Diagnostic techniques for inflammatory eye disease: past, present and future: a review

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

Schematic interpretation of indocyanine green angiography in posterior uveitis using a standard angiographic protocol

OBJECTIVE: Indocyanine green angiography (ICGA) detects fluorescence produced by the ICG molecule in the near infrared wave lengths showing choroidal vascular structures. Indocyanine green angiography may prove useful in the workup of uveitis with choroidal involvement. The authors' purpose was to test a standardized ICGA protocol for posterior uveitis to gather systematic and comparable data and to design a schematic approach for the interpretation of angiographic signs. DESIGN: The proposed ICGA procedure included the search for preinjection fluorescence. In the early phase of ICGA (until +/- 2-3 minutes postinjection), posterior pole frames were taken to detect abnormalities in the retinal and choroidal arteriovenous circulation patterns. During the intermediate phase (12 +/- 3 minutes), posterior pole frames and eight 360 degrees panorama frames were taken to detect fluorescence abnormalities in the background impregnation of the choroid, the same sequence being repeated in the late phase (40 +/- 10 minutes). A cohort of more than 300 patients was analyzed in this standard fashion in 2 centers. PARTICIPANTS AND MAIN OUTCOME MEASURE: Determination of ICGA features and the proposed schematic approach for ICGA interpretation were based on the analysis of 109 cases of posterior uveitis with a well-determined diagnosis. RESULTS: For uveitis, the intermediate and late phases of ICGA were found to yield the most valuable information showing either ICG hyperfluorescence or hypofluorescence or both. The ICG hyperfluorescence, always reflecting increased leakage or staining but not window defects because there is no pigment epithelium screen in ICGA, could originate either from increased leakage of the choriocapillaris, the large choroidal, or the retinal vessels. The characteristic ICG hypofluorescent dark dots indicating impairment of physiologic impregnation of the choroid could take at least five different patterns. CONCLUSION: To date, ICGA features still are difficult to interpret. The proposed standardized ICGA protocol and schematized interpretation for posterior uveitis will help determine ICGA semiology for these disorders and might give new insights into their pathophysiology

Manifestations retiniennes au cours du SIDA. [Retinal manifestations of AIDS]

Cytomegalovirus (CMV) retinitis is the most common retinal opportunistic infection in AIDS patients and is the main cause of blindness. It is generally associated with a CD4+ lymphocyte count below 50/microL. CMV retinitis is often asymptomatic (54% of the cases), frequent ophtalmoscopic screening is very important. Two virostatic drugs (Cymevan and Foscavir) have been approved for the treatment of CMV retinitis. Both are effective in preventing the progression of the lesion within 3 weeks of induction therapy. Long-term use of virostatic maintenance therapy delays the onset of relapses. The differential diagnosis of CMV retinitis are: human immunodeficiency virus retinopathy, varicella-zoster virus retinitis, ocular toxoplasmosis, syphilis, candida endophthalmitis in intravenous drug users, and unfrequently, tuberculosis, choroidal pneumocystosis, intraocular lymphoma