Association between intermediate uveitis and toxocariasis in the Korean population

Intermediate Uveitis: A Review

PURPOSE

This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU).

METHODS

Narrative literature review.

RESULTS

IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice.

CONCLUSIONS

IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.

Clinical Features and Prognostic Factors in Northern Chinese Patients with Peripheral Granuloma Type of Ocular Toxocariasis: A Retrospective Cohort Study

PURPOSE

To summarize the clinical features and probable factors associated with recurrence within 6 months in northern Chinese ocular toxocariasis (OT) patients.

METHODS

A retrospective cohort study (38 OT eyes) was conducted. Clinical features, aqueous inflammatory cytokines, complications, and parameters associated with recurrence after treatment were analyzed.

RESULTS

The initial best-corrected visual acuity (BCVA) was related to the anterior inflammation grade at the onset (P = .028). The mean BCVA and anterior inflammation improved significantly (P < .05) after treatment. The OT eyes had higher aqueous humor cytokine levels (IL-6, IL-8, and IL-10) compared with the normal eyes (P < .001). More severe anterior inflammation grade or longer duration of uveitis were more likely to increase the probability of recurrence (P = .008 and P = .025), TA injection during/after vitreous surgery can reduce the probability of recurrence (P = .031).

CONCLUSIONS

The combination therapy of vitreoretinal surgery, steroids, and albendazole therapy may reduce inflammation and recurrence of OT effectively.Abbreviations: BCVA: best-corrected visual acuity; BFGF: basic fibroblast growth factor; CFT: central foveal thickness; CI: confidence interval; ELISA: Enzyme-linked immunosorbent assay; ERM: epiretinal membrane; IOP: intraocular pressure; IQR: interquartile range; IL: interleukin; LFM: laser flare meter; MH: macular hole; OCT: optical coherence tomography; OR: odds ratio; OT: ocular toxocariasis; RD: retinal detachment; TA: triamcinolone acetonide; TCLA: Toxocara canis larva crude antigen; TGF: transforming growth factor; VCAM: vascular cell adhesion molecule; VEGF: vascular endothelial growth factor.

Designing and standardizing Toxocara serologic diagnostic kit and determining anti-Toxocara antibodies frequency in patients referred to health care centers in Urmia (northwest of Iran)

Toxocariasis is a helminthic zoonosis caused by larval stages of the roundworm of dog, Toxocara canis, and less frequently by T. cati, the roundworm of cats. Eosinophilia in peripheral blood may be indicative of a disease; however, it does not necessarily represent toxocariasis. Therefore, it is necessary to investigate the relationship between eosinophilia and toxocariasis in a region. The aims of this study were the diagnosis of hyperosinophilia patients using traditional ELISA kit and also by a handmade ELISA kit produced by T. canis excretory-secretory (TCES) antigens as well as the determination of the abundance of anti-Toxocara antibodies among people referred to Urmia, northwest of Iran care centers. Traditional ELISA kit was used to determine anti-TCES-specific IgG antibodies on 180 hypereosinophilic samples. These antibodies were evaluated in 1002 samples, including 180 hypereosinophilic samples and 822 random samples without eosinophilia by a handmade ELISA kit produced by TCES antigens. A Western-blot confirmatory test was performed on ELISA-positive samples. Our results showed a 17.22% prevalence rate of Toxocara antibodies among hypereosinophilic samples with traditional ELISA kit, and this rate was 3.89% in the 1002 study population with random sampling (with or without eosinophilia). Also, there was a good match between the results of handmade ELISA with those of traditional kit. The positive results in the ELISA method were confirmed by the Western-blot analysis. Our findings show that although the high eosinophil count is not necessarily a sign of toxocariasis, in Urmia distric, about one-fifth of eosinophilia cases have anti-toxocariasis antibodies. In addition, the abundance of anti-Toxocara antibodies in this area was 3.89%.

New insight into the diagnostic cut-off value of serum anti-Toxocara IgG for ocular toxocariasis in uveitis patients

Uveitis is one of the commonest causes of vision loss worldwide and its exact etiology is still not clarified in most patients. The current study is a trial to assess the efficacy of serum anti-Toxocara immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA) as a diagnostic tool for ocular toxocariasis (OT) and to detect OT prevalence and the associated ocular manifestations in sera of patients with uveitis. One hundred and twelve patients (62 females and 50 males) with uveitis were diagnosed by ophthalmologists, radiologists and rheumatologists according to ocular manifestations, laboratory and radiological investigations. Serum anti-Toxocara IgG titers were determined by ELISA in sera of all patients. Our results revealed that OT is highly associated with intermediate and posterior uveitis. Children and young adult females, especially those residing in rural areas, complained mainly of diminution of vision in the left eye, with strabismus and leukocoria. At a cut-off value of 0.258, the sensitivity and specificity of IgG ELISA were 93.3% and 100%, respectively. In conclusion, at a novel cut-off value of 0.258 the serum anti-Toxocara IgG ELISA is predicted to be a diagnostic tool for OT regarding sensitivity and specificity. Also, it has potential importance in the interpretation and differential diagnosis of OT. Thus, serum anti-Toxocara IgG ELISA should be a routine test for screening of suspected cases.