these patients have a complete infectious, inflammatory, and neoplastic workup owing to the possible overlap of masquerade clinical signs and symptoms.
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Affiliation(s)
- Patrick Wang
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - Eric K Chin
- Retina Consultants of Southern California, Redlands, CA, USA.,Loma Linda University Medical Center, Veterans Affair Hospital, Loma Linda, CA, USA
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Kim KW, Kusuhara S, Tachihara M, Mimura C, Matsumiya W, Nakamura M. A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer. Am J Ophthalmol Case Rep 2021; 22:101072. [PMID: 33796799 PMCID: PMC7995477 DOI: 10.1016/j.ajoc.2021.101072] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 02/02/2021] [Accepted: 03/07/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To report a case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer. Observations A 71-year-old man, who was diagnosed with metastatic lung cancer (squamous cell carcinoma), presented with blurry vision 2 weeks after the initiation of pembrolizumab monotherapy. His best-corrected visual acuity (BCVA) was 20/20 OU, and slitlamp examination revealed fine keratic precipitates, anterior chamber cells (1+) and flare (1+) in both eyes. Dilated fundus examination showed no remarkable finding in the right eye and vitreous haze (2+), perivascular exudates, and vessel sheathing in the left eye. Fluorescence angiography demonstrated dye leakage from the optic disc and both retinal arteries and veins extending from the posterior to the peripheral retina in both eyes. The patient was diagnosed with panuveitis and retinal vasculitis as Grade 3 immune-related adverse event (irAE). Pembrolizumab was discontinued and oral prednisone 70mg/day was given for 1 week. The dose was reduced to 30mg/day for the next 3 weeks and was then stopped. One month after the treatment, intraocular inflammation became quiescent. With a good response to the treatment of irAE, pembrolizumab was restarted. Recurrence of ocular inflammation occurred over the next 1.5 years, but all of which were successfully treated with sub-Tenon's injection of triamcinolone acetonide (STTA). The patient maintained BCVA of 30/20 OU at the latest visit. Conclusions and importance We showed a case of retinal vasculitis occurred as an irAE of pembrolizumab for metastatic lung cancer. Retinal vasculitis was well managed with transient pembrolizumab discontinuation and oral corticosteroid therapy, and pembrolizumab was restarted with the aid of STTA. As ocular irAEs might be controlled by local corticosteroid therapy, the decision to continue immune checkpoint inhibitor therapy should be made on a case-by-case basis.
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Affiliation(s)
- Kyung Woo Kim
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Corresponding author. Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chihiro Mimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Matsumiya
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Yang S, Huang Z, Liu X, Li H, Xie L, Chen X, Wen F, Liang D, Su W. Comparative study of adalimumab versus conventional therapy in sight-threatening refractory Behçet's uveitis with vasculitis. Int Immunopharmacol 2021; 93:107430. [PMID: 33581500 DOI: 10.1016/j.intimp.2021.107430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/21/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anti-tumor necrosis factor-alpha was regarded as an option in treatment of non-infectious uveitis. However, few studies in the far easter region have concentrated on this therapy and current studies have not emphasized the elimination of retinal vasculitis. To compare the effectiveness of adalimumab (ADA) plus conventional therapy (CT) versus CT alone in treating patients with retinal vasculitis (RV) due to refractory Behçet's uveitis (BU). DESIGN Retrospective cohort study. METHODS Clinical records of BU patients with previously treated but poorly controlled RV were analyzed. Patients were allocated into two groups depending on ADA use. Each group was treated for no less than 6 months between February 2015 and September 2020. The primary outcome parameter was the RV score. Best-corrected visual acuity (BCVA), number of relapses, macular thickness and ocular complications were considered concomitantly. RESULTS Forty-two patients (72 eyes) were included; 21 patients were in CT group, and 21 patients were in ADA group. Inflammatory parameters improved in both groups. The improvement in the fluorescein angiography (FA) score and anterior chamber inflammation were significantly better in ADA group than in CT group (P < 0.05). The relapse time was significantly lower in ADA group than in CT group (P = 0.01). Daily glucocorticoid dose tapers were more evident in ADA group than in CT group (P < 0.05). Adverse events were detected in 7 patients (5 had upper respiratory tract infection and 2 had gastrointestinal discomfort) in ADA group; in CT group, upper respiratory infection and recurrent gum swelling were observed in 1 patient each. CONCLUSION Our results indicate that ADA plus CT outperforms CT alone in patients with RV due to refractory BU. More agile ADA use in these patients should be considered to achieve optimal treatment.
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Affiliation(s)
- Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Zhaohao Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xiuxing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - He Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Lihui Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xiaoqing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Dan Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.
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Kataoka K, Horiguchi E, Kawano K, Ushida H, Nakano Y, Ito Y, Terasaki H. Three cases of brolucizumab-associated retinal vasculitis treated with systemic and local steroid therapy. Jpn J Ophthalmol 2021; 65:199-207. [PMID: 33543352 DOI: 10.1007/s10384-021-00818-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To describe three Japanese cases of retinal vasculitis that occurred following intravitreal brolucizumab injections and the systemic and local steroid treatment administered. CASES Three patients developed intraocular inflammation (IOI) and retinal vasculitis following the first injection of brolucizumab for age-related macular degeneration. For two eyes, monthly aflibercept injections did not control exudation, and therapy was changed to brolucizumab; one eye was treatment-naïve. All three patients noticed blurry vision and floaters 11-18 days after brolucizumab injections, and the treated eyes exhibited anterior chamber cells, fine keratic precipitates, vitreous cells, and vitreous haze. Ultra-widefield color images of the fundus showed retinal hemorrhage in the peripheral retina and, in two cases vascular sheathing. Ultra-widefield fluorescein angiography (FA) showed segmental vascular leakage in all eyes and leakage from the optic disc in two eyes. Vascular filling defects were noted in the peripheral retinae of two eyes. Brolucizumab-associated retinal vasculitis was diagnosed, and treated with 30 mg/day of oral prednisolone, subtenon triamcinolone acetonide injection (20 mg/0.5 ml), and 0.1% betamethasone sodium phosphate solution. After 1 week, color fundus images and FA showed improvements in vascular sheathing, leakage from retinal vessels, and optic disc leakage, but the vascular filling defects remained. Visual acuity was restored in all three eyes 6 weeks after the onset. CONCLUSION Brolucizumab-associated IOI, including retinal vasculitis and retinal occlusion, is a rare but important adverse event that can cause severe vision loss. Prompt diagnosis with FA and treatment with systemic or local steroids should be considered.
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Affiliation(s)
- Keiko Kataoka
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Etsuyo Horiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenichi Kawano
- Department of Ophthalmology, Yokkaichi Municipal Hospital, Mie, Japan
| | - Hiroaki Ushida
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuyako Nakano
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuki Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Saadouli D, Lahmar A, Ben Mansour K, El Afrit N, Yahyaoui S, El Afrit MA. [Ocular manifestations of Behçet's disease]. J Fr Ophtalmol 2020; 44:196-202. [PMID: 33380351 DOI: 10.1016/j.jfo.2020.04.058] [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: 01/19/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Behçet's disease is a systemic inflammatory disease. Ocular involvement is an important diagnostic criterion, and this disease may be associated with severe visual loss. PURPOSE The goal of this study was to specify the epidemiological, clinical and therapeutic features of ocular involvement in patients with Behçet's disease and to identify risk factors for poor visual outcomes. METHODS A retrospective study was performed in 93 patients diagnosed with ocular Behçet's disease over a period of 9 years. Epidemiological, clinical, and therapeutic data was obtained from medical records and analyzed retrospectively. Poor visual outcome was defined as visual acuity limited to light perception without projection or no light perception. RESULTS The male:female ratio was 1.9. The mean age was 34.5 years. Ocular involvement was the presenting sign in 4%, bilateral in 61% and active in 68.8%. Uveitis was the most common presentation (57%), dominated by panuveitis, followed by retinal vasculitis (51.6%) and papilledema (10.7%). Maculopathy (26.8%) and cataract (18.2%) were the most common complications. Twenty patients (21.5%) had no light perception or light perception without projection. Treatment was based on corticosteroids in combination with immunosuppressive therapy (Azathioprine) in 55.9% of cases. Our study indicates a significant association of male gender and panuveitis with a poor visual outcome. CONCLUSION Ocular involvement in Behçet's disease is frequent and serious, which may lead to blindness. Male gender and panuveitis were predictors of poor visual prognosis.
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Affiliation(s)
- D Saadouli
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - A Lahmar
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - K Ben Mansour
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - N El Afrit
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis
| | - S Yahyaoui
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - M A El Afrit
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
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Iyer PG, Peden MC, Suñer IJ, Patel N, Dubovy SR, Albini TA. Brolucizumab-related retinal vasculitis with exacerbation following ranibizumab retreatment: A clinicopathologic case study. Am J Ophthalmol Case Rep 2020; 20:100989. [PMID: 33294727 PMCID: PMC7695942 DOI: 10.1016/j.ajoc.2020.100989] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 01/03/2023] Open
Abstract
Purpose To describe the clinical and pathologic characteristics of a case of retinal vasculitis and vitritis following brolucizumab administration and subsequent ranibizumab treatment. Observations A 76-year old Caucasian woman experienced pain, decreased vision and floaters one week after receiving her third monthly intravitreal brolucizumab injection in the right eye for exudative age-related macular degeneration. Examination was significant for 0.5+ anterior chamber cells, vitritis, mild peripheral vascular sheathing, and decreased vision from 20/70 to 20/200. She was started on topical 1% prednisolone acetate with improvement in her examination. She was switched to ranibizumab one month after her last brolucizumab injection of the right eye. Three weeks after her ranibizumab injection, she noticed photophobia, pain and decreased vision. Examination revealed worsening uveitis, vitritis, vascular sheathing, and decreased vision to count fingers. Despite starting on 0.05% difluprednate drops every 2 hours and oral high-dose methylprednisolone, the patient did not have any significant improvement in her symptoms or examination. She underwent pars plana vitrectomy and vitreous biopsy with intravitreal triamcinolone injection to the right eye. Vitreous biopsy and culture ruled out infectious endophthalmitis, and further cytopathologic analysis revealed chronic inflammatory infiltrate. Conclusion and importance Treatment with brolucizumab can result in intraocular inflammation and retinal vasculitis likely due to a delayed hypersensitivity reaction to the drug, supported by cytopathologic analysis of a vitreous sample. We demonstrate a case where retreatment with an alternative anti-VEGF agent resulted in worsening vision and vasculitis.
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Affiliation(s)
- Prashanth G Iyer
- Bascom Palmer Eye Institute, 900 Northwest 17th Street, Miami, FL, USA
| | - Marc C Peden
- Retina Associates of Florida, 602 S. MacDill Ave. Tampa, FL, USA
| | - Ivan J Suñer
- Retina Associates of Florida, 602 S. MacDill Ave. Tampa, FL, USA
| | - Nish Patel
- Bascom Palmer Eye Institute, 900 Northwest 17th Street, Miami, FL, USA
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, 900 Northwest 17th Street, Miami, FL, USA.,Florida Lions Ocular Pathology Laboratory, USA
| | - Thomas A Albini
- Bascom Palmer Eye Institute, 900 Northwest 17th Street, Miami, FL, USA
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Marrero FM, De Jesus E, Alvarez S, Mendez Bermudez IJ, Vila M, Santos C, Oliver AL. Characteristics, Upon Presentation, of a Cohort of Hispanic Patients with Birdshot Retinochoroidopathy. P R Health Sci J 2020; 39:249-253. [PMID: 33031692] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe the characteristics, upon presentation, of a cohort of Hispanic patients with birdshot retinochoroidopathy. METHODS A retrospective chart review of Hispanic patients with birdshot retinochoroidopathy of was performed. The demographic and clinical characteristics were analyzed. RESULTS Nine patients who met the research criteria for a diagnosis of birdshot retinochoroidopathy were identified and included in the analysis, all of whom were HLA-A29 positive. The median age of the cohort upon presentation was 52 years; 89% of the patients were female, and all were Hispanics. Ninety-four percent of the eyes had an initial visual acuity of 20/50 or better, while 72% had measured 20/25 or better. Sixty-one percent of the eyes had retinal vasculitis, which was bilateral in 83% of the cases. Thirty-three percent of the patients had, upon presentation, evidence of cystoid macular edema, which was always bilateral. All the eyes had the typical birdshot lesions, at presentation. CONCLUSION Birdshot retinochoroidopathy can be found in Hispanic patients. Our study suggests that the characteristics upon presentation in Hispanics may be similar to those of Caucasian cohorts.
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Affiliation(s)
- Frances M Marrero
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Edgar De Jesus
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Samuel Alvarez
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Israel J Mendez Bermudez
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico; School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Mariam Vila
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Carmen Santos
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Armando L Oliver
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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DeVience EX, Schechet SA, Carney M, Kaleem M, DeVience S, Chang L, Gerbo M, Hinkle DM. Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis. Int Ophthalmol 2021; 41:211-9. [PMID: 32875361 DOI: 10.1007/s10792-020-01569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe two distinct presentations of syphilitic fundus features in a series of patients with ocular syphilis. METHODS This is a retrospective, interventional case series of 22 eyes from 16 serology confirmed cases. Clinical examination, fluorescein angiography, and optical coherence tomography were performed at presentation and following high-dose intravenous penicillin G. RESULTS In our cohort, the mean age was 47.6 years (range 24-59 years) and 14 patients were male (87.5%), 11 patients were positive for human immunodeficiency virus (68.8%), and 6 had bilateral involvement (37.5%). Mean best-corrected visual acuity improved from 0.99 ± 0.79 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation to 0.29 ± 0.36 LogMAR on final visit (P < 0.01). Posterior segment examinations in eyes with retinitis showed two distinct types (1) discrete, placoid lesions in the macula consistent with acute syphilitic posterior placoid chorioretinitis or (2) punctate inner retinitis with corresponding fluorescein pooling in a segmental pattern. These findings rapidly resolved after antibiotic therapy. CONCLUSION In the era of resurgence, ocular syphilis may present with two phenotypes of discrete retinal lesions. Recognition of the characteristic ocular features may help make the diagnosis and monitor treatment response.
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López-Herrero F, Sánchez-Vicente JL, Espiñeira-Periñán MA, de Las Morenas-Iglesias J, Franco-Ruedas C, Rueda-Rueda T. Chronic cytomegalovirus necrotizing retinitis in a patient with scleroderma and mixed connective tissue disease. Arch Soc Esp Oftalmol (Engl Ed) 2020; 96:392-396. [PMID: 34217479 DOI: 10.1016/j.oftale.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
The case is presented of a 52-year-old woman with scleroderma, mixed connective tissue disease, and interstitial lung disease, who developed chronic cytomegalovirus necrotizing retinitis while on treatment with prednisone, mycophenolate, and hydroxychloroquine. Initially diagnosed as macular hole, the patient underwent a pars plana vitrectomy. Two months after surgery, due to progressive worsening, the diagnosis was made and treatment started (intravenous and intravitreal ganciclovir). The patient developed severe macular atrophy with final visual acuity of counting fingers. A chronic retinal necrosis can be caused by cytomegalovirus infection in non-HIV patients with partial immune dysfunction from other causes, characterized by a slowly progressive granular retinitis with occlusive vasculitis.
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Affiliation(s)
- F López-Herrero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M A Espiñeira-Periñán
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | | | - C Franco-Ruedas
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - T Rueda-Rueda
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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41
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Sonne SJ, Shieh WS, Srivastava SK, Smith BT. Lymphoma masquerading as occlusive retinal vasculitis: A case study. Am J Ophthalmol Case Rep 2020; 19:100777. [PMID: 32613135 PMCID: PMC7320315 DOI: 10.1016/j.ajoc.2020.100777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/11/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe a case of retinal lymphoma presenting as an occlusive retinal vasculitis without vitritis that was exquisitely responsive to intravitreal dexamethasone implant (IVDI). Observation A 66-year old male presented with decreased vision in the right eye and was diagnosed with occlusive retinal vasculitis and prominent cystoid macular edema though he lacked vitritis. A complete systemic workup for infectious, inflammatory, and infiltrative etiologies was unremarkable. Intravenous methylprednisolone and cyclophosphamide had no clinical effect. Due to persistent perivascular exudates and refractory macular edema, IVDI was administered with marked improvement in vision and clinical findings. Subsequent retinal vasculitis in the left eye responded to IVDI as well. The patient remained disease free for months while on weekly adalimumab. He then presented with acute vision loss in the left eye due to a lymphomatous subretinal infiltration and a new lesion in the corpus callosum. He has remained disease free for more than two years after intravitreal methotrexate injections and rituximab with an autologous stem cell transplant. Conclusion and importance Lymphoma may present as an occlusive retinal vasculitis without vitritis and can be masked due to its response to IVDI.
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Affiliation(s)
- Scott J Sonne
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | | | - Bradley T Smith
- The Retina Institute, St. Louis, MO, USA.,Washington University, Department of Ophthalmology and Visual Sciences, St. Louis, MO, USA
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Ishida T, Takase H, Arai A, Ohno-Matsui K. Multimodal imaging of secondary vitreoretinal lymphoma with optic neuritis and retinal vasculitis. Am J Ophthalmol Case Rep 2020; 18:100696. [PMID: 32322750 PMCID: PMC7163062 DOI: 10.1016/j.ajoc.2020.100696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 08/04/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To report the findings determined by multimodal imaging in an eye with secondary vitreoretinal lymphoma (VRL) with optic neuritis and retinal vasculitis. Observation The case was a 71-year-old woman with a secondary VRL exhibiting optic neuritis and retinal vasculitis in her right eye. Color fundus photographs and fluorescein angiograms showed optic neuritis and vasculitis in the posterior pole of the right eye. Indocyanine green angiography showed dye staining of the retinal vein walls in the late phase. Fundus autofluorescence showed fuzzy hyper-autofluorescence surrounded by mottled hyper-and hypo-autofluorescence in the right eye. OCT showed a retina with uniform infiltration and a thickened retinal pigmented epithelium (RPE) layer, perforated RPE, small RPE detachments, and hyperrefrective or isorefrective masses on the degenerated RPE layer in the marginal area. Her left eye showed a degenerated RPE and oval shaped iso-reflective lesions on the RPE. Conclusion The findings indicate that it is important to examine the marginal areas of eyes clinically diagnosed with VRL accompanied by optic neuritis and retinal vasculitis by multimodal imaging because these images can show the inflammatory signs of typical VRL including the sub-RPE lesions.
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Affiliation(s)
- Tomoka Ishida
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Takase
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Arai
- Department of Laboratory Molecular Genetics of Hematology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Jain A, Chea S, Matsumiya W, Halim MS, Yaşar Ç, Kuang G, Sepah YJ, Khanani AM, Do DV, Nguyen QD. Severe vision loss secondary to retinal arteriolar occlusions after multiple intravitreal brolucizumab administrations. Am J Ophthalmol Case Rep 2020; 18:100687. [PMID: 32280811 DOI: 10.1016/j.ajoc.2020.100687] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To describe a case of unilateral retinal arteriolar occlusion following multiple intravitreal brolucizumab injections for neovascular age-related macular degeneration (nAMD). Observations A 92-year-old Caucasian woman presented with blurry vision in her left eye (OS) after receiving the third dose of intravitreal brolucizumab. At the time of presentation, visual acuity (VA) was 20/40 in her right eye (OD) and had decreased from 20/150 to count finger (CF) at 1-foot OS. On examination, there was no evidence of active inflammation in the anterior chamber OU. Dilated fundus examination showed no vitritis in OD and 1+ vitreous cells OS, flame-shaped hemorrhage at the superior optic disc margin, and retinal whitening surrounding the proximal portion of the supero-temporal branch of the central retinal artery. There were drusen in OS and retinal pigment epithelial (RPE) changes in the maculae of OU. Intra-arteriolar greyish deposits were seen OS. Fluorescein angiography (FA) showed hyper-fluorescence in the maculae corresponding to fibrovascular pigment epithelial detachments (PED) OU. No peri-vascular leakage was noted OU. Delayed filling of multiple arterioles in early and late phases OS was observed on FA. The patient was diagnosed with retinal arteriolar occlusion associated with repeated intravitreal brolucizumab administrations. Conclusion Retinal arteriolar occlusion with severe vision loss, possibly secondary to inflammatory responses, can occur after subsequent intravitreal brolucizumab injections, even if no inflammation occurred after initial administrations. Vaso-occlusive disease should be considered as a potential ocular complication, with acute as well as delayed onset, following intravitreal brolucizumab therapy.
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Haug SJ, Hien DL, Uludag G, Ngoc TTT, Lajevardi S, Halim MS, Sepah YJ, Do DV, Khanani AM. Retinal arterial occlusive vasculitis following intravitreal brolucizumab administration. Am J Ophthalmol Case Rep 2020; 18:100680. [PMID: 32258827 PMCID: PMC7125319 DOI: 10.1016/j.ajoc.2020.100680] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To describe retinal arterial occlusion and vasculitis following intravitreal brolucizumab administration in a patient with neovascular age-related macular degeneration (nAMD). Observation An 88-year-old Caucasian woman with neovascular age-related macular degeneration (nAMD) complained of painless loss of vision with light sensitivity in both eyes (OU) four weeks after bilateral intravitreal brolucizumab. Upon examination, her visual acuity decreased to 20/40 in the right eye (OD) and 20/50 in the left eye (OS). Examination revealed 0.5+ and 1+ anterior chamber cells in OD and OS, respectively. The patient was treated with 1% prednisolone acetate eyedrops in both eyes, and after several weeks, the anterior chamber cells resolved. However, the patient still reported a decline in visual acuity (VA). Fluorescein angiography (FA) revealed retinal arterial occlusion, vasculitis, and optic nerve inflammation in the left eye. Retinal intra-arterial grayish materials were also detected. Laboratory evaluations were performed for common infectious and inflammatory causes and were normal or negative. A delayed inflammatory reaction to brolucizumab was suspected as the cause of the ocular inflammation and retinal vasculitis. An intravitreal dexamethasone implant was inserted into the left eye to treat the inflammation. One week after the dexamethasone implant, VA improved to 20/40 in OU; FA showed improvement, but residual peri-vascular leakage remained. Conclusion Medication-associated uveitis is a rare adverse effect that can lead to vision loss. The index report illustrates a case of intraocular inflammation, retinal arterial vaso-occlusion and vasculitis associated with intravitreal brolucizumab. The delay in developing uveitis suggests that the inflammation is due to a delayed hypersensitivity reaction which can occur several days or weeks after administration of the inciting agent. Recently, several cases of uveitis and vasculitis associated with brolucizumab have been presented and those cases have similar features compared to the index case (1). Therapy with steroids (either intraocular or systemic), after infectious etiologies have been excluded, may be beneficial in halting inflammation and preventing further vision loss.
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Affiliation(s)
| | - Doan Luong Hien
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Gunay Uludag
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Than Trong Tuong Ngoc
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,University of California, Davis, CA, USA
| | - M Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Ocular Imaging Research and Reading Center (OIRRC), Sunnyvale, USA
| | - Yasir J Sepah
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Ocular Imaging Research and Reading Center (OIRRC), Sunnyvale, USA
| | - Diana V Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA.,University of Nevada, Reno, NV, USA
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Venkat AG, Sharma S. Automated measurement of leakage on wide-field angiography in the assessment of retinal vasculitis. J Ophthalmic Inflamm Infect 2020; 10:4. [PMID: 32009203 PMCID: PMC6995796 DOI: 10.1186/s12348-019-0193-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Automated analysis of leakage on fluorescein angiography is a measurable and clinically applicable endpoint that can be used to follow patients with posterior uveitis. A number of studies have analyzed the use of automated analysis of leakage on fluorescein angiography and are reviewed in this article.
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Affiliation(s)
- Arthi G Venkat
- Cleveland Clinic, Cole Eye Institute, 9500 Euclid Avenue, Desk i32, Cleveland, OH, 44195, USA
| | - Sumit Sharma
- Cleveland Clinic, Cole Eye Institute, 9500 Euclid Avenue, Desk i32, Cleveland, OH, 44195, USA.
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Sánchez-Vicente JL, Moruno-Rodríguez A, de Las Morenas-Iglesias J, Muñoz-Morales A, Rueda-Rueda T, López-Herrero F. Diagnosis of Eales disease from a macular epiretinal membrane. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:556-560. [PMID: 31331646 DOI: 10.1016/j.oftal.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 06/10/2023]
Abstract
Macular involvement is a common finding in patients with Eales disease. The purpose of this communication is to describe the diagnosis of Eales disease from the finding of a macular epiretinal membrane in a young patient. The case is presented of a 38-year-old man referred to this medical service unit with blurred vision developed over the past 3 months, and was associated with vitreoretinal traction and a macular epiretinal membrane. After an ophthalmological examination including the retinal periphery, optical coherence tomography, tuberculin test, interferon gamma release assay (IGRA), and a systemic study, the patient was diagnosed with Eales disease. Macular oedema or epiretinal membranes due to Eales disease are relatively common. Sd-OCT is recommended in all patients with Eales disease. On the other hand, the presence of epiretinal membranes in young patients usually suggests a non-idiopathic aetiology.
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Affiliation(s)
- J L Sánchez-Vicente
- Sección de Retina Quirúrgica, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Moruno-Rodríguez
- Sección General, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J de Las Morenas-Iglesias
- Sección General, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - A Muñoz-Morales
- Sección de Córnea, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - T Rueda-Rueda
- Sección de Uveítis, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F López-Herrero
- Sección de Retina Médica, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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47
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Ho M, Chen LJ, Sin HPY, Iu LPL, Brelen M, Ho ACH, Lai TYY, Young AL. Experience of using adalimumab in treating sight-threatening paediatric or adolescent Behcet's disease-related uveitis. J Ophthalmic Inflamm Infect 2019; 9:14. [PMID: 31367810 PMCID: PMC6669227 DOI: 10.1186/s12348-019-0181-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To report the clinical outcomes of adalimumab in treating refractory Behcet’s disease (BD)-related uveitis in paediatric or adolescent patients. Methods Retrospective review of five paediatric or adolescent patients with BD-related uveitis with a minimum follow-up of 24 months. Results Disease quiescence was observed in 9 (90%) of 10 eyes at 12 months. The mean number of relapses per year per patient was 5 (range, 3–7) before initiation of adalimumab treatment. This was reduced to 0.2 relapse per patient per year among the five patients during the first 24 months after starting adalimumab treatment. At baseline, 5 eyes had active retinal vasculitis. Retinal vasculitis resolved in all cases (100%) after starting adalimumab. The mean time to complete resolution of inflammation was 3.4 weeks. The mean ± standard deviation logMAR best-corrected visual acuity was 0.711 ± 0.63 at baseline and improved to 0.172 ± 1.04 at 12 months (P < 0.001). None of the patients developed any adverse events associated with adalimumab treatment. Conclusion Adalimumab was effective in preventing irreversible sight-threatening BD-related uveitis in paediatric or adolescent patients. Adalimumab appears to be a promising treatment option for young patients with recalcitrant BD-related uveitis and has a favourable safety profile.
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Affiliation(s)
- Mary Ho
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Li Jia Chen
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR.,Department of Ophthalmology & Visual Sciences, Hong Kong Eye Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Helena P Y Sin
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Lawrence P L Iu
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Marten Brelen
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR.,Department of Ophthalmology & Visual Sciences, Hong Kong Eye Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Assunta C H Ho
- Department of Paediatrics, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR.,Department of Ophthalmology & Visual Sciences, Hong Kong Eye Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR. .,Department of Ophthalmology & Visual Sciences, Hong Kong Eye Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong SAR.
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48
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Bazvand F, Khojasteh H, Zarei M. Novel findings in enhanced S-cone syndrome: a case with macular retinal neovascularization and severe retinal vasculitis. Doc Ophthalmol 2019; 139:221-226. [PMID: 31292819 DOI: 10.1007/s10633-019-09706-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 06/27/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe a novel association of enhanced S-cone syndrome (ESCS) with macular retinal neovascularization and severe retinal vasculitis. METHODS Clinical examination, spectral domain optical coherence tomography, fluorescein angiography, fundus autofluorescence, infrared reflectance and electroretinography were used to study a 25-year-old male with a history of night blindness from early childhood and recent accelerated visual loss in right eye. RESULTS Pigmented lesions were observed along the arcades without peripheral retinal involvement. Intraretinal cystoid spaces, retinal neovascularization of posterior pole and severe peripheral and posterior retinal vasculitis were found on clinical examination and multimodal imaging. Based on characteristic clinical and electroretinographic findings, a diagnosis of ESCS was made. CONCLUSION This case highlights novel associations of retinal neovascularization and vasculitis with ESCS.
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Affiliation(s)
- Fatemeh Bazvand
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, Iran
| | - Hasan Khojasteh
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, Iran
| | - Mohammad Zarei
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, Iran.
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49
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Sheemar A, Temkar S, Takkar B, Sood R, Sinha S, Chawla R, Vohra R, Venkatesh P. Ultra-Wide Field Imaging Characteristics of Primary Retinal Vasculitis: Risk Factors for Retinal Neovascularization. Ocul Immunol Inflamm 2018; 27:383-388. [PMID: 30207804 DOI: 10.1080/09273948.2018.1508729] [Citation(s) in RCA: 6] [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] [Indexed: 10/28/2022]
Abstract
Aim: To evaluate patterns of retinal vasculitis with ultra-wide field imaging (UWF) and ascertain the risk factors for retinal neovascularization. Methods: Consecutive patients of retinal vasculitis were included prospectively. Patients with retinal vasculitis secondary to uveitis were excluded. UWF was done for all the patients. Retinal involvement was classified into three zones and area of capillary non-perfusion was stratified into clock hours. Results: Two hundred patients were included, 85% (n = 170) were male. Mean age was 28.99 ± 10.56 years. Clinical examination revealed 65% cases (n = 130) to be bilateral, while UWF angiography detected 72.5% (n = 145) to have bilateral involvement. Retinal neovascularization was present in 47% (n = 188).Presence of posterior disease had very high odds ratio for development of retinal neovascularization as compared to cases restricted to retinal periphery (OR = 45.03, CI = 6.10-332.30, p = < 0.001). Conclusion: UWF imaging is useful in detecting retinal vasculitis, which is otherwise obscure to clinical examination and assessing risk factors for retinal neovascularization.
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Affiliation(s)
- Abhishek Sheemar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Shreyas Temkar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Brijesh Takkar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rita Sood
- b Department of Medicine , All India Institute of Medical Sciences , New Delhi , India
| | - Sanjeev Sinha
- b Department of Medicine , All India Institute of Medical Sciences , New Delhi , India
| | - Rohan Chawla
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rajpal Vohra
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Pradeep Venkatesh
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
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50
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Merle H, Donnio A, Jean-Charles A, Guyomarch J, Hage R, Najioullah F, Césaire R, Cabié A. [Ocular manifestations of emerging arboviruses: Dengue fever, Chikungunya, Zika virus, West Nile virus, and yellow fever (French translation of the article)]. J Fr Ophtalmol 2018; 41:659-668. [PMID: 30173871 DOI: 10.1016/j.jfo.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 01/12/2023]
Abstract
Arboviruses are viral diseases transmitted by mosquitoes and tics bites. They are a major cause of morbidity and sometimes mortality. Their expansion is constant and due in part to climate change and globalization. Mostly found in tropical regions, arboviruses are sometimes the source of epidemics in Europe. Recently, the Chikungunya virus and the Zika virus were responsible for very large epidemics impacting populations that had never been in contact with those viruses. There are currently no effective antiviral treatments or vaccines. Ocular manifestations due to those infections are thus more frequent and increasingly better described. They are sometimes, as with Zika, complicated by a congenital ocular syndrome. The goal of this review is to describe the ophthalmological manifestations of Dengue fever, Chikungunya virus, Zika virus, West Nile virus, and yellow fever.
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Affiliation(s)
- H Merle
- EA4537, Inserm CIC 1424, service d'ophtalmologie, université des Antilles, France.
| | - A Donnio
- EA4537, Inserm CIC 1424, service d'ophtalmologie, université des Antilles, France
| | - A Jean-Charles
- EA4537, Inserm CIC 1424, service d'ophtalmologie, université des Antilles, France
| | - J Guyomarch
- EA4537, Inserm CIC 1424, service d'ophtalmologie, université des Antilles, France
| | - R Hage
- EA4537, Inserm CIC 1424, service d'ophtalmologie, université des Antilles, France
| | - F Najioullah
- EA4537, Inserm CIC 1424, laboratoire de virologie, université des Antilles, France
| | - R Césaire
- EA4537, Inserm CIC 1424, laboratoire de virologie, université des Antilles, France
| | - A Cabié
- EA4537, Inserm CIC 1424, service des maladies infectieuses et tropicales, université des Antilles, France
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