Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee

Sève, P.; Cacoub, P.; Bodaghi, Bahram; Trad, S.; Sellam, Jérémie; Bellocq, David; Bielefeld, P.; Sène, Damien; Kaplanski, Gilles; Monnet, Dominique; Brézin, Antoine P.; Weber, Michel; Saadoun, David; Chiquet, Christophe; Kodjikian, Laurent

doi:10.1016/j.autrev.2017.10.010

Cited by 109 publications

(91 citation statements)

References 135 publications

(161 reference statements)

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“…7, 30,34,36,62,63 Conversely, sarcoidosis is responsible for about 7 to 27% of cases of panuveitis and is one of the most important systemic association in Europe and Japan, along with Behçet's disease and tuberculous uveitis. 16,25,55 Signs of uveitis may be absent; thus, a patient with sarcoidosis-associated "silent uveitis" may develop permanent ocular damage before the diagnosis is made. In the series by Rothova et al, 29 of 121 patients (24%) with proven sarcoidosis were diagnosed with uveitis, and 10 of them (8%) were diagnosed in the absence of ocular complaints at the first ophthalmological screening.…”

Section: Posterior Uveitismentioning

confidence: 99%

“…Ocular sarcoidosis can mimic almost any other eye disease, including anterior, intermediate, or posterior uveitis, panuveitis, or a masquerade syndrome. 55,65 The differential diagnosis of ocular sarcoidosis mostly varies according to the clinical manifestations (►Table 3). Alternative ocular disorders to be considered include mainly diseases such as tuberculosis, syphilis, and viral infections.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…According to different studies, the sensitivity varies from 58 to 84% for ACE and 60 to 78% for lysozyme, and the specificity from 83 to 95% for ACE and 76 to 95% for lysozyme. 55,75,76 ACE has a lower specificity in younger patients, while treatment with an ACE inhibitor makes this test uninterpretable. Lysozyme may be raised, particularly in infectious uveitis.…”

Section: Traditional Approachmentioning

confidence: 99%

“…75,106 Given the high cost of 18-FDG PET and dosimetric considerations, we think that its use should be limited to patients presenting with positive predictive factors. 55,105 The value of fine-needle mediastinal aspiration in patients with lymph node labeling on 18-FDG PET should be demonstrated.…”

Section: Algorithmmentioning

confidence: 99%

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Ocular Sarcoidosis

Sève

Jamilloux

Tilikete

et al. 2020

Semin Respir Crit Care Med

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Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.

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Section: Posterior Uveitismentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

Section: Traditional Approachmentioning

confidence: 99%

Section: Algorithmmentioning

confidence: 99%

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Ocular Sarcoidosis

Sève

Jamilloux

Tilikete

et al. 2020

Semin Respir Crit Care Med

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“…The etiological diagnosis of uveitis remains a challenge due to the wide variety of diagnoses. An accurate history and detailed physical examination are the first steps in evaluating a patient with uveitis [12]. Then, on the basis of clinical findings, the physician may order various diagnostic tests.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the cost-consequence of a standardized strategy for the etiological diagnosis of uveitis (ULISSE study)

et al. 2020

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Main objective To prospectively assess the cost-consequence of a standardized diagnostic strategy as to compared to an open one for the etiological diagnosis of uveitis. Design This was a prospective, non-inferiority, multicentre, randomized controlled trial. Methods We included all consecutive patients with uveitis who had visited at least one of the Departments of Ophthalmology. In the standardized group, patients had a minimal work-up

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A novel peptide derived from the mannose binding lectin inhibits LPS‐activated TLR4/NF‐κB signaling and suppresses ocular inflammation

Lee

Wang

Jin

et al. 2023

Cell Biology International

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Uveitis is a major cause of vision impairment worldwide. Current treatments have limited effectiveness but severe complications. Mannose binding lectin (MBL) is an important protein of the innate immune system that binds to TLR4 and suppresses LPS-induced inflammatory cytokine secretion. MBL-mediated inhibition of inflammation via the TLR4 pathway and MBL-derived peptides might be a potential therapeutics. In this study, we designed a novel MBL-derived peptide, WP-17, targeting TLR4. Bioinformatics analysis was conducted for the sequence, structure and biological properties of WP-17. The binding of WP-17 to THP-1 cells was analyzed using flow cytometry. Signaling molecules were analyzed by western blotting, and activation of NF-κB was measured by immunofluorescencehistochemical analysis. Effects of WP-17 were studied in vitro using LPSstimulated THP-1 cells and in vivo in endotoxin-induced uveitis (EIU). Our results showed that WP-17 could bind to TLR4 expressed on macrophages, thus downregulating the expression levels of MyD88, IRAK-4, and TRAF-6, and inhibiting the downstream NF-kB signaling pathway and LPS-induced expression of TNF-α and IL-6 in THP-1 cells. Moreover, in EIU rats, intravitreal pretreatment with WP-17 demonstrated significant inhibitory effects on ocular inflammation, attenuating the clinical and histopathological manifestations of uveitis, reducing protein leakage and cell infiltration into the aqueous humor, and suppressing TNF-α and IL-6 production in ocular tissues. In summary, our study provides the first evidence of a novel MBL-derived peptide that suppressed activation of the NF-кB pathway by targeting TLR4. The peptide effectively inhibited rat uveitis and may be a promising candidate for the management of ocular inflammatory diseases.

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Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee

Abstract: A strategy is proposed for the etiologic diagnosis of uveitis. The benefit of more invasive investigations remains to be determined.

Cited by 109 publications

References 135 publications

Ocular Sarcoidosis

Ocular Sarcoidosis

Evaluating the cost-consequence of a standardized strategy for the etiological diagnosis of uveitis (ULISSE study)

A novel peptide derived from the mannose binding lectin inhibits LPS‐activated TLR4/NF‐κB signaling and suppresses ocular inflammation

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