TY - JOUR
T1 - Incidence rates and risk factors for ocular complications and vision loss in HLA-B27-associated uveitis
AU - Loh, Allison R.
AU - Acharya, Nisha R.
N1 - Funding Information:
The Department of Ophthalmology at University of California, San Francisco (UCSF) is supported by a core grant from the National Eye Institute (Bethesda, Maryland) ( EY02162 ). Dr Acharya is supported by a National Eye Institute K23EY017897 grant and a Research to Prevent Blindness Career Development Award (New York, New York). This work was supported in part by a grant from the Doris Duke Charitable Foundation (New York, New York) to UCSF to fund Allison Loh. The authors report no financial disclosures or conflicts of interest. Involved in design and conduct of the study (N.A.); collection and management of data (A.L., N.A.); analysis and interpretation of data (A.L., N.A.); and preparation, review, and approval of the manuscript (A.L., N.A.). This study was approved by expedited review by the University of California, San Francisco Committee on Human Research. Due to the retrospective nature of the research, the committee waived the need for informed consent. The study and data accumulation were in conformity with all county, federal, and state laws. Additionally, the study was performed in accordance with HIPAA regulations and in adherence to the tenets of the Declaration of Helsinki.
PY - 2010/10
Y1 - 2010/10
N2 - Purpose: To calculate the incidence rates of ocular complications and vision loss in HLA-B27-associated uveitis and to explore the effect of chronic inflammation on clinical outcomes. Design: Retrospective longitudinal cohort study. Methods: The clinical records of 99 patients (148 uveitis-affected eyes) with HLA-B27-associated uveitis seen at a tertiary care center were included. The main outcome measures were ocular complications (posterior iris synechiae, band keratopathy, posterior subcapsular [PSC] cataracts, ocular hypertension, hypotony, cystoid macular edema, and epiretinal membrane) and vision loss. Anterior chamber inflammation was defined as <1+ grade inflammation. Chronic uveitis was defined as persistent inflammation with relapse in <3 months after discontinuing treatment or requiring medications to suppress inflammation for >3 months after reviewing the patient's entire clinical course. Results: The clinical course was most commonly acute/recurrent (75%) or chronic (20%). The most common complications to develop during follow-up were ocular hypertension (0.10/eye-year) and PSC cataracts (0.09/eye-year). In multivariate analysis, the presence of posterior synechiae at presentation, inflammation, corticosteroid-sparing therapy, corticosteroid injections, chronic disease, and male gender were associated with a statistically significant increased risk of developing vision loss (20/50 or worse). Chronic disease course was associated with a 7-fold increased risk of visual impairment (hazard ratio [HR] = 6.8, P < .0001). The presence of inflammation during follow-up was associated with an increased risk of developing visual impairment (HR = 6.2, P < .0001). In multivariate analysis, chronic disease course and topical corticosteroids were associated with an increased risk of developing any incident ocular complication (HR = 2.2, P = .04 and HR = 3.3, P = .01, respectively). Conclusions: Poorly controlled inflammation was associated with the development of ocular complications including vision loss. Patients with chronic inflammation were also at greater risk of complications.
AB - Purpose: To calculate the incidence rates of ocular complications and vision loss in HLA-B27-associated uveitis and to explore the effect of chronic inflammation on clinical outcomes. Design: Retrospective longitudinal cohort study. Methods: The clinical records of 99 patients (148 uveitis-affected eyes) with HLA-B27-associated uveitis seen at a tertiary care center were included. The main outcome measures were ocular complications (posterior iris synechiae, band keratopathy, posterior subcapsular [PSC] cataracts, ocular hypertension, hypotony, cystoid macular edema, and epiretinal membrane) and vision loss. Anterior chamber inflammation was defined as <1+ grade inflammation. Chronic uveitis was defined as persistent inflammation with relapse in <3 months after discontinuing treatment or requiring medications to suppress inflammation for >3 months after reviewing the patient's entire clinical course. Results: The clinical course was most commonly acute/recurrent (75%) or chronic (20%). The most common complications to develop during follow-up were ocular hypertension (0.10/eye-year) and PSC cataracts (0.09/eye-year). In multivariate analysis, the presence of posterior synechiae at presentation, inflammation, corticosteroid-sparing therapy, corticosteroid injections, chronic disease, and male gender were associated with a statistically significant increased risk of developing vision loss (20/50 or worse). Chronic disease course was associated with a 7-fold increased risk of visual impairment (hazard ratio [HR] = 6.8, P < .0001). The presence of inflammation during follow-up was associated with an increased risk of developing visual impairment (HR = 6.2, P < .0001). In multivariate analysis, chronic disease course and topical corticosteroids were associated with an increased risk of developing any incident ocular complication (HR = 2.2, P = .04 and HR = 3.3, P = .01, respectively). Conclusions: Poorly controlled inflammation was associated with the development of ocular complications including vision loss. Patients with chronic inflammation were also at greater risk of complications.
UR - http://www.scopus.com/inward/record.url?scp=77957285597&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77957285597&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2010.04.031
DO - 10.1016/j.ajo.2010.04.031
M3 - Article
C2 - 20643395
AN - SCOPUS:77957285597
SN - 0002-9394
VL - 150
SP - 534-542.e1-e2
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 4
ER -