Clinical course and visual outcome in patients with diabetes mellitus and uveitis

Abstract

PurposeWe report the clinical course and visual outcome of patients with diabetes mellitus (DM) who subsequently developed uveitis from any cause.MethodsLongitudinal, retrospective case note review.ResultsA total of 36 patients (M/F: 18/18, 58 eyes) were included, Of the 36 patients, 35 had Type 2 DM and one had Type 1 DM. Mean age of onset of DM was 49 years and uveitis 55 years. The uveitis was bilateral in 22 (61%) patients. There were 19 patients with anterior uveitis, 12 with panuveitis and 5 with intermediate uveitis. Mean follow up was 4.4 years (range 1-18). Mean number of uveitis recurrences was 3 (range 1-7). Causes of vision of 6/18 or worse appeared related to the uveitis in 9 eyes and diabetes in 4 eyes. Cataract occurred in 22 eyes, glaucoma in 17 eyes, and cystoid macular oedema in 10 eyes. Diabetic retinopathy was detected in 38 (65.5%) eyes (29 non-proliferative including 6 with clinically significant macular oedema, and 9 proliferative). Progression of diabetic retinopathy to proliferative stage occurred in 7 eyes of 4 patients over a mean duration of 4.4 years. In 10 patients with active uveitis the mean HbA1c was 80 mmol/mol [9.5%], (range 49-137 [6.6-14.7]), and 67 mmol/mol [8.3%] (range 46-105 [6.4-11.8]) when the uveitis was quiescent, p = 0.01. Better glycaemic control was required in 10 patients during episodes of uveitis.ConclusionsPatients with DM who develop uveitis may have a high complication rate, reduced vision and poor glycaemic control. Checking blood glucose during episodes of uveitis is important.

Exacerbation of autoimmune uveitis by obesity occurs through the melanocortin 5 receptor

“…There have been reports that diabetic retinopathy can exacerbate uveitis and uveitis can accelerate diabetic retinopathy . While the HFD model we used only achieved moderate diabetes, it did exacerbate the uveitis.…”

Clinical features of patients with diabetic anterior uveitis

“…These findings suggest that severe disruption of the blood–ocular barrier occurs in conditions of more severe hyperglycaemia, which in turn likely promotes infiltration of inflammatory cells and leakage of protein from the iris vessels. Oswal and colleagues5 also suggested that poor glycaemic control may be a trigger for recurrence of uveitis of all types, since they observed a statistically significant difference in HbA1c between active and quiescent phase of uveitis in their patients. In our study, we observed recurrent anterior uveitis in two patients, both of whom had poor control of their diabetes, and mechanistically it would be reasonable to consider good glycaemic control to be an important factor in the prevention of recurrent inflammation.…”

A Mirage of a dislocated lens in uveitis

“…Elevated intraocular fibronectin 7 may play a role in such cases. However, poor diabetic control and idiopathic uveitis has been linked 8,9 with severe anterior segment inflammation and poor vision at presentation, along with diabetic retinopathy; all three features were present in our patient. Bilateral uveitis 9 is also more common in such patients with a higher complication rate.…”