Biologic Agents in Inflammatory Eye Disease

Non-infectious uveitis is a potentially sight threatening disease. Along the years, several therapeutic strategies have been proposed as a means to its treatment, including local and systemic steroids, immunosuppressives and more recently, biologic agents. The introduction of biologics can be defined as a new era: biologic therapies provide new options for patients with refractory and sight threatening inflammatory disorders. The availability of such novel treatment modalities has markedly improved the therapy of uveitis and considerably increased the possibility of long-term remissions. This article provides a review of current literature on biologic agents, such as tumor necrosis factor blockers, anti-interleukins and other related biologics, such as interferon alpha, for the treatment of uveitis. Several reports describe the efficacy of biologics in controlling a large number of refractory uveitides, suggesting a central role in managing ocular inflammatory diseases. However, there is still lack of randomized controlled trials to validate most of their applications. Biologics are promising drugs for the treatment of uveitis, showing a favorable safety and efficacy profile. On the other hand, lack of evidence from randomized controlled studies limits our understanding as to when commence treatment, which agent to choose, and how long to continue therapy. In addition, high cost and the potential for serious and unpredictable complications have very often limited their use in uveitis refractory to traditional immunosuppressive therapy

Aqueous humour concentrations after topical apPlication of combinEd levofloxacin-dexamethasone eye dRops and of its single components: a randoMised, assEssor-blinded, parallel-group study in patients undergoing cataract surgery: the iPERME study

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A Clinical Picture of the Visual Outcome in Adamantiades-Behçet’s Disease

Adamantiades-Behc¸et’s disease is a multisystemic vasculitis with multiorgan involvement. Ocular disorders occur often in this syndrome typically in the form of a relapsing-remitting panuveitis and vasculitis and can lead to blindness as one of its most disabling complications if left untreated. There are known risk factors related with the worst visual prognosis, which require early and intensive treatment in order to obtain a rapid suppression of inflammation and to prevent future relapses. The management strategy to avoid vision loss and blindness currently involves the use of local and systemic drugs including steroids and immunosuppressive and biologic agents.This review aims to demonstrate how the introduction and the use of biologic agents improves the visual outcome of patients with Adamantiades-Behc¸et’s diseas

Amniotic membrane application in complex cases of penetrating keratoplasty surgery

INTRODUCTION. The aim of the study is to investigate the ability of an amniotic membrane implant combined with penetrating keratoplasty to reduce early and mid-term complications in complex cases such as penetrating burns, infective ulcers, keratitis, or corneal graft failure. MATERIALS AND METHODS. Fifty patients: 12 with keratitis, 24 with infective ulcers, 10 with penetrating trauma, and four with a history of corneal graft failure, were divided into two groups. The first group of 25 patients (Group A) underwent penetrating keratoplasty alone, while the second group of 25 patients (Group B) received penetrating keratoplasty associated with an amniotic membrane implant. Amniotic membrane implantation was performed in a ‘patch modality’, and the membrane was sewn to the graft with the epithelium/basement membrane side facing inwards. All patients were evaluated, respectively, 3, 15, 30, 90, and 180 days after surgery. At each visit a slit-lamp examination was performed together with corneal thickness and endothelial cell count assessment. All the data were subjected to statistical analysis with Student’s t-test. RESULTS. At the slit-lamp examination in Group A 48% of patients showed Descemet folds at one and three months, respectively, while 80% of patients of Group B did not show any Descemet folds. In Group A we registered two cases of early graft failure and two cases of shallow anterior chamber, while none of these complications appeared in Group B. In Group A the average corneal thickness at 15, 30, 90, and 180 days post-operatively was, respectively, 695 ± 43 μm, 658 ± 31 μm, 588 ± 12 μm, and 518 ± 20 μm, while in Group B it was found to be, respectively, 667 ± 12 μm, 632 ± 17 μm, 562 ± 16 μm, and 516 ± 10 μm. Differences in corneal thickness between Group A and Group B were found to be statistically significant (p = 0.05). Endothelial cell count was in Group A 2582 c/mm2 at 15 days, 2500 c/mm2 at one month, 2335 c/mm2 at three months, and 2111 c/mm2 at six months, while the average count for Group B patients was 2607 c/mm2, 2503 c/mm2, 2299 c/mm2, and 2086 c/mm2, respectively. Differences in endothelial cell count between the two groups did not show any statistical significance (p > 0.05). CONCLUSIONS. Amniotic membrane implantation associated with penetrating keratoplasty reduces early and mid-term complications of corneal grafts in patients with high risk of failure. This positive effect may be due to the anti-inflammatory, neurotrophic, and anti-angiogenetic properties of the amniotic membrane. Longer observation and larger case series can be useful in evaluation of the functional outcome of grafts in these patients

Ophthalmologic evaluation of severely obese patients undergoing bariatric surgery: A pilot, monocentric, prospective, open-label study

PURPOSE: The aim of this study was to investigate the pathogenic role of obesity on blinding eye diseases in a population of severely obese patients with no history of eye diseases, and to verify whether weight loss induced by bariatric surgery may have a protective effect. METHODS: This was a pilot, monocentric, prospective, and open label study conducted at the University Hospital of Pisa. Fifty-seven severely obese patients with a mean body mass index value of 44.1 ± 6 kg/m2 were consecutively recruited and received a complete ophthalmological evaluation and optical coherence tomography. Twenty-nine patients who underwent gastric bypass were evaluated also 3 months, and 1 year after surgery. RESULTS: At baseline, blood pressure value were directly and significantly related to intraocular pressure values (p<0.05, R = 0.35). Blood pressure values were also significantly and inversely related to retinal nerve fiber layer thickness, particularly in the temporal sector (RE p<0.05 r-0.30; LE p<0.01, R = -0.43). Moreover, minimum foveal thickness values were significantly and inversely associated with body mass index (RE p<0.02, R = -0.40; LE p<0.02, R = -0.30). A significant reduction of body mass index (p<0.05) and a significant (p<0.05) improvement of blood pressure was observed three months and one year after gastric bypass, which were significantly associated with an increase in retinal nerve fiber layer thickness and minimum foveal thickness values in both eyes (p<0.05). CONCLUSIONS: The results of this study suggest that obese patients may have a greater susceptibility to develop glaucomatous optic nerve head damage and age-related macular degeneration. Moreover, weight reduction and improvement of comorbidities obtained by bariatric surgery may be effective in preventing eye disease development by improving retinal nerve fiber layer and foveal thickness

Amniotic membrane application in complex cases of penetrating keratoplasty surgery

INTRODUCTION. The aim of the study is to investigate the ability of an amniotic membrane implant combined with penetrating keratoplasty to reduce early and mid-term complications in complex cases such as penetrating burns, infective ulcers, keratitis, or corneal graft failure. MATERIALS AND METHODS. Fifty patients: 12 with keratitis, 24 with infective ulcers, 10 with penetrating trauma, and four with a history of corneal graft failure, were divided into two groups. The first group of 25 patients (Group A) underwent penetrating keratoplasty alone, while the second group of 25 patients (Group B) received penetrating keratoplasty associated with an amniotic membrane implant. Amniotic membrane implantation was performed in a 'patch modality', and the membrane was sewn to the graft with the epithelium/basement membrane side facing inwards. All patients were evaluated, respectively, 3, 15, 30, 90, and 180 days after surgery. At each visit a slit-lamp examination was performed together with corneal thickness and endothelial cell count assessment. All the data were subjected to statistical analysis with Student's t-test. RESULTS. At the slit-lamp examination in Group A 48% of patients showed Descemet folds at one and three months, respectively, while 80% of patients of Group B did not show any Descemet folds. In Group A we registered two cases of early graft failure and two cases of shallow anterior chamber, while none of these complications appeared in Group B. In Group A the average corneal thickness at 15, 30, 90, and 180 days post-operatively was, respectively, 695 ± 43 μm, 658 ± 31 μm, 588 ± 12 μm, and 518 ± 20 μm, while in Group B it was found to be, respectively, 667 ± 12 μm, 632 ± 17 μm, 562 ± 16 μm, and 516 ± 10 μm. Differences in corneal thickness between Group A and Group B were found to be statistically significant (p = 0.05). Endothelial cell count was in Group A 2582 c/mm2 at 15 days, 2500 c/mm2 at one month, 2335 c/mm2 at three months, and 2111 c/mm2 at six months, while the average count for Group B patients was 2607 c/mm2, 2503 c/mm2, 2299 c/mm2, and 2086 c/mm2, respectively. Differences in endothelial cell count between the two groups did not show any statistical significance (p > 0.05). CONCLUSIONS. Amniotic membrane implantation associated with penetrating keratoplasty reduces early and mid-term complications of corneal grafts in patients with high risk of failure. This positive effect may be due to the anti-inflammatory, neurotrophic, and anti-angiogenetic properties of the amniotic membrane. Longer observation and larger case series can be useful in evaluation of the functional outcome of grafts in these patients

Blindness and glaucoma: A multicenter data review from 7 academic eye clinics

Purpose To evaluate frequency, conversion rate, and risk factors for blindness in glaucoma patients treated in European Universities. Methods This multicenter retrospective study included 2402 consecutive patients with glaucoma in at least one eye. Medical charts were inspected and patients were divided into those blind and the remainder (''controls''). Blindness was defined as visual acuity-0.05 and/or visual field loss to less than 10°. Results Unilateral and bilateral blindness were respectively 11.0% and 1.6%at the beginning, and 15.5%and 3.6% at the end of the observation period (7.5±5.5 years, range:1-25 years)//conversion to blindness (at least unilateral) was 1.1%/year. 134 eyes (97 patients) developed blindness by POAG during the study. At the first access to study centre, they had mean deviation (MD) of -17.1±8.3 dB and treated intraocular pressure (IOP) of 17.1±6.6 mmHg. During follow-up the IOP decreased by 14%in these eyes but MD deteriorated by 1.1±3.5 dB/year, which was 5-fold higher than controls (0.2±1.6 dB/year). In a multivariate model, the best predictors for blindness by glaucoma were initial MD (p<0.001), initial IOP (p<0.001), older age at the beginning of follow-up (p<0.001), whereas final IOP was found to be protective (p<0.05). Conclusions In this series of patients, blindness occurred in about 20%. Blindness by glaucoma had 2 characteristics: late diagnosis and/or late referral, and progression of the disease despite in most cases IOP was within the range of normality and target IOP was achieved//it could be predicted by high initial MD, high initial IOP, and old age

La trabeculoplastica e l'iridoplastica - Caso clinico 11.2

Caso clinico in paziente iperteso oculare trattato prima con farmaci e successivamente con trabeculoplastica laser selettiv

Coinvolgimento oculare nella malattia di Behcet

PURPOSE: To assess the prevalence of ocular involvement in a cohort of patients with Behçet's disease (BD) who have been followed in the last twenty years and to compare any possible differences in the prevalence of ocular lesions according to the gender. METHODS: One hundred and ten patients were retrospectively studied. The males/females, ratio was 1.6:1, with a mean disease duration of 11±5 yrs. Their mean age was 42±9 years (min:18, max:77), while the mean age at disease onset was 30±4 years (min:13, max:58). Prevalence of ocular clinical features and therapeutic approach were retrospectively analysed in all patients. RESULTS: Prevalence of ocular ocular involvement was observed in 40% (18% males and 22% females; mean age at the onset 25,8±9 years). The mean time between the first initial symptoms of BD and the onset of eye lesions was 3±2 years; additionally unilateral ocular disease occurred in 17 patients (36% ), while the other cases (64%) experienced bilateral involvement. The number of episodes of ocular lesions was the following: 32% posterior uveitis, 27% anterior uveitis, while panuveitis developed in 17% subjects. Loss of vision occurred in both eyes in 1 case and in one eye in 3 patients. In 31 patients the disease course was recurrent (28 males, 3 females). Additionally, comparing the frequency of ocular lesions according to the gender, we observed that males were characterised by a higher prevalence of posterior uveitis (26/29 males versus 6/18 females, p< 0,0001) and retinal vasculitis (15/29 males versus 6/18 females, p< 0.01). CONCLUSIONS: In our cohort 40% of patients experienced inflammatory eye involvement, often within 3 years after the initial symptoms of disease. Panuveitis and retinal vasculitis seem more common in males characterised by a more frequent recurrent course

Ophthalmological evaluation in severely obese patients undergoing bariatric surgery: a pilot, monocentric, prospective, open-label study.

Abstract Background: There are known ophthalmologic alterations described in severely obese patients regarding the optic nerve head, the lens and the fovea. The aim of this study is to examine various ophthalmologic parameters in severely obese patients before and after gastric bypass surgery and to evaluate if there is a difference of the parameters studied related to the extent and timing of weight loss . Methods: Fifty-seven patients with a mean body mass index value of 43.5 Kg 3.5 Kg/m2 and a mean age of 46.2 years were prospective evaluated. All patients underwent a complete ophthalmological evaluation before, 3 months and one year after bariatric surgery. Visual acuity, intraocular pressure, central corneal thickness measurement, indirect fundus ophthalmoscopy with 90D Volk’s lens and optical coherence tomography of the fovea and of the optic nerve head were performed in all patients enrolled. Anthropometric parameters were also registered at baseline, 3 months and one year after gastric bypass surgery. Results: all the ophthalmologic parameters evaluated were within normal range at baseline and after gastric bypass surgery. At baseline blood pressure value were directly and significantly related with intraocular pressure values (p<0.05, R 0.35). Blood pressure, particularly systolic values, was significantly and inversely related with retinal nerve fiber layer thickness, particularly in the temporal sector (RE p<0.05 r-0.31; LE p<0.01 r -0.43). Moreover, minimum foveal thickness values were significantly and inversely related with body mass index (RE p<0.02 r-0.40; LE p<0.02 r -0.30) at baseline. Thirty-two patients underwent gastric bypass surgery and for all of them we have available data both at 3 months and after one year. A significant reduction of blood pressure and body mass index has been observed (p<0.05) both after three months and after one year (p<0,05). Moreover, regarding ophthalmologic parameters, the RNFL thickness increased significantly in our population in both eyes in the superior sector (p<0,005), and in the left eye also in the inferior and temporal sector (p<0,05). Conclusions: At baseline although all the ophthalmologic parameters were within normal limits, the inverse correlation between blood pressure and retinal nerve fiber layer thickness could explain the major susceptibility of obese patients to develop glaucomatous optic nerve head damage; and similarly the inverse correlation between body mass index and minimum foveal thickness value may explain a major susceptibility to develop maculopathy. After gastric bypass surgery, blood pressure values and body mass index significantly ameliorated and regarding ophthalmologic parameters there was a significant increase of retinal nerve fiber layer thickness in both eyes. So, the weight reduction and the consequent reduction of blood pressure value seems to influence positively ophthalmologic parameters. Certainly, additional data are needed to confirm our first impression