Clinical Services
Uveitis

The mission of Uveitis Clinic in TMDU is to provide the best care to every patient with uveitis. We should offer the most up-to-date knowledge, technologies, and medical and surgical treatments to make diagnosis and to treat uveitis and its complications.

Definition: Uveitis is one of the leading causes of blindness in the world. It is inflammatory conditions of intraocular tissues such as the uvea (iris, ciliary body, and the choroid), retina, and the sclera. Early diagnosis and treatment are essential to prevent the complication of uveitis and to save from the blindness.

Symptoms: Ocular symptoms of uveitis vary depending on the anatomical site in the eye, severity of inflammation, and etiology of uveitis. The major symptom includes: eye redness, ocular pain, floaters, light sensitivity, blurred vision, and decreased vision. In some cases, extraocular symptoms, e.g. headache, fever, skin lesions, or joint pain, may also be present.

Etiology: The etiologies of uveitis are composed of, infectious, non-infectious, idiopathic, and masquerade. The major causes of non-infectious uveitis in Japan are sarcoidosis, Vogt-Koyanagi-Harada disease, and Behcet's disease. Pathogenesis of non-infectious uveitis is believed to be autoimmune mechanisms. Infectious uveitis is caused by various infectious agents such as viruses, bacteria, fungi, and parasites,. The most common pathogen in Japan is herpes viruses such as herpes simplex viruses, varicella zoster virus, and cytomegalovirus. Tuberculosis and toxoplasmosis are also important infectious uveitis although its incidences today are much less than they used to be. Intraocular lymphoma mimics uveitis but it is actually a life-threatening malignant disease.

Diagnosis: Diagnosis of uveitis is made by the combination of the patients' life history, ocular and systemic symptoms, ocular examinations, and systemic examinations including blood tests, chest X-ray, or tuberculin skin test. The patients are often referred to other medical specialists such as rheumatologists, pulmonologists, dermatologists, neurologists, and others.

If infectious uveitis or intraocular lymphoma is suspected, analysis of intraocular fluids is performed using molecular diagnosis (polymerase chain reaction) and immunological tests (measurements of antibodies or cytokines). In our laboratory, we have established comprehensive polymerase chain reaction (PCR) system to detect genomic DNA of infectious agents including human herpes virus type 1 to 8, human lymphotropic virus type 1, toxoplasma, syphilis, and many others. We also perform broad range PCR to detect bacterial 16S ribosomal RNA and fungal 28S ribosomal RNA to prove the presence of bacteria or fungi at the site of intraocular inflammation. For those who are suspected to be suffering from intraocular lymphoma, we perform PCR for immunoglobulin heavy chain gene rearrangement or T cell receptor gene rearrangement, as well as cytokine measurement using intraocular fluids to prove the increase of interleukin (IL)-10 concentration or IL-10/IL-6 ratio.

Medical Treatment: Uveitis needs specific treatment according to its etiology. Most of the noninfectious uveitis needs local or systemic corticosteroid therapy, and in some cases, additional or alternative immunosuppressive agents such as methotrexate or cyclosporine are used. Biological agents such as anti-TNF alpha antibody (infliximab) is approved for the treatment of Behcet's disease by the Ministry of Health, Labour and Welfare of Japan. Infectious uveitis needs to be treated by anti-viral, anti-bacterial, and anti-fungal agents specific to pathogenic agents in each patient. Therefore, the accurate diagnosis is crucial to cure the patients. Because intraocular lymphoma is not only sight threatening but lethal disease, we perform intraocular chemotherapy and systemic chemotherapy concomitantly.

Surgical treatment: Uveitis causes various ocular complications such as cataract, glaucoma, vitreous opacity, cystoid macular edema, epiretinal membrane, and retinal detachment. Surgical treatment is therefore necessary for such patients in combination with sufficient medical treatment. Vitrectomy is performed in some refractory uveitis, such as acute retinal necrosis, bacterial endophthalmitis, or presumed intraocular lymphoma, to remove microbe or tumor cells, to use the intraocular fluids obtained by vitrectomy for the diagnosis.

Emeritus Professor: Manabu Mochizuki
Chief: Hiroshi Takase
Staff members: Masaru Miyanaga, Koju Kamoi, Shintaro Horie, Yuko Kawazoe, Sayaka Kanda, Urara Fukuchi, Atsuko Ishizuka, Yukiko Terada, Shoko Fukuda, Hiroyuki Takahashi, Mitsuhiro Ide, Sayaka Akaike, Hisako Karube.

1. Wang L, Sato-Otsubo A, Sugita S, Takase H, Mochizuki M, Usui Y, et al. High-resolution genomic copy number profiling of primary intraocular lymphoma by single nucleotide polymorphism microarrays. Cancer Sci. 2014;105: 592-9.
2. Takeuchi M, Kezuka T, Sugita S, Keino H, Namba K, Kaburaki T, et al. Evaluation of the Long-Term Efficacy and Safety of Infliximab Treatment for Uveitis in Behcet's Disease: A Multicenter Study. Ophthalmology. 2014.
3. Takase H, Kubono R, Terada Y, Imai A, Fukuda S, Tomita M, et al. Comparison of the ocular characteristics of anterior uveitis caused by herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Jpn J Ophthalmol. 2014;in press.
4. Takahashi H, Takase H, Ishizuka A, Miyanaga M, Kawaguchi T, Ohno-Matsui K, et al. Choroidal thickness in convalescent vogt-koyanagi-harada disease. Retina. 2014;34: 775-80.
5. Noguchi Y, Nishio A, Takase H, Miyanaga M, Takahashi H, Mochizuki M, et al. Audiovestibular findings in patients with Vogt-Koyanagi-Harada disease. Acta Otolaryngol. 2014;134: 339-44.
6. Nagata K, Maruyama K, Sugita S, Fukuchi U, Terada Y, Ishizuka A, et al. Age differences in sarcoidosis patients with posterior ocular lesions. Ocul Immunol Inflamm. 2014;22: 257-62.
7. Koizumi N, Inatomi T, Suzuki T, Shiraishi A, Ohashi Y, Kandori M, et al. Clinical features and management of cytomegalovirus corneal endotheliitis: analysis of 106 cases from the Japan corneal endotheliitis study. Br J Ophthalmol. 2014.
8. Kawaguchi T, Kawazoe Y, Kamoi K, Miyanaga M, Takase H, Sugita S, et al. Clinical course of patients with Behcet's uveitis following discontinuation of infliximab therapy. Jpn J Ophthalmol. 2014;58: 75-80.
9. Arai H, Sakai T, Okano K, Aoyagi R, Imai A, Takase H, et al. Presumed toxoplasmic central retinal artery occlusion and multifocal retinitis with perivascular sheathing. Clin Ophthalmol. 2014;8: 789-92.
10. Sugita S, Ogawa M, Shimizu N, Morio T, Ohguro N, Nakai K, et al. Use of a comprehensive polymerase chain reaction system for diagnosis of ocular infectious diseases. Ophthalmology. 2013;120: 1761-8.
11. Mochizuki M, Sugita S, Kamoi K. Immunological homeostasis of the eye. Prog Retin Eye Res. 2013;33: 10-27.
12. Maruyama K, Nagata K, Kojima K, Inaba T, Sugita S, Mochizuki M, et al. Intraocular Invasion of Adult T-Cell Leukemia Cells without Systemic Symptoms after Cataract Surgery. Case Rep Ophthalmol. 2013;4: 252-6.
13. Kawazoe Y, Sugita S, Yamada Y, Akino A, Miura K, Mochizuki M. Psoriasis triggered by infliximab in a patient with Behcet's disease. Jpn J Ophthalmol. 2013;57: 95-7.
14. Iwahashi-Shima C, Azumi A, Ohguro N, Okada AA, Kaburaki T, Goto H, et al. Acute retinal necrosis: factors associated with anatomic and visual outcomes. Jpn J Ophthalmol. 2013;57: 98-103.
15. Takase H, Mochizuki M. The role of imaging in the diagnosis and management of ocular sarcoidosis. Int Ophthalmol Clin. 2012;52: 113-20.
16. Sugita S, Shimizu N, Watanabe K, Ogawa M, Maruyama K, Usui N, et al. Virological analysis in patients with human herpes virus 6-associated ocular inflammatory disorders. Invest Ophthalmol Vis Sci. 2012;53: 4692-8.
17. Sugita S, Kamoi K, Ogawa M, Watanabe K, Shimizu N, Mochizuki M. Detection of Candida and Aspergillus species DNA using broad-range real-time PCR for fungal endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2012;250: 391-8.
18. Ohguro N, Sonoda KH, Takeuchi M, Matsumura M, Mochizuki M. The 2009 prospective multi-center epidemiologic survey of uveitis in Japan. Jpn J Ophthalmol. 2012;56: 432-5.
19. Ogawa M, Sugita S, Watanabe K, Shimizu N, Mochizuki M. Novel diagnosis of fungal endophthalmitis by broad-range real-time PCR detection of fungal 28S ribosomal DNA. Graefes Arch Clin Exp Ophthalmol. 2012.
20. Nagata K, Maruyama K, Uno K, Shinomiya K, Yoneda K, Hamuro J, et al. Simultaneous analysis of multiple cytokines in the vitreous of patients with sarcoid uveitis. Invest Ophthalmol Vis Sci. 2012;53: 3827-33.
21. Kojima K, Maruyama K, Inaba T, Nagata K, Yasuhara T, Yoneda K, et al. The CD4/CD8 ratio in vitreous fluid is of high diagnostic value in sarcoidosis. Ophthalmology. 2012;119: 2386-92.
22. Kamoi K, Mochizuki M. HTLV-1 uveitis. Front Microbiol. 2012;3: 270.
23. Kamoi K, Mochizuki M. HTLV infection and the eye. Curr Opin Ophthalmol. 2012;23: 557-61.
24. Yamada Y, Sugita S, Tanaka H, Kamoi K, Takase H, Mochizuki M. Timing of recurrent uveitis in patients with Behcet's disease receiving infliximab treatment. Br J Ophthalmol. 2011;95: 205-8.
25. Sugita S, Shimizu N, Watanabe K, Katayama M, Horie S, Ogawa M, et al. Diagnosis of bacterial endophthalmitis by broad-range quantitative PCR. Br J Ophthalmol. 2011;95: 345-9.
26. Sugita S, Ogawa M, Inoue S, Shimizu N, Mochizuki M. Diagnosis of ocular toxoplasmosis by two polymerase chain reaction (PCR) examinations: qualitative multiplex and quantitative real-time. Jpn J Ophthalmol. 2011;55: 495-501.
27. Cao X, Shen D, Callanan DG, Mochizuki M, Chan CC. Diagnosis of systemic metastatic retinal lymphoma. Acta Ophthalmol. 2011;89: e149-54.
28. Yamada Y, Sugita S, Tanaka H, Kamoi K, Kawaguchi T, Mochizuki M. Comparison of infliximab versus ciclosporin during the initial 6-month treatment period in Behcet disease. Br J Ophthalmol. 2010;94: 284-8.
29. Tanaka A, Takase H, Adamus G, Mochizuki M. Cancer-associated retinopathy caused by benign thymoma. Br J Ophthalmol. 2010;94: 526-8.
30. Takase H, Shimizu K, Yamada Y, Hanada A, Takahashi H, Mochizuki M. Validation of international criteria for the diagnosis of ocular sarcoidosis proposed by the first international workshop on ocular sarcoidosis. Jpn J Ophthalmol. 2010;54: 529-36.
31. Nakauchi Y, Takase H, Sugita S, Mochizuki M, Shibata S, Ishiwata Y, et al. Concurrent administration of intravenous systemic and intravitreal methotrexate for intraocular lymphoma with central nervous system involvement. Int J Hematol. 2010;92: 179-85.
32. Mizuki N, Meguro A, Ota M, Ohno S, Shiota T, Kawagoe T, et al. Genome-wide association studies identify IL23R-IL12RB2 and IL10 as Behcet's disease susceptibility loci. Nat Genet. 2010;42: 703-6.
33. Miyanaga M, Sugita S, Shimizu N, Morio T, Miyata K, Maruyama K, et al. A significant association of viral loads with corneal endothelial cell damage in cytomegalovirus anterior uveitis. Br J Ophthalmol. 2010;94: 336-40.
34. Miyanaga M, Kawaguchi T, Miyata K, Horie S, Mochizuki M, Herbort CP. Indocyanine green angiography findings in initial acute pretreatment Vogt-Koyanagi-Harada disease in Japanese patients. Jpn J Ophthalmol. 2010;54: 377-82.
35. Kawaguchi T, Sugita S, Yamada Y, Miyanaga M, Mochizuki M. Regression of optic disc neovascularization in patients with Behcet's uveoretinitis after infliximab therapy. J Ocul Pharmacol Ther. 2010;26: 627-30.
36. Ishida T, Ohno-Matsui K, Kaneko Y, Tobita H, Shimada N, Takase H, et al. Fundus autofluorescence patterns in eyes with primary intraocular lymphoma. Retina. 2010;30: 23-32.
37. Sugita S, Takase H, Sugamoto Y, Arai A, Miura O, Mochizuki M. Diagnosis of intraocular lymphoma by polymerase chain reaction analysis and cytokine profiling of the vitreous fluid. Jpn J Ophthalmol. 2009;53: 209-14.
38. Miyanaga M, Shimizu K, Kawaguchi T, Miyata K, Mochizuki M. A clinical survey of uveitis in HTLV-1 endemic region. Ocul Immunol Inflamm. 2009;17: 335-41.
39. Kamoi K, Yoshida T, Takase H, Yokota M, Kawaguchi T, Mochizuki M. Seroprevalence of Bartonella henselae in patients with uveitis and healthy individuals in Tokyo. Jpn J Ophthalmol. 2009;53: 490-3.
40. Ishida T, Sugamoto Y, Sugita S, Mochizuki M. Prophylactic vitrectomy for acute retinal necrosis. Jpn J Ophthalmol. 2009;53: 486-9.
41. Herbort CP, Rao NA, Mochizuki M. International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop On Ocular Sarcoidosis (IWOS). Ocul Immunol Inflamm. 2009;17: 160-9.
42. Kamoi K, Mochizuki M. Phaco dislocation technique in young patients with uveitis. J Cataract Refract Surg. 2008;34: 1239-41.