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Mehrine Shaikh, Alla Hynes, Veena Raiji, ; Racial Differences in HLA-B27 Associated Anterior Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5314.
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To report our experience with HLA-B27 related Anterior Uveitis in our Washington, DC based referral center and specifically its distribution by race.
All patients with anterior uveitis between 2007-2009 were identified based on ICD-9 code search. Patients with HLA-B27 related disease were identified and data collected included age, sex, race (based on patient self-identification), ocular exam findings, number of recurrences, results of uveitis work-up, systemic co-morbidities and therapies employed. Statistical analysis by race was done using Chi-squared and Fisher’s exact test.
59 patients with HLA-B27 related anterior uveitis were seen, 19 African Americans and 40 non-African American. The average age at presentation of African American patients was 42.2 years and of non-African American patients was 42.4 years. There were more females in the African American group (63%) compared with the non-African American group (45%), although this difference was not statistically significant. 47.4% of African Americans and 52.5% of non-African Americans had an HLA-B27 associated systemic disease. Final log MAR visual acuity was 0.169 in African Americans and 0.058 in non-African Americans (p=0.114). Additionally, we noted a trend toward more frequent cystoid macular edema in our African American patients (10.5%) compared with our non-African American patients (2.5%), however this was not statistically significant (p-value 0.24). 58.0% of African Americans and 7.5% of non-African Americans had hypopyon (p<0.001). Only 26.3% of African American patients with HLA-B27 related anterior uveitis were diagnosed with the HLA-B27 antigen prior to presentation to our clinic, requiring work-up and subsequent diagnosis with HLA-B27 antigen positivity by our service in 73.7% of African Americans compared with 23.5%% of non-African American patients.
In our study both African American and non-African Americans had associated HLA-B27 systemic disease at similar rates. African Americans had a trend toward poorer visual outcomes and were more likely to have hypopyon. This underlines the necessity for casting a wide diagnostic net in patients with anterior uveitis without attention to racial background. The relationship between the HLA-B27 antigen and anterior uveitis varies amongst races and may be changing due to the increasing heterogeneity of our population.
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