Characteristics of Uveitis Presenting for the First Time in the Elderly

Study 1¹

Purpose: This study was aimed at describing the clinical characteristics of uveitis presenting de novo in the elderly.

Patients and Methods: The study design was a description of a retrospectively identified case series. A population of 138 patients (209 eyes) with uveitis beginning after age 60 was analyzed.

Results: Uveitis in the elderly accounted for 10.4% of the authors’ uveitis population. The localization of uveitis was anterior in 56.5% of patients, intermediate uveitis was diagnosed in 1.4%, posterior uveitis was found in 25.4%, while 16.7% of patients presented with panuveitis. Idiopathic uveitis accounted for the majority of cases (31.2%), whereas herpes zoster ophthalmicus (11.6%), herpes simplex virus (6.5%), presumed sarcoidosis (5.8%), syphilis (4.3%), and birdshot chorioretinopathy (3.6%) were the most frequent specific diagnostic entities. Secondary elevation of intraocular pressure was common (67 eyes, or 32%). The development of macular edema complicated 28.7% of cases (60 eyes). Two cases of intraocular lymphoma were identified in 19 diagnostic vitreous biopsy specimens. Fifty-two percent of eyes retained visual acuity of 20/40 or more; 32.6% had final visual acuity worse than 20/100.

Conclusion: Uveitis presenting for the first time in the elderly is not uncommon. Idiopathic uveitis accounts for the majority of cases, and herpes zoster ophthalmicus and herpes simplex virus are particularly prevalent. Intraocular lymphoma does not predominate in this age group. With adequate control of intraocular inflammation and its sequelae, the visual prognosis in patients in this age group with uveitis is relatively good.

Study 2²

Purpose: To describe uveitis clinical characteristics in the elderly.

Patients and 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 in 22.0% 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 diagnostic entities accounted for 26.3%. Panuveitis (41.7%) and sarcoidosis (37.4%) were detected at a significantly higher frequency than in the younger population. Contrarily, ankylosing spondylitis and established ophthalmological entities (pars planitis, Birdshot chorioretinopathy, Fuchs heterochromic cyclitis) were more common in patients younger than 60 years old.

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

References

• Chatzistefanou K, Markomichelakis NN, Christen W, Soheilian M, Foster CS. Characteristics of uveitis presenting for the first time in the elderly. Ophthalmology. 1998 Feb;105(2):347-52.
• Grégoire MA, Kodjikian L, Varron L, Grange JD, Broussolle C, Seve P. Characteristics of uveitis presenting for the first time in the elderly: analysis of 91 patients in a tertiary center. Ocul Immunol Inflamm. 2011;19(4):219-26.

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