10
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Changing patterns in uveitis South India: Comparison between two decades

      article-commentary
      Indian Journal of Ophthalmology
      Medknow Publications & Media Pvt Ltd

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Uveitis is a complex intraocular inflammatory disease that results from several causes: infections – endogenous and exogenous, systemic diseases, organ-specific autoimmune processes (primarily to T-cell-mediated Th2 and or Th17 processes), trauma, and masquerade syndromes presenting with clinical features of uveitis. About 3%–10% of blindness in developed countries and 25% of blindness in India and other developing countries are attributed to uveitis and its complications such as secondary cataract, glaucoma, cystoid macular edema, or retinal photoreceptor or optic nerve damage. Infections are a leading cause of uveitis in India and other developing countries, whereas idiopathic uveitis, believed to be an organ-specific immune inflammatory process, is a leading cause in developed countries and account for only 30% of patients.[1] Compared to previous decades, now one is able to arrive at a specific etiology in about 55.4%–60.6% of patients in India.[2 3] This is due to awareness of changing demographic features, recognition of specific uveitis entities, and prompt and better reporting of newer etiologic agents – West Nile Virus (WNV), chikungunya, and Rickettsia-induced uveitis. Now, we have well-defined diagnostic criteria for entities – ocular tuberculosis (TB), Vogt–Koyanagi–Harada (VKH), and ocular sarcoidosis. In the past two decades, other factors that have led to a fall in incidence of idiopathic uveitis and an increase in specific diagnosis are wide-field imaging, optical coherence tomography, autofluorescence, increased availability of nucleic acid amplification techniques, such as polymerase chain reaction (PCR) for infectious uveitides, such as TB, toxoplasmosis, viral uveitis (herpes simplex virus [HSV], varicella zoster virus [VZV], and cytomegalovirus [CMV]), and bacterial/fungal infections, high-resolution computerized tomography, positron-emission tomography scan, and magnetic resonance imaging.[1 3] Anterior uveitis is the most common uveitis presentation in most published studies and regional change in patterns of anterior uveitis have been reported from tertiary eye care centers in India. From Northeast India, Das et al. have recognized an increase in the diagnosis of HLA-B27-associated acute anterior uveitis in 2012 and a sharp decrease in the number of idiopathic anterior uveitis compared to 2005.[4] They have also shown that diagnosis of herpetic uveitis (HSV, VZV, and CMV) and Fuchs' uveitis syndrome was on the rise when compared to their 2005 study.[5] A similar finding is also reported by Dogra et al. and they attribute the increased incidence of the viral disease may be attributed to high clinical suspicion, based on classic signs (iris changes/high intraocular pressure) and the recent availability of PCR-based diagnosis.[3] Regional differences exist – Rathinam and Namperumalsamy have a higher incidence of trematode and leptospira-induced anterior uveitis compared to studies from Northern India.[2 3] Other causes of anterior uveitis reported are TB, sarcoidosis, leprosy, juvenile idiopathic arthritis (JIA), phacolytic uveitis, syphilis, and masquerade uveitis.[2] Ocular manifestations of parasitic infections – gnathostomiasis and dirofilariasis have been reported from Northeast India.[6] Less common are incidences of intermediate, posterior, and panuveitis, not necessarily in that order. Older studies showed TB as the most common cause of intermediate uveitis in North India,[7] while sarcoidosis and leptospiral uveitis were more common causes in South India.[2] Other less common entities seen in this anatomical site are uveitis due to idiopathic, multiple sclerosis, and JIA.[2] Toxoplasmosis, TB, leptospirosis, sarcoidosis, and viral uveitis (acute retinal necrosis and CMV) account for majority of the posterior uveitis. TB is the most common cause of choroiditis and vasculitis, while viral and toxoplasmosis are common causes of retinitis in North India. White dot syndromes such as acute posterior multifocal placoid pigment epitheliopathy, multiple evanescent white dot syndrome are less commonly seen in this part of the world. Rare causes reported were Behçets disease, neuroretinitis, masquerade syndromes, metastasis, and cysticercosis.[3] Diffuse or panuveitis can be caused by TB, sarcoidosis, VKH, sympathetic ophthalmitis, Behcet's disease, viral (VZV, CMV), and endophthalmitis – both exogenous and endogenous and sympathetic ophthalmitis. Syphilis as an etiologic agent (0.2%–1.6%) ranks low in the list of infectious cause of uveitis in many studies across India. Endophthalmitis accounted for 10% and idiopathic panuveitis for 32.7% of panuveitis in South India, while in the North, it was 14.5% and 23.5%, respectively.[2 3] Since the mid-2000's, newer uveitic entities of infectious etiology have been reported from South India – WNV-associated uveitis,[8] chikungunya-associated uveitis,[9] and Rickettsiosis-associated retinitis.[10] One often encounters these patients in clusters, most of them following a presumed outbreak of the disease in the community. We treated 254 eyes of 248 patients with acquired ocular toxoplasmosis between October 2004 and May 2005 caused by a presumed outbreak of Toxoplasmosis from a contaminated water source in South India.[11] We also recently treated a cluster of 12 patients (23 eyes) with retinitis due to Rickettsia conorii infection proved serologically (unpublished data). In conclusion, causes of uveitis differ in developed and developing countries and such etiologic differences could play a significant role in the high levels of blindness that occur in developing countries. Periodic epidemiological studies can show changing patterns in uveitis. Awareness of such regional variations of disease patterns is imperative to arrive at a differential diagnosis and do tailored laboratory investigations.[12] Ocular TB remains the most common infective etiology of uveitis, the emergence of new infectious causes of uveitis which can also occur in clusters – WNV, chikungunya, and Rickettsiosis needs to be kept in mind. There is a notable decreasing trend toward the diagnosis of idiopathic uveitis. Local drug delivery and use of biological agents are providing novel approaches to the management of recalcitrant noninfectious uveitis.

          Related collections

          Most cited references11

          • Record: found
          • Abstract: found
          • Article: not found

          Global variation and pattern changes in epidemiology of uveitis.

          Uveitis, a complex intraocular inflammatory disease results from several etiological entities. Causes of uveitis are known to vary in different populations depending upon the ecological, racial and socioeconomic variations of the population studied. Tropical countries are unique in their climate, prevailing pathogens and in the existing diseases, which further influence the epidemiological and geographical distribution of specific entities. We provide an overview of the pattern of uveitis of 15221 cases in 24 case series reported from several countries over 35 years (1972-2007) and we integrate it with our experience of an additional 8759 cases seen over six years (1996-2001) at a large community-based eye hospital. Uveitis accounted for 0.8% of our hospital-based outpatient visits. The uveitis was idiopathic in 44.6%, the most commonly identified entities in the cohort included leptospiral uveitis (9.7%), tuberculous uveitis (5.6%) and herpetic uveitis (4.9%). The most common uveitis in children below 16 years (616 patients; 7.0% of the total cohort) was pediatric parasitic anterior uveitis, (182 children, 29.5% of the pediatric cohort), whereas the most common uveitis in patients above 60 years (642 patients; 7.3% of the total cohort) was herpetic anterior uveitis, (78 patients, 12.1% of the elderly cohort). Etiologies varied with the age group of the patients. As in other tropical countries, a high prevalence of infectious uveitis was seen in this population.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Pattern of uveitis in a referral eye clinic in north India.

            To report the pattern of uveitis in a north Indian tertiary eye center. A retrospective study was done to identify the pattern of uveitis in a uveitis clinic population of a major referral center in north India from January 1996 to June 2001. A standard clinical protocol, the "naming and meshing" approach with tailored laboratory investigations, was used for the final diagnosis. 1233 patients were included in the study; 641 (51.98%) were males and 592 (48.01%) females ranging in age from 1.5 to 75 years. The anterior uveitis was seen in 607 patients (49.23%) followed by posterior uveitis (247 patients, 20.23 %), intermediate uveitis (198 patients, 16.06%) and panuveitis (181 patients, 14.68%). A specific diagnosis could be established in 602 patients (48.82%). The infective aetiology was seen in 179 patients, of which tuberculosis was the commonest cause in 125 patients followed by toxoplasmosis (21 patients, 11.7%). Non-infectious aetiology was seen in 423 patients, of which ankylosing spondylitis was the commonest cause in 80 patients followed by sepigionous choroidopathy (62 patients, 14.65%). Tuberculosis and toxoplasmosis were the commonest form of infective uveitis, while ankylosing spondylitis and serpiginous choroidopathy were commonly seen as the non-infective causes of uveitis in North India.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Ocular manifestations associated with chikungunya.

              To report ocular manifestations associated with chikungunya. Retrospective, nonrandomized, observational case series. Nine chikungunya patients with ocular involvement. All patients with chikungunya infection presenting with ocular complaints from September 2006 to October 2006 were included in the study. The infection was confirmed by demonstration of chikungunya immunoglobulin M antibody in sera of all patients. All patients underwent an ophthalmic examination including fundus photography, fundus fluorescein angiography, confocal microscopy of keratic precipitates, and optical coherence tomography. Positive ocular changes were recorded and tabulated. Characteristics, frequency, and locations of ocular lesions found in the participants. There were 9 patients with ocular lesions; 1 had nodular episcleritis, 5 presented with acute iridocyclitis, and 3 had retinitis. Four to 12 weeks before the development of ocular manifestations, all of these patients had fever. Although there were no specific changes of iridocyclitis that were diagnostic of the fever, the retinal changes were consistent with viral retinitis. All patients recovered from the infection with relatively good vision. It appears that iridocyclitis and retinitis are the most common ocular manifestations associated with chikungunya, with a typically benign clinical course. Less frequent ocular lesions include episcleritis. All the patients responded well to the treatment with preservation of good vision. To the best of our knowledge, similar ocular manifestations associated with chikungunya infection have not been reported. In the differential diagnosis of iridocyclitis and retinitis with features suggestive of a viral infection, the entity of chikungunya-associated ocular changes should be considered in the regions affected by the epidemic.
                Bookmark

                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                April 2018
                : 66
                : 4
                : 528-529
                Affiliations
                [1]Uvea Clinic, Aravind Eye Hospital, Salem, Tamil Nadu, India
                Author notes
                Correspondence to: Dr. Manohar Babu Balasundaram, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Salem, Tamil Nadu, India. E-mail: dr.mb@ 123456cbe.aravind.org
                Article
                IJO-66-528
                10.4103/ijo.IJO_363_18
                5892055
                29582813
                63157b56-db50-4b6a-927d-a9d677620aed
                Copyright: © 2018 Indian Journal of Ophthalmology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Commentary

                Ophthalmology & Optometry
                Ophthalmology & Optometry

                Comments

                Comment on this article