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Deepika Shah, Craig Newcomb, Grace Levy-Clarke, Robert Nussenblatt, James Rosenbaum, Eric Suhler, Jennifer Thorne, C. Stephen Foster, Douglas Jabs, John Kempen; The Prevalence, Incidence and Risk Factors for Exudative Retinal Detachment in Uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2939.
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To evaluate the prevalence, incidence, and risk factors associated with exudative retinal detachment (ERD) in patients with uveitis.
We performed a retrospective chart review of a large multi-center cohort (Systemic Immunosuppressive Therapy for Eye Disease Cohort Study) of patients with ocular inflammation at four tertiary care academic ocular inflammation centers in the US between 1978 and 2007, evaluating the prevalence, incidence and risk factors for ERD.
138 of 8478 uveitic patients presented with prevalent ERD (1.6%). Risk factors for prevalent ERD were Vogt-Koyanagi-Harada syndrome (VKH) (odds ratio (OR) 80.92, p<0.0001), sympathetic ophthalmia (SO) (OR 8.01, p=0.0064), retinochoroiditis (OR 8.92, p<0.0001), panuveitis (OR 6.14, p<0.0001),posterior uveitis (OR 12.36, p<0.0001), posterior scleritis (OR 30.33, p<0.0001), and necrotizing scleritis(OR 5.75, p=0.0213). Clinical features predictive of ERD were choroidal neovascularization (OR 2.61, p=0.0219) and band keratopathy (OR 2.89, p=0.0007). Among the 5409 uveitic patients with follow-up and initially free of ERD, 105 incident ERD cases were observed (incidence rate=0.65%/person-year). Among the ocular inflammatory diagnoses, only retinochoroiditis (hazard ratio (HR) 7.13, p=0.0014) was significantly associated with incident ERD. VKH (HR=3.88, p=0.21), SO (HR=3.27, p=0.32), and posterior scleritis (4.46, p=0.14) had increased incidence, but not to a statistically significant degree. Systemic diagnoses of rheumatoid arthritis (HR 2.39, p=0.0367) and juvenile idiopathic arthritis (HR 2.35, p=0.0402) had higher incidence of ERD. In both the prevalence (OR=4.36, p<0.0001) and incidence analyses (HR=2.80, p<0.0001), active inflammation was associated with higher risk of ERD. In the incidence analysis, a dose-response relationship with ERD incidence was observed for time-updated anterior chamber cell grade, and for vitreous cell grade, as well as a higher risk among cases with vitreous haze.
ERD is a rare finding strongly, not only associated at presentation with VKH and posterior scleritis, but also with active inflammation, other forms of chorioretinal or scleral inflammation. These results are informative in indicating that an important number of ERD cases are unrelated to VKH or posterior scleritis, especially following initial presentation, and confirm the importance of controlling inflammation to avoid ERD.
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