Search

Purpose: To examine the real-world management and outcomes of uveitic cystoid macular oedema (CME). Design: Retrospective study. Methods: Patients with uveitic CME were identified from the Inflammatory Eye Disease database. 248 eyes of 218 patients with uveitic CME were identified. Main Outcome Measures: Time to resolution, time to recurrence and vision loss. Results: Median age at time of CME was 51.7 years [IQR 37.3–63.9]. Overall likelihood of resolution was 209/248 eyes (85.3%). Resolution occurred in 34.1% with topical therapy, 69.2% treated with oral prednisone (72.9% if prednisone dose ≥ 60 mg/day), 73.5% treated with orbital floor steroid, and 86.7% treated with intravitreal steroid. On multivariate analysis, ERM was associated with decreased resolution of CME (HR 0.735 p = 0.045). Additionally, infectious aetiology approached significance (HR 0.635 p = 0.059) for CME resolution. Recurrence occurred in 85 eyes (36.5%). Predictors of increased likelihood of recurrence were current smoking status (HR 1.818 p = 0.042) and subretinal fluid at diagnosis (HR 1.577 p = 0.043). Eyes with infectious aetiology had lower chance of CME resolution, but those that did resolve had lower probability of recurrence (HR 0.891 p = 0.019). Moderate vision loss (20/50–20/200) occurred in 24 eyes (9/7%) and severe vision loss (≤20/200) in 17 eyes (6.9%). Conclusions: Management of CME is challenging given the heterogeneous aetiologies, severity of the macular edema as well as response to the therapy. A high rate of resolution was observed, given sufficient time, but recurrence occurs in one-third. Current smoking status plays an important role in the risk of recurrence of CME and patients should be encouraged to stop smoking. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) anterior uveitis and corneal endotheliitis are the most common ocular diseases caused by CMV infections in immunocompetent patients. The incidence of CMV corneal endotheliitis is relatively high in middle-aged men. CMV corneal endotheliitis presents with mild anterior chamber inflammation, corneal edema, keratic precipitates, and elevated intraocular pressure. It resembles Posner–Schlossman syndrome and Fuchs uveitis because of the elevated intraocular pressure. Without proper diagnosis and treatment, it may progress to bullous keratopathy or glaucoma, necessitating keratoplasty or glaucoma surgery. Therefore, early diagnosis and treatment are important for a good prognosis. Aqueous humor analysis can facilitate the diagnosis of CMV corneal endotheliitis, and early antiviral treatment can decrease the risk of corneal compensation or glaucomatous optic atrophy. In this article, we review the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of CMV corneal endotheliitis along with the evidence for early clinical diagnosis and active antiviral treatment. [ABSTRACT FROM AUTHOR]

To examine the frequency of recurrence and identify risk factors for recurrence in patients with acute anterior uveitis (AAU). Retrospective cohort study from a single tertiary ophthalmic clinical center. All subjects with AAU identified from a database of Inflammatory Eye Disease presenting to Te Whatu Ora (Auckland, New Zealand) between 2008 and 2021. Data were collected retrospectively from chart review and electronic patient records for all patients during the study period. Rates of recurrence were reported using the Kaplan–Meier estimator. Multivariate analysis of risk factors for recurrence was calculated using a marginal Cox regression model. The primary outcome measure was disease recurrence. Secondary outcome measure was moderate vision loss (≤20/50). A total of 2763 eyes of 2092 subjects with AAU were studied, with a median follow-up time of 8.9 years and a total follow-up of 19 794.9 eye-years. Recurrence occurred in the ipsilateral eye in 1258 eyes (45.5%) and in the contralateral eye in 522 eyes (27.3%). Rates of ipsilateral recurrence over 10 years were 38.1% for idiopathic disease, 43.2% for human leukocyte antigen B27 (HLA-B27)/inflammatory arthritis, and 44.9% for viral uveitis. On multivariate analysis, the following were associated with increased risk of ipsilateral recurrence: older age (P < 0.001), Māori ethnicity (P = 0.006), Asian ethnicity (P < 0.001), HLA-B27/inflammatory arthritis (P < 0.001), and viral uveitis (P = 0.018). There was no association with gender, smoking, bilateral disease, or hypertensive uveitis. Rates of contralateral eye involvement were significantly lower than ipsilateral eye recurrence. Contralateral recurrence at 10 years was 15.2% in idiopathic uveitis, 37.6% in HLA-B27/inflammatory arthritis, and 2.0% in viral uveitis. Risk factors identified for contralateral eye involvement were Māori ethnicity (P = 0.003), Pasifika (Pacific Islanders) ethnicity (P = 0.021), and HLA-B27/inflammatory arthritis (P < 0.001). Moderate vision loss (≤20/50) was present in 411 eyes (14.9%) at final follow-up and was more common if time to first recurrence was shorter (P < 0.001). Approximately half of patients with AAU will develop recurrence in the ipsilateral eye, and one-quarter will have recurrence in the contralateral eye. Patients with viral disease have the highest risk of ipsilateral recurrence and lowest risk of contralateral recurrence. Patients with risk factors for recurrence should be managed and counseled appropriately to minimize the risk of visual loss and complications of uveitis. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (KD) is a significant cause of acquired heart disease in children, particularly in developed countries. Incomplete Kawasaki disease (IKD) lacks some of the classic KD symptoms, complicating diagnosis. This study explores the potential role of anterior uveitis (AU) as a diagnostic marker for IKD and its possible association with reducing the incidence of coronary artery lesions (CALs). Methods: A retrospective review of medical records was conducted on 111 pediatric patients diagnosed with IKD at two tertiary care centers between January 2018 and December 2023. The cohort consisted of 33 patients with AU and 78 without AU. The AU group had a mean age of 4.1 years, while the non-AU group had a mean age of 4.5 years. AU was present in 30% of cases. The study primarily focused on the time to diagnosis, incidence of CALs, and the independent association of AU with CALs using multivariate logistic regression analysis. Results: Patients with AU were diagnosed and treated earlier, with a mean time to diagnosis of 5.1 days compared to 7.4 days in the non-AU group. Additionally, the incidence of CALs was significantly lower in the AU group (4.4%) compared to the non-AU group (31.8%, p < 0.001). Multivariate analysis revealed that AU was independently associated with a significantly reduced risk of CALs (OR = 0.066, 95% CI = 0.009–0.494, P = 0.008). Conclusions: This study suggests that AU may be associated with earlier diagnosis and treatment of IKD, potentially lowering the risk of CALs. While AU shows promise as a diagnostic marker, further prospective studies are needed to validate these findings and determine whether AU should be integrated into clinical guidelines for earlier detection of IKD and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence, incidence, and sociodemographic characteristics of uveitis in Colombia based on the National Health Registry of Colombia, the Integrated Social Protection Information System database (SISPRO). Methods: We performed a cross-sectional study using SISPRO. Along with the International Classification of Diseases, we were able to identify cases of general uveitis (GU), anterior (AU), and posterior uveitis (PU) from 2015 to 2019. For 2020, we used a statistical model for spatial data to predict the prevalence/incidence of the diseases and compared it to the data retrieved in SISPRO. Results: The average prevalence of GU was 14.66 cases per 100,000 inhabitants, while the average incidence rate of GU during the same period was 13.61 cases per 100,000 inhabitants per year. In 2020, there was a noticeable decrease in the incidence and prevalence of GU. Similar trends were observed when analyzing the incidence and prevalence of AU and PU separately. Females accounted for most reported cases, and there was a notable shift towards older age groups (over 50 years) for uveitis occurrence in males and females. Regions such as Bogotá, Antioquia, Valle del Cauca, and the Andean region had higher numbers of cases and a more significant disease burden. Conclusions: Our study represents Colombia's first population-based characterization of GU, AU, and PU epidemiology. Our results highlight the importance of understanding disease patterns according to sociodemographic factors intrinsic to distinct geographic locations to design better preventive, diagnostic, and treatment approaches in the Colombian population. [ABSTRACT FROM AUTHOR]

Anterior uveitis is the most common type of uveitis worldwide. The etiologies of anterior uveitis can be divided into infectious and non-infectious (idiopathic, autoimmune, autoinflammatory, trauma, and others). The viral pathogens most commonly associated with infectious anterior uveitis include Herpes Simplex Virus, Varicella-Zoster Virus, Cytomegalovirus, and Rubella Virus. Other emerging causes of viral anterior uveitis are West Nile Virus, Human-Immunodeficiency Virus, Epstein-Barr Virus, Parechovirus, Dengue Virus, Chikungunya Virus, and Human Herpesvirus type 6,7, and 8. Early recognition allows prompt management and mitigates its potential ocular complications. This article provides an updated literature review of the epidemiology, clinical manifestations, diagnostic tools, and treatment options for viral anterior uveitis. [ABSTRACT FROM AUTHOR]

Purpose: To quantitatively analyze choroidal and retinal vascular changes in HLA-B27-associated anterior uveitis. Study Design: A retrospective study. Methods: Medical records of 51 eyes with unilateral HLA-B27-associated anterior uveitis, their fellow eyes and 47 sex and age-matched healthy eyes were retrospectively reviewed. Their choroidal and retinal vasculature were analyzed using swept-source (SS) optical coherence tomography (OCT) and OCT angiography (OCTA) scans. Results: Deep capillary plexus (DCP) vessel density (VD) (p < 0.001), choroidal vascularity index (CVI) (p = 0.012), and choriocapillary flow deficit (CCFD) (p < 0.001) of uveitic and fellow eye group were significantly higher than those of control group. On the contrary, superficial capillary plexus (SCP) VD (p < 0.001) of uveitic and fellow eye group were significantly lower than of control group. The vascular parameters of uveitis and fellow eye group showed no significant difference between uveitic and resolution period. Conclusion: Certain choroidal and retinal vascular parameters were significantly changed in both HLA-B27-associated anterior uveitis without posterior segment involvement and the quiet fellow eyes, suggesting their possible effects as a systemic inflammatory disorder. [ABSTRACT FROM AUTHOR]

Abstract Background Kawasaki disease (KD) is a significant cause of acquired heart disease in children, particularly in developed countries. Incomplete Kawasaki disease (IKD) lacks some of the classic KD symptoms, complicating diagnosis. This study explores the potential role of anterior uveitis (AU) as a diagnostic marker for IKD and its possible association with reducing the incidence of coronary artery lesions (CALs). Methods A retrospective review of medical records was conducted on 111 pediatric patients diagnosed with IKD at two tertiary care centers between January 2018 and December 2023. The cohort consisted of 33 patients with AU and 78 without AU. The AU group had a mean age of 4.1 years, while the non-AU group had a mean age of 4.5 years. AU was present in 30% of cases. The study primarily focused on the time to diagnosis, incidence of CALs, and the independent association of AU with CALs using multivariate logistic regression analysis. Results Patients with AU were diagnosed and treated earlier, with a mean time to diagnosis of 5.1 days compared to 7.4 days in the non-AU group. Additionally, the incidence of CALs was significantly lower in the AU group (4.4%) compared to the non-AU group (31.8%, p

Topiramate (TPM), a sulphonamide derivative, is a commonly used medication by physicians and psychiatrists. Topiramate-induced angle closure glaucoma (ACG) and TPM-induced myopic shift are reported ocular adverse reactions of this drug. We report here a case of TPM-induced ciliochoroidal effusion presenting as bilateral acute angle closure with anterior uveitis and myopic shift in a patient with migraine. The acute and often bilateral severe visual deterioration in patients on TPM therapy cannot only be disturbing to the patient but can also be a challenge to the attending ophthalmologist to manage. We highlight the confusing presentation leading to the initial misdiagnosis of bilateral ACG and challenges in the management of this potentially sight-threatening condition.

Abstract Background To investigate the subfoveal retinal and choroidal thickness in patients with unilateral Fuchs Uveitis Syndrome (FUS). Methods This comparative contralateral study was performed in affected eyes with FUS versus fellow eyes. For each eye parameters such as subfoveal choroidal thickness (SCT), subfoveal choriocapillary thickness (SCCT), central macular thickness (CMT), and central macular volume (CMV) were measured; then the measured values of affected and fellow unaffected eye were compared. Results Thirty-seven patients (74 eyes) including 19 females (51.4%) with a mean age of 36.9 ± 7.6 years were enrolled. The mean SCT was lower in the affected eyes (344.51 ± 91.67) than in the fellow (375.59 ± 87.33) with adjusting for duration of disease and axial lengths (P

This study aimed to evaluate the characteristics of anterior uveitis in patients presenting with poorly controlled diabetes mellitus and with no other identifiable cause for their uveitis. A retrospective study of 121 eyes in 89 patients who presented at Auckland District Health Board with idiopathic acute anterior uveitis and uncontrolled diabetes between September 2009 and January 2022. The diagnosis of diabetes mellitus was known prior to presentation in 80 subjects (89.9%) and was discovered as a result of screening tests in the remainder. Mean HbA1c at presentation was 117.3 mmol/mol. Most uveitis was severe with 3+ (30 eyes, 25.4%) or 4+ cells (30 eyes, 25.4%) in the anterior chamber. Recurrence occurred in 22 eyes (18.2%) and was associated with elevated HbA1c. The visual prognosis was good with median visual acuity at 12 months of 6/7.5. Poorly controlled diabetes can be associated with acute anterior uveitis. [ABSTRACT FROM AUTHOR]

Background: To investigate the subfoveal retinal and choroidal thickness in patients with unilateral Fuchs Uveitis Syndrome (FUS). Methods: This comparative contralateral study was performed in affected eyes with FUS versus fellow eyes. For each eye parameters such as subfoveal choroidal thickness (SCT), subfoveal choriocapillary thickness (SCCT), central macular thickness (CMT), and central macular volume (CMV) were measured; then the measured values of affected and fellow unaffected eye were compared. Results: Thirty-seven patients (74 eyes) including 19 females (51.4%) with a mean age of 36.9 ± 7.6 years were enrolled. The mean SCT was lower in the affected eyes (344.51 ± 91.67) than in the fellow (375.59 ± 87.33) with adjusting for duration of disease and axial lengths (P < 0.001). The mean SCCT, CMT, and CMV were higher in eyes with FUS than in fellow eyes (P < 0.05). Conclusions: The result of our study demonstrated that affected eyes in patients with FUS tend to have thinner SCT and thicker SCCT and CMT compared to uninvolved fellow eyes. [ABSTRACT FROM AUTHOR]

Bilateral acute iris transillumination (BAIT) is a clinical condition characterized by acute bilateral loss of iris pigment epithelium and iris transillumination. Because of the similar presentation, it is commonly confused with anterior uveitis, making it an important differential diagnosis for this condition. We report the case of a 60-year-old male patient who presented all the characteristics of BAIT after undergoing systemic treatment with moxifloxacin and that had the intraocular pressure (IOP) successfully controlled with selective laser trabeculoplasty (SLT). SLT might be an effective therapeutic option and should be considered for the control of IOP in BAIT. [ABSTRACT FROM AUTHOR]

To identify the clinical characteristics that may predict the diagnosis of Rubella virus (RV) or Cytomegalovirus (CMV) among cases of chronic treatment resistant or steroid dependent unilateral anterior uveitis (AU). Thirty-three consecutive patients with a diagnosis of CMV and 32 patients with RV chronic AU were enrolled. The respective frequency of certain demographic and clinical characteristics was compared between the two groups. The presence of abnormal vessels in the anterior chamber angle (75% and 6.1%, respectively, p <.001), vitritis (68.8%–12.1%, p <.001), iris heterochromia (40.6%–15.2%, p =.022) and iris nodules (21.9%–3%, p =.027) were more common among RV AU. Conversely, intraocular pressure greater than 26 mmHg was more commonly encountered in CMV associated AU (63.6%–15.6%, respectively, p <.001) and large keratic precipitates were detected only in CMV-associated AU. RV- and CMV-induced chronic AU differ significantly in the prevalence of specific clinical characteristics. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo evaluate the clinical characteristics, treatment outcomes and ocular complications in patients with HLA-B27-associated AU compared to those without HLA-B27.From the population-based data of all adult patients with AU during 2009–2020 (n = 413), 241 patients tested for HLA-B27 were included. Age of the initial onset, gender, etiology, course of uveitis, visual outcomes and complications were studied.170 patients (71%) were HLA-B27+ and 71 (29%) HLA-B27-. Mean age at uveitis onset was 37 ± 13 in HLA-B27+ (95% CI, 35.4–39.3) and 43 ± 14 (95% CI, 40.3–46.4) in HLA-B27- patients (p = 0.001). Male:female ratio was 1.1:1 among HLA-B27+ and 0.58:1 (p = 0.024) in HLA-B27- patients. Most patients, 63% in HLA-B27+ and 68% in HLA-B27- had chronic uveitis. Recurrences were noted in 31% in HLA-B27+ group compared to 13%in HLA-B27-. 51% and 17% of HLA-B27+ and HLA-B27- patients, respectively, had systemic disease-associated uveitis. Etiology was Idiopathic in 44% and 69% of HLA-B27+ and HLA-B27- patients, respectively (p < 0.001). After the follow-up, +2 and −4 ETDRS letters changes were noted in HLA-B27+ and HLA-B27- patients (p = 0.005). Ocular complications developed in 43% and 47%, and surgical treatment of complications was required in 20% and 33% of patients in HLA-B27+ and HLA-B27- patients (p = 0.009). 1% (HLA-B27+) and 3% (HLA-B27-) developed visual impairment.Our results highlight the differences in the age of uveitis onset, gender distribution, course of uveitis, etiology, and treatment outcomes in HLA-B27+ and HLA-B27-uveitis. HLA-B27 seems to be associated with younger age at uveitis onset, more recurrences, systemic diseases, and better treatment outcomes with less complications. [ABSTRACT FROM AUTHOR]

Abstract 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

Abstract Background Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. Body The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. Conclusions We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.

Abstract 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.

PurposeMethodsResultsConclusionsTo describe long-term efficacy and safety of oral valganciclovir in the treatment of presumed cytomegalovirus (CMV) unilateral hypertensive anterior uveitis.Retrospective review of 40 patients (40 eyes).All patients presented with high intraocular pressure (mean 39.35 ± 7.58 mmHg), associated with signs of mild anterior uveitis. Oral valganciclovir resulted in control of the intraocular pressures and inflammation in 35 eyes. At the dose of ≥450 mg twice daily, no relapses were documented. The follow-up period ranged from 12 to 108 months (24.45 ± 14.56). At the final follow-up, the intraocular pressure was reduced to 14.92 ± 2.43 mmHg (<0.001). Drug-related complications in the form of leukopenia and azoospermia were reported in one patient.Oral valganciclovir effectively and safely controls intraocular pressure and inflammation in presumed CMV anterior uveitis. A long-term treatment course seems necessary. [ABSTRACT FROM AUTHOR]

Objective Animals studied Procedures Results Conclusion To determine the prevalence of anterior uveitis in dogs and cats hospitalized with a diagnosis of systemic inflammatory response syndrome (SIRS).Dogs and cats hospitalized between May 2020 and January 2021 were prospectively included.Patients were categorized into two different groups: The first group included patients diagnosed with SIRS, and the second group included patients hospitalized without SIRS as a control group. Daily physical and ophthalmological examinations were conducted during hospitalization. Diagnosis of anterior uveitis was made based on the presence of aqueous flare, low intraocular pressure, and other associated ocular signs such as episcleral injection and miosis. A multinomial logistic regression analysis was conducted to investigate factors associated with SIRS and anterior uveitis development.The study comprised 42 patients with SIRS and 26 patients without SIRS. Among those with SIRS, 38% developed anterior uveitis, whereas only 7.7% of patients without SIRS showed signs of anterior uveitis. The prevalence of uveitis was significantly higher in animals with SIRS compared to those without SIRS (p < .05).Anterior uveitis is more prevalent in patients with SIRS than patients without SIRS. Therefore, complete ophthalmic examination is recommended in all patients presenting with this syndrome. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionThis study aims to understand the practice patterns among ophthalmologists in North America who manage patients with acute, non-infectious anterior uveitis.An eight-question survey was designed to elucidate the practice patterns of ophthalmologists across various geographic locations and practice settings regarding the management of anterior uveitis. This survey was distributed via the American Uveitis Society and Young Uveitis Specialists email listserv to ophthalmologists who self-identify as uveitis specialists and have a patient population that is at least 30% uveitis.A total of 102 responses were received and analyzed (37% response rate). Respondents practiced predominantly in North America, and 40% had received subspecialty training in uveitis. All respondents chose topical corticosteroid therapy as first-line treatment for acute, unilateral, or bilateral non-infectious idiopathic anterior uveitis. The most common initial frequency for prednisolone acetate administration was six times/day while the patient was awake (29.7%) and patients are typically seen in follow-up within a week (75% of respondents). If there is a lack of treatment response within 2–3 weeks with the initial topical treatment, 42 respondents (41.2%) chose to switch to difluprednate eye drops and 29 (28.4%) recommended switching to oral prednisone.Our results show that topical corticosteroid, most frequently prednisolone acetate 1%, is the treatment of choice for patients with acute noninfectious anterior uveitis. Reported initial medication dosing and follow-up care approaches are highly variable, which suggests heterogeneity in practice patterns. Further research on the optimal initial dosing is needed. [ABSTRACT FROM AUTHOR]

Purpose: To report the uveitic manifestations of patients with systemic lupus erythematosus (SLE). Methods: This was a retrospective analysis of all SLE cases with ocular manifestations seen by a single ophthalmologist between 2015 and December 2021. Results: In total, seven patients with a median age of 40 (range 18-50) years were included in the study. Female (85.7%) predominance was noted. Ocular findings were bilateral in 71% (five patients) of cases. Majority (10 eyes, 83%) of the patients had retinal vasculitis as the common finding. Antinuclear antibodies were positive in all the patients. The vision improved in two (16.6%) eyes, was stable in eight (66%) eyes, and worsened in one (8%) eye. All the patients were treated with oral steroids along with immunosuppressive agents. Conclusion: Though SLE is rare cause of uveitis, it can be associated with significant ocular morbidity. Hence, early diagnosis and treatment can salvage vision in many cases. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our aim in this study is to compare patients with ankylosing spondylitis (AS), a rheumatologic disease that can cause eye involvement and the normal population in terms of orbital Doppler findings, which is an inexpensive and easily applicable method that can be used in early diagnosis and follow-up. METHODS: The study was planned prospectively. The data of patients with AS were compared to those of age- and gender- matched healthy volunteers. A total of 42 participants, 23 (54.8%) males and 19 (45.2%) females, with a mean age of 42.4±12.6 years were included in the study. In addition to demographic information, such as age and gender, the diameter, peak systolic velocity, end-diastolic velocity, mean velocity, resistive index, pulsatility index, and blood flow volumes of the central retinal artery of the left eye were measured using spectral Doppler ultrasonography. RESULTS: According to the comparison of the patients with and without AS according to orbital Doppler ultrasonography findings, the mean velocity, resistive index, and volume measurements of the patients with AS were significantly higher than those without AS (p=0.028, p=0.039, and p=0.038, respectively). However, in the subgroup analysis of the AS group, the Doppler findings did not significantly differ between the patients with and without anterior uveitis. CONCLUSION: In the patient group with AS, independent of anterior uveitis (AU), there was a difference in Doppler parameters and therefore in ophthalmic vasculature. In patients with AS, orbital vascularity changes can be detected with orbital Doppler US before clinical signs appear. [ABSTRACT FROM AUTHOR]

Purpose: To report the first case of uveitis-glaucoma-hyphema (UGH) syndrome post implantable collamer lens (ICL).Methods: Case reportResults: A 41-year-old female presented to our clinic complaining of bilateral eye pain and redness for two weeks. Her past medical history was significant for ICL, in both eyes and multiple sclerosis controlled with treatment. She had a long-standing history of bilateral recurrent uveitis and glaucoma. Ultrasound biomicroscopy revealed several sulcus cysts displacing the ICLs haptic into the ciliary body, leading to iris abrasion and uveitis-glaucoma-hyphema syndrome.Conclusion: We present the first published case worldwide about UGH syndrome secondary to ICL. This is an unusual complication, and measures can be taken to avoid it. This provides evidence of the importance of postoperative follow-up by the surgeon and appropriate work-up when such cases are suspected. [ABSTRACT FROM AUTHOR]

Background: Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. Body: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. Conclusions: We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis. [ABSTRACT FROM AUTHOR]

To elucidate whether wide-field fluorescein angiography (WFFA) can yield additional information in patients with newly diagnosed idiopathic acute anterior uveitis (AAU). The WFFA was performed in patients with idiopathic AAU, and the findings were analyzed according to the scoring system by Angiography Scoring for Uveitis Nomenclature. Forty-four eyes of 30 patients (22 eyes of 13 patients in the pediatric group and 22 eyes of 17 patients in the adult group) were studied. The mean age was 12.41 ± 3.92 (range, 5–18) years in the pediatric group and 42.36 ± 32.07 (range, 24–68) years in the adult group. Thirteen eyes (59%) of pediatric patients and 12 eyes (54%) of adult patients showed some evidence of posterior segment activity on the WFFA (p =.764). Systemic treatment was administered in 53.8% of the pediatric and 5.9% of adult patients, depending on the disease severity. Pediatric patients with idiopathic AAU may have subtle posterior segment manifestations more than adult patients, and posterior segment findings may affect the treatment preferences of physicians. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Assessing anterior chamber inflammation is highly subjective and challenging. Although various grading systems attempt to offer objectivity and standardization, the clinical assessment has high interobserver variability. Traditional techniques, such as laser flare meter and fluorophotometry, are not widely used since they are time-consuming. With the development of optical coherence tomography with high sensitivity, direct imaging offers an excellent alternative to assess objectively inflammation with the potential for automated analysis. We describe various anterior chamber inflammation grading methods and discuss their utility, advantages, and disadvantages. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the feasibility of anterior segment optical coherence tomography (AS-OCT) for measuring anterior chamber (AC) cells in children with uveitis and to compare different AS-OCT acquisition modes.DesignValidity and reliability analysis.MethodsWe enrolled children younger than 18 years who had uveitis involving the anterior segment and children without eye disease as controls. All underwent clinical grading of AC cells. AC images of each eye were obtained using the Optovue Avanti RTVue XR AS-OCT. Two acquisition modes were used: a single cross-sectional line scan and an 8-line radial scan in an asterisk pattern. Two independent, masked graders counted cells manually on AS-OCT images. Rater agreement was assessed using intraclass correlation (ICC).ResultsIncluded were 30 children (59 eyes) with uveitis (median age 13.0 years, range 3-17 years) and 20 control children (40 eyes, median age 10.5 years, range 4-17 years). The number of eyes assigned each clinical grade of cells were as follows: none, 32 (54%); 0.5+, 12 (20.3%); 1+, 5 (8.5%); 2+, 8 (13.6%); 3+, 2 (3.4%). ICC of graders for line and radial scan protocols were 0.87 and 0.90. There was no significant difference between acquisition modes for pooled grader results (95% CI for difference: -0.04 to 0.14). ICC of cell counts between line and radial scan protocols was 0.85 (95% CI: 0.69-0.90). No control eyes had cells on AS-OCT images.ConclusionsQuantification of AC cell in children with uveitis is feasible with AS-OCT and has excellent reliability between different graders and acquisition modes.

Purpose: To report the uveitic manifestations of patients with systemic lupus erythematosus (SLE). Methods: This was a retrospective analysis of all SLE cases with ocular manifestations seen by a single ophthalmologist between 2015 and December 2021. Results: In total, seven patients with a median age of 40 (range 18–50) years were included in the study. Female (85.7%) predominance was noted. Ocular findings were bilateral in 71% (five patients) of cases. Majority (10 eyes, 83%) of the patients had retinal vasculitis as the common finding. Antinuclear antibodies were positive in all the patients. The vision improved in two (16.6%) eyes, was stable in eight (66%) eyes, and worsened in one (8%) eye. All the patients were treated with oral steroids along with immunosuppressive agents. Conclusion: Though SLE is rare cause of uveitis, it can be associated with significant ocular morbidity. Hence, early diagnosis and treatment can salvage vision in many cases.

Theileriosis is one of the crucial vector-transmitted diseases in cross-bred dairy cattle in India and it is commonly caused by Theileria annulata. Frequently reported clinical signs in theileriosis were pyrexia, lymphadenopathy, conjunctival petechiae, and anemia. The purpose of the present communication report the anterior uveitis and bilateral corneal opacity in young crossbred calves due to theileriosis. Two Jersey crossbred calves aged between 22 to 40 days were presented to the clinic with a history of inappetence, pyrexia, severe tick infestation, corneal opacity, and proptosis. Ultrasonography of the eye revealed anterior uveitis and peripheral blood smears revealed the presence of piroplasms of Theileria in the erythrocytes and further confirmation was done by PCR assay. The calves were treated with injections of buparvaquone, flunixin meglumine, and vitamin A along with eye drops containing gatifloxacin, flurbiprofen, and carboxy methyl cellulose sodium.

Background: Anterior uveitis (AU) is a significant concern in patients with ankylosing spondylitis (AS), and the choice of tumor necrosis factor inhibitors (TNFi) as a treatment modality raises questions regarding its effects on AU. We compared the effects of TNFi on AU in patients with AS. Methods: Patients diagnosed with AS and treated with at least one TNFi, including anti-TNFα antibodies (adalimumab and infliximab) or a soluble TNF receptor molecule (etanercept), between January 2010 and December 2022, were retrospectively reviewed. We compared the recurrence rate of AU in patients with a history of uveitis and the incidence of new-onset AU in those without a history of uveitis among the three TNFi groups. We also compared the effects of two different TNFi agents in patients who underwent TNFi switching. Results: Within two years of treatment initiation, there was no significant difference in AU recurrence among the three TNFi groups. However, the incidence of new-onset AU was significantly higher in the etanercept group than in the adalimumab group (26.4% vs. 6.3%; p = 0.024). After two years, the AU recurrence rate was significantly lower in the adalimumab group than in the other groups (p < 0.001). Among patients who underwent anti-TNFi switching, adalimumab treatment was associated with a significantly lower incidence of uveitis than etanercept (p = 0.023). Conclusion: In the short-term period following TNFi therapy, etanercept induced new-onset AU more frequently than adalimumab in patients with AS. Adalimumab recipients experienced fewer AU recurrences during the subsequent long-term period compared to other TNFi recipients. [ABSTRACT FROM AUTHOR]

To report on the value of presence of pigmentation on central anterior lens capsule (PioLe) in HLA B27- associated anterior uveitis (HLA B27-AU). 268 patients (320 eyes) with AU were reviewed. Two diagnostic models to predict probability of HLA-B27-AU were developed. The first model included 6 variables (age, gender, unilaterality, presence of non-granulomatous keratic precipitates, hypopyon, and intraocular pressure (IOP). The second model was developed to investigate the added value of PioLe into the first model. Unilaterality, presence of hypopyon, IOP <21 mmHg and PioLe were characteristic for HLA-B27 positive patients (P≤0.003 for all). All of 6 variables had area under receiver operating characteristic curves (AuROC) ≤ 60, but PioLe reached even higher value (65.5). Diagnostic model I and II had AuROC 76.3% (95%CI, 68.4%-84.2%) and 80.0% (95%CI, 72.6%-87.5%), respectively. Unilaterality, hypopyon, IOP <21 mmHg and presence of PioLe are clinical signs suggesting HLA B27- AU. [ABSTRACT FROM AUTHOR]

Theileriosis is one of the crucial vector-transmitted diseases in cross-bred dairy cattle in India and it is commonly caused by Theileria annulata. Frequently reported clinical signs in theileriosis were pyrexia, lymphadenopathy, conjunctival petechiae, and anemia. The purpose of the present communication report the anterior uveitis and bilateral corneal opacity in young crossbred calves due to theileriosis. Two Jersey crossbred calves aged between 22 to 40 days were presented to the clinic with a history of inappetence, pyrexia, severe tick infestation, corneal opacity, and proptosis. Ultrasonography of the eye revealed anterior uveitis and peripheral blood smears revealed the presence of piroplasms of Theileria in the erythrocytes and further confirmation was done by PCR assay. The calves were treated with injections of buparvaquone, flunixin meglumine, and vitamin A along with eye drops containing gatifloxacin, flurbiprofen, and carboxy methyl cellulose sodium. [ABSTRACT FROM AUTHOR]

Extra-articular manifestations (EAMs) in ankylosing spondylitis (AS) are common and most extra-articular manifestations such as acute iritis and inflammatory bowel disease are positively correlated with disease activity of AS. Vasculitis is an extra-articular manifestation of AS. However cutaneous leukocytoclastic vasculitis (CLV) is uncommon in AS patients. In this article, we report a case of a 66-year-old female patient who has had AS for long time. Although the patient's articular manifestations were stable, the aortic aneurysm and CLV continued to occur sequentially. This article reminds clinicians that even AS patients with stable articular manifestations should be followed up regularly. All extra-articular manifestations of AS patients should be taken seriously and treated as soon as possible under the guidance of rheumatoid immunologists.

Background. Cytomegalovirus (CMV), a human beta-herpesvirus, persists latently lifelong after infection. CMV reactivation that occurs periodically can cause disease in target organs including the eye, not only in immunosuppressed, but also in immunocompetent people. Due to its immunosuppressive properties, persistent CMV is involved in the pathogenesis of diverse diseases. The aim was to study the features of antibody formation against six individual CMV proteins and to conduct a correlation analysis with parameters of peripheral blood lymphocyte profile in patients with anterior uveitis of varying severity (without hypopion-mild course, with hypopion-more severe course). Materials and methods. 36 patients with anterior uveitis were examined. Group I consisted of 20 patients without hypopion, group II 16 people with hypopion. No characteristic features of CMV anterior uveitis (elevated intraocular pressure, stromal iris atrophy) were found. Blood serum anti-CMV IgG antibodies (markers of chronic infection) were measured by ELISA, antibodies against individual recombinant CMV antigens were assessed by Line-Immunoassay specific to the main non-structural immediate early protein (IE), DNA-binding phosphoprotein p52, phosphoproteins of the tegument p150, p65, p28, GB-AD envelope glycoprotein. Lymphocyte subset composition was studied by flow cytometry: T-lymphocytes (CD3+), T-helper cells (CD3+CD4+CD8), T-cytotoxic (CD3+CD4CD8+), T-double-positive (CD3+CD4+CD8+), natural killers (CD16+CD56+), B-lymphocytes (CD19+). Statistical analysis was performed using StatTech v. 3.0.2 program (Stattech LLC, Russia). Results. In mild anterior uveitis, there was observed a significantly increased percentage of CD16+CD56+ and a decreased absolute number of CD3+CD8+ compared with anterior uveitis of a more severe course. Only in the group of patients with hypopion (more severe course) there was a direct significant correlation between level of antibodies against IE, p65, p28 antigens and percentage of double-positive cells (CD3+CD4+CD8+) as well as an negative significant relationship between the level of antibodies against IE, p65 and p52 antigens and CD19+ lymphocytes. Conclusion. The data obtained are consistent with few reports on the role of double-positive lymphocytes in the pathogenesis of severe forms of some viral diseases. Further studies are needed to assess an effect of individual viral antigens on CD3+CD4+CD8+ level in patients with chronic CMV infection to confirm the role of double-positive lymphocytes in the pathogenesis of a more severe course of anterior uveitis.

Posner-Schlossman syndrome(PSS)is a sporadic and recurrent self-limiting anterior uveitis, and its pathogenesis remains unclear. It was considered to be a prostaglandin-mediated inflammatory response. In recent years, it has been found to be related to viral infection, immune genetics, vascular endothelial dysfunction, and other factors. Clinically, the disease is predominantly unilateral. The patients with PSS suffer from increased intraocular pressure, mild pain in the affected eye, as well as blurred vision, and irisopsia. Seldom damage to the optic nerve and visual field was reported. The commonly treatment of PSS is local medication, such as anti-inflammatory drugs and intraocular pressure lowering drugs; otherwise systemic medication can be employed in severe cases. Surgical treatment can be performed for PSS if uncontrolled intraocular pressure elevation, frequent attacks, and optic nerve damage and visual field defect due to prolonged disease course. Early diagnosis and treatment of PSS can effectively reduce glaucoma-related damages. This review discussed the research progress of PSS from various aspects, aiming to provide references for the etiology, pathogenesis, and clinical diagnosis and treatment of this disease.

Abstract A 6‐year‐old neutered male Siamese cat was referred for investigation of hindlimb ataxia and blindness of 2 weeks’ duration. A swollen right hind limb, with no history of trauma, and no evidence of an external wound, was observed on physical examination. Ophthalmic examination revealed bilateral absence of the menace response and changes consistent with uveitis. Blood tests identified changes consistent with inflammation including serum amyloid A elevation. Infectious disease testing was negative. Degenerate neutrophils and bacterial cocci were detected on fine needle aspiration cytology of the affected limb. Thoracic radiography and abdominal ultrasonography identified no abnormalities. Primary pyomyositis was suspected and clindamycin was prescribed following Penrose drain tube placement. In addition, eye drops containing tobramycin, atropine, and prednisolone were administered. The clinical signs and serum amyloid A level were markedly improved after 5 days of treatment. Based on the medical history and lack of other findings, the uveitis was suspected to be secondary to the pyomyositis. The clinical signs resolved completely, and no recurrence was reported within a 6‐month follow‐up period. To the best of our knowledge, primary pyomyositis with uveitis has not been previously reported in cats.

Abstract Background To report a case of simultaneous occurrence of acute exacerbation of ocular graft-versus-host disease (GVHD) and anterior uveitis following coronavirus disease 2019 (COVID-19) vaccination. Case presentation A 60-year-old man with primary myelofibrosis and GVHD after receiving allogeneic hematopoietic stem cell transplantation (HSCT), developed acute exacerbation of ocular GVHD and anterior uveitis after receiving first dose of COVID-19 vaccine. The patient developed erythema of the eyelids, conjunctival hyperemia, superficial punctate keratopathy, and prominent anterior chamber inflammation in both eyes. The ocular GVHD and anterior uveitis were managed with mainly topical corticosteroids, antibiotics, lubricants, and systemic corticosteroids, but were difficult to control. Intravitreal injection of dexamethasone was administered, and the inflammation gradually subsided 6 months after the onset of initial symptoms. Conclusions Clinicians should be aware of rare refractory anterior uveitis and acute exacerbation of ocular GVHD after COVID-19 vaccination in patients undergoing HSCT. Early diagnosis and aggressive treatment should be considered to reduce the likelihood of severe complications.

Helicobacter pylori is a common gram-negative bacterium, which is associated with a variety of gastroenteric diseases, such as gastritis, duodenal ulcer and gastric cancer. Recent studies suggested a potential role of Helicobacter pylori in the pathogenesis of common ocular diseases, such as central serous chorioretinopathy, glaucoma, anterior uveitis and ocular adnexal lymphoma. Helicobacter pylori might affect the pathophysiological process of ocular diseases through oxidative damage, circulatory disorders and immune injury. Some studies also suggested that eradication of Helicobacter pylori had certain effects on some ocular diseases. This review aims to summarize current evidence of the Helicobacter pylori in the pathogenesis of common ocular diseases, so as to encourage innovative approaches in the prevention and treatment of these ocular diseases.

Background: Noonan syndrome (NS) represents a fairly common genetic disorder with a highly variable phenotype. Its features include inherited heart defects, characteristic facial features, short stature, and mild retardation of motor skills. Case presentation: A 16-year-old Caucasian girl with NS reported visual deterioration, photophobia, and pain in the right eye (RE). The initial best-corrected visual acuity (BCVA) was 0.3 in the RE. An examination demonstrated conjunctival and ciliary body hyperemia, keratic precipitates, and flare in the anterior chamber. In addition, post-hemorrhagic floaters, tortuous vessels, and an epiretinal membrane in the RE were present. Diagnosis of unilateral anterior uveitis was made, and this resolved after the use of topical steroids and cycloplegic drops. Due to the presence of retinal telangiectasias and extraocular exudates (consistent with Coats' disease (CD) stage 2A) in the RE, laser therapy was performed. The patient remains under constant follow-up, and after one year, the BCVA in the RE was 0.7. Conclusions: Here, we report the clinical characteristics, genetic findings, and retinal imaging results of a patient with NS. To our knowledge, this is, to date, the first report of an association of NS with a PTPN11 mutation with anterior uveitis and CD. [ABSTRACT FROM AUTHOR]

A 4-yr-old, male, captive-born African helmeted turtle (Pelomedusa subrufa) was presented for an ocular disorder of 3 days duration. Physical examination showed edema of all limbs and blepharedema of the left eye. Ophthalmic examination revealed severe blepharoconjunctivitis, a large melting corneal ulcer, and stromal densification that prevented evaluation of the anterior chamber. Examination of the right eye was unremarkable. Ultrasonography of the left eye revealed corneal perforation associated with severe anterior uveitis. Enucleation was performed based on the poor prognosis for the eye and the risk of septicemia. Providencia rettgeri was identified from bacterial culture. Fungal culture was negative. Histopathology of the eyeball revealed a corneal perforation associated with edema and heterophilic infiltration of the corneal stroma. Three weeks after surgery, the enucleation wound had healed. Providencia rettgeri has been reported as a rare cause of keratitis in humans. A systematic literature review showed one case of a melting corneal ulcer in an Asian rhinoceros (Rhinoceros unicornis) associated with this infectious agent. This is the first report of corneal perforation associated with P. rettgeri in a reptile. [ABSTRACT FROM AUTHOR]

A 6‐year‐old neutered male Siamese cat was referred for investigation of hindlimb ataxia and blindness of 2 weeks' duration. A swollen right hind limb, with no history of trauma, and no evidence of an external wound, was observed on physical examination. Ophthalmic examination revealed bilateral absence of the menace response and changes consistent with uveitis. Blood tests identified changes consistent with inflammation including serum amyloid A elevation. Infectious disease testing was negative. Degenerate neutrophils and bacterial cocci were detected on fine needle aspiration cytology of the affected limb. Thoracic radiography and abdominal ultrasonography identified no abnormalities. Primary pyomyositis was suspected and clindamycin was prescribed following Penrose drain tube placement. In addition, eye drops containing tobramycin, atropine, and prednisolone were administered. The clinical signs and serum amyloid A level were markedly improved after 5 days of treatment. Based on the medical history and lack of other findings, the uveitis was suspected to be secondary to the pyomyositis. The clinical signs resolved completely, and no recurrence was reported within a 6‐month follow‐up period. To the best of our knowledge, primary pyomyositis with uveitis has not been previously reported in cats. [ABSTRACT FROM AUTHOR]

Abstract Background Oligoarticular juvenile idiopathic arthritis (oligo-JIA) is considered as an antigen-driven lymphocyte-mediated autoimmune disease. Natural antibodies (NAbs) are pre-immune antibodies produced in the absence of exogenous antigen stimulation, participating in both, innate and adaptive immunity. Considering their major immunoregulatory role in homeostasis and autoimmune pathogenesis, we designed this study to further elucidate their role in oligo-JIA pathogenesis. Methods Seventy children with persistent oligo-JIA and 20 healthy matched controls were enrolled in the study. Serum IgM and IgA antibodies against human G-actin, human IgG F(ab΄)2 fragments and the hapten TriNitroPhenol (TNP) as well as the total concentration of serum IgM and IgA were measured by in-house enzyme-immunoassays. Kolmogorov–Smirnov normality test, Kruskal–Wallis H and Mann–Whitney tests were used to assess data distribution, and significant differences of non-parametric data between groups of the study. Backward regression analysis was used to analyze the effect of multiple factors (age, gender, disease activity, anti-nuclear antibody positivity, presence of uveitis) on continuous dependent variables (activities and activity/ concentration ratios of IgM and IgA NAbs). Results The ratios of IgA anti-TNP, anti-actin and anti-F(ab΄)2 levels to total serum IgA concentration were found to be significantly increased in patients with oligo-JIA compared to healthy subjects. Significantly elevated levels of IgM anti-TNP antibodies were also found in children with inactive oligo-JIA compared to those of children with active disease and of healthy controls. In the presence of anterior uveitis, IgM anti-TNP levels were significantly higher than in patients without uveitis or in healthy controls. Backward regression analysis revealed that the disease activity and the presence of anterior uveitis independently affect IgM anti-TNP levels. Conclusuions Our findings are in accordance with the hypothesis that NAbs contribute to the pathogenesis of autoimmune diseases and provide additional evidence that disturbances in natural autoimmunity may contribute to the as yet unclarified pathogenesis of oligo-JIA.

PurposeMethodsResultsConclusionWe report the rare occurrence of unilateral acute hypertensive uveitis in the acute phase of systemic leptospirosis.Observational case report and review of literature.A young male mason from coastal Karnataka in south India, presenting with acute febrile illness, was diagnosed to have systemic leptospirosis. He also had features of sudden raised intraocular pressure with anterior uveitis in one eye, which subsided with medical management.Leptospirosis should be considered as a differential in the diagnosis of acute hypertensive uveitis. [ABSTRACT FROM AUTHOR]