Ocular Immunology and Inflammation最新文献

Purpose: To evaluate the effects of rheumatoid arthritis (RA) on the anterior and posterior segment structures of the eye.

Methods: This retrospective study included 80 eyes from 40 patients diagnosed with RA who were referred to our clinic for detailed ophthalmological examinations between January 2018 and May 2020. A control group comprising 80 eyes from 40 healthy individuals who presented for routine ophthalmological evaluation was also included. Comprehensive ophthalmological examinations, corneal topography, and optical coherence tomography İmages were analyzed.

Results: Compared with the control group, the RA group demonstrated a significant reduction in anterior chamber depth, iridocorneal angle, and subfoveal choroidal thickness. Conversely, an increase in retinal nerve fiber layer (RNFL) thickness was detected in the superior and temporal quadrants. However, no statistically significant differences were found between groups in central corneal thickness, corneal volume, horizontal and vertical keratometry values within the 5-mm zone, central macular thickness, and RNFL thickness in the global, nasal, and inferior quadrants.

Conclusion: In patients with RA, ocular inflammation is associated with reduced tear production and alterations in ocular structures. The observed decreases in anterior chamber depth, iridocorneal angle, and subfoveal choroidal thickness, along with increased RNFL thickness in the superior and temporal quadrants, are likely attributable to underlying inflammatory mechanisms.

Purpose: This case report describes an unusual bilateral corneal perforation secondary to severe Neisseria gonorrhoeae keratoconjunctivitis and the development of a self-sealing conjunctival flap in an immunocompetent patient.

Methods: Interventional case report.

Results: A prior healthy 42-year-old male presented with reduced vision, Neisseria gonorrhoeae conjunctivitis, and bilateral corneal perforation. Additionally, an unprecedented formation of a self-sealing conjunctival flap was observed in both eyes. Despite initial treatment with topical and intravenous broad-spectrum antibiotics, a tectonic penetrating keratoplasty was required to achieve visual recovery.

Conclusions: Adult gonococcal conjunctivitis (GC) typically occurs by direct inoculation and is usually unilateral. GC may be associated with severe infectious keratitis leading to corneal perforation. Tectonic corneal grafting combined with antimicrobial treatment had a favorable outcome in this extremely rare bilateral case.

Purpose: To examine the incidence, clinical features, causative pathogens, treatment approaches, and outcomes of microbial keratitis (MK)-induced endophthalmitis.

Methods: Retrospective analysis of all cases of MK-induced endophthalmitis over a period of 10 years (2008-2018). Details regarding clinical presentation, medical and surgical intervention, outcomes, culture results, and antibiotic susceptibility were collected. Univariate analysis was performed to obtain p values described in the study.

Results: Of 491 endophthalmitis cases, 30 (6.12%) were associated with MK. The mean age (± standard deviation) was 52.7 ± 27.1 years. Gram-positive bacteria (92.3%) were the most common isolates. At presentation, the median best-corrected visual acuity (BCVA) was light perception. Treatment included intravitreal antibiotics in all cases. In some cases (40%), vitrectomy, therapeutic keratoplasty, or amniotic membrane transplantation was performed. At 1 year, the median BCVA was hand motion, with only 16.7% of eyes achieving a BCVA of 20/200 or better. Eyes with secondary keratitis (associated with previous surgery) had significantly better visual outcomes at 12 months compared to those with primary keratitis (p = 0.008). Evisceration was performed in 13.3% of the cases.

Conclusion: While diagnosing endophthalmitis in eyes with microbial keratitis can be challenging, B-scan ultrasonography was an effective diagnostic tool. The visual outcome is usually poor, especially in Staphylococcus epidermidis infected eyes and primary keratitis.

Purpose: To apply a deep learning-based approach for the automated assessment of media haze and vascular leakage in uveitis using CFP and FFA, and to evaluate its performance against conventional methods.

Methods: A total of 756 CFP images and 740 FFA images from 213 uveitis patients were collected. EfficientNetV2-L, InceptionV3, and MobileNetV3 models were developed for media haze assessment using annotations from intermediate ophthalmologists. LadderNet was used for segmenting vascular and leakage areas. Correlation analyses were conducted between media haze, inflammatory factors, and vascular leakage. K-means clustering was applied to identify leakage patterns, and follow-up validations were performed to evaluate treatment efficacy.

Results: In the 9-level media haze classification, EfficientNetV2-L achieved the highest performance with an average Micro-AUC of 0.933, outperforming InceptionV3 (0.893) and MobileNetV3 (0.683). Under a simplified 6-level scoring system, EfficientNetV2-L maintained its superiority with an average Micro-AUC of 0.906. LadderNet demonstrated high accuracy in vascular and leakage segmentation, with Dice similarity coefficients (DSC) of 0.95 and 0.89, respectively. Significant positive associations were found between media haze and leakage area, as well as between the neutrophil-to-lymphocyte ratio (NLR) and leakage area, relative leakage area, and leakage rate. K-means clustering identified distinct leakage patterns, and follow-up validations indicated reductions in leakage severity and NLR post-treatment.

Conclusion: This study underscores the potential of deep learning in automating uveitis diagnosis, improving accuracy, and offering novel indicators for disease activity and treatment outcomes.

Purpose: Acute retinal necrosis (ARN) is a severe and vision-threatening complication of herpesvirus infection, characterized by rapid progression and significant visual morbidity. While intravenous acyclovir remains the cornerstone treatment, adjunctive therapies such as intravitreal antivirals and surgical interventions may reduce complications.

Methods: This retrospective study analyzed 18 ARN cases from two reference hospitals in São Paulo, Brazil, over a seven-year period (2017-2024).

Results: The cohort primarily consisted of female patients (57.9%), with a mean age of 51.4 years. The majority (83.3%) were immunocompetent and 94.4% had unilateral initial manifestation. Retinal detachment was the most common complication, occurring in 50% of cases, followed by vitreous haze (11.1%) and phthisis bulbi (11.1%). Visual acuity (VA) outcomes were generally poor, with 61.1% of patients experiencing deterioration, 27.8% showing improvement, and only 11.1% maintaining their initial VA. The mean initial VA was < 20/200, emphasizing the severity of disease presentation and the consequences of delayed diagnosis and referral.

Conclusion: In this case series, ARN occurred predominantly in immunocompetent individuals and carried a high risk of retinal detachment, further complicating visual prognosis. The high rate of retinal detachment observed, despite standard antiviral therapy, raises the possibility that delays in diagnosis or referral may have influenced outcomes. Further research is warranted to optimize treatment protocols for this rare yet devastating condition, particularly in mitigating the risk of retinal detachment and improving long-term visual outcomes.

Hassoun M et al. report that intravitreal adalimumab is non-inferior to subcutaneous administration for controlling intraocular inflammation in non-infectious uveitis. This correspondence discusses the broader clinical implications of these findings, highlighting cost considerations, the need to balance systemic safety with local procedural risks, and the importance of patient-reported outcomes and extended dosing regimens to enhance treatment acceptability.

Purpose: To identify all possible ophthalmic presentations in children with Presumed trematode-induced uveitis, and determine their incidence in Beni Suef. Additionally, it explores potential correlations between ocular signs and demographic variables.

Methods: The study is a retrospective, case series which was conducted in three phases. The first phase involved subject recruitment and demographic data collection. The second phase included a thorough general examination and laboratory workup. In the third phase, ophthalmological examination was conducted.

Results: A total of 83 patients (99 eyes) were included. 80 of them were males. The mean age was 11.1 ± 2.7 years. Unilateral ocular involvement was seen in 66 patients. Anterior chamber granuloma was the most frequent presentation (71.7%), followed by ciliary body granuloma (15.2%) and vitritis (13.1%). Corneal granuloma occurred in 10.1%, macular edema in 9.1%, episcleral involvement in 6.1%, and iris involvement in 5.1%. Complications included cataracts (9 cases) and phthisis bulbi (1 case). One case showed hemorrhagic AC granuloma. Anterior chamber granuloma was more common in older children (mean age 11.5 years, p = 0.010), while vitritis was more common in younger ones (mean age 9.1 years, p = 0.029). No significant correlation was found between ocular signs and residence.

Conclusion: In Beni Suef, children with presumed trematode-induced uveitis have diverse ocular manifestations, primarily anterior chamber and ciliary body granulomas with vitritis. Complications such as cataract and phthisis bulbi may occur. Atypical cases, including hemorrhage within a granuloma, may develop. The study suggests age-related variations in ocular signs but no significant correlation with residence.

Purpose: To report a rare case of unilateral dacryoadenitis and contralateral solitary choroidal granuloma as the initial presentation of systemic sarcoidosis, highlighting diagnostic challenges and treatment complications.

Methods: A 45-year-old male presenting with right-sided dacryoadenitis and a contralateral choroidal granuloma was evaluated. The diagnostic work-up included clinical examination, orbital and chest CT, SPECT-CT with gallium-67, biopsies of the lacrimal gland and mediastinal lymph nodes, serum ACE and lysozyme levels, and fundus imaging with EDI-OCT. The diagnosis of sarcoidosis was established based on WASOG and IWOS criteria. Treatment included corticosteroids, azathioprine, and adalimumab. Anti-tubercular therapy was subsequently added after a later diagnosis of tuberculosis during sarcoidosis treatment.

Results: At presentation, visual acuity was 20/200 in the right eye (OD) and 20/25 in the left eye (OS), with right-sided proptosis and photophobia. Orbital CT showed lacrimal gland enlargement; biopsy revealed lymphoplasmacytic infiltration without granulomas. EDI-OCT confirmed a solitary choroidal granuloma in the OS. Elevated ACE and lysozyme, bilateral hilar lymphadenopathy, and gallium-67 uptake supported the sarcoidosis diagnosis. Initial immunosuppressive therapy improved symptoms, but disseminated tuberculosis developed, requiring 14 months of anti-tubercular therapy.

Conclusion: This case highlights the diagnostic complexity of ocular sarcoidosis with inconclusive histopathology and underscores the diagnostic value of solitary choroidal granuloma. In tuberculosis-endemic regions, thorough infectious screening before immunosuppression and long-term multidisciplinary follow-up are essential to prevent serious complications.

Purpose: Diagnosis of giant cell arteritis (GCA) can sometimes be challenging, especially in the setting of a negative CRP.

Methods: We report a challenging case of GCA.

Results: A 73-year-old male patient presented with unilateral paracentral acute middle maculopathy (PAMM). Because the patient demonstrated homolateral internal carotid artery stenosis, and two negative CRP tests, the diagnosis of GCA could have been overlooked if diffuse aortitis had not been observed on supraortic CT-scan. The diagnosis was further confirmed with PET scan, demonstrating femoral arteritis in addition to aortitis.

Conclusion: If PAMM and negative CRP are frequently encountered in "cranial GCA," "aortoarteritic GCA" is usually associated with inflammatory signs, which was not the case in this patient, reminding us that a high degree of suspicion should always be maintained in case of PAMM in elderly patients.