A Study on Ocular Morbidity among Patients with Psoriasis Visiting a Tertiary Care Hospital in Karnataka, Southern India

Evaluation of corneal topographic parameters in patients with psoriasis

BACKGROUND

To evaluate corneal topographic parameters in patients with psoriasis.

METHODS

This prospective, cross-sectional study included 50 right eyes of 50 patients with psoriasis and 50 right eyes of 50 age- and sex-matched healthy individuals. Detailed dermatological and ophthalmological examinations were performed in all cases. Noninvasive tear break-up time (NIBUT), meibography, keratometry values, and high-order corneal aberrations (HOAs) were obtained using corneal topography and compared to healthy subjects. These values were also evaluated according to anti-tumor necrosis factor alpha (anti-TNF-α) use, the Psoriasis Area and Severity Index (PASI) score, psoriasis duration, and patient age. The chi-square test, Mann-Whitney U test, and Pearson correlation test were used for statistical assessment.

RESULTS

Lower NIBUT and higher meibomian gland loss (MGL) were detected in psoriasis patients compared to healthy controls. There were no significant differences between the groups in terms of corneal HOAs. Higher MGL was detected in patients using anti-TNF-α than in patients not using it. A positive correlation was found among topographic parameters, especially between PASI score and the patient's age. No correlations were found between the disease duration and the other parameters.

CONCLUSION

NIBUT and MGL are more common in psoriasis patients than in healthy subjects. The relationship between anti-TNF-α use, PASI score, patient age, and corneal parameters should be considered in the follow-up and treatment of ocular findings in psoriasis patients.

Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

Psoriasis is a chronic autoimmune inflammatory disease that remains active for a long period, even for life in most patients. The impact of psoriasis on health is not only limited to the skin, but also influences multiple systems of the body, even mental health. With the increasing of literature on the association between psoriasis and extracutaneous systems, a better understanding of psoriasis as an autoimmune disease with systemic inflammation is created. Except for cardiometabolic diseases, gastrointestinal diseases, chronic kidney diseases, malignancy, and infections that have received much attention, the association between psoriasis and more systemic diseases, including the skin system, reproductive system, and oral and ocular systems has also been revealed, and mental health diseases draw more attention not just because of the negative mental and mood influence caused by skin lesions, but a common immune-inflammatory mechanism identified of the two systemic diseases. This review summarizes the epidemiological evidence supporting the association between psoriasis and important and/or newly reported systemic diseases in the past 5 years, and may help to comprehensively recognize the comorbidity burden related to psoriasis, further to improve the management of people with psoriasis.

Evaluation of ocular surface epithelial and stromal thicknesses in psoriasis using anterior segment optical coherence tomography

PURPOSE

To evaluate the epithelial and stromal thicknesses of conjunctiva and cornea in psoriatic patients with anterior segment optical coherence tomography (AS-OCT), METHODS: In this cross-sectional study, 61 patients with psoriasis and 42 age-matched, healthy individuals were enrolled. The epithelial and stromal thicknesses of both inferotemporal bulbar conjunctiva and central cornea were measured using AS-OCT.

RESULTS

Both the tear breakup time and Schirmer-1 test values were significantly lower in the psoriasis group compared with the controls (p < 0.05). The epithelial thickness of conjunctiva and cornea did not differ between psoriasis and control groups (p > 0.05). The central corneal stroma was significantly thicker in the psoriasis group (p = 0.04). PASI was positively correlated with the thickness of central cornea stroma (r = 0.442, p = 0.006) in the nail psoriasis group.

CONCLUSIONS

Psoriasis is not associated with altered epithelial thicknesses of the cornea and conjunctiva. It is accompanied by the stromal thickening of the cornea without conjunctival stromal involvement.

Identifying and Treating Ocular Manifestations in Psoriasis

Psoriasis is a chronic immune-mediated inflammatory skin condition that commonly presents with red, thickened, and scaling plaques. Given the prominent cutaneous manifestations of psoriasis, more subtle ophthalmic findings of the disease may initially go undetected, with the potential for significant ocular morbidity. Associated ocular disease can involve nearly any structure of the eye, with the eyelids most commonly being affected, resulting in relatively common signs and symptoms of ocular surface discomfort. The presence of intraocular inflammation (i.e., uveitis) or retinal involvement carry a heightened risk of vision loss, and are often more difficult to diagnose outside of the ophthalmology clinic. Early detection and treatment of ocular disease can limit morbidity and are critical to the management of these patients, which requires coordination of care between dermatologists and ophthalmologists. The objective of this article was to review the most common ocular conditions that affect psoriatic patients, when to consider referral to an ophthalmologist, and to summarize the adverse ocular effects of current psoriasis treatments.

Risk of incident cataract in patients with psoriasis: A population-based cohort study

Patients with psoriasis are predisposed to ocular complications. However, there is a paucity of data addressing the association between psoriasis and subsequent cataract development. The present study was conducted to evaluate whether there is an increased risk of cataract among patients with psoriasis. The study subjects of this cohort study were selected based on Chang Gung Research Database from 1 January 2003 to 31 December 2012. Follow-up ended 31 December 2017. Patients aged 20 years and older with psoriasis were enrolled. The participants of the control group were selected by matching with sex, age, and index date at a 4:1 ratio. Patients previously diagnosed with cataract were excluded. The hazard ratios associated with psoriasis were estimated using Cox regression analysis with competitive risk model. We also evaluated the relationship between the risk of cataract and systemic therapies as well as phototherapy and topical corticosteroid in patients with psoriasis. A total of 6823 patients with psoriasis and 27 292 matched controls were enrolled in the study. The psoriasis group had higher incidence rates than the control group for cataract (44.08 vs 19.45 per 10 000 person-years; adjusted hazard ratio, 1.778 [95% confidence interval, 1.530-2.066; p < 0.001]). Psoriatic patients receiving phototherapy for more than 200 sessions had a higher risk of cataract (adjusted hazard ratio, 2.933; 95% confidence interval, 1.192-7.218; p = 0.019), especially those receiving narrowband ultraviolet B therapy. The present study demonstrated a positive association between psoriasis and cataract. Physicians should be alert to visual function in patients with psoriasis, especially those receiving long-term phototherapy.

Analysis of corneal densitometry and endothelial morphometry in patients with psoriasis

BACKGROUND

To evaluate corneal endothelial properties and corneal densitometry values in patients with psoriasis and to compare the results with those of healthy controls.

METHODS

This prospective, comparative, and cross-sectional study included 106 eyes of 53 patients who were diagnosed with psoriasis and 106 eyes of 53 age-gender matched healthy controls. All patients were evaluated in terms of ocular surface tests such as Schirmer-1 and tear break-up time (TBUT). Corneal endothelial measurements were performed using noncontact specular microscopy. Corneal tomographic and densitometric measurements were obtained using the Scheimpflug imaging system. Measurements were also evaluated according to the psoriasis area and severity index (PASI) score.

RESULTS

The mean TBUT and Schirmer 1 test values were significantly lower in the psoriasis group than in the healthy controls (p = 0.02, p < 0.001, respectively). While the mean endothelial cell density was significantly lower in patients with psoriasis than the healthy controls (2389.9±314.9 cells/mm² vs. 2512.4±289.7 cells/mm², p = 0.02), the mean average endothelial cell area, standard deviation of cell area, coefficient of variation of cell area were significantly higher in patients with psoriasis (426.6±62.7 µm² vs. 403.2±46.1 µm², p = 0.01; 206.4±52.3 µm² vs. 183.2±43.8 µm², p = 0.006; and 48.1±6.3% vs. 45.7±6.7%, p = 0.04, respectively). Most of the densitometry measurements in concentric zones were higher in patients with psoriasis than in healthy controls, but none of the differences reached statistical significance.

CONCLUSIONS

A regular eye examination is crucial in patients with psoriasis because corneal structural and functional changes, particularly endothelial alterations, are of utmost importance in planning intraocular surgeries in patients with psoriasis.

The risk of psoriasis in patients with uveitis: A nationwide population-based cohort study

Objective

To evaluate whether the risk of subsequent psoriasis and psoriatic arthritis development is increased in patients with uveitis.

Methods

In Taiwan’s national health insurance research database, we identified 195,125 patients with new-onset uveitis between 2001 and 2013. We randomly selected 390,250 individuals without uveitis who were matched 2:1 to uveitis cases based on age, sex and year of enrolment. The characteristics of the two groups were compared. Using multivariate Cox regression, hazard ratios (HRs) for psoriasis or psoriatic arthritis corresponding to uveitis were computed after adjustment for age, sex, insurance cost and comorbidities. In subgroup analyses, separate HRs for mild psoriasis, severe psoriasis and psoriatic arthritis were calculated.

Results

The mean age of the study cohort was 50.2 ± 17.2 years. Hypertension, diabetes, hyperlipidaemia and obesity were more prevalent in the uveitis group (all p < 0.0001). The hazard of psoriasis or psoriatic arthritis development was significantly greater in the uveitis group than in the non-uveitis group (p < 0.0001); this increased risk persisted after adjustment for confounders [adjusted HR = 1.41; 95% confidence interval (CI), 1.33–1.48]. Adjusted HRs showed an increasing trend from mild psoriasis (1.35; 95% CI, 1.28–1.44) to severe psoriasis (1.59; 95% CI, 1.30–1.94) and psoriatic arthritis (1.97; 95% CI, 1.60–2.42).

Conclusions

This nationwide population-based cohort study revealed that patients with uveitis have an increased risk of subsequent psoriasis or psoriatic arthritis development.

The study of dry eye and meibomian glands in psoriasis

BACKGROUND

To investigate aqueous and lipid layers of the tear film as well as meibomian gland structure by meibography in psoriatic patients in the Iranian population.

METHODS

This case-control study was conducted on 31 psoriasis patients and 31 controls in Birjand University of Medical Sciences in 2018. The sampling method was available from the date of approval of the proposal in the Ethics Committee until it reached the sample size. After entering the study, patients were examined individually with a slit lamp. Then, Ocular Surface Disease Index (OSDI) score assessment, Schirmer test 1, lacrimal measurement with SM tube, tear break-up time (TBUT), and meibomian glands imaging by SBM Sistemi were done. Finally, the obtained data were entered into SPSS 15 software and analyzed at a significant level of less than 0.05.

RESULTS

The two groups were matched according to age and gender (p = 0.39 and p = 0.80; respectively). With the exception of the SM Tube score, the mean of all tear film and meibomian glands functional and structural parameters including Schirmer test 1, TBUT, and meibography were significantly different between patients and control groups. Moreover, the proportion of abnormal OSDI (OSDI ⩾ 13) and the dry eye was significantly higher in psoriasis patients.

CONCLUSIONS

Psoriasis is associated with dry eye as well as meibomian glands atrophy and dysfunction.

Ocular surface disease in psoriatic patients in a developing country

PURPOSE

To evaluate ocular surface changes among patients with psoriasis in Malaysia, a developing country in Southeast Asia.

METHODS

An interdisciplinary case-control study (60 psoriasis patients and 40 control subjects) to look at the differences in ocular surface manifestations between patients with psoriasis and a group of age-, gender- and ethnicity-matched healthy controls.

RESULTS

One hundred and twenty eyes of 60 patients with psoriasis and 80 eyes of 40 healthy controls without psoriasis were included in the study. Mild-to-moderate psoriasis was found in 42 patients (70%), while 18 patients (30%) had severe psoriasis. Psoriatic arthritis was found in 19 patients (32%). Of the 60 psoriatic patients, the prevalence of ocular involvement was 65% (39/60), in which 32% (19/60) had dry eyes, 27% (16/60) had lid margin abnormalities, 33% (20/60) had cataract, and one had history of anterior uveitis. Compared to controls, ocular surface of psoriatic patients showed more eyelid margin abnormalities, higher meibomian gland loss and lower tear film break-up time. The estimated odds ratio for dry eyes in the psoriasis group was 2.2 (95% CI: 0.8-6.9).

CONCLUSION

Ocular surface disorders encompassing eyelid margin abnormalities, meibomian gland loss and tear dysfunction occur at an earlier and higher rate among psoriatic patients.

The Incidence and Prevalence of Uveitis in Psoriasis: A Systematic Review and Meta-Analysis

BACKGROUND

The systemic effects and comorbidities of psoriasis include ocular disorders, such as uveitis. Patients with psoriatic arthritis in particular have been demonstrated to have an elevated risk for developing uveitis. Presently, the risk of uveitis in psoriasis has yet to be fully elucidated and this systematic review seeks to address this gap.

OBJECTIVE

To examine the prevalence and incidence of uveitis in psoriasis patients compared to non-psoriasis patients.

METHODS

We conducted a systematic review search on MEDLINE, Embase, and CENTRAL electronic databases with no lower limit on year of publication.

RESULTS

Fourteen articles met our inclusion criteria, with a total of 234 143 psoriasis subjects. Two studies found that participants with severe psoriasis were at a greater risk of uveitis than those with mild psoriasis. A random-effects meta-analysis of the 3 studies, which reported risk of incidence of uveitis in psoriasis patients compared to non-psoriasis controls, found a pooled risk ratio of 1.29 (95% CI, 1.10-1.51), indicating an increased risk of uveitis in psoriasis. Three studies compared risk of uveitis in psoriatic arthritis with psoriasis-only participants, all finding that psoriatic arthritis was associated with a greater risk of uveitis.

CONCLUSIONS

In summary, our findings suggest that psoriasis is associated with an increased risk of uveitis, with or without psoriatic arthritis.