Purchase this article with an account.
Himanshu Banda, Chris Stelton, Steven Yeh; Characteristics of Multiple Sclerosis Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4143.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The association between uveitis and multiple sclerosis (MS) has been well documented. Visual prognosis is uncertain, as there is limited data implicating the role of immunomodulatory therapy for MS in the concurrent treatment of associated uveitis. We performed a retrospective, observational clinical chart review to understand the changes in patients with MS associated uveitis, as well as comparing visual acuity outcomes of these patients with and without systemic immunomodulatory therapy.
A database search was completed for patients treated for uveitis and MS. For each patient, age, gender, ethnicity, presenting symptoms, anatomic location of uveitis, laterality, MS treatment modalities, uveitis treatment modalities, and visual acuity (VA) were recorded. Uveitis was classified using the Standardization of Uveitis Nomenclature (SUN) workshop.
Ten patients were identified, all of whom were women. Five were African-American and five were Caucasian. Median patient age was 49.5 (range 29-82). 10% were unilateral 90% were bilateral; of bilateral cases, 22% had asymmetric findings. 70% of patients presented with intermediate uveitis, 20% with panuveitis and 10% with anterior uveitis. Seven patients were on immunomodulatory therapy for MS at the time uveitis was diagnosed. Uveitis was treated with topical steroids in 30% of cases, periocular steroids in 60% of cases, and systemic therapy (corticosteroids or mycophenolate mofetil) in 30% of cases. A fluocinolone acetonide intravitreal implant was used in two patients after failing multiple periocular steroid injections. Two patients treated locally for uveitis did not start systemic immunomodulatory therapy after a diagnosis of MS was confirmed. These patients had a worse visual outcome compared to those receiving local uveitis treatment and systemic MS immunomodulators.
Uveitis is a rare manifestation of MS, most commonly involving females presenting with bilateral, intermediate uveitis. This study demonstrates that MS patients on immunomodulatory agents with concurrent uveitis may have a different visual prognosis compared to patients who are not systemically treated. However, the relationship between MS systemic disease control and prognosis or reversibility of ocular disease entities is poorly understood. A multispecialty approach to MS uveitis research may help identify patterns between treatment modalities and visual acuity outcomes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only