Assessment of quality of life, psychosocial, and epidemiological aspects in patients diagnosed with tuberculous uveitis.

PURPOSE: To assess the quality of life in patients diagnosed as having tuberculous uveitis and its association with sociodemographic, clinical, and psychosocial aspects. METHOD: By conducting standardized interviews, clinical and demographic data were collected using a measure developed in this study. This measure was applied in addition to other measures, namely SF-12, Hospital Anxiety and Depression Scale, and NEI-VFQ-39, which were used to assess health-related quality of life, anxiety and depression symptoms, and visual functioning. RESULTS: The study included 34 patients [mean age: 46.5 ± 15.1 years, female patients: 21 (61.8%)]. The mean of the VFQ-39 score was 74.5 ± 16.6 and that of SF-12 physical and mental component scores were 45.8 ± 10.1 and 51.6 ± 7.5, respectively, for the health-related quality of life. Anxiety symptoms were the most prevalent compared with depression symptoms and were found in 35.3% of the participants. CONCLUSION: Tuberculous uveitis affects several scales of quality of life, thereby affecting a population economically active with a social, psychological, and economic burden.

Assessment of quality of life, psychosocial, and epidemiological aspects in patients diagnosed with tuberculous uveitis

ABSTRACT Purpose: To assess the quality of life in patients diagnosed as having tuberculous uveitis and its association with sociodemographic, clinical, and psychosocial aspects. Method: By conducting standardized interviews, clinical and demographic data were collected using a measure developed in this study. This measure was applied in addition to other measures, namely SF-12, Hospital Anxiety and Depression Scale, and NEI-VFQ-39, which were used to assess health-related quality of life, anxiety and depression symptoms, and visual functioning. Results: The study included 34 patients [mean age: 46.5 ± 15.1 years, female patients: 21 (61.8%)]. The mean of the VFQ-39 score was 74.5 ± 16.6 and that of SF-12 physical and mental component scores were 45.8 ± 10.1 and 51.6 ± 7.5, respectively, for the health-related quality of life. Anxiety symptoms were the most prevalent compared with depression symptoms and were found in 35.3% of the participants. Conclusion: Tuberculous uveitis affects several scales of quality of life, thereby affecting a population economically active with a social, psychological, and economic burden.

Role of Interferon-Gamma Release Assay for the Diagnosis and Clinical Follow up in Ocular Tuberculosis.

PURPOSE: To assess the performance of interferon-gamma release assay (IGRA) associated with tuberculosis skin test (TST) for ocular tuberculosis (OTB) diagnosis and therapeutic decision making. METHOD: One hundred and ninety-one patients with ocular inflammation were prospectively followed-up. Patients with clinical signs highly suspected of OTB, TST≥10 mm, and/or IGRA≥0.35 IU/mL received antitubercular therapy (ATT). Sensitivity (Se), specificity (Sp), and area under the curve (AUC) were assessed. RESULTS: Seventy-two (37.7%) patients received ATT for presumed OTB. Combining TST and IGRA had Se=89.6%, Sp=99.2%, and AUC (0.98) significantly higher compared to TST (0.85, Z=6.3, p<.001) or IGRA (0.95, Z=2.5, p=.01). Prior history of corticosteroids or immunosuppressant with concomitantly oral prednisone and baseline IGRA> 2.0 IU/mL was associated significantly with more recurrences in ATT patients (p=.01)      . CONCLUSION: Considering TST and IGRA together was more effective in assessing OTB diagnosis. The real value of the IGRA test to predict recurrences needs further studies.

Current Practices in Ocular Tuberculosis: A Survey of Brazilian Specialists.

Purpose: To describe the approach of Brazilian specialists in the diagnosis and treatment of tuberculosis-associated uveitis (TBU).Methods: Members of the Brazilian Uveitis Society received an electronic invitation to participate in an online questionnaire.Results: Of the 169 invited specialists, 78 answered the questionnaire. Specialists evaluated 5.6 patients with TBU annually. Tuberculin skin test (TST, 81%) was primarily used for diagnosis. Patients with presumed TBU should always be tested for syphilis and HIV according to 51 (88%) and 47 (81%) of respondents, respectively. Chest computed tomography (CT, 72%) was preferable to chest radiography (CXR) for diagnosis. A positive TST (81%) and CXR (60%) were the main indicators of anti-tuberculous therapy, with 34%, 39%, and 14% of specialists treating for 6, 9, and 12 months, respectively.Conclusions: TST remains the preferred method for TBU diagnosis and prompt treatment by Brazilian specialists, though there is no consensus regarding disease treatment and management.

Effectiveness of Treatments for Ocular Toxoplasmosis.

Purpose: To evaluate the effectiveness of treatments for ocular toxoplasmosis (OT).Methods: A review of charts was conducted from patients who experienced an active episode of OT treated at the Federal University of São Paulo and associated sites. OT charts were reviewed to determine treatment effectiveness based on clinical judgment, taking clinical course and outcome into consideration in addition to change in best-corrected visual acuity. Treatment emergent adverse events (TEAEs) were used to assess safety.Results: Overall, 451/1200 patient charts met the inclusion criteria. The most commonly prescribed treatment was trimethoprim + sulfamethoxazole (52.3%) followed by pyrimethamine + sulfadiazine (28%). Treatment was successful in 96.9% of patients. Irrespective of the treatment, active lesions were resolved in 63.9% of patients within 6 weeks. Vision improved in 56.3% of patients. The incidence of TEAEs was low (10%).Conclusions: All treatments were effective for active episodes of OT, with few side effects.

Comparison of clinical effects of two latanoprost 0.005% solutions (Xalatan® and Arulatan®) in primary open-angle glaucoma or ocular hypertensive patients: a randomized clinical trial.

Purpose: To evaluate the therapeutic non-inferiority between two ophthalmic latanoprost 0.005% solutions (Arulatan® [ALT] versus the reference drug Xalatan® [XLT]) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH). Patients and methods: This was a 12-week Phase IV, experimental, randomized, parallel-group, double-masked clinical trial. Consecutive patients with POAG or OH from the Glaucoma Service of Instituto Paulista de Estudos e Pesquisas em Oftalmologia (São Paulo, Brazil) were enrolled between July and December 2017. The primary outcome of the study was an analysis of therapeutic non-inferiority between ALT versus XLT at 12 weeks, while secondary outcomes were mean intraocular pressure (IOP) change from baseline at 2, 6 and 12 weeks, mean IOP at 2, 6 and 12 weeks, and topical and systemic side effects. Statistical significance was set at P<0.05. Computerized analysis was performed using the R software, version 3.4.4. Results: A total of 45 patients were randomized to the two treatment groups: ALT (22) and XLT (23). A statistically significant reduction in IOP from baseline was observed in both treatment groups at all timepoints, while no statistically significant difference between groups was detected. By week 12, observed IOP reduction was -7.95 and -7.89 mmHg in the ALT and in the XLT groups, respectively (P=0.60). Treatment difference between the ALT and the XLT groups was -0.06 mm Hg (95% CI: -0.97, 0.85) and fell within the interval set for therapeutic non-inferiority. There was no statistically significant difference between the two groups in terms of safety profiles. The most commonly reported side effect was mild conjunctival/palpebral hyperemia. Conclusion: ALT was considered non-inferior to XLT in achieving a statistically significant reduction in IOP at 12 weeks in POAG and OH patients. No significant difference in the occurrence of side effects was found between both groups.

Quality of Life and Psychological Aspects in Patients with Visual Impairment Secondary to Uveitis: A Clinical Study in a Tertiary Care Hospital in Brazil.

PURPOSE: To evaluate the quality of life in individuals with bilateral visual impairment secondary to uveitis and its association with sociodemographic, clinical and psychosocial aspects. METHODS: Data were collected through a structured interviews, using four forms; the SF-12v2, HADS, NEI-VFQ-25 and a specific form developed to collect clinical and sociodemographic data. RESULTS: 80 patients were included with a mean age of 42.8 years; 63.8% female; 57.5% with permanent reduction of familiar income. The average number of medical visits was 15.2 ±10.7/year. In terms of health-related quality of life (HRQol), the mean of VFQ-25 score was 36.6 ± 15.1 and the mean of SF-12 physical and mental components scores were 43.3 ± 9.9 and 44.9 ± 12.2. Anxiety and depression symptoms were found in 65.1% and 32.5% of patients, respectively. CONCLUSIONS: Visual impairment has impact on several scales of HRQoL leading to productivity loss and consumption of health resources.

Qualidade de vida de pacientes pseudofácicos submetidos à cirurgia de catarata com implante de lente intra-ocular acomodativa / Quality of life of pseudophakic patients with accommodative intraocular lens implant

OBJETIVO: Avaliar a função visual e satisfação dos pacientes submetidos à cirurgia de catarata com implante de lente intra-ocular acomodativa e o impacto na sua qualidade de vida. MÉTODOS: Retrospectivamente, foram avaliados questionários aplicados após um ano da cirurgia de 22 pacientes que foram incluídos num estudo clínico para avaliar segurança e eficácia de uma lente intra-ocular de silicone de câmara posterior designada para corrigir visão para longe e perto. RESULTADOS: Do total dos pacientes operados, 16 (73 por cento) eram bilaterais e 6 (27 por cento) unilaterais, com idade média de 70,2 anos. Dos pacientes com implante unilateral, 5 (83,3 por cento) declararam melhora acentuada da visão e 1 (16,7 por cento) referiu máxima melhora. Quanto ao nível de satisfação, 5 (83,3 por cento) ficaram satisfeitos e 1 (16,7 por cento) muito satisfeito com o resultado cirúrgico. A visão noturna foi declarada como sem dificuldade por 3 (50,0 por cento), pouca dificuldade por 2 (33,3 por cento) e dificuldade moderada por 1 (16,7 por cento). No grupo bilateral, 7 (43,8 por cento) consideraram excelente a qualidade da visão para perto, 7 (43,8 por cento) muito boa, 1 (6,2 por cento) adequada e 1 (6,2 por cento) ruim. A visão intermediária foi classificada como excelente por 6 (37,5 por cento), muito boa por 9 (56,3 por cento) e adequada por 1 (6,2 por cento). A qualidade da visão para longe foi considerada excelente por 9 (56,3 por cento), muito boa por 3 (43,8 por cento), adequada por 2 (12,5 por cento) e não muito boa por 2 (12,5 por cento). Em relação à visão noturna 9 (56,3 por cento) declararam não ter dificuldade alguma, 5 (31,2 por cento) pouca dificuldade e 2 (12,5 por cento) dificuldade moderada. CONCLUSÕES: Considerando a propriedade óptica da LIO, a maioria dos pacientes apresentou uma melhora considerável da função visual, sem a necessidade de correção óptica, e, portanto, com impacto positivo na qualidade de vida.