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Ocular Oncology and Pathology Jun 2024Mitogen-activated protein kinase kinase (MEK) inhibitors are targeted anticancer agents that are prescribed to treat a broad range of cancers. Despite their strong...
INTRODUCTION
Mitogen-activated protein kinase kinase (MEK) inhibitors are targeted anticancer agents that are prescribed to treat a broad range of cancers. Despite their strong efficacy profile, MEK inhibitors have been associated with ocular toxicities, most notably, self-limited serous detachments of the neurosensory retina. In this report, we outline 3 cases of a rarely documented toxicity, MEK inhibitor-associated ocular hypertension.
CASE PRESENTATIONS
In the first case, a 69-year-old female with metastatic cholangiocarcinoma presented with an intraocular pressure (IOP) of 25 mm Hg right eye (OD) and 27 mm Hg left eye (OS) 2 months after starting trametinib therapy. Similarly, in the second case, a 26-year-old female with Langerhans cell histiocytosis presented with an elevated IOP of 24 mm Hg bilaterally (OU) 13 months after beginning treatment with an investigational MEK inhibitor. In the third case, a 46-year-old male with Langerhans cell histiocytosis presented with a new onset of elevated IOP of 24 mm Hg 21 days after initiating treatment with cobimetinib. All 3 patients' IOP returned to normal following dorzolamide/timolol administration and continued their cancer therapy.
DISCUSSION/CONCLUSION
This report presents 3 cases of elevated IOP in patients taking three distinct MEK inhibitors which would suggest that IOP-elevating effects exist across the class of MEK inhibitors. All 3 patients had a satisfactory response to topical pressure-lowering drops while continuing their life-preserving MEK inhibitor drug dose, indicating that discontinuation of therapy may not be necessary. Due to the increasing use of MEK inhibitors, it is important that ophthalmologists familiarize themselves with the broad range of potential adverse ocular effects of MEK inhibitors.
PubMed: 38882021
DOI: 10.1159/000535427 -
Translational Cancer Research May 2024Programmed cell death-1 (PD-1) inhibitors and anti-angiogenic drugs have become a hotspot in research of anti-tumor programs; however, they can also cause some rare...
BACKGROUND
Programmed cell death-1 (PD-1) inhibitors and anti-angiogenic drugs have become a hotspot in research of anti-tumor programs; however, they can also cause some rare drug-related adverse reactions. Immune checkpoint inhibitors (ICIs) cause adverse reactions in the body, collectively known as immune-related adverse events (irAEs). Ocular side effects can occur in both targeted and immunotherapy patients, including dry eye, blurred vision, uveitis, conjunctivitis, retinopathy, or thyroid eye disease. To our knowledge, this is the first case report describing corneal ulcers secondary to dry eye in a patient treated with the combination of PD-1 inhibitor sintilimab and multi-targeted receptor tyrosine kinase inhibitor (TKI) anlotinib.
CASE DESCRIPTION
A 65-year-old woman with non-small cell lung cancer (NSCLC) and bone metastases, without pre-existing ocular conditions, experienced mild dry eye symptoms 1 month following treatment with sintilimab (200 mg q3w) in combination with anlotinib (12 mg q3w). Unrelieved dry eye symptoms occurred after the third cycle of chemotherapy, and she was diagnosed with dry eye syndrome. Subsequently, she received corneal protective lens, sodium hyaluronate eye drops, and prednisone treatment. Her corneal epithelial damage did not improve significantly, and within the following 2 months, her vision decreased in both eyes and progressed to bilateral corneal ulcers. Oral administration of sintilimab and anlotinib was interrupted, and treatments such as corticosteroids, anti-inflammatory drugs, and corneal repair were administered; however, both eyes presented with corneal subepithelial defect and corneal scarring. Due to a shortage of donors, no corneal transplantation surgery could be performed.
CONCLUSIONS
The development of corneal epithelial disorders in patients receiving target therapy and immunotherapy may not be reversed by reducing its dose. Although the condition is controlled with the use of glucocorticoids, some eye side effects cannot be cured. The timely detection and intervention of adverse effects of anti-tumor drugs by oncologists and ophthalmologists is critical for rational prescription. Ophthalmologists should be aware of eye side effects in patients using immunotherapy to ensure appropriate treatment and minimize potential eye complications such as dry eye, conjunctivitis, etc.
PubMed: 38881937
DOI: 10.21037/tcr-23-1952 -
International Journal of Surgery Case... Jul 2024Purtscher retinopathy is the rare form of occlusive microvasculopathy, characterized by multiple retinal white areas around the optic nerve head and fovea with...
INTRODUCTION AND IMPORTANCE
Purtscher retinopathy is the rare form of occlusive microvasculopathy, characterized by multiple retinal white areas around the optic nerve head and fovea with paravascular clearing and may be related to intraretinal hemorrhages. Acute Pancreatitis (AP) is one of the most common gastrointestinal reasons for hospital admissions globally. The complications of Acute Pancreatitis may include Purtscher's-like retinopathy, which has a low incidence rate of less than 0.24 instances per million cases. This case report highlights the value of thorough medical history taking and examination, and it apprises the consideration of ophthalmological manifestation in patients of Acute Pancreatitis.
CASE PRESENTATION
A 34-year-old female came to the emergency room due to intense abdominal pain associated with nausea and vomiting, which worsened over the last 24 h. The pain was described as continuous, sharp, and cramping-like in the upper abdomen, radiating to the back. Lab tests revealed elevated serum amylase and lipase levels, indicating pancreatitis, along with slight leukocytosis. A contrast-enhanced CT scan confirmed acute pancreatitis with mild inflammation and enlargement of the pancreas. Two days after admission, the patient experienced a sudden and painless loss of central vision in both eyes. There was no history of trauma or any other significant relevant history, other than pancreatitis. The ophthalmologist's examination found reduced visual acuity (6/60 in the right eye, 3/60 in the left eye), normal corneas, and anterior chambers.
DISCUSSION
Inkeles and Walsh established the first link between acute pancreatitis and Purtscher-like retinopathy when they reported three cases of the distinctive retinal appearance in individuals with acute pancreatitis in 1975.
CONCLUSION
The recovery and prognosis in cases of Purtscher-like retinopathy is variable and further research is required to ascertain the usage of corticosteroids and pentoxifylline in improving the course of a patient's with Purtscher's-like retinopathy.
PubMed: 38875828
DOI: 10.1016/j.ijscr.2024.109881 -
Molecular Genetics & Genomic Medicine Jun 2024To characterize the phenotype and genotype of a Chinese family with autosomal-dominant retinitis pigmentosa (RP) accompanied by iris coloboma.
PURPOSE
To characterize the phenotype and genotype of a Chinese family with autosomal-dominant retinitis pigmentosa (RP) accompanied by iris coloboma.
METHODS
The proband, a 34-year-old male, was examined with his family by using fundus photography, optical coherence tomography (OCT), autofluorescence, and full-field electroretinography (ffERG). Genetic analyses were conducted through whole-exome sequencing (WES) to screen for variations.
RESULTS
Three members of this Chinese family were shown to be bilateral iris coloboma. The male proband and his mother exhibited typical RP feature. The proband's late grandfather had been documented manifestation of iris coloboma. The mode of inheritance was confirmed to be autosomal dominance. Through linkage analysis and WES, a heterozygous variation in the miR-204 gene (n.37C>T), a noncoding RNA gene, was identified in these three members.
CONCLUSIONS
In this third independent and the first Asian family, the existence of a miR-204 variant associated with RP accompanied by iris coloboma was confirmed. Our findings reinforce the significance of miR-204 as an important factor influencing visual function in the retina. When phenotypes like RP accompanied by iris coloboma in an autosomal-dominant pattern, including in Chinese patients, miR-204 aberrations should be considered.
Topics: Adult; Female; Humans; Male; Middle Aged; Coloboma; East Asian People; Iris; MicroRNAs; Pedigree; Phenotype; Retinitis Pigmentosa
PubMed: 38867642
DOI: 10.1002/mgg3.2481 -
Clinical Ophthalmology (Auckland, N.Z.) 2024Anti-vascular endothelial growth factor (anti-VEGF) agents are widely prescribed for the treatment of neovascular age-related macular degeneration (nAMD). Although...
BACKGROUND
Anti-vascular endothelial growth factor (anti-VEGF) agents are widely prescribed for the treatment of neovascular age-related macular degeneration (nAMD). Although studies have investigated patient choice of anti-VEGF agent, little is known regarding factors that influence physician preference of anti-VEGF agent for their patients.
OBJECTIVE
To describe physician rationale and challenges in prescribing anti-VEGF treatments for patients with nAMD.
METHODS
Data were drawn from the Adelphi Real World nAMD Disease Specific Programme™, a cross-sectional survey with retrospective data capture of physicians and their patients with nAMD in the United States between October 2021 and May 2022. Physicians (n = 56) reported data for up to 13 consecutively consulting patients (n = 451), including current anti-VEGF treatments used, factors affecting physicians' choice of anti-VEGF agent and treatment strategy, and restrictions on specific agents.
RESULTS
Most physicians prefer employing a "treat-and-extend" treatment strategy, over "fixed interval" or "pro re nata" strategies. However, in routine clinical practice, "treat-and-extend" was reported for less than half of nAMD-diagnosed eyes. Top factors influencing physician choice of anti-VEGF agent and treatment strategy included maximizing clinical benefit (eg visual acuity gains and fluid control), patient convenience, and reducing out-of-pocket costs. However, physicians also reported facing substantial roadblocks in prescribing their choice of anti-VEGF agent, including restrictions on approved agents and gaps in insurance coverage. Persistent fluid was the most common physician-selected reason for switching a patient away from an anti-VEGF agent.
CONCLUSION
Physicians face barriers to prescribing their preferred anti-VEGF agents in real-world healthcare settings. Overcoming these challenges may improve treatment outcomes for patients with nAMD.
PubMed: 38860119
DOI: 10.2147/OPTH.S461846 -
Cureus May 2024Purpose Community screening programs have been in effect since they were utilized in the 19th century at county fairs. A free pediatric health screening program was...
Purpose Community screening programs have been in effect since they were utilized in the 19th century at county fairs. A free pediatric health screening program was created by an osteopathic medical school in South Carolina in collaboration with a pediatric dental outreach organization to engage the local underserved community and train community-minded medical professionals. This study sought to demonstrate the efficacy and need for a student-run monthly pediatric health screening program in an underserved pediatric demographic. Methods A retrospective study of preexisting de-identified data obtained from a student-run health screening program was analyzed to determine the efficacy of the screening program in detecting chronic health risk factors in children in an underserved population. Patients were recruited through a partnership with a free dental clinic for underserved and uninsured children. Patients who attended the clinic were offered the opportunity to have a free, comprehensive health assessment following their dental visit. The function of this program was unique in that uninsured, underserved patients were provided free dental care and a free health assessment. Pediatric patients were screened for basic health information such as weight, height, BMI, vision, cardiovascular health, hypertension, asthma (reported via questionnaire by either the parent or child when applicable), nutrition, and lead poisoning (via questionnaire). The program also offered families additional support by connecting them to local resources and answering any questions they had about their children's health. Data from 14 health screening events was collected for quality improvement and efficacy monitoring. Descriptive analyses were performed. Results and analysis The health screening program assessed 124 children between October 2021 and March 2023 over 14 health screening events. The patients ranged from one year old to 26 years old, with a mean age of 9.65 years. Patients were predominantly Hispanic (79.67%). About one-third (27.64%) of children who were screened had positive findings associated with increased risk for chronic disease. Nearly half (43.90%) of families that were screened requested further information on ways to obtain health insurance and regular primary care services (utilized Access Health). Of the one-third of children with positive risk factors, 12.20% reported positive findings associated with asthma. Of the patients with positive risk factors, 8.94% had vision abnormalities, most of whom had not been seen by an ophthalmologist. This preliminary analysis will be followed by a secondary analysis that further investigates patient demographics (primarily Hispanic) as well as age distribution across various risk factors. Conclusion This pediatric health screening program has demonstrated a basic level of efficacy by successfully identifying increased risk for chronic disease in the underserved pediatric population. The need for these screening events was highlighted by the identification of untreated positive findings.
PubMed: 38860058
DOI: 10.7759/cureus.60085 -
Cureus Jun 2024Introduction Glaucoma is the major cause of irreversible blindness worldwide. Glaucoma affects the optic nerve head in the posterior segment of the eye and the defects...
Introduction Glaucoma is the major cause of irreversible blindness worldwide. Glaucoma affects the optic nerve head in the posterior segment of the eye and the defects lead to permanent blindness if left untreated. Poor knowledge about this disease is strongly correlated with delayed diagnosis. This study aimed to evaluate doctors' knowledge and self-care practices about glaucoma at a tertiary care hospital in Chennai, presuming that healthcare professionals constitute an effective conduit between the population at risk and ophthalmologists. Methods We carried out this cross-sectional survey among 252 doctors practicing allopathic medicine in a tertiary care hospital in Chennai from July 2022 to December 2022. We have collected 252 samples by simple random sampling method. We have excluded doctors who have a degree in ophthalmology or practicing it. The data collection was interview-based using a pre-designed, structured questionnaire that contained questions on sociodemographic characteristics age, gender, and specialty in medicine. It also included questions assessing knowledge and self-care practices about glaucoma among doctors of various specialties other than ophthalmology. We entered the collected data into Microsoft Excel (Microsoft Corporation, Redmond, WA), cleaned it, and analyzed it using SPSS version 16. Results The mean age of the doctors was 33.24 ± 10.90 years in this study. About 132 (52.4%) of the study participants were females. Only 91 (36.1%) of respondents knew that glaucoma may permanently impair vision, but nearly 240 (95.2%) believed that it could be treated. Two hundred seventeen (86.1%) participants were aware that glaucoma runs in families. About 218(86.5%) doctors were aware that glaucoma destroys the optic nerve in the eye, and 171 (67.9%) knew that peripheral vision loss happens before central vision loss. Only 146 (57.9%) of physicians had their eye pressure examined. About 232(92.1%) doctors had their eyes checked routinely. Only 42 (16.7%) of physicians took part in glaucoma awareness campaigns. Nearly 199 (79%) of those surveyed thought it was required to check a patient's family members for glaucoma. We note that among doctors, the knowledge and practice score of correct replies was strongly connected with work experience (P value = 0.035). Conclusion The need for extensive eye health education and information distribution for healthcare workers should be stressed. Teaching the hospital staff about the symptoms and prognosis of this "silent thief of sight" might be a crucial first step in providing preventive ophthalmic treatment.
PubMed: 38859946
DOI: 10.7759/cureus.62043 -
Beyoglu Eye Journal 2024The focus of this study was to assess and compare the h-indexes of editorial board members from eight ophthalmology journals in Türkiye and explore the potential...
OBJECTIVES
The focus of this study was to assess and compare the h-indexes of editorial board members from eight ophthalmology journals in Türkiye and explore the potential correlations between these indexes and the sub-specialties of board members.
METHODS
Conducted in December 2023, this cross-sectional study utilized publicly available data from Google Scholar (GS), Web of Science, and Scopus. The h-index and number of publications by editorial board members from eight Turkish ophthalmology journals were analyzed. Statistical analysis for this study involved the use of SPSS, employing descriptive statistics, one-way analysis of variance, and tests for group comparisons.
RESULTS
Of the 415 editorial board members, 26 were not ophthalmologists and 12 worked abroad; the credentials of 10 could not be verified. A total of 367 authors were evaluated, revealing significant differences in publication numbers and h-indices among the different subspecialties. Notably, the retinal specialists demonstrated higher productivity. Variability in citation counts was observed across databases, with GS having the widest range. Differences were also noted in the publication and h-index among the editorial boards of different journals.
CONCLUSION
The h-index and number of publications effectively reflected the active status of ophthalmology authors. This study contributes valuable information regarding Turkish ophthalmology journals and their editorial boards, serving as an inspiration for young ophthalmologists. These findings underscore the diverse successes of ophthalmologists across subspecialties, encouraging the exploration of less-explored areas in academic pursuits.
PubMed: 38855950
DOI: 10.14744/bej.2024.03030 -
Missouri Medicine 2024
Topics: Humans; Exercise; COVID-19
PubMed: 38854612
DOI: No ID Found -
Cureus May 2024Dry eye disease is a common clinical problem encountered by ophthalmologists worldwide. Interest in this entity has increased in recent years due to the consequences it... (Review)
Review
Dry eye disease is a common clinical problem encountered by ophthalmologists worldwide. Interest in this entity has increased in recent years due to the consequences it has on the ocular surface after any surface procedure. With changing times, several new factors have come to light that can influence this disease. The effect of the COVID-19 pandemic has also been greatly felt, with a range of causes, starting from increased screen work to inflammatory processes, exacerbating the condition in many. With changes in the concepts of the etiopathogenesis of the disease, a paradigm shift has taken place in the approaches to treatment. More researchers are in favor of a new tear film-oriented approach that tries to localize the disease to a single component in the tear film. Innovation of newer techniques for the treatment of meibomian gland disease has also made its foray into clinical ophthalmology. Newer drug formulations and molecules are underway to better treat the inflammatory component of the disease. Many other receptors and targets for the treatment of dry eyes are being researched. This review hopes to provide a succinct, narrative summary of the relevant research on dry eye disease to date to increase awareness about the nature and future course of this disease and its management.
PubMed: 38854318
DOI: 10.7759/cureus.59985