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Jennifer E. Thorne, Anthony Gregory, Ebenezer Daniel, C Stephen Foster, Douglas A. Jabs, Grace A. Levy-Clarke, Robert B. Nussenblatt, James T. Rosenbaum, Eric B. Suhler, John H. Kempen; Risk Factors for Loss of Visual Acuity among Patients with Uveitis Associated With Juvenile Idiopathic Arthritis: The SITE Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6253.
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To describe the incidence of and risk factors for ocular complications and loss of visual acuity (VA) in patients with juvenile idiopathic arthritis (JIA)-associated uveitis.
327 patients (599 affected eyes) with JIA-associated uveitis managed at five tertiary ocular inflammation clinics in the United States were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Demographic and clinical characteristics were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Loss of VA to 20/50 or worse and to 20/200 or worse and the development of ocular complications were assessed.
At presentation, 240 (40.3%) eyes had a VA of 20/50 or worse; 144 (24.2%) had a VA of 20/200 or worse; and 359 (60.2%) had at least one ocular complication. Over a median follow up of 3 years (range = 1 month to 25 years), the rates of VA loss to the 20/50 or worse and 20/200 or worse thresholds were 0.18 and 0.09 per eye-year (EY), respectively. Among the affected eyes, the incidence of developing at least one new ocular complication over follow up was 0.15/EY (95% confidence interval [CI]: 0.13/EY, 0.17/EY). However, among eyes with uveitis that had no complications at presentation, the rate of developing at least one ocular complication during follow up was 0.07/EY (95% CI: 0.04, 0.11). After controlling for confounding factors, presence of posterior synechiae, active uveitis, and prior intraocular surgery were statistically significantly associated with VA to the 20/50 or worse and 20/200 or worse thresholds at presentation and during follow up. Increasing anterior chamber cell was associated with increased rates of visual loss in a dose-dependent fashion. Use of immunosuppressive drugs reduced the risk of visual loss, particularly for the 20/50 or worse outcome (hazard ratio = 0.43, 95% CI: 0.23, 0.81, P<0.01).
Ocular complications and vision loss were common in our cohort. Active uveitis had a dose-dependent association with vision loss and use of immunosuppressive drugs reduced the risk of vision loss; thus reinforcing the recommendation that aggressive control of intraocular inflammation is critical to the prevention of visual loss among patients with JIA-related uveitis.
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