Idiopathic Acute Anterior Uveitis Research Articles

The relation of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and mean platelet volume with idiopathic acute anterior uveitis

Objective In this study leukocyte, lymphocyte, neutrophil, platelet count, mean platelet volume (MPV), neutrophil/lymphocyte (NLR) ratio and platelet/lymphocyte ratio (PLR) were retrospectively evaluated in patients with idiopathic acute anterior uveitis. Materials and methods Medical records were retrospectively reviewed from March 2016 to February 2020. Fifty patients (25 men and 25 women) and as the control group, 50 healthy volunteers (25 males and 25 females) were included in this study. Blood samples of the patients were taken before starting treatment. A complete ophthalmological examination, including corrected visual acuity, tonometry, slit lamp and fundus examination, was performed in all patients. Gender, age, leukocyte, neutrophil, lymphocyte, platelet, MPV, PLR, and NLR values of the patients were recorded. Results In this study, a statistically significant difference was found in leukocyte ( p < .001), neutrophil ( p < .001), platelet ( p < .001), NLR ( p < .001) and PLR ( p < .001) values. No significant difference was found between the two groups in terms of lymphocyte count ( p = .063) and in the MPV value ( p = .051). Leukocyte, neutrophil, platelet count, NLR, and PLR values were higher in the uveitis group compared to the control group. In the receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) for NLR was 0.805, with a sensitivity of 56.0% and a specificity of 98.0%. The AUC for PLR was 0.657, with a sensitivity of 52.0% and a specificity of 98.0%. Conclusion In this retrospective study, leukocyte, neutrophil, platelet count, PLR, and NLR levels were significantly higher in patients with idiopathic acute anterior uveitis compared to the control group. These blood parameters are useful as diagnostic markers and can be used in early diagnosis.

Diabetes Mellitus Related Anterior Uveitis – An Overlooked Clinical Entity

ABSTRACT Background This study aimed to evaluate the characteristics of anterior uveitis in patients presenting with poorly controlled diabetes mellitus and with no other identifiable cause for their uveitis. Methods A retrospective study of 121 eyes in 89 patients who presented at Auckland District Health Board with idiopathic acute anterior uveitis and uncontrolled diabetes between September 2009 and January 2022. Results The diagnosis of diabetes mellitus was known prior to presentation in 80 subjects (89.9%) and was discovered as a result of screening tests in the remainder. Mean HbA1c at presentation was 117.3 mmol/mol. Most uveitis was severe with 3+ (30 eyes, 25.4%) or 4+ cells (30 eyes, 25.4%) in the anterior chamber. Recurrence occurred in 22 eyes (18.2%) and was associated with elevated HbA1c. The visual prognosis was good with median visual acuity at 12 months of 6/7.5. Conclusion Poorly controlled diabetes can be associated with acute anterior uveitis.

Wide-Field Fluorescein Angiography in Patients With Idiopathic Acute Anterior Uveitis

ABSTRACT Purpose To elucidate whether wide-field fluorescein angiography (WFFA) can yield additional information in patients with newly diagnosed idiopathic acute anterior uveitis (AAU). Methods The WFFA was performed in patients with idiopathic AAU, and the findings were analyzed according to the scoring system by Angiography Scoring for Uveitis Nomenclature. Results Forty-four eyes of 30 patients (22 eyes of 13 patients in the pediatric group and 22 eyes of 17 patients in the adult group) were studied. The mean age was 12.41 ± 3.92 (range, 5–18) years in the pediatric group and 42.36 ± 32.07 (range, 24–68) years in the adult group. Thirteen eyes (59%) of pediatric patients and 12 eyes (54%) of adult patients showed some evidence of posterior segment activity on the WFFA (p = .764). Systemic treatment was administered in 53.8% of the pediatric and 5.9% of adult patients, depending on the disease severity. Conclusion Pediatric patients with idiopathic AAU may have subtle posterior segment manifestations more than adult patients, and posterior segment findings may affect the treatment preferences of physicians.

Serum Maresin 1 levels in idiopathic acute anterior uveitis patients

The purpose of the present study is to assess the levels of Maresin 1 (MaR1) in patients with idiopathic acute anterior uveitis (IAAU) and to compare the MaR1 results with healthy controls. This study includes 24 patients with idiopathic AAU and 24 healty controls (C). The serum MaR1 levels were analyzed using enzyme-linked immunosorbent assays (ELISA). The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured at the time of diagnosis. MaR1 levels were statistically significant when the IAAU group was compared with group C (P<0.001). When idiopathic AAU patients were compared with group C, no statistically significant difference was found between ESR and CRP levels (P=0.086, P=0.549 respectively). Serum MaR1 levels are an important biomarker of disease in patients with idiopathic AAU.

Resident Perspectives 56–3

Resident Perspectives 56–3

Association of Killer Cell Immunoglobulin-like Receptor and Human Leukocyte antigen-C Genotype with HLA-B27 Associated Acute Anterior Uveitis and Idiopathic Acute Anterior Uveitis in a Chinese Han Population

ABSTRACT Purpose whether killer cell immunoglobulin-like receptors (KIRs) and human leukocyte antigens C (HLA-C) are associated with HLA-B27 associated acute anterior uveitis (B27AAU) and idiopathic AAU (IAAU) remains unclear. Methods PCR with sequence-specific primers was used to analyze KIR genes and HLA-C alleles in a Chinese Han population of 196AAU patients and 210 control subjects. Results The higher frequencies of HLA-C2 and KIR2DL1/HLA-C2 (p = .009 and p = .044, respectively) and the lower frequencies of HLA-C1C1 and HLA-C1 (p = .034 and p = .009, respectively) were observed in B27AAU than control group. The higher frequencies of KIR2DL2 and KIR2DL2/HLA-C1 (p = .009 and p = .044, respectively) and the lower frequencies of KIR2DL3 and KIR2DL3/HLA-C1 (p = .000 and p = .001, respectively) were observed in IAAU than control group. Conclusions HLA-C2 and KIR2DL1/HLA-C2, KIR2DL2, and KIR2DL2/HLA-C1 might be susceptible for B27AAU and IAAU, respectively. HLA-C1C1 and HLA-C1, KIR2DL3 and KIR2DL3/HLA-C1 might protect from B27AAU and IAAU, respectively.

A Cross-Sectional Online Survey Identifies Subspecialty Differences in the Management of Pediatric Cataracts Associated with Uveitis.

IntroductionTo determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of intraocular lenses.MethodsUveitis ophthalmologists and pediatric ophthalmologists were surveyed via an online poll regarding their therapeutic management of pediatric uveitic cataract and intraocular lens (IOL) placement.ResultsSixty-two responses from uveitis ophthalmologists and 47 responses from pediatric ophthalmologists were recorded. According to 79% of all responses, uveitis was not a contraindication for primary IOL implantation in patients with controlled intraocular inflammation. Pediatric ophthalmologists were more likely to respond that the presence of chronic juvenile idiopathic arthritis-associated iridocyclitis, pars planitis, or recurrent acute anterior uveitis is a contraindication for primary IOL implantation in pediatric cases with full control of intraocular inflammation. There was no consensus within either specialty with regard to the preferred IOL material for lens implantation. Uveitis ophthalmologists were more likely to report the use of intravenous and intravitreal steroids for perioperative treatment. In cataract surgery for a child with recurrent acute anterior uveitis, a higher percentage of uveitis ophthalmologists (71%) than pediatric ophthalmologists (50%) responded that the posterior capsule should be primarily opened. A higher percentage of uveitis ophthalmologists also stated that anterior vitrectomy should be performed at the time of cataract surgery in all three uveitis types.ConclusionsPediatric ophthalmologists and uveitis ophthalmologists have similar approaches to the management of pediatric uveitic cataract removal and IOL insertion, but several differences remain between these subspecialties. Continued collaboration between the subspecialties would be helpful to better develop consistent criteria to improve patient care.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00245-x) contains supplementary material, which is available to authorized users.

Ultrasonographic Enthesis Evaluation in Patients with Recurrent Acute Anterior Uveitis with and without Spondyloarthropathy

Background: spondyloarthritis (SpA) is a group of chronic diseases recognized by arthritis and extraarticular lesions e.g. uveitis, enthesitis, dermatological affection. About 35% of SpA patients may present with recurrent attacks of acute anterior uveitis (AAU). Purpose: it was to detect whether patients with idiopathic recurrent AAU who were positive or negative for Human Leukocyte Antigen B27 (HLA–B27) had a frequency of enthesis lesions compared to that seen in patients with SpA. Patients and Methods: a prospective study of enthesis evident on musculoskeletal ultrasound examination was done on sixty patients and twenty controls, the eighty were categorized into 4 groups; group 1 included 20 patients with known SpA group 2 included 20 with recurrent AAU HLA–B27 positive and didn’t have SpA aspects group 3 included 20 with recurrent AAU HLA–B27 negative and didn’t have SpA and group 4 included 20 healthy controls. Using Madrid Sonography Enthesitis Index (MASEI) twelve enthesis locations were assessed in each participant. Results: a total of 960 entheses sites were examined by ultrasonography in all 80 participants. The MASEI cut-off limit of ≥18 points was 75%, 60%, 45%, and 10% of the participants in the 4 groups; respectively. The MASEI score was significantly higher in groups 1&2 than in groups 3&4. The differences between the two groups were statistically significant. Conclusion: a high percent of HLA–B27 positive patients with idiopathic recurrent AAU without characteristics of SpA have enthesis lesions with about percent to those seen in patients with known SpA.

Aqueous Humor Analysis Identifies Higher Branched Chain Amino Acid Metabolism as a Marker for Human Leukocyte Antigen-B27 Acute Anterior Uveitis and Disease Activity

Human leukocyte antigen-B27 (HLA-B27)-positive acute anterior uveitis (AAU) has a higher recurrence rate and shows more anterior chamber cell infiltration compared with HLA-B27-negative patients, suggesting distinct etiologies of these clinically overlapping conditions. To advance our understanding of the biology of AAU, we characterized the metabolic profile of aqueous humor (AqH) of patients with HLA-B27-associated AAU (B27-AAU) and noninfectious idiopathic AAU (idiopathic AAU). Experimental laboratory study. AqH samples from 2 independent cohorts totaling 30 patients with B27-AAU, 16 patients with idiopathic AAU, and 20 patients with cataracts underwent 2 individual rounds of direct infusion mass spectrometry. Features predicted by direct infusion mass spectrometry that facilitated maximum separation between the disease groups in regression models were validated by liquid chromatography/tandem mass spectrometry-based quantification with appropriate standards. Partial least square-discriminant analysis revealed metabolite profiles that were able to separate patients with B27-AAU from those with iodiopathic AAU. Pathway enrichment analysis, based on metabolites on which separation of the groups in the partial least square-discriminant analysis model was based, demonstrated the involvement of branched-chain amino acid biosynthesis, ascorbate and aldarate metabolism, the tricarboxylic acid cycle, and glycolysis-diverting pathways (eg, serine biosynthesis) across all investigated cohorts. Notably, the metabolite ketoleucine was elevated in B27-AAU across all 3 runs and moderately-but robustly-correlated with anterior chamber cell count (correlation coefficient range 0.41-0.81). These results illustrate metabolic heterogeneity between HLA-B27-positive and HLA-B27-negative AAU, including an increase of branched-chain amino acid biosynthesis, that reflects disease activity in AAU.

The Expression of Calprotectin and Factors in TLR4/NF-κB/MyD88 Pathway in Patients with Idiopathic Acute Anterior Uveitis

ABSTRACTPurpose: The purpose of the article is to investigate the contribution of calprotectin and factors in toll-like receptor 4/nuclear factor-κB/myeloid differentiation factor 88 (TLR4/NF-κB/MyD88) pathway in patients with idiopathic acute anterior uveitis (IAAU).Methods: In total, 72 patients with IAAU and 56 healthy individuals were enrolled. Serum calprotectin, TLR-4, and MyD88 were determined. Best-corrected visual acuity, uveitis activity grading, and macular thickness measured by optical coherence tomography were performed.Results: Serum calprotectin, TLR4, and MyD88 levels were higher in IAAU group than those in healthy individuals. Serum calprotectin level was positively correlated with uveitis activity grading and macular thickness. Receiver operating characteristic curve analysis showed serum calprotectin had larger area under curve than serum TLR4 and MyD88.Conclusions: The calprotectin and TLR4/NF-κB/MyD88 signal might contribute to the pathogenesis of IAAU and serum calprotectin might be a specific biomarker for the measurement of ocular inflammation in IAAU.

Analysis of choroidal and central foveal thicknesses in acute anterior uveitis by enhanced-depth imaging optical coherence tomography

BackgroundCurrently, there are a limited number of reports of structural changes in the retina and choroid in acute anterior uveitis (AAU). The aim of this study was to evaluate choroidal and central foveal thicknesses during episodes of AAU.MethodsThe medical records of 120 patients with AAU and 120 healthy subjects matched for age, sex, and spherical equivalent of refractive error were reviewed. Subjects were divided into group 1 (AAU-affected eyes), 2 (unaffected fellow eyes), and 3 (healthy control eyes).ResultsIn the uveitis group, etiologic diagnoses included human leukocyte antigen (HLA)-B27-associated (n = 71) and idiopathic (n = 49) AAU. The mean subfoveal choroidal thicknesses (SFCTs) in groups 1–3 were 326.7 ± 64.2, 296.1 ± 66.6, and 294.9 ± 41.7 μm, respectively. The corresponding mean central foveal thicknesses (CFTs) were 273.5 ± 29.3, 264.4 ± 24.6, and 263.0 ± 30.8 μm, respectively. The AAU group exhibited a significantly greater SFCT than the control groups (P < .001). Relative to the control group, while eyes with idiopathic AAU exhibited a significantly greater CFT, those with HLA-B27-associated AAU exhibited no such significant difference. Anterior chamber cell grade was not associated with SFCT or CFT.ConclusionsThe SFCT increased significantly during AAU. This indicates the importance of OCT examination for detection of subclinical choroidal and retinal changes in all types of AAU.

Novel biomarkers for patients with idiopathic acute anterior uveitis: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio.

To assess the levels of the neutrophil to lymphocyte ratio (N/L) and the platelet to lymphocyte ratio (P/L) in patients with idiopathic acute anterior uveitis (AAU) and to compare with healthy controls. Thirty-six male patients with idiopathic AAU and 36 male healthy subjects were enrolled in this retrospective study. Complete ophthalmological examination and complete blood count measurements results of all subjects were evaluated. There was a significant difference in N/L and P/L between idiopathic AAU and control groups (P=0.006, P=0.022). Also, correlation analysis revealed a significant correlation between C-reactive protein (CRP) and N/L (P=0.002; r=0.461). Our study for the first time provides evidence of N/L and P/L may be useful biomarkers in patients with idiopathic AAU. N/L is correlated with CRP, so it can be a useful biomarker to predict the prognosis in idiopathic AAU.

Clinical analysis of 240 patients with HLA-B27 associated acute anterior uveitis.

To analyze the prevalence of HLA-B27 associated acute anterior uveitis and to identify its clinical features. A total of 240 patients with HLA-B27 associated acute anterior uveitis, who were admitted to Zhejiang Ophthalmologic Hospital between December 2006 and October 2012, were retrospectively analyzed. The age of onset, sex, affected eyes, HLA-B27 antigen detection, recurrence, joint involvement, and surgical complications were investigated. The average age of onset was 37.0±12.0 years and the ratio of male to female patients was 2.4:1. Most cases had alternate unilateral or bilateral involvement. Among all participants, 234 cases (97.5%) were HLA-B27 positive, and 124 cases (51.7%) had spondyloarthropathies (SpA), dominated by 108 cases with ankylosing spondylitis (AS,45.0%), and mostly seen in male subjects (P<0.05). Six patients were HLA-B27 negative (2.5%) and no statistical significance was noted between male and female patients (P>0.05). A total of 193 cases (80.4%) presented with complications, mainly fibrinous exudation, posterior synechia, and vitreous opacity. HLA-B27 that is associated acute anterior uveitis with a relatively high incidence and recurrence presents with more severe clinical features than does idiopathic acute anterior uveitis, and it often accompanies systemic arthritic diseases. HLA-B27 antibody detection is associated with the diagnosis and treatment of acute anterior uveitis.

High Efficacy of Methotrexate in Patients with Recurrent Idiopathic Acute Anterior Uveitis: a Prospective Study.

To evaluate prospectively the efficacy of methotrexate (MTX) in the treatment of recurrent idiopathic acute anterior uveitis (RIAAU). Nineteen out of 22 RIAAU patients completed the study (two patients withdrew their consent shortly after study initiation, one patient discontinued after 4weeks because of the adverse effects). All patients were treated with MTX in a starting dose of 15mg/week, increased to target dose of 25mg/week after 4weeks. In patients taking systemic corticosteroids (CS) the dose was gradually tapered (by 2.5mg every week) until discontinuation. The mean follow-up period was 3.3years (19-59months). Sixteen patients (84%) remained flare-free on MTX therapy. In the remaining three patients the mean interval between flares increased from 4.8 to 18.3months. Systemic CS were tapered off in all patients. The number of acute anterior uveitis flares in the whole cohort decreased from 2.12 to 0.11/patient-year (p<0.0001). All flares observed on MTX therapy occurred in HLA-B27-positive patients. MTX dosed at 25mg/week is highly effective in the treatment of RIAAU.

Is there a seasonal relationship with idiopathic anterior uveitis presentation?

PurposeTrigger mechanisms for relapse of idiopathic acute anterior uveitis (AAU) include psychological stresses and depression. Seasonality is known to affect other stress related diseases such as bipolar disorder, with depression episodes more common in autumn and winter. This study aims to investigate whether seasonality is related to AAU presentations.MethodsThe electronic patient records for the eye casualty department were retrospectively searched between January 2010 and December 2014 for all new presentations of AAU. Time of presentation was grouped into seasons. The p value was calculated from two tailed z scores of the season sample means.ResultsTwo thousand, five hundred and sixty‐three new presentations of AAU were recorded during the study period. Of these 634 (24.73%) presentations were in spring, 652 (25.44%) were in summer, 647 (25.24%) were in autumn and 630 (24.58%) were in winter. No temporal correlation was found for AAU presentations during either autumn (p = 0.86) or winter (p = 0.76).ConclusionsNo seasonal relationship with AAU presentations has been found. Stress as a trigger for AAU relapses is still not fully understood but associations are more likely to be found at the individual level.

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye.

Ankylosing spondylitis (AS) and related forms of spondyloarthritis (SpA) are associated with some extra-articular features, and the most common symptomatic association is with acute anterior uveitis (AAU). Thus, approximately 40 % of patients with AS will experience a sudden onset of a unilateral anterior uveitis sometime during the course of their disease. Patients with AAU, especially those who are HLA-B27 positive, should be questioned about inflammatory low back pain and also evaluated for other clinical features of SpA. Since a prolonged delay in diagnosis is common among SpA patients and occurrence of AAU may be the reason for their first interaction with medical care, occurrence of AAU presents a unique opportunity for identifying such undiagnosed SpA patients. Therefore, a novel evidence-based algorithm called Dublin Uveitis Evaluation Tool (DUET) has been proposed to guide ophthalmologists and primary care physicians to refer appropriate AAU patients to rheumatologists. In a large two-phase study, approximately 40 % of patients presenting with idiopathic AAU were noted to have undiagnosed SpA, and DUET algorithm was noted to have excellent sensitivity (96 %) and specificity (97 %). It has a positive likelihood ratio (LR) 41.5 and negative LR 0.03. In most instances, the eye inflammation responds well to corticosteroid and mydriatic eye drops and without the need for additional therapy. Use of oral corticosteroids is reserved for patients, especially with associated chronic inflammatory bowel disease or psoriatic arthritis presenting with bilateral, chronic, anterior, and/or intermediate uveitis, and this treatment is rarely needed for more than a couple of weeks. A very small percentage may be more refractory to such treatment and require potential novel therapies, including the use of tumor necrosis factor blockers.

A novel evidence-based detection of undiagnosed spondyloarthritis in patients presenting with acute anterior uveitis: the DUET (Dublin Uveitis Evaluation Tool)

BackgroundTo date, there are no formal guidelines or referral pathways for acute anterior uveitis (AAU) patients developed or endorsed by any international or national societies. The objective of our study...

The Manchester Uveitis Clinic: The First 3000 Patients—Epidemiology and Casemix

Purpose: To demonstrate the demography, anatomical, and diagnostic classification of patients with uveitis attending the Manchester Uveitis Clinic (MUC), a specialist uveitis clinic in the northwest of England, UK.Methods: Retrospective retrieval of data on a computerized database incorporating all new referrals to MUC from 1991 to 2013.Results: A total of 3000 new patients with uveitis were seen during a 22-year period. The anatomical types seen were anterior 46%; intermediate 11.1%; posterior 21.8%; and panuveitis 21.1%. The most common diagnoses were Fuchs heterochromic uveitis (11.5% of total), sarcoidosis-related uveitis (9.7%), idiopathic intermediate uveitis (7.9%), idiopathic acute anterior uveitis (7.0%), and toxoplasmosis (6.9%). Syphilis and tuberculosis-associated uveitis increased markedly in frequency during the study period.Conclusions: The uveitis casemix in this region reflects a predominantly white Caucasian population in a temperate country, but with changing characteristics owing to increasing immigration, enhanced diagnostic techniques, changes in referral pattern, and some real changes in disease incidence.

SAT0237 Dublin Uveitis Evaluation Tool (DUET): A Proposed Algorithm and Its Performance Evaluation for the Best Referral By Ophthalmologists of Acute Anterior Uveitis Patients with Possible Underlying Spondyloarthropathy

BackgroundRecent reports claim that the prevalence figures of mostly undiagnosed underlying Spondyloarthropathy (SpA) is more than 60% among patients presenting with acute anterior uveitis (AAU). To date, there are no...

Elevated levels of anti‐endotoxin antibodies in patients with bilateral idiopathic acute anterior uveitis

Endotoxins have been proved to be responsible for acute anterior uveitis (AAU) in animals in a well-established experimental model of endotoxin-induced uveitis (EIU). The purpose of our study was the detection of antibodies against endotoxins of selected enterobacteria in the serum of patients with idiopathic AAU and searching for correlations between the levels of these antibodies and the presence of HLA-B27 antigen as well as characteristic signs of EIU such as bilaterality and the absence of spontaneous recurrences of the disease. Reactions of serum IgG antibodies with lipopolysaccharides (LPSs) of Escherichia coli O1, E. coli O10, E. coli O111, E. coli J5, and Klebsiella pneumoniae O3 were determined for 60 patients with idiopathic AAU and 40 healthy volunteers. The presence of HLA-B27 antigen in patients was determined. Documentation of the frequency of recurrences of AAU during a follow-up period of 8 years was collected. We have observed that the sera of patients with a first attack of AAU reacted stronger with the LPS of K. pneumoniae O3 than the sera of patients with relapse of the disease. Patients with bilateral AAU had markedly higher levels of antibodies against four of the five used LPSs than patients with one eye involved. A multiply comparison showed higher levels of IgG reacting with LPS of E. coli O111 in patients with bilateral eye inflammation admitted with the first attack of AAU comparing to controls. The incidence of recurrent form of AAU was significantly increased in HLA-B27-positive patients compared to HLA-B27-negative patients. However, we found in HLA-B27 carriers that those with the bilateral form of AAU had over three times smaller risk of recurrence and showed stronger immunization by endotoxins than patients with unilateral inflammation. Our results suggest a potential role of endotoxins in the aetiology of the nonrecurrent bilateral form of AAU. We suggest that not only HLA-B27 status but also determination of number of involved eyes may be useful to assess the risk of recurrence of the idiopathic AAU.