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Uveitis is a significant public health problem, withpublished series estimating that uveitic diseases mayaccount for up to 10% of legal blindness in Westerncountries.1Uveitis in patients older than 60 years has

been considered uncommon, but two recent epide-miologic studies showed that the burden of uveitisin elderly population is significant.2, 3 First, Gritzand Wong reported a cross-sectional study of 2070people within 6 Northern Californian medical centercommunities.2They observed that the incidence ofuveitis rose with age, peaking at 102.7/100,000 insubjects aged 65 years and older. Prevalence findingswere similar, rising up to a high of 234.6/100,000 inpatients at the age of 60 or more years. Reeves et al.used longitudinal Medicare claims data to estimatethe annual incidence and prevalence of uveitis inthe U.S. elderly population.3 They found an aver-age cumulative incidence of 340.9/100,000 personsper year and a doubling of the cumulative incidencefrom 511/100,000 in 1991 to 1231/100,000 in 1999.

Several case series examining referral populationshave addressed the elderly population.4-9 In thosestudies published between 1982 and 2003, idiopathicuveitis accounted for the majority of cases. Recentadvances have been made in recognizing, diagnos-ing, and classifying uveitis and associated systemicdisease. Given these data, we decided to perform aretrospective analysis of elderly, newly diagnosed,patients seen at our tertiary ophthalmology centerfrom March 2003 to February 2010. We described theclinical features and systemic associations of thosepatients and compared the data with the results inthe younger population.

Patients and Methods

We present the clinical records of 302 consecu-tive patients with newly diagnosed uveitis. Theywere referred to the Internal Medicine Department,

Ocular Immunology & Inflammation,19(4), 219226, 2011

Copyright 2011 Informa Healthcare USA, Inc.

ISSN: 0927-3948 print/ 1744-5078 online

DOI: 10.3109/09273948.2011.580071

Received 22 August 2010; revised 01 April 2011; accepted 05 April 2011

Correspondence: Pascal Sve. Department of Internal Medicine, Htel Dieu, 1 place de lHpital, 69288 Lyon Cedex 02, France. E-mail:[email protected]

ORIGINAL ARTICLE

Characteristics of Uveitis Presenting for the First Time inthe Elderly: Analysis of 91 Patients in a Tertiary Center

Marie-Alix Grgoire, MD1, Laurent Kodjikian, MD, PhD2, Loig Varron, MD1,Jean-Daniel Grange, MD2, Christiane Broussolle, MD, PhD1, and Pascal Seve, MD, PhD1

1Department of Internal Medicine, Htel Dieu, Hospices Civils de Lyon, Lyon, France; and University Claude Bernard,Lyon, France, and 2Department of Ophtalmology, Croix-Rousse University Hospital, Lyon, France; and University

Claude Bernard, Lyon, France

ABSTRACT

Purpose: To describe uveitis clinical characteristics in the elderly.

Methods: Retrospective review of 91 patients at the age of 60 or more years at the authors uveitis tertiary

center over a 7-year period.Results: Uveitis in the elderly accounted for 30.1% of this population. Uveitis localization was anterior in22.0% of patients, intermediate in 8.8%, posterior in 20.9%, while 41.7% patients presented with panuveitis.Sarcoidosis (37.4%) and idiopathic uveitis (36.3%) accounted for the majority of cases, whereas other diagnosticentities accounted for 26.3%. Panuveitis (41.7%) and sarcoidosis (37.4%) were detected at a significantly higherfrequency than in the younger population. Contrarily, ankylosing spondylitis and established ophthalmologi-cal entities (pars planitis, Birdshot chorioretinopathy, Fuchs heterochromic cyclitis) were more common inpatients younger than 60 years old.

Conclusion: In the authors experience, sarcoidosis is the leading cause of uveitis in the elderly. Idiopathicuveitis and other specific entities account for less than two-thirds of cases.

Keywords: diagnosis, elderly, epidemiology, sarcoidosis, uveitis
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220 M-A Grgoire et al.

Ocular Immunology & Inflammation

Htel-Dieu Hospital, University of Lyon, by theOphthalmological Department between March 2003and February 2010. These records were retrospectivelyreviewed. Among these patients, the reports of 91patients at the age 60 or more years were analyzed andcompared to the younger patients.

Exclusion criteria were exogenous endopthalmitis(postoperative or traumatic) and uveitis associated with

HIV. Patients seen at the Ophthalmological Departmentwith obvious ophthalmological entities (e.g., typicaltoxoplasmic retinochoroiditis or anterior uveitis withkeratitis) were not referred to the Internal MedicineDepartment and therefore were not included.

Each patient had a full ophthalmologic examina-tion, including slit-lamp examination, tonometry, oftenlaser flare meter testing, and indirect ophthalmoscopy.Ancillary ophthalmic tests (e.g., optical coherencetomography, fluorescein and indocyanin angiography,visual field testing) were performed, depending on theclinical presentation. The terminology and classifica-tion of uveitis used, including anatomic criteria, were

those given by the International Uveitis Study Group.10We also identified ocular features: granulomatous andnongranulomatous uveitis.

Depending on the anatomical classification, allpatients underwent the standard screening protocolfor uveitis, which included tuberculosis skin test,determination of C-reative protein level and eryth-rocyte sedimentation rate (ESR), complete blood cellcount (CBC), serological test for HIV and syphilis,and radiological chest examination. Patients werenot on immunosuppression at time of testing. Humanleukocyte antigen (HLA)-B27 typing was performed

for patients with nongranulomatous acute anterioruveitis. In case of chronic uveitis or granulomatousuveitis, evaluations of serum angiotensin-convert-ing enzyme (ACE) and serum lysozyme levels andchest CT scan were performed. Serological tests forToxoplasma gondii, lumbar puncture, chest CT scan,and cerebral MRI were performed in patients withposterior uveitis or panuveitis. This workup wascompleted for some patients with anterior chamberparacentesis (polymerase chain reaction, e.g., herpesvirus, Toxoplasma, Bartonella, Tropheryma whipplei,RNA16, IL-10, and IL-6 measurement) and vitreous

biopsy, if appropriate.

The diagnostic battery for sarcoidosis also includedconjunctiva or skin biopsy, when clinically suspiciousfeatures were present. Some patients underwent sali-vary gland or transbronchial lung biopsy, bronchoal-veolar lavage (BAL), and nuclear imaging (gallium scanor fluorine-18 fluorodeoxyglucose positron emissiontomography (18F-FDG PET).

The criteria used for the diseases most commonlydiagnosed in this study were as follows. Ocular toxo-plasmosis was diagnosed based on examination andelevated IgG anti-Toxoplasmaserology. The presence of

a typical fundus change of focal retinochoroiditis wasrarely observed for our patients; they often presentedatypical ocular manifestations like papilledema alone.Syphilis was diagnosed when treponemal hemaggluti-nation (TPHA) and nontreponemal (VDRL) tests werepositive. Herpetic keratouveitis or uveitis was diag-nosed based on the presence of corneal scars compat-ible with a previous herpetic keratitis and/or sectorial

iris atrophy and/or ocular hypertension and positiveIgG serologic findings. Ocular syndromes included aclearly defined uveitis entity without systemic involve-ment, such as HLA-B27-associated anterior uveitis (AU)(typical unilateral AU with sudden onset and duration< 3 months in HLA-B27-positive individuals without

joint involvement) or Fuchs uveitis syndrome (typicallow-grade unilateral anterior and intermediate uveitiswith insidious onset, chronic course, iris transillumina-tion defects or heterochromia, diffuse stellar cornealprecipitates, resistance to local or oral prednisone andwith later development of subcapsular cataract andglaucoma).

Evaluation of patients with uveitis potentiallyassociated with spondylarthropathies was basedon the European Spondylarthropathy Study GroupCriteria.11A diagnosis of Behet disease was based onthe International Study Group Classification Criteriafor Behcets Disease.12Vogt-Koyanagi-Harada diseasewas diagnosed according to the revised criteria.13 Adiagnosis of sarcoidosis was based on criteria verysimilar to those proposed by Abad et al.14 For theseauthors, sarcoidosis is consideredprovenwhen patho-logic examination of biopsy material showed a nonca-seating granuloma;presumedwhen the patients met at

least 2 of 4 of the following criteriapathologic chestradiography or computed tomography, predominantlyCD4 lymphocytosis in BAL fluid, elevated serum ACElevel, elevated gallium uptakebut biopsy results werenormal or unavailable; and indeterminatewhen only 1criterion is met. We used equally fluorine-18 fluoro-deoxyglucose positron emission tomography (18F-FDGPET) and gallium uptake to diagnose sarcoidosis-asso-ciated uveitis, based on previous studies showing that18F-FDG PET is more accurate than gallium for assess-ing both extrapulmonary and pulmonary involvementin sarcoidosis patients.15, 16

Cases of uveitis that were not associated with a

detectable infectious agent or the above systemic dis-orders were classified as idiopathic.

Statistical Analysis

Analysis used the Statview version 5.0 statistical pack-age (SAS Institute, Cary, NC). Results are expressed asmeans standard deviation or median (range). Groupswere compared by Mann-Whitney test, chi-square test,or Fishers exact test as appropriate.
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Uveitis in the Elderly 221

2011 Informa Healthcare USA, Inc.

RESULTS

Demographics

In the population, we identified 91 patients (30.1%) pre-senting with their first episode of uveitis at the age of 60or more years. The average age at onset of the diseasewas 70 years old (range, 6084 years). Our population

comprised 56 women and 35 men. Most of them wereCaucasian (90%) and 6 were African (10%).

Classification of Disease by Intraocular Location andComplications

The localization of uveitis was anterior in 20 cases(22%). Intermediate uveitis was diagnosed in 8 patients(8.8%) and posterior uveitis was diagnosed in 19 patients(20.9%). Thirty-eight patients (41.7%) presented withpanuveitis. Six patients (6.6%) presented with anterioruveitis associated with intermediate uveitis. Chronicuveitis occurred more often: 69 patients (75.8%), 34 withpanuveitis, 17 with posterior uveitis, 8 with intermedi-ate uveitis, 7 with anterior uveitis and 3 with anteriorand intermediate uveitis. Overall, 52.7% of the patientssuffered from bilateral involvement. Thirty-eight casesof uveitis (42%) were granulomatous (11 anterior uveitisand 27 panuveitis).

Diagnoses

Table 1 summarizes the various causes and associatedsystemic factors observed in the population. Sarcoidosiswas the most frequent etiology (37.4 %), including

biopsy-proven sarcoidosis in 16 patients. In 3 of these

patients,

18

F-FDG-PET identified occult sites, and sub-sequent mediastinal or subclavicular biopsy revealed anoncaseating granuloma without evidence of infection.In 12 other patients, the clinical suspicion of sarcoidosis(presumedsarcoidosis) was supported by a positive chest

x-ray or chest CT in combination with an elevated ACElevel (7 patients); a positive chest x-ray or chest CT incombination with a CD4 lymphocytosis in BAL fluid (2patients); a positive chest x-ray or chest CT associatedwith hypermetabolic foci on 18F-FDG PET scan consis-tent with sarcoidosis (3 patients). Six other patients wereconsidered cases of indeterminatesarcoidosis, on the sole

basis of FDG uptake (3 patients).

Other specific diagnoses included HLA-B27-associated uveitis (5/91, 5.5%), herpes simplex uveitis(4/91, 4.4%), toxoplasmosis (3/91, 3.3%), tuberculosis(3/91, 3.3%), herpes zoster ophthalmicus (1/91, 1.1%),toxocariasis (1/91, 1.1%), and Wegener granulomato-sis (1/91, 1.1%). Diagnostic vitrectomy performed in8 patients uncovered 4 cases of intraocular large celllymphoma. Established ophthalmological entitiesincluded birdshot chorioretinopathy (1/91, 1.1%) andFuchs heterochromic cyclitis (1/91, 1.1%). Idiopathicuveitis accounted for 33 patients (36.3%).

Treatment

Twenty-three patients (25.2%) received topical orregional steroids (with or without concomittant admin-istration of systemic nonsteroidal anti-inflammatoryagents). Of these cases, there were 14 patients with idio-pathic uveitis, 5 patients with sarcoidosis (2 proven and3 presumed sarcoidosis), 2 with HLA-B27-associateduveitis, 1 with toxocariasis, and 1 patient with herpessimplex uveitis. Twenty-eight patients (30.8%) requiredthe addition of systemic steroids: 21 patients with sarcoi-dosis (10 with proven sarcoidosis, 7 with presumed sar-

coidosis, and 4 with indeterminate sarcoidosis), 6 withidiopathic uveitis, and the last patient presented withHLA-B27-associated uveitis. Seven patients receivedantibiotics: 3 patients treated for tuberculosis, 3 patientstreated for toxoplasmosis, and the last one for whomtoxoplasmosis was first suspected (but finally classifiedas idiopathic uveitis). Four patients received anti-viraltherapy: acyclovir or valaciclovir for herpes uveitis.Four patients with lymphoma received specific thera-peutics (radiotherapy, chemotherapy). Two patientswere treated with salazopyrin, for HLA-B27-associateduveitis. Imunosuppressive agents were proposed for 2other patients (methotrexate and anti-TNF drugs for

Wegener granulomatosis, methotrexate for presumedsarcoidosis). Twenty-one patients did not receive anytreatment (12 patients with idiopathic uveitis, 7 patientswith sarcoidosis, 1 patient with birdshot chorioretinopa-thy, and 1 patient with Fuchs heterochromic cyclitis).

Comparison of Elderly Patients and Younger Patients(Tables 2a and 2b)

Our study found that the epidemiological character-istics of uveitis in the elderly differed markedly fromthose in younger patients. After the age of 60 years,panuveitis and sarcoidosis were statistically morecommon (38/91 versus 56/211, p= .008; 34/91 versus

TABLE 1 Distribution of specific diagnostic entities in elderlypatients presenting with uveitis.

Diagnosis Number of patients (%)

Sarcoidosis 34 (37.4)

Proven 16

Presumed 12

Indeterminate 6

Idiopathic uveitis 33 (36.3)HLA-B27-associated uveitis 5 (5.5)

Herpes simplex virus 4 (4.4)

Intraocular Lymphoma 4 (4.4)

Toxoplasmosis 3 (3.2)

Tuberculosis 3 (3.2)

Toxocariasis 1 (1.1)

Herpes zoster ophthalmicus 1 (1.1)

Fuchs heterochromic cyclitis 1(1.1)

Birdshot chorioretinopathy 1 (1.1)

Wegeners granulomatosis 1 (1.1)

Total 91 (100.0)


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pattern of uveitis, the investigations performed to deter-mine the cause of the intraocular inflammation, and thecriteria used for the disease classification. Such factorsmay explain some of the discrepancies observed amongstudies that aimed to describe the clinical characteristicsof uveitis presenting de novo in the elderly.

The anatomic distribution of uveitis in our series ofelderly patients differs from younger patients. Panuveitis

was statistically more common in the first group. Theprevalence of elderly patients with panuveitis (41.7%)was higher than the percentages reported by Favre et al.7(15.9%), but similar to the report of Bouillet et al.5(42%).On the contrary, the percentage of older patients withanterior uveitis was much lower than those reported bymost of authors in previous studies.

In our study, 33 patients (36.3 %) were designatedas idiopathic uveitis cases. This percentage does notdiffer significantly from that of other series of uveitisin elderly patients5-7and confirms that a precise under-lying etiology is discovered at a similar rate in olderpatients as in the general uveitis population.

As in other studies in patients after the age of 60, aremarkably wide range of specific uveitis entities were

diagnosed in our series. However, as in the studiesof Chatzistefanou and Favre, several entities (Reiteruveitis, Posner-Schlossmann syndrome, Behet uveitis,Vogt-Koyanagi-Harada disease) were not encounteredafter the age of 60 years.6, 7Fuchs heterochromic irido-cyclitis is very unusual since it was reported for 1 of ourpatients, for 2 patients in Kirschs study, and for 1 patient

TABLE 3 Comparison of localization of uveitis in our study and series of the literature.

Makley9

Favre7

Barton4

Chatzistefanou6

Bouillet5

Kirsch8

Our studyTotal number of patients 1820 435 71 1328 125 193 302

Frequency of elderly patients (%) 229 (13) 94 (21.8) 71 (100) 138 (10.4) 19 (15.2) 51 (26.4) 91 (30.1)

Percentage of female patients 51.0 59.6 ND 74.0 74.0 60.8 61.5

Percentage of white patients ND ND ND 95.0 ND ND 90.0

Percentage of black patients ND ND ND 2.0 ND ND 10.0

Percentage of hispanicpatients ND ND ND 1.5 ND ND 0

Anterior uveitis 85 (37.1) 62 (66.0) 44 (61.9) 78 (56.5) 5(26.3) 24 (47.0) 22 (24.1)

Intermediate uveitis 0 4 (4.2) 6 (8.4 ) 2 (1.4) 0 5 (9.8) 9 (9.9)

Posterior uveitis 139 (60.7) 13 (13.8) 7 (9.4) 35 (25.4) 6 (31.6) 11 (21.5) 17 (18.7)

Panuveitis 5 (2.2) 15 (15.9 ) 14 (19.7) 23 (16.7) 8 (42.0) 11 (21.5) 40 (44.0)

Note. ND, not developed in the original article.

TABLE 2B Diagnosis of the uveitis in elderly patients and younger patients.

Diagnosis Elderly patients Younger patients p

Sarcoidosis 34 (37.4) 32 (15.2)


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in Favres study.7, 8 Toxoplasmosis retinochorodoiditiswas never diagnosed in the studies of Favre, Barton,and Kirsch, while it accounted for a small percentagein Chatzistefanous and our study (2.9 and 3.2%).4, 6-8In accordance to previous reports, we showed thatother entities, including ankylosing spondylitis, HLA-B27-associated uveitis, and birdshot chorioretinopathy,continued to make their first appearance in patients

after the age of 60 years.We subsequently compared the frequency of the

most common diagnostics entities in the elderly withtheir frequency in younger patients examined in ourcenter. As reported by other authors, intraocular lym-phomas represent a small proportion of our populationof elderly patients, which does not markedly differ withthe frequency observed in younger patients.5-7A previ-ous study identified an age peak for ocular lymphomabetween 60 and 65 years old, but we had not reported ahigh prevalence of this diagnosis in our study.17

In our study, sarcoidosis was statistically more com-mon in older patients (37.4%), which was much higher

than the percentage reported in other studies. On the

contrary, ankylosing spondylitis and established oph-thalmological entities, including pars planitis, weremore common in the younger population. These data aresimilar to the analysis reported by Favre et al.7but dif-fer from the results of Chatzistefanou et al.6and Kirschet al.8. In the latter studies, herpes virus infections werethe most frequent specific entities (respectively 18.1 and15.6%). We need to consider the referral tertiary bias of

our study, which could explain the low rate of uveitislinked to infections (toxoplasmosis or herpes simplexvirus).

The high proportion of sarcoidosis in our populationmay be explained, in part, by the extended diagnostic

battery for sarcoidosis, which included invasive andmodern investigations, such as chest CT, bronchoalveo-lar lavage fluid examination, salivary gland biopsy, andFDG-PET. Another explanation is the diagnosis criteriawe used (Abad criteria)14; other studies used differentdiagnosis criteria. In Chatzistefanous study,6the diag-nosis of presumed sarcoidosis was based on at leasttwo of the following three features: (1) elevated serum

ACE level; (2) symmetric hilar lymphadenopathy on

TABLE 5 Categories of sarcoidosis for each study.

Diagnosis Makley9 Favre7 Barton4 Chatzistefanou6 Bouillet5 Kirsch8 Our study

Sarcoidosis 3 (1.3%) 18 (19.8) 3 (4.2%) 11 (8.0%) 3 (15.8%) 3 (5.8%) 34 (37.4%)

Proven 3 (1.3%) 0 1 (1.4%) 3 (2.2%) ND ND 16 (17.6%)

Presumed 0 18* 2 (2.8%) 8 (5.8%) ND ND 12 (13.2%)

Indeterminate 0 0 0 0 ND ND 6 (6.6%)

Proven and presumed sarcoidosis 3 (1.3%) 18 (19.8) 3 (4.2) 11 (8.0%) ND ND 28 (30.8%)

Note. ND, not developed in the original article.*We considered the 18 patients in the study with presumed sarcoidosis; but the diagnosis criteria differed from others studies.Indeed, Favre et al. used these criteria: suggestive intraocular signs of sarcoidosis and 2 positive tests among the elevated ACE and/orelevated serum lysozyme, positive chest-x ray, and cutaneous anergy to tuberculin.

TABLE 4 Distribution of specific diagnostic entities in our study and series of the literature.

Diagnosis Makley9 Favre7 Barton4 Chatzistefanou6 Bouillet5 Kirsch8 Our study

Idiopathic uveitis 12 (5.2) 23 (25.4) 34 (68.0) 43 (31.2) 5 (26.3) 26 (50.9) 33(36.3)

Sarcoidosis 3 (1.3) 18 (19.8) 3 (4.2) 11(8.0) 3 (15.8) 3 (5.8) 34 (37.4)

Herpes viruses 9 (3.9) 30 (46.4) 1 (1.4) 25 (18.1) 0 8 (15.6) 5 (5.3)

Tuberculosis 10 (4.4) 0 0 0 0 2 (3.9) 3 (3.2)

Syphilis 0 0 0 6 (4.3) 0 0 0

Ankylosing spondylitis 0 0 0 6 (4.3) 2 (10.5) 0 0

Birdshotchorioretinop. 0 1 (1.0) 0 5 (3.6) 2 (10.5) 5 (9.8) 1 (1.1)

Fuchs iridoc cyclitis 0 2 (2.0) 0 0 0 1 (1.9) 1 (1.1)

Multifocal Choroiditis 0 0 0 5 (3.6) 0 0 0

Intraocular lens-related 0 0 0 5 (3.6) 0 0 0

Toxoplasmosis 34 (14.8) 0 0 4 (2.9) 1 (5.3) 0 3 (3.2)

Wegeners granulomatosis 0 0 0 3 (2.2) 1 (5.3) 0 1 (1.1)

HLA-B27- associated uveitis 0 4 (4.4) 0 3 (2.2) 1 (5.3) 3 (5.8) 5 (5.5)

Intraocular lymphoma 0 1 (1.0) 0 2 (1.4) 2 (10.5) 0 4 (4.4)

Systemic lupus erythematosus 0 0 0 2 (1.4) 0 0 0

Sympathetic ophthalmia 0 0 0 2 (1.4) 0 0 0

Lens-induced uveitis 0 0 0 2 (1.4) 0 0 0

Diabetes mellitus 0 0 5 (7.0) 0 0 0 0

Neoplasia 0 0 2 (2.8) 0 0 0 0

Other 161 (70.4) 15 (16.0) 26 (36.6) 14 (10.1) 2 (10.5) 3 (5.9) 1

Total 229 94 71 138 19 51 91
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chest x-ray; and (3) consistent gallium scan findings.The criteria used by Favre et al.7 were suggestiveintraocular signs of sarcoidosis and 2 positive testsamong the following: elevated ACE and/or elevatedserum lysozyme, positive chest-x ray, and cutaneousanergy to tuberculin. In Bartons study, diagnosis ofsarcoidosis was made from positive chest radiographfindings or from biopsy of a skin lesion.4Makley et al.

reported only proven sarcoidosis, which is why theyobtained the lowest rate of sarcoidosis (1.3%). We diag-nosed sarcoidosis based on only one of the diagnosiscriteria (6 indeterminate sarcoidosis), but in 3 cases,it was based on the FDG-PET. Previous reports haveshown that FDG-PET is as sensitive as gallium scan todiagnose pulmonary and extrapulmonary sarcoidosis.15,17Moreover, if the 6 cases of indeterminate sarcoidosisare excluded, the incidence of sarcoidosis (proven andpresumed sarcoidosis) stays high: 30.8% (Table 5 sum-marizes the different categories of sarcoidosis for eachstudy). But we also should note that if the 6 cases ofindeterminate sarcoidosis are excluded, these patients

would increase the percentage of patients with idio-pathic uveitis. In that event, idiopathic uveitis becomesthe most frequent etiology (42.8%), before sarcoidosis(30.8%).

In most studies on ocular sarcoidosis, two age peaksare noted: the first between 20 and 30 years and thesecond around 60 years.1820Moreover, several studieswith chest CT have shown that sarcoidosis was prob-ably underestimated in uveitis patients older than 60years.21, 22

CONCLUSIONS

Our study shows that characteristics of uveitis inelderly people differ from those in younger patients.Sarcoidosis and idiopathic uveitis accounted for themajority of cases, whereas HLA-B27-associated uveitis,herpes virus infections, and intraocular lymphoma werethe other most frequent specific diagnostic entities.Intraocular lymphomas represented a small proportionof our population. Sarcoidosis is most common in theelderly and statistically significant when compared toits prevalence in younger patients. Idiopathic uveitisis the next most common diagnosis; its prevalence is

essentially no different than in the younger patients.This study shows that specific etiologies have to be dis-cussed in the case of uveitis in the elderly. Indeed, thepossibilities of sarcoidosis and its impact outside of theeye have to be taken into account, especially in terms ofpulmonary complications.

Our patient group represents a tertiary referralcenter selected sample of patients, and this obviouslyshould be taken into account in the evaluation andgeneralization of our findings. However, in terms ofdemographics, our work doesnt differ from previous

studies (percentage of female, racial distribution). Thesedata should influence the diagnostic approach in elderlypatients presenting with uveitis.

ACKNOWLEDGMENT

Study performed at Hospices Civils de Lyon, Quai des

Clestins, 69288 Lyon Cedex 02, France.

Declaration of interest:The authors report no conflictsof interest. The authors alone are responsible for thecontent and writing of the paper.

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