Relevance of diagnostic investigations in patients with uveitis: Retrospective cohort study on 300 patients

- One third of uveitis remains of undetermined origin.
- Three items are easy-to-use to predict contribution of investigations and diagnoses.
- Neurological investigations could be guided by ophthalmological findings.
- Identification of these factors might improve the diagnostic workup adapted to each patient.

ObjectiveThe diagnostic workup of uveitis is a challenge due to the wide range of diagnoses and the lack of a well-codified diagnostic procedure. We aimed to evaluate the relevance of diagnostic investigations for the etiological diagnosis of uveitis.MethodsRetrospective cohort study of patients referred for etiological diagnosis of uveitis. Uveitis related to ophthalmological diseases or occurring during the course of previously diagnosed diseases were not included.ResultsThree hundred patients were included. Chest CT-scan was suggestive of sarcoidosis in 83 (29%). Features associated with abnormal CT-scan were: snowballs and/or peripheral multifocal choroiditis (PMC) upon ocular examination (P = 0.004), blood lymphopenia (P < 0.0001), angiotensin converting enzyme (ACE) level > 1.5 ULN (P = 0.0003). Bronchoscopy showed granuloma in 18 (11%) while alveolar lymphocytosis suggestive of sarcoidosis was reported in 45 (27%). Presence of granuloma on bronchial biopsies was always associated with chest CT-scan abnormalities, whereas 31% of patients with alveolar lymphocytosis had normal CT-scans. Features associated with contributive bronchoscopy were: snowballs and/or PMC (P = 0.003), ACE > 1.5 ULN (P = 0.007), abnormal chest-CT scan (P < 0.0001). Salivary gland biopsy revealed granuloma in 12 patients (5%). Cerebral MRI was abnormal in 15 patients (9%) who mostly presented with snowballs and/or retinal vasculitis. Finally, the main causes of uveitis were latent tuberculosis (25%) and sarcoidosis (22%), but 34% remained of undetermined origin. Uveitis relapses were observed in 31% and did not differ between patients with an identified diagnosis and those with idiopathic uveitis.ConclusionIdentification of factors associated with abnormal investigations might improve the optimal diagnostic workup adapted to each patient.