Outcomes in anterior uveitis associated with the HLA-B27 haplotype

doi:10.1016/S0161-6420(98)99033-9

Ophthalmology

Volume 105, Issue 9, 1 September 1998, Pages 1646-1651

https://doi.org/10.1016/S0161-6420(98)99033-9 Get rights and content

Abstract

Objective

This study aimed to test the hypothesis that patients presenting with anterior uveitis who are HLA-B27 positive, either with or without associated systemic disease, have a less-favorable outcome than do patients with idiopathic anterior uveitis who are HLA-B27 negative.

Design

Retrospective case-controlled series.

Participants

Ninety-seven patients who were HLA-B27 positive with no systemic disease, 94 patients who were HLA-B27 positive with systemic disease, and 72 patients who were HLA-B27 negative who presented with anterior uveitis were studied.

Main outcome measures

Ocular complications (e.g., secondary glaucoma, cataract formation, pupillary synechiae, vitritis, cystoid macular edema, and optic disc edema), medical and surgical treatment, number of recurrent attacks, and final visual acuity were recorded for all patients.

Results

The patients who were HLA-B27 positive, either with or without systemic disease, experienced a greater number of complications than did the patients who were HLA-B27 negative. Periocular corticosteroids, systemic corticosteroids, and systemic immunosuppressive chemotherapy were required in a far greater number of HLA-B27-positive patients than in HLA-B27-negative patients (60% vs. 11%, 53% vs. 7%, and 18% vs. 1%, respectively; P < 0.001). The percentage of legally blind eyes was significantly greater in the HLA-B27-positive group, both with and without systemic disease, when compared with the HLA-B27-negative group (11% vs. 2%; P < 0.005).

Conclusions

The prognosis of anterior uveitis associated with the HLA-B27 haplotype, either with or without associated systemic disease, is less favorable when compared with that of HLA-B27-negative patients with idiopathic anterior uveitis.

Section snippets

Patients and methods

The clinical records of all patients with anterior uveitis seen at the Immunology & Uveitis Service, Massachusetts Eye & Ear Infirmary, between January 1982 and December 1993 were analyzed throughout patients’ entire follow-up and the following data were obtained: gender, race, age at presentation, age at onset of uveitis, follow-up time, clinical diagnosis or systemic disease association or both, clinical presentation, number and duration of recurrent inflammatory attacks, prevalence of severe

Results

A total of 191 consecutive patients, representing 28.2% of patients with anterior uveitis, referred to our service tested HLA-B27 positive and had no other primary ocular diagnosis and/or systemic disease association other than seronegative spondyloarthropathy or inflammatory bowel disease or both. Seventy-two patients (122 eyes) tested HLA-B27 negative and suffered from anterior uveitis of unknown etiology (idiopathic). The HLA-B27-positive group was further divided into 97 (50.8%) patients

Discussion

Anterior uveitis is the most common form of uveitis, and its association with the HLA-B27 haplotype in the white population has been estimated to be approximately 50%.14, 15 Patients with HLA-B27-positive anterior uveitis frequently present with unilateral or bilateral alternating, nongranulomatous, recurrent iridocyclitis in association with nonspecific arthritic symptoms or with a seronegative spondyloarthropathy.9 These clinical characteristics have made this group of patients

References (20)

A. Weiner et al.
Clinical patterns and associated conditions in chronic uveitis
Am J Ophthalmol
(1991)
D.A. Brewerton et al.
Acute anterior uveitis and HL-A 27
Lancet
(1973)
D. Wakefield et al.
Acute anterior uveitis and HLA-B27
Surv Ophthalmol
(1991)
A. Rothova et al.
Clinical features of acute anterior uveitis
Am J Ophthalmol
(1987)
D.A. Lee et al.
The clinical diagnosis of Reiter’s syndrome. Ophthalmic and nonophthalmic aspects
Ophthalmology
(1986)
A. Rodriguez et al.
Posterior segment ocular manifestations in patients with HLA-B27-associated uveitis
Ophthalmology
(1994)
D.A. Brewerton et al.
Ankylosing Spondylitis and HL-A 27
Lancet
(1973)
L.P. D’Alessandro et al.
Anterior uveitis and hypopyon
Am J Ophthalmol
(1991)
R.R. Tamesis et al.
Ocular Syphilis
Ophthalmology
(1990)
A. Linssen et al.
Outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis
Am J Ophthalmol
(1995)

There are more references available in the full text version of this article.

Cited by (141)

An observational study on ocular manifestations in patients of psoriasis in a tertiary care hospital in western India
2022, Medical Journal Armed Forces India
Citation Excerpt :
Psoriatic arthritis is an inflammatory, seronegative, spondyloarthropathy (SpA) that is associated with HLA B27 positivity in 10–25%5,6 and has been reported in up to 30% psoriatic patient and usually manifests as asymmetrical oligoarthritis.7 There is a known association of uveitis and HLA-B27 spondyloarthropathies, including psoriatic arthritis.7,8 The ocular involvement in psoriatic arthritis in the form of uveitis is severe and recurrent.7,8
The aim of the study is to observe the ocular manifestation in patients of psoriasis.
All the diagnosed cases of Psoriasis by the dermatology department of this tertiary care hospital were included in this study. Relevant details of the history pertaining to disease duration, type of psoriasis, and treatment undertaken including ocular symptoms were obtained. Disease severity was quantified using the PASI score. Complete ocular examination including intraocular pressure, Schirmer I and II tests, Tear Film Breakup Tme (TBUT); was carried out for all the patients.
Of 126 patients of psoriasis, ocular manifestations were seen in 76 patients (60.3%). Dry eyes (27%) and blepharitis (15.9%) were the most common ocular manifestations. Uveitis was seen in 3.2% of the patients of which 75% patients were HA B27-positive psoriatic arthritis, which was statistically significant (p = 0.001). There was no statistical correlation between duration of the disease and ocular manifestations (p value is 0.077 using chi square test). The ocular manifestations were more common in patients with PASI score 10 when compared with the patients with PASI score 10 (p value = 0.028) which was statistically significant.
In our study, prevalence of ocular manifestation was 60.3% which increased with the increasing PASI score. Dry eyes and blepharitis were the most common manifestations. Hence, routine ocular examination is recommended in patients with psoriasis.
Varicella-zoster virus infection presenting with unilateral keratouveitis and papillitis in an immunocompetent adult
2022, Photodiagnosis and Photodynamic Therapy
We report a case of unilateral varicella-zoster virus (VZV) related keratouveitis and papillitis. A 54-year-old male presented with headache, left forehead rash, and decreased vision in the left eye. Examination of the left eye showed visual acuity (VA) of 0.15, relative afferent pupillary defect, anterior stromal corneal edema, nongranulomatous keratic precipitates, a swollen and hyperemic optic disc. The patient could read 6/12 of the Ishihara plates in the left eye. Optical coherence tomography (OCT) showed optic disc edema and OCT angiography (OCTA) revealed increased peripapillary vascularity. Computerized visual field testing demonstrated an enlarged blind spot and lower altitudinal defect. Serum anti-VZV IgM antibody level was elevated. The patient was put on oral acyclovir and prednisone treatment. At 1-month follow-up visit, VA increased to 0.9 and color vision was 11/12 Ishihara plates. OCT showed resolution of optic disc edema and OCTA demonstrated normalization of the increased peripapillary vascularity. Computerized visual field test demonstrated improvement in the lower altitudinal visual field defect and normalization of the enlarged blind spot. Optic nerve involvement in VZV infection occurs rarely, especially in immunocompetent patients as in our case.
What Does Human Leukocyte Antigen B27 Have to Do with Spondyloarthritis?
2020, Rheumatic Disease Clinics of North America
Recurrent and chronic anterior uveitis: Long-term outcome and treatment strategies
2024, Indian Journal of Ophthalmology
A large meta-analysis identifies genes associated with anterior uveitis
2023, Nature Communications
Clinical characterization of patients with HLA-B27-associated uveitis and evaluation of the impact of systemic treatment on the recurrence rate: a cross-sectional study
2023, Journal of Ophthalmic Inflammation and Infection

View all citing articles on Scopus

View full text

Outcomes in anterior uveitis associated with the HLA-B27 haplotype

Abstract

Objective

Design

Participants

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Am J Ophthalmol

Lancet

Surv Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Lancet

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol