Abstract
Human T-cell leukemia virus type 1 (HTLV-1) was the first retrovirus described as a causative agent for human disease. In the field of ophthalmology, a close relationship between HTLV-1 infection and uveitis was identified through a series of clinical and laboratory studies in the late 1980s–1990s. Since then, HTLV-1-related ocular manifestations such as keratoconjunctivitis sicca, interstitial keratitis, optic neuritis and adult T-cell leukemia/lymphoma (ATL)-related ocular manifestations have continuously been reported. During the three decades since the association between HTLV-1 and ocular pathologies was discovered, ophthalmic practice and research have advanced with the incorporation of new technologies into the field of ophthalmology. Accordingly, new findings from recent research have provided many insights into HTLV-1-associated ocular diseases. Advanced molecular technologies such as multiplex polymerase chain reaction (PCR)/broad-range PCR using ocular samples have enabled rapid and accurate diagnosis. Advanced ophthalmic technologies such as widefield fundus camera and optical coherence tomography (OCT) have clarified various features of HTLV-1-associated ocular manifestations, and identified characteristics such as the “knob-like ATL cell multiple ocular infiltration” (KAMOI) sign. Advanced drug delivery methods such as intravitreal injection and sub-Tenon injection have led to progress in preventing disease progression. This article describes global topics and the latest research findings for HTLV-1-associated ocular diseases, with reference to a large-scale nationwide survey of ophthalmologists. Current approaches and unmet needs for HTLV-1 infection in ophthalmology are also discussed.
Highlights
“Seeing is believing” is an old but profound proverb
Human T-cell leukemia virus type 1 (HTLV-1) is a retrovirus that has been attracting worldwide attention since it was found that fully half of Aboriginal adults in central Australia are infected by the virus (Gruber, 2018)
HTLV1 carriers face a credible threat of intraocular inflammation, safety assessments of drugs have not been completed and current guidelines do not mention whether patients should be checked for HTLV-1 infection prior to the administration of drugs
Summary
“Seeing is believing” is an old but profound proverb. we humans typically obtain 80% of our information on the outside world through sight. Many ophthalmologists have reported a variety of ocular manifestations related to HTLV-1 infection. From the latter half of the 1980s to the early 1990s, the relationship between HTLV1 and ocular inflammation, i.e., uveitis, has been reported from the perspective of clinical research among HTLV-1 carriers (Ohba et al, 1989; Nakao et al, 1991; Mochizuki et al, 1992c; Nakao and Ohba, 1993). HTLV-1-associated ocular disease is estimated to occur all over the world, corresponding to the geographical distribution of HTLV-1 infection (Gessain and Cassar, 2012). The various types of reports published from across the world were analyzed, classified and summarized from the perspective of relationships between HTLV-1-associated ocular diseases and region/ethnic susceptibility. Corneal manifestations have since been published from all over the world, such as Martinique (Merle et al, 1996), Brazil (Yamamoto et al, 2002; Pinheiro et al, 2006; Rathsam-Pinheiro et al, 2019), and the United States (Buggage et al, 2001)
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