The research conducted on uveitis at University Medical Center (UMC) Utrecht is highly regarded the world over. For the second time in three years, in 2007 ophthalmologists at UMC Utrecht received an international prize for the best article of the year in the field of uveitis. The prize was awarded by the International Ocular Inflammation Society (IOIS). The ophthalmologists also received a prize for the best publication from the American Academy of Ophthalmology.

The ophthalmologists do research in the following areas:

• Basic research: Exactly how do our eyes work?
• Clinical research: What are the best diagnostic procedures and treatments?
• Research on what causes uveitis
• Research in children

What causes eyesight to deteriorate?

Uveitis can lead to visual impairment (poor eyesight). Ophthalmologists at UMC Utrecht studied the causes of blindness and visual impairment in more than 500 patients with uveitis. They found that this is not caused by the inflammation itself, but rather by the resulting fluid that builds up in the macula. The macula is the part of the eye that makes it possible for us to see clearly. “It was an important discovery,” says Professor Aniki Rothova. She is professor of ophthalmology and specialized in uveitis. “Now, as soon as we see there is fluid in the macula, we treat it immediately. If we wait until the inflammation is gone or until the patient’s vision is worse, we’re often too late. By that time, the fluid has damaged the retina to such an extent that there’s nothing we can do to improve the situation.” For their discovery, the uveitis group received the international prize for the best article of the year on uveitis.

Blindness caused by leaking blood vessels

So how does the fluid actually get into the eye? Doctors have known for some time that leaking blood vessels play a role in this. People used to think this could only be caused by the eye inflammation. Researchers discovered it might also be a vascular problem: as a result of high blood pressure or other vascular diseases, fluid can easily pass through the damaged blood vessels. Because of this discovery, doctors now use medication for vascular diseases to treat leaking blood vessels in the eye.

Birdshot retinopathy

The eyes of patients with the inflammation known as birdshot retinopathy are filled with many tiny lesions. Over the past number of years, the uveitis group has studied a large number of people suffering from this mysterious condition. The study’s conclusion was astonishing: the current treatment does not work. Researchers will now try to find out which treatment does work.
The uveitis group received the international prize for the best article of the year on uveitis for this study as well.

Working together with the lab

The uveitis group works together closely with the lab at the Department of Virology. They were the first in the world to discover that an HIV virus can cause uveitis, and also found a number of other new causes for the condition. Another important discovery was that the rubella virus (also known as German measles) can “hide” in the eye and result in uveitis years after the rubella infection. The patient’s vision becomes more and more blurred, they develop cataracts prematurely, and often glaucoma as well. In glaucoma, pressure inside the eye rises. This can gradually lead to visual impairment. This discovery explains why the standard treatment with prednisone does not work.

Uveitis in children

Twenty percent of children with juvenile arthritis develop uveitis. In the research she conducted for her doctoral dissertation, Karen Sijssens studied:

• what causes this,
• which complications can arise,
• whether it is possible to predict which children will respond well to treatment and which will not, and
• how to prevent increased pressure in the eye.

Sijssens discovered that not only does juvenile arthritis respond well to the medication methotrexate® , it also inhibits the development of cataracts in children with arthritis-related uveitis.