Ester Carreño

Cytokine and chemokine levels in tears from healthy subjects

Acta Ophthalmol. 2010: 88: e250–e258

Multicenter study of intravitreal dexamethasone implant in noninfectious uveitis: indications, outcomes, and reinjection frequency.

PURPOSE To identify clinical outcomes and treatment patterns of intravitreal dexamethasone implant (Ozurdex; Allergan, Inc) in noninfectious uveitis in the clinical setting. DESIGN Multicenter retrospective cohort study. METHODS Eighty-two eyes (63 patients) receiving 142 implant injections over 35 months were included. Treatment indication, uveitis diagnosis, visual acuity, intraocular pressure, vitreous haze score, central retinal thickness by optical coherence tomography, phakic status, number of injections, time to reinjection, systemic treatments, and complications data were collected. Time to visual acuity and vitreous haze score improvement as per the Standardization of Uveitis Nomenclature guidelines were also determined. RESULTS The probability of visual acuity improvement (≥0.3 logarithm of the minimal angle of resolution units improvement) was 39% at 1 month, 49% at 3 months, 52% at 6 months, and 58% at 12 months. Eyes with baseline vitritis (vitreous haze score ≥+0.5, n = 45) had a probability of vitreous haze score improvement (2-step decrease or change from +0.5 to 0) at 2 weeks of 41%, at 1 month 63%, at 3 months 73%, at 6 months 79%, and at 12 months 88%. In eyes that completed 12-month follow-up (n = 54), 40.7% underwent 2 injections (mean time to second injection of 6.6 ± 1.9 months) and 11.2% required ≥3 injections (mean time to third injection of 11 ± 1.5 months). CONCLUSIONS Dexamethasone implant use in uveitis provides favorable visual acuity and vitreous haze score outcomes but requires repeated injections, an important consideration when choosing intraocular treatment as a route to controlling uveitis.

Assesment of fundus autofluorescence in serpiginous and serpiginous-like choroidopathy

AimsThe aim of this study was to correlate the activity status disclosed in fluorescein angiography (FA) and fundus autofluorescence (FAF) imaging, and the variations of FAF images in the evolution of serpiginous choroidopathy (SC) and serpiginous-like choroidopathy (SLC).MethodsProspective consecutive case series. Patients with SC or SLC were included from July 2009 to December 2010. All patients underwent FAF imaging (Spaide Autofluorescence Filters, Topcon TRC 50IX) and FA (Topcon TRC 50IX).ResultsTwelve patients (eight males, mean age 51.2 years) were included. Bilateral involvement in nine cases. Three different patterns of FAF images were present: active inflammation, transitional, and inactive inflammation.ConclusionFAF may be a useful tool for following patients with SC and SLC. It is possible to reserve other invasive techniques, such as FA, for cases with suspicious activity disclosed by FAF imaging.

Evidence for Tocilizumab as a Treatment Option in Refractory Uveitis Associated with Juvenile Idiopathic Arthritis

Objective. To report on experience using the anti-interleukin 6 receptor antibody tocilizumab (TCZ) to treat severe and therapy-refractory uveitis associated with juvenile idiopathic arthritis (JIA). Methods. Retrospective data were gathered from patients with JIA receiving TCZ treatment for uveitis. JIA and related uveitis data (disease onset, activity, structural complications, and topical and systemic antiinflammatory treatment) were evaluated at the start of TCZ (baseline) and every 3 months during TCZ therapy. Results. A total of 17 patients (14 women) with active uveitis were included (mean age 15.3 ± 6.9 yrs, mean followup time 8.5 mos). In all patients, uveitis had been refractory to previous topical and systemic corticosteroids, methotrexate (MTX), and other synthetic and biological disease-modifying antirheumatic drugs, including ≥ 1 tumor necrosis factor-α (TNF-α) inhibitor. Uveitis inactivity was achieved in 10 patients after a mean of 5.7 months of TCZ treatment (in 3 of them, it recurred during followup) and persisted in the remaining 7 patients. By using TCZ, systemic corticosteroids or immunosuppressives could be spared in 7 patients. Macular edema was present in 5 patients at baseline and improved in all of them under TCZ treatment. Arthritis was active in 11 patients at the initial and in 6 at the final followup visit. Conclusion. TCZ appears to represent a therapeutic option for severe JIA-associated uveitis that has been refractory to MTX and TNF-α inhibitors in selected patients. The present data indicate that inflammatory macular edema responds well to TCZ in patients with JIA-associated uveitis.

Managing juvenile idiopathic arthritis-associated uveitis

Bilateral chronic anterior uveitis is an extra-articular feature of juvenile idiopathic arthritis. Although figures vary, uveitis occurs in approximately 11%-13% of patients with this disease and is most commonly associated with the female gender, oligoarthritis, and presence of antinuclear antibodies. The disease has an insidious onset and is often asymptomatic. Managing patients with juvenile idiopathic arthritis-associated uveitis remains challenging as the disease may prove to be refractory to traditional treatment regimens. Stepwise immunomodulatory therapy is indicated, with new biologic drugs being used last in cases of refractory uveitis. Small scale studies and practice have provided the evidence to undertake randomized control trials to evaluate the efficacy, safety, and cost-effectiveness of anti-tumor necrosis factor-α therapies, such as infliximab and adalimumab. These have demonstrated promising results, with further data awaited from ongoing trials for adalimumab (as SYCAMORE and ADJUVITE trials). Lower grade evidence is supporting the use of newer biologics such as rituximab, daclizumab, tocilizumab, and abatacept in those cases refractory to anti-tumor necrosis factor-α therapy.

Multimodal imaging in acute posterior multifocal placoid pigment epitheliopathy demonstrating obstruction of the choriocapillaris

Optical coherence tomography angiography (OCTA) provides noninvasive in vivo vascular imaging of the retina and choriocapillaris. To highlight OCTA utility, the authors align structural changes and their resolution with functional outcome. The authors present a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and sequential changes during transition to inactive disease. In the acute phase, altered flow and nonperfusion were seen in defined islands of choriocapillaris. Over time, progressive reperfusion was observed and accompanied clinical resolution and functional visual restoration. The imaging features acquired described the level of nonperfusion the authors had assumed when extrapolating findings from multiple independent imaging modalities. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:677-681.].

Update on twice-daily bromfenac sodium sesquihydrate to treat postoperative ocular inflammation following cataract extraction

Ophthalmic bromfenac sodium sesquihydrate is a topically applied selective cyclooxygenase (COX)-2 inhibitor. It is similar to amfenac, except for a bromine atom at the C4 of the benzoyl ring position, which markedly affects its in vitro and in vivo potency, extends the duration of anti-inflammatory activity, and enhances its inhibitory effect on COX-2 absorption across the cornea and penetration into ocular tissues. The United States Food and Drug Administration approved bromfenac in 2005 for the treatment of postoperative inflammation and the reduction of ocular pain in patients who have undergone cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs), and among them bromfenac, could be even more effective than steroids at reestablishing the blood–aqueous barrier, as revealed by flare on slit-lamp examination and as quantitatively measured using ocular fluorophotometry. Similar to other NSAIDs, it has a role in inhibiting intraoperative miosis during cataract surgery. However, bromfenac also seems to be useful in other situations, such as refractive surgery, allergic conjunctivitis (not useful in dry eye), choroidal neovascularization, and even ocular oncology. No reports of systemic toxicity have been published and bromfenac has good topical tolerance with a low incidence of adverse effects.

Multimodal Imaging of Macular Serpiginous Choroidopathy From Acute Presentation to Quiescence

The authors report imaging findings in a case of macular serpiginous choroidopathy (MSC). Near-infrared reflectance (NIR), fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT) were performed on a 25-year-old man presenting with decreased visual acuity and a blind spot in his left eye. Fundus examination revealed a yellow subretinal infiltrate inferior to the macula with active edges. On SD-OCT, areas of disease activity presented as a diffuse hyperreflective signal in the outer nuclear layer (ONL). Inactive lesions presented as localized thinning of the ONL. NIR allowed clear visualization of a hyperreflective junctional line between the active and inactive areas that subsequently became disrupted. FAF revealed a diffuse hypoautofluorescent halo surrounding an area of hyperautofluorescence in the acute phase and later better-defined lesions and hypoautofluorescent lesion edges.

Fatal disseminated Scedosporium prolificans infection initiated by ophthalmic involvement in a patient with acute myeloblastic leukemia.

Scedosporium prolificans is an opportunistic saprophytic fungus that rapidly disseminates and is intrinsically resistant to currently available antifungal drugs. We report a fatal case of disseminated S. prolificans infection that started with orbital and ocular involvement in a patient with secondary acute myeloblastic leukemia.

Corneal inflammation from pine processionary caterpillar hairs.

Purpose: Hairs from the caterpillar of the pine processionary moth, Thaumetopoea pityocampa, located in the pine forests of southern Europe and elsewhere, can become embedded in the cornea and conjunctiva. Disorders produced by the urticating hairs can be classified into a broad spectrum of severity from mild keratoconjunctivitis to anaphylactic shock. This report presents 3 cases that illustrate the range of corneal responses to embedded hairs of the processionary moth caterpillar. Methods: Case series and review of the literature. Results: A 51-year-old man (case 1), a 46-year-old woman (case 2), and a 67-year-old man (case 3) presented different manifestations as a result of contact with pine processionary caterpillar hairs. Case 1 had acute keratitis with decreased vision. He was treated with a corneal depot steroid 4 times daily for 3 months. After 4 months, he was asymptomatic. Case 2 had acute keratitis without vision symptoms. She was released without treatment, and 1 month later was asymptomatic. Case 3 experienced dry gritty sensations, probably because of blepharitis, but also presented asymptomatic caterpillar hairs embedded in the corneal stroma. He was instructed regarding lid hygiene for his blepharitis, and after 3 months the embedded caterpillar hairs had disappeared. Conclusions: The most common ocular presentation of embedded hairs from the pine processionary moth caterpillar is keratitis. The urticating hairs can cause corneal infiltrates that disappear progressively over time. Steroid eye drops accelerate the resorption of these infiltrates.