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Vorobichik Berar O, Tzadok M, Zloto O, Moroz I, Hecht I, Musika AA, Shlomovitz O, Fabian ID, Vishnevskia Dai V. Mammalian target of rapamycin inhibitors for the treatment of astrocytic hamartoma in tuberous sclerosis complex (TSC). Graefes Arch Clin Exp Ophthalmol 2022; 260:3061-3068. [PMID: 35230473 DOI: 10.1007/s00417-022-05585-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: 08/14/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disorder. Fifty percent of patients with TSC will develop retinal astrocytic hamartoma (RAH). The mammalian target of rapamycin (mTOR) inhibitors interferes with the pathological mechanisms of TSC. Treatment of RAH with mTOR inhibitors has been described in only a few isolated case reports. The purpose of this study was to assess the effect of mTOR inhibitors on RAH in a small cohort of patients. METHODS The medical records of all consecutive patients with ocular manifestations of TSC that were treated with mTOR inhibitors at the Sheba Medical Center from January 2014 to December 2018 were retrospectively reviewed. Data collection included demographics, medical history, ocular presentation, ocular treatment, and treatment outcome. Tumor size was assessed by a masked observer, before and after treatment. Lesion measurements were made with Heidelberg SD-OCT (HRA + OCT SPECTRALIS), and fundus photos were taken with RetCam3® (Natus, USA) and analyzed by "ImageJ" software. RESULTS Eleven patients with tuberous sclerosis and astrocytic hamartoma were treated with mTOR inhibitors in the study period. Of them, 6 children (11 eyes, 20 tumors) had proper imaging of tumor size before and after treatment. The analysis included these 11 eyes. All six patients had non-ocular manifestations of TSC, including dermatologic (n = 5), neurologic (n = 5), and renal (n = 3) involvement. Ocular involvement included in five eyes (45%) tumors near the optic disc and in four eyes (37%) foveal tumors. The mean follow-up duration was 2.15 ± 1.4 years (range 10 months to 4.5 years). The average tumor base reduction in the treated group was 17.8% ± 15.9. The average maximal thickness at baseline was 414 ± 174 μm (range 152-686 μm). There was a 14% ± 7.1 reduction after treatment. None of the tumors showed evidence of growth at the final follow-up. CONCLUSION The findings of this study suggest that mTOR inhibitors can reduce tumor size and that they can be considered as an optional treatment in certain conditions. This preliminary report is the first to quantitatively assess pre- and posttreatment tumor size, in young patients.
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Affiliation(s)
- Ofri Vorobichik Berar
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Tzadok
- Pediatric Neurology Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Moroz
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel
| | - Anne Ampaire Musika
- Department of Ophthalmology, College of Health Science, Makerere University, Kampala, Uganda
| | - Omer Shlomovitz
- Pediatric Neurology Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido-Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vicktoria Vishnevskia Dai
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Jacoby E, Zloto O, Vishnevskia Dai V. Anterior chamber infiltration of CAR T-cells. Am J Ophthalmol Case Rep 2021; 24:101223. [PMID: 34746512 PMCID: PMC8554163 DOI: 10.1016/j.ajoc.2021.101223] [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: 12/02/2020] [Revised: 05/30/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
A unique image of anterior chamber infiltration in a 2-year-infant with leukemia, treated with CD19 CAR T cells. Despite significant lymphopenia and resemblance of fungal infection initially, biopsy and cytologic analysis from anterior chamber fluid confirmed that this was CAR T-cell infiltration, likely targeting microscopic leukemia, unknown to us treating physicians. This is a unique case in 2 aspects: first, to state the high quality of CAR T-cell trafficking; and second – given the wide use of these cells currently, this image may help educate clinicians regarding this potential diagnosis.
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Affiliation(s)
- Elad Jacoby
- Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofira Zloto
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Vicktoria Vishnevskia Dai
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
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Skaat A, Solomon A, Moroz I, Hai OV, Rechtman E, Vishnevskia Dai V, Rotenstreich Y. Increased electroretinogram a-wave amplitude after intravitreal bevacizumab injection for neovascular age-related macular degeneration. Acta Ophthalmol 2011; 89:e269-73. [PMID: 20946333 DOI: 10.1111/j.1755-3768.2010.02005.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the effect of bevacizumab (Avastin), a vascular endothelial growth factor inhibitor, on retinal function by full-field electroretinography (ERG) in patients with neovascular age-related macular degeneration (AMD). DESIGN A prospective, nonrandomized, controlled interventional clinical trial. METHODS Twelve patients (aged 50)85) with neovascular AMD each received one unilateral intravitreal injection of bevacizumab 1.25 mg⁄ 0.05 ml as part of the standard management for choroidal neovascular AMD. Before and 1 month after injection, all patients underwent bilateral full-field ERG scanning by a masked technician according to the ISCEV protocol, and their wave amplitudes were recorded. Untreated eyes served as controls. Scotopic responses were recorded at four incremental light intensities and photopic responses at two incremental light intensities. Changes in ERG-amplitude responses were calculated. Repeated-measures ANOVA was used for data analysis. RESULTS Mean pre- and postinjection differences in a-wave amplitudes between the incremental light intensities in injected eyes were significantly higher than in controls (15.92 versus 1.33 lV for scotopic responses and 4.97 versus )1.06 lV for photopic responses; p = 0.057 and p = 0.01, respectively). Mean b-wave amplitudes in injected eyes were significantly higher than in controls for photopic responses (p = 0.048), but for scotopic responses, the difference between treated and untreated eyes was not significant (p = 0.23). CONCLUSIONS Intravitreally injected bevacizumab improves both rod and cone functioning in patients with neovascular AMD, as demonstrated by the increase in the ERG a-wave responses of these patients. Other measured ERG parameters yielded no significant photoreceptor toxicity.
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Affiliation(s)
- Alon Skaat
- Goldschleger Eye Research Institute, Sheba Medical Center, Tel-Hashomer, Israel
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