Exudative Retinal Detachment in Ocular Inflammatory Diseases: Risk and Predictive Factors

Abstract

Purpose: This study evaluated the risk and risk factors for exudative retinal detachment (ERD) in ocular inflammatory diseases.

Design: Retrospective cohort study.

Methods: Patients with noninfectious ocular inflammation had been followed longitudinally between 1978 and 2007 at 4 US subspecialty uveitis centers. The main outcome measurements were occurrences of ERD and predictive factors.

Results: A total of 176 of 14,612 eyes with ocular inflammation presented with ERD. Among uveitis cases, Vogt-Koyanagi-Harada syndrome (VKH) (odds ratio [OR] = 109), undifferentiated choroiditis (OR = 9.18), sympathetic ophthalmia (OR = 8.43), primary or secondary panuveitis (OR = 7.09), multifocal choroiditis with panuveitis (OR = 4.51), and "other" forms of posterior uveitis (OR = 16.9) were associated with a higher prevalence of ERD. Among the 9,209 uveitic or scleritic eyes initially free of ERD and followed, 137 incident ERD cases were observed over 28,949 eye-years at risk (incidence rate = 0.47% [0.40%-0.56%/eye-year]). VKH (HR = 13.2), sympathetic ophthalmia (HR = 5.82), undifferentiated choroiditis (HR = 6.03), primary or secondary panuveitis (HR = 4.21), and rheumatoid arthritis (HR = 3.30) were significantly associated with incident ERD. A significant dose-response relationship with the prevalence and incidence of ERD were observed for AC cells and vitreous cell activity. African Americans had significantly higher prevalence and incidence of ERD.

Conclusions: Other ocular inflammatory conditions in addition to VKH syndrome and posterior scleritis were associated with increased risk of ERD, indicating that ERD does not necessarily dictate a diagnosis of VKH or posterior scleritis. In addition, the relationship between ERD and inflammatory severity factors implies that inflammation is a key predictive factor associated with developing ERD and requires early and vigorous control.

Figures 1a and b:

Pie chart indicating the percentage of prevalent (present at initial visit; Figure 1a) and incident (Figure 1b) exudative retinal detachments associated with various inflammatory disease diagnoses.

Figure 2:

Cumulative incidence of exudative retinal detachment (ERD)in patients with non-infectious uveitis and/or scleritis as a percentage over time; 95% confidence intervals are indicated in gray. 0.3 logMAR is equivalent to doubling of the visual angle.

Figure 3:

Mean logMAR visual acuity in cases of non-infectious uveitis and/or scleritis are given at the visit preceding incident exudative retinal detachment, at the time exudative retinal detachment was diagnosed, and at the visit following exudative retinal detachment diagnosis.