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Results for “Uveitis, Intermediate”

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PubMed2006

Borrelia hermsii causing relapsing Fever and uveitis.

PURPOSE: To describe a case of uveitis that is associated with Borrelia hermsii relapsing fever. DESIGN: Interventional case report. METHODS: A 12-year-old boy with two weeks of relapsing fevers 10 days after camping in remote eastern Oregon was examined. Borrelia hermsii immunoglobulin M and G levels were markedly elevated. Intravenous ceftriaxone, followed by four weeks of oral cephuroxime was administered, but the patient developed unilateral floaters and blurred vision in association with anterior and intermediate uveitis. RESULTS: Doxycycline was administered for presumed residual infection. Four weeks later, the visual acuity had improved. The anterior chamber was quiet, and topical corticosteroid was tapered successfully. CONCLUSION: Although rare, Borrelia hermsii should be included in the list of spirochetal diseases that are associated with uveitis.

Anti-Bacterial Agents↗

PubMed2006

High incidence of antibodies to lens proteins in sera from patients with uveitis.

BACKGROUND: Uveitis is an intraocular inflammatory disease in which autoimmune reactions have been discussed in playing an important role. Many data in this respect derived from the animal model of "experimental autoimmune uveitis", where several organ-specific autoantigens have been described such as the retinal S-antigen and the interphotoreceptor retinoid-binding protein. However, their diagnostic and pathogenic role in humans has been controversially discussed. In recent studies, the possible relevance of betaB1-crystallin, present in lens and ciliary body, has been outlined. We, therefore, wanted to analyse whether sera from patients with uveitis might contain antibodies to lens proteins METHODS: Human lenses from cadaveric eyes were shock frozen, homogenized, and resuspended. The resulting suspension (human lens protein fraction--HLPF) was analyzed for antigenicity by ELISA and Western blotting with patients' sera. A total of 165 patients with uveitis, 54 patients with scleritis and episcleritis, 56 patients with other eye diseases, and 112 healthy blood donors were studied. RESULTS: Twenty-six (49%) of the 53 patients with anterior uveitis, 17 (32%) of the 53 patients with intermediate uveitis and 7 (22%) of 32 patients with posterior uveitis reacted in the ELISA with the HLPF. Antibodies to lens antigens were detected in one-third of patients with panuveitis and retinal vasculitis. In contrast, only 12% of the healthy blood donors were positive in the ELISA. The number of patients with an autoimmune response to alpha-crystallins in Western blot predominated in all investigated groups. CONCLUSIONS: These data indicate that antibodies to lens proteins occur in a high incidence in sera from patients with uveitis. Forty-nine percent of the patients with anterior uveitis and only 12% of healthy controls were positive in the ELISA. In our groups of patients and controls the autoantibodies reacted in the Western blot predominantly with alpha-crystallin. Further studies are required to analyze in more detail the clinical and etiopathogenetic relevance of the antilens antibodies in uveitis.

Autoantibodies↗

PubMed1994

Evaluation of laser flare-cell photometry in the appraisal and management of intraocular inflammation in uveitis.

BACKGROUND: Laser flare-cell photometry enables objective and quantitative measurement of anterior chamber inflammation. Systematic data currently are used mainly for clinical research; few are yet available in uveitis. The authors prospectively studied the amount, duration, and pattern of inflammation for well-defined uveitic conditions and evaluated the potential usefulness of laser flare-cell photometry in uveitis. METHODS: Mean initial flare was calculated in HLA-B27-positive acute anterior uveitis, acute herpes zoster uveitis, acute retinal necrosis (ARN), Fuchs heterochromic cyclitis, intermediate uveitis (pars planitis-type), posterior sarcoidosis, posterior pole toxoplasmosis, and birdshot chorioretinopathy. Evolution of aqueous flare and cells was analyzed for acute anterior uveitis, ARN, and pars planitis treated for cystoid macular edema (CME), all of which received a standardized therapy. RESULTS: Blood-aqueous barrier disruption was very pronounced in acute anterior uveitis (170.2 +/- 33 photons/msecond), ARN (177.4 +/- 88 photons/msecond), moderate in posterior sarcoidosis (38.1 +/- 11 photons/msecond), acute zoster uveitis (25.8 +/- 6.1 photons/msecond), and pars planitis (19.1 +/- 2.9 photons/msecond) but only minimal in Fuchs heterochromic cyclitis (10.2 +/- 3.5 photons/msecond), toxoplasmosis (9.0 +/- 1.2 photons/msecond) and birdshot chorioretinopathy (5.7 +/- 1.1 photons/msecond). For acute anterior uveitis, ARN, and pars planitis with CME, the inflammatory patterns were determined. The potential of laser flare-cell photometry for precise follow-up and adjustment of therapy was illustrated in cases of anterior and posterior uveitis. CONCLUSION: The authors' findings show that laser flare-cell photometry allows quantitative assessment of inflammation in uveitis and contributes to improved management of patients with uveitis.

Adolescent↗

PubMed1994

[Uveitis in the elderly].

BACKGROUND: There is only scarce information available in the literature on uveitis of older patients. The aim of this study was to study this age group in greater detail. PATIENTS AND METHODS: 435 patients were seen in the uveitis clinic of the University Eye Hospital Jules Gonin from January 1990 to March 1993. We analysed here the 94 (21.8%) patients that presented a first episode of uveitis after the age of sixty. RESULTS: This collective was characterised by an increased frequency of the anatomic diagnosis of panuveitis (p < 0.0001), and of the specific diagnosis of zoster uveitis (p < 0.0001), sarcoidosis (p < 0.0001), uveitis associated with scleritis (p < 0.05) and granulomatous anterior uveitis (p < 0.01). The frequency of diagnosis of intermediate uveitis was significantly reduced (p < 0.034) as were the specific diagnosis of HLA-B27 positive acute anterior uveitis (p < 0.001), pars planitis (p < 0.08) and non granulomatous anterior uveitis (p < 0.01). Reiter's uveitis, Possner-Schlossmann Syndrome, Behçet's uveitis, Vogt-Koyanagi-Harada disease and Toxoplasmosis retinochoroiditis were never diagnosed in this group of elderly patients. The proportion of defined specific diagnosis (75.5%) was comparable to the group of patients of less than 60 years old. CONCLUSION: As can be seen from our data, epidemiological characteristics of old age uveitis differ markedly from younger patients which should influence the diagnostic approach in these patients.

Aged↗

PubMed1998

Chronic uveitis in Kinshasa (D R Congo).

PURPOSE: To determine frequencies of different types of chronic uveitis and the possible associated conditions. METHODS: In the retrospective study a review is made of all 336 consecutive patients with chronic uveitis seen during 1983 through 1993. All patients were evaluated ophthalmologically and most of them medically. Traumatic uveitis was excluded from this study. RESULTS: There were 171 (51%) males and 165 (49%) females. Of 336 patients with chronic uveitis, 194 (58%) had anterior uveitis, 76 (23%) had isolated posterior uveitis, 38 (11%) had panuveitis and 28 (8%) intermediate uveitis. Associated conditions were found in 151 (46%) of 336 patients. AIDS, Herpes Zoster Ophthalmicus, toxoplasmosis, tuberculosis, rheumatoid arthritis and onchocerciasis were the most common associated disease respectively in 12.5%, 6.4%, 6%, 6%, 6% and 4% of cases. CONCLUSION: The findings of this study were different from those of other studies published in Europe and the United States.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Uveitis in northern Portugal.

During the past four years 450 patients (247 female - mean age 36 years and 203 male - mean age 34 years) with intraocular inflammation were evaluated using standard diagnostic criteria, to establish a uveitis survey profile. Patients were divided into four anatomic groups: anterior uveitis (270 cases = 60%), posterior uveitis (108 cases = 24%), panuveitis (54 cases = 12%) and intermediate uveitis (18 cases = 4%). A probable aetiological diagnosis was made in 232 cases (51.5%). Rheumatic diseases were diagnosed most commonly (55 cases = 12.2%), mainly ankylosing spondylitis, as is true for other European countries. Ocular toxoplasmosis was a frequent cause of uveitis, as in Brazil and West Africa, thus requiring a prompt diagnosis and treatment. Behçet's syndrome was associated with HLA B5 (65%) as in Japanese and Mediterranean populations. In our area AIDS retinitis is becoming an important differential diagnosis.

Adolescent↗

PubMed2003

[Familial uveitis. Forms and incidence in patients at the University Eye Hospital Tubingen].

OBJECTIVE: A familial accumulation in some forms of uveitis has rarely been described. The objective of this study was to identify such cases and to examine both clinical course and similarities in the HLA-pattern. METHODS: From 1993 to 2000 all new uveitis patients, who were examined in the uveitis clinic of the University Eye Hospital Tuebingen, were asked about a positive family history. If possible, all affected family members underwent an ophthalmological examination and HLA-typing was performed. RESULTS: In 7 families we found a familial accumulation of uveitis. The underlying etiologies were anterior uveitis in ankylosing spondylitis with HLA-B27 association, anterior uveitis in Blau syndrome with no HLA association, anterior and intermediate uveitis in sarcoidosis with no HLA association, and panuveitis in Behçet's disease with HLA-B51 association. For familial uveitis we calculated an incidence of 0.03 cases per 100,000 persons and year. CONCLUSION: Our data confirm that familial forms of uveitis are very rare. We suggest that these may be subgroups of known uveitis syndromes (e.g. sarcoidosis, ankylosing spondylitis). The factors causing the inheritance are still unknown. By genetic examination of families with uveitis it may be possible to identify single uveitis genes or possible antigens.

Academic Medical Centers↗

PubMed2006

[Intraocular fluids analysis for etiologic diagnosis of presumed infectious uveitis].

PURPOSE: To study the etiologic distribution of patients with presumed infectious uveitis who underwent ocular fluid analysis. PATIENTS AND METHODS: We retrospectively analyzed vitreous and or aqueous humor samples of patients with presumed infectious uveitis, referred to the department of Ophthalmology of the University Hospital of Rouen, France, between January 1997 and June 2004. We excluded patients with postsurgical or endogenous endophthalmitis. We noted clinical features and intraocular sample analysis methods for each pathogen. RESULTS: The study included 42 patients, 24 men and 18 women, aged between 6 and 79 years (mean, 39.5 years). Uveitis was unilateral in 88% of cases and bilateral in 12%. Posterior uveitis was predominant (52%), followed by panuveitis (24%), anterior (14%), and intermediate uveitis (10%). Aqueous humor and vitreous analysis confirmed etiological diagnosis for 13 of 41 patients (31%) and three of six cases (50%), respectively. Inflammation was controlled or stabilized in all cases. The most pejorative visual outcome was observed for candidiasis and viral retinitis. Positivity of intraocular samples was variable, depending on the suspected pathogen, with results similar to those reported in other studies. DISCUSSION: Atypical features in potential infectious uveitis justify ocular paracentesis or vitrectomy, which are more efficient since molecular biological tools have become available. Sensitivity of aqueous humor analysis is high for posterior uveitis and suspicion of viral retinitis. New molecular variants applied to ocular samples will improve the etiological diagnosis of infectious uveitis, particularly for pathogens that are difficult to culture, such as fungi and bacteria.

Adolescent↗

PubMed1996

Endogenous uveitis: an analysis of 1,417 cases.

A retrospective study on 1,417 uveitic patients referred to the Ocular Immunovirology Service of the University of Rome 'La Sapienza' was carried out to determine the occurrence of the various forms of uveitis. To detect also the possible changing patterns of uveitis during the last 25 years the obtained data were compared with those reported in two previous studies performed by the same author, at the same institution in 1978 and 1985. Anterior uveitis was the most frequent anatomical type of intraocular inflammation (49.12%); intermediate uveitis was diagnosed in 12.42% of all the cases and showed an increased incidence over the years (p < 0.0001). Posterior and diffuse uveitis accounted for 22.1 and 16.37% of the cases. An improvement in diagnostic definition has been confirmed by the significant decrease in the percentage of 'idiopathic uveitis' from 56.8 to 38.1% (p < 0.0001). Associated infectious conditions were detected in 17.43% of the cases. Toxoplasma gondii was the most common etiologic agent of uveitis (6.63%). An associated systemic disease was diagnosed in 15.03% of uveitic patients, and 6% of them were affected with Behçet's disease. Specific ocular diseases and clinical entities increased from 7.8 and 14.68% to 29.42% in the last 25 years (p < 0.0001), the most frequent being pars planitis (11.99%) and Fuchs' heterochromic iridocyclitis (8.32%).

Adolescent↗

PubMed1999

[Eye and sarcoidosis].

Sarcoidosis is a multisystem granulomatous disease, of unknown cause, characterised by non-caseating granulomas. The most common organs involved are the lung, thoracic lymph nodes, skin and eyes. Ophthalmic involvement occurred in approximately 30% of the patients and could be the first manifestation of the disease and preceding pulmonary involvement for many years. If anterior uveitis is the most common ocular manifestation, the posterior segment involvement (intermediate uveitis, vasculitis, choroidal granuloma, macular oedema...) is less common but more visually disabling. The non specific ocular manifestations of the disease make it as a difficult diagnosis. The "suspected sarcoidosis" diagnosis is made with regards to clinical, radiological and (or) biological criteria and the "definitive diagnosis" require the demonstration of a non-caseating, granulomatous, non-infectious inflammation process on biopsy.

Choroid Diseases↗

PubMed2000

[Intraocular correction of aphakia after cataract extraction for uveitis in adolescents].

PURPOSE: To demonstrate 3 cases with pediatric pseudophakia after cataract extraction as a complication of unilateral uveitis. MATERIAL AND METHODS: The boys were at the age of 8, 11 and 15 years at the moment of surgery. Uveitis was monocular, the etiology unknown and clinically significant cataract was diagnosed after several months from the beginning of inflammation. The last recurrence of uveitis was observed 1 to 6 months before operation. There were intermediate uveitis (2 cases) and anterior uveitis (1 cases). In 2 eyes PMMA implant was placed in-the-bag and in one eye in the ciliary sulcus. During surgery we did not observe any complications except greater tendency to bleeding. Follow-up after operation ranged from 1.5 to 2.5 years. RESULTS: Visual acuity before cataract extraction was 0.01; 0.04 and 0.02 and during last visit after surgery it was 0.9, 0.6 and 0.4 respectively. Postoperative near distance visual acuity was 0.5, 0.75 and 1.25. We observed cystoid macular oedema in the latter case. Two months after PC-IOL implantation the symptoms of mild inflammation in the eye of 15-year-old boy with anterior uveitis occurred. Intraocular pressure before and after operation ranged from 12 to 17 mm Hg. Corneal central endothelial cell density was from 2850/mm2 to 3100/mm2 before and from 2469/mm2 to 2979/mm2 during last visit. CONCLUSION: Cases of posterior pseudophakia during uveitis in children showing good functional and anatomical state of eyes in the long term observation after IOL implantation recommend the intraocular correction in carefully selected uveitic pediatric patients.

Adolescent↗

PubMed2005

[Uveitis in childhood sarcoidosis].

BACKGROUND: Sarcoidosis is a rare cause of uveitis in childhood. Differentiation from other rheumatic diseases may be difficult. We report on five children with uveitis in childhood sarcoidosis and review the previous literature. RESULTS: Children were aged between seven month and 13 years at the time of diagnosis of uveitis. Four of the five patients had panuveitis, the fifth one had intermediate uveitis. In addition, three children had systemic disease with skin, joint and central nervous system involvement. The two children younger than 5 years showed the clinical triad of eye, joint and skin disease. Uveitic complications included corneal band keratopathy, cataract, posterior synechiae, macular scars and choroidal neovascularisation. Vision-limiting complications were found in six of nine eyes at the first visit. CONCLUSION: In childhood sarcoidosis two clinical courses can be differentiated. Younger children aged up to five years express a clinical triad of arthritis, skin lesions and uveitis. In the older group of patients, the clinical course is more similar to that of adults. Rapid diagnosis and quiescence of disease are of particular importance to improve the long-term visual prognosis.

Adolescent↗

PubMed2002

[Efficiency of mycophenolate mofetil in the treatment of intermediate and posterior uveitis].

BACKGROUND: The severity of disease and the side-effects of long-term corticosteroid treatment support the rationale for other immunosuppressive drugs in the management of uveitis. Mycophenolate mofetil (MMF) is a selective inhibitor of ionosine monophosphate dehydrogenase and exerts its major effects by modulation of the function of T and B lymphocytes. This study was undertaken to evaluate the clinical effect of MMF in the control of intermediate and posterior uveitis. METHODS: A retrospective study of 18 consecutive patients with intermediate or posterior uveitis treated with MMF was performed. Activity of intraocular inflammation was graded according to the guidelines of the international uveitis study group before and during treatment with MMF. Furthermore, the ability of MMF treatment to reduce the steroid dosage and/or substitute other immunosuppressive agents with unacceptable side-effects (cyclosporin A, tacrolimus, azathioprine) was evaluated. RESULTS: The indication for treatment with MMF in all 18 patients (age range: 11-73 years) was either poor control of ocular inflammation by the previous immunosuppressive therapy or unacceptable side-effects of this therapy. The daily MMF dose was 2 g and therapy was combined with cyclosporin A and/or prednisolone. One patient received MMF monotherapy. Corticosteroids were discontinued in 4 patients and the steroid dose could be reduced in 14 patients following MMF therapy. Marked resolution of ocular inflammatory activity occurred in 13 patients. The most frequently observed side-effects of MMF were myalgia, fatigue, headache and gastrointestinal problems. CONCLUSION: MMF was effective in disease control in the majority of patients with intermediate and posterior uveitis and proved to be a useful second line immunosuppressant for refractory intraocular inflammatory disease with an acceptable profile of side-effects.

Adolescent↗

PubMed1990

A prospective study on the etiology of uveitis.

We prospectively studied and classified 152 cases of endogenous uveitis treated at the Ophthalmological Clinic in Split, Yugoslavia, according to clinical presentation, several immunologic parameters including HLA subtyping, and the presence of an associated systemic disease. Using our diagnostic criteria we successfully classified 91.4% of patients. Anterior uveitis was the most common form of clinical presentation (94 patients, 61.8%), whereas an intermediate uveitis was present in only 5.3% of patients (8 patients). By HLA typing we found that 115 patients (75.7%), were positive for HLA-B27 (57 patients, 50%), B5 (30 patients, 26%) and B35 (28 patients, 24%) risk antigens. Of these patients 96 (83%) had an associated systemic illness. In the 8.6% of cases (13 cases) in which the etiology of an endogenous uveitis was not determined, none were associated with an HLA-B risk antigen. Our study emphasizes the association of HLA-B risk antigens and concurrent systemic disease in patients with endogenous uveitis.

Adolescent↗

PubMed2005

Vitrectomy in the treatment of uveitis.

PURPOSE: To assess the evidence that pars plana vitrectomy (PPV) is useful in improving vision, reducing disease activity, or ameliorating cystoid macular edema (CME) in patients with uveitis. DESIGN: Review of the literature. METHODS: A Medline search was conducted for relevant articles published in English, German, or French. Articles were analyzed for content and evidence level. RESULTS: A total of 44 interventional case series published between 1981 and 2005 were identified that included 1575 patients (1762 eyes). Evidence level was grade CII-3 indicating possibly improved clinical outcomes with fair or poor evidence. The average age of patients was 36 years with a median duration of uveitis before surgery of 48 months and a median follow-up of 1.9 years. Intermediate uveitis was present in 841 eyes. Cystoid macular edema and cataract were common co-morbidities, and there were large numbers of additional surgical procedures. Visual outcomes in 39 articles were stated as improved in 708 eyes (68%), unchanged in 202 eyes (20%), and worsened in 124 eyes (12%). Reduction in systemic medication following PPV was reported in 25 studies. The median reported percentage of patients per study with CME was 36% preoperatively and 18% postoperatively. CONCLUSIONS: Based on the evidence in the literature, PPV is possibly relevant to the outcomes of improving vision and reducing inflammation and CME. Randomized, controlled, collaborative trials or hypothesis-based case series with precise outcome measures that incorporate control groups would improve the quality of evidence supporting PPV as an adjunct to the medical treatment of uveitis.

Adolescent↗

PubMed2006

Impact of macular edema on visual acuity in uveitis.

OBJECTIVE: To investigate the impact of cystoid macular edema (CME) on visual acuity in patients with uveitis. DESIGN: Cross-sectional study. PARTICIPANTS: The data from 529 patients (842 eyes) with uveitis were analyzed. MAIN OUTCOME MEASURES: We recorded gender and age of the patients, anatomic site and diagnosis of uveitis, associations with systemic diseases, onset and duration of uveitis, presence of CME, best-corrected visual acuity, and the causes of decrease in visual acuity. RESULTS: Cystoid macular edema was noted in 175 (33%) of all uveitis patients, of whom 77 (44%) had visual acuity of 20/60 or less in at least 1 eye. The mean visual acuity for eyes with CME was significantly worse than for eyes without CME (0.25 vs. 0.4; P = 0.003). Of all uveitis patients, 185 (35%) had visual acuity of 20/60 or less in at least 1 eye, which was caused by CME in 77 (42%) patients. Poor visual acuity in patients with CME was associated with the advanced age of the patients, chronic inflammation, and various specific uveitis entities. The development of visually impaired or blind eyes in patients with panuveitis and intermediate uveitis was caused in most cases by CME (59% and 85%, respectively). CONCLUSIONS: Cystoid macular edema was a major cause of visual loss in patients with uveitis. The unsatisfactory visual acuity in patients with uveitis underlines the need for improved management of this complication.

Adolescent↗

PubMed2006

Uveitis in the elderly: epidemiological data from the National Long-term Care Survey Medicare Cohort.

PURPOSE: There is a paucity of population-based data on the epidemiology of uveitis in the elderly. In the past 40 years, only 2 U.S. population-based studies have examined the epidemiology of uveitis. The conclusions of these studies on the burden of uveitis in the elderly differ greatly. In this analysis, we use Medicare claims data to define the population-based incidence and prevalence of uveitis in the United States elderly population. DESIGN: Cohort study. PARTICIPANTS: A cohort of 21644 Medicare beneficiaries drawn for the National Long-term Care Survey, a random sample of U.S. adults 65 years and older, was followed up from 1991 through 1999. METHODS: The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes specific to uveitis were queried. To decrease the inclusion of uveitis caused by surgery, diagnoses occurring within 3 months of intraocular surgery were excluded. The incidence and prevalence of uveitis by anatomic location was calculated for each year in the study. MAIN OUTCOME MEASURES: The onset of uveitis during a given year and its presence in subsequent years. RESULTS: The cumulative yearly incidence of uveitis ranged from 302/100000 to 424/100000 persons per year and averaged 340.9/100000 persons per year. Anterior uveitis was the most common form of uveitis in this population, with a mean incidence of 243.6 cases per 100000 persons per year. The incidence of posterior uveitis averaged 76.6/100000 and the incidence of panuveitis/endophthalmitis averaged 41.7/100000. Only 2 cases of intermediate uveitis occurred during the study period. The cumulative prevalence of uveitis doubled from 511/100000 in 1991 to 1231/100000 in 1999, with anterior uveitis accounting for most prevalent cases in every year. CONCLUSIONS: The burden of uveitis in the elderly is substantial and is higher than previously thought. Longitudinal analysis of Medicare claims data may provide a useful tool for monitoring uncommon diseases, such as uveitis, in the elderly population.

Aged↗

PubMed1993

Clinical and immunologic features of human T-cell lymphotropic virus type I uveitis.

The clinical features of idiopathic uveitis were compared by the seropositivity for human T-cell lymphotropic virus type I. The statistical analysis of various clinical variables disclosed that the uveitis seen in seropositive patients (93 patients) had a significantly higher incidence of floaters, vitreous opacities, retinal vasculitis, and intermediate uveitis than that in seronegative patients (222 patients) (P < .05). The odds ratios of the virus infection for these clinical manifestations were high and statistically significant, suggesting that the virus infection has a role as a risk factor for the development of these clinical manifestations. Although visual acuity at the initial examination was almost equal between the two groups, after the therapy with topical or systemic corticosteroids, or both, visual acuity in seropositive patients was much better than that in seronegative patients. The surface phenotype of peripheral lymphocytes in the two groups was compared as follows: CD4-positive T lymphocytes (P < .05), CD4/8 ratio (P < .01), and CD25-positive T lymphocytes (P < .05) were significantly higher in seropositive patients than in seronegative patients.

Adult↗