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Ebenezer Daniel, Maxwell Pistilli, H Nida Sen, Eric B Suhler, Jennifer E Thorne, C Stephen Foster, Douglas A Jabs, Robert B Nussenblatt, James T Rosenbaum, John H Kempen, Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Research Group; Incidence and Risk Factors for Ocular Hypertension in Adults with Non-infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6031.
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To describe risk (factors) for ocular hypertension (OHT) in patients with non-infectious uveitis.
Retrospective cohort study; expert chart review of every eye at every visit of patients with non-infectious uveitis was done in 5 ocular inflammation clinics. Data on intraocular pressure (IOP), demographics, ocular characteristics and treatment were collected. Ocular hypertension (OHT) outcomes included IOP≥21 and ≥30mmHg, and a ≥10mmHg IOP increase from baseline. Outcomes were counted as having occurred in eyes receiving anti-glaucoma drops or surgery.
OHT ≥30mmHg occurred in 723 of 5270 eyes with an estimated cumulative incidence of 14.1% (95%CI 12.7% - 15.5%) at 2 years (Figure 1). Factors associated with increased risk included systemic hypertension (adjusted hazard ratio (aHR)=1.28, 95% confidence interval (CI) 1.04-1.57), worse presenting visual acuity (VA) (20/200 or worse vs 20/40 or better, aHR=2.29, 95%CI 1.84-2.86), pars plana vitrectomy (aHR=2.68, 95%CI 2.03-3.53), 1+ (aHR=1.44, 95%CI 1.08-1.92) and ≥2+ (aHR= 1.59, 95%CI 1.20-2.11) vs no anterior chamber cells; peripheral anterior synechiae (PAS) (aHR =1.81, 95%CI 1.28-2.55); and a prior history of having OHT in the other eye :contralateral IOP ≥21 mmHg (aHR=2.68, 95%CI 2.20-3.26), ≥30 mmHg (aHR=4.91, 95%CI 3.12-7.72), and prior/current use of IOP-lowering drops or surgery (aHR=4.16, 95%CI 3.20-5.41) vs eyes without such history. Increased risk was observed with use of systemic (aHR=1.64, 95% CI 1.35-2.00) and periocular corticosteroids (aHR=2.37, 95%CI 1.70-3.30) and fluocinolone acetonide implants(aHR=8.26, 95%CI 1.88-36.3).Topical corticosteroid use [≥ 4X/day] showed increasing risk with increasing numbers of drops (Figure 2). OHT risk was less in patients with bilateral uveitis vs unilateral uveitis (aHR=0.69, 95%CI 0.54-0.87). Risk factors were similar for the ≥21 mmHg and ≥10mmHg IOP increase outcomes.
Approximately one-seventh of eyes developed IOP≥30 mmHg or required IOP-lowering treatment within 2 years. Hypertension, worse presenting VA, unilaterality of uveitis, history of OHT in the other eye, PAS, pars plana vitectomy, and anterior chamber cells (time-updated) were risk factors. All forms of corticosteroid therapy used to treat uveitis were associated with increased risk (several-fold with implants and high dose [≥8X/day] topical therapy).
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