Patterns of Uveitis in a Tertiary Care Referral Institute in Saudi Arabia

Purpose: To present the pattern, causes and complications of uveitis in one of the tertiary eye centers in Saudi Arabia.

Methods: In this retrospective study, clinical records of randomly selected cases of uveitis attending the King Khaled Eye Specialist Hospital, Saudi Arabia, from 2001 to 2010, were reviewed.

Results: Our series included 888 out of 1286 cases of uveitis. Among them, there were 390 men (43.9%) with a mean age of 39.6 ± 11 (range: 6–94 years). The prevalence of uveitis among all eye patients was 1.5% and the annual incidence was 129 cases. Uveitis was bilateral in 567 patients (63.8%), mainly anterior in 27.3%, intermediate in 12.7%, posterior in 7.1%, while 52.9% were panuveitis. Infective etiology was seen in 180 patients (20.3%), of which presumed tuberculous uveitis (PTU) was the commonest cause in 94 patients (52%), followed by herpetic in 46 (26%) and toxoplasmosis in 29 (16%). Vogt–Koyanagi–Harada (VKH) 22%, Behçet uveitis (BU) 14.6%, idiopathic anterior uveitis 12.5%, presumed tuberculous uveitis (PTU) 10.6%, and idiopathic intermediate uveitis (10.1%) accounted for the majority of cases, whereas other diagnostic entities accounted for 30%. The most common cause of anterior uveitis was idiopathic uveitis (101; 41.7%), followed by herpetic (46; 19%). Toxoplasmosis was the most frequent cause of posterior uveitis (29; 46.3%). Intermediate uveitis was most commonly idiopathic (86; 76.1%). VKH disease was the most common cause of panuveitis (195; 41.5%), followed by Behçet disease (118; 25.1%). The common complications of uveitis were glaucoma (34.1%), posterior synechiae (22.3%) and cataract (15.1%).

Conclusions: The most common anatomic diagnosis was panuveitis. VKH disease and Behçet disease were the most frequent causes and glaucoma was the most common complication of uveitis.     

Chronic Anterior Uveitis in Children

Purpose: To describe the visual prognosis and remission rate of chronic anterior uveitis in pediatric patients.

Methods: A retrospective case series of children with chronic anterior uveitis treated in the University of Buenos Aires. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Uveitis remission was defined according to SUN criteria.

Results: There were 35 pediatric patients (61 eyes), mean age of uveitis onset was 7.69 ± 3 years, 60% were females and 74% had bilateral disease, median follow-up was 60 months (range: 12–192 months). JIA was more frequent in females (80.95 vs 21.43; p<0.0001) and oligoarthritis was the most common form. Remission rate was higher in males (HR = 4.99; 95% CI = 1.16–21.51; p = 0.031). More than 40 eyes remained with the same BCVA at 1 year of follow-up.

Conclusions: Although remission was not common and only occurred after long-term follow-up, visual prognosis was good

Received 30 August 2015; revised 6 March 2016; accepted 14 March 2016; published online 18 May 2016     

Treatment of Cytomegalovirus Anterior Uveitis with Oral Valaciclovir

We report a patient with cytomegalovirus anterior uveitis who was treated with oral valaciclovir preventing recurrence of his uveitis. Valaciclovir appears to be a good alternative to valganciclovir for maintenance therapy in this condition.     

Granuloma Annulare Anterior Uveitis

Purpose: To present a case of bilateral granuloma annulare anterior uveitis. Design: Case report. Methods: Clinical case presentation and review of literature. Results: A 72-year-old woman with a history of granuloma annulare (GA) presented with acute bilateral granulomatous anterior uveitis. General physical exam revealed hypo- and hyper-pigmented punctate and annular skin lesions on both arms characteristic of GA. Infectious and autoimmune workup revealed a mildly elevated angiotensin converting enzyme (ACE) level. Her uveitis resolved with topical prednisolone and homatropine. Conclusions: Granuloma annulare is a rare cause of anterior uveitis that is diagnosed by characteristic skin findings and may be associated with sarcoidosis.     

Chikungunya Virus Infection Associated with Encephalitis and Anterior Uveitis

Chikungunya virus (CHIKV) is an RNA virus transmitted by Aedes mosquitoes. The clinical manifestations include fever, arthralgia, rash, and other atypical clinical findings including ocular lesions. We report the case of a 57-year-old man with meningoencephalitis and anterior uveitis due to CHIKV. The patient had developed bilateral anterior uveitis with iris atrophy and a cotton wool spot on the left eye, and his serum, urine, saliva, and cerebrospinal fluid were positive for CHIKV by RT-PCR. The spectrum of the ophthalmologic manifestations and its pathophysiology in cases of CHIKV infections needs to be better understood. Additional studies examining the ocular lesions caused by CHIKV could improve the therapeutic goals of reducing the morbidity and sequels.     

Causes of Visual Loss Associated with Uveitis in a Singapore Tertiary Eye Center

Purpose: To identify the causes of visual loss associated with uveitis and its risk factors.

Methods: Review of 359 patients attending a uveitis service.

Results: Anterior uveitis (n?=?229, 63.8%) was most common, followed by panuveitis (n?=?55, 15.3%). There were 82 infective cases with 29.3% associated with tuberculosis. Visual loss occurred in 100 (27.9%) patients, of which 27 (7.5%) had severe visual loss. The main causes of visual loss were cataract (26%) and glaucoma (12%). Cystoid macular edema (14.8%) accounted for severe visual loss. Panuveitis was predictive for visual loss (p?=?0.022, odds ratio (OR) 2.22) and severe visual loss (p?=?0.01, OR 3.47). Posterior uveitis (p?=?0.005, OR 5.01) and chronic uveitis (p?=?0.008, OR 3.83) also showed higher risk for severe visual loss.

Conclusion: With panuveitis being the second most common presentation, early specialist referral is essential in preventing visual loss.     

Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers

Purpose: To evaluate diagnostic methods and clinical signs of CMV anterior uveitis (AU), a rarely described entity in Europe.

Methods: We included patients with clinical characteristics of CMV AU and positive PCR and/or Goldmann-Witmer coefficient (GWc) for CMV.

Results: We report 21 patients with unilateral uveitis (100%) and signs of Posner-Schlossman syndrome (PSS) (n = 20, 95.2%), Fuchs uveitis syndrome (FUS) (n = 1, 4.7%), and endotheliitis (n = 4, 19,04%). PCR was positive in 15/21 (71.4%) and GWc in 8/9 patients (88.9%) in aqueous for CMV. GWc was the only positive test in 6/9 patients (66,6%). When PCR alone was performed (without GWc) in the first tap, repeated aqueous taps were needed, twice in five cases and thrice in one case.

Conclusion: Combining PCR and GWc were very helpful to confirm the clinical diagnosis of CMV AU. In case of very high clinical suspicion and negative results, repeated tap seems to be recommended.     

Anterior and Intermediate Uveitis Following Yellow Fever Vaccination with Fractional Dose: Case Reports

Purpose: To describe two cases of anterior and intermediate uveitis following yellow fever vaccination with fractional dose.

Methods: Case report.

Results: Case 1: A 35 year-old healthy woman presented with unilateral anterior uveitis 10 days after the yellow fever vaccination. Testing excluded infectious and rheumatic diseases and the episode was fully recovered after a short course of topical treatment. Case 2: A 21 year-old previously healthy woman presented with blurred vision in the left eye (OS) 14 days after the yellow fever vaccination. The ophthalmic examination of the OS revealed intermediated uveitis. Testing excluded infectious and neurological diseases. After six weeks of treatment with oral prednisone, the ocular inflammation had resolved.

Conclusion: Physicians should be aware of the possibility of eye inflammation following the yellow fever vaccination.     

Pattern of Uveitis in a Referral Hospital in Bangladesh

Purpose: To report the pattern of uveitis in a tertiary eye care center in Bangladesh.

Methods: Retrospective analysis of all uveitis cases visiting uveitis clinic of Bangladesh Eye Hospital between January, 2009 and April, 2015.

Results: In total, 652 patients (mean age 32.3 years, female 47.8%) were included in the study. Uveitis was bilateral in 42.6% of cases. Anterior uveitis was the most common (39.2%) case, closely followed by intermediate uveitis (22.2%), posterior uveitis (22%), and panuveitis (16.4%). Specific diagnosis was established in 53.3% of patients. The three most common specific diagnoses were ocular tuberculosis (10.7%), followed by HLA-B27-related uveitis (10.1%) and Vogt–Koyanagi–Harada disease (VKHD; 8.4%).

Conclusion: Ocular tuberculosis remained an important cause of uveitis in Bangladesh while HLA-B27 and VKHD were found to be the most common non-infectious uveitic entity.     

Causes of Uveitis in a Tertiary Center in Chile: A Cross-sectional Retrospective Review

Abstract

Purpose: To describe the pattern of uveitis in a tertiary center in Santiago, Chile.

Methods: We reviewed all of the case records with a presumptive diagnosis of uveitis from patients referred to the Uveitis Department of Hospital del Salvador between 2002 and 2012. Initial assessment was standardized. We tested for association among causes, gender, and age groups.

Results: Anterior uveitis was the leading anatomical location of the inflammation (40.4%). A specific etiology was demonstrated in 59% of cases (28.7% infectious). Vogt-Koyanagi-Harada syndrome (VKH) was the most frequent cause of uveitis (17.2%). We found association between idiopathic intermediate uveitis, toxocariasis, juvenile idiopathic arthritis, VKH, toxoplasmosis, diabetes mellitus (DM)-associated uveitis, tuberculosis, and idiopathic anterior uveitis and age groups. VKH, DM-associated uveitis, and syphilis-associated uveitis were associated with gender.

Conclusions: Our sample shows a distribution of causes of uveitis similar to those in developed countries. The prevalence of VKH is higher than expected.     

Changes in Corneal Thickness and Specular Microscopic Indices in Acute Unilateral Anterior Uveitis

Purpose: To compare central corneal thickness (CCT) and specular microscopic indices in active unilateral anterior uveitis with the same indices 1 week after the initiation of treatment. Methods: This study included 30 eyes with active unilateral idiopathic anterior uveitis. CCT and specular microscopic indices were compared before and after 1 week of the treatment with topical medications.

Results: At the first visit, mean CCT was significantly greater in affected eyes (mean?±?standard deviation: 514.0?±?23.0) than in fellow eyes (493.2?±?10.6) (p?p?Conclusion: We found that eyes with unilateral active anterior uveitis had increased CCT in comparison to their healthy fellow eyes without a change in the specular microscopic indices.     

Spectrum of Uveitis in A German Tertiary Center: Review of 474 Consecutive Patients

Abstract

Purpose: To analyze the spectrum of uveitis at a German tertiary center.

Patients and methods: A total of 474 consecutive patients with uveitis were classified according to the primary anatomic site of inflammation, examined for laterality of disease, and screened for etiologies.

Results: Out of the total, 253 patients (53%) had anterior uveitis, 90 patients (19%) had intermediate uveitis, 100 patients (21%) had posterior uveitis, and 31 patients (7%) had panuveitis. Fifty-six percent of the patients had bilateral involvement, predominantly in intermediate uveitis (ratio 4:1) and panuveitis (ratio 3.4:1). Regarding the etiology of all uveitis cases we found 17% infectious, 23% specific clinical entities, 20% associated with systemic disease (most commonly sarcoidosis with 11%), and 41% idiopathic uveitis.

Conclusions: Anterior uveitis was the most common anatomic site of intraocular inflammation. Using a tailored approach, screening for systemic etiologies is recommended, since 20% of all patients had associated systemic diseases.     

Patterns of Uveitis in Patients Admitted to a University Hospital in Riyadh,Saudi Arabia

Purpose: To analyze clinical patterns, causes, and systemic disease associations among patients with uveitis admitted to King Abdulaziz University Hospital.

Methods: The authors retrospectively reviewed the medical records of 351 patients (600 eyes).

Results: The study subjects consisted of 183 (52.1%) males and 168 (47.9%) females, with a mean age of 39.9 ± 14.2 years at presentation. The most common anatomic diagnosis was panuveitis (68.6%), followed by posterior uveitis (12.7%), anterior uveitis (12.7%), and intermediate uveitis (6.0%). The most common identifiable specific diagnoses were presumed tuberculous uveitis (PTU) (28.2%), Vogt-Koyanagi-Harada (VKH) disease (19.4%), Behçet disease (BD) (12.5%), and toxoplasmosis (8.2%). After a mean follow-up period of 29.5 ± 22.1 months, 63.5% of the eyes achieved visual acuity of 20/40 or better. Eyes from patients with PTU had the worst final visual outcome.

Conclusions: The most common anatomic diagnosis was panuveitis. PTU, VKH disease, BD, and toxoplasmosis were the most frequent specific diagnoses.     

Anterior Segment Characteristics of Fuchs Uveitis Syndrome

Purpose: To evaluate the differences in the biometric parameters of the anterior segment in Fuchs' uveitis syndrome (FUS).

Methods: 30 eyes of 15 consecutive patients with unilateral FUS were examined. Anterior segment parameters were measured by rotating Scheimpflug imaging camera. Central endothelial cell count was measured by noncontact specular microscopy.

Results: The central cornea was thinner (p?p?p?p?Conclusions: Scheimpflug imaging method is a useful tool to analyze the anterior segment parameters in FUS. Endothelial cell loss, as well as decreased percentage of endothelial hexagonal cells, is obtained by noncontact specular microscopy in patients with FUS.     

Patterns of Uveitis at Two University-Based Referral Centres in Cape Town,South Africa

Purpose: To analyze the pattern of uveitis at two tertiary hospitals in South Africa which has a high prevalence of HIV, TB and syphilis.

Methods: Data of 198 patients were obtained retrospectively between August 2014 and August 2016, including patient demographics, clinical examination, special investigations and final diagnosis.

Results: Infectious uveitis was the most common aetiological category (47%), followed by idiopathic (34.8%) and non-infectious (18.2%). Syphilis was the most common identifiable cause (16.2%). Other important causes were toxoplasmosis, herpes viruses, tuberculosis and HLA-B27. HIV positive patients, who constituted 40% of the study population, were more likely to present with a posterior or panuveitis (relative risk 1.50, 95% CI 1.19–1.89) and more likely to have an infectious cause compared to HIV negative patients (relative risk 2.47, 95% CI 1.82–3.35).

Conclusions: This study emphasizes the importance of HIV testing and investigations for infectious causes of uveitis, especially syphilis, in this population.     

PCR Multiplex for CMV Detection in Patients with Anterior Uveitis

Purpose: Describing the utility of Polymerase Chain Reaction for Cytomegalovirus (CMV-PCR) in the diagnosis of suspected viral anterior uveitis (AU).

Patients and methods: We analyzed aqueous humor (AH) CMV-PCR positivity and treatment modifications in 47 eyes of 46 patients with viral uveitis and its correlation with high intraocular pressure (HIOP), uveitis clinical characteristics and time intervals from samples to uveitis diagnosis and to relapse.

Results: CMV-PCR positive results occurred in 13 eyes (27.7%) of 12 patients. They were more frequent in HIOP eyes (34.2%, p = 0.047) and with Posner–Schlossman Syndrome (56.2%, p = 0.002). CMV-PCR positivity (p = 0.001) and HIOP (p = 0.038) increased the probability of treatment change. Although CMV-PCR positive results decreased over time (p = 0.002), they were not related to activity or proximity to inflammatory uveitis episode.

Conclusion: HIOP AU eyes should be considered for CMV-PCR AH analysis due to possible treatment modifications.     

Incidence and Risk Factors for Developing Glaucoma Among Patients with Uveitis in a University-based Tertiary Referral Center in Riyadh,Saudi Arabia

Purpose: To investigate the incidence and risk factors of secondary glaucoma among uveitis patients.

Methods: Retrospective review of medical records of 642 patients (1220 eyes).

Results: Glaucoma was diagnosed in 169 (13.9%) eyes and was most common in eyes with anterior uveitis (19.1%) (p?p?Conclusions: Incidence of glaucoma differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of glaucoma.     

Clinical Patterns and Causes of Intraocular Inflammation in a Uveitis Patient Cohort from Egypt

Purpose: To analyze the patterns and causes of intraocular inflammation in patients attending uveitis referral clinics in Egypt.

Methods: The study included 454 patients with uveitis examined both at the Department of Ophthalmology, Alexandria Faculty of Medicine, and tertiary uveitis referral clinics in Cairo and the International Eye Clinic in Upper Egypt, between August 2013 and March 2016. All patients had a comprehensive ocular examination and systemic work-up. Standard diagnostic criteria for uveitis syndromes were employed for all patients and ancillary ocular or systemic investigations were ordered as required by the suspected uveitis entity.

Results: The mean age at presentation was 30 years (range: 4–75). The male to female ratio was 1.1:1. Panuveitis was the most common anatomic pattern (43%), followed by anterior (40.7%), posterior (9%), and intermediate uveitis (7.3%). Anterior uveitis was most commonly attributed to pediatric parasitic anterior chamber granulomas (22.2%). Intermediate uveitis was most commonly idiopathic (81.8%). Toxoplasma retinitis was the most common cause of posterior uveitis (31.7%). Behçet disease was the most common cause of panuveitis followed by Vogt–Koyanagi–Harada (VKH) disease (45.6% and 22.1%, respectively). Among non-infectious etiologies, Behçet disease was the most frequent etiology (28.6%), while for infectious causes, herpetic uveitis was found to be the most frequent cause (39.8%).

Conclusions: In this uveitis patient population from Egypt, panuveitis was the most commonly encountered anatomic diagnosis. Behçet disease was the most common identified cause of uveitis followed by VKH disease. Herpes-related uveitides and parasitic granulomas represented the most evident causes of infectious uveitis.     

Glaucoma Secondary to Uveitis in Children in a Tertiary Care Referral Center

Purpose: To study outcome of secondary glaucoma in pediatric uveitis patients.

Methods: Retrospective analysis of records of uveitis patients ≤16 years.

Results: Of 182 pediatric uveitis patients, secondary glaucoma was seen in 48 patients (75 eyes, 26.23%) with female preponderance (F:M-29:19) . JIA was the most common etiology (35.71%). BCVA of ≥20/40 was seen in 22 eyes at presentation and in 38 eyes at final follow up (p<0.001). Twenty eight children (66.67%) received systemic antiglaucoma therapy while 17 children (21 eyes) required surgery (60.71%). Logistic regression showed pseudophakia could predict the higher use of oral antiglaucoma medication (p=0.03) while anatomical site of involvement was predictive of higher chances of surgery (p=0.003). Overall success was seen in 82.10% and 71.64% using IOP limit of 21 and 18 mmHg respectively at mean follow-up of 3.9 years.

Conclusion: Pediatric uveitic glaucoma though require multitude of therapies, can be managed effectively with appropriate therapy.     

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.