Posterior segment manifestations in patients with HLA-B27 associated uveitis

Purpose

Posterior segment involvement in patients with HLA-B27 associated uveitis is a relatively uncommon condition, with a prevalence of 17.4 to 23.1%. This retrospective cohort study investigated the prevalence and characterized the posterior segment involvement in eyes with HLA-B27 associated uveitis. We also aimed to assess the patient characteristics which are associated with posterior segment involvement.

Methods

Medical records of 65 patients (130 eyes) with HLA-B27 associated uveitis, from two university uveitis clinics (United States and Turkey) were reviewed. Posterior segment findings were identified based on medical records and optical imaging including color fundus photography, fluorescein angiography and optical coherence tomography. Findings identified were vitreous haze, vasculitis, optic disc leakage and macular edema. Clinical course of anterior uveitis was described as acute, recurrent, or chronic according to the standardization of uveitis nomenclature (SUN) classification. Recurrent uveitis was defined as repeated episodes separated by periods of inactivity without treatment ≥ 3 months in duration, and chronic uveitis was persistence or relapse of symptoms within 3 months after discontinuation of treatment. Patients who had significant systemic and ocular comorbidities were excluded from the study. Data was collected using REDCap and analyzed using Stata ver. 16.1.

Results

Forty-four patients were included from US while 21 patients were included from Turkey. The mean age at presentation was 41 ± 15.1 years with a majority being male [42 (65%)] and non-Hispanic Caucasian [34 (53%)]. Overall, 26 patients (36 eyes) demonstrated posterior segment findings; 15 (34%) belonged to US while 11 (52.4%) patients belonged to Turkey. Among eyes with posterior segment involvement, most common findings were peripheral vasculitis and vitreous haze [13 (36.11%) each] followed by macular edema and disc leakage [6 (16.67%) each]. Patients with chronic uveitis (5/7) presented with more posterior segment involvement in US while patients with recurrent uveitis (5/6) presented with more posterior segment findings in Turkish cohort.

Conclusions

Posterior ocular findings can be seen in up to 40% of patients with HLA-B27-associated uveitis. Patients with chronic or recurrent uveitis are more likely to have posterior segment involvement and therefore should warrant more comprehensive evaluation for posterior disease.