The Association with rhegmatogenous retinal detachment and paediatric atopic dermatitis: a 12-year Nationwide Cohort Study

Risk of Developing Pediatric Uveitis Among Patients With Early-Onset Atopic Dermatitis

Importance

The relationship between atopic dermatitis (AD) and pediatric uveitis may be underexplored, warranting large-scale, multicenter studies.

Objective

To evaluate the risk of pediatric uveitis among children with early-onset AD compared with a matched control population.

Design, Setting, and Participants

This cohort study used aggregated electronic health records of US patients with early-onset AD and matched controls from January 1, 2004, through December 14, 2024, sourced from health care organizations in the collaborative research network TriNetX. Patients with early-onset AD and matched controls without AD were included in the analysis; those with uveitis prior to AD diagnosis were excluded. Propensity score matching was applied to balance baseline characteristics. The analyses were conducted on December 14, 2024.

Exposure

International Classification of Diseases, 10th Revision (ICD-10) diagnosis code for AD.

Main Outcomes and Measures

The primary outcome was the hazard ratio (HR) for developing pediatric uveitis in the AD cohort compared with the matched controls. Cox proportional hazards models were applied to assess the risk.

Results

A total of 114 889 patients were identified in the AD cohort (mean [SD] follow-up, 6.0 [3.3] years; mean [SD] age, 0.5 [0.7] years; 64 817 male [56.4%]) and the control cohort (mean [SD] follow-up, 6.6 [3.7] years; mean [SD] age, 0.6 [0.8] years; 65 377 male [56.9%]) after matching. The AD cohort demonstrated a higher risk of developing pediatric uveitis compared with controls (94 [0.08%] vs 58 [0.05%]; HR, 1.92 [95% CI, 1.38-2.66]). Sensitivity analyses among patients without dupilumab use (89 of 113 284 [0.08%] vs 59 of 113 284 [0.05%]; HR, 1.77 [95% CI, 1.27-2.46]) and those without autoimmune conditions (80 of 114 425 [0.07%] vs 61 of 114 425 [0.05%]; HR, 1.52 [95% CI, 1.09-2.12]) similarly indicated an increased risk in the AD cohort. Additionally, patients with severe AD had a higher risk of developing pediatric uveitis compared with those with nonsevere AD (12 of 3004 [0.40%] vs 97 of 126 482 [0.08%]; HR, 3.64 [95% CI, 2.00-6.66]).

Conclusions and Relevance

This cohort study of children with early-onset AD found an elevated risk of pediatric uveitis compared with matched controls, independent of autoimmune conditions or dupilumab use. These findings support the potential need to consider ophthalmologic monitoring in children with early-onset AD to try to detect and subsequently manage uveitis if it develops.

Comprehensive evaluation of ocular complications in atopic dermatitis: insights from a contemporary cohort study in Korean population

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with various systemic and ocular complications. This study aimed to investigate the prevalence, risk factors, and clinical characteristics of ocular complications in a cohort of Korean AD patients.

METHODS

A retrospective review of medical records was conducted for AD patients who visited the dermatology and ophthalmology clinics at the same institution. Demographic data, clinical characteristics, and types of ocular complications were recorded. Logistic regression analysis was performed to identify factors associated with ocular complications.

RESULTS

A total of 212 AD patients were included in the study. The intraocular complications had a prevalence of 1.9%, whereas ocular surface diseases were observed more frequently, with prevalence of 13.2%. Among the ocular complications, blepharitis was the most prevalent, followed by atopic keratoconjunctivitis. Subcapsular cataract, atrophic hole, and retinal detachment were also observed. The head and neck score in the Eczema Area and Severity Index (EASI) emerged as a significant predictor for intraocular complications, independent of age, gender, total EASI score, and family history. No significant association was found between total EASI score and ocular surface disease.

CONCLUSION

This study provides insights into the prevalence and risk factors of ocular complications in Korean AD patients. The head and neck score in EASI was identified as a significant predictor for intraocular complications. These findings emphasize the importance of comprehensive evaluation and interdisciplinary care for AD patients, particularly in identifying and managing potential vision-threatening complications.

Atopic Dermatitis Leading to Blindness: A Frequently Forgotten Sequelae

A 12-year-old boy with underlying severeand poorly controlled atopic dermatitis (AD) associated with atopic conjunctivitis and rhinitis presented with a right painless blurring of vision for two weeks. On examination, his right eye visual acuity was 1/60,with grade 1 relative afferent pupillary defect (RAPD). Anterior segment examination revealed anterior uveitis with dense posterior subcapsular cataract and hazy fundus view. B-scan ultrasound suggested a shallow total retinal detachment. Intraoperatively, a large retinal dialysis was found. This paper highlights the need for a high index of suspicion of retinal dialysis in a child with underlying AD and the importance of good control of this systemic condition to prevent ocular morbidity.

Levofloxacin susceptibility of Staphylococci from conjunctiva in patients with atopic dermatitis

PURPOSE

The ocular surface in patients with atopic dermatitis (AD) is known to harbor an abundance of gram-positive cocci, particularly Staphylococcus aureus (S. aureus). This study reviewed the results of microbial cultures from the conjunctiva in AD patients, with special attention to the levofloxacin susceptibility of Staphylococci.

STUDY DESIGN

Retrospective, single-center study.

METHODS

This study involved 131 eyes of 112 Japanese patients with AD (87 men and 25 women, mean age: 40.4 ± 12.2 years) who underwent ocular surgery at Kyorin University Hospital. Bacterial isolates were collected from the conjunctival sacs in the preoperative period. Drug resistance to methicillin and levofloxacin was judged using the minimal inhibitory concentrations of oxacillin and levofloxacin determined by the broth dilution method.

RESULTS

One hundred and fifty-seven strains were identified in 103 of the 131 eyes examined. S. aureus was isolated from 74 eyes (56.5%), followed by Staphylococcus epidermidis (S. epidermidis). In S. aureus, 11 strains (14.9%) were methicillin-resistant, and 18 (24.3%) were levofloxacin-resistant. In S. epidermidis, 15 strains (26.8%) were methicillin-resistant, and 17 (30.4%) were levofloxacin-resistant. No significant differences were observed in levofloxacin susceptibility with age, sex, previous ocular surgery, or duration of previous surgery. However, logistic multivariate analysis revealed that levofloxacin-resistant Staphylococci were concurrently resistant to methicillin, suggesting multidrug resistance.

CONCLUSION

Distinctive bacterial distribution and drug resistance need consideration in the managing of ocular disorders among patients with AD.

The interface targeting hnRNPA2B1 regulates the repression of transthyretin against human retinal microvascular endothelial cells in high-glucose environment

BACKGROUND

The interaction between transthyretin (TTR) and heterogeneous nuclear ribonucleoprotein (hnRNP)A2B1 is involved in the neovascularization of human retinal microvascular endothelial cells (hRECs) under hyperglycemic conditions. However, whether the TTR-hnRNPA2B1 interface can be altered and how this protein-protein interaction and associated downstream pathways are regulated is unclear.

METHODS

We performed homologous sequential analysis and binding energy assays using Discovery Studio and designed substitution targeting three fragments of the interface (fragment 1: aa 34-39, -RKAADD-; fragment 2, aa 61-68, -EEEFVEGI-; and fragment 3, aa 96-102, -TANDSGP-) to disrupt or stabilize the TTR-hnRNPA2B1 complex and were subjected to Co-immunoprecipitation analysis. To investigate the effect of TTR-hnRNPA2B1 interface alterations on the physiological properties of hRECs, we performed CCK-8, EdU, migration, wound healing and tube formation assays. To study the downstream genes, we performed qRT-PCR and western blot.

RESULTS

Nineteen TTR substitutions were recombinantly expressed in soluble form, results indicated that reducing the binding energy stabilized the TTR-hnRNPA2B1, while increasing the binding energy had the opposite effect. The native TTR significantly prohibited the proliferation, DNA synthesis, migration and tube formation capacities of hRECs, while fragment 1 always reduced these effects. However, the I68R and D99R substitutions in fragments 2 and 3, respectively, increased the inhibitory effect of TTR. Furthermore, our qRT-PCR and western blot results showed that the expression and protein levels of STAT-4, miR-223-3p and FBXW7 were also regulated by the alteration of the TTR-hnRNPA2B1 interface.

CONCLUSION

This work suggests that the formation of the TTR-hnRNPA2B1 complex plays vital role in hyperglycemia, and modification of this interface regulates the TTR-mediated inhibition of hREC neovascularization via the STAT-4/miR-223-3p/FBXW7 pathway. This mechanism could have important implications for diabetic retinopathy treatment.

Comorbidity Identification and Referral in Atopic Dermatitis: a Consensus Document

BACKGROUND

Atopic dermatitis (AD) is associated with different comorbidities.

OBJECTIVE

To develop evidence-based and practical recommendations for comorbidity detection in patients with AD in daily practice.

METHODS

We employed a modified RAND/UCLA methodology, including a systematic literature review (SLR). A group of six experts on AD was established. We conducted a comprehensive search strategy on Medline, Embase, and Cochrane Library up to June 2020. The selection criteria included studies with AD patients with any comorbidity reporting data on comorbidity prevalence, burden, and management. The included studies quality was assessed. The SLR results were discussed in a nominal group meeting, and several recommendations were generated. The recommendation agreement grade was tested on additional experts through a Delphi process.

RESULTS

The recommendations cover the following issues: 1) Which comorbidities should be investigated at the first and subsequent visits; 2) How and when should comorbidities be investigated (screening); 3) How should patients with specific comorbidities be referred to confirm their diagnosis and initiate management; 4) Specific recommendations to ensure an integral care approach for AD patients with any comorbidity.

CONCLUSIONS

These recommendations seek to guide dermatologists, patients, and other stakeholders in regard to early comorbidity identification and AD patient referral to improve decision-making.

Iris Retraction Without Hypotony

PURPOSE

All published cases of iris retraction syndrome have been associated with low intraocular pressure. We report here a case clinically indistinguishable from iris retraction syndrome except for the absence of hypotony, which has not been previously described in the literature.

OBSERVATIONS

A 35-year-old woman with a history of atopic dermatitis developed a rapidly progressive anterior subcapsular cataract and acute uveitis. During follow-up, the presence of bilateral iris retraction was noted, while ocular pressure was either normal or elevated, and the position did not normalize with pupillary dilation. The clinical course was complicated by retinal detachment and posterior cyclitic membrane, which was managed with pars plana vitrectomy, lensectomy, and dissection of cyclitic membrane. The case was further complicated by ocular hypertension attributed to steroid response and formation of an epiretinal membrane. Following micropulse cyclophotocoagulation, placement of an Ahmed tube shunt, epiretinal membrane peel, and placement of secondary intraocular lens, our patient eventually had a good visual outcome.

CONCLUSIONS AND IMPORTANCE

Hypotony is generally recognized as a key physiological step in the development of iris retraction syndrome. Our case demonstrates that posterior bowing of the iris can occur in the absence of hypotony, and suggests that an alternative mechanism involving posterior cyclitic membrane may be responsible.