Received: 27 May 2020; Published on-line: 27 August 2020
Findings of ocular and brain hemodynamics in patients with anterior uveitis complicated by macular edema
N.I. Khramenko, Cand Sc (Med), N.V. Konovalova, Dr Sc (Med)
SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine"; Odesa (Ukraine)
TO CITE THIS ARTICLE: Khramenko NI, Konovalova NV. Findings of ocular and brain hemodynamics in patients with anterior uveitis complicated by macular edema. J.ophthalmol.(Ukraine).2020;4:14-22.http://doi.org/10.31288/oftalmolzh202041322
Background: Uveitis is the fifth most common cause of visual loss in the developed world, accounting for about 10% of legal blindness. Macular edema (ME) has been found to be the most important cause of both blindness and visual impairment (29% and 41%, respectively) in patients with uveitis. The rate of macular edema in patients with anterior uveitis may be as high as one-third. Molecular mechanisms and pathophysiology of inflammatory retinal detachment in uveitis have been only partially elucidated. It is still unclear why some patients exhibit only one episode of ME, while others have a chronic or recurrent course of ME and are resistant to immunomodulatory and anti-inflammatory therapy.
Purpose: To identify the features of ocular and brain hemodynamics in patients with anterior uveitis complicated by ME.
Material and Methods: Totally, 155 uveitis patients (primary anterior uveitis, 30 patients; recurrent anterior uveitis, 125 patients) who were examined and treated at Uveitis Department and Visual Function Research Laboratory were involved in this study. Not only routine studies, but also optical coherence tomography, electrical impedance studies (ophthalmic rheography and rheoencephalography), and adaptation potential studies were performed.
Results: Most cases (73.3%) with primary uveitis had a unilateral disease (p = 0.05), and as much as 50% of patients with recurrent uveitis had a bilateral disease. Macular edema was found in 18.4% of cases with primary uveitis, 20.8% of cases with frequently recurring uveitis, 3.3% of cases with infrequently recurring uveitis, and 11.5% of cases with non-identified recurrence pattern of uveitis. The rate of ME was higher in a bilateral primary disease (37.5%) than in a unilateral primary disease (p = 0.009). Macular edema was found 17% more frequently (p = 0.03) in frequently recurring uveitis than in infrequently recurring uveitis. Among patients with ME, those with frequent recurrences of anterior uveitis had the lowest mean visual acuity (0.28 ± 0.07). Compared to patients without ME, those with ME exhibited a 50% and 22.2% higher ocular pulse blood filling (OPBF, expressed as RQ, ‰ rheographic coefficient) in primary anterior uveitis and in recurrent anterior uveitis, respectively. In addition, compared to patients with uncomplicated anterior uveitis, those with ME exhibited a 71% and a 33.3% higher ocular blood flow velocity in primary anterior uveitis and in recurrent anterior uveitis, respectively. Relative pulse blood filling of the internal carotid system in patients with recurrent anterior uveitis complicated by ME was 30% higher than in patients with uncomplicated recurrent anterior uveitis. Our study of the adaptation potential, an integrative indicator of the cardiovascular system’s response to the stimulus, found that, among the anterior uveitis patients, the vast majority (84%) showed stressed adaptation mechanisms.
Conclusion: Macular edema was found in 18.4% of cases with primary uveitis, 20.8% of cases with frequently recurring uveitis, and 3.3% of cases with infrequently recurring uveitis. The disease bilaterality in primary anterior uveitis and frequent recurrences in recurrent anterior uveitis were found to be aggravating factors for the development of ME. Compared to patients with uncomplicated anterior uveitis, those with ME exhibited a 50% and 22.2% higher OPBF expressed as RQ in primary anterior uveitis and in recurrent anterior uveitis, respectively. Relative pulse blood filling of the internal carotid system in patients with recurring anterior uveitis complicated by ME was 30% higher than in patients with recurring uncomplicated anterior uveitis.
Keywords: anterior uveitis, complications, macular edema, ocular and brain hemodynamics, ophthalmic rheography, rheoencephalography
1. Gritz DC, Wong IG. Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study. Ophthalmology. 2004 Mar;111(3):491-500; discussion 500.
2. Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C., Androudi S. A Focus on the Epidemiology of Uveitis. Ocul Immunol Inflamm. 2018;26(1):2-16.
3. Rothova A, Suttorp-van Schulten MS, Treffers WF, Kijlstra A. Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol. Br J Ophthalmol. 1996 Apr;80(4):332-6.
4. Ad?n A, Moll-Udina A, Alba-Linero C, Figueroa-Vercellino JP, Lloren? V. Recent progress in the treatment of uveitic macular edema. Expert Rev Ophthalmol. 2019;14(4-5):227-36.
5. Levin MH, Pistilli M, Daniel E, Gangaputra SS, Nussenblatt RB, Rosenbaum JT, et al. Incidence of visual improvement in uveitis cases with visual impairment caused by macular edema. Ophthalmology. 2014 Feb. 121(2):588-95.e1.
6. Rothova A. Medical treatment of cystoid macular edema. Ocul Immunol Inflamm. 2002 Dec;10(4):239-46.
7. Kempen JH, Sugar EA, Jaffe GJ, Acharya NR, Dunn JP, Elner SG, et al. Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. Ophthalmology. 2013 Sep;120(9):1852-9.
8. Koronis S, Stavrakas P, Balidis M, Kozeis N, Tranos PG. Update in treatment of uveitic macular edema. Drug Des Devel Ther. 2019 Feb 19;13:667-680.
9. Tran TH, de Smet MD, Bodaghi B, Fardeau C, Cassoux N, Lehoang P. Uveitic macular oedema: correlation between optical coherence tomography patterns with visual acuity and fluorescein angiography. Br J Ophthalmol. 2008 Jul;92(7):922-7.
10. Markomichelakis NN, Halkiadakis I, Pantelia E, et al. Patterns of macular edema in patients with uveitis: qualitative and quantitative assessment using optical coherence tomography. Ophthalmology. 2004 May;111(5):946-53.
11. Massa H, Pipis SY, Adewoyin T, Vergados A, Patra S, Panos GD. Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges. Clin Ophthalmol. 2019 Sep 10;13:1761-1777.
12. Khramenko NI. Ocular hemodynamics and activity of autonomic nervous system at different stages of the course of anterior uveitis. J Ophthalmol (Ukraine). 2015;5:25-29.
13. Khramenko NI, Konovalova NV, Kravchenko LI. [Regional hemodynamics at different stages of the course of anterior uveitis]. In: [Filatov Memorial Lectures: Proceedings of the International Ophthalmological Conference]. May 24-25, 2015; Odesa. p. 118-9. Russian.
14. Khramenko NI, Konovalova NV, Shaibi Abderrakhim. [OCT study of the sensory retina and choroid in patients with uveitis]. Oftalmol Zh. 2014;3:34-40. Russian.
15. Khramenko NI, Konovalova NV, Naritsyna NI, Ivanitska OV, Serebrina TM, Kushnir VL, Rybalko AV. [Ocular hemodynamics in the complicated course of chronic recurrent anterior uveitis]. Odeskii Medychyi Zhurnal. 2016; 2(154):53-7. Ukrainian.
16. Baevskii RM. [Prediction of states on the verge of norm and pathology]. Moscow: Meditsina; 1979. pp. 248-77. Russian.
17. Matas J, Lloren? V, Fonollosa A, Esquinas C, Diaz-Valle D, Berasategui B, et al. Predictors for functional and anatomic outcomes in macular edema secondary to non-infectious uveitis. PloS one. 2019 Jan 24;14(1):e0210799.