From EyeWorld <Eye_World@xmr3.com>
The National Eye Institute has awarded a $1.2 million research grant to the University of Utah, Salt Lake City, and the University of Cincinnati, Ohio, to study the use of iontophoresis for ocular drug delivery.
The grant was announced in a press release from Aciont Inc. (Salt Lake City), a company that is attempting to commercialize iontophoresis for posterior segment ocular applications. Faculty members at the two universities have been collaborating with Aciont on developing ocular drug delivery applications, according to the press release.
In iontophoresis, an electrical current is used to transport ionized agents through tissue. This is the basis of Aciont’s Visulex trans-scleral drug delivery system. The company and its collaborators hope that the system will improve the treatment of posterior segment diseases such as age-related macular degeneration.
Wednesday, February 14, 2007
Saturday, February 3, 2007
The Prevalence of Sight-threatening Uveitis in Scotland.
- Br J Ophthalmol. 2006 Aug 17; [Epub ahead of print]
Aberdeen Royal Infirmary, United Kingdom.
AIM: To identify and quantify the prevalence of patients within Scotland with uveitis receiving systemic immunosuppression. METHODS: Anonymised data was prospectively collected on all patients with uveitis requiring systemic immunosuppression. Seven Health Boards participated over a four-month period between 1st August 2005 and 30th November 2005. RESULTS: 373 patients were identified. 55% were female. Mean age was 46.4 years (range 7-97 years). Using the data from the seven participating Health Boards an estimated Scottish prevalence of 9 per 100,000 was calculated. Prevalence varied between 2 and 9 per 100,000. Within NHS Grampian all patients with uveitis, whether sight-threatening or not, are followed up at a specialist clinic. Extrapolating this figure to the Scotland a prevalence of 25 per 100,000 would be expected. DISCUSSION: The data from NHS Grampian would suggest there is a significant shortfall in the number of patients identified by survey. If the "missing population" exists then where are they? Some may be receiving appropriate treatment at non-specialist clinics, while simple under-reporting may play a part. Greater concern is for those patients receiving inappropriate treatment for their uveitis, or for those within the community either oblivious to or in self- denial of their condition.
PMID: 16916876 [PubMed - as supplied by publisher]
Retention Time for Corticosteroid-Sparing Systemic Immunosuppressive Agents in Patients with Inflammatory Eye Disease.
- Br J Ophthalmol. 2006 Aug 16; [Epub ahead of print]
Oregon Health & Science University, United States.
BACKGROUND: Multiple immunosuppressive medications have been used to manage inflammatory eye disease when control cannot be achieved by corticosteroid alone. However, while clinical studies support effectiveness of the majority of these agents, comparative studies have not been undertaken. Retention time, a measure of the duration of therapy with any given drug, is a crude indicator of drug effectiveness and tolerability that facilitates such a comparison. We compared the retention time for corticosteroid-sparing immunosuppressive agents in patients attending our tertiary referral inflammatory eye disease clinic. METHODS: We reviewed clinical records of all patients attending an inflammatory eye disease clinic at the Casey Eye Institute over a one year period (2003). From these records we collected the following clinical data: age; gender; ocular diagnosis; and use of steroid- sparing systemic immunosuppression, including drug(s), duration of therapy and, if ceased, reason(s) for cessation. Cox regression analysis, adjusted for clustering, was used to compare other medications against methotrexate. RESULTS: 107 of 302 patients (35%) seen at the inflammatory eye disease clinic in 2003, had a total of 193 current or past prescriptions for systemic steroid- sparing immunosuppressive agents. The treated group, the majority of whom had uveitis, included 32 males and 75 females, aged 5 to 86 years. Most commonly prescribed were methotrexate (66 uses, 34%), cyclosporine (37 uses, 19%), azathioprine (26 uses, 13%), mycophenolate mofetil (22 uses, 11%), and cyclophosphamide (15 uses, 8%). Patients were retained statistically significantly less on cyclosporine (p = 0.004), azathioprine (p = 0.04), mycophenolate mofetil (p = 0.04), and cyclophosphamide (p = 0.0001) compared to methotrexate. Reasons for cessation included adverse events, lack of effectiveness, success/remission, cost and desire for fertility. CONCLUSIONS: In patients with inflammatory eye disease, methotrexate may offer a superior combination of effectiveness and tolerability over other commonly used corticosteroid-sparing immunosuppressive agents. In this study there was a two-fold risk of not being retained on azathioprine, mycophenolate mofetil and cyclosporine and a four-fold risk of not being retained on cyclophosphamide compared to methotrexate.
PMID: 16914474 [PubMed - as supplied by publisher]
Primary intraocular lymphoma: a review.
- Semin Ophthalmol. 2006 Jul-Sep;21(3):125-33.
Retina Specialists of Boston, Cambridge, MA, USA.
Primary intraocular lymphoma (PIOL) is a type of primary central nervous system lymphoma (PCNSL). It is the most common neoplastic masquerade syndrome involving the eye. Its protean ocular manifestations, plus in many cases the initial positive response to corticosteroid therapy for presumed uveitis, delay accurate diagnosis. A high index of suspicion is essential, followed by tissue biopsy with cytology and ancillary studies. Current treatment is based on chemotherapy featuring high-dose methotrexate and radiation therapy. Prognosis is poor due to CNS involvement, but newer therapies have had some success in prolonging survival.
PMID: 16912010 [PubMed - in process]
Ocular cicatricial pemphigoid, keratomycosis, and intravenous immunoglobulin therapy.
- Cornea. 2004 Nov;23(8):819-22.
Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
PURPOSE: To report the case of a patient developing fungal keratitis in the context of uncontrolled ocular cicatricial pemphigoid (OCP), which, despite intravenous immunoglobulin (IVIg) and other immunomodulatory therapy, progressed to end-stage pemphigoid, with corneal opacification, ankyloblepharon, and xerosis. Keratoprosthesis (KPro) restored functional vision for the patient. METHODS: A 39-year-old man presented with uncontrolled CP and corneal ulcer in the left eye. Conjunctival biopsy diagnosed OCP; corneal scraping and biopsy diagnosed the cause of the corneal ulcer. OCP was treated with systemic steroids, immunosuppressive drugs, and IVIg. Visual rehabilitation was accomplished with Ahmed valve and a type II Dohlman KPro. RESULTS: Immunohistology of the biopsied conjunctiva showed IgG at the epithelial basement membrane zone, confirming the clinical diagnosis of OCP. Microbiologic studies of the corneal biopsy specimen were negative for Acanthamoeba and herpes but positive for Aspergillus niger. The patient's keratomycosis resolved with topical antifungal therapy. Treatment with Dapsone, intravenous-pulse steroid, oral cyclophosphamide, and intravenous immunoglobulin (IVIg) failed to control the OCP, with resultant complete conjunctivization of the cornea. Keratoprosthesis improved the patient's visual acuity from hand movements to 20/20. CONCLUSIONS: Patients with uncontrolled OCP are at increased risk of corneal infection. The difficulty in diagnosing keratomycosis and the relatively rare occurrence of OCP explain the uniqueness of our reported case. OCP may progress to "end-stage" disease despite therapy. Keratoprosthesis can restore vision in selected otherwise seemingly hopeless cases.
PMID: 15502484 [PubMed - indexed for MEDLINE]
Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison.
- Ophthalmology. 2002 Aug;109(8):1532-7.
Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA.
PURPOSE: To compare clinical characteristics and outcomes in patients with uveitis caused by herpes simplex virus (HSV) and varicella zoster virus (VZV). DESIGN: Retrospective comparative study. PARTICIPANTS: Forty patients with HSV uveitis and 24 patients with VZV uveitis. METHODS: A retrospective study of 40 patients with HSV and 24 patients with VZV uveitis was performed. The patients were followed between May 1987 and September 1999 (median follow-up time, 46 months). The diagnosis of HSV uveitis was made clinically and serologically, and the diagnosis of VZV uveitis was made clinically. MAIN OUTCOME MEASURES: Clinical presentation of the disease, ocular complications, visual acuity, surgical and medical treatments needed. RESULTS: Both populations were comparable for gender and age at disease onset. The course of the disease tended to be remitting and recurrent in HSV patients and chronic in VZV patients (P = 0.046). The most frequent ocular complication in both groups was secondary glaucoma (54% HSV, 38% VZV). Twenty-five percent of VZV patients developed posterior pole complications (cystoid macular edema, epiretinal membrane, papillitis, retinal fibrosis, and detachment) compared with 8% of HSV patients (P = 0.069). Treatment modalities selected were generally similar in the two groups, although periocular and systemic steroids were required more frequently in HSV patients (60% versus 25%; P = 0.01). Surgical procedures were required with similar frequency in both populations. The percentage of eyes that were legally blind at end of follow-up was also comparable (HSV, 20%; VZV, 21%). The visual outcome was similar in the studied populations. CONCLUSIONS: This study represents the only direct comparison of HSV and VZV uveitis patients reported in the literature. HSV patients were more likely to be treated with periocular and systemic steroids, and VZV patients were more likely to develop posterior pole complications (a finding of borderline significance). Other parameters evaluated in this study were not statistically different in the two patient groups.
PMID: 12153807 [PubMed - indexed for MEDLINE]
Efficacy and safety of chlorambucil in intractable noninfectious uveitis: the Massachusetts Eye and Ear Infirmary experience.
- Ophthalmology. 2002 Jan;109(1):137-42.
Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
PURPOSE: To report our experience with the use of chlorambucil for otherwise treatment-resistant uveitis and to assess its safety and efficacy. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Twenty-eight patients with intractable noninfectious uveitis. METHODS: We reviewed the records of 28 patients (56 eyes) with chronic noninfectious uveitis who were treated with chlorambucil from 1987 to 2000. Diagnoses included Adamantiades-Behcet's disease (ABD) (7 patients), juvenile rheumatoid arthritis (JRA)-associated uveitis (10 patients), pars planitis (2 patients), sympathetic ophthalmia (1 patient), idiopathic uveitis (6 patients), Crohn's disease (1 patient), and HLA-B27-associated uveitis (1 patient). All patients were refractory to other immunomodulatory therapy and systemic steroids. The median duration of treatment with chlorambucil was 12 months (range, 4-50 months), whereas the median daily dosage was 8 mg (range, 4-22 mg). Patients were followed for a median follow-up period of 46 months (range, 4-166 months) after chlorambucil treatment was begun and continued to be followed for relapse after cessation of therapy. MAIN OUTCOME MEASURES: Visual outcome, response to treatment, treatment-related side effects, drug dosage, previous and final treatment, discontinuation of systemic corticosteroids. RESULTS: Chlorambucil was discontinued in seven patients because of side effects: two females had temporary amenorrhea develop, two patients had unacceptable gastrointestinal intolerance, one patient had infection, and 2 patients had progressive leukopenia. Nineteen patients (68%) showed positive clinical response to the treatment, four (14%) initially responded then relapsed after discontinuation of the drug, three patients with ABD had improvement of ocular disease but worsening of systemic symptoms, and two had persistent inflammation. Visual acuity was improved in 24 eyes (43%), stable in 22 (39%), and worsened in 10 eyes (18%). Systemic prednisone was successfully discontinued in 19 of the 28 patients (68%), and 14 patients were free of inflammation at the end of follow-up without any systemic medication. CONCLUSIONS: Chlorambucil can be a safe and effective alternative for preserving vision in patients with otherwise treatment resistant uveitis.
PMID: 11772593 [PubMed - indexed for MEDLINE]
The effect of treatment and its related side effects in patients with severe ocular cicatricial pemphigoid.
- Ophthalmology. 2002 Jan;109(1):111-8.
Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA.
PURPOSE: To determine the clinical outcome of patients with ocular-cicatricial pemphigoid (OCP) and the influence of systemic treatment on clinical progression. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Sixty-one patients with biopsy-proven OCP. METHODS: Patients with documented disease progression treated with chemotherapy and/or corticosteroids were followed between 1985 and 2000. The parameters evaluated were ocular stage at presentation, visual acuity, ocular complications, disease progression, control of ocular inflammation, and presence of extraocular involvement. Systemic treatment and related side effects were analyzed. MAIN OUTCOME MEASURES: Visual acuity, ocular complications, extraocular involvement, disease progression, clinical outcome, systemic treatment, and related side effects. RESULTS: Sixty-one patients (32 female; 29 male) with a mean age of 67 years were studied. Extraocular involvement was present in 50% of patients. Sixty percent of eyes were initially seen with stage III (advanced cicatrizing) disease at first evaluation. Seven percent of involved eyes at first visit and 21% at the end of follow-up were legally blind. The most common ocular complications encountered were dry eye, corneal abnormalities, and glaucoma. Dapsone was the most commonly used drug (51 patients), followed by methotrexate (24 patients), azathioprine (23 patients), and cyclophosphamide (15 patients); prednisone, always given as adjunctive treatment, was used in 17 patients. Control of ocular inflammation (total or partial) was achieved in 90% of patients, but 46% of them needed continuation of systemic treatment to avoid disease recurrences, and 10% progressed despite different drugs used. Two agents were required in 32% of cases to control disease activity. The most common treatment-related side effects were hematologic complications (n = 34) followed by gastrointestinal (n = 17), cardiovascular (n = 15), and urinary complications (n = 11). Dapsone was responsible for the greatest number of side effects (n = 43); methotrexate caused the least trouble (n = 6). Corticosteroid-related complications (n = 34) were mostly cardiovascular and endocrinologic. CONCLUSIONS: Ocular-cicatricial pemphigoid is an autoimmune disease that, untreated, progresses to conjunctival scarring and blindness; systemic immunosuppression is required to control it. Long-term systemic treatment and more than one drug are frequently necessary to avoid recurrences, exposing elderly patients to a higher risk of drug toxicity. The most frequently encountered treatment-related side effects were anemia, leukopenia, liver toxicity, and hypertension.
PMID: 11772589 [PubMed - indexed for MEDLINE]
Eye involvement in autoimmune blistering diseases.
Clin Dermatol. 2001 Nov-Dec;19(6):742-9. Review. No abstract available.
Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. Tonyekong@aol.com
PMID: 11705684 [PubMed - indexed for MEDLINE]
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