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Acta Ophthalmologica Feb 2020To analyse the distribution and treatment of uveitis in a region of southern Sweden and compare the results with previously reported European data.
PURPOSE
To analyse the distribution and treatment of uveitis in a region of southern Sweden and compare the results with previously reported European data.
METHODS
Anonymized data for all individuals in the region with an ICD-10 diagnosis that indicated uveitis between 2013 and 2017 were extracted from a computerized healthcare register.
RESULTS
In total, 2483 patients were diagnosed with uveitis during 2013-2017. Anterior uveitis was diagnosed in 93%, intermediate in 1%, posterior in 5% and panuveitis in 1% of cases. An associated diagnosis was found in 14%, and the five most common associated diseases were herpes simplex/zoster (4.9%), inflammatory bowel disease (2.2%), rheumatic arthritis (1.9%), ankylosing spondylitis (1.8%) and sarcoidosis (1.8%). Systemic treatment was used in 14% of the cases. The period prevalence of uveitis was 700 cases per 100 000 individuals, and the yearly incidence was estimated to 108 cases/year/100 000 individuals.
CONCLUSIONS
Compared with studies from referral clinics, this community-based study had a large proportion of anterior uveitis (93%) and uveitis without associated diagnosis (86%). Uveitis was also much more common among elderly than shown in previous research. The distribution of possible associated diagnosis conformed to several previous European studies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Middle Aged; Morbidity; Registries; Retrospective Studies; Sweden; Uveitis; Young Adult
PubMed: 31161663
DOI: 10.1111/aos.14130 -
Research Square Aug 2023Studies on uveitis in Sierra Leone were conducted prior to the Ebola Virus Disease epidemic of 2013-16, which was associated with uveitis in 20% of survivors. They did...
BACKGROUND/OBJECTIVES
Studies on uveitis in Sierra Leone were conducted prior to the Ebola Virus Disease epidemic of 2013-16, which was associated with uveitis in 20% of survivors. They did not include imaging or investigation of tuberculosis and used laboratory services outside the country. We performed a cross-sectional study on patients presenting with uveitis to establish their clinical characteristics and identify the impact of in-country laboratory diagnoses.
METHODS
We invited uveitis cases presenting to Eye Clinics in Sierra Leone from March to September 2022 to participate in the study. They underwent a diagnostic work-up, including fundus and ocular coherence tomography imaging. Active uveitis cases underwent further investigations including serology and immunological tests for syphilis, tuberculosis and herpetic viruses and HIV, and chest radiographs.
RESULTS
We recruited 128 patients. The mean age was 36 ± 14 years and there was an equal gender split. Panuveitis was the predominant anatomical uveitis type (n=51, 40%), followed by posterior uveitis (n=36, 28%). Bilateral disease affected 40 patients (31%). Active uveitis was identified in 75 (59%) cases. ICD 11 definition of blindness with VA<3/60 occurred in 55 (33%) uveitis eyes. Aetiology of uveitis from clinical and laboratory assessment demonstrated that most cases were of undifferentiated aetiology (n=66, 52%), followed by toxoplasmosis (n=46, 36%). Trauma contributed to eight (6%) cases, syphilis to 5 (4%) cases and Ebola to 2 (2%).
CONCLUSIONS
Uveitis was associated with high levels of visual impairment. Posterior and panuveitis contributed to the highest proportion of uveitis cases. Laboratory studies helped differentiate syphilis as a significant aetiology of uveitis.
PubMed: 37609303
DOI: 10.21203/rs.3.rs-3222203/v1 -
Saudi Journal of Ophthalmology :... 2022Posterior uveitis is sight-threatening disease entity that can be caused by infectious and non-infectious entities. Vision loss in posterior uveitis can be following...
Interpreting posterior uveitis by integrating indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography data: A narrative review.
Posterior uveitis is sight-threatening disease entity that can be caused by infectious and non-infectious entities. Vision loss in posterior uveitis can be following complications such as cystoid macular edema, epiretinal membrane, artery and vein occlusions, vasculitis, papillitis, choroidal neovascular membrane, retinal neovascularization, tractional retinal detachment, vitreous hemorrhage, glaucoma, cataract, among others. Diagnosis of posterior uveitic entities have been revolutionized following introduction of choroidal imaging with techniques such as indocyanine green angiography (ICGA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Med Line search and PubMed search was performed pertaining to causes of posterior uveitis, ICGA in posterior uveitis, OCT in posterior uveitis, OCTA in posterior uveitis, retinal and choroidal vascular changes in posterior uveitis, quantification of choriocapillaris lesion area in posterior uveitis, subfoveal choroidal thickness in posterior uveitis, quantification of choriocapillaris in posterior uveitis, vascular indices for quantification of choriocapillaris. This review article highlights various changes in the choroid and the quantification of choroid using various parameters in ICGA, OCT and OCTA.
PubMed: 36618566
DOI: 10.4103/sjopt.sjopt_69_22 -
Ophthalmology and Therapy Aug 2023Scientific evidence of the effectiveness of the tumor necrosis factor inhibitor adalimumab (ADA) in pediatric patients with non-infectious non-anterior uveitis is still...
INTRODUCTION
Scientific evidence of the effectiveness of the tumor necrosis factor inhibitor adalimumab (ADA) in pediatric patients with non-infectious non-anterior uveitis is still limited. The aim of this study is to investigate the therapeutic role of ADA in a cohort of pediatric patients with non-anterior uveitis.
METHODS
This is an international multicenter study analyzing real-life data referred to pediatric patients treated with ADA for intermediate uveitis/pars planitis, posterior uveitis and panuveitis. Data were drawn from the AutoInflammatory Disease Alliance (AIDA) registry for patients with uveitis.
RESULTS
Twenty-one patients (36 affected eyes) were enrolled, and all patients benefited from ADA administration. In detail, 11 patients (19 affected eyes) did not experience further ocular inflammation after ADA introduction; 10 cases (17 affected eyes) showed a significant clinical improvement consisting of a decrease in severity and/or frequency of ocular relapses. The number of ocular flares dropped from 3.91 to 1.1 events/patient/year after ADA introduction (p = 0.0009); macular edema and retinal vasculitis were respectively observed in 18 eyes and 20 eyes at the start of ADA and in 4 eyes and 2 eyes at the last assessment. The mean daily glucocorticoid dosage significantly decreased from 26.8 ± 16.8 mg/day at the start of ADA to 6.25 ± 6.35 mg/day at the last assessment (p = 0.002). Intermediate uveitis/pars planitis (p = 0.01) and posterior uveitis (p = 0.03) were more frequently observed in patients with full response to ADA; panuveitis (p = 0.001) was significantly more frequent among patients continuing to experience uveitic flares. This could be related to a higher use of systemic glucocorticoids (p = 0.002) and conventional immunosuppressants (p = 0.007) at the start of ADA when treating intermediate uveitis/pars planitis. Regarding the safety profile, only one adverse event was reported during ADA treatment, consisting of the development of generalized adenopathy.
CONCLUSIONS
ADA proved to have an effective therapeutic role in all pediatric patients with non-anterior uveitis enrolled in the study. An overall glucocorticoid-sparing effect was observed despite the severity of cases enrolled. A more aggressive treatment of panuveitis and posterior uveitis at start of ADA could increase the likelihood of full response to therapy.
PubMed: 37166627
DOI: 10.1007/s40123-023-00712-1 -
Annals of Translational Medicine Nov 2022To analyze the clinical characteristics and long-term treatment outcomes of patients with posterior scleritis.
BACKGROUND
To analyze the clinical characteristics and long-term treatment outcomes of patients with posterior scleritis.
METHODS
This retrospective, observational case series analyzed medical records of 14 patients diagnosed with infectious or non-infectious posterior scleritis between May 2005 and March 2020 at Severance Hospital and Gangnam Severance Hospital.
RESULTS
A total of 12 patients with non-infectious and two with infectious posterior scleritis were treated. Conjunctival injection (85.7%) was the most common symptom, followed by pain on eyeball movement (57.1%), and decreased visual acuity (42.9%). Anterior uveitis (64.3%) was the most common associated clinical finding. In five eyes (35.7%), immunosuppressive agents were administered in addition to corticosteroids to control the inflammation. Recurrence was noted in three eyes (21.4%), all of them showing non-infectious scleritis. The final visual acuity of the patients did not show significant change compared to that at the first visit (P=0.878).
CONCLUSIONS
Most posterior scleritis patients were of non-infectious type and some needed additional immunosuppressive treatment. In patients with a history of ocular surgery or trauma, especially with the presence of pus-containing nodules, infectious posterior scleritis should always be considered. Since impaired vision does not improve significantly after treatment of posterior scleritis, prompt diagnosis and aggressive treatment are recommended.
PubMed: 36467362
DOI: 10.21037/atm-22-721 -
Indian Journal of Ophthalmology Jul 2024To evaluate the spectrum of uveitis occurring after 60 years of age in elderly patients who presented to a tertiary care eye center in India.
PURPOSE
To evaluate the spectrum of uveitis occurring after 60 years of age in elderly patients who presented to a tertiary care eye center in India.
METHODS
Retrospective study of patients who visited a tertiary eye care institute between January 2010 and July 2020.
RESULT
Eighty-seven patients developed uveitis after 60 years, with only 44.8% having sufficient follow-up documentation and were included in the final analysis. The median age of these patients was 64 (IQR: 62-70) years, and 69% of them were male. Among the identifiable causes of uveitis, infectious uveitis (36%) was the most common and noninfectious uveitis was noted in 23% of patients. The most common subtype of uveitis was anterior uveitis (52%), followed by intermediate uveitis (32%), panuveitis (11%), and posterior uveitis (7%). Tuberculosis (28%) was the most common cause in our cohort, followed by HLA B27 (10%), sarcoid (8%), and Vogt-Koyanagi-Harada disease (5%). In 41% of patients, a definitive diagnosis of uveitis could not be achieved, and the anterior uveitis group had the highest number of undifferentiated uveitis cases. There were no undifferentiated cases of uveitis in the posterior and panuveitis category. The median follow-up period of these patients was 52 (15-91) months and 66% of eyes had recurrence. A statistically significant improvement in vision was seen in anterior uveitis and panuveitis groups, whereas the median visual acuity of the intermediate uveitis group remained stable throughout the follow-up period.
CONCLUSION
Uveitis in the elderly can have a higher recurrence rate; however, the lack of follow-up in these groups of patients is a major challenge.
Topics: Humans; Male; India; Retrospective Studies; Female; Aged; Middle Aged; Uveitis; Follow-Up Studies; Visual Acuity; Incidence
PubMed: 38454869
DOI: 10.4103/IJO.IJO_2788_23 -
Frontiers in Medicine 2021Myopia represents a major socioeconomic burden with an increasing prevalence worldwide. Pathologic myopia refers to myopic patients with structural changes in the... (Review)
Review
Myopia represents a major socioeconomic burden with an increasing prevalence worldwide. Pathologic myopia refers to myopic patients with structural changes in the posterior pole including different patterns of chorioretinal atrophy, choroidal neovascularization (CNV) and vitreomacular tractional diseases. Multifocal choroiditis (MFC) is one of the most frequent noninfectious posterior uveitis, and epidemiologically typically affects young myopic females. Acute and chronic chorioretinal atrophic changes are the hallmark feature of MFC, with CNV developing in almost one third of cases. Thus, differentiation of inflammatory lesions due to MFC or neurodenegerative lesions due to pathologic myopic is key in order to establish a particular prognosis, follow-up schedule, and therapeutic approach. The aim of the present manuscript is to summarize and illustrate the main multimodal imaging features of these diseases.
PubMed: 35141257
DOI: 10.3389/fmed.2021.831764 -
Case Reports in Ophthalmological... 2021Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare oculorenal inflammatory entity with a probable autoimmune etiology. Interstitial nephritis may be...
Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare oculorenal inflammatory entity with a probable autoimmune etiology. Interstitial nephritis may be asymptomatic and usually has a benign course with spontaneous resolution. Uveitis, instead, is classically anterior, bilateral, and nongranulomatous, but it can be unilateral and presents as posterior uveitis or panuveitis, sometimes with a chronic or recurrent evolution. The frequent time lag of ocular and renal manifestations makes this diagnosis particularly challenging. The authors describe four cases of this rare entity, two with tubulointerstitial nephritis preceding ocular manifestations and the remaining, instead, with uveitis preceding renal involvement. The therapeutic approach included systemic corticosteroids in all cases. The addition of immunosuppressive therapy was required in three patients to achieve uveitis control. TINU is probably an underrecognized entity and should always be considered in the differential diagnosis of a chronic or recurrent idiopathic uveitis, especially in young patients who may have mild and asymptomatic renal disease.
PubMed: 34123446
DOI: 10.1155/2021/1812271 -
Biomedicines Apr 2023Choroidal caverns (CCs) have been described in association with age-related macular degeneration and pachychoroid disease. However, it is unknown if caverns are found in...
Choroidal caverns (CCs) have been described in association with age-related macular degeneration and pachychoroid disease. However, it is unknown if caverns are found in patients with chronic non-infectious uveitis (NIU). Herein, we evaluated patients with NIU who had optical coherence tomography and indocyanine green angiography for CCs. Clinical and demographic characteristics were extracted from the chart review. Univariate and multivariate mixed-effects logistical models were used to assess the association between clinical and demographic factors and the presence of CCs. One hundred thirty-five patients (251 eyes) met the inclusion criteria: 1 eye had anterior uveitis, 5 had intermediate uveitis, 194 had posterior uveitis, and 51 had panuveitis. The prevalence of CCs was 10%. CCs were only observed in patients with posterior and panuveitis, with a prevalence of 10.8% and 7.8%, respectively. Multifocal choroiditis (MFC) was the type of uveitis where CCs were most frequently observed, with 40% of eyes with MFC having CCs. In addition, male sex ( = 0.024) was associated with CCs. There was no significant difference in the degree of intraocular inflammation or mean subfoveal choroidal thickness between CC+ and CC- eyes. This is the first study to describe CCs in uveitis. Overall, these findings suggest that caverns may be a sequela of structural and/or vascular perturbations in the choroid from uveitis.
PubMed: 37238939
DOI: 10.3390/biomedicines11051268 -
Indian Journal of Ophthalmology Dec 2022To evaluate efficacy of topical interferon alfa-2b (IFN) in the treatment of uveitic macular edema (UME).
PURPOSE
To evaluate efficacy of topical interferon alfa-2b (IFN) in the treatment of uveitic macular edema (UME).
METHODS
This is a prospective, interventional case study of patients with UME. Injection IFN was reconstituted into eye drops and a four times/day (QID) application was prescribed. Central macular thickness (CMT) on optical coherence tomography (OCT) scan was evaluated. Improvement in CMT by ≥50 μm from the baseline was studied in eyes with presenting CMT ≥400 μm.
RESULTS
Twenty eyes of 20 patients with UME were studied: anterior uveitis (n = 3), anterior + intermediate uveitis (n = 5), posterior uveitis (n = 3), retinal vasculitis (n = 3), and panuveitis (n = 6). Mean CMT at the presentation was 423.3 μm (range: 270-604 μm), which improved at 1 month (n = 16), 2 months (n = 10), and ≥3 months (n = 11) follow-up, to 415.3 μm (range: 247-579 μm) (P = 0.411), 364.4 μm (range: 258-566 μm) (P = 0.099), 344 μm (range: 258-484 μm) (P = 0.001), respectively. Twelve eyes of 12 patients had presenting CMT ≥400 μm. In these cases, decrease in CMT by ≥50 μm was seen in 4/10, 4/5, and 5/6 eyes at 1 and 2 months and ≥3 months follow-up. Mean follow-up was 4 months (range: 1-17 months). Complete resolution of UME was seen only in three eyes. No ocular or systemic side effects were observed.
CONCLUSION
Topical IFN therapy in QID doses is safe but may have limited role in UME. Long-term therapy may improve its efficacy. Larger studies with dose modification, combination with other drugs, and with homogeneous uveitis population are recommended.
Topics: Humans; Macular Edema; Prospective Studies; Uveitis; Eye; Uveitis, Anterior
PubMed: 36453344
DOI: 10.4103/ijo.IJO_1450_22