ABSTRACT
PURPOSE: To compare the efficacy of infliximab and adalimumab in patients with refractory uveitis-related macular edema (ME). METHODS: A retrospective study was conducted in all patients with refractory uveitis-related ME treated with infliximab or adalimumab in Pitié-Salpêtrière hospital between January 1, 2006 and January 1, 2016. All patients underwent a complete ophthalmologic examination, OCT and retinal angiography at baseline, and 6 (M6) and 24 months (M24) after treatment initiation. Main outcome was a decrease in central foveal thickness (CFT) on OCT. RESULTS: Twenty-five patients were included: 12 treated with adalimumab and 13 treated with infliximab. The median baseline CFT was 381 µm (Q1 = 254; Q3 = 470) in the adalimumab group and 469 µm (307; 539) in the infliximab group. At M6, 6/12 adalimumab-treated patients (50%) and 8/13 infliximab-treated patients (61%) were responders. The median CFT decrease from baseline was 61 µm (17-136) and 66 µm (-59-119) respectively at M6 and M24 in the adalimumab group versus 92 µm (9-165) and 52 µm (33-130) respectively at M6 and M24 in the infliximab group (all p > 0.05). CONCLUSION: No significant difference in efficacy was observed between infliximab and adalimumab at M6 and M24.
Subject(s)
Adalimumab/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Infliximab/therapeutic use , Macular Edema/drug therapy , Uveitis/drug therapy , Adult , Female , Fluorescein Angiography , Humans , Macular Edema/diagnosis , Macular Edema/physiopathology , Male , Middle Aged , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Uveitis/diagnosis , Uveitis/physiopathology , Visual Acuity/physiologyABSTRACT
Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).
Subject(s)
Practice Guidelines as Topic , Uveitis/therapy , Adrenal Cortex Hormones/therapeutic use , Antibodies, Monoclonal/therapeutic use , Biological Products/therapeutic use , Biological Therapy/methods , Expert Testimony , Humans , Immunosuppressive Agents/therapeutic use , Practice Guidelines as Topic/standards , Tumor Necrosis Factor-alpha/immunologyABSTRACT
The incidence of uveal melanoma, in particular that of the ciliary body, is very low in black people, including West Indians. When symptomatic, it manifests as decreased or impaired visual acuity and seldom, if ever, pain. We report a case of ciliary body melanoma that is of scientific interest for two reasons: 1) a West Indian melanoderm patient being affected, 2) presentation as a recurrent uveitis with a transient increase of intraocular pressure, and without any decline in visual acuity. We recommend that in any case of uveitis, black patients included, a ciliary body tumor should always be excluded by pupillary dilation.
Subject(s)
Ciliary Body/pathology , Melanoma/diagnosis , Uveal Neoplasms/diagnosis , Uveitis/diagnosis , Diagnosis, Differential , Female , Humans , Melanoma/complications , Melanoma/pathology , Middle Aged , Uveal Neoplasms/complications , Uveal Neoplasms/pathology , Uveitis/etiology , West IndiesSubject(s)
Chorioretinitis/diagnosis , Toxoplasma , Toxoplasmosis, Ocular/diagnosis , Toxoplasmosis, Ocular/etiology , Toxoplasmosis/complications , Acyclovir/therapeutic use , Adult , Alprazolam/administration & dosage , Antimalarials/therapeutic use , Aripiprazole/administration & dosage , Chorioretinitis/drug therapy , Chorioretinitis/parasitology , Humans , Immunocompetence , Male , Pyrimethamine/therapeutic use , Suicide, Attempted/prevention & control , Toxoplasma/isolation & purification , Toxoplasmosis/diagnosis , Toxoplasmosis/drug therapy , Toxoplasmosis, Ocular/drug therapySubject(s)
Delayed Diagnosis/adverse effects , Eye Infections, Bacterial/diagnosis , Syphilis/diagnosis , Diagnosis, Differential , Diagnostic Errors/adverse effects , Disease Progression , Eye Infections, Bacterial/pathology , Female , Humans , Middle Aged , Neurosyphilis/diagnosis , Neurosyphilis/pathology , Paraneoplastic Syndromes, Ocular/diagnosis , Syphilis/pathology , Tomography, Optical CoherenceABSTRACT
Primary cutaneous mucinous carcinoma, a tumor of the sweat glands, is a rare tumor localized to the eyelid in 40% of cases. We report a case of a primary cutaneous mucinous carcinoma of the upper eyelid in a 53-year-old Caucasian male who appeared to have a chalazion. Histology showed rows and lobules of epithelial cells with discretely anisonucleotic nuclei and few mitotic figures scattered throughout the tumor cells, surrounded by a mucoid substance. Immunohistochemical analysis was cytokeratin 7 positive and cytokeratin 20 negative, and imaging and endoscopic screening were negative for metastasis, favoring the diagnosis of primary cutaneous mucinous carcinoma. Despite a high recurrence rate of about 35%, this type of tumor displays an indolent course, and metastatic spread is very rare.