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Rebecca Low, Elizabeth Chen, Helen Mi, Muhammad Amir Bin Ismail, Su Ling Ho email@example.com, Wee Kiak Lim, Stephen Teoh, Rupesh Agrawal; Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) - Report 2: Investigations, Complications And Treatment. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4159.
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Ocular inflammation is seen in a significant proportion of patients presenting to the tertiary eye centre. The Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) outlines the epidemiology of 2200 patients presenting with ocular inflammation and their etiological factors, as discussed in OASIS - Report 1: Epidemiology and Classification. In OASIS - Report 2, we aim to focus on the investigations and management of these patients and discuss the disease specific complications and outcomes.
Retrospective cohort study of 2200 consecutive new cases from the OASIS database over a 12-year period (2004 to 2015) at a tertiary eye care center in Singapore.
The most common investigations ordered were the complete blood count (44.4%) and inflammatory markers – ESR (41.5%), and CRP (34.3%). The workup for infective causes mainly includes Venereal Disease Research Laboratory (VDRL) (41.9%) and Tuberculosis T-spot (25.1%). HLA-B27 typing has a higher diagnostic yield than anti-nuclear antibody (ANA) testing as it picked up 48.3% who had HLA-B27 associated uveitis or ankylosing spondylitis, compared to ANA being positive only for 4.3% who had systemic lupus erythematosus or juvenile idiopathic arthritis. In terms of treatment, 24.6% of patients received systemic corticosteroids, 8.7% required additional immunosuppressant, and 0.9% required additional biologic agents. The main complications were ocular hypertension (16.0%), cystoid macular edema (2.7%) and cataract (2.6%). Ocular hypertension was seen in most patients with anterior uveitis (276/353, 78.2%, p<0.001). Cystoid macular edema was seen mostly in posterior uveitis (29/59, 49.2%, p<0.001). We observed a significant association between age group of 45-64 years with ocular hypertension (44.8%, p<0.001) and cataract (43.1%, p=0.004). The etiological diagnosis with highest incidence of hypertension is Posner Schlossman Syndrome (78/353, 22.1%). The most common etiological cause remains idiopathic for cystoid macular edema (13/59, 22%) and cataract (12/58, 20.7%).
Rationalization of investigations in patients with ocular inflammation is needed to avoid unnecessary testing. Complications that develop differ according to geographical regions due to the differing epidemiology of uveitis.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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