Intermediate uveitis, posterior uveitis, and panuveitis in the Mid-Atlantic USA

Abstract

BackgroundThe purpose of this study was to identify the causes, clinical features, and outcomes of intermediate uveitis, posterior uveitis, and panuveitis in patients managed in a mid-Atlantic tertiary care center.MethodsThis was a retrospective observational study of intermediate uveitis, posterior uveitis, and panuveitis patients seen at the University of Virginia from 1984 to 2014.ResultsOne hundred and fifty-nine intermediate uveitis, posterior uveitis, and panuveitis patients (237 eyes) were identified. The patient population was 54.72% female; 67.30% of patients were Caucasian, and 22.01% were African–American. Mean age at diagnosis was 45.5 years. Mean duration of follow-up was 3.95 years. Mean number of visits to the clinic was 10.35. Of 491 uveitis patients, 26 (5.30%) had intermediate uveitis, 62 (12.60%) had posterior uveitis, and 71 (14.50%) had panuveitis. The leading diagnoses in the intermediate uveitis group were pars planitis (73.08%) and sarcoidosis (11.54%); toxoplasma uveitis (17.74%), multifocal choroiditis (14.52%), undifferentiated posterior uveitis (14.52%), and birdshot chorioretinitis (11.29%) in the posterior uveitis group; and undifferentiated panuveitis (29.58%), post-surgical panuveitis (18.31%), sarcoidosis (12.68%), acute retinal necrosis (12.68%), and toxoplasma uveitis (4.23%) in the panuveitis group. The most common treatment modalities included local steroids (57.23%) and systemic steroids (42.14%). Ocular hypertension was found in 38 patients (23.90%). Glaucoma surgery was performed in 18.24% of patients and cataract surgery in 21.38%. Mean best-corrected visual acuity was 0.66 logMAR at baseline across all anatomical locations and 0.57 logMAR at final follow-up. Best-corrected visual acuity improved or remained stable during follow-up in all groups.ConclusionThe most common diagnoses in our series by anatomical location were pars planitis (intermediate uveitis), toxoplasmosis (posterior uveitis), and undifferentiated uveitis (panuveitis). Panuveitis had significantly worse visual outcomes and higher rates of complications than did intermediate or posterior uveitis, a finding that confirms earlier reports. In this series, unilateral disease, regardless of anatomical location, was associated with poorer visual outcome, in contrast with the findings of other reports.

Intermediate Uveitis Etiology, Complications, Treatment, and Outcomes in a Colombian Uveitis Referral Center

“…Regarding visual acuity, studies have described values from 0.1 to 0.3 LogMAR, 27 , 28 , 31 , 37 which coincides with our results. Additionally, several ocular findings and complications have been reported as poor prognostic factors for final BCVA in patients with IU.…”

“…Concerning etiology, despite fifteen patients had abnormal laboratory findings, ten of them were not specific for any systemic or infectious etiology (eg leukocytosis or elevated CRP) thus were classified as idiopathic. This was the most common etiology in our study, followed by tuberculosis, MS, and JIA, which coincides with Indian 29 and Philippines 30 studies’ results; and differs from the results in Europe, 17 , 18 USA, 31 , 32 and Canada, 33 where sarcoidosis is the second most common cause. Interestingly, in our region sarcoidosis is infrequent and poorly described.…”

Recognizing Uncommon White Retinal Vasculopathy

“…In general, the non-specific inflammatory response is more widespread and involves longer sections of multiple vessels. These retinal findings are typically transient in appearance, and when associated with posterior uveitis, more often affect patients younger than 50 years of age [49,50]. Reports also seem to suggest that involvement of longer segments of multiple vessels is more common than small isolated areas of regard.…”

Fungi, Bacteria, Nano-particulates, Mycotoxins and Human Health in Water- Damaged Indoor Environments

“…It is associated with nano-particulates shed by mold that contain 1, 3-beta glucans, mycotoxins and a variety of antigenic proteins [14,21,25,[48][49][50][51][52][53][54][55].…”