Ophthalmology Interest Group-Universidad del Rosario (OIG UR), Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
PLoS One. 2024 Oct 25;19(10):e0307455. doi: 10.1371/journal.pone.0307455. eCollection 2024.
To summarize and meta-analyze uveitis characteristics and multiple sclerosis (MS) phenotype of patients with multiple sclerosis-associated uveitis (MSAU) within a systematic review and meta-analysis.
A comprehensive literature search was performed on January 25, 2023, utilizing PubMed, Embase, and Virtual Health Library (VHL) databases. We included studies involving patients with MSAU, such as case series with over 10 patients, cross-sectional, case-control, and cohort studies. Quality and risk of bias were assessed using CLARITY tools and validated metrics like the Hoy et al. and Hassan Murad et al. tools. The pooled analysis focused on 1) uveitis characteristics, 2) ocular complications, 3) MS phenotype, and 3) administered treatments for uveitis and MS. Gender-based subgroup analysis was conducted across continents; heterogeneity was measured using the I2 statistic. Statistical analysis was performed using R software version 4.3.1. The study was registered in PROSPERO with CRD42023453495 number.
Thirty-six studies were analyzed (24 with a low risk of bias, 8 with some concerns, and 4 with a high risk of bias), including 1,257 patients and 2,034 eyes with MSAU. The pooled analysis showed a mean age of 38.2 ± 12.1 years with a notable female predominance (67%, 95% CI [59%-73%]). MS before uveitis was seen in 59% of the cases (95% CI [48%-69%]), while uveitis was present before MS in 38% (95% CI [30%-48%]). The mean age for the first uveitis episode was 35.7 ± 8.3 years, predominantly affecting both eyes (77%, 95% CI [69%-83%], from 23 studies involving 452 patients). Intermediate uveitis was the most frequent anatomical location (68%, 95% CI [49%-82%], from 22 studies involving 530 patients), often following a recurrent course (63%, 95% CI [38%-83%]). Key complications included vision reduction (42%, 95% CI [19%-70%], from five articles involving 90 eyes), macular compromise (45%, 95% CI [20%-73%], from 4 studies involving 95 eyes), and cataracts (46%, 95% CI [32%-61%], from eight articles involving 230 eyes). Concerning MS phenotype, relapsing-remitting MS (RRMS) was the most common subtype (74%, 95% CI [64%-82%], from eight articles involving 134 patients), followed by secondary progressive MS (24%, 95% CI [18%-33%], from eight articles involving 125 patients). The most frequently occurring central nervous lesions were supratentorial (95%, 95% CI [70%-99%], from two articles involving 17 patients) and spinal cord (39%, 95% CI [16%-68%], from two articles involving 29 patients). The mean Expanded Disability Status Scale (EDSS) score and annual recurrence rates were 2.9 ± 0.6 and 1.07 ± 0.56, respectively. Treatment trends showed the prevalent use of Fingolimod (96%, 95% CI [17%-100%], from two articles involving 196 patients), Mycophenolate (48%, 95% CI [11%-87%], from four articles involving 51 patients), and Interferon-beta (43%, 95% CI [24%-65%], from 11 articles involving 325 patients).
MSAU primarily affects young adult females, typically presenting as bilateral intermediate uveitis with vision-related complications. The most common MS phenotype is RRMS, often associated with supratentorial and spinal cord lesions on imaging. These findings give ophthalmologists and neurologists a comprehensive clinical picture of MSAU, facilitating prompt diagnosis.
通过系统评价和荟萃分析总结并分析多发性硬化相关性葡萄膜炎（MSAU）患者的葡萄膜炎特征和多发性硬化（MS）表型。
于 2023 年 1 月 25 日在 PubMed、Embase 和虚拟健康图书馆（VHL）数据库中进行全面的文献检索。我们纳入了涉及 MSAU 患者的研究，如超过 10 例患者的病例系列、横断面、病例对照和队列研究。使用 CLARITY 工具和 Hoy 等人验证的指标（如 Hassan Murad 等人的工具）评估质量和偏倚风险。荟萃分析重点关注 1）葡萄膜炎特征，2）眼部并发症，3）MS 表型，以及 3）用于治疗葡萄膜炎和 MS 的治疗方法。在跨大陆进行了基于性别的亚组分析；使用 I2 统计量测量异质性。使用 R 软件版本 4.3.1 进行统计分析。该研究已在 PROSPERO 中以 CRD42023453495 号注册。
共分析了 36 项研究（24 项低偏倚风险，8 项存在一些关注，4 项高偏倚风险），包括 1257 名患者和 2034 只眼的 MSAU。荟萃分析显示，平均年龄为 38.2±12.1 岁，女性占比显著（67%，95%CI [59%-73%]）。59%的病例中 MS 先于葡萄膜炎发生（95%CI [48%-69%]），而 38%的病例中葡萄膜炎先于 MS 发生（95%CI [30%-48%]）。首次葡萄膜炎发作的平均年龄为 35.7±8.3 岁，主要影响双眼（77%，95%CI [69%-83%]，来自 23 项涉及 452 名患者的研究）。中间葡萄膜炎是最常见的解剖部位（68%，95%CI [49%-82%]，来自 22 项涉及 530 名患者的研究），常呈复发性病程（63%，95%CI [38%-83%]）。关键并发症包括视力下降（42%，95%CI [19%-70%]，来自 5 项涉及 90 只眼的研究）、黄斑病变（45%，95%CI [20%-73%]，来自 4 项涉及 95 只眼的研究）和白内障（46%，95%CI [32%-61%]，来自 8 项涉及 230 只眼的研究）。关于 MS 表型，复发缓解型 MS（RRMS）是最常见的亚型（74%，95%CI [64%-82%]，来自 8 项涉及 134 名患者的研究），其次是继发进展型 MS（24%，95%CI [18%-33%]，来自 8 项涉及 125 名患者的研究）。最常见的中枢神经系统病变是幕上病变（95%，95%CI [70%-99%]，来自 2 项涉及 17 名患者的研究）和脊髓病变（39%，95%CI [16%-68%]，来自 2 项涉及 29 名患者的研究）。平均扩展残疾状况量表（EDSS）评分和年复发率分别为 2.9±0.6 和 1.07±0.56。治疗趋势显示，Fingolimod 的使用最为普遍（96%，95%CI [17%-100%]，来自 2 项涉及 196 名患者的研究），Mycophenolate 的使用也较多（48%，95%CI [11%-87%]，来自 4 项涉及 51 名患者的研究），干扰素-β的使用也较多（43%，95%CI [24%-65%]，来自 11 项涉及 325 名患者的研究）。
MSAU 主要影响年轻成年女性，通常表现为双侧中间葡萄膜炎，并伴有与视力相关的并发症。最常见的 MS 表型是 RRMS，常伴有幕上和脊髓病变。这些发现为眼科医生和神经科医生提供了 MSAU 的全面临床图像，有助于快速诊断。
