Three hundred forty-nine patients met the inclusion criteria and were enrolled in this study. A total of 181 patients (51.9%) had UME; of these, 70.2% had unilateral UME. The mean follow-up period for all patients was 40 ± 33.7 months. Table 1 summarizes the demographic data and baseline characteristics of all the patients with and without UME. Overall, the mean age (± SD) was 40.6 ± 16.6 years and 57.3% were female. A trend toward a higher mean age was observed in the UME group than in the non-UME group (42.2 ± 16.3 vs. 38.9 ± 16.7 years, P = 0.063).
Table 1
Demographic and baseline characteristics of all patients.
Parameters | Total (N = 349) | UME (n = 181) | Non-UME (n = 168) | P value |
Follow-up time (months), mean ± SD | 39.95 ± 33.65 | 36.65 ± 30.60 | 43.49 ± 36.41 | 0.058 |
Age (years), mean ± SD | 40.6 ± 16.6 | 42.2 ± 16.3 | 38.9 ± 16.7 | 0.063 |
Female gender, n (%) | 200 (57.3) | 97 (53.6) | 103 (61.3) | 0.150 |
Bilateral uveitis, n (%) | 190 (54.4) | 92 (50.8) | 98 (58.3) | 0.160 |
Chronic uveitis, n (%) | 255 (73.1) | 126 (69.6) | 129 (76.8) | 0.130 |
Location of inflammation, n (%) | | | | |
Intermediate uveitis | 59 (16.9) | 20 (11.1) | 39 (23.2) | 0.009* |
Posterior uveitis | 144 (41.3) | 82 (45.3) | 62 (36.9) | |
Panuveitis | 146 (41.8) | 79 (43.7) | 67 (39.9) | |
Granulomatous inflammation, n (%) | 175 (50.1) | 90 (49.7) | 85 (50.6) | 0.870 |
Etiology, n (%) | | | | |
Infection | 131 (37.5) | 85 (47.0) | 46 (27.4) | 0.001* |
Immune-mediated | 88 (25.2) | 37 (20.4) | 51 (30.4) | |
Idiopathic | 130 (37.3) | 59 (32.6) | 71 (42.3) | |
Diagnosis, n (%) | | | | |
Tuberculosis | 44 (12.6) | 25 (13.8) | 19 (11.3) | |
ARN/PORN/CMVR | 42 (12) | 28 (15.5) | 14 (8.3) | |
Vogt-Koyanagi-Harada disease | 27 (7.7) | 16 (8.8) | 11 (6.5) | |
White dot syndrome | 19 (5.4) | 2 (1.1) | 17 (10.1) | |
Parasite-related uveitis | 18 (5.2) | 11 (6.1) | 7 (4.2) | |
Sarcoidosis | 17 (4.9) | 8 (4.4) | 9 (5.4) | |
Behçet's disease | 13(3.7) | 6 (3.3) | 7 (4.2) | |
Syphilis | 9 (2.6) | 7 (3.9) | 2 (1.2) | |
HLA-B27/SNSA | 7 (2) | 1 (0.5) | 6 (3.6) | |
Toxoplasmosis | 7 (2) | 6 (3.3) | 1 (0.6) | |
Cat-scratch neuroretinitis | 6 (1.7) | 4 (2.2) | 2 (1.2) | |
Endogenous endophthalmitis | 5 (1.4) | 4 (2.2) | 1 (0.6) | |
Juvenile idiopathic arthritis | 3 (0.9) | 3 (1.7) | 0 | |
Systemic lupus erythematosus | 2 (0.6) | 1 (0.5) | 1 (0.6) | |
Maximal macular thickness (µm), mean ± SD | 358.11 ± 136.26 | 443.66 ± 142.29 | 265.94 ± 19.68 | < 0.001* |
ARN acute retinal necrosis; CMVR cytomegalovirus retinitis; HLA human leukocyte antigen; PORN progressive outer retinal necrosis; SD standard deviation; SNSA seronegative spondyloarthropathy; UME uveitic macular edema.
The majority of patients presented with bilaterality (54.4%), a chronic course (73.1%), and panuveitis (41.8%). Granulomatous inflammation was observed in 50.1% of patients. IU was observed in 16.9%, PU in 41.3%, and panuveitis in 41.8% of all patients, with a higher proportion of patients with PU and panuveitis in the UME group than in the non-UME group. Statistically significant differences were found between the two groups with respect to the location of the inflammation (P = 0.009). When evaluating the location of uveitis in relation to IU, PU, and panuveitis, UME occurred in 33.9%, 56.9%, and 54.1% of patients with IU, PU, and panuveitis, respectively.
The etiology of uveitis was established in 219 patients (62.8%). One hundred thirty-one (37.5%) were diagnosed with an infectious etiology and 88 (25.2%) were diagnosed with a recognized immune-mediated process. The remaining 130 patients (37.3%) were classified as idiopathic. Infectious uveitis accounted for the majority of cases in the UME group compared to the non-UME group (P = 0.001). Among the 181 patients with UME, 85 (47.0%) had infectious uveitis, 37 (20.4%) had a recognized immune-mediated process, and 59 (32.6%) had idiopathic inflammation. Regarding the etiology of uveitis, UME was observed in 62.4%, 42%, and 45.4% of the patients with infectious, immune-mediated and idiopathic uveitis, respectively. Based on the diagnosis, UME occurred in more than 50% of patients with juvenile idiopathic arthritis (3 of 3 [100%]), toxoplasmosis retinochoroiditis (6 of 7 [85.7%]), endogenous endophthalmitis (4 of 5 [80%]), syphilitic uveitis (7 of 9 [77.8%]), viral posterior/panuveitis (28 of 42 [66.7%]), cat-scratch neuroretinitis (4 of 6 [66.7%]), parasite-related uveitis (11 of 18 [61.1]), Vogt-Koyanagi-Harada disease (16 of 27 [59.3%]), and tuberculous uveitis (25 of 44 [56.8%]).
The mean maximum macular thickness was significantly greater in the UME group than in the non-UME group (443.66 ± 142.29 vs. 265.94 ± 19.68 µm, P < 0.001). The configuration of UME is summarized in Table 2. DiffME alone was the most frequent finding (36.5%), followed by the combined form of SRD, and CME/DiffME (32.6%), and CME (30.9%).
Table 2
Characteristics of uveitic macular edema.
Parameters | n (%) |
Cystoid macular edema alone | 56 (30.9) |
Diffuse macular edema alone | 66 (36.5) |
Serous retinal detachmenta | 59 (32.6) |
a Presence of serous retinal detachment combined with cystoid macular edema or diffuse macular edema.
Predictive factors associated with UME are shown in Table 3. In multivariate analysis, increasing age at the onset of uveitis was significantly associated with UME (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00-1.03, P = 0.036). PU and panuveitis were significantly correlated with UME compared to intermediate uveitis (aOR 2.09, 95% CI 1.14–3.86, P = 0.018). Uveitis of infectious etiology was also significantly associated with UME compared to noninfectious uveitis (aOR 2.13, 95% CI 1.34–3.37, P = 0.001).
Table 3
Univariate and multivariate analyses of predictive factors associated with uveitic macular edema.
Parameters | Univariate analysis | Multivariate analysis |
OR | 95% CI | P value | aOR | 95% CI | P valuea |
Age of uveitis onset | 1.01 | 1.00-1.03 | 0.064 | 1.01 | 1.00-1.03 | 0.036* |
Female gender | 0.73 | 0.48–1.12 | 0.146 | | | |
Bilateral uveitis | 0.74 | 0.48–1.13 | 0.160 | | | |
Chronic uveitis | 0.69 | 0.43–1.12 | 0.132 | | | |
Posterior and panuveitisb | 2.43 | 1.35–4.38 | 0.003* | 2.09 | 1.14–3.86 | 0.018* |
Granulomatous inflammation | 0.97 | 0.64–1.47 | 0.871 | | | |
Infectious uveitisc | 2.35 | 1.5–3.67 | < 0.001* | 2.13 | 1.34–3.37 | 0.001* |
aOR adjusted odds ratio; CI confidence interval; OR odds ratio; UME uveitic macular edema.
a P-value of Wald test.
b Compared to intermediate uveitis.
c Compared to noninfectious etiology.