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J. E. Thorne, F. Woreta, S. R. Kedhar, J. P. Dunn, D. A. Jabs; Clinical Outcomes of Patients With Juvenile Idiopathic Arthritis (JIA) Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4403.
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To estimate the rates of developing structural ocular complications and visual acuity loss in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, to describe the risk factors for developing visual acuity loss, and to describe the association between therapy and the incidence of ocualar complications and visual acuity loss.
75 patients with JIA-associated uveitis evaluated from July 1984 through August 2005 at a single academic center were included. Clinical data on these patients were collected retrospectively and analyzed using longitudinal data analysis techniques. Outcome measures included the development of structural ocular complications and loss of visual acuity to the 20/50 or worse and 20/200 or worse thresholds.
Over a median follow-up of 3 years, the incidence rate of an ocular complication was 0.33/eye-year (EY). Rates of loss of visual acuity to 20/50 or worse and to 20/200 or worse were 0.10/EY and 0.08/EY respectively. Risk factors at presentation for incident vision loss included the presence of posterior synechiae, anterior chamber flare ≥ 1+, and an abnormal intraocular pressure (IOP). Ocular inflammation of ≥ 0.5+ cells during follow-up was associated with an increased risk of 20/50 or worse (RR = 2.02, P = 0.006) and of 20/200 or worse visions (RR = 2.99, P = 0.03). Immunosuppressive drug therapy reduced the risk of hypotony by 74% (P = 0.002), epiretinal membrane formation by 84% (P = 0.05), and 20/200 or worse visual acuity in the better-seeing eye by 60% (P = 0.04).
Incident vision loss and ocular complications were common. Presence of posterior synechiae, flare ≥ 1+, and abnormal IOP at presentation and active inflammation during follow-up were associated with the development of vision loss. Immunosuppressive drug therapy reduced the risk of some complications in affected eyes and of blindness in the better-seeing eye.
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