Case Reports: Chemokine and Cytokine Profiling in Patients with Herpetic Uveitis

Abstract

Purpose: To report cytokine/chemokine profiles of ocular fluid in two patients with herpetic uveitis.

Methods: Cytokine and chemokine profiling of ocular fluid was performed in two patients with herpetic uveitis. Ocular fluid findings were correlated with disease manifestations and the patients' clinical course.

Observation: Case 1 was a 45-year-old female, who was evaluated for an 11-day history of recurrent redness, and decreased vision in the right eye (OD) and was diagnosed with acute retinal necrosis. Ocular fluid from anterior chamber paracentesis was positive for varicella zoster virus (VZV) via PCR testing. Subsequently, the patient developed proliferative vitreoretinopathy requiring a pars plana vitrectomy. Ocular fluid sample cytokine/chemokine analysis detected IFN-γ, TNF-α, IL-8, IL-18, MIP-1β, IP-10, and MCP-1 with MCP-1 being the most abundant cytokine. Case 2 was a 30-year-old female with a two-month history of progressive pain and decreased vision OD. She was diagnosed with hypertensive anterior uveitis after diagnostic anterior chamber paracentesis. Despite successful therapy for the anterior uveitis, her intraocular pressure remained elevated and required a glaucoma filtration procedure. Ocular fluid sample was collected at the time of surgery for cytokine/chemokine profiles analysis, and levels of 7 cytokines/chemokines were detected including IL-6, IL-8, IL-18, MIP-1β, IP-10, MCP-1, and IL-1RA with IL-1RA being the most abundant cytokine.

Conclusion: Cytokine/chemokine profiles of two patients with herpetic uveitis showed elevated levels of MCP-1, IP-10, IL-8, and IL-18 while IL-1RA was elevated in the chronic phase of hypertensive anterior uveitis. Further studies of cytokines and chemokines will improve our understanding of soluble mediators and potential targets for herpetic uveitis.

Keywords: acute retinal necrosis; anterior hypertensive uveitis; case reports; chemokine; cytokine.

Figure 1

Wide-field fundus photograph of patient 1 who has acute retinal necrosis due to varicella zoster virus shows moderate vitreous haze, diffuse multifocal whitening, and retinal hemorrhage at presentation (A). Following treatment, there is persistent vitreous opacity, but the retinitis has improved with consolidation and well-demarcated borders of the retinitis involving the temporal retina (B). Chemokine and cytokine analysis of ocular fluid at the time of retinal detachment shows elevated levels of MCP-1 and IP-10, as well as other soluble mediators (C).

Figure 2

High-magnification slit lamp photograph shows multiple areas of iris pigment loss, particularly along the inferior and temporal pupil. The tube shunt is also visible superotemporally (A). Cytokine and chemokine profiling shows elevated IL-1RA, MCP-1, IP-10 levels, as well as other soluble mediators (B).