Factors Predictive of Remission of Chronic Anterior Uveitis

Abstract

Purpose : To estimate the incidence of medication-free remission of chronic anterior uveitis and to identify predictors thereof.

Methods : The Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Study is a retrospective cohort study of patients with ocular inflammatory diseases seen at 5 tertiary referral centers in the United States. Standardized chart review methods were used to identify all patients diagnosed with chronic anterior uveitis. The main outcome measure was incidence of medication-free remission. Remission was defined as inactive uveitis off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of their last visits. Estimation of remission incidence and identification of associated predictors used survival analysis.

Results : 2364 eyes were included in the study. The cumulative medication-free remission incidence within 5 years was 49.4% [95% Confidence Interval (CI), 46.9% - 52.0%]. Clinical factors at baseline that were predictive of less remission included: longer duration of uveitis prior to presentation [adjusted hazard ratio (aHR), 0.72; 95% CI, 0.56-0.92; for 2-5 years vs. less than 6 months)], presence of vitreous cells (aHR, 0.66; 95%, CI 0.49–0.89, for 1+ vs. no cell), prior cataract surgery (aHR, 0.73; 95% CI, 0.61–0.88), and prior glaucoma surgery (aHR, 0.62; 95% CI, 0.46–0.83). Time-updated clinical factors that were predictive of less remission included: keratic precipitates (aHR, 0.41; 95% CI 0.27–0.63), band keratopathy (aHR, 0.73; 95% CI, 0.57–0.93), and synechiae (aHR, 0.53; 95% CI, 0.36-0.79). Systemic diagnosis with Behçet Disease (aHR, 0.25; 95% CI, 0.08-0.80) was also associated with a lower incidence of uveitis remission.

Conclusions : Approximately half of chronic anterior uveitis cases remitted within five years. Longer duration of uveitis, higher grade of vitreous cells, prior cataract surgery, prior glaucoma surgery, presence of keratic precipitates, band keratopathy, iris synechiae, and diagnosis with Behçet Disease predict less remission; cases with these factors should be managed taking into account the higher probability of a longer disease course.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.