This multicenter study aimed to assess the short-term effectiveness and safety of faricimab in treatment-naïve patients with wet age-related macular degeneration (wAMD) in Japan. We retrospectively ...reviewed 63 eyes of 61 patients with wAMD, including types 1, 2, and 3 macular neovascularization as well as polypoidal choroidal vasculopathy (PCV). Patients received three consecutive monthly intravitreal injections of faricimab as loading therapy. Over these 3 months, visual acuity improved gradually compared to baseline. Moreover, the central foveal thickness decreased significantly at 1, 2, and 3 months compared to baseline (p < 0.0001). At 3 months after initiation of faricimab therapy, a dry macula (defined as absence of intraretinal or subretinal fluid) was achieved in 82% of the eyes. Complete regression of polypoidal lesions was observed in 52% of eyes with PCV. Subfoveal choroidal thickness also decreased significantly at 1, 2, and 3 months compared to baseline (p < 0.0001). Although retinal pigment epithelium tears developed in two eyes, there were no other ocular or systemic complications observed during the 3 months of loading therapy. In conclusion, loading therapy using faricimab resulted in improved visual acuity and retinal morphology in Japanese patients with wAMD without particular safety issues.
Background
To analyze clinical features, treatment, complications, and visual outcomes of ocular sarcoidosis at a tertiary center in Tokyo.
Methods
Clinical records of 53 patients with ocular ...sarcoidosis (“definite” or “presumed”) presenting between 2013 and 2018 to the Kyorin Eye Center were retrospectively reviewed. Diagnosis was based on the revised criteria of the International Workshop on Ocular Sarcoidosis.
Results
Definite (biopsy-proven) disease was present in 87% of patients and presumed disease in 13%. The mean age at presentation was 58 years (13–81 years) and 68% were women. The mean follow-up was 34 months (6–70 months). Forty-five patients (85%) had panuveitis, and the most common ocular clinical sign suggestive of ocular sarcoidosis was bilaterality (92%). Ocular complications were observed in 93 eyes (85%), most commonly cataract (73%), epiretinal membrane (24%), macular edema (24%) and glaucoma (19%). Thirty-one eyes (30%) underwent cataract surgery and 12 eyes (12%) underwent pars plana vitrectomy. Ten patients (19%) received systemic corticosteroid therapy and 33 eyes (32%) received periocular corticosteroid injections. The best-corrected visual acuity was 1.0 or better in 51% of eyes at presentation, 57% at 6 months, 50% at 12 months, and 58% at 36 months.
Conclusions
The majority of ocular sarcoidosis patients were women, had bilateral disease and panuveitis involvement. Most eyes maintained good visual acuity, although surgical interventions for cataract and epiretinal membrane were common.
Braking indices of pulsars present a scientific challenge as their theoretical calculation is still an open problem. In this paper, we report results of a study regarding such calculation which ...adapts the canonical model (which admits that pulsars are rotating magnetic dipoles) basically by introducing a compensating component in the energy conservation equation of the system. This component would correspond to an effective force that varies with the first power of the tangential velocity of the pulsar's crust. We test the proposed model using data available and predict braking indices values for different stars. We comment on the high braking index recently measured of the pulsar J1640-4631.
High flow rate in nozzle jet flushing is effective for smooth debris exclusion from the wire EDM gap, but this leads to large wire deflection and vibration, resulting in the wire breakage and low ...shape accuracy. In this paper, the influence of nozzle jet flushing on wire breakage was experimentally investigated with varying the machined kerf length and machining conditions. Furthermore, the flow fields and debris residence time in the kerf, hydrodynamic stress distributions acting on the wire, and wire deflections were numerically analyzed. Based on the analyzed results, the causes of wire breakage were discussed.
To analyse clinical features, systemic associations, treatment and visual outcomes in Japanese patients with scleritis.
Clinical records of 83 patients with scleritis who presented between 1998 and ...2008 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo, were reviewed.
Of the 83 patients, 57 (69%) had diffuse anterior scleritis, 9 (11%) had nodular anterior scleritis, 8 (10%) had necrotising anterior scleritis and 9 (11%) had posterior scleritis. There was a slight predominance of women (55%) and unilateral disease (53%). Mean age at presentation was 51 years (range 12-82 years). Secondary ocular complications were observed in 78% of patients, including anterior uveitis in 25% and increased intraocular pressure in 40%. Investigation revealed a systemic disease association in 24 patients (29%), including six patients (7.2%) with tuberculosis and 18 patients (22%) with rheumatologic disease. Thirty-five patients (42%) received systemic corticosteroid treatment and 19 patients (23%) received immunosuppressive agents. All 17 patients with necrotising anterior scleritis or posterior scleritis were treated with oral corticosteroids and/or immunosuppressive drugs. Visual outcomes were generally good; however, poorer outcomes were observed in eyes with necrotising scleritis, mostly due to corneal ulceration or corneal opacification.
A systemic disease association was identified in 29% of Japanese patients with scleritis. Roughly one-half of patients received oral corticosteroids and/or immunosuppressive drugs to control inflammation, with generally good visual outcomes.
COVID Vaccine-Associated Uveitis Habot-Wilner, Zohar; Neri, Piergiorgio; Okada, Annabelle A. ...
Ocular immunology and inflammation
ahead-of-print, Številka:
ahead-of-print
Journal Article
Recenzirano
Following the pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, different vaccines were developed and approved by the main medical ...authorities under emergency protocol regulations. Although highly effective and well-tolerated in most patients, vaccines can uncommonly cause ocular adverse effects. In this article, the current evidence related to vaccine-associated uveitis is reviewed.
A literature review of uveitis post various SARS-CoV-2 vaccinations.
Uveitis was reported following various forms of vaccinations but was more commonly seen following the Pfizer mRNA vaccine which is the most used vaccination worldwide. In western countries, the most common uveitis is mild anterior uveitis, developing within a week of first or subsequent vaccination with good resolution following appropriate topical steroid therapy in most cases. Posterior uveitis and particularly Vogt-Koyanagi-Harada disease was more prevalent in Asia. Uveitis may develop among known uveitis patients and those with other autoimmune diseases.
Uveitis following Covid vaccinations is uncommon and has a good prognosis.
The uveitis community deemed this project necessary as currently the agreement among uveitis experts on diagnosis is modest at best.3 The SUN Working Group elected to focus on improving clinical ...research in the field of uveitis, as this effort was most likely to have a major impact on improving the management of patients with uveitis. The first step was using formal consensus techniques to standardize uveitis clinical research reporting, which has gained widespread acceptance.2 The next step was developing standardized terminology, striving for harmonization with Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) so that the definitions could be applied to future bioinformatics work.4 The third step was the development of classification criteria for 25 of the most common uveitic entities.5 Classification criteria exist for the purposes of clinical research and are not “diagnostic criteria” for the purposes of treating individual patients.6 Although classification criteria optimize sensitivity and specificity, if a trade-off is needed, they emphasize specificity to select a homogeneous group of patients to be entered into clinical research studies. Additional features that do not add to diagnostic accuracy are not included in the final criteria.1,5 Mutton fat keratic precipitates, sometimes termed “granulomatous” (a term more properly reserved for histopathology), did not discriminate adequately among the various diseases.1,5 Similarly, hypopyon, despite its classic nature, was not selected for Behçet disease criteria owing to its low frequency and presence in other uveitic diseases.1 Sets of features were compared among cases from different regions of the world to ensure worldwide applicability of the final criteria.1 The final product had a high degree of accuracy, >93% for all classes of disease and 94% for panuveitides, with a 0% misclassification rate for Behçet disease uveitis.
To provide guidance on the management of patients with neovascular age-related macular degeneration and its subtypes who respond poorly to anti-vascular endothelial growth factor (anti-VEGF) therapy, ...and to identify cases where suspending anti-VEGF treatment may be warranted.
Through a literature review and the combined knowledge and clinical experience of retinal experts, the Steering Committee of the Bayer-sponsored Vision Academy developed an algorithm for determining when to suspend anti-VEGF treatment of neovascular age-related macular degeneration in cases of futility.
Consideration of factors that may cause suboptimal response to anti-VEGF therapy, such as undertreatment or misdiagnosis of the underlying condition, and factors that may preclude continued treatment, such as injection- or drug-induced complications, is necessary for adjusting treatment protocols in patients who respond poorly to anti-VEGF. If poor response to treatment persists after switching to an alternative anti-VEGF agent and no change in response is observed after withholding treatment for a predetermined period of time ("treatment pause"), anti-VEGF treatment may be considered futile and should be suspended.
This publication introduces an algorithm to guide the management of neovascular age-related macular degeneration in patients showing poor response to anti-VEGF treatment and provides expert guidance for suspending anti-VEGF treatment in cases of futility.
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