Abstract
Purpose: :
To present the etiologic factors for uveitis in patients from the referral centre
Methods: :
Retrospective study on the clinical records of 151 consecutive patients, diagnosed and treated for uveitis,for the period from May 2010 to November 2011. Follow-up period varied from 6 to 18 months. In all patients, a full ophthalmologic exam and review of systems was performed. Additional serologic and imaging modalities of investigation were made depending on the clinical presentation.Results of treatment were considered to support or reject a presumed diagnosis.
Results: :
In 81 (53.64 %) out of 151 patients, on the basis of clinical evidence, results of imaging and serologic methods,an infectious etiology of the uveitis was considered. Out of these,in 56 patients (37.08%), there was a high clinical probability of VZV ocular infection, supported by serologic studies. VZV infection was manifested as keratouveitis in 28 of the patients (50.0%), iridocyclitis in 23(41.07%), acute retinal necrosis in 3(5.35%),and neuroretinitis in 2 (3.57%). Nine patients (5.96%) had uveitis, which, according to our diagnostic work-up, could be associated with ocular tuberculosis. Ocular toxoplasmosis was diagnosed in 10 patients (6.62%). Two patients (1.32%) with intermediate uveitis showed elevated serum titers of Borrelia burgdorferi. CMV ocular infection was suspected in three cases (1.98%) of iridocyclitis. One patient (0.66%) with intermediate uveitis was positive for Chlamydia trachomatis. Concerning non-infectious and immune-mediated uveitis, we described 20 patients (13.24%). Nine patients (5.96%) with iridocyclitis had serologic evidence of HLA B27. In 2 patients (1.32%), Posner-Schlossman syndrome was suspected. Fuchs iridocyclitis was observed in 2 cases (1.32%). Sarcoidosis was diagnosed in 1 patient (0.66%). Six patients with panuveitis had clinical and serologic evidence for Behcet disease. Despite the thorough clinical exam and specialized investigative methods available, etiologic diagnosis could not be made in 50 cases (33.11%).
Conclusions: :
Uveitis is a broad concept, that represents a large and diverse group of inflammatory conditions. Etiology is quite varied and only after considering clinical data with the results of the latest specialized diagnostic modalities, an etiologic diagnosis could be made with a higher degree of certainty. Therefore, an interdisciplinary approach should be applied to all patients with uveitis in an attempt to determine the specific etiology and help choose the most appropriate management.
Keywords: uveitis-clinical/animal model • varicella zoster virus • bacterial disease