title: Risk of Retinal Neovascularization in Cases of Uveitis.
abstract: OBJECTIVE
  To evaluate the risk of and risk factors for retinal neovascularization (NV) in cases of uveitis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Patients with uveitis at 4 US academic ocular inflammation subspecialty practices.
  
  
  METHODS
  Data were ascertained by standardized chart review. Prevalence data analysis used logistic regression. Incidence data analysis used survival analysis with time-updated covariates where appropriate.
  
  
  METHODS
  Prevalence and incidence of NV.
  
  
  RESULTS
  Among uveitic eyes of 8931 patients presenting for initial evaluation, 106 of 13,810 eyes had NV (prevalence = 0.77%, 95% confidence interval [CI], 0.60-0.90). Eighty-eight more eyes developed NV over 26,465 eye-years (incidence, 0.33%/eye-year; 95% CI, 0.27-0.41). Factors associated with incident NV include age <35 years compared with >35 years (adjusted hazard ratio [aHR], 2.4; 95% CI, 1.5-3.9), current cigarette smoking (aHR, 1.9; 95% CI, 1.1-3.4), and systemic lupus erythematosus (aHR, 3.5, 95% CI, 1.1-11). Recent diagnosis of uveitis was associated with an increased incidence of NV (compared with patients diagnosed >5 years ago, aHR, 2.4 [95% CI, 1.1-5.0] and aHR, 2.6 [95% CI, 1.2-6.0] for diagnosis within <1 year vs. 1-5 years, respectively). Compared with anterior uveitis, intermediate uveitis (aHR, 3.1; 95% CI, 1.5-6.6), posterior uveitis (aHR, 5.2; 95% CI, 2.5-11), and panuveitis (aHR, 4.3; 95% CI, 2.0-9.3) were associated with a similar degree of increased NV incidence. Active (aHR, 2.1, 95% CI, 1.2-3.7) and slightly active (aHR, 2.4, 95% CI, 1.3-4.4) inflammation were associated with an increased incidence of NV compared with inactive inflammation. Neovascularization incidence also was increased with retinal vascular occlusions (aHR, 10, 95% CI, 3.0-33), retinal vascular sheathing (aHR, 2.6, 95% CI, 1.4-4.9), and exudative retinal detachment (aHR, 4.1, 95% CI, 1.3-13). Diabetes mellitus was associated with a somewhat increased incidence of retinal NV (aHR, 2.3, 95% CI, 1.1-4.9), and systemic hypertension (aHR 1.5, 95% CI, 0.89-2.4) was associated with nonsignificantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus.
  
  
  CONCLUSIONS
  Retinal NV is a rare complication of uveitis, which occurs more frequently in younger patients, smokers, and those with intermediate/posterior/panuveitis, systemic vasculopathy, retinal vascular disease, or active inflammation. Inflammation and retinal NV likely are linked; additional studies are needed to further elucidate this connection.
authors.affiliation: Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Retina Northwest P.C., Portland, Oregon.
authors.forename: Apurva K
authors.initials: AK
authors.lastname: Patel
authors.affiliation: Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania.
authors.forename: Craig W
authors.initials: CW
authors.lastname: Newcomb
authors.affiliation: Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon.
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Liesegang
authors.affiliation: Om Eye Care Hospital, Belgaum, Karnataka, India; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts.
authors.forename: Siddharth S
authors.initials: SS
authors.lastname: Pujari
authors.affiliation: Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.affiliation: Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
authors.affiliation: Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: Devers Eye Institute, Portland, Oregon; The Tampa Bay Uveitis Center, Safety Harbor, Florida.
authors.forename: Grace A
authors.initials: GA
authors.lastname: Levy-Clarke
authors.affiliation: Laboratory of Immunology, National Eye Institute/National Institutes of Health, Bethesda, Maryland.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nussenblatt
authors.affiliation: Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Internal Medicine, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Devers Eye Institute, Portland, Oregon.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.affiliation: Laboratory of Immunology, National Eye Institute/National Institutes of Health, Bethesda, Maryland.
authors.forename: H Nida
authors.initials: HN
authors.lastname: Sen
authors.affiliation: Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Division of Ophthalmology Somdech Phra Pinklao Hospital, Naval Medical Department, Royal Thai Navy, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Pichaporn
authors.initials: P
authors.lastname: Artornsombudh
authors.affiliation: Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts.
authors.forename: Srishti
authors.initials: S
authors.lastname: Kothari
authors.affiliation: Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Ocular Inflammation Service University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu.
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D015861:Retinal Neovascularization / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014605:Uveitis / Q000150:complications*