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  • Importance of Baseline Fluorescein Angiography for Patients Presenting to Tertiary Uveitis Clinic. American journal of ophthalmology Karaca, I., Bromeo, A., Ghoraba, H., Lyu, X., Thng, Z. X., Yasar, C., Akhavanrezayat, A., Yavari, N., Kirimli, G. U., Than, N. T., Shin, Y., Gupta, A. S., Khatri, A., Mohammadi, S. S., Hung, J. H., Or, C., Do, D. V., Nguyen, Q. D. 2024

    Abstract

    To ascertain whether the use of ultra-wide-field fluorescein angiography (UWFFA) at baseline visit alters the assessment of disease activity and localization, as well as the management of patients presenting to a tertiary uveitis clinic.Retrospective comparison of diagnostic approaches.Baseline visits of 158 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were evaluated by three uveitis-trained ophthalmologists (I.K., A.B., and H.G.). Each eye had undergone clinical examination along with ultra-wide-field fundus photography (UWFFP) (Optos Plc, Dunfermline, Scotland, UK), spectral-domain optical coherence tomography (SD-OCT, Spectralis Heidelberg, Heidelberg Engineering, Heidelberg, Germany) and UWFFA (Optos Plc, Dunfermline, Scotland, UK) at the baseline visit. Investigators were asked to successively determine disease activity, localization of disease (anterior, posterior or both), and management decisions based on clinical examination and UWFFP and SD-OCT (Set 1) and Set 1 plus UWFFA (Set 2). The primary outcome was the percentage of eyes whose management changed based on the availability of UWFFA, compared with Set 1.The mean age of the patients was 46.9±22.4 (range, 7-96) and 91 (57.6%) were female. With Set 1 alone, 138 (55.2%) eyes were found to have active disease; localization was anterior in 58 (42.0%) eyes, posterior in 53 (38.4%) eyes and anterior + posterior in 27 (19.6%) eyes. With Set 2, 169 eyes of 107 patients had active anterior, posterior or pan-uveitis. In comparison with Set 1, assessment with Set 2 identified additional 31 (18.3%) eyes with active disease (p=0.006), and additional 31 (18.3%) eyes having disease in both anterior + posterior segments (p<0.001). Regarding the primary outcome, management was changed in 68 (27.4%) eyes in Set 2, compared to Set 1.Baseline UWFFA may alter assessment of disease activity, localization, and management decisions compared to clinical examination with only UWFFP and SD-OCT for eyes with uveitis. Thus, UWFFA may be considered as an essential tool in the evaluation of uveitis patients at the baseline visit.

    View details for DOI 10.1016/j.ajo.2024.04.016

    View details for PubMedID 38701875

  • Intravenous cyclophosphamide therapy for patients with severe ocular inflammatory diseases who failed other immunomodulatory therapies. Journal of ophthalmic inflammation and infection Karaca, I., Tran, E. M., Park, S., Bromeo, A., Khojasteh, H., Tran, A. N., Yavari, N., Akhavanrezayat, A., Yasar, C., Uludag Kirimli, G., Than, N. T., Hassan, M., Or, C., Ghoraba, H., Do, D. V., Nguyen, Q. D. 2024; 14 (1): 12

    Abstract

    Ocular inflammatory diseases, including scleritis and uveitis, have been widely treated with immunomodulatory therapies (IMTs) as a steroid-sparing approach. Such strategy includes conventional therapies (antimetabolites, alkylating agents, and calcineurin inhibitors) as well as biologic agents like adalimumab, infliximab, rituximab, and tocilizumab. Cyclophosphamide (CP) is an alkylating agent and mainly inhibits the functioning of both T and B cells. Though known to have potential adverse events, including bone marrow suppression, hemorrhagic cystitis, and sterility, CP has been shown to be efficacious, especially in recalcitrant cases and when used intravenous (IV) for a limited period.We conducted a retrospective case-series to assess the safety and efficacy of CP therapy for patients with severe ocular inflammatory diseases who failed other IMTs. Medical records of 1295 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were reviewed. Seven patients (10 eyes) who received CP therapy for ocular inflammatory diseases with at least one year of follow-up were included. The mean age of the patients (4 males, 3 females) was 61.6 ± 14.9 (43.0-89.0) years. Clinical diagnoses included necrotizing scleritis (5 eyes), peripheral ulcerative keratitis (2 eyes), orbital pseudotumor (1 eye), HLA-B27 associated panuveitis and retinal vasculitis (2 eyes). Ocular disease was idiopathic in 3 patients, and was associated with rheumatoid arthritis, IgG-4 sclerosing disease, dermatomyositis, and ankylosing spondylitis in 1 patient each. All the patients had history of previous IMT use including methotrexate (5), mycophenolate mofetil (3), azathioprine (1), tacrolimus (1), adalimumab (2), infliximab (4), and rituximab (1). The mean follow-up time was 34.4 ± 11.0 (13-45) months, and mean duration of CP therapy was 11.9 ± 8.8 (5-28) months. Remission was achieved in 5 patients (71.4%). Four patients (57.1%) experienced transient leukopenia (white blood cell count < 4000/mL).CP therapy can be considered a potentially effective and relatively safe therapeutic option for patients with severe ocular inflammatory diseases who failed other IMTs including biologics (TNFa and CD20 inhibitors).

    View details for DOI 10.1186/s12348-023-00372-z

    View details for PubMedID 38466527

    View details for PubMedCentralID PMC10928035

  • Structural and Functional Changes in Non-Paraneoplastic Autoimmune Retinopathy. Diagnostics (Basel, Switzerland) Akhavanrezayat, A., Khatri, A., Onghanseng, N. G., Halim, M. S., Or, C., Sredar, N., Razeen, M., Hasanreisoglu, M., Regenold, J., Thng, Z. X., Mohammadi, S. S., Jain, T., Yavari, N., Bazojoo, V., Gupta, A. S., Mobasserian, A., Yasar, C., Than, N. T., Uludag Kirimli, G., Karaca, I., Shin, Y., Yoo, W., Ghoraba, H., Do, D. V., Dubra, A., Nguyen, Q. D. 2023; 13 (21)

    Abstract

    BACKGROUND: To describe longitudinal changes in patients with non-paraneoplastic autoimmune retinopathy (npAIR) by utilizing different diagnostic modalities/tests.METHODS: The index study is a retrospective longitudinal review of sixteen eyes of eight patients from a tertiary care eye hospital diagnosed with npAIR. Multiple diagnostic modalities such as wide-angle fundus photography (WAFP), WA fundus autofluorescence (WAFAF), spectral-domain optical coherence tomography (SD-OCT), Goldmann visual field (GVF) perimetry, microperimetry (MP), electrophysiologic testing, and adaptive optics scanning laser ophthalmoscopy (AOSLO) were reviewed and analyzed.RESULTS: At the baseline visits, anomalies were detected by multimodal diagnostic tests on all patients. Subjects were followed up for a median duration of 11.5 [3.0-18.7] months. Structural changes at the baseline were detected in 14 of 16 (87.5%) eyes on WAFP and WAFAF and 13 of 16 (81.2%) eyes on SD-OCT. Eight of the ten (80%) eyes that underwent AOSLO imaging depicted structural changes. Functional changes were detected in 14 of 16 (87.5%) eyes on GVF, 15 of 16 (93.7%) eyes on MP, and 11 of 16 (68.7%) eyes on full-field electroretinogram (ff-ERG). Multifocal electroretinogram (mf-ERG) and visual evoked potential (VEP) tests were performed in 14 eyes, of which 12 (85.7%) and 14 (100%) of the eyes demonstrated functional abnormalities, respectively, at baseline. Compared to all the other structural diagnostic tools, AOSLO had a better ability to demonstrate deterioration in retinal microstructures occurring at follow-ups. Functional deterioration at follow-up was detected on GVF in 8 of 10 (80%) eyes, mf-ERG in 4 of 8 (50%) eyes, and MP in 7 of 16 (43.7%) eyes. The ff-ERG and VEP were stable in the majority of cases at follow-up.CONCLUSIONS: The utilization of multimodal imaging/tests in the diagnosing and monitoring of npAIR patients can aid in identifying anomalous changes over time. Analysis of both the anatomical and functional aspects by these devices can be supportive of detecting the changes early in such patients. AOSLO shows promise as it enables the capture of high-resolution images demonstrating quantifiable changes to retinal microstructure.

    View details for DOI 10.3390/diagnostics13213376

    View details for PubMedID 37958272

  • Ocular manifestations and clinical outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU). Eye (London, England) Uludag Kirimli, G., Hassan, M., Onghanseng, N., Or, C., Yasar, C., Park, S., Akhavanrezayat, A., Mobasserian, A., Yavari, N., Bazojoo, V., Khojasteh, H., Ghoraba, H., Karaca, I., Trong Tuong Than, N., Zaidi, M., Nguyen, Q. D. 2023

    Abstract

    PURPOSE: To describe the various ocular clinical features and visual outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU).METHODS: The medical records of 13 patients (26 eyes) diagnosed with TINU were reviewed.RESULTS: Twenty-six (26) eyes of 13 patients with TINU were reviewed in this study. The median age at onset of uveitis was 14 (range, 9-45). Eight (61.5%) subjects were female. The median follow-up of patients was 30 months (range, 6-89 months). Posterior segment findings were seen in 18 eyes of 9 patients (69.2%). The most common posterior findings were optic nerve head inflammation (16 eyes, 88.8%) and retinal vasculitis (13 eyes, 72.2%). Other posterior findings included vitritis (8 eyes, 44.4%), macular edema (6 eyes, 33.3%), snowball (4 eyes, 22.2%), and chorioretinal lesions (2 eye, 11.1%). Eight patients had fluorescein angiography (FA) data available and most eyes had retinal capillary leakage (13 eyes, 81.2%) followed by optic disc staining/leakage (12 eyes, 75%). Twelve (12) patients (92.3%) were treated with immunomodulatory treatment (IMT) and/or biologics. Five patients (%38.4) required biologics to control intraocular inflammation.CONCLUSION: Posterior segment involvement may be common in patients with TINU syndrome. FA provides significant information for detecting posterior segment involvement and disease activity in TINU. The majority of patients required systemic treatment in order to control intraocular inflammation and prevent relapses.

    View details for DOI 10.1038/s41433-023-02695-6

    View details for PubMedID 37626158

  • Association of oral montelukast with reduced odds of developing exudative age-related macular degeneration. Retina (Philadelphia, Pa.) Matsumiya, W., Karaca, I., Pham, B. H., Akhavanrezayat, A., Uludag, G., Yasar, C., Ghoraba, H., Mobasserian, A., Regenold, J., Halim, M. S., Sepah, Y. J., Do, D. V., Chong, V., Nguyen, Q. D. 2023

    Abstract

    This study was conducted to evaluate the association of oral montelukast, selective antagonism for cysteinyl leukotriene receptor 1, with reduced odds of exudative age-related macular degeneration (exAMD) development.This case-control study was conducted using Institutional Cohort Finder tool, and included 1913 patients with exAMD (ICD: H35.32 and 362.52) and 1913 age- and gender-matched control subjects without exAMD. Sub-analysis among 1913 exAMD and 324 non-exudative AMD was also conducted.A total of 47 (2.5%) exAMD cases were identified to have a history of oral montelukast use prior to exAMD diagnosis, compared to 84 (4.4%) controls. Montelukast usage was significantly associated with reduced odds of exAMD in the multivariable analysis (adjusted OR: 0.50, 95% CI: 0.31 - 0.80) as well as NSAID usage (adjusted OR: 0.69). Caucasian race, history of smoking, non-exudative macular degeneration in either eye were also found to have significant relationship with increased odds of exAMD. In the sub-analysis, montelukast usage showed significant association with reduced odds of developing exAMD from non-exudative AMD (adjusted OR: 0.53 95% CI: 0.29 - 0.97) as well as the presence of atopic disease (adjusted OR: 0.60).The study results suggested that oral montelukast is linked to reduced odds of exAMD development.

    View details for DOI 10.1097/IAE.0000000000003870

    View details for PubMedID 37339446

  • Clinical characteristics and management of non-infectious necrotizing scleritis Khatri, A., Uludag, G., Akhavanrezayat, A., Karaca, I., Yavari, N., Than, N., Shin, Y., Yasar, C., Ahmed, M., Mobasserian, A., Jison, L., Xian, T., Lin, C., Yu, C., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Repeatability of photopic negative response parameters in normal subjects using Diopsys® NOVA™ Sendino, I., Akhavanrezayar, A., Yavari, N., Perez-Alvarez, A., Karaca, I., Park, S., Khojasteh, H., Ghoraba, H., Or, C., Bromeo, A., Yasar, C., Than, N., Bajozoo, V., Uludag, G., Do, D. V., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Correlation between fixed-luminance flicker full-field electroretinogram response and macular cone density using adaptive optics fundus camera Mohammadi, S., Khojasteh, H., Yavari, N., Bajozoo, V., Akhavanrezayar, A., Yasar, C., Durand, M., Ghoraba, H., Karaca, I., Ongpalakorn, P., Bromeo, A., Mobasserian, A., Lyu, X., Tran, A., Do, D. V., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Nationwide incidence and prevalence of uveitis in South Korea using National Health Insurance Service Database from 2010 to 2021 Shin, Y., Hong, E., Kim, J., Park, S., Akhavanrezayat, A., Karaca, I., Bromeo, A., Yasar, C., Or, C., Uludag, G., Ongpalakorn, P., Bajozoo, V., Yavari, N., Lyu, X., Tran, A., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Impact of anti-optic nerve antibodies in patients with autoimmune retinopathy Ongpalakorn, P., Park, S., Or, C., Akhavanrezayat, A., Karaca, I., Bromeo, A., Mobasserian, A., Yasar, C., Yavari, N., Uludag, G., Than, N., Shin, Y., Tran, A., Bazojoo, V., Do, D., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • licker electroretinography findings in patients with unilateral non-infectious retinal vasculitis using Diopsys® NOVA device Lyu, X., Park, S., Shin, Y., Karaca, I., Akhavanrezayar, A., Ghoraba, H., Bazojoo, V., Or, C., Ongpalakorn, P., Tran, A., Mobasserian, A., Than, N., Khojasteh, H., Bromeo, A., Yasar, C., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Repeatability of fixed-luminance parameters of full-field electroretinography in patients with non-infectious uveitis Yasar, C., Park, S., Akhavanrezayat, A., Karaca, I., Uludag, G., Yavari, N., Ghoraba, H., Or, C., Khojasteh, H., Ongpalakorn, P., Shin, Y., Bromeo, A., Bazojoo, V., Lyu, X., Tran, A., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Longitudinal analysis of full-field electroretinography findings in non-infectious retinal vasculitis patients with significantly improved inflammation Gupta, A., Park, S., Karaca, I., Khojasteh, H., Akhavanrezayat, A., Uludag, G., Tran, A., Lyu, X., Yasar, C., Ongpalakorn, P., Mobasserian, A., Ghoraba, H., Bromeo, A., Or, C., Shin, Y., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Longitudinal changes of flicker electroretinogram parameters measured by Diopsys® in patients with retinal vasculitis Mobasserian, A., Yavari, N., Park, S., Uludag, G., Ghoraba, H., Khojasteh, H., Karaca, I., Yasar, C., Bajozoo, V., Or, C., Akhavanrezayat, A., Ongpalakorn, P., Lyu, X., Tran, A., Do, D., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Assessment of the relationship between presence of active retinal vasculitis and aqueous flare values using laser flare meter Tran, A., Akhavanrezayat, A., Karaca, I., Khojasteh, H., Halim, M., Uludag, G., Shin, Y., Ghoraba, H., Or, C., Hassan, M., Bromeo, A., Ongpalakorn, P., Yasar, C., Bazojoo, V., Do, D., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Intravenous cyclophosphamide therapy for patients with severe ocular inflammatory diseases who failed other immunomodulatory therapies Karaca, I., Tran, E., Park, S., Khojasteh, H., Tran, A., Bromeo, A., Akhavanrezayat, A., Yavari, N., Yasar, C., Uludag, G., Shin, Y., Jison, L., Or, C., Ghoraba, H., Do, D., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Neurosarcoidosis, Coccidioidomycosis, or Both! International medical case reports journal Akhavanrezayat, A., Matsumiya, W., Ongpalakorn, P., Ghoraba, H. H., Or, C., Khojasteh Jafari, H., Kirimli, G. U., Yasar, C., Than, N. T., Karaca, I., Zaidi, M., Mobasserian, A., Yavari, N., Bazojoo, V., Shin, Y. U., Bromeo, A. J., Nguyen, Q. D. 2023; 16: 887-895

    Abstract

    Purpose: To report a case of neurosarcoidosis (NS) who was initially diagnosed as Coccidioidomycosis immitis (CI) infection.Observations: A 57-year-old diabetic man presented with sudden painless diminution of vision, metamorphopsia, and color vision deficits in the left eye (OS) for one month. His vision was 20/20 in the right eye (OD) and 20/40 OS. Ophthalmic examination revealed left relative afferent pupillary defect, blurred optic nerve margin, creamy chorioretinal infiltration around the optic disc, and mild macular edema. OD examination was non-revealing. Chest CT scan with contrast showed calcified mediastinal lymph nodes, but biopsy of the lymph nodes was normal. Brain and orbit MRI demonstrated soft tissue abnormality with enhancement in left orbital apex with involvement of the extraocular muscles. CSF culture was negative, but complement fixation had positive titer of 1:2 for CI. The patient was diagnosed with CI meningitis, and antifungal therapy was initiated. Slight visual and symptomatic improvement was observed, which was not completely satisfactory. Biopsy of extraocular orbital muscle five months later revealed non-caseating granulomatous inflammation, leading to initiation of prednisone trial therapy. Nine months later, the patient was referred to a tertiary center owing to persistence of optic disc edema OS. PET CT was consistent with a diagnosis of sarcoidosis. Antifungal treatment was discontinued, and oral prednisone with methotrexate was initiated. Subsequently, methotrexate was replaced by infliximab to further manage ocular inflammation and neurologic symptoms which was effective. Vision was 20/20 OD and 20/30 OS at the most recent visit.Conclusion and Importance: Signs and symptoms of neurosarcoidosis and coccidioidomycosis can be similar and deceiving. The index case underscores importance of considering appropriate differential diagnoses in patients with similar symptoms and signs who may respond to preliminary designated treatment but not to the optimal extent. Considering such possibility could assist clinicians in managing the patients timely and efficiently.

    View details for DOI 10.2147/IMCRJ.S434632

    View details for PubMedID 38164515

  • Pars plana vitrectomy with internal limiting membrane flap versus pars plana vitrectomy with conventional internal limiting membrane peeling for large macular hole. The Cochrane database of systematic reviews Ghoraba, H., Rittiphairoj, T., Akhavanrezayat, A., Karaca, I., Matsumiya, W., Pham, B., Mishra, K., Yasar, C., Mobasserian, A., Abdelkarem, A. A., Nguyen, Q. D. 2023; 8: CD015031

    Abstract

    BACKGROUND: Macular hole (MH) is a full-thickness defect in the central portion of the retina that causes loss of central vision. According to the usual definition, a large MH has a diameter greater than 400 m at the narrowest point. For closure of MH, there is evidence that pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling achieves better anatomical outcomes than standard PPV. PPV with ILM peeling is currently the standard of care for MH management; however, the failure rate of this technique is higher for large MHs than for smaller MHs. Some studies have shown that the inverted ILM flap technique is superior to conventional ILM peeling for the management of large MHs.OBJECTIVES: To evaluate the clinical effectiveness and safety of pars plana vitrectomy with the inverted internal limiting membrane flap technique versus pars plana vitrectomy with conventional internal limiting membrane peeling for treating large macular holes, including idiopathic, traumatic, and myopic macular holes.SEARCH METHODS: The Cochrane Eyes and Vision Information Specialist searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registries on 12 December 2022.SELECTION CRITERIA: We included randomized controlled trials (RCTs) that evaluated PPV with ILM peeling versus PPV with inverted ILM flap for treatment of large MHs (with a basal diameter greater than 400 m at the narrowest point measured by optical coherence tomography) of any type (idiopathic, traumatic, or myopic).DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and assessed the certainty of the body of evidence using GRADE.MAIN RESULTS: We included four RCTs (285 eyes of 275 participants; range per study 24 to 91 eyes). Most participants were women (63%), and of older age (range of means 59.4 to 66 years). Three RCTs were single-center trials, and the same surgeon performed all surgeries in two RCTs (the third single-center RCT did not report the number of surgeons). One RCT was a multicenter trial (three sites), and four surgeons performed all surgeries. Two RCTs took place in India, one in Poland, and one in Mexico. Maximum follow-up ranged from three months (2 RCTs) to 12 months (1 RCT). No RCTs reported conflicts of interest or disclosed financial support. All four RCTs enrolled people with large idiopathic MHs and compared conventional PPV with ILM peeling versus PPV with inverted ILM flap techniques. Variations in technique across the four RCTs were minimal. There was some heterogeneity in interventions: in two RCTs, all participants underwent combined cataract-PPV surgery, whereas in one RCT, some participants underwent cataract surgery after PPV (the fourth RCT did not mention cataract surgery). The critical outcomes for this review were mean best-corrected visual acuity (BCVA) and MH closure rates. All four RCTs provided data for meta-analyses of both critical outcomes. We assessed the risk of bias for both outcomes using the Cochrane risk of bias tool (RoB 2); there were some concerns for risk of bias associated with lack of masking of outcome assessors and selective reporting of outcomes in all RCTs. All RCTs reported postoperative BCVA values; only one RCT reported the change in BCVA from baseline. Based on evidence from the four RCTs, it is unclear if the inverted ILM flap technique compared with ILM peeling reduces (improves) postoperative BCVA measured on a logarithm of the minimum angle of resolution (logMAR) chart at one month (mean difference [MD] -0.08 logMAR, 95% confidence interval [CI] -0.20 to 0.05; P = 0.23, I2 = 65%; 4 studies, 254 eyes; very low-certainty evidence), but it may improve BCVA at three months or more (MD -0.17 logMAR, 95% CI -0.23 to -0.10; P < 0.001, I2 = 0%; 4 studies, 276 eyes; low-certainty evidence). PPV with an inverted ILM flap compared to PPV with ILM peeling probably increases the proportion of eyes achieving MH closure (risk ratio [RR] 1.10, 95% CI 1.02 to 1.18; P = 0.01, I2 = 0%; 4 studies, 276 eyes; moderate-certainty evidence) and type 1 MH closure (RR 1.31, 95% CI 1.03 to 1.66; P = 0.03, I = 69%; 4 studies, 276 eyes; moderate-certainty evidence). One study reported that none of the 38 participants experienced postoperative retinal detachment.AUTHORS' CONCLUSIONS: We found low-certainty evidence from four small RCTs that PPV with the inverted ILM flap technique is superior to PPV with ILM peeling with respect to BCVA gains at three or more months after surgery. We also found moderate-certainty evidence that the inverted ILM flap technique achieves more overall and type 1 MH closures. There is a need for high-quality multicenter RCTs to ascertain whether the inverted ILM flap technique is superior to ILM peeling with regard to anatomical and functional outcomes. Investigators should use the standard logMAR charts when measuring BCVA to facilitate comparison across trials.

    View details for DOI 10.1002/14651858.CD015031.pub2

    View details for PubMedID 37548231

  • Efficacy and Safety of Tocilizumab in the Management of Non-Infectious Uveitis Failed with Conventional Immunomodulatory and Anti-TNFα Therapies. Ocular immunology and inflammation Uludag, G., Karaca, I., Akhavanrezayat, A., Yasar, C., Matsumiya, W., Pham, B. H., Halim, M. S., Trong Tuong Than, N., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2022: 1-7

    Abstract

    To determine the outcomes of intravenous (IV) tocilizumab (TCZ) in patients with non-infectious uveitis who failed with conventional immunomodulatory and anti-TNFα therapies.Records of seven patients with non-infectious uveitis treated with monthly IV TCZ (4-10 mg/kg) or biweekly IV TCZ (8 mg/kg) were reviewed. Outcome measures were changes in visual acuity, anterior chamber cell and flare grade, vitreous haze, central subfield thickness (CST), and fluorescein angiography (FA) score.Ten eyes of seven patients received TCZ therapy. Median age of patients was 14 (range, 7-24) years. Median duration of TCZ therapy was 15 (range, 5-32) months. Mean CST reduced from 373 ± 101.0 μm to 298.2 ± 40.3 μm. Mean FA score reduced from 12.5 ± 4.3 to 3.6 ± 2.6. One patient developed elevated liver transaminases.IV TCZ is a potentially effective and safe therapeutic option for the management of refractory non-infectious uveitis.

    View details for DOI 10.1080/09273948.2022.2126374

    View details for PubMedID 36542775

  • Bilateral retinal vasculitis associated with cold agglutinin disease treated with obinutuzumab and infliximab. American journal of ophthalmology case reports Than, N. T., Yaşar, Ç., Pham, B. H., Lam, B. C., Doan, H. L., Akhavanrezayat, A., Halim, M. S., Iberri, D. J., Hien, D. L., Dong Nguyen, Q. 2022; 28: 101752

    Abstract

    To describe the clinical course and management of a patient with bilateral retinal vasculitis associated with cold agglutinin disease (CAD) treated with obinutuzumab and infliximab.A 69-year-old Hispanic woman was referred to a tertiary Uveitis Clinic with progressively worsening blurry vision, right eye (OD) worse than left eye (OS). Past ocular history was significant for epiretinal membranes in both eyes (OU). Past medical history was notable for non-specific joint disease, primarily affecting her knees bilaterally, and pulmonary symptoms (e.g., dyspnea, productive cough) of unclear etiologies one year before presentation. She had been evaluated by rheumatologists and pulmonologists and was placed on low doses of prednisone and methotrexate. Upon examination, her visual acuity was 20/40 in OD and 20/25 in OS. Anterior segment exam was unremarkable with no cell or flare in OU. Dilated fundus examination was notable for 0.5+ vitreous haze in OU and mild vessel attenuation in OU. Wide-angle fluorescein angiography (FA) revealed mild bilateral periphery peri-vasculature leakage in OU. Initial blood evaluations revealed decreased hematocrit, and positive anti-nuclear antibody. Her peripheral smear disclosed 3+ agglutination. She was initially treated with mycophenolate mofetil 1000 mg twice daily and prednisone 20 mg then referred to hematology. Further work up revealed high-titer cold agglutinin and positive thermal amplitude screen at 30 °C. Bone marrow examination demonstrated a chronic lymphocytic leukemia (CLL)-like monoclonal B-cell lymphocytosis. Anti-CD20 monoclonal antibody therapy with obinutuzumab was started in an effort to treat the underlying CLL clone and address the associated ocular vasculitis related to CAD. Three months later, after eight cycles of obinutuzumab, the patient's best- corrected visual acuity (BCVA) continued to be stable at 20/30 in OD and 20/20 in OS. However, FA showed persistent diffuse perivascular leakage. Intravenous infliximab with concurrent intravenous methylprednisolone infusions were started. After two cycles of treatment, FA showed significantly improved perivascular leakage. Visual acuity remained stable at 20/25 in OU.Ocular involvement in CAD is rare. The index case is the first report of retinal vasculitis in a patient with CAD. Our report not only describes the unique course of CAD-related retinal vasculitis, but also introduces and underscores a successful therapeutic plan.

    View details for DOI 10.1016/j.ajoc.2022.101752

    View details for PubMedID 36425783

    View details for PubMedCentralID PMC9679462

  • Multifocal electroretinographic findings in angiographic macular leakage in the setting of intermediate, posterior, or panuveitis. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Ghoraba, H., Hwang, J., Karaca, I., Khojasteh, H., Or, C., Regenold, J., Zaidi, M., Yavari, N., Than, N. T., Park, S. W., Yasar, C., Akhavanrezayat, A., Nguyen, Q. D. 2022

    Abstract

    To evaluate the functional implications of angiographic macular leakage without the presence of intraretinal fluid on optical coherence tomography (OCT) in eyes with intermediate, posterior, or panuveitis.Retrospective study on patients with a diagnosis of intermediate, posterior, or panuveitis. Patients who had fluorescein angiography, OCT, and multifocal electroretinography (mfERG) within a predetermined time frame were included. Demographic and clinical data including types of ocular inflammation and best-corrected visual acuity (BCVA), in addition to OCT, fluorescein angiography, and mfERG data were collected. The study cohort was divided into 2 groups based on the presence of angiographic macular leakage and macular edema (ME): group 1 (no ME and no macular leakage) and group 2 (presence of macular leakage without ME).A total of 29 patients (43 eyes) were included in the study, with 13 patients (17 eyes) in group 1 and 16 patients (26 eyes) in group 2. No statistically significant differences in age, sex, anterior-chamber cells, lens status, vitreous cells, vitreous haze, BCVA, or mean central subfoveal thickness were found between groups 1 and 2. All mfERG values, including N1 and P1 response densities and timings for rings 1-5, did not show any statistically significant difference between group 1 and 2. No correlation was found between either of BCVA or central subfoveal thickness and any of mfERG values for rings 1-3.In absence of ME, angiographic macular leakage in eyes with uveitis might not be associated with worse macular function when compared with eyes without angiographic macular leakage.

    View details for DOI 10.1016/j.jcjo.2022.11.002

    View details for PubMedID 36442516

  • Electroretinographic findings in retinal vasculitis. The British journal of ophthalmology Ghoraba, H. H., Matsumiya, W., Or, C., Khojasteh, H., Patel, P., Karaca, I., Regenold, J., Zaidi, M., Hwang, J., Lajevardi, S., Yavari, N., Than, N. T., Park, S. W., Akhavanrezayat, A., Uludag, G., Yasar, C., Leung, L. B., Nguyen, Q. D. 2022

    Abstract

    To describe and correlate electroretinographic responses with clinical and angiographic findings in retinal vasculitis (RV).Medical records of patients with diagnosis of RV at a tertiary eye centre from December 2017 to May 2021 were reviewed. Cases in which fluorescein angiography (FFA) and full field electroretinography (ffERG) were done within 1 month were included. FFAs were graded according to the Angiography Scoring for Uveitis Working Group from 0 to 40, where 0 is normal. A novel ffERG grading system was implemented where individual waves were graded for timing and amplitude and general ffERG score was determined with 6 being a perfect score.20 patients (34 eyes) were included. Mean age was 43.9±19.8 years; 70% were female. Median best-corrected visual acuity was 0.8 (0.08-1). Mean FFA score was 12.6±6.5. Median general ffERG score was 5 (0-6). 68% and 91% of eyes had responses with general ffERG scores ≥5 and 4, respectively. Flicker timing was most commonly affected.FFA scores weakly correlated with delayed photopic cone b-wave and flicker timing (p=0.03 and 0.016, respectively). Vitreous haze moderately correlated with delayed cone b-wave timing (p<0.001), delayed flicker timing (p=0.002) and weakly correlated with lower flicker amplitude (p=0.03). Underlying systemic disease was associated with poor ffERG responses.In this study, RV was not frequently associated with severe global retinal dysfunction Higher FFA scores, and vitreous haze grading were weakly, but significantly, correlated with cone-generated ffERG responses.

    View details for DOI 10.1136/bjo-2022-321716

    View details for PubMedID 36130816

  • Repeatability of electroretinogram measurements Or, C., Ghoraba, H., Zaidi, M., Akhavanrezayat, A., Regenold, J., Uludag, G., Yasar, C., Park, S., Than, N., Hwang, J., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Posterior manifestations and longitudinal outcomes in TINU syndrome Uludag, G., Hassan, M., Regenold, J., Akhavanrezayat, A., Mobasserian, A., Yasar, C., Or, C., Khojasteh, H., Ghoraba, H., Karaca, I., Zaidi, M., Yavari, N., Than, N., Park, S., Bazojoo, V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Novel retinopathy in pediatric retinal vasculitis: long term follow up Yasar, C., Ghoraba, H., Regenold, J., Or, C., Halim, M., Uludag, G., Hwang, J., Karaca, I., Mobasserian, A., Akhavanrezayat, A., Yasar, M., Khojasteh, H., Sepah, Y. J., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Electroretinographic findings in retinal vasculitis Ghoraba, H., Matsumiya, W., Patel, P., Or, C., Karaca, I., Regenold, J., Zaidi, M., Khojasteh, H., Hwang, J., Lajevardi, S., Yavari, N., Park, S., Akhavanrezayat, A., Mobasserian, A., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Correlation between Diopsys (R) NOVA fixed-luminance flicker phase and Diagnosys (R) flicker implicit time Regenold, J., Ghoraba, H., Hien Luong Doan, Zaidi, M., Hwang, J., Or, C., Karaca, I., Akhavanrezayat, A., Ngoc Than, Yasar, C., Yavari, N., Park, S., Khan, Y., Mobasserian, A., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Multifocal electroretinographic findings in eyes with posterior uveitis and angiographic macular leakage Hwang, J., Karaca, I., Lajevardi, S., Or, C., Zaidi, M., Regenold, J., Halim, M., Uludag, G., Yasar, C., Bazojoo, V., Than, N., Mobasserian, A., Sepah, Y. J., Khojasteh, H., Nguyen, Q., Ghoraba, H. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Effect of Topical Bromfenac on Macular Thickness Changes after Vitrectomy or Phacovitrectomy for Epiretinal Membrane Park, S., Byon, I., Zaidi, M., Regenold, J., Uludag, G., Akhavanrezayat, A., Mobasserian, A., Or, C., Yasar, C., Ghoraba, H., Than, N., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis. Clinical ophthalmology (Auckland, N.Z.) Ghoraba, H. H., Matsumiya, W., Khojasteh, H., Akhavanrezayat, A., Karaca, I., Or, C., Yavari, N., Lajevardi, S., Hwang, J., Yasar, C., Do, D., Nguyen, Q. D. 2022; 16: 1697-1706

    Abstract

    Purpose: To evaluate the safety of intravenous high-dose pulse methylprednisolone succinate (IVHDM) in the management of severe or refractory non-infectious pediatric uveitis.Methods: We reviewed all uveitis patients who were ≤16 years of age and who received IVHDM with a dose of ≥500 mg per day (1-3 days a month) for at least 3 months during their management at a tertiary care eye hospital.Results: Twenty pediatric patients with severe or refractory uveitis who received IVHDM were identified. Six patients received IVHDM either once, as a preoperative medication, or at a lower dose than 500 mg, and were excluded. The remaining 14 patients received IVHDM for at least 4 months. Age (mean±SD) was 11.9±2.4 years and 50% were female. Duration of treatment was 14.2±7.5 months. Thirteen patients received IVHDM in combination with other immunomodulatory therapy (IMT). Except for two outliers, IVHDM was given at a dose of 8-25 mg/kg per infusion. Three major adverse events (AEs) occurred in two patients: a single episode of bradycardia, compression fracture following minor trauma and adrenal insufficiency. The number of AEs (major and minor) strongly correlated with duration of treatment (p=0.004) and moderately correlated with the cumulative dose/weight (p=0.051). Weight gain was associated with the use of concomitant oral steroids and not with duration of treatment or cumulative dose.Conclusion: IVHDM may be a valid therapeutic option for aggressive/refractory pediatric uveitis. The reported AEs in this series can also be attributed to the concurrent IMT or the underlying disease itself.

    View details for DOI 10.2147/OPTH.S366370

    View details for PubMedID 35673349

  • Effect of Pupil Size on Fixed-Luminance Flicker Full-Field Electroretinogram Magnitude. Clinical ophthalmology (Auckland, N.Z.) Mobasserian, A., Zaidi, M., Halim, S., Hwang, J. J., Regenold, J., Akhavanrezayat, A., Karaca, I., Khojasteh Jafari, H., Yavari, N., Matsumiya, W., Yasar, C., Than, N. T., Uludag, G., Do, D., Ghoraba, H., Nguyen, Q. D. 2022; 16: 3733-3740

    Abstract

    Purpose: Diopsys NOVA fixed-luminance flicker full-field electroretinogram (ffERG) device is a potential adjunct to conventional flicker ffERG testing for assessing cone cell function. Magnitude of measured electrical response is known to vary with pupil size in conventional ffERG testing. The index study characterizes the relationship between magnitude of measured electrical activity and pupil size, both pupil diameter and pupil area, for this device.Methods: Seventeen patients (34 eyes) with no known ocular diseases were enrolled in the study. Electrophysiologic function of cone cells was evaluated using fixed-luminance flicker ffERG before and after dilation. Linear regression models, with inter-eye correlations controlled as fixed-effects, were used to characterize the effect of pupil dilation on the magnitude of the measured responses.Results: Mean age of study patients was 33.5 (standard deviation 7.4 years), and 35.3% of the subjects were female. Mean value of electrical response magnitude was 10.07±2.79V before dilation and 15.30±4.08V after dilation. The correlations of ERG magnitude with pupil diameter and with pupil area were not significant for either dilated or undilated eyes considered separately but were highly significant (p<0.001) for dilated and undilated eyes considered in aggregate. ERG magnitude tended to increase by 1.08 V for every 1 mm increase in pupillary diameter.Conclusion: An increase in pupil size, both pupil diameter and pupil area, is significantly associated with an increase in flicker ffERG magnitude recorded by the Diopsys device, suggesting that pupil size should be measured and considered when making clinical judgments based on the flicker ffERGs recorded by the device, and that pupil size-specific reference ranges could improve the clinical utility of the device.

    View details for DOI 10.2147/OPTH.S382207

    View details for PubMedID 36389637

  • Ocular Gene Therapy: A Literature Review with Special Focus on Immune and Inflammatory Responses. Clinical ophthalmology (Auckland, N.Z.) Ghoraba, H. H., Akhavanrezayat, A., Karaca, I., Yavari, N., Lajevardi, S., Hwang, J., Regenold, J., Matsumiya, W., Pham, B., Zaidi, M., Mobasserian, A., DongChau, A. T., Or, C., Yasar, C., Mishra, K., Do, D., Nguyen, Q. D. 2022; 16: 1753-1771

    Abstract

    Gene therapy has emerged as a research topic of choice in recent years. The eye in particular is one of few organs of the body for which gene therapy has received Food and Drug Administration approval, and it remains a field of great interest for gene therapy development. However, its associated immune and inflammatory reactions may render the treatment ineffective or harmful, which are of particular concern for the eyes due to their susceptibility to inflammation. The severity of immune and inflammatory reactions depends on the choice of vector and its route of administration. Furthermore, most preclinical and clinical studies have shown that the dose of vectors is correlated with the degree of humoral response and ocular inflammation. The route of administration directly impacts the degree of immune and inflammatory reaction. Subretinal delivery produces a weaker humoral response than the intravitreal route. However, some studies have demonstrated that the subretinal delivery induces a stronger inflammatory reaction. On the other hand, several instances of vision loss due to severe late onset intraocular inflammation were reported in a clinical trial involving intravitreal delivery of viral vectors. When compared with the intravitreal route, suprachoroidal gene delivery has been shown to produce weaker humoral response. However, unlike the subretinal space, the suprachoroidal space is not known to have immune privilege status. Inflammatory reactions following ocular gene therapy are typically mild and most clinical and preclinical studies have shown that they can be controlled with topical, local or systemic steroids. However, severe inflammatory responses may occur and require aggressive management to avoid permanent vision loss. Further investigations are required to elucidate and expand our knowledge of inflammatory reactions, and their optimal management, following ocular gene therapy.

    View details for DOI 10.2147/OPTH.S364200

    View details for PubMedID 35685379

  • Structural changes of corneal epithelium in belantamab-associated superficial keratopathy using anterior segment optical coherence tomography. American journal of ophthalmology case reports Matsumiya, W., Karaca, I., Ghoraba, H., Akhavanrezayat, A., Mobasserian, A., Hassan, M., Regenold, J., Yasar, C., Liedtke, M., Kitazawa, K., Nguyen, Q. D. 2021; 23: 101133

    Abstract

    Purpose: To describe structural changes in corneal epithelium using anterior segment optical coherence tomography (AS-OCT) in two relapsed and refractory multiple myeloma (RRMM) patients with bilateral belantamab-associated superficial keratopathy (BASK).Observations case 1: A 56-year-old male who was diagnosed with RRMM and initiated on belantamab mafodotin, presented on day 42 (three weeks after the second infusion) with decreased pinhole visual acuity from 20/20 and 20/25 to 20/70 and 20/50 in the right eye and left eye, respectively. Slit-lamp examination revealed moderate superficial keratopathy with microcystic-like epithelial changes (MECs) in the paracentral cornea in both eyes. AS-OCT demonstrated increased bilateral heterogeneous signal intensity and hyperreflective lesions as well as increased thickness in the paracentral corneal epithelium with uninvolved central cornea. Given bilateral MECs, the third infusion was withheld, and then given on day 62 after five weeks of drug-free interval. Although MECs had improved on day 82, pinhole visual acuity remained at 20/50 and 20/40 in the right eye and the left eye. AS-OCT showed that hyperreflective lesions mostly resolved and corneal epithelial thickness returned to baseline, despite a slightly increased persisting heterogeneous signal intensity in the peripheral corneal epithelium in both eyes.Case 2: A 77-year-old male with RRMM was started on belantamab mafodotin infusions. His pinhole visual acuity decreased from 20/40 and 20/30 at baseline to 20/60 and 20/40 on day 41 (three weeks after the second infusion) in the right eye and left eye, respectively. Slit-lamp examination showed diffuse, moderate MECs in both eyes, which was more severe in the peripheral cornea. AS-OCT demonstrated increased bilateral heterogeneous signal intensity and hyperreflective lesions in the corneal epithelium, which are more severe in the right eye along with increased corneal epithelial thickness. Therefore, belantamab mafodotin was withheld.Conclusions and Impotance: AS-OCT objectively demonstrated structural changes such as signal intensity and thickness alterations with hyperreflective lesions in the corneal epithelium related to BASK. AS-OCT might be useful for clinicians to monitor ocular surface adverse events in RRMM patients receiving belantamab mafodotin and to adjust therapeutic plans for the patients.

    View details for DOI 10.1016/j.ajoc.2021.101133

    View details for PubMedID 34169181

  • Oral montelukast is associated with decreased odds of diabetic retinopathy Pham, B., Matsumiya, W., Akhavanrezayat, A., Uludag, G., Yasar, C., Ghoraba, H., Hwang, J., Lajevardi, S., Lam, B., Regenold, J., Yavari, N., Bazojoo, V., Karaca, I., Mobasserian, A., Nguyen, H., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Effect of pupil size on fixed-luminance flicker full-field electroretinogram magnitude Mobasserian, A., Halim, M., Hwang, J., Regenold, J., Akhavanrezayat, A., Ghoraba, H., Matsumiya, W., Yavari, N., Karaca, I., Yasar, C., Lajevardi, S., Pham, B., Do, D., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Novel retinopathy identified in pediatric retinal vasculitis Yasar, C., Matsumiya, W., Akhavanrezayat, A., Ghoraba, H., Halim, M., Uludag, G., Pham, B., Hwang, J., Karaca, I., Lajevardi, S., Lam, B., Regenold, J., Sepah, Y. J., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Correlation between photoreceptor density in adaptive optics imaging with retinal structure and sensitivity in autoimmune retinopathy Matsumiya, W., Akhavanrezayat, A., Uludag, G., Yasar, C., Ghoraba, H., Mobasserian, A., Karaca, I., Lam, B., Pham, B., Hwang, J., Afridi, R., Halim, M., Do, D., Sepah, Y., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Association of oral montelukast with reduced odds of developing neovascular age-related macular degeneration Karaca, I., Matsumiya, W., Akhavanrezayat, A., Uludag, G., Yasar, C., Mobasserian, A., Hwang, J., Lajevardi, S., Lam, B., Afridi, R., Do, D., Sepah, Y., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Altered patient demography and increased complexity of ICD coding in uveitis over 10 years Hwang, J., Halim, M., Uludag, G., Yasar, C., Ghoraba, H., Pham, B., Lajevardi, S., Lam, B., Regenold, J., Bazojoo, V., Karaca, I., Mobasserian, A., Do, D. V., Sepah, Y. J., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Efficacy and safety of tocilizumab in the management of non-infectious retinal vasculitis Uludag, G., Halim, M., Akhavanrezayat, A., Matsumiya, W., Yasar, C., Pham, B., Hwang, J., Lajevardi, S., Lam, B., Karaca, I., Mobasserian, A., Regenold, J., Do, D. V., Sepah, Y. J., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Structural and functional changes in non-paraneoplastic autoimmune retinopathy Akhavanrezayat, A., Onghanseng, N. L., Halim, M., Uludag, G., Ghoraba, H., Matsumiya, W., Pham, B., Mobasserian, A., Regenold, J., Yasar, C., Karaca, I., Bazojoo, V., Lajevardi, S., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Safety of intravenous high-dose pulse methylprednisolone succinate in the management of pediatric uveitis Ghoraba, H., Akhavanrezayat, A., Matsumiya, W., Pham, B., Yasar, C., Karaca, I., Mobasserian, A., Regenold, J., Lam, B., Hwang, J., Lajevardi, S., Yavari, N., Halim, M., Sepah, Y. J., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Reperfusion of retinal ischemia in retinal occlusive vasculitis with nicotinic acid and infliximab in Adamantiades-Behcet's disease. American journal of ophthalmology case reports Al-Moujahed, A., Hien, D. L., Akhavanrezayat, A., Pham, B. H., Tuong Ngoc, T. T., Doan, H. L., Yasar, C., Lajevardi, S., Nguyen, H. V., Nguyen, Q. D. 2021; 21: 101027

    Abstract

    To describe a case of ischemic retinal vasculitis in Adamantiades-Behcet disease (ABD) that demonstrated significant resolution of retinal ischemia following treatment with nicotinic acid and infliximab.Observations: A 12-year-old male with a history of recurrent oral ulcers, fevers, and failure to thrive was admitted to the hospital with fever, oral and perirectal mucositis, and poor oral intake one month before presentation to uveitis clinic. He was suspected to have ABD and was treated with three doses of intravenous (IV) methylprednisolone (30 mg/kg/day) which led to improvement in his systemic symptoms. One week after admission, he complained of decreased vision in both eyes (OU), during which he was found to have anterior uveitis in OU and was referred to the Uveitis Clinic. Upon examination, his visual acuity was 20/80 in OU. Intraocular pressures were within normal limits. Anterior chamber evaluation revealed 0.5+ cells and 1.5+ flare in OU. Posterior examination revealed pale optic nerve, sclerosis and vascular sheathing of retinal arteries, and collateral vessels in OU. Fluorescein angiography (FA) showed optic disc leakage and widespread retinal ischemia in OU. The patient was diagnosed with retinal occlusive vasculitis associated with ABD. He was initially treated with infliximab (5 mg/kg), systemic methylprednisolone, and mycophenolate mofetil. Three months later, his BCVA improved to 20/70 OU with slight improvement of retinal ischemia on FA. Nicotinic acid was added to his treatment regimen. Due to logistic challenges, he did not receive infliximab treatment during the subsequent three months. However, three months after beginning nicotinic acid therapy, FA revealed significant improvement of his retinal ischemia OU. Conclusion: To our knowledge, the index report is the first to show that nicotinic acid may improve retinal ischemia in vaso-occlusive retinal vasculitis and be an integral part of the treatment regimen of this sight-threatening condition.

    View details for DOI 10.1016/j.ajoc.2021.101027

    View details for PubMedID 33615039

  • Anti-interleukin-6 receptor therapy with tocilizumab for refractory pseudophakic cystoid macular edema. American journal of ophthalmology case reports Pham, B. H., Hien, D. L., Matsumiya, W., Tuong Ngoc, T. T., Doan, H. L., Akhavanrezayat, A., Yasar, C., Nguyen, H. V., Halim, M. S., Nguyen, Q. D. 2020; 20: 100881

    Abstract

    Purpose: To describe the clinical course of a patient with refractory pseudophakic cystoid macular edema treated with interleukin-6 receptor antagonist tocilizumab.Observations: An 80-year-old Caucasian man with past ocular history significant for glaucoma (right eye) and iritis presented with cystoid macular edema (CME) in the right eye (OD). His ocular surgery history was significant for cataract extraction with posterior chamber intraocular lenses in 1999 and YAG laser capsulotomy in 2014 in both eyes (OU). His medications at time of presentation included latanoprost and dorzolamide-timolol in OD for glaucoma, as well as prednisolone in OD for iritis. Upon examination, his visual acuity was 20/250 in OD and 20/20 in the left eye (OS). Intraocular pressure was 20mmHg in OD and 10mmHg in OS. Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed CME and a cup-to-disk ratio of 0.9 in OD and normal findings in OS. Initial spectral domain optical coherence tomography (SD-OCT) demonstrated intraretinal fluid in both outer and inner layers as well as mild subretinal fluid with an intact ellipsoid zone in OD. Fluorescein angiography revealed perifoveal leakage in OD. Laboratory evaluations, including infectious work-up, were unremarkable. While the patient's CME initially improved after initiation of therapy with topical prednisolone and oral acetazolamide, the CME later recurred after systemic acetazolamide was stopped due to intolerable side effects. Despite multiple therapeutic approaches, including topical and systemic corticosteroids (both oral and intravenous) and topical interferon alpha2b over the course of more than one year, the patient's visual acuity continued to worsen with increasing intra- and subretinal fluid in the macula. Due to the refractory CME, the patient was started on monthly infusions of anti-interleukin (IL)-6 receptor tocilizumab (8 mg/kg) with three days of methylprednisolone infusions (500 mg/day). After nine cycles of treatment, SD-OCT demonstrated restoration of normal foveal contour with complete resolution of CME.Conclusions and Importance: IL-6 inhibition with tocilizumab may be a safe and effective treatment for refractory CME. Further studies are needed to elucidate the nature and extent of therapeutic IL-6 inhibition in CME.

    View details for DOI 10.1016/j.ajoc.2020.100881

    View details for PubMedID 32875161

  • Severe vision loss secondary to retinal arteriolar occlusions after multiple intravitreal brolucizumab administrations. American journal of ophthalmology case reports Jain, A. n., Chea, S. n., Matsumiya, W. n., Halim, M. S., Yaşar, Ç. n., Kuang, G. n., Sepah, Y. J., Khanani, A. M., Do, D. V., Nguyen, Q. D. 2020; 18: 100687

    Abstract

    To describe a case of unilateral retinal arteriolar occlusion following multiple intravitreal brolucizumab injections for neovascular age-related macular degeneration (nAMD).A 92-year-old Caucasian woman presented with blurry vision in her left eye (OS) after receiving the third dose of intravitreal brolucizumab. At the time of presentation, visual acuity (VA) was 20/40 in her right eye (OD) and had decreased from 20/150 to count finger (CF) at 1-foot OS. On examination, there was no evidence of active inflammation in the anterior chamber OU. Dilated fundus examination showed no vitritis in OD and 1+ vitreous cells OS, flame-shaped hemorrhage at the superior optic disc margin, and retinal whitening surrounding the proximal portion of the supero-temporal branch of the central retinal artery. There were drusen in OS and retinal pigment epithelial (RPE) changes in the maculae of OU. Intra-arteriolar greyish deposits were seen OS. Fluorescein angiography (FA) showed hyper-fluorescence in the maculae corresponding to fibrovascular pigment epithelial detachments (PED) OU. No peri-vascular leakage was noted OU. Delayed filling of multiple arterioles in early and late phases OS was observed on FA. The patient was diagnosed with retinal arteriolar occlusion associated with repeated intravitreal brolucizumab administrations.Retinal arteriolar occlusion with severe vision loss, possibly secondary to inflammatory responses, can occur after subsequent intravitreal brolucizumab injections, even if no inflammation occurred after initial administrations. Vaso-occlusive disease should be considered as a potential ocular complication, with acute as well as delayed onset, following intravitreal brolucizumab therapy.

    View details for DOI 10.1016/j.ajoc.2020.100687

    View details for PubMedID 32280811

    View details for PubMedCentralID PMC7139151