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Will optical coherence tomography angiography (OCTA) replace invasive imaging techniques like fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography entirely? While OCTA is being increasingly applied in the field of medical retina, will we see this change in the subspeciality of uveitis? In this article, five uveitis specialists with renowned imaging expertise answer to 10 specific questions to address this issue. The final verdict based on the comments of the experts suggests that FFA and ICG cannot be replaced by OCTA in uveitis, at least for now. While OCTA can offer new insights into the pathogenesis of certain inflammatory conditions and help in the diagnosis of complications like inflammatory choroidal neovascularisation, multimodal imaging is still the preferred approach in the assessment of patients with uveitis. [ABSTRACT FROM AUTHOR]

The aim is to unravel the mechanism of mesalazine (5-ASA) on proinflammatory cytokines in PBMCs of patients with HLA-B27 +and HLA-B27 -acute anterior uveitis (AAU), and whether this may explain the different effects of 5-ASA in both disoders. PBMCs from 12 HLA-B27+ and 4 HLA-B27- AAU patients were preincubated with 5-ASA and stimulated with LPS. As mesalazine (5-ASA) could be involved in ER stress, proinflammatory and ER stress-associated cytokines and markers were measured. Mesalazine (5-ASA) suppressed IL-6 mRNA in healthy donors and in HLA-B27+ and HLA-B27- patients but did not lead to induction and secretion of IL-1β. In HLA-B27 + or – patients the ER stress-associated markers CHOP (DDIT3) and ATF6 were suppressed. Here we show that mesalazine (5-ASA) inhibits the transcription of proinflammatory and (ER) stress associated cytokines and markers, independently of the HLA-B27 status. Results show the similarities of both AAU types but do not decipher the mechanism why the HLA-B27 status determines the therapeutic response to mesalazine in AAU. [ABSTRACT FROM AUTHOR]

To study the epidemiological and clinical features of uveitis post-COVID-19 vaccination. Retrospective chart review of patients presenting with uveitis after COVID-19 vaccination in tertiary uveitis services. In total, 25 patients, 76% females, mean age 43.2 years, were included. Uveitis occurred after Pfizer, Moderna, Astra-Zeneca and Covaxin vaccination. Anterior uveitis was the most frequent type of uveitis (56%). History of uveitis was found in 19 cases (76%), among whom 90.9% of the tested patients developed anti-Sars-CoV-2 spike antibodies after vaccination. In a mean follow-up of 5 months, one-line decrease in visual acuity was found in 12% of patients. During post-vaccine uveitis, 15.8% of cases needed an increase in their systemic therapy. According to Naranjo score, new-onset uveitis had a higher probability of being associated with vaccination (p <.01). COVID-19 vaccination can cause uveitis but has no significant impact on the visual prognosis after resolution. [ABSTRACT FROM AUTHOR]

Treatments varied considerably, but included: systemic plus intravitreal chemotherapy (16 patients; 51/6%); systemic chemotherapy with full-brain radiation (12 patients; 38.7%); systemic chemotherapy alone (8 patients; 25.8%); autologous hematopoietic stem cell transplantation (8 patients; 25.8%); intravitreal chemotherapy alone (3 patients; 9.7%); and systemic plus intrathecal chemotherapy (2 patients; 6.5%). The use of EBV therapy with foscarnet or ganciclovir has been suggested by some, but is not universally employed.[28] The review reminds us to consider VRL in HIV-positive patients with intermediate or posterior uveitis and, conversely, to consider HIV infection is those found to have VRL with or without PCNSL. While clinical and ophthalmic imaging findings often suggest the diagnosis, additional testing typically involves contrast-enhanced CNS or full-body CT or CT/PET imaging to evaluate for extraocular involvement in patients suspected of having VRL or uveal lymphoma, respectively. The 2017 World Health Organization (WHO) Classification of Tumors and Hematopoietic and Lymphoid Tissues recognized five main categories of lymphoid neoplasms: 1) precursor lymphoid neoplasms; 2) mature B-cell neoplasms; 3) mature T- and NK-cell neoplasms; 4) Hodgkin lymphomas; and 5) immunodeficiency-associated lymphoproliferative disorders.[[1]] Intraocular lymphomas are generally uncommon, but when they do occur, are almost always non-Hodgkin, B-cell in type, and one of two broad categories. [Extracted from the article]

For example, Robinson and colleagues[40] found genes specifically associated with uveitis, but not joint disease in HLA B27-associated anterior uveitis. The authors acknowledged the prior, corroborative work of El-Asrar et al,[33] who showed that aqueous humor IL-6 levels were significantly higher in uveitis patients who were HLA-B27-positive or who had Behçet disease (BD) compared to patients with Vogt-Koyanagi-Harada (VKH) disease, ocular sarcoidosis (OS), or idiopathic granulomatous uveitis ( I P i <.0001), and suggested that measurement of tear IL-6 and IL-10 levels might offer a noninvasive way to predict disease recurrences over time in HLA-B27-positive patients with uveitis. Anukul et al[25] compared the frequency of HLA-DRB1 and DQB1 class II allele genotypes in 23 patients with VKH disease to 20 patients with other forms of uveitis seen in a referral clinic in Northern Thailand. [Extracted from the article]

Limited data suggest that subcutaneous administration of TCZ may be less effective than intravenous dosing in patients with ocular inflammatory disease, although several patients have experienced control of their inflammation with subcutaneous delivery and this route may be better tolerated. Four patients discontinued therapy due to TCZ-associated side effects, including neutropenia, persistent dizziness and nausea, angioedema, and severe abdominal pain. Tocilizumab (TCZ; Actemra®; Roche/Genentech in the US; Chugai Pharmaceutical Co. in Japan) is a recombinant, humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor and currently approved by the Food and Drug Administration (FDA) and the European Commission to treat adults with moderately to severely active rheumatoid arthritis (RA) and pediatric patients with polyarticular Juvenile Idiopathic Arthritis (JIA) or systemic JIA. The authors concluded that intravenous TCZ can be a safe and effective treatment for patients with refractory JIA-associated uveitis and that selected patients may be successfully switched from monthly intravenous to weekly subcutaneous TCZ following a prolonged period of control. [Extracted from the article]

Retinal vasculitis (RV) is a common complication of both intermediate and panuveitis.[[1]] Clinically, RV tends to be diffuse, venous, and non-occlusive, and is often accompanied by both optic disc and macular edema. All patients who present with uveitis and RV should be tested for tuberculosis, sarcoidosis and syphilis with chest imaging, a complete blood cell count with differential, and a treponemal antibody test. While patients with systemic vasculitis should undergo routine dilated eye examinations, the occurrence of RV in such settings is uncommon. Patients with retinal vasculitis rarely suffer from systemic vasculitis. [Extracted from the article]

Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. The risk of such vision loss seems to be less when patients are treated by uveitis subspecialists, leading some to suggest that early subspeciality referral might bode best for all but the most mild or routine cases, particularly since both perceived and measured vision loss appear to materially diminish the quality of life of patients with uveitis. Uveitis accounts for 10% to 20% of blindness in the United States and Europe, and perhaps as much as 25% in the developing world.[[1], [3]] Vision Loss in patients with uveitis is common and appears to be related most directly to the severity, location and duration of the inflammation, and to the occurrence of secondary, vision-threatening complications such as cataract, macular edema, and glaucoma.[[5], [7], [9], [11], [13]] Prompt and complete control of inflammation is important, therefore, to limit both vision loss and its psychosocial impact. The authors identified 93 subjects with anterior uveitis (1.0%) and 48 with non-anterior uveitis (0.53%) who met their criteria of blindness in at least one eye, and 13 with anterior uveitis and 7 with non-anterior uveitis who met their blindness criteria bilaterally. [Extracted from the article]

Viral anterior uveitis (VAU) needs to be suspected in anterior uveitis (AU) associated with elevated intraocular pressure, corneal involvement, and iris atrophic changes. Common etiologies of VAU include herpes simplex, varicella-zoster, cytomegalovirus, and rubella virus. Clinical presentations can vary from granulomatous AU with corneal involvement, Posner-Schlossman syndrome, Fuchs uveitis syndrome, and endothelitis. Due to overlapping clinical manifestations between the different viruses, diagnostic tests like polymerase chain reaction and Goldmann-Witmer coefficient analysis on the aqueous humor may help in identifying etiology to plan and monitor treatment. [ABSTRACT FROM AUTHOR]

An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB. [ABSTRACT FROM AUTHOR]

Epstein-Barr Virus (EBV), also known as Human HerpesVirus-4 (HHV-4), is a -type herpesvirus with a global infection prevalence of over 95%.[1],[2] Infection, which occurs nasopharyngeally via either aerosol or direct contact, tends to be asymptomatic in children, but may be associated with the development of infectious mononucleous (IM) in 50% or more of adolescents and young adults. Such observations, together with the fact that a molecular resemblance exists between several EBV proteins and selected self-antigens, has led some experts to propose that EBV reactivation followed by bystander leukocyte activation with epitope spreading and/or molecular mimicry between EBV and self-proteins might contribute to the pathogenesis of autoimmune disease in some patients. Several studies[23] [31] have assessed intraocular levels of EBV DNA and/or anti-EBV antibodies in patients with uveitis, providing evidence for the presence of EBV in up to 10% of eyes with active inflammation. A similar case of purported bilateral EBV-associated scleritis complicated by perforation in a 71-year-old Japanese woman with elevated serum anti-EBV antibody titers has been reported.[54] The authors suggested that the serologic and PCR-based test results, together with the slow therapeutic response to combined corticosteroids and an anti-viral agent, supported the causal association with EBV. [Extracted from the article]

19 Mobini N, Dhillon R, Dickey J, Spoon J, Sadrolashrafi K. Exclusive cutaneous and subcutaneous sarcoidal granulomatous inflammation due to immune checkpoint inhibitors: report of two cases with unusual manifestations and review of the literature. Whether such patients experience reactivation of previously asymptomatic systemic sarcoidosis or develop sarcoidosis I de novo i following tattoo placement was not known. Both patients were found to have evidence of previously undiagnosed systemic sarcoidosis with elevated serum angiotensin converting enzyme levels and lung involvement - including mild interstitial involvement in one patient and hilar adenopathy in the second. The word "tattoo" was introduced into the English language in the mid-eighteenth century through the writings of James Cook, a British naval officer who sailed and explored the South Pacific. [Extracted from the article]

The authors talk about vaccine-associated uveitis monitored by Vaccine Adverse Event Reporting System (VAERS) by referring to three articles published within the issue. Topics include molecular mimicry and antigen-specific cell and antibody-mediated hypersensitivity reactions, inflammation induced by adjuvants, Shoenfeld syndrome, and a case study of a 43-year-old man of mixed White and American Indian ancestry who developedbilateral uveitis three days after intradermal hepatitis B virus.

Diagnosis of uveitis is often challenging, but can be easy in typical viral-induced anterior uveitis (VIAU). Associated symptoms and signs are an important source of information. Certain classical clinical features such as keratic precipitates (KPs) distribution, iris atrophy, elevated intraocular pressure (IOP), and unilaterality are commonly used to support the diagnosis of VIAU. However, many etiologies of anterior uveitis may to a certain extent mimic VIAU, especially the ones with unilateral granulomatous KPs and elevated IOP. This review begins with how the clinician can differentiate viral from nonviral anterior uveitis, and subsequently focuses on the key features which may aid in differentiating among the different viruses that cause VIAU. [ABSTRACT FROM AUTHOR]

Purpose: To summarize the available published data regarding the treatment of JIA-associated chronic uveitis.Methods: Available peer-reviewed publications regarding the treatments of JIA-associated uveitis were read by multiple authors (RMA, EM, JET, and DH) and the data from these reports were synthesized for this review.Results: Juvenile idiopathic arthritis (JIA)-associated chronic uveitis is a significant cause of ocular morbidity and visual impairment in children, often resulting in more frequent complications and worse visual outcomes than other types of pediatric uveitis. Since not all patients respond to the first medication introduced, it is useful to have a wide range of available treatment modalities to address recalcitrant disease. Treatment options for JIA-associated uveitis have increased substantially over the past decade, particularly with the availability of newer biological agents in addition to established medication classes such as anti-inflammatories (including topical and systemic corticosteroids) and antimetabolites.Conclusions: Although data are increasing regarding biologic agents, definitive randomized prospective clinical trials would be helpful to determine their optimal dose, frequency, treatment duration, and long-term safety in children. [ABSTRACT FROM AUTHOR]

The article discusses the diagnoses, characteristics, treatment and outcomes of uveitis or eye inflammation, following a mosquito-borne viral infection. Topics include ocular infection by Zika virus, cases of Purtscher-like retinopathy after dengue fever and association of chikungunya virus infection with blurred vision.

An editorial is presented on topics including an introduction to the journal's first edition and Volume 26 in 2018, 'Disease of the Year' reviews as a part of the edition for having completed 10 years. It states that edition includes an analysis of topics such as 'Virus-induced anterior Uveitis,' and 'Macular Edema'. It mentions members of its editorial board lead by Vishali Gupta. It also mentions an increase in the journal's page budget in 2018 from 900 pages to 1,360 pages and 8 issues.