BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the study:
“Uveitis” is one of the most common forms of intraocular inflammation. It includes a large group of intraocular inflammatory diseases of diverse etiology. It causes vision loss both directly through inflammation and via complications such as macular edema, glaucoma, cataract, and others. The variation in the spectrum of disease is largely due to complex geographic, ecological, racial, nutritional, and socioeconomic differences.
Anterior uveitis which can be categorized as iritis, anterior cyclitis and iridocyclitis is the most common type of all uveitic entities. It often causes a painful red eye. Acute anterior uveitis causes mild vision loss but still contributes significantly to the total burden. The precise cause of anterior uveitis is often obscure and the correct diagnosis is often challenging. The treatment for uveitis itself can result in both ocular and systemic complications. The morbidity associated with the disease is moderately high.
KIMS, Hubli being tertiary care hospital and major referral center we get fair number of cases of anterior uveitis per OPD.Hence in the study conducted every effort is made to establish the exact cause and accurate diagnosis in all the cases. Early institution of the treatment with monitoring is done for better results.
6.2 Review of literature:
Anterior uveitis is the commonest form of all uveitis (57.4%). Anterior uveitis has an incidence of roughly 17 cases per 100,000 population.1 On the basis of overall clinical presentation, acute unilateral, non-infectious and nongranulomatous forms occur more frequently. Idiopathic anterior uveitis is common in all age groups. Mean age at presentation is 38.3yr and commonly affects middle aged (17-59)yr. It is more common in males (61.3%) compared to females (38.6%).
Herpetic anterior uveitis (16.7%), lens induced uveitis (14.6%) and leprosy uveitis (4.9%) are more common in elderly population. Fuch’s heterochromatic uveitis (9.8%), uveitis associated with spondyloarthropathy (8.2%), herpetic uveitis(8.2%) and traumatic (7.8%) are common in middle aged 2.Ankylosing spondylitis(18.91%)is the most common cause for non-infective anterior uveitis and tuberculosis (7.9%) for infective anterior uveitis.3
HLA A9 and B27 is more common in acute anterior uveitis associated with Ankylosing Spondylitis(AS)4. It is sudden in onset and the inflammation is active in one eye, but the attacks tend to recur , often in the contralateral eye. Complete resolution within several months of the onset is the rule.
Tuberculosis is a well known cause of acute or chronic granulomatous anterior uveitis that may be associated with iris or angle granulomas with mutton fat keratic precipitates (KP’s) and posterior synechiae.5
Varicella zoster virus (VZV) typically causes unilateral acute anterior uveitis. The intensity of iris atrophy and pupil distortion, but not ocular hypertension , correlate with the viral load of VZV in the aqueous humour.6
Fuch’s heterochromic iridocyclitis (FHI) is a rare form of unilateral anterior uveitis which is characterised by diffuse, stellate KP’s and iris heterochromia. Bilateral diffuse stellate KP’s are a more specific sign.7 Any surgical intervention into the anterior chamber produces hemorrage and is termed Amsler’s sign.
The commonest form of anterior uveitis in leprosy is a chronic , low grade bilateral uveitis which produces minimal or no symptoms until late in the disease process. Acute anterior iridocyclitis is uncommon and occurs bilaterally.8
Vogt-Koyanagi-Harada (VKH) syndrome is reported to recur, typically as a recurrent anterior uveitis with or without recurrent posterior involvement.This is directly related to the failure to prescribe adequate corticosteroid therapy in the initial phase of the syndrome.9
Morbidity arises from iritis and any associated disease process, if present. Associated ocular complications (eg: cataract, glaucoma, macular edema) may result in severe vision loss.
Acute anterior uveitis is associated with lowest rate of complications and lower frequency of visual loss. Chronic anterior uveitis with iris changes has a higher frequency of complications and visual loss.10
The etiology of anterior uveitis is diverse and hence its differential diagnosis. The diagnosis depends on patient’s history, detailed clinical examination and laboratory investigations which are tailored accordingly.
Corticosteroids have long been the cornerstone of treatment. The principles for uveitis treatment espoused by the International Uveitis Study Group advise to use steroids aggressively as the first step on a step ladder algorithm through all routes necessary to achieve algorithm through all routes necessary to achieve resolution of the inflammation. A slow taper is important to help maintain the level of remission. Other available modalities of treatment are cycloplegics, NSAID’s and immunomodulators.
The medications used are not free of side effects, this necessitates close monitoring.11
6.3 Aims and Objectives:
Clinical study of anterior uveitis concerns with
Mode of onset- Acute, chronic or recurrent
Associated and precipitating factors
Investigations to establish the exact cause and accurate diagnosis.
The efficacy of the treatment to be given and prognosis.