Ocular Immunology and Inflammation最新文献

Purpose: To identify the incidence of cataract and the outcomes of cataract surgery in eyes with ocular cicatricial pemphigoid (OCP).

Methods: Phakic eyes were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study and followed for the incidence of visually significant cataract defined as: newly reduced visual acuity 20/50 or worse attributed to cataract; and/or incident cataract surgery. Secondarily, all eyes with OCP that underwent cataract surgery and had a year of follow up thereafter, were included in an analysis of visual outcome.

Results: Three hundred fifty-five phakic eyes (200 patients) with OCP were at risk. Eighty eyes developed visually significant cataract over 1064 eye years (incidence rate = 7.5%/eye-year, 95% confidence interval [CI] = 5.6 to 10.1). Higher age was associated with increased incidence of cataract (adjusted hazard ratio [aHR] = 4.47; 95% CI, 1.95-10.23 for age 60-75 inclusive and aHR = 8.37; 95% CI, 3.60-19.42 for age > 75, each compared with age <60 years). Seventy-nine eyes of 61 patients were monitored for > = 1 year following cataract surgery. Cataract surgery was associated with an improvement of vision around 4 lines, which was sustained through at least 48 months. Poorer pre-operative visual acuity was associated with poorer long-term visual outcome.

Conclusions: The incidence of cataract was high in this older population. No factors predictive of cataract such as duration of OCP or use of corticosteroids were identified. Visual acuity improved after surgery by a median of 4 lines' gain at one year; poorer long-term outcome among those with initially poorer visual acuity may be secondary to corneal scarring.

Purpose: We sought to re-evaluate the utility of inpatient ocular Candidiasis screening, subsequent interventions, and outcomes, to ultimately guide alignment between American Academy of Ophthalmology (AAO) and Infectious Diseases Society of America (IDSA) guidelines.

Methods: A retrospective cohort study was conducted from 2017-2024 at two tertiary care centers in the New York metropolitan area. Inclusion criteria included positive Candidal cultures, a pertinent International Classification of Diseases, 10^th revision (ICD-10) code, or both. Culture results, mental status, visual acuity, ocular symptoms, systemic antifungal use, dilated fundus exam (DFE) findings, immunocompromised status, and interventions performed were recorded.

Results: Of 897 patient encounters meeting inclusion criteria, 285 (31.8%) underwent consultation to rule-out ocular Candidiasis. Among these patients, 212 (74.4%) had an unremarkable DFE, 35 (12.3%) had DFE findings attributable to other comorbidities, 24 (8.4%) had nonspecific DFE findings requiring follow-up, nine (3.2%) were diagnosed with Candida retinitis, and one (0.4%) had Candida endophthalmitis. There were no statistically significant differences in the odds of DFE positivity between the immunocompromised versus immunocompetent group (χ2 = 0.881, p = 0.348) or the symptomatic versus asymptomatic group (χ2 = 0.297, p = 0.586). During the entire study period, no ophthalmology-directed interventions were made.

Conclusion: Candida endophthalmitis and Candida retinitis are rare in the inpatient setting, even in patients with confirmed Candidemia. Patients are universally started on empiric intravenous antifungal treatment by primary or infectious disease teams prior to ophthalmology consultation, limiting the yield of these examinations. Further studies should be undertaken to create a protocol for these patients such that serious sequelae of disease are prevented while resources are also utilized appropriately.

Purpose: To describe an atypical case of bilateral uveal effusion, presumably triggered by amoxicillin, in a 10-year-old child with pneumonia.

Methods: A comprehensive ophthalmological evaluation and imaging studies, including anterior segment and macular optical coherence tomography, ultrasound biomicroscopy, and B-mode ultrasonography, were performed to assess anatomical changes and confirm the diagnosis.

Results: A 10-year-old boy presented with an acute, painless loss of visual acuity in both eyes, primarily affecting distance vision. He had a recent history of pneumonia, which had been treated with amoxicillin. Ophthalmic examination revealed bilateral acute myopia, significant refractive error, and shallow anterior chambers in both eyes. Ultrasound biomicroscopy and anterior segment optical coherence tomography revealed fluid in the supraciliary space and anterior rotation of the ciliary processes, suggestive of uveal effusion. Based on these findings, uveal effusion was suspected, prompting the discontinuation of amoxicillin. The patient was treated with topical dexamethasone, cyclopentolate, and oral azithromycin. After stopping amoxicillin and initiating treatment, the patient's myopia resolved, anterior chamber depth normalized, and the uveal effusion was resolved within three days. The patient remained asymptomatic during a 6-month follow-up period.

Conclusion: This case suggests a possible link between amoxicillin use and bilateral uveal effusion, a relationship not previously reported. Healthcare professionals should consider uveal effusion in the differential diagnosis of patients presenting with bilateral acute myopia, particularly when associated with recent medication use. Further research is needed to explore the potential role of amoxicillin in inducing uveal effusion.

Purpose: The prognostic importance of vitreous cells (VC) in patients with Behçet syndrome (BS) is unknown. We aimed to determine the frequency of developing posterior uveitis (PU) and any additional risk factors associated with the development of PU in BS patients with VC at diagnosis.

Methods: The charts of 572 consecutive BS patients who were registered between 2010 and 2012 were reviewed. Among the patients with a follow-up of ≥2 years, we included 110 patients with VC in one or both eyes and 147 patients without any eye findings in both eyes at baseline and compared them for the development of PU.

Results: Among the 110 included patients with VC, 61 had VC in both eyes, 34 had VC in only one eye, and 15 had VC in one eye and PU in the other eye. There was anterior uveitis (AU) in addition to VC in the same eye in 13 patients at baseline. PU developed in 24 (22%) of these patients during a mean follow-up of 1.9 ± 1.1 years. This was significantly more frequent than the 147 patients without any eye findings at baseline, among whom there were only 2 patients who developed PU (p < 0.001). Multivariate logistic regression analysis showed that having AU in addition to VC in the same eye (OR, 5.03, 95% CI; 1.37-18.47) was an independent risk factor for the development of PU in patients with VC.

Conclusion: Careful follow-up is required for patients with VC at diagnosis, since 22% developed PU within 2 years.

The inclusion criteria of patients in this study were inconsistent especially in distinguishing Fuchs' uveitis and herpetic uveitis from Posner-Schlossman syndrome, indicating well-defined inclusion criteria were needed. CMV anterior uveitis and Posner-Schlossman syndrome may not be the same disease, CMV may only act as a triggering factor for Posner-Schlossman syndrome, and the clinical manifestations of mild anterior segment inflammation were mainly caused by inflammatory reactions mediated by autoimmune factors. Although the antiviral medication was important in the treatment of Posner-Schlossman syndrome, the role of other treatment methods especially topical steroids should not be ignored.

Purpose: We report the rare occurrence of unilateral acute hypertensive uveitis in the acute phase of systemic leptospirosis.

Methods: Observational case report and review of literature.

Results: A young male mason from coastal Karnataka in south India, presenting with acute febrile illness, was diagnosed to have systemic leptospirosis. He also had features of sudden raised intraocular pressure with anterior uveitis in one eye, which subsided with medical management.

Conclusion: Leptospirosis should be considered as a differential in the diagnosis of acute hypertensive uveitis.

Purpose: To study the clinical features, causative factors and treatment outcomes in patients with infectious scleritis seen in India.

Methods: A retrospective study of all patients examined at a tertiary care center between August 2012 and March 2021.

Results: Forty-five patients (45 eyes; mean age 52.7 ± 17.5 years) were included in the study. The mean duration of symptoms was 3.1 ± 4.4 months. Inciting factors were found in 53.3% (injury: 33.3%; ocular surgery: 20.0%). The scleritis was predominantly anterior (97.8%), with multiple lesions in 40.0%, a solitary lesion in 31.1%, and diffuse in 28.9%. Associated features included uveitis (51.1%), keratitis (37.8%), hypopyon (15.6%), and endophthalmitis (6.7%). Causative organisms included bacteria (53.3%), fungi (35.6%), and presumed herpes virus (11.1%). All patients were treated with antimicrobial agents along with systemic corticosteroids where indicated. Surgical treatment included scleral debridement (37.8%), patch grafts (4.4%), and penetrating keratoplasty (2.2%). Complete resolution of scleritis was seen in 86.7%, with a mean duration of therapy of 2.9 ± 2.5 months. The mean follow-up was 8.3 ± 14.3 months. 51.1% of patients lost functional vision (<6/60). Causes of decreased vision included corneal scar, cataract, macular scar, glaucomatous optic atrophy, and phthisis bulbi. On bivariate analysis, poor visual acuity at presentation was associated with a worse visual outcome (p = 0.02). Other risk factors included necrotizing scleritis, multifocal scleritis, the presence of keratitis and uveitis.

Conclusion: In our study, infectious scleritis resulted from bacterial and fungal infections. The scleritis resolved in most subjects, however, vision loss was frequent due to infection-related complications.

Purpose: To evaluate the effects of rheumatoid arthritis (RA) on choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT).

Methods: The study included 56 eyes of 56 rheumatoid arthritis patients and 65 eyes of 65 age- and sex-matched healthy normal participants. CVIs of all participants were measured by transferring enhanced depth imaging optical coherence tomography (EDI-OCT) images to the image J program that is software used for image binarization and compared between the 2 groups. SFCT, central macular thickness (CMT) and optic disc parameters of all participants were measured with spectral domain OCT and compared.

Results: The mean CVI values of the RA and control groups were 65.9 ± 1.52 and 68.56 ± 1.62, respectively, and were significantly lower in the RA group (p = 0.001). Mean SFCT values of the RA and control groups were 290.11 ± 15.18 and 332.88 ± 11.04, respectively, and SFCT was significantly lower in the RA group (p = 0.001). RA patients have thin SFCT and low CVI. There was no significant difference between the two groups in terms of CMT and optic disc parameters.

Conclusion: RA patients have lower CVI and thinner SFCT than healthy participants.

Purpose: The choroidal thickening and serous retinal detachments that characterize Vogt-Koyanagi-Harada (VKH) disease can be imaged in detail using spectral domain optical coherence tomography (SD-OCT). Whether specific qualitative and quantitative SD-OCT features at presentation were associated with visual outcomes in a randomized controlled trial comparing methotrexate to mycophenolate for steroid-sparing control of uveitis were evaluated.

Methods: An exploratory subanalysis of data from the FAST trial in which SD-OCT images from VKH participants were analyzed for presence/absence of bacillary detachments, retinal pigment epithelium (RPE) folds, and internal limiting membrane (ILM) fluctuations was performed. A modified RPE undulation index was calculated to provide a quantifiable surrogate marker for choroidal folds.

Results: SD-OCT images were available from 158 eyes with VKH. At baseline, bacillary detachments were present in 23.5% of eyes, RPE folds in 22.8% of eyes, and ILM fluctuations in 35.2% of eyes. For each 0.1 unit increase in modified RPE undulation index, there was an associated 0.13 increase in mean logMAR BSCVA at baseline. None of the SD-OCT features were associated with BSCVA at the 6-month primary endpoint. Indeed, mean final BSCVA was similar in those with and without the SD-OCT features of interest at baseline, and was between 0.1 and 0.2 logMAR (Snellen visual acuity 20/25 to 20/30).

Conclusions: While eyes with VKH may present with a variety of SD-OCT imaging pathology prior to starting immunosuppression with methotrexate or mycophenolate mofetil, final visual outcome in our study was excellent. With appropriate immunosuppression, good visual outcomes are possible in VKH.ClinicalTrials.gov Identifier NCT01829295Date of Registration: April 11, 2013.

Purpose: To review the clinical presentation and diagnostic workup of patients presenting with ocular sarcoidosis as initial manifestation of the disease and identify risk factors for disease recurrence.

Methods: All cases of sarcoidosis followed in our departments of Ophthalmology and Internal Medicine were retrospectively reviewed. Among 177 patients, 50 had ocular sarcoidosis as initial presentation of the disease. Clinical, biological, radiological, and treatment data were collected. Logistic regression analysis was conducted to identify risk factors for recurrence.

Results: Mean age of patients was 51 years, with an equal M/F ratio. Bilateral ocular involvement was present in 86% of cases, with granulomatous panuveitis being the most common manifestation (48%). Two-thirds of patients had extraocular symptoms related to the disease, mostly fatigue. The most frequently involved extraocular site was the supradiaphragmatic lymph nodes, identified in 84% of cases. CRP was normal in 68% of patients, while ACE and lysozyme were elevated in 19% and 64% of cases, respectively. Histopathological confirmation was obtained in 68% of patients. Female sex (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.50-40.40, p = 0.021) and granulomatous panuveitis (OR 7.23, 95% CI 1.70-40.99, p = 0.013) were identified as significant risk factors for disease recurrence.

Conclusion: Ocular sarcoidosis is a common initial presentation of systemic sarcoidosis. Diagnosis should be suspected in the presence of bilateral granulomatous panuveitis. Chest CT scan or ¹⁸F-FDG PET/CT is mandatory for systemic workup and biopsy is necessary for definite diagnosis. Female sex and a panuveitis presentation are significantly associated with disease recurrence.