Uveitis causes according to immune status of patients

Abstract

Purpose The advances in medicine have led to an increased number of people living with some form of immunodeficiency. Most ocular infections in immunocompromised patients may lead to irreversible blindness. We identify the causes of uveitis in immunocompetent and immunocompromised patients. Methods A retrospective cohort study of 1354 consecutive patients. All patients underwent a standard work‐up for uveitis. Results An immunocompromised state was identified in 171/1354 patients (13%), of whom 40 had Human immunodeficiency virus (HIV) infection, 52 received immunosuppressive medications, 28 had concurrent malignant disorder and 20 had other causes for their immunosuppression. In addition, 93/1354 patients (7%) had diabetes mellitus (DM). The prevalence of intraocular infections was much higher in immunocompromised patients than in immunocompetent patients and DM (p < 0.001). Causes of uveitis differed between the diverse immunocompromised groups. The non‐HIV immunocompromised patients showed primarily intraocular herpes simplex and varicella zoster virus infections, whilst HIV‐positive patients exhibited frequently cytomegalovirus (CMV) retinitis and syphilis. Patients with generalized malignancies were characterized by a lower prevalence of infections and higher prevalence of sarcoidosis. Patients with DM typically showed sarcoidosis and bacterial intraocular infections. The percentage of undetermined uveitis diagnoses was markedly lower in immunosuppressed patients (p < 0.001). Conclusion In immunocompromised patients with uveitis, infections were diagnosed in 46% of cases in contrast to 12% in the immunocompetent patients. The causes of uveitis differed among the various types of immunosuppression. Immunocompromised patients with uveitis require a rapid assessment for the most expected infections.

Increased incidence of glaucoma medication usage in middle-aged Australian males taking antiretroviral medication – a population-based study

“…While HIV is a risk factor for the development of herpes zoster ophthalmicus (HZO) which can cause a hypertensive uveitis in up to 56% of HZO cases [51][52][53][54][55][56], the overall incidence of HZO in HIV/AIDS patients is low [57]. CMV is also known to cause a hypertensive anterior uveitis especially in immunocompetent Asian patients [58], although it is much more likely to manifest as retinitis in HIV/AIDS patients without need for IOPlowering therapy [45,59,60]. Patients with CMV retinitis may however develop Immune Recovery Uveitis (IRU) after commencement of ART [61], which carries an approximately 33% incidence of ocular hypertension [62].…”

Uveitis as an Open Window to Systemic Inflammatory Diseases

“…Uveitis can be either inaugural (10–20%) or develop within 2 to 3 years after the onset of oral ulcers. BD represents 4.2% of all uveitis cases in the ULISSE study [ 29 ] and 1.8% to 6.1% of severe uveitis treated in European specialized centers [ 18 , 19 , 20 ]. Among patients with BD’s uveitis, 90% have posterior uveitis or panuveitis and 78% have bilateral involvement; furthermore, 89% have retinal vasculitis and 44% macular edema [ 114 ], which can cause visual impairment (with blindness in 13–21% of cases) [ 64 , 115 ].…”

“…In the last twenty years alone, ten studies have been carried out on the distribution, clinical patterns, and etiologies of uveitis [ 18 , 19 , 20 ], mostly in ophthalmological centers, in Western Europe. As shown in Table 2 , three systemic diseases are particularly prevalent: HLA-B27- and spondyloarthropathy (Spa)-associated uveitis, BD, and sarcoidosis.…”

Neutrophil Extracellular Traps: Current Perspectives in the Eye

“…The main non-infectious causes of uveitis are acute anterior uveitis, Behçet’s disease (BD), Vogt-Koyanagi-Harada (VKH), and juvenile idiopathic arthritis (JIA), among others. Interestingly, it has been described that in non-infectious uveitis, the immune response is the main responsible cause [100].…”