Dupilumab-associated ocular surface disease: An interdisciplinary decision framework for prescribers in the Australian setting.

BACKGROUND/OBJECTIVES: Dupilumab-associated ocular surface disease (DAOSD) is of particular relevance in patients with atopic dermatitis (AD). Guidance on DAOSD assessment and management in the Australian setting is needed to reduce its impact and minimise disruption to treatment. METHODS: A systematic review of the literature was undertaken to identify data pertaining to the incidence, pathophysiology, risk factors and management of DAOSD. A critical review of this literature was used to inform a decision framework for dupilumab-prescribers and develop a graded severity scoring tool to guide appropriate management options. RESULTS: DAOSD typically emerges within 4 months of commencing dupilumab and the occurrence of new events diminishes over time. The reported incidence varies widely depending on the nature and source of the data: 8.6-22.1% (clinical trials programme), 0.5-70% (real-world data; differences in study size, duration of follow-up, ophthalmologist intervention, use of prophylaxis). Occurrence increases with AD severity and in patients with prior history of ocular disease; pathophysiology is still to be fully characterised. Management options have evolved over time and include lubricants/artificial tears, corticosteroids, calcineurin inhibitors, antihistamines, anti-inflammatory agents and antimicrobial agents. Current therapies aim to resolve symptoms or reduce severity to levels sufficiently tolerable to enable continuation of dupilumab therapy. CONCLUSIONS: Recommendations for DAOSD assessment and management include identification of high-risk patients, vigilance for red flags (keratoconus, herpetic and bacterial keratitis), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician and ophthalmologist referral for collaborative care of moderate-severe DAOSD and high-risk patients.

Development and surgical implantation of a vision prosthesis model into the ovine eye.

PURPOSE: A surgical technique was designed and tested to enable the implantation of an intraocular electrical retinal stimulator. METHOD: An inoperative perspex and silicone model was constructed to closely resemble the anticipated properties of the proposed visual prosthesis. The animal model chosen for these experiments was the sheep, because the dimensions of its ocular anatomy are approximately 30% larger than the human's, being otherwise grossly similar. The surgical method involved transplanar port-hole lensectomy and vitrectomy, insertion of the model implant through a limbal incision, and fixation of the perspex subunit close to the location of the native crystalline lens, by way of trans-pars plana fixation sutures. Adequate pre-retinal positioning of the implant's silicone extension was obtained by way of its inherent elastic recoil. RESULTS: The procedure was performed without macroscopic evidence of undue surgical trauma. CONCLUSION: Although further long-term experiments are required to fully assess the surgical procedure and biocompatibility of the implant, intraoperative assessment and postmortem computed tomographic imaging of the globe has confirmed the successful intraocular positioning and fixation of the implant.