Visual outcomes and ocular morbidity of patients with uveitis referred to a tertiary center during first year of follow-up

Abstract

Purpose To describe the visual outcomes and morbidity of newly referred uveitis patients. Methods Retrospective cohort study of 133 newly referred uveitis patients with active uveitis who required care in a tertiary center for at least 1 year. Main outcomes were best-corrected visual acuity (BCVA) at referral and 1 year after referral, duration of visual impairment, systemic medications used, as well as all complications and surgeries during the first year of follow-up. Generalized estimating equation models was used to assess prognosticators for poor BCVA. Results The mean age at onset of uveitis was 43 years. The proportion of patients with at least one eye with BCVA ≤ 0.3 decreased from 35% at referral to 26% (P = 0.45) at 1-year follow-up. The mean duration of visual impairment in the first year after referral was 4 months per affected eye. At 1-year follow-up, bilateral visual impairment was observed in 4% but at least one ocular complication developed in 66% and 30% of patients required at least one intraocular surgery. Systemic immunosuppressive treatment was required in 35% of patients and the mean number of visits to ophthalmologist was 11 per year, while 8% of patients required hospital admission. Prognosticators for poor visual outcome included surgery undergone before referral (odds ratio (OR), 3; 95% CI, 1-11; P = 0.047), visual impairment at referral (OR, 21; 95% CI, Po0.001), and glaucoma before referral (OR, 7; 95% CI, 2-28; P = 0.007). Conclusions Patients with severe uveitis had a favorable BCVA 1 year after referral with only 4% of patients having bilateral visual impairment. This, in contrast to the prolonged duration of visual impairment during the first year of follow-up and the demanding care.

Phacoemulsification with primary implantation of an intraocular lens in patients with uveitis

“… 14 , 15 Few patients with uveitis had a history of CME compared to previous studies. 1 , 16 As expected, posterior synechiae was only seen in eyes with uveitis, resulting in more frequent need of intraoperative mechanical pupil dilation. However, we did not find a significant difference in intraoperative complications between the two groups.…”

Efficacy of glaucoma drainage devices in uveitic glaucoma and a meta-analysis of the literature

“…The incidence of secondary glaucoma caused by uveitis (uveitic glaucoma) is reported to be 10–20% [ 3 ]. Patients with both glaucoma and uveitis have a high risk of severe visual impairment [ 2 , 4 ]. Uveitic glaucoma presents a two-pronged problem: inflammatory damage to the trabecular meshwork and uvea (e.g., synechiae) coupled with steroid-induced increase in intraocular pressure (IOP).…”

Relevance of erythrocyte sedimentation rate and C-reactive protein in patients with active uveitis

“…Biomarkers like ESR and CRP are commonly assessed during the diagnostic workup of new uveitis patients for potential detection of infections or systemic immune-mediated disease-causing uveitis [1–4, 18–21]. Elevated levels of ESR are due to a higher plasma protein levels (e.g., fibrinogen, gamma globulins) and CRP is an acute phase protein released after tissue injury caused by infections or other sources of inflammation [8, 22].…”

“…Uveitis is an intraocular inflammation of multiple causes, which may result in permanent visual loss [ 1 – 4 ]. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), both non-specific markers of inflammation, are usually included in the initial diagnostic workup.…”