ABSTRACT
Purpose: To assess the efficacy and safety of adalimumab in elderly patients with noninfectious uveitis (NIU).Methods: An observational, retrospective, multicenter study was done. Changes in best-corrected visual acuity (BCVA), inflammatory activity parameters, central retinal thickness (CRT), and the occurrence of adverse events (AE) developed during follow-up were recorded.Results: A total of 82 eyes from 41 patients 60 years of age and older with noninfectious uveitis treated with adalimumab were included. A significant improvement in BCVA (71.5 to 75.4 letters, p = .001) and in CRT (311.1 µm to 265 µm, p = .001) was observed. Moreover, a significant decrease from baseline in the rate of patients with anterior chamber cell (ACC) >0+ (34.6% to 5.7%, p = <0.001) or vitreous haze>0+ (21.3% to 4.3%, p = .002) was determined. AEs were observed in 11 patients (26.8%).Conclusion: Adalimumab can be safe and efficacious for the treatment of NIU in patients 60 years of age and older.
Subject(s)
Adalimumab/therapeutic use , Tumor Necrosis Factor Inhibitors/therapeutic use , Uveitis/drug therapy , Adalimumab/adverse effects , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Tumor Necrosis Factor Inhibitors/adverse effects , Uveitis/physiopathology , Visual Acuity/physiologyABSTRACT
Objective: To describe the clinical and Anterior Segment Swept-Source Optical Coherence Tomography (AS-SS OCT) findings in Bilateral Acute Depigmentation of the Iris (BADI).Design: Retrospective descriptive study of three clinical cases.Results: Three women diagnosed with BADI shared a history of bacterial infections treated with moxifloxacin. The AS-SS OCT showed damage from the collarette to the root of the iris, without affecting the pupillary area. In the affected areas, the anterior edge had lost its homogeneous hyper-reflectivity. The stroma was thinned and showed a patchy and diffused hyper-reflectivity. The pigmentary epithelium appeared unaffected.Conclusions: AS-SS OCT findings, not previously described, locate the damage in BADI in the anterior edge and iridian stroma, areas which are rich in melanocytes and permeable to aqueous humor.
Subject(s)
Hypopigmentation/pathology , Iris Diseases/pathology , Iris/pathology , Pigment Epithelium of Eye/pathology , Tomography, Optical Coherence/methods , Acute Disease , Aged , Anterior Eye Segment/pathology , Female , Humans , Middle Aged , Young AdultABSTRACT
PURPOSE: Describing the utility of Polymerase Chain Reaction for Cytomegalovirus (CMV-PCR) in the diagnosis of suspected viral anterior uveitis (AU). PATIENTS AND METHODS: We analyzed aqueous humor (AH) CMV-PCR positivity and treatment modifications in 47 eyes of 46 patients with viral uveitis and its correlation with high intraocular pressure (HIOP), uveitis clinical characteristics and time intervals from samples to uveitis diagnosis and to relapse. RESULTS: CMV-PCR positive results occurred in 13 eyes (27.7%) of 12 patients. They were more frequent in HIOP eyes (34.2%, p = 0.047) and with Posner-Schlossman Syndrome (56.2%, p = 0.002). CMV-PCR positivity (p = 0.001) and HIOP (p = 0.038) increased the probability of treatment change. Although CMV-PCR positive results decreased over time (p = 0.002), they were not related to activity or proximity to inflammatory uveitis episode. CONCLUSION: HIOP AU eyes should be considered for CMV-PCR AH analysis due to possible treatment modifications.
Subject(s)
Aqueous Humor/virology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/genetics , DNA, Viral/analysis , Eye Infections, Viral/diagnosis , Polymerase Chain Reaction/methods , Uveitis, Anterior/diagnosis , Adult , Aged , Aged, 80 and over , Cytomegalovirus Infections/virology , Eye Infections, Viral/virology , Female , Humans , Male , Middle Aged , Retrospective Studies , Uveitis, Anterior/virology , Young AdultABSTRACT
OBJECTIVE: To describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis METHODS: Descriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy (PC) and the pre- and post-surgical visual acuity (VA), were analysed. RESULTS: In both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors (P = .002, OR 6.83), the surgical difficulties and complications (P = .001, OR 7.54) and postsurgical complications (P = .069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91% respectively of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P = .357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P = .001), neither the location nor the uveitis course influenced the PC rate. CONCLUSIONS: The consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation.
Subject(s)
Cataract/etiology , Phacoemulsification , Uveitis/complications , Acrylic Resins , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Hydrophobic and Hydrophilic Interactions , Intraoperative Complications/epidemiology , Lens Implantation, Intraocular , Lenses, Intraocular , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Objetivo: Describir los resultados de la facoemulsificación con implante de lente acrílica en cataratas de pacientes adultos con y sin uveítis. Métodos: Estudio comparativo descriptivo retrospectivo de 35 pacientes (45 ojos) con uveítis (grupo 1) y 38 (44 ojos) sin uveítis (grupo 2) intervenidos por el mismo cirujano, homogéneos en cuanto a sexo, técnica quirúrgica, tipo de lente implantada (hidrofóbica o hidrofílica) y seguimiento. Se recogen las características pre-quirúrgicas de riesgo, dificultades y complicaciones intra-quirúrgicas y posquirúrgicas, la fecha de capsulotomía posterior y la agudeza visual previa y posterior a la cirugía. Resultados: En ambos grupos la facoemulsificación coaxial se utilizó en el 75% de los ojos, MICS bimanual en el 20% y microcoaxial en el resto. Los factores de riesgo prequirúrgicos (p=0,002, OR 6,83), las dificultades y complicaciones intraquirúrgicas (p=0,001, OR 7,54) y posquirúrgicas (p=0,069, OR 3,42) fueron más frecuentes en el grupo 1. El 93 y 91% respectivamente de ojos ganaron 2 o más líneas de AV. Tras un seguimiento medio de 4,9 años en ambos grupos, el 22,7 y el 32% (log-rank p=0,357) necesitaron capsulotomía posterior (CP). Las lentes hidrofílicas precisaron, en ambos grupos, capsulotomía más temprana que las hidrofóbicas (log rank P=0,001), ni la localización ni el curso de la uveítis se relacionaron con la necesidad de CP. Conclusiones: Las secuelas características de la inflamación previa hacen que la cirugía de la catarata en pacientes con uveítis sea más dificultosa, pero con complicaciones postquirúrgicas, resultados visuales y necesidad de CP similares al de nuestros pacientes sin inflamación(AU)
Objective: To describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis Methods: Descriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy (PC) and the pre- and post-surgical visual acuity (VA), were analysed. Results: In both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors (P=.002, OR 6.83), the surgical difficulties and complications (P=.001, OR 7.54) and postsurgical complications (P=.069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91% respectively of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P=.357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P=.001), neither the location nor the uveitis course influenced the PC rate. Conclusions: The consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation(AU)
