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Intraocular Inflammation (intraocular + inflammation)
Selected Abstracts1264: Laboratory work-up and specialized investigationsACTA OPHTHALMOLOGICA, Issue 2010U PLEYER Based on the anatomical involvement of the eye intraocular inflammation is classified into anterior, intermediate, posterior and panuveitis. All subtypes of uveitis are potentially related to infectious and noninfectious etiologies. This presentation will assist the participants in accurately diagnosing uveitis in a step latter approach including physical and laboratory investigations. In addition, a tailored approach based on confounding clinical observations with specialized investigations will help to further differentiate clinical entities. In cases of suspected intraocular infections the option of intraocular fluid evaluation for antibody testing and polymerase chain testing against the causative agent will be presented. Taken together, this part of the course will provide a rational decision-making strategy for diagnosis of patients with uveitis. [source] 4255: Integrating the interplay between innate and adaptive immunity in the development of non infectious uveitisACTA OPHTHALMOLOGICA, Issue 2010AD DICK Purpose Whilst uveitis is a CD4 T cell mediated disease, there remains both the interplay with innate immunity at both the affector (initiation) of disease and moreso the phenotype and severity of the effector stages of disease. Methods The talk will describe the experimental evidence to describe the interplay of T cells and myeloid cells within the retina during intraocular inflammation. Results TNF, whilst a pleitropic cytokine, has significant influence of the disease phenotype and disease course we observe experimentally. TNF is requred for activation of myeloid cells (macrophages)when in presence of Th1 CD4 T cells, which results in contribution to tissue damage but also controlling T cell proliferation in situ via generation of myeloid suppressor cells. Moreover, the role of resident myeloid cells (microglia) is to down-regulate the immune response. The role of myeloid cells in the healing response and angiogenesis will also be discussed with respect to T cell responses. Conclusion Myeloid cells are actively conditioned by their envirnoment (cognate and soluble factors) to respond accordingly. As such the regulation of immune response and healing that follows is dictated by the innate system in response to changes in local and systemic conditions. [source] 2262: Study of the role of P2Y receptors in the development of experimental autoimmune uveitisACTA OPHTHALMOLOGICA, Issue 20103Article first published online: 23 SEP 2010, L JUDICE DE MENEZES RELVAS Purpose During autoimmune uveitis (AU), retinal specific auto-reactive T lymphocytes (TL) are activated, alter blood retinal barrier(BRB) and penetrate the eye where they start an inflammatory reaction. Nucleotides, normally present at low concentration in extracellular media, can act as a danger signal, through P2 receptors activation and might be implicated in AU. In this work we would like to investigate if the expression of the nucleotide receptor P2Y2 has any role in experimental autoimmune uveitis (EAU). Methods EAU will be induced in WT and P2Y2 KO mice by IRBP peptide 1-20 injection. 12 days later, TL from spleen and lymph nodes will be purified and restimulated by IRBP. TL proliferation will be measured by thymidine incorporation and cytokines secretion by ELISA. TL from the 2 groups of mice will also be adoptively transfered in WT mice. Similarly, TL from WT mice will be adoptively transfered in WT and P2Y2 KO mice. EAU development will be graded by clinical and histological scores. Results TL generated in KO mice proliferate and produce less IFN, and IL-17, after IRBP restimulation than TL generated in WT mice. Accordingly, adoptive transfer of TL generated in KO mice induce significantly a lower grade of disease than those generated in WT mice. Finally, adoptive transfer of TL generated in WT mice induce disease of significantly lower grade in KO mice recipient than in WT mice recipient. Conclusion Our preliminary data shows that P2Y2 KO mice have a defective immune response after immunisation and develop lower intraocular inflammation following adoptive transfer with TL. Altogether this suggests that P2Y2, as danger receptor signals, play an important role in the development of uveitis. [source] 2263: Analysis of the utility of QuantiFERON-TB GoldTM in tube and measurement of IFN, release by peripheral mononuclear cells in response to different mycobacterium antigen in the work-up of patients with uveitisACTA OPHTHALMOLOGICA, Issue 2010D MAKHOUL Purpose Tuberculosis remains an important cause of infectious uveitis and immune reaction against mycobacteria may contribute to the development of certain forms of autoimmune uveitis. Moreover, many non-infectious uveitis patients are treated with immunomodulatory treatment. The evaluation of tuberculosis immunity is thus an important aspect in the work-up of patients with uveitis. In this work, we would like to investigate the usefulness of different methods of tuberculosis immunity testing in a series of patients with intraocular inflammation. Methods Patients with uveitis will undergo a standard diagnosis procedure, including a chest Xray. Quantiferon TB Gold in Tube (QFT) and tuberculin skin test (TST) will be performed. IFN, production by mononuclear cells in response to PPD and to HBHA will be measured by ELISA. Results Thirty-two patients have already been recruited. Sixteen had a negative QFT and a negative TST. In two of them, mononuclear cells produce IFN, in response to PPD (but not to HBHA) and in 1 in response to HBHA (but not to PPD). In 11 patients QFT and TST were positive. In this group, IFN, response to PPD was observed in 82% but only in 50% in response to HBHA. Discordant results between QFT and TST were observed in 5 patients. One had a positive QFT and a negative TST and 4 had a positive TST and a negative QFT. In this group IFN, response to PPD or HBHA was not observed. Conclusion Discordant results between QuantiFERON-TB Gold and TST were observed in 15 % of uveitis patients. Analysis of the IFN, production in response to PPD and to HBHA seems to add important information in both concordant and discordant group. [source] Regional Immunity of the EyeACTA OPHTHALMOLOGICA, Issue 3 2010Manabu Mochizuki Abstract. This article reviews molecular mechanism of intraocular inflammation in animal models and in humans, and the immunological defence system of the eye with particular attention to ocular pigment epithelium. In experimental autoimmune uveitis (EAU), T lymphocytes, particularly CD4+ T lymphocytes, play a central role in its immunopathogenic mechanisms. In humans, activated CD4+ T cells also play a central role in the immunopathogenic mechanisms. This notion is demonstrated in two human diseases: one is Vogt,Koyanagi,Harada disease, and the other is human T-cell leukemia virus type 1 (HTLV-1) uveitis. Activated CD4+ T cells infiltrating the eye are harmful to vision-related cells and tissues in the eye and cause sight-threatening conditions. However, the eye has regional defence systems to protect itself from these harmful activated T cells. We focus on ocular pigment epithelium (PE) and demonstrate immunoregulatory activity of iris PE and retinal PE. Iris PE suppresses activated CD4+ T cells by cell-to-cell contact with a crucial role played by B7-2 molecule on iris PE and CTLA4 on T cells. The actual immunosuppressive factor being membrane bound TGF-,. In contrast, retinal PE suppresses activated CD4+ T cells by soluble factors, such as soluble TGF-, and thrombospondin 1. In addition to the direct T-cell suppression by ocular PE, ocular PE has the capacity to promote activated T cells to regulatory T cells and use them as a tool to amplify the immune down regulation in the eye. The molecular mechanisms of generation of T regulatory cells by iris PE and retinal PE is also discussed. [source] Non-viral strategies of intra-ocular gene deliveryACTA OPHTHALMOLOGICA, Issue 2009F BEHAR-COHEN Purpose Systemic anti TNF strategies are efficient to treat intraocular inflammation but require repeated injections and are associated to severe systemic side effects. Our aim was to develop a non viral gene transfer method to produce locally anti-inflammatory proteins in a sustained and minimally invasive manner in the ocular media. For this purpose, we have transformed the ciliary muscle into a bioreactor, using an electrically assisted gene transfer technique. Methods Electrotransfer (ET) of plasmids, encoding for different variants of TNF alpha soluble receptors, was performed in the ciliary muscle cells. Using toptimized conditions, soluble receptors were dosed in the ocular media up to 8 months after a single treatment. The technique has been applied in two models of intraocular inflammation: Endotoxin-Induced Uveitis (EIU) and auto immune experimental uveitis (EAU) in rats. Results When performed 8 days or 3 months before the LPS challenge, ET significantly reduced both clinical and histological signs of EIU. Particularly, iNOS, IL6 and TNF were down regulated while IL10 was upregulated. Importantly, systemic TNF alpha was not decreased demonstrating a local effect of the treatment. In EAU, ET significantly delayed the onset of EAU and deceased its severity. Similarly, a switch towards a Th2 cytokines profile was observed in the ocular media without any effect on systemic TNF alpha. Conclusion - ET is a safe and efficient non viral method to produce locally TNF alpha soluble receptors. - Local anti TNF allows for a local intraocular immunomodulation, without affecting systemic TNF. ET could therefore be used to reduce systemic side effects of anti TNF and prevent repeated injections. [source] Gene therapy for posterior uveitisACTA OPHTHALMOLOGICA, Issue 2009AD DICK Purpose To investigate the role of gene therapy incorporating release of immunomodulatory cytokines in animal models of intraocular inflammation Methods By inoculating with either AAV or lente viruses incorporating genes for IL-1RA or IL-10 into either the anterior chamber or subretinally we onserved the ability to suppress either endotoxin induced uveitis (EIU) or experimental autoimmiune uveoretinitis (EAU). Results Anterior chamber inoculation with lente-IL-10 or IL-1RA successfully suppresses inflammation and protein exudation into the eye during the course of EIU. Subretinal injection of AAV-IL-10 suppresses EAU. The extent of local macrophage activation is also suppressed as there is marked reduction in nitrotyrosine expression within the retina. Conclusion Gene therapy with immunomodulatory cytokines offers a potential to suppress active inflammatory processes within the retina. Mechanisms will be discussed in the talk in relation to macrophage activation and restoring myeloid cell (microgolial) homeostasis within the retina. [source] Precise monitoring of intraocular inflammation by LFP: the gold standardACTA OPHTHALMOLOGICA, Issue 2009I TUGAL-TUTKUN Purpose Laser flare photometry is an objective quantitative method that enables accurate measurement of anterior chamber flare with a very high reproducibility. Methods Review of literature Results Clinical studies of uveitis patients have shown that flare measurements by laser flare photometry allowed precise monitoring of well defined uveitic entities and prediction of disease relapse. It is useful both in acute and chronic forms of intraocular inflammation. Sensitivity of laser flare photometry has been shown in posterior uveitic entities as well. Relationships of laser flare photometry values with complications of uveitis and visual loss have been reported. Conclusion Flare measurement by laser flare photometry should be included in the routine follow-up of patients with uveitis. [source] The present role of corticosteroids in uveitisACTA OPHTHALMOLOGICA, Issue 2009M KHAIRALLAH Corticosteroids are the most widely used anti-inflammatory and immunosuppressant drugs in ophthalmology in general, and remain the mainstay of therapy for patients with uveitis. An infectious etiology for intraocular inflammation should be adequately excluded or appropriately covered with anti-infectious therapy before administration of corticosteroid therapy. Topical corticosteroids alone are usually effective in the management of anterior uveitis and have little activity against intermediate or posterior uveitis. Ocular adverse effects of topical steroid therapy mainly include ocular hypertension and cataract. The use of periocular steroid injections (subconjunctival, anterior or posterior subtenon, orbital floor) are important modalities in the management of anterior uveitis refractory to topical treatment and intermediate or posterior uveitis, particularly unilateral cases. Systemic corticosteroids remain the initial drug of choice for most patients with severe bilateral intermediate or posterior uveitis. Therapy is initiated with 1.0 to 2.0 mg/Kg of oral prednisone or prednisolone as a single morning dose, followed by a slow taper. Use of intravenous pulse steroid therapy is an important option in acute, severe, bilateral posterior segment inflammation. In several cases, the level of systemic steroid required to control the inflammation is too high and unacceptable. Immunosuppressive drugs as steroid-sparing agents are indicated is such cases. Intravitreal injection of triamcinolone acetonide and slow-release intraocular devices are therapeutic options that can be used in selected uveitis cases refractory to conventional therapy and biologic agents. [source] Optimised monitoring of inflammation suppressive therapy (IST) in uveitisACTA OPHTHALMOLOGICA, Issue 2009CP HERBORT Purpose The array of inflammation suppressive therapies (IST) has increased trumendously in the last two decades including the availability of biological molecules with potent immunomodulatary activities as well as new immunosuppressive agents. In parallel measuring methods for intraocular inflammation have become available allowing much more acurate monitoring of the evolution of inflammation and its response to therapy. In addition to the traditionally used fluorescein angiography (FA), laser flare photometrry (LFP), indocyanine green angiography ICGA) and optical coherence tomography (OCT) are among the new investigational methods that have become available, each of them allowing us to establish inflammatory activity with increased precision and to explore compartments previously poorly accessible. Methods The advantages of each method will be put forward. Illustrative cases will be taken as examples to show the degree of precision obtained by combining the different methods presently at our disposal for the follow-up and monitoring of inflammation suppressive treatment. Results These cases will show that the presently available tools for optimal monitoring of intraocular inflammation allow the clinician to be better aware of the level of inflammatory activity and to better adapt his treatment. Conclusion Not only he availability of potent new therapies but also the possibility to follow more precisely intraocular inflammation with new precise devices has certainly changed the outcome of uveitis cases in recent years. [source] Ocular toxoplasmosis recurrences: a single center case reportACTA OPHTHALMOLOGICA, Issue 2009U SERRA Purpose To describe recurrence patterns in a cohort of patients with aqueous humor proven ocular toxoplasmosis, followed during 3 years, at a single referral center. Methods Retrospective, observational, non comparative case series including 43 patients who suffered from an active episode of toxoplasmic retinochoroiditis during 2005, confirmed by aqueous humour polymerase chain reaction (PCR) positivity and assisted at the Ophthalmology Department of the Pitié-Salpêtrière Hospital in Paris, France. Clinical files were analyzed in terms of signs of intraocular inflammation, number, size and location of retinochoroidal active lesions and scars, presence of ocular complications related to toxoplasmic retinochoroiditis, angiographic and visual field findings and therapeutic management. Results 20 males and 23 females (mean age 37 year-old) were followed after an episode of toxoplasmic retinochoroiditis confirmed by analysis of ocular fluids. Five of them were immunocompromised and twelve have already experienced at least a previous episode of active toxoplasmic retinochoroiditis. Recurrences occurred in 13 patients (28%) with a mean age of 48 years. These episodes were noted during the first year of follow-up, between 12 and 24 months and between 24 and 36 months in 4, 5 and 3 patients respectively. Conclusion Recurrences seem to be more frequent if they occur during the first year after the initial episode of retinochoroiditis, especially in older patients. Prospective studies are needed in order to confirm these preliminary data. [source] Clinical features of intraocular inflammation in Hokkaido, JapanACTA OPHTHALMOLOGICA, Issue 4 2009Hirokuni Kitamei Abstract. Purpose:, We aimed to investigate the clinical features of intraocular inflammation/uveitis in Hokkaido, Japan. Methods:, We retrospectively reviewed the medical records of 1240 uveitis patients (511 men, 729 women) who visited Hokkaido University Hospital, Sapporo, Japan between 1994 and 2003. Results:, Mean age at disease onset was 41.7 ± 17.8 years in men and 45.7 ± 18.3 years in women. Anterior, posterior and combined anterior and posterior segment intraocular inflammation accounted for 45.1%, 4.7% and 50.2% of cases, respectively. Sarcoidosis was the most frequent aetiology (14.9%), followed by Vogt,Koyanagi,Harada (VKH) disease (9.7%) and Behçet's disease (6.7%). Aetiologies in 49.8% patients were unknown. In sarcoidosis, women represented 72.4% of patients, and disease onset occurred at 35.1 ± 19.0 years of age in men and 50.3 ± 16.5 years in women. In VKH disease, 54.2% of patients were women, and disease onset took place at 45.9 ± 15.8 years in men and 46.4 ± 14.1 years in women. In Behçet's disease, men accounted for 56.6% of patients, and disease onset occurred at 35.5 ± 8.5 years in men and 44.5 ± 11.5 years in women. Conclusions:, Women were more prone to developing sarcoidosis compared with men. By contrast, men were more prone to developing Behçet's disease. The mean age at disease onset in both sarcoidosis and Behçet's disease was significantly lower in men than in women. [source] Antimicrobial treatment of presumed ocular tuberculosisACTA OPHTHALMOLOGICA, Issue 2007S KOUPRIANOFF Purpose: Uveitis secondary to a tuberculosis is rarely reported, even in a tertiary a care center. The prevalence of tuberculosis is low in Western Europe and its microbiological identification is difficult. However, anti tuberculosis treatment may be useful when the diagnosis of tuberculosis is presumed. Methods: The clinical records of patients with suspected tuberculosis uveitis referred to the Ophthalmology Department of the Grenoble University, between January 2005 and January 2007 were retrospectively analyzed. Patients were included in this series if they received a specific antituberculosis treatment. Results: This series included 10 patients (3M/7F, mean age 54.1). The clinical features of ocular inflammation were: bilateral panuveitis, episcleritis, bilateral posterior uveitis, and pars planitis. Tuberculin skin test, chest computerized tomography, BK sputum, and internal medicine consultation were performed for all patients. The diagnosis of presumed tuberculosis was based upon: history, thoracic imaging, and tuberculin skin test. None had extra-ocular symptoms. Sputum cultures were negative, 2 adenopathy biopsies confirmed the diagnosis. Nine patients received specific antituberculosis therapy, without systemic steroid therapy. All of them improved; no relapse occurred after 1 to 2 years after the end of therapy. In one case, tuberculosis specific therapy allowed to taper the systemic steroid therapy. Conclusions: The diagnosis of uveitis associated with tuberculosis is difficult since it depends on a spectrum of indirect signs. Bacteriological identification is rarely obtained. In presumed ocular tuberculosis, antituberculosis therapy may be useful to control intraocular inflammation, with or without steroid therapy. [source] Bilateral combined retinal and choroidal detachment in antineutrophil cytoplasmic antibody-positive scleritisACTA OPHTHALMOLOGICA, Issue 4 2003B Non Matthews Abstract. Purpose:, To describe a rare complication of scleritis in a patient with positive serum antineutrophil cytoplasmic antibodies (ANCA). Methods:, We present a case report of a patient who developed bilateral retinal and choroidal detachment associated with ANCA-positive scleritis. Results:, Oral steroids alone were insufficient to maintain sustained remission of ocular inflammation. Clinical relapse of the scleritis was associated with ANCA titres becoming positive again. A combination of cyclophosphamide and steroids was successful in achieving control of the intraocular inflammation over a follow-up period of 18 months. Conclusion:, Bilateral combined retinal and choroidal detachment is a potentially blinding complication of ANCA-positive scleritis. Monitoring of ANCA titres is useful in the management of the disease. [source] Uveitis: what do we know and how does it help?CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2001Susan Lightman PhDFRCOphth ABSTRACT Uveitis essentially means intraocular inflammation and encompasses a wide variety of different disorders. This includes both mild and severe types of inflammation affecting different parts of the eye. Histologically, all uveitis is characterized by an influx of lymphocytes into the affected tissue. In all types these lymphocytes are predominantly of the CD4 type, whether the disorder is mild or blinding, giving no clue as to why. New studies comparing cells in ocular fluids taken from inflamed eyes with different types of inflammation have, for the first time, shown a difference in the cytokine profile, so that in visually benign disease interleukin 10 levels are higher than in those which are blinding. The potential for this in terms of therapy is discussed. [source] Mycophenolate mofetil in uveitisACTA OPHTHALMOLOGICA, Issue 2009P NERI Purpose To review the current Literature and to describe the experience of a tertiary referral centre on the use of mycophenolate mofetil (MMF) treatment in uveitis. Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results The long-lasting remission in several systemic diseases, such as Crohn's disease, severe atopic dermatitis, Wegener's granulomatosis and microscopic polyangioitis, rheumatoid arthritis, pemphigus vugaris, and psoriasis, have been proven. Recent publications have have recently confirmed the satisfactory control of uveitis with MMF in a large cohort of patients. Moreover, the long-term control of cystoid macular oedema (CMO) unresponsive to the traditional therapy has been described, as well as for the choroidal neovascularization (CNV). Conclusion Non-infectious uveitis is one of the leading causes of visual impairment in ophthalmology. Steroids can control such disease, even though a long-term treatment is not recommended: several complications, such as high blood sugar level, osteoporosis, blood cell abnormalities, cataract and glaucoma, can occur. MMF is a reversible, non competitive, selective inhibitor of the de-novo pathway of purine synthesis; mycophenolic acid has a strong effect to Type II isoform of inosine monophosphate dehydrogenase enzyme, providing a stronger cytostatic effect on lymphocytes than on other cells types, with minor action to Type I expressed in most other cells. The specific action of MMF on selected targets makes it a promising drug for the control of non-infectious intraocular inflammations. [source] | ||||||||||