Background
Methods
Selection of participants
Data collection and assessment
Statistical analysis
Results
COVID-19 infection increased uveitis relapse
Characteristics | COVID-19 infected patients | COVID-19 uninfected patients | P Value |
---|---|---|---|
(n = 288, eyes = 482) | (n = 61, eyes = 102) | ||
Age (years) (M-IQR) | 31.0 (14.0–46.0) | 31.0 (15.0–55.0) | 0.374 |
Gender (Male/female) (n, %) | 130 (45.1)/158 (54.9) | 35 (57.4)/26 (42.6) | 0.062 |
Course of disease (years) (M-IQR) | 2.50 (1.17–4.90) | 3.4 (1.54-6.00) | 0.033 |
BCVAa (logMAR, M-IQR) | 0.00 (0.00-0.22) | 0.10 (0.00-0.30) | 0.100 |
The anterior chamber cell grade recorded as 0b (eyes, %) | 398 (82.6) | 82 (80.4) | 0.601 |
Infective uveitis (n, %) | 9 (3.1) | 4 (6.6) | 0.361 |
Anatomical classification (n, %) | |||
Anterior uveitis | 30 (10.4) | 11 (18.0) | 0.093 |
Intermediate, posterior or panuveitis | 258 (89.6) | 50 (82.0) | |
Uveitis-related systemic diseases (n, %) | |||
Vogt-Koyanagi-Harada disease | 47 (16.3) | 4 (6.6) | 0.05 |
Behcet’s disease | 26 (9.0) | 5 (8.2) | 0.836 |
Ankylosing Spondylitis | 19 (6.6) | 2 (3.3) | 0.488 |
Other diseasesc | 16 (5.6) | 5 (8.2) | 0.623 |
Profile and treatment of COVID-19-infected patients
Etiology (n, %) | Total (n = 288) | Relapsed patients | Non-relapsed |
---|---|---|---|
(n = 83) | patients (n = 205) | ||
Vogt-Koyanagi-Harada disease | 47 (16.3) | 14 (16.9) | 33 (16.1) |
Behcet’s disease-related uveitis | 26 (9.0) | 4 (4.8) | 22 (10.7) |
Ankylosing spondylitis associated uveitis | 19 (6.6) | 9 (10.8) | 10 (4.9) |
Other systemic diseases-related uveitisa | 16 (5.6) | 6 (7.2) | 10 (4.9) |
Viral anterior uveitis | 4 (1.4) | 1 (1.2) | 3 (1.5) |
Fuchs’ heterochromic iridocyclitis | 4 (1.4) | 1 (1.2) | 3 (1.5) |
Cytomegalovirus retinitis | 2 (0.7) | 0 | 2 (1.0) |
Acute retinal necrosis syndrome | 2 (0.7) | 0 | 2 (1.0) |
Posner-Schlossman Syndrome | 2 (0.7) | 0 | 2 (1.0) |
Toxoplasmosis | 1(0.3) | 0 | 1 (0.5) |
Idiopathic uveitis | 165 (57.3) | 48 (57.8) | 117 (57.1) |
Parameters | Relapsed patients (n = 83, eyes = 126) | Non-relapsed patients (n = 205, eyes = 356) | Univariate | Multivariate | ||
---|---|---|---|---|---|---|
OR (95% CI) | P Value | OR (95% CI) | P Value | |||
Age (years) (M-IQR) | 31 (15–48) | 31 (14–44) | 1.006 (0.992–1.020) | 0.398 | NA | NA |
Gender (male/female) (n, %) | 32 (38.6)/51(61.4) | 98 (47.8)/107(52.2) | 1.460 (0.868–2.455) | 0.154 | NA | NA |
Course of disease (years) (M-IQR) | 3.25 (1.58–5.33) | 2.17 (1.08-4.00) | 1.054 (0.995–1.116) | 0.075 | 1.082 (1.016–1.151) | 0.013 |
BCVAa (logMAR, M-IQR) | 0.00 (0.00-0.22) | 0.00 (0.00-0.15) | 0.831 (0.518–1.333) | 0.443 | NA | NA |
The anterior chamber cell grade recorded as 0b (eyes, %) | 103 (81.7) | 295 (82.9) | 0.926 (0.545–1.572) | 0.776 | NA | NA |
Infectious uveitis (n, %) | 1 (1.2) | 8 (2.2) | 3.330 (0.410-27.051) | 0.260 | NA | NA |
Anatomical classification (n, %) | ||||||
Anterior uveitis | 10 (12.0) | 20 (9.8) | 1 | 0.565 | NA | NA |
Intermediate, posterior or panuveitis | 73 (88.0) | 185 (90.2) | 0.789 (0.352–1.767) | NA | NA | NA |
Uveitis-related systemic diseases (n, %) | ||||||
Vogt-Koyanagi-Harada disease | 14 (16.9) | 33 (16.1) | 0.946 (0.477–1.875) | 0.873 | NA | NA |
Behcet’s disease | 4 (4.8) | 22 (10.7) | 2.374 (0.792–7.115) | 0.123 | NA | NA |
Ankylosing Spondylitis | 9 (10.8) | 10 (4.9) | 0.422 (0.165–1.079) | 0.072 | 0.406 (0.145–1.133) | 0.085 |
Other diseasesc | 6 (7.2) | 10 (4.9) | 0.658 (0.231–1.873) | 0.433 | NA | NA |
Other systemic diseases (n, %) | ||||||
Hypertension | 9 (10.8) | 12 (5.9) | 0.511 (0.207–1.264) | 0.146 | NA | NA |
Diabetes | 2 (2.4) | 9 (4.4) | 1.860 (0.393–8.796) | 0.434 | NA | NA |
Malignancy | 1 (1.2) | 3 (1.5) | 1.218 (0.125–11.879) | 0.865 | NA | NA |
Time since the last relapse > 1 year (n, %) | 20 (24.1) | 82 (40.0) | 0.476 (0.268–0.847) | 0.012 | 0.335 (0.177–0.632) | 0.001 |
Systemic medicationd(n, %) | ||||||
Prednisone | 36 (43.4) | 91 (44.4) | 0.960 (0.574–1.605) | 0.875 | NA | NA |
Immunosuppressants | 31 (37.3) | 103 (50.2) | 0.590 (0.350–0.995) | 0.048 | NA | NA |
Cyclosporin A | 4 (4.8) | 3 (1.5) | 3.409 (0.746–15.578) | 0.114 | NA | NA |
Methotrexate | 22 (26.5) | 82 (40.0) | 0.541 (0.308–0.949) | 0.032 | 0.516 (0.288–0.926) | 0.026 |
Mycophenolate mofetil | 8 (9.6) | 19 (9.3) | 1.044 (0.438–2.489) | 0.922 | NA | NA |
Azathioprine | 0 | 1 (0.5) | 0 | 1.000 | NA | NA |
Adalimumab | 22 (26.5) | 72 (35.1) | 0.666 (0.378–1.173) | 0.159 | NA | NA |
Types of systemic medications (n, %) | 205 | |||||
0 | 32 (38.6) | 58 (28.3) | 1 | 0.349 | NA | NA |
1 | 20 (24.1) | 55 (26.8) | 0.659 (0.337–1.287) | NA | NA | NA |
2 | 19 (22.9) | 66 (32.2) | 0.558 (0.288–1.081) | NA | NA | NA |
3 types and above | 12 (14.5) | 26 (12.7) | 0.738 (0.324–1.682) | NA | NA | NA |
Self-delayed Medicationse (n, %) | 19 (22.9) | 39 (19.0) | 1.264 (0.680–2.348) | 0.459 | NA | NA |
Vaccination (n, %) | 76 (91.6) | 192 (93.7) | 1.360 (0.523–3.540) | 0.528 | NA | NA |
Risk factors for uveitis relapse post-COVID-19 infection
New-onset uveitis post-COVID-19 infection
Patient No. | Sex | Age | Time interval of onset (days) | Etiology | eye | History of uveitis-related systemic disease | History of ocular disease | Initial visit | Treatment | Follow-up time (months) | Final visit | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
BCVA (Log-MAR) | IOP | Ocular examinations | BCVA (Log-MAR) | IOP | Ocular examinations | ||||||||||
1 | F | 57 | 26 | VKH | OU | - | Cataracts | 0.8/0.7 | 16.2/19.3 | OU: AC cells grade 2+; Dust-like KPs; VH grade 2+; Optic disc edema; ERD; Choroiditis | Steroid eye drops; Mydriatic eye drops; Oral prednisone | 6 | 0.1/0.1 | 15.7/16.4 | OU: AC cells grade 0; VH grade 0; Resolution of sub-retinal fluids |
2 | F | 49 | 42 | VKH | OU | - | - | 0.3/1.0 | 13.6/13.6 | OU: Optic disc edema ; ERD; Choroiditis | Oral prednisone | 1.5 | 0.2/0.4 | 14.9/13.0 | OU: Resolution of subretinal fluids |
3 | F | 76 | 30 | VKH | OU | - | Cataracts | 0.8/1.0 | 23.2/20.9 | OU: AC cells grade 3+; VH grade 1+; Optic disc edema; ERD; Choroiditis | Steroid eye drops; Mydriatic eye drops; Oral prednisone | 1 | 0.5/0.5 | 12.7/14.9 | OU: Resolution of subretinal fluids |
4 | M | 23 | 10 | VKH | OU | - | FS-LASIK Postoperative | 0.0/0.0 | 17.7/16.3 | OU: Optic disc edema; ERD; Choroidi-tis | Oral prednisone | 6.5 | 0.0/0.0 | 14.8/13.4 | OU: Resolution ofsubretinal fluids |
5 | F | 7 | 28 | JIA-related anterior uveitis | OS | JIA | - | 0.0 | 9.7 | OS: AC cells grade 2+; Mutton-fat KPs | Steroid eye drops; Mydriatic eye drops; | 2 | 0.0 | 11.8 | OS: AC cells grade 0 |
6 | F | 69 | 1 | Idiopathic anterior uveitis | OD | - | AMD | 1.3 | 16.4 | OD: AC cells grade 0.5+ | Steroid eye drops | 2 | 1.3 | 18.6 | OD: AC cells grade 0 |
7 | F | 58 | 20 | Idiopathic anterior uveitis | OS | - | - | 0.1 | 18.5 | OS: AC cells grade 2+; | Steroid eye drops; Mydriatic eye drops; | 2 | 0.0 | 19.8 | OS: AC cells grade 0 |
8 | M | 12 | 8 | pediatric intermedia-te uveitis | OU | - | - | 0.0/0.0 | 16.2/12.8 | OU: AC cells grade2+; VH grade 0.5+;Peripheral retinal capillary leakage | Steroid eye drops; Mydriatic eye drops; Oral methotrexate; ad-alimumab | 5 | 0.0/0.0 | 16.8/15.9 | OU: AC cells grade 0;VH grade 0 |
9 | F | 53 | 10 | Idiopathic posterior uveitis | OS | - | - | 0.0 | 17.5 | OS: VH grade 0.5+; Chorioretinitis | Oral prednisone | No follow-up visits | - | - | - |
10 | F | 56 | 20 | Idiopathic panuveitis | OS | - | Cataracts | 0.0 | 13.4 | OS: AC cells grade 1+; VH grade 0.5+; Chorioretinitis | Patient refused oral corticostero-ids; Steroid eye drops; Mydriatic eye drops; | 1.5 | 0.0 | 18.3 | OS: AC cells grade 0;VH grade 0.5+; Chorioretinitis |
11 | F | 60 | 3 | Idiopathic panuveitis | OD | - | - | 0.4 | 17.3 | OD: iris posterior synechia; VH grade 2+; diffuse retinal vasculitis; | Steroid eye drops; Mydriatic eye drops; Oral prednisone | 5 | 0.0 | 18.7 | OD: VH grade 0; Reduced retinal vascular leakage |
12 | F | 39 | 34 | Idiopathic panuveitis | OS | - | - | 0.4 | 9.6 | OS: AC cells grade 3+; VH grade 2+; Chorioretinitis | Steroid eye drops; Mydriatic eye drops; Oral prednisone; Oral azathioprine | 6 | 0.0 | 13.2 | OS: AC cells grade 0;VH grade 0 |
13 | F | 13 | 7 | pediatric panuveitis | OU | - | OS: Amblyopia | 0.1/0.7 | 11.1/10.5 | OD: AC cells grade2+; VH grade 3+. OS: AC cells grade1+; VH grade 2+. OU: Mutton-fat KPs; iris posterior synechia; CME | Steroid eye drops; Mydriatic eye drops; Oral prednisone; Oral methotrexate | No follow-up visits | - | - | - |