University of Groningen
Herpetic and HLA-B27 associated anterior uveitis
Hoeksema, Lisette
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Publication date: 2019
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Citation for published version (APA):
Hoeksema, L. (2019). Herpetic and HLA-B27 associated anterior uveitis: ocular complications, prognosis and vision-related quality of life. Rijksuniversiteit Groningen.
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Summary
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SUMMARY
Uveitis an important cause of blindness and visual impairment. The ocular characteristics, complications and visual acuity (VA) during follow-up differ for the different uveitis entities. The burden of anterior uveitis (AU) can be measured by determining the vision related quality of life (VR-QOL) and is an important measuring tool. We believe that it is important to investigate homogeneous uveitis groups to contribute to a more personalized care of uveitis patients. In addition, using the guidelines for uniform reporting in uveitis as developed by the standardization of uveitis nomenclature (SUN) working group, will enable comparisons with future studies in the field. This thesis discusses two types of anterior uveitis, HLA-B27 associated AU, the most common non-infectious form, and herpetic AU, the most common infectious form.
In chapter 1 we provide an introduction to this thesis and give information about the aims of the studies we conducted. Chapter 2 gives information on the rate of complications, ocular characteristics and the visual prognosis in herpetic (HSV and VZV) AU compared to HLA-B27 associated AU. We found a worse visual prognosis in herpetic versus HLA-B27 associated AU, which is probably related to a higher prevalence of corneal scarring and glaucoma in the former. In addition, herpetic AU patients have more ocular complications overall. This information may be helpful in developing individualized entity-related counseling strategies.
In chapter 3 we describe the incidence of elevated intraocular pressure (IOP) and secondary glaucoma in herpetic (HSV and VZV) AU. We found that elevated IOP and secondary glaucoma are frequent complications of viral AU. In addition, we found a wide variety between studies regarding the definitions of elevated IOP and secondary glaucoma, and as a result a wide variation in reported incidences of these complications. This underlines the need for standardized criteria such as developed by the SUN working group.
We evaluated whether ocular and patient characteristics differ between unilateral (always the same eye) or bilateral (simultaneous or alternating) HLA-B27 associated AU with or without systemic disease in chapter 4. We found that unilateral and bilateral HLA-B27 associated AU are generally comparable, which indicates that it is probably the same disease entity. This study shows that unilateral and bilateral patients both have a good prognosis with regard to VA and the development of ocular complications. In addition, bilateral AU patients more often had an associated systemic disease.
In chapter 5 we report on the VR-QOL and the prevalence and severity of depression in herpetic (HSV and VZV) AU. Herpetic AU affects the VR-QOL, but only in a moderate way. The prevalence of depression in our group of herpetic AU patients was low and therefore does not seem to indicate a need for specific screening and intervention measures in this specific patient group.
In chapter 6 we evaluate the VR-QOL in a group of patients with HLA-B27 associated AU. Patients with HLA-B27 associated AU have a relatively high VR-QOL. However, the presence of a systemic disease is associated with considerably lower VR-QOL and general health scores and may be associated with an increased risk of depression. In addition, depression itself is associated with a lower VR-QOL.
In chapter 7 the most important findings are discussed and ideas for future research are given.
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