The Usefulness of Aqueous Fluid Analysis for Epstein–Barr Virus in Patients with Uveitis

Purpose: To determine characteristics of patients with laboratory findings indicative of intraocular Epstein–Barr-virus (EBV) infection and to establish the usefulness of the laboratory analysis in patients with uveitis. Methods: Retrospective study of patients who underwent diagnostic aqueous fluid analysis. Diverse demographic data of patients were registered. Results: EBV-PCR tested positive in 3/201 (1%) and EBV-GWC in 22/245 (9%). The prevalence of immunosuppression was similar in EBV positive (by PCR/GWC) and EBV negative patients (7/25; 28% vs. 50/272;18%, P = 0.29). Out of all 22 EBV-GWC positive patients, GWC was between 3 and 10 in 91%. In total, 14 patients had laboratory results indicating only EBV infection. Patients without an alternative explanation for uveitis (6/14; 43%) had a chronic recurrent course and good visual prognosis. Conclusion: Low EBV-GWC values combined with multiple positive GWC and/or PCR for other infectious agents. Intraocular assessment for EBV in the initial examination of uveitis patients has limited value

Relevance of erythrocyte sedimentation rate and C-reactive protein in patients with active uveitis

Purpose: To relate erythrocyte sedimentation rates (ESR) and C-reactive protein (CRP) values to different uveitis entisties. Methods: A retrospective study of patients with a first episode of active uveitis visiting the Erasmus University Medical Center, uveitis clinic, Rotterdam, the Netherlands, was performed. Levels of ESR and CRP were determined within 2 weeks and 1 week after onset of uveitis, respectively. Uveitis had to be of unknown origin at that moment. The specific etiologic groups were related to ESR and CRP values. Results: The majority of patients with uveitis had ESR and/or CRP values within the normal limits and no association of ESR and/or CRP with the specific cause of uveitis was observed. However, elevation of ESR ≥ 60 mm/h and/or CRP ≥ 60 mg/L was mostly seen in patients with systemic immune-mediated diseases (8/59, 14% of all with immune-mediated diseases) or systemic infectious causes (7/38, 18% of all infectious uveitis). Patients with ocular toxoplasmosis typically exhibited normal ESR and CRP (9/11, 82%) while patients with endogenous endophthalmitis had elevated ESR and/or CRP in 6/7, 86%. Sarcoidosis-associated uveitis showed predominantly elevated ESR (13/24, 54%; range 20–59 mm/h in 11/13, 85%). Human immunodeficiency virus–positive patients had more often elevated ESR values when compared to the remainder of patients (9/11, 82% vs. 64/163, 39%, 18%, P = 0.009). The cause of uveitis was established in 19/20 (95%) of patients with ESR ≥ 60 mm/h and/or CRP ≥ 60 mg/L. Conclusions: The majority of patients with first attack of uveitis had ESR and CRP within the normal limits. Elevated levels of ESR and CRP reflected systemic involvement and high levels of both values were associated with established uveitis cause

Prevalence of Positive QuantiFERON-TB Gold In-Tube Test in Uveitis and its Clinical Implications in a Country Nonendemic for Tuberculosis

Purpose: To report on the prevalence and clinical implications of positive QuantiFERON-Gold (QFT-G) test results in the diagnostic evaluation of a large cohort of consecutive patients with uveitis in the Netherlands. Design: Retrospective cross-sectional study. Methods: This study included 710 consecutive patients who all underwent evaluation for uveitis including QFT-G testing. The ocular features, comorbidity, and abnormalities in diagnostic imaging and laboratory tests were registered for QFT-G–positive patients with uveitis. Results: Of all patients, 13% (92/710) were positive for QFT-G. Previously treated tuberculosis (TB) was documented in 2 patients. Of all 92 QFT-G–positive patients, culture-proven active TB was observed in 1 case. The proportion of patients with uveitis of unknown etiology was higher in QFT-G–positive than in the QFT-G–negative patients (54/92, 59% vs 238/618, 39%; P = .0004). The uveitis features of QFT-G–positive patients were mainly nonspecific. Of all QFT-G–positive patients with uveitis, 17 patients had chest imaging changes suggesting either TB or sarcoidosis. Twenty-nine QFT-G–positive patients with otherwise unexplained uveitis completed antituberculous therapy (29/710; 4% of all included patients) with beneficial effect in most cases. Conclusion: The QFT-G tested positive in 13% of patients with uveitis in the Netherlands, whereas only sporadic patients had a documented previous or active TB infection. The proportion of patients with unexplained uveitis was higher in QFT-G–positive patients. Though the association between uveitis and a positive QFT-G test might be coincidental, the majority of treated QFT-G–positive patients with otherwise unexplained severe uveitis cause had a beneficial response to antituberculous therapy

Ocular Involvement in Sarcoidosis

Ocular involvement in sarcoidosis occurs in ∼40% and the eye is the presenting organ in roughly 20%. The course of ocular disease does not necessarily parallel that of systemic disease. Uveitis is the most common presentation and shows mainly a chronic course; anterior uveitis is associated with better visual prognosis than posterior localization. Painful bilateral anterior granulomatous uveitis most commonly occurs in black patients at younger age, while painless posterior bilateral involvement with peripheral multifocal choroiditis is commonly seen in elderly white females. Patients with posterior uveitis develop often ocular complications and central nervous system involvement. Vitritis, segmental periphlebitis, choroidal granulomas, and peripheral multifocal chorioretinitis are often seen clinical features. Optic nerve involvement is uncommon, but if present, results often in poor visual outcome. Lacrimal gland and conjunctival involvement are also common and present clinically as dry eyes or remain asymptomatic with good visual prognosis. Sarcoidosis-associated uveitis is mostly managed by local treatment with steroid drops or periocular and intraocular steroid injections or with novel intraocular corticosteroid implants. Patients with sight-threatening disease or optic nerve involvement need systemic therapy. Systemic therapy is based on a step-up regimen where corticosteroids are used in the initial phase of the disease and if long-term treatment is required, steroid-sparing immunomodulatory drugs are implemented such as methotrexate or biological agents. Despit