Visual Outcome and Predictors of Poor Visual Outcome among Uveitis Patients Attended at KCMC Eye Department, Moshi—Northern Tanzania

摘要

Background: Uveitis, an inflammatory disease of the middle layer of the human eye is a potentially blinding disease, carrying social, economic and individual consequence. Though not being a leading blinding disease, it causes visual impairment and blindness with its complications like cataract and glaucoma. Few studies have addressed the visual outcome after diagnoses and follow-up of patients with uveitis; and at our setting, few is known about the visual outcome, factors predicting poor outcome. Methodology and Materials: This was a hospital-based cohort study conducted at the Kilimanjaro Christian Medical Center (KCMC), Eye Department. Files of patients attended from January 2010 to December 2017 were assessed. Measures of Central Tendency and their corresponding dispersion were used to summarize continuous variables and proportions for categorical variables. One sample paired t-test was used to assess differences in mean Best Corrected Visual Acuity (BCVA) and Wilcoxon Signed Rank test for differences in median BCVA between the first visit and at one year respectively. Association between predictors and poor outcome was analyzed by using Chi square test. Multivariate regression was used to control for potential confounders and a p value less than 0.05 was considered as statistical significant. Results: A total of 291 patients were assessed, majority of them being female (54.6%), with median age being 53 years. The proportion of visual impairment reduced from the initial 57.7% at presentation to 28.2% at one year. The mean BCVA improved from the initial 0.96 log MAR to 0.70 log MAR at one year. The main factors associated with poor presenting vision were: Cataract (p value < 0.001), Cystoid Macular Edema (CME: p value < 0.001), Maculopathy (p value = 0.042), Keratopathy (p value < 0.001), Posterior Synechiae (PS: p value = 0.044), Abnormal Intraocular Pressure (IOP: p value = 0.036) and non-anterior location (p value = 0.042). At one year, the factors associated with poor outcome were: retinal detachment (p value = 0.022), Glaucoma (p value = 0.018) and Maculopathy (p value = 0.039). Conclusions: at one year of follow-up of patients with uveitis, the proportion of visual impairment reduces significantly, with improvement also being observed on mean visual acuity. The most common predictors of poor visual outcome were Cataract, Glaucoma CME, abnormal IOP and Maculopathy.