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34 EUROTIMES | Volume 18 | Issue 2 T NFα-inhibitors, commonly known as biologicals, have become a key component of treatment of uveitis in children, particularly when steroids are no longer desired and when steroid-sparing treatments fail, according to Joke de Boer MD, a uveitis specialist in Utrecht, the Netherlands. She provided an update on behalf of Dr Manfred Zierhut during a Joint Symposium on Paediatric Uveitis, organised by WSPOS and EURETINA. She reviewed the most important studies to date that looked at the use of the three main biologicals (etanercept, infliximab and adalimumab) in paediatric uveitis. The first with etanercept were published as early as 2001, with the drug being used for treatment-resistant chronic uveitis in children. The results were encouraging, but etanercept has since been abandoned in favour of infliximab and adalimumab. A 2005 study by Kotaniemi et al. suggested that infliximab was superior to etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis (JIA). Dr Zierhut and his team studied the use of adalimumab in children with chronic anterior uveitis in whom previous therapy had been ineffective. A main inclusion criterion was the unsuccessful use of at least one additional immunosuppressant besides steroids. Indeed, all 18 patients had been previously treated with cyclosporine and methotrexate. Of these 18 patients, many had also undergone treatment with azathioprine (12) mycophenolate mofetil (4) cyclophosphamide (2) and even other biologicals, including etanercept (8) and infliximab (5). “The extent of the previous treatment characterised the severity of the uveitis seen in the patients included in the study,” said Dr de Boer. The results were very encouraging. Adalimumab was considered “effective” in 16 of the 18 patients (88.8 per cent), mildly effective in one (5.6 per cent) and not effective in one (5.6 per cent). No worsening of the uveitis was seen during the study. However, Dr de Boer emphasised the potential for adverse events, including production of autoantibodies. To prevent this problem, the recommendation was to continue methotrexate during treatment with biologicals. All patients must be screened for latent tuberculosis and, using MRI, for demyelinating disease. Regarding the risk of tumours after biologicals, Dr de Boer said that studies have shown no higher incidence than with the traditional disease-modifying anti-rheumatic drugs (DMARDs). Dr de Boer also introduced delegates to a less well-known drug, rituximab. This is a chimeric monoclonal antibody that binds the CD20 protein found on the surface of B cells, leading to the cells’ death. This biological agent, primarily used to treat hematologic neoplasia, might see use in uveitis treatment in the future. Joke de Boer – [email protected] POSITIVE RESULTS Biological agents a key to treatment by Leigh Spielberg in Milan Update INTERNATIONAL MEETING ON Anterior segment surgery 21 st 23 rd JUNE 2013 For further information: www.femtocongress.com VENUE: GRAN GUARDIA PALACE - VERONA - ITALY Under the patronage of Organizer: Roberto Bellucci M.D. DIRECTOR OF THE OPHTHALMIC UNIT, HOSPITAL OF VERONA DAY 1 Friday, June 21 st Afternoon: 16,30 – 18,30 • Instructional course: Basics of femtolaser surgery for ophthalmologists DAY 2 Saturday, June 22 nd Morning: 8,30 – 13,00 1 st Session: CORNEA CHAIR: GIORGIO MARCHINI, MD • Penetrating keratoplasties • Deep anterior lamellar keratoplasties • Endothelial keratoplasties • The postoperative • Rings and co. DAY 2 Saturday, June 22 nd Afternoon: 14,30 – 18,00 2 nd Session: REFRACTIVE CHAIR: SIMONETTA MORSELLI, MD • The femto and the flap • Results of femtolasik • Presbylasik • Intrastromal treatments • Corneal inlays • Corneal incisions DAY 3 Sunday, June 23 rd Morning: 9,00 – 13,30 3 rd Session: CATARACT CHAIR: ROBERTO BELLUCCI, MD • The state of the art • Different lasers • Changes in surgery • Results: anatomical and optical quality • Complications • Future trends • Special cases Preliminary programme PAEDIATRIC OPHTHALMOLOGY e extent of the previous treatment characterised the severity of the uveitis seen in the patients included in the study “ Joke de Boer MD contact T he US space programme has always barred its astronauts from having refractive surgery. But last September, the National Aeronautics and Space Agency (NASA) began allowing astronaut applicants to undergo LASIK. NASA based its decision on extensive testing of advanced technology LASIK by the US military. The US Air Force recently approved LASIK for its pilots. "Many years ago when LASIK was becoming popular in the community we didn't understand the implications of LASIK relative to the environment of the cockpit," said Steven Schallhorn MD, a NASA consultant who was the director of refractive surgery for the US Navy before his military retirement last year. Dr Schallhorn said that there were concerns about how LASIK would perform in space, such as how the flap would hold up in a low-oxygen, low- pressure environment. n From EuroTimes, Volume 13, Issue 2, February 2008 From the Archive NASA approves all-laser LASIK for astronauts
