-
Simon R J Taylor,
Alay Banker,
Ariel Schlaen,
Cristobal Couto,
Egbert Matthe, Lavnish Joshi,
Victor Menezo,
Ethan Nguyen,
Oren Tomkins-Netzer,
Asaf Bar,
Jiten Morarji,
Peter McCluskey,
Sue Lightman
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE:: To assess the outcomes of the intravitreal administration of methotrexate in uveitis. METHODS:: Multicenter, retrospective interventional case series of patients with noninfectious uveitis. Thirty-eight eyes of 30 patients were enrolled, including a total of 54 intravitreal injections of methotrexate at a dose of 400 µg in 0.1 mL. The primary outcome measure was visual acuity. Secondary outcome measures included control of intraocular inflammation and cystoid macular edema, time to relapse, development of adverse events, and levels of systemic corticosteroid and immunosuppressive therapy. RESULTS:: Methotrexate proved effective in controlling intraocular inflammation and improving vision in 30 of 38 eyes (79%). The side effect profile was good, with no reported serious ocular adverse events and only one patient having an intraocular pressure of >21 mmHg. Of the 30 eyes that responded to treatment, 8 relapsed, but 22 (73%) entered an extended period of remission, with the Kaplan-Meier estimate of median time to relapse for the whole group being 17 months. The eight eyes that relapsed were reinjected and all responded to treatment. One eye relapsed at 3 months, but 7 eyes again entered extended remission. Of the 14 patients on systemic therapy at the start of the study, 8 (57%) were able to significantly reduce this following intravitreal methotrexate injection. CONCLUSION:: In patients with uveitis and uveitic cystoid macular edema, intravitreal MTX can effectively improve visual acuity and reduce cystoid macular edema and, in some patients, allows the reduction of immunosuppressive therapy. Some patients relapse at 3 to 4 months, but a large proportion (73%) enter an extended period of remission of up to 18 months. This larger study extends the results obtained from previous smaller studies suggesting the viability of intravitreal methotrexate as a treatment option in uveitis.
Retina (Philadelphia, Pa.) 04/2013; · 2.93 Impact Factor
-
Acta ophthalmologica 12/2012; · 2.44 Impact Factor
-
Ophthalmology 11/2012; 119(11):2412-2412.e2. · 5.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: To report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal necrosis (ARN). METHODS: This study reports a retrospective, interventional case series of nine consecutive patients with ten eyes with newly diagnosed ARN treated with oral valacyclovir as the sole antiviral agent. Eight patients received oral valacyclovir 1 g tid (Valtrex, GlaxoSmithKline) and one patient with impaired renal function received oral 1 g tid. The main outcome measures were response to treatment, time to initial response to treatment, time to complete resolution of retinitis, best corrected visual acuity (BCVA) at final follow-up, retinal detachment and development of recurrent or second eye disease. RESULTS: Retinitis resolved in ten of ten (100%) affected eyes. The median time to initial detectable response was seven days and the median time to complete resolution was 21 days. A final BCVA of 20/40 or better was achieved in 6/10 (60%) of eyes. 3/10 eyes (30%) developed a retinal detachment. No patients developed either disease reactivation or second eye involvement over the course of the study (mean follow up 31 weeks, range 7 to 104 weeks). CONCLUSIONS: Treatment with oral valacyclovir as the sole antiviral therapy resulted in complete resolution of retinitis. Final BCVA and retinal detachment rate were comparable with previously reported outcomes for intravenous acyclovir.
BMC Ophthalmology 09/2012; 12(1):48. · 1.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report a patient with necrotising scleritis in whom infliximab was used for short-term steroid-sparing while rituximab took effect. This enabled disease control without requiring an extended period of high-dose corticosteroid administration or the concurrent use of cyclophosphamide.
Case reports in ophthalmology. 09/2012; 3(3):286-90.
-
[show abstract]
[hide abstract]
ABSTRACT: We present the first reported case of acute endophthalmitis due to Rhizobium radiobacter after an intravitreal injection of ranibizumab for neovascular age-related macular degeneration.
Case reports in ophthalmology. 09/2012; 3(3):283-5.
-
[show abstract]
[hide abstract]
ABSTRACT: This article reviews the ocular and neuro-opthalmic manifestations of phacomatoses, while emphasizing important differential diagnoses that exist based on their clinical features. Variations in the definition of phacomatoses do exist, but conditions not meeting the classical definition are also presented.
British journal of hospital medicine (London, England: 2005) 12/2011; 72(12):677-81. · 0.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To report the long-term outcome of the treatment of refractory ophthalmic Wegener's granulomatosis (WG) with rituximab (RIT), including rates of relapse, predictors of relapse, and results of repeat treatment.
Retrospective case series.
We included 20 consecutive patients with refractory ophthalmic WG treated with RIT.
Intravenous RIT infusion, 2 doses of 1 g given 2 weeks apart.
Regular clinical, serologic, and immunologic examinations for disease activity and extent, and for treatment-related side effects.
All 20 patients entered remission, the median time to remission being 2 months (range, 1-6). Seven patients (35%) relapsed at a median of 13 months (range, 9-18). Five of these patients took a second course of RIT, and all achieved remission without further relapse. In the 16 patients with positive anti-proteinase-3 (PR3) titers at baseline, rising anti-PR3 titer was a statistically significant predictor of relapse. There were 4 severe adverse events during the study, of which one was directly attributed to treatment with RIT.
In this series of 20 patients with refractory ophthalmic WG, RIT was effective in inducing remission. Relapse occurred in one third of patients within 18 months and seemed to be predictable by rising anti-PR3 titers, but retreatment with RIT was effective in this group. In patients with ophthalmic WG, RIT may be capable of inducing extended remission, in contrast with other biologic and conventional treatments in common use.
Proprietary or commercial disclosure may be found after the references.
Ophthalmology 09/2011; 118(12):2498-503. · 5.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Corticosteroids remain the mainstay of the management of patients with uveitis. Topical corticosteroids are effective in the control of anterior uveitis, but vary in strength, ocular penetration and side effect profile. Systemic corticosteroids are widely used for the management of posterior segment inflammation which requires treatment, particularly when it is associated with systemic disease or when bilateral ocular disease is present. However, when ocular inflammation is unilateral, or is active in one eye only, local therapy has considerable advantages, and periocular injections of corticosteroid are a useful alternative to systemic medication and are very effective in controlling mild or moderate intraocular inflammation. More recently, the injection of intraocular corticosteroids such as triamcinolone have been found to be effective in reducing macular oedema and improving vision in uveitic eyes which have proved refractory to systemic or periocular corticosteroids. The effect is usually transient, lasting around 3 months, but can be repeated although the side effects of cataract and raised intraocular pressure are increased in frequency with intraocular versus periocular corticosteroid injections. This has led to the development of new intraocular corticosteroid devices which are designed to deliver sustained-release drugs and obviate the need for systemic immunosuppressive treatment. The first such implant was Retisert, which is surgically implanted (in the operating theatre) and is designed to release fluocinolone over a period of about 30 months. More recently, Ozurdex, a 'bioerodible' dexamethasone implant which can be inserted in an office setting, has completed phase III clinical trials in patients with intermediate and posterior uveitis. This implant lasts approximately 6 months, and has been found to be effective with a much better side effect profile than Retisert or intravitreal triamcinolone injection, at least for one injection.
Ophthalmologica 01/2010; 224 Suppl 1:46-53. · 1.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the efficacy of rituximab in patients with refractory ophthalmic Wegener's granulomatosis (WG).
Data from 10 consecutive patients with refractory ophthalmic WG treated with rituximab were retrospectively reviewed. In all patients, the ophthalmic disease was driving treatment decisions, and disease activity had persisted despite standard immunosuppressive treatment. Patients had refractory scleritis (n=3), orbital granulomas causing optic nerve compromise (n=4), or a combination of both conditions (n=3). All patients had been treated with at least 3 different immunosuppressive agents, and 5 patients had previously been treated with tumor necrosis factor alpha blockade. Rituximab was administered intravenously in 2 doses, 2 weeks apart, in combination with standard treatment. Disease activity was monitored clinically by an interdisciplinary approach, including disease activity scoring, immunodiagnostics, and magnetic resonance imaging, as well as by corresponding reductions in the required dose of conventional medication.
A beneficial response to treatment with rituximab was seen in all 10 patients, including induction of clinical remission. In all patients, the peripheral blood B cell count fell to zero during treatment with rituximab. Titers of classic antineutrophil cytoplasmic antibodies fell in association with B cell counts, and this reduction was correlated with improved clinical findings.
In contrast to previous observations, this study showed that treatment with rituximab was associated with clinical improvement in patients with refractory ophthalmic WG.
Arthritis & Rheumatism 05/2009; 60(5):1540-7. · 7.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Wegener's granulomatosis (WG) is a multisystem small-vessel vasculitis which is characterised by granulomatous inflammation. Respiratory tract involvement is most commonly seen, affecting up to 85% of patients, closely followed by the renal system in up to 75% of patients; ocular involvement in WG is estimated to occur in 50-60% of patients. The purpose of this review is to provide an overview of the renal and ocular manifestations of WG and discuss the rationale behind the therapeutic approach. In particular, we will focus on how understanding the disease processes in both of these organs has led to more targeted therapy. The mechanism of action of the various immunosuppressive medications in both systemic and ocular inflammation and the evidence available for their use will also be discussed.
Inflammation & allergy drug targets. 04/2009; 8(1):70-9.
-
[show abstract]
[hide abstract]
ABSTRACT: A patient undergoing chemotherapy for treatment of acute lymphocytic leukemia developed septicemia that was treated with linezolid for 16 days. The patient subsequently reported reduced vision in both eyes and was found to have bilateral optic neuropathy. After the discontinuation of linezolid treatment, both the optic neuropathy and visual impairment resolved without sequelae.
Clinical Infectious Diseases 03/2009; 48(7):e73-4. · 9.15 Impact Factor
