Showing papers in "Ocular Immunology and Inflammation in 2011"
TL;DR: Interleukine-8 plays important roles in ocular inflammation and angiogenesis in conjunctiva, cornea, iris, retina, and orbit and anti-IL-8 targeted immunotherapy has been introduced as an important treatment modality.
Abstract: Introduction: This review presents the current in vitro and in vivo animal and human research on the roles of IL-8 in ocular inflammatory diseases.Materials and Methods: Data sources were a literature review using Pub Med, Medline, and ISI databases (from 1990 to 2011). Search items included interleukine-8 (IL-8), CXCL8, chemokines, cytokines, alone or in combination with the, serum, aqueous, vitreous, eye, ocular, ocular tissues, ophthalmic, and review.Results: IL-8 may be involved in primary or secondary ocular inflammations. Ocular effects of IL-8 differ based on the source of the secretion and site of the action. The most important effects of IL-8 in the eyes are angiogenic activities and induction of ocular inflammation.Conclusion: IL-8 plays important roles in ocular inflammation and angiogenesis in conjunctiva, cornea, iris, retina, and orbit. Anti-IL-8 targeted immunotherapy has been introduced as an important treatment modality, provided that IL-8 signal blocking takes place in desired areas and ...
150 citations
TL;DR: Findings of congenital and acute acquired ocular toxoplasmosis include retinal scars, white-appearing lesions in the active phase often associated with vitritis, and fibrous bands, secondary serous or rhegmatogenous retinal detachments, optic neuritis and neuropathy, cataracts, and choroidal neovascular membranes are reviewed.
Abstract: Clinical manifestations of ocular toxoplasmosis are reviewed. Findings of congenital and acute acquired ocular toxoplasmosis include retinal scars, white-appearing lesions in the active phase often associated with vitritis. Complications can include fibrous bands, secondary serous or rhegmatogenous retinal detachments, optic neuritis and neuropathy, cataracts, increased intraocular pressure during active infection, and choroidal neovascular membranes. Recurrences in untreated congenital toxoplasmosis occur in teenage years. Manifestations at birth are less severe, and recurrences are fewer in those who were treated promptly early in the course of their disease in utero and in the first year of life. Severe retinal involvement is common at diagnosis of symptomatic congenital toxoplasmosis in the United States and Brazil. Acute acquired infections also may be complicated by toxoplasmic retinochoroiditis, with recurrences most common close to the time of acquisition. Suppressive treatment can reduce recurrent disease.
99 citations
TL;DR: Tocilizumab seems to be a promising treatment in refractory uveitis; a new humanized monoclonal antibody against the interleukin-6 receptor (IL-6R).
Abstract: Purpose: To report on two patients with refractory uveitis treated with tocilizumab; a new humanized monoclonal antibody against the interleukin-6 receptor (IL-6R).Design: Retrospective interventional case series.Methods: Both patients received a monthly infusion of tocilizumab 8 mg/kg; associated with corticosteroids. Outcome measures were visual acuity and central retinal thickness evaluated with optical coherence tomography.Results: An improvement in visual acuity and a decrease in macular edema were observed in these two patients.Conclusions: Tocilizumab seems to be a promising treatment in refractory uveitis. A prospective study is needed to evaluate the role of this new agent in the management of refractory uveitis.
91 citations
TL;DR: The authors attempt to provide a simple and practicable algorithm for a clinically tailored diagnostic approach in atypical instances of toxoplasmic retinochoroiditis.
Abstract: Toxoplasmic retinochoroiditis is deemed a local event, which may fail to evoke a detectable systemic immune response. A correct diagnosis of the disease is a necessary basis for estimating its clinical burden. This is not so difficult in a typical clinical picture. In atypical cases, further diagnostic efforts are to be installed. Although the aqueous humor may be analyzed for specific antibodies or the presence of parasitic DNA, the DNA burden therein is low, and in rare instances a confirmation would necessitate vitreous sampling. A laboratory confirmation of the diagnosis is frustrated by individual differences in the time elapsing between clinical symptoms and activation of specific antibody production, which may result in false negatives. In congenital ocular toxoplasmosis, a delay in the onset of specific local antibody production could reflect immune tolerance. Herein, the authors attempt to provide a simple and practicable algorithm for a clinically tailored diagnostic approach in atypical instances.
85 citations
TL;DR: Over several decades, genetic findings have provided clues to advance the understanding of mechanisms of uveitis and to catalyze new research on diagnostics, animal models, and therapies, but these discoveries have come with the caveat that a genetic finding does not automatically reveal the disease-relevant functional effect of the associated variant.
Abstract: The discovery of the association of HLA B27 with spondyloarthropathy led to more questions than answers about the role of this gene in disease susceptibility. The realization that HLA B27 was not responsible for all of the genetic effects helped to lay a foundation for further investigation into the genetics of uveitis. Over several decades, genetic findings have provided clues to advance the understanding of mechanisms of uveitis and to catalyze new research on diagnostics, animal models, and therapies. From the early candidate gene studies on immune mediators to the recent genome-wide investigations, much has been discovered. However, these discoveries have come with the caveat that a genetic finding does not automatically reveal the disease-relevant functional effect of the associated variant.
66 citations
TL;DR: Behçet disease should be considered in the differential diagnosis of childhood uveitis, particularly in endemic areas, and the collaboration of pediatricians, rheumatologists, dermatologists, ophthalmologists, and other specialists when necessary is required in the diagnosis and management of children with Behçet Disease.
Abstract: Purpose: To investigate the incidence and clinical characteristics of Behcet disease in children.Methods: The authors retrospectively reviewed the charts of 3382 patients with Behcet disease from October 1986 to December 2005 at Ankara University Medical School Behcet Unit and/or Atmaca private clinic.Results: 110 children were diagnosed with Behcet disease. The 110 children represented 3.3% of the total number of Behcet patients that were reviewed. 62.7% were girls and 37.3% were boys. The mean age at initial manifestation was 11.63 ± 3.46 years and at diagnosis was 14.15 ± 2.13 years. Ocular involvement was found in 30.9% of the children. Of these, 61.8% were bilateral and 38.2% were unilateral. Anterior uveitis was found in 18 eyes (32.8%), posterior uveitis in 24 eyes (43.6%), and panuveitis in 13 eyes (23.6%).Conclusion: Behcet disease should be considered in the differential diagnosis of childhood uveitis, particularly in endemic areas. The collaboration of pediatricians, rheumatologists, dermatolog...
66 citations
TL;DR: Topical corticosteroids and cycloplegic agents remain the cornerstones of treatment for AAU, and biological agents such as anti-TNF and anti-CD20 therapy may be effective in refractory severe AU but are rarely required.
Abstract: Acute anterior uveitis (AAU) is the most common form of uveitis, accounting for approximately 90% of all cases. Half of all cases of AAU are HLA-B27 positive. The disease is typically acute in onset, unilateral, nongranulomatous inflammation involving the iris and ciliary body, with a tendency to recurrent attacks. Approximately 50% of all patients with HLA-B27 AAU develop an associated seronegative arthritis (SNA), while approximately 25% of the patients initially diagnosed with HLA-B27 SNA develop AAU. Environmental factors play a critical role in the pathogenesis of AAU; in particular, bacterial triggers have been strongly implicated in the development of this disease. Topical corticosteroids and cycloplegic agents remain the cornerstones of treatment for AAU. Salazopirine and methotrexate are effective in decreasing recurrent attacks. Biological agents such as anti-TNF and anti-CD20 therapy may be effective in refractory severe AU but are rarely required.
66 citations
TL;DR: White dot syndromes are rare diseases and may be associated with other autoimmune diseases and further studies are needed to draw conclusions about visual prognosis, development of other ocular conditions, and associated medical diseases.
Abstract: Purpose: To measure the incidence of white dot syndromes (WDS) in a community-based population and to report clinical features and outcomes.Methods: Multicenter retrospective study using the Rochester Epidemiology Project medical records linkage system of Olmsted County, Minnesota. Databases were searched to identify all patients with WDS from January 1, 1988 through December 31, 2008.Results: Mean ophthalmic follow-up was 4.5 years and mean general medical follow-up was 9.1 years. The incidence of WDS was 0.45 per 100,000 per year (95% CI 0.19–0.71). Incidence rates for specific disease entities were also calculated. The authors report some associated autoimmune diseases in this series. Multiple evanescent white dot syndrome (MEWDS) was more common in females, and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) was more common in males. Both MEWDS and APMPPE generally carried a good visual prognosis. Fifty percent of cases with APMPPE had a positive history of psoriasis. The only punct...
62 citations
TL;DR: HLA*29:02 transgenic mice in which a spontaneous posterior uveitis is observed after 6 months of age provide further evidence that the HLA-A29 molecule plays a role in the pathogenesis of the disease.
Abstract: Birdshot chorioretinopathy primarily affects patients of European descent. At least 96%, if not all patients, are HLA-A29 carriers. HLA-A*29:01 and HLA-A*29:02, the two main subtypes of HLA-A29, differ only by a single mutation. In the general population HLA-A*29:02 is most frequent in whites, while HLA-A*29:01 is more frequent in Asians. The differential distribution of HLA-A*29:01 and HLA-A*29:02 has been actively debated as an explanation for the selective development of the disease in patients of European descent, but is no longer a valid argument. Another factor, probably not HLA linked, is either protective in Asians and in Africans or, conversely, triggers an autoimmune reactivity that is possibly present in whites and absent in Asians and in Africans. HLA-A*29:02 transgenic mice in which a spontaneous posterior uveitis is observed after 6 months of age provide further evidence that the HLA-A29 molecule plays a role in the pathogenesis of the disease.
55 citations
TL;DR: Opinions about therapy differ and controversy remains about its type, efficacy, and length, but it is suggested that intravitreal therapy may be promising for OT.
Abstract: Purpose: To review current evidence for the treatment of ocular toxoplasmosis (OT). Design: Narrative review and expert recommendations. Methods: Meta-analysis and selected original articles from the medical literature were reviewed critically. Expert recommendations were analyzed. Results: Numerous observational studies suggest a benefit of short-term antimicrobial therapy for toxoplasmic retinochoroiditis in immunocompetent patients, although its efficacy has not been proven in randomized clinical trials. A randomized clinical trial revealed that intermittent trimethoprim/sulfamethoxazole treatment could decrease the rate of recurrence in high-risk patients. Intravitreal injection of clindamycin and dexamethasone was an acceptable alternative to the classic treatment for OT in a randomized clinical trial. Conclusions: Opinions about therapy differ and controversy remains about its type, efficacy, and length. Intravitreal therapy may be promising for OT. A recent description of the presence of parasitemi...
55 citations
TL;DR: The aim of the present review was to report on the results of a survey of leading uveitis experts, in which the authors asked participants to address some of the most important issues related to diagnosis, pathophysiology, and treatment of ocular toxoplasmosis.
Abstract: Toxoplasmosis, a major cause of infectious uveitis, was elected by the editors of Ocular Immunology and Inflammation as the disease of the year for 2011. The aim of the present review was to report on the results of a survey of leading uveitis experts, in which the authors asked participants to address some of the most important issues related to diagnosis, pathophysiology, and treatment of ocular toxoplasmosis. The survey revealed generally good consensus regarding clinical signs of typical and atypical toxoplasmic retinochoroiditis. In contrast, views regarding diagnostic approach, possible epidemiological influences, transmission of disease, and trigger factors seemed less clearly defined. Responses revealed a large number of drug regimens in use for both congenital and acquired disease. Finally, recurrence prophylaxis was not regularly recommended by the majority of experts.
TL;DR: An algorithm for the treatment of inflammatory ME is proposed and the authors point out that the individual risk–benefit ratio, especially with systemic immunosuppressive therapy, should always be considered.
Abstract: The aim of this review is to summarize the recent developments in the treatment of inflammatory macular edema (ME). Inflammatory ME represents a major cause of visual loss in uveitis and its adequate management is crucial for the maintenance of useful vision in patients with uveitis. Recent studies favor early treatment of inflammatory ME, even in patients with full visual acuity. After recapitulating the standard treatment modalities for inflammatory ME the authors address novel corticosteroid implants. They review the literature on the efficacy of anti-VEGF agents for inflammatory ME and point out their beneficial, but transient effects. Further, they present recent data on the value of systemic biologics in uveitic ME and evaluate the effectiveness of vitrectomy. Finally, they propose an algorithm for the treatment of inflammatory ME and point out that the individual risk-benefit ratio, especially with systemic immunosuppressive therapy, should always be considered.
TL;DR: There can be considerable overlap in both clinical and imaging findings in APMPPE mimicking acute VKH, making it difficult to differentiate these two entities.
Abstract: Purpose: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with exudative retinal detachment, simulating acute Vogt-Koyanagi-Harada (VKH) disease and to review relevant imaging literature.Methods: Ophthalmologic examination, laboratory evaluation, fluorescein angiography, and B-scan ultrasonography performed at baseline, as well as spectral domain optical coherence tomography (OCT) and fundus autofluorescence performed upon initial presentation and at 5-day, 1-month, and 3-month follow-up.Results: OCT demonstrated outer retinal hyperreflectance and subretinal fluid in the acute phase that disappeared 5 days later. Choroidal thickening was noted on OCT and ultrasonography. Retinal pigment epithelium lesions were hypoautofluorescent acutely but became hyperautofluorescent later in the disease course.Conclusions: At presentation, there can be considerable overlap in both clinical and imaging findings in APMPPE mimicking acute VKH, making it difficult to differentiate thes...
TL;DR: Current knowledge on the role of parasite genetics in influencing susceptibility to ocular toxoplasmosis and on the immuno-pathogenesis of this disease are reviewed.
Abstract: Toxoplasma gondii is a major cause of chronic parasitic infection in the world. This protozoan can cause retino-choroiditis in newborns and in adults, both immunocompetent and immunodeficient. This disease tends to be recurrent and can lead to severe visual impairment. The authors review current knowledge on the role of parasite genetics in influencing susceptibility to ocular toxoplasmosis and on the immuno-pathogenesis of this disease.
TL;DR: KPro-associated corneal melt is uncommon and appears to occur in patients with preexisting inflammatory disorders, which might not have been previously diagnosed and timely explantation of KPro and replacement with donor cornea may prevent a poor outcome.
Abstract: Purpose: To describe the clinical features and outcomes of corneal melt associated with Boston type I keratoprosthesis (KPro) implantation.Methods: Medical records of patients who experienced corneal melt following KPro implantation were reviewed retrospectively.Results: Sixty-six adult patients had KPro implantation from January 2004 to November 2010. Six patients had an underlying inflammatory ocular surface disorder. Four experienced corneal melt (6.1%) 5–42 months after the initial surgery. One patient was diagnosed with Sjogren’s syndrome as a result of diagnostic workup following melt. Three patients were treated with systemic immunomodulatory therapy; two experienced fungal keratitis and subsequent endophthalmitis. KPro had to be explanted and replaced with donor cornea in all cases.Conclusions: KPro-associated corneal melt is uncommon and appears to occur in patients with preexisting inflammatory disorders, which might not have been previously diagnosed. Timely explantation of KPro and replacement...
TL;DR: In the index study, the employment of MMF has decreased frequency of attacks in recurrent PIC and fundus autofluorescence (FAF) may be employed to monitor and predict the response to treatment.
Abstract: Purpose: To compare the frequencies of attacks before and after immunomodulatory therapy (IMT) with mycophenolate mofetil (MMF) in recurrent punctate inner choroidopathy (PIC) and to report fundus autofluorescence (FAF) findings.Methods: Eight patients who had at least two recurrent episodes of increased activity before MMF and 12 months of documented clinical course before and after MMF were included. The frequencies of attacks before and after MMF were compared. FAF images evaluated.Results: Before MMF, the 8 patients experienced 19 attacks of recurrent disease activity; during MMF therapy, 3 (38%) patients experienced 6 recurrent episodes. The attack frequencies were 1.09 ± 0.75 before and 0.23 ± 0.32 during treatment (p = .036). Among the 6 patients who had FAF, surrounding hyperautofluorescent halo was detected in 4 and recurrence occurred in 2 who did not show any changes on the intensity during treatment.Conclusion: In the index study, the employment of MMF has decreased frequency of attacks in rec...
TL;DR: IFN alpha has been demonstrated to be a successful and well-tolerated treatment option for resistant chronic pseudophakic CME and further studies are necessary to evaluate the role of IFN alpha in Irvine-Gass syndrome.
Abstract: Purpose: To describe treatment of chronic Irvine-Gass syndrome (CME) with interferon (IFN) alpha.Methods: Interventional retrospective case series. IFN alpha-2a was administered at a dose of 3 million IU/day subcutaneously for 4 weeks, and was tapered thereafter. Treatment efficacy was assessed by best-corrected visual acuity (BCVA) and by optical coherence tomography (OCT).Results: Three patients (4 eyes) with chronic Irvine-Gass syndrome were treated. Ineffective pretreatment included local and systemic corticosteroids. Within 4 weeks, IFN alpha led to resolution of CME in all eyes. BCVA improved in 3 eyes and remained unchanged in 1 eye. During follow-up of 3–11 months no relapse of CME occurred. No systemic or local side effects were noted.Conclusions: IFN alpha has been demonstrated to be a successful and well-tolerated treatment option for resistant chronic pseudophakic CME. Further studies are necessary to evaluate the role of IFN alpha in Irvine-Gass syndrome.
TL;DR: Findings suggest that PEDF may act as an anti-inflammatory factor against decrease of GS expression in retinal Müller cells in diabetic retinopathy.
Abstract: Purpose: A predominant function of Muller cells is to regulate glutamate levels, but in diabetic retinopathy (DR) the function is compromised. The present study was performed to investigate the role of pigment epithelial-derived factor (PEDF) on the expression of glutamine synthetase (GS) in retina of diabetic rats.Methods: The levels of interleukin-1s (IL-1s), PEDF, and GS in the retina of diabetic rats were analyzed by Western blotting and real-time-RT-PCR, and glutamate concentrations in retina or vitreous body were determined by high-pressure liquid chromatography. After being treated with PEDF in diabetic rats, these proteins (IL-1s and GS) and their mRNAs, as well as glutamate concentrations, were detected. To confirm the effect of PEDF on GS against the role of IL-1s, treatments with IL-1s companied with or without PEDF were performed in the eyes of normal rats.Results: Diabetes increased IL-1s levels and decreased PEDF and GS levels in retina. Simultaneously, diabetes induced elevated glutamate co...
TL;DR: Chest HRCT was found to be a useful tool in the diagnosis of granulomatous uveitis, especially tuberculosis associated uveita, and can aid in therapeutic decisions.
Abstract: Aim: To evaluate the role of high-resolution computerized tomography (HRCT) of the chest as a diagnostic tool in granulomatous uveitis.Design: Observational case series.Methods: Fifty-eight consecutive patients were evaluated with chest HRCT based on clinical diagnosis of granulomatous uveitis, which was further classified using SUN classification as anterior, intermediate, posterior, and panuveitis. Clinical profile, laboratory findings, chest radiographs, and chest HRCT scans were analyzed.Results: Of 58 patients, 35 were males and 23 females with mean age of 43.5 years. Forty-seven patients had bilateral and 11 had unilateral involvement. Eighty-one percent of patients referred for chest HRCT demonstrated signs suggestive of tuberculosis, 8.6% patients showed signs suggestive of sarcoidosis, and 10.3% patients showed normal chest HRCT.Conclusion: Chest HRCT was found to be a useful tool in the diagnosis of granulomatous uveitis, especially tuberculosis associated uveitis, and can aid in therapeutic dec...
TL;DR: The demographics and clinical characteristics in patients with intraocular cysticercosis are analyzed, and it is found that the cyst may be in either the vitreous cavity or the subretinal space, and visual acuity at presentation is often poor.
Abstract: Purpose: To analyze the demographics and clinical characteristics in patients with intraocular cysticercosis.Methods: Retrospective case series and comprehensive literature review.Results: Intraocular cysticercosis was diagnosed in 21 of 21,079 patients (0.10%) seen by the uveitis service at Aravind Eye Hospital. At presentation, visual acuity was 20/200 or worse in 14 eyes (63.6%). Inflammation was unilateral in all but one patient (95.2%). The cyst was located in the vitreous cavity in 36.4% of eyes and in the subretinal space in 63.6% of eyes. In the literature review, most patients were affected unilaterally (98.5%); visual acuity at presentation was 20/200 or worse in 82.3% of eyes; and the cyst was located in the vitreous cavity in 59.5% of eyes.Conclusions: Intraocular cysticercosis usually affects young patients unilaterally. The cyst may be in either the vitreous cavity or the subretinal space, and visual acuity at presentation is often poor.
TL;DR: Ocular manifestations in Systemic lupus erythematosus are not uncommon and the eye can get affected in more than a third of the cases, according to this study.
Abstract: Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease, particularly prevalent in women, probably with a genetic predisposition with “triggering” from contact from an environm...
TL;DR: It is suggested that HMGB1 contributes to inflammatory disorders of the external eye, and 18β-glycyrrhetic acid may scavenge the protein and inhibit its detrimental effects.
Abstract: Purpose: High-mobility group proteins are chromatin-binding factors with key roles in nuclear homeostasis. Evidence indicates that extracellularly released high-mobility group box 1 protein (HMGB1) behaves as a cytokine, promoting inflammation and disease pathogenesis. HMGB1 release occurs during endophtalmitis or uveoretinitis.Methods: The authors investigated the presence of HMGB1 in tear fluid of patients with different inflammatory disorders of the external eye.Results: Data demonstrate that HMGB1 content is close to detection limit in tears of control subjects but highly increased (about 15-fold) in patients with conjunctivitis or blepharitis. The authors also report that 18β-glycyrrhetic acid impairs antibody recognition of HMGB1, suggesting direct binding to the protein. Accordingly, 18β-glycyrrhetic acid prevented HMGB1-dependent COX2 expression and cluster formation in primary cultures of human macrophages.Conclusion: Together, these findings suggest that HMGB1 contributes to inflammatory disorde...
TL;DR: Most cases are idiopathic (pars planitis); only few children presented associated systemic disease and macular edema and severe vitritis at presentation are associated with increased risk of visual impairment.
Abstract: Purpose: To investigate clinical data, outcome, and treatment of intermediate uveitis in children.Methods: Retrospective cohort study, including 116 children affected by intermediate uveitis.Results: Sixty-two percent of patients were males. Ocular involvement was bilateral in 84%. Mean age at uveitis onset was 10.3 ± 3.6 years and 12.2 ± 7 years at first visit. Ninety-seven percent were classified as having idiopathic uveitis. The incidence of ocular complications during follow-up was 0.131/eye-year. Macular edema or a marked vitreous haze at presentation may be risks factors for incident visual loss. The most frequent causes of visual loss were macular edema (64%) and cataract (21%).Conclusions: Most cases are idiopathic (pars planitis); only few children presented associated systemic disease. Macular edema and severe vitritis at presentation are associated with increased risk of visual impairment. Cystoid macular edema is the main cause of visual impairment.
TL;DR: Intravitreal foscarnet was efficacious in the treatment of acyclovir-resistant ARN caused by VZV and may be used as the sole treatment in patients with intolerance to systemic administration.
Abstract: Purpose: To report of a case of acute retinal necrosis (ARN), successfully treated with intravitreal foscarnet.Methods: Case report.Results: A 40-year-old man diagnosed with varicella zoster virus (VZV)-induced ARN failed standard acyclovir treatment. He was treated subsequently with intravenous foscarnet, but developed acute renal failure after 1 day of treatment. All systemic anti-viral agents were discontinued, and intravitreal foscarnet was administered weekly. After 5 injections, the retinitis was dramatically improved.Conclusions: Intravitreal foscarnet was efficacious in the treatment of acyclovir-resistant ARN caused by VZV. It may be used as the sole treatment in patients with intolerance to systemic administration.
TL;DR: Early treatment with plasma exchange achieved reperfusion of the occluded microvascular circulation with correspondingly good visual recovery and should be considered when patients present with corticosteroid refractory retinal vasculitis associated with SLE.
Abstract: Purpose: To report a case of acute occlusive retinal vasculopathy secondary to systemic lupus erythematosus (SLE) successfully treated with plasma exchange and rituximabMethods: Case ReportResults: A 25-year-old female presenting acutely with lupus retinal vasculitis was treated urgently with plasma exchange after failure to respond to intravenous methylprednisolone. Following this, fluorescein angiography demonstrated reperfusion of occluded arterioles. Visual acuity improved from 6/60 to 6/6 bilaterally. Remission was maintained following rituximab (Rituxan) in combination with mycophenolatemofetil and oral prednisolone.Conclusions: Early treatment with plasma exchange achieved reperfusion of the occluded microvascular circulation with correspondingly good visual recovery and should be considered when patients present with corticosteroid refractory retinal vasculitis associated with SLE.
TL;DR: Evidence for KIRs in the pathogenesis of uveitis has been found, and a trend toward decreased activation and stronger inhibition was found in HLA-B27-associated disease, except for the weakly inhibitory 3DL1 and Bw4T80 combination.
Abstract: Purpose: to review the function and genetics of killer immunoglobulin-like receptors (KIRs) and studies of KIR genetic associations with uveitis.Methods: Review of published studies.Results: KIRs are receptors on NK and some T cells. They may inhibit or activate cellular function, such as cytotoxicity and cytokine production. Studies have been published examining KIR gene associations with birdshot chorioretinopathy (BCR), Vogt-Koyanagi-Harada (VKH) disease, and HLA-B27-associated acute anterior uveitis (AAU) and axial spondyloarthropathy. Evidence for increased activating and/or less inhibitory KIR and HLA gene combinations was found for BCR and VKH disease. In HLA-B27-associated disease, a trend toward decreased activation and stronger inhibition was found, except for the weakly inhibitory 3DL1 and Bw4T80 combination. This latter combination was also found to confer risk in BCR.Conclusions: KIR genetics are complex, as are the functions of KIR-bearing cells. Nonetheless, evidence for KIRs in the pathoge...
TL;DR: In the authors’ experience, sarcoidosis is the leading cause of uveitis in the elderly, and Idiopathic Uveitis and other specific entities account for less than two-thirds of cases.
Abstract: Purpose: To describe uveitis clinical characteristics in the elderly.Methods: Retrospective review of 91 patients at the age of 60 or more years at the authors’ uveitis tertiary center over a 7-yea...
TL;DR: An overview of the differential diagnosis of ocular toxoplasmosis is provided, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting.
Abstract: The diagnosis of ocular toxoplasmosis is mainly clinical, based in the presence of focal necrotizing retinochoroiditis often associated with a preexistent chorioretinal scar, and variable involvement of the vitreous, retinal blood vessels, optic nerve, and anterior segment of the eye. Recognition of this clinical spectrum of toxoplasmic retinochoroiditis is crucial, but other infectious, noninfectious, and neoplastic entities should also be considered in the differential diagnosis. Investigations such as serological tests, polymerase chain reaction of ocular fluids, and assessment of intraocular antibody synthesis are helpful in uncertain cases. This article provides an overview of the differential diagnosis of ocular toxoplasmosis, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting. Ocular toxoplasmosis has multiple clinical manifestations, which partially overlap with those of other entities and these should be carefully considered when making the differential diagnosis, particularly in less typical cases.
TL;DR: The most commonly encountered organisms were Propionibacterium acnes (n = 8) and Staphylococcus epidermidis (n= 6), in 2 cases with the same organism as a matching positive used needle.
Abstract: Purpose: To determine the incidence of bacterial contamination of needles used for intravitreal injections.Methods: Patients undergoing intravitreal injections were enrolled prospectively. No pre-injection antibiotics were administered. Following povidone–iodine irrigation, conjunctival cultures were taken and the injection was performed. The needle was cultured. A dry control needle was exposed to the surgical field and cultured.Results: No patients developed endophthalmitis. Eighteen injection needles (18%) yielded positive bacterial growth. The most commonly encountered organisms were Propionibacterium acnes (n = 8) and Staphylococcus epidermidis (n = 6). Four control needles showed positive growth, in 2 cases with the same organism as a matching positive used needle. The difference between contamination rates of used and control needles was significant (p = .002, McNemar’s test).Conclusions: Bacterial contaminants are present on a substantial proportion of needles. Since the needle contacts both the o...
TL;DR: RT-PCR for Treponema pallidum in aqueous humor is useful to confirm syphilitic panuveitis and positive results were positive in the 3 cases of panuve inflammation and negative in the 2 other cases.
Abstract: Purpose: To report the additional clinical value of real-time Polymerase chain reaction (PCR) in the detection of Treponema pallidum in aqueous humor.Methods: A real-time (RT) PCR assay targeting the polymerase 1 gene of Treponema pallidum was performed in aqueous humor samples collected in consecutive patients with ocular syphilis.Results: Five patients presenting with optic neuritis (1), posterior placoid chorioretinitis (1), or panuveitis with retinitis (3) were tested. The PCR results were positive in the 3 cases of panuveitis and negative in the 2 other cases.Conclusion: RT-PCR for Treponema pallidum in aqueous humor is useful to confirm syphilitic panuveitis.