^99Tc—MDP对兔实验性葡萄膜炎的治疗作用

目的探讨^99锝-亚甲基二膦酸盐（^99Tc-MDP,云克）对兔实验性葡萄膜炎的治疗作用。方法实验兔22只随机分为生理盐水组、地塞米松组、云克组。ELISA法测定实验性葡萄膜炎兔动物模型造模前、造模后5d、给药治疗后10d、停药后5d、4个不同阶段白细胞介素（IL-2）、干扰素（IFN-γ）、肿瘤坏死因子（TNF-α）的血清质量浓度;浊度法及细胞技术池测定不同治疗阶段房水蛋白及房水细胞计数,于不同阶段摘除眼球行组织病理学观察。结果与生理盐水组比较,地塞米松组及云克组均可使兔血清IL-2、IFN-γ、TNF—α水平和房水细胞计数、房水蛋白质量浓度降低,差异均有统计学意义（P〈0．05）,地塞米松组与云克组2组间差异无统计学意义（P〉0．05）。地塞米松组及云克组在治疗后眼球的组织病理学显示炎症较治疗前减轻。结论云克在一定程度上有降低兔实验性葡萄膜炎血清IL-2、IFN-γ、TNF-α质量浓度及房水细胞计数、房水蛋白质量浓度以及减轻眼球炎症的作用。     

病毒性角膜葡萄膜炎58例临床分析

目的探讨疱疹病毒性角膜葡萄膜炎的临床特点、诊断、治疗方法及其预后。方法收集2003年1月-2007年12月疱疹病毒性角膜葡萄膜炎患者58例,均为单眼发病;其中男39例,女19例;年龄16～63岁,平均（38．5±12．9）岁,依据其临床资料和实验室检查结果,对其临床特征、诊断、治疗和视力预后进行分析。结果58例患者中有16例伴发角膜实质炎,12例伴发树枝状角膜炎,9例伴发带状疱疹病毒感染;31例（53．4％）患者眼压升高。经过2～4周的抗炎及抗病毒治疗后,54例（93．1％）患者角膜虹膜炎症消失,眼压降至正常,视力恢复。3例（5．2％）患者因角膜云翳致视力减退。1例患者（1．7％）发生角膜穿孔,最终因角膜变性和粘连性白斑而致盲。结论病毒感染可导致角膜葡萄膜炎和小梁网炎,并引起眼压升高,通过积极抗炎和抗病毒治疗,可迅速控制炎症及眼压。     

Topical interferon – A novel treatment for pseudophakic macular edema

Purpose:The aim of this study was to evaluate the efficacy of topical interferon (IFN) therapy in pseudophakic cystoid macular edema (P-CME).Methods:This is a prospective, interventional case series of patients with P-CME. Patients presenting with P-CME were given the option of topical IFN therapy against conventional treatment with oral, topical, intravitreal, and periocular steroid therapy and antivascular growth factors. Patients who consented for the same were advised to use the IFN drops four times/day. Commercially available injection IFN alfa-2b was reconstituted to prepare the eye drops (1 MIU/ml). Optical coherence tomography (OCT) was done at the baseline and on each review visit until complete resolution of P-CME.Results:Eight eyes of eight patients diagnosed with P-CME were studied. Mean central macular thickness (CMT) on OCT at the presentation (n = 8) and at 4 weeks post topical IFN therapy (n = 6) was 560.1 μm (range: 349–702 μm) and 344.33 μm (range: 250–390 μm), respectively. All eyes except one had posterior capsular rent (PCR). Five patients had regular follow-up until resolution. The mean duration of complete first resolution of P-CME was 5 weeks (range: 4–7.1 weeks) in those patients. Relapse was seen in three patients who responded after resuming or continuing the therapy. Case 1 had 9 months follow-up after completion of IFN therapy, and no recurrence was noted. No ocular or systemic side effects related to the topical IFN therapy were noted clinically, except papillary conjunctivitis in one patient.Conclusion:Topical IFN therapy can be a noninvasive, economical, and effective choice of treatment for P-CME, especially in the case of PCR, and where steroids are contraindicated.     

结核性葡萄膜炎初始抗结核治疗矛盾反应的临床特征

目的 总结结核性葡萄膜炎矛盾反应的临床特点。设计回顾性病例系列。研究对象2012-2020年北京同仁医院眼科结核性葡萄膜炎初始抗结核治疗后出现矛盾反应者8例(10眼)。方法 回顾患者的病历资料。平均随访(10.0±5.6)个月。主要指标眼前节、及眼底表现,治疗情况。结果 患者平均年龄(45.0±10.8)岁。8例患者中1例(12.5%)患活动性肺结核,6例(75.0%)可疑既往肺结核感染,1例(12.5%)无明确结核病史。矛盾反应发生于初始抗结核治疗后平均(0.9±0.3)个月(0.5～1.5个月)。其中脉络膜结核瘤2眼(20.0%),表现为瘤体扩大,表面视网膜脱离;全葡萄膜炎3眼(30%),表现为前房、玻璃体炎性反应加重,黄斑水肿加重;中间型葡萄膜炎2眼(20%),表现为玻璃体混浊加重;匐行样脉络膜炎3眼(30%),表现为眼底黄白色病灶增多、高自发荧光区域增多。所有患者在矛盾反应出现后在抗结核同时全身或局部加用糖皮质激素,炎性反应均得到有效控制。结论 结核性葡萄膜炎患者矛盾反应多发生于肺结核非活动期初始抗结核治疗1个月左右,规范抗结核和糖皮质激素联合应用可明显减轻矛盾反应。(眼科,2...     

Harada-like syndrome post-Covishield vaccination: A rare adverse effect

Covishield is in wide use in India with about 80% efficacy. Serious side effects are still under study. A 30-year-old female presented to us 7 days post-vaccination with a 5-day history of sudden diminution of vision in both eyes. The clinical findings were suggestive of the Vogt-Koyanagi-Harada (VKH) syndrome. She was treated with high-dose oral steroids. At this juncture, the association was unclear. However, it was justified by an acute flare-up of uveitis on day 2 post the second dose of vaccination despite ongoing steroids. A direct correlation of Harada-like syndrome with the Covishield vaccine is observed here.     

The incidence of uveitis after systemic lymphoma in Taiwan: An 18-year nationwide population-based cohort study

Although uveitis can be an intraocular presentation of systemic lymphoma, it may be associated with direct lymphomatous infiltration and immune-mediated alterations. There have been no published studies describing the incidence of uveitis after systemic lymphoma. We conducted a nationwide cohort study to investigate the incidence of uveitis after systemic lymphoma diagnosis in Taiwan. Data were collected from the Taiwan National Health Insurance system and included patients newly diagnosed with systemic lymphoma between 2000 and 2017. We observed the risk of uveitis among study population since the index date until December 2017. The 1:8 of systemic lymphoma patient and paired comparison was identified by time distribution matching and individual paired with sex and age. Subsequent propensity score matching (PSM) was used to select the 1:1 of systemic lymphoma patient and paired comparison by greedy algorism with caliper of 0.05. The multiple Cox proportional hazard regression model was used to compare the developmental risk of uveitis (time-to-uveitis) between the systemic lymphoma and non-systemic lymphoma, while controlling for selected covariates. After time distribution matching, we selected 6846 patients with systemic lymphoma, and 54,768 comparisons. Among patients with systemic lymphoma groups, there were more men than women (52.94% vs 47.06%) and the mean age was 53.32 ± 21.22 years old. Systemic lymphoma incidence rates (per 10,000 person-months) of uveitis were 1.94 (95% confidence interval [CI], 1.60–2.35) in the systemic lymphoma cohort and 1.52 (95% CI, 1.42–1.63) in the non-systemic lymphoma cohort. Compared with the non-systemic lymphoma cohort, adjusted hazard ratio (aHR) of developing uveitis were 1.24 (95% CI, 1.00–1.52) in people with systemic lymphoma. But not significant in after PSM, aHR of developing uveitis were 1.17 (95% CI, 0.90–1.53). This 18-year nationwide population-based cohort study in Taiwan, showed that the risk of uveitis in patients’ systemic lymphoma was not significantly higher than non-systemic lymphoma after PSM. In elderly and rheumatic patients with intraocular inflammation, it is important to first exclude uveitis masquerade syndrome, which could be a harbinger of intraocular involvement from systemic lymphoma. Further large-scale prospective clinical studies to investigate whether systemic lymphoma influences the incidence of uveitis are warranted.     

LV Prasad Eye Institute EyeSmart electronic medical record-based analytics of big data: LEAD-Uveitis Report 1: Demographics and clinical features of uveitis in a multi-tier hospital based network in Southern India

Purpose:To describe the demographics and epidemiology of uveitis presenting to a multi-tier ophthalmology hospital network in Southern India.Methods:Cross-sectional hospital-based study of 19,352 patients with uveitis presenting between March 2012 and August 2018.Results:In total, 1,734,272 new patients were seen across the secondary and tertiary centers of our multi-tier ophthalmology hospital network during the study period. Among them, 25,353 eyes of 19,352 patients were diagnosed with uveitis and were included in the study. Uveitis constituted 1.11% of all cases. The majority of patients were male (60.33%) and had unilateral (68.09%) affliction. The most common age group was 21–50 years with 12,204 (63.06%) patients. The most common type of uveitis was anterior uveitis, which was seen in 7380 (38.14%) patients, followed by posterior uveitis in 5397 (23.89%) patients. Among the infectious causes, tuberculosis was the most common etiology (2551 patients, 13%) followed by toxoplasmosis (1147 patients, 6%)Conclusion:Uveitis constituted 1.11% of all cases presenting to our clinics. It was more common in the age group of 21–50 and was predominantly unilateral. Anterior uveitis was the most common subtype seen in 38%.     

巨噬细胞在葡萄膜炎免疫调节治疗机制中的研究进展

葡萄膜炎是一类常见的累及葡萄膜、视网膜、视网膜血管及玻璃体的顽固性致盲性的炎性疾病,它的发生与其各细胞亚群免疫机制失衡相关,巨噬细胞在机体先天免疫系统中起核心作用,能将人体内炎性致病菌有效清除,在应激反应中,巨噬细胞可通过极化参与机体的病原体反应和炎症调节,因此,为了系统地了解巨噬细胞极化平衡在葡萄膜炎的免疫调节机制中发挥的重要作用,文章主要通过对巨噬细胞的来源认识、机制通路的研究从而将其与葡萄膜炎疾病发生发展相联系,最后针对相关诊疗进展进行综述。