RESUMEN
PURPOSE: Evaluate the response to adalimumab (ADA) in pediatric chronic anterior uveitis (pCAU). METHODS: Retrospective chart review of pCAU patients treated with ADA. Outcomes evaluated included the proportion of patients achieving zero ocular inflammation and discontinuation of topical corticosteroids, visual outcomes, and incidence of uveitis recurrences after ≥ 12 months of prescribing ADA. Incidence and risk factors for developing anti-adalimumab antibodies (AAAs) were also evaluated. RESULTS: Of 27 children aged 11 years, 16 (59%) were Caucasian and 6 (22%) African Americans. Thirteen (48%) patients had idiopathic pCAU, 12 (44%) had juvenile idiopathic arthritis (JIA) related pCAU, and 2 (7%) had tubulointerstitial nephritis and uveitis syndrome. At baseline, African American children had worse visual acuity (p = 0.026). At 1 year, 21 (78%) children achieved zero ocular inflammation (remission). Risk factors associated with non-remission were being African American (20% vs. 94%, p = 0.003) and experiencing ≥ 1 episode of uveitis recurrence (100% vs. 0%, p < 0.001). Six episodes of uveitis recurrence were documented in five children, four of whom were African American. Topical corticosteroids were discontinued in 83% of children, and visual acuity remained stable for 1 year. Twelve children were tested for AAAs due to arthritis or uveitis flare-ups, with five (42%) being positive. No significant factors were associated with the development of AAAs. CONCLUSIONS: We found that ADA is effective in controlling inflammation, reducing the need for topical corticosteroids, and maintaining visual acuity in pCAU. There appears to be racial differences in African American children who had worse baseline disease and poorer outcomes. Studies are necessary to understand better and address these disparities.
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Adalimumab , Uveítis Anterior , Agudeza Visual , Humanos , Niño , Adalimumab/uso terapéutico , Masculino , Femenino , Estudios Retrospectivos , Uveítis Anterior/tratamiento farmacológico , Uveítis Anterior/diagnóstico , Enfermedad Crónica , Antiinflamatorios/uso terapéutico , Antiinflamatorios/administración & dosificación , Adolescente , Resultado del Tratamiento , Estudios de Seguimiento , PreescolarRESUMEN
This retrospective cohort study investigated patients with cytomegalovirus anterior uveitis (CMV AU) and compared treatment outcomes between regional and systemic antiviral therapies. Treatment modalities included topical (2% ganciclovir [GCV] eye drops or 0.2% GCV eye gel) and systemic (intravenous GCV or oral valganciclovir) groups. The comparison parameters included response rates, time to response, recurrence rates, time to recurrence, and complications. Forty-four patients (54.5% male) with a mean age of 56 ± 9.87 years were enrolled, with 31 eyes in the topical group and 13 eyes in the systemic group. The median response time was significantly slower in the topical group (63 days [IQR 28-112]) compared to the systemic group (28 days [IQR 24-59]) (p = 0.04). Treatment response rates were 87.1% (27/31) in the topical group and 100% (13/13) in the systemic group (p = 0.30), while recurrence rates were 37% (10/27) and 69.2% (9/13) (p = 0.056), with a median time to recurrence of 483 days [IQR 145-1388] and 392 days [IQR 203.5-1907.5] (p = 0.20), respectively. In conclusion, both topical and systemic GCV treatments demonstrated favorable outcomes for CMV AU. Systemic GCV showed rapid control of intraocular inflammation.
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Antivirales , Infecciones por Citomegalovirus , Ganciclovir , Uveítis Anterior , Humanos , Masculino , Femenino , Persona de Mediana Edad , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/virología , Uveítis Anterior/tratamiento farmacológico , Uveítis Anterior/virología , Antivirales/uso terapéutico , Antivirales/administración & dosificación , Estudios Retrospectivos , Resultado del Tratamiento , Ganciclovir/uso terapéutico , Ganciclovir/administración & dosificación , Anciano , Citomegalovirus , Adulto , Valganciclovir/uso terapéutico , Recurrencia , Soluciones OftálmicasRESUMEN
HLA-B*27 was one of the first HLA alleles associated with an autoimmune disease, i.e., axial spondyloarthritis (axSpA) and acute anterior uveitis (B27AAU), which cause joint and eye inflammation, respectively. Gastrointestinal inflammation has been suggested as a trigger of axSpA. We recently identified a bacterial peptide (YeiH) that can be presented by HLA-B*27 to expanded public T cell receptors in the joint in axSpA and the eye in B27AAU. While YeiH is present in enteric microbiota and pathogens, additional evidence that pathogenic T cells in HLA-B*27-associated autoimmunity may have had a prior antigenic encounter within the gastrointestinal tract remains lacking. Here, we analyzed ocular, synovial, and blood T cells in B27AAU and axSpA, showing that YeiH-specific CD8+ T cells express a mucosal gene set and surface proteins consistent with intestinal differentiation, including CD161, integrin α4ß7, and CCR6. In addition, we found an expansion of YeiH-specific CD8+ T cells in axSpA and B27AAU blood compared with that from individuals acting as healthy controls, whereas influenza-specific CD8+ T cells were equivalent across groups. Finally, we demonstrated the dispensability of TRBV9 for antigen recognition. Collectively, our data suggest that, in HLA-B27-associated autoimmunity, early antigen exposure and differentiation of pathogenic CD8+ T cells may occur in enteric organs.
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Espondiloartritis Axial , Antígeno HLA-B27 , Receptores CCR6 , Uveítis Anterior , Humanos , Uveítis Anterior/inmunología , Antígeno HLA-B27/genética , Antígeno HLA-B27/inmunología , Receptores CCR6/genética , Receptores CCR6/metabolismo , Receptores CCR6/inmunología , Espondiloartritis Axial/inmunología , Femenino , Masculino , Adulto , Linfocitos T CD8-positivos/inmunología , Integrinas/metabolismo , Integrinas/inmunología , Persona de Mediana EdadRESUMEN
A 64-year-old male, working at a mountain site in Taitung County, suffered from primary open angle glaucoma (POAG) post trabeculectomy with well-controlled intraocular pressure (IOP) in both eyes (OU). He presented with headache accompanied by red eyes (OU) for 10 days. Physical examination revealed fever up to 38.2°C, neck stiffness, one eschar at the left forearm and another at the left ankle. Abnormal laboratory data indicated bacterial infection with central nervous system involvement. Ophthalmic examination showed elevated IOP, moderate conjunctival congestion, subconjunctival hemorrhage, anterior uveitis, cotton-wool spots on the retina and multiple white dots on the temporal retina (OU). Under the impression of uveitis in tsutsugamushi disease with atypical meningitis, oral doxycycline, anti-glaucoma and anti-inflammation eye drugs were prescribed. IOP returned to 12 mmHg and anterior uveitis subsided. The lesions of cotton-wool spots on the retina disappeared within 2 weeks, but multiple white dots remained persistently on the temporal retina.
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Infecciones Bacterianas del Ojo , Glaucoma de Ángulo Abierto , Presión Intraocular , Tifus por Ácaros , Humanos , Masculino , Persona de Mediana Edad , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Presión Intraocular/fisiología , Tifus por Ácaros/diagnóstico , Tifus por Ácaros/tratamiento farmacológico , Tifus por Ácaros/microbiología , Tifus por Ácaros/complicaciones , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/microbiología , Antibacterianos/uso terapéutico , Orientia tsutsugamushi/aislamiento & purificación , Doxiciclina/uso terapéutico , Uveítis Anterior/microbiología , Uveítis Anterior/diagnóstico , Uveítis Anterior/tratamiento farmacológico , TrabeculectomíaRESUMEN
The gut microbiota plays a pivotal role in regulating host immunity, and dysregulation of this interaction is implicated in autoimmune and inflammatory diseases, including spondyloarthritis (SpA). This review explores microbial dysbiosis and altered metabolic function observed in various forms of SpA, such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), acute anterior uveitis (AAU), and SpA-associated gut inflammation. Studies on animal models and clinical samples highlight the association between gut microbial dysbiosis, metabolic perturbations and immune dysregulation in SpA pathogenesis. These studies have received impetus through next-generation sequencing methods, which have enabled the characterization of gut microbial composition and function, and host gene expression. Microbial/metabolomic studies have revealed potential biomarkers and therapeutic targets, such as short-chain fatty acids, and tryptophan metabolites, offering insights into disease mechanisms and treatment approaches. Further studies on microbial function and its modulation of the immune response have uncovered molecular mechanisms underlying various SpA. Understanding the complex interplay between microbial community structure and function holds promise for improved diagnosis and management of SpA and other autoimmune disorders.
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Disbiosis , Microbioma Gastrointestinal , Espondiloartritis , Humanos , Microbioma Gastrointestinal/fisiología , Microbioma Gastrointestinal/inmunología , Disbiosis/inmunología , Espondiloartritis/inmunología , Espondiloartritis/microbiología , Animales , Espondilitis Anquilosante/inmunología , Espondilitis Anquilosante/microbiología , Espondilitis Anquilosante/terapia , Artritis Psoriásica/inmunología , Artritis Psoriásica/microbiología , Uveítis Anterior/inmunología , Uveítis Anterior/microbiología , Ácidos Grasos Volátiles/metabolismoRESUMEN
OBJECTIVES: This study explores the clinical characteristics associated with the occurrence of acute anterior uveitis (AAU) in patients with axial spondyloarthritis (axSpA) within a large, multicentre database. METHODS: This observational, cross-sectional study of patients with axSpA used data from the Chinese Spondyloarthritis Registry between August 1, 2018, and March 31, 2020. The demographic and clinical features of patients with and without AAU were compared. Univariate and multivariate analyses were performed to determine the association between variables and uveitis. RESULTS: A total of 4304 patients were included in this study. The prevalence of AAU in patients with axSpA was 10.59%. Multivariate logistic regression analysis revealed a positive correlation between AAU and age at diagnosis (odds ratio [OR], 1.026; p<0.001), disease duration (OR, 2.117; p<0.001), current or past Achilles tendinitis (OR, 1.692; p<0.001), current or past dactylitis (OR, 1.687; p=0.002), current or past psoriasis (OR, 3.932; p<0.001), presence of human leukocyte antigen-B27 (HLA-B27) (OR, 2.787; p<0.001), and a good response to non-steroidal anti-inflammatory drugs (NSAIDs) (OR, 1.343; p=0.027). CONCLUSIONS: AAU was the most common extra-articular manifestation in the Chinese Spondyloarthritis Registry. In Chinese patients with axSpA, older age at diagnosis, longer disease duration, presence of HLA-B27, current or past Achilles tendinitis, current or past dactylitis, current or past psoriasis, and a good response to NSAIDs were positively associated with AAU.
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Espondiloartritis Axial , Sistema de Registros , Uveítis Anterior , Humanos , Uveítis Anterior/epidemiología , Uveítis Anterior/diagnóstico , Masculino , Femenino , Adulto , Estudios Transversales , Persona de Mediana Edad , China/epidemiología , Espondiloartritis Axial/epidemiología , Espondiloartritis Axial/tratamiento farmacológico , Espondiloartritis Axial/diagnóstico , Prevalencia , Antígeno HLA-B27/sangre , Enfermedad Aguda , Factores de Riesgo , Pueblos del Este de AsiaRESUMEN
PURPOSE: The identification of infectious etiologies is important in the management of uveitis. Ocular fluid testing is required, but multiplex testing faces challenges due to the limited volume sampled. The determination of antibody repertoire of aqueous humor (AH) is not possible with conventional assays. We investigated the use of a highly multiplexable serological assay VirScan, a Phage ImmunoPrecipitation Sequencing (PhIP-Seq) library derived from the sequences of more than 200 viruses to determine the antibody composition of AH in patients with uveitis. DESIGN: Prospective, case control study. METHODS: We analyzed the paired AH and plasma samples of 11 immunocompetent patients with active polymerase chain reaction-positive cytomegalovirus (CMV) anterior uveitis and the AH of 34 control patients undergoing cataract surgery with no known uveitis in an institutional practice. The samples were tested using VirScan PhIP-Seq, and the entire pan-viral antibody repertoire was determined using peptide tile ranking by normalized counts to identify significant antibodies enrichment against all viruses with human tropism. RESULTS: Significant enrichment of antibodies to Herpesviridae, Picornavirdae, and Paramyxoviridae was detectable in 20 µL of AH samples from patients with CMV uveitis and controls. Patients with CMV uveitis had relative enrichment of anti-CMV antibodies in AH compared with their plasma. Epitope-level mapping identified significant enrichment of antibodies against CMV tegument protein pp150 (P = 1.5e-06) and envelope glycoprotein B (P = .0045) in the AH compared with controls. CONCLUSIONS: Our proof-of-concept study not only sheds light on the antibody repertoire of AH but also expands the utility of PhIP-Seq to future studies to detect antibodies in AH in the study of inflammatory eye diseases.
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Anticuerpos Antivirales , Humor Acuoso , Infecciones por Citomegalovirus , Citomegalovirus , Infecciones Virales del Ojo , Humanos , Humor Acuoso/virología , Humor Acuoso/inmunología , Estudios Prospectivos , Infecciones Virales del Ojo/inmunología , Infecciones Virales del Ojo/virología , Infecciones Virales del Ojo/diagnóstico , Femenino , Masculino , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Persona de Mediana Edad , Citomegalovirus/inmunología , Citomegalovirus/genética , Infecciones por Citomegalovirus/virología , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/diagnóstico , Anciano , Estudios de Casos y Controles , Adulto , Uveítis Anterior/inmunología , Uveítis Anterior/virología , Uveítis Anterior/diagnóstico , ADN Viral/análisis , Reacción en Cadena de la Polimerasa , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Several autoimmune disorders have been linked to polymorphisms in IL10 and IL6R genes. This research aimed to study whether single nucleotide polymorphisms (SNPs) in the genes of IL10 and IL6R were associated with acute anterior uveitis (AAU) in Han Chinese. METHODS: Genotyping was carried out by the iPLEX Gold Genotyping Assay. Our study comprised 420 patients with AAU and 918 healthy subjects from Han Chinese. Using the chi-square (χ2) test, alleles and genotypes were analyzed between AAU subjects and healthy controls. RESULTS: All ten SNPs were successfully genotyped and four SNPs (IL10/rs1800871, IL10/rs3021094, IL10/rs2222202, IL6R/rs4845618) exhibited weak associations with AAU, as indicated by their Puncorr values. However, upon applying the Bonferroni correction, there was no significant association between AAU and the control subjects. Additionally, the haplotype analysis of the ten SNPs revealed no association with AAU. CONCLUSION: Our findings suggested that polymorphisms of the tested ten SNPs on the IL10 and IL6R genes did not show any association with the risk of developing AAU among the Han Chinese population.
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Pueblos del Este de Asia , Predisposición Genética a la Enfermedad , Interleucina-10 , Receptores de Interleucina-6 , Uveítis Anterior , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Enfermedad Aguda , Alelos , Pueblo Asiatico/genética , Estudios de Casos y Controles , China/epidemiología , Frecuencia de los Genes , Genotipo , Haplotipos , Interleucina-10/genética , Polimorfismo de Nucleótido Simple , Receptores de Interleucina-6/genética , Uveítis Anterior/genéticaRESUMEN
OBJECTIVES: To evaluate the effectiveness of the anterior segment optical coherence tomography (AS-OCT) for the screening of anterior uveitis in children diagnosed with juvenile idiopathic arthritis (JIA). METHODS: A cross-sectional, observational, non-randomised study was conducted in JIA patients younger than 18 years. All patients underwent anterior segment (AS-OCT) and macular OCT. RESULTS: A total of 300 eyes of 150 patients diagnosed with JIA were included; 74% were females, and mean age was 11.12 ± 3.51 years old (range 4.13-18.60). In the slit-lamp examination, anterior uveitis was diagnosed in 16 eyes. In the AS-OCT, anterior uveitis was suspected in 27 eyes; cells were detected in 27 eyes and retrokeratic precipitates in 5 eyes. Sensitivity was 0.94 and specificity was 0.96, positive predictive value was 0.59 and negative predictive value was 0.99, and Kappa-Cohen index was 0.71. CONCLUSIONS: AS-OCT could be considered for the screening of anterior segment uveitis in children diagnosed with JIA.
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Artritis Juvenil , Tomografía de Coherencia Óptica , Uveítis Anterior , Humanos , Artritis Juvenil/diagnóstico por imagen , Artritis Juvenil/complicaciones , Niño , Femenino , Masculino , Estudios Transversales , Adolescente , Uveítis Anterior/diagnóstico por imagen , Preescolar , Valor Predictivo de las Pruebas , Cámara Anterior/diagnóstico por imagen , Cámara Anterior/patología , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: The human gut microbiome (GM) is involved in inflammation and immune response regulation. Dysbiosis, an imbalance in this ecosystem, facilitates pathogenic invasion, disrupts immune equilibrium, and potentially triggers diseases including various human leucocyte antigen (HLA)-B27-associated autoinflammatory and autoimmune diseases such as inflammatory bowel disease (IBD) and spondyloarthropathy (SpA). This study assesses compositional and functional alterations of the GM in patients with HLA-B27-associated non-infectious anterior uveitis (AU) compared to healthy controls. METHODS: The gut metagenomes of 20 patients with HLA-B27-associated non-infectious AU, 21 age- and sex-matched HLA-B27-negative controls, and 6 HLA-B27-positive healthy controls without a history of AU were sequenced using the Illumina NovaSeq 6000 platform for whole metagenome shotgun sequencing. To identify taxonomic and functional features with significantly different relative abundances between groups and to identify associations with clinical metadata, the multivariate association by linear models (MaAsLin) R package was applied. RESULTS: Significantly higher levels of the Eubacterium ramulus species were found in HLA-B27-negative controls (p = 0.0085, Mann-Whitney U-test). No significant differences in microbial composition were observed at all other taxonomic levels. Functionally, the lipid IVA biosynthesis pathway was upregulated in patients (p < 0.0001, Mann-Whitney U-test). A subgroup analysis comparing patients with an active non-infectious AU to their age- and sex-matched HLA-B27-negative controls, showed an increase of the species Phocaeicola vulgatus in active AU (p = 0.0530, Mann-Whitney U-test). An additional analysis comparing AU patients to age- and sex-matched HLA-B27-positive controls, showed an increase of the species Bacteroides caccae in controls (p = 0.0022, Mann-Whitney U-test). CONCLUSION: In our cohort, non-infectious AU development is associated with compositional and functional alterations of the GM. Further research is needed to assess the causality of these associations, offering potentially novel therapeutic strategies.
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Microbioma Gastrointestinal , Antígeno HLA-B27 , Uveítis Anterior , Humanos , Antígeno HLA-B27/genética , Antígeno HLA-B27/inmunología , Femenino , Masculino , Microbioma Gastrointestinal/fisiología , Persona de Mediana Edad , Uveítis Anterior/microbiología , Uveítis Anterior/inmunología , Adulto , Estudios de Casos y Controles , AncianoRESUMEN
PURPOSE: To report a case of phacolytic glaucoma with atypical presentation in a patient which was diagnosed with biometry swept source optical coherence tomography (SS-OCT) and anterior segment spectral domain OCT (SD-OCT). METHODS: A 56-year-old male with a history of cytomegalovirus (CMV) chronic anterior uveitis in the right eye presented with a white cataract, minimal anterior chamber reaction and intraocular pressure (IOP) of 56â mmHg. Visual acuity was light perception. The anterior chamber was deep, without evidence of macroscopically visible capsular rupture. A surgical intervention was necessitated with the puzzle being whether to proceed with a trabeculectomy or a combined phaco-trabeculectomy. After a routine preoperative assessment with intraocular lens Master700, the disintegration of the natural lens was noticed. Anterior segment Spectralis OCT confirmed a lamellar separation of the anterior one third of the lens, resembling a poultaceous material. After an uneventful phacoemulsification, visual acuity was 6/6, IOP was well-controlled on maximum topical antiglaucoma treatment and no CMV recurrence was observed. RESULTS: The diagnosis of phacolytic glaucoma was established with the aid of current imaging OCT systems. Both OCT images were suggestive of a phacolytic nature of our case, despite the fact that the clinical presentation was not in concordance with such a typical case. In view of our findings the decision was to proceed with cataract extraction alone. CONCLUSION: This is the first time that we image and document the phacolytic nature of a natural lens. Our patient did not have the typical clinical presentation and was differentially diagnosed with biometry SS-OCT and confirmed by anterior segment SD-OCT.
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Segmento Anterior del Ojo , Biometría , Infecciones por Citomegalovirus , Infecciones Virales del Ojo , Presión Intraocular , Tomografía de Coherencia Óptica , Uveítis Anterior , Humanos , Masculino , Tomografía de Coherencia Óptica/métodos , Persona de Mediana Edad , Uveítis Anterior/diagnóstico , Uveítis Anterior/virología , Presión Intraocular/fisiología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/virología , Infecciones por Citomegalovirus/complicaciones , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/virología , Segmento Anterior del Ojo/diagnóstico por imagen , Facoemulsificación , Agudeza Visual/fisiología , Catarata/diagnóstico , Catarata/complicaciones , Citomegalovirus/aislamiento & purificación , Glaucoma/diagnósticoRESUMEN
A 71-year-old woman had 2 months of worsening vision and pain in her right eye. Examination revealed retrocorneal plaque, peaking of the pupil, and temporal prominent scleral vessels with inferotemporal scleral thinning. What would you do next?
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Segmento Anterior del Ojo , Complicaciones Posoperatorias , Humanos , Segmento Anterior del Ojo/diagnóstico por imagen , Segmento Anterior del Ojo/patología , Femenino , Masculino , Anciano , Persona de Mediana Edad , Inflamación/etiología , Endoftalmitis/etiología , Endoftalmitis/diagnóstico , Uveítis Anterior/etiología , Uveítis Anterior/diagnóstico , Trabeculectomía/efectos adversosRESUMEN
Purpose: To report patients who first presented with various ocular manifestations and eventually ascertained to have underlying dengue. Methods: A prospective study was conducted at multiple tertiary eye-care centers in India from 2012 to 2022. Cases reporting initially with ocular features along with fever/past history of fever over the last two weeks or with clinical features of dengue were selected. After an ophthalmological examination, patients underwent complete serological and biochemical analysis and those with reduced platelet counts were evaluated for dengue. Results: Out of 564 cases, 15 patients were verified to be afflicted with dengue eventually. A rising trend of cases was seen every year and out of 15 cases, eight cases were reported during the Covid-19 pandemic (from 2020 to 2022), but were COVID-negative. 9 cases presented with acute redness followed by diminished vision. Seven cases presented a history of fever over the last few days and one had traveled from dengue endemic area. The various ocular presentations included subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth-nerve palsy, and vitreous hemorrhage. On serological examination, all 15 patients were detected to have low platelets. All cases responded well with supportive treatment and the ocular features subsided in all within a couple of weeks with good visual recovery. Conclusion: In a tropical nation, such as India, with endemic dengue zones and increasing figures of dengue lately, ophthalmologists must include dengue fever among the differential diagnoses in various ocular presentations like subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth nerve palsy, and vitreous hemorrhage. Abbreviations: DHF = dengue hemorrhagic fever, PCR = polymerase chain reaction, RT-PCR = real-time automated reverse transcriptase (RT-PCR), SD = standard deviation, MAC-ELIS = IgM antibodies capture enzyme-linked immunosorbent assay, RE = right eye, LE = left eye, CECT = Contrast-enhanced computed tomography.
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Enfermedades del Nervio Abducens , Dengue , Infecciones Virales del Ojo , Queratitis , Uveítis Anterior , Humanos , Hemorragia Vítrea , Pandemias , Estudios Prospectivos , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/epidemiología , Dengue/complicaciones , Dengue/diagnóstico , Dengue/epidemiologíaRESUMEN
Objective: Our purpose was to present a case of a patient diagnosed with herpes zoster ophthalmicus with multiple ocular manifestations. Case presentation: A 70-year-old Caucasian male presented to the hospital for headache and skin hyperesthesia on the scalp and forehead on the left side. The diagnoses of herpes zoster ophthalmicus and acute conjunctivitis were made for the left eye. The patient was followed up for 6 months and during that period the following diagnoses were made for the same eye: peripheral sterile corneal infiltrates, episcleritis, and hypertensive anterior uveitis. Discussions: Herpes zoster ophthalmicus occurs when the reactivation of the dormant virus involves the ophthalmic division of the trigeminal nerve. The most frequent ocular presentations are conjunctivitis, keratitis, uveitis, episcleritis, and scleritis. The standard therapy consists of antivirals, such as acyclovir, valacyclovir, and famciclovir to limit the replication of the virus. The patient's risk factors, the course of treatment, and the severity of the disease, all affect the prognosis, which is highly variable. Prevention of the disease consists of vaccination with one of the following two vaccines, Zostavax and Shingrix. Conclusions: Final visual acuity for the left eye remained 1 despite numerous manifestations of the disease. Abbreviations: VZV = Varicella-zoster virus, BCVA = best-corrected visual acuity, OU = both eyes, OD = right eye, OS = left eye, IOP = intraocular pressure, NCT = non-contact tonometer, ZVX = Zostavax vaccine.
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Conjuntivitis , Herpes Zóster Oftálmico , Vacuna contra el Herpes Zóster , Escleritis , Uveítis Anterior , Masculino , Humanos , Anciano , Herpes Zóster Oftálmico/complicaciones , Herpes Zóster Oftálmico/diagnóstico , Herpes Zóster Oftálmico/tratamiento farmacológico , Uveítis Anterior/diagnóstico , Uveítis Anterior/tratamiento farmacológico , Uveítis Anterior/etiologíaRESUMEN
Purpose: Nonanterior uveitis frequently involves the retinal vasculature; however, no molecular markers associated with the retinal vascular disease are currently known. In this study, we aimed to identify serum biomarker signatures associated with retinal vascular involvement in noninfectious pediatric uveitis. Methods: We performed a 384-plex targeted proteomic analysis of serum samples of 154 noninfectious pediatric uveitis patients diagnosed with nonanterior uveitis (n = 74), idiopathic chronic anterior uveitis (iCAU, n = 36), or juvenile idiopathic arthritis-associated uveitis (JIA-U, n = 44), as well as 22 noninflammatory pediatric controls. Data on retinal vascular involvement (i.e., papillitis, cystoid macular edema, retinal vasculitis, or retinal capillary leakage on optical coherence tomography and/or fluorescein angiography) were used to stratify cases in the nonanterior uveitis group. Results: In the analysis of nonanterior uveitis, we identified nine proteins significantly associated with retinal vascular involvement, including F13B, MYOM3, and PTPN9. These proteins were enriched through pathway enrichment analysis for the coagulation cascade. Comparing cases and controls, we identified 63 differentially expressed proteins, notably proteins involved in platelet biology and complement cascades, which could be primarily attributed to differences in serum proteomes between anterior uveitis and nonanterior uveitis groups. Conclusions: Serum proteins related to the coagulation and complement cascade are associated with retinal vascular involvement in pediatric uveitis patients. Our results indicate involvement of mediators that could interact with the microcirculation in pediatric uveitis and might serve as potential biomarkers in personalized medicine in the future. Translational Relevance: Our targeted proteomics analysis in serum of pediatric uveitis patients indicates involvement of mediators that could interact with the microcirculation in pediatric uveitis and might serve as potential biomarkers in personalized medicine in the future.
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Enfermedades de la Retina , Uveítis Anterior , Uveítis , Humanos , Niño , Proteómica , Uveítis/diagnóstico , Uveítis Anterior/diagnóstico , BiomarcadoresRESUMEN
PURPOSE: To evaluate the utility of ultrawide-field fluorescein angiography (UWFFA) in patients with anterior uveitis by investigating the detection of retinal vascular leakage (RVL) and the subsequent implications on disease diagnosis and management. STUDY DESIGN/MATERIALS AND METHODS: Patients, who were referred to the National Eye Institute (NEI) for evaluation of anterior uveitis and underwent UWFFA imaging at the initial visit, were included in this study. The electronic medical records of eligible patients were reviewed. The UWFFA images were assessed for severity of retinal vascular leakage, presence of macular leakage, and optic disc leakage by a two-grader system, and intergrader agreement was calculated using the κ-value. Patients with altered diagnoses and management attributable to UWFFA results were noted. RESULTS: A total of 93 eyes of 63 patients were included in the study. Of 93 eyes, 31 (33.3%) eyes had RVL on UWFFA, with 26 (28.0%) eyes and 5 (5.4%) eyes showing mild and moderate-severe RVL, respectively. Twenty-five (26.9%) eyes showed macular leakage, and 7 (7.5%) eyes showed optic disc leakage. The κ-values ranged from 0.85 - 0.87 indicating excellent intergrader agreement. Of the 31 eyes with RVL, the diagnosis was changed to anterior/intermediate uveitis for 9 (29.0%) eyes and to panuveitis for 4 (12.9%) eyes. Systemic treatment was escalated in 5 patients. CONCLUSION: Our results suggest that UWFFA imaging is useful in detecting subclinical posterior involvement in patients with anterior uveitis. Moreover, UWFFA results in altered diagnosis and treatment approaches in a portion of patients.
Asunto(s)
Angiografía con Fluoresceína , Uveítis Anterior , Humanos , Angiografía con Fluoresceína/métodos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Uveítis Anterior/diagnóstico , Estudios Retrospectivos , Anciano , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Adulto Joven , Permeabilidad Capilar , Adolescente , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/diagnóstico por imagenRESUMEN
BACKGROUND: Patients with spondyloarthritis (SpA)/HLA-B27-associated acute anterior uveitis (AAU) experience recurring acute flares, which pose significant visual and financial challenges. Despite established links between SpA and HLA-B27-associated AAU, the exact mechanism involved remains unclear, and further understanding is needed for effective prevention and treatment. METHODS: To investigate the acute pathogenesis of SpA/HLA-B27-associated AAU, Mendelian randomization (MR) and single-cell transcriptomic analyses were employed. The MR incorporated publicly available protein quantitative trait locus data from previous studies, along with genome-wide association study data from public databases. Causal relationships between plasma proteins and anterior uveitis were assessed using two-sample MR. Additionally, colocalization analysis was performed using Bayesian colocalization. Single-cell transcriptome analysis utilized the anterior uveitis dataset from the Gene Expression Omnibus (GEO) database. Dimensionality reduction, clustering, transcription factor analysis, pseudotime analysis, and cell communication analysis were subsequently conducted to explore the underlying mechanisms involved. RESULTS: Mendelian randomization analysis revealed that circulating levels of AIF1 and VARS were significantly associated with a reduced risk of developing SpA/HLA-B27-associated AAU, with AIF1 showing a robust correlation with anterior uveitis onset. Colocalization analysis supported these findings. Single-cell transcriptome analysis showed predominant AIF1 expression in myeloid cells, which was notably lower in the HLA-B27-positive group. Pseudotime analysis revealed dendritic cell terminal positions in differentiation branches, accompanied by gradual decreases in AIF1 expression. Based on cell communication analysis, CD141+CLEC9A+ classic dendritic cells (cDCs) and the APP pathway play crucial roles in cellular communication in the Spa/HLA-B27 group. CONCLUSIONS: AIF1 is essential for the pathogenesis of SpA/HLA-B27-associated AAU. Myeloid cell differentiation into DCs and decreased AIF1 levels are also pivotal in this process.
Asunto(s)
Espondiloartritis , Uveítis Anterior , Humanos , Enfermedad Aguda , Teorema de Bayes , Perfilación de la Expresión Génica , Estudio de Asociación del Genoma Completo , Antígeno HLA-B27/genética , Antígeno HLA-B27/metabolismo , Espondiloartritis/genética , Espondiloartritis/metabolismo , Uveítis Anterior/genética , Uveítis Anterior/metabolismoRESUMEN
BACKGROUNDS: Acute anterior uveitis (AAU) is the most common extra-musculoskeletal manifestation in axial spondyloarthritis (axSpA). OBJECTIVES: The aim of the study is to evaluate the factors associated with AAU attacks in patients with axSpA during a 36-month follow-up period. METHODS: In total, 469 patients with axSpA were included in this observational study. Demographic data, clinical characteristics, disease activity measurements, and treatment patterns were compared between patients with and without a history of AAU. The development of AAU and its related factors were investigated using generalized estimating equations, which is a technique for longitudinal data analysis. RESULTS: Overall, 99 (21%) out of 469 patients experienced at least one AAU attack, with 77 patients (78%) having a history of AAU and 53 patients (58% of whom had a history of AAU) experiencing AAU attacks during the follow-up period. At baseline, patients with a history of AAU were found to be older (p = .001), be more likely to have peripheral arthritis (p < .001), have higher serum CRP levels (p = .016), have a higher frequency of sulfasalazine (SLZ) and tumor necrosis factor inhibitors (TNFi) use (p < .001 and p < .001, respectively). In the longitudinal analysis, having a history of AAU was identified as the only independent determinant of the development of AAU. CONCLUSIONS: AAU history might be a risk factor for the development of AAU attacks in patients with axSpA. Although TNFi and SLZ were prescribed more frequently to patients with a history of AAU, the effectiveness of these agents in preventing further AAU attacks was not demonstrated.