Original article
Ocular Hypotony in Patients With Juvenile Idiopathic Arthritis–Associated Uveitis

https://doi.org/10.1016/j.ajo.2016.09.018Get rights and content

Purpose

To analyze occurrence, risk factors, and course of ocular hypotony (OH) in juvenile idiopathic arthritis–associated uveitis (JIAU).

Methods

Epidemiologic and ophthalmologic data at baseline and during follow-up of JIAU patients with and without ocular hypotony were evaluated.

Results

OH developed in 57 of the 365 JIAU patients during the follow-up (mean 4.5 ± 3.5 years). In 40 patients with follow-up ≥12 months, OH was unrelated to previous ocular surgery: risk factors at baseline (univariate logistic regression analysis) included longer total duration of uveitis (odds ratio [OR] 1.13, P < .001), bilateral uveitis (OR 3.51, P = .009), low visual acuity (OR 5.1, P = .001), high laser-flare (LF) values (OR 1.74, P = .01), and presence of posterior synechiae (OR 3.28, P = .004). Increased anterior chamber (AC) cell and LF values were observed within 3 months prior to onset of transient (≤3 months; 37.5%) or persistent OH (>3 months; 62.5%). AC cell and LF values decreased within 3 months after onset of transient OH, while LF levels remained elevated ≥12 months in persistent OH. Optic disc edema and epiretinal membrane formation was found more frequently after OH onset.

Conclusions

OH was observed in 15.6% of JIAU patients. Longer total uveitis duration, bilateral uveitis, low visual acuity, high AC flare and LF grades, and presence of posterior synechiae at baseline were risk factors for subsequent OH. Burden of OH might be improved with immunosuppression.

Section snippets

Methods

Medical records of all children with JIA-associated uveitis followed up between April 3, 2001 and November 28, 2013 at the Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany, were retrospectively reviewed. The study was conducted in accordance with the Declaration of Helsinki. Approval from the ethics committee is not required for retrospective chart reviews in Germany. Only patients who were referred to the uveitis center within the first year of uveitis onset were

Patient Characteristics

A total of 365 patients with JIA-associated uveitis were identified in the uveitis center database. Epidemiologic data for these patients are shown in Table 1. JIAU patients were predominantly of female sex (69.6%), had early onset of arthritis, and were ANA positive (74.5%), and the majority was classified as having persistent oligoarthritis (73.0%). In 150 patients (41.2%), uveitis-related secondary complications were documented already at baseline, for example, band keratopathy (17.5%),

Discussion

In this study we analyzed the occurrence and course of OH in a large cohort of JIAU at a single tertiary uveitis center. Up to now, only limited data on this issue were available for uveitis in general, and data for JIAU were even scarcer.15, 16, 28, 29, 30 In our study, we found an occurrence of OH in about 15% of our patients with JIAU (mean follow-up time 4.5 years), which was higher than in previous publications, where a prevalence of OH between 3% and 9% was reported.9, 13, 14, 15, 16 The

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    Michael R.R. Böhm is currently affiliated with the Department of Ophthalmology, Clinic for Diseases of the Anterior Segments of the Eyes, Essen University Hospital, Essen, Germany.

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