Risk of choroidal neovascularization among the uveitides

Sally L. Baxter, Maxwell Pistilli, Siddharth S. Pujari, Teresa L. Liesegang, Eric B. Suhler, Jennifer Thorne, C. Stephen Foster, Douglas A. Jabs, Grace A. Levy-Clarke, Robert B. Nussenblatt, James T. Rosenbaum, John H. Kempen

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the risk, risk factors, and visual impact of choroidal neovascularization (CNV) in uveitis cases. Design: Retrospective cohort study. Methods: Standardized medical record review at 5 tertiary centers. Results: Among 15 137 uveitic eyes (8868 patients), CNV was rare in the cases of anterior or intermediate uveitis. Among the 4041 eyes (2307 patients) with posterior uveitis or panuveitis, 81 (2.0%) had CNV at presentation. Risk factors included posterior uveitis in general and specific uveitis syndromes affecting the outer retina-retinal pigment epithelium-choroid interface. Among the 2364 eyes (1357 patients) with posterior uveitis or panuveitis and free of CNV at the time of cohort entry, the cumulative 2-year incidence of CNV was 2.7% (95% confidence interval [CI], 1.8% to 3.5%). Risk factors for incident CNV included currently active inflammation (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.26 to 3.60), preretinal neovascularization (aHR, 3.19; 95% CI, 1.30 to 7.80), and prior diagnosis of CNV in the contralateral eye (aHR, 5.79; 95% CI, 2.77 to 12.09). Among specific syndromes, the incidence was greater in Vogt-Koyanagi-Harada syndrome (aHR, 3.37; 95% CI, 1.52 to 7.46) and punctate inner choroiditis (aHR, 8.67; 95% CI, 2.83 to 26.54). Incident CNV was associated with a 2-line loss of visual acuity (+0.19 logarithm of the minimal angle of resolution units; 95% CI, 0.079 to 0.29) from the preceding visit. Conclusions: CNV is an uncommon complication of uveitis associated with visual impairment that occurs more commonly in forms affecting the outer retina-retinal pigment epithelium-choroid interface, during periods of inflammatory activity, in association with preretinal neovascularization, and in second eyes of patients with unilateral CNV. Because CNV is treatable, a systematic approach to early detection in high-risk patients may be appropriate.

Original languageEnglish (US)
JournalAmerican Journal of Ophthalmology
Volume156
Issue number3
DOIs
StatePublished - Sep 2013

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Choroidal Neovascularization
Uveitis
Confidence Intervals
Posterior Uveitis
Panuveitis
Choroid
Retinal Pigment Epithelium
Retina
Intermediate Uveitis
Choroiditis
Uveomeningoencephalitic Syndrome
Anterior Uveitis
Vision Disorders
Incidence
Visual Acuity
Medical Records
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Baxter, S. L., Pistilli, M., Pujari, S. S., Liesegang, T. L., Suhler, E. B., Thorne, J., ... Kempen, J. H. (2013). Risk of choroidal neovascularization among the uveitides. American Journal of Ophthalmology, 156(3). https://doi.org/10.1016/j.ajo.2013.04.040

Risk of choroidal neovascularization among the uveitides. / Baxter, Sally L.; Pistilli, Maxwell; Pujari, Siddharth S.; Liesegang, Teresa L.; Suhler, Eric B.; Thorne, Jennifer; Foster, C. Stephen; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Kempen, John H.

In: American Journal of Ophthalmology, Vol. 156, No. 3, 09.2013.

Research output: Contribution to journalArticle

Baxter, SL, Pistilli, M, Pujari, SS, Liesegang, TL, Suhler, EB, Thorne, J, Foster, CS, Jabs, DA, Levy-Clarke, GA, Nussenblatt, RB, Rosenbaum, JT & Kempen, JH 2013, 'Risk of choroidal neovascularization among the uveitides', American Journal of Ophthalmology, vol. 156, no. 3. https://doi.org/10.1016/j.ajo.2013.04.040
Baxter, Sally L. ; Pistilli, Maxwell ; Pujari, Siddharth S. ; Liesegang, Teresa L. ; Suhler, Eric B. ; Thorne, Jennifer ; Foster, C. Stephen ; Jabs, Douglas A. ; Levy-Clarke, Grace A. ; Nussenblatt, Robert B. ; Rosenbaum, James T. ; Kempen, John H. / Risk of choroidal neovascularization among the uveitides. In: American Journal of Ophthalmology. 2013 ; Vol. 156, No. 3.
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abstract = "Purpose: To evaluate the risk, risk factors, and visual impact of choroidal neovascularization (CNV) in uveitis cases. Design: Retrospective cohort study. Methods: Standardized medical record review at 5 tertiary centers. Results: Among 15 137 uveitic eyes (8868 patients), CNV was rare in the cases of anterior or intermediate uveitis. Among the 4041 eyes (2307 patients) with posterior uveitis or panuveitis, 81 (2.0{\%}) had CNV at presentation. Risk factors included posterior uveitis in general and specific uveitis syndromes affecting the outer retina-retinal pigment epithelium-choroid interface. Among the 2364 eyes (1357 patients) with posterior uveitis or panuveitis and free of CNV at the time of cohort entry, the cumulative 2-year incidence of CNV was 2.7{\%} (95{\%} confidence interval [CI], 1.8{\%} to 3.5{\%}). Risk factors for incident CNV included currently active inflammation (adjusted hazard ratio [aHR], 2.13; 95{\%} CI, 1.26 to 3.60), preretinal neovascularization (aHR, 3.19; 95{\%} CI, 1.30 to 7.80), and prior diagnosis of CNV in the contralateral eye (aHR, 5.79; 95{\%} CI, 2.77 to 12.09). Among specific syndromes, the incidence was greater in Vogt-Koyanagi-Harada syndrome (aHR, 3.37; 95{\%} CI, 1.52 to 7.46) and punctate inner choroiditis (aHR, 8.67; 95{\%} CI, 2.83 to 26.54). Incident CNV was associated with a 2-line loss of visual acuity (+0.19 logarithm of the minimal angle of resolution units; 95{\%} CI, 0.079 to 0.29) from the preceding visit. Conclusions: CNV is an uncommon complication of uveitis associated with visual impairment that occurs more commonly in forms affecting the outer retina-retinal pigment epithelium-choroid interface, during periods of inflammatory activity, in association with preretinal neovascularization, and in second eyes of patients with unilateral CNV. Because CNV is treatable, a systematic approach to early detection in high-risk patients may be appropriate.",
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AU - Pistilli, Maxwell

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AU - Suhler, Eric B.

AU - Thorne, Jennifer

AU - Foster, C. Stephen

AU - Jabs, Douglas A.

AU - Levy-Clarke, Grace A.

AU - Nussenblatt, Robert B.

AU - Rosenbaum, James T.

AU - Kempen, John H.

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N2 - Purpose: To evaluate the risk, risk factors, and visual impact of choroidal neovascularization (CNV) in uveitis cases. Design: Retrospective cohort study. Methods: Standardized medical record review at 5 tertiary centers. Results: Among 15 137 uveitic eyes (8868 patients), CNV was rare in the cases of anterior or intermediate uveitis. Among the 4041 eyes (2307 patients) with posterior uveitis or panuveitis, 81 (2.0%) had CNV at presentation. Risk factors included posterior uveitis in general and specific uveitis syndromes affecting the outer retina-retinal pigment epithelium-choroid interface. Among the 2364 eyes (1357 patients) with posterior uveitis or panuveitis and free of CNV at the time of cohort entry, the cumulative 2-year incidence of CNV was 2.7% (95% confidence interval [CI], 1.8% to 3.5%). Risk factors for incident CNV included currently active inflammation (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.26 to 3.60), preretinal neovascularization (aHR, 3.19; 95% CI, 1.30 to 7.80), and prior diagnosis of CNV in the contralateral eye (aHR, 5.79; 95% CI, 2.77 to 12.09). Among specific syndromes, the incidence was greater in Vogt-Koyanagi-Harada syndrome (aHR, 3.37; 95% CI, 1.52 to 7.46) and punctate inner choroiditis (aHR, 8.67; 95% CI, 2.83 to 26.54). Incident CNV was associated with a 2-line loss of visual acuity (+0.19 logarithm of the minimal angle of resolution units; 95% CI, 0.079 to 0.29) from the preceding visit. Conclusions: CNV is an uncommon complication of uveitis associated with visual impairment that occurs more commonly in forms affecting the outer retina-retinal pigment epithelium-choroid interface, during periods of inflammatory activity, in association with preretinal neovascularization, and in second eyes of patients with unilateral CNV. Because CNV is treatable, a systematic approach to early detection in high-risk patients may be appropriate.

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