Posterior segment inflammation in HLA-B27+ acute anterior uveitis: clinical characteristics.
OBJECTIVE
To examine clinical characteristics of patients who have posterior segment manifestations in HLA-B27-associated acute anterior uveitis.


METHODS
Medical records of 114 HLA-B27-positive patients with acute anterior uveitis were reviewed in a retrospective fashion. Criteria for inclusion were the presence of acute anterior uveitis, a positive HLA-B27 antigen, and one of the following findings: vitreous cells >/=+2; cystoid macular edema; papillitis; vasculitis; or pars plana exudates. Twenty-four patients met the inclusion criteria.


RESULTS
Posterior segment manifestations were found in 24 (21.05%) of 114 patients with HLA-B27+ acute anterior uveitis. Eighteen patients had diffuse vitritis (75%), seven had cystoid macular edema (29.1%), and two had papillitis (8.3%). Three patients had more than one finding. The prevalence of associated systemic disease (15 of 24 patients, 62.5%) and hypopyon (6 of 24 patients, 25%) in patients with posterior segment involvement was significantly higher than in the group of patients without posterior segment involvement (systemic disease, 33 of 90, 36.7%, p=0.04, exact chi-quare test; hypopyon, 4 of 90, 4.4%, p=0.006, exact chi-square test). The mean visual acuity at the last visit was 20/30 (range 20/20-20/100). Immunosuppressive therapy (other than corticosteroids) and surgical intervention were not required in the treatment of patients with posterior segment manifestations. CONCLUSION<?Pub Caret>: HLA-B27+ anterior uveitis is associated with posterior segment manifestations. Patients with posterior segment involvement have a significantly higher incidence of associated systemic diseases and hypopyon.
The Cleveland Clinic Foundation, Division of Ophthalmology, Cleveland, OH 44195, USA.
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D000208:Acute Disease; D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D015796:HLA-B27 Antigen / Q000032:analysis*; D006801:Humans; D008269:Macular Edema / Q000150:complications; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D014222:Triamcinolone Acetonide / Q000627:therapeutic use; D014606:Uveitis, Anterior / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology*; D014822:Vitreous Body / Q000473:pathology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D015796:HLA-B27 Antigen; D011239:Prednisolone; D014222:Triamcinolone Acetonide