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Demyelinating plaque-associated uveitis

  • Inflammatory Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To report the clinical and fluorescein angiographic (FA) features of demyelinating plaque-associated uveitis (DPU), a subset of uveitis in which patients have demyelinating plaques on the brain/cervical magnetic resonance image (MRI) but do not meet the criteria for multiple sclerosis (MS).

Methods

In this retrospective observational study, Persian Patients were diagnosed with DPU and included if (1) they never satisfied the MS criteria, (2) all other possible etiologies were excluded, and (3) they were followed for at least 2 years.

Results

After a median follow-up of 3 years (interquartile range, 2.0–5.3), 8 out of 40 (20%) patients diagnosed with DPU were excluded as they subsequently met the MS criteria. Of remaining 32 patients studied, the mean age was 36.3±9.9 (range 20–56 years), and 30 (93.8%) were female. Twenty-four (75.0%) showed bilateral involvement and 27 (84.4%) had insidious-chronic course. Uveitis was classified as intermediate (with or without anterior uveitis) in 29 (90.6%) and isolated anterior in 3 (9.4%) patients. Nine (28.1%) patients had at least one systemic neurological complaint. Ocular findings were: granulomatous keratic precipitates in 43/44 (97.7%) eyes; snowballs in 25/52 (48.1%) eyes; snowbanks in 4/52 (7.7%) eyes; cystoid macular edema in 20/56 (35.7%) eyes; and optic neuritis in 5/56 (8.9%) eyes. Visual acuity was ≥ 20/40 in 39 eyes (69.6%) at presentation which improved to 46 eyes (81.2%) at 2-year follow up. The two most frequent findings in FA were optic disc leakage/staining in 44/52 (81.5%) eyes, and peripheral retinal perivascular leakage in 39/52 (76.9%) eyes, which in 14/52 (26.9%) eyes extended beyond the equator.

Conclusion

DPU usually presents as a bilateral chronic granulomatous intermediate and, less often, isolated anterior uveitis, especially in females. Most are neurologically asymptomatic. Visual outcome is generally favorable. In FA, peripheral retinal perivascular leakage is common. DPU patients have an increased tendency to develop MS and should be prohibited from anti-TNF treatment.

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Author information

Authors and Affiliations

  1. Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattar khan St., Niayesh Ave, Tehran, 14455-364, Iran

    Alireza Hedayatfar & Pasha Anvari

  2. Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran

    Alireza Hedayatfar

  3. Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Lausanne, Switzerland

    C. P. Herbort Jr.

  4. Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland

    C. P. Herbort Jr.

  5. Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore

    Soon-Phaik Chee

  6. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Soon-Phaik Chee

  7. Duke-NUS Medical School, Singapore, Singapore

    Soon-Phaik Chee

Authors
  1. Alireza Hedayatfar
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  2. Pasha Anvari
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  3. C. P. Herbort Jr.
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  4. Soon-Phaik Chee
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Corresponding author

Correspondence to Alireza Hedayatfar.

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Ethical approval

Ethics approval for this study was obtained from the Research Ethics Committees of Iran University of Medical Sciences (Research Ethics Committees Certificate: IR.IUMS.REC.1402.032).

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Research Ethics Committees of Iran University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hedayatfar, A., Anvari, P., Herbort, C.P. et al. Demyelinating plaque-associated uveitis. Graefes Arch Clin Exp Ophthalmol 262, 575–582 (2024). https://doi.org/10.1007/s00417-023-06270-3

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  • DOI: https://doi.org/10.1007/s00417-023-06270-3

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