Causes of Uveitis in the General Practice of Ophthalmology

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Purpose

Most uveitis case series have come from tertiary care centers, and the relative frequencies of disorders they report may reflect referral bias. We sought information about the types of uveitis encountered in the general practice of ophthalmology.

Methods

We prospectively examined 213 consecutive cases of general uveitis, defined as intraocular inflammation other than cytomegalovirus retinopathy, seen by a group of community-based comprehensive ophthalmologists. This group of cases was compared with 213 consecutive cases of general uveitis examined by a uveitis specialist at a university referral center in the same community. All cases were categorized by anatomic site of inflammation and disease course, and, if possible, they were assigned a specific diagnosis. Cases of cytomegalovirus retinopathy and masquerade syndrome seen during the same intervals were recorded separately.

Results

The distribution of general uveitis cases by anatomic site of disease was significantly different between the community-based practices (anterior, 90.6%; intermediate, 1.4%; posterior, 4.7%; panuveitis, 1.4%) and the university referral practice (anterior, 60.6%; intermediate, 12.2%; posterior, 14.6%; panuveitis, 9.4%; P < .00005). A cause or clinical syndrome could be assigned to 47.4% of cases in the community-based practices, and to 57.8% of cases in the university referral practice (P = .03). HLA-B27-associated anterior uveitis, cytomegalovirus retinopathy, and toxoplasmic retinochoroiditis were among the five most common forms of uveitis in both practice settings.

Conclusion

The relative frequencies with which various forms of uveitis are seen in a tertiary referral center do not necessarily reflect the experience of ophthalmologists from the community in which the center is located. Anterior uveitis and disorders of sudden onset constitute a greater proportion of cases seen by community-based comprehensive ophthalmologists.

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This study was supported by the Charles Ruggles Foundation for Ophthalmic Research, Santa Monica, California; an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York (Jules Stein Eye Institute); and the Heed Ophthalmic Foundation, Chicago, Illinois (Dr. Helm). Dr. Helm was a 1992-93 Abe Meyer Fellow in cornea-external ocular disease and uveitis. Members of the study group are given at the end of the article.

Reprint requests to Gary N. Holland, M.D., Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90095-7003.

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