Exudative Retinal Detachment in Ocular Inflammatory Diseases: Risk and Predictive Factors - 21/09/20

Doi : 10.1016/j.ajo.2020.06.019

Deepika N. Shah ^a,^b, Ahmad Al-Moujahed ^c, Craig W. Newcomb ^d, R. Oktay Kaçmaz ^e,^f, Ebenezer Daniel ^g, Jennifer E. Thorne ^h,ⁱ, C. Stephen Foster ^e,^j, Douglas A. Jabs ^h,ⁱ, Grace A. Levy-Clarke ^k, Robert B. Nussenblatt ^k,^{^{†
Deceased.}}, James T. Rosenbaum ^l,^m,ⁿ, H. Nida Sen ^k, Eric B. Suhler ^l,^m,^o, Nirali P. Bhatt ^p, John H. Kempen ^j,^q,^r,^⁎
on behalf of
the Systemic Immunosuppressive Therapy for Eye Diseases Research Group
^a Eye Doctors of Washington, Washington, DC, USA
^b Department of Ophthalmology, Georgetown University, Washington, DC, USA
^c Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
^d Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
^e Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA
^f Mallinckrodt Pharmaceuticals, Bedminster, New Jersey, USA
^g Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
^h Department of Ophthalmology, Wilmer Eye Institute, the Departments of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
ⁱ Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
^j Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
^k Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
^l Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA
^m Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
ⁿ Legacy Devers Eye Institute, Portland, Oregon, USA
^o Portland Veterans' Affairs Medical Center, Portland, Oregon, USA
^p Department of Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
^q Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
^r Myung Sung Christian Medical Center Eye Unit, Myung Sung General Hospital and Myung Sung Medical School, Addis Ababa, Ethiopia

^∗Inquiries to John H. Kempen, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Schepens Eye Research Institute, 20 Staniford Street, Boston, Massachusetts 02114, USADepartment of OphthalmologyMassachusetts Eye and Ear and Harvard Medical SchoolSchepens Eye Research Institute20 Staniford StreetBostonMassachusetts02114USA

Abstract

Purpose

This study evaluated the risk and risk factors for exudative retinal detachment (ERD) in ocular inflammatory diseases.

Design

Retrospective cohort study.

Methods

Patients with noninfectious ocular inflammation had been followed longitudinally between 1978 and 2007 at 4 US subspecialty uveitis centers. The main outcome measurements were occurrences of ERD and predictive factors.

Results

A total of 176 of 14,612 eyes with ocular inflammation presented with ERD. Among uveitis cases, Vogt-Koyanagi-Harada syndrome (VKH) (odds ratio [OR] = 109), undifferentiated choroiditis (OR = 9.18), sympathetic ophthalmia (OR = 8.43), primary or secondary panuveitis (OR = 7.09), multifocal choroiditis with panuveitis (OR = 4.51), and “other” forms of posterior uveitis (OR = 16.9) were associated with a higher prevalence of ERD. Among the 9,209 uveitic or scleritic eyes initially free of ERD and followed, 137 incident ERD cases were observed over 28,949 eye-years at risk (incidence rate = 0.47% [0.40%-0.56%/eye-year]). VKH (HR = 13.2), sympathetic ophthalmia (HR = 5.82), undifferentiated choroiditis (HR = 6.03), primary or secondary panuveitis (HR = 4.21), and rheumatoid arthritis (HR = 3.30) were significantly associated with incident ERD. A significant dose-response relationship with the prevalence and incidence of ERD were observed for AC cells and vitreous cell activity. African Americans had significantly higher prevalence and incidence of ERD.

Conclusions

Other ocular inflammatory conditions in addition to VKH syndrome and posterior scleritis were associated with increased risk of ERD, indicating that ERD does not necessarily dictate a diagnosis of VKH or posterior scleritis. In addition, the relationship between ERD and inflammatory severity factors implies that inflammation is a key predictive factor associated with developing ERD and requires early and vigorous control.

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Plan

Methods

Data Collection

Statistical Methodology and Outcome Measurements

Results

Prevalence of ERD

Incidence and Risk Factors for Developing ERD

Impact of ERD on Visual Acuity

Discussion

Supplemental Material available at AJO.com.

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Vol 218

P. 279-287 - octobre 2020 Retour au numéro

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Exudative Retinal Detachment in Ocular Inflammatory Diseases: Risk and Predictive Factors - 21/09/20

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