Intermediate uveitis in Indian population

Abstract

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.

Fig. 1

Recurrences in different etiologies. IU intermediate uveitis, IOTB intraocular tuberculosis

Fig. 2

Comparison of recurrences within IU with presumed TB group. ATT antitubercular treatment