Abstract
Purpose :
Cataract is a leading cause of visual impairment related to uveitis. The time to development of cataract following use of topical CS is not well characterized. Based on prior time-updated analyses, both the degree of anterior uveitis activity and the use of topical CS (given to treat uveitis activity) contribute to cataract incidence and are best modeled by an effect modification approach. We hypothesized that the time of greatest risk of cataract following use of topical CS could be identified using latency modeling.
Methods :
Eyes with anterior uveitis were followed over time for cataract in a parent retrospective cohort study. In addition to uveitis activity and topical corticosteroid use at each visit, other covariates predictive of cataract incidence in this dataset (treated as nuisance variables for this analysis) were available. We modeled the latency of incidence of cataract in relationship to these and other predictive factors, during 1-90, 91-180, 181-270, and 271-365 days following covariate observations using a Cox model with time-updated covariates with the eye as the unit of analysis.
Results :
With both low (grade 0.5+ or less) and higher (grade 1+ or more) levels of anterior chamber inflammation, a dose response relationship of topical corticosteroid dose and the incidence of cataract was seen (see Table). The highest risk, and only category that was statistically significantly elevated, was at doses equivalent to two drops per day of prednisolone acetate 1% or more. The effect of topical corticosteroids was larger when anterior chamber inflammation was grade 0.5+ or less (minimally active or inactive) than when it was 1+ or more (active). The effect was similar across all approximate three month intervals (lags) after the treatment that were studied.
Conclusions :
The results suggest that the incidence of cataract following use of higher doses of topical corticosteroids is increased over all three month period up to one year of follow-up, with no clear period of maximum lagged effect. The effect of topical corticosteroids is less when uveitis is active, probably because the treatment partially mitigates the cataractogenic effect of uveitis activity itself.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.