Document Detail


Incidence rates and risk factors for ocular complications and vision loss in HLA-B27-associated uveitis.
MedLine Citation:
PMID:  20643395     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Allison R Loh; Nisha R Acharya
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of ophthalmology     Volume:  150     ISSN:  1879-1891     ISO Abbreviation:  Am. J. Ophthalmol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-24     Completed Date:  2010-10-06     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  0370500     Medline TA:  Am J Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  534-542.e2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Blindness / diagnosis,  epidemiology*
Chronic Disease
Eye Diseases / diagnosis,  epidemiology*
Female
Follow-Up Studies
HLA-B27 Antigen / immunology*
Humans
Incidence
Male
Retrospective Studies
Risk Factors
Uveitis, Anterior / epidemiology*,  immunology
Visual Acuity / physiology
Grant Support
ID/Acronym/Agency:
EY02162/EY/NEI NIH HHS; K23 EY017897/EY/NEI NIH HHS; K23EY017897/EY/NEI NIH HHS
Chemical
Reg. No./Substance:
0/HLA-B27 Antigen
Comments/Corrections

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