Profile of patients with uveitis referred to a multidisciplinary unit in northern Spain

Prevalence and risk factors for complicated immuno-mediated uveitis: experience in a tertiary hospital

OBJECTIVE

To describe the characteristics of patients with uveitis and ocular complications in a tertiary hospital. As well as to determine the risk factors for the development of an ocular complication.

METHODS

Retrospective study of patients with uveitis evaluated in a Uveitis Unit of the Virgen de las Nieves Hospital from January 2018 to October 2022. A descriptive and analytical study was carried out using logistic regression to know the predictive factors of a poor ocular prognosis.

RESULTS

A total of 127 patients were studied, of which 63% were women and 83.5% were Caucasian. The median age was 51 years IQR (15-88) years. Following the SUN classification, uveitis was predominantly bilateral (55.1%) and anterior (52%), had a recurrent evolution in 51,2% and only 12,6% were granulomatous. Of the total uveitis, 74,2% of the sample turned out to have an immune-mediated profile, although a final diagnosis was only reached in 46,1% of the patients. A total of 17,3% patients suffer from loss of vision. Visual complications in decreasing order were: posterior synechiae (15,6%), cystic macular edema (14.8%), cataracts (13,1%), glaucoma (8,2%), epiretinal membranes (4,9%) and neovascular membranes (1,7%) and retinal detachment (4%). In the bivariate analysis, ethnicity other than Caucasian was significant, p = 0,024, and a number of outbreaks greater than 2, p = 0,045. The rest of the variables analyzed were not significant. In the multivariate analysis, they were significant outbreaks OR: 1,2 CI (1,051-1,426) and ethnicity OR: 0,11 CI (0,014-0,938).

CONCLUSIONS

The number of outbreaks and non-Caucasian race were related to a greater probability of presenting an ocular complication. An earlier and more specific diagnosis of the etiology, especially in these patients, would allow earlier treatment and improve their prognosis.

Uveitis: Study of 109 cases

PURPOSE

Analyse and describe the anatomical and etiological classification, clinical and epidemiological characteristics and most frequent symptoms of uveitis cases in our population.

PATIENTS AND METHOD

Descriptive, retrospective observational study of uveitis cases treated in the Ophthalmology Department of Virgen del Rocío University Hospital in 2021. The demographic and clinical characteristics were studied.

RESULTS

A total of 109cases of uveitis were studied, 46 men and 63 women, with a mean age of 45.43±16.11 years. The most frequent symptoms were pain (74.31%), hyperemia (73.39%) and blurred vision (65.14%). The most frequent anatomical classification was anterior (55.96%), followed by panuveitis (18.35%), posterior (12.84%) and intermediate uveitis (7.34%). Regarding etiology, most uveitis were idiopathic (42.99%), followed by non-infectious (38.32%) and finally infectious (18.69%).

CONCLUSIONS

In southern España, the characteristics of uveitis are similar to other studies in Western countries.

Complications of uveitis in a Spanish population, UveCAM study

OBJECTIVE

To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UVECAM study.

PATIENTS AND METHODS

Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UVECAM study) during a period of 1 year. Description of complications and study of their possible determinants by means of multivariate regression models.

RESULTS

Information on the development of complications was available in 371 of the 386 patients of the UVECAM study. The most frequent complications were posterior synechiae (19.0%), ocular hypertension (14.0%), macular edema (7.5%), epirretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%) and cataract (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution.

CONCLUSION

Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process and chronic or recurrent evolution.

Fungi of the human eye: Culture to mycobiome

The focus of the current review is multi-fold and compares the diversity and abundance of fungi on the ocular surface by the conventional culture-based method with the more sensitive, high throughput, culture-independent NGS method. The aim is to highlight the existence of a core ocular mycobiome and explore the transition of the ocular fungal microbiota from the normal eye to the diseased eye. PubMed, Google Scholar and Medline were used to search for publications and reviews related to cultivable fungi and the mycobiome of the normal and diseased eye. The conventional cultivable approach and the NGS approach confirm that the eye has its own mycobiome and several confounding factors (age, gender, ethnicity etc.) influence the mycobiome. Further, dysbiosis in the mycobiome appears to be associated with ocular diseases and thus impacts the health of the human eye. Considering that the mycobiome of the eye is influenced by several confounding factors and also varies with respect to the disease status of the eye there is a need to extensively explore the mycobiome under different physiological conditions, different ethnicities, geographical regions etc. Such studies would unravel the diversity and abundance of the mycobiomes and contribute to our understanding of ocular health. Research focused on ocular mycobiomes may eventually help to build a targeted and individualized treatment.

Multidisciplinary care and units for uveitis in the internal medicine departments in Spain: Survey of the Systemic Autoimmune Diseases Group

OBJECTIVE

To identify the multidisciplinary uveitis units in which internal medicine departments participate in collaboration with ophthalmology departments in Spain.

MATERIAL AND METHODS

We conducted a multicentre, observational cross-sectional study that collected information using a structured survey sent by email to 1015 partners of the Systemic Autoimmune Diseases Workgroup of the Spanish Society of Internal Medicine (GEAS-SEMI) from the 1st to the 31st of March 2017.

RESULTS

We identified a total of 21 support units/consultations for the ophthalmology departments. Seventeen (81%) of the units were specific internal medicine-ophthalmology consultations, and 5 (24%) units had been created in the past 5 years. A median of 460 patients were assessed per unit by the end of the year.

CONCLUSIONS

This study shows, for the first time in Spain, the important and close collaboration between ophthalmologists and internists, especially in highly specialised national reference institutions.

Multidisciplinary care and units for uveitis in the internal medicine departments in Spain: Survey of the Systemic Autoimmune Diseases Group

OBJECTIVE

To identify the multidisciplinary uveitis units in which internal medicine departments participate in collaboration with ophthalmology departments in Spain.

MATERIAL AND METHODS

We conducted a multicentre, observational cross-sectional study that collected information using a structured survey sent by email to 1015 partners of the Systemic Autoimmune Diseases Workgroup of the Spanish Society of Internal Medicine (GEAS-SEMI) from the 1st to the 31st of March 2017.

RESULTS

We identified a total of 21 support units/consultations for the ophthalmology departments. Seventeen (81%) of the units were specific internal medicine-ophthalmology consultations, and 5 (24%) units had been created in the past 5 years. A median of 460 patients were assessed per unit by the end of the year.

CONCLUSIONS

This study shows, for the first time in Spain, the important and close collaboration between ophthalmologists and internists, especially in highly specialized national reference institutions.

Complications and visual acuity of patients with uveitis: Epidemiological study in a reference unit in northern Spain

OBJECTIVE

To describe uveitis complications and visual acuity in a cohort of 500 patients in a multidisciplinary unit in northern Spain.

MATERIAL AND METHODS

Retrospective-prospective study of complications and visual acuity of 500 adult patients evaluated in the Multidisciplinary Unit of the Navarra Hospital Complex from the period January 2010 until March 2015. An analysis was made of the complications, visual acuity and visual loss, with a follow-up of one-year. A comparative study was also made of the complications with 2 previous series published in Madrid and Holland.

RESULTS

Moderate-severe visual loss was 13.5% in the right eye, and 13% in the left eye. Visual loss was associated with an age of 65 years or above. Complications were observed in 35% of patients, and cataract was the most frequent complication (10%), followed by synechiae (8%), and macular oedema (5%). Compared with the 2 other series, the present cohort showed a higher proportion of cataracts.

CONCLUSIONS

Visual loss was associated with older age and cataract was the most common complication in our study.

Enigma of serpiginous choroiditis

Serpiginous choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like choroiditis (SLC) and multifocal serpiginoid choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC.

A Retrospective Observational Study of Uveitis in a Single Center in Poland with a Review of Findings in Europe

BACKGROUND This study aimed to review the causes, presentation, and clinicopathological associations of uveitis in a single department of ophthalmology in Poland, and to compare the findings with previously published studies from other European countries. MATERIAL AND METHODS Review of local patient records between 2005-2015 identified patients diagnosed with uveitis. Data obtained included age, gender, imaging findings, and laboratory diagnostic findings. A literature review identified 24 publications from 1976-2017 that reported observational data from patients with uveitis in Europe. Statistical analysis compared the findings. RESULTS Between 2005-2015, 279 patients were diagnosed with uveitis (mean age, 38.3±15.3 years) (61.6% women) including unilateral uveitis (60.5%), with posterior uveitis (48.4%), anterior uveitis (26.5%), and intermediate uveitis (12.9%). A general etiology was established in 76.3% and included ocular-specific syndromes (31.8%), infection (27.9%), and an association with systemic disease (16.8%), but 23.6% were unclassifiable. Specific causes of uveitis included toxoplasmosis (17.9%), Fuchs uveitis (12.2%), white dot syndromes (WDS) (10.4%), sarcoidosis (6.1%), toxocariasis (6.1%), HLA-B27-associated acute anterior uveitis (AAU) (5.7%), multiple sclerosis (4.7%), ankylosing spondylitis (3.6%) and herpesvirus infection (2.5%). Data from 26 published studies (24,126 patients with uveitis) from 12 European countries showed that idiopathic uveitis was most common (36.6%); the identified causes included toxoplasmosis (9.4%), WDS (7.2%), and Fuchs uveitis (6.1%). CONCLUSIONS In a single ophthalmic center in Poland, and throughout Europe, the causes of uveitis are varied. Genetic, geographic, social and environmental factors are likely to affect the cause of uveitis in different populations.

The microbiome and HLA-B27-associated acute anterior uveitis

Acute anterior uveitis (AAU) and the spondyloarthritis (SpA) subtypes ankylosing spondylitis, reactive arthritis and psoriatic arthritis are among the inflammatory diseases affected by the biology of the intestinal microbiome. In this Review, the relationship between AAU, SpA and the microbiome is discussed, with a focus on the major SpA risk gene HLA-B*27 and how it is associated with both intestinal tolerance and the loss of ocular immune privilege that can accompany AAU. We provide four potential mechanisms to account for how dysbiosis, barrier function and immune response contribute to the development of ocular inflammation and the pathogenesis of AAU. Finally, potential therapeutic avenues to target the microbiota for the clinical management of AAU and SpA are outlined.