Ocular Immunology and Inflammation最新文献

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.

Purpose: To describe a stress-related choroidopathy presenting as bilateral subretinal fluid (SRF) and choroidal hypoperfusion after a traffic accident without direct ocular injury, with rapid recovery following vasodilator therapy.

Methods: Retrospective case report with multimodal imaging, including color fundus, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and clinical course.

Results: A 48-year-old man experienced profound bilateral visual loss after head and facial trauma. The initial diagnosis made at an outside hospital was "bilateral optic nerve injury." On presentation at our clinic, OCT revealed substantial macular SRF in both eyes (OU) while fluorescein angiography (FA) was unremarkable. ICGA demonstrated mid- to late-phase patchy hypofluorescence corresponding to the areas of SRF. The patient was treated with intravenous alprostadil (prostaglandin E1, 5 µg daily) plus subcutaneous compound anisodine (0.2 mg daily). SRF resolved in the right eye (OD) by day 1 and in the left eye (OS) by day 3. By week 3, best-corrected visual acuity (BCVA) improved to 0.9 OD and 0.8 OS; ICGA hypofluorescence resolved; OCTA demonstrated qualitative increases in choroidal vessel volume (CVV), choroidal stromal volume (CSV), and choroidal thickness.

Conclusions: We propose Stress Vasoreactivity Chorioretinopathy (SVC)-a transient, sympathetic-mediated choroidal vasoconstriction causing segmental hypoperfusion, secondary retinal pigment epithelium (RPE) pump failure, and SRF. In post-traumatic visual loss without ocular impact, early multimodal imaging and vasodilator therapy may expedite recovery.

Purpose: To describe the diagnostic and therapeutic management of a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) presenting with unilateral bacillary layer detachment (BALAD) in a young Caucasian woman.

Methods: Case report.

Results: A 29-year-old female patient presented with bilateral fine keratic precipitates (KPs) and anterior chamber cells, along with a yellowish plaque-like macular lesion in the right eye. Multimodal imaging (MMI) was performed, including color fundus photography, optical coherence tomography (OCT), OCT angiography (OCT-A), fundus autofluorescence (FAF), fluorescein angiography (FA), and indocyanine green angiography (ICGA). MMI revealed a unilateral BALAD with bilateral choroidal involvement. Serologic testing for infectious diseases was negative, and biochemical blood tests were unremarkable.Based on the clinical findings, MMI features, and laboratory results, a diagnosis of APMPPE was established. The patient was successfully treated with systemic corticosteroid therapy, achieving sustained quiescence during long-term follow-up and partial restoration of the ischemic lesions.

Conclusion: BALAD is an OCT finding that can be associated with various underlying etiology. A thorough review of the patient's history and symptoms, along with comprehensive MMI, is essential to establish the correct diagnosis and non-invasively monitor disease remission during follow-up.

Purpose: Anterior Segment Optical Coherence Tomography (AS-OCT) can assess anterior chamber's (AC) changes. This study aims to describe AC changes in eyes with endophthalmitis using AS-OCT.

Methods: Electronic patient records, slit lamp photography and anterior segment infrared imaging were reviewed in this retrospective single-center cohort study and correlated to swept-source AS-OCT scans of eyes with endophthalmitis.

Results: Fourteen eyes of 14 patients with postoperative (n = 6 after cataract surgery; n = 6 after anti-VGEF-injection) and endogenous (n = 2) endophthalmitis were included. The visual acuity was light perception (n = 3), hand movement (n = 7) and ≥1.30 LogMar (n = 4). On slit lamp examination, hypopyon (n = 13) and fibrin (n = 5) were seen. AS-OCT detected hypopyon (n = 13) and fibrin formations (n = 10); hypopyon appeared as a hyperreflective level at the bottom of the AC and showed a hyperreflective lamellar prolongation on the corneal endothelium. Fibrin had the shape of hyperreflective filaments and presented in four patterns: single-stranded, stork-nest-like, cloth-like, or with a mixed phenotype.

Conclusion: AS-OCT imaging may visualize inflammatory activity of the AC in endophthalmitis and enable a morphological characterization of fibrin formation. Characteristic findings are also seen in cases with reduced corneal transparency.

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 assess the duration, reversibility, alterations and prognosis of ocular adverse events (AEs) in participants treated with bemarituzumab, a first-in-class FGFR2b-targeted inhibitor in FGFR2b-overexpressing gastric/gastroesophageal junction cancer (G/GEJC), and to propose early intervention management strategy.

Methods: This was a prospective, observational study of 11 participants with FGFR2b-overexpressing G/GEJC treated with bemarituzumab. All participants received ocular evaluations at baseline, and subsequent 6-week intervals. Evaluations included best-corrected visual acuity (BCVA), dry eye examinations, corneal morphology analysis, and fundus photography.

Results: 11 participants occurred ocular AEs, 8 participants finished the study. BCVA loss was first detected on day 131.5 ± 40.2 post-baseline (6.6 ± 2.5 doses following the initial bemarituzumab administration), with a loss of 2.1 ± 0.7 lines. Ocular Surface Disease Index (OSDI) scores increased (55.1 ± 18.1) at week 18. Corneal alterations manifested as punctate epitheliopathy, arc-shaped corneal defects, and ulcerative keratitis. In vivo confocal microscopy (IVCM) demonstrated features of corneal dysmaturation, including intraepithelial microcysts and abnormally thickened, cord-like structures within the basement membrane layer. After 134.1 ± 55.0 days of administering topical eye drops, the BCVA, dry eye and corneal epithelial alterations returned to baseline levels. Prophylactic administration of FGF-based eye drops helped prevent bemarituzumab treatment discontinuation, alleviated drug-related ocular symptoms, and improved prognosis.

Conclusions: The ocular AEs occurred frequently in patients receiving bemarituzumab, requiring close ophthalmic monitoring and prophylactic administration of FGF-based eye drops. Collaboration between oncologists and ophthalmologists is critical for the timely management of treatment-related AEs, which could ultimately improve overall clinical outcomes.

Pediatric uveitis is a leading cause of visual impairment, often resulting in severe complications without timely and appropriate intervention. Its etiology varies geographically, necessitating a comprehensive epidemiological assessment. To identify prevalent causes of pediatric uveitis, assess geographic variations, and evaluate demographic patterns. A systematic search of PubMed, Scopus, Web of Science, and CENTRAL was conducted for studies published between 2005 and 2025. Retrospective cohort and cross-sectional studies reporting pediatric uveitis etiology were included. Data were pooled using a random-effects model, with heterogeneity assessed via I² statistics. Out of a total of 8,974 studies initially considered, only 30 met the criteria for inclusion. Idiopathic uveitis was the most common diagnosis (39.71%, 95% CI: 32.02-47.94%). Juvenile idiopathic arthritis (JIA)-associated uveitis was most prevalent (15.59%, 95% CI: 11.92-20.14%) of all cases and was the leading defined non-infectious cause, Behçet's disease (4.8%) and Vogt-Koyanagi-Harada disease (3.63%) of all cases. Infectious uveitis was dominated by toxoplasmosis (7.24%), tuberculosis (4.43%), and toxocariasis (3.02%) infections of all cases. Significant geographic disparities were observed, with JIA more prevalent in high-income countries and infectious uveitis more common in lower-resource regions. Pediatric uveitis presents substantial regional variability, with idiopathic cases being generally predominant. Enhanced diagnostic tools and multidisciplinary management are essential for early detection and improved outcomes. Standardizing diagnostic criteria can help reduce the burden of pediatric uveitis worldwide.

Dry eye disease (DED), a multifactorial disorder characterized by tear film instability and ocular surface inflammation, remains a therapeutic challenge due to its complex immunopathogenesis. Emerging evidence highlights dendritic cells (DCs), including conventional (cDCs) and plasmacytoid subsets (pDCs), as pivotal mediators bridging innate and adaptive immune responses in DED. This review delineates the mechanisms by which DCs drive DED progression. Hyperosmolar stress, apoptotic debris, and goblet cell dysfunction activate DCs, promoting their migration to draining lymph nodes and subsequent priming of Th1/Th17 cells, which perpetuate lacrimal gland inflammation and ocular surface damage. Functional alterations in DCs that exacerbate neural-immune crosstalk include upregulated TLR7/9, STING, and S100A8/A9 pathways, and enhanced pro-inflammatory cytokine production including IL-12, IFN-I, and IL-23. Clinically, in vivo confocal microscopy reveals elevated corneal DCs density and activation, which correlate with symptom severity, tear break-up time, and corneal nerve abnormalities, underscoring their potential as diagnostic and prognostic biomarkers. Therapeutic strategies targeting DCs include reducing DCs density and activation (e.g. netrin-1, mesenchymal stem cell-derived extracellular vesicles), modulating inflammatory cytokine production (e.g. thrombospondin-1, mesenchymal stem cell, and butyrate), and regulating DCs-T cells interactions (e.g. neurokinin-1 antagonists, CD40/CD40L blockade), which offer novel avenues for immune regulation.

Purpose: This study aimed to investigate anterior scleral stromal thickness (AST) in patients with rheumatoid arthritis (RA) and primary Sjögren's Syndrome (SjS) compared with healthy controls and to explore its relationship with disease duration.

Methods: The study included 156 participants: 58 with RA, 42 with SjS and 56 healthy controls. The majority of participants were women (n = 130), with a mean age of 51.1 ± 9.38 years. All patients were receiving immunosuppressive therapy and had no history of scleritis. AST and conjunctiva-tenon-episcleral complex thickness (CTEC) were measured using anterior segment OCT at distances of 0, 1, 2 and 3 mm from the scleral spur in the medial-inferior-lateral-superior quadrants. Statistical analyses, including group comparisons and correlation analyses, were performed to assess intergroup differences and associations with disease duration.

Results: The proportion of women was significantly higher and the disease duration was significantly shorter in the SjS group. Compared with controls, the RA group showed significantly thinner medial CTEC at 1, 2, and 3 mm from the scleral spur, whereas inferior AST at the scleral spur was thicker. No significant differences in AST or CTEC parameters were observed in the SjS group relative to controls.

Discussion: RA is associated with localized alterations in anterior scleral morphology, while SjS does not appear to significantly affect these parameters. These findings may reflect the impact of timely diagnosisand effective immunosuppressive therapy in limiting ocular tissue involvement. However, the absence of a standardized anatomical reference point for scleral thickness measurements complicates direct comparison among scientific studies.