Significance Of Diagnostic Anterior Chamber Puncture And Vitreous Needle Aspiration/Vitrectomy And Intraocular Fluid Detection In The Clinical Diagnosis And Treatment Of Unknown Cause Uveitis

Objective:To explore the significance of diagnostic anterior chamber puncture and vitreous needle aspiration/vitrectomy and intraocular fluid laboratory tests in the clinical diagnosis and treatment of unknown cause uveitis.Method:According to the inclusion and exclusion criteria,36 patients with standard compliance were screened.Diagnostic anterior chamber puncture and vitreous needle aspiration/vitrectomy were performed on these patients to obtain intraocular fluid and then tested.Detection indicators including inflammatory cytokines,virus and Mycobacterium tuberculosis antigens,microbial culture and microbial nucleic acids.For the collection methods of samples and complications,all the aqueous or vitreous humor inflammatory cytokines,virus and Mycobacterium tuberculosis PCR and gene chip test results in these eyes with unknown cause uveitis were analyzed.Results:1 Methods and complications of intraocular fluid sample collectionAmong the 36 patients with unknown cause uveitis enrolled,36 eyes were selected,21 eyes received anterior chamber puncture to obtain aqueous humor(22 times),12 eyes received vitreous needle aspiration(12 times)and 7 eyes received vitrectomy(7 times)to obtain vitreous humor.Totally 22 aqueous humor samples and 19 vitreous humor samples were obtained.4 eyes received both anterior chamber puncture to obtain aqueous humor and vitreous needle aspiration/vitrectomy to obtain vitreous humor,1 eyes received anterior chamber puncture to obtain aqueous humor for testing 2 times.In the process of 22 times anterior chamber puncture acquisition,8 times(36.4%)appeared slight iris bleeding,no other complications.No serious complications were seen in the patients who received vitreous aspiration and vitrectomy.2 Test methods and results of aqueous humorOf the 22 aqueous samples,4 were tested for viral real time PCR(RT-PCR).Only one test result showed that HSV-1 was infected and the rest was negative.18 aqueous humor samples were tested for inflammatory cytokines.Interleukin-6(IL-6)and interleukin-8(IL-8)levels were higher than normal values in 15 samples(83.3%)and 14 samples(77.8%)respectively,and there was significant statistical significance(P<0.05).Interleukin-10(IL-10)levels were higher than the normal values in 7 samples(38.9%),and no significant statistical significance(P<0.05).The levels of interleukin-1β(IL-1β)and tumor necrosis factor-a(TNF-α)were higher than normal values in 2 samples(11.1%)and 1 samples(5.6%)respectively.There is no result of the interleukin 12p70 level above normal value.Both IL-6 and IL-8 levels were higher than normal values in 12 samples(66.7%),and there is strong correlation between them(P<0.05),and all these eyes were found with severe anterior segment uveitis.All the results of IL-10/IL-6<1,and did not support B-cell lymphoma diagnosis.3 Test methods and results of vitreous humorAmong the 19 vitreous humor samples by vitreous needle aspiration/vitrectomy obtained,12 were tested by microbial culture with 9 were tested by gene chip test at the same time,5 were tested by virus RT-PCR,and 2 were tested for Mycobacterium tuberculosis by RT-PCR.5 positive results(41.7%)were found in the microbial culture,and 6 positive results(66.7%)in the gene chip test.There was no statistical significance difference between these two groups(P = 0.387>0.05).In the 9 samples of simultaneous tested by gene chip and microbial culture,4 samples were positive results,including 1 Streptococcus pyogenes,2 Staphylococcus epidermidis and 1 Candida albicans,2 samples with positive gene chip test results and negative microbial culture results,1 case of Staphylococcus aureus and 1 case of Enterococcus faecalis,respectively.No samples with negative gene chip test result and positive microbial culture results.One sample was only tested for microbial culture,suggesting that Staphylococcus epidermidis infection.Of the 5 samples tested for viral RT-PCR,3 samples were positive,with 1 CMV and EBV infection,1 VZV infection and 1 HSV-1 infection.2 tuberculosis patients were performed vitrectomy due to serious vitreous opacity,and vitreous humor were obtained for Mycobacterium tuberculosis RT-PCR test with both negative results.Conclusions:Diagnostic anterior chamber puncture and vitreous needle aspiration/vitrectomy is safe and effective,combined with intraocular fluid detection may provide more useful information to the clinical diagnosis and treatment of unknown cause uveitis,especially provide a great help to the etiological diagnosis and selection of suitable treatment methods in infectious uveitis.There is still many studies should be performed on the detection of cytokine levels in the non-infectious uveitis to help the diagnosis and treatment of unknown cause uveitis.