Punctate Inner Choroidopathy and Choroidal Neovascularization in Korean Patients

ABSTRACT

Purpose: To describe the clinical features and outcomes of punctate inner choroidopathy (PIC) in Korean patients

Methods: We retrospectively reviewed the medical records of patients with PIC between 2004 and 2015. The main outcome measures included best-corrected visual acuity (BCVA), presence of choroidal neovascularization (CNV), and optical coherence tomography findings. Patients with and without CNV were compared.

Results: Forty eyes of 26 patients were included. The final BCVA was better than 20/40 in 33 eyes (82.5%). CNV was initially present in 12 eyes (30.0%). The mean initial and final logMAR BCVA was poorer for eyes with CNV than for eyes without CNV. Eyes with CNV exhibited a larger myopic refractive error, inflammatory lesions confined within the posterior pole, and a decreased final subfoveal choroidal thickness compared with eyes without CNV.

Conclusion: PIC in the Korean population generally exhibits favorable visual outcomes, and eyes with CNV show more abnormalities and poorer outcomes.     

Niveles séricos de inmunoglobulinas,componentes 3 y 4 del complemento,alelo HLA-B27 y espondiloartropatía en pacientes con uveítis anterior no infecciosa

ObjectiveTo identify the relationship between serum immunoglobulin levels, complement components 3 and 4, the presence of the HLA-B27 allele and diagnosis of spondyloarthropathies in patients with non-infectious anterior uveitis.Materials and methodsThe participants were 197 patients with a non-infectious anterior uveitis. The concentrations of serum immunoglobulins, and C3 and C4 proteins of the complement were determined by turbidimetry. The personal history of suspected immunodeficiency, ophthalmological complications, arthralgia, family history of spondyloarthropathies and the presence of the HLA-B27 allele were collected.ResultsA family history of spondyloarthropathy, axial arthralgias, and ophthalmological complications were more frequent in HLA-B27 positive patients (P = .0005, P ≤ .0001, and P ≤ .0001, respectively) and in patients with spondyloarthropathy diagnoses (P ≤ .0001, P ≤ .0001, and P ≤ .0001, respectively). A personal history of recurrent sepsis, and gastrointestinal abnormalities was associated with the presence of the HLA-B27 allele (P ≤ .0001, and P = .0240, respectively) and with the diagnosis of spondyloarthropathy (P = .0492, and P = .0017, respectively). IgG decrease was observed (χ2 = 18.5, OR 5.03, 95% CI 2.32-10.89; P = .0001) and IgM (OR 7.13, 95% CI 1.40-36.4; P = .0128) in patients positive for the HLA-B27 allele and in patients with a diagnosis of spondyloarthropathies (P = .0364 and P = .0028, respectively). The decrease of C3 proteins (OR 4.82; CI 95% 1.35-17.11; P = .0328) and C4 (OR 9.09; CI 95% 2.13-38.88; P = .0074) were associated with a spondyloarthropathies diagnosis.ConclusionsPatients with non-infectious anterior uveitis, positive for the HLA-B27 allele and diagnosed with spondyloarthropathies have alterations in serum immunoglobulin levels and complement components 3 and 4, which could contribute to the perpetuation and worse clinical course of this disease.     

Hypomethylation of Notch1 DNA is associated with the occurrence of uveitis

Uveitis is a serious intra-ocular inflammatory disease that can lead to visual impairment even blindness worldwide. Notch signaling can regulate the differentiation of naive CD4⁺ T cells, influencing the development of uveitis. DNA methylation is closely related to the autoimmune diseases. In this study, we measured the Notch1 DNA methylation level, determined the Notch1 and related DNA methylases mRNA expression and evaluated the ratio of T helper type 17 regulatory T cell (Th17/T_reg) in peripheral blood mononuclear cells (PBMCs) from uveitis patients and normal control subjects; we also tested the levels of relevant inflammatory cytokines in serum from the participants. Results indicated that compared with those in normal control individuals, the expression of ten–eleven translocation 2 (TET2) and Notch1 mRNA is elevated in uveitis patients, whereas the methylation level in Notch1 DNA promotor region [−842 ~ −646 base pairs (bp)] is down-regulated, and is unrelated to anatomical location. Moreover, the Th17/T_reg ratio is up-regulated in PBMCs from uveitis patients, accompanied by the elevated levels of proinflammatory cytokines [e.g. interleukin (IL)-2, IL-6, IL-17 and interferon (IFN)-γ] in serum from uveitis patients. These findings suggest that the over-expression of TET2 DNA demethylase may lead to hypomethylation of Notch1, activate the Notch1 signaling, induce naive CD4⁺ T cells to differentiate theTh17 subset and thus disturb the balance of the Th17/T_reg ratio in uveitis patients. Overall, hypomethylation of Notch1 DNA is closely associated with the occurrence of uveitis. Our study preliminarily reveals the underlying mechanism for the occurrence of uveitis related to the hypomethylation of Notch1 DNA, providing a novel therapeutic strategy against uveitis in clinical practice.     

Folate receptor-targeted aminopterin therapy is highly effective and specific in experimental models of autoimmune uveitis and autoimmune encephalomyelitis

EC0746 is a rationally designed anti-inflammatory drug conjugate consisting of a modified folic acid-based ligand linked to a γ-hydrazide analog of aminopterin. In this report, EC0746's effectiveness was evaluated against experimental retinal S-antigen (PDSAg) induced autoimmune uveitis (EAU) and myelin-basic-protein induced autoimmune encephalomyelitis (EAE). In both models, functional FR-β was detected on activated macrophages in local (retinal or central-nervous-system, respectively) and systemic (peritoneal cavity) sites of inflammation. In myelin-rich regions of EAE rats, an increased uptake of ^99mTc-EC20 (etarfolatide; a FR-specific radioimaging agent) was also observed. EC0746 treatment at disease onset suppressed the clinical severity of both EAU and EAE, and it strongly attenuated progressive histopathological changes in the affected organs. In all parameters assessed, EC0746 activity was completely blocked by a benign folate competitor, suggesting that these therapeutic outcomes were specifically FR-β mediated. EC0746 may emerge as a useful macrophage-modulating agent for treating inflammatory episodes of organ-specific autoimmunity.     

白内障超声乳化吸除术联合人工晶体植入术治疗葡萄膜炎并发白内障的临床研究

目的 观察白内障超声乳化吸除术联合人工晶体植入术治疗葡萄膜炎并发白内障的临床效果.方法 选取2017年1月-2019年3月本院收治的92例(92只眼)葡萄膜炎并发白内障患者为研究对象,遵循随机对照原则将其分为对照(n=46)和观察组(n=46).对照组行常规小切口白内障囊外切除术联合人工晶体植入术治疗,观察组行白内障超...     

Ultrasound biomicroscopy as a tool in the evaluation and management of ocular hypotony in uveitis

Purpose:Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony.Methods:This was a retrospective hospital-based interventional case-series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020.Results:Thirty-six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow-up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow-up.Conclusion:We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.     

Multimodal Imaging in Masquerade Syndromes

Masquerade syndromes present to uveitis clinics due to the appearance of inflammatory signs and chronic symptoms that are not responsive to conventional treatment. They are frequently misdiagnosed and treated as refractory inflammatory conditions, which delays appropriate diagnosis and management. This review of literature focuses on the commonly encountered masquerade syndromes and discusses the role of multimodal imaging in addressing these complex clinical presentations. We review the conventional imaging techniques for these patients and discuss emerging technological advances that may help in establishing a diagnosis. We present cases highlighting the utility of multimodal imaging in identifying the etiology.