DeCure for Anterior uveitis

In a retrospective case note review of 163 children with chronic anterior uveitis diagnosed between 1982 and 1998, 34 patients (21%) developed at least one complication (cataract surgery, ocular hypertension treatment, or visual acuity worse than 6/24). The strongest predictor of complications was severe disease at onset (p = 0.001). Other risk factors included uveitis present at the first eye examination, non-oligoarticular juvenile idiopathic arthritis, late onset arthritis, and male sex in the standard screening cohort. Factors associated with remission (inactive uveitis off all topical treatment for more than six months) included membership of the standard screening cohort, onset after 1990, white race, mild disease at onset, and a long interval between arthritis and uveitis onset. The authors concluded that most children remit without visually disabling complications and that targeting aggressive immunosuppression at high-risk patients before complications develop might reduce the complication rate.

A prospective observational study of 117 patients with active uveitis presenting to an emergency eye care centre in Brazil found that anterior uveitis was the most common form (70.1%), followed by posterior uveitis (26.5%) and panuveitis (3.4%). The majority of patients were male (63.2%), with a mean age of 43.2 years. Almost all had unilateral disease (94.9%) and acute onset, with a mean symptom duration of 6.2 days. Ocular pain (76.9%), redness (59.8%), and visual blurring (46.2%) were the most frequent symptoms. An etiological diagnosis was made at the initial emergency evaluation in 38.5% of patients. Patients with anterior uveitis presented with better visual acuity than those with posterior uveitis.

A study testing the hypothesis that stressful life events trigger recurrence of idiopathic recurrent acute anterior uveitis compared 35 patients presenting with a recurrence to 29 controls with other ocular problems. Using the Holmes and Rahe scale and the Spielberger state-trait anxiety inventory, the patients with uveitis did not report a higher number of stressful life events or higher levels of anxiety in the month preceding symptom onset. Scores for both groups were comparable to published norms for healthy adults of the same age and sex. The authors concluded that stress was not shown to be involved in triggering recurrence in this study.

A 2009 review proposed that acute and recurrent anterior uveitis may be associated with activation of Toll-like receptors by pathogen-associated molecular patterns (such as lipopolysaccharide from gram-negative bacteria) and by damage-associated molecular patterns (such as heat shock proteins and S100 proteins) released from ocular tissue damage, which could perpetuate or reactivate inflammation. A 2021 thesis applied genome-wide association study, Mendelian randomisation, and cytokine proteomics to acute anterior uveitis, identifying multiple susceptibility loci, environmental risk factors, potential biomarkers, and a polygenic risk score. What remains missing is prospective validation of the polygenic risk score in diverse populations, randomised trials testing whether early aggressive immunosuppression in children identified as high-risk actually reduces complication rates without unacceptable toxicity, and a clearer understanding of which specific innate immune triggers are clinically relevant in human disease rather than only in animal models.