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Harpreet Walia, Sheila Angeles-Han, Larry Vogler, Sampath Prahalad, Christine Kennedy, Sunil Srivastava, G B. Hubbard, III, Scott Lambert, Steven Yeh; Ocular Complications And Treatment Of HLA-B27-associated Uveitis: Comparison Of Pediatric And Adult Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4285.
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To compare the baseline clinical ophthalmic features, systemic disease associations, and steroid-sparing immunomodulatory therapy (IMT) required in adult and pediatric patients with HLA-B27+ uveitis.
Retrospective review of HLA-B27+ uveitis patients from a university-based academic practice. Medical records were reviewed for demographics, visual acuity (VA), IMT, and the presence of cataract, posterior synechiae, cystoid macular edema (CME), epiretinal membrane (ERM), ocular hypertension (OHTN) and hypotony.
Nine eyes from 7 pediatric patients and 26 eyes from 16 adult patients with HLA-B27+ uveitis were evaluated (Table 1). Two of 7 pediatric patients and 12 of 16 adult patients were female. In pediatric eyes, VA was 20/50 or worse in 44% and 20/200 or poorer in 11%. In adult eyes, VA was 20/50 or worse in 23% and 20/200 or worse in 12%. Anterior/intermediate uveitis was found in 57% of pediatric patients while anterior uveitis was seen in 94% of adults (p=0.067). Secondary complications in pediatric eyes included cataract (55%), posterior synechiae (33%), OHTN (33%), and CME (22%). In adults, cataract (54%), posterior synechiae (46%), OHTN (33%) and CME (8%) were seen with similar frequencies. The most common systemic disease association was spondyloarthropathy in pediatric patients (29%) and anklyosing spondylitis in adult patients (31%). Steroid-sparing IMT was required in 57% of pediatric patients and 13% of adults (p=0.045).
Moderate-severe visual loss was more common in pediatric patients compared to adults with HLA-B27+ uveitis but the difference was not statistically significant. Anterior/intermediate uveitis was more common in pediatric patients than adults, prompting steroid-sparing IMT in the majority of cases.
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