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Chang Sup Lee, Asima Bajwa, James Patrie, Wenjun Xin, Ashvini Reddy; Management and Outcomes of Uveitis in a Tertiary Eye Center Over 30 Years. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5760. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report the long-term, clinical outcomes of patients with uveitis managed in a tertiary medical center at University of Virginia over a 30 year period.
Retrospective, observational study of patients with uveitis seen at the University of Virginia from 1984-2014. Descriptive statistics and, where appropriate, Wilcoxon Rank Sum test and Pearson's Exact Chi-Square test were used to analyze demographics, laterality, anatomic location, etiology, total number of visits, change in best-corrected visual acuity (BCVA), management, intraocular pressure (IOP), and cataract.
The study included 644 eyes of 491 patients. 153 patients (31.2%) had bilateral disease and 213 (43.4%) were male. Mean age was 51.7±1.1 (SE) years at presentation. The mean number of visits per patient was 11.2±14.8 (median 6.0; range, 1.0-155).<br /> <br /> The mean BCVA was 0.54±0.03 logMAR at initial presentation and 0.52±0.04 logMAR (P=0.002) at last follow-up. Change in mean visual acuity from presentation to last follow-up was not statistically significant for anterior (0.44±0.04 to 0.45±0.04, P=0.058), posterior (1.07±0.13 to 0.99±0.13, P=0.197) and panuveitis (0.43±0.05 to 0.45±0.08, P=0.216). For patients with intermediate uveitis, the mean BCVA significantly improved by the final visit (0.61±0.17 and 0.27±0.07, P=0.038). Severe vision loss (>1.0 logMAR) was rarely seen with traumatic uveitis and HLA-B27-associated anterior uveitis.<br /> <br /> Local steroids were given to 365 patients (74.6%) and systemic steroids to 133 (27.3%). Antimetabolites were used in 52 (10.6%) patients and anti-tumor necrosis factor agents in 17 (3.5%). Intravitreal injection was given to 54 patients (11.1%); subtenon injection was given to 23 (4.7%). Vitrectomy was performed in 46 patients (9.4%). Mean initial IOP was 15.8±6.4 mmHg, and mean final IOP was 14.9±5.0 mmHg. 116 (23.7%) patients received medical treatment for ocular hypertension (IOP>21 mmHg), and 43 (8.8%) patients underwent glaucoma surgery. 129 (26.4%) patients underwent cataract surgery.
In this large series of patients with uveitis, mean BCVA improved from initial presentation to last follow-up, and this improvement was statistically significant. Patients with intermediate uveitis had a better final visual acuity than those with anterior, posterior or panuveitis. The majority of patients were managed with local or systemic steroids, and many developed glaucoma and cataract requiring treatment.
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