Eva Jakob

Uveitis Subtypes in a German Interdisciplinary Uveitis Center—Analysis of 1916 Patients

Objective Studies on the epidemiology of uveitis are rare and cohorts are small. We analyzed the frequencies of classified forms of uveitis in all patients at our center. Methods We studied 1916 consecutive patients with inflammatory eye disease. Data were analyzed regarding associated systemic disease, infection, ocular syndromes, anatomic localization, age, and sex. Results In 59.1% of patients, a classified form of uveitis was observed: associated systemic diseases in 43.7%, the most frequent ones sarcoidosis (17.4%) and ankylosing spondylitis (16.8%); ocular syndromes in 34.3%, the most frequent HLA-B27-positive anterior uveitis (AU; 35.1%) and Fuchs uveitis syndrome (FUS; 34.3%); and infections in 22.4%, the most frequent herpetic infections (46.1%) and toxoplasmosis (31.5%). We found AU in 45.4% of patients (15.4% HLA-B27-positive AU and 11.3% FUS), intermediate uveitis in 22.9% (unclassified 53.7% and multiple sclerosis 10.3%), and posterior uveitis in 13.5% (24.7% toxoplasmosis). Panuveitis was diagnosed in 6.2% of cases (Behçet’s disease 12.6%; sarcoidosis 10.9%). The remaining 12.0% of cases showed extrauveal manifestations (scleritis, episcleritis, keratitis, optic neuritis, myositis, and orbital inflammation). Conclusion We describe the largest cohort to date of consecutive patients from a specialized uveitis center. The high frequency of classified disease, nearly 60% in our clinic, shows the usefulness of an interdisciplinary approach, oriented on anatomic presentation.

Interferon versus Methotrexate in Intermediate Uveitis With Macular Edema: Results of a Randomized Controlled Clinical Trial

PURPOSE To compare interferon (IFN) beta with methotrexate (MTX) in the treatment of intermediate uveitis with macular edema. DESIGN Monocentric, prospective, randomized, controlled clinical trial. METHODS SETTING Specialized uveitis center at the University of Heidelberg. PATIENT OR STUDY POPULATION: Patients with either primary intermediate uveitis or uveitis associated with multiple sclerosis. MAIN INCLUSION CRITERIA: Visual acuity of 20/30 or worse (0.2 logarithm of the minimal angle of resolution) and macular edema of more than 250 μm (central 1-mm in optical coherence tomography; Stratus). Randomization into either IFN beta 44 μg subcutaneously 3 times weekly or 20 mg MTX subcutaneously once weekly. MAIN OUTCOME MEASURES At 3 months, the primary outcome parameter of mean change in visual acuity was evaluated and efficacy was determined. Secondary parameters were macular edema by optical coherence tomography, inflammatory activity, and retinal sensitivity by microperimetry (MP-1; Nidek). In case of treatment failure, switching to the other treatment arm was possible. RESULTS Nineteen patients were included. Ten were randomized to MTX, and 9 were randomized to IFN beta. At 3 months, visual acuity improved a mean 0.31 logarithm of the minimal angle of resolution (range, -0.02 to -0.96, 15.6 letters on the Early Treatment Diabetic Retinopathy Study chart) in the IFN beta group versus a mean 0.09 logarithm of the minimal angle of resolution (range, 0.12 to -0.38, 4.7 letters) in the MTX arm (P = .0435, Mann-Whitney U test). Macular thickness decreased by a mean of 206 μm (range, -41 to -416 μm) in the IFN arm, but increased by 47 μm (range, 108 to -28 μm) in the MTX group (P < .0001). CONCLUSIONS Although the sample size is small, results of the trial support superiority of IFN beta over MTX in the treatment of macular edema in the setting of intermediate uveitis.

Three Years of Experience with QuantiFERON-TB Gold Testing in Patients with Uveitis

Abstract Purpose: Overview of the results of QuantiFERON-TB Gold (QFT) testing on uveitis patients in an interdisciplinary setting for a period of 3 years. Methods: Database search of all the patients tested for tuberculosis (Tb) with QFT. Results: Of 343 tested patients, overall 80 (23.3%) were positive and 253 (73.8%) negative (results were nonconclusive for 10 patients). Anatomic localization of the patients who tested positive were distributed (% of QFT+ tests) as anterior n = 12 (15.0%), intermediate n = 22 (27.5%), posterior n = 26 (32.5%), and pan n = 18 (22.5%). In 43 QFT+ patients we presumed a diagnosis of Tb due to additional clinical findings. Of these patients 16 were treated with full therapy following WHO recommendations. Conclusions: QFT testing gives surprisingly high numbers of positives in uveitis patients. This is not sufficiently explained by immigrant status of the patients. The frequency of positives is substantially higher than in other cohorts. This raises important questions regarding treatment implications.

Experiences with Rituximab for the Treatment of Autoimmune Diseases with Ocular Involvement

Objective. To report the efficacy of rituximab (RTX) in the treatment of ocular or orbital inflammation accompanying autoimmune diseases refractory to previous standard immunosuppressive therapy. Methods. We reviewed medical records of 9 consecutive patients with noninfectious ocular or orbital inflammation treated with RTX. Results. Over a mean followup of 42 months, 7 patients were in clinical remission, 1 had partial response to treatment, and 1 did not respond. Best corrected visual acuity improved ≥ 1 line in 4 patients, was stable in another 4 patients, and worsened in 1. Concomitant immunosuppressive therapy was tapered in 6 cases. Systemic corticosteroids were tapered or kept below 7.5 mg a day in 5 patients 1 year after the first RTX cycle. Conclusion. RTX therapy, in patients who are refractory to standard immunosuppressive therapy, was effective and showed a beneficial response to treatment including induction of clinical remission of inflammation in most patients.

Randomized Controlled Study to Evaluate the Efficacy of Adalimumab in Patients with Different Forms of Refractory Uveitis

ABSTRACT Purpose: TNF alpha inhibitors have revolutionized the care of vision-threatening uveitis. This study evaluated the efficacy of adalimumab (ADA) for the treatment of refractory noninfectious uveitis. Design: Randomized, prospective, controlled, two-center clinical trial Methods: Patients with active uveitis despite combined oral low-dose prednisolone and immunosuppression were randomized for additional ADA with corticosteroids in a fixed tapering regime, or corticosteroids only. Primary outcome measure at three months was improved best-corrected visual acuity (BCVA; >2 lines). In case of treatment failure, switch to the other arm was possible. Results: Twenty-five patients (10 ADA, 15 controls) were included. BCVA increased with ADA by > 2 lines in 6/10 patients (60%; mean increase of 0.23 logMAR), but in only 2/15 from controls (13%, mean increase of 0.04 logMAR, Fisher´s exact test p = 0.00221). Conclusions: The results show superiority of ADA over controls in severe ocular inflammation including anterior uveitis.

Difficulties of Interpreting Borrelia Serology in Patients with Uveitis

Purpose: We aimed to review all uveitis patients with a positive Borrelia serology to evaluate positve results in uveitis subtypes. Further we wanted to test a self-assembled Interferon gamma release assay (IGRA) as a possible supplement method in these patients. Methods: Patients where serology for Borrelia was ordered from September 2005 to May 2008, were identified by database search. Patients with positive results in ELISA and Western Blot were retested by a self-assembled IGRA. Bayes Theorem was applied. Results: Testing for Borrelia was ordered for 184 patients. 18 patients (9,8%) showed positive results. 11 were positive for IgG (5,9 %), 3 were positive for IgG and IgM (1,6 %) and 4 for IgM (2,1%). Applying Bayes Theorem, we calculated a posttest-probability of 9% in case of a positive test result. 16 of the 18 patients were retested by IGRA. None of them showed a positive result. Conclusions: A positive serology with uveitis as the only clinical symptom is not sufficient to confirm Borreliosis as 5,9 % of patients with uveitis and a positive IgG serology correspond to the normal spread of Borrelia in the population. Looking at posttest-probability shows a lot of false-positive test results when testing all uveitis patients for Borrelia routinely.

Fuchs Uveitis Syndrome

The disease was primarily described by Lawrence in 1843 in a report about four patients with cataract and heterochromia. Other components of the disease were published later by Weill in 1904. Ernst Fuchs published in 1904 a series of 38 patients entitled in German language “About complications of heterochromia”. Since then thousands of patients have been described, and several major reviews have been published to define and extend the clinical spectrum of this interesting disease.