MEDICAL ABSTRACTS

Marc D. Myers, O.D.

Marc D. Myers, O.D.

Infliximab therapy is welltolerated and effective intreating refractorynoninfectious scleritis

Doctor P, Sultan A, Syed S, et al.Infliximab for the treatment ofrefractory scleritis. Br J Ophthalmol2010;94(5):579-83.

Nearly half of all cases of scleritis areassociated with systemic autoimmunedisorders. Scleritis has a high morbidityrate despite treatment with systemicimmunosuppressive and corticosteroidtherapy. Previous reports discuss theuse of infliximab (Remicade, Centocor,Horsham, Pennsylvania) for uveitis,but little is known about its use fornoninfectious scleritis refractory toconventional treatment.

Researchers reviewed the charts of10 individuals with scleritis diagnosedbetween September 2003 and October2007. Scleritis was classified as ante-rior versus posterior and graded oninflammation and injection. Infliximabwas administered in a loading dose, 2weeks apart, followed by maintenanceinjections at approximately 1-monthintervals. Follow-up was maintainedfor 6 to 48 months (mean, 16.4), and7 to 24 infusions (mean, 16.2) wereadministered. The patients rangedfrom 35 to 70 years old.

Infliximab was well tolerated andeffective in 9 of the 10 patients. The1 patient who had to discontinue treat-ment had a drug-induced lupus reac-tion. Six patients achieved remission,which was defined as the discontinu-ation of concomitant immunosuppres-sant therapy. Two patients had todiscontinue treatment temporarily be-cause of upper respiratory infections.

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Eight patients continue to receiveinfliximab therapy and may continueindefinitely because the appropriatelength of treatment has not been de-fined. The researchers have foundmonthly treatment to be well toleratedand help eliminate flare ups.

Researchers found infliximabtherapy at monthly dosing intervalsto be well tolerated and effective intreating refractory noninfectious scle-ritis. Like other immunosuppressants,infliximab has the potential side effectof drug-induced lupus. Researchersrecognized the limitation of the studybecause of its small size, retrospectivenature, lack of control group, shortperiod of follow-up, and lack of ran-domization.

Stephen Hess, O.D.

doi:10.1016/j.optm.2010.07.006

Treating a largepopulation at a high riskfor trachomatousblindness

Huget P, Bella L, Einterz EM, et al.Mass treatment of trachoma withazithromycin 1.5% eye drops in theRepublic of Cameroon: feasibility,tolerance and effectiveness. Br JOphthalmol 2010;94(1):157-60.

In 2006, The Republic of Cameroonnoticed a high prevalence of trachomain the Kolofata health district. To com-bat this potentially blinding disease,Cameroon’s National Program ofPrevention implemented a mass elimi-nation program. Their goal was to ad-minister antibiotic eye drops to the

tometric Association. All rights reserved.

entire population of this region. Astudy was conducted to determine thefeasibility, tolerance, and effectivenessof using 1.5% azithromycin ophthal-mic drops to eliminate trachoma in alarge population.

To properly eliminate trachoma inthe Kolofata region of Cameroon, aseries of mass treatments was given tothe entire population once a year for 3consecutive years. Numerous pro-grams and policies from the WorldHealth Organization were usedthroughout the duration of the study.Such policies include the protocol fortrachoma prevalence survey as well asthe simplified grading system for therecognition and registering of tra-choma cases. Each neighborhood hada community health worker who wasresponsible for going door to door andadministering 1.5% azithromycin eyedrops to each individual morning andnight for 3 days. The program wasable to reach 111,340 individuals or96.6% of the population. Nurses ineach area gave basic questionnaires