Acute Anterior Uveitis Associated Optic Disc Edema

Abstract

Abstract: : Purpose:To describe the clinical characteristics and response to therapy of optic disc edema (ODE) associated with acute anterior uveitis (AAU). Methods:Retrospective non–comparative case series from one university–based uveitis referral clinic and one general ophthalmology clinic over a 16 month period. Results:During the study period, 89 patients with AAU were evaluated in the uveitis referral clinic and 123 patients in the general clinic. Seven of the 89 patients (8%) in the uveitis referral clinic and 2 of the 123 patients (1.6%) in the general clinic had ODE associated with AAU. Of the 9 total patients with AAU–associated ODE, 14 eyes were affected. Five patients (55%) had both bilateral AAU and ODE, 2 patients had bilateral AAU and unilateral ODE, and 2 patients had unilateral AAU and unilateral ODE. Mean patient age was 29.6 years, 66% were male, and 66% were Caucasian. HLA–B27 positivity was the most frequently associated finding. ODE presented a mean of 14.5 days following the development of AAU. Optic nerve function remained intact in all patients, with the exception of an enlarged blind spot. Cranial MRIs were obtained on 6 of 9 patients. An abnormality was revealed in one patient who had a history suggestive of a systemic process. Therapy was directed at the AAU and consisted of topical corticosteroids in all patients, sub–Tenonâ|*128*|^TMs injection of corticosteroid in 2 patients, oral prednisone in 2 patients, and oral weekly methotrexate in one patient. Resolution of the AAU occurred over a mean of 5.29 weeks while ODE resolved over a mean of 6.85 weeks. Resolution of ODE trailed that of the AAU by a mean of 1.5 weeks (range 0 to 6 weeks). Conclusions: ODE associated with AAU is a known phenomenon, but we are not aware of any reports detailing the clinical characteristics of this entity. Male gender, Caucasian race, and HLA–B27 positivity were the most common associations. Treatment directed at the AAU resulted in resolution of both the AAU and ODE, though resolution of the ODE trailed that of the AAU in all but one patient, with a range of up to 6 weeks. ODE associated with AAU did not result in optic nerve dysfunction other than an enlarged blind spot. Neuroimaging was revealing in only a single patient who had other findings suggesting a systemic process, therefore history and physical examination should guide the decision on whether to image a patient, rather than the presence of ODE, if in association with AAU.

Keywords: uveitis–clinical/animal model • optic disc • inflammation