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Céline Mebsout, Audrey Fel, Christine Fardeau, Phuc Lehoang, Bahram Bodaghi; Psoriatic uveitis : a potentially severe and sight-threatening entity?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5785.
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To describe the clinical characteristics and therapeutic management of psoriatic uveitis.
A retrospective study of patients with psoriatic uveitis referred to the Ophthalmology clinic of Pitié-Salpétrière Hospital.<br /> Clinical characteristics, therapy, complications and severity of uveitis were reviewed. Complications and the visual outcome have been evaluated in this group.
Nine patients were finally included with a mean follow-up of 10.4 years. The mean age at presentation was 38.6 years. Among them, only 33.3% (3 of 9 patients) were HLA-B27 positive and 66.7% (6/9) had psoriatic arthritis. Uveitis was bilateral in 6 patients (66.7%). Posterior involvement was noted in 55.6% (5/9) of cases, (3 patients with vitritis, 3 with cystoid macular edema, 2 with papillitis and 1 with retinal vasculitis). Secondary glaucoma occurred in 2 patients (22.2%) with severe consequences. Twenty percent of affected eyes (3 of 15 eyes) developed legal blindness (visual acuity less than 20/400). The final visual acuity ranged from 20/20 to no light perception; with a mean visual acuity of 20/40. Uveitis was considered severe in 7 patients (77.8%). Three patients (33.3%) received long-term oral corticosteroids and 44.4% (4/9) required intravenous pulses of methylprednisolone. Methotrexate therapy was necessary in 6 patients (66.7%) and TNFα blockers were introduced in 5 patients (55.6%). Two patients needed other immunosuppressive agents (cyclosporine, azathioprine, mycophenolate mofetil, abatacept, anakinra and tocilizumab). Dexamethasone intravitreal implant was used in each eye of one patient for cystoid macular edema. Severe complications of therapy (skin carcinoma and severe infections) occurred in one patient.
In this case series, most of the patients had a severe psoriatic uveitis. Larger multicentre studies are needed in order to confirm these results and clearly identify this entity as a worrying condition, requiring an appropriate therapeutic strategy.
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