Abstract

FR.24.01

PCR diagnostic in uveitis

Garweg J. G. 
Swiss Eye Institute, Bern, Switzerland

The introduction of pathogen detection using polymerase chain reaction (PCR) in the late eighties has enhanced the sensitivity of clinical infectological diagnostics, and moreover contributed widely to our current understanding of the underlying pathophysiological mechanisms. Thanks to low sample volume and quality requirements pathogen DNA detection has become well established routine diagnostic for viral, bacterial, parasitic and fungal disease. Nevertheless, the clinical interpretation of results has to respect that the detection of pathogen DNA is neither proof of its vitality nor of its contribution to the disease process.
Molecularbiological diagnostic has widely contributed to the differentiation between infectious and infection-driven immunologic processes. We have learned why in distinct situations anti-infective therapy needs to be supplemented by anti-inflammatory treatment in order to work. Not at least, the more recent use of biologicals for the treatment of chronic endogenous uveitis is based on molecular biologically collected knowledge on systemic and local cytokine dynamics.
The application of PCR in uveitis has more recently targeted on the identification of genetic and immunogenetic predisposition for inflammatory disease. Another application includes the molecular characterisation of pathogen subtypes which might be related to the pattern and severity of clinical disease. Finally, PCR also contributes to the diagnostic of atypical and mascerade syndromes, i.e. in chronic diseases resistant to established therapy due to low grade pathogen involvement or intraocular malignancies, namely lymphoma. Obviously, clinical applications of PCR have markedly gone behind infectological diagnostics and still grow to contribute to our understanding of the pathophysiology of underlying disease mechanisms.

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