Triggering factors associated with a new episode of recurrent acute anterior uveitis

To identify triggering factors for the next inflammatory episode of recurrent acute anterior uveitis (RAAU), a 1:1 case–control study was conducted. We interviewed RAAU patients with recent acute anterior uveitis attack and quiescent controls for their information during a previous month using Srithanya Stress Test (ST-5) and questionnaires about potential triggering factors. Asymptomatic controls were matched for age (± 5 years), sex, and HLA-B27. There were 39 pairs of cases and controls. Patients who recently experienced a uveitis attack demonstrated higher mean ST-5 scores (3.7 ± 2.9 vs 0.7 ± 1.1) and shorter sleep time (6.3 ± 1.4 vs 7.4 ± 0.7 h per day) compared with their controls. In the multivariate conditional logistic regression analysis, ST-5 score ≥ 3 (OR 9.07, 95% CI 1.14–72.16, p = 0.037) and sleep time < 7 h per day (OR 12.12, 95% CI 1.37–107.17, p = 0.025) were more likely to trigger a uveitis attack in RAAU accounted for patients’ age, sex, HLA- B27 positivity, and presence of concurrent anti-inflammatory drugs for co-existing diseases. Other suspected triggering factors were not found to have any significant association. In short, stress and inadequate sleep may lead to the future episode of acute anterior uveitis in RAAU. Both physical and emotional stress management should be advised to RAAU patients to minimize recurrences and further complications.

Triggering Factors Associated With a New Episode of Recurrent Acute Anterior Uveitis

To identify triggering factors for the next inflammatory episode of recurrent acute anterior uveitis (RAAU), a 1:1 case-control study was conducted. Patients with recent acute anterior uveitis and matched controls were interviewed using Srithanya Stress Test (ST-5) and questionnaires about potential triggering factors. Asymptomatic controls were matched for age (±5 years), sex, and HLA-B27. There were 39 pairs of cases and controls. Within 1-month before the interview, patients who recently experienced a uveitis attack demonstrated higher mean ST-5 scores (3.7±2.9 vs 0.7±1.1) and shorter sleep time (6.3±1.4 vs 7.4±0.7) compared with their controls. In the multivariate conditional logistic regression analysis, ST-5 score ≥3 (OR 9.17; 95%CI 1.15-72.84, p=0.036) and sleep time <7 hours per day (OR 11.57; 95% CI 1.42-94.55, p=0.022) were more likely to trigger a uveitis attack in RAAU accounted for age, sex, and HLA-B27 positivity of the patients. Other suspected triggering factors were not found to have any significant association. In short, emotional stress and inadequate sleep are the major triggering factors that lead to the future episode of acute anterior uveitis in RAAU. Both physical and emotional stress management may be helpful to minimize recurrences and further complications.

Prevalence, risk factors and management of ocular hypertension or glaucoma in patients with Vogt-Koyanagi-Harada disease

Background/aimsThis study was performed to examine the prevalence, risk factors and treatment outcome of OHT/glaucoma in Chinese patients with Vogt-Koyanagi-Harada (VKH).MethodsRetrospective non-interventional case series were conducted on a total of 2281 patients with VKH referred from April 2008 to April 2019. Of these cases, 1457 had a minimum follow-up period of 3 months and were included for this study. Medical records were reviewed for demographic, ocular and treatment data.ResultsAmong 2914 eyes of 1457 patients with VKH, 695 (23.9%) eyes of 425 patients (29.2%) developed OHT/glaucoma. The risk factors of OHT/glaucoma included initial BCVA of 20/200 or worse (OR=4.826), final best-corrected visual acuity (BCVA) of 20/50–20/100 (OR=5.341) and final BCVA of 20/200 or worse (OR=4.235), the interval between uveitis attack and referral time interval being 2 months or more (OR=3.318), more than three recurrent episodes (OR=4.177) and posterior synechiae (OR=1.785). The main possible mechanisms of OHT/glaucoma were inflammatory factor-induced open-angle OHT/glaucoma in 277 eyes (39.9%) and pupillary block arising from complete posterior synechiae in 201 eyes (28.9%). In these 695 eyes with OHT/glaucoma, normalised intraocular pressure (IOP) was achieved in 389 eyes (56.0%) following medical treatment. In the remaining 306 eyes, various surgical interventions were performed and a normalised IOP could be achieved in 249 eyes (81.4%).ConclusionOHT/glaucoma is a common complication in Chinese patients with VKH. Risk factors of OHT/glaucoma included worse acuity at first and final visits, the longer interval between uveitis attack and referral, more recurrent episodes and posterior synechiae.

Lymphopaenia as a predictor of sarcoidosis in patients with a first episode of uveitis

Background/aimsThe diagnostic properties of conventional diagnostic tests (ACE and chest radiography) for sarcoidosis-associated uveitis are not ideal. The diagnostic value of lymphopaenia for sarcoidosis-associated uveitis is investigated.MethodsA retrospective study of 191 consecutive patients with a first uveitis episode visiting the ophthalmology department (Erasmus Medical Center, Rotterdam, The Netherlands). Receiver operating characteristics (ROC) analysis was performed and compared with known ROC values from literature of conventional diagnostic tests for sarcoidosis-associated uveitis. An ideal cut-off was determined for lymphopaenia by calculation of the highest Youden index.ResultsOut of all patients with first uveitis attack, 32/191 or 17% were subsequently diagnosed with biopsy-proven or radiological diagnosis of sarcoidosis. Lymphopaenia (<1.5×109/L) was significantly more often observed in patients with sarcoidosis-associated uveitis compared with patients with non-sarcoidosis-associated uveitis (p<0.05). The sensitivity and specificity of lymphopaenia was 75 % and 77 %, respectively. The optimal cut-off for lymphopaenia for diagnosing sarcoidosis-associated uveitis was 1.47 ×109/L. Lymphopaenia resulted in a 12.0 (95% CI 4.7 to 30.5 fold risk for having sarcoidosis, corrected for sex, race and age at onset of uveitis in patients with a first uveitis attack.ConclusionLymphopaenia is a non-invasive and useful marker for diagnosing sarcoidosis-associated uveitis.