Uveitis overview

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Uveitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2] Basir Gill, M.B.B.S, M.D.[3]

Overview

Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea". In common usage, it may refer to an inflammatory process involving the interior of the eye. The uvea consists of the iris, ciliary body, and choroid; it provides most of the blood supply to the retina. Uveitis may occur unilaterally or bilaterally, affect the anterior, intermediate, or posterior segment of the eye, may be infectious or non infectious, and granulomatous or non-granulomatous. The exact pathogenesis of uveitis is not fully understood. It is thought that uveitis is mediated by a genetic predisposition and an acquired cross immunity to infectious agents, or cross immunity to self-antigens due to underlying autoimmune diseases. Common causes of uveitis include seronegative spondyloarthropathy, sarcoidosis, juvenile idiopathic arthritis, systemic lupus erythematosus, Behçet syndrome, multiple sclerosis, AIDS, syphilis, and tuberculosis. Uveitis must be differentiated from other diseases such as conjunctivitis, endophthalmitis, or scleritis. A history of cigarette smoking is associated with all etiologies and subtypes of uveitis. Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States. If left untreated uveitis can progress to permanent vision loss or result in complications such as cataracts, glaucoma, and retinal detachment. A history of an underlying associated condition along with symptoms of eye pain, redness, photophobia, floaters, and blurry vision is strongly suggestive of uveitis. There are no specific laboratory or physical examination findings associated with uveitis. Imaging modalities may assist in diagnosing an underlying condition, though have no diagnostic utility for uveitis itself. Slit lamp test is the diagnostic modality of choice. Other ophthalmologic studies may assist in further characterizing the disease. Mainstay medical therapy is by high dose corticosteroids. Targeted antimicrobials may be required to treat an underlying infection. Surgical intervention is reserved for managing complications of uveitis such as cataract surgery or glaucoma surgery. The only indicated guideline for screening is in patients suspected of or diagnosed with juvenile idiopathic arthritis. Prompt treatment of a potential underlying infection may help prevent development of uveitis.

Historical Perspective

Uveitis was first discovered by Hippocrates, a Greek physician, and was a well known to other major medical physicians, such as Galen and Aëtius of Amida. In 1952, corticosteroids were used to treat uveitis for the first time.[1]

Classification

Uveitis is best described using various, concurrent classification systems. Uveitis may be classified according to anatomical location into 4 subtypes, depending on which part of the uvea is primarily affected: anterior, intermediate, posterior, and panuveitis. Based on the duration of symptoms it may be further sub-classified as acute or chronic. Upon further investigation, uveitis may be classified according to histological features of the inflammation such as granulomatous or non-granulomatous. Additionally, uveitis may be described by the laterality of the condition (unilateral or bilateral). Finally, uveitis may be classified by general underlying systemic causes such as infectious, autoimmune, drug-induced, or idiopathic.[2][3][4][5][6]

Pathophysiology

The healthy eye maintains immune privilege, limiting responses to self and foreign antigens through the blood–retina barrier, regulatory T cells, and anti-inflammatory cytokines such as TGF-β and IL-10.[7][8] Noninfectious uveitis results from loss of immune tolerance to retinal proteins, causing aberrant T-cell activation.[7][8] Infectious uveitis arises when pathogens breach the blood–retina barrier and may amplify inflammation via antigenic mimicry.[8] In both forms, MHC class II–mediated antigen presentation activates CD4+ T cells, which differentiate into Th1 and Th17 cells that infiltrate ocular tissues and secrete IFN-γ, IL-2, and IL-17, driving recruitment of inflammatory cells and resulting in chorioretinitis, vasculitis, and edema. [7][8][9][10]

Causes

Common causes of uveitis include seronegative spondyloarthropathy, sarcoidosis, juvenile idiopathic arthritis, systemic lupus erythematosus, Behçet syndrome, multiple sclerosis AIDS, syphilis, and tuberculosis.[6][11]

Differentiating Uveitis from Other Diseases

Uveitis must be differentiated from other diseases that cause conjunctival injection, eye pain, photophobia, or visual disturbance. Masquerade syndromes, which are ophthalmic disorders that clinically present as either an anterior or posterior uveitis but are not primarily inflammatory, must be differentiated from uveitis. As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype.[12][6][13][14]

Epidemiology and Demographics

Worldwide, the prevalence of uveitis ranges from 38 to 714 per 100,000 persons. The prevalence among different subtypes of uveitis varies greatly. Anterior, chronic, non-granulomatous and non-infectious subtypes are more commonly seen than others. The worldwide incidence of uveitis ranges from 17 to 52 per 100,000 persons per year. The age, sex, and race distribution is also dictated by the prevalence of the underlying cause within those demographic groups. Uveitis is associated with 3% to 10% of vision impairment in the US and Europe, and up to one-fourth of blindness in low- and middle-income countries.[5][6][11][15]

Risk Factors

A history of cigarette smoking is associated with all etiologies and subtypes of uveitis.[16] Some underlying causes have specific potent risk factors for developing uveitis such as seronegative spondyloarthropathies, immunosuppression, sarcoidosis, and juvenile idiopathic arthritis.[13] Geographic variation in etiology and presentation is driven by differences in infection burden, air pollution, tobacco smoking, and genetic background. [17][18]

Screening

There is insufficient evidence to recommend routine screening for uveitis for the general population. For patients diagnosed with or suspected of having juvenile idiopathic arthritis (JIA), screening guidelines have been recommended by the American Academy of Pediatrics (AAP) and the British Society of Paediatrics and Rheumatology (BSPAR).[19][20]

Natural History, Complications and Prognosis

If left untreated, uveitis can progress to permanent vision loss. Complications of uveitis include cataracts, glaucoma, macular edema, and retinal detachment. With appropriate treatment, most attacks of anterior uveitis resolve within days to weeks, however, relapses are common. Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment. [21][22][4][23][24]

Diagnosis

History and Symptoms

Obtaining a complete history is an important aspect of making a diagnosis of uveitis. It provides insight into cause, precipitating factors, and associated underlying conditions. Uveitis can present unilaterally or bilaterally. Symptoms may develop acutely or insidiously, and may vary depending on the underlying etiology of the uveitis. Acute uveitis attacks are more commonly symptomatic and affect the anterior chamber. Symptoms of anterior uveitis include eye pain, eye redness, and photophobia. Intermediate, posterior, and panuveitis commonly present with floaters, blurry vision, and impaired vision. Chronic uveitis usually has an indolent courses and may not present with eye pain or redness.[6]

Physical Examination

A complete medical history and comprehensive eye examination must be performed by an optometrist or ophthalmologist to properly diagnosis uveitis. Eye examination of patients with uveitis is usually remarkable for eye redness and increased or decreased intraocular pressure. Depending on the affected anatomy of the uvea, "snowbanking" or optic disc edema may be seen on dilated fundus exam, and mutton fat keratic precipitates on slit lamp test may also be appreciated.[25][26] A complete physical examination can provide insight into the cause, and associated underlying conditions.

Laboratory Findings

There is no single international consensus diagnostic algorithm, and the investigations are tailored to, Regional infection prevalence, comorbidities and immunosuppression, and clinical presentation.[15] The presence of certain non-specific laboratory findings, in the presence of uveitis, may be suggestive of certain underlying causes. Examples of tests that may demonstrate abnormal findings include CBC, ESR, CRP, complete metabolic panel, iron studies, and serology titers.[27][28][29][30][31] Immunocompromised patients, particularly those with HIV, require comprehensive infectious screening including for CMV, Candida and other opportunistic pathogens.[32][33][34][35]

X Ray

There are no diagnostic x ray findings associated with uveitis. Positive x ray findings may be found in underlying conditions such as sarcoidosis[36], tuberculosis[37], and seronegative spondyloarthropathies[38][39].

CT

There are no diagnostic CT scan findings associated with uveitis. The presence of certain CT findings, in the presence of uveitis, may be suggestive of specific underlying causes such as inflammatory bowel disease[40][41][42], sarcoidosis[43][44], and Behcet's disease[45][46].

MRI

There are no diagnostic MRI findings associated with uveitis. The presence of certain MRI findings, in the presence of uveitis, may be suggestive of specific underlying causes such as sarcoidosis, multiple sclerosis, Behcet's disease, syphilis, and joint abnormalities in seronegative spondyloarthropathies.[47][48][49][50][39]

Ultrasound

There are no diagnostic ultrasound findings associated with uveitis.

Other Imaging Findings

There are no other diagnostic imaging findings associated with uveitis.

Other Diagnostic Studies

Other diagnostic studies associated with uveitis include slit lamp test and ocular tonometry. The slit lamp test is considered a gold standard modality in diagnosing uveitis. While intraocular pressure may increase or decrease depending on the anatomical location and severity of the inflammation, slit lamp test findings are relatively more consistent. Common slit lamp test findings include presence of inflammatory cells in the anterior chamber, keratic precipitates, and mutton fat precipitates. Slit lamp test findings associated with anatomical location include snowbanking in intermediate uveitis (e.g., pars planitis), snowballing in vitritis, and retinal edema in posterior uveitis.[6][51]

Treatment

Medical Therapy

Noninfectious anterior uveitis is treated first-line with topical prednisolone acetate 1% with intensive dosing and taper [5], with rimexolone showing comparable efficacy [52]; periocular or intravitreal corticosteroids are second-line when topical therapy is inadequate and systemic therapy is undesirable.[53][54][55] Moderate-to-severe intermediate, posterior uveitis, and panuveitis require systemic and/or intravitreal corticosteroids with immunosuppression [15], typically oral prednisone or IV methylprednisolone for severe disease, achieving rapid remission in many patients. [56][57]

DMARDs are first-line steroid-sparing systemic therapy for noninfectious posterior uveitis, and adalimumab is second line for refractory disease. [58][59][60][61][62][63][64] Corticosteroid treatment carries significant risk of cataract, glaucoma, and ocular hypertension [5][54][65][66]. Infectious uveitis requires pathogen-directed antimicrobial therapy first, with corticosteroids used only as adjuncts and never alone; gram-positive organisms predominate in endophthalmitis[67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86]

Surgery

There is no indication for surgical intervention in uveitis. Surgical management of uveitis is most commonly reserved for management of complications of uveitis or, rarely, for diagnostic purposes. Common complications of uveitis requiring surgery include cataract surgery, glaucoma surgery, or band keratopathy. Common indications for the diagnostic utility of surgery in uveitis include vitreous tap, vitreous biopsy, and posterior uveal biopsy.[87]

Primary Prevention

Appropriate treatment of an underlying disorder may help to prevent uveitis in persons with a systemic infection or inflammatory disease.

Secondary Prevention

There are no secondary prevention methods associated with uveitis.

References

  1. ↑ Foster CS, Vitale AT. Diagnosis & Treatment of Uveitis. JP Medical Ltd; 2013. https://books.google.com/books?id=vZxqM6cuQI4C&pg=PA192&lpg=PA192&dq=hippocrates+uveitis&source=bl&ots=xx1OQjRvqA&sig=pMnw0pkRrVrfVJICFWWJT1c_XLQ&hl=en&sa=X&ved=0ahUKEwjt--2LtYrPAhXBFR4KHa8XDXMQ6AEIJzAB#v=onepage&q=hippocrates%20uveitis&f=false Accessed on September 12, 2016
  2. ↑ Deschenes J, Murray PI, Rao NA, Nussenblatt RB, International Uveitis Study Group (2008). "International Uveitis Study Group (IUSG): clinical classification of uveitis". Ocul Immunol Inflamm. 16 (1): 1–2. doi:10.1080/09273940801899822. PMID 18379933.
  3. ↑ Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group (2005). "Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop". Am J Ophthalmol. 140 (3): 509–16. PMID 16196117.
  4. ↑ 4.0 4.1 McCluskey PJ, Towler HM, Lightman S (2000). "Management of chronic uveitis". BMJ. 320 (7234): 555–8. PMC 1117601. PMID 10688564.
  5. ↑ 5.0 5.1 5.2 5.3 Gutteridge IF, Hall AJ (2007). "Acute anterior uveitis in primary care". Clin Exp Optom. 90 (2): 70–82. doi:10.1111/j.1444-0938.2006.00128.x. PMID 17311570.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Guly CM, Forrester JV (2010). "Investigation and management of uveitis". BMJ. 341: c4976. doi:10.1136/bmj.c4976. PMID 20943722.
  7. ↑ 7.0 7.1 7.2 Lee RW, Dick AD (January 2012). "Current concepts and future directions in the pathogenesis and treatment of non-infectious intraocular inflammation". Eye (Lond). 26 (1): 17–28. doi:10.1038/eye.2011.255. PMC 3259588. PMID 21960067.
  8. ↑ 8.0 8.1 8.2 8.3 Egwuagu CE, Alhakeem SA, Mbanefo EC (2021). "Uveitis: Molecular Pathogenesis and Emerging Therapies". Front Immunol. 12: 623725. doi:10.3389/fimmu.2021.623725. PMC 8119754 Check |pmc= value (help). PMID 33995347 Check |pmid= value (help).
  9. ↑ Saari KM, Päivönsalo-Hietanen T, Vaahtoranta-Lehtonen H, Tuominen J, Sillanpää M (August 1995). "Epidemiology of endogenous uveitis in south-western Finland". Acta Ophthalmol Scand. 73 (4): 345–9. doi:10.1111/j.1600-0420.1995.tb00040.x. PMID 8646582.
  10. ↑ Thorne JE, Suhler E, Skup M, Tari S, Macaulay D, Chao J, Ganguli A (November 2016). "Prevalence of Noninfectious Uveitis in the United States: A Claims-Based Analysis". JAMA Ophthalmol. 134 (11): 1237–1245. doi:10.1001/jamaophthalmol.2016.3229. PMID 27608193.
  11. ↑ 11.0 11.1 Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ; et al. (1996). "Referral patterns of uveitis in a tertiary eye care center". Arch Ophthalmol. 114 (5): 593–9. PMID 8619771.
  12. ↑ Prior-Español Á, Martínez-Morillo M, Holgado-Pérez S, Juega FJ (2016). "Differential diagnosis of acute bilateral uveitis in the rheumatologist's office". Reumatol Clin. 12 (3): 174–175. doi:10.1016/j.reuma.2015.05.012. PMID 26187650.
  13. ↑ 13.0 13.1 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Category:Uveitis
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  15. ↑ 15.0 15.1 15.2 "Review on the Worldwide Epidemiology of Uveitis - Elisabetta Miserocchi, Giovanni Fogliato, Giulio Modorati, Francesco Bandello, 2013".
  16. ↑ Lin P, Loh AR, Margolis TP, Acharya NR (2010). "Cigarette smoking as a risk factor for uveitis". Ophthalmology. 117 (3): 585–90. doi:10.1016/j.ophtha.2009.08.011. PMC 2830339. PMID 20036011.
  17. ↑ Guo X, Chen Z, Xing Y (2021). "Immune-Mediated Uveitis and Lifestyle Factors: A Review". Ophthalmic Res. 64 (5): 687–695. doi:10.1159/000518496. PMID 34348329 Check |pmid= value (help).
  18. ↑ Bai YC, Wang CY, Lin CL, Lai JN, Wei JC (2021). "Association Between Air Pollution and the Risk of Uveitis: A Nationwide, Population-Based Cohort Study". Front Immunol. 12: 613893. doi:10.3389/fimmu.2021.613893. PMC 8013994 Check |pmc= value (help). PMID 33815370 Check |pmid= value (help).
  19. ↑ Sen ES, Dick AD, Ramanan AV (2015). "Uveitis associated with juvenile idiopathic arthritis". Nat Rev Rheumatol. 11 (6): 338–48. doi:10.1038/nrrheum.2015.20. PMID 25825278.
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  21. ↑ MedlinePlus Medical Encyclopedia Uveitis(2014)https://medlineplus.gov/ency/article/001005.htm
  22. ↑ Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet
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  25. ↑ Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet
  26. ↑ Wyngaarden, James B.; Smith Jr., Lloyd H. (1988), Cecil Textbook Of Medicine, Philadelphia, PA: W.B. Saunders Company, pp. 2293–2294, ISBN 0-7216-1850-2
  27. ↑ Majumder PD, Sudharshan S, Biswas J (2013). "Laboratory support in the diagnosis of uveitis". Indian J Ophthalmol. 61 (6): 269–76. doi:10.4103/0301-4738.114095. PMC 3744779. PMID 23803478.
  28. ↑ Agrawal RV, Murthy S, Sangwan V, Biswas J (2010). "Current approach in diagnosis and management of anterior uveitis". Indian J Ophthalmol. 58 (1): 11–9. doi:10.4103/0301-4738.58468. PMC 2841369. PMID 20029142.
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  32. ↑ Tyagi M, Das AV, Kaza H, Basu S, Pappuru RR, Pathengay A, Murthy S, Agrawal H (April 2022). "LV Prasad Eye Institute EyeSmart electronic medical record-based analytics of big data: LEAD-Uveitis Report 1: Demographics and clinical features of uveitis in a multi-tier hospital based network in Southern India". Indian J Ophthalmol. 70 (4): 1260–1267. doi:10.4103/ijo.IJO_1122_21. PMC 9240530 Check |pmc= value (help). PMID 35326028 Check |pmid= value (help).
  33. ↑ "Uveitis in HIV-Infected Patients - J-C.K. Mwanza, D.L. Kayembe, 2001".
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  44. ↑ Nakatsu M, Hatabu H, Morikawa K, Uematsu H, Ohno Y, Nishimura K; et al. (2002). "Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign". AJR Am J Roentgenol. 178 (6): 1389–93. doi:10.2214/ajr.178.6.1781389. PMID 12034602.
  45. ↑ Ahn JM, Im JG, Ryoo JW, Kim SJ, Do YS, Choi YW; et al. (1995). "Thoracic manifestations of Behçet syndrome: radiographic and CT findings in nine patients". Radiology. 194 (1): 199–203. doi:10.1148/radiology.194.1.7997553. PMID 7997553.
  46. ↑ Emad Y, Abdel-Razek N, Gheita T, el-Wakd M, el-Gohary T, Samadoni A (2007). "Multislice CT pulmonary findings in Behçet's disease (report of 16 cases)". Clin Rheumatol. 26 (6): 879–84. doi:10.1007/s10067-006-0408-x. PMID 17024317.
  47. ↑ Smith JK, Matheus MG, Castillo M (2004). "Imaging manifestations of neurosarcoidosis". AJR Am J Roentgenol. 182 (2): 289–95. doi:10.2214/ajr.182.2.1820289. PMID 14736648.
  48. ↑ Lövblad KO, Anzalone N, Dörfler A, Essig M, Hurwitz B, Kappos L; et al. (2010). "MR imaging in multiple sclerosis: review and recommendations for current practice". AJNR Am J Neuroradiol. 31 (6): 983–9. doi:10.3174/ajnr.A1906. PMID 20019103.
  49. ↑ Hegde AN, Mohan S, Lath N, Lim CC (2011). "Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus". Radiographics. 31 (1): 5–30. doi:10.1148/rg.311105041. PMID 21257930.
  50. ↑ Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
  51. ↑ National Eye Institute (2016) https://nei.nih.gov/health/uveitis/uveitis
  52. ↑ Biswas J, Ganeshbabu TM, Raghavendran SR, Raizada S, Mondkar SV, Madhavan HN (May 2004). "Efficacy and safety of 1% rimexolone versus 1% prednisolone acetate in the treatment of anterior uveitis--a randomized triple masked study". Int Ophthalmol. 25 (3): 147–53. doi:10.1007/s10792-004-5195-2. PMID 15847313.
  53. ↑ Takase H, Acharya NR, Babu K, Bodaghi B, Khairallah M, McCluskey PJ, Tesavibul N, Thorne JE, Tugal-Tutkun I, Yamamoto JH, Rao NA, Smith JR, Mochizuki M (November 2021). "Recommendations for the management of ocular sarcoidosis from the International Workshop on Ocular Sarcoidosis". Br J Ophthalmol. 105 (11): 1515–1519. doi:10.1136/bjophthalmol-2020-317354. PMID 32933934 Check |pmid= value (help).
  54. ↑ 54.0 54.1 Thorne JE, Sugar EA, Holbrook JT, Burke AE, Altaweel MM, Vitale AT, Acharya NR, Kempen JH, Jabs DA (February 2019). "Periocular Triamcinolone vs. Intravitreal Triamcinolone vs. Intravitreal Dexamethasone Implant for the Treatment of Uveitic Macular Edema: The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial". Ophthalmology. 126 (2): 283–295. doi:10.1016/j.ophtha.2018.08.021. PMC 6348060. PMID 30269924.
  55. ↑ Yeh S, Khurana RN, Shah M, Henry CR, Wang RC, Kissner JM, Ciulla TA, Noronha G (July 2020). "Efficacy and Safety of Suprachoroidal CLS-TA for Macular Edema Secondary to Noninfectious Uveitis: Phase 3 Randomized Trial". Ophthalmology. 127 (7): 948–955. doi:10.1016/j.ophtha.2020.01.006. PMID 32173113 Check |pmid= value (help).
  56. ↑ Jabs DA, Rosenbaum JT, Foster CS, Holland GN, Jaffe GJ, Louie JS, Nussenblatt RB, Stiehm ER, Tessler H, Van Gelder RN, Whitcup SM, Yocum D (October 2000). "Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel". Am J Ophthalmol. 130 (4): 492–513. doi:10.1016/s0002-9394(00)00659-0. PMID 11024423.
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  72. ↑ Zhang T, Zhu Y, Xu G (2017). "Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis". J Ophthalmol. 2017: 6594849. doi:10.1155/2017/6594849. PMC 5511639. PMID 28751982.
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  74. ↑ Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, Dick AD, Kempen JH, Bodaghi B, Thorne JE, Barisani-Asenbauer T, de Smet MD, Smith JR, McCluskey P, La Distia Nora R, Jabs DA, de Boer JH, Sen HN, Goldstein DA, Khairallah M, Davis JL, Rosenbaum JT, Jones NP, Nguyen QD, Pavesio C, Agrawal R, Gupta V (January 2024). "The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2-global current practice patterns for the management of Cytomegalovirus anterior uveitis". Eye (Lond). 38 (1): 68–75. doi:10.1038/s41433-023-02631-8. PMC 10764804 Check |pmc= value (help). PMID 37419958 Check |pmid= value (help).
  75. ↑ Zandi S, Bodaghi B, Garweg JG (2018). "Review for Disease of the Year: Treatment of Viral Anterior Uveitis: A Perspective". Ocul Immunol Inflamm. 26 (7): 1135–1142. doi:10.1080/09273948.2018.1498109. PMID 30096015.
  76. ↑ Brodie JT, Thotathil AZ, Jordan CA, Sims J, Niederer RL (November 2024). "Risk of Recurrence in Acute Anterior Uveitis". Ophthalmology. 131 (11): 1281–1289. doi:10.1016/j.ophtha.2024.06.003. PMID 38852922 Check |pmid= value (help).
  77. ↑ La Distia Nora R, Putera I, Mayasari YD, Hikmahwati W, Pertiwi AM, Ridwan AS, Sitompul R, Westcott M, Chee SP, Pavesio C, Thng ZX, Gupta V, Agrawal R (2022). "Clinical characteristics and treatment outcomes of cytomegalovirus anterior uveitis and endotheliitis: A systematic review and meta-analysis". Surv Ophthalmol. 67 (4): 1014–1030. doi:10.1016/j.survophthal.2021.12.006. PMID 34954093 Check |pmid= value (help).
  78. ↑ Ude IN, Yeh S, Shantha JG (March 2022). "Cytomegalovirus retinitis in the highly active anti-retroviral therapy era". Ann Eye Sci. 7. doi:10.21037/aes-21-18. PMC 9053080 Check |pmc= value (help). PMID 35498636 Check |pmid= value (help).
  79. ↑ Chiang WY, Lin CP, Cho WH, Yang CH, Chen SN, Hwang YS, Hsu SM, Hwang DK, Chen SC, Kuo HK, Sheu SJ (August 2023). "Cytomegalovirus Uveitis: Taiwan expert consensus". J Formos Med Assoc. 122 (8): 668–674. doi:10.1016/j.jfma.2023.03.014. PMID 37003913 Check |pmid= value (help).
  80. ↑ Khan FA, Slain D, Khakoo RA (December 2007). "Candida endophthalmitis: focus on current and future antifungal treatment options". Pharmacotherapy. 27 (12): 1711–21. doi:10.1592/phco.27.12.1711. PMID 18041891.
  81. ↑ Rex JH, Bennett JE, Sugar AM, Pappas PG, van der Horst CM, Edwards JE, Washburn RG, Scheld WM, Karchmer AW, Dine AP (November 1994). "A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute". N Engl J Med. 331 (20): 1325–30. doi:10.1056/NEJM199411173312001. PMID 7935701.
  82. ↑ Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD (February 2016). "Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America". Clin Infect Dis. 62 (4): e1–50. doi:10.1093/cid/civ933. PMC 4725385. PMID 26679628.
  83. ↑ Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JA, Bennett JE (August 2016). "Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America". Clin Infect Dis. 63 (4): e1–e60. doi:10.1093/cid/ciw326. PMC 4967602. PMID 27365388.
  84. ↑ Kalogeropoulos D, Sakkas H, Mohammed B, Vartholomatos G, Malamos K, Sreekantam S, Kanavaros P, Kalogeropoulos C (January 2022). "Ocular toxoplasmosis: a review of the current diagnostic and therapeutic approaches". Int Ophthalmol. 42 (1): 295–321. doi:10.1007/s10792-021-01994-9. PMC 8351587 Check |pmc= value (help). PMID 34370174 Check |pmid= value (help).
  85. ↑ Pradhan E, Bhandari S, Gilbert RE, Stanford M (May 2016). "Antibiotics versus no treatment for toxoplasma retinochoroiditis". Cochrane Database Syst Rev. 2016 (5): CD002218. doi:10.1002/14651858.CD002218.pub2. PMC 7100541 Check |pmc= value (help). PMID 27198629.
  86. ↑ Feliciano-Alfonso JE, Muñoz-Ortiz J, Marín-Noriega MA, Vargas-Villanueva A, Triviño-Blanco L, Carvajal-Saiz N, de-la-Torre A (July 2021). "Safety and efficacy of different antibiotic regimens in patients with ocular toxoplasmosis: systematic review and meta-analysis". Syst Rev. 10 (1): 206. doi:10.1186/s13643-021-01758-7. PMC 8287816 Check |pmc= value (help). PMID 34275483 Check |pmid= value (help).
  87. ↑ Katzav S, Shapiro J, Segal S, yM (1986). bmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3744781 "General nesthesia during excision of a mouse tumor accelerates postsurgical growth of metastases by suppression of natural killer cell activity" Check |url= value (help). Isr J Med Sci. 22 (5): 339–45. PMID PMC3744781 : PMC3744781 Check |pmid= value (help).

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