Anterior Uveitis and Hypopyon

D’Alessandro, Leonardo; Forster, David J.; Rao, Narsing A.

doi:10.1016/s0002-9394(14)76733-9

Cited by 54 publications

(21 citation statements)

References 12 publications

(4 reference statements)

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“…The incidence of hypopyon in our series seems lower than that of D’Alessandro, et al , who observed hypopyon in 4.6% of a series of patients with anterior uveitis 1. However, because the duration of follow-up was not reported, the results cannot be directly compared.…”

Section: Discussioncontrasting

confidence: 86%

“…The frequency of hypopyon has been described in two small to moderate-sized series of patients with various types of uveitis. D’Alessandro et al retrospectively reviewed 155 cases of acute anterior uveitis and found 11 (7%) cases of hypopyon (duration of follow-up not reported), 9 of which were associated with HLA-B27 1. BenEzra et al reviewed 49 patients with Behçet’s disease, finding that 17 (35%) developed hypopyon over 6–10 years of follow-up 2.…”

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confidence: 99%

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Hypopyon in Patients with Uveitis

et al. 2010

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PURPOSE-To evaluate the risk of and risk factors for hypopyon among patients with uveitis, and to evaluate the risk of visual changes and structural complications following hypopyon. DESIGN-Retrospective cohort study.PARTICIPANTS-Patients with uveitis at four academic ocular inflammation subspecialty practices. METHODS-Data were ascertained by standardized chart review.MAIN OUTCOME MEASURES-Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and of structural ocular complications following hypopyon.RESULTS-Among 4,911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2,885 initially free of hypopyon were followed over 9,451 person-years, during which 81 (2.8%) developed hypopyon (8.57/1000 person-years). Risk factors Corresponding Author: John H. Kempen, M.D., Ph.D.; Center for Preventive Ophthalmology and Biostatistics; Department of Ophthalmology; University of Pennsylvania; 3535 Market Street, Suite 700; Philadelphia, PA 19104 john.kempen@uphs.upenn.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2011 February 1. Published in final edited form as:Ophthalmology. CONCLUSIONS-Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Behçet's disease, HLA-B27 positivity, and diagnosis of a spondyloarthropathy. Intermediate uveitis cases (+/− anterior uveitis) had lower risk of hypopyon than other forms of uveitis. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity.Hypopyon-layering of white blood cells in the anterior chamber-signifies severe anterior segment intraocular inflammation. The frequency of hypopyon has been described in two small to moderate-sized series of patients with various types of uveitis. D'Alessandro et al retrospectively reviewed 155 cases of acute anterior uveitis and found 11 (7%) cases of hypopyon (duration of follow-up not reported), 9 of which were associated with HLA-B27. 1 BenEzra et al reviewed 49 patients with Behçet's disease, finding that 17 (35%) developed hypopyon over 6-10 years of follow-up.2 The incidence of hypopyon for other forms of uveitis is unclear.Data regarding the risk factors for hypopyon and regarding its prognostic significance are limited. Nussenblatt et al reported that the occurrence of hypopyon did not worsen the visual prognosis of patients with Behçet's disease. 3 However, the relationship betw...

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Section: Discussioncontrasting

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Hypopyon in Patients with Uveitis

et al. 2010

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“…Chorioretinal lesions are not characteristic. The iritis associated with ankylosing spondylitis can be intense with hypopyon [7] (pus in the anterior chamber of the eye), fibrin, or posterior synechiae (the pupil becoming attached to the lens posterior to it). However, the visual prognosis associated with this form of uveitis is excellent, and most patients recover full vision after an attack subsides, usually within 2 months.…”

Section: The Phenotype Of Uveitis With Spondyloarthritismentioning

confidence: 99%

Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease

Rosenbaum

2015

Clin Rheumatol

100

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Uveitis is a common complication of spondyloarthritis. The "phenotype" of the uveitis characteristic of ankylosing spondylitis (sudden onset, anterior, unilateral, recurrent, more often male) may differ from the phenotype often seen with either psoriatic arthritis or inflammatory bowel disease (insidious onset, anterior and intermediate, bilateral, chronic, and/or more often female). The frequency of uveitis is also much greater in association with ankylosing spondylitis than with either inflammatory bowel disease or psoriasis. Uveitis may affect the choice of therapy and can rarely be a complication of therapy. Uveitis and arthritis also co-exist in several animal models.

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“…rifabutin). 11-13 In fact, in the United States, because of the much greater prevalence of the spondyloarthropathies than of Behçet disease, a patient presenting with hypopyon uveitis is more likely to have spondyloarthropathy-associated uveitis. 11 However, in the Middle East and the Far East, the situation is reversed due to the greater prevalence of Behçet disease.…”

Section: Characterization Of the Uveitismentioning

confidence: 99%

“…11-13 In fact, in the United States, because of the much greater prevalence of the spondyloarthropathies than of Behçet disease, a patient presenting with hypopyon uveitis is more likely to have spondyloarthropathy-associated uveitis. 11 However, in the Middle East and the Far East, the situation is reversed due to the greater prevalence of Behçet disease. A study using anterior chamber paracentesis for polymerase chamber reaction (PCR) analysis for viral DNA demonstrated that classic appearing “herpetic uveitis” with sectoral iris atrophy nearly always (>95%) was herpetic uveitis on PCR testing.…”

Section: Characterization Of the Uveitismentioning

confidence: 99%

Approach to the Diagnosis of the Uveitides

Jabs

Busingye

2013

American Journal of Ophthalmology

134

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Purpose To describe an approach to diagnosing the uveitides, a collection of about 30 separate diseases characterized by intraocular inflammation. Design Perspective. Methods Integration of clinical approach with a more formal, informatics-derived approach to characterization and a Bayesian approach to laboratory testing. Results The patient’s uveitis is characterized along several dimensions: course, laterality, anatomic location of the inflammation, morphology, presence of active infection, and the host (age, presence of a systemic disease). Posterior uveitis can be characterized further by whether it is primarily a retinitis, choroiditis, or retinal vasculitis, by whether it is paucifocal or multifocal, and by the morphology of the lesions. This characterization narrows the differential diagnosis to one or, at most, a few diseases. Laboratory screening (i.e. testing all patients) should be reserved for those diseases that can present as any type of uveitis, whereas targeted testing (i.e. testing a subset with specific features) is used selectively. Laboratory testing should be used to identify an infection (which will alter therapy) or a systemic disease that will affect the patient’s health. A uveitis that is not one of the established diagnoses is designated as “undifferentiated” with the course, laterality, and anatomic location (e.g. undifferentiated bilateral chronic anterior uveitis). We avoid the term “idiopathic” uveitis as most identified non-infectious uveitic diseases are idiopathic, and most systemic diseases associated with uveitis also are idiopathic (e.g. juvenile idiopathic arthritis). Conclusion This approach should lead to the correct diagnosis of the specific uveitic disease in the large majority of cases without overuse of laboratory testing.

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Anterior Uveitis and Hypopyon

Cited by 54 publications

References 12 publications

Hypopyon in Patients with Uveitis

Hypopyon in Patients with Uveitis

Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease

Approach to the Diagnosis of the Uveitides

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