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Karen Small, Jing Hua, Alexander Cohn, Stephen D Anesi, C. Stephen Foster; Delayed Acceleration of Severity in Recurrent Acute HLA-B27 Associated Anterior Uveitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):524.
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Steroid treatment responses to acute flares of anterior uveitis are titrated to the level of inflammation observed when the patient presents. We performed a chart review to investigate the phenomenon whereby mild flares in HLA-B27 patients may become more severe despite topical steroid treatment.
Patients included in this study were evaluated at Massachusetts Eye Research and Surgery Institution (MERSI) from January 1, 2004 until November 30, 2016. Inclusion criteria were individuals who were HLA-B27 positive and who developed acute anterior uveitis. The authors evaluated the clinical records to identify uveitis flares where the subsequent exam documented worse anterior inflammation than at initial presentation despite treatment with topical steroids. Patients were excluded if they were diagnosed with any other significant ocular inflammatory condition.
There were 218 HLA-B27 positive patients identified. Of these, 22 eyes of 22 patients (10.1%) were found to exhibit delayed acceleration. The average interval from initial presentation was 9.1 days with standard deviation of 6.7 days. The phenomenon exhibited no gender preference, consisting of 11 males, and 11 females, with the average age of 42.4 years (ranging from 20.7 to 65.1 years). Two patients (9.1%) were on immunomodulatory therapy, and 1 patient (4.5%) was taking oral prednisone. Patients had an average of 1.7 other flares while a patient at MERSI, and 9 patients (40.9%) had no other flares. None of the other documented flares exhibited the delayed inflammatory acceleration.
HLA-B27 patients in this study were observed to have a unique characteristic during intervals of breakthrough where the disease process becomes active again. These patients may require more frequent and higher doses of steroid treatment at initial presentation of a flare to avoid subsequent aggressive inflammatory acceleration.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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