Analysis of Routine Investigations for Recurrent Non–granulomatous Anterior Uveitis in Eastern Ontario

Abstract

 

Abstract:

 

Anterior uveitis is a common condition. It may be idiopathic or associated with systemic disorders. It is recommended that bilateral, granulomatous, or recurrent non–granulomatous cases be tested further to rule out systemic disease. Tests include CBC, HLA–B27, ACE, ESR, ANA, VDRL/FTA–ABS, PPD, lyme titre, and chest Xray. Causes of iritis vary between populations due to geographic and demographic differences, but the same tests are commonly performed despite these differences. We studied the trends in routine tests for iritis patients in our population in Eastern Ontario, Canada. By noting the frequency of positive test results, influence on patient management, and impact on the diagnosis of systemic disease, we can develop a regimen of tests more specific to our population and more cost–effective.

 

Data on 63 consecutive patients presenting with recurrent non–granulomatous iritis was compiled. Demographics, clinical data from the first visit, past medical history, laboratory tests, and subsequent diagnosis of systemic disease were noted. Exclusion criteria were a first episode of iritis, granulomatous uveitis, traumatic iritis, post–op iritis, or eye surgery within 6 months. Descriptive statistics were used to identify trends in the data.

 

See Table 1. Only HLA–B27, ACE, and chest Xray led to further work–up and new diagnoses of systemic disease in our patients. CBC, ANA, and ESR, when positive, led to no further work–up or diagnoses. No positive results were obtained with VDRL/FTA–ABS, lyme titer or PPD.

 

 

^{In our population in Eastern Ontario, many of the routine tests for cases of anterior uveitis are consistently negative, and others, when positive, are ignored as they prompt no further work–up, and do not alter management, nor lead to diagnosis of systemic disease. These tests should be reserved for cases in which the medical history strongly suggests a particular diagnosis. Positive HLA–B27, ACE or chest Xray often leads to further work–up and diagnosis of systemic disease in our population. A more specific and cost–effective approach to investigating these patients is possible, and further study is warranted.}

 

 

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • uveitis-clinical/animal model