Article

Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial.

National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Ocular immunology and inflammation (Impact Factor: 0.72). 04/2012; 20(2):104-12. DOI: 10.3109/09273948.2011.647228
Source: PubMed

ABSTRACT To assess the prevalence of hypotony in patients with severe forms of uveitis.
The Multicenter Uveitis Steroid Treatment (MUST) Trial, a randomized study, enrolled 255 patients. Patients with hypotony at the baseline visit were identified.
Twenty (8.3%) of 240 patients with sufficient data had hypotony. Hypotony was more common in patients with uveitis ≥5 years duration (odds ratio [OR] = 5.0; p < .01), and in eyes with a history of ocular surgery (vitrectomy vs. none, OR = 3.1; p = .03). Hypotony was less in patients with older age of uveitis onset (>51 years vs. <51 years, OR = 0.1; p = .02), in Caucasian patients (OR = 0.1; p < .01) compared to African American patients. Hypotonous eyes were more likely to have visual impairment (OR = 22.9; p < .01).
Hypotony is an important complication of uveitis and more commonly affects African-American patients, those with uveitis onset at a younger age, and those with longer disease duration. It is associated with visual impairment.

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    ABSTRACT: PURPOSE: The aim of the present study was to develop and optimize sinomenine hydrochloride (SIN) in situ gel for uveitis treatment. METHODS: Carbopol 940 was used as the gelling agent in combination with hydroxypropyl methylcellulose (HPMC), which acts as a viscosity enhancer. The formulations were prepared using various concentrations of Carbopol 940 and HPMC. The prepared in situ gels were evaluated for gellation, drug release, ocular irritation, elimination time and pharmacokinetic studies. Furthermore, the effect of SIN on the development of experimental autoimmune anterior uveitis (EAAU) was assessed. RESULTS: The optimum concentration of Carbopol was 0.1% (w/v), and that for HPMC was 0.4% (w/v). Which showed a significant enhancement in gel strength in the physiological condition while free flowing at non-physiological condition. Optimum formula F2-3 consisting of 0.5% SIN was prepared and kept as gel group, and 0.5% SIN solution was prepared and kept as control group. Gel group provided sustained release of the drug over a period of 480min. No evidence of overt toxicity and irritation was observed in any study. The elimination time of control group and gel group was completed within 10min and 25min, respectively. The area under the aqueous humor concentration vs. time curve (AUC0-t) and maximum concentration (Cmax) values of gel group was 2.70-fold and 1.79-fold higher than that of control group. Additionally, clinical examination showed that SIN suppressed inflammation in EAAU. CONCLUSIONS: These results support the potential applications of SIN in situ gel for uveitis treatment.
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