Publications by authors named "Uwe Pleyer"

Background: Adalimumab, an anti-TNF-α biologic agent, has emerged as a principal treatment option for patients with non-infectious uveitis. The influence of adalimumab anti-drug antibodies (AAA) on the efficacy of adalimumab therapy is not yet fully understood. We aim to understand their clinical implications in the context of therapeutic drug monitoring and the factors contributing to the formation of these antibodies.

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Background: Allogeneic graft rejection is the leading cause of graft failure in corneal transplantation (CT) despite the immune privilege of the anterior chamber and corneal bed. The ability to identify patients at higher risk of acute rejection before or after CT could have a major impact on the clinical management of these patients.

Methods: To address this important issue, a multicenter European cohort of low-risk (n = 142) and high-risk (n = 102) CT recipients was established, and the immune system was evaluated in detail in peripheral blood mononuclear cells and plasma before and 6 and 12 mo posttransplantation.

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Article Synopsis
  • Tocilizumab (TCZ) is a drug used for rheumatic diseases that has shown promise in treating refractory non-infectious uveitis (NIU), particularly in Birdshot NIU, and this study examined its long-term effects.
  • Eight patients were monitored over an average of 33 months using various imaging techniques to assess retinal and choroidal inflammation, with significant improvements noted in retinal inflammation and central retinal thickness (CRT) after six months.
  • While TCZ effectively reduced retinal vasculitis and improved CRT, it was less effective for choroidal inflammation, indicating a need for further research to optimize TCZ treatment in NIU patients.
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  • Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe, drug-induced skin conditions that can be life-threatening and are now viewed as different levels of the same disease known as epidermal necrolysis (EN).
  • A new guideline has been created based on scientific literature and expert consensus to help medical professionals in diagnosing and treating EN.
  • This guideline targets various specialists like dermatologists and intensive care doctors, as well as informing patients, families, insurers, and policymakers about EN and includes recommendations for acute care and follow-up treatment.
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Article Synopsis
  • Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious, mostly drug-related conditions that affect the skin and mucous membranes, categorized under the umbrella term epidermal necrolysis (EN), which varies in severity.* -
  • A new guideline for diagnosing and treating SJS/TEN was created based on extensive scientific research and consensus among experts, involving various medical specialties to provide a comprehensive approach to patient care.* -
  • The guideline is designed for healthcare professionals across multiple fields, as well as patients, their families, insurers, and policymakers, with the first part specifically addressing diagnosis, initial treatment, and systemic immunotherapy.*
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Spondyloarthritis (SpA) is a term to describe a group of chronic inflammatory rheumatic diseases, which have common pathophysiological, genetic, and clinical features. Under the umbrella term SpA, two main groups are subsumed: axial SpA (radiographic axSpA and non-radiographic axSpA) and peripheral SpA (with the leading representative being psoriatic arthritis (PsA) but also arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, and undifferentiated pSpA). The key clinical symptom in axSpA is chronic back pain, typically with inflammatory characteristics, which starts in early adulthood, while the leading clinical manifestations of peripheral SpA (pSpA) are arthritis, enthesitis, and/or dactylitis.

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The conjunctiva has immune-responsive properties to protect the eye from infections. Its innate immune system reacts against external pathogens, such as fungi. The complement factor C5a is an important contributor to the initial immune response.

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Approximately 0.5-1% of patients with multiple sclerosis (MS) have co-existing uveitis. Both intraocular inflammation and MS mainly affect women in younger adulthood.

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Purpose: The Treatment exit Options For non-infectious Uveitis (TOFU) registry documents disease courses for non-anterior non-infectious uveitis entities with and without treatment to generate more evidence for clinical management recommendations including treatment exit strategies. In this article, we present the participants' baseline characteristics after the first 3 years.

Methods: TOFU is an observational, prospective registry and recruits patients ≥18 years of age with non-anterior non-infectious uveitis with or without a history of previous disease-modifying antirheumatic drugs (DMARDs) treatment.

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Background: Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately treated. Fluocinolone-acetonide sustained-release-0.2 µg/day intravitreal (FAc) implants are indicated for prevention of relapse in recurrent NIU-PS.

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Inflammatory changes in the retinal vessels can be attributed to a wide range of etiologies. These include infections, intraocular and systemic autoimmune processes, general diseases and iatrogenic factors. As the endothelium of the retinal capillaries forms the inner blood-retinal barrier, a disruption of this structure is directly associated with consequences for the fluid electrolyte balance of the retina.

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Macular edema (ME) remains a primary cause of visual deterioration in uveitis. Visual acuity (VA) can often be maintained using corticosteroid depot systems. This study evaluated the efficacy of a fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN) in treating non-infectious uveitis using real-world data.

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Fundus autofluorescence (FAF) is a prompt and non-invasive imaging modality helpful in detecting pathological abnormalities within the retina and the choroid. This narrative review and case series provides an overview on the current application of FAF in posterior and panuveitis. The literature was reviewed for articles on lesion characteristics on FAF of specific posterior and panuveitis entities as well as benefits and limitations of FAF for diagnosing and monitoring disease.

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Objective: This study aims to describe the outcome of corneal grafts, both low risk and high risk, after successfully reversed immunological rejection.

Methods: Datasets on reversed rejection episodes in penetrating and endothelial keratoplasties between 2014 and 2019 (n=876) were extracted from the Adverse Immune Signatures and their Prevention in Corneal Transplantation database, which contains the prospectively and consecutively collected corneal transplants from five European centres. Stratified by the preoperatively determined risk status for immunological rejection, the outcome parameters analysed included visual acuity, intraocular pressure, endothelial cell density and central corneal thickness before and after reversed rejection episodes.

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Purpose: To investigate differences in the retinal vessel area density (VAD) on optical coherence tomography angiography (OCTA) between eyes with unilateral herpetic viral anterior uveitis (VAU) (herpes-simplex virus (HSV) and varicella-zoster virus (VZV)) and the non-affected fellow eye.

Methods: In this monocentric, observational, prospective case series we analyzed the VAD of the macula, optic disc, and peripapillary region in affected and non-affected eyes of 22 patients with HSV-positive and 22 patients with VZV-positive VAU using OCTA. We analyzed also the visual field mean deviation (MD), the retinal nerve fiber layer (RNFL) thickness, Bruch's Membrane Opening-Minimum Rim Width (BMO-MRW), and ganglion cell layer (GCL) thickness on OCT and correlated the results with the different VADs.

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Purpose: This study aimed to investigate the association between age, immune response, and clinical presentation of ocular toxoplasmosis (OT).

Design: This was a monocentric, retrospective, observational cohort study.

Methods: A review of the medical records of patients with active OT at the Uveitis Center, Charité Universitätsmedizin, was conducted.

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Article Synopsis
  • Physiological wound healing in the cornea is a complex, multifactorial process crucial for maintaining its integrity and function, aiming to prevent light-scattering scars.
  • Improper wound healing can lead to significant issues like corneal fibrosis and loss of optical clarity, potentially resulting in reduced vision or blindness.
  • Understanding the mechanisms and available treatments—ranging from topical therapies to surgical options—is vital for addressing corneal wound healing disorders and preventing long-term damage.
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Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation.

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Article Synopsis
  • The study investigates the awareness and diagnostic practices related to monogenic uveitis (mU) among uveitis specialists through an anonymous survey conducted with members of the Autoinflammatory Diseases Alliance and International Uveitis Study Group.
  • Results showed that a majority of participants rated their knowledge of mU as poor, with 60.4% identifying NOD2 as the primary gene, and success rates in clinical scenarios varied significantly, especially among those in multidisciplinary teams.
  • The findings highlight knowledge gaps and barriers in prescribing disease-modifying anti-rheumatic drugs (DMARDs), suggesting that the results could guide the development of better clinical guidelines and improve patient care.
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Tear film hyperosmolarity induces dry eye syndrome (DES) through transient receptor potential vanilloid type 1 (TRPV1) activation. L-carnitine is a viable therapeutic agent since it protects against this hypertonicity-induced response. Here, we investigated whether L-carnitine inhibits TRPV1 activation by blocking heat- or capsaicin-induced increases in Ca influx or hyperosmotic stress-induced cell volume shrinkage in a human corneal epithelial cell line (HCE-T).

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Purpose: To analyse differences in the retinal microvasculature in eyes with cytomegalovirus (CMV)-positive Posner-Schlossman syndrome (PSS) compared to the non-affected eyes using optical coherence tomography angiography (OCTA).

Methods: In this monocentric, observational prospective case series, 25 patients with unilateral CMV-positive PSS were included. We compared the vessel area densities (VAD) in the macula, optic disc, and peripapillary region in PSS-affected and non-affected eyes using OCTA.

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Objective: Spondyloarthritis (SpA) is a group of immune-mediated diseases highly concomitant with nonmusculoskeletal inflammatory disorders, such as acute anterior uveitis (AAU) and Crohn's disease (CD). The gut microbiome represents a promising avenue to elucidate shared and distinct underlying pathophysiology.

Methods: We performed 16S ribosomal RNA sequencing on stool samples of 277 patients (72 CD, 103 AAU, and 102 SpA) included in the German Spondyloarthritis Inception Cohort and 62 back pain controls without any inflammatory disorder.

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Article Synopsis
  • Vernal keratoconjunctivitis (VKC) is a serious allergic eye disease mainly affecting children in warm, humid areas, leading to potential vision loss if untreated.
  • About 55%-60% of VKC patients show sensitization to allergens and involvement of immunoglobulin E (IgE), indicating complex immunological mechanisms.
  • The monoclonal antibody omalizumab has shown promise in managing VKC by improving symptoms and reducing steroid use in children, but more extensive clinical trials are needed to confirm its effectiveness.
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