Biography:

In the past Erik Letko has collaborated on articles with Szilard Kiss. One of their most recent publications is Original articleLong-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome☆. Which was published in journal Ophthalmology.

More information about Erik Letko research including statistics on their citations can be found on their Copernicus Academic profile page.

Erik Letko's Articles: (4)

Original articleLong-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome☆

AbstractPurposeTo investigate the spectrum of ocular involvement, to examine the clinical outcome, and to analyze the influence of treatment in patients with chronic ocular manifestations of Reiter's syndrome (RS) referred to a tertiary care ocular immunology service.DesignRetrospective, noncomparative, interventional case series.ParticipantsTwenty-five patients with RS evaluated at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1981 through 2001.MethodsCharts of patients were reviewed and data on age, gender, follow-up time, ocular symptoms, extraocular involvement, ocular complications, therapy, and visual acuities were recorded.Main outcome measuresVisual acuity, ocular complications, disease progression, clinical outcome, and systemic treatment.ResultsTwenty-five patients (20 male and 5 female) diagnosed with RS, with a mean age at presentation to our service of 37 years, were studied. The mean follow-up was 48.5 months. Eighty-five percent of patients tested were positive for human leukocyte antigen B27. Sixty-four percent of patients had a positive family history. All patients had oligoarthritis and enthesitis, most commonly affecting the back (56%), Achilles tendon (52%), and sacroiliac joint (24%). Eighty percent had a history of infection, most frequently urethritis (68%). Forty-four percent had a history of mucocutaneous lesions. All patients demonstrated ocular involvement at the time of diagnosis (68% with unilateral and 32% with bilateral disease), 84% had evidence of uveitis, 3% had scleritis, 2% had conjunctivitis, and 1% had pars planitis and iridocyclitis. During follow-up, the ocular complications included conjunctivitis (96%), anterior uveitis (92%), posterior uveitis (64%), keratitis (64%), cataract (56%), intermediate uveitis (40%), scleritis (28%), cystoid macular edema (28%), papillitis (16%), and glaucoma (16%). Systemic treatment for ocular inflammation was initiated in all patients. Ninety-six percent were treated with nonsteroidal anti-inflammatory agents. Eighty-eight percent were treated with corticosteroids, 64% requiring systemic prednisone. Immunosuppressive therapy was initiated in 52% of patients, with all receiving methotrexate. Seven patients required more than one immunosuppressive agent. The mean initial visual acuity was 20/25 in the right eye and 20/30 in the left eye. The mean final visual acuity was 20/25 in the right eye and 20/25 in the left eye.ConclusionsReiter's syndrome may be associated with chronic recurrent ocular inflammation. Systemic therapy (including immunosuppressive treatment) typically is required to control the ocular inflammation and to prevent progressive visual loss.

Original articleSecondary Graft Failure and Repeat Endothelial Keratoplasty after Descemet's Stripping Automated Endothelial Keratoplasty

ObjectiveTo identify the causes of secondary graft failure after Descemet's stripping automated endothelial keratoplasty (DSAEK) and to evaluate the clinical outcomes of repeat endothelial keratoplasty (REK) in this patient population.DesignRetrospective case series.ParticipantsPatients of a private practice Price Vision Group in Indianapolis, Indiana.MethodsAn initial consecutive series of primary DSAEK procedures performed by a single surgeon between October 2004 and December 2008 was reviewed to identify reasons for and outcomes of REK.Main Outcome MeasuresVisual acuity and causes of secondary graft failure.ResultsIn a consecutive series of 1050 primary DSAEK procedures, REK for secondary graft failure was performed in 37 eyes (3.5%). The most common reason for REK in this group was unsatisfactory visual acuity relative to the anticipated vision potential (n = 28/37; 76%). Unsatisfactory visual acuity was associated with abnormalities of donor tissue within the pupillary area, including wrinkles or folds, irregular graft thickness, and opacity in the interface. In the 28 eyes with unacceptable visual acuity after initial DSAEK, the median best spectacle-corrected visual acuity (BSCVA) before and after REK was 20/60 (range, 20/40–20/400) and 20/30 (range, 20/20–20/100), respectively, and 75% had BSCVA 20/40 or better after REK. The mean corneal thickness in the 28 eyes regrafted for unsatisfactory vision before and after REK was 809 μm (range, 642–979 μm) and 657 μm (range, 549–801 μm), respectively. Secondary graft failure caused by endothelial decompensation was the reason for repeat endothelial graft in the remaining 9 eyes (9/37; 24%). Eight eyes had a history of glaucoma, and 6 of them had glaucoma surgery. An episode of immune rejection reaction was documented in 6 of 9 eyes with endothelial decompensation.ConclusionsOur data suggest that the most common reason for REK after DSAEK is unsatisfactory vision. Patient and physician expectations for visual acuity are higher with DSAEK compared with penetrating keratoplasty. Repeat endothelial keratoplasty can provide improved vision in selected patients.Financial Disclosure(s)The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Original articleEfficacy and Safety of Intravenous Secukinumab in Noninfectious Uveitis Requiring Steroid-Sparing Immunosuppressive Therapy

PurposeSecukinumab, a fully human anti–interleukin-17A monoclonal antibody, exhibited promising activity in a proof-of-concept study when administered in intravenous (IV) doses to patients with active, chronic, noninfectious uveitis. This study compared the efficacy and safety of different IV and subcutaneous (SC) doses of secukinumab in patients with noninfectious uveitis.DesignMulticenter, randomized, double-masked, dose-ranging, phase 2 clinical trial.ParticipantsThirty-seven patients with active noninfectious intermediate uveitis, posterior uveitis, or panuveitis who required corticosteroid-sparing immunosuppressive therapy.MethodsPatients were randomized to secukinumab 300 mg SC every 2 weeks for 4 doses, secukinumab 10 mg/kg IV every 2 weeks for 4 doses, or secukinumab 30 mg/kg IV every 4 weeks for 2 doses. Intravenous or SC saline was administered to maintain masking. Efficacy was assessed on day 57 (2–4 weeks after last dose).Main Outcome MeasuresPercentage of patients with treatment response, defined as (1) at least a 2-grade reduction in vitreous haze score or trace or absent vitreous haze in the study eye without an increase in corticosteroid dose and without uveitis worsening or (2) reduction in corticosteroid dosages to prespecified levels without uveitis worsening. Percentage of patients with remission, defined as anterior chamber cell and vitreous haze scores of 0 or 0.5+ in both eyes without corticosteroid therapy or uveitis worsening.ResultsSecukinumab 30 mg/kg IV and 10 mg/kg IV, compared with the 300 mg SC dose, produced higher responder rates (72.7% and 61.5% vs. 33.3%, respectively) and remission rates (27.3% and 38.5% vs. 16.7%, respectively). Statistical and clinical superiority for the 30 mg/kg IV dose compared with the 300 mg SC dose was established in a Bayesian probability model. Other measures, including time to response onset, change in visual acuity, and change in vitreous haze score, showed numeric trends favoring IV dosing. Secukinumab, administered in IV or SC formulations, appeared safe and was well tolerated.ConclusionsIntravenous secukinumab was effective and well tolerated in noninfectious uveitis requiring systemic corticosteroid-sparing immunosuppressive therapy. Greater activity with IV dosing suggests that patients may not receive sufficient drug with SC administration. High-dose IV secukinumab may be necessary to deliver secukinumab in therapeutic concentrations.

CME REVIEW ARTICLEStevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature

ObjectiveTo perform a comprehensive review of Stevens-Johnson syndrome and toxic epidermal necrolysis.Data SourcesA MEDLINE search was performed for the years 1975 to 2003 using the keywords Stevens-Johnson syndrome and toxic epidermal necrolysis to identify relevant articles published in English in peer-reviewed journals.Study SelectionAll clinical studies that reported on 4 or more patients, review articles, and experimental studies that concerned disease mechanisms were selected and further analyzed. Clinical reports that included fewer than 4 patients were selected only if they were believed to carry a significant message about disease mechanism or therapy.ResultsStevens-Johnson syndrome and toxic epidermal necrolysis seem to be variants of the same disease with differing severities. A widely accepted consensus regarding diagnostic criteria and therapy does not exist at present. Despite the recent experimental studies, the pathogenic mechanisms of these diseases remain unknown. Although progress in survival through early hospitalization in specialized burn units has been made, the prevalence of life-long disability from the ocular morbidity of Stevens-Johnson syndrome and toxic epidermal necrolysis has remained unchanged for the past 35 years. Further progress depends on modification of the acute phase of the disease rather than continuation of supportive care. The available published evidence indicates that a principal problem in the pathogenesis is immunologic and that immunomodulatory intervention with short-term, high-dose intravenous steroids or intravenous immunoglobulin holds the most promise for effective change in survival and long-term morbidity.ConclusionsThe results of this review call for a widely accepted consensus on diagnostic criteria for Stevens-Johnson and toxic epidermal necrolysis and multicenter collaboration in experimental studies and clinical trials that investigate disease mechanisms and novel therapeutic interventions, respectively.

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