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Jie Gao, Marina Peskina, Marisa Walsh, Peter Chang, Stephen D Anesi, Charles S Foster; Retinal Vasculitis in HLA-B27 Associated Anterior Uveitis on Wide-Field Anigiography. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4079.
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© ARVO (1962-2015); The Authors (2016-present)
HLA-B27 associated uveitis is primarily thought to be an anterior segment uveitis. We performed a retrospective, observational study to review the incidence of retinal vasculitis on widefield fluorescein angiography (WF-FA) in our HLA-B27 anterior uveitis patient population at the Massachusetts Eye Research and Surgery Institute (MERSI).
Our database was searched for patients with the diagnosis of HLA-B27 associated uveitis. Inclusion criteria included a clinical diagnosis of unilateral anterior uveitis, HLA-B27 positive serology testing, and that the patient performed at least one WF-FA. Paitents with other identifiable causes of uveitis were excluded. 27 patients were found and their WF-FAs were examined to look for retinal vasculitis defined as: 1). Far-peripheral (FP) vasculitis involving vessels from the vortex veins out to the ora serrata. 2). Mid-peripheral (MP) vasculitis involving vessels beyond the main arcade vessels extending to the vortex veins. 3). Posterior-pole vasculitis (PP) involving any of the main arcade vessels.
7 of 27 patients (26%) show evidence of active retinal vasculitis on WF-FA. 1 of 7 patient (14%) had PP vasculitis occurring during an active anterior chamber (AC) flare-up. 2 of 7 patients (29%) had MP vasculitis despite no AC inflammation. 4 of 7 patients (57%) had FP vasculitis. Of the 4 patients with FP vasculitis, only 1 of them showing signs of active AC inflammation at time of examination, and this patient showed bilateral FF vasculitis despite the fellow eye showing no signs of AC inflammation. Another 1 of the 4 patients showed bilateral FP vasculitis despite both eyes showing no signs of AC inflammation.9 total eyes showed retinal vasculitis. 3 of 9 eyes (33%) showed retinal vasculitis during episodes of active AC inflammation. 1 of the previous 3 eyes eventually had resolution of vasculitis with treatment. 6 of 9 eyes (67%) showed retinal vasculitis despite no active AC inflammation at time of clinical exam. 1 of the previous 6 showed resolution of vasculitis on treatment. Another 1 of the previous 6 developed vasculitis when treatment was temporarily stopped.
We concluded that retinal vasculitis is an under reported complication of HLA-B27 associated anterior uveitis. What is more striking is the fact that the majority of eyes that exhibited retinal vasculitis did not have active anterior chamber inflammation at the time of the exam.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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