Skip to main content

Advertisement

SpringerLink
Log in

Do systemic steroids increase the risk of ocular complication in uveitis patients? Focus on a Italian referral center

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Introduction

To describe the ocular inflammatory and iatrogenic complications in a cohort of uveitic patients treated in an Italian referral centre.

Material and methods

Retrospective non-comparative case series. Medical history and clinical findings of all consecutive patients referred to the uveitis center of Pisa University from January 2015 to January 2017 were reviewed. Only patients with at least three follow-up visits in our center were included in our series.

Results

Three hundred and eighty-nine patients were visited in our center during study period; only 142 patients (90 men and 52 female) satisfied the inclusion criteria. Mean age at presentation was 41 ± 14 years. The most common ocular feature was anterior uveitis (46%) and was mainly unilateral. A specific etiological diagnosis was established in 61% of patients. At presentation, 71.43% of patients were on medical therapy for rheumatic disease; 42.86% of patients used systemic steroids Cataract and ocular hypertension were the most common ocular complications during the study period but were not statistically related to systemic steroid treatment.

Conclusions

Systemic steroids treatment in uveitis patients does not seem to increase the risk of iatrogenic complications such as cataract and glaucoma. In our series, increasing age appears to be the main risk factor for cataract and glaucoma development.

Key points

• Cataract, ocular hypertension, and glaucoma are the most common iatrogenic complications.

• Systemic steroids can be safely used in uveitis patients.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Prete M, Dammacco R, Fatone MC, Racanelli V (2015) Autoimmune uveitis: clinical, pathogenetic, and therapeutic features. Clin Exp Med 16:125–136. https://doi.org/10.1007/s10238-015-0345-6

    Article  CAS  PubMed  Google Scholar 

  2. Gritz DC, Wong IG (2004) Incidence and prevalence of uveitis in northern California: the northern California epidemiology of uveitis study. Ophthalmology 111:491–500. https://doi.org/10.1016/j.ophtha.2003.06.014

    Article  PubMed  Google Scholar 

  3. Rim TH, Kim SS, Il HD, Yu SY, Chung EJ, Lee SC (2017) Incidence and prevalence of uveitis in South Korea: a nationwide cohort study. Br J Ophthalmol 102:79–83. https://doi.org/10.1136/bjophthalmol-2016-309829

    Article  PubMed  Google Scholar 

  4. Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C, Androudi S (2016) A focus on the epidemiology of uveitis. Ocul Immunol Inflamm 26:2–16. https://doi.org/10.1080/09273948.2016.1196713

    Article  PubMed  Google Scholar 

  5. Miserocchi E, Fogliato G, Modorati G, Bandello F (2013) Review on the worldwide epidemiology of uveitis. Eur J Ophthalmol 23:705–717. https://doi.org/10.5301/ejo.5000278

    Article  PubMed  Google Scholar 

  6. Jabs DA (2008) Epidemiology of uveitis. Ophthalmic Epidemiol 15:283–284. https://doi.org/10.1080/09286580802478724

    Article  PubMed  Google Scholar 

  7. Dick AD, Tundia N, Sorg R, Zhao C, Chao J, Joshi A, Skup M (2016) Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Ophthalmology 123:655–662. https://doi.org/10.1016/j.ophtha.2015.10.028

    Article  PubMed  Google Scholar 

  8. Kotaniemi K, Kautiainen H, Karma A, Aho K (2001) Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: a prospective study. Ophthalmology 108:2071–2075. https://doi.org/10.1016/S0161-6420(01)00773-4

    Article  CAS  PubMed  Google Scholar 

  9. Cimino L, Aldigeri R, Marchi S, Mastrofilippo V, Viscogliosi F, Coassin M et al (2018) Changes in patterns of uveitis at a tertiary referral center in northern Italy: analysis of 990 consecutive cases. Int Ophthalmol. https://doi.org/10.1007/s10792-016-0434-x

  10. Bodaghi B, Cassoux N, Wechsler B, Hannouche D, Fardeau C, Papo T et al (2001) Chronic severe uveitis: etiology and visual outcome in 927 patients from a single center. Medicine (Baltimore) 80:263–270. https://doi.org/10.1097/00005792-200107000-00005

    Article  CAS  Google Scholar 

  11. Llorenç V, Mesquida M, Sainz De La Maza M, Keller J, Molins B, Espinosa G et al (2015) Epidemiology of uveitis in a Western urban multiethnic population. The challenge of globalization. Acta Ophthalmol 93:561–567. https://doi.org/10.1111/aos.12675

    Article  PubMed  Google Scholar 

  12. Jakob E, Reuland MS, Mackensen F, Harsch N, Fleckenstein M, Lorenz HM et al (2009) Uveitis subtypes in a German interdisciplinary uveitis center - analysis of 1916 patients. J Rheumatol 36:127–136. https://doi.org/10.3899/jrheum.080102

    Article  PubMed  Google Scholar 

  13. Jones NP (2015) The Manchester uveitis clinic: the first 3000 patients--epidemiology and casemix. Ocul Immunol Inflamm 23:118–126. https://doi.org/10.3109/09273948.2013.855799

    Article  PubMed  Google Scholar 

  14. Munk MR, Bolz M, Huf W, Sulzbacher F, Roberts P, Simader C, Rückert R, Kiss CG (2013) Morphologic and functional evaluations during development, resolution, and relapse of uveitis-associated cystoid macular edema. Retina 33:1673–1683. https://doi.org/10.1097/IAE.0b013e318285cc52

    Article  PubMed  Google Scholar 

  15. Branson SV, McClafferty BR, Kurup SK (2017) Vitrectomy for epiretinal membranes and macular holes in uveitis patients. J Ocul Pharmacol Ther 33:298–303. https://doi.org/10.1089/jop.2016.0142

    Article  CAS  PubMed  Google Scholar 

  16. D’Ambrosio E, Tortorella P, Iannetti L (2014) Management of uveitis-related choroidal neovascularization: from the pathogenesis to the therapy. J Ophthalmol 2014:1–6. https://doi.org/10.1155/2014/450428

    Article  Google Scholar 

  17. Sancho L, Kramer M, Koriat A, Eiger-Moscovich M, Sharon Y, Amer R (2018) Complications in intermediate uveitis: prevalence, time of onset, and effects on vision in short-term and long-term follow-up. Ocul Immunol Inflamm:1–9. https://doi.org/10.1080/09273948.2017.1420203

    Article  Google Scholar 

  18. Kanda T, Shibata M, Taguchi M, Ishikawa S, Harimoto K, Takeuchi M (2014) Prevalence and aetiology of ocular hypertension in acute and chronic uveitis. Br J Ophthalmol 98:932–936. https://doi.org/10.1136/bjophthalmol-2013-304416

    Article  PubMed  Google Scholar 

  19. Dietlein TS (2003) Glaucoma and uveitis. Causes of and treatment options for increased intraocular pressure in cases of inflammatory ophthalmology. Ophthalmologe 100:991–1006 quiz 1007-8

    Article  CAS  Google Scholar 

  20. Komae K, Takamoto M, Tanaka R, Aihara M, Ohtomo K, Okinaga K, Matsuda J, Nakahara H, Fujino Y, Kaburaki T (2017) Initial trabeculectomy with mitomycin-C for secondary glaucoma-associated with uveitis in Behçet disease patients. J Glaucoma 26:603–607. https://doi.org/10.1097/IJG.0000000000000665

    Article  PubMed  Google Scholar 

  21. Heiligenhaus A, Walscheid K, Pleyer U (2018) Cataracts in uveitis. Klin Monatsbl Augenheilkd 235:568–575. https://doi.org/10.1055/a-0586-3974

    Article  PubMed  Google Scholar 

  22. Mehta S, Linton MM, Kempen JH (2014) Outcomes of cataract surgery in patients with uveitis: a systematic review and meta-analysis. Am J Ophthalmol 158:676–692.e7. https://doi.org/10.1016/j.ajo.2014.06.018

    Article  PubMed  Google Scholar 

  23. Jancevski M, Foster CS (2010) Cataracts and uveitis. Curr Opin Ophthalmol 21:10–14. https://doi.org/10.1097/ICU.0b013e328332f575

    Article  PubMed  Google Scholar 

  24. Chan N-W, Ti S-E, Chee S-P (2017) Decision-making and management of uveitic cataract. Indian J Ophthalmol 65:1329–1339. https://doi.org/10.4103/ijo.IJO_740_17

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cunningham ET, Wender JD (2010) Practical approach to the use of corticosteroids in patients with uveitis. Can J Ophthalmol 45:352–358. https://doi.org/10.3129/i10-081

    Article  PubMed  Google Scholar 

  26. LeHoang P (2012) The gold standard of noninfectious uveitis: corticosteroids. New Treat Noninfectious Uveitis. https://doi.org/10.1159/000336676

    Chapter  Google Scholar 

  27. Taylor SRJ, Isa H, Joshi L, Lightman S (2010) New developments in corticosteroid therapy for uveitis. Ophthalmologica 224:46–53. https://doi.org/10.1159/000318021

    Article  CAS  PubMed  Google Scholar 

  28. Cunningham MA, Edelman JL, Kaushal S, Zarbin M, Chu D (2008) Intravitreal steroids for macular edema: the past, the present, and the future. Surv Ophthalmol. https://doi.org/10.1016/j.survophthal.2007.12.005

    Article  Google Scholar 

  29. Jaffe GJ, Ben-nun J, Guo H, Dunn JP, Ashton P (2000) Fluocinolone acetonide sustained drug delivery devine to treat severe uveitis. Ophthalmology 107:2024–2033. https://doi.org/10.1016/S0161-6420(00)00466-8

    Article  CAS  PubMed  Google Scholar 

  30. Tufail A, Lightman S, Kamal A, Pleyer U, Gajate Paniagua NM, Dot C et al (2018) Post-marketing surveillance study of the safety of dexamethasone intravitreal implant in patients with retinal vein occlusion or noninfectious posterior segment uveitis. Clin Ophthalmol Volume 12:2519–2534. https://doi.org/10.2147/OPTH.S181256

    Article  Google Scholar 

  31. Jabs DA, Rosenbaum JT, Foster CS, Holland GN, Jaffe GJ, Louie JS, Nussenblatt RB, Stiehm ER, Tessler H, van Gelder RN, Whitcup SM, Yocum D (2000) Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 130:492–513. https://doi.org/10.1016/S0002-9394(00)00659-0

    Article  CAS  PubMed  Google Scholar 

  32. Posarelli C, Arapi I, Figus M, Neri P (2011) Biologic agents in inflammatory eye disease. J Ophthalmic Vis Res 6:309–316

  33. Hatemi G, Seyahi E, Fresko I, Talarico R, Hamuryudan V (2016) One year in review 2016: Behcet’s syndrome. Clin Exp Rheumatol 4(6 Suppl 102):10–22

  34. Neri P, Azuara-Blanco A, Forrester JV (2004) Incidence of glaucoma in patients with uveitis. J Glaucoma 13:461–465. https://doi.org/10.1097/01.ijg.0000146391.77618.d0

    Article  PubMed  Google Scholar 

  35. Grajewski RS, Caramoy A, Frank KF, Rubbert-Roth A, Fätkenheuer G, Kirchhof B, Cursiefen C, Heindl LM (2015) Spectrum of uveitis in a German tertiary center: review of 474 consecutive patients. Ocul Immunol Inflamm 23:346–352. https://doi.org/10.3109/09273948.2014.1002567

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy

    Chiara Posarelli, Giovanna Vella, Andrea Passani & Michele Figus

  2. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    Rosaria Talarico & Marta Mosca

Authors
  1. Chiara Posarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosaria Talarico
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanna Vella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Passani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marta Mosca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michele Figus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara Posarelli.

Ethics declarations

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study

Disclosures

None.

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Posarelli, C., Talarico, R., Vella, G. et al. Do systemic steroids increase the risk of ocular complication in uveitis patients? Focus on a Italian referral center. Clin Rheumatol 38, 2917–2923 (2019). https://doi.org/10.1007/s10067-019-04585-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-019-04585-3

Keywords

Search

Navigation