Massachusetts Eye Research and Surgery Institution MERSI

Waltham, MA, United States

Massachusetts Eye Research and Surgery Institution MERSI

Waltham, MA, United States
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PURPOSE:: To assess long-term effectiveness of rituximab therapy for refractory noninfectious uveitis affecting the posterior segment. METHODS:: Retrospective case series. Patients diagnosed with recalcitrant noninfectious posterior uveitis who were treated with rituximab intravenous infusions between 2010 and 2015 were included. Patients underwent best-corrected visual acuity testing and fluorescein angiography evidence of disk or vascular staining at 6, 12, 18, and 24 months. Patients had at least 24 months of follow-up. RESULTS:: Eleven patients (21 eyes) with refractory posterior uveitis treated with intravenous rituximab were included. Nine (81.8%) patients were female. Mean follow-up was 29.3 ± 7.8 months. rituximab was administered as complementary therapy because of previous inefficacy of other therapies in 7 (63.7%) patients, and it was the only treatment in four (36.3%) patients who did not tolerate other drugs. Inflammation signs by fluorescein angiography were controlled in nine (81.8%) patients at the end of follow-up. Baseline best-corrected visual acuity was 20/80 (logarithm of the minimal angle of resolution 0.6 ± 0.4), and final best-corrected visual acuity was 20/40 (0.3 ± 0.5) (P = 0.005). No significant side effects were reported. CONCLUSION:: Rituximab therapy was associated with stability and remission of recalcitrant noninfectious posterior uveitis in patients who did not tolerate or did not respond to other therapies. © 2017 by Ophthalmic Communications Society, Inc.


You C.,Tianjin Medical University | Ma L.,Massachusetts Eye Research and Surgery Institution MERSI | Lasave A.F.,Massachusetts Eye Research and Surgery Institution MERSI | Foster C.S.,Harvard University
Ocular Immunology and Inflammation | Year: 2017

Aims: To evaluate the efficacy and safety of rituximab (RTX) induction and maintenance treatment for patients with scleritis and granulomatosis with polyangiitis (GPA), Wegener’s. Methods: Nine patients (12 eyes) with scleritis with GPA who did not respond to corticosteroids and more than one immunosuppressive agent who received ongoing maintenance RTX treatment were identified. Demographics and outcome measures were recorded. Results: Median follow-up time of 30 months (range, 15 to 87 months). All 12 eyes achieved remission during the RTX maintenance period with a median time in remission of 14 months (range, 5–76 months), and median interval between RTX initiation and inactive disease of 5 months (range, 2–8 months). Two eyes in two patients relapsed. One received steroid eye drops, and the other received a short-term increased dose of intravenous corticosteroids. Conclusions: RTX was effective as an induction and maintenance treatment in our small cohort of patients with GPA-associated scleritis. © 2017, Taylor & Francis. All rights reserved.


Arcinue C.A.,Massachusetts Eye Research and Surgery Institution MERSI | Arcinue C.A.,Ocular Immunology and Uveitis Foundation | Ceron O.M.,Massachusetts Eye Research and Surgery Institution MERSI | Ceron O.M.,Ocular Immunology and Uveitis Foundation | And 3 more authors.
Journal of Ocular Pharmacology and Therapeutics | Year: 2013

Purpose: To evaluate the efficacy and safety of the fluocinolone acetonide (Retisert) implant compared with the dexamethasone (Ozurdex) implant in patients with noninfectious uveitis. Design: Comparative case series. Study Participants: Twenty-seven eyes received either the fluocinolone acetonide (FA) (n=16) or dexamethasone (n=11) implant. Methods: Chart review of patients at the Massachusetts Eye Research and Surgery Institution (MERSI) was done and patients were selected and matched according to age, sex, and type of uveitis. Eyes that received either the FA or dexamethasone implant, with follow-up ranging from 6 months to 2 years, were included. Main Outcome Measure: The recurrence rate of uveitis after implantation. Results: There were no significant differences in the baseline demographic characteristics. The majority of cases were idiopathic panuveitis, with 36.4% and 31.3% of eyes in the Ozurdex and Retisert groups, respectively. Recurrence rates of uveitis were 1.7 and 0.5 per 100 person-months in the Retisert and Ozurdex groups, respectively, with Retisert-implanted eyes 3.16 times more at risk of recurrence; however, this difference was not statistically significant (P=0.41). No significant differences were seen in terms of improvement in inflammatory score and best-corrected visual acuity (BCVA). The median survival time for a second implant was 13 and 28 months for the Ozurdex and Retisert groups, respectively (P=0.0028). Eyes with the Ozurdex were 5 times more likely to receive a second implant (P=0.02). No eyes in the Ozurdex group needed additional glaucoma medications, surgery, or laser compared to 44% of eyes in the Retisert group. Eyes with the Retisert implant had a statistically higher rate of having more glaucoma medications, surgery, or laser (P=0.02). In the Ozurdex group, 50% of phakic eyes at baseline had cataract progression and subsequent surgery compared with 100% of Retisert phakic eyes. Eyes with the Retisert implant are 4.7 times more at risk of cataract progression (P=0.04). Conclusions: The dexamethasone (Ozurdex) implant seems comparable to the fluocinolone acetonide (Retisert) implant in preventing recurrence of noninfectious uveitis and in improving inflammation and BCVA. However, there were higher rates of cataract progression and need for glaucoma medications, laser, and surgery with the Retisert implant. © Copyright 2013, Mary Ann Liebert, Inc.


PubMed | The August Pi i Sunyer Biomedical Research Institute IDIBAPS, University of Barcelona and Massachusetts Eye Research and Surgery Institution MERSI
Type: Journal Article | Journal: Acta ophthalmologica | Year: 2016

To evaluate serum cytokine profile from patients with active scleritis in a two-centre prospective case-control study.The serum of 20 active scleritis patients not treated with any local, periocular, or systemic immunomodulatory therapy (IMT) was analysed with multiplex assay to determine the levels of 11 cytokines interleukin (IL)-1, IL-6, IL-2, IFN-, IL-10, IL-12p40, IL-13, IL-17A, IL-5, TNF-, and TNF-, and with ELISA to determine the levels of TGF-1, IL-22, and IL-23. Twenty-five age-matched healthy volunteers were used as controls. In a subgroup of 13 patients with active disease, a second serum sample was obtained when the disease was inactive and levels of IL-22 were determined. Serum IL-22 levels from patients with active scleritis were correlated with type of scleritis (non-necrotizing and necrotizing), degree of inflammation (0-4+:2+ and >2+), and associated systemic disease.Serum levels of IL-22 were elevated in active scleritis patients compared to controls (6.411.52pg/ml versus 1.930.39pg/ml, p=0.012) and significantly decreased after scleritis remission with the use of IMT (p=0.005). There was no statistical association with scleritis type, degree of inflammation, or associated systemic disease. The serum levels of other cytokines were not significantly different from controls.In our study cohort, IL-22 serum levels were significantly elevated in active scleritis patients compared to controls and decreased significantly after remission. Our results suggest that IL-22, a T helper (Th) 17- and Th22- derived cytokine, may play a critical role in the physiopathology of scleritis.


Sarup V.,Massachusetts Eye Research and Surgery Institution MERSI | Sarup V.,Ocular Immunology and Uveitis Foundation OIUF | Sarup V.,Harvard University | Foster C.S.,Massachusetts Eye Research and Surgery Institution MERSI | And 2 more authors.
Seminars in Ophthalmology | Year: 2013

Chronic uveitides can lead to serious sequlae over time including blindness. Human Leukocyte antigen (HLA) plays an important role in immunological response of the eyes. Some of these uveitides are associated with certain Human Leukocyte antigen (HLA) types. This article reviews these relationships and their significance. © 2013 Informa Healthcare USA, Inc. All rights reserved.

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