Author’s Name(s): Amir Vosoughi, Parsa Mehraban Far, Sterling King, Imane Marrakchi, Andre Jastrzebski

Author’s Disclosure Block: Amir Vosoughi, none; Parsa Mehraban Far, none; Sterling King, none; Imane Marrakchi, none; Andre Jastrzebski, none

Abstract Body
Purpose: Uveitis is commonly regarded as a disease primarily affecting young and middle-aged individuals. When uveitis does appear in older patients, it is frequently attributed to masquerade syndromes, particularly neoplastic conditions. There are few studies that specifically explore the epidemiology or clinical patterns of uveitis in this age group. To address this gap, we conducted the first systematic review to evaluate the proportion, incidence, and clinical patterns of uveitis in patients aged 60 and above. Study Design: Systematic review. Methods: A systematic search of Medline, Embase, and Covidence was conducted in September 2024. Independent reviewers performed abstract and full-text screening in duplicate. Studies were included if they (1) reported on the proportion or etiology of new-onset uveitis in patients aged 60 or above, (2) were published between January 2005 and September 2024, and (3) focused on incident cases, providing information on the age of onset and clinical presentation. All values are reported as median percentages±interquartile range (IQR), unless otherwise stated. Results: The search yielded a total of 2,873 articles. After screening the titles and abstracts of 2,844 articles, 131 were deemed eligible for full-text review, of which 40 studies were included in the final analysis. These studies included a total of 75,032 patients aged 60 or above. The proportion of uveitis cases in patients 60 years and older, compared to other age groups, was 20.9±15.2%. Developed countries had a significantly higher proportion of uveitis compared to developing countries (22.7±17.6% vs. 14.4±9.3%, p=0.006). Six studies examined the incidence of uveitis in the elderly, revealing a global incidence of 120.2 per 100,000 person-years. The anatomic distribution of uveitis, in decreasing frequency, was anterior (60.4±21.9%), panuveitis (16.1±7.0%), posterior (13.4±13.2%), and intermediate (8.0±6.1%). The leading etiology was idiopathic uveitis (42.4±13.1%), followed by herpetic uveitis (12.0±16.7%), and HLA-B27-associated uveitis (5.1±8.8%).Among the 12 studies that reported on masquerade syndromes, 200 cases were identified, accounting for 4.9±4.1% of all cases. Of these, 94.9% were neoplastic masquerade syndromes, with lymphoma comprising 89.3% of neoplastic cases. Conclusion: Uveitis is a common condition in patients aged 60 and older, with anterior uveitis being the most common. A higher proportion of uveitis cases is observed in developed countries. Idiopathic, herpetic, and HLA-B27-associated uveitis are the leading causes. Masquerade syndromes represent a small fraction (4.9%) of cases, with lymphoma being the most common etiology.