Risk of Retinal Neovascularization in Cases of Uveitis.
Publication/Presentation Date
3-1-2016
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.
Volume
123
Issue
3
First Page
646
Last Page
654
ISSN
1549-4713
Published In/Presented At
Patel, A. K., Newcomb, C. W., Liesegang, T. L., Pujari, S. S., Suhler, E. B., Thorne, J. E., Foster, C. S., Jabs, D. A., Levy-Clarke, G. A., Nussenblatt, R. B., Rosenbaum, J. T., Sen, H. N., Artornsombudh, P., Kothari, S., Kempen, J. H., & Systemic Immunosuppressive Therapy for Eye Diseases Research Group (2016). Risk of Retinal Neovascularization in Cases of Uveitis. Ophthalmology, 123(3), 646–654. https://doi.org/10.1016/j.ophtha.2015.10.056
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
26686964
Department(s)
Administration and Leadership
Document Type
Article