葡萄膜專題演講會 | Uveitis Symposium
13 Dec 2025
14:30
17:30
701F
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14:30
15:33
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許淑娟 Shwu-Jiuan SheuTaiwan
Moderator
Risk factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patientsPurpose: This study aims to examine factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patients. Specifically, we focus on the initial HbA1C at diagnosis, its change at ophthalmologic visit and medication adherence (MR).
Research Design and Methods: A prospective study involving 300 type II DM patients (≥20 years) was conducted from July 2022 to January 2024. MR was assessed using the Taiwanese version of the Morisky Medication Adherence Scale-8 (MMAS-8). DR progression was evaluated through a defined clinical scoring system. Statistical analyses included chi-square tests and logistic regression to examine the factors associated with STDR severity and progression.
Results: After excluding 122 patients for missing data, 178 participants were analyzed. Changes in HbA1c were strongly associated with STDR. Both improvements and deteriorations or sustained high in HbA1c levels were linked to an increased likelihood of advanced DR scores compared to sustained low group. Those with sustained high HbA1c had the most impact. High initial HbA1c had a greater impact on females, age <65, patients lacking exercise or diet control. Patients with low or moderate MR showed significantly higher HbA1c level at ophthalmologic visit, and increased risk developing STDR. Age ≥65 years was a protective factor against higher DR scores.
Conclusions: This study highlights the relationship between initial blood glucose levels at diabetes diagnosis, and subsequent HbA1c change during ophthalmology visits concerning DR severity and progression. High initial HbA1c might indicate the need for frequent ophthalmic visit.
許聖民 Sheng-Min HsuTaiwan
Moderator
Pseudophakic Macular Edema: Stopping Vision Loss Before It StartsPseudophakic macular edema (Ervine-Gass syndrome) remains the most common cause of decreased visual acuity after uneventful cataract surgery. Previous study reported that 26.8% of eyes with pseudophakic macular edema did not recover 6/6 vision. Clinically significant pseudophakic macular edema impairing patients' vision is found in 1-2% of patients with its peak 6 weeks following surgery, but subclinical macular edema can be seen in about 30% of patients in FA and up to 40% in OCT. To date, there are no uniform recommendations for the treatment of pseudophakic macular edema. Therefore, I will present two cases of pseudophakic macular edema here and discuss the strategies for treatment.
701F
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14:30
14:55
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Marion MunkSwitzerland
Speaker
Leveraging AI and in silico modeling in uveitsArtificial intelligence (AI) and in silico modeling hold growing potential in improving our understanding and clinical management of uveitis. This work highlights two complementary approaches: the use of AI to identify imaging-based risk factors for disease progression, and the application of computational biology to investigate potential immunological mechanisms such as molecular mimicry. Based on longitudinal clinical imaging data, machine learning tools were applied to extract and analyze relevant biomarkers with the aim of predicting inflammatory complications. In parallel, bioinformatic methods were used to explore structural and functional similarities between microbial and ocular proteins, supporting hypotheses around immune-mediated tissue damage. Together, these approaches demonstrate how AI-driven analysis and in silico tools can contribute to both individualized disease monitoring and a deeper insight into uveitis pathophysiologyLeveraging Bioinformatics to Identify Targetable Mechanisms in Diabetic Retinal DiseaseThis presentation highlights a bioinformatics-driven approach to understanding how different retinal cells respond to diabetic conditions, with the goal of identifying novel pathways relevant to disease progression and potential therapeutic intervention. By analyzing large-scale transcriptomic datasets from retinal tissue, gene expression changes specific to retinal cells can be mapped to key metabolic and inflammatory signaling networks. This method enables the discovery of altered pathways that may not be apparent through conventional analysis, providing deeper insight into the cellular mechanisms driving diabetic retinopathy. Focusing on pathway-level changes—such as those related to lipid metabolism, cytokine signaling, and cellular stress—this approach offers a powerful tool to uncover molecular targets that could be leveraged for future drug development. The integration of computational biology with retinal cell-specific data opens new avenues for precision medicine and the development of targeted therapies in diabetic retinal disease.
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14:55
14:58
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14:58
15:13
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Marion MunkSwitzerland
Speaker
Leveraging AI and in silico modeling in uveitsArtificial intelligence (AI) and in silico modeling hold growing potential in improving our understanding and clinical management of uveitis. This work highlights two complementary approaches: the use of AI to identify imaging-based risk factors for disease progression, and the application of computational biology to investigate potential immunological mechanisms such as molecular mimicry. Based on longitudinal clinical imaging data, machine learning tools were applied to extract and analyze relevant biomarkers with the aim of predicting inflammatory complications. In parallel, bioinformatic methods were used to explore structural and functional similarities between microbial and ocular proteins, supporting hypotheses around immune-mediated tissue damage. Together, these approaches demonstrate how AI-driven analysis and in silico tools can contribute to both individualized disease monitoring and a deeper insight into uveitis pathophysiologyLeveraging Bioinformatics to Identify Targetable Mechanisms in Diabetic Retinal DiseaseThis presentation highlights a bioinformatics-driven approach to understanding how different retinal cells respond to diabetic conditions, with the goal of identifying novel pathways relevant to disease progression and potential therapeutic intervention. By analyzing large-scale transcriptomic datasets from retinal tissue, gene expression changes specific to retinal cells can be mapped to key metabolic and inflammatory signaling networks. This method enables the discovery of altered pathways that may not be apparent through conventional analysis, providing deeper insight into the cellular mechanisms driving diabetic retinopathy. Focusing on pathway-level changes—such as those related to lipid metabolism, cytokine signaling, and cellular stress—this approach offers a powerful tool to uncover molecular targets that could be leveraged for future drug development. The integration of computational biology with retinal cell-specific data opens new avenues for precision medicine and the development of targeted therapies in diabetic retinal disease.
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15:13
15:16
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15:16
15:26
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賴佐庭 Tso-Ting LaiTaiwan
Speaker
ROP: Consensus of Pediatric Retina GroupOBJECTIVE: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness, particularly in preterm infants. In Taiwan, the absence of national guidelines and the variability in clinical practice have highlighted the need for locally adapted consensus recommendations. METHODS: An expert panel of eleven ophthalmologists from eight tertiary centers in Taiwan convened to develop a consensus on ROP management. Through a structured process that included key question formulation, systematic literature review, iterative discussion, and voting, the panel established consensus statements. Agreement was defined as >/=75% of panelists voting "agree" or "strongly agree" using a five-point Likert scale. RESULTS: Consensus recommendations were developed across three major domains: screening, treatment, and follow-up. For screening, the panel endorsed criteria commonly used in Taiwan-gestational age <32 weeks or birth weight <1500 g-but emphasized the need for population-based validation. Both anti-vascular endothelial growth factor (VEGF) agents and laser photocoagulation were recognized as acceptable first-line treatments for type 1 ROP, with individualized treatment decisions based on disease characteristics, anesthesia risk, and follow-up capacity. Guidelines were also established for the management of ROP reactivation, procedural protocols, and agent selection. For follow-up, the panel recommended extended surveillance after anti-VEGF therapy and outlined the criteria for identifying and monitoring persistent avascular retina. Follow-up schedules were proposed to detect long-term ocular and neurodevelopmental complications. CONCLUSIONS: This consensus provides updated evidence-based guidance for ROP care in Taiwan, addressing both traditional and emerging clinical challenges. These recommendations aim to standardize care practices while remaining adaptable to future research and evolving clinical needs.What Else Behind Diabetic Retinopathy Beside Anti-VEGF?Diabetic retinopathy (DR) has long been characterized as a microvascular disease, and anti-VEGF therapy remains one of the standard treatments for its sight-threatening complications. However, accumulating evidence demonstrates that DR is a complex neurovascular disorder in which neurodegeneration, oxidative stress, chronic inflammation, dysregulated cell death pathways, and impaired autophagy play central roles. Preclinical studies highlight early retinal neurodegeneration, glial dysfunction, and microglia-mediated inflammation as substantial contributors to DR development and progression, which might precede clinically visible vascular changes. Oxidative stress is another major driver, triggering mitochondrial injury, endothelial dysfunction, and aberrant programmed cell death—including apoptosis, pyroptosis, and necroptosis—which further accelerates neurovascular impairment.
A growing body of experimental work has explored therapeutic strategies beyond VEGF suppression. Antioxidants such as astaxanthin have been shown to restore autophagy and enhance Nrf2-mediated defense mechanisms in photoreceptors under high-glucose stress—findings demonstrated in our own studies. Similarly, targeting inflammatory pathways with agents such as fenofibrate or cilostazol has been shown to reduce inflammatory mediators, oxidative damage, and retinal apoptosis in diabetic models. Additional approaches, including fibroblast growth factor 1 treatment and interventions aimed at preventing high-glucose-induced cellular senescence, further underscore the multifaceted nature of DR pathophysiology.
Together, these insights suggest that DR extends far beyond vascular endothelial dysfunction, and effective long-term management may require therapies targeting oxidative stress, inflammation, neuroprotection, autophagy regulation, and metabolic resilience. This talk will review these emerging mechanisms and discuss future therapeutic perspectives that complement, rather than replace, anti-VEGF therapy.
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15:26
15:28
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15:28
15:33
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15:33
16:15
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15:33
15:45
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Rina La Distia NoraIndonesia
Speaker
Revisiting Tuberculosis in Uveitis: Immunopathogenesis and the Role of Antitubercular Therapy.Tuberculosis-associated uveitis (TB-uveitis) remains a major cause of intraocular inflammation in TBendemic countries. Its immunopathogenesis involves both direct ocular infection by Mycobacterium
tuberculosis and immune-mediated responses to mycobacterial antigens. The overlapping clinical features
and absence of systemic TB in many cases make diagnosis and treatment particularly challenging.
This presentation revisits the current understanding of TB-uveitis, focusing on the immune mechanisms
involved and their clinical implications. We discuss how latent TB infection may act as a trigger for ocular
inflammation and explore the limitations of existing diagnostic criteria.
To address the uncertainty surrounding treatment decisions, we conducted a randomized controlled trial
in Indonesia involving patients with uveitis of undetermined cause who tested positive for QuantiFERONTB
Gold Plus. All participants received immunosuppressive therapy, with half receiving additional
antitubercular therapy (ATT). At six months, the ATT group had significantly higher rates of complete
uveitis resolution and fewer relapses during extended follow-up.
We also conducted a translational study evaluating peripheral blood expression of interferon-inducible
genes. A higher baseline gene expression score was associated with favorable treatment outcomes,
suggesting a potential role for immune biomarkers in guiding therapy.
This talk integrates clinical and translational findings to offer a more personalized and evidence-based
approach to managing TB-uveitis. The goal is to move beyond empirical ATT toward tailored treatment
strategies informed by immunologic profiles and regional disease patterns.
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15:45
15:48
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15:48
15:58
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許詠瑞 Yung-Ray HsuTaiwan
Speaker
Loose Zonules, Steady Hands: Saving the Unstable LensZonular dehiscence with vitreous prolapse represents one of the most challenging scenarios in cataract surgery. This case involves a 65-year-old female referred intraoperatively for severe temporal zonular dialysis extending 120° with vitreous prolapse into the anterior chamber.
In such situations, initial management options depend on the degree of capsular support and the surgeon’s familiarity with the anterior or posterior segment approaches. Possible options include: (1) primary pars plana lensectomy and vitrectomy (PPLV) with Yamane double-needle intrascleral fixation of an IOL; (2) anterior vitrectomy with in-the-bag or supplemental scleral fixation of a one-piece IOL using sutures; (3) pars plana vitreous levitation–assisted phacoemulsification; or (4) use of hooks or rings to preserve capsular support for in-the-bag implantation.
In this case, I stabilized the anterior capsule using iris retractors, performed a careful anterior vitrectomy, and completed a slow-motion phacoemulsification to minimize zonular stress. Following cortical cleanup, both an in-the-bag IOL and capsular tension ring (CTR) were successfully implanted. The patients visual acuity on postoperative day 1 was 0.9.
This surgical video illustrates a practical surgical maneuver with controlled movements, vitreous management, and structural stabilization techniques that allow safe phacoemulsification even in the setting of profound zonular loss.Pattern and Distribution of Uveitis Etiologies in Taiwan: A Multi-Center Perspective Uveitis is a heterogeneous group of intraocular inflammatory disorders with diverse etiologies and variable regional patterns. To delineate the current epidemiologic landscape of uveitis in Taiwan, a nationwide multicenter retrospective study was conducted collaboratively by the Taiwan Ocular Inflammation Society. Newly diagnosed uveitis cases from July 2022 to June 2023 were collected from 15 tertiary referral centers across northern, central, southern, and eastern Taiwan.
A total of 1,654 cases were analyzed. The mean age at onset was 49.5 ± 18.3 years, with nearly equal sex distribution (50.6% male). Anatomical classification includes anterior uveitis (64.3%), followed by panuveitis (22.4%), posterior uveitis (11.0%), and intermediate uveitis (2.3%). Etiologically, 43.6% were non-infectious, 23.5% infectious, and 32.9% undifferentiated. The leading non-infectious entities were HLA-B27/ankylosing spondylitis–related uveitis (15.4%), glaucomatocyclitic crisis (5.0%), and Vogt-Koyanagi-Harada syndrome (3.3%). Among infectious causes, herpetic anterior uveitis (7.7%), cytomegalovirus anterior uveitis (5.1%), and endogenous bacterial endophthalmitis (3.9%) predominated.
This large-scale multicenter study represents the most comprehensive epidemiological overview of uveitis in Taiwan to date. The unique disease pattern and relevant diagnostic challenges will be analyzed in this talk.
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15:58
16:00
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16:00
16:08
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黃謙傑 Jerry HuangTaiwan
Speaker
Infectious Uveitis in Asia: Warning Scenarios Not to Be MissedInfectious uveitis remains a significant cause of visual morbidity in Asia, demanding prompt diagnosis and management. This review highlights critical warning scenarios that clinicians must not overlook, including differentiating acute anterior uveitis from bacterial endophthalmitis, and distinguishing tuberculous retinal vasculitis from Eale's disease. Additionally, it emphasizes the importance of recognizing sarcoidosis versus fungal endophthalmitis to avoid misdiagnosis and delayed treatment. Comparative analysis underlines key clinical features, auxiliary investigations, and response to therapy, guiding accurate diagnosis in resource-limited settings. Awareness of these differing presentations and potential pitfalls is essential to prevent irreversible visual loss and to optimize patient outcomes.
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16:08
16:10
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16:10
16:15
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16:15
16:55
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701F
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16:15
16:30
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Kenichi NambaJapan
Speaker
Clinical feature and treatments of severe ocular sarcoidosisThe most common cause of uveitis in Japan is ocular sarcoidosis. Only cases meeting the diagnostic criteria qualify as ocular sarcoidosis, but the total number of suspected cases that do not meet the criteria is also significant.
Ocular sarcoidosis presents with a wide range of ocular findings, affecting areas from the anterior to the posterior segment, and shows considerable individual variation. It often presents with little anterior chamber inflammation or vitreous opacity, frequently arising from elevated intraocular pressure due to gonio nodules, sometimes leading to misdiagnosis as primary open-angle glaucoma. Conversely, it can also present with severe findings, including marked vitreous haze, retinal vascular sheathing, retinal exudates, and cystoid macular edema, potentially leading to permanent visual impairment. The clinical course also varies significantly between individuals. Some cases resolve with a single treatment, remain stable without recurrence, and have a favorable visual prognosis. However, other cases involve prolonged inflammation necessitating long-term treatment. In such protracted cases, complications such as concomitant cataracts, secondary glaucoma, and macular degeneration frequently lead to visual impairment.
Sarcoidosis is a disease relatively responsive to steroid therapy. Treatment primarily involves steroid eye drops along with mydriatic eye drops. If eye drops do not respond, oral steroids or periocular steroid injections are used. Oral methotrexate or oral adalimumab may sometimes be necessary. However, ocular sarcoidosis is a disease manifesting in waves of symptoms, and often resolves spontaneously.
I will present actual cases and discuss the above points accordingly.
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16:30
16:35
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16:35
16:50
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Soumyava BasuIndia
Speaker
Chronic uveitis: lessons from the clinic and the labChronic, recurrent inflammation is the primary cause of vision loss and structural complications (photoreceptor loss, cataract, glaucoma, and others) in uveitis. To understand if local factors drive chronic inflammation, we investigated the clinical patterns of recurrent inflammation, and the immunological landscape of vitreous samples, in non-infectious uveitis. In the clinical studies, we retrospectively analyzed HLA-B27 acute anterior uveitis (AAU) patients with documented 2 recurrences for the laterality patterns of recurrent inflammation. Recurrence patterns were classified as ipsilateral (group A) and contralateral (group B) based on the laterality of the second episode. We found that ipsilateral recurrences are more common and severe in HLA-B27 AAU, regardless of the presence of systemic disease or therapy. Similar results were also noted for recurrent inflammation in Behcet’s uveitis, supporting the hypothesis that an eye-specific immune memory exists in non-infectious uveitis.
To further characterize the eye-specific immune-memory, we investigated the immune phenotypes and functional attributes of eye-infiltrating immune cells in the vitreous fluids of uveitis patients. Among the various memory T-cell populations in the vitreous, we found CD69+CD103+ tissue resident memory (TRM) T-cell populations. Although the primary function of these cells is long-term immune protection, these TRM cells have also been linked to chronic and recurrent inflammation in numerous autoimmune diseases affecting various organs. Our studies revealed that eye-infiltrating CD4 and CD8 TRMs are functionally distinct, antigen-responsive, and associated with disease prognosis in uveitis, underscoring their potential as biomarkers and possible therapeutic targets.
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16:50
16:55
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16:55
17:30
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701F
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16:55
17:05
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Sarah CouplandUnited Kingdom
Speaker
Uveal melanoma prognostication: beyond chromosome 3Prognosis for uveal melanoma (UM) is determined by a combination of clinical, histopathological, and molecular factors. Clinical markers include tumour size and location, while histopathological factors include cell type and mitotic activity. The Liverpool Ocular Oncology Centre has a long track record in UM prognostication, and has devised an algorithm (LUMPO3) for more precise risk stratification and identifying patients at high risk for metastasis. It is a multiparametric model, which also included genetic data, particularly chromosome 3 and 8. It has been demonstrated that BAP1 immunohistochemistry is a very close surrogate for the status of the BAP1 gene, which if mutated is associated with a poor prognosis in UM. Our recent work has investigated the inclusion of BAP1 immunohistochemistry in LUMPO3, in labs where chromosomal analysis is not available. Early detection of metastatic UM is critical, as the prognosis is poor once widespread metastases develop. If detected earlier, surgical and newer immunotherapy options have been demonstrated to prolong survival.Decoding intraocular masqueradeIntraocular lymphomas can be divided into 3 main subtypes: primary vitreoretinal lymphoma (VRL), primary choroidal lymphoma, and secondary intraocular lymphoma. VRL is a rare but aggressive form of non-Hodgkin lymphoma that affects the eye. The most common subtype is a Diffuse large cell B-cell lymphoma (DLBCL), and displays a similar morphology, immuno- and genetic profile to the primary CNS lymphomas. Indeed, VRL can relapse in the CNS, and similarly CNSL can involve the eye. VRL often "masquerades" as chronic uveitis, making early and accurate diagnosis challenging but crucial for effective treatment and improved prognosis. In contrast, primary choroidal lymphoma is an indolent non-Hodgkin lymphoma similar to the Marginal Zone B-cell lymphomas of the ocular adnexa, and do not spread to the CNS. This lecture will provide an update about the biology, diagnostics and treatment of VRL and choroidal lymphomas. It will also provide examples of differential diagnoses to consider in vitrectomy specimens.Update of Ocular Adnexal LymphomasOcular adnexal lymphomas are most commonly non-Hodgkin lymphomas (NHL) that develop in the conjunctiva, eyelid, lacrimal gland, and orbit. The most common subtype is an extranodal marginal zone lymphoma (EMZL), which often presents as a painless, salmon-coloured lesion on the conjunctiva or as a mass causing symptoms like proptosis, double vision, or swelling in the orbit. Other common NHL of the ocular adnexa include follicular lymphomas, diffuse large cell B-cell lymphomas and mantle cell lymphomas. Treatment varies as per lymphoma subtype and requires joined-up assessment with the haematologists and radiologists. Typically treatment is local with low-dose radiation therapy being a standard option for localised disease, while systemic treatment may be used for more advanced cases. This lecture will provide an update about the biology, diagnostics and treatment of ocular adnexal lymphomas.
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17:05
17:15
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賴勇仁 Yung-Jen LaiTaiwan
Speaker
Ocular Complications and Long-Term Care in Immunocompromised Pediatric PatientsThis presentation provides a comprehensive overview of ocular complications in immunocompromised pediatric patients, drawing on the clinical experience of a tertiary referral center. We will outline the classification, diagnosis, and treatment protocols for opportunistic infections, with a specific focus on cytomegalovirus (CMV) retinitis and fungal chorioretinitis in children. Beyond acute infection control, we will discuss the critical management of long-term sequelae, including recurrences, tractional retinal detachment (TRD), and cataract formation. This session highlights the necessity of a systematic, multidisciplinary approach to preserve vision in this high-risk pediatric population.
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17:15
17:25
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李岳章 Yueh-Chang LeeTaiwan
Speaker
Inherited Retinal Disease-Associated UveitisInherited retinal diseases (IRDs) are traditionally regarded as non-inflammatory disorders characterized by progressive photoreceptor degeneration. However, uveitis may occasionally occur in patients with IRDs, creating diagnostic challenges and influencing therapeutic decisions. This presentation highlights two clinically important scenarios illustrating this overlap: retinal pigmentary changes mimicking retinitis pigmentosa (RP) as a manifestation of advanced uveitis, and recurrent macular edema in advanced RP that responds to intravitreal anti-VEGF therapy.
Chronic or recurrent posterior uveitis can produce pigmentary alterations resembling the bone-spicule pattern seen in RP, potentially leading to misdiagnosis of a primary inherited dystrophy. Correctly identifying inflammation-induced pigmentary change is essential, as addressing the underlying uveitis may alter disease course. Conversely, in patients with genetically confirmed RP, macular edema—often persistent or recurrent—may show meaningful improvement after anti-VEGF treatment, suggesting that secondary vascular leakage and inflammatory activity contribute to visual decline in these eyes.
Emerging genetic and mechanistic reports suggest that inflammation may play a role in selected IRDs. Variants in genes such as CRB1, ALPK1, CAPN5, and VCAN1 have been associated with impaired retinal barrier function, activation of proinflammatory pathways, altered immune regulation, or abnormal vitreous architecture, each of which may increase susceptibility to inflammatory manifestations. While these findings are not universal across all IRDs, they provide potential explanations for cases in which uveitis precedes, accompanies, or complicates retinal degeneration.
Recognizing these overlapping presentations is important for accurate interpretation of retinal findings, appropriate use of imaging and genetic testing, and individualized therapeutic planning, particularly in patients presenting with atypical features or unexplained inflammation.
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17:25
17:30
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