Uveitis and Immunological Disorders

by Pleyer, Uwe; Foster, C. Stephen, M.D.

• ISBN13: 9783540307976
• ISBN10: 3540307974
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-12-04
• Publisher: Springer Verlag

Summary

Uveitis and immune-mediated disorders encompass a wide spectrum of potentially blinding diseases that are seen in daily practice by many ophthalmologists. In recent years enormous progress has been made in understanding the principal mechanisms of inflammatory and immunological processes in ocular disorders. The purpose of this volume of Essentials in Ophthalmology is to provide the ophthalmologist with our present understanding of the pathogenesis of the most frequent immune-mediated disorders of the eye and a practical approach to these diseases. Uveitis and Immunological DisordersFills the gap between textbooks and original research publicationsFocuses on clinical aspects of inflammatory eye diseasesCovers a broad spectrum, including diseases affecting the conjunctiva, sclera and cornea, as well as intraocular inflammationIncludes basic research aspects, such as immune mechanisms and genetics Is quick and easy to read with highly structured core messages and summaries for the clinicianThis publication will serve not only as a valuable source of up-to-date information for ophthalmologists but will also be of interest to pediatricians, specialists in internal medicine and dermatologists confronted with inflammatory eye diseases.

Table of Contents

Contact Lens-Related Corneal Infection
Barry A. Weissman
Anthony J. Aldave
Bartly J. Mondino
Introduction	2	(2)
Risk Factors	4	(2)
Extended Wear	4	(1)
Contact Lens Care	5	(1)
Role of Hypoxia	5	(1)
Role of Immunology	5	(1)
Role of Orthokeratology	6	(1)
Microbes	6	(3)
Bacterial Infections	6	(1)
Protozoal Infections	7	(1)
Fungal Infections	8	(1)
Viral Infections	8	(1)
Treatment	9	(2)
Bacterial Infections	9	(1)
Role of Steroids	10	(1)
Additional Diagnostic and Therapeutic Steps	10	(1)
Acanthamoeba Infections	10	(1)
Fungal Infections	11	(1)
Successful Treatment	11	(1)
Concluding Remarks	11	(4)
References	11	(4)
New Insights into the Diagnosis and Treatment of Dry Eye Syndrome
Miki Uchino
Murat Dogru
Kazuo Tsubota
Introduction	15	(1)
Sjogren's Syndrome	16	(1)
Diagnosis of Dry Eye Disease	16	(4)
Symptoms	17	(1)
Assessment of Ocular Surface Epithelial Health Status	17	(1)
Ocular Surface Vital Staining: Flourescein staining	17	(1)
Ocular Surface Vital Staining: Rose Bengal/Lissamine Green Staining	17	(1)
Assessment of Tear Film Stability: Invasive TBUT Using Fluorescein	17	(1)
Assessment of Aqueous Tear Quantity	17	(1)
Newer Diagnostic Tools	18	(1)
Diagnosis of Sjogren's Syndrome	19	(1)
Ocular Features of Sjogren's Syndrome	19	(1)
Treatment of Dry Eyes	20	(5)
General Health Care in Sjogren's Syndrome	20	(1)
Artificial Tear Solutions	20	(1)
Autologous Serum Eye Drops	21	(1)
Albumin as a Tear Supplement in the Treatment of Severe Dry Eyes	21	(1)
Lacrimal Punctal Occlusion	22	(1)
Future Therapeutic Expectations	22	(1)
References	23	(2)
Allergic Conjunctivitis: Clinical Consequences and an Update on Understanding Its Pathophysiology
Andrea Leonardi
Introduction	25	(1)
Clinical Forms	26	(4)
Seasonal and Perennial Allergic Conjunctivitis	26	(1)
Vernal Keratoconjunctivitis	26	(2)
Atopic Keratoconjunctivitis	28	(1)
Giant Papillary Conjunctivitis Contact	29	(1)
Blepharoconjunctivitis	29	(1)
Diagnosis	30	(3)
Diagnostic Assays in Ocular Allergy	30	(1)
Skin-Prick Test	30	(1)
Patch Test	31	(1)
In Vitro Assays	31	(1)
Local Tests	31	(1)
Conjunctival Provocation Test or Conjunctival Allergen Challenge	31	(1)
Measurement of Specific IgE in Tears	32	(1)
Measurement of Total IgE in Tears	32	(1)
Conjunctival Cytodiagnosis	32	(1)
Tear Chemical Mediator Measurement	33	(1)
Immunopathogenesis	33	(4)
Sensitization	34	(1)
Allergic Response	34	(3)
Treatment of Ocular Allergy	37	(9)
Anti-Allergic Medication	38	(1)
Vasoconstrictors	38	(1)
Antihistamines	38	(1)
Systemic Antihistamines	38	(1)
Mast Cell Stabilizers	38	(1)
Dual Action Anti-Allergic Molecules	39	(1)
Nonsteroidal Anti-Inflammatory Drugs	39	(1)
Corticosteroids	39	(1)
Immunomodulators	40	(1)
Nonpharmacological Management	40	(1)
Surgical Treatment	41	(1)
References	41	(5)
Current Aspects of the Immunobiology and Prevention of Corneal Graft Rejection: What Have We Learned from 100 Years of Keratoplasty?
X.Q. Li
S. Schlickeiser
U. Pleyer
Introduction	46	(4)
History and Prevalence of Allograft Rejection	46	(1)
Local Immunological Features of the Cornea	46	(1)
Corneal Immunogenicity	46	(2)
Immune Privilege	48	(2)
Anterior Chamber-Associated Immune Deviation	50	(1)
Mechanisms of Corneal Allograft Rejection	50	(10)
Antigen Presentation	51	(1)
Antigen-Presenting Cells	51	(1)
Direct/Indirect Pathway of Antigen Presentation	51	(2)
T Cell Activation: Principle of Costimulation	53	(1)
CD28-CD80/CD86 Costimulatory Signal Pathway	53	(1)
CD40-CD154 (CD40L) Costimulatory Signal Pathway	53	(2)
Role of Immune Cells and Molecular Mediators in Graft Rejection	55	(1)
Cellular Infiltration	55	(1)
Molecular Mediators	55	(2)
Th1/Th2 Paradigm	57	(1)
Role of Draining Cervical Lymph Nodes in Corneal Allograft Rejection	58	(1)
Role of Cytotoxic T Lymphocyte Response in Corneal Graft Rejection	58	(2)
Strategies for the Prevention of Allograft Rejection	60	(17)
Use of HLA-matched Transplants	60	(2)
Immunmodulatory Agents in Keratoplasty	62	(1)
Care of Normal-Risk Keratoplasty Patients	62	(3)
Care of High-Risk Keratoplasty Patients	65	(3)
Future Aspects: Immunological and Gene Therapy Approaches	68	(1)
Monoclonal Antibodies and Other ``Biologicals''	68	(1)
Gene Therapy	68	(1)
References	69	(8)
Autoimmune Keratitis
John D. Gottsch
Introduction	77	(1)
Background	78	(1)
Differential Diagnosis of Patient with Stromal Thinning Ulceration	78	(1)
Laboratory Tests	78	(1)
Autoimmune Keratitis	79	(6)
Mechanisms of Autoimmune Keratopathy	79	(1)
Rheumatoid Arthritis	79	(1)
Rheumatoid Peripheral Ulcerative Keratitis	80	(1)
Diagnosis	80	(1)
Treatment	80	(1)
Rheumatoid Paracentral Ulcerative Keratitis	81	(1)
Scleritis-Associated Peripheral Keratopathy	81	(1)
Postsurgical Ulcerative Keratitis	82	(1)
Sjogren's Syndrome	82	(1)
Wegener's Granulomatosis	83	(1)
Polyarteritis Nodosa	83	(1)
Systemic Lupus Erythematosus	83	(1)
Relapsing Polychondritis	84	(1)
Mooren's Ulcer	84	(1)
Systemic Immunosuppression in Autoimmune Keratitis	85	(1)
Classification of Immunosuppressive Drugs	85	(1)
Antimetabolites	86	(1)
Alkylating Agents	86	(1)
T Cell Inhibitors	86	(1)
Proinflammatory Cytokine Antibodies	86	(1)
Surgical Intervention in Autoimmune Keratitis	86	(2)
Gluing	86	(1)
Corneal Patch Grafting	87	(1)
Ulceration in the Setting of a Patch Graft	87	(1)
Conclusions	88	(4)
References	88	(4)
Recent Developments in Herpes Stromal Keratitis
Gregory M. Frank
Robert L. Hendricks
Introduction	92	(1)
HSV-1 Latency and Recurrent HSK	92	(1)
Murine Model of HSK	93	(1)
T Lymphocyte Involvement in HSK	94	(1)
Antigen Presentation in HSK	95	(1)
Cytokines and Chemokines in HSK	96	(1)
New Experimental Approaches to Treating HSK	97	(4)
References	98	(3)
Genetic Insights into Uveitis
Friederike Mackensen
Zili Zhang
Tammy M. Martin
James T. Rosenbaum
Introduction	101	(2)
Overview	101	(1)
General Approaches to Genetic Study	102	(1)
Uveitis Associated with Human Leukocyte Antigen Genes	103	(3)
What Is the Human Leukocyte Antigen?	103	(1)
From HLA Association to Disease?	103	(1)
HLA-Associated Uveitis	104	(1)
Acute Anterior Uveitis	104	(1)
Chronic Anterior Uveitis in Juvenile-Onset Arthritis	104	(1)
Pars Planitis	104	(2)
Birdshot Retinochoroidopathy	106	(1)
Uveitis Associations with Non-HLA Genes	106	(3)
Tumor Necrosis Factor Alpha	106	(1)
Interferons	107	(1)
CARD15/NOD2	108	(1)
Concluding Remarks	109	(4)
References	110	(3)
Cataract Surgery in Patients with Uveitis
Jorge L. Alio
Javier A. Montero
Introduction	113	(1)
Surgical Indication	114	(1)
Patient Preparation	115	(1)
Control of Inflammation	115	(2)
Surgical Procedure	117	(6)
Choice of Intraocular Lens	119	(2)
Combined Surgery	121	(1)
Glaucoma	121	(1)
Vitrectomy	122	(1)
Postoperative Inflammation	123	(1)
Complications	124	(1)
Cataract Surgery in Specific Cases	125	(7)
Cataract Surgery in Children with Uveitis	125	(1)
Phacoemulsification in Fuchs' Heterochromic Cyclitis	125	(1)
Ocular Toxoplasmosis	126	(1)
Pars Planitis, Behcet's Disease, VKH Syndrome, and Multifocal Chorioretinitis	126	(1)
References	127	(5)
Ocular Toxoplasmosis
Cristina Muccioli
Rubens Belfort Jr
Introduction	132	(1)
Epidemiology	132	(1)
Infection	133	(1)
Clinical Features	133	(1)
Ocular Disease	133	(3)
Newborns with Congenital Disease	134	(1)
Signs Associated with Active Disease	134	(1)
Course of Disease	134	(1)
Immunosuppressed Patients	134	(2)
Clinical Signs and Symptoms	136	(1)
Serologic Tests	136	(1)
Imaging and Diagnostic Tests	137	(2)
Fluorescein Angiography	137	(1)
Indocyanine Green Angiography	138	(1)
Optical Coherence Tomography	138	(1)
Ultrasonography	139	(1)
Pathology	139	(1)
Treatment	139	(2)
Goal	139	(1)
Antimicrobial Agents	139	(1)
Corticosteroids	140	(1)
Complications	140	(1)
Disease in Immunosuppressed Patients	141	(4)
Risk Factor	141	(1)
Ocular Disease	141	(1)
References	142	(3)
Vogt-Koyanagi-Harada Disease and Sympathetic Ophthalmia
P. Kumar Rao
Narsing A. Rao
Introduction	145	(1)
Vogt-Koyanagi-Harada Disease	145	(6)
Historical Aspects	146	(1)
Epidemiology	146	(1)
Clinical Features	146	(3)
Pathogenesis and Pathology	149	(1)
Laboratory Investigations	150	(1)
Differential Diagnosis	150	(1)
Treatment	150	(1)
Prognosis and Complications	151	(1)
Sympathetic Ophthalmia	151	(6)
Clinical Features	152	(1)
Pathology and Pathogenesis	152	(1)
Differential Diagnosis	153	(1)
Therapy	153	(1)
Complications and Prognosis	153	(1)
References	154	(3)
Neoplastic Masquerade Syndromes
Sarah E. Coupland
Introduction	157	(1)
Lymphoid Malignancies	158	(9)
Primary Intraocular Lymphoma	158	(1)
Epidemiology of PIOL	159	(1)
Symptoms and Signs of PIOL	159	(1)
Ophthalmic Findings in PIOL	159	(1)
Diagnostic Techniques	160	(1)
Laboratory Studies: Cytological and Histological Diagnosis in PIOL	160	(2)
Biochemical and Molecular Analysis of PIOL	162	(1)
Treatment of PIOL	163	(1)
Prognosis of PIOL	164	(1)
Primary Uveal Lymphomas	164	(1)
Primary Choroidal Lymphoma	165	(1)
Primary Iridal Lymphoma	166	(1)
Secondary Intraocular Lymphoma or Leukemia	167	(1)
Post-Transplantation Lymphoproliferative Disorder	167	(1)
Nonlymphoid Malignancies	167	(10)
Uveal Melanoma	167	(1)
Retinoblastoma	167	(1)
Juvenile Xanthogranuloma	167	(1)
Metastatic Tumors	168	(1)
Uveal Metastases	168	(1)
Retinal Metastases	168	(1)
References	169	(8)
Tumor Necrosis Factor Alpha-Targeted Therapies in Uveitis
Susan Cochrane
Andrew D. Dick
Introduction	177	(1)
Evidence of the Use of Anti-TNFa Agents	178	(1)
What is TNFa?	178	(1)
Role in the Immune Response	178	(1)
Role in Uveitis -- Data in Animals and Man	178	(1)
Experimental Autoimmune Uveoretinitis	178	(1)
Endotoxin-Induced Uveitis	179	(1)
Clinical Uveitis	179	(1)
Anti-TNFa Agents	179	(6)
Neutralizing Antibodies	180	(1)
Infliximab	180	(1)
Adalimumab	181	(4)
Fusion Proteins	185	(1)
Etanercept	185	(1)
Other Fusion Proteins	185	(1)
Studies in Uveitis	185	(3)
Posterior Segment Intraocular Inflammation	185	(1)
Behcet's Disease	185	(1)
Other Posterior Segment Intraocular Inflammation	186	(1)
Anterior Uveitis -- Juvenile IdiopathicArthritis and Ankylosing Spondylitis	186	(1)
Other Ocular Inflammation	187	(1)
Caveats	188	(2)
Inhibition of Macrophage Function -- Tuberculosis	188	(1)
Lymphoma Development	188	(1)
Multiple Sclerosis and TNFa Blockade	189	(1)
Other Autoimmune Disease and Autoantibody Production	189	(1)
Anti-Drug Antibodies	190	(1)
Future Directions	190	(3)
References	191	(2)
Immunotherapy of Uveitis: is Gene Therapy in our Future?
Rachel R. Caspi
Human Inflammatory Uveitis of Putative Autoimmune Origin	193	(1)
Experimental Autoimmune Uveoretinitis - a Model for Human Autoimmune Uveitis	194	(4)
Immunotherapeutic Paradigms: Antigen-Specific vs. Non-Antigen-Specific; Systemic vs. Local	198	(1)
Gene Therapy as an Approach to Immunotherapy	199	(8)
Gene Therapy of EAU by Peripheral Expression of a Uveitogenic Retinal Antigen	199	(3)
Cellular Therapy with Autologous B Cells Expressing a Uveitogenic Epitope	202	(1)
DNA Vaccination for Tolerance	203	(1)
Local Transfer into the Eye of Genes Encoding Immunoinhibitory Molecules	204	(2)
RNA Interference as a Future Prospect	206	(1)
Conclusions	207	(4)
Acknowledgements	207	(1)
References	207	(4)
Optic Neuritis from the Perspective of an Ophthalmologist
Klaus Ruether
Introduction	211	(1)
Pathogenesis	212	(1)
Pathology and Immunology	212	(1)
Relationship Between Optic Neuritis and Multiple Sclerosis	213	(1)
Diagnosis	213	(7)
Ophthalmologic	213	(6)
Non-Ophthalmologic Diagnostic Tools	219	(1)
Treatment	220	(5)
Natural Course	220	(1)
High-Dose Methylprednisolone	220	(1)
Immunomodulation	221	(1)
References	222	(3)
Subject Index	225