Mochizuki Manabu, Sugita Sunao, Kamoi Koju, Takase Hiroshi
Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan.
Jpn J Ophthalmol. 2017 Jan;61(1):1-20. doi: 10.1007/s10384-016-0474-9. Epub 2016 Oct 27.
Uveitis is a sight-threatening intraocular inflammatory disorder which may occur from both infectious and non-infectious or autoimmune causes. The frequency of infectious uveitis and autoimmune uveitis varies depending on countries and regions. According to a nationwide survey conducted by the Japanese Ocular Inflammation Society, infectious and non-infectious uveitis accounted for 16.4 and 50.1% of new patients, respectively while the remaining 33.5% of new uveitis cases were not classified or were idiopathic uveitis. Infectious uveitis is particularly important because it causes tissue damage to the eye and may result in blindness unless treated. However, it can be treated if the pathogenic microorganisms are identified promptly and accurately. Remarkable advancements in molecular and immunological technologies have been made in the last decade, and the diagnosis of infectious uveitis has been greatly improved by the application of molecular and immunological investigations, particularly polymerase chain reaction (PCR). PCR performed on a small amount of ocular samples provides a prompt, sensitive, and specific molecular diagnosis of pathogenic microorganisms in the eye. This technology has opened a new era in the diagnosis and treatment of uveitis, enabling physicians to establish new clinical entities of uveitis caused by infectious microorganisms, identify pathogens in the eyes of many patients with uveitis, and determine prompt diagnosis and appropriate therapy. Here we review the PCR process, new PCR tests specialized for ocular diseases, microorganisms detected by the PCR tests, diseases in the eye caused by these microorganisms, and the clinical characteristics, diagnosis, and therapy of uveitis.
葡萄膜炎是一种威胁视力的眼内炎症性疾病，可由感染性、非感染性或自身免疫性原因引起。感染性葡萄膜炎和自身免疫性葡萄膜炎的发病率因国家和地区而异。根据日本眼部炎症学会进行的一项全国性调查，感染性和非感染性葡萄膜炎分别占新患者的16.4%和50.1%，而其余33.5%的新葡萄膜炎病例未分类或为特发性葡萄膜炎。感染性葡萄膜炎尤为重要，因为它会对眼睛造成组织损伤，若不治疗可能导致失明。然而，如果能及时准确地识别致病微生物，就可以进行治疗。在过去十年中，分子和免疫技术取得了显著进展，分子和免疫检测，特别是聚合酶链反应（PCR）的应用，极大地改善了感染性葡萄膜炎的诊断。对少量眼部样本进行PCR检测可对眼中的致病微生物进行快速、灵敏和特异的分子诊断。这项技术开创了葡萄膜炎诊断和治疗的新纪元，使医生能够确定由感染性微生物引起的葡萄膜炎的新临床类型，识别许多葡萄膜炎患者眼中的病原体，并确定快速诊断和适当的治疗方法。在此，我们综述了PCR检测过程、专门用于眼部疾病的新型PCR检测方法、通过PCR检测检测到的微生物、这些微生物引起的眼部疾病，以及葡萄膜炎的临床特征、诊断和治疗。
