Purpose: To report 2 cases of persistent inflammation associated with human leukocyte antigen-B27 (HLA-B27) after pars plana vitrectomy (PPV) with scleral buckling. Methods: Two cases were analyzed. Results: A 47-year-old man had pars plana vitrectomy (PPV), scleral buckle (SB) placement, and endolaser for a macula-on rhegmatogenous retinal detachment (RRD). A 61-year-old man also had uneventful PPV, SB placement, and endolaser for a macula-off RRD. Postoperatively, both patients reported eye pain and had persistent intraocular inflammation. Both were found to be HLA-B27 positive despite having no previous signs or symptoms that would warrant HLA-B27 testing. Conclusions: Discovering the source of prolonged postoperative inflammation is critical in initiating the correct treatment and removing suspicion of infection. Although intraocular inflammation associated with HLA-B27 does not often present initially after surgery, HLA-B27 testing should be considered in cases of persistent, unexpected postoperative inflammation.
LlopSMPapaliodisGN. Cataract surgery complications in uveitis patients: a review article. Semin Ophthalmol. 2018;33(1): 64-69.
2.
GuindoletDDureauPTerradaC, et al. Cataract surgery with primary lens implantation in children with chronic uveitis. Ocul Immunol Inflamm. 2018;26(2):298-304.
3.
VaudauxJDEperonSNguyenCGuex-CrosierY. Inflammation in cataract surgery. Expert Rev Ophthalmol. 2007;2(5):803-818.
4.
InoueYKadonosonoKYamakawaT, et al. Surgically-induced inflammation with 20-, 23-, and 25-gauge vitrectomy systems. Retina. 2009;29(4):477-480.
5.
BansalRDograMChawlaRKumarA. Pars plana vitrectomy in uveitis in the era of microincision vitreous surgery. Indian J Ophthalmol. 2020;68(9):1844-1851.
6.
RomanoVAngiMScottiF, et al. Inflammation and macular oedema after pars plana vitrectomy. Mediators Inflamm. 2013; 2013:1-8.
7.
BoveyEHHerbortCP. Vitrectomy in the management of uveitis. Ocul Immunol Inflamm. 2000;8(4):285-291.
8.
HeiligenhausABornfeldNFoersterMHWessingA. Long-term results of pars plana vitrectomy in the management of complicated uveitis. Br J Ophthalmol. 1994;78(7):549-554.
9.
GirardLJRodriguezJMailmanMLRomanoTJ. Cataract and uveitis management by pars plana lensectomy and vitrectomy by ultrasonic fragmentation. Retina. 1985;5(2):107-114.
10.
VerbraekenH. Therapeutic pars plana vitrectomy for chronic uveitis: a retrospective study of the long-term results. Graefes Arch Clin Exp Ophthalmol. 1996;234(5):288-293.
11.
MielerWFAabergTM. Vitreous surgery in the management of peripheral uveitis. Dev Ophthalmol. 1992;23:239-250.
12.
WakefieldDClarkeDMcCluskeyP. Recent developments in HLA B27 anterior uveitis. Front Immunol. 2021;11:608134.
13.
KopplinLJMountGSuhlerEB. Review for disease of the year: epidemiology of HLA-B27 associated ocular disorders. Ocul Immunol Inflamm. 2016;24(4):470-475.
14.
RosenbaumJTLinPAsquithM. Does the microbiome cause B27-related acute anterior uveitis?Ocul Immunol Inflamm. 2016; 24(4):440-444.
Van Der VeerEGKeunenJERothovaA. Severe HLA B27-associated uveitis complicated by hypotony, serous retinal detachment, and ciliochoroidal effusion. Ocul Immunol Inflamm. 2014;22(1):23-26.
Hacquard-BouderCIttahMBrebanM. Animal models of HLA-B27-associated diseases: new outcomes. Joint Bone Spine. 2006;73(2):132-138.
27.
Luthra-GuptasarmaMSinghB. HLA-B27 lacking associated β2-microglobulin rearranges to auto-display or cross-display residues 169-181: a novel molecular mechanism for spondyloarthropathies. FEBS Lett. 2004;575(1-3):1-8.
28.
EvansDMSpencerCCAPointonJJ, et al. Interaction between ERAP1 and HLA-B27 in ankylosing spondylitis implicates peptide handling in the mechanism for HLA-B27 in disease susceptibility. Nat Genet. 2011;43(8):761-767.
29.
MearJPSchreiberKLMünzC, et al. Misfolding of HLA-B27 as a result of its B pocket suggests a novel mechanism for its role in susceptibility to spondyloarthropathies. J Immunol. 1999;163(12):6665-6670.
30.
RosenbaumJTAsquithM. The microbiome and HLA-B27-associated acute anterior uveitis. Nat Rev Rheumatol. 2018;14(12):704-713.
31.
MartinTMRosenbaumJT. An update on the genetics of HLA B27-associated acute anterior uveitis. Ocul Immunol Inflamm. 2011;19(2):108-114.
MarcheseACavalleriMBandelloFModoratiGMiserocchiE. Ocular decompression retinopathy after cataract surgery in HLA-B27 associated anterior uveitis. Ocul Immunol Inflamm. 2022;30(7-8):1977-1979.
34.
NomaHYasudaKShimuraM. Involvement of cytokines in the pathogenesis of diabetic macular edema. Int J Mol Sci. 2021; 22(7):3427.
35.
DoctorMBParameswarappaDCRaniPK. Medical management of silicone oil associated acute postoperative ocular inflammation. BMJ Case Rep. 2021;14(7):e242251.
36.
JabsDA. Immunosuppression for the uveitides. Ophthalmology. 2018;125(2):193-202.
JhajGKopplinLJ. Ocular features of the HLA-B27-positive seronegative spondyloarthropathies. Curr Opin Ophthalmol. 2018;29(6):552-557.
39.
MitulescuTCTrandafirMDimăncescuMG, et al. Advances in the treatment of uveitis in patients with spondyloarthritis - is it the time for biologic therapy?Rom J Ophthalmol. 2018;62(2): 114-122.
40.
SchwartzmanSSchwartzmanM. The use of biologic therapies in uveitis. Clin Rev Allergy Immunol. 2015;49(3):307-316.
41.
TrivediAKatelarisC. The use of biologic agents in the management of uveitis. Intern Med J. 2019;49(11):1352-1363.
42.
ReveilleJDHirschRDillonCFCarrollMDWeismanMH. The prevalence of HLA-B27 in the US: data from the US national health and nutrition examination survey, 2009. Arthritis Rheum. 2012;64(5):1407-1411.
