Uveitis And Immunological Disorders

by Pleyer, Uwe; Mondino, Bartly J.

• ISBN13: 9783540200451
• ISBN10: 3540200452
• Format: Hardcover
• Copyright: 2004-12-16
• Publisher: Springer Verlag

Summary

Uveitis and immunological 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 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 Disorders fits in the series of Essentials in Ophthalmology to fill the gap between textbooks and original research publications. With a broad spectrum of contributions, including diseases affecting the conjunctiva, sclera and cornea as well as intraocular inflammation, this publication will serve not only as a valuable source of up-to-date information for ophthalmologists but also be of interest to pediatricians, specialists in internal medicine and dermatologists confronted with inflammatory eye diseases. Although mainly focused on clinical aspects of inflammatory eye diseases, several contributions address aspects such as immune mechanisms and genetics of these diseases.

Table of Contents

Targets in Ocular Allergy
Alessandra Micera
Sergio Bonini
Alessandro Lambiase
Roberto Sgrulletta
Stefano Bonini
Introduction	1	(1)
Chronic Allergic Eye Diseases	2	(1)
Effector Cells and Cytokine Release	2	(1)
Chemokines and Adhesion Molecules	3	(1)
Neuropeptide and Growth Factor Involvement	4	(1)
Tissue Remodelling and the Contribution of Fibroblasts	5	(1)
Metabolism of Extracellular Matrix	6	(1)
Conclusions	7	(4)
References	8	(3)
Dry Eye: Inflammation of the Lacrimal Functional Unit
Stephen C. Pflugfelder
Michael E. Stern
Introduction	11	(3)
Basics	11	(1)
Lacrimal Functional Unit	12	(2)
Specific Pathologies of the Lacrimal Functional Unit	14	(2)
Dysfunction of the Afferent System	14	(1)
Dysfunction of the Efferent System	15	(1)
Glandular Dysfunction	15	(1)
Lacrimal Keratoconjunctivitis Inflammation	16	(3)
Corneal Epithelial Disease	17	(1)
Conjunctival Epithelial Disease	17	(1)
Inflammation	18	(1)
Diagnosis	19	(2)
Therapies	21	(4)
References	22	(3)
Ocular Cicatricial Pemphigoid
Ahmed Muna
C. Stephen Foster
Introduction	25	(1)
Pathophysiology	26	(1)
Epidemiology	26	(1)
Clinical History	26	(1)
Clinical Signs	26	(1)
Staging	27	(1)
Diagnosis	28	(1)
Laboratory Tests	28	(1)
Conjunctival Biopsy	28	(1)
Histology	29	(1)
Treatment	29	(4)
Medical	29	(2)
Surgery	31	(2)
Collaborative Care	33	(1)
Prognosis	33	(2)
References	34	(1)
Immunomodulation for Corneal Transplantation
Douglas J. Coster
Keryn A. Williams
Introduction	35	(1)
Why Has Corneal Transplantation Fallen Behind Solid Organ Grafting?	36	(1)
Immunomodulation for Corneal Transplantation	36	(1)
Actuarial Survival Data on Corneal Transplantation	37	(1)
Options for Immunomodulation	38	(1)
Corneal Privilege	38	(1)
Mechanisms of Corneal Allograft Rejection	39	(1)
The Afferent Limb: Sensitization to Corneal Alloantigens	39	(1)
The Efferent Limb: Histological Correlates	40	(1)
Current Approaches to Immunomodulation for Corneal Transplantation	41	(4)
Anti-inflammatory Measures	41	(1)
Atraumatic Microsurgical Technique	41	(1)
Topical Corticosteroids	41	(1)
HLA Matching for Class I and Class II Antigens	41	(1)
Systemic Immunosuppression	42	(1)
Systemic Corticosteroids	42	(1)
Antiproliferative Agents	43	(1)
Calcineurin Blockers	43	(1)
Combination Therapy	44	(1)
Side Effects of Systemic Immunosuppression	44	(1)
Novel Approaches to Immunomodulation	45	(1)
Monoclonal Antibody Fragments	45	(1)
Gene Therapy	45	(1)
Conclusion	46	(6)
References	46	(6)
Scleritis
Alisa Kim
Sean Dumars
Samir Shah
Bartly Mondino
Introduction	52	(5)
Classification	52	(3)
Anatomy	55	(1)
Pathogenesis	55	(1)
Histopathology	56	(1)
Clinical Presentation	57	(5)
History: Ocular Symptoms	57	(1)
Physical Examination: Ocular Signs	58	(2)
Associated Ocular Manifestations	60	(1)
Systemic Diseases: Clinical Evaluation	61	(1)
Diagnostic Tools	62	(1)
Medical Management	63	(1)
Surgical Management	64	(3)
References	65	(2)
Clinical Aspects of MALT
Erich Knop
Nadja Knop
Uwe Pleyer
Introduction	67	(1)
Structure and Function of MALT	68	(8)
Structure of MALT	68	(3)
Eye-Associated Lymphoid Tissue (EALT)	71	(3)
Basic Functions of MALT	74	(2)
Dry Eye Disease	76	(5)
Introduction	75	(1)
Epidemiology, Definition and Characteristics of Dry Eye	76	(4)
Novel Therapeutic Approaches to Dry Eye Disease	80	(1)
Ocular Allergy	81	(3)
Introduction	81	(1)
Epidemiology, Definition and Characteristics of Allergic Eye Disease	81	(3)
Course and Therapy Options in Allergic Ocular Disease	84	(1)
Keratoplasty	84	(7)
Introduction	84	(1)
Immunological Characteristics of Keratoplasty	85	(2)
References	87	(4)
Immunogenetics of Ocular Inflammatory Disease
Ralph D. Levinson
Introduction	91	(2)
Human Leukocyte Antigens	93	(3)
HLA Nomenclature	94	(1)
Class I HLA	94	(1)
Class II HLA	95	(1)
HLA Haplotypes and Linkage Disequilibrium	95	(1)
HLA and Disease Pathogenesis	95	(1)
HLA Associations with Ocular Inflammatory Disease	96	(5)
Class I HLA Associations with Ocular Inflammatory Disease	96	(2)
Class II HLA Associations with Ocular Inflammatory Disease	98	(2)
HLA Associations with Ocular Infections	100	(1)
HLA Associations with External Ocular Inflammation	100	(1)
HLA Associations with Extraocular Disease	100	(1)
Non-HLA Genes Associated with Ocular Inflammatory Disease	101	(1)
Other Ocular Diseases	102	(1)
Conclusion	102	(7)
References	102	(7)
Immune Mechanisms in Uveitis
Ling Chen
Lynn K. Gordon
Introduction	109	(1)
Animal Uveitis Models	110	(7)
Experimental Autoimmune Uveitis (EAU)	110	(6)
Endotoxin-Induced Uveitis (EIU)	116	(1)
Experimental Melanin-Protein-Induced Uveitis (EMIU)	116	(1)
Experimental Autoimmune Pigment Epithelial Membrane Protein-Induced Uveitis (EAPU)	117	(1)
Immune Mechanisms in Human Uveitis	117	(8)
HLA-Associated Human Uveitis	117	(2)
Behcet's Disease	119	(1)
Vogt-Koyanagi-Harada Syndrome	120	(1)
References	121	(4)
The Tip of the Iceberg: Current Knowledge of Uveitis in Juvenile Arthritis
Uwe Pleyer
Claudia Sengler
Natasa Orlic
Rolf Keitzer
Introduction	125	(1)
Classification of Arthritis	126	(1)
Epidemiology	126	(1)
Pathogenesis	127	(1)
Risk Factors for the Development of Uveitis in JRA	128	(1)
Clinical Features of Uveitis in JCA	128	(1)
Complications of Uveitis in JCA	129	(1)
Macula Edema	130	(1)
Differential Diagnosis	130	(1)
Prognostic Factors for Uveitis	131	(2)
Gender	132	(1)
Type of Arthritis	132	(1)
Onset of Arthritis	132	(1)
Severity of Uveitis at-Onset	132	(1)
Correlation of Uveitis and Arthritis Activity	133	(1)
Treatment of Uveitis in JCA	133	(3)
Topical Steroid Treatment	133	(1)
Nonsteroidal Anti-inflammatory Drugs (NSAID)	134	(1)
Systemic Immunomodulatory Agents	134	(2)
Recommendations for Ocular Screening in JCA	136	(5)
References	136	(5)
Herpes Viruses in Ocular Inflammation
Bahram Bodaghi
Phuc LeHoang
Introduction	141	(2)
Fundamental Virology	143	(1)
Epidemiology	143	(1)
Pathophysiology	144	(1)
Experimental Viral Uveitis	144	(1)
Experimental Models to Study Viral Retinitis	145	(1)
Clinical Features	145	(5)
Anterior Uveitis	145	(2)
Viral Retinopathies	147	(2)
Differential Diagnosis	149	(1)
Putative Viral-Associated Uveitis	150	(1)
Diagnosis	150	(3)
Obtention of Ocular Fluids	151	(1)
Herpes Viruses	151	(1)
Search for Antiviral Antibodies	152	(1)
Treatment	153	(8)
Anterior Uveitis	153	(1)
Viral Retinopathies	154	(3)
References	157	(4)
Cytomegalovirus and the Eye
Marc D. de Smet
Introduction	161	(1)
Populations at Risk	161	(2)
HIV Associated Immunosuppression	161	(1)
Immunosuppression in Non-HIV Settings	162	(1)
Appearance and Course	163	(3)
Manifestation Prior to Initial Treatment	163	(1)
Manifestations Under Therapy	164	(1)
Differential Diagnosis	165	(1)
Investigations	166	(1)
Therapeutic Agents	166	(1)
Ganciclovir	166	(1)
Valganciclovir	167	(1)
Foscarnet	167	(1)
Other Agents	167	(1)
Screening and Treatment Algorithms	167	(1)
CMV in HIV Infected Patients	168	(1)
CMV in Other Immunosuppressive States	168	(1)
Management of Complications	168	(5)
Immune Recovery	168	(1)
Retinal Detachment	168	(1)
References	169	(4)
Behcet's Disease
Manfred Zierhut
Nicole Stubiger
Christoph Deuter
Ina Kotter
Introduction	173	(1)
Definition and Epidemiology of BD	174	(4)
Definition	174	(1)
History	174	(1)
Epidemiology	174	(4)
Genetics of BD	178	(4)
Immunology	182	(2)
T Cells	182	(1)
NK Cells	183	(1)
Neutrophils	183	(1)
Endothelial Dysfunction	183	(1)
Coagulation and Fibrinolytic Pathway Abnormalities	184	(1)
General (Extraocular) Manifestations of BD	184	(3)
Oral Aphthous Ulcerations	184	(1)
Genital Ulcerations	185	(1)
Skin Lesions	185	(1)
Pathergy Phenomenon	185	(1)
Skeletal System	185	(1)
Gastrointestinal Manifestations	186	(1)
Neurological Manifestations	186	(1)
Vascular Manifestations	186	(1)
Rare Manifestations	187	(1)
Life Expectancy	187	(1)
Ocular Involvement	187	(3)
Anterior Segment Changes	188	(1)
Posterior Segment Changes	188	(1)
Complications	189	(1)
Diagnosis	190	(1)
Therapy	190	(12)
Local Treatment	191	(1)
Systemic Treatment	191	(3)
Surgical Treatment	194	(1)
Practical Treatment Recommendations	194	(1)
References	195	(7)
Choroiditis: General Considerations and Classification
Carl P. Herbort
Introduction	202	(1)
Indocyanine Green Angiography (ICGA)	202	(4)
Physicochemical Properties of Indocyanine Green (ICG)	202	(2)
Standard ICG Angiographic Protocol for Inflammatory Diseases	204	(1)
Principles for the Interpretation of ICGA [9, 10]	204	(1)
Differences Between Fluorescein and Indocyanine Green Angiography	205	(1)
Clinico-pathologic-angiographic Correlations	205	(1)
Relevance of ICGA in Ocular Inflammatory Diseases	205	(1)
The Concepts of Inflammatory Choriocapillaropathy and Stromal Choroiditis [12]	206	(4)
Primary Inflammatory Choriocapillaropathy (PICCP)	206	(1)
Stromal Choroiditis	207	(1)
Secondary Inflammatory Choriocapillaropathy	207	(1)
References	207	(3)
Primary Inflammatory Choriocapillaropathies
Luca Cimino
Alessandro Mantovani
Carl. P. Herbort
Introduction	210	(1)
Angiographic Signs in Inflammatory Choriocapillaropathies	211	(2)
Angiographic Signs in Inflammatory Choriocapillaropathies	213	(1)
Patient History, Systemic and Ocular Symptoms and Signs in Primary Inflammatory Choriocapillaropathies	213	(1)
Practical Attitude in Primary Inflammatory Choriocapillaropathies (PICCP)	214	(1)
Specific Entities	215	(9)
Multiple Evanescent White Dot Syndrome (MEWDS)	215	(1)
Acute Idiopathic Blind Spot Enlargement (AIBSE)	216	(1)
Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) or Acute Multifocal Ischaemic Choriocapillaropathy (AMIC)	217	(2)
Multifocal Choroiditis (MFC), Including Punctate Inner Choroiditis (PIC), Diffuse Subretinal Fibrosis and Presumed Ocular Histoplasmosis Syndrome (POHS)	219	(3)
Serpiginous Choroiditis	222	(2)
Rare Entities	224	(2)
Acute Zonal Occult Outer Retinopathy (AZOOR) and Acute Annular Outer Retinopathy (AAOR)	224	(1)
Acute Macular Neuroretinopathy (AMN)	225	(1)
Overlapping Clinical Pictures in PICCPs: The Choriocapillaris as the Common Denominator of PICCPs	226	(2)
Association of Different PICCPs in the Same Patient	226	(1)
Intermediary Forms of PICCP	226	(1)
Unclassifiable Primary Inflammatory Choriocapillaropathies	227	(1)
Conclusion	228	(5)
References	228	(5)
Stromal Choroiditis
Nadia Bouchenaki
Carl O. Herbort
Introduction	233	(22)
Specific Entities	234	(1)
Primary Stromal Choroiditis	234	(9)
Stromal Choroiditis as a Random Involvement of a Systemic Disease	243	(6)
Other Infectious Choroiditides	249	(2)
References	251	(4)
Immunomodulatory Therapy in Uveitis
Stephan R. Thurau
Gerhild Wildner
Introduction	255	(2)
Cytotoxic Drugs	257	(4)
Azathioprine	258	(1)
Methotrexate	258	(1)
Mycophenolate Mofetil	259	(1)
Leflunomide	259	(1)
Cyclophosphamide	259	(1)
Chlorambucil	260	(1)
Antibiotics	261	(1)
Sulphasalazine	261	(1)
Calcineurin Inhibitors	261	(1)
Cyclosporine A (CsA)	261	(1)
Tacrolimus (FK506)	262	(1)
Sirolimus (Rapamycin)	262	(1)
Immunomodulatory Substances	262	(4)
Thalidomide	262	(1)
Anti-TNF-α Treatment	263	(2)
Interferon-α	265	(1)
Daclizumab	266	(1)
Oral Tolerance Induction	266	(7)
Retinal Autoantigens as Tolerogens	266	(1)
HLA-peptide B27PD as Oral Tolerogen	267	(1)
References	268	(5)
Vitrectomy in Uveitis
Matthias D. Becker
Arnd Heiligenhaus
Marc De Smet
Janet Davis
Introduction	273	(1)
General Approach to PPV in Uveitis	273	(1)
Patient Selection	273	(1)
Timing of Surgery	273	(1)
Technical Considerations	274	(1)
Diagnostic Procedures	274	(1)
Perioperative Management	274	(3)
Assessment of Other Ocular Disease	274	(1)
Concomitant Medical Management	275	(2)
Combined Surgery	277	(2)
Cataract Surgery	277	(1)
Membrane Peeling	278	(1)
Cryotherapy	278	(1)
Diagnostic PPV	278	(1)
Postoperative Complications	279	(1)
Hypotony	279	(1)
Retinal Detachment	279	(1)
Vitreous Haemorrhage	280	(1)
Uveitis Recurrence	280	(1)
PPV in Specific Diseases	280	(5)
Fuchs Uveitis Syndrome	280	(1)
Behcet's Disease	280	(1)
Intermediate Uveitis	280	(1)
Childhood Uveitis	281	(1)
Infectious Uveitis	281	(2)
References	283	(2)
Subject Index	285