Caracterización clínica-epidemiológica de las uveítis y su relación con la pérdida visual / Clinical-epidemiologic Characterization of Uveitis and its Relation to Visual Loss

Objetivo: Caracterizar clínica y epidemiológicamente las uveítis y su relación con la pérdida visual. Métodos: Se realizó un estudio observacional prospectivo y longitudinal de serie de casos en 137 pacientes, atendidos en la consulta de úvea del Hospital General Provincial "Carlos Manuel de Céspedes", desde febrero de 2015 hasta febrero del 2018. Se estudiaron las variables: sexo, edad, la clasificación anatómica de las uveítis, clasificación de las uveítis según lateralidad de las crisis, etiología, complicaciones oculares y pérdida visual. Se confeccionaron tablas y gráficos que expresaron los resultados en números absolutos y porcientos, además se emplearon la prueba de la ji al cuadrado de asociación y coeficiente phi de correlación. Resultados: Predominó la edad de 41 a 60 años (37,2 por ciento) y el sexo femenino (60,6 por ciento). Resultaron más frecuentes las uveítis anteriores unilaterales de causa infecciosa. La complicación más frecuente fue la catarata (25,8 por ciento). La mayoría de los pacientes presentaron pérdida visual, con predominio de la leve (36,5 por ciento). Existió asociación estadísticamente significativa entre la clasificación anatómica las de uveítis y la gravedad de la pérdida visual. Conclusiones: Los pacientes más afectados fueron las mujeres entre la cuarta y sexta década de vida. Predominaron los pacientes con uveítis anteriores unilaterales. Las infecciones fueron la causa más común, así como la catarata resultó la complicación más frecuente. La gravedad de la pérdida visual guardó relación directa con la clasificación anatómica de la uveítis(AU)

Objective: To clinically and epidemiologically characterize uveitis and its relation to vision loss. Methods: A prospective and longitudinal observational study of case series was performed in 137 patients, seen in the uvea consultation of the Carlos Manuel de Céspedes Hospital, from February 2015 to February 2018. The following variables were studied: gender, age, anatomical classification of uveitis, classification of uveitis according to laterality of the crisis, etiology, ocular complications and vision loss. Tables and graphs were prepared to express the results in absolute numbers and percentages, and the chi-squared test of association and the phi correlation coefficient were used. Results: Predominance was between 41 and 60 years of age (37.2 percent) and female sex (60.6 percent). Unilateral anterior uveitis of infectious cause was more frequent. The most frequent complication was cataract (25.8 percent). Most patients presented vision loss, with predominance of mild vision loss (36.5 percent). There was a statistically significant association between the anatomical classification of uveitis and the severity of vision loss. Conclusions: The most affected patients were females between the fourth and sixth decade of life. Patients with unilateral anterior uveitis predominated. Infections were the most common cause, and cataract was the most frequent complication. The severity of vision loss was directly related to the anatomical classification of uveitis(AU)

La uveítis y el glaucoma, un reto para el oftalmólogo / Uveitis and glaucoma, a challenge for ophthalmologists

La incidencia y la prevalencia de las uveítis varía alrededor del mundo, así como los agentes causales y el grupo de edad más afectado. De forma general, pueden asociarse a gran número de complicaciones oculares que originan marcada disminución de la visión, a veces de modo irreversible, e incluso pueden llevar a la ceguera de uno o de ambos ojos. Existe una asociación frecuente entre uveítis y glaucoma. La incidencia de glaucoma secundario a uveítis oscila sobre el 10 por ciento, con fluctuaciones relacionadas con su origen y la edad de presentación. Una parte de las uveítis cursa con hipertensión ocular más o menos marcada durante o después del proceso inflamatorio, lo que constituye un reto para el oftalmólogo, quien debe tratar simultáneamente dos entidades con terapéuticas prácticamente antagónicas. El tratamiento de la inflamación ocular está bien establecido; la hipertensión ocular debe ser tratada sobre la base de las características y el origen de cada entidad. Realizamos una revisión del tema por su importancia, así como de los elementos a tener en cuenta para un mejor resultado del tratamiento en estos pacientes. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

The incidence and prevalence of uveitis vary around the world, and so do its causative agents and most affected age group. In general terms, these may be associated to a large number of ocular complications which cause marked, at times irreversible vision reduction, and may even lead to vision loss in one or both eyes. An association is often found between uveitis and glaucoma. The incidence of glaucoma secondary to uveitis ranges around 10 percent, with fluctuations related to its origin and presentation age. A form of uveitis develops with more or less marked ocular hypertension during or after the inflammation process. This is a challenge for ophthalmologists, who should treat two conditions simultaneously with practically opposite therapies. The treatment for ocular inflammation is well established, whereas ocular hypertension should be treated according to the characteristics and origin of each condition. Due to its importance, we conducted a review of the topic, as well as of the elements to be borne in mind to obtain better treatment results. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

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.

Análise retrospectiva e caracterização epidemiológica dos casos de uveíte em hospital terciário / Epidemiological analysis of cases of uveitis in a tertiary Hospital

Resumo Objetivo: Analisar a distribuição dos casos de uveíte em pacientes atendidos no Setor de Uveíte do Serviço de Oftalmologia do Hospital Federal Servidores do Estado do Rio de Janeiro. Métodos: Estudo epidemiológico retrospectivo, transversal e descritivo pela análise de prontuários de 63 pacientes atendidos no Serviço de Oftalmologia do Hospital Federal dos Servidores do Estado do Rio de Janeiro, no Setor de Uveíte, no período de Março a Outubro de 2016. Resultados: A média de idade foi de 45,54 (±15,8), sendo 50,8% do sexo feminino e 49,2% do masculino. Uveítes anteriores corresponderam à 63,49% dos casos, intermediárias 1,58% posterior 19,04% e panuveíte 15,87%. Apenas 33,3% dos pacientes encontravam-se com processo inflamatório ativo no momento da avaliação. Cerca de 74,6% das uveítes tinham causas não infecciosas e em 12,69% não foi possível a determinação etiológica. A causa isolada mais frequente foi Espondilite Anquilosante, responsável por 28,57% dos casos. Demonstrou-se que 55,5% dos pacientes tinham acometimento bilateral e 71,14% apresentavam uveíte não granulomatosa. Conclusões: Estudos epidemiológicos que tratam de uveíte são, em geral, realizados em centros terciários de atendimento, que por vezes apresentam perfil etiológico destas inflamações intra-oculares diferente da população geral.

Abstract Objective: To analyze the distribution of uveitis in patients at Uveitis Sector of Federal Hospital of Servants of Rio de Janeiro State. Methods: Retrospective epidemiological study of 63 appointments performed by ophthalmologist of Uveitis Sector at Federal Hospital of Servants of Rio De Janeiro State, between March and October of 2016. Results: The mean age was 45.54 (±15.8). 50.5% were female. Anterior uveitis corresponded to 63.49%. Only 33.3% of patient had an active inflammation at the moment of medical avaliation. 74.6% of uveitis had non-infeccious causes, and in 12.69% the etiology could not be determined. Ankylosing spondylitis was the most frequent cause, responsible for 28.57% of cases. 55.5% of patients had a bilateral uveitis, and 71.14% non-granulomatous uveitis. Conclusions: Epidemiological studies about uveitis are usually made in terciary hospitals, which do not reflect the epidemiological profile of population in general.

Estudo da prevalência das uveítes em hospital oftalmológico terciário em Teresina, Piauí, Brasil / Study of the prevalence of uveitis in a tertiary ophthalmology hospital in Teresina, Piauí, Brazil

RESUMO Objetivo: analisar a prevalência das uveítes em pacientes atendidos em um serviço oftalmológico terciário em Teresina, Piauí. Métodos: estudo retrospectivo baseado em prontuários de pacientes atendidos nesse serviço. Foram descritos: gênero, faixa etária, procedência, doença de base, diagnóstico anatômico, aspecto clínico e tempo de evolução. Resultados: foram incluídos 403 prontuários constatando-se que a cada 1000 pacientes atendidos neste serviço, 3,2 tinham uveíte.A idade média dos pacientes foi de 42 anos, tanto o gênero feminino (50,6%) quanto o gênero masculino (49,4%) foram acometidos similarmente, com 61,5% dos pacientes provenientes da capital. A doença de base mais frequente foi a toxoplasmose, seguida das uveítes idiopáticas apenas com manifestações oculares. Quanto à classificação anatômica, 49,6% foram posteriores e 3,5% foram intermediárias. Em relação ao aspecto clínico, 64% foram granulomatosas, 24,8% não-granulomatosas e 11,2% não foram classificáveis. Segundo a evolução clínica, 41,4% foram agudas, seguidas de 30,8% crônicas, 14,4% recorrentes e em 13,4% os pacientes não foi feito o acompanhamento. Conclusão: pudemos constatar que para cada 1000 pacientes atendidos neste serviço 3,2 tinham uveíte, apresentando-se a toxoplasmose como importante fonte de uveíte neste serviço.

ABSTRACT Objective: To analyze the prevalence of uveitis in patients treated at a tertiary ophthalmic service in Teresina, Piauí State, Brazil. Methods: This was a retrospective study based on medical records of patients treated at this service. Sex, age, origin, underlying diseases, anatomical diagnosis, clinical aspects and progression time were described. Results: 403 records were included, noting that 3.2 out of every 1,000 patients treated at the service had uveitis.The average age of patients was 42 years old, with both sexes (50.6% females and 49.4% males) affected similarly, and with 61.5% coming from the state capital, Teresina. The most common underlying disease was toxoplasmosis, followed by idiopathic uveitis with ocular manifestations only. As to the anatomical classification, 49.6% of them were posterior and only 3.5% were intermediate. Regarding the clinical aspects, 64% were granulomatous, 24.8% non-granulomatous, and 11.2% were not classifiable. According to the clinical progression, 41.4% were acute, followed by 30.8% chronic, 14.4% recurrent cases, and 13.4% of patients did not return for medical care. Conclusion: we found that for every 1,000 patients treated at the service, 3.2 had uveitis, with toxoplasmosis itself found to be an important source of uveitis.

Iridociclitis heterocrómica de Fuchs: una uveítis subdiagnosticada / Fuchs heterochromic iridocyclitis: an underdiagnosed uveitis

Objetivo: caracterizar clínicamente 20 de casos de Iridociclitis Heterocrómica de Fuchs subdiagnosticados por su cuadro clínico. Metodología: estudio observacional, descriptivo y retrospectivo de reporte de 20 casos con evaluación clínica y registro fotográfico. Resultados: fueron evaluados 20 casos referidos a la consulta de uveítis por oftalmología general, de los cuales 13 fueron mujeres (65%) con una edad promedio al momento de la evaluación de 52 años (R= 33-80 años). Diecisiete casos tuvieron compromiso unilateral (85%) y 3 bilateral (15%) para un total de 23 ojos comprometidos. La uveítis fue clasificada como anterior en 20 ojos (86,95%), crónica en 20 ojos (86,95%) y no granulomatosa en el 100% de los casos. El tiempo promedio de evolución de la enfermedad fue de 82 meses (R= 4 - 240 meses), y el tiempo promedio de diagnóstico por especialista en uveítis fue de 1,75 meses (R=0-18 meses). El 100% de los pacientes consultaron por cambios en la agudeza visual, sin manifestación de ojo rojo o dolor. La agudeza visual inicial promedio fue de 20/40 (rango 20/1000-20/20), con una reacción inflamatoria de bajo grado con promedios por debajo de 1+ en todos los signos inflamatorios. La evidencia de precipitados queráticos estrellados difusos típicos se presentó en el 100% de los casos y en el iris se encontró heterocromía en un 50% (10 casos), atrofia del iris en 80% (18 casos) y nódulos (Koeppe y Busacca) en 8 ojos (34,78%). Como complicaciones asociadas se encontró catarata en 10 ojos (43.47%) y glaucoma en 8 ojos (34.78%). Conclusión: las características clínicas de la Iridociclitis Heterocrómica de Fuchs, especialmente lo discreto de sus síntomas y lo sutil de sus cambios biomicroscópicos, específicamente la heterocromía del iris que se sugiere como un marcador clínico importante de esta condición, han llevado a un subdiagnóstico o a un diagnóstico retardado de esta patología, siendo identificada en muchas ocasiones como cuadros de uveítis anterior sin etiología esclarecida y generando tratamientos crónicos con corticoesteroides que a la larga se convierten en factor de riesgo para complicaciones tales como catarata de presentación temprana y glaucoma.

Objetive: clinical characterization of 20 underdiagnosed cases of Fuchs Heterochromic Irido cyclitis. Methods: observational, descriptive and retrospective study report of 20 cases with clinical evaluation and photographic record. Results: a total of 20 cases referred to uveal specialist from general ophthalmology were evaluated. It was found that the group of women with 13 cases (65%) predominated with respect to men 7 cases (35%), the average age at evaluation was 52 years (range 33-80). Twenty three eyes were diagnosed, 17 cases were unilateral (85%) and 3 cases were bilateral (15%). 100% of patients complaint for changes in AV, without red eye or pain. Uveitis was classifi ed as anterior in 20 eyes (86,95%), chronic in 20 eyes (86,95%) and non-granulomatous in 23 eyes (100%). The average time evolution was found in 82 months (R 4-240 months), and the time of diagnosis by uveitis specialist was 1,75 months (0-18 months). Initial AV average found was 0.48 (0,02-1), with a low mean anterior chamber reaction cellularity of 0,80+ cells; fl are 0,69+, average cellularity at anterior vitreous of 0,26+ cells and vitreous opacity was 0,45+. Typical diffuse stellate keratic precipitates were present in 100% cases and heterochromia was found in 10 of cases (50%), iris atrophy in 18 cases (80%) and nodules (Koeppe and Busacca) in 8 eyes (34.78%). Th e average intraocular pressure was found in 15.74 mmHg. Cataract associated complications found in 10 eyes (43.47%) and glaucoma in 8 eyes (34.78%). Conclusión: clinical features in Fuchs Heterochromic Iridocyclitis, has discrete symptoms and subtle biomicroscopic changes; heterochromia is an important clinical marker of this condition, lack of identifi cation of this signs may delay the timely and proper diagnosis. This entity has been confused as anterior uveitis without known etiology and for this reason many ophthalmologists treat these cases with corticosteroids that eventually become a risk factor for complications such as early cataract and glaucoma.

Clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center in Brazil / Características clínicas e epidemiológicas das uveítes em um serviço de urgência oftalmológica no Brasil

Purpose: To analyze the clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center. Methods: We conducted a prospective, observational study of patients with active uveitis admitted between May 2012 and July 2012 to an emergency eye care center. Results: The majority of patients were male (63.2%), with a mean age of 43.2 years; 66.2% patients were of mixed ethnicity, 22.5% were Caucasian, and 11.3% were black. Anterior uveitis was observed in 70.1% patients, posterior uveitis in 26.5%, and panuveitis in 3.4%; no patient was diagnosed with intermediate uveitis. All patients had a sudden and acute presentation. The most frequent symptoms were ocular pain (76.9%), redness (59.8%), and visual blurring (46.2%). The majority of patients had unilateral disease (94.9%) with a mean symptom duration of 6.2 days. Diffuse and anterior uveitis were associated with ocular pain (p<0.001). Scotomata and floaters were more frequent in patients with posterior uveitis (p=0.003 and p=0.016, respectively). Patients with anterior uveitis presented with better visual acuity (p=0.025). Granulomatous keratotic precipitates were more frequent in patients with posterior uveitis (p=0.038). An etiological diagnosis based on the evaluation at the emergency center was made in 45 patients (38.5%). Conclusions: Acute anterior uveitis was the most frequent form of uveitis. Initial patient evaluation provided sufficient information for deciding primary therapy and aided in arriving at an etiological diagnosis in a considerable number of patients. .

Objetivo: Analisar as características clínicas e epidemiológicas das uveítes em um serviço de atendimento oftalmológico de urgência. Métodos: Estudo prospectivo, observacional de pacientes com uveíte ativa admitido entre maio e julho de 2012, em um serviço de atendimento oftalmológico de emergência. Resultados: A maioria dos pacientes eram do sexo masculino (63,2%) e a média de idade foi de 43,2 anos; 66,2% dos pacientes tinham etnia mista, 22,5% eram brancos e 11,3% negros. Uveíte anterior foi observada em 70,1% dos pacientes, uveíte posterior em 26,5%, e panuveíte em 3,4%, nenhum foi diagnosticado com uveíte intermediária. Todos os pacientes tiveram apresentação súbita e aguda. Os sintomas mais frequentes foram: dor ocular (76,9%), hiperemia conjuntival (59,8%) e baixa visual (46,2%). A maioria dos pacientes tinha doença unilateral (94,9%), com duração média dos sintomas de 6,2 dias. Uveítes anteriores e difusas foram associadas com dor ocular (p<0,001). Escotomas e a "floaters" foram mais frequentes na uveíte posterior (p=0,003 e p=0,016, respectivamente). Pacientes com uveíte anterior apresentaram melhor acuidade visual (p=0,025). Precipitados ceráticos granulomatosos foram mais frequentes em pacientes com uveíte posterior (p=0,038). Um diagnóstico etiológico com base na avaliação inicial no serviço de emergência foi possível em 45 pacientes (38,5%). Conclusão: A uveíte anterior aguda foi a uveíte mais frequentemente encontrada no serviço de urgência oftalmológica. A avaliação inicial do paciente forneceu informações suficientes para a conduta terapêutica primária, e possibilitou diagnóstico etiológico em um número considerável de pacientes. .

Visual impairment from uveitis in a reference hospital of Southeast Brazil: a retrospective review over a twenty years period / Deficiência visual em uveítes em hospital de referência da região sudeste do Brasil: uma revisão retrospectiva de 20 anos

PURPOSE: To identify the frequency and causes of uveitis leading to visual impairment in patients referred to the Low Vision Service - Department of Ophthalmology - UNIFESP, over a twenty years period. METHODS: In a retrospective study, medical records of 5,461 patients were reviewed. Data from the first clinical evaluation at the Low Vision Service were collected, patient's age, gender and cause of visual impairment were analyzed. Patients with uveitis had their chart reviewed for anatomical classification and clinical diagnosis. RESULTS: The mean age of the patients referred to the Low Vision Service was 42.86 years and the mean age of patients with uveitis diagnosis was 25.51 years. Retinal disorders were the most common cause of visual impairment (N=2,835 patients; 51.9%) followed by uveitis (862 patients, 15.7%). Uveitis was posterior in 792 patients (91.9% of uveitis) and toxoplasmosis was the most common diagnosis (765 patients, 88.7%). CONCLUSIONS: In our study, uveitis represents the second cause of visual impairment in patients referred for visual rehabilitation and toxoplasmic retinochoroiditis was the most common clinical diagnosis. It affects a young working age population with a relevant social and economic impact, but the early diagnosis and treatment can improve the quality of life of these patients.

OBJETIVO: Identificar a frequência e as causas de uveítes que resultam em deficiência visual, em pacientes encaminhados ao Serviço de Visão Sub-Normal do Departamento de Oftalmologia - UNIFESP, durante um período de 20 anos. MÉTODOS: Em um estudo retrospectivo foram revisados 5.461 prontuários. Foram coletados os dados da primeira avaliação clínica realizada no Setor de Visão Sub-Normal, que inclui idade do paciente, sexo e a causa da deficiência visual. Os registros clínicos dos pacientes com diagnóstico de uveíte foram revisados para classificação anatômica e diagnóstico. RESULTADOS: A média de idade dos pacientes encaminhados para o Setor de Visão Sub-Normal foi de 42.86 anos e a média de idade dos pacientes com diagnóstico de uveíte foi de 25.51 anos. As doenças retinianas foram as causas mais comuns de deficiência visual (N=2.835 pacientes; 51.9%), seguida por uveítes (N=862 pacientes, 15.7%). Foi observado uveíte posterior em 792 pacientes (91.9% dos casos de uveíte) e, dentre estes, toxoplasmose foi o diagnóstico mais comum (765 pacientes, 88.7%). CONCLUSÕES: Em nosso estudo, uveíte representa a segunda causa de deficiência visual nos pacientes encaminhados para reabilitação visual e retinocoroidite por toxoplasmose foi o diagnóstico clínico mais comum. Uveíte afeta uma população jovem e em idade laboral, portanto com relevante impacto social e econômico, mas o diagnóstico e tratamento precoce podem melhorar a qualidade de vida destes pacientes.

Frecuencia de alelos HLA de clase I y II en una cohorte de pacientes con espondiloartritis provenientes del noroccidente colombiano / Frequency of HLA alleles class I and II in a cohort of northwestern Colombian patients with spondyloarthritis

Introducción. Las espondiloartritis son enfermedades reumatológicas crónicas que afectan el esqueleto axial y las articulaciones periféricas, con varias manifestaciones extraarticulares. La asociación con el HLA-B27 sigue siendo uno de los vínculos más fuertes conocidos entre estas entidades y el complejo mayor de histocompatibilidad; sin embargo, la distribución mundial del HLA-B27 varía considerablemente y se han descrito asociaciones con genes no HLA-B27. Objetivo. Conocer la frecuencia de alelos HLA de clase I y II en pacientes con espondiloartritis provenientes del noroccidente colombiano y su frecuencia en las manifestaciones clínicas y radiológicas específicas. Materiales y métodos. Se condujo un estudio descriptivo, observacional, de corte transversal, retrospectivo y prospectivo entre 2005 y 2008 de 56 pacientes colombianos con espondiloartritis. Se identificaron los alelos correspondientes a los loci HLA de clase I y II (HLA-B, HLADQB1 y HLADRB). Se analizó su frecuencia con las manifestaciones clínicas axiales, periféricas, extraarticulares y radiológicas. Resultados. Se encontró una baja frecuencia de HLA-B27 en la población total (50 %), aunque fue el alelo más frecuente, junto con HLA-DRB4*01 (35,7 %) y HLA-DQB1*0501 (28,6 %), en todos los pacientes en general y en cada una de las manifestaciones clínicas y radiológicas. Se resalta la alta frecuencia de HLA-B27 y HLA-DRB4*01 (64,3 %) en pacientes con dactilitis, hallazgo novedoso sin previa descripción. Conclusión. Los alelos HLA-B27, HLA-DRB4*01 y HLA-DQB1*0501 fueron frecuentes en los diferentes subtipos de espondiloartritis y en las manifestaciones clínicas axiales, periféricas y extraarticulares específicas, además de la sacroiliítis radiológica.

Introduction. Spondyloarthritis is a chronic rheumatic disease that affect the axial skeleton and peripheral joints, along with several extra-articular manifestations. The association with HLA-B27 remains one of the strongest known links between these entities and the major histocompatibility complex. However, the global distribution of HLA-B27 varies considerably and furthermore, associations with non-HLA-B27 genes have been described. Objective. The frequency of HLA class I and II was determined in a population of patients with spondyloarthritis with respect to detection in the clinical setting and by radiology. Materials and methods. A descriptive, observational, cross-sectional, retrospective and prospective study was conducted in 56 patients from northwestern Colombia. Each was diagnosed with spondyloarthritis between 2005 and 2008. In each case, alleles were identified for the loci HLA class I and II (HLA-B; HLADQB1 and HLADRB). The frequency of these alleles in the axial, peripheral, extraarticular and radiological manifestations. Results.The frequency of HLA-B27 was 50% overall, and it was the most frequent allele. The two other alleles were HLA.DRB4*01 at 35.7% and HLA-DQB1*0501 at 28.6%, as detected in each of the clinical and radiological manifestations. A high frequency of HLA-B27 and HLA-DRB4*01 (64.3%) was noted in patients with dactylitis. Conclusion. The alleles HLA-B27, HLA-DRB4*01 and HLA-DQB1*0501 were common in the different subtypes of spondyloarthritis and were frequent in the specific clinical axial, peripheral and extraarticular clinical manifestations, as well as radiological sacroiliitis.

Patterns of uveitis in the Middle East and Europe

To compare the patterns of uveitis, emphasizing similarities and discrepancies, in the Middle East and Europe. Six articles reporting uveitis patterns from the Middle East including a total of 2, 693 cases, and seven articles with a sum of 4, 379 cases from Europe were analyzed and patterns in each region were defined and compared. In both regions, uveitis was most commonly seen in the fourth decade of life with anterior uveitis being the most common anatomical form. Idiopathic cases accounted for the majority of anterior and intermediate uveitis; toxoplasmosis was the most frequent entity in posterior uveitis while Behcet's disease and idiopathic forms were the next most common causes in the Middle East and in Europe, respectively. Since patterns of uveitis differ in various geographic regions, discovering these patterns would be helpful for the diagnosis and treatment of this broad category of conditions. This necessitates applying a universal diagnostic classification system to enable accurate comparisons

Ocular lesions in HTLV-1 infected patients from Salvador, State of Bahia: the city with the highest prevalence of this infection in Brazil / Lesões oculares em pacientes infectados pelo HTLV-1 em Salvador, Estado da Bahia: a cidade com maior prevalência desta infecção no Brasil

In order to determine the prevalence of ocular lesions in HTLV-1 infected patients in Salvador Bahia, a transversal study was conducted on 140 HTLV-1 infected patients (90 asymptomatic and 50 tropical spastic paraparesis/HTLV-1-associated myelopathy) between June 2004 and November 2005. The ophthalmological examination included visual acuity measurement, ocular motility, biomicroscopy of the anterior and posterior chambers, intraocular pressure and evaluation of lachrymal secretion. Observation verified 4 (2.8 percent) out of 140 patients with uveitis (two patients had intermediate uveitis and two had pan-uveitis) and 39 (36.4 percent) out of 107 patients with keratoconjunctivitis sicca. The prevalence of Keratoconjunctivitis sicca was significantly higher among the TSP/HAM patients (OR age adjusted=3.64; 95 percentCI 1.59-8.32). Uveitis and corneal opacities were also important findings, indicating the strong need for periodic ophthalmological follow-up in all HTLV-1 subjects.

Com o objetivo de determinar a prevalência de lesões oculares, em portadores de HTLV-1 em Salvador, Bahia, foi realizado um estudo transversal em 140 pacientes (90 assintomático e 50 com paraparesia espática tropical/mielopatia associada ao vírus linfotrópico de células T humanas) entre junho de 2004 e novembro de 2005. O exame oftalmológico incluiu medida da acuidade visual, exame da motilidade ocular, biomicroscopia anterior e posterior, pressão intraocular e avaliação do filme lacrimal. Observamos 4.0 (2.8 por cento) pacientes com uveites (dois com uveíte intermediária e dois com panuveíte) e 39 (36,4 por cento) pacientes com ceratoconjuntivite seca. A prevalência de Ceratoconjuntivite seca foi significantemente mais elevada entre os pacientes com TSP/HAM (RC ajustada para idade = 3,64; IC 95 por cento 1,59-8,32). As uveítes e opacidades corneanas foram também, patologias importantes, indicando a necessidade de acompanhamento oftalmológico periódico nos portadores de HTLV-1.

Tuberculous uveitis at a referral center in southeastern Brazil / Uveíte por tuberculose em um centro de referência no Sudeste do Brasil

OBJETIVO: Descrever a ocorrência de uveíte por tuberculose (UTB) em um centro de referência em Minas Gerais, Brasil. MÉTODOS: Um total de 16 pacientes (idade > 15 anos) atendidos consecutivamente de janeiro de 2001 a julho de 2004 no Centro de Referência de Uveíte do Estado de Minas Gerais para avaliação diagnóstica de uveíte foi selecionado para este estudo. Foram coletados dados demográficos e clínicos, assim como dados sobre avaliação para toxoplasmose, sífilis e doenças reumatológicas, teste tuberculínico e sorologia anti-HIV. RESULTADOS: Dos 16 pacientes, 11 (69 por cento) tinham UTB. História prévia de contato com tuberculose pulmonar foi relatada por 72 por cento (8/11) dos pacientes do grupo com UTB e por 20 por cento (1/5) dos pacientes do grupo sem UTB. Embora a razão de chances para essa associação tenha sido de 10,67 (IC95 por cento: 0,59-398,66), o valor de p apresentou significância limítrofe (0,078). Não houve diferença quanto ao quadro ocular inflamatório e ao resultado do teste tuberculínico entre os pacientes com UTB e os sem UTB. Todos os pacientes tinham sorologia negativa para o HIV e foram acompanhados por 2 anos. CONCLUSÕES: Neste estudo, a história prévia de contato com tuberculose pulmonar foi de grande ajuda para o diagnóstico da UTB.

OBJECTIVE: To describe the occurrence of tuberculous uveitis (TBU) at a referral center in the state of Minas Gerais, Brazil. METHODS: A total of 16 consecutive patients (>15 years of age) who underwent diagnostic evaluation of uveitis between January of 2001 and July of 2004 at the Minas Gerais State Referral Center were selected for study. Demographic and clinical data, as well as data related to screening for toxoplasmosis, syphilis, and rheumatologic diseases, together with the results of tuberculin skin testing and HIV testing, were collected. RESULTS: Of the16 patients evaluated, 11 (69 percent) were found to have TBU. A history of contact with pulmonary tuberculosis was reported by 8 (72 percent) of the 11 patients with TBU and by 1 (20 percent) of the 5 with non-TBU. Although the odds ratio for this association was 10.67 (95 percent CI: 0.59-398.66), the p value was borderline significant (p = 0.078). There was no difference between the patients with TBU and those with non-TBU in terms of the status of ocular inflammation or the tuberculin skin testing results. All of the patients were HIV negative and were monitored for two years. CONCLUSION: In this study, a history of contact with pulmonary tuberculosis proved to be useful in diagnosing TBU.

Striving for the perfect surgery in traumatic cataract following penetrating trauma in a tertiary care hospital at eastern Nepal.

This study analyzes the result of traumatic cataract surgery in a tertiary care hospital at eastern Nepal. It is a hospital-based study of 112 patients (age 15-62), who underwent cataract extraction for unilateral traumatic cataracts. The study was carried out to evaluate the surgical outcome of tramatic cataract. Thirty-eight eyes had associated posterior capsular defect. No serious postoperative complications were encountered. Posterior capsular opacification at the end of sixth week was evident only in two eyes. Best corrected visual acuity nof 6/18 or more at the eighth week was achieved in 61 (54%) eyes. Astigmatism of less than 3D was achieved in 82 (73%) eyes. Rational surgical approach in traumatic cataract provides encouraging results. To comment on actual outcome long term follow up is mandatory.

The incidence and clinical characteristics of the immune phase eye disease in treated cases of human leptospirosis.

BACKGROUND: Uveitis is increasingly being reported from south India following epidemics of leptospirosis. The incidence of eye involvement in treated patients has not been investigated properly in prospective studies. AIMS: To determine the incidence, clinical spectrum and risk factors for Leptospiral uveitis in antibiotic-treated patients. SETTINGS AND DESIGN: A prospective cohort study conducted among the patients treated for leptospirosis at Calicut Medical College between July and November 2002 and a seroprevalence study among sewage workers. Materials And Methods: As many as 360 patients admitted with suspected leptospirosis were studied by clinical examination, baseline ophthalmic survey, laboratory investigations and Leptospira serology (Microagglutination test - MAT; and IgM and IgG using ELISA) during the epidemic. Of the 282 seropositive and antibiotic-treated cases, 174 patients who completed 30 months of regular follow-up were analyzed. A cross-sectional serosurveillance also was performed among 50 sewage workers to determine the baseline MAT titer. Statistical Analysis: Univariate analysis and logistic regression. RESULTS: Thirty-two patients (18.4%) developed the eye disease during follow-up. The mean age was 43.9 years and the sex ratio was equal. Twenty-one patients (65.6%) had anterior uveitis. Only six patients (18.8%) had visual symptoms. Median duration for developing anterior uveitis was 4 weeks. Recurrent uveitis was not seen following treatment. None had vision-threatening eye disease. Clinical and laboratory abnormalities during the acute phase did not pose risk for development of the eye disease later. Forty-six sewage workers (92%) showed a MAT titer of 1/25. CONCLUSIONS: Uveitis is common following acute leptospirosis. Antibiotic-treated patients during the acute phase of illness developed only mild uveitis.

Global variation and pattern changes in epidemiology of uveitis.

Uveitis, a complex intraocular inflammatory disease results from several etiological entities. Causes of uveitis are known to vary in different populations depending upon the ecological, racial and socioeconomic variations of the population studied. Tropical countries are unique in their climate, prevailing pathogens and in the existing diseases, which further influence the epidemiological and geographical distribution of specific entities. We provide an overview of the pattern of uveitis of 15221 cases in 24 case series reported from several countries over 35 years (1972-2007) and we integrate it with our experience of an additional 8759 cases seen over six years (1996-2001) at a large community-based eye hospital. Uveitis accounted for 0.8% of our hospital-based outpatient visits. The uveitis was idiopathic in 44.6%, the most commonly identified entities in the cohort included leptospiral uveitis (9.7%), tuberculous uveitis (5.6%) and herpetic uveitis (4.9%). The most common uveitis in children below 16 years (616 patients; 7.0% of the total cohort) was pediatric parasitic anterior uveitis, (182 children, 29.5% of the pediatric cohort), whereas the most common uveitis in patients above 60 years (642 patients; 7.3% of the total cohort) was herpetic anterior uveitis, (78 patients, 12.1% of the elderly cohort). Etiologies varied with the age group of the patients. As in other tropical countries, a high prevalence of infectious uveitis was seen in this population.

Uveitis and anti nuclear antibody positivity in children with juvenile idiopathic arthritis.

This study was conducted to determine the frequency of antinuclear antibodies (ANA) positivity and uveitis in our newly diagnosed juvenile idiopathic arthritis (JIA) patients classified according to International League Against Rheumatology (ILAR) classification criteria. Ninety-two girls and 106 boys, totally 198 children were enrolled in the study. of them 36 (18.2 percent) were found to be ANA positive. Chronic anterior uveitis was detected in 20 (10.1 percent) patients. ANA positivity was determined in 4 of the systemic JIA patients, in whom no uveitis had been detected. Twenty-five of 37 patients with oligoarticular JIA were ANA positive, in 10 of them uveitis was also diagnosed. ANA were positive in 3 of 34 patients with RF positive polyarticulat JIA, only one patient had positive ANA, and another one had uveitis. Nine patients were extended JIA and in none of them, ANA positivity or uveitis were present. Of 43 patients classified as enthesitis related arthritis (ERA), uveitis was diagnosed in 6 and there was no evidence of ANA positivity, but one had uveitis. We conclude that the incidence of ANA positivity and uveitis is low in Turkish children with JIA.

Causas das uveítes em serviço terciário em São Paulo, Brasil / Causes of uveitis in a tertiary center in São Paulo city, Brazil

OBJETIVO: Analisar as causas das uveítes em pacientes atendidos no Serviço de Uveítes do HC-FMUSP no período de fevereiro a agosto de 2002. MÉTODOS: Realizou-se estudo retrospectivo baseado em prontuários de 262 pacientes que compareceram no serviço no período acima. Os seguintes dados foram analisados: idade, sexo, diagnósticos anatômico e etiológico, atividade da doença e complicações oculares. RESULTADOS: A idade média dos pacientes foi de 41 anos, sendo 60 por cento do sexo feminino e 40 por cento do masculino. O diagnóstico anatômico distribuiu-se em anterior (20 por cento), intermediário (4,5 por cento), posterior (39,7 por cento) e difuso (31,3 por cento). A etiologia foi determinada em 79,4 por cento dos casos, sendo os diagnósticos mais freqüentes toxoplasmose (22 por cento), síndrome de Vogt-Koyanagi-Harada (13 por cento) e doença de Behçet (10 por cento). Causas infecciosas foram observadas em 79 por cento das uveítes posteriores, ao passo que causas não infecciosas em 61 por cento das uveítes anteriores e 73 por cento das difusas. Foram observados alguns diagnósticos raros, tais como uveíte associada ao HTLV-I/II, síndrome do anticorpo antifosfolípide e retinopatia auto-imune. Quanto à atividade de doença ocular, a doença estava ativa em 15 por cento dos pacientes e inativa em 85 por cento. As complicações mais comuns foram catarata (42 por cento) e glaucoma (13 por cento). CONCLUSÕES: Estudos epidemiológicos podem refletir diferentes padrões de etiologia das uveítes; no entanto eles podem mostrar características particulares de cada centro (terciário, critério de diagnóstico, interesses específicos). O presente estudo demonstra a importância das uveítes endógenas (síndrome de Vogt-Koyanagi-Harada e doença de Behçet), assim como das uveítes infecciosas (toxoplasmose e toxocaríase) em nosso meio.

Neovascularização ocular em pacientes portadores de uveíte / Ocular neovascularization in patients with uveitis

A neovascularização ocular é uma complicação séria das uveítes. Parece que o nervo óptico e a retina são afetados numa maior frequência, embora neovasos podem crescer na íris, no corpo ciliar, e na coróide. Inúmeros fatores de crescimento neovascular e fatores inibitórios foram identificados in vitro. A neovascularização é um elemento do processo de cicatrização pós inflamatória em todas as partes do corpo, e continua durante o tempo que o estímulo angiogênico estiver presente. A neovascularização secundária a uveíte parece ser determinada pela gravidade da inflamação e pela presença de não perfusão retiniana / Ocular neovascularization is a serious complication of uveitis. The condition appears to affect the retina and optic disc most often, although new vessels may arise from the iris, ciliary body, and choroid as well. Numerous neovascular growth and inhibitory factors have been identified in vitro. Neovascularization is a fundamental element of the postinflammatory healing process in all parts of the body, and continues for as long as the appropriate angiogenic stimulus is present. Uveitic neovascularization appears to be determined by the severity of the inflammation and the presence of retinal nonperfusion. Neovascularization can be identified on clinical examination, but...