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Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges:...
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Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges: Part II

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

Deadline for manuscript submissions: closed (20 November 2023) | Viewed by 6936

Special Issue Editor

Prof. Dr. Pascal Sève

E-Mail Website
Guest Editor
Internal Medicine, University of Lyon, Lyon, France
Interests: uveitis; sarcoidosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Intraocular inflammatory disorders encompass a broad spectrum of disease in which the eye or its various parts may be attacked by the immune system, leading to severe visual impairment. Uveitis is the third leading cause of blindness and currently accounts for approximately 10% of preventable vision loss in the US and up to 15% worldwide. In the recent past, tremendous progress in the treatment landscape as well as the optimization of diagnostic monitoring tools have made it possible to change the natural history of non-infectious uveitis, with a consequent improvement in disease-related morbidity. The ULISSE study showed that the rate of diagnoses is comparable between a standardized strategy and an open strategy. The investigations requested in the absence of guidance prove to be of very limited interest. Conversely, some simple complementary examinations have shown significant benefit. Several studies have clarified the value of investigations such as magnetic resonance imaging, nuclear imaging, and anterior chamber tap for the diagnosis. Based on the results from randomized controlled trials, the treatment of chronic non-infectious uveitis has extended to biotherapies such as adalimumab and tocilizumab. Despite these exciting progresses, treating physicians still face old and new challenges in the diagnosis and management of non-infectious uveitis and its complications. In the future, analyses of endocular specimens, combining the microbiologic techniques of multiplex PCR and the measurement of cytokine or chemokine levels, could guide the diagnosis of uveitis when caused by an inflammatory disease. The advent of many novel different molecules represents new challenges for laboratories, where reliable tests must be identified in order to optimize the choice and monitoring of systemic treatments.

The present Special Issue aims to provide an overview of the latest research on the diagnosis and treatment of non-infectious uveitis. We welcome all types of papers on the broad spectrum of clinical characteristics, prognosis, pathophysiology, and treatment of uveitis.

Prof. Dr. Pascal Sève
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • uveitis
  • diagnosis
  • Behçet’s syndrome
  • sarcoidosis
  • HBA-B27 acute anterior uveitis
  • Vogt–Koyanagi–Harada disease
  • birdshot retinochoroidopathy
  • systemic treatment

Related Special Issues

Published Papers (4 papers)

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Research

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14 pages, 1530 KiB  
Article
Long-Term Outcomes of Birdshot Chorioretinopathy Treated with Corticosteroids: A Case Reports
by Dino Ferracci, Thibaud Mathis, Antoine Gavoille, Mathieu Gerfaud-Valentin, Arthur Bert, Meriem Hafidi, Philippe Denis, Olivier Loria, Laurent Kodjikian and Pascal Sève
J. Clin. Med. 2023, 12(16), 5288; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12165288 - 14 Aug 2023
Viewed by 1291
Abstract
Purpose: To report the progression of patients diagnosed with birdshot chorioretinopathy (BSCR) initially treated with corticosteroids. Methods: We included 39 BSCR patients that were followed for ≥1 year. We analyzed their progression under treatment after 1, 3, 6 months, 1 year, and at [...] Read more.
Purpose: To report the progression of patients diagnosed with birdshot chorioretinopathy (BSCR) initially treated with corticosteroids. Methods: We included 39 BSCR patients that were followed for ≥1 year. We analyzed their progression under treatment after 1, 3, 6 months, 1 year, and at the end of follow-up. In order to determine the efficiency of initial loading doses, patients were classified into two groups according to their initial treatment: methylprednisolone followed by prednisone (n = 28) and prednisone alone (n = 11). Results: At the end of follow-up, 31/39 (79.5%) patients had reached inflammation control. Thirteen out of 28 (46.4%) and 6/11 (54.5%) patients were treated exclusively with corticosteroids, and 18/19 (94.7%) of them had reached inflammation control at the end of follow-up; their mean (range) corticosteroid dose was 3.5 (0–10) mg/day. Conclusions: We found that the prolonged corticosteroid therapy treatment strategy resulted in inflammation control in half of BSCR patients. This control was maintained with low doses of cortisone, usually <5 mg/day. Full article
(This article belongs to the Special Issue Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges: Part II)
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10 pages, 285 KiB  
Article
Analysis of Peripapillary Retinal Nerve Fiber Layer Thickness in Acute Anterior Uveitis among Children with HLA-B27-Positive Juvenile Idiopathic Arthritis
by Marta Świerczyńska, Agnieszka Tronina and Erita Filipek
J. Clin. Med. 2023, 12(14), 4842; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12144842 - 22 Jul 2023
Cited by 1 | Viewed by 1034
Abstract
Purpose: The aim of this study was to evaluate changes in the thickness of the peripapillary retinal nerve fiber layer (pRNFL) in children with a diagnosis of juvenile idiopathic arthritis (JIA) who were positive for human leukocyte antigen (HLA)-B27, treated for the first [...] Read more.
Purpose: The aim of this study was to evaluate changes in the thickness of the peripapillary retinal nerve fiber layer (pRNFL) in children with a diagnosis of juvenile idiopathic arthritis (JIA) who were positive for human leukocyte antigen (HLA)-B27, treated for the first episode of unilateral acute anterior uveitis (AAU). Materials and Methods: This retrospective study included 41 children (aged 5 to 14 years; mean age 8.32 ± 2.4 years) with HLA-B27 positivity and unilateral JIA-AAU, and 40 healthy children. Optical coherence tomography (OCT) imaging was performed during active inflammation and subsequent noninflammatory phases (6 months after the resolution of inflammatory symptoms in the anterior segment of the eye). Results: There was a marked difference in mean pRNFL thickness between eyes with AU in the active phase, unaffected fellow eyes and the control group (110.22 ± 5.95 μm, 102.39 ± 4.39 μm and 95.83 ± 8.84 μm, respectively; p < 0.001). The thickness of pRNFL in eyes with AU in the active phase in all sectors was greater compared to unaffected fellow eyes (p < 0.001) and normal eyes (p < 0.001). In addition, it was demonstrated that pRNFL thickness was significantly increased in the superior and temporal sectors in the unaffected fellow eyes compared to the control group (128.73 ± 13.16 μm vs. 121.48 ± 13.35 μm and 71.37 ± 4.02 μm vs. 64.98 ± 9.12 μm, respectively). Even during the inactive phase, eyes with AU, compared to the healthy control group, had significantly greater pRNFL thickness in the inferior sector (129.78 ± 11.98 μm vs. 122.3 ± 14.59 μm; p = 0.018), along with the temporal sector (70.88 ± 5.48 μm vs. 64.98 ± 9.12 μm; p = 0.001). Conclusions: An increase in pRNFL thickness in children with unilateral JIA-AAU who were positive for HLA-B27 antigen can be observed in both eyes compared to healthy controls, and this change may persist even after the inflammatory symptoms have resolved. Measurements of pRNFL thickness resulting from JIA-AU-associated glaucoma should be performed during quiescent periods to avoid subclinical changes in pRNFL thickness caused by inflammation. However, when reviewing the results, it should be noted that changes in pRNFL parameters may be present despite evidence of a resolution of inflammation. Full article
(This article belongs to the Special Issue Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges: Part II)
11 pages, 1803 KiB  
Article
Clinical Features and Risk Factors of Uveitis in Korean Children with Juvenile Idiopathic Arthritis: A Retrospective Cohort Study
by Jinsoo Kim, Min Seon Park, Soonil Kwon, Kwang Nam Kim, Han Wool Kim and Bum-Joo Cho
J. Clin. Med. 2023, 12(10), 3438; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12103438 - 12 May 2023
Viewed by 1140
Abstract
This study aimed to investigate the clinical features and risk factors of uveitis in Korean children with juvenile idiopathic arthritis (JIA). The medical records of JIA patients diagnosed between 2006 and 2019 and followed up for ≥1 year were retrospectively reviewed, and various [...] Read more.
This study aimed to investigate the clinical features and risk factors of uveitis in Korean children with juvenile idiopathic arthritis (JIA). The medical records of JIA patients diagnosed between 2006 and 2019 and followed up for ≥1 year were retrospectively reviewed, and various factors including laboratory findings were analyzed for the risk of developing uveitis. JIA-associated uveitis (JIA-U) developed in 30 (9.8%) of 306 JIA patients. The mean age at the first uveitis development was 12.4 ± 5.7 years, which was 5.6 ± 3.7 years after the JIA diagnosis. The common JIA subtypes in the uveitis group were oligoarthritis-persistent (33.3%) and enthesitis-related arthritis (30.0%). The uveitis group had more baseline knee joint involvement (76.7% vs. 51.4%), which increased the risk of JIA-U during follow-up (p = 0.008). Patients with the oligoarthritis-persistent subtype developed JIA-U more frequently than those without it (20.0% vs. 7.8%; p = 0.016). The final visual acuity of JIA-U was tolerable (0.041 ± 0.103 logMAR). In Korean children with JIA, JIA-U may be associated with the oligoarthritis-persistent subtype and knee joint involvement. Full article
(This article belongs to the Special Issue Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges: Part II)
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Review

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20 pages, 1150 KiB  
Review
Behçet’s Disease Uveitis
by Morgane Joubert, Anne-Claire Desbois, Fanny Domont, Amine Ghembaza, Alexandre Le Joncour, Adrien Mirouse, Georgina Maalouf, Mathilde Leclercq, Sarah Touhami, Patrice Cacoub, Bahram Bodaghi and David Saadoun
J. Clin. Med. 2023, 12(11), 3648; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12113648 - 24 May 2023
Cited by 1 | Viewed by 3055
Abstract
Uveitis in Behçet’s disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior, or panuveitis. Uveitis may be the first sign of [...] Read more.
Uveitis in Behçet’s disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior, or panuveitis. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralization usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10–15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, the prevention of recurrent attacks, the achievement of complete remission, and the preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update to a previous article by our team on pathogenesis, diagnostic approaches, and the therapeutic strategy of BD uveitis. Full article
(This article belongs to the Special Issue Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges: Part II)
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