Autoimmune ocular diseases are a type of inflammatory eye condition characterized by the involvement of the immune response. This includes various types disease such as autoimmune uveitis, thyroid-associated eye disease, and primary Sjögren's syndrome. In recent years, breakthroughs have been achieved in inducing transplant tolerance, understanding tumor immune evasion, and preventing autoimmune diseases using immune checkpoint molecules. Negative immune checkpoints effectively control disease progression by inhibiting T cell proliferation, reducing inflammatory cytokine levels, and ultimately regulating autoimmune balance. Therefore, the negative immune checkpoint molecules are expected to be used as a new therapeutic target in the future, and the combination therapy through the combination of negative immune checkpoint drugs is expected to become an important direction to improve the efficacy of the treatment of autoimmune diseases.
ObjectiveTo observe the clinical features of uveal effusion syndrome (UES) and the efficacy of sclerectomy in the treatment of UES.MethodsA retrospective case series. Twenty patients (36 eyes) of UES with sclerectomy were enrolled in this study from June 2012 to December 2016 in Beijing Tongren Hospital. Among them, there were 12 males (22 eyes) and 8 females (14 eyes), with an average age of 37.8 years. All patients suffered from bilateral diseases, including 4 patients in single eye group and 16 patients in double eye group. Visual acuity, intraocular pressure, indirect ophthalmoscope, UBM, FFA combined with ICGA, A/B ultrasonography, axial length (AL) and scleral thickness were measured. All patients underwent lamellar sclerectomy, and those with exudative retinal detachment underwent four quadrant lamellar sclerectomy, followed by four quadrant full-thickness sclerectomy with the size of 1 mm × 2 mm in the center of the scleral bed. The follow-up time after operation was more than 6 months.Visual acuity, intraocular pressure and fundus examination were performed 1, 3 and 6 months after operation with the same equipment and methods before operation.ResultsThere was no obvious inflammation in the anterior chamber of all eyes, and intraocular pressure was 24-28 mmHg (1 mmHg = 0.133 kPa) in 4 eyes (11.1%). Axial length of 8 eyes (22.2%) were 16-18 mm (true microphthalmia). 12 eyes (33.3%) had scleral thickness＞1.0-1.8 mm. Visual acuity ranged from hand movement to 0.05 in 20 eyes, 0.1 to 0.3 in 10 eyes and＞0.3 in 6 eyes. Fundus examination showed peripheral choroidal and ciliary detachment; UBM examination showed annular peripheral ciliary and choroidal detachment. 32 eyes (88.9%) were complicated with exudative retinal detachment. FFA examination showed that 14 eyes (38.9%) had leopard spot changes. Compared with preoperative vision, the visual acuity improved in 28 eyes (77.8%) and remained unchanged in 8 eyes (22.2%) after surgery. Thirty-two eyes with different degrees of retinal detachment were found before surgery. After surgery, ciliary body detachment, choroidal detachment and retinal detachment were restored. Six eyes (16.7%) recurred and underwent sclerectomy again.ConclusionsThe mild symptoms and recurrent attack are the characteristics of UES. Sclerectomy is an effective method to treat UES.