Patterns of uveitis at the Apex Institute for Eye Care in India: Results from a prospectively enrolled patient data base (2011–2013)

Abstract

The purpose of the study was to identify the clinical and etiological profile of uveitis at the apex institute for eye care in India. This is a prospective, prevalence study. 980 consecutive patients with uveitis referred to uvea clinic, Dr. RP Centre for Ophthalmic Sciences (Ophthalmology division, All India Institute of Medical Sciences). Demographic data of each patient were noted and a thorough ocular examination including slit lamp examination and dilated fundus evaluation was carried out. OCT and fluorescein angiography were undertaken whenever indicated. Uveitis was classified based on the anatomic location of inflammation (IUSG classification). Relevant serological and radiological investigations were obtained based on systemic symptomatology, and if the uveitis was recurrent (even in the absence of systemic symptoms). The presence of a systemic disease was confirmed by obtaining an internist consultation. The main outcome measures include pattern of uveitis according to anatomical classification and the etiology. Out of 980 patients with uveitis, 413 (42.14 %) patients had anterior uveitis, 131 (13.36 %) had intermediate uveitis, 165 (16.83 %) had posterior uveitis, 91 (9.2 %) had panuveitis, 47 (4.7 %) had retinal vasculitis, 22 (2.24 %) had scleritis, 17 (1.7 %) had masquerade syndromes, 8 (0.8 %) had keratouveitis, 22 (2.24 %) had sclerokeratouveitis, 19 (1.9 %) had endophthalmitis and 45 (4.5 %) had other causes of inflammation including trauma and intraocular surgery. Out of all uveitic patients definite etiological correlation could be made out in 225 (23 %) patients; thus 77 % were categorised as idiopathic. Only 9 % of all patients were found to have uveitis with an infectious etiology. Amongst infectious causes of uveitis tuberculosis was the leading cause, accounting for sixty percent of all infectious uveitis (approximately 5 % of overall uveitis). Non-infectious uveitis etiology accounted for more than 90 % of all cases with ankylosing spondylitis being the most common followed by sarcoidosis and juvenile rheumatoid arthritis. Amongst known uveitic syndromes serpiginous like choroidopathy was the most common and was followed by acute posterior placoid pigmented epitheliopathy and Fuch's heterochromic iridocyclitis. Infection, including tuberculosis, is an infrequent cause of uveitis in the study population. Multicentric, collaborative efforts are required to improve levels of clinical evidence and evolve consensus in establishing stringent guidelines for labelling uveitis as being of infectious etiology.

Viral posterior uveitis

“…131,153,188,248 The family of HHV includes HSV-1, HSV-2, VZV, Epstein-Barr virus (EBV), and CMV. HHV is an important infectious cause of ocular inflammation.…”

“…55,131,150,153 Uveitis can occur at any age, but the mean age of incidence is between 30 to 40 years in most studies. 12,55,131,150,153,188,248 About 60%–80% of uveitis occurs between the ages of 20 to 50 years. 242 In terms of anatomic classification, anterior uveitis is the most common form of uveitis, followed by panuveitis, posterior uveitis, and intermediate uveitis.…”

“…The prevalence of anterior uveitis, panuveitis, posterior uveitis, and intermediate uveitis is reported to be 24.5%–52.3%, 11.8%–52.9%, 7.1%–46.0%, and 6.3%–19.3%, respectively, in several studies. 12,55,131, 150,153,188,248 The causes of posterior uveitis can be infectious (bacterial, viral, fungal, and parasitic), noninfectious (autoimmune or associated with a systemic disease), or part of a masquerade syndrome. 53 A significant proportion of the cases of posterior uveitis are infectious (Table 1).…”

“…53 A significant proportion of the cases of posterior uveitis are infectious (Table 1). 12,55,131,150,153,188,248 …”

Retina and the tubercle Bacillus: Four decades of our journey and current understanding

“…In this study, we found 5% of our patients having uveitis in association with past or current definitive diagnosis of pulmonary or extrapulmonary tuberculosis. [26] We are yet to consider a diagnosis of presumed ocular tuberculosis as a distinct entity and do not treat patients with antitubercular drugs due to several reasons. A few of these being lack of Level 1–Level 2 evidence, suggested clinical, serological (nucleic acid amplification assays and interferon gamma release assays [IGRAs]) and tissue (aqueous and vitreous) approaches having several limitations and unanswered questions, known side effects of antitubercular drugs (14.1%) and concerns of promoting development of drug-resistant strains.…”