Ocular Immunology and Inflammation最新文献

Purpose: The anti-inflammatory effect of therapeutic pars plana vitrectomy (PPV) in the management of posterior segment uveitis is incompletely quantified. In this study, we evaluated the change in total immunosuppression load (TIL) following PPV for the eyes of patients with non-infectious uveitis.

Methods: Retrospective chart review of patients with non-infectious posterior segment uveitis on continuous anti-inflammatory therapy (systemic corticosteroids ± immunomodulatory therapy [IMT]) ±3 months, who received therapeutic PPV for non-resolving inflammation. The TIL scores were calculated by adding the total daily dose of prednisolone graded on a scale of 0-9, and of the IMT graded between 0 and 3, and calculating the mean values for the pre-operative and post-operative visits, respectively.

Results: Sixty-five eyes of 65 patients were included. Mean follow-up was 19.1 ± 14.6 months pre-operatively and 9.4 ± 7.1 months post-operatively. Mean TIL scores for the post-operative visits (2.6 ± 1.9) were significantly lower than the pre-operative (4.4 ± 1.7) visits (p < 0.001). Mean logMAR BCVA was four lines better 1 month post-operatively (0.5 ± 0.4) than the immediate pre-operative vision (0.9 ± 0.6, p < 0.001). On multivariate regression analyses, the reduction in mean TIL scores post-operatively was more with longer durations of pre-operative treatment (adjusted risk ratio [aRR] = -0.04, p = 0.04), while the improvement in one-month post-operative BCVA was more if pre-operative vitreous haze was ≥2+ (aRR = -0.25, p = 0.02). Post-operative adverse outcomes included new-onset cystoid macular edema (n = 6), raised intraocular pressure (n = 5), and intra-operative retinal break (n = 1). Eleven (16.9%) patients were off all immunosuppression during the final follow-up.

Conclusions: Therapeutic PPV allowed control of intraocular inflammation on less intensive systemic anti-inflammatory therapy. Post-operative adverse outcomes observed were manageable.

Purpose: To investigate the patterns and outcomes of pediatric uveitis.

Methods: Retrospective review of patients with uveitis in pediatric age group.

Results: A total of 184 patients (335 eyes) were included. There were 96 (52.2%) boys and 88 (47.8%) girls, with a mean age of 12.8 ± 3.4 years at presentation. Panuveitis was most common (55.2%), followed by anterior uveitis (29.6%), intermediate uveitis (12.2%) and posterior uveitis (3%). Uveitis was non-granulomatous in 71% and non-infectious in 94.6% of the eyes. The most identifiable specific diagnoses were Vogt-Koyanagi-Harada (VKH) disease (21.2%), juvenile idiopathic arthritis (6.5%), sarcoidosis (4.3%), and presumed tuberculous uveitis (3.3%). After 1-year follow-up, 85.4% of the eyes achieved visual acuity of 20/40 or better.

Conclusions: The most common anatomic diagnosis was panuveitis. VKH disease was the most frequently diagnosed entity.

Purpose: This study aimed to the detect of structural and functional changes in the retina and choroid in patients with vitiligo using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).

Materials and methods: Thirty patients with vitiligo and 30 healthy participants were enrolled in the study. Central macular thickness (CMT), retina nerve fiber layer (RNFL) thickness, choroidal thickness (CT), foveal avascular zone (FAZ) area, and superficial and deep vascular density (VD) ratios were compared between the groups.

Results: The mean age was 43.32 ± 12.13 and 45.90 ± 7.50 years, respectively (p = 0.435). CMT, RNFL thicknesses (except temporal quadrant), CT, superficial and deep VD, and FAZ area were similar between the two groups (p > 0.05 for all). Temporal RNFL thicknesses were lower in vitiligo patients than in control groups (p = 0.005). There was a moderate negative correlation between the duration of vitiligo disease and the mean RNFL thickness, inferior RNFL thickness, superficial total, superior, superior inner, outer, and superior outer VD values. No correlation was found between the VASI (Vitiligo area scoring index) score in vitiligo patients and OCT and OCTA values.

Conclusion: Although it is known that vitiligo causes melanocyte loss in ocular tissues, there was no significant effect of vitiligo on superficial and deep retinal VD. Further comprehensive studies with a larger and more diverse population of vitiligo patients are needed to explore this further.

Purpose: To conduct a systematic review and meta-analysis to provide an outline of available data on the association between serum vitamin D levels and vernal keratoconjunctivitis (VKC) and to determine the possible relationship in children.

Methods: Systematic research on all articles published until July 2023 was conducted in PubMed, SCOPUS, Web of Science, and Embase. All observational-analytical studies that measured vitamin D levels in patients with VKC were included. Extracted data were included in two separate meta-analyses: 1) a meta-analysis on the standardized mean difference (SMD) of vitamin D levels between VKC patients and the control group and 2) a meta-analysis on the prevalence of vitamin D deficiency in VKC patients.

Results: Seven relevant studies that included 316 patients, with the mean age of 10.8 3 ± 1.14 years, with VKC were included in this meta-analysis. The mean serum vitamin D level was significantly lower in the patients with VKC as compared with the control group (SMD: -0.92; 95% CI -1.15, -0.69, p < 0.001). The overall prevalence of vitamin D deficiency among VKC patients was 63.7% (95% CI 42.5%-80.7%, p < 0.001). VKC patients spent significantly less time outdoors during daylight compared to healthy individuals (SMD = -0.90, 95%CI -1.28, -0.52, p < 0.001).

Conclusion: VKC patients have lower serum vitamin D than healthy controls. This finding underscores the potential role of vitamin D in the immunopathogenesis of VKC.

This systematic review evaluates the real-world efficacy and safety of the 0.19 mg fluocinolone acetonide (FAc) sustained-release intravitreal implant for treating non-infectious uveitis affecting the posterior segment of the eye (NIU-PS). Following PRISMA guidelines, a search was conducted in PubMed, Embase and Web of Science, with the latest update on September 20, 2024. Twelve real-world studies involving a total of 382 patients (514 eyes) were included in the review. Compared to baseline, the studies consistently showed reduced mean central retinal thickness for up to 36 months post-FAc implantation, while mean visual acuity was stable or significantly improved. Intraocular inflammation, as per the Standardization of Uveitis Nomenclature grading system, was persistently absent or improved, with evidence extending to 12 months following implantation. While FAc generally showed potential to reduce or maintain systemic immunosuppressive treatments, this effect was not consistently observed, particularly in cases involving choroidal inflammation. Local rescue treatment was used in up to 24% of eyes. Mean intraocular pressure remained stable for 36 months with up to 38.5% of eyes requiring either supplemental or initial IOP-lowering medication. Limited data was available on cataract development. A few cases of hypotony as well as one case of retinal detachment were observed. Overall, current real-world evidence aligns with clinical trial findings, suggesting that the 0.19 mg FAc implant is an effective adjunctive maintenance treatment for NIU-PS with a consistent safety profile. Further studies are needed to refine treatment guidelines.

Purpose: To evaluate differences in the incidence of ocular complications among pediatric and young adult patients with non-infectious uveitis receiving immunosuppressive therapy (IMT), according to the time from uveitis onset to IMT initiation in Japan.

Methods: Patients aged < 20 years exhibiting uveitis treated with IMT (e.g. methotrexate, cyclosporine, infliximab, or adalimumab) were categorized into three groups according to the time from uveitis onset to IMT initiation: ≤6 months, early IMT group; 7 months to 2 years, intermediate IMT group; and ≥ 2 years, late IMT group. The percentage of ocular complications was compared among these groups. Laser flare values were recorded to evaluate disruption of the blood-aqueous barrier (BAB).

Results: Forty-three patients (84 eyes) who received IMT during the follow-up period were included. Among them, 28 patients (65.1%) experienced ≥ 1 ocular complication, with percentage of 56.0% in the early IMT group, 77.8% in the intermediate group, and 77.8% in the late group. Common complications were cataract (27.4%), posterior synechiae (17.9%), and macular edema (10.7%). The early IMT group did not require surgical intervention. The late IMT group experienced a high percentage of ocular complications despite IMT initiation. The mean laser flare value during follow-up was consistently higher in the late group (113.2 pc/ms) than in the early group (14.4 pc/ms) and intermediate group (28.7 pc/ms).

Conclusion: In pediatric and young adult patients with chronic non-infectious uveitis, early IMT initiation may prevent permanent breakdown of the BAB, reduce the incidence of ocular complications, and decrease the need for surgical intervention.

Purpose: To report two cases of bilateral blepharokeratoconjunctivitis associated with hidradenitis suppurativa (HS).

Methods: Case report and literature review. The clinical courses of two patients with HS, including ocular presentation and medical management, are described.

Results: Two female patients aged 18 and 23-years-old with severe HS presented with bilateral blepharokeratoconjunctivitis. Shared slit lamp findings included bilateral corneal neovascularization and inferior corneal thinning. Systemic immunosuppression was needed in the first case, which resulted in improvement in the patient's ophthalmic and dermatological findings.

Conclusion: We report two cases of bilateral blepharokeratoconjunctivitis in two patients with severe HS. To our knowledge, this association has not previously been described in the literature. Clinicians should be aware of this association given its potentially visually devastating manifestations and the need for early therapeutic interventions.

Purpose: To characterize the ocular inflammatory manifestations of inflammatory bowel disease (IBD) and examine the impact of ocular inflammation on IBD treatment.

Methods: A single-center retrospective chart review of patients with an IBD diagnosis and ophthalmology visit between January 2016 and January 2022 was conducted. Patients with a diagnosis of uveitis, scleritis, or peripheral ulcerative keratitis (PUK) confirmed by an optometrist or ophthalmologist were included.

Results: Charts of 1320 IBD patients were reviewed; 42 patients with uveitis, 2 patients with scleritis, and 2 patients with PUK were identified. Anterior uveitis was the most common form of uveitis (38/42, 90.5%), often in an episodic (31/38, 81.6%) and unilateral (19/38, 50.0%) pattern. Four patients (4/42, 9.5%) had posterior segment uveitis: two with panuveitis, one with intermediate uveitis, and one with posterior uveitis. Patients on systemic therapy for IBD did not routinely undergo changes to therapy following the development of ocular inflammation (27/36, 75.0%). Therapy alterations were more frequent with the development of posterior segment uveitis, scleritis, or PUK (4/6, 66.7%) compared with anterior uveitis (5/30, 16.7%). In 10 patients, uveitis onset preceded IBD diagnosis; in these patients, tumor necrosis factor (TNF) inhibitors were often used at the time of subsequent IBD diagnosis (5/10, 50.0%).

Conclusions: Unilateral anterior uveitis was the most common form of ocular inflammation among patients with IBD. Development of uveitis did not routinely require modification of immunomodulatory therapies; however, therapy changes were more common with posterior segment uveitis, scleritis, and PUK.

Purpose: To analyze changes in tear levels of inflammatory mediators in symptomatic contact lens (CL) wearers after refitting with daily disposable CLs and to identify potential biomarkers of success in CL discomfort (CLD) management.

Methods: Symptomatic CL wearers (CLDEQ-8 ≥ 12) were refitted (V1) with daily disposable CLs (Delefilcon A). After one month (V2), participants were classified into the post-fitting non-symptomatic (CLDEQ <12) and symptomatic (CLDEQ ≥12) groups. At each visit, the participants were clinically evaluated, tears were collected, and 20 inflammatory mediators and substance P (SP) were measured using multiplex immunobead analysis and ELISA, respectively. The detection rates and concentrations were compared between visits and groups, and logistic regression models were performed.

Results: Forty-three subjects (32 women/11 men; mean age: 23.2 ± 4.9 years) were enrolled. The IL-1β and IL-9 detection rates were higher at V2 (p ≤ 0.044). The detection rates of IL-1β, IL-9, MIP-1α/CCL3, and MMP-9 at V1 (p ≤ 0.045) and IL-17A at V2 (p ≤ 0.014) were higher in the post-fitting symptomatic group. The tear IL-9 concentration was increased at V2 (p = 0.018). The tear concentrations of fractalkine/CX3CL1, IL-2, IL-6, IL-10, MCP-3/CCL7, MIP-1β, NGF, RANTES/CCL5, and TNF-α were higher in the post-fitting symptomatic group (p ≤ 0.044). Additionally, levels of fractalkine/CX3CL1, IL-2, IL-6, IL-10, RANTES/CCL5, and TNF-α at V1 were significantly associated with the post-fitting grouping (p ≤ 0.044).

Conclusions: Low tear concentrations of specific inflammatory mediators may be used as a predictive biomarker of success for refitting symptomatic CL wearers with daily disposable CLs. However, complementary treatments might be required for symptomatic CL wearers with higher levels of these inflammatory molecules.

Purpose: To present paradoxical reaction (PR) in three cases with ocular tuberculosis (OTB) treated with antitubercular therapy (ATT), highlighting diagnostic challenges and treatment strategies.

Methods: We retrospectively reviewed clinical records of three OTB patients presenting with paradoxical worsening after ATT initiation at two Brazilian university hospitals.

Results: The patients (2 males, 1 female) experienced worsening clinical presentation (increased inflammation, vision loss) within two to three weeks after initiating ATT. One patient who was HIV-positive with unilateral multifocal choroiditis developed PR soon after starting antiretroviral therapy. The second patient presented with a choroidal tuberculoma in both eyes. The third patient also had multifocal choroiditis and developed a localized choroidal elevation with a double-layer sign as a manifestation of PR. All patients were maintained on ATT therapy in association with corticosteroids and experienced improvement of inflammatory signs.

Conclusion: This case series highlights the potential for PR in OTB patients. Close monitoring and prompt therapeutic adjustments are crucial for management success.