Incidence of Cataract in Eyes with Anterior Uveitis

Abstract

Purpose : To identify the incidence of and risk factors for cataract in eyes with anterior uveitis

Methods : Retrospective cohort study of eyes with anterior uveitis followed at five US tertiary uveitis facilities. We evaluated the incidence of cataract in patients with anterior uveitis. Cataract was defined in two ways: newly reduced visual acuity worse than 20/40 attributed to cataract; and/or incident cataract surgery. The secondary objective was to evaluate factors potentially predictive of cataract development.

Results : Among 4677 eyes (of 2993 patients) with anterior uveitis, 546 (11.7%) had primary anterior uveitis, 2312 (49.4%) recurrent anterior uveitis, and 1819 (38.9%) chronic anterior uveitis. 773 eyes (16.5%) developed cataract; 309 (6.6%) were identified due to visual acuity reduction worse than 20/40 and 464 (9.9%) based on occurrence of cataract surgery. The incidence rate for the first of these events was 3.75%/eye-year over the first 8 years of the study. Factors predictive of increased risk of cataract development included: age over 65 (adjusted hazard ratio (HR), 4.79; 95% CI, 2.95-7.77), higher grade of anterior chamber (AC) cell score at the previous visit (0.5+ vs 0, HR, 0.92; 1+ vs 0, HR, 2.54, 95% CI 1.66-3.91; ≥2+ vs 0 grade–HR, 3.10; 95% CI, 2.00-4.80), prior incisional glaucoma surgery (HR, 1.70; 95% CI, 1.03-2.80), presence of band keratopathy (HR, 2.16; 95% CI, 1.42-3.27), presence of posterior synechiae (HR, 3.43; 95% CI, 2.65-4.43), and highly elevated intraocular pressure (IOP≥30 mmHg vs. 6-20 mmHg —HR, 2.27; 95% CI, 1.18-4.37). Use of topical corticosteroids was not associated with higher cataract risk in the presence of grade 1+ or higher AC cells. In eyes with grade 0 AC cells, ≥2 drops/day (HR, 2.01, 95% CI, 1.42-2.85) but not >0 but <2 drops/day (HR, 1.31, 95% CI, 0.77-2.23) were associated with increased cataract risk. In eyes with grade 0.5+ AC cells, both ≥2 drops/day (HR, 2.29, 95% CI, 1.09-4.81) and >0 but <2 drops/day (HR, 2.89, 95% CI: 1.06-7.86) were associated with increased cataract risk.

Conclusions : Cataract occurred in 3.75%/eye-year within the first 8 years of observation. Cataract risk factors include advanced age, high anterior chamber cell grade, prior incisional glaucoma surgery, presence of band keratopathy, presence of posterior synechiae, and IOP≥30 mmHg. Topical corticosteroids were associated with increased cataract risk only when anterior chamber cells were absent or minimally present.

This is a 2020 ARVO Annual Meeting abstract.