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Erick Rivera-Grana, Rene Choi, James T. Rosenbaum; Reclassifying Idiopathic Uveitis: Lessons from a Tertiary Uveitis Center. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4165. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Idiopathic uveitis is the most common diagnosis in most series from uveitis clinics. We sought to determine the percentage of patients initially diagnosed as idiopathic, non-infectious uveitis referred to a tertiary uveitis center who were subsequently found to have an identifiable cause of uveitis.
We performed a computerized database analysis of 179 consecutive patients who were referred to our practice with the diagnosis of idiopathic, non-infectious uveitis between 2008 and 2016. Patients were evaluated by a thorough history and ophthalmic examination with selected laboratory testing targeted by clues from the history and exam. Standardization of Uveitis Nomenclature (SUN) criteria was used to assess ocular inflammation.
71.8% of all referrals for non-infectious uveitis were labelled initially as having idiopathic disease during this 9 year interval. Females were most commonly affected (121/179) (67.6%). The most common type of onset was sudden in 109/179 (60.8%) of patients, followed by insidious with 60/179 (33.5%); 10/179 (5.5%) could not be accurately assessed. Fifty-two out of 179 (29.0%) patients were subsequently diagnosed with an underlying condition. Sarcoidosis was the most common (19/52 or 36.5%), including 4 of 19 (21.0%) of these patients who were also found to have cardiac involvement. Sarcoidosis was usually diagnosed by chest CT scanning of selected patients. After sarcoidosis, the next most common were HLA-B27 associated uveitis (11/52, 21.1%), infectious uveitis (6/52, 11.5%), tubulo-interstitial nephritis with uveitis (6/52, 11.5%), and juvenile idiopathic uveitis (4/52, 7.7%). Other diagnoses included Bechet’s disease, multifocal choroiditis, Crohn’s disease, multiple sclerosis, and relapsing polychondritis. An underlying condition was not found in 127/179 (70.9%) patients.
We report that 29% of patients referred to our tertiary uveitis center diagnosed as “idiopathic” uveitis had an associated identifiable cause. Identifying an underlying condition associated with uveitis could be potentially lifesaving for some illnesses (e.g. sarcoidosis with cardiac involvement) and is critical to management (e.g. infection). Limited testing allowed classification of many patients who had been previously incorrectly labeled with idiopathic uveitis. Idiopathic uveitis, however, remains the most common diagnosis in our uveitis clinic.
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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