Title of Presentation: Lucentis for Inflammatory Macular Edema (LIME): Interim Results
Author(s): Nisha Acharya, M.D., M.S., Kevin Hong, Salena Lee, OD.
Address: F.I. Proctor Foundation, 513 Parnassus Ave, San Francisco, CA 94143-0412
Phone: (415) 476-8131 Fax: (415) 476-0527 Email: nisha.acharya@ucsf.edu
Purpose: To report short-term results of intravitreal ranibizumab (IVR) injections for refractory macular edema (ME) associated with uveitis.
Methods: Prospective interventional case series of 7 eyes in 7 patients with refractory ME. IVR injections (0.05 mg/0.05 ml) were given monthly for 3 months. The primary outcome was mean change in best spectacle-corrected visual acuity (BSCVA) from baseline at 3 months. Secondary outcome measures included mean change in central retinal thickness (CRT) as measured by OCT from baseline at 3 months, and the incidence of ocular and non-ocular adverse events. Changes in BSCVA and CRT were analyzed using the Wilcoxon signed-rank test.
Results: The mean duration of uveitis and ME prior to study entry was 84 months (range 20 to 240) and 44 months (range 6 to 91), respectively. At baseline, the mean BSCVA was 49.9 letters (20/100), improving to 59.4 letters (20/63) at 3 months. The mean CRT at baseline was 555 m, improving to 215 m at 3 months. The mean difference in BSCVA and CRT between baseline and 3 months was statistically significant for each outcome (P=0.04). No ocular or systemic side effects were noted. One patient had to drop out of the study after 1 injection due to non-medical circumstances.
Conclusions: In this first report of IVR in patients with refractory ME due to uveitis, short-term results indicate that IVR is safe and effective in decreasing ME and improving BSCVA.
Title of Presentation: A Dexamethasone Posterior-Segment Drug Delivery System for Treatment of Persistent Postoperative and Uveitic Macular Edema
Author(s): Michael R. Robinson, MD, Allergan, Inc., Irvine, CA, USA, Rubens Belfort, Jr. MD PhD, Federal University of Sao Paulo, Dept. of Ophthalmology; Paulista School of Medicine – Sao Paulo Hospital, Sao Paulo, Brazil, George A Williams MD, Beaumont Eye Institute, Royal Oak, MI, USA, Baruch D Kuppermann MD PhD, University of California, Irvine, Irvine, CA, USA
Mark S Blumenkranz MD, Stanford University, Stanford, CA, USA, Julia A Haller MD, Wills Eye Hospital, Philadelphia, PA, USA, David V Weinberg MD, Medical College of Wisconsin, Milwaukee, WI, USA, Scott M Whitcup MD, Allergan, Inc., Irvine, CA, USA
Address: Michael R. Robinson, MD, Allergan, Inc, 2525 Dupont Drive, Irvine, CA 92612_
Phone: 714-246-6415 Fax: 714-246-4002 E-mail: robinson_michael@allergan.com
Purpose: To evaluate the efficacy, safety and duration of action of an intravitreal bioerodible sustained dexamethasone drug delivery system (DEX-DDS) in patients with uveitic or postoperative macular edema. The DEX-DDS has a pharmacokinetic profile with vitreous levels of dexamethasone at 6 months.
Methods: The subset of patients with macular edema of ≥ 90 days duration due to uveitis or Irvine-Gass syndrome who had been enrolled in a larger, multicenter, randomized clinical trial were evaluated. They had received treatment with 700μg (n=14) or 350μg (n=13) DEX-DDS, or were observed (n=14). Outcome measures were recorded on days 1, 7, 30, 60, 90, and 180 following DEX-DDS implantation, and included the proportion of patients achieving a ≥10-letter or ≥15-letter improvement in best-corrected visual acuity, change in fluorescein angiographic leakage, and safety measures.
Results: At day 90, 14.3% (2/14) of patients in the observation group, 53.8% (7/13) of the 700μg group (P=.029), and 41.7% (5/12) of the 350μg DEX-DDS group (P=.117) had improved visual acuity by ≥10 letters. Improvement ≥15 letters was seen in 53.8% (7/13) of the 700μg group (P=.008), 16.7% (2/12) of the 350μg group (P=.449), and 7.1% (1/14) of the observation group. For many patients, acuity improvements persisted through day 180. DEX-DDS 700μg improved fluorescein leakage and was well tolerated.
Conclusions: In a population of patients with persistent inflammatory macular edema, DEX-DDS treatment produced improvements in visual acuity and fluorescein leakage, and was well tolerated. A limitation of this study was that, as a subset analysis of a larger Phase II trial, it had a small number of patients. However, these results were consistent with the larger study group.
Title of Presentation: Epidemiology and course of disease in childhood uveitis
Author(s) H. Nida Sen, MD, MHSc1 Janine A. Smith, MD1, Friederike Mackensen, MD3, Julie F. Leigh, MD2, Angela S. Watkins, MD3, Dmitry Pyatetsky, MD2, Howard. Tessler2, Robert B. Nussenblatt, MD, MPH1, James T. Rosenbaum, MD3, George F. Reed, PhD1, Susan Vitale, PhD, MHS1, Justine R. Smith, MBBS, PhD*3, Debra A. Goldstein, MD, FRCS(C) *2
Address: 1020 N Stafford St #301 Arlington, VA 22201
Phone: 202-232-0510 Fax: 202-741-2821 E-mailndamd@yahoo.com
Purpose: To describe the disease characteristics and visual outcome of pediatric uveitis.
Design: Retrospective longitudinal observation.
Participants: 527 pediatric uveitis patients from the National Eye Institute, University of Illinois at Chicago and Oregon Health Sciences University.
Methods: Retrospective review of clinical charts.
Main outcome measures: Demographics, uveitis disease characteristics, complications, treatments, and visual outcomes and were calculated at baseline and at 1, 3, 5 and 10 year time points.
Results: Patient population was 54 % female; 62.4% White, 12.5% Black, 2.7% Asian, 2.1 % multiracial and 14.61% Hispanic. Median age at diagnosis was 9.4 years. The leading diagnoses were idiopathic uveitis (28.8%), juvenile idiopathic arthritis (20.9%), and pars planitis (17.1%). Insidious onset (58%) and persistent duration (75.3%) were most common. Anterior uveitis was predominant (44.6%). Complications were frequent, and cystoid macular edema (OR 2.94, p=0.006) and hypotony (OR 4.54, p=0.026) had the most significant visual impact. Ocular surgery was performed in 18.9% of patients. The prevalence of legal blindness was 9.23% at baseline, 6.52% at 1 year, 3.17% at 3 years, 15.15% at 5 years and 7.69% at 10 years. Posterior uveitis and panuveitis had more severe vision loss. Hispanic ethnicity was associated with a higher prevalence of infectious uveitis and vision loss at baseline.
Conclusions: The rate and spectrum of vision threatening complications of pediatric uveitis are significant. Prospective studies using standard outcome measures and including diverse populations are needed to identify children most at risk.
Title of Presentation: Posterior Uveal Cleft and Hypotony Complicating Insertion of a Fluocinolone Acetonide Implant
Author(s): Sirichai Pasadhika, MD, Justine R Smith, MBBS, PhD, Christina J Flaxel, MD.
Address: Casey Eye Institute, Oregon Health & Science University. 3375 SW Terwilliger Blvd, Portland, OR 97239
Phone: 503-494-5023 Fax: 503-494-6875 E-mail: pasadhik@ohsu.edu
Purpose: To describe posterior uveal cleft and chronic hypotony occurring in association with a Fluocinolone acetonide (FA) implant (Retisert®) that was successfully treated by vitrectomy, removal of the implant and cryotherapy.
Design: Interventional case report.
Methods: A 57-year-old female patient with idiopathic uveitis, well-controlled with cyclosporine, developed chronic hypotony with maculopathy after insertion of an FA implant. Visual acuity (VA) in affected eye was counting fingers, and intraocular pressure (IOP) was 0 mmHg. Wound leakage, cyclodialysis cleft and cyclitic membrane were excluded. Ultrasound biomicroscopy (UBM) demonstrated a posterior uveal cleft at the site of implant, which was presumed to have created a channel for passage of intraocular fluid to the suprachoroidal space. The patient was treated with pars plana vitrectomy, removal of the implant, cryotherapy at the implant site and intravitreal triamcinolone acetonide injection.
Results: The procedure was well tolerated. Intraoperative finding suggested incarceration of an implant. IOP was normalized 5 days after the surgery. Postoperative VA improved to 20/200 at 2 weeks after the surgery, and remained stable through 1 year of follow-up. Uveitis remains well-controlled with cyclosporine at 12 months after the procedure.
Conclusions: Posterior uveal cleft may cause hypotony as a complication of insertion of a FA implant. The UBM is a crucial investigation to establish the diagnosis, and to exclude other pathologies including cyclodialysis cleft and cyclitic membrane. It may fail to demonstrate incarceration of an implant, however. Proper surgical technique may prevent this complication.
Title of Presentation: The Uveitis subtype associated with Spondylarthropathies varies regarding to gender and the type of Spondylarthropathy involved
Authors: F. Mackensen, M.D. Becker, R. Max
Address: Interdisciplinary Uveitis Center, University of Heidelberg
Purpose: Inflammatory bowel disease (IBD) and Spondyarthropathies (SpA) are said to be associated with distinct types of Uveitis. We compared Uveitis subtypes in patients with IBD and SpA, as well as in different SpA subtypes.
Methods: We identified 162 patients with SpA (AMOR classification): 93 Ankylosing Spondylitis (AS), 43 with undifferenciated (u)Spa, 10 reactive Arthritis, 12 Psoriasis Arthropathy (PsA), and 5 enteropathy associated (eSpA) and their Uveitis (SUN classification) from our electronic database.
Results: Patients with AS were male (67%) and HLA-B27+ (84%) showing typical unilateral or alternating anterior Uveitis with sudden onset in 77%. Still, 23% (21) showed bilateral anterior Uveitis. In this subgroup females predominated with 55% . They were HLA-B27+ in 80%.
Patients with uSpA were male (60 %) and HLA-B27+ (82%), but only showed typical Uveitis in 58%. A higher number of other Uveitis subtypes was found: 27% showed bilateral anterior and 15% other Uveitis subtypes. Again there was a female predominance, without change in HLA-B27 positivity (79%).
A different pattern was found in the PsA cohort, which was female (58%) and HLA-B27 was infrequent. Here 25% of the patients had typical Uveitis, whereas 17% showed bilateral anterior and 58% other subtypes of Uveitis.
Patients with eSpA were female in 80%, and HLA B27 was less frequent (40%). None of the eSpA group had typical Uveitis, 80% a bilateral anterior and 20% other Uveitis subtypes.
Conclusion: The frequency of a “typical” Uveitis associated with SpA in our cohort varied from 77% to 0 %, decreasing from AS to eSpA. We saw a high number of other Uveitis subtypes, with a female predominance. Maybe women with SpA have a higher risk for atypical Uveitis.
Title of Presentation: Effect of resistant cytomegalovirus (CMV) on mortality among patients with AIDS and CMV retinitis.
Author(s): DA Jabs for the Cytomegalovirus Retinitis and Viral Resistance Study Group
Address:_Department of Ophthalmology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1183, New York, NY 10029
Phone: 212-241-6752 Fax:_212-241-5764 E-mail: douglas.jabs@mssm.edu
Background: Cytomegalovirus (CMV) infection in HIV-infected patients is associated with an increased rate of progression to AIDS, and CMV retinitis is associated with an increased mortality among patients with AIDS.
Methods: Two hundred sixty-six patients with AIDS and CMV retinitis were enrolled in a prospective cohort study and treated with either ganciclovir or foscarnet. These patients were evaluated for the occurrence of CMV resistant to either ganciclovir or foscarnet from specimens of blood or urine taken at regular and pre-specified intervals. The effect of resistant CMV on mortality was evaluated using a time-dependent Cox proportional hazard model.
Results: Median survival of the cohort was 12.6 months. In a multivariate model, resistant CMV was associated an increased risk for mortality (hazard ratio [HR] = 1.65, 95% CI = 1.04 – 2.48, P=0.033). Among the other risk factors tested, only time since AIDS diagnosis was significantly associated with an increased mortality (HR = 1.10/year since AIDS diagnosis, P=0.001).
Conclusions: Resistant CMV is associated with an increased mortality among patients with AIDS and CMV retinitis.
Title of Presentation: APMPPE with serous retinal detachment and papilitis – A rare clinical senario.
Author(s): ALOK SEN, PRADHNYA SEN, GUNJAN PRAKASH, BK JAIN
Address: SADGURU NETRA CHIKITSALAYA CHITRAKOOT, UTTAR PRADESH, INDIA
Phone: 09918659865 E-mail:acsen@rediffmail.com
ABSTRACT
APMPPE with serous retinal detachment and papilitis – A rare clinical senario.
AUTHORS: ALOK SEN, PRADHNYA SEN, GUNJAN PRAKASH, BK JAIN
We report a rare clinical manifestation of APMPPE presenting with profound visual loss, unilateral serous retinal detachment involving macula and papillitis. The patient recovered completely following treatment with systemic corticosteroids. Though APMPPE is usually self limiting and does not warrant treatment, we treated this patient with systemic steroids because of sight threatening involvement of posterior pole and optic disc. We would recommend use of systemic steroids in such atypical cases; however it would require larger study to substantiate our findings.
Title of Presentation: Evaluation of Dry Eye Patients for Presence of Underlying Sjögren’s Syndrome
Authors: Esen Karamursel Akpek1, MD; Alena Klimava, BS1; Jennifer E. Thorne, MD2, 3, PhD; Don Martin, MD4,5; Kaevalin Lekhanont, MD1; Ann Ostrovsky, MD1
Address: 1The Ocular Surface Diseases and Dry Eye Clinic, Division of Cornea and External Disease, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
2Division of Ocular Immunology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
3Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
4General Internal Medicine and 5Rheumatology Divisions, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
Phone: (410) 955 5494 Fax: (410) 614 2816 E-mail: esakpek@jhmi.edu
ABSTRACT
Purpose: To evaluate the rate of primary Sjögren’s syndrome (SS) in a cohort of patients with dry eye syndrome.
Methods: Medical records of patients with a primary diagnosis of dry eye syndrome (ICD code 375.15 or 370.33) were reviewed retrospectively. Patients with aqueous tear deficiency who had 2 or more visits to a single dry eye center, during a 2-year period (1/2004 to 1/2006) were considered.
Results: Two hundred and twenty patients with aqueous tear deficient dry eye syndrome were identified. A total of 57 (25.9 %) patients had an underlying rheumatic condition; 25 patients (11.4%) had rheumatoid arthritis and 24 (10.9%) had primary SS. Majority of the patients with rheumatoid arthritis (96%) carried the diagnosis at the time of presentation. Of all patients with primary Sjögren’s syndrome, 8 (33.3%) carried the diagnosis at the time of presentation. Twelve were diagnosed as a result of the initial evaluation. Among those only 8 (33.3%) tested SSA, SSB or ANA antibody positive. Four patients (20.8%) tested only ANA positive at a titer of <1/320, and required minor salivary gland biopsy for definitive diagnosis. Additional 4 patients (16.7%) were diagnosed during follow-up. These were the patients that initially tested negative for antibodies and eventually had minor salivary gland biopsy findings consistent with SS.
Conclusions: Primary SS appeared to be underdiagnosed in dry eye patients with aqueous tear deficiency and should be the focus of diagnostic evaluations. A minor salivary gland biopsy might be required for a definitive diagnosis in significant proportion of the patients with SS.