Ocular Immunology and Inflammation

ISSN: 0927-3948 (Print) 1744-5078 (Online) Journal homepage: https://www.tandfonline.com/loi/ioii20

Uveitis in China

Shaozhen Li & Peizeng Yang

To cite this article: Shaozhen Li & Peizeng Yang (1994) Uveitis in China, Ocular Immunology and
Inflammation, 2:4, 247-252, DOI: 10.3109/09273949409057083

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 Letter to the Editor

Ocular Immunology and Inflammation Uveitis in China

0927-394819WS 3.50

Ocular Immunology and Injknmation Shaozhen Li

-1994, V O ~2,. NO. 4, pp. 247-252 Peizeng Yang
0Rolus Press
Buren (The Netherlands) 1994
Zhongshan Ophthalmic Center
Accepted 18 October 1994 Sun Yat-sen University of Medical Sciences
Guangzhou, P.R. China

Dear Editor,

Recent issues of the journal have addressed epidemiological aspects of

uveitis in Turkey and Switzerland’v2.Since little information has been pub-
lished concerning epidemiology of uveitis in China in the generally available
literature, we would like to review the Chinese literature on this subject.

I . UVEITIS A N D BLINDNESS Since the 1950’s at least 30 groups O f oph-

thalmologists have conducted the investigation into causes of blindness in
different parts of China. It was reported that uveitis was responsible for 4%
to 10% of the blindness being the third to the fifth common cause in some
~eries.~-~
Most blindness caused by uveitis, unlike that caused by other eye dis-
eases, was incurable because of severe complications occurring after recur-
rent attacks of uveitis. Among the blindness caused by uveitis, 87 to 100%
was incurable according to the data from two reports.336Most blind people
were young adults because of their predominance in the patients with uve-
itis. The data of a survey on blindness in 14003 people showed that patients
aged from 2 0 to 50 years old accounted for 53% of the blind people caused
by uveitis.’
Syphilis and tuberculosis, which were the main entities of the uveitis lead-
ing to blindness in China before the I ~ ~ o ’ares , rarely seen now. Iritis or
iridocyclitis outnumbers other types in the blind people caused by uveitis,
especially in early reports.

2 . SPECTRUM OF UVEITIS

( I ) Anatomical classijication Anterior uveitis, accounting for 45.7% of the

uveitic patients, is the most common type of uveitis, based on the geograph-
ical category, followed by panuveitis (34%), intermediate uveitis ( I I %) and
posterior uveitis (9.3%) (Fig. I ) . * Intermediate uveitis is easily missed or
misdiagnosed as another type of uveitis due to its anatomical location. Dur-
ing the past three years, we have found that more than 50 patients with inter-
mediate uveitis are missed or misdiagnosed by others.

Letter to the Editor 247

Fig. I . Diagram of anatomical
classification of uveitis A: Anterior U
3
..
.. B: Panuveitis
..
..
..
..
.. C: Intermediate U
...
. ..
..
..
..
..
..
..
D: Posterior U
..
.... ....
....
..

(2) Features of some entities of uveitis Posner-Schlossman syndrome oc-

curs frequently in Shanghai, the incidence being 0.12%.At least 271 patients
with Posner-Schlossman syndrome have been reported in this areag (Table
I). The geographical difference as regards other uveitis entities has not been
addressed in China.
Ocular toxoplasmosis, one of the common entities in Europe and South
America, is less seen in China. The prevalence of positive serum anti-toxo-
plasma antibody ranges from 8.2 to 28.5% in the general population. Only in
0.8% of them develops uveitis. Several series of investigations show differ-
ent results as regards the prevalence of positive serum antitoxoplasma anti-
body between patients and healthy controls. It was found that the positive
rate in patients with uveitis (3 I .4%) was significantly higher than that ob-
served both in patients with other eye diseases ( I I .9%)and in normal indi-
viduals (9.3%). Other reports showed that there was a marked difference
only between patients with posterior uveitis or panuveitis and controls, while
other authors claimed that no difference was found as regards the prevalence
TABLE I . Some entities of uveitis of serum antibody specific to toxoplasma between patients with uveitis and
in China controls."

Uveitis entities Data collected

Posner-Schlossman syndrome occurs frequently in Shanghai, 271 cases, incidence: 0.12%
Sympathetic ophthalmia 43 I cases, male>female
Behcet's disease 800 cases
Ocular toxoplasmosis less seen, positive serum antibody:
general population: 8.2-28.5% (0.8% with uveitis)
uveitis (3 I 4 % )
other eye diseases without uveitis (11.9%)
controls (9.3%)
Vogt-Koyanagi-Harada syndrome 487 cases, 14.2%(in 600 cases of uveitis)
Fuchs' syndrome 198 cases
Syphilis and tuberculosis main entities of uveitis causing blindness before the 1950'S, rarely seen now
Rheumatic uveitis the most common entity: 20.5% (in 600 cases of uveitis)

248 Shaozen Li & Peizeng Yang

 Rheumatic disease, Vogt-Koyanagi-Harada(VKH) syndrome, and inter-
mediate uveitis are the most common entities encountered in China,’’ ac-
counting respectively for 20.5%, 14.2% and I I% of 600 patients with uve-
i t k 8 In another report, intermediate uveitis and VKH syndrome accounted
respectively for 28.6% and 1 8 . 9 % of the patients with uveitis.12 A paper
summarized recently by us showed that rheumatic disease is the first com-
mon entity followed by Fuchs’ syndrome and herpes simplex virus infection
in 198 patients with anterior uveitis. It was reported that ankylosing spondy-
litis was responsible for 12.8% of the anterior uveitis cases.13
At least 800 patients with Behcet’s disease, 487 patients with VKH syn-
drome, 43 I patients with sympathetic ophthalmia, 190 patients with Fuchs’
syndrome have been reported during the past decades.

(3)Other entities of uveitis or association with systemic diseases reported in

China In addition to the entities stated above, the following entities of uve-
itis have been reported: sarcoidosis, toxocariasis, systemic lupus erythemato-
sus, diabetes mellitus, polychondritis, leprosy, leptospirosis, brucellosis,
traumatic uveitis, virus infections, fungal infections, tumor, drug-induced
uveitis, lens-induced uveitis, artificial lens-induced uveitis, acute retinal ne-
crosis syndrome, acute multifocal posterior placoid epitheliopathy, acquired
immune deficiency syndrome and Lyme disease.

3. IMMUNOLOGICAL A N D IMMUNOGENETIC STUDIES O N H U M A N U V E -

ITIS Immunological studies on human uveitis began in the late 1970’s in
China. Immune investigations including those non-specific and specific to
uvea, lens, retina extract, recently to purified S-antigen and IRBP have been
carried out in some laboratories. T-cell subsets, immune complex, erythro-
cyte immune reaction, serum interleukin 2 level of the uveitic patients have
been studied during the last decade14-17(Table 2).
Immunogenetic studies showed that acute anterior uveitis was highly
linked with HLA-B27 antigen with a relative risk from 7.5 to 72.3,’*’19simi-
lar to the results presented in other countries (Table 3). VKH syndrome was
proved to be associated with HLA-B22, HLA-DQ and HLA-DRw53 with
the relative risk respectively of 8.7, 16, and 34.2; somewhat similar to the
results presented in Japan (Table 4). Sympathetic ophthalmia was, unlike the
results in other countries, associated with HLA-B22, with a relative risk of
7.3 (Table 5).

4. PRACTICAL APPROACH TO THE TREATMENT OF UVEITIS The treatment of

uveitis has been widely studied in China. Corticosteroids are still the main-
stay of treatment for uveitis although other drugs have been proven to be
effective for a few of the uveitic patients. A combination of immunosup-

TABLE 2.Immunological studies on

In the late 1970’s non-specific immune investigation
human uveitis
During the 1980’s immune response specific to uvea, lens and retinal extract.
immunogenetic study, CIC determination
During the 1990’s immune response specific to retinal S-antigen
T cell subsets
erythrocyte immune reaction
IL-2 level determination

Letter to the Editor 249

TABLE 3. Acute anterior uveitis and HLA antigen in different areas

Nation HLA antigen Positive rate Positive rate in general Relative Reference
in patients(%) population(%) risk

China B27 46-69.4 3.3-3.9 17.6-65.9I 18~x9

Finland B27 84 13-14 32 20
Germany
Denmark B27 71 8 26 21
France
Britain I4 22
Greece I0 23
Soviet Union 9 24
(former)
USA B27 60 6.9 25

TABLE 4. VKH syndrome and HLA antigen in different areas

Nation HLA antigen Positive rate in Positive rate in general Relative risk Reference
patients( %) population( %)
DRq 80 20
China DRw53 I00 60
DRq-DRw53 80 15.4
Bw54 43 17.9
Japan c wI 57 35.7
DRq 84.8 42.7
DRw53, Dw IS, DQw4
Europe Dw3, DR3, DQw2 ? 21

T A B L E 5. Sympathetic ophthalmia
and HLA antigen in different areas
pressives (especially chlorambucil) with TCM herbs has been designed for
the treatment of uveitis refractory to other medicines, especially for the treat-
ment of Behcet’s disease. Good results have been achieved in most patients.
Sixteen patients with stubborn Behcet’s disease were treated by the combi-
nation of chlorambucil and TCM herbs (Radix rehrnannia, Cortex rnoutan
radicis, Flos ionicerae, Radix paeoniae rubra, Radix scutellariae, etc.) with
complete uveitis remission in 1 3 patients and partial uveitis remission in
three patients. The extraocular manifestations disappeared in 14patients and
were partially improved in two patients. The TCM herbs are primarily those
to clear away heat and toxic materials from blood, to cool the blood and to

Nation HLA antigen Positive rate in Positive rate in general Relative Reference
patients(%) population( %) risk
~~~~~~~~ ~

China B22 38.89 7.69 7.34 28

USA All 32.1 7.7 3.9 29
Japan Bw54 40 16 3.5 21930
DRq I00 20 82.5
DRw53 I00 40 31.4
-424, Dw15, DQw4
Europe Dw3, DR3, DQwz ? 21

250 Shaozen Li & Peizeng Yang

 remove blood stasis, based on TCM theory.31 It has been experimentally
proved that the herbs stated above are able to suppress the release of
lysosomes, increase the activity of superoxide dismutase and to decrease the
hyperfunction of thrombocyte~.~*>~~
Uveitis or sclerouveitis refractory to other therapy was also treated by
Cyclosporine A combined with TCM herbs. Cyclosporine A, however, can-
not be widely used for the treatment of uveitis in China, due to its high cost.
The new knowledge about pathogenesis and therapy of uveitis has done
much to change peoples’ ideas in the time-choosing and management of
complicated cataract and secondary glaucoma. Operation should be taken
into account if the inflammation of patients with cataract or glaucoma are
not controlled by various managements. Intraocular lens implantation was
used for some uveitic patients with complicated cataract, achieving good
results. In 21 eyes receiving filtering surgery, though the uveitis had not
been controlled preoperatively,no eyes underwent aggravation of inflamma-
tion and visual improvement was achieved in I I eyes po~toperatively.~~

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