Abstract
Cases of infectious uveitis in immunodeficient patients may present with atypical clinical features because the clinical course of disease is usually affected by the compromised immune system. Therefore, it is sometimes difficult to determine the correct diagnosis. The aim of this study was to evaluate a prevalence of immunodeficient HIV-negative individuals among patients with infectious uveitis and to assess diagnostic and therapeutic approaches. A retrospective study. In years 2003-2017, we diagnosed 594 patients with infectious uveitis. In 35 of them, infectious uveitis occurred on the basis of immunodeficiency (malignancy, immunosuppressive therapy etc.). The most common infectious uveitis was cytomegalovirus retinitis, followed by acute retinal necrosis, herpetic anterior uveitis, endogenous fungal endophthalmitis, toxoplasmic retinochoroiditis, progressive outer retinal necrosis and syphilis. In indicated cases, intraocular fluid examination was a valuable diagnostic tool. After initiation of treatment, improvement of BCVA was observed in 13 eyes, stabilization in 13 eyes and deterioration in 11 eyes. In some patients who experienced adverse effects of medication, the recommended doses were decreased. Our experience shows that patients with diagnoses of acute retinal necrosis or progressive outer retinal necrosis have a poor visual prognosis. The occurrence of cytomegalovirus retinitis signifies a very unfavorable survival prognosis in patients who underwent hematopoietic stem cell transplantation; the patients in our study died within 1 year from cytomegalovirus retinitis diagnosis.
Highlights
Infectious uveitis accounts for approximately 17-23% of all uveitis cases in developed countries
Cases of infectious uveitis in immunodeficient patients may present with atypical clinical features because the clinical course of disease is usually affected by the compromised immune system
We evaluated age of patients at time of presentation of infectious uveitis, unilateral or bilateral involvement, initial and final best-corrected visual acuity (BCVA), effect of therapy and possible complications
Summary
Infectious uveitis accounts for approximately 17-23% of all uveitis cases in developed countries. The causative agents differ throughout the world depending on geographic and demographic factors. The most common type of uveitis in Western countries is the anterior form. Posterior uveitis is more frequent in Africa, Asia and South America. The most common are herpes viruses and Toxoplasma gondii[1,2,3,4,5]. Many etiological agents are ubiquitous, e.g. seroprevalence of cytomegalovirus (CMV) rises depending on age of patients from 60 to 90%. Immunodeficient patients (AIDS, malignancy, immunosuppressive treatment after organ transplantation or due to autoimmune disease) may develop systemic infectious diseases, carrying a significant risk of morbidity and mortality[6]
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