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Delayed Acceleration of Acute Flare Severity in Patients with HLA-B27 Associated Anterior Uveitis
Jordan Ueberroth, MD
Jordan A Ueberroth,1,2 Karen W. Small,1,2 Marina Peskina,1,2 Peter Y. Chang,1,2 C. Stephen Foster,1,2,3 Stephen D. Anesi 1,2
1. Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, MA, USA
2. Ocular Immunology and Uveitis Foundation (OIUF), Waltham, MA, USA
3. Harvard Medical School, Boston, MA, USA
Purpose: The HLA-B27 allele and its associated systemic illnesses are the most commonly identified etiology implicated in the development of acute anterior uveitis. The clinical presentation and severity of an HLA-B27 associated anterior uveitis flare varies widely and treatment with topical corticosteroids is titrated according to the flare severity. This study describes a novel phenomenon whereby mild acute anterior uveitis flares in HLA-B27 patients become more severe despite treatment with topical steroids.
Methods: This a retrospective observational study. Data were obtained using standardized chart review of all patients treated at the Massachusetts Eye Research and Surgery Institution (MERSI) between January 1, 2005 and January 1, 2019 who were HLA-B27 positive and developed acute anterior uveitis. Patients were excluded if they were diagnosed with any other significant ocular inflammatory condition. The primary outcome measure was the percentage of patients who demonstrated worsening of anterior chamber inflammation on immediate follow-up after the initial flare presentation despite treatment with topical steroids.
Results: A total of 131 acute anterior uveitis flares in 81 eyes of 81 HLA-B27 positive patients were included in the study. Of the 131 uveitis flares, 34 flares (25.95%) in 29 eyes of 29 patients (35.80%) demonstrated worsening anterior chamber inflammation on subsequent follow-up despite treatment with topical steroids. Nine patients with accelerated flare severity were women and twenty patients were men; the average age of patients with accelerated flare severity was 46.4 years. The acceleration of severity of the anterior uveitis flare occurred 7.08 +/- 3.79 days after initial presentation of the flare.
Conclusions: This study describes a unique phenomenon among patients with HLA-B27 associated acute anterior uveitis whereby an initial mild flare worsens in severity despite treatment with topical steroids. Delayed acceleration of uveitis flare severity among patients who are HLA-B27 positive may justify more aggressive treatment of mild disease flares in this population.