Noninfectious uveitis refers to a category of inflammatory diseases involving the uvea, with the exception of infectious factors or masquerade syndrome. The diagnosis and follow-up of noninfectious uveitis that involving retina or choroid require fundus imaging techniques. Fundus autofluorescence is a noninvasive imaging technique. Compared with fundus colorized photography, fundus fluorescein angiography and indocyanine green angiography, fundus autofluorescence indicates the functional status of retinal pigment epithelium and photoreceptor cells in a better way, thus playing a role in the pathophysiological mechanisms investigating, early diagnosis, disease progression monitoring and prognosis estimating of noninfectious uveitis, such as Vogt-Koyanagi-Harada disease, Beh?et disease, multifocal choroiditis, punctate inner choroidopathy, birdshot chorioretinopathy, multiple evanescent white dot syndrome, acute zonal occult outer retinopathy, acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis.
Uveitis is a group of inflammatory diseases affecting the uveal tract, retina, retinal blood vessels and vitreous. Due to its complex etiology, various entities, diverse and lack of constancy in treatment, some patients can experience visual impairment and even loss. In view of the fact that blindness caused by uveitis is mostly incurable and occurs usually in young and middle-aged people, it accounts for an important part of blinding eye diseases and has attracted worldwide attention. With the continuous development of precision medicine, clinicians will face new problems and challenges in disease diagnosis, and further in-depth research is needed to explore more optimized and efficient diagnostic processes and examinations to improve the diagnosis of uveitis in China.
The etiology of uveitis is complex and the clinical manifestations are varied. Diagnosis and treatment are often very difficult. Detailed medical history, thorough ocular examination and laboratory examination are important basis for diagnosis. In recent years, with the appearance of microincision vitrectomy surgery, it has been applied widely in the diagnosis and treatment of uveitis. It can confirm diagnosis, manage the fundus complications of uveitis, and has certain therapeutic effects. But it is worth emphasizing that the indications of vitrectomy must be strictly controlled. Suitable indications and surgical timing are the key to the effective diagnosis and treatment of uveitis.
PURPOSE: To investigate the influence of transforming growth factor-beta
(TGF-beta;) on endotoxin-induced uveitis (EIU).
METHODS: TGF- beta; was abstracted from humam platelets using Bio-gel P-60 chromatography. It was introduced either topically(drops) or intraperitoneally into the SD rats after footpad injection of lipopolysaccbaride(LPS). The inflammation in the anterior uvea was clinically evaluated with slitlamp every day.
RESULTS :TGF-beta; obtained from Biogel P-60 chromatography displayed single band on SDS-PAGE,showing a molecular weight of 12 500 EIU occurs significantly earlier and more severe in the rats which only received LPS injection than in the TGF-beta; treated rats. The duration of the inflammation was also much longer in the untreated rats than in the treated rats (P＜0. 001). CONCLUSION: TGF-beta; purified from human platelets may partly prevent the development of EIU and effectively reduce the severity of the inflammation induced by LPS injection.
（Chin J Ocul Fundus Dis,1996,12: 101-104)
Objective To investigate the effect of bromocriptine on rats with experimental autoimmune uveoretinitis.Methods Tweenty-four Wistar rats were immunized by bovine soluble antigen and randomly divided into treatment and control group. The rats in treatment group took bromocriptine orally with the dosage of 5 mg/(kg·d), which could inhibit prolactin (PRL) deliverance, while the rats in control group took glucose solution orally with the dosage of 50 g/(L·d). The clinical changes of all the rats and the delayed type hypersensitivity (DTH) response were detected. The rats were anesthetized and killed after im munized for 21 days, and the eyes were removed and examined histologically.Results The occurrence of EAU and histology scores of rats in treatment group were lower than the controls (P＜0.05,P＜0.001). The DTH response of two groups had no statistic difference (P＞0.05). Conclusions Bromocriptine can generally inhibit PRL deliverance, and may also inhibit the occurrence of EAU in rats through neuroendocrine-immune regulating network. (Chin J Ocul Fundus Dis，2003，19：34-37)
Objective
To study the clinical classification and etiologies of uveitis based on 1214 uveitis patients reffered to Zhongshan Ophthalmic Center.
Methods
A retrospective analysis was made on the patients with uveitis, coming from all over China between January 1996 and December 2001. All kinds of uveitis were classified according to the anatomical criteria and etiological criteria. The relevant data of these patients, such as the age at uveitis onset and sex were also analyzed.
Results
The total number of the patients is 1214 (male 698, female 516), with the average age at disease onset being 34.43. Anterior uveitis, the most common type, was seen in 546 cases, accounting for 44.98% of all the patients, followed in descending order by panuveitis (530 cases, 43.66%), intermediate uveitis(78 cases, 6.43%) and posterior uveitis(60 cases, 4.94%). Etiological factors and clinical entities were identified in 703 patients, accounting for 57.91% of all the patients, and the other 511 patients were idiopathic ones. The most common types of anterior uveitis were idiopathic uveitis(316 cases, 57.88%), followed by Fuchs syndrome(85 cases) and ankylosing spondylitis(45 cases). BehCcedil;et disease(218 cases, 41.13%) and Vogt-Koyanagi-Harada syndrome(196 cases, 36.98%) were the most common entities in panuveitis. Neither etiological factors nor clinical entities could be identified in the patients with intermediate uveitis and those with posterior uveitis.
Conclusions
Uveitis occurs mostly in young and middle-aged adults. In general, a predilection was seen in the male as compared with the female in the development of uveitis. Idiopathic anterior uveitis, BehCcedil;et disease and Vogt-Koyanagi-Harada syndrome are the most common entities of uveitis seen in China. Classification based on etiological and anatomical factors may provide a reasonable system for the study of uveitis.
(Chin J Ocul Fundus Dis, 2002, 18: 253-255)
Objective To examine the levels of interferon-gamma; (INF-gamma;), tumor necrosis factor-alpha; (TNF-alpha;) and interleukin-6(IL-6) in serum of patients with acute uveitis before and after treatment, and to explore the possible roles of those cytokines in the initiation and progression of the uveitis. Methods A series of 75 patients with acute uveitis,and 30 healthy persons from our hospital were investigated. The levels of INF-gamma;, TNF-alpha; and IL-6 in acute phase and convalescent phase were measured by the enzymelinked immunosorbent assay. Result The serum levels of INF-gamma;, TNF-alpha; and IL-6 in acute phase were significantly higher than that of the convalescent phase and the healthy controls (F=65.805/50.418/155.381, P=0.000). A significant negative correlation was found between the serum levels of INF-gamma;, TNF-alpha; and IL-6 in acute phase with their initial visual acuity(r=-0.656, -0.592 and -0.653, Plt;0.01). There was also a positive correlation among the serum levels of INF-gamma;, TNF-alpha; and IL-6(r=0.340, 0.467 and 0.338, Plt;0.05). Conclusions There are high serum levels of INF-gamma;, TNF-alpha; and IL-6 in patients with acute uveitis, and the cytokines levels were decreased after the treatment. The results suggested that the INF-gamma;, TNF-alpha; and IL-6 involved in initiation and progression of uveitis.
Objective To analyze the onset, clinical manifestation, causation, complications of pediatric uveitis. Methods One hundred and two patients with uveitis under 16 year-old were retrospectively studied. They visited the clinic in Peking University First Hospital from November 1979 to December 2008. Their age ranged from 2.5 to 16 years old, with a mean of 11.9 years. Routine exam was carried out, including visual acuity, slit lamp, fundus, and laboratory workup. The diagnosis and classification were made by the anatomic location according to the standard of The International Uveitis Working Group. The data of disease history, age of onset, manifestation, recurrence, causation, systemic diseases, complications, and lab examination were analyzed.Results A total of 102 patients (170 eyes) with pediatric uveitis were included in this study, 68 patients (66.6%) were bilateral cases. Anterior uveitis represented in 38 patients (37.3%), intermediate uveitis in 19 (18.6%), posterior uveitis in 10 (9.8%), and panuveitis in 35 (34.3%). The disease duration was from five days to 2.4 years, with a mean of 3.6 months. The follow-up time was two weeks to more than ten years. The first three causes of pediatric uveitis were juvenile idiopathic arthritis, Vogt-Koyanagi-Harada disease, and Behccedil;etprime;s disease. 36 patients were found with complications, and among them 19 had complicated cataract, seven had secondary glaucoma, five had corneal band dystrophy, 12 had iris synechia (both anterior and posterior), one had retinal detachment, two had eye atrophy, and one patient with juvenile idiopathic arthritis had bilateral femoral head necrosis because of the use of steroid and hip joint was replaced. There were ten children suffering more than two complications. Conclusions Pediatric uveitis is a possible blindness disease with variety of etiology and manifestations,and tends to cause complications. Early and special attention must be taken to avoid serious consequences.
Objective To observe the interferon-gamma; (IFN-gamma;), interleukin-2 (IL-2) levels of Th1 cytokine and IL-4、IL-10 levels of Th2 cytokine in serum and culture supernatants of splenic cells of the rats in the prevention of experimental autoimmune uveoretinitis（EAU）by oral tolerance. Methods 72 Lewis rats were randomly divided into EAU group，oral tolerance group (which including 10 mu;g、100 mu;g、1 mg、10 mg of S antigen group respectively) and control group，12 rats in each group. The animal model of EAU was induced by immunization with S antigen（50 mu;g）and Freundrsquo;s complete adjuvant. Oral tolerance 10 mu;g、100 mu;g、1 mg and 10 mg group were fed with 1 ml mixture of 10 mu;g、100 mu;g、1 mg、10 mg S antigen and 1 mg trypsin inhibitor respectively by intubation，once the other day，totally 7 times，and then induced EAU according to above methods；control group was fed with 1 ml mixture of phosphate buffered saline and 1 mg trypsin inhibitor，once the other day，totally 7 times，and then induced EAU. The clinical manifestation of EAU in the eye were recorded,the eyeballs were enucleated at the peak of EAU，followed by pathological grading. Meanwhile the serum was colleced; splentic cells were separated and cultured to collect the supernatant. Cytokine levels of IFN-gamma;, IL-2, IL-4 and IL-10 in serum, cultured supernatant of splenic cells were determined by enzyme-linked immunosorbent assay (ELISA). Results Compared with EAU and control group, the levels of IFN-gamma; and IL-2 (Th1 cytokine) in the serum in 100 mu;g and 1 mg group were decreased while the levels of IL4 and IL10 (Th2 cytokine) were increased，the differences were statistically significant（F=51.9, 68.8, 35.7,7.5,P＜0.01). Compared the levels of Th1 and Th2 cytokines in the serum in 10 mu;g, 10 mg group with EAU and control group, the differences were not statistically significant. In 100 mu;g、1 mg group, the levels of IFN-gamma; and IL-2 (Th1 cytokine) in the culture supernatant of splenic cells were decreased while the levels of IL-4 and IL-10 (Th2 cytokine) were increased, compared with EAU and control group, the differences were statistically significant（F=57.1,15.6,33.1,167.7, P＜0.01）. Compared the levels of Th1 and Th2 cytokine in the culture supernatant of splenic cells in 10 mu;g、10 mg groups with EAU and control group, the difference are not statistically significant. Conclusions In the process to prevent EAU by oral intake, the levels of IFN-gamma; and IL-2 (Th1 cytokine ) were decrease while the levels of IL-4 and IL-10 (Th2 cytokine). Oral administration with too high or low dose of the antigen can not prevent EAU as well as the cytokine levels do not change obviously. Cytokines has played an important role in the prevention of EAU.
PURPOSE:To investigate and changes of the retina and the chorid induced by lipopolysaccharide (LPS)in Lewis rats and to compare the results obtained on tissue wholemounts and sections.
METHODS:Immunohistochemistry was carried out both on wholemounts of the retina and the chorid-sclera complex and on ocular sections from normal Lewis rats and those after LPS injection.
RESULTS:It was shown on the tissue wholemounts that monocytes were attached to retinal blood vessels and emigrated into the choroid as early as 4hrs after LPS injection. Severe involvement of the retina and macrophages into whole area of these tissues.Furthermore increasing number of major histocompatibility complex classⅡ(MHC classⅡ)positive cells was observed in the choroid.The results on tissue sections revealed that the retina and the choroid were both involved as videnced by infiltration of these cells at some time points after LPS injection.
CONCLUSION:Wholemount technique provides undoubtful evidences to show that the retina and choroid are primarily and severely involuted after LPS injection.The endotoxin induced uveitis is,for the first time,presumed to be model for human generalized uveitis.
（Chin J Ocul Fundus Dis,1996,12:33-36）
