Risk of Cataract in Intermediate Uveitis.
To determine the incidence of and predictive factors for cataract in intermediate uveitis.Retrospective cohort study METHODS: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at five participating United States tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status.Among 2,190 eyes of 1,302 patients with intermediate uveitis the cumulative incidence of cataract formation was 7.6% by one year (95% CI=6.2-9.1%), increasing to 36.6% by ten years (95% CI=31.2-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (HR=2.68, 95% CI=2.00-3.59, p<0.001), and in eyes with epiretinal membrane formation (HR=1.54, 95% CI=1.15-2.07, p=0.004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/day or ≥4 periocular corticosteroid injections. Low dose corticosteroid medications (oral prednisone 7.5mg daily or less, or topical corticosteroid drops <2 times/day) were not associated with increased cataract risk.Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity, and with higher doses of corticosteroid medications, the latter being potentially modifiable.
Authors: Caroline L Minkus, Maxwell Pistilli, Kurt A Dreger, Tonetta D Fitzgerald, Abhishek R Payal, Hosne Begum, R Oktay Kaçmaz, Douglas A Jabs, Robert B Nussenblatt, James T Rosenbaum, Grace A Levy-Clarke, H Nida Sen, Eric B Suhler, Jennifer E Thorne, Nirali P Bhatt, C Stephen Foster, Jeanine M Buchanich, John H Kempen, Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study Research Group