Clinical Features and Prognosis of Uveitis in a Turkish Patient Population with Ankylosing Spondylitis: Incidence and Management of Ocular Complications

Purpose: To investigate clinical features, visual prognosis, and ocular complications in patients with ankylosing spondylitis (AS)-associated anterior uveitis (AU).

Methods: Data of 211 eyes of 145 patients with AU associated with AS were reviewed retrospectively.

Results: Mean follow-up time was 6.31 ± 6.33 years. Men were younger than women at AS diagnosis (p = 0.035). The mean number of uveitis flares was highest during the first quarter of the year and lowest during the third quarter (p = 0.017). Immunosuppressive agent use was higher in women than men (p = 0.052). Ocular complications developed in 120 eyes (56.9%), and the complication rate was 0.146/eye year. Males developed cystoid macular edema more frequently than females (p = 0.05). Glaucoma was observed more often in early-onset disease (age at AS onset <45 years) than late-onset disease (p = 0.028).

Conclusions: Visual prognosis of AU in patients with AS was good, although more than half of the eyes developed ocular complications (56.9%).     

Ankylosing Spondylitis Patients with HLA-B*2704 have More Uveitis than Patients with HLA-B*2705 in a North Chinese Population

Purpose: To investigate the correlation between clinical features of ankylosing spondylitis (AS) and different human leukocyte antigen (HLA)-B27 subtypes.

Methods: We conducted a cross-sectional study of 216 patients with AS. HLA-B27 and its subtypes were detected by polymerase chain reaction with sequence specific primer (PCR-SSP). Clinical features were compared between the different HLA-B27 subtypes. A meta-analysis on uveitis frequencies in AS patients with HLA-B*2705 vs 2704 was performed.

Results: The most prevalent subtypes of HLA-B27 were HLA-B*2704 (66.1%) and HLA-B*2705 (32.2%). There were 57 HLA-B27-positive AS patients with the history of uveitis; 45 were B*2704 and 12 were B*2705. Patients with B*2704 had more uveitis than B*2705 (p = 0.021). After meta-analysis, there was no significant difference in the presence of uveitis between HLA-B*2704 and HLA-B*2705.

Conclusions: AS patients with B*2704 have a higher risk of uveitis than AS with B*2705 in a north Chinese people.     

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis

Abstract

Purpose: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. Methods: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV–EDV)/PSV]. Results: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. Conclusion: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.     

Clinical Analysis of 240 Patients with HLA-B27 Associated Acute Anterior Uveitis

 Purpose: To analyze the prevalence of HLA-B27 associated acute anterior uveitis and to identify the clinical features. Methods: A total of 240 patients with HLA-B27 associated acute anterior uveitis who were admitted to Zhejiang Ophthalmologic Hospital between December 2006 to October 2012 were retrospectively analyzed. The age of onset, sex, affected eyes, HLA-B27 antigen detection, recurrence, joint involvement and surgical complications were investigated. Results: The average age of onset was 37.0±12.0 years and the ratio of male to female patients was 2.4:1. Most cases had alternate unilateral or bilateral involvement. Among all paricipants, 234 cases (97.5%) were HLA-B27 positive, and 124 cases (51.7%) had spondyloarthropathies (SpA), dominated by 108 cases with ankylosing spondylitis (AS,45.0%), and mostly seen in male subjects (P<0.05). Six patients were HLA-B27 negative  (2.5%). No statistical significance was noted between male and female patients (P>0.05). A total of 193 cases (80.4%) presented with complications, mainly fibrinous exudation, posterior synechia and vitreous opacity. Conclusion: HLA-B27 associated acute anterior uveitis with a relatively high incidence and recurrence presnets with more severe clinical features than idiopathic acute anterior uveitis, and often accompanied with systemic arthritic diseases. HLA-B27 antibody detection is associated with the diagnosis and treatment of acute anterior uveitis.     

Clinical features of ankylosing spondylitis associated with acute anterior uveitis in Chinese patients

AIM: To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS: Two hundred and three patients with uveitis associated with AS followed-up in the Third Military Medical University Daping Hospital between 2005 and 2010 were retrospectively evaluated in this study. Complete ophthalmological examinations were evaluated at baseline and during the follow-up period. The gender, age, follow-up time, mean frequency of uveitis onset, and accompanying eye examination findings, history, demographical parameters were reviewed. All the patients presented complete clinical and radiologic (sacroiliac, lumbar, dorsal and cervical spine, knee, ankle, shoulder, hip, elbow) evaluation. HLA-B27 typing was also searched. RESULTS: There were 203 patients diagnosed with AS associated uveitis. All showed sacroiliac X-ray changes indicative of AS. There were 184 male and 19 female patients. The average age of patients was 35±12 (range 18–50). Mean follow-up period was 2.4 years (1-5 years). Acute anterior uveitis was the most common type of uveitis in both genders. 121 eyes presented unilateral involvement (55.2%), and 92 eyes presented bilateral involvement (45.3%) with onset alternately. 22 eyes occurred hypopyon, 16 eyes were found anterior vitreous cells, 7 eyes were noted reactive macular edema or exudation, 29 eyes presented posterior synechiae of iris, and 14 eyes presented cataract, 9 eyes presented secondary glaucoma, 2 eyes presented bend corneal degeneration and 1 eyes presented atrophy of eyeball. At the final visit, uveitis was well controlled in most patients. CONCLUSION: AS associated with uveitis in Chinese patients mainly manifests as acute anterior uveitis. A combination of corticosteroids with other mydriasis agents is effective for most AS associated with uveitis patients. In general, the prognosis is good in these cases.     

Characteristics and Clinical Outcomes of Hypertensive Anterior Uveitis

ABSTRACT

Objective

The objective of this article is to determine characteristics and outcome of hypertensive anterior uveitis and prevalence of the Herpesviridae family.

Study: Retrospective cohort study.     

Visual Prognosis and Ocular Complications in Herpetic versus HLA-B27- or Ankylosing Spondylitis-associated Anterior Uveitis

Purpose: To investigate the visual prognosis and ocular complications in patients with herpetic versus HLA-B27 associated anterior uveitis (AU).

Methods: This was a retrospective, observational study conducted at the ophthalmology department of the University Medical Center of Groningen. Sixty-two herpetic and 113 HLA-B27-associated AU patients were included. The main outcome measures were visual acuity and ocular complications.

Results: Visual acuity over time was significantly lower in herpetic as compared to HLA-B27 AU, mainly due to corneal scarring. The incidence rate of any ocular complication was higher in herpetic AU compared to HLA-B27-associated AU (0.140/EY versus 0.076/EY, p?=?<0.001), which was mainly due to glaucoma (0.033/EY versus 0.004/EY, p?p?Conclusions: The most prominent finding was a worse visual prognosis in herpetic AU, which is probably related to higher prevalence of corneal scarring and glaucoma. In addition, herpetic AU patients have more ocular complications overall.     

急性前色素膜炎与HLA—B27抗原的相关性

对52例急性前色素膜炎患者,50例健康人,19例其他色素膜炎患者进行HLA-B27抗原的测定,结果急性前色素膜炎患者HLA-B27抗原阳性率为60%,正常对照组为2%,说明HLA-B27为急性前色素膜炎的相关抗原。HLA-B27阳性的急性前色素膜炎患者与HLA-B27阴性的急性前色素膜炎患者的临床现象是不同的。     

Clinical Characteristics of Uveitis in Patients with Psoriasis in Korea: A Retrospective Multicenter Case Series

PurposeTo describe the clinical characteristics and treatment outcomes of uveitis in patients with psoriasis in Korea.MethodsThe medical records of 20 patients (27 eyes) with psoriatic uveitis in two tertiary hospitals were retrospectively reviewed. We analyzed data about patient demographics, uveitis types, laterality, onset of disease, human leukocyte antigen (HLA) types, intraocular pressure, visual acuity, comorbidities, and medical treatments and outcomes for uveitis and psoriasis.ResultsThe cohort comprised 11 males and nine females (age of onset, 50.1 ± 13.2 years) and the mean follow-up period was 3.9 ± 4.0 years. Types of uveitis included anterior (85%), intermediate (10%), and panuveitis (5%). A total of 13 (65%) cases presented with unilateral involvement and 12 out of 18 patients (66.7%) were positive for HLA-B27. The average intraocular pressure of affected eyes was 11.6 ± 3.6 at the first visit and 13.8 ± 3.6 mmHg at the final visit. The average logarithm of the minimum angle of resolution visual acuity of affected eyes at the initial examination was 0.16 ± 0.52 and 0.27 ± 0.71 at the last examination. Most common comorbidity (13 patients, 65%) was psoriatic arthritis (PsA). All cases underwent topical corticosteroid treatment; however, 11 (55%) required systemic corticosteroid and immunosuppressants for the treatment of uveitis. Notable deterioration in visual outcome was found in two cases (10%) due to severe intraocular inflammation and its complications (uveitic glaucoma and bullous keratopathy). Recurrent uveitis was observed in 57.9% of patients. Patients with PsA tended to have higher positive rate of HLA-B27 (83.3%). However, there was no significant correlation between visual prognosis and location of psoriatic uveitis, presence of PsA, and HLA-B27 positivity.ConclusionsPsoriatic uveitis in Koreans usually presents with anterior uveitis with unilateral involvement. PsA was the most common comorbidity. In majority of patients, visual outcomes are satisfactory with appropriate topical or systemic immunosuppressive treatment.     

Clinical Features and Outcomes of HLA-B27-Positive and HLA-B27-Negative Acute Anterior Uveitis in a Turkish Patient Population

Purpose: To compare the clinical features and outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis (AAU) in a large Turkish patient population. Methods: Forty-four patients with HLA-B27-positive AAU and 65 with HLA-B27-negative AAU were reviewed retrospectively. HLA-B27 typing, gender, laterality, clinical features (fibrinous reaction, hypopyon formation), ocular complications, medical treatment, and final visual acuity were recorded. Statistical analyses included Student's t-test, Fisher's exact test, Yate's corrected χ test, and Mann-Whitney U test. A p-value of < 0.05 was considered statistically significant. Results: Forty percent of all patients with AAU were found to be positive for HLA-B27 antigen. HLA-B27-positive AAU was significantly more common in males and HLA-B27-negative AAU in females. Unilateral or bilateral alternating AAU as well as fibrinous reaction and hypopyon formation were more common in HLA-B27-positive patients. Posterior iris synechiae and cataract formation were more common and systemic immunosuppressive agents were exclusively required in patients with HLA-B27-negative AAU. Visual outcome did not differ significantly between the HLA-B27-positive and HLA-B27-negative groups. Conclusions: HLA-B27 association is less common in Turkish patients with AAU than in other populations reported in the literature. Although distinct features of HLA-B27 uveitis were confirmed in our study, visual outcome did not differ from idiopathic AAU. Therefore, we believe that HLA-B27 typing in patients with AAU helps the clinician with the diagnosis. However, it has a limited value in determining the prognosis.     

Clinical and Demographic Characteristics of Patients with Uveitis Starting Later in Life

Abstract

Purpose: To evaluate uveitis cases presenting at older ages for the first time.

Methods: We retrospectively analyzed the clinical data related to the 90 eyes of 68 patients who presented with a first episode of uveitis at the age of ≥60 years and were seen at the Uveitis Division of the Ulucanlar Eye Hospital from 1996 to 2013.

Results: The location of the uveitis was anterior in 51 (75%) patients. Nine patients (13.2%) presented with panuveitis, 5 (7.3%) with posterior uveitis, and 3 (4.4%) patients with intermediate uveitis. Idiopathic uveitis in 23 (33.8%) and presumed herpetic anterior uveitis in 23 (33.8%) patients were the most common diagnoses, while other diagnostic entities accounted for 22 (32.3%) patients. The most common complications were elevation of intraocular pressure in 17.7%, cystoid macular edema (CME) in 11.1%, and corneal scar in 11.1% of eyes.

Conclusions: While idiopathic uveitis and presumed herpetic anterior uveitis were the most common causes, although in an endemic country, Behçet disease was not a common cause of uveitis in the elderly population.     

Demographic and Clinical Features of Pediatric Uveitis in Israel

ABSTRACT

Purpose: To report the epidemiology, etiology, ocular characteristics, treatment and visual outcome of pediatric uveitis in Israel.

Methods: Retrospective study from two tertiary uveitis centers.

Results: Included were 107 patients (182 eyes), 55% females. Mean age at diagnosis 8.8 years. Uveitis was predominantly anterior, idiopathic, bilateral, and chronic. Systemic associations were seen in 36% of patients of which the most common disease was juvenile idiopathic arthritis. Infectious uveitis accounted for 37% of posterior uveitis cases of which toxoplasmosis was the most common cause. Anterior segment complications were commonly observed at presentation (41%); the most predominant were posterior synechiae, cataract, and band keratopathy. The most common posterior segment complications were papillitis, epiretinal membrane, and macular atrophy/scar. Ninety-three percent of eyes had visual acuity >20/40 at last follow-up.

Conclusion: The pattern of pediatric uveitis in Israel is similar to that in the western world. Visual outcome was good in most eyes.     

Assessment of Corneal Parameters with Scheimpflug Imaging in Patients with Ankylosing Spondylitis

Purpose: To evaluate corneal parameters of patients with ankylosing spondylitis (AS) by Scheimpflug imaging and also to clarify the associations between disease severity and clinical status of AS and corneal parameters. Methods: Fifty-seven patients with AS and 57 healthy subjects were included in this cross-sectional study. All participants underwent a detailed ophthalmological evaluation. Corneal parameters were measured by Pentacam. In addition, Schirmer test, tear break-up time (TBUT), corneal fluorescein staining, and Ocular Surface Disease Index (OSDI) scores were evaluated. Duration of disease and scores of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Quality of Life scale (ASQoL) of the patients were recorded. The laboratory evaluation consisted of human leukocyte antigen (HLA)-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results: Corneal parameters were significantly different between patients with AS and healthy controls. The mean central corneal thickness (538?±?26?µm versus 569?±?27?µm, p?3 versus 62.3?±?3.40?mm³, p?p?Conclusion: The AS patients have thinner corneas compared to control subjects, which may be affected by tear disfunction and inflammatory processes.     

Clinical Characteristics of Herpes Simplex Virus Associated Anterior Uveitis

Purpose: The aim of this study is to describe the clinical characteristics of molecularly proven Herpes simplex virus (HSV) anterior uveitis.

Methods: The literature on HSV anterior uveitis whereby the diagnosis was confirmed by polymerase chain reaction (PCR) and or Goldmann–Witmer coefficient in aqueous humor was reviewed. Three studies from Europe and one from Japan could be included.

Results: It was observed that HSV anterior uveitis is mostly an acute unilateral disease mainly occurring in middle-aged people with a predominance in females. The incidence of keratitis in HSV is between 33 and 41%. High intraocular pressure is frequently observed and ranged from 46 to 90%. Sectorial iris atrophy may be absent, especially early in the disease.

Conclusion: The clinical characteristics of HSV anterior uveitis can mimic other viral and non-infectious anterior uveitis entities especially at onset. Aqueous humor analysis for PCR and GWC can be useful in case of suspected viral uveitis.     

HLA-B27相关前葡萄膜炎的研究进展

HLA-B27阳性前葡萄膜炎是前葡萄膜炎最常见的类型,患者多为青壮年,反复发作,常引起一些并发症,严重影响视力,并可伴有其他系统性疾病。但其发病机制目前仍不清楚,尚无特效的治疗方法。近年来,建立了一些前葡萄膜炎动物模型,如内毒素诱导的前葡萄膜炎和HLA-B27转基因动物模型,并进行了一系列的研究。一些新的治疗方法在临床及动物实验中也取得了很好的疗效。就HLA-B27相关前葡萄膜炎的发病机制、流行病学、动物模型及一些新的治疗方法进行综述。     

人类白细胞抗原-B27相关性急性前葡萄膜炎病情与脉络膜厚度变化的关系

目的　探讨人类白细胞抗原（human leukocyte antigen,HLA）-B27相关性急性前葡萄膜炎（acute anterior uveitis,AAU）病情与脉络膜厚度变化的相关性。方法　HLA-B27 相关性AAU患者32例32眼及其对侧眼被纳入本研究,除对患者进行眼底荧光血管造影（fluorescein fundus angiography,FFA）等常规检查外,利用光学相干断层扫描 （optical coherence tomography,OCT） 对患者双眼黄斑中心凹下脉络膜厚度（subfoveal choroidal thickness,SFCT）及黄斑中心凹视网膜厚度（central foveal thickness,CFT）进行测量。对比AAU患者治疗前后SFCT及CFT变化。结果　FFA显示,32眼HLA-B27相关性AAU患者视盘毛细血管均有荧光素渗漏 （100.0%）,其中13眼（40.63%）视网膜毛细血管荧光素渗漏 。OCT检测结果显示,在炎症急性期,32眼HLA-B27相关性AAU患者的黄斑区脉络膜血管扩张显著。HLA-B27 相关性AAU患眼的SFCT ［（342.54±70.71）μm］较对侧眼的SFCT［（283.41±79.15）μm］显著增加 （P=0.003）,AAU患眼的CFT［（281.46±56.42）μm］与对侧眼的CFT［（268.49±51.91）μm］比较,差异无统计学意义（P=0.342）。经治疗炎症消退后,AAU患眼的SFCT减少至（284.13±99.07）μm,与治疗前相比,差异有统计学意义（P=0.009）。结论　HLA-B27 相关性AAU患眼SFCT增加,脉络膜厚度可作为评估HLA-B27相关性AAU病情严重程度的指标之一。     

Prevalence and Levels of Serum Antibodies to Gram Negative Microorganisms in Turkish Patients with HLA-B27 Positive Acute Anterior Uveitis and Controls

Purpose: Acute anterior uveitis (AAU), seronegative spondyloarthropathies such as ankylosing spondylitis and reactive arthritis form the group of “HLA-B27-associated diseases.” The aim of this study was to analyze the prevalence and levels of serum antibodies against gram negative bacteria in Turkish patients with AAU. Methods: Twenty-five patients each with previously diagnosed HLA-B27 positive and negative AAU and 25 age-and sex-matched healthy control subjects were included in the study. Serum IgM, IgG and IgA antibodies to Yersiniae enterocolitica, Campylobacter jejuni and Chlamydia trachomatis were measured using enzyme linked immunosorbent assay (ELISA). Categorical data were analyzed by chi-square test. Serum levels were analyzed using the Kruskal-Wallis test. Results: The prevalence of serum IgM, IgG and IgA antibodies did not differ significantly between the HLA-B27 positive AAU, HLA-B27 negative AAU and control groups with the exception of serum IgA antibodies against Yersiniae enterocolitica. IgA antibody against Yersiniae enterocolitica was found to be more frequently positive in the control group. Comparison of serum IgM, IgG and IgA antibody levels did not significantly differ between three groups. Conclusions: Serum antibody positivity against Yersiniae enterocolitica, Campylobacter jejuni and Chlamydia trachomatis is not frequent in the HLA-B27 positive and negative AAU patients. Serum levels of IgM, IgG, and IgA antibodies also did not show significant difference between three groups. No association between these microorganisms and the etiology of AAU was evident.     

HLA-B27阳性与阴性葡萄膜炎患者外周血中炎症因子表达研究

目的：通过分析比较人白细胞抗原-B27(HLA-B27)阳性及阴性葡萄膜炎患者外周血中炎症因子的表达变化情况,探讨其相关性。

方法：回顾性研究。选取2020-01/2022-04我院初诊为葡萄膜炎的患者76例,采集静脉血分离有核细胞,用流式细胞术(直接免疫荧光法)检测HLA-B27,分成HLA-B27阳性组(≥90%)35例和HLA-B27阴性组(≤5%)41例。提取全血RNA,用RT-qPCR方法检测并比较白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、蛋白酶激活受体2(PAR2)、肿瘤坏死因子-α(TNF-α)、白细胞介素增强因子-3(ILF3)mRNA表达。

结果：两组患者IL-1β、IL-10、PAR2、TNF-α mRNA表达均无差异(均P>0.05)。HLA-B27阳性组患者IL-6 mRNA较HLA-B27阴性组升高,ILF3 mRNA较HLA-B27阴性组降低(均P<0.05)。

结论：HLA-B27阳性相关的葡萄膜炎患者外周血中炎性指标IL-6表达显著升高,ILF3较HLA-B27阴性组表达下降,可作为其辅助诊疗指标。     

急性前葡萄膜炎的HLA-B27阳性与阴性患者的临床对比

目的:用微量淋巴细胞毒试验对急性前葡萄膜炎(acuteanterioruveitis,AAU)HLA-B27抗原基因进行检测,观察HLA-B27阳性与阴性患者的临床特征有无差异及临床意义。方法:用微量淋巴细胞毒试验对100例AAU患者进行HLA-B27检测,并随机抽取20例阳性和20例阴性AAU患者进行临床特征观察。结果:在100例AAU患者中HLA-B27阳性64例,阴性36例,分别抽取的20例经比较,HLA-B27阳性患者多见于男性,单眼多见,以粉尘状KP,发病时视力下降明显,易复发,且并发症多为其特征,激素治疗效果佳。结论:对AAU患者进行HLA-B27检测,对评价葡萄膜炎的病因和预后有一定价值。HLA-B27阳性与阴性患者的临床特征有一定程度差异。