Clinical Profile and Ocular Morbidities in Patients with Both Diabetic Retinopathy and Uveitis

Purpose

To describe the clinical profile and complications of diabetic retinopathy (DR) and uveitis in patients with coexisting conditions and to derive associations based on site of primary inflammation, stage of DR, and complications of each.

Design

Single-center, cross-sectional observational study.

Participants

Sixty-six patients with coexisting DR and uveitis.

Methods

Electronic medical records of 66 such cases were evaluated. The demographic data, diabetic status, clinical characteristics, and complications of DR and uveitis on the final follow-up were recorded.

Main Outcome Measures

Associations between best corrected visual acuity (BCVA), prevalence of various stages, and complications of DR among eyes with and without uveitis, and correlation between the intensity and primary sites of inflammation among eyes with proliferative and nonproliferative changes.

Results

Of the 132 eyes, all had DR and 97 eyes had uveitis (35 unilateral and 31 bilateral cases). Mean age of patients was 53.4 ± 8.7 years, duration of diabetes was 10.5 ± 6.9 years, and duration of uveitis was 61.3 ± 68.8 months. Of uveitis patients, 54.6% had anterior uveitis (AU), 20.6% had intermediate, 10.3% posterior, and 14.4% panuveitis. Forty-nine point five percent of eyes had proliferative DR (PDR) changes. There was a higher proportion PDR cases among anterior (56.6%), posterior (70%), and panuveitis (64.3%), with difference in AU cases approaching statistical significance (P = 0.067). Conversely, significant (P < 0.001) intermediate uveitis cases had nonproliferative changes (80%). Final BCVA was significantly poorer in the group with uveitis (P = 0.045). The proportion of fibrovascular proliferations, tractional detachments. and iris neovascularization among proliferative retinopathy eyes with uveitis (14.6%, 18.8%, and 12.5% respectively) was higher than those without uveitis (5.3%, 10.5%, and 5.3%). Among uveitis cases, 58.5% eyes developed cataracts, 44.3% had posterior synechiae, 12.3% developed secondary glaucoma, 4.1% had epiretinal membrane, 4.1% had band-shaped keratopathy, and 1.0% developed macular neovascularization.

Conclusions

Eyes with coexisting DR and uveitis have a higher prevalence of neovascular and uveitis complications along with a risk of poorer visual outcomes. Treatment should aim at limiting the duration and intensity of inflammation. Strict glycemic control is essential for inflammation control and preventing the progression of DR to more advanced stages.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.