Post-Colectomy Uveitis in Ulcerative Colitis: A Case Series.

Purpose: To characterize the course of uveitis in ulcerative colitis (UC) patients following colectomy and assess whether uveitis activity arises and/or persists independently of colonic disease.

Methods: This is a retrospective case series from a tertiary uveitis referral center. Patients with non-infectious uveitis, a confirmed diagnosis of UC, and a history of colectomy were included. Clinical data were extracted, including demographics, ocular history, treatment regimens, and disease activity. Uveitis flares were defined as the presence of at least 1+ cells or flare in the anterior chamber, 1+ vitreous cells and/or haze or angiographic evidence of active inflammation as noted by the investigators.

Results: We identified 73 patients with UC-associated uveitis and 11 had a history of colectomy. Post-colectomy uveitis flares occurred in all 11 patients. Notably, eight patients experienced de novo uveitis activity following their colectomy. The remaining three uveitis patients had documented uveitis flares prior to colectomy. A total of 25 flares were documented, including multiple recurrences in three patients. One patient experienced 13 flares and ultimately required enucleation. Excluding this difficult case, patients with long-term follow-up (≥1 year) generally responded to topical steroid therapy. However, several flares occurred despite concurrent immunomodulatory therapy.

Conclusion: This case series highlights that uveitis flares may persist or recur following colectomy in UC patients, supporting the hypothesis that uveitis activity can occur independently of intestinal inflammation. These findings support the need for continued ophthalmologic surveillance in UC patients post-colectomy.