No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Uveitis: A global perspective
Abstract
To study the patterns of uveitis in various geographic regions.
A systematic literature review was performed using the MEDLINE database, from 1966 to present. Studies that satisfied our described selection criteria were analyzed to provide a global perspective on uveitis.
Twenty-two studies, which were the best available representatives of Australia, North and South America, Europe, Asia, and Africa, were included in the final analysis. The distribution of uveitis cases according to the anatomical site of inflammation in the various regions, and the causes and clinical disease associations of anterior, intermediate, posterior, and pan-uveitis were studied for each of the regions and a comparative analysis was performed.
There are similarities and distinct differences in the patterns of uveitis in the various geographic regions. Such patterns of uveitis are influenced by combinations of geographical, environmental, and genetic factors.
... Увеитът е хронично заболяване, което се характеризира с вътреочно възпаление. Засяга предимно лица в трудоспособна възраст и води до слепота и инвалидизация [8]. Лицата, диагностицирани с увеит, имат не само проблеми с хронифицирането на заболяването и страничните ефекти от провежданото лечение, но и с непредсказуемостта на възпаленията, нестабилна зрителна острота, промени във възпалителната активност и понякога неочаквани усложнения на заболяването [11,19,35]. ...
... В развитите страни увеитът е втората причина след диабетната ретинопатия за слепота при лица на възраст между 20 и 65 г. [37], представляваща до 10% от случаите на регистрирана слепота [8,34,37,39,41]. Над 50% от лицата с увеит ще развият усложнения, свързани със заболяването, а над 30% ще имат зрително увреждане [8,16,34,39]. ...
... [37], представляваща до 10% от случаите на регистрирана слепота [8,34,37,39,41]. Над 50% от лицата с увеит ще развият усложнения, свързани със заболяването, а над 30% ще имат зрително увреждане [8,16,34,39]. В резултат на това увеитът е свързан с икономическа, социална и лична тежест [4,9,22,39], което води до неработоспособност, намаляване на възможността за справяне с ангажиментите на работното място или в дома [13] и загуба на работа [21], застрашава-ща заетостта и финансовото благополучие на пациентите. ...
Uveitis is a chronic disease characterized by intraocular inflammation. It mainly affects people of working age and leads to blindness and disability. The aim of the present study was to provide a systematic review of the literature data on quality of life in patients with uveitis. Material and methods: For the period 1996-2021, in the available databases (PubMed, BioMedCentral, ScienceDirect, Scopus, Web of Science) a systematic analysis of scientific publications examining the assessment of quality of life in patients with uveitis was performed. Results: 5,238 publications were found for the study period, of which 1,141 were reviews and 1,647 were articles with research results. In developed countries, uveitis is the second leading cause of diabetic retinopathy of blindness in people between the ages of 20 and 65, representing up to 10% of cases of registered blindness. Over 50% of people with uveitis will develop complications related to the disease, and over 30% will have visual impairment. As a result, uveitis is associated with economic, social and personal burden, leading to incapacity for work, reduced productivity at work or at home, and job loss, which threatens the employment and financial well-being of patients. Conclusion: The quality of life in patients with uveitis is closely related to visual impairment (anterior and posterior uveitis) and pain syndrome (anterior uveitis). Uveitis is a disease that is most often chronic with a different period of time of manifestations of the disease, which requires constant monitoring.
... We observed toxoplasmosis to be the most frequent cause of uveitis in this group. [8,9] In our study, panuveitis (13,14.61%) was more frequent than intermediate uveitis (12,13.48%) similar to studies from North Africa and North India. ...
... [8,9] In our study, panuveitis (13,14.61%) was more frequent than intermediate uveitis (12,13.48%) similar to studies from North Africa and North India. ...
... Infectious aetiologies such as tuberculosis and toxoplasmosis are most common in reports from India. [11,13,14] This study thus reports the pattern of uveitis in a tertiary care hospital of North India. The limitation of this study is small sample size, and larger population is likely to add more information. ...
... According to the standardization of Uveitis Nomenclature (SUN) working group criteria, IU ia defined as an intraocular inflammation mainly focused on vitreous, peripheral retina, and ciliary body with minimal or no anterior segment inflammation [1] . Intermediate uveitis accounts for 1.4 -31% of all uveitis patients [2][3][4][5][6][7][8][9][10] . The incidence of IU varies between 1.4 -2/100.000 ...
... It can have various etiologies and presentations, and its complications can be severe if not managed properly. Globally, IU is the least common type of uveitis reported, representing about 16% of all uveitis anatomical locations [2,22,23] . Distribution patterns are influenced by demographic, genetic, and environmental factors. ...
... Other studies have found that the cause of uveitis remains unknown in approximately 30-60% of patients. 21,22 Interestingly, studies from Africa, the Mediterranean region, China, and Japan have reported a higher prevalence of Behçet's disease, 10,23-25 while Western countries have higher rates of HSV, CMV, and seronegative spondyloarthropathies. 21 These variations may be attributed to geographical and racial factors. ...
... 21,22 Interestingly, studies from Africa, the Mediterranean region, China, and Japan have reported a higher prevalence of Behçet's disease, 10,23-25 while Western countries have higher rates of HSV, CMV, and seronegative spondyloarthropathies. 21 These variations may be attributed to geographical and racial factors. 18 A recent study by Abdelwareth Mohammed et al., conducted in a different geographic location in Egypt, reported that Behçet's disease (29.1%), parasitic anterior chamber (AC) granulomatous uveitis (14.4%), and VKH (12.8%) were the most commonly recognized causes of uveitis. ...
Aim:
The aim of this research is to evaluate the demographic attributes and clinical manifestations of uveitis in adult patients frequenting the Mansoura Ophthalmic Center.
Methods:
Utilizing a cross-sectional, prospective, analytical study design, this research engaged adult patients visiting the outpatient uveitis clinic at the Mansoura Ophthalmic Center. Comprehensive case evaluations involved collecting detailed patient histories, examining ophthalmic records, and conducting thorough ocular examinations. These examinations encompassed the assessment of visual acuity, slit-lamp examination, and fundus examination. Furthermore, selected cases underwent optical coherence tomography (OCT) and fundus fluorescein angiography (FFA).
Results:
The Study involved an examination of 411 eyes belonging to 254 uveitic patients. In the Egyptian context, anterior uveitis surfaced as the most prevalent form of uveitis. The average Best-Corrected Visual Acuity (BCVA) among the cases studied was 0.797 ± 0.77 LogMAR, with the majority of cases demonstrating vision superior to 0.3 LogMAR. Notably, the principal causes of vision loss were generally reversible. Macular edema was identified as the leading cause of vision loss, representing 20.7% of cases as evidenced by OCT. The ratio of non-infectious to infectious uveitis stood at 92.2% to 7.8%. The most commonly observed etiologies of non-infectious uveitis included Behçet's disease (33.3%), Vogt-Koyanagi-Harada (VKH) syndrome (19.7%), idiopathic causes (19.2%), and ankylosing spondylitis (AS) (11.9%). Conversely, the most frequent infectious etiologies were trematode-induced uveitis (2.9%), herpetic uveitis (1.7%), toxoplasmosis (1.5%), tuberculosis (TB) (1.5%), and brucellosis (0.2%).
Conclusions:
This study conclusively indicates that anterior uveitis is the predominant anatomical type of uveitis in Egypt. Further, etiological diagnoses of uveitis should particularly emphasize Behçet's disease, VKH syndrome, and ankylosing spondylitis.
... This disease has been significantly studied recently, and some of these studies have compared their results with those from other regions. Despite this, a global comparison does not yet exist [28]. ...
Monoclonal antibodies (mAbs) have revolutionized the landscape of cancer therapy, offering unprecedented specificity and diverse mechanisms to combat malignant cells. These biologic agents have emerged as a cornerstone in targeted cancer treatment, binding to specific antigens on cancer cells and exerting their therapeutic effects through various mechanisms, including inhibition of signaling pathways, antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and antibody-dependent cellular phagocytosis (ADCP). The unique ability of mAbs to engage the immune system and directly interfere with cancer cell function has significantly enhanced the therapeutic armamentarium against a broad spectrum of malignancies. mAbs were initially studied in oncology; however, today, treatments have been developed for eye diseases. This review discusses the current applications of mAbs for the treatment of ocular diseases, discussing the specificity and the variety of mechanisms by which these molecules exhibit their therapeutic effects. The benefits, drawbacks, effectiveness, and risks associated with using mAbs in ophthalmology are highlighted, focusing on the most relevant ocular diseases and mAbs currently in use. Technological advances have led to in vitro production methods and recombinant engineering techniques, allowing the development of chimeric, humanized, and fully human mAbs. Nowadays, many humanized mAbs have several applications, e.g., for the treatment of age-related macular disease, diabetic retinopathy, and uveitis, while studies about new applications of mAbs, such as for SARS-CoV-2 infection, are also currently ongoing to seek more efficient and safe approaches to treat this new ocular disease.
... Selvakumar et al. also highlighted the diagnostic application of exosomes in diabetic retinopathy [87], further underlining the significance of exosomes in the development of theranostics or therapeutics in the near future for diabetic retinopathy treatment. Uveitis: Uveitis, an autoimmune disease responsible for blindness worldwide [88], involves middle-layer inflammation of the eyes, complicating diagnostic, and clinical therapy efforts (Table 5 provides details) [89,90]. ...
... Uveitis, a complex and potentially sight-threatening condition, refers to inflammation of the uveal tract, comprising the iris, ciliary body and choroid [1]. this ocular disorder is accountable for approximately 10% of cases of visual impairment in the developed world [2]. the aetiology of uveitis is diverse, encompassing infectious agents, autoimmune disorders and idiopathic causes [3]. ...
Purpose
To offer consensus on the utilization of corticosteroids (CS) for treating non-infectious uveitis in the context of clinical practice in Taiwan. This entails examining the different administration methods, their advantages and disadvantages, and considering alternative treatments according to the prevailing evidence and health policies.
Methods
Ten ophthalmologists and one rheumatologist convened on December 11, 2022, to review and discuss literature on the topic. The databases explored were the Central Cochrane library, EMBASE, Medline, PUBMED, and Web of Science using relevant keywords. The search spanned from January 1996 to June 2023. After the initial results of the literature review were presented, open voting determined the final statements, with a statement being accepted if it secured more than 70% agreement. This consensus was then presented at significant meetings for further discussions before the final version was established.
Results
A flow chart and nine statements emerged from the deliberations. They address the importance of CS in uveitis management, guidelines for using topical CS, indications for both periocular or intravitreal and systemic therapies, and tapering and discontinuation methods for both topical and systemic CS.
Conclusion
While CS are a cornerstone for non-infectious uveitis treatment, their administration requires careful consideration, depending on the clinical situation and the specific type of uveitis. The consensus generated from this article provides a guideline for practitioners in Taiwan, taking into account local health policies and the latest research on the subject. It emphasizes the significance of strategic tapering, the potential for alternative therapies, and the importance of patient-centric care.
... We conducted a descriptive study of the patients with NIU followed up in the multidisciplinary uveitis unit of our hospital. The results did not differ from those reported in other published series [25][26][27][28]. There was no significant difference in sex, the mean age at diagnosis was 42.8 years, and the most frequent cases were anterior (74.4%) as well as unilateral (76.1%) uveitis. ...
Background:
The aim of this study was to describe the characteristics of patients with uveitis associated with an immunologic or idiopathic disease that requires immunosuppressive treatment and the response to such treatments in real clinical practice.
Methods:
An observational, descriptive, longitudinal, and retrospective study of a cohort of patients diagnosed with noninfectious uveitis was performed. To assess the response to treatment, we evaluated the change in visual acuity, vitritis, and the presence of macular edema.
Results:
We included 356 patients. Overall, 12% required treatment with systemic corticosteroids, and 66 patients (18.5%) required immunosuppressive/biological treatment, with methotrexate being the most used (55%). Immunosuppressive drugs were used in 59 cases (in 56 patients, as the first choice of treatment and for 3 patients as the second choice after treatment with biologics). Treatment with biologics was the first choice in 10 patients out of 66 (15%), and 34 (48%) required them at some time during the disease, with adalimumab being the most commonly used. Thirty-five patients (53%) needed to switch drugs due to a lack of response to the first one. There were no differences between different drugs in the resolution of vitritis and improvement in vision.
Conclusions:
The use of systemic corticosteroids and immunosuppressive/biologics was necessary for a high number of patients with noninfectious uveitis. In our series, tocilizumab was significantly more effective in the resolution of macular edema.
... The results did not differ from other published series. [23][24][25][26]. There was no significant difference in sex, the mean age at diagnosis was 42.8 years, and the most frequent anatomical location was the anterior (74.4%) as were the unilateral cases (76.1%). ...
To describe the characteristics of patients with uveitis associated with an immunologic or idio-pathic disease that requires immunosuppressive treatment and the response to such treatments in real clinical practice. Observational, descriptive, longitudinal, and retrospective study of a cohort of patients diagnosed with idiopathic uveitis or autoimmune disease-related uveitis. To assess the response to treatment we have evaluated the change in visual acuity and vitritis and the presence of macular edema. We included 356 patients. Twelve percent required treatment with systemic corticosteroids and 66 patients (18.5%) immunosuppressive/biological treatment, with metho-trexate being the most used (55%). Immunosuppressive drugs were used in 59 cases the least re-sponsive being mycophenolate mofetil. Ten patients of the 66 (15%) started treatment with bio-logics. Thirty-five patients (53%) needed to switch drugs due to a lack of response to the first one. There were no differences between different drugs in the resolution of vitritis and improvement of vision. The disappearance of macular edema was achieved in all patients treated with tocilizumab. The use of systemic corticosteroids and Immunosuppressive/biologics was necessary for a high number of patients with non-infectious uveitis. In our series tocilizumab was significantly more effective in the resolution of macular edema.
... [4][5][6] Anterior uveitis is less frequent in India, Japan, Korea, and South Africa, probably due to the low prevalence of the HLA-B27 haplotype in those populations. [7] Chronic and recurrent anterior uveitis comprises approximately 11%-31% of all anterior uveitis cases. [8,9] Anterior uveitis is considered to have a better prognosis in terms of visual acuity and rate of ocular complications compared to other types such as intermediate, posterior, and pan-uveitis. ...
Purpose
To study the long-term clinical outcome and treatment strategies of recurrent and chronic non-infectious anterior uveitis.
Methods
Multicenter study of anterior uveitis patients from 2001 to 2022. Outcome measures included ocular complications, medical and surgical therapies, and visual acuity measured at the beginning of follow-up and at 1, 2, and 5 years thereafter.
Results
In total, 76 patients were included, with a mean follow-up of 6.8 years. Idiopathic anterior uveitis was the most common etiology (56%). Immunomodulatory agents (IMAs) were used in almost half of the cohort. Early initiation of IMAs was associated with a lower risk of developing glaucoma ( P = 0.019). Mean best corrected visual acuity (BCVA) improved after 5 years in both groups. Early use of immunomodulation was correlated with a better visual outcome at 2 years ( P = 0.024).
Conclusion
Chronic and recurrent anterior uveitis were associated with greater risk than expected for ocular complications, surgeries, and vision impairment. Early initiation of immunomodulation should be strongly considered to improve clinical course and outcome.
... Vogt-Koyanagi-Harada (VKH) disease is one of the most common uveitis [1]. Uveitis is the leading cause of vision loss and accounts for an estimated 25% of all blindness cases in Western and developing countries [2]. ...
Vogt–Koyanagi–Harada disease (VKH) is an autoimmune disease, and glucocorticoid therapy (GC) is widely used for VKH. We provided a profile of leukocyte populations and serum cytokines in VKH patients under GC. A prospective observational study was conducted on three treatment-naïve VKH patients. Peripheral blood samples were collected from the patients before GC (VKH-acute) and after 6 months (VKH-remission), and healthy individuals were used as controls. Proportions of 37-type leukocytes and levels of 27-kind cytokines were measured by mass cytometry and multiplex bead analysis. Property similarity was analyzed using hierarchical cluster analysis. The leukocytes and cytokines were broadly classified into four and three clusters: (1) a cluster with high intensity in VKH-acute consisting of B cells, Th2-like, Th17-like, basophils, and IL-7 and IP-10; (2) a cluster with high intensity in VKH-remission composed of monocytes, neutrophils, IL-4, and TNFα; in leukocytes, (3) a cluster with low intensity in VKH-acute and -remission consisting of CD8+ T cells, Th1-like, and NKT cells; (4) a cluster with low intensity in VKH-remission composed of NK cells, Tregs, and DCs; and in cytokines, (5) a cluster with high intensities in VKH-acute and -remission comprising G-CSF, MCP-1, eotaxin, and IL-17A. These findings suggest that inflammatory composition in blood during the acute phase of VKH represents complex hyperimmune responses dominantly driven by Th and B cells.
... compared to those living in Asia (0.63%, 95% CI 0.06%-1.32%). The possible explanation for the regional difference may be that autoimmune uveitis was the most common subtype of uveitis in Europe, and a large number of patients with autoimmune diseases other than IBD were also prone to uveitis (Chang & Wakefield, 2002). In addition, there is evidence that lifestyle and environmental factors in developed countries contribute to the risk of IBD. ...
Purpose
Uveitis is one of the ocular manifestations of inflammatory bowel disease (IBD) that is often overlooked and has been considered a sign of severe IBD. As typical subtypes of IBD, differences exist in the prevalence of uveitis between Crohn's disease (CD) and ulcerative colitis (UC). Our study systematically assessed differences in the prevalence of uveitis between CD and UC.
Methods
The Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines were used. We performed a systematic review of published literature from PubMed and Embase on 30 March 2022. Two investigators independently selected studies, extracted data and evaluated methodological quality. Either a fixed‐ or a random‐effects model was used to calculate the risk ratio (RR), odds ratio (OR) and 95% confidence interval (95% CI) depending on the heterogeneity of studies. Sensitivity analysis was used to examine the heterogeneity by removing article by article, while subgroup analysis was conducted in accordance with various regions.
Results
Our study included data from 14 studies encompassing 115 854 participants. The prevalence of uveitis in IBD was estimated to be 2.38% (95% CI 1.60%–3.17%). The prevalence of uveitis in CD (3.27%, 95% CI 2.15%–4.39%) was significantly higher than in UC (1.60%, 95% CI 0.93%–2.27%; RR 1.76, 95% CI 1.39–2.22, p < 0.05). In subgroup analysis, a higher incidence of CD combined with uveitis was also observed in IBD patients residing in Europe (RR 1.75, 95% CI 1.37–2.24).
Conclusions
Data from 115 854 IBD patients showed that CD patients were more likely to suffer from uveitis than UC patients. Ocular manifestations in IBD, particularly CD, warrant greater attention.
... In contrast, AU is the second most common form of uveitis, falling behind posterior uveitis, in Asian countries, with relatively lower frequencies of HLA-B27 positive idiopathic AU and spondyloarthropathies in these populations. 11,12,74,79 In general, intraocular inflammation arises from the dysfunction of natural defense mechanisms in the eye. Disrupting the blood-ocular barrier leads to leukocyte infiltration, protein leakage, and spillover of the inflammatory cells from the uveal tissue into the AC. ...
... Additionally, over 50% of individuals affected by these conditions will develop associated complications, and more than 30% will suffer visual impairment. [4][5][6][7] Thus, NIU can have a strong negative socioeconomic impact on these patients, many of whom are in the working-age group, 8 ...
ABSTRACT
Purpose: To assess factors that impact the risk of relapse in patients with non-infectious uveítis (NIU) who undergo adalimumab tapering after achieving remission.
Design: Retrospective study.
Methods:
- Setting: Multicenter study.
- Study Population: Patients with NIU treated with adalimumab and subsequently tapered.
- Observation Procedure: Patient demographics, type of NIU, onset and duration of disease, period of inactivity before tapering adalimumab and tapering Schedule were collected.
- Main Outcome Measures: Independent predictors of the rate of uveitis recurrence after adalimumab tapering.
Results: 328 patients were included (54.6% female) with a mean age of 34.3 years. The mean time between disease onset and initiation of adalimumab therapy was 35.2±70.1 weeks.
Adalimumab tapering was commenced after a mean of 100.8±69.7 weeks of inactivity. Recurrence was observed in 39.6% of patients at a mean of 44.7±61.7 weeks. Patients who experienced recurrence were significantly younger than those without recurrence (mean 29.4 years vs. 37.5 years, p=0.0005) and the rate of recurrence was significantly higher in younger subjects (HR=0.88 per decade of increasing age, p=0.01). The lowest rate of recurrence was among Asian subjects. A faster adalimumab taper was associated with an increased recurrence rate (HR=1.23 per unit increase in speed, p<0.0005). Conversely, a more extended period of remission prior to tapering was associated with a lower rate of recurrence (HR=0.97 per 10-weeks longer period of inactivity, p=0.04).
Conclusions: When tapering adalimumab, factors that should be considered include patient’s age, race, and duration of disease remission on adalimumab. A slow tapering Schedule is advisable.
... Numbers are per eyes.DiscussionUveitis comprises a wide range of intraocular in ammatory disorders of various aetiologies. The type, clinical associations and causes of uveitis are strongly in uenced by genetic, ethnic, geographic, nutritional and environmental factors.17 MMC enhanced trabeculectomy has considerably increased the success rate of glaucomas with high risk for surgical failure including uveitic glaucoma. ...
Purpose
To evaluate the outcomes of initial trabeculectomy in granulomatous and non-granulomatous uveitis.
Methods
Retrospective comparative study of 68 eyes that underwent an initial trabeculectomy.
Results
The mean follow-up was 74.18 and 74.86 months in both groups (p = 0.95). The intraocular pressure decreased from 40.03 mmHg (± 7.2) and 36.48 mmHg (± 11.3) to 14.00 mmHg (± 6.2) and 13.48 mmHg (± 5.7), the number of medications decreased from 3.73 (± 0.7) and 3.58 (± 0.9) to 1.00 (± 1.4) and 1.13 (± 1.4) on the last follow-up (p < 0.01) in the granulomatous and non-granulomatous groups, respectively. More eyes in the granulomatous uveitis group developed delayed postoperative complications like cataract, transient hypotony and glaucoma progression. Success rates were 64.9 and 71.0%, while failure rates were 35.1 and 29.0% in both groups (p = 0.84).
Conclusions
Trabeculectomy seems to have comparable IOP control and survival in granulomatous and non-granulomatous uveitis. Nevertheless, more eyes in the granulomatous uveitis group developed late onset complications.
... The prevalence of VKH disease varies among different countries and ethnic groups (18). In Asian, VKH disease represents one of the most common uveitis entities (25). VKH disease is a complex disease involving multiple interactions among different immune cell populations (18). ...
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a serious pandemic. COVID-19 vaccination is urgent needed for limiting SARS-CoV-2 outbreaks by herd immunity. Simultaneously, post-marketing surveillance to assess vaccine safety is important, and collection of vaccine-related adverse events has been in progress. Vision-threatening ophthalmic adverse events of COVID-19 vaccines are rare but are a matter of concern. We report a 45-year-old Japanese male with positive for HLA-DR4/HLA-DRB1*0405, who developed bilateral panuveitis resembling Vogt-Koyanagi-Harada (VKH) disease after the second dose of Pfizer-BioNTech COVID-19 mRNA (BNT162b2) vaccine. Glucocorticosteroid (GC) therapy combined with cyclosporine A (CsA) readily improved the panuveitis. The immune profile at the time of onset was analyzed using CyTOF technology, which revealed activations of innate immunity mainly consisting of natural killer cells, and acquired immunity predominantly composed of B cells and CD8⁺ T cells. On the other hand, the immune profile in the remission phase was altered by GC therapy with CsA to a profile composed primarily of CD4⁺ cells, which was considerably similar to that of the healthy control before the vaccination. Our results indicate that BNT162b2 vaccine may trigger an accidental immune cross-reactivity to melanocyte epitopes in the choroid, resulting in the onset of panuveitis resembling VKH disease.
... Uveitis is a potentially blinding ocular inflammatory group of diseases affecting all range of ages and both males and females [1]. It can be triggered by genetic and environmental factors with the majority of them are still being explored [2]. In order to treat and more importantly prevent uveitis attacks, there is a need to identify these triggers and to ...
Purpose
To explore the effect of pregnancy on the clinical course, outcome, and treatment in multiparous women with non-infectious uveitis.
Methods
Retrospective study of women with a history of non-infectious uveitis and pregnancies prior to and during disease course. Disease activity and severity 1-year prior pregnancy, during pregnancy, and 1-year postpartum were recorded as well as patients’ and diseases’ characteristics. The main outcome measures included the rate and severity of uveitis attacks and the effect on ocular complications and therapies.
Results
Included were 32 women (70 pregnancies, mean of 2.6 pregnancies/patient), with a mean follow-up time of 6.5 years. The most common uveitis types were anterior (31%) and pan-uveitis (31%). Flare-ups were more frequent in the year prior to pregnancy, in the first trimester, and in the postpartum period and decreased markedly during pregnancy. Women who experienced a flare-up during pregnancy had a higher rate of flare-ups in the year prior pregnancy than those who did not experience a flare-up during pregnancy (p-0.047). The rate of flare-ups 12 months’ postpartum was also higher compared to women without any flare-up during pregnancy (p = 0.01). Severity of flare-ups in the postpartum period was worse in women who experienced a flare-up during pregnancy compared to women without flare-ups (p = 0.001). The severity of flare-ups was higher in the first pregnancy compared to subsequent pregnancies.
Conclusions
Women who had active or non-controlled uveitis prior to pregnancy have higher disease activity and severity during pregnancy as well. The first pregnancy seems to behave differently from subsequent pregnancies, in terms of disease severity.
... Many studies have shown differences in the clinical manifestation of uveitis in correlation with sex, age, race, genes, socioeconomic factors, environmental exposure, geographical region, and immunological response [11][12][13][14]. These studies have been crucial to the early diagnosis and management of the disease [10,15,16]. ...
Purpose
To describe the distribution patterns and clinical characteristics of patients diagnosed with uveitis at a specialized uveitis center in Bogotá, Colombia, from 2013 to 2021 and compare these patterns with the previously reported between 1996 and 2006.
Methods
We performed an observational descriptive cross-sectional study systematically reviewing clinical records of patients attending between 2013 and 2021. Data were analyzed and compared with previous reports.
Results
Of the 489 patients with uveitis, 310 were females (63.4%). The mean age of onset was 38.7, with a range between 1 and 83 years. Bilateral (52.8%), anterior (45.8%), non-granulomatous (90.8%), and recurrent (47.6%) were the most common types of uveitis found in our population sample. The most common cause of uveitis in this study was idiopathic, followed by toxoplasmosis and HLA-B27 + associated uveitis, which differs from the previous Colombian study where ocular toxoplasmosis was the most frequent cause. This highlights a significant shift from infectious etiologies to more immune-mediated processes as the cause of uveitis in Colombia nowadays.
Conclusion
The results of this study provide a comparison between the clinical patterns of presentation of uveitis from 1996 to 2006 and the patterns observed from 2013 to 2021, enhancing awareness about the changing dynamics of uveitis in Colombia to guide a better understanding of the diagnosis, classification, and correlation with other systemic conditions of the disease.
... Uveitis is a known inflammation of eye, specifically the inflammation of the middle layer of the eye wall tissue, called uvea. Several inflammatory signs including eye redness, foggy vision and pain rise up suddenly, and worsening of the situation can result in severe problems including vision loss (Chang and Wakefield, 2002;Wakefield and Chang, 2005;Bose et al., 2016). Development of lipopolysaccharide-induced uveitis was efficiently suppressed by FX in male Lewis rats, as described in a study by Shiratori et al. (2005). ...
Fucoxanthin (FX) is a special carotenoid having an allenic bond in its structure. FX is extracted from a variety of algae and edible seaweeds. It has been proved to contain numerous health benefits and preventive effects against diseases like diabetes, obesity, liver cirrhosis, malignant cancer, etc. Thus, FX can be used as a potent source of both pharmacological and nutritional ingredient to prevent infectious diseases. In this review, we gathered the information regarding the current findings on antimicrobial, antioxidant, anti-inflammatory, skin protective, anti-obesity, antidiabetic, hepatoprotective, and other properties of FX including its bioavailability and stability characteristics. This review aims to assist further biochemical studies in order to develop further pharmaceutical assets and nutritional products in combination with FX and its various metabolites.
Purpose:
This study aimed to investigate demographic features, diagnoses of uveitis (intraocular inflammation), and real-world clinical practice in the use of local and systemic therapies for patients with uveitis in Tokyo, Japan.
Methods:
Clinical records of 1,174 consecutive new patients (480 males, 694 females) referred to the Kyorin Eye Center, Kyorin University Hospital between January 2011 and December 2018 were retrospectively reviewed.
Results:
Mean age at presentation was 52.6 years (range 4-94 years). By anatomic location, 439 patients (37.4%) had anterior uveitis, 18 (1.5%) had intermediate uveitis, 214 (18.2%) had posterior uveitis and 503 (42.8%) had panuveitis. The 3 most common diagnoses were sarcoidosis (9.1%), Vogt-Koyanagi-Harada (VKH) disease (8.3%), and acute anterior uveitis (5.7%). Compared to our previous study, rates of herpetic anterior uveitis and cytomegalovirus (CMV) retinitis increased while tuberculosis-related uveitis decreased. Unclassified uveitis remained the most common diagnosis (44.9%). Systemic corticosteroids and/or immunomodulatory agents were used in only 18.3% of patients. Immunomodulatory drugs including biologic agents were utilized in 4.9% of patients.
Conclusions:
The most common uveitis anatomic type was panuveitis due mainly to high rates of sarcoidosis and VKH disease. Diagnoses of herpetic anterior uveitis and CMV retinitis increased, while tuberculosis-related uveitis decreased. Less than one-fifth of uveitis patients required systemic treatment.
Purpose:
To characterize the spectrum of uveitis in patients visiting three tertiary hospitals in Hanoi, Vietnam.
Methods:
This study collected prospective and multicenter data from patients diagnosed with uveitis at three tertiary hospitals in Hanoi City, Vietnam, between January 2022 and January 2024. Data on age, sex, clinical and laboratory findings, and etiology were collected.
Results:
Of 410 patients included, 54.6% were women. The mean age of patients was 39.9 years. Most cases were unilateral and chronic. Anterior uveitis was the most common case (40%), followed by panuveitis (30%), posterior uveitis (26.1%), and intermediate uveitis (3.9%). Undifferentiated uveitis, accounting for 32%, was the most prevalent form across all anatomical groups. The leading etiologies for anterior uveitis included Posner-Schlossman syndrome (18.5%), cytomegalovirus (CMV)-induced uveitis (11%), and Herpes simplex virus-induced uveitis (8.5%). For posterior uveitis, the primary causes were Vogt-Koyanagi-Harada (VKH) syndrome (17.8%), toxocariasis (10.3%), and toxoplasmosis (6.5%). The identified causes of panuveitis included VKH syndrome (24.4%), Behcet's disease (15.4%), and CMV-induced panuveitis (5.7%). We observed six cases of uveitis associated with Haemophilus influenzae (1.5%) without any concomitant systemic symptoms. In our patient population, the most common complication was cataract (11.2%), followed by uveitic macular edema (11%).
Conclusions:
Various uveitis patterns were observed among Vietnamese patients, with non-infectious uveitis being predominant.
Introduction
Uveitis is characterized by inflammation of uveal tissue which can lead to significant loss of vision if not treated promptly. The uveitis pattern differs from region to region. There are various studies available from South, North, West and other parts of India but none from Tripura.
Materials and Methods
This prospective observational study was done to identify the pattern of uveitis in patients attending a tertiary care hospital at Tripura Medical College & Dr. BRAM teaching Hospital between March 2022 to September 2023. Tailored investigations were performed to find the specific cause of uveitis.
Results
A total of 125 patients with uveitis were included. Anterior uveitis (64%) was the most common followed by Panuveitis (16.8%), Intermediate uveitis (12%) and posterior uveitis (7.2%). The specific diagnosis could be established in 45 (36%) cases. The infective etiology was seen in 13 (10.4%) patients, of which Herpetic cause was the commonest cause seen in 6 (4.8%) patients. Non infective etiology was seen in 32 (25.6%) patients, of which seronegative spondyloarthritis was the commonest cause seen in 14 (11.2%) followed by VKH in 6 (4.8%).
Conclusion
Anterior uveitis with less severe form is more common and of them idiopathic form is more common followed by uveitis due to seronegative spondyloarthritis. Herpetic uveitis is more common infective uveitis in this study.
Purpose:
To investigate the patterns and outcomes of pediatric uveitis.
Methods:
Retrospective review of patients with uveitis in pediatric age group.
Results:
A total of 184 patients (335 eyes) were included. There were 96 (52.2%) boys and 88 (47.8%) girls, with a mean age of 12.8 ± 3.4 years at presentation. Panuveitis was most common (55.2%), followed by anterior uveitis (29.6%), intermediate uveitis (12.2%) and posterior uveitis (3%). Uveitis was non-granulomatous in 71% and non-infectious in 94.6% of the eyes. The most identifiable specific diagnoses were Vogt-Koyanagi-Harada (VKH) disease (21.2%), juvenile idiopathic arthritis (6.5%), sarcoidosis (4.3%), and presumed tuberculous uveitis (3.3%). After 1-year follow-up, 85.4% of the eyes achieved visual acuity of 20/40 or better.
Conclusions:
The most common anatomic diagnosis was panuveitis. VKH disease was the most frequently diagnosed entity.
Ophthalmic diseases include a wide array of conditions, each requiring individualized treatment approaches. In ophthalmic research and as therapeutics against potential pharmacological indications, several subtypes of exosomes (EVs) have been reconnoitered, mainly for their regenerative, neuroprotective, and anti-inflammatory characteristics. EVs are recently gaining wider attention as promising vehicles for therapies because of their natural participation in communication between cells and targeted delivery. These small vesicles, derived from cells, transport numerous molecules between cells, thus contributing advantages like low immunogenicity, stability, and the ability to target cells specifically. These inherent advantages of carrying the therapeutic cargo and enabling intercellular signaling make them a captivating avenue for progressing ophthalmic disease treatment options. While research is ongoing, and clinical applications are still emerging, several EV subtypes have shown promise for possible applications in addressing several ophthalmic diseases, such as glaucoma, age-related macular degenerative disorders, retinal degenerative disorders, and ocular inflammatory conditions.
Bacground
Idiopathic uveitis is the most common uveitis type and is viewed as an inconclusive diagnosis for patients as well as physicians. Human leukocyte antigen (HLA) typing helps in understanding the pathogenesis of several diseases. Limited knowledge is known regarding the association of HLA with idiopathic uveitis.
Aim
This was a cross-sectional observational case–control study evaluating HLA-A and HLA-B allelic and phenotypic frequencies in patients with idiopathic uveitis.
Patients and methods
HLA-A and HLA-B molecular typing by PCR-sequence-specific oligonucleotide probes and LIRAS interpretation software was performed for 60 patients with idiopathic uveitis and 60 controls recruited from Kasr Al-Ainy Hospitals, Cairo University.
Results
Anterior uveitis pattern was the most common (55%), followed by pan-uveitis (35%) and posterior uveitis (10%). Overall, 40% of patients had bilateral uveitis, whereas 60% had unilateral uveitis. A total of 23 HLA-A and 43 HLA-B variant alleles were detected. HLA-A*09 and HLA-A*10 allele and phenotype frequencies were significantly higher in the patient group ( P =0.023 and 0.034, and P= 0.013 and 0.029, respectively). HLA-B*07 allele and phenotype frequencies were significantly higher in the control group ( P =0.007 and 0.006, respectively). HLA-B*27 and HLA-B*05 were detected in 8.3 and 26.7%, respectively, with no significant difference.
Conclusion
HLA-A*09 and HLA-A*10 alleles were statistically significantly higher in patients with idiopathic uveitis. HLA-B*07 might be a protective allele against disease development. Larger cohort needs to be tested to validate these findings. Routine HLA typing and proper follow-up for primarily diagnosed idiopathic uveitis is recommended as it might reveal secondary causes for uveitis, especially in patients with positive HLA-B*27 and HLA-B*05 .
Objective:
To determine the clinical and epidemiological characteristics of patients with noninfectious uveitis at a university hospital in Paraguay.
Methodology:
An observational, descriptive, cross-sectional, retrospective study was performed. Consecutive patients who attended the Ophthalmology Service of the Hospital de Clínicas from January 2020 to October 2021 and who were diagnosed with non-infectious uveitis were included. The variables studied were sex, age, origin, reason for consultation, anatomical classification, clinical course, systemic and ocular associations, and bilaterality.
Results:
A total of 78 medical records of patients meeting the inclusion and exclusion criteria were analyzed. Of the patients, 66.7% were female and 42 (53.8%) were from the Central Department. The anterior anatomical location of uveitis was the most frequent (53.9%), followed in decreasing order by panuveitis, posterior uveitis, and intermediate uveitis. Regarding anterior uveitis, 24 patients (57.1%) had unilateral uveitis, 40 (95.2%) were non-granulomatous, 19 (45.2%) presented an acute clinical course, the most frequent reason for consultation was "red and painful eye" with 15 patients (35.7%), the most frequent systemic association was HLA- B27+ in 16 patients (38.1%). As for panuveitis, 13 patients (50%) were associated with Vogt-Koyanagi-Harada syndrome, and of the latter, two patients were related to rheumatoid arthritis.
Conclusion:
The clinical and epidemiological patterns observed in this study were largely consistent with those reported in the literature. Notably, the most frequent associations differed from those reported in the literature: HLA-B27+ for anterior uveitis, rheumatoid arthritis for posterior uveitis, and a significant percentage of Vogt-Koyanagi-Harada syndrome among panuveitis cases.
Fuchs Uveitis Syndrome (FUS), also known as Fuchs Heterochromic Iridocyclitis, is a chronic form of uveitis characterized by mild inflammation primarily affecting one eye. This study aimed to investigate the clinical and epidemiological features of FUS in an Iranian population. A retrospective analysis was conducted on 466 patients diagnosed with FUS at an ophthalmology center affiliated with Isfahan University of Medical Sciences between 2003 and 2021. The Kimura et al. criteria were used for FUS diagnosis. Demographic data, clinical characteristics, misdiagnosed cases, concurrent diseases, and associated ocular findings were analyzed. The study included 507 eyes of 466 FUS patients, with a mean age of 34.01 ± 11.25 years. Iris atrophy, keratic precipitates, and vitritis were common clinical findings. Heterochromia was an infrequent feature. Initial misdiagnosis occurred in 13 patients, with pars planitis being the most common incorrect diagnosis. Toxoplasmosis and multiple sclerosis were common concurrent diseases. Pediatric FUS cases were noted, possibly attributed to early-onset manifestations. Differences in clinical characteristics were observed when compared to other populations. This study provides insights into the clinical and epidemiological aspects of FUS in an Iranian population. Variations in clinical features, misdiagnosis patterns, and concurrent diseases were noted. Attention to specific clinical parameters can aid in accurate FUS diagnosis. Understanding these differences contributes to a better understanding of FUS presentation and its relationship with other diseases.
Purpose:
To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center.
Methods:
Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center.
Results:
Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs.
Conclusions:
The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.
Anterior Uveitis (AU) is the inflammation of the anterior part of the eye, the iris and ciliary body and is strongly associated with HLA-B*27. We report AU exome sequencing results from eight independent cohorts consisting of 3,850 cases and 916,549 controls. We identify common genome-wide significant loci in HLA-B (OR = 3.37, p = 1.03e-196) and ERAP1 (OR = 0.86, p = 1.1e-08), and find IPMK (OR = 9.4, p = 4.42e-09) and IDO2 (OR = 3.61, p = 6.16e-08) as genome-wide significant genes based on the burden of rare coding variants. Dividing the cohort into HLA-B*27 positive and negative individuals, we find ERAP1 haplotype is strongly protective only for B*27-positive AU (OR = 0.73, p = 5.2e-10). Investigation of B*27-negative AU identifies a common signal near HLA-DPB1 (rs3117230, OR = 1.26, p = 2.7e-08), risk genes IPMK and IDO2, and several additional candidate risk genes, including ADGFR5, STXBP2, and ACHE. Taken together, we decipher the genetics underlying B*27-positive and -negative AU and identify rare and common genetic signals for both subtypes of disease.
In this study, we reported the patterns, epidemiology, and clinical features of anterior uveitis (AU) in Taiwan, an area of Eastern Asia. This prospective, cross-sectional case series study was performed to identify patients with AU at two tertiary medical centers (Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Veterans General Hospital) located at the southern Taiwan between December 1, 2018, and March 31, 2020. The clinical diagnoses, ocular presentations, and laboratory data, including the results of the aqueous polymerase chain reaction tests, were investigated in these patients. A total of 112 patients, with a mean age of 48.9 years, were included. Most patients (87.5%) presented with unilateral eye disease, with 30 cases of ocular hypertension at the first presentation (27%). The most common clinical diagnoses were idiopathic AU (37.5%), human leukocyte antigen (HLA)-B27-associated acute AU (25.0%), and herpetic AU (18.8%). Among patients with herpetic AU, cytomegalovirus (CMV) was the most common pathogen (17/21, 81%). Compared to HLA-B27-associated acute AU, CMV-related AU was mostly observed in patients that were older in age, exhibited higher intraocular pressure, more keratic precipitates, greater iris atrophy, and more pseudophakia, but was least reported in those with posterior synechiae. This prospective study identified the pattern and clinical features of AU in southern Taiwan.
Purpose of the review
The purpose of this review is to provide a comprehensive summary of observational studies evaluating anxiety and depression in patients with uveitis.
Recent findings
A higher prevalence of depression was reported in patients with uveitis compared to healthy controls in most observational studies. Symptoms of anxiety were often, but not always, significantly worse in patients with uveitis compared to controls. Most studies found that patients with uveitis had reduced vision-related quality of life that was associated with anxiety and depression symptoms.
Summary
Patients with uveitis have a higher risk of experiencing symptoms of depression and could benefit from screening and treatment. Preliminary screening for vision-related quality of life could also help determine if the patient requires assistance in mental health or other aspects of daily living.
Objectives
This study is aimed at identifying critical therapeutic targets of Astragalus membranaceus (Huangqi (HQ)) and investigating the effects and mechanisms of HQ treating uveitis. The potential drug targets of HQ and main active ingredients were obtained from the traditional Chinese medicine (TCM) systems pharmacology database and analysis platform (TCMSP, http://tcmspnw.com ).
Materials and Methods
Cytoscape software was used to identify the disease targets of uveitis. Drug targets and disease targets were compared, and intersected hubs were applied for the active ingredient-target network and protein-protein-interaction (PPI) network construction. Signaling pathway enrichment annotation was performed to identify possible signaling involved in uveitis treatment. An endotoxin-induced uveitis (EIU) model was established, and the therapeutic effects of total flavonoids of Astragalus (TFA) on uveitis were investigated by examining the improvement of eye symptoms, histopathological alterations, and the levels of cytokines.
Results
Based on network pharmacological analysis, HQ could modulate the initiation and progression of uveitis by reducing the production of cytokines and regulating cell apoptosis via the NOD-like receptor (NLR), apoptosis, and toll-like receptor (TLR) signaling pathways. Based on animal experiments, high-dose TFA could reduce rat’s iris congestion, reduce anterior chamber exudation and pus, restore pupil size, and decrease the release of inflammatory factors IFN-γ and IL-10. Network pharmacological and experimental analyses revealed that TFA regulates the release of inflammatory factors through the NLR and TLR signaling pathways, thus regulating the immune system of EIU rats and ultimately relieving inflammation responses in uveitis rats.
Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) and serpiginous choroiditis are two diseases classified as "white spot syndromes." Both are inflammatory/autoimmune diseases with suspected primary involvement of the choriocapillaris. The former usually has an excellent prognosis, while the latter can rapidly induce legal blindness. Whereas these diseases are well defined and well known, other entities (such as persistent placoid maculopathy or ampiginous choroiditis) with features of both APMPPE and serpiginous choroiditis have been described more recently. This review aims to describe demographic characteristics and multimodal imaging features to help differentiate between these four diseases.
Purpose:
To explore the patterns of uveitis in a main ophthalmic referral center in the Eastern province of Saudi Arabia.
Methods:
A retrospective chart review of uveitis cases was conducted in a tertiary eye hospital for five years. In addition, a comprehensive review of Saudi publications about uveitis patterns in the literature.
Results:
Out of 222 patients included, 54.4% were females, with a mean age of 38.5 years. Uveitis was bilateral in 55.7%, non-granulomatous in 55.9%, and infectious in 11.3%. Most of the cases were anterior uveitis (51.1%), followed by panuveitis (26%), intermediate uveitis (12.8%), and posterior uveitis (10%). Apart from idiopathic cases (43.7%), the most common diagnoses were Vogt-Koyanagi-Harada disease (11.3%) and Behcet's disease (7.7%) in adults. Juvenile idiopathic arthritis (7.2%) was commonest among children. Posterior synechiae was the leading complication (32.0%), followed by cataracts (22.8%).
Conclusions:
VKH and Behçet disease were the primary non-idiopathic etiologies in Saudi Arabia.
In this article, we present a review of patient-reported outcome measures (PROMs) used to evaluate the quality of life (QoL) in uveitis and provide a quality assessment of the psychometric properties of the PROMs, making it easier to choose the best questionnaire for uveitis. Our review included 158 articles. A total of 98 PROMs were used to measure QoL in uveitis and the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ 25) was the most frequently used PROM in these studies. There were five uveitis-specific PROMs, but they were meant for either birdshot choroidopathy or cytomegalovirus (CMV) retinitis or paediatric uveitis. There are no PROMs developed explicitly for the more common, anterior uveitis, intermediate uveitis, panuveitis and chronic uveitis. The uveitis specific PROMs performed better in our quality assessment criteria compared to other PROMs. However, these PROMs were constructed using traditional classical test theory and have not been assessed using the modern family of psychometric assessment methods such as Rasch analysis. As new therapeutic modalities for uveitis such as the new biological agents and steroid implants continue to evolve, a comprehensive PROM will be increasingly valued in clinical trial settings to compare the effects of treatments from the patient perspective.
Purpose:
To elucidate detailed epidemiological profile of common types of anterior uveitis (AU) in real-world clinical setting of a tertiary facility in Japan, and to evaluate the characteristic clinical findings at initial presentation.
Study design:
Retrospective cohort study.
Methods:
Clinical charts of 275 patients (335 eyes) aged 52.5 ± 19.1 years were reviewed retrospectively. Herpetic AU was diagnosed by multiplex polymerase chain reaction tests using aqueous humor. Time of uveitis onset, gender, laterality, disease course since the initial onset of AU, visual acuity (VA) and intraocular pressure (IOP) at first visit, and definitive diagnosis were collected from clinical charts.
Results:
Acute AU (AAU) was the most common (21.8%) form of AU; followed by herpetic AU (20.7%) comprising Herpes Simplex Virus (HSV) (8.0%), Varicella Zoster Virus (VZV) (9.1%) and cytomegalo virus (CMV) (3.6%); scleritis (13.5%); diabetic iritis (7.6%), and Posner-Schlossman syndrome (5.5%). Unilateral AU constituted 78.2%, and VA less than 20/30 accounted for 31.2%. Of all the eyes, 16.1% had an IOP higher than 20 mmHg, out of which 37.0% had herpetic AU, followed by scleritis in 25.9%, and Posner-Schlossman syndrome (PSS) in 11.1%. AU patients over 60 years of age were 40.4%, in which 34.2% had herpetic AU, followed by scleritis in 14.4% and AAU in 13.5%. Herpetic AU patients were significantly older and had higher IOP compared with AAU patients.
Conclusion:
The most frequent AU was AAU, followed by herpetic AU. Herpetic AU patients were older and had higher intraocular pressure than AAU patients, although VA was equally impaired in both groups.
Introduction:Anterior uveitis includes iritis, iridocyclitis and anterior cyclitis. Aim of the study is to evaluate clinical profile of anterior uveitis in tertiary care centre in Western Maharashtra. Methodology:An observational ,descriptive , cross sectional study was conducted at tertiary care hospital in rural set up. A total 35 eyes of 27 patients diagnosed with anterior uveitis were evaluated. All patients underwent complete ophthalmic evaluation and systemic examination. Results:This study included 35 eyes of 27 patients. Anterior uveitis affected most commonly in people of age group of 5th and 6th decade. No gender predilection was seen. In majority of patients etiology was idiopathic (19 cases /70.37%) while of Rheumatoid Arthritis 2 cases were seen (7.40%). Majority of patients had non- granulomatous type of uveitis 91.42%. Unilateral presentation was seen in 70.37% of cases. Most common complication seen was complicated cataract seen in 7 eyes (20%).). Most of the eyes with anterior uveitis had cells of grade grade 2+( 37.14 %) and flare 1+ (28.57%). Conclusion:Anterior uveitis was most commonly observed in 5th and 6th decade of life. In most of the patients etiology was idiopathic. Acute anterior uveitis was most common common case presentation. Majority of patients of anterior uveitis had unilateral involvement and complicated cataract was the most common complication seen.
In the second in our series developed by great Ormond Street Hospital, Reshma Pattani explains uveitis and how it can affect children
Background
In Thailand, several novel laboratory investigations are recently available to help differentiate the uveitic etiologies. The update on uveitis epidemiological data in Thailand is necessary to better understand the disease burden and provide guidance on management. The current study aims to describe the prevalence and identify factors associated with poor visual outcomes of uveitis patients at a tertiary center in Thailand.
Methods
A 5-year-prospective study of uveitis cases presented at a tertiary referral center in the central region of Thailand is conducted.
Background: Since prevalence of the Severe Acute Respiratory Syndrome 2 (SARS-CoV-2), millions of infected people presented with various manifestations. Some studies report ocular complications, such as conjunctivitis and sub-conjunctival haemorrhage, as an initial manifestation of Corona Virus Disease 2019 (COVID-19). This article aims to report unilateral acute anterior non-granulomatous uveitis manifested in COVID-19. Systemic work up and laboratory results, confirmed the diagnosis.
Materials and Methods: A 37-year-old female patient with a history of hypothyroidism, fever, weakness and lethargy, throbbing chest pain, non-productive cough and diffuse painful redness of the left eye with positive COVID-19 polymerase chain reaction (PCR) test from nasopharyngeal and oropharyngeal swabs and erythrocyte sedimentation rate of 43 mm/h is reported.
Results: Demographically, the patient was a 37-year-old female. On ophthalmologic examination, right and left eye vision were 10/10 and 5.10, respectively. The relative afferent pupillary defect was negative. External ocular motility was within normal limits. On slit lamp biomicroscopy, conjunctival peri-limbal injection, 2+ cells and 3+ flares in the anterior chamber of the left eye, posterior synechiae was seen and the vitreous cavity was clear. Right eye examination was completely normal.
Conclusion: Covid-19 can be associated with ocular involvement as acute non-granulomatous anterior uveitis, which can be prevented ocular complications and vision loss if diagnosed and treated early. Acute anterior non-granulomatous uveitis can also be an early sign of Covid-19 disease, which should raise clinical suspicion of the disease and therefore reduce the morbidity and mortality of Covid-19 disease by starting timely treatment.
Post-infectious uveitis describes the condition of chronic immune mediated ocular inflammation associated with pathogens such as Mycobacterium tuberculosis (Mtb). Mtb associated post-infectious uveitis can be modeled in mice by intravitreal injection of heat-killed Mtb (HKMtb). To better understand how prior systemic exposure to the pathogen alters the local immune response to Mtb, we used flow cytometry and multiplex ELISAs to compare ocular responses to intravitreal HKMtb in the presence or absence of a systemic “prime” of HKMtb. Priming resulted in exacerbation of local inflammation with significantly increased clinical and histologic inflammation scores and increased vitreous cytokines concentrations one day after intravitreal injection of HKMtb. Seven days after injection, uveitis in unprimed animals had largely resolved. In contrast in primed animals, clinical signs of chronic inflammation were associated with a significant increase in the number of ocular T cells, NK cells, and Ly6Chi macrophages and increasing vitreous concentrations of IL-17, VEGF, MIG(CXCL9), IP-10(CXCL10), IL-12p40 and MIP-1α(CCL3). In mice lacking mature T and B cells (RAG2 deficient), the impact of priming on the ocular immune response was ameliorated with significantly lower vitreous cytokine concentrations and spontaneous resolution of uveitis. Altogether these results suggest that the ocular response to Mtb is exacerbated by prior systemic Mtb infection and chronic post-infectious uveitis is mediated by local production of cytokines and chemokines that amplify Th17 and Th1 responses. This mouse model of chronic Mtb associated uveitis will help elucidate mechanisms of disease in patients with post-infectious uveitis.
Purpose:The aim was to study the pattern of uveitis and any seasonal variation in the incidence of uveitis at a tertiary care hospital. Methods: A observational study was conducted on 150 patients of all new uveitis cases between August 2019 to August 2021 at a tertiary care hospital, J.L.N. medical college and hospital, Ajmer, Rajasthan. We grouped the months into winter, autumn, monsoon, spring and summer according to Indian season. Patients were screened a detailed clinical and laboratory investigation to nd out there clinical etiological causes. Results: There was male predominance (56.7%) with male to female ratio 1.3:1. We found more unilateral (76%) uveitis with more Right eye (38.7%) involvement. Anterior uveitis 97(64.66%) followed by 26(17.34%) Posterior uveitis, 23(15.34%) Intermediate uveitis and rest 4 (2.66%) Panuveitis in anatomical presentation. The incidence of uveitis increases in winter season 49(32.7%) followed by spring 35(23.3%), autumn 33(22.0%), monsoon 26(17.3%) and summer 7(4.7%). Conclusions: Non-infectious uveitis were more common followed by infectious. Idiopathic and HLA-B27 associated uveitis were most common entity and ocular tuberculosis was leading cause of infectious entity. Seasonally uveitis were more in winter, spring and less in summer.
To analyze the referral patterns and diagnosis of uveitis during the past decade in a large tertiary eye center.
The records of 1237 patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary from 1982 to 1992 were classified and analyzed. Data regarding sex, race, nationality, referral site, ages at presentation and onset of uveitis, ocular involvement, clinical characteristics, ocular condition, and systemic disease associations were obtained.
The mean age at onset of uveitis was 37.2 years; the male-to-female ratio was 1:1.4. Most patients were white (85.8%), born in the United States (83.1%), and referred from within New England (84.7%). Anterior uveitis was most common (51.6%), followed by posterior uveitis (19.4%), panuveitis (16.0%), and intermediate uveitis (13.0%). Chronic (58.3%), nongranulomatous (77.7%), and noninfectious (83.1%) were the most frequent types of uveitis. The most common entities included idiopathic (34.9%), seronegative spondyloarthropathies (10.4%), sarcoidosis (9.6%), juvenile rheumatoid arthritis (5.6%), systemic lupus erythematosus (4.8%), Behçet's disease (2.5%), and the acquired immunodeficiency syndrome (2.4%).
The appearance of new uveitic entities, such as the acute retinal necrosis syndrome, multifocal choroiditis and panuveitis, birdshot retinochoroidopathy, and acquired immunodeficiency syndrome-related uveitis, and the reemergence of the classic infectious causes of uveitis, tuberculosis and syphilis, have changed the way we approach the diagnosis and management of posterior and panuveitis at the Massachusetts Eye and Ear Infirmary.
A prospective study was conducted of 865 patients with uveitis to determine the frequency of associated systemic diseases and to assess the value of limited laboratory screening of these patients. All patients underwent a standard diagnostic protocol followed--when indicated--by special tests and procedures performed in order of likelihood ('tailored approach'). For 628 patients (73%) a specific diagnosis was established based on history, ophthalmologic examination, and laboratory and radiographic studies. A definite association with systemic disease was determined for 220 patients (26%). A relationship with a subclinical systemic disorder could be presumed in 201 cases (23%) and a well-established clinical uveitis entity without a recognisable systemic disorder was present in 207 cases (24%). For 237 patients (27%) a diagnosis could not be determined. The most frequently observed systemic diseases were sarcoidosis (7%) and HLA-B27-associated seronegative spondylarthropathies (6%). Presumed or definite toxoplasmosis was encountered in 10% of cases. HLA-B27-associated acute anterior uveitis was the most common clinical entity (17%). In the majority of cases the presence of a systemic disease was not suspected prior to eye involvement and was only recognised after the subsequent diagnostic procedures.
An analysis was made of 1309 patients with uveitis seen at University Hospitals participating in the Uveitis Centre of the Netherlands Ophthalmic Research Institute. In this series B27-associated anterior uveitis was the most frequent entity (18%) followed by Toxoplasma chorioretinitis (7%). Sarcoid uveitis, pars planitis and Fuchs' heterochromic cyclitis each accounted for approximately 4-5% of cases. In 44% of the patients no specific diagnosis could be made. Central diagnosis registration is of great importance when conducting clinical uveitis research.
In 1992, non-onchocercal uveitis caused 9% of blindness, 8% of visual impairment, and 11% of uniocular blindness among patients visiting an eye hospital in Sierra Leone, west Africa. The aim of this study was to determine the aetiology of uveitis in this population.
General and ophthalmic examination complemented by serum and aqueous humour analyses for various infectious agents was performed for 93 uveitis patients and compared with serum (n = 100) and aqueous humour (n = 9) analysis of endemic controls.
At the initial examination, 45 patients (48%) proved to be severely visually handicapped. After clinical and laboratory analyses, an aetiological diagnosis was established for 49 patients (52%). Toxoplasma gondii was the most important cause of uveitis (40/93; 43%). Anti-toxoplasma IgM antibodies were detected in serum samples of seven of 93 patients (8%) compared with one of 100 controls (1%, p < 0.05). At least six patients (15%) with ocular toxoplasmosis had acquired the disease postnatally. Antibodies against Treponema pallidum were detected in 18 of 92 patients (20%) and in 21 controls (21%). Other causes of uveitis were varicella zoster virus (one patient), herpes simplex virus (two patients), and HLA-B27 positive acute anterior uveitis with ankylosing spondylitis (one patient), while one patient had presumed HTLV-I uveitis.
In a hospital population in Sierra Leone, west Africa, uveitis was associated with severe visual handicap and infectious diseases. Toxoplasmosis proved to be the most important cause of the uveitis. Although the distribution of congenital versus acquired toxoplasmosis in this population could not be determined, the results indicate an important role of postnatally acquired disease. The results further suggested minor roles for HIV, tuberculosis, toxocariasis, and sarcoidosis as causes of uveitis in this population.
Reports of racial differences in the incidence of sarcoidosis, a granulomatous disorder of unknown etiology, are primarily based on studies of military and veteran populations. To determine racial differences in sarcoidosis incidence in a metropolitan population the authors conducted a study of newly diagnosed cases that occurred between 1990 and 1994 among members of the Health Alliance Plan health maintenance organization in Detroit, Michigan. The study population was racially heterogeneous, was limited to individuals aged 20-69 years, and comprised about 5% of the Detroit metropolitan area population in that age group. Annual age-adjusted incidence, in number of new cases per 100,000, was highest in African-American females (39.1 cases). The next highest incidence was found in African-American males (29.8 cases), followed by Caucasian females (12.1) and Caucasian males (9.6). African-American females aged 30-39 years were at the greatest risk, with an annual incidence of 107/100,000. Overall, African Americans had about a threefold higher age-adjusted annual incidence (35.5/100,000) compared with Caucasians (10.9/100,000). Additional adjustment for sex, area of residence, and year of study resulted in 3.8-fold greater risk for African Americans compared with Caucasians. This study further confirmed the higher incidence of sarcoidosis in African Americans compared with Caucasians, but the racial difference was lower than previously reported. The results should be more generalizable than previous studies done with select populations and should serve as a useful frame of reference for future epidemiologic research of sarcoidosis.
Behçet's disease (BD) is known to be associated with HLA-B51 in many ethnic groups. However, the pathogenic gene responsible for BD is as yet unknown. To localize the critical region of the pathogenic gene, microsatellite markers distributed around the HLA-B gene were investigated. The BD patients studied were of three ethnic origins: Japanese, Greek, or Italian.
The total group consisted of 172 BD patients, of whom were 95 Japanese, 55 Greek, and 22 Italian. Eight polymorphic microsatellite markers distributed within 1100 kb of the HLA-B gene were analyzed using PCR and subsequent automated fragment detection by fluorescent-based technology.
Among the eight markers, allele 348 of the MIB microsatellite was remarkably common in all three BD populations (Japanese, PC: = 0.000014; Greek, PC: = 0. 00047; Italian, PC: = 0.11). However, HLA-B51 was found to be the marker most strongly associated with BD in each population (Japanese, PC: = 0.000000000017; Greek, PC: = 0.00000032; Italian, PC: = 0. 0074). In genotypic differentiation between the patients and controls, only HLA-B51 was found to be significantly associated with BD in all three populations. Stratification analysis suggested that significant associations of BD with MICA and other microsatellites resulted from a linkage disequilibrium with HLA-B51.
These results suggest that the pathogenic gene of BD is HLA-B51 itself and not other genes located in the vicinity of HLA-B.
Objective:
To analyze the referral patterns and diagnosis of uveitis during the past decade in a large tertiary eye center.Design:
The records of 1237 patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary from 1982 to 1992 were classified and analyzed. Data regarding sex, race, nationality, referral site, ages at presentation and onset of uveitis, ocular involvement, clinical characteristics, ocular condition, and systemic disease associations were obtained.Results:
The mean age at onset of uveitis was 37.2 years; the male-to-female ratio was 1:1.4. Most patients were white (85.8%), born in the United States (83.1%), and referred from within New England (84.7%). Anterior uveitis was most common (51.6%), followed by posterior uveitis (19.4%), panuveitis (16.0%), and intermediate uveitis (13.0%). Chronic (58.3%), nongranulomatous (77.7%), and noninfectious (83.1%) were the most frequent types of uveitis. The most common entities included idiopathic (34.9%), seronegative spondyloarthropathies (10.4%), sarcoidosis (9.6%), juvenile rheumatoid arthritis (5.6%), systemic lupus erythematosus (4.8%), Behçet's disease (2.5%), and the acquired immunodeficiency syndrome (2.4%).Conclusion:
The appearance of new uveitic entities, such as the acute retinal necrosis syndrome, multifocal choroiditis and panuveitis, birdshot retinochoroidopathy, and acquired immunodeficiency syndrome—related uveitis, and the reemergence of the classic infectious causes of uveitis, tuberculosis and syphilis, have changed the way we approach the diagnosis and management of posterior and panuveitis at the Massachusetts Eye and Ear Infirmary.
In this paper the literature concerning the demographic characteristics of uveitis will be reviewed, and a 10-year retrospective survey of the disease among residents of Rochester, Minnesota, will be presented.Descriptive epidemiology attempts to measure the risk of developing a disease in different populations and to characterize the affected individuals with respect to geographic location, age, sex, race, occupation, socioeconomic status, and time of illness. There is, to our knowledge, no data on the prevalence of uveitis in the United States based on a survey of all residents of a community. If the prevalence of uveitis could be measured accurately in several places, it might be possible to identify those population characteristics associated with an unusual prevalence of the disease. Clinical and laboratory research as well as epidemiological analysis could then be concentrated on populations with contrasting risks of developing uveitis, in the hope of identifying causal factors with a
Behcet's disease occurs most frequently among the Japanese and Mediterranean populations. This disease was shown to have a close association with HLA-Bw51, a split antigen of HLA-B5. Frequency of this antigen is highest in the male complete type, and lowest in the female incomplete type. Most patients inherited the HLA-B5 from their mothers, and not from the fathers. The frequency of HLA-B5 is equally high in populations with a high incidence of Behcet's disease, and it is possible that the susceptibility genes to Behcet's disease have been spread by the old nomadic tribes or by the Turks via the Silk Route.
During the period from January 1990 to December 1993, 558 new patients (250 female and 308 male, mean age 44 years; range 5-92) were seen at the Uveitis Clinic of the Hopital Jules Gonin. These 558 patients (740 eyes) were subdivided into anterior uveitis (343 patients-61%), intermediate uveitis (57 patients-10%), posterior uveitis (118 patients-21 %) and panuveitis (40 patients-7%). The incidence of uveitis for the referral area considered was calculated to be 17.5 per 100,000 inhabitants per year. A specific diagnosis was found in 386 cases (69%). The most frequently diagnosed entities were HLA-B27-associated acute anterior uveitis (89 cases-15.9%), uveitis associated with acute herpes zoster ophthalmicus (54 cases-9.7%), toxoplasmosis (53 cases-9.5%), sarcoidosis (33 cases-5.9%), typical pars planitis (31 cases-5.6%), Fuchs' heterochromic cyclitis (30 cases-5.4%), herpetic anterior uveitis (23 cases-4.1 %) and acute retinal necrosis (13 cases-2.3%). Incidence and distribution of most disease entities correspond to those of other European and American series.
Over a five-year period 245 Patients with uveitis were investigated at the Uveitis Clinic, Sydney Eye Hospital, for possible aetiological and relevant disease associations. Uveitis was anterior in 75% of patients, posterior in 21% and generalized in 4%. Anterior uveitis (AU) was idiopathic in 52% of cases. In patients tested for the HLA-B27 antigen, 47% were HLA-B27 positive, including all cases of ankylosing spondylitis (8% of cases) and Reiter's syndrome (3% of cases). There was a marked male predominance in patients with AU, especially in HLA-B27 positive individuals. Posterior uveitis (PU) was most frequently unilateral, chronic and idiopathic (24% of cases), whilst recognizable aetiologies included toxoplasmosis (20%), Behçet's syndrome (14%), sarcoidosis (12%) and pars planitis (12%). The peak age of onset in patients presenting with AU was 30 to 40 years, whilst patients with PU presented a decade earlier. There were no major differences between males and females in the age of onset of their uveitis.
This report describes a retrospective study of all new patients in our uveitis clinic between January 1992 and December 1994, undertaken to identify the pattern of uveitis in the Indian subcontinent. A standard clinical protocol, and the naming-meshing system with tailored laboratory investigations were used to arrive at a final uveitic diagnosis. Uveitis comprised 1.5% of new cases seen at the centre. Out of 1273 uveitis cases, anterior uveitis was the most common type (39.28%), followed by posterior uveitis (28.75%), intermediate uveitis (17.44%), and panuveitis (14.53%). The most commonly affected age group were patients in their forties (23.57%). Uveitis was less common in children below 10 years (3.61%) and in adults over 60 years of age (6.44%). Men (62.21%) were more commonly affected than women (37.79%). Aetiology remained undetermined in 59.31% of cases. Anterior uveitis was most commonly idiopathic (58.6%). The most common cause of posterior uveitis was toxoplasmosis (27.87%), and that of panuveitis was the Vogt-Koyanagi-Harada syndrome (21.08%). A higher incidence of microbiologically proven tubercular uveitis (5 cases), and uveitis due to live intraocular nematode (4 cases), and malaria (1 case), were seen, in contrast to other studies. Only 2 cases of AIDS with ocular lesions were seen. This paper reveals the pattern of uveitis seen at a major referral eye institute in India.
Ten years ago, The American Journal of Ophthalmology published the first patient series describing the ophthalmic manifestations of the acquired immunodeficiency syndrome (AIDS). 1 At that time, AIDS was a newly described, and still unnamed, disorder. 2-5 There were fewer than 300 cases nationwide and its cause remained a mystery. Few could have imagined the magnitude of the AIDS epidemic to come, or the enormous changes in society and health care that it would engender. The current statistics on AIDS are staggering. The rate at which new cases were reported began to slow in the late 1980s, but the number of new cases has increased every year since the syndrome was initially described. By late 1991, there had been approximately 200,000 patients with AIDS in the United States, 65% of whom had died. 6 The acquired immunodeficiency syndrome is now the second leading cause of death among men 25 to 44 years of age. 7 It is estimated that one in 75 men and one in 700 women in the United States between the ages of 15 and 49 years are infected with human immunodeficiency virus (HIV), the agent responsible for AIDS. 8 Over 1 million people in this country are believed to be infected with HIV. It is estimated that 58,000 to 85,000 of them will develop the full AIDS illness in 1992. 9,10 Homosexual/bisexual men still account for most cases, but the groups whose numbers are increasing most rapidly include patients exposed through intravenous drug use or heterosexual contact and children infected by perinatal transmission. 11
Because of the frequency of ocular toxoplasmosis and its occurrence in multiple siblings in southern Brazil, a population-based household survey was performed to better understand the epidemiologic characteristics of the disease in this region. Of 1,042 individuals examined, 184 (17.7%) were deemed to have ocular toxoplasmosis on the basis of conservative assessment of ophthalmic findings. Of those with ocular toxoplasmosis, 183 (99.5%) had specific IgG antibodies, compared with only 140 of 181 age-matched control subjects (77.4%; P less than .001). The prevalence of ocular toxoplasmosis was 0.9% in 1- to 8-year-olds, 4.3% in 9- to 12-year-olds, 14.3% in 13- to 16-year-olds, and 21.3% (95% confidence interval, 18.6% to 24.2%) in all individuals 13 years or older. The prevalence of ocular toxoplasmosis in this population was more than 30 times higher than previous estimates for the same condition elsewhere. The low prevalence in the young children we studied supplements previous data suggesting that, in this population, ocular toxoplasmosis is a sequela of postnatal rather than congenital infection.
During the past four years 450 patients (247 female - mean age 36 years and 203 male - mean age 34 years) with intraocular inflammation were evaluated using standard diagnostic criteria, to establish a uveitis survey profile. Patients were divided into four anatomic groups: anterior uveitis (270 cases = 60%), posterior uveitis (108 cases = 24%), panuveitis (54 cases = 12%) and intermediate uveitis (18 cases = 4%). A probable aetiological diagnosis was made in 232 cases (51.5%). Rheumatic diseases were diagnosed most commonly (55 cases = 12.2%), mainly ankylosing spondylitis, as is true for other European countries. Ocular toxoplasmosis was a frequent cause of uveitis, as in Brazil and West Africa, thus requiring a prompt diagnosis and treatment. Behçet's syndrome was associated with HLA B5 (65%) as in Japanese and Mediterranean populations. In our area AIDS retinitis is becoming an important differential diagnosis.
Uveitis can be classified in a variety of ways and this fact makes it difficult to compare results. Therefore we classified uveitis by the location with the method of Henderly; anterior-, posterior-, intermediate- and panuveitis. We determined the frequency of occurrence, etiology and clinical characteristics of various forms of uveitis. We conducted a retrospective analysis of 683 patients with uveitis seen at Seoul National University Hospital from January 1978, to December 1987. The results were as follows. 1. 192 cases (28.1%) occurred as anterior uveitis, 218 cases (31.9%) as posterior uveitis, 166 cases (24.3%) as panuveitis and 107 cases (15.7%) as pars planitis. Posterior uveitis was the most common form of uveitis. 2. In cases of anterior uveitis, 142 cases (74.0%) were idiopathic, traumatic uveitis was seen in 18 cases. In posterior-uveitis, 111 cases (50.9%) were idiopathic, retinal vasculitis including Eales' disease in 60 cases (27.5%), toxoplasmosis in 23 cases (10.6%). In cases of panuveitis, idiopathic form occurred in 80 cases (48.2%), Behçet's disease in 41 cases (24.7%). The idiopathic form was the most common entity in all locations of uveitis.
A review of 240 consecutive Chinese patients with endogenous uveitis seen over a 3-year period was made in Taiwan. The frequency of major types of uveitis was 110 cases (45.8%) of acute anterior uveitis, 43 cases (17.9%) of Behçet's disease, 22 cases (9.2%) of Harada's disease, 10 cases (4.2%) of peripheral uveitis, 6 cases (2.5%) of virus-induced uveitis and 5 cases (2.1%) of Fuchs' heterochromic cyclitis. Only 1 case (0.4%) of sarcoidosis was found. Of the 110 cases of acute anterior uveitis, 80.9% presented with HLA-B27 antigen. The incidences of types of endogenous uveitis in Chinese differ from those in Caucasians, Japanese and Negro races in the USA.
We conducted a retrospective analysis of 600 patients with uveitis seen at the Estelle Doheny Eye Center to determine the frequency of occurrence of the various forms of uveitis and to see if the causes of uveitis have changed as compared with previous studies. In 402 cases (67.0%) we established a specific diagnosis based on history, physical findings, and laboratory studies: 167 cases (27.8%) involved primarily the anterior segment, 230 (38.4%) the posterior segment, and 111 (18.4%) occurred as panuveitis. Intermediate uveitis (pars planitis) was the single most frequently diagnosed uveitic entity and accounted for 92 cases (15.4%). We compared our findings with those of previously published studies and found that, as new diseases occur and improved diagnostic techniques become available, the differential diagnosis of uveitis continues to change.
The histocompatibility antigen HL-A 27 (W 27) was identified in 26 out of 50 patients with acute anterior uveitis, compared with 2 out of 50 controls. 21 patients had significant, associated diseases, and 18 of these had HL-A 27. HL-A 27 was present in 8 of the 29 patients with no associated diseases.
Analysis of the immunological features of anterior uveitis (AU) revealed a dichotomy of abnormalities defined in terms of the HLA-B27 status of the patient. HLA-B27-positive AU was characterised by the occurrence of iris autoantibodies and an absolute T cell lymphopenia during active disease which returned to normal with recovery. This phenomenon was not observed in HLA-B27-negative AU or in controls and could not be attributed to antilymphocyte antibodies as these were not detected. Furthermore, there were no changes in T-cell subsets (helper and suppressor T lymphocytes). Compared with HLA-B27-positive AU patients, the HLA-B27-negative group demonstrated elevated IgE levels and increased prevalence of smooth muscle autoantibodies.
The pattern of uveitis seen in a caucasian population in Iowa was found to be very similar to that seen in London in spite of geographical and climatic differences in the two locations. Acute anterior uveitis was the commonest type of uveitis but fewer of the Iowa patients showed radiological evidence of ankylosing spondylitis or Reiter's syndrome. Toxoplasmosis was responsible for 9% of cases in both series. It is concluded that genetic factors are more important than geographic location in determining the types of uveitis which occur in a caucasian population.
Frequency of HLA-A, B, and C antigens was studied in 184 patients with Behçet's disease to investigate the immunogenetically determined predisposition to this disease. A statistically significant increased incidence of HLA-B5 or Bw51 was noted in the patients as compared with the normal control subjects. No significant difference was observed in the distribution of other HLA antigens. On the basis of HLA studies, it seems likely that the susceptibility genes to Behçet's disease closely linked to HLA-Bw51 may have been spread by the old nomadic tribes or the Turks via the Silk Route.
We conducted a retrospective analysis of 1122 patients with endogenous uveitis treated at the University Eye Clinic in Turku during the years 1980-1982 and 1988. Of the 1122 patients 568 were men and 554 women; 1034 (92.2%) had anterior uveitis, 15 (1.3%) intermediate uveitis, 64 (5.7%) posterior uveitis and 9(0.8%) panuveitis; 867 (77.3%) were unilateral and 255 bilateral; 789 of 1067 cases (73.9%) were of sudden onset and 278 of insidious onset; 808 of 1102 cases (73.3%) were of short duration and 294 of long duration; and 519 (46.3%) single and 603 repeated. In this study uveitis occurred significantly more often (44.2%) in the age group 20-39 years than in other age groups (p < 0.00001). Anterior and posterior uveitis were more often unilateral than bilateral (p < 0.0005) and of sudden onset than of insidious onset (p < 0.00008). Acute anterior uveitis was the most common uveitic entity and accounted for 745 cases (66.4%). Acute anterior uveitis associated with ankylosing spondylitis was the single most frequently seen diagnostic group including 144 cases (12.8%) with a statistically significant male predominance (p < 0.00001).
A retrospective study was conducted to assess the causes of blindness and visual impairment in patients who visited an eye hospital in Sierra Leone, West Africa, in 1989 and 1992. These data were compared with figures from 1981. Throughout the years, senile cataract was the major cause of blindness, followed by uveitis (including onchocerciasis). Uveitis remained the second most important cause of blindness in this population, despite the significant decrease in blindness from onchocerciasis (from 30% in 1981 to 15% in 1992). An increasing number of patients with uveitis from non-onchocercal origin was observed: almost 10% of the blindness found in 1992 was due to uveitis of non-onchocercal origin. A reduction in visual handicap in patients with non-onchocercal uveitis could be achieved if local hospitals could obtain more accurate diagnoses in these patients.
A nationwide survey was carried out to estimate the frequency and distribution of Vogt-Koyanagi-Harada disease in Japan. A questionnaire was mailed to the Departments of Ophthalmology in hospitals with 200 or more beds. Responses were received from 489 out of 1,077 institutions, or 45.5%. The annual prevalence was estimated to be 15.5 per million and the incidence was 6.5 per million, based on the number of reported cases and the response rate per prefecture. It was estimated that 1,800 patients were treated for this disease annually and that there were about 800 new cases each year. Geographical distribution showed no special characteristics such as those seen with Behçet's disease. The results of the analysis of 1,833 reported cases showed that females were slightly more often affected than males. For both male and female patients, the age distribution on the first visit showed a peak in the fifth decade and a median age of 42.3 years.
The data of 750 consecutive uveitis patients who visited the uveitis department of the Rotterdam Eye Hospital were analysed by computer. Anterior uveitis was diagnosed most frequently (52%), mostly the acute form. We found a high percentage of Fuchs' heterochromic iridocyclitis and HLA-B27+ iridocyclitis.
In the posterior uveitis group appeared the more recent clinical entities such as acute retinal necrosis, Birdshot retinochoroidopathy, CMV-retinitis, AMPPE and ocular candidiasis. Ocular Toxoplasmosis was still the leading cause in this group.
These data will be compared with other studies of similar populations. Factors influencing frequency of subtypes of uveitis and bias of this study will be discussed.
Most uveitis case series have come from tertiary care centers, and the relative frequencies of disorders they report may reflect referral bias. We sought information about the types of uveitis encountered in the general practice of ophthalmology.
We prospectively examined 213 consecutive cases of general uveitis, defined as intraocular inflammation other than cytomegalovirus retinopathy, seen by a group of community-based comprehensive ophthalmologists. This group of cases was compared with 213 consecutive cases of general uveitis examined by a uveitis specialist at a university referral center in the same community. All cases were categorized by anatomic site of inflammation and disease course, and, if possible, they were assigned a specific diagnosis. Cases of cytomegalovirus retinopathy and masquerade syndrome seen during the same intervals were recorded separately.
The distribution of general uveitis cases by anatomic site of disease was significantly different between the community-based practices (anterior, 90.6%; intermediate, 1.4%; posterior 4.7%; panuveitis, 1.4%) and the university referral practice (anterior, 60.6%; intermediate, 12.2%; posterior, 14.6%; panuveitis, 9.4%; P < .00005). A cause or clinical syndrome could be assigned to 47.4% of cases in the community-based practices, and to 57.8% of cases in the university referral practice (P = .03). HLA-B27-associated anterior uveitis, cytomegalovirus retinopathy, and toxoplasmic retinochoroiditis were among the five most common forms of uveitis in both practice settings.
The relative frequencies with which various forms of uveitis are seen in a tertiary referral center do not necessarily reflect the experience of ophthalmologists from the community in which the center is located. Anterior uveitis and disorders of sudden onset constitute a greater proportion of cases seen by community-based comprehensive ophthalmologists.
A retrospective study on 1,417 uveitic patients referred to the Ocular Immunovirology Service of the University of Rome 'La Sapienza' was carried out to determine the occurrence of the various forms of uveitis. To detect also the possible changing patterns of uveitis during the last 25 years the obtained data were compared with those reported in two previous studies performed by the same author, at the same institution in 1978 and 1985. Anterior uveitis was the most frequent anatomical type of intraocular inflammation (49.12%); intermediate uveitis was diagnosed in 12.42% of all the cases and showed an increased incidence over the years (p < 0.0001). Posterior and diffuse uveitis accounted for 22.1 and 16.37% of the cases. An improvement in diagnostic definition has been confirmed by the significant decrease in the percentage of 'idiopathic uveitis' from 56.8 to 38.1% (p < 0.0001). Associated infectious conditions were detected in 17.43% of the cases. Toxoplasma gondii was the most common etiologic agent of uveitis (6.63%). An associated systemic disease was diagnosed in 15.03% of uveitic patients, and 6% of them were affected with Behçet's disease. Specific ocular diseases and clinical entities increased from 7.8 and 14.68% to 29.42% in the last 25 years (p < 0.0001), the most frequent being pars planitis (11.99%) and Fuchs' heterochromic iridocyclitis (8.32%).
In the study of uveitis, epidemiology is frequently neglected. Our uveitis register consisted of data collected on all uveitis patients except minor, easily resolved, anterior uveitis cases at the Leicester Royal Infirmary. The diagnoses of these patients were classified by the aetiological method. A total of 712 patients was entered into the register over a period of 10 years starting from January 1985. In the study, 73.0% of the cases fit into named clinical syndromes while 27.0% of the cases were diagnosed as idiopathic but uncategorised. The commonest definable cause of anterior uveitis was HLA-B27-related acute anterior uveitis, comprising 15.2% of all uveitis cases. Intermediate uveitis accounted for 7.9% of all cases while the commonest definable cause of posterior uveitis was toxoplasmosis, forming 4.6% of all uveitis cases. The aim of the study was to present data relating to diagnostic categories from a primary and secondary uveitis clinic, and to explore the usefulness of such a uveitis register within an ophthalmic department.
Etiological characteristics of endogenous uveitis vary among areas and races around the world. There are few epidemiological reports on the etiology of uveitis from areas within Asia. We report statistical data on uveitis in Japan.
We reviewed all of the records of patients with endogenous uveitis who visited the Uveitis Survey Clinic of Hokkaido University Hospital in 1981 and 1994 and extended the survey to include new patients with uveitis seen over the 3-year period from 1992 to 1994.
Bechcet's disease, sarcoidosis and Vogt-Koy-anagi-Harada disease were the three most frequently diagnosed diseases in both 1981 and 1994. The proportion of patients with unclassified uveitis decreased from 38% to 30% during the 13-year period from 1981 to 1994 as a result of the establishment of new disease categories during this time. Notable additions included human T-lymphotropic virus type 1-associated uveitis and tubuloinerstitial nephritis and uveitis syndrome. Sarcoidosis is now the most frequent endogenous uveitis in our clinic.
Not only does the etiological basis of uveitis vary among ethnic groups but advances in clinical and basic research have changed the diagnostic approach to uveitis, altering the etiological profile over time.
We studied the case records of 1122 patients with endogenous uveitis including 418 new cases treated at the University Eye Clinic in Turku during the years 1980-1982 and 1988. The mean annual incidence and prevalence rates (per 100,000 population) of idiopathic acute anterior uveitis were 17.1 and 48.5, respectively, sarcoid anterior uveitis 0.5 and 1.5, Posner-Schlossman syndrome 0.4 and 1.9, herpes zoster uveitis 0.4 and 0.7, idiopathic chronic anterior uveitis 0.3 and 7.3, herpes simplex keratouveitis 0.3 and 0.5, juvenile rheumatoid arthritis 0.2 and 2.4, Fuchs' heterochromic iridocyclitis 0.2 and 0.5, intermediate uveitis 0.3 and 1.4, and of toxoplasmic retinochoroiditis 0.3 and 2.4. The incidence and prevalence rates of acute anterior uveitis associated with ankylosing spondylitis were 2.0 and 10.3 per 100,000 population, respectively, and this disease association occurred more often in men than in women (p < 0.001). The mean annual incidence of idiopathic acute anterior uveitis was significantly lower in the age group 0-19 years than in the other age groups (p < 0.001).
Previous epidemiologic studies of uveitis have focused on predominantly Caucasian populations, and none have been based in the Southeast. We analyzed the epidemiology of uveitis among a referral population with a high percentage of African Americans in the United States.
We evaluated demographic data from 385 consecutive patients referred to the Duke Uveitis Clinic.
Of the 385 patients, 120 (31%) were African American and 258 (67%) Caucasian; 237 (62%) were female and 148 (38%) male. The most common diagnoses among the 385 patients were idiopathic panuveitis (64 patients [17%]), idiopathic anterior uveitis (47 patients [12%]), pars planitis (46 patients [12%]), sarcoidosis (44 patients [11%]), and toxoplasmosis (39 patients [10%]). These diagnoses were also the most common among the 120 African American patients: 33 patients (28%) had idiopathic panuveitis, 30 (25%) had sarcoidosis, 10 (8%) had idiopathic anterior uveitis, 8 (7%) had toxoplasmosis, and 6 (5%) had pars planitis. Among the 258 Caucasian patients, the most common diagnoses were pars planitis (39 patients [15%]), idiopathic anterior uveitis (37 patients [14%]), toxoplasmosis (30 patients [12%]), idiopathic panuveitis (28 patients [11%]), and multifocal choroiditis and panuveitis (MCP) (17 patients [7%]). Categorizing diagnoses of all 385 patients by anatomic location, panuveitis was most frequent (148 patients [38%]), followed by anterior uveitis (97 patients [25%]), posterior uveitis (93 patients [24%]), and intermediate uveitis (47 patients [12%]).
The higher frequency of sarcoidosis and idiopathic panuveitis than previously reported is related to our larger African American population base. The racial composition of the Southeast does not, however, account for differences such as our higher percentage of MCP; it is possible that other genetic or environmental factors play a role in this region.
This study aimed to test the hypothesis that patients presenting with anterior uveitis who are HLA-B27 positive, either with or without associated systemic disease, have a less-favorable outcome than do patients with idiopathic anterior uveitis who are HLA-B27 negative.
Retrospective case-controlled series.
Ninety-seven patients who were HLA-B27 positive with no systemic disease, 94 patients who were HLA-B27 positive with systemic disease, and 72 patients who were HLA-B27 negative who presented with anterior uveitis were studied.
Ocular complications (e.g., secondary glaucoma, cataract formation, pupillary synechiae, vitritis, cystoid macular edema, and optic disc edema), medical and surgical treatment, number of recurrent attacks, and final visual acuity were recorded for all patients.
The patients who were HLA-B27 positive, either with or without systemic disease, experienced a greater number of complications than did the patients who were HLA-B27 negative. Periocular corticosteroids, systemic corticosteroids, and systemic immunosuppressive chemotherapy were required in a far greater number of HLA-B27-positive patients than in HLA-B27-negative patients (60% vs. 11%, 53% vs. 7%, and 18% vs. 1%, respectively; P < 0.001). The percentage of legally blind eyes was significantly greater in the HLA-B27-positive group, both with and without systemic disease, when compared with the HLA-B27-negative group (11% vs. 2%; P < 0.005).
The prognosis of anterior uveitis associated with the HLA-B27 haplotype, either with or without associated systemic disease, is less favorable when compared with that of HLA-B27-negative patients with idiopathic anterior uveitis.
Infectious causes of uveitis are common in the developing world and include some causes that are rarely encountered in industrialized nations, such as tuberculosis, leptospirosis, leprosy, onchocerciasis, and cystercicosis. Ocular toxoplasmosis occurs in all countries but is more common in Central and South America, the South Pacific, and western Europe. AIDS-related opportunistic infections occur wherever HIV infection is prevalent, including North and South America, western and eastern Europe, the former Soviet Union, sub-Saharan Africa, and South and Southeast Asia. Physicians who care for patients in the developing world should consider these infectious possibilities whenever their patients develop uveitis.
To assess the prevalence of active and inactive uveitis unrelated to previous surgery or trauma in an urban population in southern India.
As part of the Andhra Pradesh Eye Disease Study, 2522 subjects (85.4% of those eligible), a sample representative of the population of Hyderabad city in southern India, underwent interview and detailed dilated eye examination. Presence of sequelae of uveitis without current active inflammation was defined as inactive uveitis.
Unequivocal evidence of active or inactive uveitis unrelated to previous surgery or trauma was present in 21 subjects, an age-sex adjusted prevalence of 0.73% (95% confidence interval (CI) 0.44-1.14%). Active uveitis was present in eight subjects, an age-sex adjusted prevalence of 0.37% (95% CI 0. 19-0.70), of which 0.06% was anterior, 0.25% intermediate, and 0.06% posterior. The 0.36% (95% CI 0.17-0.68%) prevalence of inactive uveitis included macular chorioretinitis scars (0.26%), anterior (0. 07%) and previous vasculitis involving the whole eye (0.03%). The prevalence of visual impairment due to uveitis of less than 6/18 in at least one eye was 0.27%, less than 6/60 in at least one eye was 0. 16%, and less than 6/60 in both eyes was 0.03%.
These population based cross sectional data give an estimate of the prevalence of various types of uveitis in this urban population in India. Active or past uveitis that might need treatment at some stage was present in one of every 140 people in this population.
To report the results of a retrospective analysis among endogenous uveitis patients in the north-eastern area of Italy.
The authors reviewed a series of 655 new cases treated between October 1986 and December 1993. The incidence of endogenous uveitis was calculated based on a 100,000 patient population.
The average incidence was 11.40/100,000. The majority of patients were between the ages of 20 and 70 years (74.43%). A probable diagnosis was determined in 55.57% of cases; anterior uveitis was diagnosed in 58.01% of cases, posterior uveitis in 26.11%, panuveitis in 12.98%, and intermediate uveitis in 2.9% of cases. The authors observed recurrences in 25.49% of cases. While the first cases are almost equally distributed in the various months, the recurrences seem to be significantly more frequent in the cold (from November to February; mean air temperature <8 degrees) and transitional months (October and from March to May; mean air temperature from 8 degrees C to 18 degrees C) than in the warm months (from June to September; mean air temperature >18 degrees C). Respectively p=0.003 and p=0.029.
The incidence in this series is lower than in other European and American studies. Despite the high rate of idiopathic cases in this study, the authors support that the presentation of single case experiences may allow improved multi-centric analysis and a greater understanding of the epidemiology of uveitis.
Epidemiological study of patients with uveitis in Buenos Aires, Argentina
- C Couto
- Merlo Jl Dernouchamps Jp
- C L Verougstraete
- Tassignon
- Mj
16 Couto C, Merlo JL. Epidemiological study of patients with uveitis in Buenos Aires, Argentina. In: Dernouchamps JP, Verougstraete C, Caspers-Velu L, Tassignon MJ, editors. Recent advances in uveitis. Proceedings of the Third International Symposium on Uveitis, Brussels, Belgium, 1992. Amsterdam: Kugler Publications, 1993;171–174.
Uveitis in northern Portugal
- J Palmares
- M E Coutinho
- J Castro-Correia
Jaffe GI Uveitis in the southeastern United States
- P T Merrill
- Kim I Cox
- T A Betor
- C C Mccallum
Epidemiology of uveitis. Preliminary results of a prospective study in the Savoy
- E Vadot
- E Barth
- P Billet
Epidemiological studies on Behcet's disease in the Hokkaido district
- K Aoki
- K Fujioka
- H Katsumata
Epidemiological study on endogenous uveitis in Japan
- M Sugita
- Y Enomoto
- S Nakaura
- S Ohba
- T Yamamoto
- S Ohno
- Henderly DE
Changing patterns of uveitis
- D E Henderly
- A J Genstler
- R E Smith
- N A Rao
Epidemiological study of patients with uveitis in
- C Couto
- J L Merlo