Reggio Emilia (Northern Italy) Interdisciplinary Uveitis Clinic: What We Have Learned in the Last 20 Years.

PURPOSE: To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center. METHODS: Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center. RESULTS: Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs. CONCLUSIONS: The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.

Anterior Segment Optical Coherence Tomography in Uveitis-Glaucoma-Hyphema Syndrome.

PURPOSE: Uveitis-Glaucoma-Hyphema (UGH) syndrome results from contact between the intraocular lens (IOL) and the iris or ciliary body, leading to uveal structure erosion and blood-aqueous barrier breakdown. Treatment involves various drugs, with IOL removal often being necessary. Diagnosis relies on clinical signs, but imaging techniques like ultrasound biomicroscopy (UBM) or anterior segment optical coherence tomography (AS-OCT) are crucial. AS-OCT accurately depicts IOL position and potential contact, emerging as a primary alternative to UBM in the diagnosis. Our study aimed to correlate AS-OCT findings with clinically detectable iris atrophy in pseudophakic patients with IOL-iris chafing and UGH syndrome. METHODS: The study retrospectively analyzed patients diagnosed with UGH syndrome presenting at the Ocular Immunology Unit of Reggio Emilia, Italy, from January 2019 to August 2023. Patients' data were collected. Ophthalmological exams and imaging were performed. The peephole sign in AS-OCT images was evaluated. Statistical analyses were conducted, with a significance level of p ≤ 0.05. RESULTS: The study reviewed 22 eyes of 22 patients with UGH syndrome. Four eyes were excluded, leaving 18 patients (8 females, 10 males). Common misdiagnoses included idiopathic anterior uveitis (55.5%) and herpetic anterior uveitis (16.7%). All patients had iris transillumination defects, mostly focal (77.8%). AS-OCT revealed IOL chafing in all the eyes, with peephole sign correlation. More peephole signs occurred with IOL in the sulcus (p-value = 0.08). CONCLUSION: The study recommends AS-OCT for UGH syndrome confirmation and UBM when IOL-iris chafing is not observed on AS-OCT scans.

Effectiveness of Pegylated Interferon Alpha-2a in Post-Uveitic Macular Edema Previously Responding to Non-Pegylated Interferon.

PURPOSE: To evaluate the efficacy of pegylated interferon (PEG-IFN) alpha-2a to treat post-uveitic relapsing macular edema (ME) after withdrawal of non-PEG IFN alpha-2a or 2b to maintain treatment efficacy. METHODS: This retrospective study investigated subjects with post-uveitic ME who received weekly subcutaneous PEG-IFN alpha-2a injections. Comparisons between baseline central macular thickness (CMT) and best-corrected visual acuity (BCVA) and those at all follow-up visits were made. RESULTS: Six patients (nine eyes) were treated and followed up for six months. CMT (mean [standard deviation]) decreased from 375[117] to 283[39] µm after one month (p < 0.001), remaining significantly lower up to the final follow-up visit at six months (275[38] µm, p = 0.008), and BCVA (0.21[0.16] logMAR at baseline) showed an improvement of 0.12[0.11] logMAR (p = 0.026) at six months. Neither recurrences nor any serious adverse events were recorded. CONCLUSIONS: Post-uveitic ME patients were effectively and safely treated with PEG-IFN alpha-2a.

Could different aqueous humor and plasma cytokine profiles help differentiate between ocular sarcoidosis and ocular tuberculosis?

OBJECTIVE AND DESIGN: A cross-sectional single-center study was conducted to assess cytokine levels in aqueous humor (AH) and plasma of three different uveitis entities: definite ocular sarcoidosis (OS), definite OS associated with QuantiFERON®-TB Gold test positivity (Q + OS) and presumed tubercular uveitis (TBU). SUBJECTS: Thirty-two patients (15 OS, 5 Q + OS, 12 TBU) were included. METHODS: Quantification of selected cytokines was performed on blood and AH samples collected before starting any treatment. Statistical analysis was conducted using the Kruskal-Wallis test, the Mann-Whitney or Fisher test and the Principal Component Analysis (PCA). RESULTS: IL-6, IL-8 and IP-10 levels were higher in AH samples than in peripheral blood. In AH samples, BLC, IL-8 and IP-10 were significantly higher in definite OS than in presumptive TBU. There were no statistically significant differences in terms of cytokine levels between Q + OS and presumptive TBU. PCA showed a similar cytokine pattern in the latter two groups (IFNγ, IL-15, IL-2, IP-10, MIG), while the prevalent expression of BLC, IL-10 and MIP-3 α was seen in definite OS. CONCLUSIONS: The different AH and plasma cytokine profiles observed in OS compared to Q + OS and TBU may help to differentiate OS from TBU in overlapping clinical phenotypes of granulomatous uveitis (Q + OS).

[Effects on renal function of a drug antagonistic to morphine-like peptide systems after water load]. / Effetti sulla funzionalita' renale di un farmaco antagonista dei sistemi peptidergici morfino-simili dopo carico idrico.

Following i.v. administration of 0,4 mg Naloxone, a pure antagonist of opioid peptides, a study of renal function was performed in 5 patients who underwent oral water load equal to 20 cc/Kg water for 15-20 min. Within 15 min after administration of the drug all cases showed a further increase in urinary flow resulting from an increase in glomerular filtration rate and CH2O. The absence of systemic haemodynamic changes (BP, HR) suggested an intrarenal origin of the phenomena observed, as a sign of expansion of the system responsible for free water elimination. We put forward the hypothesis that Naloxone inhibits the antidiuretic activity of opioid peptides - in any case quiescent under water load conditions - which is masked by osmotic and volume mechanism.

[Effect, on renal function, of a product rich in polyunsaturated fatty acids: results obtained in subjects with chronic renal failure caused by nephroangiosclerosis]. / Effetti sulla funzionalita' renale di un prodotto ricco di acidi grassi polinsaturi: risultati ottenuti in soggetti con insufficienza renale cronica da nefroangiosclersoi.

Subjects with renal chronic failure were studied. Four patients were treated with 2,5 mg/Kg of phosphatidylcholine, a drug with an high content of polyunsatured fatty acids. The drug's effects, studied during three successive 30 min. Clearance periods, were the same as in healthy subjects, i.e.: a statistically significant increase of: urine flow, renal blood flow, glomerular filtration rate and sodium excretion. In other 6 patients, administration of i.v. lysine acetylsalicylate (10,5 mg/Kg) caused a decrease of the parameters under study, that were increasing for a previous dose of phosphatidylcholine and made ineffective another administration of this drug. If the thesis is assumed that in normal subjects phenomena may be referred to the local synthesis of PG, then the authors believe that the potential synthesis capacity of these substances is not compromised in chronic renal failure.

[Effect, on renal function, of a product rich in polyunsaturated fatty acids: results obtained in healthy subjects]. / Effetti sulla funzionalita renale di un prodotto ricco di acidi grassi polinsaturi: risultati ottenuti in soggetti sani.

In 7 healthy subjects a 2,5 mg/Kg dose of i.v. phosphatidylcholine a drug with an high content of polyunsaturated fatty acids, caused variations in renal functionality as follows: a statistically significant increase of: urine flow, renal blood flow, glomerular filtration rate and sodium excretion. The above phenomena which resulted in a hypertonic poliuria, were detected during three 30 mins clearance periods. In other 5 subjects, a dose of lysine acetylsalicylate (10,5 mg/Kg) either suppressed the phenomena induced by the previous administration of phosphatidylcholine or prevented them to appear when the drug was given successively. Authors suggest that the data obtained may be ascribed to stimulation of local PG synthesis.

Possible mixed agonist--antagonist activity of D-sulpiride at dopamine receptor level in man.

The effects of different doses of D-sulpiride (1, 6, 12 and 25 mg, i.v.) on arterial blood pressure (ABP), heart rate (HR) and prolactin (PRL), growth hormone (GH), insulin and gastrin secretions have been studied in 8 normal men. D-Sulpiride increased systolic ABP with a maximum effect rather 12 mg i.v., while it had only slight effects on diastolic ABP and HR. PRL secretion was increased by D-sulpiride in a dose-dependent way, while insulin secretion was lowered and GH secretion slightly enhanced only in a restricted range of doses (6 mg and 12 mg i.v., respectively). Gastrin secretion seemed to be unaffected by D-sulpiride at any of the tested doses. These results are discussed in view of a possible mixed agonist--antagonist activity of D-sulpiride at dopamine receptor level in contrast with the relatively pure antagonistic action of the levo isomer.

[Effect of polyunsaturated fatty acids on experimental ulcer in the rat]. / Effetti degli acidi grassi polinsaturi sull'ulcera sperimentale del ratto.

The increase of gastric mucosal defensive reachons under linoleic acid loading (20 mg/kg i.m. x 2 x 10 die; 140-220 mg/kg per os x 2 x 15 die), was evaluated in hydrocortisone treated rats (10 mg/kg i.m. x 2 x 10 die) and in rats stressed by immobilisation at a low temperature (at 4 degrees for 1 hour). The incidence and extent of gastric lesions were recorded, in both samples treated differentialy, and in control groups. Although the results were not similarly significant in every case, the capacity of the linoleic acid administrations in limiting the gastric mucose injury was evident. This protective capacity is not dependent on the lesive agent.