Autoimmune ocular diseases are a type of inflammatory eye condition characterized by the involvement of the immune response. This includes various types disease such as autoimmune uveitis, thyroid-associated eye disease, and primary Sjögren's syndrome. In recent years, breakthroughs have been achieved in inducing transplant tolerance, understanding tumor immune evasion, and preventing autoimmune diseases using immune checkpoint molecules. Negative immune checkpoints effectively control disease progression by inhibiting T cell proliferation, reducing inflammatory cytokine levels, and ultimately regulating autoimmune balance. Therefore, the negative immune checkpoint molecules are expected to be used as a new therapeutic target in the future, and the combination therapy through the combination of negative immune checkpoint drugs is expected to become an important direction to improve the efficacy of the treatment of autoimmune diseases.
ObjectiveTo observe the clinical features of uveal effusion syndrome (UES) and the efficacy of sclerectomy in the treatment of UES.MethodsA retrospective case series. Twenty patients (36 eyes) of UES with sclerectomy were enrolled in this study from June 2012 to December 2016 in Beijing Tongren Hospital. Among them, there were 12 males (22 eyes) and 8 females (14 eyes), with an average age of 37.8 years. All patients suffered from bilateral diseases, including 4 patients in single eye group and 16 patients in double eye group. Visual acuity, intraocular pressure, indirect ophthalmoscope, UBM, FFA combined with ICGA, A/B ultrasonography, axial length (AL) and scleral thickness were measured. All patients underwent lamellar sclerectomy, and those with exudative retinal detachment underwent four quadrant lamellar sclerectomy, followed by four quadrant full-thickness sclerectomy with the size of 1 mm × 2 mm in the center of the scleral bed. The follow-up time after operation was more than 6 months.Visual acuity, intraocular pressure and fundus examination were performed 1, 3 and 6 months after operation with the same equipment and methods before operation.ResultsThere was no obvious inflammation in the anterior chamber of all eyes, and intraocular pressure was 24-28 mmHg (1 mmHg = 0.133 kPa) in 4 eyes (11.1%). Axial length of 8 eyes (22.2%) were 16-18 mm (true microphthalmia). 12 eyes (33.3%) had scleral thickness＞1.0-1.8 mm. Visual acuity ranged from hand movement to 0.05 in 20 eyes, 0.1 to 0.3 in 10 eyes and＞0.3 in 6 eyes. Fundus examination showed peripheral choroidal and ciliary detachment; UBM examination showed annular peripheral ciliary and choroidal detachment. 32 eyes (88.9%) were complicated with exudative retinal detachment. FFA examination showed that 14 eyes (38.9%) had leopard spot changes. Compared with preoperative vision, the visual acuity improved in 28 eyes (77.8%) and remained unchanged in 8 eyes (22.2%) after surgery. Thirty-two eyes with different degrees of retinal detachment were found before surgery. After surgery, ciliary body detachment, choroidal detachment and retinal detachment were restored. Six eyes (16.7%) recurred and underwent sclerectomy again.ConclusionsThe mild symptoms and recurrent attack are the characteristics of UES. Sclerectomy is an effective method to treat UES.
Objective To observe the ultrasonographic features of idiopathic uveal effusion syndrome (IUES). MethodsA retrospective controlled study. From January 2012 to December 2023, 13 patients with IUES (26 eyes) diagnosed by ophthalmology examination in Department of Ophthalmonogy of Beijing Tongren Hospital (IUES group) and 22 healthy people with 30 eyes (control group) were included in the study. Both eyes of all participants were examined by color Doppler ultrasound (CDU) and ultrasonic biomicroscopy (UBM). The thickness of the ocular wall at 300 μm on the temporal side of the optic disc was measured by CDU. UBM was used to measure the thickness of the nasal and temporal scleral processes. Corneal thickness (CT), anterior chamber depth (AD), lens thickness (LT) and axial length (AL) were measured by A-mode ultrasound. There were no significant differences in age (t=0.842), sex component ratio (χ2=0.540), eye difference (χ2=0.108) and AL (t=0.831) between IUES group and control group (P＞0.05). The CDU and UBM imaging features and biometrics of IUES affected eyes were observed. Independent sample t test was used for comparison between groups. ResultsCDU examination results showed that in 26 eyes of IUES group, choroidal detachment occurred in 20 eyes (76.9%, 20/26), which showed arc-shaped band echo connected with peripheral and equatorial eye wall echo, with uniform low echo area below, and blood flow signal could be seen on the band echo. The echo thickened and decreased in 4 eyes (15.3%, 4/26). Nine eyes (33.3%, 9/26) were accompanied by retinal detachment, which showed that the posterior pole vitreous echo was connected to the optic disc echo, and the blood flow signal was seen on the ribbon echo. UBM results showed ciliary detachment in 22 eyes (84.7%, 22/26), showing a spongy thickening of the ciliary body with interlamellar echo separation and an echoless area between the sclera. Ciliary body echo thickened and decreased in 2 eyes (7.7%, 2/26). Shallow space between ciliary body and sclera was observed in 2 eyes (7.7%, 2/26). Compared with the control group, CT (Z=2.054), LT (Z=1.867), scleral thickness (Z=2.536) and ocular wall thickness (Z=2.094) were thickened in IUES group, and AD (Z=1.888) were decreased, with statistical significance (P＜0.05). ConclusionsThe CDU of IUES is characterized by a thickened echo of the ocular wall and a uniform low echo area under the detached choroid. UBM is characterized by a spongy thickening of the ciliary body echo with interlaminar echo separation.