Caroline L Minkus1, Maxwell Pistilli2, Kurt A Dreger3, Tonetta D Fitzgerald2, Abhishek R Payal4, Hosne Begum5, R Oktay Kaçmaz6, Douglas A Jabs7, Robert B Nussenblatt8, James T Rosenbaum9, Grace A Levy-Clarke10, H Nida Sen8, Eric B Suhler11, Jennifer E Thorne7, Nirali P Bhatt2, C Stephen Foster12, Jeanine M Buchanich13, John H Kempen14. 1. From the Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. 2. Department of Ophthalmology, the Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Population, Family, and Reproductive Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, the Johns Hopkins School of Medicine, Baltimore, Maryland. 4. Department of Ophthalmology, the Johns Hopkins School of Medicine, Baltimore, Maryland; Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts. 5. Department of Ophthalmology, the Johns Hopkins School of Medicine, Baltimore, Maryland. 6. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom. 7. Department of Ophthalmology, the Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 8. Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland. 9. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 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. 10. Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland; The Tampa Bay Uveitis Center, St. Petersburg, Florida. 11. Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon. 12. Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts;; Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts. 13. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 14. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts;; Department of Ophthalmology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; MCM Eye Unit, MyungSung Christian Medical Center (MCM General Hospital) and MyungSung Medical School, Addis Ababa, Ethiopia. Electronic address: John_kempen@meei.harvard.edu.
Abstract
PURPOSE: To determine the incidence of and predictive factors for cataract in intermediate uveitis. DESIGN: Retrospective cohort study. METHODS: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status. RESULTS: Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk. CONCLUSIONS: Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.
PURPOSE: To determine the incidence of and predictive factors for cataract in intermediate uveitis. DESIGN: Retrospective cohort study. METHODS: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status. RESULTS: Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk. CONCLUSIONS: Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.
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