R. W. A. M. Kuijpers

Anti-TNF-alpha therapy for sight threatening uveitis.

Aim: To describe the effect of additional treatment with anti-TNF-α therapy in a case series of 13 patients with serious sight threatening uveitis. Methods: 13 patients with serious sight threatening uveitis were included, of whom six had Behçet’s disease, five had idiopathic posterior uveitis, one had sarcoidosis, and one birdshot retinochoroiditis. Onset and course of ocular inflammation, inflammatory signs, and visual acuity were assessed. Patients were treated with 200 mg (approximately 3 mg/kg) infliximab infusion. Repeat infusions were given based on clinical response. Results: Infliximab treatment resulted in an effective suppression of ocular inflammation in all patients. In patients with non-Behçet’s disease uveitis visual acuity in six out of eight improved or was stable. In patients with Behçet’s disease visual acuity in five out of six improved or was stable. Conclusion: Anti-TNF-α treatment may be of value in the treatment of uveitis, and in patients with Behçet’s disease, leading to suppression of ocular inflammation, vasculitis, and improvement of vision in the majority. Based on these results a controlled masked study is warranted.

Autologous peripheral retinal pigment epithelium translocation in patients with subfoveal neovascular membranes

Aim: To evaluate the possibility of translocating autologous peripheral retinal pigment epithelial (RPE) cells and enhance their adhesion to improve functional outcome after choroidal neovascular membrane extraction in patients with subfoveal neovascular membranes. Methods: A prospective, non-controlled surgical study in eight consecutive patients operated between February and July 2001 with final data monitoring in July 2002. All patients had mixed subfoveal membranes of 2–4 disc diameters. Functional tests included Snellen vision and central fixation testing. During vitrectomy, after the extraction of the neovascular complex, 8×104–16×104 RPE cells were removed from the periphery and translocated under the macula following the submacular injection of 2 μg of poly-l-lysine to promote adhesion of the cells. Results: With a follow up ranging from 3 months to 16 months, a pigmented area was seen in the extraction bed of the neovascular membrane in only one patient. Fixation was at the edge of the extraction bed in three patients. Vision remained the same in five patients and deteriorated in three (all with retinal detachment). Retinal detachment due to proliferative vitreoretinopathy occurred in three patients. Conclusions: The translocation of autologous peripheral RPE cells after membrane extraction was technically possible in a sterile manner, but was associated with a high proliferative vitreoretinopathy rate and in the present series had no measurable positive effect on functional outcome.

Mast cells are major contributors to the pathophysiology of Graves’ Ophthalmopathy (GO)

Mast cell numbers are elevated in GO orbital tissue and are mainly located adjacent to orbital fibroblasts. Mast cells are potent producers of a variety of factors, such as histamine and tryptase. Mast cell stabilizing agents resulted in clinical improvements in GO patients. These data suggest an important role for mast cells in GO and warrants further studies into their contributing role.