Adalimumab for the Treatment of Non-Infectious Uveitis: A Real Life Experience.

OBJECTIVE: To describe the efficacy and safety of adalimumab for the treatment of non-infectious uveitis (NIU) in four Uveitis Units from tertiary Spanish hospitals. METHODS: Multicenter and retrospective clinical cohort study including all patients with NIU treated with adalimumab from January 2012 to October 2022 in four uveitis units was performed. Efficacy was measured with the number of relapses, ocular inflammation and reduction in immunosuppression and corticosteroid dosage before and after adalimumab use. We collected data regarding adverse effects and examined the immunogenicity of adalimumab. RESULTS: One hundred and twenty-two patients (59% females), with a mean age of 48.6 years (SD = 14.8) accounting for 217 eyes were included. The majority (92.6%) were Caucasian. Uveitis analyzed were predominantly panuveitis (34.7%), bilateral (77.9%), acute (41.5%), and non-granulomatous (90%). Most of them were immune mediated (42.6%), and the main reason to initiate adalimumab was refractory disease (96.7%). The analysis was statistically significant due to the reduction in the number of immunosuppressive drugs as well as the dose of oral corticosteroids and the number of relapses during follow-up (p < 0.001). The decrease in ocular inflammation parameters and the improvement in visual acuity (p < 0.05) were also significant. There were no deaths due to the drug and only one reported case of serious infection. In total, 10.9% of 73 patients tested developed anti-adalimumab antibodies and 4.1% lupus-like. CONCLUSIONS: We consider adalimumab as a leading drug in the treatment of NIU with high safety and efficacy.

White Dot Syndromes: Report of Three Cases.

Introduction: The term white dot syndromes has been used to refer conditions that differ in their morphology and prognosis. We report three cases of different pathologies encompassed within the white dot syndromes. Case Presentations: Case 1: A 26-year-old female presented with scotoma in her right eye. Fundus examination revealed multiple white dots that demonstrated early hyperfluorescence with late staining on FA. OCT showed discontinuities in inner segment-outer segment junction associated with columnar-shaped outer retinal hyperreflective bands. AF revealed multiple hyperautofluorescent dots around the posterior pole, compatible with multiple evanescent white dot syndrome. The symptoms improved without treatment. Case 2: A 16-year-old male presented with retinal lesions compatible with punctate inner choroidopathy in his right eye. OCT showed lesion in the outer retinal layer. FAF revealed parafoveal hypoautofluorescent dots with early hyperfluorescence and late staining on FFA. After oral corticotherapy, they progress to atrophic scars. Case 3: A 65-year-old male presented with scotoma and decreased vision in his right eye. OCT showed hyperreflectivity in the outer layer that progresses to a large atrophic plaque with foveal affectation. FAF demonstrated hyperautofluorescent placoid lesion occupying macular area, compatible with acute posterior multifocal placoid pigment epitheliopathy. Retinal lesions improved with systemic corticosteroids. Conclusion: The FAF pattern helps know the distribution of the lesions. It represents a noninvasive method that has been shown to be useful in the diagnosis and monitoring of white dot syndromes.

Towards an Integrated Care Organisation from a CEO Perspective.

Many experimental projects towards Person-Centred Care (PCC) are successful in the early stages, but founder when the attempt is made to scale them up to encompass the whole organisation. This case study therefore focusses on one manager's attempts to extend the successes of a preliminary project 'Etxean Ondo' that aimed to provide adequate support for the elderly living at home or in nursing homes, as well as for their families and care professionals. Through in-depth interviews with stakeholders, this qualitative study, based on Grounded Theory, sets out to analyse which behaviours, attitudes and values on the part of management appeared to favour full-integration of PCC in this wider context. Analysis of the data gathered allowed the researcher to generate an experimental case model which suggests how the extrinsic, intrinsic and transcendent motivation of stakeholders can be aligned with the goals of upper management to promote full-integration of PCC in such a way as to generate trust, increase participant engagement and create a win-win situation for all. Whilst this is clearly an experimental project, it is hoped that the model provided may prove helpful to other researchers and managers interested in pioneering this type of comprehensive organisational strategic change towards integration.

Intraocular lens opacification after nonpenetrating glaucoma surgery with mitomycin-C.

A 58-year-old woman had successful phacoemulsification with intraocular lens (IOL) implantation in January 2001. Two years later, nonpenetrating glaucoma surgery with mitomycin-C (MMC) 0.02% was performed for uncontrolled glaucoma. Two months later, opacification of the anterior IOL surface was observed. The IOL was removed and a hydrophobic acrylic AcrySof IOL (Alcon) implanted. The opacified IOL was studied by flame atomic absorption spectrometry, which showed the presence of calcium carbonate. A new IOL of the same model was placed in an aqueous solution with calcium carbonate and basic pH, and the same opacification developed. We hypothesize that the change in aqueous humor pH after glaucoma surgery and the characteristics of the IOL precipitated deposition of calcium.

Surgical treatment of a dislocated intraocular lens-capsular bag-capsular tension ring complex.

We describe a surgical technique for managing late dislocation of an intraocular lens-capsular bag-capsular tension ring (IOL-CB-CTR) complex. Two 10-0 polypropylene sutures are placed transsclerally over and under the CTR through the anterior and posterior capsules to capture the CTR, which then is retracted and sutured through the sclera. The same maneuver is performed 180 degrees away. This simple, easy, effective procedure can be performed with a small corneal incision and does not require extraction of the IOL-CB complex. Although the CTR does not completely prevent IOL-CB dislocation, it provides the possibility of suturing the IOL-CB to the sulcus without replacing the IOL.

Extraction of endocapsular tension ring after phacoemulsification in eyes with pseudoexfoliation.

PURPOSE: To describe an easy and effective surgical technique for removing the endocapsular tension ring (CTR) after phacoemulsification. DESIGN: New surgical technique. METHODS: One 10-0 polypropylene suture needle is passed through the hole at one end of the CTR. Then, the CTR is introduced into the capsular bag before phacoemulsification. If the posterior capsule ruptures, the CTR can be removed by pulling the suture toward the corneal incision and rotating the CTR to remove it. RESULTS: We performed this technique in 23 cases with a risk of zonular damage and did not encounter complications at any point in the procedure. CONCLUSIONS: We recommend this procedure in eyes with risk of zonular dialysis and posterior capsule rupture, especially in advanced pseudoexfoliative cataracts or if the surgeon has limited experience with these cases.