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Comprehensive analysis of vitreous specimens for uveitis classification: a prospective multicentre observational study.

Comprehensive analysis of vitreous specimens for uveitis classification: a prospective multicentre observational study.
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Maruyama K, Inaba T, Sugita S, Ichinohasama R, Nagata K, Kinoshita S, Mochizuki M, Nakazawa T,


Maruyama K, Inaba T, Sugita S, Ichinohasama R, Nagata K, Kinoshita S, Mochizuki M, Nakazawa T, (click to view)

Maruyama K, Inaba T, Sugita S, Ichinohasama R, Nagata K, Kinoshita S, Mochizuki M, Nakazawa T,

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BMJ open 2017 11 167(11) e014549 doi 10.1136/bmjopen-2016-014549

Abstract
PURPOSE
To determine the clinical relevance of vitreous biomarkers in patients with uveitis.

DESIGN
Multicentre, prospective, observational study.

SETTING
Uveitis outpatient clinics of two academic medical centres in Japan.

PATIENT POPULATION
This study included 234 eyes of 191 patients with various uveitis aetiologies: definitive sarcoidosis (61 eyes of 46 patients), suspected sarcoidosis (60 eyes of 45 patients), intraocular tumour (34 eyes of 27 patients), viral infection (20 eyes of 18 patients), non-sarcoidosis (16 eyes of 16 patients) and unknown aetiology (43 eyes of 39 patients).

OBSERVATION PROCEDURE
Vitreous samples (taken by pars planta vitrectomy) were analysed with flow cytometry, cytology and multiplex PCR analysis.

MAIN OUTCOME MEASURES
The primary outcome measures were the diagnostic values of various biomarkers (T cells, B cells and pathogen DNA) in vitreous samples. The secondary outcome was visual acuity after vitrectomy.

RESULTS
Sarcoidosis showed higher CD4/CD8 or CD4(+) measurements than other aetiologies (p<0.01). In samples with viral infection, pathogen DNA was detected, and CD8(+) counts were higher than the other aetiologies (p<0.01). Eyes with tumour had higher CD19(+) (p<0.05). Non-sarcoidosis had lower CD4/CD8 than sarcoidosis, higher CD8(+) than sarcoidosis and lower CD19(+) than tumour (p<0.01). Unknown uveitis had lower CD4/CD8 than sarcoidosis (p<0.01), and higher CD4/CD8 than non-sarcoidosis, viral infection or tumour (p<0.001). Visual acuity improved after vitrectomy (p<0.001). CONCLUSIONS
Uveitis aetiologies had distinct vitreous biomarker profiles, especially of infiltrating lymphocytes. Analyses of CD4/CD8 ratio, T-lymphocyte and B-lymphocyte subset, and pathogen DNA in vitreous samples have good safety profiles and high diagnostic value for uveitis classification.

TRIAL REGISTRATION NUMBER
UMIN000004980; Pre-results.

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