Intermediate Uveitis: Pattern of Etiology, Complications, Treatment and Outcome in a Tertiary Academic Center

Overview

Journal Orphanet J Rare Dis

Publisher Biomed Central

Specialty General Medicine

Date 2017 Apr 29

PMID 28449695

Citations 15

Authors

Thomas Ness

Daniel Boehringer

Sonja Heinzelmann

Affiliations

Soon will be listed here.

Abstract

Background: Patients with intermediate uveitis (IU) represent a heterogenous group characterized by a wide spectrum of etiologies and regional differences. Aim of the study was to analyze the characteristics of patients with IU examined in an academic center in Germany.

Methods: We conducted a retrospective analysis of the clinical records of all patients with intermediate uveitis referred to the Eye Center, University of Freiburg from 2007 to 2014. Diagnosis followed the Standardization in Uveitis Nomenclature (SUN) criteria. Data analysis included: etiology of IU, demographics, complications, treatment and visual acuity.

Results: We identified 159 patients with intermediate uveitis during that period. Mean age at diagnosis was 35 years. Most are female (64%), and the mean duration of IU was 6.1 years (range 1 month - 35 years). Etiology of IU was idiopathic in 59%. Multiple sclerosis (MS) (20%) and sarcoidosis (10%) were frequent systemic causes of IU. Other etiologies including infectious diseases (tuberculosis, borreliosis) or immune-mediated conditions (eg, after vaccination) were present in 11%. The pattern of complications included macular edema (CME) (36%), cataract (24%), secondary glaucoma (7%), and epiretinal membrane formation (19%). Periphlebitis and optic neuritis were more frequent in conjunction with MS. Treatment comprised local and systemic steroids, immunosuppressive agents, biologics, and surgery. Best corrected visual acuity was better than 20/25 in 60% of the eyes after more than 10 years of follow-up.

Conclusions: In our German academic center, most IU cases were idiopathic or associated with MS or sarcoidosis. In contrast to other countries, infectious cases were rare. Patients' overall visual prognosis is favorable even when the duration of IU has been long and and despite numerous complications.

Citing Articles

The brain-eye connection: More than just action potentials.

Walsh J J Exp Med. 2024; 221(11).

PMID: 39387899 PMC: 11471833. DOI: 10.1084/jem.20241519.

[Uveitis and multiple sclerosis : Clinical aspects, diagnostics, management and treatment].

Stubiger N, Ruprecht K, Pleyer U Ophthalmologie. 2024; 121(8):665-678.

PMID: 39037464 DOI: 10.1007/s00347-024-02084-8.

Clinical characteristics of intermediate uveitis in adults according to criteria of the SUN working group.

Yargi-Ozkocak B, Altan C, Kemer-Atik B, Basarir B Int Ophthalmol. 2023; 43(10):3681-3693.

PMID: 37395903 DOI: 10.1007/s10792-023-02778-z.

Sarcoidosis-Related Uveitis: A Review.

Giorgiutti S, Jacquot R, El Jammal T, Bert A, Jamilloux Y, Kodjikian L J Clin Med. 2023; 12(9).

PMID: 37176633 PMC: 10178951. DOI: 10.3390/jcm12093194.

Intermediate uveitis: Etiologies and outcomes in a tertiary referral hospital in KSA.

Al-Hujaili H, Alabduljabbar K, AlAkeely A, Al-Dhibi H Saudi J Ophthalmol. 2022; 35(2):81-83.

PMID: 35391818 PMC: 8982936. DOI: 10.4103/1319-4534.337853.

References

Demicheli V, Debalini M, Rivetti A . Vaccines for preventing tick-borne encephalitis. Cochrane Database Syst Rev. 2009; (1):CD000977. PMC: 6532705. DOI: 10.1002/14651858.CD000977.pub2. View

Petrushkin H, Kidd D, Pavesio C . Intermediate uveitis and multiple sclerosis: to scan or not to scan. Br J Ophthalmol. 2015; 99(12):1591-3. DOI: 10.1136/bjophthalmol-2015-307269. View

Herbort C, Rao N, Mochizuki M . International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop On Ocular Sarcoidosis (IWOS). Ocul Immunol Inflamm. 2009; 17(3):160-9. DOI: 10.1080/09273940902818861. View

Jabs D, Nussenblatt R, Rosenbaum J . Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005; 140(3):509-16. PMC: 8935739. DOI: 10.1016/j.ajo.2005.03.057. View

Manohar Babu B, Rathinam S . Intermediate uveitis. Indian J Ophthalmol. 2009; 58(1):21-7. PMC: 2841370. DOI: 10.4103/0301-4738.58469. View

Jones N . The Manchester Uveitis Clinic: The first 3000 patients, 2: Uveitis Manifestations, Complications, Medical and Surgical Management. Ocul Immunol Inflamm. 2014; 23(2):127-34. DOI: 10.3109/09273948.2014.968671. View

Biousse V, Trichet C, Bloch-Michel E, Roullet E . Multiple sclerosis associated with uveitis in two large clinic-based series. Neurology. 1999; 52(1):179-81. DOI: 10.1212/wnl.52.1.179. View

Gundlach E, Hoffmann M, Prasse A, Heinzelmann S, Ness T . Interleukin-2 Receptor and Angiotensin-Converting Enzyme as Markers for Ocular Sarcoidosis. PLoS One. 2016; 11(1):e0147258. PMC: 4723126. DOI: 10.1371/journal.pone.0147258. View

Khairallah M, Ben Yahia S, Ladjimi A, Messaoud R, Zaouali S, Attia S . Pattern of uveitis in a referral centre in Tunisia, North Africa. Eye (Lond). 2005; 21(1):33-9. DOI: 10.1038/sj.eye.6702111. View

10.

Bonfioli A, Damico F, Curi A, Orefice F . Intermediate uveitis. Semin Ophthalmol. 2005; 20(3):147-54. DOI: 10.1080/08820530500232035. View

11.

Tsui I, Kaines A, Schwartz S . Patterns of periphlebitis in intermediate uveitis using ultra wide field fluorescein angiography. Semin Ophthalmol. 2009; 24(1):29-33. DOI: 10.1080/08820530802520186. View

12.

Ness T, Hengel H . [Adverse ocular effects of vaccinations]. Ophthalmologe. 2016; 113(7):615-22. DOI: 10.1007/s00347-016-0313-x. View

13.

Oruc S, Kaplan A, Galen M, Kaplan H . Uveitis referral pattern in a Midwest University Eye Center. Ocul Immunol Inflamm. 2004; 11(4):287-98. DOI: 10.1076/ocii.11.4.287.18270. View

14.

Schmidt S, Wessels L, Augustin A, Klockgether T . Patients with Multiple Sclerosis and concomitant uveitis/periphlebitis retinae are not distinct from those without intraocular inflammation. J Neurol Sci. 2001; 187(1-2):49-53. DOI: 10.1016/s0022-510x(01)00520-2. View

15.

Boskovich S, Lowder C, Meisler D, GUTMAN F . Systemic diseases associated with intermediate uveitis. Cleve Clin J Med. 1993; 60(6):460-5. DOI: 10.3949/ccjm.60.6.460. View

16.

Donaldson M, Pulido J, Herman D, Diehl N, Hodge D . Pars planitis: a 20-year study of incidence, clinical features, and outcomes. Am J Ophthalmol. 2007; 144(6):812-817. DOI: 10.1016/j.ajo.2007.08.023. View

17.

Lauer A, Smith J, Robertson J, Rosenbaum J . Vitreous hemorrhage is a common complication of pediatric pars planitis. Ophthalmology. 2002; 109(1):95-8. DOI: 10.1016/s0161-6420(01)00866-1. View

18.

Yang P, Zhang Z, Zhou H, Li B, Huang X, Gao Y . Clinical patterns and characteristics of uveitis in a tertiary center for uveitis in China. Curr Eye Res. 2005; 30(11):943-8. DOI: 10.1080/02713680500263606. View

19.

Doser A, Hartmann K, Fleisch F, Kuhn M . [Suspected neurological side-effects of tick-borne meningoencephalitis vaccination: experiences of the Swiss Adverse Drug Reaction Reporting Center]. Praxis (Bern 1994). 2002; 91(5):159-62. DOI: 10.1024/0369-8394.91.5.159. View

20.

Bajwa A, Osmanzada D, Osmanzada S, Khan I, Patrie J, Xin W . Epidemiology of uveitis in the mid-Atlantic United States. Clin Ophthalmol. 2015; 9:889-901. PMC: 4445955. DOI: 10.2147/OPTH.S80972. View