Skip to main content

Advertisement

Log in

Epidemiology and characteristics of common forms of anterior uveitis at initial presentation in a tertiary facility in Japan

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To elucidate detailed epidemiological profile of common types of anterior uveitis (AU) in real-world clinical setting of a tertiary facility in Japan, and to evaluate the characteristic clinical findings at initial presentation.

Study design

Retrospective cohort study.

Methods

Clinical charts of 275 patients (335 eyes) aged 52.5 ± 19.1 years were reviewed retrospectively. Herpetic AU was diagnosed by multiplex polymerase chain reaction tests using aqueous humor. Time of uveitis onset, gender, laterality, disease course since the initial onset of AU, visual acuity (VA) and intraocular pressure (IOP) at first visit, and definitive diagnosis were collected from clinical charts.

Results

Acute AU (AAU) was the most common (21.8%) form of AU; followed by herpetic AU (20.7%) comprising Herpes Simplex Virus (HSV) (8.0%), Varicella Zoster Virus (VZV) (9.1%) and cytomegalo virus (CMV) (3.6%); scleritis (13.5%); diabetic iritis (7.6%), and Posner-Schlossman syndrome (5.5%). Unilateral AU constituted 78.2%, and VA less than 20/30 accounted for 31.2%. Of all the eyes, 16.1% had an IOP higher than 20 mmHg, out of which 37.0% had herpetic AU, followed by scleritis in 25.9%, and Posner-Schlossman syndrome (PSS) in 11.1%. AU patients over 60 years of age were 40.4%, in which 34.2% had herpetic AU, followed by scleritis in 14.4% and AAU in 13.5%. Herpetic AU patients were significantly older and had higher IOP compared with AAU patients.

Conclusion

The most frequent AU was AAU, followed by herpetic AU. Herpetic AU patients were older and had higher intraocular pressure than AAU patients, although VA was equally impaired in both groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wakefield D, Chang JH. Epidemiology of uveitis. Int Ophthalmol Clin 2005;45:1–3.

    Article  Google Scholar 

  2. Gonzalez MM, Solano MM, Porco TC, Oldenburg CE, Acharya NR, Lin SC, et al. Epidemiology of uveitis in a US population-based study. J Ophthalmic Inflamm Infect. 2018;8:6.

    Article  Google Scholar 

  3. Suttorp-Schulten MS, Rothova A. The possible impact of uveitis in blindness: a literature survey. Br J Ophthalmol. 1996;80:844–8.

    Article  CAS  Google Scholar 

  4. Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of uveitis nomenclature working G. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509–16.

    Article  Google Scholar 

  5. Oruc S, Kaplan AD, Galen M, Kaplan HJ. Uveitis referral pattern in a Midwest University Eye Center. Ocul Immunol Inflamm. 2003;11:287–98.

    Article  Google Scholar 

  6. Yang P, Zhang Z, Zhou H, Li B, Huang X, Gao Y, et al. Clinical patterns and characteristics of uveitis in a tertiary center for uveitis in China. Curr Eye Res. 2005;30:943–8.

    Article  Google Scholar 

  7. Soheilian M, Heidari K, Yazdani S, Shahsavari M, Ahmadieh H, Dehghan M. Patterns of uveitis in a tertiary eye care center in Iran. Ocul Immunol Inflamm. 2004;12:297–310.

    Article  Google Scholar 

  8. Singh R, Gupta V, Gupta A. Pattern of uveitis in a referral eye clinic in north India. Indian J Ophthalmol. 2004;52:121–5.

    Google Scholar 

  9. Hamade IH, Elkum N, Tabbara KF. Causes of uveitis at a referral center in Saudi Arabia. Ocul Immunol Inflamm. 2009;17:11–6.

    Article  Google Scholar 

  10. Bro T, Tallstedt L. Epidemiology of uveitis in a region of southern Sweden. Acta Ophthalmol. 2020;98:32–5.

    Article  Google Scholar 

  11. Hermann L, Falcão-Reis F, Figueira L. Epidemiology of Uveitis in a tertiary care centre in Portugal. Semin Ophthalmol. 2021;36:51–7.

    Article  Google Scholar 

  12. Rosenbaum JT. Acute anterior uveitis and spondyloarthropathies. Rheum Dis Clin North Am. 1992;18:143–51.

    Article  CAS  Google Scholar 

  13. D’Ambrosio EM, La Cava M, Tortorella P, Gharbiya M, Campanella M, Iannetti L. Clinical features and complications of the HLA-B27-associated acute anterior uveitis: a metanalysis. Semin Ophthalmol. 2017;32:689–701.

    Article  Google Scholar 

  14. Yang P, Wan W, Du L, Zhou Q, Qi J, Liang L, et al. Clinical features of HLA-B27-positive acute anterior uveitis with or without ankylosing spondylitis in a Chinese cohort. Br J Ophthalmol. 2018;102:215–9.

    Article  Google Scholar 

  15. Miserocchi E, Waheed NK, Dios E, Christen W, Merayo J, Roque M, et al. Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison. Ophthalmology. 2002;109:1532–7.

    Article  Google Scholar 

  16. Kawaguchi T, Kawazoe Y, Kamoi K, Miyanaga M, Takase H, Sugita S, et al. Clinical course of patients with Behcet’s uveitis following discontinuation of infliximab therapy. Jpn J Ophthalmol. 2014;58:75–80.

    Article  CAS  Google Scholar 

  17. Testi I, Aggarwal K, Jaiswal N, Dahiya N, Thng ZX, Agarwal A, et al. Antiviral Therapy for Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV)-induced anterior uveitis: a systematic review and meta-analysis. Front Med (Lausanne). 2021;8:686427.

    Article  Google Scholar 

  18. Goda C, Kotake S, Ichiishi A, Namba K, Kitaichi N, Ohno S. Clinical features in tubulointerstitial nephritis and uveitis (TINU) syndrome. Am J Ophthalmol. 2005;140:637–41.

    Article  Google Scholar 

  19. Mackensen F, Smith JR, Rosenbaum JT. Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology. 2007;114:995–9.

    Article  Google Scholar 

  20. Wells JM, Smith JR. Uveitis in juvenile idiopathic arthritis: recent therapeutic advances. Ophthalmic Res. 2015;54:124–7.

    Article  CAS  Google Scholar 

  21. Mizushima Y. [Revised diagnostic criteria for Behcet’s disease in 1987]. Ryumachi. 1988;28:66–70 (in Japanese).

    CAS  Google Scholar 

  22. Ishihara M. Validity, usefulness and difficulties of the diagnosis of sarcoidosis by new diagnostic criteria and guidelines for sarcoidosis. Nippon Ganka Gakkai Zasshi. 2010;114:665–7 (in Japanese).

    Google Scholar 

  23. Criteria for diagnosis of Behçet’s disease. International Study Group for Behçet’s Disease. Lancet (London). 1990;335:1078–80.

    Google Scholar 

  24. Tuncer S, Adam YS, Urgancioglu M, Tugal-Tutkun I. Clinical features and outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis in a Turkish patient population. Ocul Immunol Inflamm. 2005;13:367–73.

    Article  CAS  Google Scholar 

  25. Wakefield D, Zierhut M. Controversy: ocular sarcoidosis. Ocul Immunol Inflamm. 2010;18:5–9.

    Article  Google Scholar 

  26. Wakefield D, Clarke D, McCluskey P. Recent developments in HLA B27 Anterior Uveitis. Front Immunol. 2020;11:608134.

    Article  CAS  Google Scholar 

  27. Sugita S, Ogawa M, Shimizu N, Morio T, Ohguro N, Nakai K, et al. Use of a comprehensive polymerase chain reaction system for diagnosis of ocular infectious diseases. Ophthalmology. 2013;120:1761–8.

    Article  Google Scholar 

  28. Mochizuki M, Sugita S, Kamoi K, Takase H. A new era of uveitis: impact of polymerase chain reaction in intraocular inflammatory diseases. Jpn J Ophthalmol. 2017;61:1–20.

    Article  CAS  Google Scholar 

  29. Sugita S, Shimizu N, Watanabe K, Mizukami M, Morio T, Sugamoto Y, et al. Use of multiplex PCR and real-time PCR to detect human herpes virus genome in ocular fluids of patients with uveitis. Br J Ophthalmol. 2008;92:928–32.

    Article  CAS  Google Scholar 

  30. Classification Criteria for Herpes Simplex Virus Anterior Uveitis. Am J Ophthalmol. 2021;228:231–6.

    Article  Google Scholar 

  31. Classification Criteria for Varicella Zoster Virus Anterior Uveitis. Am J Ophthalmol. 2021;228:165–73.

    Article  Google Scholar 

  32. Classification Criteria for Cytomegalovirus Anterior Uveitis. Am J Ophthalmol. 2021;228:89–95.

    Article  Google Scholar 

  33. Watanabe T, Keino H, Nakayama K, Taki W, Echizen N, Okada AA. Clinical features of patients with diabetic anterior uveitis. Br J Ophthalmol. 2019;103:78–82.

    Article  Google Scholar 

  34. Classification Criteria for Tubulointerstitial Nephritis With Uveitis Syndrome. Am J Ophthalmol. 2021;228:255–61.

    Article  Google Scholar 

  35. Standardization of Uveitis Nomenclature Working G. Classification criteria for Fuchs Uveitis Syndrome. Am J Ophthalmol. 2021;228:262–7.

    Article  Google Scholar 

  36. Deschenes J, Murray PI, Rao NA, Nussenblatt RB. International Uveitis Study Group (IUSG): clinical classification of uveitis. Ocul Immunol Inflamm. 2008;16:1–2.

    Article  Google Scholar 

  37. Terada Y, Kaburaki T, Takase H, Goto H, Nakano S, Inoue Y, et al. Distinguishing features of Anterior Uveitis caused by Herpes Simplex Virus, Varicella-Zoster Virus, and Cytomegalovirus. Am J Ophthalmol. 2021;227:191–200.

    Article  CAS  Google Scholar 

  38. Sonoda KH, Hasegawa E, Namba K, Okada AA, Ohguro N, Goto H, et al. Epidemiology of uveitis in Japan: a 2016 retrospective nationwide survey. Jpn J Ophthalmol. 2021;65:184–90.

    Article  Google Scholar 

  39. Smith JA, Mackensen F, Sen HN, Leigh JF, Watkins AS, Pyatetsky D, et al. Epidemiology and course of disease in childhood uveitis. Ophthalmology. 2009;116:1544–51 51 e1.

    Article  Google Scholar 

  40. Kitamei H, Kitaichi N, Namba K, Kotake S, Goda C, Kitamura M, et al. Clinical features of intraocular inflammation in Hokkaido, Japan. Acta Ophthalmol. 2009;87:424–8.

    Article  Google Scholar 

  41. Keino H, Nakashima C, Watanabe T, Taki W, Hayakawa R, Sugitani A, et al. Frequency and clinical features of intraocular inflammation in Tokyo. Clin Exp Ophthalmol. 2009;37:595–601.

    Article  Google Scholar 

  42. Chang JH, Wakefield D. Uveitis: a global perspective. Ocul Immunol Inflamm. 2002;10:263–79.

    Article  Google Scholar 

  43. Goto H, Mochizuki M, Yamaki K, Kotake S, Usui M, Ohno S. Epidemiological survey of intraocular inflammation in Japan. Jpn J Ophthalmol. 2007;51:41–4.

    Article  Google Scholar 

  44. Ohguro N, Sonoda KH, Takeuchi M, Matsumura M, Mochizuki M. The 2009 prospective multi-center epidemiologic survey of uveitis in Japan. Jpn J Ophthalmol. 2012;56:432–5.

    Article  Google Scholar 

  45. Brewerton DA, Caffrey M, Nicholls A, Walters D, James DC. Acute anterior uveitis and HL-A 27. Lancet (London). 1973;302:994–6.

    Article  CAS  Google Scholar 

  46. Wakefield D, Chang JH, Amjadi S, Maconochie Z, Abu El-Asrar A, McCluskey P. What is new HLA-B27 acute anterior uveitis? Ocul Immunol Inflamm. 2011;19:139–44.

    Article  CAS  Google Scholar 

  47. Otsuka A, Morita M, Yamada H. Clinical characteristics of Japanese patients with axial spondyloarthritis, and short-term efficacy of adalimumab. J Orthop Sci. 2015;20:1070–7.

    Article  CAS  Google Scholar 

  48. Mapstone R, Woodrow JC. HL-A 27 and acute anterior uveitis. The Br J Ophthalmol. 1975;59:270–5.

    Article  CAS  Google Scholar 

  49. Pathanapitoon K, Dodds EM, Cunningham ET Jr, Rothova A. Clinical spectrum of HLA-B27-associated ocular inflammation. Ocul Immunol Inflamm. 2017;25:569–76.

    Article  CAS  Google Scholar 

  50. Sakai JI, Usui Y, Suzuki J, Kezuka T, Goto H. Clinical features of anterior uveitis caused by three different herpes viruses. Int Ophthalmol. 2019;39:2785–95.

    Article  Google Scholar 

  51. Takase H, Kubono R, Terada Y, Imai A, Fukuda S, Tomita M, et al. Comparison of the ocular characteristics of anterior uveitis caused by herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Jpn J Ophthalmol. 2014;58:473–82.

    Article  CAS  Google Scholar 

  52. Chatzistefanou K, Markomichelakis NN, Christen W, Soheilian M, Foster CS. Characteristics of uveitis presenting for the first time in the elderly. Ophthalmology. 1998;105:347–52.

    Article  CAS  Google Scholar 

  53. Abdulaal MR, Abiad BH, Hamam RN. Uveitis in the aging eye: incidence, patterns, and differential diagnosis. J Ophthalmol. 2015;2015:509456.

    Article  Google Scholar 

  54. Kanda T, Shibata M, Taguchi M, Ishikawa S, Harimoto K, Takeuchi M. Prevalence and aetiology of ocular hypertension in acute and chronic uveitis. Br J Ophthalmol. 2014;98:932–6.

    Article  Google Scholar 

  55. Chan NS, Chee SP, Caspers L, Bodaghi B. Clinical features of CMV-associated Anterior Uveitis. Ocul Immunol Inflamm. 2018;26:107–15.

    Article  CAS  Google Scholar 

  56. Chee SP, Jap A. Presumed fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome: comparison of cytomegalovirus-positive and negative eyes. Am J Ophthalmol. 2008;146:883-9.e1.

    Article  Google Scholar 

  57. Touhami S, Qu L, Angi M, Bojanova M, Touitou V, Lehoang P, et al. Cytomegalovirus Anterior Uveitis: clinical characteristics and long-term outcomes in a French Series. Am J Ophthalmol. 2018;194:134–42.

    Article  Google Scholar 

  58. Miyanaga M, Sugita S, Shimizu N, Morio T, Miyata K, Maruyama K, et al. A significant association of viral loads with corneal endothelial cell damage in cytomegalovirus anterior uveitis. Br J Ophthalmol. 2010;94:336–40.

    Article  Google Scholar 

  59. Murata K, Ishida K, Ozawa K, Sawada A, Mochizuki K, Yamamoto T. The characteristics of Posner-Schlossman syndrome: A comparison in the surgical outcome between cytomegalovirus-positive and cytomegalovirus-negative patients. Med (Baltim). 2019;98:e18123.

    Article  Google Scholar 

  60. Choi JA, Kim KS, Jung Y, Park HY, Park CK. Cytomegalovirus as a cause of hypertensive anterior uveitis in immunocompetent patients. J Ophthalmic Inflamm Infect. 2016;6:32.

    Article  Google Scholar 

  61. De Simone L, Belloni L, Aldigeri R, Zerbini A, Mastrofilippo V, Sangiovanni A, et al. Aqueous tap and rapid diagnosis of cytomegalovirus anterior uveitis: the Reggio Emilia experience. Graefes Arch Clin Exp Ophthalmol. 2019;257:181–6.

    Article  Google Scholar 

  62. Bloch-Michel E, Nussenblatt RB. International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease. Am J Ophthalmol. 1987;103:234–5.

    Article  CAS  Google Scholar 

  63. Tabbut BR, Tessler HH, Williams D. Fuchs’ heterochromic iridocyclitis in blacks. Arch Ophthalmol (Chicago, Ill: 1960). 1988;106:1688–90.

  64. Herbort CP, Khairallah M. Editorial: Fuchs’ uveitis: from Imperial Vienna to global appraisal. Int Ophthalmol. 2010;30:449–52.

    Article  Google Scholar 

Download references

Acknowledgements

The study was supported by grants from the Grants-in-Aid for Scientific Research C (M. Takeuchi, 20K09840) from the Japan Society for the Promotion of Science. The authors thank Eiko Machida, Kiyoko Yamada, Tomomi Nakamura, and Saeko Kanno for their contribution to the present report.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Masaru Takeuchi.

Ethics declarations

Conflicts of interest

R. Okazawa, None; S. Iwai, None; K. Nagura, None; D. Sora, None; T. Sato, None; K. Takayama, None; K. Harimoto, None; T. Kanda, None; M. Takeuchi, None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: Masaru Takeuchi

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okazawa, R., Iwai, S., Nagura, K. et al. Epidemiology and characteristics of common forms of anterior uveitis at initial presentation in a tertiary facility in Japan. Jpn J Ophthalmol 67, 22–31 (2023). https://doi.org/10.1007/s10384-022-00961-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-022-00961-w

Keywords

Navigation