Publications by authors named "John H Kempen"
Purpose: To report the design of FLuorometholone as Adjunctive MEdical therapy for TT surgery (FLAME) trial.
Design: Parallel design, double-masked, placebo-controlled clinical trial with 1:1 randomization to fluorometholone 0.1% eye drops twice daily or placebo twice daily for 4 weeks in eyes undergoing trachomatous trichiasis (TT) surgery for assessing the efficacy, safety, and cost-effectiveness of fluorometholone 0.
Purpose: The anti-inflammatory effect of therapeutic pars plana vitrectomy (PPV) in the management of posterior segment uveitis is incompletely quantified. In this study, we evaluated the change in total immunosuppression load (TIL) following PPV for the eyes of patients with non-infectious uveitis.
Methods: Retrospective chart review of patients with non-infectious posterior segment uveitis on continuous anti-inflammatory therapy (systemic corticosteroids ± immunomodulatory therapy [IMT]) ±3 months, who received therapeutic PPV for non-resolving inflammation.
Purpose: Evaluation of longer-term effectiveness of three intravitreal therapies (methotrexate, ranibizumab, or dexamethasone implant) for participants enrolled in the randomized comparative effectiveness trial the Macular Edema Ranibizumab versus Intravitreal anti-inflammatory Therapy (MERIT) Trial followed for24 weeks.
Design: Multicenter randomized controlled clinical trial with masked evaluation of retinal thickness and visual acuity.
Participants: Patients with persistent or recurrent uveitic macular edema.
Vitamin D Supplementation and Remission from Chronic Anterior Uveitis.
Ocul Immunol Inflamm
November 2024
Purpose: Chronic anterior uveitis (CAU) often requires suppressive therapy, which has potential side effects including cataract, ocular hypertension, and increased risk of infection. No remittive therapy is currently available; however, several studies have demonstrated an association between low 25-hydroxy Vitamin D (25OHD) levels and either uveitis incidence or uveitis disease activity. This study investigates the potential of Vitamin D supplementation as a remittive treatment for CAU.
View Article and Find Full Text PDFArticle Synopsis
- This study is the first of its kind to statistically assess how well the Collaborative Ocular Tuberculosis Study (COTS) calculator predicts the need for antitubercular therapy (ATT) in patients with suspected tubercular uveitis (TBU) in an international setting.
- The main goal was to determine if a score of 4 or higher on the COTS calculator effectively guides the initiation of ATT.
- Results showed that among 492 participants, 45.7% received a high probability for ATT initiation, and the COTS-5 score showed the highest specificity at 88.7%, suggesting its effectiveness compared to clinician judgment.
Article Synopsis
- Intermediate uveitis involves inflammation of the vitreous and pars planitis, which can stem from various causes including infections, systemic diseases, or may be idiopathic (unknown origin).
- The specific term "pars planitis" refers to the idiopathic form characterized by distinctive findings like snowballs and snowbanks in the eye.
- Diagnosis relies on recognizing symptoms (like floaters) and conducting a thorough eye examination, while advanced techniques like PCR testing help identify underlying infectious or neoplastic causes.
Purpose: We compared the distribution of the HLA-B27 allele among Ethiopian patients with acute anterior uveitis (AAU) and controls without that disease.
Methods: The clinical features of patients were collected from their medical records. HLA-B27 genotyping was performed for 64 patients, with AAU using the real-time polymerase chain reaction (RT-PCR), and the results were compared to those from a panel of 192 healthy, unrelated volunteer control participants (refraction patients and volunteers) free of signs of anterior uveitis.
Article Synopsis
- The integration of AI in healthcare is revolutionizing the management of complex conditions like uveitis, which requires specialized knowledge due to its various causes and treatment responses.
- AI's potential in this field includes classifying diseases, analyzing imaging data, predicting outcomes, and identifying new treatments, addressing the shortage of uveitis specialists and improving patient care.
- However, successfully applying AI in clinical settings faces challenges, such as the need for extensive datasets, transparency in algorithms, and real-world validation of these models.
Article Synopsis
- The FLAME Trial examines the effectiveness of fluorometholone 0.1% eyedrops as a supplementary treatment for patients undergoing trachomatous trichiasis (TT) surgery in Ethiopia.
- The study is a randomized, double-masked, placebo-controlled trial involving up to 2500 participants, with a focus on preventing recurrent postoperative trichiasis over a one-year period.
- The primary goal is to assess the incidence of post-surgery TT along with various secondary outcomes, including complications and cost-effectiveness of the treatment.
Purpose: To evaluate the incidence, remission, and relapse of post-surgical cystoid macular edema (PCME) following cataract surgery in inflammatory eye disease.
Methods: A total of 1859 eyes that had no visually significant macular edema prior to cataract surgery while under tertiary uveitis management were included. Standardized retrospective chart review was used to gather clinical data.
Article Synopsis
- A study evaluated the incidence of significant posterior capsule opacification (PCO) and YAG laser capsulotomy among uveitic eyes after cataract surgery, revealing that about 16% of eyes experienced PCO with reduced visual acuity within a year.* -
- Analysis of 1,855 uveitic eyes found that younger patients, those with poorer preoperative vision, and postoperative inflammation were more likely to develop PCO, while younger age and female sex were risk factors for needing YAG laser capsulotomy.* -
- The findings indicate that PCO is common in uveitic patients post-surgery, with 22% of eyes undergoing YAG laser treatment in the same timeframe, emphasizing the need for
Purpose: This study aims to understand the practice patterns among ophthalmologists in North America who manage patients with acute, non-infectious anterior uveitis.
Methods: An eight-question survey was designed to elucidate the practice patterns of ophthalmologists across various geographic locations and practice settings regarding the management of anterior uveitis. This survey was distributed via the American Uveitis Society and Young Uveitis Specialists email listserv to ophthalmologists who self-identify as uveitis specialists and have a patient population that is at least 30% uveitis.
Infectious diseases affecting the eye often cause unilateral or asymmetric visual loss in children and people of working age. This group of conditions includes viral, bacterial, fungal and parasitic diseases, both common and rare presentations which, in aggregate, may account for a significant portion of the global visual burden. Diagnosis is frequently challenging even in specialist centres, and many disease presentations are highly regional.
View Article and Find Full Text PDFPurpose: To assess the diagnostic performance of two chatbots, ChatGPT and Glass, in uveitis diagnosis compared to renowned uveitis specialists, and evaluate clinicians' perception about utilizing artificial intelligence (AI) in ophthalmology practice.
Methods: Six cases were presented to uveitis experts, ChatGPT (version 3.5 and 4.
Background/aims: Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1-22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia.
Methods: Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included.
Acute retinal necrosis is a progressive intraocular inflammatory syndrome characterized by diffuse necrotizing retinitis that can lead to a poor visual outcome, mainly from retinal detachment. The antiviral treatment approach for acute retinal necrosis varies as there are no established guidelines. We summarize the outcomes of acute retinal necrosis with available antiviral treatments.
View Article and Find Full Text PDFPurpose: To investigate the demographic and clinical characteristics of patients with sympathetic ophthalmia (SO) and define the risk factors for its incidence following trauma and ophthalmic procedures.
Design: Retrospective cohort study.
Participants: Patients in the American Academy of Ophthalmology's (Academy) IRIS Registry (Intelligent Research in Sight) who were (n=1523) or were not diagnosed with SO following a documented procedure or trauma between January 1, 2013, and December 31, 2019.
Introduction: Accurate diagnosis and timely management are vital for favorable uveitis outcomes. Artificial Intelligence (AI) holds promise in medical decision-making, particularly in ophthalmology. Yet, the diagnostic precision and management advice from AI-based uveitis chatbots lack assessment.
View Article and Find Full Text PDFPsychosocial Well-Being and Quality of Life in Uveitis: A Review.
Ocul Immunol Inflamm
September 2024
Purpose: As a potentially sight-threatening disease with ocular, systemic, and treatment-related complications, uveitis diminishes quality of life (QOL) and affects psychosocial well-being. This review summarizes the existing tools for evaluating psychosocial well-being and/or QOL in patients with uveitis, explores the biological and non-biological factors affecting psychosocial well-being and/or QOL, and proposes future directions for incorporating these tools into clinical practice.
Methods: A systematic search of the MEDLINE, Embase, and Cochrane databases from inception to June 8, 2022 was conducted, screening for articles focused on psychosocial well-being and/or QOL in patients with uveitis.
Article Synopsis
- The study aimed to analyze the relationship between immunosuppression and overall as well as cancer-specific mortality in patients with noninfectious ocular inflammatory disease.
- Researchers examined data from over 15,000 patients over a median of 10 years and found there were 1970 deaths, with 435 attributed to cancer.
- The results indicated that patients on various immunosuppressants experienced similar mortality rates compared to the general U.S. population, suggesting that these treatments did not significantly increase overall or cancer mortality risk.
Aims: To present current practice patterns in the diagnosis and management of Cytomegalovirus anterior uveitis (CMV AU) by uveitis experts worldwide.
Methods: A two-round modified Delphi survey with masking of the study team was performed. Based on experience and expertise, 100 international uveitis specialists from 21 countries were invited to participate in the survey.
Article Synopsis
- The study aimed to evaluate and create consensus guidelines among global uveitis specialists regarding the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) associated anterior uveitis (AU).
- An online Delphi survey gathered responses from 76 uveitis experts across 21 countries, with findings leading to the establishment of treatment guidelines via the TITAN working group.
- Key conclusions highlighted specific diagnostic signs for HSV and VZV AU, preferred use of valacyclovir for treatment, and a variety of opinions on treatment duration and managing recurrences.
Purpose: To estimate the incidence/risk factors for cataract in noninfectious anterior uveitis.
Design: Retrospective multicenter cohort study (6 US tertiary uveitis sites, 1978-2010).
Methods: Data were harvested by trained expert reviewers, using protocol-driven review of experts' charts.
Purpose: To evaluate the rate of, risk factors for, and outcomes of cataract surgery in patients with intermediate, posterior, and panuveitides treated with systemic corticosteroids and immunosuppression.
Design: Cohort study of participants from a randomized clinical trial.
Methods: A multicenter clinical trial with extended follow-up comprised the study setting.