Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis.
Moradi Ahmadreza, Stroh Inna G, Reddy Ashvini K, Hornbeak Dana M, Leung Theresa G, Burkholder Bryn M, Thorne Jennifer E
AI Summary
This study found severe uveitis increases hypotony risk in JIA-associated uveitis, while immunosuppression reduces it. Aggressive inflammation control may prevent vision-threatening hypotony.
Abstract
Objective
To describe risk factors for hypotony in patients with juvenile idiopathic arthritis (JIA)-associated uveitis.
Design
Retrospective cohort study.
Methods
All patients with JIA-associated uveitis (N = 108; affected eyes = 196) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014 were included in this study. Prevalence and incidence of hypotony (intraocular pressure [IOP] <5 mm Hg) and low IOP (5 mm Hg ≤ IOP < 8 mm Hg) and risk factors for developing hypotony were analyzed.
Results
At presentation, 9.3% of patients (7.1% of affected eyes) had hypotony. During a median follow-up of 5.3 years, the rate of developing hypotony and low IOP were 0.04 per eye-year (/EY; 95% confidence interval [CI]: 0.02/EY, 0.05/EY) and 0.06/EY (95% CI: 0.04/EY, 0.08/EY), respectively. Risk factors for development of hypotony during follow-up appeared to be associated with more severe uveitic disease, such as the presence of panuveitis (adjusted hazard ratio [aHR], 43.1; P = .004), anterior chamber cells or flare ≥ 3+ (aHR, 25.6, P < .001), posterior synechiae (aHR, 5.9, P = .02), and the use of oral corticosteroid (aHR 28.9; P = .003) at the presenting examination. Receiving immunosuppressive drug therapy at the time of presentation was associated with a lower risk of development of hypotony (aHR, 0.02; P = .002).
Conclusions
Hypotony affects a small but significant proportion of patients with JIA-associated uveitis and is associated with signs of active and severe uveitis. Immunosuppression was associated with significantly lower risk of hypotony, suggesting that aggressive control of the inflammation may reduce risk of hypotony in JIA-associated uveitis.
MeSH Terms
Shields Classification
Key Concepts5
At presentation, 9.3% of patients with juvenile idiopathic arthritis (JIA)-associated uveitis (7.1% of affected eyes) had hypotony (intraocular pressure [IOP] <5 mm Hg) in a retrospective cohort study of 108 patients (196 affected eyes) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014.
During a median follow-up of 5.3 years, the rate of developing hypotony (intraocular pressure [IOP] <5 mm Hg) in patients with juvenile idiopathic arthritis (JIA)-associated uveitis was 0.04 per eye-year (/EY; 95% confidence interval [CI]: 0.02/EY, 0.05/EY) in a retrospective cohort study of 108 patients (196 affected eyes) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014.
During a median follow-up of 5.3 years, the rate of developing low IOP (5 mm Hg ≤ IOP < 8 mm Hg) in patients with juvenile idiopathic arthritis (JIA)-associated uveitis was 0.06/EY (95% CI: 0.04/EY, 0.08/EY) in a retrospective cohort study of 108 patients (196 affected eyes) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014.
Risk factors for development of hypotony in patients with juvenile idiopathic arthritis (JIA)-associated uveitis during follow-up were associated with more severe uveitic disease, including the presence of panuveitis (adjusted hazard ratio [aHR], 43.1; P = .004), anterior chamber cells or flare ≥ 3+ (aHR, 25.6, P < .001), posterior synechiae (aHR, 5.9, P = .02), and the use of oral corticosteroid (aHR 28.9; P = .003) at the presenting examination, as found in a retrospective cohort study of 108 patients (196 affected eyes) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014.
Receiving immunosuppressive drug therapy at the time of presentation was associated with a lower risk of development of hypotony (adjusted hazard ratio [aHR], 0.02; P = .002) in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, suggesting that aggressive control of the inflammation may reduce risk of hypotony, as found in a retrospective cohort study of 108 patients (196 affected eyes) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014.
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