Clinical Advances in the Diagnosis and Treatment of Uveitis—2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 15 October 2024 | Viewed by 1681

Special Issue Editor


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Guest Editor
Department of Ophthalmology, University of Hamburg, Hamburg, Germany
Interests: uveitis; diagnosis; new diagnostic testings; imaging; new treatment strategies; bDMARDS; small molecules
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Special Issue Information

Dear Colleagues,

We are pleased to announce the 2nd Edition of the Special Issue “Clinical Advances in the Diagnosis and Treatment of Uveitis”, which comes as a result of the first edition's success, in which we published eight papers.

For the last few decades, there has been an increasing pace of progress in diagnosis and in new treatment options for patients who are suffering from uveitis.

Uveitis is an inflammation of the uvea. The uvea consists of the middle layer of pigmented vascular structures of the eye and includes the iris, ciliary body, and choroid. Ocular inflammation can be in the form of anterior, intermediate, posterior, or pan-uveitis, as described by the Standardization of Uveitis Nomenclature (SUN) Working Group. It affects approximately 1:4500 people, while occurring most commonly between the ages of 20 and 60, with men and women being affected equally. Even in Western countries, uveitis is estimated to be responsible for approximately 10–20% of blindness. Evidence suggests that early diagnosis and more aggressive therapy improves ocular outcomes.

Several methods can be employed to diagnose uveitis in patients, including microbiological, immunological, imaging and molecular diagnostic testing, e.g., interferon-gamma release assay (IGRA) for confirming acute or latent tuberculosis or the spectral domain optical coherence tomography (OCT) including OCT–angiography (OCTA) for imaging the retina, the choroid, and their vasculature.

Immunomodulatory therapy has been associated with the control of inflammation, which is associated with better visual outcomes. Nevertheless, in the last century, visual outcomes were uncertain during treatment with conventional disease-modifying antirheumatic drugs (cDMARDs); however, the prognosis has improved dramatically since the FDA approved the first biologic drug in the late 1990s, the TNF-alpha-blocking agent etanercept. The biological (b)DMARDs are a constantly expanding medication class. The inhibitors of other pro-inflammatory cytokines, e.g., the interleukin (IL)-6 blockade with tocilizumab or the B-cell-depleting agent rituximab, also belong to this class. Other new therapeutics that enhance anti-inflammatory cytokines (e.g., IL-10) or block small molecule signaling (phosphodiesterase and tyrosine kinase inhibition) are in development, or in use, for other inflammatory indications.

This Special Issue compiles articles that reflect the current state of the art within this field and are also indicative of some of the anticipated advances in the diagnosis and treatment of uveitis.

Prof. Dr. Nicole Stuebiger
Guest Editor

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Keywords

  • uveitis
  • diagnosis
  • new diagnostic tests
  • imaging
  • new treatment strategies
  • bDMARDS
  • small molecules

Published Papers (2 papers)

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Research

12 pages, 1489 KiB  
Article
Comparison of Incidence or Recurrence of Anterior Uveitis in Patients with Ankylosing Spondylitis Treated with Tumor Necrosis Factor Inhibitors
by Hyeon Yoon Kwon, Yu Jeong Kim, Tae-Hwan Kim and Seong Joon Ahn
J. Clin. Med. 2024, 13(3), 912; https://doi.org/10.3390/jcm13030912 - 05 Feb 2024
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Abstract
Background: Anterior uveitis (AU) is a significant concern in patients with ankylosing spondylitis (AS), and the choice of tumor necrosis factor inhibitors (TNFi) as a treatment modality raises questions regarding its effects on AU. We compared the effects of TNFi on AU [...] Read more.
Background: Anterior uveitis (AU) is a significant concern in patients with ankylosing spondylitis (AS), and the choice of tumor necrosis factor inhibitors (TNFi) as a treatment modality raises questions regarding its effects on AU. We compared the effects of TNFi on AU in patients with AS. Methods: Patients diagnosed with AS and treated with at least one TNFi, including anti-TNFα antibodies (adalimumab and infliximab) or a soluble TNF receptor molecule (etanercept), between January 2010 and December 2022, were retrospectively reviewed. We compared the recurrence rate of AU in patients with a history of uveitis and the incidence of new-onset AU in those without a history of uveitis among the three TNFi groups. We also compared the effects of two different TNFi agents in patients who underwent TNFi switching. Results: Within two years of treatment initiation, there was no significant difference in AU recurrence among the three TNFi groups. However, the incidence of new-onset AU was significantly higher in the etanercept group than in the adalimumab group (26.4% vs. 6.3%; p = 0.024). After two years, the AU recurrence rate was significantly lower in the adalimumab group than in the other groups (p < 0.001). Among patients who underwent anti-TNFi switching, adalimumab treatment was associated with a significantly lower incidence of uveitis than etanercept (p = 0.023). Conclusion: In the short-term period following TNFi therapy, etanercept induced new-onset AU more frequently than adalimumab in patients with AS. Adalimumab recipients experienced fewer AU recurrences during the subsequent long-term period compared to other TNFi recipients. Full article
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19 pages, 1880 KiB  
Article
Classification of Peripheral Blood Leukocyte Phenotypes and Serum Cytokines in Vogt–Koyanagi–Harada Disease before and after Glucocorticoid Therapy
by Tomohito Sato, Nanae Taniguchi, Yoshiaki Nishio, Masataka Ito and Masaru Takeuchi
J. Clin. Med. 2023, 12(24), 7742; https://doi.org/10.3390/jcm12247742 - 17 Dec 2023
Viewed by 700
Abstract
Vogt–Koyanagi–Harada disease (VKH) is an autoimmune disease, and glucocorticoid therapy (GC) is widely used for VKH. We provided a profile of leukocyte populations and serum cytokines in VKH patients under GC. A prospective observational study was conducted on three treatment-naïve VKH patients. Peripheral [...] Read more.
Vogt–Koyanagi–Harada disease (VKH) is an autoimmune disease, and glucocorticoid therapy (GC) is widely used for VKH. We provided a profile of leukocyte populations and serum cytokines in VKH patients under GC. A prospective observational study was conducted on three treatment-naïve VKH patients. Peripheral blood samples were collected from the patients before GC (VKH-acute) and after 6 months (VKH-remission), and healthy individuals were used as controls. Proportions of 37-type leukocytes and levels of 27-kind cytokines were measured by mass cytometry and multiplex bead analysis. Property similarity was analyzed using hierarchical cluster analysis. The leukocytes and cytokines were broadly classified into four and three clusters: (1) a cluster with high intensity in VKH-acute consisting of B cells, Th2-like, Th17-like, basophils, and IL-7 and IP-10; (2) a cluster with high intensity in VKH-remission composed of monocytes, neutrophils, IL-4, and TNFα; in leukocytes, (3) a cluster with low intensity in VKH-acute and -remission consisting of CD8+ T cells, Th1-like, and NKT cells; (4) a cluster with low intensity in VKH-remission composed of NK cells, Tregs, and DCs; and in cytokines, (5) a cluster with high intensities in VKH-acute and -remission comprising G-CSF, MCP-1, eotaxin, and IL-17A. These findings suggest that inflammatory composition in blood during the acute phase of VKH represents complex hyperimmune responses dominantly driven by Th and B cells. Full article
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