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"apellidos" => "García-Delpech" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "Udaondo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Díaz-Llopis" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia biológica en oftalmía simpática refractaria a tratamiento inmunosupresor combinado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 607 "Ancho" => 1500 "Tamanyo" => 90277 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">At the angiographic level, after 5 months of treatment, considerable improvement of the right eye ocular fundus can be seen. At the right, the serous detachment is completely gone, as well as a clear reduction of the peripapillary diffusion and the absence of focal exudation points.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The objective of this communication is to report on the efficiency and advantages of the anti-TNF biological drug (adalimumab) in sympathetic ophthalmia (OS), bilateral panuveitis in which this treatment has not yet been described in world literature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 40-year-old woman exhibiting sympathetic ophthalmia in the right eye with 2 years evolution after left eye retina detachment surgery failure.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite systemic treatment with prednisone 30–90<span class="elsevierStyleHsp" style=""></span>mg/day, methotrexate 15<span class="elsevierStyleHsp" style=""></span>mg/week and cyclosporine 150<span class="elsevierStyleHsp" style=""></span>mg/day, the inflammation persisted, exhibiting in the ocular fundus multiple Dalen-Fuchs nodules as well as serous neuroepithelium in the entire macular area, as evidenced by optic coherence tomography (OCT). Fluorescein angiography revealed large contrast diffusion at the peripapillary level and multiple focal exudation points corresponding to said Dalen-Fuchs nodules. At that time, the visual acuity of the patient was of light perception.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Intravitreal treatment was established with 3 triamcinolone injections (Trigón<span class="elsevierStyleSup">®</span>) (4<span class="elsevierStyleHsp" style=""></span>mg/0.1<span class="elsevierStyleHsp" style=""></span>ml) at 1 month intervals, with the patient exhibiting temporary improvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Considering the resistance and after discarding active tuberculosis and latent hepatitis B, systemic immunosuppressant treatment was established with subcutaneous adalimumab 40<span class="elsevierStyleHsp" style=""></span>mg (Humira<span class="elsevierStyleSup">®</span>) on alternate weeks. This achieved the remission of the condition and stability for the past 18 months, with the virtual disappearance of the chorioretinal infiltration lesions as well as the total reapplication of the retina at the posterior pole level and the reduction of focal and peripapillary diffusion in angiography (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The soluble tumor necrosis factor (TNF) is a natural cytokine that intervenes in normal inflammatory and immunological responses. Adalimumab (Humira<span class="elsevierStyleSup">®</span>) is a recombinant human monoclonal antibody that bonds with the soluble tumor necrosis factor (TNF-alfa9) with high specificity and affinity and neutralizes its biological function.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is indicated for treatment of rheumatologic diseases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">According to the recently published description by Díaz-Llopis et al., adalimumab would be the choice for the biological treatment of uveitis, exhibiting considerable advantages compared to infliximab, such as ease of application (on an outpatient basis due to being subcutaneous) and low periodicity (2 weeks), as well as the lower risk of adverse reactions as it is a completely humanized monoclonal antibody. In addition, its high efficiency and the vast experience in its use raise the possibility of considering it as second or third line treatment.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Various drugs have been utilized for managing SO. Early corticoids treatments in combination with other immunosuppressant agents such as chlorambucyl, cyclophosphamide, azathiprine an cyclosporine can produce improvements in vision.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, poor residual visual acuity is associated to glaucoma, macular chorioretinal scars or persistent uncontrollable inflammation as in the present case.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This letter presents the first case described in world literature evidencing an objective success of adalimumab as a treatment for SO. No side effects have been observed in the midterm, allowing for a reduction of the corticoids dosage down to a maintenance regime of 10<span class="elsevierStyleHsp" style=""></span>mg/day.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: López-Prats MJ, et al. Terapia biológica en oftalmía simpática refractaria a tratamiento inmunosupresor combinado. Arch Soc Esp Oftalmol. 2011;86:222–26.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1307 "Ancho" => 950 "Tamanyo" => 259299 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison between the condition of the neuro epithelium detachment comprising the entire posterior pole, before and after treatment with adalimumab.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 607 "Ancho" => 1500 "Tamanyo" => 90277 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">At the angiographic level, after 5 months of treatment, considerable improvement of the right eye ocular fundus can be seen. At the right, the serous detachment is completely gone, as well as a clear reduction of the peripapillary diffusion and the absence of focal exudation points.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "General principles for the treatment of non-infectious uveitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Díaz-Llopis" 1 => "R. Gallego-Pinazo" 2 => "S. García-Delpech" 3 => "D. Salom-Alonso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Inflamm Allergy Drug Targets" "fecha" => "2009" "volumen" => "8" "paginaInicial" => "260" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19754409" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento con Adalimumab—nuevo antiTNF—del síndrome de Vogt Koyanagi-Harada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Díaz-Llopis" 1 => "L. Amselem" 2 => "F.J. Romero" 3 => "S. García-Delpech" 4 => "M.L. Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2007" "volumen" => "82" "paginaInicial" => "131" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17357888" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000008600000007/v1_201305091027/S2173579411000314/v1_201305091027/en/main.assets" "Apartado" => array:4 [ "identificador" => "8723" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000008600000007/v1_201305091027/S2173579411000314/v1_201305091027/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579411000314?idApp=UINPBA00004N" ]
Journal Information
Vol. 86. Issue 7.
Pages 222-223 (July 2011)
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Vol. 86. Issue 7.
Pages 222-223 (July 2011)
Letter to the Editor
Biological therapy in sympathetic ophthalmia refractory to combined immunosuppressive treatment
Terapia biológica en oftalmía simpática refractaria a tratamiento inmunosupresor combinado
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