Uveitis is a group of inflammatory diseases affecting the uveal tract, retina, retinal blood vessels and vitreous. Due to its complex etiology, various entities, diverse and lack of constancy in treatment, some patients can experience visual impairment and even loss. In view of the fact that blindness caused by uveitis is mostly incurable and occurs usually in young and middle-aged people, it accounts for an important part of blinding eye diseases and has attracted worldwide attention. With the continuous development of precision medicine, clinicians will face new problems and challenges in disease diagnosis, and further in-depth research is needed to explore more optimized and efficient diagnostic processes and examinations to improve the diagnosis of uveitis in China.

Uveitis is an inflammatory disease, a leading cause of blindness, the pathogenesis of which is not fully understood.In recent years, it has been found that interleukin (IL)-23/IL-17 pathway plays an important role in the occurrence of uveitis.The IL-23/IL-17 pathway mainly acts on target cells through activating the T helper 17 cells, resulting in the production of inflammatory factors and chemokines as well as the damage of retinal pigment epithelium, which can cause uveitis.The IL-23/IL-17 pathway is regulated by a giant network, and the regulation of it by its positive and negative factors can lead to immune disorders and participate in the occurrence of uveitis.The polymorphism of genes in IL-23/IL-17 pathway and regulatory network is closely related to uveitis, which provides an important basis for the genetic pathogenesis of uveitis.In addition, clinical trials have confirmed the efficacy of biological agents targeting IL-23/IL-17 pathway, which provides a new research direction for the treatment of uveitis.The IL-23/IL-17 pathway and its physiological function, the positive and negative factors and gene polymorphism of IL-23/IL-17 pathway and its regulatory network in uveitis were summarized, and the research progress of biological agents of IL-23/IL-17 pathway in uveitis were reviewed in this article in order to deepen the understanding of the pathogenesis of uveitis and guide clinical practice.

Background The conventional study of antigen-presenting cells(APCs)in eye relies on in vitro histoimmunochemistry,but its outcome is influenced by many factors.The anterior chamber injection of fluoresceinmarked antibody was used as a new approach before,however,it is liable to lead to injury of cornea.The intravitreal injection of fluorescein-labeled antibody may be important for the in vivo study of the phenotype features of APCs in iris,which is significant for evaluating the function of APCs in immune homeostasis.Objective This study was to investigate the phenotype characters,distribution and morphology of different types of APCs in the normal murine iris.Methods Fifty-one SPF female BALB/c mice(from 6-to 8-week old)were randomized into 17 groups according to the injection of different antibodies.Alexa Fluor 594 or Alexa Fluor 488-tagged ovalbumin (OVA),CD11 c,major histocompatibility complex Ⅱ (MHC-Ⅱ),F4/80,B7-1 and B7-2 monoclonal antibodies or mixtures of two antibodies (2.0 μl)were intravitreally injected at 0.5 mm far from corneal limbus with microneedle under the biomicroscope.The iris tissues were isolated 24 hours after injection.The phenotype characters,precise distribution and morphology of different types of APCs were identified by epifluorescence microscope and laser confocal microscope.In vitro staining was also performed to validate the in vivo staining results.Results After in vivo staining via intravitreal injection,the cell positive for OVA as well as MHC-Ⅱ,F4/80,CD11 c,B7-1 and B7-2 were exhibited with the regular networkline appearance throughout the normal murine iris.Positive cells tagged with Alexa Fluor 594 or Alexa Fluor 488 presented the red or green fluorescence.Double-fluorescein staining showed that about 90％ of F4/80+ cells were OVA+,and MHC-Ⅱ was expressed in about 60％ of F4/80+ cells and CD11c+cells,and about 35％ of F4/80+ cells and CD1 1 c+ cells expressed B7-1 and B7-2 simultaneously,and over 70％ of OVA+ cells were positive to MHC-Ⅱ.These labeled cells were identified as two populations based on their shape.One type was dendritiform cell (DC) with a small cell body and many long dendrites,including OVA+,CD1 1 c+,F4/80+ cells and MHC-Ⅱ + cells ; and the other types were polymorphic population being round,pleomorphic or irregular shape with a large cell body and a few short dendrities,including B7-1 + and B7-2+ cells.Conclusions In vivo intravitreal injection of labeled antibodies can be adapted to visualize the labeled cells in the murine iris.APCs with distinct morphologies,phenotypes and distribution may contribute to the immunologically privileged feature and inflammation of the eye.

Background Research determined that TLR4 is positively expressed on the macrophages in iris and ciliary in acute endotoxin-induced uveitis(EIU),indicating that TLR4 participated in the pathogenesis of the anterior uveitis.Objective The aim of this study is to observe the expressions of toll-like receptor-4(TLR4),Myeloid differentiation factor 88(MyD88),NF-κB p65 in iris tissue in the eyes with endotoxin-induced acute anterior uveitis.Methods Animal models of acute anterior uveitis were established by a hind footpad injection of 200μg Cholera vibrio LPS in 40 SPF Wistar rats with the age of 6-8 weeks.Other 10 age-matched rats were as normal controls.Ocular inflammation was examined under the slit lamp microscope at the 2-hour interval after the injection and intensity of inflammation was scored according to the standard of Lajavardi[4].Histopathology examination was performed for the evaluation of inflammatory reaction of iris and ciliary tissues by HE staining at 24 hours after LPS injection.Expressions of TLR4,MyD88 and NF-κB p65 in iris and ciliary body tissue were detected through immunohistochemistry.TLR4~+,MyD88~+ and NF-κB p65~+ cells were counted.Results The inflammatory reaction was gradually enhanced after injection of LPS and peaked at 24 hours and allivated 48 hours later.The infiltration of lots of inflammatory cells and fibrinous exudate were exhibited in the anterior chamber,posterior chamber,iris and ciliary tissue under the optical microscope at 24 hours after injection of LPS.No positive expressions of TLR4,MyD88 and NF-κB p65 in iris-ciliary body complex were found in normal control rats.The positive cells for TLR4,MyD88 and NF-κB p65 in iris-ciliary body complex were significantly different among 12 hours group,48 hours group and 72 hours groups(F=46.79,P＜0.05;F=54.37,P＜0.05;F=85.32,P＜0.05),and the positive cells for TLR4,MyD88 and NF-κB p65 peaked at 24 hours after injection of LPS.Conclusion The expression of TLR4 and its downstream signal transduction molecules MyD88,NF-κB p65 vary in uvea during EIU,indicating the potential role of LR4-MyD88 dependent pathway in the pathogenesis of acute anterior uveitis.

Objective To investigate the association between interleukin-23 receptor (IL-23R) gene rs1343151 single nucleotide polymorphism and ankylosing spondylitis (AS) in Chinese Han patients. Methods The genotypes of IL-23R SNP was detected in 104 Chinese AS patients and 95 ethnically matched blood donors by TaqMan probe assays. The allele and genotype frequencies and risk factors of AS were analyzed by Chi-square test in both groups. Results The rs 1343151 genotypes in AS patients consisted of homozygote C/C (90.4%),C/T (9.6%), while The rs1343151 genotypes in the controls were. composed of C/C (91.6%), C/T (8.4%). No significant difference was found in the distribution of rs1343151 genotypes between these two groups (x2=0.086, P>0.05). The frequency of rs1343151 allele in AS patients was also not significantly increased when compared with the control group (x2 =0.082,P>0.05). Conclusion There may be no association between the IL-23R gene rs1343151 SNP and ankylosing spondylitis in Chinese Hart population.

The knowledge of uveitis of Chinese eye doctors has been improved in general.While the usage of glucocorticoid agents Was more reasonable,other non-corticoid immunosuppressant get moreattention recently.The usage of antibiotics also has being reduced gradually.The international impact of our uveitis research has been enhanced.However there are still some problems,such as big difference between different regions of uveitis research,still many misunderstandings on the treatment of uveitis complications,and the reasonable evaluation of intravitreal injection with glucocorticoid needs emphasis.In China Behcet's disease and Vogt-Koyangi-Harada syndrome are the most common uveitis subtypes which can lead to blindness,but some rare subtypes of uveitis are also increasing such as syphilitic uveitis,acquired immune deficiency syndrome(AIDS),mycotic endophthalmitis and masquerade syndrome.In the future we need cooperative studies between multicenters to investigate the effectiveness of different treatment strategies for Behcet's disease and Vogt-Koyangi-Harada syndrome,and to optimizing the best therapeutic schedule.We also need to pay more attentions to the clinical features of those uveitis subtypes which increased recently;and to investigate the prevention and therapeutic effect of induction of immune tolerance to uveitis.

Objective To detect the changes of function of blood-aqueous barrier in different Syndrome stages of patients with Vogt-Koyanagi-Harada (VKH) syndrome in order to provide the appropriate therapy. Methods According to clinical manifestation, 77 patients (144 eyes) with VKH syndrome were divided into 4 groups: 10 cases in posterior uvietis stage group (20 eyes), 27 in anterior uveal involvement stage group (50 eyes), 23 in recurrent anterior uvitis stage group (41 eyes), and 17 in convalescent stage group (33 eyes). The other 50 cases (100 eyes) were in the control group. Flare and cells of anterior chamber in patient with VKH Syndrome at different stages were graded and measured by laser flare and cell meter (LFCM) and slitlamp microscope. Results According to the results of slitlamp biomicroscopy, anterior chamber flare and cells were at the 0 grade in the patients at posterior uvietis stage (20 eyes). The results of LFCM examination revealed that the flare value and cells were (9.7?3.4) pc/ms and (0.9?0.6)/0.5 mm3 in posterior uvietis stage group, and (5.3?2.3) pc/ms and (0.8? 0.6)/0.5 mm3 in the control group. The differences between the two groups were significant (P

Objective To investigate the clinical manifestations and possible reasons of the missed and inaccurate diagnosis of Fuchs syndrome. Methods The clinical data of 85 patients with Fuchs syndrome who were diagnosed and treated from June 1999 to December 2003 were retrospectively analyzed. The disease history of each patient was carefully recorded. Slit-lamp microscopy was performed on the patients. The character and distribution of keratic precipitates (KP), color of the iris, depigmentation, and complications were noted in detail. The data recorded in other hospitals were analyzed and the reasons of missed and inaccurate diagnosis were statistically analyzed. Results The age of the patients ranged from 13 to 72 years, and binocular involvement was noted in 76 patients. None of the patients showed ciliary congestion and iris synechiae. Middle-sized or stellated KP was found. Triangle-distributed KP was seen in 13 patients, and diffuse distribution behind the corneal or in the pupil area was in 72. Anterior-chamber flare was observed in all of the patients, while anterior-chamber cells were only noted in 42 patients. The iris with different degrees of depigmentation was found in all the patients. Complicated cataract and increased intraocular pressure occured in 44 and 19 patients, respectively. The diagnosis in other hospitals mainly included uveitis, anterior uveitis and complicated cataract. Conclusions Fuchs syndrome is characterized by depigmented iris and typical KP. Missed and inaccurate diagnosis is mainly due to the unawareness of its clinical features.

Objective To investigate the features and main reasons of blindness induced by uveitis in China. Methods A retrospective analysis was performed on the data from 1 214 patients with uveitis, referring to Zhongshan Ophthalmic Center, with special respect to the incidence of blindness in different uveitis entities, the characteristics of blindness, and possible causes for the blindness. Results In the affected 1 892 eyes of 1 214 patients with uveitis, 355 eyes (18.83%) were blind. The mean age at the onset of blindness was 34.38 years and the gender ratio of male to female was 1.52:1. The blindness led by panuveitis was found in 248 eyes (26.27%), including 128 (51.61%) and 73 (29.44%) blind eyes caused by Behcet's disease and Vogt-Koyanagi-Harada syndrome. Complicated cataract, vitreous opacity and secondary glaucoma were responsible for the blindness of the patients with panuveitis [89(35.89%), 53 (21.37%), and 30 eyes (12.10%), respectively]. Blindness caused by anterior uveitis was noted in 79 eyes (10.73%) with the main reasons of complicated cataract [56 eyes (70.89%)] and secondary glaucoma [16 eyes (20.25%)], posterior uveitis in 15 eyes (15.63%) with the main reason of vitreous opacity [9 eyes (60.00%)], macular diseases in 3 eyes (20.00%), intermediate uveitis in 13 eyes (11.21%) with the main reasons of vitreous opacity [8 eyes (61.54%)], and complicated cataract in 5 eyes (38.46%). Conclusions Uveitis is one of the important causes leading to blindness, especially in the young adults. Panuveitis, especially Behcet's disease and Vogt-Koyanagi-Harada syndrome, are the most common entities responsible for blindness in patients with uveitis. Complicated cataract and secondary glaucoma are the main causes of blindness in uveitis.

Objective To investigate the expression of costimulatory molecules( B7, CD28, and CTLA-4) of peripheral blood lymphocytes in patients with Behcet′s ) disease(BD). Methods Lymphocytes were obtained in 24 patients with BD and 20 healthy individuals, and the expression of CD80(B7-1), CD86(B7-2), CD28 and CTLA-4 on T and B cells were detected by direct three-color immunofluorescence flow cytometry. Results Significantly increased expression of CTLA-4 on CD4 + T cells [(3. 18?1. 18)%] was found in BD patients compared with that in controls [(1. 73?0. 66) %] ( t=-3. 722,P