Ocular Immunology and Inflammation最新文献

Purpose: To report the clinical features and treatment outcomes in adult Caucasians with ocular toxocariasis (OT) and investigate their prognosis depending on their serological status.

Methods: Retrospective observational cohort study (2016-2021) including consecutive adults with uveitis and positive western blot (WB) in the aqueous humor or vitreous. The presence of serum antibodies was not necessary for inclusion, allowing to compare the outcomes depending on the serological status.

Results: Seventeen eyes of 15 patients were included. Mean age at diagnosis was 51.9 years. Vitreous inflammation was the most frequent sign (100%). Vitreoretinal tractions (41.2%) and chorioretinal granulomas (58.8%) were less prevalent. Atypical features were: spontaneous intravitreal hemorrhage (23.5%), exudative retinal detachment (11.8%), isolated macular edema (17.6%), papillitis (29.4%) and vasculitis (47.1%). Twenty percent of patients had a positive serum serology. Baseline clinical features did not differ statistically depending on the serological status; however, the degree of inflammation was numerically higher in patients with negative serology. Overall, macular thickness, anterior and posterior segment inflammation improved significantly after treatment with oral albendazole, systemic ± local corticosteroids. Vitrectomy (47.1%) was performed in case of persistent vitritis (62.5%), retinal detachment (12.5%) and intravitreous hemorrhage (25%).

Conclusion: OT has no pathognomonic sign and atypical presentations were not infrequent in this adult Caucasian cohort. Serum antibodies were rarely positive, stressing on the importance of ocular sample analysis, especially in case of atypical features. Serum antibodies may prove useful in forecasting the rapidity of inflammation clearance. Antiparasitic and anti-inflammatory treatment was safe and efficient in most cases.

Purpose: To report the trends of immunosuppressive drug use for non-infectious uveitis and explore their relationship with industry payments.

Methods: A retrospective review of ophthalmologists reimbursed by Medicare for the administration of adalimumab (ADA), repository corticotropin (RCI), methotrexate (MTX), and mycophenolate mofetil (MMF) between 2014 and 2018.

Results: A total of 316 ophthalmologists were reimbursed by Medicare for 1567 ADA, 465 RCI, 1752 MTX, and 12 333 MMF administrations. The number and dollar amount of industry payments were positively associated with ADA and RCI use (P < 0.001). From 2014 to 2018, there was a positive trend in the proportion of ADA (P = 0.007) and RCI (P = 0.007) used and negative trend in the proportion of MMF (P = 0.025) used.

Conclusion: From 2014 to 2018, the use of ADA and RCI increased while MMF decreased and MTX remained stable. There was a positive association between ADA and RCI use and physician-industry interactions. A causal relationship is not determined.

Purpose: To evaluate the efficacy and safety of switching from adalimumab originator (Humira, AbbVie) to SB5, adalimumab biosimilar (Adalloce, Samsung Bioepis) in patients with noninfectious uveitis (NIU).

Methods: Fifteen patients (29 eyes) with NIU who were switched from adalimumab originator to SB5 and followed up for 6 months or longer were retrospectively included. Data consisted of best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), anterior chamber (AC) cell grade, anterior vitreous (AV) cell grade, vitreous haze grade, central macular thickness (CMT, μm), and macular volume (MV, mm³) at pre-switching, 2, 4, and 6 months post-switching.

Results: There were no significant differences in BCVA, AC and AV cell grades, and vitreous haze grades at 2, 4, and 6 months post- compared with pre-switching, and no significant differences in CMT and MV at 2 and 6 months post-switching. CMT and MV decreased from 260.55 ± 67.44 μm and 8.37 ± 1.14 mm³ at pre-switching to 244.14 ± 60.31 μm (p = 0.032) and 8.11 ± 1.20 mm³ (p = 0.027) at 4 months post-switching, respectively. There was no recurrence of uveitis, as defined by AC cell grade, vitreous haze, or BCVA. Four patients (27%) were switched back to adalimumab originator after a mean of 9 weeks, due to discomfort during the injection (three patients) and technical difficulty with the new injection device (one patient). No other adverse events occurred after switching to SB5.

Conclusion: Switching from adalimumab originator to SB5 for NIU does not result in clinically significant differences in treatment efficacy and safety.

Purpose: To investigate the causal association between gut microbiota and allergic conjunctivitis.

Methods: A two-sample Mendelian randomization (MR) analysis was performed using the summary statistics of gut microbiota (18,340) from MiBio-Gen consortium and allergic conjunctivitis data (n = 218,792) obtained from the IEU Open GWAS project. F-statistics and sensitivity analyses were used to address potential biases and ensure the reliability of our findings. Reverse MR analysis was conducted to assess the possible of reverse causal relationships.

Results: The inverse variance weighted estimates revealed the protective potential of the phylum Euryarchaeota against allergic conjunctivitis (OR = 0.87, p = 6.17 × 10^-4). On the other hand, the genus Christensenellaceae R.7 group (OR = 0.75, p = 2.89 × 10^-3), family Peptostreptococcaceae (OR = 0.83, p = 6.22 × 10^-3), genus Lachnospiraceae FCS020 group (OR = 0.82, p = 0.02) all showed a suggestive protective association with allergic conjunctivitis. Additionally, sensitivity analysis confirmed the robustness of the above associations. In the reverse MR analysis, no significant causal association was found between gut microbiota and allergic conjunctivitis.

Conclusion: This study has revealed a potential causal correlation between the phylum Euryarchaeota and allergic conjunctivitis, offering new insights to improve prevention and treatment of this condition.

In response to Dr. Kasperkiewicz's commentary on our meta-analysis conducted by Bocanegra-Oyola et al., we fully agree with refining diagnostic processes for ocular pemphigoid, particularly in differentiating it from pseudopemphigoid. We concur that relying solely on clinical findings may result in misdiagnoses. Confirming the diagnosis via biopsy can be challenging, requiring multiple biopsies in some patients, and should always be supported by a multidisciplinary clinical assessment involving ophthalmologists and dermatologists.

Purpose: To report the clinical course of two cases of acute retinal necrosis (ARN) caused by varicella zoster virus (VZV) and cytomegalovirus (CMV) co-infection detected by polymerase chain reaction (PCR) on aqueous tap.

Methods: Observational case reports.

Results: Two patients presented to our services with unilateral panuveitis suggestive of ARN complicated by hemorrhagic vasculitis and started empirical therapy. Aqueous PCR was performed on the same day and showed double positivity for VZV and CMV, which guided treatment. At follow-up, wide-field color fundus imaging and high-resolution optical coherence tomography showed resolution of active retinitis.

Conclusion: Our cases suggest that ARN complicated by hemorrhagic vasculitis may be secondary to CMV and VZV co-infection, both in patients with an unremarkable clinical history and in those with immunodeficiency. In our cases, aqueous PCR testing was of paramount importance to determine the aetiology of ARN and to adjust the antiviral therapy accordingly.

Purpose: Orbital/periorbital tuberculosis (TB) is an uncommon manifestation of extrapulmonary TB, presenting diagnostic challenges due to its varied clinical features that can mimic other diseases. This report aims to present a rare case of periorbital TB in a young man.

Methods: Case report.

Results: A 36-year-old man presented with painless left periorbital swelling and discharge following facial trauma. Despite initial treatment with antibiotics elsewhere, symptoms persisted. Imaging revealed a periorbital abscess with adjacent bone involvement. Microbiologic studies demonstrated Mycobacterium tuberculosis complex growth, confirming TB. There was no evidence of systemic TB. The patient received anti-tuberculosis therapy. At the 8-month follow-up, he remained symptom-free.

Conclusion: Orbital/periorbital TB, although rare, should be taken into consideration in regions with high TB prevalence when dealing with chronic, non-resolving periorbital lesions. Advanced imaging and molecular diagnostics play crucial roles in confirming the diagnosis, especially given the low sensitivity of traditional culture methods for extrapulmonary TB.

Purpose: Purtscher-like retinopathy is a rare microvascular occlusive disease that has been reported in few literature especially in pediatric patients. The ocular manifestation is associated with various systemic disorders, though its distinct pathophysiology and appropriate therapies remain unclear. This research presents three cases of Purtscher-like retinopathy secondary to febrile illnesses in pediatric patients.

Methods: Medical history and clinical findings were retrospectively collected.

Results: We report a series of three pediatric patients (age range, 7-13 years) who developed Purtscher-like retinopathy, secondary to febrile illnesses, including systemic juvenile idiopathic arthritis, thrombotic microangiopathy, and COVID-19 infection. All patients received steroidal therapy to control underlying conditions and ocular disease, with visual improvement in different degrees.

Conclusions: Clinician awareness of Purtscher-like retinopathy is crucial for the prompt diagnosis and treatment of pediatric patients with protracted high fevers and febrile viral illnesses.