Browsing by Author "Valenzuela, Rodrigo A."
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Item Definition of Uveitis Refractory to Treatment: A Systematic Review in the Absence of a Consensus(2020) Valenzuela, Rodrigo A.; Flores, Iván; Pujol, Myriam; Llanos, Carolina; Carreño, Ester; Rada, Gabriel; Herbort Jr, Carl P.; Cuitino, Loreto; Urzúa, CristhianPurpose: To evaluate the different definition of refractoriness in uveitis in the literature. Methods: We systematically searched the literature in order to identify definitions of refractory noninfectious uveitis in adult patients. A search strategy in the databases of MEDLINE and Scopus was used to find articles published between January 2005 and October 2018. Results: Definitions of corticosteroids-refractoriness were related to two main concepts: persistence of inflammation despite the use of corticosteroid and recurrences above a dosage threshold. In terms of immunomodulatory therapy and biologic agents, we observed a great variety of definitions: persistence of inflammation, number of attacks, side effects or complications, symptoms, and best-corrected visual acuity. Conclusions: The results of this systematic review demonstrate the current lack of consensus on the definition for refractory uveitis, regardless of the treatment being used and revealed a new terminology based on a comprehensive and operational definition for each specific category of refractoriness.Item Initial-onset acute and chronic recurrent stages are two distinctive courses of VogtKoyanagi-Harada disease(2020) Urzúa, Cristhian; Herbort Jr., Carl; Valenzuela, Rodrigo A.; El-Asrar, Ahmed M. Abu; Arellanes-Garcia, Lourdes; Schlaen, Ariel; Yamamoto, Joyce; Pavesio, CarlosPurpose: To describe distinctive stages of Vogt-Koyanagi-Harada (VKH) disease: initial-onset acute versus chronic recurrent disease. Methods: A comprehensive literature review regarding stages and clinical presentations of VKH disease was conducted. Results: Despite a list of signs that has been described as characteristic features of early or late phases of VKH disease, the current classification -developed by an international committee and published in 2001- does not consider a distinction regarding the time from onset of disease symptoms, and specific findings observed at certain time point from the symptoms presentation and outcomes related to the stage of VKH disease. In that sense, chronic recurrent VKH disease is more refractory to treatment and is associated with a higher rate of complications. Accordingly, this subset of VKH patients has poorer functional and anatomical outcomes than patients with an initial-onset acute disease. Conclusions: An early clear distinction of VKH phenotype [Initial-onset acute versus chronic recurrent disease] should be considered in each clinical scenario, evaluating the delay in diagnosis and the clinical presentation, since it may help clinicians to perform a correct disease prognosis categorization and thus to make treatment decisions in terms of potential refractoriness or expected clinical outcomes.Item New Pharmacological Strategies for the Treatment of Non-Infectious Uveitis. A Minireview(2020-05) Valenzuela, Rodrigo A.; Flores, Iván; Urrutia, Beatríz; Fuentes, Francisca; Sabat, Pablo E.; Llanos, Carolina; Cuitino, Loreto; Urzúa, CristhianNon-infectious uveitis (NIU) is a group of disorders characterized by intraocular inflammation at different levels of the eye. NIU is a leading cause of irreversible blindness in working-age population in the developed world. The goal of uveitis treatment is to control inflammation, prevent recurrences, and preserve vision, as well as minimize the adverse effects of medications. Currently, the standard of care for NIU includes the administration of corticosteroids (CS) as first-line agents, but in some cases a more aggressive therapy is required. This includes synthetic immunosuppressants, such as antimetabolites (methotrexate, mycophenolate mofetil, and azathioprine), calcineurinic inhibitors (cyclosporine, tacrolimus), and alkylating agents (cyclophosphamide, chlorambucil). In those patients who become intolerant or refractory to CS and conventional immunosuppressive treatment, biologic agents have arisen as an effective therapy. Among the most evaluated treatments, TNF-α inhibitors, IL blockers, and anti-CD20 therapy have emerged. In this regard, anti-TNF agents (infliximab and adalimumab) have shown the strongest results in terms of favorable outcomes. In this review, we discuss latest evidence concerning to the effectiveness of biologic therapy, and present new therapeutic approaches directed against immune components as potential novel therapies for NIU.