AimTo assess the relevance of therapeutic drug monitoring (TDM) of adalimumab (ADA) treatment for the control of intraocular inflammation and treatment adjustment in chronic non-infectious uveitis (CNIU).MethodsRetrospective study of CNIU patients treated with ADA and for whom at least one dosage of serum ADA level and an antibodies against ADA (AAA) serology were performed, between June 2003 and July 2019.ResultsA total of 44 ADA-treated patients benefited from a TDM. A total of 48/79 (61%) TDM were performed in responders, 11/79 (14%) in primary non-responders, and 20/79 (25%) in secondary non-responders. Responders had significantly higher ADA levels than non-responders (p=0.0004). AAA were detectable in six patients, they were primary non-responders (n=2), secondary non-responders (n=3) or responders (n=1). In the five non-responders and immunised patients, ADA was switched (to golimumab or methotrexate). Among non-responders, TDM led to an increased frequency of injections 12/31 (38%), increased dose 1/31 (3%) and switch of treatment 10/31 (32%) (one missing data). No modification of biotherapy was performed 7/31 (22%) and only local or oral corticotherapy was adjusted. In 24/31 cases of therapeutic adjustment in non-responders, an improvement was observed in 87% of cases. Among responders for whom the ADA level was above the efficacy threshold, the frequency of injections was decreased for 15/31 (48.4%) cases and no relapse was observed in 12/15 (80%) cases.ConclusionTDM of ADA treatment proved relevant to provide CNIU patients with a personalised and optimised treatment course (in terms of frequency and type of drug).
Aim:To assess the efficacy of focal photocoagulation of capillary macroaneurysms (CMA) to reduce the burden of intravitreal injections (IVI) in patients with macular edema (ME). Materials and Methods: Retrospective multicenter study in patients with diabetic ME or ME secondary to retinal vein occlusion (ME-RVO). CMA associated with ME were selectively photocoagulated. Patients were followed for one year after photocoagulation. Results: 93 eyes of 76 patients were included in this study. At 6 months after the laser (n = 93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 2.52 to 1.52 at 6 months, p < 0.001). The mean BCVA remained stable (0.32 and 0.31 logMAR at baseline and 6 months, p = 0.95). At 12 months (n = 81/93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 4.44 to 2.95 at 12 months, p < 0.001), while the mean BCVA remained stable (0.32 and 0.30 logMAR at baseline and 12 months, p = 0.16). Conclusion: Focal laser photocoagulation of CMA seems to be effective and safe for reducing the burden of IVI in patients with ME. Their screening during the follow-up should be considered closely.
Purpose:
To compare the impact of total corneal astigmatism (TCA) estimated with the Abulafia-Koch formula (TCA
ABU
) versus measured by Total Keratometry (TK), swept-source optical coherence tomography (OCT) coupled with telecentric keratometry (TCA
TK
) on the refractive outcomes after cataract surgery with toric intraocular lens (IOL) implantation.
Methods:
Two hundred one eyes of 146 patients who underwent cataract surgery with toric IOL implantation (XY1AT; HOYA Corporation) were included in this single-center, retrospective study. For each eye, TCA
ABU
(estimated from the anterior keratometry values measured with the IOLMaster 700 [Carl Zeiss Meditec AG]) and TCA
TK
(measured using TK IOLMaster 700) were entered into the HOYA Toric Calculator. Patients were operated on based on TCA
ABU
. For each eye, centroid and mean absolute error in predicted residual astigmatism (EPA) were calculated according to TCA used (TCA
ABU
or TCA
TK
). The cylinder power and the axis of the posterior chamber IOL were compared.
Results:
The mean uncorrected distance visual acuity was 0.07 ± 0.12 logMAR, the mean spherical equivalent was 0.11 ± 0.40 D, and mean residual astigmatism was 0.35 ± 0.36 D. Mean centroid EPA was 0.28 D at 132° with TCA
ABU
and 0.35 D at 148° with TCA
TK
(
P
(x) < .001;
P
(y) < .01). Mean absolute EPA was 0.46 ± 0.32 D with TCA
ABU
and 0.50 ± 0.37 D with TCA
TK
(
P
< .01). In the with-the-rule astigmatism subgroup, a deviation from the target of less than 0.50 D was achieved in 68% of eyes with TCA
ABU
versus 50% of eyes with TCA
TK
. The proposed posterior chamber IOL was different depending on the calculation methods used in 86% of cases.
Conclusions:
Both calculation methods showed excellent results. However, the predictability error was significantly reduced when TCA
ABU
was used compared to TCA
TK
measured with the IOLMaster 700 in the whole cohort. Finally, TCA was overestimated by TK in the with-the-rule astigmatism subgroup.
[
J Refract Surg.
2023;39(3):171–179.]
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