Ocular Sarcoidosis and Autoimmune Polyglandular Syndrome Type 2: A Case Report.

PURPOSE: to describe a clinical case of ocular sarcoidosis in a patient with Autoimmune Polyglandular Syndrome Type 2 (APS-2). METHODS: an 86-year-old female diagnosed with APS-2 was referred to our uveitis department with rapid visual loss in her left eye during a 3-month period. Her best-corrected visual acuity (BCVA) was counting fingers in her left eye (OS) and 20/40 in her right eye (OD). Slit-lamp biomicroscopy was unremarkable OD but revealed granulomatous keratic precipitates OS. Fundoscopy revealed bilateral optic disc oedema and +2 and 4+ vitritis (SUN classification) in her OD and OS, respectively. RESULTS: the patient underwent chest X-Ray which revealed bilateral hilar lymphadenopathy and fibrosis. On high-resolution computed tomography of the lungs, ground-glass opacities were visible, and a diagnosis of ocular sarcoidosis was presumed. After exclusion of infectious diseases, the patient was treated with methotrexate and oral corticosteroids and there was substantial improvement of the optic nerve oedema and vitritis. At the most recent visit, 2 years later, OS BCVA was 20/50. CONCLUSION: There may be an association between ocular sarcoidosis and APS or other autoimmune disorders.

Regulatory T cells and IL-17A levels in noninfectious uveitis.

PURPOSE: Regulatory T cells (Tregs) have been intensively studied in a myriad of autoimmune diseases. As for noninfectious uveitis (NIU), results have been contradictory, and studies have failed to demonstrate a consistent reduction in Treg cell frequency in patients with active disease. The present study aims to characterize T lymphocyte subsets, including naïve and memory Tregs as well as their respective CD39 expression, in the peripheral blood of NIU patients. Inflammatory as well as suppressive cytokine profiles were also evaluated. METHODS: T cell subpopulations were evaluated by multiparametric flow cytometry using anti-CD3, anti-CD4, anti-CD45, anti-CD45RA, anti-CD197, anti-CD25, anti-CD127, and anti-CD39. Treg cells were defined as CD3 + CD4+CD25hiCD127low. A multiplex bead-based immunoassay was used to determine TNF-α, IFN-É£, IL-17A, IL-10, and TGF-ß levels. RESULTS: Twenty-nine patients with active NIU were included as well as 15 sex- and age-matched controls. There were no significant differences in T lymphocyte subsets, including Tregs, between patients and controls. However, patients with a lower grade of anterior chamber or vitreous inflammatory cellular reaction showed higher memory Treg counts than controls, with no respective increase in CD39+ expression, and a tendency for higher IL-17A levels (p = 0.06). This IL-17A elevation was present in the total NIU group (p = 0.08) as well as a positive correlation between IL-17A levels and the absolute counts of memory Tregs (p = 0.013; R = 0.465). Patients with higher IL-17A levels also showed higher serum concentrations of memory (p = 0.001) and naïve (p = 0.003) Tregs as well as elevated TNF-α (p < 0.0001) and IFN-É£ (p = 0.016) levels. Negative correlations were observed between IL-10 and TGF-ß levels and the percentages of memory (p = 0.030; R = - 0.411) and total CD39+ Tregs (p = 0.051; R = - 0.373) in the peripheral blood of NIU patients. CONCLUSION: Our results showed that total Treg levels were not reduced in patients with NIU. Further characterization of Treg subsets, including memory Tregs and respective CD39 expression, may provide additional insight on the role of Treg cells in NIU. Consistent high levels of circulating IL-17A in NIU patients are in accordance with previous studies and reinforce this cytokine's vital role in uveitis pathogenesis and its possible use as a therapeutic target.

Roles of interleukin-17 in uveitis.

Th17 cells, a CD4+ T-cell subset, produce interleukin (IL)-17, a pro-inflammatory cytokine that has been shown to be involved in several forms of infectious and noninfectious uveitis. Here, we explore the roles of this IL in uveitic disorders as well as in experimental autoimmune uveitis, the possible pathogenic implications of several cytokines associated with IL-17 and analyze the current outcomes and goals for drugs aiming for the IL-17 pathway.

Asteroid hyalosis: clinical review of 58 cases / Asteroides hialoides - revisão de 58 casos clínicos

OBJECTIVE: Understand the behavior, functional repercussion and relationship with epidemiological factors of asteroid hyalosis (AH) and retrospective observational case series. METHODS: Fifty-eight patients diagnosed with AH (24 women and 34 men) were studied. All patients were submitted to a thorough ophthalmological examination. RESULTS: We observed a statistical association between the presence of AH and male sex (p=0,042). An increase in prevalence of this pathology was observed with increasing age. We determined an odds ration of 5,24 of a patient over 50 years old having AH, when compared to patients bellow this threshold. Eighty-six percent of patients had unilateral vitreous deposits. We measured a lower IOP in the affected eye, with the difference being in average 2,68 ± 1,45 mmHg (p=0,037). We observed no statistical association between AH and age related macular degeneration, diabetes or glaucoma. Five eyes were submitted to facoemulsification combined with pars plana vitrectomy with an average gain of 7 lines (Snellen) in visual acuity (p=0,03). CONCLUSION: In our sample a clear association between AH, ageing and male sex was observed. The majority of patients had unilateral vitreous deposits. Vitrectomy in association with facoemulsification is a safe and effective intervention in this group of patients.

OBJETIVO: Compreender o comportamento dos asteroides hialoides, sua repercussão funcional em relação aos fatores epidemiológicos,de modo retrospectivo e observacional de casos clínicos. MÉTODOS: Cinquenta e oito doentes com diagnóstico de asteroides hialoides (24 mulheres e 34 homens) foram estudados. Todos os doentes foram submetidos a exame oftalmológico completo. RESULTADOS: Observamos uma associação estatística entre a presença de asteroides hialoides e o sexo masculino (p=0,042). Verificamos um aumento de prevalência desta patologia com o aumento da idade sendo o risco relativo após os 50 anos de 6,25 face aos doentes abaixo desta idade. Oitenta e seis por cento dos doentes estudados apresentavam depósitos unilaterais. Não observamos associação estatística entre a presença de asteroides hialoides e a degeneração macular ligada à idade, diabetes mellitus ou glaucoma. Em 5 dos olhos estudados avaliamos o resultado funcional de cirurgia de facoemulsificação associada à vitrectomia via pars plana e observamos um ganho médio de 7 linhas de acuidade visual de Snellen (p=0,03) pós-cirurgia. CONCLUSÃO: A amostra apresenta uma clara associação entre o envelhecimento e sexo masculino e a incidência de asteroides hialoides. Na maioria dos doentes estudados os depósitos foram unilaterais. A vitrectomia via pars plana, associada à facoemulsificação é uma terapêutica segura e eficaz neste grupo de doentes.