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.

Clinical profile and management with immunosuppressants and biologics in Behcet's uveitis: A cohort of 25 patients from a tertiary eye care center in South India.

Purpose: To report the clinical profile of Behcet's disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in South India. Methods: This was a retrospective, observational study. Records of 45 eyes of 25 patients between January 2016 and December 2021 were retrieved from the hospital database. Complete ophthalmic evaluation and systemic examination by the rheumatologist with appropriate investigations had been done. Results were analyzed using Statistical Package for the Social Sciences (SPSS) software. Results: Males (19, 76%) were found to be more affected than females (6, 24%). Mean age of presentation was 27.68 ± 11.08 years. Twenty patients had bilateral involvement (80%), and unilateral involvement was seen in five patients (20%). Seven eyes of four patients (16%) had isolated anterior uveitis, out of which one patient had unilateral and three patients had bilateral involvement. Twenty-six eyes of 16 patients (64%) had posterior uveitis, out of which six patients had unilateral and 10 had bilateral involvement. Twelve eyes of seven patients (28%) had panuveitis, out of which two patients had unilateral and five had bilateral involvement. Hypopyon was seen in five eyes (11.1%) and posterior synechiae in seven eyes (15.55%). Posterior segment findings included vitritis (24.44%), vasculitis (17.78%), retinitis (17.78%), disc hyperemia (11.11%), and disc pallor (8.89%). Steroids alone were given in five patients (20%) and intravenous methylprednisolone (IVMP) was given in four patients (16%). Immunosuppressive agents along with steroids were given in 20 patients (80%), of which azathioprine alone was given in seven patients (28%), cyclosporin alone was given in two patients (8%), mycophenolate mofetil alone was given in three patients (12%), combination of azathioprine and cyclosporin was given in six patients (24%), and combination of methotrexate and mycophenolate mofetil was given in one patient (4%). Biologics were given in 10 patients (40%) - adalimumab in seven patients (28%) and infliximab in three patients (12%). Conclusion: Behcet's disease is an uncommon uveitis in India. Addition of immunosuppressants and biologics to conventional steroid therapy gives better visual outcomes.

Prevalence, clinical profile, investigations, and visual outcome of sarcoid intermediate uveitis in a tertiary eye care center in South India.

Purpose: To report the prevalence, clinical profile, investigations, and visual outcomes of sarcoid intermediate uveitis in a tertiary eye care center in South India. Methods: Retrospective, observational case series. Records of 29 patients with sarcoid intermediate uveitis were retrieved. Complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done. Results were analyzed using SPSS software. Results: Mean age group was 42.14 ± 11.31 years. The bilateral presentation was more common and females were more affected than males. Anterior chamber cells and flares in 22.4% of cases (N = 11 eyes), posterior synechiae in 20.4% (N = 10 eyes), and both small and mutton fat keratic precipitates in 14.2% of cases (N = 7 eyes) were noted; only one eye had Busacca nodules similar to other granulomatous uveitis. Cystoid macular edemas were present in three eyes. Treatment with oral steroids and systemic immunosuppression resulted in good visual recovery. The mean presenting visual acuity in right and left eye were 0.2 and 0.3, respectively. The mean final visual acuity in right and left eye was 0.1 and 0.3, respectively. Conclusion: Sarcoid intermediate uveitis is quite common in a tuberculosis endemic country like India. A complete review of systems with appropriate investigations is essential to prevent visual complications.