Multiple sclerosis-associated uveitis in Persian population, a multicenter study

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-10-20 DOI:10.1016/j.msard.2024.105947

Pasha Anvari , Sahba Fekri , Alireza Hedayatfar , Hora Heidari , SeyedehMaryam Hosseini , Saeed Khamesi , Kosar Kohandel , Zahra Mahdizad , Masoud Soheilian , Mohammad Zarei , Hanieh Niktinat , Nazanin Ebrahimiadib

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Abstract

Purpose

To report the characteristics of multiple sclerosis-associated uveitis (MSU) among the Persian population.

Patients and methods

Retrospective, nonrandomized, multicenter study. Epidemiological characteristics, ocular and neurologic findings, angiographic features, and visual outcomes in MSU were studied.

Results

92 patients (173 eyes) were included; the mean age at the time of uveitis onset was 35.9 ± 10.9 years (range; 10–60 years), 84.8 % were female, and 88.0 % had bilateral involvement. The anatomical subgroups were isolated anterior uveitis (AU) in 12.0 %, intermediate uveitis (IU) with or without AU in 84.8 % and pure retinal vasculitis in 3.3 % of patients. None of the patients were defined as having posterior or panuveitis. Uveitis had an insidious onset and chronic course in 89.1 % patients and was of granulomatous type in 81.9 %. The diagnosis of MS precedes uveitis onset in 48.8 % patients (range 1 to 35 years, median: 7 years) and was concurrent or after the uveitis onset in 52.2 % patients (range; 1 to 12 years; median: 2 years). Undifferentiated intermediate uveitis was the most common initial diagnosis (30.4 %) before MS establishment. 89.1 % of patients received at least one conventional immunotherapy agent. Peripheral retinal perivascular leakage (81.4 %) and optic disc hyperfluorescence (74.4 %) were the two most common fluorescein angiography (FA) findings The major causes of visual impairment were cataracts (52.7 %), cystoid macular edema (CME) (31.5 %), and optic neuritis (29.2 %). During an average follow-up time of 4.76 ± 3.18 years (range: 1–12 years), visual acuity improved –0.09 logMar/year and most eyes maintain relatively good visual acuity.

Conclusion

MSU usually presents as chronic granulomatous bilateral IU and less often isolated AU, especially in females. Retinal vasculitis can be a prominent feature. Clinically, it may resemble Undifferentiated intermediate uveitis . In geographical areas where MS is prevalent, the indication of neuroimaging should be expanded and include patients presenting with chronic granulomatous IU or AU especially if accompanied by retinal vasculitis.

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一项多中心研究：波斯人群中的多发性硬化症相关葡萄膜炎。

目的：报告波斯人群中多发性硬化症相关葡萄膜炎（MSU）的特征：回顾性、非随机、多中心研究。研究内容包括流行病学特征、眼部和神经系统检查结果、血管造影特征以及 MSU 的视力结果：共纳入 92 名患者（173 只眼）；葡萄膜炎发病时的平均年龄为（35.9 ± 10.9）岁（范围：10-60 岁），84.8% 为女性，88.0% 为双侧受累。在解剖亚组中，12.0%的患者为孤立的前葡萄膜炎（AU），84.8%的患者为伴有或不伴有前葡萄膜炎的中间葡萄膜炎（IU），3.3%的患者为纯视网膜血管炎。没有一名患者被定义为后葡萄膜炎或泛葡萄膜炎。89.1%的患者葡萄膜炎起病隐匿，病程慢性，81.9%为肉芽肿型。48.8%的患者在葡萄膜炎发病前被诊断出多发性硬化症（病程1至35年，中位数：7年），52.2%的患者在葡萄膜炎发病时或发病后被诊断出多发性硬化症（病程1至12年，中位数：2年）。未分化的中度葡萄膜炎是 MS 确诊前最常见的初始诊断（30.4%）。89.1%的患者至少接受过一种常规免疫疗法。周围视网膜血管周围渗漏（81.4%）和视盘高荧光（74.4%）是两种最常见的荧光素血管造影（FA）结果，视力受损的主要原因是白内障（52.7%）、囊样黄斑水肿（31.5%）和视神经炎（29.2%）。平均随访时间为 4.76 ± 3.18 年（范围：1-12 年），视力改善幅度为-0.09 logMar/年，大多数患者的视力保持相对较好：结论：MSU通常表现为慢性肉芽肿性双侧IU，孤立性AU较少见，尤其是女性。视网膜血管炎可能是一个突出特征。临床上，它可能类似于未分化中间葡萄膜炎。在多发性硬化症流行的地区，神经影像学检查的适应症应扩大到慢性肉芽肿性 IU 或 AU 患者，尤其是伴有视网膜血管炎的患者。

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.