Journal of Ophthalmic Inflammation and Infection最新文献

Objective: To report a case series of non-infectious anterior scleritis resistant to multiple lines of conventional therapies which were eventually successfully treated with off-label subconjunctival dexamethasone implant (Ozurdex^®) injection (SDI).

Methods: A retrospective case series of 4 patients (6 eyes).

Results: In the index case series, the patients had a mean age of 57.2 years (range 36 to 82 years, SD 19.2 years) with 50% being female. Two patients had underlying autoimmune diseases: rheumatoid arthritis (n = 1), and granulomatosis with polyangiitis (GPA) (n = 1). The other patients were diagnosed with idiopathic anterior scleritis after extensive systemic investigations (n = 2). The mean follow-up duration and the mean number of concomitant therapies prior to SDI was 27 (SD 17.7) months and 2 (SD 0.81), respectively. In all patients, symptom resolution and significant improvement in disease activity were achieved after SDI, persisting for an extended period following the resorption of the implant. No scleral melt, infection or ocular hypertension were noted following SDI.

Conclusion: SDI may be a safe and effective therapeutic option for resistant non-infectious anterior scleritis.

Introduction: Seasonal allergic conjunctivitis (SAC) is a hypersensitivity condition characterized by itching, tearing, and redness. It affects over 20% of the general population with limited therapeutic options. Reproxalap, a novel small-molecule aldehyde trap, has emerged as a potential treatment option for SAC by targeting reactive aldehydes involved in inflammation. In this systematic review and meta-analysis, we assessed the efficacy and safety of Reproxalap in treating SAC.

Methods: Multiple databases were searched including PubMed, Cochrane Library, Scopus, and Google Scholar, to identify relevant studies. Clinical trials involving patients diagnosed with SAC and treated with Reproxalap (0.25% or 0.5%) were included. The primary outcomes were symptom relief (efficacy) and side effects (safety). Data extraction and risk of bias assessment were performed independently by two reviewers. Meta-analysis was conducted using RevMan 5.4 software.

Results: Five RCTs involving 625 participants were included. Reproxalap significantly reduced ocular itching compared to control groups for both 0.25% (SMD: -0.31, 95% CI: -0.50 to -0.13, P = .001) and 0.5% concentrations (SMD: -0.31, 95% CI: -0.51 to -0.10, P = 0.004). No significant difference was observed between the two doses (SMD: -0.02, 95% CI: -0.23 to 0.19, P = 0.83). Side effects were more frequent in both Reproxalap groups compared to controls, with odds ratios of 35.31 (95% CI: 17.83 to 69.90, P < 0.00001) for 0.25% and 45.64 (95% CI: 18.49 to 112.66, P < 0.00001) for 0.5%. The 0.5% dose had significantly higher odds of side effects compared to the 0.25% dose (OR: 1.66, 95% CI: 1.10 to 2.51, P = 0.02). Heterogeneity was low for all outcomes (I² = 0%).

Conclusion: Reproxalap reduces ocular itching associated with SAC. While both 0.25% and 0.5% concentrations are effective, safe and tolerable. Further research should focus on the long-term benefits and applicability of Reproxalap on diverse populations.

Purpose: To describe a case of acute multifocal retinitis (AMR) and retinal vasculitis associated with Rickettsia typhi.

Methods: Case report.

Results: A 37-year-old previously healthy female presented with acute bilateral panuveitis that was preceded by a febrile illness with pneumonitis and transaminitis. On exam she had bilateral multifocal small white retinal lesions, vascular sheathing, and hemorrhages. The retinal lesions, which appeared consistent with infiltrates and/or ischemia, were confined within the inner or middle retinal layers on optical coherence tomography (OCT) and corresponded to late leakage on fluorescein angiography (FA). There was no evidence of choroidal involvement on indocyanine green angiography (ICGA). Based on the imaging findings and history, the diagnosis of AMR with associated small vessel retinal vasculitis was made and the patient was started empirically on doxycycline. Workup was positive for R. typhi. At follow-up, there was resolution of visual symptoms and nearly all retinal lesions.

Conclusions: Rickettsial disease should be highly suspected in a patient with AMR and occlusive small vessel vasculitis. Retinal lesions may be either infiltrative or ischemic in nature. Diagnosis, which can be aided by multimodal retinal imaging, is essential for prompt initiation of appropriate antibiotic therapy.

Purpose: To describe the efficacy and safety of the ab externo open-conjunctiva XEN^® 63 μm gel stent in uveitic glaucoma.

Case presentation: A case report of a 15-year-old patient with bilateral uncontrolled uveitic glaucoma secondary to chronic anterior uveitis was presented. Several medical ophthalmological and rheumatological evaluation visits were conducted. Preoperative intraocular pressure was 28 mmHg in the right eye and 32 mmHg in the left eye. She underwent a trabeculectomy in her right eye developing hypotonic maculopathy and decompression retinopathy, requiring surgical revision. Considering the complications endured in the right eye, it was decided to perform an ab externo open-conjunctiva XEN^® 63 μm implant in her left eye with no postoperative complications. Postoperative course was uneventful with well-controlled intraocular pressure (11 mmHg) and no progression of glaucomatous damage, one year after the procedure. Anterior segment optical coherence tomography evidenced a well-functioning and non-encapsulated bleb along the follow up. Eventually, there were no postoperative uveitic episodes, with 40 mg Adalimumab as a steroid-sparing agent.

Conclusion: Uveitic glaucoma presents both clinical and therapeutic challenges. Traditional surgery such as trabeculectomy may entail postoperative complications such as hypotonic maculopathy and decompression retinopathy. This is the first case reporting the efficacy and safety of ab externo open-conjunctiva XEN^® 63 μm implant in uveitic glaucoma, highlighting its potential usefulness in such clinical scenarios.

Background: Corneal refractive surgeries offer rapid vision correction, while dry eye disease remains a common postoperative complication that significantly impacts patients' quality of life. The etiology of postoperative dry eye is multifactorial. Cyclosporine A (CsA) has been employed in the treatment of dry eye due to its ability to suppress T cell-mediated immune responses and reduce inflammation. The present study was designed to assess the early effect of 0.05% cyclosporine A (CsA) eye drops on tear film stability, ocular surface inflammation and goblet cell function in patients following corneal refractive surgery.

Methods: One hundred forty-four eyes of 72 participants undergoing corneal refractive surgery were enrolled and randomized into additional 0.05% CsA eye drops treated group or conventional schedule treated group. Ocular Surface Disease Index (OSDI), relevant ocular surface clinical parameters, tear inflammatory cytokine levels, conjunctival impression cytology, and gene expression of Keratin 7 (KRT-7) as well as Mucin5AC (Muc5AC) in conjunctival epithelial cells were measured before surgery (baseline) and at 1 month after surgery. All indicators and their changing value were compared against baseline or across different groups.

Results: 0.05% CsA treatment exhibited greater changes in OSDI, NIBUT, LLT and CFS in the early postoperative period (P = 0.004, P = 0.002, P = 0.032, P = 0.008). Compared to control group, there was a more significant decrease in IFN-γ and TNF-α levels in tear fluid in CsA group after surgery (P = 0.012, p = 0.032). Additionally, KRT-7 and IFN-γ showed recovery in conjunctival cells with 0.05% CsA treatment (P = 0.003, P = 0.019). The postoperative KRT-7 and Muc5AC levels were negatively correlated with corresponding IFN-γ levels in tear fluid among all subjects (r = -0.200, p = 0.016; r = -0.229, p = 0.006).

Conclusions: For patients undergoing refractive surgery, the application of 0.05% CsA suppressed the expression of inflammatory cytokines such as IFN-γ and TNF-α, and preserved goblet cell function. These effects ultimately contribute to maintaining ocular surface stability and alleviating dry eye related symptoms during the early postoperative period following refractive surgery.

Purpose: Pre-operative antisepsis of the conjunctiva is indicated prior to intraocular surgery to prevent post-interventional endophthalmitis. In Germany, antisepsis with 5% povidone-iodine (PI) aqueous solution is explicitly required prior to intravitreal injections (IVI), and also generally recommended for intraocular surgery. However, this concentration often leads to a foreign body sensation and an unpleasant burning in combination with dry eye symptoms. Postoperative eye pain, persistent corneal epithelial defects, and a risk of keratitis are further side effects. Due to the repetitive nature of IVI, these symptoms are particularly present in IVI patients. A reduced concentration may be favorable to decrease patient discomfort. A 1.25% PI solution does not increase the iodine concentration in the aqueous humor and is also used for prophylaxis of ophthalmia neonatorum and for preoperative antisepsis; in both cases the renal iodine excretion stays in a physiological range thus thyroid diseases are no contraindication for its use. Thus, the efficacy of reduced concentrations of PI should be evaluated in vitro.

Methods: PI with dilutions below 5% (0.625 - 2.5% serial 1:2 dilution) was tested in vitro in a quantitative suspension assay and in a quantitative carrier test without and with addition of matrices to identify their antimicrobial effect against Staphylococcus epidermidis, Pseudomonas aeruginosa, Cutibacterium acnes and Candida albicans.

Results: No differences in the antimicrobial effect was seen due to reduced concentrations of PI in comparison to a 5% solution. However, a trend was seen regarding the required contact time of the antiseptic solution.

Conclusion: The in-vitro tests have shown adequate antisepsis of 1.25% PI prior to intraocular surgery. However, it is important to pay attention to a sufficient contact time of the antiseptic of about 1 min before ophthalmologic intervention. In order to give final recommendations, in vivo testing is needed to build a robust data foundation.

Purpose: To report IgG4-related ophthalmic disease (IgG4-ROD) presenting as posterior scleritis in a pediatric patient.

Observations: A 7-year-old girl presented with proptosis, painful eyelid swelling, and restricted extraocular movements (EOM) of her left eye (OS). Visual acuity (VA) was 20/20 in right eye (OD) and counting fingers (CF) at 1 foot in OS. Slit lamp examination revealed 2 + anterior chamber (AC) cells, optic disc edema (ODE) with elevated appearance of macula in OS. Optical coherence tomography (OCT) showed significant subretinal fluid (SRF) in macula, B-scan ultrasound (US) demonstrated T-sign in OS. Orbital MRI was also consistent with posterior scleritis and periorbital inflammation. Extensive systemic work-up was unremarkable. Thus, the patient was started on intravenous methylprednisolone (IVMP) 30 mg/kg/day for 3 days, along with topical therapy in OS, which led to an improvement of proptosis, EOM restriction, AC cells, as well as ODE and SRF in macula in OS. Fluorescein angiography (FA) showed leakage from optic disc in OS. The patient was then switched to oral prednisone with slow tapering and started on methotrexate (MTX). Given the recurrence of proptosis and painful eyelid swelling on systemic steroid tapering, serum IgG4 levels were ordered and found to be elevated at 149.9 mg/dL (range, 1-99). Therefore, the patient was diagnosed as 'possible' IgG4-ROD (based on diagnostic criteria) and started on infliximab (7.5 mg/kg) and IVMP monthly infusions with continuation of MTX 20 mg weekly and slower tapering of oral prednisone, which led to resolution of clinical findings, improvement of VA to 20/20 in OS.

Conclusion and importance: Posterior scleritis may be the initial presentation of IgG4-ROD in children. Refractory course is not uncommon. Biologics are effective in the long-term control of inflammation.

Syphilis is one of sexually transmitted infections (STIs). The incidence of Treponema pallidum infection has increased in the last 20 years. This rise is also evident in ophthalmological practice, with cases of ocular syphilis becoming more frequent.We present a case of a 29-year-old patient with blurred vision in his left eye. Patient showed no general symptoms, nor previous history of eye disorders. On ophthalmological examination, the best-corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and 20/80 in the left eye (OS). The left eye presented high intraocular pressure (IOP) of 31 mmHg and symptoms of anterior uveitis with a linear branching corneal erosion. A B-scan ultrasound of the left eye revealed no vitritis. The preliminary diagnosis of herpetic infection was made, and antiviral therapy was introduced. Despite the initial improvement, symptoms of active anterior uveitis were found on follow-up visits. After approximately 4 weeks of ambulatory treatment, the patient was admitted to the hospital because of roseolae and lumps of the left iris, which appeared accompanied by a rash on patients' lower limbs. Laboratory tests confirmed syphilis and human immunodeficiency virus (HIV) coinfection. During hospitalization intravenous treatment with penicillin and antiretroviral drugs was introduced. Therapy with penicillin was continued to 21 days with improvement in examination. On a follow-up visit after 6 months BCVA in both eyes was 20/20.It is crucial to consider testing for STIs, especially Treponema pallidum infection, in the diagnostic process of patients with nontypical or nonresponsive to treatment ocular symptoms.

Purpose: To present a pediatric case of acute retinal pigment epitheliitis (ARPE) and propose a classification based on imaging findings and prognosis.

Methods: A case report with literature review.

Results: The case demonstrated hallmark ARPE features alongside an atypical disease course, indicating a broader clinical spectrum. Multimodal imaging plays a crucial role in differentiating ARPE from mimicking retinal disorders.

Conclusion: ARPE may represent a spectrum of subtypes with varying prognostic implications. A classification based on age, laterality and imaging biomarkers could improve diagnostic accuracy and patient management.

Background: Despite uveitis subspecialty workforce shortages, uveitis specialists remain engaged in research. This study examines the relationship between the proportions of uveitis-focused articles in high-impact ophthalmology journals and fellowship-trained uveitis specialists on their editorial boards.

Methods: A bibliometric analysis was conducted on articles published from 2014 to 2023 in the five highest-impact ophthalmology journals: Ophthalmology, JAMA Ophthalmology, British Journal of Ophthalmology (BJO), American Journal of Ophthalmology (AJO), and Investigative Ophthalmology and Visual Science (IOVS). Editorial board members with uveitis or ocular immunology fellowships were identified from public domain sources. Articles were screened using uveitis MeSH terms. Data analysis was performed using STATA to assess the relationship between the proportions of uveitis-focused articles and uveitis-trained editors.

Results: From 2014 to 2023, 3.57% (575/16,093) of articles published in the five journals were uveitis-focused. The proportion of uveitis-focused articles ranged from 1.74% in IOVS to 5.89% in AJO. On average, fellowship-trained uveitis specialists comprised 5.28% of editorial board members annually. There were positive correlations between the proportions of uveitis-focused articles and uveitis-trained editors annually (r = 0.6799, p < 0.00005) and over the 10-year period (r = 0.2675, p < 0.00005). No significant correlation was observed within individual journals.

Conclusions: Uveitis research remains underrepresented in high-impact ophthalmology journals despite research productivity in the field. While a positive correlation between uveitis-trained editors and uveitis-focused articles was found across all journals, this trend did not hold within individual journals. Enhancing uveitis research visibility in high-impact journals is essential to advancing clinical knowledge, improving patient outcomes, and inspiring ophthalmologists to enter this underserved subspecialty.