Trends in Patterns of Intermediate Uveitis in a Tertiary Institution in Singapore

Abstract

PurposeThe study aims to describe the characteristics and etiologic causes of intermediate uveitis (IU) patients seen by a tertiary eye center in Singapore over 8 years.MethodsThis was a retrospective analysis of the clinical records of consecutive new cases of IU that presented to the uveitis subspecialty clinic from 2004–2011 at Tan Tock Seng Hospital. Data collected included demographics, clinical and laboratory findings. Diagnoses were based on standardized clinical history, ophthalmological examination and investigations.ResultsThere were 66 new cases of IU, comprising 5.7% of 1168 new uveitis patients. The median age of diagnosis was 40 years (mean 39.4±15.9), with largest subgroup of the patients in the age group of 41–60 years (36.4%). The majority was Chinese (57.6%), followed by Asian Indians (18.2%) and Malays (16.7%). The ethnicity distribution was dissimilar to our ethnic distribution in Singapore (p<0.001) with an increased incidence of IU in the Asian Indian population. Most were idiopathic (59.1%) in etiology, followed by tuberculosis (TB) (15.2%). Ocular complications developed in 21 patients (31.8%), with cystoid macular edema (CME) being the commonest (28.8%). Severe vitritis occurred in 9.1% of patients, and was significantly associated with TB-associated IU (p<0.001). There was a downward trend for the incidence of the proportion of IU patients over the total uveitis patients (p = 0.021), with Spearman’s rho of −0.786.ConclusionsDespite the downward trend, TB-associated IU was still of higher prevalence compared to less endemic areas, emphasizing the need for increased TB surveillance. A high index of suspicion for TB-associated IU is required in patients with severe vitritis. Comparisons with other countries revealed disparities in the IU etiologies, indicating possible geographical differences. Prevalence of known immune-mediated etiologies of IU is less compared to the western population. Our study also suggests a probable predisposition of the Singapore local Indian population for IU.

Changing uveitis patterns in South India - Comparison between two decades

“…Epidemiologic knowledge is important to guide clinicians in their consideration of differential diagnoses and clinical investigations. [ 7 ] Changing pattern of any disease in a subset of the population is an important health indicator. [ 8 ] There are lots of similar reports from different parts of India and world.…”

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

“…15 All of the patients in our study required treatment, while other studies reported the use of treatment in 75.8-77.5% of their patients. 15,35 In our patients, the most common treatments used were corticosteroids, followed by oral antimetabolites; and the most used adjuvant therapy were topical NSAIDs in cases in which macular edema was present. Similarly, other studies reported systemic corticosteroids to be the most common treatment, followed by oral immunosuppressive therapy.…”

“… 15 All of the patients in our study required treatment, while other studies reported the use of treatment in 75.8–77.5% of their patients. 15 , 35 …”

Intermediate Uveitis

“…Acute or subacute presentation and dense vitritis, especially unilaterally, should suggest a differential that includes necrotizing herpetic retinopathy, toxoplasma chorioretinitis, and endophthalmitis. In one series of intermediate uveitis, patients with tuberculosis had more severe vitritis [19].…”

“…Miserocchi et al reviewed 24 uveitis surveys reporting over 26,000 patients that were published before 2012; the average reported prevalence of intermediate uveitis was 9.5 +/À 5.6% [18]. Incident cases of intermediate uveitis accounted for 5.7% of 1168 new cases of uveitis presenting from 2004 to 2011 in Singapore [19].…”