Diagnosis Of Uveitis Research Articles

The management of adult and paediatric uveitis for rheumatologists.

Uveitis encompasses multiple different conditions that are all characterized by intra-ocular inflammation. Uveitis occurs in the context of many different rheumatological conditions and carries a substantial risk to vision. Uveitis can develop both at the early stages of rheumatic diseases, sometimes even preceding other clinical features, and at later stages of disease. Uveitis can also occur as either a direct or anindirect complication of therapies used to treat patients with rheumatic disease. Conversely, patients with uveitis of non-rheumatic aetiology sometimes require immunosuppression, a treatment option that is not readily accessible to ophthalmologists. Thus, collaborative working between rheumatologists and ophthalmologists is critical for optimal management of patients with uveitis. This Review is written with rheumatologists in mind, to assist in the care of patients with uveitis. We collate and summarize the latest evidence and best practice in the diagnosis, management and prognostication of uveitis, including future trends and research priorities.

Polymerase Chain Reaction for Detection of Mycobacterium tuberculosis in Granulomatous Anterior Uveitis – An Analysis of 51 Eyes

ABSTRACT Purpose To evaluate the role of polymerase chain reaction (PCR) in detecting Mycobacterium tuberculosis (MTb) in granulomatous anterior uveitis and comparing the results with those of Mantoux test, QuantiFERON-TB Gold test, and High-Resolution Computed Tomography of Chest (HRCT-chest). Methods Data of 51 eyes of 38 patients with clinical features of granulomatous anterior uveitis undergoing anterior chamber fluid aspiration for PCR for MTb targeting IS6110 and MPB64 were studied. Results Out of 38 patients, 25 (65.8%) were positive for MTb genome on PCR. 24 patients were tested for Mantoux, out of which 12 patients (50%) were positive and 12 patients (50%) were negative. 22 out of 38 patients had undergone QuantiFERON-TB Gold (QFT) test, out of which 10 (45.5%) were positive and 12 (54.5%) were negative. 36 out of 38 patients had undergone HRCT. Eight out of 38 (21.1%) patients had significant findings in HRCT-chest, as well as PCR positivity for MTb genome while 12 (31.6%) patients did not have any significant findings on HRCT-chest, but were positive for PCR. Conclusion PCR for MTb is a valuable tool in the diagnosis of tubercular anterior uveitis. PCR can be positive even in cases of negative Mantoux test, QFT, and HRCT-chest in granulomatous anterior uveitis.

Use of immunomodulatory treatment for non-infectious uveitis: an International Ocular Inflammation Society report of real-world practice

BackgroundNon-infectious uveitis is a diverse group of inflammatory conditions that collectively account for substantial blindness worldwide. Expert guidelines and results of clinical trials guide treatment, but real-world clinical care is...

Deciphering infectious uveitis etiology: Immune cell profiling in keratic precipitates using in vivo confocal microscopy

PurposeTo elucidate the etiology of infectious uveitis through the comprehensive analysis of keratic precipitates (KPs) using in vivo confocal microscopy (IVCM). DesignCross-sectional, observational case series. MethodsThis single-center, cross-sectional study was conducted at a tertiary care eye hospital from January 2021 to October 2023. It involved a detailed ophthalmologic evaluation of all subjects and included a total of 46 eyes from 36 subjects who were diagnosed with infectious uveitis. IVCM, specifically utilizing the HRT II Rostock corneal module, was employed to study the biomicroscopic morphology of KPs. The categorization of KPs was based on cell size, morphology, and reflection. ResultsCells of KPs were assessed for size, morphology, and reflection through in vivo confocal microscopy. Patients, ranging in age from 13 to 80 years (median 51 years), exhibited diverse morphologic forms of KPs. Neutrophil-dominated KPs with uniform size were predominantly observed in bacterial and fungal endophthalmitis cases (19/19, 100 %), accompanied by small numbers of mononuclear-macrophages in three eyes (3/19, 15.8 %). Viral uveitis cases displayed a broader array of immune cell types, including characteristic striated or dendritic cells in all eyes (27/27, 100 %). Lymphocytes were commonly present (24/27, 88.9 %), forming clusters in sixteen eyes and dispersed in the corneal endothelium below the midline in eight eyes. Neutrophil infiltration was notable in three cytomegalovirus-infected eyes (3/27, 11.1 %). A marked increase in sub-basal corneal epithelial Langhans cells was associated with viral uveitis. ConclusionsNeutrophil-dominated KPs strongly indicate endogenous bacterial or fungal endophthalmitis, while the presence of dendritic cells and lymphocytes in KPs is suggestive of viral uveitis. In vivo confocal microscopy emerges as a crucial tool for differentiating the etiologic diagnosis of infectious uveitis.

INTRAVITREAL 0.18-mg FLUOCINOLONE ACETONIDE IMPLANT FOR PEDIATRIC UVEITIS.

This study reports the outcomes of the 0.18-mg intravitreal fluocinolone acetonide implant in the treatment of pediatric noninfectious uveitis. A retrospective cohort study was performed on patients under 18 years old who received fluocinolone acetonide implant between June 1, 2020 and March 1, 2023. Data collected included demographics, uveitis diagnosis, use of anti-inflammatory therapy, visual acuity, intraocular pressure, and grading of uveitis activity. Uveitis recurrence was defined as increased inflammation that required additional anti-inflammatory therapy. Eleven eyes from seven patients were included in this study. One patient (one eye) had a diagnosis of immune recovery uveitis and the remaining six patients (10 eyes) had pars planitis. The rate of remaining recurrence-free was 82% at 6 months, 60% at 12 months, and 60% at 24 months. Two of the six phakic eyes at baseline required cataract extraction during follow-up. Two of the four eyes that did not have intraocular pressure-lowering surgery before implantation required surgery in follow-up. The 0.18-mg fluocinolone acetonide implant has a similar efficacy for the treatment of pediatric uveitis, particularly pars planitis, as in the adult population, although with higher rates of ocular hypertension requiring intervention.

Herpes Zoster Ophthalmicus Uveitis: Onset and Complications

To describe the timing of uveitis onset and frequency of associated complications in individuals with herpes zoster ophthalmicus (HZO). Retrospective, cohort study. Individuals with acute HZO seen at the Auckland District Health Board from 2006 to 2016 were studied. The primary outcome measures were the proportion who developed uveitis and time to diagnosis of uveitis following the onset of HZO. Secondary outcome measures included complications of HZO uveitis and effects of prompt antiviral (within 72 hours) on outcomes. A total of 869 patients with HZO were included for analysis, of whom 413 (47.6%) developed uveitis. Median time from onset of rash to diagnosis of uveitis was 10 days (IQR 6-14). Of the 658 individuals examined within the first week following rash onset (days 0 through 7), 17.6% (116/658) were diagnosed with uveitis at that initial presenting examination, with an additional 24.9% (164/658) diagnosed with uveitis at a subsequent visit. Complications were higher in eyes with uveitis, including moderate or severe vision loss, corneal scarring, neurotrophic keratitis, band keratopathy, corneal melt, elevated intraocular pressure, glaucoma, and cataract (all P < .01). Prompt antiviral was associated with a lower rate of moderate vision loss among eyes with uveitis (P = .02). Uveitis occurred in approximately half of individuals with HZO and was most frequently diagnosed during the second week following rash onset. Eyes with uveitis were more likely to have other ocular complications and loss of vision.

Development of a Consensus Guideline for the Diagnosis and Management of Chronic Noninfectious Uveitis Affecting the Posterior Segment.

A consensus exercise was carried out to address unmet needs in the classification, diagnosis, and management of patients with chronic noninfectious uveitis affecting the posterior segment (NIU-PS), with a focus on chronic postoperative inflammation/cystoid macular edema. Eight experts participated in roundtable discussions and consensus-building exercises to develop clear guidelines for the diagnosis and management of chronic NIU-PS. The group addressed questions surrounding clinical features, diagnostic tests, and treatment considerations. Clinicians agreed that chronic uveitis/intraocular inflammation should be defined as having persistence or recurrence for 3 or more months. Diagnosis is informed by evaluation of signs and symptoms, use of imaging, and exclusion of infectious etiologies. Management should be initiated with the least invasive therapies, proceeding to intraocular injections, and/or long-term intravitreal or systemic therapies, as necessary. This article offers an up-to-date consensus guideline based on clinical experience. Future clinical trials may help to test and reevaluate these recommendations. [Ophthalmic Surg Lasers Imaging Retina 2024;55:652-658.].

Authors’ Reply to Letter to the Editor– in Response to: Comment on Dheyab AM et al. “Long-Term Efficacy of Oral Valganciclovir in Presumed Cytomegalovirus Unilateral Hypertensive Anterior Uveitis”

ABSTRACT The clinical diagnosis of presumed cytomegalovirus hypertensive anterior uveitis was based on the following criteria: 1) Recurrent episodes of unilateral hypertensive anterior uveitis characterized by acute elevation of intraocular pressure, a few medium-sized or mutton-fat keratic precipitates and mild anterior chamber reaction. These findings might be associated with corneal endotheliitis and iris atrophy. 2) Posterior synechiae and vitreous involvement are typically absent. 3) Intact corneal sensation.

Advances in the diagnosis of ocular diseases: an innovative approach through an expert system

In the context of ophthalmic care, where early diagnosis of eye disorders plays a crucial role in patients' quality of life, this study focused on the development and evaluation of an expert system based on SWI Prolog. The main objective of this research was to provide an effective method for the preliminary diagnosis of ocular disorders, including cataract, trachoma, uveitis, glaucoma, and presbyopia. For the evaluation of the system, a confusion matrix was implemented and accuracy, sensitivity and specificity were calculated using a sample of 30 cases, of which 20 were positive and 10 negatives. The findings revealed an outstanding accuracy of 95%, with a sensitivity and specificity of 90%. This highlights the potential of the tool as an effective means of early detection of visual problems. In conclusion, this expert system represents a significant advance in ophthalmologic diagnosis, with important implications for clinical care and patients' quality of life, although expansion and validation of the tool in further clinical studies is suggested for its wider and more successful implementation in the field of ophthalmology.

Metagenomic Next-Generation Sequencing for the Diagnosis of Viral Infectious Uveitis and Its Mimics

ABSTRACT Purpose To investigate the value of metagenomic next-generation sequencing (mNGS) for virus detection in patients with suspected viral infectious uveitis. Methods In this retrospective, multicenter case series study, 70 patients with suspected viral infectious uveitis were recruited. All patients underwent mNGS test using intraocular fluid samples and serological screening tests for pathogens. Twelve cases also underwent a PCR panel test for herpetic viruses using intraocular fluid samples; 7 cases also underwent aqueous anti-herpetic viral IgG level tests. Results Among 70 patients with suspected viral infectious uveitis, 34 cases were female, mean age was 45.3 years with a range from 6 to 78 years; 53 cases (75.7%) were diagnosed as infectious uveitis, 17 cases (24.3%) diagnosed as non-infectious uveitis. Among 53 cases with infectious uveitis, herpetic viruses, Bartonella henselae, Toxoplasma gondii, and Treponema pallidum were detected in 43, 6, 4, and 1 case, respectively. Among 43 cases with viral infectious uveitis, herpetic virus was detected in 39 cases by mNGS, the other 4 cases showed negative results in mNGS test, but positive results in 2 cases in serological screening tests, in 1 case in PCR, and in 1 case in aqueous anti-herpetic viral IgG level test, respectively. The sensitivity, specificity, positive predictive value, negative predictive value of mNGS in detecting viruses were 90.7%, 100%, 100%, and 81.0%, respectively. Conclusions mNGS is a sensitive and valuable method to detect viruses in intraocular fluid samples, and an alternative for pathogen detection in cases with suspected viral infectious uveitis but negative test results in PCR.

Paediatric Uveitis - the uniqueness in clinical presentation and the efficacy of biologics treatment

AimsTo evaluate unique clinical characteristics of paediatric uveitis in our locality and treatment outcomes especially the efficacy of biologics.MethodsThis was a retrospective cohort.Results37 paediatric uveitis cases involving 67 eyes were included. Male-to-female ratio was 1:1.3. Mean age of uveitis onset was 11 ± 3.7 (4–18). 81.1% cases suffered from bilateral uveitis. 75.7% cases were chronic uveitis. Nearly half of the cases (40.5%) presented with anterior uveitis. The predominant diagnosis of uveitis in our cohort was idiopathic. Unlike studies from other populations, the associated systemic conditions in this mostly Chinese cohort were Behçet’s disease (8.1%), tubulointerstitial nephritis and uveitis (8.1%) and HLA-B27 associated uveitis (8.1%). Steroid response was a common phenomenon, observed in 40.5% of cases. The most common complication was posterior synechiae (45.9%), followed by cataract (37.8%), glaucoma (27.0%), band keratopathy (18.9%) and macular oedema (13.5%). 3/37 patients encountered either first attack of uveitis or flare after receiving COVID-19 vaccine. 54.1% of patients required systemic steroid for disease control. The majority required steroid sparing immunotherapy, including Methotrexate (43.2%), Mycophenolate Mofetil (24.3%), Cyclosporine A (8.1%), Azathioprine (5.4%) and Tacrolimus (2.7%). Resistant cases required biologics including tumour necrosis factor alpha inhibitors (Adalimumab 32.4%, Infliximab 2.7%) and interleukin-6 inhibitors (Tocilizumab 2.7%).ConclusionsClinical presentation of the local paediatric uveitis differs from previously described features in Caucasian and other populations. According to our experience as a tertiary eye centre, Behçet’s disease, tubulointerstitial nephritis and uveitis and HLA-B27 associated uveitis were more often encountered than Juvenile Idiopathic Arthritis associated uveitis. Our report evaluated the efficacy of immunomodulatory therapy and biologics in controlling uveitis and reducing ocular complications.

Assessment of the degree of inflammatory reaction in uveitis: diagnostic capabilities of clinical methods

Inflammatory diseases of the uvea demonstrate a high incidence and a significant prevalence among people of working age. Uveitis complications often lead to blindness and low vision in patients of various age groups. Diagnostics and monitoring the efficacy of uveitis therapy requires the use of quantitative criteria to assess the degree of inflammatory reaction. The aim of this review is to analyze the informative value and accuracy of various clinical methods for subjective and objective assessment of the inflammatory reaction in the anterior and posterior segments of the eye in uveitis. To assess the inflammatory reaction in uveitis in everyday clinical practice, biomicroscopy is most often used, which is characterized by subjectivity associated with the level of qualification of the ophthalmologist. Other clinical methods, such as fluorescein angiography, optical coherence tomography-angiography, have high sensitivity and informative value along with independence from the subjective impression of the examiner. However, the first of them is invasive, and the second is still not available to a wide range of practicing ophthalmologists today, especially in the “angio” mode. Laser flare photometry is of special importance in the diagnosis of uveitis. It is both a non-invasive and sensitive method that makes it possible to obtain quantitative indicators characterizing the activity of uveal inflammation. The prospects for the application and development of this method are important both for clinical practice and for research purposes.

Cataract Development Among Pediatric Patients With Uveitis

ImportanceThe long-term estimated risk of development of cataracts among pediatric patients with uveitis is not clear.ObjectiveTo describe factors associated with the development of cataracts among pediatric patients with uveitis.Design, Setting, and ParticipantsThis cohort study used the international TriNetX database to enroll pediatric patients with and without uveitis from January 1, 2002, to December 31, 2022. The nonuveitis cohort consisted of randomly selected control patients matched by age, sex, race and ethnicity, and specific comorbidities.ExposureDiagnosis of uveitis, identified using diagnostic codes.Main Outcomes and MeasuresThe primary outcome was the risk of developing cataracts among the uveitis group compared with the nonuveitis comparison group, with hazard ratios (HRs) and 95% CIs reported.ResultsA total of 22 687 pediatric patients with uveitis (mean [SD] age, 10.3 [5.6] years; 54.2% male) and 22 687 comparators without uveitis (mean [SD] age, 10.3 [5.6] years; 54.5% male) were enrolled in the study. The risk of cataracts was increased among pediatric patients with uveitis up to a follow-up duration of 20 years (HR, 17.17; 95%CI, 12.90-22.80) from the index date. Subgroup analyses revealed an elevated cataract risk across age groups: 0 to 6 years (HR, 19.09; 95% CI, 10.10-36.00), 7 to 12 years (HR, 27.16; 95% CI, 15.59-47.20), and 13 to 18 years (HR, 13.39; 95% CI, 8.84-20.30); both female sex (HR, 13.76; 95% CI, 9.60-19.71) and male sex (HR, 11.97; 95% CI, 8.47-16.91); and Asian (HR, 13.80; 95% CI, 3.28-58.07), Black or African American (HR, 10.41; 95% CI, 5.60-19.36), and White (HR, 15.82; 95% CI, 11.05-22.60) race. Furthermore, increased cataract risks were also observed among those with and without a history of immunosuppressive agents (with: HR, 26.52 [95% CI, 16.75-41.90]; without: HR, 17.69 [95% CI: 11.39-27.40]), a history of steroid eye drop use (with: HR, 29.51 [95% CI, 14.56-59.70]; without: HR, 16.49 [95% CI, 11.92-22.70]), and a history of intraocular procedures (with: HR, 11.07 [95%CI, 4.42-27.71]; without: HR, 14.49 [95% CI, 10.11-20.70]).Conclusions and RelevanceIn this cohort study of pediatric patients with uveitis, an elevated risk of cataracts following a uveitis diagnosis was found compared with pediatric patients without uveitis. The findings suggest that pediatric patients with uveitis should be monitored for cataract development.

Цитологические исследования при диагностике увеита. Клинический пример

Purpose. To demonstrate on a clinical example the use of laboratory cytological methods for the differential diagnosis of masquerade syndrome and uveitis. Methods. A clinical example of а 77-year-old patient is presented. She was diagnosed with uveitis and received courses of anti-inflammatory therapy for 6 years without positive dynamics. Further, an assumption was made about the tumor cause of inflammation (primary bilateral intraocular lymphoma), a diagnostic vitrectomy with vitreous sampling for cytological examination was performed. Cytological examination confirmed the diagnosis of lymphoma. Results A patient with uveitis was suspected to have masquerade syndrome. A cytological examination of the vitreous body was performed; as a result, the diagnosis of intraocular lymphoma was unequivocally confirmed. The patient’s examination plan and further treatment were radically revised. Key words: intraocular lymphoma; uveitis; cytological examination.

Manifestations and Management of Inflammatory Eye Disease in Patients with Inflammatory Bowel Disease

ABSTRACT Purpose To characterize the ocular inflammatory manifestations of inflammatory bowel disease (IBD) and examine the impact of ocular inflammation on IBD treatment. Methods A single-center retrospective chart review of patients with an IBD diagnosis and ophthalmology visit between January 2016 and January 2022 was conducted. Patients with a diagnosis of uveitis, scleritis, or peripheral ulcerative keratitis (PUK) confirmed by an optometrist or ophthalmologist were included. Results Charts of 1320 IBD patients were reviewed; 42 patients with uveitis, 2 patients with scleritis, and 2 patients with PUK were identified. Anterior uveitis was the most common form of uveitis (38/42, 90.5%), often in an episodic (31/38, 81.6%) and unilateral (19/38, 50.0%) pattern. Four patients (4/42, 9.5%) had posterior segment uveitis: two with panuveitis, one with intermediate uveitis, and one with posterior uveitis. Patients on systemic therapy for IBD did not routinely undergo changes to therapy following the development of ocular inflammation (27/36, 75.0%). Therapy alterations were more frequent with the development of posterior segment uveitis, scleritis, or PUK (4/6, 66.7%) compared with anterior uveitis (5/30, 16.7%). In 10 patients, uveitis onset preceded IBD diagnosis; in these patients, tumor necrosis factor (TNF) inhibitors were often used at the time of subsequent IBD diagnosis (5/10, 50.0%). Conclusions Unilateral anterior uveitis was the most common form of ocular inflammation among patients with IBD. Development of uveitis did not routinely require modification of immunomodulatory therapies; however, therapy changes were more common with posterior segment uveitis, scleritis, and PUK.

Systemic Fluoroquinolone Use and Risk of Uveitis or Retinal Detachment

Fluoroquinolone use has been associated with increased risk of uveitis and retinal detachment in noninterventional studies, but the findings have been conflicting and causality is unclear. To estimate the association of systemic fluoroquinolone use with acute uveitis or retinal detachment, using multiple analyses and multiple databases to increase the robustness of results. This cohort study used data from the Clinical Practice Research Datalink Aurum and GOLD UK primary care records databases, which were linked to hospital admissions data. Adults prescribed a fluoroquinolone or a comparator antibiotic, cephalosporin, between April 1997 and December 2019 were included. Adults with uveitis or retinal detachment were analyzed in a separate self-controlled case series. Data analysis was performed from May 2022 to May 2023. Systemic fluoroquinolone or comparator antibiotic. The primary outcome was a diagnosis of acute uveitis or retinal detachment. Hazard ratios (HRs) were estimated in the cohort study for the association of fluoroquinolone prescription with either uveitis or retinal detachment, using stabilized inverse probability of treatment weighted Cox regression. Rate ratios (RRs) were estimated in the self-controlled case series, using conditional Poisson regression. Estimates were pooled across databases using fixed-effects meta-analysis. In total, 3 001 256 individuals in Aurum (1 893 561 women [63.1%]; median [IQR] age, 51 [35-68] years) and 434 754 in GOLD (276 259 women [63.5%]; median [IQR] age, 53 [37-70] years) were included in the cohort study. For uveitis, the pooled adjusted HRs (aHRs) for use of fluoroquinolone vs cephalosporin were 0.91 (95% CI, 0.72-1.14) at first treatment episode and 1.07 (95% CI, 0.92-1.25) over all treatment episodes. For retinal detachment, the pooled aHRs were 1.37 (95% CI, 0.80-2.36) at first treatment episode and 1.18 (95% CI, 0.84-1.65) over all treatment episodes. In the self-controlled case series, for uveitis, the pooled adjusted RRs (aRRs) for fluoroquinolone use vs nonuse were 1.13 (95% CI, 0.97-1.31) for 1 to 29 days of exposure, 1.16 (95% CI, 1.00-1.34) for 30 to 59 days, and 0.98 (95% CI, 0.74-1.31) for 60 days for longer. For retinal detachment, pooled aRRs for fluoroquinolone use vs nonuse were 1.15 (95% CI, 0.86-1.54) for 1 to 29 days of exposure, 0.94 (95% CI, 0.69-1.30) for 30 to 59 days, and 1.03 (95% CI, 0.59-1.78) for 60 days or longer. These findings do not support an association of systemic fluoroquinolone use with substantively increased risk of uveitis or retinal detachment. Although an association cannot be completely ruled out, these findings indicate that any absolute increase in risk would be small and, hence, of limited clinical importance.

Diagnosis and treatment of syphilitic uveitis: Taiwan experts consensus.

A recent resurgence in the incidence of syphilis has sparked a new interest in this old disease. Syphilitic uveitis remains a challenging disease, among the variable syphilis infections, due to the diagnostic complexity and the wide clinical manifestations. Here, we provide recommendations regarding clinical manifestations, diagnosis, and treatment for patients with syphilitic uveitis in Taiwan based on an expert meeting and consensus from experienced uveitis specialists.

FACTORS ASSOCIATED WITH DELAYED DIAGNOSIS IN PATIENTS WITH PRIMARY VITREORETINAL LYMPHOMA.

To identify demographic and clinical factors associated with delayed diagnosis in patients with primary vitreoretinal lymphoma (VRL). Retrospective, tertiary referral center-based cohort study of all patients at Mayo Clinic in Rochester, Minnesota, with a biopsy-proven diagnosis of VRL from January 1, 2000, to October 31, 2022. There were 87 patients included during the 22-year study period with 73 patients (83.9%) diagnosed with VRL upon initial evaluation at the tertiary center, with the other 14 patients (16.1%) diagnosed later. The median referral time was 4.8 months (range: 0-113 months). Patients who received an initial diagnosis of inflammatory uveitis or another incorrect diagnosis elsewhere were referred slower than those initially diagnosed with VRL (P = 0.04). The most common incorrect initial diagnosis from an outside institution was inflammatory uveitis (n = 35, 40.2%). When patients were split into four groups based on referral time, prior use of corticosteroids was associated with a significant delay in referral (P = 0.03). Diagnosing VRL continues to be challenging, as months-long delays from initial evaluation to expert referral center evaluation are common. Prior use of corticosteroids was associated with delay in diagnosis and referral time, underscoring the need to increase awareness regarding differences between VRL and uveitis.

Роль С3-, С4-компонентов системы комплемента в патогенезе герпетического увеита

Herpetic anterior uveitis is mainly considered as acute unilateral anterior uveitis with non-granulomatous, granulomatous, or stellate keratic precipitates, which is associated with iris atrophy, decreased corneal sensation, and an acute rise in the intraocular pressure. The diagnosis of herpetic anterior uveitis usually is based on clinical findings. We presented several clinical cases with atypical manifestations. Our study aims to understand the role of the complement system’s C3 and C4 fractions in the pathogenesis of herpetic anterior uveitis.

Diagnosis and Treatment of Uveitis in Children: A Summary of the Latest Data from a 5-Year Literature Review (2018-2023).

Pediatric uveitis has a low incidence. It is very diverse in its presentation and is often the first sign of a severe systemic disease. The pediatric population poses a special therapeutic and diagnostic challenge due to the potentially adverse effects of therapeutic agents on the young body and difficult cooperation with the patient during the examination, as well as the increased risk of complications that can lead to severe disability. The most commonly diagnosed type of uveitis is non-infectious, with first-line therapy consisting of systemic corticosteroids followed by disease-modifying drugs (methotrexate (MTX), mycophenolate mofetil (MMF), and cyclosporin A (CsA)). In severe, refractory cases, biologic therapy is used. The authors reviewed the current literature on the etiology, diagnostic tools, and treatment of uveitis in the pediatric population covering the years 2018-2023, presenting current methods of modern diagnosis and treatment. The reason for writing this article was the need to update the knowledge on uveitis, driven by the increasing prevalence of autoimmune uveitis in the pediatric population. This trend presents significant challenges in diagnosing and treating the disease, as well as managing its complications. Correctly identifying the pathogenetic factor of uveitis can facilitate the diagnosis of the systemic disease underlying the ocular infection and enable the timely implementation of systemic treatment. Furthermore, the emergence of new diagnostic methods necessitates a revision and update of ophthalmic knowledge, essential for both ophthalmologists and other specialists involved in the treatment of uveitis.