Bilateral uveitis after phakic intraocular lens implantation and management with adalimumab

Soheilian, Masoud; Jabbarpourbonyadi, Mohammadhossein; Soheilian, Roham; Peyman, Gholam A.

doi:10.1016/j.jcrs.2012.02.026

Cited by 13 publications

(16 citation statements)

References 6 publications

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“… 19 However, the number of SO patients is limited; thus, such encounters are limited to case reports. 15 , 16 , 19 Despite the limited availability of approved non-steroidal immunosuppressive therapy for non-infectious uveitis in Japan, these two detailed cases show the successful treatment of SO with adalimumab. These two cases also reveal the importance of the early initiation of adalimumab in glaucoma or diabetic patients, in order to avoid the side effects of corticosteroid treatment.…”

Section: Discussionmentioning

confidence: 87%

“… 14 Soheilian et al first reported on the effectiveness of adalimumab for a patient with refractory SO after phakic intraocular lens implantation. 15 Kase et al described the use of adalimumab therapy for refractory paediatric SO after trauma. 16 These cases show the successful use of adalimumab therapy for SO patients with a history of glaucoma filtration surgery.…”

Section: Discussionmentioning

confidence: 99%

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Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab

Hiyama

Harada

Kiuchi

2019

American Journal of Ophthalmology Case Reports

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PurposeSympathetic ophthalmia (SO) is an autoimmune, bilateral, granulomatous panuveitis, which occurs following penetrating eye injury or eye surgery. We report two cases of refractory SO in patients with a history of trabeculectomy, which were treated effectively with adalimumab.ObservationsCase 1: A 69-year-old male with a history of trabeculectomy for rubeotic glaucoma of the right eye, secondary to diabetic retinopathy 8 years prior, presented with a decrease in visual acuity of the left eye due to SO. After two rounds of pulse corticosteroid therapy (intravenous infusion of 1 g methylprednisolone/day for 3 days), serous retinal detachment (SRD) was resolved. As oral prednisolone was tapered to avoid deterioration of the diabetes mellitus, we shifted to other immunosuppressive therapies to control inflammation. Methotrexate 6mg/week (0.1 mg/kg) was introduced first, but was discontinued owing to side effects. After 6 months of cyclosporine 100 mg/day (1.5 mg/kg, max. dose 2.3 mg/kg), the SRD relapsed. Adalimumab was then introduced, which led to remission of SRD, and inflammation was controlled for 7 months.Case 2: A 43-year-old male, with a history of trabeculectomy for primary open-angle glaucoma of the right eye 4 years prior, presented with blurred vision in the right eye. Optical coherence tomography revealed SRD and choroidal thickening in both eyes. Pulse corticosteroid therapy (intravenous infusion of 1 g methylprednisolone/day for 3 days) was initiated, followed by oral prednisolone. SRD gradually improved, but it did not resolve completely. Given the severe visual loss the patient had experienced due to the primary open-angle glaucoma, oral prednisolone was tapered quickly to avoid steroid-induced intraocular pressure (IOP) elevation. Cyclosporine 125 mg/day (1.8 mg/kg, max. dose 2.1 mg/day) was introduced first, but was later discontinued because of side effects. Adalimumab was then administered, causing the SRD to disappear; and IOP was well-controlled. After the introduction of adalimumab, control of intraocular inflammation was achieved and IOP remained within the target range for 7 months.Conclusions and importanceSO requires long-term immunosuppressive treatment. Adalimumab is an effective treatment in cases of steroid or immunosuppressant refractory SO, particularly for glaucoma patients, in whom long-term steroid therapy should be avoided.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab

Hiyama

Harada

Kiuchi

2019

American Journal of Ophthalmology Case Reports

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“…So konnte bei einem 7-jährigen Kind mit therapierefraktärer SO Infliximab erfolgreich eingesetzt werden [37]. Ebenfalls zeigte Adalimumab bei SO nach Trauma im Kindesalter ein gutes Ergebnis [38]. Weitere Kasuistiken zu Anti-TNF-α-Therapie und SO liegen u. a. von Payal u.…”

Section: Bildgebende Verfahrenunclassified

Sympathetic Ophthalmia – a Contribution to Immunology, Clinic and Current Imaging

Rua

Pohlmann

Pleyer

2020

Klin Monbl Augenheilkd

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Background Sympathetic ophthalmia (SO) is a rare inflammation of an operated or injured eye that spreads to the fellow eye. It is typically a bilateral granulomatous panuveitis. The traumatized eye is referred to as inciting eye and the fellow eye as sympathizing eye. The pathophysiology of the disease is not entirely understood, but there is strong evidence of an autoimmune genesis. Patients/Material and Methods A selective literature search on epidemiology, immunology, clinical features and risk factors of SO was carried out. In addition, our own experience using multimodal imaging for this clinical entity was introduced. Results In the literature, the incidence after traumatic eye injuries is 0.1 – 3% and approximately 0.01% after intraocular surgery. Among the iatrogenic causes, vitreoretinal surgery has the highest rate of SO, presumably due to disruption of the blood-retinal barrier and involvement of retinal and choroidal tissue, which are susceptible to anterior traction, phthisis and chronic inflammation. In 90% of patients, the disease develops within a year following the eliciting event and is associated with a potentially bilateral risk of blindness. Typical symptoms include bilateral visual impairment with photophobia, dull pain and photopsia. The spectrum of clinical manifestations ranges from granulomatous anterior uveitis and vitritis, to choroiditis, serous retinal detachment and Dalen-Fuchs nodules in the context of posterior involvement. The diagnosis of SO is generally based on clinical presentation and is supported by imaging methods. These primarily comprise fluorescein and indocyanine green angiography, which are increasingly being supplemented by non-invasive methods such as optical coherence tomography. They can provide important information for assessment of severity, differential diagnosis as well as for disease monitoring. The differential diagnosis includes i. a. Vogt-Koyanagi-Harada syndrome, ocular sarcoidosis and the rare phacoanaphylactic endophthalmitis. Immediate systemic high-dose steroid therapy is used as initial treatment. The course of the disease is often relapsing to chronic progressive. Immunomodulators such as ciclosporine A, azathioprine, cyclophosphamide, mycophenolate mofetil, and biologics are increasingly being used and contribute to the significantly better prognosis of the disease. Generally, SO can be triggered by any kind of intraocular intervention. Conclusion SO remains a threatening clinical diagnosis that poses diagnostic and therapeutic challenges. It can be triggered post-traumatic, but also any intraocular surgery. This should be taken into account when assessing the indication for intraocular eye surgery, especially in eyes with reduced visual outcome.

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“…4 Another case of an adult with SO refractory to multiple immunosuppressants achieved inflammation resolution with addition of adalimumab, a recombinant human monoclonal anti-TNF-α antibody dosed subcutaneously. 5 In a series of 131 patients with refractory uveitis, addition of adalimumab reduced immunosuppressive load by 50% in 85% of patients. 6 …”

Section: Commentmentioning

confidence: 99%

Adalimumab for Pediatric Sympathetic Ophthalmia

et al. 2014

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Bilateral uveitis after phakic intraocular lens implantation and management with adalimumab

Cited by 13 publications

References 6 publications

Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab

Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab

Sympathetic Ophthalmia – a Contribution to Immunology, Clinic and Current Imaging

Adalimumab for Pediatric Sympathetic Ophthalmia

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