Ocular Inflammation (ocular + inflammation)

Distribution by Scientific Domains

Selected Abstracts

Definite multiple sclerosis and uveitis: a two cases report

S. Chebel
Uveitis has infrequently been described as a manifestation of ocular inflammation in patients with multiple sclerosis (MS). Two patients with pre-existing definite MS and uveitis were described. The first patient had features of intermediate uveitis, and the second case had a features of retinal periphlebitis. However, each patient had neurologic signs consistent with MS and a negative laboratory tests for inflammatory and infectious diseases. The presence of neurological involvement with uveitis need a sequential diagnostic search. [source]

Thioredoxin interacting protein (TXNIP) induces inflammation through chromatin modification in retinal capillary endothelial cells under diabetic conditions

Lorena Perrone
Chronic hyperglycemia and activation of receptor for advanced glycation end products (RAGE) are known risk factors for microvascular disease development in diabetic retinopathy. Thioredoxin-interacting protein (TXNIP), an endogenous inhibitor of antioxidant thioredoxin (TRX), plays a causative role in diabetes and its vascular complications. Herein we investigate whether HG and RAGE induce inflammation in rat retinal endothelial cells (EC) under diabetic conditions in culture through TXNIP activation and whether epigenetic mechanisms play a role in inflammatory gene expression. We show that RAGE activation by its ligand S100B or HG treatment of retinal EC induces the expression of TXNIP and inflammatory genes such as Cox2, VEGF-A, and ICAM1. TXNIP silencing by siRNA impedes RAGE and HG effects while stable over-expression of a cDNA for human TXNIP in EC elevates inflammation. p38 MAPK-NF-,B signaling pathway and histone H3 lysine (K) nine modifications are involved in TXNIP-induced inflammation. Chromatin immunoprecipitation (ChIP) assays reveal that TXNIP over-expression in EC abolishes H3K9 tri-methylation, a marker for gene inactivation, and increases H3K9 acetylation, an indicator of gene induction, at proximal Cox2 promoter bearing the NF-,B-binding site. These findings have important implications toward understanding the molecular mechanisms of ocular inflammation and endothelial dysfunction in diabetic retinopathy. J. Cell. Physiol. 221: 262,272, 2009. © 2009 Wiley-Liss, Inc [source]

1362: Infectious posterior uveitis

Several infectious agents (parasites, bacteria, fungi, and viruses) can invade the eye and lead to ocular inflammation. Infectious causes should always be considered and ruled out in all patients with posterior uveitis. Toxoplasma gondii is by far the most common cause of infectious posterior uveitis in all ages, while Toxocara canis infects typically children. Onchocerciasis and other parasitic diseases may also cause posterior uveitis, more commonly in developing countries. Nowadays, old bacterial diseases, tuberculosis and syphilis, emerged as common causes of posterior uveitis. Bartonella henselae and Borrelia burgdorferi are other bacteria that can also cause posterior uveitis. Fungal posterior uveitis usually occurs in immunosuppressed patients or in intravenous drug users. Herpes viruses (HSV, VZV, CMV) are also associated with infectious retinitis, in immunocompromised as well as immunocompetent patients, with quite destructive clinical course. Recently, more viruses (such as West Nile virus, Rift valley fever, dengue fever, and chikungunya) have been recognized as etiologic factors of posterior infectious uveitis. A rapid and accurate diagnosis is of high importance for the successful treatment and visual outcome of infectious uveitis. Techniques and methods, such PCR and detection of specific antibodies in the intraocular fluids (Goldmann-Witmer coefficient), play a key role towards the detection of the pathogen of posterior infectious uveitis. [source]

1366: Take home messages

This basic level course addressed the pathophysiology of ocular inflammation, its classifications and the major subtypes of uveitis, highlighting some of the new developments in uveitis that have become available in the past years and have contributed to the improvement in the care of the patients. It put forward clinical knowledge in uveitis, diagnostic tools as well as therapeutic strategies that allow ophthalmologists to go further in the precision of the assessment and monitoring of intraocular inflammatory activity as well as in therapeutic intervention. [source]

2267: Safety of the anterior vitreous detachment induced by microplasmin, pharmacologic vitreolysis to separate the posterior capsule from the anterior hyaloid

Purpose The aim of this project is to establish the safety of the use of microplasmin in the vitreolenticular interface to promote the separation of the anterior hyaloid from the posterior capsule. Methods The safety of the use of microplasmin solution will be examined in 24 eyes of 12 rabbits after having performed a cataract surgery and a primary posterior continuous curvilinear capsulorhexis and having exposed the anterior hyaloid interface with a solution of different doses of microplasmin (125µg or 250µg in 0.1ml balanced salt solution)and having left this solution in place during different time intervals starting from 5 minutes to one hour. The rabbit eyes will be examined at well-defined time intervals: day 1 and 7, month 1,2,3,6 and 12. Slitlamp examination and OCT-SLO imaging will be performed to monitor ocular inflammation, visual axis reproliferation and anterior vitreous anatomy. Conclusion Congenital cataracts, whether or not combined with persistent fetal vasculature may present different degrees of congenital dysgenesis of the vitreolenticular interface. Pharmacological separation of the interface between posterior lens capsule and anterior hyaloid would be benificial to improve the surgical outcome. Therefore the feasibility, safety and clinical application of intravitreal injection of microplasmin for this indication need to be examined first. [source]

Functional and morphological changes in the eyes of Behçet's patients with uveitis

Masaru Takeuchi
Abstract. Purpose:, Behçet's disease (BD) is a chronic, recurrent, multisystem disorder, and serious ocular involvement may lead to blindness. In some BD patients, latent tissue damage caused by recurrent ocular inflammation is not reflected by visual acuity or ophthalmoscopic findings. In this study, we evaluated the morphological and functional changes of ocular features related to duration of uveitis from onset in BD patients, and analysed their association with visual acuity. Methods:, Thirty-eight eyes of 20 patients with ocular BD were enrolled. Eyes with marked complications such as cataract, glaucoma, cystoid macular oedema, macular degeneration and optic atrophy were excluded from the study. During clinical remission of ocular inflammation, perimetric sensitivity and retinal thickness were measured by Micro Perimeter 1 (MP-1) and optical coherence tomography (OCT), respectively. The relationship between MP-1 and OCT findings, best-corrected visual acuity (BCVA) converted to logarithm of the minimum angle of resolution (logMAR) and duration from initial onset of uveitis were analysed statistically. Results:, logMAR correlated with perimetric sensitivity measured with MP-1 at the fovea, inner macula and outer macula, but not with retinal thickness based on OCT. The duration of uveitis correlated significantly with logMAR and with OCT-based retinal thickness at the fovea, inner macular and outer macula, but not with MP-1-derived retinal perimetric sensitivity. No correlation was found between OCT-based retinal thickness and the corresponding MP-1-derived retinal sensitivity at the fovea, inner macula or outer macula. Conclusion:, These results demonstrate that visual acuity, retinal perimetric sensitivity and retinal thickness decrease with an increase in the duration of uveitis in BD patients, but that retinal perimetric sensitivity is relatively preserved among these factors. [source]

Regulation of transgene expression

Purpose Regulation of the transgene expression in the targeted cells is of course of major importance when using gene therapy. Actually, we have a huge range of possibilities to regulate gene expression. Methods There are two main classes of promoters: constitutive and inducible promoters. Amongst constitutive promoters, we have two sub-forms: non-tissue and tissue specific promoters. The lasts allows us to better target the tissue or cells in which we want to express our gene of interest. On the other hand, inducible promoters have been widely developed recently and allow us to obtain a regulated expression, depending on different factors. Very recently, disease specific inducible promoters emerged for a more precise regulation. Results We will together examine more precisely the different possibilities offered by gene regulation in Gene Therapy. Thereafter, we will more specifically describe usable promoters in ocular inflammation. Finally we will examine the effects of some inflammatory, disease specific, promoters. Conclusion Regulation of transgene expression is one of the fundaments of efficient gene transfer. Recent developments actually allow us to play within the targeted cell(s) to obtain an expression in specific conditions. [source]

Progress in monitoring inflammation in JIA

Purpose To analyze the most appropriate strategy to monitor ocular inflammation in children with juvenile idiopathic arthritis - associated uveitis. Methods Slit lamp biomicroscopy is widely used to evaluate the importance of anterior segment flare and cells in children with anterior uveitis. However, different studies have clearly shown that other tools such as laser flare photometry and OCT may improve the monitoring during the follow-up. Therefore, both tests are performed in all children referred to our Department for the management of JIA-associated uveitis. Results Laser flare photometry showed for the first time that active ocular inflammation may be associated with a significant level of flare even in the absence of detectable cells. This is a major finding to start a therapeutic approach or change it for a more aggressive strategy and monitor the decrease of flare. Moreover, the level of flare decrease under therapy may predict further serious complications such as secondary glaucoma or cataract. OCT features are important to identify macular alterations in nearly 85% of children with anterior uveitis associated with JIA. Conclusion Both laser flare photometry and OCT are non invasive and quantitative methods that may significantly improve the visual outcome of JIA-associated uveitis. [source]

Infliximab (Remicade?) in uveitis: a review

Tumor necrosis factor (TNF)-, has been implicated as an important mediator in autoimmune ocular inflammatory disease pathogenesis as shown by animal studies and its detection in the ocular fluids of patients with uveitis. Blockade of TNF-, has emerged as one of the most promising therapies in autoimmune diseases including uveitis. Currently, there are three TNF-, antagonists: two monoclonal antibodies (infliximab and adalimumab) and a soluble receptor that binds soluble TNF-, (etanercept). Infliximab is a chimeric monoclonal antibody directed against TNF-,. It binds with high affinity to both the soluble and the membrane-bound TNF-, and inhibits a broad range of biologic activities of TNF-,. Binding to membrane TNF-, can mediate programmed cell death. Several studies reported that infliximab therapy was rapidly effective and safe treatment for refractory noninfectious uveitis including childhood uveitis and is indicated as rescue therapy for relapses of ocular inflammation or as maintenance therapy when conventional immunosuppression fails. It also allowed a reduction of corticosteroids and immunosuppressive drugs required to control the disease. However, repeated infusions are required to maintain long-term remission. Moreover, infliximab administration is costly and requires hospital admission. Adalimumab, fully humanized monoclonal anti- TNF-, antibody, was also found to be effective and safe therapy for the management of refractory noninfectious uveitis. Several studies reported that infliximab was more effective than etanercept in the treatment of refractory uveitis. Perhaps infliximab's ability to target membrane-bound TNF-, in addition to the soluble form may contribute to its increased efficacy in comparison with etanercept for uveitis. [source]

Foveal serous detachment in juvenile idiopathic arthritis(JIA)-associated uveitis

Purpose To characterize the foveal serous detachment(FSD) in JIA-associated uveitis. To investigate the correlation with visual acuity (VA) and ocular inflammation. Methods 9 children having FSD with JIA-associated uveitis were identified between 2005-2007. All were treated with periocular steroid injection and systemic anti-TNF , antibody.Outcome measures included VA,ocular inflammation quantified by laser flare photometry and the macular profile analyzed by OCT. Results All patients(8 female,1 male) had bilateral uveitis and 6 had bilateral SRD. All patients had risk factors to develop severe anterior uveitis. The mean age at the onset of uveitis and at the onset of FSD was 4.1±1.1years and 7.6±2.2years. At the onset of FSD 6 children were refractory to methotrexate and systemic corticosteroids. It had a high frequency of ocular complications:87% posterior synechiae, 80% cataract, 60% band keratopathy and 20% glaucoma.FSD appeared isolated in 21% of eyes,it was associated with diffuse macular edema in 46% and with cystoid macular edema in 12% of cases. Before therapeutic intensification,the mean VA was 0.46logMAR,the mean foveal thickness(FT) was 261,m. At 6 months follow-up:VA increased to 0.22logMAR(p=0.017),the reduction of flare was 41%(p=0.003),the mean FT was 229,m(p=0.59). At 12 months follow-up,the mean VA was 0.19logMAR(p=0.0029),the mean FT was 196,m(p=0.009),only 1 eye showed persistant SRD. Conclusion FSD is a late-stage complication of sustained and insufficiently treated anterior uveitis in JIA-associated uveitis and must be considered for the long-term visual outcome. An agressive immunomodulatory strategy is mandatory in order to achieve strict control of ocular inflammation and improve the visual function. [source]

Effect of bromfenac ophthalmic solution on ocular inflammation following cataract surgery

Masaru Miyanaga
Abstract. Purpose:, This study compared the post-cataract surgery anti-inflammatory effects of topical treatment with 0.1% bromfenac, 0.1% betamethasone or both on postoperative anterior chamber inflammation and corneal swelling. Methods:, Seventy-two patients with no eye disease other than cataract were enrolled in a prospective, randomized study to undergo phacoemulsification combined with intraocular lens implantation. After cataract surgery, patients were randomized to treatment with bromfenac, betamethasone or both agents. Twenty-five eyes were assigned to bromfenac, 23 to betamethasone and 24 to the combined treatment group. Inflammatory reactions in the anterior chamber were measured with laser flare photometry preoperatively and at 1 and 3 days, 1 and 2 weeks, and 1 and 2 months postoperatively. Intraocular pressure (IOP) and corneal thickness were measured at the same time-points. Best corrected visual acuity (BCVA) was measured preoperatively and at 2 days, 1 and 2 weeks, and 1 and 2 months postoperatively. Specular microscope endothelial photography of the central region of the cornea was performed preoperatively and at 3 months after surgery. Results:, There were no significant differences among the bromfenac, betamethasone and combined treatment groups in BCVA, IOP, aqueous flare or corneal thickness. Cystoid macular oedema was present in one eye treated with betamethasone. Conclusions:, There were no significant differences in anti-inflammatory effects among the three treatments. These findings suggest that bromfenac is as effective as betamethasone in minimizing inflammatory reactions after cataract surgery. [source]

Antimicrobial treatment of presumed ocular tuberculosis

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]

Effects of intraperitoneal vitamin E, melatonin and aprotinin on leptin expression in the guinea pig eye during experimental uveitis

Aysel Kükner
Abstract. Purpose:,To observe ultrastructural changes and leptin expression in the guinea pig eye during experimental uveitis (EU) and the effects of vitamin E, melatonin and aprotinin on leptin expression. Methods:,Thirty male guinea pigs were randomly classified into five groups. Group 1 was the control group. Groups 2, 3, 4 and 5 received intravitreal injections of bovine serum albumin (BSA) to induce EU. At the same time on the third day, groups 3 (EU + vitamin E), 4 (EU + melatonin) and 5 (EU + aprotinin) received intraperitoneal vitamin E (150 mg/kg), melatonin (10 mg/kg) and aprotinin (20 000 IU/kg), respectively. On the sixth day, histopathological and clinical scoring of inflammation were performed, and leptin expression was investigated in the retina, choroid, sclera, episclera and cornea, and compared. Results:,There was a remarkable increase in leptin expression in the retina, choroid, sclera and episclera in the EU group. Leptin expression in the treatment groups was similar to that in the control group. At light and electron microscopic levels, ganglion cells were oedematous and inner plexiform layer thickness had increased in the EU group retinas. Oedema was decreased in the treatment groups. Comparison of the EU and treatment groups revealed significant differences histopathologically and clinically. Conclusion:,Experimental uveitis causes an increase in leptin expression in the retina, choroid, sclera and episclera of guinea pigs. Vitamin E, melatonin and aprotinin inhibit this increase. Leptin seems to be closely related to ocular inflammation. [source]

Bilateral combined retinal and choroidal detachment in antineutrophil cytoplasmic antibody-positive scleritis

B 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]

Ophthalmic presentation of Wegener's granulomatosis on a background of polymyalgia rheumatica

Georgina C Clark MBBS MA
Abstract We present a case of Wegener's granulomatosis (WG) in a 79-year-old man with limbitis and granulomatous conjunctivitis, on a background of polymyalgia rheumatica (PMR). The undifferentiated nature of ocular presentations of WG can be diagnostically challenging, especially in cases, such as this, where findings are initially inconclusive and evolve with time. This case highlights the significance of a history of PMR in patients with ocular inflammation. The systemic inflammatory systems of WG, including arthralgias, may mimic other conditions such as PMR. Patients with undifferentiated ocular inflammatory syndromes should be questioned regarding arthralgias, myalgias and stiffness. Such symptoms, or a background of PMR, should raise suspicion of WG. [source]

Which way forward for treatment of severe ocular inflammation?

Sue Lightman PhD FRCOphth
No abstract is available for this article. [source]

1266: Main anterior entities 1: non-granulomatous

Purpose To describe the clinical course, the laboratory work-up and the treatment of different types of anterior non-granulomatous uveitis. Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results The lecture describes the most typical subsets of non-granulomatous uveitis. Most part of the talk is dedicated to the most common form of non-granulomatous anterior uveitis: the acute anterior uveitis (AAU), which is very often associated with the HLA-B27 allele. This antigen is also typically associated with the spondyloarthropathies, which are inflammatory joint diseases of the vertebral column. The correct interpretation of the clinical pattern can drive the decision towards the right therapeutic strategy. Other uveitis entities are described also. Conclusion Non-granulomatous uveitis is one of the most important ocular inflammations. It is mandatory to pay attention to the clinical findings and to the laboratory work-up, in order to achieve a good therapeutic approach. [source]

Discontinuous drug combination therapy in autoimmune ocular disorders

Jelka G. Orsoni
Abstract. Purpose:, This study aimed to assess the effectiveness of a steroid-sparing immunosuppressive treatment (IST) protocol in the control of severe or steroid-resistant autoimmune ocular inflammatory diseases. Methods:, We carried out a prospective, non-randomized clinical study. Patients presenting with ocular inflammations that failed to respond adequately to steroids alone after monotherapy for a mean period of 9 ± 2 months (internal control) were offered the option to switch to a combined IST. The protocol consisted of different immunosuppressive drugs added in a stepladder sequence, where each drug (including the steroids) was administered discontinuously. Main outcome measures were control of inflammation, visual acuity and safety of treatment. Results:, A total of 76 subjects (121 affected eyes) enrolled in the IST protocol. Mean length of follow-up was 43 ± 15 months. Complete control of inflammation was achieved in 86% of patients. During the first year of IST, the rate of inflammatory recurrences/patient was 0.78 ± 1.13. This ratio diminished further during succeeding follow-up. Mean best corrected visual acuity improved from 0.31 logMAR to 0.24 logMAR (p < 0.001). Blood pressure and uric acid blood levels significantly altered for the worse in the study group. Conclusions:, Immunosuppressive treatment was effective in achieving inflammatory quiescence in a large majority of patients. The study also demonstrated the longterm safety of the protocol and its steroid-sparing effect. [source]