Recent Advances in Diagnosis and Treatment of Infectious Uveitis Prevalent in Asia-Pacific Region

Abstract

The role of infections in intraocular inflammation is being increasingly recognized across the world. The Asia-Pacific region, being the single largest and most populous geographical entity on the planet, is home to a wide variety of such infections. Not surprisingly, there has been an explosion in the literature on infectious uveitis emerging from Asia-Pacific countries. In this review, we have covered recent advances in the diagnosis, treatment, and pathogenesis of common forms of infectious uveitis from the Asia-Pacific region. Much of the literature is focussed on the diagnosis of these infections by clinical criteria and laboratory investigations. There has also been an increased emphasis on the application of newer modes of ocular imaging and understanding pathomechanisms of ocular inflammation in these infections. Together this research has significantly improved our understanding of the diagnosis and management of infectious uveitis.

The impact of aqueous humor polymerase chain reaction and serological test results for establishing infectious uveitis diagnosis: An Indonesian experience

“…One of the most important factors to consider when treating uveitis is determining whether the underlying cause is infectious or non-infectious [ 18 ]. In developing countries, including Indonesia, where ancillary testings are not easily accessible in all centers, implementing a diagnostic approach based on clinical pattern recognition is essential in managing uveitis cases [ 6 , 7 , 8 ]. Determining a specific pathogen that causes infectious uveitis is paramount to guide an appropriate antimicrobial treatment administration [ 19 ].…”

“…The diagnosis of uveitis, particularly infectious uveitis, is challenging with its variation of phenotypes. Suspicion of infection in the first place needs a high index of clinical suspicion based on the clinical presentation [ 6 , 7 , 8 ]. The ancillary investigations are not mandatory but are often considered beneficial to guide the diagnosis even in the era of advanced diagnostic procedures.…”

“…The ancillary investigations are not mandatory but are often considered beneficial to guide the diagnosis even in the era of advanced diagnostic procedures. These include multimodal imaging, serological tests for a specific immunoglobulin, and even intraocular fluid polymerase chain reaction (PCR) addressing a specific pathogen based on clinicians' preferences [ 7 , 9 ]. However, firm diagnostic criteria are lacking for most infectious uveitis entities; thus, it leads experts to make a consensus for giving a specific treatment instead, as in ocular tuberculosis [ 10 ].…”

Outcomes and prognostic factors of cataract surgery in cytomegalovirus related anterior uveitis

“…Moreover, there is a higher incidence of CMV-positive anterior uveitis among Asian patients for reasons yet unclear. 34 Anterior chamber aspirate was also not routinely performed during cataract surgery since all patients had quiescent disease for ≥3 months before they were considered for cataract surgery. Another limitation of the study is that several experienced surgeons performed the phacoemulsification and the decision for adjunct intraoperative steroid was at the surgeon's discretion.…”

Iris depigmentation and cytomegalovirus in aqueous humor as predictors of uveitic activity and recurrence in chronic and recurrent anterior uveitis

“…Cytomegalovirus anterior uveitis (CMV AU) is becoming more recognized as the cause of chronic or recurrent AU in immunocompetent patients. [ 1 2 3 ] To date, the gold standard in diagnosis relies on the positive identification of CMV in the aqueous humor by polymerase chain reaction (PCR). The rate of a positive diagnosis is dictated by the sensitivity of the PCR, the amount of aqueous aspirate, and the stage of the viral infection.…”