Ocular Immunology and Inflammation最新文献

Introduction: Biologic agents targeting interleukin-6 (IL-6) have gained attention as a promising treatment option for non-infectious uveitis (NIU) cases resistant to first-line therapies. IL-6 plays a pivotal role in the pathogenesis of uveitic conditions and its complications (i.e. macular edema and neovscularization). This review aims to assess the therapeutic potential of IL-6 inhibitors in managing NIU, especially focused in clinical outcomes, such as visual acuity and macular edema.

Methods: Narrative review of studies evaluating the efficacy of IL-6 inhibitors in patients with NIU. Parameters assessed include control of inflammation, corticosteroid-sparing effects, visual acuity improvement, and reduction of macular edema.

Results: IL-6 inhibitors have demonstrated efficacy in controlling inflammation in 34% to 88% of cases and reducing corticosteroid dependence in approximately 55% of patients. Complete remission rates have been reported between 60% and 70%, with improvement in macular edema observed in 35.8% to 100% of cases. These results suggest that IL-6 inhibitors could be a therapeutic alternative for managing difficult cases of NIU.

Conclusions: IL-6 inhibitors, including Tocilizumab and Sarilumab, have shown efficacy in controlling inflammation, improving visual outcomes, and reducing corticosteroid dependence in NIU. However, despite these promising results, further studies are needed to establish their long-term efficacy and safety. These therapies hold great potential for the future management of patients with uveitis.

Purpose: To report a case of possible multiple evanescent white dot syndrome secondary (MEWDS) to acute retinal pigment epitheliitis (ARPE).

Methods: Case report.

Results: A 16-year-old female presented to the ophthalmology emergency department with a 5-day history of blurred vision in the left eye (OS). Initial examination revealed a visual acuity (VA) of 89 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS)(-0.08 logMAR) chart in the right eye (OD) and 53 letters(0.64 logMAR) in the OS. Anterior segment biomicroscopy was normal, with no evidence of inflammation in the anterior chamber. Evaluation of the posterior pole revealed an alteration in the retinal pigment epithelium (RPE) in the OS. Optical coherence tomography (OCT) at the macular level showed disruption at the external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and the RPE-Bruch's membrane (RPE-Bm) complex. Fundus autofluorescence (FAF) demonstrated hypofluorescent areas in the peripapillary region. No treatment was indicated. After two weeks, there was an improvement in VA, with 90 ETDRS letters(-0.1 logMAR) in the OD and 85 letters(0.0 logMAR) in the OS, as well as improvement in the OCT at the level of the ELM and EZ. However, a marked increase in white spots was observed throughout the posterior pole. By 5-months post-onset, a complete resolution of retinal alterations was observed in both OCT and FAF.

Conclusion: ARPE and MEWDS exhibit overlapping clinical features, which can sometimes complicate differentiation. This case is consistent with MEWDS secondary to ARPE, although an atypical presentation of MEWDS cannot be ruled out.

Purpose: Birdshot uveitis is a rare ophthalmic condition that can be challenging to control. The readability of online patient resources may impact the management of patients with birdshot. Thus, we examined the readability of online patient resources and identified differences in readability among sources and sections of websites.

Methods: We queried 3 search engines (Google, Yahoo, Bing) for search results based on a series of terms related to birdshot uveitis. One hundred and twenty results were retrieved and 17 articles were assessed for readability analysis using validated readability and grade-level metrics. Articles were scored based on their entire textual content and, when feasible, also based on sections (e.g. background, diagnosis, treatment). Statistical analyses were conducted using ANOVA and Tukey's honestly significant difference.

Results: The websites analyzed were from hospitals and academic centers (5), private practices (3), patient advocacy organizations (4), and other non-profits (5). On average, online patient resources are too difficult to read according to readability scores and grade levels ranging from late high school to college graduate. Articles written by non-profits other than advocacy organizations had an average of 6.5% more complex words than articles written by hospitals and academic centers (p < 0.05). Multiple metrics revealed that the treatment sections were less readable than the causes and symptoms sections.

Conclusion: The readability of online patient resources for birdshot far exceeds reading levels recommended by the AMA, NIH, and patient safety organizations. Efforts should be made to improve the readability of patient education materials and patient understanding of their disease.

Purpose: Patients with Crohn's disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease.

Methods: In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities.

Results: Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48-2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15-1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89-2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31-1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29-1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33-1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65-2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37-1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11-2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14-1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18-1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22-1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37-1.71, p < 0.001).

Conclusions: Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement.

Purpose: To estimate the number of ocular syphilis (OS) cases diagnosed in a tertiary care centre in Portugal, correlate with increasing syphilis diagnoses and characterize the OS population.

Materials and methods: Retrospective, observational, single-center study that included patients diagnosed with OS between 2015 and 2023 at the local health unit of Coimbra. Demographic data were collected, and a complete ophthalmological examination was performed with multimodal imaging acquisition. Data on syphilis reports from the National System of Epidemiologic Surveillance were correlated with OS data.

Results: Fifty-four patients with OS were observed; mean age was 54.17 ± 14.46 years, 38 (70.37%) were male and 18 (47.37%) men who have sex with men. The proportion of OS in syphilis patients per year ranged from 0% to 10.34%. One-quarter were co-infected with HIV. Forty-nine patients (91.84%) complained of decreased visual acuity on presentation. Twenty-two (40.74%) had systemic findings (mostly skin rash). Two-thirds had bilateral disease and half presented with anterior segment involvement. Eighty-five percent had posterior segment involvement, mostly placoid chorioretinitis. Forty-one percent had optic nerve involvement. All patients were admitted and underwent 2-week treatment with intravenous penicillin. Visual acuity improved from logMAR 0.70 to logMAR 0.26 (p < 0.001).

Conclusions: Ocular syphilis is a heterogeneous disease with a wide range of presentations. The incidence is on the rise and therefore OS must be considered in every patient with anterior and posterior uveitis, panuveitis and optic neuritis, with or without systemic manifestations.

Purpose: To describe a rare case of posterior scleritis associated with late-onset Takayasu arteritis.

Methods: A case report of a 75-year-old female presenting with posterior scleritis, eventually diagnosed with late-onset Takayasu arteritis was described. Several medical evaluation visits were conducted, including ophthalmological and rheumatological follow-up. Multiple diagnostic tests were carried out, and the cornerstones of the treatment were corticosteroids and the IL-6 inhibitor tocilizumab.

Results: The patient was admitted to our hospital's emergency room with right unilateral eyelid edema, chemosis and red eye. She had previously experienced two episodes that were misdiagnosed as preseptal cellulitis. The presence of choroidal folds and the T sign on the ultrasound exam were highly suggestive of posterior scleritis. Later, the patient was diagnosed with Takayasu arteritis, a type of large vessel vasculitis. Treatment with steroids was started, which was later switched to IL-6 inhibitors to achieve better control of the systemic disease.

Conclusion: Posterior scleritis is often misdiagnosed, necessitating high clinical suspicion. Multimodal diagnosis is important to establish an accurate diagnosis. Up to 34% of cases may be associated with a systemic disease. This is the first case described in the literature of posterior scleritis associated with late-onset Takayasu arteritis.

Purpose: To report a case of asymmetric melanoma-associated retinopathy (MAR) associated with metastatic melanoma which was thought to be in remission for 6 years. Identification of MAR led to the discovery of recurrent malignancy.

Method: A man in his 60s presented with monocular visual disturbances with a large relative afferent pupillary defect, rapidly progressing visual field defect and otherwise normal eye examination. Initial work-up for retrobulbar optic neuropathy was inconclusive. After a few months, similar symptoms developed in his fellow eye and a full-field electroretinogram revealed a reduced b:a wave ratio suspicious for MAR.

Results: Visual field defects were present in both eyes at initial examination, but the visual field of one eye progressed rapidly while the fellow eye did not develop symptoms or progress until roughly 3 months later. Visual field defects and symptoms improved following resection of the lymph node with active metastatic disease and serum plasmapheresis.

Conclusion: This report highlights a case of MAR with asymmetric objective findings and progression of visual field defects. It also demonstrates the success of plasmapheresis, in combination with treating recurrent metastatic disease, in improving visual function.

Purpose: To assess the effectiveness and risk of intravitreal injection of dexamethasone implants in treating macular edema (ME) secondary to acute retinal necrosis (ARN).

Methods: In this retrospective, noncomparative case series study, five patients who developed secondary ME after ARN and received an intravitreal dexamethasone implant injection were enrolled. The features of secondary ME on OCT and the outcomes of dexamethasone intravitreal implanting were presented.

Results: The mean age of the patients was 59 years (range, 51-61 years). All patients had unilateral involvement, and all 5 eyes showed mild to moderate anterior uveitis, retinal necrosis, and vasculitis. Herpes zoster virus was detected in all eyes using PCR, and timely antiviral and anti-inflammatory treatment was performed. Aqueous humor samples were negative for herpes zoster virus DNA, and resolution of viral retinitis was noted upon the occurrence of ME. Additionally, three eyes received pars plana vitrectomy with silicone oil prior to ME development. All eyes presented with intraretinal fluid, hyper-reflective foci, and impairments of the external limiting membrane/ellipsoid zone at varying degrees on OCT images. Epiretinal membrane was exhibited in 80% of eyes, but no vitreoretinal traction was detected. Subretinal fluid was visible in 60% of eyes. ME was relieved effectively in all eyes after intravitreal dexamethasone implanting. One of these patients experienced three episodes of ME. No recurrence of retinal necrosis or corticosteroid-associated ocular hypertension was observed during the follow-up period.

Conclusion: Intravitreal injection of dexamethasone implants can effectively alleviate ME secondary to ARN and improve visual acuity with no adverse reactions.

Purpose: To outline the therapeutic approach for a rare case of Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP) and examine the current management recommendations of this uncommon condition.

Methods-results: Literature review on the current treatment options in BDUMP cases. An 82-year-old woman was referred to our clinic due to bilateral visual loss. She was treated elsewhere with anti-vascular endothelial growth factors (anti-VEGF) in both eyes for presumed choroidal neovascularization (CNV) without improvement. Her past medical history (PMH) entailed colon cancer, treated with surgical resection and adjuvant chemotherapy 15 years ago. The patient presented with low visual acuity in both eyes, multiple oval orange patches in the fundus with striking hyperfluorescent pattern in fluorescein angiography (FA), giraffe pattern in fundus autofluorescence (FAF) and rapidly progressive cataracts. Intravitreal dexamethasone implants were administered with mild improvement and subretinal fluid absorption.

Conclusions: The management strategy in BDUMP should focus on the systemic, often occult malignancy. There is no standard treatment protocol for BDUMP; however, plasmapheresis in combination with primary malignancy treatment seems to yield promising results in current literature reports. Anti-VEGF injections failed to control BDUMP sequelae, however intravitreal dexamethasone implants may offer temporary relief.

Purpose: While substantial research has focused on systemic immunomodulatory therapy for ocular cicatricial pemphigoid (OCP), limited data exist on managing associated ocular surface disease (OSD). This study evaluates treatments for OCP-related OSD at our institution.

Methods: We conducted a retrospective analysis of patients diagnosed with cicatrizing conjunctivitis at the University of Colorado Hospital from January 1, 2013, to October 31, 2023. Patients with cicatrizing conjunctivitis due to non-OCP conditions were excluded, and disease severity was classified using the Foster Staging System.

Results: Our review included 30 patients with OCP, all with at least six months of follow-up. The mean age of symptom onset (n = 19) was 62.2 years (SD = 16.4), while the mean age at diagnosis (n = 28) was 65.1 years (SD = 12.7). The most common OSD treatments at the last visit were preservative-free artificial tears (87%), topical corticosteroids (43%), autologous serum eye drops (40%), topical antibiotics (30%), and topical immunomodulators (23%). All patients used at least one treatment, with 83.3% on prescription therapies. Patients averaged 3.33 (SD: 1.4) treatments, with 1.7 (SD: 1.2) being prescriptions. Topical immunomodulators had the highest discontinuation rate at 73.1% (n = 19/26). Autologous serum eye drops and topical corticosteroids were the least discontinued treatments. Number of total treatments, prescriptions, and procedures sharply increased at stage three OCP.

Conclusions: The number of treatments and procedures increased with OCP severity, indicating that advanced OCP often necessitated more intensive OSD management.