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A. R. Loh, K. Hong, K. Ray, N. R. Acharya; Predictors of Clinical Outcomes in HLA-B27-Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):285.
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To evaluate the prevalence of ocular complications in patients with HLA-B27-associated uveitis and to describe predictors of visual loss.
In a single-center, academic practice, clinical data from 93 patients with HLA-B27-associated uveitis evaluated between March 2002 and November 2008 were analyzed. The outcome measure was final visual acuity in affected eyes. Acuities were converted to logMAR, and poor control of uveitis was defined by > grade 0 cell by the SUN classification.
The average age at presentation was 32.2 years (range 2-84) and 50 of 93 (54%) were male. The majority of the patients self-identified as Caucasian (69, 76%) or Asian (14, 15%). Nearly one-third of patients (24, 30%) reported current or previous smoking, and there were 53 (57%) with at least six months follow-up. The course was most commonly recurrent (54, 58%) or chronic (23, 25%). The largest proportion of HLA-B27 patients had unilateral uveitis (45, 48%) followed by unilateral alternating (34, 38%) and bilateral concomitant (11, 12%). The inflammation was overwhelmingly non-granulomatous (88, 97%) and anterior (87, 94%). Nearly half of the patients had an HLA-B27-associated systemic disease (43, 46%): ankylosing spondylitis (26, 28%) or reactive arthritis (7, 8%). Within the 141 total affected eyes, the most common ocular complication at presentation was cataract (41, 34%) followed by posterior synechiae (23, 16%) and elevated intraocular pressure (11, 8%). The most common complication to develop during treatment was cataracts (24, 26%), followed by elevated intraocular pressure (25, 19%) and posterior synechiae (14, 12%). Nearly half of the HLA-B27 patients received oral steroids during the course of follow up (42, 45%) and some received steroid intraocular injections (27, 28%). Twenty patients (22%) received steroid-sparing immunosuppression and 17 patients (18%) received biologics during the course of treatment. For patients with greater than six months of follow-up, the mean percentage of follow-up time with poor control was 14.1% (range 0 - 58%). Predictors of poor final visual acuity included poor presentation visual acuity (p<0.0001), presence of cataract on presentation (p=0.002), and development of high intraocular pressure (p=0.013). In a multivariate regression model, presentation acuity was by far the largest predictor of final acuity.
In our academic center, 25% of HLA-B27-associated uveitis is chronic, higher than previous case series. Poor vision at presentation is by far the largest determinant of final acuity, with development of intraocular pressure during treatment also a risk factor for a poor outcome.
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