Intravitreal fluocinolone acetonide 0.19 mg (Iluvien®) for the treatment of uveitic macular edema: 2-year follow-up of 20 patients.

PURPOSE: To evaluate intravitreal 0.19 mg fluocinolone acetonide implant (FAi) (Iluvien®) for the treatment of chronic non-infectious uveitis with associated cystoid macular edema (CME). METHODS: A retrospective review of medical reports from a single Danish tertiary centre including 20 patients (20 eyes), treated with 0.19 mg FAi for non-infectious uveitic CME. The primary endpoints were change in best corrected visual acuity (BCVA) and central retinal thickness (CRT). The secondary endpoints were recurrence rate, change in systemic treatment, and intraocular pressure (IOP). RESULTS: Mean follow-up of the 20 eyes was 2.3 ± 1.1 years. BCVA improved at 6 (p = 0.13), 12 (p = 0.05), 18 (p = 0.03), and 24 months and CRT decreased at 6 (p = 0.004), 12 (p = 0.006), 18, and 24 months after 0.19 mg FAi. Within 18 months after implantation, four of 14 patients (28.6%) relapsed. Three of five patients discontinued systemic corticosteroids within 4 months and one patient continued with reduced dose. Five of 10 patients receiving disease-modifying antirheumatic drugs (DMARDs) at time of implantation discontinued within 1 year. No patients started new systemic treatment. Eight eyes were treated with topical IOP-lowering medication at the time of implantation, of these two later underwent trabeculectomy. There were no complications associated with previous glaucoma surgery. CONCLUSION: This long-term follow-up study showed that intravitreal treatment with 0.19 mg FAi should be considered in the treatment of chronic non-infectious uveitic CME in selected patients. This treatment is safe even in selected glaucoma patients and may offer reduction or cessation of local or systemic anti-inflammatory treatment.

Spondylitis-psoriasis-enthesitis-enterocolitis-dactylitis-uveitis-peripheral synovitis (SPEED-UP) treatment.

Axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), psoriasis, inflammatory bowel disease (IBD), and noninfectious uveitis form a distinct group among the immune mediated inflammatory diseases. Thus, many patients suffer from more than one of these disease manifestations. Here, we will use the term spondylitis-psoriasis-enthesitis-enterocolitis-dactylitis-uveitis-peripheral synovitis (SPEED-UP) spectrum disease. The aim is to review the new targeted pharmacological treatment options for all these diseases. All biological or targeted synthetic drugs with U.S. Food and Drug Administration (FDA) or European Medicines Agency (EMA) approval for any of the diagnoses axSpA, PsA, psoriasis, IBD, or non-infectious uveitis were included. Some of the drugs have documented efficacy in more than one of the diseases, e.g. tumor necrosis factor (TNF) inhibitors. However, other drugs are particularly effective for a specific inflamed tissue and approved in only one or two of the disease entities, e.g. abatacept for peripheral arthritis and vedolizumab for inflammatory bowel disease. This contributes with bedside to bench understanding of the immunology underlying this disease spectrum and provides clinicians with an overview that can assist stratified treatment decisions. We hope that this review will help guide clinicians to speed up treatment of patients with this disease spectrum.

[Hydroxychloroquine treatment rarely causes eye damage when used correctly].

Hydroxychloroquine (HCQ) is used in the treatment of rheumatologic diseases including systemic lupus erythematosus, rheumatoid arthritis and other conditions. Besides reducing joint and skin inflammation, growing evidence shows other beneficial effects of HCQ, e.g. a positive effect on cardiovascular risk, pregnancy outcome, and flare reduction. In this review, we wish to emphasise "best practice" in the use of HCQ based on the present literature, to show the typical eye damage, which may occur, and to highlight which precautions should be made, so that retinal injury does not occur.

"Ant-egg" cataract revisited.

PURPOSE: Hereditary congenital cataract varies immensely concerning location and form of the lens opacities. A specific and very rare phenotype is called "ant-egg" cataract first described in 1900. "Ant-eggs" have previously been examined using light microscopy, backscattered electron imaging and X-ray scans and electron microscopy. The purpose of this study was to further characterize "ant-egg" cataract using modern technology and display the history of the "ant-eggs" after cataract extraction. METHODS: "Ant-eggs" were examined using Heidelberg SPECTRALIS Optical Coherence Tomography (OCT)(Heidelberg Engineering, Heidelberg, Germany). Ten "ant-eggs" were extracted; four of these as well as control tissue were analyzed by mass spectrometry (AB Sciex). Proteins were identified and their approximate abundances were determined. Immunohistochemical staining was carried out on the remaining "ant-eggs" for cytokeratin and S100. RESULTS: In anterior OCT-images, the "ant-egg" structures are localized on the iris. Comparative pictures showed that they stayed in the same location for more than 45 years. Mass spectrometry of "ant-eggs" yielded a proteome of 56 different proteins. Eighteen of the 56 "ant-egg" proteins (32 %) were neither present in our controls nor in a known fetal lens proteome. Among these were cytokeratin and Matrix-Gla protein. Immunohistochemical reactions were positive for cytokeratin and S100. CONCLUSIONS: This study demonstrates the previously unknown protein composition of the "ant-egg" structures in "ant-egg" cataract. Eighteen of these proteins are not natively found in the human lens. Moreover, "ant-eggs" do not vary over time, after cataract extraction, regarding size and location.

Changes in Corneal Power After Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To examine the optical effects of Descemet stripping automated endothelial keratoplasty (DSAEK) by evaluating changes in anterior and posterior corneal curvatures and aberrations. METHODS: Eighty-three eyes treated using DSAEK combined with cataract surgery (the DSAEK group) and 41 control eyes of healthy patients (the control group) were included. Patients were examined before and 1 year after surgery with autokeratometry and Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany). The preoperative posterior corneal curvature was estimated from the anterior corneal curvature. RESULTS: The mean intended postoperative refraction in the DSAEK group was -0.75 ± 0.62 diopters (D), which was statistically different from the achieved refraction of +0.50 ± 0.93 D at the 1-year follow-up (P < .001). The average biometry prediction error was a hyperopic shift of +1.27 ± 0.80 D. Anterior corneal power was significantly higher before than after DSAEK with a difference of -0.63 ± 0.68 D (P = .03) correlating significantly with the hyperopic change (r(2) = 0.23, P < .01). The posterior corneal power after DSAEK showed a significant steepening of -0.69 ± 0.38 D (P < .01) from the estimated preoperative power and a difference of -0.64 ± 0.38 D (P < .01) from the posterior corneal power in the control group. The change correlated significantly with the hyperopic change (r(2) = 0.10, P < .01). The combined changes in anterior and posterior keratometry increased the correlation coefficient to r(2) = 0.34 (P < .01). Significant differences were observed for total higher-order aberrations root mean square and coma root mean square after DSAEK compared to controls. No significant changes were observed in spherical aberration. CONCLUSIONS: The hyperopic shift in the DSAEK group can be explained by changes in anterior and posterior corneal surfaces. Spherical aberration was not changed by DSAEK, suggesting that aspherical intraocular lenses may be implanted on the same indications as in normal cataract surgery.

Intraocular pressure and corneal biomechanics in Fuchs' endothelial dystrophy and after posterior lamellar keratoplasty.

PURPOSE: To evaluate the precision of techniques for measuring intraocular pressure (IOP) in corneas with presumably altered biomechanical properties. METHODS: Intraocular pressure was measured with a Goldmann applanation tonometer (GAT), ocular response analyzer (ORA) and dynamic contour tonometer (DCT) in 70 eyes. Thirty-five eyes were normal corneas, 18 eyes had Fuchs' endothelial dystrophy, and 17 eyes had undergone Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery. Corneal hysteresis (CH), corneal resistance factor (CRF) as well as central corneal thickness (CCT) were recorded with the ORA. RESULTS: The measured cornea-corrected IOP using ORA was significantly higher than GAT in all three groups (p< 0.001). The DCT differed significantly from the Goldmann only in the Fuchs' group (p= 0.04). The Goldmann and DCT showed no significant between-group differences, whereas IOP measured with the ORA was different between groups (p< 0.001). CH in the DSEAK group differed significantly from the controls (p< 0.001), but there was no significant difference between the DSEAK and Fuchs' groups (p= 0.21). CCT did not differ significantly between the DSAEK and Fuchs' group (p= 0.47). However, both these groups differed significantly from the controls (p< 0.001). CONCLUSION: Corneal hysteresis and CRF are reduced in Fuchs' endothelial dystrophy as well as after posterior lamellar keratoplasty. GAT and DCT seem to measure IOP correctly in patients with Fuchs' endothelial dystrophy as well as after posterior lamellar keratoplasty. Corneal-corrected IOP as measured with the ORA appears to overestimate IOP in patients with Fuchs' endothelial dystrophy as well as after posterior lamellar keratoplasty.