Incidence of and Risk Factors for Cataract in Anterior Uveitis

Abstract

Purpose : To estimate the incidence and risk factors for cataract in anterior uveitis

Methods : Data were harvested by trained expert reviewers using protocol-driven chart review. Cataract incidence—newly reduced visual acuity worse than 20/40 attributed to cataract or incident cataract surgery—was studied in 4105 eyes of 2645 patients with anterior uveitis.

Results : Cataract developed in 558 eyes (13.6%, 0.043/eye-year). Time-updated risk factors associated with cataract included: older age (over 65 vs. <18 years: adjusted hazard ratio (aHR)=4.79; 95%CI, 2.95- 7.77); higher anterior chamber cell grade (P(trend)=0.0006), prior incisional glaucoma surgery (aHR=1.70; 95%CI, 1.03-2.80), band keratopathy (aHR=2.16; 95%CI, 1.42-3.27), posterior synechiae (aHR=3.43; 95%CI, 2.65-4.43), elevated intraocular pressure (IOP)≥30 vs 6-20 mmHg: aHR=2.27; 95%CI, 1.18-4.37). Higher dose topical corticosteroid use (≥2 drops/day) was associated with 2-to 3-fold higher cataract risk in eyes with anterior chamber cell grades of 0 or 0.5+, but was not associated with higher cataract risk in the presence of ≥grade 1+ anterior chamber cells. Primary (aHR=0.61; 95%CI, 0.32-1.14) and recurrent (aHR=0.72; 95%CI, 0.55-0.94) had lower cataract risk than chronic anterior uveitis.

Conclusions : Cataract complicates a large minority of anterior uveitis cases. Several fixed and modifiable risk factors were identified and a point system developed to guide cataract risk minimization. Topical corticosteroids only were associated with increased cataract risk when anterior chamber cells were absent or minimally present, suggesting their use to treat active inflammation (which itself is cataractogenic) does not cause a net increase in cataract incidence.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.