Department of Ophthalmology, The University of Pennsylvania, The Ocular Inflammation Service and Center for Preventive Ophthalmology and Biostatistics, Philadelphia, Pennsylvania, USA.
Ophthalmology. 2010 Feb;117(2):366-72. doi: 10.1016/j.ophtha.2009.07.025. Epub 2009 Dec 14.
To evaluate the risk of and risk factors for hypopyon among patients with uveitis and to evaluate the risk of visual changes and complications after hypopyon.
Retrospective cohort study.
Patients with uveitis at 4 academic ocular inflammation subspecialty practices.
Data were ascertained by standardized chart review.
Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and ocular complications after hypopyon.
Among 4911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2885 initially free of hypopyon were followed over 9451 person-years, during which 81 patients (2.8%) developed hypopyon (8.57/1000 person-years). Risk factors for incident hypopyon included Behçet's disease (adjusted relative risk [RR]=5.30; 95% confidence interval [CI], 2.76-10.2), spondyloarthropathy (adjusted RR=2.86; 95% CI, 1.48-5.52), and human leukocyte antigen (HLA)-B27 positivity (adjusted RR=2.04; 95% CI, 1.17-3.56). Patients with both a spondyloarthropathy and HLA-B27 had a higher risk than either factor alone (crude RR=4.39; 95% CI, 2.26-8.51). Diagnosis of intermediate uveitis (+/- anterior uveitis) was associated with a lower risk of hypopyon (with respect to anterior uveitis only, adjusted RR=0.35; 95% CI, 0.15-0.85). Hypopyon incidence tended to be lower among patients with sarcoidosis (crude RR=0.22; 95% CI, 0.06-0.90; adjusted RR=-0.28; 95% CI, 0.07-1.15). Post-hypopyon eyes and eyes not developing hypopyon had a similar incidence of band keratopathy, posterior synechiae, ocular hypertension, hypotony, macular edema, epiretinal membrane, cataract surgery, or glaucoma surgery. Post-hypopyon eyes were more likely than eyes not developing hypopyon to gain 3 lines of vision (crude RR=1.54; 95% CI, 1.05-2.24) and were less likely to develop 20/200 or worse visual acuity (crude RR=0.41; 95% CI, 0.17-0.99); otherwise, visual outcomes were similar in these groups.
Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Behçet's disease, HLA-B27 positivity, and spondyloarthropathy. Intermediate uveitis cases (+/- anterior uveitis) had a lower risk of hypopyon. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity.
评估葡萄膜炎患者发生前房积脓的风险和风险因素，并评估前房积脓后视力变化和并发症的风险。
回顾性队列研究。
4 家学术眼内炎症亚专科的葡萄膜炎患者。
通过标准化图表审查确定数据。
前房积脓的患病率和发生率、前房积脓的危险因素，以及前房积脓后视力变化和眼部并发症的发生率。
在 4911 例葡萄膜炎患者中，在队列入组时发现 41 例（8.3/1000）存在前房积脓。其中，2885 例最初无前房积脓患者随访 9451 人年，在此期间 81 例（2.8%）发生前房积脓（8.57/1000 人年）。前房积脓的发生危险因素包括贝切特病（调整后的相对风险[RR]=5.30；95%置信区间[CI]，2.76-10.2）、脊柱关节病（调整后的 RR=2.86；95%CI，1.48-5.52）和人类白细胞抗原（HLA）-B27 阳性（调整后的 RR=2.04；95%CI，1.17-3.56）。同时患有脊柱关节病和 HLA-B27 的患者的风险高于任一因素单独存在时的风险（粗 RR=4.39；95%CI，2.26-8.51）。中间葡萄膜炎（伴或不伴前葡萄膜炎）的诊断与前房积脓的风险较低相关（与仅前葡萄膜炎相比，调整后的 RR=0.35；95%CI，0.15-0.85）。前房积脓的发生率在结节病患者中较低（粗 RR=0.22；95%CI，0.06-0.90；调整后的 RR=-0.28；95%CI，0.07-1.15）。发生前房积脓的眼和未发生前房积脓的眼后发性白内障、后发性粘连、眼内压升高、低眼压、黄斑水肿、视网膜前膜、白内障手术或青光眼手术的发生率相似。发生前房积脓的眼比未发生前房积脓的眼获得 3 行视力的可能性更高（粗 RR=1.54；95%CI，1.05-2.24），发生 20/200 或更差视力的可能性更低（粗 RR=0.41；95%CI，0.17-0.99）；否则，这些组的视力结果相似。
前房积脓在葡萄膜炎患者中并不常见。危险因素包括贝切特病、HLA-B27 阳性和脊柱关节病。中间葡萄膜炎（伴或不伴前葡萄膜炎）病例发生前房积脓的风险较低。平均而言，发生前房积脓的眼与其他患有葡萄膜炎的眼相比，发生结构性眼部并发症或丧失视力的可能性没有更高。
