PROGRAM CHAIRMAN: GLENN J. JAFFE ,MD · PROGRAM CHAIRMAN Glenn J. Jaffe, MD Robert Machemer Professor of Ophthalmology Chief, Vitreoretinal Division Director, Duke Reading Center

PROGRAM CHAIRMAN: GLENN J. JAFFE, MD

ANNUAL WINTERSYMPOSIUM

PROGRAM CHAIRMAN

Glenn J. Jaffe, MDRobert Machemer Professor of OphthalmologyChief, Vitreoretinal DivisionDirector, Duke Reading CenterDuke Eye CenterDurham, NC

GUEST SPEAKERS

Joseph A. Izatt, PhD

Michael J. Fitzpatrick Professor of EngineeringBiomedical Engineering DepartmentDuke UniversityDurham, NC

Philip Seo, MD

Associate Professor of MedicineJohns Hopkins University School of MedicineBaltimore, MD

James T. Rosenbaum, MD

Richard Chenoweth Chair of OphthalmologyLegacy Devers Eye InstituteEdward E. Rosenbaum Professor of Inflammation ResearchOregon Health & Science UniversityPortland, OR

Sunil Srivastava, MD

Vitreoretinal Staff PhysicianCleveland ClinicCleveland, OH

AUS 20th ANNUAL WINTER SYMPOSIUM 3

SATURDAYJ A N U A R Y 1 6

7:00-8:00 amRegistration/Breakfast

7:00-9:30 amExhibits

8:00-8:05 amOpening RemarksGLENN J. JAFFE, MD

8:05-9:27 amCASE PRESENTATIONS/FREE PAPERS

8:05-8:12 amIntermediate Uveitis Associatedwith Periodic Fever, AphthousStomatitis, Pharyngitis, andCervical Adenitis (PFAPA)SyndromeRENE CHOI, MD, PhD

8:12-8:17 amDiscussion

8:17-8:24 amAn Unusual Case of Recurrent VitritisPAULINE T. MERRILL, MD


8:29-8:41 amPseudohypopyon in Patients withMalignancy – A ComprehensiveReview of Published CasesANANDA KALEVAR, MD


8:46-8:53 amAcute Retinal NecrosisHERSHEL R. PATEL, MD


8:58-9:05 amUveitis and NeovascularGlaucomaSWETANGI BHALEEYA, MD


9:10-9:22 amInfliximab Treatment of ChronicAnterior Uveitis in Children:Longitudinal Assessment of Cells and FlareMEGHAN BERKENSTOCK, MDSanten, Inc. Travel Grant Awardee

Background/Purpose: Infliximab has becomea popular treatment for chronic anterior uveitis(CAU) in children, but published studies todate about its effect on inflammation in thispopulation have been difficult to interpret andcompare because of differential follow-up andnon-standardized outcome measures. Instudies of CAU in children, specific time-dependent changes in anterior chamber cellsand flare have been associated with a reducedrisk of disease-related adverse events (AE). Inthis study, we describe the course of cells andflare in this population during infliximabtherapy.

Methods: In this retrospective study, wereviewed the medical records of 23 children(42 affected eyes) with CAU in a tertiaryreferral practice who were treated withinfliximab. The following information wascollected for each case: age at onset of uveitis;sex; associated systemic disease, if present(JIA, other); and duration of uveitis before startof infliximab. The following information wascollected from each ophthalmic examination:cells (categorized on the basis of SUN criteria);flare (as determined by laser flare photometry);presence of uveitis complications; and compli-cations attributable to drug infusion.

Kaplan-Meier analyses were used to determineintervals to outcome measures for control ofuveitis and for loss of control, as definedbelow. Outcomes for cells and for flare wereanalyzed separately. For cells, control of inflam-mation was defined as <1+ cells. For flare,control of inflammation was defined as a 20%reduction (for values greater than 20 photonunits per millisecond [pu/msec]) or anabsolute value <20 pu/msec; these definitionscorrespond to levels shown to be protectiveagainst AE (uveitic complications, vision loss).The eye was the unit of analysis.

Results: Mean age at uveitis diagnosis was4.48 years (range 1-10 years) and the meanduration of uveitis prior to start of infliximabwas 5.43 years (range 0.75 to 23.25 years).The majority of patients were female (73.9%)and had a diagnosis of JIA (56.5%). Medianduration of treatment with infliximab during thestudy period was 4 years. Median time todecrease of cells to <1+ was 1.9 months(95% CI=0.4-2.8 mos., range 0.0-10.4 mos.);median time to decrease of flare to <20pu/msec was 1.35 mos. (95% CI=undefined,range 0.0-112.9 mos.).

The median time to loss of control based oncells (≥1+ after initial decrease to less than1+) was 5.9 months (95% CI=3.8-8.1,incidence 14.8/100 eye-mos.); median time toloss of control based on flare (≥20 pu/msec)was 14.0 months (95% CI=undefined,incidence 4.2/100 eye-mos.). Among studyeyes, 9 developed cataracts and 1 developedposterior synechiae during treatment. Infusionrelated problems developed in 3 children after4-14 infusions (anaphylactoid reaction, rash,and pruritus).

Conclusion: This study illustrates the potentialuse of a standardized, time-dependentassessment of drug effect on CAU in children,using objective measures of inflammation andoutcomes shown to be related to disease-associated AE. Cells and flare can changeindependently, but the majority of patientsachieved levels of cells or flare or both within 2 mos. that are protective against AE. Thestudy also provides objective evidence thatinfliximab may lose effect over time, but vision-threatening complications remained infrequentduring treatment.

Support: Endowment for Children with Uveitis, UCLA Stein Eye Institute, Los Angeles,California, the Skirball Foundation, New York,New York.


9:27-9:30 amClosing RemarksGLENN J. JAFFE, MD

9:30 amEnd of Morning Session

3:30-4:00 pmAprès Ski Refreshments

3:30-7:40 pmExhibits

4 AUS 20th ANNUAL WINTER SYMPOSIUM


4:00-6:17 pmSCIENTIFIC SESSION 1: RETINAL VASCULITIS

4:00-4:05 pmIntroductionGLENN J. JAFFE, MD

4:05-4:12 pmVasculopathy or Vasculitis?Bilateral Vision Loss in a Young Lupus PatientSARJU PATEL, MD

4:12-4:17 pmDiscussion

4:17-5:02 pmUpdate on Systemic Vasculitis and Rheumatic DiseasesPHILIP SEO, MDThe last decade has seen substantial changesin the approach to systemic vasculitis and otherrheumatic diseases. New classification criteriahave been introduced for systemic lupuserythematosus, rheumatoid arthritis, andsystemic vasculitis, and new treatmentstrategies emphasize a move away fromcytotoxic agents and towards biologic therapies.We will review recent changes in the overallapproach to these diseases, and define therole of newer agents, such as rituximab,belimumab, and tocilizumab in the manage -ment of the ANCA-associated vasculitides, andother rheumatic diseases associated withocular disease.


5:17-6:02 pmRetinal Vasculitis: A Rheumatologic PerspectiveJAMES T. ROSENBAUM, MDSystemic forms of vasculitis can be classifiedon the basis of the size of the vessel involved,the histopathology, and the location of thevessel. Systemic vasculitis is usually diagnosedbased on a biopsy or occasionally by angiog-raphy or by the clinical presentation andlaboratory findings. A diagnosis of systemicvasculitis implies histological abnormality of the vessel wall.

In contrast retinal vasculitis is rarely diagnosedby biopsy. Furthermore, findings indicative ofretinal vasculitis such as fluorescein staining donot imply a structural change in the vesselwall. Consequently patients with retinalvasculitis rarely have a systemic vasculitis andconversely, patients with systemic vasculitisrarely have retinal vasculitis.

Retinal vasculitis can be central or peripheral;occlusive or non-occlusive; arterial, venous, ormixed; symptomatic or asymptomatic; andprimary or secondary to either an infection orsecondary to a recognized cause of uveitis.These classification variables have therapeuticimplications.

Rheumatologists and ophthalmologistsfrequently communicate poorly in the manage -ment of patients with retinal vasculitis.


6:17-6:37 pmBreak

6:37-7:30 pmCASE PRESENTATIONS/FREE PAPERS

6:37-6:44 pmPediatric Retinal Vasculitis: An Unusual Case of FerningDILRAJ S. GREWAL, MD


6:49-7:01 pmOptical Coherence Tomography Angiography in Retinal VasculitisANGELA BESSETTE, MDSanten, Inc. Travel Grant Awardee

Purpose: To evaluate the retinal microvas -culature in a cohort of patients with retinalvasculitis using optical coherence tomographyangiography (OCTA)

Methods: This is a retrospective cohort studyof optical coherence tomography angiographyin patients with retinal vascular inflammation.OCTA images were evaluated for qualitativechanges and compared to fluorescein angiog-raphy images where available.

Results: 19 patients with retinal vasculitis were identified. Mean age was 43 years andincluded 10 women and 9 men. Thediagnostic spectrum included 8 patients withSusac syndrome, 3 patients with Behcet’sdisease, one patient with anti-synthetasesyndrome, one patient with intermediateuveitis, and 6 patients with idiopathic retinalvasculitis. OCTA imaging on 11 patientsrevealed findings not visible on fluoresceinangiography. These included loss of retinalblood flow in the superficial and deep vascularlayers, capillary remodeling, and normalcapillary flow in eyes with exudates.Quantitative analysis was also performed andrevealed decreased density of blood vessels inareas of retinal vascular loss.

Conclusions: OCT angiography provides infor-mation on capillary blood flow in patients withretinal vasculitis. In some patients, OCTArevealed capillary abnormalities that were notvisible on fluorescein angiography.


7:06-7:13 pmRetinal Vasculitis Associated withSystemic Lupus ErythematosusOZLEM SAHIN, MD


7:18-7:25 pmOcclusive Vasculitis –Inflammatory or Not?LANA RIFKIN, MD


7:30-7:40 pmINDUSTRY PARTNER PRESENTATIONS

7:30-7:40 pm AbbVie

7:40 pmEnd of Evening Session

7:45-10:00 pmDinner at The Canyons Grand Summit Hotel

SUNDAYJ A N U A R Y 1 7

7:00-8:00 amBreakfast


8:00-8:05 amIntroductionGLENN J. JAFFE, MD


8:05-8:17 am Up in the AIR: Challenges inDiagnosis and Management ofAutoimmune RetinopathySHELLY LEE, MD


8:22-8:34 amTubulointerstitial Nephritis and Uveitis Syndrome:Characterization of Clinical FeaturesANJUM KOREISHI, MD


8:39-8:46 amBilateral CME in IgG4-related DiseasePAULINE T. MERRILL, MD


8:51-9:03 amModulation of InflammatorySignaling in an Animal Model for UveitisJESSICA WEINSTEIN, MD


9:08-9:15 amRetinitisNATHAN STEINLE, MD


9:20-9:30 amINDUSTRY PARTNER PRESENTATIONS

9:20-9:25 amAllergan, Inc.

9:25-9:30 amBausch + Lomb

9:30 amEnd of Morning Session

3:30-4:00 pmAprès Ski Refreshments

3:30-7:33 pmExhibits

4:00-6:05 pmSCIENTIFIC SESSION 2: UVEITIS IMAGING

4:00-4:05 pmIntroductionGLENN J. JAFFE, MD

4:05-4:50 pmNew Technologies for Real-TimeOphthalmic Imaging and Surgical GuidanceJOSEPH A. IZATT, PhDOptical coherence tomography (OCT) andscanning laser ophthalmoscopy (SLO) obtainmicron-scale measurements of structure andfunction in living tissues and organisms. Wehave developed next-generation versions ofthese technologies customized for new appli-cations in flexible hand-held imaging andophthalmic microsurgery. These technologyadvances allow for real time volumetric micro -structural imaging in living patients, which weare deploying for pediatric and intrasurgicalapplications.

Compact multi-modal combinations of OCTwith confocal microscopy allow for imaging ofindividual retinal receptor cells without adaptiveoptics. We also report on a novel microscope-

integrated optical coherence tomographysystem that achieves the first micrometer-scalefour dimensional live imaging of human micro-surgery via a custom microscope-integratedsystem with a stereoscopic heads-up display.The lecture will review the current state ofthese technologies and provide an overview ofselected applications in both anterior segmentand retinal imaging.


5:05-5:50 pmMulti-modal Imaging in Uveitis,the Present Choices in Hardwareand the Future in SoftwareSUNIL SRIVASTAVA, MDMulti-modal imaging has improved our under-standing of complex inflammatory diseases.Imaging allows clinicians to determine diag -nosis and disease activity. Each new imagingdevice seems to identify yet another finding inthe ocular anatomy of these complex diseases.The future of imaging in uveitis however, maynot be in the fastest device with the highestresolution but with software enhancementswhich allow precise measurements of diseaseactivity. The purpose of this talk is to discussthe utility of the current imaging tools and thefuture improvements in software which couldpotentially advance our field.


6:05-6:25 pmBreak

6:25-7:23 pmCASE PRESENTATIONS/FREE PAPERS

6:25-6:37 pmAssociation of Disorganization of Retinal Inner Layers with Visual Acuity in Eyes with Uveitic Cystoid Macula EdemaDILRAJ S. GREWAL, MD Santen, Inc. Travel Grant Awardee

Purpose: To investigate whether disorgani-zation of retinal inner layers (DRIL) and otherspectral-domain optical coherence tomography(SDOCT)–derived anatomical variables areassociated with visual acuity (VA) in eyes withuveitic cystoid macular edema (CME).


Methods: Prospective, multiple center trial (A Multicenter Study Open Label Study of theLong-term Safety and Efficacy of the HumanAnti-TNF Monoclonal Antibody Adalimumab inSubjects with Non-infectious Intermediate-,Posterior-, or Pan-uveitis) in which Best-corrected ETDRS VA testing and SpectralisSD-OCT imaging were performed.

Two inde pendent readers (DG and MO),masked to the treatment groups analyzed thecentral 1-mm foveal region for pre-specifiedanatomical parameters including central subfieldthickness (CFT), horizontal length and verticalextent of DRIL (% of scans with DRIL), definedas inability to identify and demarcate anyboundaries of the ganglion cell/inner plexiformlayer complex, inner nuclear layer or outer plexi -form layer. Foveal DRIL was defined as averageDRIL extent >500 µm across the scans.

Other morphological parameters analyzedinclude presence of subretinal fluid, epiretinalmembrane, hyperreflective foci (HRF) in theinner or outer retina, average and largest sizeof intraretinal (IR) cysts, extent of disruption of external limiting membrane (ELM) and ellip -soid zone (EZ). Measurements were obtainedeither at baseline or follow-up. Pre liminaryanalysis on a subsample of patients identifiedto have CME, and with good quality OCT scansare presented. Data were analyzed by linearregression adjusted for clustered observations.

Results: Thirty-five eyes of 25 patients (16female, 9 male) with a mean age of 50.4 ±16.1 years were analyzed. Inter-readerspearman rank correlation coefficients rangedbetween 0.79 to 0.91 for the morphologicalvariables for the two readers. At baseline meanlogMAR VA was 0.39 (range -0.04 to 0.88),CFT was 494 µm (range 287 to 863 µm),horizontal DRIL length was 307 µm (range 0 to 637 µm), vertical DRIL extent was 80.8%(range 0 to 100%), ELM disruption length was80 µm (range 0 to 365 µm), EZ disruptionlength was 129 µm (range 0 to 663 µm), sizeof IR cysts was 0.538 mm2,(range 0 to 1.61mm2) and size of largest IR cyst was 0.090mm2 (range 0 to 0.37mm2). At baseline,16/34 eyes had subretinal fluid, 30/35 eyeshad ERM, 34/35 eyes had HRF in inner orouter retina and 9/35 eyes had foveal DRIL.

Using a regression analysis for associationbetween SDOCT parameters and logMAR at allvisits (n=74), parameter estimates (95% confi-dence interval) were 0.057 (0.025 to 0.088)for CFT per 100 µm (p<0.001), 0.149 (0.041to 0.256) for foveal DRIL (p=0.008), 0.046(0.024 to 0.068) for average horizontal DRILlength per 100 µm (p<0.001), 0.003 (0.002to 0.005) for average vertical DRIL length(p<0.001), -0.012 (-0.076 to 0.052) for meanELM disruption per 100 µm (p=0.714), 0.031(-0.011 to 0.073) for mean EZ layer disruption

per 100 µm (p=0.143), 0.167 (0.074 to0.260) for average size of IR cysts per mm2

(p<0.001), 1.226 (0.758 to 1.695) for size of largest IR cyst per mm2 (p<0.001) and -0.017 (-0.622 to 0.587) for presence of HRFin both inner and outer retina, -0.174 (-0.778to 0.430) in outer and -0.109 (-0.711 to0.493) in inner retina vs. no HRF (p=0.048).

Conclusion: Preliminary analysis suggests that CFT, DRIL, size of IR cysts and presence of HRF in eyes with uveitic CME is associatedwith visual acuity. DRIL, size of IR cysts andpresence of HRF had a stronger associationwith VA than disruption of outer retinal layers.Further analysis will help determine if DRIL canbe used as a surrogate marker of VA and as apredictive biomarker for future VA outcomes in eyes with uveitic CME.


6:42-6:54 pmOptical Coherence Tomography in Rodent Models of Anterior UveitisKATHRYN PEPPLE, MD, PhD


6:59-7:06 pmManagement of Choroidal GranulomaDAVID RP ALMEIDA, MD, PhD, MBA


7:11-7:18 pmCPCGLENN J. JAFFE, MD

7:18-7:23 pm Discussion

7:23-7:33 pmINDUSTRY PARTNER PRESENTATIONS

7:23-7:28 pm Santen, Inc.

7:28-7:33 pmMallinckrodt Pharmaceuticals

7:33 pmEnd of Evening Session

MONDAYJ A N U A R Y 1 8

7:00-7:45 amBreakfast


7:45-7:50 amIntroductionGLENN J. JAFFE, MD


7:50-7:57 amTarantula-hair Associated PanuveitisLANA RIFKIN, MD

7:57-8:02 am Discussion

8:02-8:09 amLupus Choroiditis?JULIA SHULMAN, MD


8:14-8:26 amInjectable Fluocinolone Implantfor Intermediate, Posterior,Panuveitis. 2 Year Results of a Prospective TrialGLENN J. JAFFE, MD


8:31-8:38 amSubretinal MassAKBAR SHAKOOR, MD


8:43-8:50 amProptosis in a Patient with HIVANDREW W. ELLER, MD


8:55-9:00 amClosing Remarks

9:00 amMeeting Adjourned


David RP Almeida, MD,PhD, MBAMinneapolis, MN(319) [email protected]

Robert Beardsley, MDEugene, OR(541) [email protected]

Meghan Berkenstock, MDLos Angeles, CA(610) [email protected]

Angela Bessette, MDRochester, NY(570) [email protected]

Swetangi Bhaleeya, MDTampa, FL(870) [email protected]

Pooja V. Bhat, MDChicago, IL(205) [email protected]

Rene Choi, MD, PhDSalt Lake City, UT(201) [email protected]

Emmett T. Cunningham,MD, PhD, MPHHillsbourgh, CA(857) [email protected]

Mark S. Dacey, MDDenver, CO(303) [email protected]

Heather Dealy, MDWilmington, DE(302) [email protected]

Andrew W. Eller, MDGuest: AndreaPittsburgh, PA(412) [email protected]

James C. Folk, MDIowa City, IA(319) [email protected]

Debra A. Goldstein, MDGuests: David Cohen, Jacob, SophieChicago, IL(773) [email protected]

Dilraj S. Grewal, MDDurham, NC(617) [email protected]

David C. Gritz, MD, MPHPelham, NY(914) [email protected]

Eileen Hwang, MD, PhDSalt Lake City, UT(609) [email protected]

Joseph A. Izatt, PhDGUEST SPEAKERDurham, NC(919) [email protected]

Douglas A. Jabs, MDGuests: Ethylin, AlexandraNew York, NY(410) [email protected]

PARTICIPANT LIST


Glenn J. Jaffe, MDPROGRAM CHAIRMANDurham, NC(919) [email protected]

Guy V. Jirawuthiworavong, MDGuest: JustinTorrance, CA(310) [email protected]

Ananda Kalevar, MDGuest: Catherine BezeauSan Francisco, CA(415) [email protected]

Anjum Koreishi, MDChicago, IL(716) [email protected]

Shelly Lee, MDAlbuquerque, NM(951) [email protected]

Craig Leong, MDWalnut Creek, CA(925) [email protected]

Ashleigh L. Levison, MDPhoenix, AZ(480) [email protected]

Rebecca Manning, MDGuest: Joe BassRaleigh, NC(919) [email protected]

Pauline T. Merrill, MDGuest: Chris FosterChicago, IL(312) [email protected]

John Pak, MD, PhDChicago, IL(312) [email protected]

Alan Palestine, MDGuest: Heather BarberAurora, CO(301) [email protected]

Hershel R. Patel, MDGuest: AnandTampa, FL(813) [email protected]

Sarju Patel, MDNew York, NY(646) [email protected]

Kathryn Pepple, MD, PhDMercer Island, WA(281) [email protected]

Lana Rifkin, MDGuest: IlyaBrookline, MA(502) [email protected]

James T. Rosenbaum, MDGUEST SPEAKERGuest: Sandra LewisPortland, OR(603) [email protected]

Ozlem Sahin, MDAnkara, [email protected]

Anita Schadlu, MDPhoenix, AZ(602) [email protected]



Philip Seo, MDGUEST SPEAKERBaltimore, MD(410) [email protected]

Akbar Shakoor, MDSalt Lake City, UT(717) [email protected]

Julia Shulman, MDNew York, NY(917) [email protected]

Sunil K. Srivastava, MDGUEST SPEAKERGuests: Rachel Gurshman.Samuel and Reena SrivastavaCleveland, OH(216) [email protected]

Nathan Steinle, MDArroyo Grande, CA(805) [email protected]

Russell N. Van Gelder, MD, PhDGuests: Suzanne Dintzis, MaxMercer Island, WA(206) [email protected]

Albert T. Vitale, MDSalt Lake City, UT(801) [email protected]

Jessica Weinstein, MD, MSNew Orleans, LA(786) [email protected]

Robert T. Wendel, MDSacramento, CA(916) [email protected]

PARTICIPANT LIST continued

Diane Bishop, PhDMallinckrodt PharmaceuticalsNew Berlin, WI(262) [email protected]

Kate Cernok, PhDSanten, Inc.Costa Mesa, CA(949) [email protected]

Sheila Elliott Mallinckrodt PharmaceuticalsMassapequa Park, NY(516) [email protected]

Stacy Golphin Mallinckrodt PharmaceuticalsHayward, CA(510) [email protected]

Maggie Hayes Santen, Inc.St Petersburg, [email protected]

Lester Hosten, MDMallinckrodt PharmaceuticalsWashington, DC(240) [email protected]

Eric J. Kiernan Bausch + LombTimonium, MD(443) [email protected]

Eric King Heidelberg EngineeringCarlsbad, CA(919) [email protected]

Schalon H. NewtonCavtheRx Inc.Guest: Giulia NewtonIrvine, CA(949) [email protected]

Fran Olson Mallinckrodt PharmaceuticalsHayward, CA(510) [email protected]

Al Perry Mallinckrodt PharmaceuticalsWesley Chapel, FL(352) [email protected]

Josh Petit Mallinckrodt PharmaceuticalsHayward, CA(510) [email protected]

Michele Ronis Mallinckrodt PharmaceuticalsOld Greenwich, CT(917) [email protected]

Mavrick Scott Allergan, Inc.Olympia, WA(253) [email protected]

Alexandra Song, MD, MPHAbbVieNorth Chicago, IL(773) [email protected]

Samir TariAbbVieNorth Chicago, IL(224) [email protected]

CORPORATE REPRESENTATIVES

Save the Date JANUARY 14-16

AUS21st Annual Winter Symposium

2017

LOCATION TO BE ANNOUNCED

INDUSTRY PARTNERS

The AUS gratefully acknowledges the following companies for their contributions:

PLATINUM

AbbVie

GOLD

Allergan, Inc.Bausch + Lomb

Mallinckrodt Pharmaceuticals

SILVER

Santen, Inc.

BRONZE

Heidelberg Engineering, Inc.

GRANTS3 travel grants provided courtesy of

Santen, Inc.

MEETING PLANNER

MEDICAL CONFERENCE PLANNERS, INC.914-722-0664

[email protected]

PROGRAM CHAIRMAN: GLENN J. JAFFE ,MD · PROGRAM CHAIRMAN Glenn J. Jaffe, MD Robert Machemer Professor of Ophthalmology Chief, Vitreoretinal Division Director, Duke Reading Center

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