Degree, duration and causes of visual loss in uveitis

INTRODUCTION: The uvea is the middle vascular tract of eyeball. Inflammation of uveal tract is called uveitis. It is one of the most under diagnosed and under treated condition in ophthalmology . Being highly vascular , it is the main source of nutrition to the eyeball . For the same reason , it is an important source of hematogenous dissemination from and into the eye . It consists of three parts namely – iris , ciliary body and choroid. Except for the anterior surface of iris , most of it is hidden between the other two layers and require special investigative techniques for diagnosis . It is very sensitive due to the rich innervation and obviously due to above reasons, it responds to any insult to the eyeball by getting inflamed. AIM OF THE STUDY: 1. To study the clinical patterns of uveitis in the patients referred to a tertiary care hospital 2. To evaluate the complications associated with uveitis 3. To investigate the degree, duration and causes of visual loss in these patients and to compare the same with other studies. MATERIALS AND METHODS: A randomized prospective study was performed on consecutive uveitis patients referred to the Uvea clinic, Department of Ophthalmology, Government Rajaji Hospital, Madurai. The study was started in the month of September 2004 and 100 patients were selected and followed up for a period of 2 years. Inclusion Criteria: The patients included in this study had Age > 15 years, Uveitis new case Exclusion Criteria : The following patients are excluded from the study Age < 15 years - Intraocular inflammation secondary to bacterial / fungal keratitis - Onset of uveitis was < 3 months of intraocular surgery - Patients treated outside with periocular, Systemic steroids / Immuno suppressives - Patients having speech / hearing problems. SUMMARY: In this study, uveitis commonly occurred in males (60% of cases) 60% of uveitis had acute course, while 40% had chronic course. i.e., Acute uveitis is commonest in this study. Permanent visual damage leading to severe visual loss occurred in 6 patients leading to the mean duration of 24 months of visual loss. The mean duration of visual loss in cases with moderate visual loss was 17.25 moths. CONCLUSION: Visual loss is common in patients with uveitis. This prospective study was basically a descriptive study analyzing 100 cases of uveitis that presented to the eye department of Govt. Rajaji Hospital. In out study, the commonest cause of uveitis was idiopathic followed by tuberculosis. There was a male preponderance. This may be due to the fact that males tend to seek more medical care, as they are wage earners in a developing country. Acute uveitis was the common presentation. Anterior uveitis was commoner. Majority of the patients were in the economically productive age group of 31-50 years. So visual loss made socio economic impact on the community. The common complications of uveitis were cystoid macular edema, cataract and a combination of these both. The most common cause of visual loss in uveitis patients were cystoid macular edema. Male patients with uveitis had a higher risk of visual loss. Pan uveitis had the worst prognosis of vision. Bilateral chronic visual loss usually result in significant permanent visual damage