Potential Predictors of Poor Visual Outcome in Human Leukocyte Antigen-B27-Associated Uveitis

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• 作者：Fleurieke H. Verhagen^a ; ^b ; ^{F.H.Verhagen@umcutrecht.nl" class="auth_mail" title="E-mail the corresponding author} ; Anna H. Brouwer^a ; Jonas J.W. Kuiper^a ; ^b ; Jeannette Ossewaarde-van Norel^a ; Ninette H. ten Dam-van Loon^a ; Joke H. de Boer^a
• 刊名：American Journal of Ophthalmology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：165
• 期：Complete
• 页码：179-187
• 全文大小：305 K

文摘

To identify potential predictors of permanent vision loss in patients with human leukocyte antigen (HLA)-B27-associated uveitis in a tertiary referral center.

Design

Retrospective case-control study.

Methods

The charts of 212 patients (338 eyes) with HLA-B27-associated uveitis that visited the University Medical Center Utrecht with a follow-up of at least 6 months were retrospectively studied. Clinical features at presentation and during follow-up were compared to final visual outcome in quiescent state. Eyes with (sub-) normal vision (>20/50) were compared with visually impaired (≤20/50) and blind (≤5/50, or a visual field of <10 degrees) eyes, using survival analysis. A multivariate Cox proportional hazards analysis was performed to analyze potential predictors for permanent vision loss.

Results

Median follow-up was 10.4 years (range, 0.5–44.7 years). During follow-up 226 eyes (66%) experienced vision loss up to 20/50, but most recovered. Twenty patients (9%) became permanently visually impaired or blind in at least 1 eye because of uveitis, after a median of 9.7 years (range, 0–20.9 years). The main cause was secondary glaucoma or related to glaucoma surgery (12/22 eyes, 55%). Survival analysis showed, after adjustment for age and sex, an ocular pressure of >21 mm Hg, hypotony, and panuveitis to be potential predictors at presentation, and the development of secondary glaucoma or hypotony to be predictors of blindness or visual impairment during follow-up.

Conclusions

The long-term visual prognosis of HLA-B27-associated uveitis is relatively good, but the true incidence of permanent vision loss is probably still underestimated. Our findings highlight the importance of proper control of intraocular pressure.