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Long-term effects of tocilizumab on retinal and choroidal inflammation in Birdshot uveitis. 托西珠单抗对鸟样葡萄膜炎视网膜和脉络膜炎症的长期影响
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-11-21 DOI: 10.1186/s12348-024-00443-9
Lynn S Zur Bonsen, Daniel Schulze, Steffen E Künzel, Anne Rübsam, Uwe Pleyer, Dominika Pohlmann

Background: Tocilizumab (TCZ), an interleukin-6 receptor antagonist, is approved for treating rheumatic diseases and has demonstrated efficacy in managing refractory non-infectious uveitis (NIU). This retrospective study aimed to investigate the long-term effects of TCZ on inflammation in the retinal and choroidal compartments in Birdshot NIU.

Methods: Eight patients (16 eyes) received TCZ and were included in the analysis. The primary outcomes measured were inflammatory activity in the retina and choroid, assessed by fluorescein angiography (FA) and indocyanine green angiography (ICGA) using the Angiography Scoring for Uveitis Working Group at baseline, 6, 12, 24, and 36 months.

Results: The mean follow-up time with TCZ treatment was 33 months. At baseline, the median FA score was 14 (quartiles: 10.25, 15.25), which significantly decreased over time (at 36 months: 8 (5.5, 11); p = 0.004). In contrast, the ICGA score significantly increased within the first year (median at baseline: 5 (4.75, 7.25); at 6 months: 7 (6, 9.25); at 12 months: 7 (6.5, 9.25); p = 0.002), but returned to baseline levels after two years (at 24 months: 5 (5, 6.5); at 36 months: 5.5 (4, 7.5)). Central retinal thickness (CRT) improved significantly after 6 months (median at baseline: 295 µm (275, 322); at 6 months: 275 µm (251, 308); p = 0.01).

Conclusion: TCZ is effective in reducing retinal vasculitis and CRT in refractory Birdshot uveitis over time, but might be less effective in managing choroidal inflammation. Further studies are needed to determine the optimal treatment strategies for TCZ therapy in NIU.

背景:托西珠单抗(Tocilizumab,TCZ)是一种白细胞介素-6受体拮抗剂,已被批准用于治疗风湿性疾病,并在治疗难治性非感染性葡萄膜炎(NIU)方面取得了疗效。这项回顾性研究旨在探讨TCZ对鸟枪状非感染性葡萄膜炎患者视网膜和脉络膜炎症的长期影响:8名患者(16只眼)接受了TCZ治疗,并纳入分析。测量的主要结果是视网膜和脉络膜的炎症活动,分别在基线、6、12、24 和 36 个月时通过荧光素血管造影术 (FA) 和吲哚青绿血管造影术 (ICGA),使用葡萄膜炎血管造影术评分工作组进行评估:结果:TCZ治疗的平均随访时间为33个月。基线时,FA评分的中位数为14(四分位数:10.25,15.25),随着时间的推移显著下降(36个月时,FA评分为8(5.5,11)):8 (5.5, 11); p = 0.004).相比之下,ICGA 分数在第一年内明显增加(基线时的中位数:5(4.75,7.25);6 个月时的中位数:7(6,9.25)):7 (6, 9.25); at 12 months:7 (6.5, 9.25); p = 0.002),但两年后又恢复到基线水平(24 个月时:5 (5, 6.5); at 36 months:5.5 (4, 7.5)).视网膜中央厚度(CRT)在 6 个月后明显改善(基线中位数:295 µm (275, 322);6 个月时:275 µm (251, 322)):275 µm (251, 308); p = 0.01):结论:随着时间的推移,TCZ能有效减轻难治性鸟影葡萄膜炎患者的视网膜血管炎和CRT,但在控制脉络膜炎症方面可能效果较差。要确定TCZ治疗NIU的最佳治疗策略,还需要进一步研究。
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引用次数: 0
"Infectious uveitis: a comprehensive systematic review of emerging trends and molecular pathogenesis using network analysis". "传染性葡萄膜炎:利用网络分析法对新趋势和分子致病机理进行全面系统的回顾"。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-11-20 DOI: 10.1186/s12348-024-00444-8
Muhammad Arif Asghar, Shixin Tang, Li Ping Wong, Peizeng Yang, Qinjian Zhao

Background: Infectious uveitis is a significant cause of visual impairment worldwide, caused by diverse pathogens such as viruses, bacteria, fungi, and parasites. Understanding its prevalence, etiology, pathogenesis, molecular mechanism, and clinical manifestations is essential for effective diagnosis and management.

Methods: A systematic literature search was conducted using PubMed, Google Scholar, Web of Science, Scopus, and Embase, focusing on studies published in the last fifteen years from 2009 to 2023. Keywords included "uveitis," "infectious uveitis," "viral uveitis," and others. Rigorous inclusion and exclusion criteria were applied, and data were synthesized thematically. Gene symbols related to infectious uveitis were analyzed using protein-protein interaction (PPI) networks and pathway analyses to uncover molecular mechanisms associated with infectious uveitis.

Results: The search from different databases yielded 97 eligible studies. The review identified a significant rise in publications on infectious uveitis, particularly viral uveitis, over the past fifteen years. Infectious uveitis prevalence varies geographically, with high rates in developing regions due to systemic infections and limited diagnostic resources. Etiologies include viruses (39%), bacteria (17%), and other pathogens, substantially impacting adults aged 20-50 years. Pathogenesis involves complex interactions between infectious agents and the ocular immune response, with key roles for cytokines and chemokines. The PPI network highlighted IFNG, IL6, TNF, and CD4 as central nodes. Enriched pathways included cytokine-cytokine receptor interaction and JAK-STAT signaling. Clinical manifestations range from anterior to posterior uveitis, with systemic symptoms often accompanying ocular signs. Diagnostic strategies encompass clinical evaluation, laboratory tests, and imaging, while management involves targeted antimicrobial therapy and anti-inflammatory agents.

Conclusion: This review underscores the complexity of infectious uveitis, driven by diverse pathogens and influenced by various geographical and systemic factors. Molecular insights from PPI networks and pathway analyses provide a deeper understanding of its pathogenesis. Effective management requires comprehensive diagnostic approaches and targeted therapeutic strategies.

背景:传染性葡萄膜炎是全球视力损伤的重要原因,由病毒、细菌、真菌和寄生虫等多种病原体引起。了解其发病率、病因、发病机制、分子机制和临床表现对有效诊断和治疗至关重要:使用 PubMed、Google Scholar、Web of Science、Scopus 和 Embase 进行了系统的文献检索,重点是 2009 年至 2023 年过去 15 年中发表的研究。关键词包括 "葡萄膜炎"、"传染性葡萄膜炎"、"病毒性葡萄膜炎 "等。采用了严格的纳入和排除标准,并按主题对数据进行了综合。利用蛋白质-蛋白质相互作用(PPI)网络和通路分析对与传染性葡萄膜炎相关的基因符号进行了分析,以揭示与传染性葡萄膜炎相关的分子机制:从不同的数据库中搜索到97项符合条件的研究。综述发现,在过去十五年中,有关传染性葡萄膜炎(尤其是病毒性葡萄膜炎)的论文显著增加。传染性葡萄膜炎的发病率因地域而异,在发展中地区,由于全身感染和诊断资源有限,发病率较高。病因包括病毒(39%)、细菌(17%)和其他病原体,主要影响 20-50 岁的成年人。发病机制涉及感染病原体与眼部免疫反应之间复杂的相互作用,其中细胞因子和趋化因子起着关键作用。PPI网络突出了IFNG、IL6、TNF和CD4作为中心节点的作用。丰富的通路包括细胞因子-细胞因子受体相互作用和 JAK-STAT 信号转导。临床表现从前葡萄膜炎到后葡萄膜炎不等,全身症状往往伴随眼部症状。诊断策略包括临床评估、实验室检测和影像学检查,而治疗则涉及有针对性的抗菌治疗和抗炎药物:本综述强调了传染性葡萄膜炎的复杂性,它由多种病原体引起,并受到各种地理和系统因素的影响。PPI 网络和通路分析的分子洞察力加深了对其发病机制的理解。有效的治疗需要全面的诊断方法和有针对性的治疗策略。
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引用次数: 0
Isolated hydatid cyst in the medial rectus muscle: unveiling a rare orbital occurrence. 内侧直肌孤立性水瘤囊肿:揭开罕见眼眶病的面纱。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-11-12 DOI: 10.1186/s12348-024-00436-8
Alireza Attar, Behzad Khademi, Mohammad Hassan Jalalpour

Background: Orbital hydatid disease, while rare, should be included in the differential diagnosis of unilateral proptosis, particularly in endemic areas. Accurate diagnosis and comprehensive management are essential for effective treatment and favorable long-term outcomes.

Case presentation: A 12-year-old boy presented with a one-month history of diplopia and left-sided proptosis. A CT scan revealed a cystic mass within the left medial rectus muscle. Surgical intervention confirmed the presence of a hydatid cyst following cyst rupture and irrigation with hypertonic saline. The patient underwent a two-month course of albendazole therapy. Initially, the patient experienced persistent exotropia and diplopia, but at the three-year follow-up, he exhibited no diplopia or proptosis and only mild residual exotropia.

Conclusion: This case underscores the importance of considering orbital hydatid cysts in the differential diagnosis of unilateral proptosis in endemic regions. Heightened awareness, accurate diagnosis, and a tailored therapeutic approach, including surgical removal and antiparasitic treatment, are crucial for successful management and improved long-term outcomes.

背景:眼眶包虫病虽然罕见,但应列入单侧突眼的鉴别诊断中,特别是在流行地区。准确诊断和综合治疗对有效治疗和长期预后至关重要:一名 12 岁男孩因复视和左侧眼球突出就诊一个月。CT 扫描显示左侧内侧直肌内有一个囊性肿块。在囊肿破裂并用高渗盐水冲洗后,手术治疗证实了水瘤囊肿的存在。患者接受了为期两个月的阿苯达唑治疗。最初,患者出现持续性外斜和复视,但在三年的随访中,他没有出现复视或突眼,仅有轻度残余外斜:本病例强调了在地方病流行地区鉴别诊断单侧突眼时考虑眼眶水瘤囊肿的重要性。提高意识、准确诊断和有针对性的治疗方法(包括手术切除和抗寄生虫治疗)是成功治疗和改善长期预后的关键。
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引用次数: 0
Ocular loaiasis in France: the first case report from Brittany. 法国的眼孢子虫病:布列塔尼的首例病例报告。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-11-06 DOI: 10.1186/s12348-024-00437-7
Sarah Kerkouri, Thomas Monfort, Dorothée Quinio, Béatrice Cochener-Lamard

We report the case of a 21-year-old Cameroonian woman residing in France for one year, who presented to our department with left eye discomfort and itching. Examination revealed a mobile translucent cord beneath the nasal-inferior conjunctiva, prompting suspicion of loaiasis. Anesthesia was administered for extraction, revealing a 31 mm male Loa loa. A positive microfilarial load, albeit low, confirmed the diagnosis and the diagnostic workup excluded other locations. Treatment with diethylcarbamazine was well-tolerated. This case highlights the importance of considering loaiasis in non-endemic regions and underscores the need for interdisciplinary collaboration in its diagnosis and management.

我们报告了一例在法国居住了一年的 21 岁喀麦隆妇女的病例,她因左眼不适和瘙痒到我科就诊。检查发现,她的鼻下结膜下有一条活动的半透明线状物,因此怀疑是卢埃虫。麻醉后进行了摘除,发现了一条 31 毫米长的雄性 Loa loa。尽管微丝蚴载量较低,但阳性结果证实了诊断,而且诊断工作排除了其他部位。使用乙胺嗪治疗效果良好。该病例强调了在非流行地区考虑洛艾病的重要性,并强调了在诊断和管理中进行跨学科合作的必要性。
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引用次数: 0
Effect of intravitreal injection of anti-interleukin (IL)-6 antibody in experimental autoimmune uveitis in mice. 玻璃体内注射抗白细胞介素(IL)-6 抗体对实验性自身免疫性葡萄膜炎小鼠的影响
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-11-04 DOI: 10.1186/s12348-024-00441-x
Kristin Hösel, Büsra Chasan, Jan Tode, Stefan Rose-John, Johann Baptist Roider, Christoph Ehlken

Purpose: The aim of this study was to assess the functional and clinical impact of intravitreal administration of a neutralizing anti-IL-6 antibody in the treatment of experimental autoimmune uveitis (EAU) in mice.

Methods: EAU was induced in 17 female B10.RIII mice by administering Inter-Photoreceptor-Binding-Protein (IRBP) in complete Freund's adjuvant, followed by a boost with Pertussis toxin. Intravitreal injections of anti-Interleukin (IL)-6 antibody were administered on days 10, 13, and 16 after EAU induction (day 0) into the randomized treatment eye, with an isotype antibody similarly injected into the fellow control eye. Visual acuity was assessed using the optomotor reflex via OptoDrum, and clinical scoring was performed via fundus imaging (utilizing 6 EAU grades) in a single-blinded manner on days 0, 10, 13, 16, and 18.

Results: Uveitis developed in all 17 mice. Significantly higher visual acuity was observed in treated eyes compared to control eyes on days 13, 16, and 18. The most pronounced effect was noted on days 16 and 18 (p < 0.001). On days 13, 16, and 18 the number of eyes with lower EAU-score was significantly higher in the treatment group, with the most notable effect observed on day 18 (p < 0.003).

Conclusion: Intravitreal administration of anti-IL-6 treatment notably mitigates experimental autoimmune uveitis in mice, both functionally and clinically. Further investigations are warranted to assess the potential of intravitreal anti-IL-6 therapy as a treatment option for non-infectious uveitis in humans.

目的:本研究旨在评估玻璃体内注射中和性抗IL-6抗体治疗小鼠实验性自身免疫性葡萄膜炎(EAU)的功能和临床影响:方法:在17只雌性B10.RIII小鼠体内注射完全弗氏佐剂中的光感受器间结合蛋白(IRBP),然后注射百日咳毒素,诱发EAU。在EAU诱导(第0天)后的第10、13和16天,向随机治疗眼进行抗白细胞介素(IL)-6抗体的玻璃体内注射,同时向同组对照眼注射同型抗体。在第 0、10、13、16 和 18 天,通过 OptoDrum 使用视运动反射评估视力,并以单盲方式通过眼底成像(采用 6 个 EAU 等级)进行临床评分:结果:17 只小鼠均发生了葡萄膜炎。在第 13、16 和 18 天,与对照组相比,治疗组小鼠的视力明显提高。第 16 天和第 18 天的效果最明显(P玻璃体内注射抗IL-6可显著减轻小鼠实验性自身免疫性葡萄膜炎的功能和临床症状。有必要进行进一步研究,以评估玻璃体内抗IL-6疗法作为人类非感染性葡萄膜炎治疗方案的潜力。
{"title":"Effect of intravitreal injection of anti-interleukin (IL)-6 antibody in experimental autoimmune uveitis in mice.","authors":"Kristin Hösel, Büsra Chasan, Jan Tode, Stefan Rose-John, Johann Baptist Roider, Christoph Ehlken","doi":"10.1186/s12348-024-00441-x","DOIUrl":"10.1186/s12348-024-00441-x","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to assess the functional and clinical impact of intravitreal administration of a neutralizing anti-IL-6 antibody in the treatment of experimental autoimmune uveitis (EAU) in mice.</p><p><strong>Methods: </strong>EAU was induced in 17 female B10.RIII mice by administering Inter-Photoreceptor-Binding-Protein (IRBP) in complete Freund's adjuvant, followed by a boost with Pertussis toxin. Intravitreal injections of anti-Interleukin (IL)-6 antibody were administered on days 10, 13, and 16 after EAU induction (day 0) into the randomized treatment eye, with an isotype antibody similarly injected into the fellow control eye. Visual acuity was assessed using the optomotor reflex via OptoDrum, and clinical scoring was performed via fundus imaging (utilizing 6 EAU grades) in a single-blinded manner on days 0, 10, 13, 16, and 18.</p><p><strong>Results: </strong>Uveitis developed in all 17 mice. Significantly higher visual acuity was observed in treated eyes compared to control eyes on days 13, 16, and 18. The most pronounced effect was noted on days 16 and 18 (p < 0.001). On days 13, 16, and 18 the number of eyes with lower EAU-score was significantly higher in the treatment group, with the most notable effect observed on day 18 (p < 0.003).</p><p><strong>Conclusion: </strong>Intravitreal administration of anti-IL-6 treatment notably mitigates experimental autoimmune uveitis in mice, both functionally and clinically. Further investigations are warranted to assess the potential of intravitreal anti-IL-6 therapy as a treatment option for non-infectious uveitis in humans.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"57"},"PeriodicalIF":2.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safety and efficacy of intravitreal dexamethasone implantation along with phacoemulsification and intraocular lens implantation in children with uveitis. 在葡萄膜炎儿童中进行玻璃体内地塞米松植入术以及超声乳化术和眼内人工晶体植入术的安全性和有效性。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-24 DOI: 10.1186/s12348-024-00440-y
Hui Feng, Weixin Chen, Jianzhu Yang, Haorong Kong, Hongyu Li, Meng Tian, Jing Mo, Yuan He, Hong Wang

Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation in pediatric uveitis.

Methods: A retrospective analysis was conducted on pediatric uveitis patients undergoing phacoemulsification and intraocular lens implantation with intravitreal dexamethasone implantation. Patients with a minimum follow-up of 6 months were included. Primary outcome measures included ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis.

Results: 36 eyes of 28 patients were ultimately included in this study. The mean preoperative BCVA was 1.00 (0.40-1.50) LogMAR. BCVA significantly improved to 0.40 (0.20-0.54) LogMAR at 1 month postoperatively (P = 0.006), further improving to 0.30 (0.20-0.40) LogMAR at 3 months postoperatively (P = 0.001). BCVA remained stable at 0.30 (0.20-0.70) LogMAR at 6 months postoperatively (P = 0.005). Mean IOP showed no statistically significant difference during the follow-up period of three to six months after surgery. Eight children experienced recurrence of ocular inflammation during the 6-month follow-up period. No cases of worsening macular edema, glaucoma, or elevated IOP were observed in any patient.

Conclusion: Intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation is a safe and effective method for preventing and treating postoperative inflammation in children with uveitis.

目的:评估在小儿葡萄膜炎患者接受超声乳化术和眼内人工晶体植入术期间植入玻璃体内地塞米松的安全性和有效性:对接受超声乳化和眼内人工晶体植入术的小儿葡萄膜炎患者进行回顾性分析。患者的随访时间至少为 6 个月。主要结果指标包括眼部炎症、眼压(IOP)、最佳矫正视力(BCVA)和葡萄膜炎恶化:本研究最终纳入了 28 名患者的 36 只眼睛。术前 BCVA 的平均值为 1.00 (0.40-1.50) LogMAR。术后 1 个月,BCVA 明显改善至 0.40 (0.20-0.54) LogMAR(P = 0.006),术后 3 个月进一步改善至 0.30 (0.20-0.40) LogMAR(P = 0.001)。术后 6 个月时,BCVA 稳定在 0.30 (0.20-0.70) LogMAR(P = 0.005)。术后三到六个月的随访期间,平均眼压没有明显的统计学差异。在 6 个月的随访期间,有 8 名患儿的眼部炎症复发。没有发现任何患者出现黄斑水肿恶化、青光眼或眼压升高的情况:结论:在超声乳化和眼内人工晶体植入术中植入地塞米松是预防和治疗葡萄膜炎患儿术后炎症的一种安全有效的方法。
{"title":"Safety and efficacy of intravitreal dexamethasone implantation along with phacoemulsification and intraocular lens implantation in children with uveitis.","authors":"Hui Feng, Weixin Chen, Jianzhu Yang, Haorong Kong, Hongyu Li, Meng Tian, Jing Mo, Yuan He, Hong Wang","doi":"10.1186/s12348-024-00440-y","DOIUrl":"https://doi.org/10.1186/s12348-024-00440-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation in pediatric uveitis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pediatric uveitis patients undergoing phacoemulsification and intraocular lens implantation with intravitreal dexamethasone implantation. Patients with a minimum follow-up of 6 months were included. Primary outcome measures included ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis.</p><p><strong>Results: </strong>36 eyes of 28 patients were ultimately included in this study. The mean preoperative BCVA was 1.00 (0.40-1.50) LogMAR. BCVA significantly improved to 0.40 (0.20-0.54) LogMAR at 1 month postoperatively (P = 0.006), further improving to 0.30 (0.20-0.40) LogMAR at 3 months postoperatively (P = 0.001). BCVA remained stable at 0.30 (0.20-0.70) LogMAR at 6 months postoperatively (P = 0.005). Mean IOP showed no statistically significant difference during the follow-up period of three to six months after surgery. Eight children experienced recurrence of ocular inflammation during the 6-month follow-up period. No cases of worsening macular edema, glaucoma, or elevated IOP were observed in any patient.</p><p><strong>Conclusion: </strong>Intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation is a safe and effective method for preventing and treating postoperative inflammation in children with uveitis.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"55"},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and tolerability of subcutaneous repository corticotropin injection in refractory ocular inflammatory diseases. 皮下注射复方促肾上腺皮质激素治疗难治性眼炎的疗效和耐受性。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-24 DOI: 10.1186/s12348-024-00428-8
Negin Yavari, Hashem Ghoraba, Christopher Or, Zheng Xian Thng, S Saeed Mohammadi, Irmak Karaca, Azadeh Mobasserian, Amir Akhavanrezayat, Anthony Le, Xun Lyu, Anadi Khatri, Woong Sun Yoo, Dalia El Feky, Ngoc Trong Tuong Than, Osama Elaraby, Aim-On Saengsirinavin, Xiaoyan Zhang, Frances Andrea Anover, Ankur Sudhir Gupta, Muhammad Sohail Halim, Louis A Jison, Quan Dong Nguyen

Background: Repository corticotropin injection (RCI) has been suggested to exert immunomodulatory and anti-inflammatory effects in ocular inflammation. The index retrospective study aimed to evaluate the efficacy and tolerability of subcutaneous RCI in patients with active scleritis or uveitis.

Main body: Medical records of patients who were diagnosed with different types of active scleritis or uveitis and received RCI for more than six months at a tertiary eye center were reviewed. Patient characteristics including age, sex, comorbidities, clinical findings, treatment details, and adverse events were recorded. A total of 17 eyes of 17 patients were included. Median age was 43 years old and 53% of patients were male. Mean treatment duration was 25.4 ± 15.5 months. Indications for RCI therapy were scleritis (7 anterior and 1 posterior) (47.8%), panuveitis (17.4%), retinal vasculitis (17.4%), chronic/recurrent anterior uveitis (13%), and posterior uveitis (4.35%). RCI was initiated at a dose of 40 to 80 units 3 times weekly. Given the adequate control of inflammation, RCI was successfully discontinued in four patients (23.5%). Prior to RCI therapy, 14 (82.3%) patients were on oral prednisone at an average of 10 mg daily (range 2.5-40 mg), and two (11.7%) patients discontinued prednisone immediately before initiating RCI due to side effects. After six months of therapy, the prednisone dose was reduced in four (23.5%) patients to an average of 3 mg daily (range 1-5 mg) and was stopped in eight (53%) patients. Concomitant immunomodulatory therapies (IMTs) included mycophenolate mofetil (23.5%) and methotrexate (23.5%), and adalimumab (23.5%). Ten patients were on IMTs prior to using RCI, and during the course of treatment, IMT was stopped in two patients and reduced in one. Side effects included insomnia (23%), hypertension (11.7%), lower extremity edema (11.7%), hyperglycemia (11.7%), weight gain (11.7%), and infection (5.8%).

Conclusion: RCI may be considered as a potential therapy with acceptable tolerability for patients with non-infectious scleritis or uveitis.

背景:有研究认为,注射存留促肾上腺皮质激素(RCI)可在眼部炎症中发挥免疫调节和抗炎作用。本研究旨在评估皮下注射促肾上腺皮质激素对活动性巩膜炎或葡萄膜炎患者的疗效和耐受性:主要内容:研究人员查阅了一家三级眼科中心确诊为不同类型的活动性巩膜炎或葡萄膜炎并接受 RCI 治疗超过 6 个月的患者的病历。记录了患者的特征,包括年龄、性别、合并症、临床表现、治疗细节和不良反应。共纳入了 17 名患者的 17 只眼睛。中位年龄为 43 岁,53% 的患者为男性。平均治疗时间为(25.4 ± 15.5)个月。RCI 治疗的适应症包括巩膜炎(7 例前葡萄膜炎和 1 例后葡萄膜炎)(47.8%)、泛葡萄膜炎(17.4%)、视网膜血管炎(17.4%)、慢性/复发性前葡萄膜炎(13%)和后葡萄膜炎(4.35%)。开始使用的 RCI 剂量为 40 至 80 单位,每周 3 次。由于炎症得到了充分控制,4 名患者(23.5%)成功停用了 RCI。在接受 RCI 治疗前,14 名患者(82.3%)平均每天口服 10 毫克(范围为 2.5-40 毫克)泼尼松,其中 2 名患者(11.7%)因副作用在接受 RCI 治疗前立即停用了泼尼松。治疗 6 个月后,4 名患者(23.5%)的泼尼松剂量降至平均每天 3 毫克(1-5 毫克不等),8 名患者(53%)停止使用泼尼松。同时使用的免疫调节疗法(IMT)包括霉酚酸酯(23.5%)、甲氨蝶呤(23.5%)和阿达木单抗(23.5%)。10 名患者在使用 RCI 之前服用了 IMT,在治疗过程中,两名患者停止了 IMT,一名患者减少了 IMT。副作用包括失眠(23%)、高血压(11.7%)、下肢水肿(11.7%)、高血糖(11.7%)、体重增加(11.7%)和感染(5.8%):结论:RCI 可作为非感染性巩膜炎或葡萄膜炎患者的一种潜在疗法,其耐受性可以接受。
{"title":"Efficacy and tolerability of subcutaneous repository corticotropin injection in refractory ocular inflammatory diseases.","authors":"Negin Yavari, Hashem Ghoraba, Christopher Or, Zheng Xian Thng, S Saeed Mohammadi, Irmak Karaca, Azadeh Mobasserian, Amir Akhavanrezayat, Anthony Le, Xun Lyu, Anadi Khatri, Woong Sun Yoo, Dalia El Feky, Ngoc Trong Tuong Than, Osama Elaraby, Aim-On Saengsirinavin, Xiaoyan Zhang, Frances Andrea Anover, Ankur Sudhir Gupta, Muhammad Sohail Halim, Louis A Jison, Quan Dong Nguyen","doi":"10.1186/s12348-024-00428-8","DOIUrl":"https://doi.org/10.1186/s12348-024-00428-8","url":null,"abstract":"<p><strong>Background: </strong>Repository corticotropin injection (RCI) has been suggested to exert immunomodulatory and anti-inflammatory effects in ocular inflammation. The index retrospective study aimed to evaluate the efficacy and tolerability of subcutaneous RCI in patients with active scleritis or uveitis.</p><p><strong>Main body: </strong>Medical records of patients who were diagnosed with different types of active scleritis or uveitis and received RCI for more than six months at a tertiary eye center were reviewed. Patient characteristics including age, sex, comorbidities, clinical findings, treatment details, and adverse events were recorded. A total of 17 eyes of 17 patients were included. Median age was 43 years old and 53% of patients were male. Mean treatment duration was 25.4 ± 15.5 months. Indications for RCI therapy were scleritis (7 anterior and 1 posterior) (47.8%), panuveitis (17.4%), retinal vasculitis (17.4%), chronic/recurrent anterior uveitis (13%), and posterior uveitis (4.35%). RCI was initiated at a dose of 40 to 80 units 3 times weekly. Given the adequate control of inflammation, RCI was successfully discontinued in four patients (23.5%). Prior to RCI therapy, 14 (82.3%) patients were on oral prednisone at an average of 10 mg daily (range 2.5-40 mg), and two (11.7%) patients discontinued prednisone immediately before initiating RCI due to side effects. After six months of therapy, the prednisone dose was reduced in four (23.5%) patients to an average of 3 mg daily (range 1-5 mg) and was stopped in eight (53%) patients. Concomitant immunomodulatory therapies (IMTs) included mycophenolate mofetil (23.5%) and methotrexate (23.5%), and adalimumab (23.5%). Ten patients were on IMTs prior to using RCI, and during the course of treatment, IMT was stopped in two patients and reduced in one. Side effects included insomnia (23%), hypertension (11.7%), lower extremity edema (11.7%), hyperglycemia (11.7%), weight gain (11.7%), and infection (5.8%).</p><p><strong>Conclusion: </strong>RCI may be considered as a potential therapy with acceptable tolerability for patients with non-infectious scleritis or uveitis.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"56"},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Foscarnet eyedrops for the treatment of refractory herpetic keratitis. 治疗难治性疱疹性角膜炎的 Foscarnet 眼药水。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-23 DOI: 10.1186/s12348-024-00395-0
Caroline C Awh, Austen N Knapp, Jeffrey M Goshe, Craig W See, Careen Y Lowder

Purpose: The purpose of this case series is to describe the clinical course of patients receiving foscarnet eyedrops for the treatment of refractory herpetic keratitis.

Observations: Six patients diagnosed with herpetic keratitis were treated with foscarnet 24 mg/mL (2.4%) eyedrops with resulting improvement in keratitis.

Conclusion: Topical foscarnet may be a safe and effective treatment for herpetic keratitis in conjunction with, or as an alternative to, conventional antiviral therapy. This is an off-label use of foscarnet.

目的:本系列病例旨在描述接受福斯卡尼眼药水治疗难治性疱疹性角膜炎患者的临床过程:六名确诊为疱疹性角膜炎的患者接受了福斯卡尼 24 毫克/毫升(2.4%)眼药水的治疗,结果角膜炎得到了改善:结论:局部使用福斯卡尼可能是治疗疱疹性角膜炎的一种安全有效的方法,可与传统抗病毒疗法结合使用或作为其替代疗法。这是福斯奈特的标签外使用。
{"title":"Foscarnet eyedrops for the treatment of refractory herpetic keratitis.","authors":"Caroline C Awh, Austen N Knapp, Jeffrey M Goshe, Craig W See, Careen Y Lowder","doi":"10.1186/s12348-024-00395-0","DOIUrl":"https://doi.org/10.1186/s12348-024-00395-0","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this case series is to describe the clinical course of patients receiving foscarnet eyedrops for the treatment of refractory herpetic keratitis.</p><p><strong>Observations: </strong>Six patients diagnosed with herpetic keratitis were treated with foscarnet 24 mg/mL (2.4%) eyedrops with resulting improvement in keratitis.</p><p><strong>Conclusion: </strong>Topical foscarnet may be a safe and effective treatment for herpetic keratitis in conjunction with, or as an alternative to, conventional antiviral therapy. This is an off-label use of foscarnet.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"54"},"PeriodicalIF":2.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Persistent syphilitic ocular manifestations despite treatment: a case series. 虽经治疗但仍有梅毒眼部表现:一个病例系列。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-18 DOI: 10.1186/s12348-024-00435-9
Sairi Zhang, Kaersti L Rickels, Vignesh Krishnan, Sami H Uwaydat

Background: Penicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection.

Case series: Recommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops.

Case 2: A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated.

Conclusion: When treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection.

背景:几十年来,青霉素一直是治疗梅毒最有效的药物。梅毒性视网膜表现可能在治疗后持续存在,并导致视力问题。在本病例系列中,我们描述了三名梅毒患者因慢性炎症、治疗不彻底和再感染而导致后段表现持续存在:所有患者的最初治疗都是静脉注射青霉素14天。病例系列:建议所有患者的初始治疗均为静脉注射青霉素 14 天,在开始青霉素治疗 48 小时后再口服泼尼松。病例 1:一名 48 岁女性患者的视力逐渐下降,已持续两个月。眼底造影显示梅毒性外视网膜病变(SOR)、乳头炎和急性梅毒性后胎盘脉络膜视网膜病变(ASPPC)。治疗后,她出现了持续性囊样黄斑水肿(CME),并接受了玻璃体内曲安奈德注射和酮咯酸滴眼液治疗。病例 2:一名 24 岁男性患者突然视力下降两天。影像学检查显示,他患有 ASPPC、乳头炎和 SOR。他只接受了 10 天的青霉素静脉注射治疗。他的 SOR 持续存在,并接受了强力霉素和泼尼松治疗。病例 3:一名 52 岁的男性患者因眼部疼痛和视力下降就诊一周。影像学检查显示他患有 ASPPC 和乳头炎。治疗一个月后,他出现持续性乳头炎,于是重新开始口服泼尼松。一年后,他被发现复发了ASPPC,并被证实再次感染了梅毒,因此他接受了再次治疗:结论:在治疗持续性梅毒眼部表现时,我们建议检查青霉素治疗是否彻底,RPR滴度是否下降。结论:在治疗梅毒眼部顽固表现时,我们建议检查青霉素治疗是否彻底,RPR 滴度是否下降,如果两者都成立,则应对患眼进行抗炎治疗。导致视力预后不良的其他因素包括治疗延误、初始视力差、黄斑水肿和艾滋病病毒合并感染。
{"title":"Persistent syphilitic ocular manifestations despite treatment: a case series.","authors":"Sairi Zhang, Kaersti L Rickels, Vignesh Krishnan, Sami H Uwaydat","doi":"10.1186/s12348-024-00435-9","DOIUrl":"10.1186/s12348-024-00435-9","url":null,"abstract":"<p><strong>Background: </strong>Penicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection.</p><p><strong>Case series: </strong>Recommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops.</p><p><strong>Case 2: </strong>A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated.</p><p><strong>Conclusion: </strong>When treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"53"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11489380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
First report of uncommon mycobacteria in post LASIK keratitis: Mycobacterium wolinskyi. 首次报告 LASIK 术后角膜炎中的不常见分枝杆菌:沃林斯基分枝杆菌。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12348-024-00438-6
Sébastien van Delden, Hélène Buvelot, Giorgio Enrico Bravetti, Truong-Thanh Pham, Gabriele Thumann, Horace Massa

Laser assisted in situ keratomileusis (LASIK) surgery is the leading and most performed refractive surgery nowadays. A possible complication of LASIK surgery is infectious keratitis which can lead to disastrous corneal damage and result in permanent loss of vision. LASIK procedures have become increasingly accessible, and the demand for refractive surgery has risen among patients, challenging the medical field to improve the prevention of post-operative infections. Nevertheless, a wide range of pathogens have been described as responsible for post-LASIK keratitis. However, non-tuberculous mycobacterial keratitis remains an infrequent occurrence and is poorly described in the literature. To the best of our knowledge, this is the first ever reported case of post-LASIK keratitis caused by Mycobacterium wolinskyi. We describe the clinical and microbial characteristics, leading to its challenging treatment choice.

激光辅助原位角膜磨镶术(LASIK)是目前最主要、最常用的屈光手术。LASIK 手术可能出现的并发症是感染性角膜炎,它会导致灾难性的角膜损伤,导致永久性视力丧失。LASIK 手术越来越普及,患者对屈光手术的需求也越来越高,这对医学界提高术后感染预防能力提出了挑战。然而,LASIK 术后角膜炎的病原体种类繁多。然而,非结核分枝杆菌性角膜炎仍然很少发生,文献中也鲜有描述。据我们所知,这是第一例由 Wolinskyi 分枝杆菌引起的角膜切割激光术后角膜炎。我们描述了该病例的临床和微生物特征,从而为其治疗选择提出了挑战。
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引用次数: 0
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Journal of Ophthalmic Inflammation and Infection
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