Journal of Ophthalmic Inflammation and Infection最新文献

Purpose: To investigate the safety and efficacy of rituximab in patients with refractory noninfectious uveitis and scleritis.

Methods: A retrospective review of 24 patients (47 eyes) treated with rituximab for refractory noninfectious uveitis and scleritis in the period between January 2018 and December 2024. The diagnosis of these patients included chronic recurrent uveitis associated with Vogt-Koyanagi-Harada disease (n = 16), idiopathic granulomatous uveitis (n = 3), multiple sclerosis-associated uveitis (n = 2), progressive subretinal fibrosis (n = 1) and scleritis (n = 2). The primary outcomes were disease quiescence and improvement in best-corrected visual acuity (BCVA). Secondary outcomes included reduction in corticosteroid and immunosuppressive therapy and adverse events.

Results: Rituximab was successful in inducing and maintaining disease quiescence and significantly improved visual acuity in patients presenting with uveitis and scleritis. After starting rituximab therapy, BCVA improved at 1 year from 0.93 ± 0.67 logMAR (Snellen: 20/160) to 0.63 ± 0.83 logMAR (Snellen: 20/80) (p < 0.001). Follow-up period ranged from 12 to 80 months (mean 41 ± SD 20.5). At the last follow-up, BCVA continued to improve to 0.46 ± 0.73 logMAR (Snellen: 20/60) (p < 0.001). Nine of twenty-four patients (37.5%) required more than 3 rituximab doses for disease control. Rituximab successfully reduced corticosteroid use, allowing 87.5% (21/24) of patients to discontinue steroids completely, with the remaining needing ≤ 7.5 mg/day. Mycophenolate mofetil dosage significantly decreased from a mean of 1840 ± SD 323 mg to 1045 ± SD 688 mg daily (p < 0.001), with two patients discontinuing all medications. All patients were flare-free at last follow-up.

Conclusions: Rituximab is an effective and safe treatment for refractory noninfectious uveitis and scleritis. It offers significant visual improvement, disease quiescence which potentially reduces reliance on corticosteroids and immunomodulatory therapy.

Purpose: Ocular toxoplasmosis (OT) is the most common cause of posterior uveitis globally, with a significant risk of visual impairment. However, the lack of standardized data collection hinders meaningful comparisons across studies. This study aimed to develop a consensus-based set of Common Data Elements (CDEs) for observational studies in OT using a Delphi approach.

Design: A set of CDEs was developed through a combination of a comprehensive literature review, a hybrid workshop, and a Delphi consensus process. This effort was led by an international panel of experts in OT to define a standardized CDE set for research and clinical purposes.

Methods: A multidisciplinary steering committee identified an initial list of candidate CDEs through a targeted literature review. A panel of 30 international experts participated in a structured, one-round Delphi process to evaluate and refine these CDEs. Consensus was determined based on predefined thresholds for inclusion, exclusion, and modification.

Results: A total of 139 CDEs were categorized across nine domains: Demographic and Background Information, Medical and Ocular History, Clinical Presentation, Clinical Findings, Lesion Characteristics, Diagnostics, Imaging Findings, Treatment and Interventions, and Outcomes. All 139 CDEs met the inclusion criteria, with 79.8% rated as "very important". The consensus underscores the importance of a comprehensive, standardized dataset for OT research.

Conclusions: This study establishes the first expert-derived standardized dataset requested for reporting OT outcomes, providing a framework to standardize data collection for future observational studies. Adopting these CDEs will enhance data comparability, improve meta-analyses, and strengthen the evidence base for clinical decision-making in OT. Future work will focus on real-world validation and refinement of this dataset.

Background: The purpose of this case report is to describe the long-term findings and management of recurrent uveitis in a patient with autoimmune lymphoproliferative syndrome (ALPS).

Case observation: A 25-year-old female with a history of ALPS and previous uveitis flares presented with reduced vision and pain in the left eye. Uveitis flares began at age 4 and continued into adulthood prompting multiple medical regimen changes. Ocular involvement included anterior uveitis, posterior uveitis, and panuveitis. The laterality of uveitis flares favored the left eye, however bilateral episodes were documented. The patient was diagnosed with recurrent anterior uveitis and treated with topical corticosteroids with subsequent resolution of her symptoms. However, the patient continued to develop recurrent uveitis prompting low-dose long-term maintenance treatment with topical corticosteroids. Additionally, methotrexate was added which led to uveitis resolution and inactive disease for over a year on this treatment regimen.

Conclusions: Uveitis secondary to chronic autoimmune disease, such as ALPS, offer long-term challenges for ocular health management. Due to the recurrent nature of uveitis flares in patients with ALPS, long-term ophthalmic and systemic management may be warranted with low-dose maintenance topical corticosteroid or systemic immunomodulation. Response to topical and systemic therapy can be highly patient specific. Complex side effect profiles of many systemic immunotherapies make drug tolerability an important treatment consideration. Multidisciplinary coordination of systemic immunosuppression should be tailored to the patient's anti-inflammatory needs, as well as careful monitoring of adverse events.

Background: Adalimumab is a monoclonal antibody approved for the treatment of autoimmune diseases and non-infectious uveitis (NIU). It targets tumor necrosis factor alpha, a key mediator in inflammation. However, the development of anti-adalimumab antibodies (AAA) can reduce therapeutic efficacy and prompt treatment modifications. This study aimed to describe the clinical characteristics of patients with transient AAA and compare them to patients with persistent AAA, testing whether serum antibody and drug levels differ between groups.

Main body: We conducted a retrospective cohort study using the Stanford Research Repository (STARR) to identify patients treated with adalimumab for autoimmune conditions between June 2006 and May 2024 who developed AAA. Patients whose AAA became undetectable on follow-up testing were compared to an age-, sex-, and disease-matched cohort with persistent AAA. Demographics, diagnoses, treatment details, serum adalimumab and AAA levels, and concomitant immunomodulatory therapy (IMT) were analyzed. Among 190 AAA-positive patients, 18 (9.47%) demonstrated antibody resolution over a median follow-up of 6.5 months. These patients had lower median AAA levels (39.55 ng/mL vs. 92.35 ng/mL, p=0.020) and higher adalimumab levels (6.25 μg/mL vs. 1.55 μg/mL, p=0.018) than controls. AAA resolution was negatively correlated with AAA levels (p=0.018) and positively correlated with adalimumab levels (p=0.016).

Conclusions: Therapeutic monitoring of AAA and drug levels may help guide personalized therapeutic strategies and support continued treatment in selected patients.

Background: Vogt-Koyanagi-Harada (VKH) disease affects visual function, but the recovery process of color vision remains incompletely understood. This study aimed to assess color vision recovery in VKH using cone contrast testing and explore its relationship with cone cell density measured using adaptive optics imaging.

Methods: Twenty-two eyes of 11 patients with VKH were evaluated at baseline (serous retinal detachment resolution) and at 3, 6, and 12 months post-treatment. Cone contrast scores and cone cell density were measured using the ColorDx^® CCT-HD™ system and rtx1™ adaptive optics fundus camera, respectively. Pre-treatment optical coherence tomography (OCT) was used to analyze the cystoid spaces.

Results: Color vision defects observed at baseline-especially in S-cones-significantly improved by 6 months for all cone types. Cone contrast scores correlated significantly with cone cell density (ρ = 0.63-0.66, p < 0.0001). Eyes with cystoid spaces on pre-treatment OCT showed lower cone contrast scores and cone density. S-cones demonstrated greater vulnerability and slower recovery than L- and M-cones.

Conclusion: This study emphasizes the importance of comprehensive visual function assessment, including color vision evaluation, in VKH patients. Cone contrast testing captures qualitative aspects of visual function not reflected in standard acuity tests. The combination of cone contrast testing and adaptive optics imaging provides insights into the structure-function relationship in color vision recovery.

Purpose: Dysregulation of the microbiota on different mucosal surfaces is associated with both immune-mediated and malignant diseases. Nevertheless, the involvement of different microbial communities is still poorly characterized. The aim of our study was to compare oral and gut microbiota composition between patients with uveitis, vitreoretinal lymphoma (VRL), and controls.

Methods: This study was designed as a prospective observational study. The inclusion criteria were treatment-naïve patients with immune-mediated uveitis or newly diagnosed VRL. The buccal swab and faecal samples were collected and bacterial 16S ribosomal RNA gene sequencing was used to identify the oral and gut microbiota.

Results: We enrolled 18 patients with uveitis, median age 39 years, 16 patients with VRL, median age 67.5 years, and 16 controls, median age 63 years. In the oral microbiota, the patients suffering from uveitis showed significant enrichment of genera Pseudomonas (p < 0.0001 and p < 0.0001), and Diaphorobacter (p = 0.007 and 0.013) and reduction of Streptococcus (p < 0.0001 and p < 0.0001) when compared to patients with VRL and control subjects, respectively. In addition, these patients had also significantly higher relative abundance of the genus Enhydrobacter (p = 0.029) and lower abundance of the genera Gemella (p = 0.002), Neisseria (p = 0.008), and Prevotella (p = 0.011) when compared to patients with VRL. We found only minor changes in the gut microbiota.

Conclusion: Our study, as the first one, highlighted significant differences in the composition of oral microbiota among patients with uveitis, VRL, and control subjects.

Purpose: To report a case of chronic unilateral nodular anterior scleritis as a rare, isolated presentation of IgG4-related ophthalmic disease.

Case: A fifty-two-year-old patient was evaluated for painful, nodular scleral injection of the right eye, diagnosed as nodular anterior scleritis. There was only a partial response to topical corticosteroid and systemic immunomodulatory therapy. This, in combination with a sharp delineation between normal and abnormal sclera lead to the decision to perform a diagnostic biopsy of the lesion. Histopathology showed an IgG4 lymphoplasmacytic infiltration of the scleral tissue.

Conclusions: There are few documented reports of scleritis as the presenting manifestation of IgG4-related disease. IgG4-related disease is an increasingly recognized etiology to be considered in evaluating and managing scleritis.

Background: Postoperative cystoid macular edema (PCME) is a primary cause of reduced vision following both cataract and/or vitreoretinal surgery, which may spontaneously resolve. This study aimed to evaluate the effectiveness and safety of the fluocinolone acetonide intravitreal (FAc) implant (0.2 µg/day) in patients with refractory PCME.

Methods: Retrospective, non-interventional, and single center study conducted on patients with PCME treated with 0.2 µg/day FAc implant. All the patients received previous treatment with topical corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), triancinolone injection and dexamethasone implant. The primary end-points were the mean change in best-corrected-visual-acuity (BCVA) and the proportion of patients gaining ≥ 15 letters from baseline to the last follow-up visit. The secondary endpoints included the mean CRT reduction and the mean intraocular pressure (IOP) during the 36 months study period.

Results: Eight eyes from 8 patients were included in the study. Median (95% Confidence-interval) BCVA was significantly improved from 60.0 (50.05-69.95) letters at baseline to 80.15 (77.25-85.00) letters at month-36, p = 0.043. At the last follow-up visit, 5 (62.5%) eyes gained ≥ 15 letters, without any eye experiencing a loss of BCVA compared to baseline. There was significant CRT reduction from baseline (median: 497.5 μm; 95%CI: 380.0-596.0 μm) to month-36 (Median: 252.0 μm; 95%CI: 242.0-268.0 μm); p = 0.012. Regarding safety, IOP remained stable from baseline (median: 14.5mmHg; 95%Confidence-interval: 12.0-23.0 mmHg) to the last follow-up visit (median: 13.5mmHg; 95% Confidence-interval: 9.0-19.0 mm Hg); p = 0.123.

Conclusions: The FAc implant significantly improved both visual and anatomic outcomes, and was effective in preventing recurrences, while maintaining a reasonable safety profile, in PCME refractory to intravitreal triancinolone and dexamethasone.