April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Incidence and Risk Factors for Ocular Hypertension in Adults with Non-infectious Uveitis
Author Affiliations & Notes
  • Ebenezer Daniel
    The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA
  • Maxwell Pistilli
    Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA
  • H Nida Sen
    The Laboratory of Immunology, National Eye Institute, Bethesda, MD
  • Eric B Suhler
    Portland Veteran’s Affairs Medical Center, Portland, OR
    Department of Ophthalmology, Oregon Health and Science University, Portland, OR
  • Jennifer E Thorne
    The Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
    The Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD
  • C Stephen Foster
    The Massachusetts Eye Research and Surgery Institution, Cambridge, MA
    Department of Ophthalmology, Harvard Medical School, Boston, MA
  • Douglas A Jabs
    The Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
    The Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, NY
  • Robert B Nussenblatt
    The Laboratory of Immunology, National Eye Institute, Bethesda, MD
  • James T Rosenbaum
    The Devers Eye Institute, Portland, OR
    Department of Ophthalmology, Oregon Health and Science University, Portland, OR
  • John H Kempen
    The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
  • Footnotes
    Commercial Relationships Ebenezer Daniel, None; Maxwell Pistilli, None; H Nida Sen, None; Eric Suhler, None; Jennifer Thorne, Abbvie (C), Allergan (F), Gilead (C), Navigent (C), NEI (F), NIAID (F), RPB (F), Xoma (C); C Stephen Foster, None; Douglas Jabs, None; Robert Nussenblatt, None; James Rosenbaum, Abbott (F), Allergan (C), Bristol-Myers (F), Elan (C), Eye Gate (F), Genentech (C), Genentech (F), Lux (C), Novartis (C), Regeneron (C), Sanofi (C), Santen (C), Tiva (C), UCB (C), Xoma (C); John Kempen, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 6031. doi:
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      Ebenezer Daniel, Maxwell Pistilli, H Nida Sen, Eric B Suhler, Jennifer E Thorne, C Stephen Foster, Douglas A Jabs, Robert B Nussenblatt, James T Rosenbaum, John H Kempen, ; Incidence and Risk Factors for Ocular Hypertension in Adults with Non-infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6031.

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Abstract
 
Purpose
 

To describe risk (factors) for ocular hypertension (OHT) in patients with non-infectious uveitis.

 
Methods
 

Retrospective cohort study; expert chart review of every eye at every visit of patients with non-infectious uveitis was done in 5 ocular inflammation clinics. Data on intraocular pressure (IOP), demographics, ocular characteristics and treatment were collected. Ocular hypertension (OHT) outcomes included IOP≥21 and ≥30mmHg, and a ≥10mmHg IOP increase from baseline. Outcomes were counted as having occurred in eyes receiving anti-glaucoma drops or surgery.

 
Results
 

OHT ≥30mmHg occurred in 723 of 5270 eyes with an estimated cumulative incidence of 14.1% (95%CI 12.7% - 15.5%) at 2 years (Figure 1). Factors associated with increased risk included systemic hypertension (adjusted hazard ratio (aHR)=1.28, 95% confidence interval (CI) 1.04-1.57), worse presenting visual acuity (VA) (20/200 or worse vs 20/40 or better, aHR=2.29, 95%CI 1.84-2.86), pars plana vitrectomy (aHR=2.68, 95%CI 2.03-3.53), 1+ (aHR=1.44, 95%CI 1.08-1.92) and ≥2+ (aHR= 1.59, 95%CI 1.20-2.11) vs no anterior chamber cells; peripheral anterior synechiae (PAS) (aHR =1.81, 95%CI 1.28-2.55); and a prior history of having OHT in the other eye :contralateral IOP ≥21 mmHg (aHR=2.68, 95%CI 2.20-3.26), ≥30 mmHg (aHR=4.91, 95%CI 3.12-7.72), and prior/current use of IOP-lowering drops or surgery (aHR=4.16, 95%CI 3.20-5.41) vs eyes without such history. Increased risk was observed with use of systemic (aHR=1.64, 95% CI 1.35-2.00) and periocular corticosteroids (aHR=2.37, 95%CI 1.70-3.30) and fluocinolone acetonide implants(aHR=8.26, 95%CI 1.88-36.3).Topical corticosteroid use [≥ 4X/day] showed increasing risk with increasing numbers of drops (Figure 2). OHT risk was less in patients with bilateral uveitis vs unilateral uveitis (aHR=0.69, 95%CI 0.54-0.87). Risk factors were similar for the ≥21 mmHg and ≥10mmHg IOP increase outcomes.

 
Conclusions
 

Approximately one-seventh of eyes developed IOP≥30 mmHg or required IOP-lowering treatment within 2 years. Hypertension, worse presenting VA, unilaterality of uveitis, history of OHT in the other eye, PAS, pars plana vitectomy, and anterior chamber cells (time-updated) were risk factors. All forms of corticosteroid therapy used to treat uveitis were associated with increased risk (several-fold with implants and high dose [≥8X/day] topical therapy).

     
Keywords: 746 uveitis-clinical/animal model • 568 intraocular pressure  
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