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D. Huie, S. R. Tari, S. Schwartzman, C. Samson; Characteristics of HLA-B27 Positive Patients Treated at the New York Eye and Ear Infirmary. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3888.
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© ARVO (1962-2015); The Authors (2016-present)
The HLA-B27 gene has been associated with a number of inflammatory conditions, including uveitis and ankylosing spondylitis. This study is set out to identify the main characteristics of HLA-B27 positive patients treated at The New York Eye and Ear Infirmary.
Retrospective chart review of HLA-B27 positive patients in a tertiary care center in New York City.
Thirty-three patients positive for HLA-B27 were studied. The average age was 40.9 ± 15.7 years (Mean ± Standard Deviation) and ranged from 12-77. Eighteen patients were males (54.6%). Nineteen patients (57.6%) were white, nine (27.3%) were Hispanic, two (6.1%) were black, two (6.1%) were Asian, and one (3%) was recorded as "other." Anterior chamber involvement included 31 (94%) cases of which 7 (22.7%) patients had intermediate and/or posterior involvement also. Ankylosing spondylitis was present in five (16.1%) of the patients. All 33 patients were treated with ocular steroids, and 21 were also treated with systemic steroids, with most patients responding favorably. Visual acuity improved from 0.46 ± 0.42 LogMAR units in the initial visit to 0.31 ± 0.34 LogMAR units (p ≤ 0.05) in the final visit. After 6 months of treatment, the percentage of patients still on systemic steroids dropped to 30%, dropping again to 18% after 1 year of treatment, and to 15% after 2 years of treatment. Uncontrolled inflammation was initially present in 97% of patients. After 6 months, 27% of patients were still uncontrolled, with 42% uncontrolled after 1 year, and 36% uncontrolled after 2 years. Control of inflammation was defined as an uninterrupted period of 6 months with less than 1+ cells in the anterior chamber. It should be noted that while a large number of patients remained uncontrolled after 2 years of treatment, most of these patients suffered from inflammation in the 1+ to 2+ cells range, as opposed to inflammation in the 3+ to 4+ range which many patients presented with initially.
HLA-B27 associated uveitis seems to have a favorable visual prognosis if treated at early stages. Treatment with topical and systemic steroids resulted in a statistically significant improvement in visual acuity and control of inflammation in the majority of the patients.
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