F.I. Proctor Foundation, University of California, San Francisco, San Francisco, CA 94143-0412, USA.
Am J Ophthalmol. 2010 Oct;150(4):534-542.e2. doi: 10.1016/j.ajo.2010.04.031.
To calculate the incidence rates of ocular complications and vision loss in HLA-B27-associated uveitis and to explore the effect of chronic inflammation on clinical outcomes.
Retrospective longitudinal cohort study.
The clinical records of 99 patients (148 uveitis-affected eyes) with HLA-B27-associated uveitis seen at a tertiary care center were included. The main outcome measures were ocular complications (posterior iris synechiae, band keratopathy, posterior subcapsular [PSC] cataracts, ocular hypertension, hypotony, cystoid macular edema, and epiretinal membrane) and vision loss. Anterior chamber inflammation was defined as ≥1+ grade inflammation. Chronic uveitis was defined as persistent inflammation with relapse in <3 months after discontinuing treatment or requiring medications to suppress inflammation for >3 months after reviewing the patient's entire clinical course.
The clinical course was most commonly acute/recurrent (75%) or chronic (20%). The most common complications to develop during follow-up were ocular hypertension (0.10/eye-year) and PSC cataracts (0.09/eye-year). In multivariate analysis, the presence of posterior synechiae at presentation, inflammation, corticosteroid-sparing therapy, corticosteroid injections, chronic disease, and male gender were associated with a statistically significant increased risk of developing vision loss (20/50 or worse). Chronic disease course was associated with a 7-fold increased risk of visual impairment (hazard ratio [HR] = 6.8, P < .0001). The presence of inflammation during follow-up was associated with an increased risk of developing visual impairment (HR = 6.2, P < .0001). In multivariate analysis, chronic disease course and topical corticosteroids were associated with an increased risk of developing any incident ocular complication (HR = 2.2, P = .04 and HR = 3.3, P = .01, respectively).
Poorly controlled inflammation was associated with the development of ocular complications including vision loss. Patients with chronic inflammation were also at greater risk of complications.
计算 HLA-B27 相关性葡萄膜炎的眼部并发症和视力丧失的发生率，并探讨慢性炎症对临床结果的影响。
回顾性纵向队列研究。
纳入了在一家三级保健中心就诊的 99 例（148 只患眼）HLA-B27 相关性葡萄膜炎患者的临床记录。主要观察指标是眼部并发症（后发性虹膜睫状体炎、带状角膜病变、后囊下[PSC]白内障、高眼压、低眼压、黄斑囊样水肿和视网膜前膜）和视力丧失。前房炎症定义为≥1+级炎症。慢性葡萄膜炎定义为在停止治疗后 3 个月内炎症复发或在回顾患者整个临床过程后需要药物抑制炎症超过 3 个月的持续性炎症。
疾病过程最常见的是急性/复发性（75%）或慢性（20%）。在随访过程中最常见的并发症是高眼压（0.10/眼年）和 PSC 白内障（0.09/眼年）。多变量分析显示，初诊时存在后发性虹膜睫状体炎、炎症、皮质类固醇保眼治疗、皮质类固醇注射、慢性疾病和男性是发生视力丧失（20/50 或更差）的风险显著增加的因素。慢性病程与视力损害的风险增加 7 倍相关（风险比[HR] = 6.8，P <.0001）。随访期间存在炎症与发生视力损害的风险增加相关（HR = 6.2，P <.0001）。多变量分析显示，慢性病程和局部皮质类固醇与发生任何眼部并发症的风险增加相关（HR = 2.2，P =.04 和 HR = 3.3，P =.01）。
未得到有效控制的炎症与眼部并发症（包括视力丧失）的发生有关。慢性炎症患者发生并发症的风险也更高。
