Demography and clinical pattern of newly diagnosed uveitis patients in Malaysia

Abstract

Introduction Uveitis is one of the common causes of visual impairment in Malaysia. It remains a challenging entity to diagnose and manage due to variation in its clinical presentation. This study aims to observe the demographic and clinical pattern of cases from the participating ophthalmology units in Malaysia. Methods This study involved prospective and multicentered data collection for patients newly diagnosed with uveitis from 1st January 2018 to 31st December 2018. Variables collected and analyzed included age, gender, ethnicity, nationality, state of origin, laterality, granulomatous or non-granulomatous uveitis, and etiology of uveitis. Results A total of 1199 newly diagnosed uveitis patients were analyzed within the study period. There was a significant association between the anatomical location of uveitis with age at presentation. The percentage of patients with anterior uveitis was higher in the ‘40 to 60’ years and ‘above 60’ years age groups at 52.1% (n = 210) and 61.3% (n = 114) respectively. In contrast the percentage of patients with posterior and panuveitis was higher in the 1 to 20 and 20 to 40 years age groups at 51.4% (n = 54) and 48.7% (n = 246) respectively. Sixty three percent of the patients presented with unilateral uveitis (n = 760, p < 0.001) vs bilateral. Non-granulomatous uveitis comprised 84.5% of all patients (n = 1013, p < 0.001) compared to granulomatous uveitis. Non-infectious etiology contributed to 65.7% of all patients (n = 788, p < 0.001) with the majority being unclassifiable uveitis (n = 686, 57.2%,). Specific inflammatory entities contributed to only 8.5% (n = 102) of the non-infectious causes with Vogt-Koyanagi-Harada (VKH) syndrome being the most common (n = 25, 2.1%,). Infectious uveitis comprised 34.3% (n = 411) with tubercular (TB) uveitis (n = 105, 8.8%) and viral uveitis (n = 107, 8.9%) contributing the most followed by ocular Toxoplasmosis (n = 93,7.8%).] Conclusion This study has highlighted the demographic data and common causes of uveitis in Malaysia.

Treatment of uveitis and scleritis patients in Malaysia

“…It is noteworthy that contrary to other published studies, aetiologies such as Birdshot chorioretinopathy, onchocerciasis, toxocariasis, Lyme disease, and presumed ocular histoplasmosis syndrome (POHS) were not seen in our population. It is well-known that the aetiology for uveitis varied depending upon epidemiology, geographical, climate variation, and disease dissemination, hence some diseases are not frequently encountered in our part of the world [13][14][15][16][17][18][19][20][21][22][23][24][25] . Herpetic iridocyclitis was the commonest infectious aetiology in our study, similar to Singapore [30] , Thailand [29] , Taiwan China [7] , Japan [32] , and Italy [18] .…”

“…It is interesting to note that the Malays ethnicity has the highest number of ocular toxoplasmosis compared to other races (Chinese and Indian). One local-based study found that the highest sero-prevalence of toxoplasmosis was in the Malays when compared with other races (Chinese and Indians) [19] . This could be explained by the previous findings of Malay's preponderance of keeping pet cats in their house where they might be more prone to be exposed to contaminated cat faeces [19] .…”

“…Early diagnosis and timely treatment of uveitis and scleritis are imperative to reduce the risk of visual impairment [8,13] . Epidemiology of ocular inflammation is considerably diverse worldwide and various factors influence it which include host, environmental, genetic, ethnic, socioeconomic, and demographic factors [1][2]6,8,[10][11][13][14][15][16][17][18][19][20][21][22][23][24][25] . A better understanding of the demographic and causes of uveitis and scleritis in various geographic areas will prevent unnecessary laboratory testing, and the delay in commencing treatment [4] .…”

Comparison of Infliximab with Adalimumab for the treatment of non- infectious uveitis: a systematic review and meta-analysis

“…The incidence is estimated at 17-52/100000 person-years [2], and 22% patients with uveitis, simultaneously, has the risk to be blind [3]. Noninfectious uveitis (NIU) are relatively more common than infectious uveitis both in adult [4] and children [5]. In a newly published article, NIU contributes to 65.7% of all 1199 patients with uveitis, and another national registry report [5] from Turkey demonstrates that 333 out of 442 (75.3%) children with uveitis are NIU.…”

Comparison of infliximab with adalimumab for the treatment of non-infectious uveitis: a systematic review and meta-analysis

“…The incidence is estimated to be 17–52/100,000 person-years [ 2 ], and 22% of patients with uveitis are at risk of going blind at the same time [ 3 ]. Non-infectious uveitis (NIU) is relatively more common than infectious uveitis in both adults [ 4 ] and children [ 5 ]. In a recently published article, NIU contributed to 65.7% of all 1199 patients with uveitis, and another national registry report [ 5 ] from Turkey demonstrated that 333 of 442 (75.3%) children with uveitis were NIU.…”