Risk of choroidal neovascularization among the uveitides

Abstract

Purpose: To evaluate the risk, risk factors, and visual impact of choroidal neovascularization (CNV) in uveitis cases.

Design: Retrospective cohort study.

Methods: Standardized medical record review at 5 tertiary centers.

Results: Among 15,137 uveitic eyes (8868 patients), CNV was rare in the cases of anterior or intermediate uveitis. Among the 4041 eyes (2307 patients) with posterior uveitis or panuveitis, 81 (2.0%) had CNV at presentation. Risk factors included posterior uveitis in general and specific uveitis syndromes affecting the outer retina-retinal pigment epithelium-choroid interface. Among the 2364 eyes (1357 patients) with posterior uveitis or panuveitis and free of CNV at the time of cohort entry, the cumulative 2-year incidence of CNV was 2.7% (95% confidence interval [CI], 1.8% to 3.5%). Risk factors for incident CNV included currently active inflammation (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.26 to 3.60), preretinal neovascularization (aHR, 3.19; 95% CI, 1.30 to 7.80), and prior diagnosis of CNV in the contralateral eye (aHR, 5.79; 95% CI, 2.77 to 12.09). Among specific syndromes, the incidence was greater in Vogt-Koyanagi-Harada syndrome (aHR, 3.37; 95% CI, 1.52 to 7.46) and punctate inner choroiditis (aHR, 8.67; 95% CI, 2.83 to 26.54). Incident CNV was associated with a 2-line loss of visual acuity (+0.19 logarithm of the minimal angle of resolution units; 95% CI, 0.079 to 0.29) from the preceding visit.

Conclusions: CNV is an uncommon complication of uveitis associated with visual impairment that occurs more commonly in forms affecting the outer retina-retinal pigment epithelium-choroid interface, during periods of inflammatory activity, in association with preretinal neovascularization, and in second eyes of patients with unilateral CNV. Because CNV is treatable, a systematic approach to early detection in high-risk patients may be appropriate.

Figure 1

prevalence of choroidal neovascularization (CNV) among various diagnoses in patients with posterior or panuveitis, with 95% confidence intervals.

Figure 2

Kaplan-Meier analysis of the risk of choroidal neovascularization (CNV) among patients with posterior or panuveitis initially free of CNV at the time of cohort entry and followed up over time. Shaded area indicates 95% confidence interval.

Figure 3

Kaplan-Meier analysis of the risk of choroidal neovascularization (CNV) in the second eye among patients with bilateral posterior or panuveitis and existing unilateral CNV (solid line), compared to eyes of patients with bilateral posterior or panuveitis and initially free of CNV (dashed line). Shaded area indicates 95% confidence interval.