Pattern of uveitis in a referral centre in Tunisia, North Africa

Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Eye (Impact Factor: 2.08). 02/2007; 21(1):33-9. DOI: 10.1038/sj.eye.6702111
Source: PubMed


To analyse the pattern of uveitis in a referral centre in Tunisia, North Africa.
The study included 472 patients with uveitis examined at the Department of Ophthalmology of Monastir (Tunisia) from January 1992 to August 2003. All patients had a comprehensive ocular and systemic history, including an extensive review of medical systems. Complete ophthalmic examination was performed in all cases, including best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, and dilated fundus examination with three-mirror lens. Standard diagnostic criteria were employed for all syndromes or entities of uveitis.
The mean age at onset of uveitis was 34 years. The male-to-female ratio was 1:1.1. Uveitis was unilateral in 282 patients (59.7%) and bilateral in 190 patients (40.3%). Anterior uveitis was most common (166 patients; 35.2%), followed by posterior uveitis (133 patients; 28.2%), panuveitis (100 patients; 21.2%), and intermediate uveitis (73 patients; 15.5%). A specific diagnosis was found in 306 patients (64.8%). The most common cause of anterior uveitis was herpetic uveitis (56 patients; 33.7%). Toxoplasmosis was the most frequent cause of posterior uveitis (51 patients; 38.3%). Intermediate uveitis was most commonly idiopathic (63 patients; 86.3%). Behçet's disease was the most common cause of panuveitis (36 patients; 36%), followed by Vogt-Koyanagi-Harada (VKH) disease (15 patients; 15%). A total of 16 patients (3.4%) suffered from blindness, and 59 (12.5%) from uniocular blindness.
In a hospital population in Tunisia, the most common causes of uveitis were Behçet's disease, herpes simplex infection, toxoplasmosis, and VKH disease.

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    • "By reviewing 75 VKH patients seen at the National Eye Institute between 1978 and 1996, 78.7% of patients were females [7]. In other areas, the recently reported proportions of affected females with VKH are 78.9% in Mexico [9]; 62.9–75% in Saudi Arabia [8, 30, 31]; 65.3% in Tunisia, North Africa [32]; 73.7% in Japan [33]; 84.44% in South India [34]; 70% in Brazil [35]; and 71.1% in Turkey [36]. Sukavatcharin et al. reported that females constituted 62.5% of patients in 48 case series in a Hispanic population [37]. "
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    ABSTRACT: Vogt-Koyanagi-Harada disease (VKH) and sympathetic ophthalmia (SO) are types of T-cell mediated autoimmune granulomatous uveitis. Although the two diseases share common clinical features, they have certain differences in gender predilections. VKH classically has been reported as more prevalent in females than males, yet some studies in Japan and China have not found differences in gender prevalence. Male patients have a higher risk of chorioretinal degeneration, vitiligo, and worse prognosis. Conversely, the changing levels of estrogen/progesterone during pregnancy and the menstrual cycle as well as higher levels of TGF-β show a protective role in females. Potential causes of female predilection for VKH are associated with HLA-DR and HLA-DQ alleles. SO, a bilateral granulomatous uveitis, occurs in the context of one eye after a penetrating injury due to trauma or surgery. In contrast to the female dominance in VKH, males are more frequently affected by SO due to a higher incidence of ocular injury, especially during wartime. However, no gender predilection of SO has been reported in postsurgical cases. No clinically different manifestations are revealed between males and females in SO secondary to either ocular trauma or surgery. The potential causes of the gender difference may provide hints on future treatment and disease evaluation.
    Full-text · Article · Mar 2014 · Journal of Ophthalmology
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    • "In our study, similar to studies from North Africa and North India, panuveitis was more frequent than intermediate uveitis.11-13 Behcet's disease was the most frequent cause of panuveitis while most cases of intermediate uveitis were idiopathic. "
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    ABSTRACT: Purpose To ascertain the patterns of uveitis at Motahari uveitis clinic, Shiraz University of Medical Sciences, a tertiary referral center in Shiraz, Southern Iran. Methods All new cases of uveitis referred from June 2005 to July 2011 to our center were consecutively enrolled in the study. After taking a complete history of systemic and ocular diseases, all patients underwent a complete ophthalmologic examination including determination of Snellen visual acuity, slit lamp biomicroscopy, applanation tonometry and dilated fundus examination. Patients were classified according to International Uveitis Study Group definitions. Results A total of 475 subjects were evaluated; mean age at the onset of uveitis was 30.5 ±15.14 years. Uveitis was unilateral in 292 (61.4%) and bilateral in 183 (38.6%) patients. Anterior uveitis was the most common type of inflammation (190 patients, 40%), followed by posterior uveitis (133 patients, 28%), panuveitis (99 patients, 20.8%) and intermediate uveitis (53 patients, 11.1%). A specific cause was found in 295 patients (61.9%). HLA-B27 negative was the most common cause of anterior uveitis (84 patients, 44.2%), Behcet's disease was the most common etiology of panuveitis (34 cases, 34.3%) and toxoplasmosis was the most common cause of posterior uveitis (56 patients, 42.1%). The great majority of intermediate uveitis cases were idiopathic (49 patients, 92.4%). Conclusion The most common type of uveitis in Southern Iran is anterior. The most common underlying disorders are HLA-B27 negative, toxoplasmosis and Behcet's disease.
    Full-text · Article · Jan 2014 · Journal of Ophthalmic & Vision Research
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    • "The prevalence of uveitis is estimated at 38 cases per 100,000 people, so it meets the criteria for classification as a rare disease [2,11-19]. It is particularly prevalent in younger people; the mean age of uveitis patients at the onset of the disease is less than 40 years of age [20-22]. "
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    ABSTRACT: Background Uveitis is an autoimmune disease of the eye that refers to any of a number of intraocular inflammatory conditions. Because it is a rare disease, uveitis is often overlooked, and the possible associations between uveitis and extra-ocular disease manifestations are not well known. The aim of this study was to characterize uveitis in a large sample of patients and to evaluate the relationship between uveitis and systemic diseases. Methods The present study is a cross-sectional study of a cohort of patients with uveitis. Records from consecutive uveitis patients who were seen by the Uveitis Service in the Department of Ophthalmology at the Medical University of Vienna between 1995 and 2009 were selected from the clinical databases. The cases were classified according to the Standardization of Uveitis Nomenclature Study Group criteria for Uveitis. Results Data were available for 2619 patients, of whom 59.9% suffered from anterior, 14.8% from intermediate, 18.3% from posterior and 7.0% from panuveitis. 37.2% of all cases showed an association between uveitis and extra-organ diseases; diseases with primarily arthritic manifestations were seen in 10.1% of all cases, non-infectious systemic diseases (i.e., Behçet´s disease, sarcoidosis or multiple sclerosis) in 8.4% and infectious uveitis in 18.7%. 49.4% of subjects suffering from anterior uveitis tested positively for the HLA-B27 antigen. In posterior uveitis cases 29% were caused by ocular toxoplasmosis and 17.7% by multifocal choroiditis. Conclusion Ophthalmologists, rheumatologists, infectiologists, neurologists and general practitioners should be familiar with the differential diagnosis of uveitis. A better interdisciplinary approach could help in tailoring of the work-up, earlier diagnosis of co-existing diseases and management of uveitis patients.
    Full-text · Article · Aug 2012 · Orphanet Journal of Rare Diseases
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