Factors Predictive of Remission of New-Onset Anterior Uveitis

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• 作者：Pichaporn Artornsombudh ; MD¹ ; ² ; Maxwell Pistilli ; MS² ; C. Stephen Foster ; MD¹ ; ³ ; Siddharth S. Pujari ; MBBS ; MS¹ ; ⁴ ; Sapna S. Gangaputra ; MD ; MPH⁵ ; ⁶ ; Douglas A. Jabs ; MD ; MBA⁷ ; ⁸ ; ⁹ ; Grace A. Levy-Clarke ; MD¹⁰ ; Robert B. Nussenblatt ; MD ; MPH¹⁰ ; James T. Rosenbaum ; MD¹¹ ; ¹² ; Eric B. Suhler ; MD ; MPH¹¹ ; ¹³ ; Jennifer E. Thorne ; MD ; PhD⁹ ; ¹⁴ ; John H. Kempen ; MD ; PhD² ; ¹⁵ ; ¹⁶ ; ^{john.kempen@uphs.upenn.edu" class="auth_mail}
• 刊名：Ophthalmology
• 出版年：March, 2014
• 年：2014
• 卷：121
• 期：3
• 页码：778-784
• 全文大小：359 K

文摘

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Purpose

To identify factors predictive of remission of inflammation in new-onset anterior uveitis cases treated at tertiary uveitis care facilities.

Design

Retrospective cohort study.

Participants

Patients seeking treatment at participating academic uveitis clinics within 90 days of initial diagnosis of anterior uveitis.

Methods

Retrospective cohort study based on standardized chart review.

Main Outcome Measures

Factors predictive of remission (no disease activity without corticosteroid or immunosuppressive treatments at all visits during a 90-day period).

Results

Nine hundred ninety eyes (687 patients) had a first-ever diagnosis of anterior uveitis within 90 days before initial presentation and had follow-up visits thereafter. The median follow-up time was 160 days. Systemic diagnoses with juvenile idiopathic arthritis (JIA; adjusted hazard ratio [aHR], 0.38; 95% confidence interval [CI], 0.19-0.74) and Beh莽et's disease (aHR, 0.10; 95% CI, 0.01-0.85) were associated with a lower incidence of uveitis remission. Cases of bilateral uveitis (aHR, 0.68; 95% CI, 0.54-0.87) and those with a history of cataract surgery before presentation (aHR, 0.51; 95% CI, 0.29-0.87) also had a lower incidence of remission. Regarding clinical findings at the initial visit, a high degree of vitreous cells at initial presentation was associated with a lower incidence of remission (for 1+ or more vs. none: aHR, 0.72; 95% CI, 0.55-0.95). An initial visual acuity of 20/200 or worse, with respect to 20/40 or better, also was predictive of a lower incidence of remission (aHR, 0.52; 95% CI, 0.32-0.86).

Conclusions

Factors associated with a lower incidence of remission among new-onset anterior uveitis cases included diagnosis with JIA, Beh莽et's disease, bilateral uveitis, history of cataract surgery, findings of 1+ or more vitreous cells at presentation, and an initial visual acuity of 20/200 or worse. Patients with these risk factors seem to be at higher risk of persistent inflammation; reciprocally, patients lacking these factors would be more likely to experience remission. Patients with risk factors for nonremission of uveitis should be managed taking into account the higher probability of a chronic inflammatory course.