Abstract
Purpose
To clarify the clinical features of uveitis in elderly patients in central Tokyo.
Methods
We retrospectively identified 1424 patients with uveitis who visited the Uveitis Clinic of the University of Tokyo Hospital between January 2013 and December 2018. The patients were categorized into two groups based on their ages at the time of disease onset: patients aged 65 years or older were included in Group A, whereas those younger than 65 years were included in Group B. The etiological classification of uveitis and its causes were investigated for each group.
Results
Group A presented significantly higher rates of infectious uveitis (35.5% vs. 17.8%, p < 0.0001) and masquerade syndromes (17.9% vs. 5.0%, p < 0.0001) than Group B. Furthermore, Group A had significantly higher rates of sarcoidosis (23.1% vs. 9.3%, p < 0.0001), intraocular lymphoma (16.6% vs. 4.6%, p < 0.0001), cytomegalovirus iritis (11.0% vs. 5.6%, p = 0.0043), and cytomegalovirus retinitis (5.2% vs. 1.5%, p = 0.0020) than Group B.
Conclusion
Our results demonstrate a clear difference in the causative diseases of uveitis between elderly and non-elderly patients. These findings may support ophthalmologists in their diagnostic process for elderly patients with uveitis.
This is a preview of subscription content, access via your institution.
Code availability
Not applicable.
Data availability
The datasets used and analyzed during the current study can be obtained from the corresponding author on reasonable request.
References
- 1.
Durrani OM, Tehrani NN, Marr JE, Moradi P, Stavrou P, Murray PI (2004) Degree, duration, and causes of visual loss in uveitis. Br J Ophthalmol 88:1159–1162. https://doi.org/10.1136/bjo.2003.037226
- 2.
Pakzad-Vaezi K, Or C, Yeh S, Forooghian F (2014) Optical coherence tomography in the diagnosis and management of uveitis. Can J Ophthalmol 49:18–29. https://doi.org/10.1016/j.jcjo.2013.10.005
- 3.
Harper TW, Miller D, Schiffman JC, Davis JL (2009) Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol 147:140-147.e2. https://doi.org/10.1016/j.ajo.2008.07.043
- 4.
Nakahara H, Kaburaki T, Takamoto M, Okinaga K, Matsuda J, Konno Y, Kawashima H, Numaga J, Fujino Y, Amano S (2015) Statistical analyses of endogenous uveitis patients (2007–2009) in central Tokyo area and comparison with previous studies (1963–2006). Ocul Immunol Inflamm 23:291–296. https://doi.org/10.3109/09273948.2014.920036
- 5.
Nakahara H, Kaburaki T, Tanaka R, Takamoto M, Ohtomo K, Karakawa A, Komae K, Okinaga K, Matsuda J, Fujino Y (2017) Frequency of uveitis in the central Tokyo area (2010–2012). Ocul Immunol Inflamm 25:S8–S14. https://doi.org/10.3109/09273948.2015.1133840
- 6.
Shirahama S, Kaburaki T, Nakahara H, Tanaka R, Takamoto M, Fujino Y, Kawashima H, Aihara M (2018) Epidemiology of uveitis (2013–2015) and changes in the patterns of uveitis (2004–2015) in the central Tokyo area: a retrospective study. BMC Ophthalmol 18:189. https://doi.org/10.1186/s12886-018-0871-6
- 7.
Abaño JM, Galvante PR, Siopongco P, Dans K, Lopez J (2017) Review of epidemiology of uveitis in Asia: pattern of uveitis in a tertiary hospital in the Philippines. Ocul Immunol Inflamm 25:S75–S80. https://doi.org/10.1080/09273948.2017.1335755
- 8.
Goto H, Mochizuki M, Yamaki K, Kotake S, Usui M, Ohno S (2007) Epidemiological survey of intraocular inflammation in Japan. Jpn J Ophthalmol 51:41–44. https://doi.org/10.1007/s10384-006-0383-4
- 9.
Ohguro N, Sonoda KH, Takeuchi M, Matsumura M, Mochizuki M (2012) The 2009 prospective multi-center epidemiologic survey of uveitis in Japan. Jpn J Ophthalmol 56:432–435. https://doi.org/10.1007/s10384-012-0158-z
- 10.
Hwang DK, Chou YJ, Pu CY, Chou P (2012) Epidemiology of uveitis among the Chinese population in Taiwan: a population-based study. Ophthalmology 119:2371–2376. https://doi.org/10.1016/j.ophtha.2012.05.026
- 11.
Rim TH, Kim SS, Ham DI, Yu SY, Chung EJ, Lee SC; Korean Uveitis Society (2018) Incidence and prevalence of uveitis in South Korea: a nationwide cohort study. Br J Ophthalmol 102:79–83. https://doi.org/10.1136/bjophthalmol-2016-309829
- 12.
Uhlenberg P (2009) International handbook of population aging. Springer, Berlin
- 13.
Nakatani H (2019) Population aging in Japan: policy transformation, sustainable development goals, universal health coverage, and social determinates of health. Global Health Med 1: 3–10. https://doi.org/10.35772/ghm.2019.01011
- 14.
World Health Organization (2001) Men, ageing and health: achieving health across the life span. WHO/NMH/NPH/01.2.
- 15.
Jabs DA, Nussenblatt RB, Rosenbaum J, Standardization of Uveitis Nomenclature (SUN) Working Group (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 140:509–516. https://doi.org/10.1016/j.ajo.2005.03.057
- 16.
Suzuki Kurokawa M, Suzuki N (2004) Behcet’s disease. Clin Exp Med 4:10–20. https://doi.org/10.1007/s10238-004-0033-4
- 17.
Mochizuki M, Smith JR, Takase H, Kaburaki T, Acharya NR, Rao NA; International Workshop on Ocular Sarcoidosis Study Group (2019) Revised criteria of International Workshop on Ocular Sarcoidosis (IWOS) for the diagnosis of ocular sarcoidosis. Br J Ophthalmol 103:1418–1422. https://doi.org/10.1136/bjophthalmol-2018-313356
- 18.
Read RW, Holland GN, Rao NA, Tabbara KF, Ohno S, Arellanes-Garcia L, Pivetti-Pezzi P, Tessler HH, Usui M (2001) Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol 131:647–652. https://doi.org/10.1016/S0002-9394(01)00925-4
- 19.
Takase H, Okada AA, Goto H, Mizuki N, Namba K, Ohguro N, Sonoda KH, Tomita M, Keino H, Kezuka T, Kubono R, Mizuuchi K, Shibuya E, Takahashi H, Yanai R, Mochizuki M (2015) Development and validation of new diagnostic criteria for acute retinal necrosis. Jpn J Ophtalmol 59:14–20. https://doi.org/10.1007/s10384-014-0362-0
- 20.
Holland GN (1994) Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive committee of the American Uveitis Society. Am J Ophthalmol 117:663–667. https://doi.org/10.1016/S0002-9394(14)70075-3
- 21.
Kaburaki T, Taoka K, Matsuda J, Yamashita H, Matsuda I, Tsuji H, Tanaka R, Nakazaki K, Nakamura F, Kamiya K, Kurokawa M, Ohtomo K, Aihara M (2017) Combined intravitreal methotrexate and immunochemotherapy followed by reduced-dose whole-brain radiotherapy for newly diagnosed B-cell primary intraocular lymphoma. Br J Haematol 179:246–255. https://doi.org/10.1111/bjh.14848
- 22.
Cassoux N, Giron A, Bodaghi B, Tran TH, Baudet S, Davy F, Chan CC, Lehoang P, Merle-Béral H (2007) IL-10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma. Invest Ophthalmol Vis Sci 48:3253–3259. https://doi.org/10.1167/iovs.06-0031
- 23.
Whitcup SM, Stark-Vancs V, Wittes RE, Solomon D, Podgor MJ, Nussenblatt RB, Chan CC (1997) Association of interleukin 10 in the vitreous and cerebrospinal fluid and primary central nervous system lymphoma. Arch Ophthalmol 115:1157–1160. https://doi.org/10.1001/archopht.1997.01100160327010
- 24.
Davis JL, Miller DM, Ruiz P (2005) Diagnostic testing of vitrectomy specimens. Am J Ophthalmol 140:822–829. https://doi.org/10.1016/j.ajo.2005.05.032
- 25.
Baehring JM, Androudi S, Longtine JJ, Betensky RA, Sklar J, Foster CS, Hochberg FH (2005) Analysis of clonal immunoglobulin heavy chain rearrangements in ocular lymphoma. Cancer 104:591–597. https://doi.org/10.1002/cncr.21191
- 26.
Sugita S, Takase H, Sugamoto Y, Arai A, Miura O, Mochizuki M (2009) Diagnosis of intraocular lymphoma by polymerase chain reaction analysis and cytokine profiling of the vitreous fluid. Jpn J Ophthalmol 53:209–214. https://doi.org/10.1007/s10384-009-0662-y
- 27.
Ohta K, Sano K, Suzuki T, Hidaka E, Yoshida A, Kikuchi T (2007) B cell clonality of primary central nervous system and primary intraocular lymphomas. Jpn J Ophthalmol 51:147–149. https://doi.org/10.1007/s10384-006-0406-1
- 28.
Ohno S, Char DH, Kimura SJ, O’Connor GR (1977) HLA antigens and antinuclear antibody titres in juvenile chronic iridocyclitis. Br J Ophthalmol 61:59–61. https://doi.org/10.1136/bjo.61.1.59
- 29.
Liu Y, Takusagawa HL, Chen TC, Pasquale LR (2011) Fuchs heterochromic iridocyclitis and the rubella virus. Int Ophthalmol Clin 51:1–12. https://doi.org/10.1097/IIO.0b013e31822d6923
- 30.
Salah S, Abad S, Monnet D, Brézin AP (2018) Sarcoidosis. J Fr Ophtalmol 41:e451–e467. https://doi.org/10.1016/j.jfo.2018.10.002
- 31.
Huh J (2012) Epidemiologic overview of malignant lymphoma. Korean J Hematol 47:92–104. https://doi.org/10.5045/kjh.2012.47.2.92
- 32.
Fuentes E, Fuentes M, Alarcón M, Palomo I (2017) Immune system dysfunction in the elderly. An Acad Bras Cienc 89:285–299. https://doi.org/10.1590/0001-3765201720160487
- 33.
Port AD, Orlin A, Kiss S, Patel S, D’Amico DJ, Gupta MP (2017) Cytomegalovirus retinitis: a review. J Ocul Pharmacol Ther 33:224–234. https://doi.org/10.1089/jop.2016.0140
- 34.
Hikita S, Sonoda K, Hijioka K, Fujimoto T, Ito T, Ishibashi T (2012) Incidence of uveitis in the northern Kyushu region of Japan - comparison between the periods of 1996–2001 and 2003–2008. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 116:847–855
- 35.
Sagoo MS, Mehta H, Swampillai AJ, Cohen VM, Amin SZ, Plowman PN, Lightman S (2014) Primary intraocular lymphoma. Surv Ophthalmol 59:503–516. https://doi.org/10.1016/j.survophthal.2013.12.001
- 36.
Ogawa M, Sugita S, Shimizu N, Watanabe K, Nakagawa I, Mochizuki M (2012) Broad-range real-time PCR assay for detection of bacterial DNA in ocular samples from infectious endophthalmitis. Jpn J Ophthalmol 56:529–535. https://doi.org/10.1007/s10384-012-0174-z
- 37.
Ogawa M, Sugita S, Watanabe K, Shimizu N, Mochizuki M (2012) Novel diagnosis of fungal endophthalmitis by broad-range real-time PCR detection of fungal 28S ribosomal DNA. Graefes Arch Clin Exp Ophthalmol 250:1877–1883. https://doi.org/10.1007/s00417-012-2015-7
- 38.
Shirahama S, Kaburaki T, Takada S, Nakahara H, Tanaka R, Komae K, Fujino Y, Kawashima H, Aihara M (2020) Comparison of visual field defect progression in secondary Glaucoma due to anterior uveitis caused by three types of herpes viruses. Graefes Arch Clin Exp Ophthalmol 258:639–645. https://doi.org/10.1007/s00417-019-04559-w
- 39.
Pasadhika S, Rosenbaum JT (2015) Ocular sarcoidosis. Clin Chest Med 36:669–683. https://doi.org/10.1016/j.ccm.2015.08.009
- 40.
Peterson K, Gordon KB, Heinemann MH, DeAngelis LM (1993) The clinical spectrum of ocular lymphoma. Cancer 72:843–849. https://doi.org/10.1002/1097-0142(19930801)72:3%3C843::AID-CNCR2820720333%3E3.0.CO;2-#
- 41.
Berenbom A, Davila RM, Lin HS, Harbour JW (2007) Treatment outcomes for primary intraocular lymphoma: implications for external beam radiotherapy. Eye (Lond) 21:1198–1201. https://doi.org/10.1038/sj.eye.6702437
Acknowledgements
We would like to thank Editage for English language editing.
Funding
This study was supported by a grant from the Japan Foundation for Applied Enzymology (2019).
Author information
Affiliations
Contributions
S.S., H.S., R.T., and T.K. designed the research strategies, collected the data, and wrote the manuscript. H.F., H.I., K.K., and H.N. collected the data and wrote the manuscript. H.K. and M.A wrote and revised the manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare no conflict of interest.
Consent to participate
Opt-out consent was obtained from all patients. This is a method used for the recruitment of participants into studies where information is provided to the potential participant regarding the research and their involvement and where their participation is presumed unless they decline to participate.
Ethics approval
This retrospective study was approved by the Research Ethics Committee of the Graduate School of Medicine and the Faculty of Medicine at the University of Tokyo. It was conducted in accordance with the tenets of the Declaration of Helsinki.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Shintaro Shirahama and Hirotsugu Soga were co–first authors.
Rights and permissions
About this article
Cite this article
Shirahama, S., Soga, H., Tanaka, R. et al. Clinical features of uveitis in elderly patients in central Tokyo (2013–2018). Int Ophthalmol (2021). https://doi.org/10.1007/s10792-021-01721-4
Received:
Accepted:
Published:
Keywords
- Infectious uveitis
- Sarcoidosis
- Intraocular lymphoma
- Tokyo
- Elderly patients