Abstract
Investigations used to aid diagnosis and prognosticate outcomes in ocular inflammatory disorders are based on techniques that have evolved over the last two centuries have dramatically evolved with the advances in molecular biological and imaging technology. Our improved understanding of basic biological processes of infective drives of innate immunity bridging the engagement of adaptive immunity have formed techniques to tailor and develop assays, and deliver targeted treatment options. Diagnostic techniques are paramount to distinguish infective from non-infective intraocular inflammatory disease, particularly in atypical cases. The advances have enabled our ability to multiplex assay small amount of specimen quantities of intraocular samples including aqueous, vitreous or small tissue samples. Nevertheless to achieve diagnosis, techniques often require a range of assays from traditional hypersensitivity reactions and microbe specific immunoglobulin analysis to modern molecular techniques and cytokine analysis. Such approaches capitalise on the advantages of each technique, thereby improving the sensitivity and specificity of diagnoses. This review article highlights the development of laboratory diagnostic techniques for intraocular inflammatory disorders now readily available to assist in accurate identification of infective agents and appropriation of appropriate therapies as well as formulating patient stratification alongside clinical diagnoses into disease groups for clinical trials.
Highlights
Intraocular inflammatory eye diseases though relatively uncommon remain an important cause of visual impairment
Since the late 20th century, advances in molecular techniques have led to increasing our understanding of the pathogenetic mechanisms that are associated with various forms noninfectious uveitides, and to improved refined, sensitive and specific diagnosis of infectious causes
In a recent survey of treatment patterns of noninfectious uveitis by Ophthalmologists in the USA, it was found that up to 60% of patients were still treated with greater than 30mg of steroids for more than 1.5 years as maintenance therapy to control inflammation and the use of immunosuppressive therapy was only used in 12% of patients. 75% of physicians were not aware of treatment guidelines for uveitis [4]
Summary
Intraocular inflammatory eye diseases though relatively uncommon remain an important cause of visual impairment. Recent molecular technique advancements including polymerase chain reaction (PCR) and the use of cytokine analysis in the form of interferon gamma release assays (IGRAs) have been added to the armamentarium of diagnostic tests to increase the specificity and sensitivity of the diagnosis of TB-associated uveitis. More recently dysregulation of the innate immune system (autoinflammation) has been recognized to be the underlying mechanism for various genetic and multifactorial disorders including Blau syndrome and Behcet’s disease resulting in non-specific inflammatory changes due to overexpression of chemokines and cytokines including IL-1, IL-6 and TNF-α [30,103] These biomarkers have been described in various intraocular inflammatory conditions and purported to deliver both diagnostic and prognostic uses.
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