Ocular Immunology and Inflammation最新文献

Purpose: To evaluate the efficacy of subpalpebral ocular continuous lavage (SOCL) with 0.5% voriconazole combined with systemic antifungals (SOCL+M) versus systemic antifungals alone (M) in fungal keratitis.

Methods: This was a multicenter, prospective, non-randomized trial with masked outcome assessment. Treatment allocation-to either subpalpebral 0.5% voriconazole lavage combined with systemic antifungals or systemic antifungals monotherapy-was determined by patient preference and physician recommendation. The study protocol was standardized across sites through centralized training and adherence was monitored with monthly audits. The primary outcome was 3-month cure rate; secondary outcomes included penetrating keratoplasty (PKP) rate, hypopyon resolution time, and corneal parameter changes over one month.

Results: Compared to the M group, the SOCL+M group exhibited a significantly higher cure rate (69.0% vs. 40.7%; OR = 3.23, 95% CI: 1.49-7.03, p = 0.003) and a lower rate of penetrating keratoplasty (0% vs. 10%, p = 0.027) at the 3-month follow-up. The hypopyon resolution time occurred more rapidly in the SOCL+M group (6.79 ± 3.36 days vs. 10.06 ± 3.62 days, p = 0.009). Furthermore, the SOCL+M group showed significantly greater reductions in corneal infiltration, epithelial defect, and fungal density at 1 month compared to the M group (all p < 0.05).

Conclusions: SOCL represents an innovative adjunctive therapy for fungal keratitis, offering significant clinical advantages including accelerated corneal healing, higher cure rates, and reduced need for therapeutic keratoplasty, with strong translational potential.

Purpose: To analyze the clinical patterns and systemic associations of ocular inflammation from a 10-year registry in Taiwan.

Methods: We retrospectively reviewed 1404 patients diagnosed with uveitis, scleritis, and uveitis masquerade syndromes (UMS) at a tertiary referral center from 2013 to 2023. The Standardization of Uveitis Nomenclature (SUN) criteria were assessed for real-world applicability.

Results: This registry included cases with uveitis (n = 1,254, 89.3%), scleritis (n = 91, 6.5%), and UMS (n = 59, 4.2%). Among uveitis group, anterior uveitis (AU) was the most common (68.9%), including 41.9% cases belongs to acute anterior uveitis (AAU). In AAU cases, a high HLA-B27 positivity rate of 68.3% was observed. Of AU cases tested with aqueous polymerase chain reaction (PCR), 46.4% were positive, most commonly for CMV. Notably, 20.3% of CMV AU cases required repeat taps for diagnosis. Pediatric ocular inflammation (n = 46) was predominantly AU (71.7%), with a low association with juvenile idiopathic arthritis (JIA) (4.3%). The leading three noninfectious panuveitis causes were VKH disease (4.1%), sarcoidosis (3.5%), and Behçet's disease (1.2%). Among scleritis, 13.2% were associated with rheumatological disease, which all preceded ocular manifestations. Overall, 49.6% met SUN criteria.

Conclusion: This cohort revealed several distinctive features of ocular inflammation in Taiwan, including high HLA-B27 positivity rate in AAU, diagnostic challenges in CMV anterior uveitis, low systemic association in pediatric uveitis and scleritis, a non-low prevalence of sarcoidosis, and milder Behçet's disease presentations. The 49.6% SUN classification rate underscores the need for ongoing real-world data updates to refine classification systems.

Purpose: To quantitatively assess the progression of fundus depigmentation in Vogt-Koyanagi-Harada (VKH) disease using ultra-widefield fundus photography (UWF-FP) and to investigate its relationship with inflammatory activity, treatment, and best-corrected visual acuity (BCVA).

Methods: This retrospective longitudinal cohort study included 28 eyes from 14 VKH patients followed for at least three years. UWF-FP images (Optos Silverstone) were analyzed using a custom ImageJ macro to calculate the percentage of choroidal depigmentation within a standardized rectangular region centered on the optic nerve head. Depigmentation values were correlated with BCVA (logMAR), cumulative inflammatory episodes, and baseline systemic therapy. Disease activity was defined according to the Standardization of Uveitis Nomenclature (SUN) criteria. Statistical analyses were performed using R software.

Results: The mean percentage of depigmentation increased from 10.47% ± 18.84% at baseline to 26.82% ± 28.63% at the last follow-up (mean 4.29 ± 1.78 years; p < 0.001). Greater cumulative inflammatory episodes were associated with steeper depigmentation progression (r = 0.73, p < 0.001). BCVA improved from 0.62 logMAR at baseline to 0.11 logMAR at last follow-up but showed a moderate positive correlation with depigmentation (r = 0.64), suggesting that structural changes persist despite visual recovery. Patients receiving combined corticosteroid-immunosuppressive therapy exhibited significantly slower depigmentation progression compared with corticosteroid monotherapy.

Conclusion: Quantitative assessment of fundus depigmentation using UWF-FP provides an objective imaging biomarker of disease progression in VKH. Depigmentation correlates with inflammatory burden and long-term visual outcome. Early initiation of combined therapy may limit depigmentation and improve disease control.

Purpose: This study evaluated four artificial intelligence (AI) models-ChatGPT, Copilot, DeepSeek, and Gemini-for their ability to generate PubMed citations related to ocular inflammation and uveal disease. The aim was to assess their performance in a specialized clinical context and determine whether these tools can support accurate academic referencing.

Methods: Thirty-five clinical paragraphs from The Review of Ophthalmology (4th edition) were provided to each model, which was instructed to generate AMA 11-style PubMed citations. Outputs were examined for accuracy, DOI matching, and clinical relevance. Expert reviewers classified each citation as Fully Cited, Partially Cited, or Not Cited. Statistical differences among the models were assessed using ANOVA with post hoc analysis.

Results: DeepSeek, a domain-specific model, outperformed other models with an accuracy of 65.7% (p < 0.001). Copilot and ChatGPT achieved moderate accuracy rates of 42.9% and 37.1% (p = 0.042), respectively, whereas Gemini performed the worst, with an accuracy of 5.7% (p < 0.001). These results were statistically significant, as confirmed by ANOVA and post hoc analysis. Additional errors included incorrect citations, DOI mismatches, and incomplete reference lists. Expert validation also showed that DeepSeek produced the highest number of fully accurate citations, while the remaining models generated more partial or uncited references.

Conclusion: AI tools can assist with citation generation, but their reliability varies significantly. Domain-specific systems perform better, yet inconsistencies such as partial citations and hallucinated details highlight the continued need for expert oversight. Accurate academic referencing still depends on combining AI-generated material with careful human review.

Purpose: A comparative evaluation of Meibomian Gland (MG) dysfunction and Dry Eye Disease (DED) between patients of Mucous Membrane Pemphigoid (MMP) with and without obvious ocular complaints and their age-matched controls.

Methods: This cross- sectional study included three groups: Group 1- MMP with ocular symptoms; Group 2 - MMP without ocular symptoms who were under treatment in the autoimmune bullous disease clinic of the Dermatology Department; Group 3- healthy age-matched controls. Meibography was performed using an infrared analyzer, and the MG area loss was recorded using meibography images.

Results: A total of 123 eyes from 64 subjects were included, 35 in group 1, 24 in group 2 and 64 in group 3. The mean ocular surface disease index (OSDI) score in group 1 (35.29 ± 14.03) was higher than in group 2 (16.71 ± 5.76) and group 3 (17.34 ± 12.23) [p < 0.01]. Ocular group 1 had the highest rate of severe grade Meibomian gland area loss (78.5%), followed by group 2 (21.4%) and the control group (0%), (p < 0.01).

Conclusions: This study objectively demonstrated the MG damage in patients with MMP and highlighted subclinical ocular disease activity in asymptomatic patients with MMP presumed to have no ocular involvement. Based on these findings, it may be advisable to recommend regular ophthalmological evaluations and meibography for MMP patients without obvious ocular symptoms, to detect the early signs of ocular involvement. Early detection could prompt modifications in their systemic therapy, helping to prevent the progression of this potentially blinding disease.

Objective: To explore the population level trends in new incidence of uveitis diagnoses as they relate to seasonal variation across the United States.

Design: Retrospective cross-sectional study.

Subjects: Subjects with uveitis in the TriNetX Research USA "No Date Shift" network between 2016 and 2024.

Methods: Subjects with uveitis as identified by International Classification of Disease -10 encounter diagnoses codes were collected. They were further stratified based on anatomic location (anterior, intermediate, panuveitis, posterior, scleritis, unspecified/systemic) or etiology (infectious, noninfectious, idiopathic). Uveitis diagnosis was calculated as incident cases by season from a baseline ophthalmology patient population and further analyzed using analysis of variation (ANOVA) to isolate significant trends.

Main outcome measures: Incidence and difference between group means of new uveitis diagnosis stratified by season, anatomic, and etiologic classification.

Results: ANOVA post-hoc comparisons between seasons showed no association between all permutations of seasonal variations. When stratified by etiology, infectious uveitis had significantly lower incidence in the spring months compared to summer (Mean -3.75, 95% CI -7.49 to -0.02, p = 0.049).

Conclusions: This study presents a novel observation that infectious uveitis may vary based on season. Prospective studies are needed to verify these observations.

Purpose: To present a rare case of brucellosis with intraretinal abscess formation, highlighting its atypical ocular presentation, diagnostic challenges, and therapeutic response.

Methods: A single case report of a 52-year-old woman with sudden visual loss in the left eye, supported by multimodal imaging and systemic evaluation.

Results: The patient presented with decreased visual acuity and retinal lesions suggestive of inflammatory pathology. Optical coherence tomography (OCT) revealed an intraretinal solid lesion with associated fluid. Despite negative initial serologic screening and Rose-Bengal test, empirical treatment with doxycycline and rifampicin was initiated based on clinical suspicion and Brucella IgG positivity. Over time, visual acuity improved significantly, with radiologic and serologic findings supporting the diagnosis of ocular brucellosis; also, cerebrospinal fluid analysis on day 20 confirmed neurobrucellosis.

Conclusion: This case demonstrates that brucellosis, though rarely affecting the retina, can present as an intraretinal abscess even in the absence of early serologic confirmation. In endemic regions, brucellosis should be considered in the differential diagnosis of atypical retinal lesions. Prompt empirical therapy may prevent permanent visual loss.

Purpose: To determine the epidemiology of sarcoidosis and sarcoid uveitis and the investigations, systemic treatments, and complications of sarcoid uveitis on a population level.

Methods: We performed a retrospective cohort study using the TriNetX United States Collaborative Network to identify cases using the International Classification of Diseases, 10th Revision (ICD-10) codes. We calculated the incidence and prevalence of sarcoidosis in our cohort and uveitis in sarcoidosis patients per 100,000 persons from 2013 to 2025. We assessed the management pathways and the ocular complication rates in sarcoid uveitis patients.

Results: Among 108,597,869 patients, 146,356 had sarcoidosis, and 5,609 had sarcoid uveitis, with mean ages of 62.6 years and 58.8 years, respectively, and female predominance in both cohorts (56.5-60.4%). Most sarcoidosis patients were White (53.4%), while the majority of sarcoid uveitis patients were Black or African American (43.68%). Almost 4% of patients with sarcoidosis developed uveitis within 5 years, and the incidence of uveitis in sarcoidosis patients remained relatively constant, while the prevalence of both sarcoidosis in our cohort and uveitis in sarcoidosis patients increased in our study period. In sarcoid uveitis patients, the most common investigative and treatment modalities were chest X-ray (41%) and glucocorticoids (44%), respectively, and the most common ocular complications within 5 years of sarcoid uveitis diagnosis were cataract (35.7%), glaucoma (30.6%), cystoid macular edema (16.1%), and low vision and blindness (10.2%).

Conclusion: Sarcoidosis prevalence rose over 12 years, but uveitis rates remained stable. One-third of sarcoid uveitis patients developed major ocular complications, highlighting the disease burden.

Purpose: To evaluate the levels of inflammatory factors in tear fluid of patients with Human Leukocyte Antigen (HLA)-B27-associated uveitis, elucidating the underlying immunopathogenic mechanisms and identifying potential biomarkers for therapeutic targeting.

Methods: Eighteen patients with unilateral HLA-B27-associated uveitis and 23 healthy controls were included in the study. Schirmer's strips-based tear fluid was used to measure the levels of Interleukin (IL)-1β, IL-6, IL-17A, IL-10, Tumour Necrosis Factor alpha (TNFα), Matrix Metalloproteinase 9 (MMP9), Intercellular Adhesion Molecule 1 (ICAM1) and Vascular Endothelial Growth Factor-A (VEGF-A) by microfluidic cartridge‑based multiplex ELISA.

Results: Tear fluid levels of IL-17A and MMP9 were significantly elevated in eyes with active uveitis compared to controls (p < 0.01). Additionally, IL-17A level was significantly higher in eyes with multiple uveitis episodes compared to controls (p < 0.05). Distinct inter-cytokine correlations were observed between uveitic and control eyes. Positive correlations observed between IL-17A and MMP9; and MMP9 and TNFα were limited to uveitic eyes. Similarly, positive correlations of ICAM-1 levels with IL-1β, IL-6, IL-17A, TNFα and MMP9 were observed only in eyes with uveitis and not in control eyes.

Conclusion: Elevated levels of IL-17A and MMP9 in patients suggests their central role in mediating inflammatory process and highlights their potential as novel therapeutic targets in the management of HLA-B27-associated uveitis.

Purpose: To describe a rare, PCR-confirmed case of bilateral fibrinous anterior uveitis with hypopyon after primary varicella infection in an immunosuppressed adult, highlighting the value of early testing and antiviral therapy for vision preservation.

Methods: A 24-year-old man, immunosuppressed after bone marrow transplantation for acute myeloblastic leukemia, developed pain, redness, and blurred vision in the left eye two weeks after systemic varicella; the right eye became involved three days later. Both eyes had fibrinous anterior uveitis with hypopyon, elevated intraocular pressure, and early patchy iris atrophy. Aqueous humor real-time PCR confirmed varicella-zoster virus and excluded herpes simplex virus and cytomegalovirus.

Results: Best-corrected visual acuity improved from 20/150 to 20/25 in both eyes. Treatment included intravenous acyclovir for 10 days, intensive topical corticosteroids, cycloplegics, and temporary topical antiglaucoma therapy, followed by oral valacyclovir tapered from 1000 mg twice daily to 500 mg twice daily over eight weeks and continued for six months. Inflammation resolved, intraocular pressures normalized, and bilateral patchy iris atrophy persisted. Fundus examinations remained normal, with no retinal lesions or optic nerve abnormalities on serial examinations.

Conclusion: Sequential bilateral varicella-zoster virus anterior uveitis in adults is exceedingly rare and usually associated with systemic immunosuppression. PCR confirmation, together with elevated intraocular pressure and iris atrophy, supports the diagnosis and underscores the value of early molecular testing. Prompt systemic antiviral therapy with vigilant control of inflammation and intraocular pressure is essential to preserve vision. Long-term follow-up is crucial to detect intraocular pressure elevation or recurrence at an early stage.