Goichi Akiyama

Health- and vision-related quality of life in patients receiving infliximab therapy for Behçet uveitis

Objective To evaluate the changes in health-related and vision-related quality of life (HR-QoL and VR-QoL) in patients with Behçet uveitis (BU) receiving infliximab therapy. Methods Twenty patients with recurrent BU attacks were enrolled. All patients were treated with infliximab. We evaluated the mean number of uveitis attacks and the mean score of extraocular manifestations by Behçet disease current activity form (BDCAF) during the 6 months before and the 6 and 12 months after initiation of infliximab. The EuroQol-5D questionnaire (EQ-5D) and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were self-administered in all patients before treatment and, 6 and 12 months after treatment. Patients’ pre- and post-treatment EQ-5D and NEI VFQ-25 scores were compared. Results By the 6- and 12-month follow-up, the frequency of uveitis attacks and the BDCAF scores was significantly decreased compared with the 6 months before starting infliximab (p<0.0001). Fully completed questionnaires were received from all patients. Infliximab therapy was associated with a significant improvement of the EQ-5D (p<0.0001), NEI VFQ-25 composite score (p=0.0001), general health score (p=0.0001) and mental health score (p=0.0001). This result shows a significant decrease in inflammatory activity of the disease and consequently improvement in HR-QoL and VR-QoL scores with a rising response pattern in all dimensions. Conclusions Relief of uveitis attacks and extraocular manifestations by infliximab therapy significantly improved the HR-QoL and VR-QoL in patients with BU.

Therapeutic effect of stealth-type polymeric nanoparticles with encapsulated betamethasone phosphate on experimental autoimmune uveoretinitis.

PURPOSE The therapeutic effects of betamethasone phosphate (BP) encapsulated in biocompatible and biodegradable blended nanoparticles of poly(lactic acid) (PLA) homopolymers and PEG-block-PLA copolymers (stealth nanosteroids) were examined in an experimental autoimmune uveoretinitis (EAU) model in Lewis rats. METHODS EAU was induced by S-antigen peptide in Lewis rats. Accumulation of systemically administered Cy7-labeled stealth nanoparticles in inflamed eyes of rats with EAU was assessed using in vivo fluorescence imaging, and the therapeutic effect of stealth nanosteroids, nonstealth nanosteroids, or saline on EAU was examined. The eyes were obtained 7 days after the treatment, and the histologic score was determined using pathologic findings. The expression of inflammatory cytokines including IL-6, IL-17, and VEGF was determined immunohistochemically. RESULTS Cy7-stealth nanoparticles accumulated in inflamed eyes of rats with EAU and remained in situ for a 3-day period. Systemically administered stealth nanosteroids (100 μg of BP) reduced the clinical scores of rats with EAU within 1 day and maintained the effect for 2 weeks. This treatment also decreased the histologic scores and the expression of inflammatory cytokines in the retina of EAU. CONCLUSIONS The strong therapeutic benefit on EAU obtained with the stealth nanosteroids may have been due to prolonged blood circulation and targeting to the inflamed uvea and retina, in addition to sustained release in situ.

A Case of Retinitis Pigmentosa Requiring Vitrectomy because of Repeated Vitreous Hemorrhage.

A male patient with retinitis pigmentosa (RP) accompanied by repeated vitreous hemorrhage in both eyes underwent unilateral vitrectomy. Visual acuity recovered to 0.8 in the operated right eye, and no hemorrhage, complications or progression of RP were observed. Fluorescein angiography performed 2 months after surgery detected neovascularization at the optic disc in the operated right eye, but not in the non-operated left eye, and no avascular areas were found in either eye. Vitrectomy may be effective for the treatment of RP accompanied by vitreous hemorrhage.