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Zeina A Haddad, Asima Bajwa, James Patrie, xin wenjun, Ashvini Reddy, ; Infectious Uveitis in Virginia. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5767.
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To report the causes, clinical features, and outcomes of infectious uveitis seen at the University of Virginia (a tertiary care center) from 1984-2014.
Retrospective review of 491 uveitis patients. Descriptive statistics were used to report and analyze demographic features, diagnoses, visual acuity (VA), laboratory findings, and outcomes.
77/491 pts (16%) had infectious uveitis (mean age 58 yrs, 71% F, 77% Caucasian). Mean f/u was 5 yrs (range 4 d-30 yrs). 62/77 patients (81%) had unilateral uveitis, and 60 patients (80%) had insidious onset. Anterior uveitis was the most common anatomic classification (39 patients, 51%) followed by panuveitis (20 patients, 26%), and posterior uveitis (18 patients, 23%).<br /> The most common infectious etiology was herpetic anterior uveitis (37 patients, 48%) followed by toxoplasma uveitis (14 patients, 18%). The most prevalent viral pathogen was herpes zoster (VZV) (21 patients, 27%) followed by herpes simplex (HSV) (20 patients, 26%). Acute retinal necrosis (ARN) was diagnosed in 14 patients (18%). Aqueous humor was analyzed in all 14 patients with ARN and was positive in 7 patients (50%). Of the 14 patients with ARN, 4 tested positive for cytomegalovirus (CMV) and 3 for VZV. Only 5 patients had classic CMV retinitis (6%). 3 patients (4%) had fungal endophthalmitis, one had syphilitic chorioretinitis (1%), and one had tuberculous uveitis (1%).<br /> The age distribution among different types of uveitis is shown in Table 1. On presentation, 43 patients (56%) had a VA better than 20/40 and 17 (22%) had a VA worse than 20/200. VA at last f/u was better than 20/40 in 39 patients (51%) and worse than 20/200 in 22 patients (29%).<br /> Table 2 shows the VA at last f/u among the different types of uveitis. 16 (21%) and 10 (13%) of the eyes required cataract and vitrectomy surgery, respectively. 14 of the eyes (18%) were on IOP-lowering medications and four (5%) needed glaucoma surgery.
The most common type of infectious uveitis seen over the study period was herpetic anterior uveitis secondary to VZV or HSV, found to be most prevalent in patients above 60 yrs old. This finding is comparable to other American epidemiologic studies. Ocular toxoplasmosis and ARN were also common causes of infectious uveitis. PCR of intraocular fluid yielded an etiologic diagnosis in 50% of ARN cases. 51% of patients had a VA better than 20/40 at last f/u which could be secondary to prompt referral and appropriate treatment.
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