[The status and prospects of immunological research in uveitis].

Uveitis is a group of common sight-threatening intraocular inflammatory diseases. Besides of few patients caused by infectious agents, most of patients caused by the autoimmune reactions. In recent years, the basic and clinical researches in the immunology of uveitis had many advances. The complex immunologic mechanisms in uveitis were explained from the levels of cellular and molecular immunology. And the theoretical basis on the treatment of uveitis was established. But there are some unresolved questions existed in the fields of uveitis researches, such as the mechanisms of body defense system to prevent the intraocular inflammation, the pathogenesis of infection that causes the autoimmune response and the autoimmune uveoretinitis, the susceptible gene of uveitis and the related factors associated with occurrence and chronic in uveitis. The deeper studies on these questions will be benefit to the diagnosis and treatment of human refractory uveitis.

[Progresses and existed problems on the diagnosis and treatment of Vogt-Koyanagi-Harada disease].

Vogt-Koyanagi-Harada disease is a multi-systems inflammatory disease that affects the eye, skin, inner ear and meninges. The characteristics of this disease are with meningismus, auditory dysfunction and integumentary changes. Bilateral granulomatous panuveitis with serous retinal detachments are the typical ocular findings. Vogt-koyanagi-Harada disease is characterized by the acute onset, poor response to the treatment and high blindness rate. The diagnosis is mainly made on the history and ocular findings with various systemic manifestations. Fundus angiography is often used to assist in the diagnosis. High dosages of systemic corticosteroids are the first line therapeutical choice. The immunosuppressive agents and biologic agents combined with systemic corticosteroids shows good results in some recurrent cases. The good visual prognosis is guarded with earlier accurate diagnosis and aggressive treatment.

[Advances in the clinical treatment of Behcet disease].

Behcet disease was a chronic and recurrent systemic vasculitis, the etiology and pathogenesis were not fully understood, the infectious agents, autoimmunological mechanisms and genetic factors were involved. The treatment of complicated uveitis was difficult and the visual prognosis was usually poor. The current treatment strategies of Behcet disease included immunosuppressive agents, systemic corticosteroids and biological agents. The combinations of these drugs were the rules.

[The diagnosis and treatment analysis of anterior uveitis].

OBJECTIVE: To explore the clinical characters, effects of treatment, the prognosis of visual acuity and the problems in the treatment of the anterior uveitis. METHODS: The retrospective case series study was used to observe the clinical characters and treatment effects of 478 cases of anterior uveitis from January 2001 to June 2007 in Tianjin Eye Hospital. Among the 478 cases of patients, the male was 281 cases and the female was 197 cases. The mean age was (36 +/- 15) years old. Both the clinical examinations and immunologic investigations were performed. The clinical characters, effects of treatment, complications and prognosis of the anterior uveitis were analyzed. RESULTS: There were 242 cases (50.6%) with acute anterior uveitis, 197 cases (41.2%) with recurrent anterior uveitis and 39 cases (8.2%) with chronic anterior uveitis. There were 231 cases (48.3%) with idiopathic uveitis, 76 cases (15.9%) with human leukocyte antigen-B27 associated uveitis without systemic diseases, 52 cases (10.9%) with herpetic uveitis, 34 cases (7.1%) with ankylosing spondylitis, 29 cases (6.1%) with Fuchs syndrome, 24 cases (5.0%) with glaucomatocyclitic crisis and 17 cases (3.6%) with juvenile idiopathic arthritis-associated uveitis. The rate of complications was 31.6% (151 cases), the rate of mild visual impairment (less than 0.5) was 11.1% (53 cases), the moderate and severe visual impairment (less than 0.3) was 7.5% (36 cases), and the rates of blindness (less than 0.05) was 2.5% (12 cases). CONCLUSIONS: The types of anterior uveitis are varied. Idiopathic anterior uveitis, human leukocyte antigen-B27 associated uveitis and herpetic uveitis are the most common entities. The careful clinical and immunologic examinations could be benefit for the etiological diagnosis and prompt treatment.

[Problems to be resolved urgently on amblyopia diagnosis and prevention in China].

For many years, the best corrected vision less than 0.9 was an unique amblyopia diagnostic criteria in the clinical practices in China. Because of no different visual acuity criteria for younger-aged children, the amblyopia prevalence was increased. In clinical practice, two phenomenons exist in the amblyopia diagnosis and prevention. One is that ignores the risk factors for amblyopia development and only considers the factor of visual acuity. The other is that only uses a corrected visual acuity of 0.9 as diagnostic criteria and ignores the visual development with ages. Therefore, it should be taken the different visual acuity criteria for amblyopia diagnosis in younger-aged children. And it should be emphasized on the co-existed risk factors in the amblyopia diagnosis.

[Recent advances in studies of clinical treatment of uveitis].

Uveitis is a common immune-related intraocular inflammation, the topical or systemic corticosteroids are the first-line drugs for the treatment of uveitis. The combined immunomodulatory agents of cyclosporine, mycophenolate mofetil, azathioprine or cyclophosphamide are helpful for the treatment of severe or refractory uveitis. The new biologic agents, tumor necrosis factor inhibitors, interferon alpha or the interleukin-2 receptor antagonists, are also helpful for certain types of refractory uveitis. Intravitreal steroids injection or vitrectomy would be beneficial for specific types of uveitis and their complications. The advances of uveitis treatment in recent years are reviewed.

[Pay a special attention to the influences of age on children amblyopia diagnosis].

The degree of decline of visual acuity in amblyopia diagnosis is not same between the countries. The visual acuity less than 0.9 as amblyopia diagnostic criteria in our country is higher than that of the other countries. We found the 5% lower reference limit of the distance visual acuity among 3 approximately 6 years old children was less than 0.7. Less than 0.9 as diagnostic criteria is too high for younger children, which makes some developing children as amblyopia, more than millions of children were treated as amblyopia by mistakes. Considering the age influences on amblyopia diagnosis improperly, it would build up the higher referring rate and high false positive rate, increasing the screening expenses and family expenses during the children's vision screening. So we suggested that it should take a different visual acuity standard for younger children when diagnosing amblyopia.

[The suppression of the experimental autoimmune uveoretinitis with retinal S antigens by intranasal tolerance induction].

OBJECTIVE: The aim was to investigate the suppression of rat experimental autoimmune uveoretinitis( EAU) by induced immune tolerance via intranasal administration of retinal S antigens. METHODS: The bovine S antigen was purified from bovine retina by salt precipitation and ionic exchange chromatography, the female Lewis rats were used to induce immune tolerance by intranasal administration with purified bovine retinal S antigens and then the rats were used to produce the EAU model by retinal S antigens challenge. The rate of EAU occurrence, the clinical and histological scores, the skin delayed-type hypersensitivity and lymphocyte proliferation stimulated by retinal S antigen and concanavalin A were recorded. The adjunct effect of cyclophosphamide on tolerance induction was observed. RESULTS: After intranasal administration of retinal S antigens, EAU was induced in two of eight ( 25% ) rats in tolerant group, sis of six (100%) rats in control group , the difference of EAU induction rate was significant in tolerant group compared with control (P = 0. 0097) . The average onset time in tolerant group were 16. 5 days, the control group was 10. 3 days, the difference was significant ( F = 26. 32, P = 0. 000; q = 9. 723, P <0. 01). The average clinical scores of EAU in tolerant group were 0. 89, the control group was 3. 94, the difference was significant( F = 12. 48 ,P = 0. 000; q = 7. 904, P < 0. 01 ). The average histological scores of EAU in tolerant group were 1. 21, the control group was 4. 12, the difference was significant( F = 11. 80, P = 0. 000; q = 7. 510,P <0. 01). The histological features in tolerant group were iris blood vessels slightly dilation, few exudates in anterior chamber and vitreous cavity; there were slighter retina swallow and the photoreceptors damages in the tolerant group. The skin delayed-type hypersensitivity and the proliferative responses of lymphocytes stimulated by S antigen and concanavalin A in tolerant group were slighter than that in the control group. Intraperitoneal injection of cyclophosphamide enhanced the effect of immune tolerance slightly. Only intraperitoneal injection of cyclophosphamide did not diminish the severity of the rat EAU. CONCLUSION: The intranasal induced tolerance by retinal S antigens can suppress effectively the prevalence of rat experimental autoimmune uveoretinitis induced by retinal S antigens.

[The clinical analysis of endophthalmitis caused by minor ocular perforation].

OBJECTIVE: To discuss the incidence rate and causes of endophthalmitis caused by minor ocular perforation. To document its damage to the visual function, so as to improve the rate of prevention of this disease. METHODS: The following clinical information of 153 cases with minor ocular perforations from a retrospective study was collected: general conditions, injury objects, wound shape and size, presence or absence of ocular foreign body, associated organic injuries, visual functions in the early stage after injury, speed of occurrence of infection, and positive rate of microbiological tests. The results with the drug treatments and surgical therapy were analyzed. RESULTS: All of 153 cases were followed up from 3 months to 7 years. The visual acuity in 13 cases (8.5%) was over 0.3. 140 cases (91.5%) were less than 0.3. Enucleating was performed in 37 cases (24.2%). CONCLUSION: The patients with minor ocular perforations tend to have good visual acuity in the early stage after injury. But their visual acuity was lost in 4 to 12 hours if rapid and severe infections occurred. The risk of endophthalmitis should be recognized and evaluated on time in the early stage after injury.