Calidad de vida en pacientes con uveítis

Zusammenfassung

Backgound. Uveitis is characterized by inflammation of the middle layer of the eyeball wall; however, adjacent structures may be involved. Although it can affect the population of any age, the highest prevalence occurs in young adults. In addition, more than 50% of those affected by this ocular inflammation will develop complications related to uveitis and more than 30% will suffer visual impairment. These conditions not only lead to a significant health cost derived from the care of these patients, but also associate a significant economic, social and personal burden that leads to reduced productivity and work incapacity. The evaluation of the patient's vision-related quality of life (QOLV) through standardized questionnaires allows us to objectively assess the real burden of the disease and the patient's degree of suffering in relation to their vision. Likewise, various sociodemographic and clinical characteristics related to uveitis have been associated with impaired quality of life in these patients. Purpose. Evaluate VRQoL and its different domains in patients with uveitis. To describe the sociodemographic and clinical profile of patients with uveitis, as well as to evaluate the influence of sociodemographic characteristics, anatomical location of uveitis, unilateral or bilateral involvement, severity of ocular inflammation, treatment received and best corrected visual acuity (BCVA) binocular distance in the different subscales of the HRQoL. Methods. This work was carried out in the Uveitis Unit of the Reina Sofía General University Hospital in Murcia. This is an observational, cross-sectional study that includes 136 patients with non-infectious uveitis of more than 12 months of evolution (study group) and 136 patients with sociodemographic and clinical characteristics similar to those of the study group, but without ocular inflammatory disease (control group). From all of them, sociodemographic variables, personal history and clinical variables in relation to their underlying systemic disease were collected. In addition, the following variables related to their inflammatory process were collected from the patients in the study group: best binocular distance corrected visual acuity (BCVA), intraocular pressure, slit-lamp examination to assess inflammatory activity in the anterior chamber and vitreous, fundus examination, optical coherence tomography and angiography if required. Both groups of patients were administered the NEI VFQ-25 questionnaire to find out the status of their HRQoL. Results. For the treatment of the data obtained, the free software statistical package R (R Core Team, 2021) was used. A descriptive and correlational study was carried out, using the Spearman correlation coefficient. To search for significant differences, we opted for Student's t-test and ANOVA, according to the type of variable. Throughout the analysis, a p-value of less than 0.05 and a significance level of α = .05 were taken. The mean age of the patients in the study group was 47 .2 ± 15.7 years and 50.74% of the sample of this group were male.No statistically significant differences were found between the sociodemographic and clinical variables of both groups.The most frequent form of presentation in our patients was uveitis bilateral anterior location, binocular distance BCVA was 0.84 ± 0.24 In relation to HRQoL, we found statistically significant differences in all subscales of the NEI VFQ-25 questionnaire, with a worse score and In the study group patients, less in the general health subscale (p=0.054) and in color vision (p=0.28). Regarding the relationship between the anatomical location of uveitis and HRQoL, patients with panuveitis obtained a worse result in all the domains of the NEI VFQ-25 questionnaire except in work difficulties (p=0.052). The patients with bilateral uveitis were the ones who obtained the worst score in the subscales of the HRQoL questionnaire, but significant differences were only observed in the domain of social functionality (p= 0.049) and in the degree of dependency (p= 0.047). The patients who received systemic treatment were the ones who obtained the best scores in the subscales of the NEI VFQ-25 questionnaire, finding statistically significant differences in ocular pain, distance vision and mental health. Finally, in relation to BCVA, we found a positive correlation (0.71) with HRQoL and a negative correlation with age and the location of the inflammatory process (-0.44), likewise, it was positively correlated with the general vision subscales (0.46), near vision (0.38), distance vision (0.44), social functioning (0.45), mental health (0.28), driving (0.39), and peripheral vision (0.26). Conclusions. Patients with uveitis have a worse HRQoL compared to other patients with similar diseases, but without ocular inflammation, presenting lower scores in almost all HRQoL subscales. A better comprehensive assessment of these patients should be carried out due to the impact that ocular inflammation has on their HRQoL.