Sharief, LAT; (2016) Local and systemic factors impacting on visual outcome in uveitis. Doctoral thesis , UCL (University College London).

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Abstract

Uveitis is the fourth most common cause of blindness among the working age group in developed countries. The aim of this research is to examine the influence of diabetes mellitus, cataract surgery, and retinal vasculitis on the visual outcome and prognosis of eyes with uveitis. The studied cohort included 1169 patients with uveitis attending Moorfields Eye Hospital between January 2012 and December 2013. The first study divided uveitis cases with diabetes into two groups; the first group included 99 eyes with diabetes diagnosed prior to uveitis. The second group included 96 eyes with uveitis later diagnosed with diabetes. Within the first group, 28.2% had vision loss mainly from maculopathy with the risk of vision loss 4.6 times higher when compared to the control group of non-diabetic uveitis group. The diagnosis of diabetes in the second group was associated with a drop in the mean vision over the year post diagnosis. The mean dose of corticosteroid was lower post diagnosis (15 mg versus 10 mg, p=0.03), and relapses were significantly less often treated with systemic corticosteroid alone (70.2% vs. 55.6% of the relapses, p=0.003). The second study included 236 eyes with retinal vasculitis (121 ischaemic, 115 non- ischaemic) which was compared to non-vasculitis control group (1022 eyes). Macular ischaemia increased the risk of vision loss in vasculitis by 4.4 times. Retinal vasculitis had twice the risk of macular oedema compared to non-vasculitis. Macular oedema and ischaemia increased risk of vision loss in ischaemic vasculitis while corticosteroids reduce the risk by 30%. Retinal ischaemia involving ≥ 2 quadrants was associated with increased risk of NV formation. The third study included 228 uveitic eyes undergone cataract surgery and was compared to a control group of 300 phakic eyes with uveitis. The vision continued to improve from the baseline first postoperative week. However, risk of vision loss and CMO were twice more in the pseudophakic group compared to the control. The rate of uveitis relapse and rate of using high dose of corticosteroids was significantly lower postoperatively versus preoperatively.

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