Clinical Manifestations and Implications of Nonneoplastic Uveitis Masquerade Syndrome

Yung-Ray Hsu; Ling-Uei Wang; Fang-Ting Chen; Jia-Kang Wang; Tzu-Lun Huang; Pei-Yao Chang; Yun-Ju Chen

doi:10.1016/j.ajo.2021.12.018

Clinical Manifestations and Implications of Nonneoplastic Uveitis Masquerade Syndrome

Am J Ophthalmol. 2022 Jun:238:75-85. doi: 10.1016/j.ajo.2021.12.018. Epub 2022 Jan 5.

Authors

Yung-Ray Hsu¹, Ling-Uei Wang², Fang-Ting Chen³, Jia-Kang Wang⁴, Tzu-Lun Huang⁵, Pei-Yao Chang⁶, Yun-Ju Chen³

Affiliations

¹ From the Department of Ophthalmology, Far Eastern Memorial Hospital (Y.-R.H., L.-U.W., F.-T.C., J.-K.W., T.-L.H., P.-Y.C., Y.-J.C.), New Taipei City, Taiwan; Department of Ophthalmology, National Taiwan University Hospital (Y.-R.H., F.-T.C., J.-K.W., P.-Y.C., Y.-J.C.), Taipei, Taiwan; National Taiwan University College of Medicine (Y.-R.H., F.-T.C., Y.-J.C.), Taipei, Taiwan. Electronic address: yungrayhsu@gmail.com.
² From the Department of Ophthalmology, Far Eastern Memorial Hospital (Y.-R.H., L.-U.W., F.-T.C., J.-K.W., T.-L.H., P.-Y.C., Y.-J.C.), New Taipei City, Taiwan.
³ From the Department of Ophthalmology, Far Eastern Memorial Hospital (Y.-R.H., L.-U.W., F.-T.C., J.-K.W., T.-L.H., P.-Y.C., Y.-J.C.), New Taipei City, Taiwan; Department of Ophthalmology, National Taiwan University Hospital (Y.-R.H., F.-T.C., J.-K.W., P.-Y.C., Y.-J.C.), Taipei, Taiwan; National Taiwan University College of Medicine (Y.-R.H., F.-T.C., Y.-J.C.), Taipei, Taiwan.
⁴ From the Department of Ophthalmology, Far Eastern Memorial Hospital (Y.-R.H., L.-U.W., F.-T.C., J.-K.W., T.-L.H., P.-Y.C., Y.-J.C.), New Taipei City, Taiwan; Department of Ophthalmology, National Taiwan University Hospital (Y.-R.H., F.-T.C., J.-K.W., P.-Y.C., Y.-J.C.), Taipei, Taiwan; Department of Electrical Engineering, Yuan Ze University (J.-K.W., T.-L.H.), Taoyuan, Taiwan.
⁵ From the Department of Ophthalmology, Far Eastern Memorial Hospital (Y.-R.H., L.-U.W., F.-T.C., J.-K.W., T.-L.H., P.-Y.C., Y.-J.C.), New Taipei City, Taiwan; Department of Electrical Engineering, Yuan Ze University (J.-K.W., T.-L.H.), Taoyuan, Taiwan.
⁶ From the Department of Ophthalmology, Far Eastern Memorial Hospital (Y.-R.H., L.-U.W., F.-T.C., J.-K.W., T.-L.H., P.-Y.C., Y.-J.C.), New Taipei City, Taiwan; Department of Ophthalmology, National Taiwan University Hospital (Y.-R.H., F.-T.C., J.-K.W., P.-Y.C., Y.-J.C.), Taipei, Taiwan.

PMID: 34995524
DOI: 10.1016/j.ajo.2021.12.018

Abstract

Purpose: To investigate the clinical manifestations and systemic and ocular implications of nonneoplastic uveitis masquerade syndrome (NNUMS).

Design: Retrospective case series.

Methods: The clinical data of 830 consecutive patients who presented with uveitis at a tertiary referral center in northern Taiwan between August 2013 and August 2020 were analyzed. The clinical characteristics and outcomes of patients with NNUMS were evaluated.

Results: Overall, 3.7% of patients were determined to have uveitis masquerade syndrome. Among them, 24 patients (77%; 34 eyes) were diagnosed as having NNUMS. The main presenting anatomical location was posterior uveitis (58.8%). In the NNUMS group, a high chorioretinal involvement rate (94.1%) and delayed diagnosis from symptom onset (45.8% cases were diagnosed after more than 90 days) were found. Multimodal imaging was the major decisive diagnostic factor. Systemic condition alterations requiring urgent treatment were noted in 29.2% of cases. Ocular complications were noted in 58.8% of cases; 60% of those were observed on referral. Following appropriate treatment, visual acuity could be maintained in 88.3% of cases. The 5 major categories of NNUMS were retinal vascular disorders, rhegmatogenous retinal detachment, retinal dystrophy, central serous chorioretinopathy, and uveal effusion syndrome.

Conclusion: NNUMS is a group of heterogeneous diseases with a complex diagnostic process and significant ocular and systemic effects. High awareness regarding common clinical manifestations is crucial for physicians to make the appropriate diagnosis and management.

Keywords: Nonneoplastic; choroid; intraocular inflammation; masquerade syndromes; retina; uveitis.

MeSH terms

Central Serous Chorioretinopathy* / complications
Humans
Orbital Diseases*
Retinal Detachment* / complications
Retinal Detachment* / etiology
Retrospective Studies
Uveitis* / complications
Uveitis* / diagnosis
Visual Acuity