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Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis.
Am J Ophthalmol. 2016 09; 169:113-124.AJ

Abstract

OBJECTIVE

To describe risk factors for hypotony in patients with juvenile idiopathic arthritis (JIA)-associated uveitis.

DESIGN

Retrospective cohort study.

METHODS

All patients with JIA-associated uveitis (N = 108; affected eyes = 196) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014 were included in this study. Prevalence and incidence of hypotony (intraocular pressure [IOP] <5 mm Hg) and low IOP (5 mm Hg ≤ IOP < 8 mm Hg) and risk factors for developing hypotony were analyzed.

RESULTS

At presentation, 9.3% of patients (7.1% of affected eyes) had hypotony. During a median follow-up of 5.3 years, the rate of developing hypotony and low IOP were 0.04 per eye-year (/EY; 95% confidence interval [CI]: 0.02/EY, 0.05/EY) and 0.06/EY (95% CI: 0.04/EY, 0.08/EY), respectively. Risk factors for development of hypotony during follow-up appeared to be associated with more severe uveitic disease, such as the presence of panuveitis (adjusted hazard ratio [aHR], 43.1; P = .004), anterior chamber cells or flare ≥ 3+ (aHR, 25.6, P < .001), posterior synechiae (aHR, 5.9, P = .02), and the use of oral corticosteroid (aHR 28.9; P = .003) at the presenting examination. Receiving immunosuppressive drug therapy at the time of presentation was associated with a lower risk of development of hypotony (aHR, 0.02; P = .002).

CONCLUSIONS

Hypotony affects a small but significant proportion of patients with JIA-associated uveitis and is associated with signs of active and severe uveitis. Immunosuppression was associated with significantly lower risk of hypotony, suggesting that aggressive control of the inflammation may reduce risk of hypotony in JIA-associated uveitis.

Authors+Show Affiliations

Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: jthorne@jhmi.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27345732

Citation

Moradi, Ahmadreza, et al. "Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis." American Journal of Ophthalmology, vol. 169, 2016, pp. 113-124.
Moradi A, Stroh IG, Reddy AK, et al. Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis. Am J Ophthalmol. 2016;169:113-124.
Moradi, A., Stroh, I. G., Reddy, A. K., Hornbeak, D. M., Leung, T. G., Burkholder, B. M., & Thorne, J. E. (2016). Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis. American Journal of Ophthalmology, 169, 113-124. https://doi.org/10.1016/j.ajo.2016.06.026
Moradi A, et al. Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis. Am J Ophthalmol. 2016;169:113-124. PubMed PMID: 27345732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis. AU - Moradi,Ahmadreza, AU - Stroh,Inna G, AU - Reddy,Ashvini K, AU - Hornbeak,Dana M, AU - Leung,Theresa G, AU - Burkholder,Bryn M, AU - Thorne,Jennifer E, Y1 - 2016/06/23/ PY - 2015/11/30/received PY - 2016/06/12/revised PY - 2016/06/13/accepted PY - 2016/6/28/entrez PY - 2016/6/28/pubmed PY - 2017/5/5/medline SP - 113 EP - 124 JF - American journal of ophthalmology JO - Am J Ophthalmol VL - 169 N2 - OBJECTIVE: To describe risk factors for hypotony in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN: Retrospective cohort study. METHODS: All patients with JIA-associated uveitis (N = 108; affected eyes = 196) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014 were included in this study. Prevalence and incidence of hypotony (intraocular pressure [IOP] <5 mm Hg) and low IOP (5 mm Hg ≤ IOP < 8 mm Hg) and risk factors for developing hypotony were analyzed. RESULTS: At presentation, 9.3% of patients (7.1% of affected eyes) had hypotony. During a median follow-up of 5.3 years, the rate of developing hypotony and low IOP were 0.04 per eye-year (/EY; 95% confidence interval [CI]: 0.02/EY, 0.05/EY) and 0.06/EY (95% CI: 0.04/EY, 0.08/EY), respectively. Risk factors for development of hypotony during follow-up appeared to be associated with more severe uveitic disease, such as the presence of panuveitis (adjusted hazard ratio [aHR], 43.1; P = .004), anterior chamber cells or flare ≥ 3+ (aHR, 25.6, P < .001), posterior synechiae (aHR, 5.9, P = .02), and the use of oral corticosteroid (aHR 28.9; P = .003) at the presenting examination. Receiving immunosuppressive drug therapy at the time of presentation was associated with a lower risk of development of hypotony (aHR, 0.02; P = .002). CONCLUSIONS: Hypotony affects a small but significant proportion of patients with JIA-associated uveitis and is associated with signs of active and severe uveitis. Immunosuppression was associated with significantly lower risk of hypotony, suggesting that aggressive control of the inflammation may reduce risk of hypotony in JIA-associated uveitis. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/27345732/Risk_of_Hypotony_in_Juvenile_Idiopathic_Arthritis_Associated_Uveitis_ DB - PRIME DP - Unbound Medicine ER -