When and which second-line workup to perform for uveitis: a tertiary care center experience

Objective: Uveitis are inflammatory disorders of various etiologies. The first-line etiological workup is currently poorly codified, and some patients undergo sequential investigations. However, what leads the clinician to perform subsequent exams and the relevance of such exams remain to be determined. The main objective of the study was to evaluate the relevance and modalities of a second-line workup of patients with uveitis. Materials and Methods: We performed a monocentric retrospective study in Nancy University Hospital. All adult patients who underwent an etiological workup in the Internal Medicine Department between January 2014 and December 2021 were included. Results: Among the 247 patients included, 52 underwent a second-line workup, resulting in a modified diagnosis for 18 of them (34.6%), mainly sarcoidosis, intraocular lymphoma, and Crohn's disease. On multivariate analysis, a follow-up longer than 40 months and idiopathic uveitis were associated with the realization of a second-line workup (OR = 2.97 [1.58 - 5.61]; p = 0.001, and OR = 6.13 [2.3-16.1]; p < 0.01, respectively). The presence of synechia and ocular granuloma were associated with a modification of the diagnosis (OR = 8.03 [1.85-45.48]; p = 0.01, and OR = 5.14 [1.22-24.78]; p = 0.03, respectively). Conclusion: The second-line workup is relevant in up to one-third of patients, mainly if presenting with a modification of ophthalmological examination, synechiae, and a granulomatous feature, and should focus on intraocular lymphoma, sarcoidosis, and Crohn's disease. Larger studies are needed to provide guidelines for second-line workup.