Department of Ophthalmology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
Department of Ophthalmology, Academic Medical Center, Amsterdam, the Netherlands.
Acta Ophthalmol. 2019 Feb;97(1):53-59. doi: 10.1111/aos.13877. Epub 2018 Sep 21.
The advances in medicine have led to an increased number of people living with some form of immunodeficiency. Most ocular infections in immunocompromised patients may lead to irreversible blindness. We identify the causes of uveitis in immunocompetent and immunocompromised patients.
A retrospective cohort study of 1354 consecutive patients. All patients underwent a standard work-up for uveitis.
An immunocompromised state was identified in 171/1354 patients (13%), of whom 40 had Human immunodeficiency virus (HIV) infection, 52 received immunosuppressive medications, 28 had concurrent malignant disorder and 20 had other causes for their immunosuppression. In addition, 93/1354 patients (7%) had diabetes mellitus (DM). The prevalence of intraocular infections was much higher in immunocompromised patients than in immunocompetent patients and DM (p < 0.001). Causes of uveitis differed between the diverse immunocompromised groups. The non-HIV immunocompromised patients showed primarily intraocular herpes simplex and varicella zoster virus infections, whilst HIV-positive patients exhibited frequently cytomegalovirus (CMV) retinitis and syphilis. Patients with generalized malignancies were characterized by a lower prevalence of infections and higher prevalence of sarcoidosis. Patients with DM typically showed sarcoidosis and bacterial intraocular infections. The percentage of undetermined uveitis diagnoses was markedly lower in immunosuppressed patients (p < 0.001).
In immunocompromised patients with uveitis, infections were diagnosed in 46% of cases in contrast to 12% in the immunocompetent patients. The causes of uveitis differed among the various types of immunosuppression. Immunocompromised patients with uveitis require a rapid assessment for the most expected infections.
医学的进步导致越来越多的人患有某种形式的免疫缺陷。大多数免疫功能低下患者的眼部感染可能导致不可逆转的失明。我们确定了免疫功能正常和免疫功能低下患者葡萄膜炎的病因。
对 1354 例连续患者进行回顾性队列研究。所有患者均接受了葡萄膜炎的标准检查。
在 1354 例患者中发现 171 例（13%）免疫功能低下，其中 40 例为人类免疫缺陷病毒（HIV）感染，52 例接受免疫抑制药物治疗，28 例同时患有恶性疾病，20 例因其他原因免疫抑制。此外，1354 例患者中有 93 例（7%）患有糖尿病（DM）。与免疫功能正常患者和 DM 患者相比，免疫功能低下患者眼内感染的患病率要高得多（p<0.001）。葡萄膜炎的病因在不同免疫抑制组之间存在差异。非 HIV 免疫抑制患者主要表现为眼内单纯疱疹和水痘带状疱疹病毒感染，而 HIV 阳性患者则常表现为巨细胞病毒（CMV）视网膜炎和梅毒。全身恶性肿瘤患者的感染率较低，结节病的患病率较高。DM 患者通常表现为结节病和细菌性眼内感染。免疫抑制患者未确定的葡萄膜炎诊断百分比明显较低（p<0.001）。
在免疫功能低下的葡萄膜炎患者中，46%的患者诊断为感染，而免疫功能正常的患者中为 12%。葡萄膜炎的病因因各种类型的免疫抑制而不同。免疫功能低下的葡萄膜炎患者需要快速评估最常见的感染。
