Active Uveitis Research Articles

Adalimumab for the Treatment of Adults With Non-Infectious Uveitis


 Four systematic reviews (SRs) and 1 economic evaluation were identified regarding the clinical effectiveness (including safety) and cost-effectiveness of adalimumab in adults with non-infectious uveitis.
 In adults with active non-infectious uveitis (VISUAL I), adalimumab significantly lowered the risk of treatment failure and significantly improved changes in best-corrected visual acuity, anterior chamber cell grade, and vitreous haze grade. Additionally, the number and rate of adverse events and serious adverse events were greater in the adalimumab group compared to the placebo group. Clinical effectiveness and safety findings from the Japanese sub study (VISUAL I Japan) and data from a randomized controlled trial of a younger adult population (ADUR) demonstrated that adalimumab may have no treatment effect.
 In adults with inactive non-infectious uveitis (VISUAL II), adalimumab significantly lowered risk of treatment failure; however, adalimumab may have no treatment effect on changes in best-corrected visual acuity, anterior chamber cell grade, and vitreous haze grade. Additionally, the number and rate of adverse events and serious adverse events were variable in the adalimumab versus placebo groups (e.g., number of adverse events was greater in the adalimumab group but the rate of adverse events was higher in the placebo groups). Clinical effectiveness and safety findings from the Japanese substudy (VISUAL II Japan) demonstrated that adalimumab may have no treatment effect.
 Considering both active and inactive non-infectious uveitis (VISUAL I, VISUAL I [Japan], VISUAL II, VISUAL II [Japan], and ADUR), change in vitreous haze grade improved significantly more in the adalimumab group than the control group.
 In the perspective of the health care system in the UK, adalimumab (plus systemic corticosteroid and immunosuppressant therapy) is not more cost-effective than systemic corticosteroid and immunosuppressant use alone (modelled by placebo data) in adults with active and inactive non-infectious uveitis influencing the posterior segment (i.e., back of the eye).
 No evidence-based guidelines regarding the use of adalimumab for the treatment of adults with non-infectious uveitis were identified.

Outcome of cataract surgery in pediatric uveitis (experience at King Khalid Eye Specialist Hospital).

BACKGROUND:Cataract is a major complication of uveitis in children that requires timely management to restore good vision and prevent amblyopia. In surgical management of uveitic pediatric cataracts, published literature has shown a variety of clinical factors affecting the final visual outcome. The aim of this study is to investigate and report the clinical outcomes of cataract surgery and contributing factors impacting such outcomes in children with uveitis.MATERIALS AND METHODS:A retrospective case series of all pediatric patients (<18 years) who were diagnosed with uveitis and had cataract surgery at a tertiary eye institutions, between January 2000 and October 2016. Outcomes measures include best-corrected visual acuity (BCVA) and postoperative complications. Success was defined as BCVA of ≥20/60. Factors related to successful outcome were analyzed.RESULTS:The study sample was comprised of 26 patients (39 eyes). The median postoperative follow-up was 6.4 years. At the last follow-up, only 2 eyes had active uveitis, 3 eyes were controlled without medications, and 34 eyes were controlled with systemic or topical medications. At the last follow-up, 64% of eyes had BCVA ≥20/60. Anterior uveitis and postoperative aphakia were two determinants, in statistically significant manner, found to be positively related to clinical success (P = 0.01 and 0.04, respectively). Etiology of uveitis and use of preoperative intravenous methylprednisolone were not related to the success of obtaining BCVA ≥20/60 (P = 0.5 and 0.99, respectively).CONCLUSIONS:Cataract surgery improves the visual function of children with clinically significant uveitic cataracts. In this study, we found diagnosis of anterior uveitis and postoperative aphakia to be associated with better final postoperative visual outcomes.

Intraocular Pressure Elevation After Posterior Subtenon Triamcinolone Acetonide Injection in Pediatric Non-Infectious Uveitis.

The objectives of the study were to evaluate non-infectious pediatric uveitis patients developing elevated intraocular pressure (IOP) and glaucoma following posterior subtenon triamcinolone acetonide (PSTA) injection. The data of 26 pediatric (<18 years) patients with active uveitis were retrospectively evaluated. Exclusion criteria were patients with a previous IOP >21 mmHg and previous subtenon or intraocular steroid injection. The IOP values of the patients before and after the PSTA injection and the treatments administered were recorded. PSTA injection was used in a total of 40 eyes. The mean IOP was 14.0±2.3 (12-19) mmHg before PSTA. The IOP was elevated (≥21 mmHg) in 19 eyes (48%) after PSTA with a mean IOP of 32.9±11.7 mmHg (22-55). The mean interval time to IOP elevation was 3.3±1.9 weeks (1-8). The IOP was controlled in 15 eyes (79%) with topical anti-glaucomatous and these patients were considered as having transient IOP elevation. Trabeculectomy with mitomycin C was required in 4 eyes (21%) in whom the IOP could not be controlled despite the use of maximum topical medication and oral acetazolamide at a mean duration of 9.7±3.6 months (4-19). Subtenon deposit excision was performed in 2 eyes (11%). The mean IOP at the last follow-up was 16.0±2.4 mmHg (12-20). In our study, an IOP elevation rate as high as 47% was found in pediatric non-infectious uveitis patients following only a single PSTA injection. Steroid-induced IOP elevation and resistant glaucoma can develop even after the first PSTA administration in pediatric uveitis. Filtration surgery and the excision of subtenon triamcinolone deposits, when present, are important in glaucoma management. The risk/benefit ratio must be carefully considered when administering steroid injections to children with uveitis.

Changes in Choroidal Vascularity Index (CVI) in Intermediate Uveitis.

PurposeTo investigate the longitudinal changes in choroidal vascularity index (CVI) in eyes with active and quiescent intermediate uveitis using enhanced depth imaging optical coherence tomography (EDI-OCT).MethodsEDI-OCT images of eyes with active and quiescent intermediate uveitis were retrospectively reviewed and binarized using ImageJ software. Choroidal parameters including CVI, total choroidal area (TCA), luminal area (LA), stromal area (SA), and subfoveal choroidal thickness (SCT) were measured and compared between baseline and follow-up visits among eyes with active and quiescent intermediate uveitis.ResultsThirty-eight eyes from 21 patients with active intermediate uveitis and 30 eyes from 17 patients with quiescent intermediate uveitis were included. CVI in eyes with active intermediate uveitis significantly increased from baseline (66.50% ± 3.40%) with resolution of inflammation on follow-up (68.82% ± 3.90%; P < 0.001). In eyes with quiescent intermediate uveitis at baseline eyes, CVI did not significantly change after follow-up (66.34% ± 3.19% to 66.25% ± 3.13%; P = 0.850).ConclusionsCVI significantly increased when active inflammation in intermediate uveitis resolved while CVI remained unchanged at follow-up in quiescent intermediate uveitis.Translational RelevanceCVI may be a useful noninvasive tool to monitor treatment response in intermediate uveitis. Our findings also highlight the involvement of choroidal vasculature in uveitic eyes without any clinical evidence of choroiditis.

Infection with SARS-CoV-2 causes flares in patients with juvenile idiopathic arthritis in remission or inactive disease on medication

BackgroundFlares of juvenile idiopathic arthritis (JIA) have been described in the context of various infections. Flares of rheumatic diseases in adults have been described following infection with SARS-CoV-2 in several cohorts. So far, the effect of infection with SARS-CoV-2 on the course of JIA is unknown.MethodsThe database of the German Center for Pediatric and Adolescent Rheumatology was searched for patients with confirmed infection with SARS-CoV-2 and subsequent disease flare, admitted from July 2020 until June 2021. cJADAS-27, ESR and C-reactive protein, as well as uveitis activity, medication at the time of flare and treatment of flare was extracted. Patient cases were described individually.ResultsOut of 988 patients admitted, five patients with remission off medication (n = 2) or inactive disease on medication (n = 3) were identified, with flare symptoms up to four weeks after infection with SARS-CoV-2.ConclusionsFlares can occur after infection with SARS-CoV-2 in patients with JIA in remission or inactive disease on medication. Treating physicians need to be aware of this fact, especially when counseling patients with rheumatic diseases about the respective dangers of COVID-19 and vaccination against SARS-CoV-2.

P057 Uveitis in enthesitis-related arthritis: what are the predictive factors?

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. Uveitis is its most common extra-articular manifestation [1]. It is a potentially sight-threatening condition with a considerable risk of morbidity. This study aimed to describe the prevalence and characteristics of JIA-related uveitis in enthesitis-related arthritis (ERA) patients. Methods We conducted a retrospective study including 40 patients with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR). All selected patients presented with ERA. A screening of uveitis was conducted in all patients. Clinical, radiologic and, biologic features of JIA were collected. We evaluated the association between these features and the presence of uveitis. Results The mean age of our patients was 24 years, with a sex ratio of 3. The mean age at the onset of JIA was 11 years. Upon screening, fifteen percent of the patients had active uveitis. Nine percent of the patients presented with an acute onset of JIA. Forty-six percent had initial spinal symptoms, while 26% presented with peripheral onset. Upon examination, 4% of the patients presented with monoarthritis, 20.4% with oligoarthritis and 34.8% with polyarthritis. Thirteen percent had enthesitis. Fifty-seven percent of the patients had coxitis. Sixty-eight percent had sacroiliitis. The mean CRP and ESR levels were respectively 16 mg/l and 34. Human leucocyte antigen (HLA) B27 screening came back positive in 11% of the cases. The mean BASDAI and BASFI levels were both at 4.7. The mean MASES was 0.44. Twenty percent of the patients received NSAIDs. Eleven percent received methotrexate, 18% salazopyrine and, 5.6% biologics. A significant association was established between the presence of uveitis and a polyarticular onset of JIA (P = 0.036). However, no significant associations were established with the sex of patients (P = 0.457), age of onset (P = 0.828), activity of the disease as evaluated by BASDAI (P = 0.40) and MASES (P = 0.87), inflammatory markers (CRP P = 0.946, and ESR P = 0.662), the use of NSAIDS (P = 1), methotrexate (P = 0.318), salazopyrine (P = 0.170) and biologics (P = 1). Conclusion In conclusion, uveitis associated with JIA is a serious and sight-threatening disease. Several factors associated with a more severe disease development have been identified [2–4]. Our study showed a significant association between the polyarticular onset of JIA and the occurrence of uveitis. Also, our study showed no significant association with male gender and HLA-B27 in children, unlike previous studies of spondyloarthritis conducted in adults [5–6]. We conclude that the screening of uveitis should be performed in all JIA patients, especially those presenting initially with polyarthritis.

The prophylactic effect of betaxolol 0.5% versus brimonidine 0.2% on IOP elevation after Nd:YAG laser posterior capsulotomy

ABSTRACT Clinical relevance Posterior capsule opacification is a common late complication of cataract surgery. Posterior capsule opening with Nd:YAG laser, which is the standard treatment, may cause transient elevation of intraocular pressure (IOP). Background To evaluate the efficacy of betaxolol 0.‌5% compared to brimonidine 0.2%, in prevention of intraocular pressure increase after Nd:YAG Laser posterior capsulotomy. Methods In a double masked randomised clinical trial, 38 eyes from 38 pseudophakic patients over 21 years of age who had significant posterior capsule opacification after phacoemulsification were randomly assigned to receive either betaxolol 0.‌5% (18 eyes) or brimonidine 0.‌2% (20 eyes) one hour before Nd:YAG Laser posterior capsulotomy.‌ Exclusion criteria were: glaucoma or history of glaucoma surgery, active uveitis, active ocular infection, pregnancy, unstable cardiovascular condition and severe asthma and lung diseases. Intraocular pressure was measured by Goldmann applanation tonometry, 1 hour before applying the laser and 4 hours after the laser application. Results There was no statistically significant difference between the two groups regarding the baseline mean IOP and the 4-hour post-laser mean IOP. There was a statistically significant decrease in the 4-hour post-laser mean IOP as compared to the baseline mean IOP in each group. The mean IOP change in the betaxolol group, was −2.39 ± 1.79 mm Hg and in the brimonidine group was −4.25 ± 2.20 mm Hg. The difference was statistically significant (P = 0.007). None of the patients experienced clinically significant IOP increase (≥5 mm Hg) in either group. Conclusion Use of a single topical dose of betaxolol 0.5% and brimonidine 0.2%, 1 hour before laser treatment, can prevent significant acute IOP increase after Nd:YAG laser posterior capsulotomy, and betaxolol may provide a new alternative for prophylactic use.

EFFECT OF HUMAN HERPES VIRUS REACTIVATION ON SYSTEMIC CYTOKINE PRODUCTION IN PATIENTS WITH BEHCET’S DISEASE AND UVEITIS

Behcet’s disease (BD) is a systemic autoinflammatory-autoimmune disease (chronic systemic vasculitis) of unknown etiology, almost 70% of patients develop uveitis. BD pathogenesis is complex, human herpesviruses (HHV) play an important role among infectious trigger factors. Ability of herpesviruses to modulate cytokine production and evade host’s immune response is known.Aim of the study was to assess the effect of Herpes simplex virus type 1, Herpes simplex virus type 2, Cytomegalovirus, Epstein-Barr virus on systemic levels of chemokines, pro- and anti-inflammatory cytokines in BD with and without uveitis. Serum samples were collected from 116 BD patients chronically infected with HHV and examined in ELISA-test for markers of HHV reactivation (IgG-antibodies to immediate early HSV antigens 1, 2 and CMV, early EBV antigen). Concentration of IL-1β, IFNγ, MCP-1, IL-2, IL-4, IL-5, IL-6, IL-8, IL-12p70, IL-13, IL-18, TNFα, GMCSF, Eotaxin, GRO-α, IP-10, MIP-1α, MIP-1β, SDF-1α, RANTES detected in multiplex analysis. TGF-β1, TGF-β2 were measured in ELISA-test. Depending on presence and activity of uveitis 3 groups of patients with BD were identified: group 1 – active uveitis, group 2 – remission of uveitis, group 3 – BD without ocular manifestations. After serological study 2 subgroups were highlighted in each group: a) patients with antibody markers of reactivation of at least one HHV, b) patients chronically infected with HHV, without serological signs of reactivation. Mean level and detection rate of cytokines and chemokines in patients with active uveitis (1a, 1b) and in remission (2a, 2b) were compared with patients without eye damage (3a, 3b). Chronic HHV infection (subgroup “b”) was compared with reactivation (subgroup “a”). A significant increase of MCP-1/ CCL2, MIP-1α/CCL3, MIP-1β/CCL4, RANTES/CCL5, IP-10, SDF-1α chemokines in serum, as well as IFNγ, TGF-β1, and TGF-β2 was observed in patients with uveitis (regardless of their activity) and HHV reactivation compared to patients without uveitis. Our data indicate that systemic production of cytokines and chemokines in BD patients and uveitis could be affected by the activity of chronic herpesvirus infections, and the greatest changes are related to chemokines.

Clinical effectiveness and safety of baricitinib for the treatment of juvenile idiopathic arthritis-associated uveitis or chronic anterior antinuclear antibody-positive uveitis: study protocol for an open-label, adalimumab active-controlled phase 3 clinical trial (JUVE-BRIGHT)

BackgroundJuvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease and the most common systemic disorder associated with uveitis in childhood. Uveitis is more common in JIA patients who are antinuclear antibody (ANA)-positive, have an early-onset disease, and have oligoarticular arthritis. JIA-associated uveitis (JIA-uveitis) is typically anterior, chronic, bilateral, nongranulomatous, and asymptomatic. Visual outcomes in JIA-uveitis have improved with current screening and treatment options; however, many patients fail to respond or do not achieve long-lasting remission. Baricitinib, an oral selective Janus kinase (JAK)1 and 2 inhibitor, may impact key cytokines implicated in the pathogenesis of JIA-uveitis or ANA-positive uveitis, representing a potential novel treatment option for disease management.MethodsThe multicenter, phase 3 trial will be conducted using an open-label Bayesian design. The study will enroll at least 20 and up to 40 patients aged 2 to <18 years with active JIA-uveitis or chronic ANA-positive uveitis without systemic features. At least 20 patients who have had an inadequate response or intolerance to methotrexate (MTX-IR), but not biologic disease-modifying antirheumatic drugs (bDMARDs), will be randomized (1:1) to open-label baricitinib or adalimumab. Approximately 20 additional patients who are MTX-IR or bDMARD inadequate responders will receive baricitinib treatment. Patients will be treated with once daily oral baricitinib at a fixed dose by age group (4 mg for patients aged ≥6 to <18 years and 2 mg for patients <6 years) or adalimumab (20 mg for patients weighing <30 kg and 40 mg for patients ≥30 kg) as a subcutaneous injection every 2 weeks. Treatment with stable background conventional synthetic DMARDs, low-dose corticosteroids, and/or nonsteroidal anti-inflammatory drugs is allowed. The primary endpoint is the proportion of patients with response at week 24. Patients may continue treatment for up to 5 years.DiscussionThis is the first pediatric clinical trial to assess the clinical effectiveness and safety of a JAK inhibitor in JIA-uveitis or chronic ANA-positive uveitis. A novel Bayesian design is used to assess the efficacy of baricitinib, including an adalimumab reference arm, in this small patient population with unmet medical need.Trial registrationEudraCT 2019-000119-10. Registered on January 4, 2019; NCT04088409. Registered on September 12, 2019

Adalimumab in patients with vision-threatening uveitis: real-world clinical experience

ObjectivesBiologics are rapidly emerging as an effective vision saving addition to systemic uveitis therapy. The aim of this multicentre retrospective study is to review the outcomes of a large group...

Role of Adalimumab Biosimilar in the Treatment of Non-Anterior Uveitis Associated with Behçet's Syndrome.

IntroductionTo evaluate the efficacy of SB5, an adalimumab biosimilar, in the management of Behçet’s syndrome (BS)-related uveitis.MethodsData from eight BS patients (16 eyes) with active non-anterior uveitis and/or systemic uncontrolled disease or performing non-medical switch to SB5 were retrospectively collected and analyzed.ResultsComplete control of uveitis was observed in all 16 eyes without relapses during follow-up. The number of relapses 12 months prior to SB5 initiation and at last follow-up was 100 and 0 per 100 patients/year, respectively (p = 0.010). At baseline, four eyes had active retinal vasculitis, whereas at 3 months and at last follow-up, retinal vasculitis had resolved in all of them (p = 0.018). Median visual acuity did not vary significantly between baseline and last follow-up visit (p = 0.109). No ocular complications emerged during treatment.ConclusionsSB5 is effective in the treatment of BS-related non-anterior uveitis. It reduces uveitis relapses and controls retinal vasculitis while allowing preservation of visual acuity.

Evaluation of systemic immune-inflammation index level as a novel marker for severity of noninfectious uveitis.

To evaluate the association of systemic immune-inflammation index (SII) levels, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) with severity of noninfectious uveitis. This retrospective study included 46 patients with noninfectious uveitis (uveitis group) and 46 age- and sex-matched healthy subjects (control group). The demographic and ocular findings, localization, and activity of uveitis were recorded at the time of onset evaluation. SII, NLR, and PLR levels of patients were compared between the groups. SII, NLR, and PLR levels were significantly higher in uveitis group when compared to control group (p < 0.001, p = 0.005, and p = 0.001, respectively). While SII and NLR were significantly higher in severe anterior uveitis than mild anterior uveitis (p = 0.006 and p = 0.021, respectively), only SII was significantly higher in severe posterior and panuveitis than mild ones (p = 0.038). SII, as a novel inflammation index, may be more significant tool than NLR and PLR in determining the severity of the uveitis. Furthermore, SII may be a potential useful index in clinical practice to follow-up and manage these patients by monitoring response to anti-inflammatory treatment modalities.

Golimumab in juvenile idiopathic arthritis-associated uveitis unresponsive to Adalimumab

ObjectiveTo assess the efficacy of golimumab (GLM) as a treatment option for juvenile idiopathic arthritis (JIA)-associated uveitis refractory to adalimumab (ADA).MethodsRetrospective single-centre study including patients with JIA receiving GLM for active uveitis after failing ADA. JIA- and uveitis-related data, including intraocular inflammation, best-corrected visual acuity, corticosteroid-sparing potential, and ocular complications were evaluated at start of GLM treatment, at 1 month and 3 months, and every 3 months thereafter during GLM administration. We further investigated the association of response to GLM with primary and secondary failure of ADA treatment.ResultsTen patients were studied, all female (17 affected eyes, mean age 14.3 + 6.7 yrs., mean follow-up 25.2 + 21.7 mos). Two patients were switched to GLM because of primary non-response to ADA. Eight were switched because of loss of response (LOR).In 5 of the latter LOR was associated with neutralizing anti-ADA-antibodies. Response to GLM was observed in all 8 patients with LOR, while the 2 patients with primary non-response to ADA also did not respond to GLM. Three of the 8 responders experienced LOR. At the end of follow-up 4 of the 5 remaining responders had achieved complete response. One had achieved partial response.ConclusionGLM is an efficacious therapeutic option in patients who experience LOR to ADA. Our data indicate that patients without primary response to ADA should be rather switched to a biologic agent with a different mode of action instead of further blocking the TNF-alpha pathway.

Rhegmatogenous retinal detachment presentation and surgery in uveitic eyes

Background/aimsTo explore the occurrence, uveitis activity, features, rate of proliferative vitreoretinopathy (PVR) and outcomes following rhegmatogenous retinal detachment (RRD) in a large tertiary referral uveitis service.MethodsRetrospective analysis of subjects attending...

Post-remission retinal microvascular and choroidal thickness changes in eyes with Behḉet's disease posterior uveitis: an OCTA longitudinal study.

To investigate the retinal microvascular and choroidal thickness changes in eyes with active Behḉet's disease posterior uveitis and post-remission. A prospective longitudinal observational analytic study where patients with active Behḉet's posterior uveitis (BU) were assessed by optical coherence tomography angiography (OCTA) and enhanced depth imaging OCT during activity and after remission, for retinal microvascular and subfoveal choroidal thickness (SFCT) changes. 26 eyes of 20 patients were included. With remission of active posterior uveitis, capillary density in both layers increased, only being significant in the superficial capillary plexus (SCP) 1.81 ± 3.57% (p = 0.025), while the foveal avascular zone (FAZ) area increased by 0.036 ± 0.069mm (p = 0.023). OCTA can be used to monitor the activity of Behḉet's posterior uveitis. Comparing the retinal microvascular changes during activity and after remission, the superficial capillary plexus was found to be more indicative of the activity status, while the deep capillary plexus and foveal avascular zone area-being more irreversible-are more useful as prognostic indicators. Subfoveal choroidal thickness, on the other hand, proved to be a consistent indictor of visual function; however, its change doesn't accurately reflect the activity status.

Role of MCP-1 and IL-8 in viral anterior uveitis, and contractility and fibrogenic activity of trabecular meshwork cells

The inflammatory chemokines, monocyte chemoattractant protein (MCP)-1 and IL-8, are produced by normal trabecular meshwork cells (TM) and elevated in the aqueous humor of primary open angle glaucoma (POAG) and hypertensive anterior uveitis associated with viral infection. However, their role in TM cells and aqueous humor outflow remains unclear. Here, we explored the possible involvement of MCP-1 and IL-8 in the physiology of TM cells in the context of aqueous outflow, and the viral anterior uveitis. We found that the stimulation of human TM cells with MCP-1 and IL-8 induced significant increase in the formation of actin stress fibers and focal adhesions, myosin light chain phosphorylation, and the contraction of TM cells. MCP-1 and IL-8 also demonstrated elevation of extracellular matrix proteins, and the migration of TM cells. When TM cells were infected with HSV-1 and CMV virus, there was a significant increase in cytoskeletal contraction and Rho-GTPase activation. Viral infection of TM cells revealed significantly increased expression of MCP-1 and IL-8. Taken together, these results indicate that MCP-1 and IL-8 induce TM cell contractibility, fibrogenic activity, and plasticity, which are presumed to increase resistance to aqueous outflow in viral anterior uveitis and POAG.

Incisional Infection Postphacoemulsification in a Chilean Flamingo (Phoenicopterus chilensis).

A 32-year-old captive female Chilean flamingo (Phoenicopterus chilensis) was diagnosed with a hypermature resorbed cataract in the right eye and a mature cataract with phacolytic uveitis in the left eye. No other systemic or neurologic physical abnormalities were detected. The patient was considered blind from bilateral cataracts, and with a reduced quality of life, surgery was indicated to remove the mature cataract in the left eye. Before surgery, the phacolytic uveitis was treated in the left eye for 1 week with topical and systemic anti-inflammatory and antibiotic medication. Unilateral phacoemulsification was performed on the left eye while under general anesthesia. The individual recovered uneventfully and regained vision in the left eye. The bird was returned to its enclosure 8 days after the surgical procedure. No abnormalities were noted in behavior or reintegration. Three weeks after the phacoemulsification was performed in the left eye, the individual presented with active uveitis, without vision loss, suspected secondary to incisional infection, which was managed with topical and systemic anti-inflammatory and antibiotic medication. At day 41 the patient was discharged with no disease conditions affecting the left eye, and the flamingo's vision was considered significantly improved compared with initial presentation. Phacoemulsification was safe and effective in removing the lens, resolving phacolytic uveitis, and restoring vision in spite of the postsurgical incisional infection. Some adaptations in the surgical approach and medical management are recommended on the basis of morphology, feeding habits, and behavior of this aquatic avian species to avoid postsurgical incisional infection and uveitis.

Factors of Excessive Proliferation after Trabeculectomy in Pediatric Uveitic Glaucoma

Objective: to study efficacy and factors of excessive proliferation after trabeculectomy (T) in pediatric uveitic glaucoma (UG).Patients and Methods. 102 children aged from 3 to 17.5 years (mean 124.5 ± 2.8 month) with uncontrolled on maximum topical hypotensive therapy open angle or combined (with peripheral anterior synechiae) form of UG underwent T (148 eyes, 180 operations). 76.1 % operations were performed with intraoperative 5-fluorouracil, 8.3 % — with mitomycin C, 6.1 % — with bioresorbable, 1.7 % — with collagen drainage, 7.8 % — without antimetabolites or drainages. Kaplan-Meier survival analysis was performed.Results. Overall absolute (without hypotensive therapy) success probabilities were 67 %, 46 %, 39 %, qualified success (with hypotensive therapy) — 93 %, 72 %, 54 % at 1, 3, 5 years after T respectively. Factors associated with failure were primary location of inflammation in anterior uvea, aphakic or pseudophakic eye, repeat T, bioresorbable drainage (vs. 5-fluorouracil), persistent inflammation after T. Age and uveitis activity at the moment of T, duration hypotensive therapy before primary T, postoperative complications (9.4 %), frequency of postoperative topical steroid had no significant influence on surgical success.Conclusion. T with intraoperative antimetabolites is effective, safe and nowadays may be recommended as first choice operation in pediatric open angle or combined UG.

Calcium-Phosphate Nanoparticles — a System for Drug Delivery to the Anterior Eye Chamber

Purpose: to prepare and characterize calcium-phosphate nanoparticles loaded with compounds of different nature: low-molecular inhibitor of angiotensin-converting enzyme lisinopril, and high-molecular enzyme superoxide dismutase 1. To estimate the possibility of enhancing the biological efficacy of these compounds via incorporation to the nanoparticles.Material and methods. To increase the stability of calcium-phosphate nanoparticles coating with β-D-cellobiose was used. The size, surface charge (ζ-potential) of the particles and efficacy of including of the selected compounds to the particles were measured. Comparative assessment of the efficacy of lisinopril solution and lisinopril in nanoparticles was made via the estimation of their ocular hypotensive effect in normotensive rabbits. To compare the efficacy of the superoxide dismutase 1 solution and superoxide dismutase 1 in nanoparticles the rabbit model of immunogenic uveitis was used. We estimated the clinical score for several signs of uveitis, protein level, and antioxidant activity in aqueous humor.Results. Calcium-phosphate nanoparticles containing lisinopril had average hydrodynamic radius of 170–300 nm and negative ζ-potential of –17 mV. Particles containing superoxide dismutase 1 had average hydrodynamic radius of 220–450 nm and negative ζ-potential of –4 mV. Lisinopril in nanoparticles caused a significantly greater decrease of intraocular pressure than lisinopril solution. Superoxide dismutase 1 in calcium-phosphate nanoparticles more efficiently decreased the clinical manifestations of uveitis and normalized the biochemical processes in aqueous humor than the enzyme in buffer solution.Conclusion. Incorporation of both low-molecular and high-molecular drugs to the calcium-phosphate nanoparticles enhance their bioavailability and therapeutic efficiency. The data obtained give evidence of the prospectively of the using of these nanoparticles as vehicles for the ophthalmic drugs used in eyedrops.

The acute phase response protein SERPINA3 is increased in tear fluid from the unaffected eyes of patients with unilateral acute anterior uveitis

BackgroundTo identify candidate tear fluid biomarkers in patients with unilateral acute anterior uveitis (AAU) that can aid in the differentiation between these patients and patients with bacterial keratitis or healthy controls.MethodsThirteen patients (40.1 ± 16.2 years of age) with unilateral AAU, seven patients with unilateral bacterial keratitis (40.2 ± 15.3 years of age), and 14 healthy subjects (41.1 ± 11.6 years of age) were included. The tear proteome of affected eyes was compared with that of the unaffected eye or healthy controls. Proteins were identified by liquid chromatography tandem mass spectrometry and enzyme-linked immunosorbent assay.ResultsRelative protein ratios were detected and calculated for 272 unique proteins. Compared with healthy controls and the unaffected eye, the top upregulated proteins in AAU eyes were submaxillary gland androgen regulated protein 3B (SMR3B) and SMR3A. Similarly, the top upregulated proteins in bacterial keratitis were S100 calcium-binding protein A9 and orosomucoid 2. The acute phase response protein Serpin Family A Member 3 (SERPINA3) was increased in the healthy eye of AAU patients (P = 0.019) compared with healthy controls. Laser flare measurements in affected eyes of AAU patients showed positive logarithmic correlation with SERPINA3 in tear samples of the unaffected eye (P = 0.022). The use of SERPINA3 as a tear biomarker yielded a sensitivity of 85% and a specificity of 71% in detecting patients with AAU in the study population.ConclusionsThe acute phase response protein SERPINA3 was increased in tear samples of unaffected eyes of patients with unilateral AAU compared with healthy controls. This study highlights SERPINA3 as a potential biomarker for AAU. Future research should explore the dynamic properties of SERPINA3 in the tear fluid of active and quiescent uveitis eyes.