TY - JOUR
T1 - Factors Predictive of Remission of Chronic Anterior Uveitis
AU - Sobrin, Lucia
AU - Pistilli, Maxwell
AU - Dreger, Kurt
AU - Kothari, Srishti
AU - Khachatryan, Naira
AU - Artornsombudh, Pichaporn
AU - Pujari, Siddharth S.
AU - Foster, C. Stephen
AU - Jabs, Douglas A.
AU - Nussenblatt, Robert B.
AU - Rosenbaum, James T.
AU - Levy-Clarke, Grace A.
AU - Sen, H. Nida
AU - Suhler, Eric B.
AU - Thorne, Jennifer E.
AU - Bhatt, Nirali P.
AU - Kempen, John H.
N1 - Publisher Copyright:
© 2019 American Academy of Ophthalmology
PY - 2020/6
Y1 - 2020/6
N2 - Purpose: To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. Design: Retrospective cohort study. Participants: Patients diagnosed with anterior uveitis of longer than 3 months’ duration followed up at United States tertiary uveitis care facilities. Methods: Estimation of remission incidence and identification of associated predictors used survival analysis. Main Outcome Measures: Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. Results: Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% (95% confidence interval [CI], 30.4%–35.2%). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95% CI, 0.44–0.83), bilateral uveitis (aHR, 0.75; 95% CI, 0.59–0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56–0.88), and glaucoma surgery (aHR, 0.63; 95% CI, 0.45–0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95% CI, 0.21–0.60) and synechiae (aHR, 0.62; 95% CI, 0.41–0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95% CI, 1.02–1.63). Conclusions: Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.
AB - Purpose: To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. Design: Retrospective cohort study. Participants: Patients diagnosed with anterior uveitis of longer than 3 months’ duration followed up at United States tertiary uveitis care facilities. Methods: Estimation of remission incidence and identification of associated predictors used survival analysis. Main Outcome Measures: Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. Results: Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% (95% confidence interval [CI], 30.4%–35.2%). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95% CI, 0.44–0.83), bilateral uveitis (aHR, 0.75; 95% CI, 0.59–0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56–0.88), and glaucoma surgery (aHR, 0.63; 95% CI, 0.45–0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95% CI, 0.21–0.60) and synechiae (aHR, 0.62; 95% CI, 0.41–0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95% CI, 1.02–1.63). Conclusions: Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.
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U2 - 10.1016/j.ophtha.2019.11.020
DO - 10.1016/j.ophtha.2019.11.020
M3 - Article
C2 - 31932091
AN - SCOPUS:85077704614
SN - 0161-6420
VL - 127
SP - 826
EP - 834
JO - Ophthalmology
JF - Ophthalmology
IS - 6
ER -