CLINICAL PROFILE OF ACUTE ANTERIOR UVEITIS IN A TERTIARY HEALTH CARE CENTRE IN WESTERN ODISHA

Dr. Kanhei charan Tudu1, Dr. Jayashree Dora2 and Dr. Ranjulata Mohanty3. 1. Associate professor, Department of Ophthalmology, Veer Surendra Sai Institute of Medical Science and Research, Burla, Sambalpur, Odisha-768017. 2. Professor & H.O.D., Department of Ophthalmology, Veer Surendra Sai Institute of Medical Science and Research, Burla, Sambalpur, Odisha-768017. 3. PG student, Department of Ophthalmology, Veer Surendra Sai Institute of Medical Science and Research, Burla, Sambalpur, Odisha-768017. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
105 entities. On the basis of overall clinical presentation is acute, unilateral, noninfectious and nongranulomatous forms 2 . The precise cause of anterior uveitis is often obscure and the correct diagnosis is often challenging. The cause of inflammation might be infections agent or trauma, but in most cases the underlying mechanism appears to be autoimmune in nature 3 . In order to enhance understanding and management of ocular inflammation International ocular Inflammation Society (IOIS) has been founded 4 .
The aim of our study is to find out the clinical profile of all patients presenting with acute anterior uveitis attending the Ophthalmology Department of VSS Medical College, Burla, Sambalpur over a period of two years.

Materials and Methods:-
A prospective clinical study was conducted between December 2012 to October 2014. A standard clinical proforma was filled in all cases, which included salient feature in history, visual acuity using Snellens visual acuity chart, clinical findings, laboratory investigations, and the final etiology.The anterior uveitis associated with penetrating ocular injuries, corneal ulcer, intraocular surgeries, intermediate, posterior or panuveitis and mascquerade syndrome were excluded from the study. All patients were examined under slit lamp. Details on disease severity, laterality, chronicity, ocular signs and associated systemic conditions were noted. Presentation was considered as unilateral if active inflammation was present in only one eye and bilateral if both eyes presented with active inflammation. Intraocular inflammation was assigned as anterior uveitis which include iritis, anterior cyclitis, iridocyclitis based on International Uveitis Study Group Criteria. The inflammation was defined as acute if symptoms were present for less than three months, chronic if symptoms were present for three months or more and recurrent if two or more episodes of inflammation separated by a disease free period. A short differential diagnosis was made in each case. Subsequently, a tailored laboratory investigation was carried out. Investigations included, total and differential counts, erythrocyte sedimentation rate, urine and stool examination, Mantoux test, Serological tests for syphilis, HIV, rheumatoid factor were done in all cases. Radiological investigations included x-ray of chest, lumbosacral and knee joints. Other special investigations were considered whenever necessary like skin tests, ELISA for IgG, IgM, etc. Consultation was done with other medical specialities, whenever needed. Final etiological diagnosis was made based on history, clinical features, laboratory investigations and systemic evaluation by other medical specialities. The anterior uveitis was considered to have idiopathic etiology when it was not associated with HLA-B27 haplotype and neither with defined clinical syndromes nor with definitive aetiology 5 .

Results:-
This study was conducted in the Department of Ophthalmology, V.S.S Medical College & Hospital, Burla, Sambalpur, Odisha between December 2012 to October 2014. 102 patients in the age group of 10 -80 years were included and during the study following observations were found.
In our study males were affected more (57.84 %) compared to females (42.16 %). This may be because men tend to seek medical attention more often than women and socio-economic habits may put male patients at a greater risk for development of anterior uveitis as compared to Rathinam et al study 61.3% were males and 38.7% were females and Alezandro Rodriguez et al reported 38.9% male and 61.1% female involvement in their study.
In our present study unilateral involvement was seen in 91.18 % as compared to bilateral involvement in 8.82 % of cases. In our study 95 patients (93.14%) had non-granulomatous inflammation and in 7 patients (6.86%) it was granulomatous. Findings are comparable with previous studies.
In the present study idiopathic (31.37%) was the most common cause of anterior uveitis followed by phacolytic (20.59%) aetiology. Although herpes zoster accounted for 16.67% of the cases, which is comparable with other two studies where it stood first, is not the most common in present study. However it was the most common infectious cause in our study. 5.88 % of the patients had tubercular anterior uveitis which is comparable with Rathinam et al and Singh et al 8 study, where as there is no data in Henderly et al 10 study. This difference may be because all other studies were conducted at referral centers, where cases usually chronic and recurrent ones, are referred from primary and secondary centers. Whereas present study was done in a general ophthalmic clinic and most people were from villages.

Conclusion:-
In this study it was found that acute anterior uveitis is more common in 21-40 years age group ( 61.77%) and less common over 60 years (9.8%), males were affected more than females of ratio 1.4:1, unilateral presentation (91.18%) is commoner than bilateral presentation (8.82%) and nongranulaomatous type of inflammation (93.14%) is more frequent presentation then granulomatous (6.86%). The etiology is mainly idiopathic in 31.37 % cases and specific diagnosis was reached in 68.63% cases. However further research is required with quite sufficient number of cases to reveal definite etiology, management and to decrease the morbidity conditions associated with it.