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Ocular Immunology and Inflammation Jul 2022The immune checkpoint inhibitors (ICPIs) comprise a class of oncologic immunotherapies. The most recent US Food and Drug Administration-approved ICPI is cemiplimab...
PURPOSE
The immune checkpoint inhibitors (ICPIs) comprise a class of oncologic immunotherapies. The most recent US Food and Drug Administration-approved ICPI is cemiplimab (Libtayo®). Cemiplimab, like the other ICPIs, blocks checkpoint receptors in order to disinhibit T-cells so that they may detect and eliminate tumor cells. Consequently, treatment with ICPIs is associated with immune-related adverse events including uveitis.
METHODS
Case report.
RESULTS
A 63-year-old man with a history of metastatic squamous cell carcinoma developed blurry vision 3 months after starting treatment with cemiplimab. The patient was found to have posterior uveitis with retinal vasculitis that was successfully controlled with discontinuation of the medication as well as treatment with local and systemic steroids.
CONCLUSION
Similar to other ICPIs, uveitis may be associated with cemiplimab. In the setting of posterior uveitis, treatment may require cessation of cemiplimab and intensive steroid treatment.
Topics: Antibodies, Monoclonal, Humanized; Humans; Immune Checkpoint Inhibitors; Male; Middle Aged; Skin Neoplasms; Uveitis; Uveitis, Posterior
PubMed: 33793370
DOI: 10.1080/09273948.2021.1872649 -
Ocular Immunology and Inflammation Sep 2023Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide, affecting individuals acrossdifferent age groups. The key to reducing vision loss includes... (Review)
Review
INTRODUCTION
Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide, affecting individuals acrossdifferent age groups. The key to reducing vision loss includes prompt diagnosis and treatment. However, despite the prevalence of ocular toxoplasmosis, there has been little consensus regarding its pathophysiology,clinical features, diagnosis, and especially management.
METHODS
The data sources were literature reviews, including Pub Med and Medline databases. Search terms included toxoplasmosis, retinitis, vasculitis, vitritis, uveitis alone or in combination with, serum, aqueous, vitreous eye, ocular and review.
RESULTS
In this review paper, we have sought to provide an overview of the pathophysiology, epidemiology, and clinical features of the disease, both based on current literature and our own clinical experience. We have also discussed the use of serology, ocular fluid, and ophthalmic investigations that could further facilitate the diagnosis of ocular toxoplasmosis.Different management strategies have been reported worldwide, including newer approaches such as local therapy.
CONCLUSION
A better understanding of critical aspects of ocular toxoplasmosis will hopefully lead to reduced morbidity, including blindness associated with this condition.
Topics: Humans; Toxoplasmosis, Ocular; Eye; Uveitis; Uveitis, Posterior; Retinitis
PubMed: 36095008
DOI: 10.1080/09273948.2022.2117705 -
Journal Francais D'ophtalmologie Apr 2020Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized... (Review)
Review
Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized pre-therapeutic evaluation providing diagnostic certainty, but some simple tests allow us to identifiy the main etiologies. The ophthalmologist identifies the type of uveitis, and the internist completes the investigations according to the ophthalmologist's findings. Fundus photographs, optical coherence tomography, and fluorescein and indocyanine green angiography should be considered during diagnosis and follow-up. Ocular complications of uveitis are numerous. They require close monitoring and specific medical and sometimes surgical management. The growing number of available drugs makes it possible to optimize the management of these conditions with varied etiologies and presentations. Currently, systemic corticosteroids remain the mainstay of therapy, and other alternatives are considered in the case of poor tolerance, steroid resistance or dependence. The choice of a systemic, periocular or intravitreal treatment depends on several factors: chronicity or recurrence of uveitis, duration, bilaterality, association with a systemic inflammatory disease, the presence of contraindications to certain treatments, and also socioeconomic constraints. It is of the utmost importance to find the best compromise allowing tight control of ocular inflammation by means of adapted systemic and/or local treatment while avoiding the main complications.
Topics: Glucocorticoids; Humans; Immunosuppressive Agents; Panuveitis; Tomography, Optical Coherence; Uveitis, Intermediate; Uveitis, Posterior; Vision Disorders
PubMed: 31818505
DOI: 10.1016/j.jfo.2019.03.033 -
The British Journal of Ophthalmology Oct 1990
Review
Topics: Animals; Disease Models, Animal; Humans; Immunotherapy; Uveitis, Posterior
PubMed: 2285687
DOI: 10.1136/bjo.74.10.620 -
Progress in Retinal and Eye Research Mar 2020A diagnostic sign refers to a quantifiable biological parameter that is measured and evaluated as an indicator of normal biological, pathogenic, or pharmacologic... (Review)
Review
A diagnostic sign refers to a quantifiable biological parameter that is measured and evaluated as an indicator of normal biological, pathogenic, or pharmacologic responses to a therapeutic intervention. When used in translational research discussions, the term itself often alludes to a sign used to accelerate or aid in diagnosis or monitoring and provide insight into "personalized" medicine. Many new diagnostic signs are being developed that involve imaging technology. Optical coherence tomography is an imaging technique that provides in vivo quasi-histological images of the ocular tissues and as such it's able to capture the structural and functional modifications that accompany inflammation and infection of the posterior part of the eye. From the hyperreflective inflammatory cells and deposits in the vitreous and on the hyaloid, to the swollen photoreceptors bodies in multiple evanescent white dots syndrome, and from optical differences in the subretinal fluid compartments in Vogt-Koyanagi-Harada disease to the hyporeflective granulomas in the choroid, these tomographical signs can be validated to reach the status of biomarkers. Such non-invasive imaging diagnostic signs of inflammation can be very useful to clinicians seeking to make a diagnosis and can represent a dataset for machine learning to offer a more empirical approach to the detection of posterior uveitis.
Topics: Choroid; Humans; Tomography, Optical Coherence; Uveitis, Posterior; Visual Acuity
PubMed: 31513851
DOI: 10.1016/j.preteyeres.2019.100797 -
Klinische Monatsblatter Fur... Oct 2020Childhood uveitis is an ophthalmological challenge, since on the one hand it often remains asymptomatic and difficult to detect, and on the other hand it often has a...
Childhood uveitis is an ophthalmological challenge, since on the one hand it often remains asymptomatic and difficult to detect, and on the other hand it often has a chronic course and is associated with a high risk of complications threatening the vision. The most important risk factors for childhood uveitis are underlying rheumatic diseases; recommendations for ophthalmological monitoring have been developed together with paediatric rheumatologists. Intermediate and posterior uveitis are rare in children. The therapy must effectively control inflammation and at the same time cause only minimal side effects. Since steroids in particular cause side effects frequently, an immunosuppressive therapy must be initiated early in an interdisciplinary cooperation with paediatric rheumatologists and parents with the goal of minimising steroids.
Topics: Arthritis, Juvenile; Child; Humans; Ophthalmology; Steroids; Uveitis; Uveitis, Posterior
PubMed: 33059377
DOI: 10.1055/a-1252-5281 -
International Ophthalmology Clinics 2011
Review
Topics: Anti-Infective Agents; Child; Diagnosis, Differential; Eye Infections; Humans; Incidence; United States; Uveitis, Posterior
PubMed: 21139480
DOI: 10.1097/IIO.0b013e318200e0ed -
International Ophthalmology Nov 2020To review the current regimens and novel therapeutic modalities in various stages of research and development for the management of non-infectious posterior uveitis... (Review)
Review
PURPOSE
To review the current regimens and novel therapeutic modalities in various stages of research and development for the management of non-infectious posterior uveitis (NIPU).
METHODS
We performed a thorough review of current literature using PubMed, Google Scholar and Clinicaltrials.gov to identify the published literature about the available therapeutics and novel drugs/therapies in different stages of clinical trials.
RESULTS
The current management regimen for non-infectious posterior uveitis includes corticosteroids, immunomodulatory therapies and anti-metabolites. However, NIPU requires long-term management for efficacious remission of the disease and to prevent disease relapse. Long-term safety issues associated with steroids have led to efforts to develop novel therapeutic agents including biological response modulators and immunosuppressants. The current therapeutic agents in various stages of development include calcineurin inhibitors, biologic response modifiers and a more a comprehensive modalities like ocular gene therapy as well as novel drug delivery mechanisms for higher bioavailability to the target tissues, with minimal systemic effects.
CONCLUSION
Novel efficacious therapeutic modalities under development will help overcome the challenges associated with the traditional therapeutic agents.
Topics: Adrenal Cortex Hormones; Humans; Immunosuppressive Agents; Uveitis; Uveitis, Posterior
PubMed: 32617804
DOI: 10.1007/s10792-020-01496-0 -
Chemical Immunology and Allergy 2007Sight-threatening intraocular inflammation affecting the posterior segment of the eye may be predominantly located in the peripheral retina and vitreous (intermediate... (Review)
Review
Sight-threatening intraocular inflammation affecting the posterior segment of the eye may be predominantly located in the peripheral retina and vitreous (intermediate uveitis) or postequatorially where it manifests as inflammation of the retina, retinal vessels and/or optic nerve with cellular infiltration of the choroid and retina and edema particularly at the macula. Involvement of the macula is the main cause for visual loss. Experimental models of posterior uveitis have revealed much concerning the mechanisms of inflammatory cell damage to the retina, implicating CD4 T cells, effector macrophages and pro-inflammatory cytokines. In particular, transgenic and gene deletion models of inflammation have allowed an understanding of how immune privilege in the posterior segment of the eye is disrupted. Importantly, this has led to the development of new treatments with novel immunosuppressants and 'biologics' and the promise of cell-based therapies which may allow customized therapies tailored to the individual's inflammatory profile.
Topics: Animals; Disease Models, Animal; Humans; Uveitis; Uveitis, Intermediate; Uveitis, Posterior
PubMed: 17264499
DOI: 10.1159/000099274 -
Canadian Journal of Ophthalmology.... Feb 2013The differential diagnosis of posterior infectious uveitis is broad. There are, however, a few common infectious causes of posterior uveitis that should always be... (Review)
Review
The differential diagnosis of posterior infectious uveitis is broad. There are, however, a few common infectious causes of posterior uveitis that should always be considered. The more common infectious causes of posterior uveitis include syphilis, toxoplasmosis, tuberculosis, endogenous endophthalmitis, and viral causes (including herpes simplex virus, herpes zoster virus, and cytomegalovirus). The clinical features, diagnostic tools, and treatment options for each of these are reviewed in this article.
Topics: Eye Infections; Humans; Uveitis, Posterior
PubMed: 23419296
DOI: 10.1016/j.jcjo.2012.11.013