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Article ; Online: Effect of macronutrients (carbon, nitrogen, and phosphorus) on the growth of Chlamydomonas reinhardtii and nutrient recovery under different trophic conditions.

Oz Yasar, Cigdem / Fletcher, Louise / Camargo-Valero, Miller Alonso

Environmental science and pollution research international

2023 Volume 30, Issue 51, Page(s) 111369–111381

Abstract: More stringent discharge standards have led to the development of an alternative nutrient recovery system from wastewater. Microalgae cultivation in wastewater treatment works has presented considerable promise from the perspective of sustainable ... ...

Abstract	More stringent discharge standards have led to the development of an alternative nutrient recovery system from wastewater. Microalgae cultivation in wastewater treatment works has presented considerable promise from the perspective of sustainable resource management. Growth kinetics models are useful tools to optimize nutrient recovery from wastewater by algal uptake. Therefore, this research aims to identify the growth kinetics of Chlamydomonas reinhardtii under both heterotrophic and phototrophic conditions with different nutrient concentrations that typify those found in wastewater treatment works. In addition, the effects of macronutrients (C, N, and P) on heterotrophic and phototrophic microalgae growth and nutrient recovery were studied. Greater specific growth rates were achieved under heterotrophic conditions than in phototrophic cultivation. The maximum specific growth rates and nutrient recovery efficiencies were achieved at 5 mg P L
MeSH term(s)	Chlamydomonas reinhardtii ; Wastewater ; Nitrogen/pharmacology ; Phosphorus/pharmacology ; Carbon/pharmacology ; Nutrients ; Microalgae ; Biomass
Chemical Substances	Wastewater ; Nitrogen (N762921K75) ; Phosphorus (27YLU75U4W) ; Carbon (7440-44-0)
Language	English
Publishing date	2023-10-09
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1178791-0
ISSN	1614-7499 ; 0944-1344
ISSN (online)	1614-7499
ISSN	0944-1344
DOI	10.1007/s11356-023-30231-2
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Article: Intravenous cyclophosphamide therapy for patients with severe ocular inflammatory diseases who failed other immunomodulatory therapies.

Karaca, Irmak / Tran, Elaine M / Park, SungWho / Bromeo, Albert / Khojasteh, Hassan / Tran, Anh Ngọc Tram / Yavari, Negin / Akhavanrezayat, Amir / Yasar, Cigdem / Uludag Kirimli, Gunay / Than, Ngoc Tuong Trong / Hassan, Muhammad / Or, Christopher / Ghoraba, Hashem / Do, Diana V / Nguyen, Quan Dong

Journal of ophthalmic inflammation and infection

2024 Volume 14, Issue 1, Page(s) 12

Abstract: Background: Ocular inflammatory diseases, including scleritis and uveitis, have been widely treated with immunomodulatory therapies (IMTs) as a steroid-sparing approach. Such strategy includes conventional therapies (antimetabolites, alkylating agents, ... ...

Abstract	Background: Ocular inflammatory diseases, including scleritis and uveitis, have been widely treated with immunomodulatory therapies (IMTs) as a steroid-sparing approach. Such strategy includes conventional therapies (antimetabolites, alkylating agents, and calcineurin inhibitors) as well as biologic agents like adalimumab, infliximab, rituximab, and tocilizumab. Cyclophosphamide (CP) is an alkylating agent and mainly inhibits the functioning of both T and B cells. Though known to have potential adverse events, including bone marrow suppression, hemorrhagic cystitis, and sterility, CP has been shown to be efficacious, especially in recalcitrant cases and when used intravenous (IV) for a limited period. Main findings: We conducted a retrospective case-series to assess the safety and efficacy of CP therapy for patients with severe ocular inflammatory diseases who failed other IMTs. Medical records of 1295 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were reviewed. Seven patients (10 eyes) who received CP therapy for ocular inflammatory diseases with at least one year of follow-up were included. The mean age of the patients (4 males, 3 females) was 61.6 ± 14.9 (43.0-89.0) years. Clinical diagnoses included necrotizing scleritis (5 eyes), peripheral ulcerative keratitis (2 eyes), orbital pseudotumor (1 eye), HLA-B27 associated panuveitis and retinal vasculitis (2 eyes). Ocular disease was idiopathic in 3 patients, and was associated with rheumatoid arthritis, IgG-4 sclerosing disease, dermatomyositis, and ankylosing spondylitis in 1 patient each. All the patients had history of previous IMT use including methotrexate (5), mycophenolate mofetil (3), azathioprine (1), tacrolimus (1), adalimumab (2), infliximab (4), and rituximab (1). The mean follow-up time was 34.4 ± 11.0 (13-45) months, and mean duration of CP therapy was 11.9 ± 8.8 (5-28) months. Remission was achieved in 5 patients (71.4%). Four patients (57.1%) experienced transient leukopenia (white blood cell count < 4000/mL). Short conclusion: CP therapy can be considered a potentially effective and relatively safe therapeutic option for patients with severe ocular inflammatory diseases who failed other IMTs including biologics (TNFa and CD20 inhibitors).
Language	English
Publishing date	2024-03-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2592309-2
ISSN	1869-5760
ISSN	1869-5760
DOI	10.1186/s12348-023-00372-z
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Article ; Online: Importance of Baseline Fluorescein Angiography for Patients Presenting to Tertiary Uveitis Clinic.

Karaca, Irmak / Bromeo, Albert / Ghoraba, Hashem / Lyu, Xun / Thng, Zheng Xian / Yasar, Cigdem / Akhavanrezayat, Amir / Yavari, Negin / Kirimli, Gunay Uludag / Than, Ngoc Tuong Trong / Shin, YongUn / Gupta, Ankur Sudhir / Khatri, Anadi / Mohammadi, S Saeed / Hung, Jia-Horung / Or, Christopher / Do, Diana V / Nguyen, Quan Dong

American journal of ophthalmology

2024

Abstract: Purpose: To ascertain whether the use of ultra-wide-field fluorescein angiography (UWFFA) at baseline visit alters the assessment of disease activity and localization, as well as the management of patients presenting to a tertiary uveitis clinic.: ... ...

Abstract	Purpose: To ascertain whether the use of ultra-wide-field fluorescein angiography (UWFFA) at baseline visit alters the assessment of disease activity and localization, as well as the management of patients presenting to a tertiary uveitis clinic. Design: Retrospective comparison of diagnostic approaches. Methods: Baseline visits of 158 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were evaluated by three uveitis-trained ophthalmologists (I.K., A.B., and H.G.). Each eye had undergone clinical examination along with ultra-wide-field fundus photography (UWFFP) (Optos Plc, Dunfermline, Scotland, UK), spectral-domain optical coherence tomography (SD-OCT, Spectralis Heidelberg, Heidelberg Engineering, Heidelberg, Germany) and UWFFA (Optos Plc, Dunfermline, Scotland, UK) at the baseline visit. Investigators were asked to successively determine disease activity, localization of disease (anterior, posterior or both), and management decisions based on clinical examination and UWFFP and SD-OCT (Set 1) and Set 1 plus UWFFA (Set 2). The primary outcome was the percentage of eyes whose management changed based on the availability of UWFFA, compared with Set 1. Results: The mean age of the patients was 46.9±22.4 (range, 7-96) and 91 (57.6%) were female. With Set 1 alone, 138 (55.2%) eyes were found to have active disease; localization was anterior in 58 (42.0%) eyes, posterior in 53 (38.4%) eyes and anterior + posterior in 27 (19.6%) eyes. With Set 2, 169 eyes of 107 patients had active anterior, posterior or pan-uveitis. In comparison with Set 1, assessment with Set 2 identified additional 31 (18.3%) eyes with active disease (p=0.006), and additional 31 (18.3%) eyes having disease in both anterior + posterior segments (p<0.001). Regarding the primary outcome, management was changed in 68 (27.4%) eyes in Set 2, compared to Set 1. Conclusion: Baseline UWFFA may alter assessment of disease activity, localization, and management decisions compared to clinical examination with only UWFFP and SD-OCT for eyes with uveitis. Thus, UWFFA may be considered as an essential tool in the evaluation of uveitis patients at the baseline visit.
Language	English
Publishing date	2024-05-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	80030-2
ISSN	1879-1891 ; 0002-9394
ISSN (online)	1879-1891
ISSN	0002-9394
DOI	10.1016/j.ajo.2024.04.016
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Article ; Online: Pars plana vitrectomy with internal limiting membrane flap versus pars plana vitrectomy with conventional internal limiting membrane peeling for large macular hole.

Ghoraba, Hashem / Rittiphairoj, Thanitsara / Akhavanrezayat, Amir / Karaca, Irmak / Matsumiya, Wataru / Pham, Brandon / Mishra, Kapil / Yasar, Cigdem / Mobasserian, Azadeh / Abdelkarem, Amira Ahmed / Nguyen, Quan Dong

The Cochrane database of systematic reviews

2023 Volume 8, Page(s) CD015031

Abstract: Background: Macular hole (MH) is a full-thickness defect in the central portion of the retina that causes loss of central vision. According to the usual definition, a large MH has a diameter greater than 400 µm at the narrowest point. For closure of MH, ...

Abstract	Background: Macular hole (MH) is a full-thickness defect in the central portion of the retina that causes loss of central vision. According to the usual definition, a large MH has a diameter greater than 400 µm at the narrowest point. For closure of MH, there is evidence that pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling achieves better anatomical outcomes than standard PPV. PPV with ILM peeling is currently the standard of care for MH management; however, the failure rate of this technique is higher for large MHs than for smaller MHs. Some studies have shown that the inverted ILM flap technique is superior to conventional ILM peeling for the management of large MHs. Objectives: To evaluate the clinical effectiveness and safety of pars plana vitrectomy with the inverted internal limiting membrane flap technique versus pars plana vitrectomy with conventional internal limiting membrane peeling for treating large macular holes, including idiopathic, traumatic, and myopic macular holes. Search methods: The Cochrane Eyes and Vision Information Specialist searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registries on 12 December 2022. Selection criteria: We included randomized controlled trials (RCTs) that evaluated PPV with ILM peeling versus PPV with inverted ILM flap for treatment of large MHs (with a basal diameter greater than 400 µm at the narrowest point measured by optical coherence tomography) of any type (idiopathic, traumatic, or myopic). Data collection and analysis: We used standard methodological procedures expected by Cochrane and assessed the certainty of the body of evidence using GRADE. Main results: We included four RCTs (285 eyes of 275 participants; range per study 24 to 91 eyes). Most participants were women (63%), and of older age (range of means 59.4 to 66 years). Three RCTs were single-center trials, and the same surgeon performed all surgeries in two RCTs (the third single-center RCT did not report the number of surgeons). One RCT was a multicenter trial (three sites), and four surgeons performed all surgeries. Two RCTs took place in India, one in Poland, and one in Mexico. Maximum follow-up ranged from three months (2 RCTs) to 12 months (1 RCT). No RCTs reported conflicts of interest or disclosed financial support. All four RCTs enrolled people with large idiopathic MHs and compared conventional PPV with ILM peeling versus PPV with inverted ILM flap techniques. Variations in technique across the four RCTs were minimal. There was some heterogeneity in interventions: in two RCTs, all participants underwent combined cataract-PPV surgery, whereas in one RCT, some participants underwent cataract surgery after PPV (the fourth RCT did not mention cataract surgery). The critical outcomes for this review were mean best-corrected visual acuity (BCVA) and MH closure rates. All four RCTs provided data for meta-analyses of both critical outcomes. We assessed the risk of bias for both outcomes using the Cochrane risk of bias tool (RoB 2); there were some concerns for risk of bias associated with lack of masking of outcome assessors and selective reporting of outcomes in all RCTs. All RCTs reported postoperative BCVA values; only one RCT reported the change in BCVA from baseline. Based on evidence from the four RCTs, it is unclear if the inverted ILM flap technique compared with ILM peeling reduces (improves) postoperative BCVA measured on a logarithm of the minimum angle of resolution (logMAR) chart at one month (mean difference [MD] -0.08 logMAR, 95% confidence interval [CI] -0.20 to 0.05; P = 0.23, I Authors' conclusions: We found low-certainty evidence from four small RCTs that PPV with the inverted ILM flap technique is superior to PPV with ILM peeling with respect to BCVA gains at three or more months after surgery. We also found moderate-certainty evidence that the inverted ILM flap technique achieves more overall and type 1 MH closures. There is a need for high-quality multicenter RCTs to ascertain whether the inverted ILM flap technique is superior to ILM peeling with regard to anatomical and functional outcomes. Investigators should use the standard logMAR charts when measuring BCVA to facilitate comparison across trials.
MeSH term(s)	Female ; Humans ; Male ; Cataract ; Multicenter Studies as Topic ; Myopia/surgery ; Retina ; Retinal Perforations/surgery ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy/methods
Language	English
Publishing date	2023-08-07
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ISSN	1469-493X
ISSN (online)	1469-493X
DOI	10.1002/14651858.CD015031.pub2
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Article ; Online: ASSOCIATION OF ORAL MONTELUKAST WITH REDUCED ODDS OF DEVELOPING EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

Matsumiya, Wataru / Karaca, Irmak / Pham, Brandon Huy / Akhavanrezayat, Amir / Uludag, Gunay / Yasar, Cigdem / Ghoraba, Hashem / Mobasserian, Azadeh / Regenold, Jonathan / Halim, Muhammad Sohail / Sepah, Yasir J / Do, Diana V / Chong, Victor / Nguyen, Quan Dong

Retina (Philadelphia, Pa.)

2023 Volume 43, Issue 11, Page(s) 1914–1921

Abstract: Purpose: This study was conducted to evaluate the association of oral montelukast, selective antagonism for cysteinyl leukotriene receptor 1, with reduced odds of exudative age-related macular degeneration (exAMD) development.: Methods: This case- ... ...

Abstract	Purpose: This study was conducted to evaluate the association of oral montelukast, selective antagonism for cysteinyl leukotriene receptor 1, with reduced odds of exudative age-related macular degeneration (exAMD) development. Methods: This case-control study was conducted using institutional cohort finder tool, and included 1913 patients with exAMD (ICD: H35.32 and 362.52) and 1913 age- and gender-matched control subjects without exAMD. Subanalysis among 1913 exAMD and 324 nonexudative AMD was also conducted. Results: A total of 47 (2.5%) exAMD cases were identified to have a history of oral montelukast use before exAMD diagnosis, compared with 84 (4.4%) controls. Montelukast usage was significantly associated with reduced odds of exAMD in the multivariable analysis (adjusted odds ratio [OR]: 0.50, 95% confidence interval: 0.31-0.80) and nonsteroidal anti-inflammatory drug usage (adjusted OR: 0.69). Caucasian race, history of smoking, and nonexudative macular degeneration in either eye were also found to have a significant relationship with increased odds of exAMD. In the subanalysis, montelukast usage showed significant association with reduced odds of developing exAMD from nonexudative AMD (adjusted OR: 0.53, 95% confidence interval: 0.29-0.97) and the presence of atopic disease (adjusted OR: 0.60). Conclusion: The study results suggested that oral montelukast is linked to reduced odds of exAMD development.
MeSH term(s)	Humans ; Case-Control Studies ; Smoking ; Macular Degeneration/diagnosis
Chemical Substances	montelukast (MHM278SD3E)
Language	English
Publishing date	2023-06-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	603192-4
ISSN	1539-2864 ; 0275-004X
ISSN (online)	1539-2864
ISSN	0275-004X
DOI	10.1097/IAE.0000000000003870
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Article ; Online: Prevalence of Pseudoexfoliation Syndrome in Turkish Patients with Senile Cataract.

Gunes, Alime / Yasar, Cigdem / Tok, Levent / Tok, Ozlem

Seminars in ophthalmology

2016 Volume 32, Issue 3, Page(s) 297–301

Abstract: Purpose: To investigate the prevalence of pseudoexfoliation syndrome (PEX) among Turkish patients with senile cataract.: Materials and methods: Records of 352 eyes of 352 patients who underwent cataract surgery were analyzed in this retrospective ... ...

Abstract	Purpose: To investigate the prevalence of pseudoexfoliation syndrome (PEX) among Turkish patients with senile cataract. Materials and methods: Records of 352 eyes of 352 patients who underwent cataract surgery were analyzed in this retrospective study. The presence of PEX, type of cataract, intraocular pressure (IOP), glaucoma, age-related macular degeneration, and systemic diseases (coronary artery disease, hypertension, diabetes mellitus) were recorded. Results: The overall prevalence of PEX syndrome was detected to be 11%. The mean age of PEX patients was significantly higher than without PEX (74.4 ± 7.2 years and 69.3 ± 11.4 years, respectively, p = 0.004). The most common cataract type in the PEX patients was mixed-type cataract determined in 51.2% of patients. IOP was significantly higher in eyes with PEX than in eyes without it (16.1 ± 4.5 mmHg and 14.7 ± 3.8 mmHg, respectively; p = 0.03). Moreover, the prevalence of age-related macular degeneration was found to be significantly higher, and prevalence of glaucoma slightly higher in PEX patients than without PEX. Conclusion: Pseudoexfoliation syndrome is a common condition in Turkish people. PEX is associated with mixed type of cataract, age-related macular degeneration, and elevated IOP. Therefore, PEX patients should be checked for concomitant diseases.
MeSH term(s)	Aged ; Cataract/complications ; Cataract/epidemiology ; Cataract/physiopathology ; Exfoliation Syndrome/complications ; Exfoliation Syndrome/epidemiology ; Exfoliation Syndrome/physiopathology ; Female ; Humans ; Male ; Phacoemulsification ; Prevalence ; Retrospective Studies ; Turkey/epidemiology ; Visual Acuity
Language	English
Publishing date	2016-01-21
Publishing country	England
Document type	Journal Article
ZDB-ID	632820-9
ISSN	1744-5205 ; 0882-0538
ISSN (online)	1744-5205
ISSN	0882-0538
DOI	10.3109/08820538.2015.1068344
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Article: Neurosarcoidosis, Coccidioidomycosis, or Both!

Akhavanrezayat, Amir / Matsumiya, Wataru / Ongpalakorn, Prapatsorn / Ghoraba, Hashem H / Or, Chris / Khojasteh Jafari, Hassan / Kirimli, Gunay Uludag / Yasar, Cigdem / Than, Ngoc Trong Tuong / Karaca, Irmak / Zaidi, Moosa / Mobasserian, Azadeh / Yavari, Negin / Bazojoo, Vahid / Shin, Yong Un / Bromeo, Albert John / Nguyen, Quan Dong

International medical case reports journal

2023 Volume 16, Page(s) 887–895

Abstract: Purpose: To report a case of neurosarcoidosis (NS) who was initially diagnosed as : Observations: A 57-year-old diabetic man presented with sudden painless diminution of vision, metamorphopsia, and color vision deficits in the left eye (OS) for one ... ...

Abstract	Purpose: To report a case of neurosarcoidosis (NS) who was initially diagnosed as Observations: A 57-year-old diabetic man presented with sudden painless diminution of vision, metamorphopsia, and color vision deficits in the left eye (OS) for one month. His vision was 20/20 in the right eye (OD) and 20/40 OS. Ophthalmic examination revealed left relative afferent pupillary defect, blurred optic nerve margin, creamy chorioretinal infiltration around the optic disc, and mild macular edema. OD examination was non-revealing. Chest CT scan with contrast showed calcified mediastinal lymph nodes, but biopsy of the lymph nodes was normal. Brain and orbit MRI demonstrated soft tissue abnormality with enhancement in left orbital apex with involvement of the extraocular muscles. CSF culture was negative, but complement fixation had positive titer of 1:2 for CI. The patient was diagnosed with CI meningitis, and antifungal therapy was initiated. Slight visual and symptomatic improvement was observed, which was not completely satisfactory. Biopsy of extraocular orbital muscle five months later revealed non-caseating granulomatous inflammation, leading to initiation of prednisone trial therapy. Nine months later, the patient was referred to a tertiary center owing to persistence of optic disc edema OS. PET CT was consistent with a diagnosis of sarcoidosis. Antifungal treatment was discontinued, and oral prednisone with methotrexate was initiated. Subsequently, methotrexate was replaced by infliximab to further manage ocular inflammation and neurologic symptoms which was effective. Vision was 20/20 OD and 20/30 OS at the most recent visit. Conclusion and importance: Signs and symptoms of neurosarcoidosis and coccidioidomycosis can be similar and deceiving. The index case underscores importance of considering appropriate differential diagnoses in patients with similar symptoms and signs who may respond to preliminary designated treatment but not to the optimal extent. Considering such possibility could assist clinicians in managing the patients timely and efficiently.
Language	English
Publishing date	2023-12-28
Publishing country	New Zealand
Document type	Case Reports
ZDB-ID	2495077-4
ISSN	1179-142X
ISSN	1179-142X
DOI	10.2147/IMCRJ.S434632
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Article ; Online: Electroretinographic findings in retinal vasculitis.

Ghoraba, Hashem H / Matsumiya, Wataru / Or, Christopher / Khojasteh, Hassan / Patel, Prem / Karaca, Irmak / Regenold, Jonathan / Zaidi, Moosa / Hwang, Jaclyn / Lajevardi, Sherin / Yavari, Negin / Than, Ngoc Trong Tuong / Park, Sung Who / Akhavanrezayat, Amir / Uludag, Gunay / Yasar, Cigdem / Leung, Loh-Shan B / Nguyen, Quan Dong

The British journal of ophthalmology

2023 Volume 107, Issue 12, Page(s) 1834–1838

Abstract: Aim: To describe and correlate electroretinographic responses with clinical and angiographic findings in retinal vasculitis (RV).: Methods: Medical records of patients with diagnosis of RV at a tertiary eye centre from December 2017 to May 2021 were ... ...

Abstract	Aim: To describe and correlate electroretinographic responses with clinical and angiographic findings in retinal vasculitis (RV). Methods: Medical records of patients with diagnosis of RV at a tertiary eye centre from December 2017 to May 2021 were reviewed. Cases in which fluorescein angiography (FFA) and full field electroretinography (ffERG) were done within 1 month were included. FFAs were graded according to the Angiography Scoring for Uveitis Working Group from 0 to 40, where 0 is normal. A novel ffERG grading system was implemented where individual waves were graded for timing and amplitude and general ffERG score was determined with 6 being a perfect score. Results: 20 patients (34 eyes) were included. Mean age was 43.9±19.8 years; 70% were female. Median best-corrected visual acuity was 0.8 (0.08-1). Mean FFA score was 12.6±6.5. Median general ffERG score was 5 (0-6). 68% and 91% of eyes had responses with general ffERG scores ≥5 and 4, respectively. Flicker timing was most commonly affected.FFA scores weakly correlated with delayed photopic cone b-wave and flicker timing (p=0.03 and 0.016, respectively). Vitreous haze moderately correlated with delayed cone b-wave timing (p<0.001), delayed flicker timing (p=0.002) and weakly correlated with lower flicker amplitude (p=0.03). Underlying systemic disease was associated with poor ffERG responses. Conclusion: In this study, RV was not frequently associated with severe global retinal dysfunction Higher FFA scores, and vitreous haze grading were weakly, but significantly, correlated with cone-generated ffERG responses.
MeSH term(s)	Humans ; Female ; Young Adult ; Adult ; Middle Aged ; Male ; Retina/diagnostic imaging ; Retinal Vasculitis/diagnosis ; Electroretinography ; Retinal Cone Photoreceptor Cells ; Fluorescein Angiography
Language	English
Publishing date	2023-11-22
Publishing country	England
Document type	Journal Article
ZDB-ID	80078-8
ISSN	1468-2079 ; 0007-1161
ISSN (online)	1468-2079
ISSN	0007-1161
DOI	10.1136/bjo-2022-321716
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Article ; Online: Ocular manifestations and clinical outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU).

Uludag Kirimli, Gunay / Hassan, Muhammad / Onghanseng, Neil / Or, Chris / Yasar, Cigdem / Park, Sungwho / Akhavanrezayat, Amir / Mobasserian, Azadeh / Yavari, Negin / Bazojoo, Vahid / Khojasteh, Hassan / Ghoraba, Hashem / Karaca, Irmak / Trong Tuong Than, Ngoc / Zaidi, Moosa / Nguyen, Quan Dong

Eye (London, England)

2023 Volume 38, Issue 2, Page(s) 349–356

Abstract: Purpose: To describe the various ocular clinical features and visual outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU).: Methods: The medical records of 13 patients (26 eyes) diagnosed with TINU were reviewed.: Results: Twenty- ... ...

Abstract	Purpose: To describe the various ocular clinical features and visual outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU). Methods: The medical records of 13 patients (26 eyes) diagnosed with TINU were reviewed. Results: Twenty-six (26) eyes of 13 patients with TINU were reviewed in this study. The median age at onset of uveitis was 14 (range, 9-45). Eight (61.5%) subjects were female. The median follow-up of patients was 30 months (range, 6-89 months). Posterior segment findings were seen in 18 eyes of 9 patients (69.2%). The most common posterior findings were optic nerve head inflammation (16 eyes, 88.8%) and retinal vasculitis (13 eyes, 72.2%). Other posterior findings included vitritis (8 eyes, 44.4%), macular edema (6 eyes, 33.3%), snowball (4 eyes, 22.2%), and chorioretinal lesions (2 eye, 11.1%). Eight patients had fluorescein angiography (FA) data available and most eyes had retinal capillary leakage (13 eyes, 81.2%) followed by optic disc staining/leakage (12 eyes, 75%). Twelve (12) patients (92.3%) were treated with immunomodulatory treatment (IMT) and/or biologics. Five patients (%38.4) required biologics to control intraocular inflammation. Conclusion: Posterior segment involvement may be common in patients with TINU syndrome. FA provides significant information for detecting posterior segment involvement and disease activity in TINU. The majority of patients required systemic treatment in order to control intraocular inflammation and prevent relapses.
MeSH term(s)	Humans ; Female ; Male ; Uveitis/diagnosis ; Uveitis/drug therapy ; Nephritis, Interstitial/diagnosis ; Nephritis, Interstitial/drug therapy ; Inflammation ; Biological Products
Chemical Substances	Biological Products
Language	English
Publishing date	2023-08-25
Publishing country	England
Document type	Journal Article
ZDB-ID	91001-6
ISSN	1476-5454 ; 0950-222X
ISSN (online)	1476-5454
ISSN	0950-222X
DOI	10.1038/s41433-023-02695-6
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Article ; Online: Bilateral retinal vasculitis associated with cold agglutinin disease treated with obinutuzumab and infliximab.

Than, Ngoc Trong Tuong / Yaşar, Çigdem / Pham, Brandon Huy / Lam, Brandon Chau / Doan, Huy Luong / Akhavanrezayat, Amir / Halim, Muhammad Sohail / Iberri, David Joseph / Hien, Doan Luong / Dong Nguyen, Quan

American journal of ophthalmology case reports

2022 Volume 28, Page(s) 101752

Abstract: Purpose: To describe the clinical course and management of a patient with bilateral retinal vasculitis associated with cold agglutinin disease (CAD) treated with obinutuzumab and infliximab.: Observations: A 69-year-old Hispanic woman was referred to ...

Abstract	Purpose: To describe the clinical course and management of a patient with bilateral retinal vasculitis associated with cold agglutinin disease (CAD) treated with obinutuzumab and infliximab. Observations: A 69-year-old Hispanic woman was referred to a tertiary Uveitis Clinic with progressively worsening blurry vision, right eye (OD) worse than left eye (OS). Past ocular history was significant for epiretinal membranes in both eyes (OU). Past medical history was notable for non-specific joint disease, primarily affecting her knees bilaterally, and pulmonary symptoms (e.g., dyspnea, productive cough) of unclear etiologies one year before presentation. She had been evaluated by rheumatologists and pulmonologists and was placed on low doses of prednisone and methotrexate. Upon examination, her visual acuity was 20/40 in OD and 20/25 in OS. Anterior segment exam was unremarkable with no cell or flare in OU. Dilated fundus examination was notable for 0.5+ vitreous haze in OU and mild vessel attenuation in OU. Wide-angle fluorescein angiography (FA) revealed mild bilateral periphery peri-vasculature leakage in OU. Initial blood evaluations revealed decreased hematocrit, and positive anti-nuclear antibody. Her peripheral smear disclosed 3+ agglutination. She was initially treated with mycophenolate mofetil 1000 mg twice daily and prednisone 20 mg then referred to hematology. Further work up revealed high-titer cold agglutinin and positive thermal amplitude screen at 30 °C. Bone marrow examination demonstrated a chronic lymphocytic leukemia (CLL)-like monoclonal B-cell lymphocytosis. Anti-CD20 monoclonal antibody therapy with obinutuzumab was started in an effort to treat the underlying CLL clone and address the associated ocular vasculitis related to CAD. Three months later, after eight cycles of obinutuzumab, the patient's best- corrected visual acuity (BCVA) continued to be stable at 20/30 in OD and 20/20 in OS. However, FA showed persistent diffuse perivascular leakage. Intravenous infliximab with concurrent intravenous methylprednisolone infusions were started. After two cycles of treatment, FA showed significantly improved perivascular leakage. Visual acuity remained stable at 20/25 in OU. Conclusions and importance: Ocular involvement in CAD is rare. The index case is the first report of retinal vasculitis in a patient with CAD. Our report not only describes the unique course of CAD-related retinal vasculitis, but also introduces and underscores a successful therapeutic plan.
Language	English
Publishing date	2022-11-12
Publishing country	United States
Document type	Case Reports
ISSN	2451-9936
ISSN (online)	2451-9936
DOI	10.1016/j.ajoc.2022.101752
Database	MEDical Literature Analysis and Retrieval System OnLINE

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