Non-infectious Uveitis Patients Research Articles

Lipid profile alterations in non-infectious uveitis: correlation with quantitative optical coherence tomography angiography parameters

Background/aimsLipid profiles have been changed in numerous chronic conditions. The impact of uveitis on lipid metabolism remains unclear.MethodsThis is a cross-sectional study included 416 patients with non-infectious uveitis (NIU) and...

Exploring the involvement of the alternative complement pathway in non-infectious uveitis pathogenesis.

Non-infectious uveitis is a complex disease characterized by intraocular inflammation of the uveal area and the leading cause of vision impairment and blindness in young people globally. However, what triggers inflammation and contributes to its recurrence remains unclear. The complement system has been linked to various immunological and inflammatory conditions. In the present study, we have systematically evaluated the role of the alternative complement pathway in the pathogenesis of non-infectious uveitis. Quantitative PCR was done in the peripheral leukocytes to study the expression of genes and regulatory miRNA in both anterior and posterior uveitis (n=28 in each category). Multiplex ELISA was performed to measure alternative pathway complement components, such as C3b, factor B, and CFH, and aqueous humor of infectious and non-infectious uveitis patients and non-inflammatory controls (n=10 each). Western blotting was done to validate the ELISA findings in a subset of patients and controls. Downregulation of C3 and CFH mRNA in the peripheral blood was shown by quantitative PCR in the group of anterior uveiits (AU), while the opposite result was found in the group of posterior uveitis (PU). ELISA levels of C3b and CFH proteins were significantly higher in aqueous humor of infectious and non-infectious uveitis (*p = 0.03 and **p = 0.0007 respectively) as compared to the control group. Western blotting further validated (VitH) the activation of the complement cascade in the aqueous (AH) and vitreous humor of patients with non-infectious uveitis, with an increased level of C3b (n=6) and CFH (n=4) in aqueous humor. C3b level was significantly increased while CFH was reduced relative to controls in the vitreous humor (VitH) of posterior uveitis patients compared to controls (n=27 in each category). A C3b to CFH ratio was computed to assess the regulation of complement activation and this index was several folds higher in both anterior and posterior uveitis (n=10 each). The expression of miRNA-hsa-miR-146a and miRNA-hsa-miR-155-5p that regulates CFH was downregulated and nicely correlated with the increased complement proteins in both anterior and posterior uveitis (n=10 each). Our results demonstrate a clear role of CFH and the activation of the alternative complement pathway in the pathogenesis of non-infectious uveitis; however, its therapeutic potential warrants further investigations.

Clinical characteristics of non-infectious uveitis treated with and without systemic immunomodulatory therapy

ObjectiveTo compare the patient characteristics and long-term outcomes for those treated with and without systemic immunomodulatory therapy (IMT) for non-infectious uveitis (NIU). DesignRetrospective cohort study. ParticipantsAll consecutive adults with NIU receiving care at 5 uveitis subspecialty tertiary care clinics between 2010 and 2021. MethodsClinical outcomes were evaluated on initial presentation and at the last available follow-up. The main outcome measures were baseline characteristics and final visual acuity. ResultsA total of 914 NIU patients (418 IMT, 496 non-IMT) with a median age of 51.0 years and 57.4% female were identified. Over half the patients had bilateral disease, with a significantly higher proportion of bilateral cases in the IMT group compared with the non-IMT group (p < 0.001). The IMT group was more likely to have chronic uveitis (p < 0.001), with a higher proportion of patients experiencing cataracts and cystoid macular edema (p < 0.001 for both). A significantly higher proportion of non-IMT patients had anterior uveitis and an idiopathic etiology (p < 0.001). Overall, visual acuity improved significantly from baseline to last follow-up in the entire cohort (p < 0.001), with a slightly better improvement in the IMT group. Multivariable linear regression analysis suggested that baseline visual acuity and panuveitis were significant predictors of final visual acuity (p < 0.001 for both). ConclusionsNIU patients on IMT are often younger, suffer from bilateral and chronic uveitis, and are more likely to have ocular complications. Those in the non-IMT group are more likely to have anterior idiopathic NIU. Baseline visual acuity and panuveitis are the main predictors of final vision outcomes among patients with NIU.

Immunogenicity of Adalimumab in Patients with Non-Infectious- Uveitis: Systematic Review and Meta-Analysis

ABSTRACT Objective To review the prevalence, incidence, and risk factors for developing anti-drug antibodies (AAA) in patients with non-infectious uveitis (NIU) treated with Adalimumab (ADA). Methods A systematic literature search was performed on PubMed, EMBASE, Virtual Health Library, Cochrane, and medRxiv. Meta-analysis was performed using random effects. Results Nine out of 2,373 studies were included. The prevalence of AAA in NIU patients treated with ADA was 9% (95% CI: 2% to 37%, I2 = 95% with a P<0.01), it was significantly higher in real-life scenarios (observational studies) than in clinical trials. The pooled incidence at 12 months was 27% (CI 95% 16%-42% I2 = 0%). Several factors have been associated with AAA generation in NIU patients, including the non-use of concomitant immunosuppressants, presence of autoimmune systemic disease, female gender, etc. Conclusion This study showed that AAA prevalence is higher in real-life scenarios compared to clinical trials. Further research is needed to elucidate the factors that trigger AAA generation in NIU patients.

Noninfectious Uveitis Risk After COVID-19 Vaccination: A Nationwide Retrospective Cohort Study

To investigate the incidence and risk of noninfectious uveitis (NIU) following COVID-19 vaccination compared with an unvaccinated, uninfected control group. Retrospective population-based cohort study. We included 5,185,153 individuals who received the first vaccine dose in the exposed group and 2,680,164 individuals in the unexposed, uninfected control group. The study observed for 180 days from their index date. Cumulative incidence and risk of NIU following COVID-19 vaccination, and attributable risk factors were assessed. Multivariable analysis showed elevated risk of nonanterior NIU within 60 days (hazard ratio [HR] 1.27 [95% confidence interval {CI} 1.03-1.55] and 61-180 days (HR 1.39 [95% CI 1.20-1.62]). Subgroup analysis highlighted an increased risk in females for early and delayed nonanterior uveitis (HR 1.44 [95% CI 1.08-1.92]; HR 1.78 [95% CI 1.43-2.20], respectively). Regardless of the location and onset timing of uveitis, a history of NIU was identified as the most significant risk factor, with a high hazard ratio ranging from 100 to 200. COVID-19 vaccination may modestly increase the risk of nonanterior uveitis especially in females. Despite adjustments, bias may persist in the exposed group, owing to significant differences between unexposed and exposed groups and low incidence of nonanterior uveitis in the unexposed group. Future research should aim to refine these findings by assessing uveitis risk in prior NIU patients and by enlarging the sample size or cohort matching.

Increased Risk of Celiac Disease in Patients with Uveitis

ABSTRACT Purpose To examine whether patients with non-infectious uveitis (NIU) are at increased risk for celiac disease (CeD). Methods Celiac antibody testing was completed in 112 patients. The control group included patients who had undergone upper endoscopy for suspicion of CeD. Results 2/112 (1.79%) of patients with NIU had positive anti-tTG serology and CeD was confirmed in both patients. When compared to the expected risk of CeD in the general Israeli population of 0.31%, this corresponded to an odds ratio of 5.77 (95% CI 1.4118 to 23.4737, P = 0.049). Three additional patients had positive serology for CeD but the diagnosis was not confirmed. Conclusions An increased risk of CeD was detected in patients with NIU. We therefore recommend screening for CeD in NIU patients. Larger prospective studies are required to further validate these results.

Comparison of infliximab with adalimumab for the treatment of non-infectious uveitis: a systematic review and meta-analysis

PurposeTo compare the efficacy and safety of infliximab with that of adalimumab in the treatment of non-infectious uveitis (NIU).MethodsWe searched for relevant studies in the PubMed, Embase, ClinicalTrials.gov, Cochrane Library databases, Grey Matters, Grey Literature Report, OpenGrey, China National Knowledge Infrastructure (CNKI), and Wan Fang databases up to September 2022. The incidences of complete remission of inflammation, response to therapy, adverse events and corticosteroid-sparing effect were evaluated.ResultsEleven clinical trials covering 1459 NIU patients were included. Complete remission of inflammation after therapy was achieved in 161 (37.5%) patients in the infliximab group and 151 (39.6%) patients in the adalimumab group. These two groups were not significantly different (P = 0.37). Four studies reported response to anti-TNF therapy involving 449 patients, of whom 241/272 (88.6%) treated with infliximab and 153/177 (86.4%) treated with adalimumab achieved partial or complete remission of inflammation. No significant difference was observed between the two cohorts in terms of response to therapy (P = 0.86). There was no significant difference between infliximab and adalimumab with regard to corticosteroid-sparing effect (P = 0.58). The pooled effect size (P = 0.001) showed a statistically significant difference, with the incidence of adverse events being 17.91% for infliximab and 12.12% for adalimumab.ConclusionOur systematic review and meta-analysis of 11 studies suggests that infliximab and adalimumab have similar therapeutic efficacy and corticosteroid-sparing effect in patients with NIU. However, adalimumab has a marginal advantage over infliximab in terms of adverse events. Large-scale RCTs with a longer follow-up are required to further evaluate these two anti-TNF-α agents in patients with NIU.

Transcriptome network analysis implicates CX3CR1-positive type 3 dendritic cells in non-infectious uveitis.

Type I interferons (IFNs) promote the expansion of subsets of CD1c+ conventional dendritic cells (CD1c+ DCs), but the molecular basis of CD1c+ DCs involvement in conditions not associated without elevated type I IFNs remains unclear. We analyzed CD1c+ DCs from two cohorts of non-infectious uveitis patients and healthy donors using RNA-sequencing followed by high-dimensional flow cytometry to characterize the CD1c+ DC populations. We report that the CD1c+ DCs pool from patients with non-infectious uveitis is skewed toward a gene module with the chemokine receptor CX3CR1 as the key hub gene. We confirmed these results in an independent case-control cohort and show that the disease-associated gene module is not mediated by type I IFNs. An analysis of peripheral blood using flow cytometry revealed that CX3CR1+ DC3s were diminished, whereas CX3CR1- DC3s were not. Stimulated CX3CR1+ DC3s secrete high levels of inflammatory cytokines, including TNF-alpha, and CX3CR1+ DC3 like cells can be detected in inflamed eyes of patients. These results show that CX3CR1+ DC3s are implicated in non-infectious uveitis and can secrete proinflammatory mediators implicated in its pathophysiology. The presented work is supported by UitZicht (project number #2014-4, #2019-10, and #2021-4). The funders had no role in the design, execution, interpretation, or writing of the study.

Dual-Energy X-Ray Absorptiometry Scan Utilization and Skeletal Fragility Among Non-Infectious Uveitis Patients Exposed to Oral Glucocorticoids

ABSTRACT Introduction Currently, little is known regarding bone health surveillance for glucocorticoid-exposed non-infectious uveitis (NIU) patients or their baseline risks of skeletal fragility outcomes. Methods Using claims data, we calculated rates of dual-energy x-ray absorptiometry (DXA) screening for glucocorticoid-exposed NIU and rheumatoid arthritis (RA) patients. Separately, we compared risks of skeletal fragility metrics amongst NIU patients, RA patients, and controls, independent of glucocorticoid use. Results The adjusted hazard ratio (aHR) of NIU patients to have a DXA scan was 0.64 (95% CI, 0.63–0.65; p < .001) compared to RA patients. The aHR for any skeletal fragility outcome amongst NIU patients was 0.97 (p < .02) compared to normal controls, while RA patients had excess risk (aHR, 1.15; p < .001). Conclusions NIU patients are 36% less likely to receive a DXA scan after high-dose glucocorticoid exposure compared with RA patients. No elevated risk of osteoporosis for NIU patients was found compared to normal controls.

Pattern of non-infectious uveitis and visual outcome in a tertiary care university-based hospital: A multidisciplinary approach

Aim of the workTo study the pattern of non-infectious uveitis (NIU) in different systemic autoimmune diseases and to determine the visual outcome and complications in relation to systemic immunomodulatory therapy. Patients and methodsThe study was conducted on 105 NIU patients with different autoimmune diseases: Behçet’s disease (BD), Vogt–Koyanagi–Harada (VKH), juvenile idiopathic arthritis (JIA), sarcoidosis, idiopathic uveitis and ankylosing spondylitis (AS). All patients were subjected to full ophthalmological examination. ResultsThe frequency of NIU was highest in BD (n = 61;58.1 %) followed by VKH (n = 24;22.9 %), JIA (n = 8;7.6 %), sarcoidosis (n = 7;6.7 %), idiopathic uveitis (n = 4;3.8 %) and AS(n = 1;1%) and their mean age at NIU onset was 30 ± 12 years. Panuveitis (PanU) was identified in 84 (80 %), anterior uveitis (AU) in 11(10.5 %), posterior uveitis (PU) in 9 (8.6 %) and intermediate uveitis (IU) in one (1 %) patient. A chronic recurrent course was detected in 98 (93.3 %) patients and bilateral involvement was present in 86 (81.9 %). Laterality of eye affection (unilateral or bilateral) was not related to eye activity or type of uveitis. The most common complication was cataract (17.1 %). A significant relation was found between the control of eye activity and immunosuppression intake in the last 6 months (p = 0.002). 38 (36.2 %) patients were considered legally blind. A non-significant relation was found between legal blindness with type of uveitis (p = 0.82), immunosuppressives(p = 0.06) or biological therapy (p = 0.35). ConclusionThe most common pattern of NIU in systemic autoimmune diseases was panuveitis. Behçet’s disease and VKH disease were the most frequent etiologies for NIU and cataract was the most common complication.

Differential Proteins Expression Distinguished Between Patients With Infectious and Noninfectious Uveitis

ABSTRACT Purpose We investigated the aqueous humor proteome and associated plasma proteome in patients with infectious or noninfectious uveitis. Methods AH and plasma were obtained from 28 patients with infectious uveitis (IU), 29 patients with noninfectious uveitis (NIU) and 35 healthy controls undergoing cataract surgery. The proteins profile was analyzed by SomaScan technology. Results We found 1844 and 2484 proteins up-regulated and 124 and 161 proteins down-regulated in the AH from IU and NIU groups, respectively. In the plasma, three proteins were up-regulated in NIU patients, and one and five proteins were down-regulated in the IU and NIU patients, respectively. The results of pathway enrichment analysis for both IU and NIU groups were related mostly to inflammatory and regulatory processes. Conclusion SomaScan was able to detect novel AH and plasma protein biomarkers in IU and NIU patients. Also, the unique proteins found in both AH and plasma suggest a protein signature that could distinguish between infectious and noninfectious uveitis.

The efficacy and safety of TNF inhibitor (golimumab) as salvage treatment in patients with refractory noninfectious uveitis.

Tumor necrosis factor inhibitor (TNFi) is recently reported to treat noninfectious uveitis (NIU) effectively. However, as a new kind of TNFi, golimumab is just on the market in China for several years, and its administration for NIU treatment lacks sufficient evidence. Therefore, the current study aimed to investigate the efficacy and safety of golimumab in refractory NIU patients. Thirty NIU patients with 49 affected eyes refractory to conventional treatments (corticosteroids and immunosuppressive agents) were consecutively enrolled. They received treatment of TNFi (50mg golimumab every 4weeks) for at least 6months. The anterior chamber cell grade, vitreous haziness grade, central macular thickness, and visual acuity were evaluated at baseline, month (M) 1, M3, and M6. After treatment, the anterior chamber cell grade declined from baseline (0.6 ± 0.7) to M6 (0.3 ± 0.5) (P < 0.001); the vitreous haziness grade decreased from baseline (1.2 ± 1.2) to M6 (0.4 ± 0.5) (P < 0.001); meanwhile, the central macular thickness also reduced from baseline (351.4 ± 90.8μm) to M6 (271.8 ± 54.4μm) (P < 0.001). In terms of visual acuity (LogMAR), it showed a declined trend from baseline (0.5 ± 0.3) to M6 (0.4 ± 0.2), but without statistical significance (P = 0.096). Subgroup analyses revealed that TNFi history related to decreased golimumab efficacy. In addition, 13.3% of patients had adverse events, including elevated liver enzymes (6.7%), fatigue (3.3%), and rash (3.3%). Golimumab is effective and safe for refractory NIU treatment, while a large-scale trial is still needed for verification.

Association between Immunosuppressive Drugs and Coronavirus Disease 2019 Outcomes in Patients with Noninfectious Uveitis in a Large US Claims Database

PurposeTo determine the dose-dependent risk of systemic corticosteroids (SCs) and the risk of other immunosuppressive therapies on coronavirus disease 2019 (COVID-19) infection, hospitalization, and death in patients with noninfectious uveitis (NIU).DesignA retrospective cohort study from January 20, 2020, to December 31, 2020 (an era before widespread COVID-19 vaccination), using the Optum Labs Data Warehouse, a US national de-identified claims database.ParticipantsPatients who had at least 1 NIU diagnosis from January 1, 2017.MethodsUnadjusted and adjusted hazard ratios (HRs) were estimated for each variable and COVID-19 outcome using Cox proportional hazards models, with time-updated dichotomous indicators for outpatient immunosuppressive medication exposure. To assess the dose-dependent effect of SC exposure, the average daily dose of prednisone over the exposed interval was included in the adjusted models as a continuous variable, in addition to the dichotomous variable.Main Outcome MeasuresIncidence rates of COVID-19 infection, COVID-19–related hospitalization, and COVID-19–related in-hospital death.ResultsThis study included 52 286 NIU patients of whom 12 000 (23.0%) were exposed to immunosuppressive medications during the risk period. In adjusted models, exposure to SCs was associated with increased risk of COVID-19 infection (HR, 2.66; 95% confidence interval [CI], 2.19–3.24; P < 0.001), hospitalization (HR, 3.26; 95% CI, 2.46–4.33; P < 0.001), and in-hospital death (HR, 1.99; 95% CI, 0.93–4.27; P = 0.08). Furthermore, incremental increases in the dosage of SCs were associated with a greater risk for these outcomes. Although tumor necrosis factor-α (TNF-α) inhibitors were associated with an increased risk of infection (HR, 1.48; 95% CI, 1.08–2.04; P = 0.02), other immunosuppressive treatments did not increase the risk of COVID-19 infection, hospitalization, or death.ConclusionsThis study from an era before widespread COVID-19 vaccination demonstrates that outpatient SC exposure is associated with greater risk of COVID-19 infection and severe outcomes in patients with NIU. Future studies should evaluate the impact of immunosuppression in vaccinated NIU patients. Limiting exposure to SCs and use of alternative therapies may be warranted.

Intraocular Pressure Elevation After Posterior Subtenon Triamcinolone Acetonide Injection in Pediatric Non-Infectious Uveitis.

The objectives of the study were to evaluate non-infectious pediatric uveitis patients developing elevated intraocular pressure (IOP) and glaucoma following posterior subtenon triamcinolone acetonide (PSTA) injection. The data of 26 pediatric (<18 years) patients with active uveitis were retrospectively evaluated. Exclusion criteria were patients with a previous IOP >21 mmHg and previous subtenon or intraocular steroid injection. The IOP values of the patients before and after the PSTA injection and the treatments administered were recorded. PSTA injection was used in a total of 40 eyes. The mean IOP was 14.0±2.3 (12-19) mmHg before PSTA. The IOP was elevated (≥21 mmHg) in 19 eyes (48%) after PSTA with a mean IOP of 32.9±11.7 mmHg (22-55). The mean interval time to IOP elevation was 3.3±1.9 weeks (1-8). The IOP was controlled in 15 eyes (79%) with topical anti-glaucomatous and these patients were considered as having transient IOP elevation. Trabeculectomy with mitomycin C was required in 4 eyes (21%) in whom the IOP could not be controlled despite the use of maximum topical medication and oral acetazolamide at a mean duration of 9.7±3.6 months (4-19). Subtenon deposit excision was performed in 2 eyes (11%). The mean IOP at the last follow-up was 16.0±2.4 mmHg (12-20). In our study, an IOP elevation rate as high as 47% was found in pediatric non-infectious uveitis patients following only a single PSTA injection. Steroid-induced IOP elevation and resistant glaucoma can develop even after the first PSTA administration in pediatric uveitis. Filtration surgery and the excision of subtenon triamcinolone deposits, when present, are important in glaucoma management. The risk/benefit ratio must be carefully considered when administering steroid injections to children with uveitis.

Follow-up Findings of Non-infectious Pediatric Uveitis Patients.

Objectives:In this study, we aimed to describe the demographic and clinical findings of children with uveitis at a tertiary pediatric rheumatology and ophthalmology center.Materials and Methods:A retrospective cross-sectional study was conducted with 46 patients who were diagnosed with uveitis before the age of 16 years and were followed regularly for at least 6 months between January 2013 and June 2019. Demographic data, uveitis characteristics, underlying diseases, systemic treatment modalities, drug side effects, complications, and surgical intervention were evaluated.Results:Eighty-three eyes of 46 patients were included in the study. The mean age at diagnosis of uveitis was 9.2±4.5 (1.6-15.6) years, and the mean uveitis follow-up period was 54±41 (6-191) months. Twenty-one patients (45.7%) had uveitis associated with rheumatologic diseases. Juvenile idiopathic arthritis was the most common disease (23.9%). Visual acuity was categorized as moderately impaired in 6 eyes (7.2%), severely impaired in 4 eyes (4.8%), and blindness in 1 eye (1.2%). Methotrexate (87%) was the most frequently used systemic immunosuppressive agent in treatment. Adalimumab (73.9%) was added to treatment in resistant cases. Thirtyfive patients (76.1%) had complications in at least 1 eye secondary to uveitis or uveitis treatment. Posterior synechiae (11 eyes, 13.2%) was the most common complication during treatment.Conclusion:In order to preserve visual acuity, pediatric uveitis should be recognized early and especially persistent/chronic cases should be started on effective systemic treatment immediately.

Efficacy and Safety of Adalimumab in Noninfectious Uveitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Patients with noninfectious uveitis (NIU) are at risk of systemic side effects of long-term glucocorticoid therapy and uncontrolled inflammatory complications. In urgent need to identify more aggressive therapies, adalimumab (ADA) may be the right choice. Objectives: To summarize the current evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of ADA in the treatment of NIU. Methods: We searched Pubmed, Embase, Web of Science, Cochrane Library databases, and Clinical Trials Registry for qualifying articles from their inception to November 19, 2020, with no language restriction. Randomized controlled trials comparing ADA with conventional routine treatment in noninfectious uveitis patients of any age, gender, or ethnicity were included. The primary outcome was the time to treatment failure (TF). The secondary outcomes were the change in best-corrected visual acuity (BCVA), change in the anterior chamber (AC) cell grade, change in vitreous haze (VH) grade, and adverse events (AEs). Main results: The six studies comprised 605 participants in all, and the sample size of each study ranged from 16 to 225. The overall pooled results of the primary outcome (HR = 0.51; 95% CI, 0.41 to –0.63) showed that ADA nearly halved the risk of treatment failure compared to placebo for NIU patients. The pooled mean difference of change in BCVA was -0.05 (95% CI, −0.07 to −0.02). The pooled mean difference of change in AC cell grade and VH grade was −0.29 (95% CI, −0.62 to −0.05) and −0.21 (95% CI, −0.32 to −0.11), respectively. The incidence of AEs in the ADA group was numerically higher than that of AEs in the placebo group (2,237 events and 9.40 events per patient-year, equivalent to 1,257 events and 7.79 events per patient-year). Conclusion: This meta-analysis of six RCTs further confirmed that ADA considerably lowered the risk of treatment failure or visual loss, and moderately reduced AC cell grades and VH grades with slightly more AEs, as compared to placebo. ADA is both effective and safe in treating NIU. Systematic Review Registration: [https://clinicaltrials.gov], identifier [CRD42020217909].

Comparison of pediatric patients with noninfectious idiopathic uveitis and noninfectious uveitis associated with an underlying systemic disease: from a referral center in Turkey

ABSTRACT Aim: The aim of this study was to determine the demographic, clinical, treatment, and outcome features of pediatric noninfectious uveitis patients at a Turkish tertiary center. Materials and methods: This retrospective cohort study included 101 pediatric patients with noninfectious uveitis. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow-up, associated systemic diseases, laboratory findings, medications used, and status of uveitis at the time of data collection were obtained from the patients’ files. The patients were divided into two groups according to etiology of uveitis, as follows; group 1: idiopathic noninfectious uveitis; group 2: noninfectious uveitis in association with an underlying systemic disease. Clinical findings were compared between the two groups. Results: Mean age at diagnosis of uveitis was 9.36 ± 4.24 years and mean duration of follow-up was 48.4 ± 9.2 months. Anterior uveitis was the most common form, accounting for 69.3% (n = 70) of the patients. There were 67 (66.3%) patients in group 1 and 34 (33.7%) patients in group 2. Mean age at diagnosis of uveitis was lower in group 2 (p < 0.05). Although gender, type of inflammation, laterality of eye involvement, and mean age at initiation of biological treatment did not differ between the groups; symptomatic uveitis was more common in group 1, whereas anterior uveitis was also more common in group 2 (p < 0.05). At the time of data collection 16 (15.8%) of the patients had active uveitis. Ocular complications were observed fewer in idiopathic noninfectious uveitis group than noninfectious uveitis associated with an underlying systemic disease (p < 0.05). Biological therapy was administered in 26.8% of the patients in group 1, versus 67.6% of those in group 2. Ocular complications were observed in 22.8% of the patients at presentation or during the follow-up. Conclusion: Herein a large retrospective cohort of noninfectious pediatric uveitis has been described. The findings indicate that noninfectious idiopathic uveitis is characterized by more symptomatic, later onset, and fewer complications than noninfectious uveitis associated with an underlying systemic disease.

Contemporaneous Risk Factors for Visual Acuity in Non-Infectious Uveitis

ABSTRACT Introduction We evaluated the associations of clinical and demographic characteristics with visual acuity (VA) with over 5 years in a subspecialty noninfectious uveitis population. Methods Retrospective data from 5,530 noninfectious uveitis patients were abstracted by expert reviewers, and contemporaneous associations of VA with demographic and clinical factors were modeled. Results Patients were a median of 41 years old, 65% female, and 73% white. Eyes diagnosed ≥5 years prior to cohort entry had worse VA (−1.2 lines) than those diagnosed <6 months prior, and eyes with cataract surgery performed prior to entry had worse VA (−5.9 lines) than those performed during follow-up. Vitreous haze (−4.2 lines for 3+ vs quiet), hypotony (−2.5 lines for ≤5 mm Hg vs 6–23 mm Hg), and CNV (−1.8 lines) all were strongly associated with reduced VA. Conclusion Factors associated with reduced VA included well-known structural complications, and lack of subspecialty care during cataract surgery.

Antiphospholipid antibodies may be associated with uveitis.

To evaluate the prevalence of a spectrum of autoantibodies in adult patients with non-infectious uveitis compared to healthy controls. This is a case-control study conducted in a tertiary referral center. Serum positivity to auto-antibodies directed at membranous phospholipids (aPL), nuclear antigens, and cytoplasmic (ANCA) antigens were assessed in sera from 63 non-infectious uveitis patients, and 78 healthy controls. Uveitis patients' demographic and clinical data were collected retrospectively from their medical charts. Of the spectrum of antibodies evaluated only aPL were linked with uveitis (OR 11.2, CI 1.4-92.1), as 13 (20.6%) uveitis patients were positive to at least one of the screened aPL, namely either anti-cardiolipin (aCL), anti-β2-glycoprotein (aβ2GPI), or anti-phosphatidylserine/prothrombin (aPS/PT). aCL antibodies were detected in 5/63 (7.9%) of uveitis patients and in none of controls (p = 0.016). Positivity to either aCL or aβ2GPI was noted in 8/63 (12.7%) of uveitis patients and in 1 (1.3%) of the controls (p = 0.011). Of the 13 uveitis patients positive to any of the aPL antibodies, 8 (62%) had exclusively anterior uveitis, 9 (69%) were idiopathic, and none had evidence of posterior vaso-occlusive involvement or systemic thrombotic manifestations. An association between aPL and uveitis among an unselected population of patients with no evidence of thrombosis or presence of the antiphospholipid syndrome was documented in this study. This link was observed, alike the general population of uveitis patients, mainly in patients with anterior eye inflammation. A possible interaction between aPL and uveitis, mediated by non-thrombotic mechanisms, requires further studies.

SAT0522 PROGRESSION OF VISION-RELATED QUALITY OF LIFE AND IDENTIFICATION OF RISK FACTORS IN NON-INFECTIOUS UVEITIS PATIENTS

Background:Uveitis are characterized by inflammation of the middle layer of the eye wall. In developed countries uveitis are the second major treatable cause of blindness in those 20–65 years of age. Additionally, more than 50% of the subjects affected with these conditions will develop complications related to the uveitis, and more than 30% will suffer visual impairment. As a result, these conditions are associated with an important burden. The assessment of the patient’s quality of life (QoL) through standardized and validated questionnaires allows us to evaluate objectively the burden of the disease. Several studies have shown that the QoL of uveitis patients is reduced when compared with that of general population. Moreover, several socio-demographic and clinical related characteristics have been associated with impaired QoL. However, no longitudinal analysis of the vision-related (VR) QoL in clinical practice has been carried out.Objectives:To describe VR-QoL in non-infectious uveitis (NIU) patients during a follow-up period of two years. Furthermore, to analyse the influence of socio-demographic, clinical and treatment factors on the progression of VR-QoL.Methods:Longitudinal prospective study which includes patients examined in a multidisciplinary tertiary uveitis clinic, with a diagnosis of NIU. In each of these patients a yearly determination of VR-QoL was carried out following the VFQ-25 questionnaire, finally including all those who had completed at least an initial questionnaire and a second one after two years of follow-up. Analysis of risk factors at baseline in repeated VFQ-25 measurements was carried out by generalized estimating equations (GEE) models. Variables related to demographic, clinical and treatment factors with a determination of p-value &lt;0.15 were included in multivariable models, which were then compared using theQuasi Akaike Information Criteria(qAIC). A local Ethics Committee approved the execution of this project.Results:128 patients were included, 117 of which also had an evaluation after the first year of follow-up. 55.5% were female with a median age of 34 years at the start of symptoms and of 37 years at the moment of attending our clinic for the first time. First evaluation of VR-QoL was determined a median (p25-p75) of 6.1 (1.8-13.1) years after that first visit. The most frequent locations of NIU were anterior (41.1%), panuveitis (27.4%), posterior (16.1%) and intermediate (15.3%). At our first evaluation, 27.3% of patients were receiving treatment with topical steroids, 22.3% oral, 49.2% immunosuppressant drugs (both synthetic and/or biological) and 19.05% biological therapies. The median (p25-p75) VFG25 determinations at baseline, first and second years of follow-up were 0.87 (0.78-0.93), 0.88 (0.80-0.93) y 0.89 (0.81-0.94), with no significant differences (first year vs. Baseline p = 0.54; 2 years vs. Baseline p = 0.61).In the GEE multivariable models the presence at baseline of permanent incapacity due to NIU, concomitant thyroid disease, worse visual acuity, unilateral pattern, cataracts, retinal vasculitis, epiretinal membrane and use of azathioprine were independently associated with a worse VR-QoL (Table 1).Table 1.Risk factors related to VR-QoL in patients with NIUVariablesCoef. (IC 95%)p-valueVisual acuity23.6 (12.3 - 34.8)&lt;0.01Permanent incapacity-24.8 (-33.7 - -15.9)&lt;0.01Unilateral NIU-2.9 (-5.7 - -0.006)0.05Cataracts-5.2 (-10 - -0.3)0.037Vasculitis-13.3 (-23.4 - -3.1)0.011Epiretinal membrane-6.8 (-12.7 - -0.8)0.026Azathioprine-7.5 (-14.7 - -0.3)0.041Conclusion:During these two years of follow-up, no significant changes have taken place regarding VR-QoL in patients with NIU assessed at a tertiary centre. Other than visual acuity at baseline, certain ocular manifestations and clinical comorbidities have also been shown to have an independent effect on the VR-QoL of these patients.Disclosure of Interests:None declared