Deepika N Shah1, Ahmad Al-Moujahed2, Craig W Newcomb3, R Oktay Kaçmaz4, Ebenezer Daniel5, Jennifer E Thorne6, C Stephen Foster7, Douglas A Jabs6, Grace A Levy-Clarke8, Robert B Nussenblatt9, James T Rosenbaum10, H Nida Sen8, Eric B Suhler11, Nirali P Bhatt12, John H Kempen13. 1. Eye Doctors of Washington, Washington, DC; Department of Ophthalmology, Georgetown University, Washington, DC. 2. Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA. 3. Department of Biostatistics & Epidemiology/Center for Clinical Epidemiology & Biostatistics, Perelman School of Medicine, Philadelphia, PA. 4. Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Mallinckrodt Pharmaceuticals, Bedminster, New Jersey. 5. Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, Philadelphia, PA. 6. The Wilmer Eye Institute, the Departments of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Center for Clinical Trials and Evidence Synthesis, the Department of Epidemiology, the Johns Hopkins UniversityBloomberg School of Public Health, Baltimore, Maryland. 7. Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. 8. Laboratory of Immunology, National Eye Institute, Bethesda, Maryland. 9. Laboratory of Immunology, National Eye Institute, Bethesda, Maryland. Electronic address: john_kempen@meei.harvard.edu. 10. Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Legacy Devers Eye Institute, Portland, Oregon. 11. Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon. 12. Department of Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania. 13. Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia.
Abstract
PURPOSE: To evaluate the risk/risk factors for exudative retinal detachment (ERD) in ocular inflammatory diseases. DESIGN: Retrospective cohort study. METHODS: Patients with non-infectious ocular inflammation had been followed longitudinally between 1978-2007 at four US subspecialty uveitis centers. The main outcome measures were ERD occurrence and its predictive factors. RESULTS: One hundred seventy-six of 14,612 eyes with ocular inflammation presented with ERD. Among uveitis cases, Vogt-Koyanagi-Harada syndrome (VKH) (OR=109), undifferentiated choroiditis (OR=9.18), sympathetic ophthalmia (OR=8.43), primary or secondary panuveitis (OR=7.09), multifocal choroiditis with panuveitis (OR=4.51), and "other" forms of posterior uveitis (OR=16.9) were associated with a higher prevalence of ERD. Among the 9,209 uveitic or scleritic eyes initially free of ERD and followed-up, 137 incident ERD cases were observed over 28,949 eye-years at risk (incidence rate=0.47% (0.40%-0.56%)/eye-year). VKH (HR=13.2), sympathetic ophthalmia (HR=5.82), undifferentiated choroiditis (HR=6.03), primary or secondary panuveitis (HR=4.21), and rheumatoid arthritis (HR=3.30) were significantly associated with incident ERD. A significant dose-response relationship with ERD prevalence and incidence was observed for anterior chamber cells and vitreous cell activity. African Americans had significantly higher prevalence and incidence of ERD. CONCLUSIONS: Other ocular inflammatory conditions besides VKH and posterior scleritis were associated with increased ERD risk, indicating that ERD does not necessarily dictate a diagnosis of VKH or posterior scleritis. In addition, the relationship of ERD with inflammatory severity factors implies that inflammation is a key predictive factor that is associated with developing ERD and requires early and vigorous control.
PURPOSE: To evaluate the risk/risk factors for exudative retinal detachment (ERD) in ocular inflammatory diseases. DESIGN: Retrospective cohort study. METHODS:Patients with non-infectious ocular inflammation had been followed longitudinally between 1978-2007 at four US subspecialty uveitis centers. The main outcome measures were ERD occurrence and its predictive factors. RESULTS: One hundred seventy-six of 14,612 eyes with ocular inflammation presented with ERD. Among uveitis cases, Vogt-Koyanagi-Harada syndrome (VKH) (OR=109), undifferentiated choroiditis (OR=9.18), sympathetic ophthalmia (OR=8.43), primary or secondary panuveitis (OR=7.09), multifocal choroiditis with panuveitis (OR=4.51), and "other" forms of posterior uveitis (OR=16.9) were associated with a higher prevalence of ERD. Among the 9,209 uveitic or scleritic eyes initially free of ERD and followed-up, 137 incident ERD cases were observed over 28,949 eye-years at risk (incidence rate=0.47% (0.40%-0.56%)/eye-year). VKH (HR=13.2), sympathetic ophthalmia (HR=5.82), undifferentiated choroiditis (HR=6.03), primary or secondary panuveitis (HR=4.21), and rheumatoid arthritis (HR=3.30) were significantly associated with incident ERD. A significant dose-response relationship with ERD prevalence and incidence was observed for anterior chamber cells and vitreous cell activity. African Americans had significantly higher prevalence and incidence of ERD. CONCLUSIONS: Other ocular inflammatory conditions besides VKH and posterior scleritis were associated with increased ERD risk, indicating that ERD does not necessarily dictate a diagnosis of VKH or posterior scleritis. In addition, the relationship of ERD with inflammatory severity factors implies that inflammation is a key predictive factor that is associated with developing ERD and requires early and vigorous control.