Developments in uveitis
Ilknur Tugal-Tutkun
Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University; Uveitis Outpatient Clinic, Eye Protection Foundation Bayrampasa Eye Hospital, Istanbul, Turkey
Date of Acceptance 14-Dec-2022
Date of Web Publication 27-Dec-2022
Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul
DOI: 10.4103/sjopt.sjopt_211_22
Tugal-Tutkun I. Developments in uveitis. Saudi J Ophthalmol 2022;36:335-6
Tugal-Tutkun I. Developments in uveitis. Saudi J Ophthalmol [serial online] 2022 [cited 2023 Jan 31];36:335-6. Available from: https://www.saudijophthalmol.org/text.asp?2022/36/4/335/365584
Uveitis is a rapidly evolving field in ophthalmology. Major progress has been achieved with the use of novel imaging modalities, better detection and recognition of infectious etiologies, and availability of biologic agents for the treatment of the most difficult cases of noninfectious uveitis.
This special issue on developments in uveitis includes major review articles, original articles, and case reports exemplifying challenges met in the diagnosis and/or treatment of uveitis patients.
Laser flare photometry (LFP) is the only objective, quantitative, and precise measure of intraocular inflammation. In a review article, Kesim et al.[1] outlined basic principles of LFP and provided a literature review on the use of LFP in specific uveitis entities, including HLA-B27-related anterior uveitis, Fuchs uveitis, juvenile idiopathic arthritis-associated uveitis, Behçet's disease uveitis, and Vogt–Koyanagi–Harada (VKH) disease.
Multimodal imaging has become the mainstay of diagnosis and monitoring of posterior uveitis. In a major review article, Chandrasekaran et al.[2] focused on choroidal imaging with indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT-angiography (OCTA). They outlined characteristic findings on each of these imaging modalities in various posterior uveitic entities and provided a review of recent literature on choroidal biomarkers such as choroidal thickness and vascularity index on choroidal OCT and capillary flow changes on OCTA.
There are three major reviews on infectious uveitis. Gozzi et al.[3] have reviewed clinical characteristics and management of viral anterior uveitis caused by herpes simplex virus 1 and 2, varicella-zoster virus, cytomegalovirus, and rubella virus, the latter being associated with Fuchs uveitis in Western countries. They have also described the current approach to the definitive diagnosis of viral anterior uveitis with the analysis of aqueous humor for viral antigens and local production of antiviral antibodies. Yen et al.[4] have provided an update on tubercular uveitis in a major review article including epidemiology, clinical forms, diagnostic features, laboratory investigations, and treatment of tubercular uveitis. Their discussion also included specific questions on when to start antituberculous therapy, how long to treat, and whether to use concomitant corticosteroids. In a review article on rickettsial ocular disease, Abroug et al.[5] have summarized the epidemiology and systemic features of rickettsioses and provided an update on ocular clinical and imaging features, diagnosis, management, and prognosis of especially posterior segment involvement in this entity.
Takeuchi et al.[6] have reported on the efficacy and safety of adalimumab for the treatment of chronic recurrent uveitis associated with VKH disease with sunset-glow fundus. In this retrospective study of 50 VKH patients, the authors found a significant improvement in visual acuity and significant reductions in LFP flare count, subfoveal choroidal thickness, ICGA score, and corticosteroid dose at 6 months of adalimumab treatment compared to baseline. Improvement in visual acuity was found to be significantly associated with the reduction in flare counts, indicating the importance of LFP in monitoring patients with chronic VKH disease. Adalimumab treatment was discontinued due to adverse events in 3 (6%) cases in their study.
There are also interesting case reports included in this issue. Tokuc et al.[7] reported a case of acute posterior multifocal placoid pigment epitheliopathy found to be associated with acute systemic Epstein-Barr virus infection. Karaca et al.[8] reported a case of acute iridocyclitis and cystoid macular edema due to iris chafing caused by a minimally invasive glaucoma surgery – microstent device. Alsarhani et al.[9] reported a case of macular hole and rhegmatogenous retinal detachment secondary to macular involvement of Behçet retinitis. Oray et al.[10] reported a challenging case of Behçet's uveitis complicated with resistance to treatment and adverse effects of medications.
We thank the authors for their contributions to this special issue on developments in uveitis and hope that the readers will obtain information that will be useful in the diagnosis, monitoring, and treatment of their uveitis patients.
Kesim C, Chehab Z, Hasanreisoglu M. Laser flare photometry in uveitis. Saudi J Ophthalmol 2022;36:337-43.
Chandrasekaran PR, Aljneibi S, Agarwal A, Pichi F, Neri P. Interpreting posterior uveitis by integrating indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography data: A narrative review. Saudi J Ophthalmol 2022;36:344-54.
Gozzi F, Gentile P, De Simone L, Bolletta E, Alessandrello F, Belloni L, Bonacini M, Croci S, Zerbini A, Cimino L. Viral anterior uveitis. Saudi J Ophthalmol 2022;36:355-364.
Yen DJ, Betzler BK, Neo E, Lai SS, Arora A, Agrawal R, et al. An excursion into ocular tuberculosis. Saudi J Ophthalmol 2022;36:365-73.
Abroug N, Nabi W, Amor HB, Ksiaa I, Khochtali S, Attia S, et al. Rickettsial disease: An underestimated cause of posterior uveitis. Saudi J Ophthalmol 2022;36:374-9.
Takeuchi M, Nakai S, Usui Y, Namba K, Suzuki K, Harada Y, et al. Adalimumab treatment for chronic recurrent Vogt-Koyanagi-Harada disease with sunset glow fundus: A multicenter study. Saudi J Ophthalmol 2022;36:380-6.
Tokuc EO, Yumuk Z, Karabas VL. Acute posterior multifocal placoid pigment epitheliopathy associated with infectious mononucleosis: A rare presentation. Saudi J Ophthalmol 2022;36:387-9.
Karaca I, Korot E, Ghoraba H, Regenold J, Mobasserian A, Khan Y, et al. Acute iridocyclitis and cystoid macular edema related to kinked Hydrus® Microstent in advanced glaucoma. Saudi J Ophthalmol 2022;36:390-3.
Alsarhani WK, Saifaldein AA, Abu ElAsrar AM. A novel mechanism of macular holes in patients with Behçet's uveitis. Saudi J Ophthalmol 2022;36:394-6.
Oray M, Cebeci Z, Kir N, Tugal-Tutkun I. How challenging can it be to treat Behçet uveitis? Saudi J Ophthalmol 2022;36:397-9.