Chronic severe uveitis - Etiology and visual outcome in 927 patients from a single center

To determine the infectious etiologies, associated conditions, and visual prognosis of patients with uveitis, we retrospectively analyzed the records of 927 consecutive patients with severe ocular inflammation defined as chronic or sight-threatening who were referred for diagnostic and/or therapeutic management between 1991 and 1996. A minimal follow-up of 2 years was required. The mean age at onset of uveitis was 37.1 years, and the female to male ratio was nearly 1. Most patients were Caucasian (92%). Uveitis was chronic in 81% of cases, associated with an initially reduced visual acuity in 21.1% of cases. The disease was unilateral in 58.7% and bilateral in 41.3% of cases. Panuveitis was the most common presentation (34.9%), followed by anterior (28.5%), posterior (21.6%), and intermediate uveitis (15%). An associated condition was determined in 67.5% of cases. Noninfectious uveitis and systemic diseases were associated in 24.9% of patients. Most patients required systemic high-dose steroids and/or immunosuppressive regimens (77.5%). Cystoid macular edema and cataract were the most common complications. Intraocular inflammation was controlled in 81% of the patients. Final visual acuity was less than 20/200 in 3.1% of bilateral and 9.7% of unilateral cases. The management of patients with severe and sight-threatening forms of uveitis is efficiently performed in collaboration with internal medicine physicians and depends on a complete diagnostic procedure and well-adapted treatment. As a result, the rate of blindness due to uveitis can be decreased.