Macular structural changes and factors affecting final visual acuity in patients with Behçet uveitis

A Bibliometric Analysis of Uveitis in the Past 20 Years

PURPOSE

To assess the quantity and quality of global research on uveitis, visualize the research hotspots, and reveal the study trends in uveitis.

METHODS

This bibliometric analysis was performed with the data obtained from the Web of Science core collection (WoSCC) database and Scopus. Bibliometrix and VOSviewer were used to analyze and visualize study trends and hotspots. Citespace was used to conduct the cooperation and co-citation network analysis.

RESULTS

A total of 5837 and 7195 documents were exported for further analysis in WoSCC and Scopus, respectively. The USA has published the most articles related to uveitis (1627, 27.87%, WoS; 1979, 27.51%, Scopus) and accounted for the most frequency of total citations (42345 times total citations 35 900 times without self-citations in WoSCC database). Most of the papers focusing on uveitis were published in Ocular Immunology and Inflammation (761, 13.04% within WoS; 793, 11.02% within Scopus). Additionally, novel biotherapy is the hotspot of uveitis research which also may be a sustained research interest in the future.

CONCLUSIONS

An increasing trend of publications was found in uveitis research. The USA was the leading contributor in this field, and it was the center of cooperation network. Our study provided an overview of uveitis research, which may serve as a valuable reference and guide for stakeholders interested in uveitis.

Risk factors, clinical features and treatment of Behçet's disease uveitis

Behçet's disease is a systemic vasculitis frequently associated with intraocular inflammation. Recent findings identified independent clinical clusters in Behçet's disease, each involving distinct combinations of affected organs. Ocular Behçet's disease, mainly manifested as uveitis, is characterized as an independent cluster with a low likelihood of association with other system involvements, such as intestinal, cardiovascular, or central nervous system. A prevailing theory suggests that the pathogenesis of the disease is multifactorial, where a variety of genetic and infectious agents may interact with each other to cause the disease. Among sporadic cases, the human leukocyte antigen (HLA) genes, including HLA-B51, HLA-A26, HLA-B15, and HLA-B5701, have been found to be a key component conferring genetic susceptibility. Outside the HLA region, a set of susceptibility variants are identified, closely related to interleukin (IL)-23/IL-17 pathway, tumor necrosis factor (TNF) signaling, and pattern recognition receptor systems. Microbial infections, such as Streptococcus sanguinis, Mycobacterium tuberculosis, and Herpes simplex virus (HSV), are linked to play the triggering of disease in immunogenetically predisposed individuals. Clinically, due to the notable relapsing-remitting course of ocular Behçet's disease, the prevention of recurrent attack would be the primary treatment goal. Combination of corticosteroids and immunomodulatory drugs, such as anti-TNF agents, interferon, and conventional immunosuppressants (e.g. cyclosporine, azathioprine), have been the mainstream regimen for the disease. Future research may focus on comparing the effectiveness of immunomodulatory drugs and identifying the most suitable subgroups for a specific drug on the basis of the knowledge of the molecular heterogeneity of the disease.

OPTICAL COHERENCE TOMOGRAPHY CHARACTERISTICS OVER TIME IN BEHÇET'S UVEITIS

PURPOSE

To analyze the characteristics of macular optical coherence tomography in patients with Behçet's uveitis (BU).

METHODS

Retrospectively analyzing optical coherence tomography images and clinical data of patients with Behçet's uveitis who visited our hospital from January 2010 to July 2022.

RESULTS

One hundred and one patients (174 eyes) were included. We analyzed the development of optical coherence tomography changes in these patients and its relationship with acuity vision and found that cystic macular edema, hyperreflexive retinal spots, inner nuclear layer edema, and outer nuclear layer edema appeared at any time during the disease course. Epiretinal membranes appeared beginning 1 to 2 weeks after onset and worsened over time, and foveal atrophy occurred beginning at 2 to 4 weeks. Foveal atrophy, foveal layers disappear, ellipsoid zone (EZ) disruption, retinal pigment epithelium (RPE) disruption, RPE hyperreflection, and choroidal hyperreflection were correlated with visual acuity. Kaplan‒Meier survival analysis showed at 60 months of follow-up, and almost all patients with foveal atrophy, EZ disruption, RPE disruption, RPE hyperreflection, and choroidal hyperreflection had visual acuity less than logMAR 1.0. EZ disruption and RPE disruption were reversible with aggressive treatment from 4 to 12 months after onset, but was less recoverable after 2 years. In advanced stages, optical coherence tomography manifested as structural disturbances and atrophy of the macular area, highly reflective material deposition in the RPE layer, and a thick macular epimembrane.

CONCLUSION

Optical coherence tomography showed that severe lesions occurred in macula of patients with Behçet's uveitis in early stage. Aggressive treatment can partially reverse it.

Uveitis in Behçet disease - an update

PURPOSE OF REVIEW

Uveitis is a major manifestation of Behçet disease (BD) and potentially has a high morbidity. This article reviews recently published data on BD uveitis.

RECENT FINDINGS

A set of classification criteria and a diagnostic algorithm have been developed for BD uveitis. Recent reports have confirmed male predominance and posterior segment inflammation in the majority of BD uveitis patients. A high uveitis attack severity score, fluorescein angiographic leakage at the posterior pole, and disruption of outer retinal layers on optical coherence tomography (OCT) predict poor visual outcome. OCT-angiography studies have suggested subclinical changes of retinal capillaries in patients with or without ocular involvement. In a randomized controlled trial, interferon-α was superior to cyclosporine. Favorable outcomes were reported with earlier initiation, optimization, and withdrawal of infliximab after remission. Adalimumab as first-line was superior to conventional therapy.

SUMMARY

Classification criteria will be used to select a homogeneous group of patients for research and the diagnostic algorithm may help ophthalmologists predict the probability of BD uveitis based on ocular findings. Fluorescein angiography and OCT are the routine imaging modalities. Clinical relevance of OCT-angiography is unclear. Interferon-α, infliximab, and adalimumab have proven superior efficacy compared to conventional therapy.

Probiotic Supplementation Improved Acute Anterior Uveitis of 3-Year Duration: A Case Report

BACKGROUND Uveitis is a clinical condition characterized by acute blurry vision related to an inflammation of the uvea. Gut microbiome dysbiosis can influence the prognosis of uveitis by inducing a loss of intestinal immune homeostasis leading to a lower activation threshold of the immune cells. This promotes a pro-inflammatory response resulting in reactivation of the disease. This is the case report of a 21-year-old woman with a 3-year history of acute anterior uveitis (AAU) of the right eye, who responded favorably to probiotic dietary supplementation. CASE REPORT A 21-year-old woman, previously unknown to our Ophthalmology Unit, presented with ocular pain and redness. Three years ago, she had been diagnosed with monolateral AAU in the right eye. Her medical and family histories were unremarkable. After a complete clinical evaluation, we decided to start a combination treatment protocol with continuous use of probiotics and the use of ocular steroids only during an exacerbation of the condition. To monitor the trend of the disease, she underwent a monthly clinical examination for the following year. During this period, we observed a decrease in ocular inflammation with a gain in the primary outcome (best-corrected visual acuity), and the steroids and atropine were discontinued for the following months. CONCLUSIONS This case report describes a patient with a 3-year history of AAU, who responded well to a combination treatment of dietary probiotic supplementation and steroids, demonstrating that probiotics can reduce recurrences of AAU.