Journal of Ophthalmic Inflammation and Infection最新文献

Background: Autoimmune inflammatory ocular diseases, including uveitis, scleritis, and ocular mucous membrane pemphigoid, can cause severe, vision-threatening complications and are often associated with systemic autoimmune conditions. Standard therapies involve corticosteroids, conventional disease-modifying antirheumatic drugs (cDMARDs), and biologics, yet some cases remain refractory. Janus kinase (JAK) inhibitors have emerged as a promising therapeutic option for such refractory cases and are increasingly being explored as potential primary or secondary line therapies.

Main body: This systematic review synthesized evidence from case reports and case series describing the use of JAK inhibitors in non-infectious ocular inflammation. A comprehensive search of PubMed and MEDLINE (from inception to March 2025) identified 22 studies (12 case reports, 10 case series) involving 43 patients (64 eyes). Patients ranged from 13 to 85 years (mean = 41) with a female predominance (69.7%). Reported ocular conditions included scleritis (46.5%), uveitis (34.9%), ocular mucous membrane pemphigoid (7.0%), keratitis (4.7%), keratoconjunctivitis (4.7%), and non-specific orbital inflammation (2.3%). Most patients had failed prior therapies with corticosteroids, cDMARDs (80%), and biologics (51%) before initiating JAK inhibitors. Tofacitinib (62.8%) was the most frequently used agent. The median follow-up was approximately 2.5 months (range: 1-78 months). Complete remission was achieved in 69.7% of patients, while 27.9% experienced partial or marked improvement. More than half of the patients were able to taper or discontinue corticosteroids. No relapses were reported during follow-up. Reported adverse events were mild and included elevated transaminases, leukopenia, neutropenia, and herpes virus reactivation.

Conclusion: JAK inhibitors demonstrate promising efficacy and an acceptable safety profile in refractory autoimmune ocular inflammatory diseases, enabling high rates of remission and reduced steroid dependence. These findings highlight their potential role in treatment algorithms and underscore the need for further prospective studies to define their long-term efficacy, safety, and optimal use.

Purpose: To evaluate the clinical course, factors contributing to healing, and outcomes of medically treated dematiaceous fungal keratitis (DFK) at a rural secondary eye care center in North India.

Methods: This retrospective, electronic medical record-based study was conducted over one year at a secondary care center. Patients of all age groups with culture-proven DFK who completed follow-up until corneal healing were included. Demographic, clinical, and microbiological data were analyzed. All patients received therapeutic debridement and natamycin monotherapy. Voriconazole was added in non-responders, and oral antifungals were used for corneal melt or posterior segment involvement. Cases requiring therapeutic keratoplasty (TPK) or evisceration were classified as poor outcomes.

Results: Hundred and eight eyes were included in the study. The mean age was 43.2 years, with 78.7% males. Trauma, most commonly from sugarcane leaves, was reported in 80.6%. Ulcers were mild in 50%, moderate in 39.8%, and severe in 10.2%. Half were small in size; 89.8% were superficial, while 5.6% showed full-thickness involvement. Neurotrophic-like defects were seen in 48.5% and significantly associated with ulcer size (p = 0.004). Healing occurred within 2 weeks in 44.5% and within 4 weeks in 33.7%. Delayed healing (21.8%) correlated with larger, deeper ulcers, hypopyon, and neurotrophic-like defects. TPK/evisceration (12%) was significantly associated with prior steroid use, vascularization, hypopyon, and corneal melt (p < 0.05).

Conclusion: Despite prolonged healing, DFK has a high resolution rate with appropriate medical therapy, minor procedures, and complete debridement. Poor prognostic factors include large and deep infiltrates, hypopyon, and prior steroid use.