Probiotic Supplementation Improved Acute Anterior Uveitis of 3-Year Duration: A Case Report

Abstract

Patient: Female, 18-year-old Final Diagnosis: Autoimmune uveitis Symptoms: Anterior phlogosis • recurrent eye redness Medication: — Clinical Procedure: Best-corrected visual acuity • fundus examination • intraocular pressure measurment • slit lamp examination • spectral domain OCT (SD-OCT) Specialty: Ophthalmology Objective: Unusual setting of medical care Background: Uveitis is a clinical condition characterized by acute blurry vision related to an inflammation of the uvea. Gut microbiome dysbiosis can influence the prognosis of uveitis by inducing a loss of intestinal immune homeostasis leading to a lower activation threshold of the immune cells. This promotes a pro-inflammatory response resulting in reactivation of the disease. This is the case report of a 21-year-old woman with a 3-year history of acute anterior uveitis (AAU) of the right eye, who responded favorably to probiotic dietary supplementation. Case Report: A 21-year-old woman, previously unknown to our Ophthalmology Unit, presented with ocular pain and redness. Three years ago, she had been diagnosed with monolateral AAU in the right eye. Her medical and family histories were unremarkable. After a complete clinical evaluation, we decided to start a combination treatment protocol with continuous use of probiotics and the use of ocular steroids only during an exacerbation of the condition. To monitor the trend of the disease, she underwent a monthly clinical examination for the following year. During this period, we observed a decrease in ocular inflammation with a gain in the primary outcome (best-corrected visual acuity), and the steroids and atropine were discontinued for the following months. Conclusions: This case report describes a patient with a 3-year history of AAU, who responded well to a combination treatment of dietary probiotic supplementation and steroids, demonstrating that probiotics can reduce recurrences of AAU.

What do we know about the connection between gut microbiota and pain?

“…She was successfully treated with dietary probiotic and steroids. The possible explanation is that gut dysbiosis can influence the prognosis of uveitis by inducing a loss of the gut's immune homeostasis, thus promoting inflammation [15]. The results of this study are consistent with another case report.…”

Targeting the Gut–Eye Axis: An Emerging Strategy to Face Ocular Diseases

“…In humans, data obtained from a case report conducted on a 21-year-old woman affected by refractory acute anterior uveitis showed that combining steroids with probiotics improves visual acuity and limits ocular inflammation [207]. While in this study a probiotic mixture composed of Bifidobacterium bifidum, Bifidobacterium lactis, and Bifidobacterium breve was used [207], the potential of using other probiotic formulations as therapeutic treatment for uveitis remains to be investigated. ↓ Acellular capillaries (retina) ↓ TNF-α, ICAM-1, MCP-1, IL-1α (retina) [212] Ang Daily for 1 month ↓ Dry eye ↑ Intestinal homeostasis [198] Abbreviations: ACE2: angiotensin-converting enzyme Additional evidence on the immunomodulatory potential of probiotics comes from two independent prospective comparative pilot studies carried out in 20 adults and 26 children with chalaziosis.…”

“…Based on these advantages, probiotics have been considered a potential treatment for various diseases associated with GM dysbiosis, including intestinal bowel syndrome, ulcerative colitis, rheumatoid arthritis, major depressive disorder, and even cancer [189][190][191][192]. Although in the context of eye disorders the evidence remains scarce, results from preclinical studies are promising, and preliminary data coming from human studies are encouraging the design of further clinical trials [193][194][195][196] (Table 1) [197][198][199][200][201][202][203][204][205][206][207][208][209][210][211][212][213]. There is evidence that mice with ocular inflammation receiving eye drops containing the cell-free supernatant of the probiotic Lactiplantibacillus plantarum show reduced ocular inflammation, lower amount of infiltrating inflammatory cells, and diminished levels of the pro-inflammatory cytokines TNF-α and IFN-γ [205].…”

“…Of note, no benefits were observed when Escherichia coli Nissle 1917 was administered following the same experimental protocol, highlighting the importance of strain selection for a therapeutic success [200]. In humans, data obtained from a case report conducted on a 21-year-old woman affected by refractory acute anterior uveitis showed that combining steroids with probiotics improves visual acuity and limits ocular inflammation [207]. While in this study a probiotic mixture composed of Bifidobacterium bifidum, Bifidobacterium lactis, and Bifidobacterium breve was used [207], the potential of using other probiotic formulations as therapeutic treatment for uveitis remains to be investigated.…”