Chronic inflammation in HLA-B27-associated uveitis linked to greater risk of complications

Researchers retrospectively calculated rates of ocular complications and vision loss in a longitudinal cohort study of 99 patients with HLA-B27 associated uveitis (148 affected eyes) followed for a mean of 2.1 years. They also evaluated the effect of chronic inflammation on clinical outcomes. This paper should be of interest to uveitis specialists, as well as general ophthalmologists. HLA-B27-associated uveitis often presents acutely, and these patients may first present to a general ophthalmologist.

The study's authors found that patients with chronic disease, posterior synechia and active inflammation were more likely to develop vision loss, with visual acuity measured at 20/50 or worse during follow-up. Using longitudinal data analysis, the authors observed that the presence of anterior chamber cells ≥ 1+ was strongly associated with the development of visual impairment. Chronic disease course was associated with developing any incident ocular complication. 

The study's results suggest that patients who develop posterior synechia or a chronic disease course may be at particular risk for developing other ocular complications, including vision loss. While these findings may not be surprising to uveitis specialists and are not unique to HLA-B27-associated uveitis, they may be helpful for the general ophthalmologist as a guideline for determining which uveitis cases are severe enough to require referral to a uveitis specialist for further treatment. The results also suggest that the development of chronic disease (i.e., relapse within three months after discontinuing treatment, or requiring medication for longer than three months during a flare) may be a good reason to refer a patient to a uveitis specialist for more aggressive therapy in an effort to avoid ocular complications and vision loss.