Apurva K Patel1, Craig W Newcomb2, Teresa L Liesegang3, Siddharth S Pujari4, Eric B Suhler5, Jennifer E Thorne6, C Stephen Foster7, Douglas A Jabs8, Grace A Levy-Clarke9, Robert B Nussenblatt10, James T Rosenbaum11, H Nida Sen10, Pichaporn Artornsombudh12, Srishti Kothari13, John H Kempen14. 1. Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Retina Northwest P.C., Portland, Oregon. 2. Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania. 3. Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon. 4. Om Eye Care Hospital, Belgaum, Karnataka, India; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts. 5. Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon. 6. Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 7. Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ophthalmology, Harvard Medical School, Boston, Massachusetts. 8. Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 9. Devers Eye Institute, Portland, Oregon; The Tampa Bay Uveitis Center, Safety Harbor, Florida. 10. Laboratory of Immunology, National Eye Institute/National Institutes of Health, Bethesda, Maryland. 11. Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Internal Medicine, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Devers Eye Institute, Portland, Oregon. 12. Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Division of Ophthalmology Somdech Phra Pinklao Hospital, Naval Medical Department, Royal Thai Navy, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 13. Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts. 14. Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Ocular Inflammation Service University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu.
Abstract
PURPOSE: To evaluate the risk of and risk factors for retinal neovascularization (NV) in cases of uveitis. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with uveitis at 4 US academic ocular inflammation subspecialty practices. METHODS: Data were ascertained by standardized chart review. Prevalence data analysis used logistic regression. Incidence data analysis used survival analysis with time-updated covariates where appropriate. MAIN OUTCOME MEASURES: Prevalence and incidence of NV. RESULTS: Among uveitic eyes of 8931 patients presenting for initial evaluation, 106 of 13,810 eyes had NV (prevalence = 0.77%, 95% confidence interval [CI], 0.60-0.90). Eighty-eight more eyes developed NV over 26,465 eye-years (incidence, 0.33%/eye-year; 95% CI, 0.27-0.41). Factors associated with incident NV include age <35 years compared with >35 years (adjusted hazard ratio [aHR], 2.4; 95% CI, 1.5-3.9), current cigarette smoking (aHR, 1.9; 95% CI, 1.1-3.4), and systemic lupus erythematosus (aHR, 3.5, 95% CI, 1.1-11). Recent diagnosis of uveitis was associated with an increased incidence of NV (compared with patients diagnosed >5 years ago, aHR, 2.4 [95% CI, 1.1-5.0] and aHR, 2.6 [95% CI, 1.2-6.0] for diagnosis within <1 year vs. 1-5 years, respectively). Compared with anterior uveitis, intermediate uveitis (aHR, 3.1; 95% CI, 1.5-6.6), posterior uveitis (aHR, 5.2; 95% CI, 2.5-11), and panuveitis (aHR, 4.3; 95% CI, 2.0-9.3) were associated with a similar degree of increased NV incidence. Active (aHR, 2.1, 95% CI, 1.2-3.7) and slightly active (aHR, 2.4, 95% CI, 1.3-4.4) inflammation were associated with an increased incidence of NV compared with inactive inflammation. Neovascularization incidence also was increased with retinal vascular occlusions (aHR, 10, 95% CI, 3.0-33), retinal vascular sheathing (aHR, 2.6, 95% CI, 1.4-4.9), and exudative retinal detachment (aHR, 4.1, 95% CI, 1.3-13). Diabetes mellitus was associated with a somewhat increased incidence of retinal NV (aHR, 2.3, 95% CI, 1.1-4.9), and systemic hypertension (aHR 1.5, 95% CI, 0.89-2.4) was associated with nonsignificantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus. CONCLUSIONS: Retinal NV is a rare complication of uveitis, which occurs more frequently in younger patients, smokers, and those with intermediate/posterior/panuveitis, systemic vasculopathy, retinal vascular disease, or active inflammation. Inflammation and retinal NV likely are linked; additional studies are needed to further elucidate this connection.
PURPOSE: To evaluate the risk of and risk factors for retinal neovascularization (NV) in cases of uveitis. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with uveitis at 4 US academic ocular inflammation subspecialty practices. METHODS: Data were ascertained by standardized chart review. Prevalence data analysis used logistic regression. Incidence data analysis used survival analysis with time-updated covariates where appropriate. MAIN OUTCOME MEASURES: Prevalence and incidence of NV. RESULTS: Among uveitic eyes of 8931 patients presenting for initial evaluation, 106 of 13,810 eyes had NV (prevalence = 0.77%, 95% confidence interval [CI], 0.60-0.90). Eighty-eight more eyes developed NV over 26,465 eye-years (incidence, 0.33%/eye-year; 95% CI, 0.27-0.41). Factors associated with incident NV include age <35 years compared with >35 years (adjusted hazard ratio [aHR], 2.4; 95% CI, 1.5-3.9), current cigarette smoking (aHR, 1.9; 95% CI, 1.1-3.4), and systemic lupus erythematosus (aHR, 3.5, 95% CI, 1.1-11). Recent diagnosis of uveitis was associated with an increased incidence of NV (compared with patients diagnosed >5 years ago, aHR, 2.4 [95% CI, 1.1-5.0] and aHR, 2.6 [95% CI, 1.2-6.0] for diagnosis within <1 year vs. 1-5 years, respectively). Compared with anterior uveitis, intermediate uveitis (aHR, 3.1; 95% CI, 1.5-6.6), posterior uveitis (aHR, 5.2; 95% CI, 2.5-11), and panuveitis (aHR, 4.3; 95% CI, 2.0-9.3) were associated with a similar degree of increased NV incidence. Active (aHR, 2.1, 95% CI, 1.2-3.7) and slightly active (aHR, 2.4, 95% CI, 1.3-4.4) inflammation were associated with an increased incidence of NV compared with inactive inflammation. Neovascularization incidence also was increased with retinal vascular occlusions (aHR, 10, 95% CI, 3.0-33), retinal vascular sheathing (aHR, 2.6, 95% CI, 1.4-4.9), and exudative retinal detachment (aHR, 4.1, 95% CI, 1.3-13). Diabetes mellitus was associated with a somewhat increased incidence of retinal NV (aHR, 2.3, 95% CI, 1.1-4.9), and systemic hypertension (aHR 1.5, 95% CI, 0.89-2.4) was associated with nonsignificantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus. CONCLUSIONS:Retinal NV is a rare complication of uveitis, which occurs more frequently in younger patients, smokers, and those with intermediate/posterior/panuveitis, systemic vasculopathy, retinal vascular disease, or active inflammation. Inflammation and retinal NV likely are linked; additional studies are needed to further elucidate this connection.
Authors: John H Kempen; Ebenezer Daniel; Sapna Gangaputra; Kurt Dreger; Douglas A Jabs; R Oktay Kaçmaz; Siddharth S Pujari; Fahd Anzaar; C Stephen Foster; Kathy J Helzlsouer; Grace A Levy-Clarke; Robert B Nussenblatt; Teresa Liesegang; James T Rosenbaum; Eric B Suhler Journal: Ophthalmic Epidemiol Date: 2008 Jan-Feb Impact factor: 1.648
Authors: J C Khan; D A Thurlby; H Shahid; D G Clayton; J R W Yates; M Bradley; A T Moore; A C Bird Journal: Br J Ophthalmol Date: 2006-01 Impact factor: 4.638