Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Feb;262(2):575-582.
doi: 10.1007/s00417-023-06270-3. Epub 2023 Oct 19.

Demyelinating plaque-associated uveitis

Alireza Hedayatfar  1   2 , Pasha Anvari  3 , C P Herbort Jr  4   5 , Soon-Phaik Chee  6   7   8
Affiliations
Observational Study

Demyelinating plaque-associated uveitis

Alireza Hedayatfar et al. Graefes Arch Clin Exp Ophthalmol. 2024 Feb.

Abstract

Purpose: To report the clinical and fluorescein angiographic (FA) features of demyelinating plaque-associated uveitis (DPU), a subset of uveitis in which patients have demyelinating plaques on the brain/cervical magnetic resonance image (MRI) but do not meet the criteria for multiple sclerosis (MS).

Methods: In this retrospective observational study, Persian Patients were diagnosed with DPU and included if (1) they never satisfied the MS criteria, (2) all other possible etiologies were excluded, and (3) they were followed for at least 2 years.

Results: After a median follow-up of 3 years (interquartile range, 2.0-5.3), 8 out of 40 (20%) patients diagnosed with DPU were excluded as they subsequently met the MS criteria. Of remaining 32 patients studied, the mean age was 36.3±9.9 (range 20-56 years), and 30 (93.8%) were female. Twenty-four (75.0%) showed bilateral involvement and 27 (84.4%) had insidious-chronic course. Uveitis was classified as intermediate (with or without anterior uveitis) in 29 (90.6%) and isolated anterior in 3 (9.4%) patients. Nine (28.1%) patients had at least one systemic neurological complaint. Ocular findings were: granulomatous keratic precipitates in 43/44 (97.7%) eyes; snowballs in 25/52 (48.1%) eyes; snowbanks in 4/52 (7.7%) eyes; cystoid macular edema in 20/56 (35.7%) eyes; and optic neuritis in 5/56 (8.9%) eyes. Visual acuity was ≥ 20/40 in 39 eyes (69.6%) at presentation which improved to 46 eyes (81.2%) at 2-year follow up. The two most frequent findings in FA were optic disc leakage/staining in 44/52 (81.5%) eyes, and peripheral retinal perivascular leakage in 39/52 (76.9%) eyes, which in 14/52 (26.9%) eyes extended beyond the equator.

Conclusion: DPU usually presents as a bilateral chronic granulomatous intermediate and, less often, isolated anterior uveitis, especially in females. Most are neurologically asymptomatic. Visual outcome is generally favorable. In FA, peripheral retinal perivascular leakage is common. DPU patients have an increased tendency to develop MS and should be prohibited from anti-TNF treatment.

Keywords: Fluorescein angiography; Multiple sclerosis; Retinal vasculitis; Uveitis, anterior; Uveitis, intermediate.

PubMed Disclaimer

References

    1. Casselman P, Cassiman C, Casteels I et al (2021) Insights into multiple sclerosis-associated uveitis: a scoping review. Acta ophthalmologica 99(6):592–603. https://doi.org/10.1111/aos.14697 - DOI - PubMed
    1. Messenger W, Hildebrandt L, Mackensen F et al (2015) Characterisation of uveitis in association with multiple sclerosis. Br J Ophthalmol 99(2):205–209. https://doi.org/10.1136/bjophthalmol-2014-305518 - DOI - PubMed
    1. Bosch X, Saiz A, Ramos-Casals M, BIOGEAS Study Group (2011) Monoclonal antibody therapy-associated neurological disorders. Nature reviews. Neurology 7(3):165–172. https://doi.org/10.1038/nrneurol.2011.1 - DOI - PubMed
    1. Mohan N, Edwards ET, Cupps TR et al (2001) Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides. Arthritis Rheum 44(12):2862–2869. https://doi.org/10.1002/1529-0131(200112)44:12%3c2862::aid-art474%3e3.0.... - DOI - PubMed
    1. Kemanetzoglou E, Andreadou E (2017) CNS Demyelination with TNF-α blockers. Curr Neurol Neurosc Rep 17(4):36. https://doi.org/10.1007/s11910-017-0742-1 - DOI

Publication types

Substances

LinkOut - more resources