搜索结果：Journal of ophthalmic inflammation and infection

Uveitis refers to the inflammation of the uveal tract of the eye (iris, ciliary body and choroid). In the developed world, it accounts for 10&#x2013;15% of all cases of blindness. Anterior uveitis accounts is the most common form of uveitis. There is an unmet need for a topically administered non-steroidal drug to treat anterior uveitis. We tested two topical formulations of mycophenolate (MPA), an inhibitor of inosine monophosphate dehydrogenase (IMPDH) enzyme, as a potential steroid-sparing treatment for uveitis. We studied first the binding of MPA to a three-dimensional model of human IMPDH2 generated with AlphaFold 3. Next, we formulated mycophenolate sodium as an aqueous suspension and mycophenolate mofetil as an ointment. Permeability of mycophenolate through the corneal barrier was measured using a Franz cell assay using a goat eye cornea as the membrane. Drug concentration in the different compartments of the eye involved in anterior uveitis was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Both formulations were tested for acute ocular irritation in vivo, and efficacy in a rabbit model of uveitis. The AlphaFold 3 model of IMPDH2 offered a detailed map of the MPA binding site. MPA makes hydrogen bonds to main chain atoms of S276 and G326 and side chain atoms of S276, T333 and Q441 as well as hydrophobic interactions with S276, G415 and Y430. The computational analysis shed new insights on the mechanism of mycophenolate inhibition and allosteric regulation of the enzyme. Mycophenolate was stable over 6&#x2009;months in both suspension and ointment. Topical application of mycophenolate sodium 1% and 2% suspension eye drop exhibited a drug flux of 81&#xb7;81ug/cm2 and 140.42 ug/cm2, respectively, through the corneal barrier, greater than 11.01 ug/cm2 and 26.54 ug/cm2 achieved with mycophenolate mofetil 1% and 2% ointments, respectively. The formulations were non-irritant to eyes of New Zealand white rabbits. No systemic clinical signs of toxicity and necropsy findings were observed. Mycophenolate sodium 2% suspension-treated group showed significant reduction (p&#x2009;<&#x2009;0.0010) in the uveitis score with reduced leukocyte counts in the anterior chamber compared to vehicle control and was not statistically different from positive control prednisone steroid (p&#x2009;=&#x2009;0.44). Topical mycophenolate sodium 2% suspension could emerge as an effective non-steroidal treatment for anterior uveitis and merits clinical evaluation. The online version contains supplementary material available at 10.1186/s12348-026-00569-y.

Uveitis is a major cause of blindness in developed countries, and adverse effects associated with long-term use of topical or systemic steroids and immunosuppressive agents are notable. This study aimed to evaluate the efficacy and safety of hydroxychloroquine (HCQ) in sarcoidosis-associated uveitis (SAU) and idiopathic uveitis (IdU). This monocentric retrospective study included 42 patients with SAU and 15 patients with IdU treated with HCQ for at least six months between March 2003 and December 2022. All types of uveitis were included. Most patients had chronic bilateral granulomatous SAU or IdU. Efficacy was determined by the success rate of HCQ at 6 and 12 months, and at the last visit and was defined as having control of inflammation, no more than 5&#xa0;mg prednisone daily and less than or equal to 2 drops of dexamethasone phosphate 0.1%, and no treatment failure due to safety. Biomicroscopic data, best-corrected visual acuity, inflammation grading (SUN criteria) and optionally data from optical coherence tomography and fluorescein or indocyanine green angiography were assessed. The Fisher's exact test and the Wilcoxon rank test were used for the comparison of qualitative data and quantitative data respectively. Prednisone dose was compared using a mixed model. The median [IQR] duration to the last visit was 19.5 [11-44.8] months in SAU patients and 18 [13-38] months in IdU patients. At the last visit, 55% of patients with SAU (including 70% of anterior SAU and 77% of intermediate SAU) and 40% patients with IdU (including 27% of anterior IdU) were successfully treated with HCQ ; the median [IQR] prednisone dose decreased from 10 [8.0-27.5] to 4 [2.5-5.75] mg/day and from 15.5 [12.5-19.5] to 3.0 [3.0-5.0] mg/day in SAU and IdU patients, respectively. The reduction in median prednisone dose was significant in patients with SAU (p&#x2009;=&#x2009;0.002). The incidence rate ratio of flare was 0.73 (p&#x2009;=&#x2009;0.143) in SAU patients and 0.26 (p&#x2009;<&#x2009;0.001) in IdU patients. HCQ could be an interesting therapeutic option for specific types of SAU and IdU. Additionally, HCQ decreased the incidence of flare-ups and the need for oral prednisone in these patients.

To analyze the clinical features of ocular surface diseases caused by Epstein-Barr virus (EBV) infection. A retrospective case series study was conducted. Data from 48 patients (54 eyes) with EBV infection who visited Peking University Third Hospital between January 2023 and October 2025 were collected. Patient demographics and baseline information were recorded. Ophthalmic slit-lamp examination, ocular surface (conjunctiva/cornea) scrapings, bacterial culture of ocular secretions, real-time fluorescence quantitative PCR detection, EBV-specific antibody testing, and metagenomic next-generation sequencing (mNGS) were performed. Among patients infected with EBV on the ocular surface, the majority were middle-aged individuals in the 31&#x2013;40 age group. The primary risk factors for onset were keeping pets (10/48), followed by colds (6/48); among those keeping pets, parrots were the most common (5/9). The main clinical manifestations were foreign body sensation (37/54) and yellow discharge (34/54). Common signs included mixed conjunctival hyperemia (31/54), follicles on the lower eyelid conjunctiva (17/54), papillae on the upper eyelid conjunctiva (8/54), and punctate epithelial defects on the cornea (17/54). In most ocular surface scrapings, small round lymphocytes were observed alongside a small number of reactive lymphocytes (44/54), which could simultaneously present with a large number of neutrophils (36/54). There was a significant difference between the presence of yellow discharge and the type of conjunctival hyperemia [Formula: see text]. However, no statistically significant correlation was found between the presence of yellow discharge and the presence of neutrophils in the scraping results [Formula: see text]. Significant differences were found in EBV viral loads among different groups of combined symptoms [Formula: see text] and among different follicle groups [Formula: see text]. No statistically significant correlation was found between the lymphocyte count in the scraping and the EBV viral load in the affected eye [Formula: see text]. EBV infection of the ocular surface is prone to concurrent infections; therefore, a detailed medical history inquiry is crucial. Ocular surface tissue scraping examination can rapidly identify viral infection-related inflammatory characteristics and rule out bacterial/fungal infections, providing effective supportive auxiliary diagnostic evidence for viral ocular surface infection, and precise diagnosis of EBV infection needs to be achieved in combination with molecular biological and serological tests.

Conjunctivitis is one of the most common eye infections seen in hospitals. Youngsters under the age of seven, women at age 22 and men at age 28 are most likely to be diagnosed with this infection. The current study was designed to identify and characterize the conjunctivitis associated pathogens and to evaluate their sensitivity or resistance against&#xa0;commonly used antibiotics (metronidazole, ciprofloxacin, azithromycin, and levofloxacin), aqueous plant extracts (Ficus religiosa, Syzygium cumini, Azadirachta indica, Allium cepa, Eucalyptus camaldulensis, Syzygium aromaticum, Aloe barbadensis, and Citrus limon) and green synthesized silver nanoparticles. The samples were taken at Fatima Memorial Hospital, Lahore. Blood agar test was used for screening of alpha and beta hemolytic bacterial pathogens. Antibacterial activity against pathogenic isolates was done using well diffusion method. Antibiotics showed range of bactericidal potential against pathogens considerably more effective against isolated bacteria. Maximum antibacterial activity against bacterial strains was observed in E. camaldulensis, S. cumini, and C. limon (13.66&#x2009;&#xb1;&#x2009;1.20 to 9&#x2009;&#xb1;&#x2009;0.57, 15.5&#x2009;&#xb1;&#x2009;0.76 to 10.33&#x2009;&#xb1;&#x2009;1.45, and 21.33&#x2009;&#xb1;&#x2009;0.88 to 12.66&#x2009;&#xb1;&#x2009;0.33 respectively). Green synthesized silver nanoparticles showed better results as antibacterial agents with the zones of inhibition measuring 11.66&#x2009;&#xb1;&#x2009;0.66 to 8.83&#x2009;&#xb1;&#x2009;0.72; 12.5&#x2009;&#xb1;&#x2009;0.62 to 9.83&#x2009;&#xb1;&#x2009;0.72; 16.16&#x2009;&#xb1;&#x2009;1.09 to 10.83&#x2009;&#xb1;&#x2009;1.01; 13.33&#x2009;&#xb1;&#x2009;1.20 to 8.83&#x2009;&#xb1;&#x2009;0.72; 12.16&#x2009;&#xb1;&#x2009;1.16 to 7.33&#x2009;&#xb1;&#x2009;0.66, and 13.16&#x2009;&#xb1;&#x2009;0.59 to 8.33&#x2009;&#xb1;&#x2009;0.88 respectively. Biochemical and molecular characterization of pathogens was done. Bacterial strains were identified as Bacillus thuringiensis, Bacillus cereus, Bacillus paramycoides, Bacillus coahuilensis and Pseudomonas aeruginosa. This study showed that because of mis- use or over use of antibiotics, pathogens have developed resistance. So conventional medication may be replaced by biological antibacterial tools such as plant extracts and green synthesized&#xa0;silver nanoparticle.

Ocular toxoplasmosis is a leading cause of vision impairment and is burdened by the risk of recurrence. This study, conducted at the University Hospital of Verona, aimed to identify potential risk factors associated with disease recurrence. A total of 86 patients were treated for ocular toxoplasmosis between 1996 and 2023, with 43 completing treatment and follow-up of at least 18 months after treatment. Patients were treated with one of two therapeutic options: either trimethoprim-sulfamethoxazole or pyrimethamine-sulfametopyrazine. Over the study period, 21 patients experienced at least one recurrence, with a median time for the first recurrence of approximately six years. The average follow-up duration was eight years, and the probability of recurrence after seven years was 58%. Sleep duration emerged as a significant risk factor, as patients who slept between six and eight hours per night had a lower likelihood of recurrence. No significant associations were found with other factors, including gender, ethnicity, country of birth, education level, smoking, alcohol consumption, age at diagnosis, autoimmune diseases, vitamin deficiencies, vaccinations, cat ownership, consumption of raw or undercooked meat, place of residence, occupational soil exposure, primary infection (IgM positive), or the affected eye's laterality. Moderate evidence suggested a potential link between recurrences and psychological factors, such as stressful life events, lesion location, and pregnancy following the first diagnosis. Notably, women who experienced pregnancy after diagnosis had a threefold increased risk of recurrence. Regarding visual outcomes, there was modest evidence indicating that patients treated with trimethoprim-sulfamethoxazole achieved better final visual acuity compared to those treated with pyrimethamine. However, this difference was not statistically significant, and the underlying mechanism remains unclear. The findings highlight the potential role of sleep duration in reducing recurrence risk and suggest a possible association between psychological stress, post-diagnosis pregnancy, and recurrence. Additionally, trimethoprim-sulfamethoxazole treatment may contribute to better long-term visual acuity, although further research is needed to confirm these observations.

Assessing periocular inflammation is essential in several disorders, including Thyroid Eye Disease (TED). The Clinical Activity Score (CAS) is the most commonly used method to assess orbital inflammation, but is associated with significant inter-observer variability. The aim of this study was to assess the ability of Infrared Thermography (IRT) to detect orbital inflammation in TED and other orbital inflammation disorders (OOID). A retrospective study was conducted between March 2020 and November 2023. Patients were divided into four groups: active TED (CAS&#x2009;&#x2265;&#x2009;3), non-active TED (CAS&#x2009;<&#x2009;3), OOID, and healthy controls. Demographics, proptosis, and CAS were recorded. IRT was performed in 6 periocular areas, including the caruncle. Four IRT periocular patterns were characterized. Hundred and ten patients (63.64% of women) with a mean age of 59.47 (25-93) years were included. Thirteen (11.82%) patients were included in the active TED group, 44 (40.00%) in the non-active TED group, 17 (15.45%) in the OOID group and 36 (32.73%) in the control group. Non-active TED and control patients had lower mean caruncular and periocular temperatures compared to active TED and OOID patients (p&#x2009;<&#x2009;0.05). The caruncular temperature was significantly higher in active TED patients compared to OOID patients (p&#x2009;<&#x2009;0.05). Non-active TED and control patients mainly showed round and upper coma IRT patterns while active TED and OOID patients showed crab claw and other IRT patterns (p&#x2009;<&#x2009;0.05). Periocular IRT measurement is a rapid, simple, non-invasive, cost-effective, and reproducible method for detecting orbital inflammation and allows differentiating active TED from OOID.

Microsporidia are a diverse group of obligate, intracellular, eukaryotic, spore-forming fungi like and not typical true fungi. Ocular manifestations vary from early to late stages of infection and include keratoconjunctivitis, stromal keratitis, scleritis, and rarely endophthalmitis. It is rarely reported in ophthalmology literature. The purpose of this study is to evaluate the characteristics and outcome of 26 cases of microsporidial keratitis. We retrospectively reviewed the medical records of 26 immunocompetent patients with microsporidial keratitis presented in the period between 2007 and 2024. The inclusion criteria were all patients with confirmed diagnosis of microsporidial keratitis based on the clinical symptoms and confirmation of diagnosis that was done by microscopic identification of microsporidial organisms in corneal or conjunctival scrapings. The study included 26 patients (mean age: 39 years), with a male predominance (65%). Most were initially misdiagnosed, with epithelial or bacterial keratitis being the most common preliminary diagnoses. The most frequent presentation was diffuse epithelial keratitis (58%), followed by stromal infiltrates and keratoconjunctivitis. Notably, 53% of patients had a history of topical steroid use, and 23% reported prior application of unsterile topical honey. Visual acuity at presentation varied, with 27% presenting at 20/200 or worse. Visual outcomes improved over time, with patients presenting with diffuse epithelial keratitis showing the most favorable recovery. Stromal and disciform keratitis presentations were associated with poorer visual outcomes at 1 month. Microsporidial keratitis is frequently misdiagnosed, leading to delayed treatment. Diffuse epithelial keratitis was the most common presentation and associated with better visual outcomes, while stromal involvement correlated with poorer prognosis. Early diagnosis and appropriate management are essential to optimize visual recovery.

Cataract surgery in uveitic eyes with persistent hypotony is considered high-risk and is often deferred. This report describes the perioperative management and visual outcomes in such complex cases. To evaluate the effectiveness of a tailored surgical and immunosuppressive approach for patients with uveitis, cataracts, and chronic hypotony (IOP&#x2009;&#x2264;&#x2009;5 mmHg). A retrospective review of two cases: a 21-year-old female with chronic intermediate non-granulomatous uveitis and a 17-year-old male with Vogt-Koyanagi-Harada (VKH) disease. Both developed bilateral cataracts and persistent hypotony. A multi-step protocol was implemented, involving aggressive immunosuppression (azathioprine/methotrexate plus adalimumab) and an average of two periocular triamcinolone acetonide (40&#xa0;mg/mL) injections per eye to elevate IOP to a safe surgical threshold (&#x2265;&#x2009;8 mmHg). After achieving&#x2009;&#x2265;&#x2009;3 months of quiescent inflammation and normalized IOP, patients underwent lens aspiration with intravitreal triamcinolone injection and were intentionally left aphakic. Preoperative IOP was successfully elevated to a mean of 10 mmHg. One eye experienced an intraoperative complication (dropped nucleus) requiring pars plana vitrectomy; this eye later developed corneal decompensation necessitating penetrating keratoplasty. Postoperative inflammation resolved within one week in all eyes. On long-term follow-up (mean 24 months), inflammation remained controlled on maintenance immunosuppression. At the two-year follow-up, best-corrected visual acuity was 20/30 in three eyes and 20/50 in the eye that required additional surgeries. IOP was maintained at &#x2265;&#x2009;8 mmHg in all eyes. A meticulously planned, multi-modal approach-involving aggressive control of inflammation, targeted reversal of hypotony with periocular steroids, and strategic surgical timing with intentional aphakia-can lead to successful anatomical and visual outcomes in high-risk uveitic patients with cataracts and persistent hypotony.

To report a case of recurrent bilateral combined branch retinal vein occlusion (BRVO) and branch retinal artery occlusion (BRAO) with paracentral acute middle maculopathy (PAMM) as the first manifestation of lung adenocarcinoma. A 54-year-old male with a history of inferonasal BRVO in the left eye (LE), was referred to our department for blurred vision in the LE. On examination, best-corrected visual acuity was 20/20 in the right eye (RE) and 20/25 in the LE. Fundus examination showed tortuosity and dilatation of the inferotemporal branch vein, cotton-wool spots, retinal hemorrhages, and areas of retinal whitening in both eyes corresponding to a BRVO associated with BRAO and PAMM. A few months later, the patient complained of blurred vision in the RE. Examination revealed a superior temporal BRVO and BRAO. An exhaustive work-up was performed. Results showed a high level of antiphospholipid antibodies. Chest scan showed the presence of a pulmonary mass related to lung adenocarcinoma. The patient underwent a surgical removal of the lung tumoral mass and chemotherapy. The level of antiphospholipid antibodies was back to normal and no recurrence of ocular symptoms was noted after a follow-up of one year. The association between retinal vascular occlusions and systemic carcinomas is rare. Malignant tumors may induce a hypercoagulation state and an increased risk of thromboembolic complications including branch retinal vascular occlusions.

Autoimmune inflammatory ocular diseases, including uveitis, scleritis, and ocular mucous membrane pemphigoid, can cause severe, vision-threatening complications and are often associated with systemic autoimmune conditions. Standard therapies involve corticosteroids, conventional disease-modifying antirheumatic drugs (cDMARDs), and biologics, yet some cases remain refractory. Janus kinase (JAK) inhibitors have emerged as a promising therapeutic option for such refractory cases and are increasingly being explored as potential primary or secondary line therapies. This systematic review synthesized evidence from case reports and case series describing the use of JAK inhibitors in non-infectious ocular inflammation. A comprehensive search of PubMed and MEDLINE (from inception to March 2025) identified 22 studies (12 case reports, 10 case series) involving 43 patients (64 eyes). Patients ranged from 13 to 85 years (mean&#x2009;=&#x2009;41) with a female predominance (69.7%). Reported ocular conditions included scleritis (46.5%), uveitis (34.9%), ocular mucous membrane pemphigoid (7.0%), keratitis (4.7%), keratoconjunctivitis (4.7%), and non-specific orbital inflammation (2.3%). Most patients had failed prior therapies with corticosteroids, cDMARDs (80%), and biologics (51%) before initiating JAK inhibitors. Tofacitinib (62.8%) was the most frequently used agent. The median follow-up was approximately 2.5 months (range: 1-78 months). Complete remission was achieved in 69.7% of patients, while 27.9% experienced partial or marked improvement. More than half of the patients were able to taper or discontinue corticosteroids. No relapses were reported during follow-up. Reported adverse events were mild and included elevated transaminases, leukopenia, neutropenia, and herpes virus reactivation. JAK inhibitors demonstrate promising efficacy and an acceptable safety profile in refractory autoimmune ocular inflammatory diseases, enabling high rates of remission and reduced steroid dependence. These findings highlight their potential role in treatment algorithms and underscore the need for further prospective studies to define their long-term efficacy, safety, and optimal use.

Identifying underlying disease associations in patients with scleritis remains a clinical challenge. This study aimed to assess the contribution of systemic examination, longitudinal follow-up, and additional investigations to the identification of associated diseases in patients with scleritis. We retrospectively reviewed 98 patients with scleritis in whom no associated disease had been identified at presentation, assessed in two internal medicine departments in Lyon between July 2011 and September 2023. Data were collected at the initial presentation, prior to the identification of any underlying disease. The primary outcome was the contribution of systemic examination to the identification of associated diseases. After a median follow-up of 42 months [15.5-100], an associated disease was identified in 37 patients (37.8%), including 23 systemic diseases (23.5%), 12 infectious diseases (12.2%), and 2 cases of drug-induced scleritis (2.0%). Systemic examination contributed to the identification of an associated disease in 20 patients (20.4%), mainly through ear, nose and throat (ENT) and dermatological assessments. In 70% of these patients, systemic manifestations preceded the first episode of scleritis, while in the remaining 30% they developed during follow-up. In three patients, scleritis was the initial and sole manifestation, and the diagnosis was established through additional investigations during follow-up. The positive predictive value (PPV) of non-specific anti-neutrophil cytoplasmic antibodies (ANCA) was 29%, with a negative predictive value (NPV) of 98%. When specific ANCA testing was performed, the PPV increased to 86%. Repeating laboratory investigations during follow-up did not yield additional diagnoses. Systemic examination contributed to the identification of an associated disease in one-fifth of patients. Scleritis may be the first clinical manifestation of an underlying systemic disease, supporting the need for systematic and prolonged follow-up. These findings also underline the diagnostic value of specific ANCA testing, whereas repeating laboratory investigations after an initial negative assessment appears of limited utility.

Adalimumab is effective in treating non-infectious uveitis (NIU), but some patients develop anti-drug antibodies against adalimumab (ADA-A), which can reduce its effectiveness, resulting in active inflammation and vision loss. We sought to determine the prevalence of ADA-A in adults receiving adalimumab for NIU, and investigate factors associated with the presence of ADA-A. In this cross-sectional study, eighty-one (46 female) consecutive adult patients receiving adalimumab for NIU at The Royal Victorian Eye and Ear Hospital, and Eye Surgery Associates in Melbourne, Australia were recruited from March 2023 to February 2024 inclusive. The median age of patients was 45 years (range 18, 87) with median disease duration of 5.3 years (range 0.4, 25.3), and median duration of adalimumab therapy of 2.3 years (range 0.2, 13.1). Panuveitis (N&#x2009;=&#x2009;27, 33%) was the commonest anatomical form of uveitis treated, and most patients had bilateral uveitis (N&#x2009;=&#x2009;73, 90%). The most common diagnoses were presumed idiopathic uveitis (N&#x2009;=&#x2009;27, 33%) and sarcoidosis (N&#x2009;=&#x2009;13, 16%). Most patients (N&#x2009;=&#x2009;50, 62%) were concurrently treated with conventional immunosuppression, most commonly using methotrexate (N&#x2009;=&#x2009;32, 40%). ADA-A were present in 5/81 patients (6.2%, 95%CI 2.7, 13.6), and their presence was associated with higher Body Mass Index [median 34.9&#xa0;kg/m2 (IQR 32.5, 38.0) vs. 28.4&#xa0;kg/m2 (IQR 24.4, 31.9), p&#x2009;=&#x2009;0.010], higher C-reactive protein [median 7.4&#xa0;mg/L (IQR 5.5, 7.9) vs. 2.0&#xa0;mg/L (IQR 0.0, 6.0), p&#x2009;=&#x2009;0.030], lower patient-reported health [median 5/10 (IQR 5, 6) vs. 8/10 (IQR 6, 8), p&#x2009;=&#x2009;0.024], and lower serum adalimumab levels [median 0.0&#xa0;&#xb5;g/mL (IQR 0.0, 0.0) vs. 5.0&#xa0;&#xb5;g/mL (IQR 2.8, 7.8), p&#x2009;=&#x2009;0.002]. There was no association between ADA-A and the duration of adalimumab therapy, use of concurrent conventional immunosuppression, presence of systemic inflammatory disease, uveitis activity, visual acuity or adverse effects to adalimumab. ADA-A were uncommon, and their presence may be associated with obesity, increased C-reactive protein, and poorer patient-reported health. Within the limitations of our statistical power, the presence of ADA-A was not associated with systemic inflammatory disease, uveitis activity, nor adalimumab monotherapy.

Chronic non-infectious uveitis can lead to vision loss if not adequately controlled. Thus, steroid-sparing immunomodulatory therapy (IMT) is often required to achieve and maintain disease quiescence. It is unclear if biologic agents inhibiting tumor necrosis factor alpha (TNF-&#x3b1;) provide superior control of chronic uveitis compared to conventional IMTs on their own or as combination therapy. This is a multicenter retrospective cohort study using the TriNetX US Collaborate network. Adult patients (&#x2265;18&#x2009;years) with chronic non-infectious uveitis who achieved steroid-sparing quiescence on IMT were included. Patients were grouped by initial maintenance with conventional IMT (methotrexate, mycophenolate mofetil, or azathioprine), biologic TNF-&#x3b1; inhibitor (adalimumab or infliximab) or combination therapy (both conventional IMT and biologic agent), and the incidence of flares over 6, 12, 18 and 24&#x2009;months of follow-up were analyzed. Outcomes were compared between groups using paired chi-squared tests on propensity score matched cohorts with relative risk (RR) and 95% confidence intervals calculated for each outcome. A total of 2,912 patients on conventional IMT, 736 patients on biologic therapy and 1,313 on combination therapy met the definition of steroid-sparing control. Patients on combination therapy had significantly lower rates of flares as compared to those on conventional IMT at 6&#x2009;months (RR 0.53; p&#x2009;=&#x2009;0.0070), 12&#x2009;months (RR 0.52; p&#x2009;=&#x2009;0.0011), 18&#x2009;months (RR 0.56; p&#x2009;=&#x2009;0.0022) and 24&#x2009;months (RR 0.56; p&#x2009;=&#x2009;0.0012). No difference in the rate of flares was found between combination versus biologic therapy, or conventional IMT versus biologic therapy at 6-, 12-, 18- and 24&#x2009;months. Patients initially treated with conventional IMT had higher rates of augmentation or switching to biologic therapy at 12&#x2009;months (RR 1.74; p&#x2009;=&#x2009;0.0386), 18&#x2009;months (RR 1.65; p&#x2009;=&#x2009;0.0219) and 24&#x2009;months (RR 1.65; p&#x2009;=&#x2009;0.0114). The current study indicates that for patients with chronic uveitis who achieve steroid-sparing control on IMT, those treated with a combination of a conventional IMT and a biologic TNF-&#x3b1; inhibitor have a lower risk of disease activation as compared to those on conventional IMT.

To report a rare presentation of periocular necrotizing fasciitis (NF) following a surgical site infection after aesthetic rhinoplasty. We present two otherwise healthy patients who developed periocular swelling, erythema, and pain extending to the temporal region and nasal bridge, accompanied by areas of periocular necrosis. Neither patient had a history of trauma. One patient underwent an uneventful aesthetic rhinoplasty more than one month earlier, followed by a recent postoperative nasal hump shaving performed in an outpatient setting at the surgeon's office. The second patient had a similar history of uneventful aesthetic rhinoplasty two weeks earlier. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scores were 6 and 7, suggesting a high likelihood of the disease. Orbital computed tomography (CT) revealed severe preseptal soft tissue swelling extending to adjacent areas with no evidence of intraorbital involvement. A clinical diagnosis of periocular NF was established, and both patients were treated with intravenous broad-spectrum antibiotics, followed by prompt surgical debridement of necrotic tissue. Bacterial cultures revealed growth of Streptococcus viridans and Staphylococcus species. Both patients achieved complete recovery without recurrence or significant complications. Although periocular NF is rare, a high index of suspicion is essential for early diagnosis, particularly in patients with a recent history of facial surgery or trauma. Prompt recognition and management can prevent catastrophic outcomes, including orbital involvement and vision-threatening complications.

Cat scratch disease (CSD) is the commonest etiology of neuroretinitis (NR) and is caused by Bartonella henselae. The objective of this study was to look at clinical, imaging characteristics and outcomes among serology confirmed Cat scratch disease Neuroretinitis (CSD NR). A retrospective review of clinical records of 33 eyes from 28 patients was undertaken over a 5-year period between April 2015 and February 2020. Mean age at presentation was 34.3 years. Twenty-two (78.6%) had contact with cat. Mean duration of ocular symptoms was 7.0 days. Eighteen (64.3%) had history of fever while 24 (85.7%) complained of blurring of vision. Median baseline logMAR visual acuity was 0.8 (0.2-2.00) and median final logMAR VA was 0.2 (0.00-1.8), p&#x2009;<&#x2009;0.01. Anterior segment inflammation was absent (57.6%) or mild (36.4%). An inflammatory angiomatous optic nerve head lesion was present in 9 (27.3%) eyes. Seventeen (51.5%) eyes had retinal infiltrates or focal retino-choroiditis. This was seen in 66.7% eyes presenting within a week and was absent in 77.8% presenting after a week (p&#x2009;=&#x2009;0.034). Eight (24.2%) eyes had no macula exudates at presentation out of which 7 had peripapillary subretinal fluid (SRF) on optical coherence tomography (OCT). Median baseline oct central subfoveal thickness (CST) was 303&#xa0;&#x3bc;m (213&#x2013;1159) and median final CST was 262&#xa0;&#x3bc;m (193&#x2013;344), p&#x2009;<&#x2009;0.001. Hyperreflective vitreous dots on OCT were present in 16 (50.0%) with no clinical evidence of vitritis or vitreous cells in 18.75%. Peripapillary SRF was seen in 26 (81.3%), subfoveal SRF in 23 (71.9%), macula intraretinal fluid (IRF) in 12 (37.5%) and abnormal foveal contour in 22 (68.8%). Fluorescein angiography showed disc leakage in 10 out of 15 eyes (66.7%). All patients received treatment, 17(60.7%) with oral antibiotics and 11 (39.3%) with additional oral steroids. Presenting visual acuity was moderate to poor with good final visual outcomes. Severe anterior uveitis was uncommon. Absence of baseline macular exudates maybe associated with peripapillary subretinal fluid. Retinal infiltrates or focal retino-choroiditis were common but seen early in presentation. Hyperreflective dots in the vitreous on OCT may precede clinical visualization of vitreous involvement. Significant reduction in CST on OCT was seen at six weeks.

We report a rare case of cytomegalovirus (CMV) iridocyclitis and vitreoretinal lymphoma (VRL) that developed sequentially in the same eye during long-term infliximab (IFX) therapy for ulcerative colitis. This case highlights both the risk of opportunistic ocular infections and lymphoproliferative disorders coexisting in the same eye and the diagnostic challenges associated with prolonged immunosuppression. A 65-year-old man presented to the ocular inflammatory service at Nippon Medical School Tama-Nagayama Hospital with deteriorating vision in the left eye. His medical history included IFX therapy for 11 years for ulcerative colitis, a 7-year history of bilateral primary open-angle glaucoma, and recurrent iridocyclitis in the left eye. Slit-lamp examination revealed mutton-fat keratic precipitates and dense vitreous opacities. Multiplex PCR of the aqueous humor detected CMV and Epstein-Barr virus (EBV). The cytological grading of the vitreous fluid was class IIIb. Cytokine analysis revealed an interleukin (IL)-10/IL-6 ratio of >&#x2009;1.0, and immunoglobulin heavy chain gene rearrangement revealed monoclonality. Based on these findings, the patient was diagnosed with concurrent CMV iridocyclitis and VRL in the same eye. EBV positivity in the aqueous humor may have been associated with VRL development under prolonged immunosuppression. Topical ganciclovir was initiated for CMV iridocyclitis. The patient underwent bilateral ocular radiotherapy (40&#xa0;Gy) and systemic chemotherapy with rituximab, methotrexate, procarbazine, and vincristine after IFX cessation. Although inflammatory and infiltrative lesions resolved, his final visual acuity was 20/200 due to glaucomatous visual field loss. The present case highlights both the risk of opportunistic ocular infections and lymphoproliferative disorders associated with prolonged immunosuppression and the diagnostic challenge when both conditions coexist in the same eye. Careful monitoring and close collaboration between ophthalmologists and internists are essential for the early diagnosis and appropriate management of such patients.

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis characterized by asthma, eosinophilia, and systemic vasculitis. Ocular involvement is uncommon (6-20%) and usually follows systemic disease. In contrast, granulomatosis with polyangiitis (GPA) more frequently (30-60%) involves the orbit and may present as isolated orbital disease. Distinguishing EGPA from GPA can therefore be challenging when orbital inflammation is the initial manifestation, particularly in children. A 7-year-old girl was referred with unilateral orbital swelling that was initially treated as preseptal cellulitis with oral amoxicillin and topical ciprofloxacin, without clinical improvement. Examination revealed a firm, mobile, tender superotemporal orbital mass with restricted upgaze, while visual acuity and fundus examination were normal. Orbital magnetic resonance imaging demonstrated an extraconal lesion exerting mass effect on the superior rectus muscle, globe, and lacrimal gland. The lesion was isointense on T1-weighted images, hyperintense on T2-weighted images, and showed marked contrast enhancement without diffusion restriction. Orbital biopsy revealed dense eosinophilic infiltration with granuloma formation and perivascular inflammation. Serologic testing demonstrated positive perinuclear (P-) ANCA with elevated myeloperoxidase (MPO) antibodies, supporting a diagnosis within the spectrum of ANCA-associated vasculitis. Systemic evaluation revealed no other inflammatory lesions, apart from bilateral otitis media with effusion. The patient underwent surgical debulking, which relieved the mass effect and provided diagnostic tissue. Subsequent treatment with high-dose systemic corticosteroids and rituximab resulted in clinical improvement with sustained systemic clinical and biochemical remission. Follow-up MRI, however, showed no significant reduction in the size of the orbital mass, necessitating a second, more extensive surgical debulking. Isolated orbital inflammation may represent an initial manifestation of ANCA-associated vasculitis in pediatric patients. Although eosinophil-rich granulomatous inflammation and MPO-ANCA positivity may suggest eosinophilic granulomatosis with polyangiitis, predominant orbital and ENT involvement in the absence of asthma or other atopic features may be more consistent with localized granulomatosis with polyangiitis. This case underscores the importance of early orbital biopsy, comprehensive serological evaluation, and cautious interpretation of residual orbital lesions within a multidisciplinary, longitudinal diagnostic approach.

To describe the clinical features, complications, and long-term visual outcomes of cytomegalovirus (CMV) retinitis in patients presenting to a tertiary eye center. A retrospective chart review of patients who were diagnosed with CMV retinitis between 2014 and 2024. Twelve eyes of 8 patients were included. Five patients (62.5%) were males and 3 (37.5%) were females. All patients were immunocompromised. Four patients (40%) were on immunosuppressive medications after renal transplantations for chronic renal failure (CRF), three patients had human immunodeficiency virus (HIV) infections, and one patient had a congenital immunodeficiency disease. The baseline best-corrected visual acuity (BCVA) was 0.8&#x2009;&#xb1;&#x2009;0.9 (Snellen&#x2009;=&#x2009;20/125). Seven eyes (58.3%) had a hemorrhagic type of retinitis, and 5 eyes had granular retinitis (41.7%). Vitritis was found only in 2 eyes (16.7%), vasculitis was found in 3 eyes (25%), and occlusive vasculitis was found in 2 eyes (16.7%), and all of these features were present in patients who were non-HIV infected. The mean BCVA on the last visit was 0.9&#x2009;&#xb1;&#x2009;1.2 (Snellen&#x2009;=&#x2009;20/160). Visual threatening complications included macular atrophy, optic disc pallor, rhegmatogenous retinal detachment (RRD), and NVG. The clinical picture of CMV retinitis is better related to the level of immunity than the classification of HIV vs. non-HIV related. Signs of inflammatory response were absent in HIV-infected patients. The online version contains supplementary material available at 10.1186/s12348-026-00572-3.

Ocular toxoplasmosis represents the most common cause of posterior uveitis worldwide and remains a major cause of visual morbidity, particularly among young and immunocompetent individuals. The purpose of this study is to assess the efficacy and safety of combined intravitreal trimethoprim/sulfamethoxazole and dexamethasone with concurrent systemic cotrimoxazole and oral corticosteroids in patients with active Toxoplasma chorioretinitis. This retrospective interventional case series included a total of seven eyes from seven consecutive patients with active necrotizing toxoplasma retinochoroiditis and dense vitritis involving zone 1. All examinations were performed by a uveitis specialist. Each patient received a single intravitreal injection of trimethoprim/sulfamethoxazole and dexamethasone, in addition to systemic cotrimoxazole and prednisolone. Clinical evaluation included best-corrected visual acuity (BCVA), intraocular pressure (IOP), grading of ocular inflammation, and fundus examination. Patients were followed weekly for one month and subsequently on a monthly basis for three months. All patients demonstrated a rapid reduction in inflammation and lesion size, accompanied by improvement in BCVA, achieving a final visual acuity of 8/10 to 10/10 at one month. No ocular or systemic complications, IOP elevation, or recurrence were observed during the three-month follow-up period. Adjuvant intravitreal cotrimoxazole therapy appears to be a safe and effective option for vision-threatening ocular toxoplasmosis, providing rapid disease control and excellent visual outcomes.