Diagnostic efficacy of elevated serum angiotensin-converting enzyme and lymphopenia between presumed sarcoid uveitis and presumed tubercular uveitis.

PURPOSE: To evaluate the diagnostic efficacy of elevated serum angiotensin-converting enzyme (sACE) and lymphopenia in presumed sarcoid and tubercular uveitis. METHODS: A single-centre retrospective study was conducted on a cohort of 755 adult patients with uveitis between January 2019 and June 2020. Demographic, clinical and laboratory data were retrieved from our hospital database. Measurements of serum angiotensin-converting enzyme (sACE) and lymphocyte counts were analysed. RESULTS: The mean age of the patients was 41 ± 13 years. Presumed sarcoid uveitis was diagnosed in 50 (7%) patients, presumed tubercular uveitis in 222 (29.4%) and other uveitic entities noted in 483 (64%). Intermediate and posterior uveitis were the most common anatomical diagnosis in presumed sarcoid uveitis (59% and 20%, respectively) and in presumed tubercular uveitis (46% and 38%, respectively). Elevated sACE was noted in 76% of presumed sarcoid uveitis and 46% in presumed tubercular uveitis. The combination of high serum angiotensin-converting enzyme along with lymphopenia was only in 17% in presumed sarcoid uveitis and 9.7% in presumed tubercular uveitis. sACE was found to be a significant risk factor for presumed sarcoid uveitis with an odds ratio of 3.603 (p < 0.002), and in presumed tubercular uveitis odds ratio was not significant with odds ratio of 1.19. Lymphopenia was not found to be a significant factor in both groups. CONCLUSION: Elevated sACE activity was an independent risk factor for presumed sarcoid uveitis over lymphopenia alone or in combination with lymphopenia.

Ocular manifestations of HLA B 27 associated uveitis: a study of 255 cases from a tertiary eye care centre from South India.

PURPOSE: To describe the clinical profile of HLA B-27-associated uveitis in Indian population. METHOD: We conducted a retrospective review of medical records of 431 eyes of 255 consecutive patients with HLA B-27-associated uveitis, presented to our institute between 2012 and 2017. RESULT: The study observed a male preponderance (75.7%) and the mean age of patients was 35.6 ± 13.3 years. A total of 412 (95.3%) eyes had anterior uveitis, 17(3.9%) eyes had anterior and intermediate uveitis and 3 eyes (0.7%) had intermediate uveitis. Retinal vasculitis was detected in four eyes (0.9%). A total of 176 patients (69%) in the study had evidence of systemic disease and 85% patients developed recurrences. In addition to the treatment with topical and oral steroid, immunosuppressive was required in 39.6% patients and 4% patients received biological therapy. The majority of the eyes (78.4%) had a good visual outcome, while 61 (14.2%) eyes had moderate visual impairment and 32 (7.4%) eyes had severe visual impairment at the time of final follow-up. CONCLUSION: HLA-B27-associated uveitis can be associated with higher number of posterior segment involvement than it is estimated and aggressive therapy in moderate-to-severe uveitis can prevent severe visual impairment in these patients.