|Year : 2021 | Volume
| Issue : 1 | Page : 95-96
Department of Ophthalmology, Government Medical College, Thrissur, Kerala, India
|Date of Submission||23-Feb-2021|
|Date of Acceptance||01-Mar-2021|
|Date of Web Publication||19-Apr-2021|
Dr. Neethu Pradeep
Department of Ophthalmology, Government Medical College, Thrissur, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pradeep N. Journal Review. Kerala J Ophthalmol 2021;33:95-6
| Impact of COVID-19 Pandemic on Uveitis Patients Receiving Immunomodulatory and Biological Therapies (Cope Study)|| |
Aniruddha Kishandutt Agarwal, Sridharan Sudharshan, Padmamalini Mahendradas, Kalpana Babu, Pratik Shenoy, Mohit Dogra, Reema Bansal, Manisha Agarwal, Jyotirmay Biswas, S. Balamurugan, Rupesh Agrawal, Vishali Gupta
High dose of corticosteroids and immunomodulatory therapies (IMTs) are considered to be the mainstay of management in uveitis. Patients on these drugs are prone to COVID-19 infection and may be subjected to severe forms of disease. It was in March 2020, during the early stages of the pandemic, uveitis specialists became concerned about the use of high-dose therapies in their patients. It is in this backdrop, a study was undertaken to assess the impact of this pandemic on uveitis management, which forms the basis of this paper.
This study was done as prospective case series in which 284 eyes from 176 patients were included. Noninfectious uveitis (NIU) patients who received corticosteroids, IMTs, and biologicals in the pre-COVID period and who were subjected to follow-up during the period between March 1, and June 25, 2020, were considered for this study. Clinical details, disease activity, time since the last activity, and treatment history of each subject were recorded with the intention of identifying relapse of disease if any, and evaluation was done at regular intervals. Data were collected online, and statistical tools such as descriptive analysis and Mann–Whitney U-test were used.
Out of 176 patients, 108 have bilateral disease. Ninety patients had active NIU and remaining were quiescent on maintenance therapy. Among eyes with active NIU, 12.2% were given intravenous methylprednisolone (IVMP) for severe vision-threatening uveitis. However, in 7.77%, the uveitis experts preferred to not treat with IVMP despite an indication for the same. Among active NIU patients who were started on oral corticosteroids, rapid tapering was done in 57.4%. No alterations were made for those on maintenance therapy (≤10 mg/kg/day dose). 161 (91.5%) patients were receiving systemic IMT, and 25 patients (14.2%) were given biological therapies. IMT was altered in 29/161 (18.0%) subjects, but no alterations were made with biological agents.
Among eyes with inactive NIU (n = 163 eyes), relapse was noted in 53 eyes (32.5%, 29 subjects), and 24 subjects had relapse in both eyes. Of the nine subjects who stopped medications, five developed active uveitis. All these subjects were treated with a bridge course of oral corticosteroids and frequent topical corticosteroids/intravitreal injections. None of the subjects developed symptoms related to COVID-19 during the study.
Based on the observations, it was found that, in the case of patients with stable on-going therapies for NIU, sudden reduction in dosages can result in increase in recurrences. Hence, the implication of the study is that a major deviation from the current treatment practice will lead to a not so desirable outcome in case of uveitis patients. The uniqueness of the study lies in the time period during which it was conducted.
The study has certain limitations. It does not mention how many subjects were eligible for inclusion and how many potentially eligible subjects came to the hospital for follow-up. Had these details been included it would have been possible to get an idea about the number of patients having relapse or worsened symptomatology but unable to access hospital care. This is an observational study and cannot determine the therapeutic value or clinical utility of therapies. The number of COVID patients was very low during the study period. Hence, the study has constraints in authentically proving the impact of this pandemic on uveitis treatment.
The study concluded that during the COVID-19 pandemic, uveitis specialists may tend to reduce the ongoing systemic IMT or prefer less aggressive treatment strategies for NIU, which put these subjects at high risk of uveitis relapse.
| Differential Effects on Ocular Biometrics by 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia Progression Study|| |
Fen Fen Li, Ka Wai Kam, Yuzhou Zhang, Shu Min Tang, Alvin L. Young, Li Jia Chen, Clement C. Tham, Chi Pui Pang, Jason C. Yam
High myopia is associated with sight-threatening complications such as macular hemorrhage, retinal detachment, cataract, and glaucoma. These complications have an adverse effect on the quality of life of affected persons, and moreover, the economic burden in managing them is relatively high. It is a universally accepted fact that atropine eye drops in low concentrations can delay the myopic progression. The present study was done taking into consideration of this fact.
The study aims at determining which all factors affecting myopic progression can be arrested by providing atropine in various concentrations. Hence, the purpose was to evaluate changes in ocular biometrics in groups receiving 0.05%, 0.025%, and 0.01% atropine compared with placebo over 1 year based on the Low-Concentration Atropine for Myopia Progression (LAMP) study. This was a double-blinded, randomized, placebo-controlled trial.
The study population included 383 children who had completed 1st year of LAMP study in the age group of 4–12 years, who had been given different concentrations of atropine or placebo once daily in both eyes. Of the total, 102 were in the 0.05% atropine group, 91 in the 0.025% atropine group, 97 children in the 0.01% atropine group, and 93 children in the placebo group.
IOL Master was used to measure cycloplegic spherical equivalent (SE), axial length (AL), corneal curvature (K), and anterior-chamber depth (ACD). Corneal astigmatism and lens power were calculated. The ocular biometric parameter changes were compared among groups. Contributions to SE progression from ocular parameters were determined and compared among groups.
Over 1 year, the changes in AL were 0.20 ± 0.25 mm, 0.29 ± 0.20 mm, 0.36 ± 0.29 mm, and 0.41 ± 0.22 mm in the 0.05% atropine, 0.025% atropine, 0.01% atropine, and placebo groups, respectively (P < 0.001), with a concentration-dependent response. This study demonstrated that largest reduction in AL was found in subjects who were given 0.05% atropine. Changes in ACD remained similar across all concentrations. AL elongation contributed most of the SE progression. Corneal power remained stable, and its changes were similar across all atropine concentration. Lens power decreased over time in each concentration, but its changes also were similar across all concentrations.
The major strength of the study is its methodology. Possible biases were minimized by using generalized estimating equations. There is direct comparison between different atropine concentrations with placebo in the study. To avoid the effects of accommodation, measurements were done after complete cycloplegia.
However, the study is not free from limitations. The current study reported only the 1st-year period of atropine treatment compared with the placebo. Further, lens power was not measured directly. The future scope is that further studies can be conducted to evaluate the long-term ocular biometric changes after stoppage of treatment.
From the findings of this study, it can be concluded that antimyopic effect of low-concentration atropine was achieved mainly by retardation of axial elongation. Low concentrations of atropine have no clinical effect on corneal or lens power.
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Conflicts of interest
There are no conflicts of interest.