Dana M R, Merayo-Lloves J, Schaumberg D A, Foster C S
Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston 02114, USA.
Ophthalmology. 1996 Nov;103(11):1846-53. doi: 10.1016/s0161-6420(96)30417-x.
The purpose of the study is to delineate the visual prognosticators in sarcoid-associated uveitis given the current standards of care.
The records of 60 patients with sarcoid-associated uveitis who were observed for at least 6 months were studied retrospectively. Multivariate regression models using the generalized estimating equations approach to adjust for the correlation between fellow eyes were applied to determine disease, patient, and treatment characteristics that altered the odds of visual rehabilitation.
One hundred twelve eyes of 43 women and 17 men who met the inclusion criteria were identified. Seventy-seven percent of patients were white, 15% black, and 8% of Hispanic origin. Uveitis developed in the patients at a mean age of 42 (range, 4-82) years. Of the 112 affected eyes, 81% had granulomatous and 15% nongranulomatous uveitis. Most patients (66%) had anterior or intermediate uveitis alone. Ninety-one percent had chronically smoldering disease; another 7% had recurrent flares, and only 1 patient had a monophasic acute course to her uveitis. Vision-threatening complications developed in many patients, including 58% in whom cystoid macular edema developed and 25% in whom media opacities developed, requiring cataract surgery or vitrectomy or both. Overall, 34% of treated eyes and 51% of patients had final visual acuities that were superior to their acuities at presentation. The factors most significantly associated with a final visual acuity of worse than 20/40 after controlling for potential confounders were as follows: delay in presentation to a subspecialist (odds ratio [OR] = 2.94, P = 0.05), total duration of uveitis (OR = 1.04, P = 0.09), development of cystoid macular edema (OR = 0.37, P = 0.07) or glaucoma (OR = 4.54, P = 0.02), presence of intermediate (OR = 5.00, P = 0.01) or posterior uveitis (OR = 8.33, P = 0.04), and systemic steroid use (OR = 0.30, P = 0.03) were the parameters most strongly correlated with a lack of visual acuity improvement. Delay in presentation to a subspecialist (OR = 20.00, P = 0.01), development of glaucoma (OR = 50.00, P = 0.005), presence of intermediate (OR = 25.00, P = 0.02) or posterior uveitis (OR = 50.00, P = 0.02), black race (OR = 11.11, P = 0.02), (log) visual acuity at presentation (OR = 0.05, P = 0.0001), and use of systemic steroids (OR = 0.07, P = 0.02).
Multivariate outcomes analysis, particularly after correcting for the correlation between fellow eyes, is a useful analytic tool for optimization of standards of care and for disease risk stratification to aid both physicians and patients.
鉴于当前的治疗标准，本研究旨在明确结节病相关性葡萄膜炎的视觉预后指标。
对60例结节病相关性葡萄膜炎患者的记录进行回顾性研究，这些患者均接受了至少6个月的观察。采用广义估计方程法的多变量回归模型来调整双眼之间的相关性，以确定影响视力恢复几率的疾病、患者及治疗特征。
共纳入43名女性和17名男性，其112只眼睛符合纳入标准。77%的患者为白人，15%为黑人，8%为西班牙裔。葡萄膜炎患者的平均发病年龄为42岁（范围4 - 82岁）。在112只受累眼睛中，81%为肉芽肿性葡萄膜炎，15%为非肉芽肿性葡萄膜炎。大多数患者（66%）仅患有前部或中间部葡萄膜炎。91%的患者患有慢性隐匿性疾病；另有7%的患者有复发，仅有1例患者的葡萄膜炎呈单相急性病程。许多患者出现了威胁视力的并发症，包括58%的患者发生了黄斑囊样水肿，25%的患者出现了介质混浊，需要进行白内障手术或玻璃体切除术或两者皆需。总体而言，34%的治疗眼和51%的患者最终视力优于就诊时。在控制潜在混杂因素后，与最终视力低于20/40最显著相关的因素如下：转诊至专科医生的延迟（比值比[OR]=2.94，P = 0.05）、葡萄膜炎的总病程（OR = 1.04，P = 0.09）、黄斑囊样水肿的发生（OR = 0.37，P = 0.07）或青光眼的发生（OR = 4.54，P = 0.02）、存在中间部（OR = 5.00，P = 0.01）或后部葡萄膜炎（OR = 8.33，P = 0.04）以及全身使用类固醇（OR = 0.30，P = 0.03）是与视力改善缺乏最密切相关的参数。转诊至专科医生的延迟（OR = 20.00，P = 0.01）、青光眼的发生（OR = 50.00，P = 0.005）、存在中间部（OR = 25.00，P = 0.02）或后部葡萄膜炎（OR = 50.00，P = 0.02）、黑人种族（OR = 11.11，P = 0.02）、就诊时的（对数）视力（OR = 0.05，P = 0.0001）以及全身使用类固醇（OR = 0.07，P = 0.02）。
多变量结果分析，尤其是在纠正双眼之间的相关性之后，是优化治疗标准以及进行疾病风险分层的有用分析工具，有助于医生和患者。
