Ocular Immunology and Inflammation最新文献

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.

Purpose: To examine the recurrence of cytomegalovirus (CMV) iritis in patients using low-dose ganciclovir (GCV) eye drops.

Methods: We included patients with dormant CMV iritis who were treated using 2% GCV eye drops at the University of Tokyo Hospital between January and June 2023 and whose dosage of GCV eye drops was required to be reduced due to the unstable GCV supply. Patients were excluded if they had active CMV retinitis and underwent corneal transplantation. We examined the recurrence of CMV iritis after the reduction of GCV eye drops.

Results: Fifteen eyes of 14 patients (mean age, 62.4 ± 13.0 years) were included. The frequency of GCV eye drops was reduced from four times a day to twice in 13 eyes and three times in two eyes. The mean observation period after the reduction of GCV eye drops was 202.5 ± 155.8 days. Although there were no recurrences in the 6 months prior to the reduction of GCV eye drops, recurrences were observed in five eyes (33.3%) after the reduction. The mean time from GCV reduction to recurrence was 59.2 ± 11.3 days. Patients who survived the first 3 months without recurrence had no recurrence later.

Conclusion: Recurrences of CMV iritis were observed in one-third of the eyes within 3 months after dosage reduction of 2% GCV eye drops.

For the past 50 years, significant progress has been made in understanding Seasonal Hyperacute Panuveitis (SHAPU), a mysterious blinding disease first reported in Nepal in 1975. Predominantly affecting Nepalese children, SHAPU occurs cyclically every odd year from September to December. While initially misclassified as endophthalmitis, SHAPU is set apart by its lack of trauma or surgery, failure to grow organisms in most intraocular fluid cultures, and its hallmark presentation of a "white pupil in red eye" with an association with moth exposure. Recent findings have expanded SHAPU's geographical scope beyond Nepal, with cases reported in Bhutan. Moreover, sporadic summer outbreaks have emerged, showing worse clinical outcomes than the typical cases. Recent studies suggest that the Gazalina moth may play a role, although the exact cause of SHAPU remains undetermined. Despite the increased understanding of SHAPU's geographic distribution and cyclical patterns, it is possible that some cases remain misdiagnosed or underreported. Continued research is critical to further exploring the aetiology of SHAPU, which will lead to better diagnostic tools, targeted treatments, and improved outcomes. The inclusion of SHAPU under more general categories such as endophthalmitis underscores the need for a clearer distinction of this condition to prevent blindness in at-risk populations.

Purpose: This study aimed to investigate demographic features, diagnoses of uveitis (intraocular inflammation), and real-world clinical practice in the use of local and systemic therapies for patients with uveitis in Tokyo, Japan.

Methods: Clinical records of 1,174 consecutive new patients (480 males, 694 females) referred to the Kyorin Eye Center, Kyorin University Hospital between January 2011 and December 2018 were retrospectively reviewed.

Results: Mean age at presentation was 52.6 years (range 4-94 years). By anatomic location, 439 patients (37.4%) had anterior uveitis, 18 (1.5%) had intermediate uveitis, 214 (18.2%) had posterior uveitis and 503 (42.8%) had panuveitis. The 3 most common diagnoses were sarcoidosis (9.1%), Vogt-Koyanagi-Harada (VKH) disease (8.3%), and acute anterior uveitis (5.7%). Compared to our previous study, rates of herpetic anterior uveitis and cytomegalovirus (CMV) retinitis increased while tuberculosis-related uveitis decreased. Unclassified uveitis remained the most common diagnosis (44.9%). Systemic corticosteroids and/or immunomodulatory agents were used in only 18.3% of patients. Immunomodulatory drugs including biologic agents were utilized in 4.9% of patients.

Conclusions: The most common uveitis anatomic type was panuveitis due mainly to high rates of sarcoidosis and VKH disease. Diagnoses of herpetic anterior uveitis and CMV retinitis increased, while tuberculosis-related uveitis decreased. Less than one-fifth of uveitis patients required systemic treatment.

Birdshot chorioretinopathy (BSCR) is a bilateral, chronic posterior uveitis with characteristic clinical and imaging findings. Multimodal imaging including optical coherence tomography, fluorescein, and indocyanine green angiography is useful in diagnosis, as well as monitoring disease activity. Cystoid macular edema, choroidal thickening and infiltration, ellipsoid loss, and vasculitis are important imaging markers for disease activity. The purpose of this case series is to discuss the spectrum of disease presentations and highlight both common and atypical imaging characteristics of BSCR that may provide clinical insight to allow for better identification and treatment of disease.