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Purpose: To evaluate the clinical characteristics, treatment outcomes and ocular complications in patients with HLA-B27-associated AU compared to those without HLA-B27., Methods: From the population-based data of all adult patients with AU during 2009-2020 ( n  = 413), 241 patients tested for HLA-B27 were included. Age of the initial onset, gender, etiology, course of uveitis, visual outcomes and complications were studied., Results: 170 patients (71%) were HLA-B27+ and 71 (29%) HLA-B27-. Mean age at uveitis onset was 37 ± 13 in HLA-B27+ (95% CI, 35.4-39.3) and 43 ± 14 (95% CI, 40.3-46.4) in HLA-B27- patients ( p  = 0.001). Male:female ratio was 1.1:1 among HLA-B27+ and 0.58:1 ( p  = 0.024) in HLA-B27- patients. Most patients, 63% in HLA-B27+ and 68% in HLA-B27- had chronic uveitis. Recurrences were noted in 31% in HLA-B27+ group compared to 13%in HLA-B27-. 51% and 17% of HLA-B27+ and HLA-B27- patients, respectively, had systemic disease-associated uveitis. Etiology was Idiopathic in 44% and 69% of HLA-B27+ and HLA-B27- patients, respectively ( p  < 0.001). After the follow-up, +2 and -4 ETDRS letters changes were noted in HLA-B27+ and HLA-B27- patients ( p  = 0.005). Ocular complications developed in 43% and 47%, and surgical treatment of complications was required in 20% and 33% of patients in HLA-B27+ and HLA-B27- patients ( p  = 0.009). 1% (HLA-B27+) and 3% (HLA-B27-) developed visual impairment., Conclusion: Our results highlight the differences in the age of uveitis onset, gender distribution, course of uveitis, etiology, and treatment outcomes in HLA-B27+ and HLA-B27-uveitis. HLA-B27 seems to be associated with younger age at uveitis onset, more recurrences, systemic diseases, and better treatment outcomes with less complications.

Objective: Ocular toxoplasmosis (OT) can cause posterior uveitis; causes of recurrent OT are not well understood. We explored clinical, immunological and genetic properties associated with recurrent OT., Methods and Analysis: A recurrent OT patient population (n=9) was identified. Clinical history, ophthalmological findings and immunological properties were assessed. B and T cell immunophenotyping including interferon-gamma (IFN-γ) responses were analysed. An analysis of 592 immunodeficiency genes was performed., Results: The patients experienced 2-7 OT episodes (average 3.7). The first episode occurred at an average of 23.8 (SD 10.1) years of age. All patients had anterior uveitis, vitritis and various fundus lesions of OT. The patients had lymphocyte maturation abnormalities; the proportion of naive CD4 + CD45RA + CCR7 + T cells was high in 5/9 cases, and the percentage of CD4 + CD45RA - CCR7 - T effector memory cells was reduced in 7/9 cases. An increased percentage of CD19 + CD38 low CD21 low activated B cells was observed in 5/9 cases. IFN-γ response was reduced in CD4 + (8.45±4.17 vs 21.27±11.0, p=0.025) and CD8 + (39.0±9.9 vs 18.1±18.1, p=0.017) T cells. Genetic analysis revealed several potentially harmful variants in immunologically active ERCC3, MANBA, IRF4, HAVCR2, CARMIL2, CD247, MPO, C2 and CD40 genes., Conclusion: Our recurrent OT cases had deviations in lymphocyte maturation and IFN-γ responses possibly caused by genetic reasons. However, limitations of our study include failure to identify uniform genetic mechanisms. In addition, we cannot rule out the possibility that the immunological abnormalities can be triggered by chronic toxoplasmosis. Despite the limitations, our findings contribute to the understanding of ocular immunity and development of recurrent OT., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Pediatric uveitis is typically asymptomatic and may become chronic affecting ocular structures and vision. We evaluated visual outcomes, clinical features, medication, and uveitis activity in children with either idiopathic uveitis (idio-U) or juvenile idiopathic arthritis associated uveitis (JIA-U)., Methods: A longitudinal, population-based cohort study of children with uveitis in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution, etiology, systemic association, uveitis activity, medication, and visual outcomes., Results: A total of 119 patients aged < 16 years with uveitis were included. Uveitis was idio-U in 23% and associated with JIA in 77% of cases. 37% of the patients in the idio-U group and 65% in the JIA-U were girls (p = 0.014). The mean age at first uveitis was 10.0 (SD 3.4) years in idio-U and 5.5 (SD 3.3) years in JIA-U (p < 0.001). Anterior location of uveitis was noted in 74% in idio-U and 99% in JIA-U (p < 0.001). Mostly, uveitis was chronic (59% in idio-U and 75% in JIA-U) and bilateral (56% in idio-U and 64% in JIA-U). Topical corticosteroids were initially used by 89% and 100%, systemic corticosteroids by 30% and 27% in some extent during the follow-up, disease-modifying antirheumatic drugs (DMARDs) by 33% and 85% (p < 0.001) of the patients in idio-U and JIA-U, respectively. Biologic disease-modifying antirheumatic drugs (bDMARDs) were more common in JIA-U (55% vs. 15% in idio-U, respectively, p < 0.001). Most patients had normal visual acuity (Snellen > 0.8, [6/7.5]) in the affected eye and bilaterally in 85% idio-U and 70% JIA-U. Only 5 patients (4%) had visual impairment in one, but none in both eyes. Uveitis activity by SUN classification was 0 + in 81% and 72%, 0.5 + in 19% and 25%, and 1 + in 0% and 3% in the idio-U and JIA-U, respectively., Conclusions: Children with uveitis have good visual acuity and a low rate for visual impairment. In addition, modern treatment with DMARDs and bDMARDs seems to save vision., (© 2023. The Author(s).)

Objectives: Ocular candidiasis (OC) can complicate Candida bloodstream infection (BSI). Antifungal treatment improves the prognosis of patients with BSI, but the effects of choice and timing of first-line medication on OC risk are incompletely understood. We explored the early treatments, risk factors and ocular presentations in Candida BSI., Methods and Analysis: All patients (n=304) with Candida BSI during 2008-2017 at Oulu University Hospital were included. Those patients in whom clinical condition was appropriate for ocular examination (OE), including biomicroscopy (n=103), were carefully analysed by ophthalmologists. Criteria for patient selection were considered. Candida and yeast species, antifungal medications, echocardiography, underlying diseases and clinical properties of the patients with Candida BSI were analysed., Results: Clinical condition in 103 patients had been considered appropriate for OE. OC was diagnosed in 33 of the 103 patients. Candida albicans was the most common finding (88%) in OC. Patients in intensive care, alcohol-related conditions or poor prognosis were less frequently examined. Persistent candidemia increased the risk of OC. Chorioretinitis and endophthalmitis were diagnosed in 94% and 48% of the patients with OC, respectively. Any early antifungal treatment decreased the endophthalmitis risk. Echinocandin lowered the OC risk in those with central venous catheters (CVCs) or abdominal malignancy., Conclusion: Critical condition of patients with Candida BSI affects the selection and results of OE. OC was associated with C. albicans BSI especially among those with persistent candidemia, CVC or abdominal malignancy. Any early antifungal treatment reduced endophthalmitis risk. Early echinocandin treatment may reduce the risk of OC in selected patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To analyse the prevalence, incidence and aetiology of paediatric uveitis., Methods: A retrospective, population-based cohort study of Finnish children with uveitis in Northern Ostrobothnia Hospital District in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution of the disease, aetiology and systemic association., Results: One hundred fifty patients aged <16 years (mean age 6.9 ± 3.9 years) with uveitis were included, out of whom 53% were girls. The first uveitis episode occurred at 1-6 years in 59%, and 62% of them were girls. In the age group of 7-15 years, boys were diagnosed with uveitis more frequently than girls (61% versus 39%, respectively). Seventy percent of the girls were diagnosed with their first uveitis episode at the age of 1-6 years, whereas only 48% of the boys were diagnosed at that age. The prevalence of uveitis increased from 64/100 000 children <16 years in 2008 (95% CI, 47.7-84.2) to 106/100 000 in 2017 (95% CI, 84.6-130.2). The incidence of childhood uveitis in 2008-2017 was 14/100 000 person-years in children <16 years (95% CI, 11.3-16.5). Eighty-seven percent of the cases were non-infectious, 9% were infectious, and 3% had masquerade syndromes. Sixty-one percent of patients had juvenile idiopathic arthritis (JIA)., Conclusion: The prevalence of paediatric uveitis has increased during the last decade in both genders. Uveitis is more frequent in girls, and they were diagnosed at a younger age than boys. Idiopathic cases and JIA accounted for a majority of aetiological features., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose:: The purpose of this study was to evaluate the visual function and the ophthalmic status of young Finnish adults with long duration of type 1 diabetes in relation to the history of the metabolic control., Methods:: A population-based cohort of children with type 1 diabetes examined in the Northern Ostrobothnia hospital district in 1989 (n = 216) was re-examined 18 years later. High-contrast visual acuity (best-corrected visual acuity), contrast sensitivity, refractive error, lens status, intraocular pressure, stage of diabetic retinopathy and received treatments were evaluated. The metabolic control was reflected by the mean of glycated haemoglobin A1 or glycated haemoglobin A1c values of the years 1983-1989 and 1992-2007, respectively., Results:: In all, 96 men and 76 women age 30 ± 3 years with type 1 diabetes duration of 23 ± 4 years attended the re-evaluation. About 60% (103/172) had normal best-corrected visual acuity and 3% had low vision. Contrast sensitivity was abnormal in two-thirds. Half had myopia. Four patients had cataract surgery. Low childhood glycated haemoglobin A1 was indicative, and favourable glycated haemoglobin A1c during youth was a significant predictor of better contrast sensitivity and ocular state in adulthood., Conclusion:: The majority of the patients have useful vision, although minor functional impairments are commonly detectable. Long duration of type 1 diabetes in association with non-optimal glycaemic control threatens visual function already at young adulthood. Thus, strong emphasis to control diabetes from onset is important in maintaining good visual function.

The purpose of this descriptive study was to examine nursing students' perceptions of student self-determination in a Finnish health-care institute and to find out whether background data were in any way associated with these perceptions. To do this we developed a 56-item Students Self-Determination Questionnaire (SSDQ), which was completed by 435 nursing students. The results showed that self-determination is important for nursing students and that they are willing to exercise self-determination in their training. In practice, however, the students were not very active in this respect, nor did they feel that they were getting very much support from teaching staff. The meaning of self-determination increased with age and with increasing experience.