Ocular Immunology and Inflammation最新文献

Purpose: To report a treatment approach of a rare presentation of herpes zoster ophthalmicus (HZO) with optic neuropathy and oculomotor nerve palsy.

Methods: Report of one case.

Results: Multiple lesions involving the optic nerve and cavernous sinus were demonstrated on magnetic resonance imaging in a patient with a characteristic herpes zoster rash in the V1 dermatomal distribution. Following treatment with systemic ganciclovir and intravenous corticosteroids, the patient experienced dramatic improvement in visual acuity, from hand motion to 20/25.

Conclusion: This report demonstrates a rare case of HZO optic neuropathy with cavernous sinus involvement that was successfully treated with an unconventional medication regimen.

Purpose: To characterize the spectrum of uveitis in patients visiting three tertiary hospitals in Hanoi, Vietnam.

Methods: This study collected prospective and multicenter data from patients diagnosed with uveitis at three tertiary hospitals in Hanoi City, Vietnam, between January 2022 and January 2024. Data on age, sex, clinical and laboratory findings, and etiology were collected.

Results: Of 410 patients included, 54.6% were women. The mean age of patients was 39.9 years. Most cases were unilateral and chronic. Anterior uveitis was the most common case (40%), followed by panuveitis (30%), posterior uveitis (26.1%), and intermediate uveitis (3.9%). Undifferentiated uveitis, accounting for 32%, was the most prevalent form across all anatomical groups. The leading etiologies for anterior uveitis included Posner-Schlossman syndrome (18.5%), cytomegalovirus (CMV)-induced uveitis (11%), and Herpes simplex virus-induced uveitis (8.5%). For posterior uveitis, the primary causes were Vogt-Koyanagi-Harada (VKH) syndrome (17.8%), toxocariasis (10.3%), and toxoplasmosis (6.5%). The identified causes of panuveitis included VKH syndrome (24.4%), Behcet's disease (15.4%), and CMV-induced panuveitis (5.7%). We observed six cases of uveitis associated with Haemophilus influenzae (1.5%) without any concomitant systemic symptoms. In our patient population, the most common complication was cataract (11.2%), followed by uveitic macular edema (11%).

Conclusions: Various uveitis patterns were observed among Vietnamese patients, with non-infectious uveitis being predominant.

Purpose: To determine the patterns of uveitis evident in patients presenting at the Uveitis Department of a tertiary care eye hospital located in Karachi, Pakistan.

Study design: Prospective cross-sectional study.

Location and duration of study: This study was conducted at Layton Rahmatullah Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital-Korangi, Karachi, Pakistan from August 2020 to July 2023.

Methodology: This prospective study was conducted at the Uveitis Department of LRBT Tertiary Teaching Eye Hospital, Karachi, Pakistan, from August 2020 to July 2023, following ethical review board approval. Patients underwent detailed history-taking, clinical examination by a uveitis specialist. Informed written consent was obtained. Demographic data were recorded, excluding post-opendophthalmitis cases. Laboratory tests and ocular investigations were performed when necessary.

Result: In this study, 5791 patients were analysed, with a predominance of females (55.4%) and a mean age of 38.22 ± 13.06 years. Bilateral eye involvement was found in 60.4% of cases, and the most common uveitis types were anterior (35.1%) and pan-uveitis (28.9%). Non-infectious uveitis (72.14%) was more prevalent, with idiopathic uveitis being the most common cause (33.2%). Significant associations were found between anatomical locations of uveitis and various clinical characteristics (age, gender, eye involvement and infection status). For instance, anterior uveitis was more commonly associated with unilateral eye involvement, while bilateral eye involvement was more frequent in cases of pan-uveitis and posterior uveitis. Additionally, infectious aetiology was more prevalent in pan-uveitis and posterior uveitis (p < 0.001).

Conclusion: The primary aim of this study was to determine the patterns of uveitis cases observed at a tertiary eye care hospital in Karachi, Pakistan. The predominant aetiology identified was idiopathic uveitis. Nevertheless, it is essential to recognize that the determined prevalence may be subject to the inherent limitations of this study, notably pertaining to financial barriers and limited availability of diagnostic modalities.

Purpose: To describe a case of early-stage Extensive Macular Atrophy with Pseudodrusen-like appearance (EMAP) presenting with acute monocular loss and atypical retinal lesions suggestive of posterior uveitis.

Methods: Case report with longitudinal follow-up including visual field testing and multimodal imaging.

Results: A 53-year-old woman presented with sudden vision loss in her right eye (RE). Best corrected visual acuity (BCVA) was 20/400 in RE and unaffected in left eye (LE). Fundoscopy revealed bilateral pseudodrusen and peripheral paving-stone degeneration, consistent with stage 1 EMAP. Autofluorescence showed a hyper-autofluorescent reticular pattern in RE, colocalizing with pseudodrusen. Optical coherence tomography (OCT) demonstrated retinal pigment epithelium (RPE) thickening, RPE-Bruch's membrane separation, and atypical feathery lesions in the RE, along with ellipsoid (EZ) loss. In the LE, only pseudodrusen and RPE-Bruch's membrane separation were observed. Oral prednisone (30 mg, tapered) was initiated. At 24 weeks, the EZ had recovered, the feathery lesions resolved, and the RPE appeared normal, with a reduced hyper-autofluorescent pattern in the RE. At 30 weeks, the patient returned with recurrent vision loss in her RE. OCT revealed EZ loss without further lesions. After treatment with intravenous methylprednisolone and oral prednisone (tapered) plus methotrexate (15 mg/week), BCVA improved to 20/32, and EZ fully recovered.

Discussion: We describe a case of stage 1 EMAP presenting with symptoms and lesions suggestive of concomitant Multiple Evanescent White Dot Syndrome (MEWDS)-like reaction. After treatment, resolution of inflammatory features and a partial improvement of the RPE abnormalities were observed.

Purpose: To report a complex case of serpiginous-like choroiditis (SLC) in a patient with anti-neutrophil cytoplasmic antibody (ANCA)-anti-proteinase 3 (PR3)-associated vasculitis with systemic involvement.

Methods: Case report.

Results: A 40-year-old male from a tuberculosis (TB)-endemic region presented with bilateral active SLC lesions. He was diagnosed with ANCA-PR3 vasculitis with unilateral otitis media, nasopharyngeal mass, lung abscess, pleurisy, and joint pain, all of which responded well to corticosteroids and rituximab. Extensive evaluations and biopsies ruled out Mycobacterium tuberculosis infection. Despite consensus criteria recommending anti-tubercular therapy (ATT), the SLC lesions were effectively managed with an intravitreal dexamethasone implant and systemic azathioprine, showing no recurrence at 18 months without ATT.

Conclusions: The development of SLC lesions in the context of systemic autoimmune conditions like ANCA-PR3 vasculitis is uncommon. In these cases, the need for ATT should be carefully evaluated, with close attention to systemic disease manifestations and tailored management strategies.

Purpose: To present a case of indolent, nonprogressive multifocal choroidal lesions and contribute to the limited reports aiding this diagnosis, supplemented by a review of the literature.

Methods: Clinical records of a patient were reviewed alongside relevant literature from PubMed, Cochrane, and Google Scholar.

Results: A male in late 50s presented with a 10-year history of unilateral yellow-white asymptomatic fundus lesions in the left eye. Extensive multimodal imaging and workup for systemic lymphoma, sarcoidosis, autoimmune diseases, birdshot chorioretinopathy, and related infections yielded negative results. Indocyanine Green Angiography (ICGA) revealed hypofluorescent spots in the mid-late frames and fluorescence blockage consistent with fundus lesions. Enhanced-depth OCT revealed choroidal thickening and hyporeflective spaces within the outer choroid corresponding to the lesions. During Fluorescein angiography, the lesions became more iso-fluorescent and stained minimally in the late phase, indicating they are not full thickness and spare the inner choroid. Short-wave autofluorescence was normal. B-scan ultrasound revealed two shallow, lesions without retinal infiltration. Partial lesion regression and progression were observed over time. Steroid treatment aimed at reducing lesion choroidal thickening had a mild effect. Despite discontinuation, the patient remained asymptomatic without vision impairment or intraocular inflammation. The right eye remained unaffected.

Conclusion: Indolent, nonprogressive, multifocal, and choroidal lesions likely represent benign lymphocytic infiltrates localised within the outer choroid. Mild steroid response suggests a non-inflammatory process. The lack of reports presents a gap in ophthalmology. Diagnosis of this case is based on similar presentation of other cases. Surveillance rather than biopsy or treatment is recommended for asymptomatic patients.

Purpose: To investigate the efficacy and safety of the Preserflo MicroShunt (PMS) in treating glaucoma secondary to different uveitic glaucoma (UG) types in a European population.

Methods: This study evaluated consecutive eyes with UG that received the PMS. The primary outcome measure was 12-month surgical success (≥20% IOP reduction, target IOP of 6-21 mmHg). Complete success was considered without IOP-lowering medication or additional surgery other than needling. Qualified success A was considered regardless of medication use, and qualified success B regardless of medication and/or incisional bleb revision. The secondary outcome measures included revision and complication rates.

Results: Twenty-five eyes (viral group: 10 with Fuchs uveitis syndrome and six with herpetic uveitis; juvenile idiopathic arthritis (JIA) group: nine with JIA-related uveitis) were included. The 12-month complete success rate was significantly higher in the viral group than in the JIA group (69% vs 11%; p = 0.0059, log-rank test). The qualified success rates in the viral and JIA groups were 75% and 22% for category A (p = 0.029) and 94% and 56% for category B (p = 0.0237), respectively. Among the viral and JIA groups, 13% and 11% required medication, respectively. Incisional bleb revisions were conducted within 12 months in 25% and 78%, respectively (p = 0.0131, log-rank test). Complications were self-limiting, with no uveitic activity observed.

Conclusion: The PMS is safe and effective for glaucoma secondary to viral anterior uveitis. Conversely, it is moderately effective in eyes with JIA-related UG, with a high probability of bleb fibrosis development.

Purpose: Ocular tuberculosis (OTB), an extrapulmonary manifestation of tuberculosis (TB), significantly impacts vision acuity and presents challenges in diagnosis and treatment. With ongoing research efforts, new insights into its pathogenesis and treatment have emerged. This study employed bibliometric methods to investigate key research areas and emerging trends, aiming to provide a comprehensive overview of the field.

Methods: The documents about OTB from January 1, 2003 to December 31, 2023, were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer, CiteSpace, R package bibliometrix, and GraphPad were utilized to analyze the data and visualize the network of the country, organization, author, journal, and keyword related to the field of OTB.

Results: 300 articles in the past 21 years were included in this research. The overall number of annual publications exhibits an upward trend. The most productive country, institution, author, and journal were India, Post Graduate Institute of Medical Education & Research (PGIMER), Gupta Vishali, and Ocular Immunology and Inflammation. The main keywords focused on ocular tuberculosis, intraocular tuberculosis, and uveitis. The time trend of keyword occurrences indicated that "T cells" and "aqueous humor" have become new hotspots. Burst detection analysis of keywords shows that "pattern" and "standardization" have emerged as new focal points.

Conclusions: This study represents the first bibliometric analysis on OTB, offering insights into hot topics and emerging trends within this field. T cells and aqueous humor are identified as novel directions for ongoing research endeavors. The latest research focus is on the standardization of OTB in diagnosis, treatment, and other aspects.

Purpose: To develop a novel grading scale for assessing conjunctival inflammation in cicatrizing conjunctivitis associated with Pemphigoid.

Methods: We performed a retrospective analysis of digital slit-lamp images for patients with cicatricial pemphigoid in which best-quality conjunctival images for each eyelid at each photographic session was selected and anonymized. These images were subsequently prospectively assessed for inflammation severity on a scale of 0-4+ by a fellowship-trained ophthalmologist specializing in pemphigoid. The most representative image grade of inflammation was then compiled to create a visual composite, accompanied by corresponding verbal descriptions for each level of inflammation. The primary outcome measure was the development of a novel 4-point grading scale demonstrating progressive degrees of conjunctival inflammation in patients with cicatrizing conjunctivitis associated with pemphigoid.

Results: A total of 6,969 conjunctival images from 113 patients with cicatrizing conjunctivitis secondary to pemphigoid were reviewed and narrowed to 452 images, each representing the best single clarity image from each eyelid per photo session. The images were then sorted into five groups by degree of inflammation (0-4+). The most representative photographs of the upper and lower eyelids in each group were then selected to create a visual composite with an associated verbal descriptor for each level of inflammation.

Conclusion: A novel 4-point grading scale was developed incorporating both verbal descriptors and visual components to quantify conjunctival inflammation in patients with cicatrizing conjunctivitis associated with Pemphigoid.

Purpose: This study aimed to investigate the clinical characteristics, diagnostic markers, and treatment outcomes of varicella-zoster virus-associated anterior uveitis (VZV-AU) with and without ophthalmic herpes zoster (herpes zoster ophthalmicus (HZO) and zoster sine herpete (ZSH), respectively).

Methods: Clinical records of 47 VZV-AU patients (21 ZSH, 26 hZO) were retrospectively reviewed for clinical findings, medication use, and PCR using aqueous humor (AH) results.

Results: There was no significant difference in age, gender, visual acuity (VA), or intraocular pressure (IOP) between the two groups. At the initial visit, small-to-medium white keratic precipitates (KPs) were significantly more observed in ZSH group than in HZO group, although there was no significant difference in the frequencies of other ocular findings between the two groups. Early antiviral medication use was significantly higher in HZO group (96.2%) than in ZSH group (19.1%). PCR was performed in 85.7% of ZSH and 53.8% of HZO patients. VZV-DNA positivity and viral load were similar between groups. Multivariate analysis revealed a positive correlation between white KPs and VZV viral load in AH. Although the ultimate use of antiviral medication was still less in ZSH group (71.4%), there were no significant differences in VA and IOP at the last visit between the two groups.

Conclusion: Patients with ZSH had more white KPs and received less early antiviral medication than those with HZO. However, visual outcomes were similar between the two groups. Small-to-medium white KPs were significantly associated with the viral load of VZV in AH, suggesting that they could be an active marker.