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Recurrent and Chronic Anterior Uveitis. Clinical Characteristics and Long-term Outcome
Yael Sharon,1,4 Lee Goren,1 Edward Barayev,1 Ron Neumann,3 David S. Chu,4,5 Michal Kramer,1,2
1. Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital,
Petach Tikva, Israel
2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3. Maccabi Health Care Services, Tel Aviv, Israel
4. Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey, USA
5. Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
Purpose: To study the long-term clinical outcome and treatment strategies of recurrent and chronic non-infectious anterior uveitis to better ascertain the common notion that anterior uveitis is a benign condition that is easily taken care with topical steroids and does not represent a medical challenge
Methods: Retrospective study of recurrent and chronic anterior uveitis patients in three tertiary medical centers from 2001 to 2020. Patient- and disease-related data was retrieved. Infectious etiologies, Fuchs’ heterochromic uveitis and pediatric patients were excluded. Outcome measures included ocular complications, medical and surgical therapies, number of uveitis attacks and best corrected visual acuity (BCVA) measured at the beginning of follow-up, and at 1,2 and 5-years thereafter.
Results: Included were 76 patients (125 eyes), 32 males and 44 females, with a mean follow-up of 6.8 years. Idiopathic anterior uveitis was the most common etiology (57%), followed by HLA-B27-associated uveitis (37%). Recurrent anterior uveitis was diagnosed in 51% of patients and the rest (49%) had chronic anterior uveitis. Immunomodulatory agents (IMAs) were used in almost half of the cohort (37 patients). Ocular complications included cataract, posterior synechiae, glaucoma and cystoid macular edema. Ocular surgeries performed during follow up included cataract surgery in 41eyes, and trabeculectomy in 14eyes. Early initiation of IMAs was associated with a lower risk of developing glaucoma (P=0.019). Mean BCVA improved after 5 years of follow-up in both groups (recurrent and chronic uveitis). Median time to initiation of IMAs was 24 months. Early use of IMAs also correlated with a better visual outcome at 2 years (P=0.024).
Conclusions: Chronic and recurrent anterior uveitis are associated with increased risk for ocular complications, the need for ocular surgeries and vision impairment. Early initiation of IMAs may be considered to improve clinical outcome. The authors believe these data reassure that recurrent acute and chronic anterior uveitis pose a medical challenge that cannot be handled with topical steroids alone.