[Articular diseases and uveitis]

Ocular inflammation is a common clinical manifestation related to several autoimmune systemic disorders, specially spondyloarthropaties. In this group, there are different clinical diseases that are related to special uveitic patterns. Several discriminative patterns have been defined that closely link uveitis with certain systemic or ophthalmic diseases. Unilateral recurrent anterior acute uveitis is the most frequent form of uveitis related to spondyloarthropaties, and is sometimes the initial manifestation of an undiagnosed spondyloarthropaty. The collaboration of ophthalmologists, rheumatologists and internal medicine specialists is very important for the correct management and treatment of these patients.

[Clinical value of the local parameters of lipid peroxidation and antioxidative defense in patients after cataract extraction]

The postoperative period of cataract extraction and the parameters of lipid peroxidation (LPO) (dienic conjugates, TBA-active compounds) and the antioxidative activity (AOA) of tear were studied in 77 patients in relation to the type of a surgical intervention--extracapsular cataract extraction (ECCE) and phacoemulsification (PE). The incidence of severe postoperative uveitis was more than 3 times higher on days both 1 and 5 after surgery. Tear studies revealed a significant increase in the concentration of LPO products just on day 1, with its further slight increase by day 5 along with a further significant reduction in AOA, which indicates the significant consumption of antioxidative defense components and the expediency of using antioxidants. Comparison of tear biochemical parameters revealed no difference in patients after ECCE and PE. Thus, peroxidation processes reflect the severity of an inflammatory reaction in the early postoperative period, the study of the processes in tear is a noninvasive, high-informative method for recording the balance of LPO and antioxidative defense processes, which will assist in determining the direction of therapeutic measures to improve the outcome of a surgical intervention.

The antitoxoplasma gondii antibodies incidence to the different ocular diseases patients cases of human ocular toxoplasmosis infections in Romania

Toxoplasmosis is an anthropo-zoonosis widely spread around the earth, whose ocular complications are very frequent and are often a first sign of infestation. This is a retrospective statistic research based on the clinical survey and periodic control of a lot of 135 patients with toxoplasmosis, out of which 90 presented ocular toxoplasmosis.

[Non-infectious systemic diseases and uveitis]

Uveitis can be defined as any inflammation affecting the uveal tract, although in clinical practice this term includes any intraocular inflammatory event. The etiology of this inflammation can be related to an endogenous mechanism in the clinical course of a systemic disease (sarcoidosis, Behçet's disease, multiple sclerosis, Vogt-Koyanagi-Harada disease, etc.), or an isolated ocular entity. Sometimes, ocular inflammation is the initial manifestation of an undiagnosed systemic disease. On the other hand, ocular involvement could be the main cause of morbidity of the disease, and early diagnosis and treatment is an important issue in order to avoid irreversible ocular damage. In this article, the authors review some relevant clinical, diagnostic and therapeutic topics related to the most common non-infectious systemic diseases associated with uveitis.

Uveitis with biopsy-proven sarcoidosis in Chinese--a study of 60 patients in a uveitis clinic over a period of 20 years

BACKGROUND

The aim of this study was to assess the clinical features of uveitis with biopsy-proven sarcoidosis in Chinese patients.

METHODS

This was a retrospective study of uveitis patients with biopsy-proven sarcoidosis who consecutively visited the uveitis clinic of Taipei Veterans General Hospital from 1986 to 2005. Medical records were reviewed to obtain demographic data, initial symptoms, biopsy sites, pulmonary conditions detected by chest X-ray and manifestations of uveitis. From 2002 onwards, patients also received chest computed tomography (CT).

RESULTS

A total of 60 uveitis patients with biopsy-proven sarcoidosis were identified. Forty-four patients (73%) were found in the last 4 years. Female predominance with a male-to-female ratio of 1:6.5 was found. The most common initial symptom was uveitis in 41 patients (68%). The most common positive biopsy sites were mediastinal lymph nodes, lung, conjunctiva and skin. Twenty (90.9%) of 22 patients with chest X-ray stage 0 showed >or= stage 1 on CT. The mean age at uveitis onset was 47.7+/-14.7 years (range, 21-76 years), with no gender difference (p=0.913). A peak incidence was found in the 6th decade of life. There was bilateral eye involvement in 54 patients (90%). Frequency of the manifestations of uveitis showed isolated anterior uveitis in 2 patients (3.3%), isolated posterior uveitis in 8 patients (13.3%), intermediate and posterior uveitis (i.e. anterior uveitis sparing) in 16 patients (26.7%), and panuveitis in 34 patients (56.7%).

CONCLUSION

A marked increase was noted since 2002. One of the causes is the performance of chest CT. Chest CT is useful to discover mediastinal lymphadenopathy and other lesions suggestive of sarcoidosis, as well as to help guide tissue confirmation in patients with peculiar uveitis features indicative of sarcoidosis. Female predominance and peak incidence of uveitis onset in the 6th decade of life were found. The posterior segment was the most common localization of uveitis in biopsy-proven sarcoidosis in Chinese.

["White dot syndromes" in childhood]

BACKGROUND

The term "white dot syndromes" describes a group of heterogeneous inflammatory disorders of the choriocapillaris. They were first described a few decades ago and our knowledge about these variable diseases is very limited, especially in regard to their overall incidence and their differential diagnostic relevance in uveitis of childhood.

MATERIAL AND METHODS

A retrospective analysis has been performed of all cases of white dot syndromes in 407 patients with paediatric uveitis who were examined between 1996 and 2006. The relevant literature was reviewed.

RESULTS

The following incidence of white dot syndromes in childhood was found: acute posterior multifocal placoid pigmentepitheliopathy (APMPPE) (n = 4), multiple evanescent white dot syndrome (MEWDS) (n = 4), multifocal choroiditis and panuveitis (MCP) (n = 3) and 1 case of serpiginous choroiretinitis. The review of literature shows a different age predilection of the different white dot diseases. The relative frequency of white dot syndromes in paediatric uveitis patients is estimated to be between 1 - 5%.

CONCLUSION

"White dot syndromes" are an important differential diagnosis in uveitis of childhood. ICG angiography is an important tool for the diagnosis and follow-up examinations of these inflammatory diseases of the choriocapillaris. The different entities of white dot syndromes show differences concerning incidence, prevalence, course of disease, rate of complications and therapeutic implications.

[Inhibitors of tumour necrosis factor-alpha for the treatment of arthritis and uveitis in childhood]

BACKGROUND

Chronic uveitis in childhood is a common complication of juvenile idiopathic arthritis (JIA) that frequently leads to loss of vision. Besides from corticosteroids and immunosuppressive drugs, Tumour necrosis factor-alpha (TNF-alpha) inhibitors are used frequently.

MATERIALS AND METHODS

The literature published before September 2006 was evaluated for the usefulness of TNF-alpha inhibitors (etanercept, infliximab, adalimumab) for the treatment of JIA-associated uveitis.

RESULTS

TNF-alpha inhibitors are effective drugs for the treatment of chronic uveitis in childhood. The response rate of uveitis in childhood to etanercept was approximately 50%. However, disease recurrence, first manifestations of uveitis and new complications occurred during the treatment. Infliximab and adalimumab appear to be more effective for the treatment of uveitis in childhood than etanercept.

CONCLUSIONS

The therapy with TNF-alpha inhibitors is expensive and increases the long-term risk for secondary diseases, such as tuberculosis and probably malignant lymphoma. Their use should be restricted to uveitis patients not responding to corticosteroids and at least one of established immunosuppressive drugs.

Manifestations and treatment of ocular syphilis during an epidemic in France

OBJECTIVES

To review cases of ocular syphilis presenting to a tertiary uveitis clinic during a syphilis epidemic in France between January 2001 and January 2004.

STUDY DESIGN

Retrospective chart and patient database review.

RESULTS

Ten patients who presented with symptoms and signs of uveitis tested positive for active syphilis. Some of the patients also presented with a rash or headache. Human immunodeficiency virus (HIV) antibody testing was positive in eight of the 10 patients, with CD4 cell counts >200 cells/mm3 in seven of the patients. Ocular inflammation resolved and visual acuity improved in all patients after treatment.

CONCLUSIONS

A diagnosis of ocular syphilis should be considered in any patient with visual loss associated with a rash or headache, irrespective of the patient's CD4 cell count. Ocular syphilis in HIV-positive patients should be treated as neurosyphilis, whereas ocular syphilis in non-HIV patients can be treated as secondary syphilis.

The prevalence of ocular involvement in patients with inflammatory bowel disease

PURPOSE

The aim of this prospective randomized clinical study was to evaluate the prevalence of ocular involvement in patients with inflammatory bowel disease (IBD).

MATERIALS AND METHODS

We prospectively evaluated 116 patients who went to the gastroenterology clinic with endoscopically proven IBD between December 2001 and February 2005. All patients were examined for evidence of ocular manifestations of IBD. Twenty patients had Crohn's disease and 96 had ulcerative colitis. The examination consisted of slit-lamp examinations, tonometry, visual acuity, and indirect ophthalmoscopy.

RESULTS

The mean age of the 116 patients with IBD who were enrolled was 40.6 +/- 14.4 years (range 16 to 75). Twelve of 20 patients (60%) with Crohn's disease and 22 of 96 patients (22.92%) with ulcerative colitis had ocular involvement. The most common ocular findings were conjunctivitis (8.62%) and blepharitis (6.9%) followed by uveitis (5.17%), cataract (5.17%), and episcleritis (3.45%). Extraintestinal complications were seen in 12 (35.3%) of 34 patients with ocular involvement and in 16 (19.5%) of 82 patients without ocular involvement.

CONCLUSION

Because the ocular complaints of IBD patients are often nonspecific, it may be helpful to performed eye examinations as a routine component in the follow-up of these patients. It is well-known that early diagnosis and treatment of ocular involvement may prevent serious ocular complications that could be associated with significant visual morbidity. In addition, clinicians should be aware that some ocular diseases, such as uveitis and scleritis, might precede a diagnosis of ulcerative colitis or Crohn's disease.

The incidence and clinical characteristics of the immune phase eye disease in treated cases of human leptospirosis

BACKGROUND

Uveitis is increasingly being reported from south India following epidemics of leptospirosis. The incidence of eye involvement in treated patients has not been investigated properly in prospective studies.

AIMS

To determine the incidence, clinical spectrum and risk factors for Leptospiral uveitis in antibiotic-treated patients.

SETTINGS AND DESIGN

A prospective cohort study conducted among the patients treated for leptospirosis at Calicut Medical College between July and November 2002 and a seroprevalence study among sewage workers.

MATERIALS AND METHODS

As many as 360 patients admitted with suspected leptospirosis were studied by clinical examination, baseline ophthalmic survey, laboratory investigations and Leptospira serology (Microagglutination test - MAT; and IgM and IgG using ELISA) during the epidemic. Of the 282 seropositive and antibiotic-treated cases, 174 patients who completed 30 months of regular follow-up were analyzed. A cross-sectional serosurveillance also was performed among 50 sewage workers to determine the baseline MAT titer.

STATISTICAL ANALYSIS

Univariate analysis and logistic regression.

RESULTS

Thirty-two patients (18.4%) developed the eye disease during follow-up. The mean age was 43.9 years and the sex ratio was equal. Twenty-one patients (65.6%) had anterior uveitis. Only six patients (18.8%) had visual symptoms. Median duration for developing anterior uveitis was 4 weeks. Recurrent uveitis was not seen following treatment. None had vision-threatening eye disease. Clinical and laboratory abnormalities during the acute phase did not pose risk for development of the eye disease later. Forty-six sewage workers (92%) showed a MAT titer of 1/25.

CONCLUSIONS

Uveitis is common following acute leptospirosis. Antibiotic-treated patients during the acute phase of illness developed only mild uveitis.

Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor

OBJECTIVE

To study the influence of ethnicity on the risk of developing juvenile idiopathic arthritis (JIA) in a multiethnic community of patients with unrestricted access to health care.

METHODS

A questionnaire on ethnicity was distributed to all patients with JIA being followed up at the Hospital for Sick Children in Toronto, Ontario, Canada. Of 1,082 patients, 859 (79.4%) responded to the questionnaire. To calculate the relative risk (RR) of developing JIA in this study cohort, the results were compared with data from the age-matched general population of the Toronto metropolitan area (TMA) as provided in the 2001 census from Statistics Canada.

RESULTS

European descent was reported by 69.7% of the patients with JIA compared with a frequency of 54.7% in the TMA general population, whereas a statistically significantly lower than expected percentage of the patients with JIA reported having black, Asian, or Indian subcontinent origin. Children of European origin had a higher RR for developing any of the JIA subtypes except polyarticular rheumatoid factor (RF)-positive JIA, and were particularly more likely to develop the extended oligoarticular and psoriatic subtypes. A higher frequency of enthesitis-related JIA was observed among patients of Asian origin, while those of black origin or native North American origin were more likely to develop polyarticular RF-positive JIA.

CONCLUSION

In this multiethnic cohort, European descent was associated with a significantly increased risk of developing JIA, and the distribution of JIA subtypes differed significantly across ethnic groups.

Behçet's disease in Tunisia. Demographic, clinical and genetic aspects in 260 patients

OBJECTIVES

To analyze demographic, clinical and genetic features of Behçet's disease (BD) in Tunisia and to compare them with other ethnic and geographic groups.

METHODS

Two hundred and sixty patients with BD (International Study Group criteria) received in the Department of Internal Medicine of the University Hospital La Rabta in Tunisia, from 1987 to 2006, were retrospectively studied. Demographic, clinical, and genetic data were recorded and analyzed using SPSS 11.0.

RESULTS

The cohort consisted of 188 males and 72 females (M/F = 2.61). The mean age at the onset of the disease was 29 years. Oral and genital ulcers (GU) were seen in 100% and 83% respectively. The most other common clinical features of BD were ocular involvement (51%), arthritis (38.8%), venous thrombosis (33%) and neuropsychiatric symptoms (24.2%). Only 1.5% had gastrointestinal lesions. HLA-B51 frequency was significantly higher in patients with BD (54% vs. 25.5% in healthy controls, p < 0.05). DVT and pseudofolliculitis were significantly more frequent in men whereas arthritis and erythema nodosum were significantly more frequent in women. DVT was also significantly more frequent in patients with GU and those with neurological involvement. GU, positive pathergy test and DVT were significantly less frequent in patients with ocular involvement. Neurological involvement consisted of 47 cases with CNS parenchymal lesions and 22 with cerebral vascular lesions (13 had both lesions); HLA B51 was significantly less frequent in patients with neurological involvement.

CONCLUSION

Our series was characterized by particular aspects such as high frequency of DVT and neuropsychiatric involvement, and rare occurrence of gastrointestinal lesions. The results confirm the ethnic and geographic variation of BD expression.

Striving for the perfect surgery in traumatic cataract following penetrating trauma in a tertiary care hospital at eastern Nepal

This study analyzes the result of traumatic cataract surgery in a tertiary care hospital at eastern Nepal. It is a hospital-based study of 112 patients (age 15-62), who underwent cataract extraction for unilateral traumatic cataracts. The study was carried out to evaluate the surgical outcome of tramatic cataract. Thirty-eight eyes had associated posterior capsular defect. No serious postoperative complications were encountered. Posterior capsular opacification at the end of sixth week was evident only in two eyes. Best corrected visual acuity nof 6/18 or more at the eighth week was achieved in 61 (54%) eyes. Astigmatism of less than 3D was achieved in 82 (73%) eyes. Rational surgical approach in traumatic cataract provides encouraging results. To comment on actual outcome long term follow up is mandatory.

Juvenile idiopathische Arthritis und Uveitis: Epidemiologie einschließlich der Daten aus der Kerndokumentation

Uveitis is a potentially vision-threatening extra-articular manifestation of juvenile idiopathic arthritis (JIA) that manifests in approximately 13 % of all patients. According to the national ophthalmological and paediatric rheumatological database, one out of four children with JIA and uveitis develops ocular complications such as synechiae, band keratopathy, cataract, glaucoma and macula oedema. Independent risk factors of uveitis include the presence of a certain JIA subgroup, of antinuclear antibodies and age at onset. A late diagnosis, however, seems to be the relevant risk factor for uveitis complications in the course of the disease. The diagnosis of uveitis as early as possible is therefore the most important factor for a reduction of the morbidity of uveitis. Due to the usual lack of symptoms the diagnosis of uveitis requires, however, an examination by an ophthalmologist. This should be done immediately after the diagnosis of JIA and repeated in a risk-adapted manner during the follow-up.

Andere entzündlich rheumatische Erkrankungen mit Uveitis neben der juvenilen idiopathischen Arthritis

In childhood and adolescence, uveitis is part of the clinical spectrum of many inflammatory-rheumatic diseases. Besides juvenile idiopathic arthritis juvenile, ankylosing spondylitis, infection-associated arthritides, infantile sarcoidosis, systemic vasculitides, inflammatory bowel diseases, hereditary autoinflammatory syndromes and the TINU syndrome have to be excluded. These inflammatory diseases can be differentiated clinically in connection with immunogenetic and molecular genetic investigations. Early diagnosis of uveitis as well as the underlying diseases is mandatory for an early treatment and therefore for a good prognosis.

Vitrektomie bei Uveitis im Kindes- und Jugendalter

PURPOSE

The role of vitrectomy in pediatric uveitis has as yet not been established. Addressing this question has been reinforced since the recent introduction of the new and relatively well tolerated medical treatment options using biologicals, i. e. TNFalpha blocking agents.

METHODS

A systematic review of literature has been supplemented by results of vitrectomy performed in 41 consecutive eyes of 33 children and adolescents at our institution and followed for 0.5 to 10 years.

RESULTS

No single controlled study on the role of vitrectomy for uveitis has been identified. Beyond a total of 44 case series including 1762 eyes within the last 25 years, 3 papers specifically focussed on vitrectomy for pediatric uveitis including 73 eyes. This series included 29 eyes of our series. Published and recent own data indicate 2 specific findings consistent for all series: reduction of CME presence from 36 to 6.9% with a resulting visual improvement in 79.1% of cases and a quietening down of inflammatory activity postoperatively allowing to taper down or stop steroid and immunosuppressive therapy from preoperatively 80 and 30% to approximately 30 and 10%, respectively.

CONCLUSION

In the absence of evidence-based results, the data from case series indicate that vitrectomy for pediatric uveitis at least meets the expectations from vitrectomy in adult forms of uveitis regarding the reduction of cystoid macular edema and required systemic steroid and immunosuppressive therapies.

Prevalence and outcome of juvenile idiopathic arthritis-associated uveitis and relation to articular disease

OBJECTIVE

To determine prevalence and complications of juvenile idiopathic arthritis (JIA)-associated uveitis, and to evaluate risk factors for uveitis and its relation to articular disease.

METHODS

Records of 309 patients with JIA (244 female, 65 male, mean age at onset 4.9 yrs) were retrospectively reviewed. Occurrence of uveitis and complications were assessed among oligoarticular-onset JIA (193 patients), polyarticular-onset JIA (66 patients), and systemic-onset JIA (50 patients). The presence of antinuclear antibodies (ANA) was determined in patients with oligoarticular-onset JIA. Therapy and relapses of uveitis and arthritis were recorded at each visit during the followup (mean followup 7.6 yrs).

RESULTS

Sixty-two patients developed uveitis (20.1%); 57 patients had oligoarticular-, 3 polyarticular-, and 2 systemic-onset JIA. Uveitis was asymptomatic in 56/62 cases. Fifty-five of the 62 patients (88.7%) developed uveitis within 4 years from disease onset. In patients with oligoarticular-onset JIA, an early age at disease onset and the presence of ANA (p < 0.05) and DRB1*11 (p < 0.03) were the best predictors of uveitis, while a polyarticular course was not associated to uveitis (p > 0.05). Active arthritis was present at the first episode of uveitis in 46/62 patients. Forty-four of the 62 patients experienced relapses of uveitis: in 20/62, relapses were concomitant to arthritis relapses; in 24/62 relapses presented without active arthritis. Complications of uveitis developed in 35.5% of the patients (22/62), leading to visual impairment in 13 patients.

CONCLUSION

Current guidelines provide early identification of uveitis in 90% of patients. With the exception of the first episode of uveitis, uveitis and arthritis seem to run different courses; close ophthalmologic scrutiny then should also be maintained during arthritis remission.

Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines

OBJECTIVES

To analyse the prevalence and complications of uveitis and their predictors in a large cohort of patients with juvenile idiopathic arthritis (JIA).

METHODS

Data of 3271 JIA patients as classified by International League of Associations for Rheumatology (ILAR) criteria included in a national database during 1 yr were analysed.

RESULTS

Uveitis prevalence was 12% of all JIA patients. The most frequent were oligoarthritis extended (25%) and persistent (16%). JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs 7.0 yrs) or ANA-positive (86% vs 42%) than the patients without uveitis. Predictors of uveitis included age at onset (P= 0.03) and ANA-positivity (P< 0.01) besides the presence of a certain JIA subgroup (P= 0.04). Uveitis was clinically silent in 75% of the oligoarthritis but in none of the enthesitis-related arthritis patients. The median onset of uveitis was 5.5 months after arthritis manifestation. In 73%, 77% and 90%, uveitis developed within 1, 2 and 4 yrs after arthritis, respectively. Anterior uveitis was the most common anatomic type of uveitis (83%). Uveitis complications at mean follow-up of 5.6 yrs were common (56%), and predictors for complications included presence of complications at first visit (P< 0.001) and uveitis manifestation before arthritis (P= 0.001), but not ANA positivity.

CONCLUSIONS

The JIA subgroups markedly differ with respect to the prevalence and course of associated uveitis. Ophthalmological screening should be initiated early after arthritis onset and the intervals be related to the JIA subgroup. A modification of the current screening guidelines is suggested.

Intraocular diseases - anterior uveitis

Uveitis is a general term for inflammatory disorders of the uveal tract and encompasses a wide range of underlying etiologies. It may be idiopathic, associated with systemic diseases or result from a variety of infectious agents. Uveitis is responsible for over 2.8% of blindness in the United States. Each year, 17.6% of active uveitis patients experience a transient or permanent loss of vision. Anterior uveitis (AU), which refers to inflammation within the anterior segment of the eye, is the most common form of uveitis. Experimental autoimmune AU (EAAU) is an organ-specific autoimmune disease of the eye, which serves as an animal model of idiopathic human AU. Recently, type I collagen was identified as the target autoantigen in EAAU. Thus, human AU may be an e xample of autoimmunity to local ocular collagen.

Juvenile idiopathic oligoarthritis: analysis of 42 cases in Jordan

We conducted a retrospective chart review for all 42 patients, 9 males and 33 females, diagnosed with juvenile idiopathic oligoarthritis between July 1995 and October 2004 at the paediatric rheumatology clinic in King Hussein Medical Centre. Age range was 1.2-15.2 years, mean 3.6 (standard deviation 2.4) years. Of those <6 years, 80% were females. Most patients (64%) had monoarthritis; the knee was the most common joint affected (71%). Two patients had developed extended oligoarthritis. Nine (21%) had asymptomatic uveitis: 6 females (P = 0.350), 7 (77%) <3 years of age (P = 0.301) and 7 (77%) with antinuclear antibodies (ANAs) (P = 0.071). Eighteen (43%) females were positive for ANAs. Most patients had undergone unnecessary, lengthy work-up and treatment before diagnosis.

Tumor Necrosis Factor Gene Polymorphisms in Tunisian Patients With Behçet’s Disease

Behcet's disease (BD) is an inflammatory disorder that is mainly characterized by recurrent oral and genital ulcers, skin lesions, and uveitis. Recent reports focused on the genetic factors of susceptibility to this disease and especially the TNF in view of the major role played by this proinflammatory cytokine in the lesional process of Behcet's disease. In this report, we investigated the possible association between Behcet's disease and the TNF-alpha gene promoter polymorphisms -1031T/C, -308A/G, and the TNF-beta polymorphism +252A/G in Tunisian population. We compared the distribution of these polymorphisms between 89 BD patients and 157 healthy controls using polymerase chain reaction restriction fragment length-polymorphism (PCR-RFLP) analysis. The frequency of the TNF-alpha -1031C allele was significantly higher in Behcet's patients than in healthy controls (p = 0.015; chi(2) = 5.84; OR = 1.65; 95% CI = 1.08-2.54), whereas the frequencies of the TNF-alpha -308G and the TNF-beta +252G alleles were similar in the two compared groups. These results suggest that the variability of the TNF-alpha -1031T/C polymorphism can be associated with the susceptibility to Behcet's disease in our study group. Therefore, the TNF molecule may have an important genetically and/or functionally implication in the pathogenesis of BD in the Tunisian population.

Epidemiological survey of intraocular inflammation in Japan

PURPOSE

To report the frequency and trend of intraocular inflammation based on a survey of new ophthalmology patient visits to university hospitals throughout Japan during 2002.

METHODS

A questionnaire was sent to the departments of ophthalmology in 110 university hospitals nationwide to survey the total number of new patients who visited the outpatient clinics for the first time between 1 January and 31 December 2002, and also the number of patients diagnosed with intraocular inflammation during this period.

RESULTS

The surveys completed by 41 university hospitals were analyzed in this study. During 2002, a total of 151 299 new ophthalmological patients presented at the 41 institutions, and 3060 (2.2%) of the new patients were diagnosed as having intraocular inflammation. The most frequent intraocular inflammatory disease identified was sarcoidosis (13.3%), followed by Vogt-Koyanagi-Harada (VKH) disease (6.7%), Behçet disease (6.2%), bacterial endophthalmitis (3.8%), herpetic iridocyclitis (3.6%), diabetic iritis (1.6%), human leukocyte antigen-B27-associated uveitis (1.5%), acute retinal necrosis (1.3%), ocular toxoplasmosis (1.1%), ocular toxocariasis (1.1%), uveitis associated with human T lymphotropic virus-1 (also known as HAU) (1.1%), and others. Infectious intraocular inflammation accounted for 16% of all uveitis cases.

CONCLUSIONS

Through the collaboration of a large number of institutions, some aspects of the epidemiology of intraocular inflammation in Japan were elucidated. However, the disease concept and diagnostic criteria remain ambiguous for a considerable number of diseases within the spectrum of intraocular inflammation, and the possibility that such factors may bias the present findings cannot be denied. In the future, a prospective survey based on well-defined, common diagnostic criteria is required to obtain more precise epidemiological data.

Elevation of serum Krebs von den Lunge-6 levels in patients with tubulointerstitial nephritis and uveitis syndrome

BACKGROUND

Tubulointerstitial nephritis and uveitis (TINU) syndrome is characterized by a combination of idiopathic acute tubulointerstitial nephritis and uveitis. Krebs von den Lunge-6 (KL-6) is a human glycoprotein secreted by type II alveolar cells in the lung, and its serum levels increase in patients with pneumonia of various causes, as well as ocular sarcoidosis. The aim of the present study is to quantify serum KL-6 levels in patients with TINU syndrome, which has no pulmonary and sarcoid lesions, and elucidate the usefulness of KL-6 for the diagnosis and follow-up of this syndrome.

METHODS

Serum and urinary samples were obtained from 17 patients with TINU syndrome and 36 age-matched patients with uveitis from other causes. Sarcoidosis was eliminated because serum KL-6 levels increased during their lung lesion. Serum KL-6 level was determined by using a human KL-6 electrochemiluminescence immunoassay. Formalin-fixed paraffin-embedded renal tissue sections were incubated with anti-KL-6 monoclonal antibody, then examined immunohistochemically.

RESULTS

Mean serum KL-6 levels for patients with TINU syndrome and those with uveitis from other causes were 363.35 +/- 51.06 and 213.19 +/- 10.28 U/mL, respectively (P < 0.001). Urinary beta(2)-microglobulin levels of patients with TINU syndrome and uveitis from other causes were 4.06 +/- 1.31 and 0.16 +/- 0.20 mg/L, respectively (P < 0.001). All patients with TINU syndrome showed a simultaneous decrease in serum KL-6 and urinary beta(2)-microglobulin levels after the beginning of treatment. Strong immunoreactivity for KL-6 was observed in renal distal tubules in biopsy tissue of patients with TINU syndrome.

CONCLUSION

We show a significant increase in serum KL-6 levels in patients with TINU syndrome, whereas levels were normal in patients with other causes of uveitis without nephritis. Renal distal tubules stained strongly with anti-KL-6 antibody, suggesting that high KL-6 levels may reflect the renal lesion of TINU syndrome. Serum KL-6 may be a potential laboratory parameter for the diagnosis and follow-up of patients with TINU syndrome that could complement urinary beta(2)-microglobulin measurements.

Global variation and pattern changes in epidemiology of uveitis

Uveitis, a complex intraocular inflammatory disease results from several etiological entities. Causes of uveitis are known to vary in different populations depending upon the ecological, racial and socioeconomic variations of the population studied. Tropical countries are unique in their climate, prevailing pathogens and in the existing diseases, which further influence the epidemiological and geographical distribution of specific entities. We provide an overview of the pattern of uveitis of 15221 cases in 24 case series reported from several countries over 35 years (1972-2007) and we integrate it with our experience of an additional 8759 cases seen over six years (1996-2001) at a large community-based eye hospital. Uveitis accounted for 0.8% of our hospital-based outpatient visits. The uveitis was idiopathic in 44.6%, the most commonly identified entities in the cohort included leptospiral uveitis (9.7%), tuberculous uveitis (5.6%) and herpetic uveitis (4.9%). The most common uveitis in children below 16 years (616 patients; 7.0% of the total cohort) was pediatric parasitic anterior uveitis, (182 children, 29.5% of the pediatric cohort), whereas the most common uveitis in patients above 60 years (642 patients; 7.3% of the total cohort) was herpetic anterior uveitis, (78 patients, 12.1% of the elderly cohort). Etiologies varied with the age group of the patients. As in other tropical countries, a high prevalence of infectious uveitis was seen in this population.

The prevalence of sight-threatening uveitis in Scotland

AIM

To identify and quantify the prevalence of patients with uveitis receiving systemic immunosuppression in Scotland.

METHODS

Anonymised data were prospectively collected on all patients with uveitis requiring systemic immunosuppression. Seven health boards participated over a 4-month period between 1 August 2005 and 30 November 2005.

RESULTS

373 patients were identified, of whom 205 (55%) were female. The mean age was 46.4 (range 7-97 years). Using the data from the seven participating health boards, an estimated Scottish prevalence of 9 per 100 000 was calculated. Prevalence varied between 2 and 59 per 100 000. In National Health Service Grampian, all patients with uveitis, whether sight-threatening or not, are followed up at a specialist clinic. Extrapolating this figure to Scotland gives a prevalence of 25 per 100 000.

DISCUSSION

The data from National Health Service Grampian suggest that there is a significant shortfall in the number of patients identified by survey. If the "missing population" exists, then where are they? Some might be receiving appropriate treatment at non-specialist clinics, although simple under-reporting may play a part. Greater concern is for those patients receiving inappropriate treatment for their uveitis, or for those within the community who are either oblivious to or in self denial of their condition.