Remission of Intermediate Uveitis: Incidence and Predictive Factors

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• 作者：John H. Kempen^a ; ^b ; ^c ; ^{john.kempen@uphs.upenn.edu" class="auth_mail" title="E-mail the corresponding author}Author Vitae ; Dina Y. Gewaily^a ; ^d ; Craig W. Newcomb^b ; ^c ; Teresa L. Liesegang^e ; R. Oktay Kaç ; maz^g ; ^h ; Grace A. Levy-Clarkeⁱ ; ^j ; Robert B. Nussenblattⁱ ; James T. Rosenbaum^e ; ^f ; ^k ; H. Nida Senⁱ ; Eric B. Suhler^e ; ^l ; Jennifer E. Thorne^m ; ⁿ ; C. Stephen Foster^g ; ^o ; Douglas A. Jabsⁿ ; ^p ; ^q ; Abhishek Payal^a ; ^f ; ^l ; Tonetta D. Fitzgerald^a ; for the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Research GroupJohn H. Kempen ; MD ; PhD (Principal Investigator ; Penn Center Director) ; Marshall M. Joffe ; MD ; PhD (Statistical Methodologist) ; Kurt A. Dreger ; BS (Database Construction ; Management) ; Tonetta D. Fitzgerald ; BA ; COA ; CCRC (Project Coordinator) ; Craig W. Newcomb ; MS (Biostatistician) ; Maxwell Pistilli ; MS (Biostatistician) ; Srishti Kothari ; MBBS ; DOMS ; DNB (Postdoctoral Fellow) ; Naira Khacharyan ; MD ; MPH ; DrPH (Postdoctoral Fellow) ; Pichaporn Artornsombudh ; MD (Postdoctoral Fellow) ; Asaf Hanish ; MPH (Biostatistical Programmer) ; Abhishek Payal ; MBBS ; MPH (Postdoctoral Fellow) ; Sapna S. Gangaputra ; MBBS ; MPH (Postdoctoral Fellow) ; Jennifer E. Thorne ; MD ; PhD (Center Director ; 2007-present) ; Hosne Begum ; MBBS ; MPH (Study Coordinator) ; Kurt A. Dreger ; BS (Database Construction ; Management) ; Ebenezer Daniel ; MBBS ; MPH ; PhD (Postdoctoral Fellow) ; James P. Dunn ; MD (Major Clinician) ; Sapna S. Gangaputra ; MBBS ; MPH (Postdoctoral Fellow) ; Douglas A. Jabs ; MD ; MBA (Clinic Founder ; Former Clinic Director) ; Abhishek Payal ; MBBS ; MPH (Postdoctoral Fellow) ; Kathy J. Helzlsouer ; MD ; MHS (Cancer Epidemiologist) ; Douglas A. Jabs ; MD ; MBA (Founder of JHU Clinic ; JHU Clinic Director 2005-2007) ; C. Stephen Foster ; MD ; FACS ; FACR (Center Director ; Founder ; Director ; Founder of previous Massachusetts Eye & Ear Infirmary Center ; 2004-2005) ; Srishti Kothari ; MBBS ; DOMS ; DNB (Postdoctoral Fellow) ; Naira Khacharyan ; MD ; MPH ; DrPH (Postdoctoral Fellow) ; Pichaporn Artornsombudh ; MD (Postdoctoral Fellow) ; R. Oktay Kaç ; maz ; MD ; MPH (Postdoctoral Fellow) ; Abhishek Payal ; MBBS ; MPH (Postdoctoral Fellow) ; Siddharth S. Pujari ; MBBS ; MPH (Postdoctoral Fellow) ; H. Nida Sen ; MD ; MS (NEI Center Director) ; Robert B. Nussenblatt ; MD ; MPH (Center Founder ; Co-Director) ; Grace A. Levy-Clarke ; MD (Former Center Director) ; Sapna S. Gangaputra ; MBBS ; MPH (Postdoctoral Fellow) ; Eric B. Suhler ; MD ; MPH (Center Director) ; James T. Rosenbaum ; MD ; FACR (Center Founder ; Co-Director) ; Teresa Liesegang ; COT ; CRC (Project Coordinator) ; Jeanine Buchanich ; PhD (Epidemiologist) ; Terri L. Washington (Project Coordinator)
• 刊名：American Journal of Ophthalmology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：164
• 期：Complete
• 页码：110-117.e2
• 全文大小：837 K

文摘

To evaluate the incidence of remission among patients with intermediate uveitis; to identify factors potentially predictive of remission.

Design

Retrospective cohort study.

Methods

Involved eyes of patients with primary noninfectious intermediate uveitis at 4 academic ocular inflammation subspecialty practices, followed sufficiently long to meet the remission outcome definition, were studied retrospectively by standardized chart review data. Remission of intermediate uveitis was defined as a lack of inflammatory activity at ≥2 visits spanning ≥90 days in the absence of any corticosteroid or immunosuppressant medications. Factors potentially predictive of intermediate uveitis remission were evaluated using survival analysis.

Results

Among 849 eyes (of 510 patients) with intermediate uveitis followed over 1934 eye-years, the incidence of intermediate uveitis remission was 8.6/100 eye-years (95% confidence interval [CI], 7.4–10.1). Factors predictive of disease remission included prior pars plana vitrectomy (PPV) (hazard ratio [HR] [vs no PPV] = 2.39; 95% CI, 1.42–4.00), diagnosis of intermediate uveitis within the last year (HR [vs diagnosis >5 years ago] =3.82; 95% CI, 1.91–7.63), age ≥45 years (HR [vs age <45 years] = 1.79; 95% CI, 1.03–3.11), female sex (HR = 1.61; 95% CI, 1.04–2.49), and Hispanic race/ethnicity (HR [vs white race] = 2.81; 95% CI, 1.23–6.41). Presence/absence of a systemic inflammatory disease, laterality of uveitis, and smoking status were not associated with differential incidence.

Conclusions

Our results suggest that intermediate uveitis is a chronic disease with an overall low rate of remission. Recently diagnosed patients and older, female, and Hispanic patients were more likely to remit. With regard to management, pars plana vitrectomy was associated with increased probability of remission.