Cytokines and Chemokines Involved in Acute Retinal Necrosis.

Purpose: To investigate which cytokines and chemokines are involved in the immunopathogenesis of acute retinal necrosis (ARN), and whether cytokine profiles are associated with clinical manifestations, such as visual outcome. Methods: Serum and aqueous humor (AH) samples of 19 patients with ARN were analyzed by multiplex immunoassay. Infectious controls consisted of 18 patients with rubella virus-associated Fuchs' uveitis and 20 patients with ocular toxoplasmosis all confirmed by intraocular fluid analyses. The control group consisted of seven paired AH and serum samples from seven noninflammatory control patients with age-related cataract. In each sample, 4 anti-inflammatory, 12 proinflammatory, 2 vascular, and 4 other immune mediators were measured. In addition, various clinical characteristics were assessed. Results: In ARN, 10 of the 22 mediators, including most proinflammatory and vascular mediators such as IL-6, IL-8, IL-18, MIF, MCP-1, Eotaxin, IP-10, IL-15, sICAM-1, and sVCAM-1, were significantly elevated when compared to all controls. In addition, one anti-inflammatory mediator (IL-10) was significantly elevated in ARN as compared to the controls. No association was found between the time of sampling and the extent and levels of immune mediator expression. Conclusions: The pathogenesis of ARN is characterized by the presence of predominantly proinflammatory cytokines and chemokines with high expression levels as compared to other infectious causes of uveitis. There are no indications for an obvious Th-1 or Th-17 pathway. The combined data suggest that immune mediator expression is related to severity of disease, which is more fulminant in ARN, rather than to a specific uveitis entity.

Intraocular and serum levels of vascular endothelial growth factor in acute retinal necrosis and ocular toxoplasmosis.

PURPOSE: To determine the intraocular and serum vascular endothelial growth factor (VEGF) levels in patients with acute retinal necrosis (ARN) and compare those with VEGF levels found in patients with ocular toxoplasmosis (OT). METHODS: Paired intraocular fluid and serum samples of 17 patients with ARN and of 16 patients with OT were analyzed by ELISA for VEGF levels, and the clinical records were reviewed. RESULTS: The mean intraocular VEGF levels in patients with ARN were higher than in patients with OT (P = 0.005), whereas the serum levels did not differ. Intraocular VEGF levels exceeded the serum levels in 8 of 17 patients (47%) with ARN compared with 1 of 16 patients (6%) with OT (P = 0.009). The group with high intraocular VEGF was associated with a more extensive retinitis and lower visual acuity at 3-month follow-up (P < 0.001 and P = 0.031, respectively). CONCLUSION: Intraocular VEGF levels were elevated in patients with ARN compared with OT patients. Our results suggest strong intraocular VEGF production in ARN, which might be of importance for the treatment of these patients.