HLA typing in congenital toxoplasmosis.

HLA-A, HLA-B, HLA-C, and HLA-D typing was performed in 47 mothers of patients suffering from ocular toxoplasmosis to investigate whether an immunogenetic predisposition exists for developing congenital toxoplasmosis in their offspring. No significant association between any HLA antigen was observed in the mothers of patients with ocular toxoplasmosis, although a total absence of the HLA-B51 antigen was found in this group. HLA-A, HLA-B, and HLA-C typing was also performed in their children (52 patients with ocular toxoplasmosis), to investigate a possible relation between the severity of ocular toxoplasmosis and an eventual immunogenetic factor. In the patients with ocular toxoplasmosis an increased frequency of the HLA-Bw62 antigen was observed in correlation with severe ocular involvement.     

Does autoimmunity to S-antigen play a role in Fuchs' heterochromic cyclitis?

Autoimmunity directed against retinal or choroidal antigens has been suggested to play a role in the chorioretinal lesions observed in patients with Fuchs'' heterochromic cyclitis. This hypothesis was addressed and patients with Fuchs'' heterochromic cyclitis were tested for cellular immunity (migration inhibitory factor assay) against human retinal S-antigen. A significantly higher percentage of patients with Fuchs'' heterochromic cyclitis had a positive cellular autoimmune response to S-antigen than healthy controls and other patients with anterior uveitis. This finding is remarkable since Fuchs'' heterochromic cyclitis is generally classified as an anterior uveitis and patients with Fuchs'' heterochromic cyclitis without chorioretinal lesions also had a positive test. In view of these results and a sensitisation against a corneal antigen reported earlier in Fuchs'' heterochromic cyclitis, it is suggested that a chronic low grade grade anterior uveitis or chorioretinitis of unknown origin may cause the release of potent autoantigens in these patients.     

The pros and cons of intravitreal triamcinolone injections for uveitis and inflammatory cystoid macular edema

Intravitreal triamcinolone acetonide (IVTA) injections are gaining in popularity and are regularly administered nowadays for various ocular diseases. This paper presents a literature review on the use, efficacy, and complications of IVTA application in non-infectious uveitis and inflammatory cystoid macular edema (CME). In addition, we describe the experiences of our own institute. IVTA applications brought about a quick improvement in vision in the majority of cases. Drawbacks included the temporary duration of the effect with the need for repeated injections which re-exposed patients to the risk of complications. The risk of bacterial endophthalmitis was 0.5% and was further influenced by the specific IVTA preparation. Based on the literature review, we chose ready-for-use IVTA injections prepared by our pharmacy department, in which 90% of the toxic additives were removed and the dispensed dose of triamcinolone acetonide was validated to diminish the risk of endophthalmitis. Elevated intraocular pressure (IOP) was seen in 30-43% of the eyes and cataract developed in 29% of the eyes of patients, who were usually of advanced age. In conclusion, the rapid effect of IVTA might be of value in severe presentations of non-infectious uveitis and CME and might shorten the time interval needed for the improvement.     

Rapid progression of diabetic retinopathy in eyes with posterior uveitis

PURPOSE: To report on two patients who developed rapid progression of asymmetric diabetic retinopathy (DRP) in eyes affected by posterior uveitis in contrast to their fellow eyes not affected by uveitis. DESIGN: Observational case report. METHODS: Two patients with diabetes mellitus (DM) and unilateral uveitis underwent repeated ophthalmologic examinations and fluorescein angiography. RESULTS: Two patients with DM and unilateral posterior uveitis developed proliferative DRP in eyes with previous uveitis within 3 months after the uveitis subsided. In contrast, the retinal findings of nonuveitic eyes remained unchanged on follow-up of several years. CONCLUSIONS: Since the pathogenesis of intraocular inflammation and diabetic retinopathy acts through similar biochemical mediators and pathways, it is feasible that posterior uveitis accelerates the progression of diabetic retinopathy. Our results support this hypothesis and point out a risk for rapid retinopathy development in eyes affected with posterior uveitis.     

Distinct Cytokine Patterns in the Aqueous Humor of Children,Adolescents and Adults with Uveitis

Purpose: To determine the immune mediator profile in relation to age in the aqueous humor (AqH) of patients with uveitis. Methods: AqH of children, adolescents, and adults with uveitis was analyzed for 16 immune mediators. Results: No significant differences were found for IL-8, RANTES, and IP-10. The concentrations of the remaining 13 mediators were significant lower in adults compared with children and adolescents, except for IL-6, which was higher. Conclusions: Various immune mediators are present in higher concentrations in AqH of children and adolescents with different uveitis entities compared with that of adults, except IL-6, which was higher in adults.     

Impact of ocular graft‐versus‐host disease on visual quality of life in patients after allogeneic stem cell transplantation: questionnaire study

Purpose: To determine the influence of ocular complications on quality of life (QoL) 3 years after allogeneic stem cell transplantation (allo‐SCT). Methods: All 54 adult patients that underwent and survived allo‐SCT in 2006/2007 in our centre received two questionnaires (VFQ‐25: visual function questionnaire‐25 and OSDI: ocular surface disease index). In addition, the following data were included: gender, age, underlying disease, presence of chronic and/or ocular graft‐versus‐host disease (GVHD), number of visits to an ophthalmologist, manifestations of dry eye disease, the duration of follow‐up and treatment for ocular GVHD. Results: Ocular GVHD developed in 26% (14 of 54) of patients and 71% (10 of 14) received treatment for ocular GVHD. The presence of ocular GVHD correlated with the severity of systemic GVHD (correlation coefficient: 0.52, p = 0.00). The Karnofsky scores were significantly lower in the patients with ocular GVHD compared to the patients with no ocular GVHD (p = 0.001). Karnofsky scores were weakly correlated with the severity of systemic GVHD (correlation coefficient: 0.25, p = 0.03. Three years after the all‐SCT, OSDI and VFQ‐25 scores were significantly impaired in patients with ocular GVHD [mean: 76.5; range (46.1–100) and mean: 31.1; range (0–72.9)] compared to patients with no ocular GVHD [mean: 89.4; range (45.2–100) and mean: 12.9; range (0–58.3); p = 0.02]. The scores of the VFQ‐25 were significantly lower in the domains of general health, ocular pain, social functioning and role difficulties. Conclusion: The long‐term vision‐related QoL measured by the OSDI and VFQ‐25 was impaired in patients with ocular GVHD.     

The diagnostic value of intraocular fluid analysis by polymerase chain reaction in Thai patients with uveitis

Uveitis is a major cause of severe visual impairment throughout the world and can be initiated by various infectious and non-infectious causes. Early recognition of specific infections is important as the treatment with antimicrobial agents might stop the progression or even cure the eye disease. To determine the infectious causes of uveitis in Thailand, intraocular fluid samples of 100 HIV-negative patients and 47 HIV-positive patients with uveitis were examined using real-time PCR analysis for herpes simplex virus, varicella zoster virus, cytomegalovirus and Toxoplasma gondii. Positive PCR results were found in 33/100 (33%) HIV-negative patients and in 33/47 (70%) HIV-positive patients with uveitis. In Thailand, cytomegalovirus was identified as the most frequent cause of infectious uveitis in both HIV-negative and HIV-positive patients (49 and 91%, respectively). PCR analysis of intraocular samples in uveitis was a valuable diagnostic assay. The pattern of uveitis observed in the Far East differs from that found in the West.     

Rubella Virus-associated Anterior Uveitis in a Vaccinated Patient: A Case Report

Rubella virus is involved in the pathogenesis of Fuchs heterochromic uveitis and almost all cases in Europe show an active antibody production in the aqueous humor against rubella virus. Herein we report a case of a fully vaccinated patient with common variable immunodeficiency who developed unilateral Fuchs heterochromic uveitis secondary to rubella virus which was proven by intraocular fluid examination. Awareness of rubella associated anterior uveitis should remain also in vaccinated patients, especially those without a fully competent immune system.     

Causes of Hypertensive Anterior Uveitis in Thailand

ABSTRACT

Purpose

To determine the prevalence of viral infections in patients with hypertensive anterior uveitis in Thailand from polymerase chain reaction (PCR) of aqueous humor.     

Risk factors for cystoid macular oedema in patients with uveitis

PURPOSE: To determine ophthalmologic and systemic factors associated with the presence of cystoid macular oedema (CMO) in patients with uveitis. METHODS: Retrospective cross-sectional study in which 97 consecutive patients with uveitis filled in an extensive questionnaire for the presence of cardiovascular diseases and its risk factors. An analysis of the ophthalmologic and questionnaire data was conducted. RESULTS: CMO was present in 44% (43/97) of patients. Its presence was strongly associated with increasing age (P=0.001) and age at onset of uveitis (P<0.001). For patients older than 50 years, the risk of having CMO was 3.8-fold (95% confidence intervals 1.6-9.0) larger than for younger patients. The most frequent anatomic location of uveitis associated with CMO was panuveitis (49%). Papillary leakage on fluorescein angiography was associated with CMO (P<0.001), independently of other risk factors. After adjustment for age, multivariate logistic regression showed no association between cardiovascular disease and its risk factors and the presence of CMO. CONCLUSIONS: Age, independent of duration of uveitis, was a major risk factor for the presence of CMO in uveitis. A positive correlation between CMO and papillary leakage on angiography was noted.