The Manchester Uveitis Clinic: The First 3000 Patients—Epidemiology and Casemix

Jones, Nicholas P.

doi:10.3109/09273948.2013.855799

Cited by 161 publications

(105 citation statements)

References 22 publications

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“…Amongst known uveitic syndromes serpiginous like choroidopathy (30) was the most common diagnosis and was followed by acute posterior multifocal placoid pigmented epitheliopathy (APMPPE) (20) and Fuch's heterochromic iridocyclitis (16). Multifocal choroiditis with panuveitis (12) and toxoplasmosis (9) were the other common uveitic entities (Table 2). …”

Section: Etiological Diagnosismentioning

confidence: 97%

“…In some instances some diseases, like Behcet's syndrome, with high prevalence in old surveys have shown a decreasing trend in more recent surveys [8]. Various epidemiological studies are available from different regions of the world [3,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Few reports are also available from different regions of our country as well [25][26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 97%

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

et al. 2015

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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.

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Section: Etiological Diagnosismentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

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

et al. 2015

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“…For example, among 3000 new patients with uveitis attending a specialist uveitis clinic in England during a 22-year period, the anatomical distribution of uveitis was as follows: anterior 46 %, intermediate 11.1 %, posterior 21.8 %, and panuveitis 21.1 % [6]. Uveitis occurs in up to 50 % of patients with AS during course of their disease, and in contrast, it affects roughly 2 to 5 % of patients with IBD and approximately 7 % of patients with psoriatic arthritis [2•].…”

Section: Epidemiologymentioning

confidence: 99%

“…Although infectious and neoplastic causes exist, the majority of cases are presumed to be immune in origin, and this is reflected in the high prevalence of systemic disease among patients with AAU [2•, 3]. However, there are similarities as well as distinct differences in the patterns of uveitis in the various regions of the world because of geographical, environmental, and genetic differences [4][5][6][7][8].There are many recent advances in the field of immunopathology, and several immunological pathways are now known to be involved in the development of uveitis. It may be caused by several mechanisms, such as infectious, inflammatory (no obvious infection), autoimmune, or idiopathic [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 98%

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

2015

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Ankylosing spondylitis (AS) and related forms of spondyloarthritis (SpA) are associated with some extra-articular features, and the most common symptomatic association is with acute anterior uveitis (AAU). Thus, approximately 40 % of patients with AS will experience a sudden onset of a unilateral anterior uveitis sometime during the course of their disease. Patients with AAU, especially those who are HLA-B27 positive, should be questioned about inflammatory low back pain and also evaluated for other clinical features of SpA. Since a prolonged delay in diagnosis is common among SpA patients and occurrence of AAU may be the reason for their first interaction with medical care, occurrence of AAU presents a unique opportunity for identifying such undiagnosed SpA patients. Therefore, a novel evidence-based algorithm called Dublin Uveitis Evaluation Tool (DUET) has been proposed to guide ophthalmologists and primary care physicians to refer appropriate AAU patients to rheumatologists. In a large two-phase study, approximately 40 % of patients presenting with idiopathic AAU were noted to have undiagnosed SpA, and DUET algorithm was noted to have excellent sensitivity (96 %) and specificity (97 %). It has a positive likelihood ratio (LR) 41.5 and negative LR 0.03. In most instances, the eye inflammation responds well to corticosteroid and mydriatic eye drops and without the need for additional therapy. Use of oral corticosteroids is reserved for patients, especially with associated chronic inflammatory bowel disease or psoriatic arthritis presenting with bilateral, chronic, anterior, and/or intermediate uveitis, and this treatment is rarely needed for more than a couple of weeks. A very small percentage may be more refractory to such treatment and require potential novel therapies, including the use of tumor necrosis factor blockers.

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“…However, a recent large study from this tertiary centre 5 permits only 671 of 3000 uveitis patients (21%) to be so labelled if severely affected. Uveitis causes visual loss from direct inflammation, but also substantially from macular oedema, epiretinal membrane, cataract, glaucoma, choroidal neovascular membrane and retinal detachment.…”

mentioning

confidence: 99%