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Intermediate uveitis in Indian population

PURPOSE: Intermediate uveitis (IU) is generally believed to be autoimmune in nature requiring systemic corticosteroid and immunomodulatory therapy. This belief stems from the published reports from the developed countries; and the scenario maybe different in the developing countries that maybe endem...

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Autores principales: Parchand, Swapnil, Tandan, Manjari, Gupta, Vishali, Gupta, Amod
Formato: Texto
Lenguaje:English
Publicado: Springer-Verlag 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102854/
https://www.ncbi.nlm.nih.gov/pubmed/21484178
http://dx.doi.org/10.1007/s12348-011-0020-3
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author Parchand, Swapnil
Tandan, Manjari
Gupta, Vishali
Gupta, Amod
author_facet Parchand, Swapnil
Tandan, Manjari
Gupta, Vishali
Gupta, Amod
author_sort Parchand, Swapnil
collection PubMed
description PURPOSE: Intermediate uveitis (IU) is generally believed to be autoimmune in nature requiring systemic corticosteroid and immunomodulatory therapy. This belief stems from the published reports from the developed countries; and the scenario maybe different in the developing countries that maybe endemic for certain infections. There are no large series available on the etiologic causes of intermediate uveitis from the developing countries. The present series aims to describe the etiology, treatment, and course of IU in North Indian population. METHODS: In a retrospective analysis, records of 205 patients seen with a referral diagnosis of IU were retrieved and analyzed. After determining the etiology, 122 patients who had a definitive diagnosis of IU and a minimum follow-up of 1 year were analyzed further. All patients underwent investigations to rule out any possible etiology and received stepwise therapy comprising of depot or systemic corticosteroids, immunosuppressive/immunomodulatory therapy and pars plana vitrectomy. Specific therapy was administered wherever etiology could be determined. The primary outcome measure was recurrence of inflammation after a minimum of 6 months of initiating treatment. RESULTS: There were 55 men and 67 women, and the disease was bilateral in 82 patients. Tuberculosis was the most common underlying etiology seen in 57 (46.7%), followed by sarcoidosis in 22 (18%), pars planitis in 35 (28.7%), and IU of idiopathic type in 8 (6.5%). Seventy three (59.8%) of 122 patients received systemic steroids, 55 (45.1%) were treated with periocular steroid, and 19 (15.6%) received immunomodulatory therapy. Specific antimicrobial therapy in the form of antitubercular treatment (ATT) was given in 42 patients. The recurrences were seen in 35 patients (28.7%) over a median follow-up of 18 months. Recurrences were seen more commonly in eyes with snow banking (P = 0.011); cystoid macular edema (P = 0.015), and in eyes that received local therapy (P = 0.001). Out of 57 patients who were diagnosed as intraocular tuberculosis, 42 patients (73.6%) received specific antitubercular treatment. Only 5 of 42 patients (11.9%) who received ATT had recurrence of inflammation compared to 7 out of 15 patients (46.7%) who did not receive ATT (P = 0.005). CONCLUSIONS: Tuberculosis is an important etiologic cause of IU in developing countries like India where the disease is endemic. It is important to investigate these patients as specific therapy with ATT helped in reducing the recurrences significantly.
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spelling pubmed-31028542011-07-14 Intermediate uveitis in Indian population Parchand, Swapnil Tandan, Manjari Gupta, Vishali Gupta, Amod J Ophthalmic Inflamm Infect Original Research PURPOSE: Intermediate uveitis (IU) is generally believed to be autoimmune in nature requiring systemic corticosteroid and immunomodulatory therapy. This belief stems from the published reports from the developed countries; and the scenario maybe different in the developing countries that maybe endemic for certain infections. There are no large series available on the etiologic causes of intermediate uveitis from the developing countries. The present series aims to describe the etiology, treatment, and course of IU in North Indian population. METHODS: In a retrospective analysis, records of 205 patients seen with a referral diagnosis of IU were retrieved and analyzed. After determining the etiology, 122 patients who had a definitive diagnosis of IU and a minimum follow-up of 1 year were analyzed further. All patients underwent investigations to rule out any possible etiology and received stepwise therapy comprising of depot or systemic corticosteroids, immunosuppressive/immunomodulatory therapy and pars plana vitrectomy. Specific therapy was administered wherever etiology could be determined. The primary outcome measure was recurrence of inflammation after a minimum of 6 months of initiating treatment. RESULTS: There were 55 men and 67 women, and the disease was bilateral in 82 patients. Tuberculosis was the most common underlying etiology seen in 57 (46.7%), followed by sarcoidosis in 22 (18%), pars planitis in 35 (28.7%), and IU of idiopathic type in 8 (6.5%). Seventy three (59.8%) of 122 patients received systemic steroids, 55 (45.1%) were treated with periocular steroid, and 19 (15.6%) received immunomodulatory therapy. Specific antimicrobial therapy in the form of antitubercular treatment (ATT) was given in 42 patients. The recurrences were seen in 35 patients (28.7%) over a median follow-up of 18 months. Recurrences were seen more commonly in eyes with snow banking (P = 0.011); cystoid macular edema (P = 0.015), and in eyes that received local therapy (P = 0.001). Out of 57 patients who were diagnosed as intraocular tuberculosis, 42 patients (73.6%) received specific antitubercular treatment. Only 5 of 42 patients (11.9%) who received ATT had recurrence of inflammation compared to 7 out of 15 patients (46.7%) who did not receive ATT (P = 0.005). CONCLUSIONS: Tuberculosis is an important etiologic cause of IU in developing countries like India where the disease is endemic. It is important to investigate these patients as specific therapy with ATT helped in reducing the recurrences significantly. Springer-Verlag 2011-02-23 /pmc/articles/PMC3102854/ /pubmed/21484178 http://dx.doi.org/10.1007/s12348-011-0020-3 Text en © The Author(s) 2011 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Original Research
Parchand, Swapnil
Tandan, Manjari
Gupta, Vishali
Gupta, Amod
Intermediate uveitis in Indian population
title Intermediate uveitis in Indian population
title_full Intermediate uveitis in Indian population
title_fullStr Intermediate uveitis in Indian population
title_full_unstemmed Intermediate uveitis in Indian population
title_short Intermediate uveitis in Indian population
title_sort intermediate uveitis in indian population
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102854/
https://www.ncbi.nlm.nih.gov/pubmed/21484178
http://dx.doi.org/10.1007/s12348-011-0020-3
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