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University of Groningen
Herpetic and HLA-B27 associated anterior uveitisHoeksema, Lisette
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Publication date:2019
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):Hoeksema, L. (2019). Herpetic and HLA-B27 associated anterior uveitis: ocular complications, prognosisand vision-related quality of life. [Groningen]: Rijksuniversiteit Groningen.
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Download date: 14-06-2020
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SUMMARY
Uveitis an important cause of blindness and visual impairment. The ocular characteristics,
complications and visual acuity (VA) during follow-up differ for the different uveitis entities. The
burden of anterior uveitis (AU) can be measured by determining the vision related quality of
life (VR-QOL) and is an important measuring tool. We believe that it is important to investigate
homogeneous uveitis groups to contribute to a more personalized care of uveitis patients. In
addition, using the guidelines for uniform reporting in uveitis as developed by the standardization
of uveitis nomenclature (SUN) working group, will enable comparisons with future studies in
the field. This thesis discusses two types of anterior uveitis, HLA-B27 associated AU, the most
common non-infectious form, and herpetic AU, the most common infectious form.
In chapter 1 we provide an introduction to this thesis and give information about the aims of
the studies we conducted. Chapter 2 gives information on the rate of complications, ocular
characteristics and the visual prognosis in herpetic (HSV and VZV) AU compared to HLA-B27
associated AU. We found a worse visual prognosis in herpetic versus HLA-B27 associated AU,
which is probably related to a higher prevalence of corneal scarring and glaucoma in the former.
In addition, herpetic AU patients have more ocular complications overall. This information may
be helpful in developing individualized entity-related counseling strategies.
In chapter 3 we describe the incidence of elevated intraocular pressure (IOP) and secondary
glaucoma in herpetic (HSV and VZV) AU. We found that elevated IOP and secondary glaucoma
are frequent complications of viral AU. In addition, we found a wide variety between studies
regarding the definitions of elevated IOP and secondary glaucoma, and as a result a wide variation
in reported incidences of these complications. This underlines the need for standardized criteria
such as developed by the SUN working group.
We evaluated whether ocular and patient characteristics differ between unilateral (always the
same eye) or bilateral (simultaneous or alternating) HLA-B27 associated AU with or without
systemic disease in chapter 4. We found that unilateral and bilateral HLA-B27 associated AU
are generally comparable, which indicates that it is probably the same disease entity. This study
shows that unilateral and bilateral patients both have a good prognosis with regard to VA and
the development of ocular complications. In addition, bilateral AU patients more often had an
associated systemic disease.
In chapter 5 we report on the VR-QOL and the prevalence and severity of depression in herpetic
(HSV and VZV) AU. Herpetic AU affects the VR-QOL, but only in a moderate way. The prevalence
of depression in our group of herpetic AU patients was low and therefore does not seem to
indicate a need for specific screening and intervention measures in this specific patient group.
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In chapter 6 we evaluate the VR-QOL in a group of patients with HLA-B27 associated AU.
Patients with HLA-B27 associated AU have a relatively high VR-QOL. However, the presence of
a systemic disease is associated with considerably lower VR-QOL and general health scores and
may be associated with an increased risk of depression. In addition, depression itself is associated
with a lower VR-QOL.
In chapter 7 the most important findings are discussed and ideas for future research are given.
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