Posterior Segment Involvement in Korean Patients with HLA-B27-Associated Uveitis

Kim, Sang Jin; Chung, Hum; Yu, Hyeong Gon

doi:10.1080/09273940802553261

Cited by 15 publications

(17 citation statements)

References 17 publications

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“…Several reports on retinal vasculitis in HLA-B27-positive patients were previously published and were considered a part of atypical posterior segment manifestations in HLA-B27-associated uveitis. 2,[4][5][6][7][8][9] From a cohort of 166 patients with HLA-B27-associated uveitis, Rodriguez et al reported 7 (4%) patients with retinal vasculitis, which is in accordance with our findings. 4 The occurrence of retinal vasculitis in HLA-B27-associated disease may in fact even be higher than 3%, as not all our patients with retinal vasculitis were tested for HLA-B27.…”

Section: Discussionsupporting

confidence: 91%

“…HLA-B27-associated uveitis typically presents as a recurrent unilateral acute anterior uveitis (AAU), 1 although posterior segment manifestations in HLA-B27-associated uveitis are regularly reported. [2][3][4] The most common posterior segment manifestations include vitritis, cystoid macular edema (CME), and optic disc leakage. [2][3][4] Occasional cases of retinal vasculitis in HLA-B27-positive patients are also documented, and constitute about 20-25% of those with posterior segment involvement.…”

mentioning

confidence: 99%

“…[2][3][4] The most common posterior segment manifestations include vitritis, cystoid macular edema (CME), and optic disc leakage. [2][3][4] Occasional cases of retinal vasculitis in HLA-B27-positive patients are also documented, and constitute about 20-25% of those with posterior segment involvement. 2,[4][5][6][7][8][9] It is not known whether the association of HLA-B27-antigen and retinal vasculitis is coincidental or whether retinal vasculitis might occur as a specific manifestation of an HLA-B27-associated disease.…”

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confidence: 99%

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The clinical characteristics of retinal vasculitis in HLA-B27-positive patients

Braakenburg

Rothova²

2013

Ocular Immunology and Inflammation

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

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confidence: 99%

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The clinical characteristics of retinal vasculitis in HLA-B27-positive patients

Braakenburg

Rothova²

2013

Ocular Immunology and Inflammation

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“…[4][5][6][7][8][9][10] The most common findings reported include vitritis, retinal vasculitis, papillitis, epiretinal membrane formation, and CME. As regards the latter manifestation, Uy et al found its frequency in HLA-B27-associated AAU to be 13.7%.…”

Section: Discussionmentioning

confidence: 99%

Retinal Thickening in HLA-B27–Associated Acute Anterior Uveitis: Evolution with Time and Association with Severity of Inflammatory Activity

Balaskas

Ballabeni

Guex-Crosier

2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To describe the evolution of retinal thickness in eyes affected with acute anterior uveitis (AAU) in the course of follow-up and to assess its correlation with severity of inflammatory activity in the anterior chamber.METHODS. 72 eyes (affected and fellow eyes) of 36 patients presenting with HLA-B27related acute anterior uveitis were included in a prospective, institutional, cohort study. Patients were followed daily until beginning of resolution of inflammatory activity and weekly thereafter. Optical coherence tomography and laser flare photometry were performed at each visit. Treatment consisted of topical corticosteroids. Main outcome measures were retinal thickness of affected eyes, difference in retinal thickness between affected and fellow eyes and their evolution in time, association between maximal retinal thickness, and initial laser flare photometry.RESULTS. Difference in retinal thickness between affected and fellow eyes became significant on average 7 days from baseline and remained so throughout follow-up (P < 0.001). There was a steep increase in retinal thickness of affected eyes, followed by a progressive decrease after reaching a peak value. Maximal difference in retinal thickness between affected and fellow eyes was observed between 17 and 25 days from baseline and exhibited a strong, positive correlation with initial laser flare photometry values (P ¼ 0.015). CONCLUSIONS.Retinal thickness in eyes affected with AAU presents a steep increase over 3 to 4 weeks and then gradually decreases. Severity of inflammation at baseline predicts the amount of retinal thickening in affected eyes. A characteristic pattern of temporal response of retinal anatomy to inflammatory stimuli seems to arise. (Invest Ophthalmol Vis Sci. 2012; 53:6171-6177) DOI:10.1167/iovs.12-10026 H LA-B27-associated acute anterior uveitis (AAU) is an important pathological entity in view of its high frequency and associated morbidity. Younger patients at the productive age range are more commonly affected; and, despite its overall favorable prognosis, HLA-B27-associated AAU remains a considerable public health concern, following a typically recurrent natural history and engendering potentially visionthreatening ocular complications, such as cystoid macular edema (CME). [1][2][3] In contrast to the development of florid macular edema, subclinical retinal thickening in the context of AAU, although long suspected by clinicians, has yet to be verified in a prospective trial. The understanding of this phenomenon and its evolution over time could shed light into the mechanisms of other relevant clinical manifestations, such as the increased susceptibility of carriers of the HLA-B27 molecule to develop macular edema following ocular surgery. 4 The purpose of this prospective study was to describe the response of retinal anatomy to inflammatory stimuli over time in the course of an episode of AAU. We particularly attempted to demonstrate the presence of subclinical retinal thickening in eyes of patients with HLA-B27-associated AAU w...

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“…Of these less typical presentations, posterior segment involvement in a patient with HLA-B27-associated uveitis is perhaps most common, and can include vitritis with or without pars plana exudates, optic disc swelling or papillitis, and CME. 46,[49][50][51] Hypotony maculopathy has also been reported in association with severe HLA-B27-associated AU, but is rare. 52,53 It is important to separate genuine inflammatory involvement located in the posterior segment from what can be considered complication of AU, such as CME.…”

Section: Less Common Forms Of Hla-b27-associated Uveitismentioning

confidence: 99%

Clinical Spectrum of HLA-B27-associated Ocular Inflammation

Pathanapitoon

Dodds

Cunningham

et al. 2016

Ocular Immunology and Inflammation

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Human leukocyte antigen (HLA)-B27-associated anterior uveitis (AU) is the most commonly diagnosed form of AU and represents the largest entity of non-infectious uveitis around the world. The most typical ocular manifestation associated with HLA-B27 consists of unilateral AU of acute onset. The HLA-B27-associated acute AU represents a distinct clinical entity occurring typically in young adults between the ages of 20 and 40 years. HLA-B27-associated acute AU is typically unilateral and lasts usually several weeks and diminishes within 3 months in the majority of patients. The anterior chamber shows typically severe cellular reaction and flare, as well as a fibrinous exudate. Frequently, posterior synechiae are formed and occasionally hypopyon is present. The pattern of the disease is recurrent with a full remission between the attacks. Intraocular pressure during active periods is typically low due to inflammation of ciliary body and decreased aqueous production. Less typical presentations are also recognized and include the development of chronic inflammation, posterior segment involvement, episcleritis, and scleritis. An isolated retinal vasculitis in HLA-B27-positive patients may develop, mostly in those with inflammatory bowel disease. Chronic AU, which may be either unilateral or bilateral affects up to 20% of patients. Ocular complications of HLA-B27-associated AU are diverse and include commonly posterior synechiae, cataract, glaucoma and/or hypotony. The visual outcome and complications of HLA-B27-associated AAU are frequently being compared with HLA B27-negative patients with AU and show that the prognosis of HLA-B27-associated uveitis is rather favorable, as <2% developed legal blindness and <5% visual impairment. A novel algorithm called the "Dublin Uveitis Evaluation Tool (DUET)" has been proposed to guide ophthalmologists to refer appropriate HLA-B27-positive patients with uveitis to rheumatologists.

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Posterior Segment Involvement in Korean Patients with HLA-B27-Associated Uveitis

Abstract: Patients with posterior segment involvement showed worse visual outcome than patients without posterior involvement.

Cited by 15 publications

References 17 publications

The clinical characteristics of retinal vasculitis in HLA-B27-positive patients

The clinical characteristics of retinal vasculitis in HLA-B27-positive patients

Retinal Thickening in HLA-B27–Associated Acute Anterior Uveitis: Evolution with Time and Association with Severity of Inflammatory Activity

Clinical Spectrum of HLA-B27-associated Ocular Inflammation

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