COVID-19 vaccination, dengue hepatitis, and recurrent unilateral anterior uveitis

A 36-year-old Asian Indian male presented with redness and pain in his right eye of 1 week duration. He was diagnosed to have right acute anterior uveitis and had a history of being admitted at a local hospital for dengue hepatitis a month earlier. He had been on adalimumab 40 mg three weekly once and oral methotrexate 20 mg/week for human leucocyte antigen (HLA) B27 spondyloarthropathy and recurrent anterior uveitis. Our patient had re-activation of his anterior chamber inflammation on three distinct occasions: first, 3 weeks following recovery from coronavirus disease 2019 (COVID-19), the second after the second dose of COVID-19 vaccination, and the third after recovery from dengue fever-associated hepatitis. We propose molecular mimicry and bystander activation as the postulated mechanisms for the re-activation of his anterior uveitis. In conclusion, patients with auto-immune diseases can have recurrent ocular inflammation following COVID-19 or its vaccination or dengue fever as seen in our patient. The anterior uveitis is usually mild and responds to topical steroids. Additional immuno-suppression may not be needed. Mild ocular inflammation following vaccination should not deter individuals from getting COVID-19 vaccination.

Granulomatous anterior uveitis following mRNA-based COVID-19 vaccination: A case report

A 23-year-old patient presented with complaints of redness, pain, photophobia, and blurred vision in the right eye 15 days after she received the third dose of BNT162b2 vaccination. Ocular examination revealed 2+ cellular reactions in the anterior chamber and mutton fat keratic precipitate with no vitritis or retinal alterations. Active uveitis findings regressed with corticosteroid and cycloplegic eye drops. We present a case of unilateral granulomatous anterior uveitis following the BNT162b2 vaccination, with no etiologic factor in uveitis work-up and no previous history of uveitis before vaccination. This report demonstrates a potential causal association of coronavirus disease 2019 (COVID-19) vaccine with granulomatous anterior uveitis.

Research progress on the correlation between Helicobacter pylori and ocular diseases / 国际眼科杂志(Guoji Yanke Zazhi)

Helicobacter pylori is a common gram-negative bacterium, which is associated with a variety of gastroenteric diseases, such as gastritis, duodenal ulcer and gastric cancer. Recent studies suggested a potential role of Helicobacter pylori in the pathogenesis of common ocular diseases, such as central serous chorioretinopathy, glaucoma, anterior uveitis and ocular adnexal lymphoma. Helicobacter pylori might affect the pathophysiological process of ocular diseases through oxidative damage, circulatory disorders and immune injury. Some studies also suggested that eradication of Helicobacter pylori had certain effects on some ocular diseases. This review aims to summarize current evidence of the Helicobacter pylori in the pathogenesis of common ocular diseases, so as to encourage innovative approaches in the prevention and treatment of these ocular diseases.

Research progress of Posner-Schlossman syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

Posner-Schlossman syndrome(PSS)is a sporadic and recurrent self-limiting anterior uveitis, and its pathogenesis remains unclear. It was considered to be a prostaglandin-mediated inflammatory response. In recent years, it has been found to be related to viral infection, immune genetics, vascular endothelial dysfunction, and other factors. Clinically, the disease is predominantly unilateral. The patients with PSS suffer from increased intraocular pressure, mild pain in the affected eye, as well as blurred vision, and irisopsia. Seldom damage to the optic nerve and visual field was reported. The commonly treatment of PSS is local medication, such as anti-inflammatory drugs and intraocular pressure lowering drugs; otherwise systemic medication can be employed in severe cases. Surgical treatment can be performed for PSS if uncontrolled intraocular pressure elevation, frequent attacks, and optic nerve damage and visual field defect due to prolonged disease course. Early diagnosis and treatment of PSS can effectively reduce glaucoma-related damages. This review discussed the research progress of PSS from various aspects, aiming to provide references for the etiology, pathogenesis, and clinical diagnosis and treatment of this disease.

Snowball-associated ocular injury – An unusual presentation

Background: Snow ball associated ocular injuries are rare. We present the 1st case of a snow ball injury reported in India with symptoms occurring after 10 days. Purpose: To highlight the fact that symptoms can occur many days after the injury. The injuries can cause structural damage to ocular structures and can be permanent. Synopsis: A 25?year?old Asian Indian female presented with increased redness and blurring of vision of a day's duration. She had been playing in the snow and had an apparent injury to the right eye 10 days earlier. She had no symptoms at that point of time. Her uncorrected visual acuity by Snellen’s chart was 20/20 in both the eyes. Intraocular pressure was normal in both the eyes. On evaluation of the right eye she had traumatic anterior uveitis and mydriasis and the left eye was normal. There was no evidence of posterior segment involvement. She was treated with topical steroids and her anterior chamber inflammation improved but she had persistent mydriasis with no effect on her near vision. She was subsequently lost to follow after a month. Highlights: Rare case of ocular injury caused by a hurtling snow ball. Demonstration of anterior chamber inflammation with a video Infrared video imaging of the pupil in bright and dark showing anisocoria worse in bright light. Protective goggles are a must while indulging in these activities.

COVID-19 vaccination and recurrent anterior uveitis

A 35-year-old Asian Indian female previously diagnosed with bilateral anterior uveitis and on oral methotrexate developed bilateral anterior uveitis following first/second dose of coronavirus disease 2019 (COVID-19) vaccination. She had skipped her weekly dose of oral methotrexate following first dose of vaccination. Following the second dose, she reduced her oral methotrexate from 25 to 15 mg on her own, but did not stop like the previous occasion. She had extensive workup for her uveitis in the past with only positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) antibodies. She developed unilateral anterior uveitis after she had COVID-19 in July 2022, which resolved with topical steroids and continuation of immunosuppression. This report illustrates that COVID-19 or its vaccination may presumably play a role in triggering the immune system and can cause recurrent ocular inflammation even in the absence of an extraocular inflammation.

A STUDY OF CLINICAL AND ETIOLOGICAL PATTERN AND SEASONAL VARIATION IN THE INCIDENCE OF ANTERIOR UVEITIS AT A TERTIARY CARE CENTER

Purpose: The aim was to study the various pattern and any seasonal variation in the incidence of anterior uveitis at a tertiary care center. An observational study was conducted on 100 patients of all Methods: new uveitis cases who attended the OPD between January 2020 to December 2021 of a tertiary care center, J.L.N. medical college and hospital, Ajmer, Rajasthan. We grouped the months into winter, autumn, monsoon, spring and summer according to Indian weather. Cases were screened along with detailed clinical and laboratory investigation to ?nd out there clinical etiological causes. 100 Patients of uveitis were examined. There was male predominance (66%) with male to female Result: ratio 1.94:1. We found cases with unilateral (91%) uveitis to be more common, with more Right eye (48%) involvement. Majority (40%) of cases remained idiopathic. HLA-B27 (37%) was commonest association followed by lens induced and Tuberculosis. The incidence of uveitis in winter season (38%) followed by 33% in transitional season and 29% in summer. Non- Conclusion: infectious uveitis were more common. In Non-infectious uveitis, most common entity found to be Idiopathic and HLA-B27 associated whereas in infectious uveitis, ocular tuberculosis was found to be the leading cause. Seasonally uveitis were more in winter and less in summer

Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India

Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.

An analysis of the clinical profile of patients with uveitis following COVID-19 infection

Purpose: To describe the clinical profile of patients presenting with uveitis following COVID?19 infection at a tertiary care eye hospital in South India. Methods: In this retrospective chart review, all consecutive cases presenting with an acute episode of intraocular inflammation and a history of COVID?19 infection diagnosed within the preceding 6 weeks, between March 2020 and September 2021, were included. Data retrieved and analyzed included age, sex, laterality of uveitis, and site of inflammation. The diagnosis was categorized based on the SUN working group classification criteria for uveitis. Details regarding clinical features, investigations, ophthalmic treatment given, response to treatment, ocular complications, and status at last visit were also accessed. Statistical analysis of demographical data was done using Microsoft Excel 2019. Results: Twenty?one eyes of 13 patients were included in this hospital?based retrospective observational study. The study included six male and seven female patients. The mean age was 38 ± 16.8 years. Eight patients had bilateral involvement. Seven patients were diagnosed with anterior uveitis, three with intermediate uveitis, one with posterior uveitis, and two with panuveitis. All patients responded well to treatment and were doing well at their last visit. Two patients had complications that necessitated surgical treatment, following which they recovered good visual outcomes. Conclusion: With prompt diagnosis and appropriate management, all the patients with uveitis post?COVID?19 infection recovered with good visual outcomes. Thus, ophthalmologists must be aware of the possible uveitic manifestations following even uneventful COVID?19 infection

Serum IL-35 and TGF-β1 expression levels in patients with acute anterior uveitis and their clinical significance / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the changes of serum IL-35 and TGF-β1 expression levels and the correlation between them in patients with acute anterior uveitis, and to explore the clinical significance of IL-35 and TGF-β1 levels in patients with acute anterior uveitis.<p>METHODS: Thirty patients with acute anterior uveitis confirmed in the Department of Ophthalmology of Gansu Provincial Hospital into 2018-05/2019-05 were selected as the case group, and thirty healthy patients who received physical examination at the Gansu Provincial Hospital during the same period were selected as the control group. Serum IL-35 and TGF-β1 expression levels between the two groups were detected by Elisa. Modified endotoxin-induced uveitis(EIU)clinical standard was used for the severity of acute anterior uveitis. <p>RESULTS: Serum IL-35 and TGF-β1 expression levels in the acute anterior uveitis group were significantly higher than that in the healthy control group(all<i> P</i><0.05), and there was no significant correlation between serum IL-35 and TGF-β1 levels as well as the severity of acute anterior uveitis(<i>r</i>s=0.087, 0.044, all<i> P</i>>0.05). There was a significant positive correlation between serum IL-35 and TGF-β1 expression levels in patients with acute anterior uveitis(<i>r</i>s=0.637, <i>P</i><0.001).<p>CONCLUSION: The expression levels of IL-35 and TGF-β1 in serum are closely related to the occurrence and development of acute anterior uveitis and may play a synergistic role in immunosuppression in acute anterior uveitis.

Expression and significance of EPO and HIF-1α in serum and aqueous humor of patients with acute anterior uveitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To detect the expression of erythropoietin(EPO)and hypoxia-inducible factor-1α(HIF-1α)in serum and aqueous humor of patients with acute anterior uveitis(AAU), and to explore their clinical significance. <p>METHODS: From January 2018 to December 2020, 60 patients with AAU in our hospital were prospectively selected as the research objects, and 60 patients with proliferative vitreoretinopathy in the same period were taken as control(control group). The serum and aqueous humor of two groups were collected, enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of EPO and HIF-1α in serum and aqueous humor; the self-rating anxiety scale(SAS)and the self-rating depression scale(SDS)were used to evaluate the AAU patients, and the severity of the disease was scored; Pearson method was used to analyze the correlation between SAS score, SDS score and levels of EPO and HIF-1α in serum and aqueous humor, and the correlation between levels of EPO and HIF-1α in the serum and aqueous humor. Spearman was used to analyze the correlation between the disease severity score of AAU patients and the levels of EPO and HIF-1α in serum and aqueous humor. <p>RESULTS: Compared with the control group, the levels of EPO and HIF-1α in the serum and aqueous humor of the study group were higher(<i>P</i><0.01). Among AAU patients, 23 were negative of SAS score and 37 were positive, and 29 were negative of SDS score and 31 were positive. Compared with patients with negative SAS score, the level of HIF-1α in serum and the level of EPO in the aqueous humor were higher in patients with positive SAS score(<i>P</i><0.05); compared with patients with negative SDS score, the level of EPO in serum and the levels of EPO and HIF-1α in aqueous humor were higher in patients with positive SDS score(<i>P</i><0.01). There were 26 mild patients and 34 severe patients with AAU. Compared with mild patients with AAU, the levels of EPO and HIF-1α in serum and aqueous humor were increased in severe patients(<i>P</i><0.01). Pearson analysis showed that the SAS and SDS scores of AAU patients were not significantly correlated with the levels of EPO and HIF-1α in serum and aqueous humor(<i>P</i>>0.05), there was a positive correlation between EPO and HIF-1α in serum(<i>P</i><0.05), and between EPO and HIF-1α in aqueous humor(<i>P</i><0.05). Spearman analysis showed that the disease severity score of AAU patients was positively correlated with the levels of EPO and HIF-1α in serum and aqueous humor(<i>P</i><0.05). <p>CONCLUSION: EPO and HIF-1α are highly expressed in serum and aqueous humor of AAU patients, and they are closely related. The two are closely related to the disease severity score, and should be paid attention to clinically.

Changes and clinical significance of serum interleukin-9 and other T helper cell-related cytokines in patients with acute anterior uveitis / 中华实验眼科杂志

Objective:To explore the role of interleukin (IL)-9 and other T helper (Th) cell-related cytokines in the pathogenesis of acute anterior uveitis.Methods:A cross-sectional study was conducted.Thirty-six patients (36 eyes) with acute anterior uveitis who were treated at Gansu Provincial Hospital from May 2018 to May 2019 and 40 matched healthy subjects (40 eyes) who had no eye diseases or systemic diseases in the same period were enrolled as the acute anterior uveitis group and healthy control group, respectively.The disease severity of the subjects in the acute anterior uveitis group was graded and the subjects were divided into mild, moderate and severe groups according to the grading.Serum of all subjects was collected to determine the concentration of serum IL-9, IL-17, transforming growth factor-β 1 (TGF-β 1), interferon-γ (IFN-γ), IL-4, IL-35 and IL-22 by enzyme linked immunosorbent assay (ELISA) method.Spearman rank correlation analysis was used to evaluate the relationship between IL-9 concentration and other Th cell-related cytokines.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Gansu Provincial Hospital (No.2019-204). Written informed consent was obtained from each subject prior to any medical examination. Results:The serum levels of IL-9, IFN-γ, IL-4, TGF-β 1, IL-35 and IL-22 in the acute anterior uveitis group were significantly higher than those in the healthy control group, and the differences were statistically significant (all at P<0.05). There was no statistically significant difference in the concentration of IL-17 between the two groups ( U=704.500, P=0.872). The IL-9 concentration of patients with acute anterior uveitis in the mild, moderate and severe groups was 57.24 (47.47, 65.10), 71.68 (67.55, 78.91) and 114.01 (74.78, 139.30) ng/L, respectively, and the overall difference was statistically significant ( Z=8.766, P=0.012), and the IL-9 concentration of the mild group and the moderate group was significantly lower than that of the severe group (both at P<0.05). The concentration of IL-9 in the patients with acute anterior uveitis was positively correlated with the concentration of IL-17, TGF-β 1 and IL-35 ( rs=0.449, 0.517, 0.400; all at P<0.05), and no significant correlations were found between the concentration of IL-9 and the concentration of IFN-γ, IL-4 and IL-22 ( rs=0.293, 0.286, 0.316; all at P>0.05). Conclusions:IL-9 plays a role in promoting the immune inflammatory response in the occurrence and development of acute anterior uveitis, and it is closely related to Th17 and Treg cell-related cytokines (TGF-β 1, IL-35).

Evaluation of factors for predicting risk of uveitis recurrence in Behcets disease patients

This study aimed to investigate the predictive factors for uveitis recurrence (UR) risk in Behcet's disease (BD) patients. BD patients (n=164) with a history of uveitis were recruited, and demographic data, clinical features, and laboratory tests were recorded. Uveitis was defined as anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis referring to the "International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease". In total, there were 70 UR patients and 94 non-UR patients. Compared to non-UR patients, UR patients appeared to be older and presented with increased uveitis occurrence rate and times within 3 months, oral ulcers occurrence rate, as well as higher concentrations of triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), and serum amyloid A (SAA). Multivariate logistic model disclosed that uveitis occurrence times within 3 months, oral ulcers, TG, LDL, and SAA independently predicted higher risk of UR. Furthermore, receiver operating characteristic curve analysis showed that the combination of uveitis occurrence times within 3 months, oral ulcers, TG, LDL, and SAA exhibited a high predictive value for UR risk with an area under the curve of 0.983 (95%CI: 0.969−0.998). In conclusion, uveitis occurrence times within 3 months, oral ulcers, TG, LDL, and SAA might be potential predictive factors for UR risk in BD patients, which can help in prevention and management of the disease.

Clinical Presentation And Quality Of Life In Patients With Acute Anterior Uveitis Associated With Seronegative Spondyloarthropathies

Aim of the study. To characterize clinical features and quality of life in patients with acute anterior uveitis (AAU) associated with seronegative spondyloarthropathies (SpA). Material and Methods. 68 SpA patients with or without AAU were included in the prospective clinical study. VF-14 questionnaire, macula OCT, lens opacities using LOCS III were assessed. Results. Macula was thicker in uveitic (279.31 (53.64) μm) compared to fellow eyes (261.52 (43.714) μm), p<0.05. More patients without AAU were treated with methotrexate, p<0.05. VF-14 values differed between LOCS III grade P1 (93.29 (11.21)) and P3 (80.36 (8.18)); C1 (92.79 (11.79)) and C2 (85.92 (17.17)) and C3 (74.05 (11.89)); NO1 (92.06 (14.17)) and NO3 (84.82 (9.22) scores), p<0.05. Conclusions. Maculae thickness in uveitic eyes was increased. More patients without AAU were treated with methotrexate. VF-14 scores were lower for patients with higher LOCS III grade and recurrent AAU.

The Effect of Tumor Necrosis Factor-Alpha Inhibitors on Uveitis in Patients with Ankylosing Spondylitis

BACKGROUND: Tumor necrosis factor-alpha (TNF-α) inhibitors (TNFis), which are the main treatment for ankylosing spondylitis (AS), have been reported not only to reduce the incidence of anterior uveitis (AU) but also to induce it, and these effects differ among the various types of TNFis in clinical use. The present study investigated the effect of TNFis on uveitis by analyzing the long-term clinical course of AU in AS patients treated with TNFi therapy. METHODS: Patients treated with at least one TNFi between January 2007 and July 2017 were reviewed, and 54 patients with at least one episode of AU were included in this study. The TNFis included anti-TNF-α antibodies (adalimumab, infliximab, and golimumab), and a soluble TNF receptor molecule (etanercept). The effect of prevention of AU, the likelihood of new-onset uveitis after the initiation of TNFi therapy, and the effects of drug switching and dose escalation were assessed. RESULTS: The first uveitis flare was observed before TNFi therapy in 39 patients and after TNFi therapy in 15 patients. Anti-TNF-α antibodies were more efficacious in decreasing the recurrence of AU than etanercept. Among patients in which uveitis first occurred after beginning TNFi therapy, patients on etanercept tended to first develop AU less than 1 year after starting the drug, and their AS tended to be well-controlled at the time of uveitis flares. Patients with a uveitis flare before their medication was switched did not recur afterwards, and five of eight patients showed no relapse after dose escalation. CONCLUSION: TNFis have various effects on AU. TNFis, particularly anti-TNF-α antibodies, should be considered in patients with AS and frequent AU relapse. Additionally, clinicians should consider whether AU is due to an absence of a therapeutic response of AS to TNFi treatment or to TNFi treatment itself, and appropriate treatment changes should be made accordingly.

Active uveitis induces transient refractive error changes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the impact of active uveitis on refractive error changes.<p>METHODS: A prospective cohort study was conducted on 66 patients(88 eyes)with active uveitis. The subjects were classified based on the anatomical location of their disease activity as anterior, intermediate, posterior and pan-uveitis. Cycloplegic refraction was performed in both active and quiescent phases, and the results were compared. <p>RESULTS: Spherical changes in active anterior non-granulomatous uveitis resulted in an average of -0.25(0.77)D(95%<i> CI</i>: -0.5 to 0)shift toward myopia(<i>P</i>=0.039)and in active intermediate uveitis, an average of +0.39(0.8)D(95% <i>CI</i>: 0.09-0.69)shift toward hyperopia(<i>P</i>=0.003). Spherical equivalent changes in active intermediate uveitis resulted in hyperopic shift \〖+0.43(0.94)D, 95% <i>CI</i>: 0.08-0.79, <i>P</i>=0.005\〗. Cylinder had only significant changes in pan-uveitis \〖-0.3(0.39)D, 95% <i>CI</i>: -0.58 to -0.02, <i>P</i>=0.043\〗. In multivariate analysis, we noted that course of disease activity(acute versus recurrent)and anatomical location of disease activity had statistically significant effects on spherical equivalent changes(<i>P</i>=0.003 and <i>P</i>=0.004, respectively).<p>CONCLUSION: Active uveitis has a significant effect on the refractive status of the eye, the changes of which depend on the inflamed anatomical area.

An unusual occurrence of stromal keratitis in dengue fever

Dengue is a mosquito-borne infection endemic in the tropical and subtropical regions of the world. Classic dengue fever is a self-limiting, influenza-like illness transmitted by Aedes aegypti mosquito. Ophthalmic manifestations though rare can involve both the anterior and posterior segments and are usually associated with the thrombocytopenic state. However, ophthalmic complications such as anterior uveitis and vasculitis suggest immune-mediated pathogenesis. Herein, we report a rare case of stromal keratitis and an unusual occurrence of simultaneous bilateral blindness following dengue fever in a young girl.

Análise da frequência de uveítes em pacientes com espondiloartrites, suas complicações e associação com parâmetros clínicos da doença / Analysis of the frequency of uveitis in spondyloarthritis patients and associations with clinical parameters of the disease

Resumo Objetivo: A uveíte anterior aguda é a principal manifestação extra-articular na espondiloartrite. O objetivo deste estudo foi analisar se a presença da uveíte se associa com diferentes manifestações clínicas, laboratoriais, radiológicas e a terapêutica nos pacientes com espondiloartrite. Métodos: Estudo observacional retrospectivo realizado com 153 pacientes portadores de espondiloartrite atendidos no período de 1997 a 2017 na Grande Florianópolis, Brasil. Foram analisados dados demográficos, laboratoriais, clínicos e do tratamento de pacientes com espondiloartrite em relação a presença ou não de uveíte. Resultados: A uveíte foi encontrada em 26,8% dos pacientes. A presença de complicações foi rara, ocorrendo catarata em somente quatro pacientes e glaucoma em dois deles. Foi observada uma tendência a maior frequência de uveíte anterior aguda no sexo masculino (p=0,06), nos pacientes com história familiar (p=0,19) e HLA-B27 positivos (p=0,14). Pacientes com espondiloartrite e uveíte mais frequentemente usavam anti-TNF (p=0,04) e apresentavam sacroiliite em exames de imagem (p=0,02). Não observou-se associação entre a uveíte e o acometimento cardiovascular (p=0,44), cutâneo (p=0,13) ou gastrointestinal (p=0,10). Conclusão: A uveíte que ocorre em pacientes com espondiloartrite é comum, tem predomínio no sexo masculino e é mais frequente em pacientes com HLA-B27 positivo. O uso de imunobiológicos como o anti-TNF é frequente nos pacientes com uveíte.

Abstract Objective: Acute anterior uveitis (AAU) is the most common extra-articular manifestation of spondyloarthritis. The aim of this study is to analyze if the presence of uveitis is associated with a diferent clinical manifestation, laboratorial, radiological and therapetiuc among spondyloarthritis patients. Methods: This was a observational retrospective study with 153 patients with spondyloarthritis attended in the period from 1997 to 2017 in Florianopolis, Brazil. It was analyzed demografical, laboratorial, clinical and therapeutic data in spondyloarthritis patients with or without uveitis. Results: 26,8% of the patients with spondyloarthritis presented uveitis. The presence of complications was rare, with cataract occurring in only four patients and glaucoma in two of them. A higher frequency of acute anterior uveitis in males (p = 0.06) was observed in patients with a family history (p = 0.19) and HLA-B27 positive (p = 0.14). Patients with spondyloarthritis and uveitis more frequently used anti-TNF (p = 0.04) and presented sacroiliitis on imaging tests (p = 0.02). There was no association between uveitis and cardiovascular (p = 0.44), cutaneous (p = 0.13) or gastrointestinal involvement (p = 0.10). Conclusion: Uveitis in patients with spondylarthritis is common, predominantly in males, and more frequently in HLA-B27 positive patients. The use of immunobiological agents such as anti-TNF is common in patients with uveitis.

Presumptive Diagnosis of Recurrent Herpes-induced Anterior Uveitis with Acute Hypopyon

PURPOSE: We report an unusual case of presumptive diagnosis of herpes-induced anterior uveitis with acute hypopyon after trauma. CASE SUMMARY: A 82-year-old male was diagnosed with herpes keratitis due to dendritic keratitis in the left eye, and the lesion disappeared after antiviral treatment. However, 1 year later, the patient visited again with visual loss, pain, and tearing of the left eye after trauma. At the examination, best-corrected visual acuity was counting fingers and the intraocular pressure was 27 mmHg in the left eye. Slit-lamp examination revealed corneal epithelial erosion, moderate corneal edema, and prominent inflammation with 2 mm high hypopyon in the anterior chamber. We thought that bacterial endophthalmitis had rapidly progressed after trauma, so we performed bacterial cultures and an intravitreal antibiotics injection. Considering the clinical manifestations of lesions and herpes keratitis in the past, we could not exclude herpes virus infection. Cultures were negative and the symptoms improved, so the antiviral treatment was gradually reduced and stopped at 2 months. However, recurrence was observed on day 5 after stopping antiviral therapy. We therefore assumed that recurrent herpes virus caused anterior uveitis, and then, antiviral and steroid therapy was resumed. The patient subsequently showed improvement in his symptoms and recovered his visual acuity. CONCLUSIONS: When acute hypopyon is observed in the anterior chamber after trauma, not only bacterial iritis and endophthalmitis but also viral-induced anterior uveitis should be considered in the differential diagnosis.