Onset Of Uveitis Research Articles

Evaluation of changes in choroidal vascularity during acute anterior uveitis attack in patients with ankylosing spondylitis by using binarization of EDI-optical coherence tomography images.

To evaluate the effect of the first acute anterior uveitis (AAU) attack on the choroid by using an image binarization tool on images from enhanced depth imaging (EDI)-optical coherence tomography (OCT) scans in patients with ankylosing spondylitis (AS). In this study, three groups were formed: uveitic eyes (UE; n = 20) of patients with AS, the non-uveitic eyes (NUE; n = 20) of these patients, and the eyes of healthy controls (n = 20). EDI-OCT images were obtained during the first AAU attack and at three months after treatment in patients with AS. An image binarization tool (ImageJ software; Bethesda, MD USA) was used on EDI-OCT images to determine choroidal structures. Choroidal vascularity index (CVI) was defined as the ratio of luminal area to total subfoveal choroidal area. Compared to the convalescent period, CVI was found to be significantly increased in UE (63.2 ± 2.87 vs. 60.9 ± 5.2 %, p = 0.045) and NUE (63.8 ± 5.67 vs. 61.5 ± 4.3 %, p = 0.039), while stromal area (SA) was found to be significantly reduced only in UE (0.487 ± 0.19 vs. 0.569 ± 0.18, p = 0.012) in the attack period. Changes in the CVI values of UE and NUE groups in the first AAU attack shows that there is underlying choroidal inflammation in patients with AS. It also seems that SA is the most affected choroidal structure in eyes suffering from an attack. The present study revealed that CVI measurements can be used for follow-up and the determination of treatment response in AS patients with AAU attack.

Quantitative measurements with optical coherence tomography angiography in Behçet uveitis.

The aim of this study was to evaluate the quantitative measurements obtained by optical coherence tomography angiography in patients with Behçet uveitis. A total of 22 consecutive patients with Behçet uveitis and 19 age-matched healthy individuals were included in the study. Quantitative analysis of optical coherence tomography angiography images was performed. Comparisons between the patients and the control groups and correlation analysis between optical coherence tomography angiography results and age, visual acuity, duration of uveitis, central macular thickness, and fluorescein angiography scores in the patient group was performed. The mean superficial foveal avascular zone area was 283.040 ± 113.003 µm2 in the patient group and 254.268 ± 75.813 µm2 in the control group (p = 0.821). The mean deep foveal avascular zone area was 317.657 ± 116.225 µm2 in the patient group and 332.954 ± 94.783 µm2 in the control group (p = 0.775). The foveal avascular zone area could not be calculated in eight eyes with macular atrophy in the patient group because of unclear foveal avascular zone borders. Both superficial and deep capillary vessel density in all regions were lower in the patient group than in the control. Superior, inferior, and temporal capillary vessel density were correlated with fluorescein angiography score (Pearson's r = -0.380, 0.392, and -0.384, p < 0.05 in superficial plexus; r= -0.357, -0.401, and -0.321, p < 0.05 in deep plexus, respectively). The foveal avascular zone area was correlated with central macular thickness in both superficial and deep plexus (r= -0.387 and -0.331, p < 0.05, respectively). Recurrent uveitis attacks affecting the macula are associated with a decrease in capillary vessel density and expansion in the foveal avascular zone area in Behçet disease. The qualitative evaluation of the optical coherence tomography angiography findings may be more valuable in patients with macular atrophy.

Importance of pediatric rheumatologists and transitional care for juvenile idiopathic arthritis-associated uveitis: a retrospective series of 9 cases

BackgroundJuvenile idiopathic arthritis-associated uveitis (JIA-U) is a serious condition associated with the risk of blindness. However, pediatric rheumatologists rarely encounter cases of blindness, because most patients reach adulthood during the course of follow-up before blindness occurs. Here, we report the progress of 9 patients with JIA-U, including 2 patients who became blind after the transition period. We aimed to highlight the importance of the role of pediatric rheumatologists and transitional care in preventing blindness associated with JIA-U.Case presentationWe conducted a retrospective analysis of the case records of 9 JIA-U patients (1 male, 8 female; median age 16.8 years, range 5.5–19.8 years). All patients presented with oligo-juvenile idiopathic arthritis (oligo-JIA) (one presented with extended oligo-JIA); the median age of uveitis onset was 5.0 years (range 3.0–13.0 years), and the onset of uveitis preceded the onset of arthritis in 2 patients. The median disease duration was 12.5 years (range 3.5–24.7 years); 4 patients had anti-nuclear antibody (ANA) positivity (≧1:160) (all with a homogeneous and speckled-pattern subtype). All patients were negative for rheumatoid factor. Eight patients received methotrexate, 7 patients received one or more biologic drugs (etanercept, infliximab, adalimumab, and golimumab), and 6 patients required ophthalmic surgery at an early age (≦ 18 years).Two patients developed blindness after the transition period. Medical examination by pediatric rheumatologists and use of biologics had been delayed in both patients. One patient developed depression after transition and interrupted her own treatment.ConclusionsThe reason for blindness in the 2 patients was thought to be the delay in the commencement of treatment and failure to provide transitional care. Inflammation is difficult to control in JIA-U even with appropriate treatment. Pediatric rheumatologists must be informed about the risk of JIA-U blindness, especially after transition. To ensure a good prognosis, the specialized treatment with the involvement of pediatric rheumatologists is necessary early on, and consideration for transitional medicine is essential. Therefore, this report reaffirms the importance of planned transitional care that has been advocated for globally.

Electroretinogram abnormalities in non-infectious uveitis often persist.

PurposeIn uveitis, a prolonged implicit time of the cone b‐wave is a characteristic electroretinogram (ERG) abnormality. We investigated whether this can improve or deteriorate over time and which clinical factors are associated with change.MethodsProspective cohort study. Patients with a non‐infectious uveitis were included. An ERG was measured in the first year of uveitis onset and a follow‐up ERG one year later. Changes in the implicit time of the cone b‐wave were investigated in relation to clinical parameters including the following: demographics, uveitis characteristics, treatment, best‐corrected visual acuity, optical coherence tomography parameters and fluorescein angiography scores.ResultsOf 98 eyes (63 patients), 40 showed a prolonged cone b‐wave on the first ERG, which improved in 10 eyes. Eyes with an improved ERG more often had a panuveitis with initially a higher incidence of cells in the anterior chamber during the first ERG, which resolved at the time of their follow‐up ERG. Five of the 58 eyes with a normal first ERG had a deteriorated follow‐up ERG. These eyes had more frequently an active uveitis at the time of the follow‐up ERG. Of the 78 eyes with a stable cone b‐wave, 16 had a quiescent inflammation during follow‐up. There were no differences in age or treatment.ConclusionIn most patients with non‐infectious uveitis, ERG abnormalities appear to be irreversible, even when the inflammation becomes quiescent. However, some ERGs improved, which was associated with reduction in inflammation of the anterior chamber due to panuveitis. In contrast, a worsened ERG was associated with a persistence of inflammation.

Prevalence and clinical features of systemic diseases in Chinese patients with uveitis

PurposeSystemic diseases are frequently associated with uveitis but are often not recognised by clinicians. An estimate of the prevalence in a large-scale uveitis population is essential for understanding the epidemiological...

Enthesitis-related Arthritis: Prevalence and Complications of Associated Uveitis in Children and Adolescents From a Population-based Nationwide Study in Germany

Enthesitis-related arthritis (ERA) represents a subgroup of juvenile idiopathic arthritis (JIA) that is regularly accompanied by anterior uveitis. This study describes the prevalence and characteristics of ERA-related uveitis. Cross-sectional data from the National Pediatric Rheumatological Database (NPRD) were used to characterize ERA-related uveitis (ERA-U). In addition to sociodemographic variables, we documented the occurrence of uveitis and course of disease, including symptoms, visual acuity, and complications, as well as JIA characteristics such as disease activity (Juvenile Arthritis Disease Activity Score 10), functional ability (Childhood Health Assessment Questionnaire score), laboratory variables, and treatment. In the years from 2002 to 2014, there were 3778 (15.2%) of a total of 24,841 JIA patients recorded in the NPRD who had ERA, and 280 (7.4%) of them had developed uveitis. Detailed ophthalmological documentation by a uveitis add-on module was available for 22.9% of these patients. Uveitis onset was acutely symptomatic in 63% of patients. Patients with uveitis were more frequently male, HLA-B27-positive, younger at ERA onset, and they had higher erythrocyte sedimentation rate values at first uveitis documentation than those without uveitis. Uveitis was diagnosed at a mean age of 11.5 (± 3.9) years (50% within 2 years after ERA onset). Systemic treatment with corticosteroids and synthetic and biologic disease-modifying antirheumatic drugs was associated with a (not significantly) lower risk of developing uveitis. The course of disease in ERA-U patients is frequently similar to HLA-B27-associated uveitis in adults; however, a subgroup of patients presents with asymptomatic uveitis.

Clinical features of patients with Behcet's uveitis

Objective: To characterize the clinical features of patients with Behcet's uveitis. Methods: Retrospective case series study. Medical records of patients who were diagnosed as Behcet's uveitis in Peking Union Medical College Hospital between January 1998 and November 2015 were retrospectively reviewed. Information about the clinical manifestation, complication, best corrected visual acuity (logarithm of the minimum angle of resolution) and medication was collected. The correlation of visual acuity and the disease course, as well as inflammation relapse times before and after biological agents applied was analyzed. Chi square test and Wilcoxon signed-rank test were applied for statistical analysis. Results: A total of 132 patients (233 eyes) with Behcet's uveitis were included, among which 104 (78.8%) were male and 28 (21.2%) were female, with statistically significant difference (χ(2)=43.76, P<0.01). The average age at the onset of uveitis was (28.9±8.7) years, with most patients at 21-40 years (102 cases, 77.3%). Oral aphthae (132 cases, 100.0%) were the most frequent extraocular manifestations, followed by dermatologic lesions (103 cases, 78.0%), genital ulcers (90 cases, 68.2%), arthritis (44 cases, 33.3%) and positive pathergy test (39 cases, 29.5%). Ocular involvement was bilateral in 76.5% (101 cases) of the patients, and panuveitis was the most common type (110 cases, 83.3%). Complications were seen in 80.7% (188/233) of the eyes, with cataract (58.8%, 137/233) and macular edema (59.1%, 114/193) being the most common anterior and posterior segment complications, respectively. At the eighth year of uveitis, best corrected visual acuity decreased to less than 0.3 in 20.9% (9/43) of the eyes, and more than 1.0 in 39.5% (17/43) of the eyes. A combination of glucocorticoids and immune modulators remained the first line therapy (97.0%, 128/132) for Behcet's uveitis. For 16 refractory cases, an addition of biological agents significantly reduced the inflammation relapse [0.5 (0.0, 1.5) times per year vs. 4.0 (1.0, 5.5) times per year, Z=-2.81, P=0.005]. Conclusions: Behcet's uveitis mainly affects working-age males and manifests as bilateral panuveitis. Complications are commonly seen in uveitic eyes. Patients' visual acuity is significantly impaired. A combination of glucocorticoids and immune modulators is effective for most patients, but for refractory cases, an addition of biological agents provides better effects. (Chin J Ophthalmol, 2020, 56: 217-223).

Can the CRP/albumin Ratio be Used as a New Indicator of Activation in Patients with Uveitis?

ABSTRACT Purpose: To evaluate whether the C-reactive protein (CRP)/albumin ratio (CAR) in patients with uveitis during an attack is a marker that can give information about the activity, severity and prognosis of the disease. Methods: This study included 35 patients with an uveitis attack and 35 healthy volunteers. The localization and severity of uveitis were recorded. Patients’ complete blood count (CBC) during the attack, CRP, CAR, erythrocyte sedimentation rate(ESR), neutrophil/lymphocyte ratio(NLR), and platelet/lymphocyte ratio(PLR) were recorded. Results: The mean age was 34.1 ± 12.5 years for the 35 uveitis cases and 30.1 ± 4.1 years for the healthy volunteers. CRP and CAR were significantly higher in uveitis patients (p = .015 and 0.011, respectively). While CRP and CAR were significantly higher in severe anterior uveitis than mild anterior uveitis (p = .036 and 0.022, respectively), only CAR was significantly higher in severe posterior and panuveitis than mild ones(p = .017). Conclusion: CAR may be an important parameter in determining the activation of the uveitis.

Anterior segment parameters in Behçet's patients with ocular involvement.

To evaluate anterior segment findings in Behçet's disease patients within the ocular involvement inactive period. One hundred twenty patients with Behçet uveitis in the inactive period (Behçet's disease group) and 121-age and sex matched healthy subjects (control group) were examined. Anterior segment parameters were assessed by Scheimpflug camera. In Behçet's disease group, the mean age was 39.89 ± 10.16years, and 55.8% of patients were male; in the control group, the mean age was 38.69 ± 14.08years, and 56.2% of control subjects were male. Pachymetric measurements of corneal apex (523.84 ± 30.36µ vs 540.73 ± 27.85µ, p < 0.001) thinnest point (518.70 ± 30.75µ vs 537 ± 28.66µ, p < 0.001), mean corneal volume (57.90 ± 3.39mm3 vs 59.57 ± 3.37mm3, p < 0.001) were significantly lower and anterior elevation [5.0 (1.0-34.0) vs 2.0 (1.0-7.0) diopter(D), p < 0.001], posterior elevation [11.0 (1.0-66.0) vs 4.0 (0-22.0) D, p < 0.001)] and corneal astigmatism [1.1 (0-7.1) vs 0.7 (0.1-5.7) D, p = 0.005] were significantly higher in the Behçet's disease group than in control group. No significant difference was found in other anterior segment parameters between the Behçet's disease group and control group. Concurrent keratoconus was detected in two cases (1.7%). A statistically significant correlation was found between the corneal measurements and frequency of uveitis attacks. The chronic inflammatory process associated with various proinflammatory cytokines, which play a role in the pathogenesis of keratoconus, may also contribute to a decrease in corneal thickness and corneal volume in Behçet's patients with ocular involvement.

Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

ABSTRACT Purpose: To describe the results of tocilizumab treatment in children with refractory non-anterior uveitis. Methods: A case series of seven children with refractory non-anterior uveitis (onset ≤16 years) with leakage on fluorescein angiogram (FA) were treated with tocilizumab intravenously every 4 weeks (eight mg/kg). Minimum follow-up was 6 months. Reported outcomes are changes in BCVA, central macular thickness (CMT) on OCT image, FA scores, dose of systemic steroids, complications and side effects. Results: In all patients, there was an improvement of macular edema and capillary leakage on FA. The median FA score decreased from 14 (10–18) at baseline to 8 (2–9) after 6 months of treatment (p = .018). The CMT decreased from 321 (314–384) to 295 (255–312) (p = .043). BCVA improved in five eyes and worsened in one eye due to cataract. No systemic or ocular complications were reported. Conclusion: Tocilizumab is an effective therapeutic option for reducing disease activity in children with refractory non-anterior uveitis.

Behçet Üveitinde İnterferon-Alfa-2a Tedavisi Sonuçları

Objective: To evaluate the efficacy and safety of interferon-alpha-2a (IFNα-2a) therapy in patients with Behçet uveitis. Material and Methods: The patients who were treated with IFNα-2a therapy due to Behçet uveitis refractory to conventional immunosuppressive therapies were evaluated retrospectively. The visual acuities, activity of ocular inflammation were recorded at each visit during the follow-up and ocular and systemic side effects were also monitored. The paired sample t-test was used in comparison of pre- and postIFNα-2a visual acuity values. Results: Twenty-five patients (23 males and 2 females) with refractory Behçet uveitis were included in this study. The average patient age at the time of diagnosis was 28.96±7.56 years. The mean follow-up period after the initiation of IFNα-2a therapy was 18.16±12.12 months. The mean best corrected visual acuity (BCVA) at the last visit before IFNα-2a therapy was 0.48±0.32 in the right eye and 0.44±0.38 in the left eye. At the end of follow-up, the mean BCVA was 0,61 ± 0.36 in the right and 0.60 ± 0.38 in the left, which improved with IFNα-2a therapy in both eyes (p=0.010, p=0.003; respectively). The mean number of uveitis attacks per year was 2.74±0.96 before the IFNα-2a therapy. During the IFNα-2a therapy period, mean 1.17 uveitis attacks per year were observed in 6 patients. The complete or partial remission was achieved in 22 (88%) patients with IFNα-2a treatment. The IFNα-2a therapy was discontinued due to complete remission in 5 (20%) patients during follow-up. In 3 patients (treatment failure in 2 and progressive weight loss in 1), switch to anti-tumor necrosis factor was recommended. Conclusion: Interferon alpha-2a treatment is an effective and safe treatment option in Turkish population with Behçet uveitis refractory to conventional immunosuppressive therapies.

Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis

BackgroundRefractory non-infectious uveitis is a serious condition that leads to ocular complications and vision loss and requires effective systemic treatment to control disease. The effectiveness of long-term infliximab [IFX] in refractory non-infectious childhood uveitis and the impact of treatment adherence on disease control were evaluated.MethodsRetrospective, single-center study between December 2002 and April 2016 of 27 children with refractory non-infectious uveitis [17 with juvenile idiopathic arthritis, JIA] treated with long-term IFX [9+ months]. Disease activity was assessed prior to and while on IFX using the Standardization of Uveitis Nomenclature [SUN]. Number of visits per year with active uveitis was analyzed by repeated measures logistic regression analysis from 2 years prior to IFX initiation or from onset of uveitis until most recent visit on IFX. Incomplete treatment adherence was assessed for each visit and defined as any deviance in corticosteroid use, prescribed infusion frequency, and/or follow-up examination frequency.ResultsPrimary outcomes were sustained uveitic and systemic disease control prior to and during IFX treatment and the impact of incomplete adherence on uveitic disease control while on IFX. Secondary outcomes included corticosteroid and glaucoma medication requirement, ocular complications and need for surgical intervention. Mean age at IFX initiation was 10.4 ± 4.5 years; initial mean dose was 6.6 ± 2.2 mg/kg [and given at weeks 0, 2, 4 and q4 weeks thereafter for 93%]. Median duration on IFX was 35 [range 9–128] months. Prior to IFX, 14/27 patients had failed adalimumab ± methotrexate [MTX]; 21/27 failed MTX. IFX led to uveitis control in 89% and arthritis control in 76% (13/17). The odds ratio of having controlled disease after IFX was 4.1 (2.6, 6.4) compared to pre-treatment visits. Topical corticosteroids and glaucoma medications were statistically decreased (p = 0.007 right eye [OD], 0.003 left eye [OS] and p = 0.001 OD, p = 0.028 OS respectively). Incomplete adherence to treatment showed 10.3 times greater odds (7.1, 15.0) of having disease activity than full adherence.ConclusionsThis study adds significantly to the IFX literature by documenting outstanding uveitis control with long-term IFX treatment in non-infectious pediatric uveitis patients. Higher dosage and shorter interval were utilized without adverse effects. Importantly, this is the first study, to our knowledge, to document the significant impact of treatment adherence on uveitis control.

Earlier use of systemic immunosuppression is associated with fewer ophthalmic surgeries in paediatric non-infectious uveitis

Background/aimsThere is a paucity of large trials investigating the effect of management strategies for paediatric non-infectious uveitis on complications requiring surgery. The purpose of our study is to investigate whether...

Identification of Underlying Inflammation in Vogt–Koyanagi–Harada Disease with Sunset Glow Fundus by Multiple Analyses

Purpose To evaluate underlying subclinical ocular inflammation in Vogt–Koyanagi–Harada (VKH) disease with sunset glow fundus (SGF) by multiple analyses. Study Design Retrospective observational study. Methods Clinical records of 34 eyes of 17 VKH patients with SGF in whom laser flare photometry (LFP), enhanced depth imaging optical coherence tomography (EDI-OCT), and indocyanine green angiography (ICGA) were performed on the same day were reviewed. The mean age was 57.3 ± 16.3 years, and the mean duration from the initial onset of uveitis was 47.1 ± 22.1 months. Flare counts, ICGA scores, and subfoveal choroidal thickness (SFCT) were compared between eyes. Results Although clinical ocular inflammation was observed only in 4 eyes (11.8%), inflammatory signs were observed in 23 out of 34 eyes by LFP (67.6%), in 27 eyes by ICGA (79.4%), and in 10 eyes by SFCT (29.4%). Active inflammatory signs detected by ICGA were observed in 77.8% by LFP and in 25.9% by SFCT. The strength of agreement (Cohen's kappa coefficient) between positive ICGA score and positive flare score was 0.406 (95% CI: 0.076–0.7359, P < 0.01), but there was no association between positive ICGA score and increased SFCT. In addition, positive flare count was the significant prognostic factor of positive ICGA score with odds ratio 11.7. Conclusions Subclinical ocular inflammation signs were detected in most VKH patients with SGF by ICGA and a substantial proportion of which were also detected by LFP, whereas SFCT was less sensitive to detect subclinical inflammation.

Frequency of uveitis and its associations with HLA B27 in ankylosing spondylitis patients

Aim: To investigate the prevalence of uveitis in ankylosing spondylitis (AS) patients and its relationship with HLA B27. Methods: The data of 95 patients with AS who admitted to Tokat Gaziosmanpasa University Internal Medicine and Rehabilitation Outpatient Clinics between 2010 and 2019 were analyzed retrospectively. Demographic characteristics, HLA B27 positivity and detailed eye consultation notes of the patients were recorded. Results: Of the 95 patients, 65 (68%) were male and 30 (32%) were female. The mean age of the patients was 38.3 ± 11.6 years. The HLA B27 results of 10 patients could not be reached. 22% of the patients had at least one episode of uveitis attack. While 82% (70/85) of patients had HLA B27 positivity, this rate was 86% in (18/21) patients with uveitis. Conclusion: Uveitis is a disease that can cause permanent loss of vision. In our study, no significant difference was found between the presence of uveitis and the presence of HLA B27 in patients with AS and this finding needs to be supported by randomized studies.

P30 Extra-ocular manifestations of children with sarcoid-like uveitis

Abstract Background Paediatric sarcoidosis represents a spectrum of disease. Early onset sarcoidosis &amp; Blau syndrome associated with NOD2 mutations are characterized by fever, rash, arthritis &amp; organomegaly. Later onset sarcoidosis has wider organ involvement (lungs, kidneys, lachrymal &amp; extra-ocular glands). Both presentations may lead to long term complications due to end-stage organ damage. Ocular sarcoidosis has a well described uveitis phenotype. We aim to describe a retrospective cohort of children with sarcoid-like uveitis &amp; their systemic manifestations at time of study; compare cohort of patients fulfilling IWOS criteria for ocular sarcoidosis versus who did not; and describe their management in retrospective cohort. Methods We performed a retrospective case review of all children currently followed at GOSH with ocular sarcoidosis phenotype with uveitis (ophthalmologist definition based on IWOS, or diagnosis of idiopathic uveitis with raised ACE level at least once. We collected demographics &amp; all extra-ocular involvement described in sarcoidosis. Results n = 52; 27/52 males. Median age at onset of uveitis 4.20 years (1.41-15.16). 49/52 bilateral uveitis. 27/52 (50%) &lt;8years age at onset &amp; 2/6 NOD 2 + belonged to this group. Median ACE 68 U/L at presentation (0-90U/L). Median maximum ACE 74 (14-420). NOD2 tested in 12 patients: 6+ , 6- . 1/6 positive patient had Blau phenotype. Ethnicity: African 12/52, asian 11/52, caucasian 14/52, unknown 15/52. Uveitis: Anterior 17/52(32.6%), Anterior+Intermediate 1/52, intermediate 5/52(9.6%) , posterior 2/52, panuveitis 25/52(48%), undocumented 2/52. ANA positive (&gt;1:80) in 15/47 (32%). Systemic involvement (n = 52): arthritis 29%, liver 29%, lymphadenopathy 19%, renal 16%, lungs 15.3%, skin 17.3%, spleen 7.7%, glands 1.9%. Patients as per adult IWOS criteria: Definite 12/52, Presumed 6/52, Probable7/52 and Not fulfilling – 27/52. Systemic involvement in patients not fulfilling IWOS criteria (27/52) – renal 14.8%, arthritis 22.2%, hilar or peripheral lymphadenopathy 0 %, skin involvement 7.4%, lung 18.5%, splenomegaly 3.7%. Comparing IWOS fulfilling (25) with the ones who did not (27) – systemic involvement consistently less common in the ones NOT fulfilling but only reaches statistical significance difference for involvement. Lymphadenopathy and skin (p &lt; 0.001 and p &lt; 0.050 respectively). Suggesting that paediatric age group cannot be classified as per the adult IWOS ocular sarcoidosis criteria and needs early systemic screening. Medications used to treat uveitis and/or extra-ocular manifestations: methotrexate alone 25%, methotrexate + adalimumab 21.1%, mycophenolate mofetil 9.61%, only systemic steroids 3.8%. 9 patients- no systemic medications at any time during their disease. Conclusion Most sarcoid-like uveitis patients had at least one systemic involvement. 51.9% patients did not fulfil the IWOS ocular sarcoidosis criteria, still had systemic involvement. Hilar lymphadenopathy criteria cannot be applied to the paediatric population, peripheral more common. ACE not a sensitive biomarker to predict sarcoidosis. 17.3 % had mild phenotype &amp; required no treatment. This study demonstrates the importance of close monitoring for systemic manifestations &amp; highlights good clinical response to steroids, MTX, MMF and anti-TNF. Conflicts of Interest The authors declare no conflicts of interest.

P38 Never say never: new onset uveitis in adolescence

Abstract Background To highlight the importance of considering new onset uveitis in adolescent patients with longstanding juvenile idiopathic arthritis (JIA). Methods We performed a retrospective review of electronic medical records. Results A 16 year-old girl was diagnosed in 2004, aged 15 months with extended oligoarticular JIA (ANA positive, &gt;1/640 homogeneous). Her initial treatment included intra-articular steroid injections and approximately eighteen months later methotrexate, which she remained on for four years. During this time she received occasional intra-articular steroid injections. Etanercept was added in 2009 due to persistent active disease and she continued on this treatment regime for the next five years. Methotrexate was discontinued in 2013 due to intolerance. Etanercept was discontinued in 2014 due to disease remission but was restarted after three months when her arthritis flared. In 2018 biologic treatment was changed due to poor disease control. Etanercept was switched to adalimumab, initially alternate weeks but increasing to weekly together with multiple joint injections. Six months later, her disease control remained poor and drug levels and antibodies were measured. She had a strongly positive anti-drug antibody level&gt;200 AU/ml and her adalimumab level was &lt;0.4mgs/L (normal range 5-10). At this time our patient now aged 16 presented with a four-week history of intermittent reduced vision in her right eye. Ophthalmology review found bilateral anterior uveitis. This patient had regular eye screening from her JIA diagnosis until her 11th birthday, showing no previous evidence of uveitis. Following diagnosis of uveitis she was commenced on steroid eye drops and IV methylprednisolone to treat both her uveitis and arthritis. Infliximab, (6mg/kg) was commenced then increased (10mg/kg) for ongoing uveitis and methotrexate was restarted. Despite this treatment she has persistent low grade right uveitis. Her left eye has settled and she has no lens opacities or raised intraocular pressures. She continues with joint discomfort secondary to her hypermobility but her arthritis is currently quiescent. Conclusion Type of arthritis and age at onset historically dictated the risk of developing uveitis. However uveitis can present in any age group and in patients with any type of JIA. In our case uveitis developed for the first time almost 15years after diagnosis. With disease modifying treatments now widely used early in the management of JIA, uveitis may be masked and therefore present late or atypically. It is rare for uveitis to present so long after diagnosis, however this case highlights that rheumatology teams should be aware that it can still develop. Therefore we should never say never! Conflicts of Interest The authors declare no conflicts of interest.

Etiologic Spectrum and Follow-Up Results of Noninfectious Uveitis in Children: A Single Referral Center Experience.

This study aims to investigate the etiologic spectrum, demographic features, and long-term follow-up results of children with noninfectious uveitis (NIU). Files of patients with NIU were reviewed between May 2010 and September 2017. The cohort consisted of 54 juvenile uveitis patients (26 males, 28 females; mean age 7.7 years; interquartile range [IQR] 9.2 years) with 93 affected eyes. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow-up, associated systemic diseases, pertinent laboratory tests, medications used, and status of uveitis at the time of enrollment were recorded from the files. All patients had final systemic and ocular examination at the last month of enrollment. Twenty-seven patients (50.0%) had juvenile idiopathic arthritis (JIA), 17 (31.4%) had idiopathic uveitis, six (11.1%) had Behçet disease (BD), and four (7.5%) had tubulointerstitial nephritis and uveitis (TINU) syndrome. Median duration of follow-up for uveitis was 16 (IQR: 15) months. Anterior uveitis was seen in 81.4% of the patients (65.9% had bilateral and 34.1% had unilateral anterior uveitis). Bilateral intermediate uveitis was observed in 11.2% and bilateral panuveitis in 7.4% of the patients. At the time of enrollment, 45 uveitis patients (83.3%) were under remission. Complications of uveitis were observed in 18.5% of the patients. Patients with JIA and BD should be regularly checked for uveitis. It is challenging to find an etiology in uveitis patients referred from ophthalmologists if initial questioning and examination do not reveal an overt rheumatologic disease. However, a simple urine test may help in establishing the diagnosis of TINU syndrome.

Do Season and Environment Have a Role in the Incidence of Anterior Uveitis Attacks?

ABSTRACT Purpose To investigate the seasonal influence on the incidence of uveitis attacks. Methods An ecological study was designed including 731 uveitis attacks in 594 patients diagnosed at the eye emergency of a hospital in Madrid between 2014 and 2017. The incidence of uveitis attacks, B27+, and presumed herpetic attacks were calculated, and their correlations with seasonal and environmental variables in the same timeframe were analyzed. The analyzed variables were precipitation, barometric pressure, temperature, humidity, wind speed, global solar radiation, ultraviolet radiation, air pollution components (particulate matter and polluting gases), and the incidence of influenza. Results The incidence of attacks was significantly higher in the winter than in the autumn (p = .025). It showed a significant correlation to the number of rainy days per month (r = 0.612;p = .04), and the average wind speed (r = 0.469;p = .02) after Bonferroni correction. Conclusion Uveitis episodes happened more frequently under rainy and windy conditions. Most factors were not significantly correlated to attacks.

Association Between Climate Change and the Onset of Uveitis in Mainland China

Background: Although uveitis is one of the leading causes of blindness worldwide, no clear breakthrough has been made regarding its environmental influences. This research is aimed at quantifying the association between climate change and the onset of uveitis. Methods: We combined data from the largest database of uveitis cases with surface climate data to construct panel data. These longitudinal data were used to complete models. We used choropleth maps to visually assess geographical variations. Findings: Analyzing data from 12,721 patients with uveitis from 2006 to 2017 with these climate data, we find that a 1 °C increase in monthly temperature is associated with a rise in approximately 2 uveitis cases per 1000 individuals. This temperature-uveitis association is present across provinces and is getting stronger over time. A stronger temperature-uveitis association is observed in provinces of mainland China. We also find obvious evidence of temporal displacement across the full sample, stratified by age, sex and uveitis type. We predict that mainland China may experience increased uveitis cases due to warming induced by future climate change. Interpretation: Our study is the largest-ever investigation of the association between uveitis and climate change, and for the first time, provides evidence that rising temperature can affect the onset of uveitis on a large scale. These results may help promote and implement policies to mitigate future temperature increases and the burden of disease caused by global warming. Funding Statement: This study was supported by National Key R&D Program of China (2016YFC0904000), Natural Science Foundation Major International (Regional) Joint Research Project (81720108009), Chongqing Key Laboratory of Ophthalmology (CSTC, 2008CA5003), Chongqing Science & Technology Platform and Base Construction Program (cstc2014pt-sy10002) and the Natural Science Foundation Project of Chongqing (cstc2017shmsA130073). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All studies were approved by the respective institutional ethics committees, and written informed consent was obtained from all participants.