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Paul M. Kabasele, Simon R. Taylor, Sue L. Lightman; Causes Of Visual Loss In Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2728.
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To determine the causes of visual loss in patients with uveitis.
This was a retrospective study.
1594 patients (2543 eyes), 737 males and 857 females. The mean age at first presentation or onset was 41.8 years. Seventy five percent were aged between 24-63 years, 6% were ≤ 16 years. Anterior uveitis accounted for 41%. Intermediate uveitis was diagnosed in 26%, panu/posterior uveitis and retinal vasculitis in 26.5% and 6% respectively. The mean age at diagnosis of AU was 42, 38 for IU, and 41 for Panu/Pu. In 32.4% of patients, a systemic disease was found. At presentation, 48.8% of patients had BCVA≤6/12 in at least one eye. At one year follow up, we found 9% of patients with visual loss, and 2 third of patients who had a follow-up of more than 10 years were visually impaired. In the group of eyes with AU, 15.4% developed visual loss. Most of these eyes (9.4%) had mild to moderate vision loss. Twenty seven percent of eyes with IU were visually impaired, 2/3 of which had mild to moderate visual loss. Eyes with pan/posterior uveitis and retinal vasculitis had vision loss in 44.9% and 43.7% respectively. In these two groups, most eyes developed severe visual loss to legal blindness. Visual loss was due to macular damage in 55% of cases (23% CME and 32% chronic changes). Glaucoma accounted for 13.3% and was the major complication in AU (27.7%). CME was the leading cause of visual loss in eyes with IU (42.2%), and chronic macular changes were the main cause in panu/posterior uveitis (36.9%). The prevalence of CME decreased with time, from 34% at 1 year follow up to 14.6% in eyes that were followed up for more than 10 years. Glaucoma increased with time, from 8.4% at one year follow up to 29.4% after 10 years. Ischemia accounted for 3.2% of causes of visual loss and is not affected by time. In children, 22.2% of eyes were visually impaired, the main cause being CME (55.8%), followed by macular scars (17.6%). In this group, glaucoma accounted for 3%.
Rothova et al in 1996 reported 41% of visual impairment due to CME, and 11% due to glaucoma. In this study, CME accounted for 23%. Merayo-Lloves et al reported glaucoma in uveitic eyes in 9.6% and found that this complication was more frequent in AU (67%). Similarly, we found that glaucoma was the leading cause of visual loss in anterior uveitis. We report 13.3% and, like Neri et al, we found that its prevalence increased with time. Uveitis is still a sight threatening condition. Causes of visual loss in early phases of the disease are reversible. However, chronic macular damage, glaucoma and ischemia lead to irreversible visual loss.
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