Oftalʹmologiâ (Jun 2019)
The Role of the Complex Clinical-Anamnestic and the Laboratory Examination in Establishing the Etiology of Endogenous Uveitis
Abstract
Purpose: to estimate the results of the clinical and laboratory survey among patients with uveites for refinement of the disease’s etiology.Patients and Methods. 107 patients with uveites (114 eyes) were under control. A standard ophthalmologic survey was done with them; a serodiagnosis (immunoassay analysis) towards Toxoplasma gondii, Herpes simplex virus Ist, IInd types, Citomegalovirus, Chlamidia trachomatis; a bacteriological examination of tear fluid, some material from nose and cavity to definite factors of virulence and antibiotic sensitivity of exuded microorganisms. A molecular and genetic survey (PCR) of tear fluid towards Toxoplasma gondii , Herpes simplex virus Ist, IInd types, Citomegalovirus was done among 30 people.The results. Provocative factors of the disease were detected in 42 % of cases. Concomitant diseases were in 77 %. Diseases of cardiovascular system prevailed in 49 %; ceiling of mouth cavity in 42 %; systemic diseases in 29.3 %. The most widespread were anterior uveites in 60.5 %; recur character prevailed in 51 %; deteriorations progressed in 58.8 % of cases. A chronic infection with herpes viruses was among almost all the patients (HSV I, II — 100 %, CMV — 96.3 %). To Toxoplasma gondii specific IgG were detected in 44.9 %, IgM in 2.8 %; to Clamidia trachomatis specific IgG in 21.5 %. 66 strains of bacteria were selected: from tear fluid — 34, from mouth — 17, from nasal cavity — 15; gram-positive bacteria of Staphylococcus prevailed in 83.3 %. In some cases of revealing S. aureus, which were isolated from all three biotypes, they were close to their phenotypic characteristics, which indicates to their etiologic importance in uveites’ progress. The research of tear fluid in PTSR turned to be less informative. Based on the anamnesis and the results of a complex survey it managed to become possible to decipher the etiology of the disease in 74.6 %. Among them were 67.1 % of infectious and infectious-allergic uveites; 80.7 % of bacterial uveites; 15.8 % of virus uveites and 3.5 % of parasitic uveites. 28.2 % of inflammations occurred on a background of system and syndromic diseases, the majority of diseases were on a background of Behterev’s disease and rheumatoid arthritis, 45.5 % for each. Non-infectious autoimmune and toxical-allergic reasons were set in 4.7 % of cases.Conclusion. It is more expediently to use a complex diagnostic approach with taking into account clinical and anamnestic information and laboratory information of the survey in the investigation of uveitis etiology.
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