RESUMEN
Th17/Treg cell balance is essential for immune homeostasis and when disrupted, is associated with the occurrence and development of inflammation in numerous autoimmune diseases. However, its contribution in pathophysiology of uveitis remains unexplored. In this study, we deciphered the role of Th17/Treg cell balance in autoimmune uveitis subjects. Using flow cytometry, we detected the frequencies and absolute count of both Th17 and Treg cells in the aqueous humor and peripheral blood of patients and healthy controls. Our results for the first time reveal a significant increase (p < 0.01 and p < 0.005) in Th17 population alongside a significant decrease (p < 0.001 and p < 0.003) in Treg cell population in both the aqueous humor and PBMCs of uveitis patients. Further we analyzed the expression of Th17-Treg associated genes and cytokines via qPCR and ELISA respectively. These findings align with our flow cytometry results, as evident by a significant (p < 0.002) up-regulation of IL-17 and a concurrent down regulation of IL-10 at transcriptional levels. Moreover, IL-17A cytokine was found to be substantially high (p < 0.001) and IL-10 (p < 0.02) down regulated in serum. Interestingly, we demonstrated a significant correlation of Th17/Treg cells in aqueous humor with those in peripheral blood. Conclusively, our results suggest the pivotal role of Th17/Treg cell axis in the immuno-pathophysiology of human uveitis. Further we propose the therapeutic potential of targeting this novel axis for ameliorating the disease burden associated with uveitis.
Asunto(s)
Humor Acuoso , Linfocitos T Reguladores , Células Th17 , Uveítis Intermedia , Humanos , Células Th17/inmunología , Células Th17/metabolismo , Linfocitos T Reguladores/inmunología , Linfocitos T Reguladores/metabolismo , Femenino , Masculino , Adulto , Humor Acuoso/inmunología , Humor Acuoso/metabolismo , Uveítis Intermedia/inmunología , Uveítis Intermedia/diagnóstico , Citocinas/metabolismo , Persona de Mediana Edad , Adulto JovenRESUMEN
PURPOSE: To report a case series of human immunodeficiency virus (HIV)-negative patients with healed cytomegalovirus retinitis presenting with proliferative retinopathy (in the form of neovascularisation elsewhere). METHODS: Retrospective case series. Multimodal imaging was performed at each follow-up visit. RESULTS: Three patients with non-HIV immune dysfunction were followed up after healing of CMV retinitis. All three developed neovascularisation. Patient 1 after 4 months presented with vitreous haemorrhage for which pars plana vitrectomy was performed. Patient 2 developed neovascularization at disc and neovascularisation elsewhere 4 months after resolution, and patient 3 despite being affected by bilateral CMV retinitis, presented with unilateral neovascularization at 14 month after resolution of retinitis. CONCLUSION: Increased incidence of this rare entity could be attributed to partial immune dysfunction in non-HIV patients, limited area of retinitis with a more aggressive occlusive vasculitis. Extensive occlusion with more area of viable retina for angiogenic factor production explains this phenomena. It emphasizes the need for continued follow-up even after healing and to differentiate it from reactivation of retinitis and immune recovery uveitis.Abbreviation: CMV: cytomegalovirus; HIV: human immunodeficiency virus; BCVA: best corrected visual acuity.
RESUMEN
Management of mis-dissected lenticule during Small-incision lenticule extraction (SMILE) is technically challenging and might be experienced more by novice surgeons especially in eyes with low refractive errors and thin lenticules. Presently, we describe a rescue method of inverse centripetal dissection (ICD) to manage mis-dissected lenticules. In this technique, after inadvertent dissection of posterior plane prior to anterior plane, the double-ended SMILE dissector is rotated along its shaft axis clockwise from the left upper margin of the mis-dissected lenticule to form an inversely folded lenticule which is then subsequently dissected centripetally till midline. This is then extracted by performing lenticulorrhexis with a pair of microforceps. We performed this technique in 10 eyes of 10 patients and the lenticule extraction was accomplished successfully in all eyes. At six months follow-up, the uncorrected visual acuity was 20/20 with a clear interface in all eyes. The ICD approach might serve as a useful rescue technique for managing mis-dissected lenticules.
Asunto(s)
Cirugía Laser de Córnea , Errores de Refracción , Sustancia Propia/cirugía , Disección , Humanos , Láseres de Excímeros , Refracción Ocular , Agudeza VisualRESUMEN
Purpose: This study aimed to determine the anatomical and functional outcomes of pars plana vitrectomy without encircling band for primary rhegmatogenous retinal detachments with inferior breaks utilizing 3D heads up viewing system. Method: This prospective, single-center study included 22 consecutive eyes with primary rhegmatogenous retinal detachments with only inferior breaks with proliferative vitreoretinopathy (PVR) CP2 or less, who underwent pars plana vitrectomy without encircling band, with silicon oil as tamponade. All surgeries were performed by a single surgeon. The single operation success rate was recorded after silicon oil removal. Results: The patient population consisted of 08 women (36%) and 14 men (64%) with a mean age of 56.6 +/- 14.7 years. The mean follow-up period was 8 months. A single break was present in 13 cases (59%), and 2-4 breaks were present in 9 cases (40.9%). The mean time for the surgical procedure was 35 min (range: 25-50). The macula was found to be detached in 19 cases (86.36%) and attached in 3 cases (13.6%). Single operation success rate (SOSR) of vitrectomy, after silicon oil removal without encircling band, for primary rhegmatogenous retinal detachment (RRD) with inferior breaks was 95.4%. One case redetached due to PVR changes and underwent re-surgery. Final reattachment was achieved in all 22 cases (100%). Mean best-corrected visual acuity (BCVA) significantly improved from 1.43 ± 0.59 logarithm of the minimum angle of resolution (logMAR) to postoperative BCVA was 0.48 ± 0.34 logMAR (P = 0.001). Conclusion: Pars plana vitrectomy without encircling band, utilizing 3D heads up the system in RRDs with inferior breaks in eyes with PVR grade C2 or less, provides good outcome.