| I The Clinical StudyObjective: This study aims to investigate the clinical characteristics and therapeutic effects of monocular and binocular uveitis patients.Methods: This study retrospectively analyzed the clinical data of 178patients(301 eyes)with uveitis who received hospitalization from January 2014 to January 2019.These 178 cases(301 eyes)were divided into monocular uveitis(55 cases,55 eyes)and binocular uveitis(123 cases,246 eyes).The composition and clinical characteristics,diagnostic classification and related aetiology,serological and imaging characteristics,treatment methods and therapeutic effects of uveitis patients were observed and analyzed.Results:(1)Clinical features: the age of onset of the monocular group was42.21±22.49(0.58 to 82 years),the age of onset of binocular was 36.65±15.63(5 to 76 years),there was no statistical difference in the age of onset between unilateral and binocular uveitis.There were 31 males(56.36%)and 24 females(43.64%)in the monocular group;65 males(52.85%)and 58 females(47.15%)in the binocular group.There was no significant difference in gender composition between the two groups.The time to onset of the monocular group ranged from 1 day to 2 years(85.67±169.51)days.The binocular onset time ranged from 2 days to 4 years(74.33±185.55)days.There was no statistical difference in onset time between the two groups.The visual acuity of monocular patients’ affected eye and healthy eye before treatment were 0.70(0.64)and 0.13(0.37),respectively.There was a statistical difference between the visual acuity between the affected eye and healthy eye in monocular patients.The visual acuity of binocular patients’ right eye and left eye before treatment were 0.70(0.60)and 0.92(0.64),respectively.There was no statistical difference between the visual acuity between the right eye and left eye in binocular patients.In patients with monocular uveitis,the IOP of the affected eye and healthy eye were 15(6.25)(4～87.99 mm Hg)and 14(5.00)(7～21mm Hg),respectively.The IOP of the right eye and the left eye of binocular uveitis patients was 15(6.25)(7 ～61mm Hg)and 15(6.25)(6～69mm Hg),respectively.There was no statistical difference between the IOP in the affected and healthy eye or between the right and the left eye.(2)The included monocular uveitis patients’ diagnoses are as follows: 28 cases of idiopathic uveitis(50.91%),14 cases of iridocyclitis(25.45%),5 cases of granulomatous uveitis(9.09%),2 cases of syphilitic uveitis(3.64%),2 cases of retinal vasculitis(3.64%),1 case of Fuchs syndrome(1.82%),1 case of endophthalmitis(1.82%),and 1 case of glaucoma syndrome(1.82%),and 1 case with choroidal vasculitis(1.82%).The included binocular uveitis patients’ diagnoses are as follows: 70 cases with Vogt-Koyanagi Harada disease(56.91%),39 cases with idiopathic uveitis(37.71%),4 cases of granulomatous uveitis(3.25%),3 cases of iridocyclitis(2.44%),2 cases of Behcet’s disease(1.63%),2 cases of syphilitic uveitis(1.63%),cases of CMV uveitis(1.63%),and 1 case of Fuchs syndrome(0.81%).(3)In aspects of serology and imaging: in monocular uveitis patients,six patients were found as erythrocyte sedimentation rate increased(10.90%),two patients were found as HLA-B27-positive(3.64%),and two patients were found as syphilis-positive(3.64%).In binocular uveitis patients,18 patients were found erythrocyte sedimentation rate increased(14.63%),two patients were found as HLA-B27-positive(1.63%),two patients were found as syphilis-positive(1.63%),one patient was found as HIV-positive 1 person(0.81%),one patient was found RF increased(0.81%).No abnormal was discover in the remaining patients.OCT results in monocular uveitis patients were mainly thickening of the retinal neuroepithelial layer in the macular area,were mainly macular oedema and retinal neuroepithelial detachment in binocular uveitis.The FFA examination found that retinal vascular leakage or vascular staining were mainly found in retinal vasculitis,syphilis uveitis,Beh?et’s disease,CMV uveitis,Fuchs syndrome,and other diseases.In the post-uveitis stage of VKH,FFA also showed characteristic fluorescence changes,including the early punctate high fluorescence spots,the late fluorescent dye accumulation under the retina,and multi-lake-like fluorescence accumulation.The B-ultrasound mainly manifests as vitreous turbidity,choroidal thickening,exudative retinal detachment and vitreous organizing.Exudative retinal detachment was mainly in patients with binocular uveitis.(4)In the treatment aspect: after treatment,the visual acuity of monocular uveitis patients improved in 32 eyes(64%),remained unchanged in13 eyes(26%),and decreased in 5 eyes(10%).The visual acuity of monocular uveitis patients before and after treatment was statistically significant(P=0.002).The visual acuity of binocular uveitis patients improved after treatment in 219eyes(93%),remained unchanged in 18 eyes(5%),and decreased in 5 eyes(accounting for 2%).The visual acuity of the right eye and the left eye was 0.22(0.30)and 0.30(0.24),respectively.There was no statistical difference between the visual acuity of the eyes in binocular uveitis.The difference was statistically significant between the visual acuity before and after treatment(P=0.000).There was a statistically significant difference between the degree of visual acuity changes in patients with monocular uveitis after treatment and those with binocular disease(P=0.004).The visual acuity of binocular uveitis patients significantly improved than that in the monocular group.The patients with a shorter course(time from onset to treatment ≤ seven days)had a significantly better visual acuity improvement and a significantly better ending visual acuity than that of patients with a longer course(> 7 days)(P equalled to 0.0048 and0.0004,respectively).The patients with a higher initial dose of methylprednisolone treatment(≥240mg/day)had a significantly better visual acuity improvement and a significantly better ending visual acuity than that of patients with a lower initial dose(<240mg/day)(P equalled to 0.000 and 0.0214,respectively).Conclusion: In this study,patients with monocular uveitis were mainly idiopathic uveitis(50.91%),and patients with binocular uveitis were mainly VKH(56.91%).Most uveitis patients were not with a clear cause.HLA-B27-related uveitis mainly appeared in patients with iridocyclitis,suggesting that HLA-B27-related uveitis may be prone to anterior uveitis.The improvement of vision after treatment of binocular uveitis was better than that of monocular uveitis treatment.Among the different types of uveitis,the vision improvement after VKH treatment was the best.The improvement of vision was better in the patients who seek treatment as soon as possible after the onset(short course)and the patients who started high-dose treatment with glucocorticoids,suggesting that the treatment of uveitis patients should be treated as soon as possible.Sufficient hormone treatment should be given at the beginning to be more beneficial to the improvement of patients’ visionII The Experimental StudyObjective: This study aims to explore the differences in the concentration of IL-6,IL-10,IL-17 and IFN-α in the aqueous humour of monocular and binocular uveitis patients.Methods: The aqueous humour of uveitis patients and the control group(age-related cataract patients)were collected and analyzed by enzyme-linked immunosorbent assay(ELISA).The concentrations of IL-6,IL-10,IL-17 and IFN-α in each patient’s aqueous humour were detected.This study compared the difference in cytokine concentration between each group.The correlation between the expression of each cytokine was also analyzed.Results: This study included a total of 41 uveitis patients(17 cases of monocular uveitis and 24 cases of binocular uveitis)and 34 age-related cataract patients in the control group.The concentrations of IL-6,IL-10 and IL-17 A in aqueous humor were 17.63±16.65pg/ml,0.0001±0.0006pg/ml and2.07±3.44pg/ml in cataract group.In monocular uveitis patients,the concentrations of IL-6,IL-10,and IL-17 A in aqueous fluid were3061.30±6048pg/ml,1.39±2.65pg/ml,and 14.43±28.74pg/ml.In binocular uveitis patients,the concentrations of IL-6,IL-10,and IL-17 A in aqueous humor were 3294.05±10634pg/ml,9.40±18.75pg/ml,and 14.04±16.50pg/ml.Except for the concentration of IFN-α in the aqueous humour of a control patient of206.3pg/ml,no IFN-α was detected in the rest of the patients’ aqueous humour.Spearman correlation test showed that the expression levels of IL-6 and IL-17 A in the aqueous humour of the control group had a weak positive correlation(r2=0.19,P=0.011);the expression levels of IL-10 and IL-17 A in the aqueous humour of patients with monocular uveitis had a weak positive correlation(r2=0.35,P=0.015).The concentrations of IL-6,IL-10 and IL-17 A in aqueous humour of patients with unilateral and binocular uveitis were significantly higher than those in the control group(all P values were less than 0.05).The concentration of IL-10 in aqueous humour of patients with binocular uveitis was significantly higher than that in the monocular group(P<0.05).Subgroup analysis of the uveitis group showed no statistical difference in the expression of various factors in different diseases(P values were all greater than 0.05).Conclusion: The concentrations of IL-6,IL-10 and IL-17 A in the aqueous humour of monocular and binocular uveitis were significantly higher than those in the control group,indicating that IL-6,IL-10 and IL-17 A were involved in the occurrence and development of uveitis;low IFN-α expression in the aqueous humour of uveitis patients suggested that the expression of the anti-inflammatory factor,IFN-α,may not have been activated in the early stage of uveitis;the concentration of IL-10 in the aqueous humour of binocular uveitis was significantly higher than that of patients with monocular uveitis.The primary function of IL-10 is to inhibit the expression of pro-inflammatory cytokines,and IL-10 has the effect of negative immune regulation.These have a specific relationship with treatment effect of binocular uveitis better than monocular uveitis(results of the paper’s first part). |
PDF Full Text Request