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H Nida Sen, Lea T. Drye, Debra A. Goldstein, Theresa A. Larson, Pauline T. Merrill, Peter Reed Pavan, John D. Sheppard, Jr., Alyce Burke, Sunil K. Srivastava, Douglas A. Jabs; Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment Trial. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4269.
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To assess the prevalence of hypotony and associated clinical features in patients with intermediate, posterior and panuveitis.
The Multicenter Uveitis Steroid Treatment Trial (MUST), a 23-center prospective randomized study comparing treatments for intermediate, posterior and panuveitis, enrolled 255 patients. Patients with hypotony (IOP≤7) at the baseline visit were identified. Clinical and ocular characteristics associated with hypotony were assessed.
Among 251 patients with sufficient data (474 eyes), 24 patients (32 eyes) with hypotony were identified (9.7%); eight had bilateral hypotony (33%). The odds of hypotony were significantly higher in patients with chronic uveitis ≥5 yrs (OR: 5.9; 95% CI, 2.1 to 16.3; p<0.01) and sarcoidosis (OR: 3.5; 95% CI, 1.2 to 9.7; p:0.02). The odds of hypotony were lower in patients with older age (20-50 or ≥51) at the onset of uveitis (OR: 0.1, 95% CI,0.0 to 0.40 and OR: 0.3; 95% CI, 0.1 to 0.8; p≤ 0.01) compared to those with younger age at onset (<20), and in Caucasian patients (OR: 0.2; 95% CI, 0.1 to 0.5; p<0.01). The odds of hypotony were higher in eyes with pars planitis (OR: 3.3; 95% CI, 1.4 to 8.0; p:0.01) and when there was a history of glaucoma surgery (OR: 4.3; 95% CI, 1.8 to 10.1; p<0.01). Hypotony was associated with reduced visual acuity ≤ 20/50 (OR: 5.9; 95% CI, 2.3 to 15.3; p<0.01)
Hypotony is an uncommon but important complication of chronic uveitis, and appears to preferentially affect patients with uveitis onset at a younger age, patients of non-Caucasian race and those with longstanding disease. It is associated with other serious ocular structural complications and low visual acuity.
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