Dr. Diva Kant Misra, M15899, Dr. Dipankar Das, Dr. Vivek Paulbuddhe, Dr.Harsha Bhattacharjee
Full text AIOC 2017-FP1023:
Section: Inflammation
Title of the paper:Pattern of Intermediate uveitis in North East India
Chief and presenting author-Diva Kant Misra (M15899)
Co-authors: Dipankar Das, Vivek Paulbuddhe, Harsha Bhattacharjee
Sri Sankaradeva Nethralaya, Guwahati, Assam, INDIA
Abstract
Purpose: To describe the pattern of intermediate uveitis (IU) in North East Indian patients. Methods: Retrospective review of patients with IU with at least 6 months follow-up from 2011 to 2015. Results: 157 patients were identified and the mean follow-up was 45.7 months. The mean age at presentation was 42.5 years. Higher incidence was seen in males (52.2%) as compared to females (47.7%). Fifty-two(33.1%) of IU cases were considered tubercular after investigations. At the last follow-up, 79.6% eyes retained vision of at least 20/40. Poor visual outcome was significantly associated with poor presenting visual acuity, persistent cystoid macular edema, and increased disease duration. Conclusions: IU in North East Indian patients was mainly of tubercular etiology, with good visual outcome
Introduction:
Intermediate uveitis (IU) is a form ofuveitis that mainly involves the pars plana, peripheralretina, and underlying choroid [1]. Theprimarysiteofinflammationisthevitreous.The prevalenceof IU varies from2–31% in different populations [2].Itispredominantlyseeninthethirdandfourthdecadeoflife. The etiological factors ofIU are notcompletelyunderstoodandit is found to be idiopathicinmoststudies. However,insomecases,systemicinfections (lyme,syphilis,tuberculosis)or non-infectious diseases(multiple sclerosisandsarcoidosis)maybetheunderlyingcause. Despite various studies on IU, there is lack of data on pattern of IU from the Indian subcontinent, specially the North East Indian population.
Aim &Objectives:The aim of our study was to identify the pattern ofIU in a tertiary eye care centre in North East India. Special attention was paid to the clinical spectrum,etiology, underlying systemic diseases, complications,and visual prognosis.
Methodology: This study was approved by institutional research and ethics committee.
- Place of study: Sri Sankaradeva Nethralaya, Guwahati, Assam, India.
- Type of study: Hospital based, retrospective, observational study
- Material & methods: Retrospective review of records was done from hospital database, which included all patients presented to uvea clinic at a tertiary ophthalmic care centre from January 2011 to January 2015. The patients were classified according to current International Uveitis Study Group (IUSG) classification based on the localization of intraocular inflammation and patients diagnosed as IU were taken up for the study. Various defining descriptors based on clinical onset, duration and course were included based on IUSG study. Ocular findings were analyzed in each case by external examination, slit-lamp biomicroscopy, applanation tonometry, and indirect ophthalmoscopy with scleral depression after maximum pupillary dilatation. Ancillary and laboratory investigations were carried out in each case in a tailored approach. Statistical analysis was performed using Pearson’s chi-square test. A finding was considered statistically significant if the P value was <0.05.
Results:
One fifty seven(157) patients diagnosed as IU were included in this study.Higher incidence was seen in males (52.2%) as compared to females (47.7%). The mean follow-updurationwas of45.7months.Themean age at the time of presentationwas 42.5years(range, 7–84 years).
The most common presenting was found to be diminution of vision (58.0%), floaters ( 18.4%) followed by pain and redness.
No underlying disease could be identified in 54.05%, followed by Tubercular in 28.6% and in 17.75% had sarcoidoisis.. The mean duration of active disease was 42.4 ± 26.4 months.
71.1% of patients required systemic corticosteroid, 5.73% received immunosuppressive drugs( methotrexate), and 40.09% of eyes were administered periocular/intravitreal corticosteroid injections.
In terms of Ocular complications of IU most common were cystoid macular oedema (38.4%) and cataract (26.3%).
After treatment, visual acuity (VA) improved in (68.8%), further deteriorated in (18.6%), and was unchanged in (12.6%). At the last follow-up, 79.6% eyes retained vision of at least 20/40
Conclusion: To the best of our knowledge,thisisthefirstreportfrom North Eastern part of India profiling the pattern of IU.In North East Indian patients IUwas often bilateral and seenattheendofthethirddecadeoflife. Though,majorityofourcaseswereidiopathic, tuberculosis and sarcoidosisformed the remaining bulk ofdiagnoses.ThemostcommoncomplicationwasCMEfollowed bycataract.Visualprognosiswasgoodformostcases.
References:
- Nussenblatt RB, Whitcup SM, Palestine AG (2004) Uveitis: fundamentals and clinical practice, 3rd edn. CV Mosby, St. Louis, pp 291–300.
- Chang JH, Wakefield D. Uveitis: a global perspective. Ocul Immunol Inflamm. 2002;10(4):263–279.