Vitamin D deficiency and non-infectious uveitis:A systematic review and Meta-analysis

Background: Vitamin D plays a critical role in immunomodulation, and its deficiency is implicated in the pathogenesis of several autoimmune diseases. Nevertheless, its relationship with non-infectious uveitis (NIU), an inflammatory ocular disorder, remains inconclusive. Methods:A systematic search was conducted in three databases from database inception until May 8, 2023, to investigate the potential relationship between vitamin D deficiency and NIU. We included observational studies reporting the measurement of vitamin D levels in patients with NIU and healthy controls without restriction of language or date of publication. Three pairs of authors independently screened the title and abstracts for potential eligibility and then in full text. A third author resolved disagreements. Three pairs of independent reviewers abstracted the data from the fully reviewed records and evaluated the risk of bias. We followed The MOOSE and PRISMA guidelines. Random effects meta-analyses were used for primary analysis. Studies not included in the meta-analysis were summarized descriptively. This review was registered in PROSPERO: CRD42022308105. Findings: Of 933 records screened, 11 studies were included, and five were meta-analyzed, encompassing 354 cases and 5728 controls (mean participant age ranging from 7.1 to 58.9 years). Patients with vitamin D deficiency exhibited an Odds Ratio of 2.04 (95% CI = 1.55–2.68, P &lt; 0.00001) for developing NIU compared to controls. Overall, potential sources of bias were low across most studies. Interpretation: Our findings suggest that vitamin D may play an essential role in the pathophysiology of NIU. While the included studies demonstrated generally low potential bias, additional rigorous prospective studies are necessary to confirm these findings and further elucidate the underlying mechanisms involved. Vitamin D supplementation could represent a possible therapeutic strategy for preventing or managing NIU if substantiated. Clinicians should consider screening for and addressing vitamin D deficiency in patients with or at risk for NIU.</p

Antiviral treatment for acute retinal necrosis:A systematic review and meta-analysis

Acute retinal necrosis is a progressive intraocular inflammatory syndrome characterized by diffuse necrotizing retinitis that can lead to a poor visual outcome, mainly from retinal detachment. The antiviral treatment approach for acute retinal necrosis varies as there are no established guidelines. We summarize the outcomes of acute retinal necrosis with available antiviral treatments. Electronic searches were conducted in PubMed/MEDLINE, EMBASE, Scopus, and Google Scholar for interventional and observational studies. Meta-analysis was performed to evaluate the pooled proportion of the predefined selected outcomes. This study was registered in PROSPERO (CRD42022320987). Thirty-four studies with a total of 963 participants and 1,090 eyes were included in the final analysis. The estimated varicella-zoster virus and herpes simplex virus polymerase chain reaction-positive cases were 63% (95% CI: 55–71%) and 35% (95% CI: 28–42%), respectively. The 3 main antiviral treatment approaches identified were oral antivirals alone, intravenous antivirals alone, and a combination of systemic (oral or intravenous) and intravitreal antivirals. The overall pooled estimated proportions of visual acuity improvement, recurrence, and retinal detachment were 37% (95% CI: 27–47%), 14% (95% CI: 8–21%), and 43% (95% CI: 38–50%), respectively. Patients treated with systemic and intravitreal antivirals showed a trend towards better visual outcomes than those treated with systemic antivirals (oral or intravenous) alone, even though this analysis was not statistically significant (test for subgroup differences P = 0.83).</p

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Effects of the COVID-19 pandemic on the treatment and follow-up of patients with uveitis before and after March 2020 in an ophthalmological center in Bogota, Colombia

Introducción: La uveítis es una causa común de discapacidad visual significativa. Según diferentes estudios tiene una incidencia estimada de 17 a 52 por 100.000 habitantes por año y una prevalencia estimada de 38 a 714 casos por 100.000 habitantes. Puede asociarse a enfermedades sistémicas autoinmunes e infecciosas, requiriendo un abordaje interdisciplinario y un seguimiento estrecho para evitar complicaciones asociadas. El confinamiento derivado de la pandemia por SARS-CoV-2 (COVID-19) representó un desafío para el manejo y seguimiento de pacientes con uveítis a nivel mundial. Objetivo: Identificar el efecto que tuvo la pandemia de COVID-19 en el tratamiento y seguimiento de pacientes con uveítis en un centro oftalmológico de Bogotá, Colombia. Métodos: Estudio observacional de corte transversal, en el que se recopiló información de las historias clínicas de los pacientes de un centro de oftalmología de Bogotá, Colombia. Se obtuvo el consentimiento informado previo a la aplicación de una encuesta telefónica para la recolección de datos. Los pacientes se clasificaron en 2 grupos: Con seguimiento pospandemia (Wf) y sin seguimiento pospandemia (Nf). Se realizaron análisis estadísticos univariados y bivariados con el sistema JAMOVI 2.2.5 según las características de las variables. Resultados: Sesenta y tres pacientes fueron incluidos en el estudio. Se documentó cambio de tratamiento en el 40,7% (Wf) y el 44% (Nf) de los pacientes y se informó continuación del seguimiento de uveítis en el 70,9% (Wf) y el 61,1% (Nf) de los pacientes. La inflamación intraocular prepandemia se relacionó con una mayor percepción de dificultad en el seguimiento por parte del especialista en úvea (p: 0,049). El 50% de los pacientes con inflamación intraocular durante la evaluación prepandemia persistió con inflamación en la evaluación pospandemia (p: 0,052). No hubo ninguna diferencia estadísticamente significativa en las variables de tratamiento antes y después de la pandemia. Conclusión: La pandemia de COVID-19 representó un desafío para los pacientes con uveítis y los médicos en cuanto al tratamiento y seguimiento. Hay poca información en la literatura que retrate el impacto de la pandemia en los pacientes con uveítis. Se requieren más estudios para mejorar las estrategias de acceso y seguimiento de nuestros pacientes, incluso en condiciones donde la asistencia se ve afectada.Background: Uveitis is a common cause of significant visual impairment. According to different studies, it has an estimated incidence of 17 to 52 per 100,000 inhabitants per year and an estimated prevalence of 38 to 714 cases per 100,000 inhabitants. It can be associated with autoimmune and infectious systemic diseases, requiring an interdisciplinary approach and close follow-up to avoid associated complications. The lockdown derived from the SARS-CoV-2 (COVID-19) pandemic represented a challenge for managing and following up patients with uveitis worldwide. Objective: To identify the effect that the COVID-19 pandemic had on the treatment and follow-up of patients with uveitis in an ophthalmological center in Bogota, Colombia. Methods: This is a cross-sectional observational study, in which information was collected from the patient's medical records from an ophthalmology center in Bogotá, Colombia. Informed consent was previously obtained before applying a phone survey to gather data. Patients were classified into 2 groups: With post-pandemic follow-up (Wf) and without post-pandemic follow-up (Nf). Univariate and bivariate statistical analyses were performed with the JAMOVI 2.2.5 system according to the variables’ characteristics. Results: Sixty-three patients were included in the study. Change in the treatment was documented in 40.7% (Wf) and 44% (Nf) of patients and continuation of the uveitis follow-up was reported in 70.9% (Wf) and 61.1% (Nf) of the patients. Pre-pandemic intraocular inflammation was related to a greater difficulty perception in follow-up by the uvea specialist (p: 0.049). Fifty percent of the patients with intraocular inflammation during the pre-pandemic evaluation persisted with inflammation in the post-pandemic evaluation (p: 0.052). There was not any statistically significant difference in treatment variables before and after the pandemic. Conclusion: The COVID-19 pandemic represented a challenge for patients with uveitis and physicians in terms of treatment and follow-up. There is little information in the literature that portrays the impact of the pandemic on uveitis patients. More studies are required to improve our patients' access and follow-up strategies, even in conditions where attendance is affected

Ophthalmic manifestations in children with Down Syndrome in Bogotá, Colombia

Abstract Background To describe the ocular features of a cohort of children with Down Syndrome (DS) in Bogotá, Colombia. Methods We performed a cross-sectional study, evaluating 67 children with DS. A pediatric ophthalmologist performed a complete optometric and ophthalmological evaluation of each child, including visual acuity, ocular alignment, external eye examination, biomicroscopy, auto-refractometry, retinoscope in cycloplegia, and fundus examination. Results were reported as frequency distribution tables with percentages for categorical variables and means and standard deviation or median and interquartile ranges for continuous variables, according to their distribution. We used the Chi-square test or Fisher’s exact test for categorical variables and ANOVA or Kruskal–Wallis for continuous variables when indicated. Results A total of 134 eyes from 67 children were evaluated. Males represented 50.7%. The children’s age ranged from 8–16 years, with a mean of 12.3 (SD 2.30). The most frequent refractive diagnosis per eye was hyperopia (47%), followed by myopia (32.1%) and mixed astigmatism (18.7%). The most frequent ocular manifestations were oblique fissure (89.6%), followed by amblyopia (54.5%) and lens opacity (39.4%). Female sex was associated with strabismus (P = 0.009) and amblyopia (P = 0.048). Conclusion Our cohort had a high prevalence of disregarded ophthalmological manifestations. Some of these manifestations, such as amblyopia, can be irreversible and severely affect the neurodevelopment of DS children. Therefore, ophthalmologists and optometrists should be aware of the visual and ocular affection of children with DS to assess and provide appropriate management. This awareness could improve rehabilitation outcomes for these children

Early detection of optic nerve head changes using optical coherence tomography after using mesenchymal stromal cells as intravitreal therapy in rabbit models of ocular hypertension

Background and Aim: Stem cell therapy is considered a promising treatment for several neurodegenerative diseases. However, there are very few studies on the use of this therapy in glaucoma models. By detecting the changes produced by glaucoma early, cell therapy could help prevent the events that lead to blindness. In this study, early changes in the optic nerve head (ONH) as detected by optical coherence tomography (OCT) after the application of human Wharton’s jelly-derived mesenchymal stromal cells (hWJ-MSCs) in an experimental model of ocular hypertension (OH) were evaluated. Materials and Methods: Fifteen New Zealand rabbits were randomly divided into the following three groups: G1: OH, G2: hWJ-MSCs, and G3: OH + hWJ-MSCs. An OH model was constructed, and the intraocular pressure (IOP) was measured regularly. At week 7, 105/100 μL hWJ-MSCs were intravitreally injected. Retinography and OCT were used to evaluate structural changes in ONH. Results: IOP increased significantly in G1 and G3 from week 3 onward. Retinography revealed more significant optic nerve changes, that is, papillary asymmetry suggestive of optic nerve excavation, vascular alterations, and irregular hypopigmentation peripheral to the optic disk margin, in G1 compared with G3. OH locates the hWJ-MSCs solution in the vitreous in front of the optic nerve. OCT revealed retinal nerve fiber layer (RNFL) reduction in all groups, reduced optic cup volume in G2 and G3 between weeks 1 and 9, and significant ganglion cell layer thickness reduction in G1 and a slight increase in G3. Conclusion: Intravitreal hWJ-MSCs injection produced changes in optic cup volume, which were detected early on by OCT; however, RNFL could not be restored in this OH model

Colombian Ocular Diseases Epidemiology Study (CODES): incidence and sociodemographic characterisation of keratoconus between 2015 and 2020

Objective To estimate the incidence and describe the demographic characteristics of keratoconus (KC) in Colombia using national health registry data between January 1st 2015 and December 31th 2020.Methods and analysis We conducted a nationwide, population-based study using the Integrated Social Protection Information System from the Colombian Ministry of Health, the unique official database in the country. We used the International Classification of Diseases code for KC (H186) to identify the number of new cases of KC and estimate the incidence rates both overall and according to age and sex. We made a standard morbidity ratio map to graph Colombia’s morbidity risk of KC onset.Results Of 50 372 424 subjects, 21 710 had KC between 2015 and 2020. However, due to the COVID-19 pandemic, all the incidence rates of this study were based on the 18 419 reported until 2019. The incidence rate in the general population was 10.36 (95% CI 10.08 to 10.64) per 100 000 inhabitants. The incidence peak among males was in their early 20s and females in their late 20s. The overall male to female incidence rate ratio was 1.60. Regarding the distribution of the disease, most cases were reported in Bogotá (48.64%), Antioquia (14.04%) and Cundinamarca (10.38%).Conclusion We performed the first nationwide, population-based study of KC in Latin America, finding distribution patterns similar to those reported in the literature. This study provides valuable information on the epidemiology of KC in Colombia, which is helpful in the development of policies for the diagnosis, prevention and treatment of the disease

Viral Anterior Uveitis:A Practical and Comprehensive Review of Diagnosis and Treatment

Anterior uveitis is the most common type of uveitis worldwide. The etiologies of anterior uveitis can be divided into infectious and non-infectious (idiopathic, autoimmune, autoinflammatory, trauma, and others). The viral pathogens most commonly associated with infectious anterior uveitis include Herpes Simplex Virus, Varicella-Zoster Virus, Cytomegalovirus, and Rubella Virus. Other emerging causes of viral anterior uveitis are West Nile Virus, Human-Immunodeficiency Virus, Epstein-Barr Virus, Parechovirus, Dengue Virus, Chikungunya Virus, and Human Herpesvirus type 6,7, and 8. Early recognition allows prompt management and mitigates its potential ocular complications. This article provides an updated literature review of the epidemiology, clinical manifestations, diagnostic tools, and treatment options for viral anterior uveitis.</p

Anterior chamber inflammation grading methods:A critical review

Assessing anterior chamber (AC) inflammation is highly subjective and challenging. Although various grading systems attempt to offer objectivity and standardization, the clinical assessment has high interobserver variability. Traditional techniques, such as laser flare meter and fluorophotometry, are not widely used since they are time-consuming. With the development of optical coherence tomography with high sensitivity, direct imaging offers an excellent alternative to objectively assess inflammation with the potential for automated analysis. We describe various AC inflammation grading methods and discuss their utility, advantages, and disadvantages.</p

Immunogenicity of Adalimumab in Patients with Non-Infectious- Uveitis: Systematic Review and Meta-Analysis

To review the prevalence, incidence, and risk factors for developing anti-drug antibodies (AAA) in patients with non-infectious uveitis (NIU) treated with Adalimumab (ADA). A systematic literature search was performed on PubMed, EMBASE, Virtual Health Library, Cochrane, and medRxiv. Meta-analysis was performed using random effects. Nine out of 2,373 studies were included. The prevalence of AAA in NIU patients treated with ADA was 9% (95% CI: 2% to 37%, I2 = 95% with a P2 = 0%). Several factors have been associated with AAA generation in NIU patients, including the non-use of concomitant immunosuppressants, presence of autoimmune systemic disease, female gender, etc. This study showed that AAA prevalence is higher in real-life scenarios compared to clinical trials. Further research is needed to elucidate the factors that trigger AAA generation in NIU patients.</p