Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA; Legacy Devers Eye Institute, Legacy Health System, Portland, Oregon, USA.
Am J Ophthalmol. 2019 Feb;198:193-199. doi: 10.1016/j.ajo.2018.10.018. Epub 2018 Oct 22.
Idiopathic uveitis is frequently the most common diagnosis in series from uveitis clinics. This study sought to determine the percentage of patients initially diagnosed as idiopathic, noninfectious uveitis referred to a tertiary uveitis center who were subsequently found to have an identifiable cause of uveitis.
Retrospective case series.
We performed a computerized database analysis of 179 consecutive patients who were referred to our practice with the diagnosis of idiopathic, noninfectious uveitis between 2008 and 2016. Patients were evaluated by a thorough history and ophthalmic examination with selected laboratory testing targeted by clues from the history and examination. Standardization of Uveitis Nomenclature (SUN) criteria were used to better assess different types of uveitis.
Fifty-two out of 179 (29.0%) patients initially diagnosed with idiopathic uveitis were subsequently diagnosed with an underlying condition. Among patients referred with a diagnosis of idiopathic disease, female patients were most commonly affected (121/179; 67.6%). Among subsequent diagnoses, sarcoidosis was the most common (19/52 or 36.5%), followed by HLA-B27-associated uveitis (11/52, 21.1%), infectious uveitis (6/52, 11.5%), tubulointerstitial nephritis with uveitis (6/52, 11.5%), and juvenile idiopathic uveitis (4/52, 7.7%). Other diagnosable conditions included Behçet disease, multifocal choroiditis, panuveitis, Crohn disease, multiple sclerosis, and relapsing polychondritis. An underlying condition was not found in 127 of 179 (70.9%) patients.
We report that 29% of patients referred to our tertiary uveitis center diagnosed as "idiopathic" had an associated identifiable cause. Identifying an underlying condition associated with uveitis could be potentially lifesaving for some illnesses (eg, sarcoidosis with cardiac involvement) and is critical to management (eg, infection). Although we were able to use limited testing to classify many patients who had been previously incorrectly labeled with idiopathic uveitis, idiopathic uveitis remains the most common diagnosis in our uveitis clinic.
特发性葡萄膜炎是葡萄膜炎门诊最常见的诊断之一。本研究旨在确定被转诊至三级葡萄膜炎中心的最初诊断为特发性、非感染性葡萄膜炎的患者中，有多少人随后被发现存在可识别的葡萄膜炎病因。
回顾性病例系列研究。
我们对 2008 年至 2016 年间因特发性、非感染性葡萄膜炎被转诊至我们诊所的 179 例连续患者进行了计算机数据库分析。通过详细的病史和眼科检查，结合病史和检查线索进行有针对性的实验室检查，对患者进行评估。采用葡萄膜炎命名标准（SUN）来更好地评估不同类型的葡萄膜炎。
最初诊断为特发性葡萄膜炎的 179 例患者中有 52 例（29.0%）随后被诊断为潜在疾病。在因特发性疾病被转诊的患者中，女性最常见（179 例中的 121 例，占 67.6%）。在随后的诊断中，结节病最常见（52 例中的 19 例，占 36.5%），其次是 HLA-B27 相关葡萄膜炎（52 例中的 11 例，占 21.1%）、感染性葡萄膜炎（52 例中的 6 例，占 11.5%）、伴有葡萄膜炎的肾小管间质性肾炎（52 例中的 6 例，占 11.5%）和青少年特发性葡萄膜炎（52 例中的 4 例，占 7.7%）。其他可诊断的疾病包括贝切特病、多灶性脉络膜炎、全葡萄膜炎、克罗恩病、多发性硬化症和复发性多软骨炎。在 179 例患者中，有 127 例（70.9%）未发现潜在疾病。
我们报告称，在被转诊至我们的三级葡萄膜炎中心的患者中，有 29%被诊断为“特发性”的患者存在可识别的相关病因。确定与葡萄膜炎相关的潜在病因对某些疾病（如伴有心脏受累的结节病）可能具有潜在的挽救生命的作用，对治疗也至关重要（如感染）。尽管我们能够使用有限的检查来对以前被错误诊断为特发性葡萄膜炎的许多患者进行分类，但特发性葡萄膜炎仍然是我们葡萄膜炎诊所最常见的诊断。
