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W. Lim, S. Chee; HLA B27+ve vs HLA B27-ve Acute Anterior Uveitis - Is There a Difference? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2383.
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Purpose: To report the clinical presentation, response to therapy, relapse rate and complications between the HLA B27 +ve and HLA B27-ve acute anterior uveitis (AAU) Methods: A review of the clinical case records of 304 consecutive AAU patients referred to the uveitis clinic in Singapore National Eye Centre from Jan 1997 to Dec 2001. The age, racial distribution, gender, clinical presentation, slit-lamp findings, type of therapy received and response, recurrences, ocular complications, and the final visual outcome were studied. Results: The mean age of the cohort was 39.3 years (SD 10.5, range 14 -70). The racial distribution reflected Singapore national racial distribution with 78.2% Chinese, 11.6% Malay, 8.8% Indians and 1.3% others. There were 40.1% female and 59.9% males. There was no difference between both HLA B27 +ve and HLA b27-ve group in age of presentation and gender. However, there was a significantly higher proportion of Chinese with HLA B27+ve AAU (86.9 %) as compared to Malay (35.3%)and Indian (46.2%). Over 2/3 of both cohort presented had eye redness, blurring of vision and ocular pain. HLA B27 +ve cohort had significantly more severe iridocyclitis at presentation with higher proportions with posterior synechiae (68% vs 41%), hypopyon (27% vs 6%) and fibrin in AC (59% vs 18%) compared to HLA B27-ve cohort. HLA B27+ve cohort took longer to achieve quiescence (mean 42.5 days vs 33.7 days, p< 0.49) while on intensive topical steroids therapy. The mean number of recurrences in the HLA B27+ve and HLA B27-ve cohort group were 2.57 and 1.65 respectively (p<0.0149). The annualized recurrence rates for B27+ve and B27 -ve cohorts were 1.02 and 0.81 recurrences per year respectively. 28.3 % of the HLA B27+ve cohort and 14.7% of HLA B27-ve cohort was associated with systemic disease. Of which, more than half was diagnosed after the onset of uveitis. With the exception of glaucoma, there was no statistic difference when comparing ocular complications between the 2 cohorts. The glaucoma prevalence was 20% in the HLA B27-ve cohort and 6% in the B27+ve cohort. 4.4% and 8.8% of HLA B27 +ve and HLA B27-ve cohort respectively had a final visual acuity of 20/50 or worse with the main causes being glaucoma, cataract, and macular edema. Conclusion: HLA B27+ve was more prevalent among Chinese AAU patients and was associated with more severe AC inflammation. Despite increased risk of recurrences, longer duration for remission and more severe presentation, the visual prognosis remained good with no increase risk of ocular complications and poor visual outcome.
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