Etiological and Clinical Characteristics of HLA-B27-associated Uveitis in a Tertiary Referral Center

Abstract

Objectives:To investigate the demographic, etiologic, and clinical features of HLA-B27-associated uveitis.Materials and Methods:The clinical records of 91 patients diagnosed with HLA-B27-associated uveitis at the Ulucanlar Eye Training and Research Hospital between the years of 2005 and 2016 were reviewed. Each patient’s presenting complaints, best-corrected visual acuities in first and last visits, biomicroscopic and fundoscopic examination findings, frequency and seasonal distribution of attacks, and demographic data such as age and sex were noted. Therapeutic approaches, duration of follow-up, and complications were analyzed.Results:A total of 91 patients (179 eyes) aged 19-82 years (mean age 46.52±13.06 years) were included. Forty-three patients (47.3%) were female and 48 (52.7%) were male. Bilateral involvement was observed in 44 (48.4%) and unilateral involvement was observed in 47 (51.6%) patients. The most frequent complaint was redness (67%), followed by decreased and/or blurred vision (50.5%). The mean follow-up time was 38.2 months (range, 1-245 months). Anterior uveitis was most common anatomical subtype, seen in 86 (94.5%) of the patients. Mean number of attacks was 1.93±1.45 per patient-year and a significantly higher number of uveitis attacks (47%) occurred in winter. Twenty-four patients (26.3%) were diagnosed with ankylosing spondylitis. Fibrinous uveitis was detected in 36 patients (39.5%). Posterior synechia developed in 41 (22.9%) and hypopyon developed in 7 (3.9%) eyes. The most common complications were cataract (n=12, 6.7%) and ocular hypertension (n=15, 8.3%).Conclusion:Ninety-one (6.3%) of the 1422 patients followed in our uvea clinic were diagnosed with HLA-B27-associated uveitis. HLA-B27-associated uveitis is characterized by acute, recurring sudden-onset iridocyclitis with a moderate to severe amount of fibrin and cells in the anterior chamber, and is easily treatable. Visual prognosis is good despite the complications.

<p>Clinical Profile of <em>HLA-B27</em>-Associated Uveitis in an Egyptian Cohort</p>

“…Acute episodes of anterior uveitis associated with HLA-B27 positivity generally respond favorably to topical steroids, as have been previously published. 6 , 8 In agreement with the literature in this respect, topical steroids were the principal treatment of acute anterior uveitis in our study. In our series, subconjunctival injection was viewed necessary in only 6.2% of our patients’ eyes, approximately half the percentage reported by a study from turkey, 8 and oral steroids were given to 11.4% of our patients, which is nearer to the lower end of the range of values published from other areas of the world (8.8% 8 – 48.8% 2 ).…”

“…Regarding the intraocular pressure, the percentage of eyes that developed secondary elevation of the intraocular pressure in our series (9.1%) approached those from other studies. 2,29,34 At the other end of the spectrum, acute attacks of HLA-B27-associated uveitis could be associated with a temporary decrease of intraocular pressure, as have been previously reported, 8 and this was reinforced in 13.1% of eyes in our study. Chronic hypotony in those eyes, however, is much less common, 40,41 and in our series, 1.3% of the study eyes had not recovered from hypotony, by the last follow-up visit.…”

“…The second most commonly diagnosed systemic disease among our patients was undifferentiated spondyloarthropathy (9.2%). However, the fact that in HLA-B27-positive patients, uveitis can precede the onset of spondylitis by an average of about 8 years, 3 , 8 , 35 , 36 raises the possibility that a study with a longer follow-up period may reveal a higher prevalence of systemic comorbidity and renders it necessary to periodically review those patients’ systemic symptoms and signs, and particularly in patients with posterior segment inflammation who appeared to be idiopathic by the end of the study period, we could not determine with certainty whether HLA-B27 positivity was incidental or integral to their posterior segment inflammation.…”

“…Moreover, patients have shown considerable variability with respect to the ocular features, the systemic comorbidities, as well as the response to the different treatment modalities. 7,8 The aim of the current study is to describe the clinical profile of patients with HLA-B27-associated uveitis at 2 uveitis referral clinics in Egypt between January 2010 and June 2018.…”

“…Moreover, patients have shown considerable variability with respect to the ocular features, the systemic comorbidities, as well as the response to the different treatment modalities. 7 , 8 …”