Ocular Immunology and Inflammation最新文献

Purpose: To present a case of retinal toxicity following intravitreal clindamycin injection in a patient with toxoplasma retinochoroiditis and to review the relevant literature.

Methods: A single case was evaluated, documented, and described.

Results: A 41-year-old woman with reactivated Toxoplasma retinochoroiditis in her right eye received intravitreal clindamycin (1 mg/0.1 mL) and dexamethasone (0.4 mg/0.1 mL). Regrettably, her visual acuity declined to hand motion one day post-injection. Fundus examination revealed extensive macular necrosis with retinal vascular occlusion, suggestive of retinal infarction. Despite high dose systemic steroid therapy, her condition progressed to macular atrophy and severe vision loss.

Conclusion: Macular infarction is a rare but devastating complication of intravitreal clindamycin injection. This risk should always be considered when intravitreal therapy is planned for the treatment of ocular toxoplasmosis.

Purpose: To report the clinical presentations and outcome of ocular tuberculosis (OTB) in an Egyptian cohort.

Methods: The medical records of 42 consecutive patients with presumed ocular tuberculosis referred to a tertiary referral center in Alexandria, Egypt, were reviewed retrospectively.

Results: Sixty-seven eyes of 42 patients were included in the study. The most common clinical presentation was anterior and intermediate uveitis in 25 eyes (37.3%), followed by anterior uveitis in 14 eyes (20.9%), intermediate uveitis in 11 eyes (16.4%), panuveitis in 10 eyes (14.7%), scleritis and sclerouveitis in 4 eyes (5.8%), and posterior uveitis in 3 eyes (4.5%). Nearly half of the patients, 20 patients (47.6%), were treated with combined ATT and oral corticosteroids; 8 patients (19%) received ATT alone; 6 patients (14.3%) were treated with oral corticosteroids only; and 11 patients (19.1%) were started on systemic immunosuppressants after initiation of ATT. Periocular corticosteroids were required in 14 patients (33.3%) and intravitreal Ozurdex injections in 6 patients (14.3%) to control intraocular inflammation and cystoid macular edema. The most commonly reported ocular complications of tubercular uveitis were posterior synechiae, followed by cystoid macular edema, cataract, and ocular hypertension.

Conclusion: Ocular tuberculosis should be considered in cases of recurrent or treatment-resistant uveitis, even in patients without systemic Tb manifestation and with normal chest imaging. In our cohort, anterior and intermediate uveitis were the most common presentations. Most cases were treated with antituberculous treatment whether alone or combined with oral corticosteroids for optimal disease control.

The article provides valuable insight on presentation and management of isolated anterior uveitis and with vitritis following intravitreal (IVT) faricimab. We highlight additional points. First sterile intraocular inflammation (IOI) onset ranges from 1-35 days; however, two patterns have been described: acute onset within 5 days and delayed onset at approximately 14 days following a mean of four IVT injections, although it may occur after the first. Sterile IOI may be recognised by delayed onset, suggestive of a type IV hypersensitivity reaction rather than infectious causes and by absence of hypopyon, although may present in severe cases. Second, faricimab's dual inhibition may alter ocular immune surveillance, potentially facilitating herpes simplex virus reactivation. Increased vigilance for dendritic ulcers is therefore warranted, and antiviral therapy should be initiated prior to corticosteroids. Finally, management should be guided by severity, with anterior or vitreous tap considered to exclude exogenous endophthalmitis. Resolution typically occurs within 15 days.

Purpose: To report the case of an adult male patient with chronic lymphocytic leukemia (CLL) under treatment with ibrutinib who developed bilateral anterior uveitis and cystoid macular edema associated with the drug, and to compare this presentation with previously published cases.

Case description: A 60-year-old male with a 7-year history of CLL treated with ibrutinib presented to the ophthalmology service with a one-week history of subjective decrease in visual acuity in the right eye, without other associated symptoms. On examination, best corrected visual acuity was 20/60 in the right eye and 20/25-2 in the left eye. Slit-lamp evaluation revealed +0.5 anterior chamber cells in both eyes and a dyscoria in the right eye secondary to posterior synechiae. Fundus examination of the right eye demonstrated elevation of the macula. Optical coherence tomography (OCT) of the macula revealed cystoid macular edema in the right eye, with a central retinal thickness of 528µm. After discussion with the treating oncologist, ibrutinib therapy was continued. The patient was managed with tapering topical corticosteroids, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and mydriatic agents, achieving a favorable clinical response with resolution of the inflammation.

Conclusion: This case underscores the importance of recognizing ocular adverse effects associated with ibrutinib therapy. Increased awareness among clinicians may facilitate early diagnosis and timely intervention, thereby improving the visual prognosis of affected patients. Early ophthalmologic evaluation should be considered in individuals receiving ibrutinib who develop visual symptoms.

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.

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.

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.

Purpose: Intermediate uveitis (IU) can occur secondary to systemic autoinflammatory disorders, such as juvenile idiopathic arthritis and multiple sclerosis. In contrast, pars planitis (PP) specifically refers to an idiopathic form of IU, characterized by the absence of any identifiable underlying systemic condition. The frequency of the association between PP and CNS demyelination is unknown in children.

Methods: A retrospective analysis of paediatric PP patients' clinical and brain magnetic resonance imaging (MRI) data was conducted to investigate the coexistence of PP and CNS demyelinating pathologies in children.

Results: The cohort comprised 65 paediatric patients with PP, mean age 13.25 ± 3.1, (range 6-18, median 13) years, 41.5% female, who had at least one brain MRI. The mean follow-up was 4.02 ± 2.76 (range 0.5-11, median 4) years. Demyelinating lesions on MRI were visible in 5/65 (7.7%) patients. None reported neurological symptoms nor had abnormal findings on neurological examination. Three patients who had been undergoing adalimumab (ADA) treatment for a period of between three months and four years had their ADA therapy stopped when a demyelinating lesion was observed on MRI. Additionally, mycophenolate mofetil or methotrexate treatment was maintained as a maintenance therapy. The other two patients had not received any immunomodulatory treatment when demyelinating lesions were identified, and MRI findings were taken into consideration when treatment was planned.

Conclusions: Demyelinating lesions of the CNS can be detected in paediatric PP patients at a rate similar to adults. Clinicians should be aware of the presence of silent demyelination in PP and plan the anti-inflammatory treatment accordingly.