Relationship between Uveitis and Thyroid Disease: A 13-Year Nationwide Population-based Cohort Study in Taiwan.

Purpose: To investigate whether patients with thyroid disease are at increased risk of uveitis.Methods: Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with thyroid disease from 2000 to 2012. The endpoint of interest was a diagnosis of uveitis.Results: In analyzing 21,396 patients with thyroid disease, yielding 85,584 matched comparisons, patients with thyroid disease to have a significantly higher cumulative incidence of uveitis when compared to the control cohort with the Kaplan-Meier analysis. This result was further confirmed by Cox regression analysis. The increased risk was persistent in both genders. The association between thyroid disease and uveitis was stronger in patients without diabetes or hypertension.Conclusion: Patients with thyroid disease were found to have a higher risk for uveitis. For certain age groups or patients without diabetes or hypertension, the role of thyroid disease might be more crucial for uveitis development.

Incidence and Risk Factors for Blindness in Uveitis: A Nationwide Cohort Study from 2002 to 2013.

Purpose: To investigate the incidence and risk factors of blindness in uveitis.Methods: From a national sample cohort (n = 1,025,340), we selected 9,036 new-onset uveitis patients. Incidences of unilateral and bilateral blindness (visual acuities ≤20/400) were estimated and socioeconomic and clinical risk factors for unilateral blindness in uveitis patients were identified.Result: Incidence of unilateral and bilateral blindness was 2.93 and 0.42 per 1,000 person-years, respectively. The risk factors for unilateral blindness were age >40 (hazard ratio [HR], 2.77, 95% CI [confidence interval], 1.11-6.92) and low household income (HR, 1.50; 95% CI, 1.02-1.98) in uveitis overall, and Behçet's disease (HR, 4.49; 95% CI, 1.59-12.71) in non-anterior uveitis, respectively.Conclusions: Low household income and Behçet's disease influence the risk of blindness in uveitis patients. These findings will help in assessing blindness-related socioeconomic burdens and planning health-care strategies for uveitis patients.

A retrospective review of the adverse effects of biological therapy and reasons for its discontinuation in a resource-limited setting.

BACKGROUND: Biological disease-modifying antirheumatic drug therapies have become the gold standard of treatment for refractory rheumatic conditions in well-resourced countries. There is a significant risk of infection and reactivation of latent infections, in particular tuberculosis, with the use of biological therapies. Their safety and reasons for discontinuation in a resource-limited environment are still unclear. OBJECTIVES: The primary objective was to describe the nature and frequency of adverse events as well as the main reason for discontinuation of biological treatment. METHODS: We conducted a retrospective, descriptive folder review of all patients started on biological therapy for rheumatic conditions from November 2011 to December 2016. RESULTS: A total of 31 patients were included. The rheumatic diseases included in the study were ankylosing spondylitis (AS) (35%), rheumatoid arthritis (RA) (19%), systemic lupus erythematosus (16%), juvenile idiopathic arthritis (13%), vasculitides (10%) and psoriatic arthritis (7%). Adverse events occurred in 26 patients (84%). Serious adverse events occurred in 14 patients (45%) with recurrent uveitis being the most common, occurring in 5 patients (16%). One patient developed pulmonary tuberculosis (PTB). Discontinuation or switching of biological therapy occurred in 13 patients (42%), with the main reasons being serious adverse events in 7 patients (23%) and treatment failure in 6 (19%). The median (interquartile range (IQR)) Bath Ankylosing Spondylitis Disease Activity Index score improved from 6.4 (5 - 7.4) to 2.8 (0.9 - 5.0), a statistically significant difference of -3.5 (p=0.001) (95% confidence interval (CI) -5.3 - -1.7) over a median (IQR) of 20 (9 - 30) months in the AS group. The median (IQR) Clinical Disease Activity Index score improved from 39 (34.5 - 43) to 21 (18.7 - 25.5), a statistically significant difference of -17.4 (p=0.044) (95% CI -34.1 - -0.7) over a median (IQR) of 39 (21 - 50) months in the RA group. CONCLUSIONS: Recurrent uveitis occurred in almost half of the patients with AS and was also the main reason for discontinuation of biological therapy. We did not document an increased risk of PTB. Disease activity scores showed significant improvement. The study is limited by the small number of patients on biological therapy, a reflection of the impact of severe resource constraints.

Association of Hypovitaminosis D With Increased Risk of Uveitis in a Large Health Care Claims Database.

Importance: Understanding the role of vitamin D-which regulates inflammatory responses-in noninfectious uveitis (an inflammatory disease) may provide insight into treatment and prevention of this disease. Objective: To investigate whether there is an association between hypovitaminosis D and incident noninfectious uveitis. Design, Setting, and Participants: In a retrospective case-control study, data from a health care claims database containing deidentified medical claims from a large private insurer were used to identify 558 adults enrolled from January 1, 2000, to December 31, 2016, who received a diagnosis of noninfectious uveitis from an eye care clinician (with receipt of a confirmatory diagnosis within 120 days of the initial diagnosis) and who had a vitamin D level measured within 1 year before the first diagnosis. Exclusion criteria included having systemic disease or receiving medication known to lower vitamin D levels, having undergone intraocular surgery, and having infectious uveitis. Each case patient was matched with 5 controls on the basis of age, sex, race/ethnicity, and index date (2790 controls). The controls had vitamin D level determined either within 1 year before or within 6 months after receiving an eye examination with normal findings. Multiple logistic regression models were used to examine the association between hypovitaminosis D and noninfectious uveitis. Main Outcomes and Measures: The primary, prespecified analysis assessed the association of noninfectious uveitis with hypovitaminosis D (vitamin D level ≤20 ng/mL). Results: The 558 cases and 2790 controls were matched on age, and each group had a mean (SD) age of 58.9 (14.7) years. Among the cohort of 3348 patients, 2526 (75.4%) were female, and the racial/ethnic distribution in the matched samples was 2022 (60.4%) white, 552 (16.5%) black, 402 (12.0%) Hispanic, 162 (4.8%) Asian, and 210 (6.3%) unknown. Patients with normal vitamin D levels had 21% lower odds of having noninfectious uveitis than patients with low vitamin D levels (odds ratio [OR], 0.79; 95% CI, 0.62-0.99; P = .04). In a race-stratified analysis, an association between vitamin D and uveitis was found in black patients (OR, 0.49; 95% CI, 0.30-0.80; P = .004) and was qualitatively similar but nonsignificant in white patients (OR, 0.87; 95% CI, 0.62-1.21; P = .40) and Hispanic patients (OR, 0.60; 95% CI, 0.33-1.10; P = .10). Conclusions and Relevance: This and other reports have found an association between hypovitaminosis D and noninfectious uveitis. However, these studies cannot establish a causal relationship. Prospective studies are warranted to evaluate whether hypovitaminosis D causes increased risk of uveitis and the role of vitamin D supplementation in prevention and treatment of uveitis.

Pediatric Uveitis.

Pediatric uveitis differs from adult-onset uveitis and is a topic of special interest because of its diagnostic and therapeutic challenges. Children with uveitis are often asymptomatic and the uveitis is often chronic, persistent, recurrent, and resistant to conventional treatment. Anterior uveitis is the most common type of uveitis in children; the prevalence of intermediate, posterior, and panuveitis varies geographically and among ethnic groups. Regarding etiology, most cases of pediatric uveitis are idiopathic but can be due to systemic inflammatory disorders, infections, or a manifestation of masquerade syndrome. Ocular complications include cataracts, hypotony or glaucoma, band keratopathy, synechiae formation, macular edema, optic disc edema, choroidal neovascular membranes, and retinal detachment. These complications are often severe, leading to irreversible structural damage and significant visual disability due to delayed presentation and diagnosis, persistent chronic inflammation from suboptimal treatment, topical and systemic corticosteroid dependence, and delayed initiation of systemic disease‒modifying agents. Treatment for noninfectious uveitis is a stepwise approach starting with corticosteroids. Immunomodulatory therapy should be initiated in cases where quiescence cannot be achieved without steroid dependence. Patients should be monitored regularly for complications of uveitis along with systemic and ocular adverse effects from treatments. The goals are to achieve steroid-free durable remission, to reduce the risk of sight-threatening complications from the uncontrolled ocular inflammation, and to avoid the impact of lifelong burden of visual loss on the child and their family. Multidisciplinary management will ensure holistic care of affected children and improve the support for their families.

Ruthenium-106 brachytherapy for choroidal melanoma without transpupillary thermotherapy: Similar efficacy with improved visual outcome.

PURPOSE: To evaluate efficacy and toxicity of two different protocols for eye-conserving treatment of patients with small to intermediate-sized choroidal melanomas; the current ruthenium-106 (Ru106) brachytherapy protocol and the preceding protocol of Ru106-brachytherapy with transpupillary thermotherapy (Ru106/TTT). METHODS AND MATERIALS: Long-term outcomes of 449 consecutive patients, of whom 196 (43.6%) treated using Ru106/TTT and 253 (56.3%) treated using Ru106, were compared in terms of local control, survival, eye preservation and visual outcome. RESULTS: Median follow-up was 82.8 months. Patients in the Ru106-group had smaller, less centrally located tumours and better pre-treatment visual acuity (VA). Five-year cumulative incidence of local failure was 11.2% for Ru106/TTT and 5.2% for Ru106, which was not statistically significant after correction for differences in baseline characteristics (hazard ratio for Ru106 = 0.57, p = 0.14). Cumulative incidence of distant metastases was 11.2 versus 6.2%, and cumulative incidence of cause-specific death was 22.4 versus 5.5% for Ru106/TTT and Ru106 respectively. Enucleation was performed in 9.2 versus 4.0% for Ru106/TTT versus Ru106; 5.1 versus 3.2% for local failure and 2.6 versus 0.8% for complications. At one year of follow-up, significantly more patients had lost useful vision (VA < 0.33) in the Ru106/TTT-group than in the Ru106-group (50.0 versus 24.5%). After two and three years, the differences decreased (54.6 versus 34.0% and 61.7 versus 45.8%, respectively) and lost statistical significance. CONCLUSIONS: Both the current Ru106 and the preceding Ru106/TTT-protocols provided excellent tumour control, cosmetic and functional eye preservation and vital prognosis. The Ru106-protocol yielded prolonged preservation of VA and should be regarded the current standard of treatment.

Psoriasis and comorbidities. Epidemiological studies.

Psoriasis is a prevalent chronic inflammatory disease whose exact aetiology is not fully understood, but both genetic and environmental factors have been implicated in the onset and progression of the disease. At the skin level, psoriasis is characterized by localized or widespread thick raised silvery-white scaling and pruritic plaques and studies have shown that psoriasis negatively affects patients' quality of life, and depression occurs more often in patients with psoriasis. However, data have shown that psoriasis is a systemic disease which affects the joints, vasculature, and other tissues as well. Indeed, approximately one-third of patients with psoriasis develop psoriatic arthritis, and patients with severe psoriasis have a shortened life expectancy. Although our knowledge of the pathogenesis of psoriasis has advanced significantly in the past decade, as have the pharmacological treatment options which are now available, several important knowledge gaps remain. Many of the proinflammatory mediators involved in psoriasis have also been implicated in some central nervous system (CNS) diseases. However, studies on associations between psoriasis and CNS diseases are scarce. Based on nationwide registry data from the entire Danish population, the present thesis examined the associations between psoriasis and certain CNS diseases. The specific objectives of this work were to investigate the independent impact of depression on the risk of cardiovascular disease (CVD) in patients with psoriasis, the relationship between psoriasis and uveitis, and the risk of incident multiple sclerosis (MS) following the onset of psoriasis, respectively. The main results were a significantly increased risk of myocardial infarction, stroke, and CVD death in patients with psoriasis during stages of acute depression. Moreover, we found a bidirectional relationship between psoriasis and uveitis, where the occurrence of either disease significantly increased the risk of the other. Perhaps most notably, however, was that we found a psoriasis-severity dependent increased risk of MS. In conclusion, psoriasis was significantly associated with certain CNS diseases, and the risk of CVD was strongly associated with acute depression in these patients. These novel findings suggest an important link between psoriasis and CNS diseases, and high-light the necessity for a holistic approach to the diagnosis and treatment of patients with psoriasis.

Increased risk of co-morbid eye disease in patients with chronic renal failure: a population-based study.

PURPOSE: A large-scale population-based study on ophthalmic disorders among patients suffering from chronic renal failure (CRF) is lacking in the literature. This study examined the prevalence and risk of selected ocular co-morbidities (including retinal disorders, uveitis, glaucoma, cataract, and dry eye) in patients with CRF. METHODS: Data were sourced from the Taiwan Longitudinal Health Insurance Database. 9,149 patients with CRF were included in the study group, and 27,447 matched patients in the comparison group (age 40-98 years). We calculated the prevalence of retinal disorders, uveitis, glaucoma, cataract, and dry eye for patients with and without CRF. Conditional logistic regression analyses were also performed to compare the risk of ophthalmic disorders for patients with and without CRF, after taking into consideration sex, age group, diabetes, hypertension, monthly income, geographic region, and level of urbanization of the patient's community. RESULTS: In this study, patients with CRF had significantly higher prevalence of retinal disorders (16.62% vs. 9.70%), uveitis (1.38% vs. 0.95%), glaucoma (7.56% vs. 5.70%), and cataract (33.08% vs. 28.90%) than patients without CRF (all p < 0.001). However, no significant difference was observed in the prevalence of dry eye between these two groups. After adjusting for potential confounders, patients with CRF had higher odds of retinal disorder (odds ratio, OR, 1.84, 95% confidence interval, CI, 1.72-1.98), uveitis (OR 1.33, 95% CI 1.07-1.66), glaucoma (OR 1.35, 95% CI 1.23-1.48), and cataract (OR 1.24, 95% CI 1.18-1.31) than patients without CRF. CONCLUSION: We conclude that patients with CRF had a significantly higher prevalence of retinal disorders, uveitis, glaucoma, and cataract compared with patients without CRF.

Syphilitic uveitis in patients infected with human immunodeficiency virus.

BACKGROUND: This work investigates the incidence and clinical features of syphilitic uveitis in patients infected with human immunodeficiency virus (HIV). MATERIAL AND METHODS: We retrospectively reviewed syphilitic uveitis in patients coinfected with HIV that presented at a referral center between July 2001 and November 2003. RESULTS: Twelve patients (20 eyes) were included. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in three patients. All patients were male and homosexual. One patient has been previously treated for syphilis with benzathine penicillin G. One patient presented with anterior uveitis and 11 patients had panuveitis or posterior uveitis. Necrotizing retinitis was noted in seven eyes (35%), posterior placoid chorioretinitis in six eyes (30%) and optic nerve involvement in five eyes (25%). Of nine patients with available cerebrospinal fluid (CSF) studies, seven (77.8%) had CSF abnormalities. Eleven patients were treated with intravenous penicillin G and one with intravenous ceftriaxone sodium. One patient required a second course of antibiotics to control uveitis. Ocular inflammation decreased and visual acuity improved in all nine patients for whom follow-up was available after treatment. CONCLUSION: Manifestations of syphilitic uveitis in HIV-infected patients are multiple, with high frequencies of posterior uveitis, posterior placoid chorioretinitis, necrotizing retinitis and optic nerve involvement. Syphilitic uveitis in HIV-infected patients seems to have a more severe course and may relapse despite high-dose intravenous penicillin therapy.

Hyperhomocysteinaemia is associated with uveitis but not with deep venous thrombosis in Behcet's disease.

Plasma homocysteine was assessed in Behcet's disease (BD) patients in order to determine the prevalence of hyperhomocysteinaemia in BD and to test its association with clinical manifestations of the disease. The study included 59 patients with BD and 118 age- and sex-matched healthy subjects. Plasma homocysteine, vitamin B(12) and folate were assessed by automated immunoassay methods. Hyperhomo-cysteinaemia was defined as plasma homocysteine >15 micromol/l. Plasma homocysteine concentrations and the prevalence of hyperhomocysteinaemia were significantly higher in BD patients than in controls [median (5th-95th percentile), 11.3 (6.6-28.1) vs. 10.6 (6.6-17.1) micromol/l, and 25.4% vs. 9.3%, respectively]. In BD patients, hyperhomocysteinaemia was related to male gender, disease severity and uveitis [odds ratio (OR), 5.32; 95% confidence interval (CI), 1.43-21.61; p = 0.008], but not to age, smoking, disease activity, deep venous thrombosis, arthritis or neurological involvement. The association between uveitis and hyperhomocysteinaemia persisted (multi-adjusted OR, 7.46; 95% CI, 1.03-54.3; p = 0.05) after adjusting for gender, age, disease activity and duration, smoking, deep venous thrombosis, and serum concentrations of creatinine, vitamin B(12) and folate. Plasma homocysteine should be measured in patients with BD, and the effect of B-vitamin supplementation should be tested in those with hyperhomo-cysteinaemia.

Uveítis en la infancia: estudio de área sur oriente de Santiago / Uveitis in childhood: study of orient-south area of Santiago

Propósito: determinar la frecuencia y características de las uveítis en la edad pediátrica en nuestro medio. Método: estudio retrospectivo de las fichas de los pacientes menores de 16 años controlados por uveítis en el Hospital Sótero del Río, Santiago, desde 1985 a 1994. Resultados: cuarenta y ocho pacientes (29,1 por ciento) eran menores de 16 años. Predominaron las uveítis unilaterales (70,8 por ciento), granulomatosas (64,6 por ciento) y crónicas (54,2 por ciento). Encontramos uveítis anterior en 20,8 por ciento, intermedia en 10,4 por ciento, posterior en 56,3 por ciento y difusa en 12,5 por ciento. Efectuamos un diagnóstico específico en 39 casos (81,3 por ciento), siendo las entidades más frecuentes la toxocariasis (40 por ciento), toxoplasmosis (21 por ciento) y pars planitis (10 por ciento). El peor pronóstico visual < 0,1, seguida de las posteriores (50 por ciento), anteriores (23,1 por ciento) e intermedias (11,1 por ciento) (p <0,05). El 41 por ciento de los ojos afectados presentó visión final < 0,1. Conclusiones: las uveítis en la infancia son frecuentes en nuestro medio predominado las etiologías parasitarias con compromiso del segmento posterior del ojo. Su pronóstico visual es malo, ya que conducen con lata frecuencia a la ceguera del ojo afectado a edades tempranas de la vida