Ocular Immunology and Inflammation最新文献

Purpose: To observe the changes in the axial length (AL) in patients of acute retinal necrosis (ARN) undergoing vitrectomy and investigate the correlated factors.

Methods: Retrospective case series. Patients diagnosed as ARN undergoing vitrectomy with silicone oil (SO) tamponade, and with attached retina more than one year after silicone oil removal (SOR) were included. Medical records and AL measured by Zeiss IOLMaster 700 were reviewed before vitrectomy, before SOR, and one year after SOR. Residual retinal index, a parameter reflecting the residual retinal area after vitrectomy was analyzed based on the ultra-wide-field fundus imaging. The AL change (ΔAL) was calculated and clinical factors related to ΔAL were investigated.

Results: In total, 45 eyes from 45 patients were included. The AL at pre-vitrectomy and pre-SOR was 23.84 ± 1.45 and 23.53 ± 1.53 mm among all 45 eyes, with a ΔAL of 0.31 ± 0.62 mm (p < 0.001). Among the 22 eyes with AL measured at one year after SOR, the AL at pre-SOR and one-year post-SOR was 23.82 ± 1.60 and 23.16 ± 0.79 mm, with a ΔAL of 0.67 ± 1.58 mm (p < 0.001). After excluding highly myopic eyes, the ΔAL was 0.31 ± 0.59 mm (n = 42, p < 0.001) between pre-vitrectomy and pre-SOR, and 0.22 ± 0.32 mm (n = 20, p = 0.001) between pre-SOR and one-year post-SOR. Multivariable regression analysis revealed the variable that remained independently associated with ΔAL between pre-SOR and one-year post-SOR was the residual retinal index (β = -0.568, p = 0.006).

Conclusion: For ARN patients undergoing vitrectomy, AL decreased significantly both post-vitrectomy and post-SOR. The refractive shift should be considered before intraocular lens implantation.

Background: Posterior scleritis (PS) is a rare phenotype of scleritis. Comprehensive epidemiological studies on PS in children are limited. We aimed to report on its clinical and imaging features in one of the largest pediatric series to date.

Methods: Retrospective review of medical files.

Results: Included were 12 children (7 girls, mean±SD age at diagnosis 13.75 ± 3.3 years,18 eyes, mean follow-up ±SD of 46.7 ± 45.9 months). All patients presented with eye pain followed by headache. Papillitis was the most common presenting sign (16 eyes, 88.9%). Seven patients (58%) showed laboratory markers of systemic inflammation. One patient had periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA). In 2 other patients, Behҫet disease and inflammatory bowel disease were diagnosed subsequently. Initial echography showed increased posterior scleral thickness (mean±SD 2.9 ± 0.68 mm) with a significant reduction four ± 2 months later (mean±SD 1.85 ± 0.62 mm). Retinal nerve fiber layer (RNFL) was thickened in all examined eyes (mean±SD 136.2 ± 28.4 µm) at presentation and it significantly decreased with treatment (109.8 ± 8.2 µm two months later). In 5 patients (42%), diagnosing PS was prompted by Brain imaging. PS was part of orbital inflammatory syndrome in 4 patients (33.3%). All patients were treated with systemic steroids and 91% required steroid-sparing agent. Adalimumab was added in 2 patients. A chronic course was observed in 63.6%. Remission was achieved in 4 patients. Mean±SD presenting LogMAR VA was 0.23 ± 0.3 with marked improvement to 0.04 ± 0.07 one month later.

Conclusion: Searching for an associated autoinflammatory/autoimmune disease is an important step in patients' triaging. B-scan ultrasound remains the gold standard test. OCT proved to be of practical importance in delineating the magnitude of RNFL thickness and could serve as a potential imaging biomarker of disease activity.

Purpose: This multicenter study aimed to investigate the clinical characteristics and factors associated with specific viral pathogens in patients with acute retinal necrosis (ARN).

Methods: A retrospective multicenter cohort study included ARN patients who underwent aqueous or vitreous polymerase chain reaction (PCR) testing. Multivariable mixed-effects Poisson regression was used to identify factors associated with viral pathogens.

Results: A total of 56 patients (65 eyes) with ARN were included, with a mean age was 39.9 ± 23.2 years. Anterior chamber cell showed significant inflammation in 89.2%, while vitreous haze was present in 100%. Multifocal retinitis was found in 92.3% of cases. Among these, 49.2% had diffuse or confluent patterns, 15.4% were circumferential, and 23.1% showed satellite lesions. Additionally, 18.5% were ameboid or scalloped shape, while 9.2% had wedge shapes. Varicella zoster virus (VZV) was the most common pathogen (30.8%), followed by Herpes simplex virus (HSV) (13.8%), Cytomegalovirus (CMV) (10.8%), Epstein-Barr virus (EBV) (9.2%), and human herpesvirus (HHV) (3.0%). Co-infections were observed in 20% of eyes. CMV-related ARN was significantly associated with wedge-shaped retinitis (aRR 4.19) and immunocompromised host (aRR 8.8). Younger age and optic disc edema (aRR 5.41) were correlated with HSV-related ARN.

Conclusion: VZV was the predominant viral pathogen, with the increasing prevalence of CMV, EBV, and co-infection. Wedge-shaped retinitis and immunocompromised status were notably associated with CMV-related ARN, findings that may guide antiviral therapy decisions in settings where PCR diagnostics are either unavailable or delayed, ultimately improving visual outcomes.

Purpose: To report the clinical presentation and follow-up, including the optical coherence tomography, angiography and electrophysiology of two individuals from the same family presenting with an isolated retinal dystrophy and optic nerve edema who were diagnosed with ROSAH-like syndrome.

Method: Observational case report of a 55-year-old woman and her 36-year-old son with a genetic analysis of ROSAH, after a long-term follow-up.

Results: Both the mother and her son displayed severe optic nerve infiltration and retinal pigment atrophy with intraocular inflammation, which were not improved by immunosuppressive treatment. Systemic investigations were not relevant of a syndromic presentation. Whole exome sequencing revealed the same ALPK1 missense pathogenic variant c.710C>T; p.(Thr237Met) responsible for ROSAH syndrome.

Conclusion: ALPK1 variant responsible for ROSAH syndrome may cause severe retinal dystrophy and an uveitis-like presentation resistant to conventional immunosuppressive drugs, without the systemic symptoms common to the ROSAH syndrome.

Purpose: This study aims to explore the relationship between autoimmune rheumatic diseases (ARDs) and the risk of iridocyclitis (IC) using Mendelian randomization (MR) analysis.

Methods: Data of ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), juvenile idiopathic arthritis (JIA), Behcet's disease (BD), and iridocyclitis were obtained from genome-wide association studies with large sample sizes. The instrumental variable utilized in this study for each exposure was the single nucleotide polymorphism. The inverse-variance weighted (IVW) method, which included random effects, was used to analyze causal effects. In addition, sensitivity analyses were conducted using the weighted median and MR-Egger methods. The presence of pleiotropic effects was identified and addressed through MR pleiotropic effects residual and outlier tests, as well as MR-Egger modeling.

Results: We found a causal effect of AS (IVW, OR = 2.74 × 10²⁹, 95% CI 6.39 × 10⁷ - 1.18 × 10⁵¹, p = 0.008) on IC. Conversely, we also found a causal effect of IC on AS (IVW OR = 1.01, 95% CI 1.00 - 1.01, p < 0.001). Besides, sensitivity analysis showed no evidence of pleiotropy and heterogeneity. However, no causal relationship between SLE, JIA, BD, and IC was detected.

Conclusion: Bilateral causal relationships of IC and AS were identified, which could offer evidence for clinical use and lay the groundwork for detecting potential mechanism behind them.

Purpose: HLA-G is a non-classical HLA class I gene encoding a molecule endowed with immunomodulatory properties, playing important immunosuppressive and tolerogenic roles in immuno-privileged organs. Fluctuations in its expression levels have been correlated with the predisposition to autoinflammatory disorders, notably uveitis, characterized by inflammation of the uvea. In the present work, DNA was obtained from saliva samples of 147 Spanish patients with uveitis, with subsequent analysis focusing on the distribution of polymorphisms within the 3'UTR region of the HLA-G gene (a region known to modulate the expression of the HLA-G molecule).

Methods: Analysis techniques employed included PCR-RFLP or DNA sequencing. Comparative analysis was conducted against a control cohort comprising 117 healthy individuals.

Results: The frequency of the UTR-2 haplotype is increased in patients affected with anterior uveitis (OR (95% CI) 2.35 (1.06-5.21); p = 0.036). Additionally, a higher number of patients with posterior uveitis bearing in homozygosis the G allele of the 3142 C/G SNP (OR (95% CI) 2.67 (1.15-6.20); p = 0.023), was observed. Both markers are associated with diminished HLA-G expression.

Conclusion: These findings present the first evidence of the involvement of polymorphisms within the 3'UTR region of the HLA-G gene in susceptibility to uveitis.

Purpose: To assess the patient barriers to adherence with appointment follow-up in patients with ocular inflammatory disorders across the United States.

Methods: This was a multicenter study of adult and pediatric patients at the Wilmer Eye Institute, University of Texas at Austin, University of Wisconsin-Madison, University of Minnesota, Minneapolis Veterans Administration Hospital, and Washington University of St. Louis. The primary outcome was self-reported adherence to follow-up visits. Secondary outcomes were the reasons for missing follow-up including sub analyses of patient demographics. Eligible patients completed a self-reporting survey to assess barriers to attending follow-up visits.

Results: The survey was fully completed by 210 subjects and partially by 40 (250 in total), of whom were 67% white, 59% female, and 51% had a college or advanced degree. Most patients had bilateral (68%), anterior (51%) uveitis. Patients were treated with topical corticosteroids (33%), immunosuppressive agents (23%), or both (22%). Most patients (79%) did not miss or cancel appointments. Ninety-seven percent of patients had medical insurance and some paid (39%) more than 40 dollars for their copay. Copay costs limited the number of visits patients could attend in 7% of patients. Eight percent of patients missed appointments due to inability to take off time from work and 5% missed visits due to lack of transportation.

Conclusion: Most patients with ocular inflammation reported good adherence to follow-up appointments. Insurance type, copay costs, transportation, patient scheduling, and patient understanding were all minimally reported to effect patient visit attendance.

The aim of this review is to provide an update on both the differential diagnosis of intermediate uveitis (IU) and the special investigations that may be required to determine the underlying etiology of this condition. The authors describe how they identified the relevant publications included in this review and then proceed to outline the possible causes of IU by classifying them into the following categories: Idiopathic, infectious, systemic, genetic/hereditary, drug-induced and masquerades. Thereafter, the special investigations relevant to each cause are discussed individually.

Purpose: To describe a case series of presumed Sympathetic Ophthalmia (SO) triggered by diode laser cyclophotocoagulation (CPC) for the treatment of neovascular glaucoma.

Methods: Patients developing bilateral granulomatous uveitis after CPC between 2014 and 2024. Cases with prior ocular trauma or penetrating ocular surgery were excluded. Treatment consisted of systemic steroids acutely and subsequently steroid-sparing drugs for long-term control.

Results: Three patients were included. The cause of neovascular glaucoma in the inciting eyes was a central retinal vein occlusion. The ocular inflammation was characterised by vitritis, serous retinal detachment, and choroidal thickening. The follow-up for each case was 2, 6 and 10 years, respectively. During this period, all patients remained under constant immunosuppression due to recurrence of inflammation while attempting tapering of systemic therapy after a period of clinical stability. The final best-corrected visual acuity of the sympathising eyes was ≥6/9 Snellen and there was no perception of light in the inciting eyes. The blind eyes were comfortable and did not require surgical removal.

Conclusions: Patients responded well to prompt immunosuppression and preserved vision in the sympathising eye. Steroid-sparing medication could not be stopped due to inflammation flare-ups and risk of visual loss. There could be a potential link between breakdown of the blood-retina barrier prior to the development of SO and sustained inflammatory reaction.

Purpose: To report on the clinical and cytopathological features of metastatic lung adenocarcinoma to the eye masquerading as an intermediate uveitis.

Methods: Retrospective chart review.

Results: A 63-year-old woman with a history of lung adenocarcinoma in remission presented with progressive vision loss and floaters in the right eye. Clinically, her uveitis was classified as a non-granulomatous anterior/intermediate uveitis. Pars plana vitrectomy was performed and cytopathology of the vitreous was unremarkable but directed polymerase chain reaction (PCR) was positive for HSV-1. Despite dual antiviral and antibiotic therapy, her visual acuity and intraocular inflammation progressively worsened prompting repeat vitrectomy with cytopathology revealing metastatic adenocarcinoma.

Conclusion: Intraocular metastatic lung adenocarcinoma can masquerade as an intermediate uveitis, presenting significant diagnostic challenges. Early and repeated cytopathological analysis of vitreous samples is crucial when the diagnosis remains uncertain, as it can lead to timely and accurate identification of metastatic carcinoma, thereby improving patient management and outcomes. This case underscores the diagnostic challenges and clinical complexity of distinguishing intraocular metastatic lung adenocarcinoma from intermediate uveitis.