The Ocular Immunology and Uveitis Foundation preferred practice patterns of uveitis management

Preble

et al. 2016

Sci Rep

Self Cite

Autoantigen-specific regulatory immunity emerges in the spleen of mice recovering from experimental autoimmune uveitis (EAU), a murine model for human autoimmune uveoretinitis. This regulatory immunity provides induced tolerance to ocular autoantigen, and requires melanocortin 5 receptor (MC5r) expression on antigen presenting cells with adenosine 2 A receptor (A2Ar) expression on T cells. During EAU it is not well understood what roles MC5r and A2Ar have on promoting regulatory immunity. Cytokine profile analysis during EAU revealed MC5r and A2Ar each mediate distinct T cell responses, and are responsible for a functional regulatory immune response in the spleen. A2Ar stimulation at EAU onset did not augment this regulatory response, nor bypass the MC5r requirement to induce regulatory immunity. The importance of this pathway in human autoimmune uveitis was assayed. PBMC from uveitis patients were assayed for MC5r expression on monocytes and A2Ar on T cells, and comparison between uveitis patients and healthy controls had no significant difference. The importance for MC5r and A2Ar expression in EAU to promote the induction of protective regulatory immunity, and the expression of MC5r and A2Ar on human immune cells, suggests that it may be possible to utilize the melanocortin-adenosinergic pathways to induce protective immunity in uveitic patients.

mentioning

confidence: 99%

“…This immunosuppressive strategy places the patient at an increased susceptibility to infection. In addition, non-steroidal anti-inflammatory drugs such as naproxen and celecoxib can cause gastrointestinal bleeding2425. Biologics are another class of therapies that target specific cytokines or cytokine receptors to inhibit the inflammatory response262728.…”

mentioning

confidence: 99%

MC5r and A2Ar Deficiencies During Experimental Autoimmune Uveitis Identifies Distinct T cell Polarization Programs and a Biphasic Regulatory Response

Preble

et al. 2016

Sci Rep

Self Cite

Postgraduate Medical Journal

“…There is however significant worldwide variation, with tropical and less developed countries exhibiting higher incidence and prevalence largely due to a much higher burden of infectious causes 4. It is estimated that more that 2 million people worldwide have uveitis,5 and is thought to be responsible for 10% of worldwide blindness. Some studies suggest that it is increasing in incidence 3…”

Section: Epidemiologymentioning

confidence: 99%

Uveitis: a sight-threatening disease which can impact all systems

Krishna

Ajanaku

Denniston

et al. 2017

Uveitis describes a group of conditions characterised by intraocular inflammation. The term uveitis technically describes inflammation of the uvea which comprises the iris, ciliary body and choroid, however now encompasses inflammation of adjacent intraocular structures such as the retina, vitreous and optic nerve. Uveitis is a significant cause of blindness worldwide, but its impact is generally underappreciated due to a lack of awareness and understanding of the condition among the public and most non-ophthalmic healthcare professionals. In this review, we provide an introduction to uveitis for the non-specialist, outlining the clinical presentations that should raise the suspicion of the disease, the signs that should be looked for and a framework in which to understand the condition. We show how a logical approach to classifying uveitis by aetiology and anatomical focus of disease provides the basis for treatment strategies (drug and route of administration) and clinical presentation and prognosis. We also show why understanding uveitis is helpful to clinicians working in almost every speciality due to the wide-ranging associations with systemic disease.

Journal of Ophthalmology

“…Several authors have reported that vitrectomy effectively alleviated intraocular inflammation and improved visual acuity in IU [5–9]. To achieve optimal outcomes, it was recommended that a clinically quiescent state with no intraocular inflammation should be maintained for at least three months before surgery [10–14]. However, several authors have reported successful results without complete control of inflammation prior to surgery for various subtypes of uveitis [15–17].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Inflammatory Control and Surgical Outcome of Vitrectomy in Intermediate Uveitis

Shin

Joong

et al. 2017

Purpose. To demonstrate the long-term effectiveness of vitrectomy for intermediate uveitis (IU) and to determine whether complete control of inflammation before vitrectomy is necessary. Methods. This retrospective study included 66 eyes of 66 patients with IU who underwent vitrectomy for vitreoretinal complications. Eyes were followed for at least 12 months after vitrectomy. The degree of inflammation control and visual acuity were compared before and after vitrectomy. These parameters were compared according to the presence of complete inflammation control before surgery. Results. The indications of vitrectomy included epiretinal membrane (26 eyes), vitreous opacity (21 eyes), and tractional retinal detachment (12 eyes), among others. Uveitic attacks did not occur in 44 of the 66 patients after vitrectomy. The numbers of uveitis attacks, local steroid injections, and systemic medications significantly decreased, and vision meaningfully improved after vitrectomy. These parameters did not differ significantly, regardless of the presence of preoperative inflammation. Conclusions. This study showed that vitrectomy is a good modality to manage vitreoretinal complications associated with IU, even if complete control of intraocular inflammation is not achieved before vitrectomy.