記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We report a rare case of cytomegalovirus (CMV) iridocyclitis and vitreoretinal lymphoma (VRL) that developed sequentially in the same eye during long-term infliximab (IFX) therapy for ulcerative colitis. This case highlights both the risk of opportunistic ocular infections and lymphoproliferative disorders coexisting in the same eye and the diagnostic challenges associated with prolonged immunosuppression. CASE PRESENTATION: A 65-year-old man presented to the ocular inflammatory service at Nippon Medical School Tama-Nagayama Hospital with deteriorating vision in the left eye. His medical history included IFX therapy for 11 years for ulcerative colitis, a 7-year history of bilateral primary open-angle glaucoma, and recurrent iridocyclitis in the left eye. Slit-lamp examination revealed mutton-fat keratic precipitates and dense vitreous opacities. Multiplex PCR of the aqueous humor detected CMV and Epstein-Barr virus (EBV). The cytological grading of the vitreous fluid was class IIIb. Cytokine analysis revealed an interleukin (IL)-10/IL-6 ratio of > 1.0, and immunoglobulin heavy chain gene rearrangement revealed monoclonality. Based on these findings, the patient was diagnosed with concurrent CMV iridocyclitis and VRL in the same eye. EBV positivity in the aqueous humor may have been associated with VRL development under prolonged immunosuppression. Topical ganciclovir was initiated for CMV iridocyclitis. The patient underwent bilateral ocular radiotherapy (40 Gy) and systemic chemotherapy with rituximab, methotrexate, procarbazine, and vincristine after IFX cessation. Although inflammatory and infiltrative lesions resolved, his final visual acuity was 20/200 due to glaucomatous visual field loss. CONCLUSIONS: The present case highlights both the risk of opportunistic ocular infections and lymphoproliferative disorders associated with prolonged immunosuppression and the diagnostic challenge when both conditions coexist in the same eye. Careful monitoring and close collaboration between ophthalmologists and internists are essential for the early diagnosis and appropriate management of such patients.

DOI： 10.1186/s12348-026-00594-x

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Many cases of hypertensive uveitis progress to visual field narrowing due to difficulty controlling intraocular pressure. The purpose of this retrospective study was to identify factors related to avoidance of trabeculectomy (TLE) in patients with hypertensive uveitis. METHODS: Participants comprised patients diagnosed with ocular inflammatory disease at Nippon Medical School Tama Nagayama Hospital, Ocular Inflammation Service between April 2018 and September 2022. Logistic regression analysis was performed using avoidance of TLE as the objective variable and the following as explanatory variables: age, sex, use of biologics, granulomatous type, background disease, and treatment. RESULTS: A total of 745 eyes in 480 patients were investigated. Mean age was 57.1 ± 19.6 years, with a male-to-female ratio of 205:275. Hypertensive uveitis was identified in 200 patients (41.7%). The most common causative disease was scleritis (26.5%), followed by sarcoidosis (16.7%), Vogt–Koyanagi–Harada disease (6.0%), Behcet’s disease (5.2%), herpetic keratouveitis (5.0%), HLA-B27-associated uveitis (2.3%), cytomegalovirus iritis/corneal endotheliitis (1.7%), and Posner–Schlossman syndrome (0.6%). The disease type for the remaining 21.9% was unclassifiable. Anti-inflammatory treatments were: topical steroid (100%), sub-conjunctival or sub-Tenon injection of steroid (16.8%), oral steroid (16.6%), oral immunosuppressants (9.1%), and biologics (8.2%). Sixty-eight eyes (9.1%) had a history of TLE. Factors associated with avoidance of TLE were use of biologics (odds ratio [OR] 2.93, p = 0.01) and use of oral immunosuppressants (OR 1.42, p = 0.08). CONCLUSION: Around 9.1% of hypertensive uveitis cases progress to needing TLE. Use of biologics and oral immunosuppressants may help avoid TLE among patients with hypertensive uveitis.

DOI： 10.1186/s12348-025-00551-0

PubMed

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記述言語：日本語   出版者・発行元：日本緑内障学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：日本緑内障学会  

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記述言語：日本語   出版者・発行元：日本緑内障学会  

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J-GLOBAL

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