Juvenile Idiopathic Arthritis-Associated Uveitis: Incidence of Ocular Complications and Visual Acuity Loss
Accepted 12 January 2007. published online 28 February 2007.
Purpose
To estimate the incidences of ocular complications and vision loss in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, to describe risk factors for vision loss, and to describe the association between therapy and complications and vision loss.
Design
Retrospective cohort study.
Methods
setting: Single-center, academic practice. study population: A total of 75 patients with JIA-associated uveitis evaluated between July 1984 and August 2005. procedures: Clinical data on these patients were analyzed. outcome measures: Occurrence of ocular complications and visions of 20/50 or worse and 20/200 or worse.
Results
Over a median follow-up of three years, the incidence of any ocular complication was 0.33/eye-year (EY). Rates of vision loss to 20/50 or worse and 20/200 or worse were 0.10/EY and 0.08/EY, respectively. Risk factors at presentation for incident vision loss included presence of posterior synechiae, anterior chamber flare ≥ 1+, and abnormal intraocular pressure (IOP). During follow-up, ocular inflammation ≥ 0.5+ cells was associated with an increased risk of visual impairment (relative risk [RR] = 2.02, P = .006) and of blindness (RR = 2.99, P = .03). Immunosuppressive drug therapy reduced the risk of hypotony by 74% (P = .002), epiretinal membrane formation by 86% (P = .05), and blindness in the better eye by 60% (P = .04).
Conclusions
Incident vision loss and complications were common. Presence of posterior synechiae, anterior chamber flare ≥ 1+, and abnormal IOP at presentation were associated with vision loss during follow-up. Use of immunosuppressive drugs reduced the risk of some ocular complications and of blindness in the better-seeing eye.
aDepartment of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
bDepartment of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
cDepartment of Epidemiology, Center for Clinical Trials, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Inquiries to Jennifer E. Thorne, Wilmer Eye Institute, 550 North Broadway, Suite 700, Baltimore, MD 21205
ABSTRACT