In ophthalmology, it’s often simple enough to diagnose conditions that only affect the eyes as they are… naturally, the most common diseases that a clinician will treat on a day-to-day basis. When issues become more symptomatic and affect the body in more unusual ways, while still clearly having an ocular component… Well, that’s when things become all the more interesting and challenging.
Uveitis, a common inflammation of the eye, is relatively simple to treat when it remains where it belongs but it is also a systemic disease, and that makes it more difficult to treat. So what’s a clinician to do when faced with a more complex version of this disease, and what tools can they rely on?
During the 15th Congress of the Asia-Pacific Vitreo-Retina Society (APVRS 2022), held in Taipei, Taiwan, in November last year, the subject of systemic uveitis garnered a lot of attention. Uveitis Pearls for Diagnosis was a symposium that examined its relation to systemic diseases in order to not only accurately diagnose it, but also understand what technologies can be used to achieve this. These include artificial intelligence (AI), genetics, imaging technology, and more. This session was one of the highlights of the conference – and below are some of the most important takeaways from the session.
Can’t Catch a Break From Behcet’s Disease
The first presentation of the symposium gave a comprehensive overview of the systemic implications of uveitis and how genetics play a crucial role in the identification and treatment of the disease. Immunogenetics in the Diagnosis of Uveitis was presented by Dr. Masaki Takeuchi, an ophthalmologist at Yokohama City University (Yokohama, Japan), and drew on his own research into the rare genetic condition, Behcet’s disease. This disorder causes inflammation throughout the body’s blood vessels, and as it’s an autoimmune disease it can attack healthy cells, and cause uveitis in the process as well.
Dr. Takeuchi described one study involving 3,477 patients diagnosed with Behcet’s disease, along with an equivalently numbered control group, which examined the genetic markers that were associated with non-infectious uveitis. He reported that in patients with Behcet’s disease, those with the HLA-B*51 and HLA-A*26 genetic markers were associated with higher incidences of non-infectious uveitis, identifying that there is a genetic link between the two diseases. Dr. Takeuchi concluded by saying that further development of genome analysis research would contribute considerably to a greater understanding of non-infectious uveitis.
Top Warning Signs for Uveitis Vision Loss
Case studies are always exciting to report on but what makes us even happier is when an ophthalmologist uses their case study history to create some actionable tips for all of us to learn from. That’s what we got from Dr. Shwu-Jiuan Sheu, an ophthalmologist at Kaohsiung Medical University Hospital (Kaohsiung, Taiwan), in her presentation Pearls for the Diagnosis of Infectious Uveitis. Her presentation focused on highlighting the various warning signs of uveitis in patients, especially when it came to those with more systemic forms of the disease.
In fact, her comprehensive outline of the risk factors for vision loss among uveitis patients was one of the standouts of the whole symposium, starting with a recent history of ocular surgery and there being signs of retinitis. Dr. Sheu also reported that ophthalmologists should look out for signs of suspected endogenous and exogenous endophthalmitis like fever, and systemic infection, as well as issues like septic abortion and drug abuse. Finally, she also said that clinicians should keep their eyes peeled for vision-threatening retina conditions like retinal vasculitis and retinal detachment, as well as poor visual acuity and the presence of an invisible fundus.
Toxoplasmosis – It Comes from Cats
Now here at the Media MICE team, we do enjoy taking things a bit left field, thinking outside the box, doing things differently, etc, and that’s why we just had to feature Pearls in the Management of Complications of Ocular Toxoplasmosis. This was a fascinating presentation given by hometown hero Dr. Hien Luong Doan from the Pham Ngoc Thach School of Medicine (Saigon, Vietnam), and it was really insightful to learn that a large percentage (up to 35% in some cases) of cases of uveitis are caused by the toxoplasma gondii parasite, one that is transmitted from felines to humans (we bet you’ll be looking at your housecat differently now).
Dr. Doan warned that some of the complications of ocular toxoplasmosis in cases involving uveitis include vascular occlusion, choroidal neovascularization (CNV), which were his primary focuses, while also mentioning epiretinal membrane, cataract, macular edema, and a whole host of other nasty problems. When it came to vascular occlusion, Dr. Doan reported that in 76% of cases, vascular occlusion is passed through the toxoplasmic lesion, while in 24% of cases, it is located within one optic disc diameter of the lesions.
In his concluding remarks, Dr. Doan stated that early intervention is crucial if the lesion is near the retinal vessels and that making the diagnosis between vascular occlusion and CNV can be challenging. He recommends using anti-VEGF treatments as a first line therapy for CNV lesions and noted that controlling inflammation is crucial to achieving the best patient outcomes.
Keen to undergo an inundation of knowledge about uveitis, whether it’s systemic or not, or want to get tucked into a tasty treat for the brain about toxoplasmosis? Then make sure you head on over to the APVRS 2022 website where this symposium and others like it are available to consume on demand. Enjoy the knowledge, and make sure you keep your peepers peeled for more APVRS updates.
Editor’s Note: The 15th Congress of the Asia-Pacific Vitreo-retina Society (APVRS 2022) was held on November 18 to 20, 2022, in Taipei, Taiwan. Reporting for this story took place during the event.