Risk Factors For Retinal Neovascularization In Patients With Uveitis

Abstract

Purpose: : To evaluate the risk of retinal neovascularization (NV) in patients with uveitis and evaluate potential risk factors and associated features.

Methods: : Retrospective cohort study of patients with uveitis at five academic ocular inflammation subspeciality practices. Data were ascertained by standardized chart review. Incidence data were analyzed using survival analysis with time-updated covariates where appropriate.

Results: : 95/8771 patients presenting for initial evaluation had NV giving a prevalence of 1.1%. 79 patients developed NV over 15522.84 person-years for an incidence of 0.51% per person-year. Factors associated with incident NV include age <35 as compared to >35 years (crude hazard ratio (HR) = 1.76, 95% confidence interval 1.1-2.7), bilateral inflammation (2.6; 1.3-5.4), and diagnosis of uveitis within the last 5 years as compared to >5 years (2.3; 1.2-4.4). As compared to anterior uveitis, intermediate uveitis carried a crude HR of 4.4 (2.2-8.7), posterior uveitis 5.1 (2.5-10), and panuveitis 5.3 (2.6-11). Patients with retinal NV were more likely to have retinal vascular occlusions (15; 4.6-57), retinal vascular sheathing (4.2; 2.3-7.7), and exudative retinal detachment (5.1; 1.6-16). Systemic lupus erythematosus also was associated with NV (4.3; 1.6-12). The presence of currently active inflammation was weakly associated as compared to inactive inflammation (1.6; 0.95-2.6).

Conclusions: : Retinal NV is a rare but vision-threatening complication of uveitis, which occurs more frequently in cases with more posterior disease and involvement of the retinal vascular system. Our results suggest that controlling inflammation might help to avoid this serious complication.

Keywords: retinal neovascularization • inflammation • autoimmune disease