Ocular Immunology and Inflammation最新文献

This review offers a comprehensive synthesis of current evidence on near-infrared autofluorescence (NIR-AF) in non-infectious uveitis, highlighting its strengths, limitations, and role in diagnosis, monitoring, and understanding disease mechanisms. Unlike blue-light autofluorescence, which mainly detects lipofuscin, NIR-AF visualizes melanin and related compounds in the retinal pigment epithelium (RPE) and choroid, providing deeper penetration, reduced phototoxicity, and greater comfort. Across entities like Vogt-Koyanagi-Harada disease, MEWDS, punctate inner choroidopathy, APMPPE, and Fuchs' heterochromic iridocyclitis, NIR-AF reveals patterns often invisible on conventional imaging-detecting subclinical lesions, differentiating active from inactive disease, and tracking RPE changes over time. Its persistence in showing hypoautofluorescent or hyperautofluorescent lesions after clinical resolution offers unique insight into residual or subclinical inflammation. The technique complements OCT, fluorescein, and indocyanine green angiography, adding a melanin-specific layer to multimodal imaging. Limitations include a weaker signal compared to BL-AF, susceptibility to media opacities, equipment-dependent variability, and lack of standardized interpretation criteria. While it cannot quantify choroidal melanin loss directly and image acquisition can be challenging, its non-invasive, repeatable nature and diagnostic yield make it a promising tool for longitudinal uveitis care. Further prospective studies, standardization, and AI-driven analysis could expand its clinical impact, potentially cementing NIR-AF as an essential component in uveitis imaging strategies.

Purpose: To describe clinical characteristics, patterns, and surgical outcomes in the management of presumed trematode-induced granulomatous intermediate uveitis (PTIGIU).

Methods: Retrospective single-center study in which patients exposed to fresh water canal exposure with PTIGIU were enrolled. Surgery was done after failure of medical treatment in the form of lensectomy and pars plana vitrectomy (PPV). Post-operative functional and anatomical outcomes were assessed.

Results: 58 eyes of 56 patients were included with mean age of 12.6 ± 3.07 years, 89.3% males. Ciliary body (CB) granulomas were most commonly present inferiorly (41%) and either extend anteriorly to the lens or circumferential along the CB or posteriorly to the retina and were associated with retinal pathologies in 86.2%; the most common of which was tractional retinal detachment (TRD) (60%). According to retinal pathology, eyes were grouped; Group A: 43 eyes, with early disease, having no or localized peripheral retinal detachment (RD) and B: 15 eyes, with advanced cicatricial disease. Inflammation was well controlled 6 months post-surgery in both groups; however, Group A showed better functional (p = 0.003) and anatomical outcomes (p = 0.01). Lens morphology was negatively correlated with retinal pathology (p = 0.036).

Conclusion: PTIGIU is a potentially blinding disease, with earlier surgical intervention showing better anatomical and functional outcomes.

Purpose: Case report.

Methods: Melanoma-associated retinopathy (MAR) is a rareparaneoplastic autoimmune disorder characterized by retinal dysfunction inpatients with cutaneous melanoma. While typically presenting with photopsias, nyctalopia, and peripheral vision loss, diagnosis remains challenging due tooften normal fundoscopic findings and variable autoantibody detection. Thisreport describes a unique case of recurrent MAR managed successfully withintravitreal dexamethasone over a decade-long follow-up.

Results: A 48-year-old man with stage IV cutaneousmelanoma with BRAF V600E mutation achieved complete systemic remission with vemurafenib. During ophthalmological screening, he reported nyctalopia andphotopsias; clinical examination and optical coherence tomography wereunremarkable. Full-field electroretinography (ERG) revealed an electronegativewaveform (reduced b-wave), confirming MAR despite negative antiretinalantibodies. Sub-Tenon's triamcinolone and intravenous immunoglobulin failed toimprove symptoms, but bilateral intravitreal dexamethasone implants (Ozurdex) resolved visual disturbances and normalized ERG. Over ten years, eight MAR recurrences occurred - each treated successfully with Ozurdex - without melanoma relapse.

Conclusion: MAR can be presented as the first sign of melanoma relapse. This case underscores MAR's potential for recurrence despite durable melanoma remission and highlights intravitreal dexamethasone as an effective long-term therapy. The absence of autoantibodies and late flares challenges current diagnostic paradigms, emphasizing ERG's critical role. Proactive ophthalmologic surveillance and individualized local therapy canpreserve vision in this underrecognized condition.

Objectives: Non-infectious uveitis (NIU) is an immune-mediated, vision-threatening disease often requiring immunomodulatory therapy. We systematically evaluate the efficacy and safety of immunomodulatory therapies for the management of NIU.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched up to December 2024. Randomized, controlled trials (RCTs) assessing the efficacy and safety of immunomodulatory agents for uveitis were included. Bayesian network meta-analyses were conducted to compare treatments across trials, while frequentist meta-analyses were performed to estimate the absolute treatment failure rate at month 6 and the overall SAEs rate. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool.

Results: Sixteen randomized controlled trials, involving 11 immunomodulatory therapies, were included from 6097 records retrieved. Among them, adalimumab plus corticosteroids was associated with significant reduction in hazard of treatment failure over time (HR 0.51, 95% CrI: 0.24-0.95) compared with corticosteroids monotherapy. The estimated overall treatment failure rate at month 6 was 37.6%, and the number of SAE was around 10.1%. No significant differences were observed in treatment failure rates at month 6, changes in BCVA or number of SAEs across treatments.

Conclusions: Adalimumab plus corticosteroids significantly prolonged the relapse-free period compared with corticosteroids monotherapy. Mycophenolic acid showed favorable trend in both efficacy and safety. Despite immunomodulatory treatment, the risk of uveitis relapse still remains and warrants continued attention.

Purpose: To explore the clinical characteristics of moxifloxacin-associated bilateral acute iris transillumination (BAIT) and provide references for diagnosis and treatment.

Methods: The clinical reports of moxifloxacin-associated BAIT were collected before August 31, 2025, and the clinical data were extracted for retrospective analysis.

Results: A total of 40 patients were included, with a median age of 53 (range 26, 77), including 28 (70.0%) women. The median occurrence time of BAIT was 14 days (rang 0.2, 60). Patients may present with photophobia (75.0%), decreased vision (67.5%), ocular pain (50.0%), and high intraocular pressure (32.5%). Ophthalmic examination shows iris transillumination. After the patients discontinued moxifloxacin and received topical steroids and anti-glaucoma treatment, the symptoms of most patients improved, while transillumination remained.

Conclusions: The patient developed ocular symptoms such as photophobia, ocular pain and decreased vision during the use of moxifloxacin, which requires further examination. If iris transillumination, ocular hypertension and acute pigment dispersion of the iris pigment epithelium are found during ophthalmic examination, the possibility of BAIT should be considered.

Purpose: Fungal endophthalmitis (FE) is a rare but severe intraocular infection that may cause irreversible vision loss. Because conventional cultures are slow and insensitive and serum β-D-glucan (BDG) has limited value for intraocular disease, we evaluated the diagnostic accuracy of BDG testing in aqueous humor (AH) and vitreous humor (VH) for FE.

Methods: We searched PubMed, Web of Science, EMBASE, and the Cochrane Library for studies of intraocular BDG testing for FE. Pooled sensitivity and specificity were calculated using a random-effects model, and the area under the summary receiver operating characteristic (SROC) curve and diagnostic odds ratio were used to assess diagnostic performance. Study quality was evaluated with QUADAS-2. An exploratory post hoc subgroup analysis compared AH and VH when specimen-specific data were available.

Results: Six studies were identified and included. The pooled sensitivity and specificity of intraocular BDG testing were 0.86 (95% CI: 0.77-0.92) and 0.85 (95% CI: 0.78-0.90), respectively. The area under the SROC curve was 0.913, indicating good diagnostic accuracy, and no heterogeneity was observed for either sensitivity or specificity (both I² = 0.0%). Methodological quality was moderate, mainly because of patient-selection bias. In an exploratory specimen-type subgroup, study-level estimates ranged as follows: AH sensitivity 0.82-0.86 and specificity 0.80-0.87; VH sensitivity 0.94-1.00 and specificity 0.82-0.96.

Conclusion: Intraocular BDG shows high diagnostic accuracy for FE and may serve as a valuable adjunctive tool, particularly when conventional culture methods are inconclusive or delayed.

Purpose: To investigate trends in the diagnostic approach to nonparaneoplastic autoimmune retinopathy (npAIR).

Methods: We queried PubMed for clinical reports on npAIR published between January 2016 and September 2025. Articles were assessed to determine criteria used to establish diagnosis of npAIR using a standardized grading system. Articles were categorized as case reports (≤3 patients) or case series (>3 patients).

Results: 36 case reports and 41 case series met eligibility criteria (755 total cases). Author subspecialty included 34% uveitis, 20% inherited retinal disease (IRD), 16% general retina, 10% miscellaneous, and 19% unknown specialty. Over 80% of publications reported electroretinography and anti-retinal antibody testing for diagnosis of npAIR. Fundus autofluorescence (FAF) was performed in 67% of case reports and at least one patient in 51% of case series. Widefield FAF was used in 19% of case reports and in at least one patient in 20% of case series. Genetic testing was reported in 22% of case reports and in at least one patient in 27% of case series. Studies with an IRD specialist as first or last author most commonly used genetic testing (35%).

Conclusions: Literature on npAIR is hampered by variability in classification schemes and incomplete reporting. Nonspecific electroretinography testing and antiretinal antibody testing are widely employed while widefield autofluorescence testing and genetic testing are not commonly used. Expanded access to these tools provides an opportunity to update diagnostic criteria of npAIR. Improved classification will permit us to better understand the natural history of disease.

Purpose: The more widely known ocular toxicity of Mirvetuximab soravtansine-gynx (MIRV) is keratopathy. Clinical trial data provides little detail on the lesser known toxicity of anterior uveitis from MIRV. We discuss the potential mechanism for this toxicity and provide suggested adjustments to current clinical practice for patients on this drug.

Methods: This retrospective case series, single center study included 42 consecutive patients treated with MIRV at Memorial Sloan Kettering Cancer Center for High-grade serous ovarian cancer and examined in our ophthalmology department between March 1, 2024 - July 15, 2025.

Results: Seventeen of forty-two (40%) patients (median age of 69 years) developed keratitis, and three (7.1%) patients, developed grade 1+ bilateral non-granulomatous anterior uveitis on treatment with MIRV. Uveitis was diagnosed after a median of 12 cycles (range 9-14).

Conclusion: Although a small cohort, our findings suggest that MIRV-induced anterior uveitis is more common than initially thought. Reassuringly, all cases observed have been mild and reversible with topical steroid drops and most patients were able to continue on MIRV (lifesaving) treatment.

Paediatric neoplastic uveitis masquerade syndrome (UMS) is a rare but serious condition in which intraocular malignancies mimic inflammatory uveitis. Children may present with symptoms of intraocular inflammation such as redness, pain, light sensitivity, and blurred vision. The diagnostic challenge is compounded by the difficulty of examining younger patients and the absence of systemic warning signs. Accurate diagnosis is essential because the therapies for uveitis and ocular neoplasms vary fundamentally, and delayed recognition can be life-threatening.Although the most frequent neoplastic masquerades are acute leukaemia and retinoblastoma (RB), medulloepithelioma and metastatic tumours may also occur. Acute lymphoblastic leukaemia, the most common childhood malignancy, can manifest as anterior pseudohypopyon, iris infiltration or neovascularization, or posterior segment findings, including haemorrhages, Roth spots, and serous retinal detachment. Ocular involvement may indicate relapse. RB, the most common primary intraocular cancer in children, usually presents with leukocoria or strabismus. However, its diffuse infiltrating variant can masquerade as intraocular inflammation with pseudohypopyon, iris neovascularization, vitreous seeds, and vitreous haemorrhage. Unlike classic RB, this variant often lacks a discrete calcified mass, further complicating the diagnosis, which frequently results in misdiagnosis of uveitis.Multimodal ophthalmic imaging, including enhanced depth optical coherence tomography, fluorescein angiography, and ultrasonography, may aid in the diagnosis. Computed tomography or magnetic resonance imaging, combined with a comprehensive history and laboratory evaluation, can help distinguish neoplastic masquerades from inflammatory diseases. Early recognition, prompt referral to an oncology or ocular oncology department, and multidisciplinary care are critical because a timely diagnosis can preserve both vision and life.

Introduction: Birdshot chorioretinopathy (BSCR) is a chronic posterior uveitis. In some cases, hyperreflective material between the retinal pigment epithelium (RPE) and Bruch's membrane is noted on optical coherence tomography (OCT), the so-called double-layer sign. This study describes the clinical features associated with the double-layer sign on OCT in BSCR.

Methods: In retrospective, observational study of patients with BSCR, charts and OCT images of consecutive patients were reviewed and the presence of the double-layer sign on OCT was noted. Clinical features associated with the double-layer sign were analyzed.

Results: Forty-nine patients with HLA-A29+ BSCR were retrospectively reviewed and 15 eyes (15%) of 9 patients (18%) demonstrated the presence of the double-layer sign on OCT. The presence of CNV corresponding to the double-layer sign on OCT was confirmed in eyes that had additional imaging (11 out of 15 eyes; 73%). Intra- or subretinal exudation was present at some point during follow-up in 5/15 eyes (33%), and 3/15 eyes received treatment with intravitreal bevacizumab (20%).

Conclusions: Birdshot chorioretinopathy can develop a double-layer sign on OCT often harboring a non-exudative or minimally active choroidal neovascularization. This sign in patients with BSCR might indicate chronic inflammation involving the posterior pole.