· 2018. 1. 20. · psivida corp. 7:30 pm end of evening session 7:45-10:00 pm dinner at the...

PROGRAM CO-CHAIRS:

ALBERT T. VITALE, MD and ALAN G. PALESTINE, MD

22nd ANNUAL

WINTER SYMPOSIUMJANUARY 13-15, 2018

Canyons Grand Summit Hotel, Park City, Utah

Program Co-Chairs

Alan G. Palestine, MDProfessor of Ophthalmologyand RheumatologyUniversity of ColoradoAnschutz Medical CampusAurora, CO

Guest Speakers

AUS 22ND ANNUAL WINTER SYMPOSIUM

Ian Crozier, MDNational Institutes of HealthIntegrated Research FacilityNational Institute of Allergy & Infectious DiseasesChandler, AZ

Michael A. Postow, MDMedical OncologistMemorial Sloan KetteringNew York, NY

Emmett T.Cunningham, Jr., MD, PhD, MPH

Director of the Uveitis ServiceCalifornia Pacific Medical CenterSan Francisco, CA

Steven Yeh, MDDirector of the Uveitis Serviceand M. Louise SimpsonAssociate Professor ofOphthalmologyEmory Eye CenterAtlanta, GA

Albert T. Vitale, MDProfessor, Ophthalmology and Visual SciencesJohn A. Moran Eye CenterUniversity of UtahSalt Lake City, UT

SaturdayJ A N U A R Y 13

7:00-8:00 amRegistration/Breakfast

7:00-9:35 amExhibits

8:00-8:05 amOpening Remarks ALBERT T. VITALE, MD

8:05-9:35 amCASE PRESENTATIONS, FREE PAPERS AND DISCUSSIONS

8:05-8:12 amRecurrent Bilateral CMVRetinitis in Susacs Syndrome:Management Challengesand Imaging Findings DILRAJ GREWAL, MD

8:12-8:17 amDiscussion

8:17-8:29 amCytomegalovirus Retinitis:Does Immune RecoveryRetinitis Exist?DOUGLAS A. JABS, MD, MBA


8:34-8:46 amImmunosenescence and CytomegalovirusAnterior UveitisJAY SIAK, MBBS, FRCOphth, FRCSEd (Ophth), MCI


8:51-8:58 amChronic GranulomatousDiseaseJULIA SHULMAN, MD


9:03-9:10 amA Good Lesson from a Surprise DiagnosisASHLEIGH LEVISON, MD


9:15-9:27 amReclassifying IdiopathicUveitis: Lessons from aTertiary Uveitis CenterRENE CHOI, MD, PhDTravel Grant Awardee

Purpose: Idiopathic uveitis is the mostcommon diagnosis in most series fromuveitis clinics. We sought to determine thepercentage of patients initially diagnosed as idiopathic, non-infectious uveitis referredto a tertiary uveitis center who were sub -sequently found to have an identifiablecause of uveitis.

Methods: We performed a computerizeddatabase analysis of 249 consecutivepatients who were referred to our practice.One hundred and seventy-three of thesepatients (173/249 or 69%) were referredwith the diagnosis of idiopathic, non-infec-tious uveitis between 2008 and 2016.Patients were evaluated by a thoroughhistory and ophthalmic examination withselected laboratory testing targeted by cluesfrom the history and exam.

Results: Fifty out of 173 (28.9%) patientswere subsequently diagnosed with anunderlying condition. Sarcoidosis was themost common (18/50 or 36%) amongthose with an identifiable cause), including4 of 18 (22.2%) patients who were foundto have cardiac involvement. The next most

common were HLA-B27 associated uveitis(11/50, 22%), infectious (6/50, 12%),tubulo-interstitial nephritis with uveitis(5/50, 10%), and juvenile idiopathic arthritis(4/50, 8%). Other conditions includedBehcet’s disease, multifocal choroiditis,Crohn’s disease, multiple sclerosis, andrelapsing polychondritis. An underlyingcondition was not found in 123 (123/173or 71.1%) patients.

Conclusions: We report that 29% ofpatients referred to our tertiary uveitiscenter diag nosed as “idiopathic” had anassociated identifiable cause. Identifying anunderlying condition associated with uveitiscould be potentially lifesaving for someillnesses (eg. sarcoidosis with cardiacinvolvement) and is critical to management.Although we were able to use limited test -ing to classify many patients who had beenpreviously incorrectly labeled with idiopathicuveitis, idiopathic uveitis remains the mostcommon diagnosis in our uveitis clinic.


9:32-9:35 amWrap Up

9:35 amEnd of Morning Session

3:30-4:00 pmBreak

3:30-7:30 pmExhibits

4:00-4:05 pmIntroduction ALAN G. PALESTINE, MD

4:05-6:05 pmSCIENTIFIC SESSION 1: Drug Induced Uveitis:Familiar Agents to Novel Medications withUnexpected InflammatoryManifestations

AUS 22nd ANNUAL WINTER SYMPOSIUM 3

4:05-4:50 pmDrug-Induced Uveitis –Agents Old and NewEMMETT T. CUNNINGHAM, JR., MD, PhD, MPHAlthough uncommon, drug-induced uveitis is well-recognized and associatedwith an increasing number of pharma-cotherapeutics. This presentation willsummarize the prevalence and presentationof intraocular inflammation reported inassociation with the more commonly used agents.

4:50-5:05 pmDiscussion

5:05-5:50 pmNon-Ocular ImmunotherapySide Effects: What Can We Learn to Approach OurPatients with Ocular Toxicity?MICHAEL A. POSTOW, MDImmunotherapy has shown recent signifi -cant success in treating patients withcancer. In this talk, we will first discuss themechanism of action of new immuno -therapy drugs, predominantly immunecheckpoint blocking antibodies. Immunecheckpoint blockade refers to the strategyof enhancing a patient’s immune responseby blocking normally negative regulators ofimmunity such as cytotoxic T lymphocyteantigen-4 (CTLA-4) and programmed celldeath-1 (PD-1) or its ligand, PD-L1. Whenthese targets are blocked, a spectrum oftoxicities may result that can affect anyorgan system.

The timing of these various toxicities, bestmanagement strategies, and unique consid-erations for this patient population will bereviewed with a focus on non-ocular toxic-ities. Additionally, although little remainsknown about underlying mechanisms, wewill discuss preliminary data from transla-tional studies in patients that suggest Tcells, antibodies, and cytokines may beinvolved in the mechanism of specificimmune checkpoint induced inflammatoryevents. These studies may provide someinsights into approaching ocular toxicityfrom these drugs.


6:05-6:25 pmBreak

6:25-7:18 pmCASE PRESENTATIONS, FREE PAPERS AND DISCUSSIONS

6:25-6:32 pmFosamax AssociatedChorioretinitisYING QIAN, MD


6:37-6:44 pmVKH-like Uveitis Followed by Autoimmune Retinopathyin a Patient with MetastaticCutaneous MelanomaJOSEPH ALSBERGE, MD


6:49-7:01 pmPhase 3 Study of InjectableFluocinolone Implant toTreat Intermediate, Posterior, and PanuveitisGLENN J. JAFFE, MD


7:06-7:13 pmAbandon the Goal of aUnifying Therapeutic?LAURA KOPPLIN, MD, PhD


7:18-7:30 pmINDUSTRY PARTNERPRESENTATIONS

7:18-7:21 pmAldeyra Therapeutics

7:21-7:24 pmAllergan, Inc.

7:24-7:27 pmClearside Biomedical, Inc.

7:27-7:30 pmpSivida Corp.

7:30 pmEnd of Evening Session

7:45-10:00 pmDinner at The CanyonsGrand Summit Hotel

SundayJ A N U A R Y 14

7:00-8:00 amBreakfast


8:00-8:05 amIntroduction ALAN G. PALESTINE, MD


4 AUS 22nd ANNUAL WINTER SYMPOSIUM

8:05-8:17 amAnalysis of the RetinalVasculature Using OpticalCoherence TomographyAngiography in BirdshotChorioretinopathy SHILPA KODATI, MD Travel Grant Awardee

Purpose: To evaluate changes in the retinalvasculature and choriocapillaris in birdshotchorioretinopathy (BCR) including quanti-tative analysis of the superficial and deepcapillary plexus using optical coherencetomography angiography (OCT-A).

Methods: A retrospective review of BCRand normal patients with OCT-A imageswas conducted. All images were acquiredon the AngioPlex Cirrus HD-OCT platform.Images were assessed for the presence offlow voids at the level of the choriocapil-laris. Vessel density (VD) and fovealavascular zone (FAZ) at the level of thesuperficial capillary plexus (SCP) and deepcapillary plexus (DCP) were calculatedusing image J software and fractaldimension using Fractalyse software.

Results: 32 eyes from 19 patients with BCR(mean age 59.5 years, 12 female, 17 male)and 21 normal eyes (39 years, 11 female, 8 male) were identified. All BCR patientswere HLA-A29 positive. Qualitative analysisof OCT-A images from BCR patientsrevealed flow voids at the level of thechoriocapillaris consistent with atrophy in 4 eyes (12.5%) and an absent DCP in 5eyes (15.6%). Mean VD and FD of the SCPwere significantly (p< 0.001) lower in BCReyes (VD of SCP: 0.31; VD of DCP: 0.38;FD of SCP: 1.73; VD of DCP: 1.77)compared to normal eyes (VD of SCP:0.43; VD of DCP: 0.45; FD of SCP 1.80; FD of DCP: 1.81). In contrast, no significantdifference in FAZ was observed betweenBCR (SCP: 0.36; DCP: 0.64) and normaleyes (SCP: 0.29; DCP: 0.53).

Conclusions: Our results demonstratedecreased vessel density and fractaldimension in patients with BCR andsuggest that analysis of the retinal vascu-lature using OCT-A provides additionalinformation to fluorescein angiography andmay be a useful marker to assess diseaseseverity in BCR.


8:22-8:29 amMultifocal ChorioretinalConundrumMARK JOHNSON, MD


8:34-8:41 amAn Unusual RetinalDetachmentPAULINE MERRILL, MD


8:46-8:58 amScleral Windows to TreatExudative Detachment inUveal Effusion Syndrome:Structural Outcomes andImaging ObservationsDILRAJ GREWAL, MD


9:03-9:13 amHand, Food, Mouth, and Eye?LANA M. RIFKIN, MD


9:18-9:26 amINDUSTRY PARTNERPRESENTATIONS

9:18-9:23 amAbbvie

9:23-9:26 amGilead Sciences, Inc.

9:26-9:30 amWrap Up

9:30 amEnd of Morning Session

3:30-4:00 pmBreak

3:30-7:20 pmExhibits

4:00-4:05 pmIntroduction ALBERT T. VITALE, MD

4:05-6:05 pmSCIENTIFIC SESSION 2:Infectious Posterior Uveitis:Diagnoses Not to Miss and New and EmergingInfections, in the Office andfrom a Global Perspective

4:05-4:50 pmInfectious Posterior Uveitis:Ebola, Zika, and EmergingInfectious DiseasesSTEVEN YEH, MDRecent insights into posterior uveitisassociated with syphilis, tuberculosis, andherpes simplex virus have allowed ophthal-mologists to promptly diagnose andmanage these sight-threatening diseases.However, emerging infectious diseases ofpublic health consequence – Ebola, Zika,Chikungunya, and others – require anongoing awareness of the impact of globaltravel, systemic manifestations of disease,laboratory diagnostics, and ophthalmicfindings. In particular, the spectrum ofuveitis described with these emerginginfectious diseases representing the contribution of viral infection and inflam-mation will be discussed.



5:05-5:50 pmThe Eye’s Window toEmerging Viral Threats: New Questions of (un)usual Uveitis SuspectsIAN CROZIER, MDIn the context of recent global out breaks,uveitis has been increasingly described inacutely ill or convalescing patients withEbola virus and Zika virus infections, and isof potential concern with other emergingviruses. In addition to the usual suspects,eye care providers should consider thesepathogens in the right clinical or epidemio-logic setting. As part of a steep ophthalmiclearning curve in outbreak settings, newquestions are being asked of the host-pathogen interaction, especially of thebreach and persistence of emerging viruses in ocular (and other) immune-privileged tissues.

Recent insight from human ophthalmicbedsides and from animal model and basic science benches will be discussed,highlighting unanswered questions aboutdisease pathogenesis and viral persistencethat have implications for patients, for eyecare providers, and for the public healthand scientific communities. Finally, otherpathogens currently on the emerging threatradar-screen will briefly be reviewed.


6:05-6:25 pmBreak

6:25-7:18 pmCASE PRESENTATIONS, FREE PAPERS AND DISCUSSIONS

6:25-6:32 pmDrenching Fever andMultifocal ChorioretinitisLYNN M. HASSMAN, MD, PhD


6:37-6:44 pmEye Exam to MonitorTreatment in AIDS-relatedXDR TBDAVID HEIDEN, MD


6:49-6:56 pmTB or not TB?JONATHAN P. HESTON, MD, MSc


7:01-7:13 pmIncidence and Associationsof Endophthalmitis in Anti-VEGF IntravitrealInjections and Steriod ImplantsMAHDI ROSTAMIZADEH, MD Travel Grant Awardee

Purpose: Anti-VEGF and steroid intravitrealtherapy has become the mainstaytreatment of many retinal diseases. Thoughthe risk of complications is relatively low,endophthalmitis remains the most devas-tating complication. The purpose of ourstudy is to determine which intravitrealinjection from both anti-VEGF and steroidtherapies had the most post injectionendophthalmitis outcomes. We hypothesizethat out of both groups the steroid intra -vitreal injections would have a higher rateof endophthalmitis due to their effects on damping the immune system and thelarger size of the wound created by theimplant injections. Within the anti-VEGFgroup we hypothesize that bevacizumabwould have the highest rate due topossible contamination during thecompounding process.

Methods: After approval was obtainedfrom the Valley Retina Institute institutionalreview board, electronic medical chartswere searched based on internationalclassification of disease codes 9 and 10 forintravitreal injections and endophthalmitis.

A total of 38,691 injections were given over a 5 year period: 17,631 Bevacizumab,9,257 Ranibizumab, 8,415 Aflibercept,1,033 Dexamethasone implant, and 16fluocinolone acetonide implant. Afteraccounting for duplicates, excluding cataractand bleb related endophthalmitis weidentified 11 patients that had endoph-thalmitis after an injection. Data collected atdiagnosis included, medication name, pre-and post-injection visual acuity and intraocular pressure, days between initialinjection and presentation of symptoms,final visual acuity, causative organisms, siteof injection, and type of anesthetic andpreparation. We divided the number ofendophthalmitis cases by the total amountof injections in each group to find theincidence. Chi-square and proportionalmethods were used to calculate statisticalsignificance and confidence intervalsrespectively.

Results: Out of all the patients given injections, 20 out of 38,691 (0.036%;0.03-0.07% 95% confidence interval [CI])developed endophthalmitis. Ranibizumabwas found to have the lowest at 0.032%(3 out of 9257). 1 in 16 patients thatreceived fluocinolone acetonide implantpresented with endophthalmitis making itthe highest rate at 6%. Ozurdex had thesecond highest rate at 0.38% (4 out of1033). 12 out of 20 patients had vitreousbiopsies performed, 7 with positive resultsfor bacterial and fungal species. Averagetime of presentation was 6.7 days afterinitial intravitreal therapy. Between anti-VEGF injections and steroid injections was a statistical significance in the rate ofendophthalmitis (0.025% vs 0.28%p=0.000015). Incidence between variousanti-VEGF injections bevacizumab,ranibizumab and aflibercept were not found to be statistically significant (0.028%vs 0.032% vs 0.048% p=0.731).

Conclusions: Our results show thatpatients that received steroidal intravitrealinjections had a higher rate of endoph-thalmitis. There was no statistical differencebetween the various anti-VEGF agents. Our limitation for this study is the lownumber of steroidal injections relative toanti-VEGF therapy, further investigation witha higher sample size would add morepower to a future study.

6 AUS 22nd ANNUAL WINTER SYMPOSIUM


7:18-7:20 pmWrap Up

7:20 pmEnd of Evening Session

MondayJ A N U A R Y 15

7:00-8:00 amBreakfast


8:00-8:05 amIntroduction ALAN G. PALESTINE, MD


8:05-8:12 amPanuveitis in Patient with Active Scleroderma and Secondary RaynaudEDUARDO UCHIYAMA, MD


8:17-8:24 amBilateral SerousDetachments in a 10 y/o FemaleLEANNE LABRIOLA, DO


8:29-8:36 amPost Cataract Surgery Uveitis,Endophthalmitis, Uveitis?KARL BECKER, MD


8:41-8:48 amCMV Retinitis Associatedwith Panretinal Vasculopathyand Rubeotic GlaucomaHELEN K. LI, MD


8:53-9:00 amScleral MassesANJUM KOREISHI, MD


9:05-9:12 amUnknownANDREW W. ELLER, MD


9:17-9:29 amOCT-angiography in White Dot SyndromeMARIE-HELENE ERRERA, PharmD, MD, PhD


9:34-9:35 amWrap Up

9:35 amMeeting Adjourned


Industry Partners

The AUS gratefully acknowledges the following companies for their contributions:

DIAMONDP

Santen, Inc.

PLATINUMP

Abbvie

GOLDP

Allergan, Inc.Clearside Biomedical, Inc.

pSivida Corp.

SILVERP

Aldeyra TherapeuticsBausch + Lomb

Gilead Sciences, Inc.Mallinckrodt Pharmaceuticals, Inc.

MEETING PLANNER

MEDICAL CONFERENCE PLANNERS, INC.914-722-0664

[email protected]

· 2018. 1. 20. · psivida corp. 7:30 pm end of evening session 7:45-10:00 pm dinner at the...

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